Diurnal Index Research Articles

Examining the Pre- and Post-percutaneous Coronary Intervention Blood Pressure Variability Using Ambulatory Blood Pressure Monitoring in Patients With Stable and Unstable Coronary Artery Disease.

Introduction The World Health Organization has drawn attention to the fact that coronary artery disease (CAD) is our modern "epidemic." Nowadays, sudden death during sleep has become prevalent due to a lack of oxygen supply to the heart. CAD causes more deaths and disabilities and incurs greater economic costs than any other illness in the developed world. The prevalence of cardiovascular disorders and heart disease is on the rise in India. Hypertension is one of the leading risk factors for all cardiovascular diseases. This study aims to compare blood pressure variability before and after percutaneous coronary intervention (PCI), using ambulatory blood pressure monitoring (ABPM) in patients with stable and unstable CAD. Materials and methods This prospective observational study was conducted among 52 patients with stable and unstable CAD, admitted to the medicine department, who required PCIat a tertiary care hospital. Before and after PCI, the same antihypertensive drugs were orally administered. ABPM was performed before PCI and one day after PCI. ABPM was conducted every 30 minutes during the day and every 60 minutes during the night over a 24-hour period using a mobil-o-graph (IEM, Germany). The results of the observed parameters were analyzed using the HMS Client-Server 4.0 system (Informer Technologies, Inc., Los Angeles, USA). The collected data were analyzed using SPSS Statistics version 21.0 software (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). Results Out of 52 patients, 28 (53.8%) had stable CAD and 24 (46.2%) had unstable CAD. The mean age of patients with stable and unstable CAD was 56.64±9.44 and 57.04±12.36 years, respectively. The majority of patients with stable (67.9%) and unstable CAD (62.5%) were males. Various other variables were considered, such as lipid profile, blood sugar, cardiac troponin-I, and medical history, including hypertension and type 2 diabetes mellitus. Among stable CAD patients, a comparison between pre- and post-PCI systolic blood pressure (SBP) did not show a significant difference in all SBP measurements (p>0.05). However, the mean diurnal index was significantly lower following PCI compared to before PCI (p=0.019). Among unstable CAD patients, a comparison between pre- and post-PCI SBP showed a significant change in peak daytime, average daytime, and diurnal index (p<0.05). For all other SBP measurements, the difference between pre- and post-PCI measurements was not statistically significant (p>0.05). In patients with stable CAD, a statistically significant change in diastolic blood pressure (DBP) following PCI was observed for peak daytime, peak nighttime, and average nighttime values. In contrast, for patients with unstable CAD, a statistically significant change in DBP following PCI was observed for peak daytime, peak nighttime, and minimum daytime values (p<0.05). Statistically, post-PCI, there was no significant difference between the two groups for SBP and DBP measurements (p>0.05). Additionally, there was no significant difference between the two groups pre- and post-PCI in the pattern of dipping. Conclusion A comparison of the ABPM before and after PCI showed that, within 48 hours post-PCI, the ambulatory blood pressure indicators did not differ statistically from those before PCI.

DIPPING STATUS OF BLOOD PRESSURE AND PROGNOSIS

Objective: Ambulatory blood pressure monitoring (ABPM) plays an important role in monitoring the effectiveness of antihypertensive treatment. It enables to obtain clear information about absolute values and variability of blood pressure in time-defined periods. The aim of our work was to evaluate the clinical benefit not only from the point of view of BP control, but also from the prognostic aspect by determining the diurnal index. Design and method: To control the effectiveness of antihypertensive treatment, we used ABPM - Cardiosoft-Tonoport V, General Electric (USA) with oscillometric blood pressure measurement. We analyzed 206 ABPM records in hospitalized patients. There were 93 men (45%) and 113 women (55%). The monitored group of patients was divided into 4 groups according to age. There were 31 persons in the age group of 18-44 years, 78 persons in the age group of 45-64 years, 52 persons in the age group of 65-74 years and 45 persons in the oldest age group (75 years and over). In 15 patients (7.3%), we did not determine the diurnal sign for night waking. Results: The group of dippers consisted of 79 people (38.3%), there were also 79 people (38.3%) in the group of non-dippers, there were 30 risers (14.6%) and 3 extreme dippers (1.5%). Following the further fate of the investigated persons, we found that 19 persons (9.2%) died within 2 years, of which 14 were from groups with a disturbed diurnal index (9 non-dippers and 5 risers). Conclusions: Our results point to the fact that in addition to the basic parameters of BP used as an indicator of blood pressure control, the analyses of diurnal character disturbances has a importance in prognostic aspect. Identifying these patients may therefore be helpful in the management of hypertension and comorbidities.

