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Non-dipper hipertansif hastalarda kardiyak rehabilitasyonun inflamatuar parametrelere etkisi

Year 2021, Volume: 12 Issue: 2, 140 - 146, 30.06.2021

Abstract

Amaç: Hipertansif hastalarda kan basıncının düşmemesinin kardiyovasküler hastalık riskini artırdığı gösterilmiştir. İnflamasyonun kardiyovasküler hastalık ve dipper olmayan hipertansiyonun etiyopatogenezinden sorumlu olduğu bilinmektedir. Dipper olmayan hipertansif hastalarda kardiyak rehabilitasyonun inflamatuar parametrelere etkisini belirlemeyi amaçladık.
Gereç ve Yöntemler: Tıbbi tedavi gören 56 dipper hipertansif hasta, klinik ve demografik özellikler açısından 58 dipper olmayan hipertansif hasta ile karşılaştırıldı. Dipper olmayan tüm hipertansif hastalar 16 haftalık kardiyak rehabilitasyon programına sevk edildi. İnflamatuar parametreler olarak, C-reaktif protein (CRP) ve nötrofil-lenfosit oranı (NLR) kardiyak rehabilitasyondan önce ve sonra ölçüldü. Kardiyak rehabilitasyonun sonunda 24 saatlik ambulatuvar kan basıncı monitörizasyonu tekrarlandı ve diürnal varyasyon analiz edildi.
Bulgular: Yaş, cinsiyet, gündüz sistolik ve diyastolik kan basıncı açısından dipper ve dipper olmayanlar arasında anlamlı fark bulunmazken, dipper olmayanlarda gece sistolik ve diyastolik kan basıncı daha yüksekti. İnflamatuar belirteçler olarak başlangıç CRP (0,46 ± 0,19'a karşı 0,38 ± 0,19) ve NLR (2,21 ± 0,69'a karşılık 1,82 ± 0,69) dipperlere kıyasla dipper olmayanlarda daha yüksek bulunmuştur (sırasıyla P = 0,019 ve P = 0,004). Kardiyak rehabilitasyon programından sonra, hem CRP (0.46 ± 0.19'a karşı 0.41 ± 0.16; P = 0.012) hem de NLR (2.21 ± 0.69'a karşı 2.07 ± 0.66; P = 0.005) dipper olmayanlarda önemli ölçüde azaldı. Kardiyak rehabilitasyon programının, dipper olmayanlarda kan basıncının günlük değişimleri üzerinde hiçbir etkisi yoktu. Dipper olmayan 58 kişiden 6'sı, kardiyak rehabilitasyondan sonra dipper olmayan modelden dipper paterne dönüştü.
Sonuç: Bu çalışma, kardiyak rehabilitasyonun dipper olmayan hipertansif hastalarda kardiyovasküler risk belirteçlerini oluşturan inflamatuvar parametreleri azaltabileceğini göstermiştir.

Supporting Institution

Yok

Project Number

-

References

  • 1. Verdecchia P, Schillaci G, Guerrieri M et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528-36.
  • 2. Salles GF, Reboldi G, Fagard RH et 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.
  • 3. Nami R, Mondillo S, Agricola E et al. Aerobic exercise training fails to reduce blood pressure in nondipper-type hypertension. Am J Hypertens 2000; 13: 593-600.
  • 4. Di Raimondo D, Tuttolomondo A, Miceli S, Milio G, Licata G, Pinto A. Aerobic physical activity based on fast walking does not alter blood pressure values in non-dipper essential hypertensives. Int Angiol 2012; 31: 142-9.
  • 5. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000; 342: 836-43.
  • 6. Ermis N, Yagmur J, Acikgoz N et al. Serum gamma-glutamyl transferase (GGT) levels and inflammatory activity in patients with non-dipper hypertension. Clin Exp Hypertens 2012; 34: 311-5.
  • 7. Sunbul M, Gerin F, Durmus E et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens 2014; 36: 217-21.
  • 8. Conraads VM, Vanderheyden M, Paelinck B et al. The effect of endurance training on exercise capacity following cardiac resynchronization therapy in chronic heart failure patients: a pilot trial. Eur J Cardiovasc Prev Rehabil 2007; 14: 99-106.
  • 9. Cerqueira E, Marinho DA, Neiva HP, Lourenco O. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. Front Physiol 2019; 10: 1550.
  • 10. Karvonen J, Vuorimaa T. Heart rate and exercise intensity during sports activities. Practical application. Sports Med 1988; 5: 303-11.
  • 11. Borg GA. Perceived exertion. Exerc Sport Sci Rev 1974; 2: 131-53.
  • 12. Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens 2013; 31: 639-48.
  • 13. Hornyak M, Cejnar M, Elam M, Matousek M, Wallin BG. Sympathetic muscle nerve activity during sleep in man. Brain 1991; 114: 1281-95.
  • 14. Floras JS, Sinkey CA, Aylward PE, Seals DR, Thoren PN, Mark AL. Postexercise hypotension and sympathoinhibition in borderline hypertensive men. Hypertension. 1989; 14: 28-35.
  • 15. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005; 46: 667-75.
  • 16. Bartlett DB, Shepherd SO, Wilson OJ et al. Neutrophil and Monocyte Bactericidal Responses to 10 Weeks of Low-Volume High-Intensity Interval or Moderate-Intensity Continuous Training in Sedentary Adults. Oxid Med Cell Longev 2017; 2017: 8148742.
  • 17. Nieman DC, Nehlsen-Cannarella SL, Markoff PA et al. The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 1990; 11: 467-73.
  • 18. Johari Moghadam A, Azizinejad S. Study of High Sensitive C-Reactive Protein (HS-CRP) After Cardiac Rehabilitation Program in Patients Undergoing Isolated CABG. Int J Biomed Sci 2016; 12: 143-8.
  • 19. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol 2018; 9: 754.
  • 20. Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET. Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation 2002; 105: 564-9.
  • 21. Okita K, Nishijima H, Murakami T, Nagai T, Morita N, Yonezawa K, et al. Can exercise training with weight loss lower serum C-reactive protein levels? Arterioscler Thromb Vasc Biol 2004; 24: 1868-73.
  • 22. De Rosa S, Cirillo P, Pacileo M, Di Palma V, Paglia A, Chiariello M. Leptin stimulated C-reactive protein production by human coronary artery endothelial cells. J Vasc Res 2009; 46: 609-17.
  • 23. Gazi E, Bayram B, Gazi S et al. Prognostic Value of the Neutrophil-Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction. Clin Appl Thromb Hemost 2015; 21: 155-9.
  • 24. Balta S, Ozturk C, Balta I et al. The Neutrophil-Lymphocyte Ratio and Inflammation. Angiology 2016; 67: 298-9.
  • 25. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347: 1557-65.

