Blood Pressure Pattern Research Articles

Blood pressure patterns of gestational hypertension or non-severe pre-eclampsia beyond 36weeks' gestation and the adverse maternal outcomes: Secondary analysis of the HYPITAT study.

To identify patterns in changes of blood pressure for women with gestational hypertension (GH) or non-severe pre-eclampsia (PE) beyond 36 gestational weeks, and assess their association with a composite adverse maternal outcome. Secondary analysis of a randomized controlled trial (HYPITAT). We investigated patterns of one-week blood pressure changes post-admission, explored factors contributing to diverse patterns using ANOVA and Chi-square tests, and assessed the correlation between these patterns and a composite adverse maternal outcome defined as severe maternal morbidity, mortality, post-partum hemorrhage and cesarean section. Among 384 women, 187 developed the composite outcome. We identified three and four typical patterns in systolic and diastolic blood pressure changes, respectively. Diastolic blood pressure patterns statistically significantly varied across maternal ethnicity and diagnosis at admission. Compared to a pattern of steady diastolic blood pressure, the odds ratio (95% confidence interval) for the composite adverse maternal outcome was 2.59 (1.31, 5.13) or 2.09 (1.02, 4.26), contingent on covariates, when a pattern of increasing diastolic blood pressure was present. The results of sensitivity analysis excluding severe hypertension from the composite outcome indicated that the main findings are robust. Maternal ethnicity and diagnosis may affect diastolic blood pressure patterns, and a pattern of increasing diastolic blood pressure was likely associated with elevated risk of the composite adverse maternal outcome. This underscores the potential significance of recognizing these patterns for sequential risk assessment and individualized management in late GH and non-severe PE.

Parathyroid hormone and vitamin D modulate nocturnal blood pressure dipping: a retrospective cohort study in primary hypertension

ABSTRACT Background Non-dipper hypertension, defined by reduced nocturnal blood pressure (BP) decline, increases cardiovascular risk. Calcium-phosphate metabolism (parathyroid hormone [PTH], vitamin D [25(OH)D]) may influence circadian BP rhythms, but their independent roles remain unclear. Objective To investigate associations between PTH, 25(OH)D, and nocturnal BP dipping in primary hypertension, addressing prior inconsistencies. Methods This retrospective cohort included 585 hypertensive adults stratified by nocturnal systolic BP dipping (dippers [≥10% decline, n = 250]; non-dippers [<10%, n = 335]) using 24-hour ambulatory monitoring. Serum PTH, 25(OH)D, renal/metabolic parameters, and vascular indices were analyzed. Multivariate linear regression assessed associations with dipping, adjusted for age, sex, renal function, and arterial stiffness. Results Non-dippers showed elevated PTH (median: 5.23 vs. 4.70 pmol/L, p = .011) and lower 25(OH)D (30.89 vs. 36.79 nmol/L, p < .001). Adjusted models confirmed PTH (β=−0.21, 95% CI:−0.34–−0.08; p = .002) and 25(OH)D (β = 0.03, 95% CI:0.01–0.04; p < .001) as associated factors of dipping. Although statistically significant, these correlations were modest and suggested possible trends rather than strong causal relationships. Age/sex effects on BP patterns became nonsignificant after adjusting for calcium-phosphate markers. Conclusion Calcium-phosphate dysregulation (elevated PTH, low vitamin D) independently contributes to non-dipping, suggesting biomarker-guided approaches for circadian BP control. Demographic disparities in dipping may reflect underlying mineral metabolism disturbances. Prospective trials should explore calcium-modulating therapies (e.g. vitamin D supplementation) in non-dipper hypertension.

