Morning Blood Pressure Research Articles

SLEEP BLOOD PRESSURE MEASURED WITH A HOME BLOOD PRESSURE MONITOR WAS INDEPENDENTLY ASSOCIATED WITH INCIDENCE OF CARDIOVASCULAR DISEASES: THE NAGAHAMA STUDY

Objective: Nocturnal blood pressure (BP) was reported to be associated with cardiovascular diseases. However, nocturnal BP measured using ambulatory monitoring device usually includes BP without sleep. We investigated an association between sleep BP measured using a timer-equipped home BP monitor and cardiovascular diseases in a general population. Design and method: Study population was 6,037 middle-aged and older community residents (mean age: 57.8 years old, men: 30.9%). Participants were required to sleep with wrapping cuffs in the upper-arm and sleep BP was measured automatically at 0:00, 2:00, and 4:00. Actigraph was used to determine BP measured during sleep. Participants were also measured home morning BP manually using a same device. Incidence of cardiovascular diseases including stroke and myocardial infarction were assessed by reviewing personal hospital records. Results: Mean morning systolic and diastolic BP was 126 ± 18 and 77 ± 11 mmHg, respectively, while sleep systolic and diastolic BP was 112 ± 15 and 66 ± 9 mmHg. During 5.0 years mean follow-up period, we observed 80 cases of cardiovascular diseases (stroke and myocardial infarction). Morning hypertension (>135/85 mmHg) [hazard ratio (HR) = 3.22, P < 0.001] and sleep hypertension (>120/70 mmHg) [HR = 2.21, P = 0.002], but not office hypertension (>140/90 mmHg) [HR = 1.44, P = 0.127], was significantly associated with incidence of cardiovascular diseases independently of age, sex, and body mass index. Clinical characteristics including sleep efficiency (normotension: 91 ± 4%, sleep hypertension: 89 ± 5%, morning hypertension: 90 ± 4%, sleep and morning hypertension: 89 ± 5%, P< 0.001) and oxygen desaturation index (5.9 ± 4.8, 8.3 ± 6.6, 9.3 ± 7.1, 11.1 ± 9.0 times/h, P < 0.001) differed significantly by the hypertension status. However, sleep hypertension [HR = 2.94, P = 0.015], morning hypertension [HR = 4.81, P < 0.001], and sleep and morning hypertension [HR = 4.71, P < 0.001] was identified as significant factors for cardiovascular diseases after adjustment of covariates including the sleep parameters. Conclusions: High sleep BP measured home BP monitoring device was independently associated with incidence of cardiovascular disease in a general population.

METHODOLOGICAL AND DIAGNOSTIC RELIABILITY OF 24-H ABPM: A PARADIGM SHIFT IN DAILY CLINICAL PRACTICE?

Objective: Blood pressure measurementst form the cornerstone of diagnosing, treating, and researching arterial hypertension. The 24-hour ambulatory blood pressure monitoring (24-h ABPM) is widely considered best practice, but challenges such as availability and cost persist. This study evaluates the validity, accuracy, and practicality of ABPM in clinical settings. Design and method: Retrospectively analyzing 450 24-h ABPM measurements from the Nephrology Center Göttingen, using validated devices from I.E.M. and BOSO, this study assesses adherence to European Society of Hypertension (ESH) and German Hypertension Society (DHL) guidelines. Criteria include a minimum 24-hour recording, at least 20 valid day and 7 valid night measurements, and a minimum of 70% overall validity. Patient cancellations are considered if measurements end before 7:30 a.m. or last less than 22 hours without technical faults. Results: Only 23% (n=106) of ABPMs met all guideline criteria; 77% failed at least one criterion. In 27% (n=120) of cases, duration was below 24 hours, and in 22% (n=98), it was below 22 hours. Motion artifacts caused validity failures in 50%, daytime pressurization issues in 17%, and nighttime issues in 27%. Patient cancellations constituted 20.6% (n=93), with adipose patients 40% more likely to cancel. Diabetes and severe hypertension correlated with a 40% reduction in guideline-conforming measurements. Sixteen percent (n=72) were canceled without recording early morning blood pressure, correlating strongly with cardiovascular risk. Conclusions: The study emphasizes the importance of correct ABPM execution, urging explicit discussions with patients. Acknowledging ABPM limitations, the paper recommends additional methods like telemetrically transferred blood pressure measurements at home (idTM) for intervention options. Given the variability in ABPM data quality, its validity must be scrutinized case by case. The findings advocate for increased use of home blood pressure measurements, aligning with current guidelines for diagnostics and therapy.

