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There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima–media thickness in hypertensive patients

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Abstract

Purpose

There are limited data about increased aortic intima–media thickness (A-IMT) in the presence of subclinical target organ damage in hypertensive (HT) patients. In this study, we aimed to determine the frequency of increased A-IMT, the parameters determining increased A-IMT, and the relationship between increased A-IMT and other vascular IMT measurements.

Materials and methods

We prospectively included 265 patients (mean age 54.1 ± 10.6 years, male/female 91/174) with essential HT. Physical examination of all patients was performed. Laboratory data and antihypertensive treatments were recorded. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed. Bilateral carotid, brachial, and femoral artery and abdominal A-IMT values were measured by B-mode ultrasonography (USG). Patients were categorized into two main groups: patients with increased A-IMT (≥ 3 mm) or normal A-IMT (< 3 mm).

Results

Increased A-IMT was detected in 55 patients (20.8%). There was a close relationship between increased A-IMT and advanced age, presence of coronary artery disease, high morning blood pressure surge (MBPS), and bilateral carotid and femoral IMT. Parameters associated with increased A-IMT in univariate analysis were assessed by regression analysis. Left femoral IMT and MBPS were independently associated with increased A-IMT. In the regression model, each 5-mmHg elevation in MBPS increased the risk of increased A-IMT by 34.2%. The cutoff value of MBPS obtained by the ROC curve analysis was 32 mmHg for the prediction of increased A-IMT (sensitivity 76.3%, specificity 63.5%). The area under the curve was 0.784 (95% CI 0.720–0.847, p < 0.001).

Conclusion

Abdominal A-IMT increased at a significant rate in patients with HT. An independent association was found between MBPS and A-IMT, which can both be easily detected by ABPM and B-mode USG. The high MBPS level was considered to be a simple and inexpensive method for detecting subclinical target organ damage. A-IMT measurement should also be a part of abdominal USG, which is a routine examination in HT patients.

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References

  1. Salonen R, Salonen JT. Carotid atherosclerosis in relation to systolic and diastolic blood pressure: Kuopio Ischaemic Heart Disease Risk Factor Study. Ann Med. 1991;23:23–7.

    Article  CAS  Google Scholar 

  2. Mancia G, Fagard R, Narkiewicz K, et al. ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–219.

    Article  Google Scholar 

  3. Sartorato P, Zulian E, Benedini S, et al. Cardiovascular risk factors and ultrasound evaluation of intima–media thickness at common carotids, carotid bulbs, and femoral and abdominal aorta arteries in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab. 2007;92:1015–8.

    Article  CAS  Google Scholar 

  4. Belhassen L, Carville C, Pelle G, et al. Evaluation of carotid artery and aortic intima–media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery. J Am Coll Cardiol. 2002;39:1139–44.

    Article  Google Scholar 

  5. Kallizaros JE, Tsioufis CP, Stefanadis CI, et al. Close relation between carotid and ascending aortic atherosclerosis in cardiac patients. Circulation. 2000;102:263–8.

    Google Scholar 

  6. Tomochika Y, Tanaka N, Ono S, et al. Assessment by transesophageal echography of atherosclerosis of the descending thoracic aorta in patients with hypercholesterolemia. Am J Cardiol. 1999;83:703–9.

    Article  CAS  Google Scholar 

  7. Labropoulos N, Zarge J, Mansour MA, et al. Compensatory arterial enlargement is a common pathobiologic response in early atherosclerosis. Am J Surg. 1998;176:140–3.

    Article  CAS  Google Scholar 

  8. Meena D, Prakash M, Gupta Y, et al. Carotid, aorta and renal arteries intima–media thickness in patients with sporadic idiopathic hypoparathyroidism. Indian J Endocrinol Metab. 2015;19:262–6.

    Article  Google Scholar 

  9. Muller JE, Stone PH, Turi ZG, et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med. 1985;21:1315–22.

    Article  Google Scholar 

  10. Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke. 1998;29:992–6.

    Article  CAS  Google Scholar 

  11. Muller JE, Ludmer PL, Willich SN, et al. Circadian variation in the frequency of sudden cardiac death. Circulation. 1987;75:131–8.

    Article  CAS  Google Scholar 

  12. Alpaydin S, Turan Y, Caliskan M, et al. Morning blood pressure surge is associated with carotid intima–media thickness in prehypertensive patients. Blood Press Monit. 2017;22:131–6.

    Article  Google Scholar 

  13. Kario K, Pickering TG, Umeda Y, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107:1401–6.

    Article  Google Scholar 

  14. Gosse P, Lasserre R, Minifie C, et al. Blood pressure surge on rising. J Hypertens. 2004;22:1113–8.

    Article  CAS  Google Scholar 

  15. Metoki H, Ohkubo T, Kikuya M, et al. Prognostic significance for stroke of a morning pressure surge and a nocturnal blood pressure decline: the Ohasama Study. Hypertension. 2006;47:149–54.

    Article  CAS  Google Scholar 

  16. Li Y, Thijs L, Hansen TW, International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Investigators, et al. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension. 2010;55:1040–8.

    Article  CAS  Google Scholar 

  17. Amici A, Cicconetti P, Sagrafoli C, et al. Exaggerated morning blood pressure surge and cardiovascular events: a 5-year longitudinal study in normotensive and well-controlled hypertensive elderly. Arch Gerontol Geriatr. 2009;49:e105–9.

