Non-dipping Status Research Articles

The Combination of Non-dipper Heart Rate and High Brain Natriuretic Peptide Predicts Cardiovascular Events: The Japan Morning Surge-Home Blood Pressure (J-HOP) Study.

BACKGROUNDWe hypothesized that the association between the dipping heart rate (HR) pattern and cardiovascular (CV) events differs according to the brain natriuretic peptide (BNP) level.METHODSWe examined a subgroup of 1,369 patients from the Japan Morning Surge Home Blood Pressure study; these were patients who had CV risk factors and had undergone ambulatory blood pressure (BP) monitoring. HR non-dipping status was defined as (awake HR − sleep HR)/awake HR <0.1, and high BNP was defined as ≥35 pg/ml. We divided the patients into four groups according to their HR dipper status (dipping or non-dipping) and BNP level (normal or high).RESULTSThe mean follow-up period was 60 ± 30 months. The primary endpoints were fatal/nonfatal CV events (myocardial infarction, angina pectoris, stroke, hospitalization for heart failure, and aortic dissection). During the follow-up period, 23 patients (2.8%) in the dipper HR with normal BNP group, 8 patients (4.4%) in the non-dipper HR with normal BNP group, 24 patients (9.5%) in the dipper HR with high-BNP group, and 25 patients (21.0%) in the non-dipper HR with high-BNP group suffered primary endpoints (log rank 78.8, P < 0.001). Non-dipper HR was revealed as an independent predictor of CV events (hazard ratio, 2.13; 95% confidence interval, 1.35–3.36; P = 0.001) after adjusting for age, gender and smoking, dyslipidemia, diabetes mellitus, chronic kidney disease, BNP, non-dipper BP, 24-h HR, and 24-h systolic blood pressure.CONCLUSIONSThe combination of non-dipper HR and higher BNP was associated with a higher incidence of CV events.

Blood pressure profile and endothelial function in restless legs syndrome

Restless legs syndrome (RLS) is frequently comorbid with hypertension and cardiovascular diseases; however this relationship and underlying mechanisms remain controversial. After clinical evaluation, 84 drug-free patients with primary RLS (53 women; mean age 55.1 ± 12.3 years) and 76 controls (47 women; mean age 52.2 ± 15.3 years) underwent 24-hour ambulatory blood pressure (BP) and polysomnographic monitoring, and peripheral arterial tonometry to assess endothelial function for 61 patients and 69 controls. Hypertension was diagnosed in 11.9% of patients with RLS based on office measurement, and in 46.4% on the 24 h recording, with nighttime hypertension, two times more frequent than daytime hypertension. Periodic limb movement during sleep (PLMS), markers of sleep fragmentation, and systolic and mean BP non-dipping profile were more frequent among patients. BP non-dipping status was associated with older age, later RLS onset and diagnosis, RLS severity and higher sleep fragmentation. The mean 24-hour, daytime and nighttime BP values, the frequency of hypertension and the endothelial function were comparable between groups. However, both systolic and diastolic BP trajectories over a 24-hour period differed between groups. In conclusion, patients with RLS exhibit a 24-hour BP deregulation with increased frequency of systolic non-dipping profiles that could worsen the risk for CVD morbidity and mortality.

The relationship between diurnal blood pressure abnormalities and target organ damage in normotensive subjects. Which is more important? Increased blood pressure levels or circadian blood pressure abnormalities

