Night Diastolic Blood Pressure Research Articles

Preliminary Study on the Effect of a Night Shift on Blood Pressure and Clock Gene Expression.

Night shift work has been found to be associated with a higher risk of cardiovascular and cerebrovascular disease. One of the underlying mechanisms seems to be that shift work promotes hypertension, but results have been variable. This cross-sectional study was carried out in a group of internists with the aim of performing a paired analysis of 24 h blood pressure in the same physicians working a day shift and then a night shift, and a paired analysis of clock gene expression after a night of rest and a night of work. Each participant wore an ambulatory blood pressure monitor (ABPM) twice. The first time was for a 24 h period that included a 12 h day shift (08.00-20.00) and a night of rest. The second time was for a 30 h period that included a day of rest, a night shift (20.00-08.00), and a subsequent period of rest (08.00-14.00). Subjects underwent fasting blood sampling twice: after the night of rest and after the night shift. Night shift work significantly increased night systolic blood pressure (SBP), night diastolic blood pressure (DBP), and heart rate (HR) and decreased their respective nocturnal decline. Clock gene expression increased after the night shift. There was a direct association between night blood pressure and clock gene expression. Night shifts lead to an increase in blood pressure, non-dipping status, and circadian rhythm misalignment. Blood pressure is associated with clock genes and circadian rhythm misalignement.

Correlation between blood pressure variability and deep cerebral microbleeds in patients with acute ischemic stroke.

To observe the 24-h ambulatory blood pressure characteristics of patients with acute ischemic stroke and explore the correlation between blood pressure variability and strictly deep cerebral microbleeds (CMBs). A convenient sampling method was used to enrol 131 patients with acute ischemic stroke in the Department of Neurology between April 2021 and May 2022. Hospitalised patients with acute ischemic stroke were assessed retrospectively; their ambulatory blood pressure was monitored continuously for 24 h, and the relevant parameters were recorded. Magnetic susceptibility-weighted imaging was used to divide the CMBs into a strictly deep CMB group ( n = 24) and a non-CMB group ( n = 107) according to the location of the CMBs. A logistic regression analysis was performed to determine the independent correlation between the 24-h ambulatory blood pressure parameters and strictly deep CMBs. The receiver operating characteristic (ROC) was further used to analyse the predictive value of the ambulatory blood pressure parameters for strictly deep CMBs in patients with acute ischemic stroke. The results showed that the night systolic blood pressure standard deviation and the night diastolic blood pressure standard deviation (NDBP-SD) in the strictly deep CMB group were higher than those in the non-CMB group ( p < 0.05). The multiple logistic regression analysis indicated that the NDBP-SD (odds ratio [OR] = 1.205, 95% confidence interval [CI]: 1.011-1.436, p = 0.038) was an independent risk factor for strictly deep CMBs in patients. The ROC curve analysis revealed that the area under the curve value of the NDBP-SD was 0.682, and the intercept was 7.81. When NDBP-SD is ≥ 7.81, the occurrence of strictly deep CMBs is closely related (OR = 3.872, 95% CI: 1.347-11.125, p = 0.012). The NDBP-SD is an independent risk factor for strictly deep CMBs in patients with acute ischemic stroke. When NDBP-SD is > 7.81, it may promote the production of strictly deep CMBs.

PS-C13-11: EFFECT OF HYPOKALEMIA ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Object: Analyzing the changes of left ventricular structure and function in essential hypertension patients with hypokalemia, we want to provide an evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia. Methods: 413 patients with hypertension who were hospitalized in the Hypertension Center of Lanzhou University Second Hospital from January 2015 to June 2021 were selected, including 270 cases of essential hypertension and 143 cases of essential hypertension with hypokalemia. Collect patient general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness and other indicators. After propensity score matching, 108 cases in the essential hypertension group and the essential hypertension with hypokalemia group were each, and statistical analysis was performed. Results: Albumin, and urea-creatinine ratio levels of the essential hypertension with hypokalemia group were significantly reduced, and the ratios of sodium ions and sodium potassium were lower than those of the primary hypertension group. Correlation analysis shows that the left ventricular mass index was positively correlated with and the course of hypertension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, creatinine, sodium-to-potassium ratio, mean systolic blood pressure during the day, mean diastolic blood pressure during the day, mean systolic blood pressure at night, mean night diastolic blood pressure. Multiple linear regression analysis showed that the left ventricular mass index was independently positively correlated with systolic blood pressure, hypertension course, creatinine, sodium-to-potassium ratio, night systolic blood pressure, 24 h average systolic blood pressure, and 24 h systolic blood pressure load rate; potassium ion, low density Lipoprotein, angiotensin II and left ventricular mass index are independently and negatively correlated. Conclusion: There are more obvious ventricular structural changes in essential hypertension patients with hypokalemia; serum potassium ion concentration and sodium-to-potassium ratio are independent risk factors for left ventricular mass index in essential hypertension patients with hypokalemia.

