Dipping Profile Research Articles

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

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

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.

40. Nocturnal Hypertension and Dipping Pattern in Acute Stroke Patients

Background: In acute stroke patients, there is a well-known disruption of blood pressure patterns. The relationship between nocturnal hypertension as well as dipping patterns in acute stroke patients with neurological outcomes and recurrent stroke events is still being studied to create optimal blood pressure management.Until now, publications about blood pressure patterns in acute stroke patients are still limited. Objective: This article aims to describe events of nocturnal hypertension and dipping pattern in acute stroke patients. Method: We took secondary data from the use of an ambulatory blood pressure monitoring (ABPM) device for 24 hours that had been performed on acute stroke patients in the stroke unit dr. Cipto Mangunkusumo Hospital from October – December 2022. From the use of ABPM, the subject's blood pressure was grouped based on the dipping profile and the incidence of nocturnal hypertension. Result: A total of 9 subjects were included in the study, with median age 62 (49–75) years old, 66.7% had an ischemic stroke, and 33.3% hemorrhagic. Nocturnal hypertension was found in 77.8% among subjects who was meassured at onset #5 days, whereas in patients who were meassured at onset >5 days, all had nocturnal hypertension. Nocturnal hypertension events did not occur in subjects without comorbid hypertension. Of all nine subjects, abnormal dipping patterns was found in 6 (66.7%) subjects (non-dipper 2 (22.2%), reverse dipper 3 (33.3%), and extreme dipper 1 (11.1%)). Conclusion: From this research, there is a high incidence of nocturnal hypertension and abnormal dipping pattern in acute stroke patients.

Control of Arterial Hypertension by the AhR Blocker CH-223191: A Chronopharmacological Study in Chronic Intermittent Hypoxia Conditions.

Chronic intermittent hypoxia (CIH) is a major contributor to the development of hypertension (HTN) in obstructive sleep apnea (OSA). OSA subjects frequently display a non-dipping pattern of blood pressure (BP) and resistant HTN. After discovering that AHR-CYP1A1 axis is a druggable target in CIH-HTN, we hypothesized that CH-223191 could control BP in both active and inactive periods of the animals, recovering the BP dipping profile in CIH conditions.We evaluated the chronopharmacology of the antihypertensive efficacy of the AhR blocker CH-223191 in CIH conditions (21% to 5% of O2, 5.6cycles/h, 10.5h/day, in inactive period of Wistar rats). BP was measured by radiotelemetry, at 8am (active phase) and at 6pm (inactive phase) of the animals. The circadian variation of AhR activation in the kidney in normoxia was also assessed, measuring the CYP1A1 (hallmark of AhR activation) protein levels.Despite drug administration before starting the inactive period of the animals, CH-223191 was not able to decrease BP during the inactive phase, in CIH conditions, therefore not reverting the non-dipping profile. These results suggest that a higher dose or different time of administration of CH-223191 might be needed for an antihypertensive effect throughout the 24-h cycle.

Loss of nocturnal dipping pattern of skin sympathetic nerve activity during and following an extended-duration work shift in residents in training

BackgroundExtended-duration work shifts (EDWSs) might affect the health of physician residents, causing autonomic alteration. Skin sympathetic nerve activity (SKNA) recorded by noninvasive neuro-electrocardiography (neuECG) is used to estimate cardiac sympathetic tone. In this study, we aim to evaluate the impact of EDWSs on nocturnal SKNA assessed in resident doctors. MethodsTwenty-four residents working EDWSs and 12 PhD students not working nightshift schedules were prospectively recruited. The neuECG was performed between 12 am and 6 am for 5 consecutive nights. SKNA was filtered from neuECG recorded signals. The questionnaires regarding work stress and sleep quality, blood pressure, and salivary alpha-amylase and cortisol levels were administered. ResultsThe hours of weekly working and sleep opportunities were similar between residents and students, while residents reported more work stress and worse sleep quality. In residents, SKNA at 6 am (SKNA6am) was significantly higher than SKNA2am during the precall night, revealing a dipping pattern. However, the SKNA dipping disappeared during the on-call night and prominently flattened during the first postcall night, the full recovery of which was delayed until the second postcall nights. The morning blood pressure and salivary alpha-amylase and cortisol levels were similar between the precall and postcall days. In contrast, SKNA in students exhibited a constant dipping profile for all recorded nights. ConclusionsIn healthy young adults, SKNA presents a dip night. The SKNA dip is impaired by working a nightshift, with a delayed recovery. The neuECG might serve as a useful tool to detect subclinical autonomic disturbances in shiftworkers.

