Nocturnal Blood Pressure Decline Research Articles

Sleep, Death and the Heart

Normal sleep is associated with state changes in heart rate, blood pressure and neural circulatory control. During slow wave sleep, heart rate, blood pressure and sympathetic activity decrease whereas during REM sleep, sympathetic traffic to blood vessels increases significantly and heart rate and blood pressure are very labile. While these changes are physiologic, they may have implications for ischemia and arrhythmias in people with an underlying vulnerable substrate. While the overall decline in blood pressure during sleep is physiologic, subjects in whom the blood pressure decline is blunted or absent (non-dippers) are often at higher risk for cardiac and vascular events. Conversely, excessive nocturnal blood pressure decline has also been associated with cardiovascular risk including development of lacunar infarction. REM sleep has been linked to significant arrhythmias including asystole. REM has also been associated with coronary vasospasm and with angina (with ST depression) that causes waking from sleep. REM may also contribute to arrhythmogenesis in patients with ion-channelopathies. Indeed in patients with Long QT2 and Long QT3 syndromes, there is a markedly increased risk of fatal arrhythmic events occurring during sleep. Patients with Brugada syndrome also have a high risk of sleep-related sudden death. Interestingly these patients may have a higher than expected prevalence of obstructive sleep apnea. Disturbed sleep may also predispose to cardiac ischemia, arrhythmias and death. Obstructive sleep apnea (OSA) has been implicated in nocturnal angina and in myocardial infarction presenting during the nighttime hours. Apneic episodes have also been linked to bradyarrhythmias, including cardiac asystole. OSA patients have a higher risk of experiencing sudden death at night, and of receiving nighttime shocks from implanted defibrillators.

GW26-e0487 Relationship between Blood Pressure Circadian Rhythm and Early Renal damage in the patients with Primary Hypertension

To investigate the relationship between blood pressure circadian rhythm and early renal injury for the patients with primary hypertension. A total of 225 hypertensive patients were divided into two groups according to nocturnal blood pressure decline rate (<10% into non-dippers and ≥10% into

Effect of glycaemic control on the diurnal blood pressure variation and endogenous secretory receptor for advanced glycation end product (esRAGE) levels in type 1 diabetes mellitus

The relationship between plasma endogenous secretory receptor for advanced glycation end product (esRAGE) level and diurnal variation of blood pressure in type 1 diabetic patients based on their glycemic status has not yet been studied. So, the aim of the present study was to see if a correlation exists between plasma esRAGE levels and dipper status in type 1 diabetic patients based on their glycaemic status. Type 1 diabetic patients were divided as good and poor glycaemic controlled groups based on their HbA1c values. Blood glucose levels, insulin, insulin antibodies, homocysteine and esRAGE levels were determined. The hourly daytime and night-time blood pressure was monitored by using a non-invasive blood pressure (NIBP) apparatus. Of the 16 patients in the well-controlled group, most (14/16) were dippers (95 % confidence interval 1.5 to 20.7 vs. P = 0.006, Fisher’s exact test) when compared to those in the poorly controlled group (5/18). There was a significant correlation between plasma esRAGE levels and % decline in nocturnal blood pressure in both the good (r = 0.69, P = 0.003) and poorly (r = 0.79, P = 0.0002) controlled groups. Most of the poorly controlled patients showed abnormal circadian blood pressure pattern and low esRAGE level and hence were more prone to end organ damage.

