Nocturnal Systolic Blood Pressure Research Articles

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

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

Impact of a telerehabilitation programme combined with continuous positive airway pressure on symptoms and cardiometabolic risk factors in obstructive sleep apnea patients.

Obstructive sleep apnea syndrome is a common sleep-breathing disorder associated with adverse health outcomes including excessive daytime sleepiness, impaired quality of life and is well-established as a cardiovascular risk factor. Continuous positive airway pressure is the reference treatment, but its cardiovascular and metabolic benefits are still debated. Combined interventions aiming at improving patient's lifestyle behaviours are recommended in guidelines management of obstructive sleep apnea syndrome but adherence decreases over time and access to rehabilitation programmes is limited. Telerehabilitation is a promising approach to address these issues, but data are scarce on obstructive sleep apnea syndrome. The aim of this study is to assess the potential benefits of a telerehabilitation programme implemented at continuous positive airway pressure initiation, compared to continuous positive airway pressure alone and usual care, on symptoms and cardiometabolic risk factors of obstructive sleep apnea syndrome. This study is a 6-months multicentre randomized, parallel controlled trial during which 180 obese patients with severe obstructive sleep apnea syndrome will be included. We will use a sequential hierarchical criterion for major endpoints including sleepiness, quality of life, nocturnal systolic blood pressure and inflammation biological parameters. m-Rehab obstructive sleep apnea syndrome is the first multicentre randomized controlled trial to examine the effectiveness of a telerehabilitation lifestyle programme in obstructive sleep apnea syndrome. We hypothesize that a telerehabilitation lifestyle intervention associated with continuous positive airway pressure for 6 months will be more efficient than continuous positive airway pressure alone on symptoms, quality of life and cardiometabolic risk profile. Main secondary outcomes include continuous positive airway pressure adherence, usability and satisfaction with the telerehabilitation platform and medico-economic evaluation. Clinicaltrials.gov Identifier: NCT05049928. Registration data: 20 September 2021.

PS-C16-14: EFFECT OF THE COVID-19 PANDEMIC ON AMBULATORY BLOOD PRESSURE MEASUREMENT

Introduction: The world is currently facing the fourth wave of the COVID-19 pandemic. The aim of this study is to assess the effect of this pandemic on ambulatory blood pressure measurements (ABPM) and to investigate the effect of SARS-CoV2 infection on blood pressure (BP). Methods: We conducted a uni-centric retrospective study on the ERASME hospital ABPM register, from 2010 to 2021. The nycthemeral blood pressure (BP) profile of the pandemic period (January 2020 to October 2021) was compared with that of the previous 5 control periods from January 2010 to October 2019. We also determined the diurnal, nocturnal and 24-hour high blood pressure frequencies for each period. Furthermore, for the COVID-19 period, the BP profiles of COVID-19 positive and negative patients were compared. Finally, in COVID-19 positive patients, we compared ABPMs performed before COVID-19 infection with those performed post-infection. Results: After excluding incomplete and poor-quality ABPM, 16,977 ABPMs were selected. The COVID-19 period accounted for 10.58% of ABPMs compared with 15–20% for pré-COVID periods. We observed that diurnal (83.20 vs 81.20; p < 0.001), nocturnal (73.02 vs 71.09; p < 0.001) and 24-hour (79.51 vs 77.50; p < 0.001) diastolic BPs were higher in the COVID-19 period. In contrast, diurnal (131.64 vs 133.18; p < 0.001), nocturnal (121.07 vs 121.93; p = 0.034) and 24-hour (127.82 vs 128.97; p < 0.001) systolic BPs were lower during the pandemic. In logistic regression, diastolic diurnal (OR:1.58 [1.33–1.89]; p < 0.001), nocturnal (OR:1.18 [1.02 - 1.36]; p = 0.026) and 24-hour (OR:1.22 [1.01 - 1.49]; p = 0.044) hypertension were associated with the COVID-19 period, when adjusted for age, gender or history of hypertension. Also, diurnal (OR:0.63 [0.55–0.71]; p < 0.001) and nocturnal (OR:0.82 [0.72–0.93]; p = 0.002) systolic hypertension were less frequent in the COVID-19 period. When comparing BPs between COVID-19 positive and negative patients, there was no significant difference. When ABPMs were compared before and after infection in COVID-19 positive patients, diastolic diurnal (88.41 vs. 78.88; p = 0.001), nocturnal (77.91 vs. 70.55; p = 0.027) and 24-hour (84.57 vs. 75.99; p = 0.002) BPs were higher after COVID-19 infection. Conclusion: Our study shows that during the COVID-19 pandemic, diastolic BP was higher and systolic BP was lower compared to the pre-COVID-19 period. We also observed an increase in diastolic BP after COVID-19 infection.

