Systolic Blood Pressure Dipping Research Articles

Nocturnal systolic blood pressure dipping among people living with HIV and people without HIV: a cross-sectional study in Rural Uganda.

In this study, we investigated sleep quality, depression and stress symptoms as hypothesized factors affecting the association between HIV status and nocturnal blood pressure dipping status in rural Uganda. Individuals living with HIV (PLHIV) and people without HIV (PwoHIV) underwent 24-hour ambulatory blood pressure monitoring (ABPM) and classified as extreme dippers, dippers and non-dippers based on a percentage nocturnal drop in mean systolic and diastolic blood pressure. Ordinal logistic regression models were used to assess the effect of different exposure variables (HIV status, sleep quality and other covariates) on the outcome (dipping status). The median age was 45 years (IQR: 35-54) and 80% of the participants were female. 24% of PwoHIV and 16% of PLHIV were overweight, 10% of HIV negative and 3% of the HIV positive individuals were obese. Depression was prevalent in both PLHIV and PwoHIV. Additionally, poor sleep quality was more prevalent in PLHIV compared to PwoHIV (70% versus 58%, P= 0.046). The study found that 53% of participants had normal dipping, while 35.1% were non-dippers, with non-dipping being more prevalent in PwoHIV individuals (34.9% vs 29.7%, P<0.001). PLHIV had 3.6 times the odds of being extreme dippers compared to PwoHIV (OR 3.64, 95% CI: 1.40 - 9.44). This study identified high proportions of non-dipping BP profiles among both PLHIV and PwoHIV. However, the odds of being extreme dippers were higher among PLHIV compared to PwoHIV. Further research is needed to understand the underlying mechanisms contributing to extreme dipping patterns in PLHIV.

Predictors of daytime blood pressure, nighttime blood pressure, and nocturnal dipping in patients with chronic kidney disease.

Increasing attention has recently been paid to discrepancies between office and ambulatory blood pressure (BP) control in patients with chronic kidney disease (CKD), but information on mechanisms underlying circadian BP variations in CKD remains scarce. We described circadian BP patterns and their predictors in patients with CKD stages 1 to 5 referred for kidney function testing in a French tertiary hospital: 1122 ambulatory BP measurements from 635 participants. Factors associated with daytime and nighttime systolic BP (SBP) as well as with nocturnal SBP dipping (ratio of average nighttime to daytime SBP) were analyzed with linear mixed regression models. Participants (mean age 55 ± 16 years; 36% female, mean GFR 51 ± 22 mL/min/1.73m2) had a mean daytime and nighttime SBP of 130 ± 17 and 118 ± 18 mm Hg, respectively. The prevalence of impaired dipping (nighttime over daytime SBP ratio ≥ 0.9) increased from 32% in CKD stage 1 to 68% in CKD stages 4-5. After multivariable adjustment, measured GFR, diabetes, and sub-Saharan African origin were more strongly associated with nighttime than with daytime SBP, which led to significant associations with altered nocturnal BP dipping. For a 1 SD decrease in measured GFR, nighttime BP was 2.87 mmHg (95%CI, 1.44-4.30) higher and nocturnal SBP dipping ratio was 1.55% higher (95%CI, 0.85-2.26%). In conclusion, the prevalence of impaired nocturnal BP dipping increases substantially across the spectrum of CKD. Along with sub-Saharan African origin and diabetes, lower measured GFR was a robust and specific predictor of higher nighttime BP and blunted nocturnal BP decline.

Device-estimated sleep metrics do not mediate the relation between race and blood pressure dipping in young black and white women.

Short, disturbed, and irregular sleep may contribute to blunted nocturnal blood pressure (BP) dipping, a predictor of cardiovascular disease. Black women (BLW) demonstrate less BP dipping and poorer sleep health than White women (WHW). However, it remains unclear whether device-estimated sleep health metrics mediate the relation between race and BP dipping in young women. We hypothesized that the relation between race and BP dipping would be partly mediated by sleep health metrics of sleep duration, sleep efficiency, and sleep regularity. Participants (20 BLW, 17 WHW) were 18-29 years old, normotensive, nonobese, and without evidence of sleep disorders. Systolic and diastolic BP dipping were derived from 24-h ambulatory BP monitoring. Habitual sleep duration and sleep efficiency were estimated via 14 days of wrist actigraphy. Sleep duration regularity was calculated as the standard deviation (SD) of nightly sleep duration (SDSD). Sleep timing regularity metrics were calculated as the SD of sleep onset and sleep midpoint (SMSD). Mediation analysis tested the mediating effect of each sleep metric on the relation between race and BP dipping. BLW experienced less systolic (P=.02) and diastolic (P=.01) BP dipping. Sleep duration (P=.14) was not different between groups. BLW had lower sleep efficiency (P<.01) and higher SDSD (P=.02), sleep onset SD (P<.01) and SMSD (P=.01). No sleep metrics mediated the relation between race and BP dipping (all indirect effects P>.38). In conclusion, mediation pathways of sleep health metrics do not explain racial differences in nocturnal BP dipping between young BLW and WHW.

