Blood Pressure Dipping Research Articles

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.

Assessing the relationship between lipoprotein(a) levels and blood pressure among hypertensive patients beyond conventional measures. An observational study

High lipoprotein(a) (Lp(a)) levels are associated with an increased risk of arterial hypertension (AHT) and atherosclerotic cardiovascular disease. However, little is known about the detailed profile of AHT based on Lp(a) levels. This observational study focused on elucidating the relationship between Lp(a) concentrations and specific indices obtained from 24-h ambulatory blood pressure (BP) monitoring in hypertensive patients over 18 years of age. We gathered and analyzed data on BP indices along with demographic, epidemiological, clinical, and laboratory variables from 227 hypertensive patients, median age 56 years, including 127 women (56%). After comparing hypertensive patients with Lp(a) levels above and below 125 nmol/L, we found that a 10 mmHg increase in nocturnal systolic BP and all pulse pressure indices (24-h, daytime, and night-time) was associated with an increased risk of high Lp(a) levels by more than 20% and 40%, respectively. Similarly, each 10% increase in the area under the function over time of nocturnal diastolic BP dipping was associated with more than a 30% decrease in the odds of belonging to the elevated Lp(a) levels category. Additionally, Lp(a) levels above 125 nmol/L were associated with higher 24-h, daytime, and night-time systolic BP and pulse pressure load. The relationship between Lp(a) and AHT appears to extend beyond conventional BP measurements, which may be relevant given the prognostic implications of nocturnal BP and pulse pressure indices.

While You Are Sleeping: Marital Ambivalence and Blunted Nocturnal Blood Pressure.

Marital relationships offer health benefits, including a lower risk of cardiovascular disease (CVD). However, quality of the relationship matters; ambivalent behaviors may increase CVD risk by affecting blunted nocturnal blood pressure (BP) dipping. This study tracked daytime and nocturnal SBP and DBP in 180 normotensive individuals (90 couples; participant mean age 25.04; 91.58% white) over a 24 h period using ambulatory blood pressure monitors to explore the impact of martial quality. Results showed that perceptions of spousal ambivalence were associated with blunted nocturnal BP dipping. Perceptions of one's own behavior as ambivalent also showed blunted nocturnal dipping. When in an ambivalent relationship, a gender interaction was found such that women were most likely to have blunted SBP dipping, but men were more likely to have blunted nocturnal DBP dipping. Overall, this study found an association between ambivalence and BP dipping, thus uncovering one virtually unexplored pathway by which marital relationships may have adverse effects on health.

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.

Effects of rotating shift work schedule on blood pressure dipping profile in healthy nurses

Effects of rotating shift work schedule on blood pressure dipping profile in healthy nurses

Sex difference in nocturnal blood pressure dipping in adolescents with varying degrees of adiposity

BackgroundFor adolescents, abnormal dipping patterns in blood pressure (BP) are associated with early-onset organ damage and a higher risk of cardiovascular disorders in adulthood. Obesity is one of the most common reasons for abnormal BP dipping in young people. However, it is unknown whether the severity of obesity is associated with BP dipping status and whether this association is sex-dependent.Methods499 participants between 12 and 17 years old with overweight or obesity underwent ambulatory blood pressure monitoring (ABPM) between April 2018 and January 2019 in Beijing and Baoding. Participants were grouped by body mass index (BMI) into overweight (BMI 85th–95th percentile), obese (BMI ≥ 95th percentile) and severely obese (BMI ≥ 120% of 95th percentile or ≥ 35 kg/m2) groups. Non-dipping was defined as a < 10% reduction in BP from day to night. The interaction effect between sex and obesity degree was also analyzed.Results326 boys and 173 girls were included, of whom 130 were overweight, 189 were obese, and 180 were severely obese. Girls with severe obesity had a higher prevalence of non-dipping, but boys showed no significant differences in BP dipping status between obesity categories. In addition, as obesity severity went up, a more evident increase in night-time SBP was observed in girls than in boys.ConclusionsSeverely obese is associated with a higher prevalence of non-BP dipping patterns in girls than in boys, which suggests that the relationship between the severity of obesity and BP dipping status might be sex-specific.

