Morning surge, pulse wave velocity and autonomic function tests in patients older than 65 years

SANCHEZ GELOS DIEGO F; OTERO-LOSADA MATILDE E; GRANA DANIEL R; MILEI JOSE

Stockholm

Congreso; ESC Congress 2010; 2010

European Society of Cardiology

PURPOSE: The significance of morning surge (MS) in blood pressure (BP) remains obscure because the available prospective studies have generated conflicting results, partly because of differences in definitions and assessment conditions. The objective of this study was to contribute to a better knowledge of the relationships between MS and pulse wave velocity (PWV) with several autonomic function tests. METHODS 59 patients >65 years old (44 women, 74¡¾1 years and 15 men, 76¡¾2 years) underwent a 24 hs ambulatory blood pressure monitoring and conventional tests to assess autonomic nervous activity (Ewing¢¥s protocol). Also, a complete clinical evaluation was performed. Pulse wave velocity was obtained from the pressure values of digitized carotid and femoral arteries. MS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep systolic BP (Kario). Data was evaluated by bivariate correlation analysis using the Pearson¢¥s coefficient (R). RESULTS: (I) PWV correlated with: a) heart rate variation during deep breathing (E:I) in women (R= -0.266, p<0.05, n=44), b) orthostatism in men (R= 0.574, p<0.02, n=15) and c) the immediate heart-rate response to standing (R= -0.472, p<0.04) and E:I values (R= 0.492, p<0.04) in men. (II) MS correlated with: a) handgrip in diurnal hypertensive patients (R= 0.416, p<0.04, n=18), b) E:I values in women (R= -0.292, p<0.03, n=44), c) orthostatism in dippers (R= -0.324, p<0.04, n=31) and non-dippers (R= 0.375, p<0.03, n=25). d) left ventricular mass (R=0.420, p<0.004, n=44), e) posterior wall thickness (R=0357, p<0.02, n=45) and f) BMI >25 (R=0.336, p<0.01 n=58). (III) PWV-MS was observed in non-dippers (R= 0.377, p<0.04, n=25), mainly in women (R= 0.529, p<0.02, n=16). PWV-MS were reciprocally related in all patients with MS values ¡Â 40 mm Hg (breakpoint average= MS+ 1 SD) in the studied sample (R= -0.319, p<0.03, n=47) regardless sex or dipping status. CONCLUSIONS: These results indicate that in hypertensive patients older than 65 years, PWV correlates with sympathetic and parasympathetic damage in men, MS with left ventricular mass and both, MS-PWV with non-dippers in women. Although these correlations suggest an involvement of the autonomic nervous system and left ventricular mass, more studies are required to better elucidate the relationship between MS and PWV.