Non-dipping Pattern Research Articles

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 1. How to correctly measure blood pressure in children and adolescents.

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.

Nondipping blood pressure pattern predicts cardiovascular events and mortality in patients with atherosclerotic peripheral vascular disease.

Patients with peripheral vascular disease (PVD) are often underdiagnosed and undertreated. Nocturnal nondipping blood pressure (BP) pattern, as diagnosed by ambulatory BP monitoring (ABPM), is associated with increased cardiovascular risk, but has not been studied in patients with PVD. We aimed to investigate if a nondipping BP pattern predicts cardiovascular events or all-cause death in outpatients with PVD. Consecutive outpatients with carotid or lower-extremity PVD were examined with 24-hour ABPM (n = 396). Nondipping was defined as a < 10% fall in systolic BP level during night-time. We used Cox regression models adjusting for potential confounders. We also evaluated the incremental prognostic value of dipping status in the COPART risk score. Our primary composite outcome was cardiovascular events or all-cause death. In the cohort (mean age 70; 40% women), 137 events occurred during a 5.1-year median follow-up; incident rate of 7.35 events per 100 person-years. Nondipping was significantly associated with outcome (hazard ratio 1.55, 95% CI 1.07-2.26, p = 0.021) in a fully adjusted model. When adding nondipping to the risk markers in the COPART risk score, the model fit significantly improved (χ2 7.91, p < 0.005) and the C-statistic increased from 0.65 to 0.67. In a cohort of outpatients with PVD, nondipping was an independent risk factor for future cardiovascular events or mortality and seemed to be a strong predictor in patients with carotid artery disease but not in lower-extremity PVD. Additional studies are needed to evaluate the clinical utility of ABPM for improved prevention in these high-risk patients. (ClinicalTrials.gov Identifier: NCT01452165).

Circadian blood pressure variability and asymmetric dimethylarginine in patients with glaucoma: cross-sectional study of The LIGHT cohort.

Glaucoma is reportedly associated with asymmetric dimethylarginine (ADMA) and circadian blood pressure (BP) variability, including night-time SBP. We determined whether ADMA level is associated with night-time SBP in patients with glaucoma. In this cross-sectional study, we measured the serum ADMA level and ambulatory BP of 163 patients with glaucoma and 705 participants without glaucoma. Based on the tertiles of serum ADMA level, the patients were divided into three groups: low, intermediate, and high-ADMA. Night-time SBP was determined based on ambulatory BP measured every 30 min for 48 h. The nondipper BP pattern was defined as having a night-time mean SBP decline of less than 10% relative to the mean daytime SBP. In the glaucoma group, the night-time SBP in the high-ADMA group was significantly higher than in the low-ADMA group (123.0 and 114.4 mmHg, respectively; P = 0.003). Multivariable analysis adjusted for the potential confounders showed the night-time SBP, and the odds ratio for nondipper in the high-ADMA group were also significantly higher than in the low-ADMA group ( P = 0.030 and P = 0.021, respectively). Significant associations between continuous serum ADMA levels with night-time SBP and nondipper were also found ( P = 0.002 and 0.006, respectively). In the control group, however, no significant associations were found between serum ADMA levels and night-time SBP and nondipper. A significant interaction effect of the serum ADMA levels and glaucoma on nondipper was found ( P = 0.004). Serum ADMA level was significantly associated with the disturbance of circadian BP variability in patients with glaucoma.

5. Nocturnal Dipping Pattern in Hypertensive Patients as a Risk Factor for Cerebral Small Vessel Disease (CSVD): A Systematic Review and Meta-Analysis

