Standard Deviation Of Diastolic Blood Pressure Research Articles

Study on blood pressure rhythm in hypertensive patients withdeficiency syndrome and a random forest model for predicting hypertension withdeficiency syndrome.

To investigate blood pressure rhythm (BPR) in Yin deficiency syndrome of hypertension (YDSH) patients and develop a random forest model for predicting YDSH. Our study was consistent with technical processes and specification for developing guidelines of Evidence-based Chinese medicine clinical practice (T/CACM 1032-2017). We enrolled 234 patients who had been diagnosed with primary hypertension without antihypertensive medications prior to the enrollment. All participants were divided into Yin deficiency group (YX, n = 74) and non-Yin deficiency group (NYX, n = 160). Participants were professionally grouped by three experienced chief Traditional Chinese Medicine (TCM) physicians according to four examinations (i.e., inspection, listening and smelling, inquiry and palpation). We collected data on 24 h ambulatory blood pressure monitoring (ABPM) and YDSH rating scale. We divided 24 h of a day into 12 two-hour periods [Chen-Shi (7:00-9:00), Si-Shi (9:00-11:00), Wu-Shi (11:00-13:00), Wei-Shi (13:00-15:00), Shen-Shi (15:00-17:00), You-Shi (17:00-19:00), Xu-Shi (19:00-21:00), Hai-Shi (21:00-23:00), Zi-Shi (23:00-1:00), Chou-Shi (1:00-3:00), Yin-Shi (3:00-5:00), Mao-Shi (5:00-7:00)] according to the theory of "midnight-midday ebb flow". We used random forest to build the diagnostic model of YDSH, with whether it was Yin deficiency syndrome as the outcome. Compared with NYX group, YX group had more female participants with older age, lower waist circumference, body mass index (BMI), diastolic blood pressure (DBP), and smoking and drinking rate (all P ＜ 0.05). The YDSH rating scores of YX group [28.5 (21.0-36.0)] were significantly higher than NYX group [13.0 (8.0-22.0)] (P < 0.001), and the typical symptoms of YX group included vexing heat in the chest, palms and soles, dizziness, dry eyes, string-like and fine pulse, soreness and weakness of lumbus and knees, palpitations, reddened cheeks, and tinnitus (all P < 0.05). The ratio of non-dipper hypertension in YX group was higher than in NYX group (56.9% vs 44.4%, P = 0.004). Compared with NYX group, 24 h DBP standard deviation (SD), nighttime DBP SD, Si-Shi DBP, Si-Shi mean arterial pressure (MAP), Hi-Shi systolic blood pressure (SBP), Hi-Shi DBP, Hi-Shi MAP, Zi-Shi SBP, Zi-Shi DBP, Zi-Shi MAP, Chou-Shi SBP SD, Chou-Shi DBP SD, Chou-Shi SBP coefficient of variation (CV) were lower in YX group (all P ＜ 0.05). Binary Logistic Regression analysis showed that the diagnosis of YDSH was positively correlated with age, heart rate, YDSH rating scores, and four TCM symptoms including vexing heat in the chest, palms and soles, string-like and fine pulse, soreness and weakness of lumbus and knees, and reddened cheeks (all P ＜ 0.05), but was negatively correlated with smoking (P﹥0.05). In addition, the diagnosis of YDSH was positively correlated with daytime SBP SD, nighttime SBP SD, nighttime SBP CV, and Hi-Shi SBP CV, but was negatively correlated with 24 h SBP CV, daytime DBP SD, nighttime DBP SD, and Hi-Shi DBP (all P ＜ 0.05). Hi-Shi SBP CV had independent and positive correlation with the diagnosis of YDSH after adjusting the variables of age, gender, course of hypertension, BMI, waist circumference, SBP, DBP, heart rate, smoking and drinking (P = 0.029). Diagnostic model of YDSH was established and verified based on the random forest. The results showed that the calculation accuracy, specificity and sensitivity were 77.3%, 77.8% and 76.9%, respectively. The BPR was significantly attenuated in YDSH patients, including lower 24 h DBP SD and nighttime DBP SD, and Hi-Shi SBP CV is independently correlated with the diagnosis of YDSH. The prediction accuracy of diagnosis model of YDSH based on the random forest was good, which could be valuable for clinicians to differentiate YDSH and non-Yin deficiency patients for more effective hypertensive treatment of TCM.

