Nocturnal Systolic Blood Pressure Fall Research Articles

Impact of Daytime and Nighttime Blood Pressure and Nocturnal Blood Pressure Fall on Heart Failure Risk in Treated Hypertension.

To evaluate the impact of daytime, nighttime and nocturnal blood pressure (BP) fall on heart failure (HF). We analyzed data of five cohorts including 15,526 treated hypertensive patients, experiencing 625 HF events, by study-level meta-analysis. The pooled hazard ratios (HR) and 95% confidence intervals (CI) for 1-SD increase in BP parameters or per group were calculated. When individually analyzed after adjustment for covariates, clinic systolic BP (SBP) (HR 1.20, 95% CI 1.01-1.43), daytime SBP (HR 1.34, 95% CI 1.06-1.70), nighttime SBP (HR 1.43, 95% CI 1.20-1.71), nighttime diastolic BP (DBP) (HR 1.26, 95% CI 1.05-1.52), % of nocturnal SBP fall (HR 0.81, 95% CI 0.75-0.88) and nondipping (HR 1.64, 95% CI 1.54-1.98) were associated with HF. If daytime or nighttime BPs were further adjusted for clinic BP results remained similar. When clinic, daytime and nighttime BPs were mutually adjusted, nighttime SBP (HR 1.43, 95% CI 1.27-1.61) and nighttime DBP (HR 1.37, 95% CI 1.14-1.64) remained associated with outcome. Heterogeneity across cohorts was explained by BP, sex and follow-up duration. In sensitivity analyses, for daytime and nighttime BP, no study had relevant influential effect on overall estimates. Looking for publication bias and adjusting for missing studies by Duval and Tweedie's method, clinic SBP lost significance but daytime SBP, and nighttime SBP and DBP remained significantly associated with HF. daytime and nighttime BPs are stronger than clinic BP in predicting HF, nighttime BP is stronger than daytime BP and a reduced nocturnal BP fall is associated with outcome.

Effect of renal denervation on diastolic function in patients with resistant hypertension and type 2 diabetes mellitus

Aim: To assess the change in the left ventricular (LV) diastolic function (DF) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) during 6-month follow-up after renal denervation (RDN) according to echocardiography in conjunction with changes in hemodynamic parameters.Material and Methods. A single center prospective interventional study with renal denervation included 30 patients with RHTN and T2DM. All patients underwent measurement of office and 24-hour blood pressure (BP), echocardiography according to the standard method with an assessment of LV DF.Results. At 6 months after RDN, a significant antihypertensive effect was noted (p < 0.05), as well as an improvement in LV DF in the form of a decrease in E/e` by 1 c.u. was observed in 50% (15) patients. A significant decrease in the average E/e` was documented (–1.3 [95% CI –2.55; –0.08], р = 0.038). There were no changes in the indexed volumes of the left atrium (р = 0.940). The baseline values of E/e` had correlation with the level of mean pulse BP 24h (r = 0.51, р = 0.001) in the absence of significant relationships with other ABPM parameters. A decrease in systolic BP 24h by 3 mm Hg and an increase in nocturnal systolic BP fall by 1.6% were accompanied by a decrease in the average E/e` by 1 unit. According to the ROC-analysis, baseline level of nocturnal systolic BP fall 5.5% or less associated with a decrease in the E/e` ratio by more than 1 unit.Conclusion. Renal denervation in patients with RHTN and T2DM is accompanied by a favorable effect on LV diastolic function during 6-month follow-up, closely related to the hemodynamic effects of the procedure such as a decrease in systolic and pulse BP 24h, as well as improvement in the circadian rhythm of BP.

Diurnal rhythm of blood pressure in patients with polycythemia vera.

