Mean 24-h Systolic Blood Pressure Research Articles

Correlations between indices of dynamic components of ambulatory blood pressure and renal damage in elderly Chinese male with essential hypertension

ObjectiveTwenty-four-hour ambulatory blood pressure monitoring (ABPM) is an accurate method to document changes in blood pressure (BP) and is more predictive than office and home BP monitoring for cardiovascular outcomes in elderly people. We aimed to determine the relationship between ABPM indices and renal damage in elderly Chinese male patients with essential hypertension.MethodsWe investigated 998 Chinese men (mean age of 78.44 ± 12.02 years) with essential hypertension. Renal function, laboratory testing, and ABPM, including ABP, BP variability, and BP circadian rhythms were investigated. Data were shown according to BP controlling status. The relationships between ABPM indices and renal damage [expressed by urine protein, urine albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN)] were assessed using multiple regression analysis.ResultsAfter adjustments for age, common cardiovascular risk factors, and medications, uACR level was positively associated with 24-h mean systolic blood pressure (SBP), 24-h mean pulse pressure (PP), and 24-h SBP percent time of elevation. eGFR level was negatively associated with the 24-h mean SBP and 24-h mean PP. BUN level was positively correlated with the 24-h mean SBP, 24-h mean PP, and 24-h SBP percent time of elevation, whereas the BUN level was negatively associated with the 24-h DBP SD.ConclusionThe ABPM indices associated with renal damage may be regarded as an early predictive marker for renal function impairment in Chinese elderly male patients with hypertension.

The REDUCE HTN: REINFORCE: Randomized, Sham-Controlled Trial of Bipolar Radiofrequency Renal Denervation for the Treatment of Hypertension

ObjectivesThe aim of this study was to investigate bipolar radiofrequency renal denervation in patients with hypertension not receiving medications at baseline. BackgroundA blood pressure–reducing effect of renal denervation has been difficult to isolate in clinical investigations. MethodsREDUCE HTN: REINFORCE (Renal Denervation Using the Vessix Renal Denervation System for the Treatment of Hypertension) was a randomized, sham-controlled multicenter trial. Patients with office systolic blood pressure (SBP) of 150 to 180 mm Hg and average 24-h ambulatory SBP of 135 to 170 mm Hg after medication washout underwent bipolar radiofrequency renal denervation or a sham procedure. The planned outcome was 8-week change in 24-h ambulatory SBP. Enrollment was terminated for apparent futility before a sufficient sample for powered efficacy comparisons was enrolled. Safety assessments included all-cause death, renal failure, severe hypotension or syncope, hypertensive crisis, and renal artery stenosis. ResultsBaseline 24-h blood pressure was 148.3 ± 10.9/85.7 ± 9.1 mm Hg for the denervation group (n = 34, mean age 58.5 ± 10.1 years, 47% women) and 149.1 ± 7.2/86.4 ± 9.8 mm Hg for the control group (n = 17, mean age 58.2 ± 9.8 years, 24% women). At 8 weeks, mean 24-h SBP reductions for the renal denervation and control groups were −5.3 mm Hg (95% confidence interval [CI]: −8.8 to −1.8 mm Hg) and −8.5 mm Hg (95% CI: −13.3 to −3.8 mm Hg), respectively (difference 3.3 mm Hg; 95% CI: −2.8 to 9.3 mm Hg; p = 0.30). Antihypertensive medications could then be added. By 6 months, decreases in SBP were greater for the denervation group, yielding between-group differences of −7.2 mm Hg (95% CI: −15.2 to 0.8 mm Hg; p = 0.08), −9.7 mm Hg (95% CI: −17.7 to −1.7 mm Hg; p = 0.02), and −11.4 mm Hg (95% CI: −19.2 to −3.7 mm Hg; p < 0.01) for 24-h, daytime ambulatory, and office measurements, respectively. Through 12 months, 1 patient (renal denervation group) had a hypertensive urgency requiring immediate management, and 1 experienced progression of renal artery stenosis. ConclusionsFuture studies of radiofrequency renal denervation must anticipate delayed treatment effects. (Renal Denervation Using the Vessix Renal Denervation System for the Treatment of Hypertension [REDUCE HTN: REINFORCE]; NCT02392351)

Diurnal rhythm of blood pressure among Nigerians with hypertension using 24-hour ambulatory blood pressure monitoring.