Analysis of the relationship between blood pressure variability and subtle cognitive decline in older adults

BACKGROUND Blood pressure variability (BPV) has been shown to be related to mild cognitive impairment and Alzheimer's disease in a number of studies. However, the relationship between BPV and subtle cognitive decline (SCD) has received minimal attention in this field of research to date and has rarely been reported. AIM To examine whether SCD is independently associated with changes in BPV in older adults. METHODS Participants were selected based on having participated in cognitive function evaluation and ambulatory blood pressure measurement at the Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine between June 2020 and August 2022. The participants included 182 individuals with SCD as the experimental group and 237 with normal cognitive function as the control group. The basic data, laboratory examinations, scale tests, and ambulatory blood pressure test results of the two groups were analyzed retrospectively, and the relationship between SCD and BPV was subsequently evaluated. RESULTS Significant differences were observed between the two groups of participants (P &lt; 0.05) in terms of age, education level, prevalence rate of diabetes, fasting blood glucose level, 24-h systolic blood pressure standard deviation and coefficient of variation, 24-h diastolic blood pressure standard deviation and coefficient of variation. The scale monitoring results showed significant differences in the scores for memory, attention, and visual space between the experimental and control groups. Logistic regression analysis indicated that age, education level, blood sugar level, and BPV were factors influencing cognitive decline. Linear regression analysis showed that there was an independent correlation between blood pressure variation and SCD, even after adjusting for related factors. Each of the above differences was still significant. CONCLUSION This study suggests that increased BPV is associated with SCD.

Changes in Blood Pressure Variability in Children with Postural Tachycardia Syndrome.

(1) Objective: In this research, we explored the difference in blood pressure variability (BPV) between children with postural tachycardia syndrome (POTS) and healthy children. Furthermore, we tried to investigate the effect of BPV on POTS and its relationship with prognosis of POTS. (2) Methods: 47 children with POTS (11.2 ± 1.8 years, 23 males) were enrolled in the POTS group and 30 healthy children (10.9 ± 1.9 years, 15 males) were matched for the control group. All participants completed 24 h ambulatory blood pressure monitoring (24hABPM). Thirty-three children with POTS were followed up for 52.0 (30.5, 90.5) days and were divided into a response group and a non-response group after evaluation. (3) Results: The 24 h diastolic blood pressure standard deviation (24hDSD), daytime diastolic blood pressure standard deviation (DDSD), nighttime systolic blood pressure standard deviation (NSSD), daytime diastolic blood pressure variation coefficient (DDCV) and nighttime systolic blood pressure variation coefficient (NSCV) in the control group were lower than those in the POTS group (p < 0.05). Percentage of females, age and height were lower in the response group than in the non-response group in children with POTS (p < 0.05). Univariate analysis showed that 24hDSD, DDSD, NSSD, DDCV and NSCV were potential risk factors for POTS, and sex and height were potential risk factors for poor prognosis of POTS. After adjusting for covariates, the risk of POTS increased by 48%, 53% and 49% when DDSD, NSSD and NSCV increased by 1 mmHg, 1 mmHg and 1%, respectively. The risk of poor prognosis in females was 12.99 times higher than that in males. (4) Conclusions: The results suggest that children with POTS may have an abnormal circadian rhythm in blood pressure and increased BPV. DDSD, NSSD and NSCV are independent risk factors for POTS, and being female is an independent risk factor for poor prognosis of POTS.

Cuffless Blood Pressure Estimation Using Dual Physiological Signal and Its Morphological Features

Prehypertension is difficult to diagnose early because of its hidden nature. Long-term monitoring of blood pressure (BP) can help in the early detection and timely treatment of this condition. This study proposes an innovative and efficient BP detection platform that combines portable electrocardiography (ECG) and photoplethysmogram (PPG) signals simultaneous acquisition equipment and BP detection algorithm to obtain real-time BP values conveniently and accurately for a long time. In this study, nine kinds of feature parameters and classification algorithm are used to build multiple linear regression (MLR) models. It not only adopts the Multi-Parameter Intelligent Monitoring in Intensive Care Units (MIMIC-II) database to train and validate the model but also uses self-developed equipment for acquisition and verification in long-term health monitoring. According to the experimental results, the mean absolute error (MAE) and standard deviation (SD) of systolic BP (SBP) have estimated values of 4.46 and 3.20 mmHg, respectively, and simultaneously, the MAE and SD of diastolic BP (DBP) are 4.20 and 3.28 mmHg, respectively. Moreover, both SBP and DBP experimental results conform to the Advancement of Medical Instrumentation BP standard. The proposed BP acquisition platform is proven to be capable of easily acquiring ECG and PPG signals with the proposed sensor device, and the MLR algorithm can also effectively and accurately monitor BP values for a long time.

