title: Increased morning blood pressure surge and coronary microvascular dysfunction in patient with early stage hypertension.
abstract: Morning blood pressure surge (MBPS) is defined as an excessive increase in blood pressure (BP) in the morning from the lowest systolic BP during sleep, and it has been reported as a risk factor for cardiovascular events in current clinical studies. In this study, we evaluated the association between the rate of BP variation derived from ambulatory BP monitoring data analysis and coronary microvascular function in patients with early stage hypertension. One hundred seventy patients with prehypertension and Stage 1 hypertension who fulfilled the inclusion and exclusion criteria were included in the study. We divided our study population into two subgroups according to the median value of coronary flow reserve (CFR). Patients with CFR values <2.5 were defined as the impaired CFR group, and patients with CFR values ≥2.5 were defined as the preserved CFR group, and we compared the MBPS measurements of these two subgroups. CFR was measured using transthoracic Doppler echocardiography (TTDE). Ambulatory 24-hour systolic and diastolic BP, uric acid, systolic MBPS amplitude, diastolic MBPS amplitude, high-sensitivity C-reactive protein, and mitral flow E/A ratio were statistically significant. These predictors were included in age- and gender-adjusted multivariate analysis; ambulatory 24-hour systolic BP (ß = 0.077, P < .001; odds ratio [OR] = 1.080; 95% confidence interval [CI] [1.037-1.124]) and systolic MBPS amplitude (ß = 0.043, P = .022; OR = 1.044; 95% CI [1.006-1.084]) were determined to be independent predictors of impaired CFR (Hosmer-Lemeshow test, P = .165, Nagelkerke's R(2) = 0.320). We found that increased changes in MBPS values in patients with prehypertension and Stage 1 hypertension seemed to cause microvascular dysfunction in the absence of obstructive coronary artery disease.
authors.affiliation: Istanbul Medeniyet University, Cardiology Department, Internal Medicine Department, Istanbul, Turkey. Electronic address: caliskandr@gmail.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Caliskan
authors.affiliation: Baskent University, Ankara Teaching and Medical Research Center, Internal Medicine and Cardiology Department, Konya, Turkey.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Caliskan
authors.affiliation: Baskent University, Ankara Teaching and Medical Research Center, Internal Medicine and Cardiology Department, Konya, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Gullu
authors.affiliation: Istanbul Medeniyet University, Cardiology Department, Internal Medicine Department, Istanbul, Turkey.
authors.forename: Nursen
authors.initials: N
authors.lastname: Keles
authors.affiliation: Istanbul Medeniyet University, Cardiology Department, Internal Medicine Department, Istanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Bulur
authors.affiliation: Konya Teaching and Medical Research Center, Cardiology Department, Konya, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Turan
authors.affiliation: Istanbul Medeniyet University, Cardiology Department, Internal Medicine Department, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Kostek
authors.affiliation: Baskent University, Ankara Teaching and Medical Research Center, Internal Medicine and Cardiology Department, Konya, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Ciftci
authors.affiliation: Baskent University, Ankara Teaching and Medical Research Center, Internal Medicine and Cardiology Department, Konya, Turkey.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Guven
authors.affiliation: Fatih University, Cardiology Department, Istanbul, Turkey.
authors.forename: Soe Moe
authors.initials: SM
authors.lastname: Aung
authors.affiliation: Baskent University, Ankara Teaching and Medical Research Center, Internal Medicine and Cardiology Department, Konya, Turkey.
authors.forename: Haldun
authors.initials: H
authors.lastname: Muderrisoglu
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002940:Circadian Rhythm; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D014421:Turkey / Q000453:epidemiology
keywords: Coronary flow reserve; morning blood pressure surge; prehypertension