Nocturnal Blood Pressure Reduction Research Articles

Efficacy of angiotensin receptor blockers for nocturnal blood pressure reduction: a systematic review and meta-analysis

Background Nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients. Objective Nocturnal BP control is of great importance for cardiovascular risk reduction. This systematic review and meta-analysis aimed to explore the efficacy of angiotensin receptor blockers (ARBs) for nocturnal BP reduction in patients with mild to moderate hypertension. Methods PICOS design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R. Results Seventy-seven studies with 13,314 participants were included. The overall analysis indicated that nocturnal BP drop varied considerably among different ARBs. Allisartan (13.04 [95% CI (−18.41, −7.68)] mmHg), olmesartan (11.67 [95% CI (−14.12, −9.21)] mmHg), telmisartan (11.11 [95% CI (−12.12, −10.11)] mmHg) were associated with greater reduction in nocturnal systolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1. While, the variation tendency of last 4–6 h ambulatory BP was basically consistent with nocturnal BP. Additionally, allisartan showed improvement effect in the proportion of patients with dipping BP pattern. Conclusions This study demonstrates that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nighttime BP more than daytime BP and improve the dipping pattern.

Study of nycthemeral variations in blood pressure in patients with non-arteritic anterior ischemic optic neuropathy.

The objective of this study was to analyze the nycthemeral variations in blood pressure (BP) in individuals who presented with non-arteritic anterior ischemic optic neuropathy (NAION). BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.-6 a.m.; definition 2, 10 p.m.-7 a.m.; and definition 3, 10 p.m.-8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10-20%), mild dippers (0-10%), reverse dippers (< 0%), and extreme dippers (> 20%). The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.-6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension after ABPM. No risk factor for NAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). In our population of patients who had an episode of NAION, the proportion of extreme dippers was higher than that usually found in the literature. However, extreme dipping is not a frequent feature of patients with NAION as compared to patients with systemic hypertension. ABPM is recommended for all patients with NAION and unknown history of systemic hypertension.

Management of nocturnal hypertension: An expert consensus document from Chinese Hypertension League.

Nocturnal hypertension is highly prevalent among Chinese and Asian populations, which is mainly attributed to high salt intake and high salt sensitivity. Nocturnal hypertension increases the risk of cardiovascular and all-cause mortality, independent of daytime blood pressure (BP). However, it can usually be detected by 24-h ambulatory BP monitoring, rather than routine office or home BP measurement, thus is often underdiagnosed in clinical practice. Currently, no specific guidance is available for the management of nocturnal hypertension in China or worldwide. Experts from the Chinese Hypertension League summarized the epidemiologic and pathophysiologic characteristics and clinical phenotype of nocturnal hypertension and provided consensus recommendations on optimal management of nocturnal hypertension, with the goal of maximally reducing the cardiovascular disease risks. In this consensus document, 24-h ABPM is recommended for screening and diagnosis of nocturnal hypertension, especially in the elderly, patients with diabetes, chronic kidney diseases, obstructive sleep apnea and other conditions prone to high nocturnal BP. Lifestyle modifications including salt intake restriction, exercise, weight loss, sleep improvement, and mental stress relief are recommended. Long-acting antihypertensive medications are preferred for nocturnal and 24-h BP control. Some newly developed agents, renal denervation, and other device-based therapy on nocturnal BP reduction are evaluated.

