Higher 24-hour Systolic Blood Pressure Research Articles

FACTORS ASSOCIATED WITH PROGRESSION OF ARTERIAL STIFFNESS IN ISCHEMIC STROKE SURVIVORS: THE NORWEGIAN STROKE IN THE YOUNG STUDY

Objective: Progressive arterial stiffening may contribute to risk for recurrent cardiovascular events in ischemic stroke survivors. Few studies have investigated sex differences in prospective change in arterial stiffness in this patient group. Design and method: Arterial stiffness by carotid-femoral pulse wave velocity (PWV) and ambulatory 24-hours blood pressure (BP) were assessed in 81 women and 190 men included in the Norwegian Stroke in the Young (NOR-SYS) study at 3 months and 5.5 years after the incident ischemic stroke. Results: At baseline patients were 49.5 ± 9.9 years old. Women had less prevalent hypertension (48 % vs. 62 %, p<0.05) than men, while age, obesity and smoking prevalence did not differ significantly. During follow-up, BP increased from 129/79 mmHg to 133/83 mmHg in women (p<0.05) and remained statistically unchanged in men (136/83 vs 139/84 mmHg, p = 0.10). Among patients with hypertension, 79% of women were treated at baseline and 77% at follow-up (p = ns), while antihypertensive treatment increased from 82% to 87% in men (p<0.05). Daily smoking was reduced from 47% to 21% in women and from 51% to 21% in men (both p<0.001). Fewer women than men were treated with statins at follow-up (63% vs. 76%, p<0.05). PWV was lower in women than in men both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p<0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, increase in PWV was associated with higher 24-hour systolic BP, and lack of antihypertensive treatment at follow-up (both with p<0.05); while no association was found with sex, smoking at follow-up or statin treatment (Table1). Conclusions: In ischemic stroke survivors, 5-year increase in PWV did not differ between the sexes and was associated with higher 24-hour systolic BP and lack of antihypertensive treatment, pointing to the importance of antihypertensive treatment in this patient group.

The Relationship between the Waist Circumference and Increased Carotid Intima Thickness in Obese Children.

Background: This study aimed to evaluate the cardiometabolic risk factors in normotensive obese and hypertensive obese (HT-obese) children by comparison of anthropomorphic measurements, fat distribution, carotid artery intima-media thickness (CIMT), and inflammatory markers. Methods: Fifty-three obese patients 10-18 years of age with a BMI-for-age/gender >95th percentile and 20 age- and gender-matched healthy volunteers enrolled in the study. Obese patients were divided into two groups according to the presence of hypertension (HT), as follows: HT-obese subgroup (n = 30) and nonhypertensive obese (non-HT-obese) subgroup (n = 23). Results: Weight standard deviation score (SDS), BMI-SDS, waist circumference (WC) SDS, and the fat tissue z-score were significantly higher (p < 0.001 for all) in the obese patients than the control groups. Obese patients had higher 24-hour systolic blood pressure (SBP) SDS and leptin, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, and interleukin-6 levels. Furthermore, CIMT and CIMT-SDS were significantly higher in them. HT-obese patients (n = 30) had significantly higher WC-SDS and lower serum leptin and adiponectin levels than those of non-HT-obese group (n = 23). Finally, an association between increased CIMT-SDS and WC-SDS (β = 0.399, p = 0.002) and 24-hour SBP-SDS (β = 0.272, p = 0.009) was shown. Conclusions: Association between increased WC and HT implies the importance of central obesity in atherosclerosis. We concluded that WC measurement could be used to define risk groups since it is related to cardiometabolic complications.

Left Ventricular Structure in Patients With Mild-to-Moderate CKD—a Magnetic Resonance Imaging Study

IntroductionThe high burden of left ventricular (LV) abnormalities in patients with advanced chronic kidney disease (CKD) is well established. However, less is known about the prevalence, patterns, and determinants of LV abnormalities in patients with early CKD.MethodsWe examined LV structure in 290 patients with a median estimated glomerular filtration rate (eGFR) of 51 ml/min per 1.73 m2 by magnetic resonance imaging (MRI). We explored associations with clinical and hemodynamic parameters, hydration (bioimpedance), endothelial function, inflammation (including C-reactive protein and tumor necrosis factor−α and its soluble receptors) and mineral bone disease (MBD) markers (including vitamin D, parathyroid hormone, α-klotho and fibroblast growth factor−23).ResultsNormal geometry was found in 56% of patients, dilation in 4%, concentric remodeling in 10%, and LV hypertrophy in 29%. Linear regression analysis revealed that greater LV mass was independently associated with male sex, greater body mass index (BMI), and higher 24-hour systolic blood pressure (24-hour SBP). Concentric remodeling was independently associated with age, male sex, higher 24-hour SBP, and greater hemoglobin levels. Surprisingly, neither hydration status, nor endothelial function, nor any of the inflammatory or MBD parameters added significantly to these models.ConclusionAbnormal LV structure was found in almost one-half of the patients. Reducing BMI and 24-hour SBP and avoiding high hemoglobin concentrations appear to be the key factors to prevent abnormal LV remodeling in patients with mild-to-moderate CKD.

