Time Rate of Blood Pressure Variation Is Associated With Endothelial Function in Patients With Metabolic Syndrome

Abstract

SummaryThe time rate of blood pressure (BP) variation indicates the speed of BP fluctuations. Previous studies have demonstrated that the time rate of BP variation was associated with target organ damage. However, the association between time rate of BP variation and endothelial function has not been evaluated.24-hour ambulatory blood pressure monitoring (ABPM) was performed in 61 patients with metabolic syndrome. Time rate of BP variation was calculated from BP recordings of ABPM. Endothelial function was assessed using reactive hyperemia-peripheral arterial tonometry index (RHI) by EndoPat2000. Multiple linear regression models were used to detect the association between time rate of BP variation and RHI.Among all the subjects (n = 61), the multiple linear regression models revealed that the daytime rate of systolic blood pressure (SBP) variation was independently associated with RHI (β = -0.334, P = 0.008). A 0.1 mmHg/minute increase in the daytime rate of SBP variation correlated with a decline of 0.20 in RHI. The same effect was also found in the subjects with eGFR ≥ 60 mL/ (minute*1.73 m 2 ). A greater association was found in those who were not taking a statin, β-blocker, ACEI/ARB, or diuretic and those without diabetes compared with those with any antihypertensive medication or with diabetes. Other ambulatory blood pressure parameters and central hemodynamics were not found to be associated with RHI.Our findings have shown that the daytime rate of SBP variation was associated with endothelial function in patients with metabolic syndrome, independent of other BP parameters and central hemodynamics. (Int Heart J 2016; 57: 226-233) Key words: RHI, Ambulatory blood pressure monitoring, Target organ damage, Blood pressure variability A mbulatory blood pressure monitoring (ABPM) is widely used in patients with prehypertension and hypertension, and its use is gradually increasing. Many studies have suggested that systolic blood pressure (BP), diastolic BP, and the degree of BP variability (BPV) calculated from ABPM are associated with target organ damage, cardiovascular disease risk, and long-term prognosis.1,2) Mancia, et al described a new BP phenomenon called time rate of BP variation, which is a measure of the speed of BP fluctuations derived from a computerized analysis of ABPM data.3) Current evidence has suggested that the time rate of BP variation was associated with target organ damage, such as increased common carotid artery intima-media thickness, 4,5) increased left ventricular mass, 6) impaired renal function, 7) and coronary atherosclerosis. 8)Endothelial dysfunction is one of the important pathophysiological processes of the early stage in patients with metabolic syndrome (MetS), and is an early manifestation before atherosclerotic plaque detected by angiography or ultrasound, 9) and is a sign of poor cardiovascular prognosis.10) Early detection of endothelial dysfunction has attracted more and more attention in clinical practice. Reactive hyperemia-peripheral arterial tonometry index (RHI) is...

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