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Gece Sistolik Kan Basıncı Yükselmelerinin Santral Hemodinamikler ve Arteriyel Sertleşme ile İlişkisi

Is Nocturnal Systolic Blood Pressure Rise Associated with Central Hemodynamics and Arterial Stiffness?

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DOI: 
DOI 10.5262/tndt.2012.1003.06

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Abstract (2. Language): 
OBJECTIVE: The aim of this study was to assess central hemodynamics and parameters of arterial stiffness of cases with nocturnal blood pressure rise. MATERIAL and METHODS: In this retrospective study, ambulatory blood pressure monitoring of 252 hypertensive patients was performed with the Mobil-O-Graph Arteriograph. RESULTS: 174 (%69.0) out of 252 patients were female and 78 (%31) were male and the mean age was 54.5±14.4. When Pearson’s correlation test was performed, the nocturnal systolic blood pressure (SBP) decline was associated with age (r=-0.169, p=0.008), diurnal pulse wave velocity (PWV) (r=-0.179, p=0.005), nocturnal diastolic blood pressure (DBP) decline (r=0.790, p<0.001), nocturnal central SBP (r=-0.410, p<0.001), and nocturnal augmentation index (Aix@75) (r=-0.215, p=0.001). When patients were divided into three groups as 10 % or more nocturnal SBP decline, less than 10 % nocturnal SBP decline and nocturnal SBP increase, there were statistically signifi cant differences regarding nocturnal pulse pressure (p<0.001), nocturnal DBP decline (p<0.001, nocturnal Aix@75 (p<0.001), and nocturnal peripheral resistance (p<0.001). CONCLUSION: We believe that strict follow up of conventional risk factors causing arterial stiffness in patients with less than 10 % nocturnal BP decline or increase and also the use of chronotherapy may be useful.
Abstract (Original Language): 
AMAÇ: Bu çalışmanın amacı, gece KB yükselen hastaların santral hemodinamik ve arteriyel sertleşme göstergelerini incelemektir. GEREÇ ve YÖNTEMLER: Bu geriye dönük çalışmada, 252 hipertansif hastanın ayaktan kan basıncı (KB) izlemi Mobil-O-Graph Arteriograph cihazı kullanılarak yapıldı. BULGULAR: Toplam 252 hastanın 174’ü (%69,0) kadın, 78’i (%31) erkek ve yaş ortalamaları 54,5±14,4 idi. Pearson korelasyon testi uyguladığımızda; sistolik kan basıncında gece düşmeleri, yaş (r=-0,169, p=0,008), 24 saat (24s) sürecinde periferik direnç (r=-0,171, p=0,007), gündüz nabız dalga hızı (NDH) (r=-0,179, p=0,005), gece diyastolik kan basıncında (DKB) azalma (r=0,790, p<0,001), gece santral sistolik kan basıncı (SKB) (r=-0,410, p<0,001), gece santral DKB (r=-0,387, p<0,001), gece arttırma indeksi (Aix@75) (r=-0,215, p=0,001), gece periferal direnç (r=-0,321, p<0,001) ile ilişkiliydi. Hastaları sistolik kan basıncında gece düşmelerine göre; kan basıncında %10 ve daha fazla düşme olanlar, %10’dan daha az düşme olanlar ve gece kan basıncı artanlar olmak üzere üç gruba ayırdığımızda gruplar arasında hemoglobin düzeyi (p=0,033), gece nabız basıncı (p<0,001), gece DKB düşmesi (p<0,001), gece Aix@75 (p<0,001), gece periferal direnç (<0,001) göstergeleri arasında istatistiksel olarak anlamlı fark vardı. SONUÇ: Gece kan basıncı yükselen ve %10’dan az düşen hastaların arteriyel sertleşmeye neden olan geleneksel risk faktörlerinin sıkı izleminin ve hipertansiyon tedavilerinde kronoterapinin kullanılmasının yararlı olabileceğini düşünüyoruz.

REFERENCES

References: 

