Nighttime Systolic Blood Pressure Research Articles

BLOOD PRESSURE CONTROL AND CIRCADIAN RHYTHM AMONG PATIENTS WITH PROGRESSIVE GLAUCOMA – PRELIMINARY RESULTS

Objective: Blood pressure (BP) control, postural changes and daily variability in patients with progressive glaucoma. Design and method: The study included 55 patients with different duration of open-angle glaucoma who had disease progression during the visit qualifying for this observational study. During two separate visits with 7 to 14 days interval, an ophthalmological and the clinical examination (standardized questionnaire, three BP measurements, orthostatic test, 24hour ABPM) were performed. The criterion for hypertension (HT) control in treated patients aged 80 years and over was office BP <150/90 mmHg. Postural hypotension was defined as a drop in systolic BP (SBP) of at least 20 mmHg and/or a drop in diastolic BP (DBP) of at least 10 mmHg within 1, 3, or 5 minutes after standing. The validated devices were used to obtain BP measurements. Results: The mean age of patients was 69 years, most subjects were over 60 years of age; 40% were men, 75% were treated for hypertension (HT). ∗Data from ABPM are currently available for 39 patients. Patients with glaucoma progression noted in the short course of the disease (<5 years) were more likely to have uncontrolled HT in the office setting; in ABPM also had higher daytime SBP and greater daily SBP variability, although no statistical significance was observed. In turn, the oldest patients with long-term (>10 years) progressive glaucoma had too low nighttime SBP and DBP values. Conclusions: Conclusions. The results indicate an unfavorable prognostic impact of insufficient HT control and daily BP variability in people with a few years of glaucoma history. In the oldest patients, too low BP levels throughout the 24-hour period may contribute to its progression. Since most our patients had ABPM performed for the first time, emphasis should be placed on more frequent monitoring of circadian BP profile in glaucoma patients, especially among the oldest.

Effects of Heavy Alcohol Use on Nighttime Blood Pressure, Sleep Quality, and Urine Catecholamines

Heavy alcohol drinking habits contribute to the development of hypertension; this is partly due to overactivation of the sympathetic nervous system and the increased release of catecholamines. Recently, heavy alcohol drinking has been linked to poor sleep quality, but the underlying mechanisms remain unclear. We postulated that long-term frequent heavy alcohol use could increase catecholamine levels and cause blood pressure dysregulation at night, altogether influencing sleep quality. Therefore, the purpose of this study is to test the following hypothesis that compared to non-heavy drinkers, heavy drinkers have a higher level of nighttime catecholamines, a higher levels of nighttime blood pressure, and poorer sleep quality. A total of 44 men and postmenopausal women non-smokers, free of major clinical diseases, were included in this study. Heavy drinkers were defined as those having a dried blood spot phosphatidylethanol (PEth, a biomarker to detect heavy alcohol drinking) level ≥ 20 ng/mL. Participants wore an ambulatory blood pressure monitor for 24 hours and catecholamines were measured from urine samples collected in the same 24-hour period. Sleep quality was measured by using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. There were 21 heavy drinkers (mean±SEM for age: 58±1 and BMI: 26.2±0.7 kg/m2) and 23 non-heavy drinkers (age: 58±1 and BMI: 27.5±0.8 kg/m2; P≥0.3 vs. heavy drinkers). Compared to non-heavy drinkers, heavy drinkers had a higher nighttime systolic blood pressure (SBP), higher diastolic blood pressure (DBP), and a lower SBP dipping ratio (heavy drinkers vs. non-heavy drinkers for nighttime SBP: 118±3 vs. 109±2 mmHg, P=0.02; nighttime DBP: 70±2 vs. 65±2 mmHg, P=0.04; and SBP dipping ratio: 10.6±1.4% vs. 14.5±1.6%, P=0.04). No differences were found in nighttime urine catecholamines between heavy drinkers and non-heavy drinkers (P≥0.3). A total of 13 participants had a PSQI score higher than 5, indicating poor sleep quality; however, PSQI scores were similar between heavy and non-heavy drinkers (P=0.8). These findings indicate that heavy drinkers had a higher nighttime blood pressure and are consistent with the observation that heavy drinking is associated with an increased risk of hypertension in mid-life adults. Interestingly, the increase in nighttime blood pressure does not appear to be related to catecholamines and sleep quality in apparently healthy mid-life adults does not appear to be influenced by heavy drinking habits. This work was supported by NIAAA AA028537 to CLH and AHA 1266805160 to TH. 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.

HYPERTENSION RELATED NETOSIS IS STRONGLY DEPENDENT ON NIGHTTIME BLOOD PRESSURE IN A COHORT OF NEWLY DIAGNOSED, TREATMENT NAÏVE HYPERTENSIVE PATIENTS