Aortic-brachial stiffness mismatch as potential marker of subclinical arterial damage in patients with rheumatoid arthritis

Aortic-brachial stiffness mismatch is a potential new marker of a subclinical vascular damage that has never been studied in patients with rheumatic diseases. The aim of the study was to assess the frequency of arterial stiffness mismatch in rheumatoid arthritis (RA) and to evaluate its clinical associations. Materials and Methods. The study group included 85 patients with RA (males 22.4 %, aged 59.7 ± 14.3 years, hypertension in 65 %, mean disease activity score (DAS-28 (C-reactive protein) 3.7 ± 1.1), and the control group included 40 subjects matched by gender, age and risk factors. The study methods included measurements of clinical and ambulatory brachial and aortic blood pressure (BP) (BPLab-Vasotens), arterial stiffness parameters parameters (applanation tonometry, SphygmoCorAtCor), cardio-ankle vascular index (VaSera) and cardio-vascular risk assessments using the SCORE, American College of Cardiology/American Heart Association (ACC/AHA) 2013 pooled cohort equations and QRisk2 scoring systems. The arterial stiffness gradient was calculated as a ratio between carotid-femoral (cf) and carotid-radial (cr) pulse wave velocity, and its elevation of ≥ 1 was considered as arterial stiffness mismatch. A p-value of 0.05 was considered significant. Results and Discussion. The mean stiffness gradient in RA patients without and with hypertension was 1.1 ± 0.1 and 1.4 ± 0.4, respectively (р 0.001); in controls, 0.99 ± 0.2 and 1.3 ± 0.3, respectively (р 0.001). The frequency of stiffness mismatch in the RA group was significantly higher compared to the controls in the whole study population (88.2 % vs 65 % (р = 0.002)) and in both normotensive and hypertensive subgroups (76.7 % vs 43.8 % (p = 0.03), and 94.5 % vs 79.2 % (p = 0.04), respectively). The same trend was observed in the subgroups with normal carotid-femoral pulse wave velocity: arterial stiffness mismatch was present in 82.1 % of RA patients vs. 51.9 % control subjects (p = 0.004). The stiffness gradient was associated with age (r = 0.63), hypertension duration (r = 0.56), cardio-vascular risk by the ACC/AHA 2013 (r = 0.69) and Qrisk2 (r = 0.7) scoring systems, nocturnal aortic systolic BP (r = 0.53), cardio-ankle vascular index (r = 0.60) and diurnal index of brachial systolic BP (r = -0.4). Significant differences in stiffness gradient values were observed in the subgroups based on elevation of aortic systolic BP and pulse wave velocity above individual reference values, aortic pulse pressure 50 mmHg, cardio-ankle vascular index 9, presence of high cardio-vascular risk, masked and nocturnal hypertension, and non-dipping. Conclusion. Patients with RA are characterized by higher frequency of arterial stiffness mismatch compared to controls, irrespective of the history of hypertension or the values of carotid-femoral pulse wave velocity. Arterial stiffness mismatch is associated with unfavorable 24-h BP profile, higher frequency of nocturnal hypertension and cardio-vascular risk.

AMBULATORY BLOOD PRESSURE MONITORING IN HUNGARY: THE FIRST CROSS-SECTIONAL RESULTS OF AN OPEN LABEL, PROSPECTIVE, OBSERVATIONAL STUDY

Objective: Background: Ambulatory blood pressure monitoring (ABPM) is gold standard method in the diagnosis and follow-up of hypertensive patients. There is no systematic assessment on the daily practice of the utilization of ABPM in Hungary. Aim: The goal of the project is to assess the indication and the number of monitoring, and to analyze the blood pressure results. Design and method: This is a multicenter, open-label, observational non-interventional study. Data collection is performed in GPs’ practices and in outpatient clinics of cardiology and internal medicine. Meditech ABPM-06 monitors are used for ABPM measurements. Basic patients’ data are documented in an eCRF and all ABPM data are transferred through a closed online surface into the database for further analysis. Results: 7498 ABPM were performed between 21st of February and 21st of December, 2021. The monitoring was performed mainly by GPs (62%). The average age of the patients was 54.4 years (12–96 years). More than half of the patients (54%) were female. The indication of ABPM was elevated blood pressure (BP) at home (59.7%), labile BP (41.5%), therapy control (17.0%), suspicion of white coat hypertension (13.5%), suspicion of masked hypertension (2.5%), suspicion of nocturnal hypertension (3.2%) and suspicion of secondary hypertension (1.3%). The average duration of hypertension among hypertensive patients was 9.8 years (1–73 years). 32.6% of the patients were newly diagnosed as hypertensive. The average 24-hour systolic blood pressure was 133.9 mmHg, the average diastolic blood pressure was 79.3 mmHg, while the average pulse rate was 73.2 beats/min. The 24-hour average percent time elevation of systolic and diastolic blood pressure was 53.0% and 38.8%, respectively. The average systolic diurnal index was 9.6%, the average diastolic diurnal index was 13.3%. Conclusions: The two most frequent indication for ABPM in the routine practice are elevated home BP and labile BP values. One third of the patients was newly diagnosed as hypertensive subject. ABPM was performed mainly in patients with uncontrolled hypertension. The routine use of ABPM may increase the awareness of hypertension.