Effects of At-Risk Drinking on Ambulatory Blood Pressure in Young Adults

Introduction: At-risk drinking is associated with an increased risk of cardiovascular diseases (CVD) even in young adults. However, this association is mainly based on offce blood pressure (BP) measurement. Ambulatory BP monitoring captures diurnal variation in BP and is a more sensitive CVD predictor than offce BP. Therefore, the purpose of this study is to investigate the effects of at-risk drinking on ambulatory BP in young healthy adults with normal offce BP. Method: A total of 20 healthy men and women (21-35 years), non-smokers, were included in this cross-sectional study. All participants had an offce BP lower than 130/80 mmHg. Using the US Alcohol Use Disorders Identification Test (USAUDIT), at-risk drinkers were defined as those having a total USAUDIT score higher than 7 for men (6 for women). All participants underwent 24-hour ambulatory BP monitoring (Oscar 2™, SunTech Medical®). To investigate the vascular mechanisms underlying the effects of at-risk drinking on ambulatory blood pressure, aortic arterial stiffness and wave reflection were measured as pulse wave velocity (PWV) and augmentation index (AIx) by using SphygmoCor XCEL system (AtCor Medical). Results: No differences were found in age and BMI between at-risk drinkers (n=10) vs. low-risk drinkers (n=10; mean ± SD for age: 26.7 ± 3.7 vs. 26.6 ± 4.3 years, P>0.99 and BMI: 24.5 ± 2.4 vs. 23.8 ± 2.9 kg/m2, P=0.6). At-risk drinkers had a higher total USAUDIT score (10.6 ± 2.7 vs. 1.4 ± 1.2, p<0.001). While there was no difference between at-risk drinkers and low-risk drinkers in 24-hour, daytime, and nighttime systolic and diastolic BP (P≥0.5), at-risk drinkers had a higher blood pressure morning surge compared to low-risk drinkers (systolic: 34 ± 10 vs. 22 ± 6 mmHg, P=0.014 and diastolic: 29 ± 9 vs. 15 ± 4 mmHg, P=0.002). No significant difference was found in PWV (5.7 ± 0.6 Vs. 5.5 ± 0.7 m/sec, P=0.4) and AIx (8 ± 8 Vs. 15 ± 11, P=0.1). Conclusion: Our results indicate that despite similar offce BP, young adult at-risk drinkers had higher BP morning surge, an independent risk factor for cardiovascular events, than low-risk drinkers. These findings provide implications in using USAUDIT and out-of-offce BP measurements for cardiovascular disease risk assessment. This work was supported by NIAAA AA028537 to CLH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

A novel TASK channel antagonist nasal spray reduces sleep apnea severity in physiological responders: a randomized, blinded, trial.

