Published Online
on March 7, 2005

A more recent version of this article appeared on April 1, 2005

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Submitted on September 13, 2004
Revised on November 4, 2004

Time Rate of Blood Pressure Variation Is Associated With Increased Common Carotid Artery Intima-Media Thickness

Nikos A. Zakopoulos^*; Georgios Tsivgoulis; Gerassimos Barlas; Christos Papamichael; Konstantinos Spengos; Efstathios Manios; Ignatios Ikonomidis; Vassilios Kotsis; Ioanna Spiliopoulou; Konstantinos Vemmos; Myron Mavrikakis; and Spyridon D. Moulopoulos

From the Department of Clinical Therapeutics "Alexandra" Hospital, University of Athens, Greece.

^* To whom correspondence should be addressed. E-mail: nzakop{at}med.uoa.gr.

Abstract--The extent of target-organ damage has been positively associated with the magnitude of blood pressure (BP) variability in essential hypertension. However, the clinical implications of the rate of BP changes have never been investigated. We evaluated the association between the rate of systolic BP (SBP) variation derived from ambulatory BP monitoring (ABPM) data analysis and the extent of common carotid artery (CCA) intima-media thickness (IMT) in normotensive (n=280) and in uncomplicated hypertensive subjects (n=234). The 24-hour rate of SBP variation was significantly (P<0.001) higher in hypertensive (0.608 mm Hg/min; 95% confidence interval [CI], 0.595 to 0.622) than in normotensive individuals (0.567 mm Hg/min; 95% CI, 0.555 to 0.578), even after adjusting for baseline characteristics, day-night BP changes, 24-hour heart rate (HR), SBP, and HR variability. In the entire group of patients, multiple linear regression models revealed independent determinants of CCA-IMT in the following rank order: age (P<0.001), 24-hour rate of SBP variation (P<0.001), male gender (P=0.004), cholesterol (P=0.009), and smoking (P=0.014). A 0.1 mm Hg/min increase in the 24-hour rate of SBP variation was associated to an increment of 0.029 mm (95% CI, 0.018 to 0.040) in CCA-IMT independent of BP and HR levels, BP and HR variability, and dipping status. The rate of SBP variation during the morning BP surge correlated independently (P<0.001) to larger CCA-IMT values after adjustment for baseline characteristics and other ABPM parameters. Thus, the rate of BP fluctuations is greater in hypertensive patients and correlates to increased CCA-IMT. This finding indicates that steeper BP variations may produce a greater stress on the vessel wall and consequently result in medial hypertrophy of the large arteries.

Key words: blood pressure • carotid arteries • blood pressure monitoring • baroreflex • ultrasonography

Related Article:

Morning Surge and Variability in Blood Pressure: A New Therapeutic Target?

Kazuomi Kario
Hypertension 2005 45: 485-486. [Extract] [Full Text] [PDF]

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