Nocturnal Blood Pressure Fall Research Articles

Cardio-Ankle Vascular Index and left ventricular mass as markers of nocturnal blood pressure fall in the general population.

Findings regarding the association between Cardio-Ankle Vascular Index (CAVI) and the extent of nocturnal blood pressure (BP) fall in the general population are scanty. We sought to investigate this issue in the participants enrolled in the Pressioni Monitorate E Loro Associazioni (PAMELA) study. The study included 491 participants who attended the second and third surveys of the PAMELA study performed after 10 and 25years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure BP monitoring (ABPM), blood examinations, echocardiography, and CAVI measurements. In the whole study, both CAVI and left ventricular mass index (LVMI) were inversely correlated with nocturnal SBP fall, expressed as day-night percent change (r = - 0.152, p = 0.0007, and r = - 0.213, p < 0.0001, respectively). However, after adjustment for sex and age, the correlation remained significant only for LVMI (r = - 0.124, p = 0.006). Non-dipper participants exhibited significantly higher sex-age adjusted LVMI (91 ± 22 vs 82 ± 18g/m2 (p < 0.0001)), but not of CAVI (9.07 ± 2.0 and 9.57 ± 2.2m/s, p = ns). Similar results were found when classifying participants into quartiles of nocturnal SBP drop. Finally, both sex-age adjusted CAVI and LVMI were positively correlated with mean nocturnal SBP (r = 0.181, p < 0.001, and r = 0.240, p < 0.0001). Although arterial stiffness assessed by CAVI, unlike LVMI, is unrelated with the degree of nocturnal BP drop, this marker is useful in identifying nocturnal hypertension and optimizing cardiovascular risk stratification in the community.

Impact of nocturnal blood pressure dipping on recurrence of atrial fibrillation after pulmonary vein isolation.

Lack of the typical nocturnal blood pressure (BP) fall, i.e non-dipper, has been known as a cardiovascular risk. However, the influence of non-dipper on atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been unclear. We investigated the clinical impact of non-dipping as evaluated by 24-hour ambulatory BP monitoring on the long-term outcome of AF recurrence post-PVI in 76 AF patients with a history of increased BP. The PVI procedure was successful in all 76 patients (mean age, 66±9years; antihypertensive medication, 89%; non-paroxysmal AF, 24%). Twenty patients had AF recurrence during a median follow-up of 1138 days. There was no difference in BP levels between the AF recurrence and non-recurrence groups (average 24 h systolic BP:126 ± 17 vs.125 ± 14 mmHg; P = 0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs.15.0%; P = 0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF and average 24-hr systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI:1.05-7.34], P = 0.039). Non-dipper patients had a larger left atrial (LA) volume index than the dipper patients (45.9 ± 17.3 vs.38.3 ± 10.2 ml/m2, P = 0.037). Among the 58 patients who underwent high-density voltage mapping in LA, 11 patients had a low-voltage area (LVA) defined as an area with a bipolar voltage < 0.5 mV. However, there was no association of LVA with non-dipper or dipper (22.2% vs.16.1%, P = 0.555). Non-dipper is an independent predictor of AF recurrence post-PVI. Management of abnormal diurnal BP variation post-PVI may be important.

Abstract 15200: Impact of Nocturnal Blood Pressure Fall on Long-Term Outcome for Recurrence of Atrial Fibrillation After Catheter Ablation

Introduction: Hypertension is known as a risk factor to progress the etiology of atrial fibrillation (AF). However, influence of non-dipper on AF recurrence after pulmonary vein isolation (PVI) remains unknown. Methods: We investigated the clinical impact of non-dipper evaluated by 24-hour ambulatory BP monitoring on the long-term outcome for AF recurrence in 76 AF patients underwent the PVI. Results: All of 76 patients (mean age:66±9 years, hypertension:78%, non-paroxysmal AF:24%) had procedural success of PVI. Twenty patients had AF recurrence during follow-up of median of 1158 days post-PVI. There was no difference in BP level between the AF recurrence and non-recurrence groups (average 24h-systolic BP:126±17 vs. 125±14mmHg, P=0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs. 15.0%, P=0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF, and average 24h-systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI: 1.05-7.34], P=0.039). The patients with non-dipper had a larger left atrial (LA) volume index than those with dipper (45.9±17.3 vs. 38.3±10.2ml, P=0.037). In 58 patients underwent the high-density voltage mapping in LA, 11 patients had low voltage area (LVA) defined as an area with a bipolar voltage &lt; 0.5mV. There was no difference in existence of LVA between patients with non-dipper and those with dipper (22.2% vs. 16.1%, P=0.555). Conclusions: Non-dipper is an independent predictor of AF recurrence after PVI. Management for abnormal diurnal BP variation may be important in patients after PVI.