Preclinical and human physiological studies indicate that topical, selective TASK 1/3 K+ channel antagonism increases upper airway dilator muscle activity and reduces pharyngeal collapsibility during anesthesia and nasal breathing during sleep. The primary aim of this study was to determine the effects of BAY2586116 nasal spray on obstructive sleep apnea (OSA) severity and whether individual responses vary according to differences in physiological responses and route of breathing. Ten people (5 females) with OSA [apnea-hypopnea index (AHI) = 47 ± 26 events/h (means ± SD)] who completed previous sleep physiology studies with BAY2586116 were invited to return for three polysomnography studies to quantify OSA severity. In random order, participants received either placebo nasal spray (saline), BAY2586116 nasal spray (160 µg), or BAY2586116 nasal spray (160 µg) restricted to nasal breathing (chinstrap or mouth tape). Physiological responders were defined a priori as those who had improved upper airway collapsibility (critical closing pressure ≥2 cmH2O) with BAY2586116 nasal spray (NCT04236440). There was no systematic change in apnea-hypopnea index (AHI3) from placebo versus BAY2586116 with either unrestricted or nasal-only breathing versus placebo (47 ± 26 vs. 43 ± 27 vs. 53 ± 33 events/h, P = 0.15). However, BAY2586116 (unrestricted breathing) reduced OSA severity in physiological responders compared with placebo (e.g., AHI3 = 28 ± 11 vs. 36 ± 12 events/h, P = 0.03 and ODI3 = 18 ± 10 vs. 28 ± 12 events/h, P = 0.02). Morning blood pressure was also lower in physiological responders after BAY2586116 versus placebo (e.g., systolic blood pressure = 137 ± 24 vs. 147 ± 21 mmHg, P < 0.01). In conclusion, BAY2586116 reduces OSA severity during sleep in people who demonstrate physiological improvement in upper airway collapsibility. These findings highlight the therapeutic potential of this novel pharmacotherapy target in selected individuals.NEW & NOTEWORTHY Preclinical findings in pigs and humans indicate that blocking potassium channels in the upper airway with topical nasal application increases pharyngeal dilator muscle activity and reduces upper airway collapsibility. In this study, BAY2586116 nasal spray (potassium channel blocker) reduced sleep apnea severity in those who had physiological improvement in upper airway collapsibility. BAY2586116 lowered the next morning's blood pressure. These findings highlight the potential for this novel therapeutic approach to improve sleep apnea in certain people.

Habitual salt preference worsens blood pressure in hospitalized hypertensive patients with omicron infection under epidemic-related stress

BackgroundWe investigated the synergistic effect of stress and habitual salt preference (SP) on blood pressure (BP) in the hospitalized Omicron-infected patients.MethodsFrom 15,185 hospitalized Omicron-infected patients who reported having high BP or hypertension, we recruited 662 patients. All patients completed an electronic questionnaire on diet and stress, and were required to complete morning BP monitoring at least three times.ResultsThe hypertensive group (n = 309) had higher habitual SP (P = 0.015) and COVID-19 related stress (P < 0.001), and had longer hospital stays (7.4 ± 1.5 days vs. 7.2 ± 0.5 days, P = 0.019) compared with controls (n = 353). After adjusting for a wide range of covariates including Omicron epidemic-related stress, habitual SP was found to increase both systolic (4.9 [95% confidence interval (CI), 2.3–7.4] mmHg, P < 0.001) and diastolic (2.1 [95%CI, 0.6–3.6] mmHg, P = 0.006) BP in hypertensive patients, and increase diastolic BP (2.0 [95%CI, 0.2–3.7] mmHg, P = 0.026) in the control group. 31 (8.8%) patients without a history of hypertension were discovered to have elevated BP during hospitalization, and stress was shown to be different in those patients (P < 0.001). In contrast, habitual SP was more common in hypertensive patients with uncontrolled BP, compared with patients with controlled BP (P = 0.002).ConclusionsHabitual SP and psychosocial stress were associated with higher BP in Omicron-infected patients both with and without hypertension. Nonpharmaceutical intervention including dietary guidance and psychiatric therapy are crucial for BP control during the long COVID-19 period.

Effects of different physical exercise types on health outcomes of individuals with hypertensive disorders of pregnancy: a prospective randomized controlled clinical study