24-HOUR AMBULTORY BLOOD PRESSURE MEASUREMENT USING A NOVEL NON-INVASIVE, CUFF-LESS, WIRELESS DEVICE

Objective: Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for the diagnosis and treatment of hypertension. Technical limitations, low compliance, and complex procedures limit their use. The aim of the present study was to test the accuracy of a new photoplethysmography (PPG)-based, wearable device (Wrist-monitor) as compared to the standard cuff-based ABPM device. Design and method: 24H ABPM was performed in parallel for both devices on volunteers aged 18–65 years while documenting their daily activities. The level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between devices. Receiver Operating Characteristic (ROC) curve analysis was used to classify hypertension based on the average Wrist-monitor measurements as compared to a cuff-based ABPM device. Results: The study included 28 subjects (18 men) mean age of 41.5 ± 16.2 years. The Bland-Altman analysis resulted in a 24H bias of -1.1 mmHg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was -1.9 mmHg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mmHg for DBP and SBP respectively). ROC curve analysis yielded a mean area under the curve (AUC) of 1 for SBP and 24H BP measurements. AUCs of 0.994 and 0.955 were found for the daytime DBP and night DBP, respectively. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared to the cuff-based device (p &lt; 0.001). Conclusions: The cuff-less device provides comparable measurements to those obtained with the currently used cuff-based ABPM device, with significantly less inconvenience to the subject.

STUDY ON HYPERTENSION-RELATED TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION PATIENTS WITH HYPOKALEMIA

Objective: To explore the early target organ damage in essential hypertension patients with hypokalemia,we nalysed ambulatory blood pressure, cardiac structure and function, early renal function, neck blood vessels and head imaging in patients with essential hypertension. Design and method: 590 patients with hypertension who were nalysedsed from January 2015 to June 2021 were selected, including 257 cases with hypokalemia and 76 cases have primary aldosteronism.Collect patients’ general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure monitoring.The results were statistically nalysed by SPSS. Results: Compared with the essential hypertension group,average systolic blood pressure during the day, average diastolic blood pressure during the day, average systolic blood pressure at night, and average diastolic blood pressure at night, 24 h average systolic blood pressure, 24 h average diastolic blood pressure, daytime systolic blood pressure load rate, night diastolic blood pressure load rate, 24 h systolic blood pressure load rate, and 24 h diastolic blood pressure load rate were significantly higher in both the hypokalemia group and the essential hyperaldosteronism group (P &lt; 0.05). Urinary microalbumin in the primary hypertension with hypokalemia group and primary aldosteronism group was significantly higher than that in the primary hypertension group (P &lt; 0.05).The 24 h average diastolic blood pressure, night systolic blood pressure load rate, and 24 h systolic blood pressure load rate were all positively correlated with urine microalbumin(P &lt; 0.05); they were negatively correlated with serum potassium ion (P &lt; 0.05). The nighttime mean systolic blood pressure and nighttime systolic pressure load rate were independently positively correlated with urine microalbumin (P &lt; 0.05), and serum potassium ions were independently negatively correlated with urine microalbumin by Multiple linear regression analysis (P &lt; 0.05). Conclusions: Essential hypertension patients with hypokalemia have higher 24 h blood pressure and blood pressure load rate, and have more serious early renal damage than patients with normal potassiumic Otherwise, Serum potassium concentration was an independent risk factor for urinary microalbumin in essential hypertension patients with hypokalemia

EFFECT OF HYPOKALEMIA ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Analyzing the changes of left ventricular structure and function in essential hypertension patients with hypokalemia, we want to provide an evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia. Design and method: 413 patients with hypertension were selected, including 270 cases of essential hypertension and 143 cases of essential hypertension with hypokalemia.Collect patient general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness and other indicators.After propensity score matching, 108 cases in the essential hypertension group and the essential hypertension with hypokalemia group were each, and statistical analysis was performed. Results: Albumin, and urea-creatinine ratio levels of the essential hypertension with hypokalemia group were significantly reduced, and the ratios of sodium ions and sodium potassium were lower than those of the primary hypertension group. Correlation analysis shows that the left ventricular mass index was positively correlated with and the course of hypertension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, creatinine, sodium-to-potassium ratio, mean systolic blood pressure during the day, mean diastolic blood pressure during the day, mean systolic blood pressure at night, mean night diastolic blood pressure. Multiple linear regression analysis showed that the left ventricular mass index was independently positively correlated with systolic blood pressure, hypertension course, creatinine, sodium-to-potassium ratio, night systolic blood pressure, 24 h average systolic blood pressure, and 24 h systolic blood pressure load rate; potassium ion, low density Lipoprotein, angiotensin II and left ventricular mass index are independently and negatively correlated. Conclusions: There are more obvious ventricular structural changes in essential hypertension patients with hypokalemia; serum potassium ion concentration and sodium-to-potassium ratio are independent risk factors for left ventricular mass index in essential hypertension patients with hypokalemia.

