Night time blood pressure and cardiovascular structure in a middle-aged general population in northern Italy: the Vobarno Study

Abstract

The aim was to determine, in a cross-sectional study, the relation between structural alterations in the heart and carotid arteries, and blood pressure (BP) changes from day to night time, measured by ambulatory BP (ABP). In 225 untreated subjects (107 F, 118 M, age range 48–64 years) and 59 treated subjects (24 M, 35 F, age range 50–64), living in a small town of northern Italy (Vobarno, Brescia) carotid intima media thickness as well as the occurrence of plaque, were evaluated by ultrasound. Echocardiographic left ventricular (LV) mass was measured according to the Penn Convention. BP was determined by clinic measurement and by 24-h non-invasive ABP monitoring. Subjects were divided in two groups, according to the decrease of night time systolic BP (SBP) ‘dippers’ (SBP decreased by at least 10% during night time) and ‘non-dippers’ (decrease of night time SBP <10%). The intima-media thickness in the common carotid, in the carotid bifurcation, in the internal carotid artery and average intima-media thickness were significantly greater in untreated non-dippers as compared with dipper subjects (ANOVA P < 0.05). A significantly higher prevalence of plaque was observed in untreated non-dippers as compared with dippers (P = 0.002). After adjusting for age, sex, 24-h SBP, and smoking, IMT in the carotid bifurcation and average intima-media thickness remained significantly greater in non-dipper subjects (P < 0.05 for all comparisons). No significant differences in LV mass were observed between dippers and non-dipper subjects. In conclusion, in a general population of unselected middle-aged subjects, night time BP values, among other risk factors, seem to represent an important determinant of carotid wall structure.

References

  1. 1

    Salonen R, Seppanen K, Rauramaa R, Salonen JT Progression of carotid atherosclerosis and its determinants: a population based ultrasonographic study Atherosclerosis 1990 81 33–40

    CAS  PubMed  Article  Google Scholar 

  2. 2

    O’Leary DH et alExtracranial carotid atherosclerosis in a general population. The Framingham Heart Study Stroke 1988 19 143–146

    Google Scholar 

  3. 3

    Bonithon-Kopp C et alEarly carotid atherosclerosis in healthy middle-age French women Stroke 1993 24 1837–1843

    CAS  PubMed  Article  Google Scholar 

  4. 4

    Admani AK, Mangion DM, Naik DR Extracranial carotid artery stenosis: prevalence and associated risk factors in elderly strokepatients Atherosclerosis 1991 86 31–37

    CAS  PubMed  Article  Google Scholar 

  5. 5

    Luisiani L et alPrevalence of atherosclerotic involvement of the internal carotid artery in hypertensivepatients Int J Cardiol 1987 17 51–56

    Article  Google Scholar 

  6. 6

    Roman MMJ et alDeterminants of cardiac and vascular hypertrophy in hypertension Hypertension 1995 26 369–373

    CAS  PubMed  Article  Google Scholar 

  7. 7

    Crouse JR et alRisk factors for extracranial carotid artery atherosclerosis Stroke 1987 18 990–996

    CAS  PubMed  Article  Google Scholar 

  8. 8

    Salonen R, Salonen JT Determinants of carotid intima-media thickness: a population-based ultrasonography study in eastern Finnish men J Intern Med 1991 229 225–231

    CAS  PubMed  Article  Google Scholar 

  9. 9

    O’Leary DH et alDistribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study Stroke 1992 23 1752–1760

    PubMed  Article  Google Scholar 

  10. 10

    Muiesan ML et alCardiac and vascular structural changes: prevalence and relation to ambulatory blood pressure in a middle aged general population in northern Italy: the Vobarno Study Hypertension 1996 27 1046–1053

    CAS  PubMed  Article  Google Scholar 

  11. 11

    Cuspidi C et alCardiac and carotid structure inpatients with established hypertension and white coat hypertension J Hypertens 1995 13 1707–1711

