Diurnal Systolic Blood Pressure Research Articles

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

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

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

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

Diurnal changes in blood pressure and heart rate in children with narcolepsy with cataplexy.

The hypocretin neurons in the lateral hypothalamus are connected not only to brain alertness systems but also to brainstem nuclei that regulate blood pressure and heart rate. The premise is that regulation of blood pressure and heart rate is altered and affected by methylphenidate, a stimulant drug in children with narcolepsy with cataplexy. The changes in 24-hr ambulatory systolic and diastolic blood pressure and heart rate were compared among pre-treated narcolepsy with cataplexy patients (40 males, 10 females), with mean age 10.4 ± 3.5 years (M ± SD, range 5-17 years) with values from 100 archival age-sex-body mass index matched controls. Patients had a lower diurnal systolic blood pressure (-6.5 mmHg; p=0.000) but higher heart rate (+11.0bpm; p=0.000), particularly evident in the waketime, while diastolic blood pressure was comparable. With methylphenidate (18 mg sustained release at 08:00 hours), patients with narcolepsy with cataplexy had higher systolic blood pressure (+4.6 mmHg, p=0.015), diastolic blood pressure (+3.3 mmHg, p=0.005) and heart rate (+7.1bpm, p=0.028) during wake time, but nighttime cardiovascular values were unchanged from pre-treated values; amplitude variation in cardiovascular values was unchanged over 24 hr. In conclusion, children with narcolepsy with cataplexy had downregulation blood pressure profile but a higher heart rate, and lesser non-dipping profiles. Daytime methylphenidate treatment increases only waketime blood pressure and further elevated heart rate values.

Spectrum of Cardiovascular Autonomic Dysfunction and 24-hour Blood Pressure Variability in Idiopathic Parkinson's Disease.

Uncertainty prevails regarding the patterns of autonomic dysfunction in patients with idiopathic Parkinson's disease (IPD). This study was undertaken with the aim of assessing the complete spectrum of cardiovascular autonomic function tests (CAFTs) and blood pressure variability patterns in IPD patients while comparing the same with age-matched controls. Patients with IPD presenting to the Christian Medical College and Hospital from December 2016 to November 2018 along with age-matched controls were prospectively evaluated using CAFTs. The IPD patients also underwent ambulatory blood pressure (BP) monitoring (ABPM), and the diurnal systolic BP differences were used to classify into dippers (10-20%), non-dippers (0-10%), reverse dippers (<0%), and extreme dippers (>20%). Autonomic dysfunction (AD) was prevalent in 41 (68.3%) IPD patients even in early disease (median (inter-quartile range) symptom duration 2 (1-4) years, mean Hoehn and Yahr (H&Y) stage 2 (1.5-2.8). Both sympathetic and parasympathetic parameters were impaired among IPD patients when compared to healthy controls. (E: I ratio 1.17 ± 0.12 vs 1.26 ± 0.14 (P < 0.001), Valsalva ratio (VR) 1.33 ± 0.27 vs 1.55 ± 0.25 (P < 0.001), PRT100 9.6 ± 8.0 vs 3.1 ± 1.8 (P < 0.001), tilt-up SBPAvg change 8.8 (4.2-13.8) vs 1.8 (-2.9-6.1) (P < 0.001), tilt-up HRAvg change 4.8 (2.2-8.2) vs 1.9 (-0.7-5.1) (P < 0.001). BP variability was demonstrated in 47 (79.7%) of IPD patients, with reverse dipping pattern in 28 (47.5%) seen more frequently in this cohort. Timely detection of AD may be helpful not only in recognizing IPD in its pre-motor stages but also in optimizing management for this population of patients. BP variability and abnormal dipping patterns on ABPM can be a potential marker of dysautonomia.

