Dipper Hypertensive Patients Research Articles

Comparison of Copeptin Levels in Non- Dipper and Dipper Hypertension Patients

Amaç: Kardiyovasküler hastalıklar açısından hipertansiyon önemli bir risk faktörüdür. Amblatuvar kan basıncı monitörizasyonu(AKBM) ile yapılan çalışmalar kan basıncının gün içerisinde değiştiğini ve sirkadiyen bir ritminin olduğunu ortaya koymuştur. Kan basıncında gece % 10 veya daha fazla düşme olması dipper hipertansiyon (HT), olmaması non-dipper HT olarak nitelendirilmiştir. Non-dipper HT’li hastalarda kardiyovasküler riskin arttığı gösterilmiştir. Copeptin ise antidiüretik hormonun parçası olan bir molüküldür. Bazı çalışmalarda kardiyovasküler hastalıklar, serebrovasküler hastalıklar, sepsis ve şok gibi durumlarda kanda copeptin düzeyi hızlı bir yükseliş göstermektedir. Bu çalışmada dipper ve non-dipper hasta gruplarında serum copeptin düzeylerini karşılaştırmayı amaçladık. Materyal ve Metod: Bu çalışmaya yeni HT tanısı konulan 73 hasta çalışma grubu olarak ve 35 sağlıklı bireyde kontrol grubu olarak dahil edildi. HT tanısı konulan bireyler AKBM göre dipper HT ve non-dipper HT alt gruplarına ayrıldı. Çalışmaya alınan tüm bireylerin temel biyokimyasal parametreleri ve copeptin düzeyleri çalışıldı. Bulgular: Non-dipper HT'u olan bireylerin serum copeptin düzeyleri, hem kontrol hem dipper hasta grubuna göre serum copeptin düzeylerinden anlamlı olarak daha yüksek bulundu. İkili korolerasyon analizlerinde copeptin ile trigliserid arasında pozitif korelasyon görüldü. Diğer biyokimyasal belirteçler ile copeptin arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Sonuç: Serum copeptin düzeyleri prognoztik olarak kötü seyreden non-dipper hipertansif olan hasta grubunda yüksek saptandı. Bu bulgu artmış copeptin düzeyinin non-dipper HT’u olan hastaların prognozu ile ilişkili olduğunu düşündürmektedir. Bu nedenle copeptin düzeyi hipertansiyonlu hastalarda bir prognoztik parametre olarak kullanılabilir.

The relationship between nondipper hypertension and triglyceride glucose index.

Nondipper hypertensive patients have an increased incidence of damage to end organs, including the brain, heart, and kidney, and a worse cardiovascular prognosis. The triglyceride glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to the traditional risk factors of cardiovascular disease. To the best of our knowledge, whether there is a relationship between the TyG index and impaired diurnal blood pressure (BP) has not been investigated. This study aimed to compare the TyG index between normotensive, nondipper, and dipper hypertensive patients. A total of 1037 patients grouped according to the results of ambulatory BP monitoring were included, with group 1 including dipper hypertensive ( n = 368), group 2 including nondipper hypertensive ( n = 496), and group 3 including normotensive control ( n = 173) patients. In both the univariate and multivariate logistic regression analyses, TyG index [odds ratio (OR), 4.656; 95% confidence interval (CI), 3.014-7.193; P < 0.001], age (OR, 1.011; 95% CI, 1.002-1.021; P = 0.018), and glomerular filtration rate (GFR) (OR, 0.979; 95% CI, 0.971-0.987; P < 0.001) were independent predictors of nondipper hypertension (HT). In the ROC analysis, a TyG index cutoff value of at least 4.74 predicted nondipper hypertensive patients with a sensitivity of 59.7%, and a specificity of 59.9% [area under the curve = 0.647 (0.614-0.680); 95% CI; P < 0.001]. We showed that TyG index, age, and GFR are independent predictors in patients with nondipper HT. TyG index, a simple, cost-effective, and rapid tool can predict the nondipper pattern in essential HT.

