Non-dipping Blood Pressure Research Articles

The Impact of Blood Pressure Rhythm and Perioperative Blood Pressure Variability on Short-Term Prognosis in Patients with Type A Aortic Dissection.

Aims/Background Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. Methods This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. Results The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis (p < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. Conclusion A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures.

The Influence of Non-Dipping Pattern of Blood Pressure in Gestational Hypertension on Early Onset of Hypertension Later in Life-Single Center Experience in Very-High-Risk Southeast and Central European Country.

Gestational hypertension (GH) and preeclampsia (PE) are associated with the onset of hypertension. This study aimed to investigate whether the blood pressure (BP) pattern in GH is associated with the prevalence of hypertension later in life. In this prospective cohort study pregnant women screened for GH underwent medical history, laboratory analysis, ambulatory blood pressure monitoring (AMBP), and transthoracic echocardiography (with left ventricular global longitudinal strain (LVGLS)) assessment. Overall, 138 GH (67 non-dippers and 71 dippers), 55 preeclamptic, and 72 normotensive pregnant controls were included. Women were followed in the postpartum period, first after 6 weeks and later on, for the occurrence of hypertension. The median follow-up was 8.97 years (8.23; 9.03). Non-dippers and PE compared with normotensives and dippers had a higher prevalence of hypertension onset (p < 0.01), as well as significantly reduced absolute values of LVGLS during pregnancy, after delivery, and at the time of onset of hypertension during follow-up (p < 0.01). Night-time diastolic BP, LVGLS, age, and left ventricular ejection fraction were the strongest predictors of postpartum onset of hypertension. The non-dipping BP pattern in GH was significantly associated with the onset of hypertension later in life, as well as with decreased systolic function.

Nocturnal blood pressure dipping and left ventricular hypertrophy among hypertensive outpatients in a Ghanaian hospital.

To investigate the association between the extent of nocturnal systolic blood pressure decline and left ventricular hypertrophy in patients with primary hypertension who were receiving antihypertensive drug therapy. This was a cross-sectional hospital-based study from November 2020 to March 2021. The study was conducted at the Polyclinic of Korle Bu Teaching Hospital, Ghana. Outpatients ≥18 years old with primary hypertension who were receiving antihypertensive drug therapy. Each participant underwent a 24-hour ambulatory blood pressure monitoring and a transthoracic echocardiogram. Left ventricular hypertrophy and the extent of mean systolic blood pressure decline during sleep. 180 participants were recruited, comprising 110 (61.1%) females. The participants' mean (±SD) age was 57.6 ± 11.0 years. 80% had a non-dipping blood pressure pattern, and 43.9% had left ventricular hypertrophy. Uncontrolled office blood pressure was an independent predictor of left ventricular hypertrophy in these patients (AOR 2.010, 95% CI 1.048-3.855, p=0.036); however, a non-dipping nocturnal systolic blood pressure status was not (AOR 1.849, 95% CI 0.850-4.022, p=0.121). 61.1% had abnormal left ventricular geometry, with concentric hypertrophy being the predominant geometric pattern. Left ventricular hypertrophy and non-dipping nocturnal blood pressure were common in these hypertensive Ghanaian patients on antihypertensive therapy. Left ventricular hypertrophy was associated with uncontrolled office blood pressure but not the extent of nocturnal systolic blood pressure declines during a single 24-hour ambulatory blood pressure recording. None declared.

Abstract P157: Acute GPER1 Activation Reduces Blood Pressure during the Inactive Period in Aged Female Mice

