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24-Hour ambulatory blood pressure levels and control in a large cohort of adult outpatients with different classes of obesity

Journal of Human Hypertension volume 33, pages 298–307 (2019)Cite this article

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Abstract

Effective and sustained blood pressure (BP) control in hypertensive patients with moderate-to-severe obesity is often difficult to achieve. We evaluated clinic, 24h, day-time and night-time systolic/diastolic BP levels and control in a large cohort of adult outpatients with different classes of obesity. A single center, prospective, cohort study was conducted at Hypertension Unit, Division of Cardiology, Sant’Andrea Hospital, Rome Italy. All BP measurements were performed and BP thresholds were set according to guidelines. Study population was stratified according to BMI. We included 4,766 individuals (women 48.6%, age 60.3 ± 11.6 years, clinic BP 143.8 ± 18.2/90.9 ± 12.3 mmHg, 24h BP 130.2 ± 13.3/79.1 ± 9.5 mmHg), among whom 36.0% had normal weight, 43.5% were overweight, 15.7% had class I, and 4.8% class II/III obesity. Obese outpatients had higher prevalence of risk factors, and were treated more frequently and with more antihypertensive drugs than those with normal body weight. Obese outpatients showed higher systolic BP levels at all BP measurements, mostly 24h and night-time periods, than those observed in normal weight outpatients. BMI resulted significantly related with clinic (r = 0.053; P < 0.001), 24h (r = 0.098; P < 0.001) and night-time systolic BP (r = 0.126; P < 0.001), and left ventricular mass indexed by height^2.7 (r = 0.311; P < 0.001). BMI was also negatively and independently associated with predefined BP goals at all types of BP measurements. Obesity was associated with higher systolic BP levels during the entire 24h period and increased left ventricular mass. These effects were independently observed, even after correction for major cardiovascular risk factors and comorbidities, as well as the number and type of antihypertensive drug classes.

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References

  1. Bhurosy T, Jeewon R. Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic status? ScientificWorldJournal. 2014;2014:964236.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

  3. Stevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metr. 2012;10:22.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32:1431–7.

    Article  CAS  Google Scholar 

  5. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body–mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–32.

    Article  PubMed  Google Scholar 

  7. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hall JE. The kidney, hypertension, and obesity. Hypertension. 2003;41(3 Pt 2):625–33.

    PubMed  Google Scholar 

  9. Garrison RJ, Kannel WB, Stokes J 3rd, Castelli WP. Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med. 1987;16:235–51.

    Article  CAS  PubMed  Google Scholar 

  10. Jones DW, Miller ME, Wofford MR, Anderson DC Jr., Cameron ME, et al. The effect of weight loss intervention on antihypertensive medication requirements in the hypertension Optimal Treatment (HOT) study. Am J Hypertens. 1999;12(12 Pt 1-2):1175–80.

    Article  CAS  PubMed  Google Scholar 

  11. O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–68.

    Article  PubMed  Google Scholar 

  12. Tocci G, Presta V, Figliuzzi I, Attalla El Halabieh N, Battistoni A, Coluccia R, et al. Prevalence and clinical outcomes of white-coat and masked hypertension: analysis of a large ambulatory blood pressure database. J Clin Hypertens. 2018;20:297–305.

    Article  Google Scholar 

  13. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  14. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  PubMed  Google Scholar 

  15. Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  16. Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The task force on diabetes and cardiovascular diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28:88–136.

    Article  CAS  PubMed  Google Scholar 

  17. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J. 2008;29:2909–45.

    Article  PubMed  Google Scholar 

  18. Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28:1598–660.

    Article  CAS  PubMed  Google Scholar 

  19. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. Eur Heart J. 2007;28:2525–38.

    Article  PubMed  Google Scholar 

  20. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:1583–633.

    Article  PubMed  Google Scholar 

  21. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40:2276–93.

    Article  PubMed  Google Scholar 

  22. Scuteri A, Morrell CH, Orru M, AlGhatrif M, Saba PS, Terracciano A, et al. Gender specific profiles of white coat and masked hypertension impacts on arterial structure and function in the SardiNIA study. Int J Cardiol. 2016;217:92–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cuspidi C, Sala C, Tadic M, Rescaldani M, Grassi G, Mancia G. Untreated masked hypertension and subclinical cardiac damage: a systematic review and meta-analysis. Am J Hypertens. 2015;28:806–13.

    Article  PubMed  Google Scholar 

  24. Baird SW, Jin Z, Okajima K, Russo C, Schwartz JE, Elkind MSV, et al. Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment. J Hum Hypertens. 2018;32:122–8.

    Article  PubMed  Google Scholar 

  25. Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24h ambulatory blood pressure and hypertension. Hypertension. 2005;45:602–7.

    Article  CAS  PubMed  Google Scholar 

  26. Kang IS, Pyun WB, Shin J, Kim JH, Kim SG, Shin GJ. Association between central obesity and circadian parameters of blood pressure from the korean ambulatory blood pressure monitoring registry: Kor-ABP registry. J Korean Med Sci. 2013;28:1461–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The association of pediatric obesity with nocturnal non-dipping on 24h ambulatory blood pressure monitoring. Am J Hypertens. 2016;29:647–52.

    Article  PubMed  Google Scholar 

  28. Palatini P, Reboldi G, Beilin LJ, Casiglia E, Eguchi K, Imai Y, et al. Prognostic value of ambulatory blood pressure in the obese: The Ambulatory Blood Pressure-International Study. J Clin Hypertens (Greenwich). 2016;18:111–8.

    Article  Google Scholar 

  29. Mourad JJ, Lopez-Sublet M, Aoun-Bahous S, Villeneuve F, Jaboureck O, Dourmap-Collas C, et al. Impact of miscuffing during home blood pressure measurement on the prevalence of masked hypertension. Am J Hypertens. 2013;26:1205–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome, Italy

    Ilaria Figliuzzi, Vivianne Presta, Francesca Miceli, Barbara Citoni, Maria Beatrice Musumeci, Andrea Ferrucci, Massimo Volpe & Giuliano Tocci

  2. IRCCS Neuromed, Pozzilli (IS), Italy

    Roberta Coluccia, Massimo Volpe & Giuliano Tocci

  3. Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Pisa, Italy

    Giovanni Ceccarini, Guido Salvetti & Ferruccio Santini

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  1. Ilaria Figliuzzi
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  2. Vivianne Presta
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  4. Barbara Citoni
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  5. Roberta Coluccia
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Correspondence to Giuliano Tocci.

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Figliuzzi, I., Presta, V., Miceli, F. et al. 24-Hour ambulatory blood pressure levels and control in a large cohort of adult outpatients with different classes of obesity. J Hum Hypertens 33, 298–307 (2019). https://doi.org/10.1038/s41371-018-0132-4

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