Abnormalities in circadian blood pressure variability and endothelial function: pragmatic markers for adverse cardiometabolic profiles in asymptomatic obese adults.
BACKGROUND
Cardiovascular disease (CVD) risk, although perceived to be high, is often difficult to demonstrate in disease free (healthy) obese adults.


OBJECTIVE
Changes in circadian blood pressure variability (CBPV) and endothelial function (EF) may be early correlates of cardiometabolic disorders.


METHODS
Asymptomatic men and women in 3 groups: normal weight (n = 10), overweight (n = 10) and obese (n = 15) were evaluated. Blood pressure and heart rate were recorded over 7 days: every 30 minutes during the day and every 60 minutes during the night, by automatic ambulatory monitoring. Resting EF was assessed in a fasting state between 8-10 AM by brachial ultrasound. Anthropometric and cardiometabolic indicators were measured and correlations with CBPV and EF were investigated.


RESULTS
The 3 groups had (Mean(SD)) BMI: 22.6(1.6), 27(3) and 34(5) kg/m2, respectively, weight: 64(16), 79(14), 95(16) kg and waist circumference: 79(9), 93(10), 107(13) cm. None in normal-weight or overweight groups had abnormal CBPV, while 8 of 15 obese adults had one or more CBPV abnormities (p < 0.05). Obese adults with CBPV abnormalities had elevated hs-CRP (15.3(9.3) mg/L), fibrinogen (593(97) mg/dl), fasting serum glucose (102(16) mg/dL), and cardiac risk ratios (Total-C/HDL-C: 5.2(1.9), LDL-C/HDL-C: 3.1(1.4)). Adults in the 3 respective groups who did not have CBPV abnormalities had flow-mediated brachial artery dilatation (FMD) of 0.22(0.06); 0.20(0.04), 0.23(0.02) mm over resting diameter. Obese participants with CBPV abnormalities (Mesor-hypotension, circadian hyper amplitude tension, elevated pulse pressure), had attenuated FMD at 78, 52, and 56% of resting reference diameter (means 0.18(0.07), 0.12(0.08), and 0.13(0.05) mm; p < 0.05), respectively.


CONCLUSIONS
Asymptomatic obese adults with abnormal CBPV and EF exhibit unfavorable cardiometabolic profiles.
Gupta
Alok K
AK
Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA. alok.gupta@pbrc.edu
Cornelissen
Germaine
G
Greenway
Frank L
FL
Dhoopati
Vijay
V
Halberg
Franz
F
Johnson
William D
WD
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology*; D001835:Body Weight / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D015897:Comorbidity; D004730:Endothelium, Vascular / Q000378:metabolism* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D007249:Inflammation / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D011379:Prognosis; D012307:Risk Factors
D015415:Biomarkers