Nighttime Systolic Blood Pressure Research Articles

Diastolic Blood Pressure Abnormalities and Their Relationship with Glycemic Control in Pediatric Type 1 Diabetes.

Background/Objectives: Type 1 diabetes (T1D) in children is associated with increased cardiovascular risk, partly due to coexisting blood pressure (BP) disturbances. Ambulatory blood pressure monitoring (ABPM) is recommended for detecting subtle BP abnormalities, yet the relationship between glycemic control, T1D duration, and specific BP disturbances remains unclear. This study evaluated associations between HbA1c levels, T1D duration, and ABPM-derived BP parameters in a pediatric population with T1D. Methods: We included 357 children and adolescents (aged 7-18.8 years) with T1D treated at a tertiary center. All participants underwent 24 h ABPM. Glycemic control was assessed using HbA1c; values > 6.5% were considered suboptimal. We analyzed associations between HbA1c, T1D duration, and various BP parameters, including daytime and nighttime systolic and diastolic BP, nocturnal dipping, and hypertension defined by ABPM criteria. Logistic regression analyses were performed to identify independent predictors of elevated HbA1c. Results: Arterial hypertension was confirmed in 10% of patients, and 41% showed a non-dipping BP profile. There were no significant differences in HbA1c or T1D duration between dippers and non-dippers. However, patients with HbA1c > 6.5% had significantly higher 24 h diastolic BP and were more likely to meet hypertension criteria (p = 0.009). In univariate regression, both longer T1D duration (OR = 1.086; p = 0.033) and higher 24 h diastolic BP (OR = 1.065; p = 0.0068) were associated with elevated HbA1c. Both remained significant in multivariate analysis. Conclusions: Impaired glycemic control in children and adolescents with T1D was independently associated with higher 24 h diastolic BP and longer diabetes duration.

Psychophysiological correction of occupation-related arterial hypertension

Introduction. The relevance of optimizing medical and preventive measures for occupation-related arterial hypertension is determined by the significant prevalence of the disease among workers in hazardous industries and the social significance of the disease. The validity of studying the addition of psychophysiological effects to drug therapy is associated with a sufficient volume of research proving the pathogenetic role of chronic stress in the development of arterial hypertension. The purpose. To study of the effectiveness of the psychophysiological component of medical and preventive measures for occupation-related arterial hypertension. Materials and methods. An observational comparative study was conducted to evaluate the effectiveness of programs of resonance-acoustic oscillations in patients with arterial hypertension working in conditions where hygienic standards for indicators of industrial noise, heating microclimate, and labour intensity exceeded the norms. The study was conducted using dynamic monitoring of arterial pressure indices before and after sessions of psychophysiological correction conducted against the background of individually selected hypotensive therapy. The comparison group included patients with arterial hypertension of the same enterprise who received only drug therapy. Results. Positive trend were revealed in the form of a decrease in clinical blood pressure (BP), average daily and average night-time BP values, and arterial pressure variability after sessions of psychophysiological correction conducted against the background of individually selected hypotensive therapy. The effectiveness of the impact of resonance-acoustic oscillation programs in the main group was established in the form of a decrease in clinical systolic BP, average daily systolic BP, and average night-time systolic BP relative to similar indices in the examined control group. Limitations. The patients were workers in the aircraft engineering industry, working in conditions where hygienic standards for industrial noise, heating microclimate, and labour intensity were exceeded. It is difficult to isolate the leading factor causing hypertension. The data are limited to voluntary study participants. Conclusions. The effectiveness of the psychophysiological component of medical and preventive measures for occupation-related arterial hypertension has been established.

A comparative study of oxidative stress, vascular calcification, and volume status in non-dippers and dippers receiving maintenance hemodialysis.

A comparative study of oxidative stress, vascular calcification, and volume status in non-dippers and dippers receiving maintenance hemodialysis.

Association between estimated daily salt intake from spot urine and nocturnal blood pressure in hypertensive patients under antihypertensive treatment.

