Diurnal Blood Pressure Pattern Research Articles

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.

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.

Hypertension in kidney transplant recipients.

Kidney transplantation is considered the treatment of choice for end-stage kidney disease patients. However, the residual cardiovascular risk remains significantly higher in kidney transplant recipients (KTRs) than in the general population. Hypertension is highly prevalent in KTRs and represents a major modifiable risk factor associated with adverse cardiovascular outcomes and reduced patient and graft survival. Proper definition of hypertension and recognition of special phenotypes and abnormal diurnal blood pressure (BP) patterns is crucial for adequate BP control. Misclassification by office BP is commonly encountered in these patients, and a high proportion of masked and uncontrolled hypertension, as well as of white-coat hypertension, has been revealed in these patients with the use of ambulatory BP monitoring. The pathophysiology of hypertension in KTRs is multifactorial, involving traditional risk factors, factors related to chronic kidney disease and factors related to the transplantation procedure. In the absence of evidence from large-scale randomized controlled trials in this population, BP targets for hypertension management in KTR have been extrapolated from chronic kidney disease populations. The most recent Kidney Disease Improving Global Outcomes 2021 guidelines recommend lowering BP to less than 130/80 mmHg using standardized BP office measurements. Dihydropyridine calcium channel blockers and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers have been established as the preferred first-line agents, on the basis of emphasis placed on their favorable outcomes on graft survival. The aim of this review is to provide previous and recent evidence on prevalence, accurate diagnosis, pathophysiology and treatment of hypertension in KTRs.

Diurnal blood pressure variation in adults after abdominal surgery–An observational cohort study

ObjectiveTo describe the prevalence of various circadian blood pressure patterns in adults recovering from abdominal surgery, and to evaluate the association between loss of normal circadian variation in blood pressure and hypotension during the initial 2 postoperative days. DesignA post-hoc analysis of data obtained from two randomized trials. SettingOperating rooms of the Cleveland Clinic. PatientsAdults having abdominal surgery from 2015 to 2019 with at least one overnight stay. Participants were continuously monitored by wearable vital signs monitors starting in the post-anesthesia care unit and for the first 48 postoperative hours. InterventionsNone. The exposure of interest was the degree of nocturnal decrease in blood pressure - normal nocturnal decrease in blood pressure (“normal dipping”, more than 10% decrease compared to day-time), no nocturnal decrease (“non-dipping”, less than 10% nocturnal decrease), or nocturnal increase in blood pressure (“rising”). MeasurementsPostoperative hypotension, defined by the time weighted average (TWA) area under a mean arterial pressure (MAP) threshold of 70 mmHg. ResultsIn total, 590 patients were eligible for analysis (mean(SD) age 50(15) years, 56% females, median [IQR] surgery duration 4.0 [2.7, 5.8] hours). Median TWA area under a MAP threshold of 70 mmHg was 0.96 (95%CI 0.59, 1.33) mmHg*minute per monitoring hour lower in patients with either no nocturnal blood pressure decrease (N = 317, 54%), or an increase in nocturnal blood pressure (N = 211, 36%), than in the reference group of patients with normal nocturnal decrease (N = 62, 11%), P < 0.001 for both. ConclusionsAbnormal diurnal blood pressure patterns are common in adults during the initial 2 days after abdominal surgery. Lack of normal night-time decrease in blood pressure is associated with less postoperative hypotension. Future studies should evaluate whether abnormal postoperative diurnal blood pressure patterns are associated with worse outcomes.