NON-DIPPING BLOOD PRESSURE PATTERNS AND ASSOCIATED TARGET ORGAN DAMAGE IN ELDERLY HYPERTENSIVE PATIENTS

Background: Older adults with hypertension face an increased risk of adverse cardiovascular outcomes, emphasizing the importance of target organ damage (TOD) in their treatment. The non-dipping blood pressure (BP) pattern, characterized by inadequate reduction of nocturnal BP (less than 10-20%), is associated with a higher likelihood of TOD in individuals with essential hypertension. This study aimed to examine the characteristics of non-dipping BP patterns among elderly individuals with essential hypertension and evaluate their associations with TOD. Methods: A descriptive cross-sectional study was conducted, involving 96 patients aged ≥60 years (mean age 70.9 ± 7.9 years, 35.4% male). Participants underwent routine clinical and laboratory assessments, including clinic and 24-hour ambulatory blood pressure monitoring. TOD was defined as the presence of left ventricular (LV) hypertrophy, renal impairment, or proteinuria. Results: Non-dipping patterns for systolic and diastolic BP were observed in 36 (36.5%) and 41 (42.7%) patients, respectively. TOD was present in 61 (63.5%) patients. Non-dipping systolic patients exhibited lower rates of diabetes mellitus (37.1% vs. 81.3%, p=0.006), dyslipidemia (68.6% vs. 100%, p=0.011), higher levels of creatinine (median 85.6, interquartile range [IQR] 72.1-101 vs. 70.8, IQR 62.4-78.3 µmol/l, p=0.012), and higher LV mass index (median 106.6, IQR 96.4-148.4 vs. 93.7, IQR 72.9-111.5 g/m2, p=0.028) compared to dipping patients. Non-dipping diastolic patients had a lower prevalence of dyslipidemia (73.2% vs. 100%, p=0.048) and a lower body mass index (median 23, IQR 19.73-25 vs. 25.26, IQR 22.54-27.17 kg/m2, p=0.013). Multivariate analysis, after adjusting for cardiovascular risk, showed that non-dipping patterns (both systolic and diastolic) were associated with TOD (odds ratio 7.21; 95% confidence interval 1.47-35.36, p=0.015). Conclusion. Our study underscores the significant association between non-dipping blood pressure patterns and TOD in elderly individuals with essential hypertension. The notable prevalence of non-dipping patterns emphasizes the clinical importance of monitoring and managing these patterns in clinical practice.

The effects of Olmesartan/amlodipine administered in the Morning or At Night on nocturnal blood pressure reduction in Chinese patients with mild-moderate essential hypertension (OMAN Trial): study protocol for a prospective, multicenter, randomized, open-label clinical trial {1}

IntroductionHypertension increases the risk of cardiovascular disease. Uncontrolled nocturnal blood pressure is prevalent in patients taking antihypertensive medication, with an incidence rate of 30–60%. Although chronotherapy with antihypertensive agents may provide a new direction for effective control of nocturnal blood pressure, the clinical evidence base remains controversial. This research is presently underway to compare the effects of morning and bedtime administration of antihypertensive medication on nocturnal reduction and circadian rhythm of blood pressure in patients with hypertension.Methods and analysisThis study is being performed as a randomized, multicenter, open-label, parallel-group, clinical trial in which 720 participants are to undergo 24-h ambulatory blood pressure measurement (ABPM) and office blood pressure measurement (OBPM) at baseline before being randomly assigned to a morning (6–10 am) or a bedtime (6–10 pm) administration group. Each participant receives one 20/5-mg tablet of olmesartan/amlodipine (OA) daily for 4 weeks and is then followed up at 4-week intervals for a total of 12 weeks. During follow-up, the OA dosage is adjusted according to the ABPM and OBPM results. Patients with uncontrolled hypertension at the first follow-up visit will receive an increase in OA dosage to 1.5 tablets/day. For patients with blood pressure that is still uncontrolled after a further 4 weeks, the dosage of OA can be increased to 2 tablets/day. The primary objective is the reduction in mean nocturnal systolic blood pressure between baseline and week 12. The secondary objectives are the reduction in ambulatory blood pressure at weeks 4 and 12 and the blood pressure control rate at weeks 4, 8, and 12.DiscussionAntihypertensive chronotherapy remains controversial. A superiority test hypothesis design has been adopted for this trial, in which all participants will be taking the same antihypertensive medication. We anticipate that our findings will determine if nocturnal blood pressure control in Chinese patients with essential hypertension varies according to whether antihypertensive medication is taken in the morning or at bedtime. This study may provide scientific evidence for the application of chronotherapy in clinical practice.Trial registrationChiCTR2200059719. Registered on 10 May 2022(http://www.chictr.org.cn/edit.aspx?pid=169782&htm=4) {2a,2b}