ABSTRACTObjective: Circadian blood pressure (CBP) abnormalities are well-known risk factors for many diseases such as cardiovascular, cerebrovascular, and chronic kidney disease. The object of this study was to evaluate the relationship between abnormalities in CBP rhythm and target organ damage (TOD) in normotensive non-dipper (non-DP) subjects.Methods: The 24-h ambulatory BP monitoring (ABPM) and echocardiography were performed and urinary albumin excretion (UAE) was measured in 127 normotensive dipper (DP) (42 males, 85 females) and 337 (89 males, 248 females) normotensive non-DP subjects.Results: When we compared DP and non-DP subjects; Pulse wave velocity (PWV) (7.12 ± 1.72 vs 7.57 ± 1.87 m/s, p = 0.02), the percentile of corrected PWV (cPWV) (7.1 vs. 20.2, p= 0.001) and the percentile of corrected augmentation index (cAIx) (23.5 vs. 33.9, p = 0.03), left ventricle mass index (LVMI) (78.00 ± 23.27 vs. 95.59 ± 18.29 g/m2, p = 0.01), relative wall thickness (RWT)(0.36 ± 0.13 vs 0.46 ± 0.09, p = 0.01), percentile of proteinuria (8.6 vs 29.2%, p = 0.00) were higher in non-DP group. In the correlation analyses, the PWV, LVMI, RWT were negatively correlated with the rate of systolic fall in nighttime (%)(−0.15, p = 0.01 vs. −0.23, p = 0.02 vs. −0.27, p = 0.00). It was observed that cPWV, cAIx, and UAE were independently associated with age and non-DP status (NDS), in logistic regression analysis.Conclusions: Our results suggested that normotensive persons with CBP abnormalities had TOD. In light of the data of this article, non-dipper status is detected in the early period and if the provision of diurnal blood pressure rhythm may reduce the incidence of future adverse events in nondipper normotensive subjects.

Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure.

BackgroundIncreased blood pressure (BP) variability and nondipping status seen on 24‐hour ambulatory BP monitoring are often observed in autonomic failure (ATF).Methods and ResultsWe assessed BP variability and nocturnal BP dipping in 273 patients undergoing ambulatory BP monitoring at Southwestern Medical Center between 2010 and 2017. SD, average real variability, and variation independent of mean were calculated from ambulatory BP monitoring. Patients were divided into a discovery cohort (n=201) and a validation cohort (n=72). ATF was confirmed by formal autonomic function test. In the discovery cohort, 24‐hour and nighttime average real variability, SD, and variation independent of mean did not differ significantly between ATF (n=25) and controls (n=176, all P>0.05). However, daytime SD, daytime coefficient of variation, and daytime variation independent of mean of systolic BP (SBP) were all significantly higher in patients with ATF than in controls in both discovery and validation cohorts. Nocturnal BP dipping was more blunted in ATF patients than controls in both cohorts (both P<0.01). Using the threshold of 16 mm Hg, daytime SD SBP yielded a sensitivity of 77% and specificity of 82% in detecting ATF in the validation cohort, whereas nondipping status had a sensitivity of 80% and specificity of 44%. The area under the receiver operator characteristic of daytime SD SBP was greater than the area under the receiver operator characteristic of nocturnal SBP dipping (0.79 [0.66‐0.91] versus 0.73 [0.58‐0.87], respectively).ConclusionsDaytime SD of SBP is a better screening tool than nondipping status in detecting autonomic dysfunction.

Effects of Bariatric Surgery Versus Medical Therapy on the 24-Hour Ambulatory Blood Pressure and the Prevalence of Resistant Hypertension.

Bariatric surgery is an effective strategy for blood pressure (BP) reduction, but most of the evidence relies on office BP measurements. In this study, we evaluated the impact of bariatric surgery on 24-hour BP profile, BP variability, and resistant hypertension prevalence. This is a randomized trial including obese patients with grade 1 and 2 using at least 2 antihypertensive drugs at maximal doses or >2 at moderate doses. Patients were allocated to either Roux-en-Y Gastric Bypass (RYGB) combined with medical therapy or medical therapy alone for 12 months. The primary outcome was the 24-hour BP profile and variability (average real variability of daytime and night time BP). We evaluated the nondipping status and prevalence of resistant hypertension as secondary end points. We included 100 patients (76% female, body mass index, 36.9±2.7 kg/m2). The 24-hour BP profile (including nondipping status) was similar after 12 months, but the RYGB group required less antihypertensive classes as compared to the medical therapy alone (0 [0-1] versus 3 [2.5-4] classes; P<0.01). The average real variability of systolic nighttime BP was lower after RYGB as compared to medical therapy (between-group difference, -1.63; 95% CI, -2.91 to -0.36; P=0.01). Prevalence of resistant hypertension was similar at baseline (RYGB, 10% versus MT, 16%; P=0.38), but it was significantly lower in the RYGB at 12 months (0% versus 14.9%; P<0.001). In conclusion, RYGB significantly reduced antihypertensive medications while promoting similar 24-hour BP profile and nondipping status. Interestingly, bariatric surgery improved BP variability and may decrease the burden of resistant hypertension associated with obesity. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT01784848.

