Nocturnal Blood Pressure Decrease Research Articles

Normotensive non-dipping blood pressure profile does not predict the risk of chronic kidney disease progression.

The lack of a decrease in nocturnal blood pressure is a risk factor for the progression of chronic kidney disease (CKD); however, it currently remains unknown whether it is a risk factor in normotensive CKD patients. We conducted a retrospective cohort study and enrolled 676 CKD patients who underwent ambulatory blood pressure monitoring (ABPM). According to their nocturnal blood pressure dipping pattern (>10%: dipper or <10%: non-dipper) and average 24-h systolic blood pressure (>130/80 mmHg: hypertension or <130/80 mmHg: normotension), patients were divided into four groups. The estimated glomerular filtration rate (eGFR) decline over 2 years and relevant clinical parameters were analyzed among groups. Among all participants, 82.7% were non-dippers and half of them were normotensive. The eGFR decline was the most rapid in hypertensive non-dipper patients (4.73 ± 0.45 ml/min/1.73 m2/2 years), and was not significantly different between normotensive non-dipper (1.31 ± 0.49 ml/min/1.73 m2/2 years) and dipper patients (1.69 ± 0.80 ml/min/1.73 m2/2 years). A multivariate regression analysis revealed that the amount of urinary protein (95% confidence interval (CI): 1.51-2.63), 24-h systolic blood pressure (95% CI 1.13-1.45), and eGFR (95% CI 1.02-1.44) were associated with a rapid eGFR decline. We conclude that, according to the ABPM-based analysis, a non-dipping blood pressure pattern in normotensive CKD patients does not predict the risk of a rapid decline in eGFR. This suggests that the control of blood pressure, rather than its circadian rhythm, is essential for the preservation of eGFR.

Nocturnal blood pressure decrease in patients with chronic kidney disease and in healthy controls - significance of obstructive sleep apnea and renal function.

BackgroundChronic kidney disease (CKD) is often associated with a blunted nocturnal BP decrease and OSA. However, it is not fully clear whether a relationship exists between reduction in renal function and obstructive sleep apnea (OSA) on the one hand and relative nocturnal BP decrease in CKD patients on the other. The aim of this study was to investigate the association between nocturnal BP decrease and renal function, the degree of OSA, vasoactive hormones, and renal sodium handling in CKD3-4 patients and healthy age-matched controls.MethodsWe performed brachial and central 24-hour ambulatory BP measurement and CRM in 70 CKD3-4 patients and 56 controls. In plasma, we measured renin, AngII, aldosterone, and vasopressin. In urine, 24-hour excretion of sodium, protein fractions from the epithelial sodium channel (u-ENaCγ), and the AQP2 water channels (u-AQP2) were measured.ResultsCKD patients had lower relative nocturnal BP decrease than controls: brachial (10% vs 17%, P=0.001) and central (6% vs 10%, P=0.001). Moderate-to-severe OSA was more frequent in patients (15 vs 1%, P<0.0001). Neither the presence of OSA nor eGFR were predictors of either brachial or central nocturnal BP decrease. CKD3-4 nondippers were more obese, had higher HbA1c level, and more often a history of acute myocardial infarction than CKD3-4 dippers (P<0.05).ConclusionCKD3-4 patients had lower brachial and central nocturnal BP decrease than healthy controls. OSA and eGFR were not associated with nondipping in CKD patients or healthy controls. Nondipping in CKD3-4 was associated with obesity, diabetes, and cardiovascular disease.ClinicalTrials.gov IDNCT01951196.

