Circadian Blood Pressure Profile Research Articles

BLOOD PRESSURE CONTROL AND CIRCADIAN RHYTHM AMONG PATIENTS WITH PROGRESSIVE GLAUCOMA – PRELIMINARY RESULTS

Objective: Blood pressure (BP) control, postural changes and daily variability in patients with progressive glaucoma. Design and method: The study included 55 patients with different duration of open-angle glaucoma who had disease progression during the visit qualifying for this observational study. During two separate visits with 7 to 14 days interval, an ophthalmological and the clinical examination (standardized questionnaire, three BP measurements, orthostatic test, 24hour ABPM) were performed. The criterion for hypertension (HT) control in treated patients aged 80 years and over was office BP <150/90 mmHg. Postural hypotension was defined as a drop in systolic BP (SBP) of at least 20 mmHg and/or a drop in diastolic BP (DBP) of at least 10 mmHg within 1, 3, or 5 minutes after standing. The validated devices were used to obtain BP measurements. Results: The mean age of patients was 69 years, most subjects were over 60 years of age; 40% were men, 75% were treated for hypertension (HT). ∗Data from ABPM are currently available for 39 patients. Patients with glaucoma progression noted in the short course of the disease (<5 years) were more likely to have uncontrolled HT in the office setting; in ABPM also had higher daytime SBP and greater daily SBP variability, although no statistical significance was observed. In turn, the oldest patients with long-term (>10 years) progressive glaucoma had too low nighttime SBP and DBP values. Conclusions: Conclusions. The results indicate an unfavorable prognostic impact of insufficient HT control and daily BP variability in people with a few years of glaucoma history. In the oldest patients, too low BP levels throughout the 24-hour period may contribute to its progression. Since most our patients had ABPM performed for the first time, emphasis should be placed on more frequent monitoring of circadian BP profile in glaucoma patients, especially among the oldest.

CHARACTERISTICS OF CIRCADIAN BLOOD PRESSURE PROFILE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND THEIR ASSOCIATION WITH THYROID FUNCTION

The paper presents the results of a study of circadian arterial blood pressure (ABP) profile in patients with Acute Coronary Syndrome (ACS) and their association with thyroid-stimulating hormone (TSH) levels.
 Aim. To conduct a comparative analysis of circadian BP monitoring (CBPM) indicators in patients with ACS and their association with the TSH level.
 Materials and Methods. The study includes 125 patients with ACS aged 36 to 81 (mean age - 60.98± 0.81 years old). The patients were divided into two groups according to thyroid function. Group one (I) included 51 individuals (40.8%) - hypothyroid patients (TSH level>4mIU/ml), mean age - 62.51±1.18 years old; Group II included 74 individuals (59.2%) - euthyroid patients (TSH level 0.4-4mIU/ml), mean age - 59.93±1.08 years old. The serum-free thyroxine (FT4) levels were within the normal range in both groups. In the general group, the proportion of individuals with unstable angina (UA) was 28.8%, and with myocardial infarction (MI) - 71.2%. In particular, in Group I, the proportion of individuals with UA was 23.53%, and with MI - 76.47%; in Group II, the proportion of individuals with UA was 32.43%, and with MI - 67.57%, p>0,05 between Groups I and II. The circadian BP monitoring was carried out using the Biomed ВАТ41-2 device after stabilization of the patient's condition (on the second day of hospital admission). The following indicators have been determined: systolic BP (SBP) - daytime, nighttime, and average daily (24 hours) (SBPd, SBPn, and SBPav); diastolic BP (DBPd, DBPn, and DBPav); pulse BP (PBPd, PBPn, and PBPav); time index (TI) for SBPd, SBPn, and SBPav (SBPd TI, SBPn TI, and SBPav TI) and DBP (DBPd TI, DBPn TI, and DBPav TI); variability of SBPd, SBPn, and SBPav (SBPd var, SBPn var, and SBPav var) and DBP (DBPd var, DBPn var, and DBPav var); average daily index for SBP (SBP AvDI) and DBP (DBP AvDI); average daily heart rate (HRav). To study thyroid function in patients enrolled, TSH and FT4 levels were determined by chemiluminescent immunoassay method on the ARCHITECT iSystem analyzer using reagent kits for the quantitative determination of TSH (ARCHITECT TSH) and FT4 (ARCHITECT Free T4).
 Results and Discussion. The comparison of the CBPM results in both groups of patients with ACS shows significantly higher mean nighttime (SBPn and DBPn) levels in Group I patients compared to Group II patients: SBPn - by 6.27% (125.44±2.98 mm Hg (I) versus 117.58±2.26 (II), p<0,05), DBPn - by 6.15% (73.65±1.91 mm Hg (I) versus 69.12±1.62 (II), p<0,05), in the absence of a significant between-group difference between the mean levels of respective daytime and average daily indicators. Mean DBPn TI value also turned out to be significantly higher in Group I patients compared to Group II patients - by 33.69% (42.47±4.60% (I) versus 28.16±3.60% (II), p<0.01). Significant difference was detected between mean SBP AvDI and DBP AvDI indicators in hypothyroid patients (I) versus respective indicators in euthyroid patients (II): SBP AvDI (I) 2.52±1.25% versus SBP AvDI (II) 5.99±0.98, p<0.05; and DBP AvDI (I) 4.69±1.38% versus DBP AvDI (II) 8.88±1.32, p<0.05.
 Conclusions. 1. Mean nighttime BP indicator (SBPn, DBPn, and DBPn TI) levels were significantly higher in the Group of hypothyroid patients with ACS, compared to euthyroid patients. In addition, the proportion of patients whose mean nighttime SBP and DBP levels exceeded the permissible values (SBPn<120, DBPn<70 mm Hg) was significantly higher in the Group of hypothyroid patients (I) compared to the Group of euthyroid patients (II). 2. Every third hypothyroid patient (I) (SBP AvDI: 37.25% and DBP AvDI: 31.37%) had a night-peaker circadian BP profile, characterized by nighttime BP increase instead of reduction, which suggests an extremely unfavorable prognosis. The findings may signal an additional adverse effect of thyroid dysfunction on arterial tone and, accordingly, BP regulation, which brings about a high risk of complications of ACS.