Study of 24 Hours/2 day Monitoring of Blood Pressure in Subjects with Traumatic Paraplegia

Cardiovascular dysfunction and cognitive decline are more common in traumatic spinal cord injury (SCI). Most people with a cervical or upper-thoracic SCI usually experience conditions called orthostatic hypotension and autonomic dysreflexia, which are described by the serious changes in systemic blood pressure. To evaluate baseline heart rate (HR), baseline blood pressure (BP) and ABPM monitoring in traumatic paraplegia patients. In this study, total 36 diagnosed of paraplegia patients was based on Asia Impairment Scale (AIS), paralysed by RTA, or fall from height within 7 days of injury were included in this study. The blood pressure was monitoring for 24 hour/2 day and repeated after 12th day of first monitoring. Ambulatory blood pressure was monitored by ABPM machine at HALF hourly from 6 am – 10 pm and one hourly from 10 pm – 6 am. All the continuous variables were compared by t- test. The night dipping (Systole) and morning surge (Systole) were significantly lower at 12th days as compared to within 7 Days (p=0.002). Whereas the diurnal Index (Diastole) and diurnal Index (MAP) were comparable in between within 7 days and 12th days. The mean SBP max and SBP min were significantly lower at 12th day as compared to within 7 days. Whereas DBP max and min were comparable in between within 7 days and at 12th days. The changes in min., max and mean double product (All, active periods, and passive periods) were also not found to be statistically significant in between within 7 days and at 12th day. The traumatic paraplegic patients have altered diurnal index, morning surge, night dipping and systolic blood pressure on APBM monitoring.

The circadian rhythm of arterial blood pressure in Alzheimer's disease and vascular dementia.

Hypertension is considered a risk factor for stroke and dementia. Ambulatory blood pressure monitoring (ABPM) is a useful tool in the diagnosis and treatment of hypertension. This study aimed to evaluate blood pressure using ABPM, in 30 Alzheimer's disease (AD) patients and 30 vascular dementia (VaD) patients in comparison with 30 healthy controls. BP was recorded every 15min from 6 AM to 10 PM, and every 30min from 10 PM to 6 AM. Mean systolic (SBP) and diastolic (DBP) blood pressure during daytime, nighttime, diurnal index, pulse pressure, and heart rate were extracted from the ABPM recordings.VaD patients presented higher SBP values compared to AD patients and healthy controls. DBP values in the AD group were the lowest, while VaD patients presented the highest DBP values, including day and nighttime. Mean arterial pressure values were also the highest in the VaD group, while AD patients had similar values with the control group. The VaD patients presented the lowest systolic diurnal index compared to AD patients and controls. The mean pulse pressure and nighttime pulse pressure values were higher in both groups of dementia patients when compared with the control group. Increased SBP, pulse pressure, and alteration in the circadian pattern with the highest incidence of the non-dipper and reverse dipper patterns were found in patients with dementia when compared with the healthy elderly. Also, decreased values of DBP were found in AD patients, especially during the night period.

COMBINATION OF NON-DIPPING PROFILE WITH HIGH NIGHTTIME SYSTOLIC BLOOD PRESSURE IN RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER CARDIOVASCULAR RISK

Objective: Non-dipping profile is an important predictor of adverse cardiovascular (CV) outcomes. Its associations with subclinical vascular damage in rheumatoid arthritis (RA) are not known yet. We aimed to assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with CV risk in patients with RA. Design and method: The study group included 85 patients with RA (females 77.6%, aged 59.7 ± 14.3 years, HTN 65%, mean DAS-28 3.7 ± 1.1) and control group (40 patients matched by gender, age and risk factors). Office BP was measured with a validated oscillometric device, 24-hour ABPM by BPLab Vasotens. CV risk was calculated as mSCORE. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn &lt; 120 mmHg (G2), non-dippers with SBPn &gt; 120 (G3). p &lt; 0.05 was considered significant. Results: Rate of BP control was 58% in RA and 67% in the controls (p = 0.48). Patients with RA vs controls were characterized by higher mean SBPn (123 ± 17 vs 112 ± 10 mmHg, p = 0.002), lower diurnal index (DI) (median 4 vs 7.5%, p = 0.006), higher rate of night hypertension (49.4 vs 12.5% (χ2 = 17, p &lt; 0.001)). RA patients more often had non-dipping profile (DI &lt; 10%): 83.5 vs 62.5%, (χ2 = 7.4, p = 0.02). In RA group patients with SBPn &gt; 120mmHg had higher age (64.8 ± 12.6 vs 54.8 ± 14.3 years), office BP (142 ± 19/82 ± 11 vs 121 ± 14/76 ± 9mmHg), HTN duration (med 5.5 vs 0 years), mSCORE (med 6.1 vs 2.5%), p &lt; 0.001 for trend. Patients with DI &lt; 10% had higher age (60.8 ± 14.8 vs54.1 ± 10 years, p = 0.04). SBPn significantly correlated with age (r = 0.5), office SBP (r = 0.6) and DBP (r = 0.3), mSCORE (r = 0.5);non-dipping pattern–with age (r = 0.2). After adjustment by SBPn, no differences were observed between G1 and G2. Patients in G3 vs G1 had higher CRP (med 16.6 vs 6.7 mg/l, p = 0.03), mSCORE (med 7.1 vs2.3%, p &lt; 0.001 for both); in G3 vs G2–higher mSCORE (med 7.1 vs 2.1%), p &lt; 0.001 for trend and ESR (med 46 vs 23 mm/h, p = 0.03). Conclusions: Patients with RA were characterized by higher incidence of non-dipping pattern, SBPn elevation. Combination of high SBPn and non-dipping pattern was associated with higher CV risk. These associations may be mediated by inflammation. The publication was prepared with the support of the RUDN University Program 5-100.

