Isolated Nocturnal Hypertension Research Articles

Circulating angiotensin-(1-7) is decreased in patients with isolated nocturnal hypertension.

Isolated nocturnal hypertension (INHT), defined as nighttime elevated blood pressure (BP) with normal daytime BP assessed by ambulatory BP monitoring, is associated with higher cardiovascular morbidity and mortality. We hypothesized that an alteration in the circulating renin-angiotensin system (RAS) contributes to INHT development. We examined circulating levels of angiotensin (Ang) (1-7) and Ang II and ACE2 activity in 26 patients that met the INHT criteria, out of 50 that were referred for BP evaluation (62% women, 45 ± 16 years old). Those with INHT were older, had a higher BMI, lower circulating Ang-(1-7) (P = 0.002) and Ang II levels (P = 0.02) and no change in ACE2 activity compared to those normotensives. Nighttime DBP was significantly correlated with Ang-(1-7) and Ang II levels. Logistic regression showed significant association in Ang-(1-7) and Ang II levels with INHT. Our study reveals differences in circulating RAS in individuals with INHT.

Association of Isolated Nocturnal Hypertension (INH) and Target Organ Damage in Light of the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines

Association of Isolated Nocturnal Hypertension (INH) and Target Organ Damage in Light of the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines

Isolated Nocturnal Hypertension in People Living With Human Immunodeficiency Virus: A Cross-Sectional Study.

Nocturnal hypertension (NH) is a potent cardiovascular risk factor described frequently in people with HIV (PWH). Isolated NH (INH) is less well reported in PWH because of the need for ambulatory blood pressure monitoring (ABPM) in office normotensive patients. We aim to document the prevalence of NH and INH and the clinical factors associated with these phenotypes. Cross-sectional study from an HIV program in Argentina. Office and ABPM measurements, as well as clinical and laboratory exploration, were performed. We defined INH as NH with daytime normotension in patients with office normotension. We obtained ABPM in 66 PWH, 60% male, aged 44.7 (IQR 27-69) years; 87% receiving antiretroviral therapy, and 86.2% virologically suppressed. ABPM-based hypertension prevalence was 54.7% (95% CI: 42.5-66.3). The prevalence of NH was 48.5% (32/66), while the INH prevalence was 19.7% (95% CI: 11.7-30.9). No differences were found regarding sex, HIV viral load, CD4+ T lymphocytes count, or years of infection between normotensive and INH patients. Multiple linear regression model adjusted for sex and age determined that body mass index (β = 0.93, P < 0.01), plasma uric acid (β = 0.25, P = 0.04), plasma potassium (β = -10.1, P = 0.01), and high-sensitivity C-reactive protein (hs-CRP) (β = 0.78, P = 0.02) independently predicted nocturnal systolic blood pressure (BP) in PWH. In a multiple logistic regression model adjusted for age and sex, the presence of sedentariness, plasma potassium <4 mEq/L, BMI, and hs-CRP levels were predictors of INH. INH is highly prevalent in PWH. Metabolic and inflammatory markers predict nocturnal SBP in PWH.

Prevalence and Characteristics of Isolated Nocturnal Hypertension and Masked Nocturnal Hypertension in a Tertiary Hospital in the City of Buenos Aires.

Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5-18.2%) and 9.7 (95% CI 7.9-11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources.

Masked Hypertension in Pediatric Heart Transplant Recipients.

Masked hypertension (HTN), especially, isolated nocturnal HTN (INH) has been shown to be a risk factor for cardiovascular disease (CVD) but is not studied well in pediatric heart transplant (PHT) patients. Ambulatoryblood pressuremonitoring (ABPM) is known to identify patients with HTN but is not used routinely in PHT. A single-center, prospective, cross-sectional study of PHT recipients was performed to observe the incidence of masked HTN using 24-h ABPM. The relationship between ABPM parameters and clinical variables was assessed using Spearman correlation coefficient. p value < 0.05 was considered significant. ABPM was performed in 34 patients, mean age 14 ± 5years, median 5.5years post-PHT. All patients had normal cardiac function, left ventricular mass index and blood pressure measurements in the clinic. Four patients had known prior HTN and on medications, one of them was uncontrolled. Of the remaining 30 patients, 18 new patients were diagnosed with masked HTN, of which 14 had INH. Diurnal variation was abnormal in 82% (28/34) patients. 24-h diastolic blood pressure (DBP) index correlated with glomerular filtration rate (GFR) (r = -0.44, p = 0.01). There was no correlation between other ABPM parameters with tacrolimus trough levels. ABPM identified masked HTN in 60% of patients, with majority being INH. Abnormal circadian BP patterns were present in 82% and an association was found between GFR and DBP parameters. HTN, especially INH, is under-recognized in PHT recipients and ABPM has a role in their long-term care.