Sympathetic overactivity and nocturnal diuresis in obstructive sleep apnea alter the response to hypertension therapy

BackgroundObstructive sleep apnea (OSA) is associated with high blood pressure that responds poorly to usual antihypertensive therapy.Methods and resultsForty-one subjects with OSA had 25% higher plasma norepinephrine and 42% higher epinephrine measured every 2 h over 24 h than 20 control subjects. They also excreted more sodium during sleep. This suggested that that a sympatholytic would be a more successful antihypertensive than a diuretic. To test this hypothesis we treated a second group of 23 hypertensive apneics with placebo, 6 weeks of the sympatholytic guanfacine and 6 weeks of hydrochlorothiazide in a crossover study. Guanfacine lowered 24-hour blood pressure by 9.6/6.7 mmHg, more than the 5.4/2.9 mmHg effect of hydrochlorothiazide (P < 0.05). Nighttime systolic blood pressure dipping was poor at 6.6 ± 1.8%. Hydrochlorothiazide did not alter blood pressure dipping but guanfacine improved dipping to 9.1 ± 1.2%, a better result (P = 0.03) than from the diuretic. Central aortic pressure by pulse wave analysis was 120/84 mmHg on hydrochlorothiazide and 109/72 on guanfacine, (P < 0.05). Guanfacine, but not hydrochlorothiazide, improved baroreflex sensitivity, heart rate variability and flow mediated vascular dilation, suggesting that decreasing the elevated sympathetic nerve activity of obstructive sleep apnea returned vascular function toward normal.ConclusionsOSA is the most common condition associated with antihypertensive treatment failure. It increased sympathetic nerve activity day and night. Drugs that block sympathetic nerve function are not among the 4 most commonly recommended classes of antihypertensives but diuretics are. Sympatholytic therapy was superior to diuretic treatment for hypertension associated with sleep apnea.Trial registrationNCT, NCT02699125, Registered 26 February 2016 - Retrospectively registered, https://clinicaltrials.gov/study/NCT02699125.

Habitual Sleep Duration and Sleep Effciency Do Not Mediate the Relationship Between Race and Nocturnal Blood Pressure Dipping in Young Black and White Women

Blunted nocturnal blood pressure (BP) dipping, defined as less than 10% reduction in BP during sleep as compared to wake, independently predicts cardiovascular disease. Short and disturbed sleep associate with less nocturnal BP dipping in young adults, and Black women (BLW) demonstrate less nocturnal BP dipping and poorer sleep health compared to White women (WHW) as early as young adulthood. However, not known is if habitual, objectively estimated sleep metrics mediate the relationship between race and BP dipping in young women. Thus, this study sought to evaluate the mediating effect of objectively estimated habitual sleep duration and sleep effciency on the relationship between race and nocturnal BP dipping in apparently healthy, young BLW and WHW. We hypothesized that BLW would have lower nocturnal systolic and diastolic BP dipping than WHW, but that the relationship between race and nocturnal BP dipping would be at least partly mediated by sleep duration and sleep effciency. Participants were 18-29 years, female, normotensive, nonobese, without evidence of clinical sleep disorders, and self-identified their race as Black or White. Systolic and diastolic BP dipping were each derived from 24-hour ambulatory BP monitoring by subtracting mean asleep BP from mean awake BP, divided by mean awake BP, *100. Sleep duration (total sleep time between sleep onset and offset) and sleep effciency (total sleep time divided by total time in bed dedicated to sleep, *100) were measured via wrist actigraphy for 14 consecutive nights, and means were generated. Race differences in BP dipping and habitual sleep metrics were assessed via independent-samples t-tests. The standard mediation model as proposed by Baron and Kenney (1986) was used to assess the mediating effect of habitual sleep duration and sleep effciency on the relationship between race and systolic and diastolic BP dipping. Participants included 20 BLW (22±3 years) and 17 WHW (25±3 years). Systolic BP dipping (BLW: 9.5±5.9%, WHW: 13.9±5.1%, p=0.02) and diastolic BP dipping (BLW: 16.3±7.3%, WHW: 21.9±5.5%, p=0.01) were lower among BLW. Sleep duration was not different between races (BLW: 6.7±0.5 hrs, WHW: 7.0±0.7 hrs, p=0.14), though sleep effciency was lower among BLW (BLW: 81.6±4.4%, WHW: 86.0±3.1%, p&lt;0.01). In contrast to our hypothesis, neither habitual sleep duration nor sleep effciency significantly mediated the relationship between race and BP dipping (all indirect effects p&gt;0.38). Habitual sleep metrics did not explain race differences in nocturnal BP dipping between young BLW and WHW; thus, future work should consider other physiological, social, or environmental determinants of BP dipping in young BLW. University of Delaware Research Foundation — Strategic Initiative Grant (MAW/FP) and AHA Award #831488 (EH). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract WP289: Insufficient Low-Frequency Blood Pressure Activity Under Orthostatic Stress Predicts Blunted Night-to-Day Blood Pressure Dipping in Patients With Ischemic Cerebrovascular Disease