Nocturnal Blood Pressure Decrease in Hypertensive Patients and Normotensives- Association with Obstructive Sleep Apnoea and Renal Function

Background:Blunted nocturnal Blood Pressure (BP) decrease is seen in patients with hypertension and obstructive sleep apnoea (OSA). The influence of OSA and renal function on nocturnal BP decrease is not fully clarified.Objective:In this case control study of hypertensive patients and healthy controls, we aimed to analyse the relationship between nocturnal BP decrease on one hand and presence of OSA, renal function, plasma levels of syndecan and vasoactive hormones, and urinary sodium excretion on the other.Methods:In 75 hypertensive patients and 56 controls, we performed brachial and central 24h ambulatory BP measurement and cardio respiratory monitoring. We measured syndecan, renin, angiotensinII, aldosterone, vasopressin, and brain natriuretic peptide in plasma and 24h urinary excretion of sodium, aquaporin2, and a component of the epithelial sodium channel (u-ENaCγ).Results:Nocturnal BP decrease was lower in patients than controls, brachial (13% versus 17%,p=0.001) and central (8% versus 10%,p=0.019). Moderate-to-severe OSA was present in 13% of patients, 2% of controls (p&lt;0.005). Neither brachial nor central nocturnal BP decrease was associated with OSA, renal function, plasma levels of vasoactive hormones, syndecan-1, or urinary sodium excretion. P-syndecan and u-ENaCɣ were higher in patients than controls.Conclusion:Both brachial and central nocturnal BP decrease was lower in patients than in controls. Neither brachial nor central nocturnal BP decrease was associated with the presence of OSA, renal function, or plasma levels of vasoactive hormones. Increased syndecan in plasma in hypertensive patients suggested damage to the endothelial glycocalyx.

The Effect of Liraglutide on 24-Hour Ambulatory Blood Pressure in Patients with T2DM—A Pilot Study

The GLP-1 receptor agonists have been shown to decrease blood pressure (BP) in clinical trials using office BP measurements. However, the effect of GLP-1 agonist liraglutide on 24-hour ambulatory blood pressure and on the nocturnal BP decrease (dipping) have not been adequately assessed in large trials. To better characterize the effect of GLP-1 agonists on 24-hour ambulatory BP in subjects with T2DM we conducted a randomized controlled trial comparing the effects of liraglutide to placebo. Eleven subjects with T2DM (mean age 58.6±7.4 years, female 63.7%, African-American 72.7%) were randomized to 8 weeks of treatment with liraglutide (n=6) or placebo (n=5). ABPM and EndoPAT (Peripheral Arterial Tone) for assessment of endothelial dysfunction were done at baseline, 4 weeks and 8 weeks of therapy. Mixed models with repeated measures was used to estimate the treatment effect over time. Treatment with liraglutide was found to increase the nighttime SBP (LSM±SE): 135.3±4.3 vs. 102.1±4.5 (mmHg), p=0.0015), diastolic BP (DBP) (74.7±6.1 vs. 57.5±5.6 (mmHg), p=0.047) and increase daytime heart rate (109.5±9.2 vs. 77.1±7.9 (mmHg), p=0.021) after adjusting for age, race, history of hypertension, current use of ACE-I/ARBs and Reactive Hyperemia Index (RHI). There was no significant change in BMI between baseline and 8 weeks (1.5±2.4 vs. 1.0±2.5 (kg/m2), p=0.65). After adjustment for treatment and other covariates, abnormal RHI (≤ 1.67) was associated with decreased nighttime SBP (110.6±3.4 vs. 126.8±3.4 (mmHg), p=0.0003), and increased nighttime DBP (69.1±5.0 vs. 63.2±5.1 (mmHg), p=0.16) although lack of power to detect the statistical significance. In conclusion, our study showed that treatment with liraglutide over 8 weeks was unable to correct the abnormal elevation in nocturnal BP known to occur in patients with T2DM. ABPM also confirmed the known side effect of increase in heart rate previously seen in other liraglutide trials. Abnormal RHI tended to be associated with all patients with high DBP. Disclosure D. Lovre: None. B. Katalenich: None. C. Carrion Olmeda: None. S.B. Camitta: None. A.N. Khan: None. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis. T.K. Thethi: None.