Association between napping and 24-hour blood pressure variability among university students: A pilot study.

Blood pressure variability (BPV) has been reported to be a predictor of cardiovascular and some cognitive diseases. However, the association between napping and BPV remains unknown. This study aimed to explore the association between napping and BPV. A cross-sectional study including 105 university students was conducted. Participants' 24 h ambulatory blood pressure monitoring (24 h ABPM) were measured, and napping behaviors were investigated. BPV were measured by the 24 h ABPM, included standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Among the participants, 61.9% reported daytime napping. We found that nap duration was significantly associated with daytime CV of diastolic blood pressure (DBP) (r = 0.250, P = 0.010), nighttime CV of systolic blood pressure (SBP) (r = 0.217, P = 0.026), 24 h WCV of DBP (r = 0.238, P = 0.014), 24 h ARV of SBP (r = 0.246, P = 0.011) and 24 h ARV of DBP (r = 0.291, P = 0.003). Compared with the no napping group, 24 h WCV of DBP, daytime CV of DBP, and daytime SD of DBP were significantly higher in participants with napping duration >60 min. With multiple regression analysis we found that nap duration was an independent predictor for 24 h ARV of SBP (β = 0.859, 95% CI, 0.101-1.616, P = 0.027) and 24 h ARV of DBP (β = 0.674, 95% CI, 0.173-1.175, P = 0.009). Napping durations are associated with BPV among university students. Especially those with napping durations >60 min had a significantly higher BPV than those non-nappers.

Correlation between blood pressure variability and deep cerebral microbleeds in patients with acute ischemic stroke.

To observe the 24-h ambulatory blood pressure characteristics of patients with acute ischemic stroke and explore the correlation between blood pressure variability and strictly deep cerebral microbleeds (CMBs). A convenient sampling method was used to enrol 131 patients with acute ischemic stroke in the Department of Neurology between April 2021 and May 2022. Hospitalised patients with acute ischemic stroke were assessed retrospectively; their ambulatory blood pressure was monitored continuously for 24 h, and the relevant parameters were recorded. Magnetic susceptibility-weighted imaging was used to divide the CMBs into a strictly deep CMB group ( n = 24) and a non-CMB group ( n = 107) according to the location of the CMBs. A logistic regression analysis was performed to determine the independent correlation between the 24-h ambulatory blood pressure parameters and strictly deep CMBs. The receiver operating characteristic (ROC) was further used to analyse the predictive value of the ambulatory blood pressure parameters for strictly deep CMBs in patients with acute ischemic stroke. The results showed that the night systolic blood pressure standard deviation and the night diastolic blood pressure standard deviation (NDBP-SD) in the strictly deep CMB group were higher than those in the non-CMB group ( p < 0.05). The multiple logistic regression analysis indicated that the NDBP-SD (odds ratio [OR] = 1.205, 95% confidence interval [CI]: 1.011-1.436, p = 0.038) was an independent risk factor for strictly deep CMBs in patients. The ROC curve analysis revealed that the area under the curve value of the NDBP-SD was 0.682, and the intercept was 7.81. When NDBP-SD is ≥ 7.81, the occurrence of strictly deep CMBs is closely related (OR = 3.872, 95% CI: 1.347-11.125, p = 0.012). The NDBP-SD is an independent risk factor for strictly deep CMBs in patients with acute ischemic stroke. When NDBP-SD is > 7.81, it may promote the production of strictly deep CMBs.

Effect of Fragrance on Electroencephalographic Waves and Blood Pressure during Problemsolving Activity among Healthy College Students: A Cross-sectional Study

