Diurnal Blood Pressure Research Articles

Cerebrospinal Fluid Orexin A Levels and Autonomic Function in Kleine-Levin Syndrome

Kleine-Levin syndrome (KLS) is a rare disorder of relapsing sleepiness. The hypothesis was that the syndrome is related to a change in the vigilance peptide orexin A. From 2002 to 2013, 57 patients with relapsing hypersomnolence were clinically assessed in a referral academic center in Beijing, China, and 44 (28 males and 16 females; mean age 18.3 ± 8.9 y (mean ± standard deviation, range 9-57 y) were determined to have clinical and behavioral criteria consistent with KLS. Cerebrospinal fluid orexin A levels and diurnal blood pressure were measured in relapse versus remission in a subgroup of patients. Presenting symptoms included relapsing or remitting excessive sleepiness-associated parallel complaints of cognitive changes (82%), eating disorders (84%); depression (45%); irritability (36%); hypersexuality (18%); and compulsions (11%). Episodes were 8.2 ± 3.3 days in duration. In relapse, diurnal values for blood pressure and heart rate were lower (P < 0.001). In a subgroup (n = 34), cerebrospinal fluid orexin A levels were ∼31% lower in a relapse versus remission (215.7 ± 81.5 versus 319.2 ± 95.92 pg/ml, P < 0.001); in three patients a pattern of lower levels during subsequent relapses was documented. There are lower orexin A levels in the symptomatic phase than in remission and a fall and rise in blood pressure and heart rate, suggesting a role for orexin dysregulation in KLS pathophysiology.

Oxytocin decreases diurnal and nocturnal arterial blood pressure in the conscious unrestrained spontaneously hypertensive rat

In this study, we assessed the effects of oxytocin (OT) on mean arterial blood pressure (MAP), heart rate (HR), and locomotor activity (LA) in male spontaneous hypertensive rats (SHR) and Sprague-Dawley (SDR) controls using telemetry. OT was given by intravenous injections of 0.1, 0.2 or 0.4mg/kg to assess short term acute effects or by daily subcutaneous injections of 0.5 or 1.0mg/kg for 5 days. Compared to the saline infusion, (i) intravenous OT, regardless of concentration, increased MAP in SHR and SDR, (ii) HR increased, but was periodically lower in both strains with 0.2 or 0.4mg/kg, and (iii) no effects of OT on LA were observed. Subcutaneous injections demonstrated that (i) 1.0mg/kg for 5days lowered diurnal MAP and HR in SDR and SHR, persisting for 6 days, (ii) 1.0mg/kg decreased nocturnal HR in SDR, (iii) 0.5 and 1.0mg/kg decreased MAP with minor effects on HR in the SHR, and lastly (iv) OT decreased LA mainly during the diurnal cycle in both strains. Our main results show that OT induces significant beneficial effects on cardiovascular function over several diurnal and nocturnal cycles in the SHR, with the most prominent effect being a robust decrease in MAP.

CLINICAL EFFECTS AND RENOPROTECTIVE FACILITIES OF OLMESARTAN AND LERKANIDIPINEAS MONOTHERAPY AND WHEN COMBINED APPLICATION IN PATIENTS WITH ARTERIAL HYPERTENSION

The evaluation of the clinical efficacy and renoprotective effects of olmesartan and lercanidipine as monotherapy and when combined application in patients with arterial hypertension (AH) 1-2 degrees and microalbuminuria (MAU).It is established that the degree of blood pressure (BP) reduction and corrective influence on diurnal BP profile were similar in groups of monotherapy with olmesartan and lercanidipine. In the group of combined application of the studied drugs target BP levels were achieved in 88% of cases in the monotherapy group and 78% (1G) and 76% (2 G).Revealed renoprotective effects of olmesartan and lercanidipine as when used in monotherapy and in combination in patients with arterial hypertension of 1-2 degrees, and MAU, revealed reliable decrease in MAU. The greatest reduction in MAU was achieved in the combination therapy group.

Introduction to the American Heart Association's Hypertension Strategically Focused Research Network.