Polycythemia vera increases the risk of hypertension, but there is limited information about the effect on daily blood pressure fluctuations. This study aimed to demonstrate how diurnal blood pressure rhythm is affected in polycythemia vera patients. Fifty (50) patients (33 men; mean age 48 ± 15 years) with a diagnosis of polycythemia vera and 51 age and sex-matched healthy subjects for the control group were prospectively evaluated. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were evaluated by ambulatory blood pressure monitoring (ABPM) as average 24-hour, daytime and nighttime measures. Average 24-hour SBP and DBP, daytime SBP and DBP were similar in both groups. However, nighttime SBP and DBP were significantly higher in the polycythemia vera group compared with the control group (125.3 ± 17.2 and 73.7 ± 12.2 vs. 118.9 ± 12.2 and 69.5 ± 8.5; P = 0.034 and P = 0.044). Both nocturnal SBP fall and nocturnal DBP fall were blunted in the polycythemia vera group compared with the control group (-6.9 ± 8.9 and -11.3 ± 12.2 vs. -11.6 ± 7.7 and -16.3 ± 12.0, respectively). Both hemoglobin and hematocrit levels were positively correlated with nocturnal SBP fall (r = 0.306, P = 0.002 and r = 0.355, P < 0.001; respectively) in all patients. We found that the polycythemia vera group had significantly decreased nocturnal dipping compared with healthy controls. The SBP fall was also positively correlated with hemoglobin and hematocrit levels.

Is there an association between non-dipping blood pressure and measures of glucose variability in type 1 diabetes?

AimTo assess the relationship between glucose variability (GV) and non-dipping of blood pressure (BP) as a marker of cardiovascular autonomic neuropathy (CAN) among patients with type 1 diabetes (T1D). MethodsForty-one subjects with T1D (age 34 ± 13 years, duration 13 ± 6 years, HbA1c 8 ± 1.2%) without cardiovascular disease, dyslipidemia, or hypertension at baseline were enrolled in a 3-year observational cohort study. Subjects were phenotyped for CAN with heart rate variability, cardiovascular autonomic reflex tests, and 24-h BP profiles at baseline and during follow-up. Non-dipping was defined as nocturnal systolic and diastolic BP fall of ≤10%. Reverse dipping BP was defined as a <0% change in the day to night for systolic and diastolic BP. Indices of GV were derived from 5-day continuous glucose monitoring obtained at 3-month intervals, and serum inflammatory biomarkers in all subjects. ResultsAt baseline 10% of the T1D subjects were non-dippers. The dippers and non-dippers were similar in age, diabetes duration, glucose control, traditional cardiovascular risk factors, GV and inflammatory markers. No significant correlations were found at baseline between non-dipping nocturnal blood pressure and measures of GV. At 3 years there were no differences in risk factor profile of subjects who were non-dippers over time (progressors) and those who were dippers (non-progressors). ConclusionIn a cohort of contemporary patients with T1D following the current standard of care in diabetes, the prevalence of non-dipping is relatively low. There were no clear phenotypes that explained the difference in the risk for non-dipping, including GV. Ambulatory blood pressure monitoring could be used as a tool for improved CVD risk stratification and development of therapeutic interventions in these patients.

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

ObjectiveTo assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. MethodsA total of 26170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, <0%). ResultsThe population were 52% female, aged 58±15 years, mean body mass index (BMI) 27±5 kg/m2. Using ABPM criteria of normalcy, 22.8% were normotensives (NT), 19.1% were untreated hypertensives, 29.7% were controlled hypertensives and 28.4% were treated but uncontrolled hypertensives. Among NT, 60.7% were white-coat hypertensive. In controlled hypertensives 62.4% had OBP ≥140/90 mmHg. In treated but uncontrolled hypertensives 8.2% had masked uncontrolled hypertension. ABPM values were lower than OBP in all cases. In all subgroups the most common pattern was D (42-50%), followed by ND (35-41%), ED (7-11%) and RD (4-11%). Age and BMI were determinants of attenuation of nocturnal BP fall and ND+RD. The proportion of ND+RD was higher in patients with BMI >30 kg/m2 vs. others (46.5 vs. 42.9%, p<0.01) and in those aged ≥65 vs. <65 years (54.9. vs. 33.1%, p<0.00). Nocturnal BP fall was greater in NT than in hypertensives (11.3±6.7 vs. 9.9±7.9%, p<0.000). ConclusionsThere was a marked discrepancy between office and ABPM values. The rates of control on ABPM were more than double those on OBP. Non-dipping occurred in >43%, including in NT. Age and BMI predicted non-dipping.