Resistance Exercise Can Modify Cardiovascular Responses of Professors During Teaching and Sleep

Background: Both work activity and reduced nocturnal decrease in blood pressure (BP) are related to higher cardiovascular risk. Objectives: The aim of the present study was to assess the blood pressure and autonomic responses of university professors during teaching and sleeping periods after different resistance exercise (RE) intensities. Methods: Ten normotensive professors (33.6 ± 3.4 years, 82.4 ± 12.4 kg; 177.0 ± 7.5 cm; 26.2 ± 3.2 kg/m2) randomly underwent control (CONT) and RE before initiating their daily activities. RE consisted of a circuit training lasting 40 minutes at 40% and 80% of one repetition maximum test (40% 1RM and 80% 1RM). Systolic BP (SBP) and diastolic BP (DBP) as well as heart rate variability indicators in the time (RRi) and frequency domains (LF, HF, LF:HF ratio) were evaluated while resting and 24 hours after the sessions. The average day-period (DP), night-period (NP) and nocturnal BP fall (%NBPF) of SBP and DBP were calculated. Results: During teaching, SBP (CONT: ∆ = 8.1 ± 9.1 mmHg; 40% 1RM: ∆ = 10.8 ± 10.5 mmHg and 80% 1RM: ∆ = 10.3 ± 7.9 mmHg; P 0.05). DBP showed different results to 40% 1RM (NT: 58.8 ± 5.1 mmHg and %NBPF: -24.2 ± 3.4 %; P < 0.05) when compared with CONT (NT: 61.9 ± 5.2 mmHg and %NBPF: -18.2 ± 4.5%; P < 0.05) and 80% 1RM (NT: 63.2 ± 5.9 mmHg and %NBPF: -18.1 ± 4.9%). Conclusions: RE at 40% 1RM and 80% 1RM attenuated DBP values of subsequent teaching, however only 40% 1RM promoted better NT-BP and %NBPF values in university professors.

Association of Adenotonsillectomy With Blood Pressure Among Hypertensive and Nonhypertensive Children With Obstructive Sleep Apnea

Hypertension in childhood may continue into adulthood and lead to adverse cardiovascular outcomes. Evidence suggests that adenotonsillectomy for childhood obstructive sleep apnea (OSA) may be associated with blood pressure (BP) improvement. However, how adenotonsillectomy is associated with BP in hypertensive and nonhypertensive children with OSA remains unclear. To investigate disparities in BP changes after adenotonsillectomy in hypertensive and nonhypertensive children with OSA. From January 1, 2010, to April 30, 2016, children (aged <18 years) with symptoms of OSA treated at National Taiwan University Hospital were enrolled in this retrospective case series study. Children underwent polysomnography for diagnosis of OSA (apnea-hypopnea index >1). All children with OSA underwent adenotonsillectomy. Preoperative and postoperative overnight polysomnographic data were obtained. Office BP was measured in a sleep center before (nocturnal BP) and after (morning) polysomnography. A total of 240 nonobese children (mean [SD] age, 7.3 [3.0] years; 160 [66.7%] male and 80 [33.3%] female) with OSA were recruited. Postoperatively, the apnea-hypopnea index decreased significantly from 12.1 to 1.7 events per hour (95% CI of difference, -12.3 to -8.4 events per hour). The whole cohort had a significant decrease in nocturnal diastolic BP (66.9 to 64.5 mm Hg; 95% CI of difference, -4.1 to -0.7 mm Hg) and morning diastolic BP (66.9 to 64.4 mm Hg; 95% CI of difference, -4.2 to -0.8 mm Hg). The number (percentage) of patients with diastolic BP in the greater than 95th percentile decreased significantly nocturnally (48 [20.0%] to 33 [13.8%]; 95% CI of difference, -12.1% to -0.4%) and in the morning (52 [21.7%] to 34 [14.2%]; 95% CI of difference, -13.6% to -1.4%). Postoperatively, hypertensive children had a significant decrease in all BP measures, including mean (SD) nocturnal and morning systolic BP (nocturnal: 107.5 [8.6] mm Hg; morning: 106.0 [9.4] mm Hg), systolic BP index (nocturnal: -4.3 [8.6]; morning: -5.7 [8.5]), diastolic BP (nocturnal: 65.1 [11.5] mm Hg; morning: 64.4 [10.1] mm Hg), and diastolic BP index (nocturnal: -10.7 [17.3]; morning: -11.6 [15.7]), whereas the nonhypertensive group had a slight increase in nocturnal systolic BP (103.8 to 105.9 mm Hg; 95% CI of difference, 0.4-3.9 mm Hg). A generalized estimating equation model for subgroup comparisons revealed that children with hypertension, compared with those without, had greater improvement in all BP measures. Hypertensive children with OSA had a significant improvement in BP after adenotonsillectomy. Hypertensive children with OSA should be screened and treated by adenotonsillectomy because proper treatment not only eases OSA symptoms but also potentially prevents future cardiovascular and end-organ disease.