Associations of the –344T&gt;C polymorphism of CYP11B2 gene with 24-hour blood pressure profiles in middle-aged women with essential hypertension

Background In this cross-sectional study, we assessed the impact of –344T>C polymorphism of the CYP11B2 gene which encodes aldosterone synthase on 24-hour blood pressure patterns. Material and methods The study was performed in 137 females with essential hypertension aged 42−60 years. We measured plasma aldosterone level and renin activity (PRA), fasting glucose, lipid profiles and 24-hour urinary sodium and potassium excretion. Based on 24-hour blood pressure monitoring we identified cases with dipping and non-dipping patterns of blood pressure. Results Mean PRA and aldosterone levels and aldosterone-to-renin ratio (ARR) were within normal range. Non-dipping hypertension was found in 54.3% of patients. Genotype frequencies of TT, CC and CT were 27%, 27% and 46%, respectively. Carriers of the C allele had significantly lower nocturnal blood pressure reduction (P = 0.004) and higher nocturnal systolic (P = 0.02) and diastolic blood pressure (P = 0.044), frequency of non-dipping profile (P = 0.001), and 24-hour urinary potassium excretion (P = 0.047). Urinary sodium excretion was positively correlated with a decrease in nocturnal blood pressure (R = 0.202; P = 0.037). In a multiple regression analysis, ARR and presence of the C allele adjusted for confounding variables were inversely associated with the nocturnal blood pressure decline (b = −0.348; P = 0.022 and b = −0.222; P = 0.018, respectively). Conclusions In conclusion, in middle-aged females with essential hypertension carrying the C allele we found higher nocturnal blood pressure, lower nocturnal blood pressure reduction, and higher prevalence of non-dipping hypertension than in TT carriers.

Lack of recovery in nocturnal decline of heart rate and blood pressure after heart trasplantation

Lack of recovery in nocturnal decline of heart rate and blood pressure after heart trasplantation

PP124-SUN: Serum Albumin Levels, as a Biomarker of Nutritional Status, Influence Nocturnal Decline of Blood Pressure in Diabetic Patients with Chronic Kidney Disease (CKD)

PP124-SUN: Serum Albumin Levels, as a Biomarker of Nutritional Status, Influence Nocturnal Decline of Blood Pressure in Diabetic Patients with Chronic Kidney Disease (CKD)

复方丹参滴丸对非勺型高血压患者血压昼夜节律及高敏C反应蛋白、心功能影响

Objective: To investigate the effect of Compound Danshen Dripping Pill on circadian blood pressure, high sensitive C reactive protein and cardiac function in patients with non dipper hypertension. Methods: According to ABPM nocturnal blood pressure decline rate 140 / 90mmHg, the addition of Stan. The treatment group were treated with 10 Compound Danshen Dripping Pills, 3 times a day, June. ABPM and hs-CRP, ultrasonic Beckoning figure was examined before and after treatment. Results: All the patients completed the study in June, by antihypertensive drugs and compound Danshen dripping pills after treatment, consulting room (CSBP and CDBP) and BP are parameters of ABPM increased significantly ( P 0.05). Conclusion: Long-term use of Compound Danshen dripping pill can improve the circadian rhythm of blood pressure in patients with non dipper hypertension, reduce the high sensitive C reactive protein level, improve cardiac diastolic function.

Folate administration decreases oxidative status and blood pressure in postmenopausal women.

The purpose of this study was to evaluate whether folate exerts antioxidant effects in postmenopausal women and whether this effect is related to folate-induced modification of 24-h ambulatory blood pressure (BP). Double-blind placebo-controlled study performed in 30 apparently healthy postmenopausal women recruited at the outpatient service of University Hospital. Women, free from hormones or substances possibly interfering with the investigated parameters, were randomized to receive orally for 3weeks placebo (n=15) or 15mg/day of 5-methyltetrahydrofolate (5-MTHF; n=15). Whole-blood free oxygen radicals test (FORT), free oxygen radical defence (FORD), lipids, glucose, insulin, insulin resistance [homeostatic model assessment for insulin resistance (HOMA-IR)], homocysteine and 24-h ambulatory BP values were evaluated. In the entire group of women, FORT was independently and inversely related to the day-night difference of diastolic (r=0.420; p=0.03) and mean BP (r=0.497; p=0.01). Placebo did not affect any biochemical or BP parameter. 5-MTHF reduced FORT (-71.5±98.2; p=0.02) and increased FORD (0.5±0.9; p=0.05), decreased insulin (p=0.01), HOMA-IR (p=0.0002) and homocysteine (p=0.008). During 5-MTHF, night-time mean (p=0.001) and diastolic BP (p=0.002) decreased of about 5mmHg and the day-night difference of mean (p=0.001) and diastolic BP (p=0.002) contemporaneously increased. FORT reduction was related to the amplification of the nocturnal decline of mean (0.697; p=0.006) and diastolic BP (r=0.777; p=0.002) and to the amplification of the day-night difference of diastolic BP (r=0.63; p=0.015). Present data show a clear reduction of oxidative stress during 5-MTHF administration and a strong correlation between this decrease and the nocturnal decline of BP. The possible link between the two is worthy to be explored.