S-42-4: ISOLATED NOCTURNAL HYPERTENSION IN PATIENTS LIVING WITH HUMAN INMUNODEFICIENCY VIRUS (HIV)

Introduction: People living with HIV (PLHIV) have higher rates of cardiovascular events compared to the general population; however mechanisms behind this discrepancy are poorly understood. High prevalence of hypertension has been proposed as a mechanism underlying cardiovascular events with contradictory results when office blood pressure (BP) is considered. Ambulatory blood pressure measurements (ABPM) have the advantage to measure BP during sleep, a cause of masked hypertension. Additionally, body weight and electrolytes disturbances are common in PLHIV under antiretroviral and antibiotic therapy. We aim to describe the prevalence of isolated nocturnal hypertension (INH) and it characteristics in PLHIV. Material and methods: A random sample of PLHIV from the provincial HIV program in Cordoba, Argentina, underwent clinical and laboratory examination, and 24 h ABPM. Nocturnal hypertension (NH) was defined as nocturnal systolic BP ≥ 120 mmHg and or nocturnal diastolic BP≥70 mmHg. INH was defined in those patients with NH with daytime systolic and diastolic BP&lt; 135/85 mmHg respectively. Results: PLHIV were included in the study: 60% male, mean age was 44.6 (27–69) years old, 87% were receiving antiretroviral therapy. BMI was 25.8 ± 4.8, mean CD4 count was 404.4 ± 289, cells/ml and 86.2% were virologically suppressed. The prevalence of NH was 48.5% [95%CI:36–60%], the vast majority having INH 29/32 (90%), thus the population prevalence of INH was 43.9% [95%CI:32–55,%]. INH patients have an excess of 10.4 and 8 mmHg in 24 hr systolic BP and diastolic BP respectively compared to no INH patients (both p &lt; 0.001). No differences were found regards age, sex, viral load, CD4+ cells and years of HIV history between patients with and without INH. Multiple linear regression (adj-R2 = 0.27, p &lt; 0.001) adjusted by sex and age determined that BMI (β = 0.79, p = 0.02]), plasma uric acid (β = 0.33, p = 0.01) and plasma potassium (β = -9.5, p = 0.03]) independently predicted nocturnal systolic BP in PLHIV. In a multiple logistic regression model adjusted by age and sex, BMI≥30 was associated with INH (OR 4.04 [95%CI: 1.25–13) Conclusion: INH is highly prevalent in PLHIV conferring an excessive hypertension load that may explain the associated high CVS risk. Obesity, increased uric acid, and low plasma potassium are associated with nocturnal systolic BP. Our work suggests the routine use of ABPM and explore metabolic disturbances in obese PLHIV.

Prevalence of Isolated Nocturnal Hypertension and Development of Arterial Stiffness, Left Ventricular Hypertrophy, and Silent Cerebrovascular Lesions: The KoGES (Korean Genome and Epidemiology Study).

Background Apart from nondippers' impact on cardiovascular events, the prevalence of isolated nocturnal hypertension (INH) and its consequences on both the heart and brain were not clearly investigated in the general population. Methods and Results The participants underwent ambulatory blood pressure monitoring evaluations for arterial stiffness, echocardiography, and brain magnetic resonance imaging. They were grouped into normotension, INH, and overt diurnal hypertension, based on ambulatory blood pressure monitoring and history of antihypertensive treatment. White matter hyperintensity, arterial stiffness, and echocardiographic parameters were compared. Of the 1734 participants, there were 475 (27.4%) subjects with normotension, 314 with INH (18.1%), and 945 with overt diurnal hypertension (54.5%). Prevalence of INH was not different between sex or age. Of INH, 71.3% (n=224) was caused by elevated diastolic blood pressure. After multivariable adjustment, INH showed higher pulse wave velocity (P<0.001) and central systolic blood pressure (P<0.001), left ventricular mass index (P=0.026), and worse left ventricular diastolic function (early diastolic mitral annular velocity) (P<0.001) than normotension. Mean white matter hyperintensity scores of INH were not different from normotension (P=0.321), but the odds for white matter hyperintensity presence were higher in INH than normotension (odds ratio, 1.504 [95% CI, 1.097-2.062]; P=0.011). Conclusions INH was common in the general population and associated with increased arterial stiffness, left ventricular hypertrophy, and diastolic dysfunction. White matter hyperintensity was more likely to be present in the INH group than in the normotension group. The use of ambulatory blood pressure monitoring should be encouraged to identify masked INH and prevent the occurrence of cardiovascular events.

