Relationship Between Elevated Morning Blood Pressure Surge, Uric Acid, and Cardiovascular Outcomes in Hypertensive Patients

Abstract

Early morning blood pressure surge (MBPS) is a risk factor for cardiovascular events (CVEs), but the relationship with uric acid is not well understood. The authors aimed to determine the association between MBPS and increased uric acid and the effect of elevated MBPS and uric acid combination on CVEs. A total of 921 patients underwent 24-hour ambulatory blood pressure monitoring and were followed for a median of 40 months. During this period, 103 (11.2%) CVEs occurred. There was a significant relationship between increasing quartiles of serum uric acid level and increasing values of MBPS (P<.0001). Patients in the highest quartile stratified by elevated MBPS and serum uric acid level had a 3.55 odds of major CVE compared with patients in the lowest quartile. Serum uric acid is associated with MBPS and development of new CVEs. J Clin Hypertens (Greenwich). 2014;16:530-535. ª2014 Wiley Periodicals, Inc.

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

“…38 The LA diameter (cm) was indexed by body surface area (m 2 ), and LA enlargement was defined as LA diameter/body surface area ⩾ 2.4 cm m −2 . 27 The LV mass was indexed by height 2.7 , and LV hypertrophy was defined as LV mass/height 2.7 450 g m −2.7 for men and 447 g m −2.7 for women. 39 The LV EF was calculated using the Teichholz formula or the Simpson rule 38 and defined as low when it waso50%.…”

“…Moreover, ambulatory BP monitoring has also presented the opportunity to evaluate the morning surge (MS) of BP, that is, the difference between BP after and before awakening, which has been implicated in the occurrence of cardiovascular events, given their reported peak incidence in the morning. 23,24 Some investigators have evaluated the association between a high MS of BP and future cardiovascular complications among both hypertensive patients 8,19,[25][26][27][28][29][30][31] and general populations, 22,[32][33][34] but the results are conflicting.…”

Effects of serum uric acid on blood-pressure lowering treatment

“…In a total of 921 patients who underwent 24 hour ambulatory BP monitoring and were followed for a median of 40 months there was a significant relationship between increasing quartiles of serum uric acid level and increasing values of morning BP surge (p < .0001). Patients in the highest quartile stratified by elevated pressure surge and serum uric acid level had a 3.55 odds of major cardiovascular event compared with patients in the lowest quartile 9 .…”

“…In 81 patients with metabolic syndrome and new diagnosis of hypertension, hyperuricemia was a risk factor for non-dipping pattern ( 8 . SUA level was associated with increasing values of morning BP surge and development of new cardiovascular events 9 . In a total of 921 patients who underwent 24 hour ambulatory BP monitoring and were followed for a median of 40 months there was a significant relationship between increasing quartiles of serum uric acid level and increasing values of morning BP surge (p < .0001).…”

Prognosis in Relation to Blood Pressure Variability

“…19 Hypertensive patients with exaggerated MBps had increased values of carotid intima-media thickness and urinary catecholamine excretion, as well as higher levels of inflammatory markers, such as C-reactive protein, interleukin-6, interleukin-18 (P<0.001), and uric acid compared with those without MBps. 20,21 the association between exaggerated MBps and vascular inflammation may be a cause-effect association resulting in a vicious cycle.…”