Introductionhypertension is the most common cardiac disease in Nigeria. There are very limited studies in Nigeria on the use of 24-hour ambulatory blood pressure monitoring (24-h ABPM) for evaluation of hypertensive patients. Twenty four-hour ABPM, unlike office blood pressure (OBP), can assess diurnal variation using parameters like awake blood pressure (BP), asleep (nocturnal) BP, mean 24-hour BP and dipping pattern. This can help in assessment of increased cardiovascular risk and management of hypertensive patients. We purposed to assess the diurnal rhythm of BP among Nigerians with hypertension.Methodsthis was a prospective cross-sectional study. Consecutive 77 hypertensive subjects were studied using Schiller MT-300 for 24-h ABPM.Resultsout of the 77 patients reviewed, 39 (50.6%) were females. The mean age was 50.9 years (SD 13.5). The mean awake systolic and diastolic BP were 135.6mmHg (SD 15.0) and 83.2mmHg (SD 10.0) respectively; mean asleep systolic and diastolic BP were 127.6mmHg (SD 17.9) and 76.2mmHg (SD 12.2) respectively; and mean 24-h systolic and diastolic BP were 133.6mmHg (SD 15.3) and 81.4mmHg (SD 10.2) respectively. Awake BP was elevated in 59.7% of study subjects. Elevated awake systolic BP and awake diastolic BP were present in 50.6% and 41.6% of the study population. Nocturnal (asleep) BP was elevated in 79.2%. Non-dipping pattern was the most prevalent pattern at 55.8%, followed by dipping (24.7%), reverse dipping (15.6%) and extreme dipping (3.9%).Conclusiona high proportion had nocturnal hypertension (79.2%) and non-dipping pattern was the most prevalent pattern (55.8%). Mean awake systolic BP, mean asleep systolic and diastolic BP and mean 24-h systolic and diastolic BP were elevated. The use of 24-h ABPM will enhance assessment of increased cardiovascular risk and management of Nigerians with hypertension.

Hemodynamic profile of Spanish adults with Down syndrome

ObjectivesAlthough the reasons are unknown, the prevalence of arterial hypertension and atherosclerotic cardiovascular events in the adult population with Down syndrome (SD) is anecdotal. To better understand this finding, we evaluated the haemodynamic characteristics of a cohort of adults with SD. MethodsWe conducted a cross-sectional study of adults with SD recruited consecutively from the outpatient clinics of an internal medicine department between June and November 2018. We collected demographic, clinical and laboratory variables and employed a thoracic bioimpedance device (HOTMAN® System) for the haemodynamic measures. Outpatient blood pressure monitoring (OBPM) was conducted on a subgroup of participants. ResultsTwenty-six participants (mean age, 45±11 years) participated in the study (50 % men). The sample’s mean blood pressure (BP) was 109/69±11/9mm Hg, with a mean heart rate of 60±12 bpm. None of the participants had hypertension. The predominant haemodynamic profile consisted of normal dynamism (65 %), normal BP (96 %), hypochronotropism (46 %), normal inotropism (50 %) and hypervolaemia (54 %), with normal peripheral vascular resistance values (58 %). Twelve participants underwent OBPM (46 %). The mean 24-h systolic BP, diastolic BP, mean BP and mean heart rate were 105±11mm Hg, 67±11mm Hg, 80±11mm Hg and 61±6 bpm, respectively. ConclusionsThe most common haemodynamic profile observed in adults with SD consisted of hypochronotropism and hypervolaemia, with normal values for peripheral vascular resistance and optimal mean BP values. There were no participants with hypertension in our sample.

