Blood Pressure Dipping Research Articles

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

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

Postoperative Dipping Patterns of Mean Arterial Pressure and Mortality After Coronary Artery Bypass Grafting.

Blood pressure dipping patterns have long been considered to be associated with adverse events. We aimed to investigate whether dipping patterns of postoperative MAP were related to 90-day and hospital mortality in patients undergoing CABG. Four thousand three hundred ninety-one patients were classified into extreme dippers (night-to-day ratio of MAP ≤ 0.8), dippers (0.8 < night-to-day ratio of MAP ≤ 0.9), non-dippers (0.9 < night-to-day ratio of MAP ≤ 1), and reverse dippers (> 1). Compared with non-dippers, reverse dippers were at a higher risk of 90-day mortality (aHR = 1.58; 95% CI, 1.10-2.27) and hospital mortality (aOR = 1.97; 95% CI, 1.12-3.47). A significant interaction was observed between hypertension and dipping patterns (P for interaction = 0.02), with a significant increased risk of 90-day mortality in non-hypertensive reverse dippers (aHR = 1.90; 95% CI, 1.17-3.07) but not in hypertensive reverse dippers (aHR = 1.26; 95% CI, 0.73-2.19).

The Effect of Night Shift on Blood Pressure in Healthcare Workers.

Individuals across all age groups may experience elevated blood pressure due to a combination of internal and environmental factors. Factors influencing arterial pressure include diet, stress, sleep patterns, and lifestyle. This study aims to investigate the susceptibility to high blood pressure among occupational groups working night shifts. The study included healthcare worker participants who had at least six night shifts per month. A control group consisted of participants performing the same roles during daytime. Participants with chronic diseasesor those taking blood pressure-affecting medication were excluded. Holter recordings were made over a minimum of 48 hours, including both a free day and a work day. The study involved 114 participants-55 in the study group and 59 in the control group. Statistically significant differences were noted between the groups in the daylight-night ratios of systolic and diastolic pressures, with P values of 0.006 and 0.005, respectively. The systolic daylight-night difference was -5.7 ± 5.5% in the study group and -9.0 ± 7.0% in the control group. The diastolic daylight-night difference was -7.9 ± 9.6% in the study group and -12.7 ± 8.2% in the control group. Occupations with nighttime work schedules are often associated with non-dipping blood pressure patterns due to sleep disturbances. It is crucial to consider the blunted dipping of blood pressure induced by night shift work when assessing and monitoring hypertension and related medical conditions.

Evaluation of the Relationship between Inflammatory, Metabolic, and Liver-Related Indexes and Blood Pressure Dipping Ratios: A Retrospective Study.

Nighttime blood pressure dipping is a normal physiologic phenomenon. Lack of dipping is associated with increased cardiovascular disease; thus, non-dipping patients are candidates for more strict risk reduction strategies. Dipping presence can be identified using ambulatory blood pressure measurement (ABPM). Recent findings indicate that inflammatory, metabolic, and liver-related indices may have a role in predicting dipping presence dichotomously. To investigate whether dipping ratios correlate with that inflammatory, metabolic, and liver-related indices. Hypertensive patients with ABPM recordings were retrospectively collected. Patient characteristics, co-morbidities, medications, laboratory results, and ABPM results were analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), triglyceride-glucose index (TyG), triglyceride-to-HDL ratio (TG/HDL), total cholesterol-to-HDL ratio (TC/HDL), AST-to-ALT ratio (AST/ALT), fibrosis-4 (FIB-4), and AST-to-platelet ratio index (APRI) were calculated. Differences and correlations were analyzed between indices, dipping patterns, and ratios. Ninety-three patients were included in the study. Forty-five had either a systolic or diastolic dipping pattern. NLR, PLR, TG/HDL, and TC/HDL indices correlated negatively with dipping ratios. AST/ALT was higher in systolic dippers (1.04 vs 0.88, P = 0.03). However, no difference was observed between NLR, PLR, TyG, TG/HDL, TC/HDL, FIB-4, and APRI among different dipping presences. This study showed for the first time that there was a negative correlation between inflammatory and metabolic indices and dipping ratios.

