Blood Pressure Surge Research Articles

Relationship between morning peak phenomenon and early renal injury NGAL in H-type hypertension

Purpose To investigate the relationship between morning blood pressure surge (MBPS) and neutrophilgelatinase associated lipocalin (NGAL) in patients with H-type hypertension. Materials and Methods A total of 224 patients with diagnosed H-type hypertension [homocysteine (Hcy)≧10umol/L] were selected and underwent 24-hour ambulatory blood pressure monitoring (ABPM). In the morning peak group (115 cases), NGAL and serum cystatin C levels, -microglobulin levels were detected in each group, and general biochemical indicators were also detected. Results There was no significant difference in the course of hypertension, age, blood glucose, blood lipids, Hcy, BUN, Cr, and UA between the two groups (p > 0.05). CysC, -MG were higher than those in the nonmorning peak group, and the difference was statistically significant (p < 0.05).; Pearson correlation analysis showed that NGAL was moderately and highly correlated with CysC, systolic blood pressure morning peak, -MG, and high (p < 0.05), low-density lipoprotein (LDL-C), and Hcy were lowly correlated (p < 0.05).) and morning peak diastolic blood pressure (p > 0.05); multiple linear stepwise regression analysis indicated that morning peak systolic blood pressure, CysC,-MG, and FBG were the risk factors for NGAL. Conclusion The morning peak of systolic blood pressure in H-type hypertension is an important factor causing kidney injury. Paying attention to the ambulatory blood pressure monitoring and the control of morning peak blood pressure in patients with H-type hypertension, and early screening of NGAL has important clinical significance for the early prevention and treatment of renal injury in patients with H-type hypertension. PLAIN LANGUAGE SUMMARY The morning peak of blood pressure is closely related to target organ damage. There are few studies on the relationship between morning peak phenomenon and renal damage in patients with H-type hypertension at home and abroad. We investigated the relationship between MBPS and NGAL in H-type hypertensive patients with BUN, Cr and UA in the normal range to provide a clinical basis for early renal protection in hypertensive patients.

Association Between the Gut Microbiome and Their Metabolites With Human Blood Pressure Variability.

Blood pressure (BP) variability is an independent risk factor for cardiovascular events. Recent evidence supports a role for the gut microbiota in BP regulation. However, whether the gut microbiome is associated with BP variability is yet to be determined. Here, we aimed to investigate the interplay between the gut microbiome and their metabolites in relation to BP variability. Ambulatory BP monitoring was performed in 69 participants from Australia (55.1% women; mean±SD, 59.8±7.26 years; body mass index, 25.2±2.83 kg/m2). These data were used to determine nighttime dipping, morning BP surge (MBPS) and BP variability as SD. The gut microbiome was determined by 16S ribosomal RNA (rRNA) sequencing and metabolite levels by gas chromatography. We identified specific taxa associated with systolic BP variability, nighttime dipping, and MBPS. Notably, Alistipesfinegoldii and Lactobacillus spp. were only present in participants within the normal ranges of BP variability, MBPS and dipping, while Prevotella spp. and Clostridium spp., were found to be present in extreme dippers and the highest quartiles of BP SD and MBPS. There was a negative association between MBPS and microbial α-diversity (r=-0.244, P=0.046). MBPS was also negatively associated with plasma levels of microbial metabolites called short-chain fatty acids (r=-0.305, P=0.020), particularly acetate (r=-0.311, P=0.017). Gut microbiome diversity, levels of microbial metabolites, and the bacteria Alistipesfinegoldii and Lactobacillus were associated with lower BP variability and Clostridium and Prevotella with higher BP variability. Thus, our findings suggest the gut microbiome and metabolites may be involved in the regulation of BP variability.

