Nocturnal Blood Pressure Drop Research Articles

Cardio-Ankle Vascular Index and left ventricular mass as markers of nocturnal blood pressure fall in the general population.

Findings regarding the association between Cardio-Ankle Vascular Index (CAVI) and the extent of nocturnal blood pressure (BP) fall in the general population are scanty. We sought to investigate this issue in the participants enrolled in the Pressioni Monitorate E Loro Associazioni (PAMELA) study. The study included 491 participants who attended the second and third surveys of the PAMELA study performed after 10 and 25years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure BP monitoring (ABPM), blood examinations, echocardiography, and CAVI measurements. In the whole study, both CAVI and left ventricular mass index (LVMI) were inversely correlated with nocturnal SBP fall, expressed as day-night percent change (r = - 0.152, p = 0.0007, and r = - 0.213, p < 0.0001, respectively). However, after adjustment for sex and age, the correlation remained significant only for LVMI (r = - 0.124, p = 0.006). Non-dipper participants exhibited significantly higher sex-age adjusted LVMI (91 ± 22 vs 82 ± 18g/m2 (p < 0.0001)), but not of CAVI (9.07 ± 2.0 and 9.57 ± 2.2m/s, p = ns). Similar results were found when classifying participants into quartiles of nocturnal SBP drop. Finally, both sex-age adjusted CAVI and LVMI were positively correlated with mean nocturnal SBP (r = 0.181, p < 0.001, and r = 0.240, p < 0.0001). Although arterial stiffness assessed by CAVI, unlike LVMI, is unrelated with the degree of nocturnal BP drop, this marker is useful in identifying nocturnal hypertension and optimizing cardiovascular risk stratification in the community.

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.

EFFECT OF RENAL DENERVATION ON 24H BLOOD PRESSURE PATTERN

Objective: Endovascular renal denervation (DRN) is a therapeutic approach for resistant arterial hypertension (RH). The aim of this study was to assess the effects of RDN on 24h blood pressure. Design and method: A retrospective evaluation of ABPM data at baseline and after 6 months from RDN in patients undergoing DRN between 01/01/2011 and 31/12/2021 in the Arterial Hypertension Center of Turin. Mean 24h, Daytime, Nighttime BP and HR values and short term 24h, daytime and nigthtime BP and HR varability parameters (standard deviation, dipping and coefficient of variation) were calculated. Results: The series included 14 subjects, of which 8 (57%) were female and with an average age 54±10 years. The number of antihypertensive drugs before renal denervation was 5.7±1.0. At baseline office BP was 188/113±22±18 mmHg and ABPM 24h BP was 150/92±21±16 mmHg. Patients were considered as responders if a reduction of least 10 mmHg in systolic blood pressure (PAS) at 24h Blood Pressure Monitoring at six months from RDN was obtained. From a safety point of view, there were no short-term or long-term complications. The responders at six months were 66%. Non-responders showed an increased blood pressure variability compared to responders at baseline and only one was dipper. The responders had a statistically significant redution of SD24h after DRN, an increased average nocturnal blood pressure drop and a lower pressure variability. While in non-responders no redution in SDnight, SDday and coefficient of variation was found, by contrast all of them become dippers because mean daytime SBP increase. Conclusions: In conclusion, pressure variability (SD24h and coefficient of variation) is globally reduced in the denerved patients, this trend is particularly present in responders. The non-responders have an increased BP variability at baseline without decreasing after DRN. These results suggest that, when effective, DRN can reduce both BP levels and BP variability, thus may have an important effect in reducing cardiovascular risk.

Cognitive Decline Associated with Longitudinal Changes in 24‐h Ambulatory Blood Pressure Variability

