Blood Pressure Variability In Patients Research Articles

Intercellular adhesion molecule-1 (ICAM-1) associates with 24-hour ambulatory blood pressure variability in type 2 diabetes and controls

Background and aimEndothelial dysfunction is a common feature in hypertension and type 2 diabetes. Whether blood pressure (BP) variability is influencing serum intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) remains to be clarified. We aimed to assess the association between the circulating adhesion molecules and ambulatory blood pressure variability in patients with type 2 diabetes and controls. Patients and methodsThe study included data from type 2 diabetes with controlled BP (n = 55), type 2 diabetes with uncontrolled BP (n = 55) and control subjects (n = 28). ICAM-1 and VCAM-1 were measured with specific enzyme–linked immunosorbent assay method. BP variability was assessed using standard deviation of mean systolic and diastolic BP evaluated during 24-hour ambulatory BP monitoring. ResultsThe uncontrolled BP type 2 diabetes group had significantly higher serum ICAM-1 and VCAM-1 levels compared to controlled BP type 2 diabetes and control groups. In linear regression analysis, after adjustment, higher ICAM-1 was consistently associated with higher daytime and 24-hour diastolic BP variability, and daytime systolic BP variability in the study population. VCAM-1 was associated only with daytime systolic BP variability. ConclusionsOur study evaluating the association of serum ICAM-1 and VCAM-1 with 24-hour ambulatory BP variability in patients with type 2 diabetes and controls might offer better understanding of the mechanisms generating endothelial dysfunction. Elevated 24-hour ambulatory BP variability might induce endothelial activation by increasing circulating adhesion molecules levels.

Relationship between primary open angle glaucoma and blood pressure

Background: Glaucoma is commonly defined as high intra ocular pressure (≥21 mmHg) with optic neuropathy characterised by progressive loss of retinal ganglion cells which is associated with characteristic structural damage to the optic nerve and visual field loss. There are several studies investigating relation between primary open angle glaucoma (POAG) and both systemic hypertension and especially night hypotension. Our aim was to compare 24-h ambulatory blood pressure variability of patients with glaucoma followed-up in the eye outpatient clinic with that of patients free of glaucoma.Methods: A total of 75 patients were included in the study, 35 in the patient group and 40 in the control group. Both groups were compared for daytime, night-time, and whole day mean systolic and diastolic blood pressure (BP) readings in the ambulatory blood pressure testing.Results: Mean daytime systolic BP of the glaucoma patients was 119.5 ± 11.6 mmHg, and 128.3 ± 15.5 mmHg for control group (p = 0.008). The night-time systolic blood pressure, whole day systolic BP, and mean diastolic BP were significantly lower in patients with glaucoma (p = 0.001, p = 0.001, p = 0.028, respectively). In multiple regression analysis, we identified daytime systolic BP, night-time systolic BP, and whole day systolic BP were independent risk factors for developing glaucoma.Conclusion: If the progression of the disease is noticeable in patients with glaucoma at follow-up, night-time hypotension should be ruled out with ambulatory blood pressure and if this is observed medical treatments used by the patients should be reviewed and necessary measures should be taken.

Nebivolol reduces short-term blood pressure variability more potently than irbesartan in patients with intradialytic hypertension.

Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Studies on the effects of antihypertensive drugs on BPV in hemodialysis are scarce. This study examines the effects of nebivolol and irbesartan on short-term BPV in patients with intradialytic hypertension. This randomized-cross-over study included 38 patients (age: 60.4 ± 11.1 years, male: 65.8%) with intradialytic hypertension (intradialytic-SBP increase ≥ 10 mmHg at ≥4 over 6 consecutive sessions). After the baseline evaluation, participants were randomized to nebivolol 5 mg and subsequently irbesartan 150 mg, or vice versa, with a two-week wash-out period before initiation of the second drug. Patients underwent three respective 24 h-ABPM sessions starting before a midweek-session. We calculated the standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP with validated formulas. The post-hemodialysis and 24 h-SBP and DBP levels were significantly lower after treatment with both drugs. The systolic-BPV indices were marginally lower after nebivolol but not after irbesartan compared to baseline (SD: baseline 15.70 ± 4.69; nebivolol 14.45 ± 3.37, p = 0.090; irbesartan 15.39 ± 3.85, p = 0.706; wSD: 14.62 ± 4.36 vs 13.40 ± 3.07, p = 0.053 vs 14.36 ± 3.47, p = 0.805, respectively). The diastolic-BPV indices decreased with nebivolol and increased with irbesartan, resulting in significant differences between the two drugs (SD: baseline 10.56 ± 2.50; nebivolol 9.75 ± 2.12; irbesartan 10.84 ± 1.98, between-drug p = 0.014; wSD: baseline 9.86 ± 2.12; nebivolol 9.34 ± 2.01; irbesartan 10.25 ± 2.01, between-drug p = 0.029). The diastolic-BPV during intradialytic and day-time periods was marginally lower with nebivolol than with irbesartan. During nighttime, the BPV indices were unchanged with either drug. The short-term BPV was reduced after nebivolol but not after irbesartan treatment in patients with intradialytic hypertension. These findings suggest that sympathetic-overdrive may be a major factor that affects BPV in intradialytic hypertension patients.