Abstract 13243: Different Efficacy of Angiotensin Receptor Blockers for Nocturnal Blood Pressure Reduction in Patients With Mild to Moderate Hypertension: A Systematic Review and Meta-Analysis

Introduction: High nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients. Thus, nocturnal BP control is of great importance for cardiovascular risk reduction. Hypothesis: As the most commonly prescribed BP-lowering agents, angiotensin II receptor blockers (ARBs) maybe have different efficacy for nocturnal BP reduction in patients with mild-to-moderate hypertension (MMH). Methods: We conducted a systematic search in PubMed, EMBASE, Cochrane Library and Web of Science from inception to August 8th, 2022, and collected the ambulatory BP study data of different ARBs (allisartan, candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan) in patients with MMH following PICOs principle. Data was extracted and the risk of bias of the included studies was evaluated accordingly, and R software (version 4.0.0) was used for statistical analysis. Results: Seventy-eight studies with 13,108 patients were included. The results of meta-analysis showed that allisartan, olmesartan, telmisartan were associated with greater reduction in nocturnal systolic BP, while valsartan, olmesartan and telmisartan demonstrated greater efficacy in reducing nocturnal diastolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1 (figure). Additionally, allisartan showed more advantages in the last 4-6 hours ambulatory BP drop, the proportion of patients with dipping BP pattern, and the 24 hours ambulatory BP drop as compared to other ARBs. Conclusions: For patients with MMH, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nocturnal BP more than daytime BP and improve the dipping pattern, contribute to restore normal BP rhythm.

Associations of Diabetic Retinopathy Severity With High Ambulatory Blood Pressure and Suppressed Serum Renin Levels.

The relationships between serum renin levels, severity of diabetic retinopathy (DR), and 24-hour blood pressure (BP) have not been previously reported. To explore causes for DR and the relationships of 24-hour ambulatory BP, and hormone levels with the severity of DR. The diabetic patients were classified as having no DR, simple DR, or severe DR (preproliferative DR plus proliferative DR) based on funduscopic examination, and we measured 24-hour BP, serum active renin (ARC), aldosterone (SAC), adrenocorticotropic hormone, and cortisol levels in each group. Compared to those with no DR or simple DR, patients with severe DR showed significantly higher 24-hour BPs, including daytime and nighttime systolic and diastolic BP levels, independent of diabetic duration and HbA1c levels. The variability of nighttime systolic BP was greater in patients with severe DR than in those with nonsevere DR, although nocturnal BP reduction was similar between the groups. The ambulatory BPs were significantly inversely associated with ARC. The ARC was significantly lower in severe DR patients than in those with no DR or simple DR (3.2 [1.5-13.6] vs 9.8 [4.6-18.0] pg/mL, P < .05), but there were no differences in SAC in patients taking calcium channel blockers and/or α-blockers. No associations were found between DR severity and other hormone levels. Severe DR was associated with higher 24-hour BPs and suppressed ARC. These findings suggest that mineralocorticoid receptor overactivation may play a role in higher BP levels and severe DR in diabetic patients.

Results of the prospective observation in routine practice of hypertensive patients with concomitant chronic respiratory diseases. Part II. Predictors of adverse events