Objective: Over the last years, accumulating evidence has highlighted the key role of immunity in the inflammatory environment of essential hypertension (EH). Neutrophil extracellular traps (NETs) formation represents a protective innate immune mechanism of the neutrophils. However, excessive release of NETs (NETosis) has been shown to exert a potent pro-inflammatory and pro-thrombotic effect. Even though NETosis is increasingly implicated in the thrombo-inflammatory environment of cardiovascular disease, experimental and clinical data regarding the association between NETs and EH are scarce. Design and method: We recruited newly diagnosed, untreated hypertensives (UHTs) without overt cardiovascular disease and healthy, normotensive individuals (NTs). Office BP was measured according to guidelines. Ambulatory and central BP parameters were measured with the Mobil-O-Graph device. Plasma levels of NETs including myeloperoxidase (MPO)-DNA were determined by ELISA. Results: A total of 139 individuals including 99 UHTs and 40 NTs were included in the study. Levels of MPO-DNA were increased in UHTs compared to NTs (p<0.001). In multivariate analysis after adjustment for confounding variables (body mass index, hemoglobin, uric acid, high sensitivity c-reactive protein), hypertension was the strongest independent predictor of incident NETosis (p<0.001). Among the ambulatory BP indices, peripheral nighttime systolic BP (F:5.937; p=0.016) and central nighttime diastolic BP (F:4.751; p=0.031) were the strongest prognosticators of hypertension related NETosis (Optimal Scaling ANOVA; p=0.028). Conclusions: In a cohort of newly diagnosed, treatment-naïve hypertensive patients, nighttime BP indices are the strongest factors that can predict, independently, an increased NETosis, adding to the superior significance of nocturnal BP in cardiovascular prognosis. Further research is needed to clarify the association of NETs with hypertension as well as hypertension-mediated target organ damage.

Heart Rate Acceleration and Deceleration Capacities Associated With 24-Hour Circadian Blood Pressure Variation of Hypertension Patients

Abstract OBJECTIVE To observe the relationship between 24-hour ambulatory blood pressure circadian rhythm and heart rate acceleration (AC), deceleration capacities (DC) in patients with hypertension. METHODS A total of 198 patients with essential hypertension were included and were monitored by 24-hour ambulatory blood pressure. Based on the nocturnal decline rate of systolic blood pressure, patients were divided into 2 groups: dippers (decline rate 10%–20%, n = 58) and non-dippers (decline rate <10%, n = 140). DC and AC values were calculated based on dynamic electrocardiogram data and compared between 2 groups. Pearson correlation analysis was used to analyze the correlation between DC, AC, and blood pressure and circadian blood pressure variation. Multivariate logistic regression analysis was used to analyze the influencing factors of non-dippers. RESULTS Compared with dippers, AC increased, while DC, standard deviation of normal R–R intervals (SDNN), percentage of heart beats with difference between adjacent normal RR intervals >50 ms in the total number of NN intervals (PNN50%) decreased in non-dippers (P < 0.05). Pearson analysis showed that AC was positively correlated to nighttime systolic blood pressure (r = 0.297), slowest heart rate (r = 0.221) and negatively correlated to SDNN (r = −0.233) and PNN50 (r = −0.238), while DC was negatively correlated to nighttime systolic blood pressure (r = −0.300), 24-hour average heart rate (r = −0.144), slowest heart rate (r = −0.213), and positively correlated to SDNN (r = 0.230), PNN50 (r = 0.267) (all P < 0.05). Multivariate logistic regression analysis showed that in the model included AC, AC (odds ratio [OR] = 1.320, 95% confidence interval [CI] 1.102–1.580, P = 0.003), age (OR = 1.029, 95% CI 1.001–1.057, P = 0.039), and 24-hour average heart rate (OR = 1.062, 95% CI 1.010–1.116, P = 0.02) were independent risk factors for non-dippers, while in the model included DC, DC (OR = 0.824, 95% CI 0.709–0.956, P = 0.011), age (OR = 1.027, 95% CI 1.001–1.055, P = 0.046), and 24-hour average heart rate (OR = 1.058, 95% CI 1.007–1.113, P = 0.025) were independent risk factors for non-dippers. CONCLUSIONS AC increases and DC decreases in patients with non-dipper hypertension. Nighttime systolic blood pressure positively correlates with AC and negatively correlates with DC. AC and DC are independent risk factors for abnormal circadian rhythm of blood pressure in hypertensives.

Masked uncontrolled hypertension in patients with impaired carbohydrate metabolism

Aim. To establish the prevalence of masked uncontrolled hypertension (HTN) (MUH) in patients with diabetes or impaired glucose tolerance (IGT) and determine its clinical and hemodynamic characteristics.Material and methods. The study involved 87 patients who received regular antihypertensive therapy for hypertension and had established diabetes or IGT. The mean age of patients was 62,6±9,9 years, of which 51,7% were women, 48,3% — men. Type 2 diabetes was revealed in 77,7%, IGT — 22,8% of patients. For 24-hour blood pressure monitoring, BpLAB system (OOO Petr Telegin) was used; blood pressure (BP) was determined in the brachial artery, central blood pressure — in the aorta. We analyzed risk factors and target organ damage. The results were processed using the Excel Microsoft Office 2007 package and the Statistica 6.0 and 10.0 package from StatSoft, Inc (USA).Results. Uncontrolled hypertension was revealed in 59,8%, MUH — in 18,4%, controlled HTN — 21,8% of patients. Mean daytime and mean nighttime systolic BP in patients with MUH and uncontrolled HTN were comparable. Patients with controlled hypertension compared with MUH had lower mean day- and nighttime aortic BP by 27,1% (p<0,01) and 16,8% (p<0,01), respectively. Aortic BP was comparable in individuals with MUH and uncontrolled HTN. Asymptomatic hyperuricemia was more common in patients with uncontrolled HTN compared with MUH and controlled hypertension by 29,3% and 41,8%, respectively. With MUH, compared with controlled HTN, we revealed a higher incidence of stroke by 18,8%, a decrease in glomerular filtration rate <60 ml/min by 17,5%, albuminuria by 18,8%, left ventricular hypertrophy by 2,6 times.Conclusion. Only 41,2% of patients with diabetes and prediabetes achieve the target office BP level, while every second of these patients has MUH. MUH, compared with controlled HTN, is characterized by a higher incidence of stroke, kidney (decrease in glomerular filtration rate <60 ml/min and albuminuria) and heart damage (left ventricular hypertrophy).

