Morning rise in blood pressure is a predictor of left ventricular hypertrophy in treated hypertensive patients.

To assess the relationship between home blood pressure and left ventricular mass, we evaluated cardiac echocardiography in 297 hypertensive subjects (188 men and 109 women; mean age, 62.8+/-10.3 years) who were treated with amlodipine monotherapy over 1 year (mean dose, 5.5+/-2.3 mg/day). The morning hypertension group (n=57; 19.2%), who had a morning home systolic blood pressure (HSBP) > or =135 mmHg and an evening HSBP <135 mmHg, had a significantly greater left ventricular mass index (LVMI) concomitant with an increase in the homeostasis model assessment insulin resistance index (HOMA-IR) compared to the good control group (n=174; 58.6%), whose morning and evening HSBP were both <135 mmHg, and had a LVMI roughly equivalent to that of the poor control group (n=63; 21.2%), whose morning and evening HSBP were both > or =135 mmHg. By grouping of subjects according to the difference between morning and evening HSBP (delta HSBP), subjects with a delta HSBP> or =10 mmHg had a significantly greater LVMI than subjects with a delta HSBP <10 mmHg. Increases in LVMI in these patients were still significant after adjustment for age, gender, dose of amlodipine, alcohol consumption, body mass index, office systolic blood pressure, and morning and evening HSBP. In a stepwise multivariate regression analysis, delta HSBP (r2=36.2%, p <0.001), morning HSBP (r2=5.5%, p <0.001), HOMA-IR (r2=1.4%, p=0.016) and age (r2=1.0%, p=0.026) were determined to be significant contributing factors for LVMI. This regression model could explain 44.1% of LVMI variability. These results suggest that morning rise in blood pressure is a dominant predictor of left ventricular hypertrophy.     

Morning rise of blood pressure assessed by home blood pressure monitoring is associated with left ventricular hypertrophy in hypertensive patients receiving long-term antihypertensive medication.

To assess the influence of morning rise of systolic blood pressure (SBP) as assessed by home blood pressure monitoring on the left ventricular mass index (LVMI) in relation to the blood pressure control status, we evaluated M-mode cardiac echocardiography in 626 hypertensive subjects (412 men and 214 women; mean age, 61.3+/-10.1 years) who were receiving antihypertensive medication. The subjects were requested to measure their blood pressure at home in the morning and evening over a 3-month period. They were distributed into the following four groups by the average (ME Ave) and the difference (ME Dif) of the morning and evening SBP. The well-controlled hypertensives with a morning rise of SBP (ME Ave<135 mmHg and ME Dif>or=10 mmHg; n=45; 7.2%) had a greater LVMI (122.9+/-22.7 vs. 92.7+/-15.6 g/m2, p<0.001) than the well-controlled hypertensives without a morning rise of SBP (ME Ave<135 mmHg and ME Dif<10 mmHg; n=367; 58.6%). The uncontrolled hypertensives with a morning rise of SBP (ME Ave>or=135 mmHg and ME Dif>or=10 mmHg; n=91; 14.5%) also had a greater LVMI (136.8+/-21.9 vs. 100.2+/-17.5 g/m2, p<0.001) than the uncontrolled hypertensives without a morning rise of SBP (ME Ave>or=135 mmHg and ME Dif<10 mmHg; n=123; 19.6%). A stepwise multivariate regression analysis revealed that the ME Dif was the most important factor related to the LVMI (r2=35.1% for all subjects, p<0001; r2=39.7% for men, p<0.001; and r2=18.7% for women, p<0.001). These results suggest that morning rise of blood pressure is an important factor influencing the development of left ventricular hypertrophy in hypertensive patients on antihypertensive medication.     

中青年原发性高血压患者晨峰血压与血压变异性的关系

目的探讨中青年原发性高血压患者晨峰血压与血压变异性的关系。方法收集2011年11月至2015年1月在北京大学人民医院高血压病房住院,既往未治疗或已停止降压药物治疗4周以上,且同时完善了24 h动态血压监测和动态心电图监测的160例中青年原发性高血压患者,分析其24 h动态血压和动态心电图监测结果。根据晨峰血压水平是否超过28.67 mmHg(所有患者晨峰血压水平的最高四分位水平)分为晨峰血压增高组(44例)和非晨峰血压增高组(116例)进行组间比较。结果与非晨峰血压增高组相比,晨峰血压增高组患者24 h收缩压变异性、24 h舒张压变异性、夜间收缩压变异性、夜间舒张压变异性均增大,这4个血压变异性指标与晨峰血压之间的相关系数分别为0.325、0.315、0.316和0.286(均为P0.001);应用Logistic逐步回归分析校正了24 h收缩压水平、日间收缩压水平和血压节律等影响晨峰血压的因素后,除夜间舒张压变异性与晨峰血压的相关性消失外,24 h收缩压变异性、24 h舒张压变异性、夜间收缩压变异性与晨峰血压的相关性仍显著存在,OR值分别为2.43(1.06~5.59)、2.23(1.16~4.30)、1.32(1.06~1.64)。结论对于中青年原发性高血压患者,昼夜血压下降程度、24 h血压变异性和夜间血压变异性均与晨峰血压明显相关。与舒张压变异性相比,收缩压变异性与晨峰血压的相关性更强。24 h收缩压水平、日间收缩压水平和晨峰心率水平也在一定程度上影响着晨峰血压。     

Reducing pulse pressure in hypertension may normalize small artery structure.

