Diurnal Blood Pressure Research Articles

Chronic mistimed feeding results in renal fibrosis and disrupted circadian blood pressure rhythms.

Circadian disruption is a disturbance in biological timing, which can occur within or between different organizational levels, ranging from molecular rhythms within specific cells to the misalignment of behavioral and environmental cycles. Previous work from our group showed that less than 1 wk of food restriction to the light (inactive) period is sufficient to invert diurnal blood pressure rhythms in mice. However, kidney excretory rhythms and functions remained aligned with the light-dark cycle. Shift workers have an increased risk of cardiovascular disease that may different between sexes and often have irregular mealtimes, making the possibility of mistimed feeding as a potential contributor to the development of kidney disease. Thus, we hypothesized that chronic mistimed food intake would result in adverse cardiorenal effects, with sex differences in severity. Here, we show that chronic circadian disruption via mistimed feeding results in renal fibrosis and aortic stiffness in a sex-dependent manner. Our results indicate the importance of meal timing for the maintenance of blood pressure rhythms and kidney function, particularly in males. Our results also demonstrate that females are better able to acclimate to circadian-related behavioral change. NEW & NOTEWORTHY Circadian disruption through mistimed feeding resulted in nondipping blood pressure, renal fibrosis, and arterial stiffness that were less severe in females versus males. Mice fed exclusively during the daytime maintain their circadian rhythms of locomotor activity regardless of their loss of blood pressure rhythms. Although these mice ate less food, they maintained body weight, suggesting inefficiencies in overall metabolism. These findings demonstrate the importance of maintaining optimal food intake patterns to prevent cardiorenal pathophysiology.

Daytime actisensitivity predicts nocturnal dipping patterns and morning surge in blood pressure: the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective study.

Ambulatory blood pressure (BP) is influenced by physical activity and the BP response to physical activity (actisensitivity) differs between individuals. This study investigated associations between daytime actisensitivity and nighttime BP dipping status and morning BP surge. Twenty-four-hour ambulatory BP monitoring (ABPM) with simultaneously monitored physical activity using a multisensor all-in-one device (TM-2441; A&D Company) was performed at baseline in HI-JAMP study participants. Those with complete BP measurements and complete physical activity monitoring data were included in this analysis. Actisensitivity was calculated as the slope of the regression line between daytime SBP and log-transformed physical activity over a 5 min period before each BP reading. Hyper and negative reactivity were defined as actisensitivity greater than 90th and less than 10th percentile, respectively. Data from 2692 individuals (mean age 69.9 ± 11.9 years; mean BMI 24.8 ± 4.1 kg/m2, 53.6% men) were analyzed. Those with hyper reactivity had a high prevalence of the extreme dipper pattern of nighttime BP and exaggerated morning BP surge; those with negative reactivity had higher nighttime BP and a riser pattern of nighttime BP. Results remained significant after adjusting for 24-h physical activity. Differences in diurnal BP variability based on actisensitivity were augmented in individuals aged at least 75 years. This study is the first to investigate associations between actisensitivity and 24-h ambulatory BP profiles using an all-in-one multisensor device in a large real-world population. The associations seen between either hyper or negative actisensitivity and abnormal diurnal BP variability, especially in the elderly, could contribute to increased cardiovascular event risk. University Hospital Medical Information Network Clinical Trials Registry, UMIN000029151 (HI-JAMP study).

Prevalence and associated factors of hypertension in adults in Lubumbashi, Democratic Republic of the Congo: A hospital cross-sectional study

Introduction: Hypertension is the leading cause of morbidity and mortality from cardiovascular disease worldwide. Knowledge of its prevalence and associated factors helps to prevent its complications. The objectives of this study were to determine the prevalence and associated factors of hypertension in hospitals in Lubumbashi, Democratic Republic of the Congo.Methods: A cross-sectional analytic study was conducted among 520 adults from February 6 to November 30, 2023 in 2 health facilities in the city of Lubumbashi (Afia Polyclinic - Don Bosco and Jason Sendwe Provincial General Reference Hospital). Participants were selected by systematic random sampling. Hypertension was defined when the subject had a blood pressure (BP) ≥ 135/85 mmHg on diurnal Ambulatory Blood Pressure Monitoring (ABPM) or ≥ 180/110 mmHg on clinic oscillometric BP measurement (OBPM), or when he/she had self-reported hypertension and/or was taking antihypertensive medication even if diurnal ABPM was normal. Factors associated with hypertension were determined using a logistic regression model at the 5% significance level.Results: The prevalence of hypertension was 32.8% (95% CI: 28.9%-37.0%). Factors significantly associated with hypertension included age ≥50 years (AOR = 4.0 [1.2-12.7]), dyslipidemia (AOR = 18.6 [3.2-107.4]), hypercalcemia (AOR = 171.6 [32.5-905.9]), hyperkalemia (AOR = 27.6 [7.1-107.8]), and hypernatremia (AOR = 948.1 [160.0-5619.3]).Conclusion: This study reveals the high hospital prevalence of hypertension and the factors associated with it, emphasizing the necessity for targeted interventions for at-risk populations, especially the elderly and those with electrolyte imbalances.