Introduction: The influence of fragrance, such as perfumes and room fresheners, on the psycho-physiological activities of humans has been known for a long time. However, very few studies have been conducted to investigate its effects when a person is under stress. Aim: To determine the effect of fragrance on electroencephalographic waves and blood pressure during a problem-solving activity. Materials and Methods: This cross-sectional study was conducted among 55 college students aged 18-22 years in the electrophysiology laboratory of the Department of Physiology at Pondicherry Institute of Medical Sciences, Puducherry, India from May 2019 to June 2019. After obtaining a history and conducting an olfactory examination, participants were asked to be in the electrophysiology laboratory to record Electroencephalogram (EEG) and blood pressure before and after exposure to fragrance for five minutes. Data were statistically analysed using Fischer’s-exact test and paired t-test. Results: The study included 55 college students (38 males, 17 females) with a mean age of 19.46±1.004 years. EEG changes were compared at rest, including alpha waves (n=55), beta waves (n=55) during the problem-solving activity, and theta waves (n=55) during exposure to lavender fragrance. EEG changes were analysed using Fischer’s-exact test, and the results were statistically significant (p-value&lt;0.001). The mean±Standard Deviation (SD) of Systolic Blood Pressure (SBP) during fragrance exposure (110±11.82 mmHg) vs solving the puzzle (123.44±15.97 mmHg) was significantly lower (p-value=0.048*). The mean±SD of Diastolic Blood Pressure (DBP) during fragrance exposure (74.44±11.27 mmHg) vs solving the puzzle (74.40±12.92 mmHg) was slightly higher, but not statistically significant (p-value=0.516). Conclusion: The present study demonstrated that the use of fragrance can have a relaxing effect on the mind and body, as it increases theta wave activity in the brain and significantly reduces SBP.

Visit-to-visit variability in blood pressure and kidney disease progression in IgA nephropathy.

The visit-to-visit variability (VVV) in blood pressure (BP) is an important risk factor for stroke and coronary heart disease and may also be associated with kidney damage and the development of chronic kidney disease (CKD). Data on the association between VVV in BP and the risk of CKD progression among patients with immunoglobulin A nephropathy (IgAN) are limited. We aimed to evaluate the relationships of VVV in BP with the progression of IgAN. We assessed 1376 patients with IgAN at Peking University First Hospital. The main VVV in BP was expressed as the standard deviation (SD), coefficient of variation (CV) and average real variability (ARV). The associations of variability in BP with composite kidney disease progression events, defined as a 50% decline in estimated glomerular filtration rate (eGFR) and kidney failure, were examined using Cox models. During a median follow-up of 44.1months (interquartile range 23.0-76.7), 247 (18.0%) patients experienced composite kidney disease progression events. With a higher SD in systolic BP (SBP) values, the risk of kidney disease progression events increased {hazard ratio [HR] 1.07 [95% confidence interval (CI) 1.03-1.11]; P<.001} after maximal adjustment, including baseline SBP and mean SBP during the first 12-month period. Using the first quartile of SD SBP values as the reference, the risk of composite kidney disease progression events was higher among patients with higher SD SBP values; the HR was 2.12 (95% CI 1.31-3.44) in the highest quartile (P for trend<.001). A similar trend could be observed when analysing the SD of diastolic BP, but the risk was not significantly increased. The associations were similar when analysed with the CV and ARV. SBP variability was significantly associated with kidney disease progression in IgAN.

Association between gestational visit-to-visit blood pressure variability and adverse neonatal outcomes.

The authors aimed to explore the association between visit‐to‐visit blood pressure variability (BPV) in pregnant women and adverse neonatal outcomes. The study included 52 891 pregnant women. BPV was calculated as standard deviation (SD) and coefficient of variation (CV) of systolic blood pressure (SBP) or diastolic blood pressure (DBP). All participants were divided into four groups by the quartiles of BPV. When comparing the highest quartiles to the lowest quartiles of DBP SD in all participants, the fully adjusted ORs were 1.19 (95% CI 1.11–1.27, p for trend < .001) for fetal distress, 1.32 (95% CI 1.14–1.54, p for trend < .001) for small for gestational age, 1.32 (95% CI 1.06–1.63, p for trend = .003) for 1‐min Apgar score ≤ 7. When comparing the highest quartiles to the lowest quartiles of DBP CV, ORs were 1.22 (95% CI 1.14–1.30, p for trend < .001) for fetal distress, 1.38 (95% CI 1.17–1.61, p for trend < .001) for small for gestational age, 1.43 (95% CI 1.14–1.79, p for trend < .001) for 1‐min Apgar score ≤ 7. ORs for preterm birth and 5‐min Apgar score ≤ 7 were not statistically significant. However, in participants with gestational hypertension or preeclampsia, ORs for preterm birth were 2.80 (95% CI 1.99–3.94, p for trend < .001) in DBP SD and 3.25 (95% CI 2.24–4.72, p for trend < .001) in DBP CV when extreme quartiles were compared. In conclusion, higher visit‐to‐visit BPV was associated with adverse neonatal outcomes.