Non-dipping of blood pressure (BP) during the nighttime is an independent risk factor for hypertension. Importantly, BP dipping is diminished in postmenopausal women, suggesting that the female sex hormones may contribute to the circadian rhythm of BP. Estradiol, activates the G protein-coupled estrogen receptor 1 (GPER1), which elicits protective actions within the cardiovascular system. However, little is known about the GPER1 effect on circadian BP regulation in aged females. Taken together, we hypothesized that systemic GPER1 activation lowers BP and regulates circadian rhythm of BP in aged females. To test the hypothesis, 23-24 months-old C57BL/6J female mice (n=6) were implanted with radio-telemeters for BP recording. After 21 days of postsurgical recovery, BP was recorded. Mice were then given vehicle intraperitoneally daily for 3 consecutive days, followed by the selective GPER1 agonist (LNS8801, 400 µg/kg/day) for an additional 3 days. Data were collected over 24-hour periods according to the 12-hour active period and the 12-hour inactive period. GPER1 activation lowered 24-hour mean arterial pressure (MAP) compared to vehicle control values (113±3 vs. 117±3 mmHg; p=0.01). Similar to MAP, 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower in LNS8801-treated mice compared to corresponding vehicle-treated mice. However, there was not a significant difference in 24-hour heart rate (HR). Interestingly, MAP during the inactive period was lower in LNS8801-treated mice compared to corresponding vehicle-treated mice (104±2 vs. 110±3, respectively, p=0.02). Whereas, GPER1 activation did not elicit significant changes in MAP during the active period. Similarly, LNS8801 reduced DBP during the inactive period (88±4 vs. 96±4 mmHg; p=0.04). We extended the study in aged female mice (14–16 months) with genetic deletion of GPER1 (GPER1 KO; n=6) and wildtype littermates (WT; n=5). Genetic deletion of GPER1 increased 24-hour MAP, SBP, and DBP, whereas HR was not significantly different between genotypes. Noteworthy, GPER1 KO increased MAP during the active period (126±2 vs. 114±1 mmHg; p=0.009) and during the inactive period, compared to WT (110±3 vs. 101±1 mmHg; p=0.01). The results indicate that GPER1 activity lowers BP. Interestingly, LNS8801 acutely improves BP dipping during the inactive period. Overall, GPER1 activation elicits BP-lowering effects in aged female mice, possibly by regulating the circadian BP rhythm.

O59 INFLUENCE OF CIRCADIAN BLOOD PRESSURE PATTERN ON RIGHT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSIION

Background and Objective: It is well proven, that arterial hypertension affects left side of the heart and causes its remodeling and functional changes. Since heart works as a unit and has ventricular interdependence, aim of the study was to assess influence of hypertension and circadian blood pressure (BP) profile on a right ventricular structure and function. Methods: 75 hypertensive patients (57.13±7.27 y/o) and 25 normotensive control subjects (57.56±7.55 y/o) were involved in a study. All of them were males without history of coronary artery disease, cerebrovascular or peripheral artery disease, obstructive lung disease, significant valvular heart disease or heart failure. All of them were either lifetime nonsmokers, or stopped smoking more than 5 years. All the patients underwent to 24-hour ambulatory BP monitoring and heart ultrasound with tissue doppler imaging. Results: Hypertensive patients with dipper circadian BP profile had higher TAPSE (19±1.586 vs 17.708±2.857; P&lt;0.05), higher right ventricular ejection fraction (55.103±4.597 vs 47.829±14.605; P&lt;0,005) and lower right ventricular outflow tract diameter (29.985±3.932 vs 32.639±3.510; P&lt;0/05). None of the echo parameters were different between normotensive subjects with different circadian BP pattern. Trans tricuspid valve early diastolic (E) and late diastolic (A) peak velocities were significantly lower in hypertensive patients (1.416±0.130 vs 0.897±1.49; P&lt;0.005). Hence, non-dipper hypertensives had significantly lower tricuspid E/A ratio in comparison with dippers (0.812±0.094 vs 1.048±0.101; P&lt;0.00001). Interventricular septum and posterior wall diameters were higher in non-dipper hypertensives (1.134±0.131 vs. 1.322±0.138; P&lt;0.00001 and 1.072±0.175 vs. 1.254±0.135; P&lt;0.001; respectively). Conclusion: Study data show increased interdependence between two ventricles. Patients with arterial hypertension have systole-diastolic dysfunction, which especially well is present in patients with non-dipper circadian BP profile.

Long-term effect of obstructive sleep apnoea management on blood pressure in patients with resistant hypertension: the SARAH study.

There is a close relationship between obstructive sleep apnoea (OSA) and resistant hypertension (RH). However, studies assessing the long-term effect of diagnosing and treating OSA on blood pressure (BP) control in these patients are lacking. To address this gap, we recruited 478 RH patients from hypertension units and followed them prospectively after they were screened for OSA through a sleep study. By performing 24-h ambulatory BP monitoring (ABPM) annually, the effect of OSA management was assessed. The patients had a median (interquartile range (IQR)) age of 64.0 (57.2-69.0) years, 67% were males and most were nonsleepy, with a median (IQR) apnoea-hypopnoea index (AHI) of 15.8 (7.9-30.7) events·h-1. The median (IQR) follow-up time was 3.01 (2.93-3.12) years. At baseline, severe OSA was associated with uncontrolled BP, nocturnal hypertension and a nondipper circadian BP pattern. Moreover, these patients had higher BP values during follow-up than did patients in the other groups. However, among patients with moderate and severe OSA, the management of sleep disordered breathing, including the implementation of continuous positive airway pressure treatment, was associated with a reduction in 24-h ABPM parameters, especially night-time BP values, at the 1-year follow-up. These benefits were attenuated over time and only subjects with severe OSA maintained an ABPM night-time reduction at 3 years. Furthermore, clinical variables such as uncontrolled BP, sex and age showed a predictive value for the BP response at 1 year of follow-up. A favourable long-term decrease in BP was detected by diagnosing and treating OSA in a cohort of RH patients from hypertension units, but over time this decrease was only partially maintained in severe OSA patients.