Cardiovascular dysfunction induced by combined exposure to nicotine inhalation and high-fat diet.

Smoking and high-fat diet (HFD) consumption are two modifiable risk factors for cardiovascular (CV) diseases, and individuals who are overweight or obese due to unhealthy diet are more likely to use tobacco products. In this study, we aim to investigate the combined effects of nicotine (the addictive component of all tobacco products) and HFD on CV health, which are poorly understood. C57BL/6N male mice were placed on either HFD (60 kcal% fat) or regular diet (22 kcal% fat) and exposed to air or nicotine vapor for 10-12 wk. CV function was monitored by echocardiography and radiotelemetry, with left ventricular (LV) catheterization and aortic ring vasoreactivity assays performed at end point. Mice on HFD exhibited increased heart rate and impaired parasympathetic tone, whereas nicotine exposure increased sympathetic vascular tone as evidenced by increased blood pressure (BP) response to ganglionic blockade. Although neither nicotine nor HFD alone or in combination significantly altered BP, nicotine exposure disrupted circadian BP regulation with reduced BP dipping. LV catheterization revealed that combined exposure to nicotine and HFD led to LV diastolic dysfunction with increased LV end-diastolic pressure (LVEDP). Moreover, combined exposure resulted in increased inhibitory phosphorylation of endothelial nitric oxide synthase and greater impairment of endothelium-dependent vasodilation. Finally, a small cohort of C57BL/6N females with combined exposure exhibited similar increases in LVEDP, indicating that both sexes are susceptible to the combined effect of nicotine and HFD. In summary, combined exposure to nicotine and HFD leads to greater CV harm, including both additive and new-onset CV dysfunction.NEW & NOTEWORTHY Nicotine product usage and high-fat diet consumption are two modifiable risk factors for cardiovascular diseases. Here, we demonstrate that in mice, combined exposure to inhaled nicotine and high-fat diet results in unique cardiovascular consequences compared with either treatment alone, including left ventricular diastolic dysfunction, dysregulation of blood pressure, autonomic dysfunction, and greater impairment of endothelium-dependent vasorelaxation. These findings indicate that individuals who consume both nicotine products and high-fat diet have distinctive cardiovascular risks.

Metabolipidomic Analysis in Patients with Obstructive Sleep Apnea Discloses a Circulating Metabotype of Non-Dipping Blood Pressure.

A non-dipping blood pressure (BP) pattern, which is frequently present in patients with obstructive sleep apnea (OSA), confers high cardiovascular risk. The mechanisms connecting these two conditions remain unclear. In the present study we performed a comprehensive analysis of the blood metabolipidome that aims to provide new insights into the molecular link between OSA and the dysregulation of circadian BP rhythmicity. This was an observational prospective longitudinal study involving adults with suspected OSA who were subjected to full polysomnography (PSG). Patients with an apnea-hypopnea index ≥ 5 events/h were included. Fasting plasma samples were obtained the morning after PSG. Based on the dipping ratio (DR; ratio of night/day BP values) measured via 24 h ambulatory BP monitoring, two groups were established: dippers (DR ≤ 0.9) and non-dippers (DR > 0.9). Treatment recommendations for OSA followed the clinical guidelines. Untargeted metabolomic and lipidomic analyses were performed in plasma samples via liquid chromatography-tandem mass spectrometry. Non-dipper patients represented 53.7% of the cohort (88/164 patients). A set of 31 metabolic species and 13 lipidic species were differentially detected between OSA patients who present a physiologic nocturnal BP decrease and those with abnormal BP dipping. Among the 44 differentially abundant plasma compounds, 25 were putatively identified, notably glycerophospholipids, glycolipids, sterols, and fatty acid derivates. Multivariate analysis defined a specific metabotype of non-dipping BP, which showed a significant dose-response relationship with PSG parameters of OSA severity, and with BP dipping changes after 6 months of OSA treatment with continuous positive airway pressure (CPAP). Bioinformatic analyses revealed that the identified metabolipidomic profile was found to be implicated in multiple systemic biological pathways, with potential physiopathologic implications for the circadian control of BP among individuals with OSA.