Time of administration of treatment for hypertension in renal patients

Wang et al.1 make a valuable contribution to an aspect of blood pressure management often ignored. In 1961, in blood pressure studies over 24 h, we observed blood pressure did not fall at night in patients with malignant (accelerated) hypertension who had renal failure or were at risk of this.2 Wang et al.1 now provide a meta-analysis of subsequent studies and support our suggestion that ‘non-dipping’ hypertension is important in the generation of morbidity, and that evening administration of medication may be optimal. Their conclusion from the analysis is that evening dosing, when contrasted with morning administration, improves two surrogate markers of long-term benefit: restoring ‘dipping’ in ‘non-dipping’ hypertensives and decreasing urinary albumin. Information on renal function was provided in only two of six studies, totalling 138 patients. There was no significant change in kidney function when measured, but there was no information on the rate of progression of renal dysfunction. The studies did not follow patients for long enough to evaluate ‘hard’ endpoints, death and dialysis, and longer follow-up might have demonstrated renal function benefit from evening dosing. Another surrogate marker of prognosis in chronic kidney disease, urinary albumin excretion (UAE), was reported in only one study included in this meta-analysis. A reduction in UAE with evening dosing was highly correlated with the decrease in nocturnal blood pressure and with the increase in diurnal/nocturnal ratio of blood pressure but no rate of change in UAE was calculated. Renal function is usefully considered as the rate of deterioration. Plasma creatinine, expressed as the reciprocal of plasma creatinine, or the estimated glomerular filtration rate, often demonstrates linear progression, allowing calculation of rates of deterioration in individual patients. Future studies could usefully record more frequent measurements of plasma creatinine and UAE in each individual and identify those responding to changes in time of administration. Time series analysis, utilising Bayesian statistics with Kalman Filtering, were developed for my group to monitor progression of renal function and to detect and evaluate the probability of change.3 If this method is utilised in any prospective trial of change in administration time (or retrospectively if enough data points are available) many fewer subjects will be needed to confirm or refute the conclusions of this meta-analysis. My personal clinical experience provides examples of a change in the rate of progression of kidney failure in some patients when there were therapeutic changes to modify nocturnal blood pressure, I have proposed3, 4 that in the clinic records of renal function and of urinary albumin/creatinine ratio should be considered graphically and also analysed for changes in rate of deterioration when changes, including change in time of administration of medication, have been introduced.

Features of interrelation of the structural state of brachiocephalic arteries in middle-aged and elderly patients with characteristics of the daily profile of blood pressure in patients with essential arterial hypertension stage II.