Seasonal variation in nocturnal home blood pressure fall: the Nagahama study.

Abnormalities in circadian blood pressure (BP) variation have been suggested to be associated with cardiovascular diseases and mortality. Factors affecting this variability need to be clarified to precisely evaluate the risk of circadian BP abnormalities. Given the seasonal differences in casual BP, it was hypothesized that nocturnal BP may also differ by season. Here, we aimed to clarify the seasonality of circadian BP variation, as well as the factors associated with this seasonality, in a large-scale general population (n = 4780). This is a cross-sectional study based on multiday BP values measured in the evening, during sleep, and in the morning. Measurements were taken at home using an automatic cuff-oscillometric device. The sleeping period was objectively defined by actigraphy. The nocturnal systolic BP fall was significantly less in individuals whose BP was measured during the summer season (summer, -5.8 ± 7.8%; middle (spring or autumn), -8.2 ± 7.5%; winter, -11.0 ± 7.7%; p < 0.001), resulting in higher frequencies of riser (summer, 19.9; middle, 12.8; winter, 7.8%) and non-dipper (summer, 51.4; middle, 46.3; winter, 37.0%) patterns in the summer season (p < 0.001). The results of linear regression analysis identified the middle (β = 0.154, p < 0.001) and summer season (β = 0.261, p < 0.001) as strong positive determinants for decreasing the nocturnal SBP fall. No seasonality was observed in day-to-day variability of the dipping pattern (Kendall's coefficient: winter, 0.527; middle, 0.539; summer, 0.515). The nocturnal BP fall was largely different by season, with a higher frequency of riser and non-dipper patterns in the summer. The seasonality might not be due to the seasonal difference in day-to-day variability of nocturnal BP changes.

Abstract 075: Seasonal Variation and Day-by-day Variability in Nocturnal Blood Pressure Fall: The Nagahama Study

Backgrounds: Abnormalities in circadian blood pressure (BP) variation have been suggested to be associated with cardiovascular diseases and mortality. Factors affecting the variability need to be clarified to precisely evaluate the risk of circadian BP abnormalities. Given the seasonal differences in casual BP, it was hypothesized that nocturnal BP may also differ by season. Here we aimed to clarify seasonal and day-by-day variability of circadian BP variation in a large-scale general population. Methods: We analyzed a dataset describing in the Nagahama study. Study participants were 4,792 community residents. Evening, sleep, and morning BP values were measured for 5 days at home using an automatic cuff-oscillometric device (HEM-7080IC). Participants were required to sleep with putting a cuff on the upper arm. The BP monitor was programmed to automatically measure BP at 0, 2, and 4 o’clock, and all readings were recorded in a built-in memory of the device. Sleeping period was objectively defined by actigraphy. Results: Overall frequency of extreme-dipper, dipper, non-dipper, and riser were 6.5, 34.9, 45.1, and 13.5%, respectively. Nocturnal systolic BP fall was significantly smaller in individuals whose BP was measured during the summer season (summer, –5.8 ± 7.8%; middle, –8.2 ± 7.5%; winter, –11.1 ± 7.7%; p &lt;0.001), resulting in higher frequencies of riser (summer, 19.9; middle, 12.8; winter, 7.5%) and non-dipper (summer, 51.5; middle, 46.2; winter, 36.7%) in summer season ( p &lt;0.001). The mean ambient temperature showed significant association with nocturnal SBP dipping level (r = 0.259, p &lt;0.001). Results of linear regression analysis identified middle (beta = 0.156, p &lt;0.001) and summer season (beta = 0.263, p &lt;0.001) as strong positive determinants for decreasing nocturnal SBP fall, independently of other possible covariates. No marked seasonality was observed in day-by-day variability of the dipping pattern (Kendall’s coefficient: winter, 0.590; middle, 0.602; summer, 0.581). Conclusion: Nocturnal BP fall was largely different by season with higher frequency of riser and non-dipper in summer. The seasonality might not be due to the seasonal difference in day-by-day variability of nocturnal BP changes.