The pattern of systemic inflammation index in normotensive non-dipper and dipper hypertensive patients

Objective: Continuous inflammation at the level of the vascular endothelium plays an important role in the formation of hypertension. Diurnal blood pressure (BP) variation also is a risk factor for hypertensive target organ damage. This study planned to evaluate these inflammation processes in normotensive and hypertensive patients. Methods: This study is observational cross-sectional cohort in-design. 151 patients with a prediagnosis of hypertension included. The patients were divided into three groups (group 1: dipper normotensive, group 2: non-dipper normotensive, group 3: dipper-hypertensive) based on the results of ambulatory blood pressure monitoring. The groups were compared in terms of systemic inflammation index (SII; platelet count×neutrophil count/lymphocyte count), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other inflammation processes. Results: There was a significant difference between the three groups in terms of mean platelet volume (MPV) and red blood cell distribution width (RDW) levels (p=0.001 and p&amp;lt;0.001, respectively). A statistically significant difference was found between the groups in terms of NLR, PLR, systemic inflammation index, lymphocyte-monocyte ratio (LMR). In subgroup analysis, NLR and systemic inflammation index were similar in group 2 and group 3, but higher than in group 1 in both groups. LMR was similar in group 2 and group 3 but lower than in group 1. In subgroup analysis PLR levels were similar in group 2 and group 3 but higher than group 1 in both groups. Conclusion: This study showed that normotensive non-dipper patients had inflammation as much as dipper hypertensive patients according to measurement of MPV, RDW systemic inflammation index, PLR, NLR levels.

Evaluation of global left ventricular systolic function in dipper and newly diagnosed nondipper hypertensive patients

Abstract Objective Nondipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and methods We included 42 newly diagnosed hypertensive patients without previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by two-dimensional (2-D) speckle tracking method. Results The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of LV systolic function by GLS showed decreased values in nondippers compared with dippers (−18.13±2.07 vs. −13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), night-time systolic and diastolic blood pressures (BP), 24-hr SBP, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with left ventricular GLS. Conclusion An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain. Funding Acknowledgement Type of funding sources: None. Figure 1

Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study

BackgroundWhether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). MethodsThis case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. ResultsCSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1−3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r2 = 0.308−0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804−0.943; P = .001), with r2 = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489−47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709−196.660; P = .001) having the highest risks of CSVD (r2 = 0.413). ConclusionsLower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.

Relation between nocturnal decline in blood pressure and choroidal thickness: a comparative analysis in dipper vs. non-dipper hypertensive patients.

To compare choroidal thickness (ChT) and echocardiographical changes in patients with dipper and non-dipper systemic arterial hypertension (HT). Patients with HT were evaluated in two groups according to the 24-hour ambulatory BP monitoring. Compared to day-time values, those whose night-time SBP decreased ≥10% were defined as dippers, and those whose SBP decreased <10% were defined as non-dippers. Transthoracic echocardiography was conducted in all patients. ChT and central macular thickness were measured with spectral-domain optical coherence tomography. ChT was obtained at the subfoveal, 1500 µm nasal and temporal to the fovea. Thirty non-dipper (18 females and 12 males) and 23 dipper (16 females and seven males) hypertensive patients were recruited. Sex distribution and the mean age were similar between the groups (P = 0.472; P = 0.12). Disease duration was longer in the non-dipper group (8 ± 3.39 vs. 4.96 ± 1.19 years, P = 0.001). The non-dipper group had lower ChT in subfoveal and temporal locations (P = 0.02 and 0.03, respectively) and higher left atrial volume index (LAVI) and pulmonary valve maximum flow (PV-max; P < 0.001). The night-time SBP was negatively correlated with ChT (P = 0.048) and positive correlated with LAVI and PV-max (P < 0.05). However those correlations were not significant when were controlled by the possible confounding factors as disease duration, age and gender. Non-dipper HT patients may have thinner choroid than dippers due to longer duration of HT and higher ambulatory BP levels.