Assessment of mean platelet volume and soluble CD40 ligand levels in patients with non-dipper hypertension, dippers and normotensives

Objective: Patients with a lack of nocturnal decline in blood pressure (BP) are at an increased risk for cardiovascular events. Mean platelet volume (MPV) and soluble CD40 ligand (sCD40L) are accepted biomarkers of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV and sCD40L levels are higher in non-dipper hypertensive (NDHT) patients than in dipper hypertensive (DHT) patients and healthy controls.Methods: 124 consecutive patients were included to this study. Patients were divided into three groups: NDHT patient group [n = 43; mean age 51.8 ± 6.6; 31 males (72.1%)]; DHT patient group [n = 41; mean age 50.2 ± 7.3; 22 males (53.7%)]; and normotensive group [n = 40; mean age 49.9 ± 6.7; 22 males (55%)]. Physical examination, laboratory work-up and 24-h ABPM were performed for all participants.Results: The sCD40L and MPV levels were significantly higher in the NDHT group than in the DHT and normotensive groups (p < 0.05). In correlation analysis, MPV, 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), night-time SBP and night-time DBP were positively correlated with sCD40L.Conclusion: Our study demonstrated that MPV and sCD40L levels were significantly higher in NDHT patients compared to DHT and normotensive patients. sCD40L levels were positively correlated with MPV, 24-h SBP, 24-h DBP, night-time SBP and night-time DBP.

The relationship between dipping-non-dipping arterial blood pressure pattern and frequency of restless leg syndrome with related factors.

Objective:The lack of nocturnal decline in blood pressure (BP) is associated with an increase in cardiovascular events. Restless leg syndrome (RLS) is an uncomfortable feeling in which the patient wants to budge the legs with ache in the legs. RLS also increases the hypertension and cardiovascular risk. In this study, we aimed to evaluate the relationship between dipping and non-dipping blood pressure patterns with RLS and its severity.Methods:Two hundred patients who had 24-hour ambulatory blood pressure monitoring (ABPM) were enrolled into this cross-sectional study. They were classified by blood pressure pattern as dipping and non-dipping. Then, 100 patients with the dipper pattern and 100 patients with the non-dipper pattern were chosen. A questionnaire for RLS diagnosis that was prepared by the International RLS Study Group was given performed to the patients.Results:RLS symptom score was higher in patients with non-dipping blood pressure patterns (NDBPP), and patients with NDBPP had more severe RLS. Beside this, there were no differences in terms of RLS frequency in dipping and non-dipping blood pressure patterns.Conclusion:As a conclusion, dipping and non-dipping blood pressure patterns do not increase RLS risk. But, if patients with NDBPP have RLS, they have more severe RLS. So, we suggest that evaluating a patient with a non-dipping blood pressure pattern, considering RLS, would be helpful to ameliorate the quality of life of the patient

Aldosterone-to-renin ratio and nocturnal blood pressure decline assessed by self-measurement of blood pressure at home: the Ohasama Study