The effect of L-thyroxine replacement on blood pressure and heart rate in children with hypothyroidism: correlation with free thyroxine and thyrotropin levels

Introduction Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. Chronic administration of L-thyroxine (LT4) to children with hypothyroidism may affect cardiovascular dynamics.Aim This cross-sectional observational study measured the blood pressure (BP) and heart rate (HR) of 25 randomly selected children with hypothyroidism in relation to their serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) levels, and thyroxine dose μg/kg.Patients and methods In total, 25 randomly selected children with a mean age 9.6±4.5 years with the diagnosis of congenital or acquired hypothyroidism. They were on l-thyroxine therapy to keep serum-FT4 and TSH in the normal range for age. Their BP and HR (average of three readings), weight, height, dose of thyroxine, and their serum level of TSH and free T4 levels within 2 weeks before the clinic visit were recorded. The Z scores of the height, height standard deviation score (HSDS), body mass index standard deviation score (BMISDS), systolic (SBPSDS), and diastolic blood pressure standard deviation score (DBPSDS) were calculated (as per the 2004 guideline report on hypertension from the National Heart and Lung Institute), and HR [as per the Monitoring and Diagnosis Group at Oxford (MADOX) systematic review of 2011] was calculated for age and sex.Results The authors studied 25 children with hypothyroidism. Their dose of thyroxine was 2.11±0.7 μg/kg. Their mean serum-FT4 levels were 15.1±2.5 μg/l and TSH level was 3.9±2.8 mIU/ml. Their HtSDS (−0.57±1.4) and BMISDS (0.63±1.63) were within normal. All had normal diastolic blood pressure readings (within 2 standard deviations of the mean for age and sex). Two of the individuals had systolic BPs greater than 2SDS above the mean for age and sex, with normal BMISDS. Both had normal FT4 and TSH levels. One patient had tachycardia [HR=146/min (Z-score +3.2 for age)]. His FT4 and TSH levels were normal. There was a positive correlation between thyroxine dose/kg and serum level of FT4 (r=0.52), HR (r=0.56), SBPSDS (r=0.38), and DBPSDS (r=0.24). There was no significant correlation between the HtSDS on the one hand and FT4, TSH, or thyroxine dose on the other hand. The BMISDS was negatively correlated with TSH level (r=−0.4).Conclusion In this study on hypothyroid children on l-thyroxine therapy, 2 had high systolic BP and one had tachycardia. The significant correlation between the thyroxine dose, FT4 level, and BP and HR should alert the pediatrician to monitor BP and HR closely in relation to TSH and FT4 levels of these patients.

A Deep Learning-Based Continuous Blood Pressure Measurement by Dual Photoplethysmography Signals

This study proposed a measurement platform for continuous blood pressure estimation based on dual photoplethysmography (PPG) sensors and a deep learning (DL) that can be used for continuous and rapid measurement of blood pressure and analysis of cardiovascular-related indicators. The proposed platform measured the signal changes in PPG and converted them into physiological indicators, such as pulse transit time (PTT), pulse wave velocity (PWV), perfusion index (PI) and heart rate (HR); these indicators were then fed into the DL to calculate blood pressure. The hardware of the experiment comprised 2 PPG components (i.e., Raspberry Pi 3 Model B and analog-to-digital converter [MCP3008]), which were connected using a serial peripheral interface. The DL algorithm converted the stable dual PPG signals acquired from the strictly standardized experimental process into various physiological indicators as input parameters and finally obtained the systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). To increase the robustness of the DL model, this study input data of 100 Asian participants into the training database, including those with and without cardiovascular disease, each with a proportion of approximately 50%. The experimental results revealed that the mean absolute error and standard deviation of SBP was 0.17 ± 0.46 mmHg. The mean absolute error and standard deviation of DBP was 0.27 ± 0.52 mmHg. The mean absolute error and standard deviation of MAP was 0.16 ± 0.40 mmHg.

Long-term variability of blood pressure and incidence of heart failure among individuals with Type 2 diabetes.

