Association Between Short-Term Systolic Blood Pressure Variability and Carotid Intima-Media Thickness in ELSA-Brasil Baseline

Ribeiro, Adele; Lotufo, Paulo A; Fujita, André; Goulart, Alessandra Carvalho; Chor, Dóra; Mill, José Geraldo

doi:10.1093/ajh/hpx076

Cited by 22 publications

(25 citation statements)

References 35 publications

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“…Table 1 [12][13][14][15][16][17][18][19][20] shows the main aims, findings and conclusions of articles focusing on the association with traditional risk factors and Table 2 21-32 shows the main aims, findings and conclusions of articles focusing on the association with novel cardiovascular risk factors or other conditions.…”

Section: Resultsmentioning

confidence: 99%

“…However, this association is not limited to individuals using antihypertensives. Recently, Ribeiro et al 14 …”

Section: Main Aims and Associations Main Findings Main Conclusionmentioning

confidence: 99%

“…Blood pressure variability 14 Standardized path coefficient from BP variability to residual CIMT (after regression to assess main confounders): +0.046 (P < 0.001)…”

Section: Main Aims and Associations Main Findings Main Conclusionmentioning

confidence: 99%

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Carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a narrative review

2018

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BACKGROUND: Carotid intima-media thickness (CIMT), as measured by ultrasound, has been used in large studies as a non-invasive marker for subclinical atherosclerosis. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort of 15,105 civil servants in six Brazilian cities that included CIMT evaluation in its baseline assessment. The aim of the present narrative review was to provide an overview of ELSA-Brasil CIMT articles published up to July 31, 2017. DESIGN AND SETTING: Narrative review of ELSA-Brasil CIMT studies using baseline assessment data. METHODS: We searched PubMed for the terms “ELSA-Brasil” and “intima-media”. This search yielded 21 published articles using CIMT data from the ELSA-Brasil baseline assessment, which were included in this review. We also present information about intima-media thickness assessment from ongoing onsite reevaluations of the study participants. RESULTS: Most published studies focused on the association with traditional and novel cardiovascular risk factors. Studies also presented information about the ELSA-Brasil CIMT protocol at baseline and CIMT value distribution in this large sample. CONCLUSIONS: Analyses on the ELSA-Brasil data led to important insights on CIMT interpretation and physiology. Besides the highlighted contributions which have already been made in this field, new data gathered during the ongoing third onsite assessment will enable investigation of substantially new research questions.

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Section: Resultsmentioning

confidence: 99%

“…However, this association is not limited to individuals using antihypertensives. Recently, Ribeiro et al 14 …”

Section: Main Aims and Associations Main Findings Main Conclusionmentioning

confidence: 99%

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Carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a narrative review

2018

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“…Crucially, over time, these autonomic and neurohumoral derangements perpetuate beyond the offending events and persist into the daytime, resulting in a disturbance of the overall circadian BP rhythm and an increase in short‐ and long‐term BPV . In this respect, there is accruing evidence that not only high absolute BP levels but even their fluctuations are closely related to the development and progression of organ damage by promoting arterial remodelling, microvascular damage, hemodynamic instability, and vascular reactivity impairment . In addition, recurrent intermittent hypoxia and subsequent reoxygenation, which resembles the ischemia‐reperfusion cycle, can stimulate the release of reactive oxygen species, inflammatory cytokines, and vasoactive mediators that further promote endothelial injury and dysfunction …”

