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Association of nocturnal blood pressure patterns with inflammation and central and peripheral estimates of vascular health in rheumatoid arthritis

Journal of Human Hypertension volume 32, pages 259–267 (2018)Cite this article

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Abstract

Predictors of adverse cardiovascular outcomes include elevated nighttime systolic blood pressure (SBP) and a non-dipping pattern. We investigated whether these factors correlate with systemic inflammation, cardiovascular risk, and markers of central and peripheral vascular damage in rheumatoid arthritis (RA), a disease characterized by excess cardiovascular risk. Twenty-four-hour ambulatory blood pressure monitoring was applied in patients and controls. Vascular assessments included measurement of arterial stiffness (pulse wave velocity) and carotid atherosclerosis (carotid intima-media thickness). Peripheral vascular resistance was estimated from impedance cardiography. Cardiovascular risk was calculated from the Framingham Heart Study. RA patients exhibited a higher prevalence of non-dipping pattern, elevated nighttime SBP and blunted dipping, compared to controls without cardiovascular comorbidities. Among RA patients, dipping levels correlated with arterial stiffness, and nighttime SBP with all vascular markers and cardiovascular risk. After adjustment for inflammation, the above associations with vascular measures were no longer significant. Plain categorization to dippers and non-dippers did not reveal any differences regarding inflammation, vascular measurements, and cardiovascular risk. However, the combination of a non-dipping profile with high nighttime SBP was accompanied by significantly higher levels of arterial stiffness and cardiovascular risk, compared to non-dippers with normal nighttime SBP; these parameters were similar between the latter group and dippers. Inflammation appears to mediate the observed associations of nighttime SBP and dipping levels with markers of subclinical vascular damage in RA patients. In these patients, the combination of a non-dipping profile with elevated nighttime SBP is accompanied by prominent subclinical vascular impairment and confers the highest cardiovascular risk.

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References

  1. van Halm VP, Peters MJL, Voskuyl AE, Boers M, Lems WF, Visser M, et al. Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE Investigation. Ann Rheum Dis. 2009;68:1395–1400.

    Article  Google Scholar 

  2. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum. 2002;46:862–73.

    Article  Google Scholar 

  3. Krakoff LR. Ambulatory blood pressure improves prediction of cardiovascular risk: implications for better antihypertensive management. Curr Atheroscler Rep. 2013;15:317.

    Article  Google Scholar 

  4. O’Brien E. Twenty-four-hour ambulatory blood pressure measurement in clinical practice and research: a critical review of a technique in need of implementation. J Intern Med. 2011;269:478–95.

    Article  Google Scholar 

  5. Cicek Y, Durakoglugil ME, Kocaman SA, Cetin M, Erdogan T, Dogan S, et al. Non-dipping pattern in untreated hypertensive patients is related to increased pulse wave velocity independent of raised nocturnal blood pressure. Blood Press. 2013;22:34–8.

    Article  Google Scholar 

  6. Cuspidi C, Sala C, Tadic M, Gherbesi E, Grassi G, Mancia G. Nondipping pattern and carotid atherosclerosis: a systematic review and meta-analysis. J Hypertens. 2016;34:382–5.

    Google Scholar 

  7. Fan H-Q, Li Y, Thijs L, Hansen TW, Boggia J, Kikuya M, et al. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens. 2010;28:2036–45.

    Article  CAS  Google Scholar 

  8. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M, et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens. 2002;20:2183–9.

    Article  CAS  Google Scholar 

  9. Salles GF, Reboldi G, Fagard RH, Cardoso CRL, Pierdomenico SD, Verdecchia P, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The ambulatory blood pressure collaboration in patients with hypertension (ABC-H) meta-analysis. Hypertension. 2016;67:693–700.

    Article  CAS  Google Scholar 

  10. Mancia G, Verdecchia P. Clinical value of ambulatory blood pressure: evidence and limits. Circ Res. 2015;116:1034–45.

    Article  CAS  Google Scholar 

  11. Kaya MG, Yarlioglues M, Gunebakmaz O, Gunturk E, Inanc T, Dogan A, et al. Platelet activation and inflammatory response in patients with non-dipper hypertension. Atherosclerosis. 2010;209:278–82.

    Article  CAS  Google Scholar 

  12. Tsioufis C, Syrseloudis D, Dimitriadis K, Thomopoulos C, Tsiachris D, Pavlidis P, et al. Disturbed circadian blood pressure rhythm and C-reactive protein in essential hypertension. J Hum Hypertens. 2008;22:501–8.

    Article  CAS  Google Scholar 

  13. Hamamoto K, Yamada S, Yasumoto M, Yoda M, Yoda K, Tsuda A, et al. Association of nocturnal hypertension with disease activity in rheumatoid arthritis. Am J Hypertens. 2016;29:340–7.

    CAS  PubMed  Google Scholar 

  14. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NSHLA, Kaplan SR, Liang MH, Luthra HS, et al. the American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.

    Article  CAS  Google Scholar 

  15. Celik G, Yilmaz S, Ergulu Esmen S. Non-dipping blood pressure patterns and arterial stiffness parameters in patients with Behcet’s disease. Hypertens Res. 2015;38:856–61.