Isolated nocturnal hypertension in relation to host and environmental factors and clock genes.

Isolated nocturnal hypertension (INH) is a special type of out‐of‐office hypertension. Its determinants and pathophysiology remain unclear. In a nested case‐control study, we intend to investigate the host, environmental, and genetic factors in relation to INH. Among 2030 outpatients screened from December 2008 till June 2015, 128 patients with INH were identified, and then 128 normotensives were matched according to sex and age. INH was an elevated nocturnal blood pressure (BP ≥120/70 mmHg) in the presence of a normal daytime BP (< 135/85 mmHg). Host factors included age, sex, body mass index, smoking and drinking, sleep time and duration, heart rate, serum lipids, and serum creatinine. Environmental cues encompassed season, ambient temperature, atmospheric pressure, humidity, and wind speed, and genetic cues 29 single‐nucleotide polymorphisms (SNPs) in 12 clock genes. Daytime and nighttime BPs averaged 124.9/80.7 and 114.5/73.7 mmHg, respectively, in the INH patients and 121.0/76.5 and 101.8/63.3 mmHg in the normotensive controls. Stepwise logistic regression analyses revealed that INH was associated with nighttime heart rate (P = .0018), sleep duration (P = .0499), and relative humidity (P = .0747). The odds ratios (95% CI) for each 10 beats/min faster nighttime heart rate and 10% lower relative humidity were 1.82 (1.25‐2.65) and 0.82 (0.67‐1.00), respectively. Irrespective of the genetic models, no significant association was observed between INH and the SNPs (P ≥ .054). In conclusion, INH was associated with host and environmental factors rather than genetic markers.

Isolated Nocturnal Hypertension in Children.

Isolated nocturnal hypertension (INH) is attracting attention because it has been shown to correlate with target organ damage as well as cardiovascular events in adults. INH has also been reported in children especially in those with underlying diseases including chronic kidney disease and some studies reported association with markers of early target organ damage. INH occupies the majority of nocturnal hypertension. On the other hand, masked hypertension is largely attributed to INH. INH is usually diagnosed by ambulatory blood pressure monitoring. Recently, it became possible to monitor sleep blood pressure by an automated home blood pressure device feasible also in children. The epidemiology, methodology and reproducibility, pathophysiology, relation to target organ damage, and treatment of INH in children will be reviewed here along with adult data.

Isolated nocturnal hypertension in pediatric kidney transplant recipients.

Isolated nocturnal hypertension (INH) is defined as nighttime hypertension in the setting of normal daytime blood pressure (BP), diagnosed by ambulatory BP monitoring (ABPM). Hypertension affects 60%-80% of pediatric kidney transplant recipients, and INH is the most common type of ambulatory hypertension. INH is associated with an increased prevalence of hypertension-mediated target organ damage such as left ventricular hypertrophy in adults and in pediatric kidney transplant recipients. Ambulatory BP monitoring should be performed annually in all pediatric kidney transplant recipients to diagnose hypertension phenotypes that are not detectable by office BP such as masked hypertension, white-coat hypertension, or INH. Isolated nocturnal hypertension in pediatric transplant patients requires study as a treatment target.

