The Association of Orthostatic Hypotension with Ambulatory Blood Pressure Phenotypes in SPRINT

2020 ◽  
Author(s):  
Lama Ghazi ◽  
Paul E Drawz ◽  
Nicholas M Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Treatment Strategies ◽  
Ambulatory Bp Monitoring ◽  
Increased Risk ◽  
Trial Testing ◽  
The Difference ◽  
Pattern Versus ◽  
Reverse Dipping

Abstract Background Clinic blood pressure (BP) when measured in the seated position, can miss meaningful BP phenotypes, including low ambulatory BP (white coat effects [WCE]) or high supine BP (nocturnal non-dipping). Orthostatic hypotension (OH) measured via both seated (or supine) and standing BP, could identify phenotypes poorly captured by seated clinic BP alone. Methods We examined the association of OH with WCE and night-to-daytime systolic BP (SBP) in a subpopulation of SPRINT, a randomized trial testing the effects of intensive or standard (<120 versus <140mmHg) SBP treatment strategies in adults at increased risk of cardiovascular disease. OH was assessed during follow-up (6, 12, 24 months) and defined as a decrease in mean seated SBP ≥20 or diastolic BP ≥10 mmHg after 1 min of standing. WCE, based on 24-hour ambulatory BP monitoring performed at 27 months, was defined as the difference between 27-month seated clinic and daytime ambulatory BP ≥20/≥10 mmHg. Reverse dipping was defined as a ratio of night-to-daytime SBP >1. Results Of 897 adults (mean age 71.5±9.5 years, 29% female, 28% black), 128 had OH at least once. Among those with OH, 15% had WCE (versus 7% without OH). Moreover, 25% of those with OH demonstrated a non-dipping pattern (versus 14% without OH). OH was positively associated with both WCE (OR=2.24; 95% CI: 1.28,4.27) and reverse dipping (OR=2.29; 95% CI: 1.31, 3.99). Conclusions The identification of OH in clinic was associated with two BP phenotypes often missed with traditional seated BP assessments. Further studies on mechanisms of these relationships are needed.

Abstract P172: Orthostatic Hypotension And 24-hr Ambulatory Blood Pressure Monitoring In The Sprint Trial

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Paul Drawz ◽  
Nicholas Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Blood Pressure Monitoring ◽  
Treatment Strategies ◽  
White Coat ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Ambulatory Bp Monitoring ◽  
Trial Testing ◽  
The Difference

Background: Clinic blood pressure (BP) is measured in the seated position, which can miss important home BP phenotypes such as low ambulatory BP (white coat effects) or high supine BP (nocturnal non-dippers). Orthostatic hypotension (OH) is determined based on BP measurements in both seated (or supine) and standing positions, and thus could theoretically identify these important phenotypes in clinic. Objective: To determine the association of OH with white coat effects or night-to-daytime systolic BP (SBP) Methods: SPRINT was a randomized trial testing the effects of intensive (<120 mmHg) or standard (<140 mmHg) SBP treatment strategies in adults at higher risk of cardiovascular disease. OH was assessed at 6, 12, or 24-mths and defined as a decrease in standing and mean seated SBP ≥20 or DBP ≥10 mmHg after 1 min of standing. White coat effects, based on 24-hr ambulatory BP monitoring performed at the 27-mth visit (every 30-minutes), were defined as the difference between 27-mth seated clinic and ambulatory BP ≥ 20/≥10 mmHg. SBP dipping ratio was defined as the ratio of night-to-daytime SBP >0.9. Results: Of 897 adults (mean age 71.5 [SD, 9.5] yrs, 28.7% female, 28.0% black), 128 had OH at least once. Among those with OH, 14.8% had white coat effects versus 7.2% among those without OH. Moreover, 68.8% of those with OH demonstrated non-dipping patterns versus only 52.0% of those without OH. OH was positively associated with both white coat effects (OR=2.24; 95% CI: 1.28, 4.27) and higher night-to-daytime SBP (β=0.04; 95% CI: 0.02, 0.06) ( Table ). Conclusions: Clinic-based assessments of OH may be a useful tool for identifying BP phenotypes often missed with traditional seated BP assessments.