Progression of obstructive sleep apnoea after renal denervation is not associated with hypertension exaggeration

PurposeIn a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.Materials and methodsTwenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation.ResultsThe average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.ConclusionsAlthough the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.

EFFECTS OF SMOKING ON CIRCADIAN ARTERIAL BLOOD PRESSURE PROFILE IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME AND CHRONIC KIDNEY DISEASE

The paper presents the results of a study of the effects of smoking on circadian arterial blood pressure (ABP) profile in patients with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) and Chronic Kidney Disease (CKD).
 Aim. The research aims at studying the features of circadian blood pressure monitoring (CBPM) in patients with NSTE-ACS and CKD, smoking-dependent.
 Materials and Methods. The study includes 70 patients with NSTE-ACS and CKD aged 35 to 75 years. The patients were divided into 2 groups: Group I - 35 smokers (mean age - 60.09±1.66 years), Group II - 35 individuals who have never smoked (mean age - 62.31±1.04 years). The circadian blood pressure monitoring was carried out on the second day of hospital admission after stabilization of the patient's condition. The following indicators have been determined: systolic blood pressure (SBP) - daytime, nighttime, and average daily (24 hours) (SBPd, SBPn, and SBPav); diastolic blood pressure (DBPd, DBPn, and DBPav); pulse pressure (PBPd, PBPn, and PBPav); time index (TI) for SBPd and SBPn (SBPd TI and SBPn TI) and DBP (DBPd TI and DBPn TI); heart rate (HR). To study the renal functional status in the examined patients, the urine albumin-creatinine ratio (ACR) was determined using the semi-quantitative method. The glomerular filtration rate (GFR) was calculated using the CKD-EPI Creatinine Equation.
 Results. Mean SBP, DBP, and PBP levels were significantly higher in Group I patients compared to Group II patients: SBPd - by 5.10% (p<0.05), SBPn - by 6.60% (p<0.05); DBPd - by 9.60% (p=0.01), DBPn - by 14.10% (p<0.05); PBPd - by 7% (p=0.05), PBPn - by 8.50% (p<0.05). The mean TI value also turned out to be significantly higher in the group of smokers (I) versus non-smokers (II): SBPd TI - by 55.50% (p<0.01), SBPn TI - by 58.90% (p<0.01), DBPd TI - by 57.50% (p<0.01), DBPn TI - by 46.30% (p<0.01). The HR was higher by 10.80% in Group I patients compared to Group II patients (p<0.01). The mean GFR level in smokers is 13.00% lower than in non-smokers (p<0.05). A 57% significantly higher ACR level was found in the group of smokers (Group I) compared to non-smokers (Group II) (p<0.01).
 Conclusions. Mean SBP, DBP, PBP, TI, and HR levels were significantly higher in the group of smokers with NSTE-ACS and CKD. In the same Group, more distinct signs of kidney injury were found, namely, lower GFR values and higher ACR values, which indicates the probable adverse effect of smoking on ABP regulation and renal microvasculature.