Aim. To study the predictors of adverse events in hypertensive (HTN) patients, including those with chronic respiratory diseases (CRDs).Material and methods. Regression analysis evaluated clinical and anamnestic data and blood pressure (BP) in outpatients with stage II-III HTN (n=156): 49 patients had asthma, 20 — chronic obstructive pulmonary disease; age — 63,4±8,8 years, women — 72,4%, followup duration 29,3±8,0 months. The outcomes included in the composite primary endpoint (EP) were registered in 32 patients (death, major cardiovascular events and complications), while the secondary EPs were registered in 57 patients (hospitalizations, emergency calls, temporary disability due to cardiovascular disease/CRD, hypertensive crisis, exacerbation of CRD, pneumonia, respiratory failure), and tertiary EP — in 76 (other significant diseases/conditions, including increased blood pressure without hypertensive crisis, requiring correction of regular therapy).Results. Predictors of primary EPs were the decrease level of nocturnal diastolic BP (DBP) (β=-5,335, p=0,026), nocturnal DBP variability (β=1,796, p=0,007), blood leukocyte level (β=0,241, p=0,039); secondary EPs — systolic blood pressure ≥170 mm Hg in history (β=1,305-1,641, p=0,037-0,017), statin use (β=-0,997, p=0,037), CRD (β=0,734, p=0,023), blood platelet level (β=-0,008, p=0,022); tertiary EPs — only CRD (β=1,082, p&lt;0,0001).Conclusion. Patients with HTN need complex multifactorial prevention. It is necessary to improve the control of office and ambulatory blood pressure, blood lipids, especially in the presence of CRD, to improve the control of CRDs themselves. The method of 24-hour blood pressure monitoring should be used more often in routine practice, including assessing the degree of nocturnal blood pressure reduction and its variability.

Daily profiles of blood pressure in patients with arterial hypertension of various psychotypes

Аim: to assess the influence of the patient's psychotype on the degree of nighttime reduction in blood pressure (BP) to determine predictors of an unfavorable daily BP profile.Materials and methods. The study involved 80 patients with newly diagnosed or untreated arterial hypertension (AH), with various stages, severity, risk of developing cardiovascular complications, in the absence of concomitant severe somatic pathology, who independently consulted a local therapist. All patients underwent 24-hour blood pressure monitoring in the absence of antihypertensive therapy and the psychological profile was assessed using the SMOL questionnaire.Results. The psychopathological profile of the examined AH patients corresponded to the social and psychological adaptation. Our analysis of the indices of the averaged profile of the SMOL test, depending on the degree of reduction in nocturnal systolic blood pressure (between dipper and non-dipper profiles) and diastolic blood pressure (between dipper, non-dipper and extreme dipper patterns profiles) did not reveal statistically significant differences (p &gt; 0,05). Patients with a riser daily blood pressure profile, due to the small size of the group, were not included in the comparative analysis. The average profile of SMOL of the examined patients was noted by an increase in indicators on the scales 1 – hypochondria and 3 – emotional lability.Conclusion. The variant of the daily blood pressure profile does not depend on the psychotype of the patient; it is likely that functional and structural changes that occur during the formation of hypertension affect the type of the degree of nighttime decrease in blood pressure.

FEATURES OF HAEMOSTASIS IN DIFFERENT TYPES OF 24 HOURS DAY'S PROFILE OF BLOOD PRESSURE IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