The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients

Year 2021, Volume: 12 Issue: 2, 140 - 146, 30.06.2021

Abstract

Aim: Non-dipping pattern in blood pressure increases the risk of cardiovascular diseases in hypertensive patients. Inflammation is responsible for the etiopathogenesis of cardiovascular disease and non-dipper hypertension. We aimed to determine the effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients. 
Material and Methods: Medically treated 56 dipper hypertensive patients were compared with 58 non-dipper hypertensive patients in terms of clinical and demographic features. All non-dipper hypertensive patients were referred to the cardiac rehabilitation program for 16-week duration. As inflammatory parameters, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) were measured before and after cardiac rehabilitation. At the end of cardiac rehabilitation 24-h ambulatory blood pressure monitoring was repeated and diurnal variation was analyzed.
Results: No significant difference was found between dippers and non-dippers in terms of age, gender, daytime systolic and diastolic blood pressure, while nighttime systolic and diastolic blood pressure was higher in non-dippers. Baseline inflammatory markers such as CRP (0.46±0.19 vs. 0.38±0.19) and NLR (2.21±0.69 vs. 1.82±0.69) were found higher in non-dippers than in dippers (P=0.019 and P=0.004, respectively). After the cardiac rehabilitation program, both CRP (0.46±0.19 vs. 0.41±0.16; P=0.012) and NLR (2.21±0.69 vs. 2.07±0.66; P=0.005) significantly decreased in non-dippers. Cardiac rehabilitation program had no effect on the diurnal variation of blood pressure in non-dippers. Out of 58 non-dippers, six patients transformed from non-dipper to dipper pattern after cardiac rehabilitation.
Conclusion: This study showed that cardiac rehabilitation reduce the inflammatory parameters that constitute the cardiovascular risk markers in non-dipper hypertensive patients.

