Öz
Amaç: Sağlıklı kişilerde nörohormonal mekanizmalar nedeniyle gece tansiyon düşmektedir. Gece tansiyonunun düşmemesi ile karakterize olan non-dipper durumu kardiyovasküler hastalıklarla yakından ilişkilidir. Daha önce panik atak hastalarında kan basıncı yükselmesi ile ilgili birçok çalışma yapılmasına rağmen non-dipper tansiyon üzerine çalışılmamıştır. Biz de bu çalışmada non-dipper tansiyon ile panik atak arasındaki ilişkiyi araştırmak istedik.
Gereç ve Yöntem: Çalışmamıza en az bir aydır tedavi almayan panik atak hastası olan 168 hasta ile hiçbir hastalığı olmayan 210 kontrol hastası dahil edildi. Tüm hastalara yirmi dört saatlik tansiyon holter takıldı ve gece tansiyonları %10'dan az düşen hatalar non-dipper olarak kabul edildi. Tüm gruplar bazal biyokimyasal parametreler ve tansiyon holter sonuçlarına göre karşılaştırıldı. Ayrıca non-dipper durumu hastalık süresi ve şiddetine göre kıyaslandı.
Bulgular: Üre, albümin, kreatinin gibi biyokimyasal parametreler açısıdan iki grup arasında anlamlı farklılık saptanmadı. Ortalama, gece ve gündüz tansiyonları panik atak grubunda daha yüksek ve istatistiksel olarak anlamlı yüksek bulunmuştur. Ayrıca panik atak grubunda daha yüksek saptanan non-dipper durumu hastalığın süresi ve şiddeti ilişkili olduğu saptandı.
Sonuç: Çalışmamızda non-dipper tansiyon panik atak hastalarında daha yüksek saptanmış olup, bu durum hastalık şiddeti ve süresiyle ilişkili bulunmuştur. Çalışmamız sonucunda panik atak hastalarında artan mortalitenin kardiyovasküler bir risk faktörü olan non-dipper tansiyon ile ilişkili olduğu düşünülebilir.
Anahtar Kelimeler
Dipper tansiyon Non-dipper tansiyon Panik bozukluk Kardiyovasküler mortalite
Kaynakça
- Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B et al. A. Reproducibility of nocturnal blood pressure fall in early phases of untreated essential hypertension: a prospective observational study. J Hum Hypertens. 2004;18:503-9.
- Cuspidi C, Meani S, Salerno M, Severgnini B, Fusi V, Valerio C et al. Cardiovascular risk stratification according to the 2003 ESH-ESC guidelines in uncomplicated patients with essential hypertension: comparison with the 1999 WHO/ISH guidelines criteria. Blood Press. 2004;13:144-51.
- Stolarz-Skrzypek K, Thijs L, Richart T, Li Y, Hansen TW, Boggia J et al. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Hypertens Res. 2010;33:757-66.
- Eguchi K, Hoshide S, Ishikawa J, Pickering TG, Schwartz JE, Shimada K et al. Nocturnal nondipping of heart rate predicts cardiovascular events in hypertensive patients. J Hypertens. 2009;27:2265-70.
- Meewisse ML, Reitsma JB, de Vries GJ, Gersons BP, Olff M. Cortisol and post-traumatic stress disorder in adults: systematic review and meta-analysis. Br J Psychiatry. 2007;191:387-92.
- Abrignani, M. G., Renda, N., Abrignani, V., Raffa, A., Novo, S., Lo Baido, R. Panıc Dısorder, Anxıety, and Cardıovascular Dıseases. Clinical Neuropsychiatry. 2014;11:130-144.
- Fabbian F, Smolensky MH, Tiseo R, Pala M, Manfredini R, Portaluppi F. Dipper and non-dipper blood pressure 24-hour patterns: circadian rhythm-dependent physiologic and pathophysiologic mechanisms. Chronobiol Int. 2013;30:17-30.
- Zelinka T, Strauch B, Pecen L, Widimský J Jr. Diurnal blood pressure variation in pheochromocytoma, primary aldosteronism and Cushing's syndrome. J Hum Hypertens. 2004;18:107-11.
- Hildrum B, Romild U, Holmen J. Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway. BMC Public Health. 2011;11:601.
