Morning blood pressure surge is associated with arterial stiffness and sympathetic baroreflex sensitivity in hypertensive seniors

被引:42
|
作者
Okada, Yoshiyuki [1 ,2 ]
Galbreath, M. Melyn [1 ,2 ]
Shibata, Shigeki [1 ,2 ]
Jarvis, Sara S. [1 ,2 ]
Bivens, Tiffany B. [1 ]
Vongpatanasin, Wanpen [2 ]
Levine, Benjamin D. [1 ,2 ]
Fu, Qi [1 ,2 ]
机构
[1] Texas Hlth Presbyterian Hosp Dallas, Inst Exercise & Environm Med, Dallas, TX 75231 USA
[2] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
关键词
circadian rhythm; sympathetic nerve activity; hypertension; aging; CEREBROVASCULAR-DISEASE; CIRCADIAN VARIATION; NERVE ACTIVITY; RESPONSES; AGE; EXERCISE; STRESS; ONSET;
D O I
10.1152/ajpheart.00254.2013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Morning blood pressure (BP) surge is considered to be an independent risk factor for cardiovascular diseases. We tested the hypothesis that increased large-artery stiffness and impaired sympathetic baroreflex sensitivity (BRS) contribute to augmented morning surge in elderly hypertensive subjects. Morning surge was assessed as morning systolic BP averaged for 2 h just after waking up minus minimal sleeping systolic BP by using ambulatory BP monitoring (ABPM) in 40 untreated hypertensive [68 +/- 1 (SE) yr] and 30 normotensive (68 +/- 1 yr) subjects. Beat-by-beat finger BP and muscle sympathetic nerve activity (MSNA) were recorded in the supine position and at 60 degrees upright tilt. We assessed arterial stiffness with carotid-to-femoral pulse wave velocity (cfPWV) and sympathetic BRS during spontaneous breathing. Awake and asleep ABPM-BPs and morning surge were higher in hypertensive than normotensive subjects (all P < 0.001). cfPWV was higher (P = 0.002) and sympathetic BRS was lower (P = 0.096) in hypertensive than normotensive subjects. Hypertensive subjects with morning surge >= 35 mmHg (median value) had higher cfPWV (11.9 +/- 0.5 vs. 9.9 +/- 0.4 m/s, P = 0.002) and lower sympathetic BRS (supine: -2.71 +/- 0.25 vs. -3.73 +/- 0.29, P = 0.011; upright: -2.62 +/- 0.22 vs. -3.51 +/- 0.35 bursts.100 beats(-1).mmHg(-1), P = 0.052) than those with morning surge <35 mmHg. MSNA indices were similar between groups (all P > 0.05), while upright total peripheral resistance was higher in hypertensive subjects with greater morning surge than those with lesser morning surge (P = 0.050). Morning surge was correlated positively with cfPWV (r = 0.59, P < 0.001) and negatively with sympathetic BRS (r = 0.51, P < 0.001) in hypertensive subjects only. Thus, morning BP surge is associated with arterial stiffness and sympathetic BRS, as well as vasoreactivity during orthostasis in hypertensive seniors.
引用
收藏
页码:H793 / H802
页数:10
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