    Article  CAS  Google Scholar 

  18. Metoki H, Ohkubo T, Kikuya M, et al. Prognostic significance of night-time, early morning, and daytime blood pressures on the risk of cerebrovascular and cardiovascular mortality: the Ohasama Study. J Hypertens. 2006;24:1841–8.

    Article  CAS  Google Scholar 

  19. White WB. The risk of waking-up: impact of the morning surge in blood pressure. Hypertension. 2010;55:835–7.

    Article  CAS  Google Scholar 

  20. Zakopoulos NA, Tsivgoulis G, Barlas G, et al. Time rate of blood pressure variation is associated with increased common carotid artery intima–media thickness. Hypertension. 2005;45:505–12.

    Article  CAS  Google Scholar 

  21. Stergiou GS, Salgami EV. World Health Organization-International Society of Hypertension (WHO-ISH); USA Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-7); European Society of Hypertension-European Society of Cardiology (ESH-ESC). New European, American and International guidelines for hypertension management: agreement and disagreement. Expert Rev Cardiovasc Ther. 2004;2:359–68.

    Article  CAS  Google Scholar 

  22. Kario K. Orthostatic hypertension—a new haemodynamic cardiovascular risk factor. Nat Rev Nephrol. 2013;9:726–38.

    Article  CAS  Google Scholar 

  23. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354:2368–74.

    Article  CAS  Google Scholar 

  24. Neiva Neto EC, Piatto MJ, Paschôa AF, et al. Intima–media thickness: correlation between carotids, vertebral artery, aorta and femoral arteries. Int Angiol. 2015;34:269–75.

    PubMed  Google Scholar 

  25. Handa N, Matsumoto M, Maeda H, et al. Ultrasonic evaluation of early carotid atherosclerosis. Stroke. 1990;21:1567–72.

    Article  CAS  Google Scholar 

  26. Heiss G, Sharrett AR, Barnes R, et al. Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study. Am J Epidemiol. 1991;134:250–6.

    Article  CAS  Google Scholar 

  27. Wofford JL, Kahl FR, Howard GR, et al. Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis. Arterioscler Thromb. 1991;11:1786–94.

    Article  CAS  Google Scholar 

  28. O’Leary DH, Polak JF, Kronmal RA, The Cardiovascular Health Study Collaborative Research Group, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med. 1999;340:14–22.

    Article  Google Scholar 

  29. Cheng KS, Mikhailidis DP, Hamilton G, et al. A review of the carotid and femoral intima–media thickness as an indicator of the presence of peripheral vascular disease and cardiovascular risk factors. Cardiovasc Res. 2002;54:528–38.

    Article  CAS  Google Scholar 

  30. Kirhmajer MV, Banfic L, Vojkovic M, et al. Correlation of femoral intima–media thickness and the severity of coronary artery disease. Angiology. 2011;62:134–9.

    Article  Google Scholar 

  31. McGill HC Jr, McMahan CA, Herderick EE, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000;20:836–45.

    Article  Google Scholar 

  32. Aloi M, Tromba L, Rizzo V, et al. Aortic intima–media thickness as an early marker of atherosclerosis in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2015;61:41–6.

    CAS  PubMed  Google Scholar 

  33. Davis PH, Dawson JD, Blecha MB, et al. Measurement of aortic intimal-medial thickness in adolescents and young adults. Ultrasound Med Biol. 2010;36:560–5.

    Article  Google Scholar 

  34. Chen KY, Zannino D, Curtis N, et al. Increased aortic intima–media thickness following Kawasaki disease. Atherosclerosis. 2017;260:75–80.

    Article  CAS  Google Scholar 

  35. Yano Y, Hoshide S, Inokuchi T, et al. Association between morning blood pressure surge and cardiovascular remodeling in treated elderly hypertensive subjects. Am J Hypertens. 2009;22:1177–82.

    Article  Google Scholar 

  36. Chappell DC, Varner SE, Nerem RM, et al. Oscillatory shear stress stimulates adhesion molecule expression in cultured human endothelium. Circ Res. 1998;82:532–9.

    Article  CAS  Google Scholar 

  37. Cho JS, Ihm SH, Kim CJ, et al. Obstructive Sleep Apnea Using Watch-PAT 200 is independently associated with an increase in morning blood pressure surge in never-treated hypertensive patients. J Clin Hypertens. 2015;17:675–81.

    Article  CAS  Google Scholar 

  38. Sasaki N, Ozono R, Yamauchi R, et al. The relationship between morning hypertension and sleep quality in patients with obstructive sleep apnea syndrome. Clin Exp Hypertens. 2013;35:250–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey

    Ayse Selcan Koc & Ferıde Fatma Gorgulu

  2. Department of Cardiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey

    Yurdaer Donmez & Yahya Kemal Icen

Authors
  1. Ayse Selcan Koc
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  2. Ferıde Fatma Gorgulu
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  3. Yurdaer Donmez
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  4. Yahya Kemal Icen
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Correspondence to Ayse Selcan Koc.

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The authors declare that they have no competing interests and sources of funding.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Informed consent was obtained from patients for being included in the study.

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Koc, A.S., Gorgulu, F.F., Donmez, Y. et al. There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima–media thickness in hypertensive patients. J Med Ultrasonics 45, 597–603 (2018). https://doi.org/10.1007/s10396-018-0877-y

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  • DOI: https://doi.org/10.1007/s10396-018-0877-y

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