INTER-ARM BLOOD PRESSURE DIFFERENCE

Objective: An increased inter-arm systolic blood pressure difference (IBPD) is an easily determined physical examination finding and a significant IBPD has recently been associated with worse cardiovascular outcome. But the prevalence of IBPD in Asian population is unknown and the relationship between IBPD and blood pressure (BP) variability is not yet determined. This study was performed to describe the prevalence and clinical characteristics of the patients with increased IBPD and to examine the association between IBPD and BP variability.Design and method: A representative population (aged 20–65 years) was selected by list-assisted random-digit dialing method from a city with a population of one million. The BP of two arms was simultaneously measured using validated automatic BP measurement devices for 3 times and ambulatory blood pressure monitoring (ABPM) was performed in all included subjects. An increased IBPD was defined as > 10mmHg using the average of 3 BP differences obtained simultaneously in both arms. Results: Five hundreds of subjects were included in this study, and 13 subjects were excluded because of inadequate ABPM measurements. Mean age was 46.9 ± 9.4 years and 309 participants were female (63.4%). Overall systolic BP and diastolic BP were 118.5 ± 13.4 mmHg and 75.1 ± 10.3 mmHg and mean systolic IBPD was 5.7 ± 4.0mmHg. Of 487 subjects, 66 subjects (13.6%) had an increased systolic IBPD. Compared with those with normal IBPD, subjects with increased systolic IBPD showed higher clinic BP (127.2 ± 13.7 vs. 117.2 ± 12.8 mmHg in systolic BP, P < 0.001; 78.7 ± 11.2 vs. 74.6 ± 10.1 mmHg in diastolic BP, P = 0.002), higher 24-hour systolic BP (118.5 ± 12.0 vs. 115.6 ± 10.8 mmHg, P = 0.045) and higher 24-hour pulse pressure (42.4 ± 7.4 vs. 40.2 ± 6.5 mmHg, P = 0.012). The subjects with increased systolic IBPD showed higher 24-hour BP variability; increased standard deviation of daytime BPs, increased weighted standard deviation of BPs, increased coefficient of variation of daytime BPs and increased average real variability of both 24-hour BPs and daytime BPs (Table). There was no significant difference in nighttime dipping pattern of increased IBPD subjects. Conclusions: In this community-based cohort, an increased IBPD is common and associated with an increased short-term BP variability. Bilateral BP measurements should be emphasized in routine clinical practice.

The overdriven glomerulus as a cardiovascular risk factor

In a large cohort of patients referred for the diagnosis of hypertension by ambulatory blood pressure monitoring, the risk for cardiovascular events associated with glomerular hyperfiltration (hazard ratio: 1.53) was higher than that associated with diabetes (hazard ratio: 1.43) or with a 10 mmHg higher 24-hour systolic blood pressure (hazard ratio: 1.37) and was identical to that by smoking (hazard ratio: 1.53). Reducing glomerular hyperfiltration may improve cardiovascular outcomes in hypertensive patients, an issue that remains to be tested in appropriate randomized clinical trials.

PS 11-05 INTER-ARM BLOOD PRESSURE DIFFERENCE

Objective: An increased inter-arm systolic blood pressure difference (IBPD) is an easily determined physical examination finding and a significant IBPD has recently been associated with worse cardiovascular outcome. But the prevalence of IBPD in Asian population is unknown and the relationship between IBPD and blood pressure (BP) variability is not yet determined. Design and Method: A representative population was selected by list-assisted random-digit dialing method from a city. The BP of two arms was simultaneously measured using validated automatic BP measurement devices for 3 times and an increased IBPD was defined as ≥10mmHg using the average of 3 BP differences obtained simultaneously in both arms. Results: We recruited 497 subjects in this study, and 10 subjects were excluded because of inadequate ABPM measurements. Mean age was 46.9 ± 9.4 years and 309 participants were female (63.4%). Overall systolic BP and diastolic BP were 118.5 ± 13.4 mmHg and 75.1 ± 10.3 mmHg and mean systolic IBPD was 5.7 ± 4.0 mmHg. Of the 487 subjects, 66 subjects (13.6%) had an increased systolic IBPD. Compared with those with normal IBPD, subjects with increased systolic IBPD showed higher clinic BP (127.2 ± 13.7 vs. 117.2 ± 12.8 mmHg in systolic BP, P < 0.001; 78.7 ± 11.2 vs. 74.6 ± 10.1 mmHg in diastolic BP, P = 0.002), higher 24-hour systolic BP (118.5 ± 12.0 vs. 115.6 ± 10.8 mmHg, P = 0.045) and higher 24-hour pulse pressure (42.4 ± 7.4 vs. 40.2 ± 6.5 mmHg, P = 0.012). The subjects with increased systolic IBPD showed higher 24-hour BP variability; increased standard deviation of daytime BPs, increased weighted standard deviation of BPs, increased coefficient of variation of daytime BPs and increased average real variability of both 24-hour BPs and daytime BPs (Table). There was no significant difference in nighttime dipping pattern of increased IBPD subjects. Conclusions: In this community-based cohort, an increased IBPD is common and associated with an increased short-term BP variability.