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study.

Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991-1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping-dipping (n = 152/33.6%), dipping-non-dipping (n = 198/43.8%), non-dipping-dipping (n = 20/4.4%), and non-dipping-non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping-non-dipping group, and lowest (6.6%) in the dipping-dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping-non-dipping pattern with CV events compared with the dipping-dipping pattern remained significant (HR 4.01; 95% CI 1.89-8.67, p < 0.001). In summary, non-dipping-non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

Associations of Ambulatory Blood Pressure Measurements With High-Sensitivity Troponin and Natriuretic Peptide Levels in SPRINT.

Nighttime blood pressure (BP) has greater prognostic importance for cardiovascular disease (CVD) than daytime BP, but less is known about nighttime and daytime BP associations with measures of subclinical CVD. Among 897 Systolic Blood Pressure Intervention Trial Study (SPRINT) participants with 24-hour ambulatory BP monitoring obtained near the 27-month study visit, 849 (95%) had N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measured at the 24-month study visit. Multivariable linear regression analyses were performed to evaluate the associations of nighttime and daytime BP with cardiac biomarker levels. The mean age was 69 ± 12 years, 28% were African American, and mean nighttime and daytime SBP were 121 ± 16 mm Hg and 132 ± 14 mm Hg, respectively. In multivariable models, compared with the lowest tertile of nighttime systolic BP, the highest tertile was associated with 48% higher NT-proBNP levels (adjusted geometric mean ratio [GMR] = 1.48, 95% CI: 1.22, 1.79), and 19% higher hs-cTnT levels (adjusted GMR = 1.19, 95% CI: 1.07, 1.32). In contrast, the highest vs. lowest tertile of daytime systolic BP was not associated with NT-proBNP (adjusted GMR = 1.09, 95% CI: 0.88, 1.34), but was associated with 16% higher hs-cTnT levels (adjusted GMR = 1.16, 95% CI: 1.04, 1.30). Similar results were observed using diastolic BP. In SPRINT, both higher nighttime and daytime BP were independently associated with higher hs-cTnT levels, but only higher nighttime BP was associated with higher NT-proBNP levels.

The Hearing Function and Ambulatory Blood Pressure in Older Adults.

To examine the association between hearing function, assessed with pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults. Cross-sectional study. A total of 1404 community-dwelling individuals aged ≥65 years from the Seniors-ENRICA cohort were examined. Hearing loss was defined as PTA > 40-AudCal hearing loss decibels (dB-aHL) in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Circadian BP patterns were calculated as the percentage decline in systolic BP during the night, and participants were classified as dipper, nondipper, and riser. Ambulatory hypertension was defined as BP ≥ 130/80 mm Hg (24 hour), ≥135/85 (daytime), and ≥120/70 (nighttime) or on antihypertensive treatment. Analyses were performed with linear- and logistic-regression models adjusted for the main confounders. In multivariable analyses, the PTA was associated with higher nighttime systolic BP [β coefficient per 20 dB-aHL increment standard frequency (95% confidence interval, CI): 2.41 mm Hg (0.87, 3.95); β (95% CI) per 20 dB-aHL increment speech frequency 2.17 mm Hg (0.70, 3.64)]. Among hypertensive patients, hearing loss at standard and high-frequency PTA was associated with the riser BP pattern [odds ratio: 2.01 (95% CI, 1.03-3.93) and 1.45 (1.00-2.09), respectively]; also, hearing loss at standard PTA was linked to uncontrolled nighttime BP [1.81 (1.01-3.24)]. PTA was associated with higher nighttime BP, and hearing loss with a riser BP pattern and uncontrolled BP in older hypertensives.

Association of Periodontitis with Ambulatory Blood Pressure, Salt Intake, and Neutrophil-Lymphocyte Ratio in High-Risk Hypertensive Patients

&amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: Periodontitis and cardiovascular disease are prevalent entities that often coexist, with a common pro-inflammatory pathway. The objective of this study was to evaluate the association between periodontitis and cardiovascular pro-inflammatory parameters rarely considered within risk factors. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: Forty-three participants aged between 38-82 years were examined. An association between mean probing depth (MPD), mean attachment loss (MAL), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) was correlated with the following cardiovascular disease factors and inflammatory promoters: neutrophil-to-lymphocyte ratio (NLR), 24h ambulatory blood pressure, global cardiovascular risk, daily salt intake, night-time systolic blood pressure (nSBP), and pulse wave velocity (PWV). A two-way ANOVA and multiple comparison tests were performed using SPSS statistics software. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: A highly significant correlation (p&amp;lt;0.05) was found between BOP, MPD, and MAL with high salt intake, global cardiovascular risk estimation, nSBP, and PISA. Also, significantly statistical correlation (p&amp;lt;0.05) was found between BOP, NLR, and PWV while PISA was only associated with NLR. Logistic regression analysis identified absolute values of nSBP, salt intake and NLR as possible independent contributors to the increase in the &amp;lt;i&amp;gt;log&amp;lt;/i&amp;gt; odds of developing BOP. &amp;lt;i&amp;gt;Conclusions&amp;lt;/i&amp;gt;: Several periodontal disease parameters are linked to cardiovascular risk factors such as hypertension, neutrophil-to-lymphocyte ratio, daily salt intake and night-time systolic blood pressure.