YOUNG PATIENTS WITH TYPE 1 DIABETES MELLITUS WITHOUT CARDIOVASCULAR DISEASES ARE CHARACTERIZED BY HIGH FREQUENCY OF UNFAVOURABLE BLOOD PRESSURE PHENOTYPES

Objective: Type 1 diabetes mellitus (T1DM) remains a disease with high risk of cardiovascular disease (CVD). Hypertension (HTN) may be underdiagnosed in this population. Data on ABPM profile in patients with T1DM are lacking. The aim of the study was to assess the prevalence of different BP phenotypes and dipping patterns in patients with T1DM without known CVD. Design and method: Study group included 125 patients with T1DM aged 18–44 years: 60% males, 29.2 ± 7.6 years, median DM duration 6.9 years). 24-hour ABPM of brachial BP was performed with BPLab Vasotens. BP levels and phenotypes were classified according to 2018 ESC/ESH HTN guidelines. p &lt; 0.05 was considered significant. Results: Mean office BP was 120.9 ± 14.6/77.3 ± 9.3mmHg, daytime–120.7 ± 10.4mmHg, nighttime-112.8 ± 11.4/72.6 ± 9.9mmHg, 24-h BP–119.5 ± 9.3/75.2 ± 8.7mmHg. High normal BP was registered in 9.6% HTN in 4.8%. According to ABPM measurement sustained HTN was confirmed in 4.8%, true normotension–in 72% and masked HTN was found in 23.2%. Isolated nocturnal HTN was revealed in 14.4%. Patients with sustained HTN compared to masked HTN had longer median duration of DM (14.8 vs 5.3 years) and higher median urine albumin-creatinine ratio (UACR) (33.4 vs 18.1 mg/g), p &lt; 0.05. For further analysis patients with sustained and masked HTN were united into one group. Patients with HTN compared to normotensives were older (31.5 ± 7.9vs29.1 ± 8.2 years), higher median UACR (23.8 vs 14.5 mg/g) and received higher insulin doses (41.3vs28.6 U), p &lt; 0.01. Median SBP diurnal index (DI) in normotensives was 10.3%, in hypertensives –6.2% (p &lt; 0.05). Dipping profiles of SBP in patients with HTN and normotensives were as follows: 57.1% non-dippers, 20% night-peakers and 22.9% dippers vs 37.8% non-dippers and 62.2% dippers respectively (p &lt; 0.05). Non-dipping profile (DI &lt; 10%) compared to dipping profile was characterized by a trend to higher median UACR (27.9 vs 16.7 mg/g), longer median DM duration (7.2 vs 6.1 years), p = 0.05. Conclusions: Young patients with T1DM have high frequency of masked HTN and non-dipping profile. Worse BP phenotypes were associated with higher albuminuria. Routine ABPM may be recommended in this population in order to reveal high-risk patients and optimize the treatment. The publication was prepared with the support of the RUDN University Program 5-100

HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS AND PROTEINURIC PHENOTYPE OF CHRONIC KIDNEY DISEASE ARE CHARACTERIZED BY WORSE PARAMETERS OF 24-H CENTRAL AORTIC BLOOD PRESSURE

Objective: The aim of the study was to evaluate the 24-h profile of peripheral and central blood pressure (BP) in hypertensive patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) according to the presence of proteinuria. Design and method: The study included 90 patients with HTN, T2DM and CKD with eGFR 30-&lt;60 ml/min/1.73 m2 and urine albumin–creatinine ratio (UACR) &lt;300 mg/g (66% females, median age 60 years, median duration of DM–7.5 years, median duration of HTN 18 years). All received antihypertensive therapy and antidiabetic drugs (insulin in 58%). The analysis was performed according to CKD phenotype: proteinuric (UACR 30-&lt;300 mg/g) and non-proteinuric (UACR &lt; 30 mg/g). Office BP was measured with a validated oscillometric device. Clinical central BP and 24-hour ABPM of brachial and central aortic BP were performed with BPLab Vasotens. All results are presented as median values. p &lt; 0.05 was considered significant. Results: Office brachial BP was 156/83 mmHg, aortic – 139/90 mmHg, median UACR was 26.5 mg/g. Proteinuric phenotype was found in 78% and compared to non-proteinuric phenotype was characterized by higher rate of dyslipidemia (85% vs 45%, p = 0.0004), more frequent history of coronary artery disease (53% vs 10%, p = 0.001), longer duration of HTN and DM (19.5 vs 7.5 years and 8 vs 3 years respectively, p &lt; 0.01), lower HDL-C (1.2 vs 1.9, p = 0.02) and higher office brachial DBP (83 vs 80 mmHg, p = 0.04) and central SBP (147 vs 137 mmHg, p = 0.007). Proteinuric phenotype compared to non-proteinuric was associated with worse 24-h profile of central SBP (daytime 147 vs 138 mmHg, p = 0.008; night-time 143 vs 130 mmHg, p = 0.04). HTN phenotypes according to diurnal index for proteinuric and non-proteinuric CKD were as follows: dippers 0 vs 10%, non-dippers 6 vs 5%, night-peakers 82 vs 70% over-dippers 12 vs 15% (all differences were non-significant). Presence of proteinuric phenotype positively correlated with daytime and night-time aortic SBP (r = 0.28 and 0.21 respectively, p &lt; 0.05). Conclusions: Proteinuric phenotype of CKD in patients with HTN and T2DM is associated with worse 24-h profile of central BP. The publication was prepared with the of the RUDN University Program 5-100