Plasma Homocysteine Levels Are Associated With Circadian Blood Pressure Variation in Chinese Hypertensive Adults.

Homocysteine-lowering intervention with folate was recently shown to be able to increase day-night difference of blood pressure (BP) in humans indicating a potential relationship between homocysteine and circadian BP variation. We thus sought to investigate the association between plasma total homocysteine level (tHcy) and circadian BP variation in hypertensive adults. We enrolled 244 eligible dipping and 249 nondipping BP status adults from 560 adults who were randomly sampled from 5,233 Chinese hypertensive adults who received ambulatory BP monitoring (ABPM). We further enrolled 390 adults with CC/CT genotypes of the methylenetetrahydrofolate reductase (MTHFR) and 79 TT genotype who received ABPM at the same time from 1858 hypertensive adults with MTHFR polymorphisms detection. Plasma tHcy in nondippers was significantly higher than dippers (P < 0.001). Simple linear analysis revealed that tHcy significantly correlated with nocturnal systolic BP fall (r = -0.145, P = 0.001) and diastolic BP fall (r = -0.141, P = 0.002). Multivariate logistic regression analysis further identified tHcy as an independent factor correlated with the presence of nondipping BP status in hypertensive adults (odds ratio: 1.873, 95% confidence interval: 1.171-2.996, P = 0.009). The percentage of dipping BP status was 19.49% or 8.86% and the percentage of nondipping BP status was 80.51% or 91.14% in CC/CT or TT genotypes, respectively. The above different between CC/CT and TT genotypes was significant (P = 0.024). These results indicated that high homocysteine levels associate with disturbed circadian BP variation in Chinese hypertensive adults.

Ambulatory blood pressure monitoring in heart failure and serum sodium levels

AimsTo determine whether there are differences in blood pressure profile on dynamic assessment by ambulatory blood pressure monitoring (ABPM) according to serum sodium levels in stable heart failure patients. MethodsData were collected from the Spanish National Registry on Ambulatory Blood Pressure Monitoring in Heart Failure (DICUMAP). Patients underwent ABPM by the oscillometric principle using a Spacelabs 90121 monitor. The sample was divided into three groups according to sodium levels and their clinical and laboratory data and echocardiographic findings were analyzed. Robust statistical methods were used to compare the groups in univariate and multivariate models. ResultsA total of 175 patients (44.57% male) were analyzed. We found a predominance of anomalous circadian blood pressure profiles in all three groups, with a significantly higher percentage of risers in the lowest serum sodium group (p=0.05). In addition, in this group there were significant differences in mean 24-hour systolic blood pressure (SBP) (24-h SBP, p=0.05) and in mean daytime SBP (dSBP, p=0.008), with significant differences in nocturnal fall in SBP (p=0.05) and in diastolic blood pressure (p=0.005). In multivariate analysis a significant relationship was found between sodium levels and 24-h SBP (OR 0.97, 95% CI 0.95-0.99, p=0.01) and dSBP (OR 0.96, 95% CI 0.94-0.99, p=0.004). ConclusionA relationship was found between lower sodium levels and lower systolic blood pressure, especially during waking hours, with a lower decline between daytime and night-time blood pressure.