AbstractBackgroundCognitive decline has been associated with variability in blood pressure (BP). However, whether the increment of the BP variability during follow‐up precedes cognitive decline remains undocumented. We aimed this study to investigate cognitive decline in relation to longitudinal changes in 24‐h reading‐to‐reading BP variability.MethodsWe conducted an observational longitudinal study that included 717 dementia‐free participants from the Maracaibo Aging Study who underwent follow‐up assessment in both 24‐h ambulatory BP monitoring and cognitive tests between 1998 and 2015. Cognitive domains consisted of selective reminding tests (total, long‐term, short‐term, and recognition memory) and the Mini‐Mental State Examination (MMSE). Cognitive decline was a longitudinal decrease in cognitive scores. Participants underwent 24‐h ambulatory BP monitoring between 2‐4 times – with at least one‐year interval. Systolic and diastolic BP variability was studied during 24‐h and divided into daytime (from 06h00 to 23h00), and nighttime (23h00 to 06h00) periods. To account for BP level, we used variability independent of the mean (VIM) to compute systolic and diastolic BP variability. Other measures of BP variability included the nocturnal BP drop in comparison to the daytime BP level, which was estimated as the night‐to‐day ratio. Statistics included multivariate linear regression mixed models.ResultsOverall, the mean age was 65.6±7.36 years old and 66.5% (n = 447) of the participants were women. In mixed models, a decline in all memory domains was associated with greater variability in the 24‐h, daytime, and nighttime systolic BP during follow‐up, with an estimated decline in cognitive scores ranging from ‐0.2 to ‐0.04 points per unit increase in VIM systolic BP during follow‐up (P values ranged from 0.022 to 0.003). Decline in total, short‐term, and MMSE memory domains was associated with greater 24‐h and daytime diastolic BP variability (P≤0.015). A lower night‐to‐day dipping ratio during follow‐up increased the risk of cognitive decline, with a ‐5.8 to ‐1.6 decline in long‐term memory and MMSE scores; respectively (P≤0.037).ConclusionsCognitive decline associates with greater reading‐to‐reading 24‐h BP variability and lower falls in nocturnal BP over time. These findings might be indicative of deteriorated regulatory mechanisms to maintain steady BP levels as individuals age.

Association between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test

It is known that, a not physiological blood pressure (BP) circadian pattern has been associated with increased risk of organ damage and cardiovascular (CV) event. The aim of this study was to assess the association between circadian BP pattern and glucometabolic phenotypes occurring after oral glucose tolerance test (OGTT). We recruited 810 hypertensive Caucasian patients. All participants underwent to OGTT, laboratory test and 24-h ambulatory BP monitoring (ABPM). The analysis of collected data allowed classifying patients based on nocturnal BP profiles into four categories: dippers, non-dippers, extreme dippers, and reverse dippers. Considering the dipping pattern, the proportion of non-dippers in normal glucose tolerance patients with 1-h glucose ≥ 155 mg/dL (NGT ≥ 155) (36.4%) was higher than NGT < 155 (29.6%) and impaired glucose tolerance (IGT) (34.8%), but lower than type 2 diabetes group (T2DM) (52.6%) (p = 0.001). The proportion of dippers was lower in NGT ≥ 155 (47%) and T2DM (34.6%), when compared with NGT < 155 (53.8%) and IGT (51.2%) (p = 0.017). From logistic regression analysis, 1-h glucose ≥ 155 increased the risk of a pathological nocturnal drop in BP by 74%, (OR = 1.740, 95% CI 1.254–2.415, p < 0.0001). In addition, the improvement in 1 unit of Matsuda was responsible for a 3.5% risk decrease (OR = 0.965, 95% CI 0.958–0.971, p < 0.0001), while e-GFR determined a 0.9% risk reduction of nocturnal BP drop (OR = 0.991, 95% CI 0.984–0.999, p = 0.020). Our data demonstrated the existence, in newly diagnosed hypertensive patients, of an association between circadian BP profile and altered glycemic response during OGTT, in particular NGT ≥ 155 subjects are associated with a non-dipper BP pattern, this is clinically relevant because may explain, at least in part, the increased CV risk in this setting of patients.