Ambulatory Blood Pressure in Patients With Rheumatoid Arthritis: Association With Immune Activation.

The prevalence of hypertension, a major cardiovascular risk factor, is increased in patients with rheumatoid arthritis (RA) and may be driven by immune activation. The purpose of this study was to determine if ambulatory 24-hour blood pressure (BP) is elevated in RA vs control participants and whether it is associated with immune activation. We conducted a cross-sectional study of 46 patients with RA and 23 control participants. Participants wore an ambulatory BP monitor that obtained diurnal BP every 15-30 minutes and nocturnal BP every 30 minutes. Inflammatory mediators in plasma were measured using an inflammation proteomics panel. Differences in BP measurements were assessed by Mann-Whitney U test, and association with inflammatory mediators was assessed by Spearman correlation. Patients with RA and control participants had similar office BP, but median ambulatory systolic BP (SBP) measurements (24-hour [RA 121 mmHg vs control 116 mmHg; P = 0.01], diurnal [RA 128 mmHg vs control 120 mmHg; P = 0.003], and nocturnal [RA 112 mmHg vs control 103 mmHg; P = 0.002]) were higher in patients with RA. Patients with RA also had higher nocturnal diastolic BP (DBP; RA 63 mmHg vs control 57 mmHg; P = 0.02), but other DBP measurements were similar. Nocturnal BP dipping was less in patients with RA (12%) compared to control participants (16%; P = 0.02). In patients with RA, higher 24-hour and nocturnal SBPs and less nocturnal dipping were strongly correlated with a wide range of inflammatory mediators. Despite similar office measurements, 24-hour and nocturnal SBP measurements were higher in patients with RA than in control participants and were strongly associated with inflammation.

Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities.

Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus. To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.

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.

NOCTURNAL BLOOD PRESSURE FLUCTUATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Objective: Reverse dipping of nocturnal blood pressure (BP) is a sensitive predictor of cardiovascular morbidity and mortality. Nocturnal blood pressure fluctuations (NBPF) related to obstructive sleep apnea may be causative. Studies based on ambulatory blood pressure measurements (ABPM) can only provide mean BP values and long-term BP variability due to low frequent variability during the night. This limits the explanatory power of the method. Here, we apply non-invasive, continuously measuring methods to investigate NBPF in patients with obstructive sleep apnea syndrome (OSAS). Design and method: In a first study, we included 34 patients with suspected diagnosis of sleep apnea undergoing polysomnography. BP was estimated using pulse transit time (PTT, SOMNOscreenTM) as well as measured by Portapres®. In a second study, we included 97 patients with an apnea/hypopnea index greater than 30 (severe OSA). The systolic BP (SBP) was continuously determined using PTT (SOMNOscreenTM) during polysomnography. Results: In the first study, 11 patients with OSA were analyzed. Sleep apnea related SBP fluctuations &gt;8mmHg measured by Portapres™ were included. Both, the PTT-based method and Portapres® detected the same apnea related SBP fluctuations during night. Bland Altman plot showed a mean difference &lt;1mmHg between both methods, with limits of agreement of ±13.4 mmHg. Mean apnea related SBP fluctuations were between 28 and 29 mmHg for both methods. In the second study, we found, in addition to normal NBPFs, BP fluctuations arranged like steps in 48 patients. Thereby, the SBP decrease after the event did not reach the level before the apnea. This led to a continuous increase of the SBP baseline called “superposition” of BP. Further, this phenomenon resulted in extremely high SBP values in some of the patients. Conclusions: BP fluctuations induced by OSA may contribute to the non-dipping/reverse dipping phenomena in OSA patients. The continuously measuring methods used here offer detailed insight into patterns of BP fluctuations. This improves our understanding of BP control during night time and helps to identify patients with increased risk for cardiovascular events.