Haemodynamic Changes During Early Bereavement: Potential Contribution to Increased Cardiovascular Risk

bereavement is associated with increased cardiovascular risk, particularly in surviving spouses and parents, however the mechanism is not well understood due to limited studies. The purpose of this study was to evaluate haemodynamic changes (blood pressure (BP) and heart rate (HR)), that may contribute to increased cardiac risk in early bereavement. we enrolled 80 bereaved individuals and 80 non-bereaved as a reference group. Twenty-four hour ambulatory blood pressure monitoring was performed within two weeks (acute assessment) and at six months following bereavement. compared to the non-bereaved, the acutely bereaved had higher 24-hour systolic BP (mean (SE) 130.3 (1.5) vs 127.5 (1.4)mmHg, p=0.03), higher daytime systolic BP (135.6 (1.5) vs 131.6 (1.4)mmHg, p=0.02) and higher daytime systolic load (median % 39.0 vs 29.3, p=0.02). By six months the BP of the bereaved tended to be lower than acute measures. This difference was significant amongst those not taking BP lowering medications for 24-hour systolic BP (126.5 (2.4) vs 129.7 (2.3)mmHg, p=0.04), daytime systolic BP (129.8 (2.1) vs 133.9 (2.0)mmHg, p=0.01) and daytime diastolic pressure (76.7 (1.0) vs 78.9 (0.9)mmHg, p=0.03). Twenty-four hour heart rate was also higher acutely in the bereaved compared with the reference group (74.0 (1.2) vs 71.7 (0.9) b/min, p=0.02); at six months heart rate in the bereaved had fallen to non-bereaved levels (70.4 (0.09), p=0.02). early bereavement is associated with increased systolic blood pressure and heart rate. These haemodynamic changes may contribute to a time-limited increase in cardiovascular risk.

Importance of the Electrocardiographic Strain Pattern in Patients With Resistant Hypertension

The electrocardiographic strain pattern is a marker of left ventricular hypertrophy and adverse cardiovascular prognosis. The objective of this study was to assess the factors associated with the presence of ECG strain in patients with resistant hypertension and, specifically, to evaluate the relationships between strain and left ventricular mass (LVM) and structure. In a cross-sectional design, 440 resistant hypertensive subjects were evaluated. Clinical, laboratory, electrocardiographic, 24-hour ambulatory blood pressures, and echocardiographic variables were obtained. Statistical analysis involved bivariate tests, analysis of covariance, and multivariate logistic regression. An ECG strain pattern was present in 101 patients (23%). Patients with strain were more frequently men with lower body mass index, had more target-organ damage, higher 24-hour blood pressure, higher serum creatinine and 24-hour microalbuminuria, and more prolonged QT interval duration than those without strain. After controlling for all covariates, the presence of strain remained associated with increased LVM and wall thicknesses, both in all patients and also in those with echocardiographic left ventricular hypertrophy. Furthermore, the presence of ECG strain was associated with increased LVM (P<0.001), higher 24-hour systolic blood pressure (P<0.001), prolonged maximum QTc-interval duration (P<0.001), lower waist circumference (P=0.009), male gender (P=0.011), physical inactivity (P=0.020), higher serum creatinine (P=0.031) and fasting glycemia (P=0.027), and the presence of coronary heart disease (P=0.001) and peripheral arterial disease (P=0.045). Thus, in resistant hypertension patients, the presence of ECG strain is independently associated with increased left ventricular wall thicknesses and mass and also with other potentially adverse factors. These relationships offer insight into the known association between strain and unfavorable cardiovascular prognosis.

