Daytime Systolic Blood Pressure Variability Research Articles

24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

BackgroundBlood pressure variability is an emerging risk factor for dementia, independent and oftentimes beyond mean blood pressure levels. Recent evidence from interventional cohorts with rigorously controlled mean blood pressure levels suggest blood pressure variability over months to years remains a risk for dementia, but no prior studies have investigated relationships with blood pressure variability over shorter time periods.ObjectivesTo investigate the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering.DesignPost hoc analysis of the randomized, controlled, open-label Systolic Blood Pressure Intervention Trial clinical trial.SettingMultisite Systolic Blood Pressure Intervention Trial.Participants793 participants at increased risk for cardiovascular disease and without history of dementia at study randomization.InterventionStandard (<140 mmHg systolic blood pressure target) vs intensive (<120 mmHg systolic blood pressure target) lowering of mean blood pressure.Measurements24-hour ambulatory blood pressure monitoring 27 months after treatment randomization (standard vs intensive) and follow-up cognitive testing. Intraindividual blood pressure variability was calculated as the average real variability over 24-hour, daytime, and nighttime periods. Participants were categorized into 3 adjudicated clinical outcomes: no cognitive impairment, mild cognitive impairment, probable dementia. Cox proportional hazards models examined the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering. Associations with mean blood pressure were also explored.ResultsHigher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard group (adjusted hazard ratio [HR]: 2.56 [95% CI 1.16, 5.62], p = 0.019) but not in the intensive group (HR: 0.54 [95% CI 0.24, 1.23], p = 0.141). Similar findings were observed with daytime systolic blood pressure variability but not nighttime blood pressure variability. Mean blood pressure was not associated with cognitive outcomes.ConclusionsHigher systolic 24-hour and daytime blood pressure variability via ambulatory monitoring is associated with risk for dementia under standard blood pressure treatment. Findings support prior evidence that blood pressure variability remains a risk for dementia despite strict control of mean blood pressure levels.

Effects of concurrent exercise training on blood pressure variability and values are blunted in subjects with non-dipping blood pressure nocturnal pattern

Abstract Funding Acknowledgements Type of funding sources: None. The purpose of this study was to investigate the effects of 12-weeks concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks patients underwent six minute walk test, ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). After CT exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the nondipping group (between groups changes: -1.0 mmHg and -1.3 mmHg; p 0.02 and p 0.006 respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while were unchanged in the non-dipping group (between groups changes: -7.1 mmHg and -7.8 mmHg; p 0.004 and p 0.0002 respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small not significant changes in both groups. In conclusion: the effects of CT on BPV and BP were blunted in hypertensive subjects with non.dipping BP pattern

887 THE EFFECTS OF CONCURRENT AEROBIC PLUS RESISTANCE EXERCISE ON BLOOD PRESSURE VALUES AND VARIABILITY AND ARE BLUNTED IN HYPERTENSIVE SUBJECTS WITH NONDIPPING NOCTURNAL BLOOD PRESSURE PROFILE

Abstract Background The purpose of this study was to investigate the effects of 12-weeks of concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with nondippper BP nocturnal pattern and underlying coronary artery disease. Methods The study included 64 patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (29 pts) and nondipping (35 pts). Before starting CT and at 12 weeks patients underwent ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). Results after CT Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group (-1.2 mmHg and -1.4 mmHg respectively) while they were unchanged in the nondipping group (-0.2 mmHg and -0.1 mmHg). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group (-8.3 mmHg and -8.5 mmHg respectively) while were unchanged in the nondipping group (-1.2 mmHg and -0.7 mmHg). Nighttime systolic BP and BPV was unchanged in both groups. Conclusion the effects of CT on BP and BPV are blunted in hypertensive subjects with nondipping BP pattern. Further studies are needed in order to find out more effectives training modalities for these patients

Concurrent Aerobic Plus Resistance Training Elicits Different Effects on Short-Term Blood Pressure Variability of Hypertensive Patients in Relation to Their Nocturnal Blood Pressure Pattern.