Effect of one-day intermittent fasting on 24-hour blood pressure profile in hypertensive and normotensive patients with overweight and obesity

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): National Academy of Medical Science of Ukraine Background The modification of eating behavior is an integral part of cardiovascular disease prevention. Intermittent fasting is a modern approach towards diet correction. However, insufficient data exists on its effect and safety on daily blood pressure and lipids. The aim of this paper was to assess the response of blood pressure, blood lipids and creatinine to acute intermittent fasting (IF) in hypertensive and normotensive patients with overweight and obesity. Methods A cohort of 65 hypertensive patients and 45 young normotensive patients with overweight and obesity included. All patients were monitored for 24 hours by Ambulatory Blood Pressure monitoring by ABMP50 Machine. All hypertensive patients were on stable antihypertensive therapy for at least 3 months and had met target office blood pressure levels. Fasting glucose (FG), blood lipids, creatinine, uric acid and high sensitive C-reactive protein (hCRP) were measured before and after fasting. All patients were asked to fast (F) for 16 hours for the first time in their lives. At the end of the fasting period, all participants in the study rated their subjective state from 1 to 10. Statistical analyses were conducted by IBM SPSS Statistics 22. Results The reaction of blood pressure on intermitted fasting was similar in both groups. Decrease of day systolic blood pressure (SBP) as well as increase of night diastolic blood pressure (DPB) was observed in both groups (TABLE 1). No significant changes of daily BP were observed in normotensive patients. Daily heart rate increased in 1st group by 1,5% (p=0.003) and decreased in 2nd group by 4,2% (p=0,002). At the same time daily SBP decreased in the group of hypertensive patients. The hypertension group (65 patients) rated their subjective state higher than 5 points and expressed that fasting was easy for them, age median 57 (51:61) years old. The normotensive group rated themselves below 5 points and expressed the difficulty of fasting and low quality of sleep, age median 26 (25:45) years old. The median BMI in 1st group 32,1 (30:35) in 2nd group 27,4 (25:30) kg/m2. The mean FG before fasting in the 1st group was 5,45(±0,61) mmol/l in the 2nd group was 4,75 (±0,55) mmol/l and after IF in the 1st group 5,36 (±0,73) mmol/l in the 2nd group 4,58 (±0,64) mmol/l (p&amp;gt;0.05). In hypertension group the mean of hCRP decreased from 9.95±8.02 to 4.68±2.88 (p=0.04). The level of blood creatinine and GFR had not significant changes. Conclusion One-day intermittent fasting leads to a change in blood pressure, does not cause hypotension, and is tolerated favorably in obese patients with hypertension on stable antihypertensive therapy.

NIGHT DIASTOLIC VALUES OF AMBULATORY BLOOD PRESSURE ARE THE MORE PREDICTIVE OF THE OUTCOMES IN PREGNANCY COMPLICATED WITH HYPERTENSION