In 2014, the American Heart Association (AHA) announced the funding of a Strategically Focused Research Network (SFRN) focused on hypertension. Hypertension was chosen for a SFRN because interdisciplinary hypertension research has great potential to impact the AHA’s mission and 2020 goals of improving the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular disease (CVD) and stroke by 20% by 2020. Four centers with highly integrated basic, clinical, and population science projects were selected for the AHA SFRN: Cincinnati Children’s Hospital, Medical College of Wisconsin (MCW), University of Alabama at Birmingham (UAB), and University of Iowa (UI). The Cincinnati center is studying ambulatory blood pressure (BP) and hypertensive target organ damage in adolescents. The MCW center is studying epigenetics of hypertension by conducting studies of genome-wide DNA methylation patterns. The UAB center is studying racial differences in the prevalence and determinants of abnormal diurnal BP patterns. The UI center is studying copeptin, a possible early biomarker for preeclampsia and vascular endothelial function, and arterial stiffness changes occurring before and during preeclampsia. In this article, we provide an overview of the science being conducted at each center and describe the innovative training program incorporated into the SFRN. A goal of the Hypertension SFRN is to facilitate collaborative research. Therefore, we describe opportunities and resources available to researchers interested in collaborating with SFRN investigators. The AHA Hypertension SFRN has the potential to identify new approaches for the prevention and treatment of hypertension and, ultimately, improve the cardiovascular health of Americans. The SFRN is a mechanism initiated by the AHA to address key strategic issues as determined by the AHA Board of Directors. In 2014, hypertension was selected for a SFRN because improvement in its prevention and treatment has the potential to impact the AHA’s mission and 2020 goals: to …

Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis.

IntroductionAbnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV+) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV+ individuals, a systematic literature review and meta-analysis were performed.MethodsMedical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV+ individuals. Data were extracted by 2 reviewers and pooled differences between HIV+ and HIV-negative (HIV-) individuals in clinic BP and ABPM measures were calculated using random-effects inverse variance weighted models.ResultsOf 597 abstracts reviewed, 8 studies with HIV+ cohorts met the inclusion criteria. The 420 HIV+ and 714 HIV- individuals in 7 studies with HIV- comparison groups were pooled for analyses. The pooled absolute nocturnal systolic and diastolic BP declines were 3.16% (95% confidence interval [CI]: 1.13%, 5.20%) and 2.92% (95% CI: 1.64%, 4.19%) less, respectively, in HIV+ versus HIV- individuals. The pooled odds ratio for non-dipping systolic BP (nocturnal systolic BP decline <10%) in HIV+ versus HIV- individuals was 2.72 (95% CI: 1.92, 3.85). Differences in mean clinic, 24-hour, daytime, or nighttime BP were not statistically significant. I2 and heterogeneity chi-squared statistics indicated the presence of high heterogeneity for all outcomes except percent DBP dipping and non-dipping SBP pattern.ConclusionsAn abnormal diurnal BP pattern may be more common among HIV+ versus HIV- individuals. However, results were heterogeneous for most BP measures, suggesting more research in this area is needed.

Impaired endogenous nighttime melatonin secretion relates to intrarenal renin-angiotensin system activation and renal damage in patients with chronic kidney disease.

Activation of the intrarenal renin-angiotensin system (RAS) plays a critical role in the pathophysiology of chronic kidney disease (CKD) and hypertension. The circadian rhythm of intrarenal RAS activation leads to renal damage and hypertension, which are associated with diurnal blood pressure (BP) variation. The activation of intrarenal RAS following reactive oxygen species (ROS) activation, sympathetic hyperactivity and nitric oxide (NO) inhibition leads to the development of renal damage. Melatonin is a hormone regulating the circadian rhythm, and has multiple functions such as anti-oxidant and anti-adrenergic effects and enhancement of NO bioavailability. Nocturnal melatonin concentrations are lower in CKD patients. However, it is not known if impaired endogenous melatonin secretion is related to BP, intrarenal RAS, or renal damage in CKD patients. We recruited 53 CKD patients and conducted 24-h ambulatory BP monitoring. urine was collected during the daytime and nighttime. We investigated the relationship among the melatonin metabolite urinary 6-sulphatoxymelatonin (U-aMT6s), BP, renal function, urinary angiotensinogen (U-AGT), and urinary albumin (U-Alb). Patients' U-aMT6s levels were significantly and negatively correlated with clinical parameters such as renal function, systolic BP, U-AGT, and U-Alb, during both day and night. Multiple regression analyses for U-aMT6s levels were performed using age, gender, renal function, and each parameter (BPs, U-AGT or U-Alb), at daytime and nighttime. U-aMT6s levels were significantly associated with U-AGT (β=-0.31, p=0.044) and U-Alb (β=-0.25, p=0.025) only at night. Impaired nighttime melatonin secretion may be associated with nighttime intrarenal RAS activation and renal damage in CKD patients.

