Dipper Hypertension Research Articles

The Relationship Between Ambulatory Blood Pressure Monitoring and Uric Acid Level in Hypertensive Patients

Abstract Introduction: Serum uric acid (SUA) is the end product of purine metabolism. Excessive SUA production or decreased renal excretion causes hyperuricemia. Elevated SUA is known to be a risk factor for cardiovascular diseases. It was reported that blood pressure (BP) was higher in patients with elevated uric acid and a decrease in BP was observed after the administration of uric acid-lowering drugs. Methods: We examined the relationship between SUA levels and hypertension in patients admitted to our hospital with hypertension (HT) and undergoing ambulatory blood pressure monitoring (ABPM). A total of 310 patients were included in the study. SUA levels were determined using an enzymatic colorimetric autoanalyzer. ABPM was performed using noninvasive multitasking CR recorders (TM2425; A&D, Tokyo, Japan). Results: Hyperuricemia was observed in 49.6% of the patients. Daytime, nocturnal, and 24-hour diastolic blood pressure (DBP) were significantly higher in patients with hyperuricemia (p=0.021, p=0.029, and p=0.005, respectively). Mean arterial pressure (MAP) and nocturnal MAP values were higher in patients with hyperuricemia (p=0.022 and p=0.003, respectively). The rate of patients with dipper HT was lower in patients with hyperuricemia than those without hyperuricemia (p=0.041). The rate of reverse-dipper HT was found to be higher in patients with hyperuricemia compared to those without hyperuricemia (p=0.022). Conclusion: Elevated uric acid was correlated with DBP, reverse HT, and MAP. Measurement of SUA could provide a valuable aid for the assessment and reduction of cardiovascular risk. Further studies are required to assess the effect of lowering uric acid on the reduction of nocturnal BP and DBP. Key words: Ambulatory blood pressure monitoring, uric acid, dipper hypertension, non-dipper hypertension, reverse-dipper hypertension

Mean Platelet Volume/Platelet Count Ratio and Dipper/Non-Dipper Hypertensive Patients.

There is an interaction between mean platelet volume (MPV), platelet count (PC), inflammation, and platelet reactivity. The present study evaluated the relationship between the MPV/PC ratio and blood pressure (BP) using 24h ambulatory BP monitoring (ABPM). A total of 720 patients (male: 291) were included in the study. Based on the ABPM outcomes, they were divided into two groups: dipper hypertensive (n = 350; male: 136) and non-dipper hypertensive (n = 370; male: 155). Peripheral venous blood samples obtained at admission were used for PC and MPV calculations. Both groups displayed identical clinical characteristics. Non-dipper hypertensives had a higher MPV/PC ratio than dipper hypertensives [0.044; (0.036-0.055); 0.036 (0.030-0.042); P < .001]. According to receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of the MPV/PC ratio for predicting non-dipper patterns in hypertensive patients was 0.040 (area under the curve [AUC]: 0.726, P < .001). Sensitivity was 64.1% and specificity was 64.3%. The MPV/PC ratio may represent mechanisms involved in increasing cardiovascular risk in non-dipper hypertensives compared with dipper hypertensives.

Monocyte-to-high-density lipoprotein ratio: an independent predictor of reverse dipper pattern in hypertensive patients.

