Nocturnal Blood Pressure Decrease Research Articles

#2049 Prognosis of decreased renal function in patients with arterial hypertension

Abstract Background and Aims Chronic kidney disease and hypertension are closely related in cause and effect. As the glomerular filtration rate decreases, the frequency and severity of arterial hypertension increases. In addition, the risk of morbidity and mortality from cardiovascular diseases increases significantly with comorbidity of arterial hypertension and chronic kidney disease. The purpose of this study was to identify predictors of a decrease in GFR below 60 ml/min in patients with arterial hypertension. Method The cross-sectional study included 43 patients with arterial hypertension (average age 56.7 (10.6) years). Exclusion criteria were age over 80 years, primary kidney disease, diabetes mellitus, cancer, heart failure, stage III arterial hypertension. All patients underwent determination of cystatin C in the blood, the composition of the body was studied using the bioimpedance method and 24-hour blood pressure monitoring. To identify predictors of kidney damage, we used regression analysis with ROC curve estimation using MedCalc software. Results The optimal value (cut-off point) of the content of total adipose tissue, which allows the most accurate prediction of a decrease in GFR < 60 ml/min in patients with hypertension, was 26.1% (sensitivity −100%, specificity—77.8%), and the content of total muscle tissue—35.9% (sensitivity −100%, specificity—44.4%). The optimal value (cut-off point) of cystatin C was 1.13 (sensitivity −100%, specificity—53.9%), AUC—0.73 (0.46; 0.92). At the same time, when this predictor was included once in multiple logistic regression, the statistical significance decreased (p = 0.5). Among individual predictors of decreased renal function, indicators of 24-hour blood pressure monitoring were studied. The optimal value (cut-off point) of the ambulatory arterial stiffness index, which allows the most accurate prediction of a decrease in GFR < 60 ml/min in patients with arterial hypertension, was 0.36 (sensitivity −100%, specificity—71.4%), an indicator of an increase in the rate of increase in diastolic blood pressure. blood pressure—0.27%, AUC 0.74 (0.48; 0.91)) and the rate of increase in nighttime decrease in systolic blood pressure—8.1%, AUC 0.71 (0.47; 0.89). Conclusion Increase in total adipose tissue > 26.1%, decrease in total lean tissue <35.9%, increase in ambulatory arterial stiffness index >0.36, increase in rate of increase in diastolic blood pressure >0.27%, and increased nocturnal decrease in systolic blood pressure > 8.1% were identified as significant predictors of a decrease in GFR below 60 ml/min in hypertension.

THE EFFECT OF COVID-19 ON NOCTURNAL BLOOD PRESSURE ELEVATION IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: to evalute the effect of COVID-19 on the degree of nocturnal decrease in blood pressure (BP) against the background of antihypertensive therapy (AHT) in patients with arterial hypertension (AH). Design and method: 74 male and female patients with I-III degree of AH(ESH/ESC, 2018) were studied. The mean age of patients was 53.54±1.92 years,duration of AH was 8.61 years. 2 groups of patients were identified: I – patients with AH who had suffered COVID19, (n=42) and 2nd group – patients with AH who had not suffered COVID-19 (n=32). All patients before and 6 months of therapy measured office BP and DBPM. The daily rhythm of blood pressure was determined based on the degree of nocturnal decrease in SBP (DND SBP). Based on the DND SBP data, patients were divided into: “dippers”, “non-dippers”, “over-dippers”, “night pickers”. All patients were prescribed dual or triple AHT. The results are presented as M±SD. Results: Significant improvement in the circadian rhythm of BP with a high degree of reliability in 2nd group of patients initially amounted to 5.31±5.88% in dynamics - 11.6±3.81% (p<0.001). In 1nd group DND SBP initially was 4.8±5.8% versus– 6.3±4.4% (p > 0.01). In 1st group of patients, the number of non-dippers predominated - 53.8%, while night pickers were 15.40%, dippers - 30.8%. A similar picture was observed in group II of patients: 50.0%: 20.0%: 30.0%. Intergroup differences were not significant (χ2=0.086, p=0.958). Analysis of the dynamics of DND SBP in both groups during therapy revealed that 1st in group of patients the number of non-dippers increased significantly, amounting to 77%, while the number of dippers decreased to 23%. On the contrary, in group II of patients, the number of non-dippers and non-dippers decreased slightly to 40%, and the number of dippers significantly increased by 2 times, amounting to 60% of patients. At the same time, the intergroup difference approached significance (χ2 = 3.23, p = 0.072) Conclusions: The previous COVID-19 made a negative contribution to the antihypertensive effectiveness in terms of the dynamics of the degree of nocturnal reduction in BP.