Ambulatory blood pressure monitoring in heart failure and serum sodium levels

AimsTo determine whether there are differences in blood pressure profile on dynamic assessment by ambulatory blood pressure monitoring (ABPM) according to serum sodium levels in stable heart failure patients. MethodsData were collected from the Spanish National Registry on Ambulatory Blood Pressure Monitoring in Heart Failure (DICUMAP). Patients underwent ABPM by the oscillometric principle using a Spacelabs 90121 monitor. The sample was divided into three groups according to sodium levels and their clinical and laboratory data and echocardiographic findings were analyzed. Robust statistical methods were used to compare the groups in univariate and multivariate models. ResultsA total of 175 patients (44.57% male) were analyzed. We found a predominance of anomalous circadian blood pressure profiles in all three groups, with a significantly higher percentage of risers in the lowest serum sodium group (p=0.05). In addition, in this group there were significant differences in mean 24-hour systolic blood pressure (SBP) (24-h SBP, p=0.05) and in mean daytime SBP (dSBP, p=0.008), with significant differences in nocturnal fall in SBP (p=0.05) and in diastolic blood pressure (p=0.005). In multivariate analysis a significant relationship was found between sodium levels and 24-h SBP (OR 0.97, 95% CI 0.95-0.99, p=0.01) and dSBP (OR 0.96, 95% CI 0.94-0.99, p=0.004). ConclusionA relationship was found between lower sodium levels and lower systolic blood pressure, especially during waking hours, with a lower decline between daytime and night-time blood pressure.

Nocturnal Dipping of Blood Pressure in Renal Transplant Recipients

Background: There is a marked diurnal variation in blood pressure (BP). Compared with daytime values, BP in most subjects is considerably lower during the night and a ‘non-dipping BP profile’ is usually defined as a nocturnal SBP fall of less than 10%. Association between non-dipper pattern of circadian rhythm of BP and impaired renal capacity was observed in some studies. A circadian non-dipping pattern is often found in renal transplant recipients, and is related to poor allograft function. Materials and Method: In this analytic-cross sectional study, 24 hours ambulatory blood pressure monitoring (ABPM) was performed in 100 renal post-transplant patients, aged >18 years old, with the serum creatinine level <2 mg/dl after one month of transplant. According to the nocturnal reduction of systolic blood pressure (SBP), dipper (SBP ≥ 10%), non-dipper (0 < SBP < 10%) and reverse dipper (SBP nocturnal rise) pattern were defined. Result: Of 100 participants of this study, 56 patients (56%) were male, and 44 patients (44%) were female. Mean age of participants was 43.34 ± 2.442 years overall, 44.27 ± 2.974 years in males and 42.16 ± 4.074 years in females. Non-dipper pattern was found in 58 patients (58%), revers dipper pattern in 35 patients (35%) and dipper pattern was found only in 7 patients (7%). The nocturnal reduction of systolic blood pressure pattern in participants regarding the gender was not significant (p = 0.794). Mean age of patients with non-dipper pattern was significantly lesser than patients with revers dipper pattern (p = 0.009), but mean age of patients with dipper pattern was not significantly different from patients with non-dipper or revers dipper pattern (p = 0.368, p = 0.605). There was no significant correlation between dipper or non-dipper or revers dipper pattern with immunosuppressive drugs(cyclosporine, tacrolimus and non calcineurin inhibitors), duration of dialysis before transplant, and the time past transplant (p = 0.194, p = 0.252, and p = 0.392, respectively). Conclusion: The revers dipper pattern was seen more frequently in older patients than younger, and there was no significant correlation between dipper or non-dipper or revers dipper pattern with immunosuppressive drugs, duration of dialysis before transplant, and the time past transplant. Urology Research Center, Guilan University of Medical Sciences.