Background: Cerebral small vascular disease (CSVD) is one of the most prevalent cerebral vascular pathologies encountered by middle-aged and older people, which can be observed by magnetic resonance imaging (MRI). The most important modifiable risk factor for CSVD is hypertension. Abnormal circadian blood pressure (BP) variability has been reported to significantly damage hypertensive patients’ target organs. Moreover, in many studies, controlling sleep blood pressure has been shown to exert greater protection against stroke and cardiovascular events. Objective: We aim to assess the nocturnal dipping pattern of blood pressure with the findings of cerebral small vessel disease. Method: We performed a comprehensive search on topics that assess nocturnal blood pressure monitoring and cerebral small vessel disease findings through imaging from inception up until November 2022. Result: There were a total of 2674 patients from 5 studies. The outcome of this study reported that reverse dipping and dipping BP patterns were significantly associated with the prevalence of CSVD. Meta-analysis showed that the reverse dipping BP pattern was associated with a higher risk for CSVD (OR 2.18 [1.80, 2.64], p = 0.64; I2: 0%, p &lt; 0.00001), meanwhile dipping pattern had a lower risk for CSVD (OR 0.51 [0.42, 0.63], p = 0.04; I2: 59%, p &lt; 0.00001). There was no association between the non-dipping pattern and CSVD (OR 0.92 [0.77, 1.10], p = 0.70; I2:0%, p = 0.35). Conclusion: Nocturnal BP pattern and CSVD were shown to be associated, with the reverse dipping BP pattern having a higher risk and dipping having a lower risk.

Assessment of Hypertension in Children with Autosomal Dominant Polycystic Kidney Disease; Single-Center Experience

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary renal cystic diseases. Althoughits clinical manifestations usually occur in adulthood, hypertension (HT) is known to develop in most patients before the decline inrenal function and it is associated with faster progression to end stage kidney disease (ESKD). We investigated ambulatory bloodpressure monitoring (ABPM) results of 23 patients with ADPKD, followed up in the Pediatric Nephrology Clinic of Ondokuz MayısUniversity Medical Faculty Hospital. Patients’ demographic characteristics, laboratory and ultrasonography (US) results, officeblood pressure, and ABPM measurements were evaluated. The parameters of gender, age, increased kidney size, proteinuria,glomerular filtration rate (GFR) was compared in hypertensive and non-hypertensive group. Twenty three patients (13 girls, tenboys) with a mean age of 11.94±4.01 (min-max: 4.6-18) years and a female/male ratio of 1.3/1 were examined. Ultrasound revealedincreased kidney sizes in 12 patients (52.2%) and multiple cysts in the bilateral kidneys in 20 patients (87%). Mild to moderateproteinuria was detected in 7 patients (30.4%). The HT ratio of patients was 52.2% and 39.1% when assessed with office bloodpressure (BP) measurement and ABPM respectively. A non-dipper pattern was established in 14 patients (60.9%). Gender, age,increased kidney size, proteinuria, GFR did not differ significantly between ADPKD patients with and without ambulatory HT. Thisstudy shows that nearly half of children with ADPKD have HT by ABPM. BP should be regularly screened by ABPM in all pediatricADPKD patients.

Patrones de presión arterial de 24 horas en pacientes con insuficiencia cardiaca estable. Prevalencia y factores asociados

Introduction and objectivesHypertension is highly common in heart failure (HF). However, there is limited information on its prevalence, circadian variation, and relationship with the various HF phenotypes. The objective of this study was to describe the prevalence of hypertension and its patterns in HF. MethodsThis was a cross-sectional observational study of patients with optimized stable chronic HF. The patients underwent blood pressure (BP) measurement in the office and 24-hour ambulatory monitoring. We estimated the prevalence of hypertension, and its diurnal (controlled, uncontrolled, white coat, and masked) and nocturnal (dipper, nondipper, and reverse dipper) patterns. We also analyzed the factors associated with the different patterns and HF phenotypes. ResultsFrom 2017 to 2021, 266 patients were included in the study (mean age, 72±12 years, 67% male, 46% with reduced ejection fraction). Hypertension was present in 83%: controlled in 68%, uncontrolled in 10%, white coat in 10%, and masked in 11%. Among patients with high office BP, 51% had white coat hypertension. Among those with normal office BP, 14% had masked hypertension. The prevalence of dipper, nondipper, and reverse dipper patterns was 31%, 43%, and 26%, respectively. Systolic BP was lower in HF with reduced ejection fraction than in HF with preserved ejection fraction (P <.001). ConclusionsAmbulatory BP monitoring in HF identified white coat hypertension in more than half of patients with high office BP and masked hypertension in a relevant percentage of patients. The distribution of daytime patterns was similar to that of the population without HF in the literature, but most of the study patients had a pathological nocturnal pattern.

