Mean Daytime Systolic Blood Pressure Research Articles

Hipertansif Hastalarda Non-dipping Kan Basıncı Biçimi ve Postüral Ortostatik Taşikardi Sendromu Arasındaki İlişki

Objective: Postural orthostatic tachycardia syndrome (POTS) is an orthostatic intolerance with a pathophysiology that is likely to be heterogeneous. Hypertensive patients with a non-dipping pattern have an increased cardiovascular risk. There is a possibility that the same pathophysiological mechanisms may have a role in both POTS and the non-dipping pattern. To our knowledge, there are some studies showing the relation between POTS and non-dipping pattern in normotensive patients. However, data about this relation in hypertensive patients is limited. Our aim was to investigate the relation between 24-hour ambulatory blood pressure monitoring (ABPM) parameters and POTS in our study. Material and Methods: A total of 271 suitable patients were enrolled in our study. ABPM, Tilt table test, echocardiography, and laboratory tests were performed. Results: The study included 39 (14.3%) patients with POTS. There were no differences in the demographic variables, drug therapies, and laboratory as well as echocardiography parameters in all patients. Day-time, night-time, and 24-hour mean systolic and diastolic blood pressures and frequency of non-dipping pattern were significantly higher in patients with POTS. Day-time mean systolic blood pressure and non-dipping pattern were determined as independent predictors for POTS in multivariate logistic regression analysis. Conclusion: A relation was observed between POTS and non-dipping pattern in patients with hypertension, which needs further exploration in larger and detailed studies. Clinicians might be aware of POTS if their hypertensive patients complain of palpitations, lightheadedness, and fatigue in an upright position.

Communication of subcutaneous, visceral, periaortic, epicardial fat and metabolic parameters with arterial stiffness in young people with abdominal obesity

Obesity plays a key role in the epidemic of type 2 diabetes mellitus (DM), cardiovascular and cerebrovascular diseases. Most studies confirm the association of increased arterial stiffness with obesity. However, the interrelation of various fat depots with one of the main indicators of vascular wall stiffness - the cardiovascular vascular index (CAVI) is currently not clear. The purpose of this study is to assess arterial stiffness in people with abdominal obesity without metabolic syndrome (MS) and with MS, the connection of fat depots (visceral, subcutaneous, perivascular, epicardial fat) with the stiffness parameter CAVI. Materials and methods. 68 people with abdominal obesity (AO) at the age of 18-45 years. The study included height, weight, BMI, waist circumference, and biochemical blood tests (fast glucose and glucose tolerance, uric acid, creatinine, GFR - MDRD, lipid profile, insulin, HOMA-IR). 24-hour blood pressure monitoring, computed tomography (Aquilion One Vision Edition, Toshiba, Japan) with the definition of subcutaneous, visceral, perivascular, epicardial fat, and also calculated the ratio subcutaneous to visceral fat. It was determined CAVI on the VaSera 1000 unit (Fukuda Denshi, Japan) to assess arterial stiffness. Abdominal obesity was derteming by cut off waist circumference >80 cm for women and >94 cm for men. As a result, we were formed 2 groups: persons with abdominal obesity and the presence of no more than one additional risk factor (metabolically healthy) - group 1, persons with MS (abdominal obesity in combination with 2 and more extra risk factors) - group 2, the control group consisted of healthy individuals (n=15) without obesity - group 0. Results. There was no statistically significant difference between CAVI groups. Correlations of CAVI with age r=0.340 (p=0.005), with daytime mean systolic blood pressure - SBPm average (r=0.280, p=0.021) and with mean diastolic blood pressure - DBPm average (r=0.329, p=0.006), with night SBPm average (r=0.233, p=0.014) and with DBPm average (r=0.297, p=0.014), with the volume of periaortic fat (r=0.218, p=0.074) were found. An inverse correlation was found between CAVI and BMI (r=-0.279, p=0.021), with subcutaneous fat depot (r=-0.285, p=0.019) and with the ratio of subcutaneous to visceral fat (r=-0.303, p=0.012). According to the multivariate regression analysis, the most significant impact on CAVI is exerted by age, daytime SBPm, BMI, and the volume of periaortic fat

Diminished circadian blood pressure variability in elderly individuals with nuclear cataracts: cross-sectional analysis in the HEIJO-KYO cohort.