Association between localised retinal nerve fibre layer defects and cardiovascular risk factors

Localised retinal nerve fibre layer defects (RNFLDs) are reported to indicate the degree of glaucomatous damage but can also be sequelae of retinal vascular insufficiency as a result of systemic vascular factors. We investigated the association between RNFLDs and cardiovascular risk factors. RNFLDs were detected in 440 (29.2%) of 1508 subjects. The presence of RNFLDs was associated with higher HbA1c (odds ratio [OR] 1.289, p < 0.001), higher 24-h mean systolic blood pressure (SBP; OR 1.013, p < 0.005), and lower estimated glomerular filtration rate (eGFR; OR 0.995, p < 0.005). An increasing number of RNFLDs was correlated with higher SBP (r = 0.186, p < 0.001), higher HbA1c (r = 0.128, p < 0.010), lower eGFR (r = −0.112, p < 0.020), and younger age (r = −0.303, p < 0.001). Subjects with RNFLDs had a higher predicted 10-year risk of atherosclerotic cardiovascular disease than did those without RNFLDs (9.7% vs 7.9%, p = 0.008 in middle-aged subjects, 25.6% vs 23.2%, p = 0.040 in older subjects). In conclusion, RNFLDs are associated with SBP, eGFR, and HbA1c. Concomitant cardiovascular risk factors should be considered when evaluating patients with localised RNFLDs.

Perfil hemodinámico de los adultos españoles con síndrome de Down

ObjectivesAlthough the reasons are unknown, the prevalence of arterial hypertension and atherosclerotic cardiovascular events in the adult population with Down syndrome (SD) is anecdotal. To better understand this finding, we evaluated the haemodynamic characteristics of a cohort of adults with SD. MethodsWe conducted a cross-sectional study of adults with SD recruited consecutively from the outpatient clinics of an internal medicine department between June and November 2018. We collected demographic, clinical and laboratory variables and employed a thoracic bioimpedance device (HOTMAN® System) for the haemodynamic measures. Outpatient blood pressure monitoring (OBPM) was conducted on a subgroup of participants. ResultsTwenty-six participants (mean age, 45±11years) participated in the study (50% men). The sample's mean blood pressure (BP) was 109/69±11/9mmHg, with a mean heart rate of 60±12bpm. None of the participants had hypertension. The predominant haemodynamic profile consisted of normal dynamism (65%), normal BP (96%), hypochronotropism (46%), normal inotropism (50%) and hypervolaemia (54%), with normal peripheral vascular resistance values (58%). Twelve participants underwent OBPM (46%). The mean 24-h systolic BP, diastolic BP, mean BP and mean heart rate were 105±11mmHg, 67±11mmHg, 80±11mmHg and 61±6bpm, respectively. ConclusionsThe most common haemodynamic profile observed in adults with SD consisted of hypochronotropism and hypervolaemia, with normal values for peripheral vascular resistance and optimal mean BP values. There were no participants with hypertension in our sample.

Association of insulin resistance with polymorphic variants of Clock and Bmal1 genes: A case–control study

ABSTRACTBackground: Little information is available in the literature for the correlation of insulin resistance (IR) and CLOCK gene polymorphism in Chinese population. This study aimed to investigate the relationship of HOMA-IR (homeostasis model assessment of insulin resistance) to polymorphic variants of Clock and Bmal1 genes in Chinese patients with essential hypertension.Methods: A total of 334 outpatients with essential hypertension (103 patients of HOMA-IR positive and 231 patients of HOMA-IR negative) were recruited to analyze Clock T3111C and Bmal1 A1420G genotypes with DNA sequencing approach.Results: Waist circumference, body mass index, glycated hemoglobin, total cholesterol, triglyceride, and plasminogen activator inhibitor-1 were significantly increased, while high-density lipoprotein cholesterol was significantly decreased in patients with HOMA-IR positive (P < .05–0.001 vs. patients with HOMA-IR negative). Twenty-four-hour ambulatory blood pressure monitoring showed that 24-h mean systolic blood pressure (SBP), especially nightime SBP, was higher in patients with HOMA-IR positive (P < .05 vs. patients with HOMA-IR negative). Notably, compared with the negative group, the distribution frequency of C allele of Clock T3111C and GG genotype of Bmal1 A1420G were significantly higher in the HOMA-IR positive group (29.1 vs. 10.8% P < .000 and 43.7 vs. 27.7% P = .007, respectively). Logistic regression analysis showed that C allele of Clock T3111C (OR = 4.128, CI 95% 2.313–7.368, p = .000) and GG genotype of Bmal1 A1420G (OR = 1.983, CI 95% 1.117–3.521, p = .019) were independent risk factors for potential HOMA-IR in Chinese patients with essential hypertension.Conclusion: Our results indicated that Chinese hypertensive patients with C allele of Clock T3111C or GG genotype of Bmal1 A1420G might be susceptible to IR and are more likely to develop high nighttime SBP.