The additive effects of OSA and nondipping status on early markers of subclinical atherosclerosis in normotensive patients: a cross-sectional study.

The additive effect of hypertension on carotid atherosclerosis in patients with obstructive sleep apnea (OSA) is well-established; however, the effect of the nondipping pattern has not yet been evaluated. In this study, we aim to assess the effect of the nondipping pattern on carotid atherosclerosis, which is quantified as carotid intima-media thickness (CIMT), and on the high-risk carotid profile in normotensive patients with OSA. We included 189 patients with OSA in this cross-sectional study. We followed a 2 × 2 factorial design to create groups according to the presence of OSA and nondipping pattern. All patients underwent carotid ultrasonography to quantify their CIMT and presence of plaques. Patients who had CIMT ≥ 0.9 mm and/or carotid plaques were classified as having a high-risk carotid profile. Patients in the OSA/nondipper group had a 26% higher CIMT and five times the prevalence of a high-risk carotid profile compared to patients in the non-OSA/dipper group. CIMT was correlated with age, the apnea-hypopnea index (AHI), minimum oxygen saturation, and nighttime systolic blood pressure (SBP). Independent of age, diabetes, and AHI, a one mmHg increase in nighttime SBP was associated with a 0.22 mm increase in CIMT and a 4% increase in odds for the high-risk carotid profile. Similarly, independent of age and diabetes, being in the OSA/nondipper group was associated with 6.7 times increased odds for a high-risk carotid profile than being in the non-OSA/dipper group. Modeling with both the nondipping status and presence of OSA produced an 8% higher discriminative value than modeling with neither of these parameters. We found an additive effect of the nondipping pattern on carotid atherosclerosis in normotensive patients with OSA. Our findings suggested that in addition to having established hypertension, a nondipping pattern in normotensive patients with OSA may aggravate atherosclerosis.

Prognostic value of ambulatory blood pressure in chronic kidney disease

Background: Hypertension control is essential to prevent macro vascular complications in patients with chronic kidney disease. Ambulatory Blood Pressure Monitoring (ABPM) is the recognized gold standard for the assessment of hypertension and hence in this study ABPM assessment was done in 50 patients with dialysis dependant CKD to evaluate the adequacy of BP control and prevent adverse events.Methods: This study is a prospective observational study conducted at Aarupadai Veedu Medical College and Hospital, Pondicherry among hypertensive patients with dialysis dependant CKD patients as per standard criteria. A total of 50 patients participated in this study of both gender after obtaining written consent. Patients with coronary artery disease, diabetes mellitus, acute kidney injury were excluded from this study.Results: Out of the total 50 patients included in this study 72% had early morning dipping in BP and remaining 28% had non-dipping in systolic and diastolic pressure. The mean systolic pressure reached a maximum of 160.95mmHg to a minimum of 113.38mmHg and the mean diastolic pressure with a maximum of 98.47 to a minimum of 62.71mmHg on an overall 24 hours ABPM monitoring. The mean systolic and diastolic pressure was found to be more in the active period than in the passive period.Conclusions: Nocturnal BP is superior to day time BP in predicting CVD outcomes. This study shows both systolic and diastolic pressure variability over 24hrs maximum during night hours (nocturnal hypertension) and non-dipping of early morning BP. Both non-dipping status and nocturnal hypertension are associated with target organ damage and CV risk.

Nondipping pattern on 24-h ambulatory blood pressure monitoring is associated with left ventricular hypertrophy in chronic kidney disease.