Press coated Bioadhesive Pulsatile Tablet of Lisinopril for Chronotherapy of Cardiac Disorders: in-vitro Evaluation

The purpose of present investigation was to formulate bioadhesive pulsatile release tablet (BPRT) of lisinopril drug belong to antihypertensive category for chronotherapy of cardiac disorder. The concept behind this dosage form development is to investigate effect of coating polymer concentration on lag time and drug release from directly compressed tablet. The core tablets prepared by using various concentrations of disintegrants found suitable for complete release of drug in acidic medium indicating its solubility in gastric fluid. The FT-IR studies indicate that selected polymers are compatible with lisinopril since no interaction found in drug-excipient compatibility studies. The dissolution study clearly indicates that higher concentration of polymers which is HPMC K100M and Carbopol reduces free water volume and increase viscosity of the tablet coat causes reduction in drug release. The prepared Bioadhesive pulsatile release tablets showed desired hardness and good mucoadhesion strength. The obtained results showed capability of formulated bioadhesive pulsatile drug delivery system in a drug release for a programmable period of time to attain drug release after minimum 3 hr of Lag time. A stability results clearly indicate that developed pulsatile product was sufficiently stable under accelerated and controlled conditions. Thus, the developed pulsatile tablet can be considered to be a promising formulation for the relief of early morning surge in blood pressure and other cardiac disorders which follows a circadian rhythm.

Clinical usability of morning surge blood pressure for predicting future hypertension in a young population

Objective Early diagnosis of hypertension (HT) is a critical issue for physicians. This study was conducted to determine if morning surge blood pressure (MSBP) could be used to predict future HT. The study also examined which demographic data in a regression model might help to detect future HT without any invasive procedure.Material and methods A young population between 18 and 40 yrs of age was included in the study. MSBP and demographic data were used to determine an optimal model for predicting future HT by using Bayesian information criteria and binary logistic regression.Results 1321 patients with 24 hr ambulatory blood pressure monitoring were included in this study. The odds ratio of 10 units of increase in diastolic MSBP was 1.173511 in the model, which indicates that a 10 mmHg increase in diastolic MSBP increases the odds of future HT in the patient by 17.4 %. The odds ratio of age was 1.096365, meaning that at each age above 18 yrs, the patients' odds of future HT rise by 9.6 %. The odds ratios for gender (male) and previous HT were 1.656986 and 3.336759, respectively. The odds of future HT in males were 65 % higher than for females, and a history of HT implies that the odds of future HT were higher by 230 %.Conclusion Diastolic MSBP can be used to predict HT in young individuals. In addition, age, male gender, and previous HT add more predictive power to diastolic MSBP. This statistically significant, predictive model could be useful in lessening or preventing future HT.

Morning blood pressure surge in renal transplant recipients: Its relation to graft function and arterial stiffness.

When the blood pressure rises before awakening in the morning, it is called as morning blood pressure pulse (MBPS). MBPS is considered to be an independent risk factor for cardiovascular disease. The aim of this study was to investigate the associations between MBPS, graft function, arterial stiffness and echocardiographic indices in renal transplant recipients. Among 600 renal transplant recipients, 122 patients who had a history of hypertension and were taking at least one antihypertensive medication were enrolled in the study. Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWv), and echocardiographic indices were assessed. 24h ambulatory blood pressure was monitored for all patients. MBPS was calculated by subtracting morning systolic blood pressure from minimal asleep systolic blood pressure. Mean morning, day time and asleep systolic blood pressure values were 171.2± 23.9, 137.9 ± 18.1, and 131.7± 18.9, respectively. Nondipper hypertension status was observed in 93 patients. Mean MBPS was 35.6± 19.5mm Hg, means PWv was 6.5± 2.0m/s. Patients with MBPS ≥ 35mm Hg, had significantly lower eGFR and higher proteinuria, PWv. higher left atrium volume and LVMI. In regression analysis, day time systolic blood pressure, asleep systolic blood pressure, morning blood pressure surge, nondipper status and left ventricular mass index were detected as the predictors of graft function. Increased morning blood pressure surge is associated with graft dysfunction, increased arterial stiffness and LVMI that contribute to cardiovascular mortality and morbidity in renal transplant recipients.

