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Visit-to-visit and 24-h blood pressure variability: association with endothelial and smooth muscle function in African Americans

Abstract

The purpose of this study was to investigate the association of visit-to-visit and 24-h blood pressure (BP) variability with markers of endothelial injury and vascular function. We recruited 72 African Americans who were non-diabetic, non-smoking and free of cardiovascular (CV) and renal disease. Office BP was measured at three visits and 24-h ambulatory BP monitoring was conducted to measure visit-to-visit and 24-h BP variability, respectively. The 5-min time-course of brachial artery flow-mediated dilation and nitroglycerin-mediated dilation were assessed as measures of endothelial and smooth muscle function. Fasted blood samples were analyzed for circulating endothelial microparticles (EMPs). Significantly lower CD31+CD42− EMPs were found in participants with high visit-to-visit systolic blood pressure (SBP) variability or high 24-h diastolic blood pressure (DBP) variability. Participants with high visit-to-visit DBP variability had significantly lower flow-mediated dilation and higher nitroglycerin-mediated dilation at multiple time-points. When analyzed as continuous variables, 24-h mean arterial pressure variability was inversely associated with CD62+ EMPs; visit-to-visit DBP variability was inversely associated with flow-mediated dilation normalized by smooth muscle function and was positively associated with nitroglycerin-mediated dilation; and 24-h DBP variability was positively associated with nitroglycerin-mediated dilation. All associations were independent of age, gender, body mass index and mean BP. In conclusion, in this cohort of African Americans visit-to-visit and 24-h BP variability were associated with measures of endothelial injury, endothelial function and smooth muscle function. These results suggest that BP variability may influence the pathogenesis of CV disease, in part, through influences on vascular health.

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References

  1. Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K 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.

    Article  CAS  PubMed  Google Scholar 

  2. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension 2000; 36: 901–906.

    Article  CAS  PubMed  Google Scholar 

  3. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ et al. Long-term prognostic value of blood pressure variability in the general population. Hypertension 2007; 49: 1265–1270.

    Article  CAS  PubMed  Google Scholar 

  4. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.

    Article  PubMed  Google Scholar 

  5. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlof B et al. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol 2010; 9: 469–480.

    Article  CAS  PubMed  Google Scholar 

  6. Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S . The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III. Hypertension 2011; 57: 160–166.

    Article  CAS  PubMed  Google Scholar 

  7. Eto M, Toba K, Akishita M, Kozaki K, Watanabe T, Kim S et al. Reduced endothelial vasomotor function and enhanced neointimal formation after vascular injury in a rat model of blood pressure lability. Hypertens Res 2003; 26: 991–998.

    Article  PubMed  Google Scholar 

  8. Miao C-Y, Tao X, Gong K, Zhang S-H, Chu Z-X, Su D-F . Arterial remodeling in chronic sinoaortic-denervated rats. J Cardiovasc Pharmacol 2001; 37: 6–15.

    Article  CAS  PubMed  Google Scholar 

  9. Zhang C, Chen H, Xie H-H, Shu H, Yuan W-J, Su D-F . Inflammation is involved in the organ damage induced by sinoaortic denervation in rats. J Hypertens 2003; 21: 2141–2148.

    Article  CAS  PubMed  Google Scholar 

  10. Diaz KM, Veerabhadrappa P, Kashem MA, Feairheller DL, Sturgeon KM, Williamson ST et al. Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in african americans. Hypertens Res 2012; 35: 55–61.

    Article  CAS  PubMed  Google Scholar 

  11. Dignat-George F, Boulanger CM . The many faces of endothelial microparticles. Arterioscler Thromb Vasc Biol 2011; 31: 27–33.

    Article  CAS  PubMed  Google Scholar 

  12. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42: 1206–1252.

    Article  CAS  PubMed  Google Scholar 

  13. Diaz KM, Feairheller DL, Sturgeon KM, Veerabhadrappa P, Williamson ST, Crabbe DL et al. Increased nitric oxide and attenuated diastolic blood pressure variability in African Americans with mildly impaired renal function. Int J Hypertens 2011; 2010: 137206.

    PubMed  PubMed Central  Google Scholar 

  14. Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T . A reliable index for the prognostic significance of blood pressure variability. J Hypertens 2005; 23: 505–511.

    Article  CAS  PubMed  Google Scholar 

  15. Pierdomenico SD, Di Nicola M, Esposito AL, Di Mascio R, Ballone E, Lapenna D et al. Prognostic value of different indices of blood pressure variability in hypertensive patients. Am J Hypertens 2009; 22: 842–847.

