Morning blood pressure surge, morning platelet aggregation, and silent cerebral infarction in older Japanese hypertensive patients.
OBJECTIVE
To examine whether or not the extent of morning blood pressure surge (MBPS), defined as a morning SBP increase from sleep SBP, is associated with that of platelet aggregation, coagulation/fibrinolytic activity, and silent cerebral infarction (SCI) in older hypertensive patients.


METHODS
Sixty hypertensive patients aged at least 60 years (mean age 70.6 years; 40% men) underwent measurement of morning spontaneous small-sized platelet aggregation (SPA) detected by a light scattering intensity method, measurement of circulatory levels of von-Willebrand factor (vWF), noradrenalin, and plasma renin activity (PRA), and brain MRI.


RESULTS
The extent of MBPS, but not 24-h SBP, was associated with circulatory levels of noradrenalin, PRA, vWF, and spontaneous SPA (all P < 0.05); the association between MBPS and spontaneous SPA remained significant even after adjustment for significant covariates (P < 0.001). The patients with multiple (more than three per person) SCIs had a significantly greater extent of MBPS (43.3 vs. 31.8 mmHg), morning spontaneous SPA (20 471.9 vs. 4850.9 × 10(5) × 2 mV counts 10 min), and higher circulatory vWF (196.6 vs. 150.1%) compared with those without it (all P < 0.01). On multiple regression analysis, the odds ratio for multiple SCIs with a +1 SD increase of MBPS was 2.0, that of morning spontaneous SPA was 3.0, and that of circulatory morning vWF level was 3.3 (all P < 0.05). When MBPS increase and either platelet aggregation or vWF increases were entered into the same model, the latter parameters, but not the MBPS, were associated with multiple SCIs (both P < 0.05).


CONCLUSIONS
The extent of MBPS was associated with increased activity of morning platelet aggregation in older hypertensive patients.
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. kkario@jichi.ac.jp
Kazuomi
K
Kario
Yuichiro
Y
Yano
Takefumi
T
Matsuo
Satoshi
S
Hoshide
Yujiro
Y
Asada
Kazuyuki
K
Shimada
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D002940:Circadian Rhythm; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010974:Platelet Aggregation / Q000502:physiology*; D012083:Renin / Q000097:blood; D014841:von Willebrand Factor / Q000032:analysis
D015415:Biomarkers; D014841:von Willebrand Factor; D012083:Renin; D009638:Norepinephrine