Based on ambulatory blood pressure (BP) monitoring, the aldosterone-to-renin ratio (ARR) has been reported to be associated with a diminished nocturnal decline in BP, generally referred to as a “non-dipping” pattern. The objective of this cross-sectional study was to investigate the association between ARR and the non-dipping pattern based on home BP measurements. This study included 177 participants ≥55 years from the general population of Ohasama (mean age: 67.2 years; 74.6% women); no patient was receiving antihypertensive treatment. The median plasma renin activity (PRA), plasma aldosterone concentration (PAC) and ARR were 0.8 ng/mL/h, 8.1 ng/dL and 9.7 ng/dL per ng/mL/h, respectively. Each 1 SD increase in log-transformed (ln) ARR was significantly associated with the prevalence of the non-dipping pattern after adjustments for possible confounding factors including home morning systolic BP (odds ratio, 1.45; p = 0.049). However, no significant associations of PRA or PAC with the non-dipping pattern were observed (p ≥ 0.2). When participants were divided into four groups according to median levels of home morning and night-time systolic BPs, the group with a higher home morning systolic BP (≥128.4 mmHg) with a higher home night-time systolic BP (≥114.4 mmHg) had the greatest ARR levels (ANCOVA p = 0.01). These results support the hypothesis that relative aldosterone excess may be related to a non-dipping pattern in a general population and suggest that a non-dipping pattern can be accurately observed by home BP measurements.

PP120-MON RELATIONSHIP BETWEEN SERUM ALBUMIN LEVELS, AS A BIOMARKER OF NUTRITIONAL STATUS, AND NOCTURNAL DECLINE OF BLOOD PRESSURE IN ELDERLY PATIENTS

Rationale: Serum albumin levels are one of indicators for evaluating nutritional status and correlate negatively with C-reactive protein levels, a risk marker of inflammatory process of vascular atherogenesis, affecting circadian blood pressure (BP) rhythm. However, how serum albumin influences nighttime BP decline, which is the crucial predictor of cardiovascular events through vascular atherosclerosis, is not yet fully understood. We evaluated the relation between 24hour BP and serum albumin levels in elderly patients. Methods: Patients, who fulfilled the following enrollment criteria: 70 years old and above, estimated glomerular filtration rate >30mL/min/1.73m2, systolic and diastolic BP 0.05) with sleeping/waking mean BP ratios. Conclusion: Our findings suggest that serum albumin and total cholesterol in the elderly patients related to loss of the nocturnal BP decline, a predictor of cardiovascular organ damages. This suggests that poor nutrition has a higher cardiovascular risk and death.

Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

The relationship between circadian blood pressure (BP) variations and the extent of subclinical cardiac organ damage is still debated. In a general population, we investigated the association of night-to-day BP fall, as well as nocturnal BP level (mean and lowest values), with left ventricular (LV) hypertrophy and the value of both BP parameters in predicting new-onset LV hypertrophy. Office BP, 24-hour ambulatory BP values, and laboratory investigations were assessed on entry in 1682 subjects (50.2% men; mean age, 50.2±13.7 years) of the Pressioni Arteriose Monitorate E Loro Associazioni. Echocardiographic LV mass was measured at the initial evaluation and 10 years later. Multiple regression analyses, including daytime systolic BP (SBP), age, sex, and body mass index, showed that the lowest SBP level and the extent of nocturnal SBP decline were independently related to baseline LV mass. After adjustment for several confounders, both mean nocturnal SBP (relative risk for each 10-mm Hg increase in SBP, 1.15; 95% confidence interval, 1.01–1.23; P &lt;0.0001) and the lowest SBP level (relative risk for each 10-mm Hg increase in SBP, 1.10; 95% confidence interval, 1.02–1.19; P =0.01) were independent predictors of new-onset LV hypertrophy. This was not the case for the magnitude of nighttime SBP fall (hazard ratio for each 10% decrease in SBP, 0.91; 95% confidence interval, 0.80–1.04; P =0.18). In a general population, nighttime BP level rather than the nocturnal BP decline may be regarded as a reliable parameter for predicting the development of LV hypertrophy in subjects with normal LV mass. This finding may have important implications for optimizing cardiovascular prevention in the general population.