Circadian blood pressure profile and blood pressure changes following oral appliance therapy for obstructive sleep apnoea.

Oral appliance therapy for obstructive sleep apnoea (OSA) reduces blood pressure (BP) but there is little information on relationship to circadian BP pattern (nocturnal BP dipping or non-dipping). The aims of this study were to determine whether nocturnal dipping pattern influences BP changes following oral appliance therapy, and to determine the effect of oral appliance therapy on circadian BP pattern. Participants in two randomized trials of oral appliance therapy (1-2 months) with 24-h ambulatory BP monitoring (ABPM) data were included (N = 152). Nocturnal BP Dippers (nocturnal/diurnal SBP ratio <0.9) and non-dippers were compared for BP changes following oral appliance therapy and the effect of oral appliance therapy on nocturnal BP dipping was assessed. Of 152 participants, 64.5% were dippers. Dippers were on average younger and less likely to be hypertensive (42 vs. 82.7%, P < 0.001). Nondippers showed greater reduction in nocturnal BP measures, related to higher BP measures at baseline. There was no difference in the relationship between treatment effectiveness and BP changes between groups. Oral appliance therapy converted only 23% of baseline non-dippers to a nocturnal dipping profile. Baseline circadian BP profile influenced the BP response to oral appliance therapy, largely because of higher baseline BP in the non-dipper subgroup. Oral appliance therapy did not convert OSA patients to a more favourable circadian BP profile. Further work is required to understand the effect of oral appliance therapy on circadian BP profile and of the individuals who will receive cardiovascular benefit from oral appliance therapy.

Human Stool Metabolome Differs upon 24 h Blood Pressure Levels and Blood Pressure Dipping Status: A Prospective Longitudinal Study.

Dysbiosis of gut microbiota (GM) has been involved in the pathophysiology of arterial hypertension (HT), via a putative role of short chain fatty acids (SCFAs). Its role in the circadian regulation of blood pressure (BP), also called “the dipping profile”, has been poorly investigated. Sixteen male volunteers and 10 female partners were subjected to 24 h ambulatory BP monitoring and were categorized in normotensive (NT) versus HT, as well as in dippers versus non-dippers. Nuclear magnetic resonance (NMR)-based metabolomics was performed on stool samples. A 5-year comparative follow-up of BP profiles and stool metabolomes was done in men. Significant correlations between stool metabolome and 24 h mean BP levels were found in both male and female cohorts and in the entire cohort (R2 = 0.72, R2 = 0.79, and R2 = 0.45, respectively). Multivariate analysis discriminated dippers versus non-dippers in both male and female cohorts and in the entire cohort (Q2 = 0.87, Q2 = 0.98, and Q2 = 0.68, respectively). Fecal amounts of acetate, propionate, and butyrate were higher in HT versus NT patients (p = 0.027; p = 0.015 and p = 0.015, respectively), as well as in non-dippers versus dippers (p = 0.027, p = 0.038, and p = 0.036, respectively) in the entire cohort. SCFA levels were significantly different in patients changing of dipping status over the 5-year follow-up. In conclusion, stool metabolome changes upon global and circadian BP profiles in both genders.