IMPACT OF NON-DIPPER PATTERN ON LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN, IN HYPERTENSIVE PATIENTS. NACIM DAHMANI1, NABILA SOUFI TALEB BENDIAB2, MOUHAMED SOUFIANE LOUNES1

Objective: Several studies have shown that the non-dipper blood pressure pattern, defined by a nocturnal decrease in blood pressure (BP) of less than 10% at the 24-hour ambulatory blood pressure monitoring (ABPM), is associated with an increase in cardiovascular risk and risk of target organ damage, however, there are few data on the non-dipper effects on the longitudinal strain overall studied by 2D speckle tracking. The aim of this study is to evaluate the impact of nocturnal dipper/non-dipper pattern on the global longitudinal systolic (GLS) of left ventricle by means of two-dimensional speckle tracking echocardiography (2D STE), of hypertensive patients under treatment or not. Design and method: This is a cross-sectional descriptive study conducted over a period of 20 months, from November 2021 to June 2023. The study included a total of 382 patients with arterial hypertension, enrolled consecutively. All participants were subjected to clinical evaluation, biological examination, 24-hour ambulatory blood pressure monitoring and echocardiography with GLS. The patients were divided into dippers and non-dippers, according to the percentage reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night. The study sought to analyze the relationship between these nocturnal profiles and GLS. Results: 179 patients (46.90%) are non-dippers. The non-dippers had a significantly lower GLS value than the dippers (-19.45 ±2.03 vs -18.2 ±2.17, P < 0.001). The multivariate linear regression confirmed this independent relationship of the GLS and the non-dipping (β = -0.157, P=0.013), however, we do not find independent relationships between the non-dipping and the diastolic function on the one hand and the non-dipping and the LV geometry on the other hand. Conclusions: This study shows that non-dipping is associated with subclinical systolic dysfunction of the LV, as shown by the decrease in the GLS studied by 2D Speckle-Tracking, in hypertensive non-dippers patients.

FEATURES OF THE DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objective: To study the features of the daily blood pressure profile (DBPP) in patients with combination of arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Design and method: The study included 47 patients (average age 53.1±2.5 years), 31 women, 16 men with hypertension I-II degrees. Patients were divided into 2 groups: with COPD (n=22) and without COPD (n=25). Duration AH in the group of patients with COPD was 6.5±0.54 years, without COPD 5.1±0.66 years. Exclusion criteria's were: symptomatic hypertension, cerebrovascular accidents in history, valvular heart disease, severe rhythm and conduction disorders, endocrine disorders, severe pathologies of the liver and kidneys, receiving systemic glucocorticosteroids actions. All patients underwent a study of pulmonary function (RPF) and SMAD recorders. Applied the following patient classification scheme: “dippers” (Daily index (DI) from 10 to 20%); “nondippers” (DI from 0 to 10%); “overdippers” (DI>20%); “nightpickers” (DI<0). Results: We identified a direct correlation between the level of PBP and age patients with a combination of hypertension and COPD during all monitoring periods (r=0.629, p=0.000 (days), r=0.645, p=0.000 (day), r=0.564, p=0.000 (night)). The same dependence was noted in individuals with hypertension without lung pathology (r=0.298, p=0.021 (days), r=0.266, p=0.04 (day), r=0.346, p=0.007 (night)). Thus, we not only did not identify significant differences in the level of PBP, but also noted general regular features of its dynamics with increasing age of patients of both groups. Comparative assessment of the heart rhythm. DBP also showed significant intergroup differences. Thus, we have established the predominance of “dippers” among patients with AH without lung pathology (51.9%), while among persons with a combination of hypertension and COPD, adequate nocturnal decrease in blood pressure was observed slightly more than in a third of patients (37.4%, p=0.125). Besides, among these patients a significantly higher number of “night pickers” was identified (25% vs. 7.5%, p=0.002), the number of “nondippers” and there were “overdippers” in the compared groups was approximately the same. Conclusions: Presence of COPD in patients with hypertension worsens the course of the latter, which is expressed in a significant predominance of “nightpickers” and “non-dippers” patients.

CARDIOVASCULAR RISK AMONG MEN OF WORKING AGE WITH ARTERIAL HYPERTENSION DEPENDING ON THE ARTERIAL PRESSURE DIURNAL PROFILE