Adolescent Obesity: Some Bad News, and Maybe Some Good News

Investigators in Greece compared ambulatory blood pressure and carotid artery intimal-medial thickness (IMT, an early marker of atherosclerosis in adults) in 93 consecutive adolescents (age range, 11–18) who were referred for possible hypertension; 22 were obese (body-mass index, >95%), and 71 were not. Obese adolescents had significantly higher mean 24-hour systolic blood pressure than nonobese adolescents (129 vs. 118 mm Hg). Ultimately, 64% of obese vs. 23% of nonobese adolescents had confirmed hypertension. Mean IMT was significantly higher in obese adolescents (0.53 vs. 0.36 mm). IMT did not correlate …

Low-grade inflammation and microalbuminuria in hypertension.

Background- Albuminuria and C-reactive protein (CRP), a marker of systemic low-grade inflammation, are frequently elevated in essential hypertension and predict cardiovascular prognosis independent of conventional risk factors. However, in spite of their potentially important links, the interrelationships between the 2 parameters have not been explored in depth in hypertensive patients. Albuminuria (the mean of 3 overnight urine collections), high-sensitive CRP (hs-CRP), 24-hour blood pressure (BP), weight, lipids, poststimulative (75 g PO) plasma glucose, insulin, and insulin sensitivity by the homeostasis model assessment model were evaluated in 220 never treated, nondiabetic, uncomplicated essential hypertensive men. Albuminuria > or =15 microg/min was defined as microalbuminuria and hs-CRP values above and below median (2.3 mg/L) as high and low, respectively. Concentric left ventricular hypertrophy was diagnosed by echocardiography, and a full-blown metabolic syndrome was identified in presence of hypertension and at least 3 of following: obesity, subclinical hyperglycemia, low high-density lipoprotein (HDL) and high triglycerides. Microalbuminuria was present in 54 patients, 29 with high hs-CRP characterized by higher 24-hour systolic BP, postload glucose, body mass index, lower HDL cholesterol, more frequent metabolic syndrome, concentric LVH, and active smoking than those with either isolated microalbuminuria (n=27) or normoalbuminuria. Microalbuminuria accompanied by evidence of subclinical inflammation is a strong correlate of metabolic abnormalities in essential hypertension and identifies a patient subset at very high cardiovascular risk. In contrast, isolated microalbuminuria may represent a distinct pathophysiological condition characterized by a more benign profile and possibly a better prognosis.

Arterial blood pressure changes in children and adolescents with insulin-dependent diabetes mellitus

Diabetic nephropathy may develop in childhood and is often related to hypertension. The 24-hour ambulatory blood pressures were measured in 63 children with insulin-dependent diabetes mellitus and were compared with those of 54 healthy siblings. The patients were without clinical complications. The 24-hour recording of their blood pressures revealed higher 24-hour systolic blood pressure (SBP) (115.8 ± 8.2), 24-hour diastolic blood pressure (DBP) (67.5 ± 4.6), 24-hour mean arterial pressure (MAP) (81.8 ± 5.2) compared with control subjects: 24-hour SBP (112.7 ± 6.7), 24-hour DBP (64.7 ± 4.1), 24-hour MAP (78.9 ± 4.5) ( p = 0.03, p = 0.001, p = 0.002, respectively). Of the daytime blood pressures, SBP, DBP, MAP were also higher (117.7 ± 8.7, 69.7 ± 5.2, 83.8 ± 5.8) compared with those of siblings (114.9 ± 6.9, 67.3 ± 4.3, 81.1 ± 4.9) ( p = 0.05, p = 0.009, p = 0.008, respectively). Of the nighttime blood pressures, SBP, DBP, MAP were higher in patients (108.7 ± 8.9, 59.5 ± 6.9, 74.6 ± 6.9) compared with control subjects (104.8 ± 7.0, 55.1 ± 5.0, 70.5 ± 5.1) ( p = 0.01, p = 0.0002, p = 0.0006, respectively). Furthermore, the blood pressure burden was evaluated. Blood pressure burden was defined as the percentage of the increased blood pressure readings greater than the 95th percentile divided by the total number of recorded blood pressures during a corresponding period. Patients had a 43% higher 24-hour SBP burden (19.6 ± 16.5) and a 50% higher 24-hour DBP burden (12.3 ± 9.6) in relation to that of control subjects (13.7 ± 12.8, 8.3 ± 12.3) ( p = 0.03, p = 0.009, respectively). The SBP burden (17.9 ± 14.6) and DBP burden (11.5 ± 9.2) of the day was approximately 50% higher in the patients in relation to control subjects (11.9 ± 11.1, 7.8 ± 6.7) ( p = 0.01, p = 0.01, respectively). Therefore it seems that hemodynamic changes may appear early in children with diabetes. (J Pediatr 1996;129:667-70)