The association between the effective apnea-hypopnea index and blood pressure reduction efficacy following CPAP/oxygen treatment

BackgroundThe effect of sleep apnea treatment on reducing cardiovascular disease risk remains inconclusive. This study aims to assess if the effective apnea hypopnea index (eAHI), a measure of residual sleep apnea burden post-treatment, is a factor in determining blood pressure (BP) response to continuous positive airway pressure therapy. The eAHI integrates time on therapy, residual apnea, and % of sleep time untreated. MethodsA secondary analysis of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a randomized, controlled, parallel group assessment of continuous positive airway pressure (CPAP), oxygen and sleep hygiene. The Delta-AHI (▲AHI) was defined as the difference between baseline AHI and effective AHI at 12 weeks. Logistic and linear regression models estimated the predictors for nocturnal systolic BP change following sleep apnea therapy. ResultsOne hundred and sixty-nine subjects with a mean age of 62.82 ± 6.99 years were included in the final analysis. Fifty subjects had ▲AHI ≤8/hour of sleep and 119 subjects were higher. After adjustment, baseline mean nighttime systolic blood pressure (OR 1.036, 95% CI 1.015–1.058, p: 0.001) and ▲AHI ≥8/hour (OR 2.406, 95% CI 1.116–5.185, p:0.025) were independent predictors for mean nighttime systolic blood pressure change >3 mm Hg. The higher effective AHI was negatively related with BNP (β: −2.564, SE: 1.167, p: 0.029) and positively related with troponin change (β: 0.703, SE: 0.256, p: 0.007). ConclusionThe ▲AHI was an independent predictor of the blood pressure response to sleep apnea treatment. Register numberNCT01086800.

Clinical, Metabolic and Neurohumoral Effects of L-arginine in Patients with Coronary Heart Disease in Combination with Arterial Hypertension

The objective: to analyze the impact of complex therapy using L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid on the functional state of the endothelium, tolerance to physical activity, indicators of oxidative stress, lipid metabolism and clinical status patients with stable angina pectoris of the III functional class (FC) in comorbidity with arterial hypertension (AH) of the II grade, stage 2. Materials and methods. 100 patients with stable angina pectoris III FC and AH II grade, stage 2 aged 55–68 years participated in the study. The patients were divided into two groups: 50 patients of the 1st group received standard therapy – RAAS blocker, amlodipine, bisoprolol, acetylsalicylic acid and atorvastatin; 50 patients of the 2nd group in addition to standard therapy received a multi-component product of complex action, which includes L-arginine, ubiquinone (coenzyme Q10), Lcarnitine, lycopene, a number of plant extracts and folic acid, in a dose of 1 sachet per day. At the beginning and at the end of the study endothelial functions were assessed, daily blood pressure (BP) was monitored, physical exercise testing was performed, the weekly number of angina attacks and nitroglycerin tablet taking were recorded, oxidative status parameters were studied, quality of life was assessed, and the results were statistically processed. Results. The use of complex action preparation, which includes L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid, as adjuvant therapy demonstrated a decrease in the level of indicators of lipid peroxidation (LPO) and an increase levels of antioxidant protection parameters. In the patients of the 2nd group a statistically significant positive dynamics of the blood pressure level was found: the median of daily systolic blood pressure (SBP) decreased to 131.78 mm (p&lt;0.01). A significant decrease in median daytime and nighttime SBP and diastolic blood pressure (DBP) was also determined (p&lt;0.01). The use of a multicomponent preparation of complex action led to a significant decreased of total cholesterol (CHL) by 14.5%, TG by 10.37% and low-density lipoprotein cholesterol by 12.5%. There was also an increased level of high-density lipoprotein cholesterol by 6.48% (р&lt;0.05 for all indicators). The patients of the 2nd group demonstrated a significant increase in tolerance to physical excesses: an increase in the double product by 21.4% and the total amount of the done work by 78.4% compared to the initial values (р&lt;0.05 for both indicators). After 2 months of treatment the difference between the groups in terms of the decrease in the weekly number of angina attacks was statistically significant (р&lt;0.05). This positive trend was accompanied by a decrease in the median number of nitroglycerin tablets taken per week in the 2nd group from 5.4 to 3.0 (р&lt;0.05). In the patients of the 2nd group after 2 months of observation a statistically significant improvement in quality of life indicators according to the “Seattle Angina Questionnaire” was determined (р&lt;0.05). Conclusions. Although all study participants received identical standard antihypertensive and lipid-lowering therapy, adjuvant use of a multicomponent complex of L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts, and folic acid for 2 months demonstrated a reduction in the impact of oxidative stress with parallel restoration of antioxidant mechanisms, improvement in vascular reactivity in patients and daily control of blood pressure, contributed to the correction of the lipid profile with increased tolerance to physical exercise and, as a result of the above-mentioned effects, had a significant positive impact on the quality of life of patients.

Ambulatory blood pressure after 12 weeks of quadruple combination of quarter doses of blood pressure medication vs. standard medication.

A combination of four ultra-low-dose blood pressure (BP) medications lowered office BP more effectively than initial monotherapy in the QUARTET trial. The effects on average ambulatory BP changes at 12 weeks have not yet been reported in detail. Adults with hypertension who were untreated or on monotherapy were eligible for participation. Overall, 591 participants were randomized to either the quadpill (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or monotherapy control (irbesartan 150 mg). The difference in 24-h, daytime, and night-time systolic and diastolic ambulatory BP at 12 weeks along further metrics were predefined secondary outcomes. Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At 12 weeks, mean 24-h ambulatory SBP and DBP were 7.7 [95% confidence interval (95% CI) 9.6-5.8] and 5.3 (95% CI: 6.5-4.1) mmHg lower in the quadpill vs. monotherapy group ( P < 0.001 for both). Similar reductions in the quadpill group were observed for daytime (8.1/5.7 mmHg lower) and night-time (6.3/4.0 mmHg lower) BP at 12 weeks (all P < 0.001) compared to monotherapy. The rate of BP control (24-h average BP < 130/80 mmHg) at 12 weeks was higher in the quadpill group (77 vs. 50%; P < 0.001). The reduction in BP load was also more pronounced with the quadpill. A quadruple quarter-dose combination compared with monotherapy resulted in greater ambulatory BP lowering across the entire 24-h period with higher ambulatory BP control rates and reduced BP variability at 12 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy.