Relevance. The phenomenon of non-dipper (insufficient nocturnal decrease in blood pressure) has prognostic significance for increasing the risk of complications of arterial hypertension - myocardial infarction, stroke. To date, there are only isolated reports of platelet hemostasis in this category of individuals. Therefore, it is important to find out the peculiarities of state of platelet aggregation depending on circadian rhythm of blood pressure (BP).&#x0D; Objective is to identify the baseline level of platelet and plasma hemostasis at different 24 hours day's blood pressure profiles in middle-aged and elderly hypertensive patients.&#x0D; Materials and methods. Subjects (n=90) are divided into 3 groups. Group 1 (n=30) included middle-aged hypertensive patients (45-59 years), group 2 (n=30) − elderly hypertensive (60-74 years) patients. Patients are divided into two subgroups in each of these groups, 15 people in each: subgroup dipper (D) − with adequate nocturnal blood pressure reduction (10-20 %) and subgroup non-dipper (ND) − with insufficient nocturnal blood pressure reduction (&lt;10 %). The control group (n = 30) consisted of 15 patients without arterial hypertension for each of the examined groups. &#x0D; The state of spontaneous and induced platelet aggregation was determined. Adenosine diphosphate (1´10-5 mM/L) and adrenaline (1 µg/mL) were used as aggregation inducers on SOLAR AP-2110 optical aggregometer. The following parameters of aggregatograms were calculated: amplitude of spontaneous and induced aggregation (AA, %); time of maximal aggregation (TMA, min.); slope of aggregation (SA, %/min.). The state of plasma hemostasis was determined on hemocoagulometer Amelung KC 1A. The following parameters were determined to assess state of plasma hemostasis: fibrinogen (FG, g/L), antithrombin III (AT-III, %), fibrinolysis (min.).&#x0D; Results. The increase in induced platelet aggregation activity was found in middle-aged hypertensive patients. In subgroup D AA was 1,9 times and in subgroup ND – 2,3 times higher than the norm; the rate of SA increased by 105,5 % and 112 %, respectively. In subgroup ND compared with subgroup D AA was higher by 21 % and SA − by 3,2 %.&#x0D; In elderly hypertensive patients, the rate of spontaneous aggregation AA is 1,7 times higher in subgroup ND compared with subgroup D (4,2±1,6 % vs. 2,5±0,2 %). In the ND subgroup AA rate is 68 % higher than in the control. Indicators of induced platelet aggregation were also higher in subgroup ND compared with subgroup D: AA with induction of ADP – 74,7±25,1 % vs. 51,4±22,2 %; TMA with adrenaline induction – 8,2±2,6 minutes against 5,7±2,5 minutes, respectively. There was the significant reduction in TMA with adrenaline-induced aggregation by 30,5 % in subgroup D compared with the control also.&#x0D; Fibrinolysis activity in middle-aged hypertensive patients in subgroup D was slowed down by 36,1% compared with the control group: fibrinolysis was 215,0±49,7 minutes while 158,0±5,7 minutes in the control group.&#x0D; Conclusions. Platelet hemostasis changes with age in the direction of increasing the aggregation properties of platelets in hypertensive patients. More pronounced changes were found in patients with insufficient reduction of blood pressure at night. In elderly patients, the most significant changes are determined by adrenaline-induced aggregation compared with middle-aged patients.

STUDY OF NYCTHEMERAL VARIATIONS IN BLOOD PRESSURE IN PATIENTS WITH NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY

Objective: Non-arteritic anterior ischemic optic neuropathy (NAAION) is the most common acute pathology of the optic nerve in patients over 50 years of age and loss of vision is irreversible in the vast majority of cases. The role of nocturnal arterial hypotension in the occurrence of NAAION remains a topic of debate. Indeed, studies on this subject are rare and the results contradictory. In this study, we ubject the nychthemeral variations in blood pressure (BP) in a large cohort of patients with acute NAAION to determine the presence and extent of nocturnal arterial hypotension in this population, and thus determine whether nocturnal arterial hypotension could be involved in the pathophysiology of NAAION Design and method: BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.–6 a.m.; definition 2, 10 p.m.–7 a.m.; and definition 3, 10 p.m.–8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10–20%), mild dippers (0–10%), reverse dippers (&lt; 0%), and extreme dippers (&gt; 20%). Results: The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.–6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension (systolic and/or diastolic hypertension) after ABPM. No risk factor for NAAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). Conclusions: In our population of patients who had an episode of NAAION, the proportion of extreme dippers was higher than that usually found in the literature. The definition of the nighttime period used in this study had an impact on the proportion of extreme dippers and might probably explain the contradictory results from the few studies on this ubject.

Nighttime Blood Pressure Dipping is Attenuated in Young and Apparently Healthy Black Adults Compared to White Adults