Prediction of non-dipper blood pressure pattern in Chinese patients with hypertension using a nomogram model.

Non-dipper blood pressure has been shown to affect cardiovascular outcomes and cognitive function in patients with hypertension. Although some studies have explored the influencing factors of non-dipper blood pressure, there is still relatively little research on constructing a prediction model. This study aimed to develop and validate a simple and practical nomogram prediction model and explore relevant elements that could affect the dipper blood pressure relationship in patients with hypertension. A convenient sampling method was used to select 356 inpatients with hypertension who visited the Affiliated Hospital of Jining Medical College from January 2022 to September 2022. All patients were randomly assigned to the training cohort (75%, n = 267) and the validation cohort (25%, n = 89). Univariate and multivariate logistic regression were utilized to identify influencing factors. The nomogram was developed and evaluated based on the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and decision curve analyses. The optimal cutoff values for the prevalence of dipper blood pressure were estimated. The nomogram was established using six variables, including age, sex, hemoglobin (Hb), estimated glomerular filtration rate (eGFR), ejection fraction (EF), and heart rate. The AUC was 0.860 in the training cohort. The cutoff values for optimally predicting the prevalence of dipper blood pressure were 41.50 years, 151.00g/L, 117.53mL/min/1.73m2, 64.50%, and 75 beats per minute for age, Hb, eGFR, ejection fraction, and heart rate, respectively. In summary, our nomogram can be used as a simple, plausible, affordable, and widely implementable tool to predict the blood pressure pattern of Chinese patients with hypertension.

#2249 Morning blood pressure and heart rate surge in peritoneal dialysis patients

Abstract Background and Aims The increased surge of blood pressure (BP) early in the morning and the parallel increase of heart rate (HR) are risk factors for cardiovascular disease in general and CKD populations. Early morning changes in these parameters have not been investigated in peritoneal dialysis (PD) patients. The aim of the study is to correlate the morning fluctuations of BP and HR with left ventricular hypertrophy and cardiovascular risk. Method This was a cross-sectional study of PD patients followed-up in our Peritoneal Dialysis Unit (PDU). At their regular visit to our PDU, a 24-hour ambulatory BP measurement (Mobil-o-graph®) was performed. A diary was given to the patients in order to record the time they performed their evening exchange (continuous ambulatory peritoneal dialysis- CAPD) or connection to the automated peritoneal dialysis (APD) machine, the time they laid down, the time they approximately fell asleep, when they woke up in the morning, when they inclined from the bed and the time they performed the morning exchange or disconnection. The 24-hour BP recordings were analyzed in the available software and calculations were done based on the diary information; pre-awakening BP, HR surges, nocturnal dipping, weighted 24 h systolic BP and HR variability. Demographic, laboratory data and left heart hypertrophy parameters of the patients were also recorded. 35 patients were eligible for participation in the study; 2 denied participation, 1 was rejected due to ongoing cancer therapy and two patients were declined due to invalid BP measurements. Finally 30 patients (10 males and 20 females) were analyzed, 9 were on CAPD and 21 were on APD. Results The mean age of the patients was 60.5 ± 12.6 years old and the median PD vintage was 21.5 months (8.25-58) (Table 1). Left Ventricular Mass index (LVMi) was 99.01 ± 28 g/m2 (Table 1). The 24h systolic BP was 125.66 ± 10.9 mmHg and the diastolic BP was 79.59 ± 7.7 mmHg (Table 2). The mean pre-awaking Systolic BP surge was 10.76 ± 9.7 mmHg, the median non-dipping blood pressure 8.6 (IQR 1.11-12.86), the mean heart rate surge was 3.3 ± 4.7 /min and the mean non-dipping HR was 9.7 ± 5.9/min (Table 2). There was no statistically significant correlation of the parameters above with the LVMi. Patients with high cardiovascular risk (diabetes, coronary heart disease, heart failure) had statistically higher non-dipping BP (27 vs 12.3 mmHg, p = 0.034) and higher nighttime SPB (27 vs 20.74 mmHg, p = 0.024). When compared patients in CAPD vs APD, there were no differences in the pre-awaking BP or the rest of the measurements performed, although APD patients recorded interrupted sleep due to the alarms of the APD machine. Conclusion PD patients with high cardiovascular risk had higher nondipping BP and nighttime systolic BP compared with patients without cardiovascular disease. There were no correlations of BP and heart rate morning surge with left ventricular hypertrophy or PD mode.