Objective: The prognostic value of 24-hour ambulatory monitoring(ABPM) in pregnancy complicated with hypertension remains uncertain Design and method: Observational, 234 pregnant observed in appointment between 2007- July 2019 submitted to ABPM. Mean age 32.1 ± 5.5 years, follow-up 263.9 ± 16.5 days, was defined from gestation to delivery. Event defined: maternal death(MD), fetal or neo natal death(FD), pre-eclampsia (PE) or eclampsia(E), gestational diabetes(DG), prematurity or delayed fetal growth (PF), dystocic delivery(DD).It was observed 118 events((62 PE),32(DG),14 (PF),8(DD),2(FD)) Results: Comparing pregnancies with events versus without, those with event were significantly older, more prevalence of risk factors for BP in PG, shorter follow up / days, higher 24 h Systolic BP(SBP), 24 h Diastolic BP (DBP),day SBP and DBP, night SBP and DBP, lower Systolic and Diastolic Dipping (table 1). In Cox's multivariate analysis for events and adjusted for: age, BMI, number of risk factors for HP in PG - [pre-existing HP, previous gestational HP, previous pre-eclampsia,restriction of previous intrauterine growth, previous membrane detachment, previous fetal death, previous gestational diabetes, smoking history, obesity, family history of preeclampsia, family history of cardiovascular disease, artificial insemination]classified has:(0,1,2,3,&gt; = 4), office SBP, office DBP, gestation n°, give birth n°, were statistically significant for: 24 h SBP, 24 h DBP respectively HR 1.02 (IC1.00-1.03); 1.03 (IC1.01-1.05); Day DBP 1.02 (IC 1.00-1.05); Night SBP, Night DBP, Systolic BP dipping, Diastolic BP dipping respectively HR 1.02(IC1,01-1.03);1.03(IC1.01-1.05);0.96 (IC 0.94-0.98); 0.96 (IC 0.94-0.99) When DBP dipping was adjusted to night DBP, night DBP remains significant and DBP dipping loses respectively HR 1.03(IC 1.00-1.05) and 0.99(IC 0,95- 1.02). When analyzed DBP dipping by the pattern dipping (D)/non dipping (ND, (ND-35 D-198), in a crosstabs analysis, those with event ND pattern was found in 71% and 28,6 % with no event(X2 6.9 p &lt; 0,05). In a survival curve free of events, the presence of the diastolic dipping ND_D pattern, ND was associated to a worst prognosis (log rank 11.2 p &lt; 0.001) Conclusions: Night diastolic values are the best prognosis for prediction of events related to outcomes in pregnant woman's with hypertension, special DBP. Casual BP and even home ambulatory blood pressure are scanty for this period.

The relationship between body fat ratio and blood pressure in school-age children.

Hypertension (HTN) and obesity prevalences are rising in childhood and it is important to evaluate associations of these situations. The objective of this study is to investigate the relationship between HTN and body fat ratios (BFR) in children. This cross-sectional study was conducted among 134 participants who were directed to pediatric nephrology outpatient clinic with the prediagnosis of primary HTN. Weight, height, body fat ratio, blood pressure, and ambulatory blood pressure monitor (ABPM) was carried out for all the participants. Of the participants, 70 of them were diagnosed as hypertension with ABPM and included in the patient group, 64 of them had elevated office blood pressure (BP) but normotensive according to ABPM were included in the control group. Body fat ratio (BFR) levels of the patient group were higher than the control group (p < 0.05). There were significant linear correlation between night systolic blood pressure (SBP), night diastolic blood pressure (DBP), night mean arterial pressure (MAP), and BFR in the patient group (p < 0.05). There was a negative correlation between BFR and dipper (p = 0.022; p < 0.05) in the patient group. There was no correlation between BFR and blood pressures or dipper in the control group. According to our results BFR levels have significant association with HTN. According to our findings high BFR especially effects night BP, pulses, nondipping, and nighttime values can be evaluated only with ABPM. For prevention of HTN in children, caution should be given to monitor and lower BFR values.

SO037AMBULATORY BLOOD PRESSURE IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE - IMPROVING DIAGNOSIS AND OPTIMIZING THERAPY

Abstract Background and Aims Hypertension (AH) is an early complication of autosomal dominant polycystic kidney disease (ADPKD), which significantly increases the risk of decline of kidney function and impacts cardiovascular risk. The diagnosis of AH is often delayed and the optimal control of blood pressure (BP) is difficult to achieve in this group of patients. Of note, the optimal treatment of AH in ADPKD is yet to be established. Aim of the study was to diagnose AH (including the prevalence of masked hypertension) and to evaluate the control of BP with the use of ABPM in a cohort of ADPKD patients. Method ABPMs were performed in 163 consecutive patients, with ADPKD according to Pei criteria, appointed for the first outpatient visit. Prior to the ABPM, the diagnosis based on office BP or current AH treatment was established as well as age, sex, medication intake, and eGFR (CKD-EPI formula) were recorded. The study had a cross-sectional design. Results Out of 163 performed ABPMs, 143 were eligible for further analysis. The study group consisted of 93 females and 50 males, median age was 40 (18-87) years and median eGFR was 79.5(13-90) ml/min/1.73m2. 68% of patients had CKD G1 or 2. Median systolic blood pressure (SBP) was 127 (101-157) mmHg with blood pressure variability (BPV) 12 (7.8-23); median diastolic blood pressure (DBP) was 79 (58-98) mmHg, BPV 10.8 (6.2-17.4). 35% of patients were non-dippers, 2.7% extreme dippers and 4.9% reverse-dippers. In 31 (55%), out of 56 patients without previous diagnosis of AH, masked hypertension was found. Among 87 diagnosed with AH before the measurement, 49% were treated with 1 drug, and 29% with 2, 13% with 3, and 2% with 4. The most prevalent medication was ACE-inhibitor. Among treated, only 5.5% had all ABPM values within the target. Conclusion 55% of patients previously not diagnosed with AH on the basis of office BP proved to suffer from masked hypertension. The night DBP was the most suboptimally controlled value in ADPKD patients. Whether this is a consequence of nonadherence or suboptimal treatment, needs further investigation. ABPM is an indispensable tool in managing patients inflicted with ADPKD.