In America, Black adults are 30% more likely to die from cardiovascular disease (CVD) compared to White adults, and more than half of this racial disparity in CVD‐related mortality may be attributed to the substantially greater prevalence of high blood pressure (BP) in Black adults. Furthermore, compared to White adults with hypertension, Black adults with hypertension are less likely to exhibit a nocturnal reduction in BP (i.e., “dipping”). Importantly, non‐dipping BP is associated with target organ damage and increased CVD risk. However, it is unclear whether young and apparently healthy Black adults exhibit reduced BP dipping compared to their White peers.PURPOSETherefore, the purpose of this preliminary investigation was to determine whether there are racial differences in BP dipping using ambulatory BP monitoring (ABPM), including 24‐hour‐, daytime‐, and nighttime‐BP, in young and apparently healthy Black and White adults.METHODSWe obtained clinical BP and 24‐hour ABPM readings in 10 self‐identified White adults (5M/5F; age: 21.6±4.4 yrs; BMI: 23.8±2.9 kg/m2; Mean±SD) and 7 self‐identified Black adults (3M/4F; age: 21.7±3.5 yrs; BMI: 25.1±2.8 kg/m2). The ABPM monitors were programmed to record BP every 20 and 30 minutes during each participants daytime‐ and nighttime‐period, respectively. True daytime‐ and nighttime‐BP periods were adjusted during analysis based upon participant activity logs. We defined “non‐dipping” as a failure to achieve a dipping ratio of &lt;0.90 (night‐to‐day BP ratio). BP data were compared using independent t‐tests and the Fisher’s exact test was used to compare dipping frequency between races (α=0.05).RESULTSClinically measured BP (systolic/diastolic) was not different (P&gt;0.05) between White (117±9/67±6 mmHg) and Black (124±12/70±9 mmHg) adults. There was also no difference (P&gt;0.05) in 24‐hour‐BP between White (117±11/66±7 mmHg) and Black (114±14/63±7 mmHg) adults. Likewise, daytime‐BP was not different (P&gt;0.05) between White (122±12/71±8 mmHg) and Black (116±14/66±8 mmHg) participants, nor was there a difference in nighttime‐BP (P&gt;0.05) between White (102±9/51±4 mmHg) and Black (105±13/54±7 mmHg) adults. However, systolic BP dipping was attenuated (P=0.04) in Black (0.90±0.05) compared to White (0.84±0.07) adults. Non‐dipping of systolic BP was observed in 5 of 7 Black participants and 2 of 10 White participants (P=0.06). Diastolic BP dipping in Black adults was 0.79±0.06 and White adults was 0.73±0.09 (P=0.05). Non‐dipping of diastolic BP was observed in 1 of 7 Black participants and 1 of 10 White participants (P=1.00).CONCLUSIONSThese preliminary data suggest that despite similar clinical and 24‐hour ambulatory BP compared to White adults, young and apparently healthy Black adults exhibit impaired BP dipping, which may contribute to increased likelihood of CVD.

Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome.

ResumoFundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular.Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda.Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo.Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX.Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Aerobic exercise training improves nocturnal blood pressure dipping in medicated hypertensive individuals.

The absence of nocturnal blood pressure (BP) reduction at night in hypertensive individuals is associated with an increased cardiovascular risk. The main purpose of the present study was to investigate the effects of an aerobic training intervention on nocturnal BP dipping in medicated hypertensive individuals. At baseline, hypertensive individuals under pharmacological treatment underwent 24-h ambulatory BP monitoring and a morning urine sample to analyze albumin creatinine ratio (UACR). Then, participants were divided into nocturnal dippers ( N = 15; 59 ± 6 years) and nondippers ( N = 20; 58 ± 5 years) according to a day-to-night BP reduction of >10% or <10%, respectively. Next, participants underwent a 3-weekly, 4-month aerobic interval training intervention. Follow-up measurements revealed a reduction in daytime diastolic BP in dippers and nondippers ( Ptime < 0.001), whereas nighttime systolic BP was reduced only in nondippers ( P = 0.004). Regarding dipping pattern, nocturnal systolic BP dipping increased after training in nondippers (5 ± 3 to 9 ± 7%; P = 0.018), whereas in dippers, there was a decrease in nocturnal dipping after training (14 ± 4 to 10 ± 7%, P = 0.016). Nocturnal diastolic BP dipping did not change in nondippers (8 ± 5 to 10 ± 7%; P = 0.273) but decreased in dippers (17 ± 6 to 12 ± 8%; P = 0.004). In addition, UACR was significantly reduced in both groups after training ( Ptime = 0.020). Aerobic exercise training is associated with nocturnal BP dipping as nighttime BP was lower than before the program in medicated hypertensive individuals with an initial nondipping phenotype. The lack of improvement in individuals with a dipping phenotype warrants further investigation to discern whether dipping phenotypes influence BP responses to exercise training.

Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS.

Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration.Methods: Young and middle-aged adults (18–65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction.Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (−9.9 vs −9.9 mmHg, P > 0.05) or daytime (−11.5 vs. −10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (−10.8 vs. −10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups.Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.

Nocturnal non-dipping on 24-h Ambulatory Blood Pressure Monitoring in children and adolescents with obesity is associated with higher total cholesterol levels

ABSTRACT Background Few studies indicate the occurrence of abnormal nocturnal dipping of blood pressure (BP) in 35–50% of children and adolescents with obesity. The relation between that phenomenon and metabolic complications of obesity remains unclear. To evaluate the association between disorders of glucose and lipid metabolism, and nocturnal non-dipping in pediatric patients with obesity. Methods In 207 children (53.14% girls, mean age 14 (range 2–17), mean BMI Z-SCORE 4.38, range 2.07–10.74) standard 24-h Ambulatory Blood Pressure Monitoring was performed. Normal dipping was defined as a ≥ 10% decline in BP during the night. Results There were 106 (51.21%) cases of non-dippers. The mean 24-h nocturnal systolic BP (SBP) reduction (%) was 9.9 ± 5.5. The mean 24-h nocturnal diastolic BP (DBP) reduction (%) was 15.8 ± 8.5. There was a significant correlation between BMI Z-SCORE and mean day-time SBP (r = 0.14 P = .042). There are positive correlations between 24-h heart rate (beats/min) and BMI Z-SCORE (r = 0.15, P = .027), between fasting glucose and systolic BP Z-SCORE (r = 0.17, P = .03) and between mean diastolic BP and LDL cholesterol (r = 0.23, P = .004). Total cholesterol level was significantly higher in non-dippers (4.34 vs. 3.99 mmol/L, P = .034). There were no significant differences between non-dippers and dippers regarding fasting glucose (4.6 vs. 4.8 mmol/L), 120ʹpost load glucose (5.7 vs. 5.9 mmol/L), insulin (19 vs. 20.2 µIU/mL), HOMA-IR (2.36 vs. 2.44), LDL cholesterol (2.64 vs. 2.51 mmol/L), HDL cholesterol (1.06 vs. 1.03 mmol/L) or triglycerides (1.36 vs. 1.34 mmol/L) levels. Conclusion Nocturnal non-dipping is frequent in pediatric patients with obesity. It is associated with higher total cholesterol levels.

Features of the daily blood pressure in children with diabetes depending on the duration of the disease

Background. The presence of hypertension, which in diabetic patients occurs 2 times more often than in the general population, increases the risk of cardiovascular complications. The main tool for the diagnosis of hypertension in children is ambulatory blood pressure monitoring (ABPM) due to the fact that a number of ABPM parameters may act as predictors of the deve­lopment of cardiovascular events. The purpose was to establish the features of the daily blood pressure in children with diabetes depending on the duration of the disease. Materials and methods. The paper investigated the features of the daily arterial pressure in 53 children (mean age 14.79 ± 0.25 years) with diabetes mellitus, according to the ABPM data. Depending on the duration of the disease, there were 3 groups: group 1 — 11 children with disease duration of up to 1 year, group 2 — 19 persons with disease duration of 1–5 years, and group 3 — 23 patients with disease duration of more than 5 years. The control group consisted of 20 children, representative by the age and sex, who had no disorders of carbohydrate metabolism and intercurrent diseases. Results. In children with diabetes, with an increase in the duration of the disease, there was an elevation in the blood pressure, its variability and the index of hypertension. Hypertension occurred in 21.0 % of patients with duration of diabetes from 1 to 5 years and in 43.5 % of persons with disease duration of more than 5 years. Identified changes occurred on the background of the circadian blood pressure changes, which took place during the first year of the disease and observed in 51.0–54.5 % of patients. Among the pathological profiles of nocturnal blood pressure reduction in patients with diabetes mellitus, the non-dipper type prevailed (43.5–47.4 %). Conclusions. The majority of patients with diabetes mellitus experienced changes in blood pressure, the first signs of which were registered in the first year of the disease and progressed with an increase of its the duration. The findings suggest that children with diabetes, regardless of the duration of the disease, should be classified as high risk for developing hypertension.

