Dipper Group Research Articles

Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up

Purpose: Non-dipping blood pressure (BP) pattern has been associated with metabolic changes and cardiovascular events. With regard of diabetes, studies are scarce. Our aim was to investigate if there is an association between changes in dipping patterns and incidence of diabetes.Materials and methods: A 24-h ambulatory BP measurement was recorded in addition to other laboratory measurements, and a questionnaire and physical examination were carried out in the baseline study and after 21-year follow-up among a study population (n = 449) consisting of randomly selected middle-aged Finnish females and males without diabetes.Results: 128 (28.5%) developed diabetes during the follow-up. The incidence of new-onset diabetes was the highest, 41.0%, among those subjects who were non-dippers (their systolic BP declined <10% from daytime to nighttime) in the baseline and also in the follow-up study, while the incidence of diabetes was 19.6% in the dipper – dipper (a nighttime decline of systolic BP 10% or more) group (p = 0.003). The difference remained statistically significant after adjustment with age, sex, body mass index, fasting glucose, triglycerides, and insulin levels, smoking status, 24-h mean systolic BP, high-sensitivity C-reactive protein, estimated glomerular filtration and diuretics use. In logistic regression analysis, the non-dipper – non-dippers were at higher risk of diabetes compared with dipper – dipper group (OR = 2.27, 95% CI: 1.13–4.56, p = 0.022).Conclusions: Our prospective study shows that there is an independent association between non-dipping BP pattern and the incidence of diabetes in a 21-year follow-up.

Correlation between blood pressure rhythm and left ventricular structure and function in elderly hypertension patients

Objective To investigate the correlation between blood pressure rhythm and left ventricular structure and function in elderly hypertensive patients. Methods A total of 147 elderly patients with high blood pressure in the First Hospital of Longyan Affiliated to Fujian Medical University were selected.All the patients received 24h ambulatory blood pressure examination.According to the rhythm of blood pressure, the patients were divided into the dipper blood pressure group, the-non dipper type blood pressure group and the anti-dipper type blood pressure group.All patients were examined by echocardiography. Results According to the results of 24h dynamic blood pressure, the type of dipper blood pressure accounted for 11.56%(17 cases) in 147 elderly patients, non-dipper type blood pressure type accounted for 51.02%(75 cases), and the anti-dipper type of blood pressure type accounted for 37.41%(55 cases). The ventricular septal thickness(IVST), left ventricular diastolic inner diameter(LVEDD), left atrium inner diameter(LAD), left ventricle posterior wall thickness(LVPWT) and left ventricle mass index(LVMI) of the non-dipper blood pressure group were (10.56±1.51)mm, (50.17±4.31)mm, (34.65±5.78)mm, (9.26±0.98)mm, (102.31±23.23)g/m2, respectively.The IVST, LVEDD, LAD, LVPWT and LVMI of the anti-dipper blood pressure group were (10.51±1.86)mm, (50.20±3.66)mm, (36.96±4.22)mm, (9.42±0.99)mm, (110.47±31.96)g/m2, respectively.The IVST, LVEDD, LAD, LVPWT and LVMI of the dipper blood pressure group were (9.53±1.53)mm, (47.59±2.27)mm, (30.47±4.17)mm, (8.88±1.12)mm, (84.98±15.48)g/m2, respectively.The differences of IVST, LVEDD, LAD, LVPWT and LVMI in the three groups were statistically significant(F=1.172, 3.428, 1.006, 0.135, all P 0.05). The average daytime systolic pressure in the dipper blood pressure group was (143.06±13.70)mmHg, which was higher than that in the non-dipper blood pressure group[(133.25±13.28)mmHg] and anti-dipper blood pressure group[(131.16±12.26)mmHg], the differences were statistically significant(t=-2.734, -3.401, all P<0.05). The mean evening systolic pressure and the average nocturnal diastolic pressure of anti-dipper blood pressure group were (139.04±15.01)mmHg and (80.18±10.29)mmHg, respectively, which were higher than those of the dipper and non-dipper blood pressure group [(123.24±14.49)mmHg and (72.24±7.97)mmHg, (127.40±13.30)mmHg, (73.45±11.43)mmHg], the differences were statistically significant(t=3.822, 4.666, 2.919, 3.456, all P<0.05). LVMI was positively correlated with age, body mass index(BMI), low density lipoprotein(LDL-C), daytime average systolic pressure, night average systolic pressure, night average diastolic pressure, and 24h average systolic pressure(r=0.256, 0.241, 0.687, 0.251, 0.380, 0.203, 0.243, all P<0.05). Conclusion Anti-dipper blood pressure and non-dipper blood pressure have more significant damage to cardiac function and structure than dipper blood pressure in elderly patients with hypertension, and the elevation of nocturnal blood pressure is closely related to left heart structure and function damage.There is a high correlation between abnormal circadian rhythm of blood pressure and left ventricular hypertrophy in elderly hypertensive patients. Key words: Hypertension; Blood pressure; Circadian rhythm; Blood pressure monitoring, ambulatory; Echocardiography; Ventricular function, left; Cardiomegaly; Aged