In healthy individuals, blood pressure (BP) levels are expected to decrease by 10-20% during sleep hours, which is defined as the dipping pattern. On the other hand, the presence of a BP rise at night in hypertensive patients is defined as a reverse dipper hypertensive pattern (RDHT). RDHT has been associated with stroke and cardiovascular mortality. Similarly, the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has been associated with the prognosis of cardiovascular disease. We, therefore, aimed to assess the relationship between MHR and RDHT in patients with hypertension. A total of 363 patients were enrolled in the study, all of whom had undergone 24-hour ambulatory BP monitoring. The patients were analyzed in three groups: RDHT (n: 92), dipper hypertensive (DHT) (n: 124), and normotensive controls (n: 147). Univariable and multivariable analyses were performed to identify factors that could be used to predict RDHT presence. The RDHT group was compared with the DHT and normotensive groups. A high MHR (p = 0.014, OR: 1.110, CIs: 1.021-1.206) and low daytime diastolic BP (p = 0.026, OR: 0.951, CIs: 0.910-0.994) were found to be independent factors that differentiated RDHT from DHT. Additionally, high MHR (p < 0.001, OR: 1.244, CIs: 1.140-1.357), body mass index (p = 0.005, OR: 1.143, CIs: 1.042-1.255), and C-reactive protein (p = 0.009, OR: 1.166, CIs: 1.039-1.308) were found to be independent factors that could differentiate patients with RDHT from controls. We demonstrated that MHR, a novel inflammatory marker, independently predicts RDHT. This easily applicable and inexpensive marker can be used to predict RDHT in patients with hypertension.

The Relationship Between the Dipping Pattern and Coronary Artery Disease Severity Assessed by the SYNTAX Score in Patients With Hypertension.

Background The morbidity and mortality rates related to hypertension (HT) are still high despite the developments in this area. Nondipper hypertension (NDHT) is related to worse clinical outcomes. But the dipping pattern of HT is not still used for treatment targets. In this study, we investigated the effect of dipping patterns on coronary artery disease (CAD) complexity evaluated by the SYNTAX score (SS). Methodology Patients with stable CAD and HT were included in the study. All patients were monitored with 24-hour ambulatory monitoring, and dipping patterns were evaluated. Coronary artery complexity was determined by SS for all patients and compared along with different dipping patterns. Results A total of 331 patients with HT and stable CAD were evaluated in the study. The mean age of the patients was 62.6 ± 9.9 years, and 172 (52%) were male. The number and percentage of patients with dipper HT (DHT), NDHT, over-dipper HT (ODHT), and reverse-dipper HT (RDHT) were 89 (26%), 143 (43%), 11 (3%), and 88 (26%), respectively. When the groups were compared according to SS, the SS of the patients with RDHT were significantly higher (the SS were 6.33, 4.99, 3.09, and 2.7 for RDHT, ODHT, NDHT, and DHT, respectively, P = 0.003). The mean SS between the DHT group and the NDHT group (P = 0.03) and between the DHT group and the RDHT group (P = 0.01) was significantly different. The less decrease or increase in mean blood pressure (MnBP) values was significantly correlated with high SS. Conclusions NDHT, especially the reverse dipping pattern, is closely related to complex CAD. Meticulous consideration of dipping patterns can identify high-risk patients and improve clinical outcomes.

The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients.

The frontal QRS-T angle (fQRS-T angle) in ECG is a new measure of myocardial repolarization, in which a higher fQRS-T angle is linked with worse cardiac outcomes. Reverse dipper hypertension is also linked to poor cardiac outcomes. The purpose of this study was to investigate the association between the fQRS-T angle and reverse dipper status in individuals newly diagnosed with hypertension who did not have left ventricular hypertrophy (LVH). The investigation recruited 171 hypertensive individuals without LVH who underwent 24-h ambulatory blood pressure monitoring (ABPM). On the basis of the findings of 24-h ABPM, the study population was categorized into the following three groups: patients with dipper hypertension, non-dipper hypertension, and reverse dipper hypertension. LVH was defined by echocardiography. The fQRS-T angle was measured using the 12-lead ECG. The fQRS-T angle in individuals with reverse dipper hypertension was substantially greater than in patients with and without dipper hypertension (51° ± 28° vs. 28° ± 22° vs. 39° ± 25°, respectively, P < 0.001). The fQRS-T angle (odds ratio: 1.040, 95% confidence interval: 1.016-1.066; P = 0.001) was independently associated with reverse dipper hypertension according to multivariate analysis. In receiver operating characteristic curve analysis, the fQRS-T angle to predict reverse dipper hypertension was 33.5° with 76% sensitivity and 71% specificity. This study showed that an increased fQRS-T angle was associated with reverse dipper hypertension in newly diagnosed hypertensive patients without LVH.