Effect of renal denervation on diastolic function in patients with resistant hypertension and type 2 diabetes mellitus

Aim: To assess the change in the left ventricular (LV) diastolic function (DF) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) during 6-month follow-up after renal denervation (RDN) according to echocardiography in conjunction with changes in hemodynamic parameters.Material and Methods. A single center prospective interventional study with renal denervation included 30 patients with RHTN and T2DM. All patients underwent measurement of office and 24-hour blood pressure (BP), echocardiography according to the standard method with an assessment of LV DF.Results. At 6 months after RDN, a significant antihypertensive effect was noted (p &lt; 0.05), as well as an improvement in LV DF in the form of a decrease in E/e` by 1 c.u. was observed in 50% (15) patients. A significant decrease in the average E/e` was documented (–1.3 [95% CI –2.55; –0.08], р = 0.038). There were no changes in the indexed volumes of the left atrium (р = 0.940). The baseline values of E/e` had correlation with the level of mean pulse BP 24h (r = 0.51, р = 0.001) in the absence of significant relationships with other ABPM parameters. A decrease in systolic BP 24h by 3 mm Hg and an increase in nocturnal systolic BP fall by 1.6% were accompanied by a decrease in the average E/e` by 1 unit. According to the ROC-analysis, baseline level of nocturnal systolic BP fall 5.5% or less associated with a decrease in the E/e` ratio by more than 1 unit.Conclusion. Renal denervation in patients with RHTN and T2DM is accompanied by a favorable effect on LV diastolic function during 6-month follow-up, closely related to the hemodynamic effects of the procedure such as a decrease in systolic and pulse BP 24h, as well as improvement in the circadian rhythm of BP.

IMPACT OF NON-DIPPING PATTERN AND NOCTURNAL HYPERTENSION ON LEFT VENTRICULAR MASS INDEX IN UNTREATED WHITE-COAT HYPERTENSIVE SUBJECTS

Objective: Several studies have demonstrated that subjects with white-coat hypertension (WCH) have an increased risk of adverse cardiovascular outcome and target organ damage (TOD) progression compared to normotensives. The potentially detrimental effect of non-dipping or nocturnal hypertension on TOD has not been fully elucidated in subjects with WCH. The aim of our study was to investigate the impact of both dipping status and nocturnal hypertension on the left ventricle mass index (LVMI) of WCH individuals. Design and method: A total of 387 untreated WCH subjects underwent echocardiographic measurements. LVM was estimated using Devereux's formula according to the Penn Convention Protocol. LVMI was defined as LVM divided by the body surface area. The study population was divided into dippers (blood pressure (BP) nocturnal fall &gt;10%) and non-dippers (BP nocturnal fall &lt;10%) as well as into nocturnal hypertensives (nighttime systolic BP&gt; = 120mmHg or nighttime diastolic BP&gt; = 70mmHg) and nocturnal normotensives (nighttime systolic BP&lt;120mmHg and nighttime diastolic BP&lt;70mmHg). Statistical analysis was performed by means of independent-samples t-test, chi-square test and linear regression. Results: The percentages of non-dippers and nocturnal hypertensives in WCH subjects were 49% and 28%, respectively. The variables associated with LVMI in the univariate analyses were: age, male gender, body mass index, 24-hour diastolic BP and non-dippers. The multivariate regression analyses demonstrated significant associations of LVMI with the following factors: age (B = 5.760, 95% CI: 3.282 to 8.239; p&lt;0.001), male gender (B = 10.941, 95% CI: 5.756 to 16.125; p&lt;0.001), body mass index (B = 0.685, 95% CI: 0.138 to 1.232; p = 0.014), 24-hour diastolic BP (B = -6.634, 95% CI: -11.212 to -1.456; p&lt;0.011) and non-dippers (B = 8.415, 95% CI: 3.449 to 13.380; p = 0.001). Non-dipping pattern was correlated to an increase of 8.415 g/m2 in the LVMI in WCH subjects. Conclusions: Non-dipping status is positively and independently associated with LVMI in untreated WCH patients. In contrast, statistically significant association between nocturnal hypertension and LVMI was not observed.