Augmented circadian rhythm of the intrarenal renin-angiotensin systems in anti-thymocyte serum nephritis rats.

We report that disturbance to the circadian rhythm of urinary angiotensinogen (AGT) excretion may lead to renal damage, hypertension and diurnal blood pressure (BP) variations. We aim to clarify the circadian rhythm of the intrarenal renin-angiotensin system (RAS) and its contribution to renal damage, hypertension and BP variations, and to evaluate whether the administration of RAS blockers influences the circadian rhythms of intrarenal RAS components. Anti-thymocyte serum (ATS) nephritis rats were used as a chronic progressive glomerulonephritis model (group A) and compared with control rats (group C). Other rats with ATS nephritis received olmesartan medoxomil (an angiotensin II (AngII) type 1 receptor (AT1R) blocker; group AO) or hydralazine (a vasodilator; group AH). The levels of intrarenal RAS components were evaluated every 6 h. The expression levels of intrarenal AGT, AngII and AT1R were increased in group A and peaked at the same time as BP and urinary protein excretion during the rest phase. The amplitude of the circadian fluctuation of these proteins was more increased in group A than in group C. The circadian fluctuation of these proteins was reduced in groups AO and AH. However, renal function, proteinuria and augmentation of intrarenal RAS components were reduced only in group AO. Intrarenal RAS components, such as AGT, AngII and AT1R proteins, were increased and the amplitude of the oscillations of these proteins was augmented in ATS nephritis rats. Interestingly, renal damage may be linked to the activation of the intrarenal RAS independent of the amplitude of its oscillations and BP.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients.

BackgroundIn this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension.MethodsA total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group.ResultsThe mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors.ConclusionEFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

The Effects of Unilateral Nephrectomy on Blood Pressure and Its Circadian Rhythm.

Objective Hypertension and diurnal blood pressure (BP) variation are widely accepted as risk factors for renal damage. However, the effects of unilateral nephrectomy on BP and its circadian rhythm have not yet been clarified in patients with a compromised renal function, including dialysis patients. Methods We investigated 22 unilateral nephrectomized patients (16 men and 6 women, age: 64.5±14.3 years). The function of the circulating renin-angiotensin system (RAS) (plasma renin activity and plasma angiotensin II) and 24-h ambulatory BP monitoring (ABPM) were evaluated before and after nephrectomy. Daytime and nighttime 24-h ABPM values were determined based on sleep and waking times. Results In non-dialysis patients, the estimated glomerular filtration rate after nephrectomy was significantly lower than that before (before, 62.4±23.2 mL/min/1.73 m2 vs. after, 43.7±16.8 mL/min/1.73 m2; p<0.01). No significant differences were noted in the levels of BPs and circulating RAS before and after nephrectomy. However, the night-to-day (N/D) ratio of systolic BP (SBP) was significantly higher after nephrectomy than before (before, 93.3±6.5% vs. after, 98.4±6.9%; p<0.01), and the patterns of circadian BP rhythm also significantly differed before and after nephrectomy (p=0.022). Namely, the rates of dipper patterns decreased and nondipper and riser patterns increased after nephrectomy. In contrast, in dialysis patients, no significant differences were observed in the N/D ratio of SBP or the patterns of circadian BP rhythm before and after nephrectomy. Conclusion Unilateral nephrectomy affects the circadian rhythm of BP but not absolute values of BP.

The relationship between N‑ terminal pro B‑ type natriuretic peptide and indicators of daily monitoring of blood pressure in middle-aged hypertensive men with chronic heart failure