Effect of circadian rhythm of diastolic blood pressure on diastolic function in elderly hypertensive patients

Objective To analyze the effects of 24-hour diurnal blood pressure rhythm (BPCR) changes on diastolic function in elderly hypertensive patients. Methods From February 2016 to February 2018, one hundred and twenty elderly patients with hypertension were divided into two groups according to their 24-hour ambulatory blood pressure status: dipper group with 65 cases (nocturnal blood pressure drop rate (>10%) and non-dipper group with 55 cases (nocturnal blood pressure drop rate<10%); ambulatory blood pressure and echocardiographic relaxation were detected.Posterior wall (PW), interventricular septum (IVS), left ventricular diameter (LVEDD), left ventricular mass index (LVM) and left ventricular mass index (LVMI) were examined.Fractional shortening (FS), stroke volume (SV), cardiac output (CO) and cardiac index (CI) were calculated, and peak flow time (A peak flow time total integration, ATVI) and peak flow velocity (A Pea) were measured.K flow rate ventricular (APFV); E peak flow time ventricular integral (ETVI), early Peak flow Velocity (EPFV) and left ventricular ejection fraction (LVEF) were detected. Results The 24 h DBP, 24 hSBP, nocturnal DBP, and nocturnal SBP in dipper group were (80.27±7.29) mmHg, (125.29±10.38) mmHg, (69.98±6.36) mmHg, (110.39±10.52) mmHg, which were lower than those of the noninvasive group ((83.82±7.51) mmHg, (130.89±10.71) mmHg, (79.81±6.84) mmHg, (126.83±10.92) mmHg), the differences were statistically significant (t=12.809, 13.954, 11.053, 13.289, P=0.042, 0.021, 0.014, 0.006). The EPFV in the dipper group was (65.02±11.83) cm/s, which was higher than that in the non-dipper group ((60.84±11.29) cm/s). The A/E, ATVI, and APFV in the dipper group were (1.03±0.58), (5.59±1.72) cm, (63.74±11.06) cm/s, respectively, lower than those in non-dipper group( (1.14±0.54), (6.11±1.68) cm, (68.82±11.17) cm/s), the differences were statistically significant (t=10.895, 11.643, 12.339, 10.854, P=0.032, 0.027, 0.013, 0.006). Left ventricular diastolic function was negatively correlated with daytime DBP (r=- 0.195, -0.217, -0.174, -0.173, P<0.05) and positively correlated with nighttime SBP(r=0.194, 0.171, 0.220, 0.206, P<0.05). Conclusion In elderly hypertensive patients, the left ventricular diastolic function and left ventricular hypertrophy are more serious in non-dipper patients, and it is necessary to strengthen the control of nocturnal blood pressure in elderly hypertensive patients. Key words: Blood pressure circadian rhythm; hypertension; elderly; diastolic function

Serum hs-CRP, YKL-40 and brain-derived neurotrophic factor (BDNF) associated biomarkers in non-dipper hypertension profile?