Introduction: Blunted night-to-day blood pressure (BP) dipping was common in ischemic cerebrovascular disease (ICVD). BP dipping could be influenced by baroreflex, which stabilized BP by regulating sympathovagal balance. We sought to determine the relationship between baroreflex function and BP dipping in patients with ICVD. Methods: Patients with ICVD stable for at least 3 days were enrolled. Beat-to-beat BP and ECG were monitored in 3 phases of active standing [supine (S), supine to upright (SU), upright (U), 4 min each]. Baroreflex function was evaluated by time-domain and frequency-domain baroreflex sensitivity (BRS) and by indices of sympathovagal balance [low (0.04-0.15 Hz) to high (0.15-0.4 Hz) frequency ratio (LHR) of systolic BP (SBP) and RR interval (RRI)]. BP dipping was measured as percentage with 24h ambulatory BP monitoring. SBP dipping &lt;0 was defined as reverse BP dipping. Results: Among 66 patients, mean SBP dipping was 3.54% ± 6.85%. SBP dipping was positively related to BP-LHR SU (Spearman r=0.258, p=0.036), but had no significant correlation with time-domain and frequency-domain BRS, LHR S and LHR U of BP and RRI, or RRI-LHR SU (Table 1). Lower log BP-LHR SU was indicative of less SBP dipping [β (95% CI): 6.53 (1.67-11.40), p=0.009] and the presence of reverse BP dipping [OR (95% CI): 0.11 (0.02-0.65), p=0.015], even after adjusting age, sex, vascular risk factors, 24h mean BP level, NIHSS and mRS scores (Table 2). Conclusions: Low BP-LHR SU , which suggested sympathetic underactivation of BP activity during the orthostasis-stimulated baroreflex engagement, might be a pathophysiological link between baroreflex impairment and blunted BP dipping in ICVD.

Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics

ABSTRACT The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan–Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.

Nocturnal Systolic Blood Pressure Dipping and Progression of CKD

Nocturnal Systolic Blood Pressure Dipping and Progression of CKD

Sleep Variability, Sleep Irregularity, and Nighttime Blood Pressure Dipping.

Circadian rhythm regulates many important biological functions in humans. The goal of this study is to explore the impact of day-to-day deviations in the sleep-wake cycle on nighttime blood pressure (BP) dipping and further examine whether the ethnic difference in day-to-day deviations in sleep patterns can explain the ethnic difference in nighttime BP dipping. Twenty-four-hour ambulatory BP monitoring and 7-day accelerometer data were obtained from 365 adult participants (age range, 18.7-50.1 years; 52.6% Black participants and 47.3% European Americans; 64.1% females). Systolic BP dipping level was used to represent nighttime BP dipping. The SD of sleep duration was calculated as the index of sleep variability, and the SD of sleep midpoint was calculated as the index of sleep irregularity. A 1-hour increase in the SD of sleep midpoint was associated with a 1.16% decrease in nighttime BP dipping (P<0.001). A 1-hour increase in the SD of sleep duration was associated with a 1.39% decrease in nighttime BP dipping (P=0.017). The ethnic difference in the SD of sleep midpoint can explain 29.2% of the ethnicity difference in BP dipping (P=0.008). Sleep variability and sleep irregularity are associated with blunted BP dipping in the general population. In addition, data from the present investigation also demonstrate that the ethnic difference in sleep irregularity could partly explain the ethnic difference in BP dipping, an important finding that may help reduce the health disparity between Black participants and European Americans.