Objective To explore the impacts of different types of physical exercise on health outcomes of individuals with hypertensive disorders of pregnancy (HDPs). Methods Forty individuals with HDPs admitted to a tertiary hospital providing maternal and pediatric care between July 2023 and March 2024 were enrolled in this prospective randomized controlled clinical study and completed a ≥4-week intervention. Data were collected before the intervention and before delivery. Participants were assigned randomly to control (no exercise intervention), aerobic exercise (AE), resistance training (RT), and AE + RT groups. All participants downloaded a mobile health-education app for gestational hypertension developed by our research group. Exercise videos in the app guided participants’ performance of different types of exercise. General information; physical activity and sleep quality data; morning blood pressure, lipid profiles, and urinary micro-albumin/creatinine ratios; serum soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and advanced oxidation protein product (AOPP) concentrations; and pregnancy outcome data were collected and compared among groups. Results After the intervention, the physical activity status, sleep quality, morning blood pressure, lipid profiles, urinary micro-albumin/creatinine ratios, and pregnancy outcomes differed significantly among all groups comparing with control (all p < .05). In the three exercise groups, the serum sFlt-1, PlGF, and AOPPs levels improved significantly (all p < .05). All differences were most pronounced in the AE + RT group. Limitations The study period was relatively short. The further long-term follow-up research is needed. A larger sample size study is also needed. Conclusions The study results suggest that AE + RT interventions are beneficial for individuals with HDPs in clinical settings, and could be implemented with careful consideration of individuals’ specific conditions.

Effects of a maintenance period on ambulatory blood pressure and morning blood pressure surge in young normotensives post isometric training.

Isometric resistance training (IRT) has emerged as an efficacious therapeutic intervention to reduce ambulatory blood pressure (BP), and BP diurnal variability. However, once the required decreases in BP have been achieved the efficacy of implementing a reduced maintenance dose is not understood. Therefore, the purpose of this study was to determine the effects of an 8-week maintenance period (8-week) following the cessation of the prescribed 8-week IRT in young normotensives. Twenty-two recreationally active, not resistance trained, normotensive (24-h ambulatory SBP, ≥130mmHg) young adults were randomly assigned to a training-maintenance [TG-MT; n = 13 (female = 5); age 21 ± 2years] or a non-training control [CON; n = 9 (female = 4); age 23 ± 3years] group. Ambulatory BP, morning BP surge (MBPS) and average real variability (ARV) were measured prior to, after 8 weeks of bilateral leg IRT (4x2-minute contractions at 20% MVC with 2-min rest periods, 3days/week) and following an 8-week (once per week) maintenance period. On completion of the maintenance period the significant reductions seen following the IRT were maintained within the TG-MT group in 24-h ambulatory SBP (6 ± 4mmHg, p < 0.001), daytime (5 ± 5mmHg, p = 0.002), MBPS (7 ± 10mmHg, p = 0.019) and 24-h SBP ARV (2.03 ± 1.44mmHg, p = 0.001), daytime SBP ARV (2.04 ± 1.78mmHg, p = 0.003). These results show that reductions in ambulatory BP (24-h SBP and daytime SBP), in addition to BP diurnal variations (MBPS, 24-h SBP ARV and daytime SBP AVR) are maintained following an 8-week maintenance dose in young adults and add further weight to the growing body of evidence promoting IRT as an efficacious therapeutic exercise intervention to prevent or reduce BP.

Morning blood pressure surge and intracranial atherosclerotic plaque characteristics: a high-resolution magnetic resonance vessel wall imaging study.

To investigate the relationship between morning blood pressure surge (MBPS) and intracranial atherosclerotic plaque burden and vulnerability. A total of 267 ischaemic stroke patients were retrospectively analysed. Sleep-trough and prewaking MBPS were calculated from ambulatory blood pressure monitoring (ABPM). Plaque characteristics, including intraplaque haemorrhage (IPH), maximum wall thickness (max WT), and stenosis degree, were obtained from high-resolution MR vessel wall imaging (HR-vwMRI). Linear and logistic regression were used to detect the association. Subjects with the top tertile of sleep-trough MBPS (≥15.1 mmHg) had a lower prevalence (9.1% vs. 19.6%, P = .029) of severe stenosis (≥70%) than others. Subjects within the top tertile of prewaking MBPS (≥7.6 mmHg) had a lower percentage of IPH (27.3% vs. 40.4%, P = .035) than others. After adjusting for stroke risk factors (age, sex, diabetes, hyperlipidaemia, hyperhomocysteinaemia, smoking, and family stroke history) and 24-h mean systolic blood pressure, 10 mmHg sleep-trough MBPS increment was associated with 0.07mm max WT reduction, and the top tertile MBPS group was associated with a lower chance of severe stenosis (odd ratio = 0.407, 95% CI, 0.175-0.950). Additionally, an increased prewaking MBPS is associated with a lower incidence of IPH, with OR = 0.531 (95% CI, 0.296-0.952). Subgroup analysis demonstrated that the positive findings could only be seen in non-diabetic subjects. Increment of MBPS is negatively associated with intracranial atherosclerotic plaque burden and vulnerability, and this relationship remains significant in the non-diabetic subgroup. This study provided evidence that MBPS was associated with the intracranial atherosclerotic plaque burden and vulnerability on HR-vwMRI.