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

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

Abnormal blood pressure dipping pattern: frequency, determinants, and correlates in Diabetes Mellitus patients in the Cardiovascular Health Risk Assessment in Diabetes Mellitus (CHiD) study.

Non-dipping status is associated with increased total and cardiovascular mortality in many disease conditions including diabetes mellitus. The pattern and its implications are not well described among Africans. This study was done to describe the frequency of abnormal blood pressure (BP) dipping among T2DM subjects, its determinants and correlates in Ogbomoso, Nigeria. This was a cross-sectional study done at the LAUTECH Teaching Hospital, Ogbomoso. One hundred individuals diagnosed with T2DM were recruited and they had 24-hour ambulatory BP monitoring, echocardiography, ECG, and carotid Doppler among other evaluations. Statistical analysis was done using SPSS 27.0 (Chicago Ill, USA). The mean age of the participants was 59.3 ± 10.8 years, mean body mass index 27.7 ± 5.9kg/m2 with a mean duration of diabetes of 7.52 ± 5.54 years. Abnormal BP dipping was present in 89% (consisting of 41% or reverse dippers and 48% non-dippers). T2DM subjects with abnormal dipping pattern were more likely to be females, had higher glycated haemoglobin, lower fractional shortening, higher left atrial volume and left ventricular mass index, and a higher DM duration than those with normal BP dipping status. The major determinants of abnormal dipping pattern were the duration of diabetes and low HDL-C concentration. Abnormal BP dipping pattern is highly prevalent in T2DM subjects, especially among females. Abnormal BP dipping was also associated with markers of increased cardiovascular risk such as impaired kidney function, left ventricular hypertrophy, postural hypotension, history of intermittent claudication, and presence of plaques on carotid Doppler studies. The online version contains supplementary material available at 10.1007/s40200-023-01337-8.

Etiology, risk factors and management of hypertension post liver transplantation.

Cardiovascular events are one of the most important causes of morbidity and mortality in the long-term follow-up of liver transplant recipients. Hypertension is a significant cardiovascular risk factor that occurs frequently after pediatric liver transplantation. Chronic use of immunosuppressants - mainly calcineurin inhibitors - plays a major role in the development of post-transplant hypertension and circadian disturbances such as flattening of the nocturnal blood pressure dip. This requires special attention in children given the long timeframe during which immunosuppressive therapy is necessary. Careful and structured blood pressure monitoring and adequate treatment of hypertension are essential to optimize the quality of life and life expectancy of pediatric liver transplant patients. However, evidence-based guidelines for monitoring and management of post-transplant hypertension and its complications are lacking. We conducted a comprehensive review of the current knowledge and practices concerning post-transplant hypertension. The databases Pubmed, Embase, Web of Science and Google Scholar were scanned with the following keywords: pediatric liver transplantation, immunosuppression, tacrolimus, cardiovascular effects, hypertension, heart function, kidney function, circadian rhythm, mechanism, monitoring, and management. In this review, we describe the incidence and etiology of hypertension in pediatric liver transplant recipients, the underlying mechanisms and characteristics of calcineurin inhibitor-induced hypertension, and the consequences of and risk factors for post-transplant hypertension. We hereby present an overview of the current practices in blood pressure monitoring and antihypertensive treatment as well as an algorithm for the evaluation and management of hypertension post liver transplantation. Finally, we discuss knowledge gaps and suggestions for future research.

Nocturnal Systolic Blood Pressure Dipping and Progression of CKD

Nocturnal Systolic Blood Pressure Dipping and Progression of CKD

Clinical Significance of Nocturnal Hypertension and Nighttime Blood Pressure Dipping in Hypertension.