ASSOCIATION BETWEEN BMI AND AMBULATORY BLOOD PRESSURE CHARACTERISTICS: EVIDENCE FROM POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT

Objective: The aim of our study was to investigate the association between BMI and Chinese hypertensive patients’ ambulatory blood pressure characteristics. Design and method: According to the inclusion criteria and exclusion criteria, recruiting participants for analysis. Overweight was defined as BMI = &gt; 18.5 kg/m2, and obesity as BMI = &gt; 25 kg/m2. ABPM characteristics were defined according to European guidelines. Hypertension was defined as elevated mean ambulatory BP (&gt;135/85 mmHg in day-time, &gt;120/70 mmHg in the night-time, &gt;130/80 mmHg over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers, and extreme dippers. The effects of BMI on ambulatory blood pressure characteristics were analyzed using between-group analysis of variance and logistic regression analysis. Results: In our cohort, 35367 hypertensive patients who were eligible for this study were analyzed finally, including 19380 men (54.8%) and 15987 women (45.2%) aged from 19 to 99 (mean age 58.86 years). The mean 24hBP of the study subjects was 126.41±16.00/78.79±11.62 mmHg. The different BMI groups showed that ambulatory BP increased with BMI, and the obese group had the highest increase in BP, HR, and systolic BP (P &lt; 0.05). Blood pressure variability and systolic load tended to increase with BMI, while the nocturnal blood pressure drop rate tended to decrease. When analyzing the type of hypertension among the participants, the prevalence of MBPS and morning hypertension increased significantly with the elevated BMI (P &lt; 0.05), and the highest prevalence of MBPS was found in the obese group. Logistic regression analysis revealed that the increased risks of MBPS and morning hypertension were the highest in the obese group, corresponding to a 2.1-fold (P &lt; 0.05) and 1.6-fold (P &lt; 0.05) increase in risk, respectively, with no change in trend after adjustment. Conclusions: BMI may affect the characteristics of hypertensive patients’ ambulatory blood pressure. The blood pressure variability and 24h SBP tended to increase with BMI, and the incidence of MBPS was highest in the obese group.

The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder

BackgroundAnxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure.Objectives: The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals. MethodsThe study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method. ResultsMean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control). ConclusionsThe patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.

CIRCADIAN BLOOD PRESSURE PROFILE IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION

Objective: Disturbed circadian blood pressure (BP) profile is a risk factor for cardiovascular complications in adults. The study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). Design and method: The study included 112 children (79 boys, 33 girls, 14.7 ± 2.7 years) with untreated PH. Circadian BP profile was assessed by 24-hour ABPM. Disturbed circadian BP profile (non-dipping) was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) &lt; 10%. A nocturnal drop in SBP or DBP &gt; 20% was defined as extreme dipping. Patients were evaluated for central BP, HMOD (left ventricular mass index - LVMI, aortic pulse wave velocity, augmentation index (AIx75HR), intima-media thickness, albuminuria), and clinical and biochemical parameters, including sodium-potassium balance. Results: In the study group, the mean nocturnal drop in SBP was 10.9 ± 5.9 [%] and in DBP - 16.2 ± 8.5 [%]. Non-dipping was found in 50 (44.6%) children and extreme-dipping in 29 (25.9%) patients. The nocturnal drop in SBP correlated negatively with Z-scores of body weight (r = -0.191, p = 0.043) and BMI (r = -0.242, p = 0.010) and with LVMI [g/m2.7] (r = -0.395, p = 0.006). The nocturnal drop in SBP and DBP correlated positively with urinary potassium excretion [mmol/kg/24 h] (r = 0.656, p = 0.001 and r = 0.540, p = 0.011, respectively). Patients with disturbed circadian blood pressure profile were characterized by higher LVMI (44.5 ± 12.5 vs. 36.8 ± 8.8 [g/m2.7]) and albuminuria (median: 10.8, IQR: 5.3–53.3 vs. median: 8.1, IQR: 5.5–16.4 [mg/24 h], p = 0.043) and lower urinary potassium excretion (0.6 ± 0.2 vs. 1.1 ± 0.3 [mmol/kg/24 h]). Extreme-dipping patients had a higher AIx75HR than the other patients (median: + 3.3, IQR: -6.3- + 17.7 vs. -4.6, IQR: -17.3- + 4.0 [%], p = 0.048). Conclusions: 1. Disturbed circadian BP profile is common in children with PH and should not be considered a marker of secondary hypertension. 2. Disturbed circadian BP profile may be associated with higher body weight and lower dietary potassium intake. 3. Pediatric patients with PH and disturbed BP profile are at risk for HMOD: left ventricular hypertrophy and microalbuminuria. 4. Extreme-dipping may be associated with increased arterial stiffness in children with PH.