Association between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test

It is known that, a not physiological blood pressure (BP) circadian pattern has been associated with increased risk of organ damage and cardiovascular (CV) event. The aim of this study was to assess the association between circadian BP pattern and glucometabolic phenotypes occurring after oral glucose tolerance test (OGTT). We recruited 810 hypertensive Caucasian patients. All participants underwent to OGTT, laboratory test and 24-h ambulatory BP monitoring (ABPM). The analysis of collected data allowed classifying patients based on nocturnal BP profiles into four categories: dippers, non-dippers, extreme dippers, and reverse dippers. Considering the dipping pattern, the proportion of non-dippers in normal glucose tolerance patients with 1-h glucose ≥ 155 mg/dL (NGT ≥ 155) (36.4%) was higher than NGT < 155 (29.6%) and impaired glucose tolerance (IGT) (34.8%), but lower than type 2 diabetes group (T2DM) (52.6%) (p = 0.001). The proportion of dippers was lower in NGT ≥ 155 (47%) and T2DM (34.6%), when compared with NGT < 155 (53.8%) and IGT (51.2%) (p = 0.017). From logistic regression analysis, 1-h glucose ≥ 155 increased the risk of a pathological nocturnal drop in BP by 74%, (OR = 1.740, 95% CI 1.254–2.415, p < 0.0001). In addition, the improvement in 1 unit of Matsuda was responsible for a 3.5% risk decrease (OR = 0.965, 95% CI 0.958–0.971, p < 0.0001), while e-GFR determined a 0.9% risk reduction of nocturnal BP drop (OR = 0.991, 95% CI 0.984–0.999, p = 0.020). Our data demonstrated the existence, in newly diagnosed hypertensive patients, of an association between circadian BP profile and altered glycemic response during OGTT, in particular NGT ≥ 155 subjects are associated with a non-dipper BP pattern, this is clinically relevant because may explain, at least in part, the increased CV risk in this setting of patients.

Features of short-term variability of arterial pressure with different types of circadian rhythm in patients with hypertension disease who have suffered myocardial infarction

Abstract. Blood pressure variability is an important prognostic parameter and is an independent predictor of cardiovascular disease and mortality. Aim. To assess short-term blood pressure variability with regard to the type of diurnal blood pressure profile in hypertensive patients with myocardial infarction. Materials and methods. 78 hypertensive men who had a myocardial infarction were examined. The average age was 58.0 (54.0; 67.0) years, the experience of hypertension was 9.0 (5.0; 18.0) years, the period after the myocardial infarction was 24.5 (12.0; 84,0) months. All patients underwent daily monitoring of blood pressure with the study of average day and night pressure levels, the degree of nocturnal decrease in blood pressure, blood pressure variability with STD calculation, pure and new variability indices. The results. Increased BP variability during the day and at night was registered with all types of circadian systolic BP rhythm. The highest values of systolic BP variability (STD) during the day and at night were in patients with a night-picker circadian profile. Achieving the target level of systolic BP as a whole in the group was observed in 34.6 % of patients during the day and 42.3 % at night. Patients with an over-dipper circadian blood pressure profile, despite having the highest percentage of target blood pressure achievement, had the highest values of variability characteristics calculated by STD, pure and new indices per day (p &lt; 0.05). Conclusions. Increased blood pressure variability and pressure level at night are important criteria for assessing the prognosis of hypertensive patients after myocardial infarction. Daily monitoring of blood pressure provides a unique opportunity to objectify these prognostic parameters at different times of the day, which, together with the assessment of reaching the target level of blood pressure, is necessary to control the effectiveness of treatment.

Chronostructure and circadian rhythms of the parameters of the coagulation system and neurohumoral regulatory systems determining diurnal profile of blood pressure

The article is devoted to circadian rhythms of parameters of the hemostatic systems and humoral vasoactive factors determining diurnal profile of blood pressure. Researches indicate the presence of circadian rhythms of activity of autonomic nervous system and renin-angiotensin-aldosterone system in healthy human. Plasma catecholamines maximal activity is observed during the daytime, minimal one at night. Plasma renin activity and aldosterone concentration gradually decreases during the day, reaching its minimum at 4 p.m., followed by increase overnight to a peak at 8 a.m. Angiotensin-converting enzyme diurnal pattern is characterized by monophasic curve with maximal activity in the evening and minimum at night. Physiological features of hemostasis chronobiological characteristics in patients with coronary heart disease are present. All indexes of progressing coagulation and anticoagulation blood system has shown pronounced expressive shift of hypercoagulations in patients in the evening and at night. Fluctuations of insulin and glucose levels during 24 hours are also subject to circadian rhythm, i.e. maximal concentration is observed during the daytime, minimal one at night. Such diurnal rhythms are characteristic for patients without complicated arterial hypertension. However, circadian rhythms disturbances of humoral factors may further violate the circadian profile of blood pressure. It is pointed out that chronotherapy promote further development of the principle of individual treating approach.