Background and Objectives: The purpose of this study was to investigate the effects of a 12-week concurrent training (CT) (i.e., aerobic plus resistance exercise) on short-term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. Material and Methods: The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks, patients underwent the six minute walk test, ergometric test, assessment of 1-repetiton maximum (1 RM), and 24/h BP monitoring (24-h ABPM). Results: After CT, exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the non-dipping group (between groups changes: -1.0 ± 0.4 mmHg and -1.3 ± 0.9 mmHg; p = 0.02 and p = 0.006, respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while they were unchanged in the non-dipping group (between groups changes: -7.1 ± 2.6 mmHg and -7.8 ± 2.4 mmHg; p = 0.004 and p = 0.002, respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small but not significant changes in both groups. Conclusions: The effects of CT on BPV and BP were blunted in hypertensive subjects with a non-dipping BP pattern.

The Relationship between the Plasma Concentration of Electrolytes and Intensity of Sleep Bruxism and Blood Pressure Variability among Sleep Bruxers.

Plasma sodium plays a major role in regulating blood pressure (BP). An augmented variability of BP is considered a risk factor for the development of arterial hypertension, which is prevalent among patients with suspected sleep bruxism (SB). The aims of this study were to assess the plasma concentration of electrolytes and their effect on the intensity of SB and BP variability among sleep bruxers. A total of 51 patients were enrolled in this prospective, observational study. A single full-night polysomnographic examination was conducted in the Wroclaw Medical University Sleep Laboratory, Poland, and based on the guidelines of the American Academy of Sleep Medicine, the results were analyzed. The monitoring of ambulatory BP was performed the next day, and the plasma levels of sodium, potassium, magnesium, and calcium were measured. The mean age of the studied group was 33.9 ± 11.2 years, and the mean bruxism episode index (BEI) was 4.94 ± 3.53. The study revealed statistically significant differences in the plasma concentrations of sodium in the SB group. A decreased sodium concentration was observed in the group of mild bruxers (2 ≤ BEI &lt; 4) (139.7 ± 1.4 vs. 142.8 ± 3.2, p = 0.002) and severe bruxers (BEI ≥ 4) (140.5 ± 2.0 vs. 142.8 ± 3.2, p = 0.016) compared to nonbruxers (BEI &lt; 2). A statistically significant positive linear correlation was found between plasma sodium concentration and daytime systolic BP variability (r = 0.32, p &lt; 0.05) as well as between plasma sodium concentration and nighttime diastolic BP variability (r = 0.31, p &lt; 0.05). The preliminary results suggest the probable relationship between the lower plasma concentration of sodium and increased intensity of SB and BP variability among suspected sleep bruxers.

Effects of Concurrent Aerobic Plus Resistance Training on Blood Pressure Variability and Blood Pressure Values in Patients with Hypertension and Coronary Artery Disease: Gender-Related Differences.

The purpose of this study was to compare changes in blood pressure variability (BPV) and blood pressure (BP) values occurring in response to concurrent training (CT) between the two genders. A total of 35 males and 20 women aged 55–80 years, with hypertension and coronary artery disease, were included. They underwent a 12-week CT program. The aerobic component of CT was performed according to the rate of perceived exertion while the intensity of the resistance component was set at 60% of 1 repetition maximum for the first 4 weeks and then increased to 80%. BP and BPV were evaluated at baseline and at the end of the CT program through 24 h ambulatory blood pressure monitoring. After 12-weeks, 24 h and daytime systolic BPV decreased in both men and women without significant between-groups differences. Twenty-four-hour daytime and nighttime diastolic BPV decreased in both genders with a significantly greater decrease in women compared to men. Twenty-four-hour daytime systolic and 24 h diastolic BP decreased in men while they were unchanged in women. In conclusion, CT induced similar reductions of systolic BPV in men and women and a greater decrease in diastolic BPV in women. Conversely, CT decreased BP values in males but not in females. CT appears to be an effective intervention for reducing BPV in both genders.