The aim of our study was to evaluate the interrelation of the structural state of brachiocephalic arteries with the characteristics of the daily profile of blood pressure (BP) in middle-aged and elderly patients with essential arterial hypertension stage II. The study included 74 untreated middle-aged (n=46) and elderly (n=28) patients with essential uncomplicated hypertension, which were divided into two groups depending on age. By risk factors, degree of arterial hypertension patients did not differ significantly. In group I, a significantly higher prevalence of stenotic atherosclerosis of the carotid arteries was found in comparison with the patients of group II. In elderly patients with stenotic carotid artery atherosclerosis, a significantly higher level of systolic blood pressure (BP) was established at night time. The increase of carotid intima media thickness in patients with impaired circadian BP rhythm was associated with the insufficient degree of nocturnal decrease in systolic BP. The degree of carotid arteries stenosis in patients with preserved daily BP rhythm was associated with the increasing of systolic BP level at night time, of pulse BP level within 24 hours, and an insufficient decrease in diastolic BP at night time.

Circadian rhythm and autonomic dysfunction in presymptomatic and early Huntington's disease

IntroductionSleep and circadian rhythm disturbances are common in patients with neurodegenerative diseases such as Huntington's disease (HD). The aim of this study was to evaluate variability in circadian blood pressure (BP) to determine the association between abnormal circadian BP and sleep quality in patients with HD. MethodsCross-sectional, multicenter study of 38 HD mutation carriers (23 premanifest and 15 early stage patients) who were compared to 38 age- and sex-matched controls. BP was evaluated by ambulatory blood pressure monitoring (ABPM). Based on the percentage decrease in nocturnal BP, subjects were classified as either dippers (≥10%) or non-dippers (<10%). Sleep quality and daytime sleepiness were measured, respectively, using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Daytime Sleepiness Scale (ESS) and the scores on these indices were correlated with the ABPM findings. ResultsSixty-three percent HD mutation carriers were non-dippers (86.7% of the symptomatic and 47.8% of the premanifest patients) versus 23.7% of controls (p = 0.001). In the HD group, sleep quality was significantly more impaired (PSQI>5) (p = 0.016) with more excessive daytime sleepiness (ESS>9) (p = 0.001) than in the control group. Nocturnal non-dipping was associated with worse sleep quality in patients (p = 0.011) but not in controls. ConclusionThese results show that patients with HD present early disturbances in the circadian rhythm of BP and that this altered nocturnal BP is associated with poor sleep quality. These findings suggest the potential role of subtle hypothalamic dysfunction in this population.

Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study.

While racial variation in ambulatory blood pressure (BP) is known, patterns of diurnal dipping in the context of diabetic kidney disease have not been well defined. The authors sought to determine the association of race with nocturnal dipping status among participants with diabetic kidney disease enrolled in the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) trial. The primary outcome was nocturnal dipping-percent decrease in average systolic BP from wake to sleep-with categories defined as reverse dippers (decrease <0%), nondippers (0%-<10%), and dippers (≥10%). Twenty-four-hour ambulatory BP monitoring was completed by 108 participants (54% were nondippers, 24% were dippers, and 22% were reverse dippers). In adjusted models, the common odds of reverse dippers vs nondippers/dippers and reverse dippers/nondippers vs dippers was 2.6 (95% confidence interval, 1.2-5.8) times higher in blacks than in whites. Without ambulatory BP monitoring data, interventions that target BP in black patients may be unable to improve outcomes in this high-risk group.

Evening versus morning dosing regimen drug therapy for chronic kidney disease patients with hypertension in blood pressure patterns: a systematic review and meta-analysis.