    Article  PubMed  Google Scholar 

  16. Veerabhadrappa P, Diaz KM, Feairheller DL, Sturgeon KM, Williamson ST, Crabbe DL et al. Endothelial-dependent flow-mediated dilation in african americans with masked-hypertension. Am J Hypertens 2011; 24: 1102–1107.

    Article  CAS  PubMed  Google Scholar 

  17. Brown MD, Feairheller DL, Thakkar S, Veerabhadrappa P, Park JY . Racial differences in tumor necrosis factor-alpha-induced endothelial microparticles and interleukin-6 production. Vasc Health Risk Manag 2011; 7: 541–550.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Jenkins NT, Landers RQ, Thakkar SR, Fan X, Brown MD, Prior SJ et al. Prior endurance exercise prevents postprandial lipemia-induced increases in reactive oxygen species in circulating cd31+ cells. J Physiol 2011; 589: 5539–5553.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN et al. 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. Hypertension 2005; 45: 142–161.

    Article  CAS  PubMed  Google Scholar 

  20. Black MA, Cable NT, Thijssen DHJ, Green DJ . Importance of measuring the time-course of flow-mediated dilation in humans. Hypertension 2008; 51: 203–210.

    Article  CAS  PubMed  Google Scholar 

  21. Oshima T, Ozono R, Yano Y, Higashi Y, Teragawa H, Miho N et al. Beneficial effect of t-type calcium channel blockers on endothelial function in patients with essential hypertension. Hypertens Res 2005; 28: 889–894.

    Article  CAS  PubMed  Google Scholar 

  22. Wiltshire EJ, Gent R, Hirte C, Pena A, Thomas DW, Couper JJ . Endothelial dysfunction relates to folate status in children and adolescents with type 1 diabetes. Diabetes 2002; 51: 2282–2286.

    Article  CAS  PubMed  Google Scholar 

  23. Chan SY, Mancini GBJ, Kuramoto L, Schulzer M, Frohlich J, Ignaszewski A . The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease. J Am Coll Cardiol 2003; 42: 1037–1043.

    Article  CAS  PubMed  Google Scholar 

  24. Rocha ML, Kihara AH, Davel AP, Britto LRG, Rossoni LV, Bendhack LM . Blood pressure variability increases connexin expression in the vascular smooth muscle of rats. Cardiovasc Res 2008; 80: 123–130.

    Article  CAS  PubMed  Google Scholar 

  25. Tushuizen ME, Diamant M, Sturk A, Nieuwland R . Cell-derived microparticles in the pathogenesis of cardiovascular disease. Arterioscler Thromb Vasc Biol 2011; 31: 4–9.

    Article  CAS  PubMed  Google Scholar 

  26. Bernal-Mizrachi L, Jy W, Fierro C, Macdonough R, Velazques HA, Purow J et al. Endothelial microparticles correlate with high-risk angiographic lesions in acute coronary syndromes. Int J Cardiol 2004; 97: 439–446.

    Article  PubMed  Google Scholar 

  27. Philippova M, Suter Y, Toggweiler S, Schoenenberger AW, Joshi MB, Kyriakakis E et al. T-cadherin is present on endothelial microparticles and is elevated in plasma in early atherosclerosis. Eur Heart J 2011; 32: 760–771.

    Article  CAS  PubMed  Google Scholar 

  28. Muntner P, Joyce C, Levitan EB, Holt E, Shimbo D, Webber LS et al. Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care. J Hypertens 2011; 29: 2332–2338.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Padilla J, Johnson BD, Newcomer SC, Wilhite DP, Mickleborough TD, Fly AD et al. Normalization of flow-mediated dilation to shear stress area under the curve eliminates the impact of variable hyperemic stimulus. Cardiovasc Ultrasound 2008; 6: 44.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Rosenthal R, Rosnow RL . The Volunteer Subject. John Wiley & Sons: New York, 1975.

    Google Scholar 

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Acknowledgements

The authors thank the research subjects for their participation in the study and Melissa Diaz for her invaluable assistance with database managment. This research was supported by NIH/NHLBI Grant RO1 HL085497 (PI, Michael Brown).

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Correspondence to K M Diaz.

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Diaz, K., Veerabhadrappa, P., Kashem, M. et al. Visit-to-visit and 24-h blood pressure variability: association with endothelial and smooth muscle function in African Americans. J Hum Hypertens 27, 671–677 (2013). https://doi.org/10.1038/jhh.2013.33

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