    CAS  PubMed  Article  Google Scholar 

  12. 12

    Pierdomenico D et alTarget organ status and serum lipids inpatients with white coat hypertension Hypertension 1995 26 801–807

    CAS  Article  Google Scholar 

  13. 13

    Salonen JT, Salonen R Ultrasonographically assessed carotid morphology and the risk of coronary heart disease Arterioscler Thromb 1991 11 1245

    CAS  PubMed  Article  Google Scholar 

  14. 14

    Burke GL et alArterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Athrosclerosis Risk in Communities (ARIC) Study Stroke 1995 26 386

    CAS  Article  Google Scholar 

  15. 15

    Bots ML et alCommon carotid intima media thickness and risk of stroke and myocardial infarction. TheRotterdam Study Circulation 1997 96 1432

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. 16

    O’Leary DH et alFor the Cardiovascular Health Study Collaborative Research Group. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults N Engl J Med 1999 340 14

    Article  Google Scholar 

  17. 17

    Verdecchia P et alCircadian blood pressure changes and left ventricular hypertrophy in hypertension Circulation 1990 81 528–536

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  18. 18

    Rizzoni D et alRelationship between initial cardiovascular structural changes and daytime and night time blood pressure monitoring Am J Hypertens 1992 5 180–186

    CAS  Article  Google Scholar 

  19. 19

    Pierdomenico S et alArterial disease in dipper and non-dipper hypertensivepatients Am J Hypertens 1997 10 511–518

    CAS  PubMed  Article  Google Scholar 

  20. 20

    Roman MJ et alIs the absence of a normal nocturnal fall in blood pressure (nondipping) associated with cardiovascular target organ damage J Hypertens 1997 15 969–978

    CAS  PubMed  Article  Google Scholar 

  21. 21

    National Institutes of Health Consensus Development Panel on Health Implications of Obesity Health Implications of Obesity Ann Intern Med 1985 103 1073–1077

    Article  Google Scholar 

  22. 22

    Pignoli P et alIntimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging Circulation 1986 74 1399–1406

    CAS  Article  Google Scholar 

  23. 23

    Bond MG et alfor the ARIC study group. High resolution B-mode ultrasound scanning methods in the Atherosclerosis Risk in Communities (ARIC) study J Neuroimag 1991 1 68–73

    Article  Google Scholar 

  24. 24

    Riley WA et alHigh resolution B-mode ultrasound reading methods in the Atherosclerosis Risk in Communities (ARIC) cohort J Neuroimag 1991 1 168–172

    Article  Google Scholar 

  25. 25

    The MIDAS Research Group, Furberg CD, Byington RP, Borhani NA Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) Design Features Am J Med 1989 86 (Suppl 4A) 37–39

    Google Scholar 

  26. 26

    Salonen R, Haapanen A, Salonen JT Measurement of intima-media thickness of common carotid arteries with high resolution B-mode ultrasonography: inter and intra-observer variability Ultrasound Med Biol 1991 17 225–230

    CAS  PubMed  Article  Google Scholar 

  27. 27

    Salonen JT, Salonen R Ultrasound B-mode imaging in observational studies of atherosclerotic progression Circulation 1993 87 (Suppl II) II-56–II-65

    Google Scholar 

  28. 28

    Sahn DJ, De Maria A, Kisslo J, Weyman A Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements Circulation 1978 58 1072–1083

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  29. 29

    Devereux RB, Reichek N Echocardiographic determination of left ventricular mass in man: anatomic validation of the method Circulation 1977 55 613–618

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  30. 30

    Dubois D, Dubois EF A formula to estimate the approximate surface area if height and weight be known Arch Intern Med 1916 17 863–871

    CAS  Article  Google Scholar 

  31. 31

    Devereux RB et alStandardization of M-mode echocardiographic left ventricular anatomic measurements J Am Coll Cardiol 1984 4 1222–1230

