24-hour Blood Pressure Profile Research Articles

Abnormalities of the nocturnal blood pressure profile: significance, diagnostic possibilities, and therapeutic approaches

Impaired 24-hour blood pressure (BP) profile is receiving increasing attention due to improved detection capabilities, increased incidence, and confirmed associations with cardiovascular risk. However, there are gaps or conflicting data in knowledge about nocturnal hypertension (HTN) and non-dipping. The review focuses on current problems associated with elevated nocturnal BP with an emphasis on diagnostic capabilities, prognostic significance of changes and treatment options.

Changes in 24-hour blood pressure profile after 12 weeks of dapagliflozin treatment in patients with diabetic kidney disease: an Italian multicenter prospective study.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower ambulatory blood pressure (ABP) in patients with type 2 diabetes mellitus; whether the same holds true in diabetic kidney disease (DKD) is unknown. This information is critical to the knowledge of mechanisms of nephroprotection and safety of this therapy. This multicenter prospective study evaluates the changes in ABP after 12weeks of dapagliflozin 10mg/day in a cohort of patients with type 2 DKD and glomerular filtration rate (GFR) >25mL/min/1.73 m2. Primary endpoint was the change of nighttime systolic blood pressure (SBP). Changes of daytime SBP, prevalence of normal dipping (day/night SBP ratio <0.9) and changes in ABP patterns, that is, sustained uncontrolled hypertension (SUCH), white coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and controlled hypertension (CH) were secondary endpoints. Eighty-three of 96 patients completed the study [age 68.7±8.9 years, 73.5% males, GFR 49±17mL/min/1.73 m2, median albuminuria: 0.18 (interquartile range 0.10-0.38) g/24h]. After 12weeks of dapagliflozin, nighttime SBP declined by -3.0mmHg (95% confidence interval -5.2/-0.8mmHg; P=.010) with an improvement of nighttime SBP goal (<110mmHg) from 18.0% to 27.0% (P<.001). Similarly, the prevalence of normal dipping increased (from 31.3% to 50.6%, P=.005). A decrease in daytime (-2.4mmHg; P=.046) and office (-7.9mmHg; P=.009) SBP was also found. The decline of ambulatory and office SBP was associated with increased prevalence of CH (from 6.0% to 18.0%) and significant improvement of SUCH, WUCH and MUCH (P=.009). Albuminuria decreased (P<.001), whereas eGFR did not change (P=.297). Urinary tract infection (4.2%) and acute kidney injury (3.6%) were the main causes of drop-out. Only one patient showed a drop of nighttime SBP below 90mmHg. Dapagliflozin is associated with improvement in circadian blood pressure rhythm with no major safety signal related to excessive blood pressure decrease.

Value of proprotein convertase subtilisin/kexin type 9 and inflammatory markers in the diagnosis of carotid atherosclerosis in hypertensive men