Clinical Effectiveness of the Fixed‐Dose vs Free‐Dose Triple Combinations in Patients with Uncontrolled Arterial Hypertension

Background: The purpose of our study was a comparative assessment of the antihypertensive effectiveness of 2 triple combination antihypertensive therapy (AHT) regimens in a free-dose and fixed-dose combination of perindopril, indapamide, and amlodipine in hypertensive patients with high cardiovascular risk and a poor response to the 2-drug combinations in the clinic practice. Methods and Results: Our study included 143 patients (79 men and 88 women) with arterial hypertension (AH) Grades 1-3 (ESC/ESH, 2018) and high cardiovascular risk who did not achieve the target blood pressure (TBP) on dual combination AHT. The mean age of patients was 55.76±9.35 years; the average duration of AH was 10.69±6.61 years. All patients underwent the examinations according to the 2018 ESC/ESH Guidelines for the management of arterial hypertension. Patients included in the study were divided into 2 groups using the envelope method: Group 1 (n=84) received a fixed-dose, triple combination of perindopril, indapamide, and amlodipine; Group 2 (n=83) received a free-dose combination of these drugs. In both groups, treatment began after discontinuation of previous therapy, with a low dose of a triple combination of antihypertensive drugs (perindopril [5 mg/day], indapamide [1.25 mg/day], amlodipine [5 mg/day]) in the form of a fixed or free combination. The initial doses of perindopril/indapamide/amlodipine in both groups were not statistically different: 6.9±2.4/1.74±0.6/7.1±2.4mg/day in Group 1 and 6.9±2.7/1.95±0.6/7.1±2.5 mg/day in Group 2. After 4 weeks of therapy, if necessary, the doses of drugs were increased, starting with perindopril; the next adjustment of drug doses was carried out after 12 weeks of therapy. The final treatment results were determined after 24 weeks of AHT. Target blood pressure (TBP) of <140/90 mmHg was reached by 94.4% of patients in Group 1 and 83.3% in Group 2 (χ²=7.471, Р=0,006); TBP of <130/80 mmHg was reached by 70% of patients in Group 1 and 42% in Group 2 (χ²=11.61, Р=0,0001). A significant improvement in the diurnal BP profile was also revealed during treatment. According to ABPM data, both groups achieved TBP in terms of the average 24-h and average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP). Regarding average nighttime SBP and DBP and normalization of average nighttime diastolic blood pressure variability, target values were achieved only in Group 1(P=0.028). In both groups, 24-week triple-combination therapy led to a significant decrease in central SBP, central DBP, and pulse wave velocity (PWV). At the same time, the positive dynamics of central SBP were more pronounced in Group 1 than in Group 2 (Table 4), and PWV in Group 1 reached standard values. Conclusion: The results of our study showed that in the treatment of uncontrolled hypertension on previous therapy in AH patients with high cardiovascular risk, a single-pill triple combination of the ACEI perindopril, the CCB amlodipine, and the thiazide-like diuretic indapamide contributed to the effective daily blood pressure control, the improvement of diurnal blood pressure profile, and a positive effect on central blood pressure and PWV, thereby having a positive impact on the prognosis and quality of life of AH patients with high cardiovascular risk.

#1182 Arterial hypertension and chronic obstructive pulmonary disease—problems of choice of therapy

Abstract Background and Aims The development of hypertension in COPD is based on the early formation of endothelial dysfunction in the small and large circulatory circles, increased sympathetic activity with an imbalance in the synthesis of catecholamines, a violation of the role of the lungs in the metabolism of vasoactive substances, oxidative stress, chronic systemic inflammation, an imbalance in the renin-angiotensin-aldosterone system (RAAS). There are few studies confirming the role of RAAS components in the pathogenesis of cardiovascular changes in patients COPD. The activity of angiotensin converting enzyme (ACE) increases with hypoxia, which may play an important role in increasing the degree of systemic hypertension. An increase in the function of the RAAS is possible both under the direct influence of hypoxia and indirectly through activation of the sympathoadrenal system. To evaluate the efficacy and tolerability of the angiotensin II receptor antagonist valsartan (Nortivan) at a dose 80-160 mg per day in patients with hypertension of 1-2 degrees and COPD of stage II-IV. Method The study design is a local, open, incomparable study on the efficacy and safety of the drug Nortivan in patients with hypertension in combination with COPD. We examined 18 patients with stage II-IV in remission, suffering from grade I and II hypertension, determined in accordance with the generally accepted classification of blood pressure levels (VNOK, 2010). Results The criteria for exclusion from the study were the presence in patients of complications of hypertension, coronary heart disease, decompensated chronic pulmonary heart, endocrine diseases requiring drug correction, kidney pathology, chronic heart failure, oral steroid therapy. 10 days in the last 6 months before inclusion in the study, oncological diseases and any other conditions that could interfere with the interpretation and evaluation of the results of the study. Patients who had not previously received antihypertensive treatment were included in the study immediately, and the rest underwent a washing period for 2 weeks. Patients received Nortivan as antihypertensive therapy for 24 weeks. The effectiveness of therapy was controlled by daily monitoring blood pressure. The choice of quality criteria for the effectiveness of therapy parameters SMAD is associated with literature data and own observations on the prevalence of diurnal blood pressure profiles in patients with hypertension and COPD with no decrease or increase in blood pressure at night, when office blood pressure figures are to a lesser extent reflect the effectiveness of antihypertensive therapy. The initial dosage was 80 mg/day. With insufficient hypotensive effect, the dose of the drug was doubled at the 4th week of treatment. The basic COPD therapy did not change throughout the study period and included anticholinergic drugs (ipratropium bromide, tiotropium bromide), beta2-adrenomimetic (fe-noterol) or a combination thereof. Initially and after 24 weeks of treatment, a complete laboratory examination was performed: a clinical blood test, a biochemical blood test. The thickness of the intima-media complex of the carotid arteries and ECG was also studied. The criterion The safety of the therapy was assessed by the indicators of respiratory function, daily pulse oximetry. Conclusion The use of the drug Nortivan has shown high efficacy and safety in patients Grade I–II hypertension in combination with stage II-IV COPD. A statistically and clinically significant normalization of SMAD indicators with correction of pathological types of daily curves due to a decrease in the number of patients with an increase in or the absence of a decrease in blood pressure during the night period. The safety of using the drug in the clinical group with bronchial obstruction syndrome was confirmed by the dynamics of ventilation indicators according to spirometry and the results of daily pulse oximetry, which showed the absence of exacerbation of hypoxia during therapy.