Effect of metabolaid® on pre- and stage 1 hypertensive patients: A randomized controlled trial

• L citriodora & H sabdariffa polyphenols ease obesity-linked metabolic alterations. • LC-HS combination was assessed in pre and early stage-1 hypertensive individuals. • LC-HS combination improved anthropometric, circulating parameters and fat content. • LC-HS combination decreased average and daytime systolic/diastolic blood pressure. • LC-HS combination decreased nighttime diastolic blood pressure and % dipper status. Many patients with stage 1 hypertension have difficulties to achieve lifestyle changes to avoid the progression of the disease. The use of natural alternatives with demonstrated blood pressure-regulating properties is instrumental at this stage, avoiding the side effects found in some pharmaceutical drugs. In this context, previous studies have indicated the possibility that a botanical nutraceutical product based on the combination of Lippia citriodora and Hibiscus sabdariffa extracts has hypotensive properties in overweight and obese individuals. Therefore, we aimed to evaluate the antihypertensive properties of this dietary supplement, as well as the effect on anthropometric and circulating parameters in pre-hypertensive and early stage 1 hypertensive patients (n = 84). The nutraceutical product, rich in polyphenolic compounds, has been assessed in a 6-week randomized, double-blind, placebo-controlled trial with pre-hypertensive and early stage 1 hypertensive (non-medicated) individuals. Participants consumed early in the morning in fasting conditions 2 capsules/day containing each one 250 mg of the polyphenolic extracts. Anthropometric and blood parameters as well as punctual and continuous blood pressure monitoring were determined in placebo and experimental groups. As a result and compared to baseline values, volunteers showed a significant reduction of average daily systolic/diastolic blood pressure as well as in daytime diastolic/systolic, nighttime diastolic blood pressure and in % dipper. Intergroup analysis revealed that the consumption of the plant extract resulted in a significant reduction of body fat content (−1.26%; p < 0.05) and nocturnal systolic blood pressure (−16.60 mmHg; p < 0.05) as well as an improvement of the dipper status (3.18%; p < 0.01). In conclusion, these results suggest that the nutraceutical acts as a main regulator of the individual's blood pressure towards healthier values, and therefore may be useful for pre-hypertensive/pre-medicated individuals.

Optical coherence tomography measurements in patients with systemic hypertension.

To evaluate the effect of systemic arterial hypertension (SAH) on retinal optical coherence tomography (OCT) parameters and investigate whether a correlation exists between ambulatory blood pressure monitoring (ABPM) and OCT measurements.Material-methods: 115 SAH patients (225 eyes) and 123 healthy control cases (234 eyes) were included. ABPM was performed on 89 of 115 SAH patients. All patients underwent detailed ophthalmologic examination including imaging with OCT. SAH patients were divided into two groups (dippers, non-dippers) according to their nocturnal blood pressure (BP) reduction, and OCT measurements were compared. Average and superior retinal nerve fiber layer (RNFL) quadrants were significantly thin in hypertensive cases (p:0.002, p < 0.001, respectively). Cup area, cup/disk (c/d) area, and c/d horizontal ratios were wider; the rim area was smaller in hypertensive cases (respectively: p:0.024, p:0.017, p:0.003, p < 0.001). Total macular volume (TMV), the thicknesses in 1-3 and 1-6 mm of the macula were less in hypertensives (p < 0.001). There was no significant difference between dippers and non-dippers in RNFL thickness, macula and optic nerve head (ONH) parameters. There were statistically significant differences between healthy cases and patients with SAH in terms of RNFL, macula thicknesses and ONH parameters.

Short- and Long-Term Reproducibility of Nighttime Blood Pressure Phenotypes and Nocturnal Blood Pressure Reduction.

[Figure: see text].