To investigate the relation between the small artery structure and different blood pressure parameters, spontaneously hypertensive rats were treated from 4 to 24 weeks of age (20 weeks in total) with five different antihypertensive therapies: two angiotensin converting enzyme inhibitors (perindopril and captopril), a calcium antagonist (isradipine), a beta-blocker (metoprolol), and a vasodilator (hydralazine). At 24 weeks of age, 24-hour blood pressure was measured, and two mesenteric resistance vessels were taken from each animal. Blood pressure was 227/135 mm Hg (systolic/diastolic) and 161/106 mm Hg in untreated hypertensive and normotensive control rats, respectively. Heart rates were 376 min-1 and 295 min-1 for the two strains. All treatments reduced all blood pressure parameters except for metoprolol, which did not reduce pulse pressure. In the small arteries, the media cross-sectional area was unaffected by the treatments. When a simple correlation analysis was made, pulse pressure was found to correlate more closely (r = 0.64, p less than 0.001) to the resistance vessel media/lumen ratio than any of the other pressure parameters studied: systolic (r = 0.51, p = 0.011), mean (r = 0.41, p = 0.05), or diastolic (r = 0.28, p = 0.19). When an analysis of covariance was performed that included pulse pressure, mean blood pressure, and heart rate, which also correlated significantly to the media/lumen ratio, 81% of the variation in the media/lumen ratio could be accounted for by the variation in the three covariates (p less than 10(-5)), pulse pressure being the major factor.(ABSTRACT TRUNCATED AT 250 WORDS)     

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血压晨峰在近年来的高血压研究中受到越来越多的关注,多项研究证实血压晨峰与心脑血管病的发病及预后密切相关。现本文就血压晨峰的定义、临床意义及治疗策略做一简要综述。     

Insulin resistance and blood pressure

Insulin resistance, cardiometabolic syndrome, and hypertension are common health problems with significant consequences for individuals and society. The pathogenesis of these disorders is complex and not fully understood. In this article we review the current knowledge about the effects of lifestyle modification and pharmacologic antihypertensive agents on insulin resistance and hypertension.     

Morning rise, morning surge and daytime variability of blood pressure and cardiovascular target organ damage. A cross-sectional study in 743 subjects.

OBJECTIVE: To evaluate in a large population the relationship between cardiovascular target organ damage and values of the night-to-morning rise of systolic blood pressure (MR-BP), the morning surge of BP at the moment of rising (BP surge) and daytime BP variability (standard deviation [SD] of daytime BP). METHODS: This was a cross-sectional study, evaluating 743 subjects, aged 30-75 years, 416 female, with normal renal function and no previous cardiovascular events. The population included: I-174 patients with type 2 diabetes, II-317 hypertensive patients with ongoing treatment over at least the previous 6 months, III-127 hypertensive patients untreated in the last 6 months, IV-125 healthy normotensive subjects. All underwent 24-hour ambulatory BP monitoring to calculate MR-BP, BP surge and SD of daytime BP. Target organ evaluation included: pulse wave velocity (PWV) (an indicator of aortic stiffness) in 711 subjects, left ventricular mass index (LVMI) in 185 subjects and 24-hour albuminuria in 239 subjects. RESULTS: In the population as a whole, BP surge, MR-BP and SD of daytime BP correlated significantly with PWV (r = 0.434, p < 0.0001; r = 0.126, p < 0.001; 0.337, p < 0.001, respectively), with LVMI (r = 0.447, p < 0.0001; r = 0.307, p < 0.001; 0.162, p < 0.05, respectively) and to a lesser degree with albuminuria (r = 0.126, p < 0.05; r = 0.083, NS; 0.082, NS, respectively). In the upper quintile of distribution of BP surge, the percentage of cases with abnormal PWV (>12 m/s) (21%), cardiac hypertrophy (53 %) and microalbuminuria (47 %) was significantly greater (p < 0.03) than that observed in the lower quintile (1%, 14% and 27%, respectively). BP surge correlated more strongly with indices of target organ damage than did MR-BP or SD of daytime BP, independently of night-time BP and nocturnal BP fall. CONCLUSIONS: In this large population, MR-BP, BP surge and daytime BP variability are strongly correlated with target organ damage severity, and are probably related to organ deterioration. Of the three, morning surge of BP at the moment of rising is more strongly related to organ damage than MR-BP, perhaps because unlike MR-BP, BP surge is independent of night-time BP values.     

Morning blood pressure surge varies with age and gender in hypertensive individuals

Many studies revealed that most cardio-cerebrovascular events were closely related to morning blood pressure surge (MBPS). The aim of our study was to investigate the relationship of MBPS with age and gender in hypertensive individuals, morning blood pressures of a total of 1100 cases with primary hypertension were analyzed. In our study, the morning systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP) of hypertensives with MBPS were all higher (P<0.01). MBPS values were correlated with age (r=0.061, P<0.05). In hypertensive individuals with MBPS, morning SBP and PP increased while morning DBP decreased (P<0.01) as patients aged. Morning DBP and MAP of female patients were lower while morning PP was higher (P<0.01). These results indicated that MBPS was associated with both age and gender in hypertensive individuals.     