Ambulatory Blood Pressure in Patients With Rheumatoid Arthritis: Association With Immune Activation.

The prevalence of hypertension, a major cardiovascular risk factor, is increased in patients with rheumatoid arthritis (RA) and may be driven by immune activation. The purpose of this study was to determine if ambulatory 24-hour blood pressure (BP) is elevated in RA vs control participants and whether it is associated with immune activation. We conducted a cross-sectional study of 46 patients with RA and 23 control participants. Participants wore an ambulatory BP monitor that obtained diurnal BP every 15-30 minutes and nocturnal BP every 30 minutes. Inflammatory mediators in plasma were measured using an inflammation proteomics panel. Differences in BP measurements were assessed by Mann-Whitney U test, and association with inflammatory mediators was assessed by Spearman correlation. Patients with RA and control participants had similar office BP, but median ambulatory systolic BP (SBP) measurements (24-hour [RA 121 mmHg vs control 116 mmHg; P = 0.01], diurnal [RA 128 mmHg vs control 120 mmHg; P = 0.003], and nocturnal [RA 112 mmHg vs control 103 mmHg; P = 0.002]) were higher in patients with RA. Patients with RA also had higher nocturnal diastolic BP (DBP; RA 63 mmHg vs control 57 mmHg; P = 0.02), but other DBP measurements were similar. Nocturnal BP dipping was less in patients with RA (12%) compared to control participants (16%; P = 0.02). In patients with RA, higher 24-hour and nocturnal SBPs and less nocturnal dipping were strongly correlated with a wide range of inflammatory mediators. Despite similar office measurements, 24-hour and nocturnal SBP measurements were higher in patients with RA than in control participants and were strongly associated with inflammation.

Role of Angiotensin II on Cardiovascular/Autonomic Function and Cognition in a Novel Mouse Model of Alzheimer’s Disease

Alzheimer's disease (AD) is a multifactorial neurodegenerative disorder. Despite being the most common form of dementia in the elderly, mechanisms causing AD remain elusive. Emerging evidence have associated brain renin-angiotensin system (RAS) to AD neuropathology. RAS actions are predominantly mediated by angiotensin II (Ang II) binding to type 1 receptors. Previously, we have observed that human apolipoprotein E4-knockin (risk factor for AD) mice develop progressive hypertension and increases in Ang II levels in CSF with aging [FASEB J 36(S1): R3532]. Thus, we hypothesize that Ang II-mediated hypertension contributes to cognitive decline in AD. We have generated a novel transgenic mouse model of AD i.e. 3XE4 by breeding E4-knockin mouse with APPsw, PS1dE9, and tauP301S transgenes, to mimic human AD pathology in mice. Blood pressure (BP) and heart rate (HR) were measured by radiotelemetry in 3XE4 (n=6) and control 3XE3 (n=6) mice, before and after 28-days of Ang II infusion (1000 ng/kg/min, osmotic pump). Diurnal BP variability was calculated as the difference between night-time (11:00 PM-3:00 AM) and day-time (8:00 AM-12:00 PM). Cardiac vagal and sympathetic tones were calculated as changes in HR with atropine and propranolol (1 mg/kg each, IP), respectively. Cardiac function (echocardiography) and cognitive behavior (novel object recognition test) were measured. At baseline, BP was similar in control (127±11 mmHg) and 3XE4 (123±5 mmHg) mice. Unlike the control mice, 3XE4 mice exhibit reduced vagal tone (ΔHR= +119±22 vs. +25±24 bpm) and increased sympathetic tone (ΔHR= -76±33 vs. -212±40 bpm), which worsens with Ang II (p<0.05 vs. baseline). Interestingly, Ang II increased BP (24%), induced LV hypertrophy (26%), impaired diurnal BP variability, and evoked learning and memory deficits; albeit only in the 3XE4 mice (p<0.05 vs. control mice). These results demonstrate that Ang II-mediated hypertension and autonomic dysfunction likely exacerbate disease progression and cognitive decline in the 3XE4 mouse model of AD. Therefore, our study provides a proof-of- concept in delineating the association of ApoE4 genotype and Ang II with Alzheimer’s disease. NIH R01HL149677 and R21AG070188. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Serum isolevuglandin IgG antibody concentrations are increased in patients with systemic lupus erythematosus and associated with lower 24-hour blood pressure

