The Association Between Morning Blood Pressure Surge And Target Organ Damage In Patients With Essential Hypertension

Objective To investigate the association between morning blood pressure surge (MBPS) and target organ damage in patients with essential hypertension.Methods According to the results of 24 h ambulatory blood pressure monitoring, we divided selected 155 patients into the morning blood pressure surge group (MBPS group),83 cases and the morning blood pressure normal group (NMBPS group),72 cases. Patients in the two groups were asked about alcohol drinking and smoking history. We kept the record of the clinic blood pressure (CBP), age, course of disease and body mass index (BMI). Blood tests, including fasting plasma glucose (FPG), triglyeride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). High-sensitivity C-reactive protein (hs-CRP) were measured with turbidimetry, matrix metalloproteinase-9(MMP-9)and Microalbuminuria (mAlb) with euzymelinked immunosorbent assay (ELISA) and left ventricular weight index (LVMI) by echocardiography. All patients went through the carotid ultrasound to check and measure intima-medial thickness (CCA-IMT) and plaques of carotid arteries. Flow-mediated dilation (FMD) in the brachial artery were measured by high-resolution ultrasound technique.Results①The mutation rate was significantly higher in the MBPS group. The average of 24 h SBP, day SBP and night SBP of the MBPS group were maintained at high levels, and significantly higher than that the NMBPS group (P<0.05);②Compared with NMBPS group, MBPS group had significant increase in hs-CRP, MMP-9, mAlb and LVMI (P<0.01), while decrease in FMD (P<0.01);③The CCA-IMT of the MBPS group was significantly thicker than that the NMBPS group (P<0.05). Compared with the NMBPS group, the severity of carotid arteries plaque of the MBPS group was significantly higher (P<0.01);④Pearson relation analysis showed that MBPS level had significant positive correlation with age (r=0.302, P=0.002), course of disease(r=0.176, P=0.039), the average of 24 h SBP (r=0.491, P<0.001), LDL (r=0.359, P<0.001), hs-CRP (r=0.537, P<0.001), MMP-9 (r=0.852, P<0.001), CCA-IMT (r=0.637, P<0.001) or FMD(r=-0.271, P=0.006);⑤Multipleregression analysis showed that the average of 24 h SBP, LDL, hs-CRP, MMP-9, CCA-IMT or FMD were predictors to MBPS levels, especically the average of 24 h SBP.Conclusion①The morning blood pressure surge and target organ damage are closely related in patients with essential hypertension. It is important to control the level of the MBPS in the hypertension treatment.②It seems that the morning blood pressure is a risk factor for cardiovascular disease. The morning blood pressure surge is also an objective indicator of the severity of pathogenetic condition.③The morning blood pressure surge is related to hs-CRP, MMP-9 and FMD in patients with essential hypertension. It is indicating that compared with the NMBPS group, the inflammatory response and the severity of endothelium dependent vasodilatation the MBPS group was significantly higher. The treatment of hypertension is an integrated process, we should pay attention to not only blood pressure, but also anti-inflammatory and to improve endothelial function.