- Patten SB, Williams JV, Lavorato DH, Campbell NR, Eliasziw M, Campbell TS. Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study. Psychosom Med. 2009;71:273-9.
- Hildrum B, Mykletun A, Holmen J, Dahl AA. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry. 2008;193:108-13.
- Shinagawa M, Otsuka K, Murakami S, Kubo Y, Cornelissen G, Matsubayashi K, Yano S, Mitsutake G, Yasaka K, Halberg F. Seven-day (24-h) ambulatory blood pressure monitoring, self-reported depression and quality of life scores. Blood Press Monit. 2002;7:69-76.
- Scuteri A, Spalletta G, Cangelosi M, Gianni W, Assisi A, Brancati AM et al. Decreased nocturnal systolic blood pressure fall in older subjects with depression. Aging Clin Exp Res. 2009;21:292-7.
- Małyszczak K, Janocha A. The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder. J Psychosom Res. 2022;161:110999.
- Alici H, Ercan S, Bulbul F, Alici D, Alpak G, Davutoglu V. Circadian blood pressure variation in normotensive patients with panic disorder. Angiology. 2014;65:747-9.
- Turfaner N, Karter Y, Curgunlu A, Ayan F, Mihmanli I, Sipahioglu F. Blunted nocturnal fall of blood pressure in isolated clinical hypertension. Swiss Med Wkly. 2009;139:251-5.
- Aydin M, Ozeren A, Bilge M, Dursun A, Cam F, Elbey MA. Effects of dipper and non-dipper status of essential hypertension on left atrial mechanical functions. Int J Cardiol. 2004;96:419-24.
- Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW et al. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154:1571-5.
- Monkul ES, Tural U, Onur E, Fidaner H, Alkin T, Shear MK. Panic Disorder Severity Scale: reliability and validity of the Turkish version. Depress Anxiety. 2004;20:8-16.
- Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation. 1990;81:528-36.
- Soylu A, Yazici M, Duzenli MA, Tokac M, Ozdemir K, Gok H. Relation between abnormalities in circadian blood pressure rhythm and target organ damage in normotensives. Circ J. 2009;73:899-904.
- White WB. Importance of blood pressure control over a 24-hour period. J Manag Care Pharm. 2007;13:34-9.
- Stern N, Sowers JR, McGinty D, Beahm E, Littner M, Catania R et al. Circadian rhythm of plasma renin activity in older normal and essential hypertensive men: relation with inactive renin, aldosterone, cortisol and REM sleep. J Hypertens. 1986;4:543-50.
- Hijmering ML, Stroes ES, Olijhoek J, Hutten BA, Blankestijn PJ, Rabelink TJ. Sympathetic activation markedly reduces endothelium-dependent, flow-mediated vasodilation. J Am Coll Cardiol. 2002;39:683-8.
- Chang HA, Chang CC, Tzeng NS, Kuo TB, Lu RB, Huang SY. Decreased cardiac vagal control in drug-naive patients with panic disorder: a case-control study in Taiwan. Asia Pac Psychiatry. 2013;5:80-9.
- Kikuchi M, Hanaoka A, Kidani T, Remijn GB, Minabe Y, Munesue T et al. Heart rate variability in drug-naïve patients with panic disorder and major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33:1474-8.
- Prasko J, Latalova K, Diveky T, Grambal A, Kamaradova D, Velartova H et al. Panic disorder, autonomic nervous system and dissociation - changes during therapy. Neuro Endocrinol Lett. 2011;32:641-51.
- de Carvalho MR, Velasques BB, Freire RC, Cagy M, Marques JB, Teixeira S et al. Alpha absolute power measurement in panic disorder with agoraphobia patients. J Affect Disord. 2013;151:259-64.
- Wilkinson DJ, Thompson JM, Lambert GW, Jennings GL, Schwarz RG, Jefferys D et al. Sympathetic activity in patients with panic disorder at rest, under laboratory mental stress, and during panic attacks. Arch Gen Psychiatry. 1998;55:511-20.
- Esler M, Alvarenga M, Lambert G, Kaye D, Hastings J, Jennings G et al. Cardiac sympathetic nerve biology and brain monoamine turnover in panic disorder. Ann N Y Acad Sci. 2004;1018:505-14.
