Daytime Blood Pressure Levels Research Articles

Nighttime Blood Pressure Abnormalities in Iranian CKD Patients: Necessity to Perform Ambulatory Blood Pressure Monitoring.

Ambulatory blood pressure monitoring (ABPM) is a valuable tool for detecting abnormalities in nighttime blood pressure (BP), including non-dipping and nighttime hypertension. These abnormalities are independent predictors of a poor prognosis in patients with chronic kidney disease (CKD). The aim of our study was to analyze ABPM data and evaluate nighttime BP abnormalities in an Iranian CKD population. This cross-sectional study was conducted on sixty two patients at stages III and IV of CKD who were referred to a nephrology clinic in Tehran, Iran. The patients were classified as either dippers (19.4%) or non-dippers (80.6%), as well as nighttime normotensives (38.7%) or hypertensives (61.3%), based on ABPM data and in accordance with 2023 ESC/ESH guidelines. We compared demographic data, estimated glomerular filtration rate (eGFR), and daytime BP levels among these groups. The mean age of patients was 56.34 years, with 61.1% of them being male. Daytime pulse pressure was significantly greater in non-dippers compared to dippers (52.67 vs. 44 mmHg, P = .02). We found a significant correlation between the extent of BP dipping and eGFR (R = 0.281, P = .02). Systolic and diastolic daytime BP levels were significantly higher in individuals with nighttime hypertension. Diabetic patients were more likely to be non-dippers and have nighttime hypertension. After adjusting for age, diabetes mellitus, and daytime pulse pressure in a multivariable model, we determined that eGFR independently predicted the extent of BP dipping. Our results showed that both non-dipping and nighttime hypertension are highly prevalent in CKD patients, but they have distinct contributing factors. The eGFR was identified as an independent predictor of BP dipping, whereas nighttime BP levels were primarily determined by daytime BP levels. DOI: 10.52547/ijkd.7559.

DIFFERENCE BETWEEN CLINICAL AND AMBULATORY BLOOD PRESSURE LEVELS CORRELATES WITH EMOTIONAL INTELLIGENCE SCALE SCORES IN PATIENTS WITH HYPERTENSION

Objective: The aim of study was to define relationships between emotional intelligence, quality of life (QL) scale scores and the difference between clinical and ambulatory blood pressure (BP) in patients with hypertension. Design and method: We assessed 90 ambulatory blood pressure monitoring (ABPM) data of patients with stable hypertension and white coat hypertension without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–23.00, nighttime – 23.00–6.00. The clinical-ambulatory BP discrepancy was assessed as the difference between mean clinical BP and mean daytime BP levels. After ABPM session patients completed the emotional intelligence questionnaire (EmIn) (Lyusin D.) and QL questionnaire (J. Siegrist et al.). We analyzed the following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V- management of others’ emotions. We used Pearson correlation coefficient for statistical analysis. Results: The initial mean (M ± SD) daytime systolic BP (SBP) was 140.1 ± 12.8; diastolic (DBP) - 86.1 ± 10.5 mm Hg, age - 51,3 ± 15,3 years. We found the following significant negative correlations between III scale scores (control of emotional expression scale, of EmIn) and the difference between clinical and ambulatory BP for SBP (r = -0,25, p < 0,05). QL components did not correlate with the difference between clinical and ambulatory BP. Conclusions: The emotional self-control scores (III scale of EmIn) was negatively associated with the difference between clinical and ambulatory BP levels. Probably, a high level of the emotional expression self-control may prevent blood pressure rise at the doctor's visit, and as a result can reduce the clinical BP level and decrease of the clinical- ambulatory BP difference.

Combined effects of FTO rs9939609 and MC4R rs17782313 on elevated nocturnal blood pressure in the Chinese Han population.