CORRELATION BETWEEN SALT SENSITIVITY AND BLOOD PRESSURE VARIABILITY IN PRE-HYPERTENSIVE ADULTS

Background: Salt sensitivity is recognized as a significant modifier of blood pressure and cardiovascular risk. However, its relationship with daily blood pressure variability (BPV) in pre-hypertensive adults remains underexplored. Objective: To investigate the association between dietary salt sensitivity and 24-hour blood pressure variability among pre-hypertensive individuals. Methods: A cross-sectional study was conducted on 100 pre-hypertensive adults aged 18–45 years. Participants underwent a standardized low-sodium and high-sodium dietary intervention to determine salt sensitivity, defined as a ≥10 mmHg change in mean arterial pressure. Ambulatory blood pressure monitoring (ABPM) over 24 hours was used to assess systolic and diastolic BPV. Pearson’s correlation and multivariate regression analyses, adjusting for age, BMI, smoking status, and baseline BP, were utilized to explore relationships. Results: Forty-five participants (45%) were identified as salt-sensitive. Salt-sensitive individuals exhibited significantly higher 24-hour systolic (15.2 ± 3.9 mmHg) and diastolic BP variability (11.6 ± 2.7 mmHg) compared to salt-resistant individuals (11.4 ± 3.1 mmHg and 8.5 ± 2.2 mmHg, respectively; p &lt; 0.001). Pearson’s correlation demonstrated a moderate positive relationship between salt sensitivity and systolic (r = 0.48, p &lt; 0.001) and diastolic BPV (r = 0.42, p &lt; 0.001). Regression analysis confirmed salt sensitivity as an independent predictor of both systolic (β = 0.41, p &lt; 0.001) and diastolic BPV (β = 0.36, p = 0.002). Conclusion: Salt sensitivity is significantly associated with greater daily blood pressure variability in pre-hypertensive adults. Early identification and targeted sodium reduction strategies in salt-sensitive individuals may offer a practical approach to stabilize blood pressure patterns and reduce cardiovascular risk.

Early Pregnancy Blood Pressure Trajectories and Hypertension Years After Pregnancy.

Hypertensive disorders of pregnancy (HDP) increase cardiovascular disease risk. Blood pressure (BP) trajectories ≤20 weeks' gestation predict HDP outcomes. We hypothesized that early-pregnancy BP patterns stratify risk of developing hypertension years after pregnancy. This prospective cohort of 174 774 women without prior hypertension, kidney, liver, or heart disease, or history of preeclampsia entered prenatal care ≤14 weeks and delivered a stillborn or live singleton birth at Kaiser Permanente Northern California hospitals (2009-2019). Electronic health records provided data, including HDP for each birth, longitudinal outpatient clinical BP measurements, International Classification of Diseases codes, and medication use to identify new-onset hypertension from 2 months through 14 years post-delivery (2009-2023). Latent class trajectory modeling identified 6 BP trajectory (BPT) groups capturing both BP levels and slopes from 0 to 20 weeks' gestation. Multivariable Cox regression models estimated the hazard ratio (95% CIs) of new-onset hypertension after pregnancy associated with early-pregnancy BP trajectories, with effect modification by HDP. BP trajectories were associated with an increasing gradient of hypertension risk after pregnancy within each HDP group. Adjusted hazard ratios were higher among preeclampsia and gestational hypertension groups than for no HDP. From lowest to highest BPT groups, hazard ratios ranged from 2.91 to 27.31 for preeclampsia, 4.20 to 27.81 for gestational hypertension, and 2.92 to 10.96 for no HDP compared with lowest BP trajectories of the no HDP group (all reference 1.0). Early-pregnancy BP trajectories are strongly associated with new-onset hypertension years after pregnancy. Combined with HDP, they may stratify risk for targeted surveillance and early interventions and improve the prediction of cardiovascular disease risk in women.

Controversies in hypertension therapy: bedtime dosing or daytime dosing?

Hypertension management strategies have evolved from solely controlling office blood pressure (BP) to comprehensive 24-h BP regulation. This review synthesizes current evidence on the timing of antihypertensive medication, with a focus on circadian BP rhythms and patients with specific BP patterns or comorbidities. Bedtime dosing may benefit individuals with nocturnal hypertension and nondipper BP patterns, but large trials, such as the TIME study, have shown no significant cardiovascular outcome differences between morning and bedtime dosing. However, the optimal timing of antihypertensive medication for patients with distinct BP rhythms or comorbidities remains uncertain. Future research should investigate the potential benefits of personalized medication timing tailored to BP patterns and clinical conditions. Additionally, treatment strategies should consider BP rhythms, comorbidities, and adherence to optimize outcomes, paving the way for more effective management of hypertensive patients with complex clinical profiles.