    Article  CAS  Google Scholar 

  16. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm 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  Google Scholar 

  17. Prevoo M, van’t Hof M, Kuper H, van Leeuwen M, van de Putte L, van Riel P. Modified disease activity scores that include twenty-eight - joint counts. Arthritis Rheum. 1995;38:44–48.

    Article  CAS  Google Scholar 

  18. Rajzer MW, Wojciechowska W, Klocek M, Palka I, Brzozowska-Kiszka MM, Kawecka-Jaszcz K. Comparison of aortic pulse wave velocity measured by three techniques: complior, SphygmoCor and arteriograph. J Hypertens. 2008;26:2001–7.

    Article  CAS  Google Scholar 

  19. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular. J Am Soc Echocardiogr. 2008;21:93–111.

    Article  Google Scholar 

  20. Van De Water JM, Miller TW, Vogel RL, Mount BE, Dalton ML. Impedance cardiography the next vital sign technology? Chest. 2003;123:2028–33.

    Article  Google Scholar 

  21. Ventura HO, Taler SJ, Strobeck JE. Hypertension as a hemodynamic disease: the role of impedance cardiography in diagnostic, prognostic, and therapeutic decision making. Am J Hypertens. 2005;18:26S–43S.

    Article  Google Scholar 

  22. Crowson CS, Gabriel SE, Semb AG, van Riel PLCM, Karpouzas G, Dessein PH, et al. Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries. Rheumatology. 2017;56:1102–10.

    Article  CAS  Google Scholar 

  23. D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham heart study. Circulation. 2008;117:743–53.

    Article  Google Scholar 

  24. Bacaksiz A, Akif Vatankulu M, Sonmez O, Erdogan E, Tasal A, Turfan M, et al. Non-dipping nocturnal blood pressure in psoriasis vulgaris. Wien Klin Wochenschr. 2012;124:822–9.

    Article  Google Scholar 

  25. Pourafkari L, Masnadi-Shirazi K, Taban M, Mohammadi S, Parizad R, Ghaffari S, et al. Higher frequency of nocturnal blood pressure dipping but not heart rate dipping in inflammatory bowel disease. Dig Dis Sci. 2017;62:2863–9.

    Article  CAS  Google Scholar 

  26. Karakulak UN, Sahiner L, Maharjan N, Okutucu S, Evranos B, Aladag E, et al. Evaluation of the ambulatory arterial stiffness index in patients with rheumatoid arthritis. Blood Press Monit. 2015;20:254–9.

    Article  Google Scholar 

  27. Belt NK, Kronholm E, Kauppi MJ. Sleep problems in fibromyalgia and rheumatoid arthritis compared with the general population. Clin Exp Rheumatol. 2009;27:35–41.

  28. Taylor-Gjevre RM, Gjevre JA, Nair B, Skomro R, Lim HJ. Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthritis. Musculoskelet Care. 2011;9:152–9.

    CAS  Google Scholar 

  29. Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011;29:S92–6.

    CAS  PubMed  Google Scholar 

  30. Irwin MR, Olmstead R, Carrillo C, Sadeghi N, FitzGerald JD, Ranganath VK, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep. 2012;35:537–43.

    Article  Google Scholar 

  31. Mousa T, El-Sayed MA, Motawea AK, Salama MA, Elhendy A. Association of blunted nighttime blood pressure dipping with coronary artery stenosis in men. Am J Hypertens. 2004;17:977–80.

    Article  Google Scholar 

  32. Cicconetti P. Blunted nocturnal fall in blood pressure and left ventricular mass in elderly individuals with recently diagnosed isolated systolic hypertension. Am J Hypertens. 2003;16:900–5.

    Article  Google Scholar 

  33. Hoshide S, Kario K, Hoshide Y, Umeda Y, Hashimoto T, Kunii O, et al. Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives. Am J Hypertens. 2003;16:434–8.

    Article  Google Scholar 

  34. Cavelaars M, Tulen JHM, van Bemmel JH, van den Meiracker AH. Physical activity, dipping and haemodynamics. J Hypertens. 2004;22:2303–9.

    Article  CAS  Google Scholar 

  35. Hermida RC, Ayala DE, Mojón A, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the Mapec study. Chronobiol Int. 2010;27:1629–51.

    Article  Google Scholar 

  36. Manning G, Rushton L, Donnelly R, Millar-Craig MW. Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects. Am J Hypertens. 2000;13:1035–8.

    Article  CAS  Google Scholar 

  37. Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B, et al. Reproducibility of nocturnal blood pressure fall in early phases of untreated essential hypertension: a prospective observational study. J Hum Hypertens. 2004;18:503–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Eugenia Gkaliagkousi, Panagiota Anyfanti, Areti Triantafyllou, Antonios Lazaridis & Stella Douma

  2. Rheumatology Department, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Sophia Chatzimichailidou & Spyros Aslanidis

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  1. Eugenia Gkaliagkousi
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Correspondence to Eugenia Gkaliagkousi.

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Gkaliagkousi, E., Anyfanti, P., Chatzimichailidou, S. et al. Association of nocturnal blood pressure patterns with inflammation and central and peripheral estimates of vascular health in rheumatoid arthritis. J Hum Hypertens 32, 259–267 (2018). https://doi.org/10.1038/s41371-018-0047-0

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