Association between estimated daily salt intake from spot urine and nocturnal blood pressure in hypertensive patients under antihypertensive treatment.

Long-term effect of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea.

Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for Obstructive Sleep Apnea (OSA). Its long-term effects on Resistant Hypertension (RHT) have not yet been fully established. We conducted a prospective intervention study to evaluate the impact of long-term CPAP therapy on office and ambulatory blood pressure (BP) in patients with RHT and moderate to severe OSA. Patients who used CPAP for a minimum of 12 months were included in the CPAP group and compared with those who declined to use CPAP despite clinical indications (control group). All participants underwent 24-h ambulatory blood pressure monitoring (ABPM) at baseline and at the end of the study. Intergroup comparisons of BP changes were performed using a general linear model, including two per-protocol analyses for patients with optimal CPAP adherence (at least 4 h/night) and those with refractory hypertension. A total of 124 individuals were included (65 in the CPAP group and 59 controls), with a mean age of 60.7 ± 7.8 years. The intention-to-treat analysis found no significant differences in overall BP changes between groups. The per-protocol analyses (50 CPAP users with optimal adherence and 28 with refractory hypertension) showed significant reductions in nighttime systolic BP (-8.1 mmHg (95% CI -14.7 to -1.5) and -25.6 mmHg (95% CI -40.1 - -10.5), respectively) and in nighttime diastolic BP (-5.3 mmHg (95% CI -9.6 to -1.1) and -13.9 mmHg (95% CI -22.5 - -5.3), respectively). These findings suggest that while CPAP benefits adherent patients and refractory hypertensives, its overall long-term effects on resistant hypertension require further investigation.

Efficacy of Esaxerenone Plus a Renin-Angiotensin System Inhibitor or Calcium Channel Blocker for Nocturnal Hypertension: A Post Hoc Analysis.

Efficacy of Esaxerenone Plus a Renin-Angiotensin System Inhibitor or Calcium Channel Blocker for Nocturnal Hypertension: A Post Hoc Analysis.

Relative blood pressure increase is associated with subsequent atrial fibrillation episodes in long-term out-patient monitoring: TriggersAF

Relative blood pressure increase is associated with subsequent atrial fibrillation episodes in long-term out-patient monitoring: TriggersAF

1097 A Multi-Omics Study of the Association Between Insomnia with Objective Short Sleep Duration Phenotype and High Blood Pressure

Abstract Introduction Insomnia with objective short sleep duration is associated with increased hypertension risk. We aimed to explore the mechanism underlying the association between objective short sleep duration and hypertension in patients with chronic insomnia disorder (CID) by multi-omics. Methods CID was defined according to International Classification of Sleep Disorders-3, and objective short sleep was based on the median value of total sleep time of the overall subjects during an overnight polysomnography. We used the mean values of measured nighttime and morning systolic (SBP) and diastolic blood pressure (DBP) for analysis. Serum metabolomics and fecal 16S rDNA amplicon sequencing were used to explore characteristic metabolites and analyze gut microbiota distribution, respectively. Results One hundred three patients with CID and 70 normal sleepers were included. We found 53 objective short sleep duration insomnia phenotype (ISSD)-related serum metabolites. Among the 53 ISSD-related serum metabolites, indoxyl sulfate was positively correlated with BP after adjusting for confounding factors (SBP: β=0.250, p=0.028; DBP: β=0.256, p=0.030) in ISSD. In addition, the level of serum indoxyl sulfate was significantly correlated with the genera Prevotella 9 (r=0.378, p=0.027), CAG-56 (r=-0.359, p=0.037), Ruminiclostridium 9 (r=-0.340, p=0.049) and Ruminococcus 2 (r=-0.356, p=0.039) in ISSD. Conclusion Our study suggests that the ISSD phenotype is associated with significant changes in serum metabolic profile, including high levels of indoxyl sulfate. The latter molecule correlates both with BP and gut microbiota in patients with the ISSD phenotype, suggesting that indoxyl sulfate may be the molecular path resulting in increased hypertension risk in this phenotype. Support (if any)

Myocardial fibrosis in primary aldosteronism.

We investigated myocardial fibrosis in relation to clinical and biochemical characteristics and the metabolomics in patients with primary aldosteronism. Our study included 54 patients with primary aldosteronism. We performed cardiac magnetic resonance to evaluate focal replacement myocardial fibrosis defined as late gadolinium enhancement (LGE) and diffuse interstitial fibrosis as assessed by extracellular volume (ECV) with T1 mapping. We collected information on demographics and data of clinical biomarkers, and performed echocardiography and metabolomic analysis. Patients with LGE (n=30), compared with those without LGE (n=24), had a longer duration of hypertension, higher 24-hour, daytime and nighttime systolic blood pressure, left ventricular mass index, and plasma NT-proBNP (P<0.001). However, they had comparable T1 mapping measurements including ECV. LGE significantly (P ≤ 0.007) and positively correlated with the duration of hypertension, ambulatory systolic blood pressure and LVMI, while ECV and native T1 were significantly (P ≤ 0.027) and inversely associated with plasma renin activity and positively associated with aldosterone-to-renin ratio. Besides, both LGE and ECV significantly (P ≤ 0.030) and positively correlated with NT-proBNP. Non-targeted metabolomic analysis showed that the amino-acid metabolism, especially the L-glutamate metabolism, significantly differed between patients with LGE and those without LGE and correlated with blood pressure and echocardiographic measurements. In patients with primary aldosteronism, focal replacement fibrosis was associated with cardiac afterload factors such as blood pressure, while diffuse interstitial fibrosis was associated with hyperaldosteronism. The amino-acid metabolism, especially the L-glutamate metabolism, might be involved in the process of myocardial fibrosis.

Effect of Alcohol Abstinence on Blood Pressure in Mid-Life Heavy Drinkers

Introduction: One in five mid-life adults report heavy alcohol use, which exceeds the recommended drinking limit. Alcohol use is associated with an increased risk for hypertension. However, the effect of alcohol abstinence intervention on blood pressure (BP) in mid-life adults remains unclear. This study aims to investigate the effect of an 8-week alcohol abstinence intervention on BP in mid-life adult heavy drinkers. Methods: Eight mid-life men and four postmenopausal women, heavy drinkers and free of major clinical diseases and smoking, were included (age: 59 ± 4 yrs and body mass index: 27.5 ± 3.9 kg/m2; mean±SD). All participants were asked to abstain from alcoholic beverages for 8 weeks and received a 30-min virtual behavioral consultation session, every 2 weeks. During the intervention, alcohol use was monitored by measuring dried blood spot phosphatidylethanol (PEth; ≥20 ng/mL indicates positive test or heavy alcohol use) every 4 weeks and using the 14-day Timeline Follow-Back calendar every 2 weeks. Office seated BP (ProBP 2400, Welch Allyn®), supine central BP (SphygmoCor XCEl, AtCor Medical) and 24-hr ambulatory BP (Oscar 2TM, SunTech Medical®) were measured at pre- and post-intervention. Results: Before the intervention, all participants had a positive PEth (range: 22-213 ng/mL) and consumed 14.5±8.7 drinks/week. Throughout the intervention, both PEth levels and self-report alcohol use decreased, with two participants having a positive PEth test and an average alcohol consumption of 0.2±0.5 drinks/week after the intervention. Following the intervention, office diastolic BP decreased (pre- vs. post-intervention: 80±8 vs. 74±7 mmHg; P=0.02), with no statistical significance in office systolic BP (132±14 vs. 122±14 mmHg; P=0.068). There were significant decreases following the intervention in nighttime systolic (119±15 vs. 113±12; P=0.048) and diastolic BP (67±10 vs. 62±5; P=0.009), as well as systolic BP morning surge (29±11 vs. 21±11 mmHg; P=0.01). No difference between pre- and post-intervention was found in daytime BP (systolic: 130±12 vs. 127±11 mmHg, P=0.3; diastolic: 78±6 vs. 75±7 mmHg, P=0.2) and nighttime BP dipping ratio (systolic: 9±7 vs. 11±5 mmHg, P=0.3; diastolic: 13±10 vs. 17±6 mmHg, P=0.2), as well as central BP (systolic: 120±11 vs. 118±12 mmHg, P=0.4; diastolic: 79±8 vs. 77±6 mmHg; P=0.3). Conclusions: Our findings indicate that the 8-week alcohol abstinence intervention is effective in reducing BP for mid-life adult heavy drinkers. NIAAA AA028537 to CLH This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Predictive Accuracy of 24-Hour Ambulatory Blood Pressure Monitoring Versus Clinic Blood Pressure for Cardiovascular and All-Cause Mortality: A Systematic Review and Meta-Analysis.

According to current clinical practice guidelines, ambulatory blood pressure measurement (ABPM) is recommended to confirm diagnoses of hypertension. It remains unclear as to which method is superior in predicting mortality outcomes. Prospective observational studies, comparing ABPM with clinical blood pressure measurements (CBPM), were included with outcomes of the study being all-cause and cardiovascular mortality. Nine studies with a total of 23,140 participants were included. Each 10-mmHg increase in 24-hour mean systolic blood pressure (SBP) was linked to a higher risk of all-cause mortality (HR: 1.13, 95% CI: 1.09-1.18), while clinic blood pressure measurement (CBPM) was not a significant predictor (HR: 1.02, 95% CI: 0.90-1.13). Nighttime SBP increases of 10 mmHg were associated with a higher all-cause mortality risk than daytime SBP (HR: 1.16, 95% CI: 1.11-1.21 versus HR: 1.08, 95% CI: 1.05-1.12). For cardiovascular mortality, a 10 mmHg increase in SBP yielded an HR of 1.21 (95% CI: 1.16-1.27) for 24-hour ABPM compared to 1.08 (95% CI: 1.04-1.11) for CBPM. Similarly, for a 5 mmHg increase in diastolic blood pressure (DBP), the HR was 1.14 (95% CI: 1.07-1.20) for 24-hour ABPM versus 1.04 (95% CI: 1.01-1.07) for clinical DBP, highlighting 24-hour monitoring as a stronger predictor for cardiovascular mortality. The findings of this study support the superiority of ABPM measurements in predicting both all-cause and cardiovascular mortality.

Time-Restricted Eating Improves Blood Pressure but not Cardiovagal Baroreflex Sensitivity in Healthy Middle-Aged Adults

Time-restricted eating (TRE) is a low-cost lifestyle intervention that has been shown to reduce day- and nighttime blood pressure (BP), however previous work has mainly been done in animal models. Further, little research has investigated the effects of TRE on markers of cardiovascular health and BP regulation (i.e. baroreflex sensitivity; BRS), especially in humans. With midlife being a crucial time in which the risk of cardiovascular disease increases, understanding the effects of lifestyle interventions like TRE on middle-aged adults may provide insight on preventative strategies against disease. Therefore, the purpose of this study was to investigate the effects of TRE on cardiovascular variables and cardiovagal BRS (cvBRS) in middle-aged healthy adults. We hypothesized that TRE would reduce BP and increase cvBRS. Twenty-nine (12M/17F) healthy, middle-aged adults (56±5 years) were assessed before and after a 5-week TRE intervention. Outside of the lab, 24-hour ambulatory BP monitoring (ABPM) was performed using an inflatable arm cuff to provide nighttime, daytime, and overall BP. Morning surge index (MSI) was calculated to assess peak BP upon waking. Upon arrival to the lab in the morning following an overnight fast, cardiovascular variables were assessed including supine beat-to-beat BP and stroke volume (SV) via finger plethysmography as well as heart rate (HR) via 3-lead ECG. cvBRS was measured by obtaining the slope of the relationship between systolic BP (SBP) and R-R intervals during Phase IV of the Valsalva maneuver. Results from ABPM after 5 weeks of TRE showed nighttime SBP (Pre: 107±10 mmHg; Post: 104±8 mmHg) and diastolic BP (DBP; Pre:63±5 mmHg; Post: 62±6 mmHg) decreased (p&lt;0.05 for both). The decrease in daytime SBP (Pre: 128±10 mmHg; Post: 125±12 mmHg; p=0.055), overall SBP (Pre: 121±9 mmHg; Post: 119±11 mmHg; p=0.054), and MSI (Pre: 20.4±9.2; Post: 16.8±9.8; p=0.069) did not reach significance. There were no differences in daytime DBP (Pre: 79±7 mmHg; Post: 78±8 mmHg; p=0.175) or overall DBP (Pre: 74±6 mmHg; Post: 73±7 mmHg; p=0.130). Results from the lab visit after 5 weeks of TRE showed supine beat-to-beat SBP decreased (Pre: 126±10 mmHg; Post: 122±10 mmHg; p&lt;0.05) but the decrease in DBP did not reach significance (Pre: 78±6 mmHg; Post: 77±6 mmHg; p=0.078). There were no differences in SV (Pre: 92±19 mL; Post: 91±26 mL; p=0.380), HR (Pre: 57±8 bpm; Post: 56±8 bpm; p=0.213) or cvBRS (Pre: 9.2±5.8 ms/mmHg; Post: 10.2±6.0 ms/mmHg; p=0.123) at rest. A 5-week TRE intervention affects BP, especially reducing nighttime BP, without observable effects on daytime HR, SV, or cvBRS. Future work should consider other BP regulatory mechanisms such as sympathetic activity when investigating effects of TRE. American Heart Association (191PLOI34680015; JNB) and the National Institutes of Health (T32HL007936; SHAGM). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Evaluation of the Relationship Between Systemic Immune-Inflammatory Index and Morning Blood Pressure Surge in Newly Diagnosed Essential Hypertension Patients

Purpose: This study aims to explore the relationship between the Systemic Immune-Inflammatory Index (SII) and Morning Blood Pressure Surge (MBPS) in patients with newly diagnosed essential hypertension. Materials and Methods: A cross-sectional study was conducted between April and June 2024, involving 405 participants, 217 controls, and 188 hypertensive patients, recruited from a cardiology outpatient clinic. Participants' blood pressure was monitored using Ambulatory Blood Pressure Monitoring (ABPM), and inflammatory markers, including SII, were assessed. SII was calculated by multiplying platelet count by neutrophil count and dividing by lymphocyte count. Statistical analysis included ROC curve analysis to evaluate SII's predictive value for MBPS. Results: Hypertensive patients exhibited significantly higher 24-hour, daytime, and nighttime systolic and diastolic blood pressure values compared to controls (all p&amp;lt;0.001). MBPS and SII were also significantly elevated in the hypertensive group (both p=0.003). ROC analysis demonstrated that SII had an AUC of 0.645 (p=0.001) with a sensitivity of 56.4% and specificity of 67% at a cut-off value of 577.38 for predicting MBPS greater than 27.3 mmHg. Elevated neutrophil and platelet counts were associated with higher blood pressure levels and cardiovascular risk. Conclusion: The study identified a significant association between SII and MBPS in hypertensive patients, suggesting that systemic inflammation may play a role in the regulation of blood pressure and the pathogenesis of hypertension. SII could serve as a valuable biomarker for predicting MBPS and associated cardiovascular risks, facilitating earlier and more targeted interventions.

Chronotherapy for Hypertension: A Meta-Analysis and Systematic Review of RCTs.

The aim of this study was to evaluate the efficacy of chronotherapy for patients with essential hypertension with a range of clinical characteristics. We searched the PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials of antihypertensive therapies in which patients were randomized to morning or evening administration. The primary outcomes of the included studies were ambulatory blood pressure (BP) parameters and patient characteristics, including age, body mass index, percentage of female participants, and drug ingestion, which were described in subgroup analyses. In total, 56 studies were included in the analyses. Meta-analyses and subgroup analyses revealed that specific populations of patients benefited more from bedtime dosing than from morning dosing in both 24-h or 48-h ambulatory systolic BP (SBP) and nighttime SBP, including (1) groups aged < 60 years, (2) those with body mass index ≥ 30 kg/m2, (3) studies with ≥ 50% female participants, and (4) patients receiving antihypertensive calcium channel blockers. However, when controversial data by Hermida et al. were omitted, the effects of BP controls were observed in patients with overweight, particularly obesity. Furthermore, calcium channel blockers contributed to an obvious reduction in nighttime SBP with chronotherapy. Chronotherapy for hypertension may not be completely ineffective, and the clinical program and timing of medication administration can be selected according to the patient's clinical characteristics. Registration PROSPERO identifier number CRD42021292795.

Impact of Three-Dimensional Assessment of Maternal Left Ventricular Systolic Function on Pregnancy Outcomes

Background:Hypertensive disorders in pregnancy (HDP) are associated with adverse pregnancy outcomes. Three-dimensional (3D) echocardiography provides greater accuracy for assessing cardiac geometry and function during pregnancy. The aim was to assess the impact of the 3D left ventricle (LV) systolic function in HDP on pregnancy outcomes.Methods:The prospective cohort study included primiparous with singleton pregnancies, without previous comorbidities who underwent medical history assessment, laboratory tests, ambulatory blood pressure monitoring (ABPM), and transthoracic echocardiography at baseline and six weeks after delivery. Participants were divided into a HDP group and a control group. Pregnancy outcomes (intrauterine growth restriction (IUGR), preterm delivery, and birth weight) were recorded and analyzed.Results:The study involved 174 HDPs and 64 controls, with a median gestational age of 34 weeks (31; 36). Compared to controls HDP exhibited significantly impaired values in both two-dimensional (2D) and 3D parameters for the systolic and diastolic function of the LV. They had higher LV mass index values and lower absolute values for 2D global longitudinal strain and 3D LV strain in all directions (p < 0.001). Multivariable regression analysis revealed that body mass index (BMI) with odds ratio (OR) of 0.751 (95% confidence interval (CI): 0.666–0.847, p < 0.001) and 3D LV global area strain (GAS) with OR of 0.234 (95% CI: 0.155–0.352, p < 0.001) were the strongest predictors of IUGR, while BMI with OR of 0.832 (95% CI: 0.758–0.914), nighttime systolic blood pressure (SBP) with OR of 1.055 (95% CI: 1.032–1.079, p < 0.01) and 3D LV ejection fraction (EF) with OR of 0.780 (95% CI: 0.687–0.885) were the strongest predictors of preterm delivery. The receiver operating characteristic (ROC) curve showed that the model with BMI and 3D LV GAS can be a good predictor for IUGR with an area under the curve (AUC) 0.951 (0.925–0.976) with 89.5% sensitivity and 86.4% specificity, p < 0.001, while the model with BMI, nighttime SBP and 3D LV EF is a predictor for preterm delivery with AUC of 0.835 (0.776–0.893) with 79.1% sensitivity and 73.7% specificity, p < 0.001. Person correlation showed a significant positive correlation between birth weight and 3D GAS, r = 0.485; p < 0.001.Conclusions:LV GAS is significantly associated with IUGR and birth weight, while 3D LV EF strongly predicts preterm delivery.

Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials

Elevated nighttime blood pressure (BP) and abnormal circadian dipping patterns are associated with advanced age and coexisting illnesses and are attributed to autonomic dysfunction. Radiofrequency renal denervation (RF RDN) effectively lowers BP throughout 24 h and thus may provide an effective antihypertensive therapeutic option. This analysis assesses the effects of RDN on nocturnal hypertension with different dipper patterns defined by nighttime/daytime BP ratio (i.e. dippers, non-dippers, risers) through 2 years in patients randomized to RDN from the SPYRAL HTN-OFF MED and -ON MED trials. Office and 24-h ambulatory BP, were also evaluated in patients stratified by age, obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Among 388 patients, the baseline nighttime systolic BP (SBP) was 139.3 ± 11.3 mmHg. Patients with a riser pattern had the highest baseline nighttime SBP (152.7 ± 8.0 mmHg). At 2 years, patients experienced a significant reduction from baseline (p < 0.0001) in nighttime (−12.0 ± 17.1 mmHg), morning (−14.8 ± 20.0 mmHg), daytime (−13.8 ± 14.7 mmHg), and 24-h SBP (−13.4 ± 14.2 mmHg). The greatest reduction in SBP was in risers at nighttime (−23.7 ± 14.3 mmHg). RDN was equally effective in lowering nighttime BP in patients ≥65 years old or with OSA, CKD, or T2DM. In this pooled dataset of RF RDN patients, clinically meaningful reductions in BP over a 24-h period were observed through 2 years irrespective of dipping status. RF RDN may reduce the risk of cardiovascular outcomes in patients with uncontrolled hypertension, especially in those with elevated nighttime BP who may be the most challenging to treat.

Nighttime systolic blood pressure reduction rate and periventricular white matter hyperintensity were associated with cognitive function in Parkinson's disease.

This study aimed to investigate the relationship between nighttime systolic blood pressure (NSBP) reduction rate, white matter hyperintensity (WMH), and cognitive function in Parkinson's disease (PD) patients. All PD participants underwent 24-hour ambulatory blood pressure monitor and MRI, with the volumes of WMHs quantified. Participants were categorized into normal dipping and non-dipping groups based on dipping patterns, as well as dementia and non-dementia groups according to a Montreal Cognitive Assessment (MoCA) score of less than 20. Multivariate linear regression analysis was performed to identify independent risk factors for cognitive function. Compared to normal dippers (n = 13), non-dippers (n = 39) showed significantly lower MoCA scores, higher volumes of periventricular WMH, ratios of periventricular WMH to white matter (WM), and ratios of deep WMH to WM (P = 0.027; 0.015; 0.011; 0.023). Moreover, the ratios of juxtaventricular WMH to WM, periventricular WMH to WM, and deep WMH to WM in the dementia group were significantly higher than those in the non-dementia group (P = 0.003; 0.001; 0.011). Regression analysis revealed that education and NSBP reduction rate were independent protective factors (OR = 4.107, P < 0.001; OR = 2.062, P = 0.045), whereas ratio of periventricular WMH to WM was an independent risk factor (OR= -2.640; P = 0.011) for cognitive function in PD patients. NSBP reduction rate and ratio of periventricular WMH to periventricular WM were associated with cognitive function in PD patients. Reduced NSBP reduction may contribute to the development of WMH and consequent cognitive impairment in PD patients.

Effects of at-risk alcohol use on nighttime blood pressure, urinary catecholamines, and sleep quality in midlife adults.

The association between alcohol and hypertension has been predominantly based on office blood pressure (BP) measurements. However, little is known about the effect of alcohol use on nighttime BP and the underlying mechanisms. The purpose of this study was to investigate the effects of at-risk alcohol use on nighttime BP, urinary catecholamines, and sleep quality in midlife adults. A total of 32 midlife men and 30 postmenopausal women, free of major clinical diseases and nonsmokers (age: 58 ± 4; mean ± SD), were included. Among all participants, 22 were currently taking antihypertensive medications. At-risk drinkers were defined as those who had a dried blood spot phosphatidylethanol level ≥20 ng/mL. All participants completed 24-h ambulatory BP monitoring and urine collection to determine nighttime (or asleep) BP and nighttime urinary catecholamine levels. Sleep quality was determined by using the Pittsburgh Sleep Quality Index. In midlife adults free of antihypertensive medications, at-risk drinkers had a higher nighttime systolic (118 ± 14 vs. 107 ± 14 mmHg, p = 0.02) and diastolic BP (70 ± 9 vs. 62 ± 9 mmHg, p = 0.003) than low-risk drinkers with no between-group differences in sleep quality component scores (p ≥ 0.14). In midlife adults taking antihypertensive medications, no difference in nighttime BP was found between at-risk drinkers and low-risk drinkers (p ≥ 0.68), with a higher score for the "use of sleeping medication" component in high-risk drinkers (p = 0.02). Regardless of antihypertensive medication use, no difference between at-risk drinkers and low-risk drinkers was found in nighttime urinary catecholamine levels (p ≥ 0.19). Our findings suggest that in midlife adults free of antihypertensive medication use, at-risk alcohol use is associated with an increase in nighttime BP, and the increase in nighttime BP may be mediated by mechanisms other than increased catecholamines and poor sleep quality.