The present study aimed to determine the relationship between cataract subtypes and circadian blood pressure (BP) variability in elderly individuals. In this cross-sectional study of a community-based cohort, we assessed bilateral lens opacity using slit lamp photographs of 458 elderly individuals (mean age, 69.1 years). Cataract status was defined as a bilateral Lens Opacities Classification System III grade of ≥3 for nuclear cataract, ≥2 for cortical cataract, and ≥2 for posterior subcapsular cataract (PSC). Ambulatory BP monitoring was performed at 30-min intervals for 48 h. A nondipper pattern of BP was defined as a <10% decline in the mean nighttime systolic BP relative to the mean daytime systolic BP. The prevalence of nondipper patterns was 42.4% and 25.9% in the groups with nuclear cataracts (n = 66) and without cataracts for both eyes (n = 290), respectively. Multivariable logistic regression analysis adjusted for potential confounders revealed a significantly higher odds ratio (OR) for nondipper pattern in the group with nuclear cataract than in that without cataract (OR, 1.81; 95% confidence interval, 1.01-3.24; P = 0.047) but not in the group with cortical cataract (P = 0.61) or PSC (P = 0.95). In conclusion, circadian BP variability was significantly diminished in elderly individuals with nuclear cataracts but not in those with cortical cataracts or PSCs. These associations were independent of daytime light exposure, physical activity, and known risk factors of cataracts, such as aging, obesity, and diabetes.

FIRST RESULTS OF THE COMPARISON OF A CUFFLESS 24 HOUR BLOOD PRESSURE MEASUREMENT DEVICE WITH A CUFF-BASED STANDARD DEVICE IN A REAL LIFE SETTING

Objective: Recently, a cuffless blood pressure (BP) measurement device using the pulse-transit time (PTT) for beat-to-beat calculation of BP values initially calibrated to a single cuff-based measurement has been introduced and successfully validated over short term according to the ESH validation protocol. We evaluated this cuffless PTT device (TestBP) in a real-life setting compared to a validated, ambulatory, cuff-based standard BP device (RefBP) over 24 hours.Design and method: Between May and December 2017, 71 individuals were prospectively enrolled and categorised into three groups according to mean day-time systolic BP (<135, 135–149, > = 150 mmHg). Main exclusion criteria were age < 25 years or a difference in blood pressure > 10 mmHg between both upper extremities. Cuffless (Somnotouch NIBP) and cuff-based, standard (Spacelabs 90217A) 24 h BP measurements were performed simultaneously on the left and right arm, respectively. The first cuff-based measurement was used as calibration measurement for the TestBP. We compared the systolic and diastolic mean 24h-BP values of the RefBP and TestBP. Results: Mean age was 49 (±15) years and 51% were male. Mean (±standard deviation) 24 h BP for the TestBP and RefBP were 140.8 (±20) vs 134.0 (±17.3) mmHg for systolic (p < 0.0001) and 85.8 (±14.1) vs 79.3 (±11.7) mmHg for diastolic (p < 0.0001) BP values, respectively. Mean absolute systolic and diastolic differences were 10.2 (±7.2) and 8.2 (±5.5) mmHg, respectively. Comparing agreement between the mean 24 h BP values of the TestBP and RefBP, absolute difference was within 5, 10 and 15 mmHg in 23 (31.5%), 43 (58.9%) and 54 (74%) for systolic and 25 (34.3%), 52 (71.2%) and 66 (90.4%) for diastolic measurements. The agreement for systolic mean 24 h BP measurements stratified by daytime BP-groups are shown in Table 1. Bland-Altman plots comparing mean systolic and diastolic 24h-BP values between the two devices are shown in Figure 1. Conclusions: In our study there was a significant difference between the TestBP and RefBP with an overestimation by the new cuffless PTT device. Best agreement for systolic BP was in the range of 135–149 mmHg. Reasons for this difference between the measurement techniques need to be investigated in further studies.

Xanthine oxidase inhibition for the improvement of long-term outcomes following ischaemic stroke and transient ischaemic attack (XILO-FIST) - Protocol for a randomised double blind placebo-controlled clinical trial.

