• Users Online: 1212
  • Print this page
  • Email this page

Table of Contents
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 235-236

Systemic hemodynamic atherothrombotic syndrome: The real agent to consider for 24-h management of hypertension and cardiovascular events

1 Department of Medicine, School of Medicine, University of Sinu, Cartagena, Colombia
2 Department of Medicine, School of Medicine, University Libre, Barranquilla, Colombia
3 Department of Medicine, School of Medicine, San Martín University Foundation, Sabaneta, Colombia
4 Medical and Surgical Research Center, University of Cartagena; Colombian Chapter, Latin American Cardiology Network, Cartagena, Colombia

Date of Submission15-Aug-2021
Date of Decision28-Aug-2021
Date of Acceptance30-Aug-2021
Date of Web Publication20-Oct-2021

Correspondence Address:
Dr. Ivan David Lozada-Martinez
Medical and Surgical Research Center, University of Cartagena, 130004, Cartagena
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_94_21

Rights and Permissions

How to cite this article:
Aguas-Salazar OC, Villaveces-Buelvas MA, Martínez-Ocampo JC, Lozada-Martinez ID. Systemic hemodynamic atherothrombotic syndrome: The real agent to consider for 24-h management of hypertension and cardiovascular events. Indian J Med Spec 2021;12:235-6

How to cite this URL:
Aguas-Salazar OC, Villaveces-Buelvas MA, Martínez-Ocampo JC, Lozada-Martinez ID. Systemic hemodynamic atherothrombotic syndrome: The real agent to consider for 24-h management of hypertension and cardiovascular events. Indian J Med Spec [serial online] 2021 [cited 2023 Jun 7];12:235-6. Available from: http://www.ijms.in/text.asp?2021/12/4/235/328731

Dear Editor,

We read with great interest the article published by Kumar et al.[1] entitled “Circadian rhythm of blood pressure: Implications for antihypertensive management,” where the authors review the concept of the circadian rhythm of blood pressure, describe the phenotypes of blood pressure, discuss the neurobiology of blood pressure regulation and its impact on the variation of this hemodynamic parameter, and finally state that knowledge of these concepts can improve the management of hypertension.[2] We thank the authors for such valuable evidence. However, we consider that what the authors really wanted to represent was the concept of Systemic hemodynamic atherothrombotic syndrome (SHATS).

SHATS was recently described by Kario,[2] stating that this novel pathologic description was characterized by an exaggerated synergistic risk of hemodynamic stress and vascular disease,[2] with the potential for not only target organ injury but also for triggering major cardiovascular events, substantially raising the risk of morbidity and mortality and decreased quality of life.[3],[4],[5] However, the pathophysiological process is more complex. This syndrome has its pathophysiological basis in the hypothesis of resonance of blood pressure variability, which has a direct impact on vascular health.[3],[4],[5] This hypothesis holds that there is a vicious cycle between neurometabolic blood pressure disorder, vascular injury of large vessels, small vessels and microcirculation due to increased vascular pressures, and finally target organ injury (mainly brain, heart, kidney, and endothelium), which triggers major cardiovascular events and increased morbidity, mortality, and disability.[3],[4],[5] In addition, this syndrome has several phenotypes such as sudden morning/evening isolated elevation of systolic blood pressure (which can occur even in young people without traditional cardiovascular risk factors). Furthermore, it has been observed that external factors such as climate, alcohol, workplace, home, season, age, smoking, as well as the presence of undiagnosed hereditary disorders that affect the cardiometabolic system, influence the dynamics of this syndrome and independently increase cardiovascular risk.[3],[4],[5]

Precisely, because of the above, it proposes the use of a diagnostic and severity score for 24-h blood pressure monitoring, with the aim of substantially protecting the endothelium.[6],[7] However, evidence suggests that more and more pathophysiological mechanisms are influencing cardiovascular health (specifically of the vessels),[2] so new diagnostic and severity criteria need to be developed, including arterial kinetic parameters, arterial structure, arterial pressure, and inflammatory processes (such as the presence of inflammatory plaque and pro-inflammatory markers), in order to estimate actual vascular compromise and determine whether there is a change in global cardiovascular risk stratification.

Considering that there are still many questions about this syndrome and its translational basis, it is a fact that research on this syndrome is one of the goals of the HOPE Asia Network to reduce cardiovascular events, as it focuses on successfully achieving tight control of any phenotype of hypertension and vascular disease and thus controlling the burden of cardiovascular disease globally.


Funding: The research was totally funded by the researchers.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kumar B, Chawla O, Bhattacharjee M, Singh A. Circadian rhythm of blood pressure: Implications for antihypertensive management. Indian J Med Spec 2021;12:53-8.  Back to cited text no. 1
  [Full text]  
Kario K. Systemic hemodynamic atherothrombotic syndrome: A blind spot in the current management of hypertension. J Clin Hypertens (Greenwich) 2015;17:328-31.  Back to cited text no. 2
Buendía-Palacios DC, Hernández-Nieto B, Delgado-Marrugo RD, Barahona-Botache SA, Bolaño-Romero MP. Síndrome aterotrombótico hemodinámico sistémico: un condicionante de la insuficiencia cardíaca y vascular. Minerva Cardiol Angiol 2021 [Online ahead of print].  Back to cited text no. 3
Kario K. Systemic hemodynamic atherothrombotic syndrome and resonance hypothesis of blood pressure variability: Triggering cardiovascular events. Korean Circ J 2016;46:456-67.  Back to cited text no. 4
Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, et al. Systemic hemodynamic atherothrombotic syndrome (SHATS) – Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia. Prog Cardiovasc Dis 2020;63:22-32.  Back to cited text no. 5
Kario K. Systemic hemodynamic atherothrombotic syndrome (SHATS): Diagnosis and severity assessment score. J Clin Hypertens (Greenwich) 2019;21:1011-5.  Back to cited text no. 6
Kario K. The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020. J Clin Hypertens (Greenwich) 2020;22:321-30.  Back to cited text no. 7

This article has been cited by
1 Inotropic support in cardiogenic shock: who leads the battle, milrinone or dobutamine?
Ivan David Lozada Martinez, Andrea Juliana Bayona-Gamboa, Duvier Fabián Meza-Fandiño, Omar Andrés Paz-Echeverry, Ángela María Ávila-Bonilla, Mario Javier Paz-Echeverry, Frank Jaider Pineda-Trujillo, Gina Paola Rodríguez-García, Jaime Enrique Covaleda-Vargas, Alexis Rafael Narvaez-Rojas
Annals of Medicine and Surgery. 2022; : 104763
[Pubmed] | [DOI]
2 Morning surge blood pressure as a phenotype of systemic hemodynamic atherothrombotic syndrome
Carolay Paola Ojeda-Uparela, Natalia Sofía Pancho-Villareal, Fernando Jesús Yi-Quesada, Camilo Andrés Ramírez-Salgado, Luis Felipe Arias-Guerra, Michael Gregorio Ortega-Sierra, Md Moshiur Rahman
Iberoamerican Journal of Medicine. 2021; 4(1): 1
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded124    
    Comments [Add]    
    Cited by others 2    

Recommend this journal