Project Number

-

References

  • 1. Verdecchia P, Schillaci G, Guerrieri M et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528-36.
  • 2. Salles GF, Reboldi G, Fagard RH et 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.
  • 3. Nami R, Mondillo S, Agricola E et al. Aerobic exercise training fails to reduce blood pressure in nondipper-type hypertension. Am J Hypertens 2000; 13: 593-600.
  • 4. Di Raimondo D, Tuttolomondo A, Miceli S, Milio G, Licata G, Pinto A. Aerobic physical activity based on fast walking does not alter blood pressure values in non-dipper essential hypertensives. Int Angiol 2012; 31: 142-9.
  • 5. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000; 342: 836-43.
  • 6. Ermis N, Yagmur J, Acikgoz N et al. Serum gamma-glutamyl transferase (GGT) levels and inflammatory activity in patients with non-dipper hypertension. Clin Exp Hypertens 2012; 34: 311-5.
  • 7. Sunbul M, Gerin F, Durmus E et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens 2014; 36: 217-21.
  • 8. Conraads VM, Vanderheyden M, Paelinck B et al. The effect of endurance training on exercise capacity following cardiac resynchronization therapy in chronic heart failure patients: a pilot trial. Eur J Cardiovasc Prev Rehabil 2007; 14: 99-106.
  • 9. Cerqueira E, Marinho DA, Neiva HP, Lourenco O. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. Front Physiol 2019; 10: 1550.
  • 10. Karvonen J, Vuorimaa T. Heart rate and exercise intensity during sports activities. Practical application. Sports Med 1988; 5: 303-11.
  • 11. Borg GA. Perceived exertion. Exerc Sport Sci Rev 1974; 2: 131-53.
  • 12. Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens 2013; 31: 639-48.
  • 13. Hornyak M, Cejnar M, Elam M, Matousek M, Wallin BG. Sympathetic muscle nerve activity during sleep in man. Brain 1991; 114: 1281-95.
  • 14. Floras JS, Sinkey CA, Aylward PE, Seals DR, Thoren PN, Mark AL. Postexercise hypotension and sympathoinhibition in borderline hypertensive men. Hypertension. 1989; 14: 28-35.
  • 15. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005; 46: 667-75.
  • 16. Bartlett DB, Shepherd SO, Wilson OJ et al. Neutrophil and Monocyte Bactericidal Responses to 10 Weeks of Low-Volume High-Intensity Interval or Moderate-Intensity Continuous Training in Sedentary Adults. Oxid Med Cell Longev 2017; 2017: 8148742.
  • 17. Nieman DC, Nehlsen-Cannarella SL, Markoff PA et al. The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 1990; 11: 467-73.
  • 18. Johari Moghadam A, Azizinejad S. Study of High Sensitive C-Reactive Protein (HS-CRP) After Cardiac Rehabilitation Program in Patients Undergoing Isolated CABG. Int J Biomed Sci 2016; 12: 143-8.
  • 19. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol 2018; 9: 754.
  • 20. Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET. Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation 2002; 105: 564-9.
  • 21. Okita K, Nishijima H, Murakami T, Nagai T, Morita N, Yonezawa K, et al. Can exercise training with weight loss lower serum C-reactive protein levels? Arterioscler Thromb Vasc Biol 2004; 24: 1868-73.
  • 22. De Rosa S, Cirillo P, Pacileo M, Di Palma V, Paglia A, Chiariello M. Leptin stimulated C-reactive protein production by human coronary artery endothelial cells. J Vasc Res 2009; 46: 609-17.
  • 23. Gazi E, Bayram B, Gazi S et al. Prognostic Value of the Neutrophil-Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction. Clin Appl Thromb Hemost 2015; 21: 155-9.
  • 24. Balta S, Ozturk C, Balta I et al. The Neutrophil-Lymphocyte Ratio and Inflammation. Angiology 2016; 67: 298-9.
  • 25. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347: 1557-65.
There are 25 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Esra Poyraz

Lale Dinç Asarcıklı 0000-0002-7828-9487

Nazmiye Ozbilgin This is me 0000-0002-3334-8359

Project Number -
Publication Date June 30, 2021
Published in Issue Year 2021 Volume: 12 Issue: 2

Cite

APA Poyraz, E., Dinç Asarcıklı, L., & Ozbilgin, N. (2021). The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients. Turkish Journal of Clinics and Laboratory, 12(2), 140-146.
AMA Poyraz E, Dinç Asarcıklı L, Ozbilgin N. The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients. TJCL. June 2021;12(2):140-146.
Chicago Poyraz, Esra, Lale Dinç Asarcıklı, and Nazmiye Ozbilgin. “The Effect of Cardiac Rehabilitation on Inflammatory Parameters in Non-Dipper Hypertensive Patients”. Turkish Journal of Clinics and Laboratory 12, no. 2 (June 2021): 140-46.
EndNote Poyraz E, Dinç Asarcıklı L, Ozbilgin N (June 1, 2021) The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients. Turkish Journal of Clinics and Laboratory 12 2 140–146.
IEEE E. Poyraz, L. Dinç Asarcıklı, and N. Ozbilgin, “The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients”, TJCL, vol. 12, no. 2, pp. 140–146, 2021.
ISNAD Poyraz, Esra et al. “The Effect of Cardiac Rehabilitation on Inflammatory Parameters in Non-Dipper Hypertensive Patients”. Turkish Journal of Clinics and Laboratory 12/2 (June 2021), 140-146.
JAMA Poyraz E, Dinç Asarcıklı L, Ozbilgin N. The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients. TJCL. 2021;12:140–146.
MLA Poyraz, Esra et al. “The Effect of Cardiac Rehabilitation on Inflammatory Parameters in Non-Dipper Hypertensive Patients”. Turkish Journal of Clinics and Laboratory, vol. 12, no. 2, 2021, pp. 140-6.
Vancouver Poyraz E, Dinç Asarcıklı L, Ozbilgin N. The effect of cardiac rehabilitation on inflammatory parameters in non-dipper hypertensive patients. TJCL. 2021;12(2):140-6.


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