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

Öz

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.

Anahtar Kelimeler

• ambulatory blood pressure monitoring
• cardiac rehabilitation
• hypertension
• inflammatory markers
• non-dipping

Non-dipper hipertansif hastalarda kardiyak rehabilitasyonun inflamatuar parametrelere etkisi

Öz

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.

Anahtar Kelimeler

• ambulatuvar kan basıncı monitorizasyonu
• kardiyak rehabilitasyon
• hipertansiyon
• inflammatuar belirteçler
• non-dipping

Destekleyen Kurum

Yok

Kaynakça

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