Relationships between Easily Available Biomarkers and Non-Dipper Blood Pressure Pattern in Patients with Stable Coronary Artery Disease.

Chronic inflammation plays an essential role in the pathophysiology of both arterial hypertension (HTN) and coronary artery disease (CAD), and is more pronounced in individuals with a non-dipper circadian blood pressure (BP) pattern. A non-dipping BP pattern is in turn is associated with increased cardiovascular morbi-mortality, and a higher risk of atherosclerotic events. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) are readily available predictors of systemic inflammation and cardiovascular risk. The purpose of our study is to evaluate whether NLR, MLR and PLR can be used as cost-effective predictors of a non-dipping blood pressure pattern in hypertensive patients with stable CAD. We performed a cross-sectional retrospective analysis that included 80 patients with hypertension and stable CAD (mean age 55.51 ± 11.83 years, 71.3% male) referred to a cardiovascular rehabilitation center. All patients underwent clinical examination, 24 h ambulatory blood pressure monitoring (ABPM) and standard blood analysis. Baseline demographic characteristics were similar in both groups. Patients with non-dipper pattern had significantly higher NLR (median = 2, IR (2-3), p < 0.001), MLR (median = 0.31, IR (0.23-0.39), p < 0.001) and PLR (median = 175, IR (144-215), p < 0.001) compared to dippers. Our results suggest that MLR and PLR are inexpensive and easily accessible biomarkers that predict a non-dipping pattern in hypertensive patients with stable CAD.

Non-dipping blood pressure pattern is associated with higher risk of new-onset diabetes in hypertensive patients with obstructive sleep apnea: UROSAH data.

Impairment of circadian blood pressure (BP) patterns has been associated with cardiovascular risks and events in individuals with hypertension and in general populations, which are more likely to be found in obstructive sleep apnea (OSA). The aim of this study was to investigate the association of non-dipping BP pattern with new-onset diabetes in hypertensive patients with OSA, based on Urumqi Research on Sleep Apnea and Hypertension (UROSAH) data. This retrospective cohort study included 1841 hypertensive patients at least 18 years of age, who were diagnosed with OSA without baseline diabetes and had adequate ambulatory blood pressure monitoring (ABPM) data at enrollment. The exposure of interest for the present study was the circadian BP patterns, including non-dipping and dipping BP pattern, and the study outcome was defined as the time from baseline to new-onset diabetes. The associations between circadian BP patterns and new-onset diabetes were assessed using Cox proportional hazard models. Among 1841 participants (mean age: 48.8 ± 10.5 years, 69.1% male), during the total follow-up of 12172 person-years with a median follow-up of 6.9 (inter quartile range: 6.0-8.0) years, 217 participants developed new-onset diabetes with an incidence rate of 17.8 per 1000 person-years. The proportion of non-dippers and dippers at enrollment in this cohort was 58.8% and 41.2%, respectively. Non-dippers were associated with higher risk of new-onset diabetes compared with dippers (full adjusted hazard ratio [HR]=1.53, 95% confidence interval [CI]: 1.14-2.06, P=0.005). Multiple subgroup and sensitivity analyses yielded similar results. We further explored the association of systolic and diastolic BP patterns with new-onset diabetes separately, and found that diastolic BP non-dippers were associated with higher risk of new-onset diabetes (full adjusted HR=1.54, 95% CI: 1.12-2.10, P=0.008), whereas for systolic BP non-dippers, the association was nonsignificant after adjusted the confounding covariates (full adjusted HR=1.35, 95% CI: 0.98-1.86, P=0.070). Non-dipping BP pattern is associated with an approximately 1.5-fold higher risk of new-onset diabetes in hypertensive patients with OSA, suggesting that non-dipping BP pattern may be an important clinical implication for the early prevention of diabetes in hypertensive patients with OSA.