Abstract MP84: Incident Sleep-Disordered Breathing is Associated with Higher Blood Pressure and its Reactivity: Penn State Child Cohort

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Edward O Bixler ◽  
Duanping Liao ◽  
Alexandros N Vgontzas ◽  
Fan He ◽  
Sol M Rodriguez-Colon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Disordered Breathing ◽  
Vascular Reactivity ◽  
Population Based ◽  
Increased Risk ◽  
Penn State ◽  
State Child ◽  
The Difference ◽  
Disordered Breathing

Objectives: To examine the association between incident sleep-disordered breathing (SDB) and blood pressure and blood pressure reactivity in a population based sample of adolescents. Methods: The Penn State Child Cohort is a general population based sample of 700 children aged 5-12 years at the baseline examination (2000-2005). Currently, 300 participants have completed their 8-year follow up examination. Blood pressure was assessed at follow up in the evening using an automated device prior to the sleep recording in three positions. Three assessments in the seated position were completed after 5 minutes of rest. This was followed by 3 assessments in the supine position after 5 minutes of rest. The averages of the 2 nd and 3 rd readings for both positions are reported. Finally the subject was asked to stand as fast as possible and 2 additional readings were completed immediately upon their foot hitting the floor. These two standing readings were averaged. The difference between standing and supine BP was used as measures of vascular reactivity. The age, gender and height adjusted mean level of BP measures comparing individuals with and without incident SDB (defined as Apnea Hypopnia Index, AHI>5/hr) after excluding individuals with baseline SDB were calculated. Results: We observed no significant differences in diastolic blood pressure across the three positions. However, systolic blood pressure across all three positions and vascular reactivity were significantly elevated in those with incident SDB, as summarized in Table 1. Conclusion: In an 8-year followup of this population based sample of children, there was no persistence of SDB from baseline. Incident SDB (about 11%) was significantly associated with elevated systolic BP across all three positions. Further, SDB was associated with increased systolic BP reactivity, which has been associated with increased risk of CVD and the development of hypertension in adults.

scholarly journals Should we redifine Hypertensive response in stress test to better predict cardiovascular risk?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Silverio Antonio ◽  
P Alves Da Silva ◽  
J Valente Silva ◽  
J Brito ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Protective Factor ◽  
Antihypertensive Drugs ◽  
Stress Test ◽  
Treatment Strategies ◽  
High Rate ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systolic blood pressure (SBP) rise during exercise is normal, but some patients present with hypertensive response to exercise (HRE). The clinical implication of such phenomenon is not fully elucidated, and treatment strategies are still uncertain. Purpose To evaluate the relationship between HRE and the development of major cardiovascular events (MACE) - death, acute coronary syndrome (ACS) and stroke. Methods Single-center retrospective study of consecutive patients submitted to exercise test (ET) from 2012 to 2015. Patient’s demographics, baseline clinical characteristics, vital signs during ET and MACE occurrence during follow-up were analysed. HRE was defined as a peak systolic blood pressure (PSBP) &gt;210 mmHg in men and &gt;190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure &gt;90 mmHg or a rise of 10 mmHg. Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%) and dyslipidaemia (61%). During a mean follow-up of 60 ± 2 months, the incidence of MACE was 9.2% with ACS being the most frequent (4.2%), followed by mortality (3.8%) and stroke (2.1%). Patients with inconclusive ET had a fourfold higher risk of acute coronary events (OR 4.1, CI 95% 1.55-11.14, p = 0.005). Baseline SBP and PSBP were predictors of MACE occurrence (OR 1.022, CI 95% 1.004-1.04, p = 0.016, OR 1.031 CI 95% 1.012-1.051, p = 0.001, respectively) and were both associated with cardiovascular hospitalization (p = 0.006; p &lt; 0.001, respectively). PSBP had moderate ability to predict hospitalization of cardiovascular (CV) cause (AUC 0.71, p &lt; 0.001) with a cut-off of 193 mmHg (sensibility 91%, specify 40%) and had moderate ability to predict MACE (AUC 0.67, p &lt; 0.001) with a cut-off of 198 mmHg (sensibility 78.6%, specify 46.1%). Regarding mortality, antihypertensive therapy prior to ET was protective (p = 0.042), with no difference between different classes of drugs. Conclusion Our data reveal a high rate of MACE occurrence between patients with HRE. The finding of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs. An increased risk of ACS between patients with an inconclusive ET should lead to consider then for further investigation. HRE should be considered as part of CV risk assessment and adjusted lower HRE cut-off values should be considered in order to better predict MACE occurrence, particularly in high risk patients. Abstract Figure.