The severity of chronic heart failure and the parameters of daily blood pressure profile in patients with coronary heart disease

Aim: Although the prevalence of coronary heart disease (CHD) and hypertension which are the most common causes of the development and progression of chronic heart failure (CHF) is high, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with CHF is not mandatory to be performed. The growing number of evidence suggests that excessive decrease in BP which clearly reflects increased BP variability (BPV) affects the survival of patients with heart failure (HF). The objective of the study was to investigate the relationship between the parameters specific to CHF severity and features of daily BP profiles in patients with ischemic CHF and hypertension. Methods: Ninety patients with functional class II–IV of CHF and CHD (the main group) and 50 non-CHF patients with hypertension (the comparative group) were examined. The transthoracic echocardiography (TTE) [atrial end-systolic dimension (ESD), ventricular end-diastolic dimension (EDD), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF)] and 24-hour ABPM (BPV parameters and proportions of hypotensive episodes) were performed. The relationships between the abovementioned parameters were evaluated using the univariate correlation analysis and stepwise multiple linear regression. Results: Higher functional class of CHF is found to be associated with a higher incidence of daytime systolic BP (SBP) decline and nighttime SBP and diastolic BP (DBP) variability while higher LVEF is related to the hypotensive episodes regardless of CHF. Conclusions: It appears that the larger trials involving CHF patients with reduced LVEF should be conducted to clarify the obtained results.

Нарушения сердечного ритма и профиль артериального давления у пациентов с боевыми травмами

Aim. To investigate possible rhythm and conduction disturbances, as well as the blood pressure (BP) profile in young and middle-aged patients with combat wounds. Materials and methods. The cross-sectional study enrolled 102 patients who suffered limb injuries in the period from 13 to 114 days (median 38 days) before admission to the hospital. The age of the patients included in the study ranged from 20 to 59 years, with an average of 35.7±8.5 years. Patients underwent Holter ECG monitoring and 24-hour BP monitoring. The following questionnaires and scales were used: a questionnaire to identify signs of autonomic changes (A. Vein), a scale for assessing the severity of psychophysiological response to stress, an insomnia severity index, the Hamilton scale for assessing anxiety, the Hamilton scale for assessing depression, a questionnaire for PTSD screening, visual analog pain scale. Results. The mean heart rate per day reached 84.6±11.1 per minute, the minimum heart rate was 56.9±10.1, the maximum heart rate was 134.4±18.6 per minute. The group mean duration of tachycardia was 498.1±316 minutes (8 hours 18 minutes). There was an inverse correlation between the age of patients and the duration of tachycardia per day (r=-0.29; p=0.04), maximum heart rate (r=-0.28; p=0.007), minimum heart rate per day (r=-0.23; p=0.02). In patients 20-29 years old, the maximum heart rate reached 141.4±19.4, in patients over 40 years old – 134.3±17.9 (p=0.009). The mean value of the circadian index for the group was 1.17±0.13 (0.68-1.47). In 69.7%, the circadian index was rigid. Heart rate variability was within normal values in 32.2% of the examined patients, in 48.8% it was reduced, and in 19.1% it was sharply reduced. Heart rhythm disturbances were recorded in 65.5% of patients. The most frequently detected sinus arrhythmia (in 76.2% of cases of all arrhythmias), migration of the supraventricular pacemaker (in 27.0%) and atrial rhythm (in 11.1%). Arterial hypertension was detected in 67.7% of the examined patients. The maximum systolic BP (SBP) corresponding to arterial hypertension of the 1st degree was registered in 43.9% of patients, grade 2 – in 19.7%, grade 3 – in 3.0%, high normal BP – in 16.7%, normal BP – in 16.7%. Maximum diastolic BP (DBP) corresponding to grade 1 hypertension was found in 30.8% of patients, grade 2 – in 30.8%, grade 3 – in 15.4%, high normal BP – in 10.8%, normal BP – in 12.3%. The mean daily SBP was 126 mm Hg, DBP was 81 mm Hg. The mean daytime SBP was 128 mm Hg, DBP was 82 mm Hg. The mean nighttime SBP is 118 mm Hg, DBP is 77 mm Hg. The maximum SBP was 148 mm Hg, DBP was 97 mm Hg. When analyzing the types of daily BP curves, the vast majority of patients (44.6%) were classified as “non-dipper” type, both for SBP and DBP. Conclusions. The study results indicate that patients with combat injuries very often have sinus tachycardia, which is recorded over a long period of time. Heart rate is highest in the youngest injured patients and decreases as age increases. Sinus arrhythmia is very common, other rhythm and conduction disorders are much less common. High BP, especially DBP, is often recorded.

Effect of Accessory Renal Arteries on Essential Hypertension and Related Mechanisms.