PP.15.13] DIPPING STATUS IS CHARACTERIZED BY AUGMENTED ADMINISTRATION OF BENZODIAZEPINES AND ELEVATED ARTERIAL STIFFNESS

Objective: Blunted reduction of blood pressure (BP) fall as well as psychological stress have both been related to adverse cardiovascular prognosis and potentially share the altered sympathetic tone as a common pathophysiological substrate. We hypothesised that dipping status might be correlated with benzodiazepine's administration (sympatholytic action) in the setting of essential hypertension (EH). Design and method: Our population consisted of 134 consecutive subjects with stage I-II untreated EH (aged 52 ± 9 years, 72 male, office BP = 151/97 mmHg). They were classified according to the nocturnal BP fall on 24-hour ambulatory BP monitoring, to non-dippers (those with <10% nocturnal systolic and diastolic BP fall, n = 36) and dippers (the remaining subjects, n = 98). All participants underwent arterial stiffness evaluation on the basis of carotid to femoral pulse wave velocity (c-f PWV) by means of a computerized method (Complior SP). Anthropometric data were recorded and venous blood samples were drawn for estimation of high sensitivity C-reactive protein (hs-CRP) and homocysteine levels. Self-reported data about benzodiazepine's administration were obtained via interview. Results: Non-dippers compared to dippers did not differ regarding age, gender, body mass index, office and 24-hour systolic and diastolic BP (p = NS for all cases). Non-dippers had significantly increased 24-hour pulse pressure (54 ± 8 vs 49 ± 9 mmHg, p < 0.05). Additionally, they exhibited higher c-f PWV values (8.5 vs 7.6 m/sec, p < 0.05), increased hs-CRP (2.8 ± 0.8 vs 2.1 ± 0.6 mg/L, p < 0.05) and homocysteine levels (14.6 ± 6.8 vs 11.9 ± 5.4 mmol/L, p < 0.05). Benzodiazepine's administration as anxiolytic therapy, was significantly more prevalent among non-dippers compared to dippers (78% vs 23%, p < 0.05). Conclusions: In conclusion, non-dippers compared to dippers hypertensives are characterized by increased benzodiazepine's administration, impaired arterial elasticity and more pronounced activation of proatherogenic mechanisms.

Associations of Sleep Quality and Awake Physical Activity with Fluctuations in Nocturnal Blood Pressure in Patients with Cardiovascular Risk Factors.

BackgroundSleep quality and awake physical activity are important behavioral factors involved in the occurrence of cardiovascular diseases, potentially through nocturnal blood pressure (BP) changes. However, the impacts of quantitatively measured sleep quality and awake physical activity on BP fluctuation, and their relationships with several candidate causal factors for nocturnal hypertension are not well elucidated.MethodsThis cross-sectional study included 303 patients registered in the HSCAA study. Measurements included quantitatively determined sleep quality parameters and awake physical activity obtained by actigraph, nocturnal systolic BP (SBP) fall [100 × (1- sleep SBP/awake SBP ratio)], apnea hypopnea index, urinary sodium and cortisol secretion, plasma aldosterone concentration and renin activity, insulin resistance index, parameters of heart rate variability (HRV), and plasma brain-derived neurotrophic factor (BDNF).ResultsSimple regression analysis showed that time awake after sleep onset (r = -0.150), a parameter of sleep quality, and awake physical activity (r = 0.164) were significantly correlated with nocturnal SBP fall. Among those, time awake after sleep onset (β = -0.179) and awake physical activity (β = 0.190) were significantly and independently associated with nocturnal SBP fall in multiple regression analysis. In a subgroup of patients without taking anti-hypertensive medications, both time awake after sleep onset (β = -0.336) and awake physical activity (β = 0.489) were more strongly and independently associated with nocturnal SBP falls.ConclusionSleep quality and awake physical activity were found to be significantly associated with nocturnal SBP fall, and that relationship was not necessarily confounded by candidate causal factors for nocturnal hypertension.