AimsData on the association of long‐term variability of blood pressure (BP) with incident heart failure (HF) in individuals with Type 2 diabetes are scarce. We evaluated this association in a large community‐based sample of adults with Type 2 diabetes.Methods and resultsA total of 4200 participants with Type 2 diabetes who had available BP measurements at four visits (baseline and 12, 24, and 36 months) in the Look AHEAD (Action for Health in Diabetes) study were included. Variability of systolic BP (SBP) and diastolic BP (DBP) across the four visits was assessed using four metrics. Participants free of HF during the first 36 months were followed for HF events. Cox regression was used to generate hazard ratios (HRs) and 95% confidence intervals (CIs) for HF. Of the 4200 participants, the average age was 59 years [standard deviation (SD): 6.8]; 58.5% were women. Over a median follow‐up of 6.7 years, 129 developed HF events. After adjusting for relevant confounders, the HR of incident HF for the highest vs. lowest quartile of SD of SBP was 1.77 (95% CI 1.01–3.09); the HR for the highest (vs. lowest) quartile of variability independent of the mean of SBP was 1.29 (95% CI 0.78–2.14). The adjusted HR for participants in the highest (compared with the lowest) quartile of SD of DBP was 1.61 (95% CI 1.01–2.59), and the adjusted HR for variability independent of the mean of DBP was 1.65 (95% CI 1.03–2.65).ConclusionsA greater variability in SBP and DBP is independently associated with greater risk of incident HF in individuals with Type 2 diabetes.

A COMPARATIVE STUDY OF AMBULATORY BLOOD PRESSURE LEVELS, TRAJECTORIES AND SHORT-TERM BLOOD PRESSURE VARIABILITY IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD STAGE 2, 3A, 3B AND 4

Objective: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Design and method: This study included 48 diabetic and 48 non-diabetic adult patients (&gt;18 years) with CKD (eGFR: &lt; 90 and &gt;15 mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory BP measurement with the Mobil-O-Graph device. To evaluate the effect of diabetes and time on the trajectories of 24-hour BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated using standard deviation (SD), weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP during the 24-hour, day- and night-time periods. Results: In total, patients with DM had significantly higher 24-hour systolic BP (SBP) (132.13 ± 10.71 vs 124.16 ± 11.45 mmHg, p = 0.001) and similar 24-hour diastolic BP (DBP) (75.00 ± 8.43 vs 74.62 ± 6.86 mmHg, p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP [F = 18.766, p &lt; 0.001, partial h2 = 0.261] and marginally significant for DBP [F = 3.782, p = 0.057, partial h2 = 0.067]. 24hour SBP SD, wSD and ARV (10.94 ± 2.75 vs 9.46 ± 2.10, p = 0.004), as well as 24hour DBP SD, wSD, CV and ARV (8.23 ± 2.10 vs 7.10 ± 1.32, p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetic subjects. These findings may signify a higher cardiovascular risk of diabetic CKD patients.

P0156SHORT-TERM BLOOD PRESSURE VARIABILITY IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD STAGE 2, 3A, 3B AND 4

Abstract Background and Aims Blood pressure variability (BPV) is an important risk factor for cardiovascular events and mortality in patients with chronic kidney disease (CKD). Previous evidence suggests that BPV is gradually increasing across CKD stages. Whether type 2 diabetes mellitus (DM) is an additional risk factor for increased BPV has never been studied. The aim of this study is to examine in comparison BPV in diabetic and non-diabetic patients with CKD. Method We included 48 diabetic and 48 non-diabetic adult patients (&amp;gt;18 years) with CKD (eGFR: &amp;lt;90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory blood pressure (BP) measurement with the Mobil-O-Graph device. Brachial BP variability was calculated with validated formulas. We calculated standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP during the 24-hour, day- and night-time periods with validated formulas. Results In total population, ambulatory systolic BP (SBP) levels were significantly higher in diabetics compared to non-diabetic counterparts in all studied periods. No significant differences were evidence for ambulatory diastolic BP (DBP) in total or across CKD stages. In total, 24-hour SBP SD (15.43±4.34 vs 13.38±3.35, p=0.011), wSD (14.41±4.11 vs 12.53±3.19, p=0.014) and ARV (10.94±2.75 vs 9.46±2.10, p=0.004) were higher in patients with DM compared to those without DM. In addition, 24hour DBP SD (11.04±2.39 vs 9.80±2.28, p=0.010), wSD (10.30±2.52vs 9.05±1.99, p=0.008), CV (14.77±3.05 vs 13.14±2.96, p=0.009) and ARV (8.23±2.10 vs 7.10±1.33, p=0.002) were again different between groups. Across CKD stages 2 and 3a, BPV indices were insignificantly higher in patients with DM. In CKD Stage 3b, 24-hour SBP-SD (16.30±4.52 vs 11.35±2.62, p=0.003), wSD (15.42±4.54 vs 10.77±2.30, p=0.004), ARV (12.46±3.19 vs 8.34±2.07, p=0.001) and 24-hour DBP-CV (14.84±3.63 vs 12.18±1.91, p=0.035) were higher in diabetic compared to non-diabetic patients. In contrast, no difference between groups existed in CKD Stage 4. Conclusion Patients with DM present increased BPV in CKD Stages 2, 3a and 3b (moderately impaired renal function). This difference is not apparent in patients with advanced CKD at Stage 4.