Abstract 11584: Prevalence of Isolated Nocturnal Hypertension in Adolescents with Use of Adult Hypertension Criteria

Introduction: The 2017 Blood Pressure Guidelines aligned clinic hypertensive thresholds for children ≥13 years of age with adult BP criteria, increasing the predictive value for adverse cardiovascular outcomes. However, thresholds for adolescents have not been updated for ambulatory blood pressure monitoring (ABPM), a confirmatory test in the diagnosis of hypertension. We examined the impact of using adult ABPM criteria in adolescents, including the contribution of daytime (DH) and isolated nocturnal hypertension (INH), and associations with left ventricular hypertrophy (LVH). Methods: This retrospective study included all ABPMs obtained in 13–16-year-olds at Boston Children’s Hospital (2015-2020). ABPMs were interpreted using both pediatric and adult thresholds. For studies newly classified as hypertensive using adult criteria, available echocardiograms were reviewed for LVH. Independent T-test and Chi-square were used to compare age, gender, BMI, left ventricular mass (LVM), indexed LVM &gt;95 th percentile, and LVM z-score &gt;2 in individuals with INH vs. DH. Results: 347 ABPMs were included in this study; 92 studies (87 unique patients) were reclassified as hypertensive using adult thresholds; 96.7% of these studies were obtained in males. Of the 92 studies, 31 (33.7%) studies had INH and 58 (63.0%) had DH (54/58 had day &amp; night hypertension). There was no difference in age or BMI between INH and DH groups; more studies in the INH group were from females (p=0.05). We reviewed 14 and 42 echocardiograms for the INH and DH groups, respectively. There were no differences in indexed LVM or LVM z-score between the 2 groups. Though a small sample size, we found that 3/14 (21.4%) and 12/42 (28.6%) in the INH and DH groups respectively had an indexed LVM &gt;95 th percentile; there was no significant difference between groups (p=0.601). An LV mass z-score &gt; 2 was not seen in the INH group and was in 4/42 (9.5%) of the DH group. Conclusions: With use of adult ABPM criteria, INH significantly contributed to ABPMs reclassified as hypertensive. Prevalence of LVH was similar in INH and DH groups. Further study is needed to investigate the appropriateness of using adult thresholds for nocturnal hypertension in adolescents, whose sleep patterns may differ from adult counterparts.

Prevalence and characteristics of isolated nocturnal hypertension in the general population.

Background/AimsAscertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population.MethodsOf 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment.ResultsThe prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping.ConclusionsThe present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

CIRCULATING CERAMIDE AS A POTENTIAL BIOMARKER FOR ISOLATED NOCTURNAL HYPERTENSION

Objective: Isolated nocturnal hypertension (INH) is a subtype of hypertension characterized as an elevated blood pressure (BP) at nighttime only. To identify potential new biomarkers related with INH, we compared serum metabolite profiles between INH and normotensive controls. Design and method: Twenty-four-hour ambulatory BP monitoring was performed with Mobil-O-graph (IEM, Germany) monitors in untreated outpatients. INH was defined as a nocturnal BP greater or equal to 120/70 mmHg and daytime BP less than 135/85 mmHg at both two visits within a month. Age-sex matched normotensives (NT) were included as controls. We applied untargeted liquid chromatography tandem mass spectrometry (LC-MS) to detect serum metabolites. Multiple algorithms were first run in a training set (40 INH and 40 NT) and then in a test set (22 INH and 19 NT) to select and verify potential biomarkers. We computed student's P-values corrected by multiple comparison and VIP (Variable Importance in the Projection) score. Based on the results of untargeted LC-MS, we quantified 8 circulating sphingolipids, including sphingomyelin (SM) (d18:1/16:0), SM (d18:1/18:0), SM (d18:1/24:1), ceramide (Cer) (d18:1/16:0), Cer (d18:1/18:0), Cer (d18:1/24:1), sphingosine and sphingosine-1-phosphate in the test set by a targeted LC-MS method. Results: Orthogonal partial least squares-discriminant analysis (OPLS-DA) demonstrated a clear separation of metabolite profiles of INH patients from NT controls (R2 = 0.747, Q2 = 0.672). Cer (d18:1/16:0) had significant association with INH (odds ratio (OR) = 0.290 per SD, 95% confidence interval (CI), 0.125–0.715, P trend = 0.0027). The ceramide score, calculated as a sum of concentrations of the three ceramides, was associated with a lower risk of INH across extreme quartiles (OR = 0.592, 95% CI, 0.400–0.875, P trend = 0.0085). Moreover, Cer (18:1/16:0) significantly improved the diagnostic prediction of INH (P = 0.04). Conclusions: Our study illustrated a novel association between plasma ceramide concentration and INH. More research on ceramides in hypertensive pathobiology might be warranted.