PS-C06-11: IRISIN ASSOCIATION WITH NON DIPPER HYPERTENSION DEVELOPMENT IN OBESE PATIENTS WITH CORONARY ARTERY DISEASE

Objective: Recent investigations showed that irisin, as a possible inflammatory marker, can be closely related to heart function, vessels tone regulation and possible development of arterial hypertension HTN. The purpose of the work was to study the relationship between irisin and the development of non dipper hypertension in obese patients with coronary artery disease CAD. Design and method: 97 obese hypertensive patients with CAD were enrolled into the study. CAD was presented as chronic coronary syndrome CCS according to 2019 ESC Guidelines, essential HTN as systolic blood pressure SBP ≧ 140 mmHg and or diastolic blood pressure DBP ≧ 90mmgHg. Obesity was assessed as body mass index BMI ≧ 30 kg per m2 according to WHO criteria. The mean age of participants was 53.61 ± 4.88 years. Patients were divided into 2 groups. The first one was with dipper HTN, n 46, and the second one with non dipper HTN, n 51. Dippers were established by Holter monitoring. Serum irisin levels were measured by ELISA. Results: It was found that irisin levels were significantly lower in non dipper hypertensive subjects compared with dippers 125.72 ± 15.09 vs 141.53 ± 21.84 ng per mL, p &lt; 0.001. Irisin has a negative correlation with SPR r = 0.29, p &lt; 0.01, and after adjusted for age, sex and BMI it remained a significant link between irisin and SBP, r = 0.21, p = 0.044. In multivariate logistic regression analysis of the irisin odds ratio OR 0.859, 95 per cent Confidence Interval 0.471 to 0.993, p &lt; 0.001 was found to be independent predictors for non dipper hypertension in obese patients with CCS. Conclusions: This study shows that decreased irisin levels are significantly associated with the development of non dipper hypertension in obese patients with coronary artery disease.

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 importance of frontal QRS-T angle for predicting reverse dipper status in newly diagnosed hypertensive patients

Abstract Background The frontal QRS-T angle (fQRS-T angle) in electrocardiography is a new measure of myocardial repolarization, in which a higher fQRS-T angle is linked with worse cardiac outcomes. Reverse dipper hypertension is also linked to poor cardiac outcomes. The purpose of this study was to investigate the association between the fQRS-T angle and reverse dipper status in individuals newly diagnosed with hypertension who did not have left ventricular hypertrophy (LVH). Methods The investigation recruited 171 hypertensive individuals without LVH who underwent 24h ambulatory blood pressure monitoring (ABPM). Based on the findings of 24h ABPM, the study population was categorized into the following three groups: patients with dipper hypertension, with non-dipper hypertension, and with reverse dipper hypertension. The frontal QRS-T angle was measured using 12-lead electrocardiography (ECG). Results The fQRS-T angle in individuals with reverse dipper hypertension was substantially greater than in patients with and without dipper hypertension (510±280 vs. 280±220 vs. 390±250 respectively, p&amp;lt;0.001). The fQRS-T angle (OR: 1.040, 95% CI: 1.016–1.066; p=0.001) was independently associated with reverse dipper hypertension according to multivariate analysis. In receiver operating characteristic curve analysis, the fQRS-T angle to predict reverse dipper hypertension was 33.5° with 76% sensitivity and 71% specificity. Conclusion This study showed that an increased fQRS-T angle was a predictor of reverse hypertension in newly diagnosed hypertensive patients without LVH. Funding Acknowledgement Type of funding sources: None.

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.

Systemic Immune-Inflammation Index: A Novel Predictor for Non-dipper Hypertension.