MASKED HYPERTENSION IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE – AN UNDERESTIMATED RISK?

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension are major cardiovascular risk factors sharing a bi-directional relationship. Although nearly half of MASLD patients are suffering from arterial hypertension, data on the prevalence of different hypertension phenotypes (e.g. masked hypertension) in this patient population are scarce. Masked hypertension, which is defined by normal office blood pressure but elevated blood pressure in the ambulatory 24-hour blood pressure measurement (24-h-ABPM), often remains undetected, although it has a comparable risk for adverse cardiovascular events as sustained hypertension. Therefore, the identification of this hypertension phenotype in MASLD patients seems highly relevant. Design and method: To analyze the prevalence of masked hypertension and to improve hypertension management in MASLD patients we integrated a 24-h-ABPM-based hypertension screening and control program among MASLD patients in our outpatient liver department. A total of 226 MASLD patients were recruited during regular follow-up visits and recording of office blood pressure and 24-h-ABPM measurements were performed according to a standardized protocol. Results: For the final analysis, 218 data sets were evaluated. The median age of the included 218 patients was 51 years, 48.2% were female. 101 (46.3%) MASLD patients had prior history of hypertension. At the time of ABPM 93 (92.1%) of these patients received antihypertensive treatment. Masked hypertension was identified in 46 (21.1%) MASLD patients, 20 (43.5%) of whom were receiving antihypertensive treatment (masked uncontrolled hypertension). Interestingly, 14 (30.4%) MASLD patients with masked hypertension had isolated nocturnal masked hypertension. Furthermore, a non-dipping blood pressure pattern was recognized in 28 (60.9%) MASLD patients with masked hypertension. Conclusions: Due to the high rates of masked hypertension and abnormal nocturnal blood pressure dipping, which both represent important risk factors for adverse cardiovascular events, the establishment of hypertension screening and management programs in this high-risk population seems urgently needed. Controlled hypertension reduces the risk of cardiovascular events in this vulnerable population and, due to the strong link between MASLD and hypertension, possibly also slow the progression of MASLD to advanced liver fibrosis or cirrhosis.

IMPACT OF NON-DIPPER PATTERN ON LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN, IN HYPERTENSIVE PATIENTS. NACIM DAHMANI1, NABILA SOUFI TALEB BENDIAB2, MOUHAMED SOUFIANE LOUNES1

Objective: Several studies have shown that the non-dipper blood pressure pattern, defined by a nocturnal decrease in blood pressure (BP) of less than 10% at the 24-hour ambulatory blood pressure monitoring (ABPM), is associated with an increase in cardiovascular risk and risk of target organ damage, however, there are few data on the non-dipper effects on the longitudinal strain overall studied by 2D speckle tracking. The aim of this study is to evaluate the impact of nocturnal dipper/non-dipper pattern on the global longitudinal systolic (GLS) of left ventricle by means of two-dimensional speckle tracking echocardiography (2D STE), of hypertensive patients under treatment or not. Design and method: This is a cross-sectional descriptive study conducted over a period of 20 months, from November 2021 to June 2023. The study included a total of 382 patients with arterial hypertension, enrolled consecutively. All participants were subjected to clinical evaluation, biological examination, 24-hour ambulatory blood pressure monitoring and echocardiography with GLS. The patients were divided into dippers and non-dippers, according to the percentage reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night. The study sought to analyze the relationship between these nocturnal profiles and GLS. Results: 179 patients (46.90%) are non-dippers. The non-dippers had a significantly lower GLS value than the dippers (-19.45 ±2.03 vs -18.2 ±2.17, P &lt; 0.001). The multivariate linear regression confirmed this independent relationship of the GLS and the non-dipping (β = -0.157, P=0.013), however, we do not find independent relationships between the non-dipping and the diastolic function on the one hand and the non-dipping and the LV geometry on the other hand. Conclusions: This study shows that non-dipping is associated with subclinical systolic dysfunction of the LV, as shown by the decrease in the GLS studied by 2D Speckle-Tracking, in hypertensive non-dippers patients.

