Predictors of Mean Arterial Pressure Morning Rate of Rise and Power Function in Subjects Undergoing Ambulatory Blood Pressure Recording

Abstract

BackgroundWe determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BPpower) derived from ambulatory blood pressure recordings.MethodsBPpower and RoR were calculated from 409 ambulatory blood pressure (ABP) recordings from subjects attending a cardiovascular risk clinic. Anthropometric data, blood biochemistry, and history were recorded. The 409 subjects were 20–82 years old (average 57, SD = 13), 46% male, 9% with hypertension but not on medication and 34% on antihypertensive medication.ResultsAverage RoR was 11.1 mmHg/hour (SD = 8) and BPpower was 273 mmHg2/hour (SD = 235). Only cholesterol, low density lipoprotein and body mass index (BMI) were associated with higher BPpower and RoR (P<0.05) from 25 variables assessed. BPpower was lower in those taking beta-blockers or diuretics. Multivariate analysis identified that only BMI was associated with RoR (4.2% increase/unit BMI, P = 0.020) while cholesterol was the only remaining associated variable with BPpower (17.5% increase/mmol/L cholesterol, P = 0.047). A follow up of 213 subjects with repeated ABP after an average 1.8 years identified that baseline cholesterol was the only predictor for an increasing RoR and BPpower (P<0.05). 37 patients who commenced statin subsequently had lower BPpower whereas 90 age and weight matched controls had similar BPpower on follow-up.ConclusionsCholesterol is an independent predictor of a greater and more rapid rise in morning BP as well as of further increases over several years. Reduction of cholesterol with statin therapy is very effective in reducing the morning blood pressure surge.

The Effects of Rilmenidine and Perindopril on Arousal Blood Pressure during 24 Hour Recordings in SHR

“…Thus it is likely that perindopril has no discernible effect on the sympathetic nervous system in our current study. The lack of effect on the arousal surge is consistent with our analysis of ambulatory BP recordings in humans where we found that those hypertensive patients taking angiotensin converting enzyme inhibitors or angiotensin receptor blocking drugs had a similar rate and power of their morning surge in BP as untreated hypertensive patients [35]. This was a cross-sectional study so the conclusions are only speculative at this stage and would need to be confirmed in a blinded placebo controlled cross over study.…”

“…The rate and power of the rise in BP reflect the activation of the SNS and changes in a range of other hormones such as increasing catecholamine plasma concentrations, glucocorticoids such as cortisol (in humans) and components of the renin angiotensin system [34]. Importantly, the morning surge in the rate and power of the rise in humans is greatest in hypertensive patients [1, 2] and is an independent predictor of cardiovascular events [35]. Presumably the rate of fall and the power of the fall is related to the opposite changes as one approaches sleep.…”

Time to First Cigarette and Hypertension in Korean Male Smokers

“…BP increases about 10 to 15 mm Hg when upon waking and about 30 mm Hg if upon smoking immediately after waking. 12 13 14 15 16) However, there is currently no standard definition of morning BP surge. In the JMS-ABPM (ambulatory BP monitoring) study, average increases of 55 and 37 mm Hg were related to poor CVD outcomes.…”

“… 10 11) Nicotine and other substances absorbed as a result of cigarette smoking can increase BP by about 10 to 15 mm Hg for about 30 minutes. 12 13 14 15 16) BP is usually elevated upon waking, 8 9) and a short time to first cigarette (TTFC) after waking can induce a morning BP surge. Therefore, individuals who smoke a cigarette as soon as they wake up may experience rapid BP changes that result in blood vessel injury and accelerated atherosclerosis.…”

Time to First Cigarette and Self-Reported Health Among US Adult Smokers

“…[13][14][15] Research studies on the association between hypertension and TTFC have reported that blood pressure is generally increased on waking, 16,17 and the nicotine in tobacco can elevate blood pressure by approximately 10 to 15 mm Hg for about 30 minutes. [18][19][20][21][22] Hence, a shorter TTFC after waking can lead to a morning elevation of blood pressure. Smokers who smoke a cigarette as soon as they get up could experience sharp blood pressure changes that bring about blood vessel damage and accelerated atherosclerosis.…”