PS-P03-7: 24 HR-AMBULATORY BLOOD PRESSURE PROFILE AND CLINICAL FEATURES OF HYPERTENSIVE AND PREHYPERTENSIVE HEALTH CARE WORKERS IN A PHILIPPINE TERTIARY CENTER

Background: Hypertension is a leading cause of cardiovascular morbidity, and its prevalence is increasing most rapidly in developing countries like the Philippines, where there is poor hypertension treatment and control ABPM is an important diagnostic tool among patients because it identifies hypertension phenotypes and circadian blood pressure profile that are known to be predictors for target organ damage and increased incidence of future cardiovascular event. Objectives: To determine the blood pressure profile and phenotypes of hypertensive and pre-hypertensive health care workers and its association to BP control and dipping status. Design and Methods: This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM). Results: 181 patients were included with majority from 50–59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%). Conclusion: There was high prevalence of sustained hypertension among healthcare workers included in this study. All those known hypertensives tested had uncontrolled blood pressure despite being on one or more antihypertensive therapy, while there were also newly diagnosed with masked hypertension. The overall prevalence of non-dippers and those with elevated mean 24- hour blood pressure levels was high, and there is significant association of working longer hours and nocturnal dipping pattern. However, there was no significant difference on nocturnal dipping status and blood pressure elevation among those with those with shift work, compared to usual office work hours. This study is one of the few local data on 24hr ambulatory blood pressure measurement of Filipino hypertensive and prehypertensive patients and is one of few data on use of ambulatory blood pressure monitoring among Asians. This also highlights the importance of 24-hour ABPM to identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients according to the locally available maintenance medications.

JS-NG-7: ASSOCIATION BETWEEN PLASMA ALDOSTERONE CONCENTRATION AND AMBULATORY BLOOD PRESSURE PROFILE IN PATIENTS WITH PRIMARY ALDOSTERONISM

Background: Primary aldosteronism (PA) is a major cause of curable hypertension with its morbidity rate 5–10% in hypertensive patients reported, and thus is highly prevalent in patients with hypertension, a cause of resistant hypertension, and closely associated with target organ damage compared with essential hypertension. Although an altered circadian blood pressure (BP) rhythm estimated by ambulatory blood pressure monitoring (ABPM) has been highlighted as a major contributor of CVD in essential hypertension, there would be very few reports investigating clinical significance of ABPM in PA patients. Therefore, we aimed to examine a possible association between plasma aldosterone concentration (PAC) and ABPM profile in PA patients. Methods: Consecutive 27 PA patients, who had been diagnosed by the functional tests and underwent adrenal venous sampling (AVS) from April 2015 to March 2020, were included in this study. All clinical indexes including 24-hour ABPM were measured during the hospitalization, and all participants received dietary salt restriction with 6 g/day of salt. The 24-hour ABPM was performed from the first day of hospitalization to the next day, and AVS was performed on the third day in the morning. Regarding PAC measurement, we collected blood samples during AVS. After resting for 30 minutes in a supine position, blood samples were collected from inferior vena cava by catheterization. During AVS, we also performed ACTH stimulation, and blood samples were collected essentially 1 hour after the stimulation. Results: We firstly analyzed a correlation between PAC and ABPM profile and found that PAC measured after ACTH stimulation (post-PAC) was negatively correlated with nocturnal dipping rate in both systolic and diastolic BPs (SBP and DBP) (R = -0.430, P = 0.025, and R = -0.431, P = 0.025, respectively), while PAC measured before ACTH stimulation (pre-PAC) was not. Thus, according to the median of post-PAC, we divided participants into lower PAC and higher PAC groups and compared clinical characteristics between the two groups. Compared to the lower PAC group, nocturnal SBP and DBP dipping rates and serum potassium levels were significantly decreased in the higher PAC group (SBP dipping 10.3 ± 6.4 vs 3.5 ± 7.7 %, P = 0.02; DBP dipping 13.6 ± 7.7 vs 5.5 ± 6.3 %, P = 0.01; serum potassium 4.1 ± 0.3 vs 3.7 ± 0.4 mEq/L, P = 0.03). Conclusions: In this cross-sectional study, higher PAC was significantly associated with a non-dipper circadian BP profile characterized by lower nocturnal BP dipping rates in PA patients. Prospective longitudinal study is warranted to seek for a causal relationship between hyperaldosteronism and ABPM profile.