ARTERIAL STIFFNESS IN HYPERTENSIVE CRISIS DEPENDING ON PATIENT DIPPING PROFILE

Abstract Objective: Arterial stiffness and its value, approximated from pulse wave velocity, correlate with cardiovascular risk. Therapeutic restoration of normal physiologic blood pressure reduction by 10–20% during night-time sleep is the most significant independent predictor of decreased cardiovascular risk. The aim of this study was to present the difference in pulse wave velocity value between gender and their dipping profile. Design and method: We divided 205 patients (54% female) in four groups by their dipping profile and gender. Additionally, because pulse wave velocity depends on age, we created five main age groups (&lt;50, 51–60, 61–70, 71–80 and over 80 years). We checked their dipping profile with 24-hour ambulatory blood pressure monitoring. Pulse wave velocity was checked by Agedio oscillometer. Also, serum creatinine and glomerular filtration rate was calculated by CKD-EPI formula in all patients. Results: An average glomerular filtrate rate in dipper patients was significantly higher than non-dippers (81.32 vs 72.82 ml/min/1.73m2; p &lt; 0.05). The number of non-dippers was higher than dippers (103 vs. 39 patients, p &lt; 0.01). Women were significantly older than men (69.02 vs. 62.01 years, p &lt; 0.01). Comparing pulse wave velocity by age groups and dipping profile in men the results were: 1 – 8.20 vs 8.31m/s; 2 – 8.78 vs. 9.30m/s; 3 – 10.01m/s vs. 10.35m/s, p = NS; 4 – 11.70 vs. 13.27m/s, p &lt; 0.01. In women we found statistically higher values of pulse wave velocity compared to men of the same age groups (11.71 vs. 10.44m/s, p &lt; 0.05). By age groups and their dipping profile the results were: 1 – 9.01 vs. 9.04m/s; 2 – 9.66 vs 9.97m/s, p = NS; 3 – 10.35 vs. 11.34m/s, p &lt; 0.05; 4 – 11.85 vs. 12.91m/s, p &lt; 0.01). Conclusions: Non-dipping profile could be a potential risk factor for hypertensive crisis development. Pulse wave velocity values increased more rapidly in non-dippers compared to dippers and turned out to be higher in women compared to men of the same age. Treating and discovering non-dipper patients could decrease the level of the cardiovascular risk and potentially prevent the incidence of the hypertensive crisis events. Kidney function restoration also showed its importance in cardiovascular prevention.

PREVALENCE AND PREDICTORS OF HYPOTENSION IN NURSING HOME RESIDENTS UNDERGOING AMBULATORY BLOOD PRESSURE MONITORING

Objective: In nursing home (NH) residents, hypotension may predispose to adverse events including falls, fractures and mortality. Yet, evidence on hypotension detected by ambulatory blood pressure monitoring (ABPM) is scarce in this setting. This study aimed to determine the prevalence and the clinical predictors of ambulatory hypotension in NH residents and to analyze its related ABPM profile. Design and method: We retrospectively analysed data from a sample of 100 NH residents undergoing a comprehensive geriatric assessment and ABPM. Ambulatory hypotension was defined as a systolic blood pressure (SBP) drop of 20 mmHg or greater between two consecutive measurements to a minimum SBP &lt; 100 mmHg. Participants with nocturnal hypotension were excluded from the analysis. Predictors of ambulatory hypotension were investigated using multivariate logistic regression adjusted for comorbidities, functional status and hypotensive medications. Results: Among 91 residents (mean age 83, 56% female), 50 showed ambulatory hypotension. They had a higher prevalence of heart failure (p = 0.02) and atrial fibrillation (p = 0.007) and more commonly received digoxin (p = 0.001) and benzodiazepines (p = 0.015). At ABPM they had lower 24 h, daytime and nighttime SBP (p &lt; 0.001) and more frequently showed a white coat effect (p &lt; 0.001) and a reverse-dipping profile (p = 0.013). At multivariate analysis, benzodiazepines (OR 4.040), digoxin (OR 19.987) and creatinine &lt; 1 mg/dl (OR 3.939) were independently associated with ambulatory hypotension. Conclusions: Hypotension is common in NH residents undergoing ABPM and more frequently occurs in subjects with lower ambulatory SBP, a reverse dipping profile and a white coat effect. Benzodiazepines, digoxin and low creatinine are predictors of ambulatory hypotension in NH residents.