Ambulatory blood pressure and drug treatment for orthostatic hypotension as predictors of mortality in patients with multiple system atrophy.

Multiple system atrophy (MSA) is a rare fatal neurodegenerative disease characterized by parkinsonism, cerebellar ataxia and autonomic failure. This study was aimed at investigating possible associations between mortality, 24-h blood pressure (BP) level and variability, and drug treatments for orthostatic hypotension (OH) in MSA patients. A total of 129 patients followed at the French Reference Center for MSA who underwent routine 24-h ambulatory BP monitoring were included. Unified MSA Rating Scale (UMSARS) scores, drug treatments and the occurrence and cause of death were recorded. Seventy patients died during follow-up (2.9±1.8years), mainly from terminal illness, pulmonary or sudden death. Multivariate Cox regression analysis, after adjustment for gender, disease duration and severity (UMSARS I+II score), showed that increased daytime systolic BP variability, OH severity and OH drug treatment were independently correlated with mortality. OH treatment was associated with the risk of cardiac causes and/or sudden death (p=0.01). In a fully adjusted model, male gender [(female vs. male) hazard ratio (HR) 0.56, 95% CI 0.34-0.94, p=0.03], UMSARS I+II score (HR 1.04, 95% CI 1.02-1.06, p<0.01), systolic BP daytime variability (HR 3.66, 95% CI 1.46-9.17, p<0.01) and OH treatment (HR: 2.13, 95% CI 1.15-3.94, p=0.02) predicted mortality. Increased daytime BP variability and OH treatment were predictive of mortality in patients with MSA, independently from disease severity. Further studies are required to assess if these associations are explained by more severe autonomic dysfunction or if OH treatment exposes per se to a specific risk in this population.

24-hour blood pressure monitoring in hypertensive patients with abdominal obesity in the dynamics of antihypertensive treatment

Abstract Funding Acknowledgements Type of funding sources: None. Background 24-hour blood pressure monitoring (ABPM) is an additional method for examining patients with arterial hypertension (AH). The list of indications for its implementation is constantly expanding. One of the most important indications is the evaluation of the effectiveness of treatment against the background of physical and emotional stress. Aim study of the parameters of 24-hour blood pressure monitoring in patients with AH and AO in the dynamics of antihypertensive therapy. Methods 120 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: ACE inhibitors perindopril, thiazide diuretic indapamide and calcium antagonist amlodipine once in the morning at doses: 4 mg / 1.25 / 5 mg; 4 mg / 1.25 / 10 mg; 8 mg / 2.5 / 5 mg; 8 mg / 2.5 / 10 mg. ABPM was performed according to the standard method before and after 6 months of treatment. Results 24-hour systolic blood pressure (SBP) and 24-diastolic blood pressure (DBP) in patients were 148 (141-158) / 97 (81-101) mm Hg. 24-hour pulse blood pressure - 59 (51-63) mm Hg. The SBP time index was 86 (67-96)%, the DBP time index was 84%. Daytime SBP variability in patients was 17 (11-20) mm Hg, daytime DBP variability was 13 (8-14) mm Hg. SBP variability at night was 14 (9-13) mm Hg, DBP variability at night was 10 (8-12) mm Hg. As a result of treatment, the target blood pressure level was achieved in 69% of the examined according to the data of the office measurement of blood pressure and in 50% of the patients according to the results of ABPM. The number of patients with pathological variability of blood pressure decreased from 47% to 25% (p &amp;lt;0.05). An excessive morning rise in SBP at the beginning of the study was noted in 30% of patients, and at the end of the observation - in 15% (p &amp;lt;0.05). Morning BP dynamics was in 43%, and after therapy in 23% (p &amp;lt;0.01). The number of patients with nocturnal hypertension decreased from 75% to 35% after 6 months of treatment (p &amp;lt;0.0001). The distribution of patients by blood pressure profiles revealed that at the beginning of the study, the "diper" type was in 44% of the patients, the "over-diper" type in 22% of the patients, the "non-diper" type was in 28%, and the "night-picker" type was observed at 6%. After 6 months of treatment, the number of patients with the "diper" profile increased to 73%, and the number of patients with the "over-diper" profile decreased to 7%, the number of patients with unfavorable non-diper and night-picker profiles changed to 5% and 1% of patients, respectively. Conclusion The fixed combination of perindopril, indopamide and amlodipine led to the normalization of all parameters of the 24-hour BP profile in hypertensive patients with AO. Treatment was not accompanied by metabolic disturbances in these patients.