Cerebral perfusion, arterial hypertension and endothelial dysfunction in rheumatoid arthritis

Seventy-eight patients with RA were divided into two groups: with- and without AH.The functional methods included ultrasonic duplex angioscanning and dopplerografy of the extracranial and intracranial arteries of the head and neck and daily 24 hour monitoring of arterial blood pressure (BP). C-reactive protein (CRP), vascular endothelial adhesion molecule type 1 (sVCAM-1), von Willebrand Factor antigen (vWF AG), interleukin-8 (Il-8), rheumatoid factor (RF) IgG, endothelin-1 (ET-1) were determined by immunoenzyme analysis and velocity of sedimentation (VS). The dysfunction of endothelium was evaluated by calculation of the number of desquamated endotheliocytes cells (DE). AH occurred in 46 (59%) patients. Cerebral hypoperfusion was observed in patients with RA in whom the reduction in the high-speed indices of blood flow were correlated with BP increase. There were negative correlations between the linear speed of blood flow on the common carotid arteries and average day and night systolic BP, average day and night diastolic BP, indices of time systolic BP and diastolic BP and avariability of BP. The same results were established for the intracranial arteries: inverse correlations between the linear speed on the anterior cerebral arteries and average day systolic BP. The signs of endothelial dysfunction represented by significant differences among the indices of activation of endothelium in RA patients in comparison with the control group were shown. Content of ET-1, sVCAM-1, vWF AG, Il-8, CRP was higher in RA. The number of DE was significantly higher as well. These indices showed significant differences depending on RA activity. Correlation analysis revealed that the markers of endothelium activation sVCAM-1, vWF AG were positively correlated with the indices of immune inflammation. An increase in the activity of inflammatory process in RA leads to endothelial dysfunction, which contributes to the increase in the peripheral vascular resistance of cerebral arteries, reduction in the high-speed indices of blood flow, growth of BP variability and the increase in load by pressure.

Twenty-four-hour ambulatory blood pressure variability is associated with total magnetic resonance imaging burden of cerebral small-vessel disease.

BackgroundLacunae, brain atrophy, white matter hyperintensity, enlarged perivascular space and microbleed are magnetic resonance imaging (MRI) markers of cerebral small-vessel disease (cSVD). Studies have reported that higher blood pressure variability (BPV) predicted cardiovascular risk in hypertensive patients; however, the association between BPV and the total MRI burden of cSVD has not been investigated. In this study, we aimed to explore this relationship between BPV and cSVD MRI burden.MethodsWe prospectively recruited patients who attended our hospital for annual physical examination. Twenty-four-hour ambulatory BP monitoring was performed using an automated system. BPV was quantified by SD, weighted SD, and coefficient of variation. One point was awarded for the presence of each marker, producing a score between 0 and 5. Spearman correlation and ordinal logistic regression analyses were used to test the relationship between BPV and total cSVD MRI burden.ResultsA total of 251 subjects with an average age of 68 years were enrolled in this study, and 52.6% were male; 163 (64.94%) had one or more markers of cSVD. Correlation analysis indicated that higher systolic BP (SBP) levels and BPV metrics of SBP were positively related to higher cSVD burden. Ordinal logistic regression analyses demonstrated that higher SBP levels and SBP variability were independent risk factors for cSVD. There were no significant differences in 24-hour, day and night diastolic BP levels or BPV metrics of diastolic BP among the five subgroups.ConclusionTwenty-four-hour, day and night SBP levels and SBP variability were positively related to cSVD burden. Higher SBP levels and SBP variability were independent risk factors for cSVD.

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.