Screening indexes for cardiovascular autonomic failure in Parkinson's disease

Autonomic failure (AF) is a common source of orthostatic hypotension (OH) in Parkinson's disease (PD). The diagnosis of AF is difficult on clinical grounds alone. We used autonomic testing and 24-h BP monitoring (ABPM) in 122 PD patients to evaluate the diagnostic accuracy of AF by (1) the reduced heart rate increase to fall in blood pressure (BP) ratio (ΔHR/ΔSBP), (2) reverse dipping (RD), and (3) increased diurnal systolic BP standard deviation (SD-SBP). Among patients with OH, ΔHR/ΔSBP yielded the best accuracy (85%), with excellent sensitivity (92%) and acceptable specificity (67%). RD and, to a lesser extent, SD-SBP had high specificity (93% and 73%, respectively) but low sensitivity, resulting in overall moderate accuracy (66% and 55%, respectively). In patients with OH, the addition of ABPM indexes to ΔHR/ΔSBP did not result in a significant improvement of accuracy. In patients without OH, RD and SD-SBP may be useful showing an accuracy of 72% and 81%, respectively, with high negative predictive value when both RD and increased SD-SBP are absent. The integration of bedside (∆HR/∆SBP) and ABPM-derived indexes can assist the clinician in screening PD patients for AF and guide referral to autonomic testing.

Nocturnal Blood Pressure Is Associated With Cerebral Small-Vessel Disease in Type 1 Diabetes

Although vascular complications are a hallmark of diabetes, cerebral small-vessel disease (cSVD) in type 1 diabetes remains scarcely studied. We recently showed that cSVD is more common in individuals with type 1 diabetes than healthy control subjects and is associated with systolic office blood pressure (BP) (1). Hence, we aimed to further evaluate the impact of BP on cSVD in type 1 diabetes. This substudy of the Finnish Diabetic Nephropathy (FinnDiane) Study aims to assess early markers of cerebrovascular disease in people with type 1 diabetes and has previously been described in detail (1). Of the 191 neurologically asymptomatic study participants, 73 volunteered for a 24-h ambulatory BP monitoring (ABPM). All participants underwent a clinical study visit, and brain MRI assessed for markers of cSVD (white matter hyperintensities, lacunar infarcts, and cerebral microbleeds) (1,2). The 24-h ABPM was conducted in accordance with current standards (3). After ABPM-quality validation, we calculated average BP, mean arterial pressure (two-thirds of diastolic + one-third of systolic BP), pulse pressure (PP) (systolic − diastolic BP), BP variability (average real variability), and nocturnal dipping ([1 − nocturnal systolic / diurnal systolic BP] × 100%). Elevated BP and masked hypertension were defined as described by the European Society of Hypertension (3). We observed cSVD in 20 (27.4%) participants, of whom 14 had cerebral microbleeds, 9 white matter hyperintensities, and 2 lacunes. Table 1 includes clinical characteristics as well as main results for BP measurements based on presence or absence …

Association of Framingham score with the parameters of ambulatory blood pressure monitoring

Cardiovascular complications are a major public health problem. The Framingham Risk Score (FS) is a scoring system that assesses the 10-year risk of cardiovascular event. The objective of our study was to evaluate the association of this score with the different parameters of the ambulatory blood pressure monitoring (ABPM). We carried out a retrospective study including patients having an ABPM between January 2015 and December 2016. The FS of each patient was calculated according to the AHA recommendations, including the following parameters: age, sex, smoking, office blood pressure, body mass index, treatment of hypertension and diabetes. The comparison between the groups was carried out by One-Way ANOVA test, and the correlation between FS and ABPM parameters by the Pearson coefficient. A total of 231 patients were included, sex-ratio M/F = 0.83. The results of ABPM showed uncontrolled hypertension (37.2%), controlled hypertension (30.3%), masked hypertension (18.6%) and absence of hypertension (13.9%). Patients with uncontrolled hypertension had the highest FS (35.5 ± 26, P < 0.001). Patients without hypertension had the lowest FS (9.4 ± 10, P < 0.001). The mean FS were 20 ± 19%, 27 ± 24%, 35 ± 30%, 38 ± 28% respectively in the dippers, non-dippers, hyper-dippers and risers ( P = 0.001). Patients with nocturnal hypertension had a higher FS than other patients (29 ± 25 vs. 23 ± 22, P = 0.06). The correlation study showed that FS was negatively correlated with glomerular filtration rate ( r = −0.35, P < 0.001). FS was positively correlated with mean global systolic blood pressure ( r = 0.16, P = 0.017), mean diurnal systolic blood pressure ( r = 0.14, P = 0.4), and mean nocturnal systolic blood pressure ( r = 0.2, P = 0.002). The Framingham score is higher in patients with riser profile and nocturnal hypertension. The ABPM parameters correlated to the Framingham score are 24-hour systolic BP, diurnal systolic BP, and nocturnal systolic BP. Adequate management of other risk factors could balance the blood pressure profile, reduce cardiovascular risk and thus ensure a better quality of life for these patients.