Comparison of ambulatory blood pressure monitoring and office blood pressure in primary health care of populations at a high risk of hypertension.

Current studies have found that the incidence of masked hypertension is high in Asian countries, but the use of ambulatory blood pressure monitoring (ABPM) in Asian countries is very limited, especially in primary health care. We compared the ABPM and office blood pressure (OBP) in primary health care of a high-risk population of hypertension. The study included participants with at least one risk factor for hypertension who received primary health care. Demographic data, present medical history, personal history, and family history were collected by questionnaire. A total of 823 subjects were included in the study. There were 531 (64.5%) subjects with hypertension by ABPM and 316 patients (38.4%) by OBP. A paired chi-square test showed that the positive rate of ABPM in the diagnosis of hypertension was significantly higher than that of OBP (chi-square value 174.129, P < 0.0001). There were 24 (2.9%) patients with white coat hypertension, 239 (29.0%) with masked hypertension, 504 (52.9%) with a non-dipping pattern, 135 (16.9%) with nocturnal hypertension and 18 (2.2%) with high ambulatory BP variability. Concordance correlation coefficient showed there was a poor correlation between OBP and awake average BP. Scatter plot displayed there was a positive correlation between OBP and awake average BP, but the degree of fitting was not high. The Bland Altman plot showed that OBP and awake average BP were consistent. Although OBP and ABPM have some consistency, ABPM can screen for masked hypertension and nocturnal hypertension in primary care of populations at high risk of hypertension. Therefore, ABPM is necessary in the primary health care of populations at high risk of hypertension and can be used as a routine screening.

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

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

Pathophysiology of the Nondipping Blood Pressure Pattern.

The nondipping blood pressure (BP) pattern corresponds to a disruption in the circadian BP rhythm with an insufficient decrease in BP levels during nighttime sleep as observed using 24-hour ambulatory BP monitoring. Patients with nondipping BP pattern have poorer renal and cardiovascular outcomes, independent of their average 24-hour BP levels. The pathophysiology of nondipping BP is complex and involves numerous mechanisms: perturbations of (1) the circadian rhythm, (2) the autonomic nervous system, and (3) water and sodium regulation. This review provides an outline of the pathways potentially involved in the nondipping BP profile in different conditions. A recent hypothesis is also discussed involving the role of gut microbiota in the dipping/nondipping patterns, via the fecal diet-derived short chain fatty acids.

Daily profiles of blood pressure in patients with arterial hypertension of various psychotypes

Аim: to assess the influence of the patient's psychotype on the degree of nighttime reduction in blood pressure (BP) to determine predictors of an unfavorable daily BP profile.Materials and methods. The study involved 80 patients with newly diagnosed or untreated arterial hypertension (AH), with various stages, severity, risk of developing cardiovascular complications, in the absence of concomitant severe somatic pathology, who independently consulted a local therapist. All patients underwent 24-hour blood pressure monitoring in the absence of antihypertensive therapy and the psychological profile was assessed using the SMOL questionnaire.Results. The psychopathological profile of the examined AH patients corresponded to the social and psychological adaptation. Our analysis of the indices of the averaged profile of the SMOL test, depending on the degree of reduction in nocturnal systolic blood pressure (between dipper and non-dipper profiles) and diastolic blood pressure (between dipper, non-dipper and extreme dipper patterns profiles) did not reveal statistically significant differences (p &gt; 0,05). Patients with a riser daily blood pressure profile, due to the small size of the group, were not included in the comparative analysis. The average profile of SMOL of the examined patients was noted by an increase in indicators on the scales 1 – hypochondria and 3 – emotional lability.Conclusion. The variant of the daily blood pressure profile does not depend on the psychotype of the patient; it is likely that functional and structural changes that occur during the formation of hypertension affect the type of the degree of nighttime decrease in blood pressure.