Isolated nocturnal hypertension is associated with increased left ventricular mass index in children.

Isolated nocturnal hypertension (INH) is associated with increased prevalence of left ventricular hypertrophy (LVH) and cardiovascular morbidity and mortality in adult patients. Unlike in adults, data illustrating the possible association between INH and cardiac target organ damage is lacking in children. This study aimed to investigate whether INH is associated with increased left ventricular mass index (LVMI) and LVH in children. Retrospective data from all untreated children with confirmed ambulatory hypertension (HT) in our center was reviewed. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed concurrently. Ambulatory normotensive children served as controls. LVH was defined as LVMI ≥ 95th percentile. There were 102 ABPM studies; of these, 79 children had renal HT, and 23 had primary HT. Median age of children was 13.2 years (3.8-18.9). Nineteen children had INH, 9 children had isolated daytime HT, 54 had daytime and nighttime HT, and 20 were normotensive. The LVMI adjusted for age (patient's LVMI/95th percentile of the LVMI) was significantly higher in children with INH than in normotensive children (0.83 ± 0.03 vs. 0.74 ± 0.03, p = 0.03). Left ventricular hypertrophy was present in 11% of children with INH; this was not significantly higher than in normotensive children (0%, p = 0.23). This study investigated the association between INH and cardiac structure in children with primary and renal HT and showed children with INH had higher LVMI adjusted for age than normotensive children and children with INH had similar LVMI adjusted for age to children with isolated daytime HT.

Prevalence of isolated nocturnal hypertension according to 2018 European Society of Cardiology and European Society of Hypertension office blood pressure categories.

To estimate the prevalence of isolated nocturnal hypertension (INH) and its relationships with office blood pressure (BP) categories defined by 2018 ESC/ESH guidelines. We conducted a prospective cohort study in consecutive patients referred to perform an ambulatory blood pressure monitoring (ABPM) for diagnosis or therapeutic purposes. Office BP measurements and ABPM were performed in the same visit. The cohort was divided according to office BP in optimal, normal, high-normal and hypertension. The prevalence and adjusted risk for combined daytime and nocturnal hypertension and INH were estimated for each category. We evaluated 1344 individuals, 59.3% women (51 ± 14 years old) and 40.7% men (52 ± 15 years old). 61.5% of the individuals had nocturnal hypertension, 12.9% INH and 48.7% combined daytime and nocturnal hypertension. Prevalence of combined daytime and nocturnal hypertension increased through office BP categories (P < 0.001). Conversely, prevalence of INH was lower in individuals with hypertension than in normotensives (7.4 vs. 17.2%, P < 0.001) and similar between nonhypertensive office BP categories, 16.6, 15 and 19.4% for optimal, normal and high-normal BP, respectively (P < 0.399). In individuals with office BP values less than 140/90 mmHg, the prevalence of masked hypertension phenotypes were 8.6, 17.2 and 30.2% for daytime, INH and combined daytime and nocturnal hypertension, respectively. Adjusted risk for combined daytime and nocturnal hypertension increased significantly through office BP categories; conversely, the risk for INH was similar in all nonhypertensive office BP categories. Nocturnal hypertension was the more prevalent phenotype of masked hypertension and more than one-third of the individuals with nocturnal hypertension had INH. The risk for INH was not related to nonhypertensive office BP categories.

Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease: findings from the Cardiovascular Comorbidity in Children with Chronic Kidney Disease study.