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

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

Circadian Blood Pressure Profile in Pediatric Patients with Primary Hypertension

Our study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). The study included 112 children (14.7 ± 2.1 age, 79 boys, 33 girls) with untreated PH. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%, and a nocturnal drop >20% was defined as extreme dipping. The nocturnal SBP drop was 10.9 ± 5.9 (%), and the DBP drop was 16.2 ± 8.5 (%). Non-dipping was found in 50 (44.6%) children and extreme dipping in 29 (25.9%) patients. The nocturnal SBP decrease correlated with BMI Z-score (r = −0.242, p = 0.010) and left ventricular mass index (LVMI) (r = −0.395, p = 0.006); diastolic DBP decrease correlated with augmentation index (AIx75HR) (r = 0.367, p = 0.003). Patients with a disturbed blood pressure profile had the highest LVMI (p = 0.049), while extreme dippers had the highest augmentation index (AIx75HR) (p = 0.027). Elevated systolic and diastolic BP dipping were risk factors for positive AIx75HR (OR 1.122 95CI (1.009–1.249) and OR 1.095 95CI (1.017–1.177). We concluded that disturbed circadian BP profile was common in children with PH and should not be considered a marker of secondary hypertension. A disturbed circadian BP profile may be associated with higher body weight. In pediatric patients with PH, non-dipping is associated with increased left ventricular mass, and extreme dipping may be a risk factor for increased arterial stiffness.

CARDIOHEMODYNAMIC AND PROGNOSTIC SIGNIFICANCE OF RENAL ARTERY STENTING IN PATIENTS WITH CORONARY ARTERY DISEASE

The aim of the study is to evaluate cardiohemodynamic and prognostic significance of endovascular revascularization of renal arteries (ERRA) in patients with coronary artery disease (CAD).&#x0D; Materials and Methods. The authors examined 106 patients (84 men, 22 women; mean age 53±15). All the patients underwent both coronary angiography and renal artery angiography to verify chronic CAD. The authors analyzed the incidence and severity of arterial hypertension, the results of coronary and renal artery angiography, the outcomes of endovascular management of renal artery stenosis (RAS), and all-cause mortality rates. The follow-up period lasted for 10 years.&#x0D; Results. CAD was detected in 61 patients (58 %). Synchronous coronary and renal artery damage was detected in 12 patients (19.7 %), including hemodynamically significant renal artery stenosis (9 patients (14.8 %)). Eight patients underwent renal artery stenting. Arterial hypertension was observed in 58 of 61 patients (95.1 %) with verified CAD, including all the patients with synchronous coronary and renal artery damage. Seventeen patient (16 %) died during the monitoring period. During a 10-year period, 3 people (25 %) died from all causes in the group of RAS patients, while 14 people (14.8 %) died in the group of patients without RAS (χ=1.22; р=0.37). Twelve months after renal artery stenting, there was a decrease in systolic blood pressure load, a decrease in the number of unfavorable blood pressure profiles, and a decrease in end-diastolic dimension.&#x0D; Conclusions. In the medium term, ERRA is associated with a decrease in hypertensive load indices and systolic BP variability, an improvement of circadian blood pressure profiles, and a decrease in left ventricle end-diastolic and left atrium dimensions. Renal artery stenosis and ERRA did not significantly affect mortality over a 10-year follow-up.

CIRCADIAN BLOOD PRESSURE PROFILE IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION

Objective: Disturbed circadian blood pressure (BP) profile is a risk factor for cardiovascular complications in adults. The study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). Design and method: The study included 112 children (79 boys, 33 girls, 14.7 ± 2.7 years) with untreated PH. Circadian BP profile was assessed by 24-hour ABPM. Disturbed circadian BP profile (non-dipping) was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) &lt; 10%. A nocturnal drop in SBP or DBP &gt; 20% was defined as extreme dipping. Patients were evaluated for central BP, HMOD (left ventricular mass index - LVMI, aortic pulse wave velocity, augmentation index (AIx75HR), intima-media thickness, albuminuria), and clinical and biochemical parameters, including sodium-potassium balance. Results: In the study group, the mean nocturnal drop in SBP was 10.9 ± 5.9 [%] and in DBP - 16.2 ± 8.5 [%]. Non-dipping was found in 50 (44.6%) children and extreme-dipping in 29 (25.9%) patients. The nocturnal drop in SBP correlated negatively with Z-scores of body weight (r = -0.191, p = 0.043) and BMI (r = -0.242, p = 0.010) and with LVMI [g/m2.7] (r = -0.395, p = 0.006). The nocturnal drop in SBP and DBP correlated positively with urinary potassium excretion [mmol/kg/24 h] (r = 0.656, p = 0.001 and r = 0.540, p = 0.011, respectively). Patients with disturbed circadian blood pressure profile were characterized by higher LVMI (44.5 ± 12.5 vs. 36.8 ± 8.8 [g/m2.7]) and albuminuria (median: 10.8, IQR: 5.3–53.3 vs. median: 8.1, IQR: 5.5–16.4 [mg/24 h], p = 0.043) and lower urinary potassium excretion (0.6 ± 0.2 vs. 1.1 ± 0.3 [mmol/kg/24 h]). Extreme-dipping patients had a higher AIx75HR than the other patients (median: + 3.3, IQR: -6.3- + 17.7 vs. -4.6, IQR: -17.3- + 4.0 [%], p = 0.048). Conclusions: 1. Disturbed circadian BP profile is common in children with PH and should not be considered a marker of secondary hypertension. 2. Disturbed circadian BP profile may be associated with higher body weight and lower dietary potassium intake. 3. Pediatric patients with PH and disturbed BP profile are at risk for HMOD: left ventricular hypertrophy and microalbuminuria. 4. Extreme-dipping may be associated with increased arterial stiffness in children with PH.