Blood pressure variability in hypertensive patients with atrial fibrillation in the VALUE trial

Purpose: Blood pressure variability is associated with traditional cardiovascular risk factors, but little is known about the association with atrial fibrillation. We compared blood pressure variability in patients with and without atrial fibrillation using data from the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial.Materials and methods: The VALUE trial was a randomised-controlled trial of valsartan versus amlodipine in patients with hypertension and high cardiovascular risk, followed for 4.2 years (mean). For the present analysis we included patients with electrocardiogram at baseline and during follow-up, and ≥3 visits from 6 months onwards. We compared standard deviation (SD) of all blood pressures within each visit averaged across all visits (within-visit variability) and of mean blood pressure at each visit (visit-to-visit variability) in patients with and without atrial fibrillation at baseline. We similarly compared patients who developed non-persistent or persistent atrial fibrillation during follow-up with those who did not, using t-tests, ANOVA and linear regression.Results: Of 15,245 patients in the VALUE trial, 13,827 were eligible for analysis. SD of visit-to-visit systolic blood pressure was not significantly different between patients with and without atrial fibrillation at baseline (mean difference 0.3 mm Hg, p = 0.4), but significantly higher in patients with incident non-persistent or persistent atrial fibrillation during follow-up than in those who never developed atrial fibrillation (differences 1.2 and 1.8 mm Hg, respectively, p-values <0.0001). Associations with non-persistent and persistent atrial fibrillation were confirmed in linear regression models (p-values <0.0001). SD of within-visit systolic blood pressure was not significantly different between patients with and without atrial fibrillation at baseline (p = 0.4) but significantly higher in patients with persistent atrial fibrillation during follow-up (p = 0.04).Conclusion: In patients treated for hypertension, atrial fibrillation was not associated with increased blood pressure variability, but blood pressure variability was higher in those who developed atrial fibrillation during follow-up.

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p&lt;0.0001-0.026). Conclusion. The main BPV indices are higher in patients with asthma and COPD, in comparison with CLAD-free hypertensive patients. ABPM is the most reliable method of BPV assessment in hypertensive patients with CLAD, according to our data. The increase in BPV is associated with irreversible airway obstruction and renal function. Adverse outcomes were associated with both nighttime BPV and nocturnal BP fall, as well as with rhythm disorders and leukocyte count as a marker of systemic inflammation. BPV in patients with CLAD warrants further investigation.

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

Abstract 071: Increased Short-Term Blood Pressure Variability in Patients With Isolated Systolic Hypertension

Isolated systolic hypertension (ISH) is a clinical condition derived from increased arterial stiffness and associated with a worse cardiovascular prognosis. Increased blood pressure variability (BPV) is also associated to cardiovascular risk. We aimed to estimate short-term BPV in patients with ISH compared to those with systolic and diastolic hypertension (SDH). From the Spanish ABPM Registry database containing 63910 identified patients, we selected 20497 with ISH and 23269 with SDH. BPV estimates were obtained from ABPM records, and included standard deviation (SD), coefficient of variation (CV), weighted SD and average real variability (ARV). Comparisons were carried out by Student’s t test, and by general linear models adjusted for age, gender and office BP. Due to important differences in age between groups, a case-control matching was performed obtaining 14707 pairs matched by gender and with an age difference &lt; 2 years. Comparisons were repeated in this dataset. Patients with ISH were older, more frequently women, with diabetes and with a previous history of CV disease. Office BP was lower (155±13/81±7 vs. 159±16/98±7 mmHg; p&lt;0.001) in comparison to those with SDH. As shown in the table, systolic BPV was increased in ISH (p&lt;0.001 for all comparisons), with respect to SDH. Results were confirmed after adjustments for age, gender and office BP and in the case-control matching comparison (also adjusted for office BP). No differences in diastolic BPV were observed between groups. We conclude that ISH is associated with an increased short-term BPV. This increased BPV could be one of the factors explaining the high CV risk of ISH patients.

