.: ORİJİNAL ARAŞTIRMA
The Relation Between Non-dipping Blood Pressure Pattern and Postural Orthostatic Tachycardia Syndrome in Hypertensive Patients
Hipertansif Hastalarda Non-dipping Kan Basıncı Biçimi ve Postüral Ortostatik Taşikardi Sendromu Arasındaki İlişki
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(2):77-83
doi: 10.5336/cardiosci.2018-63303
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Postural orthostatic tachycardia syndrome (POTS) is an orthostatic intolerance with a pathophysiology that is likely to be heterogeneous. Hypertensive patients with a non-dipping pattern have an increased cardiovascular risk. There is a possibility that the same pathophysiological mechanisms may have a role in both POTS and the non-dipping pattern. To our knowledge, there are some studies showing the relation between POTS and non-dipping pattern in normotensive patients. However, data about this relation in hypertensive patients is limited. Our aim was to investigate the relation between 24-hour ambulatory blood pressure monitoring (ABPM) parameters and POTS in our study. Material and Methods: A total of 271 suitable patients were enrolled in our study. ABPM, Tilt table test, echocardiography, and laboratory tests were performed. Results: The study included 39 (14.3%) patients with POTS. There were no differences in the demographic variables, drug therapies, and laboratory as well as echocardiography parameters in all patients. Day-time, night-time, and 24-hour mean systolic and diastolic blood pressures and frequency of non-dipping pattern were significantly higher in patients with POTS. Day-time mean systolic blood pressure and non-dipping pattern were determined as independent predictors for POTS in multivariate logistic regression analysis. Conclusion: A relation was observed between POTS and non-dipping pattern in patients with hypertension, which needs further exploration in larger and detailed studies. Clinicians might be aware of POTS if their hypertensive patients complain of palpitations, lightheadedness, and fatigue in an upright position.
Keywords: Hypertension; postural orthostatic tachycardia syndrome; orthostatic intolerance; blood pressure monitoring; ambulatory
Objective: Postural orthostatic tachycardia syndrome (POTS) is an orthostatic intolerance with a pathophysiology that is likely to be heterogeneous. Hypertensive patients with a non-dipping pattern have an increased cardiovascular risk. There is a possibility that the same pathophysiological mechanisms may have a role in both POTS and the non-dipping pattern. To our knowledge, there are some studies showing the relation between POTS and non-dipping pattern in normotensive patients. However, data about this relation in hypertensive patients is limited. Our aim was to investigate the relation between 24-hour ambulatory blood pressure monitoring (ABPM) parameters and POTS in our study. Material and Methods: A total of 271 suitable patients were enrolled in our study. ABPM, Tilt table test, echocardiography, and laboratory tests were performed. Results: The study included 39 (14.3%) patients with POTS. There were no differences in the demographic variables, drug therapies, and laboratory as well as echocardiography parameters in all patients. Day-time, night-time, and 24-hour mean systolic and diastolic blood pressures and frequency of non-dipping pattern were significantly higher in patients with POTS. Day-time mean systolic blood pressure and non-dipping pattern were determined as independent predictors for POTS in multivariate logistic regression analysis. Conclusion: A relation was observed between POTS and non-dipping pattern in patients with hypertension, which needs further exploration in larger and detailed studies. Clinicians might be aware of POTS if their hypertensive patients complain of palpitations, lightheadedness, and fatigue in an upright position.
Keywords: Hypertension; postural orthostatic tachycardia syndrome; orthostatic intolerance; blood pressure monitoring; ambulatory
ÖZET
Amaç: Postüral ortostatik taşikardi sendromu (POTS) bir ortostatik tolerans bozukluğudur. Bu sendromun patofizyolojisi muhtemelen heterojendir. Hipertansif hastalarda non-dipping patern varlığı kardiyovasküler riski artırmaktadır. Aynı patofizyolojik mekanizmaların, hem POTS hem de non-dipping paternde rol alması ihtimali mevcuttur. Bildiğimiz kadarıyla, normotansif hastalarda non-dipping patern ile POTS arasındaki ilişkiyi gösteren bazı yayınlar mevcuttur. Fakat hipertansif hastalarda bu ilişkiye dair veri kısıtlıdır. Amacımız hipertansif hastalarda 24 saatlik ambulatuvar kan basıncı ölçümleri (AKBÖ) ile POTS arasında bir ilişki olup olmadığını incelemekti. Gereç ve Yöntemler: 271 hasta çalışmamıza dâhil edildi. Tüm hastalara AKBÖ, Tilt masa testi, ekokardiyografi ve laboratuvar testleri yapıldı. Bulgular: 39 (%14,3) hastada POTS saptandı. Demografik veriler, ilaç tedavileri, laboratuvar ve ekokardiyografi parametreleri tüm hastalarda benzerdi. Gündüz, gece ve 24 saatlik ortalama sistolik ve diyastolik kan basınçları ve non-dipping profil sıklığı POTS olan hastalarda belirgin olarak daha yüksekti. Çok değişkenli lojistik regresyon analizinde, gündüz ortalama sistolik kan basıncı ve non-dipping kan basıncı profili POTS gelişimi için bağımsız öngördürücüler olarak saptandı. Sonuç: Hipertansif hastalarda nondipping profil ile POTS arasında bir ilişki gözlenmiştir. Bu ilişkinin varlığını araştırmak için daha büyük ve detaylı çalışmalara ihtiyaç vardır. Klinisyenler hipertansiyon hastalarında ayağa kalkınca meydana gelen çarpıntı, yorgunluk, sersemlik gibi şikâyetler varsa POTS açısından dikkatli olmalıdırlar.