Dipping Pattern and 1-year stroke functional outcome in ischemic stroke or transient ischemic attack

ABSTRACT Aims This study aimed to explore whether a relationship exists between dipping patterns and 1-year functional outcome in patients with acute ischemic stroke (IS) or transient ischemic attack (TIA). Methods Data from the Blood Pressure and Clinical Outcome in TIA or Ischemic Stroke Study (BOSS), a nationwide, hospital-based, longitudinal cohort study, was used for this study. Patients with acute IS or TIA were recruited within 7 days after onset and ambulatory blood pressure monitoring was performed during hospitalization. Patients were defined as dippers if nocturnal systolic blood pressure fell by ≥10%, non-dippers if 0–10%, and reverse dippers if < 0%. Poor functional outcome was defined as a modified Rankin Scale (mRS) score of 3–5. Logistic regression analysis was used to test the association between dipping patterns and 1-year functional outcome. Results Among the 1808 IS/TIA patients, 19.19% were dippers, 53.21% were non-dippers, and 27.60% were reverse dippers. Poor functional outcome occurred in 22.44% of reverse dippers, which was significantly higher than that of dippers (16.14%) and non-dippers (16.53%) (P = .014). A univariate analysis revealed that reverse dipping was a risk factor for poor functional outcome (Odds ratio 1.504, 95% confidence interval 1.055–2.145, P = .024). However, this significance disappeared after adjusting for confounders. Conclusions Reverse dipping was prevalent in patients with IS/TIA. The higher incidence of 1-year poor functional outcome in reverse dippers warrants further investigation.

Inter-individual Variability To Two Modes Of Resistance Training In The Blood Pressure Dipping Response In Males

The 24-h blood pressure (BP) in response to an acute bout of resistance training exercise (RTE) varies between individuals and has received little attention in the literature, especially in the changes in BP occurring during sleep (i.e., dipping). PURPOSE: To determine the inter-individual BP dipping variability of normotensive (NT) and hypertensive (HT) individuals completing two modalities of a single session of RTE. METHODS: Volunteers were 41 males (NT n = 21, age = 19.7 ± 2.3 yr., weight = 72.5 ± 17.3 kg, height = 171.0 ± 5.0 cm, HT n = 22, age = 21.7 ± 4.6 yr., weight = 78.1 ± 11.0 kg, height = 174.0 ± 5.0 cm) who underwent a non-exercise control (CTRL), RTE low-repetitions high-sets (LRHS), and RTE high-repetitions low-sets (HRLS) conditions. The 24-h ambulatory monitoring recorded diurnal and nocturnal systolic (SBP) and diastolic (DBP) BP. Factorial ANOVA compared SBP and DBP dipping responses in NT and HT individuals. Inter-individual responses were obtained by comparing diurnal and nocturnal BP differences. The technical error of measurement (TEM) and the smallest worthwhile change (SWC) were used to compute a BP threshold to identify responders and non-responders. RESULTS: No significant group by measurement interaction was found on SBP (p = 0.301) and DBP (p = 0.574). Diurnal SBP was lower in the NT than in the HT groups (M = 117.4 ± 6.4 vs. 132.0 ± 8.2 mmHg, p ≤ 0.0001, η2 = 0.51). Diurnal DBP was lower in the NT than in the HT groups (M = 70.5 ± 6.2 vs. 77.7 ± 7.7 mmHg, p = 0.0001, η2 = 0.22). Nocturnal SBP was lower in the NT than in the HT groups (M = 106.6 ± 7.2 vs. 119.5 ± 8.3 mmHg, p ≤ 0.0001, η2 = 0.42). Nocturnal DBP was lower in the NT than in the HT groups (M = 60.4 ± 5.7 vs. 66.1 ± 8.2 mmHg, p = 0.014, η2 = 0.14). The dipping responders for SBP in the CTRL condition were 71.4% for NT and 70.0% for HT, in the HRLS condition were 66.7% for NT and 60.0% for HT, and in the LRHS condition were 57.1% for NT and 60.0% for HT. The dipping responders for DBP in the CTRL condition were 57.1% for NT and 60.0% for HT, in the HRLS condition were 61.9% for NT and 70.0% for HT, and in the LRHS condition were 71.4% for NT and 65.0% for HT. CONCLUSION: The inter-individual SBP dipping responders were similar between RTE modalities; however, for DBP, there were more HT responders than NT individuals completing a single session of HRLS RTE.