SummaryAimIn this study we investigated the association of FTO rs9939609 and MC4R. rs17782313 with elevated blood pressure in the Chinese Han population, and analysed the relationship between the rs9939609 and rs17782313 variants.MethodsWe tested the rs9939609 and rs17782313 variants with the sequence-retrieval method.ResultsThe increase in odds ratios of the A allele of rs9939609 and the C allele of rs17782313 for nocturnal blood pressure were 1.37 and 1.69. The nocturnal blood pressure of participants simultaneously carrying the A and C alleles was significantly higher than the blood pressure of those carrying neither FTO nor MC4R risk alleles (p < 0.05), and that of the controls carrying only the A or C alleles (p < 0.05). No association between the FTO or MC4R genes with daytime hypertension was found in this Chinese population (p > 0.05).ConclusionOur data suggest that the rs9939609 and rs17782313 variants may be significantly associated with nocturnal but not daytime blood pressure levels and their combined effects were significant in this Chinese Han population.

FREQUENCY OF MASKED HYPERTENSION IN DIABETIC PATIENTS BY USING AMBULATORY BLOOD PRESSURE MONITORING DEVICE

Objective: To determine the frequency of masked hypertension in normotensive type2 diabetic patients by means of ambulatory blood pressure monitoring. Methodology: A cross-sectional study was conducted in 230 normotensive patients with type 2 diabetes mellitus. Patients underwent 24 hour ambulatory blood pressure monitoring (ABPM). Patients with increased daytime blood pressure levels (􀀂135/85mmHg) were classified as having masked hypertension. Results: The prevalence of masked hypertension was 31.7% (n=73). Normotensive and masked hypertensive subjects, based on ambulatory blood pressure, were not different in terms of age and diabetes duration. The office systolic blood pressure was higher in those with masked hypertension than in the normotensive group(128.8±8.5 vs. 123.9±9.2mmHg, p= 0.003). Conclusion: Upto one third of normotensive type 2 diabetic patients have masked hypertension according to ABPM. Therefore, ABPM is important to identify this high-risk group so as to be able to take interventional measures early on.

Association between nocturnal blood pressure dipping and insulin resistance in children affected by NAFLD.

The aim of this study was to analyse the relationship between insulin-glucose metabolism, nocturnal blood pressure dipping and nonalcoholic fatty liver disease (NAFLD) in obese adolescents without diabetes. One hundred one consecutive children, with biopsy-proven NAFLD, were included in this study. Blood samples were drawn for the analyses of liver function tests, insulin-glucose metabolism and lipid profile appraisal. An ambulatory blood pressure measurement (ABPM) was performed. Seventy-six children (75.3%) were systolic nondippers, and 23 of them were diastolic nondippers (30.3%). No differences were found in the anthropometric parameters between the two groups. When compared to the systolic dippers, the systolic nondippers had higher medians of mean nocturnal blood pressure, glucose at 0, 60 and 120min in the oral glucose tolerance test (OGTT), OGTT insulin at all time points and insulin-resistance values. No correlation of histopathological features with dipping/nondipping statuses was found. We found an association between a nocturnal blood pressure fall and measures of insulin levels, independent of obesity, or daytime blood pressure levels, among the obese patients with NAFLD. Although no association between nondipping profiles and NAFLD was observed in our study, further studies with a longer term follow-up are needed, to better elucidate the complex link between these particular entities.

Relationship between copeptin and nocturnal blood pressure in young and healthy adults