Clinical and life style factors related to the nighttime blood pressure, nighttime dipping and their phenotypes in Korean hypertensive patients

BackgroundNon-dipping or reverse dipping patterns are known to be associated with adverse cardiovascular prognosis among the general population and clinical cohort. Few large sized studies have explored factors including sleep duration and sleep quality related to nighttime blood pressure (BP) and nocturnal dipping patterns.MethodsAmong 5,360 patients enrolled in Korean multicenter nationwide prospective Registry of ambulatory BP monitoring (KORABP), 981 subjects with complete data on sleep duration, sleep quality assessed using a 4-point Likert scale, and clinical variables were included in the analysis. Phenotypes of nighttime BP pattern were categorized as extreme dipper, dipper, non-dipper, and reverse dipper. Hypertension was defined as a 24-h ambulatory BPs were 130/80 mmHg or higher.ResultsAmong 981 subjects, 221 were normotensive, 359 were untreated hypertensive, and 401 were treated hypertensive. Age of the participants were 53.87 ± 14.02 years and 47.1% were female. In overall patients, sleep duration was 431.99 ± 107.61 min, and one to four points of sleep quality were observed in 15.5%, 30.0%, 30.4%, and 24.2%, respectively. Of the 760 hypertensive patients, extreme dipper, dipper, non-dipper, and reverse dipper were observed in 58 (7.63%), 277 (36.45%), 325 (42.76%), and 100 (13.16%), respectively. In multiple linear regression analysis, sleep duration (β = 0.0105, p < 0.001) and sleep quality (β = -0.8093, p < 0.001) were associated with nighttime systolic BP and sleep quality was associated with extent of nighttime systolic BP dipping (β = 0.7622, p < 0.001) in hypertensive patients. In addition, sleep quality showed positive association with dipper pattern (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 1.03–1.30) and showed negative association with reverse dipper pattern (OR = 0.73, 95% CI = 0.62–0.86) in multiple logistic regression analyses.ConclusionWhen adjusted covariates, less sleep duration and poor sleep quality were positively associated with nighttime systolic BP. Additionally, sleep quality was the independent associated factor for dipper and reverse dipper phenotypes. The study also found that male sex, low estimated glomerular filtration rate, high ambulatory BP, low office BP, and poor sleep quality were associated with blunted nighttime SBP dipping.

Nocturnal systolic blood pressure dipping and progression of chronic kidney disease.

The relationship between declining nocturnal blood pressure (BP) and adverse cardiovascular outcomes is well-recognized. However, the relationship between diurnal BP profile and the risk of chronic kidney disease (CKD) progression is unclear. Herein, we examined the association between nocturnal systolic SBP (SBP) dipping and CKD progression in 1061 participants at the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI). The main exposure was diurnal systolic BP (SBP) profile and diurnal SBP difference ([nighttime SBP-daytime SBP] × 100/daytime SBP). The primary outcome was CKD progression, defined as a composite of ≥ a 50% decline in the estimated glomerular filtration rate from baseline or the initiation of kidney replacement therapy. During 4749 person-years of follow-up (median, 4.8 years), the composite outcome occurred in 380 (35.8%) participants. Compared to dippers, the hazard ratios (HRs) for the risk of adverse kidney outcomes were 1.02 (95% confidence interval [CI], 0.64-1.62), 1.30 (95% CI, 1.02-1.66), and 1.40 (95% CI, 1.03-1.90) for extreme dipper, non-dipper, and reverse dipper, respectively. In a continuous modeling, a 10% increase in diurnal SBP difference was associated with a 1.21-fold (95% CI, 1.07-1.37) higher risk of CKD progression. Thus, decreased nocturnal SBP decline was associated with adverse kidney outcomes in patients with CKD. Particularly, patients with non-dipping and reverse dipping patterns were at higher risk for CKD progression than those with a dipping pattern.

Effect of Short versus Long Duration Naps on Blood Pressure during Simulated Night Shift Work: A Randomized Crossover Trial

