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Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients

Year 2021, Volume: 13 Issue: 3, 628 - 633, 18.10.2021

Muhammed N Murat Aksoy Yusuf Can İbrahim Kocayiğit Musatafa Tarık Ağaç

https://doi.org/10.18521/ktd.890622

Abstract

Objective: Systolic blood pressure variability (SBPV) is a measure of oscillations in SBP for 24 hours. There are conflicting data about the relationship between SBPV and cardiovascular (CV) diseases. In this study, we aim to document a relationship between SBPV and surrogate markers of CV damage in a hypertensive patient cohort.
Methods: Previously documented hypertension patients were enrolled. Patients with previously documented CV disease, diabetes mellitus and secondary hypertension were excluded. 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, electrocardiography and cardio-ankle vascular index (CAVI) measurements were performed. SBPV is defined as the standard deviation of mean systolic blood pressure readings from ABMP records. The relationship between SBPV and QTc distance, QT dispersion, presence of fragmented QRS, CAVI results were examined.
Results: 64 patients were enrolled mean age 508, 24(37%) were male]. Mean SBPV was 15.124.6 and there was not a significant correlation between SBPV CAVI, QTc measurements of the study patients but there was a significant positive correlation with QT dispersion values (28.615.2, p=0.004, p=0.354). When patients were divided into two categories as high SBPV and low SBPV, QT dispersion was consistently longer in high SBPV group (p=0.006).
Conclusion: In hypertensive patients without documented CV disease and signs of hypertensive CV changes on clinical evaluation, SBPV is positively correlated with QT dispersion but high SBPV is not related with aortic stiffness according to CAVI results. These findings might be a sign of occult left ventricular fibrosis and high risk of arrhythmia in hypertensive patients with high SBPV.

Keywords

systolic blood pressure variability hypertension cardiovascular risk

References

  • Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–125
  • Kannel WB, Wolf PA, McGee DL, Dawber TR, McNamara P, Castelli WP. Systolic blood pressure, arterial rigidity, and the risk of stroke: the Framingham study. JAMA 1981; 245:1225–1229.
  • Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens. 1987;5:93–98.
  • Parati G, Valentini M. Prognostic relevance of blood pressure variability. Hypertension. 2006;47:137–138. Sander D, Kukla C, Klingelhofer J, Winbeck K, Conrad B. Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: A 3-year follow-up study. Circulation. 2000;102: 1536 –1541.
  • Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Porcellati C. Lack of association between blood pressure variability and left ventricular mass in essential hypertension. Am J Hypertens. 1998;11:515–522.
  • Omboni S, Posokhov IN, Rogoza AN. Relationships between 24-h blood pressure variability and 24-h central arterial pressure, pulse wave velocity and augmentation index in hypertensive patients. Hypertens Res. 2017 Apr;40(4):385-391. Hayashi K, Yamamoto T, Takahara A, Shirai K. Clinical assessment of arterial stiffness with cardio-ankle vascular index: theory and appli- cations. J Hypertens 2015;33:1742–1757.
  • Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749–66.
  • Hurtado-de-Mendoza D, Corona-Villalobos CP, Pozios I, Gonzales J, Soleimanifard Y, Sivalokanathan S, Montoya-Cerrillo D et al. Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy. J Arrhythm. 2017 Jun;33(3):201-207.
  • Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006 May 30;113(21):2495-501.
  • Parati G. Blood pressure variability: its measurement and significance in hypertension. J Hypertens. 2005;23:S19–S25
  • Cardoso CR, Salles GF, Deccache W. Prognostic value of QT interval parameters in type 2 diabetes mellitus: results of a long-term follow-up prospective study. J Diabetes Complications 2003;17:169 – 78.
  • Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR. Relationship between QT interval dispersion in acute stroke and stroke prognosis: a systematic review. J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2467-2478.
  • Kadota K, Takamura N, Aoyagi K, Yamasaki H, Usa T, Nakazato M et al. Availability of cardio-ankle vascular index (CAVI) as a screening tool for atherosclerosis. Circ J. 2008 Feb;72(2):304-8.
  • Sun CK. Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness. Integr Blood Press Control. 2013 Apr 30;6:27-38.
  • Zhou TL, Henry RMA, Stehouwer CDA, van Sloten TT, Reesink KD, Kroon AA. Blood Pressure Variability, Arterial Stiffness, and Arterial Remodeling. Hypertension. 2018 Oct;72(4):1002-1010.