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in lipid metabolism, has local and systemic effects in immunoregulation and atherogenesis in hypertensive patients.Aim. To personalize cardiovascular risk (CVR) stratification taking into account the diagnostic value of PCSK9 and inflammatory markers in men with hypertension and carotid atherosclerosis.Material and methods. The study included 162 males with stage I-III hypertension of various CVR. All patients underwent collection of complaints and medical history, physical examination with anthropometry. The following laboratory test were performed: complete blood count with white blood cell differential and erythrocyte sedimentation rate, assessment of fibrinogen, C-reactive protein (CRP), total cholesterol, low-density lipoprotein cholesterol, triglycerides, blood glucose, serum creatinine level. Glomerular filtration rate and microalbuminuria were also evaluated. Serum PCSK9, interleukins-8, 10 (IL-8, 10) were determined by enzyme immunoassay. In addition, 24-hour blood pressure monitoring, extracranial artery ultrasound with determination of intima-media thickness and carotid stenosis severity were performed. Patients were divided into 3 groups according to PCSK9 level.Results. Analysis of conventional cardiovascular factors and cytokine status (IL-8 and IL-10) in patients showed an inverse relationship between age and IL-8 (r=-0,230; p=0,036), IL-8/IL-10 (r=-0,309; p=0,005); heredity and IL-8/IL-10 (r=-0,423; p=0,001). There were following relationships between CVR factors and PCSK9: direct relationship between men's age (r=0,220, p=0,032), systolic and diastolic blood pressure (r=0,230, p=0,033; r=0,260, p=0,015) and PCSK9; inverse relationship between PCSK9 and heredity (r=-0,286, p=0,011). C-reactive protein and erythrocyte sedimentation rate were associated with IL-10 levels, which are associated with anti-inflammatory activity (r=0,78; p=0,02; r=0,78; p=0,02, respectively). The IL-8/IL-10 cytokine imbalance was most pronounced in patients with a night-peaker 24-hour systolic blood pressure profile (p=0,02). Patients with intima-media thickening and plaques had a highest level of PCSK9 (p=0,006). IL-8 levels were significantly higher with unchanged intima-media thickness (p=0,01).Conclusion. In patients with high levels of PCSK9, there is a close relationship between risk factors for hypertension and cytokine imbalance. The severity of extra­cranial artery atherosclerosis significantly depends on the increase in the levels of PCSK9 (p=0,006) and inflammatory markers (IL-10) (p=0,044).

Sleep quality and cardiovascular risk in the watch setting in the Far North

Background. The study shows gender differences in sleep quality and also association of sleep disturbances (SD) with cardiovascular diseases (CVD). The watch work contributes to the biorhythms of the body disorders, including SD. Autonomous nervous system is the key regulator of circadian rhythms.Aim: To study sleep quality (SQ) in the gender aspect and cardiovascular risk in the workers of the Far North watch.Material and methods. In Yamburg, the settlement in the Far North (68° 21’ 40” north latitude), 99 males (M) and 81 females (F) with SD and normal sleep, comparable in age, northern experience, level of office blood pressure (BP) were examined. SQ analysis was conducted according to the questionnaire (Pittsburg Sleep Quality Index – PSQI). 24-hour BP monitoring, biochemical blood analysis, ultrasound examination of the carotid arteries, echocardiography, and assessment of autonomic changes was performed.Results. M significantly more often than F assessed their sleep subjectively better (p = 0.046); M and F with SD had elevated variability of systolic BP at night (p = 0.036; p = 0.039), BP 24-hour profile disorder did not depend on SQ (p = 0.2607), SD in both genders was accompanied by the increase of volumes and indices of left atrium (p = 0.0285; p = 0.0445), enhanced probability of left ventricle diastolic dysfunction for 1.9 times. SD in F enhanced the level of insulin (p = 0.0267), С-peptide (p = 0.0424), NTpro-BNP (p = 0.042) and was accompanied by autonomic dysfunction.Conclusion. In the conditions of the Arctic watch, SD is often revealed in F, is accompanied by the signs of autonomic dysfunction, more evident in F. 24-hour BP profile disorder typical for the watch work is not connected with SQ and more evident in M. SD in both genders is associated with atrial remodeling, the formation of diastolic dysfunction, but an increase in the frequency of atherosclerotic lesions of the carotid arteries, an increase in vascular inflammation factors, metabolic disorders, and neurohumoral activation, more pronounced in F, which may determine an increased risk of CVD in F in Arctic watch work conditions.

Efficacy of azilsartan medoxomil in patients with hypertension and stable coronary artery disease in combination with type 2 diabetes