Study on the related factors affecting the circadian rhythm of blood pressure in patients with essential hypertension

ABSTRACT This study explored the related factors affecting the circadian rhythm of blood pressure in patients with essential hypertension. According to blood pressure rhythm, 1007 patients with essential hypertension were divided into dipper (n = 332) and non-dipper group (n = 675). Age, gender, height and other basic information were collected, BMI was calculated, and FPG, TG, TC and other indicators were recorded. Meanwhile, carotid ultrasound, office BP, central hemodynamic parameters, and other indicators were recorded. Logistic regression was used. In comparison, dSBP, dDBP, nSBP, nDBP, nocturnal systolic blood pressure and nocturnal diastolic blood pressure drop rate, 24 hSSD, 24 hDSD and dSSD were statistically significant (P < 0.05). The results showed no distinct differences in CSP, CDP, CPP, AP, Aix and AIx75 in CAP between two groups (P > 0.05). Log regression analysis showed that for every increase in nocturnal SBP, dipper hypertension was more likely to occur than non-dipper hypertension. Circadian rhythm of blood pressure of hypertension in patients with essential hypertension is mainly the influence of circadian blood pressure and nocturnal blood pressure drop rate, especially for the nocturnal systolic blood pressure, so effective control of blood pressure at night could make the circadian rhythm of blood pressure tend to be in dipper type distribution.

IN MILD HYPERTENSIVE PATIENTS 24-HOUR AVERAGE HEART RATE IS ASSOCIATED WITH EARLY CARDIAC DAMAGE AND ENDOTHELIAL DYSFUNCTION

Objective: To investigate the correlation of 24-hour average heart rate (HR) in untreated and recently diagnosed mild hypertensives, and evaluate their association with subclinical initial signs of cardiac target organ damage (TOD), and endothelial dysfunction. Design and method: A total of 400 outpatients with initial diagnosis of mild hypertension were recruited between December 2017 and November 2019. Ambulatory electrocardiogram and blood pressure (BP) were monitored in all patients. According to the 24-hour average HR, patients were divided into fast HR group (24-hour average HR &gt; 75 beats/minute, n = 220) and non-fast HR group (24-hour average HR less or equal to 75 beats/minute, n = 180) We evaluate endothelial dysfunction by flow mediated vasodilatation (FMD) at the level of brachial artery. We use echocardiography to determine the presence of initial signs of (TOD), (presence of signs of left ventricular hypertrophy left ventricular mass indexed for height (LVMi) &gt; 48 g/m2 for men and &gt; 44 g/m2 for women and/or increased left atrial volume 4-chamber indexed for body surface area (LAVi) &gt; 34 ml/m2). Results: Endothelial dysfunction, LVMi and LAVi, 24-hour average HR, night and day average HR, diastolic BP, and daytime systolic BP were higher, while nocturnal BP drop rate was lower in patients with fast HR group than those in non-fast HR group (all P &lt; 0.04). Twenty-four-hour HR, the degree of endothelial dysfunction and TOD increased significantly with increases of office BP (P &lt; 0.04). The 24-hour average HR and resting HR were correlated positively with the presence of TOD (r = 0.159, 0.262, respectively, both P &lt; 0.01), and degree of endothelial dysfunction (r = 0.155, 0.260, respectively, both P &lt; 0.01). Multivariate linear regression analysis showed that the level of BP (B = 17.420, 16.540), nocturnal BP drop rate (B = 1.652, 1,586), and 24-hour average HR (B = 0.558, 0.5442) were correlated with the presence of TOD and FMD cuantified endothelial dysfunction. Conclusions: In patients with initial diagnosis of mild hypertension, 24-hour average heart rate is associated with the early cardiac damage and endothelial dysfunction, confirming the participation of increased heart rate in initial cardiac and vascular changes in human hypertension.