This narrative review article aims to discuss more recent evidence, current challenges, and future perspectives regarding the clinical importance of nocturnal hypertension and nighttime blood pressure dipping, with particular reference to diagnosis, prognostic value, and therapeutic approach. The importance of nighttime blood pressure and nighttime blood pressure dipping has been demonstrated in decades. Increased nighttime blood pressure has been acknowledged as an unfavorable clinical trait. However, more recent evidence suggests that the abolishment of normal circadian blood pressure rhythm is not always a solid predictor of adverse cardiovascular events and needs to be interpreted in the light of each patients' individual characteristics. Physicians treating hypertensive patients with adverse nighttime blood pressure profiles often face the dilemma of chronotherapy. This has been a blurred field for years, yet very recent evidence from appropriately designed studies attempts to shed light on this puzzling question. As 24-h ambulatory blood pressure monitoring is being increasingly recommended and applied in real-world practice for the diagnosis and monitoring of hypertension, information on nighttime blood pressure and nocturnal dipping profile is collected but is not always easy to interpret.

Obstructive sleep apnea and non-dipper: epiphenomena or risks of Alzheimer's disease?: a review from the HOPE Asia Network.

Obstructive sleep apnea (OSA) and associated nocturnal blood pressure (BP) surges is associated with non-dipper. On the other hand, the relationship between neurodegenerative diseases and non-dipper hypertension has been reported. To date, few studies have evaluated the relationships of nocturnal BP dipping patterns and OSA in relation to neurodegenerative diseases, particularly Alzheimer's disease (AD). This review examines the etiology of the association between OSA and the non-dipper pattern of hypertension and how both are involved in the development of AD. To set the stage for this review, we first focus on the pathophysiology of AD, which is interrelated with sleep apnea and non-dipper through dysregulation of central autonomic network.

Chronological distribution of readings in ambulatory blood pressure monitoring exams affects the nighttime average and the magnitude of blood pressure dipping.

Averaged nighttime blood pressure (BP) is superior to daytime BP for cardiovascular risk stratification, and the relative change between daytime/nighttime BP (dipping%) significantly predicts cardiovascular risk. Newer reports suggest that 4 measurements at night may be enough for cardiovascular risk stratification. Since BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. Therefore, we compared average nighttime BP and dipping% when using measurements in the first half (1st-half), second (2nd-half), and a combination of both (combined). Forty-three (17 females and twenty-six males) midlife adults aged 50±10 years old wore an ambulatory BP monitor for 24 hours at home, programmed to measure BP every 20 minutes when scheduled for daytime and every 30 minutes during a self-selected 8-hour nighttime for time-in-bed. We compared the nighttime BP averages and dipping% when using either the first four measurements from the 1st-half or 2nd-half of the nighttime and combined. Nighttime Systolic BP was significantly different across 1st-half, 2nd-half, and combined (111±9 vs.107±11 vs. 109±9 mmHg, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each). Systolic BP dipping% was significantly different across 1st-half, 2nd-half, and combined (9.9±5.5 vs.13.5±6.4 vs. 11.7±5.0 %, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each. Diastolic BP and diastolic dipping% were similar across the three different bins. In midlife adults, systolic nighttime BP and dipping% may depend upon when BP measurements are taken during the night.

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

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

Later circadian timing and increased sleep timing variability are associated with attenuations in overnight blood pressure dipping among chronic nightshift workers

ObjectiveDetermine relationships between overnight blood pressure, circadian phase, and sleep variability among dayshift and chronic nightshift nurses. MethodsTwenty participants working dayshift (n = 10) or nightshift (n = 10) schedules participated in a 7-day cross-sectional study. Participants underwent an evening in-laboratory melatonin assessment and wore ambulatory blood pressure devices to assess 24-hour blood pressure patterns. Overnight blood pressure dipping was calculated from sleeping/waking systolic blood pressure ratio and salivary dim-light melatonin onset determined circadian phase. Sleep variability was assessed using the standard deviation of 7-day sleep onset. ResultsNightshift workers had later circadian phase, greater sleep onset variability, and an attenuated overnight blood pressure dipping pattern. Later circadian phase was associated with attenuated dipping patterns and sleep onset variability was negatively correlated with blood pressure dipping magnitude in nightshift, but not dayshift workers. ConclusionsChronic circadian disruption via higher sleep onset variability among nightshift workers may contribute to attenuated blood pressure dipping and cardiovascular risk in this population.