The association between blood pressure variability and renal damage in patients with primary aldosteronism.

This research examines the association between blood pressure variability (BPV) and renal damage in a cohort of 129 primary aldosteronism (PA) patients, employing ambulatory blood pressure monitoring (ABPM) for comparative analysis with individuals diagnosed with essential hypertension (EH). The study reveals that PA patients exhibited significantly elevated levels of cystatin C and urine microalbumin/creatinine ratio (UACR). Additionally, a higher prevalence of non-dipping blood pressure patterns in PA patients suggests an increased risk of circadian blood pressure regulation disturbances. Notably, while most BPV indices were comparable between the two groups, the standard deviation of 24-h weighted diastolic blood pressure was markedly lower in the PA cohort, distinguishing it as a unique variable. Through multiple linear regression analysis, the duration of hypertension, angiotensin II concentrations, and daytime systolic blood pressure standard deviation emerged as significant determinants of estimated glomerular filtration rate (eGFR) in PA patients. Furthermore, UACR was significantly influenced by variables including the 24-h weighted standard deviation (wSD) of systolic BP, glycosylated hemoglobin levels, nocturnal systolic BP peaks, aldosterone-renin ratio (ARR), and total cholesterol, with the most pronounced association observed with the 24-h wSD of systolic BP (β=0.383).The study also found significant correlations between the 24-h wSD of systolic BP, ARR, HbA1c, serum potassium levels, and 24-h urinary microalbumin, underscoring the critical role of the 24-h wSD of systolic BP (β=0.267). These findings underscore the imperative of an integrated management strategy for PA, addressing the intricate interconnections among metabolic abnormalities, blood pressure variability, and renal health outcomes.

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study.

Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991-1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping-dipping (n = 152/33.6%), dipping-non-dipping (n = 198/43.8%), non-dipping-dipping (n = 20/4.4%), and non-dipping-non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping-non-dipping group, and lowest (6.6%) in the dipping-dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping-non-dipping pattern with CV events compared with the dipping-dipping pattern remained significant (HR 4.01; 95% CI 1.89-8.67, p < 0.001). In summary, non-dipping-non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

The Effect of Night Shift on Blood Pressure in Healthcare Workers.

Individuals across all age groups may experience elevated blood pressure due to a combination of internal and environmental factors. Factors influencing arterial pressure include diet, stress, sleep patterns, and lifestyle. This study aims to investigate the susceptibility to high blood pressure among occupational groups working night shifts. The study included healthcare worker participants who had at least six night shifts per month. A control group consisted of participants performing the same roles during daytime. Participants with chronic diseasesor those taking blood pressure-affecting medication were excluded. Holter recordings were made over a minimum of 48 hours, including both a free day and a work day. The study involved 114 participants-55 in the study group and 59 in the control group. Statistically significant differences were noted between the groups in the daylight-night ratios of systolic and diastolic pressures, with P values of 0.006 and 0.005, respectively. The systolic daylight-night difference was -5.7 ± 5.5% in the study group and -9.0 ± 7.0% in the control group. The diastolic daylight-night difference was -7.9 ± 9.6% in the study group and -12.7 ± 8.2% in the control group. Occupations with nighttime work schedules are often associated with non-dipping blood pressure patterns due to sleep disturbances. It is crucial to consider the blunted dipping of blood pressure induced by night shift work when assessing and monitoring hypertension and related medical conditions.

Ambulatory blood pressure and risk of heart failure: a mini-review

The aim of this mini-review is to report current knowledge about the association between ambulatory blood pressure and risk of heart failure in hypertension. We conducted a literature search through PubMed, Web of science and Cochrane Library by using terms such as ambulatory blood pressure, 24-hour blood pressure, daytime blood pressure, nighttime blood pressure, hypertension, heart failure. We identified 4 studies including 7891 patients who developed 260 cases of heart failure during the follow-up. The evaluation of published studies indicates that ambulatory blood pressure is superior to clinic blood pressure in predicting the occurrence of heart failure. Particularly, it has been reported that 24-hour blood pressure values, nighttime nondipping blood pressure pattern and ambulatory resistant hypertension are associated with increased risk of heart failure above clinic blood pressure. Nevertheless, there are still few data in the literature on this topic. Therefore, further studies are needed to broaden our knowledge on this matter to improve our therapeutic approach to prevent HF in hypertensive patients.