Effects of Dietary Nitrate Supplements on Morning Blood Pressure Surge and Sympathetic Neural Control during Orthostasis in Post‐menopausal Women

Post‐menopausal women are at greater risk for cardiovascular disease compared with age‐matched men. An exaggerated morning blood pressure surge (MBPS) in post‐menopausal women is well established as an independent risk factor for cardiovascular events. Dietary nitrate supplements such as nitrate‐rich beetroot juice (BRJ) may reduce blood pressure (BP), but no study has investigated the chronic effects of BRJ on MBPS and sympathetic neural control during orthostasis in post‐menopausal women. We hypothesized that dietary nitrate supplements would decrease MBPS and muscle sympathetic nerve activity (MSNA, microneurography) in post‐menopausal women.We performed a double‐blind, placebo‐controlled, cross‐over trial and randomly assigned healthy women [n=14, 64±3 (SD) yr] to either dietary nitrate supplements (140 ml of BRJ; 800 mg nitrate/day) or placebo (140 ml of nitrate‐depleted BRJ daily) for 2 weeks each with ≥2 weeks of washout. Twenty‐four‐hour ambulatory BP monitoring was performed and MBPS was calculated as the morning systolic BP (SBP; averaged for 2 h after wake‐up) minus the lowest nocturnal SBP before and after 2‐week BRJ or placebo intervention. BP, heart rate, and MSNA were measured during 3‐min supine rest and 5‐min 60° head‐up tilt (HUT). Cardiac output (Qc; C2H2 rebreathing) and total peripheral resistance (TPR=mean BP/Qc × 80) were also measured.MBPS decreased after BRJ intervention (Figure A; p=0.043). BRJ did not change hemodynamics or MSNA during supine rest (Figure B‐E; all, p&gt;0.05). However, upright TPR was reduced (Figure C; p=0.007), while Qc trended greater (Figure B; p=0.072) after BRJ intervention. During HUT, MSNA burst frequency (53±15 pre vs. 48±10 bursts/min post, p=0.508 for posture × intervention interaction) and burst incidence (70±17 vs. 63±15 bursts/100 heart beats, p=0.199 for interaction) were similar, but mean burst area (Figure D; p=0.010) and total activity (Figure E; p=0.015) were lower after BRJ intervention. Placebo had no significant impact on hemodynamics and MSNA in the supine position or during HUT in post‐menopausal women (all, p&lt;0.05).Collectively, dietary nitrate supplements decrease morning surge in BP and upright MSNA and vasoconstriction in post‐menopausal women. Whether reductions in sympathetic activation and peripheral vasoconstriction during orthostasis contribute to the reduced MBPS in these women remains to be determined.

Renal‐Tubular SGK1 is Involved in Blood Pressure Circadian Rhythm

As many physiological functions, blood pressure (BP) follows a circadian pattern that rises during the active and decreases during the inactive phase of the day. BP rise at the beginning of active phase (known in human as the “morning surge”) coincides with the increase in circulating glucocorticoids and aldosterone. Serum‐ and glucocorticoid‐induced kinase (SGK1), a clock‐controlled and aldosterone‐induced gene, plays a role in BP regulation in human and animal models. However, a role of SGK1 in the BP circadian regulation has not been demonstrated.Using telemetry, we analyzed BP in the inducible renal‐tubule specific Sgk1Pax8/LC1 model under basal and high‐potassium diet (HKD; 5%K+). Our data show that, under basal conditions, renal SGK1 plays no role in BP regulation. After one week of HKD and despite largely unaffected mean arterial BP (MAP), Sgk1Pax8/LC1 mice exhibit altered day/night variations. More specifically, the increase in BP during the active phase (BP surge) was blunted in both systolic and diastolic BP. After 7 weeks of HKD, more profound defect in BP was observed in the mutants as they exhibit decreased MAP, together with a dysregulated circadian rhythmicity. The BP defect was associated with abnormal NCC and ENaC expression and processing. Altogether, our data suggest that i) The kidney plays a major role in setting the BP circadian rhythm. ii) BP surge requires the renal‐tubule SGK1.