Association Between Nocturnal Blood Pressure Dipping and Chronic Kidney Disease Among Patients With Controlled Office Blood Pressure.

Although abnormal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their associations are yet unquantified by nocturnal dipping status. We examined the association of nocturnal BP dipping pattern with albuminuria and kidney function among participants with controlled hypertension without prior advanced kidney disease. Ambulatory BP (ABP) measurements were collected from 995 middle-aged, cardiology clinic patients with controlled office BP (OBP) (<140/90 mm Hg). The magnitude of dipping was calculated as the difference between daytime and nighttime systolic BP (SBP) divided by daytime SBP. Accordingly, the participants were categorized as extreme-dipper (≥20%), dipper (10% to <20%), non-dipper (0% to <10%), or reverse-dipper (<0%). We analyzed the cross-sectional associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (<60 ml/min/1.73 m2), adjusting for OBP/ABP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior. The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% extreme-dippers, 43.1% dippers, 34.7% non-dippers, and 8.7% reverse-dippers. In reference to dippers, odds ratios [95% confidence interval] for albuminuria were 1.73 [1.04-2.60] in reverse-dippers, 1.67 [1.20-2.32] in non-dippers, and 0.62 [0.38-1.04] in extreme-dippers. Likewise, abnormal dipping profile was associated with decreased kidney function: reverse-dipping, 2.02 [1.06-3.84]; non-dipping, 1.98 [1.07-3.08]; extreme-dipping, 0.69 [0.20-1.17]. The associations persisted among participants with more conservatively controlled OBP (<130/80 mm Hg). Monitoring diurnal and nocturnal BP may identify chronic kidney disease otherwise overlooked based on OBP.

Aging and Vascular Compliance in Hypertensive Patients Mirrored in Routine Investigations.

The global prevalence of arterial hypertension is increasing. Due to its consequences, hypertension is a leading cause of morbidity /mortality. In this regard, awareness of the importance of diagnosis as well as proper treatment of hypertension is mandatory. Objectives: This study aims to analyze vascular compliance and different pressure characteristics depending on age, along with highlighting some clinical-paraclinical correlations in people diagnosed with hypertension. We used usual laboratory analyzes and the blood pressure values obtained using ABPM/24 hr, in addition to highlighting the impact of age on those parameters. Materials and methods: The sample comprises of 99 adults diagnosed with hypertension. We divided them into 2 groups, according to age: cases sample: 52 patients (age> 60 years old) and control sample: 47 patients (age< 60 years old). Results: In the control group, RDW was correlated with the general and diurnal systolic and diastolic hypertonicity indexes and the platelet count was positively correlated only with the morning surge. The dipping profile correlates negatively with RDW. In the elderly, all three systolic blood pressure parameters are influenced by ESR and also correlate negatively with HDL, with an inverse proportional relationship. Statistically significant correlations were found between blood glucose and diurnal systolic and diastolic hypertonicity indexes. Mean Pulse Pressure correlates in the elderly with HDL (negative correlations) and in the young with RDW (positive correlations). Conclusions: Vascular compliance can be estimated with the help of HDL in the elderly and RDW in young people, considering the influence of the two parameters on pulse pressure.

In response to nocturnal dipping profile in chronic kidney disease: Searching for underlying mechanisms in order to prevent adverse events

In response to nocturnal dipping profile in chronic kidney disease: Searching for underlying mechanisms in order to prevent adverse events

Abnormal circadian rhythm of urinary sodium excretion correlates closely with hypertension and target organ damage in Chinese patients with CKD.