Relation of blood pressure variability to left ventricular function and arterial stiffness in hypertensive patients.

Variability of blood pressure (BP) has been reported to be related to worse cardiovascular outcomes. We examined the impact of daytime systolic BP variability on left ventricular (LV) function and arterial stiffness in hypertensive patients. Ambulatory BP monitoring (ABPM) and echocardiography were performed in 116 hypertensive patients. We assessed BP variability as standard deviations of daytime systolic BP on 24-hour ABPM. Conventional echocardiographic parameters, area strain and three-dimensional diastolic index (3D-DI) using 3D speckle tracking were measured. Arterial stiffness was evaluated by acquiring pulse wave velocity (PWV) and augmentation index. Patients with higher BP variability showed significantly increased left ventricular mass index (LVMI) and late mitral inflow velocity, as well as decreased E/A (early mitral inflow velocity/late mitral inflow velocity) ratio, area strain and 3D-DI than those with lower BP variability (LVMI: p = 0.02; A velocity: p < 0.001; E/A ratio: p < 0.001; area strain: p = 0.02; 3D-DI: p = 0.04). In addition, increased BP variability was associated with higher PWV and augmentation index (p < 0.001). Even among patients whose BP was well controlled, BP variability was related to LV mass, diastolic dysfunction and arterial stiffness. Increased BP variability was associated with LV mass and dysfunction, as well as arterial stiffness, suggesting that BP variability may be an important determinant of target organ damage in hypertensive patients.

REPRODUCIBILITY AND DETERMINANTS OF DAYTIME AND NIGHTTIME BLOOD PRESSURE VARIABILITIES

Objective: Night-time blood pressure variability (BPV) has shown to have a greater predictive capacity than daytime BPV for adverse outcome. This has been attributed to a better reproducibility of BPV during sleep than during waking hours but studies comparing the two subperiods are lacking. Design and method: To compare the reproducibility of daytime and night-time short term BPV (Standard Deviation) and to identify the determinants of BPV we recorded 24-hour blood pressure (BP) twice 3 months apart in 1051 hypertensive subjects participating in the HARVEST study. BP was measured every 10 minutes during daytime and 30 minutes during night-time. Correlations were performed with Pearson test. Consistency was obtained by calculating the difference between baseline and repeat recording, disregarding the sign of the difference. Repeatability was defined as twice the standard deviation of the changes between the two repeated recordings. Results: Systolic BPV (mean of the 2 recordings) was higher during daytime (12.9 ± 3.2 mmHg) than during night-time (10.9 ± 3.2 mmHg). Independent predictors of daytime systolic BPV were smoking, mean daytime BP, pulse pressure, BP reaction to standing, nocturnal BP fall, white-coat effect, and physical activity habits (negative). Independent predictors of night-time systolic BPV were young age, smoking, mean night-time BP, pulse pressure, BP reaction to standing, nocturnal BP fall, and male gender. Small mean changes in systolic BPV were observed at repeat recording for both daytime and night-time BPV (−0.11 ± 3.8 mmHg and 0.3 ± 4.4 mmHg, respectively). A higher correlation was found between baseline and repeat measurement for daytime BPV than night-time BPV (0.47 vs 0.36, p = 0.002). Consistency was also better for daytime than night-time BPV (2.6 ± 2.8 vs 2.9 ± 3.3 mmHg, p = 0.007) as was repeatability (7.6 vs 8.8 mmHg, respectively). Similar results were obtained for diastolic BPV. Conclusions: Contrary to what is currently thought BPV, measured twice over a 3-month period, is more reproducible during waking hours than during sleep. Smoking, mean BP level, pulse pressure, BP reaction to standing, and nocturnal BP fall, are main determinants of both daytime and night-time BPVs. In addition, BP reactivity to stress is another strong contributor to daytime BPV.

