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High pulse pressure and nondipping circadian blood pressure in patients with coronary artery disease: Relationship to thrombogenesis and endothelial damage/dysfunction.
Am J Hypertens. 2005 Jan; 18(1):104-15.AJ

Abstract

BACKGROUND

Patients with high ambulatory pulse pressure (APP) or nondipping pattern of circadian BP (nondippers) are at increased risk of cardiovascular disease that may be due to abnormalities in coagulopathy and vascular function. We hypothesized that patients with high APP or nondipper status have an adverse hemostasis profile. Accordingly, we assessed hemorheology (by plasma viscosity and fibrinogen levels), endothelial damage/dysfunction (von Willebrand factor [vWf] and flow-mediated dilatation [FMD]), thrombogenesis (D-dimer), and platelet activation (soluble P-selectin).

METHODS

Seventy-three patients (58 men, 59 +/- 11 years) with stable coronary artery disease completed 24-h ambulatory BP monitoring. Plasma viscosity was assessed on a Coulter viscometer, fibrinogen by Clauss, vWf, D-dimer and soluble P selectin by ELISA, and FMD by reactive hyperemia.

RESULTS

High APP (median APP >/=51 mm Hg) and nondipping was associated with significantly higher levels of vWf, D-dimer, fibrinogen, and soluble P-selectin compared to patients with low APP and dippers, respectively (all P < .05), even after adjustment for ages, 24-h mean systolic, mean diastolic, and mean arterial BPs. After the same adjustments, as well as for dipping status, white coat effects, and left ventricular mass, patients with high APP also had more impaired FMD and still significantly higher levels of vWf and D-dimer, compared to patients with low APP (all P < .05). However, the highest levels of vWf, fibrinogen, and soluble P-selectin and the most impaired FMD were found in those nondipper patients with concurrent high APP.

CONCLUSIONS

High ambulatory pulse pressure or nondipping pattern of circadian BP per se are important pathophysiologic factors that may influence cardiovascular risk by altering hemostasis or endothelial function.

Authors+Show Affiliations

Lee KW
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, England, UK.
Blann AD
No affiliation info available
Lip GY
No affiliation info available

MeSH

AgedBiomarkersBlood PressureBlood Pressure Monitoring, AmbulatoryCase-Control StudiesCircadian RhythmCoronary Artery DiseaseCoronary ThrombosisEndothelium, VascularFemaleFibrinogenHeart RateHumansMaleMiddle AgedMultivariate AnalysisP-SelectinPlatelet ActivationRisk FactorsThrombosisvon Willebrand Factor

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15691624

Citation

Lee, Kaeng W., et al. "High Pulse Pressure and Nondipping Circadian Blood Pressure in Patients With Coronary Artery Disease: Relationship to Thrombogenesis and Endothelial Damage/dysfunction." American Journal of Hypertension, vol. 18, no. 1, 2005, pp. 104-15.
Lee KW, Blann AD, Lip GY. High pulse pressure and nondipping circadian blood pressure in patients with coronary artery disease: Relationship to thrombogenesis and endothelial damage/dysfunction. Am J Hypertens. 2005;18(1):104-15.
Lee, K. W., Blann, A. D., & Lip, G. Y. (2005). High pulse pressure and nondipping circadian blood pressure in patients with coronary artery disease: Relationship to thrombogenesis and endothelial damage/dysfunction. American Journal of Hypertension, 18(1), 104-15.
Lee KW, Blann AD, Lip GY. High Pulse Pressure and Nondipping Circadian Blood Pressure in Patients With Coronary Artery Disease: Relationship to Thrombogenesis and Endothelial Damage/dysfunction. Am J Hypertens. 2005;18(1):104-15. PubMed PMID: 15691624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High pulse pressure and nondipping circadian blood pressure in patients with coronary artery disease: Relationship to thrombogenesis and endothelial damage/dysfunction. AU - Lee,Kaeng W, AU - Blann,Andrew D, AU - Lip,Gregory Y H, PY - 2004/05/13/received PY - 2004/06/29/revised PY - 2004/09/07/accepted PY - 2005/2/5/pubmed PY - 2006/6/6/medline PY - 2005/2/5/entrez SP - 104 EP - 15 JF - American journal of hypertension JO - Am J Hypertens VL - 18 IS - 1 N2 - BACKGROUND: Patients with high ambulatory pulse pressure (APP) or nondipping pattern of circadian BP (nondippers) are at increased risk of cardiovascular disease that may be due to abnormalities in coagulopathy and vascular function. We hypothesized that patients with high APP or nondipper status have an adverse hemostasis profile. Accordingly, we assessed hemorheology (by plasma viscosity and fibrinogen levels), endothelial damage/dysfunction (von Willebrand factor [vWf] and flow-mediated dilatation [FMD]), thrombogenesis (D-dimer), and platelet activation (soluble P-selectin). METHODS: Seventy-three patients (58 men, 59 +/- 11 years) with stable coronary artery disease completed 24-h ambulatory BP monitoring. Plasma viscosity was assessed on a Coulter viscometer, fibrinogen by Clauss, vWf, D-dimer and soluble P selectin by ELISA, and FMD by reactive hyperemia. RESULTS: High APP (median APP >/=51 mm Hg) and nondipping was associated with significantly higher levels of vWf, D-dimer, fibrinogen, and soluble P-selectin compared to patients with low APP and dippers, respectively (all P < .05), even after adjustment for ages, 24-h mean systolic, mean diastolic, and mean arterial BPs. After the same adjustments, as well as for dipping status, white coat effects, and left ventricular mass, patients with high APP also had more impaired FMD and still significantly higher levels of vWf and D-dimer, compared to patients with low APP (all P < .05). However, the highest levels of vWf, fibrinogen, and soluble P-selectin and the most impaired FMD were found in those nondipper patients with concurrent high APP. CONCLUSIONS: High ambulatory pulse pressure or nondipping pattern of circadian BP per se are important pathophysiologic factors that may influence cardiovascular risk by altering hemostasis or endothelial function. SN - 0895-7061 UR - https://www.unboundmedicine.com/medline/citation/15691624/High_pulse_pressure_and_nondipping_circadian_blood_pressure_in_patients_with_coronary_artery_disease:_Relationship_to_thrombogenesis_and_endothelial_damage/dysfunction_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓27]

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