NON-DIPPING BLOOD PRESSURE PATTERNS AND ASSOCIATED TARGET ORGAN DAMAGE IN ELDERLY HYPERTENSIVE PATIENTS

Background: Older adults with hypertension face an increased risk of adverse cardiovascular outcomes, emphasizing the importance of target organ damage (TOD) in their treatment. The non-dipping blood pressure (BP) pattern, characterized by inadequate reduction of nocturnal BP (less than 10-20%), is associated with a higher likelihood of TOD in individuals with essential hypertension. This study aimed to examine the characteristics of non-dipping BP patterns among elderly individuals with essential hypertension and evaluate their associations with TOD. Methods: A descriptive cross-sectional study was conducted, involving 96 patients aged ≥60 years (mean age 70.9 ± 7.9 years, 35.4% male). Participants underwent routine clinical and laboratory assessments, including clinic and 24-hour ambulatory blood pressure monitoring. TOD was defined as the presence of left ventricular (LV) hypertrophy, renal impairment, or proteinuria. Results: Non-dipping patterns for systolic and diastolic BP were observed in 36 (36.5%) and 41 (42.7%) patients, respectively. TOD was present in 61 (63.5%) patients. Non-dipping systolic patients exhibited lower rates of diabetes mellitus (37.1% vs. 81.3%, p=0.006), dyslipidemia (68.6% vs. 100%, p=0.011), higher levels of creatinine (median 85.6, interquartile range [IQR] 72.1-101 vs. 70.8, IQR 62.4-78.3 µmol/l, p=0.012), and higher LV mass index (median 106.6, IQR 96.4-148.4 vs. 93.7, IQR 72.9-111.5 g/m2, p=0.028) compared to dipping patients. Non-dipping diastolic patients had a lower prevalence of dyslipidemia (73.2% vs. 100%, p=0.048) and a lower body mass index (median 23, IQR 19.73-25 vs. 25.26, IQR 22.54-27.17 kg/m2, p=0.013). Multivariate analysis, after adjusting for cardiovascular risk, showed that non-dipping patterns (both systolic and diastolic) were associated with TOD (odds ratio 7.21; 95% confidence interval 1.47-35.36, p=0.015). Conclusion. Our study underscores the significant association between non-dipping blood pressure patterns and TOD in elderly individuals with essential hypertension. The notable prevalence of non-dipping patterns emphasizes the clinical importance of monitoring and managing these patterns in clinical practice.

Cardiovascular rhythmicity in overweight and obese children.

Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts. We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms. Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms. The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications.

Metabolipidomic Analysis in Patients with Obstructive Sleep Apnea Discloses a Circulating Metabotype of Non-Dipping Blood Pressure.

A non-dipping blood pressure (BP) pattern, which is frequently present in patients with obstructive sleep apnea (OSA), confers high cardiovascular risk. The mechanisms connecting these two conditions remain unclear. In the present study we performed a comprehensive analysis of the blood metabolipidome that aims to provide new insights into the molecular link between OSA and the dysregulation of circadian BP rhythmicity. This was an observational prospective longitudinal study involving adults with suspected OSA who were subjected to full polysomnography (PSG). Patients with an apnea-hypopnea index ≥ 5 events/h were included. Fasting plasma samples were obtained the morning after PSG. Based on the dipping ratio (DR; ratio of night/day BP values) measured via 24 h ambulatory BP monitoring, two groups were established: dippers (DR ≤ 0.9) and non-dippers (DR > 0.9). Treatment recommendations for OSA followed the clinical guidelines. Untargeted metabolomic and lipidomic analyses were performed in plasma samples via liquid chromatography-tandem mass spectrometry. Non-dipper patients represented 53.7% of the cohort (88/164 patients). A set of 31 metabolic species and 13 lipidic species were differentially detected between OSA patients who present a physiologic nocturnal BP decrease and those with abnormal BP dipping. Among the 44 differentially abundant plasma compounds, 25 were putatively identified, notably glycerophospholipids, glycolipids, sterols, and fatty acid derivates. Multivariate analysis defined a specific metabotype of non-dipping BP, which showed a significant dose-response relationship with PSG parameters of OSA severity, and with BP dipping changes after 6 months of OSA treatment with continuous positive airway pressure (CPAP). Bioinformatic analyses revealed that the identified metabolipidomic profile was found to be implicated in multiple systemic biological pathways, with potential physiopathologic implications for the circadian control of BP among individuals with OSA.

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

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

The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure.

Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05. The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions. MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect.

Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep.It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression.A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.