PP.24.09] ABPM AS A PREDICTOR OF EVENT IN PREGNANCY

Objective: It is still not well known the prognostic cardiovascular (CV) value of 24 h ambulatory blood pressure monitoring (ABPM) in the pregnant woman with hipertension (HT). The authors intended to assess the prognostic value of ABPM, in pregnant women with HT in predicting maternofetal event during pregnancy. Design and method: Prospective and observational study which included 139 pregnant women designed from the Obstetrics appointment to the HT appointment, having done the ABPM, between January 2007 and June 2015. The follow-up occured until the child-birth (262 ± 28 days). The definied events were: mother, fetal or neonatal dead, pre-eclampsia, eclampsia, gestational diabetes, prematurity and fetal growth restriction. Results: The study included 139 pregnant women with the age of 32 ± 6 years, 58% with cronic HT, 42% with gestacional HT. In the follow-up, were detected 71 events. About the parameters of the ABPM, the Systolic Blood Pressure dipping (SBP) verified: 87 with Dipper (D) pattern and 51 with non-Dipper (ND) pattern. Comparing pattern D vs ND, the D pattern had statisticaly significant reduction of the events (X2, p < 0,017). In the analysis of curves survivor of Kaplan-Meier free of events, the ND patter was associated with worst curves of survivor free of events (log rank 6.22, p < 0,01). In a multivariate Cox analysis adjusted for potential confounders (age, obstetric, personal and family history, body mass index) 24 h diastolic blood pressure (DBP), 24 h SBP and night DBP were predictive of maternofetal events, respectivelly (Hazzard ratio 1.03, (95% CI 1.00–1.05; p < 0.02); HR 1.03, (95% CI 1.01–1.06; p < 0,02); HR 1.04, (95% CI 1.01 -1.07; p < 0,01)), specially the night DBP. Conclusions: In our sample the ABPM found that SBP dipping and night DBP were predictive of events in puerperal, pregnancy and newborn, mainly the night DBP dippping. The authors consider that ABPM is a tool for pregnant with HT, because this is one method available that analyzes the night blood pressure which seems to be the most important.

PS 08-43] THE PATTERNS OF AMBULATORY BLOOD PRESSURE IS QUITE DIFFERENT IN PATIENTS WITH END-STAGE RENAL DISEASE ACCORDING TO DIALYSIS MODALITY

Objective: Since accurate assessment of blood pressure (BP) is essential to control BP adequately, ambulatory blood pressure monitoring (ABPM) is widely used for estimation of BP status and has prognostic significance in patients with hypertension including end-stage renal disease (ESRD). Although the ABPM patterns might be distinguished due to the inherent characteristics of dialysis modality, there has been lacking evidences until now. Therefore, the aim of this study was to elucidate difference of ABPM parameters and pattern according to dialysis modality. Design and Method: Patients were prospectively enrolled by Cardiovascular and Metabolic Disease Etiology Research center (CMERC) of Yonsei University College of Medicine between November 2013 and August 2015. We analyzed the differences of baseline characteristics, office BPs, ABPM parameters and ABPM patterns (dipper, non-dipper and reverse dipper) in ESRD patients according to dialysis modality. Results: Among a total of 174 patients, 109 (62.6%) were hemodialysis (HD) patients and 65 (37.4%) were peritoneal dialysis (PD) patients. 155 (89.1%) patients had hypertension, 96 (89.2%) in HD and 59 (90.8%) in PD. All measured diastolic BP (DBP) and 24 hours mean arterial pressure (MAP) were significantly higher in PD (office DBP, 24 h mean DBP, daytime DBP and night DBP; respectively p = 0.011, 0.006, 0.010 and 24 hours MAP; p = 0.047) compared to those in HD. The prevalence of non-dipper was higher in PD than HD (dipper vs non-dipper; 33.0% vs 39.4% in HD and 26.2% vs 47.7% in PD). Total number of antihypertensive medications was higher in PD than HD. Conclusions: ABPM patterns, DBP and 24 hours MAP in dialysis patients were significant different according to dialysis modality. Despite the effort for controlling BP by using more antihypertensive medications, BP control based on office BP is not satisfactory and adverse ABPM pattern is more prevalent in PD patients than HD.

Физиологические корреляты адаптационных реакций по Л.Х. Гаркави у подростков и молодых людей с избыточной массой тела и мягкой артериальной гипертензией