Association of Morning Surge and Postexercise Heart Rate and Blood Pressure Recovery

The autonomic nervous system plays an active role in the regulation of early morning blood pressure (BP) and BP/pulse regulation in the treadmill exercise test (TET). We evaluated the relationship between BP/pulse changes during TET and morning blood pressure surge (MS). Patients who underwent ambulatory blood pressure measurement (ABPM) and TET in the same visit between 2017 and 2020 were evaluated retrospectively. Patients with previously diagnosed hypertension and/or using antihypertensives and office BP ≥ 140/90 were excluded from the study.MS values and dipping percentage were calculated from ABPM data. The patients were analyzed by dividing them into two groups according to the MS median, and BP/pulse values during exercise and recovery periods were compared in these groups. 202 patients [median age 45 (39-51), male 134 (66.3%)] were included in the study. MS median was 18.5 (10.75-27) mmHg. TET recovery period 3rd-min systolic blood pressure (RSBP) was higher in the group with high MS (p: 0.017). Systolic and diastolic dipping percentages were higher in the group with higher MS (p: 0.015, p: 0.040, respectively). Peak systolic and diastolic BP, RSBP, and recovery 3rd min diastolic BP were positively correlated with MS (p < 0.05, for all). Additionally, an independent relationship was observed between RSBP and MS (β: 0.205, p: 0.028). We found an independent association between RSBP and MS. Increased RSBP may be associated with target organ damage and cardiovascular events such as MS.

D-dimer in Marfan syndrome: effect of obstructive sleep apnea induced blood pressure surges.

Aortic dissection and rupture are the major causes of premature death in persons with Marfan syndrome (MFS), a rare genetic disorder featuring cardiovascular, skeletal, and ocular impairments. We and others have found that obstructive sleep apnea (OSA) confers significant vascular stress in this population and may accelerate aortic disease progression. We hypothesized that D-dimer, a diagnostic biomarker for several types of vascular injury that is also elevated in persons with MFS with aortic enlargement, may be sensitive to cardiovascular stresses caused by OSA. To test this concept, we recruited 16 persons with MFS without aortic dissection and randomized them to two nights of polysomnography, without (baseline) and with OSA treatment: continuous positive airway pressure (CPAP). In addition to scoring OSA by the apnea-hypopnea index (AHI), beat-by-beat systolic BP (SBP) and pulse-pressure (PP) fluctuations were quantified. Morning blood samples were also assayed for D-dimer levels. In this cohort (male:female, 10:6; age, 36 ± 13 yr; aortic diameter, 4 ± 1 cm), CPAP eliminated OSA (AHI: 20 ± 17 vs. 3 ± 2 events/h, P = 0.001) and decreased fluctuations in SBP (13 ± 4 vs. 9 ± 3 mmHg, P = 0.011) and PP (7 ± 2 vs. 5 ± 2 mmHg, P = 0.013). CPAP also reduced D-dimer levels from 1,108 ± 656 to 882 ± 532 ng/mL (P = 0.023). Linear regression revealed a positive association between the maximum PP during OSA and D-dimer in both the unadjusted (r = 0.523, P = 0.038) and a model adjusted for contemporaneous aortic root diameter (r = 0.733, P = 0.028). Our study revealed that overnight CPAP reduces D-dimer levels commensurate with the elimination of OSA and concomitant hemodynamic fluctuations. Morning D-dimer measurements together with OSA screening might serve as predictors of vascular injury in MFS.NEW & NOTEWORTHY What is New? Surges in blood pressure caused by obstructive sleep apnea during sleep increase vascular stress and D-dimer levels in Marfan syndrome. Elevations in D-dimer can be lowered with CPAP. What is Noteworthy? D-dimer levels might serve as a marker for determining the significance of obstructive sleep apnea in persons with Marfan syndrome. D-dimer or obstructive sleep apnea screening is a potential method to identify persons with Marfan syndrome at risk for adverse cardiovascular events.