Retracted: Effect of MTHFRC677 T Gene Polymorphism on Early Morning Blood Pressure in Elderly Female Patients with H-Type Hypertension

Retracted: Effect of MTHFRC677 T Gene Polymorphism on Early Morning Blood Pressure in Elderly Female Patients with H-Type Hypertension

Abstract 16605: Differential Impact of Nighttime Home Blood Pressure on Between Patients With and Without Subclinical Heart Failure

Introduction: Nighttime blood pressure (BP) has stronger association with cardiovascular events than office BP, 24-hr BP, and awake BP. However, it was not clear whether the impact of nighttime BP is different for patients with or without heart failure (HF). Hypothesis: Nighttime home BP has stronger association with cardiovascular events in patients with HF. Methods: We analyzed the data from the Japan Morning Surge-Home Blood Pressure study with NT-proBNP and nighttime home BP measurement. We enrolled 2494 patients who had at least one cardiovascular risk factor. Morning, evening, and nighttime home BP were measured and cardiovascular events were followed up. Results: During 7.1 years follow-up, 168 events occurred. When NT-proBNP of 125pg/ml was used as cutoff, the patients with NT-proBNP&gt;125pg/ml was higher daytime home SBP and nighttime home SBP than the patients with NT-proBNP≤125pg/ml (137±16 vs 132±13 mmHg, p&lt;0.01, 126±18 vs 120±14 mmHg, p&lt;0.01, respectively). In Cox regression analysis adjusting for significant covariates, daytime and nighttime home SBP were significant predictor for the outcome in the patients with NT-proBNP&gt;125pg/ml (HR 1.02, 95%CI:1.01-1.03, p&lt;0.01, HR 1.02, 95%CI:1.00-1.03, p=0.045, respectively). On the other hands, only nighttime home SBP was remained as a predictor for the outcome in the patients with NT-proBNP≤125pg/ml (HR 1.02, 95%CI:1.00-1.03, p=0.01). Conclusions: Nighttime home BP was associated with prognosis in patients with and without subclinical HF. Daytime home BP was associated with prognosis in patients with subclinical HF but not in the without subclinical HF.

Abstract 15801: Nighttime Hypertension is a Risk Factor for Cardiovascular Events in Stage B Heart Failure Patients

Background: Nighttime blood pressure (BP) was reported to have a stronger association with cardiovascular outcome and hypertensive organ damage than clinic BP, 24-hour BP, and daytime BP in hypertensives. However, the significance of nighttime BP was not established in stage B heart failure (HF) patients. We hypothesized that nighttime BP measured by home BP monitoring device was associated with cardiovascular outcome in stage B HF patients. Method: We used the dataset of Japan Morning Surge-Home Blood Pressure study (J-HOP study), and selected 417 of stage B HF patients. The definition of stage B HF was based on Universal definition of HF. The patients with history of HF hospitalization were excluded. BP was measured on waking, before bedtime and during the night. The cardiovascular event was followed. Result: Mean follow-up period was 6.6±3.8 years, and 59 cardiovascular events were occurred. When nighttime hypertension was defined as nighttime BP &gt;120mmHg, nighttime HT group showed higher BMI, serum creatinine, HbA1c, and higher prevalence of diabetes, atrial fibrillation, and chronic kidney disease, and lower HDL-cholesterol than nighttime normotension (NT) group. With regard to BP, nighttime HT group, clinic BP, home morning BP, home evening BP, and home nighttime BP were higher in nighttime HT group than in nighttime NT group. In Kaplan-Meier analysis, nighttime HT group had a higher incident of cardiovascular event than nighttime NT group (P&lt;0.01). In Cox multivariate analysis, nighttime HT was significant predictor for cardiovascular event adjusting by significant variables (Hazard ratio 1.84, 95% Confidence interval: 1.01-3.36, P=0.046). Conclusions: Nighttime HT was a prognostic factor in stage B HT patients. Nighttime BP was a therapeutic target to improve the outcome in stage B HT patients.

Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients.

Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.

The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure.

Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05. The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions. MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Mediating effect of subclinical inflammation on the process of morning hypertension leading to atrial fibrillation in community-based older adults

ABSTRACT Background The impacts and mechanisms of morning hypertension (MHT) on the risk of new-onset atrial fibrillation (AF) in the elderly have not been clarified. We aimed to investigate an association between MHT and new-onset AF and explore a mediating effect of subclinical inflammation on this association. Methods From 2008 to 2010, 1789 older adults aged ≥60 years were recruited in Shandong area, China. Morning blood pressure (BP) was assessed using 24-hour ambulatory BP monitoring. MHT was defined as BP ≥ 135/85 mm Hg during the period from wake time to 0900 a.m. Subclinical inflammation was assessed by hypersensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and galectin-3. New-onset AF was rated during the follow-up period. Results Over an average 129.0 [standard deviation (SD): 21.58] months of follow-up, the hazard ratio of new-onset AF in MHT patients was 1.39 (95% confidence interval: 1.01 to 1.91) compared with non-MHT participants (Padjusted = 0.027). The risk of new-onset AF was 1.17-fold with one-SD increment of morning systolic BP. Subclinical inflammation was significantly associated with new-onset AF. The hazard ratios of new-onset AF were 2.29, 2.04, 2.08, 2.08, 2.03, and 3.25 for one-SD increment in hsCRP, TNF-α, SII, NLR, PLR, and galectin-3, respectively (Padjusted < 0.001). The analysis showed that hsCRP, TNF-α, SII, NLR, PLR, and galectin-3 separately mediated the process of MHT inducing new-onset AF (Padjusted < 0.05). Conclusions MHT is associated with an increased risk of new-onset AF. The subclinical inflammation might play a mediating role in this association.

The morning blood pressure surge in diabetic hypertensive patients with different dipper patterns

The morning blood pressure surge in diabetic hypertensive patients with different dipper patterns

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect.

Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep.It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression.A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.

The relationship between morning blood pressure surge and serum IGF-1 level in acromegaly patients with hypertension.

High levels of insulin-like growth factor 1 (IGF-1) in patients with acromegaly cause structural and functional changes specific to the disease. These changes lead to mortality if the disease is not treated. Circadian blood pressure (BP) rhythm as measured by 24-h ambulatory blood pressure monitoring (ABPM) can change with a decrease in BP during sleep and a sudden increase in wakefulness. We aim to evaluate the relationship between changes in BP and IGF-1 levels in patients with acromegaly. Patients who were diagnosed with acromegaly and the patient group with hypertension were included. Serum biochemistry parameters, serum IGF-1 level and ABPM follow-ups were compared in these patients. In our study, 30 patients with acromegaly and 30 patients with hypertension without acromegaly were included. Thirty of the patients were male and 30 were female. There was a statistically significant difference between the groups in terms of IGF-1(p = < 0.001) and GH(p = 0.004). There was no significant difference between patients' office systolic/diastolic BP measurements, day/night, systolic/diastolic BP measurements and all systolic/diastolic BP measurements in ambulatory blood pressure follow-ups. There was a significant difference in morning blood pressure surge(p = < 0.001). A statistically significant difference was found between the acromegaly patient groups with MBPS below and above 25mmHg in terms of IGF-1 (p = 0.025) and platelet levels (p = 0.004). As a result, cardiovascular disease risks can be predicted in patients with high serum IGF-1 levels by planning ambulatory blood pressure in the early period.

Correlation of blood pressure levels at different time periods throughout the day with total CSVD burden and MRI imaging markers.