Purpose: Copeptin is a vasopressin related stress hormone. We investigated whether copeptin is associated with 24-hour ambulatory blood pressure (BP) levels in young and healthy adults. Method: The Genetic and Phenotypic Determinants of Blood Pressure and Other Cardiovascular Risk Factors (GAPP) study is a population based cohort study of healthy adults aged 25-41 years in the Principality of Liechtenstein. Individuals with BMI >35 kg/m2 and prevalent cardiovascular disease were excluded. Copeptin was assayed using an immunoluminometric assay (BRAHMS GmbH). Ambulatory BP monitoring was performed using a validated, fully automatic, non-invasive device (Schiller BR-102 plus). Results: Of 1443 individuals included in this study, 53% were female. The median age was 38 years, BMI was 24.2 kg/m2, and 21% were active smokers. The median copeptin levels were 3.7 (interquartile range [IQR]: 2.5, 5.7) and 2.3 pmol/l (IQR: 1.6, 3.4) in men and women, respectively. In multivariable regression models, log-transformed copeptin was significantly associated with systolic and diastolic BP during sleep, as shown in the Table. However, copeptin was not associated with daytime BP levels. The relationship between copeptin and nighttime BP seemed to be stronger in men compared to women (p for interaction 0.005). View this table: Multivariable linear regression analysis Conclusion: In this large population based study of healthy adults, the stress hormone copeptin was significantly associated with elevated nighttime but not daytime BP levels. Our data therefore suggest that stress may be involved in BP elevations during sleep.

Glucose abnormalities associated with impaired nocturnal fall in blood pressure in normotensive severely obese patients

BackgroundThe purpose of this study was to identify factors affecting the nocturnal decline in blood pressure (BP) in severe obesity. MethodsClinical, biochemical, polysomnographic data, glucose tolerance status, and body fat composition were obtained in 82 candidates for bariatric surgery (mean age: 40 (11) years; BMI: 46 (4)kg/m2). To determine the nocturnal BP fall we used 24-h ambulatory BP monitoring to measure the magnitude (Δ) of nocturnal decline, the % day–night systolic BP (SBP) and diastolic BP (DBP), dipper status and nocturnal hypertension (HT). ResultsTwenty-three percent of patients had nocturnal HT. Sixty percent had non dipper status, of which 95% had nocturnal HT. No specific factors were associated with the average 24-h SBP and DBP. Having glucose abnormalities was of primary importance for all variables evaluating nocturnal BP decline independent of daytime BP levels and severity of obesity. In comparing patients with or without glucose tolerance abnormalities, the night-time SBP and DBP were significantly higher and the Δ nocturnal decline and % day–night in both SBP and DBP were significantly lower in those with glucose tolerance abnormalities. In an adjusted multivariate model, having both glucose abnormalities and nocturnal HT remained associated with non dipper status with an OR of 3.13 (95% CI 1.11–8.87, p=0.03) and 14.93 (95% CI 1.77–125.62, p=0.001), respectively. ConclusionIn normotensive severely obese patients, non dipper status and nocturnal HT are common, and the presence of glucose abnormalities was the primary variable associated with impaired nocturnal fall in BP.

Low life purpose and high hostility are related to an attenuated decline in nocturnal blood pressure.

An attenuation of the nighttime decline in blood pressure (BP) predicts cardiovascular disease and cardiovascular-related mortality, beyond daytime BP levels. We investigated whether positive and negative psychological attributes were associated with sleep-wake BP ratios and examined sleep parameters as potential mediators of these relationships. Two hundred twenty-four participants (50% men; 43% Black; mean age = 60 years) underwent ambulatory BP monitoring for 2 days and nights. Self-reports of positive and negative psychological attributes were collected. In-home polysomnography was conducted for 2 nights, and a wrist actigraph was worn for 9 nights. Sleep-wake mean arterial pressure (MAP) ratios. After adjustment for demographics, body mass index, and hypertensive status, low life purpose and high hostility were associated with high sleep-wake MAP ratios. Depression, anxiety, and optimism were not related to MAP ratios. Sleep latency, fragmentation, architecture, and the apnea-hypopnea index were examined as potential mediators between psychological attributes and MAP ratios; only long sleep latency mediated the relationship between hostility and MAP ratios. Low life purpose and high hostility are associated with high sleep-wake BP ratios in Black and White adults, and these relationships are largely independent of sleep.

