Abnormal blood pressure circadian rhythm: A target organ damage?

Izzedine, Hassane; Launay-Vacher, Vincent; Deray, Gilbert

doi:10.1016/j.ijcard.2005.03.046

Cited by 89 publications

(64 citation statements)

References 74 publications

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“…The 'non-dipping' phenomenon is a condition known to be associated in adults with an increased risk of end-organ damage [12,40,41] and this finding has generated a lot of interest for the potential relationship with vascular disease. Therefore, the high prevalence of impaired fall in nocturnal BP we found may be clinically significant and be associated with an increased risk for the development and/ or progression of microvascular and macrovascular complications.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

et al. 2009

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Aims/hypothesis The relationship between BP and microalbuminuria in young people with type 1 diabetes is not completely clear. As microalbuminuria is preceded by a gradual rise in albumin excretion within the normal range, we hypothesised that ambulatory BP (ABP) may be closely related to albumin excretion and progression to microalbuminuria. Results All ABPM variables were significantly related to baseline log 10 ACR (p<0.001). After the ABPM evaluation, 287 patients were followed for a median of 2.2 (1.0-5.5) years. ABP at baseline was independently related to mean ACR during follow-up. Nineteen initially normoalbuminuric patients developed microalbuminuria after 2.0 (0.2-4.0) years and their baseline daytime DBP was higher than in normoalbuminuric patients (p<0.001). After adjusting for baseline ACR and HbA 1c , there was an 11% increased risk of microalbuminuria for each 1 mmHg increase in daytime DBP. Forty-eight per cent of patients were non-dippers for SBP and 60% for DBP; however, ACR was not different between dippers and non-dippers and there were no differences in the nocturnal fall in BP between normoalbuminuric and future microalbuminuric patients. Conclusions/interpretation In this cohort of young people with type 1 diabetes, ABP was significantly related to ACR, and daytime DBP was independently associated with progression to microalbuminuria. Increasing albumin excretion, even in the normal range, may be associated with parallel rises in BP. Methods

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Section: Discussionmentioning

confidence: 99%

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

et al. 2009

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“…Studies have shown that OSA is more prevalent in older adults, 10 men, 11,12 and individuals of specific racial-ethnic origins. [13][14][15] Although women are believed to be less likely to have sleep apnea than men, there is growing evidence that women continue to be underdiagnosed. 16 Evidence suggests that women with OSA are far more likely to complain of insomnia, anxiety, depression, and other physiologic comorbidities than men.…”

Section: Primary Snoringmentioning

confidence: 99%

Management of sleep apnea in the neurology patient

et al. 2014

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SummaryRecognizing and treating sleep-disordered breathing (SDB) is essential in delivering neurologic care due to its association with a growing list of neurologic conditions (e.g., stroke, neurodegenerative disorders). Thus, increased proficiency in the recognition and management of SDB is likely to result in better outcomes, care, and utilization of health care resources. To date, continuous positive airway pressure remains the gold standard for patients with moderate to severe obstructive sleep apnea and has been shown to be effective in treating variations of SDB. Appropriate application of new methods and technology such as home sleep testing can help bridge the gap between the need and supply for sleep health care and delivery. Increased focus on efficacious strategies to further awareness and education for patients, caretakers, and providers is paramount to long-term adherence to treatment. S leep-disordered breathing (SDB) is one spectrum of sleep disorders that all physicians, particularly neurologists, should have ongoing educational exposure to in order to maintain a baseline level of knowledge proficiency. Mounting evidence suggests that untreated SDB has the potential to negatively affect both patient mortality and morbidity. Untreated sleep apnea, a type of SDB, is a primary risk factor for the development of several medical conditions particularly relevant to neurologists, including hypertension, coronary heart disease, and stroke.1 SDB is not only common in neurologic patients but also may directly affect the manifestation and management of neurologic disorders.2 Thus, it is imperative that neurologists are familiar with SDB and the effect it can have on clinical practice.

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“…Cross-sectional and prospective data have shown that non-dippers have more target organ damage compared to dippers in normotensive and hypertensive subjects [25]. The results of the present study show that: (i) patients who had a fall in BP at night had more pronounced cardiac abnormalities compared to those with a dipper pattern; (ii) proteinuria in spot urine was higher in the non-dipper group than in the dipper group; (iii) patients in non-dipper groups tended to be older and had a higher BMI.…”

Section: Discussionmentioning

confidence: 99%

The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients

Selçoki

Baybek

et al. 2008

Open Medicine

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AbstractIndividuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as ‘nondippers’. Non-dipping patterns in hypertensive patients have been shown to be associated with an excess of target organ damage and other adverse outcomes. The present study was designed to investigate the relationship between nocturnal BP pattern, defined on the basis of the ambulatory blood pressure monitoring (ABPM) recording, and cardiac and renal target organ damage in a population of at least one year treated essential hypertensive subjects. The present analysis involved 123 patients with treated essential hypertension attending the outpatient clinic of our centre. Each patient was subjected to the following procedures: blood sampling for routine blood chemistry, spot urine for proteinuria, 24-hour periods of ABPM, and echocardiography. In the ABPM period, a dipping pattern was observed in 65 of the 123 patients, and a non-dipping pattern in 58 patients. Body mass index was higher in the non-dippers (26 ± 4 versus 28 ± 4, p<0.05). The proteinuria in spot urine was significantly higher in the non-dippers (10 ± 6 versus 24 ± 48, p<0.03). Left ventricular mass, interventricular septum thickness, posterior wall thickness and left ventricular systolic diameter were significantly higher in the non-dippers compared to the dippers. Left ventricular diastolic function was similar in non-dipper cases, except E-wave deceleration time. In treated essential hypertensives the blunted or absent nocturnal fall in blood pressure can be a strong predictor of cardiac and renal events. Hypertensive patients should be evaluated by ambulatory blood pressure monitoring. To prevent patients at risk for morbidity and mortality casualities as a result of hypertension, patients should be evaluated by ambulatory blood pressure monitoring. This method can be utilized for exacting future follow-ups with the patient.

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Abnormal blood pressure circadian rhythm: A target organ damage?

Cited by 89 publications

References 74 publications

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

Management of sleep apnea in the neurology patient

The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients

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