Вплив блокаторів рецепторів ангіотензину II на зміни артеріального тиску при добовому моніторуванні залежно від ранкового або вечірнього прийому

The aim – to evaluate the effect of angiotensin II receptor blockers olmesartan, azilsartan and telmisartan when administered in the morning or evening hours on blood pressure (BP) indices during daily monitoring in patients with arterial hypertension (AH).Materials and methods. The study involved 126 patients with mild to moderate hypertension who were selected to compare the effect of angiotensin II receptor blockers – olmesartan, azilsartan and telmisartan – in the morning and evening hours. They were divided into 6 groups: 20 patients taking olmesartan at a dose of 20–40 mg in the morning, 20 patients taking olmesartan at a dose of 20–40 mg in the evening, 21 patients taking azilsartan at a dose of 40–80 mg in the morning, 20 patients taking azilsartan at a dose of 40–80 mg in the evening, 22 patients taking telmisartan at a dose of 40–80 mg in the morning, 23 patients taking telmisartan at a dose of 40–80 mg in the evening. Patients underwent primary examination and repeated one – after 3 months of therapy.Results and discussion. Evening reception of olmesartan, compared with morning one, led to a more pronounced decrease in diurnal systolic blood pressure (SBT) – (11.09±2.30) vs (4.06±2.25) mm Hg (p&lt;0.01). Changes in diurnal diastolic blood pressure (DBP) were statistically insignificant, although its decrease during evening reception was more significant compared to decrease during morning reception ((8.38±2.58) mm Hg versus (3.38±2.31) mm Hg). Changes in daily blood pressure against reception of azilsartan in the evening and morning hours were statistically significant, but did not differ from each other ((13.06±2.65)/(9.76±1.73) vs. (12.71±1.62)/(7.00±1.50) mm Hg). Reduction of diurnal blood pressure at the background of telmisartan administration was statistically significantly more pronounced in the morning than in the evening intake ((16.48±2.86)/(12.56±2.80) vs. (4.93±1.53)/(5.40±1.89) mm Hg, p&lt;0.01). Thus, morning reception more significantly lowered the average daily blood pressure against the background of taking telmisartan, and the evening reception – against the background of taking olmesartan. Azilsartan equally reduced the blood pressure both at evening and morning admission. The rate of achievement of target BP at daily monitoring against the background of the administration of olmesartan, azilsartan and telmisartan was 71.80; 71.0 and 75.61 %, respectively.Conclusions. Admission of telmisartan more significantly reduced the average daily blood pressure in morning hours compared to evening hours, olmesartan better lowered the average daily blood pressure when taken in the evening, and the use of azilsartan equally affected the decrease in blood pressure regardless of the time of taking the drug.

Short-Term Hemodynamic Effects of Modern Wheat Products Substitution in Diet with Ancient Wheat Products: A Cross-Over, Randomized Clinical Trial.

Recent evidence suggests that bioactive compounds isolated from cereals and legumes could exert some metabolic and vascular effects in humans. Due to the recent identification of a non-specific lipid transfer protein (nsLTP2) in wheat with antioxidant and anti-inflammatory activity, we aimed to comparatively test the hemodynamic and metabolic effects of ancient wheat foodstuffs (made of organic KAMUT® khorasan wheat) or modern wheat ones, made of a mixture of organic modern commercial durum (T. durum) varieties and soft wheat (T. aestivum), with different nsLTP2 content. Thus, we carried out a randomized, cross-over clinical trial on 63 non-diabetic healthy volunteers (aged 40–70 years) with systolic blood pressure (SBP) 130–139 mmHg and/or diastolic blood pressure (DBP) 85–90 mmHg (pre-hypertensive/borderline high pressure subjects). Each treatment period lasted four weeks. After ancient wheat foodstuffs intake, subjects experienced a significant improvement in triglycerides (−9.8% vs. baseline and −14.5% versus modern wheat), fasting plasma glucose (−4.3% versus baseline and −31.6% versus modern wheat), diurnal SBP (−3.1% vs. baseline and –30.2% vs. modern wheat) and nocturnal SBP (−3.2% vs. baseline and −36.8% vs. modern wheat), and pulse volume change (+4.2% vs. baseline and +2.3% vs. modern wheat) (p < 0.05 vs. baseline and versus modern wheat foodstuffs intake). Therefore, our findings show that substituting modern wheat products in diet with ancient wheat ones, might exert a mild improvement in 24-h SBP and endothelial reactivity in pre-hypertensive healthy subjects.