Whether the abnormal circadian rhythm of urinary sodium excretion is associated with hypertension in chronic kidney disease (CKD) is poorly understood. In this study, we assessed the relationship between the circadian rhythm of urinary sodium excretion and hypertension. Urinary samples were collected during both the day (07:00 to 22:00) and night (22:00 to 07:00) to estimate night/day urinary sodium excretion ratios. Blood pressure (BP) and clinical data were also measured. A total of 1,099 Chinese CKD patients were recruited, 308 patients were excluded, and 791 patients were final enrolled in this study. Among them, 291 patients were normotensive and 500 were hypertensive CKD patients. A 1:1 propensity score matching (PSM) analysis was performed with age and estimated glomerular filtration rate (eGFR) matched between 190 normotensive and hypertensive patients. In the full cohort and PSM cohort, multivariate regression analysis showed that the night/day urinary sodium excretion ratio was an independent risk factor for clinical hypertension, whereas 24 h urinary sodium excretion, diurnal and nocturnal urinary sodium excretion were not. When the night/day urinary sodium excretion ratios were further divided into tertiles (tertile 1 < 0.47, tertile 2, 0.47-0.84 and tertile 3 > 0.84), multivariate analysis showed that tertile 3 was independently associated with hypertension in the full and PSM cohorts. In addition, tertile 3 was also independently associated with eGFR ≤ 60 mL/min/1.73 m2 and left ventricular hypertrophy. These data suggested that an abnormal circadian rhythm of urinary sodium excretion was independently associated with hypertension and target-organ damage. Individualized salt intake and therapeutic strategies should be used to normalize the natriuretic dipping profile in CKD patients.

Dip Filter and Random Noise Suppression for GPR B-Scan Data Based on a Hybrid Method in f - x Domain

Ground-penetrating radar (GPR) is a close-range remote-sensing tool applied in a great many near-surface projects for engineering or environmental purposes. In GPR B-scans, there may exist a variety of reflections and diffractions that corresponds to different structures and targets in the subsurface media, and the noise is always embedded. To assist in the interpretation, GPR B-scans can be generally divided into two parts according to the dip attribute of the reflections, where the sub-horizontal layers and dipping structures are properly separated. In this work, we extend the f - x empirical mode decomposition (f - x EMD) to form a semi-adaptive dip filter for GPR data. In f - x domain, each frequency slice is decomposed by EMD and reconstructed to form a dipping profile and a horizontal profile respectively, where the reflections at different dips are separated adaptively. Then the noises mixed in the dipping profile are further separated by rank-deduction methods in f - x domain. The above two-step scheme constitutes the hybrid scheme, which can separate the dipping structures, sub-horizontal layers, and most of the random noise in GPR B-scans. We briefly review the basics of the f - x EMD, and then introduce the derived hybrid scheme in f - x domain. The proposed method is tested by the synthetic data, the forward simulation data, and the field data, respectively.

Diurnal changes in central blood pressure and pulse pressure amplification in patients with obstructive sleep apnoea

Study objectivesRecent evidence suggests that compared to peripheral blood pressure (BP), central BP may be more strongly associated with target organ damage and cardiovascular morbidity and mortality. Technological advances now allow the ambulatory measurement of peripheral and central BP over 24 ​h. For the first time, we set out to characterise the diurnal profile of central BP and pulse pressure amplification (PPA) in patients with obstructive sleep apnoea (OSA). MethodsIn this observational study, patients with moderate to severe OSA underwent 24 ​h central and peripheral BP testing before and after at least 4 weeks of CPAP therapy. Concurrent actigraphy was performed to confirm sleep and wake times. Results36 patients were screened, 31 had successful testing (mean (SD) age 45 ​± ​10 years, AHI 58 ​± ​27 events/hr, Office BP 136/89 ​± ​10.7/9.5 ​mmHg, 32% on anti-hypertensives, 77% dippers), 21 completed testing post CPAP. Central systolic and diastolic BP followed the same nocturnal dipping profile as peripheral BP, however the peripheral pulse pressure (PP) narrowed in sleep (−3.2 ​mmHg, p ​< ​0.001), whereas the central PP remained unchanged (0.124 ​mmHg, NS), causing a significant reduction in PPA overnight (−10.7%, p ​< ​0.001). The magnitude of dip in central systolic pressure was less than peripheral systolic pressure (by 2.3 ​mmHg, p ​< ​0.001). After treatment with CPAP, the PPA reduction overnight was attenuated (by −3.3%, p ​= ​0.004). ConclusionsIn moderate to severe OSA, central BP and PPA reduce overnight during sleep. Further randomised controlled studies are needed to quantify the differential effects of CPAP and anti-hypertensives on central versus peripheral BP.

