The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Relationship of Blood Pressure Variability and Heart Rate with Plasma hsCRP in Patients with Recently Diagnosed Hypertension

고혈압 환자에서 혈압변동성 및 심장박동수와 hsCRP와의 연관성

  • Kim, Dongmin (Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine) ;
  • Lim, Seong-Hoon (Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine) ;
  • Lee, Myung-Yong (Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine)
  • 김동민 (단국대학교 의과대학 심장혈관내과학교실) ;
  • 임성훈 (단국대학교 의과대학 심장혈관내과학교실) ;
  • 이명용 (단국대학교 의과대학 심장혈관내과학교실)
  • Received : 2012.06.04
  • Accepted : 2013.01.11
  • Published : 2013.07.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Blood pressure (BP) variability and heart rate (HR) are associated with target organ damage and cardiovascular complications; however, the exact mechanisms are uncertain. In this study, we examined the association of an inflammatory marker with BP variability and HR. Methods: A total of 151 patients diagnosed recently with hypertension were subjected to 24-h ambulatory BP monitoring. BP variability was assessed as the standard deviation of the BP recordings. The average HR and HR variability were calculated from concomitantly recorded HR values. Plasma high-sensitivity C-reactive protein (hsCRP) was used as a marker of inflammation. Results: The mean age of the study population was 44 ${\pm}$ 11.3 years, and 74.2% of the patients were male. The plasma hsCRP level was higher in male patients (0.131 ${\pm}$ 0.014 vs. 0.06 ${\pm}$ 0.023, p = 0.001) and patients with a history of smoking (0.136 ${\pm}$ 0.017 vs. 0.101 ${\pm}$ 0.017, p = 0.003). A correlation analysis showed that the variability in diastolic BP during 24-h monitoring was associated with hsCRP (p = 0.002, r = 0.258). The 24-h (p = 0.004, r = 0.236), daytime (p = 0.003, r = 0.239), and nighttime (p = 0.020, r = 0.190) average HRs were related to the hsCRP level. The 24-h HR variability (p = 0.025, r = 0.182) was also associated with hsCRP. After adjusting for the effect of related variables, the 24-h diastolic BP variability (${\beta}$ = 0.286, p = 0.011) and daytime average HR (${\beta}$ = 0.169, p = 0.049) were positively related to hsCRP. Conclusions: Plasma hsCRP is related to diastolic BP variability in recently diagnosed hypertensive patients. Moreover, HR measured with BP is associated with hsCRP. These findings suggest that inflammation mediates adverse cardiovascular outcomes of BP variability and an elevated HR.

목적: 혈압의 변동성과 심장박동수는 표적 장기 손상과 심장 혈관 합병증과 관련이 있다. 하지만 그 정확한 기전은 밝혀져 있지 않다. 이에 저자들은 혈압의 변동성 및 심장박동수와 염증 인자가 관계가 있는지 확인하고자 본 연구를 시행하였다. 방법: 최근 진단되거나 새로이 진단된 151명의 고혈압 환자의 24시간 활동성 혈압을 분석하였다. 혈압의 변동성은 측정된 혈압의 표준편차로 표시하였다. 24시간 활동성 혈압 검사 중 동시에 측정된 평균 심장박동수 및 표준편차를 측정하였다. 혈중 high-sensitivity C-reactive protein (hsCRP)를 염증 인자로 사용하였다. 결과: 대상 환자의 평균나이는 44 ${\pm}$ 11.3세로 이 중 남자는 74.2%이었다. hsCRP는 남자 환자(0.131 ${\pm}$ 0.014 vs. 0.06 ${\pm}$ 0.023, p = 0.001) 및 흡연력이 있는 환자(0.136 ${\pm}$ 0.017 vs. 0.101 ${\pm}$ 0.017, p = 0.003)에서 높게 나타났다. 상관 분석에서 24시간 동안의 이완기 혈압의 변동성은 hsCRP와 양의 상관관계를 보였다(p = 0.002, r = 0.258). 또한 24시간 동안(p = 0.004, r = 0.236), 활동시간 동안(p = 0.003, r = 0.239), 수면시간 동안의 (p = 0.020, r = 0.190) 평균 심장박동수 그리고 24시간 동안의 심장박동수의 변동성은(p = 0.025, r = 0.182) hsCRP와 양의 상관관계를 보였다. 다중선형회귀분석에서 24시간 동안의 이완기 혈압의 변동성과(${\beta}$ = 0.286, p = 0.011) 활동시간 동안의 평균 심장박동수가(${\beta}$ = 0.169, p = 0.049) hsCRP와 유의한 관계가 있었다. 결론: 24시간 활동성 혈압을 통하여 측정된 이완기 혈압의 변동성 및 심장박동수는 염증 인자인 hsCRP와 연관성이 있었다. 혈압의 변동성과 심장박동수는 염증반응과 연관하여 심장혈관 합병증에 영향을 주는 것으로 생각한다.