Postthrombectomy Systolic Blood Pressure and Clinical Outcome among Patients with Successful Recanalization

Background: Optimal blood pressure (BP) management after intraarterial thrombectomy (IAT) has yet to be thoroughly elucidated. We assessed whether maintaining a systolic BP (SBP) of ≤130 mm Hg for 24 h following IAT was associated with better outcomes in patients with successful recanalization. Methods: Patients presenting with large vessel occlusion within 4 h from symptom onset underwent IAT based on multiphase computed tomography angiography, and those achieving successful recanalization were included in this retrospective analysis. Patients were dichotomized based on a 24-h mean SBP after IAT >130 or ≤130 mm Hg, and functional outcomes were compared at 3 months. At 3 months, 24-h mean SBPs were compared based on recanalization degree, baseline collateral status, stroke mechanism, and occlusion site. Results: The proportion of favorable outcomes at 3 months (modified Rankin Scale [mRS] 0–2) was significantly lower in patients with a mean SBP >130 mm Hg over the 24 h after IAT (40.5 vs. 66.7%, p = 0.02). The distribution of mRS varied significantly among patients with complete recanalization, poor baseline collateral status (pial arterial filling score 0–3), cardioembolic stroke, or middle cerebral artery occlusion, with higher mRS values associated with higher mean SBPs. A mean SBP >130 mm Hg during the 24 h after IAT was associated with worse functional outcomes after multivariable adjustment (OR 2.66; 95% CI 1.11–6.41; p= 0.03). Conclusion: Stricter BP control during the 24 h following IAT may improve clinical outcomes in patients with large vessel occlusion who achieved successful recanalization.

Osteopontin associated with left ventricular hypertrophy and diastolic dysfunction in essential hypertension.

To investigate the relationship between circulating osteopontin (OPN) and left ventricular (LV) geometry, as well as systolic and diastolic function in patients with essential hypertension. One hundred and ninety-nine essential hypertensive patients were recruited (mean age 62.5 ± 9.5, male 59%) in this study and were classified into two groups by the median of lg OPN: patients with lg OPN <0.975 (n = 100, 50.3%, low-OPN group) and patients with lg OPN > 0.975 (n = 99, 49.7%, high-OPN group). Patients in high-OPN group had higher left ventricular mass index (LVMI) than low-OPN group (112 ± 25 vs. 106 ± 19 g/m2, p = 0.045) and higher ratio of peak early to tissue Doppler early diastolic (E/e': 11.5 ± 3.4 vs. 10.6 ± 2.5, p = 0.03). There was no difference in LV diameter, relative wall thickness, or LV ejection fraction between groups. The prevalence of left ventricular diastolic dysfunction (LVDD) was significantly greater in patients with high-OPN than low-OPN group (27% vs. 12%, P = 0.005). LVMI independently correlated to age (β = 0.239, p = 0.001), 24-h mean systolic blood pressure (β = 0.379, p < 0.001) and lg OPN (β = 0.146, p = 0.04), while adversely correlated with 24-h mean heart rate (β = -0.172, p = 0.02) in multivariable stepwise linear regression analysis. E/e' ratio was found independently correlated with age (β = 0.285, p < 0.001), sex (β = 0.204, p = 0.008) 24-h mean systolic blood pressure (β = 0.191, p = 0.01) and lg OPN (β = 0.152, p = 0.04) in multivariable stepwise linear regression analysis. In conclusion, circulating OPN was an independent risk factor for both LV hypertrophy and LVDD in essential hypertensive patients. However, OPN was not related to LV dimension and systolic function.

The association between morning blood pressure and subclinical target organ damage in the normotensive population.