BLOOD PRESSURE VARIABILITY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED NAÏVE HYPERTENSIVE PATIENTS

Objective: to assess left ventricular (LV) and left atrial (LA) echocardiographic myocardial stiffness parameters in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases in relation to short-term blood pressure variability (BPV). Design and method: Retrospective, controlled study. According to medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 100, 47.0% men, mean age 51.9 ± 6.5 years) and a group of healthy controls (n = 86, 32.6% men, mean age 48.8 ± 5.8 years) was retrospectively formed. In all included participants clinical, echocardiographic data (acquired using Vivid 7 Dimension system, GE) and ambulatory blood pressure monitoring [ABPM] (BPLab, BP2005–01.04.00.2540, Petr Telegin, Russia) parameters were available. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index (LASI), LA expansion index and tissue Doppler-derived LA strain were calculated as myocardial stiffness parameters. 2-D speckle tracking echocardiography data were used for determination of LV myocardial global longitudinal peak strain (LV GLPS). BPV was estimated as standard deviation based on ABPM reports. Hypertensive patients were divided into 2 subgroups according to median value of day-time systolic BPV (dtSBPV) – 15 mmHg and into 2 subgroups according to median value of night-time systolic BPV (ntSBPV) – 14 mmHg (subgroups of «high» and «normal» dtSBPV and ntSBPV), and study parameters analyzed separately in these subgroups compared to the control group. Results: in hypertensive patients with «high» dtSBPV (n = 59) LV GLPS (−17.5 ± 3.0%) was significantly (p = 0.002) lower in absolute value and LASI (0.17 ± 0.09) was significantly (p = 0.015) higher compared to the controls (respectively, −19.5 ± 2.6% and 0.12 ± 0.06). No significant differences in myocardial stiffness parameters were obtained compared to the controls in hypertensive patients with «normal» dtSBPV and both «normal» and «high» ntSBPV. Conclusions: the present study reveals that higher dtSPBV predispose to increased LV myocardial stiffness in untreated middle-aged patients with stage II grade 1–2 EAH without concomitant cardiovascular diseases in comparison with sex- and age-matched healthy individuals with normal blood pressure.

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 blood pressure variability and target organ damage in elderly patients.

To investigate the relationship between 24 h systolic blood pressure variability (SBPV) and target organ damage in elderly patients with essential hypertension. 180 elderly patients (≥ 80 y) with hypertension admitted to our hospital from January 2015 to January 2017 were selected as hypertension group and divided into high blood pressure variability (BPV) group and low BPV group according to the 50th percentile (P50) of 24 h SBPV, while 90 elderly non-hypertension patients admitted during the same period were enrolled as control group. 24 h ambulatory blood pressure values of patients in the three groups were recorded. The total cholesterol (TC), left ventricular mass index (LVMI), carotid artery intima-media thickness (IMT), 24 h microalbuminuria (MA) and complications with cardiovascular disease in patients of the three groups were compared and analyzed. Logistic analysis was conducted with MA, IMT and LVMI as the dependent variables and the remaining risk factors as the independent variables. 24 h SBPV and daytime SBPV (d SBPV) in patients of the hypertension group were significantly higher than those in the control group (p < 0.01); the incidences of coronary heart disease and atherosclerotic plaque as well as IMT, LVMI and MA were higher in the high BPV group than those in the low BPV group (p < 0.05 or p < 0.01). The multivariate results showed that 24 h SBPV was associated with IMT, LVMI and MA. BPV can serve as an important indicator to predict target organ damage in elderly patients with essential hypertension. 24 h SBPV can reflect the degree of target organ damage in elderly hypertensive patients.