This case-control study aimed to determine whether there were differences between patients with essential hypertension with accessory renal arteries (ARAs) and those without ARAs. The enrolled patients with essential hypertension were divided into the ARA group (n=200) and control group without ARAs (n=238). After propensity matching, 394 patients (197 in each of the 2 groups), were included. The 24-hour BP (4.33/2.43 mm Hg) and daytime BP (4.48/2.61 mm Hg) of patients in the ARA group were significantly higher than those of the control group (P<0.05). The flow-mediated dilation was lower in the ARA group (5.98±2.70 versus 5.18±2.66; P<0.05). In correlation analysis, the horizontal plasma aldosterone concentration had the highest correlation with 24-hour, daytime, and nighttime systolic BP (r=0.263, 0.247, and 0.243, respectively; P<0.05) and diastolic BP (r=0.325, 0.298, and 0.317, respectively; P<0.05). As for multivariate regression analysis, plasma aldosterone concentration was a significant risk factor for elevated 24-hour, daytime, and nighttime systolic BP (β=0.249 [95% CI, 0.150-0.349], 0.228 [95% CI, 0.128-0.329], and 0.282 [95% CI, 0.187-0.377], respectively; P<0.05) and elevated diastolic BP (β=0.289 [95% CI, 0.192-0.385], 0.256 [95% CI, 0.158-0.353], and 0.335 [95% CI, 0.243-0.427], respectively; P<0.05). Direct renin concentration was also a risk factor for 24-hour and daytime BPs, whereas heart rate was a risk factor correlated with 24-hour, daytime, and nighttime diastolic BP (all P<0.05). For the mixed-effects model for repeated measures, the results were similar to results of the multivariate regression analysis (all P<0.05). ARAs could contribute a higher BP of patients with essential hypertension and might promote the development of essential hypertension. The mechanism might be related to overactivation of the renin-angiotensin-aldosterone system and sympathetic nervous system.

Correlation analysis between cerebral microangiopathy and autonomic nervous dysfunction.

Our study was conducted aimed at investigating the potential correlation between cerebral microangiopathy and autonomic nervous dysfunction. We initially included 164 hospitalized patients with cerebral microangiopathy at our hospital from November 2019 to January 2021. Based on the inclusion and exclusion criteria, a final total of 162 patients with cerebral microangiopathy were selected. According to the patient's Autonomic Symptom Profile (ASP) score, patients with a score greater than 22 were categorized into a group with concomitant autonomic dysfunction (71 cases, combined group), while those with a score below 22 were categorized into a group of isolated cerebral microangiopathy (83 cases, cerebral microangiopathy group). The general data and laboratory examination results of the two groups were analyzed, and Pearson correlation analysis was performed to evaluate the correlation between cerebral microangiopathy and autonomic dysfunction, as well as the influencing factors of cerebral microangiopathy patients combined with autonomic dysfunction. There were no significant differences between the two groups in terms of sex, BMI, smoking, drinking, family dementia history, diabetes, hypothyroidism, carotid atherosclerosis, obstructive sleep apnea hypopnea syndrome, hyperuricemia, hyperlipidemia, chronic obstructive pulmonary disease, Hamilton Anxiety Scale score, Hamilton Depression Scale score, 24-h mean systolic blood pressure (SBP), 24-h mean diastolic blood pressure DBP, daytime mean systolic blood pressure (dSBP), daytime mean diastolic blood pressure, nighttime mean systolic blood pressure (nSBP), nighttime mean diastolic blood pressure, 24-h systolic blood pressure standard deviation (SBPSD), 24-h diastolic blood pressure standard deviation, daytime diastolic blood pressure standard deviation, nighttime diastolic blood pressure standard deviation (nDBPSD), nDBPSD (p>.05). However, significant differences were observed between the two groups regarding age, history of coronary heart disease, hypertension, leukoaraiosis, cognitive function, ASP score, SSR, 24-h SBPSD, daytime systolic blood pressure standard deviation (dSBPSD), nighttime systolic blood pressure standard deviation (nSBPSD), standard deviation of RR interval (SDNN), root mean square value of successive RR interval difference (RMSSD), high-frequency component (HF), and low-frequency component (LF) (p<.05). Moreover, the levels of TG, TC, HDL-C, and LDL-C did not show significant differences between the two groups (p>.05), but there were significant differences in blood uric acid and homocysteine (Hcy) levels (p<.05). Age, history of leukoaraiosis, cognitive function assessment, blood uric acid, Hcy levels, 24-h SBPSD, dSBPSD, and nSBPSD showed positive correlations with ASP scores and SSR in patients with cerebral microangiopathy (p<.001). In contrast, hypertension, SDNN, RMSSD, HF, and LF showed negative correlations with ASP scores and SSR (p<.001). Moreover, coronary heart disease was negatively correlated with ASP scores but positively correlated with SSR (p<.001). The independent variables included age, history of leukoaraiosis, cognitive function assessment, ASP score, SSR, blood uric acid, Hcy, bradykinin, coronary heart disease, hypertension, 24-h SBPSD, dSBPSD, nSBPSD, SDNN, RMSSD, HF, and LF, which were indicators with differences in general data and laboratory indicators. The dependent variable was patients with cerebral microangiopathy combined with autonomic nervous dysfunction. The analysis results showed that age, history of leukoaraiosis, ASP score, SSR, 24-h SBPSD, dSBPSD, nSBPSD, SDNN, RMSSD, HF, and LF were the influencing factors of patients with cerebral microangiopathy complicated with autonomic nervous dysfunction. We demonstrates that age, history of leukoaraiosis, cognitive function assessment, blood uric acid, Hcy level, 24-h SBPSD, dSBPSD, nSBPSD, blood pressure, SDNN, RMSSD, HF, LF, and coronary heart disease were highly associated with cerebral microangiopathy with autonomic dysfunction. Furthermore, the influencing factors of cerebral microangiopathy with autonomic dysfunction are age, history of leukoaraiosis, ASP score, SSR, blood pressure variability, and HRV.