To investigate whether isolatedly elevated morning blood pressure (BP) is associated with subclinical target organ damage in normotensive individuals. In all, 287 normotensive individuals were included in this cross-sectional study. Each participant underwent anthropometric measurements, serum biochemistry evaluation, 24-h ambulatory BP monitoring, echocardiography, and carotid ultrasonography. The morning BP and morning surge were defined as: the average BP within 2 h after waking up, and the difference between the mean systolic BP (SBP) within 2 h after waking up and the mean SBP during the hour that included the lowest BP reading during sleep, respectively. The prevalence of elevated morning BP was 37.3%. Individuals with elevated morning BP had higher left ventricular mass index and morning surge, and also mean 24-h, daytime, and night-time SBP and diastolic BP, BP variability (all P < 0.05). Left ventricular mass index was correlated with 24-h, daytime, night-time, and morning SBP, and morning surge (Pearson's correlation coefficients: 0.271, 0.262, 0.215, 0.368, and 0.415, respectively; all P < 0.05); and standard deviations of 24-h, daytime, and night-time SBP (Pearson's correlation coefficient: 0.303, 0.234, and 0.309, respectively), and coefficient of variations of 24-h and night-time SBP (Pearson's correlation coefficients: 0.253 and 0.271, respectively). Morning surge had the strongest correlation with left ventricular mass index in multiple regression analysis. Only daytime and morning SBP could discriminate elevated morning surge (≥35 mmHg), with an area under the curve of 0.744 and 0.864, respectively (both P < 0.01), and an optimal threshold of 121.5 mmHg for morning SBP. Our findings suggest that isolated elevation of morning BP in normotensive individuals is associated with left ventricular hypertrophy. Home monitoring of morning BP may be suitable for detecting abnormal morning surge.

Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up

Purpose: Non-dipping blood pressure (BP) pattern has been associated with metabolic changes and cardiovascular events. With regard of diabetes, studies are scarce. Our aim was to investigate if there is an association between changes in dipping patterns and incidence of diabetes.Materials and methods: A 24-h ambulatory BP measurement was recorded in addition to other laboratory measurements, and a questionnaire and physical examination were carried out in the baseline study and after 21-year follow-up among a study population (n = 449) consisting of randomly selected middle-aged Finnish females and males without diabetes.Results: 128 (28.5%) developed diabetes during the follow-up. The incidence of new-onset diabetes was the highest, 41.0%, among those subjects who were non-dippers (their systolic BP declined <10% from daytime to nighttime) in the baseline and also in the follow-up study, while the incidence of diabetes was 19.6% in the dipper – dipper (a nighttime decline of systolic BP 10% or more) group (p = 0.003). The difference remained statistically significant after adjustment with age, sex, body mass index, fasting glucose, triglycerides, and insulin levels, smoking status, 24-h mean systolic BP, high-sensitivity C-reactive protein, estimated glomerular filtration and diuretics use. In logistic regression analysis, the non-dipper – non-dippers were at higher risk of diabetes compared with dipper – dipper group (OR = 2.27, 95% CI: 1.13–4.56, p = 0.022).Conclusions: Our prospective study shows that there is an independent association between non-dipping BP pattern and the incidence of diabetes in a 21-year follow-up.

Evaluation of the effects of Uncaria rhynchophylla alkaloid extract on LPS-induced preeclampsia symptoms and inflammation in a pregnant rat model.

Excessive pro-inflammatory cytokines result in adverse pregnancy outcomes, including preeclampsia-like phenotypes, and fetal growth restriction. Anti-inflammation might be an effective therapy. The aim of this research was to investigate whether Uncaria rhynchophylla alkaloid extract (URE), a highly safe anti-inflammation constituent of the herb, can inhibit inflammation and improve clinical characteristics of preeclampsia in a lipopolysaccharide (LPS)-induced preeclampsia rat model. The rat model was established by daily administration of LPS (1 μg/kg body weight per day) from gestational day (GD) 14 to 19. Different doses of URE (35, 70, and 140 mg/kg body weight per day) were administered from GD 14 to GD 19. The effects of URE on proteinuria, maternal hypertension, pregnancy outcomes, as well as pro-inflammatory cytokines levels in serum and placenta were measured. High-dose URE (HURE) treatment decreased LPS-induced mean 24-h proteinuria and systolic blood pressure, and increased fetal weight, placental weight, and the number of live pups (P<0.05). Moreover, increased serum and placental levels of interleukin (IL)-6, IL-1β, tumor necrosis factor-α, and interferon-γ in the LPS-treated group were obviously inhibited after HURE administration (P<0.01). URE improved preeclampsia symptoms and mitigated inflammatory responses in the LPS-induced preeclampsia rat model, which suggests that the anti-inflammation effect of URE might be an alternative therapy for preeclampsia.