Aim: to investigate the relationship between cardiovascular risk (CVR) and different types of diurnal blood pressure (BP) profile among men of working age with arterial hypertension (AH).
 Materials and methods. The study included 83 men of working age (average age 48±2 years) with II stage, 2 and 3 degrees of AH. The risk of death due to cardiovascular diseases during the next 10 years was assessed using the SCORE scale. All patients underwent ambulatory BP monitoring (ABPM), according to the results of which the following diurnal BP profiles were identified: 23 (28%) patients – normal (optimal) level of nocturnal decrease in BP («dipper»; daily index (DI) 10-20%); 10 (12%) – excessive nocturnal lowering of BP («over-dipper»; DI >20%); 38 (46%) – insufficient nocturnal lowering of BP («non-dipper»; DI <10%); and 12 (14%) patients had an inverted diurnal curve («night-peaker»; DI <0%).
 Results and discussion. According to the SCORE scale, the CVR profile in «dipper» group (n=23) was as follows: low – 6 (26%) patients; moderate – 15 (65%); and high – 2 (9%). Among 10 patients of «over-dipper» group, 7 had low, 2 – moderate, and 1 – high CVR. In «non-dipper» group (n=38), there were 4 (11%) patients with low CVR, 10 (26%) with moderate, 14 (37%) with high, and 10 (26%) with very high CVR. At the same time, 7 out of 12 patients of «night-peaker» group showed very high CVR, 3 – high, and 2 – moderate (overall p<0,001). The frequency of patients with high CVR was higher in the pooled «non-dipper» and «night-peaker» group (pathological BP profile; n=50), as compared to the pooled «dipper» and «over-dipper» group (n=33): 34% vs. 9%, respectively. At the same time, the pooled «dipper» and «over-dipper» group was characterized by the higher frequency of patients with moderate (52%) and low CVR (39%), in contrast to the pooled «non-dipper» and «night-peaker» group (24% and 8%, respectively). Finally, all 17 patients with very high CVR had an abnormal diurnal BP profile (34% in the pooled «non-dipper» and «night-peaker» group) (overall p<0,001).
 Conclusions. It was established that, according to ABPM, 60% of men of working age with the AH of II stage, 2- and 3-degrees, had pathological BP profiles of the «non-dipper» and «night-peaker» types. Individuals diagnosed with nocturnal rise or insufficient diurnal BP decrease have a higher risk of cardiovascular death in the next 10 years according to SCORE. Patients with a «non-dipper» and «night-peaker» diurnal BP profiles require more aggressive drug therapy and re-examination with ABPM to control the normalization of the diurnal BP profile.

Features of Allostatic Load in Patients with Essential Hypertension without Metabolic Syndrome Depending on the Nature of Nighttime Decreases in Blood Pressure

Changes in the activity of the renin–angiotensin–aldosterone system are responsible for a stable shift in the regulation of the cardiovascular system in essential hypertension (EH). They can be characterized as hemodynamic allostasis. The purpose of our study was to determine the role of hemodynamic parameters in allostatic load in patients with EH without metabolic syndrome. Twenty-four hours of ambulatory blood pressure monitoring was performed, followed by linear and non-linear rhythm analysis. Based on the daily index, patients with EH were divided into two groups: group 1—patients with no significant nighttime decrease in blood pressure (BP); group 2—patients who had a nocturnal decrease in BP. The control group included healthy persons aged 25 to 69 years. A linear analysis was used to determine the mean values of systolic and diastolic BP, heart rate (HR), time load of BP, circadian index, and structural point of BP. Non-linear analysis was applied to determine the mesor, amplitude, range of oscillations and % rhythm of BP and HR. The allostatic load index (ALI) was also calculated on the basis of the corresponding biomarkers. It was found that ALI was significantly higher in groups 1 and 2 in comparison with the control group. The hemodynamic mechanisms of this increase were different.

Metabolipidomic Analysis in Patients with Obstructive Sleep Apnea Discloses a Circulating Metabotype of Non-Dipping Blood Pressure.

A non-dipping blood pressure (BP) pattern, which is frequently present in patients with obstructive sleep apnea (OSA), confers high cardiovascular risk. The mechanisms connecting these two conditions remain unclear. In the present study we performed a comprehensive analysis of the blood metabolipidome that aims to provide new insights into the molecular link between OSA and the dysregulation of circadian BP rhythmicity. This was an observational prospective longitudinal study involving adults with suspected OSA who were subjected to full polysomnography (PSG). Patients with an apnea-hypopnea index ≥ 5 events/h were included. Fasting plasma samples were obtained the morning after PSG. Based on the dipping ratio (DR; ratio of night/day BP values) measured via 24 h ambulatory BP monitoring, two groups were established: dippers (DR ≤ 0.9) and non-dippers (DR > 0.9). Treatment recommendations for OSA followed the clinical guidelines. Untargeted metabolomic and lipidomic analyses were performed in plasma samples via liquid chromatography-tandem mass spectrometry. Non-dipper patients represented 53.7% of the cohort (88/164 patients). A set of 31 metabolic species and 13 lipidic species were differentially detected between OSA patients who present a physiologic nocturnal BP decrease and those with abnormal BP dipping. Among the 44 differentially abundant plasma compounds, 25 were putatively identified, notably glycerophospholipids, glycolipids, sterols, and fatty acid derivates. Multivariate analysis defined a specific metabotype of non-dipping BP, which showed a significant dose-response relationship with PSG parameters of OSA severity, and with BP dipping changes after 6 months of OSA treatment with continuous positive airway pressure (CPAP). Bioinformatic analyses revealed that the identified metabolipidomic profile was found to be implicated in multiple systemic biological pathways, with potential physiopathologic implications for the circadian control of BP among individuals with OSA.