BackgroundAllopurinol, a xanthine oxidase inhibitor, reduced progression of carotid-intima media thickness and lowered blood pressure in a small clinical trial in people with ischaemic stroke. Xanthine oxidase inhibition for improvement of long-term outcomes following ischaemic stroke and transient ischaemic attack (XILO-FIST) aims to assess the effect of allopurinol treatment on white matter hyperintensity progression and blood pressure after stroke. This paper describes the XILO-FIST protocol.MethodsXILO-FIST is a multicentre randomised double-blind, placebo-controlled, parallel group clinical trial funded by the British Heart Foundation and the Stroke Association. The trial has been adopted by the Scottish Stroke Research Network and the UK Clinical Research Network. The trial is registered in clinicaltrials.gov (registration number NCT02122718). XILO-FIST will randomise 464 participants, aged greater than 50 years, with ischaemic stroke within the past month, on a 1:1 basis, to two years treatment with allopurinol 300 mg twice daily or placebo. Participants will undergo brain magnetic resonance imaging, cognitive assessment, ambulatory blood pressure monitoring and blood sampling at baseline and after two years treatment. The primary outcome will be white matter hyperintensity progression, measured using the Rotterdam progression scale. Secondary outcomes will include change in white matter hyperintensity volume, mean day-time systolic blood pressure and measures of cognitive function. Up to 100 will undergo additional cardiac magnetic resonance imaging in a sub-study of left ventricular mass.DiscussionIf white matter hyperintensity progression is reduced, allopurinol could be an effective preventative treatment for patients with ischaemic stroke and clinical endpoint studies would be needed. If allopurinol reduces blood pressure after stroke, then it could be used to help patients reach blood pressure targets.

Simultaneous performance of skin allergy tests in two organ microfluidic chips

Blood pressure (BP) can differ substantially when measured in the clinic versus outside of the clinic setting. Few population-based studies with ambulatory blood pressure monitoring (ABPM) include African Americans. We calculated the prevalence of clinic hypertension and ABPM phenotypes among 1016 participants in the population-based Jackson Heart Study, an exclusively African-American cohort. Mean daytime systolic BP was higher than mean clinic systolic BP among participants not taking antihypertensive medication (127.1[standard deviation 12.8] vs. 124.5[15.7] mm Hg, respectively) and taking antihypertensive medication (131.2[13.6] vs. 130.0[15.6] mm Hg, respectively). Mean daytime diastolic BP was higher than clinic diastolic BP among participants not taking antihypertensive medication (78.2[standard deviation 8.9] vs. 74.6[8.4] mm Hg, respectively) and taking antihypertensive medication (77.6[9.4] vs. 74.3[8.5] mm Hg, respectively). The prevalence of daytime hypertension was higher than clinic hypertension for participants not taking antihypertensive medication (31.8% vs. 14.3%) and taking antihypertensive medication (43.0% vs. 23.1%). A high percentage of participants not taking and taking antihypertensive medication had nocturnal hypertension (49.4% and 61.7%, respectively), white-coat hypertension (30.2% and 29.3%, respectively), masked hypertension (25.4% and 34.6%, respectively), and a nondipping BP pattern (62.4% and 69.6%, respectively). In conclusion, these data suggest hypertension may be misdiagnosed among African Americans without using ABPM.

PP.18.07] RELATIONSHIP OF ELASTIC VASCULAR WALL PROPERTIES, RENAL FUNCTION AND INFLAMMATORY BIOCHEMICAL MARKERS IN HYPERTENSIVE PATIENTS WITH METABOLIC DISORDERS

Objective: To study the elastic properties of vascular wall, 24-hour blood pressure (BP) profile, parameters of renal function, biochemical parameters and their relationship with metabolic disorders in patients with arterial hypertension (AH) and metabolic disorders (abdominal obesity and dyslipidemia). Design and method: 130 patients (mean age 47.20 ± 9.6 years) were divided into 2 groups. The main group (group 1) included 77 subjects with AH degree I-III and MD (mass body index (MBI) 34.5 ± 3.9 kg/m2) and the control group (group 2) contained 53 subjects with AH without MD. The parameters of 24-hour BP monitoring, sphygmography, renal function (microalbuminuria, creatinine and estimation glomerular filtration rate (eGFR) using MDRD formule), parameters of the lipid profile, inflammatory markers – homocysteine, C-reactive protein (hs-CRP) and fibrinogen were estimated. Results: In group 1 there was registered significant increase in mean 24-hour and daytime systolic BP (SBP), time and square indices, in night time SBP and diastolic BP variability (p < 0.001); in sphygmography indices (cardio-ankle vascular index (CAVI), pulse wave velocity (PVW) and anklebrachial index (ABI) (p < 0.01); in parameters of renal function - microalbuminuria and eGFR (p < 0.001); in biochemical parameters - total cholesterol, fibrinogen (p < 0.016) and hs-CRP level (p = 0.04) compared to group 2. In group 1 correlation analysis revealed a positive correlation between microalbuminuria and PWV-R (p = 0.039), creatinine and R-ABI (p = 0.007), eGFR and L-ABI (p = 0.05), hs-CRP and CAVI and between fibrinogen and eGFR (p < 0.05). Besides, regression analysis method in patients with AH degree I revealed a positive relationship of creatinine with PWV-L (R2 = 0.14, p = 0.03), in patients with AH degree II - creatinine with CAVI and MBI (R2 = 0.451, p = 0.004 and p = 0.012). Conclusions: The relationship between elastic parameters of vascular wall, inflammatory markers, parameters of renal function and MBI has a pathogenetic basis for the progression of hypertension and impaired function of the target organ.