Evening dosing regimen drug therapy on blood pressure (BP) control is used widely, but its clinical benefits and preservation or re-establishment of the normal 24-h BP dipping pattern in chronic kidney disease (CKD) patients is not known. To investigate the effect of an evening dosing regimen of antihypertensive drugs on BP patterns of CKD patients with hypertension. A systematic review was conducted by searching PUBMED, EMBASE, ASN-ONLINE, the Cochrane Library and the reference lists of relevant articles of published papers. All trials designed to evaluate the effects of evening versus morning dosing regimen drug therapy for CKD patients with hypertension were included. Meta-analysis was performed using random or fixed effects models. Five randomised controlled trials and one comparative study, including 3732 patients, met the inclusion criteria. Compared with morning dosing regimen drug therapy, evening administration of antihypertensive medication was associated with a significant reduction of 40% in non-dipper BP patterns (risk ratio (RR), 95% CI, (0.43, 0.84)). We noted a significant decrease in nocturnal systolic blood pressure (SBP) (MD -3.17 mmHg, 95% CI (-5.41, -0.94)), a significant reduction in nocturnal diastolic blood pressure (DBP) (MD -1.37 mmHg, 95% CI (-2.05, -0.69)) and a significant increase in awake SBP (MD 1.15 mmHg, 95% CI (0.10, 2.19)) in patients assigned to the evening dosing regimen drug therapy group. Patients showed no significant differences for all-cause mortality and cardiovascular mortality. This review shows that evening dosing regimen drug therapy could reverse non-dipper BP patterns in hypertensive CKD patients.

Looking for new diagnostic tools and biomarkers of hypertension in obese pediatric patients.

Development of obesity in childhood may be linked to an increased risk of hypertension. This study aimed (a) to analyze the expression of genes associated with blood pressure (BP) in obese children, (b) to evaluate ambulatory blood pressure monitoring (ABPM) as a diagnostic tool in hypertension in children, and (c) to assess the prevalence of metabolic syndrome in children with obesity. Office BP measurements and ABPM were performed in 49 children with obesity and 25 age-matched healthy children. Expressions of 12 monogenic hypertension genes and 45 genes variants associated with BP were assessed using the microarray technique. No significant differences in gene expression levels were found. Children with obesity had significantly higher (P<0.001) mean office systolic and diastolic BPs compared with the controls. The diagnosis of high normal BP and hypertension with ABPM was established in 27 and 33% of children, respectively. Nocturnal BP decrease less than 10% was found in 27% of children, whereas nocturnal BP decrease more than 20% was found in 13% of children. Nocturnal BP increase was found in 13% of patients. The diagnosis of metabolic syndrome was established in 29% of obese patients. The following can be concluded: (a) the prevalence of metabolic syndrome was found in nearly one-third of children with obesity. (b) ABPM is a useful and reliable tool in the diagnostics of pediatric hypertension. Abnormal BP can be observed in ∼50% of obese children.

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain.

Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ⩾60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (P<0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-h but not daytime or night-time BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (P<0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (P<0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (P<0.001). In conclusion, 24-h BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.

Cuff-Based Oscillometric Central and Brachial Blood Pressures Obtained Through ABPM are Similarly Associated with Renal Organ Damage in Arterial Hypertension

Background/Aims: Central blood pressure (BP) has been suggested to be a better estimator of hypertension-associated risks. We aimed to evaluate the association of 24-hour central BP, in comparison with 24-hour peripheral BP, with the presence of renal organ damage in hypertensive patients. Methods: Brachial and central (calculated by an oscillometric system through brachial pulse wave analysis) office BP and ambulatory BP monitoring (ABPM) data and aortic pulse wave velocity (PWV) were measured in 208 hypertensive patients. Renal organ damage was evaluated by means of the albumin to creatinine ratio and the estimated glomerular filtration rate. Results: Fifty-four patients (25.9%) were affected by renal organ damage, displaying either microalbuminuria (urinary albumin excretion ≥30 mg/g creatinine) or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Compared to those without renal abnormalities, hypertensive patients with kidney damage had higher values of office brachial systolic BP (SBP) and pulse pressure (PP), and 24-h, daytime, and nighttime central and brachial SBP and PP. They also had a blunted nocturnal decrease in both central and brachial BP, and higher values of aortic PWV. After adjustment for age, gender, and antihypertensive treatment, only ABPM-derived BP estimates (both central and brachial) showed significant associations with the presence of renal damage. Odds ratios for central BP estimates were not significantly higher than those obtained for brachial BP. Conclusion: Compared with peripheral ABPM, cuff-based oscillometric central ABPM does not show a closer association with presence of renal organ damage in hypertensive patients. More studies, however, need to be done to better identify the role of central BP in clinical practice.

