Oh Jaewon, Lee Chan Joo, Kim In-Cheol, Lee Sang-Hak, Kang Seok-Min, Choi Donghoon, Park Sungha, Kario Kazuomi
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
J Am Heart Assoc. 2017 Feb 14;6(2):e005424. doi: 10.1161/JAHA.116.005424.
A recent study reported that morning hypertension is associated with poor cardiovascular outcomes in hypertensive patients. However, it is unclear whether morning hypertension associated with sustained nocturnal hypertension and that associated with morning blood pressure (BP) surge differ in terms of their effects on cardiovascular target organ damage and clinical outcomes. The present study aimed to determine the association of morning hypertension with/without nocturnal hypertension with vascular target organ damage and central hemodynamics in patients at high risk for cardiovascular disease.
Ambulatory BP monitoring was performed and central BP was measured in 1070 consecutive patients with high cardiovascular risk. We grouped morning hypertension into the following 3 subtypes: (I) morning normotension; (II) morning hypertension without nocturnal hypertension; and (III) morning hypertension with nocturnal hypertension. Morning hypertension was noted in 469 (43.8%) patients and morning hypertension with nocturnal hypertension was noted in 374 (34.9%) patients. The central systolic/diastolic BP and carotid to femoral pulse wave velocity were significantly higher in the subtype III group than in the subtype I and II groups (all <0.001). Subtype III (versus subtype I) was an independent predictor of central hypertension and high-risk arterial stiffness (<0.001 and =0.018, respectively) but not vascular damage in a fully adjusted model (model Y).
Morning hypertension, especially that associated with nocturnal hypertension, is related to high central BP and increased arterial stiffness. Further studies on whether morning hypertension with or without nocturnal hypertension is related to clinical outcomes should be performed.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02003781.
最近一项研究报告称，高血压患者的清晨高血压与不良心血管结局相关。然而，与持续性夜间高血压相关的清晨高血压和与清晨血压激增相关的清晨高血压在对心血管靶器官损害和临床结局的影响方面是否存在差异尚不清楚。本研究旨在确定有无夜间高血压的清晨高血压与心血管疾病高危患者的血管靶器官损害及中心血流动力学之间的关联。
对1070例连续的心血管高危患者进行了动态血压监测并测量了中心血压。我们将清晨高血压分为以下3种亚型：（I）清晨血压正常；（II）无夜间高血压的清晨高血压；（III）伴有夜间高血压的清晨高血压。469例（43.8%）患者存在清晨高血压，374例（34.9%）患者存在伴有夜间高血压的清晨高血压。III型组的中心收缩压/舒张压和颈动脉至股动脉脉搏波速度显著高于I型和II型组（均P<0.001）。在完全调整模型（模型Y）中，III型（与I型相比）是中心高血压和高危动脉僵硬度的独立预测因素（分别为P<0.001和P=0.018），但不是血管损害的独立预测因素。
清晨高血压，尤其是与夜间高血压相关的清晨高血压，与高中心血压和动脉僵硬度增加有关。应进一步研究有无夜间高血压的清晨高血压是否与临床结局相关。