DIPPING PROFILE, NIGHTTIME SYSTOLIC BLOOD PRESSURE AND VASCULAR DAMAGE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: Both increased nighttime systolic blood pressure (SBP) and a non-dipping pattern are predictors of adverse cardiovascular outcomes. We investigated dipping profile and nighttime SBP in relationship with subclinical vascular damage in patients with rheumatoid arthritis (RA), a disease characterized by excess cardiovascular risk. Design and method: Patients with RA and non-RA individuals underwent 24-hour ambulatory blood pressure monitoring. Carotid-femoral pulse wave velocity (PWV) was assessed with applanation tonometry as a measure of central arterial stiffness. Carotid atherosclerosis was evaluated from carotid ultrasound by measurement of carotid intima-media thickness (cIMT). Peripheral vascular resistance was estimated from impedance cardiography. Disease-related characteristics were addressed, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease duration and activity, and pain. Results: RA patients (n = 91) exhibited a higher prevalence of non-dipping pattern (64.8 vs 28.0 %, p < 0.001), elevated nighttime SBP (112.6 ± 12.8 vs 105.8 ± 9.7 mmHg, p = 0.001) and a lower degree of dipping (6.5 ± 7.4 vs 13.0 ± 5.6 %, p < 0.001), compared to non-RA individuals (n = 50), whereas both office and daytime SBP did not differ. In the RA group, dipping (%) was inversely associated with PWV (r = –0.218, p = 0.045). Nighttime SBP strongly correlated with all vascular indices, including PWV (r = 0.493, p < 0.001), cIMT (r = 0.407, p < 0.001) and systemic vascular resistance index (r = 0.383, p < 0.001). In addition, nighttime SBP increased with increasing ESR (r = 0.213, p = 0.046), CRP (r = 0.245, p = 0.022), intensity of pain over the past 24-hour hours (r = 0.255, p = 0.042) and disease duration (r = 0.246, p = 0.027). The combination of a non-dipping profile with high nighttime SBP was accompanied by the highest (p = 0.019) PWV (10.0 ± 2.5 m/s), compared to both non-dippers with normal nighttime SBP (7.8 ± 2.1 m/s, p = 0.003) and dippers (8.1 ± 1.9 m/s). In the multivariate analysis for dipping, ESR was identified as an independent predictor (beta = –0.234, p = 0.037), and the same was observed in the multivariate analysis for nighttime SBP (beta = 0.201, p = 0.019). Conclusions: Patients with RA exhibit high prevalence of blunted dipping due to elevated nighttime SBP. Inflammation appears to mediate the observed associations of nighttime SBP and dipping with markers of central and peripheral vascular damage. The combination of a non-dipping profile with abnormal nighttime SBP is accompanied by pronounced subclinical vascular impairment.

ASSOCIATION OF NOCTURNAL BLOOD PRESSURE PATTERNS WITH CARDIOVASCULAR RISK IN NEWLY DIAGNOSED, NEVER-TREATED ESSENTIAL HYPERTENSIVE PATIENTS