AN HIGHER WHITE-COAT EFFECT IN THE FIRST HOURS OF AMBULATORY BLOOD PRESSURE MONITORING IS ASSOCIATED WITH MORE BLOOD PRESSURE PEAKS DURING THE WHOLE DIURNAL PERIOD

Objective: White-coat effect (WCE) is a common finding also in ambulatory blood pressure monitoring (ABPM) and like in office blood pressure (BP) measurement can determine an over-diagnosis of arterial hypertension. In our previous work we found that WCE magnitude (WCEm) is correlated with an higher BP variability during the entire 24-hours ABPM period but the effective BP load remain to be established. Design and method: We analysed 421 ABPMs (M/F 146/275) characterized by the first systolic BP value at least 10 mmHg higher than mean diurnal systolic BP (mDSBP). WCEm was evaluated as the mean value of the first two hours of recording, both for systolic and diastolic BP (sysWCEm and diaWCEm, respectively). The diurnal BP load was estimated with BP peaks, i.e. the number of systolic and diastolic BP values respectively 10 and 5 mmHg higher than mDSBP and mean diurnal diastolic BP (mDDBP). We evaluated the correlations between WCEm, BP peaks and drug classes (angiotensin-converting enzyme/angiotensin receptor blockers, beta-blockers, calcium channel blockers, thiazide diuretics, alpha-blockers, central alpha-agonists and anti-aldosterone) with a multivariate regression analysis with a p-value < 0.01 considered as statistically significant. Results: Mean age was 65 ± 1 years (M/F 66 ± 1/64 ± 1 years, n.s.) and overall mDSBP and mDDBP were 137 ± 1 and 79 ± 0.5 mmHg, whereas sysWCEm and diaWCEm were respectively 150 ± 1 and 86 ± 1 mmHg, without gender differences. Systolic and diastolic peaks were respectively 12.5 ± 0.1 and 13.5 ± 0.1; only the first was directly correlated with age (r = 0.21; p < 0.01) whereas neither of the two was correlated with drug therapy. Both systolic and diastolic peaks were significantly correlated with sysWCEm (respectively r = 0.17 and r = 0.19; p < 0.01) but not with diaWCEm; they were also correlated with mDSBP and mDDBP (respectively r = 0.35 and r = 0.31; p < 0.01). Conclusions: In patients with an higher sysWCEm, systolic and diastolic BP peaks are increased confirming an influence of WCE on the entire diurnal period of ABPM, suggesting that in patients with WCE the alarm reaction persists well beyond the two initial hours of recording alarm.

Frailty, Disability, and Ambulatory Blood Pressure in Older Adults

Background and objectiveFrailty and disability are associated with cardiovascular risk factors, including hypertension, in older people; however, little is known about their association with ambulatory blood pressure (BP). Thus, we assessed the relationship of frailty and disability with ambulatory BP in older adults. Design, setting, and participantsCross-sectional study of 1047 community-living individuals aged ≥60 years in Spain. MeasurementsBP was determined with validated devices under standardized conditions during 24 hours. Frailty was defined as having 3 or more of the following criteria: weight loss, low grip strength, low energy, slow gait speed, and low physical activity. Disability was assessed with the Lawton-Brodýs questionnaire on instrumental activities of daily living. Associations with systolic BP (SBP) and dipping (nocturnal SBP decline) were modeled and adjusted for sociodemographic variables, body mass index, lifestyles, antihypertensive drug treatment, comorbidities, 24-hour heart rate, and conventional or ambulatory SBP as appropriate. ResultsParticipants' mean age was 71.7 years (50.8% men); 6% were frail and 8.1% had disability. Compared with nonfrail participants, those with frailty had 3.5 mm Hg lower daytime SBP (P = .001), 3.3% less SBP dipping (P = .003), and 3.6 mmHg higher nighttime SBP (P = .016). Compared with participants who are not disabled, those who are disabled had 2.5 mmHg lower daytime SBP (P = .002), 2.5% less SBP dipping (P = .003), and 2.7 mmHg higher nighttime SBP (P = .011). ConclusionsIn community-dwelling older adults, frailty and disability were independently associated with lower diurnal SBP, blunted nocturnal decline of SBP, and higher nocturnal SBP. These findings may help explain the higher mortality associated with low clinic SBP in frail older subjects observed in epidemiologic studies.

