Non-dipping Status Research Articles

POS-575 GROWING GERIATRIC DIALYSIS POPULATION: ARE CHALLENGES OFTEN OVERLOOKED?

Globally, elderly patients with end-stage renal disease on kidney replacement therapy are increasing and in the Indian subcontinent too elderly dialysis population is growing faster with its emerging challenges. Data on issues related to elderly patients on hemodialysis is limited. Here we analyzed the clinical characteristics and outcome of this cohort of patients. Mortality is high in elderly patients on dialysis than not on dialysis, and it is much influenced by comorbidities This cohort study was done in a chronic hemodialysis unit where 360 patients were undergoing hemodialysis. The study period was between August 2018 and February 2020. Among this, 37 elderly patients (10.3%) with age more than 65 years were included in this study. Basic demographics, laboratory profile, 24-hr ABPM monitoring in the interdialytic period, assessment of depression using the Beck Depression Inventory, and various risk factors influencing the outcome were collected and analyzed Mean age was 67.73 years and 28 (75.7%) of them were males. Majority of them were diabetic (n=25, 67.6%), had hypertension (HT) (n=28, 75.7%) and coronary artery disease (CAD) (n= 30, 81.1%).The median dialysis vintage was 24.64 months. Most of them were on insurance payment (n=27, 73%) and others were on self-payment. 24-hr ABPM done in the interdialytic period showed uncontrolled HT in 30 (n=30, 81.1%) patients and all patients with uncontrolled HT were non-dippers. Uncontrolled HT and non-dipping status were significantly associated with coronary artery disease. Masked HT was noted in 9 patients (24.3%) who had normal peridialytic BP (n=9, 24.3%, p=0.000). The majority of them had AV fistula as the vascular access (76%)) and the remaining were on AV graft (n=7, 19%) and tunnelled catheter (n=2, 5%).In this study, AVF had better primary access survival compared to AV graft (0.001) but there was no significant difference noted in the total cumulative patency between the groups (p=0.15). The impaired vision was observed in 24 (64.9%) patients, history of fall in 5 (13.5%), arthritis in 9 (24%) patients with 3 (8%) of them immobile and 2(5%) were partially mobile. Most of the patients had varying degrees of depression (n=31, 83.7%) with severe depression in more than half of the patients (54%). No significant correlation was noted between diabetic status and mortality. Nine patients died (24%) during the study period. Uncontrolled hypertension in the interdialytic period as measured by ABPM and hypoalbuminemia were significant risk factors associated with mortality (p= 0.05). Cardiovascular events, sepsis, and stroke were the immediate causes of death. Majority of the patients had uncontrolled hypertension and non-dipping status with 24-hr ABPM measurement in the interdialytic period and were significantly associated with cardiovascular events and mortality. There was a high prevalence of depression among elderly patients on dialysis. AV fistula is the preferred choice of vascular access in the geriatric population also with better primary access survival compared to AV graft which has to be considered as an alternate option with poor vascular biology. A large number of patients with the multicenter study will throw more light on the characteristics of elderly HD patients.

24-HR AMBULATORY BLOOD PRESSURE MONITORING & ACTIGRAPHY-MEASURED SLEEP DISTURBANCES

Objective: Non-dippers tend to have a high risk for cardiovascular disease. Actigraphy has been validated for objective measures of sleep in clinical-based and population-based studies. PURPOSE: The purpose of this study was to assess Actigraphy measured sleep disturbances among dippers and non-dippers. Design and method: Thirteen (6F/7 M) relatively healthy and clinically free of any sleep-related disorder were recruited. 24-hr Ambulatory blood pressure (BP) monitor applied to the non-dominant arm was used to profile dipping and nondipping status (awake value - sleep value)/awake value < 0.1. 24-hr wrist (dominant arm) Actigraphy data were collected in 1 min epochs, and the ‘Cole-Kripke’ sleep algorithm for adults was used to assess sleep. Sleep disturbance metrics including sleep efficiency, total min in bed, total sleep time, number of awakenings, long wake after sleep onset (WASO: number of min awake between sleep onset and time of final waking) were assessed. Results: Awake SBP (Mean ± SD) for non-dippers (N = 7) 120.2 ± 8.1 vs. dippers 129.1 ± 8.1mmHg; sleep SBP for non-dippers 117.2 ± 8.4 vs. dippers 114.3 ± 5.5mmHg. Non-dippers vs. dippers sleep efficiency (85 vs. 89%); total min in bed (408 vs. 450 min); total sleep time (352 vs. 398 min); number of awakenings (21.1 ± 10.2 vs. 21.1 ± 3.1) were not statistically different. WASO for non-dippers 55.5 ± 32.5 vs. dippers 49.5 ± 18.2 min (p < 0.05). Conclusions: In our preliminary study with a very small N, WASO was 10% higher in non-dippers compared to dippers despite having similar number of awakenings. This indicates that participants with a non-dipper blood pressure profile have disturbed sleep with being awake for a greater amount of time between sleep onset and time of final waking when compared to dippers. Thus, sleep assessment among non-dippers might be reasonable.