Characterizing longitudinal blood pressure trajectories in patients at high risk for de novo postpartum hypertension: A randomized controlled trial secondary analysis

AbstractIntroductionDe novo postpartum hypertension (dnPPHTN), defined as new‐onset high blood pressure (BP) after delivery in individuals who were normotensive through pregnancy and delivery, accounts for up to two‐thirds of postpartum hypertension cases. Despite its prevalence, there is limited knowledge of BP trends in the postpartum period, hindering opportunities for early detection and timely intervention for dnPPHTN. This study aimed to characterize longitudinal postpartum BP patterns in patients at high risk for dnPPHTN.MethodsThis secondary analysis utilized data from a negative randomized controlled trial (PMID: 38641089) involving 82 normotensive patients at high risk for dnPPHTN, who were randomized to receive either a 5‐day course of 20 mg oral furosemide or placebo starting from postpartum day 1. BPs were monitored every 4‐8 h from delivery to discharge, and subsequently via Bluetooth‐enabled remote monitoring twice daily for 6 weeks. The primary goal of this secondary analysis was to characterize distinct patterns of longitudinal BP trajectories in the placebo group. Secondary goals included exploring differences in early postpartum BP trends between those who developed dnPPHTN and those who remained normotensive, as well as identifying the timing of peak BPs. Trends were assessed graphically using local polynomial regression fitting. Linear mixed‐effects models were used to examine temporal BP trajectories, including random intercepts and slopes, with an interaction term for the time trend and dnPPHTN diagnosis to explore differential impacts.ResultsA total of 40 participants from the placebo arm of the parent trial were included, contributing a total of 2235 postpartum BP measurements. Both systolic BP (SBP) and diastolic BP (DBP) increased until postpartum days 9 and 12, respectively, before subsequently declining. Significant differences in BP trajectories were observed between participants who developed dnPPHTN (n = 3; 167 BP readings) and those who remained normotensive (n = 37; 2068 BP measurements). Those with dnPPHTN had a significantly steeper rise in SBP preceding the diagnosis, which occurred at a median of 5 days (IQR 5–5.5 days). SBP rose by 1.6 mmHg more per day until its peak at postpartum day 9 in those with dnPPHTN, compared to normotensive participants (p &lt; 0.001). DBP rose by 0.3 mmHg more per day and peaked later (postpartum day 14 in those with dnPPHTN vs. day 12 in those who remained normotensive; p &lt; 0.001).ConclusionUsing remote monitoring technology, we characterized distinct postpartum BP trajectories in patients at risk for dnPPHTN, revealing a prolonged rise into the second postpartum week and trends that distinguish physiologic from pathophysiologic BP changes. These findings suggest that extended postpartum BP monitoring may be important for timely identification and intervention in patients developing dnPPHTN.

Cardiometabolic Risk in Chronic Spinal Cord Injury: A Systematic Review with Meta-Analysis and Temporal and Geographical Trends.