PS-C09-11: THE EFFICACY OF SACUBITRIL/VALSARTAN FOR NONDIPPER AND EXTREME DIPPER HYPERTENSION USING 24 AMBULATORY BP MEASUREMENT

Sacubitril/Valsartan increases natriuresis and diuresis and makes superior blood pressure control compared with usual RAS inhibitors. In Japanese clinical cicumstances,ideal blood pressure control to attain BP &lt; 130/80mmHg is difficult for next reasons. 1, Japanese predisposition towards high sodium intake. 2, Salt sensitivity due to Gene Polymorphism. 3, Increasing morbidity of obesity and Metabolic syndrome. 4, Clinical inertia to attain ideal blood pressure control especially in high risk hypertension patients ex. CKD and DM. These high risk patients often suggest nocturnal hypertension by 24 hour ambulatory blood pressure monitoring,24Hr ABPM. Nocturnal hypertension consists of non-dipper pattern, riser pattern, and often associated with cardiovascular event. On the contrary, extreme dipper pattern is sometimes found by24 Hr ABPM and it suggests high systolic BP during daytime in spite of night systolic BP decline. iIt sometimes results in stroke. Therefore antihypertensive therapies to these high risk patients by monitoring only clinic BP are surely insufficient to prevent CVD. Furthermore checking Home BP immediately after wake up is off course necessary, but still inadequate. Without monitoring by 24hr ABPM during nighttime,it is impossible to distinguish between non-dipper pattern, riser pattern and morning surge pattern. Quoting from literature, superiority of Ambulatory over Clinic Blood pressure measurement is proved in predicting mortality,The Dublin Outcome Study. It is essential to check 24hr ABPM to high risk patients. These high risk CKD or DM patients are accompanied by the diminished renal capacity to excrete sodium during daytime and compensate sodium excretion by elevating night blood pressure. This mechanism could be a component of the non dipper or riser pattern. Sacubitril/Valsartan `s effect of natriuresis and diuresis effect could be effective to excrete sodium excretion at daytime and Np makes vasodilatory effect and prohibits of aldosterone production.,and valsartan is anAT1 receptor blockade and prohibits of angiotensin2 effect. Sacubitril/Valsartan is very effective for characteristic “salt sensitive hypertension” Japanese patients. In our clinic, we prescribed 250 patients,120 patients are RAS inhibitor naive, and the rest of130 patients are switched from RAS inhibitor. We present 2 clinical cases prescribing Sacubitril/Valsartan 400 mg every morning and monitored 24hrABPM before and after prescription. 1st case is 48yrs old male, HT, DM and CKD showing non dipper-pattern. 2nd case is 86 yrs female, HT and old cerebral lacuna and left common iliac aneurysma showing extreme dipper pattern. 2 weeks after administration of Sacubitril/Valsartan, 24hr ABPM were checked and non dipper pattern disappeared in Ist patients and extreme dipper pattern disappeared in 2nd case,. Normal circadian rhythms are attained in both patients.

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

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

S-46-4: NONDIPPER PULSE RATE PATTERN WAS ASSOCIATED WITH BLOOD PRESSURE VARIABILITY AND INCREASE OF BNP: J-HOP STUDY

Background: The association between nondipper pulse rate (PR) pattern was reported. However, the association between nondipper PR pattern, blood pressure variability and hypertensive target organ damage remains unclear. Methods: Ambulatory BP monitoring (ABPM) was conducted in 1,003 hypertensive patients enrolled in the Japan Morning Surge Home Blood Pressure (J HOP) Study. Ambulatory BP monitoring was performed on a weekday with an automatic system that recorded the wearers BP and PR every 30 minutes for 24 hours. Nondipper PR status was defined as (awake PR minus sleep PR)/awake PR &lt; 0.1, and we evaluated standard deviation (SD) of systolic BP in daytime and nighttime as BP variability. We also measured the brain natriuretic peptide level (BNP), and conducted echocardiography to estimate the left ventricular mass index (LVMI). Results: The SD of systolic BP in nighttime, BNP and LVMI in patients with nondipper PR (N = 247) were higher than that in patients with dipper PR (N = 756, SD of systolic BP: 13.3 ± 4.6 vs. 12.7 ± 4.1 mmHg, p = 0.041; median BNP: 25.2 vs. 17.6 pg/dL, p &lt; 0.001, LVMI: 101.4 ± 29.1 vs. 97.3 ± 42.2 g/m2, p = 0.021). Systolic BP in nighttime in patient with nondipper PR was similar to that in patient with dipper PR (119.5 ± 15.2 vs. 119.9 ± 15.1 mmHg, p = 0.63). The SD of systolic BP in nighttime was associated with BNP and LVMI (BNP: r = 0.08, p = 0.006; LVMI r = 0.10, p = 0.001). Nondipper PR was independently associated with BNP (β = 0.10, p &lt; 0.001), but not with LVMI (β = 0.03, p = 0.37) after adjustment for systolic BP and SD of systolic BP in nighttime. Conclusions: Nondipper PR pattern was associated with blood pressure variability and hypertensive target organ damage in patients with cardiovascular risk factor.

Control of Arterial Hypertension by the AhR Blocker CH-223191: A Chronopharmacological Study in Chronic Intermittent Hypoxia Conditions.

Chronic intermittent hypoxia (CIH) is a major contributor to the development of hypertension (HTN) in obstructive sleep apnea (OSA). OSA subjects frequently display a non-dipping pattern of blood pressure (BP) and resistant HTN. After discovering that AHR-CYP1A1 axis is a druggable target in CIH-HTN, we hypothesized that CH-223191 could control BP in both active and inactive periods of the animals, recovering the BP dipping profile in CIH conditions.We evaluated the chronopharmacology of the antihypertensive efficacy of the AhR blocker CH-223191 in CIH conditions (21% to 5% of O2, 5.6cycles/h, 10.5h/day, in inactive period of Wistar rats). BP was measured by radiotelemetry, at 8am (active phase) and at 6pm (inactive phase) of the animals. The circadian variation of AhR activation in the kidney in normoxia was also assessed, measuring the CYP1A1 (hallmark of AhR activation) protein levels.Despite drug administration before starting the inactive period of the animals, CH-223191 was not able to decrease BP during the inactive phase, in CIH conditions, therefore not reverting the non-dipping profile. These results suggest that a higher dose or different time of administration of CH-223191 might be needed for an antihypertensive effect throughout the 24-h cycle.

PS-B09-7: NON-DIPPER BLOOD PRESSURE CAUSED BY INTERMITTENT HYPOXIA AND ITS POSSIBLE MECHANISM IN THE KIDNEY

Background: Non-dipper, less than 10% decrease of blood pressure in nighttime than daytime, is one of the strongest risk factor of cardiovascular diseases among hypertensive disorders. High prevalence of non-dipper among patients of sleep-apnea syndrome suggests intermittent hypoxia in nighttime as the mechanism of non-dipper, although it is still to be revealed. Purpose: To identify the mechanism of non-dipper caused by intermittent hypoxia in nighttime. Method: C57Bl/6-background male mice were kept under 8AM-8PM of light and 8PM-8AM dark cycle in closed air-conditioned system which could decrease the O2 level from 21% room air to 5% every 3 minutes. Mice were divided into two groups, normoxia (NX) or intermittent hypoxia (IH), and were kept for two weeks under room air thoroughly or under the IH only during 8 AM to 5 PM respectively. The mice were euthanized at 12PM and kidneys were obtained. Blood pressure (BP) of left carotid artery was recorded by radio-telemetry during the latter one week. To evaluate diurnal change in BP, BPs of 8AM-5PM (inactive) and 5PM-8AM (active) were compared in each of NX and IH mice. Kidney lysate was fractionated by ultracentrifuge to obtain membrane fraction of protein. Result: BP of NX mice in the active phase was significantly higher than the inactive phase, although such diurnal change was not observed in IH mice, demonstrating a development of non-dipper pattern by IH. In the kidney lysates, membrane protein expression levels of phosphorylated-Na+-Cl- cotransporter (NCC) and Na + -K+-Cl- cotransporter 2 (NKCC2) were significantly increased in IH mice compared to NX mice, but those of full-length and cleaved form of ENaCα were not changed. Transcriptional expression levels of Sgk1, Gilz, Per1/2 and Cry1/2 were significantly increased and those of Bmal1 and Clock were decreased in IH mice compared to those of NX mice. Conclusion: These data suggest that defect in molecular clock of the kidney and sodium reabsorption augmented by NCC and/or NKCC2 in the kidney contributes to the development of non-dipper.

