İpek BÜBER, Anıl TÜRKÖZ, Mehmet Koray Adali

Eritrosit Dağılım Genişliği ile Sabah Kan Basıncı Dalgalanması Arasındaki İlişki

Amaç : Eritrosit dağılım genişliği (EDG), kalp yetmezliği, koroner arter hastalığı ve akut miyokard enfarktüsü olan hastalarda olumsuz sonuçlarla ilişkilidir. Sabah kan basıncı dalgalanması (SKBD) fenomeni, sabahları kan basıncında (KB) belirgin bir artış olarak tanımlanır. Bu çalışmada, EDG ve SKBD arasındaki ilişkiyi araştırmayı amaçladık.Materyal ve Metod: Haziran 2019-Aralık 2019 tarihleri arasında ambulatuvar KB kaydı yapılan iki yüz seksen dokuz (289) hastanın verileri retrospektif olarak analiz edildi. Ambulatuar KB verileri ile SKBD hesaplanarak EDG ile ilişkisi araştırıldı. Bulgular: Eritrosit dağılım genişliği üst değerine göre (%16) SKBD değerleri karşılaştırıldı (sırasıyla %16'nın üzerinde ve %16'nın altında, (33.7±16.2; 28.1±11.5; p = 0.038*) her iki grup arasında istatistiksel olarak anlamlı bir fark mevcuttu. SKBD ile ilişkili parametreleri göstermek için yapılan çok değişkenli linear regresyon analizinde SKBD’nin EDG (p=0.03) ve ürik asit (p= 0.02) ile ilişkili olduğu bulundu.Sonuç: Çalışmamızda SKBD'nin EDG ile bağımsız olarak ilişkili olduğunu ve EDG %16'nın üzerinde olduğunda anlamlı olarak daha yüksek olduğunu gösterilmiştir. Yeni bir kardiyovasküler risk faktörü olan SKBD, olumsuz kardiyovasküler sonuçlarla bağlantılı olan EDG ile ilişkilidir. EDG’nin yüksek olması daha yüksek SKBD’yi gösterebilir. Ambulatuar KB değerlendirmelerinde sıklıkla ihmal ettiğimiz SKBD bir risk faktörü olarak değerlendirilmelidir ve tedavi konusunda hedef olup olmaması konusunda prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Sabah kan basıncı dalgalanması, eritrosit dağılım genişliği, olumsuz kardiyak sonuçlar

The Relationship with Red Cell Distribution Width and Morning Blood Pressure Surge

Objective: Red cell distribution width (RDW) is related to adverse outcomes in patients with heart failure, coronary artery disease and acute myocardial infarction. Morning Blood Pressure Surge (MBPS) phenomenon is defined as a prominent increase at BP in the morning. In this study, we aimed to investigate the relationship between these two cardiovascular risk factors, RDW and MBPS. Material and Method: The two hundred eighty-nine (289) patient’s data who underwent ambulatory blood pressure recording, between June 2019-December 2019 was analysed retrospectively. Results: Red cell distribution width upper limit is accepted as 16% in our hospital's biochemistry laboratory. When MBPS values were compared according to RDW cut-off values (respectively above 16% and 16%below), a statistically significant difference was revealed between both groups (33.7±16.2 vs 28.1±11.5; p= 0.038*). Multivariate linear regression analysis conducted for demonstrating associated parameters with MBPS and MBPS was found to be associated with RDW (p=0.03), and uric acid (P=0.02).Conclusion: Our results showed that MBPS was independently associated with RDW and was significantly higher, when RDW was above 16%. MBPS, a new cardiovascular risk factor, is associated with RDW, which has been linked to adverse cardiovascular outcomes. MBPS, which we often neglect in ambulatory blood pressure evaluations, should be considered as a risk factor and prospective studies are needed to determine whether it is a target for treatment.