Extreme dipping: is the nocturnal blood pressure fall modulated by age?

Studium Patavinum, Department of Medicine, University of Padova, Padova, Italy Correspondence to Paolo Palatini, MD, University of Padova, Padova, Italy. E-mail: [email protected]

Early Left Ventricular Dysfunction and Non-Dipping: When Ejection Fraction is Not Enough. A Meta-Analysis of Speckle tracking Echocardiography Studies.

There is evidence that a reduced nocturnal fall in blood pressure (BP) entails an increased risk of hypertensive-mediated organ damage (HMOD) and cardiovascular events. Most studies focusing on left ventricular (LV) systolic function, assessed by conventional LV ejection fraction (LVEF) in non-dippers compared to dippers failed to detect significant differences. To provide a new piece of information on LV systolic dysfunction in the non-dipping setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of LV systolic function. A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from inception until 31 July, 2022. Full articles reporting data on LV GLS and LVEF in non-dippers and dippers were considered suitable. A total of 648 non-dipper and 530 dipper individuals were included in 9 studies. LV GLS was worse in non-dipper than in their dipper counterparts (-18.4 ± 0.30 vs. -20.1 ± 0.23%, standard means difference [SMD]: 0.73 ± 0.14, confidence interval [CI]: 0.46/1.00, P < 0.0001) whereas this was not the case for LVEF (61.4 ± 0.8 and 62.0 ± 0.8%, respectively), SMD: --0.15 ± 0.09, CI: -0.32/0.03, P = 1.01). A meta-regression analysis between nighttime systolic BP and myocardial GLS showed a significant, relationship between these variables (coefficient 0.085, P < 0.0001). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the non-dipping setting can be unmasked by STE; implementation of STE in current practice may improve the detection of HMOD of adverse prognostic significance in individuals with altered circadian BP rhythm.

Abnormal circadian blood pressure regulation and cognitive impairment in α-synucleinopathies.

Circadian blood pressure (BP) rhythm is important for the maintenance of healthy daily life, and its disruption is associated with poor outcomes. Cardiovascular autonomic failure is often observed in older populations but has a greater impact on neurodegenerative disorders such as α-synucleinopathies. These BP abnormalities include orthostatic hypotension (OH), supine hypertension (SH), and a loss of nocturnal BP fall. OH not only causes falls or syncope but is also related to cognitive impairment in α-synucleinopathies. For example, OH doubles or triples the risk for the development of cognitive impairment in Parkinson's disease (PD). The diffuse central and peripheral neuropathology of α-synuclein may contribute to both OH and cognitive impairment. Moreover, repeated cerebral hypoperfusion in OH is thought to be related to cerebrovascular and neuronal damage, which may cause cognitive impairment. SH, which often coexists with OH, is also associated with cognitive impairment through cerebrovascular damage, such as white matter lesions and cerebral microbleeds. The reverse-dipping (riser) pattern on ambulatory BP monitoring is commonly observed in PD (∼56%), regardless of disease duration and severity. It is also related to cognitive impairment and more pronounced when coexisting with OH. These abnormal circadian BP profiles may be synergistically associated with cognitive impairment and poor outcomes in α-synucleinopathies. Although evidence for aggressive control of BP dysregulation improving cognitive impairment and outcomes is limited, regular BP monitoring appears to be important for total management of α-synucleinopathies.

The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder

BackgroundAnxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure.Objectives: The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals. MethodsThe study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method. ResultsMean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control). ConclusionsThe patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.