EXERCISE AS MEDICINE; CHRONOTHERAPY IN HYPERTENSION MANAGEMENT

Objective: Adequate blood pressure regulation is a critical target in the management of hypertension and CVD. Circadian rhythms are increasingly recognized for their impacts on health outcomes including vascular function and metabolism. We posited that optimized exercise combined with chronotherapy will lead to meaningful improvements in BP, vascular health, and cardiovascular outcomes by coordinating the timing of interventions with diurnal rhythms. Design and method: Our studies, funded by National Institute of Health (NIH), are focused on ambulatory BP monitoring (ABPM) to capture circadian variations in BP, including nocturnal BP and morning surge. In particular, the project focuses on the efficacy of physical activity to improve nocturnal BP. We are using a 48-hr period of ABPM to reliably access nocturnal BP, which has not been implemented in other exercise studies focusing on ambulatory BP, in addition to measuring sleep with actigraphy. Given nocturnal BP is recognized as a strong indicator of cardiovascular health and outcomes, examining how interventions modify this ambulatory BP outcome is needed to understand the effect of the intervention on health and future risk. Results: Our preliminary data on all non-Hispanic 22 female subjects included 7 African Americans with average age of 68 and average BMI of 30.6. Mean seated BP (all BP values reported in mm of Hg) was 135/73 while awake BP from ABPM was 135/76 and awake central BP (calculated with device using a proprietary algorithm) was 126/78. Mean asleep BP determined from analysis of wrist actigraphy data was 117/61 and mean asleep central BP was 112/64. Mean nocturnal BP (calculated by average of the 4 lowest systolic blood pressure measures during the asleep period, waiting at least 1 hour after going to bed) was 116.7/61.6. Average nocturnal systolic dip was 30.4 and nocturnal diastolic dip was 14.4 with percentage nocturnal dips at 20.3% and 14.2% respectively. Conclusions: In our preliminary results, we found that evening exercise as chronotherapy in hypertensive post-menopausal patients showed significant nocturnal dipping of blood pressure.

ACCURACY AND BLOOD PRESSURE THRESHOLD CONTROL ANALYSIS OF UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT: A CROSS-SECTIONAL STUDY BASED ON MULTICENTER POPULATIONS

Objective: The emergence of unattended automated office blood pressure (u-AOBP) measurement, facilitated by the flourishing development of electronic blood pressure monitors, has been proposed as a potential alternative or complementary approach for assessing patients’ blood pressure status within clinical settings. However, robust evidence is lacking to determine its application in diagnosing hypertension within the clinical practice in China. This study aims to compare u-AOBP values with standard office blood pressure data, assess the correlation between u-AOBP and diagnostic thresholds. Design and method: The study involved participants recruited from October 2023 to February 2024 in three hospitals: People's Hospital of Gongyi City in Henan Province, Nangong City Hospital in Hebei Province, and Fuwai Hospital of the Chinese Academy of Medical Sciences. Standardized validated upper arm blood pressure monitors were used to measure blood pressure. Baseline demographic data, anthropometric measurements, u-AOBP, and standard office blood pressure data were collected, along with additional examination results, including echocardiograms and 24-hour ambulatory blood pressure monitoring. Results: 1. The difference between u-AOBP and awake dynamic average blood pressure was 1.34 mmHg (95% confidence interval: 0.88-3.55 mmHg), and the difference was not statistically significant (P = 0.236). 2. The optimal cutoff values for diagnosing elevated blood pressure using u-AOBP, determined by ROC curve analysis based on awake dynamic blood pressure measurements, were 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%). 3. In participants with a dipper blood pressure diurnal rhythm, there was no statistically significant difference between standard office blood pressure and u-AOBP measurements (P &gt; 0.05). However, in the group including non-dipper rhythm participants, standard office blood pressure was higher than u-AOBP by 5.84/4.98 mmHg (P &lt; 0.05). Conclusions: 1. Unattended automated blood pressure measurements can reduce, but not eliminate, the white coat effect, with an optimal cutoff value for diagnosing elevated blood pressure determined as 130.75/83.75 mmHg. 2. In individuals with a normal dipper blood pressure diurnal rhythm, standardized u-AOBP values are equivalent to standard office blood pressure.