EFFECTS OF TRANSCUTANEOUS PERIPHERAL NERVE ELECTROSTIMULATION DEVICE FOR BLOOD PRESSURE CORRECTION

Objective: Currently the therapy of arterial hypertension (AH) is mainly based on antihypertensive medicines. The medical transcutaneous peripheral nerve electrostimulator “ABP-051’’ (“Shvabe’’&amp; “INFERUM’’, Russia) allows to influence the level of blood pressure (BP) in a non-drug way, but its effectiveness was tested only by comparing discrete blood pressure measurements. The aim of the study was to evaluate the effect of the course use of the stimulator “ABP-051’’ on the circadian blood pressure profile (CBPP), reconstructed according to three-day BP-monitoring in patients with hypertension. Design and method: Patients: the study included 62 patients with hypertension: AH patients with regular antihypertensive therapy, who were andomised into 2 groups: the main group of 52 patients who were treated by the “ABP-051’’ and 10 patients in control group with sham stimulation. Methods: all patients underwent a study of the dynamics of the level and profile of blood pressure by means assessment of CBPP (the method of non-sinusoidal variability) based on the reconstruction of three-day BP monitoring. Results: It was found that stimulation therapy is not accompanied by side effects and does not lead to significant fluctuations in blood pressure after a single procedure. During the course of therapy, a significant decrease in blood pressure and circadian profile indicators was observed in 66% of patients (fig.1). The average decrease in systolic blood pressure is -8.3 ± 7.7 mm Hg, diastolic blood pressure is 5.8 ± 3.8 mm Hg. The effect of the course treatment was observed by the end of the 2-week stimulation cycle and in most patients persisted for 2 weeks after its completion. In general, positive effects on the blood pressure profile were observed in 90% of patients, whereas there were no changes in the control group. Conclusions: The course use of “ABP-051’’ is safe and in 90% of patients with hypertension contributes to decrease of BP and/or the improvement of the circadian blood pressure profile.

Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome.

ResumoFundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular.Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda.Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo.Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX.Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Are Differences in Inflammatory Markers between Patients with and without Hypertension-Mediated Organ Damage Influenced by Circadian Blood Pressure Abnormalities?

We aimed to explore the influence that the circadian blood pressure (BP) profile could exert on the correlation between some inflammatory markers and hypertension-mediated organ damage (HMOD). This was a cross-sectional study that included patients with primary arterial hypertension older than 18 years old. We included some parameters of 24 h ambulatory blood pressure monitoring collection and several inflammatory markers, as follows: platelet count (PTC), erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive-protein, ferritin, fibrinogen, and uric acid. Myocardial hypertrophy, albuminuria, carotid intima-media thicknesses and ankle brachial index were assessed as HMOD presentations. Individuals were divided into two groups: patients with and without HMOD. We included 522 patients (47% women, mean age of 54 years). Multivariate logistic regression analysis showed that male patients older than 50 years old with uric acid levels above 7 mg/dL, ESR higher than 20 mm/h, fibrinogen greater than 320 mg/dL and PTC lower than 275 × 103/µL were associated with HMOD (p < 0.05). The circadian BP profile (dipper versus non-dipper pattern) did reach neither statistical significance nor influence the odds ratio of those inflammatory markers for HMOD. We found that differences in some inflammatory markers between patients with and without HMOD were not explained by a different circadian BP profile.