Objectives: This systematic review with meta-analysis compared cardiometabolic syndrome (CMS) in adults with chronic (≥1 year) spinal cord injury (SCI) to non-SCI individuals (controls) and athletes, analyzing the effect of specific injury characteristics and exploring temporal and geographical trends. Methods: Ovid Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from inception to September 2024. Adults with chronic SCI were included based on observational and baseline data derived from experimental studies. Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields assessed quality. Weighted means with 95% bootstrapped confidence intervals (CI) were computed for risk stratification. Group differences were assessed using random effects meta-analysis, calculating weighted mean differences with 95% bootstrapped CI. Temporal and geographical trends were evaluated with linear regression based on sample-size-weighted distributions and relevant covariates. Results: Of 31,163 identified records, 471 studies were included (n ≤ 31,782 SCI participants). CMS was present in men with SCI, paraplegia, tetraplegia, and injuries above T6; men with complete SCI (AIS A); and men and women with motor-complete SCI (AIS A-B). Compared to controls, adults with SCI had a lower body mass index (BMI), higher total and visceral fat, and worse lipid and carbohydrate profiles, including increased insulin resistance (IR). Tetraplegia was associated with greater visceral fat, poorer glycemic control, and lower BMI, insulin sensitivity, high-density lipoprotein-cholesterol (HDL-C), and triglycerides than paraplegia. Motor-complete SCI had lower BMI, HDL-C, and fasting glucose than motor-incomplete injuries. Injuries above T6 had lower blood pressure and higher fasting insulin levels than those below T6. Athletes with SCI had a lower BMI, fat mass, and fasting glucose, and higher systolic blood pressure than non-athletes with SCI, but frequently presented with obesity and carbohydrate dysfunction. Temporal analysis revealed increasing obesity trends and improved systolic blood pressure, while other CMS risk factors remained unchanged. We also identified global variations in obesity, lipids, blood pressure, and carbohydrate patterns. Conclusions: With a large sample, we revealed a widespread cardiometabolic burden in chronic SCI, even among athletes. Specifically, obesity, IR, and hypoalphalipoproteinemia worsened with increasing injury severity, alongside rising obesity trends and geographic disparities in risk profiles. These patterns highlight the evolution of what was deemed an epidemic into a global cardiometabolic pandemic.

Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials.

Elevated nighttime blood pressure (BP) and abnormal circadian dipping patterns are associated with advanced age and coexisting illnesses and are attributed to autonomic dysfunction. Radiofrequency renal denervation (RF RDN) effectively lowers BP throughout 24 h and thus may provide an effective antihypertensive therapeutic option. This analysis assesses the effects of RDN on nocturnal hypertension with different dipper patterns defined by nighttime/daytime BP ratio (i.e. dippers, non-dippers, risers) through 2 years in patients randomized to RDN from the SPYRAL HTN-OFF MED and -ON MED trials. Office and 24-h ambulatory BP, were also evaluated in patients stratified by age, obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Among 388 patients, the baseline nighttime systolic BP (SBP) was 139.3 ± 11.3 mmHg. Patients with a riser pattern had the highest baseline nighttime SBP (152.7 ± 8.0 mmHg). At 2 years, patients experienced a significant reduction from baseline (p < 0.0001) in nighttime (-12.0 ± 17.1 mmHg), morning (-14.8 ± 20.0 mmHg), daytime (-13.8 ± 14.7 mmHg), and 24-h SBP (-13.4 ± 14.2 mmHg). The greatest reduction in SBP was in risers at nighttime (-23.7 ± 14.3 mmHg). RDN was equally effective in lowering nighttime BP in patients ≥65 years old or with OSA, CKD, or T2DM. In this pooled dataset of RF RDN patients, clinically meaningful reductions in BP over a 24-h period were observed through 2 years irrespective of dipping status. RF RDN may reduce the risk of cardiovascular outcomes in patients with uncontrolled hypertension, especially in those with elevated nighttime BP who may be the most challenging to treat.

Understanding Efficacy of Using ACEIs and ARBs in Chronotherapeutic Treatment of Hypertension: Which Drug When?

Hypertension, a prevalent global health issue, poses significant risks for morbidity and mortality. The interplay between hypertension and comorbidities like diabetes and chronic kidney disease (CKD) underscores the urgency for effective management strategies. Chronotherapy, aligning medication administration with circadian rhythms, emerges as a promising approach to optimize treatment outcomes. The objective of this study is to assess the safety and efficacy of the use of ACEIs and ARBs in the chronotherapeutic treatment of hypertension. We aim to clarify the influence of circadian blood pressure patterns on the efficacy of medications and investigate the potential of chronotherapy in the management of hypertension by conducting a thorough examination of the existing literature. A literature search spanning from January 1980 to 2023 was conducted using PubMed, Scopus and Google Scholar databases. Search terms included ACE inhibitors, ARBs, chronotherapy, hypertension, and circadian rhythm of blood pressure. Studies investigating the effects of chronotherapy with ACEIs and ARBs in hypertensive patients were analyzed. Chronotherapy offers a personalized approach to hypertension management, leveraging the dynamic nature of circadian rhythms. By administering ACEIs or ARBs at night, the risk of morning blood pressure surges, associated with adverse cardiovascular events, can be mitigated. However, the optimal timing and combination of medications remain areas of ongoing research. Our review highlights the potential of chronotherapy with ACEIs and ARBs as a promising avenue for hypertension treatment. Further research is warranted to elucidate the mechanisms underlying circadian blood pressure regulation and optimize chronotherapeutic strategies. This comprehensive evaluation underscores the need for personalized treatment approaches tailored to individual circadian rhythms for improved hypertension management and reduced cardiovascular risk.