RENAL DENERVATION RESULTS IN SUBSTANTIAL NOCTURNAL BP REDUCTION IN PATIENTS WITH A REVERSED DIPPING PATTERN

Objective: We characterized patients with reverse blood pressure (BP) dipping pattern and uncontrolled hypertension (HTN) at baseline referred for radiofrequency renal denervation (RF RDN), and their subsequent BP changes. Design and method: Patients with HTN were enrolled into the Global SYMPLICITY Registry (GSR) DEFINE and underwent RF RDN. Patients were grouped into different BP dipping patterns defined by night/daytime BP ratio: dippers (ratio 0.9 or below), non-dippers (ratio 0.9 to 1.0 or below), reverse dippers (ratio &gt;1.0). Baseline characteristics and BP changes through 3yrs were compared between groups based on dipper patterns. Statistical significance was defined as p&lt;0.05. Results: As of March 2023, 3331 patients with uncontrolled BP were enrolled, 2276 of whom had 24-h BP measures and could be categorized by dipping patterns. Majority of the patients were non-dippers (44.3%), followed by dippers (34.6%) and reverse dippers (21.1%). Reverse dippers (n=480) were the oldest (62±12yrs; p=0.0024), more likely to have cardiac disease (54.2%; p&lt;0.0001), diabetes (48.1%; p&lt;0.0001) and renal disease (38.9%; p&lt;0.0001). Reverse dippers had the highest baseline 24-h ambulatory systolic BP (SBP) (156±19mmHg; p&lt;0.0001) and nighttime SBP (163±21; p&lt;0.0001). In contrast, they had the lowest daytime SBP (153±19mmHg; p&lt;0.0001) and heart rate (66±11bpm; p&lt;0.0001). Reverse dippers were prescribed the most antihypertensive drugs (5.2±1.7; p=0.0058). 3yrs after RF RDN, significant overall 24-h ambulatory SBP reduction from baseline was observed within all dipping patterns, and the largest reduction was observed within reverse dippers (-11.8±25.1mmHg; Figure), particularly in the nighttime (-21.1±23.8mmHg). Conclusions: Reverse dippers with uncontrolled HTN referred for RDN were prescribed more antihypertensive drugs and had more comorbidities compared to patients with other dipping patterns. After RF RDN, significant SBP changes from baseline were observed irrespective of dipping status. The largest BP reduction was observed in nighttime BP in patients with reverse dipping pattern. RF RDN may offer an effective adjunctive therapy to drugs to lower nighttime BP patients with a reverse dipping pattern, who have the highest risk of cardiovascular events.

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

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

NIGHTTIME BLOOD PRESSURE ASSESSED USING HOME MONITORING IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES/PREDIABETES: ASSOCIATION AND AGREEMENT WITH AMBULATORY MONITORING

Objective: To investigate the agreement between nighttime blood pressure (BP) measurements using home (HBPM) or ambulatory BP monitors (ABPM) in individuals with hypertension and type 2 diabetes mellitus (DM2) or prediabetes. Design and method: Adults with hypertension (treated or untreated) and DM2 or prediabetes underwent ABPM (measurements at 20 minutes intervals, Microlife WatchBP03) and HBPM (duplicate morning/evening measurements for 7 days, 3 nights with 3 measurements/night, Microlife WatchBP Home-N). Nighttime hypertension was defined as BP &gt;= 120/70 mmHg (systolic/diastolic). Nighttime BP dipping was calculated as the ratio of nighttime BP decline to the daytime levels. Individuals with nighttime BP dip (systolic and/or diastolic) &lt;10% were classified as non-dippers. Results: Data from 113 participants were analyzed (mean age [SD] 65±9.1 years, 67% men, body mass index 30.7±4.8 kg/m2, 84% with DM2, 22% cardiovascular disease, 94% treated hypertension). Average daytime HBPM was 129.2±13.2/73.3±7.8 mmHg and ABPM 126.7±12.1/72.5±7.4 mmHg (systolic/diastolic, p&lt;0.01/p=NS), whilst nighttime HBPM was 115.3±13.1/63.6±7.6 mmHg and ABPM 113.9±13.4/63±7.1 mmHg (systolic/diastolic, p&lt;0.05/p=NS). Strong correlation was observed between HBPM and ABPM levels: daytime r=0.71/0.74 and nighttime 0.86/0.78, systolic/diastolic, p&lt;0.01)]. Good agreement was also found between ABPM and HBPM in diagnosing nighttime hypertension (81%/90%; kappa=0.55/0.70 systolic/diastolic). Among the participants, 32%/31% were classified as non-dippers (HBPM/ABPM, p=NS), with a 74% agreement (kappa=0.41) in detecting non-dippers. Conclusions: These preliminary findings indicate that in individuals with hypertension and DM2 or prediabetes, nighttime BP assessed by a novel home monitor is feasible and shows strong correlation and satisfactory agreement with reference ABPM in detecting nighttime hypertension and non-dipping.