Abstract Background: Twenty-four hours dynamic blood pressure (BP) behaviour displays dipper profile defined as nocturnal systolic BP (SBP) reduction&gt;10% compared to daytime. Non-dipper profile, nocturnal absence of SBP fall, associates an increased cardiovascular risk. We investigated the concomitant association of inflammatory bio-markers - high-sensitivity- C-reactive protein (hs-CRP), Human Chitinase3-like1 (YKL-40) and autonomic nervous system (total brain-derived neurotrophic factor, BDNF) with respect to non-dipping blood pressure status. Material and method: Using 24h automatic BP measurements, 80 known hypertensive patients were divided into two groups: dipper group included fifty-one dipper patients (age 55.6 ±13.5 years) and non-dipper group consisted of 29 non-dipper subjects (62.07±12.03 years). Serum levels of hs-CRP were evaluated with enhanced immunoturbidimetric assay. Plasma levels of YKL-40 were measured by commercial sandwich ELISA using microplate coated with a monoclonal antibody for CHI3L1. Plasma levels of total BDNF were determined using quantitative sandwich enzyme-linked immunoassay. Statistical analysis of obtained data was performed. Results: In the non-dipper group, a significant positive association with age over 60 years, hs-CRP values above 1.90 mg/dl was observed along with increased mean values of YKL-40. Non-dipper status is independently and statistically significantly associated with elevated levels of hs-CRP (OR: 3.248, 95% CI: 1.022-10.317, p=0.046) in multivariate odds ratio analysis. No statistically significant positive association between a median total BDNF plasma level of 1430 pg/ml and the non-dipper hypertension profile was identified. Conclusion: Our study demonstrated that patients over 60 years, in particular, have a higher probability to present a non-dipping pattern of hypertension. hs-CRP and YKL-40 values are more likely to increase in the non-dipping hypertensive patients, and hs-CRP values above 1.9 mg/dl can identify the presence of a non-dipper blood pressure profile.

Effects of sleep situation on circadian rhythm of blood pressure in elderly patients with hypertension

Objective To explore the effects of sleep situation on circadian rhythm of blood pressure in elderly hypertension patients. Methods Two hundred and thirty patients (aged ≥60 years) with hypertension treated in the Department of Geriatric Cardiology of PLA General Hospital were enrolled in the study from October 2016 to December 2016. After admission, the clinical and laboratory tests data and examinations of the patients were collected and analyzed. The patients' sleep was investigated by Pittsburgh sleep quality index (PSQI). The ambulatory blood pressure rhythm was divided into three groups: reverse-dipper group (n=110), non-dipper group (n=86), and dipper group (n=34). The clinical data and sleep situation of different blood pressure rhythm groups were compared, and the effects of sleep situation on different blood pressure rhythm were analyzed. Results The total PSQI score with six domains[P 0.05)]was significantly lower in dipper group than in reverse-and non-dipper group.The sleep situation was significantly better in dipper group than in reverse-and non-dipper group (P<0.05). Multiple linear regression analysis showed a significant negative correlation between total PSQI score and nocturnal blood pressure drop after adjusting for risk factors of hypertension (β= -0.651, P<0.01). Furthermore, after further adjusting for the seven domains of the PSQI score, the negative correlation remained between the sleep time score and the nocturnal blood pressure drop (β= -1.926, P=0.031). The elderly hypertension patients with shorter sleep duration had a lower rate of nocturnal blood pressure decline, and were prone to present the reverse-dipper and non-dipper blood pressure rhythm. Conclusions The elderly hypertension patients with poor sleep quality, especially with short sleep duration, are prone to present the reverse-dipper and non-dipper blood pressure rhythm.Short sleep duration can be used as a predictor for abnormal blood pressure rhythm. Key words: Sleep; Hypertension; Circadian rhythm

Adropin and circadian variation of blood pressure.

Nocturnal hypertension and non-dipping pattern are often associated with endothelial dysfunction. Previous studies suggested that adropin, a novel secreted energy homeostasis protein, has the unique ability to regulate endothelial cell function. This study aims to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum adropin and high-sensitivity C-reactive protein (hsCRP) levels in patients with newly diagnosed untreated arterial hypertension. Twenty-four-hour ambulatory BP monitoring was recorded in 100 hypertensives (50 dippers, 50 non-dippers) and 50 healthy controls. Serum levels of adropin and hsCRP were measured and recorded. A strong correlation was found between night-time BP levels with adropin and hsCRP levels (p < 0.001). On the other hand, the non-dipper group demonstrated lower adropin levels compared to the dipper and normotensive groups: non dipper group, 2580 ± 457 pg/mL; dipper group, 3298 ± 530 pg/mL; normotensive group, 3681 ± 411 pg/mL; p < 0.001). HsCRP levels were significantly higher in the non-dipper group than in the two other groups (p = 0.017). In a multivariate logistic regression analysis, adropin (p = 0.012) and hsCRP (p = 0.039) were independently associated with a non-dipping pattern. Decreased adropin levels were found in the nocturnal hypertensive and non-dipper groups. Adropin and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that decreased levels of adropin in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to a possible future role of adropin in identifying hypertensive patients at higher risk of target organ damage.

