This article reviews the clinical value of ambulatory blood pressure (BP) vis-a-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ damage as well as protection from major cardiovascular complications to a degree that justifies the complexity and cost of the procedure.

Clinical Value of Ambulatory Blood Pressure: Evidence and Limits

https://www.onlinecjc.ca/article/S0828-282X(13)00103-7/pdf

Blood Pressure Variability: A Novel and Important Risk Factor

Clinic blood pressure (BP) is recognized as the gold standard for the screening, diagnosis, and management of hypertension. However, optimal diagnosis and successful management of hypertension cannot be achieved exclusively by a handful of conventionally acquired BP readings. It is critical to estimate the magnitude of BP variability by estimating and quantifying each individual patient's specific BP variations. Short-term BP variability or exaggerated circadian BP variations that occur within a day are associated with increased cardiovascular events, mortality and target-organ damage. Popular concepts of BP variability, including "white-coat hypertension" and "masked hypertension", are well recognized in clinical practice. However, nocturnal hypertension, morning surge, and morning hypertension are also important phenotypes of short-term BP variability that warrant attention, especially in the primary-care setting. In this review, we try to theorize and explain these phenotypes to ensure they are better understood and recognized in day-to-day clinical practice.

/pdf/understanding-short-term-blood-pressure-variability-20is5uvgi1.pdf

Understanding short-term blood-pressure-variability phenotypes: from concept to clinical practice

Objective To determine if ambulatory blood pressure (ABP) at night relative to day ABP among adolescents is influenced by unfair treatment and trait anger, and whether these associations are stronger in African Americans and adolescents from lower socioeconomic status (SES) families and neighborhoods. Methods A total of 189 healthy white and African American adolescents (ages = 14-16 years, standard deviation = 0.62, 50% female) completed 2 days and 1 night of ABP monitoring and unfair treatment and trait anger questionnaires. SES was measured using 1) parental education and 2) a composite neighborhood SES score based on U.S. Census tract data for neighborhood poverty and education. The night/day ABP ratio was calculated by dividing the night ABP mean (readings from the self-reported bedtime of each participant through 5 AM) by the day ABP mean (8:30 AM until self-reported bedtime). Results Higher trait anger was associated with a higher night/day diastolic blood pressure (DBP) ratio in the full sample, B = 0.003, SE = 0.001, t = 2.20, p = .03. A significant interaction effect for Race x Unfair Treatment on the night/day DBP ratio, B = 0.01, SE = 0.003, t = 3.17, p = .002, followed by post hoc tests indicated that greater unfair treatment was associated with a higher night/day DBP ratio among African Americans, B = 0.006, SE = 0.002, t = 2.56, p = .01. Further, among African American adolescents living in lower SES neighborhoods, greater unfair treatment predicted a higher night/day DBP ratio, B = 0.008, SE = 0.003, t = 3.15, p = .002, and higher trait anger scores predicted a higher night/day DBP ratio, B = 0.008, SE = 0.002, t = 3.19, p = .002. Conclusions Trait anger may be a factor leading to elevated nighttime DBP in both African Americans and whites. Unfair treatment and trait anger are important predictors of elevated night/day ABP ratios among African American adolescents living in lower SES neighborhoods. These factors may contribute to the onset of hypertension in African Americans at a younger age.

/pdf/unfair-treatment-and-trait-anger-in-relation-to-nighttime-3qlxwmnk7p.pdf

Unfair treatment and trait anger in relation to nighttime ambulatory blood pressure in African American and white adolescents.