Masked Hypertension, Urinary Albumin Excretion Rate, and Echocardiographic Parameters in Putatively Normotensive Type 2 Diabetic Patients

To evaluate the impact of masked hypertension in normotensive type 2 diabetic patients on microvascular complications and echocardiographic parameters. A cross-sectional study was conducted in 135 normotensive patients with type 2 diabetes. Patients underwent urinary albumin excretion rate (UAER) measurement, echocardiography, and 24-h ambulatory blood pressure monitoring (ABPM). Patients with increased daytime blood pressure levels (> or = 135/85 mmHg) were classified as having masked hypertension. The prevalence of masked hypertension was 30% (n = 41). Normotensive and masked hypertensive subjects, based on ambulatory blood pressure, were not different in terms of age, diabetes duration, smoking status, BMI, waist circumference, serum creatinine, glycemic, or lipid profiles. The office systolic blood pressure was higher in those with masked hypertension (127.8 +/- 7.5 vs. 122.9 +/- 10.2 mmHg, P = 0.003) than in the normotensive group. UAER also was increased in the group with masked hypertension (21.3 microg/min [range 2.5-1,223.5] vs. 8.1 microg/min [1.0-1,143.0], P = 0.001), as was the interventricular septum (1.01 +/- 0.15 vs. 0.94 +/- 0.13 cm, P = 0.015) and posterior wall (0.96 +/- 0.12 vs. 0.90 +/- 0.10 cm, P = 0.006) thickness. After adjustments for diabetes duration, sex, smoking, LDL cholesterol, and A1C values, all associations were sustained for daytime systolic blood pressure but not for office systolic blood pressure. Type 2 diabetic patients with masked hypertension have higher UAER as well as enlargement of ventricular walls compared with the normotensive patients, according to ABPM. Therefore, ABPM is important to identify this high-risk group so as to be able to take interventionist measures.

The influence of ambulatory blood pressure profile on left ventricular geometry.

Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure, which does not decrease enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24-hour blood pressure profile on the left ventricular geometry was examined. Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: the patients whose night blood pressure levels decreased by more than 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (nondipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Age, gender, systolic, and diastolic blood pressure were similar within the dipper and nondipper groups. Normal geometry, concentric remodeling, and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the nondipper group compared to the dipper group (42.9% vs 6.3%, P < 0.03). Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy.

Twenty-four-hour ambulatory blood pressure in old and very old subjects

To compare clinic and 24-h blood pressure levels and profiles in young elderly (aged 65-79 years) and old elderly (aged > or = 80 years) subjects. A cross-sectional observational study was conducted on 108 ambulant subjects (51 males) aged 65-95 years with no known history of hypertension, recruited from the community (55%) and hospital outpatients (35%) and inpatients (10%). Three clinic blood pressure measurements were taken, followed by 24-h ambulatory blood pressure monitoring and then a further three clinic measurements, the mean of these being defined as the clinic blood pressure. Clinic systolic blood pressure was significantly higher in females than males (148 +/- 20 versus 136 +/- 23 mmHg, P = 0.02), but 24-h systolic blood pressure was similar. Mean 24-h and daytime blood pressure levels were significantly lower than clinic blood pressure in females but in males only 24-h systolic blood pressure was lower than the clinic level. In young elderly compared to old elderly females the clinic-daytime ambulatory systolic blood pressure difference was significantly reduced (14 +/- 22 versus 1 +/- 17 mmHg, respectively; P = 0.04). A significant nocturnal systolic/diastolic blood pressure fall was seen in young elderly and old elderly males (9 +/- 12/7 +/- 7 versus 6 +/- 11/7 +/- 8 mmHg) but in females the nocturnal systolic blood pressure fall was inversely related to age (r = -0.32, P = 0.02). The white-coat effect is common in young elderly females, but uncommon in very elderly females and males aged > or = 65 years; a decline in casual blood pressure in the very elderly may partly arise from a reduction in the white-coat effect. Nocturnal blood pressure falls also decline in the very elderly, especially in females.