Chronotherapy for hypertension in patients with chronic kidney disease: a systematic review and meta-analysis in non-black patients.

To investigate the effects of chronotherapy on blood pressure in patients with chronic kidney disease (CKD). We searched PUBMED, EMBASE, ASN-ONLINE, the Cochrane Library and the reference articles of published papers without language restriction, for randomized and non-randomized trials that assessed the effect of chronotherapy versus morning dosing regimen drug therapy for CKD patients with hypertension. Meta-analysis was done with random-effect models. After application of inclusion/exclusion criteria, three randomized controlled trials including 3380 patients were analyzed. Compared with morning dosing regimen drug therapy, chronotherapy was associated with a significant decrease of 3.55% in sleep-time relative decline of systolic blood pressure (SBP) (mean difference [MD], 95% CI, [0.22, 6.88]). In the chronotherapy group, we noted a significant decrease in nocturnal SBP (MD -3.79mmHg, 95% CI, [-7.18, -0.41]) and nocturnal diastolic blood pressure (MD -1.55mmHg, 95% CI. [-2.28, -0.82]), but there was a small increase in awake SBP by 1.19mmHg (MD, 95% CI, [0.06, 2.31]). No significant difference was noted in all-cause mortality and cardiovascular mortality. This meta-analysis suggests that chronotherapy could reduce nocturnal BP in hypertensive CKD patients.

Relationship between blood pressure and retrobulbar blood flow in dipper and nondipper primary open-angle glaucoma patients.

To evaluate the relationship between retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery, and short posterior ciliary artery and 24-hour blood pressure (BP) measurements in dipper and nondipper patients with primary open-angle glaucoma (POAG). A prospective, cross-sectional, and observational study was conducted on consecutive patients, referred or recruited, attending the outpatient service of our ophthalmology department. Ambulatory BP monitoring, Doppler imaging, and ocular pulse amplitude measurements were performed on the same day. Patients with nocturnal BP decrease up to 10% of the diurnal BP were defined as dippers and those with BP decrease less than 10% were defined as nondippers. A total of 114 patients (36 nondippers and 78 dippers) were included in the study. The end-diastolic velocity was significantly lower and the resistivity index (RI) was significantly higher in the dippers than in the nondippers (p&lt;0.0001 and p&lt;0.0001, respectively). The RI in the OA was significantly correlated with daytime and nighttime systolic BP and with the daytime mean arterial pressure in the dippers. The RI in the OA significantly correlates with BP in patients with POAG with nocturnal BP dips. Additionally, retrobulbar blood flow parameters are reduced in dippers as compared with nondippers with POAG.

24時間自由行動下血圧計（ABPM）を用いた降圧治療中の夜間降圧タイプ別の血清尿酸値の検討

<b>24時間自由行動下血圧計（ABPM）を用いた降圧治療中の夜間降圧タイプ別の血清尿酸値の検討</b>

The Effect of Nocturnal Blood Pressure Changes on the Cognitive State of Patients With Parkinson’s Disease

This article has been retracted by the authors. Background: Recent data have revealed that cognitive involvement occurs, more or less, in every stage of idiopathic Parkinson’s disease (IPD), which is definitely going to cause radical changes in this traditional understanding. The effects of blood pressure changes during the night on the cognitive states of patients with IPD are not known for sure. The purpose of this study was to research the effects of blood pressure changes during the night on cognitive state of patients with IPD. Methods: A total of 30 patients, 14 females and 16 males, were followed with a diagnosis of IPD. Cognitive functions were assessed with an extensive neuropsychological test battery. Results: The fifth stage of Stroop test, test of line direction, test of face recognition and Hooper test were significantly different in dipper group when compared with the non-dipper group. Conclusion: Not having nocturnal blood pressure decrease in IPD can be accepted as a risk factor in terms of cognitive function disorders. J Neurol Res. 2015;5(3):207-212 doi: http://dx.doi.org/10.14740/jnr324w