Abstract 066: Association Between Nocturnal Blood Pressure Dipping Magnitude And Chronic Kidney Disease Risk Among Patients With Controlled Office Blood Pressure

Although abnormal diurnal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their risks are yet unquantified by BP dipping magnitude. We assessed chronic kidney disease risk across nocturnal BP dipping spectrum among patients with controlled hypertension without prior advanced kidney disease. Ambulatory BP measurements were collected from 995 middle-aged patients with controlled office BP (&lt;140/90 mmHg). The magnitude of dipping was defined as the difference between daytime and nighttime systolic BP divided by daytime systolic BP. Accordingly, patients were categorized as extreme-dipper (≥20%) dipper (10-&lt;20%), non-dipper (0-&lt;10%), or reverse-dipper (&lt;0%). We cross-sectionally analyzed continuous and categorical associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (&lt;60 ml/min/1.73m 2 ), adjusting for office/ambulatory BP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior. The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% (134 of 995) extreme-dippers, 43.1% (429 of 995) dippers, 34.7% (345 of 995) non-dippers, and 8.7% (87 of 995) reverse-dippers. In reference to dippers, odds ratios (95% confidence interval) for albuminuria were 1.73 (1.04-2.60) in reverse-dippers, 1.67 (1.20-2.32) in non-dippers, and 0.62 (0.38-1.04) in extreme-dippers; this reflects significantly lower risk (0.77, 0.55-0.95) per 10% dipping. Likewise, persons presenting reduced and reverse-directional dipping were at higher risk for decreased estimated glomerular filtration rate: reverse-dippers 2.02 (1.06-3.84); non-dippers 1.98 (1.07-3.08); extreme-dippers 0.69 (0.20-1.17), with lower risk (0.74, 0.22-1.02) per every 10%. In short, monitoring nocturnal BP patterns may identify chronic kidney disease risk otherwise overlooked based on office BP.

Team Science: American Heart Association's Hypertension Strategically Focused Research Network Experience.

In 2015, the American Heart Association awarded 4-year funding for a Strategically Focused Research Network focused on hypertension composed of 4 Centers: Cincinnati Children's Hospital, Medical College of Wisconsin, University of Alabama at Birmingham, and University of Iowa. Each center proposed 3 integrated (basic, clinical, and population science) projects around a single area of focus relevant to hypertension. Along with scientific progress, the American Heart Association put a significant emphasis on training of next-generation hypertension researchers by sponsoring 3 postdoctoral fellows per center over 4 years. With the center projects being spread across the continuum of basic, clinical, and population sciences, postdoctoral fellows were expected to garner experience in various types of research methodologies. The American Heart Association also provided a number of leadership development opportunities for fellows and investigators in these centers. In addition, collaboration was highly encouraged among the centers (both within and outside the network) with the American Heart Association providing multiple opportunities for meeting and expanding associations. The area of focus for the Cincinnati Children's Hospital Center was hypertension and target organ damage in children utilizing ambulatory blood pressure measurements. The Medical College of Wisconsin Center focused on epigenetic modifications and their role in pathogenesis of hypertension using human and animal studies. The University of Alabama at Birmingham Center's areas of research were diurnal blood pressure patterns and clock genes. The University of Iowa Center evaluated copeptin as a possible early biomarker for preeclampsia and vascular endothelial function during pregnancy. In this review, challenges faced and successes achieved by the investigators of each of the centers are presented.

Chronobiology of Natriuretic Peptides and Blood Pressure in Lean and Obese Individuals

