title: Predictors of mean arterial pressure morning rate of rise and power function in subjects undergoing ambulatory blood pressure recording.
abstract: BACKGROUND
  We determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BP(power)) derived from ambulatory blood pressure recordings.
  
  
  METHODS
  BP(power) and RoR were calculated from 409 ambulatory blood pressure (ABP) recordings from subjects attending a cardiovascular risk clinic. Anthropometric data, blood biochemistry, and history were recorded. The 409 subjects were 20-82 years old (average 57, SD = 13), 46% male, 9% with hypertension but not on medication and 34% on antihypertensive medication.
  
  
  RESULTS
  Average RoR was 11.1 mmHg/hour (SD = 8) and BP(power) was 273 mmHg(2)/hour (SD = 235). Only cholesterol, low density lipoprotein and body mass index (BMI) were associated with higher BP(power) and RoR (P<0.05) from 25 variables assessed. BP(power) was lower in those taking beta-blockers or diuretics. Multivariate analysis identified that only BMI was associated with RoR (4.2% increase/unit BMI, P = 0.020) while cholesterol was the only remaining associated variable with BP(power) (17.5% increase/mmol/L cholesterol, P = 0.047). A follow up of 213 subjects with repeated ABP after an average 1.8 years identified that baseline cholesterol was the only predictor for an increasing RoR and BP(power) (P<0.05). 37 patients who commenced statin subsequently had lower BP(power) whereas 90 age and weight matched controls had similar BP(power) on follow-up.
  
  
  CONCLUSIONS
  Cholesterol is an independent predictor of a greater and more rapid rise in morning BP as well as of further increases over several years. Reduction of cholesterol with statin therapy is very effective in reducing the morning blood pressure surge.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Head
authors.affiliation: NHMRC Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Monash Health Dandenong Australia and Monash University, Melbourne, Australia.
authors.forename: Barry P
authors.initials: BP
authors.lastname: McGrath
authors.affiliation: Monash Health Dandenong Australia and Monash University, Melbourne, Australia; Australian Catholic University, Fitzroy, Australia.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Martin
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.affiliation: National Cardiology Research Centre, Moscow, Russia.
authors.forename: Elena V
authors.initials: EV
authors.lastname: Lukoshkova
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Davern
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia.
authors.forename: Garry L
authors.initials: GL
authors.lastname: Jennings
authors.affiliation: NHMRC Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data*; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol