Nighttime Systolic Pressure Research Articles

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 < 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 < 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 < 0.05); they were negatively correlated with serum potassium ion (P < 0.05). The nighttime mean systolic blood pressure and nighttime systolic pressure load rate were independently positively correlated with urine microalbumin (P < 0.05), and serum potassium ions were independently negatively correlated with urine microalbumin by Multiple linear regression analysis (P < 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

Progression of type B intramural hematoma in patients with obstructive sleep apnea

ObjectiveIn the present study, we estimated the influence of obstructive sleep apnea (OSA) on the progression of type B intramural hematoma (IMHB). MethodsA total of 127 patients had undergone sleep evaluations and esophageal pressure measurements. The variables associated with aorta-related adverse events and mortality were summarized by logistic regression analysis and Cox proportional hazard models. A competing risk analysis of death was used to estimate aorta- and non–aorta-related mortality. ResultsThe OSA group had a greater aorta-related adverse events rate (46% vs 4%; P < .001). The mean nighttime systolic pressure (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.11-1.38; P < .001) was associated with aorta-related adverse events during the acute phase. Thoracic endovascular aortic repair (hazard ratio [HR], 16.2; 95% CI, 7.68-34.22, P < .001) and mean morning systolic pressure (HR, 1.43; 95% CI, 1.22-1.68; P < .001) were associated with a higher rate of aorta-related adverse events. OSA (HR, 3.19; 95% CI, 2.57-12.15; P < .001) and mean morning systolic pressure (HR, 1.59; 95% CI, 1.27-2.01; P = .002) were significantly associated with aorta-related mortality. Competing risk analysis revealed significantly higher aorta-related mortality in the OSA group (11.8% vs 2.0%; P = .0412). A neutrophil/lymphocyte ratio >3.52 (specificity, 90.2%; sensitivity, 89.5%) and mean platelet volume/platelet ratio >0.049 (specificity, 98.0%; sensitivity, 98.7%) had diagnostic value for detecting OSA in patients with IMHB. ConclusionsThe presence of OSA led to a higher aorta-related adverse event rate and mortality in patients with IMHB. The variables associated with these outcomes included thoracic endovascular aortic repair, mean morning and nighttime systolic pressure, and OSA. The neutrophil/lymphocyte ratio and platelet volume/platelet ratio are valuable for detecting OSA in patients with IMHB.

Association between blood pressure, inflammation and spirometry parameters in chronic obstructive pulmonary disease.

Background/AimsMany systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction.MethodsWe included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups.ResultsIn COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV1%). Diastolic blood pressure was associated with pH and HCO3 levels. The mean night time, day time pulse pressures and 24- hour pulse per minute values were also associated with all the parameters except FEV1%.ConclusionsIn this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.

INFLUENCE OF COMBINATION ANTIHYPERTENSION THERAPY ON THE PARAMETERS OF VESSEL WALL RIGIDITY IN NON-CONTROLLED ARTERIAL HYPERTENSION PATIENTS WITH DEPRESSION

Aim. Assessment of combination of antihypertension therapy (CAT) including antidepressant, on the main parameters of ambulatory blood pressure monitoring (ABPM), vascular wall rigidity parameters and central aortic pressure in patients with non-controlled arterial hypertension (NCAH) and depression disorders (DD). Material and methods. Totally, 160 patients studied with NCAH and DD, whom CAT was prescribed, that included angiotensine converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. Patients were randomized to 2 groups: in 1 group, to the therapy antidepressant escitalopram (Es) was added 10 mg per day; in 2 group — calcium antagonist amlodipine 5-10 mg per day. At baseline and in 24 weeks all included patients underwent general clinical assessment, ABPM (hardware ABPM by LLC “Piotr Telegin” BPLab Vasotens, Russia) under circumstances of free exertion regimen, with measurements interval 25 min day and 50 minutes nighttime. The following was assessed: mean daily, daytime and nighttime systolic pressure (sBP), diastolic pressure (dBP), BP variability, time index of AH, level and speed of morning BP increase, circadian index, pulse BP. In addition, the mean daily parameters of vessel rigidity were evaluated: time of reflected wave spread, evaluative velocity of pulse wave in aorta, augmentation index (Alx, %); main central aortic pressure parameters were checked: sBP (sBPao, mmHg), dBP (dBPao, mmHg), mean pressure in aorta (BPaom, mmHg), augmentation index in aorta (Alxao, %). Questionnaires were completed by patients: anxiety and depression HADS, selfestimation of depression by Tsung, Spielberger anxiety, Vein vegetative changes, life quality questionnaire SF-36 and ABPM. Results. In 24 weeks of therapy the positive statistically significant dynamics of depression spectrum disorders was marked in Es group, but in the 2nd group, by the majority of parameters depression level remained high. Usage of antidepressant as a part of CAT led to significant decrease of anxiety and vegetative changes, but in “traditional” therapy group there was increase of anxiety and vegetative disorders remained. In 1st group of patients taking antidepressant there was more prominent and statistically significant comparing to control group improvement of life quality parameters by SF-36. CAT with Es led to decrease of BP to target levels in a half of patients in 4 weeks, but in controls, to reach target values, in 75,6% it was need to increase amlodipine dosage up to 10 mg daily. Comparison of dynamics of ABPM parameters in 24 weeks showed that in the 1st group there was significantly more prominent improvement of main ABPM parameters comparing to controls. Conclusion. Usage of Es in CAT led to significant improvement of psychoemotional and vegetative status of patients, decrease of the main symptoms of depression and anxiety, improvement of life quality parameters, more rapid target BP achievement and more significant improvement of main ABPM parameters, than therapy without antidepressant.

Blood Pressure Variability and Neurological Improvement on Acute Ischemic Stroke Patients

Background: Several studies have confirmed the relationship between systolic blood pressure variability (BPV) and target organ damage, but only few studies have investigated the relationship between systolic BPV and neurological improvement on acute ischemic stroke patient. Objective: Define the correlation between systolic BPV and neurological improvement on acute ischemic stroke patients Methods: We recruited patients with acute ischemic stroke at Atma Jaya Hospital, North Jakarta, Indonesia. Systolic blood pressure (SBP) for every patient is taken 4 times a day (04.00, 11.00, 16.00, 23.00) on first three days of hospitalization. Variability of SBP is calculated as Standard Deviation (SD) of each patient's blood pressure. Neurological improvement is defined as at least a four score increase on National Institute of Health Stroke Scale (NIHSS) at discharge. We use chi square to determine the relationship between variability of daytime systolic pressure (11.00, 16.00) and nighttime systolic pressure (04.00, 23.00) with neurological improvement. Results: A total of thirty-four patients were included with twelve patients (35,3%) fulfilled the criteria for neurologic improvement. Age, sex, length of stay (LOS), and hypercholesterolemia were not associated with neurological improvement (P > 0.05). There is no significant relationship between systolic BPV and neurological improvement on acute ischemic stroke patients (P > 0.05). There is, however, a tendency of a significant relationship between nighttime systolic BPV and neurological improvement (P = 0.121) Conclusion: There is no significant relationship between systolic BPV and neurological improvement on acute ischemic stroke patients while hospitalized.

African Caribbeans have greater subclinical cerebrovascular disease than Europeans

Stroke is elevated in people of black African descent, but evidence for excess subclinical cerebrovascular disease is conflicting, and the role of risk factors in determining any ethnic differences observed unexplored. We compared prevalence of brain infarcts, and severe white matter hyperintensities (WMHs) on cerebral MRI, in a community-based sample of men and women aged 58-86 of African Caribbean (214) and European (605) descent, in London, UK. Resting, central and ambulatory blood pressure (BP) were measured; diabetes was assessed by blood testing and questionnaire. Mean age was 70. Multiple (≥4) brain infarcts and severe WMH occurred more frequently in African Caribbeans (18/43%), than Europeans (7/33%, P=0.05/0.008). Separately, clinic and night-time ambulatory BP were significantly associated with severe WMH in both ethnic groups; when both were entered into the model, the association for clinic SBP was attenuated and lost statistical significance [1.00 (0.98-1.02) P=0.9 in Europeans, 1.00 (0.97-1.04) P=0.9 in African Caribbeans], whereas the association for night-time SBP was retained [1.04 (1.02-1.07) P<0.001 in Europeans, 1.08 (1.03-1.12), P=0.001 in African Caribbeans]. The greater age-adjusted and sex-adjusted risk of severe WMH in African Caribbeans compared with Europeans [2.08 (1.15-3.76) P=0.02], was attenuated to 1.45 [(0.74-2.83) P=0.3] on adjustment for clinic and night-time systolic pressure, antihypertensive medication use and glycated haemoglobin. African Caribbeans have a greater burden of subclinical cerebrovascular disease than Europeans. This excess is related to elevated clinic and ambulatory BP, and to hyperglycaemia.

Blood Pressure in Relation to Interactions Between Sodium Dietary Intake and Renal Handling

There is abundant evidence that sodium intake is related to blood pressure. However, the relationship varies between individuals and is probably determined by renal sodium handling. We investigated clinic and ambulatory blood pressure in relation to interactions between sodium dietary intake and renal handling, as assessed by 24-hour urinary sodium excretion and endogenous lithium clearance, respectively. We calculated fractional excretion of lithium and fractional distal reabsorption rate of sodium, as markers of proximal and distal sodium handling, respectively. The 766 subjects included 379 men and 478 ambulatory hypertensive patients. They were never treated (n=697) or did not take antihypertensive medication for ≥2 weeks (n=69). In adjusted analyses, none of the associations of urinary sodium excretion, fractional excretion of lithium, and fractional distal reabsorption rate of sodium with clinic or ambulatory blood pressure were statistically significant (P≥0.09). However, there was significant (P=0.01) interaction between urinary sodium excretion and fractional excretion of lithium in relation to nighttime diastolic blood pressure. In tertile 3 but not tertiles 1 and 2 of fractional excretion of lithium, nighttime diastolic pressure was positively associated with urinary sodium excretion (P=0.03). However, nighttime diastolic pressure was higher in tertile 1 than tertile 3 of fractional excretion of lithium (+2.0 mm Hg; P=0.01), especially in the bottom tertile of urinary sodium excretion (+4.9 mm Hg; P<0.001). Similar trends were observed for nighttime systolic pressure and clinic and 24-hour diastolic pressure. In conclusion, sodium dietary intake and proximal tubular handling interact to be associated with blood pressure.

Nighttime Blood Pressure and White Matter Hyperintensities in Patients With Parkinson Disease

Increasing evidence indicates that nocturnal blood pressure level and/or loss of nocturnal blood pressure dips are sensitive markers of cardiovascular morbidity and mortality. Several studies have suggested that blunted heart rate variability and nocturnal decline in heart rate are also associated with target organ damage. These phenomena occur relatively commonly in patients with Parkinson disease (PD); however, few studies have assessed the consequences of these abnormalities in patients with PD. We investigated the influence of circadian changes in blood pressure and heart rate on white matter hyperintensities (WMHs) in patients with PD. The presence of nocturnal hypertension was associated with increased WMH score, and nighttime systolic pressure was closely related with white matter changes. Blunted heart rate variability and nocturnal decline in heart rate were also related to increasing WMH scores. The non-dipping phenomenon did not influence WMHs. These findings suggest that white matter changes are related to circadian autonomic dysfunction, particularly nocturnal hypertension in patients with PD. Therefore, it is important to monitor nocturnal blood pressure status, because modifying these circadian regulatory disturbances can be beneficial to protect against vascular brain damage in patients with PD. (Author correspondence: neuronet@catholic.ac.kr)

Vascular dysfunction during pregnancy in women with polycystic ovary syndrome

An association has been proposed between polycystic ovary syndrome (PCOS) and pregnancy-induced hypertensive disorders. Ambulatory blood pressure and carotid artery elasticity were therefore prospectively investigated in matched PCOS and control pregnancies. Twenty-two PCOS-control subject pairs with singleton pregnancies, matched for age, body mass index, parity and ethnicity, were recruited in the first trimester (T1, 11-13 weeks). Ambulatory blood pressure recording for 24 h and carotid artery ultrasound for elasticity estimation were performed in T1 and in the second (T2, 22-24 weeks) and third (T3, 32-34 weeks) trimesters. At nearly all time points during gestation, ambulatory systolic, diastolic and mean arterial pressures were elevated in PCOS versus control pregnancies. Carotid artery stiffness index was greater and compliance was less in PCOS pregnancies compared with controls. Differences in night-time systolic pressure and carotid artery elasticity were greatest in T3. PCOS also increased the incidence of pregnancy-induced hypertension (6 of 22 cases versus 0 of 22 in controls; P = 0.011). Pregnant women with PCOS have higher baseline ambulatory blood pressure and impaired arterial elasticity, suggestive of disturbed vascular adaptation to pregnancy.

