Morning rise of blood pressure and subcutaneous small resistance artery structure

Objectives It has been previously demonstrated that the morning rise (MoR) of blood pressure (BP) may predict major cardiovascular events in hypertensive patients. Structural alterations of small resistance arteries, as evaluated by the tunica media to internal lumen ratio (M/L) of subcutaneous small resistance arteries, may also predict cardiovascular events. Because an increased M/L may amplify the effect of hypertensive stimuli, the present study aimed to evaluate the possible relationships between MoR and M/L in a population of hypertensive patients. Methods Sixty-four patients with essential hypertension were included in the present study. All patients were submitted to a biopsy of subcutaneous fat. Small resistance arteries were dissected and mounted on an isometric myograph, and the M/L was measured. In addition, MoR was calculated from ambulatory blood pressure monitoring (ABPM) according to four previously published different methods (MoR1 to MoR4). Results A statistically significant correlation was observed between M/L and MoR1 (r = 0.52, P < 0.001), MoR2 (r = 0.32, P < 0.01), MoR3 (r = 0.25, P < 0.05) and MoR4 (r = 0.27, P < 0.05), as well as between internal diameter of subcutaneous small arteries and MoR1 (r = −0.45, P < 0.001) and MoR2 (r = −0.28, P < 0.05). Conclusion Our results indicate that subcutaneous small artery structure is related to MoR, possibly because an altered vascular structure may amplify BP changes or, vice versa, because a greater MoR may further damage peripheral vasculature.

[1]  T. Giles,et al.  Circadian rhythm of blood pressure and the relation to cardiovascular events , 2006, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[2]  K. Kario.  Time for focus on morning hypertension: pitfall of current antihypertensive medication. , 2005, American journal of hypertension.

[3]  E. Schiffrin.  Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. , 2004, American journal of hypertension.

[4]  K. Kario,et al.  Morning blood pressure surge and hypertensive cerebrovascular disease: role of the alpha adrenergic sympathetic nervous system. , 2004, American journal of hypertension.

[5]  K. Kawecka-Jaszcz,et al.  CHARACTERISTIC OF SUBJECTS WITH AND WITHOUT MORNING SURGE OF BLOOD PRESSURE ACCORDING TO TWO DEFINITIONS: P2.11 , 2004 .

[6]  P. Gosse,et al.  Blood pressure surge on rising , 2004, Journal of hypertension.

[7]  W. White,et al.  Effects of the angiotensin II receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure: impact on the early morning period. , 2004, American journal of hypertension.

[8]  J. Baguet,et al.  Cathepsin G is associated with atheroma formation in human carotid artery , 2004, Journal of hypertension.

[9]  C. de Ciuceis,et al.  Prognostic Significance of Small-Artery Structure in Hypertension , 2003, Circulation.

[10]  Kazuomi Kario,et al.  Morning Surge in Blood Pressure as a Predictor of Silent and Clinical Cerebrovascular Disease in Elderly Hypertensives: A Prospective Study , 2003, Circulation.

[11]  E. Porteri,et al.  Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients. , 2003, Journal of hypertension.

[12]  A. Heagerty,et al.  Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus: Evidence for the Roles of Abnormal Myogenic Responsiveness and Dyslipidemia , 2002, Circulation.

[13]  J. Redón,et al.  Uncontrolled early morning blood pressure in medicated patients: the ACAMPA study , 2002, Blood pressure monitoring.

[14]  E. Schiffrin,et al.  Small artery remodeling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension , 2001, Journal of hypertension.

[15]  E. Porteri,et al.  Structural Alterations in Subcutaneous Small Arteries of Normotensive and Hypertensive Patients With Non–Insulin-Dependent Diabetes Mellitus , 2001, Circulation.

[16]  H. Iwao,et al.  [Vascular remodeling]. , 2000, Nihon rinsho. Japanese journal of clinical medicine.

[17]  Relationship between small-artery structure and systolic, diastolic and pulse pressure in essential hypertension. , 1999, Journal of hypertension.

[18]  J. Muller,et al.  Circadian variation in cardiovascular events. , 1999, American journal of hypertension.

[19]  P. Gosse,et al.  Left ventricular mass is better correlated with arising blood pressure than with office or occasional blood pressure. , 1997, American journal of hypertension.

[20]  R. Zulli,et al.  Effects of long‐term antihypertensive treatment with lisinopril on resistance arteries in hypertensive patients with left ventricular hypertrophy , 1997, Journal of hypertension.

[21]  E. Braunwald,et al.  Circadian variation in the onset of unstable angina and non-Q-wave acute myocardial infarction (the TIMI III Registry and TIMI IIIB). , 1997, The American journal of cardiology.

[22]  M. Muiesan,et al.  ACE inhibitor ramipril is more effective than the β-blocker atenolol in reducing left ventricular mass in hypertension. Results of the RACE (ramipril cardioprotective evaluation) study , 1995 .

[23]  R. Zulli,et al.  Media: lumen ratio in human small resistance arteries is related to forearm minimal vascular resistance , 1995, Journal of hypertension.

[24]  I. Kuwajima,et al.  Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time. , 1995, American journal of hypertension.

[25]  E. Schiffrin,et al.  Morphology of resistance arteries and comparison of effects of vasoconstrictors in mild essential hypertensive patients. , 1993, Clinical and investigative medicine. Medecine clinique et experimentale.

[26]  M. Mulvany,et al.  Small artery structure in hypertension. Dual processes of remodeling and growth. , 1993, Hypertension.

[27]  E. Schiffrin.  Reactivity of small blood vessels in hypertension: relation with structural changes. State of the art lecture. , 1992, Hypertension.

[28]  R. Zulli,et al.  Relationship between initial cardiovascular structural changes and daytime and nighttime blood pressure monitoring. , 1992, American journal of hypertension.

[29]  P. Korner,et al.  Significance of cardiovascular hypertrophy in the development and maintenance of hypertension. , 1991, Journal of Cardiovascular Pharmacology.

[30]  M. Mulvany,et al.  Structure and function of small arteries. , 1990, Physiological reviews.

[31]  M. Mulvany,et al.  Abnormal structure and function of isolated subcutaneous resistance vessels from essential hypertensive patients despite antihypertensive treatment. , 1989, Journal of hypertension.

[32]  Daniel B Hier,et al.  Morning increase in onset of ischemic stroke. , 1989, Stroke.

[33]  D. Levy,et al.  Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. , 1987, The American journal of cardiology.

[34]  A. Heagerty,et al.  Evidence for increased media thickness, increased neuronal amine uptake, and depressed excitation--contraction coupling in isolated resistance vessels from essential hypertensives. , 1987, Circulation research.

[35]  S. Willich,et al.  Circadian variation in the frequency of sudden cardiac death. , 1987, Circulation.

[36]  A. Lever.  Slow pressor mechanisms in hypertension: a role for hypertrophy of resistance vessels? , 1986, Journal of hypertension.

[37]  E. Braunwald,et al.  Circadian variation in the frequency of onset of acute myocardial infarction. , 1985, The New England journal of medicine.

[38]  B. Folkow.  Physiological aspects of primary hypertension. , 1982, Physiological reviews.

[39]  M. Mulvany,et al.  Direct Evidence that the Greater Contractility of Resistance Vessels in Spontaneously Hypertensive Rats is Associated with a Narrowed Lumen, a Thickened Media, and an Increased Number of Smooth Muscle Cell Layers , 1978, Circulation research.