Avaliação das propriedades dinâmicas da pressão arterial em mulheres com antecedentes de pré‐eclâmpsia

BackgroundWe investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). MethodsIn a cross‐sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE 38±6 vs. NP 38±5 years, NS) and body mass index: (PE 25±4 vs. NP 26±4 kg/m2, NS) studied, respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility – pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) – in the central pressure wave and blood pressure (BP) on 24‐h ambulatory BP monitoring (ABPM). ResultsPE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central‐peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow‐up, the need for antihypertensive medication was seven times higher in PE than in NP. ConclusionWomen with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Assessment of central hemodynamic properties of the arterial wall in women with previous preeclampsia

BackgroundWe investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). MethodsIn a cross-sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE: 38±6 vs. NP: 38±5 years, NS) and body mass index: PE: 25±4 vs. NP: 26±4 g/m2, NS) studied respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility – pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) – in the central pressure wave and blood pressure (BP) on 24-h ambulatory BP monitoring (ABPM). ResultsPE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central-peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow-up, the need for antihypertensive medication was seven times higher in PE than in NP. ConclusionWomen with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Red Blood Cell Distribution Width in ‘Non-Dippers’ versus ‘Dippers’

Objectives: Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status. Methods: The present study involved 123 hypertensive patients and 65 age- and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 ± 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 ± 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the nighttime, these subjects were ‘dippers’, and all other subjects were ‘non-dippers’. Results: Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 ± 0.89 and 14.1 ± 1.33 vs. 13.0 ± 1.42%, p = 0.027 and p <0.001, respectively). Also RDW values in non-dippers were statistically higher compared to those in dippers (p = 0.008). Although there were negative correlations between RDW values and nocturnal systolic BP fall (p = 0.027, r = –0.199) and diastolic BP fall (p = 0.383, r = –0.079) in all hypertensive patients, these correlations did not reach a statistically significant level. Conclusion: Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls.

327 REVERSE DIPPING PATTERN WAS ASSOCIATED WITH INCREASED CARDIOVASCULAR MORTALITY

Background: Abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a predictor of cardiovascular risk. However, in a real world practice situation, the impact on cardiovascular mortality of abnormal dipping pattern has not been investigated enough to be considered as standard parameter. We investigated whether the abnormal dipping pattern is more related to increased cardiovascular mortality in a tertiary referral hospital setting. Design and methods: With inclusion/exclusion criteria, 481 patients were analyzed among total 720 subjects performed ABPM between 1995 and 1996 in Hanyang University Hospital, Seoul, Korea. Nocturnal blood pressure were classified as reverse dipper (n=129) with <0% fall; and 352 non-reverse dipper with ≥0% nocturnal systolic blood pressure fall. Follow up periods were 120 months. Results: Overall cardiovascular mortality incidences were 8.4% in non-reverse dippers and 20.3% in reverse dippers. And this remained significant in a Cox regression analysis after controlling for age, gender, body mass index, hypertension, diabetes mellitus, anti-hypertensive medication, history of cardiovascular disease, smoking and hypercholesterolemia. There was a tendency for reverse dippers were at greater risk than were non-reverse dippers (RR, 3.649, p=0.016). There was no difference in the event rate between dipper and non-dipper. Conclusion: Reverse dipping pattern maybe more frequent in real world clinical setting and it is strongly related to increased cardiovascular mortality.

To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure

Dipping and nondipping blood pressure (BP) patterns are associated with different levels of target organ damage and cardiovascular risk. The aim of our investigation was to determine the relationship between different BP patterns (dipping, nondipping, extreme dipping and reverse dipping type) and cardiac structure, and function in hypertensive patients. This cross-sectional study included 376 hypertensive patients. All subjects underwent 24-h ambulatory BP monitoring, and complete two-dimensional, pulsed and tissue Doppler echocardiography. Most of the parameters of the left ventricular (LV) diastolic function (E/A, e'/a', E/e') significantly and progressively deteriorated from the extreme dippers to the dippers and nondippers, and finally to the reverse dippers. In contrast, LV structural parameters (IVS, RWT, LV mass index) showed a statistically important difference only by comparing the dippers and the extreme dippers with the rest of the patients. Simultaneously, the right ventricular (RV) structural parameter (RVT, right ventricular thickness), and most RV diastolic parameters significantly and progressively worsened from the extreme dippers, over the dippers and the nondippers, to the reverse dippers. Daytime and night time systolic BP, nocturnal systolic BP fall, and the nondipping and the reverse dipping status were independently associated with LV and RV structure, as well as with diastolic function. LV and RV structure, and diastolic function were significantly more impaired with the nondippers and the reverse dippers compared with others.