Impact of abnormal circadian blood pressure profile on left atrial function assessed by 2D speckle tracking echocardiography and its effect on the functional capacity of hypertensive patients

Background The left atrial (LA) function has an important role in hypertension as it is strongly predictive of adverse cardiac events and death, assessment of the circadian blood pressure (BP) profile is more predictive than assessment of the office BP reading in estimating the cardiovascular risk. The 2D speckle tracking echocardiography (2D-STE) provides more insight into early hypertension-induced LA dysfunction. Aim The aim of this work is to assess the impact of abnormal circadian BP profile on LA function using 2D-STE and its effect on functional capacity in hypertensive patient with preserved ejection fraction assessed by conventional echocardiography. Patients and methods This work included 60 consecutive hypertensive patients with preserved ejection fraction by conventional echocardiography [mean age 48±5 years and body surface area (BSA) 1.9±1.1] they were classified into two groups according to the data derived from 24 h ambulatory BP, group 1: dipper group that included 28 patients (mean age 48±8 years and BSA 1.9±0.1) and group 2: nondipper group that included 32 patients (mean age 50±6 years and BSA 1.9±0.09). All patients were evaluated by comprehensive 2D and Doppler echocardiographic techniques, TDI and 2D-STE, ambulatory BP, and stress. Myocardial perfusion imaging using treadmill exercise test was done to exclude coronary artery disease (CAD) and to assess the functional capacity. Results The results showed a statistically high significant decrease in the average peak left atrial global longitudinal strain in group 2 (the nondipper group) (group 1=26±4 vs. 20.4±3.5 in group 2, P&lt;0.00), and a statistically significant decrease in the functional capacity parameter using treadmill metabolic equivalents (METs) in group 2 (group 1=7.3±1.4 vs. 6.2±0.8 in group 2, P&lt;0.01) in comparison with group 1. Also we found a significant positive correlation between the average peak atrial longitudinal strain and the functional capacity assessed by treadmill stress test (r=0.424, P=0.05). There were no other significant differences between the two groups with respect to other LA parameters by conventional echo Doppler, TDI, and 2D-STE. Conclusion Abnormal circadian BP profile add more deleterious effect on LA function in hypertensive patients as detected by 2D-STE that denotes more decrease in functional capacity and worse cardiac events.

Nocturnal diastolic blood pressure decline is associated with higher 25-hydroxyvitamin D level and standing plasma renin activity in a hypertensive population

ABSTRACTPatients with nondipper hypertension are known to carry a high risk of cardiovascular complications. Vitamin D deficiency is associated with hypertension. Because vitamin D deficiency activates the renin–angiotensin–aldosterone system (RAAS), we hypothesized that this vitamin would interact with the RAAS to influence blood pressure (BP) in nondipper hypertensive patients. We performed a cross-sectional analysis of 1,007 outpatients with hypertension (HTN). Dipper and nondipper patterns were detected, and the two groups were matched for clinical, laboratory, 25-hydroxyvitamin D (25OHD) levels, and ambulatory blood pressure recording. Plasma renin activity (PRA), angiotensin II, and plasma aldosterone concentration (PAC) were assessed in 174 patients treated with calcium channel blockers or no medication. The mean 25OHD concentration in the entire study population was 12.3ng/dL, and the prevalence of vitamin D deficiency was 87.0%. Dipper and nondipper HTN were noted in 187 patients (24.6%) and 573 patients (75.4%). 25OHD levels were similar between nondipper and dipper HTN groups. Forward stepwise logistic regression analysis showed that BMI and age were independent predictors of nondipper HTN. Neither 25OHD levels nor RAAS components were included in the model. In correlation analyses, nocturnal decline of diastolic BP was positively associated with 25OHD levels and standing PRA (r = 0.152 p = 0.045, r = 0.165 p = 0.038, respectively). The present study showed that vitamin D deficiency was astonishingly prevalent in hypertensive subjects residing in Xinjiang, China. There may be a weakly association of nocturnal DBP decline with 25OHD levels and standing PRA levels. We found no association between vitamin D deficiency and nondipper HTN.

Left atrial mechanical function and stiffness in patients with nondipper hypertension: A speckle tracking study

ABSTRACTBackground: Nondipper hypertension is associated with increased cardiovascular morbidity and mortality. Speckle tracking echocardiography is a novel and promising tool for detecting early changes in left atrial (LA) myocardial dysfunction. Our aim was to evaluate the LA mechanical function and stiffness in nondipper hypertensive patients by two-dimensional speckle tracking echocardiography strain parameters. Method: This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 nondipper patients (17 male, mean age 50.6 ± 5.4 years). LA volume indices, mitral annular velocities, and global longitudinal LA strain were measured. The ratio of E/e’ to LA strain was used as an index of LA stiffness. Results: Patients with nondipper hypertension showed increased LA volume indices and decreased LA global strain (25.3 ± 5.5 vs. 39.6 ± 9.9%, P < 0.001). LA stiffness was increased in patients with nondipper than in the dipper subjects (0.41 ± 0.15 vs. 0.19 ± 0.14, P < 0.001), and LA strain and LA stiffness were related to LA volume indices. Conclusion: Patients with nondipper hypertension have decreased LA global strain and increased stiffness, in comparison with dipper group. LA stiffness and LA strain were significantly related to LA volume indices. LA stiffness and LA strain can be used for the assessment of LA function in patients with nondipper hypertension.