Few studies have assessed the role of 24-h ambulatory blood pressure monitoring (ABPM) in adults with nondialysis chronic kidney disease (CKD). We examined the potential determinants of left ventricular hypertrophy (LVH) and mass index (LVMI) in this population. We carried out a cross-sectional study on 69 stage 3b-5 CKD adults who had ABPM and transthoracic echocardiography performed simultaneously. Hypertension (HT) was defined as 24 h blood pressure (BP) of at least 130/80 mmHg. ABPM parameters considered were BP dipping status, BP load, and the BP night-time/daytime ratio. We performed stepwise backward multivariate linear and logistic regression to assess the determinants of LVH and LVMI. ABPM parameters were considered the main independent variables, whereas HT, angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist use, glomerular filtration rate of less than 30 ml/min/1.72 m, diabetes, smoking, age, sex, hemoglobin, and parathyroid hormone levels were considered covariates. LVH was present in 22 (31.8%) patients. In linear regression analysis, systolic [β=-13.8, 95% confidence interval (CI)=-26.3 to -1.3, P=0.031] and mean (β=-13.5, 95% CI=-25.7 to -1.2, P=0.031) nondipping status was associated with increased LVMI. BP load and night-time/daytime ABPM ratio were not associated with LVMI. In logistic regression analysis, systolic nondipping status (odds ratio=0.27, 95% CI=0.08-0.91, P=0.036) was associated with LVH. Among covariates, estimated glomerular filtration rate of less than 30 ml/min/1.72 m and HT were associated with LVH and increased LVMI. At 1-year follow-up, mean nondipping status on the initial ABPM remained associated significantly with increased LVMI (β=-19.8, 95% CI=-36.6 to -3.0, P=0.022). These data confirm the high incidence of LVH among nonrenal replacement therapy CKD patients and suggest that the nondipping phenomenon on ABPM is associated independently with LVH and increased LVMI in this population.

The effect of birth season on diurnal variation of blood pressure in hypertensive patients

Background. Birth season has been found to be related to cardiovascular disorders, but the underlying mechanisms are unclear. The aim of this study was to evaluate the relationship between birth season and diurnal variation in blood pressure (BP) parameters in hypertensive patients. Material and methods. We enrolled 194 patients. The date of birth was recorded with the season of birth determined as winter (December-February), spring (March-May), summer (June-August) or autumn (September-November). All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper status. We searched for the relationship between birth season and non-dipper status and other ABPM parameters. Results. 93 patients were classified into the dipper hypertensive group and 101 patients were in the non-dipper hypertensive group. We did not find any association between non-dipper status and birth season in hypertensive patients (p = 0.517). However, we found a significant relationship between diurnal variation in BP and birth season. This difference was observed between winter and spring season. We found a significant relationship between birth season and 24-hour diastolic BP, awake diastolic BP, sleep diastolic BP and sleep mean BP (p = 0.035, p = 0.037, p = 0.036, p = 0.032, respectively). These ABPM parameters were lower in patients born in winter than in those born in spring. Conclusion. Birth season was found to be related to diurnal variation in blood pressure in hypertensive patients. Hypertensive individuals born in winter had lower blood pressure than those born in spring.

Abstract P374: 24-h Blood Pressure Profile, Non-dipping Status And Incidence Of Resistant Hypertension In Patients Randomized To Bariatric Surgery Versus Medical Therapy: The Gateway Randomized Trial

Background: Bariatric surgery represents an effective strategy for office blood pressure (BP) reduction in obese hypertensive patients. However, no previous study evaluated the impact of bariatric surgery on 24-h BP profile, non-dipping status and incidence of resistant hypertension (RH). Methods: This is a sub-analysis of a randomized clinical trial including hypertensive patients with grade 1 and 2 obesity, aged 18 to 65 years, using at least 2 drugs at optimal doses or &gt;2 at moderate doses. Patients were randomly allocated to either Roux-en-Y Gastric Bypass (RYGB) with medical therapy (MT) or MT alone for 12 months. We analyzed the 24-h BP profile, non-dipping status (defined by &lt;10% of systolic BP reduction during sleep as compared to the daytime period) and RH incidence. Results: A total of 100 patients were included (76% female, age 43.8±9.2 years, BMI 36.9±2.7 Kg/m 2 ). The 24-h BP profile was similar at 12 months in both groups, but the RYGB group required less anti-hypertensive classes compared to the MT alone (Figure). The rate of non-dipping BP did not change significantly during the follow-up (RYGB: from 18/48 (37.5%) to 22/48 (45.8%); p=0.30; MT: from 16/33 (48.5%) to 15/33 (45.5%); p=0.80). In an exploratory analysis, the incidence of RH was similar at the baseline (RYGB 10% (5/50) and MT 16% (8/50); p=0.38). After 12 months, it changed significantly in the RYGB group: 0% (0/49) while remained stable in the MT group: 14.9% (7/47) (p&lt;0.001). Conclusions: RYGB significantly reduced anti-hypertensive medications while promoting similar 24-h BP profile and non-dipping BP status compared to the MT alone. RYGB may be an attractive strategy to reduce RH incidence in obese patients.