MASKED HYPERTENSION IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE – AN UNDERESTIMATED RISK?

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension are major cardiovascular risk factors sharing a bi-directional relationship. Although nearly half of MASLD patients are suffering from arterial hypertension, data on the prevalence of different hypertension phenotypes (e.g. masked hypertension) in this patient population are scarce. Masked hypertension, which is defined by normal office blood pressure but elevated blood pressure in the ambulatory 24-hour blood pressure measurement (24-h-ABPM), often remains undetected, although it has a comparable risk for adverse cardiovascular events as sustained hypertension. Therefore, the identification of this hypertension phenotype in MASLD patients seems highly relevant. Design and method: To analyze the prevalence of masked hypertension and to improve hypertension management in MASLD patients we integrated a 24-h-ABPM-based hypertension screening and control program among MASLD patients in our outpatient liver department. A total of 226 MASLD patients were recruited during regular follow-up visits and recording of office blood pressure and 24-h-ABPM measurements were performed according to a standardized protocol. Results: For the final analysis, 218 data sets were evaluated. The median age of the included 218 patients was 51 years, 48.2% were female. 101 (46.3%) MASLD patients had prior history of hypertension. At the time of ABPM 93 (92.1%) of these patients received antihypertensive treatment. Masked hypertension was identified in 46 (21.1%) MASLD patients, 20 (43.5%) of whom were receiving antihypertensive treatment (masked uncontrolled hypertension). Interestingly, 14 (30.4%) MASLD patients with masked hypertension had isolated nocturnal masked hypertension. Furthermore, a non-dipping blood pressure pattern was recognized in 28 (60.9%) MASLD patients with masked hypertension. Conclusions: Due to the high rates of masked hypertension and abnormal nocturnal blood pressure dipping, which both represent important risk factors for adverse cardiovascular events, the establishment of hypertension screening and management programs in this high-risk population seems urgently needed. Controlled hypertension reduces the risk of cardiovascular events in this vulnerable population and, due to the strong link between MASLD and hypertension, possibly also slow the progression of MASLD to advanced liver fibrosis or cirrhosis.

Effects of chronotype on sleep, mood and cardiovascular circadian rhythms in rotating night shift medical workers.

Whether chronotype affects the health outcomes of night shift work populations is unknown. This study aimed to assess the influence of different chronotypes in the rotating night shift population on sleep status, mood, blood pressure (BP), and heart rate variability (HRV), as well as the circadian rhythm of BP and HRV. A total of 208 rotating night shift workers were included. All participants completed structured questionnaires to assess chronotype, mood and sleep status. During their daily lives outside of the night shift, they underwent 24-hour Holter electrocardiogram monitoring and 24-hour ambulatory blood pressure monitoring. Day-time and night-time BP and BP dipping were obtained. Day-time and night-time HRV values (SDNN, RMSSD, LF, HF, LF nu, SD1, SD2 and SD2/SD1) were calculated and fitted to the cosine period curve. Three circandian parameters (mesor, amplitude and acrophase) were extracted to quantify the circadian rhythm of the HRV indices. Among all three groups, E-type showed more fatigue and sleepiness. In addition, E-type showed blunted diastolic BP dipping. Notably, E-type showed association with higher RMSSD, LF, HF and SD1 in the night time, and higher mesors of RMSSD and LF and amplitude of SD2/SD1 in circadian analysis. Chronotype is a factor affecting fatigue, sleepiness and cardiovascular circadian rhythms of rotating night shift workers. Chronotype should be taken into consideration for managing night-shift rotation to promote occupational health.