晨峰血压和胱抑素C对冠心病伴高血压患者急性心肌梗死的预测

目的:探讨晨峰血压和胱抑素C(cystatinC,Cys-C)对冠心病伴高血压患者急性心肌梗死(AMI)的预测价值。方法:126例冠心病伴高血压患者行24h动态血压(AMBP)检查,分为晨峰血压阳性组(61例),晨峰血压阴性组(65例);检测每个患者的血清Cys-C。预计随访24个月,观察终点AMI。用Partial偏相关分析和多元线性回归分析晨峰血压和Cys-C与AMI的相关性。结果:与晨峰血压阴性组比较,晨峰血压阳性组收缩压(SBP)、舒张压(DBP)和血清Cys-C水平显著增高(P0.01),而HDL明显减低(P0.05)。全部患者随访中位数16.5个月(5～28个月)。总共发生AMI7例(5.56%),晨峰血压阳性组5例(8.19%)晨峰血压阴性组2例(3.08%),2组比较差异有统计学意义(P0.01)。Partial偏相关分析和多元线性逐步回归分析显示,校正年龄、性别、血糖等因素后,晨峰血压阳性组SBP和DBP与AMI发生呈正相关(P0.05);晨峰血压阳性组血清Cys-C与AMI发生呈正相关(P0.012)。结论:晨峰血压(SBP、DBP)和血清Cys-C高水平具有预测冠心病伴高血压患者发生AMI的价值。     

Adrenergic mechanisms and remodeling of subcutaneous small resistance arteries in humans

BACKGROUND: Vascular structural alterations in small resistance arteries of patients with essential hypertension (EH) are mostly characterized by inward eutrophic remodeling. In fact, no difference in the smooth muscle cell volume (CV) between normotensive subjects (NT) and essential hypertensive patients was observed. However, experimental models of hypertension with chronic infusion of agonists of adrenergic receptors were characterized by the presence of smooth muscle cell hypertrophy or hyperplasia. Recently, we have observed the presence of vascular smooth muscle cell hypertrophy in patients with renovascular hypertension. OBJECTIVE: The aim of the study to investigate the structural characteristics of subcutaneous small resistance arteries of NT, of EH, and of patients with phaeochromocytoma (Phaeo). PATIENTS AND METHODS: Thirty Phaeo, 30 NT and 30 EH were included in the study. A biopsy of subcutaneous fat was taken from all subjects. Small resistance arteries (relaxed diameter 160-280 microm) were dissected and mounted on a micromyograph and the media : lumen ratio was calculated. In nine Phaeo, nine NT and 13 EH the cell volume was measured by an unbiased stereological principle, the 'disector' method.RESULTS No difference in smooth muscle cell volume was observed between groups. However, inward remodeling in Phaeo was less marked than in EH, although the increase in media : lumen ratio was similar compared with NT. However, the lack of changes in media cross-sectional area, compared with NT, suggest that there has been little hypertrophy, the changes observed thus being eutrophic. CONCLUSIONS: Our data show, based on a reasonably large sample, that a pronounced activation of the adrenergic system is not associated with vascular smooth muscle cell hypertrophy or hyperplasia in humans. It is therefore possible that adrenergic mechanisms may have a relevant role in the development of eutrophic remodeling in small vessels.     

Morning surge in blood pressure and blood pressure variability in Asia: Evidence and statement from the HOPE Asia Network

Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. To effectively prevent end‐organ damage, maintain vascular integrity and reduce morbidity and mortality, it is essential to decrease and adequately control blood pressure (BP) throughout each 24‐hour period. Exaggerated early morning BP surge (EMBS) is one component of BP variability (BPV), and has been associated with an increased risk of stroke and cardiovascular events, independently of 24‐hour average BP. BPV includes circadian, short‐term and long‐term components, and can best be documented using out‐of‐office techniques such as ambulatory and/or home BP monitoring. There is a large body of evidence linking both BPV and EMBS with increased rates of adverse cardio‐ and cerebrovascular events, and end‐organ damage. Differences in hypertension and related cardiovascular disease rates have been reported between Western and Asian populations, including a higher rate of stroke, higher prevalence of metabolic syndrome, greater salt sensitivity and more common high morning and nocturnal BP readings in Asians. This highlights a need for BP management strategies that take into account ethnic differences. In general, long‐acting antihypertensives that control BP throughout the 24‐hour period are preferred; amlodipine and telmisartan have been shown to control EMBS more effectively than valsartan. Home and ambulatory BP monitoring should form an essential part of hypertension management, with individualized pharmacotherapy to achieve optimal 24‐hour BP control particularly the EMBS and provide the best cardio‐ and cerebrovascular protection. Future research should facilitate better understanding of BPV, allowing optimization of strategies for the detection and treatment of hypertension to reduce adverse outcomes.