Objective: Both non-dipping pattern and elevated nighttime systolic blood pressure (SBP) are predictors of adverse cardiovascular outcomes. Despite the fact that these are often related features, research to date has focused on the association of either with cardiovascular risk, as separate features. We assessed whether the combination of a dipping pattern with abnormal nighttime SBP confers increased cardiovascular risk for patients with essential hypertension Design and method: Newly diagnosed, never-treated hypertensive patients free from any known health problems were eligible to participate. Only true hypertensives, based on their office blood pressure measurements and the 24-hour ambulatory blood pressure monitoring, were included. 10-year risk of general cardiovascular disease was determined from the Framingham Heart Study. Results: In a total of 182 patients aged 46.7 ± 8.8 years, nighttime SBP positively correlated with cardiovascular risk (r = 0.190, p = 0.010). Initially, patients were classified according to their dipping status as dippers (n = 117) and non-dippers (n = 65). The groups did not differ in terms of age, gender, body mass index (BMI), office blood pressure, smoking, and lipids (p > 0.05 for all comparisons). Cardiovascular risk [9.8 (6.3–15.9) vs 10.3 (6.5–15.2) %, p = 0.981] was similar between dippers and non-dippers. Participants were then classified in three groups, based on the combination of dipping status with nighttime SBP: dippers with normal nighttime SBP (n = 45), dippers with elevated nighttime SBP (n = 72), and non-dippers (n = 65). Age, gender, BMI, smoking status, and lipids were similar between groups (p > 0.05 for all comparisons). However, dippers with normal nighttime SBP exhibited the lowest levels of office SBP (144.1 ± 13.5 vs 153.0 ± 15.2 vs 151.9 ± 14.9 mmHg, p = 0.004) and, importantly, the lowest cardiovascular risk score [8.4 (5.8–12.9) vs 11.6 (7.7–18.6) vs 10.3 (6.5–15.2) %, p = 0.050], compared to dippers with abnormal nighttime SBP and non-dippers. Conclusions: In a population of relatively young, untreated patients with uncomplicated, early-stage essential hypertension, the combination of a dipping profile with elevated nighttime SBP confers the same cardiovascular risk as the non-dipping pattern. Subsequently, further classification of dippers according to their nighttime SBP levels may improve cardiovascular risk stratification.

LB.01.09] ISOLATED NOCTURNAL HYPERTENSION AND NON DIPPING BLOOD PRESSURE

Objective: Nocturnal hypertension is associated with an increased risk of major cardiovascular events. Patients with Isolated nocturnal hypertension (INH) had more severe target-organ damage. A ’non-dipping’ Blood Pressure profile is associated with a high cardiovascular risk. The diagnosis of these two entities is easy by ambulatory blood pressure monitoring(ABPM). The aim of this study is to describe the prevalence of nocturnal hypertension and to study the dipping profile in hypertensive patients Design and method: Our study is retrospective, it includes all patients referred for diagnosis of hypertension; Before high blood pressure levels or high normal tension in whom the diagnosis is confirmed by ABPM, and the known hypertensives oriented for evaluation. A Schiller MT-300 with BR-102 plus program was used for the ABPM. 46 measures required to validate the ABPM. We studied the mean of the blood pressure over the 24 hours, the mean pressure night and day and the profile dipping in all the patients. Nocturnal hypertension and dipping profile values are those defined by ESC/ ESH 2013 and AHA/ASA 2015. Results: Twenty seven patients included in our series. It is 15 men (55%) and 12 women (45%). Mean age is 54 years [35–80 years]. Twenty five patients (93%) had nocturnal hypertension, Six (22%) of whom had isolated nocturnal hypertension. Patients with INH are six, they are 3 men and 3 women, mean age 50.5 years (43 - 59) years. Hypertension is systolic-diastolic in three patients, diastolic isolated in two patients and systolic isolated in one. The dipping profile in our series, it is normal in nine patients, 12 patients (44%) are non dippers, four Reverse dipping (15%) and two extrem dipping. Conclusions: The prevalence of isolated nocturnal hypertension is high in our series (22% of patients) and The non dipping Blood pressure is also very common (60%), together, these entities are regarded as important harbingers of poor cardiovascular prognosis. The ambulatory blood pressure monitoring(ABPM) in hypertensive patients at diagnosis and during progression is the only non-invasive way to detect nocturnal hypertension and to analyse dipping profile.