Ambulatory blood pressure monitoring in heart failure and serum sodium levels

AimsTo determine whether there are differences in blood pressure profile on dynamic assessment by ambulatory blood pressure monitoring (ABPM) according to serum sodium levels in stable heart failure patients. MethodsData were collected from the Spanish National Registry on Ambulatory Blood Pressure Monitoring in Heart Failure (DICUMAP). Patients underwent ABPM by the oscillometric principle using a Spacelabs 90121 monitor. The sample was divided into three groups according to sodium levels and their clinical and laboratory data and echocardiographic findings were analyzed. Robust statistical methods were used to compare the groups in univariate and multivariate models. ResultsA total of 175 patients (44.57% male) were analyzed. We found a predominance of anomalous circadian blood pressure profiles in all three groups, with a significantly higher percentage of risers in the lowest serum sodium group (p=0.05). In addition, in this group there were significant differences in mean 24-hour systolic blood pressure (SBP) (24-h SBP, p=0.05) and in mean daytime SBP (dSBP, p=0.008), with significant differences in nocturnal fall in SBP (p=0.05) and in diastolic blood pressure (p=0.005). In multivariate analysis a significant relationship was found between sodium levels and 24-h SBP (OR 0.97, 95% CI 0.95-0.99, p=0.01) and dSBP (OR 0.96, 95% CI 0.94-0.99, p=0.004). ConclusionA relationship was found between lower sodium levels and lower systolic blood pressure, especially during waking hours, with a lower decline between daytime and night-time blood pressure.

Ambulatory blood pressure monitoring in heart failure and serum sodium levels

AimsTo determine whether there are differences in blood pressure profile on dynamic assessment by ambulatory blood pressure monitoring (ABPM) according to serum sodium levels in stable heart failure patients. MethodsData were collected from the Spanish National Registry on Ambulatory Blood Pressure Monitoring in Heart Failure (DICUMAP). Patients underwent ABPM by the oscillometric principle using a Spacelabs 90121 monitor. The sample was divided into three groups according to sodium levels and their clinical and laboratory data and echocardiographic findings were analyzed. Robust statistical methods were used to compare the groups in univariate and multivariate models. ResultsA total of 175 patients (44.57% male) were analyzed. We found a predominance of anomalous circadian blood pressure profiles in all three groups, with a significantly higher percentage of risers in the lowest serum sodium group (p=0.05). In addition, in this group there were significant differences in mean 24-hour systolic blood pressure (SBP) (24-h SBP, p=0.05) and in mean daytime SBP (dSBP, p=0.008), with significant differences in nocturnal fall in SBP (p=0.05) and in diastolic blood pressure (p=0.005). In multivariate analysis a significant relationship was found between sodium levels and 24-h SBP (OR 0.97, 95% CI 0.95-0.99, p=0.01) and dSBP (OR 0.96, 95% CI 0.94-0.99, p=0.004). ConclusionA relationship was found between lower sodium levels and lower systolic blood pressure, especially during waking hours, with a lower decline between daytime and night-time blood pressure.