Effects of Continuous Positive Airway Pressure Therapy on Nocturnal Blood Pressure Fluctuation Patterns in Patients with Obstructive Sleep Apnea.

This retrospective study was designed to evaluate the effects of continuous positive airway pressure (CPAP) therapy, a well-established treatment for obstructive sleep apnea (OSA), on nocturnal blood pressure fluctuations (NBPFs) during rapid eye movement (REM) and non-REM sleep, and to evaluate the NBPF patterns in patients with OSA. We included 34 patients with moderate-to-severe OSA who underwent polysomnography using pulse transit time before and at 3–6 months after CPAP therapy. Nocturnal BP and NBPF frequency in REM and non-REM sleep were investigated, as well as NBPF pattern changes after receiving CPAP therapy. CPAP therapy resulted in significant reductions in the apnea–hypopnea index (AHI), arousal index, nocturnal systolic and diastolic BP, and NBPF frequency in REM and non-REM sleep (all p < 0.01). A higher AHI before CPAP resulted in lower nocturnal systolic BP (r = 0.40, p = 0.019) and NBPFs (r = 0.51, p = 0.002) after CPAP. However, 58.8% of patients showed no change in NBPF patterns with CPAP therapy. CPAP therapy significantly improved almost all sleep-related parameters, nocturnal BP, and NBPF frequency in REM and non-REM sleep periods, but NBPF patterns showed various changes post-CPAP therapy. These results suggest that factors other than OSA influence changes in NBPF patterns.

Platelet-derived extracellular vesicles correlate with therapy-induced nocturnal blood pressure changes.

Elevated nocturnal blood pressure (BP) is closely associated with increased risk of cardiovascular (CV) events. Circulating extracellular vesicles (EVs) have been proposed as a potential CV risk biomarker and shown to correlate with BP. The present study aimed to assess whether a reduction in BP is paralleled by respective changes in EVs. Fifty-five hypertensive patients (age: 57.7 ± 14.1 years) were included in the study. EVs and BP were assessed at baseline and at 12 weeks follow-up. Interventions to lower BP included advice on life-style modification only or life-style advice combined with additional pharmacotherapy. EVs were evaluated by flow cytometry (CD41+/Annexin V+) and BP by unobserved automated office BP and ambulatory BP monitoring. Nocturnal systolic BP correlated with EV levels at baseline ( P = 0.01). Multivariable regression models showed that changes in nocturnal systolic BP (adjusted R2 = 0.23; P = 0.01) and diastolic BP (adjusted R2 = 0.18; P = 0.02) were associated with respective changes in EV levels. Furthermore, intervention-induced improvement of systolic dipping was associated with a reduction in EVs in the univariate analysis (adjusted R2 = 0.06; P = 0.03). In contrast, systolic office, 24 h- and daytime-BP did not show significant associations with EVs. Patients whose medication was up-titrated at baseline showed a trend towards lower EV levels at follow-up (absolute change of -1.7 ± 1.3 EV/μl; P = 0.057). Circulating platelet-derived EVs were positively associated with nocturnal BP and therapy-induced changes over a 12-week treatment period. EVs may provide an integrated measure of BP changes achieved with pharmacotherapy.

Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes

AimsPeople with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes. MethodsFrom 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions. ResultsParticipants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24–44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09–4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23–3.00), p = 0.004). ConclusionsNon-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.

DEMOGRAPHIC FACTORS AFFECTING NOCTURNAL BLOOD PRESSURE VARIABILITY IN THE GENERAL POPULATION: RESULTS OF A LARGE DIGITAL STUDY USING AN OPTICAL BLOOD PRESSURE MONITOR

