Endothelial function in postmenopausal women with nighttime systolic hypertension

Abstract

Objective Hypertension becomes more prevalent in women during their postmenopausal years. Nighttime systolic blood pressure (SBP) is especially predictive of adverse cardiac events and the relationship between rising nighttime SBP and cardiovascular risk increases more rapidly in women compared to men. The reasons for the prognostic significance of nighttime SBP are not completely known, but may involve vascular endothelial dysfunction. The purpose of this study was to examine the relationship of nighttime SBP and endothelial function, assessed by brachial artery flow-mediated dilation (FMD) and to determine whether postmenopausal women with nighttime hypertension (SBP≥120 mm Hg) evidenced greater endothelial dysfunction compared to women with normal nighttime SBP. Methods One-hundred postmenopausal women (mean age: 65.8 ± 7.5 years, body mass index: 28.3 ± 4.7 kg/m2, hypertension: 47%, coronary artery disease: 51%, mean clinic BP 137 ± 17/67 ± 11 mm Hg, 34 with nighttime hypertension) underwent 24-hour ambulatory BP monitoring, actigraphy, and brachial artery FMD assessments. Results Multivariate regression models showed that higher nighttime SBP and larger baseline artery diameter were inversely related to FMD. Nighttime SBP and baseline artery diameter accounted for 23% of the variance in FMD. After adjusting for baseline artery diameter, women with nighttime hypertension had lower FMD than women with normal nighttime SBP (2.95%±0.65 vs 5.52%±0.46, p = .002). Conclusions In postmenopausal women, nighttime hypertension was associated with reduced endothelial function. Research examining the therapeutic benefits of treating nighttime hypertension on endothelial function and future cardiovascular risk in postmenopausal women is warranted.

Effects of exercise and stress management training on nighttime blood pressure dipping in patients with coronary heart disease: A randomized, controlled trial

“…Both exercise and stress management training have been shown to produce favorable changes in physiological regulatory systems, including improved vascular endothelial vasodilatory function. 19 Interestingly, impaired endothelial function has been linked both to nighttime hypertension and insomnia 31, 32 . Although exercise did not result in improved heart rate variability (HRV) measured during supine deep breathing, stress management training did improve HRV compared to Usual Care.…”

Adropin and circadian variation of blood pressure

“…Nocturnal HT and nocturnal non-dipping pattern are associated with inflammation and endothelial dysfunction [6,18,19]. The clinical relevance of nocturnal HT and non-dipping status in hypertensive patients lies in its proven association with more severe target organ damage and increased risk for CV events [20,21].…”

“…The guidelines for nocturnal BP according to the American Heart Association Council on High Blood Pressure Research are as follows: nocturnal BP lower than 115/65 mmHg is optimal, lower than 120/70 mmHg is normal, and higher than 125/75 mmHg is abnormal. Elevated night-time BP was associated with reduced endothelial function [6]. A non-dipping BP profile is usually defined as a nocturnal BP fall of less than 10% [7].…”

Effects of Autonomic Nervous System Activation on Endothelial Function in Response to Acute Exercise in Hypertensive Individuals: Study Protocol for A Randomized Double-Blind Study

“…Flow-mediated dilation (FMD) of the brachial artery is an indirect non-invasive technique to assess endothelial function and is chie y dependent on NO availability (11). Since acute post-exercise changes in vascular function may also predict long-term adaptations (12) the acute response to exercise has been widely studied (3,13).…”