Objective. To study the association between N‑terminal pro B‑type natriuretic peptide (NT-proBNP) and diurnal blood pressure (BP) profile in middle-aged men with arterial hypertension (HTN) and chronic heart failure (CHF). Design and methods. We surveyed 550 men from 40 to 50 years, 420 subjects were included in the study and were divided into groups: 1st group — patients with HTN without CHF (n = 180); 2nd group — patients with HTN and CHF (n = 86); 3rd group — patients with CHF without HTN (n = 74). The control group consisted of healthy men with normal BP without CHF (n = 80). NT-proBNP (fmol/ml) and 24‑hour BP monitoring were performed in all patients. Results. NT-proBNP was lower in patients with HTN 2 and 3 degree in comparison with patients with HTN 1 degree without CHF (group 1). It was not found in hypertensive patients with CHF (group 2). NT-proBNP was higher in patients with HTN 1 degree in the 1st group in comparison with patients with HTN 1 degree in the second group and lower in patients with HTN 2 and 3 degree in the first group, in comparison with patients with HTN 2 and 3 degree in the 2nd group. There was an inverse correlation between NT-proBNP and HTN degree in the 1st group (r = –0,624; p = 0,023). Conclusions . The decrease in plasma level of NT-proBNP in hypertensive patients is associated with the increase in BP. Natriuretic peptides are involved in the circadian rhythm of BP, and their level is associated with the HTN degree and «load pressure». NT-proBNP was the highest in «non-dippers» and «night-peakers» and differed significantly from «over-dippers» and patients with unchanged circadian BP profile.

0508: Brain natriuretic peptide in hypertensive patients on regular hemo-dialysis: does it have diagnostic implication?

Brain natriuretic peptide (BNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance and concomitant volume overload. The aim of this study was to evaluate the clinical usefulness of BNP in hypertensive patients on maintenance hemodialysis (HD). Design and Methods we measured BNP levels in 30 patients immediately before and after HD. All patients had preserved left ventricular ejection fraction (LVEF ≥50%) and underwent 48-hours ambulatory blood pressure measurement. Cardiac parameters were evaluated by echocardiography. The left ventricular mass index (LVMi) and BNP levels decreased significantly after HD (p<0.001). LVMi was significantly associated with the duration of hypertension (p=0.03). After HD, LVMi was significantly associated to the diurnal, nocturnal and 48-hours ambulatory blood pressure. BNP levels were associated to diastolic blood pressure and LVMi before and after HD. A BNP cut-off value of 68.91pg/mL after HD resulted in 81.8% specificity and 100% sensitivity for the presence of left ventricular hypertrophy (LVH), (AUC ROC: 0.864) in hypertensive patients. BNP had strong associations with prevalent LVH in hypertensive patients on hemodialysis.

Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients.

This study aimed to analyze whether blood pressure (BP) measurement is concordant between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and determine whether the decision on treatment changes is similar on the basis of information provided by both methods. Treated hypertensive patients were studied with ABPM and HBPM to evaluate therapeutic efficacy and/or diagnose resistant hypertension (HTN). Modification of pharmacological treatment was decided on the basis of pre-established criteria; therefore, the number of therapeutic changes between both techniques was compared. A total of 200 patients were included. The average daytime ABPM systolic blood pressure (SBP) was 136±16 compared with 136±15 (P=1) with HBPM; the average diurnal diastolic blood pressure (DBP) was 83±12 and 81±9, respectively (P=0.06). The concordance between both methods was very good for SBP [r=0.85; Bland-Altman 0.2 (95% confidence interval 0.9-1.4 mmHg)], and good for the DBP [r=0.77; Bland-Altman 1.8 (95% confidence interval 0.8-2.8 mmHg)]. Both methods were in agreement that HTN was controlled in 68 patients and that it was not controlled in 90 patients, that is, they were concordant in 158 patients (79%, κ=0.6). More patients required changes with ABPM than HBPM (149 vs. 99 patients, P<0.0001) CONCLUSION: There were no significant differences in the measurement of diurnal SBP and DBP between both methods. The concordance to determine proper control of HTN was 79%. There was a significant difference in the decision to modify the treatment in favor of the ABPM.

Peculiarities of vegetative regulation of heart activity and diurnal profile of blood pressure in patients with acute myocardial infarction, complicated by left ventricle aneurysm

In patients with myocardial infarction indexes of vegetative regulation of heart activity and diurnal blood pressure profile are connected with complicated trend of the disease. Aim. To study peculiarities of heart activity vegetative regulation, violations of heart rhythm and diurnal profile of blood pressure. Methods and results. In 108 patients with acute Q-wave myocardial infarction were investigated indexes of combined diurnal monitoring of ECG and blood pressure in dependence of left ventricle aneurysm formation. Conclusions. Increasing of sympatic influence of vegetative nervous system, prevalence of ventricular arrhythmias of «high grade», QT-interval length and predominantly adverse type of diurnal blood pressure profile were noticed in patients with myocardial infarction, complicated by left ventricle aneurysm.