MPS 10-06 Seasonal variations of 24-hour ambulatory blood pressure and blood pressure variability in the young and elderly essential hypertensive patients

Objective: Seasonal blood pressure (BP) changes has been described in clinic BP. Few studies have examined the seasonal variation in BP and BP variability, assessed by 24-hour ambulatory blood pressure monitoring (ABPM) and it remains uncertain whether the seasonal trend differs between young and elderly hypertensive patients. Design and Method: A total of 1028 untreated essential hypertensive patients (mean age 52 ± 14 years) who underwent 24-hour ABPM between January 2009 and April 2013 were enrolled. Patients were divided into young (age ≤ 70 years, n = 927) and elderly (age > 70 years, n = 101) groups. Results: Compared to elderly group, young age group had higher clinic, 24-hour, daytime and night-time diastolic BP (DBP), higher clinic, 24-hour and daytime heart rate (HR), higher 24-hour and daytime HR variability (HRV), lower night-time systolic BP (SBP) and daytime SBP variability. In young age group, significant seasonal variation of clinic DBP and daytime SBP variability with a peak in autumn, and nighttime DBP and HR with a peak in spring and the increased prevalence of non-dippers in summer were observed. On the other hand, elderly group demonstrated seasonal variation of clinic, 24-hour, daytime and nighttime HR with a peak in autumn, daytime DBP with a peak in winter and night-time SBP variability with a peak in summer. Conclusions: There was an apparent seasonal variation of DBP, HR and SBP variability in both young and elderly hypertensive patients. However, elderly patients showed more pronounced seasonal change in HR compared to younger patients.

PS 16-21 THE ROLE OF BIOCHEMICAL MARKERS OF INFLAMMATION IN THE VASCULAR WALL REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC DISORDERS

Objective: To study structural parameters of vessel wall, lipid and inflammatory biochemical parameters in patients with arterial hypertensions (AH) and abdominal obesity (AO). Design and method: 130 patients were included in the study and randomized into 2 groups. The group 1 included 77 subjects at the mean age 47.47 ± 10.17 with AH degree I-III and AO. 53 subjects at the mean age 47.67 ± 7.64 without metabolic disorders were involved in the group 2. The parameters of sphygmography and 24-hour blood pressure (BP) monitoring; biochemical parameters (lipid profile, ceruloplasmin and inflammatory markers – homocysteine, hs-CRP and endothelin-1) were estimated. Results: In group 1 there were registered: increase in sphygmography indexis (pulse wave velocity PWV, cardio-ankle vascular index CAVI and decrease ancle-brachial index ABI); increase in mean 24-hour and mean daytime systolic BP (SBP), in time and square indices and in daytime SBP variability. In biochemical parametrs increase in total cholesterol, LDL cholesterol, triglyceride, ceruloplasmin, homocysteine and hs-CRP; decrease HDL cholesterol compared to the patients in group 2. In group 1 there were registered positive correlation between inflammatory and lipid markers with parameters of sphygmography, parameters of 24-hour blood pressure monitoring. In the separation of patients by gender it has been shown that high levels of endothelin-1 and homocysteine were observed more frequently in women than men. It is noted that in women with an increase of the endothelin-1 per 1 fmol/l and homocysteine per 1 mcmol/L increased the PWV-L on 20 and 35%, accordingly. In men significant correlation parameters PWV-L with atherogenic lipid parameters and hs-CRP were identified. Conclusions: The findings indicate the nature of the close association of markers of inflammation and atherogenic lipid with remodeling process of the vessel wall in patients with AH and AO, especially obvious relationship atherogenic lipid parameters and hs-CRP in men and homocysteine, endothelin-1 in women.