EFFECTS OF GLYCOSYLATED HEMOGLOBIN LEVEL ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS

Objective: To investigate the effect of glycosylated hemoglobin (HbA1c) levels on blood pressure variability in hypertensive patients. Design and method: From September 2018 to April 2019, in the Xiangya Hospital of Central South University, 429 case of hypertensive patients with complete basic information, medical records, HbA1c measures and other biochemical indicators, as well as the 24-hour ambulatory blood pressure result were enroll in and divided into two groups (119 in the high HbA1c group with HbA1c more than 6.1 mg/dl and 310 in the normal HbA1c group with HbA1c less than 6.1 mg/dl). The blood variability, night drop rate, and fluctuations were compared between the two groups. Multivariate logistic regression analysis and Pearson correlation analysis were used to explore the relationship between HbA1c level and blood pressure variability. Results: In hypertensive patients, the level of systolic and diastolic pressure during 24-hour, daytime, nighttime and the proportion of non-dipping blood pressure in the high HbA1c group was higher than that in the normal HbA1c group (p &lt; 0.05); There was no significant difference between the two groups in blood pressure load, variability, and nocturnal blood pressure drop rate (p &gt; 0.05).Multivariate logistic regression analysis showed that nocturnal mean systolic blood pressure was a risk factor for increased HbA1c levels, with OR (95% CI) of 1.031 (1.017 to 1.045). Pearson correlation analysis implied that the level of HbA1c was positively correlated with the maximum, the minimum and the average value of 24-hour systolic pressure and mean systolic pressure of daytime and nighttime (r = 0.131, 0.129, 0.155, 0.151, 0.164; p &lt; 0.05). Further analysis of grade 3 hypertensive patients, the high HbA1c group of had the higher value of night systolic pressure load and non-dipping blood pressure ratio. Multivariate logistic regression analysis showed that the mean nocturnal systolic pressure was a risk factor for elevated HbA1c levels, with OR (95% CI) being 3.774 (1.086 to 13.117). Conclusions: HbA1c is closely related to hypertension (especially systolic blood pressure). In the grade 3 hypertensive patients, the elevated HbA1c might increase the value of the nocturnal systolic blood pressure load.

Correlation of 24-Hour Average Heart Rate With Early Renal Damage in Patients With Initial Diagnosis of Hypertension

Abstract Background To investigate the correlation of 24-hour average heart rate (HR) with early renal damage in patients with initial diagnosis of hypertension. Methods A total of 456 outpatients with initial diagnosis of hypertension were recruited between November 2015 and May 2017. Ambulatory electrocardiogram and blood pressure (BP) were monitored in all patients. According to the 24-hour average HR, patients were divided into fast HR group (24-hour average HR &amp;gt;75 beats/minute, n = 203) and nonfast HR group (24-hour average HR ≤75 beats/minute, n = 253). HR, renal function, and urinary microalbumin were analyzed. Results Albumin-to-creatinine ratio, eGFR, body mass index, total cholesterol, low-density lipoprotein cholesterol, 24-hour average HR, night and day average HR, diastolic BP, and daytime systolic BP were higher, while nocturnal BP drop rate was lower in patients with fast HR group than those in nonfast HR group (all P &amp;lt; 0.05). Twenty-four-hour HR and albumin-to-creatinine ratio increased significantly with increases of office BP (P &amp;lt; 0.05). albumin-to-creatinine ratio and eGFR in high-risk group and extremely high-risk group were significantly higher, while eGFR was lower than those in low- and middle-risk group (all P &amp;lt; 0.05). The 24-hour average HR and resting HR were positively correlated with the level of microalbuminuria (r = 0.169, 0.265, respectively, both P &amp;lt; 0.01). Multivariate linear regression analysis showed that the level of BP (B = 17.798), nocturnal BP drop rate (B = −1.766), and 24-hour average HR (B = 0.564) were correlated with microalbuminuria (all P &amp;lt; 0.01). Conclusions The 24-hour average HR is associated with the early renal damage in patients with initial diagnosis of hypertension.

Impact of different dipping patterns on left atrial function in hypertension.