Health Profiles and Blood Pressure Patterns among Residents of an Agro-Rural Settlement, South East Nigeria

Hypertension is a growing health concern globally, particularly in Nigeria, where its prevalence is increasing in both urban and rural areas. Despite this, there is limited research on agro-rural settlements in South East Nigeria, creating a knowledge gap in understanding the demographic and health profiles, including blood pressure patterns, in these areas. This community-based cross-sectional study was conducted in the Isi-Uzo Local Government Area of Enugu State, involving 400 respondents aged 35 and above from five towns. Data collection included structured questionnaires, anthropometric measurements, and blood pressure assessments. The study found that 39.3% of respondents had normal blood pressure levels, 36.8% were hypertensive, and 20.8% were at risk of hypertension. Additionally, 66.0% had a normal BMI, with 23.5% overweight and 3.5% obese. Significant associations were noted between blood pressure status and educational level, weekly exercise frequency, and exercise duration. The study emphasizes the need for targeted public health interventions addressing education, physical activity, and dietary habits to mitigate the rising burden of hypertension in agro-rural populations in Southeastern Nigeria.

Microalbuminuria as a Prognostic Marker in Essential Hypertension.

Essential hypertension is a major cardiovascular pathology globally, with an estimated prevalence of approximately 33%, and it is a significant contributor to both mortality and adverse cardiovascular events. Finding early prognostic markers in such individuals could, thus, provide enhanced risk stratification and identification of patients with higher odds of target-organ damage or adverse events. Microalbuminuria is defined as an abnormal excretion of albumin in urine, is well associated with vascular disease, endothelial dysfunction, and low-grade inflammation, and is a marker of subclinical renal damage. Through the years, microalbuminuria at baseline has been well correlated with increasing blood pressure levels and blood pressure patterns, i.e., non-dipping phenotype. At the same time, its presence in hypertensive individuals indicated increased rates of mortality, renal disease progression, and major adverse cardiovascular outcomes, including stroke and myocardial infarction. Thus, microalbuminuria can provide a prognostic marker of future adverse events in hypertensive individuals. Interestingly, standard antihypertensive pharmacotherapy and newer drugs have shown regression of microalbuminuria extent and renoprotection in both diabetic as well as hypertensive individuals, implying that early therapy could decrease the rate of disease progression and limit target-organ damage. Thus, the aim of this review is to analyze the available studies documenting the predictive role of microalbuminuria for both mortality, target- organ damage, and adverse events, as well as describe the impact of pharmacotherapy in the presence and extent of subclinical renal damage, as shown by the levels of this marker.

Data-driven discovery of midlife cardiometabolic profile associated with incident early-onset and late-onset dementia.