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.

FRI0149 Nocturnal hypertension in ra: a possible association with cardiovascular events

BackgroundAlthough cardiovascular mortality is increased in RA patients relative to the general population, the reasons for high prevalence of cardiovascular events in RA patients is not completely understood. On the...

Experimental models of melatonin-deficient hypertension

Melatonin secreted by the pineal gland plays an important role in the regulation of blood pressure (BP) and its administration reduces hypertension both in animals and humans. There are two experimental models of melatonin-deficient hypertension: one induced by pinealectomy and another by continuous 24 hour exposure to light. Both models cause melatonin deficiency and prevent darkness-mediated nocturnal melatonin secretion and are associated with increased BP and myocardial, vascular and renal dysfunction. These models also lead to neurohumoral activation of the renin-angiotensin system, sympathetic nervous system, adrenocorticotrophin-glucocorticoid axis and cause insulin resistance. Together, these alterations contribute to rise in blood pressure by vasoconstrictive or circulatory fluid volume overload. The light induced hypertension model mimics the melatonin deficiency in patients with insufficient nocturnal BP decline, in those who have night shift or who are exposed to environmental light pollution. For this reason, this model is useful in development of anti-hypertensive drugs.

Hypoalbuminemia and Hyperalbuminuria as Major Factors Regulating Circadian Blood Pressure Rhythm in Normal Subjects and Non-diabetic Patients with Early Stages of Chronic Kidney Disease

Study background: Albuminuria and nighttime blood pressure (BP) elevation are notable risk markers of chronic kidney disease (CKD). In non-diabetic patients with albuminuria, the effect of albuminuria on nocturnal BP and other risk factors that may disrupt circadian BP rhythm remain unclear. The aim of this study was to evaluate the relationship among albuminuria, serum albumin level and 24-hour BP rhythm in non-diabetic subjects. Methods: This prospective study enrolled 778 subjects (aged 20-80 years, estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2). Main outcome measure was sleeping/waking mean BP (MBP) ratio as an indicator of circadian BP rhythm. First, a cross-sectional study was performed in all individuals showing no proteinuria. Second, a study was done in subjects never treated for hypertension (hypertensive-naive) stratified by urinary albumin excretion. Third, an intervention study was conducted in patients with massive albuminuria and hypoalbuminemia to examine circadian BP changes induced by treatment. Results: In 441 subjects without proteinuria, multivariate regression analyses identified serum albumin, cholesterol level and circadian sympathovagal rhythm as independent predictors of sleeping/waking MBP ratio. Among hypertensivenaive non-diabetic subjects (n=231), sleeping/waking MBP ratio increased with increasing albuminuria and decreasing serum albumin. Of 37 non-diabetic nephrotic patients who underwent treatment, 25 with serum albumin level increased to >3 g/dL showed a significant decrease (P=0.026) in sleeping/waking MBP ratio after treatment, whereas 13 with urinary albumin/creatinine lowered to <300 mg/g showed no significant difference (P=0.191). Conclusions: This study identified low serum albumin as an independent predictor of loss of nocturnal BP decline, which was also associated with massive albuminuria. Furthermore, sleeping/waking MBP ratio was improved after hyperalbuminuria and hypoalbuminemia were reversed by treatment. These findings suggest that low serum albumin level and massive albuminuria are risk markers of disrupted circadian BP rhythm in non-diabetic early stage CKD.