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives.

Obstructive sleep apnea (OSA) is often associated with hypertension and other cardiovascular diseases. Blood pressure (BP) variability is part of the assessment of cardiovascular risk. In OSA, BP variability has been studied mainly as very short-term (beat-by-beat) and short-term (24-hour BP profile) variability. BP measured on consecutive heartbeats has been demonstrated to be highly variable, due to repeated peaks during sleep, so that an accurate assessment of nocturnal BP levels in OSA may require peculiar methodologies. In 24-hour recordings, BP frequently features a “nondipping” profile, ie, <10% fall from day to night, which may increase cardiovascular risk and occurrence of major cardiovascular events in the nocturnal hours. Also, BP tends to show a large “morning BP surge”, a still controversial negative prognostic sign. Increased very short-term BP variability, high morning BP, and nondipping BP profile appear related to the severity of OSA. Treatment of OSA slightly reduces mean 24-hour BP levels and nocturnal beat-by-beat BP variability by abolishing nocturnal BP peaks. In some patients OSA treatment turns a nondipping into a dipping BP profile. Treatment of arterial hypertension in OSA usually requires both antihypertensive pharmacological therapy and treatment of apnea. Addressing BP variability could help improve the management of OSA and reduce cardiovascular risk. Possibly, drug administration at an appropriate time would ensure a dipping-BP profile.

MP79-14 NOCTURNAL POLYURIA AND NOCTURNAL BLOOD PRESSURE PATTERNS IN MALE PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2018MP79-14 NOCTURNAL POLYURIA AND NOCTURNAL BLOOD PRESSURE PATTERNS IN MALE PATIENTS WITH LOWER URINARY TRACT SYMPTOMS Misato Takayama, So Omori, Daiki Ikarashi, Tomohiko Matsuura, Yoichiro Kato, Mitsugu Kanehira, Ryo Takata, Jun Sugimura, Takaya Abe, and Wataru Obara Misato TakayamaMisato Takayama More articles by this author , So OmoriSo Omori More articles by this author , Daiki IkarashiDaiki Ikarashi More articles by this author , Tomohiko MatsuuraTomohiko Matsuura More articles by this author , Yoichiro KatoYoichiro Kato More articles by this author , Mitsugu KanehiraMitsugu Kanehira More articles by this author , Ryo TakataRyo Takata More articles by this author , Jun SugimuraJun Sugimura More articles by this author , Takaya AbeTakaya Abe More articles by this author , and Wataru ObaraWataru Obara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2682AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nocturia is the most prevalent symptom of lower urinary tract symptoms (LUTS). The causes of nocturia include bladder storage disorders, nocturnal polyuria, and sleep disorders. Nocturnal polyuria is the largest contributor among these factors. We investigate the prevalence of nocturnal polyuria, their underlying factors, and the patterns of blood pressure variation in patients undergoing treatment for LUTS. METHODS This study was conducted from April 2015 to July 2017.Voided volume, voiding frequency and nocturnal polyuria index were determined using voiding diaries of 242 male patients (65–92years old) undergoing treatment for LUTS, whereas underlying factors were assessed using medical histories and medications. Among 242 patients, 34 (17 each in the nocturnal and non-nocturnal polyuria groups) underwent 24h ambulatory blood pressure monitoring. Measurements and assessments were performed using the portable automatic blood pressure monitor TM-2433 (A&D Company Ltd.) according to the guidelines for the clinical use of 24h ABPM (JCS 2010). Patients whose mean nocturnal blood pressure was lower than diurnal blood pressure by ≥10% and <10% were categorized as dippers, and non-dippers. Moreover, patients whose mean nocturnal blood pressure was higher than their mean diurnal blood pressure were categorized as risers. RESULTS Nocturia and nocturnal polyuria were observed in 194 (81%) and 136 (56.2%) patients, respectively.Among patients with nocturia, 130 patients (67.0%) had nocturnal polyuria, the rate of which increased with increased nocturnal voiding frequency.Significantly higher usage rates of two or more anti-hypertensives (including combinations) were observed in the nocturnal polyuria group than in the non-nocturnal polyuria group (p = 0.0351). Analysis of 24-h blood pressure variation showed that significantly higher non-decreased nocturnal blood pressures (i.e., non-dippers and risers) were observed in the nocturnal polyuria group than in the non-nocturnal polyuria group (p = 0.0365)(Fig1). CONCLUSIONS The nocturnal polyuria group had significantly higher proportions of patients who did not exhibit lowered nocturnal blood pressure, indicating the potential therapeutic value of interventions that lower nocturnal blood pressure to improve nocturnal polyuria. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1086 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Misato Takayama More articles by this author So Omori More articles by this author Daiki Ikarashi More articles by this author Tomohiko Matsuura More articles by this author Yoichiro Kato More articles by this author Mitsugu Kanehira More articles by this author Ryo Takata More articles by this author Jun Sugimura More articles by this author Takaya Abe More articles by this author Wataru Obara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High beat-to-beat blood pressure variability in atrial fibrillation compared to sinus rhythm