BackgroundDiurnal variation of natriuretic peptide (NP) levels and its relationship with 24-h blood pressure (BP) rhythm has not been established. Obese individuals have a relative NP deficiency and disturbed BP rhythmicity. ObjectivesThis clinical trial evaluated the diurnal rhythmicity of NPs (B-type natriuretic peptide [BNP], mid-regional pro-atrial natriuretic peptide [MR-proANP], N-terminal pro–B-type natriuretic peptide [NT-proBNP]) and the relationship of NP rhythm with 24-h BP rhythm in healthy lean and obese individuals. MethodsOn the background of a standardized diet, healthy, normotensive, lean (body mass index 18.5 to 25 kg/m2) and obese (body mass index 30 to 45 kg/m2) individuals, age 18 to 40 years, underwent 24-h inpatient protocol involving ambulatory BP monitoring starting 24 h prior to the visit, controlled light intensity, and repeated blood draws for assessment of analytes. Cosinor analysis of normalized NP levels (normalized to 24-h mean value) was conducted to assess the diurnal NP rhythm and its relationship with systolic BP. ResultsAmong 52 participants screened, 40 participants (18 lean, 22 obese; 50% women; 65% Black) completed the study. The median range spread (percentage difference between the minimum and maximum values) over 24 h for MR-proANP, BNP, and NT-proBNP levels was 72.0% (interquartile range [IQR]: 50.9% to 119.6%), 75.5% (IQR: 50.7% to 106.8%), and 135.0% (IQR: 66.3% to 270.4%), respectively. A cosine wave-shaped 24-h oscillation of normalized NP levels (BNP, MR-proANP, and NT-proBNP) was noted both in lean and obese individuals (prhythmicity <0.05 for all). A larger phase difference between MR-proANP BP rhythm (−4.9 h vs. −0.7 h) and BNP BP rhythm (−3.3 h vs. −0.9 h) was seen in obese compared with lean individuals. ConclusionsThis human physiological trial elucidates evidence of diurnal NP rhythmicity and the presence of an NP-BP rhythm axis. There exists a misalignment of the NP-BP diurnal rhythm in the obese, which may contribute to the disturbed diurnal BP pattern observed among obese individuals. (The Diurnal Rhythm in Natriuretic Peptide Levels; NCT03834168)

24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda.

Hypertension is diagnosed and treated based on blood pressure (BP) readings obtained in the clinic setting. Positive HIV status is associated with a higher prevalence of abnormal diurnal blood pressure patterns, diagnosed with ambulatory BP monitoring rather than the conventional method of BP measurement. Little is known about ambulatory BP profiles in people living with HIV (PLHIV) in low-income countries, especially within sub-Saharan Africa. In this study, we compared 24-hour ambulatory blood pressure profiles of 140 HIV-positive individuals vs. profiles in 166 HIV negative individuals living in rural Uganda. HIV was well-controlled, with all HIV seropositive participants reporting use of anti-retroviral therapy, and approximately 123 (88%) having undetectable viral load. Most participants reported ART use duration of less than 10 years. Compared to HIV negative participants, HIV positive participants had lower median 24-hour systolic blood pressure (110.4 mmHg (IQR: 105.7, 118.7) vs 117.7 mmHg (IQR: 110.8, 129.8), p<0.001), and 24-hour diastolic blood pressure (69.2 mmHg (IQR: 65.0, 74.9) vs. 71.9 mmHg (IQR: 67.2, 78.1), p=0.004). Adjusted results showed greater percentage systolic nocturnal dipping among PLHIV compared to HIV negative individuals (difference=2.70 (IQR: 0.94, 4.47), p <0.05). Results of the adjusted Poisson regression suggested lower prevalence of 24-hour and night hypertension among HIV positives compared to HIV negative, but were not statistically significant. Our data suggest that continuous 24-hour blood pressure measurements are lower in PLHIV on ART compared to HIV negative individuals.

Sleep Rate Mode of Pacemaker-Dependent Patients with Sick Sinus Syndrome Increases Dipper Blood Pressure and Dipper Heart Rate Patterns