Effect of insertion/deletion polymorphism of angiotensin-converting enzyme gene on efficacy of antihypertensive therapy with angiotensin II receptor blockers

The efficacy of the antihypertensive therapy may be related to genetic factors that can influence not only the degree of the blood pressure (BP) elevation but also contribute to the interindividual variability of response to the antihypertensive treatment.The aim of the work was to study pharmacodynamic parameters of the therapy efficacy with angiotensin II receptor blockers in the form of monotherapy and as part of combined drugs in patients with the arterial hypertension depending on the genetic features of patients – polymorphism of the gene encoding angiotensin-converting enzyme, or I/D-polymorphism.Materials and methods. The study included 179 patients of the Moscow region with a first-diagnosed arterial hypertension (AH) of 1–2 degree, including 141 (78.8%) women and 38 (21.2%) men aged from 32 to 69 years. By a simple randomization method, the patients were randomly allocated into groups receiving irbesartan and valsartan as mono- or combination therapy with hydrochlorthiazide. After 3 weeks of this pharmacotherapy, the presence of rs4646994 Alu Ins / Del genetic polymorphism of the angiotensin-converting enzyme (ACE) gene and the minimum equilibrium concentration of angiotensin II receptor blockers (ARBs) were determined.Results. The patients treated with irbesartan, the D/D genotype carriers, were significantly less likely to reach the target BP and more likely to require a pharmacotherapy intensification compared to I/D heterozygotes (p=0.042 and p=0.058, respectively) and I/I homozygotes (p=0.011 and p=0.011, respectively). The patients treated with valsartan, the D/D genotype carriers, significantly more often reached the target BP and significantly less often required a pharmacotherapy intensification than the I/D genotype carriers (p=0.05 and p=0.05, respectively). Herewith, at the end of the study, according to the results of the office BP measurements and daily BP monitoring, the target BP achievement was not significantly correlated with the I/D polymorphism of the ACE gene.Conclusion. When personalizing the AH therapy in patients of the Moscow region, the genotype I/I carriers by I/D polymorphism of the ACE gene, can be recommended irbesartan in the form of mono- or bicomponent therapy as a starting therapy of ARBs; the D/D genotype carriers can be recommended valsartan. A more pronounced decrease in the daytime systolic BP (SBP), the daytime diastolic BP (DBP) and the nighttime SBP variabilities in the valsartan group of patients, the D allele carriers may indicate a more persistent effect of the antihypertensive therapy.

Comparison of two single-pill dual combination antihypertensive therapies in Chinese patients: a randomized, controlled trial

BackgroundCurrent hypertension guidelines recommend combination of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker with a calcium-channel blocker or thiazide diuretic as initial antihypertensive therapy in patients with monotherapy uncontrolled hypertension. However, to what extent these two different combinations are comparable in blood pressure (BP)-lowering efficacy and safety remains under investigation, especially in the Chinese population. We investigated the BP-lowering efficacy and safety of the amlodipine/benazepril and benazepril/hydrochlorothiazide dual therapies in Chinese patients.MethodsIn a multi-center, randomized, actively controlled, parallel-group trial, we enrolled patients with stage 1 or 2 hypertension from July 2018 to June 2021 in 20 hospitals and community health centers across China. Of the 894 screened patients, 560 eligible patients were randomly assigned to amlodipine/benazepril 5/10 mg (n = 282) or benazepril/hydrochlorothiazide 10/12.5 mg (n = 278), with 213 and 212 patients, respectively, who completed the study and had a valid repeat ambulatory BP recording during follow-up and were included in the efficacy analysis. The primary outcome was the change from baseline to 24 weeks of treatment in 24-h ambulatory systolic BP. Adverse events including symptoms and clinically significant changes in physical examinations and laboratory findings were recorded for safety analysis.ResultsIn the efficacy analysis (n = 425), the primary outcome, 24-h ambulatory systolic BP reduction, was − 13.8 ± 1.2 mmHg in the amlodipine/benazepril group and − 12.3 ± 1.2 mmHg in the benazepril/hydrochlorothiazide group, with a between-group difference of − 1.51 (p = 0.36) mmHg. The between-group differences for major secondary outcomes were − 1.47 (p = 0.18) in 24-h diastolic BP, − 2.86 (p = 0.13) and − 2.74 (p = 0.03) in daytime systolic and diastolic BP, and − 0.45 (p = 0.82) and − 0.93 (p = 0.44) in nighttime systolic and diastolic BP. In the safety analysis (n = 560), the incidence rate of dry cough was significantly lower in the amlodipine/benazepril group than in the benazepril/hydrochlorothiazide group (5.3% vs 10.1%, p = 0.04).ConclusionsThe amlodipine/benazepril and benazepril/hydrochlorothiazide dual therapies were comparable in ambulatory systolic BP lowering. The former combination, compared with the latter, had a greater BP-lowering effect in the daytime and a lower incidence rate of dry cough.Trial registrationClinicalTrials.gov, NCT03682692. Registered on 18 September 2018.