Ambulatory Blood Pressure Monitoring (ABPM) in Renal Disease Patients

Background ABPM has a number of advantages over office blood pressure measurements. We report ABPM patterns in renal disease patients in Anuradhapura. Method Anonymised data were obtained from ABPM records at renal unit, teaching hospital Anuradhapura from 7th July to 6th August 2015. Patient age, sex and renal replacement status were documented. Twenty four hour average blood pressure, day and night time average blood pressures, nocturnal dipping and morning surges were recorded. Average, minimum and maximum heart rate values were also obtained. Results Of 12 patients, average age was 46.6 years and 9 (75%) were males. 7 (58.3%) were on haemodialysis. Average 24 hour blood pressure was 170.7/100.8mmHg, and day and night time blood pressures were 173.4/107.7 and 162.7/96.4mmHg respectively. 9 (75%) had inadequate control. Adequate nocturnal dip was seen in only 3 (25%) patients and only 1 (14.3%) haemodialysis patient. Average heart rate was 76 beats per minute (bpm), with 5 (41.6%) patients having minimum pulse rates below 60 bpm, and 3 (25%) having maximum pulse rates over 100 bpm. Conclusions ABPM facilitated recognition of diurnal blood pressure patterns and heart rate variations in renal disease patients, including dialysis patients. Suboptimal patterns were detected in the majority of patients. This influenced selection of antihypertensive agents with suitable durations of action and effects on heart rate, and influenced dosages and timing of administration. To the best of our knowledge, this is the first study to describe ABPM patterns in Sri Lankan patients.

Effect of glycaemic control on the diurnal blood pressure variation and endogenous secretory receptor for advanced glycation end product (esRAGE) levels in type 1 diabetes mellitus

The relationship between plasma endogenous secretory receptor for advanced glycation end product (esRAGE) level and diurnal variation of blood pressure in type 1 diabetic patients based on their glycemic status has not yet been studied. So, the aim of the present study was to see if a correlation exists between plasma esRAGE levels and dipper status in type 1 diabetic patients based on their glycaemic status. Type 1 diabetic patients were divided as good and poor glycaemic controlled groups based on their HbA1c values. Blood glucose levels, insulin, insulin antibodies, homocysteine and esRAGE levels were determined. The hourly daytime and night-time blood pressure was monitored by using a non-invasive blood pressure (NIBP) apparatus. Of the 16 patients in the well-controlled group, most (14/16) were dippers (95 % confidence interval 1.5 to 20.7 vs. P = 0.006, Fisher’s exact test) when compared to those in the poorly controlled group (5/18). There was a significant correlation between plasma esRAGE levels and % decline in nocturnal blood pressure in both the good (r = 0.69, P = 0.003) and poorly (r = 0.79, P = 0.0002) controlled groups. Most of the poorly controlled patients showed abnormal circadian blood pressure pattern and low esRAGE level and hence were more prone to end organ damage.

Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease.

Hypertension is an established risk factor for stroke, ischemic heart disease,1,2 and renal dysfunction.3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. ### Atrial Fibrillation Atrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke.4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women’s Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study.8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF ( P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF.9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. ### Chronic Kidney Disease and High BP Chronic kidney disease (CKD) is characterized by a progressive decline in an individual’s glomerular filtration rate over several decades, …

