Relationship Among Morning Blood Pressure Surge, 24-Hour Blood Pressure Variability, and Cardiovascular Outcomes in a White Population

被引:56
|
作者
Bombelli, Michele [1 ]
Fodri, Danilo [1 ]
Toso, Elena [1 ]
Macchiarulo, Mario [1 ]
Cairo, Matteo [1 ]
Facchetti, Rita [1 ]
Dell'Oro, Raffaella [1 ]
Grassi, Guido [1 ,2 ]
Mancia, Giuseppe [1 ,3 ]
机构
[1] Univ Milano Bicocca, Dipartimento Sci Salute, Med Clin, Milan, Italy
[2] Ist Ric Carattere Sci IRCCS Multimed, Milan, Italy
[3] Ist Auxol Italiano, I-20145 Milan, Italy
关键词
blood pressure; blood pressure monitoring; ambulatory; cardiovascular diseases; morbidity; mortality; LEFT-VENTRICULAR MASS; CEREBROVASCULAR-DISEASE; CIRCADIAN VARIATION; GENERAL-POPULATION; PROGNOSTIC VALUE; STROKE ONSET; HYPERTENSION; SLEEP; PAMELA; RISK;
D O I
10.1161/HYPERTENSIONAHA.114.03675
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
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 approximate to 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.
引用
收藏
页码:943 / +
页数:10
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