Relationship of short-term blood pressure variability with carotid intima-media thickness in hypertensive patients.

BackgroundHigh blood pressure (BP) is among significant risk factor for stroke and other vascular occurrences, it experiences nonstop fluctuations over time as a result of a complex interface among cardiovascular control mechanisms. Large blood pressure variability (BPV) has been proved to be promising in providing potential regulatory mechanisms of the cardiovascular system. Although the previous studies also showed that BPV is associated with increased carotid intima-media thickness (IMT) and plaque, whether the correlation between variability in blood pressure and left common carotid artery-intima-media thickness (LCCA-IMT) is stronger than right common carotid artery-intima-media thickness (RCCA-IMT) remains uncertain in hypertension.MethodsWe conduct a study (78 hypertensive subjects, aged 28–79) to evaluate the relationship between BPV and carotid intima-media thickness in Shenzhen. The blood pressure was collected using the 24 h ambulatory blood pressure monitoring, and its variability was evaluated using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) during 24 h, daytime and nighttime. All the IMT measurements are collected by ultrasound.ResultsAs the results showed, 24 h systolic blood pressure variability (SBPV) evaluated by SD and ARV were significantly related to LCCA-IMT (r1 = 0.261, P = 0.021; r1 = 0.262, P = 0.021, resp.). For the daytime diastolic blood pressure variability (DBPV), ARV indices were significantly related to LCCA-IMT (r1 = 0.239, P = 0.035), which differed form BPV evaluated by SD and CV. For the night time, there is no significant correlation between the BPV and IMT. Moreover, for all the subjects, there is no significant correlation between the BPV and RCCA-IMT/number of plaques, whereas, the SD, CV, and ARV of daytime SBP showed a positive correlation with LCCA-IMT (r1 = 0.312, P = 0.005; r1 = 0.255, P = 0.024; r1 = 0.284, P = 0.012, resp.). Moreover, the ARV of daytime SBPV, 24 h SBPV and nighttime DBPV showed a positive correlation with the number of plaques of LCCA (r1 = 0.356, P = 0.008; r1 = 0.297, P = 0.027; r1 = 0.278, P = 0.040, resp.). In addition, the number of plaques in LCCA had higher correlation with pulse pressure and diastolic blood pressure than that in RCCA. And multiple regression analysis indicated LCCA-IMT might not only be influenced by age or smoking but also by the SD index of daytime SBPV (p = 0.035).ConclusionsThe results show that SBPV during daytime and 24 h had significant correlation with IMT, for the hypertensive subjects from the southern area of China. Moreover, we also found the daytime SBPV to be the best predictor for the progression of IMT in multivariate regression analysis. In addition, the present study suggests that the correlation between BPV and left common carotid artery—intima-media thickness/number of plaques is stronger than right common carotid artery-intima-media thickness/number of plaques.

Effects of the oriental herbal medicine Bofu-tsusho-san in obesity hypertension: A multicenter, randomized, parallel-group controlled trial (ATH-D-14-01021.R2)

ObjectiveThere is no clinical evidence that supports the benefit of integrative medicine, defined as combination therapy of oriental and western medicine, on obesity-related hypertension. This study evaluates the efficacy of Bofu-tsusho-san (BOF), an oriental herbal medicine, on the ambulatory blood pressure (BP) profile in hypertensive patients with obesity. MethodsThe study design was a multicenter, randomized, open-label, parallel-group controlled trial in 107 hypertensive patients with obesity. Participants were randomly assigned to receive either the conventional control therapy or BOF add-on therapy. In both groups antihypertensive therapy was aimed at achieving the target clinic BP. The primary outcome was change in the ambulatory BP profile from baseline to 24 weeks after randomization. ResultsDaytime systolic BP variability, an important parameter of ambulatory BP profile, was decreased in the BOF group, and the difference in the changes in daytime systolic BP variability was significant between the BOF and control group (Control vs BOF; the change from baseline in daytime systolic BP variability, 1.0 ± 3.3 vs −1.0 ± 3.3%; p = 0.006). ConclusionThe BOF add-on therapy effectively improved the ambulatory BP variability. This is the first report suggesting that an integrative medicine approach may exert favorable effects on obesity-related hypertension compared with conventional pharmaceutical treatment. Clinical trial registrationUMIN000003878.