Altered sleep and neurovascular dysfunction in alpha-synucleinopathies: the perfect storm for glymphatic failure.

Clinical and cognitive progression in alpha-synucleinopathies is highly heterogeneous. While some patients remain stable over long periods of time, other suffer early dementia or fast motor deterioration. Sleep disturbances and nocturnal blood pressure abnormalities have been identified as independent risk factors for clinical progression but a mechanistic explanation linking both aspects is lacking. We hypothesize that impaired glymphatic system might play a key role on clinical progression. Glymphatic system clears brain waste during specific sleep stages, being blood pressure the motive force that propels the interstitial fluid through brain tissue to remove protein waste. Thus, the combination of severe sleep alterations, such as REM sleep behavioral disorder, and lack of the physiological nocturnal decrease of blood pressure due to severe dysautonomia may constitute the perfect storm for glymphatic failure, causing increased abnormal protein aggregation and spreading. In Lewy body disorders (Parkinson's disease and dementia with Lewy bodies) the increment of intraneuronal alpha-synuclein and extracellular amyloid-β would lead to cognitive deterioration, while in multisystemic atrophy, increased pathology in oligodendroglia would relate to the faster and malignant motor progression. We present a research model that may help in developing studies aiming to elucidate the role of glymphatic function and associated factors mainly in alpha-synucleinopathies, but that could be relevant also for other protein accumulation-related neurodegenerative diseases. If the model is proven to be useful could open new lines for treatments targeting glymphatic function (for example through control of nocturnal blood pressure) with the objective to ameliorate cognitive and motor progression in alpha-synucleinopathies.

Assessment of daily blood pressure parameters in patients after injury

ABSTRACT. Many studies have highlighted the impact of various significant risk factors on the occurrence of arterial hypertension. However, few papers have examined the effect of psychoemotional factors as important contributors to the risk of arterial hypertension for such a specific population group as contracted servicemen performing military service under conditions of performing special tasks. Furthermore, there is a lack of data on the daily profile of blood pressure in this particular group of individuals. This thesis aims to substantiate the claim that injury, as a risk factor, greatly influences changes in the daily profile of blood pressure. The study examined 118 patients, divided into an experimental group (65 people) and a control group (53 people). The daily profile of blood pressure was assessed using continuous ambulatory blood pressure monitoring. Questionnaires were used to evaluate the quality of sleep, anxiety, and depression. The findings indicated that the patients of the experimental group, following trauma, exhibited a higher index of systolic and diastolic blood pressure duration, while the mean values remained within the normal range. Additionally, these patients more frequently exhibited a blood pressure profile characterized by an insufficient nocturnal decrease in blood pressure, known as non-dipping. This could be attributed to impaired sleep quality, as well as subclinically significant manifestations of anxiety and depression caused by stress. The early detection of changes in the index of systolic and diastolic blood pressure duration, along with deviations in the daily blood pressure profile observed through continuous ambulatory blood pressure monitoring, would enable specialists to promptly address alterations in the hemodynamics of these patients and prescribe appropriate therapy. Therefore, psychoemotional stress in people who have experienced trauma is one of the trigger mechanisms for increased blood pressure. If left unaddressed, this can progress to persistent arterial hypertension.

Features of short-term variability of arterial pressure with different types of circadian rhythm in patients with hypertension disease who have suffered myocardial infarction

Abstract. Blood pressure variability is an important prognostic parameter and is an independent predictor of cardiovascular disease and mortality. Aim. To assess short-term blood pressure variability with regard to the type of diurnal blood pressure profile in hypertensive patients with myocardial infarction. Materials and methods. 78 hypertensive men who had a myocardial infarction were examined. The average age was 58.0 (54.0; 67.0) years, the experience of hypertension was 9.0 (5.0; 18.0) years, the period after the myocardial infarction was 24.5 (12.0; 84,0) months. All patients underwent daily monitoring of blood pressure with the study of average day and night pressure levels, the degree of nocturnal decrease in blood pressure, blood pressure variability with STD calculation, pure and new variability indices. The results. Increased BP variability during the day and at night was registered with all types of circadian systolic BP rhythm. The highest values of systolic BP variability (STD) during the day and at night were in patients with a night-picker circadian profile. Achieving the target level of systolic BP as a whole in the group was observed in 34.6 % of patients during the day and 42.3 % at night. Patients with an over-dipper circadian blood pressure profile, despite having the highest percentage of target blood pressure achievement, had the highest values of variability characteristics calculated by STD, pure and new indices per day (p < 0.05). Conclusions. Increased blood pressure variability and pressure level at night are important criteria for assessing the prognosis of hypertensive patients after myocardial infarction. Daily monitoring of blood pressure provides a unique opportunity to objectify these prognostic parameters at different times of the day, which, together with the assessment of reaching the target level of blood pressure, is necessary to control the effectiveness of treatment.