Negative Influence of HIV Infection on Day-Night Blood Pressure Variability

An attenuation of the physiological day-night blood pressure (BP) reduction is an important predictor of cardiovascular (CV) events and death. We compared circadian BP profile in treatment-naive HIV-infected patients and in healthy control subjects. Fifty-two antiretroviral therapy-naive HIV-infected patients (85% men, age 39 ± 11 years, BP 125/78 ± 11/9 mm Hg) and 156 age- and BP-matched HIV-negative controls (85% men, age 39 ± 10 years, BP 125/78 ± 9/7 mm Hg) underwent 24-hour BP monitoring. Subjects with a nocturnal reduction of systolic BP <10% were defined as "nondippers." Nighttime BP was higher in HIV-infected subjects (113/69 ± 11/9 vs 109/67 ± 8/6 mm Hg, P = 0.008/0.005). Nocturnal systolic/diastolic BP reduction was 8.8/13.2% in HIV-positive patients and 11.7/17.2% in HIV negative (P = 0.002/0.001). The prevalence of "nondippers" was 35% and 15%, respectively (P = 0.003). In multivariate analysis, nocturnal systolic BP fall was negatively associated to HIV infection (β = -0.22, P = 0.001). HIV viral load, low CD4 cell count, and AIDS progression risk were all related with a flattened day-night BP profile (P < 0.01). HIV infection per se negatively affects circadian BP rhythm. These findings, obtained in subjects without major CV risk factors and antiretroviral naive, suggest that day-night BP changes may play a role in the HIV-related increase in CV risk.

Nocturnal blood pressure fall as predictor of diabetic nephropathy in hypertensive patients with type 2 diabetes.

BackgroundHypertensive patients with reduced blood pressure fall (BPF) at night are at higher risk of cardiovascular events (CVE).MethodsWe evaluated in hypertensive diabetic patients, if a reduced nocturnal BPF can precedes the development of diabetic nephropathy (DN). We followed 70 patients with normal urinary albumin excretion (UAE) for two years. We performed 24-hours ambulatory BP monitoring in baseline and at the end of the study.ResultsFourteen (20%) patients (GI) developed DN (N = 11) and/or CVE (n = 4). Compared to the remaining 56 patients (GII) in baseline, GI had similar diurnal systolic (SBP) and diastolic BP (DBP), but higher nocturnal SBP (138 ± 15 vs 129 ± 16 mmHg; p < 0.05) and DBP (83 ± 12 vs 75 ± 11 mmHg; p < 0,05). Basal nocturnal SBP correlated with occurrence of DN and CVE (R = 0.26; P < 0.05) and with UAE at the end of the study (r = 0.3; p < 0.05). Basal BPF (%) correlated with final UAE (r = -0.31; p < 0.05). In patients who developed DN, reductions occurred in nocturnal systolic BPF (12 ± 5 vs 3 ± 6%, p < 0,01) and diastolic BPF (15 ± 8 vs 4 ± 10%, p < 0,01) while no changes were observed in diurnal SBP (153 ± 17 vs 156 ± 16 mmHg, NS) and DBP (91 ± 9 vs 90 ± 7 mmHg, NS). Patients with final UAE < 20 μg/min, had no changes in nocturnal and diurnal BP.ConclusionsOur results suggests that elevations in nocturnal BP precedes DN and increases the risk to develop CVE in hypertensive patients with T2DM.