Non-dipper hypertension is associated with slow coronary flow among hypertensives with normal coronary angiogram.

SummaryAimA person with a drop of more than 10% in nocturnal arterial blood pressure during the circadian rhythm is referred to as a dipper and one with a smaller decrease is referred to as a non-dipper. In our study, we aimed to compare the thrombolysis in myocardial infarction (TIMI) frame count in non-dipper and dipper hypertensive patient groups who had normal coronary artery angiographyMethodsPatients with normal coronary arteries and with ambulatory blood pressure monitoring follow ups were retrospectively investigated and 60 patients (35%, female) were included in our study. The patients were grouped as dipper (n = 30) and non-dipper (n = 30) hypertensives.ResultsThe TIMI frame counts in all three coronary arteries and the mean TIMI frame count in the dipper hypertensive patient group were significantly lower than those of the non-dipper hypertensives (right coronary artery TIMI frame count: 16.83 ± 3.70; 21.63 ± 3.44, p < 0.001; circumflex artery TIMI frame count: 21.28 ± 3.52; 25.65 ± 3.61, p < 0.001; left anterior descending artery TIMI frame count: 34.20 ± 2.80; 37.05 ± 3.30, p = 0.001; corrected left anterior descending artery TIMI frame count: 20.05 ± 1.63; 21.74 ± 1.95, p = 0.001; mean TIMI frame count: 19.31 ± 2.3; 22.94 ± 2.61, p < 0.001). The body mass index (BMI) was 23.79 ± 2.81 kg/m2 in the dipper patient group, while it was 25.47 ± 2.92 in the non-dippers. BMI was found to be significantly higher in the non-dipper group than in the dipper group (p = 0.027).ConclusionsIn this study, TIMI frame count, which is a simple, productive, objective and reproducible method for determination of microvascular changes, was found to be higher in non-dipper hypertensive patients than in the dipper patients.

Relationships of Blood Pressure Circadian Rhythm and Brain Natriuretic Peptide with Left Ventricular Hypertrophy in the Patients with Primary Hypertension.

Objective To investigate the relationships of blood pressure circadian rhythm and brain natriuretic peptide (BNP) with left ventricular hypertrophy (LVH) in patients with primary hypertension. Methods Totally 349 patients (74 with LVH and 275 without LVH) with primary hypertension were enrolled in this study.Echocardiography was performed to determine left ventricular mass index (LVMI) using the Devereux formula. The nocturnal blood pressure decline rate,24-hour blood pressure (24 h PP; especially 24 h mean systolic blood pressure,24 h SBP) and blood pressure index (PPI) were determined by 24 h-ambulatory blood pressure monitoring. These 349 hypertensive patients were divided into four groups including supper-dipper group (defined as≥;20%, n=7),dipper group (defined as 10%- 20%, n=77),non-dipper group (defined as 0- 10%, n=173),and anti-dipper group (defined as<0, n=92). The baseline demographic characteristics of patients were collected. Fasting blood sugar,blood lipids,blood urea nitrogen,serum cretinine,cystatin C,uric acid,and plasma BNP level were measured. Results The patients with LVH (n=74) had significantly higher percentage of grade 3 hypertension (85.1% vs. 46.9%;χ2=34.428,P<0.001),24 h SBP (134 mmHg vs. 129 mmHg; t=3.175,P=0.002)(1 mmHg=0.133 kPa),daytime-mean SBP (134 mmHg vs. 130 mmHg; t=2.197,P=0.029),night-mean SBP(132 mmHg vs. 121 mmHg; t=4.763,P<0.001),and 24 h PP(57 mmHg vs. 52 mmHg; t=4.120,P<0.001) and PPI (0.43 vs. 0.41; t=3.335,P=0.001) and lower nocturnal blood pressure decline rate [(1.30±8.02)% vs. (5.68±7.25)%; t=-4.510,P<0.001] than the non-LVH patients (n=275). The LVH hypertensive group had significantly higher BNP level (87.8 pg/ml vs. 28.8 pg/ml; t=2.170,P=0.034) and LVMI (135.1 g/m2 vs. 88.7 g/m2; t=15.285,P<0.001) than the control group. No significant difference was observed in the BNP level among supper-dipper,dipper,non-dipper and anti-dipper groups (P=0.137).However,the difference was statistically significant in the LVMI (P=0.001). Additionally,patients in the anti-dipper group had significantly higher LVMI than those in the dipper patients (100.3 g/m2 vs. 86.3 g/m2; t=4.335,P<0.001) and non-dipper (100.3 g/m2 vs.93.7 g/m2; t=1.987,P=0.048). Patients in the non-dipper group had significantly higher LVMI than those in the dipper group (93.7 g/m2 vs. 86.3 g/m2; t=2.693,P=0.008). The multivariate linear correation analysis and logistic regressions analysis suggested a significant correlation of LVMI with BNP and the grade of hypertension. Conclusion With the increasing of plasma BNP level,the left ventricular hypertrophy is closely related to abnormal blood pressure circadian rhythm and the grade of hypertension in primary hypertensive patients.