Factors associated with high probability of target blood pressure non-achievement in hypertensive patients

One of the topic issue of modern cardiology is factors of target blood pressure level non-achievement clarifying due to a better understanding how we can reduce cardiovascular complications. The aim of the study is to determine the factors of poor blood pressure control using the ambulatory blood pressure monitoring parameters and adenosine 5'-diphosphate-induced platelet aggregation parameters in patients with arterial hypertension. Material and methods. The study involved 153 patients with essential hypertension (EH) stage II, II degree. The ambulatory blood pressure monitoring (ABPM) was performed in patients during at least two of first-line antihypertensive drugs in optimal daily doses usage by the ABPM bifunctional device (Incart, S.-P., R.F.). Platelet aggregation was carried out using light transmittance aggregation by optical analyzer (Solar, R.B.) with adenosine 5'-diphosphate (Sigma-Aldrich) at final concentration of 10.0 × 10 -6 mol / L. The first group were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABPM results, and the second one were patients with adequately controlled EH. Groups of patients were comparable in age (60.39 ± 10.74 years vs. 62.80 ± 9.63; p = 0.181, respectively). In the group of EH patients who reached the target level of blood pressure, women predominated (60% vs. 39.81%; p = 0.021, respectively). We used the binary logistic regression analysis to determine the predictors of target blood pressure level poor reaching using ABPM and platelet aggregation parameters. Results According to the univariate logistic regression analysis, the dependent factors influencing the target blood pressure level poor reaching are the average diurnal diastolic blood pressure (DBP) (OR = 44.8); diurnal variability of systolic blood pressure (SBP) (OR = 4.4); square index of hypertension for diurnal periods SBP (OR = 318.9); square index of hypertension for diurnal periods DBP (HS = 36,6); the average pulse blood pressure (OR = 65.9), the rate of morning rise of SBP (OR = 3.6), and the maximum aggregation time of 5-minute ADP-induced platelet aggregation (OR = 3.5). Independent factors influencing the target blood pressure level pure reaching are the average diurnal DBP (OR = 47.8); variability of diurnal SBP (HS = 4.6); the maximum aggregation time of ADP-induced platelet aggregation (OR = 3.4). Female sex is associated with the best prognosis for the target level of BP reaching (OR = 0.4; 95% CI = 0.2‒0.8; p = 0.012). Conclusions . The independent factors influencing the target blood pressure level poor reaching in patients with EH are two ABPM parameters (the average diurnal diastolic blood pressure of more than 76 mm Hg and the variability of SBP diurnal more than 17 mm Hg); and one ADP-induced platelet aggregation parameter (the maximum aggregation time more than 143 seconds). The female sex is associated with better prediction of achieving the target level of blood pressure.

Serum lipid profile, sleep-disordered breathing and blood pressure in the elderly: a 10-year follow-up of the PROOF-SYNAPSE cohort

ObjectivesDyslipidemia, sleep-disordered breathing (SDB) and hypertension are comorbid factors evidenced in adults, but poorly studied in old people. This study aimed to examine the long-term evolution of the serum lipid profile, and its relationships with SDB and blood pressure (BP) in the elderly. MethodsA ten-year follow-up of the prospective Prognostic Indicator of Cardiovascular and Cerebrovascular Events (PROOF) and the Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea (SYNAPSE) cohort, which initially included 1011 elderly subjects from the general population, and who were untreated by continuous positive airway pressure (CPAP). Serum lipid profile, respiratory polygraphy for SDB and ambulatory blood pressure monitoring were performed. ResultsA total of 266 subjects (male/female 150/116; age 66.2 ± 0.8 years) were reassessed after 9.6 ± 0.7 years (age 75.8 ± 1.2 years). The prevalence of high-risk dyslipidemia decreased from 61.3 to 44.4%, and hypertension from 57.9 to 27.4%. The nocturnal oxygen desaturation index increased (mean + 2.3 ± 6.7 events/hour; p < 0.001), while the mean SaO2 and minimal SaO2 decreased. These variations (Δ) of oxygen desaturation worsened whether or not elderly subjects took anti-hypertensive and lipid-lowering treatments, and were not associated with serum lipid variations. The decrease in diurnal diastolic BP was independently associated with aging, and with the lowering of the waist/hip ratio (ΔW/H) and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, while the decrease in diurnal systolic BP only depended on aging and ΔW/H. ConclusionsThe results suggested that the observed worsening of nocturnal oxygen desaturation after 10 years in the elderly was independent of the change in circulating lipids, and not influenced by lipid-lowering treatments. However, the variation in blood pressure remained associated with aging, waist/hip and LDL-C/HDL-C ratios.Trial registry: NCT00759304 and NCT00766584 at clinicaltrials.gov.