Objective: The association between blood pressure variability (BPV) and increased cardiovascular risk is complex, and robust analyses have been limited by methodologic and statistical challenges. Short-term BVP has generally been assessed by ambulatory monitoring, and longer-term by repeated office measures. Recent advancements in optical sensors providing frequent and non-disruptive BP readings around the clock allow first characterization of night-to-night nocturnal BPV in a large population. Design and method: We nalysed 210’000 nocturnal systolic and diastolic BP (SBP, DBP) readings from 1’538 adults who wore the CE-marked Aktiia BP monitor for two weeks between April and November 2021 in Europe: mean age 56 ± 11 years, BMI 27 ± 5 Kg/m2, SBP 132 ± 14 mmHg, DBP 82 ± 10 mmHg; 15% females. For each user, we studied the variability of nocturnal BP over two weeks: we first averaged all BP readings from each night (midnight to 6am), and then calculated the standard deviation of the averaged values across nights. We finally adjusted a multivariate logistic regression to identify factors associated with high or low nocturnal BPV (defined as BPV above or below the mean of our population) based on gender, age, body mass index (BMI), and daytime home BP (measured twice by an upper-arm oscillometric cuff on day one of the monitoring period). This analysis was performed for both systolic and diastolic BPV. Results: High nocturnal systolic BPV was more likely in males (OR 1.37, CI:1.02–1.83, p = 0.035), and subjects younger than 55 years (OR 1.51, CI:1.23–1.86, p &lt; 0.001). High nocturnal diastolic BPV was more likely in females (OR 1.63, CI:1.23–2.16, p = 0.001), and subjects with a BMI below 30 kg/m2 (OR 1.71, CI:1.32–2.20, p &lt; 0.001). Daytime upper-arm cuff BP (systolic &gt; = 135mmHg or diastolic &gt; = 85mmHg) did not show a statistically significant effect in either of the two models (all p&gt; 0.2). Conclusions: This digital investigation showed greater night-to-night variability of nocturnal systolic BP in male and young subjects, and greater variability of nocturnal diastolic BP in females and non-obese subjects. The large-scale deployment of wearable medical devices that continuously record BP enables observations that may help elucidate adverse cardiovascular risk profiles in the general population.

Circulating platelet‐derived extracellular vesicles correlate with night‐time blood pressure and vascular organ damage and may represent an integrative biomarker of vascular health

Elevated office blood pressure (BP) has previously been associated with increased levels of circulating extracellular vesicles (EVs). The present study aimed to assess the relationship between levels of platelet derived EVs, ambulatory BP parameters, and pulse wave velocity as a marker of macrovascular organ damage. A total of 96 participants were included in the study. Platelet‐derived extracellular vesicles (pEVs) were evaluated by flow cytometry (CD41+/Annexin v+). BP evaluation included unobserved automated office BP and ambulatory BP monitoring. Carotid‐femoral pulse wave velocity (PWV) was measured as a marker of macrovascular damage. pEVs correlated with nocturnal systolic BP (r = 0.31; p = .003) and nocturnal dipping (r = ‐0.29; p = .01) in univariable analysis. Multivariable regression models confirmed robustness of the association of EVs and nocturnal blood pressure (p = .02). In contrast, systolic office, 24h‐ and daytime‐BP did not show significant associations with pEVs. No correlations were found with diastolic BP. Circulating pEVs correlated with pulse wave velocity (r = 0.25; p = .02). When comparing different hypertensive phenotypes, higher levels of EVs and PWV were evident in patients with sustained hypertension compared to patients with white coat HTN and healthy persons. Circulating platelet derived EVs were associated with nocturnal BP, dipping, and PWV. Given that average nocturnal BP is the strongest predictor of CV events, platelet derived EVs may serve as an integrative marker of vascular health, a proposition that requires testing in prospective clinical trials.

Specifics of daily blood pressure monitoring in patients with systemic hypertension and obstructive sleep apnoea: a case-control study

Background. The comorbidity of arterial hypertension (AH) and obstructive sleep apnea syndrome (OSA) is becoming increasingly common in clinical practice. However, the priority strategy for selecting antihypertensive therapy in such patients is yet to be defined. 24-hour blood pressure monitoring is important for determining an approach to controlling hypertension.Objectives. To study specific features of 24-hour blood pressure monitoring in comorbid AH– OSA patients.Methods. A total of 130 AH patients were surveyed. The main cohort (1) included AH–OSA patients (n = 90, mean age 54.93 ± 1.04 years), control cohort (2) — non-OSA AH patients (n = 40, mean age 57.92 ± 1.29 years). All patients had a general clinical examination with 24-hour blood pressure monitoring. OSA was verified in overnight respiratory polygraphy using an Alice PDx diagnostic appliance (USA).Results. The following specific features of 24-hour blood pressure monitoring were identified in the comorbid patients: a statistically significant growth of mean 24-hour systolic and average BP, as well as mean nocturnal systolic, diastolic and average BP; a statistically significant growth of mean 24-hour systolic, diastolic and average BP load indices. In addition, the AH-OSA patients had the statistically higher pulse pressure, systolic and average BP variability, as well as morning BP surge rate. The 24-hour BP dynamics in OSA patients had predominant morbid profiles and higher non-dipper and night-peaker rates compared to the control cohort.Conclusion. The identified specific features reflect a high risk of adverse cardiovascular events in AH–OSA comorbid patients, an earlier damage of target organs and negative prognosis of comorbidity, which warrants a further analysis of AH-specific clinical picture and personalisation of blood pressure control measures in such patients.