Cross-sectional study on the relationship between the level of serum cystatin C and blood pressure reverse dipping in hypertensive patients.

ObjectiveTo investigate the relationship between the level of serum cystatin C (s-CC) and reverse-dipper blood pressure (BP) pattern.DesignCross-sectional study.SettingSingle centre.ParticipantsA total of 718 hypertensive patients were eventually recruited from cardiac clinics between 2012 and 2014 in the Second Affiliated Hospital, Xi'an Jiaotong University. They were diagnosed as essential hypertension according to their casual office records of systolic blood pressure (SBP) and/or diastolic blood pressure (DBP). Patients were excluded if they were <18 or >90 years old, under antihypertensive treatment, night workers, suffering from acute stroke or myocardial infarction within the past 6 months, diagnosed as secondary hypertension, sleep apnoea or other sleep disorders, renal failure, cardiac failure, chronic obstructive pulmonary disease, women during pregnancy or intolerant to the ambulatory BP monitoring (ABPM).MeasurementThe selected patients were evaluated with 24 hours ABPM. Peripheral venous blood samples were collected to evaluate the s-CC levels by ELISA.MethodsThe distribution of hypertensive patients with different levels of s-CC among each circadian BP pattern group was analysed using analysis of variance. Multinomial logistic regression analysis was applied to explore the relationship between the relevant variables and ABPM results.ResultsS-CC level in reverse-dipper group (1.19±0.53 mg/L) was increased significantly when compared with dipper group (1.06±0.36 mg/L) (p=0.021). In addition, after multinomial logistic regression analysis, s-CC (OR 1.717; 95% CI 1.033 to 2.854; p=0.037) and diabetes (OR 2.313; 95% CI 1.401 to 3.821; p=0.01) were significantly different between the reverse-dipper group and dipper group. On the other hand, the decline rate of nocturnal SBP (r=−0.117; p=0.002) and DBP (r=−0.089; p=0.018) was negatively correlated with the s-CC level.ConclusionsThe s-CC level was significantly higher in the reverse-dipper group than the dipper group and that s-CC was associated with the reverse-dipper pattern of BP examined with 24 hour ABPM.

Abstract P106: Effects of Aldosterone Excess and Sodium on Dipping Patterns in Resistant Hypertensive Patients

Background: High dietary sodium intake and aldosterone excess have been independently linked to increased cardiovascular morbidity and mortality. In addition, a large body of literature indicates that aldosterone excess contributes importantly to antihypertensive treatment resistance and is associated with higher 24- hour ambulatory blood pressure (BP) levels. Objective: This study was designed to determine if high dietary sodium intake, and hyperaldosteronism combine to mediate the development of abnormal diurnal BP patterns including nocturnal hypertension and dipping BP patterns. Methods: A single-center cohort of 326 African American (AA) and Caucasian resistant hypertensive patients were prospectively evaluated by assessing 24-hr urinary aldosterone (UAldo), plasma renin activity (PRA), sodium (UNa + ) levels, and 24-hr ambulatory blood pressure monitoring (ABPM). Daytime, night-time, and 24-hr BP and dipping patterns were determined. High sodium excretion was defined as UNa + = 200 mEq/24hr and hyperaldosteronism was defined as UAldo = 12 μg/24hr and PRA ≤ 1 ng/ml/hr. Results: There was no difference in ABPM and dipping patterns when comparing the normal versus high sodium group. However, patients without high sodium excretion had better nocturnal (p=0.024) and 24- hour BP control (p=0.036). Furthermore, there was no difference in ABPM patterns when comparing patients with high versus normal sodium excretion with hyper versus non- hyperaldosteronism. Interestingly, in the group with hyperaldosteronism, patients with normal sodium excretion had improved dipping patterns, but only in the dipper group (p=0.016). Conclusions: High dietary sodium intake contributes to increased nocturnal hypertension and poor 24-h BP control, but there does not seem to be a significant relationship between hyperaldosteronism and high dietary sodium intake. This data suggests that improvements in dietary sodium intake will lead to better control of nighttime BP and 24-h BP control and therefore reduces the risk of cardiovascular disease. Further studies are underway comparing these relationships in males versus females, and AAs versus Caucasians.