[LB.03.08] RENAL FUNCTIONAL DISTURBANCIES IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENTION IN COMBINATION WITH RENAL ARTERY ABNORMALITIES

Objective: The aim of this study was to assess clinical renal disturbances in patients with resistant arterial hypertension (AH) in combination with renal artery abnormalities (RAA) in 4 years follow-up study. Design and method: 15 patients (6 males, 9 females) aged 44.1 ± 2.0 years with resistant AH (history of AH 16.5 ± 2.1 years) and RAA were examined; ambulatory blood pressure (BP) monitoring (ABPM) mean average of diurnal BP for systolic blood pressure (SBP) and diastolic blood pressure (DBP) as 160.9 ± 3.8 mmHg and 102.8 ± 2.7 mmHg, respectively; BMI 27.9 ± 1.4 kg/m2. The group was compared to the group of patients (n = 28, 11 males and 17 females) with normal renal arteries; aged 45.4 ± 1.8 years, history of AH 14.9 ± 1.3 years; diurnal SBP 158.2 ± 3.6 mmHg and DBP 95.8 ± 2.6 mmHg; BMI 29.3 ± 1.2. BP remained uncontrolled high despite the prescription of 4 antihypertensive drugs. The cases of pseudo-resistant AH had been excluded. Renal function features was evaluated by the dynamic nephroscyntigraphy in all the patients and the level of microalbuminuria was estimated (immunochemical analysis) initially and in 4 years follow-up. Results: Initially the patients with RAA had the level of urine microalbumin 39.38 ± 15.2 mg and in 4 years – 54.74 ± 20.7 mg, respectively (p > 0.05). And in the comparison group the level of microalbuminuria was stated at first point as 51.15 ± 24.9 mg and 4 years later - as 65.45 ± 24.4 mg (p > 0.05). Initially dynamic nephroscyntigraphy analysis presented maximum agent evacuating time (T max) as 6.15 ± 0.8 min and 4 years later – 3.7 ± 0.5 min (p < 0.05). In the comparison group this level was 6.45 ± 0.4 min and 5.7 ± 0.6 min, respectively (p > 0.05). Conclusions: As at first point and as 4 years later the level of microalbuminuria in patients with RAA had no significance differences with the comparison group. Maximum nephroscyntigraphy agent evacuating time (T max) significantly decreased in the main group in the 4 years follow-up period, and in patients with normal renal arteries there were no such changes. The findings may reveal severe growth rate of hypertensive nephrosclerosis of functioning renal parenchyma in patients with resistant AH and RAA.

[OP.1C.10] WHITE-COAT EFFECT IS ASSOCIATED WITH A MARKED INCREASE OF BLOOD PRESSURE VARIABILITY ON AMBULATORY BLOOD PRESSURE MONITORING