Blood pressure trends following birth in infants born under 25 weeks’ gestational age: a retrospective cohort study

ObjectiveThe aim of our study was to describe postnatal blood pressure (BP) trends and evaluate relevant dynamics and outcomes for a subgroup of extremely preterm (EPT) infants.DesignRetrospective observational cohort study.SettingPatients...

Associations of sleep-related variables with reverse dipping patterns of blood pressure in α-synucleinopathies

IntroductionThe reverse dipping blood pressure (BP) pattern is very common in α-synucleinopathies. We aimed to explore the associations of sleep-related variables with abnormal BP circadian rhythms in Parkinson's disease (PD) and multiple system atrophy (MSA). MethodsA total of 126 patients, 76 with PD and 50 with MSA, were included. All participants underwent ambulatory BP monitoring and full-night polysomnography (PSG). We analyzed abnormal dipping patterns and sleep-related parameters, including moderate to severe obstructive sleep apnea (OSA), rapid eye movement behavior disorder (RBD), average oxygen saturation (SaO2%), lowest SaO2%, duration of SaO2% <90%, and apnea-hypopnea index (AHI). Binary logistic regression was performed to explore the associations between paraclinical variables, sleep-related variables, and reverse dipping patterns. ResultsReverse dipping patterns were predominant in patients with PD (58.5 %) and MSA (68.0 %). Patients with MSA had higher AHI, RBD, and lower average SaO2% than those with PD. Taking both diseases together as a whole group of α-synucleinopathies, logistic regression analysis indicates the Hoehn-Yahr stage (odds ratio [OR] = 2.00 for reverse systolic and 2.34 for reverse diastolic dipping patterns), moderate to severe OSA (OR = 2.71 for reverse systolic and 2.53 for reverse diastolic dipping patterns), average SaO2% (OR = 1.35 for reverse systolic dipping patterns), and male sex (OR = 2.70 for reverse diastolic dipping patterns) were independently associated with reverse dipping patterns. ConclusionsReverse dipping patterns were common in patients with PD and MSA. Hoehn-Yahr stage, moderate to severe OSA, average SaO2%, and male sex were associated with reverse dipping patterns in α-synucleinopathy.

Nocturnal blood pressure dipping, blood pressure variability, and cognitive function in early and middle-aged adults.

Higher nighttime blood pressure (BP), less BP dipping, and higher BP variability have been linked with worse cognitive function in the elderly. The goal of this study is to explore whether this relationship already exists in early and middle adulthood. We further examined whether ethnic differences between African Americans and European Americans in BP parameters can explain ethnic differences in cognitive function. 24-h ambulatory BP monitoring and cognitive function were obtained from 390 participants (average age: 37.2 years with a range of 25-50; 54.9% African Americans; 63.6% females). We observed that higher nighttime BP, decreased dipping, and higher variability were significantly associated with lower scores on the Picture Sequence Memory Test. Significant negative associations between variability and overall composite scores were also observed. No significant associations between average 24-h or daytime BP and cognitive function were observed. Ethnic differences in nighttime diastolic pressures and dipping can explain 6.81% to 10.8% of the ethnicity difference in the score of the Picture Sequence Memory Test (ps<.05). This study suggests that the associations of nighttime BP, dipping, and variability with cognitive function already exist in young and middle-aged adults. Ethnic differences in nighttime BP and dipping can at least partially explain ethnic differences in cognitive function. The stronger association of these parameters with cognitive function than daytime or average BP in this age range raises the importance of using ambulatory BP monitoring for more precise detection of abnormal BP patterns in young adulthood.