Association between urinary sodium-to-potassium ratio and home blood pressure and ambulatory blood pressure: the Ohasama study

No studies have demonstrated the association between urinary sodium-to-potassium (Na/K) ratio and all out-of-office blood pressure (BP) [home morning and evening BP (self-measured at home), and 24-h, daytime, and night-time ambulatory BP] in the same cohort. We aimed to assess, which type of out-of-office BP is more strongly associated with urinary Na/K ratio in the general population. This cross-sectional study was conducted in the general population of Ohasama, Japan. Home and ambulatory BP levels were measured, and 24-h urine samples were obtained from 875 participants (men, 25.5%; mean age, 60.1 years). The urinary Na/K ratio in the 24-h urine samples was calculated. The median (interquartile range) urinary Na/K ratio was 4.19 (3.36-5.26). Significant positive trends of home morning, home evening, 24-h, and daytime SBP were observed across quartiles of urinary Na/K ratio (trend P ≤ 0.041; adjusted mean values between Q1 and Q4 of urinary Na/K ratio: 121.0-125.5 mmHg for home morning, 120.1-123.8 mmHg for home evening, 121.6-123.4 mmHg for 24-h, 127.5-129.5 mmHg for daytime). Urinary Na/K ratio was not significantly associated with office or night-time SBP and nocturnal BP fall (trend P ≥ 0.13). In the model with both home morning or evening SBP and daytime SBP, only home SBP was significantly associated with urinary Na/K ratio (P ≤ 0.048 for home SBP). These findings suggest that urinary Na/K ratio might be more strongly associated with home BP than with 24-h and daytime BP but was not associated with night-time BP.

Cardiovascular dysautonomia and cognition in Parkinson's Disease - a possible relationship.

Dementia in advanced Parkinson's Disease (PD) is a fatal milestone resulting in reduced life expectancy and nursing home placement. Cognitive impairment and cardiovascular dysautonomia are common and debilitating non-motor symptoms that frequently coexist in PD since the early stages and progress in subsequent years. In particular, blood pressure (BP) abnormalities, including orthostatic hypotension (OH), supine hypertension (SH) and the loss of nocturnal BP fall (non-dipping) in PD have been associated with cognitive deterioration. They usually have multifactorial aetiology, including neuronal (central and peripheral) mechanisms and concomitant intake of medications. BP abnormalities can influence cognition in many ways, including repeated cerebral hypoperfusion leading to cerebral ischaemic lesions, higher burden of white matter hyperintensities, and possible impact on neurodegenerative process in PD. They are often asymptomatic and remain unrecognised, hence 24-hour ambulatory BP monitoring is recommended in patients with clinical symptoms of dysautonomia. Management is challenging and should address the multifactorial nature of BP disturbances. The aim of this review was to present the state of current knowledge regarding the possible relationship between cardiovascular dysautonomia and cognition in PD, its diagnosis and treatment.

Cardiac Remodeling According to the Nocturnal Fall of Blood Pressure in Hypertensive Subjects: The Whole Assessment of Cardiac Abnormalities in Non-Dipper Subjects with Arterial Hypertension (Wacanda) Study.

Objective: Several epidemiological studies suggest that the preservation of the physiological circadian rhythm of blood pressure or its disruption affects the extent of the organ damage developed by the patient. If we classify the circadian rhythm of blood pressure into four nocturnal profiles, significant differences emerge in terms of organ damage burden and prognosis: reverse dippers have the worst prognosis while dippers and mild dippers fall into an intermediate risk range. The risk profile of extreme dippers is still debated, and the available data are very conflicting and inconclusive. Starting from this gap of knowledge, we aimed to evaluate, retrospectively, in a cohort of hypertensive subjects, the degree of cardiac involvement in relation to the different nocturnal blood pressure profiles. Methods: We retrospectively evaluated 900 patients with essential hypertension, of whom 510 met our study criteria. We graded the 510 patients in relation to the percentage of reduction in mean systolic blood pressure (SBP) at night-time compared with day-time, considering this as a continuous variable, and then compared the extreme quintiles with each other and with the middle quintile (considered as reference). Results: Patients with less (or no) reduction in nocturnal SBP (reverse dipper) showed a higher level of organ damage and comorbidities. With regard to echocardiographic indexes, patients with maximum nocturnal pressure reduction (extreme dipper) showed a lower level of remodeling and/or impairment of E/e’ ratio, Right Atrium Area, Basal Right Ventricular Diameter, Inferior Vena Cava Average Diameter, and Tricuspidal Anular Plane Systolic Excursion compared also with hypertensive patients with a physiological nocturnal pressure reduction, even after correction for the main confounders. Conclusions: These data suggest that extreme dippers may constitute the subgroup of hypertensive patients with the lowest 24-h pressure load and, therefore, less cardiac remodeling.