Objective Blunting of the sleep-related dip in blood pressure (BP) has been linked to numerous cardiovascular outcomes including myocardial infarction. Blunting of BP dipping occurs during night shift work and previous research suggest that a 60-min or longer on-shift nap is needed to restore normal/healthy BP dipping. We sought to determine the effect of different durations of napping on BP during and following simulated night shifts. We hypothesized that the greatest benefit in terms of restoration of normal BP dipping during night shift work would be observed during a longer duration nap versus a shorter nap opportunity. Methods We used a randomized crossover laboratory-based study design. Participants consented to complete three separate 72-hr conditions that included a 12-hr simulated night shift. Nap conditions included a 30-min and 2-hr nap compared to a no-nap condition. Ambulatory BP monitoring was assessed hourly and every 10-30 mins during in-lab naps. Blunted BP dipping during in-lab naps was the primary outcome. Goal enrollment of 25 (35 with attrition) provided 80% power to detect a mean difference of 5 mmHg in BP between nap conditions. Results Of the 58 screened, 28 were consented, and 26 completed all three 72-hr conditions. More than half (53.6%) were female. Mean age was 24.4 years (SD7.2). Most (85.7%) were certified as emergency medical technicians or paramedics. The mean percentage dip in systolic BP (SBP) and diastolic BP (DBP) did not differ between the 30-min and 2-hr nap conditions (p > 0.05), yet a greater proportion of participants experienced a 10-20% dip in SBP or DBP during the 2-hr nap versus the 30-min nap (p < 0.05). For every additional minute of total sleep during the 30-min nap, the percentage of SBP dip improved by 0.60%, and the percentage of DBP dip improved by 0.68% (p < 0.05). These improvements approximate to a 6% per minute relative advancement toward normal/healthy BP dipping. Conclusions Restoration of a normal/healthy dip in BP is achievable during short and long duration nap opportunities during simulated night shift work. Our findings support the hypothesis that BP dipping is more common during longer 2-hr versus shorter 30-min naps. Trial registration ClinicalTrials.gov, NCT04469803. Registered on 9 July 2020.

Ambulatory Blood Pressure Monitoring and Sleep Quality in Hypertensive Men and Women

Objectives: This study aims to provide major insight in 24-h ambulatory blood pressure monitoring (ABPM), which will describe the 24 h (Circadian rhythm) blood pressure (BP) profile by measuring its impact on the sleep quality. Materials and Methods: For the study, 25 men and 25 women were recruited. Sleep quality was assessed by the Pittsburgh Sleep Index. Using wrist actigraphy, sleep-quality was assessed during seven working non-ABPM days (starting point) and the three following 24-h ABPM days. Results: During the day, the average AMP was 139.2 10.9/83.4 8.6 mm Hg, while at night, it was 118.9 12.9/68.5 9.7 mm Hg. There were 40 dipper and 10 non-dipper, respectively, on the standard of a systolic BP dip of &lt;10%. Time had no bearing on total sleep time or sleep efficiency between ABPM days and non-ABPM days, indicating that ABPM has no negative effects on sleep quality. Conclusion: Both male and female having untreated hypertension were found to have disrupted sleep quality. Importantly, it is now evident that the ABPM has a negative impact on sleep quality for either dippers or non-dippers.

Influence of Hydration Status and Plasma Copeptin on Ambulatory Blood Pressure in Healthy Young Adults

BACKGROUND: Adequate hydration is essential for regulating various physiological systems and may influence blood pressure (BP). Hypohydration is linked with elevated copeptin (surrogate of arginine vasopressin), which is associated with elevated cardiovascular disease risk. However, there is limited information on the influence of hydration and copeptin on ambulatory BP measures in young adults. Therefore, we sought to investigate associations between hydration, copeptin, and ambulatory BP. METHODS: We studied 41 participants (19 M/22 F, 24 White/17 Black, age 21±1 years, body mass index 26±5 kg/m 2 , screening BP 111± 10/67±8 mmHg; Mean ± SD) who provided a 24-hour urine sample. We measured urine specific gravity (USG), urine osmolality (OSM), and plasma copeptin as biomarkers of hydration. We used ambulatory BP monitoring (Suntech Oscar2) to assess BP during daytime (1000-2000) and nighttime (0000-0600). Our primary outcomes were plasma copeptin (pmol/L) and night-to-day BP dip ratio (nighttime/daytime BP) in dehydrated (USG &gt;1.020 or OSM &gt;800 mOsm/kg) vs euhydrated participants. Statistical procedures included Student’s t-tests and Mann-Whitney U tests. We also used Spearman’s rho correlation (controlling for BMI, sex, and race). We set α at ≤0.05. RESULTS: Copeptin concentration was elevated in dehydrated compared with euhydrated participants (USG: 6.6±2.9 vs 4.3±2.0 pmol/L, p&lt;0.005; OSM: 6.6±2.7 vs 4.1±2.0 pmol/L, p&lt;0.001). After controlling for BMI, sex, and race, copeptin was associated with USG (rho=0.44, p=0.005) and OSM (rho=0.51, p=0.001). Systolic and diastolic BP dip ratios did not differ by hydration status for either USG or OSM ( ps&gt;0.179). Additionally, adjusted BP dip ratios were not correlated with OSM or USG ( ps&gt;0.149). Plasma copeptin was not associated with BP dip ratios ( ps&gt;0.155) but was associated with absolute nocturnal systolic (rho=-0.34, p=0.036) and diastolic BP dip (rho=-0.33, p=0.041). When we split participants by low and high copeptin concentration (median split), higher copeptin was associated with a lower (i.e., worse) systolic BP dip ratio (0.87±0.06 vs 0.90±0.06, p=0.048) and lower absolute nocturnal systolic and diastolic BP dip ( ps&lt;0.01). CONCLUSIONS: Hydration biomarkers were correlated with plasma copeptin, but not ambulatory BP. The significance of our findings are that higher copeptin was associated with blunted nocturnal BP dipping in younger adults, which could predispose them to increased future cardiovascular disease risk. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The disidentification component of decentering is a predictor of nighttime systolic and diastolic blood pressure dipping

