Objective: An excess morning blood pressure surge (MBPS) may portend an increased cardiovascular risk, but the mechanisms thereof have been little investigated. The link between MBPS, short-term blood pressure (BP) variability, and arterial stiffness has not been entirely defined. Methods: In 602 consecutive untreated hypertensive patients (4812 years, 61% men, office BP 149/ 9317/10 mmHg), we measured carotid–femoral pulse wave velocity (cf-PWV, SphygmoCor) and 24-h ambulatory BP. Using self-reported sleep and wake times, MBPS was defined as sleep-trough (ST-MBPS), prewaking, rising. Short-term BP variability was calculated as weighted 24-h SBP SD and average real variability of 24-h SBP (ARV), that is, average of absolute differences between consecutive SBP readings. Results: ST-MBPS (r¼0.16, P<0.001) and rising MBPS (r¼0.12, P¼0.003) showed a direct correlation with cf- PWV, whereas prewaking MBPS had no such relation (r¼0.06, P¼0.14). Only ST-MBPS was independently associated with cf-PWV (t¼1.96, P¼0.04) after adjustment for age, sex, height, office mean arterial pressure, heart rate, and renal function. This association was lost after further adjustment for weighted 24-h SBP SD (P¼0.13) or ARV (P¼0.24). ARV was a significant mediator of the relationship between ST-MBPS and cf-PWV (P¼0.003). Conclusion: In untreated hypertension, ST-MBPS has a direct relation with aortic stiffness, which is mediated by an increased ARV. The adverse effects of MBPS may be partly explained by its link with arterial stiffness, mediated by short-term SBP variability.
Morning pressor surge, blood pressure variability, and arterial stiffness in essential hypertension
PUCCI, GIACOMO;BATTISTA, FRANCESCA;SCHILLACI, Giuseppe
2017
Abstract
Objective: An excess morning blood pressure surge (MBPS) may portend an increased cardiovascular risk, but the mechanisms thereof have been little investigated. The link between MBPS, short-term blood pressure (BP) variability, and arterial stiffness has not been entirely defined. Methods: In 602 consecutive untreated hypertensive patients (4812 years, 61% men, office BP 149/ 9317/10 mmHg), we measured carotid–femoral pulse wave velocity (cf-PWV, SphygmoCor) and 24-h ambulatory BP. Using self-reported sleep and wake times, MBPS was defined as sleep-trough (ST-MBPS), prewaking, rising. Short-term BP variability was calculated as weighted 24-h SBP SD and average real variability of 24-h SBP (ARV), that is, average of absolute differences between consecutive SBP readings. Results: ST-MBPS (r¼0.16, P<0.001) and rising MBPS (r¼0.12, P¼0.003) showed a direct correlation with cf- PWV, whereas prewaking MBPS had no such relation (r¼0.06, P¼0.14). Only ST-MBPS was independently associated with cf-PWV (t¼1.96, P¼0.04) after adjustment for age, sex, height, office mean arterial pressure, heart rate, and renal function. This association was lost after further adjustment for weighted 24-h SBP SD (P¼0.13) or ARV (P¼0.24). ARV was a significant mediator of the relationship between ST-MBPS and cf-PWV (P¼0.003). Conclusion: In untreated hypertension, ST-MBPS has a direct relation with aortic stiffness, which is mediated by an increased ARV. The adverse effects of MBPS may be partly explained by its link with arterial stiffness, mediated by short-term SBP variability.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