Aim. To study the effect of azilsartan medoxomil (AZL-M) on the 24-hour blood pressure (BP) profile in patients with hypertension (HTN), type 2 diabetes (T2D) and stable coronary artery disease (CAD).Material and methods. A total of 183 patients with CAD in combination with HTN and T2D took part in the study (100 men (54,64%), 83 women (45,36%)). All patients were previously prescribed a statin, antiplatelet therapy, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). At baseline, the proportion of people taking ARBs and ACEIs was 30% and 70%, respectively. All study participants were discontinued from a previously prescribed ARBs or ACE inhibitors and were prescribed 6-month AZL-M (Edarbi®) therapy. During this period, according to the study plan, patients visited the medical center to assess the effectiveness and safety of therapy and blood pressure changes.Results. The mean age of the patients was 65,0 years (60-69 years), while the mean body mass index (BMI) — 31,24 kg/m2. The mean age of female participants was higher than the mean age of males: 66,35±6,59 vs 62,72±8,82 years (p=0,002). The mean BMI in women was higher and was 33.08 kg/m2, while in men it was 30,74 kg/m2 (p=0,001). Six-month AZL-M therapy decreased 24-hour BP values. Thus, the time index of systolic blood pressure (SBP) hypertension in the daytime decreased from 63% to 12%, while at night from 70% to 10%, and the time index of diastolic blood pressure (DBP) hypertension in the daytime from 18% to 10%, and at night from 44% to 8%. The main result is confirmation of AZL-M effectiveness in relation to BP control, as well as good drug tolerability. At the visit after 1-month AZL-M therapy, target BP values were recorded in 45,4% of participants, and after six months — the proportion of people with normal 24-hour BP values was 69,9%.Conclusion. Edarbi® therapy in patients with HTN in combination with T2D and stable CAD leads to 24-hour BP normalization. At the same time, the drug has a good safety profile, since the reported adverse events were not related to the drug.

24-hour blood pressure profile and systemic inflammation in patients with stable coronary artery disease with obstructive sleep apnea

Aim. To evaluate 24-hour blood pressure (BP) profile and systemic inflammation in patients with coronary artery disease (CAD) depending on the presence of obstructive sleep apnea (OSA).Material and methods. This cross-sectional cohort study included 132 patients with CAD aged 62,3±6,9 years. Depending on OSA, all patients were divided into 2 groups: group 1 (n=60) — without OSA, group 2 (n=72) — with OSA. Systemic inflammation was assessed using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), Systemic immune-inflammation index (SII) — platelets´neutrophils/lymphocytes. Blood pressure was monitored with assessment of average daily values, circadian rhythm, and variability.Results. Patients with OSA had higher nighttime blood pressure values (p&lt;0,05) and 24-hour variability (p&lt;0,05). In group 2 patients, a pathological blood pressure profile was detected in 66,7% of cases, while in group 1 — in 36,7%. The systemic inflammation indices were significantly higher in patients with OSA than in the group without OSA — NLR by 18,8% (p&lt;0,01), PLR by 22,5% (p&lt;0,01), MLR by 19,0% (p&lt;0,01), SII by 41,0% (p&lt;0,001).Conclusion. We established that patients with coronary artery disease and OSA have more pronounced systemic inflammation, more often have a pathological 24-hour BP profile ("non-dipper", "night-peaker"), BP variability, higher values of average 24-hour, daytime and nighttime BP compared with patients without OSA.

The Association Between 24-Hour Blood Pressure Profiles and Dementia.

Midlife hypertension increases risk for dementia. Around one third of adults have diagnosed hypertension; however, many adults are undiagnosed, or remain hypertensive despite diagnosis or treatment. Since blood pressure (BP) follows a circadian rhythm, ambulatory BP monitoring allows for the assessment of BP over a 24-hour period and provides an important tool for improving the diagnosis and management of hypertension. The measurement of 24-hour BP profiles, especially nocturnal BP, demonstrate better predictive ability for cardiovascular disease and mortality than office measurement. However, few studies have examined 24-hour BP profiles with respect to dementia risk. This is an important topic since improvements in BP management could facilitate the primary prevention of vascular cognitive impairment and dementia. Therefore, this review discusses the evidence linking BP to dementia, with a focus on whether the implementation of 24-hour BP measurements can improve risk prediction and prevention strategies. Pathways linking nocturnal BP to dementia are also discussed as are risk reduction strategies. Overall, limited research suggests an association between 24-hour BP elevation and poorer cognition, cerebral small vessel disease, and dementia. However, most studies were cross-sectional. Further evidence is needed to substantiate 24-hour BP profiles, over and above office BP, as predictors of vascular cognitive impairment and incident dementia.