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

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

Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients

Purpose An increased blood pressure variability (BPV) has been reported to be associated with older age and cognitive dysfunction; however, associations between increased BPV and rapid eye movement sleep behaviour disorder (RBD) has not been thoroughly investigated in patients without clinical Lewy body diseases. Materials and methods In frailty outpatient clinic, we evaluated ambulatory BP, RBD screening questionnaire (RBDSQ), and beat-to-beat heart rate variability during positional change from sitting to standing in 112 elderly hypertensive patients. Results The mean age was 81.2 ± 6.3 years (68% male). There were 15 patients who had probable RBD (RBDSQ scores ≥ 5). Patients with RBD had a greater body mass index, coefficient of variation (CV) in 24-h diastolic BP (23.5 ± 6.1 versus 18.7 ± 5.8, p = 0.005), awake diastolic BP (23.0 ± 7.7 versus 18.6 ± 6.2, p = 0.017), and nocturnal systolic BP (14.9 ± 5.5 versus 12.0 ± 4.4, p = 0.025) compared with those without RBD, while systolic BP, diastolic BP, and cognitive function did not differ significantly between patients with and without RBD. Patients with RBD exhibited larger orthostatic BP fall compared with patients without RBD (−4.9 ± 11.0 versus 7.5 ± 11.8, p = 0.009) and lower CV of R–R intervals while standing (1.3 ± 0.6 versus 2.4 ± 1.5, p = 0.039). Multiple regression analysis revealed that patients with RBD had significantly greater CV of nocturnal systolic BP independent of age, sex, BMI, history of diabetes and dyslipidaemia, and use of antihypertensive drugs (p = 0.008). Conclusion An increased BPV in ambulatory BP, associated with autonomic dysfunction, can be observed in patients with probable RBD even in elderly patients without clinical presentation of Lewy body diseases.

Analysis of Systolic Blood Pressure Level and Short-Term Variability in Masked Hypertension.

Background Patients with masked hypertension are at an elevated risk of cardiovascular events and all-cause death. This risk is close to that of sustained hypertension. The mean value and short-term variability of systolic blood pressure are considered to be risk factors for organ damage in hypertension. Objective To investigate the mean value and short-term variability of systolic blood pressure in patients with masked hypertension. Methods According to the results of in-clinic and ambulatory blood pressure measurement, participants were divided into four groups: normotension group, controlled hypertension group, masked hypertension group, and sustained hypertension group. The mean value and short-term variability of systolic blood pressure of masked hypertension group were evaluated by comparison with the other three groups. Results A total of 250 subjects were enrolled, with an average age of 65.46 ± 8.76 years, and 166 (66.4%) were male, including 62 in the normotension group, 78 in the controlled hypertension group, 69 in the masked hypertension group, and 41 in the sustained hypertension group. Compared with the normotension group and controlled hypertension group, the mean value, blood pressure load, standard deviation, and coefficient of variation of systolic blood pressure over 24 hours and during the day and night, were all higher in the masked hypertension group (P < 0.05), while the rate of the nocturnal systolic blood pressure decline was lower (P < 0.05). There were no statistically significant differences in the above indexes between the masked hypertension group and sustained hypertension group (P > 0.05). Conclusion There are higher mean value of systolic blood pressure and greater short-term variability in masked hypertension patients. Identification of masked hypertension is an important challenge in the clinic.