Objective: The increase of 24-hours blood pressure (BP) variability, assessed by ambulatory blood pressure monitoring (ABPM), is an independent risk factor for cardiovascular events. However white-coat effect (WCE) can influence at least the first part of ABPM leading to higher mean BP values and over-diagnosis of arterial hypertension. We aimed at examining to what extent WCE may affect BP variability. Design and method: We analysed 281 ABPM (M/F 101/180) in which the first systolic BP value was at least 10 mmHg higher than mean diurnal systolic blood pressure (mDSBP). WCE was evaluated during the first two hours of recording (WCE window, WCEw) as magnitude i.e. as mean SBP values (WCE magnitude, WCEm) and as duration (WCEd) i.e. the sum of the time intervals following a SBP value at least 10 mmHg higher than mDSBP. According to median values of WCEd we identified two subgroups: long-WCE (WCEd > 60 minutes) and short-WCE (WCEd =< 60 minutes) whereas for WCEm patients were subdivided in those with high-WCE (WCEm > 150 mmHg) and low-WCE (WCEm =< 150 mmHg). BP variability was assessed as mean diurnal systolic and diastolic BP standard deviation (SD). Results: Considering all ABPMs, SDs for mDSBP and for mean diurnal diastolic BP (mDDBP) were respectively 22.0 ± 0.3 and 17.8 ± 0.3 without differences between genders. After the exclusion of WCEw, these SDs fell respectively to 21.1 ± 0.3 (p < 0.05 for trend) and 17.1 ± 0.3. Considering WCEm, in the subgroup with high-WCE, SDs were higher for mDSBP and mDDBP than in the subgroup with low-WCE (respectively 23.6 ± 0.4 vs. 20.4 ± 0.4 and 19.0 ± 0.4 vs. 16.5 ± 0.4, p < 0.0001 for both), and these differences in SDs remained significant even when mDSBP and mDDBP were calculated with the exclusion of WCEw (table). In contrast no differences were observed in SDs in subgroups with long and short WCEd.Conclusions: WCE is associated with a very high systolic and diastolic BP variability on ABPM that is higher in patients with greater WCEm and persists beyond the two initial hours of recording used to classify patients as having WCE.

[PP.06.25] BETA-BLOCKERS ARE THE ONLY ANTIHYPERTENSIVE DRUGS THAT BLUNT THE DURATION OF WHITE-COAT EFFECT ESTIMATED WITH AMBULATORY BLOOD PRESSURE MONITORING

Objective: The presence of white-coat effect (WCE) on ambulatory blood pressure monitoring (ABPM) can increase mean blood pressure (BP) values determining an overestimation of the diagnosis of arterial hypertension. We previously found that WCE duration (WCEd) is longer in females than in males and significantly blunted by beta-blockers in males; however the influence of the other antihypertensive drugs was not established. Design and method: We analysed 281 ABPM (M/F 101/180) in which the first systolic value was at least 10 mmHg higher than mean diurnal systolic BP (mDSBP). WCE was evaluated during the first two hours of recording as the mean value of systolic BP (WCE magnitude, WCEm) and as WCEd i.e. the sum of the time intervals in minutes (min) following a systolic BP value of at least 10 mmHg higher than mDSBP. The relation between WCE and drug classes (angiotensin-converting enzyme/angiotensin receptor blockers, beta-blockers, calcium channel blockers, thiazide diuretics, alpha-blockers, central alpha-agonists and anti-aldosterone) was evaluated with a multivariate regression analysis with a p-value < 0.01 considered as statistically significant. Results: Mean age was 65 ± 1 years (M/F 66 ± 1/64 ± 1 years, n.s.) and overall mDSBP was 138 ± 1 mmHg, without differences between genders. Mean WCEm and WCEd were respectively 151 ± 1 mmHg (M/F 149 ± 2/152 ± 1, n.s.) and 63 ± 1.5 min (M/F 59 ± 2/66 ± 2, p < 0.02). The multivariate regression analysis showed that WCEd was correlated only with beta-blockers and male gender (table), whereas there were no relationship of WCEm with any drugs.Conclusions: WCEd is shorter in men than in women regardless of drug therapy and beta-blockers are the only antihypertensive drugs that seem to reduce WCEd estimated with ABPM, whereas they do not affect WCEm.

Nocturnal Blood Pressure Dipping is Abolished in Old-Elderly Hospitalized Patients.

During sleep there is reduction of blood pressure (BP) caused by a decrease of the sympathetic nervous tone. This nocturnal "dipping" phenomenon, assessable with ambulatory blood pressure monitoring (ABPM), is blunted with increasing age. To assess the effect of hospitalization on night-time BP fall in old-elderly patients. We analysed 78 ABPM of old-elderly hospitalized patients (mean age 91±0.5years) and those of 18 outpatients as control group. The nocturnal BP fall was assessed calculating: the dipping value (DV) i.e. the difference between mean diurnal systolic BP (mDSBP) and mean nocturnal systolic BP (mNSBP) and the "dipping pattern" i.e. mNSBP/mDSBPx100. Hospitalized patients showed a lower rate of normal dipping patterns (9 vs. 39%), an higher rate of reverse dippers (59 vs. 28%; p<0.05) and a lower DV (-0.9±1 vs. 9±4mmHg; p<0.05) than patients of control group. At multivariate regression analysis including age, gender and hospitalization, DV was significantly correlated only with the hospitalization (β -0.3, t -2.9; p<0.05). In old-elderly hospitalized patients nocturnal BP fall is abolished. This enhancement of the age related reduction of nocturnal BP dipping may be due to the stress associated with hospital environment.