Effect of continuous positive airway pressure on blood pressure in normotensive individuals with obstructive sleep apnoea: a randomised trial.

The effects of continuous positive airway pressure (CPAP) on blood pressure (BP) in normotensive subjects, particularly among those with a dipping BP pattern, remain uncertain, raising questions about its indication for this group of patients. We assessed the impact of CPAP on BP in normotensive subjects with a dipping BP pattern and severe obstructive sleep apnoea (OSA). Randomised, parallel, prospective, controlled trial. Inclusion criteria were an apnoea-hypopnea index ≥30 events/hour, mean 24-hour BP <130/80 mmHg, and daytime-to-nighttime BP reduction ≥10%. Patients were randomly assigned to receive either CPAP treatment or usual care for 12 weeks. The primary outcome was the change in ambulatory BP monitoring (ABPM) parameters from baseline to the three-month follow-up. The 60 patients who completed the follow-up had a mean age of 52.2 years (sd 10.8), and 40 of them (66.7%) were male. The intention-to-treat analysis showed no significant changes with CPAP, whereas the usual care group experienced increases in ABPM parameters. This resulted in a mean difference of -3.4 mmHg (95% CI: -6.124 to -0.676; p=0.015) in nighttime diastolic BP between the groups. The per-protocol analysis indicated significant differences between the CPAP and usual care groups for all primary endpoints, except for daytime systolic BP. For nighttime systolic BP, the difference was -6.052 mmHg (95% CI: -10.895 to -1.208; p=0.016). These findings suggest a protective effect of CPAP, highlighting the importance of CPAP prescription for this population to control potential increases in blood pressure and possibly prevent the onset of hypertension.

The relationship between proteinuria and ambulatory blood pressure in hypertensive patients

Objectives: The study aimed to investigate the relationship between proteinuria and blood pressure (BP) determined with ambulatory BP monitoring (ABPM) in patients who applied to the nephrology clinic due to hypertension. Patients and methods: A total of 163 patients (84 males, 79 females; mean age: 55.7±16.6 years; range, 18 to 80 years) were included in the cross-sectional study between January 2022 and January 2023. The amount of proteinuria was measured from 24-h urine samples. The ABPM values were measured using noninvasive multitasking BP recorders. Results: A total of 53.4% (n=87) of the patients had dipper, 29.4% (n=48) had non-dipper, and 17.2% (n=28) had reverse-dipper hypertension (HT). Dipper HT, albumin, and glomerular filtration rate were significantly lower in those with proteinuria compared to those without proteinuria. Age, creatinine, HT duration, 24-h, daytime, and nighttime systolic BP, nighttime diastolic BP, nighttime mean BP, non-dipper HT (all p&lt;0.001), 24-h diastolic BP (p=0.015), daytime mean BP (p=0.005), and reverse-dipper HT (p=0.001) were significantly higher in the group with proteinuria. Conclusion: Elevated ABPM values, non-dipper HT, and reverse-dipper HT were detected in patients who had high proteinuria. Creatinine and 24-h urine protein excretion were found to be higher in patients with non-dipper HT and reverse-dipper HT. The progression of proteinuria can be slowed down by strict BP control in hypertensive patients with proteinuria.