Section: From Pathophysiology To Clinical Practice: Implications and mentioning

confidence: 99%

Obstructive sleep apnea syndrome and the nocturnal blood pressure profile

Lattanzi

Brigo

Silvestrini

2018

J of Clinical Hypertension

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Obstructive sleep apnea syndrome (OSAS) affects 2%-7% of the adult population and is the most common sleep-related breathing disorder. 1 It is the most frequent cause of secondary and difficultto-treat hypertension and represents a well-known risk factor for hypertension-associated end-stage organ damage. 2,3 The investigation of blood pressure (BP) behavior and of its determinants in OSAS patients helps to understand some pathophysiologic aspects of hypertension, stratify the cardiovascular risk profile, and support indication for therapy in affected patients. | NO C TURNAL B P PROFILE A SS E SS MENTThe assessment of nocturnal BP profile has important clinical relevance. Indeed, clinical studies have demonstrated that nocturnal BP and BP variability (BPV) are more closely associated with the risk of developing target-organ damage and future cardiovascular events in comparison to awake BP and BPV. 4,5 Ambulatory blood pressure monitoring (ABPM), which currently represents the gold standard of nocturnal BP assessment, measures the individual BP at fixed time intervals. Because of the lack of any synchronization with sleep apnea, ABPM can fail to detect apnea-related BP fluctuations and, hence, underestimate the extent of cardiovascular risk. 6 In this issue of The Journal of Clinical Hypertension, the study by Kuwabara and colleagues explored the association between polysomnography-derived sleep parameters and nocturnal BP indices as derived by an oxygen-triggered nocturnal BP monitoring system. 7 This is an information technology-based system, which indicates BP measurements when oxygen desaturation falls below a set variable threshold continuously monitored by pulse oxymetry. 8 In this way, the system allows the detection of the nocturnal BP surge triggered by hypoxic apnea episodes.The study clearly demonstrated that, in OSAS patients, the hypoxia-peak systolic BP, defined as the maximum systolic BP value measured by the oxygen-triggered function, and the nocturnal systolic BP surge, defined as the difference between the hypoxiapeak systolic BP and the average of the systolic BP values within 30 minutes before and after the hypoxia-peak systolic BP, were higher, ranged more broadly, and were more closely associated with respiratory-related polisomnographic parameters than maximum and mean nocturnal systolic BP obtained by the fixed-interval function through conventional ABPM. 7 In particular, the lowest oxygen saturation (SpO 2 ), defined as the minimum SpO 2 value during sleep, was the strongest independent determinant of either hypoxia-peak systolic BP or nocturnal systolic BP surge. 7These findings suggest that the severity and frequency of the decrease in SpO 2 have a strong impact on the nocturnal BP trajectories, and the hypoxia-triggered nocturnal BP measurement may be a promising technique to improve the cardiovascular evaluation of OSAS patients. Noteworthy, in OSAS patients cardiovascular events occur more frequently during sleep, and hypoxia-triggered nocturnal BP surge and exaggerated BP fluctuation...

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“…In structured studies, autonomic and neurohumoral abnormalities of OSAS continue during daytime; this has caused the general circadian blood pressure rhythm to deteriorate and increase the variability of short and long term blood pressure [7], where absolute blood pressure, blood pressure fluctuations are in progress and development of organ damage in preparing arterial remodilling, microvascular damage, hemodynamic imbalance, and vascular reactivity disorder. For these reasons, cardiovascular diseases (CVD) are more common in OSAS patients [8,9].…”

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confidence: 99%

Cardiovascular Dısease Risk in Patients with Obstructıve Sleep Apnea Syndrome

Ölmez

Işık

2019

Galician med. j.

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Obstructıve sleep apnea syndrome is a clinical syndrome characterized by recurrent partial or total obstruction of the upper respiratory tract. The main symptoms are snoring, excessive daytime sleepiness and witnessed apnea. It is a disease that affects 3% to 7% of the middle-aged population. Studies and meta-analyzes have shown that cardiovascular diseases are more common in patients with obstructıve sleep apnea syndrome. Comorbid conditions such as obesity, metabolic syndrome and smoking are higher in obstructıve sleep apnea syndrome patients than in the general population. In addition, hypoxia-reperfusion injury due to intermittent oxygen desaturation occurring in obstructıve sleep apnea syndrome patients, endothelial dysfunction, increased sympathetic system activity, platelet activation, monocyte increase, which play the main role in arteriosclerosis, decreased and increased low-density lipoprotein cholesterol may also be the reason for the frequent occurrence of cardiovascular diseases. The development of cardiovascular disease in obstructıve sleep apnea syndrome patients is an important cause of morbidity and mortality. Evaluating white blood cell neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, lymphocyte/monocyte ratio, hematocrit, platelet distribution width, red cell distribution width, C-reactive protein, and monocyte/high-density lipoprotein cholesterol ratio in the follow-up of obstructıve sleep apnea syndrome patients may be helpful in predicting the development of cardiovascular diseases. Whether obstructıve sleep apnea syndrome patients have metabolic syndrome or smoking should be questioned. Obstructıve sleep apnea syndrome, obesity, smoking and depression are increasingly prevalent diseases worldwide, leading to significant mortality and morbidity. Therefore, multicentre studies involving different societies are needed.

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Association Between Short-Term Systolic Blood Pressure Variability and Carotid Intima-Media Thickness in ELSA-Brasil Baseline

Abstract: We found a small but significant association between SBP variability and CIMT values. This was additive to the association between SBP central tendency and CIMT values, supporting a role for high short-term SBP variability in atherosclerosis.

Cited by 22 publications

References 35 publications

Carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a narrative review

Carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a narrative review

Obstructive sleep apnea syndrome and the nocturnal blood pressure profile

Cardiovascular Dısease Risk in Patients with Obstructıve Sleep Apnea Syndrome

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