Role of Blood Pressure Responses to Exercise and Vascular Insulin Sensitivity with Nocturnal Blood Pressure Dipping in Metabolic Syndrome

Introduction: Nocturnal systolic blood pressure (SBP) dipping is independently related to cardiovascular disease risk, but it is unclear if vascular insulin sensitivity associates with SBP dipping in patients with metabolic syndrome (MetS). Methods: Eighteen adults with MetS (ATP III criteria 3.3 ± 0.6; 53.2 ± 6.5 years; body mass index 35.8 ± 4.5 kg/m²) were categorized as “dippers” (≥10% change in SBP; n = 4 F/3 M) or “non-dippers” (<10%; n = 9 F/2 M). Twenty-four-hour ambulatory blood pressure was recorded to assess SBP dipping. A euglycemic-hyperinsulinemic clamp (40 mU/m²/min, 90 mg/dL) with ultrasound (flow mediated dilation) was performed to test vascular insulin sensitivity. A graded, incremental exercise test was conducted to estimate sympathetic activity. Heart rate (HR) recovery after exercise was then used to determine parasympathetic activity. Metabolic panels and body composition (DXA) were also tested. Results: Dippers had greater drops in SBP (16.63 ± 5.2 vs. 1.83 ± 5.6%, p < 0.01) and experienced an attenuated rise in both SBP_slope (4.7 ± 2.3 vs. 7.2 ± 2.5 mm Hg/min, p = 0.05) and HR_slope to the incremental exercise test compared to non-dippers (6.5 ± 0.9 vs. 8.2 ± 1.7 bpm/min, p = 0.03). SBP dipping correlated with higher insulin-stimulated flow-mediated dilation (r = 0.52, p = 0.03), although the relationship was no longer significant after covarying for HR_slope (r = 0.42, p = 0.09). Conclusion: Attenuated rises in blood pressure and HR to exercise appear to play a larger role than vascular insulin sensitivity in SBP dipping in adults with MetS.

Blood Pressure Monitoring and Perinatal Outcomes in Normotensive Women with Gestational Diabetes Mellitus.

Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes.

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.

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

ObjectiveHypertension (HT) induces left atrial (LA) and left ventricular (LV) dysfunction, and an increase in arterial stiffness. In this study, we investigated the association between LA-LV–arterial coupling and nighttime systolic blood pressure (BP) as well as BP circadian rhythm in essential hypertension.MethodsWe enrolled 290 HT patients. All subjects were evaluated by 2- dimensional speckle tracking echocardiography (2DSTE), ambulatory 24 h BP monitoring (ABPM), and brachial–ankle pulse wave velocity (PWV). According to BP patterns, these patients were divided into two groups, which included dippers (n = 111), patients with a >10% reduction in BP at nighttime; non-dippers (n = 179), patients with a <10% reduction in BP at nighttime. 2D-STE based LA and LV strains were studied and the following parameters were measured, LV global longitudinal strain (GLS), LA reservoir strain (LAS−S), LA conduit strain (LAS−E), and LA booster pump strain (LAS−A). LA stiffness index (LASI) defined as the ratio of E/e′ to LAS−S, and PWV-to-GLS ratio (PWV/GLS) were calculated to reflect LA-LV–arterial coupling. Furthermore, we also explored the correlation between LASI (or PWV/GLS) and ambulatory blood pressure indexes.ResultsLeft atrial stiffness index was significantly higher in non-dippers [0.29 (0.21, 0.41)] than in dippers [0.26 (0.21, 0.33)] (P < 0.05). PWV/GLS was significantly higher in non-dippers [−80.9 (−69.3, −101.5)] than in dippers [−74.2 (−60.2, −90.6)] (P < 0.05). LAS−S, LAS−E, LAS−A,and LV GLS were significantly lower in non-dippers than in dippers (P < 0.05). Multivariate linear regression analysis revealed that nighttime systolic BP was independently correlated with LASI and PWV/GLS, even adjusted for multiple clinical risk factors, LVMI, and LVEF.ConclusionsThe dipping pattern of BP was related to the abnormalities of myocardial mechanics and LA-LV–arterial coupling. However, absolute nocturnal systolic BP value maybe more important than BP circadian profile in the progression of abnormal LA-LV–arterial coupling.