A4951 The characteristics of ambulatory blood pressure in Chinese hypertensive patients with obstructive sleep apnea

Objectives: To assess the characteristics of ambulatory blood pressure in the Chinese hypertensive patients with obstructive sleep apnea syndrome. Methods: PubMed, Cochrane Library, Embase, Science Citation Index, WanFang data, China National Knowledge Infrastructure database, and VIP were searched form these databases establishment to February 2018. Cross-sectional studies which directly compared Chinese hypertensive patients with and without obstructive sleep apnea (OSA) were included. The ambulatory blood pressure monitoring was used. The following parameters were analyzed: age, body mass index (BMI), apnea-hypopnea index (AHI), 24-h mean systolic blood pressure (SBP), 24-h mean diastolic blood pressure (DBP), day-time SBP, day-time DBP, night-time SBP, night-time DBP, pro-bedtime SBP, pro-bedtime DBP, morning SBP, morning DBP, and the number of patients with non-dippers. Data were extracted and analyzed by Cochrane Collaboration's RevMan 5.3 software. Results: Thirteen studies involving 1080 patients were included. There was no significant difference in age between the two groups, but the BMI in the OSA group was significantly greater than that in the non OSA group (P < 0.05). And AHI of hypertensive patients with OSA was significantly higher than that of patients without OSA (P < 0.05). Compared with hypertensive patients without OSA, all of the blood pressure were significantly increased except the pro-bedtime SBP and the pro-bedtime DBP. Moreover, the number of patients with non-dippers in hypertensive patients with OSA group was significantly more (P < 0.05). Conclusion: Chinese hypertensive patients with OSA not only showed a significant increase in the blood pressure level in each period, but also represented a higher proportion of non-dippers patients.

Lowering Blood Pressure with the Combination of a Sodium-Glucose Cotransporter 2 Inhibitor and a Glucagon-like Peptide-1 Receptor Agonist in Type 2 Diabetic Patients: A Clinical Evidence.

Patients with type 2 diabetes mellitus (T2DM) often have numerous cardiovascular risk factors, among which hypertension. To evaluatethe blood pressure variations among patients treated with a combination of a sodium-glucose cotransporter 2 inhibitor (iSGLT-2) and a glucagon-like peptide-1 receptor agonist (GLP-1ra). We analyze 17 patients treated withthis combination to quantify the changes on blood pressure by ambulatory blood pressure monitoring at baseline and at three and 6months follow-up. We observed a decrease of HbA1c levels (p = 0.004) at six months follow-up, a decrease in mean 24h systolic blood pressure [from 124 (11) mmHg to 123 (4.75) mmHg, p = 0.04] and in both, mean waking and sleeping systolic blood pressure, being greater the reduction in the sleeping time [118 (20) mmHg to 111 (20) mmHg, p = 0.004]. The effect of a combination therapy of an iSGLT-2 and a GLP-1ra on blood pressure in a real-world setting, may have summative effects especially in SBP.

Association of SLRPs with carotid artery atherosclerosis in essential hypertensive patients.