Anahtar Kelimeler: Hipertansiyon; postural ortostatik taşikardi sendromu; ortostatik intolerans; kan basıncı izlemi; ambulatuar
Amaç: Postüral ortostatik taşikardi sendromu (POTS) bir ortostatik tolerans bozukluğudur. Bu sendromun patofizyolojisi muhtemelen heterojendir. Hipertansif hastalarda non-dipping patern varlığı kardiyovasküler riski artırmaktadır. Aynı patofizyolojik mekanizmaların, hem POTS hem de non-dipping paternde rol alması ihtimali mevcuttur. Bildiğimiz kadarıyla, normotansif hastalarda non-dipping patern ile POTS arasındaki ilişkiyi gösteren bazı yayınlar mevcuttur. Fakat hipertansif hastalarda bu ilişkiye dair veri kısıtlıdır. Amacımız hipertansif hastalarda 24 saatlik ambulatuvar kan basıncı ölçümleri (AKBÖ) ile POTS arasında bir ilişki olup olmadığını incelemekti. Gereç ve Yöntemler: 271 hasta çalışmamıza dâhil edildi. Tüm hastalara AKBÖ, Tilt masa testi, ekokardiyografi ve laboratuvar testleri yapıldı. Bulgular: 39 (%14,3) hastada POTS saptandı. Demografik veriler, ilaç tedavileri, laboratuvar ve ekokardiyografi parametreleri tüm hastalarda benzerdi. Gündüz, gece ve 24 saatlik ortalama sistolik ve diyastolik kan basınçları ve non-dipping profil sıklığı POTS olan hastalarda belirgin olarak daha yüksekti. Çok değişkenli lojistik regresyon analizinde, gündüz ortalama sistolik kan basıncı ve non-dipping kan basıncı profili POTS gelişimi için bağımsız öngördürücüler olarak saptandı. Sonuç: Hipertansif hastalarda nondipping profil ile POTS arasında bir ilişki gözlenmiştir. Bu ilişkinin varlığını araştırmak için daha büyük ve detaylı çalışmalara ihtiyaç vardır. Klinisyenler hipertansiyon hastalarında ayağa kalkınca meydana gelen çarpıntı, yorgunluk, sersemlik gibi şikâyetler varsa POTS açısından dikkatli olmalıdırlar.
Anahtar Kelimeler: Hipertansiyon; postural ortostatik taşikardi sendromu; ortostatik intolerans; kan basıncı izlemi; ambulatuar
REFERANSLAR:
- Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. [Crossref] [PubMed]
- Jacob G, Robertson D, Mosqueda-Garcia R, Ertl AC, Robertson RM, Biaggioni I. Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. Am J Med. 1997;103(2):128-33. [Crossref]
- Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, et al. The neuropathic postural tachycardia syndrome. N Engl J Med. 2000;343(14):1008-14. [Crossref] [PubMed]
- Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia. Neurology. 1993;43(1):132-7. [Crossref] [PubMed]
- Masuki S, Eisenach JH, Johnson CP, Dietz NM, Benrud-Larson LM, Schrage WG, et al. Excessive heart rate response to orthostatic stress in postural tachycardia syndrome is not caused by anxiety. J Appl Physiol (1985). 2007;102(3):896-903. [Crossref] [PubMed]
- Novak V, Novak P, Opfer-Gehrking TL, O?Brien PC, Low PA. Clinical and laboratory indices that enhance the diagnosis of postural tachycardia syndrome. Mayo Clin Proc. 1998;73(12):1141-50. [Crossref] [PubMed]
- Dubielski Z, Zamojski M, Wiechecki B, Możeńska O, Petelczyc M, Kosior DA. The current state of knowledge about the dipping and non-dipping hypertension. Arterial Hypertens. 2016;20(2):33-43. [Crossref]
- Yıldız C, Yıldız A, Tekiner F, Karakurt A. Cardiac autonomic impairment and chronotropic incompetence in dipper and nondipper hypertension. Turkiye Klinikleri J Cardiovasc Sci. 2015;27(2):68-72. [Crossref]
- Kurpesa M, Trzos E, Drozdz J, Bednarkiewicz Z, Krzemińska-Pakuła M. Myocardial ischemia and autonomic activity in dippers and non-dippers with coronary artery disease: assessment of normotensive and hypertensive patients. Int J Cardiol. 2002;83(2):133-42. [Crossref]
- Figueroa JJ, Bott-Kitslaar DM, Mercado JA, Basford JR, Sandroni P, Shen WK, et al. Decreased orthostatic adrenergic reactivity in non-dipping postural tachycardia syndrome. Auton Neurosci. 2014;185:107-11. [Crossref] [PubMed] [PMC]
- Caf H, Dönmez Y, Güler EÇ, Kaypakli O, İçen YK, Koç M. Morning blood pressure surge is associated independently with orthostatic hypotension in hypertensive patients under treatment. Blood Press Monit. 2018;23(4):191-7. [Crossref] [PubMed]
- Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014;5(1):17-39.
- Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107(10):1401-6. [Crossref] [PubMed]
- Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2017;14(8): e155-e217. [Crossref] [PubMed]
- Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al; Chamber Quantification Writing Group. Recommendations for chamber quantification: a report from the American Society of Echocardiography?s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63. [Crossref] [PubMed]
- Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2(5):358-67. [Crossref]
- Sucu MM, Akçay M, Davutoğlu V. [Current perspective to postural orthostatic tachycardia syndrome: review]. Turkiye Klinikleri J Cardiovasc Sci. 2009;21(2):267-74.
- Plash WB, Diedrich A, Biaggioni I, Garland EM, Paranjape SY, Black BK, et al. Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics. Clin Sci (Lond). 2013; 124(2):109-14. [Crossref] [PubMed] [PMC]
- Sherwood A, Steffen PR, Blumenthal JA, Kuhn C, Hinderliter AL. Nighttime blood pressure dipping: the role of the sympathetic nervous system. Am J Hypertens. 2002;15(2 Pt 1):111-8. [Crossref]
- El Mansari M, Guiard BP, Chernoloz O, Ghanbari R, Katz N, Blier P. Relevance of norepinephrine-dopamine interactions in the treatment of major depressive disorder. CNS Neurosci Ther. 2010;16(3):e1-17. [Crossref] [PubMed] [PMC]
- Klabunde RE. Neurohumoral control of the heart and circulation. Cardiovascular Physiology Concepts. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p.136-7.
- Raj SR. Postural tachycardia syndrome (POTS). Circulation. 2013;127(23):2336-42. [Crossref] [PubMed] [PMC]
- Huang Y, Mai W, Hu Y, Wu Y, Song Y, Qiu R, et al. Poor sleep quality, stress status, and sympathetic nervous system activation in nondipping hypertension. Blood Press Monit. 2011;16(3):117-23. [Crossref] [PubMed]
- Hojo Y, Noma S, Ohki T, Nakajima H, Satoh Y. Autonomic nervous system activity in essential hypertension: a comparison between dippers and non-dippers. J Hum Hypertens. 1997;11(10):665-71. [Crossref] [PubMed]
- Tun Y, Okabe S, Hida W, Kurosawa H, Tabata M, Kikuchi Y, et al. Nocturnal blood pressure during apnoeic and ventilatory periods in patients with obstructive sleep apnoea. Eur Respir J. 1999;14(6):1271-7. [Crossref] [PubMed]
- Banskota NK, Taub R, Zellner K, Olsen P, King GL. Characterization of induction of protooncogene c-myc and cellular growth in human vascular smooth muscle cells by insulin and IGF-I. Diabetes. 1989;38(1):123-9. [Crossref] [PubMed]
- Spallone V, Gambardella S, Maiello MR, Barini A, Frontoni S, Menzinger G. Relationship between autonomic neuropathy, 24-h blood pressure profile, and nephropathy in normotensive IDDM patients. Diabetes Care. 1994;17(6):578-84. [Crossref] [PubMed]
- Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, et al. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med. 2002;347(11):797-805. [Crossref] [PubMed]
- Tutal E, Sayın B, Ertugrul DT, Ibis A, Sezer S, Ozdemir N. Is there a link between hyperuricemia, morning blood pressure surge, and non-dipping blood pressure pattern in metabolic syndrome patients? Int J Nephrol Renovasc Dis. 2013;6:71-7. [Crossref] [PubMed] [PMC]
- Fedecostante M, Spannella F, Cola G, Espinosa E, Dessì-Fulgheri P, Sarzani R. Chronic kidney disease is characterized by ?double trouble? higher pulse pressure plus night-time systolic blood pressure and more severe cardiac damage. PLoS One. 2014;9(1):e86155. [Crossref] [PubMed] [PMC]
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