The association of serum gamma-glutamyl transpeptidase level and other laboratory parameters with blood pressure in hypertensive patients under ambulatory blood pressure monitoring.

BackgroundHypertension is a very important cause of morbidity and mortality. Serum gamma-glutamyl transpeptidase (GGT) is a biomarker of oxidative stress and associated with increased risk of hypertension and diabetes. The aim of this study was to evaluate the association of serum GGT level, which is an early marker of inflammation and endothelial dysfunction, with the deterioration of the diurnal rhythm of the blood pressure.MethodsA total of 171 patients with hypertension were included in this study. Patients whose nighttime mean blood pressure, measured via ambulatory blood pressure monitoring, decreased between 10% and 20% compared with the daytime mean blood pressure were defined as “dippers”, whereas patients with a nighttime blood pressure decrease lower than 10% were defined as “non-dippers”.ResultsA total of 99 hypertensive patients (65 females/34 males) were classified as dippers and 72 patients (48 females/24 males) as non-dippers. The mean age of the non-dipper group was significantly greater than the dipper group. Serum GGT, C-reactive protein and uric acid levels were significantly higher among patients in the non-dipper group. Negative correlations were detected between GGT levels and diurnal systolic and diastolic blood pressure decreases.ConclusionOur findings revealed that GGT level was higher in the non-dipper group, and was negatively correlated with the nighttime decrease of diurnal blood pressure. C-reactive protein and uric acid levels were also higher in the non-dipper group. However, future randomized controlled prospective studies with larger patient populations are necessary to confirm our findings.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients.

BackgroundIn this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension.MethodsA total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group.ResultsThe mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors.ConclusionEFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

Dream anxiety, chronotype and dipping pattern in hypertensive patients assessed with 24 h ambulatory blood pressure monitoring

The purpose of the present study was to investigate dream anxiety, impulsivity, and chronotypes in patients with dipper/non-dipper hypertension and to compare with healthy controls. Sixty-two patients diagnosed with hypertension and 33 healthy individuals were recruited in this study. A history of current psychiatric illness or psychotropic drug usage, significant cardiac, medical or neurological disease and pregnancy were the exclusion criterias for the study. All patients and healthy controls underwent 24-h ambulatory blood pressure monitoring. The Van Dream Anxiety Scale, Morningness-Eveningness Questionnaire, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, Barratt Impulsivity Scale and Pittsburgh Sleep Quality Index were administered to all participants. There were two groups; patients with hypertension (dipper, n = 26 and non-dipper, n = 36) and healthy controls (n = 33). No differences between groups among gender (Χ2 = 4.42 and p = 0.110) and mean age (F = 0.239 and p = 0.795) were found. In patients with hypertension; dream anxiety, impulsivity, depression and trait anxiety scores were significantly higher than healthy controls. Sleep quality was poorer in patients with hypertension and there was no difference according to chronotype between patients and controls. There were no differences between dipper and non-dipper groups according to dream anxiety, sleep quality, impulsivity, state-trait anxiety, and depressive scores. In conclusion, dream anxiety is a previously unaddressed psychological entity that, in addition to anxiety, depression, impulsivity and poorer sleep quality, appears in hypertensive patients. Longitudinal studies with larger sample sizes would be valuable to elucidate the relationship between dream anxiety and hypertension patterns.