Recent research suggested that certain small leucine-rich repeat proteoglycans (SLRPs) were involved in the development of atherosclerosis. The present study investigated the relationship between carotid atherosclerosis plaque and the circulating levels of some SLRPs, including decorin, lumican, and osteoglycin, in essential hypertension. In total, 176 essential hypertensive patients were recruited (mean age 62.1 ± 9.4, male 56.8%) in this study and were classified into two groups: patients with carotid artery plaque (n = 105, 60%) and patients without carotid artery plaque (n = 71, 40%). Patients with carotid artery plaque had higher serum concentration of lumican than patients without carotid plaque (58.0 ± 1.6 vs. 52.3 ± 2.1 ng/ml, p = 0.04) after adjusting for conventional cardiovascular risk factors. There were no differences in decorin and osteoglycin between the two groups. Multivariable logistic regression analysis revealed that lumican levels (Odds ratio (OR) per standard deviation increase, 1.598; 95% confidence interval (CI), 1.012 ~ 2.523; p = 0.04), 24-h mean systolic blood pressure (OR, 1.045; 95% CI, 1.012 ~ 1.079; p = 0.006) and the use of angiotensin receptor blocker (OR, 2.813; 95% CI, 1.023 ~ 7.734; p = 0.045) were independently associated with carotid artery plaque. Besides carotid artery plaque, lumican was related to impaired glucose tolerance (r = 0.162, p = 0.046) and adversely related to osteoglycin (r = - 0.273, p < 0.001), whereas unrelated to age, sex, BMI, diabetes, blood pressure, serum lipids, high-sensitivity C-reactive protein, or carotid intima-media thickness in univariate correlation analyses. Circulating lumican was independently associated with carotid atherosclerosis plaque in essential hypertensive patients, indicating that SLRPs might be used as a promising molecular marker for atherosclerosis.

BLOOD PRESSURE CONTROL OF NIFEDIPINE GITS 60MG TREATMENT IN PREVIOUSLY UNCONTROLLED HYPERTENSIVE PATIENTS

Objective: Post-marketing surveillance data has confirmed the efficacy and tolerability of 30 and 60 mg Nifedipine GITS in the management of hypertension. However, role of high dose Nifedipine GITS in controlling blood pressure (BP) in patients with uncontrolled BP levels with prior antihypertensive therapy is not studied. This 2nd analysis of ADEPT study aimed to evaluate the effect of Nifedipine GITS 60 mg treatment on 24 hours BP control in uncontrolled hypertensive patients using Ambulatory Blood Pressure Monitoring (ABPM). Design and method: Men and women (18–65 years) whose BP was uncontrolled with prior antihypertensive monotherapy were included in a prospective, open-label, multicenter, single-arm study. Patients received oral Nifedipine GITS 60 mg for 8 weeks, OD. BP data was obtained at baseline, week 2, 4, and 8. Mean 24-h systolic (SBP) and diastolic blood pressure (DBP) data was obtained through 24-h ABPM at baseline and after Week 8. BP reduction at each hour and throughout 8-week study period was analyzed along with heart rate (HR). Results: Patients who started both baseline and week 8 ABPM between 8:00 and 11:59AM were included in the analyses (n = 138, age = 55.6 ± 8.1 years, 58% men, 42% women). Hourly variation in SBP and DBP at baseline and week 8 is represented in Fig.1. Mean 24-h SBP decreased from 129.1 ± 16.1 mmHg to 121.6 ± 12.7 mmHg and DBP decreased from 79.1 ± 10.1 mmHg to 76.0 ± 9.2 mmHg. T/P ratio for SBP was 0.71 and 0.63 for DBP. Mean change in SBP and DBP for last 4-h at baseline and week 8 was 133.4 ± 15.0 mmHg and 126.3 ± 12.6 mmHg, 82.9 ± 9.1 mmHg and 80.0 ± 8.8 mmHg respectively. Mean change in SBP and DBP for last 6-h at baseline and week 8 was 131.9 ± 14.9 mmHg and 124.6 ± 11.9 mmHg, 81.6 ± 9.0 mmHg and 78.4 ± 8.8 mmHg respectively. 24-h variation in HR was 1.5 bpm.Conclusions: Nifedipine GITS showed good efficacy in the last dosing time along with good BP control for 24-h in patients with uncontrolled BP with prior antihypertensive monotherapy.

A strategy utilizing ambulatory monitoring and home and clinic blood pressure measurements to optimize the safety evaluation of noncardiovascular drugs with potential for hemodynamic effects: a report from the SYNERGY trial.