High blood pressure (BP) is a potent risk factor for cardiovascular disease in the general population. Unfortunately, however, the standard sphygmomanometric measurements of BP, taken as an index of the average BP load, have a quite weak predictive power in the single individual. One possible reason for that is the high variability of BP, with consequent need of several measurements in order to provide a more representative estimate of the average BP load to which a given person is exposed over a given time interval. On this assumption, clinically hypertensive subjects may benefit from ambulatory BP monitoring (ABPM), a procedure which gathers several BP measurements over time, when a main condition is fulfilled: The difference in cardiovascular disease risk among different categories generated by ABPM should be greater than the difference among risk categories generated by the standard measurement of BP. As a result, statistical models including different measures of ABPM should lead, after adjustment for concomitant risk factors, to a lesser unexplained risk of cardiovascular disease than models including different measures of clinic BP.

Prognostic Value of Ambulatory Blood Pressure Monitoring

Background: Insulin resistance, assessed by triglyceride-glucose (TyG) index, and arterial stiffness contribute to the pathogenesis of hypertension and cardiovascular diseases. However, the relationship between TyG index and risk of arterial stiffness among various risk factors and comorbidities remains unclear. Objective: We aimed to analyze the significance of the TyG index in predicting the risk of arterial stiffness among the population with various risk factors and comorbidities. Method: We conducted literature search in PubMed, ScienceDirect, and Google Scholar databases from January 1, 2017 – August 31, 2022. Observational studies evaluating the association between TyG index and arterial stiffness, measured by carotid-femoral pulse wave velocity (cfPWV) or brachial-ankle pulse wave velocity (baPWV), among population with various risk factors and comorbidities, and reporting odds ratio (OR) after multivariate analysis were included. The random-effects model was used for estimating pooled ORs with the corresponding confidence intervals (CIs). Results: We included 12 observational studies including 51,258 participants. Higher TyG index was significantly associated with higher risk of arterial stiffness (OR = 1.77, CI95% = 1.5–2.1, p < 0.001), in population aged > 65 years (OR = 1.43, CI95% = 1.08–1.9, p = 0.01), with type 2 diabetes mellitus (T2DM) (OR = 1.32, CI95% = 1.17–1.49, p < 0.01), and body mass index (BMI) <25 kg/m2 (OR = 1.35, CI95% = 1.06–1.73, p = 0.02), while insignificant association was found in non-normotensive, glomerular filtration rate (GFR) <60 mL/min, smoking, and/or alcoholic populations. Conclusion: A higher TyG index is associated with higher risk of arterial stiffness, significantly in the population aged >65 years, with T2DM, and BMI <25 kg/m2. 

7. Association between Triglyceride-Glucose Index and Arterial Stiffness among Various Risk Factors and Comorbidities: An Observational Studies-based Meta-analysis and Systematic Review

Although the prognostic value of the day-night blood pressure (BP) changes is established, the most appropriate method for defining day and night is undefined. We assessed the prognostic value of the day-night BP changes by using three definitions of day and night in 2,934 initially untreated hypertensive subjects who underwent 24-hour ambulatory BP monitoring. Over a median follow-up period of 7 years, there were 356 cardiovascular events and 176 deaths. Total cardiovascular events and all-cause mortality were similarly higher in non-dippers (night/day ratio of systolic BP 10% or 0%) than in dippers regardless of the definition of day and night. In a receiver-operated characteristic (ROC) curve analysis of the night/day ratio of systolic BP on the occurrence of events, the area under the ROC curve did not differ among the different definitions of day and night (large fixed-clock intervals, narrow fixed-clock intervals, diary) for both total cardiovascular events (0.61 [95% confidence interval (CI): 0.58 to 0.64], 0.61 [95% CI: 0.57 to 0.63], 0.62 [95% CI: 0.58 to 0.65], respectively; P 0.20) and all-cause mortality (0.65 [95% CI: 0.61 to 0.70], 0.64 [95% CI: 0.60 to 0.69], 0.65 [95% CI: 0.61 to 0.70], respectively; P 0.78). The prognostic value of the diurnal BP changes is comparable when using different clock-dependent or independent

Research Article Prognostic value of circadian blood pressure changes in relation to differing measures of day and night