Hipertansiyon Hastalarında Sistolik Kan Basıncı Değişkenliği ve Kardiyovasküler Riskin Vekil Belirteçleri Arasındaki İlişki

Year 2021, Volume: 13 Issue: 3, 628 - 633, 18.10.2021

Muhammed N Murat Aksoy Yusuf Can İbrahim Kocayiğit Musatafa Tarık Ağaç

https://doi.org/10.18521/ktd.890622

Abstract

Amaç: Sistolik kan basıncı değişkenliği (SKBD) 24 saatlik kan basıncı takiplerinde sistolik kan basıncının gösterdiği yükselme ve düşme hareketinin bir ölçüsüdür. SKBD ile kardiyovasküler (KV) hastalıklar arasındaki ilişkiyi gösteren çelişkili bilgiler mevcuttur. Bu çalışmada, hipertansif bir kohortta SKBD ile KV hasarı gösteren vekil belirteçler arasındaki ilişkiyi araştırdık
Metod: Esansiyel hipertansiyon hastalarının dahil edildiği çalışmada; belgelenmiş KV hastalık, diabetes mellitus ve sekonder hipertansiyon öyküsü olan bireyler dışlandı. 24 saat ambulatuar kan basıncı ölçümü (AKBÖ), ekokardiyografi, elektrokardiyografi ve kalp-ayak bileği vaskuler indeks (KAVİ) ölçümleri yapıldı. SKBD, AKBÖ kayıtlarında ortalama sistolik kan basıncı değerinin standart sapması olarak tanımlandı. SKBD ile EKG’de QTc mesafesi, QT dispersiyonu, fragmante QRS varlığı ve KAVİ sonuçları karşılaştırıldı.
Bulgular: 64 hasta çalışmaya dahil edildi ortalama yaş 508, 24(%37) erkek. SKBD (ortalama 15.124.6) ile KAVİ ölçümü, QTc mesafesi, fragmante QRS varlığı arasında bir korelasyon bulunamadı ancak QT dispersiyonu ile pozitif bir korelasyon izlendi. Hastalar ortanca SKBD değerine göre ikiye bölünüp yüksek ve düşük SKBD olarak ikiye bölündüğünde QT dispersiyonu yüksek SKBD grubunda tutarlı ve anlamlı olarak daha yüksekti (p=0.006)
Sonuç: Belgelenmiş KV hastalıkları ve hipertansif KC değişim belirteçleri görülmeyen hipertansiyon hastalarında SKBD değerleri, QT dispersiyonu ile pozitif korelasyon gösterirken, bir aort sertlik indeksi olan KAVİ ile ilişki görülmedi. Bu bulgular SKBD’si yüksek olan hipertansif hasta grubunda gizli sol ventrikül fibrozis varlığını ve buna bağlı artmış aritmi riskini gösteriyor olabilir.