Cardiovascular event rates of patients with a dipper blood pressure (BP) and dipper heart rate (HR) pattern are lower than those of patients with nondipper BP and HR patterns. However, how the pacemaker mode affects the diurnal BP and HR patterns remains unclear.We enrolled nine patients (average age 74.4 ± 6.6 years, 4 males and 5 females) with sick sinus syndrome who required atrial pacing. We investigated sequential 6-month pacing regimens (DDD mode at 60 bpm and sleep rate mode). We set the lower rate of sleep rate mode as follows: 60 bpm during the daytime and 50 bpm during the nighttime. The order of pacing mode was randomized, with crossover design. Ambulatory BP monitoring was performed at baseline, 6 months, and 12 months, BP category was classified into four groups (extreme dipper, dipper, nondipper, and riser pattern), and HR was classified into dipper and nondipper patterns.Nighttime HR during the sleep rate mode was significantly lower than that at DDD (57.1 ± 6.2 versus 63.5 ± 3.8 bpm, P = 0.001). The dipper HR pattern was increased in the sleep rate mode compared with those at baseline or DDD mode (versus baseline: 89% versus 44%, P = 0.035; versus DDD: 89% versus 22%, P = 0.004). The dipper BP pattern significantly increased in the sleep rate mode compared with the baseline (56% versus 11%, P = 0.035), but the difference between the sleep rate mode and DDD mode was statistically marginal (56% versus 22%, P = 0.081).The pacemaker settings in the sleep rate mode increased the dipper HR and BP patterns in pacemaker-dependent patients with sick sinus syndrome.

Diurnal blood pressure pattern and cardiac damage in hypertensive patients with primary aldosteronism.

The aim of our study was to evaluate the relationship between the 24-h blood pressure (BP) profile, plasma NT-proBNP levels and left ventricular hypertrophy (LVH) in subjects with primary aldosteronism (PA) compared to patients with essential hypertension (EH). A total of 385 consecutive patients with PA [187 with aldosterone producing adenoma (APA) and 198 with idiopathic hyperaldosteronism (IHA)] and 385 patients with EH were matched based on age, sex, body mass index (BMI), BP values and duration of hypertension. Twenty-four-hour ambulatory BP monitoring (ABPM), plasma levels of NT-proBNP, left ventricular mass index (LVMI), and other clinical medical data were assessed in all patients. No differences in age, sex, BMI, clinical BP, 24-h mean BP, daytime BP, or duration of hypertension were found between groups. Nighttime systolic BP (130 ± 16 vs. 127 ± 17 mmHg, p < 0.05) and diastolic BP (82 ± 10 vs. 79 ± 11 mmHg, p < 0.01) were higher in PA patients than in EH patients. In addition, nocturnal BP decline was reduced, while median NT-proBNP (53.7 vs. 33.2 pg/ml, P < 0.001) and LVMI (113 ± 25 vs. 102 ± 26 g/m2, P < 0.001) were higher in PA patients than in EH patients. Moreover, the median NT-proBNP level was higher in APA patients than in IHA patients (68.0 vs. 42.4 pg/ml, P < 0.001). In stepwise multivariate regression analysis, LVMI was correlated with NT-proBNP, nighttime systolic BP and sex in PA patients. Patients with PA show higher nighttime BP and NT-proBNP levels and lower nocturnal BP decline than those with EH. In addition, higher nocturnal systolic BP has been shown to be strongly associated with cardiac damage in PA patients.

Ambulatory blood pressure profile and stroke recurrence

ObjectivesTo establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients.MethodsThe prospective...

Evaluation of posttraumatic stress disorder diagnosis and therapy on diurnal blood pressure patterns from 24-hour ambulatory blood pressure monitoring.

IntroductionThe veteran population has a high incidence of posttraumatic stress disorder (PTSD), which is associated with increased risk of hypertension and cardiovascular death. Ambulatory blood pressure monitoring (ABPM) can identify abnormal diurnal blood pressure (BP) patterns, which are associated with increased risk of cardiovascular events. The intent of this evaluation was to examine prior ABPM studies to determine whether veterans with PTSD are more likely to have abnormal nocturnal dipping patterns compared with the general veteran population.MethodsRetrospective chart review was performed on all archived ABPM studies and classified by nocturnal dipping status and BP control rates. Pertinent patient demographics of age, sex, concomitant PTSD, and use of selected PTSD therapies were identified at the time of ABPM study. Association between dipping status, BP control rates, and patient demographics were analyzed using appropriate statistical tests.ResultsA total of 470 ABPM studies were determined to be valid and included. There were no differences in the distribution of nocturnal dipping patterns in veterans with or without PTSD. Likewise, rates of nocturnal, awake, and 24-hour hypertension were similar between groups. In patients with PTSD who were treated with evening PTSD therapy, there was a higher rate of normal dipping status compared with those without treatment (66.7% vs 29.7%, P = .03).DiscussionVeterans with PTSD had similar distributions of dipping patterns and rates of overall, awake, and nocturnal hypertension compared with the general veteran population. The association of nocturnal PTSD therapy prescription in patients with PTSD and higher rates of normal dipping status may warrant further investigation.