ObjectiveHypertension is frequent in patients with systemic lupus erythematosus (SLE) and is a major contributor to increased cardiovascular risk. Isolevuglandins (IsoLGs) are downstream products of oxidative stress that drive hypertension and SLE disease activity in animal models. Antibodies to IsoLGs (anti-IsoLGs) are present in human SLE and associated with disease activity, but it is not known if concentrations are higher compared to control subjects or if they are associated with blood pressure (BP).MethodsWe measured serum anti-IsoLG IgG antibody concentrations by sandwich ELISA in 23 patients with SLE and 30 controls who had participated in a cross-sectional 24-hour ambulatory BP study. We examined the association between anti-IsoLG IgG antibodies and BP measurements in patients with SLE and controls by Spearman Rho (rs) and linear regression analysis.ResultsSerum anti-IsoLG IgG antibody concentrations were higher in patients with SLE than controls (P = 0.007) and inversely associated with BP in SLE but not controls. In patients with SLE antibody concentrations were inversely associated with office (rs = −0.418) and diurnal systolic BP (rs = −0.421); the relationship was stronger among patients not taking anti-hypertensives (office: rs = −0.740, diurnal systolic BP: rs = −0.802) and every 20% increase in antibody concentration was associated with 10 mmHg decrease in 24-hour systolic BP (P = 0.004).ConclusionSerum anti-IsoLG IgG antibody concentrations are higher in patients with SLE than controls and are inversely associated with 24-hour BP measurements. Since IsoLGs promote hypertension, it is possible that in SLE, IsoLG antibodies could help clear these hypertension-inducing antigens.

Impact of nocturnal blood pressure dipping on recurrence of atrial fibrillation after pulmonary vein isolation.

Lack of the typical nocturnal blood pressure (BP) fall, i.e non-dipper, has been known as a cardiovascular risk. However, the influence of non-dipper on atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been unclear. We investigated the clinical impact of non-dipping as evaluated by 24-hour ambulatory BP monitoring on the long-term outcome of AF recurrence post-PVI in 76 AF patients with a history of increased BP. The PVI procedure was successful in all 76 patients (mean age, 66±9years; antihypertensive medication, 89%; non-paroxysmal AF, 24%). Twenty patients had AF recurrence during a median follow-up of 1138 days. There was no difference in BP levels between the AF recurrence and non-recurrence groups (average 24 h systolic BP:126 ± 17 vs.125 ± 14 mmHg; P = 0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs.15.0%; P = 0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF and average 24-hr systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI:1.05-7.34], P = 0.039). Non-dipper patients had a larger left atrial (LA) volume index than the dipper patients (45.9 ± 17.3 vs.38.3 ± 10.2 ml/m2, P = 0.037). Among the 58 patients who underwent high-density voltage mapping in LA, 11 patients had a low-voltage area (LVA) defined as an area with a bipolar voltage < 0.5 mV. However, there was no association of LVA with non-dipper or dipper (22.2% vs.16.1%, P = 0.555). Non-dipper is an independent predictor of AF recurrence post-PVI. Management of abnormal diurnal BP variation post-PVI may be important.

The impact of GLP-1 receptor agonist liraglutide on blood pressure profile, hydration, natriuresis in diabetic patients with severely impaired kidney function

Chronic treatment with GLP-1R agonists may moderately lower blood pressure due to increased natriuresis and RAAS inhibition. Short-term effect of these drugs on blood pressure may be opposite and its mechanism remains unclear. We investigated the effect of a single dose of liraglutide on diurnal blood pressure profile, natriuresis, hydration and serum concentration of renin, aldosterone and atrial natriuretic peptide (ANP) in diabetic kidney disease (DKD). 17 patients with eGFR < 30 ml/min/1.73 m2 and 17 with > 60 ml/min/1.73 m2 received in a random order a single subcutaneous dose 1.2 mg liraglutide and placebo with subsequent 24 h blood pressure and natriuresis monitoring. Before and after each medication thoracic fluid index and plasma renin, aldosterone and ANP were also assessed. The blood pressure load in the daytime and nighttime were significantly increased after liraglutide compared to placebo in patients with eGFR < 30 ml/min/1.73 m2. In patients with eGFR > 60 ml/min/1.73 m2 the changes of arterial pressure were comparable, while the morning surge was significantly reduced after liraglutide compared to placebo. After liraglutide 24 h urine sodium excretion increased in both groups vs. placebo (p < 0.001), the effect was greatest in subjects with eGFR > 60 ml/min/1.73 m2. Plasma ANP increased after liraglutide in both groups, most in patients with eGFR < 30 ml/min/1.73 m2 group. Plasma aldosterone (p = 0.013) and thoracic fluid index (p = 0.01) decreased after liraglutide compared to placebo (p = 0.013 and p + 0.01, respectively. Plasma renin concentration remained unchanged. In severe chronic kidney disease liraglutide induces a transient increase of blood pressure due to reduced natriuresis. The natriuretic effect of liraglutide in DKD may be related to increased ANP and decreased aldosterone secretion.