We aimed to investigate left atrial phasic function in the recently diagnosed hypertensive patients and determine association between circadian blood pressure (BP) patterns and left atrial function. The present study involved 256 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive echocardiographic examination. All patients were divided into four groups according to the percentage of nocturnal BP drop (dippers, extreme dippers, nondippers and reverse dippers). There was no significant difference in daytime BPs between the observed groups, whereas night-time BPs significantly and gradually increased from extreme dippers and dippers, across nondippers, to reverse dippers. Total, passive and active left atrial emptying fractions that correspond with left atrial reservoir, conduit and contractile function were lower in nondippers and reverse dippers than in dippers and extreme dippers. Reservoir and contractile left atrial strains were lower in reverse dippers than in dippers and extreme dippers, whereas conduit left atrial strain was lower in reverse dippers in comparison with extreme dippers. Nondipping and reverse dipping BP patterns were, independently of age, sex, nocturnal BPs, left ventricular mass index, E/e', associated with reduced reservoir function. Nevertheless, only reverse dipping profile was independently of other circadian BP profiles, nocturnal BP, demographic and echocardiographic parameters related with reduced conduit and contractile functions. Nondipping and reverse dipping BP patterns were related with impaired left atrial phasic function. However, reverse pattern was the only circadian profile that was independently of other clinical parameters, including night-time BP, associated with decreased reservoir, conduit and contractile function.

The relationship between nocturnal blood pressure drop and body composition indices among hypertensive patients.

Among hypertensive subjects, the lack of physiological blood pressure drop as part of diurnal blood pressure variations is termed as non-dipper blood pressure. Herein, we investigated the relationship between hypertension character and body composition indices. This study included a total of 104 patients (54 M, mean age: 47.6±12.1years). Patients' heights, weights, and waist and hip circumferences were measured, and body composition indices were calculated. All patients' office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of at least 10% compared with daytime blood pressure readings is called dipper blood pressure, while a drop of less than 10% is termed as non-dipper blood pressure. Based on ambulatory blood pressure readings, the patients were grouped into Group 1 (dipper pattern; 51 pts, 34 M, mean age 45.6±12.3) and Group 2 (non-dipper pattern, 53 pts; 20 M, mean age 49.6±11.6). The proportion of females and smokers were significantly lower in Group 1 than Group 2. BRI, BAI, waist-to-height ratio, and waist circumference were significantly higher in Group 2 than Group 1. There were significant positive correlations between body roundness index (BRI), body adiposity index (BAI), waist-to-weight ratio, and WC and nocturnal mean systolic and diastolic blood pressure readings. Percent systolic nocturnal drop was significantly correlated with waist-to-height ratio, BAI, and BRI. Similarly, percent diastolic nocturnal drop and waist-to-height ratio, BAI, and BRI were correlated. In conclusion, the relatively new body composition indices, namely BRI and BAI, are more closely related to nocturnal blood pressure readings among non-dipper subjects.

P1556Cardiovascular risk in white-coat hypertension individuals stratified by their nocturnal blood pressure dipping status

Abstract Background/Introduction Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are inconsistent. On the other hand, white-coat hypertension (WCHT), defined as an elevated office BP despite a normal out-of-office BP, is characterized by a lower CV risk than that of sustained hypertension and rather comparable with that of true normotension. Purpose The present study assessed the possible relation between the nocturnal BP dipping status and the underlying CV risk in WCHT individuals. Methods Among all individuals examined in our outpatient anti-hypertensive units over the past 15 years, 2310 (42% men, 52.2±13.1 years of age) were diagnosed with WCHT (increased office BP: 156.4±10.0/99.6±6.2 mmHg and normal 24-hour ambulatory BP: 122.4±6.3/75.3±5.4 mmHg) and were enrolled in the study. A night-to-day BP ratio (from the 24-hour ambulatory BP monitoring) 0.8–0.9 defined Normal nocturnal BP Dipping, &lt;0.8 Extreme Dipping, 0.9–1 Mild Dipping and &gt;1 Absence of Dipping. The underlying 10-year CV risk of death in the studied population was calculated with the Hellenic version of the HeartScore (Hellenic Score), as proposed by the current 2018 European Society of Hypertension guidelines, based on age, gender, smoking status, systolic BP and total cholesterol levels. Results From 2310 individuals studied, 1208 (52.3%) were found with Normal Dipping, 386 (16.7%) with Extreme Dipping, 622 (26.9%) with Mild Dipping and 94 (4.1%) with Absence of Dipping. Hellenic Score was 3.21±4.67% in subjects with Normal Dipping, 3.49±4.97% in those with Extreme Dipping, 3.66±5.04% in those with Mild Dipping, 6.21±7.29%, in those with Absence of Dipping (p for trend&lt;0.05) and 3.50±4.99% in the whole cohort of the studied population. Conclusions Nocturnal BP dipping status is closely associated with the underlying CV risk of WCHT individuals. Extreme Dipping, Mild Dipping and especially Absence of Dipping increase CV risk thus necessitating closer follow-up of these individuals and possibly faster initiation of BP-lowering drug treatment.