Keywords:

Morning blood pressure surge, red cell distribution width, adverse cardiac outcomes,

PDF

___

[1] Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B. Wintrobe’s Clinical Hematology. Wolters Kluwer: Lippincott Williams&Wilkins, 2003.
[2] Isik T, Uyarel H, Tanboga IH, et al. Relation of red cell distribution width with the presence, severity, and complexity of coronary artery disease. Coron Artery Dis 2012; 23:51-6. 7.
[3] Uyarel H, Ergelen M, Cicek G, et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis 201; 22:138-44.
[4] Akin F, Köse N, Ayça B et al. Relation between red cell distribution width and severity of coronary artery disease in patients with acute myocardial infarction. Angiology. 2013 Nov;64(8):592-6.
[5] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the american college of cardiology/american heart association task force on clinical Pr. J Am Coll Cardiol. Epub 2017 Nov 13.
[6] Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. J Hypertens. 2013; 31:1281–1357
[7] Muller JE. Circadian variation in cardiovascular events. Am J Hypertens. 1999; 12:35S–42S
[8] Kario K, Pickering TG, Umeda Y, 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: 1401–1406.
[9] Li Y, Thijs L, Hansen TW, et al. International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Investigators. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension 2010; 55: 1040–1048.
[10] Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015; 52:86–105
[11] Kaypaklı O, Gür M, Harbalıoğlu H, Şeker T, Selek Ş. High morning blood pressure surge is associated with oxidative stress and paraoxonase 1 activity in newly diagnosed hypertensive patients. Clin Exp Hypertens. 2016;38(8):680-685. doi: 10.1080/10641963.2016.1200602. Epub 2016 Dec 9. PMID: 27936340.
[12] Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser 1968; 405:5.
[13] Expert Committee on the Diagnosis and Classiﬁcation of Diabetes Mellitus. Report of the expert committee on the diagnosis and classiﬁcation of diabetes mellitus. Diabetes Care 2003; 26(Suppl 1): S5–S20.
[14] Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462–1536.
[15] Wei W, Tölle M, Zidek W, van der Giet M. Validation of the mobil-O-Graph:24 h-blood pressure measurement device. Blood Press Monit 2010; 15: 225–228
[16] Shimizu M, Ishikawa J, Yano Y, Hoshide S, Shimada K, Kario K. The relationship between the morning blood pressure surge and low-grade inflammation on silent cerebral infarct and clinical stroke events. Atherosclerosis 2011; 219: 316–321.
[17] Solak Y, Yilmaz MI, Saglam M, et al. Red cell distribution width is independently related to endothelial dysfunction in patients with chronic kidney disease. Am J Med Sci. 2014; 347:118–24
[18] Kıvrak A, Özbiçer S, Kalkan GY, Gür M. Morning blood pressure surge and arterial stiffness in newly diagnosed hypertensive patients. Blood Press. 2017 Jun;26(3):181-190.
[19] Sahin O, Akpek M, Sarli B, et al. Association of red blood cell distribution width levels with severity of coronary artery disease in patients with non-ST elevation myocardial infarction. Med Princ Pract.2015;24(2):178-83
[20] Lappé JM, Horne BD, Shah SH, et al. Red cell distribution width, C-reactive protein, the complete blood count, and mortality in patients with coronary disease and a normal comparison population. Clin Chim Acta 2011; 412:2094–9.
[21] Buyukkaya E, Erayman A, Karakas E, et al. Relation of red cell distribution width with dipper and non-dipper hypertension. Med Glas (Zenica). 2016 Aug 1;13(2):75-81. doi: 10.17392/859 16.
[22] Tanindi A, Topal FE, Topal F, Celik B. Red cell distribution width in patients with prehypertension and hypertension. Blood Press 2012; 21:177–81.
[23] Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009; 169:588–94
[24] Verdecchia P, Angeli F, Mazzotta G, et al. Day-night dip and earlymorning surge in blood pressure in hypertension: prognostic implications. Hypertension. 2012; 60:34–42.
[25] Kasiakogias A, Tsioufis C, Thomopoulos C, et al. Evening versus morning dosing of antihypertensive drugs in hypertensive patients with sleep apnoea: a cross-over study. J Hypertens. 2015; 33:393–400.