Abstract WP446: Increased Nighttime Blood Pressure and Small Vessel Diseases Are Strongly Associated With Cognitive Impairment Increased Nighttime Blood Pressure and Small Vessel Diseases Are Strongly Associated With Cognitive Impairment Ischemic Stroke Patients

Purpose: To explore the relationship between diurnal blood pressure (BP) pattern and small vessel diseases, and cognitive impairment in stroke patients. Methods: Twenty-four hour blood pressure monitoring for every 30 minutes was performed for 415 patients with ischemic stroke in chronic stage. Patients with modified Rankin Scale &gt;2 were excluded. Patients whose Mini Mental State Examination &lt;24 points were diagnosed as having cognitive impairment (CI). Silent lacunae and white matter lesions (WML) on MRI were identified and multiple lacunae and/or confluent WML were estimated as extensive small vessel disease (eSVD). When the nocturnal BP decline, calculated as (daytime BP -nighttime BP) / daytime BP, was more than 1.0, patients were classified as dipper, when 0-1.0 as non-dipper and when less than 0 as riser. Patients were classified into 7 groups. A: single lacuna without CI (n=110), B: multiple lacunae without CI (n=103), C: lacunar infarct with CI (n=70), D: atherothrombotic infarction (ATB) (n=71), E: ATB with CI (n=13), F: cardio embolic infarction (CE) (n=41), G: CE with CI (n=7). Results: Average 24-hour BP values (mmHg) and nocturnal BP decline were calculated. Nocturnal BP decline in the Groups with C, E and G showed significantly lower than group A. The prevalence of riser (%) in the Groups with C, E and G showed significantly higher than group A. The prevalence of eSVD in the Groups with E showed significantly higher than group D (p=0.0011) and groups G showed significantly higher than group F (p= 0.0026). Logistic regression analysis in all patients showed that more than 75 years old (versus less than 65 years old) (OR: 4.0, p=0.0006), eSVD (OR: 23.5, p&lt;0.0001), and non-dipper and riser (versus dipper) (OR: 5.5, p=0.0003 and OR: 16.5, p&lt;0.0001, respectively) were independently associated with CI after adjustment 24-hour averaged systolic blood pressure. Conclusions: Extensive small vessel disease and increased night time blood pressure, especially riser, were strong predictors for cognitive impairment in ischemic stroke patient. In patients with ATB and CE, eSVD was the determinant for cognitive impairment. Nighttime blood pressure, not just daytime blood pressure, should be focused on to prevent post-stroke cognitive impairment.

Exercise-induced albuminuria vs circadian variations in blood pressure in type 1 diabetes.