Relationship Between Stroke Subtypes and Morning Surge or Dipping Pattern

HomeHypertensionVol. 61, No. 2Relationship Between Stroke Subtypes and Morning Surge or Dipping Pattern Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBRelationship Between Stroke Subtypes and Morning Surge or Dipping Pattern Miki Hosaka Kei Asayama Yutaka Imai Takayoshi Ohkubo Miki HosakaMiki Hosaka Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan Search for more papers by this author Kei AsayamaKei Asayama Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan, Department of Cardiovascular Diseases Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, University of Leuven, Leuven, Belgium Search for more papers by this author Yutaka ImaiYutaka Imai Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan Search for more papers by this author Takayoshi OhkuboTakayoshi Ohkubo Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan, Department of Health Science, Shiga University of Medical Science, Otsu, Japan Search for more papers by this author Originally published24 Dec 2012https://doi.org/10.1161/HYPERTENSIONAHA.111.00247Hypertension. 2013;61:e21Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2012: Previous Version 1 To the Editor:We read with interest the article by Verdecchia et al1 demonstrating that a blunted morning ambulatory blood pressure surge (MABPS) was an independent predictor of cardiovascular disease in the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study.1 Furthermore, cardiovascular risk was increased in reverse dippers and nondippers.1Kario2 reported that a high MABPS was a risk for stroke in their cohort of elderly hypertensive individuals who were older than those in the PIUMA study (72.2 versus 50.8 years). This might have resulted in the higher threshold of the top decile of MABPS among their patients (55 versus 44 mm Hg). However, Verdecchia et al1 further reported that the risk of cardiovascular events declined with higher levels of MABPS, regardless of age.In the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome (IDACO; mean age, 53.0 years) study, the top decile of MABPS (≥37.0 mm Hg) was independently associated with cardiovascular risk only when the nocturnal decline of blood pressure was simultaneously included (P=0.01).3 The Ohasama study (mean age, 61.1 years) indicated that nondippers and risers had a significantly higher risk for cerebral infarction compared with dippers and extreme dippers (relative hazard, 1.59; P=0.04). An MABPS was not associated with cerebral infarction (P for trend=0.94), whereas an MABPS and a large nocturnal decline in blood pressure were associated with cerebral hemorrhage (P≤0.04), and the threshold for a high MABPS was similar to that in the PIUMA study (25.0 versus 27.5 mm Hg).4Exaggerated MABPS is likely to be a risk for cardiovascular disease in a specific population, but not in the general population. Nevertheless, the associations of each stroke subtype with MABPS or dipping pattern would be different. Therefore, we would like to understand the association of stroke subtypes with MABPS and the dipping pattern among the PIUMA patients. We would also like to know the association between cardiovascular risk and MABPS when the degree of nocturnal decline in blood pressure is simultaneously included as in the IDACO stuy.Miki HosakaDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanKei AsayamaDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanDepartment of Cardiovascular Diseases Studies Coordinating CentreDivision of Hypertension and Cardiovascular RehabilitationUniversity of LeuvenLeuven, BelgiumYutaka ImaiDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanTakayoshi OhkuboDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanDepartment of Health ScienceShiga University of Medical ScienceOtsu, JapanDisclosuresNone.FootnotesLetters to the Editor will be published, if suitable, as space permits. They should not exceed 500 words (typed double-spaced) plus 5 references in length and may be subject to editing or abridgment.