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

ObjectiveHypertension (HT) induces left atrial (LA) and left ventricular (LV) dysfunction, and an increase in arterial stiffness. In this study, we investigated the association between LA-LV–arterial coupling and nighttime systolic blood pressure (BP) as well as BP circadian rhythm in essential hypertension.MethodsWe enrolled 290 HT patients. All subjects were evaluated by 2- dimensional speckle tracking echocardiography (2DSTE), ambulatory 24 h BP monitoring (ABPM), and brachial–ankle pulse wave velocity (PWV). According to BP patterns, these patients were divided into two groups, which included dippers (n = 111), patients with a >10% reduction in BP at nighttime; non-dippers (n = 179), patients with a <10% reduction in BP at nighttime. 2D-STE based LA and LV strains were studied and the following parameters were measured, LV global longitudinal strain (GLS), LA reservoir strain (LAS−S), LA conduit strain (LAS−E), and LA booster pump strain (LAS−A). LA stiffness index (LASI) defined as the ratio of E/e′ to LAS−S, and PWV-to-GLS ratio (PWV/GLS) were calculated to reflect LA-LV–arterial coupling. Furthermore, we also explored the correlation between LASI (or PWV/GLS) and ambulatory blood pressure indexes.ResultsLeft atrial stiffness index was significantly higher in non-dippers [0.29 (0.21, 0.41)] than in dippers [0.26 (0.21, 0.33)] (P < 0.05). PWV/GLS was significantly higher in non-dippers [−80.9 (−69.3, −101.5)] than in dippers [−74.2 (−60.2, −90.6)] (P < 0.05). LAS−S, LAS−E, LAS−A,and LV GLS were significantly lower in non-dippers than in dippers (P < 0.05). Multivariate linear regression analysis revealed that nighttime systolic BP was independently correlated with LASI and PWV/GLS, even adjusted for multiple clinical risk factors, LVMI, and LVEF.ConclusionsThe dipping pattern of BP was related to the abnormalities of myocardial mechanics and LA-LV–arterial coupling. However, absolute nocturnal systolic BP value maybe more important than BP circadian profile in the progression of abnormal LA-LV–arterial coupling.

Порівняння впливу фіксованої комбінації периндоприл/амлодипін на ураження органів-мішеней у пацієнтів з артеріальною гіпертензією з ішемічною хворобою серця та без неї (результати дослідження EPHES)

Дослідження EPHES (Evaluation of influence of fixed dose combination Рerindopril/Amlodipine on target organ damage in patients with arterial HypErtension with or without iSchemic heart di­sease — оцінка впливу фіксованої комбінації периндоприл/амлодипін на ураження органів-мішеней у пацієнтів з артеріальною гіпертензією (АГ) з ішемічною хворобою серця (ІХС) та без неї) мало за мету порівняти ефективність фіксованої комбінації (ФК) периндоприл/амлодипін щодо зниження артеріального тиску (АТ) та динаміки вираженості ураження органів-мішеней у хворих на АГ з ІХС та без неї. Матеріали та методи. У дослідження EPHES було включено 60 пацієнтів з АГ віком старше від 30 років: перша група — 30 пацієнтів без ІХС, друга — 30 пацієнтів, які мали ІХС. Строк спостереження становив 12 місяців. Усім пацієнтам у день рандомізації призначали ФК периндоприл/амлодипін у початковій дозі 5/5 мг один раз на добу. При необхідності (АТ &gt; 140/90 мм рт.ст.) дози компонентів ФК збільшували поступово кожні 2 тижні до 10/10 мг, а після 6 тижнів лікування додавався індапамід 1,5 мг. 66,7 та 96,7 % пацієнтів в першій та другій групах відповідно отримували бета-адреноблокатори. Усім пацієнтам проводили: вимірювання маси тіла та зросту, офісних рівнів систолічного АТ (САТ), діастолічного АТ (ДАТ) та частоти серцевих скорочень (ЧСС), добове моніторування АТ, визначення швидкості поширення пульсової хвилі в артеріях еластичного (ШППХе) та м’язового типів, центрального САТ, стандартизованого до ЧСС 75 уд/ хв індексу аугментації (Аіх75), біохімічне дослідження крові, електрокардіографію, ехокардіографію з допплерографією, вимірювання гомілково-плечового індексу, визначення товщини комплексу інтима-­медіа (ТКІМ). Результати. Встановлено, що призначена терапія на основі ФК периндоприл/амлодипін незалежно від наявності або відсутності ІХС ефективно (до цільових рівнів) та безпечно знижувала офісний, середньодобовий, денний, нічний та центральний АТ. При цьому достовірно зменшувалися початково підвищені денна та нічна варіабельність АТ, величина ранкового підйому САТ та частка пацієнтів з добовим профілем АТ типу «нон-дипер», проте ці показники залишалися достовірно більшими у пацієнтів з ІХС на всіх етапах лікування. Хворі з ІХС та без неї не відрізнялися за початковою величиною АІх75, і на фоні призначеної терапії спостерігалося достовірне зменшення цього показника в обох групах, проте у хворих з ІХС це зменшення АІх75 було достовірно меншим, ніж у групі без ІХС, що, імовірно, було пов’язано з більш частим застосуванням бета-блокаторів. Ефективне щодо зниження АТ лікування призводило в обох групах до достовірного зменшення ураження органів-мішеней — покращення пружно-еластичних властивостей аорти та діастолічної функції лівого шлуночка, зменшення рівня альбумінурії, гіпертрофії лівого шлуночка та розміру лівого передсердя. Ступінь зниження ШППХе був достовірно (Р &lt; 0,005) меншим у пацієнтів без ІХС, ніж у групі з ІХС — 2,5 ± 0,2 м/с проти 4,4 ± 0,5 м/с. Окрім того, незважаючи на однаковий ступінь зменшення індексу маси міокарда лівого шлуночка, покращення діастолічної функції лівого шлуночка (збільшення Е/А та зменшення Е/Е’) у групі хворих з ІХС було більшим — на 64,4 та 54,1 % проти 39,8 та 23,2 % відповідно (Р &lt; 0,05 для обох показників). Максимальна величина ТКІМ достовірно зменшилася лише в пацієнтів з ІХС. Терапія не призводила до достовірних змін біохімічних показників та добре переносилася хворими — побічні явища зареєстровані у 2 (6,5 %) в групі без ІХС та у 3 (10 %) у групі з ІХС (Р = НД між групами). Групи достовірно не відрізнялися за динамікою скарг, і серед пацієнтів з ІХС, які мали стенокардію на початку дослідження, значно зменшилася кількість приступів стенокардії за тиждень — з 2,5 ± 0,4 до 1,2 ± 0,2 (Р &lt; 0,01). Висновки. Отже, лікування АГ на основі ФК периндоприл/амлодипін було ефективним щодо зниження АТ та регресу ураження органів-мішеней незалежно від наявності ІХС. Зміни показників, що характеризують ураження органів-мішеней, дещо відрізнялися в пацієнтів з ІХС та без неї, що необхідно враховувати при виборі тактики лікування.