P5470Studying target organ damage indices in newly diagnosed and never treated extreme dipper patients with essential hypertension

Abstract Background Cardiovascular risk estimation in arterial hypertension includes the investigation for target organ damage indices (TOD). 24h ambulatory blood pressure monitoring (ABPM) represents the gold standard method for the confirmation of the arterial hypertension disease. Dipping phenomenon, defined as blood pressure decrease &gt;10% during night-time measurements, leads to hypertension burden reduce during night and carries a positive prognostic significance. However, there are doubts regarding its prognosis when it becomes augmented (extreme dipping defined as blood pressure decrease &gt;20% during night-time measurements). Aim of our study is to explore TOD existence between extreme dipper and dipper hypertensive patients with newly diagnosed and never treated arterial hypertension. Methods From the 480 total patients with newly diagnosed and never treated arterial hypertension who subjected to ABPM, we excluded 190 non-dipper patients and we divided the rest 290 hypertensives (mean age 49±11 years, 193 males) in normal dippers (n=245, mean age 49±11 years, 160 males) and extreme dippers (n=45, mean age 49±10 years, 33 males). Both groups were subjected to the following measurements: arterial stiffness (PWV), 24h microalbumin levels (MAU), carotid intima-media thickness (IMT), diastolic dysfunction (E/Ea), left ventricular mass index (LVMI) and coronary flow reserve (CFR). Results We did not find any differences within groups regarding age, sex distribution, BMI, office SBP/DBP, cenrtal SBP/DBP and daytime average SBP/DBP as well as PWV, MAU, IMT, E/Ea and CFR. We noticed that extreme dippers had reduced 24h average SBP/DBP (p=0.001 and p=0.02, respectively) and increased LVMI (86±18 vs. 79±20 gr/m2, p=0.04) compared to normal dippers. Differences in LVMI Conclusions Extreme dipper hypertensive patients have an increased LVMI, probably as a result of myocardial hypoxia due to severe blood pressure reduction over night. Our results point to the possible increased cardiovascular risk in this group of hypertensive patients.

STUDYING TARGET ORGAN DAMAGE INDICES IN NEWLY DIAGNOSED AND NEVER TREATED EXTREME DIPPER PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Cardiovascular risk estimation in arterial hypertension includes the investigation for target organ damage indices (TOD). 24 h ambulatory blood pressure monitoring (ABPM) represents the gold standard method for the confirmation of the arterial hypertension disease. Dipping phenomenon, defined as blood pressure decrease >10% during night-time measurements, leads to hypertension burden reduce during night and carries a positive prognostic significance. However, there are doubts regarding its prognosis when it becomes augmented (extreme dipping defined as blood pressure decrease >20% during night-time measurements). Aim of our study is to explore TOD existence between extreme dipper and dipper hypertensive patients with newly diagnosed and never treated arterial hypertension. Design and method: From the 480 total patients with newly diagnosed and never treated arterial hypertension who subjected to ABPM, we excluded 190 non-dipper patients and we divided the rest 290 hypertensives (mean age 49+11 years, 193 males) in dippers (n = 245, mean age 49+11 years, 160 males) and extreme dippers (n = 45, mean age 49+10 years, 33 males). Both groups were subjected to the following measurements: arterial stiffness (PWV), 24 h microalbumin levels (MAU), carotid intima-media thickness (IMT), diastolic dysfunction (E/Ea), left ventricular mass index (LVMI) and coronary flow reserve (CFR). Results: We did not find any differences within groups regarding age, sex distribution, BMI, office SBP/DBP, cenrtal SBP/DBP and daytime average SBP/DBP as well as PWV, MAU, IMT, E/Ea and CFR. We noticed that extreme dippers had reduced 24 h average SBP/DBP (p = 0.001 and p = 0.02, respectively) and increased LVMI (86+18 vs. 79+20 gr/m2, p = 0.04) compared to dippers. Conclusions: Extreme dipper hypertensive patients have an increased LVMI, probably as a result of myocardial hypoxia due to severe blood pressure reduction over night. Our results point to the possible increased cardiovascular risk in this group of hypertensive patients.