Can neutrophil to lymphocyte ratio and platelet to lymphocyte ratio be used as biomarkers for non-dipper blood pressure?

Aim: Hypertension is a major risk factor for cardiovascular diseases and non-dipper status is associated with increased risk for cardiovascular events. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are related to inflammation and cardiovascular risk. The purpose of the study is to investigate the relationship between NLR and PLR with non-dipper status of hypertensive and normotensive patients. Methods: A total of 482 patients were enrolled for the study. The study was planned as retrospective cohort study. Four groups were formed according to 24-h ambulatory blood pressure monitoring results. Group 1 was defined as hypertensive, non-dipper patients; group 2 as hypertensive, dipper patients; group 3 as normotensive, non-dipper patients and group 4 as normotensive, dipper patients.Results: Mean age of the study population was 50.1±15.5 years, 38.1% were male. According to the statistical analysis of Group 1 (n=165), Group 2 (n=88), Group 3 (n=123) and Group 4 (n=91) NLR was statistically different among groups (p&lt;0.001). Group 1 had significantly higher values compared to Group 2 (p=0.001), Group 3 (p=0.002) and Group 4 (p=0.023). In hypertensive patient group, PLR values of Group 1 was significantly higher than Group 2 (p=0.002). Pearson correlation analysis showed that NLR and PLR were correlated with BP variability (r=-0.188, p&lt;0.001 for NLR and r=-0.182 and p&lt;0.001 for PLR). Regression analysis showed NLR (p=0.040), PLR (p=0.021), age (p=0.006) and hypertension (p&lt;0.001) were independent predictors of BP variability.Conclusion: Our findings suggest that NLR and PLR can be used as inexpensive and easily accessible markers to detect non-dipper status in hypertensive patients.

Serum hs-CRP, YKL-40 and brain-derived neurotrophic factor (BDNF) associated biomarkers in non-dipper hypertension profile?

Abstract Background: Twenty-four hours dynamic blood pressure (BP) behaviour displays dipper profile defined as nocturnal systolic BP (SBP) reduction&gt;10% compared to daytime. Non-dipper profile, nocturnal absence of SBP fall, associates an increased cardiovascular risk. We investigated the concomitant association of inflammatory bio-markers - high-sensitivity- C-reactive protein (hs-CRP), Human Chitinase3-like1 (YKL-40) and autonomic nervous system (total brain-derived neurotrophic factor, BDNF) with respect to non-dipping blood pressure status. Material and method: Using 24h automatic BP measurements, 80 known hypertensive patients were divided into two groups: dipper group included fifty-one dipper patients (age 55.6 ±13.5 years) and non-dipper group consisted of 29 non-dipper subjects (62.07±12.03 years). Serum levels of hs-CRP were evaluated with enhanced immunoturbidimetric assay. Plasma levels of YKL-40 were measured by commercial sandwich ELISA using microplate coated with a monoclonal antibody for CHI3L1. Plasma levels of total BDNF were determined using quantitative sandwich enzyme-linked immunoassay. Statistical analysis of obtained data was performed. Results: In the non-dipper group, a significant positive association with age over 60 years, hs-CRP values above 1.90 mg/dl was observed along with increased mean values of YKL-40. Non-dipper status is independently and statistically significantly associated with elevated levels of hs-CRP (OR: 3.248, 95% CI: 1.022-10.317, p=0.046) in multivariate odds ratio analysis. No statistically significant positive association between a median total BDNF plasma level of 1430 pg/ml and the non-dipper hypertension profile was identified. Conclusion: Our study demonstrated that patients over 60 years, in particular, have a higher probability to present a non-dipping pattern of hypertension. hs-CRP and YKL-40 values are more likely to increase in the non-dipping hypertensive patients, and hs-CRP values above 1.9 mg/dl can identify the presence of a non-dipper blood pressure profile.

