Cardiovascular events have their greatest prevalence in the early morning period. Whether this is attributable to an arousal-dependent blood pressure (BP) increase is far from being clear. It is also not clear to what extent this phenomenon reflects overall 24-hour BP variability. In 2051 subjects (aged 25-74 years) representative of the population of Monza (Italy), we measured 24-hour ambulatory systolic BP (SBP) and calculated the difference between the 2-hour average values after morning arousal and the lowest 3 or average 2-hour values before arousal (morning BP surge 1 and 2, respectively). For either measure, we sought the relationship with a variety of indices of 24-hour SBP variability and collected information on (1) the occurrence of cardiovascular and all cause deaths during a follow-up of ≈16 years and (2) the appearance of echocardiographic left ventricular hypertrophy after 10 years from the baseline visit. Morning SBP surge 1 was directly related to indices of 24-hour SBP variability, including those made independent on the magnitude of the day-night SBP difference. There was a weak positive relationship between morning SBP surge 1 and the risk of cardiovascular and all-cause death, which disappeared after adjustment for confounders. This was the case also for development of left ventricular hypertrophy. Morning SBP surge 2 was smaller, inconsistently related to 24-hour SBP variability and not at all related to fatal events or new-onset left ventricular hypertrophy. In a white population, morning BP surge was not found to be an independent predictor of cardiovascular death, all-cause death, or development of high cardiovascular risk (as documented by new-onset cardiac damage) even when appropriately assessed by measures that reflect its association with 24-hour BP variability.

Bombelli, M., Fodri, D., Toso, E., Macchiarulo, M., Cairo, M., Facchetti, R., et al. (2014). Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population. HYPERTENSION, 64(5), 943-950 [10.1161/HYPERTENSIONAHA.114.03675].

Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population

BOMBELLI, MICHELE
Primo
;
FODRI, DANILO
Secondo
;
TOSO, ELENA;MACCHIARULO, MARIO;CAIRO, MATTEO;FACCHETTI, RITA LUCIA;DELL'ORO, RAFFAELLA;GRASSI, GUIDO
Penultimo
;
MANCIA, GIUSEPPE
Ultimo
2014

Abstract

Cardiovascular events have their greatest prevalence in the early morning period. Whether this is attributable to an arousal-dependent blood pressure (BP) increase is far from being clear. It is also not clear to what extent this phenomenon reflects overall 24-hour BP variability. In 2051 subjects (aged 25-74 years) representative of the population of Monza (Italy), we measured 24-hour ambulatory systolic BP (SBP) and calculated the difference between the 2-hour average values after morning arousal and the lowest 3 or average 2-hour values before arousal (morning BP surge 1 and 2, respectively). For either measure, we sought the relationship with a variety of indices of 24-hour SBP variability and collected information on (1) the occurrence of cardiovascular and all cause deaths during a follow-up of ≈16 years and (2) the appearance of echocardiographic left ventricular hypertrophy after 10 years from the baseline visit. Morning SBP surge 1 was directly related to indices of 24-hour SBP variability, including those made independent on the magnitude of the day-night SBP difference. There was a weak positive relationship between morning SBP surge 1 and the risk of cardiovascular and all-cause death, which disappeared after adjustment for confounders. This was the case also for development of left ventricular hypertrophy. Morning SBP surge 2 was smaller, inconsistently related to 24-hour SBP variability and not at all related to fatal events or new-onset left ventricular hypertrophy. In a white population, morning BP surge was not found to be an independent predictor of cardiovascular death, all-cause death, or development of high cardiovascular risk (as documented by new-onset cardiac damage) even when appropriately assessed by measures that reflect its association with 24-hour BP variability.
Articolo in rivista - Articolo scientifico
blood pressure; blood pressure monitoring, ambulatory; cardiovascular diseases; morbidity; mortality
English
943
950
8
Bombelli, M., Fodri, D., Toso, E., Macchiarulo, M., Cairo, M., Facchetti, R., et al. (2014). Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population. HYPERTENSION, 64(5), 943-950 [10.1161/HYPERTENSIONAHA.114.03675].
Bombelli, M; Fodri, D; Toso, E; Macchiarulo, M; Cairo, M; Facchetti, R; Dell'Oro, R; Grassi, G; Mancia, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/58485
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