PP.17.22

Objective: Study features of circadian blood pressure of patients with hypertension(HTN) and diabetes mellitus type 2(DM-2)with various frequencies of hypoglycemic states. Design and method: 81 patients with DM-2 (for 13.2 ± 3.2 years) and II - III degree HTN. First group - 21 patients, who received basal-bolus insulin therapy using human soluble insulin and insulin isophane. Second group - 33 patients who received insulin analogues – insulin aspart and detemir. Control group - 27 patients with HTN, without DM. All patients received combined hypertensive treatment, including inhibitors of RAAS. Frequency of hypoglycemia, nocturnal decrease in blood pressure (BP) and time index(TI) of circadian blood pressure monitoring were evaluated. Results: HbA1c in first group patients decreased by only 0.8%(p > 0.05), in the second group by 1.8%.(p < 0.05) Over three months, hypoglycemic states in the first group occurred in 100% of patients (16.38 ± 0.81 episodes per month), in the second group in 24.2% of patients (2.71 ± 0.35 episodes per month). Daily mean values of BP were higher in first group patients and difference between average day and night BP was absent (163.19 ± 5.53 mm Hg and 160.62 ± 5.70 mm Hg respectively(p > 0.1), i.e. elevated BP at night remained, despite administered treatment. In the second group, there was notable decrease of SBP and DBP during the day and at night (p < 0.001). Analysis of TI showed that in the first group BP was two or more times above the “safe” level as compared to second and control groups. Highest indicators of SBP and DBP load were also in the first group. Elevated BP load at night was present in all three groups but most significant in the first. First group patients registered a high level of pathological features of SBP: “non-dippers” 42.9% (in second group – 24.2%) and “night-peakers” 57.1% (in second group – 6.1%). In the first group, incidence of “dippers” was absent (in second group – 44.4%). Conclusions: Insulin analogues allow more effective decrease of HbA1c with lower risk of hypoglycemic states. Patients with frequent hypoglycemia maintain high BP variability and high percentage of pathological BP features “night-peakers and “non-dippers” despite treatment.

Associations of the –344T&gt;C polymorphism of CYP11B2 gene with 24-hour blood pressure profiles in middle-aged women with essential hypertension

Background In this cross-sectional study, we assessed the impact of –344T>C polymorphism of the CYP11B2 gene which encodes aldosterone synthase on 24-hour blood pressure patterns. Material and methods The study was performed in 137 females with essential hypertension aged 42−60 years. We measured plasma aldosterone level and renin activity (PRA), fasting glucose, lipid profiles and 24-hour urinary sodium and potassium excretion. Based on 24-hour blood pressure monitoring we identified cases with dipping and non-dipping patterns of blood pressure. Results Mean PRA and aldosterone levels and aldosterone-to-renin ratio (ARR) were within normal range. Non-dipping hypertension was found in 54.3% of patients. Genotype frequencies of TT, CC and CT were 27%, 27% and 46%, respectively. Carriers of the C allele had significantly lower nocturnal blood pressure reduction (P = 0.004) and higher nocturnal systolic (P = 0.02) and diastolic blood pressure (P = 0.044), frequency of non-dipping profile (P = 0.001), and 24-hour urinary potassium excretion (P = 0.047). Urinary sodium excretion was positively correlated with a decrease in nocturnal blood pressure (R = 0.202; P = 0.037). In a multiple regression analysis, ARR and presence of the C allele adjusted for confounding variables were inversely associated with the nocturnal blood pressure decline (b = −0.348; P = 0.022 and b = −0.222; P = 0.018, respectively). Conclusions In conclusion, in middle-aged females with essential hypertension carrying the C allele we found higher nocturnal blood pressure, lower nocturnal blood pressure reduction, and higher prevalence of non-dipping hypertension than in TT carriers.