Abstract P369: Ambulatory Blood Pressure Monitoring Profile as a Useful Tool - Assessment of an Adult Population in the Real World

Introduction: The pattern of therapeutic and diagnostic control of arterial hypertension (AH) has been better evaluated with the use of Ambulatory Blood Pressure Monitoring (ABPM) in clinical practice. Objective: The purpose of the study was to evaluate the blood pressure (BP) profile through data obtained in an adult population (18-59 years), and to further determine the differences of BP readings between users (G1) and non-users (G2) antihypertensive drugs. Method: In a cohort of 2222 non-elderly subjects, both genders, mean 43 years (56.8% female), referred for ABPM from an outpatient set-up, we studied 24-hour ABPM patterns. Results: Of 2222 adults, 1324 (59.6%) were off antihypertensive medications (G2) and of the remaining, 751 (33.8%) used one or two drugs and 6.6% used three or more drugs. Analysis of variance was applied for a comparative study of therapeutic control between groups, with a significance level of p less than 0.05. From the G2, 898 subjects (67,8%) had 24-hour BP within normal limits (119x71mmHg) and, 426 (32,2%) had an elevated mean 24-hour BP (139x87mmHg). Of the G1, subjects in monotherapy, double or triple or more antihypertensive therapies presented satisfactory control in 68% (118x71mmHg), 72% (117x70mmHg) and 66% (119x71mmHg) respectively, with no statistically significant difference between groups. The mean nocturnal drop expressed in percentage for the SBP and DBP in G2, was 11.9±2.03 and 18.4±7.19 in normotensive subjects, and 11.1±4.05 and 16.8±8.02 in hypertensive subjects, with no significant difference between different gender groups (p=0.6). Irrespective of normal nocturnal drop values in G1, we observed a significant attenuation in the subgroup using three or more drugs (percentage of 10.1±6.02 and 14.8±6.13) compared to those with monotherapy or double therapy (11.0±4 and 16.6±4.08), both with similar pattern in their dipping profile. Conclusion: The percentage diagnosis of AH by ABPM (32%) is similar to the reported papers in the literature. The pattern of nocturnal drop may help the identification of target organ damages and help in determination of therapeutic adjustments, corroborating literature data, which emphasize the use of ABPM study in the diagnostic and therapeutic evaluation.

Ocena zależności pomiędzy dobowym profilem ciśnienia tętniczego a natriurezą u pacjentów z przewlekłą chorobą nerek oraz po przeszczepieniu nerki.

Introduction. The disturbed circadian rhythm of blood pressure (BP) is more prevalent in patients with chronic kidney disease (CKD). Diminished renal capacity to excrete sodium may result in nocturnal BP elevation in order to enhance pressure natriuresis to compensate for impaired daytime natriuresis. We hypothesized that kidney transplantation (KTx) that restores glomerular filtration should normalize circadian BP profile. The aim of the study was to assess and compare natriuresis and circadian BP profiles of patients at different stages of CKD and KTx recipients. Material and methods. Blood pressure was monitored noninvasively for 24 hours and urinary samples were collected during the daytime and night-time to measure natriuresis among 55 patients with stable graft or kidney function: 41 with CKD and 14 patients after KTx. Results. Mean awake systolic blood pressure (SBP) was lower in KTx recipients than in CKD at all stages. Night-time mean BP was lowest in CKD patients with eGFR > 45 ml/min (126/68 mmHg vs. KTx 130/75 mmHg; p = 0.005). The prevalence of dipper status was also highest in CKD patients with eGFR > 45 ml/min. 50% vs. 8.3% (CKD 3b), 0% (CKD 4–5) and 7.1% (KTx) (p 60 ml/min, whereas reverse dipping profile only in those with eGFR Conclusions. Kidney transplantation improves blood pressure control and reduces a number of antihypertensive drugs used. Normal circadian rhythm could be restored only in the transplant patients with well-functioning renal graft.