Sirkadiyen kan basıncının karotis intima-media kalınlığı üzerine etkisi

Abstract

Amaç: Hipertansiyon ile aterosklerotik kardiyovasküler hastalıklar arasındaki ilişki daha önce birçok çalışmada gösterilmiştir. Diürnal kan basıncının intima-media kalınlığı üzerine olan etkisi az sayıda makalede araştırılmış ve çelişkili sonuçlar elde edilmiştir. Biz bu çalışmada antihipertansif tedavi almayan dipper, non-dipper ve revers-dipper hipertansiyonlu hastalarda aterosklerotik kardiyovasküler hastalığın göstergelerinden biri olan karotis intima-media kalınlığında farklılık olup olmadığını incelemeyi amaçladık. Gereç ve Yöntemler: Tek merkezli ve kesitsel olan bu çalışmaya, Şubat 2023 ile Mayıs 2023 tarihleri arasında, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi Kardiyoloji polikliniğine başvuran ve ayaktan kan basıncı ölçüm cihazı ile hipertansiyon tanısı konulan hastalar dahil edildi. Hastaları; dipper, non-dipper ve revers-dipper olarak 3 grup şeklinde tasarladık. 125 hastanın 38'i dipper, 53'ü non-dipper ve 34'ü ise revers-dipper idi. Bulgular: Çok değişkenli lineer regresyon analizinde bilateral ortalama karotis intima–media kalınlığı revers-dipper grubunda dipper grubuna göre istatistiksel olarak anlamlı derecede daha yüksekti [β-coefficient = 0,075, %95 Cl: 0,027-0,123, p = 0,003]. Ayrıca, ileri yaş ile bilateral ortalama karotis intima–media kalınlığı arasında istatistiksel olarak pozitif bir korelasyon vardı [β-coefficient = 0,005, %95 GA: 0,003-0,007, p <0,001]. Sonuçlar: Bu çalışmada karotis intima –media kalınlığının revers-dipper grubunda, dipper grubuna göre anlamlı derecede daha yüksek olduğu gösterildi.

Keywords

• Hipertansiyon
• Revers-dipper
• Non-dipper
• Dipper
• İntima-media kalınlığı

The effect of circadian blood pressure on carotid intima-media thickness

Abstract

Aim: The relationship between hypertension and atherosclerotic cardiovascular diseases has been shown in many studies. The effect of diurnal blood pressure on intima-media thickness has been investigated in a few articles, and contradictory results have been obtained. In this study, we aimed to investigate whether there is a difference in carotid intima-media thickness, which is one of the indicators of atherosclerotic cardiovascular disease, in dipper, non-dipper, and reverse-dipper hypertensive patients who do not receive antihypertensive treatment. Material and methods: In this single-center cross-sectional study, outpatients who applied to the cardiology department of Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey, between February 2023 and May 2023, and who were found to be hypertensive with an ambulatory blood pressure device, were included in the study. We designed the study by dividing the patients into three groups: those with a dippers BP profile, those with a non-dippers BP profile, and those with a reverse dippers BP profile. Of the 125 patients, 38 were dippers, 53 were non-dippers, and 34 were reverse dippers. Results: In multivariate linear regression analysis, bilateral mean C.IMT was statistically significantly higher in the reverse-dipper group compared to the dipper group [β-coefficient = 0.075, 95% Cl: 0.027-0.123, p = 0.003]. In addition, there was a statistically significant positive correlation between older age and bilateral mean C.IMT [β-coefficient = 0.005, 95% CI: 0.003-0.007, p <0.001]. Conclusion: This study showed that C.IMT was significantly higher in the reverse-dipper group than the dipper group.

Keywords

• Hypertension
• Reverse-dipper
• Non-dipper
• Dipper
• Intima-media thickness

Ethical Statement

Onay tarihi:03.03.2023 Onay sayı:360 Kurum: Sağlık Bilimleri Üniversitesi Gazi Yaşargil Eğitim ve Araştırma Hastanesi

References

1. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024; 45: 3912-4018.
2. Kario K, Williams B. Nocturnal hypertension and heart failure: mechanisms, evidence, and new treatments. Hypertension. 2021; 78: 564-77.
3. Lo L, Hung SWS, Chan SSW, Mak CL, Chan PF, Chao DVK. Prognostic value of nocturnal blood pressure dipping on cardiovascular outcomes in Chinese patients with hypertension in primary care. J Clin Hypertens (Greenwich). 2021; 23: 1291-9.
4. Salles GF, Reboldi G, Fagard RH, Cardoso CR, Pierdomenico SD, Verdecchia Pet al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: the ambulatory blood pressure collaboration in patients with hypertension (ABC-H) meta-analysis. Hypertension. 2016; 67: 693-700.
5. Salvetti M, Muiesan ML, Rizzoni D, Bettoni G, Monteduro C, Corbellini C et al. Night time blood pressure and cardiovascular structure in a middle-aged general population in northern Italy: the Vobarno study. J Hum Hypertens. 2001; 15: 879-85.
6. Vasunta RL, Kesäniemi YA, Ylitalo A, Ukkola O. Nondipping pattern and carotid atherosclerosis in a middle-aged population: OPERA study. Am J Hypertens. 2012; 25: 60-6.
7. Triantafyllidi H, Birmpa D, Schoinas A, Benas D, Thymis I, Varoudi M et al. Is there any true distinction in extreme dipping versus nondipping or dipping phenotype regarding hypertension-mediated organ damage in newly diagnosed and never-treated hypertensive patients? J Hum Hypertens. 2022; 36: 51-60.
8. Gong S, Liu K, Ye R, Li J, Yang C, Chen X. Nocturnal dipping status and the association of morning blood pressure surge with subclinical target organ damage in untreated hypertensives. J Clin Hypertens (Greenwich). 2019; 21: 1286-94.

9. Pierdomenico SD, Lapenna D, Guglielmi MD, Costantini F, Romano F, Schiavone C et al. Arterial disease in dipper and nondipper hypertensive patients. Am J Hypertens. 1997; 10: 511-8. 10. Roman MJ, Pickering TG, Schwartz JE, Cavallini MC, Pini R, Devereux RB. Is the absence of a normal nocturnal fall in blood pressure (nondipping) associated with cardiovascular target organ damage? J Hypertens. 1997; 15: 969-78.
10. Cuspidi C, Sala C, Tadic M, Gherbesi E, Grassi G, Mancia G. Nondipping pattern and carotid atherosclerosis: a systematic review and meta-analysis. J Hypertens. 2016; 34: 385-91.
11. Mohamed SF, Khayeka-Wandabwa C, Muthuri S, Ngomi NN, Kyobutungi C, Haregu TN. Carotid intima media thickness (CIMT) in adults in the AWI-Gen Nairobi site study: profiles and predictors. Hipertens Riesgo Vasc. 2023; 40: 5-15.
12. Yang T, Wang Y, Zhang X, Xiang S, Wen J, Wang W et al. Prevalence and influencing factors of abnormal carotid artery intima-media thickness in Henan Province in China. Front Endocrinol (Lausanne). 2023; 14: 1266207.
13. Şaylık F, Çınar T, Selçuk M, Tanboğa İH. The relationship between uric acid/albumin ratio and carotid intima-media thickness in patients with hypertension. Arq Bras Cardiol. 2023; 120: e20220819.