Skip to main content

Advertisement

Log in

Higher Frequency of Nocturnal Blood Pressure Dipping but Not Heart Rate Dipping in Inflammatory Bowel Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Masked hypertension (MHTN) and lack of nocturnal dipping in blood pressure (BP) have been linked to the state of inflammation.

Aims

We aimed to assess the frequency of nocturnal patterns of BP and heart rate (HR) in patients with IBD.

Methods

Sixty-three normotensive patients with confirmed IBD during remission and 63 healthy subjects were enrolled in a case–control study. All subjects were monitored for BP and HR over a period of 24 h under ambulatory setting. Means for BP and HR were calculated for nighttime and daytime periods. Daytime BP ≥ 135/85 mmHg, nighttime BP ≥ 120/70 mmHg, and 24-h average BP ≥ 130/80 mmHg were defined as MHTN. The main end points of this study were lack of >10% nocturnal decrease in the systolic BP (NDP-BP) and in HR (NDP-HR).

Results

After exclusion of 8 patients with IBD from analysis, 55 patients and 63 control subjects (49% men) with a mean age of 37.5 ± 11.0 years were enrolled. NDP-BP was more common in the IBD group compared to controls (55 vs. 33%; P = 0.026). MHTN was detected in 24% of IBD patients compared to 8% among controls (P = 0.017). Meanwhile, NDP-HR was observed in 22% of the IBD patients and 30% of the control group (P = 0.402). IBD remained a significant predictor of NDP-BP (odds ratio 2.60, 95% confidence interval 1.19–5.51) following an adjustment for age and gender.

Conclusions

IBD is associated with higher frequency of NDP-BP and MHTN; however, nocturnal changes in HR were similar in both groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ohkubo T, Hozawa A, Yamaguchi J, 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;20:2183–2189.

    Article  CAS  PubMed  Google Scholar 

  2. Vasunta RL, Kesaniemi YA, Ylitalo A, Ukkola O. Nondipping pattern and carotid atherosclerosis in a middle-aged population: OPERA Study. Am J Hypertens. 2012;25:60–66.

    Article  PubMed  Google Scholar 

  3. Tsioufis C, Syrseloudis D, Dimitriadis K, et al. Disturbed circadian blood pressure rhythm and C-reactive protein in essential hypertension. J Hum Hypertens. 2008;22:501–508.

    Article  CAS  PubMed  Google Scholar 

  4. Guven A, Caliskan M, Ciftci O, Barutcu I. Increased platelet activation and inflammatory response in patients with masked hypertension. Blood Coagul Fibrinolysis. 2013;24:170–174.

    PubMed  Google Scholar 

  5. Celik G, Yilmaz S, Esmen SE. Non-dipping blood pressure patterns and arterial stiffness parameters in patients with Behcet’s disease. Hypertens Res. 2015;38:856–861.

    Article  CAS  PubMed  Google Scholar 

  6. Bacaksiz A, Vatankulu MA, Sonmez O, et al. Non-dipping nocturnal blood pressure in psoriasis vulgaris. Wien Klin Wochenschr. 2012;124:822–829.

    Article  PubMed  Google Scholar 

  7. Kargili A, Karakurt F, Kasapoglu B, Derbent A, Koca C, Selcoki Y. Association of polycystic ovary syndrome and a non-dipping blood pressure pattern in young women. Clinics (Sao Paulo). 2010;65:475–479.

    Article  Google Scholar 

  8. Martynowicz H, Porebska I, Poreba R, Mazur G, Brzecka A. Nocturnal blood pressure variability in patients with obstructive sleep apnea syndrome. Adv Exp Med Biol. 2016;952:9–15.

    Article  CAS  PubMed  Google Scholar 

  9. Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension. 2005;45:602–607.

    Article  CAS  PubMed  Google Scholar 

  10. von Kanel R, Jain S, Mills PJ, et al. Relation of nocturnal blood pressure dipping to cellular adhesion, inflammation and hemostasis. J Hypertens. 2004;22:2087–2093.

    Article  Google Scholar 

  11. Ozturk K, Guler AK, Cakir M, et al. Pulse wave velocity, intima media thickness, and flow-mediated dilatation in patients with normotensive normoglycemic inflammatory bowel disease. Inflamm Bowel Dis. 2015;21:1314–1320.

    PubMed  PubMed Central  Google Scholar 

  12. Rungoe C, Basit S, Ranthe MF, Wohlfahrt J, Langholz E, Jess T. Risk of ischaemic heart disease in patients with inflammatory bowel disease: a nationwide Danish cohort study. Gut. 2013;62:689–694.

    Article  CAS  PubMed  Google Scholar 

  13. Yarur AJ, Deshpande AR, Pechman DM, Tamariz L, Abreu MT, Sussman DA. Inflammatory bowel disease is associated with an increased incidence of cardiovascular events. Am J Gastroenterol. 2011;106:741–747.