Decentering is a component of mindfulness related to being able to separate from emotions and to adopt a non-judgmental view. Prior studies on 8-week mindfulness-based stress reduction (MBSR) courses have demonstrated that as the ability to decenter increases, anxiety levels decrease. One of our recent studies demonstrated that a higher ability to decenter was associated with lower arterial stiffness. The purpose of this study was to determine if any of the three constructs of decentering (i.e., meta-awareness, disidentification, and nonreactivity) influences nocturnal blood pressure dipping. Twenty-eight adults (age 25±1 years; BMI 26±1 kg/m2) with resting blood pressure ≥120/80 mmHg volunteered for this study. All participants were non-obese, and reported no history of diabetes, smoking, or taking cardiovascular medication. Participants completed an 11-item decentering questionnaire, and then were asked to wear an ambulatory blood pressure monitor (ABPM) and actigraphy watch for 24-hours. Brachial blood pressures were measured by the ABPM every 20 minutes while awake and every 30 minutes while asleep. Daytime and nighttime systolic arterial pressures (SAP) and diastolic arterial pressures (DAP) were measured by the Spacelabs ABPM, and we calculated nighttime dipping percentages for SAP and DAP after adjusting sleep and wake times based on actigraphy data. To identify the factor structure for the decentering scale, Exploratory Factor Analysis (EFA) was performed. EFA revealed a nine-item, three-factor structure that explained 71.53% of the total variance, consisting of meta-awareness (two-items; 13.37%), disidentification (three-items; 41.11%), and nonreactivity (four-items; 17.05%). Two items were dropped from the final scale due to improper factor loadings. The items for each of the three factors were submitted to a reliability analysis, revealing acceptable Cronbach’s alpha (α &gt; 0.70) for meta-awareness (α = 0.71), disidentification (α = 0.79), and nonreactivity (α = 0.75). Multiple linear regression analyses indicated disidentification as a significant predictor of SAP dipping (β = 3.333, p = 0.032) and DAP dipping (β = 3.898, p = 0.049). The meta-awareness and nonreactivity constructs of decentering were not significant predictors of nighttime blood pressure dipping. Results suggest that greater disidentification may be associated with lower cardiovascular risk (greater SAP and DAP dipping). These findings provide promising insight into the benefits of MBSR and decentering on ambulatory blood pressure patterns, with the potential benefits of lowering overall risk for cardiovascular disease (CVD). NIH (1R15HL140596-01); Nils K. Nelson Endowment Fund This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Office blood pressure versus ambulatory blood pressure measurement in childhood obesity

BackgroundThe prevalence of obesity-related co-morbidities is rising parallel to the childhood obesity epidemic. High blood pressure (BP), as one of these co-morbidities, is detected nowadays at increasingly younger ages. The diagnosis of elevated BP and hypertension, especially in the childhood population, presents a challenge to clinicians. The added value of ambulatory blood pressure measurement (ABPM) in relation to office blood pressure (OBP) measurements in obese children is unclear. Furthermore, it is unknown how many overweight and obese children have an abnormal ABPM pattern. In this study we evaluated ABPM patterns in a population of overweight and obese children and adolescents, and compared these patterns with regular OBP measurements.MethodsIn this cross-sectional study in overweight or obese children and adolescents aged 4–17 years who were referred to secondary pediatric obesity care in a large general hospital in The Netherlands, OBP was measured during a regular outpatient clinic visit. Additionally, all participants underwent a 24-hour ABPM on a regular week-day. Outcome measures were OBP, mean ambulatory SBP and DBP, BP load (percentage of readings above the ambulatory 95th blood pressure percentiles), ambulatory BP pattern (normal BP, white-coat hypertension, elevated BP, masked hypertension, ambulatory hypertension), and BP dipping.ResultsWe included 82 children aged 4–17 years. They had a mean BMI Z-score of 3.3 (standard deviation 0.6). Using ABPM, 54.9% of the children were normotensive (95% confidence interval 44.1–65.2), 26.8% had elevated BP, 9.8% ambulatory hypertension, 3.7% masked hypertension, and 4.9% white-coat hypertension. An isolated night-time BP load > 25% was detected in almost a quarter of the children. 40% of the participants lacked physiologic nocturnal systolic BP dipping. In the group of children with normal OBP, 22.2% turned out to have either elevated BP or masked hypertension on ABPM.ConclusionsIn this study a high prevalence of abnormal ABPM patterns in overweight or obese children and adolescents was detected. Additionally, OBP poorly correlated with the child’s actual ABPM pattern. Herewith, we emphasized the usefulness of ABPM as an important diagnostic tool in this population.