CIRCADIAN BLOOD PRESSURE PROFILE IN RELATION TO LOW BACK PAIN DISABILITY INDEX

Objective: Cross-sectional observations within population cohorts have linked low back pain with hypertension in men, but not in women. The aim of the current study was to analyze 24-hour blood pressure profile in hypertensive men and women reporting low back pain. Design and method: The study group included 85 hypertensive patients (29 M/56 F, mean age 60.6 +/- 8.3 years) with episodes of low back pain during 3 weeks before examination. All patients received antihypertensive medications in the scheme of combination therapy and none of them was on chronic painkillers. Standardized questionnaire was used to collect information on life style factors. Twenty-four hour blood pressure monitoring was provided (Spacelabs 90207) and values of 24h, daytime and nighttime blood pressure were calculated, as well as nighttime blood pressure dipping. Oswestry Low Back Pain Disability Questionnaire was used to calculate disability index. Multivariable regression was used to asses the association between blood pressure an disability index, while accounting for covariates. Results: In the whole study population, no association was found between disability index and 24-hour systolic (parameter estimate: -0.053 +/- 0.23 mm Hg per 1 point increase in disability index, p = 0.86) or diastolic blood pressure (-0.018 +/ 0.14 mm Hg per 1 point increase, p = 0.90). When analyzing men and women separately, we observed in women increased daytime diastolic blood pressure with increasing disability index (+0.29 +/- 0.16 mm Hg, p = 0.044), that resulted in more prominent day-night difference with increasing disability index (+0.42 +/- 0.14% per 1 point increase in disability index). Blood pressure values over 24 hours or nighttime blood pressure was not associated with disability index. None of associations between blood pressure values and low back pain disability index were not found in men. Conclusions: Low back pain, as assessed by standardized questionnaire of disability index, is associated with elevated daytime blood pressure in hypertensive women, that might lead to more difficulties in achieving target blood pressure in this group of patients.

Comparative antihypertensive efficacy of combinations of azilsartan medoxomil or olmesartan medoxomil with amlodipine in patients with arterial hypertension, type 2 diabetes mellitus and non-alcoholic fatty liver disease

Оbjective : to compare the effectiveness of the effect of two combination therapy options on office blood pressure (BP), 24-hour blood pressure monitoring (ABPM) and 24-hour BP profile (DAP) in patients with arterial hypertension (AH) associated with type 2 diabetes mellitus (T2D) and non-alcoholic fatty liver disease (NAFLD). Materials and methods: 137 patients with uncontrolled hypertension combined with DM2 and NAFLD were examined. After randomization by the "envelope" method, patients of the 1st group were assigned a combination of azilsartan medoxomil (Az-M) with amlodipine (Aml), the 2nd group a combination of olmesartan medoxomil (Ol-M) with Aml. At baseline, at 4, 8, 12, and 24 weeks, office BP was measured, and ABPM and DAP were analyzed at baseline and at 24 weeks of the study. Results : after 12 weeks in the 1st and 2nd groups, 86,8% and 84,1% of patients, respectively, reached the target level (TA) of blood pressure, which was maintained until the end of the study. After 24 weeks, both groups showed a statistically significant improvement in ABPM parameters and optimization of DAP. At the same time, taking the Ol-M/Aml combination was accompanied by more pronounced positive dynamics of some prognostically important ABPM indicators. Conclusion : despite the significant antihypertensive effect on the background of the use of both combinations, the effect on individual parameters of ABPM Ol-M/Aml was more pronounced.