AIMTo investigated the relationship between exercise-induced ambulatory blood pressure measurement (ABPM) abnormalities in type 1 diabetes mellitus (T1DM) adolescents.METHODSWe conducted a case-control at the National Obesity Center of the Yaoundé Central Hospital, Cameroon. We compared 24 h ABPM and urinary albumin-to-creatinine ratio (ACR) at rest and after a standardized treadmill exercise between 20 Cameroonian T1DM patients and 20 matched controls. T1DM adolescents were aged 12-18 years, with diabetes for at least one year, without proteinuria, with normal office blood pressure (BP) and renal function according to the general reference population. Non-diabetic controls were adolescents of general population matched for sex, age and BMI.RESULTSMean duration of diabetes was 4.2 ± 2.8 years. The mean 24 h systolic blood pressure (SBP) and diastolic blood pressure (DBP) were respectively 116 ± 9 mmHg in the diabetic group vs 111 ± 8 mmHg in the non-diabetic (P = 0.06), and 69 ± 7 mm Hg vs 66 ± 5 mm Hg (P = 0.19). There was no difference in the diurnal pattern of BP in diabetes patients and non-diabetic controls (SBP: 118 ± 10 mmHg vs 114 ± 10 mmHg, P = 0.11; DBP: 71 ± 7 mmHg vs 68 ± 6 mmHg, P = 0.22). Nighttime BP was higher in the diabetic group with respect to SBP (112 ± 11 mmHg vs 106 ± 7 mmHg, P = 0.06) and to the mean arterial pressure (MAP) (89 ± 9 mmHg vs 81 ± 6 mmHg, P = 0.06). ACR at rest was similar in both groups (5.5 mg/g vs 5.5 mg/g, P = 0.74), but significantly higher in diabetes patients after exercise (10.5 mg/g vs 5.5 mg/g, P = 0.03). SBP was higher in patients having exercise-induced albuminuria (116 ± 10 mmHg vs 108 ± 10 mmHg, P = 0.09).CONCLUSIONExercise-induced albuminuria could be useful for early diagnosis of kidney damage in adolescents with T1DM.

PS 05-02 PREVALENCE OF ARTERIAL HYPERTENSION, DIURNAL PATTERN OF BLOOD PRESSURE IN BRANCH RETINAL VEIN OCCLUSION PATIENTS

Objective: To identify in patients with branch retinal vein occlusion using ambulatory blood pressure monitoring and clinical blood pressure measures: hypertension prevalence, and diurnal pattern of blood pressure. Design and Method: Retrospectively, 47 patients with branch retinal vein occlusion were submitted to clinical evaluation and ambulatory blood pressure monitoring. Non-dipper was defined as a fall in systolic blood pressure ≤ 10%, and dipper when this value was higher. Results: Fifteen (31.9 %) patients were diagnosed as hypertensive after office blood pressure measurement. Ambulatory blood pressure monitoring identified 13 hypertensives, 15 normotensives, 2 white-coat hypertensive and 17 masked hypertensive subjects. Among 13 hypertensive and 17 masked hypertensive subjects, 7 (23.3 %) were dippers and 23 (76.6 %) were non-dippers. Conclusions: Prevalence of masked hypertension in patients with branch retinal vein occlusion was high (64%) and more than two-thirds of hypertensive patients were non-dippers. These evidences suggest that ambulatory blood pressure monitor may be essential examination for patient with branch retinal vein occlusion.

PP.28.12] 24-HOUR PATTERNS OF CENTRAL AORTIC AND BRACHIAL SYSTOLIC BLOOD PRESSURE IN THE VERY ELDERLY

Objective: The aim of current study was to investigate and compare 24-hour profiles of central and peripheral blood pressures in the very elderly via their simultaneous ambulatory monitoring. Design and method: Parallel 24-h ambulatory aortic and brachial blood pressure monitoring was performed in 67 treated hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5% male, mean clinic brachial SBP 134,8 ± 23,2 mmHg) with an oscillometric cuff-based device BPLab Vasotens («Petr Telegin», Russia). Patients with ejection fraction < 40%, atrial fibrillation and severe comorbidities were not included. 24-h, awake and sleep-time systolic, diastolic and pulse blood pressure in aorta and brachial artery were compared in subgroups divided according to the diurnal pattern of brachial systolic blood pressure (SBP). Results: The diurnal profiles of central systolic and pulse BPs run in parallel with those of peripheral BPs in patients with all types of diurnal pattern and SBP amplification at night did not change significantly comparing to day-time values. Non-dipping or reverse-dipping SBP patterns appeared to be typical and were observed in 82,1% patients, while 50,7% participants had inadequate DBP dip < 10%. The proportionality of night-time SBP and DBP changes varied in different types of SBP diurnal profile. SBP and DBP decreased proportionally in dippers (ratio of DBP/SBP night-time reduction was 1,18) and disproportionately in non-dippers (the ratio was 2,6). In those patients with reverse-dipping pattern SBP and DBP changed in opposite directions at night. This disproportion in SBP and DBP night-time changes resulted in different intensity of PP night-time rise that was most evident in reverse-dippers. Relative nocturnal reduction of PP was 9,3 ± 4,72% in dippers, whereas non-dippers and reverse-dippers had relative PP increase of 6,2 ± 8,6 and 22,9 ± 12,3 %, respectively. Conclusions: The diurnal patterns of central and brachial BPs observed in very elderly treated hypertensives were almost parallel. PP amplification is similar in the day- and nighttime and this finding is different from previously described diurnal PP amplification behavior in younger subjects. Proportionality of SBP and DBP sleep-time changes depends on dipping status and results in nocturnal PP increase in non- and reverse-dippers.