AMBULATORY BLOOD PRESSURE MONITORING BEFORE AND AFTER TREATMENT IN SECONDARY FORMS OF HYPERTENSION

Objective: Studies using ambulatory blood pressure (BP) monitoring (ABPM) have reported that in some secondary forms of hypertension the normal nocturnal BP decrease is blunted. Design and method: The aim of our study was to compare the nocturnal BP decrease in patients with secondary hypertension before and after treatment. ABPM was performed using the validated Meditech ABPM-06. ABPM readings were obtained at 30-minute intervals for 24-hour in patients with secondary hypertension before and after treatment. The diagnosis of secondary hypertension was based on the history and laboratory data: plasma and urinary electrolytes, renal function, calcium-phosphorus system, the renin-angiotensin-aldosterone system, urinary free cortisol, suppressibility of cortisol after 1 mg dexamethasone, plasma adrenocorticotropic hormone, plasma D4 androstenedione, plasma dehydroepiandrosterone sulphate, plasma 17-alpha hydroxyprogesterone, plasma testosterone, and urinary metanephrine. BP decrease were studied in the following groups: 42 patients with primary aldosteronism (19 men and 23 women; mean age, 44±12 years), 25 patients with adrenal pheochromocytoma (11 men and 14 women; mean age, 42±13 years), and 55 patients with Cushing's syndrome (18 men and 37 women, mean age, 43±13 years). Results: Average systolic/diastolic BP decrease was: before 2/1 mmHg and after 8/6 mmHg treatment in patients with primary aldosteronism. Average systolic/diastolic BP decrease was: before 4/5 mmHg and after 9/12 mmHg treatment in patients with adrenal pheochromocytoma. Average systolic/diastolic BP decrease was: before 3/2 mmHg and after 11/9 mmHg treatment in patients with Cushing's syndrome. All differences in systolic/diastolic BP decrease were statistically significant, with a P value <.001 Conclusions: The results of our study confirm that secondary causes of hypertension lead to a reduced decrease in blood pressure during sleep. After proper treatment reduction in nighttime BP normalizes. A detailed analysis of ABPM can lead us to find the accurate etiology of hypertension.

0290 Ambulatory blood pressure monitoring does not reduce the sleep of off-duty firefighters

Abstract Introduction Ambulatory blood pressure monitoring (ABPM) across 24 hours is recommended to confirm hypertension and, outside of a laboratory setting, is the only means to measure the extent of any nocturnal decrease in blood pressure (BP) i.e., nocturnal BP dipping. The ambulatory device is traditionally programmed to inflate every 20-30 minutes during awake and sleep. Despite diagnostic benefits, ABPM may disturb sleep and lead to reduced compliance in some individuals. Firefighters, an occupational group with a greater risk of developing cardiovascular disease, often note continued vigilance during sleep, possibly reflecting light sleep and/or frequent awakenings. This potential sleep disturbance may contribute to firefighters’ cardiovascular disease risk and may also impact ABPM data. Methods To assess the effect of ABPM on total sleep time (TST) and wake after sleep onset (WASO) in firefighters, we measured sleep using wrist actigraphy in 120 firefighters (91.3% male) from two different departments in Oregon. As part of a larger longitudinal study, participants’ sleep off-shift (as noted from daily survey) was recorded for up to 14 days at two different time points, two months apart. During two consecutive days off, participants completed 24-48 hours of ABPM with simultaneous actigraphy. Overall, there were 1273 measures of sleep, 206 with the cuff and 1067 without the cuff. Separate mixed models with cuff (on/off) as a fixed effect and participant as a random effect, were run for TST and WASO. Models were adjusted for total time in bed, department, and collection interval. Results Surprisingly, TST with the cuff on was significantly greater than nights without the cuff (marginal mean ± SE: 432.0±3.1 vs. 415.9±1.7 minutes respectively, p< 0.001). Increased TST was attributable to a lower WASO with the cuff than without the cuff (43.8±2.9 vs 59.8±1.7 minutes, respectively, p< 0.001). Conclusion Contrary to our expectations, ABPM was not associated with actigraphy measured disturbed sleep among firefighters. In fact, in these data, sleep appeared to be improved while wearing the cuff. Perhaps concerns around poor sleep when wearing the device may have led to improved sleep behaviors on those nights, but this hypothesis needs further investigation. Support (if any) U19OH010154, K01HL151745

"Arterial stiffness is not associated with changes in the circadian pattern of blood pressure in patients with type 1 diabetes mellitus and cardiovascular autonomic dysfunction".

