Regression of carotid atherosclerosis by control of morning blood pressure peak in newly diagnosed hypertensive patients.

نویسندگان

  • Raffaele Marfella
  • Mario Siniscalchi
  • Francesco Nappo
  • Pasquale Gualdiero
  • Katherine Esposito
  • Ferdinando Carlo Sasso
  • Federico Cacciapuoti
  • Clara Di Filippo
  • Francesco Rossi
  • Michele D'Amico
  • Dario Giugliano
چکیده

BACKGROUND Morning blood pressure (BP) peak may be a risk factor for cardiovascular disease. Whether morning BP should be a target of hypertension treatment is not known. We investigated the relationship between morning BP variations, carotid internal-medial thickness (CIMT), circulating inflammatory markers, and sympathetic activity in hypertensive patients with different patterns of morning BP increase at baseline and after antihypertensive treatment. METHODS One hundred twenty-eight hypertensive patients with morning BP peak (MP+) were compared with 196 hypertensive patients without morning BP peak (MP-). All patients performed 24-h ambulatory BP monitoring, assessment of CIMT, circulating concentration of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-18 (IL-18), and urinary catecholamines. RESULTS Compared with MP- patients, MP+ patients had higher CIMT and urinary catecholamine output (P < .001), as well as CRP, IL-6, and IL-18 (P < .001). We randomly assigned 128 drug-naive MP+ patients to either metoprolol or carvedilol, two antihypertensive drugs with different effects on sympathetic activity. The primary outcome was change in CIMT and circulating inflammatory markers at 12 months. Morning BP decreased more among patients in the carvedilol group (P < .001), whereas clinic BP showed a similar decrease in both groups. The CIMT (P < .001), IL-6 (P < .001), IL-18 (P < .001), and CRP (P < .001) decreased more in the carvedilol group than in the metoprolol group. The CIMT regression was observed in 49% of patients in the carvedilol group and 18% of patients in the metoprolol group (P < .01). Reduction in CIMT was directly associated with changes in morning BP. CONCLUSIONS Higher CIMT and circulating inflammatory markers coexist in hypertensive patients with morning BP peak, and might contribute to their increased cardiovascular risk. Carotid atherosclerosis can be prevented by control of morning BP.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

ارتباط آدیپونکتین و نشانگر‌های آتروسکلروز پیش‌بالینی در مبتلایان جدید به دیابت نوع دو: بررسی ضخامت انتیما- میدیای شریان کاروتید و امتیاز کلسیم شریان کرونر

Background: The aim of this study was to assess the association of serum adiponectin and a set of traditional cardiovascular risk factors with carotid artery intimal-medial thickness (CIMT) and coronary artery calcium score (CACS), as markers of subclinical atherosclerosis in subjects with early type 2 diabetes mellitus. Methods: Carotid artery intima- media thickness (measured by B-mode ultrso...

متن کامل

Morning blood pressure surge as a destabilizing factor of atherosclerotic plaque: role of ubiquitin-proteasome activity.

Whether morning blood pressure surge influences the molecular mechanisms of plaque progression toward instability is not known. Recently, we have demonstrated enhanced activity of the ubiquitin-proteasome system in human plaques and evidenced that it is associated with inflammatory-induced plaque rupture. We evaluated the inflammatory infiltration and ubiquitin-proteasome activity in asymptomat...

متن کامل

Subclinical hypothyroidism and risk to carotid atherosclerosis.

OBJECTIVE The aim of this study was to assess whether subclinical hypothyroidism (SCH) is associated with carotid atherosclerosis, as well as dyslipidemia, and arterial hypertension. SUBJECTS AND METHODS The study included 69 consecutive patients with newly diagnosed SCH, and 30 matched healthy controls. Body mass index (BMI), TSH, fT4, antibodies to thyroid peroxidase (TPOabs), lipids, blood...

متن کامل

Serum Uric Acid as a Potential Concomitant with Carotid Atherosclerosis

Background: Common carotid intima-media thickness (CC-IMT) measured by ultrasonography as a non-invasive method is nowadays known as a marker for early atherosclerosis. Objectives: Survey the relationship between serum uric acid and carotid intima-media thickness considering hypertension. Materials and Methods: This study was designed as a comparative cross-sectional study in northern Ira...

متن کامل

Association between hemodynamics in the common carotid artery and severity of carotid atherosclerosis in patients with essential hypertension.

BACKGROUND Carotid intima-media thickness (IMT) and plaque burden evaluated by B-mode ultrasound have been used as relevant indicators for carotid atherosclerosis. This study was aimed to investigate the relationship between hemodynamic parameters in the common carotid artery (CCA) and the severity of carotid atherosclerosis in untreated hypertensive patients. METHODS Carotid IMT and plaque b...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • American journal of hypertension

دوره 18 3  شماره 

صفحات  -

تاریخ انتشار 2005