IntroductionThe non-dipper hypertension (HT) pattern is associated with more end-organ damage and cardiovascular events than is dipper HT. Inflammation is widely established to play a role in the pathophysiology of HT. Recently, a new inflammatory and prognostic marker called the systemic immune-inflammation index (SII) has emerged. Our goal is to determine whether there is a relationship between non-dipper HT and SII.MethodsOur study is a single-center retrospective and ninety-one patients with HT were included. All patients were analyzed with simultaneous 24-hour ambulatory blood pressure monitoring and laboratory parameters. Thirty-five patients had dipper HT while 56 patients had non-dipper HT. SII was calculated according to neutrophil, platelet, and lymphocyte counts.ResultsThe median age was 48 (45-61 interquartile range (IQR)) in the non-dipper HT group, whereas it was 54 (44-64 IQR) in the dipper HT group. Although the neutrophil level, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, SII, sleeping systolic blood pressure (BP), and sleeping diastolic BP were higher (p=0.020, p=0.041, p=0.046, p=0.019, p<0.001, and p=0.001, respectively) in the non-dipper HT group, the lymphocyte level was lower (p=0.040). A multivariate logistic regression model shows that SII (odds ratio (OR)=1.023, 95% confidence interval (CI)=1.002-1.112, p=0.012) may be an independent predictor of non-dipper HT.ConclusionOur study showed that the SII level was higher in the non-dipper HT patient group than in the dipper HT group. Furthermore, SII was an independent predictor of non-dipper HT. The high SII value in hypertension patients can be used as an early warning parameter to identify non-dipper HT patients.

Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome.

ResumoFundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular.Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda.Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo.Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX.Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Study on the related factors affecting the circadian rhythm of blood pressure in patients with essential hypertension

ABSTRACT This study explored the related factors affecting the circadian rhythm of blood pressure in patients with essential hypertension. According to blood pressure rhythm, 1007 patients with essential hypertension were divided into dipper (n = 332) and non-dipper group (n = 675). Age, gender, height and other basic information were collected, BMI was calculated, and FPG, TG, TC and other indicators were recorded. Meanwhile, carotid ultrasound, office BP, central hemodynamic parameters, and other indicators were recorded. Logistic regression was used. In comparison, dSBP, dDBP, nSBP, nDBP, nocturnal systolic blood pressure and nocturnal diastolic blood pressure drop rate, 24 hSSD, 24 hDSD and dSSD were statistically significant (P < 0.05). The results showed no distinct differences in CSP, CDP, CPP, AP, Aix and AIx75 in CAP between two groups (P > 0.05). Log regression analysis showed that for every increase in nocturnal SBP, dipper hypertension was more likely to occur than non-dipper hypertension. Circadian rhythm of blood pressure of hypertension in patients with essential hypertension is mainly the influence of circadian blood pressure and nocturnal blood pressure drop rate, especially for the nocturnal systolic blood pressure, so effective control of blood pressure at night could make the circadian rhythm of blood pressure tend to be in dipper type distribution.

Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions

Hypertensive patients have shown autonomic dysfunction that is closely associated with the measurements of heart rate variability (HRV) and heart rate turbulence (HRT). We aimed to show the alterations of HRV and HRT measurements in patients with both dipper and non-dipper hypertension. This was a retrospective study consisting of one hundred and twenty-three participants (mean age ± SD, 55.7 ± 14.8 years; range, 18–90 years). The participants were divided into two groups: Group1: The patients with dipper hypertension, Group2: The patients with non-dipper hypertension. Two cardiologists performed HRV and HRT using 24-h electrocardiography (ECG) Holter and ambulatory blood pressure monitoring (ABPM) of patients. The results indicated that patients in group 2 had higher low frequency power/high frequency power ratio (LF/HF), lower high frequency power (HF) , root mean square of standard deviation (RMSSD) values than group 1 (p = 0.007, p = 0.008, and p = 0.002, respectively). Group 2 also showed higher heart rate turbulence onset (HRTTO) and lower heart rate turbulence slope (HRTTS) values than Group 1 (p = 0.004, p = 0.001, respectively). We performed multivariate analysis and observed that HRTTS and HRTTO have statistically significant associations with the presence of dipper or non-dipper hypertension [F = 7.755, p = 0.001], LF/HF [F = 7.868, p = 0.001], and HF [F = 4.081, p = 0.020]. This study shows a statistically significant difference in HRT measurements between dipper and non-dipper hypertensive patients. Deteriorated autonomic circadian rhythm and autonomic functions may contribute to these results.

