Blood Pressure Variability and Its Management in Hypertensive Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk
Abstract
Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk
참고문헌 (26)
- Lawes CM, "International Society of Hypertension. Global burden of blood-pressurerelated disease, 2001", Lancet, 371, pp.1513~1518 (2008)
- Gradman AH, "Sleep-time blood pressure: a validated therapeutic target", J Am Coll Cardiol, 58, pp.1174~1175 (2011)
- Pickering TG, "Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research", Circulation, 111, pp.697~716 (2005)
- Hermida RC, "Decreasing sleep-time blood pressure determined by ambulatory monitoring reduces cardiovascular risk", J Am Coll Cardiol, 58, pp.1165~1173 (2011)
- Millar-Craig MW, "Circadian variation of blood-pressure", Lancet, 1, pp.795~797 (1978)
- Peixoto AJ, "Circadian blood pressure: clinical implications based on the pathophysiology of its variability", Kidney Int, 71, pp.855~860 (2007)
- Kario K, "Early morning hypertension: what does it contribute to overall cardiovascular risk assessment?", J Am Soc Hypertens, 2, pp.397~402 (2008)
- Parati G, "Blood pressure variability: its measurement and significance in hypertension", J Hypertens Suppl, 23, pp.S19~S25 (2005)
- de la Sierra A, "Diurnal blood pressure variation, risk categories and antihypertensive treatment", Hypertens Res, 33, pp.767~771 (2010)
- Cohen MC, "Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death", Am J Cardiol, 79, pp.1512~1516 (1997)
- Elliott WJ, "Circadian variation in the timing of stroke onset: a meta-analysis", Stroke, 29, pp.992~996 (1998)
- Kario K, "Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study", Circulation, 107, pp.1401~1406 (2003)
- White WB, "Ambulatory blood pressure monitoring: dippers compared with non-dippers", Blood Press Monit, 5(1), pp.S17~S23 (2000)
- Ohkubo T, "Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study", J Hypertens, 20, pp.2183~2189 (2002)
- Thompson AM, "The role of ambulatory blood pressure monitoring in chronic and end-stage renal disease", Kidney Int, 70, pp.1000~1007 (2006)
- Rothwell PM, "Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension", Lancet, 375, pp.895~905 (2010)
- Muntner P, "The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994", Hypertension, 57, pp.160~166 (2011)
- Balan H, "Chronotherapy of hypertension: when can be as important as with what", Rom J Intern Med, 46, pp.269~274 (2008)
- Parati G, "Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension", J Hypertens, 5, pp.93~98 (1987)
- Frattola A, "Prognostic value of 24-hour blood pressure variability", J Hypertens, 11, pp.1133~1137 (1993)
- Meredith PA, "A chronotherapeutic approach to effective blood pressure management", J Clin Hypertens (Greenwich), 4(4), pp.15~19 (2002)
- Dolan E, "of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study", Hypertension, 46, pp.156~161 (2005)
- Hermida RC, "Circadian variation of blood pressure: the basis for the chronotherapy of hypertension", Adv Drug Deliv Rev, 59, pp.904~922 (2007)
- Hermida RC, "Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study", Chronobiol Int, 27, pp.1629~1651 (2010)
- Hermida RC, "Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes", Diabetes Care, 34, pp.1270~1276 (2011)
- Hermida RC, "Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD", J Am Soc Nephrol, 22, pp.2313~2321 (2011)