Comparison of Serum Spexin Level and its Relationship with Echocardiographic Findings in Prediabetic Patients with and without Hypertension

Prediabetes mellitus, hypertension, and their frequent coexistence are risk factors for macrovascular and cardiovascular complications. In this study we aimed to determine the relationship between spexin levels and echocardiographic findings and hypertension in prediabetic patients. This study included 118 adult patients diagnosed with prediabetes mellitus who presented to outpatient clinics between April 2021 and January 2022. The patients were grouped into prediabetic patients with hypertension (n = 58) and those without hypertension (n = 60). The hypertension group was further divided into dipper and non-dipper groups according to the 24-hour ambulatory blood pressure monitoring. Blood samples were collected from all patients and echocardiography was performed. Spexin levels were measured by ELISA. Serum spexin levels, echocardiographic and ambulatory blood pressure monitoring findings were compared between the groups. The hypertension and non-dipper groups had significantly lower spexin levels and higher left atrial volume index, E/Em index, and interventricular septum and posterior wall thicknesses. Spexin levels were negatively correlated with body mass index (r = -0.298, P < 0.001), nighttime systolic blood pressure (r = -0.264, P = 0.006), nighttime diastolic blood pressure (r =-.255, P = 0.005), left atrial volume index (r =-.238, P = 0.009), E/Em (r =-.214,P = 0.020), and low-density lipoprotein cholesterol (r = -.243, P = 0.008). Obesity, overweight and spexin <780 pg/mL were independently associated with hypertension. Circulating spexin levels were lower in prediabetic patients with overall hypertension and in non-dipper patients, and were associated with echocardiographic and lipid parameters. The cut-off value of spexin identified in our study may be a useful indicator for hypertension detection and raise clinicians' awareness about evaluating prediabetic patients for hypertension.

CHARACTERISTICS OF CIRCADIAN BLOOD PRESSURE PROFILE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND THEIR ASSOCIATION WITH THYROID FUNCTION

The paper presents the results of a study of circadian arterial blood pressure (ABP) profile in patients with Acute Coronary Syndrome (ACS) and their association with thyroid-stimulating hormone (TSH) levels.&#x0D; Aim. To conduct a comparative analysis of circadian BP monitoring (CBPM) indicators in patients with ACS and their association with the TSH level.&#x0D; Materials and Methods. The study includes 125 patients with ACS aged 36 to 81 (mean age - 60.98± 0.81 years old). The patients were divided into two groups according to thyroid function. Group one (I) included 51 individuals (40.8%) - hypothyroid patients (TSH level&gt;4mIU/ml), mean age - 62.51±1.18 years old; Group II included 74 individuals (59.2%) - euthyroid patients (TSH level 0.4-4mIU/ml), mean age - 59.93±1.08 years old. The serum-free thyroxine (FT4) levels were within the normal range in both groups. In the general group, the proportion of individuals with unstable angina (UA) was 28.8%, and with myocardial infarction (MI) - 71.2%. In particular, in Group I, the proportion of individuals with UA was 23.53%, and with MI - 76.47%; in Group II, the proportion of individuals with UA was 32.43%, and with MI - 67.57%, p&gt;0,05 between Groups I and II. The circadian BP monitoring was carried out using the Biomed ВАТ41-2 device after stabilization of the patient's condition (on the second day of hospital admission). The following indicators have been determined: systolic BP (SBP) - daytime, nighttime, and average daily (24 hours) (SBPd, SBPn, and SBPav); diastolic BP (DBPd, DBPn, and DBPav); pulse BP (PBPd, PBPn, and PBPav); time index (TI) for SBPd, SBPn, and SBPav (SBPd TI, SBPn TI, and SBPav TI) and DBP (DBPd TI, DBPn TI, and DBPav TI); variability of SBPd, SBPn, and SBPav (SBPd var, SBPn var, and SBPav var) and DBP (DBPd var, DBPn var, and DBPav var); average daily index for SBP (SBP AvDI) and DBP (DBP AvDI); average daily heart rate (HRav). To study thyroid function in patients enrolled, TSH and FT4 levels were determined by chemiluminescent immunoassay method on the ARCHITECT iSystem analyzer using reagent kits for the quantitative determination of TSH (ARCHITECT TSH) and FT4 (ARCHITECT Free T4).&#x0D; Results and Discussion. The comparison of the CBPM results in both groups of patients with ACS shows significantly higher mean nighttime (SBPn and DBPn) levels in Group I patients compared to Group II patients: SBPn - by 6.27% (125.44±2.98 mm Hg (I) versus 117.58±2.26 (II), p&lt;0,05), DBPn - by 6.15% (73.65±1.91 mm Hg (I) versus 69.12±1.62 (II), p&lt;0,05), in the absence of a significant between-group difference between the mean levels of respective daytime and average daily indicators. Mean DBPn TI value also turned out to be significantly higher in Group I patients compared to Group II patients - by 33.69% (42.47±4.60% (I) versus 28.16±3.60% (II), p&lt;0.01). Significant difference was detected between mean SBP AvDI and DBP AvDI indicators in hypothyroid patients (I) versus respective indicators in euthyroid patients (II): SBP AvDI (I) 2.52±1.25% versus SBP AvDI (II) 5.99±0.98, p&lt;0.05; and DBP AvDI (I) 4.69±1.38% versus DBP AvDI (II) 8.88±1.32, p&lt;0.05.&#x0D; Conclusions. 1. Mean nighttime BP indicator (SBPn, DBPn, and DBPn TI) levels were significantly higher in the Group of hypothyroid patients with ACS, compared to euthyroid patients. In addition, the proportion of patients whose mean nighttime SBP and DBP levels exceeded the permissible values (SBPn&lt;120, DBPn&lt;70 mm Hg) was significantly higher in the Group of hypothyroid patients (I) compared to the Group of euthyroid patients (II). 2. Every third hypothyroid patient (I) (SBP AvDI: 37.25% and DBP AvDI: 31.37%) had a night-peaker circadian BP profile, characterized by nighttime BP increase instead of reduction, which suggests an extremely unfavorable prognosis. The findings may signal an additional adverse effect of thyroid dysfunction on arterial tone and, accordingly, BP regulation, which brings about a high risk of complications of ACS.