Non-dipping nocturnal blood pressure in psoriasis vulgaris

Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis carry an excess risk of hypertension and adverse cardiovascular (CV) events. Blood pressure (BP) has a circadian rhythm characterised with lower values at night. A blunted nocturnal BP decline defined as non-dipping accelerates the development of hypertension and CV diseases. The aim of this study is to evaluate circadian variation of blood pressure in normotensive middle-aged patients with psoriasis vulgaris. Seventy adult patients with psoriasis vulgaris (group 1) and 70 age and sex-matched healthy individuals (group 2) were included in the study. Ambulatory BP monitoring was performed in all participants over a 24-h period. Non-dippers are defined as those who show a reduction in BP of less than 10% between the average day and night systolic BP. Although mean 24-h BPs were similar in both groups, night-time BPs were significantly higher in psoriatic patients (115.1 ± 7.7 vs. 109.9 ± 6.0mmHg and 72.1 ± 7.0 vs. 67.6 ± 5.5mmHg, respectively; p < 0.05). The non-dipping pattern of BP changes was significantly more common in patients with psoriasis vulgaris compared with the control group (65.9 vs. 34.1%, p < 0.01). Psoriasis severity and BMI are independent predictors of impaired nocturnal BP regulation. Patients with psoriasis vulgaris had increased nocturnal BP and heart rate. This is the first study to demonstrate a blunted nocturnal BP decrease in normotensive patients with psoriasis.

Comparison of Ambulatory Blood Pressure Parameters of Hypertensive Patients With and Without Chronic Kidney Disease

There is strong association between chronic kidney disease (CKD) and increased prevalence of hypertension, risk of end-organ damage, and cardiovascular disease (CVD). Non-dipping, as determined by ambulatory blood pressure (BP) monitoring (ABPM), is frequent in CKD and has also been consistently associated with increased CVD risk. The reported prevalence of non-dipping in CKD is highly variable, probably due to relatively small sample sizes, reliance only on a single, low-reproducibility, 24-h ABPM evaluation per participant, and definition of daytime and nighttime periods by arbitrary fixed clock-hour spans. Accordingly, we assessed the circadian BP pattern of patients with and without CKD by 48-h ABPM to increase reproducibility of the results. This cross-sectional study involved 10 271 hypertensive patients (5506 men/4765 women), 58.0 ± 14.2 (mean ± SD) yrs of age, enrolled in the Hygia Project. Among the participants, 3227 (1925 men/1302 women) had CKD. At the time of recruitment, 568/2234 patients with/without CKD were untreated for hypertension. Patients with than without CKD were more likely to be men and of older age, have diagnoses of obstructive sleep apnea, metabolic syndrome, diabetes, and/or obesity, plus have higher glucose, creatinine, uric acid, and triglyceride, but lower cholesterol, concentrations. In patients with CKD, ambulatory systolic BP (SBP) was significantly elevated (p < .001), mainly during the hours of nighttime sleep, independent of presence/absence of BP-lowering treatment. In patients without CKD, ambulatory diastolic BP (DBP), however, was significantly higher (p < .001), mainly during the daytime. Differing trends for SBP and DBP between groups resulted in large differences in ambulatory pulse pressure (PP), it being significantly greater (p < .001) for the entire 24 h in patients with CKD. Prevalence of non-dipping was significantly higher in patients with than without CKD (60.6% vs. 43.2%; p < .001). The largest difference between groups was in the prevalence of the riser BP pattern, i.e., asleep SBP mean > awake SBP mean (17.6% vs. 7.1% in patients with and without CKD, respectively; p < .001). The riser BP pattern significantly and progressively increased from 8.1% among those with stage 1 CKD to a very high 34.9% of those with stage 5 CKD. Elevated asleep SBP mean was the major basis for the diagnosis of hypertension and/or inadequate BP control among patients with CKD; thus, among the uncontrolled hypertensive patients with CKD, 90.7% had nocturnal hypertension. Our findings document significantly elevated prevalence of a blunted nocturnal BP decline in hypertensive patients with CKD. Most important, prevalence of the riser BP pattern, associated with highest CVD risk among all possible BP patterns, was 2.5-fold more prevalent in CKD, and up to 5-fold more prevalent in end-stage renal disease. Patients with CKD also presented significantly elevated ambulatory PP, reflecting increased arterial stiffness and enhanced CVD risk. Collectively, these findings indicate that CKD should be included among the clinical conditions for which ABPM is mandatory for proper diagnosis and CVD risk assessment, as well as a means to establish the best therapeutic scheme to increase CVD event-free survival. (Author correspondence: rhermida@uvigo.es)