The relationship between visit-to-visit variability in blood pressure and incidence of metabolic syndrome: a general population-based cohort study in Korea

BackgroundPrevious studies demonstrated that visit-to-visit variability of blood pressure (BP) has significant relationship with cardiovascular disease. Visit-to-visit variability in BP might have prognostic value for cardiovascular disease. The aim of this study is to evaluate the effect of visit-to-visit variability in BP on development of metabolic syndrome in general population without cardiovascular disease, diabetes mellitus, metabolic syndrome, and BP medication.MethodWe used data from the Korean Genome Epidemiology Study conducted by the Korean Centers for Disease Control and Prevention. All cohorts who were followed first 3 periods formed the basis of the study sample, which consisted of 7195 people. Of these samples, 3431 subjects who had cardiovascular disease, diabetes mellitus, or metabolic syndrome were excluded, and 312 subjects who were using antihypertensive medication in first 3 periods were excluded. Our final study sample consisted of 3452 cohorts.ResultsThe mean age was 53.5 (8.25) years. The proportion of male was 50.2%. Average follow-up duration was 5.91 (0.17) years. In generalized estimating equation, the development of metabolic syndrome was associated with mean systolic BP (SBP) (Odd ratio (OR) 1.042, 95% confidence interval (CI) 1.035–1.048, p < 0.001), mean diastolic BP (DBP) (OR 1.058, 95% CI 1.049–1.069, p < 0.001), standard deviation (SD) of SBP (OR 1.036, 95% CI 1.017–1.055, p < 0.001), SD of DBP (OR 1.053, 95% CI 1.027–1.080, p < 0.001), and coefficient of variation (CV) of DBP (OR 1.025, 95% CI 1.005–1.046, p = 0.016) after adjusted for age, sex, and metabolic syndrome component. When mean SBP, mean DBP, SBP variability, and DBP variability were entered all together in the analysis model, SD of DBP (OR 1.033, 95% CI 1.003–1.063, p = 0.030) and CV of DBP (OR 1.027, 95% CI 1.004–1.051, p = 0.020) were significantly associated with the development of metabolic syndrome.ConclusionIn general population without cardiovascular disease, diabetes mellitus, metabolic syndrome, and BP medication, SD of DBP and CV of DBP was associated with the development of metabolic syndrome. Visit-to-visit variability in DBP might be helpful for the prediction of future metabolic syndrome development.

Hemodynamic evaluation of elderly patients during laparoscopic cholecystectomy.

to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients' comorbidities. laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient's positioning in a reverse Trendelemburg during surgery.

The association between blood pressure variability and sleep stability in essential hypertensive patients with sleep disorder

Objective: To investigate the association of blood pressure variability and sleep stability in essential hypertensive patients with sleep disorder by cardiopulmonary coupling. Methods: Performed according to strict inclusion and exclusion criteria, 88 new cases of essential hypertension who came from the international department and the cardiology department of china-japan friendship hospital were enrolled. Sleep stability and 24 h ambulatory blood pressure data were collected by the portable sleep monitor based on cardiopulmonary coupling technique and 24 h ambulatory blood pressure monitor. Analysis the correlation of blood pressure variability and sleep stability. Results: In the nighttime, systolic blood pressure standard deviation, systolic blood pressure variation coefficient, the ratio of the systolic blood pressure minimum to the maximum, diastolic blood pressure standard deviation, diastolic blood pressure variation coefficient were positively correlated with unstable sleep duration (r=0.185, 0.24, 0.237, 0.43, 0.276, P<0.05). Conclusions: Blood pressure variability is associated with sleep stability, especially at night, the longer the unstable sleep duration, the greater the variability in night blood pressure.