Purpose: Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, not entirely explained by thromboembolism. The underlying mechanisms for this association are largely unknown. Similarly, high blood pressure (BP) increases the risk for cardiovascular events. Despite this the interplay between AF and BP is insufficiently studied. The purpose of this study was to examine and quantify the beat-to-beat blood pressure variability in patients with AF in comparison to a control group of patients with sinus rhythm.Materials and methods: We studied 33 patients - 21 in atrial fibrillation and 12 in sinus rhythm - undergoing routine coronary angiography. Invasive blood pressure was recorded at three locations: radial artery, brachial artery and ascending aorta. Blood pressure variability, defined as average beat-to-beat blood pressure difference, was calculated for systolic and diastolic blood pressure at each site.Results: We observed a significant difference (p < .001) in systolic and diastolic blood pressure variability between the atrial fibrillation and sinus rhythm groups at all locations. Systolic blood pressure variability roughly doubled in the atrial fibrillation group compared to the sinus rhythm group (4.9 and 2.4 mmHg respectively). Diastolic beat-to-beat blood pressure variability was approximately 6 times as high in the atrial fibrillation group compared to the sinus rhythm group (7.5 and 1.2 mmHg respectively). No significant difference in blood pressure variability was seen between measurement locations.Conclusions: Beat-to-beat blood pressure variability in patients with atrial fibrillation was substantially higher than in patients with sinus rhythm. Hemodynamic effects of this beat-to-beat variation in blood pressure may negatively affect vascular structure and function, which may contribute to the increased cardiovascular morbidity and mortality seen in patients with atrial fibrillation.

Nerve Growth Factor in Patients With Arterial Hypertension: Neuropsychical, Hemodynamic, Metabolic Relationships

To investigate the changes of serum nerve growth factor (NGF) level in patients with arterial hypertension (AH) and obesity in dependence on the degree of psycho-emotional stress and physical activity. We examined 76 male patients with stage I and II AH with mean age 46.75±0.56 years (36 patients with and 40 without obesity). Control group consisted of 26 individuals without AH, obesity, and cardiovascular diseases. All patients underwent ambulatory blood pressure (BP) monitoring. Serum concentrations of NGF β-subunit and cortisol were determined by enzyme linked immunosorbent assay. For assessment of levels of psycho-emotional stress, reactive and personal anxiety, and physical activity we used Psychological Stress Measure (PSM-25), the Spielberger-Khanin questionnaire, and brief International Physical Activity Questionnaire (IPAQ), respectively. Level of NGF in patients with AH and obesity (0.94±0.28 ρg/ml) was higher than in non-obese patients with AH (0.21±0.06 ρg/ml; p=0.018) with highest figures in patients with insufficient physical activity and high level of psychoemotional stress. In all groups of patients there was unidirectional reverse correlation between serum NGF and cortisol levels. According to ambulatory BP monitoring, NGF level was inversely proportional to systolic and diastolic BP variability in patients with AH and obesity and in the control group. Reduced serum concentration of NGF was associated with increased levels of reactive and personal anxiety. Obtained data suggests that NGF plays an important role in complex multifactorial interactions between neuropsychic, cardiovascular and metabolic processes.