CARDIOVASCULAR RISK AMONG MEN OF WORKING AGE WITH ARTERIAL HYPERTENSION DEPENDING ON THE ARTERIAL PRESSURE DIURNAL PROFILE

Aim: to investigate the relationship between cardiovascular risk (CVR) and different types of diurnal blood pressure (BP) profile among men of working age with arterial hypertension (AH).&#x0D; Materials and methods. The study included 83 men of working age (average age 48±2 years) with II stage, 2 and 3 degrees of AH. The risk of death due to cardiovascular diseases during the next 10 years was assessed using the SCORE scale. All patients underwent ambulatory BP monitoring (ABPM), according to the results of which the following diurnal BP profiles were identified: 23 (28%) patients – normal (optimal) level of nocturnal decrease in BP («dipper»; daily index (DI) 10-20%); 10 (12%) – excessive nocturnal lowering of BP («over-dipper»; DI &gt;20%); 38 (46%) – insufficient nocturnal lowering of BP («non-dipper»; DI &lt;10%); and 12 (14%) patients had an inverted diurnal curve («night-peaker»; DI &lt;0%).&#x0D; Results and discussion. According to the SCORE scale, the CVR profile in «dipper» group (n=23) was as follows: low – 6 (26%) patients; moderate – 15 (65%); and high – 2 (9%). Among 10 patients of «over-dipper» group, 7 had low, 2 – moderate, and 1 – high CVR. In «non-dipper» group (n=38), there were 4 (11%) patients with low CVR, 10 (26%) with moderate, 14 (37%) with high, and 10 (26%) with very high CVR. At the same time, 7 out of 12 patients of «night-peaker» group showed very high CVR, 3 – high, and 2 – moderate (overall p&lt;0,001). The frequency of patients with high CVR was higher in the pooled «non-dipper» and «night-peaker» group (pathological BP profile; n=50), as compared to the pooled «dipper» and «over-dipper» group (n=33): 34% vs. 9%, respectively. At the same time, the pooled «dipper» and «over-dipper» group was characterized by the higher frequency of patients with moderate (52%) and low CVR (39%), in contrast to the pooled «non-dipper» and «night-peaker» group (24% and 8%, respectively). Finally, all 17 patients with very high CVR had an abnormal diurnal BP profile (34% in the pooled «non-dipper» and «night-peaker» group) (overall p&lt;0,001).&#x0D; Conclusions. It was established that, according to ABPM, 60% of men of working age with the AH of II stage, 2- and 3-degrees, had pathological BP profiles of the «non-dipper» and «night-peaker» types. Individuals diagnosed with nocturnal rise or insufficient diurnal BP decrease have a higher risk of cardiovascular death in the next 10 years according to SCORE. Patients with a «non-dipper» and «night-peaker» diurnal BP profiles require more aggressive drug therapy and re-examination with ABPM to control the normalization of the diurnal BP profile.

Effect of oral melatonin treatment on insulin resistance and diurnal blood pressure variability in night shift workers. A double-blind, randomized, placebo-controlled study

BackgroundNight shift work is associated with sleep disturbances, obesity, and cardiometabolic diseases. Disruption of the circadian clock system has been suggested to be an independent cause of type 2 diabetes and cardiovascular disease in shift workers. We aimed to improve alignment of circadian timing with social and environmental factors with administration of melatonin. MethodsIn a randomized, placebo-controlled, prospective study, we analysed the effects of 2 mg of sustained-release melatonin versus placebo on glucose tolerance, insulin resistance indices, sleep quality, circadian profiles of plasma melatonin and cortisol, and diurnal blood pressure profiles in 24 rotating night shift workers during 12 weeks of treatment, followed by 12 weeks of wash-out. In a novel design, the time of melatonin administration (at night or in the morning) depended upon the shift schedule. We also compared the baseline profiles of the night shift (NS) workers with 12 healthy non-night shift (NNS)-working controls. ResultsWe found significantly impaired indices of insulin resistance at baseline in NS versus NNS (p < 0.05), but no differences in oral glucose tolerance tests nor in the diurnal profiles of melatonin, cortisol, or blood pressure. Twelve weeks of melatonin treatment did not significantly improve insulin resistance, nor did it significantly affect diurnal blood pressure or melatonin and cortisol profiles. Melatonin administration, however, caused a significant improvement in sleep quality which was significantly impaired in NS versus NNS at baseline (p < 0.001). ConclusionsRotating night shift work causes mild-to-moderate impairment of sleep quality and insulin resistance. Melatonin treatment at bedtime improves sleep quality, but does not significantly affect insulin resistance in rotating night shift workers after 12 weeks of administration.