Study on the correlation between ambulatory blood pressure and left atrial diameter in patients with treated and controlled office hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients suffered from different kinds of target organ damage even after years of standardized treatment in clinic. Purpose To explore the relationship between ABPM and LAD in patients with treated essential hypertension. Methods The study enrolled 347 patients with controlled blood pressure evaluated by clinical standard in the Department of Hypertension from January 2015 to May 2020. The T test was used to compare general data, Cardiac ultrasoundwere used to compare the differences between the two groups. Spearman correlation was used to analyze the correlation between ABPM and heart rate variability and target organ damage.Logistic regression analysis was used to figure out the independent risk factor for LAD abnormity. Results (1)LAD normal group: 153 people; the LAD abnormal group: 194 people. Compared with the LAD normal group, the proportion of males, age,body mass index, duration of hypertension,fasting blood glucose, and glycosylated hemoglobin and the proportion of patients with controlled ABPM were significantly higher in the LAD abnormal group(P &amp;lt; 0.05). The average LAD in abnormal group was significantly lower than the LAD normal group (P &amp;lt; 0.05). RAS inhibitor(ACEI or ARB)usage rate of LAD normal group is significantly higher than LAD abnormal group(P &amp;lt; 0.05). On the contrary the usage rate of diuretic of the LAD normal group is lower than of the LAD abnormal group. (2)Spearman correlation analysis between the average blood pressure of each time period of ABPM and LAD found that LAD are positively correlated with the systolic blood pressure for the whole day（r = 0.141, p = 0.00）, the day time （r = 0.118, p = 0.02）or nocturnal（r = 0.178,=0.001）. However there is a negative correlation between LAD and the percentage of systolic blood pressure drops at night（r = 0.149,=0.005. (3)Through Logistic regression analysis, it was found that BMI(OR: 1.22, 95% CI: 1.125-1.324, P &amp;lt; 0.001),nocturnal average systolic blood pressure(OR: 1.02, 95% CI: 1.003-1.038, P = 0.019）, duration of hypertension (OR: 1.043, 95% CI: 1.01-1.078, P = 0.01;)and diuretic usage (OR: 0.298, 95% CI: 0.138-0.644, P = 0.002)are independent risk factors for LAD .(4) For LAD abnormity, the risk factors mentioned above were identified when the area under the LAD abnormity ROC curve exceeded 80.4 % (P = 0.11, 95% CI: 1.125-1.324, P &amp;lt; 0.001). Conclusion 1. Hypertension patients whose office blood pressure reached the standard but with uncontrolled ABPM have significantly suffered form a higher LAD enlargement than those met the standard both in clinic and ABPM. The uncontrolled ABPM is an independent risk factor for LAD. 2. In the 24-hour blood pressure, uncontrolled of SBP by time of day is positively correlated with LAD. 3. Hypertensive patients whose blood pressure in the office reach the standard should actively perform ABPM and adjust the treatment plan according to the circadian blood pressure rhythm.

Time point of nocturnal trough systolic blood pressure as an independent predictor of cardiovascular events.

Nocturnal trough systolic blood pressure (NTSBP) and Time Point of Nocturnal Trough Systolic Blood Pressure (T‐NTSBP) were important parameters of nocturnal blood pressure, the predictive values of which are unclear for stroke outcome. This study aimed to examine the relationship between NTSBP/T‐NTSBP and stroke outcome. The authors used data from a nationwide ambulatory blood pressure monitoring cohort study conducted in China, which recruited 2348 ischemic stroke and transient ischemic attack (TIA) patients. NTSBP was defined as the lowest SBP during nighttime (22:00–6:00), and T‐NTSBP was defined as the corresponding time point of NTSBP. The associations between NTSBP/T‐NTSBP and stroke outcome (stroke recurrence and combined vascular event [CVE]) at 90 days or 1 year were analyzed using cox regression models. According to NTSBP classified by quartile, hazard ratio (HR) with 95% confidence interval (CI) for NTSBP quartile 4 (>129 mm Hg) was 2.727 (1.148–6.478) for CVE at 90‐day, compared with quartile 1 (≤102 mm Hg). However, an attenuated association between NTSBP and CVE was observed at 1 year. In addition, we observed the group of T‐NTSBP at 4:00–6:00 had a lowest CVE incidence at 90 days among four groups (22:00–23:59, 00:00–1:59 2:00–3:59, 4:00–6:00). After multivariable adjustment, T‐NTSBP was significantly associated with CVE incidence at 90 days (T‐NTSBP at the 4:00–6:00 versus the 22:00–23:59 group: HR, 0.433; 95%CI, 0.190–0.986), independent of NTSBP and average nocturnal SBP. Both of NTSBP and T‐NTSBP were important predictors for short‐term cardiovascular risk in ischemic stroke and TIA patients.