Abstract T1: Prognostic Value Of 24-hour Ambulatory Blood Pressure And Heart Rate Patterns In Diabetes: A 20-year Longitudinal Analysis Of The Chronic Diabetes Complications And All-cause Mortality In Pisa From 1999 Onwards (CHAMP1ON) Study Cohort

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Martina Chiriacò ◽  
Luca Sacchetta ◽  
Giovanna Forotti ◽  
Simone Leonetti ◽  
Lorenzo Nesti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy ◽  
Diabetic Patients ◽  
Adjusted Risk ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Reverse Dipping

Background: Abnormal circadian blood pressure (BP) patterns and reduced heart rate variability (HRV) are established risk factors for cardiovascular events in diabetic patients. However, studies assessing all-cause mortality associated with altered BP patterns and HRV in diabetes are limited by follow-up periods of less than 10 years. Methods: We examined a cohort of 349 patients with type 2 diabetes ( n =284) or type 1 diabetes ( n =65) recruited in Pisa (Italy) from 1999 and followed-up for 21 years, all with available 24-hour ambulatory BP and HRV monitoring. Dipping, non-dipping and reverse dipping status were defined as a ≥10% decline, <10% decline, and ≥0.1% increase in average night-time systolic BP (SBP) compared with average daytime SBP, respectively. Results: After 6,251 person-years of follow-up (median follow-up 21.0 [14.0-21.0] years, 183 [52%] women, age 57.1±11.9 y, BMI 29.4±5.9 kg/m 2 , HbA1c 8.6±2.1%), a total of 136 (39%) deaths occurred. Compared with dippers (n=166), non-dippers (n=144) and reverse dippers (n=39) showed progressively higher prevalence of cardiac autonomic neuropathy (11%, 16% and 31%, respectively), low HRV (45% vs 53% vs 62%), 24-hour hypertension (40%, 60% and 67%), isolated nocturnal hypertension (5%, 27% and 49%), postural hypotension (14%, 26% and 43%), and lower prevalence of white-coat hypertension (31%, 17% and 13%). Reverse dippers and non-dippers had progressively lower mean overall survival (OS) compared with dippers (16.1±5.3 years, 17.5±5.3 years and 18.6±4.6 years, respectively). Reverse dippers also showed an increased risk of all-cause mortality after adjustment for age, sex, BMI, office SBP, plasma glucose, and diabetes duration and type (HR 2.3 [1.4-3.8]). Patients with low HRV had reduced mean OS than those with high HRV (16.9±5.5 and 18.8±4.4, respectively) but similar adjusted risk (HR 1.3 [0.9-1.9]). No significant interactions emerged between BP patterns, HRV and diabetes type on OS. Conclusions: Non-dipping and reverse dipping BP patterns are associated with an increased prevalence of cardiac autonomic neuropathy and reduced survival probability in diabetic patients over a 21-year follow-up, with reverse dipping more than doubling the adjusted risk of all-cause mortality.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

Abstract MP33: Association Between Neurologic Outcomes and Temporal Profile of Systolic Blood Pressure Variability After Endovascular Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ayush Prasad ◽  
Jessica Kobsa ◽  
Sreeja Kodali ◽  
Cindy Khanh Nguyen ◽  
Darko Quispe Orozco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Systolic Blood Pressure ◽  
Functional Outcome ◽  
Blood Pressure Variability ◽  
Treatment Strategies ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Increased Risk ◽  
Systolic Blood Pressure Variability