Cardiometabolic risk factors have been associated with the risk of late-onset dementia. However, evidence regarding early-onset dementia was inconsistent, and the impact of clustered cardiometabolic risk factors was unclear. We aimed to investigate the associations of cardiometabolic profiles with incident early-onset and late-onset dementia. Among 289 494 UK Biobank participants, cluster analysis was built on 12 common cardiometabolic markers. Analyses were performed on those aged <65 years at baseline (n = 249 870) for early-onset dementia and those ≥65 at the end of follow-up (n = 191 213) for late-onset dementia. During a median follow-up of 14.1 years, 279 early-onset dementia cases and 3167 late-onset dementia cases were documented. Among the five clusters of cardiometabolic profiles identified (cluster 1 [obesity-dyslipidemia pattern], cluster 2 [high blood pressure pattern], cluster 3 [high liver enzymes pattern], cluster 4 [inflammation pattern] and cluster 5 [relatively healthy pattern]), cluster 3 was significantly associated with higher risks of both early-onset and late-onset dementia; however, the risk estimate for early-onset dementia (hazard ratio 2.58, 95% CI 1.61-4.14) was larger than that for late-onset dementia (1.36, 1.09-1.71). Cluster 4 was associated with a higher risk of late-onset dementia (hazard ratio 1.39, 95% CI 1.13-1.72). No significant interactions were observed between cardiometabolic clusters and apolipoprotein E ε4 genotype. Cardiometabolic patterns characterised by relatively high liver enzyme levels or systemic inflammation were associated with increased risks of early-onset and late-onset dementia. Identification of high-risk subgroups according to distinct cardiometabolic patterns might help develop more precise strategies for dementia prevention regardless of apolipoprotein E (APOE) ε4 status.

Association between the degree of nonalcoholic fatty liver disease and nocturnal hypertension.

Nighttime blood pressure (BP) decreases have prognostic significance owing to circadian patterns. The prevalence of nonalcoholic fatty liver disease (NAFLD) has rapidly increased in recent years. We aimed to investigate circadian blood pressure changes in patients with NAFLD. The present study included 114 patients diagnosed with nonalcoholic fatty liver disease and no previous hypertension diagnosis. Thirty patients comprised the control group (no hepatosteatosis and no hypertension). The patients were divided into 3 groups based on nocturnal BP dipping. Blood pressure patterns using night-day ratios were classified as dipper (ratio ≤ 0, 9), nondipper (0, 9 < ratio ≤ 1, 0), or nocturnal hypertension (ratio > 1, 0). There were no significant differences in sex, age, presence of diabetes, or biochemical test results between the groups. According to the blood pressure pattern, the nondipper rate in the hepatosteatosis group was significantly higher than that in the control group. Patients were compared in terms of the presence and severity of hepatosteatosis according to night blood pressure patterns. A significant difference was observed between the groups (P < .001 and P = .001, respectively). We found an association between hepatosteatosis severity and night blood pressure patterns. Patients with nonalcoholic fatty liver disease have a higher incidence of nocturnal hypertension. We observed impaired circadian blood pressure changes in patients with nonalcoholic fatty liver disease.

Modulatory Effects of Hypertension on Aging-Related White Matter Hyperintensities: A Comparative Study Among Stroke Patients and Stroke-Free Community-Based Cohort.

The increased vulnerability of the aging human brain to hypertension-induced neurovascular impairments, including cerebral small vessel diseases (SVD), marked by MRI-visible white matter hyperintensities (WMH), is well recognized. We examined WMH burdens between stroke patients and stroke-free participants across three age groups and explored patterns of modifiable risk factors, specifically the modulating effects of hypertension on WMH burden, providing insights for potential therapeutic interventions. This study comprised one hospital-based cohort of 254 stroke patients and another community-based cohort of 254 stroke-free normative participants. Clinical variables were obtained consecutively, and MRI neuroimaging classified WMH as absent, mild, moderate, or severe. A step-by-step statistical analysis was performed to explore the said gaps. There were 508 participants (mean age 63.5 ± 8.9 years) with 285 males. A similar prevalence but different WMH burden was recorded between stroke and normative cohorts across different age groups. The modulating effect of hypertension on WMH severity varied across age groups and is greater in middle-aged adults; intriguingly, this effect diminished in elderly adults (b = -0.882, 95%CI [-1.591, -0.172], t = -2.442, p = 0.015). It was shown that, in a non-uniform fashion across different age groups, hypertension is a culprit risk factor for exacerbating WMH severity, and middle-aged adults are the most vulnerable. While the elevation of systolic blood pressure predisposes adults to brain white matter deterioration, the decline in diastolic blood pressure suggests a protective role. Recognizing hypertension as a modifiable risk factor and understanding the aging-related changes in blood pressure patterns open avenues for developing age-specific strategies for the mitigation and management of WMH progression.