OP-556 - The Effect of Nebivolol on Erectile Dysfunction with Dipper and Non Dipper Hypertensive Patients

Erectile dysfunction (ED) is one of the common health problem and occurs at a higher incidence in men with hypertension. Hypertension (HT) is one of the most important risk factor for ED and could also show complex characteristics, especially subtypes which are introduced by nocturnal blood pressure alterations.

The relationship of age-adjusted Charlson comorbidity ındex and diurnal variation of blood pressure

ABSTRACTBackgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients.Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed.Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = −0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012–1.165)Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality.

Evaluation of the effect of dipping pattern in hypertensive patients on the left ventricular systolic functions by two-dimensional strain analysis.

Nondipping blood pressure pattern carry a high risk of cardiovascular and cerebrovascular complications due to a higher cumulative pressure overload. We aimed to define the role of strain analysis for detecting subclinical left ventricular systolic dysfunction in recently diagnosed nondipper and dipper hypertensive patients with normal left ventricular systolic function. Study population consisted of two groups of patients, Group 1: 45 dipper patients and Group 2: 43 nondipper patients. Global and segmental two-dimensional longitudinal strain analysis were measured by speckle tracking method. The analysis of two-dimensional left ventricular global longitudinal strain and strain rates showed that there was a significant difference between groups (-18.1%±3.1% for nondippers vs -20.5%±2.4% for dippers, P<.001 for global longitudinal strain and -1.2±0.2 1/s for nondippers vs -1.31±0.16 1/s for dippers, P<.001 for global longitudinal strain rate). The nighttime systolic, diastolic, and mean blood pressure measurements were significantly higher in the nondipper group. Nocturnal dipping rates were statistically different between the groups (P<.001). Interventricular septum, posterior wall thickness, relative wall thickness, left atrial dimension, left ventricular mass, and mass index were higher in the nondipper group. Multivariate analysis demonstrated left atrium size, nocturnal dipping rate, daytime mean blood pressure, and nighttime systolic, diastolic, and mean blood pressure as independent predictors of global longitudinal strain. In our study, two-dimensional speckle tracking examination showed that the left ventricular systolic function is impaired even in the subclinical period in recently diagnosed nondipper hypertensive patients with deformational analysis.

PP.16.18] ASSOCIATION BETWEEN HYPERURICEMIA AND ABNORMAL HEART RATE RECOVERY IN HYPERTENSIVE PATIENTS WITH NON-DIPPING PATTERN

Objective: Sympatho-vagal balance, as measured by heart rate recovery (HRR) at the first minute after exercise, is correlated with long-term prognosis in patients with cardiovascular disease. Higher serum uric acid (UA) is an independent risk factor for hypertension; and hyperuricemia is associated with non-dipping pattern (<10% fall in nocturnal blood pressure) among hypertensive patients. Given the importance of nondipper hypertension on cardiovascular outcomes, the present study tested the hypothesis that heart rate recovery is associated with hyperuricemia among hypertensive patients with non-dipping pattern. Design and method: The study included 122 essential hypertensive patients (64% Male, 55 ± 3 years) subdivided into two groups according to 24-hour ABPM resuts: 48 dippers and 74 nondippers. All patients underwent ambulatory blood pressure monitoring and exercise stress testing. HRR was calculated as the difference between the heart rate at peak exercise and after 1-min cooling down. Results: No significant differences in office blood pressure (BP) values were observed between non-dipper and dipper hypertensive patients (Figure 1-2). Compared to dippers, the nocturnal systolic (Figure 3), diastolic (Figure 4), and mean BP levels (Figure 5), were found to be significantly greater among non-dippers, respectively. Non-dippers hypertensive patients showed significantly higher serum UA levels compared to dippers (Figure 6); and high sensitivity C-reactive protein (hsCRP) (Figure 7). Non-dippers hypertensive patients showed significantly lower HRR compared to dippers (Figure 8).Among non-dippers, a significant correlation between UA levels and HRR was observed (r = 0.38, P < 0.001). After adjusting for age, gender, body mass index, smoking habits, creatinine levels, hsCRP and comorbidity, multivariate analysis revealed an independent association between HRR and serum UA levels among non-dippers (ß = 0.312, P = 0.002). Conclusions: Serum UA is independently associated with abnormal heart rate recovery in hypertensive patients with nondipper circadian pattern.