Anxiety-related blood pressure variability in patients with atrial fibrillation after cardioembolic stroke

To investigate whether of anxiety-related blood pressure (BP) variability can be corrected in patients with atrial fibrillation (AF) who have experienced cardioembolic stroke (CES). The investigation enrolled 125 patients (mean age, 68.5±5.7 years) with AF, who had experienced CES. The patients were randomized into 2 groups by the envelope technique: 1) 63 patients received antihypertensive drugs and an anxiolytic (adaptol) (a study group); 2) 62 patients had antihypertensive drugs only (a comparison group). Effectiveness was evaluated 2 and 6 weeks later from the time course of changes in BP readings obtained by 24-hour Holter monitoring in relation to reactive anxiety (RA) and personal anxiety (PA) scores. The latter were determined using the Spielberger-Hanin Anxiety Self-Esteem scale. The patients with AF who had experienced CES were noted to have high BP variability associated with increased RA and PA scores. Group 1 showed statistically significant improvements in RA and PA 2 and 6 weeks after the start of treatment. The efficiency of anti-anxiety therapy (adaptol at a dose of 500 to 1500 mg/day) in combination with antihypertensive drugs is confirmed by the normalized circadian BP profile. The incorporation of an anxiolytic into pharmacotherapy regimens could improve BP, namely, to reduce and stabilize its circadian profile.

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome.

BackgroundHow short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.MethodsPatients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.ResultsA total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03–1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01–1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.ConclusionShort-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.

The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension

Intermittent fasting is a phenomenon which can be observed in most humans. The effect of intermittent fasting on blood pressure variability (BPV) has not previously been investigated. The purpose of this study was to assess the effect of fasting on blood pressure (BP) (with office, home, central, and ambulatory blood pressure monitoring [ABPM]) and on BPV. Sixty individuals were included in the study. Office, home, ABPM, and central BP measurements were performed before and during intermittent fasting. Standard deviation and coefficient variation were used for office and home BPV measurement, while the smoothness index was used to calculate ABPM variability. Patients’ BP and BPV values before and during intermittent fasting were then compared. Intermittent fasting resulted in a significant decrease in office BP values and ABPM measurements but caused no significant change in home and central BP measurements. Twenty-four hour urinary sodium excretion decreased. Smoothness values obtained from ABPM measurements were low; in other words, BPV was greater. BPV was higher in patients who woke up to eat before sunrise, but BPV was low in patients with high body mass index. Intermittent fasting produced a significant decrease in BP values in terms of office and ABPM measurements in this study but caused no significant change in central BP and home measurements. We also identified an increase in BPV during intermittent fasting, particularly in patients who rose before sunrise.

The association between plasma homocysteine and ambulatory blood pressure variability in patients with untreated hypertension

BackgroundBoth homocysteine (Hcy) and blood pressure variability (BPV) are independent predictors of stroke, however, their relationship is rarely evaluated before. This study aimed to investigate the association Hcy and ambulatory BPV in subjects with untreated primary hypertension. MethodsA total of 252 eligible patients were recruited. Plasma Hcy was measured and 24-h ambulatory blood pressure monitoring was performed for each subject. The systolic and diastolic BPV values were calculated as the SD of individual blood pressure values during 24h, daytime and nighttime, and then stratified by the tertiles of Hcy concentration (T1 to T3). Univariate and multivariate linear regression models were used to assess the relationships between Hcy tertiles and BPV variables. ResultsThe mean values of Hcy from T1 to T3 were 7.51±1.21μmol/l, 11.09±1.07μmol/l and 19.14±6.26μmol/l, respectively. Systolic and diastolic mean blood pressures were similar among subjects with different Hcy tertiles. However, both systolic and diastolic BPV variables, no matter in 24-h, daytime or nighttime, were increasing significantly along with the rises in Hcy tertiles (all p<0.05 for linear trends analysis). Multivariate linear regression analysis indicated that Hcy tertiles were significantly associated with BPV variables, independently of mean blood pressures other confounding factors. In subgroup analysis, the associations between Hcy tertiles and BPV variables were enhanced by the increased risk stratification of hypertension. ConclusionsPlasma Hcy was positively and independently associated with ambulatory BPV in patients with untreated hypertension.