Young patients with type 1 diabetes mellitus are characterised by high frequency of masked hypertension that is associated with increased arterial stiffness

Abstract Background Hypertension (HTN) is a major risk factor for microvascular complications and cardiovascular disease (CVD) in individuals with type 1 diabetes (T1D). Masked and nocturnal HTN are associated with increased cardio-vascular (CV) risk and may be common in patients with T1D. Increased arterial stiffness (AS) is associated with elevated blood pressure (BP) and vascular complications. Very few studies have analyzed the association between masked HTN and markers of AS in T1D. Purpose To evaluate BP phenotypes and their associations with AS and to assess CV risk in young patients with T1D without history of HTN and other known CVD. Methods We included 81 patients with T1D without any history of known CVD. Routine clinical and laboratory evaluation was performed. Office BP was measured with a validated oscillometric device. 24-h ABPM was performed using BPLab Vasotens (“Petr Telegin”). Central BP and AS (carotid-femoral pulse wave velocity (cfPWV)) were measured with applanation tonometry. BP phenotypes were analyzed according to the criteria recommended in ESC/ESH 2018 HTN guidelines. CV risk categories were assessed with the global scale of 10-year risk (ESC 2019). P &amp;lt;0.05 was considered significant. Data are presented as median (interquartile range (IQR)). Results The study group included 39% males, age 27 (23; 34) years, 24.7 smokers, duration of T1D– 6 (2.8; 11) years, HbA1c – 6.9% (5.6; 7.9%). Brachial BP was 122 (110; 122)/80 (70; 80) mmHg; central BP was 109 (100; 118)/72 (67; 78) mmHg, cfPWV – 6.3 (5.3; 6.7) m/s. High and very high 10-year CV risk was observed in 87.7% of patients. True HTN was observed in 5 (6.2%) patients, masked – in 31 (38.3%), white-coat – in 1 (1.2%), true normotension in 44 (54.3%). Isolated nocturnal HTN was found in 30.7% of patients with office BP &amp;lt;140/90 mmHg. 41% of all patients with clinical normotension had masked HTN and isolated nocturnal HTN was present in 74.2% of them. The most common patterns of diurnal index were non-dipping (63,9%) and night-peaking (16.6%). Patients with masked HTN compared to patients with true normotension were older (31±8.6 vs 26.4±5.5 years, p=0.02), had longer duration of T1D (6 (3; 12.9) vs 4 (0.7; 8) years, p=0.009), higher urine albumin/creatinine ratio (18.5 (11; 29) vs 8 (3; 17) mg/g, p&amp;lt;0.001) and higher cfPWV (7.2 (6.2; 8.2) vs 6.3 (5.8; 6.8) m/s, p=0.002). Conclusions Young patients with T1D and clinical normotension are characterized by high frequency of masked HTN (41%) especially isolated nocturnal HTN (74.2%), and high rate of non-dipping. Masked HTN is associated with higher cfPWV and higher albuminuria. This may reflect early vascular changes and potentially lead to further CV risk elevation in this population. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The publication was prepared with the support of the “RUDN University Program 5-100”

THU0126 COMBINATION OF NON-DIPPING PROFILE WITH ELEVATION OF NIGHTTIME SYSTOLIC BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK

Background:Nocturnal hypertension (HTN) and non-dipping profile are important predictors of adverse cardiovascular (CV) outcomes. Their associations with subclinical vascular damage in rheumatoid arthritis (RA) are still a matter of investigation. It was shown that 10-year atherosclerotic CV disease risk (rASCVD) may be more accurate in CV risk prediction in RA than SCORE. Associations of impaired 24-h BP phenotypes with CV risk in RA are not well-studied yet.Objectives:To assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with arterial stiffness and CV risk assessed by rASCVD in patients with RA.Methods:Study group included 90 patients with RA (females 78.7%, age 59.5±14.2 years, HTN 64%, median (med) HTN duration 6.4 years, RA duration – 7.2 years, seropositive RA 66%, mean DAS-28(CRP) 3.8±1.0) and control group (45 patients matched by gender, age and risk factors). All patients with HTN received antihypertensive therapy. Office BP was measured with a validated oscillometric device, 24-hour ABPM was performed with BPLab Vasotens, carotid-femoral PWV was assessed by applanation tonometry. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn&lt;120 mmHg (G2), non-dippers with SBPn≥120 (G3). CV risk in RA group was calculated as 10-year rASCVD. Risk≥7.5% was considered as high. p&lt;0.05 was considered significant.Results:Median rASCVD was 6.3%. Rate of BP control was 60% in RA and 66% in the controls (p=0.5). Patients with RA vs controls had higher mean SBPn (124±16 vs 110±8 mmHg, p=0.003), lower diurnal index (DI) (med 3.8 vs 8.1%, p=0.02), higher rate of night HTN (49.6 vs 12.2% (p=0.0002). The RA and control groups didn`t differ by dipping patterns, although RA patients more often had non-dipping profile (DI &lt;10%): 83.9 vs 61.3%, (p=0.02). RA patients with SBPn ≥120 mmHg had higher age (63.7±12.5 vs 52.9±14.5 years), office SBP (143±17 vs 122±13 mmHg), HTN duration (med 5.4 vs 0.5 years), PWV (10.3±3.0 vs 7.9±2.5 m/s) and rASCVD (12 vs 3.4%), p&lt;0.001 for trend. Analysis in hypertensive RA group confirmed significant differences in PWV (11.3±3.1 vs 9.1±3.2 m/s, p=0.02) and rASCVD (med 13.5 vs 10.5%, p=0.045). Patients with DI&lt;10% had higher age (60.9±13.8 vs 54.3±11 years, p=0.04) and rASCVD (med 8.5 vs 3.1%, p=0.02). Patients with rASCVD ≥7.5% compared to &lt;7.5% had higher SBPn (133±11 vs 112±8 mmHg), lower median DI (0 vs 6%), more often had masked HTN (43 vs 16%) and night HTN (48 vs 16%), p&lt;0.01 for trend. SBPn significantly correlated with age (r=0.6), office SBP (r=0.5) and DBP (r=0.4), PWV (r=0.6), rASCVD (r=0.6); non-dipping pattern – with age (r=0.2), and rASCVD (r=0.3). After adjustment by SBPn, no differences were observed between G2 and G3. Patients in G3 vs G1 had higher PWV (10.4±3.1 vs 7.6±1.7 m/s, p=0.004), CRP (med 15.7 vs 7.8 mg/l, p=0.03), rASCVD (med 12.8 vs 3.1%) (p&lt;0.001); in G3 vs G2 – higher PWV (10.8±3.1 vs 8.2±2.3 m/s), rASCVD (med 12.8 vs 2.7%) and ESR (med 45 vs 21 mm/h, p&lt;0.01 for trend).Conclusion:Patients with RA had higher incidence of non-dipping pattern and SBPn elevation. Combination of high SBPn and non-dipping was associated with higher arterial stiffness and CV risk – this may be mediated by inflammation. Higher CV risk was associated with masked and night HTN. This may help in defining indications for ABPM in this population.

PROGNOSTIC SIGNIFICANCE OF THE DETERMINATION OF THE DIURNAL BLOOD PRESSURE INDEX

Objective:Ambulatory blood pressure monitoring (ABPM) allows us to obtain and review its variations in defined time periods. Several studies have confirmed that the determination of the diurnal index is important from the prognostic aspect. The aim of our study was to evaluate parameters of diurnal

Changes of indices of diurnal blood pressure monitoring under the influence of treatment in patients with essential hypertension complicated with hemorrhagic stroke after early recovery period

The aim — to compare the indices of diurnal blood pressure monitoring (DBPM) in patients with essential hypertension (EH) іn ≥ 6 months after hemorrhagic stroke (HS) before and after treatment with combination of amlodipine, valsartan, hydroclorothiazide (if necessary) and magnesium oxide monohydrate.Materials and methods. The main group included 33 patients, the comparison group comprised 13 persons. In the first group the office blood pressure (BP) was і 140/90 mm Hg, in the second one it was lower. The groups were matched by main indicators. DBPM was performed twice (before and after treatment) for the main group of patients, and once for the comparison group patients.Results and discussion. In the main group, before and after treatment the mean systolic blood pressure (SBP) was 110.1 ± 16.0 mm Hg and 102.3 ± 12.6 mm Hg, respectively, at daytime, 102.6 ± 17.3 and 83.9 ± 8.1 mm Hg at night, 109.7 ± 15.7 and 96.3 ± 11.9 mm Hg (p &lt; 0.05) per day. The maximum SBP at daytime in the main group was higher before the treatment (169.3 ± 18.4 mm Hg, p &lt; 0.05). The value of the standard deviation of SBP and pulse BP decreased after treatment (p &lt; 0.05). The value of the mean real variability of SBP in the main group was 11.27 ± 2.73 mm Hg before treatment and 9.74 ± 1.84 mm Hg (p &lt; 0.05) after it. Diurnal index of SBD in the main group was 4.95 ± 9.67 % before treatment and 11.44 ± 5.43 % after it.Conclusions. The treatment of patients with EH, who had suffered HS ≥ 6 months before and had office BP ≥ 140/90 mm Hg, with combination of amlodipine (daily dose 5 — 10 mg), valsartan (daily dose 80 — 160 mg), hydroclorothiazide (12.5 mg if necessary) on the basis of chronotherapy approach and magnesium oxide monohydrate (456 mg daily during 1 month period) permits achieving the control of BP according to DBPM data in 73 % of patients. This treatment also permits statistically significant decreasing of short‑term BP variability, in particular, the standard deviation in all time intervals and the average real variability of SBD.