Keywords

sistolik kan basıncı değişkenliği hipertansiyon kardiyovasküler risk

References

  • Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–125
  • Kannel WB, Wolf PA, McGee DL, Dawber TR, McNamara P, Castelli WP. Systolic blood pressure, arterial rigidity, and the risk of stroke: the Framingham study. JAMA 1981; 245:1225–1229.
  • Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens. 1987;5:93–98.
  • Parati G, Valentini M. Prognostic relevance of blood pressure variability. Hypertension. 2006;47:137–138. Sander D, Kukla C, Klingelhofer J, Winbeck K, Conrad B. Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: A 3-year follow-up study. Circulation. 2000;102: 1536 –1541.
  • Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Porcellati C. Lack of association between blood pressure variability and left ventricular mass in essential hypertension. Am J Hypertens. 1998;11:515–522.
  • Omboni S, Posokhov IN, Rogoza AN. Relationships between 24-h blood pressure variability and 24-h central arterial pressure, pulse wave velocity and augmentation index in hypertensive patients. Hypertens Res. 2017 Apr;40(4):385-391. Hayashi K, Yamamoto T, Takahara A, Shirai K. Clinical assessment of arterial stiffness with cardio-ankle vascular index: theory and appli- cations. J Hypertens 2015;33:1742–1757.
  • Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749–66.
  • Hurtado-de-Mendoza D, Corona-Villalobos CP, Pozios I, Gonzales J, Soleimanifard Y, Sivalokanathan S, Montoya-Cerrillo D et al. Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy. J Arrhythm. 2017 Jun;33(3):201-207.
  • Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006 May 30;113(21):2495-501.
  • Parati G. Blood pressure variability: its measurement and significance in hypertension. J Hypertens. 2005;23:S19–S25
  • Cardoso CR, Salles GF, Deccache W. Prognostic value of QT interval parameters in type 2 diabetes mellitus: results of a long-term follow-up prospective study. J Diabetes Complications 2003;17:169 – 78.
  • Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR. Relationship between QT interval dispersion in acute stroke and stroke prognosis: a systematic review. J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2467-2478.
  • Kadota K, Takamura N, Aoyagi K, Yamasaki H, Usa T, Nakazato M et al. Availability of cardio-ankle vascular index (CAVI) as a screening tool for atherosclerosis. Circ J. 2008 Feb;72(2):304-8.
  • Sun CK. Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness. Integr Blood Press Control. 2013 Apr 30;6:27-38.
  • Zhou TL, Henry RMA, Stehouwer CDA, van Sloten TT, Reesink KD, Kroon AA. Blood Pressure Variability, Arterial Stiffness, and Arterial Remodeling. Hypertension. 2018 Oct;72(4):1002-1010.
There are 15 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Muhammed N Murat Aksoy 0000-0002-7722-0330

Yusuf Can 0000-0002-4535-7367

İbrahim Kocayiğit 0000-0001-8295-9837

Musatafa Tarık Ağaç 0000-0002-4748-2532

Publication Date October 18, 2021
Acceptance Date July 23, 2021
Published in Issue Year 2021 Volume: 13 Issue: 3

Cite

APA Aksoy, M. N. M., Can, Y., Kocayiğit, İ., Ağaç, M. T. (2021). Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients. Konuralp Medical Journal, 13(3), 628-633. https://doi.org/10.18521/ktd.890622
AMA Aksoy MNM, Can Y, Kocayiğit İ, Ağaç MT. Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients. Konuralp Medical Journal. October 2021;13(3):628-633. doi:10.18521/ktd.890622
Chicago Aksoy, Muhammed N Murat, Yusuf Can, İbrahim Kocayiğit, and Musatafa Tarık Ağaç. “Systolic Blood Pressure Variability and Its Relationship With Surrogate Markers of Cardiovascular Risk in Hypertensive Patients”. Konuralp Medical Journal 13, no. 3 (October 2021): 628-33. https://doi.org/10.18521/ktd.890622.
EndNote Aksoy MNM, Can Y, Kocayiğit İ, Ağaç MT (October 1, 2021) Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients. Konuralp Medical Journal 13 3 628–633.
IEEE M. N. M. Aksoy, Y. Can, İ. Kocayiğit, and M. T. Ağaç, “Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients”, Konuralp Medical Journal, vol. 13, no. 3, pp. 628–633, 2021, doi: 10.18521/ktd.890622.
ISNAD Aksoy, Muhammed N Murat et al. “Systolic Blood Pressure Variability and Its Relationship With Surrogate Markers of Cardiovascular Risk in Hypertensive Patients”. Konuralp Medical Journal 13/3 (October 2021), 628-633. https://doi.org/10.18521/ktd.890622.
JAMA Aksoy MNM, Can Y, Kocayiğit İ, Ağaç MT. Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients. Konuralp Medical Journal. 2021;13:628–633.
MLA Aksoy, Muhammed N Murat et al. “Systolic Blood Pressure Variability and Its Relationship With Surrogate Markers of Cardiovascular Risk in Hypertensive Patients”. Konuralp Medical Journal, vol. 13, no. 3, 2021, pp. 628-33, doi:10.18521/ktd.890622.
Vancouver Aksoy MNM, Can Y, Kocayiğit İ, Ağaç MT. Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients. Konuralp Medical Journal. 2021;13(3):628-33.
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