NOCTURNAL BLOOD PRESSURE DIPPING STATUS AND CARDIOVASCULAR RISK IN WHITE-COAT HYPERTENSION INDIVIDUALS

Objective:Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are i

LOW AMBULATORY DIASTOLIC BLOOD PRESSURE IS ASSOCIATED WITH BRAIN ATROPHY IN STRONGLY TREATED HYPERTENSIVE PATIENTS

Objective: Despite optimal vascular risk factor control, older hypertensive and diabetic patients frequently develop cognitive decline and dementia. Cerebral small vessel disease (CSVD) contributes to cognitive decline, but the role of blood pressure (BP) control on brain atrophy remains controversial. We aimed to investigate whether systolic and diastolic BP control is associated with grey and white matter brain volume and whether brain volume reduction is associated with cognitive decline in hypertensive and diabetic patients. Design and method: Fifteen hypertensive patients (9 with diabetes mellitus), without previous stroke, underwent 24-hour ambulatory BP measurements and 1.5T cerebral magnetic resonance imaging. Cortical grey and white matter volumes were determined automatically using the Freesurfer® software. CSDV burden was assessed by calculating the age-related white matter changes (ARWMC) scale and the total small vessel disease (TSVD) score. The Mini- Mental State Examination (MMSE), Montreal Cognitive Assessmente (MoCA), digit span, Trail Making part B and Stroop tests were used to assess executive function performance. Gender, age, diabetic status, body mass index, pulse wave velocity and other significant comorbidities were used as potential confounders. Results: In this cohort of strongly treated (>3 drugs) hypertensive patients (age 66 ± 9.9 years, 56% male, 24 h systolic/diastolic BP = 140/84 ± 12/14 mmHg, nighttime BP = 130/78 ± 12/13 mmHg), lower 24 h diastolic BP was associated with greater cortical grey matter atrophy (24 hour: aR2 = 0.780, p = 0,001; daytime aR2 = 0.711, p = 0,002; nighttime: aR2 = 0.699, p = 0,004) and greater cortical white matter atrophy (daytime aR2 = 0.422, p = 0,047). Despite worse features vs general population, no correlation was found between subcortical grey matter volume, ARWMC or TSVD, scores brain volumes and systolic BP or nocturnal BP drop. Several cognitive measures significantly correlated with cortical grey and white matter volumes. Conclusions: We hypothesise that in strongly treated hypertensive older adults, low diastolic BP may exacerbate cerebral hypoperfusion and contribute to brain atrophy and cognitive decline, independent of CSDV burden. Larger samples are needed to confirm these results.

Nocturia and increase in nocturnal blood pressure: the Nagahama study.

Abnormalities in circadian blood pressure (BP) variation, particularly increase in nocturnal BP, have been reported to be risk factors for cardiovascular disease, although the factors associated with BP abnormalities are not fully understood. This study aimed to clarify possible associations of sleep characteristics, including sleep fragmentation, sleep disordered breathing, and nocturia, with sleep BP by simultaneous multiday measurements. A cross-sectional study evaluated 5959 community participants having home-measured data on nocturnal BP change (sleep BP - awaking BP), sleep characteristics, and sleep disordered breathing. Sleep characteristics including the fragmentation index were assessed using wrist-wearable actigraphy, whereas sleep disordered breathing was assessed by 3% oxygen desaturation index obtained using a finger-type monitor. The number of nocturnal urinations was recorded in a sleep diary. Mean nocturnal SBP change was -8.5 ± 7.9%. A 3% oxygen desaturation index was associated with the BP change independently of the basic covariates (β = 0.051, P = 0.001), although the association became insignificant (P = 0.196) after adjusting the fragmentation index (β = 0.105, P < 0.001). The association of the fragmentation index was also insignificant (P = 0.153) after adjusting measurement season (middle season: β = 0.163, P < 0.001; summer season: β = 0.249, P < 0.001). In contrast, the frequency of urination showed strong and independent association (β = 0.140, P < 0.001), with smaller nocturnal BP drop in participants with frequent urination. Subjective sleep estimates and frequent nocturnal urination may represent a potential risk for circadian BP abnormalities.