The aim of this study was to perform a blood pressure (BP) safety evaluation in patients with an overactive bladder receiving solifenacin (an antimuscarinic agent), mirabegron (a β3-adrenoceptor agonist), or both compared with placebo in the SYNERGY trial. Patients were randomized to receive solifenacin 5 mg+mirabegron 50 mg (combination 5+50 mg); solifenacin 5 mg+mirabegron 25 mg (combination 5+25 mg); solifenacin 5 mg; mirabegron 50 mg; mirabegron 25 mg; or placebo for a double-blind 12-week treatment period. Systolic BP, diastolic BP, and heart rate were measured by ambulatory BP monitoring, and in the clinic or home. A total of 715 patients were analyzed in an ambulatory BP monitoring substudy. At the end of treatment, ambulatory BP monitoring measurements showed no consistent increases from baseline in the mean 24-h systolic BP or diastolic BP for combination versus monotherapy groups or for monotherapy groups versus placebo. Analysis of 1-h BP averages during the 6 h range that included the Tmax values of both study drugs showed no significant BP effects. Shift analysis (switch between different normotension/hypertension stages) did not show differences among the active and placebo groups, nor did outlier analysis of major BP changes differ between placebo and active treatment. Similarly, there were no significant signals in the 24-h heart rate. Office and home measurements were consistent with ambulatory BP monitoring findings. A paradigm of ambulatory BP monitoring analysis designed to test BP safety of noncardiovascular drugs showed that solifenacin plus mirabegron combination therapy during 12 weeks produced no meaningful changes in BP or heart rate.

The relationship of age-adjusted Charlson comorbidity ındex and diurnal variation of blood pressure

ABSTRACTBackgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients.Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed.Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = −0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012–1.165)Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality.

Increased blood pressure and aortic stiffness among abusers of anabolic androgenic steroids: potential effect of suppressed natriuretic peptides in plasma?

Abuse of anabolic androgenic steroids (AAS) is prevalent among recreational athletes and adverse effects on blood pressure (BP) and arterial stiffness could be substantial. Testosterone decreases natriuretic peptides which are key components in BP-regulation and may impair BP-homeostasis in AAS abusers. To investigate BP and aortic stiffness in relation to natriuretic peptides among current AAS abusers, former AAS abusers and controls. In this cross-sectional study, 37 current AAS abusers, 33 former AAS abusers and 30 controls were included. All participants were men involved in recreational strength training. We used 24-h BP monitoring, assessed proximal aorta distensibility index (ADI) by MRI and obtained overnight fasting blood samples to measure: midregional proatrial natriuretic peptide (MR-proANP), aldosterone, noradrenaline and copeptin. Current AAS abusers exhibited higher mean (95% confidence interval) 24-h systolic BP than controls [132 (129; 135) versus 124 (120; 128) mmHg, P = 0.005] and systolic hypertension was more frequent among current AAS abusers than controls (51 versus 17%, P = 0.009). ADI was lower among both current and former AAS abusers suggesting higher aortic stiffness; %-difference (95% confidence interval) from controls: -21% (-35; -5) and -21% (-36; -4), P < 0.05. Plasma MR-proANP was decreased, whereas aldosterone and noradrenaline were increased among current AAS abusers compared with former AAS abusers and controls. Decreased MR-proANP was independently associated with increased systolic BP and reduced ADI in multivariate linear regressions. Current AAS abusers displayed increased 24-h systolic BP and decreased plasma MR-proANP. Both current and former AAS abusers exhibited higher aortic stiffness.

Evaluation of the level of dynamic thiol/disulphide homeostasis in adolescent patients with newly diagnosed primary hypertension.

Thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defense and detoxification. This study was designed to investigate the impact of thiol/disulfide homeostasis in adolescent patients with recently diagnosed primary hypertension (HT) using a novel and automated method. Native thiol/disulphide levels were measured by a novel spectrophotometric method (Cobasc 501, Roche Diagnostics, Mannheim, Germany) in 30 patients with primary HT together with 30 healthy controls. The levels of native thiol, total thiol, and native thiol/total thiol ratios were significantly lower, while the disulphide level, disulphide/native thiol, and disulphide/total thiol ratios were significantly higher in patients with primary HT compared with the control group. There were significant positive correlations between 24-h mean systolic and diastolic blood pressure and disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios. A multiple linear regression model showed that a disulphide/native thiol ratio above 5 and family history of HT are independent predictors of HT. Our study showed that dynamic thiol/disulphide homeostasis shifted towards disulphide formation in adolescent patients with primary HT. Understanding the role of thiol/disulfide homeostasis in primary HT might provide new therapeutic intervention strategies for patients.