PP.27.18] THE INDEPENDENT RELATIONSHIP OF BLOOD PRESSURE LOAD WITH TARGET ORGAN DAMAGE IN UNTREATED HYPERTENSIVE PATIENTS. THE ROLE OF DIPPING STATUS

Objective: Blood pressure (BP) load, defined as the percentage of abnormally elevated BP readings, is provided on the report of ambulatory BP monitoring. The relationship between BP load, independently from BP level, and target organ damage (TOD) in hypertension disease is under investigation. We aimed to explore the relationship between BP load and TOD in patients with newly diagnosed essential hypertension as well as the role of dipping status. Design and method: We studied 300 patients with newly diagnosed and never treated essential hypertension (mean age 50+11 years, 187 males, 202 dippers). We performed: a. 24 h ambulatory BP measurement (ABPM) in order to measure BP load and estimate dipping status and b. we evaluated carotid-femoral artery pulse wave velocity (PWV), carotid intima-media thickness (IMT), microalbuminouria (MAU), LV remodeling (LVMI), and coronary flow reserve (CFR). Results: Dipper hypertensive patients (n = 202) were younger, mostly males with reduced 24 h SBP, 24 h PP, cIMT and LVMI compared to non-dippers (n = 98). In the whole hypertensive population, BP load parameters were, independently of 24 h mean BP, related with PWV (daytime and night-time SBP load) and IMT (daytime SBP load). In dipper hypertensive population, only daytime SBP load was independently of 24 h mean BP, related with PWV. Conclusions: Daytime and night-time SBP load are independently related with PWV and IMT, respectively, in middle-aged untreated hypertensives. Our results add new data regarding the role of daytime SBP load since its independent association with PWV was evident only in dipper hypertensives.

Serum uric acid levels and inflammatory markers with respect to dipping status: A retrospective analysis of hypertensive patients with or without chronic kidney disease

ABSTRACTBackground: The aim of this study was to evaluate serum uric acid levels, inflammatory markers [C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)] and mean platelet volume (MPV) among hypertensive patients with or without chronic kidney disease (CKD) with respect to dipping status. Methods: A total of 432 hypertensive patients with (n = 340) or without (n = 92) CKD who had ambulatory blood pressure monitoring recordings were included. Correlation of serum uric acid levels with inflammatory markers (CRP, PLR, NLR) was evaluated as was the logistic regression analysis for determinants of nondipper pattern. Results: Nondipper pattern was noted in 65.2% and 79.7% of non-CKD and CKD patients, respectively. Multivariate logistic regression analysis revealed that only serum uric acid (OR, 2.69; 95% CI, 1.60 to 4.52; p = 0.000), MPV (OR, 1.81; 95% CI, 1.30 to 2.53; p = 0.000), PLR (OR, 0.98; 95% CI, 0.97 to 0.99; p = 0.000), and serum albumin (OR, 0.42; 95% CI, 0.19 to 0.93; p = 0.031) were significant determinants of nondipper pattern in the overall study population. Conclusion: In conclusion, our findings revealed higher prevalence of nondipper pattern in hypertensive patients with than without CKD and significantly higher levels for uric acid, CRP, MPV, PLR, and NLR among nondipper than dipper hypertensive patients with CKD. High levels for uric acid and MPV and lower levels for PLR and serum albumin were noted as significant determinants of nondipper pattern among hypertensive patients.