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  32. 32

    Guidelines subcommittee: 1993 Guidelines for the Management of mild hypertension: memorandum from the World Health Organization and the International Society of Hypertension meeting J Hypertens 1993 11 90

  33. 33

    Ferrara A et alCardiovascular abnormalities in never treated hypertensives according to nondipper status Am J Hypertens 1998 11 1352–1357

    CAS  PubMed  Article  Google Scholar 

  34. 34

    Cuspidi C et alImpact of nocturnal fall in blood pressure on early cardiovascular changes in essential hypertension J Hypertens 1999 17 1339–1344

    CAS  PubMed  Article  Google Scholar 

  35. 35

    Zanchetti A et alRisk factors associated with alterations in carotid intima media thickness in hypertension: baseline data from the European lacidipine Study on Atherosclerosis J Hypertens 1998 16 949–961

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  36. 36

    Mancia G et alSystolic blood pressure and pulse pressure: role of 24-h mean values and and variability in the determination of organ damage J Hypertens 1999 17 (Suppl 5) S55–S61

    Google Scholar 

  37. 37

    Mancia G et alAmbulatory blood pressure monitoring J Hypertens 1996 14 (Suppl 2) s61–s68

    Article  Google Scholar 

  38. 38

    Verdecchia P, Schillaci G, Porcellati C Dippers versus ‘non dippers’ J Hypertens 1991 9 (Suppl 8) s42–s44

    Google Scholar 

  39. 39

    Schmieder RE et alGender-specific cardiovascular adaptation due to circadian blood pressure variations in essential hypertension Am J Hypertens 1995 8 1160–1166

    CAS  PubMed  Article  Google Scholar 

  40. 40

    Schulte KL et alRelationship between ambulatory blood pressure, forearm vascular resistance and left ventricular mass in hypertensive and normotensive subjects Am J Hypertens 1993 6 786–793

    CAS  PubMed  Article  Google Scholar 

  41. 41

    Castellano M et alAngiotensin converting enzyme I/D polymorphism and arterial wall thickness in a general population Circulation 1995 91 2721–2724

    CAS  PubMed  Article  Google Scholar 

  42. 42

    AJ Peixoto Filho, GA Mansoor, White W Effects of actual versus arbitrary awake and sleep times on analyses of 24 h blood pressure Am J Hypertens 1995 8 676–680

    Article  Google Scholar 

  43. 43

    Kronmal RA et alCarotid artery measures are strongly associated with left ventricular mass in older adults (a report from the Cardiovascular Health Study) Am J Cardiol 1996 77 628–633

    CAS  PubMed  Article  Google Scholar 

  44. 44

    Howard Get al,for the ARIC InvestigatorsCarotid artery intimal-medial thickness distribution in general population as evaluated by B-mode ultrasound Stroke 1993 24 1297–1304

    CAS  PubMed  Article  Google Scholar 

  45. 45

    Staessen JA et alPredicting cardiovascular risk using conventional vs ambulatory blood pressure in olderpatients with systolic hypertension JAMA 1999 282 539–546

    CAS  PubMed  PubMed Central  Article  Google Scholar 

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Acknowledgements

The authors wish to thank the Vobarno Town Council for their invaluable help and assistance in recruiting subjects, and conducting the study. This study was supported in part by a grant from the Lombardy Regione, Health and Hygiene Department (Regione Lombardia, Settore Sanita’ e Igiene), Italy.

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Correspondence to ML Muiesan.

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Salvetti, M., Muiesan, M., Rizzoni, D. et al. Night time blood pressure and cardiovascular structure in a middle-aged general population in northern Italy: the Vobarno Study. J Hum Hypertens 15, 879–885 (2001). https://doi.org/10.1038/sj.jhh.1001286

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Keywords

  • carotid intima-media thickness
  • atherosclerosis
  • left ventricular mass
  • ambulatory blood pressure monitoring

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