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Morning pressor surge, blood pressure variability, and arterial stiffness in essential hypertension

Pucci, Giacomo; Battista, Francesca; Anastasio, Fabio; Schillaci, Giuseppe

doi: 10.1097/HJH.0000000000001153
ORIGINAL PAPERS: BP measurement
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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 (48 ± 12 years, 61% men, office BP 149/93 ± 17/10 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 (r = 0.16, P < 0.001) and rising MBPS (r = 0.12, P = 0.003) showed a direct correlation with cf-PWV, whereas prewaking MBPS had no such relation (r = 0.06, P = 0.14). Only ST-MBPS was independently associated with cf-PWV (t = 1.96, P = 0.04) 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 (P = 0.13) or ARV (P = 0.24). ARV was a significant mediator of the relationship between ST-MBPS and cf-PWV (P = 0.003).

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.

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aDipartimento di Medicina, Università di Perugia, Perugia

bStruttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy

Correspondence to Professor Giuseppe Schillaci, MD, Dipartimento di Medicina, Università degli Studi di Perugia, Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Piazzale Tristano di Joannuccio, 1, IT-05100 Terni, Italy. Tel: +39 0744 205201; fax: +39 0744 205201; e-mail: giuseppe.schillaci@unipg.it

Abbreviations: ARV, average real variability of 24-h SBP; BP, blood pressure; BPV, blood pressure variability; cf-PWV, carotid–femoral pulse wave velocity; eGFR, estimated glomerular filtration rate; MAP, mean arterial pressure; MBPS, morning blood pressure surge; PW-MBPS, prewaking morning blood pressure surge; RB-MBPS, rising morning blood pressure surge; ST-MBPS, sleep-trough morning blood pressure surge; wSD-24 h, weighted 24-h SBP SD

Received 30 June, 2016

Revised 10 August, 2016

Accepted 16 September, 2016

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

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