Association Between Morning Blood Pressure Surge and Cardiovascular Remodeling in Treated Elderly Hypertensive Subjects

Abstract

It has remained unclear whether or not morning blood pressure (BP) surge (MS) is associated with cardiovascular remodeling in elderly (> or =60 years) hypertensive patients being treated by antihypertensive medications.In this cross-sectional study (n = 197; mean 74.6 years; 37% men), we evaluated the association between MS, defined as the highest quartile of morning BP increase from sleep (> or =48 mm Hg; n = 49), and extent of cardiac hypertrophy and carotid artery intima-media thickness (IMT).Although there were no differences in 24-h BP levels and the number of prescribed antihypertensive medications between MS and non-MS group, the use of thiazide diuretics was more frequent in MS group than non-MS group (35% vs. 19%; P < 0.05). The MS group had significantly higher levels of left ventricular mass index (LVMI) and internal-carotid artery (ICA)-IMT than the non-MS group (both P < 0.01), independent of 24-h BP levels, daytime BP variability, the degree of nocturnal BP decline, the plasma low-density lipoprotein levels, and the use of diuretics. Even in subjects with a well-controlled 24-h BP level (<130/80 mm Hg; n = 75), these relationships were similar. A multiple logistic regression analysis showed that the presence of MS was an independent determinant of LV hypertrophy (LVH) (> or =125 g/m(2) in men and > or =110 g/m(2) in women) and assignment to the highest quartile of ICA-IMT (both P < 0.05).The MS in subjects being treated with antihypertensive medications was significantly associated with cardiovascular remodeling, independently of 24-h BP level, daytime BP variability, and nocturnal BP decline.