Cardiovascular autonomic neuropathy (CAN) associates an abnormal circadian pattern in blood pressure (BP) regulation that might be aggravated by the coexistence of arterial stiffness. We aimed to evaluate the effect of arterial stiffness in the circadian rhythm of BP in patients with type 1 diabetes and CAN. Cross-sectional study including 56 consecutive patients with type 1 diabetes and CAN, with (n = 28) or without (n = 24) arterial stiffness as defined by an ankle-brachial index above 1.2. CAN was diagnosed by BP and heart rate responses to active standing and cardiovascular autonomic reflex tests. Absence of nocturnal decrease in BP-"non-dipping" pattern- was defined by a daytime to nighttime decrease in mean BP smaller than 10%. The study's subjects mean age was 40 ± 11 years-old, their mean duration of diabetes was 22 ± 10 years, and their mean A1c was 7.9 ± 1.5%. A "non-dipping" pattern was observed in 28 patients (54%) regardless of the presence or absence of arterial stiffness. Age, waist circumference, body mass index, and A1c, were introduced as independent variables into a multiple regression analysis. The stepwise model (R2: 0.113, p = 0.016) retained only A1c levels (β: ‒ 0.333, 95% confidence interval [CI]: -3.10 to -0.33) as significant predictor of the percentage of nighttime decrease in mean BP. A non-dipping pattern in BP is very common in patients with type 1 diabetes presenting with subclinical CAN and is associated with a poorer metabolic control. On the contrary, coexistence of arterial stiffness is not associated with abnormalities in circadian BP regulation.

Assessment of Oxidative Stress Markers in Hypertensive Patients under the Use of Renin-Angiotensin-Aldosterone Blockers.

As in other fields, chronotherapy applied to arterial hypertension (AHT) may have implications on oxidative stress. We compared the levels of some redox markers between hypertensive patients with morning and bedtime use of renin-angiotensin-aldosterone system (RAAS) blockers. This was an observational study that included patients older than 18 years with a diagnosis of essential AHT. Blood pressure (BP) figures were measured using twenty-four-hour ambulatory BP monitoring (24-h ABPM). Lipid peroxidation and protein oxidation were assessed using the thiobarbituric acid reactive substances (TBARS) and reduced thiols assays. We recruited 70 patients with a median age of 54 years, of whom 38 (54%) were women. In hypertensive patients with bedtime use of RAAS blockers, reduced thiol levels showed a positive correlation with nocturnal diastolic BP decrease. TBARS levels were associated with bedtime use of RAAS blockers in dipper and non-dipper hypertensive patients. In non-dipper patients, bedtime use of RAAS blockers was also associated with a decrease in nocturnal diastolic BP. Chronotherapy applied to bedtime use of some BP-lowering drugs in hypertensive patients may be linked to a better redox profile.

Superselective adrenal arterial embolization for primary aldosteronism without lateralized aldosterone secretion: an efficacy and safety, proof-of-principle study.

Superselective adrenal arterial embolization (SAAE) appears to be beneficial in primary aldosteronism (PA) patients with lateralized aldosterone secretion (unilateral PA). As confirmed by adrenal vein sampling (AVS), nearly 40% of PA patients would be PA without lateralized aldosterone secretion (bilateral PA). We aimed to investigate the efficacy and safety of SAAE on bilateral PA. We identified 171 bilateral PA patients from 503 PA patients who completed AVS. Thirty-eight bilateral PA patients received SAAE, and 31 completed a median 12-month clinical follow-up. The blood pressure and biochemical improvements of these patients were carefully analyzed. 34% of patients were identified as bilateral PA. Plasma aldosterone concentration, plasma renin activity, and aldosterone/renin ratio (ARR) were significantly improved 24-h after SAAE. SAAE was associated with 38.7% and 58.6% of complete/partial clinical and biochemical success within a median 12-month follow-up. A significant reduction in left ventricular hypertrophy was shown in patients who obtained complete biochemical success compared with partial/absent biochemical success. SAAE was associated with a more apparent nighttime blood pressure reduction than daytime blood pressure reduction in patients with complete biochemical success. No major adverse safety events related to SAAE were reported during the intraoperative, postoperative, and follow-up periods. SAAE was associated with blood pressure and biochemical improvements in part of bilateral PA and appeared safe. The biochemistry success was accompanied by improved cardiac remodeling and a more prominent decrease in nocturnal blood pressure. This study was part of a trial registered with the Chinese Clinical Trial Registry, number ChiCTR2100047689.

Вплив поліморфізма гена рецепторів ангіотензина ii типу 1 на ефективність антигіпертензивної терапії у хворих із гіпертонічною хворобою, які перенесли інфаркт міокарда за результатами довготривалого спостереження