Relationships between plasma amino acid concentrations and blood pressure in South Africans of African descent

Oral supplementation with the amino acid arginine, the precursor of the vasodilator nitric oxide (NO), is associated with a reduction in blood pressure (BP). However, it is uncertain whether a decreased plasma arginine concentration predicts increases in BP. We assessed the relationship between fasting plasma arginine or other amino acid concentrations and 24 hour ambulatory BP in 75 nevertreated participants recruited from the Johannesburg area, 55 of whom were male. Plasma amino acid concentrations were measured with high performance liquid chromatography-mass-spectrometry. Plasma arginine concentrations were not inversely correlated with ambulatory BP. However, plasma arginine concentrations were increased in 36 participants with a mean daytime systolic BP &gt;140 mm Hg (61 ± 17 μmol/L) as compared to the remaining participants (54 ± 15 μmol/L, p‹0.05). Moreover, plasma arginine concentrations were positively correlated with 24-hour diastolic BP (r=0.26, p‹0.05). In males with a BMI‹30kg/m2, plasma arginine concentrations were positively correlated with both night diastolic (r=0.46, p‹0.005) and systolic (r=0.42, p‹0.005) BP. In a multivariate model with adjustments for age gender, body mass index, and other amino acid concentrations, plasma arginine concentrations were independently and positively associated with night diastolic BP (p‹0.05). In conclusion plasma arginine concentrations are positively associated with ambulatory BP in a group of participants of African descent in South Africa. These data do not support the notion that deficiencies of arginine, the amino acid substrate for NO, are related to increases in BP in groups of African ancestry living in South Africa. However, as with other ethnic groups, the positive relationship between plasma arginine concentrations and BP suggests a reduced capacity to utilise the amino acid substrate for NO synthesis.

Clinic and ambulatory blood pressure in a population-based sample of African Americans: the Jackson Heart Study

Blood pressure (BP) can differ substantially when measured in the clinic versus outside of the clinic setting. Few population-based studies with ambulatory blood pressure monitoring (ABPM) include African Americans. We calculated the prevalence of clinic hypertension and ABPM phenotypes among 1016 participants in the population-based Jackson Heart Study, an exclusively African-American cohort. Mean daytime systolic BP was higher than mean clinic systolic BP among participants not taking antihypertensive medication (127.1[standard deviation 12.8] vs. 124.5[15.7] mm Hg, respectively) and taking antihypertensive medication (131.2[13.6] vs. 130.0[15.6] mm Hg, respectively). Mean daytime diastolic BP was higher than clinic diastolic BP among participants not taking antihypertensive medication (78.2[standard deviation 8.9] vs. 74.6[8.4] mm Hg, respectively) and taking antihypertensive medication (77.6[9.4] vs. 74.3[8.5] mm Hg, respectively). The prevalence of daytime hypertension was higher than clinic hypertension for participants not taking antihypertensive medication (31.8% vs. 14.3%) and taking antihypertensive medication (43.0% vs. 23.1%). A high percentage of participants not taking and taking antihypertensive medication had nocturnal hypertension (49.4% and 61.7%, respectively), white-coat hypertension (30.2% and 29.3%, respectively), masked hypertension (25.4% and 34.6%, respectively), and a nondipping BP pattern (62.4% and 69.6%, respectively). In conclusion, these data suggest hypertension may be misdiagnosed among African Americans without using ABPM.

Positive association between KCNJ5 rs2604204 (A/C) polymorphism and plasma aldosterone levels, but also plasma renin and angiotensin I and II levels, in newly diagnosed hypertensive Chinese: a case-control study.

Variants in G protein-coupled inward rectifier K+ channels 4 (GIRK4 also known as KCNJ5) gene are associated with primary aldosteronism, which is the most common cause of secondary hypertension. The KCNJ5 rs2604204 variant was shown to be common (minor allele frequency=32.5%) in Chinese patients with essential hypertension (EH). The relationship between KCNJ5 variant and plasma aldosterone (ALD) levels in EH patients has not been reported. We collected 229 patients with newly diagnosed EH without any antihypertensive agents. According to the median standing plasma ALD, high-ALD and control groups were divided. Clinical data and blood samples were collected. KCNJ5 rs2604204 genotype was determined by PCR. The results showed that the levels of triglyceride, uric acid, insulin, insulin resistance (IR) index, renin, angiotensin I (Ang I), angiotensin II (Ang II), cortisol, 24 h mean systolic blood pressure (SBP) and daytime mean SBP were significantly increased in the high-ALD group than those in the control group, as well as 24 h s.d. of SBP and diastolic BP (DBP), and 24 h coefficient of variance of SBP and DBP. Notably, the distribution frequency of AC and CC genotypes, and the C allele of KCNJ5 were also significantly higher in the high-ALD group. Logistic regression analysis showed that the C allele of KCNJ5 rs2604204 was one risk factor for increased plasma ALD in Chinese EH patients (P=0.008, odds ratio=2.2 (95% confidence interval 1.2-4.1)). Our findings indicated that the variation of plasma ALD might be associated with increased IR and BP variability. Moreover, KCNJ5 rs2604204 polymorphism was related to increased plasma ALD level, but also plasma renin, Ang I and II levels in newly diagnosed, never-treated EH patients.