Vascular stiffness, 24-hour blood pressure profile in patients with hypertension and anxiety-depressive disorders in andro- and menopausal periods

Aim. Identification and analysis of the features of vascular stiffness, 24-hour blood pressure (BP) profile, and central aortic pressure (CAP) in patients with hyper­tension (HTN) and anxiety-depressive disorders (ADDs) during andro- and meno­pausal periods.Material and methods. The study included 120 patients with uncontrolled hyper­tension in the andro- and menopausal periods, of which 60 patients with hyper­tension and ADDs (30 men and 30 women) with median age of 58 years (52-64 years), as well as the control group — 60 patients with hypertension without ADD (30 men and 30 women) with median age of 59 years (53-65 years). All persons included in the study underwent 24-hour ambulatory BP monitoring (ABPM) and assessed the arterial stiffness parameters and CAP.Results. Comparative evaluation of ABPM in the group of patients with HTN and ADDs revealed more pronounced pathological changes in the 24-hour BP profile compared to those in the control group. Andro- and menopause with a combination of HTN and ADDs characterized by significantly higher ABPM parameters than HTN without ADDs (regardless of the sex). At the same time, in the group of men with HTN and ADD in andropause, unfavorable changes in the main arterial stiffness parameters and CAP were more significant than in women with HTN and ADD during menopause (p&lt;0,05). In the control men groups, in comparison with women, more pronounced unfa­vo­-rable changes in certain vascular stiffness indicators, CAP and ABPM were recorded.Conclusion. In men and women in periods of andro- and menopause with HTN and ADDs, the features of arterial stiffness, CAP, and 24-hour blood pressure profile were verified in comparison with patients with HTN without ADDs. At the same time, the severity of unfavorable changes in the studied parameters in men with depression in andropause is more significant than in menopausal women.

Position of 24-hour ambulatory blood pressure monitoring in modern practice

Currently, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is the gold standard for diagnosing hypertension (HTN) and evaluating the effectiveness of antihypertensive therapy. The method provides information about some BP parameters that cannot be obtained in any other way. ABPM is reasonable in any patient with a documented increase in BP, especially if specific BP phenotypes are suspected: white coat HTN and masked HTN. Antihypertensive therapy under the ABPM, on average, is more economical and is not associated with overprescribing of drugs and their combinations. Based on the ABPM data, calculating a number of additional indicators of the 24-hour BP profile is possible, but their scope is still limited to the research field. In the conclusion on ABPM data, the results of office BP measurement and antihypertensive therapy should be indicated.

24-hour blood pressure monitoring in patients with polycythemia vera

Aim. To study the parameters of 24-hour blood pressure monitoring in patients with polycythemia vera and to determine their informational value for the diagnosis of heart damage.Materials and methods. Blood pressure parameters were monitored daily in 63 patients with I–IIB stage polycythemia vera and 52 healthy individuals to determine the occurrence of their pathological types. The sensitivity and specificity of the studied parameters were evaluated using ROC analysis for early diagnosis of heart damage in polycythemia patients. The obtained information was processed in Statistica 25.0.Results. An analysis of blood pressure load showed that 47.6%, 30.1% and 34.9% of polycythemia patients suffer from systolic arterial hypertension (p = 0.012), daytime diastolic arterial hypertension (p = 0.03), and nocturnal diastolic arterial hypertension (p = 0.001), respectively. In comparison with healthy individuals, polycythemia patients experienced a higher variability of systolic (p&lt;0.002) and diastolic (p&lt;0.001) blood pressure, as well as the morning surge of systolic pressure (p = 0.014), more frequently. In 69.8% of polycythemia patients, pathological types of 24-hour blood pressure profile – with either insufficient or excessive nocturnal reduction – were observed. Informative parameters of heart damage in polycythemia patients were found to include blood pressure load, minimum daytime systolic and diastolic blood pressure, and the rate of nocturnal decrease in diastolic pressure.Conclusions. (1) Systolic-diastolic arterial hypertension was detected in half of polycythemia patients, with pathological types of 24-hour blood pressure profile observed in the majority of patients. (2) The parameters of 24-hour blood pressure monitoring can be used for early diagnosis of heart damage in patients with polycythemia vera.

