The relationship between diurnal blood pressure abnormalities and target organ damage in normotensive subjects. Which is more important? Increased blood pressure levels or circadian blood pressure abnormalities

ABSTRACT

Objective: Circadian blood pressure (CBP) abnormalities are well-known risk factors for many diseases such as cardiovascular, cerebrovascular, and chronic kidney disease. The object of this study was to evaluate the relationship between abnormalities in CBP rhythm and target organ damage (TOD) in normotensive non-dipper (non-DP) subjects.

Methods: The 24-h ambulatory BP monitoring (ABPM) and echocardiography were performed and urinary albumin excretion (UAE) was measured in 127 normotensive dipper (DP) (42 males, 85 females) and 337 (89 males, 248 females) normotensive non-DP subjects.

Results: When we compared DP and non-DP subjects; Pulse wave velocity (PWV) (7.12 ± 1.72 vs 7.57 ± 1.87 m/s, p = 0.02), the percentile of corrected PWV (cPWV) (7.1 vs. 20.2, p= 0.001) and the percentile of corrected augmentation index (cAIx) (23.5 vs. 33.9, p = 0.03), left ventricle mass index (LVMI) (78.00 ± 23.27 vs. 95.59 ± 18.29 g/m², p = 0.01), relative wall thickness (RWT)(0.36 ± 0.13 vs 0.46 ± 0.09, p = 0.01), percentile of proteinuria (8.6 vs 29.2%, p = 0.00) were higher in non-DP group. In the correlation analyses, the PWV, LVMI, RWT were negatively correlated with the rate of systolic fall in nighttime (%)(−0.15, p = 0.01 vs. −0.23, p = 0.02 vs. −0.27, p = 0.00). It was observed that cPWV, cAIx, and UAE were independently associated with age and non-DP status (NDS), in logistic regression analysis.

Conclusions: Our results suggested that normotensive persons with CBP abnormalities had TOD. In light of the data of this article, non-dipper status is detected in the early period and if the provision of diurnal blood pressure rhythm may reduce the incidence of future adverse events in nondipper normotensive subjects.

KEYWORDS:

• Target organ damage
• normotensive nondipper status
• pulse wave velocity
• circadian blood pressure abnormalities

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Study Limitations

One of the most important limitations, due to the specifications of the device, hemodynamic evaluations were taken as twice measurement, were not 24 ABP. To remove this limitation, two measurements were taken before and after the ABP were installed and their median was calculated.

Another limitation of the present study protein excretion in urine was calculated by spot urine assay. Protein excretion could not be assessed in 24-h urine due to technical reasons. UAE is affected by daily physical activities. Even the study groups were suggested not to do exercise except daily routine activities, UAE might have been affected by their daily activities.

Another limitation of the present study is that although people with sleep disorders were left out of the study, a possible occult sleep apnea may influence endothelial function. Particularly in the early morning after a night of sleep apnea, and it may lead to an increase in UAE. Sleep quality could not be verified as in polysomnography.

Additional information

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.