256 How prevalent are markers of blood pressure instability on Ambulatory Blood Pressure Monitoring of older people with falls, faints &amp; dizziness?

Abstract Background In older people with BP-related falls, the mechanisms that usually tightly control Blood Pressure (BP) may be less efficient, leading to BP instability. This may manifest as specific markers on Ambulatory Blood Pressure Monitoring (ABPM), including BP variability, BP dipping and absence of nocturnal dipping/reverse dipping. The aim of this study therefore is to ascertain the prevalence of APBM markers of BP Instability among older people with falls/faints/dizziness and examine if there is an age-gradient seen for these markers. Methods ABPM data (minimum 25 BP values measured across 24 hours) was collected for 83 consecutive patients aged ≥70 years attending a tertiary-referral Falls &amp; Syncope Unit with falls, fainting or dizziness. Data analysed included BP Variability (standard deviation (SD) of BP values, i.e. measurement of the oscillation of BP measurements); Nocturnal dipping (decrease in average night BP compared to average day BP) and BP dips (number of systolic BP values &amp;lt;100 mm Hg). Results: Of the analysed ABPMs(n = 83, mean age 78 years, 48% female), mean number of readings per device was 34.6 (33.7–35.5). The average SD for overall systolic BP was 15.9. Over 15% of patients had an average SD ≥20 for systolic BP based on the full ABPM, reflecting high levels of BP variability. There was a significant age gradient seen for nocturnal dipping with mean change −0.30 (−9.3–8.8) in those aged ≥85 years compared to +10.9(7.3–14.6) in the 70–74 years age group. The mean number of systolic BP values&amp;lt;100 mm Hg was 2.9 (1.7–4.0). Conclusion Older patients attending with falls/faints/dizziness demonstrate significant BP variability, aberrant nocturnal dipping profiles and frequent systolic BP values dipping below 100 mm Hg. Further work is required to establish if these ABPM aberrancies are reliable predictors of future falls and potentially modifiable targets to reduce falls burden among older people.

Abstract P323: Going Beyond Spot 30-minute Nocturnal Blood Pressure (bp) Check With The Continuous Nocturnal Bp Monitoring

Background: Ambulatory Blood Pressure Monitoring (ABPM) is useful to determine nocturnal BP. However, the major limitation is the spot-check nature. The main objective of the study is to compare the nocturnal blood pressure (BP) results derived from continuous nocturnal (beat-to-beat) finger cuff BP monitoring device (CNBPM) based on pulse decomposition analysis and from conventional arm cuff-based ABPM. Methods: We prospectively enrolled 17 subjects from the community. Each subject underwent 1 day of standard 24-hour ABPM. On a second day, the subjects underwent continuous BP monitoring at nighttime only. Systolic BPs (BP hereafter) 12 AM - 6 AM constituted nocturnal BP. We compared the maximum nocturnal BP from ABPM with that from CNBPM. For paired comparison, we matched every 30-minute nocturnal BPs by ABPM, with the corresponding 30 min-averaged nocturnal BPs from CNBPM. Using these data points, we also examined nocturnal dipping by both methods. For continuous BP dipping calculation, we used late night and early AM BP recording (outside 12 AM-6 AM window) derived from continuous BP monitoring. Non-dipping was defined by &lt; 10% BP reduction at nighttime. Results: All enrolled subjects recorded both ABPM and CNBPM. Maximum nocturnal BP was lower by ABPM than by CNBPM ( M 71.28, SD 8.65 vs. M 96.11, SD 13.74), p&lt;0.0001). Paired comparison of every 30 min nocturnal BP yielded a lower nocturnal BP by ABPM than CNBPM (113.65 mmHg (18.31) vs. 113.43 (SD 27.32), p = 0.978). The mean absolute dipping was similar between ABPM and CNBPM (13.2% (7) and 9.5 (10.6), p=NS) respectively. Among 8 subjects with normal dipping, 9 subjects were categorized as non-dipping by CNBPM. Among 11 subjects who had normal dipping by ABPM, 6 subjects met non-dipping by ABPM. CNBPM was better tolerated than ABPM according to subjects. Conclusion: This study demonstrates that the clusters of BP variability overnight may be missed by a spot-check nocturnal BP measurement by ABPM. There was bias toward the underestimation of BP by ABPM when compared to CNBPM. Further studies should determine a subset of high-risk patients who may benefit from using CNBPM for accurate nocturnal BP monitoring.