The purpose of the study was to evaluate the effectiveness of antihypertensive therapy based on the data of daily blood pressure monitoring in patients with hypertension and a history of myocardial infarction, taking into account the A1166C polymorphism of the angiotensin II type 1 receptor gene, based on the results of long-term follow-up. Materials and methods. The study included 36 men with arterial hypertension of the 1st to 3rd degree who had suffered a myocardial infarction. The average age was 57.0 (52.0; 64.0) years, the experience of arterial hypertension – 6.3 (4.0; 15.0) years, the period after a myocardial infarction – 48.0 (12.0; 144.0) months. When determining the A1166C polymorphism of the angiotensin II type 1 receptor gene, patients were divided into 3 groups: group 1 consisted of 18 (50%) patients with the AA genotype, group 2 included 12 (33.3%) patients with the AС genotype, and group 3 – 6 (16.7%) patients with СС genotype of angiotensin II type 1 receptor gene. Daily blood pressure monitoring was carried out at the beginning of the study and after 38 months. Results and discussion. At the beginning of the study, based on the results of daily blood pressure monitoring, it was found that in the group as a whole, the levels of systolic blood pressure and diastolic blood pressure, the pressure load index – the diastolic blood pressure time index corresponded to the target values according to the median, but the pressure load indices for systolic blood pressure exceeded the normal range. Against the background of long-term antihypertensive therapy, a reliable decrease in systolic blood pressure levels was established for all time periods of the day, especially during the daytime. A significant decrease in the values of the pressure load indices was established – the time index of systolic blood pressure at daytime (delta -10.49%, which was -27.9%) and the area index of systolic blood pressure at daytime (delta -34.89 mm Hg x h, which was -32.0%) (p <0.05). When analyzing the effectiveness of long-term antihypertensive therapy depending on the A1166C polymorphism of the angiotensin II type 1 receptor gene, it was established that the highest percentage of achieving the target blood pressure level (66.7%) in combination with the normalization of the circadian blood pressure rhythm was determined in patients with the AA genotype of the AGTR1 gene. Among patients with AC genotype, 33.3% reached the target blood pressure levels, but it was not possible to achieve normalization of blood pressure variability and pathological patterns of the circadian rhythm of blood pressure persisted, which are signs of a prognostically unfavorable course of the disease. Among patients with CC genotype of the AGTR1 gene, against the background of long-term treatment, 33.3% achieved the target level of blood pressure, in general, the group normalized the degree of nocturnal decrease in blood pressure, but only a decrease in the levels of systolic blood pressure and diastolic blood pressure during the day in combination with increased values of pressure load indices was observed, which indicates insufficiently effective control of arterial hypertension. Conclusion. During the long-term observation of patients with hypertension and a history of myocardial infarction, an assessment of the effectiveness of antihypertensive therapy was carried out taking into account the A1166C polymorphism of the AGTR1 gene based on the results of daily blood pressure monitoring

Factors Associating with Non-Dipping Pattern of Nocturnal Blood Pressure in Patients with Essential Hypertension.

Background: In patients with essential hypertension, a non-dipping blood pressure pattern is a strong risk factor for cardiovascular diseases. However, background factors associating with such a blood pressure pattern remain unknown. Methods: Untreated essential hypertensive patients without chronic kidney diseases who were admitted to our outpatient clinic were included. Blood sampling and 24 h ambulatory blood pressure monitoring were mandatorily performed. Non-dipper status was defined as a maximum decrease in nocturnal systolic blood pressure within 10%. Clinical factors associating with non-dipper status were investigated. Results: A total of 154 patients (56 ± 12 years old, 86 men) were included. Among baseline characteristics, a higher serum uric acid level was independently associated with non-dipper status (odds ratio 1.03, 95% confidence interval 1.00−1.05, p < 0.05). Among those with non-dipper status, a higher high-sensitivity C-reactive protein level tended to be associated with incremental nighttime systolic blood pressure levels (p = 0.065). Conclusions: Hyperuricemia and micro-inflammation might be associated with attenuated nocturnal blood pressure dipping and incremental nighttime systolic blood pressure levels.

PS-BPC12-8: ASSOCIATION OF URIC ACID WITH BLOOD PRESSURE LEVEL IN ESSENTIAL HYPERTENSION: DIFFERENCES ACCORDING TO DIPPING PATTERN OF NOCTURNAL BLOOD PRESSURE