GW28-e0698 Telmisartan with amlodipine versus lisinopril with amlodipine on home blood pressure variability in patients with metabolic syndrome

The aim of the present study was to compare the effects of telmisartan combined with amlodipine, versus lisinopril combined with amlodipine, on home blood pressure and pressure variability in hypertensive patients with metabolic syndrome (MS) using home blood pressure monitoring system. This open-

Clinical study of blood pressure variability in aged patients with H type hypertension

Objective: To explore characteristics and influencing factors for blood pressure variability (BPV) in aged patients with H type hypertension. Methods: A total of 100 patients with essential hypertension, who were treated in our hospital from December 2012 to December 2013, were selected. According to serum level of homocysteine (Hcy), patients were divided into pure hypertension group (n = 42, Hcy &lt; 15.4 μmol/L) and H type hypertension group. All patients received 24 h ambulatory blood pressure monitoring (24hABPM), and BPV indexes were recorded and compared between two groups. Correlation among BPV indexes and general data were analyzed, and multi-factor linear regression analysis was used to analyze influencing factors for BPV indexes. Results: Compared with pure hypertension group, there were significant increases in 24 h systolic blood pressure standard deviation [24hSSD, (12.80 ± 2.23) vs. (16.01 ± 3.11)], daytime SSD [dSSD, (11.58 ± 2.30) vs. (13.86 ± 2.26)] and nighttime SSD [nSSD, (9.41 ± 1.64) vs. (11.71 ± 2.34)] in H type hypertension group, p &lt; .05 or p &lt; .01. Pearson correlation analysis showed that Hcy, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly positively correlated with 24hSSD, dSSD and nSSD (r = 0.201-0.508, p &lt; .05 or p &lt; .01). Multivariate linear regression analysis indicated that Hcy and TC were significantly positively correlated with 24hSSD, dSSD and nSSD (B = 0.194-0.546, p &lt; .05 or p &lt; .01). Conclusions: Systolic BPV in aged patients with H type hypertension was significantly higher than that of patients with pure hypertension, their serum Hcy level, TC elevating level were significantly positively correlated with systolic BPV and were major influencing factors for BPV in these patients.

Clinical study of blood pressure variability in aged patients with H type hypertension

Objective: To explore characteristics and influencing factors for blood pressure variability (BPV) in aged patients with H type hypertension. Methods: A total of 100 patients with essential hypertension, who were treated in our hospital from December 2012 to December 2013, were selected. According to serum level of homocysteine (Hcy), patients were divided into pure hypertension group (n = 42, Hcy < 15.4 μmol/L) and H type hypertension group. All patients received 24 h ambulatory blood pressure monitoring (24hABPM), and BPV indexes were recorded and compared between two groups. Correlation among BPV indexes and general data were analyzed, and multi-factor linear regression analysis was used to analyze influencing factors for BPV indexes. Results: Compared with pure hypertension group, there were significant increases in 24 h systolic blood pressure standard deviation [24hSSD, (12.80 ± 2.23) vs. (16.01 ± 3.11)], daytime SSD [dSSD, (11.58 ± 2.30) vs. (13.86 ± 2.26)] and nighttime SSD [nSSD, (9.41 ± 1.64) vs. (11.71 ± 2.34)] in H type hypertension group, p < .05 or p < .01. Pearson correlation analysis showed that Hcy, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly positively correlated with 24hSSD, dSSD and nSSD (r = 0.201-0.508, p < .05 or p < .01). Multivariate linear regression analysis indicated that Hcy and TC were significantly positively correlated with 24hSSD, dSSD and nSSD (B = 0.194-0.546, p < .05 or p < .01). Conclusions: Systolic BPV in aged patients with H type hypertension was significantly higher than that of patients with pure hypertension, their serum Hcy level, TC elevating level were significantly positively correlated with systolic BPV and were major influencing factors for BPV in these patients.