Hypertension is an important risk factor for atherosclerotic cerebral small vessel disease (CSVD). Higher blood pressure is associated with a higher CSVD burden and the presence of relevant magnetic resonance imaging (MRI) markers. However, the effect of blood pressure level on CSVD burden and imaging markers including white matter hyperintensity (WHM), lacune, enlarged perivascular spaces (EPVS), and cerebral microbleed (CMB) remains unknown. The purpose of this study was to investigate the correlation between blood pressure level and CSVD burden at different time periods throughout the day. In total, 144 in-patients with CSVD (66.4 ± 9.8 years, 50% male) were enrolled and underwent brain MRI, and 24-h ambulatory blood pressure was assessed. Patients were categorized into five groups according to their MRI-evaluated total CSVD burden scores (0-4). Spearman's correlation analysis was performed to examine the correlation between blood pressure levels at different time periods and the total CSVD score or the markers of periventricular WMH, deep WMH, lacune, EPVS, and CMB. Of the 144 patients, 83.3% (120/144) harbored one or more CSVD markers of interest. The systolic blood pressure (SBP) of 24-h, daytime, nighttime, and morning differed significantly among the five groups. The SBP levels increased significantly with the total CSVD scores during 24 h (P = 0.018), daytime (P = 0.018), and nighttime (P = 0.035). Spearman's correlation analysis demonstrated that the SBP of 24 h, daytime, nighttime, and morning and the diastolic blood pressure (DBP) of 24 h and morning positively and significantly correlated with the total CSVD score (P < 0.05). A logistic regression analysis indicated that both morning SBP and DBP were independent risk factors for total CSVD burden (OR = 1.13, 95% CI: 1.02-1.23, P = 0.015; OR = 1.19, 95% CI: 1.06-1.33, P = 0.005). Spearman's correlation analysis indicated a significant positive correlation between morning SBP and higher deep WMH Fazekas score (r = 0.296, P < 0.001), EPVS grade in the basal ganglia (r = 0.247, P = 0.003), and the presence of lacune (r = 0.173, P = 0.038) and CMB (r = 0.326, P < 0.001). Morning DBP only correlated positively with the presence of CMB (r = 0.292, P < 0.001). Higher SBP signficantly correlated with total CSVD burden in patients with atherosclerotic CSVD. Early morning blood pressure level is an important indicator to reflect the severity of CSVD patients.

Acute social jetlag augments morning blood pressure surge: a randomized crossover trial

Although social jetlag (SJL) is generally considered a chronic condition, even acute SJL may have unfavorable effects on the cardiovascular system. We focused on the acute effects of SJL on morning blood pressure (BP) surge. This randomized crossover trial recruited 20 healthy men. In the SJL trial, participants delayed their bedtime by three hours on Friday and Saturday nights. Participants in the control (CON) trial implemented the same sleep-wake timing as on weekdays. Pre- and post-intervention measurements were performed to evaluate resting cardiovascular variables on Friday and Monday mornings, respectively. The ambulatory BP was automatically measured during the sleep and awake periods for 2 h after the participant woke up at night before pre- and post-intervention measurements. SJL (average mid-sleep time on weekends – average mid-sleep time on weekdays) occurred only in the SJL trial (SJL: 181 ± 24 min vs. CON: 8 ± 47 min). Carotid-femoral pulse wave velocity (cfPWV) and morning BP surge on Monday in the SJL trial were significantly higher than those on Friday in the SJL trial (cfPWV: P = 0.001, morning BP surge: P < 0.001), and those on Monday in the CON trial (cfPWV: P = 0.007; morning BP surge: P < 0.001). Furthermore, a significant positive correlation was found between ΔcfPWV and Δmorning BP surge (R = 0.587, P = 0.004). These results suggest that even acute SJL augments morning BP surge. This phenomenon may correspond to increased central arterial stiffness.State the details of Clinical Trials: Name: Effect of acute social jetlag on risk factors of lifestyle-related diseases. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053204. Unique identifier: UMIN000046639. Registration date: 17/01/2022