Keywords

References

  1. Mancia G, De Backer G, Dominiczak A, et al. ESH/ESC 2007 guidelines for the management of arterial hypertension. Rev Esp Cardiol 2007;60:968.e1-94.
  2. Hansen TW, Thijs L, Li Y, et al. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension 2010; 55:1049-1057. https://doi.org/10.1161/HYPERTENSIONAHA.109.140798
  3. Kikuya M, Hozawa A, Ohokubo T, et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama Study. Hypertension 2000;36:901-906. https://doi.org/10.1161/01.HYP.36.5.901
  4. Mancia G, Bombelli M, Facchetti R, et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007;49:1265-1270. https://doi.org/10.1161/HYPERTENSIONAHA.107.088708
  5. Tatasciore A, Renda G, Zimarino M, et al. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension 2007;50: 325-332. https://doi.org/10.1161/HYPERTENSIONAHA.107.090084
  6. Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G. Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am J Hypertens 2007;20:154-161. https://doi.org/10.1016/j.amjhyper.2006.07.017
  7. Zakopoulos NA, Tsivgoulis G, Barlas G, et al. Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness. Hypertension 2005;45:505-512. https://doi.org/10.1161/01.HYP.0000158306.87582.43
  8. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987;5:93-98. https://doi.org/10.1097/00004872-198702000-00013
  9. Abramson JL, Lewis C, Murrah NV, Anderson GT, Vaccarino V. Relation of C-reactive protein and tumor necrosis factor-alpha to ambulatory blood pressure variability in healthy adults. Am J Cardiol 2006;98:649-652. https://doi.org/10.1016/j.amjcard.2006.03.045
  10. Kim KI, Lee JH, Chang HJ, et al. Association between blood pressure variability and inflammatory marker in hypertensive patients. Circ J 2008;72:293-298. https://doi.org/10.1253/circj.72.293
  11. Tatasciore A, Zimarino M, Renda G, et al. Awake blood pressure variability, inflammatory markers and target organ damage in newly diagnosed hypertension. Hypertens Res 2008;31:2137-2146. https://doi.org/10.1291/hypres.31.2137
  12. Fox K, Borer JS, Camm AJ, et al. Resting heart rate in cardiovascular disease. J Am Coll Cardiol 2007;50:823-830. https://doi.org/10.1016/j.jacc.2007.04.079
  13. Lampert R, Bremner JD, Su S, et al. Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men. Am Heart J 2008;156:759.e1-7. https://doi.org/10.1016/j.ahj.2008.03.029
  14. Lanza GA, Sgueglia GA, Cianflone D, et al. Relation of heart rate variability to serum levels of C-reactive protein in patients with unstable angina pectoris. Am J Cardiol 2006; 97:1702-1706. https://doi.org/10.1016/j.amjcard.2006.01.029
  15. Sajadieh A, Nielsen OW, Rasmussen V, Hein HO, Abedini S, Hansen JF. Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J 2004;25:363-370. https://doi.org/10.1016/j.ehj.2003.12.003
  16. Eto M, Toba K, Akishita M, et al. Impact of blood pressure variability on cardiovascular events in elderly patients with hypertension. Hypertens Res 2005;28:1-7. https://doi.org/10.1291/hypres.28.1
  17. Pringle E, Phillips C, Thijs L, et al. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens 2003;21:2251-2257. https://doi.org/10.1097/00004872-200312000-00012
  18. Sander D, Kukla C, Klingelhofer J, Winbeck K, Conrad B. Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: a 3-year follow-up study. Circulation 2000;102:1536-1541. https://doi.org/10.1161/01.CIR.102.13.1536
  19. Sega R, Corrao G, Bombelli M, et al. Blood pressure variability and organ damage in a general population: results from the PAMELA Study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertension 2002;39(2 Pt 2):710-714. https://doi.org/10.1161/hy0202.104376
  20. Eguchi K, Ishikawa J, Hoshide S, et al. Night time blood pressure variability is a strong predictor for cardiovascular events in patients with type 2 diabetes. Am J Hypertens 2009;22:46-51. https://doi.org/10.1038/ajh.2008.294