Purpose of this research is to study the physiological correlates of adaptive reactions of the organism on leukocyte formula blood using the algorithm of L.H. Garkavi in young patients with mild arterial hypertension and overweight. Materials and methods. The study included the data of comprehensive survey of 56 young men (16-26 years, mean 18.6+/-0.6 years) with mild hypertension, with overweight and obesity (BMI from 25.0 to 34.8 kg/m²). In addition to laboratory studies, multifunctional monitoring of ECG+AD (Incart, SPb) in outpa-tients was carried out for all young men. Results. There are all types of adaptive reaction in the studied group, excepting a “stress reaction”. 8 ado-lescents (14,3%) had a leukocyte distribution corresponding to a “training reaction”, 39,3% young men demon-strated a “reaction of quiet activation”, 25,0% – a “reaction of increased activation” and 21,4% of adolescents had an “over activation”. Average diastolic blood pressure in the “quiet activation” and “over activation” groups a night was higher (62,4±1,8 mm Hg, t=2,0; df=17, P=0,04 and 63,3±2,2 mm Hg, t=2,1; df=15, P=0,04) than in the “training” group (57,3±1,4 mm Hg). Night diastolic blood pressure decline in “training”, “quiet activation” and “increased activation” groups was 22,8%, 20,3% и 21,0% to be due to a tendency to excessive night decrease of diastolic blood pressure («over-dippers»).Young men with reaction of the increased activation had lower spectral power of very low, low and high frequency band in the day-time than in the “training” group. Significant correlations were obtained between systolic blood pressure value a day and night, spectral analysis of heart rate variability results and white blood parameters. Conclusion. The revealed physiological correlates allow to recommend the method of adap-tive reactions by L.H. Garkavi to assess the functional capacity of young people with mild hypertension and overweight.

The relationship between neutrophil to lymphocyte ratio and blood pressure variability in hypertensive and normotensive subjecs.

Blood pressure (BP) variability is associated with hypertensive (HT) target organ damage and cardiovascular events. The aim of this study was to investigate the relation between neutrophil to lymphocyte ratio (NLR) and BP variability in hypertensive and normotensive subjects. In this cross-sectional study, 150 subjects (63 male, mean age 52.1±5.2 years) were enrolled. In all patients, blood samples and 24-hour ambulatory blood pressure (BP) monitoring were obtained. According to 24-hour ambulatory BP results, participants were divided into four investigation categories. Group 1= Normotensive dipper (ND), Group 2= Normotensive non-dipper (NN), Group 3= HT dipper (HD), Group 4= HT non-dipper (HN). Highest NLR values were determined in the HN group (p=0.005 vs. ND, p=0.046 vs. NN and p<0.01 vs. HD). NLR values were similar among the ND, NN and HD groups (p>0.05, for all). NLR was correlated with night systolic blood pressure (SBP) (r=0.178, p=0.031), night diastolic blood pressure (DBP) (r=0.176, p=0.032) and BP variation rate (r=-0.246, p=0.003). Multiple linear regression analysis showed BP variation rate to be an independent predictor of high NLR value (ß=0.186, 95% CI=0.918-0.982, p=0.044). In ROC analysis, a level of NLR>2.7 predicted non-dipper HT with 83% sensitivity and 65% specificity (ROC area under curve: 0.653, 95% CI=0.565-0.741, p=0.001). In the present study, we found that NLR levels were significantly correlated with BP variability. The measurement of NLR may be used to indicate increased risk of HT-related adverse cardiovascular events.

晨峰血压与心脏事件的影响

目的：探讨晨峰血压与心脏事件发生的关系，对心脏事件的早期诊治提供依据。方法：选取2013年1月~2015年1月于我院心内科住院治疗的心脏事件患者72例作为实验组(心脏事件组)；其他疾病患者74例作为对照组(非心脏事件组)。给予动态血压监测，测定其24 h平均收缩压(24 hSBP)、白昼平均收缩压(dSBP)、24 h平均脉压(24 hPP)、夜间平均收缩压(nSBP)、白昼平均舒张压(dDBP)夜间平均舒张(nDBP)和24 h平均舒张压(24 hDBP)。记录每个受检者是否吸烟、肥胖及A型性格。结果：24 hSBP、dSBP、24 hPP、nSBP差异有统计学意义(P 0.05)；实验组晨峰血压较对照组明显增高，差异有统计学意义(P Objective: To investigate the relationship between morning blood pressure surge and the patients with cardiac events and provide basis for early diagnosis and treatment of cardiac events. Methods: 72 patients (cardiac events group) with cardiac events and 74 patients with other diseases (non-cardiac event group) in my hospital are chosen from January 2013 to January 2015. Testing 24-hour ambulatory blood pressure monitoring for every person and recording 24 h systolic blood pressure (24 hSBP), day mean systolic blood pressure (dSBP), the 24 h mean pause pressure(24 hPP), night mean systolic blood pressure (nSBP), day diastolic blood pressure (dDBP), night dias-tolic blood pressure (nDBP), 24 h diastolic blood pressure (24 hDBP), and asked everyone whether he (she) had a-type character, the history of smoking or the obesity. Result: 24 hSBP, dSBP, 24 hPP, nSBP in cardiac events group compared with the non-cardiac event group, P < 0.05, the difference had statistics significance. No statistical difference was detected between the two groups in dDBP, nDBP, 24 hDBP; multiple factor logistic regressive analysis suggested that morning blood pressure surge was the independent risk factor for patients with cardiac events. Conclusion: Our analysis suggested that the patients with cardiac events were influenced significantly by morning blood pressure surge.