Clinical research of Pinggan Jiangya decoction combined with penetrating needling at Baihui (GV20) in a period of day from 7 am to 9 am in the treatment of grade 1 and 2 essential hypertension

To explore the clinical effect of Pinggan Jiangya decoction combined with penetrating needling at Baihui (GV20) in a period of day from 7 am to 9 am in the treatment of grade 1 and 2 essential hypertension (EH). A total of 150 cases of grade 1 and 2 EH patients were randomized into an observation group and a control group, 75 cases in each group. In the control group, Pinggan Jiangya decoction was prescribed for oral administration one dose a day, while in the observation group, on the basis of the treatment as the control group, penetrating needling was exerted at GV20 once daily. The treatment duration was 8 weeks. Before and after treatment, the TCM syndrome score, 24 h average systolic blood pressure (24 h ASBP), 24 h average diastolic blood pressure (24 h ADBP), 24 h average pulse pressure difference (24 h PP), morning blood pressure surge (MBPS), 24 h SBP variability (24 h SBPV), 24 h DBP variability (24 h DBPV), serum levels of 5-hydroxytryptamine (5-HT) and melatonin (MT) were compared in the patients of the two groups. The clinical therapeutic effect was observed in the two groups. After the treatment, in the self-comparison of each group, the scores of headache, vertigo, backache, soft knees, tinnitus, 24 h ASBP， 24 h ADBP, 24 h PP, MBPS, 24 h SBPV and 24 h DBPV in the two groups were lower than those before treatment (P<0.01), and the above indexes in the observation group were lower than those in the control group (P<0.01). The level of serum 5-HT after the treatment was lower than that of before the treatment (P<0.01), while the level of MT was higher than that of before the treatment (P<0.01) in both two groups, and the level of 5-HT in the observation group was lower than that of the control group, while the level of MT was higher than that of the control group (P<0.01). The total effective rate of the observation group was 93.3% (70/75), better than 76.0% (57/75) of the control group (P<0.01). Pinggan Jiangya decoction combined with penetrating needling at GV20 in a period of day from 7 am to 9 am can regulate the levels of serum MT and 5-HT, effectively reduce blood pressure, improve blood pressure variability, control morning peak blood pressure, and has a remarkable effect in the treatment of grade 1 and 2 EH.

Ambulatory blood pressure monitoring for the management of hypertension.

Ambulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on daytime and nighttime blood pressure and circadian rhythm, particularly nighttime blood pressure dipping. Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure. Isolated nocturnal hypertension is a special form of masked hypertension, with normal daytime but elevated nocturnal blood pressure. It also helps in the evaluation of blood pressure fluctuation and variation, such as morning blood pressure surge and reading-to-reading blood pressure variability. ABPM may derive several other indexes, such as ambulatory blood pressure index and salt sensitivity index, which may be useful in CV evaluations.

Effects of isometric leg training on ambulatory blood pressure and morning blood pressure surge in young normotensive men and women