1. Micozkadıoğlu H: Hipertansiyon tedavisinde kan basıncı ölçümü:
Evde mi? Ofi ste mi? Ambulatuvar mı? Turk Neph Dial Transpl
2011; 20 (3): 214-219
2. Kanbay M, Turgut F, Işık A, Köroğlu M, Akçay A: Günlük kan
basıncı ritmi ile serum ürik asit ve beden kitle indeksi arasındaki
ilişki. Turk Neph Dial Transpl 2011; 20 (1): 32-37
3. García-Ortiz L, Gómez-Marcos MA, Martín-Moreiras J, González-
Elena LJ, Recio-Rodriguez JI, Castaño-Sánchez Y, Grandes G,
Martínez-Salgado C: Pulse pressure and nocturnal fall in blood
pressure are predictors of vascular, cardiac and renal target organ
damage in hypertensive patients (LOD-RISK study). Blood Press
Monit 2009; 14 (4): 145-151
4. Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati
G, Schillaci G, De Caterina R: Awake systolic blood pressure
variability correlates with target-organ damage in hypertensive
subjects. Hypertension 2007; 50 (2): 325-332
5. Kario K: Proposal of RAS-diuretic vs. RAS-calcium antagonist
strategies in high-risk hypertension: Insight from the 24-hour
ambulatory blood pressure profi le and central pressure. J Am Soc
Hypertens 2010; 4 (5): 215-218
6. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW,
Duprez DA, Fagard RH, Gheeraert PJ, Missault LH, Braun JJ,
Six RO, Van Der Niepen P, O’Brien E: Offi ce versus Ambulatory
Pressure Study Investigators. Prognostic value of ambulatory
blood-pressure recordings in patients with treated hypertension. N
Engl J Med 2003; 348 (24): 2407-2415
7. Mancia G, Parati G: Offi ce compared with ambulatory blood
pressure in assessing response to antihypertensive treatment: A
meta-analysis. J Hypertens 2004; 22 (3): 435-445
8. Asmar R, Gosse P, Queré S, Achouba A: Effi cacy of morning and
evening dosing of amlodipine/valsartan combination in hypertensive
patients uncontrolled by 5 mg of amlodipine. Blood Press Monit
2011; 16 (2): 80-86
9. Coleman CT, Stowasser M, Jenkins C, Marwick TH, Sharman JE:
Central hemodynamics and cardiovascular risk in azalmayans. J
Clin Hypertens (Greenwich) 2011; 13 (8): 557-562
10. Portaluppi F, Smolensky MH: Perspectives on the chronotherapy of
hypertension based on the results of the MAPEC study. Chronobiol
Int 2010; 27 (8): 1652-1667
11. Kim JH, Oh SJ, Lee JM, Hong EG, Yu JM, Han KA, Min KW,
Son HS, Chang SA: The effect of an Angiotensin receptor blocker
on arterial stiffness in type 2 diabetes mellitus patients with
hypertension. Diabetes Metab J 2011; 35 (3): 236-242
12. Nelson MR, Stepanek J, Cevette M, Covalciuc M, Hurst RT, Tajik
AJ: Noninvasive measurement of central vascular pressures with
arterial tonometry: Clinical revival of the pulse pressure waveform?
Mayo Clin Proc 2010; 85 (5): 460-472
13. Boutouyrie P, Achouba A, Trunet P, Laurent S; EXPLOR Trialist
Group: Amlodipine-valsartan combination decreases central
systolic blood pressure more effectively than the amlodipineatenolol
combination: The EXPLOR study. Hypertension 2010; 55
(6): 1314-1322
14. Takeda A, Toda T, Fujii T, Matsui N: Bedtime administration of
long-acting antihypertensive drugs restores normal nocturnal blood
pressure fall in nondippers with essential hypertension. Clin Exp
Nephrol 2009; 13 (5): 467-472
15. Wei W, Tölle M, Zidek W, van der Giet M: Validation of the mobil-
O-Graph: 24 h-blood pressure measurement device. Blood Press
Monit 2010; 15 (4): 225-228
16. Wassertheurer S, Kropf J, Weber T, van der Giet M, Baulmann J,
Ammer M, Hametner B, Mayer CC, Eber B, Magometschnigg D:
A new oscillometric method for pulse wave analysis: Comparison
with a common tonometric method. J Hum Hypertens 2010; 24 (8):
498-504
17. Hermida RC, Calvo C, Ayala DE, Domínguez MJ, Covelo M,
Fernández JR, Mojón A, López JE: Administration time-dependent
effects of valsartan on ambulatory blood pressure in hypertensive
subjects. Hypertension 2003; 42 (3): 283-290
18. O’Brien E, Sheridan J, O’Malley K: Dippers and non-dippers.
Lancet 1988; 2 (8607): 397
19. Covic A, Goldsmith DJ: Ambulatory blood pressure measurement
in the renal patient. Curr Hypertens Rep 2002; 4: 369-376
20. Takakuwa H, Ise T, Kato T, Izumiya Y, Shimizu K, Yokoyama H,
Kobayashi KI: Diurnal variation of hemodynamic indices in nondipper
hypertensive patients. Hypertens Res 2001; 24 (3): 195-201
21. Li Y, Staessen JA, Lu L, Li LH, Wang GL, Wang JG: Is isolated
nocturnal hypertension a novel clinical entity? Findings from a
Chinese population study. Hypertension 2007; 50 (2): 333-339
22. Tsioufi s C, Stefanadis C, Antoniadis D, Kallikazaros I, Zambaras
P, Pitsavos C, Tsiamis E, Toutouzas P: Absence of any signifi cant
effects of circadian blood pressure variations on carotid artery elastic
properties in essential hypertensive subjects. J Hum Hypertens
2000; 14 (12): 813-818
23. Consensus document on non-invasive ambulatory blood pressure
monitoring. The Scientifi c Committee. J Hypertens Suppl 1990; 8
(6): 135-140

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