TCT-491 Nocturnal Blood Pressure Fall Can Predict and Evaluate the Effect of Renal Denervation on Diastolic Function in Patients With Resistant Hypertension and Type 2 Diabetes Mellitus

TCT-491 Nocturnal Blood Pressure Fall Can Predict and Evaluate the Effect of Renal Denervation on Diastolic Function in Patients With Resistant Hypertension and Type 2 Diabetes Mellitus

Morning Surge in Blood Pressure and Stroke Events in a Large Modern Ambulatory Blood Pressure Monitoring Cohort: Results of the JAMP Study.

Morning Surge in Blood Pressure and Stroke Events in a Large Modern Ambulatory Blood Pressure Monitoring Cohort: Results of the JAMP Study.

General health of patients with diabetic macular edema-The LIPSIA study.

Cardiovascular risk factors such as hypertension or dyslipidemia can influence the incidence and progression of diabetic retinopathy (DR) and diabetic macular edema (DME). The aim of this study is to describe the comorbidities in patients with DME. Prospective, monocentric observational study. Patients presenting for the treatment of DME received laboratory and clinical examinations including 24-hour blood pressure measurement. Seventy-five consecutive patients were included in the study. The mean age was 61.0 ± 14.5 years, and 83% had type 2 diabetes. The mean body mass index (BMI) was 32.8 ± 6.0 kg/m2. Overweight (BMI ≥ 25 kg/m2) was present in 92% of all patients. HbA1c values were > 7.0% in 57%. Although 87% of the patients already received antihypertensive therapy, the blood pressure (BP) of 82% was still above the recommended target values of systolic < 140 mmHg and diastolic < 80 mmHg. An insufficient nocturnal fall of the systolic BP (< 10%, non-dipping or reverse dipping) was observed in 62%. In 83% of the patients the glomerular filtration rate was ≤ 90 ml/min/1.73m2. Despite 65% of the cohort already receiving lipid-lowering therapy, LDL cholesterol was above the target value of 1.4 mmol/l in 93%. All patients had at least one cardiovascular risk factor in addition to diabetes (overweight, hypertension, insufficient nocturnal BP fall, dyslipidemia, or renal dysfunction) and 86% had ≥ 3 risk factors. DME patients are characterized by highly prevalent cardiovascular risk factors that are poorly controlled. These comorbidities reduce the prognosis and negatively influence existing DR and DME. The data reveal an important opportunity for improving patient care by interaction of the ophthalmologist with the general practitioner and internal specialists for the detection and treatment of these conditions.

AMBULATORY BLOOD PRESSURE PHENOTYPES, VASCULAR INFLAMMATION AND ARTERIAL STIFFNESS IN ESSENTIAL HYPERTENSION

Objective: Hypertension is the leading risk factor for cardiovascular(CV) disease worldwide. Ambulatory blood pressure(ABPM) is the gold standard for the management of hypertension and its various phenotypes may provide prognostic information beyond clinic blood pressure (BP). The aim was to study the prevalence of various ABPM phenotypes and their relationship with target organ damage(TOD) i.e., urine albumin-creatinine ratio (ACR), and arterial stiffness as pulse wave velocity (PWV)vascular inflammation as high-sensitivity C-reactive protein(hs-CRP) in a Saudi hypertensive population. Design and method: We studied consecutive patients aged &gt; 18 yr-old referred to the Hypertension Clinic at King Abdul Aziz Cardiac Center, Riyadh, Saudi Arabia. ABPM was performed for a 24 hour period with an oscillometric device. Masked uncontrolled hypertension (MUCH) was defined as controlled clinic BP with daytime elevated BP (definition-1); 24-hr ambulatory BP (definition-2); and either daytime or nighttime elevated BP (definition-3). Dipping was defined as a 10–20% fall in nocturnal BP; reverse-dipping as less than 0% and extreme dipping as more than 20%. The study had Institutional Ethics Committee permission. Results: The study population included 428 subjects, (mean age 53.5 ± 14 years, female = 45%). Nine percent of the population had WC; 30% had MUCH which was driven by nocturnal hypertension with higher prevalence in patients with pre-hypertension; 24 hr, 68%; daytime, 56% and nighttime 86%(p &lt; 0.0001). Overall, 71% of the patients had MUCH which was driven by nocturnal hypertension vs. 24-hr or daytime (70%. vs. 42% vs. 32%, P &lt; 0.0001) respectively. Eighty percent of the cohort had non-dipping with similar prevalence in MUCH and uncontrolled hypertension. Compared with controlled BP, patients with MUCH had significantly higher ACR (18.8 ± 8 vs 6.2 ± 6, p &lt; 0.01), PWV(11.2 vs. 9.9, p &lt; 0.001) and hs-CRP (1.6 ± 1.4 vs. 6.4 ± 2.3, p &lt; 0.01). Conclusions: This is the first study exploring ABPM phenotypes in a Saudi hypertensive population, showing a high prevalence of MUCH in apparently well-controlled patients, driven by nocturnal hypertension and associated with prehypertension. The MUCH population had greater TOD than those with controlled BP associated with a non-dipping pattern. Our results highlight the importance of ABPM in the management of hypertension in Saudi Arabia.