Implications of Inflammatory and Oxidative Stress Markers in the Attenuation of Nocturnal Blood Pressure Dipping.

To date, no model has jointly encompassed clinical, inflammatory, and redox markers with the risk of a non-dipper blood pressure (BP) profile. We aimed to evaluate the correlation between these features and the main twenty-four-hour ambulatory blood pressure monitoring (24-h ABPM) indices, as well as to establish a multivariate model including inflammatory, redox, and clinical markers for the prediction of a non-dipper BP profile. This was an observational study that included hypertensive patients older than 18 years. We enrolled 247 hypertensive patients (56% women) with a median age of 56 years. The results showed that higher levels of fibrinogen, tissue polypeptide-specific antigen, beta-2-microglobulin, thiobarbituric acid reactive substances, and copper/zinc ratio were associated with a higher risk of a non-dipper BP profile. Nocturnal systolic BP dipping showed a negative correlation with beta-globulin, beta-2-microglobulin, and gamma-globulin levels, whereas nocturnal diastolic BP dipping was positively correlated with alpha-2-globulin levels, and negatively correlated with gamma-globulin and copper levels. We found a correlation between nocturnal pulse pressure and beta-2-microglobulin and vitamin E levels, whereas the day-to-night pulse pressure gradient was correlated with zinc levels. Twenty-four-hour ABPM indices could exhibit singular inflammatory and redox patterns with implications that are still poorly understood. Some inflammatory and redox markers could be associated with the risk of a non-dipper BP profile.

S-58-2: CUFFLESS WEARABLE 24-HOUR BLOOD PRESSURE MONIT ORING VERSUS STANDARD AMBULATORY MONITORING

Objective: Cuffless wearable blood pressure (BP) monitors have great potential in assessing 24-hour BP without user disturbance for weeks and months. However, it is uncertain whether these devices can accurately track BP changes during usual daily activities and sleep as with standard 24-hour ambulatory BP monitoring (ABPM). We assessed daytime and nighttime BP using a commercially available cuffless wearable BP device versus classic ABPM. Design and method: We included 45 individuals (age 58 ± 14 years [mean ± SD], 33% female, 80% hypertensive) in two centres (Perth, Australia; Athens, Greece). Participants used a cuffless wearable BP monitor (Aktiia, Switzerland) continuously for 7–10 days and 24-hour ABPM (MicroLife WatchBP O3, Switzerland) on the first and the last day of cuffless BP monitoring. Daily 24-hour, daytime, and nighttime BP values were averaged across the total study days for the cuffless device and across the two ABPM days. Results: The cuffless device reported higher systolic BP for 24-hours by 6.8 mmHg, 95%CI [3.7, 9.7], daytime by 3.8 mmHg [1.0, 6.7], and nighttime by 17.5 mmHg [13.6, 21.4] (all p &lt; 0.01). Cuffless 24-hour diastolic BP was comparable with ABPM (difference 1.2 mmHg, 95%CI [-1.0, 3.5]), as was daytime diastolic BP (-0.8 mmHg [-3.0, 1.3]) (both p. &lt; 27). However, the cuffless device reported higher nighttime diastolic BP by 9.2 mmHg, 95%CI [6.3, 12.2] (p &lt; 0.001). Nighttime dip as measured by the cuffless device, namely systolic BP (-5.1 mmHg, 95%CI [-13.7, 3.6]) and diastolic BP (-3.8 mmHg [-11.6, 4.2]) were substantially less than ABPM (systolic BP dip: -18.0 mmHg [-35.5, -1.2]; diastolic BP dip: -13.8 mmHg [-27.2, -0.8]). The cuffless device identified 44 nighttime non-dippers (defined as a relative dip &lt; 10%) for systolic BP and 42 non-dippers for diastolic BP, compared to 10 non-dippers for both systolic and diastolic BP as identified by ABPM (both comparisons p &lt; 0.001). Conclusions: The Aktiia cuffless wearable BP device considerably overestimated average systolic BP compared to classic ABPM and was unable to adequately track diurnal BP variation.