Blood Pressure Variability: Marker or Predictor of Cardiovascular Risk?

Background: Regardless of the mean blood pressure value, short-term and long-term BP variability (BPV) are associated with the development and progression of target organ damage and predictors of cardiovascular complications and mortality. The purpose of the present study was to evaluate the prognostic significance of increased BPV in patients with arterial hypertension (AH). Methods and Results: The study consisted of two stages. In the first stage, a retrospective analysis of 365 ABPM results was carried out. As a result of the analysis, 271 patients aged 56.1±10.0 years with uncontrolled AH Grades 1-3 (ESC/ESH, 2018) were included in this study. Depending on the values of BPV, AH patients were divided into two groups: Group 1 consisted of patients with normal BPV (n=145), and Group 2 consisted of patients with increased BPV (n=126). The second stage included 91 patients with uncontrolled hypertension without permanent antihypertensive therapy who had increased BPV. We found statistically significant differences in BP between the AH patients with normal BPV and increased BPV. Thus, in the group with normal BPV, compared with increased BPV, the parameters of the average 24-h systolic BP (SBP), daytime SBP, and nighttime SBP were statistically lower (141±14.6 vs. 147.2±20.2 mmHg, P&lt;0.004; 142.8±15.1 vs. 148.4±20.7 mmHg, P&lt;0.01; and 136.2±15.5 vs. 143.8±21.4 mmHg, P&lt;0.001; respectively). A statistically significant moderate direct correlation was found between the average 24-h SBP and the average 24-h and daytime SBP variability (SBPV) (rs=0.49 and rs=0.40 respectively, P&lt;0.001 in all cases). A statistically significant moderate to weak direct correlation also was found between the average daytime SBP, and the average 24-h and daytime SBPV (rs=0.45 and rs=0.37, respectively, P&lt;0.001 in all cases). A moderate direct correlation was found between nighttime SBP and 24-hour SBPV (rs=0.52, P&lt;0.001) and between nighttime SBP and daytime SBPV (rs=0.42, P&lt;0.001). Weak direct correlations were found between the average 24-h SBPV and central SBP (SBPc) (rs=0.34, P&lt;0.001), as well as between the average 24-h and daytime SBPV and central pulse pressure (PPc) (rs=0.33 and rs=0.32, respectively, P&lt;0.001 in all cases). A weak direct correlation was found between carotid intima-media thickness (CIMT) and the average 24-h and daytime SBPV (rs=0.37 [P&lt;0.001] and rs=0.3 [P=0.04]). Conclusion: The increased BPV is associated with impaired diurnal blood pressure profile (DBPP) and structural and functional changes in blood vessels, in particular, an increase in SBPc and PP in the aorta, and CIMT thickening, which characterizes increased BPV as a predictor of vascular remodeling in patients with uncontrolled AH.

Nocturnal systolic blood pressure dipping and progression of chronic kidney disease.

The relationship between declining nocturnal blood pressure (BP) and adverse cardiovascular outcomes is well-recognized. However, the relationship between diurnal BP profile and the risk of chronic kidney disease (CKD) progression is unclear. Herein, we examined the association between nocturnal systolic SBP (SBP) dipping and CKD progression in 1061 participants at the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI). The main exposure was diurnal systolic BP (SBP) profile and diurnal SBP difference ([nighttime SBP-daytime SBP] × 100/daytime SBP). The primary outcome was CKD progression, defined as a composite of ≥ a 50% decline in the estimated glomerular filtration rate from baseline or the initiation of kidney replacement therapy. During 4749 person-years of follow-up (median, 4.8 years), the composite outcome occurred in 380 (35.8%) participants. Compared to dippers, the hazard ratios (HRs) for the risk of adverse kidney outcomes were 1.02 (95% confidence interval [CI], 0.64-1.62), 1.30 (95% CI, 1.02-1.66), and 1.40 (95% CI, 1.03-1.90) for extreme dipper, non-dipper, and reverse dipper, respectively. In a continuous modeling, a 10% increase in diurnal SBP difference was associated with a 1.21-fold (95% CI, 1.07-1.37) higher risk of CKD progression. Thus, decreased nocturnal SBP decline was associated with adverse kidney outcomes in patients with CKD. Particularly, patients with non-dipping and reverse dipping patterns were at higher risk for CKD progression than those with a dipping pattern.