Ambulatory blood pressure monitoring in pheochromocytoma - paraganglioma: A single center experience.

Pheochromocytoma and paraganglioma (PPGL) are rare tumors, and data on ambulatory blood pressure monitoring (ABPM) in these patients and the effect of blocking on ABPM parameters is limited. We aimed to describe ABPM parameters in a cohort of PPGL at our center in western India. Retrospective study of patients with PPGL whose ABPM data was available. Demographic details, secretory status, and ABPM data were retrieved. Coefficient of variability (CV) was calculated as standard deviation/mean in percentage. In the 39 included patients, mean age at presentation was 39.3 ± 14.2 yr; 20 (51.3%) were males, 25 (64.1%) hypertensive, and mean tumor diameter was 5.3 cm. In 18 patients whose baseline ABPM was done without medications, those with nocturnal blood pressure dipping (6/18, 33%) had higher serum metanephrines (median 313.2 vs. 34.7 pg/ml, P = 0.028). Despite normal office blood pressure (BP), 8.9% of systolic BP readings were >140 mmHg, and 1.2% were >160 mmHg. Among 29 patients with both pre and post-block ABPM, mean BP (systolic 121.6 vs. 132.5 mmHg, P = 0.014; diastolic 68.9 vs. 76.4 mmHg, P = 0.005) and percentage of BP readings above 140 mmHg (median 9.4% vs. 24.4%, P = 0.016) were significantly lowered after the preoperative blockade in hypertensive ( n = 19) patients, whereas CV was similar. The post-blockade ABPM characteristics were similar in patients blocked with amlodipine or prazosin. ABPM provides additional information about BP characteristics in PPGL. The preoperative blocking decreases the magnitude of BP excursions but does not affect BP variability.

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

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

Effect of Home Blood Pressure Telemonitoring Plus Additional Support on Blood Pressure Control: A Randomized Clinical Trial*

ObjectiveCurrent clinical evidence on the effects of home blood pressure telemonitoring (HBPT) on improving blood pressure control comes entirely from developed countries. Thus, we performed this randomized controlled trial to evaluate whether HBPT plus support (patient education and clinician remote hypertension management) improves blood pressure control more than usual care (UC) in the Chinese population. MethodsThis single-center, randomized controlled study was conducted in Beijing, China. Patients aged 30–75 years were eligible for enrolment if they had blood pressure [systolic (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg; or SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg with diabetes]. We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks. The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure. ResultsTotally, 172 patients completed the study, the HBPT plus support group (n = 84), and the UC group (n = 88). Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group. The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the 12th week of follow-up. Additionally, the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group. ConclusionHBPT plus additional support results in greater blood pressure reduction, better blood pressure control, a higher proportion of dipper blood pressure patterns, lower blood pressure variability, and higher drug adherence than UC. The development of telemedicine may be the cornerstone of hypertension management in primary care.