Circadian blood pressure changes and cardiovascular risk in elderly-treated hypertensive patients

Pierdomenico, Sante D.; Pierdomenico, Anna M.; Coccina, Francesca; Lapenna, Domenico; Porreca, Ettore

doi:10.1038/hr.2016.74

Cited by 47 publications

(39 citation statements)

References 58 publications

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“…The reduction in nocturnal BP seen in this study is consistent with the suggestion that changes in BP during treatment with an SGLT2 inhibitor restore disrupted circadian BP rhythms, shifting patients with hypertension and diabetes from a nondipper to a dipper pattern. 30,31 Given the association between disrupted circadian BP patterns and cardiovascular events, [32][33][34][35] this is one plausible mechanism for the beneficial effects of SGLT2 inhibitor treatment on cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Kario

Okawara

Tomitani

et al. 2018

J of Clinical Hypertension

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Sodium‐glucose cotransporter 2 (SGLT2) inhibitors have beneficial effects on several cardiometabolic biomarkers, but this is not sufficient to fully explain the significant reduction in cardiovascular risk and mortality reported with SGLT2 inhibitor treatment in patients with diabetes mellitus. The 8‐week, randomized, open‐label SHIFT‐J study investigated the effects of adding canagliflozin vs intensified antihyperglycemic therapy on nocturnal home blood pressure (BP) in patients with poorly controlled type 2 diabetes and nocturnal BP on existing therapy. Patients were randomized to oral canagliflozin 100 mg/d or control (increased hypoglycemic dosage/addition of another hypoglycemic agent). The efficacy analysis included 78 patients (mean 69 years; 59% male). Nocturnal home systolic BP [HSBP] decreased by 5.23 mm Hg in the canagliflozin group and by 1.04 mm Hg in the control group (P = 0.078 for between‐group difference in change from baseline to week 8 [primary endpoint]); corresponding decreases in HSBP from baseline to week 4 were 5.08 and 1.38 mm Hg, respectively (P = 0.054). Reductions in morning HSBP from baseline to week 4 (−6.82 mm Hg vs −1.26 mm Hg, P = 0.038) and evening HSBP from baseline to week 8 (−8.74 mm Hg vs −2.36 mm Hg, P = 0.012) were greater in the canagliflozin group than in the control group. Body mass index (P < 0.001) and N‐terminal pro B‐type natriuretic peptide level (NT‐proBNP; P = 0.023) decreased more in the canagliflozin group than in the control group. Glycemic control improved comparably in both groups. Reduction of HSBP and NT‐proBNP level may be potential mechanism by which SGLT2 inhibitors reduce cardiovascular event risk.

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Section: Discussionmentioning

confidence: 99%

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Kario

Okawara

Tomitani

et al. 2018

J of Clinical Hypertension

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“…People with extreme dipping also had a higher probability of developing a morning surge phenomenon (an excessive increase in blood pressure in the early hours of the morning). Since morning surge is associated with an increased risk of developing stroke and other cardiovascular diseases [51,52], it would be interesting to explore more psychological risk factors associated with this pattern.…”

Section: Discussionmentioning

confidence: 99%

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

Casagrande

Favieri

Guarino

et al. 2020

IJERPH

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Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State-Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon. different declinations of BP dipping may occur. In some individuals, an excessive reduction of BP (Extreme Dipping), or an increase of the BP trend after sleep onset (Reverse Dipping) may be reported. Earlier studies mainly focused on the absence of dipping, highlighting that a non-dipping pattern is a significant predictor of a range of organ damage and cardiovascular events [3,7,8]. The increase of cardiovascular risk associated with Non-Dipping seems to be due to the difficulty in physiological recovering from the typical demand-driven elevations of blood pressure during the waking hours of the day [9] and it is characterized by a disruption of the circadian rhythm of the autonomic balance [10]. Accordingly, some studies suggested that Non-Dippers have a high sympathetic nervous system activity during wake time [11][12][13] and a lower parasympathetic nervous system activity throughout the sleep period [13,14].However, the exact causes of Non-Dipping are not fully clarified [15][16][17], and genetic, biological, environmental, and sociodemogra...

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“…In hypertensive patients, as well as in general populations, some studies observed a negative prognostic impact of MS, whereas others did not. These discrepancies may be related to the characteristics of the studied population, that is, normotensive or hypertensive, young or old, untreated or treated, and to ethnic differences, methodological issues, and the confounding relationship of MS with other features of 24‐hour BP profile, such as nighttime BP pattern …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Some investigators assessed the association between MS of BP and future cardiovascular events, both in hypertensive patients and in general populations . The available evidence, however, is not homogeneous . In hypertensive patients, as well as in general populations, some studies observed a negative prognostic impact of MS, whereas others did not.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of morning surge of blood pressure in middle‐aged treated hypertensive patients

Coccina

Pierdomenico

Cuccurullo

et al. 2019

J of Clinical Hypertension

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We investigated the prognostic value of morning surge (MS) of blood pressure (BP) in middle‐aged treated hypertensive patients. The occurrence of a composite end point (coronary events, stroke, and heart failure requiring hospitalization) was evaluated in 1073 middle‐aged treated hypertensive patients (mean age 49 years). Patients with preawakening MS of BP above the 90th percentile (27/20.5 mm Hg for systolic/diastolic BP) were defined as having high MS of BP. During the follow‐up (mean 10.9 years), 131 cardiovascular events occurred. After adjustment for various covariates, including known risk markers and ambulatory BP parameters, patients with high MS of systolic BP (hazard ratio 1.81, 95% confidence interval 1.10‐2.96) and those with high MS of diastolic BP (hazard ratio 1.98, 95% confidence interval 1.19‐3.28) were at higher cardiovascular risk than those with normal MS. In middle‐aged treated hypertensive patients, high MS of systolic and diastolic BP is independently associated with increased cardiovascular risk.

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Circadian blood pressure changes and cardiovascular risk in elderly-treated hypertensive patients

Cited by 47 publications

References 58 publications

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

Prognostic value of morning surge of blood pressure in middle‐aged treated hypertensive patients

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