Choice of optimal antihypertensive therapy in patients with diabetes mellitus type 2

Aim of the study: to develop personalized approaches to combined antihypertensive therapy in patients with type 2 diabetes mellitus and arterial hypertension, depending on the parameters of the daily blood pressure profile and heart rate variability.Material and methods. We examined 322 patients with type 2 diabetes and arterial hypertension who had not previously received antihypertensive drugs on a regular basis. At the first stage, patients were prescribed Perindopril 10 mg per day and Indapamide retard 1,5 mg per day. In the absence of reaching target blood pressure (BP) levels after 28 days, a third antihypertensive drug was added — Amlodipine 5 mg per day, followed by titration to 10 mg 1 r per day (group I) or a b-blocker — Carvedilol at a dose of 12,5 mg 2 r per day, also followed by titration up to 25 mg 2 r per day (group II). Daily monitoring of BP and ECG was carried out, the average daily heart rate (HR), circadian index (CI), as well as heart rate variability were determined.Results and its discussion. Patients with type 2 diabetes have a high variability of blood pressure throughout the day, high pulse blood pressure, as well as a rigid circadian profile of heart rate. The appointment of a standard two-component antihypertensive therapy, including Perindopril 10 mg and Indapamide retard 1,5 mg per day, allows reaching the target blood pressure only in 46% of patients. The addition of amlodipine or carvedilol significantly increases the effectiveness of therapy, allowing more than 80% of patients to achieve the target blood pressure. At the same time, the use of amlodipine leads to a greater extent to a decrease in pulse pressure, and the inclusion of carvedilol improves the circadian profile of blood pressure and heart rate, and has a positive effect on heart rate variability.

Prognostic value of ambulatory blood pressure measurement in treated hypertensive patients

Cardiovascular risk is directly correlated to the circadian blood pressure profile. The aim of this work was to evaluate the ambulatory blood pressure measurement (ABPM) parameters that can predict the occurrence of cardiovascular events over medium term. We conducted a prospective descriptive study of 240 hypertensive patients who were treated and who had had ABPM during their follow-up at the cardiology department of the hospital of the internal security forces of Marsa, with consultations between 2015 and 2016. The mean age of our population was 57.4 ± 9.54 years, with a sex ratio of 1.33. Diabetes was the most common risk factor associated with hypertension (42.1%), followed by obesity (39.2%). This is a high cardiovascular risk population with 61% of patients with 3 or more risk factors and 56.9% with high and very high-risk according to the SCORE score. The MAPA analysis showed that the mean 24-hour SSP was 129.5 ± 14 mmHg and the mean 24-hour MAP was 74.7 ± 9.8 mmHg. Electrical HVG was found in 7.2% of patients. Microalbuminuria was documented in 31.5% of patients and proteinuria in 6.8% of patients. Forty-three cardiovascular events were identified during the 4-year follow-up of our patients with a mean time to onset of 14.5 ± 9 months. In univariate analysis, there was a significant difference between patients with and without a cardiovascular event in terms of age ( P = 0.026), mean SBP both overall ( P = 0.011), diurnal ( P = 0.042) and nocturnal ( P = 0.005), maximum DBP ( P = 0.035) and PP ( P = 0.001). In multivariate analysis, the independent factors associated with cardiovascular events were mean nocturnal SBP (OR = 1.04; CI = 1.01–1.07; P = 0.001) and maximum DBP (OR = 0.96; CI = 0.92–0.99; P = 0.02). ABPM is an interesting prognostic tool in hypertensive patients, allowing the prediction of long-term cardiovascular events.