Online First

2022 : Volume 1, Issue 2

Nocturnal Surge in Blood Pressure Prior to Morning Surge: Another Phenotype of Systemic Hemodynamic Atherothrombotic Syndrome

Author(s) : Md Moshiur Rahman 6 , Yuseth Mercedes Insignares-Farak 1 , Roberto Andres Ramos-Cordoba 3 , Ana Carolina Ramirez-Echavarria 4 and George Gabriel Moldoveanu 5

1 School of Medicine , Universidad Cooperativa De Colombia , Colombia

3 School of Medicine , Universidad Juan N. Corpas , Colombia

4 School of Medicine , Universidad Metropolitana , Colombia

5 Department of Anesthesiology and Intensive Care , C.I. Parhon National Institute of Endocrinology , Romania

6 Department of Neurosurgery , Holy Family Red Crescent Medical College , Bangladesh

Int J Otolaryngol Head Neck Surg

Article Type : Editorial







Cardiovascular diseases are the leading cause of death globally, and one of the most disabling, which occurs at increasingly younger ages [1,2]. Arterial hypertension is one of the most prevalent cardiovascular diseases in the world, which carries high health costs and is a risk factor for many major cardiovascular events and other cardiometabolic disorders [1,2]. However, other conditions have been described that also silently alter vascular dynamics, and that manifest themselves through sudden blood pressure variability, especially in young people, regardless of the presence or absence of cardiovascular risk factors [3]. The systemic hemodynamic atherothrombotic syndrome (SHATS) is a concept recently described by Dr. Kazoumi Kario [4,5], where he states that through a hypothesis called "hypothesis of resonance of blood pressure variability", explains how vascular disease develops from biophysical and hemodynamic parameters, and triggers major cardiovascular events that can compromise the life of adults and young people [3-5]. Sudden elevation of blood pressure in the morning is one of the described phenotypes of SHATS [6]. The resonance hypothesis of blood pressure variability states that the sudden alteration in vascular flow, generating hemodynamic stress and injuring the endothelium [3-5]. This repetitive process causes target organ injury in the heart, kidney and brain mainly, triggering vascular disease which can be of three types: Large artery disease, small artery disease or tension vessel disease. In turn, the involvement of blood vessels also generates neuroendocrine compensatory mechanisms that affect vascular resistance and blood pressure with a tendency to rise, turning this into a vicious circle [3-5]. Considering the neurobiology of blood pressure, due to adrenergic mechanisms, this hemodynamic parameter regulates blood pressure in such a way as to allow the performance of daily life activities, while at night, cholinergic mechanisms down-regulate blood pressure [3-5]. However, it is necessary to clarify that the differences between pressures are not large. Studies have found that morning elevation of blood pressure is a negative prognostic factor for the evolution of stroke in hypertensive patients of advanced age [7]. And although this elevation correlates with 24-hour blood pressure levels, studies have found this phenotype in normotensive and younger-aged patients. Theoretically, for the proposed arguments, there is a higher risk of presenting major cerebro/cardiovascular events during the day [7]. However, nocturnal elevation of blood pressure has also been described, and this substantially worsens the functional prognosis of the events presented [8]. Since blood pressure regulation at night is by means of cholinergic mechanisms, a rise in blood pressure will generate greater alteration in vascular flow and therefore endothelial and vascular damage will be greater [8]. There is evidence to support the magnitude of the severity of events during the night compared to the day, associated factors and final outcomes. However, what is important is that this SHATS phenotype can occur in the young and in a silent form, which is a potential risk factor for minor or major cerebro-cardiovascular events [8,9], that compromise the functional capacity and survival of the individual in the medium- or long-term, and affect his or her quality of life [9]. There is much research to be done on SHATS and its phenotypes. However, it is necessary to develop practical strategies, for example through the use of technology, to constantly monitor hemodynamic parameters in population groups, in order to reduce the burden of cardiovascular disease globally. It is important to be aware of warning signs or symptoms that occur during the night hours, and that may be associated with alterations in the cardiovascular system. The underdiagnosis of this type of conditions directly affects the global health objectives set for the coming years, so multidisciplinary teams focused on SHATS and its dynamics among people with and without risk factors are needed.


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Corresponding author: Moshiur Rahman, Assistant Professor, Neurosurgery Department, Holy Family Red Crescent Medical College, Bangladesh, India.

Copyright: © 2021 All copyrights are reserved by Rahman M, published by Coalesce Research Group. This This work is licensed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

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