- Abelson JL, Liberzon I, Young EA, Khan S. Cognitive modulation of the endocrine stress response to a pharmacological challenge in normal and panic disorder subjects. Arch Gen Psychiatry. 2005;62:668-75.
Öz
Purpose: In healthy people, blood pressure falls at night due to hormonal mechanisms. The non-dipper pattern, characterised by no blood pressure drop at night, is strongly associated with cardiovascular disease. Although many studies have been conducted on blood pressure elevation in patients with panic attacks, the non-dipper pattern has not been studied. In this study, we aimed to investigate the relationship between the non-dipper pattern and panic attacks.
Materials and Methods: Our study included 168 patients with panic disorders who had not been treated for at least one month and 210 control patients without the disease. Twenty-four-hour blood pressure monitoring was performed in all patients, and patients with a nocturnal blood pressure fall of less than %10 were considered non-dippers. All groups were compared according to baseline biochemical parameters and Holter results. In addition, non-dipper pattern was compared according to disease duration and severity.
Results: There were no significant differences between the groups in biochemical parameters such as urea, creatinine, albümin). Sistole blood pressure, diastole blood pressure, dipper pattern were statistically significantly higher in the panic disorder group. In addition, the non-dipper pattern, which was higher in the panic disorder group, was found to be associated with the duration and severity of the illness.
Conclusion: In our study, non-dipper pattern was found to be higher in patients with panic disorders, and this was found to be related to the severity and duration of the disease. As a result of our study, it can be assumed that the increased mortality in panic disorder patients is related to the non-dipper pattern, which is a cardiovascular risk factor.
Anahtar Kelimeler
Dipper pattern Non-dipper pattern Panic disorder Cardiovascular mortality
Etik Beyan
Ethical approval was obtained from the Harran University Clinical Research Ethics Committee with the decision number: HRÜ.23/02/19.
Kaynakça
- Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B et al. A. Reproducibility of nocturnal blood pressure fall in early phases of untreated essential hypertension: a prospective observational study. J Hum Hypertens. 2004;18:503-9.
- Cuspidi C, Meani S, Salerno M, Severgnini B, Fusi V, Valerio C et al. Cardiovascular risk stratification according to the 2003 ESH-ESC guidelines in uncomplicated patients with essential hypertension: comparison with the 1999 WHO/ISH guidelines criteria. Blood Press. 2004;13:144-51.
- Stolarz-Skrzypek K, Thijs L, Richart T, Li Y, Hansen TW, Boggia J et al. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Hypertens Res. 2010;33:757-66.
- Eguchi K, Hoshide S, Ishikawa J, Pickering TG, Schwartz JE, Shimada K et al. Nocturnal nondipping of heart rate predicts cardiovascular events in hypertensive patients. J Hypertens. 2009;27:2265-70.
- Meewisse ML, Reitsma JB, de Vries GJ, Gersons BP, Olff M. Cortisol and post-traumatic stress disorder in adults: systematic review and meta-analysis. Br J Psychiatry. 2007;191:387-92.
- Abrignani, M. G., Renda, N., Abrignani, V., Raffa, A., Novo, S., Lo Baido, R. Panıc Dısorder, Anxıety, and Cardıovascular Dıseases. Clinical Neuropsychiatry. 2014;11:130-144.
- Fabbian F, Smolensky MH, Tiseo R, Pala M, Manfredini R, Portaluppi F. Dipper and non-dipper blood pressure 24-hour patterns: circadian rhythm-dependent physiologic and pathophysiologic mechanisms. Chronobiol Int. 2013;30:17-30.
- Zelinka T, Strauch B, Pecen L, Widimský J Jr. Diurnal blood pressure variation in pheochromocytoma, primary aldosteronism and Cushing's syndrome. J Hum Hypertens. 2004;18:107-11.
- Hildrum B, Romild U, Holmen J. Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway. BMC Public Health. 2011;11:601.
- Patten SB, Williams JV, Lavorato DH, Campbell NR, Eliasziw M, Campbell TS. Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study. Psychosom Med. 2009;71:273-9.
- Hildrum B, Mykletun A, Holmen J, Dahl AA. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry. 2008;193:108-13.