Prevalence of Autonomic Dysreflexia in Patients with Spinal Cord Injury above T6.

Objective To investigate the prevalence of autonomic dysreflexia (AD) using ambulatory blood pressure monitoring (ABPM) and the autonomic dysfunction following spinal cord injury (ADFSCI) questionnaire in patients with spinal cord injury (SCI) above T6. Methods Twenty-eight patients diagnosed with SCI above T6 were enrolled. ABPM and ADFSCI were utilized to assess AD. Using ABPM, systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) were measured at 30-minute intervals. AD was defined as SBP 20 mmHg higher than basal SBP, and the number of AD events was counted. The ADFSCI questionnaire evaluates the severity and frequency of the AD symptoms. Results According to the ABPM, AD occurred in 26 patients and AD events occurred 5.8 ± 4.7 times. Average daytime and nighttime SBP were 119.9 ± 18.8 mmHg and 123.8 ± 21.2 mmHg, respectively, and the nighttime mean SBP appeared to be 4 mmHg higher than daytime mean SBP. These findings suggest the loss of nocturnal BP dipping in SCI patients. ADFSCI results revealed that 16 of the patients evaluated were symptomatic while 12 were asymptomatic. Conclusion AD following SCI above T6 was highly prevalent and several patients seemed asymptomatic. These results suggest the necessity of proper diagnostic and therapeutic interventions for managing AD.

PS 16-21 THE ROLE OF BIOCHEMICAL MARKERS OF INFLAMMATION IN THE VASCULAR WALL REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC DISORDERS

Objective: To study structural parameters of vessel wall, lipid and inflammatory biochemical parameters in patients with arterial hypertensions (AH) and abdominal obesity (AO). Design and method: 130 patients were included in the study and randomized into 2 groups. The group 1 included 77 subjects at the mean age 47.47 ± 10.17 with AH degree I-III and AO. 53 subjects at the mean age 47.67 ± 7.64 without metabolic disorders were involved in the group 2. The parameters of sphygmography and 24-hour blood pressure (BP) monitoring; biochemical parameters (lipid profile, ceruloplasmin and inflammatory markers – homocysteine, hs-CRP and endothelin-1) were estimated. Results: In group 1 there were registered: increase in sphygmography indexis (pulse wave velocity PWV, cardio-ankle vascular index CAVI and decrease ancle-brachial index ABI); increase in mean 24-hour and mean daytime systolic BP (SBP), in time and square indices and in daytime SBP variability. In biochemical parametrs increase in total cholesterol, LDL cholesterol, triglyceride, ceruloplasmin, homocysteine and hs-CRP; decrease HDL cholesterol compared to the patients in group 2. In group 1 there were registered positive correlation between inflammatory and lipid markers with parameters of sphygmography, parameters of 24-hour blood pressure monitoring. In the separation of patients by gender it has been shown that high levels of endothelin-1 and homocysteine were observed more frequently in women than men. It is noted that in women with an increase of the endothelin-1 per 1 fmol/l and homocysteine per 1 mcmol/L increased the PWV-L on 20 and 35%, accordingly. In men significant correlation parameters PWV-L with atherogenic lipid parameters and hs-CRP were identified. Conclusions: The findings indicate the nature of the close association of markers of inflammation and atherogenic lipid with remodeling process of the vessel wall in patients with AH and AO, especially obvious relationship atherogenic lipid parameters and hs-CRP in men and homocysteine, endothelin-1 in women.