The association of C-reactive protein to albumin ratio with non-dipping status in hypertensive patients.

A reduction of less than 10% in nocturnal blood pressure (BP) compared to daytime BP is defined as non-dipper hypertension (HT). The C-reactive protein/albumin ratio (CAR) emerged as a popular and useful biomarker for cardiovascular disease. The main purpose of this study was to examine the relationship between CAR and non-dipper status. This was a cross-sectional study conducted between October 1, 2020 and December 1, 2020 and included 200 consecutive patients with elevated BP (102 women and 98 men). The numbers of dipper HT [mean BP drop at night >10%], and non-dipper HT [mean BP drop at night <10%] patients were equal in the entire study population. All data of the patients eligible for the study were retrieved from the hospital's electronic medical records. Student's t-test, Mann-Whitney U and chi-square tests, and linear and logistic regression analyses were used for statistical analyses as appropriate). A p-value <0.05 was considered statistically significant. The CAR was higher in non-dipper group than dippers (38 and 19; p<0.001). Moreover, CAR independently predicted non-dipper status [odds ratio (OR) 1.825 95% confidence interval (CI) 0.887-2.206; p = 0.012]. In our study, patients with non-dipper HT showed higher CAR values and CAR was independently associated with non-dipper status. Larger studies are needed to establish the relationship between CAR and non-dipper status and to generalize our conclusions for clinical practice.

The relationship between mean platelet volume and reverse dipping blood pressure pattern in patients with essential hypertension

ABSTRACT Objective An association between increased mean platelet volume (MPV) and cardiovascular events is well established. Recent studies suggest that a nondipper blood pressure pattern is closely related to increased MPV. Because little information has been revealed about the relationship between reverse dipper hypertension (RDHT) and MPV, we aimed to investigate this relation. Methods A total of 317 patients were retrospectively evaluated by analyzing the records of ambulatory blood pressure monitoring (ABPM). Patients were categorized into three groups according to their ABPM values as RDHT (n = 63), non-dipper hypertension (NDHT) (n = 95), and dipper hypertension (DHT) groups (n = 159). MPV and biochemical analyses were recorded from the hospital database. Results The largest MPV was found in patients with RDHT, followed by patients with NDHT and DHT group (9.1 ± 0.4 fl, 8.8 ± 0.6 fl, and 8.6 ± 0.5 fl, respectively, for all p < .05). MPV was positively correlated with mean 24-hour systolic blood pressure (SBP), mean 24-hour diastolic blood pressure (DBP), mean daytime SBP, mean nighttime SBP and mean nighttime DBP. In multivariate logistic regression analysis, MPV (OR 1.761, 95% CI 1.329 to 2.334, p = .001) and age (OR 1.065, 95% CI 1.019 to 1.113, p = .001) were found to be associated with RDHT. ROC curve analysis of MPV for prediction of RDHT showed that at the cutoff value of >9,1 fl with a sensitivity of 60% and specificity of 69%, respectively (AUC = 0.696 ± 0.035, 95% CI: 0.627–0.764). Our data show that the RDHT pattern is associated with increased MPV values in patients with essential hypertension.