Features of short-term variability of arterial pressure with different types of circadian rhythm in patients with hypertension disease who have suffered myocardial infarction

Abstract. Blood pressure variability is an important prognostic parameter and is an independent predictor of cardiovascular disease and mortality. Aim. To assess short-term blood pressure variability with regard to the type of diurnal blood pressure profile in hypertensive patients with myocardial infarction. Materials and methods. 78 hypertensive men who had a myocardial infarction were examined. The average age was 58.0 (54.0; 67.0) years, the experience of hypertension was 9.0 (5.0; 18.0) years, the period after the myocardial infarction was 24.5 (12.0; 84,0) months. All patients underwent daily monitoring of blood pressure with the study of average day and night pressure levels, the degree of nocturnal decrease in blood pressure, blood pressure variability with STD calculation, pure and new variability indices. The results. Increased BP variability during the day and at night was registered with all types of circadian systolic BP rhythm. The highest values of systolic BP variability (STD) during the day and at night were in patients with a night-picker circadian profile. Achieving the target level of systolic BP as a whole in the group was observed in 34.6 % of patients during the day and 42.3 % at night. Patients with an over-dipper circadian blood pressure profile, despite having the highest percentage of target blood pressure achievement, had the highest values of variability characteristics calculated by STD, pure and new indices per day (p &lt; 0.05). Conclusions. Increased blood pressure variability and pressure level at night are important criteria for assessing the prognosis of hypertensive patients after myocardial infarction. Daily monitoring of blood pressure provides a unique opportunity to objectify these prognostic parameters at different times of the day, which, together with the assessment of reaching the target level of blood pressure, is necessary to control the effectiveness of treatment.

Seasonal variation in diurnal blood pressure pattern

ABSTRACT Aims To explore the relationship between diurnal blood pressure (BP) pattern and season. Methods A total of 6765 eligible patients (average age 57.35 ± 15.53 years; male 51.8%; hypertensives 68.8%) from 1 October 2016 to 6 April 2022 were enrolled, who were divided into four dipper groups, dipper, non‐dipper, riser, and extreme‐dipper, according to the diurnal BP pattern calculated using their ambulatory BP monitoring data. The season which the patient was in was determined by the time of ambulatory BP monitoring examination. Results Among the 6765 patients, 2042 (31.18%) were grouped into dipper, 380 (5.6%) into extreme‐dipper, 1498 (22.1%) into riser and 2845 (42.1%) into non‐dipper. Only the dipper subjects showed age difference among seasons, with the average age significantly lower in winter. There was no seasonal difference in age for the other types. No seasonal difference was revealed in gender, BMI, hypertension or not. Diurnal BP patterns significantly differed among seasons (P < .001). Post hoc tests with Bonferroni correction indicated the significantly different diurnal BP pattern between any two seasons (P < .001), but not between spring and autumn (P = .257), and the significance of the P value was assessed at 0.008 (0.05/6) after Bonferroni correction. Multinomial logistic regression suggested season as an independent contributor to diurnal BP pattern. Conclusion Diurnal BP pattern is influenced by season.

DAYTIME SUPINE BLOOD PRESSURE NORMALIZED BY 24-HOUR VALUES INDEPENDENTLY PREDICTS FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE

Objective: Blood pressure (BP) after ischemic stroke (IS) may follow various patterns. Post-event acute BP alterations mirror both stroke and patient characteristics, and resolve over time, yet their clinical significance is low or uncertain. Whether individual BP variations, based on a single standardized measurement normalized by a background BP course, have a distinct significance for stroke outcome remains unknown. We hypothesized that the BP difference index (BPD) between daytime supine resting and a series of surrounding BP values (daytime, 24-hour (24h)) in the subacute phase of IS is associated with functional outcome. Design and method: we included 131 IS patients [age 60.8 ± 12.5 years, median (NIHSS) score 5 (3-8)]. Office BP measurements and continuous 24-hour BP monitoring were performed on day 7 after stroke onset. The daytime period was defined as the interval from 6 a.m. to 10 p.m. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale (mRS) with an mRS score of 3 to 6 (dependency or death) considered as a poor outcome. Results: In a univariate analysis, high BPD was significantly associated with a poor stroke outcome (p = 0.001, 0.003, and 0.002 for systolic, diastolic, and mean BP, respectively, irrespective of the normalization subperiod (daytime, 24h). In a multivariate analysis, the predictive value of BPD remained significant only for systolic BP [SBP] normalized by daytime or 24h mean (OR, 1.06; 95% CI, 1.01-1.11; p = 0.02) after adjustment for covariates. Moreover, the relationship was stronger in a subgroup of patients able to walk independently (mRS 0-2) on day 7 after stroke onset (adjusted OR, 1.08; 95% CI, 1.01-1.17; p = 0.049 for SBP normalized by daytime or adjusted OR, 1.09; 95% CI, 1.01-1.18; p = 0.03 for SBP normalized by 24h mean). Conclusions: We found that the higher difference between supine resting and daytime or diurnal mean BP in patients in the subacute phase of ischemic stroke is independently associated with a poor outcome. This BP index might be useful in clinical practice, including therapeutic decisions, but needs broader studies in patient populations of stroke subtypes.

High plasma aldosterone concentration is associated with worse 24-h ambulatory blood pressure profile in patients with primary aldosteronism.