CUFFLESS BLOOD PRESSURE DEVICES AND INCONSISTENT TRACKING OF BLOOD PRESSURE CHANGES

Objective: Single point calibration is common in cuffless blood pressure (BP) measurement devices. Consequently, they may be apt at re-assessing BP at that same calibration BP but have potential for increased error as BP changes from that calibration point. This study investigates one pulse waveform-based (BPro, HealthStats) and one pulse arrival time-based (Maisense Freescanâ) cuffless device in their tracking of BP changes as compared to that of conventional cuff-based oscillometric devices. Design and method: 14 participants had 24-hour assessment of BP using BPro and a validated cuff-based oscillometric device (BPLab, Petr Telegin). Nocturnal BP dipping as measured by both devices was compared. In a separate study, six participants had BP measured with a validated cuff-based oscillometric device (OMRONâ HEM-7121) and either the BPro (n = 3) or Freescanâ device (n = 3) before and during a 2-minute cold-pressor challenge. BP change from baseline as reported by the devices were compared. Results: Average nocturnal fall in BP (mean ± SD) as reported by the cuff-based device and BPro were -15 ± 8% and -10 ± 6% (p = 0.061), respectively, for systolic BP; -19 ± 8% and -10 ± 7% (p = 0.008), respectively, for diastolic BP. Nocturnal dipping (defined as nocturnal fall &gt; 10% in either systolic or diastolic BP) was detected in 6 participants with the BPro device as opposed to 14 as detected with the cuff-based device. During cold-pressor challenge, Freescanâ reported a systolic BP change of -4 ± 8 mmHg compared to the cuff measured change of 12 ± 8 mmHg (p = 0.017). BPro followed a similar trend to the Freescanâ device and reported a systolic BP change of -2 ± 2 mmHg compared to the cuff measured change of 14 ± 4 mmHg (p = 0.002). Conclusions: The BPro device was able to track nocturnal dipping in some but not all participants, with significant underestimation of nocturnal dipping in diastolic BP. Cold-pressor challenge induced BP changes that were unable to be detected by the cuffless devices. Whilst single point calibration may permit a cuffless device to assess when BP returns to that calibration point, tracking of BP changes appears to be inconsistent. Further investigation is required to understand the underlying factors that contribute to this inconsistency.

IS THERE A RELATIONSHIP BETWEEN NON-DIPPER PATTERN AND CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH DIABETES?