Effect of continuous positive airway pressure on blood pressure in normotensive individuals with obstructive sleep apnoea: a randomised trial.

The effects of continuous positive airway pressure (CPAP) on blood pressure (BP) in normotensive subjects, particularly among those with a dipping BP pattern, remain uncertain, raising questions about its indication for this group of patients. We assessed the impact of CPAP on BP in normotensive subjects with a dipping BP pattern and severe obstructive sleep apnoea (OSA). Randomised, parallel, prospective, controlled trial. Inclusion criteria were an apnoea-hypopnea index ≥30 events/hour, mean 24-hour BP <130/80 mmHg, and daytime-to-nighttime BP reduction ≥10%. Patients were randomly assigned to receive either CPAP treatment or usual care for 12 weeks. The primary outcome was the change in ambulatory BP monitoring (ABPM) parameters from baseline to the three-month follow-up. The 60 patients who completed the follow-up had a mean age of 52.2 years (sd 10.8), and 40 of them (66.7%) were male. The intention-to-treat analysis showed no significant changes with CPAP, whereas the usual care group experienced increases in ABPM parameters. This resulted in a mean difference of -3.4 mmHg (95% CI: -6.124 to -0.676; p=0.015) in nighttime diastolic BP between the groups. The per-protocol analysis indicated significant differences between the CPAP and usual care groups for all primary endpoints, except for daytime systolic BP. For nighttime systolic BP, the difference was -6.052 mmHg (95% CI: -10.895 to -1.208; p=0.016). These findings suggest a protective effect of CPAP, highlighting the importance of CPAP prescription for this population to control potential increases in blood pressure and possibly prevent the onset of hypertension.

Refined Machine Learning Approach for IoT and Fog Computing Based Health Care Monitoring System

The integration of Internet of Things (IoT) and Fog Computing technologies has paved the way for advanced healthcare monitoring systems that offer real-time, efficient, and scalable solutions for patient care. This paper proposes a refined machine learning (ML) approach to enhance the performance of IoT-based health monitoring systems, leveraging the computational power of fog nodes for data processing and analysis. The system collects health data from various IoT-enabled medical devices, including sensors for heart rate, blood pressure, glucose levels, and respiratory patterns. These data are pre-processed, filtered, and sent to fog nodes, where ML algorithms, such as decision trees, support vector machines (SVM), and deep learning models, are applied to detect anomalies, predict health conditions, and provide timely alerts. The refined ML approach involves optimizing feature selection, improving model accuracy, and reducing the latency of decision-making, all while ensuring efficient use of network resources. By distributing computational tasks to fog nodes close to the data sources, the system reduces the need for cloud-based processing, ensuring faster response times and lower bandwidth requirements. The proposed framework is evaluated in terms of its scalability, accuracy, and real-time performance in diverse healthcare scenarios. Experimental results show significant improvements in health condition prediction, anomaly detection, and energy efficiency when compared to traditional cloud-based solutions. This research highlights the potential of combining IoT, fog computing, and machine learning to build a robust, efficient, and real-time healthcare monitoring system, improving patient outcomes and facilitating continuous health management in smart environments.

Impact of a patent ductus arteriosus on non-invasive pre- and post-ductal blood pressures in extremely preterm infants during the first two postnatal weeks.

To evaluate pre- and post-ductal blood pressure (BP) in preterm infants according to patent ductus arteriosus (PDA) status obtained from targeted neonatal echocardiography (TnECHO). Retrospective cohort study of infants born at 22-28 weeks divided according to three groups: (i) No PDA, (ii) Low volume shunt, (iii) Moderate-high volume shunt. BP parameters, demographics, and clinical characteristics were compared. A total of 373 TnECHOs were included: 98 no PDA, 152 low volume shunt, and 123 moderate-high volume shunt. TnECHOs with no PDA had higher systolic, diastolic, and mean BP. Diastolic flow reversal in the post-ductal descending aorta was associated with lower post-ductal diastolic (p < 0.001) and mean BP (p < 0.001). Moderate-high volume shunt had higher rates of diastolic hypotension. BP patterns varied according to PDA status. Post-ductal hypotension was more common with a moderate-high volume shunt. PDA status in this population may be the strongest influencer of BP variability.

