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Blood pressure and heart rate variability and baroreflex sensitivity in white-coat, masked, and sustained
Chang-Sheng Sheng1, Fei-Ka Li1, Yi-Bang Cheng1
1Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
This study reveals that masked hypertension, unlike white-coat hypertension, shows altered blood pressure and heart rate variability similar to sustained hypertension. These findings highlight differences in cardiovascular autonomic regulation across hypertension types.
Area of Science:
- Cardiovascular Physiology
- Autonomic Nervous System Function
- Hypertension Research
Background:
- Hypertension is classified into white-coat, masked, and sustained types, each with potentially distinct pathophysiological mechanisms.
- Understanding the differences in blood pressure (BP) variability, heart rate variability (HRV), and baroreflex sensitivity (BRS) among these hypertension subtypes is crucial for risk stratification and management.
Purpose of the Study:
- To investigate and compare BP variability, HRV, and BRS in untreated patients with normotension, white-coat hypertension, masked hypertension, and sustained hypertension.
- To determine how age influences these cardiovascular autonomic parameters across different hypertension categories.
Main Methods:
- A cohort of 645 untreated patients were categorized into normotension, white-coat, masked, or sustained hypertension based on clinic and 24-h ambulatory BP.
- Beat-to-beat finger BP and ECG were recorded using a Finometer device in supine and standing positions.
- Frequency-domain power-spectral analysis was used to compute BP and HRV indexes, alongside BRS.
Main Results:
- Significant differences in BP variability (LF, HF power, LF/HF ratio) were observed in the supine position, with white-coat hypertension showing the lowest LF/HF ratio and sustained hypertension the highest.
- Masked and sustained hypertension exhibited significantly lower BRS compared to normotension in both positions, with a decline in BRS and BP LF/HF ratio with age in normotension and sustained hypertension.
- Heart rate variability's LF component in the supine position was lowest in white-coat hypertension.
Conclusions:
- Masked hypertension presents with cardiovascular autonomic alterations (BP variability, HRV, BRS) comparable to, though less severe than, sustained hypertension.
- White-coat hypertension demonstrates distinct patterns of BP variability and HRV compared to other hypertensive states.
- These findings underscore the importance of ambulatory BP monitoring for identifying masked hypertension and suggest differing autonomic dysfunction profiles across hypertension subtypes.
Abstract:
We investigated blood pressure (BP) and heart rate variability and baroreflex sensitivity (BRS) in white-coat, masked and sustained hypertension in untreated patients (n = 645). Normotension and white-coat, masked, and sustained hypertension were defined according to the clinic (cutoff 140/90 mmHg) and 24-h ambulatory (130/80 mmHg) BPs. The Finometer device recorded beat-to-beat finger BP and electrocardiograms in the supine and standing positions for the computation of frequency-domain power-spectral BP and heart rate variability indexes and BRS. In multivariate analysis, BP variability indexes in the supine position differed significantly (P < 0.0001) for both low-frequency (LF) and high-frequency (HF) components and the LF/HF ratio, with the lowest LF and HF power and highest LF/HF ratio in white-coat hypertension (n = 28), the highest LF and HF power and lowest LF/HF ratio in sustained hypertension (n = 198), and intermediate values in normotension (n = 189) and masked hypertension (n = 230). These differences diminished in the standing position, being significant (P < 0.0001) only for the LF component variability. The LF/HF ratio in BP in the supine position decreased with advancing age in normotension and sustained hypertension (P ≤ 0.03) but not white-coat or masked hypertension (P ≥ 0.12). For heart rate variability, a significant difference was observed only for the LF component in the supine position (P = 0.0005), which was lowest in white-coat hypertension. BRS in masked and sustained hypertension was significantly (P ≤ 0.0001) lower than that in normotension in both supine and standing positions and decreased with advancing age (P ≤ 0.0001). In conclusion, masked, but not white-coat, hypertension showed similar patterns of, but slightly less severe, changes in BP and heart rate variability and BRS to sustained hypertension.
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