Reduced Blood Pressure Dipping Is A Risk Factor for the Progression of Chronic Kidney Disease in Children.

Background: Elevated blood pressure and proteinuria are well-established risk factors for chronic kidney disease (CKD) progression in children. This study aimed to analyze risk factors for CKD progress, emphasizing detailed ambulatory blood pressure (ABPM) data. Methods: In 55 children with CKD II–V, observed for ≥1 year or until initiation of kidney replacement therapy, we analyzed ABPM, clinical, and biochemical parameters. Results: At the beginning, the glomerular filtration rate (eGFR) was 66 (interquartile range—IQR: 42.8–75.3) mL/min/1.73 m2, and the observation period was 27 (16–36) months. The mean eGFR decline was 2.9 ± 5.7 mL/min/1.73 m2/year. eGFR decline correlated (p < 0.05) with age (r = 0.30), initial proteinuria (r = 0.31), nighttime systolic and mean blood pressure (r = 0.27, r = 0.29), and systolic and diastolic blood pressure dipping (r = −0.37, r = −0.29). There was no relation between mean arterial pressure during 24 h (MAP 24 h Z-score) and eGFR decline and no difference in eGFR decline between those with MAP 24 h < and ≥50 th percentile. In multivariate analysis, systolic blood pressure dipping (beta = −0.43), presence of proteinuria (beta = −0.35), and age (beta = 0.25) were predictors of eGFR decline. Conclusions: Systolic blood pressure dipping may be a valuable indicator of CKD progression in children.

Abstract 088: Comparison Of 24-hour Blood Pressure Tracking Between A Commercially Available Cuffless Wearable Device And Standard Ambulatory Monitoring

Introduction: Cuffless blood pressure (BP) monitoring offers great potential in assessing 24-hour BP without user disturbance. Despite the myriad of commercially available cuffless BP devices, it is uncertain whether these devices can accurately track BP changes during usual daily activities and sleep as with standard 24-hour ambulatory BP monitoring (ABPM). Hypothesis: A commercially available cuffless wearable BP device, previously demonstrated to have good accuracy for seated BP, can track 24-hour BP changes as well as standard ABPM. Methods: We included 45 individuals (36 hypertensive, 15 female, age 58±14 years [mean±SD]) in two centres (Perth, Australia; Athens, Greece). Participants used a cuffless wearable BP device (Aktiia, Switzerland) continuously for 7-10 days and 24-hour ABPM (MicroLife WatchBP O3, Switzerland) on the first and the last day of cuffless BP monitoring. Daily 24-hour, daytime, and nighttime BP values were averaged across the total study days for the cuffless device and across the two ABPM days. Results: Compared to ABPM, the cuffless device reported higher 24-hour systolic BP (SBP) by 6.8 mmHg, 95% CI [3.7, 9.7], higher daytime SBP by 3.8 mmHg [1.0, 6.7], and higher nighttime SBP by 17.5 mmHg [13.6, 21.4] (all p≤0.01). Cuffless 24-hour diastolic BP (DBP) was comparable with ABPM (difference 1.2 mmHg, 95% CI [-1.0, 3.5]), as was daytime DBP (difference -0.8 mmHg, [-3.0, 1.3]) (both p≥0.27), but nighttime DBP was higher by 9.2 mmHg, [6.3, 12.2] (p&lt;0.001). Nighttime dip in SBP (-5.1 mmHg, 95% CI [-13.7, 3.6]) and DBP (-3.8 mmHg, [-11.6, 4.2]) as measured by the cuffless device were substantially less than ABPM (SBP dip: -18.0 mmHg, [-35.5, -1.2]; DBP dip: -13.8 mmHg, [-27.2, -0.8]). The cuffless device identified 44 nighttime non-dippers (defined as a relative dip &lt; 10%) for SBP and 42 non-dippers for DBP, compared to 10 non-dippers for both SBP and DBP as identified by ABPM (both comparisons p&lt;0.001). Conclusions: A commercially available cuffless wearable BP device was unable to adequately track diurnal BP variation and considerably overestimated average SBP over 24 hours as compared to standard ABPM.