The current state of blood pressure measurement and emerging technologies

Office blood pressure measurement has been the primary means of diagnosing and treating hypertension for almost a century. Increasingly, guidelines recommend out-of-office measurements (ambulatory or home blood pressure measurement) to confirm the diagnosis of hypertension and to follow treated patients. Ambulatory blood pressure measurement includes nocturnal measurement and provides a 24-hour blood pressure profile, enabling calculation of overall blood pressure, daytime mean, and nocturnal mean. Home blood pressure monitoring is a method of blood pressure measurement that is convenient and accessible. Blood pressure telemonitoring is a complementary and emerging technology that enhances the effectiveness of out-of-office blood pressure measurement and has the potential to improve the health of end users through engagement, efficiency, and enhanced communication with the care team. Blood pressure measurements can be obtained remotely, effectively transmitted to their health care team via telemonitoring for interpretation, and then a care plan can be developed and implemented. However, care must be taken to ensure that these emerging technologies record and transmit accurate blood pressure information in a secure and reliable manner.

Arterial stiffness in hypertensive patients with peripheral artery disease

Objective. To identify features of arterial stiffness, to establish relationships with indicators of the daily blood pressure profile and peripheral artery disease in patients with hypertension (HTN) in combination with subclinical and manifested atherosclerotic lesions of the arteries of the lower extremities. Design and methods. 120 patients were divided into 3 groups: group 1-46 patients with HTN and clinically manifested AALE, group 2-39 patients with HTN and asymptomatic AALE, group 3-35 HTN patients without AALE. All patients underwent general clinical laboratory and instrumental research methods, including 24-hour blood pressure ambulatory monitoring (24h-ABPM) with the assessment of 24-hour blood pressure profile and arterial stiffness parameters, ultrasonic triplex scanning (USTS) of the arteries of the lower extremities. Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA). Results. Higher values of pulse wave velocity (PWVao), augmentation index (AIx) and ambulatory arterial stiffness index (AASI) were found in the 1st group in comparison to the 2nd and 3rd groups (p &lt; 0,05). Lower reflected wave transit time (RWTT) (119,5 [112;127] ms) was found in the 1st group (128 [122;132], p = 0,001 and 126 [121;129] ms, p = 0,03 in the 2nd and and 3rd groups, respectively) groups. The maximum rate of blood pressure increase (dP/dtmax) in patients of the 1st (550 [466;666] mm Hg/s) and 2nd (634 [511;695] mm Hg/s) groups was significantly lower than in patients of the 3rd group (655 [526;806] mm Hg/s, p &lt; 0,05). A direct correlation was found between AASI values and SBP (r = 0,291, p = 0,049) and its variability (r = 0,301, p = 0,042), AASI and PBP (r = 0,518, p &lt; 0,001), its variability (r = 0,596, r &lt; 0,001) in group 1, as well as AASI and PBP (r = 0,514, p &lt; 0,001) and PBP variability (r = 0,632, p &lt; 0,001) in group 2. A correlation between AIx and the degree of stenosis (%) of the arteries of the lower extremities was found in patients with AH and AALE of varying severity (r = 0,310, p = 0,004). Conclusions. In patients with subclinical course of AALE, lower values of dP/dtmax in comparison with HTN patients without AALE indicate an increase in arterial stiffness at the initial stages of peripheral atherosclerosis. Clinically manifested atherosclerotic lesions of the arteries of the lower extremities in HTN patients are associated with a more pronounced increase in arterial stiffness, which contributes to a higher cardiovascular risk.

Effect of one-day intermittent fasting on 24-hour blood pressure profile in hypertensive and normotensive patients with overweight and obesity