    Article  PubMed  Google Scholar 

  14. Kristensen SL, Lindhardsen J, Ahlehoff O, et al. Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study. Europace. 2014;16:477–484.

    Article  PubMed  Google Scholar 

  15. O’Brien E, Parati G, Stergiou G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–1768.

    Article  PubMed  Google Scholar 

  16. Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Predictors of all-cause mortality in clinical ambulatory monitoring. Unique Asp Blood Press Dur Sleep. 2007;49:1235–1241.

    CAS  Google Scholar 

  17. Fagard RH. Dipping pattern of nocturnal blood pressure in patients with hypertension. Expert Rev Cardiovasc Ther. 2009;7:599–605.

    Article  PubMed  Google Scholar 

  18. Eguchi K, Hoshide S, Ishikawa J, et al. Nocturnal nondipping of heart rate predicts cardiovascular events in hypertensive patients. J Hypertens. 2009;27:2265–2270.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Liu M, Li Y, Wei FF, Zhang L, Han JL, Wang JG. Is blood pressure load associated, independently of blood pressure level, with target organ damage? J Hypertens. 2013;31:1812–1818.

    Article  CAS  PubMed  Google Scholar 

  20. Famoye F. Continuous Univariate Distributions, vol. 1. London: Taylor & Francis Group; 1995.

    Google Scholar 

  21. Imai Y, Abe K, Sasaki S, et al. Exogenous glucocorticoid eliminates or reverses circadian blood pressure variations. J Hypertens. 1989;7:113–120.

    CAS  PubMed  Google Scholar 

  22. Imai Y, Abe K, Sasaki S, et al. Altered circadian blood pressure rhythm in patients with Cushing’s syndrome. Hypertension. 1988;12:11–19.

    Article  CAS  PubMed  Google Scholar 

  23. Turak O, Ozcan F, Tok D, et al. Serum uric acid, inflammation, and nondipping circadian pattern in essential hypertension. J Clin Hypertens (Greenwich). 2013;15:7–13.

    Article  CAS  Google Scholar 

  24. Stolarz K, Staessen JA, O’Brien ET. Night-time blood pressure: dipping into the future? J Hypertens. 2002;20:2131–2133.

    Article  CAS  PubMed  Google Scholar 

  25. Wu GC, Leng RX, Lu Q, Fan YG, Wang DG, Ye DQ. Subclinical atherosclerosis in patients with inflammatory bowel diseases: a systematic review and meta-analysis. Angiology. 2016;68:447–461.

    Article  PubMed  Google Scholar 

  26. Papadopoulos DP, Mourouzis I, Faselis C, et al. Masked hypertension and atherogenesis: the impact of apelin and relaxin plasma levels. J Clin Hypertens (Greenwich). 2013;15:333–336.

    Article  CAS  Google Scholar 

  27. Hanninen MR, Niiranen TJ, Puukka PJ, Johansson J, Jula AM. Prognostic significance of masked and white-coat hypertension in the general population: the Finn-Home Study. J Hypertens. 2012;30:705–712.

    Article  PubMed  Google Scholar 

  28. Bjorklund K, Lind L, Zethelius B, Andren B, Lithell H. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation. 2003;107:1297–1302.

    Article  PubMed  Google Scholar 

  29. Thompson JE, Smith W, Ware LJ, et al. Masked hypertension and its associated cardiovascular risk in young individuals: the African-PREDICT study. Hypertens Res. 2016;39:158–165.

    Article  CAS  PubMed  Google Scholar 

  30. Andrikou I, Tsioufis C, Dimitriadis K, et al. Similar levels of low-grade inflammation and arterial stiffness in masked and white-coat hypertension: comparisons with sustained hypertension and normotension. Blood Press Monit. 2011;16:218–223.

    Article  PubMed  Google Scholar 

  31. Sun L, Yan B, Gao Y, et al. Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients. Sci Rep. 2016;6:25053.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Yan B, Sun L, Gao Y, et al. Blood pressure reverse dipping may associate with stable coronary artery disease in patients with essential hypertension: a cross-sectional study. Sci Rep. 2016;6:25410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Yan B, Peng L, Dong Q, et al. Reverse-dipper pattern of blood pressure may predict lacunar infarction in patients with essential hypertension. Eur J Neurol. 2015;22:1022–1025.

    Article  CAS  PubMed  Google Scholar 

  34. Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Blunted heart rate dip during sleep and all-cause mortality. Arch Intern Med. 2007;167:2116–2121.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nader D. Nader.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pourafkari, L., Masnadi-Shirazi, K., Taban, M. et al. Higher Frequency of Nocturnal Blood Pressure Dipping but Not Heart Rate Dipping in Inflammatory Bowel Disease. Dig Dis Sci 62, 2863–2869 (2017). https://doi.org/10.1007/s10620-017-4712-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4712-x

Keywords

Navigation