PP.LB03.09] ARTERIAL STIFFNESS IN EXTREME DIPPER TREATED HYPERTENSIVES CORRELATES WITH 24-H BLOOD PRESSURE PARAMETERS

Objective: It has been shown that hypertensive extreme dipper patients have stiffer large arteries than dipper patients. The goal of our study was to correlate the arterial stiffness of treated hypertensive extreme dipper patients according to mean 24-h, mean day-time and mean night-time systolic (SBP), diastolic (DBP), mean (MBP) and pulse blood pressure (PP). Design and method: We selected 987 treated hypertensive patients who underwent 24-h ambulatory blood pressure monitoring. Extreme dipper profile was defined as a mean night-time SBP reduction of at least 20% compared to the mean daytime SBP. Arterial stiffness was measured using carotid-femoral pulse wave velocity (c-f PWV). Patients with secondary hypertension, diabetes mellitus renal failure (glomerular filtration rate < 60 mL/min/1.73 m2 calculated using the Modification of Diet in Renal Disease formula), atrial fibrillation, clinical suspicion of sleep apnoea, congestive heart failure, history of coronary artery disease, and those working at night were excluded. Correlations between c-f PWV and 24-h, day-time, night-time of SBP, DBP, MBP and PP were analyzed using a linear regression model. Results: 432 patients were selected, including 56 extreme dippers: 17 men (mean age: 52 ± 9 years old) and 39 women (mean age: 58 ± 8 years old) (p = 0.033). Mean BMI was of 27.06+/−5.06 kg/m2 (17.85–42.19) without any gender difference. Significant positive linear regressions were found only between c-f PWV and mean 24-H SBP (R = 0.59, p < 0.001), mean 24-h PP (R = 0.50, p < 0.001) and mean 24 h MBP (R = 0.41, p = 0.002).Conclusions: In hypertensive extreme dipper patients, the increase in c-f PWV, reflecting increased arterial stiffness, correlates with the elevation of 24-h blood pressure parameters, particularly mean 24-h SBP and mean 24-h PP, although these patients were already treated. These findings should encourage practitioners to control very effectively SBP and the other cardiovascular risk factors to avoid worsening of the arterial stiffness.

PP.21.10] INFLAMMATORY BIOCHEMICAL MARKERS AND FUNCTIONAL PARAMETERS OF ARTERIAL WALL IN HYPERTENSIVE PATIENTS WITH METABOLIC DISORDERS

Objective: To study inflammatory biochemical markers, functional parameters of vessel wall, 24-h blood pressure (BP) profile and their correlation with metabolic disorders in patients with arterial hypertension (AH) and abdominal obesity (AO). Design and method: 248 patients were divided into 2 groups: the main group (group 1) included 168 subjects (mean age 44.36 ± 1.52 years) with AH degree I-III and AO (mass body index (MBI) 32.4 ± 4.1 kg/m2) and the control group (group 2) - 80 subjects (mean age 42.27 ± 0.85 years) without metabolic disorders. The parameters of sphygmography; 24-hour BP monitoring; inflammatory markers – homocysteine, high-sensitivity C-reactive protein (hs-CRP), TNF-alpha, fibrinogen and ceruloplasmin and lipid parameters, diene conjugates, malonic dialdehyde (MDA), catalaze were estimated. Results: In group 1 there was registered significant increase in sphygmography indices (cardio-ankle vascular index (CAVI), pulse wave velocity (PVW) and ankle-brachial index (ABI) and in BP monitoring - mean 24-h and daytime systolic BP, time and square indices, in nighttime systolic BP and diastolic BP variability. In biochemical parameters significant increase in inflammatory markers - homocysteine, hs-CRP level and in total cholesterol, low-density lipoprotein cholesterol, triglyceride level and high-density lipoprotein cholesterol was detected compared to group 2. Besides in group 1 positive correlation between parameters of sphygmography with inflammatory and lipid markers (CAVI and homocysteine, triglyceride; PVW and fibrinogen; ABI and LDL cholesterol, MDA, hs-CRP, ceruloplasmin); with MBI, 24-h BP, age and sex of patients was found. Conclusions: Biochemical markers of inflammation along with the parameters of lipid profile may be associated with vascular remodeling in patients with AH and AO.

Effects of the novel norepinephrine prodrug, droxidopa, on ambulatory blood pressure in patients with neurogenic orthostatic hypotension

The prodrug droxidopa increases blood pressure (BP) in patients with neurogenic orthostatic hypotension. The BP profile of droxidopa in neurogenic orthostatic hypotension patients (n = 18) was investigated using ambulatory BP monitoring. Following dose optimization and a washout period, 24-hour “off-drug” data were collected. “On-drug” assessment was conducted after 4–5 weeks of droxidopa treatment (mean dose, 444 mg, three times daily). Ambulatory monitoring off drug revealed that 90% of patients already had abnormalities in the circadian BP profile and did not meet criteria for normal nocturnal BP dipping. On treatment, both overall mean 24-hour systolic and diastolic BPs were higher compared to off drug (137/81 mm Hg vs. 129/76 mm Hg; P = .017/.002). Mean daytime systolic BP was significantly higher with droxidopa (8.4 ± 3.1 mm Hg; P = .014). Although nocturnal BP was not significantly higher on droxidopa versus off treatment (P = .122), increases in nocturnal (supine) BP ≥10 mm Hg were observed in four cases (22%). Severe supine systolic hypertensive readings at night (>200 mm Hg) were captured in one case and only while on treatment. These data demonstrate that ambulatory BP monitoring is useful to evaluate the circadian BP profile after initiating treatment with a pressor agent.

