Objectives:
To assess the relationship between the morning systolic central blood pressure (CBP) surge and postural brachial BP (BBP) changes in hypertensive patients with carotid artery stenosis (CAS).
Methods:
We examined 43 hypertensive patients with CAS (>70% (NASCET) (25 (58%) males; 67 ± 7 years old). Patients received antihypertensive treatment. BBP, CBP were measured in supine position after 10 min of rest and after 5 min of active orthostasis by OMRON (Japan) and SphygmoCor (AtCor Medical, Australia). Ambulatory BP monitoring was performed by BPLab (Russia) with estimation of CBP during 24 hours. The morning surge was defined as the difference between the maximum and the lowest systolic CBP within a period of ± 2 hours from the time of awake and arising. The rate of morning CBP surge was calculated as degree of increase CBP per hour.
Results:
At baseline 27 (63%) patients had uncontrolled hypertension (HTN). In active orthostasis the hypotensive reactions of systolic BBP (decline ≥ 10 mmHg) were observed in 17 patients (40%). Patients with orthostatic BP falls had higher values of systolic CBP (149,2 ± 22 vs 131,5 ± 21 mmHg, P = 0,01), amplification pressure (AP) 23,1 ± 9,4 vs 16,2 ± 8,6 mmHg, P = 0,01), duration of HTN 18 ± 11 vs 12 ± 8 years, P = 0,05) and frequency of uncontrolled HTN (88 vs 46%, P = 0,001) than patients without orthostatic hypotension (OH). The amplitude and rate of morning surge of CBP were higher in patients with OH than without orthostatic BP falls (35 ± 13 vs 23 ± 9 mmHg/22 ± 12 vs 16 ± 10 mmHg/hour, P = 0,05). The morning CBP surge was correlated negatively with orthostatic changes in BBP (r = − 0,498, P = 0.05).
Conclusion:
Patients with OH and CAS suffer more pronounced and prolonged HTN, more often of an uncontrolled pattern. Augmented morning central BP surge is associated with postural decreases of BP.