- Shinagawa M, Otsuka K, Murakami S, Kubo Y, Cornelissen G, Matsubayashi K, Yano S, Mitsutake G, Yasaka K, Halberg F. Seven-day (24-h) ambulatory blood pressure monitoring, self-reported depression and quality of life scores. Blood Press Monit. 2002;7:69-76.
- Scuteri A, Spalletta G, Cangelosi M, Gianni W, Assisi A, Brancati AM et al. Decreased nocturnal systolic blood pressure fall in older subjects with depression. Aging Clin Exp Res. 2009;21:292-7.
- Małyszczak K, Janocha A. The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder. J Psychosom Res. 2022;161:110999.
- Alici H, Ercan S, Bulbul F, Alici D, Alpak G, Davutoglu V. Circadian blood pressure variation in normotensive patients with panic disorder. Angiology. 2014;65:747-9.
- Turfaner N, Karter Y, Curgunlu A, Ayan F, Mihmanli I, Sipahioglu F. Blunted nocturnal fall of blood pressure in isolated clinical hypertension. Swiss Med Wkly. 2009;139:251-5.
- Aydin M, Ozeren A, Bilge M, Dursun A, Cam F, Elbey MA. Effects of dipper and non-dipper status of essential hypertension on left atrial mechanical functions. Int J Cardiol. 2004;96:419-24.
- Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW et al. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154:1571-5.
- Monkul ES, Tural U, Onur E, Fidaner H, Alkin T, Shear MK. Panic Disorder Severity Scale: reliability and validity of the Turkish version. Depress Anxiety. 2004;20:8-16.
- Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation. 1990;81:528-36.
- Soylu A, Yazici M, Duzenli MA, Tokac M, Ozdemir K, Gok H. Relation between abnormalities in circadian blood pressure rhythm and target organ damage in normotensives. Circ J. 2009;73:899-904.
- White WB. Importance of blood pressure control over a 24-hour period. J Manag Care Pharm. 2007;13:34-9.
- Stern N, Sowers JR, McGinty D, Beahm E, Littner M, Catania R et al. Circadian rhythm of plasma renin activity in older normal and essential hypertensive men: relation with inactive renin, aldosterone, cortisol and REM sleep. J Hypertens. 1986;4:543-50.
- Hijmering ML, Stroes ES, Olijhoek J, Hutten BA, Blankestijn PJ, Rabelink TJ. Sympathetic activation markedly reduces endothelium-dependent, flow-mediated vasodilation. J Am Coll Cardiol. 2002;39:683-8.
- Chang HA, Chang CC, Tzeng NS, Kuo TB, Lu RB, Huang SY. Decreased cardiac vagal control in drug-naive patients with panic disorder: a case-control study in Taiwan. Asia Pac Psychiatry. 2013;5:80-9.
- Kikuchi M, Hanaoka A, Kidani T, Remijn GB, Minabe Y, Munesue T et al. Heart rate variability in drug-naïve patients with panic disorder and major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33:1474-8.
- Prasko J, Latalova K, Diveky T, Grambal A, Kamaradova D, Velartova H et al. Panic disorder, autonomic nervous system and dissociation - changes during therapy. Neuro Endocrinol Lett. 2011;32:641-51.
- de Carvalho MR, Velasques BB, Freire RC, Cagy M, Marques JB, Teixeira S et al. Alpha absolute power measurement in panic disorder with agoraphobia patients. J Affect Disord. 2013;151:259-64.
- Wilkinson DJ, Thompson JM, Lambert GW, Jennings GL, Schwarz RG, Jefferys D et al. Sympathetic activity in patients with panic disorder at rest, under laboratory mental stress, and during panic attacks. Arch Gen Psychiatry. 1998;55:511-20.
- Esler M, Alvarenga M, Lambert G, Kaye D, Hastings J, Jennings G et al. Cardiac sympathetic nerve biology and brain monoamine turnover in panic disorder. Ann N Y Acad Sci. 2004;1018:505-14.
- Abelson JL, Liberzon I, Young EA, Khan S. Cognitive modulation of the endocrine stress response to a pharmacological challenge in normal and panic disorder subjects. Arch Gen Psychiatry. 2005;62:668-75.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Psikiyatri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 12 Nisan 2025 |
| Kabul Tarihi | 15 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 50 Sayı: 2 |