The use of changes in electricity consumption to assess the condition of the Water Treatment Plant

The article discusses the use of the daily diurnal energy intensity index to assess the efficiency of deepwater aggregates and the technical condition of the water treatment station

Dynamics of the Standardized Precipitation Evapotranspiration Index (SPEI) of an oil palm plantation area in Jambi province, Indonesia

Oil palm is susceptible to drought. Research to increase oil palm production continues to be developed, including the influence of drought to oil palm production. One of the methods used to analyze drought is using the Standardized Precipitation Evapotranspiration Index (SPEI). The purpose of this study is to analyze the dynamics of SPEI at diurnal, ten days periods, and monthly time scales, and their correlation with meteorological factors at an oil palm plantation in Jambi province, Indonesia for the year 2015. Using diurnal values, the SPEI does not indicate any drought as there are no values lower than -1. Using ten days periods, the SPEI shows a dry period starting from mid May to mid October. Using monthly values, the SPEI shows drought conditions with the driest month in October with SPEI reaching -2. Solar radiation and evapotranspiration are significantly correlated with the dynamics of diurnal index SPEI while precipitation affects significantly the dynamics of the SPEI at ten day and monthly periods.

Daily rhythmicity of behavioral responses in donkeys of different age groups during the cold-dry (harmattan) and hot-dry seasons in a tropical savannah

Abstract The aim of the study was to evaluate the daily rhythms of behavioral activities of adult, yearling, and foal donkeys during the cold-dry (harmattan) and hot-dry seasons in a tropical savannah. Thirty, clinically healthy free-ranging donkeys, divided into 3 groups of 10 donkeys each according to their age, served as experimental subjects. Behavioral activities of donkeys were monitored bihourly from 06:00 to 06:00 h (GMT +1) during the cold-dry and hot-dry seasons. Application of single cosinor procedure showed that behavioral activities exhibited varying levels of daily rhythmicity in both seasons. Behavioral activities of adult, yearling, and foal donkeys peaked during the afternoon period (13:11-14:45 h) of the photophase of the light–dark cycle during the cold-dry and hot-dry seasons. The diurnal index of activity rhythm showed that donkeys are mostly diurnal animals. During the study period, the percentage time spent on feeding during the harmattan season was higher (P

Evaluation of Cardiovascular Risk and Blood Pressure Parameters in Patients with Bronchial Asthma and Co-Existent Chronic Obstructive Pulmonary Disease

The combination of arterial hypertension, asthma and COPD has a significant prevalence in clinical practice. The presence of hypertension contributes to the growth of severity of asthma-COPD overlap (ACO), the worst prognosis and a high risk of cardiovascular complications. Coexistence of diseases changes the course of each of them, contributes to the early formation of complications and creates certain difficulties for therapy.The aim of work was to investigate the factors of cardiovascular risk, as well as the arterial pressure indicators of patients with ACO.Patients. 140 patients with ACO with an average forced expiratory volume for the first second (FEV1) (59.0 ± 1.4)% and the ratio of forced expiratory volume in the first second to the forced vital capacity of the lungs (FEV1 / FVC) (53.6 ± 0.8)%. Methods. All the patients underwent measurement of body weight and height, measurement of office systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour ambulatory blood pressure monitoring (ABPM), biochemical blood test, coagulogram, assessment of total cardiovascular risk on a SCORE scale, the risk of cardiovascular complications on QRISK2 scale, the risk of developing diabetes mellitus (DM) on QDiabetes scale.Results. Patients with ACO had some pathological changes in blood pressure. Also, these patients had a significant overload with arterial pressure. Also, in these patients, the diurnal index (DI) of SBP and DI DBP were significantly reduced relatively to normal values.Patients with ACO predominantly belonged to the group of moderate risk of fatal cardiovascular events in 10 years (3.83%). The QRISK2 is quite significant, and is more than 15%. There is also a fairly significant risk of developing DM (more than 13%).A higher concentration of inflammational markers was revealed in ACO patients with more severe bronchial obstruction (significant increase in C-reactive protein and fibrinogen with increased bronchial obstruction).ACO patients from subgroups GOLD 1 and GOLD 2 predominantly belonged to the group of moderate risk, and patients from the GOLD 3.4 subgroup predominantly had a high risk of developing fatal cardiovascular events over the next 10 years (according to the SCORE scale). The QRISK2 scale risk was also moderate in the first two subgroups and high in patients with severe bronchial obstruction (GOLD 3,4).Conclusions. In patients with a combination of asthma and COPD, significant cardiovascular comorbid pathology, a high prevalence of arterial hypertension, a high degree of overload with arterial pressure were found. Significant violations of the variability of blood pressure were also revealed. In this category of patients, a moderate risk of developing fatal cardiovascular events, as well as the development of diabetes within the next 10 years is also determined. Even more significant violations of blood pressure and high rates of cardiovascular risk were detected in patients with a combined pathology with a higher degree of bronchial obstruction.

Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism

AimsTo study the loss of diurnal variation in blood pressure in normotensive patients with Subclinical/overt hypothyroidism and effect of Levothyroxine (L-T4) treatment. Materials and methodsIn this interventional study Eighty patients between 17- 50 years with newly detected OH and SCH (74 women and 6 men) and nine euthyroid subjects (all men) with blood pressure <140/90 were recruited. All patients underwent 24h ambulatory blood pressure monitoring (ABPM) using ABPM machine before and after treatment with L-T4. Diurnal index (DI), Percent time elevation (PTE), Hyperbaric impact (HBI) were studied pre and post L-T4 treatment. ResultsOf the 89 subjects (22 SCH, 58 OH and 9 controls), 7 of the SCH and 30 of OH subjects reported back in follow up after L-T4 supplementation for evaluation. DI, HBI and PTE when compared at baseline between different groups (SCH- OH, SCH- control, OH- control) were insignificant. After L-T4 supplementation DI, HBI and PTE varied significantly with p value 0.007, 0.003 and 0.003 respectively between SCH- OH only. Post L-T4 analysis in SCH group was statistically insignificant (p-value 0.102) but a trend toward improvement in DI was noted (baseline and post treatment DI mean 7.00 and 13.00 respectively). ConclusionLoss of nocturnal dipping was found in patients with OH and SCH which was restored after L-T4 therapy only in patients with SCH and not with OH. Treatmentof SCH patients with high cardiovascular risk may be beneficial in this setting and can be a new indication for LT4 therapy in SCH.

Main features of the ambulatory blood pressure monitoring in the non-controlled essential hypertension patients

The problem of blood pressure (BP) effective control in Ukrainians is still relevant. Ambulatory blood pressure monitoring (ABPM) is a modern method of BP investigation. However, only some ABPM parameters, as diurnal systolic BP (SBP) and diastolic BP (DBP), now use as the diagnostic guide according to international recommendations.Aim. To determine peculiarities of ABPM parameters in treated uncontrolled hypertensive patients.Materials and methods. We investigated 153 patients with essential hypertension and divided two groups according to the level of 24-h SBP and 24-h DBP. There were 103 patients who have uncontrolled levels of BP in the first group and 50 patients with normotensive individuals in the second group.Results. We had a significant increase of SBP (21,8%; р=0,001), DBP (21,5%; р=0,001), pulse BP (PBP) (22,8%; р=0,001) and the morning surge in SBP (20,7%; р=0,004) in the first group versus the second group. Furthermore, there was a considerable rise in such parameters, like the square of hypertension of diurnal SBP in 9,2 times (р=0,001), daily in 9,5 times (р=0,001), nocturnal in 8,6 times (р=0,001); index of the square of diurnal DBP reduction in 7,2 times (р=0,001), daily in 8,1 times (р=0,001) and nocturnal in 5,7 times (р=0,001) in the first group than in the second group. There was no significant difference in index of night reduce of SBP, speed of morning rise of SBP and DBP, ambulatory arterial stiffness index (AASI) and symmetric slope index (sym_AASI).Conclusion. This study shows that treated non-controlled hypertensive patients have 20-25% increase in diurnal SBP, DBP and PBP. There is a night-fold increase in diurnal index of SBP square hypertension and a DPB seven-fold increase in diurnal index of square hypertension. There is no statistical significance in index of night reduce of SBP, speed of morning rise of SBP and DBP, AASI and sym_AASI.

0304 : Heart rate in dippers and in non-dippers investigated by ambulatory blood pressure monitoring

In normal cases, nocturnal blood pressure (BP) falls between 10–20%, compared with daytime BP (BP dipper pattern).The non-dipping pattern of ambulatory BP is associated with secondary hypertension and target organ damage. Our aim was to investigate the difference of heart rate between non-dippers and dippers. BP variability can be estimated as a standard deviation of ambulatory BP monitoring obtained by every 15–20 min measurement. The ambulatory BP and HR were monitored every 20 min with a fully automatic device. Ambulatory BP monitoring were performed in 124 patients in the University hospital Ibn Rochd in Casablanca. We measured the blood pressure and heart rate parameters. The criteria of non-dipping pattern was diurnal index, 10%. Non-dipping pattern was found in 41 cases and dipping pattern was found in 83 cases. The 24h systolic blood pressure in non-dipping group (NDG) was 133.92±16.89 mmHg, in the dipping group (DG) was 127.49±13.81 mmHg (p= 0.005) and the diastolic was 75.38±12.81 mmHg (NDG) and 75.67±11.91 mmHg (DG) (p= 0.08). The heart rate was lower in the NDG than in the DG: 69.65±9.81 vs 70.59±9.48 bpm (p= 0.02). In NDG, we found lower heart rate. Presumably reflecting altered function of the sympathetic nervous system, the baroreceptor oscillations are shifted to lower frequencies. It is clear that more work should be carried out to evaluate the impact of heart rate variability on non dipper patients. The author hereby declares no conflict of interest