Prevalence of isolated nocturnal hypertension (INH) and isolated daytime hypertension (IDH) is around 10% in adults. Data in children, especially in chronic kidney disease (CKD), are lacking. The aim of this cross-sectional multicenter cohort study was to define the prevalence of INH and IDH and its association with cardiovascular morphology and function, that is, pulse wave velocity (PWV), carotid intima-media thickness (cIMT), or left ventricular mass index (LVMI) in children with CKD. Ambulatory blood pressure (BP) monitoring profiles were analyzed in 456 children with CKD stages III-V participating in the Cardiovascular Comorbidity in Children with Chronic Kidney Disease Study (64.3% males, 71.3% congenital anomaly of the kidney and urinary tract, age 12.5 ± 3.2 years, estimated glomerular filtration rate 29 ± 12 ml/min per 1.73 m). Baseline PWV, cIMT, and LVMI were compared in normotension, INH, IDH, or sustained 24-h hypertension. Prevalence of sustained hypertension was 18.4%, of INH 13.4%, and of IDH 3.7%. PWV SDS (SD score) and cIMT SDS were significantly higher in sustained hypertension and INH, and PWV SDS was significantly higher in IDH, compared with normotension. LVMI was significantly increased in sustained hypertension, but not in INH or IDH. Determinants of INH were smallness for gestational age, older age, higher height SDS and parathyroid hormone, and shorter duration of CKD. In logistic regression analysis, day/night-time hypertension or ambulatory BP monitoring pattern (normal, INH, IDH, sustained hypertension) were independently associated with cardiovascular outcome measures: elevated night-time BP was associated with increased cIMT, PWV, and left ventricular hypertrophy; INH was associated with cIMT. INH is present in almost one out of seven children with predialysis CKD; INH and nocturnal hypertension in general are associated with alterations of arterial morphology and function.

Higher 24-hour urine Na/K and albumin-to-creatinine ratio are subclinical organ damage markers in hypertensive patients from Blida (Algeria)

The aim of this study was to evaluate the relationship between ACR (albumin-to-creatinine ratio) and markers of TOD (target organ damage) in treated hypertensive patients. We enrolled 859 consecutive essential hypertensives (mean age 55 ± 10 years, 444 females) without known cardiovascular disease (CVD). LVMI was assessed by echocardiography by using the Devereux formula. eGFR was calculated by the MDRD equation. In a 24-hour urine collection, sodium/potassium ratio and ACR were measured. Valid 24-h ambulatory BP monitoring were analyzed. Participants were grouped in 4 groups: normotensives, isolated daytime hypertensives (IDHT), isolated nocturnal hypertensives (INHT), and both-hypertensives having both daytime and nocturnal hypertension. The 24-hour urine sodium (24HUNa) was 151.7 ± 71.4, 158.4 ± 69.3, 168.7 ± 68.8 and 177.1 ± 70.7 mmol/24 hour, respectively. The 24-hour urine potassium (24HUK) was 52.4 ± 17.8, 54.1 ± 16.2, 59.8 ± 20.7 and 62.1 ± 20.4 mmol/24 hour and the 24-hour urine sodium/potassium ratio (24HUNa/24HUK) were 3.1 ± 2.2, 3.3 ± 1.5, 3.2 ± 2.7 and 3.0 ± 2.3 respectively. Compared to NT group, INHT had higher 24HUNa ( P = 0.01), and both-HT had higher 24HUNa and 24HUNa/24HUK ( P < 0.01 and 0.01, respectively). There was no difference in 24HUNa, 24HUNK and 24HUNa/24HUK between INHT and both-HT. In multivariate analysis controlled with age, gender, body mass index, estimated glomerular filtration rate, INHT showed significantly higher 24HUNa/24HUK than NT ( P < 0.02). ACR exhibited significant association with LVMI (r = 0.312, P = 0.01) and eGFR ( r = –0.122, P = 0.01). In additional analysis, ACR was associated with TOD and decreased renal function (eGFR < 60 ml/min). Specifically, ACR exhibited a significant association with the number of TOD and this association was independent of age and gender ( P < 0.01). The results of present study suggest that high ratio of sodium/potassium may be a risk of isolated nocturnal hypertension and both-hypertension. Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive value of ACR as a predictive of TOD.

The effect of treatment for sleep apnoea on determinants of blood pressure control.