Serum Uric Acid, Lipid Profile and Atherogenic Index of Plasma in Dipper and Non-dipper Normotensive Subjects

The cardiovascular risk evidentially found to have an association with disparities of the dipper and non-dipper hypertension. There is less celerity with regard to mechanism of diurnal blood pressure variations and related disorders. The serum uric acid and AIP are considered as cardiovascular risk factors. The current study aims to determine and compare serum uric acid level and atherogenic index of plasma (AIP) in dipper and non-dipper normotensive subjects. The study population is 64 healthy normotensive subjects (32 dippers and 32 non-dippers), age between 30-55 years. The subjects were identified into dippers and non-dippers by using ambulatory blood pressure monitoring device (Spacelabs 90207, USA). After identifying dipping status of the subjects, uric acid, triglycerides and HDL cholesterol were measured. AIP was calculated by using formula (log [TG/HDL]). Median (interquartile range) of serum uric acid in the dipper group was 5.08mg/dl (4.12-5.66) and the non-dipper group was 5.27mg/dl (4.63-6.33). The median (interquartile range) for AIP was 0.24 (0.05-0.38) in the dipper group and 0.48 (0.32-0.67) in the non-dipper group. The median (interquartile range) of uric acid and AIP in the non-dipper group was significantly higher than that of dipper group (p&lt;0.05). This study observed in even normotensive subjects, the non-dipper group has significantly higher serum uric acid and AIP than that of dipper group. These cardiovascular risk factors increased in non-dipper group compared to dipper group. The study come out with concluded that non-dipper group had higher cardiovascular risk than dipper group even in normotensive healthy subjects.

Circulating IL-37 levels are elevated in patients with hypertension.

Interleukin-37 (IL-37) has been reported to be closely linked to vascular diseases, including atherosclerosis and aortic calcification. The present study aimed to assess the expression levels of IL-37 in patients with hypertension. Blood samples were collected from control subjects (n=20) and patients with hypertension (n=45). Subsequently, macrophages, lymphocytes and dendritic cells were individually isolated and the mRNA expression of IL-37 was measured. In addition, the circulating IL-37 levels in control subjects (n=30) and patients with hypertension (n=334) were assessed. Furthermore, all patients who were subjected to detection of circulating IL-37 underwent ambulatory blood pressure monitoring. The results suggested that the mRNA levels of IL-37 in macrophages, but not in lymphocytes and dendritic cells, isolated from patients with hypertension were markedly elevated compared with those in cells isolated from control subjects. Circulating IL-37 levels were increased in patients with hypertension compared with those in control subjects and positively correlated with systolic and diastolic blood pressure in patients with hypertension. No differences were observed between patients with dipper hypertension and patients with non-dipper hypertension. In addition, patients with hypertension with a smoking habit, type 2 diabetes mellitus and carotid atherosclerotic plaque (CAP) exhibited higher IL-37 levels. IL-37 levels were positively correlated with creatinine, C-reactive protein and homocysteine levels. Furthermore, the results of a linear regression analysis suggested that IL-37 levels were independently associated with the presence of CAP. In conclusion, IL-37 levels are increased in patients with hypertension and may be associated with the onset of CAP.

The evaluation of ventricular arrhythmia risk by using electrocardiographic parameters in patients with dipper and non-dipper hypertension

Aim: Non-dipper hypertension (NDHT) is associated with increased cardiovascular mortality. Lots of different electrocardiographic parameters can be used for this purpose. Some electrocardiographic repolarization parameters and some particular parameters obtained from 24 hours holter recordings frequently were used. The aim of this study was to evaluate ventricular arrhythmia risk by using most of this electrocardiographic parameters in patients with dipper hypertension (DHT) and NDHT.Material and methods: 220 patients with hypertension were included this study. Patients were divided into two groups as DHT and NDHT according to the 24 hours ambulatory blood pressure monitoring. Two groups were compared with electrocardiography and echocardiography parameters and also were compared with heart rate variability (HRV) and heart rate turbulence (HRT) parameters.Results: There were no significant differences between DHT and NDHT groups with regard to demographic and laboratory datas. Also echocardiography parameters normally distributed and have no significant differences between two groups. There were no significant differences between DHT and NDHT groups with regard to left ventricular mass index (p=0.280). Although QT, QT dispersion, HRV and HRT parameters differences were not statistically significant , results were in favour of DHT in terms of ventricular arrhythmia risk. Conclusion: When hypertensive patients having no statistically significant differences in terms of left ventricular diamaters and left ventricular mass between them were divided as DHT and NDHT; there were no statistically significant differences between two groups with regard to electrocardiographic ventricular arrhythmia parameters although results were in favour of DHT.