NO DIFFERENCE OF SERUM IL-6 LEVEL AMONG DIPPER AND NON DIPPER HYPERTENSIVE PATIENTS

Background: A non-dipping BP profile is currently regarded as a risk factor for cardiovascular events and target organ damage. Mechanism explaining the relationship between hypertension and target organ damage is inflammation. IL-6 is a key mediator of this inflammatory process. Objective: To investigate serum IL-6 level in dipper and non dipper hypertensive patients. Method: Forty-eight hypertensive patients were recruited. Blood pressure was measured by 24 hours ambulatory blood pressure monitor. The presense of dipping/nondipping and Morning Blood Pressure Surge (MBPS) also considered in spite of achieving blood pressure target throghout the day. Serum level of interleukin-6 (IL-6) were measured by ELISA Result: Controlled hypertensive patients were found in 47.9% of total subjects. 85.41% of total subjects had dipping blood pressure pattern and 12.5% of total subjects had MBPS. IL-6 level in controlled and uncontrolled hypertension was 74.57 ± 76.47 pg/ml and 75.80 ± 67.27 pg/ml, respectively. Moreover, IL-6 level in dipper and non dipper hypertensive patients was 67.59 ± 66.65 pg/ml and 76.51 ± 72.48 pg/ml, respectively. Furthermore, IL-6 level in subjects with MBPS and non MBPS were 86.1 ± 63.10 pg/ml and 73.65 ± 72.67 pg/ml, respectively. There were no significant difference of IL-6 serum level between controlled and uncontrolled hypertensive patients (p = 0.688), dipper and non dipper hypertensive patients (p = 0.599), and MBPS and non MBPS hypertensive patients (p = 0.489). Conclusion: None of the dipping pattern, MBPS, and blood pressure control correlate with serum IL-6 levelincrease.

New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension: Serum YKL-40/Chitinase 3-like protein 1 levels and echocardiographic epicardial adipose tissue thickness

The aim of the present study was to investigate whether YKL-40 levels and epicardial adipose tissue (EAT) thickness were associated with non-dipping pattern in essential hypertension (HT). Age- and sex-matched 40 dipper hypertensive patients and 40 non-dipper hypertensive patients were included in the study. Non-dippers had significantly increased EAT thickness and higher YKL-40 and high-sensitivity C-reactive protein levels than dippers. Multivariate logistic regression analysis showed that the EAT thickness and serum levels of YKL-40 and high-sensitivity C-reactive protein were independent predictors of non-dipping pattern in essential HT. In essential HT, presence of non-dipping pattern is associated with increased inflammatory response.

Serum Neutrophıl Gelatınase-Assocıated Lıpocalın Levels in Patients with Non-Dipper Hypertension

Neutrophil gelatinase-associated lipocalin (NGAL) is a protein belonging to the lipocalin superfamily and plays a role in atherosclerosis, renal injury and inflammation. The present study aimed to investigate serum NGAL concentrations in groups of patients with dipper and non-dipper hypertension (HT) and to characterize the relationship between NGAL concentration and circadian blood pressure in hypertensive patients. A total of 41 (22 male, 19 female, mean age: 56.1 ±8.9 years) non-dipper HT patients, 40 (19 male, 21 female, mean age: 54.0 ±10.0 years) dipper HT patients and 42 age- and gender-matched healthy individuals were enrolled in the study. Dipper and non-dipper HT were diagnosed via ambulatory blood pressure monitoring. Serum NGAL concentrations were measured by enzyme-linked immunosorbent assay from blood samples obtained from patients. Serum NGAL concentrations were found to be significantly higher in the non-dipper and dipper HT patient groups in comparison with the control group (84.9 ±23.0 ng/ml and 62.1 ±17.8 vs. 46.6 ± 13.7 ng/ml, p <0.017, respectively). Moreover, serum NGAL concentrations were significantly higher in the non-dipper HT group in comparison with the dipper HT group (p<0.017). Serum NGAL concentration showed significant correlation with overall ambulatory BP levels both in non-dipper and dipper HP groups. Serum NGAL concentrations increased significantly in non-dipper HT patients in comparison with dipper HT patients and normotensive patients and show significant correlation with ambulatory BP levels. Serum NGAL concentration might be a useful marker in identifying HT patients with higher risk for cardiovascular mortality.