The Effect of Nocturnal Blood Pressure Changes on the Cognitive State of Patients With Parkinson’s Disease

This article has been retracted by the authors. Background: Recent data have revealed that cognitive involvement occurs, more or less, in every stage of idiopathic Parkinson’s disease (IPD), which is definitely going to cause radical changes in this traditional understanding. The effects of blood pressure changes during the night on the cognitive states of patients with IPD are not known for sure. The purpose of this study was to research the effects of blood pressure changes during the night on cognitive state of patients with IPD. Methods: A total of 30 patients, 14 females and 16 males, were followed with a diagnosis of IPD. Cognitive functions were assessed with an extensive neuropsychological test battery. Results: The fifth stage of Stroop test, test of line direction, test of face recognition and Hooper test were significantly different in dipper group when compared with the non-dipper group. Conclusion: Not having nocturnal blood pressure decrease in IPD can be accepted as a risk factor in terms of cognitive function disorders. J Neurol Res. 2015;5(3):207-212 doi: http://dx.doi.org/10.14740/jnr324w

Riser Blood Pressure Pattern Is Associated With Mild Cognitive Impairment in Heart Failure Patients.

The riser pattern, an abnormal blood pressure (BP) rhythm in which sleep BP exceeds awake BP, is a predictor of future stroke events. Although the riser pattern is caused by autonomic dysfunction, its significance in heart failure (HF) patients is not established. HF patients often suffered from cognitive impairment (CI), but the relationship between riser pattern and CI is not clearly understood. We tested the hypothesis that the riser pattern is associated with mild CI, a form of brain damage that could develop to dementia. We performed Mini-Mental State Examination (MMSE), ambulatory BP monitoring (ABPM), echocardiography, and blood tests in 444 HF patients just before leaving hospitals. Mild CI, a measure of cognitive function, was defined as the score <26. The mean age of the patients was 68±13 years; 61.5% were male; 22.5% were riser pattern. The MMSE score was significantly lower in the Riser group than in the Non-dipper and Dipper group (23±4 vs. 25±5, 26±4, respectively, P < 0.01). In multivariable logistic regression analysis, a riser pattern was significantly associated with mild CI (odds ratio 2.38, 95% confidence intervals 1.29-4.42, P < 0.01) after adjusting for significant covariates. The riser pattern was associated with mild CI in HF patients. An abnormal circadian BP rhythm in HF patients is clinically significant as a potential indicator of subclinical brain damage.

Circadian variation of acute aortic dissection.

Acute aortic dissection (AAD) is a life-threatening cardiovascular disease with high mortality. Hypertension is a well known risk factor of AAD. There have been previous reports about the association between circadian variation of blood pressure (BP) and cardiovascular events. However, little is known about the association between the onset-time of AAD and circadian variation of BP. The purpose of this study was to clarify the characteristics of circadian variation of BP in AAD and its relation to the onset-time of this disease. This study included type B spontaneous AAD patients who were referred to our institution and treated conservatively between January 2008 and June 2013. Patients with type A AAD, secondary to trauma, and type B AAD which preceded surgical intervention were excluded. Data were retrospectively collected from the hospital medical records. Sixty-eight patients with type B AAD were enrolled. The distribution of the circadian pattern in the study patients was as follows: extreme-dipper, 0% (none); dipper, 20.6% (n = 14); nondipper, 50% (n = 34); riser, 29.4% (n = 20). Non-dipper and riser patterns were more frequently observed compared with other population studies reported previously. Moreover, no patient in the dipper group had night-time onset while 31.5% of the patients in the absence of nocturnal BP fall group (non-dipper and riser) did (P = 0.01). Absence of a nocturnal BP fall was frequently seen in AAD patients. Absence of a nocturnal BP fall may be a risk factor of AAD. Circadian variation of BP may also affect the onset-time of type B AAD.

The Effect of Nocturnal Blood Pressure Changes on the Cognitive State of Patients With Parkinson’s Disease

This article has been retracted by the authors. Background: Recent data have revealed that cognitive involvement occurs, more or less, in every stage of idiopathic Parkinson’s disease (IPD), which is definitely going to cause radical changes in this traditional understanding. The effects of blood pressure changes during the night on the cognitive states of patients with IPD are not known for sure. The purpose of this study was to research the effects of blood pressure changes during the night on cognitive state of patients with IPD. Methods: A total of 30 patients, 14 females and 16 males, were followed with a diagnosis of IPD. Cognitive functions were assessed with an extensive neuropsychological test battery. Results: The fifth stage of Stroop test, test of line direction, test of face recognition and Hooper test were significantly different in dipper group when compared with the non-dipper group. Conclusion: Not having nocturnal blood pressure decrease in IPD can be accepted as a risk factor in terms of cognitive function disorders. J Neurol Res. 2015;5(3):207-212 doi: http://dx.doi.org/10.14740/jnr324w