Association of Non-Dipping Blood Pressure Patterns with Diabetic Peripheral Neuropathy: A Cross-Sectional Study among a Population with Diabetes in Greece

Diabetic peripheral neuropathy (DPN) is present in 20-50% of cases with diabetes. The pathophysiology of DPN is not yet clear regarding hypertension (HTN). The aim of this study was to assess the association between the stages of DPN and HTN in a Greek population with diabetes. We examined 102 adults for diabetic neuropathy (DPN) from November 2020 to December 2021, using the Toronto Clinical Neuropathy Scale System (TCNSS) to categorize them into two groups (no/mild DPN versus medium/severe DPN). Ambulatory blood pressure monitoring was performed to evaluate their hypertensive status. Univariate and multivariate logistic regression analyses were performed to assess the association between the stage of DPN and HTN. The multivariate analysis, considering sex, age, and dipping status, did not show statistically significant associations between stages of HTN and DPN. However, in contrast to dippers, non-dippers had an almost four-times higher risk of developing medium-to-severe DPN (odds ratio (OR) 3.93; 95% confidence interval (CI) [1.33-11.64]); females, in contrast to males, had a 65% lower risk of developing moderate/severe DPN (OR 0.35; 95%CI [0.14-0.92]). In conclusion, our findings showed no statistically significant associations between DPN and HTN; however, dipping status, hyperglycemia, and female sex were shown to play a role in the pathophysiology of DPN.

Non-dipping blood pressure pattern in pediatricians during on-duty

IntroductionPeople with a reduced nighttime dip in blood pressure have an increased cardiovascular risk. Our objective was to describe the different patterns in blood pressure (BP) among pediatricians who work in long on-duty shifts in relation with sex, medical rank and sleeping time. MethodsDescriptive, cross-sectional, two-center study. On duty pediatric Resident physicians and pediatric Consultants were recruited between January 2018 and December 2021. ResultsFifty-one physicians were included in the study (78.4% female, 66.7% Resident physicians). Resident physicians had a higher night/day ratio (0.91 vs 0.85; p<0.001) and a shorter nighttime period (3.87 vs 5.41, p<0.001) than Consultants. Physicians sleeping less than 5h had a higher night/day ratio (0.91 vs 0.87, p=0.014). Being a Resident showed a ∼4.5-fold increased risk of having a non-dipping BP pattern compared to Consultants. ConclusionWe found a potential link between both being a Resident and, probably, having shorter sleeping time, and the non-dipping BP pattern in physicians during prolonged shifts.

The combination of nondipper pulse rate pattern and nighttime high pulse rate variability is associated with an increase of brain natriuretic peptide: the J-HOP study.

The association between pulse rate (PR) and short-term PR variability and hypertensive organ damage has not been clarified. We enrolled 1439 patients from the J-HOP study. We calculated the standard deviation (SD) of PR in the nighttime using nighttime PR measurements at 30-min intervals. The SDs of PR (PR-SD) at nighttime were divided into quartiles (Q1-Q4). Nondipper PR was defined as (awake PR-sleep PR) < 0.1. Brain natriuretic peptide (BNP) levels were higher in patients with nondipper PR status in Q4 of PR-SD (nondipper PR/PR-SD Q4) than those with nondipper PR/PR-SD Q1-Q3 (37.8 vs 21.9 pg/mL, p = 0.041). The percentage of BNP > 100 pg/mL for patients with dipper PR/PR-SD Q1-Q3 was 5.2%, that for dipper PR/PR-SD Q4 was 4.8%, that for nondipper PR/PR-SD Q1-Q3 was 13.0%, and that for nondipper PR/PR-SD Q4 was 20.0% (ANOVA p < 0.001). In conclusion, BNP was high in patients having nondipper PR and high nocturnal PR-SD. Conceptual figure of subclinical heart failure and nondipper PR, PR variability. PR: pulse rate.