Acute night shift work is associated with increased blood pressure and reduced sleep duration in healthy adults.

Shift workers have a 40% higher risk for cardiovascular disease (CVD) compared to people who work day shifts. However, the acute impact of shift work on CVD risk factors in free-living settings remains unclear. We therefore investigated the impact of acute night shift work on factors related to cardiovascular health including blood pressure (BP) and sleep duration. Twenty-four rotating shift workers (19F, 23 ± 4 y, BMI: 23 ± 3 kg/m2; mean ± SD) participated in a quasi-randomized crossover study. Assessments were conducted over the course of 1 day shift and one night shift in a free-living setting. BP was measured every 30 min by an ambulatory monitor. Sleep and wake times were recorded. Mixed effects models were conducted to examine changes in variables between conditions. Acute night shift work was associated with significantly higher 24 h systolic (107 ± 1 vs. 104 ± 1 mmHg; p < 0.0001) and diastolic (67 ± 1 vs. 64 ± 1 mmHg; p < 0.0001) BP, as well as blunted dipping patterns in systolic BP (8 ± 1 vs. 12 ± 1%; p = 0.032), as compared to day shift work. Sleep duration was significantly shorter during the night shift as compared to the day shift (4 h 04 ± 19 min vs. 8 h 22 ± 18 min; p < 0.0001). As little as one night of shift work in a free-living setting is sufficient to induce multiple CVD risk factors including increased BP and reduced sleep duration in healthy adults. It is critical to identify strategies to prevent or attenuate the negative impact of shift work on CVD risk in a large portion of the working population.

The Nondipping Blood Pattern in Type 1 Diabetes Mellitus: Pathophysiology, Complications, and Management Strategies.

The nondipping blood pressure (BP) pattern, characterized by a less than 10% decline in sleep-time BP compared to awake-time values, is prevalent in individuals with type 1 diabetes mellitus (T1DM) and is associated with increased cardiovascular (CV) risk. This review discusses the prevalence, pathophysiological mechanisms, complications, and management strategies of the nondipping pattern in T1DM. The nondipping pattern is linked to poor cardiac autonomic function, higher rates of albuminuria, early markers of diabetic kidney disease, and increased arterial stiffness. It is also associated with a two-fold increase in all-cause mortality. Despite its clinical significance, there is no consensus on specific treatment recommendations for nondippers with T1DM. While some studies suggest that bedtime administration of antihypertensive medications, such as ACE inhibitors and angiotensin II receptor blockers, can improve the dipping pattern and reduce CV events, these findings are primarily based on studies in the general hypertensive population. Emerging evidence also indicates a potential role for vitamin D supplementation and lifestyle interventions in improving BP variability. Further research is needed to develop evidence-based management strategies tailored to nondippers with T1DM, aiming to reduce CV risk and improve long-term outcomes.

A Comprehensive Review on Nanoparticles as Drug Delivery System and Their Role for Management of Hypertension.

The current global epidemic of hypertension is not a disease in and of itself but rather a significant risk factor for serious cardiovascular conditions such as peripheral artery disease, heart failure, myocardial infarction, and stroke. Although many medications that work through various mechanisms of action are available on the market in conventional formulations to treat hypertension, these medications face significant difficulties with their bioavailability, dosing, and associated side effects, which significantly reduces the effectiveness of their therapeutic interventions. Numerous studies have shown that nanocarriers and nanoformulations can minimize the toxicity associated with high doses of the drug while greatly increasing the drug's bioavailability and reducing the frequency of dosing. This review sheds light on the difficulties posed by traditional antihypertensive formulations and highlights the necessity of oral nanoparticulate systems to solve these issues. Because hypertension has a circadian blood pressure pattern, chronotherapeutics can be very important in treating the condition. On the other hand, nanoparticulate systems can be very important in managing hypertension.