Is there a link between hyperuricemia, morning blood pressure surge, and non-dipping blood pressure pattern in metabolic syndrome patients?

Background:Hypertensive patients usually have a blunted nocturnal decrease, or even increase, in blood pressure during sleep. There is also a tendency for increased occurrence of cardiovascular events between 6 and 12 am due to increased morning blood pressure surge (MBPS). Co-occurrence of metabolic syndrome (MetS) and hypertension is also a common problem. Hyperuricemia might trigger the development of hypertension, chronic renal failure, and insulin resistance. In this study, we aimed to determine whether there is a relationship between hyperuricemia, MetS, nocturnal blood pressure changes, and MBPS.Method:A total of 81 newly diagnosed hypertensive MetS patients were included in this study. Ambulatory blood pressure monitoring of patients was done and patients’ height, weight, and waist and hip circumferences were recorded. Fasting blood glucose (FBG), lipid profile, creatinine, potassium, uric acid, hematocrit levels were studied.Results:Non-dipper (ie, those whose blood pressure did not drop overnight) patients had higher waist–hip ratios (WHR) (P = 0.003), uric acid (P = 0.0001), FBG (P = 0.001), total and low-density lipoprotein cholesterol levels (P = 0.0001). Risk analysis revealed that hyperuricemia was a risk factor for non-dipping pattern (P < 0.0001, odds ratio = 8.1, 95% confidence interval = 1.9–33.7). Patients in the highest quadrant for uric acid levels had higher FBG (P = 0.001), low-density lipoprotein cholesterol (P = 0.017), WHR (P = 0.01), MBPS (P = 0.003), and night diastolic blood pressure compared with lowest quadrant patients (P = 0.013). Uric acid levels were also positively correlated with night ambulatory blood pressure (ABP) (r = 0.268, P =0.05), night diastolic blood pressure (r =0.3, P =0.05), and MBPS (r =0.3, P =0.05).Conclusion:Evaluation of hypertensive patients should also include an assessment of uric acid level and anthropometric measurements such as abdominal obesity. Hyperuricemia seems to be closely related to undesired blood pressure patterns and this may signal to the clinician that an appropriate therapeutic approach is required.

Insulin Resistance and the Relationship Between Urinary Na+/K+ and Ambulatory Blood Pressure in a Community of African Ancestry

Although groups of African descent are particularly sensitive to blood pressure (BP) effects of salt intake, the role of obesity and insulin resistance in mediating this effect is uncertain. We determined whether obesity or insulin resistance is independently associated with urinary Na(+)/K(+)-BP relationships in a community sample of African ancestry. We measured 24-hour urinary Na(+)/K(+), homeostasis model assessment of insulin resistance (HOMA-IR), and nurse-derived conventional and 24-hour ambulatory BP in 331 participants from a South African community sample of black African descent not receiving treatment for hypertension. With adjustments for diabetes mellitus and the individual terms, an interaction between waist circumference and urinary Na(+)/K(+) was associated with day diastolic BP (P < 0.05) and an interaction between log HOMA-IR and urinary Na(+)/K(+) was associated with 24-hour and day systolic (P < 0.05) and 24-hour, day, and night diastolic (P < 0.002; P < 0.001) BP. The multivariable-adjusted relationship between urinary Na(+)/K(+) and night diastolic BP increased across tertiles of HOMA-IR (tertile 1: β-coefficient = -0.79 ± 0.47; tertile 2: β-coefficient = 0.65 ± 0.35; tertile 3: β-coefficient = 1.03 ± 0.46; P < 0.05 tertiles 3 and 2 vs. 1). The partial correlation coefficients for relationships between urinary Na(+)/K(+) and 24-hour (partial r = 0.19; P < 0.02), day (partial r = 0.17; P < 0.05), and night (partial r = 0.18; P < 0.02) diastolic BP in participants with log HOMA-IR greater than or equal to the median were greater than those for relationships between urinary Na(+)/K(+) and 24-hour (partial r = -0.08; P = 0.29), day (partial r = -0.10; P < 0.22), and night (partial r = -0.06; P = 0.40) diastolic BP in participants with log HOMA-IR less than the median (comparisons of r values: P < 0.05). Insulin resistance may modify the relationship between salt intake, indexed by urinary Na(+)/K(+), and ambulatory BP in groups of African descent.