Endovascular ultrasound for renal sympathetic denervation in patients with therapy-resistant hypertension not responding to radiofrequency renal sympathetic denervation

Recent studies have reported a considerable number of non-responders after renal sympathetic de-nervation (RSD) with radiofrequency technology. Here we report our results of repeat RSD using ultrasound in these patients. A cohort study was performed in patients who underwent ultrasound RSD after non-response to RSD with radiofrequency. Non-response was defined as mean daytime systolic blood pressure ≥140 mmHg and/or a reduction of ≤10 mmHg in ambulatory blood pressure measurement (ABPM) ≥6 months after radiofrequency denervation. ABPM was recorded at baseline, post radiofrequency RSD as well as at three and six months post ultrasound RSD. A total of 24 non-responders underwent retreatment with the ultrasound device at a mean 15.3±8.2 months after radiofrequency RSD. Ultrasound RSD was performed successfully in all patients without severe adverse events. Mean daytime systolic blood pressure changed from 161.7±14.6 mmHg at baseline to 158.5±9.5 mmHg post radiofrequency RSD and to 150.5±10.4 mmHg and 151.6±11.0 mmHg at three and six months, respectively, post ultrasound RSD (p<0.01 with repeated measures analysis of variance). The main results of post hoc testing were as follows: baseline versus post radiofrequency RSD, p=0.83; baseline versus three months post ultrasound RSD, p=0.01; and baseline versus six months post ultrasound RSD, p=0.04. Ultrasound RSD appears to be safe and an effective therapeutic approach in patients not responding to previous RSD with radiofrequency technology.

Associations of blood pressure variability and retinal arteriolar diameter in participants with type 2 diabetes.

Blood pressure variability is associated with macrovascular complications and stroke, but its association with the microcirculation in type II diabetes has not been assessed. This study aimed to determine the relationship between blood pressure variability indices and retinal arteriolar diameter in non-diabetic and type II diabetes participants. Digitized retinal images were analysed to quantify arteriolar diameters in 35 non-diabetic (aged 52 ± 11 years; 49% male) and 28 type II diabetes (aged 61 ± 9 years; 50% male) participants. Blood pressure variability was derived from 24-h ambulatory blood pressure. Arteriolar diameter was positively associated with daytime rate of systolic blood pressure variation (p = 0.04) among type II diabetes participants and negatively among non-diabetics (p = 0.008; interaction p = 0.001). This finding was maintained after adjusting for age, sex, body mass index and mean daytime systolic blood pressure. These findings suggest that the blood pressure variability-related mechanisms underlying retinal vascular disease may differ between people with and without type II diabetes.

Renal denervation improves exercise blood pressure: insights from a randomized, sham-controlled trial.

Despite the ongoing debate on the role of renal sympathetic denervation (RSD) in the management of therapy-resistant hypertension, little is known about its possible effects on exercise blood pressure (BP), a known predictor for future cardiovascular events. We sought to evaluate the effect of RSD on exercise BP in a randomized, sham-controlled trial in patients with mild hypertension. Patients with therapy-resistant mild hypertension (defined by mean daytime systolic BP between 135 and 149mmHg or mean daytime diastolic BP between 90 and 94mmHg on 24-h ambulatory BP measurement) were randomized to either radiofrequency-based RSD or a sham procedure. Patients underwent cardiopulmonary exercise testing at baseline and after 6months. Of the 71 patients randomized, data from cardiopulmonary exercise testing were available for 48 patients (22 in the RSD group, 26 in the sham group). After 6months, patients undergoing RSD had a significantly lower systolic BP at maximum exercise workload compared to baseline (-14.2±26.1mmHg, p=0.009). In contrast, no change was observed in the sham group (0.6±22.9mmHg, p=0.45, p=0.04 for between-group comparison). When analyzing patients with exaggerated baseline exercise BP only, the effect was even more pronounced (RSD vs. sham -29.5±23.4 vs. 0.1±25.3mmHg, p=0.008). Exercise systolic BP values in patients with mild therapy-resistant hypertension are reduced after RSD as compared to a sham-procedure.