PP.06.32] VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND ITS CORRELATION WITH DECLINE IN KIDNEY FUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Blood pressure variability (BPV) is associated with poorer outcomes in patients with diabetes. Research on the characteristics of visit-to-visit BPV and its prognostic implications is limited. This study aimed to determine the value of BPV, associated factors of systolic BPV and its correlation with decline in kidney function in patients with type 2 diabetes mellitus (T2DM). Design and method: This was a 10-year retrospective cohort study of 333 patients with T2DM at a primary care clinic. Blood pressure (BP) at every follow up visit from 2005 to 2014 were captured. BPV was defined as the standard deviation of the BP readings. Decline in kidney function was expressed as the annual rate of decline in estimated glomerular filtration rate (eGFR). Factors associated with visit-to-visit systolic BPV was determined using Pearson's correlation coefficient and independent t-test. Independent association of decline in annual eGFR rate was determined using multivariate linear regression analysis. Results: This study involved 112 male patients (33.6%) and 221 female patients (66.4%). The mean age of patients at baseline was 57.8 ± 9.5 years old. By the end of study period, the mean duration of years of diabetes was 15.9 ± 6.2 years and 298 (89.5%) of patients had co-morbid hypertension. The mean visit-to-visit systolic BPV was 12.7 ± 3.1 mmHg. Higher systolic BPV was found in patients who were older, females, with co-morbid hypertension, more frequent clinic visits, higher mean systolic BP, higher mean total cholesterol and users of antihypertensive medications. The mean annual decline in eGFR rate in this study was −0.78 ± 1.60 ml/min/1.73m2. Independent factors associated with decline in kidney function were systolic BPV, longer duration of diabetes and use of diuretics. Conclusions: The visit-to-visit standard deviation of BPV in patients with T2DM is 12.7 mmHg. Systolic BPV is an independent risk factor associated with decline in kidney function. Hence visit-to-visit BPV is an important additional target to reduce decline in kidney function in patients with T2DM.

PP.26.14] CORRELATIONS BETWEEN PSYCHOLOGICAL STATUS, QUALITY OF LIFE SCORES AND LEFT VENTRICULAR MASS INDEX, AND MEAN AMBULATORY BLOOD PRESSURE VARIABLES IN PATIENTS WITH HYPERTENSION

Objective The aim of our study was to determine correlations between psychological status and quality of life with left ventricular mass index and mean ambulatory blood pressure variables in patients with arterial hypertension (AH). Design and method We analyzed 76 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM device (Spacelabs 90207) was applied after the washout period. After ABPM session patients completed the questionnaires. Left ventricular mass index (LVMI) (L. Teichholtz et al., 1976) was measured using echocardiography. We assessed the following QL scale scores (General Well-Being Questionnaire by J.Siegrist et al.): I - physical well-being, II - physical performance, III - positive psychological well-being, IV - negative psychological well-being, V - psychological performance, VI - social well-being, VII - social performance. We analyzed the following MMPI scale scores (Minnesota Multiphasis Personality Inventory): L – lie scale, F – aggravation scale, K – correction scale, 1 – hypochondria, 2 – depression, 3 – hysteria, 4 – psychopathy, 6 – rigidity of affect, 7 – psychasthenia, 8 – schrizothemia, 9 – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results The mean ambulatory systolic BP (SBP) was 136.1 ± 11.2; diastolic (DBP) −89.1 ± 9.0 mm Hg (M ± SD). LVMI – 122,1 ± 24,9 g/m2. We found the following correlations: 1) 9 MMPI scale scores (energy, optimism, good mood) were negatively correlated with LVMI (r = −0.33, p < 0.05); 2) 9 MMPI scale scores had the negative relationships with clinical and ambulatory SBP levels (r = −0.23, r = −0.24 respectively, p < 0.05) and with SBP load variables (r = −0.25, p < 0.05). There were no significant links between QL scales scores and LVMI, ambulatory BP indices.Thus, energy, optimism, good mood (9 MMPI scale scores) had a negative correlation not only with LVMI, but also to SBP indices. Conclusions It was identified inverse correlation between psychological status (energy, optimism, good mood) and LVMI indices, and also with clinical and ambulatory SBP variables of AH patients. There were no significant links between QL scales scores and LVMI, ambulatory BP indices.