ACE-inhibitors; Angiotensin receptor blockers; Cardiovascular risk; Diabetes mellitus; Heart failure; Myocardial infarction; Renal insufficiency; Renin-angiotensin system. Angiotensin II receptor blockers (ARBs) are widely used in patients with hypertension, heart failure, di- abetic nephropathy, and other conditions. Over-stimulation of AT 2 receptor as a result of AT 1 blockade may contribute to the beneficial effects of ARBs through vasodilation and inhibition of cardiac and vas- cular hypertrophy and fibrosis. Some experimental studies, however, suggested that AT2 receptor over- stimulation, in addition to beneficial effects, might trigger inhibition of angiogenesis and apoptosis. In a review, some authors suggested that ARBs may increase the risk of myocardial infarction. This position triggered a hot scientific debate and further analyses of existing data. We completed a meta-analysis of randomized clinical trials comparing ARBs with either placebo or active drugs different from ARBs. ARBs were not associated with an excess risk of myocardial infarction (odds ratio 1.03 in a random-ef- fect model and 1.02 in a fixed-effect model). Cardiovascular mortality did not differ between ARBs and drugs different from ARBs (odds ratio 1.00 in a random-effect model and 0.99 in a fixed-effect model) and it was slightly lesser with ARBs than with placebo (odds ratio 0.91; 95% confidence interval 0.83- 0.99; p = 0.042) in a prespecified subgroup analysis. Other meta-analyses confirmed these data. In conclusion, evidence from randomized trials does not support the hypothesis that AT 2 receptor over-stimulation produces harmful clinical effects. Current indications and contraindications to the use of ARBs in patients with hypertension, heart failure, and diabetic nephropathy should be main- tained and probably extended to the entire class of these drugs.

https://www.giornaledicardiologia.it/r.php?v=683&a=7934&l=10930&f=allegati/00683_2007_08/fulltext/08-07_03 491-497.pdf

Antihypertensive therapy and cardiovascular prevention. The role of angiotensin II receptor blockers

Although the prognostic value of the day-night blood pressure (BP) changes is established, the most appropriate method for defining day and night is undefined. We assessed the prognostic value of the day-night BP changes by using three definitions of day and night in 2,934 initially untreated hypertensive subjects who underwent 24-hour ambulatory BP monitoring. Over a median follow-up period of 7 years, there were 356 cardiovascular events and 176 deaths. Total cardiovascular events and all-cause mortality were similarly higher in non-dippers (night/day ratio of systolic BP >10% or >0%) than in dippers regardless of the definition of day and night. In a receiver-operated characteristic (ROC) curve analysis of the night/day ratio of systolic BP on the occurrence of events, the area under the ROC curve did not differ among the different definitions of day and night (large fixed-clock intervals, narrow fixed-clock intervals, diary) for both total cardiovascular events (0.61 [95% confidence interval (CI): 0.58 to 0.64], 0.61 [95% CI: 0.57 to 0.63], 0.62 [95% CI: 0.58 to 0.65], respectively; P = 0.20) and all-cause mortality (0.65 [95% CI: 0.61 to 0.70], 0.64 [95% CI: 0.60 to 0.69], 0.65 [95% CI: 0.61 to 0.70], respectively; P = 0.78). The prognostic value of the diurnal BP changes is comparable when using different clock-dependent or independent definitions of day and night.

Prognostic value of circadian blood pressure changes in relation to differing measures of day and night

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Francesco Andreani

Author Tools

Chat about Author

Papers

7. Association between Triglyceride-Glucose Index and Arterial Stiffness among Various Risk Factors and Comorbidities: An Observational Studies-based Meta-analysis and Systematic Review

Research Article Prognostic value of circadian blood pressure changes in relation to differing measures of day and night

Antihypertensive therapy and cardiovascular prevention. The role of angiotensin II receptor blockers

Prognostic value of circadian blood pressure changes in relation to differing measures of day and night