Exercise-induced albuminuria and circadian blood pressure abnormalities in type 2 diabetes.

AIMTo investigate the relationship between circadian variations in blood pressure (BP) and albuminuria at rest, and during exercise in non-hypertensive type 2 diabetes (T2D) patients.METHODSWe conducted a cross-sectional study in well controlled T2D patients, non-hypertensive, without clinical proteinuria and normal creatinine clearance. In each participant, we recorded the BP using ambulatory blood pressure monitoring (ABPM) for 24-h, and albuminuria at rest and after a standardized treadmill exercise.RESULTSWe enrolled 27 type 2 patients with a median age of 52; and a mean duration of diabetes and HbA1c of 3.6 ± 0.8 years and 6.3% ± 0.5% respectively. Using a 24-h ABPM, we recorded a mean diurnal systolic blood pressure (SBP) of 128 ± 17 mmHg vs nocturnal of 123 ± 19 mmHg (P = 0.004), and mean diurnal diastolic blood pressure (DBP) of 83 ± 11 mmHg vs nocturnal 78 ± 14 mmHg (P = 0.002). There was a significant difference between albuminuria at rest [median = 23 mg, interquartile range (IQR) = 10-51] and after exercise (median = 35 mg, IQR = 23-80, P < 0.001). Patients with exercise induced albuminuria had an increase in nocturnal BP values on all three components (128 mmHg vs 110 mmHg, P = 0.03 for SBP; 83 mmHg vs 66 mmHg, P = 0.04; 106 vs 83, P = 0.02 for mean arterial pressure), as well as albuminuric patients at rest. Moreover, exercise induced albuminuria detect a less increase in nocturnal DBP (83 vs 86, P = 0.03) than resting albuminuria.CONCLUSIONExercise induced albuminuria is associated with an increase in nocturnal BP values in T2D patients.

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.

[PP.27.23] IN PATIENTS WITH WHITE-COAT EFFECT DURING AMBULATORY BLOOD PRESSURE MONITORING THE THIRD HOUR VALUES PARTIALLY REFLECT MEAN DIURNAL BLOOD PRESSURE VALUES

Objective: In previous studies we found that the increase in blood pressure (BP) induced by clinical measurement, the so called white coat effect (WCE), is frequently observed also during ambulatory blood pressure monitoring (ABPM). As in these hyperreactive patients performing a full 24-hours examination can be cumbersome, we examined to what extent the mean values of systolic BP collected at the third hour (3hSBP), when WCE tends to wear off, are representative of the mean diurnal systolic BP values (mDSBP). Design and method: In 429 ABPM (M/F 144/285) in which WCE was detected when the first systolic recorded value was at least 10 mmHg higher than mDSBP, we compared 3hSBP and mDSBP assuming a mean value of 135 mmHg as the upper limit of normotension. Results: As expected considering all ABPM there was a progressive decrease of mean values from the first to the third hour of recording (respectively 153, 139 and 134 mmHg) whereas mDSBP was 135 mmHg. Out of the 429 ABPM, 190 (44%) were above this limit with 3hSBP and 206 (48%) for mDSBP. However only 147 (34%) and 180 (42%) were diagnosed respectively as hypertensive or normotensive with both measurements, whereas 43 (10%) of those found hypertensive with 3hSBP were not so with mDSBP and 59 (14%) normotensive with 3hSBP were diagnosed as hypertensive with mDSBP. Thus inspite of the fact that overall there was a significant correlation between 3hSBP and mDSBP (r = 0.72; p < 0.01), 102 (24%) patients had a discordant diagnosis.Conclusions: Although 3hSBP provides some insight on DSBP in patients with WCE, the percent of incorrect diagnoses with 3hSBP is too high to justify the use of 3hSBP as a surrogate of conventional DSBP.