Prognosis in Relation to Blood Pressure Variability

Prognosis in Relation to Blood Pressure Variability

PP.03.33

Objective: To investigate the impacts of amlodipine, valsartan and the two drugs combination on blood pressure variability(BPV) and pulse wave velocity(PWV) Design and method: It's a prospective,open, parallel control study.119 participants who were newly diagnosed essential hypertension or receiving single antihypertensive drug were recruited and divided into three groups (amlodipine, valsartan and two drugs combination treatment). Each patient's relevant demographic data and laboratory indicators were collected, in line with his/her 24 hours ambulatory blood pressure monitoring and brachial ankle pulse wave velocity monitoring taken. All participants were given treatment respectively for 10 weeks, and then rechecked the baseline indicator, comparing their effects on BPV and PBV. Results: Amlodipine can most effectively reduce 24-hour systolic blood pressure variability and diurnal systolic blood pressure variability. Amlodipine is the most effective and valsartan is the least in terms of reducing 24-hour diastolic blood pressure variability(P < 0.05).Three kinds of antihypertensive scheme can reduce arterial stiffness (baPWV), degree from strong to weak is: valsartan, two drug combination, amlodipine. The relationship between baPWV and 24 h average systolic blood pressure, 24 h systolic/diastolic blood pressure variability, 24 h average pulse pressure, daytime highest/average systolic blood pressure, daytime systolic/diastolic blood pressure variability, daytime highest diastolic blood pressure, daytime average pulse pressure, nighttime minimum systolic blood pressure are all positively correlated (P < 0.05 or P < 0.01).Between baPWV and nocturnal systolic blood pressure drop rate is a positive correlation (P < 0.05). The relationship between baPWV and nighttime diastolic blood pressure drop rate, however, has no statistical significance. Conclusions: Three treatments can all effectively control blood pressure. Amlodipine has the strongest antihypertensive effect and can effectively reduce BPV. Valsartan has independent effect in improving arterial stiffness. Arterial stiffness is associated with blood pressure levels and BPV, and its relationship between systolic blood pressure is greater than diastolic blood pressure.

PP.17.01

Objective: In patients (pts) undergoing ambulatory blood pressure monitoring (ABPM) initial and final values of blood pressure (BP) are often markedly higher than those recorded throughout the rest of ABPM, a finding that resembles the white-coat effect (WCE) phenomenon observed with clinical measurement of BP. Design and method: Analysis was carried out in 321 ABPM (M/F 113/208) in which WCE was identified by the first measured value of BP being at least 10 mmHg greater than mean diurnal systolic blood pressure (mDSBP). mDSBP and mean 24 hours systolic BP (m24hSBP) were calculated with and without the inclusion of the first two hours and the last hour of recording (WCE window, WCEw). The magnitude of WCE (WCEm) was also examined as mSBP of WCEw values whereas WCE duration (WCEd) was calculated multiplying the number of SBP values >10 mmHg higher than mDSBP by the time interval between recordings. The same analysis was repeated gender based and in a subset of 89 ABPM (M/F 30/59) from pts on treatment with beta-blockers (BB). Results: Excluding WCEw values, mDSBP and m24hSBP fell respectively from 134 ± 1 to 131 ± 1 mmHg and from 130 ± 1 to 128 ± 1 mmHg (p < 0.01 for both) while the rate of mDSBP and m24hSBP above the conventional limits of normalcy decreased respectively from 45% to 33% and from 49% to 40%. As a result, considering both measurements, 16% of patients had a false diagnosis of hypertension. After the subtraction of WCEw values the reductions in mDSBP and m24hSBP were similar in both genders, as well as WCEm (145 ± 1 mmHg) whereas WCEd was longer in females (68 ± 2 vs 58 ± 2 minutes, p < 0.01). A shorter WCEd was found in pts on BB with respect to those not in treatment with these medications (58 ± 3 vs 67 ± 2 minutes, p < 0.01). Conclusions: In both genders inclusion of WCEw values significantly increases mDSBP and m24hSBP augmenting the number of incorrect diagnosis of hypertension. Among females WCEd is longer than in males and, overall, it is reduced by BB.

PP.23.16

Objective: Brain natriuretic peptide (BNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance and concomitant volume overload. The aim of this study was to evaluate the clinical usefulness of BNP in hypertensive patients on maintenance hemodialysis (HD). Design and method: We measured BNP levels in 30 patients immediately before and after HD. All patients had preserved left ventricular ejection fraction (LVEF > 50%) and underwent 48-hours ambulatory blood pressure measurement. Cardiac parameters were evaluated by echocardiography. Results: The left ventricular mass index (LVMi) and BNP levels decreased significantly after HD (p < 0.001). LVMi was significantly associated with the duration of hypertension (p = 0.03). After HD, LVMi was significantly associated to the diurnal, nocturnal and 48-hours ambulatory blood pressure. BNP levels were associated to diastolic blood pressure and LVMi before and after HD. A BNP cut-off value of 68.91 pg/mL after HD resulted in 81.8% specificity and 100% sensitivity for the presence of left ventricular hypertrophy (LVH), (AUC ROC: 0.864) in hypertensive patients. Conclusions: BNP had strong associations with prevalent LVH in hypertensive patients on hemodialysis.