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

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

Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients

Objective of this study was to investigate the correlation between P wave dispersion and left ventricular diastolic function, which are associated with the increased cardiovascular events in patients with dipper and non-dipper hypertensive (HT). Eighty sex and age matched patients with dipper and non-dipper HT, and 40 control subject were included in this observational cross-sectional study. P wave dispersion was measured through electrocardiography obtained during the admission. The left ventricular LV ejection fraction was measured using the modified Simpson's rule by echocardiography. In addition, diastolic parameters including E/A rate, deceleration time (DT) and isovolumetric relaxation time (IVRT) were recorded. Independent samples Bonferroni, Scheffe and Tamhane tests and correlation test (Spearman and Pearson) were used for statistical analysis. P wave dispersion was found to be significantly increased in the non-dipper than in the dipper group (56.0±5.6 vs. 49.1±5.3, p<0.001). Pmax duration was found significantly higher (115.1±5.6 vs. 111.1±5.8, p=0.003) and Pmin duration significantly lower (59.0±5.6 vs. 62.3±5.3, p=0.009) in the non-dippers. Correlation analysis demonstrated presence of moderate but significant correlation between P-wave dispersion and left ventricular mass index (r=0.412, p=0.011), IVRT (r=0.290 p=0.009), DT (r=0.210, p=0.052) and interventricular septum thickness (r=0.230 p=0.04). P wave dispersion and P Max were found to be significantly increased and P min significantly decreased in the non-dipper HT patients compared to the dipper HT patients. P-wave dispersion is associated with left ventricular dysfunction in non-dipper and dipper HT.

Comparison of inflammatory markers in non-dipper hypertension vs. dipper hypertension and in normotensive individuals: uric acid, C-reactive protein and red blood cell distribution width readings.

AimIn this study, we investigated the relationship of increased inflammatory parameters (C-reactive protein – CRP), oxidative stress markers (serum uric acid – SUA) and red blood cell distribution width (RDW) with non-dipper hypertension (NDHT).Material and methodsAmong the individuals who presented to the cardiology clinic, 40 patients (32.5% male, 67.5% female; mean age: 54.4 ±7.1) who had hypertension and were diagnosed with NDHT through ambulatory blood pressure monitoring, 40 age- and sex-matched dipper hypertension (DHT) patients (25% male, 75% female, mean age: 54.2 ±7.0), and 40 normotensive individuals (42.5% male, 57.5% female, mean age: 51.9 ±9.0) were enrolled in the study. Peripheral venous blood samples were collected from all the patients in order to evaluate the hematological and biochemical parameters. All the assessed parameters were compared among the groups.ResultsThe CRP, RDW and uric acid levels were observed to be significantly higher in the non-dipper hypertension group in comparison to the dipper hypertension patients and the normotensive population (p < 0.05). These parameters were also significantly higher in the dipper HT group compared to the normotensive population (p < 0.05).ConclusionsWe found in our study that increased CRP, uric acid and RDW levels, which are indicators of increased inflammation and oxidative stress, are significantly higher in the non-dipper HT patients in comparison to the dipper HT patients and control group.