Association between nondipping pattern and EndoPAT signal in patients with mild obstructive sleep apnea

ObjectiveTo compare vascular endothelial function between dipping (D) and nondipping (ND) patterns in patients with and without mild obstructive sleep apnea (OSA) using EndoPAT, a test of reactive hyperemia used to assess peripheral vascular endothelial function. MethodsThe sample consisted of individuals of both genders between 18 and 65 years of age with a body mass index (BMI) of ≤35 kg/m2 and apnea/hypopnea index (AHI) of ≤15. The nondipping pattern was considered present when the dip of nocturnal blood pressure (NBP) was <10%. All of the sample underwent clinical and physical evaluation, full polysomnography, 24-hour ambulatory blood pressure monitoring, and EndoPAT evaluation. A generalized linear model was used for statistical analysis. ResultsThe sample comprised 120 individuals, 35 in the control group and 85 in the mild OSA group. Four groups were formed: Control-ND, Control-D, Mild OSA-ND, and Mild OSA-D according to nocturnal ABPM patterns. The frequency of nondipping was (34.1%) in the Mild OSA group and (17.1%) in the Control group (p = 0.07). The Mild OSA-ND group had a higher augmentation index (AIx) than the Mild OSA-D group. Regression analysis showed that male gender, higher age, and nondipping status were associated with these results, whereas oxygen desaturation index (ODI) and AHI did not. With respect to the reactive hyperemia index (RHI), the Mild OSA-D group had lower values compared to the Control-ND group, but an association with OSA was not confirmed in the regression model. ConclusionNondipping status was associated with a worse augmentation index in both groups independently of AHI or oxygen desaturation index. Male gender, higher age, and nondipping status were associated with augmentation index.ClinicalTrials.gov Identifier: NCT01461486.

Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P-wave dispersion and P terminal force.

Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on left atrial (LA) systolic and diastolic functions using two-dimensional speckle tracking echocardiography (2D-STE), P-wave dispersion (PWD), and P terminal force (PTF) in hypertensive patients. A total of 72 patients and 39 healthy individuals were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Atrial electromechanical delay times, LA strain values were obtained by 2D-STE with automated software and compared between the groups. PWD and PTF data were calculated on the electrocardiography. Inter-atrial (dippers: 25.5±3.9, nondippers: 32.2±7.4, P<.001), left-atrial (dippers: 14.9±3.7, nondippers: 18.2±6.0, P=.016), and right atrial (dippers: 10.5±2.1, nondippers: 14.2±5.2, P<.001) electromechanical delay times were significantly longer in nondippers. LA strain S (dippers: 34.2 [29.7-38.7], nondippers: 27.7 [22.7-32.2], P<.001), LA strain E (dippers: 18.2 [16.6-20.1], nondippers: 14.4 [11.6-16.8], P<.001), and LA strain A (dippers: 15.8 [13.5-17.9], nondippers: 12.7 [9.9-14.5], P<.001) were significantly lower in nondippers. Nondippers also had an increased values of maximum P-wave duration (dippers: 0.117 [0.10-0.12], nondippers: 0.126 [0.12-0.14], P<.001), PWD (dippers: 0.062 [0.06-0.07], nondippers: 0.069 [0.06-0.08], P=.004), and PTF (dippers: 0.055±0.02, nondippers: 0.066±0.02, P=.02). Nondipping pattern in hypertensive patients had a worse cardiac remodeling, and impaired mechanical LA function compared with dipping pattern. The PWD and PTF findings support these changes.

NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATIO ARE INDEPENDENT PREDICTORS FOR BLOOD PRESSURE VARIABILITY

Objective: Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring is used for detection, follow-up of hypertensive patients and also demonstrates the diurnal variability of the blood pressure. Decreased blood pressure variability is associated with hypertensive target organ damage and higher risk for cardiovascular events. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are also related to inflammation and increased cardiovascular risk. The purpose of the study is to investigate the relationship between NLR and PLR with non-dipper status of hypertensive and normotensive patients.Design and method: A total of 482 patients were evaluated retrospectively. Patients with previous hypertension diagnosis, acute coronary syndrome, serious valve regurgitation or stenosis, coronary artery disease, echocardiographic findings of reduced left ventricular ejection fraction (LVEF < 55%), congenital heart diseases, abnormal kidney function, chronic liver disorders, chronic inflammatory disease, patients who had a recent history of acute infection were excluded. Results: Mean age of the study population was 50.1 ± 15.5 years, 38.1% were male. Four groups were formed according to hypertension diagnosis, dipper and non-dipper patterns. Group 1 was consisted of 165 patients with hypertensive and non-dipper status; group 2 was consisted of 88 patients with hypertensive and dipper status; group 3 was consisted of 123 patients with normotensive and non-dipper status; and group 4 was consisted of 91 patients with normotensive and dipper status. Neutrophil lymphocyte ratio was statistically different among groups (p = 0.000). Group 1 had significantly higher values compared to Group 2 (p = 0.001), Group 3 (0.002) and Group 4 (p = 0.023). In hypertensive patient group, PLR values of Group 1 was significantly higher than Group 2 (p = 0.002). Pearson correlation analysis showed that NLR and PLR were correlated with BP variability between night and day (r = -0.188, p = 0.000 for NLR and r = -0.182 and p = 0.000 for PLR). Regression analysis showed NLR (p = 0.040), PLR (p = 0.021), age (p = 0.006) and hypertension (p = 0.000) were independent predictors of BP variability. Conclusions: In conclusion NLR and PLR can be used as easily accessible and inexpensive markers for non-dipper status especially in hypertensive patients.

Nocturnal blood pressure dipping is similar in rheumatoid arthritis patients as compared to anormal population.

Rheumatoid arthritis (RA) is asystemic autoimmune inflammatory disorder which further doubles the risk of developing cardiovascular disease. Some studies suggest that in RA patients, the prevalence of hypertension increases due to prednisolone use, clinical status, genetic factors, and physical inactivity. On the other hand, dipper and non-dipper status in RA patients compared to non-RA subjects has not been investigated to our knowledge. Purpose of the study is to investigate whether non-dipper status is more deteriorated in RA patients. Sixty-five RA patients and 61age-sex-matched control patients were evaluated in this cross-sectional study. Patients were classified according to 24-h ambulatory blood pressure monitoring results. Patients with previous hypertension diagnosis, coronary artery disease, and abnormal kidney function were excluded. Mean age of the study sample was 53.7 ± 12.3years and 40.5% were male. There was no significant difference between groups in terms of basic demographic characteristics. Leukocyte counts (p = 0.001), neutrophil counts (p = 0.001), and red cell distribution width (p = 0.000) were significantly higher in the RA group. ABPM results indicate no significant difference between RA patients and the control group in terms of daytime systolic and diastolic blood pressure, nighttime systolic and diastolic blood pressure, and average systolic and diastolic blood pressure results (p > 0.05). There was no statistical difference regarding the non-dipper status of patient groups (p = 0.412). Nocturnal blood pressure dipping was significantly similar between groups (p = 0.980). In conclusion, RA patients have similar values in terms of nocturnal blood pressure dipping and hypertension diagnosis as compared to normal population.

Noctural dipping status and left ventricular hypertrophy: A cardiac magnetic resonance imaging study.

We investigate the impact of dipper status on cardiac structure with cardiovascular magnetic resonance (CMR). Ambulatory blood pressure monitoring and 1.5T CMR were performed in 99 tertiary hypertension clinic patients. Subgroup analysis by extreme dipper (n=9), dipper (n =39), non-dipper (n =35) and reverse dipper (n =16) status was performed, matched in age, gender and BMI. Left ventricular (LV) mass was significantly higher for extreme dippers than dippers after correction for covariates (100±6g/m2 vs 79±3g/m2 , P=.004). Amongst extreme dippers and dippers (n =48), indexed LV mass correlated positively with the extent of nocturnal blood pressure dipping (R=.403, P=.005). On post-hoc ANCOVA, the percentage of nocturnal dip had significant effect on indexed LV mass (P=.008), but overall SBP did not (P=.348). In the tertiary setting, we found a larger nocturnal BP drop was associated with more LV hypertrophy. If confirmed in larger studies, this may have implications on nocturnal dosing of anti-hypertensive medications.