Patients with primary aldosteronism (PA) have a higher risk of cardiovascular disease (CVD) than essential hypertension due to underlying hyperaldosteronism. However, the association between high plasma aldosterone concentrations (PACs) and diurnal blood pressure (BP) variation has not been fully elucidated. Because abnormal ambulatory blood pressure monitoring (ABPM) profiles are associated with increased CVD risk, we investigated the association between PACs and the ABPM profile in 36 patients with PA diagnosed by confirmatory tests who underwent adrenal venous sampling (AVS). The clinical parameters were measured during hospitalization for AVS. The dietary salt intake of hospitalized patients was controlled at 6 g/day. During AVS, blood samples were collected from the inferior vena cava before and 1 h after adrenocorticotropic hormone (ACTH) stimulation to measure the PACs. The post-stimulation PAC had a significant negative correlation with nocturnal BP dipping rates (R = -0.387, p = 0.020), whereas pre-stimulation PAC did not (R = -0.217, p = 0.204). The nocturnal BP dipping rates were significantly lower in the high PAC group (PAC higher than the median) than low PAC group (PAC lower than the median) (p = 0.009). Multiple regression analysis revealed that high PAC was an independent factor contributing to low nocturnal BP dipping rates (β = -0.316, p = 0.038). In conclusion, in patients with PA, hyperaldosteronism is associated with nocturnal hypertension, which is an important risk factor for CVD. Additionally, ACTH stimulation may improve the sensitivity of PACs as a clinical indicator of nocturnal hypertension.

The Vanilloid (Capsaicin) Receptor TRPV1 in Blood Pressure Regulation: A Novel Therapeutic Target in Hypertension?

Today's sedentary lifestyle with excess food and little exercise increases the number of people with hypertension, a major risk factor for stroke. New knowledge of treatments in this field is of utmost importance. In animal experiments, the activation by capsaicin of TRPV1-expressing sensory afferents evokes a drop in blood pressure by triggering the Bezold-Jarisch reflex. In hypertensive rats, capsaicin reduces blood pressure. Conversely, genetic ablation of the TRPV1 receptor results in elevated nocturnal (but not diurnal) blood pressure. These observations imply a therapeutic potential for TRPV1 activation in hypertensive patients. Indeed, in a major epidemiological study involving 9273 volunteers, dietary capsaicin was found to lower the risk for hypertension. New research indicates that the mechanism of action of capsaicin on blood pressure regulation is far more complex than previously thought. In addition to the well-recognized role of capsaicin-sensitive afferents in blood pressure regulation, TRPV1 seems to be expressed both in endothelial cells and vascular smooth muscle. This review aims to evaluate the therapeutic potential of TRPV1-targeting drugs in hypertensive patients.

Time Restricted Feeding Reverses Western Diet-Induced Disruptions in Diurnal Blood Pressure Rhythms and Aortic Media Thickening

Cardiovascular disease is one of the primary contributors to the global burden of disease. A poor diet commonly observed in the western world consisting of elevated fat, salt, and sugar is estimated to contribute to 14% of disability-associated life years and increased mortality. High fat fed animals have altered circadian rhythms and increased aortic and renal damage. As the timing of food intake is critical for establishing and maintaining proper circadian rhythms, and disruption of these rhythms is detrimental to cardiovascular health, we hypothesize that time restricted feeding, similar to intermittent fasting, will rescue western diet-induced cardiovascular disease. In this study, alongside normal diet (ND 10% kcal fat, 0.25% by weight salt. 0.7% kcal sucrose) controls, C57Bl/6J male mice were switched to a high fat (45% kcal), high salt (4% by weight), and high sugar (17% kcal) diet for 20 weeks. At 18 weeks, a portion of the western-diet (WD) mice were subjected to time-restricted feeding (TRF) where access to food was restricted to the active period, 6pm to 6am. A subset of mice were implanted with radiotelemeters 14 weeks into the study to measure 24hr conscious blood pressure. Body weight was measured throughout the study confirming increased weight gain in WD mice compared to ND mice and that TRF did not induce weight loss. By 10 weeks, WD fed animals showed increased pulse wave velocity indicative of vascular remodeling (p&lt;0.05). Remarkably, WD mice exhibited a non-dipping phenotype of their blood pressure. Active blood pressures were similar across groups 137 to 142mmHg; however, WD mice exhibited an elevation in inactive blood pressure (124mmHg) compared to ND mice (108mmHg). TRF returned inactive blood pressure (110mmHg) to ND levels despite being on a WD. The mesor of a cosiner analysis of the diurnal pattern of blood pressure is elevated in WD mice which is rescued by TRF. WD and WD-TRF mice exhibited increased perirenal fat accumulation, serum insulin, renal mass, and albuminuria compared to ND mice. There was no difference between WD and WD-TRF mice in these endpoints. We also observed increased renal inflammation in WD and WD-TRF mice measured by flow cytometric analysis of immune infiltrates, yet no effect of TRF itself. Histological analysis of aortic sections by Masson’s trichrome revealed a significant thickening of the tunica media in WD mice (52.91±1.70μm, n=15) compared to ND mice (47.12±1.88μm, n=14, p&lt;0.05) which was reversed by TRF treatment (44.97±1.22μm, n=14, p&lt;0.01). These results demonstrate that western diet contributes to chronic renal inflammation and aortic remodeling. We present novel findings that TRF rescues WD-induced non-dipping blood pressure and tunica media thickening. AHA-DF837441, NIH-1T32AI138932-01A1, 1R01HL161212-01A1, 19EIA34480023, 19IPLOI34760558, NIH-5T32GM 8111-35, AHA-MRT827566 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.