OP.1C.10] WHITE-COAT EFFECT IS ASSOCIATED WITH A MARKED INCREASE OF BLOOD PRESSURE VARIABILITY ON AMBULATORY BLOOD PRESSURE MONITORING

Objective: The increase of 24-hours blood pressure (BP) variability, assessed by ambulatory blood pressure monitoring (ABPM), is an independent risk factor for cardiovascular events. However white-coat effect (WCE) can influence at least the first part of ABPM leading to higher mean BP values and over-diagnosis of arterial hypertension. We aimed at examining to what extent WCE may affect BP variability. Design and method: We analysed 281 ABPM (M/F 101/180) in which the first systolic BP value was at least 10 mmHg higher than mean diurnal systolic blood pressure (mDSBP). WCE was evaluated during the first two hours of recording (WCE window, WCEw) as magnitude i.e. as mean SBP values (WCE magnitude, WCEm) and as duration (WCEd) i.e. the sum of the time intervals following a SBP value at least 10 mmHg higher than mDSBP. According to median values of WCEd we identified two subgroups: long-WCE (WCEd > 60 minutes) and short-WCE (WCEd =< 60 minutes) whereas for WCEm patients were subdivided in those with high-WCE (WCEm > 150 mmHg) and low-WCE (WCEm =< 150 mmHg). BP variability was assessed as mean diurnal systolic and diastolic BP standard deviation (SD). Results: Considering all ABPMs, SDs for mDSBP and for mean diurnal diastolic BP (mDDBP) were respectively 22.0 ± 0.3 and 17.8 ± 0.3 without differences between genders. After the exclusion of WCEw, these SDs fell respectively to 21.1 ± 0.3 (p < 0.05 for trend) and 17.1 ± 0.3. Considering WCEm, in the subgroup with high-WCE, SDs were higher for mDSBP and mDDBP than in the subgroup with low-WCE (respectively 23.6 ± 0.4 vs. 20.4 ± 0.4 and 19.0 ± 0.4 vs. 16.5 ± 0.4, p < 0.0001 for both), and these differences in SDs remained significant even when mDSBP and mDDBP were calculated with the exclusion of WCEw (table). In contrast no differences were observed in SDs in subgroups with long and short WCEd.Conclusions: WCE is associated with a very high systolic and diastolic BP variability on ABPM that is higher in patients with greater WCEm and persists beyond the two initial hours of recording used to classify patients as having WCE.

Correlation between carotid artery plaque and blood pressure variability in elderly patients with hypertension

Objective To investigate the correlation between carotid artery plaque and blood pressure variability (BPV) in elderly patients with hypertension. Methods One hundred sixty elderly patients with hypertension were divided into plaque and non-plaque groups according to the results of carotid artery ultrasonography. All the patients were measured by ambulatory blood pressure monitoring. The mean blood pressure, mean pulse pressure, and blood pressure variability coefficient of two groups were calculated and compared during whole day, daytime, and nighttime. The related factors of carotid artery plaque were analyzed by multivarite logistic regression analysis. Results The 24 h systolic blood pressure standard deviation, daytime and nighttime of systolic blood pressure standard deviation, daytime diastolic blood pressure standard deviation of plaque group were higher than those of non-plaque group (P<0.05). The 24 h systolic blood pressure variation (24 h SBPV) and night systolic blood pressure variation (nSBPV) were higher than those of non-plaque group (P<0.01). Multivariate regression analysis results showed that carotic artery plaque was associated positively with 24 h BPV and blood pressure variability coefficient of nighttime (P<0.05). Conclusions The elderly hypertensive patients with carotid artery plaque is associated positively with 24 h systolic blood pressure variability coefficient and blood pressure variability of nighttime. Key words: Hypertension/PP/CO; Blood pressure; Carotid artery diseases/CO

Blood pressure tracking in children and adolescents

High blood pressure is a major risk factor for cardiovascular disease. Blood pressure tracking could help to identify individuals with potential hypertension. Therefore, we have asked whether or not tracking was of predictive value for the development of hypertension in early life. Blood pressure was routinely measured in 13,261 children and adolescents in outpatient clinics as well as during hospitalization. In one analysis, 568 individuals with elevated and normotensive blood pressure values were evaluated after 2, 4, and 6 years of follow-up. In a second analysis, 2,157 individuals with normotensive blood pressure were examined in a paired t test. The follow-up analysis showed a significant tracking effect. However, the Pearson correlation coefficients of the systolic and diastolic blood pressure standard deviation scores (SDS) decreased over time. Upon the follow-up after 6 years, 35.6 % of the children and adolescents with elevated blood pressure values remained in the elevated range group. Of the children within the normotensive blood pressure range, 80.4 % remained normotensive after 6 years. Children with normotensive blood pressure showed a stronger tracking than those who had had one hypertensive blood pressure reading. Children with higher body mass index (BMI) at follow-up changed blood pressure SDS track from initially normal to higher blood pressure values. Blood pressure tracking in children and adolescents is moderate. We conclude that the predictive power of a single hypertensive blood pressure measurement during a single visit is rather small, and thus repetitive measurements across several consecutive visits are necessary.