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): National Academy of Medical Science of Ukraine Background The modification of eating behavior is an integral part of cardiovascular disease prevention. Intermittent fasting is a modern approach towards diet correction. However, insufficient data exists on its effect and safety on daily blood pressure and lipids. The aim of this paper was to assess the response of blood pressure, blood lipids and creatinine to acute intermittent fasting (IF) in hypertensive and normotensive patients with overweight and obesity. Methods A cohort of 65 hypertensive patients and 45 young normotensive patients with overweight and obesity included. All patients were monitored for 24 hours by Ambulatory Blood Pressure monitoring by ABMP50 Machine. All hypertensive patients were on stable antihypertensive therapy for at least 3 months and had met target office blood pressure levels. Fasting glucose (FG), blood lipids, creatinine, uric acid and high sensitive C-reactive protein (hCRP) were measured before and after fasting. All patients were asked to fast (F) for 16 hours for the first time in their lives. At the end of the fasting period, all participants in the study rated their subjective state from 1 to 10. Statistical analyses were conducted by IBM SPSS Statistics 22. Results The reaction of blood pressure on intermitted fasting was similar in both groups. Decrease of day systolic blood pressure (SBP) as well as increase of night diastolic blood pressure (DPB) was observed in both groups (TABLE 1). No significant changes of daily BP were observed in normotensive patients. Daily heart rate increased in 1st group by 1,5% (p=0.003) and decreased in 2nd group by 4,2% (p=0,002). At the same time daily SBP decreased in the group of hypertensive patients. The hypertension group (65 patients) rated their subjective state higher than 5 points and expressed that fasting was easy for them, age median 57 (51:61) years old. The normotensive group rated themselves below 5 points and expressed the difficulty of fasting and low quality of sleep, age median 26 (25:45) years old. The median BMI in 1st group 32,1 (30:35) in 2nd group 27,4 (25:30) kg/m2. The mean FG before fasting in the 1st group was 5,45(±0,61) mmol/l in the 2nd group was 4,75 (±0,55) mmol/l and after IF in the 1st group 5,36 (±0,73) mmol/l in the 2nd group 4,58 (±0,64) mmol/l (p&amp;gt;0.05). In hypertension group the mean of hCRP decreased from 9.95±8.02 to 4.68±2.88 (p=0.04). The level of blood creatinine and GFR had not significant changes. Conclusion One-day intermittent fasting leads to a change in blood pressure, does not cause hypotension, and is tolerated favorably in obese patients with hypertension on stable antihypertensive therapy.

Effectiveness of triple fixed-dose combination in patients with inadequate blood pressure control

Aim. In routine clinical practice, to evaluate the antihypertensive efficacy, 24-hour blood pressure (BP) control, tolerability and effect on arterial stiffness of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril according to office and 24-hour ambulatory BP monitoring (ABPM) in patients with uncontrolled hypertension (HTN) using previous therapy.Material and methods. The study included 78 both sex outpatients over 18 years of age with essential HTN. The main inclusion criterion was HTN with inadequate BP control against the background of previous combination therapy including amlodipine, indapamide and perindopril as part of free- or fixed-dose combinations of antihypertensive drugs. All patients were prescribed triple FDC of amlodipine/ indapamide/perindopril (Triplixam) in accordance with the medication instruc tions. The patient’s condition was assessed during four follow-up visits: visit 1 — inclu- sion visit, visit 2 — after 4 weeks, visit 3 — after 12 weeks, visit 4 — after 24 weeks. At each visit, achievement of the target BP levels &lt;140/90 mm Hg and &lt;130/80 mm Hg was assessed, as well as the 24-hour BP profile. The dynamics of BP decrease, achievement of target BP values, 24-hour BP profile, and the effect of therapy on arterial stiffness according to ABPM were also assessed.Results. In the analyzed group of patients, the initial office BP was 160,8± 10,3/91,5±8,1 mm Hg. After 24 weeks, there was a significant BP decrease to 121,3±3,5/73,6±4,2 mm Hg (p&lt;0,001). According to ABPM, an average daytime BP significantly (p&lt;0,001) decreased from 153,9±9,04/8,38±9,18 to 120,3±4,7/73,4±4,7 mm Hg after 24 weeks of amlodipine/indapamide/perindopril FDC therapy. Similar patterns were also found for the average values of nighttime BP. Target BP &lt;140/90 mm Hg after 4 weeks reached the majority (87,2%) of patients, and after 12 weeks, the proportion of pa tients who reached the target BP was 100%.Conclusion. In hypertensive patients with previous ineffective multiagent therapy, the triple FDC of amlodipine/indapamide/perindopril (Triplixam) provided high antihypertensive efficacy, good tolerability and adherence to therapy, and also demonstrated additional organ protection.