The relationship of age-adjusted Charlson comorbidity ındex and diurnal variation of blood pressure

ABSTRACTBackgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients.Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed.Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = −0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012–1.165)Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality.

Increasing ambulatory pulse pressure predicts the development of left ventricular hypertrophy during long-term follow-up.

Ambulatory blood pressure (ABP) has been shown to have an association with left ventricular hypertrophy (LVH). We evaluated the association between ABP characteristics and the development of LVH during long-term follow-up (20 years) in 420 middle-aged subjects from OPERA cohort. ABP measurements (ABPM) were recorded and echocardiographic examinations were performed at baseline and revisit. Anthropometrics were measured and laboratory analyses performed at visit. The questionnaire presented to all participants elicited detailed information about their habits. Left ventricular mass index (LVMI) was calculated according to Troys method. Baseline LVMI was a significant independent predictor of LVMI change (p < 0.001). None of the baseline continuous ABPM predicted the change in LVMI. A greater increase in daytime and night-time systolic blood pressure (BP) (p from 0.006 to 0.048) and 24 h, daytime and night-time pulse pressure (PP) (p from 0.005 to 0.034) predicted a greater increase in LVMI. Especially the increase in night-time SBP (p = 0.006) and PP (p = 0.005) predicted a greater increase in LVMI. We also considered circadian BP profiles among subjects, whose ABPM at baseline and echocardiographic measurements both at baseline and follow-up were available. Diastolic non-dippers were observed to show a greater increase in LVMI compared to diastolic dippers (10.6 ± 33.0 g/m2 vs. 7.0 ± 28.8 g/m2, p = 0.032), when baseline LVMI and in-office DBP were taken account. These findings suggest that an increasing ambulatory PP increases and a diastolic non-dipping status may increase the risk for the development of LVH during later life course.

Discerning the relationship between left ventricular geometry, high-sensitivity troponin T, and nondipper hypertension.

Hypertension can cause anatomic changes in the left ventricle, generally leading to abnormal geometry. High-sensitivity cardiac troponin T (hs-cTnT) values have been shown to be positively correlated with left ventricular hypertrophy in hypertensive patients. The current study investigated the diagnostic value of hs-cTnT in patient with nondipper hypertension (NDH) as well as determined the correlation between left ventricular geometric patterns and hs-cTnT values in hypertensive patients. A total of 100 consecutive patients (58 women and 42 men) who were referred to our clinic between 1 October 2015 and 1 March 2016 with elevated blood pressure (BP) were included. Of the patients, 63 had dipper hypertension [nocturnal decline in mean BP (≥10%)], whereas the remaining 37 had NDH [nocturnal decline in mean BP (<10%)]. Of note, hs-cTnT levels were measured only once during admission. Echocardiographic examinations were performed at baseline month and repeated at the sixth month. Hs-cTnT was significantly increased in those with NDH (P<0.001). The NDH group experienced significant decreases in concentric hypertrophy pattern over 6 months (P=0.014). Hs-cTnT was significantly related with nondipping status (r=0.747, P<0.001). Hs-cTnT was also an independent predictor of NDH (odds ratio=1.034, 95% confidence interval: 1.018-1049, P<0.001). Hs-cTnT value of more than 0.95 ng/l predicted NDH with a sensitivity of 75% and specificity of 98% (area under the curve: 0.86; 95% confidence interval: 0.782-0.925; P<0.001). Our current results indicate that patients with NDH had higher hs-cTnT levels than the patients with dipper hypertension. Hs-cTnT was an independent predictor of NDH and was significantly related with nondipping status. Hence, hs-cTnT may be used as diagnostic biomarker in NDH.