Objective: In essential hypertensive patients, independent of the degree of hypertension, a non-dipping blood pressure pattern is a risk factor for the development of cardiovascular diseases. Serum uric acid level was demonstrated to be an independent predictor of developing hypertension. The increase of uric acid promotes oxidative stress and inflammation, which then enhances endothelial dysfunction. In this study, the association of serum uric acid with 24 hour average blood pressure level was investigated from differences in patterns of circadian blood pressure in patients with essential hypertensive patients. Design and method: In 154 untreated essential hypertensive patients (86 males, average age 56 ± 12 years) without chronic kidney disease (urinary albumin excretion less than 300 mg/g of creatinine and estimated glomerular filtration rate 60 mL/min/1.73m2 or more), 24 hour ambulatory blood pressure monitoring and blood sampling were performed. In blood samples, biochemical parameters including highly sensitive CRP (hsCRP) and nitric oxide metabolites (NOx) were measured. Non-dipper status was defined as a decrease in nocturnal systolic blood pressure &lt; 10 %. The patients were divided into two groups according to their nocturnal systolic blood pressure status: 56 patients with non-dipper status and 98 patients with dipper status. Results: 24 hour systolic blood pressure was higher in the non-dipper patients than in the dipper group (148 ± 17 vs 139 ± 16 mmHg, p &lt; 0.001), whereas diastolic blood pressure and pulse rate did not differ between the two groups. The non-dipper group was characterized by increased serum uric acid and hsCRP and decreased plasma NOx level compared with the dipper group (6.0 ± 1.7 mg/dL, 0.10 ± 0.15 mg/dL, 41.4 ± 25.3 μmol/L in the non-dipper group vs 5.5 ± 1.5, 0.07 ± 0.11, 50.1 ± 31.3 in the dipper group, p &lt; 0.05, respectively). 24 hour systolic blood pressure correlated positively with serum uric acid and hsCRP and negatively with plasma NOx in the non-dipper group (r = 0.25, 0.32, -0.25, p &lt; 0.05, respectively), but did not so in the dipper group. Furthermore, in the non-dipper group, multiple regression analysis revealed that serum uric acid was an independent determinant for 24 hour systolic blood pressure level together with hsCRP, and plasma NOx (R2 0.25, p &lt; 0.01). Conclusions: These data indicate that the elevation of serum uric acid could associate with persistently elevated blood pressure accompanied with micro-inflammation and vascular endothelial dysfunction in essential hypertensive patients with an attenuated nocturnal blood pressure dipping.

Macro- and microhemodynamic disorders as cardiovascular risk factors in overweight young people

Obesity is associated with a high risk of cardiovascular diseases. Therefore, an urgent task of preventive medicine is to search for markers indicating the early development of cardiovascular pathology in young people in order to develop preventive measures.The aim of the study. To study macro- and microhemodynamics in young people with normal and elevated body mass index (BMI).Methods. After receiving informed consent, we evaluated microhemodynamics using Doppler ultrasound (Angiodin-PC (BIOSS, Russia); 16 MHz sensor) and macrohemodynamics by daily blood pressure monitoring (MnSDP-3 (BPLab, Peter Telegin LLC, Russia)) in students (20.05 ± 1.46 years old) who did not play sports in the period from 2019 to 2021. The subjects were divided into 2 groups according to their BMI: group 1 (control) – BMI ≤ 25 (average age 20.5 ± 0.7 years; average weight 59.47 ± 8.26 kg); group 2 – BMI ≥ 25 (average age 20.12 ± 1.73 years; average weight 83.8 ± 9.59 kg).Results. It has been proven that already at a young age, an increased BMI adversely affects the elasticity of the vascular wall. We registered a statistically significant increase in the peripheral resistance index (RI; Purcello index) (p = 0.022,) and the Stewart index (SD) (p = 0.0034) which are reflecting vascular wall remodeling. There is also a statistically significant increase in average blood pressure per day, day/night against the background of increased BMI. An insufficient degree of nocturnal decrease in systolic blood pressure is revealed, as well as an increase in pressure load and blood pressure variability.Conclusion. Since changes in the structure and function of the vessels of the microcirculatory bed are a precursor to preclinical disorders of systemic blood flow, the introduction of high-frequency Doppler ultrasound into the protocol of examination of people having metabolic syndrome will allow us to assess the functional status of large and small arteries and to identify early vascular disorders.

Correlation between Blunted Nocturnal Decrease in Diastolic Blood Pressure and Oxidative Stress: An Observational Study.

An impaired nocturnal decrease in diastolic blood pressure (DBP) increases the blood pressure (BP) load, which is a main factor in endothelial dysfunction, atherosclerosis, and arterial stiffness. We aimed to quantify some markers of oxidative stress in hypertensive patients, to compare their levels between individuals with dipper and non-dipper DBP profiles, and to assess their correlation with the nocturnal DBP (nDBP) dipping. It was an observational study that included patients older than 18 years with a diagnosis of essential hypertension who consented to participate. The collected variables were some indices of 24-h ambulatory blood pressure monitoring, demographic, epidemiological, clinical, and laboratory variables. Plasma thiobarbituric acid reactive substances (TBARS) and reduced thiols, together with serum vitamin E, vitamin A, copper (Cu), and zinc (Zn) levels were assessed as oxidative stress markers. We recruited 248 patients with a median age of 56 years (56% women). The percentage of nDBP dipping showed a weak positive correlation with reduced thiol, vitamin E, and vitamin A levels; and a weak negative correlation with Cu levels. We also found a negative correlation between nDBP dipping and the TBARS/Thiol, TBARS/Vitamin E, and TBARS/Vitamin A ratios. After multivariate analysis, we found that increased TBARS/Thiol ratio and serum Cu levels were associated with a higher risk of a non-dipper DBP profile. As in other situations of increased cardiovascular risk, an impaired nDBP decrease may coincide with abnormalities in redox status.