Serum interleukin-18 levels are associated with non-dipping pattern in newly diagnosed hypertensive patients.

Interleukin-18 (IL-18), a pro-inflammatory cytokine, increases inflammation in the endothelium. Increased inflammation plays an important role in the development of hypertension (HT). IL-18 level is higher in hypertensives than normotensives. To investigate the relationship between IL-18 level and diurnal blood pressure (BP) variations in newly diagnosed HT patients. This prospective study included 130 subjects referred to outpatient cardiology clinic with an initial diagnosis of HT. The patients were classified as dipper HT (n = 40), non-dipper HT (n = 50), and normotensive (control, n = 40) according to 24-hour ambulatory BP monitoring. All subjects underwent blood sampling after 12 hours of fasting and transthoracic echocardiography. The serum IL-18 level was significantly higher in the patient group compared with the controls (195.17 ± 93.00 mg/dl vs. 140.75 ± 71.11 mg/dl, P < 0.01) and also in the non-dipper group than in the dipper group (217.3 ± 96.90 mg/dl, 167.5 ± 80.79 mg/dl, P = 0.011). IL-18 level was positively correlated both the night-time SBP and DBP levels (r = 0.29, P = 0.02 and r = 0.34, P < 0.01, respectively). On multivariate linear regression analysis, left atrium diameter, left ventricular mass index, and serum IL-18 level were independent predictors of non-dipping pattern in newly diagnosed HT patients. Higher IL-18 level was particularly associated with an increase in the night-time BP levels. IL-18 can be used as a predictor for non-dipper HT in newly diagnosed HT patients.

Assessment of salusin alpha and salusin beta levels in patients with newly diagnosed dipper and non-dipper hypertension

ABSTRACT Objective The pathophysiology of non-dipper hypertension has not been clarified. The relationship between salusins with atherosclerosis and hypertension has gained attention in recent years. The aim of this paper is to investigate whether salusins are associated with circadian blood pressure, left ventricular mass index, and diastolic functions in newly diagnosed hypertensives. Methods The study included 88 newly diagnosed hypertensive individuals. Twenty-four-hour ambulatory blood pressure monitoring and echocardiographic examinations were performed. The patients were assigned to dipper hypertension (n = 41) and non-dipper hypertension (n = 47) groups based on the ambulatory blood pressure monitoring results according to the presence of ≥ a 10% decrease in nighttime blood pressure values or not. Serum salusin α and β levels were determined by electrochemiluminescence immunological test method. Results Compared to dipper hypertension, non-dipper hypertension group demonstrated lower salusin α levels (1818.71 ± 221.67 vs 1963 ± 200.75 pg/mL, p = .002), mitral E/A, septal E’/A’ and higher salusin β levels (576.24 ± 68.15 vs 516.13 ± 90.7 pg/ml, p = .001) and left ventricular mass index. Multivariate logistic regression analysis revealed salusin-α (OR 0.474, 95% CI 0.262 to 0.986, p = .001), salusin-β (OR 2.550, 95% CI 2.123 to 2.991, p = .018), and left ventricular mass index (OR 2.620, 95% CI 2.124 to 2.860, p = .011) as independent predictors of non-dipper hypertension. As candidate markers to predict non-dipper hypertension, decreased salusin α, and increased salusin β levels may mediate crosstalk between sympathetic and parasympathetic systems and indicate poor cardiovascular prognosis in hypertension.