Weather-Related Changes in 24-Hour Blood Pressure Profile

A downward titration of antihypertensive drug regimens in summertime is often performed on the basis of seasonal variations of clinic blood pressure (BP). However, little is known about the actual interaction between outdoor air temperature and the effects of antihypertensive treatment on ambulatory BP. The combined effects of aging, treatment, and daily mean temperature on clinic and ambulatory BP were investigated in 6404 subjects referred to our units between October 1999 and December 2003. Office and mean 24-hour systolic BP, as well as morning pressure surge, were significantly lower in hot (>90th percentiles of air temperature; 136+/-19, 130+/-14, and 33.3+/-16.1 mm Hg; P<0.05 for all), and higher in cold (<10th percentiles) days (141+/-12, 133+/-11, and 37.3+/-9.5 mm Hg; at least P<0.05 for all) when compared with intermediate days (138+/-18, 132+/-14, and 35.3+/-15.4 mm Hg). At regression analysis, 24-hour and daytime systolic pressure were inversely related to temperature (P<0.01 for all). Conversely, nighttime systolic pressure was positively related to temperature (P<0.02), with hot days being associated with higher nighttime pressure. Air temperature was identified as an independent predictor of nighttime systolic pressure increase in the group of elderly treated hypertensive subjects only. No significant relationship was found between air temperature and heart rate. Our results show for the first time that hot weather is associated with an increase in systolic pressure at night in treated elderly hypertensive subjects. This may be because of a nocturnal BP escape from the effects of a lighter summertime drug regimen and may have important implications for seasonal modulation of antihypertensive treatment.

Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients

Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients

Prognostic significance of blood pressure variability in essential hypertension

BACKGROUND: Blood pressure variability is a determinant of target organ damage in essential hypertension, but its independent prognostic significance has not yet been assessed in prospective studies of cardiovascular morbidity and mortality. OBJECTIVE: To assess the relationship between blood pressure variability, assessed non-invasively using 24 h ambulatory blood pressure monitoring and subsequent incidence of cardiovascular morbid events in persons with essential hypertension. DESIGN: Prospective observational study. PATIENTS AND METHODS: We followed for up to 8.6 years (mean 2.92) 1372 individuals with essential hypertension whose initial off-therapy diagnostic work-up included 24 h non-invasive ambulatory blood pressure monitoring. Those with a standard deviation of daytime or night-time blood pressure below or above the group mean were classified as having low or high blood pressure variability, respectively. One hundred and eighty-two participants underwent repeated ambulatory blood pressure monitoring and echocardiography during follow-up, 2.7 years later. RESULTS: Target organ damage score was greater in the participants with high variability of daytime (P = 0.004) and night-time (P = 0.011) systolic blood pressure than in those with low blood pressure variability. In those who underwent repeated echocardiography, for every quartile of baseline ambulatory blood pressure, left ventricular mass at follow-up was greater (all P < 0.05) in those with high baseline blood pressure variability than in those with low baseline variability. During follow-up there were 106 major cardiovascular morbid events. Event rate was 1.99 and 3.26 events per 100 patient-years, respectively, in participants with low and high variability of daytime systolic pressure and 1.98 and 3.38 events per 100 patient-years, respectively, in those with low and high variability of night-time systolic pressure (log-rank test: both P < 0.05). However, in a Cox multivariate analysis, the variability score for daytime and night-time systolic pressure failed to enter the model (age, diabetes mellitus, previous cardiovascular events and average night-time systolic pressure were independently associated with cardiovascular events). CONCLUSION: Increased blood pressure variability, assessed with non-invasive monitoring, is associated with a higher incidence of cardiovascular morbid complications of hypertension, but also with a higher blood pressure, older age and a higher prevalence of diabetes mellitus. Because of the relevant predictive effect of these associated factors, the adverse prognostic significance of increased blood pressure variability is no longer detectable in multivariate analysis.