Despite the reported association between diurnal variations in ambulatory blood pressure (BP) and elevated cardiovascular disease risk, little is known regarding the effects of isometric resistance training (IRT), a practical BP-lowering intervention, on ambulatory BP and morning BP surge (MBPS). Thus, we investigated whether (i) IRT causes reductions in ambulatory BP and MBPS, in young normotensives, and (ii) if there are any sex differences in these changes. Twenty normotensive individuals (mean 24-h SBP = 121 ± 7, DBP = 67 ± 6 mmHg) undertook 10-weeks of bilateral-leg IRT (4 × 2-min/2-min rest, at 20% maximum voluntary contraction (MVC) 3 days/week). Ambulatory BP and MBPS (mean systolic BP (SBP) 2 h after waking minus the lowest sleeping 1 h mean SBP) was measures pre- and post-training. There were significant reductions in 24-h ambulatory SBP in men (− 4 ± 2 mmHg, P = 0.0001) and women (− 4 ± 2 mmHg, P = 0.0001) following IRT. Significant reductions were also observed in MBPS (− 6 ± 8 mmHg, p = 0.044; − 6 ± 7 mmHg, P = 0.019), yet there were no significant differences between men and women in these changes, and 24-h ambulatory diastolic BP remained unchanged. Furthermore, a significant correlation was identified between the magnitude of the change in MBPS and the magnitude of changes in the mean 2-h SBP after waking for both men and women (men, r = 0.89, P = 0.001; women, r = 0.74, P = 0.014). These findings add further support to the idea that IRT, as practical lifestyle intervention, is effective in significantly lowering ambulatory SBP and MBPS and might reduce the incidence of adverse cardiovascular events that often occur in the morning.

Pulsatile Chronotherapeutic Drug Delivery for Controlling Early Morning Surge in Blood Pressure; Effect of Coating on Eplerenone In-vitro, In-vivo Release and Urinary Na/K Ratio

The objective of the present study was to develop time delayed chronotherapeutic formulation of Eplerenone (Ep) to provide rapid drug release after a pre-determined lag time for the treatment of early morning hypertension. Cyclodextrin complexation was used to prepare fast release Ep core tablets. The developed core tablets were then coated with different rate-controlling polymers using compression coating technique. The developed tablets were evaluated for hardness, friability, drug content and swelling index. The in-vitro drug release was carried out to study the effect of different coating materials on drug release and lag time. Tablets selected for stability study were those showing lag time of 5-7 hours followed by complete drug release; F2, F3, F7, F8, and F12. The in-vivo study was carried out on tablets with the highest t90 as compared to commercial tablets after being administered to healthy human volunteers where plasma Ep and urinary Na/K ratio were determined. Results suggested that this approach was able to provide delayed release Ep formulations that will be useful for patients with morning surge in blood pressure.

The relationship between morning blood pressure surge and asymptomatic episodes of paroxysmal atrial fibrillation in patients with systemic arterial hypertension.

Hypertension is a known risk factor for developing atrial fibrillation. However, there is limited data to investigate the association between morning blood pressure surge (MBPS) and paroxysmal atrial fibrillation (PAF). We conducted the present study to determine whether there is a relationship between asymptomatic PAF and MBPS and whether MBPS may be a predictor of asymptomatic PAF episodes. This prospective study comprised 264 adult patients who were newly diagnosed with essential hypertension or were previously diagnosed but not receiving regular antihypertensive therapy. We evaluated the patients in 2 groups according to their 24-h electrocardiography monitoring results: group 1 included patients who exhibited PAF (n = 32, 23 females/9 males; mean age 60.2 ± 7.4 years) and group 2 included patients with no signs of PAF as a control group (n = 232, 134 females/98 males; mean age 56.9 ± 9.4 years). We calculated the MBPS as the difference between mean systolic blood pressure (SBP) in the 2 h after getting up and the minimum nocturnal SBP. : MBPS values were significantly higher in group 1 than in group 2 (35.3 ± 7.0 vs. 22.0 ± 6.7, p < 0.001). MBPS was positively associated with left atrial diameter (LAD) (r = 0.441, p < 0.001), left ventricle mass index (LVMI) (r = 0.235, p < 0.001), the ratio of early (E) peak of mitral inflow velocity to early (Em) diastolic mitral annular velocity (E / Em) (r = 0.239, p < 0.001), 24-h mean (r = 0.270, p < 0.001) and daytime SBP (r = 0.291, p < 0.001). We determined a cut-off value for MBPS as 28.6 for predicting PAF episodes development and identified LAD and MBPS as independent risk factors for PAF. Patients who had larger MBPS were observed to have higher PAF incidence. MBPS values may be sensitive in predicting asymptomatic episodes of paroxysmal atrial fibrillation.