Ambulatory blood pressure as a predictor of diabetic nephropathy

Objective: The aim was to study the ambulatory blood pressure as a predictor of diabetic nephropathy (DN). Materials and Methods: A total of 73 patients with DN at Stage III were selected as DN group and 73 cases with 5-10 years of diabetes were as diabetes group. The results of blood routine, biochemical indexes, dynamic blood pressure and the diversity index, which as the predictors of DN, analyzed by multivariate logistic regression analysis and compared between two groups. Results: Body mass index, the dose of oral glucose (GLU)-lowering drugs, the levels of fasting plasma GLU, HbA1c, total cholesterol, triglyceride, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and high-sensitivity C-reactive protein index had no statistically significant difference in two groups in the course of the disease. There were significant differences in peripheral blood leukocyte count, platelet count, erythrocyte sedimentation rate, uric acid, estimated glomerular filtration rate, average daytime systolic blood pressure (SBP), average nighttime SBP, average daytime diastolic blood pressure (DBP), average night DBP, 24 h SBP variability, daytime SBP variability and nighttime SBP variability between the two groups. In univariate analysis, we found that platelet count ( P = 0.03), average night DBP ( P = 0.01), nighttime SBP variability ( P Conclusion: Platelet count, average diastolic pressure and SBP at night are the independent predictors of DN.

The Relationship between the 24 h Blood Pressure Variability and Carotid Intima-Media Thickness: A Compared Study

Large blood pressure variability (BPV) will not only harm the target organ but also increase the possibility of the cardiovascular events. Since the damage of vascular system always leads to the alteration of the carotid wall, the structure and function of the carotid artery have been extensively examined in previous studies. In this work we conduct a study (60 subjects, aged 33–79) to evaluate the relationship between BPV and carotid intima-media thickness (IMT) in Shenzhen, which is one large city in the southern area of China. In our study, the blood pressure (BP) was collected using the 24 h ambulatory BP monitoring, and the BPV was evaluated using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) during 24 h, daytime and nighttime. All the IMT measurements are collected by ultrasound. The results show that both the daytime, and 24 h systolic BPV evaluated by three indices are positively associated with IMT. Among them, daytime systolic BPV evaluated with ARV is the best variable to represent the increasing of carotid IMT. In addition, after adjusting by age, sex, smoking, hypertension, and mean BP and PP values, 24 h diastolic BPV evaluated with SD also presents the favorable performance.

Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension

Nighttime blood pressure (BP) and systolic BP variability on ambulatory blood pressure monitoring (ABPM) have been strongly associated with target-organ damage in hypertensive adults. The clinical relevance of these variables in children with hypertension remains under-studied. The study group included children aged 5-18 years old referred to the outpatient nephrology clinic for an elevated casual BP who underwent an ABPM and echocardiography (ECHO) study and did not have secondary hypertension. The interpretation of ABPM parameters and left ventricular mass index (LVMI) was based on normative references. Seventy-two children fulfilled the inclusion criteria. The association of various potential predictors including age, BMI z-score, casual BP z-score and ABPM parameters (BP z-score, BP load, nocturnal dipping and BP variability- within-subject standard deviation (SD) of BP) with LVMI was analyzed. On adjusted regression analysis, nighttime systolic BP load [standardized regression coefficient (β) 0.23; p < 0.05] and daytime systolic BP variability (β 0.37; p < 0.05) had significant association with LVMI. In children with primary hypertension, nighttime systolic BP load and daytime systolic BP variability had a stronger association with LVMI than casual BP and other ABPM parameters. Future longitudinal studies are needed to establish the causality among these variables.