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Association Between Circadian Hemodynamic Characteristics and Target Organ Damage in Patients With Essential

Hiroshi Kusunoki1,2, Yoshio Iwashima1, Yuhei Kawano1,3

  • 1Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.

American Journal of Hypertension
|June 19, 2019
PubMed

Insights

Circadian hemodynamics, including 24-hour aortic systolic blood pressure (SBP), are linked to hypertensive organ damage. Reduced nighttime blood pressure reduction may indicate subclinical damage in essential hypertension.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Circadian Biology

Background:

  • Essential hypertension is a leading cause of cardiovascular disease.
  • Subclinical target organ damage (TOD) is common in hypertensive patients.
  • Circadian hemodynamic variations may play a role in TOD development.

Purpose of the Study:

  • To investigate the association between circadian hemodynamic characteristics and asymptomatic hypertensive organ damage.
  • To identify specific hemodynamic parameters that predict TOD in essential hypertension.

Main Methods:

  • 284 essential hypertensive patients were evaluated for 24-hour hemodynamics using an oscillometric device.
  • Parameters included brachial and aortic systolic blood pressure (SBP), pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR).
  • Hypertensive target organ damage (TOD) was assessed through carotid wall thickening, left ventricular hypertrophy, and albuminuria.

Main Results:

  • 24-hour brachial and aortic SBP increased with the number of organs involved.
  • 24-hour brachial SBP and aortic SBP remained significant predictors of TOD after multivariate analysis.
  • Reduced nighttime decrease in brachial SBP, PWV, and TVR were independent predictors of TOD.

Conclusions:

  • 24-hour aortic SBP can serve as a marker for subclinical TOD in essential hypertension.
  • Blunted nocturnal blood pressure reduction in TOD patients may be linked to disturbed circadian hemodynamic variations.
  • Circadian hemodynamic variations in aortic SBP, vascular resistance, and arterial stiffness may mediate TOD.
Abstract

Keywords:
ambulatory blood pressure monitoringblood pressurecentral blood pressurehemodynamic characteristicshypertensiontarget organ damage

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