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index.

Nocturnal blood pressure (BP) surge in seconds (sec‐surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage. However, it is not clear that the severity of sec‐surge is different between sec‐surges induced by sleep apnea (SA) (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non‐SA factors (rapid eye movement, micro arousal, etc.), and sec‐surge variables associate with left ventricular hypertrophy (LVH) independently of conventional BP variables. The authors assessed these points with 41 patients (mean age 63.2±12.6 years, 29% female) who underwent full PSG, beat‐by‐beat (BbB) BP, and cuff‐oscillometric BP measurement during the night. All patients were included for the analysis comparing sec‐surge severity between inducing factors (SA and non‐SA factors). There were no significant differences in the number of sec‐surges/night between SA‐related sec‐surges and non‐SA‐related sec‐surges (19.5±26.0 vs. 16.4±29.8 events/night). There were also no significant differences in the peak of sec‐surges, defined as the maximum systolic BPs (SBPs) in each sec‐surge, between SA‐related sec‐surges and non‐SA‐related sec‐surges (148.2±18.5 vs. 149.3±19.2 mm Hg). Furthermore, as a result of multiple regression analysis (n = 18), the peak of sec‐surge was significantly and strongly associated with the left ventricular mass index (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (β = −0.04, p = .87). This study suggests that peak of sec‐surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.

Morning blood pressure surge and associated factors in patients with primary hypertension

Morning blood pressure surge and associated factors in patients with primary hypertension

Morning surge blood pressure as a phenotype of systemic hemodynamic atherothrombotic syndrome

Morning surge blood pressure as a phenotype of systemic hemodynamic atherothrombotic syndrome

Elucidation of obstructive sleep apnoea related blood pressure surge using a novel continuous beat-to-beat blood pressure monitoring system.

Obstructive sleep apnoea (OSA) episode related blood pressure (BP) surge may mediate the association of OSA with cardiovascular disease. However, BP is not measured during a clinical sleep study. We tested the feasibility of incorporating the Caretaker physiological monitor, which utilizes a novel continuous beat-to-beat (b-b) BP monitoring technology, into polysomnography (PSG) and aimed to characterize BP surges related to obstructive respiratory events. B-b BP was concurrently collected and merged with PSG data on a posthoc basis. We compared BP surge between mean respiratory (apnoea, hypopnea and desaturation-alone events) and nonrespiratory events (spontaneous or leg movement-related arousals). We examined the association of the degree of oxygen desaturation with BP surge in a given respiratory event combining all events. A total of 17 consecutive patients (12 men, mean 52 years old, nine diagnostic and eight split-night PSGs) undergoing clinically indicated PSG were included after excluding one patient with poor signal quality due to excessive movement. Caretaker was well tolerated. Mean respiratory BP surge ranged from 5 to 19 mmHg [Median (IQR) = 13.9 (9.5--16.2)]. Mean BP surge between the respiratory and nonrespiratory events was similar [13.8 (4.5) vs. 14.9 (5.3) mmHg, P = 0.13]. Accounting for the count distribution of desaturation/BP surge data pair events, there was a linear correlation between the degree of oxygen desaturation and BP surge (R = 0.57, P < 0.001). In eight patients undergoing split-night sleep studies, the number of BP surge events (≥10 mmHg/h) decreased during continuous positive airway pressure in all but one patient. We demonstrated highly variable OSA-related BP surge patterns using the Caretaker's b-b BP monitoring technology that has the potential to be integrated into sleep studies.

Does COVID‐19 influence the sympathetic regulation of blood pressure?

Does COVID‐19 influence the sympathetic regulation of blood pressure?

Ambulatory blood pressure variability measures in hypertensive patients according to non-alcoholic fatty liver disease state

Abstract Background Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events. Purpose To compare different BPV measures in hypertensive patients with and without NAFLD. Methods Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge. Results Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p&amp;lt;0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment. Conclusions Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension. Funding Acknowledgement Type of funding sources: None.