A3464 The clinical effect and contrast evaluation of office blood pressure,ambulatory blood pressure mornitoring on treatment of Yinxu-Yangkang type of primary hypertensives by TCM of Tianma Gouteng Yin

Objectives: To observe the clinical curative effect and contrast evaluation of office blood pressure,ambulatory blood pressure monitoring on treatment of Yinxu-Yangkang type of primary hypertensives by TCM of Tianma Gouteng Yin. Methods: Total of 106 cases of Yinxu-Yangkang type of primary hypertension patients diagnosed by CBP and ABPM were randomly selected to take Tianma gouten Yin with 150 ml (tid) for 4 weeks, Then, the clinical curative effect, changes in CBP and 24 hours ABP were compared. Results: The clinical symptoms of patients were improved significantly and side effects were less; The DBP reducing at night was not significant difference (p > 0.05);All of blood pressure variability, nocturnal blood pressure drop rate and heart rate were not significant difference before and after treatment (p > 0.05); ***All of 24-hour average blood pressure, daytime and nighttime (only SBP) mean blood pressure,daytime and nighttime (only SBP) blood pressure load values had significant difference (p < 0.01 or p < 0.05) before and after treatment (p < 0.01 or p < 0.05);The office blood pressure is higher than the mean ambulatory blood pressure after treatment. Conclusion: It had better improving efficacy of clinical symptoms and tolerability, and less side effects in treatment of hypertension patients byTianma gouten Yin; The reasons and possiblities of lower antihypertension effect for DBP in nighttime of Tianma gouten Yin on ambulatory blood pressure may be follows:The evidence of dose-effect relation of evidence-based medicine is still short of; blood drug concentration is not easy to keep constant in nighttime;or the bioavailability is differences obviously. To explore some new taking ways of traditional Chinese medicine in treatment of hypertension are necessary.

Antihypertensive therapy in chronic kidney disease: what targets and how to reach them

Antihypertensive therapy in chronic kidney disease: what targets and how to reach them Abstract. The primary treatment target for lowering cardiovascular risk in chronic renal failure (as well as in the general hypertensive population) is to lower sitting office blood pressure. Since the physiological nocturnal blood pressure drop ("dipping") is frequently absent or even reversed in chronic renal failure (occasionally causing nocturnal blood pressures to be higher than at daytime), 24 hour blood pressure monitoring needs to be liberally used. Systolic office blood pressures should be 130 to 139 mm Hg, diastolic 80 to 89 mm Hg, and 24 hour blood pressures 10 mm Hg lower. In kidney diseases with relevant proteinuria (> 0.5 - 1.0 g / 24 h) and in diabetics with microalbuminuria (> 30 mg / 24 h), proteinuria reduction is an important second treatment goal, because this slows progressive loss of renal function. If there still is relevant proteinuria or (in diabetics, microalbuminuria) after reaching "cardiovascular" blood pressure goals, further lowering of blood pressure below 130 mm Hg systolic should be attempted, if tolerated. Orthostasis, syncope and diastolic blood pressures < 70 mm Hg must by all means be avoided. In addition, there is no demonstrable benefit of lowering systolic blood pressure < 130 mm Hg if eGFR is < 20 ml / min / 1.73 m2. Since intake and excretion of sodium chloride play a central role in the pathogenesis of hypertension in renal failure, habitual salt overconsumers (taking more than approximately 9 g NaCl / 24 h) need to reduce their intake. For the same reason, diuretics are mandatory components of antihypertensive treatment in chronic renal failure, even if there are no signs of volume expansion at all. At eGFRs < 30 ml / min / 1.73 m2, thiazide type diuretics should replaced or supplemented by loop diuretics (e. g. torasemide). SGLT2 inhibitors are adjuvant diuretics in diabetics with an eGFR > 30 ml / min / 1.73 m2. ACE inhibitors or angiotensin 2 receptor antagonists are only mandatory if proteinuria exceeds 0.5 to 1.0 g / 24 h (or in diabetics with microalbuminuria), but not generally in chronic renal failure. At least two antihypertensive drugs are almost always required; at least one should be taken in the evening.