24-Hour blood pressure profile in patients with adrenal insufficiency

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

24-Hour blood pressure profile in patients with adrenal insufficiency

24-Hour blood pressure profile in patients with adrenal insufficiency

IMPACT OF PREVIOUS HYPERTENSIVE DISORDER DURING PREGNANCY ON ANTHROPOMETRIC MEASUREMENTS, 24-HOUR BLOOD PRESSURE AND ARTERIAL STIFFNESS

Objective: Preeclampsia (PE) increased the risk of cardiovascular diseases even in women without previous arterial hypertension (AH). The possible causes include changes in metabolic profile and vascular abnormalities, such as increased arterial stiffness. We aim to compare anthropometric measurements, 24-hour blood pressure profile, and arterial stiffness in women who developed PE during pregnancy with (superimposed PE) or without (isolated PE) a previous history of AH. Design and method: We selected from registries of a tertiary hospital women with a previous pregnancy complicated by isolated PE or superimposed PE that occurred 2 to 5 years earlier. Anthropometric measurements: weight, height, body mass index – BMI and waist circumference (WC); Blood pressure (BP) measurements: office Systolic BP (SBP) and diastolic BP (DBP); 24-ambulatory BP monitoring; Arterial stiffness: pulse wave velocity (PWV) measured by Arteriograph® method. Results: Twenty-five patients were evaluated. Conclusions: Women previous superimposed PE had higher values of WC, awake SBP and PWV when compared to women with isolated PE. These results indicate incremental impairment of vascular and metabolic profile of PE on women with previous chronic AH.

SHIFT WORK IN NURSES AND 7-DAY/24H AMBULATORY BLOOD PRESSURE MONITORING

Objective: The aim of the study is to evaluate seven day/24 h ambulatory blood pressure monitoring (ABPM) during shift work in nurses and compared then with 170 healthy subjects from our database of 7 day/24 h ABPM. Design and method: 297 healthy subjects and ten shift workers in hospital were monitored during shift work. The seven day working process was composed from the day with day work shift, night work shift systolic and diastolic blood pressure and weekly mean blood pressure values from the seven-day/24-h ambulatory blood pressure monitoring T 2431 (A and D, Japan). Results: In healthy subjects with aerobic training, seven days of systolic blood pressure was 115 ± 1.1 mmHg, diastolic 69 ± 1.4 mmHg, in days with exercise (0–24 h) systolic blood pressure was 115 ± 2.8 mmHg, diastolic 69 ± 1, 7 mmHg, in days without exercise (25–48 h) systolic blood pressure was 116 ± 3.4 mmHg, diastolic 69 ± 2.2 mmHg. In healthy subjects with combined training seven days of systolic blood pressure blood pressure was 113 ± 1.8 mmHg, diastolic 68 ± 1.4 mmHg, days with exercise (0–24 h) systolic blood pressure were 112 ± 1.9 mmHg, diastolic 69 ± 1, 5 mmHg, in days without exercise (25–48 h) systolic blood pressure was 113 ± 1.8 mmHg, diastolic 68 ± 1.4 mmHg. In patients with myocardial infarction, seventy-day mean systolic blood pressure was 122 ± 4 mmHg, diastolic 74 ± 3 mmHg, in days with exercise (0–24 h) systolic blood pressure was 121 ± 3 mmHg, diastolic 74 ± 2 mmHg, in days without exercise systolic blood pressure 121 ± 3 mmHg, diastolic 73 ± 3 mmHg. Conclusions: Our results showed that 1 hour of aerobic training, combined training did not change the 24-hour mean blood systolic and diastolic blood pressure profile assessed from a seven-day ambulatory blood pressure monitoring (7 days / 24 hours) in healthy subject and in patients, if the timing of exercise is during the day hours (6:00–22:00).