Abstract P106: Effects of Aldosterone Excess and Sodium on Dipping Patterns in Resistant Hypertensive Patients

Background: High dietary sodium intake and aldosterone excess have been independently linked to increased cardiovascular morbidity and mortality. In addition, a large body of literature indicates that aldosterone excess contributes importantly to antihypertensive treatment resistance and is associated with higher 24- hour ambulatory blood pressure (BP) levels. Objective: This study was designed to determine if high dietary sodium intake, and hyperaldosteronism combine to mediate the development of abnormal diurnal BP patterns including nocturnal hypertension and dipping BP patterns. Methods: A single-center cohort of 326 African American (AA) and Caucasian resistant hypertensive patients were prospectively evaluated by assessing 24-hr urinary aldosterone (UAldo), plasma renin activity (PRA), sodium (UNa + ) levels, and 24-hr ambulatory blood pressure monitoring (ABPM). Daytime, night-time, and 24-hr BP and dipping patterns were determined. High sodium excretion was defined as UNa + = 200 mEq/24hr and hyperaldosteronism was defined as UAldo = 12 μg/24hr and PRA ≤ 1 ng/ml/hr. Results: There was no difference in ABPM and dipping patterns when comparing the normal versus high sodium group. However, patients without high sodium excretion had better nocturnal (p=0.024) and 24- hour BP control (p=0.036). Furthermore, there was no difference in ABPM patterns when comparing patients with high versus normal sodium excretion with hyper versus non- hyperaldosteronism. Interestingly, in the group with hyperaldosteronism, patients with normal sodium excretion had improved dipping patterns, but only in the dipper group (p=0.016). Conclusions: High dietary sodium intake contributes to increased nocturnal hypertension and poor 24-h BP control, but there does not seem to be a significant relationship between hyperaldosteronism and high dietary sodium intake. This data suggests that improvements in dietary sodium intake will lead to better control of nighttime BP and 24-h BP control and therefore reduces the risk of cardiovascular disease. Further studies are underway comparing these relationships in males versus females, and AAs versus Caucasians.

High blood pressure and syncope: orthostatic hypotension as a link.

The prevalence of hypertension increases with the age. Diagnostic criteria are the same as for the young, but in older adults isolated systolic hypertension is more frequent, due to loss of vascular compliance. Blood pressure should be measured on both sides in the seated position, moreover in the supine and upright position to detect orthostatic hypotension. Ambulatory blood pressure monitoring is useful to detect white coat hypertension and masked hypertension, to tailor the treatment and search for diurnal and nocturnal blood pressure pattern abnormalities. Given that frailty can affect the relationship between blood pressure and mortality, the clinician should properly evaluate and monitor physical performance and cognitive status, throughout specific tools, as the Fried Frailty Phenotype, aiming at a systolic blood pressure target between 130 and 150 mmHg. Before starting hypotensive drugs, a careful risk and benefits' evaluation should be performed given the high risk of hypertension and hypotension consequences and the frequent coexistence of orthostatic hypotension, which predisposes to syncope and falls.

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.