Introduction: Higher systolic blood pressure variability (BPV) after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and worse functional outcomes. However, the time-varying behavior of BPV after EVT and its effects on functional outcome have not been well characterized. Methods: We analyzed data from an international cohort of patients with acute large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Parameters of BPV were calculated in 12-hour epochs using five established methodologies: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), successive variation (SV), and residual SD (rSD). Patients’ overall mean BPV was then used to assign patients into tertiles for regression analysis: low BPV, intermediate BPV, and high BPV. Functional outcome was measured with the modified Rankin Scale (mRS) at 90 days. Results: Of the 1,791 patients (age 69 ± 14, NIHSS 15 ± 6) included in our analysis, 1,085 (60.6%) had a poor 90-day outcome (mRS >3). Patients with poor outcome had significantly higher systolic BPV (p<0.05) measured as standard deviation (SBP SD) at each epoch (Figure 1B). Compared to patients with low BPV, those in the highest tertile group had significantly greater odds of a poor functional outcome after adjusting for age, sex, hypertension, NIHSS, ASPECT, tPA, time to reperfusion, and TICI score (OR 1.5; 95% CI 1.2-2; p=0.001). Patients in the highest tertile of BPV demonstrated time-dependent variability with the highest SBP SD during the first 24 hours after thrombectomy (Figure 1A). Conclusions: Higher BPV measured by SBP SD appears to be associated with poor 90-day outcome in EVT-treated stroke patients. Early treatment strategies targeting early high BPV warrant further prospective investigation.

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
Eva Mistry ◽  
Mohammad Anadani ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Adjusted Risk ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

Abstract 49: Supine Versus Seated Positions On The Detection Of Orthostatic Hypotension And Its Association With Fall Risk And Orthostatic Symptoms

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Stephen P Juraschek ◽  
Lawrence J Appel ◽  
Edgar R Miller
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Orthostatic Hypotension ◽  
Fall Risk ◽  
Ad Hoc ◽  
The Past ◽  
Trial Testing ◽  
Risk Of Falls ◽  
Orthostatic Symptoms ◽  
The Impact

Background: Hypertension trials that monitor orthostatic hypotension (OH) compare standing to seated blood pressure (BP) rather than supine BP. We determined the impact of a supine vs seated position on OH prevalence and its relationship with fall risk and orthostatic symptoms. Methods: The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a randomized trial testing the effects of vitamin D3 dose on falls in adults age ≥70 years at higher risk of falls. OH was determined at baseline, 3, 12, and 24 months with each of 2 protocols: (1) seated to standing and (2) supine to standing. OH was defined as a drop in systolic or diastolic BP of at least 20 or 10 mm Hg. Participants were asked about orthostatic symptoms in the past month. Falls were ascertained via daily fall calendar, ad hoc reporting, and scheduled interviews. Results: Among 522 participants with 953 OH assessments (mean age 76 ± 5 years, 42% women, 18% Black), mean baseline BP was 129 ± 18/68 ± 11 mm Hg. Mean BP increased 3.4/2.6 mm Hg after sitting, but decreased -3.7/-0.7 mm Hg after being supine. OH was detected in 2.2% of seated vs 14.8% of supine assessments. Supine OH better predicted falls (HR 1.60; 95% CI: 0.98, 2.61; P =0.06) than seated OH (HR 0.70; 95% CI: 0.30, 1.60; P =0.39), although both were non-significant ( Figure ). While seated OH was not associated with orthostatic symptoms, supine OH was associated with a greater risk of fainting, blacking out, seeing spots, room spinning, and headache in the prior month ( P -values of 0.048 to 0.002). Conclusions: Supine OH was more prevalent and appeared to better predict falls and orthostatic symptoms than seated OH. These findings support a supine protocol for OH in clinical practice.

Abstract P199: Keep Moving, Your Health Depends On It: Impact Of Improved Physical Activity And Weight Loss In A Wellness Program

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ebenezer T Oni ◽  
Ehimen Aneni ◽  
Maribeth Rouseff ◽  
Thinh Tran ◽  
Henry Guzman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Weight Loss ◽  
Intervention Program ◽  
South Florida ◽  
Metabolic Equivalents ◽  
Baseline Weight ◽  
The Mean ◽  
The Difference

Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost >5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.

scholarly journals Awaking Blood Pressure Surge and Progression to Microalbuminuria in Type 2 Normotensive Diabetic Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Michelangela Barbieri ◽  
Maria Rosaria Rizzo ◽  
Ilaria Fava ◽  
Celestino Sardu ◽  
Nicola Angelico ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cox Regression ◽  
Blood Pressure Monitoring ◽  
Adult Patients ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Pressure Surge

Background. We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes.Methods. Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP.Results. After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (−0.67±1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86±6.92 mmHg) during follow-up were 17.41 (95% CI 6.26–48.42);pfor trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6[1.4]to 36.8[7.1],p<0.001.Conclusion. An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.

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