Our aim was to assess the effect of continuous positive airway pressure (CPAP) on the nocturnal evolution of peripheral chemosensitivity, renin-angiotensin-aldosterone system activity, sympathetic tone and endothelial biomarkers in obstructive sleep apnoea (OSA) patients with isolated nocturnal hypertension (INH) or day-night sustained hypertension (D-NSH).In a crossover randomised trial, 32 OSA patients newly diagnosed with hypertension and without antihypertensive treatment were randomly assigned to 12 weeks of CPAP or sham CPAP. Peripheral chemosensitivity was evaluated before and after sleep using the hypoxic withdrawal test (%ΔVI).At baseline, D-NSH patients showed higher %ΔVI before sleep and higher levels of aldosterone and diurnal catecholamines. CPAP only reduced the nocturnal increase of %ΔVI in INH patients (6.9%, 95% CI 1.0-12.8%; p=0.026). CPAP-induced change from baseline in %ΔVI after sleep was 7.5% (95% CI 2.6-12.2%, p=0.005) in the INH group and 5.7% (95% CI 2.2-9.3%, p=0.004) in the D-NSH group. In contrast, %ΔVI before sleep only decreased with CPAP in the D-NSH patients (3.0%, 95% CI 0.5-5.6%; p=0.023).In conclusion, CPAP reduces the nocturnal increase of peripheral chemosensitivity experienced by INH patients and corrects the high daytime sensitivity of patients with D-NSH. Differences in response to CPAP between these patients can help better understand the mechanisms of perpetuation of hypertension in sleep apnoea.

Masked Isolated Nocturnal Hypertension in Children and Young Adults.

Isolated nocturnal hypertension (INH) is characterized by normal daytime blood pressure (BP) and elevated nighttime BP diagnosed by ambulatory BP monitoring. Masked isolated nocturnal hypertension (MINH) is a subtype of INH in which office BP is normal. We studied the frequency and characteristics of INH and MINH in children and young adults. One hundred and ninety-eight subjects seen by the pediatric nephrology service were studied retrospectively. Isolated nocturnal hypertension (INH) and MINH were diagnosed according to daytime and nighttime ABP and office BP in the case of the latter. One hundred and eighteen subjects (60%) had normotension, 6 (3%) had isolated daytime hypertension, 32 (16%) had INH, and 42 (21%) had day-night hypertension. Sixteen subjects had MINH (8.1%). The underlying diseases of MINH were as follows: no underlying disease 9 (56%), renal disease 6 (38%), and endocrine disease 1 (6%). There was no significant difference in the underlying disease, gender, age, and BMI between MINH and INH with elevated office BP. In conclusion, MINH is present in children and young adults. Since there were no specific features for MINH, screening with ambulatory or home BP monitoring during sleep may be appropriate.

LB.01.09] ISOLATED NOCTURNAL HYPERTENSION AND NON DIPPING BLOOD PRESSURE

Objective: Nocturnal hypertension is associated with an increased risk of major cardiovascular events. Patients with Isolated nocturnal hypertension (INH) had more severe target-organ damage. A ’non-dipping’ Blood Pressure profile is associated with a high cardiovascular risk. The diagnosis of these two entities is easy by ambulatory blood pressure monitoring(ABPM). The aim of this study is to describe the prevalence of nocturnal hypertension and to study the dipping profile in hypertensive patients Design and method: Our study is retrospective, it includes all patients referred for diagnosis of hypertension; Before high blood pressure levels or high normal tension in whom the diagnosis is confirmed by ABPM, and the known hypertensives oriented for evaluation. A Schiller MT-300 with BR-102 plus program was used for the ABPM. 46 measures required to validate the ABPM. We studied the mean of the blood pressure over the 24 hours, the mean pressure night and day and the profile dipping in all the patients. Nocturnal hypertension and dipping profile values are those defined by ESC/ ESH 2013 and AHA/ASA 2015. Results: Twenty seven patients included in our series. It is 15 men (55%) and 12 women (45%). Mean age is 54 years [35–80 years]. Twenty five patients (93%) had nocturnal hypertension, Six (22%) of whom had isolated nocturnal hypertension. Patients with INH are six, they are 3 men and 3 women, mean age 50.5 years (43 - 59) years. Hypertension is systolic-diastolic in three patients, diastolic isolated in two patients and systolic isolated in one. The dipping profile in our series, it is normal in nine patients, 12 patients (44%) are non dippers, four Reverse dipping (15%) and two extrem dipping. Conclusions: The prevalence of isolated nocturnal hypertension is high in our series (22% of patients) and The non dipping Blood pressure is also very common (60%), together, these entities are regarded as important harbingers of poor cardiovascular prognosis. The ambulatory blood pressure monitoring(ABPM) in hypertensive patients at diagnosis and during progression is the only non-invasive way to detect nocturnal hypertension and to analyse dipping profile.