Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients
Introduction
Carotid atherosclerosis (CAS) is the pathological basis of cardiovascular and cerebrovascular diseases. Many clinical and physiological factors are significantly associated with CAS, including ageing, smoking, hypertension, diabetes. Among them, hypertension is one of the most closely related to CAS [1], [2]. Published studies have confirmed that most patients with hypertension have different degrees of CAS [3], [4].
Patients with CAS normally have reduced blood pressure (BP) regulation because carotid sinus and aortic arch baroreflex play important roles in the regulation of cardiovascular reflex. The main clinical symptoms include either too high or too low BPs with large BP fluctuation, namely increased BPV. In general, patients with CAS have the carotid intima-media thickness (IMT) more than 0.9 [5], [6], [7]. Recent study has reported that daytime and all-day (24 h) systolic blood pressure variability (SBPV) in hypertensive patients are closely related to IMT [8], and SBPV is a good predictor of IMT progression. The clinical significance of BPV has become more attractive to researchers [9], [10], [11]. However, the relationship between different BPV metrics and CAS has not been fully agreed [8], [12], which requires further and comprehensive investigation.
Many studies have reported that BPV is a risk predictor for organ damage, and considered that BPV is more valuable than increased blood pressure (BP), leading to the suggestion that reducing BPV is more important than lowering BP [9], [10], [11], [13], [14], [15]. Recent research has also suggested that BPV is higher in hypertensive patients than in the healthy subjects [9], [10], [11]. Thus, controlling BPV has become a critical approach for BP management in hypertensive patients and patients with atherosclerotic diseases.
BPV has been defined in different ways depending on the time duration, including: very short-term (beat-to-beat), short-term (minute-to-minute or reading-to-reading within a 24-h period), middle-term (day-to-day), long-term (visit-to-visit and seasonal) [9], [10], [11], from which different BPV metrics have been derived, including the standard deviations (SD) of systolic BP (SBP), diastolic BP(DBP) and pulse pressure (PP), as well as the variability uncorrelated with mean BP [9], [10], [11]. In addition, most studies mainly focused on the increased BPV while ignoring the clinical significance of decreased BPV. Most of current BPV metrics are consistent, and have positive correlation with target organ damage. However, some studies suggested that low-reactive BPV (such as blunted surge, nocturnal hypertension, orthostatic hypotension) is also a risk factor of cardiovascular disease, which is also associated with target organ lesions of hypertensive patients. Therefore, it is necessary to study hyporeactive BPV indices and explore its relationship with hypertensive atherosclerosis [16], [17].
Various factors, including neuroendocrine factors, vascular wall elasticity, environmental factors, emotional turmoil and sudden movements, affect BPV values [9], [10], [11]. Although many studies have provided evidence that CAS is closely associated with BPV [13], [14], [15], [18], the relationship between CAS and BPV has not been quantified. In addition, different studies have used different BPV indices. This study aimed to explore the relationship between BPV metrics and the degree of CAS in patients with essential hypertension.
Section snippets
Patients
The study recruited 144 essential hypertension patients who were hospitalized in the Department of Neurology and Department of Cardiology, Weihai Central Hospital Affiliated to Qingdao University Medical College. There were 80 male and 64 female. Their age range was 45–89 year (66±9 year). This study was approved by the College Ethics Committee of Weihai Central Hospital Affiliated to Qingdao University Medical College.
The diagnosis of essential hypertension was based on the criteria reported
Results
As shown in Table 1, there was no significant difference between the non-CAS and CAS groups in gender; history of drinking, hypertension and coronary heart disease; BMI values; levels of TC, HDL-C, LDL-C, uric acid; GFR and fibrinogen (all P>0.05). However, there was a significant difference between the two groups in age, history of smoking, history of stroke, history of diabetes and the levels of TG, FBG, hs-CRP, HCY and urine protein (P<0.01 or 0.05).
Table 2 shows the 24 h ambulatory BPV
Discussion
BPV has recently attracted great attention in basic and clinical research. An increasing number of studies have concluded that increased BPV, independent of the average BP values, is a risk factor for cardiovascular and cerebrovascular diseases, which is more valuable than average BP to predict target organ lesions in hypertensive patients [9], [10]. However, other studies reported that BPV was not relevant to target organ damage in hypertensive patients [18], [19]. Therefore, further
Conflict of interest statement
The authors declare no conflict of interest.
Acknowledgments
This research was sponsored by the National Natural Science Foundation of China (Grant 61671275).
References (33)
- et al.
Subclinical atherosclerosis and relationship With risk factors of coronary artery disease in a rural population
Am. J. Med. Sci.
(2015) - et al.
Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: the AWHS study
J. Am. Coll. Cardiol.
(2016) - et al.
Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study
Atherosclerosis
(1990) - et al.
Relationship of short-term blood pressure variability with carotid intima-media thickness in hypertensive patients
Biomed. Eng. Online
(2015) - et al.
Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension
Lancet
(2010) - et al.
Morning blood pressure surge and hypertensive cerebrovascular disease: role of the alpha adrenergic sympathetic nervous system
Am. J. Hypertens.
(2004) - et al.
Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases-relationships and comparisons with vascular markers of atherosclerosis
Atherosclerosis
(2014) - et al.
Factors significantly associated with the increased prevalence of carotid atherosclerosis in a Northeast Chinese Middle-aged and elderly population: a cross-sectional study
Medicine
(2016) - et al.
Enhanced risk of carotid atherosclerosis associated with white-coat hypertension
J. Clin. Hypertens.
(2016) - et al.
Ultrasonic evaluation of early carotid atherosclerosis
Stroke
(1990)
Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study
Stroke
Assessment and management of blood-pressure variability
Nat. Rev. Cardiol.
Doubts and difficulties in studying blood pressure variability
Eur. Rev. Med. Pharmacol. Sci.
The relationship between the 24 h blood pressure variability and carotid intima-media thickness: a compared study
Comput. Math. Methods Med.
Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects
Hypertension
Blood pressure variability and multiple organ damage in primary hypertension
J. Hum. Hypertens.
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