Objective: To determine the influence of diabetes mellitus (DM) on circadian blood pressure rhythm and to investigate is there a relationship between non-dipper pattern (ND) and cardiovascular events (coronary artery disease - CAD, stroke) in patients with DM and arterial hypertension. Design and method: 184 consecutive hypertensive pts (92 men and 92 women, mean age 63.21 ± 12.62) were divided in two groups: 58 pts with type 2 diabetes mellitus (DM group) and 126 pts without diabetes (no-DM group). In all pts ambulatory blood pressure monitoring (AMBP) were performed. The values obtained by AMBP were compared between groups. ND pattern was defined as the absence of normal nocturnal fall of blood pressure (less than 10% and more than 20% compared to daily values). Results: Patients in DM group had higher systolic blood pressure (129.7 ± 17.4 vs 119.9 ± 11.5 mmHg, p = 0.001), higher values of the pulse pressure (58.7 ± 11.9 vs. 49.5 ± 9.0, p &lt; 0.001) and larger burden of high blood pressure during AMBP (51.7% vs 22.2%, p = 0.001) in comparison to pts in no-DM group. Hyperlipidemia (84,5% vs. 70,6%; p &lt; 0,05) and CAD (27,6% vs. 12,7%; p &lt; 0,05) were more common in the DM than in no-DM group. Out of 184 hypertensive pts 129 pts were nod-dippers. There was borderline significant association between the ND pattern and CAD (20.9% vs. 9.1%, p = 0.058) but without significant association with stroke (6,2% vs 1,2%, p = 0.283). Prevalence of ND pattern was higher in DM group but without significant difference compared to no-DM group (75,9% vs 67,5%, ns). In patients with DM there was no significant association between ND pattern and CAD (31,8% vs 14,3%, p = 0,308) compared to dippers. Also, there was no significant association between ND pattern and stroke in pts with DM (6,8% vs 7,1%, ns). Conclusions: Our study showed that hypertensive pts with DM have inadequate regulation of blood pressure which results in higher values of systolic and pulse pressure and higher prevalence of non-dipping pattern than in hypertensive pts without DM, but failed to prove that there is a relationship between non-dipping pattern and cardiovascular events in patients with DM.

Blood pressure and left ventricular function changes in different ambulatory blood pressure patterns at high altitude.

Acute high‐altitude (HA) exposure induces physiological responses of the heart and blood pressure (BP). However, few studies have investigated the responses associated with dipper and non‐dipper BP patterns. In this prospective study, 72 patients underwent echocardiography and 24‐h ambulatory BP testing at sea level and HA. Patients were divided into dipper and non‐dipper groups according to BP at sea level. Acute HA exposure elevated 24‐h systolic and diastolic BP and increased BP variability, particularly in the morning. Moreover, acute exposure increased left ventricular torsion, end‐systolic elastance, effective arterial elastance, and untwisting rate, but reduced peak early diastolic velocity/late diastolic velocity and peak early diastolic velocity/early diastolic velocity, implying enhanced left ventricular systolic function but impaired filling. Dippers showed pronounced increases in night‐time BP, while non‐dippers showed significant elevation in day‐time BP, which blunted differences in nocturnal BP fall, and lowest night‐time and evening BP. Dippers had higher global longitudinal strain, torsion, and untwisting rates after acute HA exposure. Variations in night‐time systolic BP correlated with variations in torsion and global longitudinal strain. Our study firstly demonstrates BP and cardiac function variations during acute HA exposure in different BP patterns and BP increases in dippers at night, while non‐dippers showed day‐time increases. Furthermore, enhanced left ventricular torsion and global longitudinal strain are associated with BP changes. Non‐dippers showed poor cardiac compensatory and maladaptive to acute HA exposure. However, the exact mechanisms involved need further illumination.

Associations of circulating irisin with 24-h blood pressure, total and visceral fat, and metabolic parameters in young adult hypertensives.

Some experimental and clinical studies suggest a possible role of irisin in central and peripheral regulation of blood pressure. The purpose of the study was to assess the associations between serum irisin levels, total and visceral fat, metabolic parameters, and blood pressure pattern during 24-h monitoring (ABPM). In 206 patients with essential hypertension receiving standard antihypertensive treatments, we assessed anthropometric indices; serum irisin, blood lipids (total cholesterol, LDL-C, HDL-C, and triglycerides), glucose and insulin; body composition including lean mass and total, visceral, android and gynoid fat using a dual-energy x-ray absorptiometry; ABPM; and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Baseline irisin levels were within normal reference ranges and comparable between the genders. There were no significant correlations of irisin with age, anthropometric variables, lipids, HOMA-IR, body composition, as well as 24-h blood pressure and dipping status. In univariate analysis, age, fat mass and distribution, lipids and glucose, HOMA-IR, and nocturnal blood pressure fall were poor predictors of irisin levels. These neutral associations were not affected by age, gender, and treatment modality. In young adult hypertensives, serum concentration of irisin was within a normal range and not associated with total and regional fat, blood lipids, insulin resistance, as well as 24-h blood pressure and the magnitude of its nocturnal fall.