NOCTURNAL NON-DIPPING STATUS AND LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS

Objective: Ambulatory Blood Pressure Monitoring (ABPM) is used to assess the dipping status in hypertensive patients according to the nocturnal blood pressure (NBP) decline: extreme dippers, dippers, non-dippers and inverted dippers. Increased NBP is currently regarded as a risk factor for cardiovascular (CV) events and hypertension-mediated organ damage (HMOD). One of the most common HMOD include left ventricular (LV) remodelling as chronic BP elevation may progressively increase LV thickness. The aim of this study is to determine if there is a higher prevalence of LVH in echocardiographic (ECHO) parameters in patients with increased NBP. Design and method: Prospective observational study. Inclusion criteria: subjects with treated hypertension undergoing ABPM performed in our Primary Health Care Unit and with ECHO in the last 3 years. Fisher's exact test was used whenever appropriate to assess independence and statistical significance of reported factors. Logistic regression analysis was performed to assess the effects and its statistical significance between established parameters. Statistical differences were indicated as p < 0.05 and p < 0.01. Statistical analysis was performed using R version 4.0.3. Results: For this study, 67 patients were screened, from which 44 were male and 23 females, average age of 55 years old. We obtained a distinct distribution of dipper and non-dipper profiles in a LVH dependent manner. The non-dipper presented higher significant effect with LVH (p < 0.01) and the results obtained from the fisher test showcase a statistically significant relation between non-dippers and LVH (annex 1) Conclusions: The limitations of this study included the small sample size and the usage of a questionable diagnose of dipping status in a 24 h period since it is often highly variable. Based on the results, there seems to be an impact of NBP on LV structure since there is a statistically significant relation between non-dipper status and LVH. Hypertensive patients should be submitted to ECHO and other forms of HMOD screening, especially non-dippers, considering their increased CV risk, in order to improve CV risk stratification therapeutic strategies.

NON-DIPPING ASSOCIATED PARAMETERS IN SINUS RHYTHM INDIVIDUALS

Objective: The aim of the study was to evaluate the association between non-dipping pattern of systolic BP (SBP) in sinus rhythm individuals. Design and method: We studied 145 individuals (mean age, 60 [95% CI, 59–62] years, 54% men), 92% was essential hypertension patients, who underwent 24-h ABPM and 24-h ECG. Averages were measured for SBP, diastolic (DBP), pulse pressure (PP), mean arterial pressure (MAP) and 24-h ambulatory arterial stiffness index (AASI) calculated. According to the degree of nocturnal SBP fall (according to the 24-hour-clock-based definition of night from 1 am to 6 am), patients were sub-classified as dippers (39%) and non-dippers (61%), which included mild dippers (60/89), extreme dippers (6/89), reverse dippers (23/89). A bivariate multivariate logistic regression analysis (Stata 15) was performed to evaluate the value of ABPM parameters for non-dipping status. Results: Comparisons between groups showed no differences in age, sex, as well as in SBP, DBP, PP, MAP. The best fitting model for explanatory non-dipping pattern (log likelihood = -97.82; AUC ROC = 0.6372) after adjustment for age, sex (male vs female), SBP, DBP, PP, MAP with ORs included AASI (11.57 [CI 95%, 1.02–130.47], p = 0.048). Conclusions: 24-h AASI is the only one ABPM parameter that associated with non-dipping pattern in individuals with sinus rhythm.

Renal function outcomes and kidney biopsy features of living kidney donors with hypertension.

The medium- to long-term outcomes of living kidney donors with hypertension compared to normotensive donors are not well understood, especially with the recent changes in hypertension guidelines. We studied a cohort of 950 living kidney donors using different definitions of hypertension based on either ≥140/90 or ≥130/80mmHg thresholds and based on either office or ambulatory blood pressure readings. Microstructural features on kidney biopsy at the time of donation were compared using different definitions of hypertension. After adjusting for years of follow-up, age, sex, and baseline eGFR, hypertension (by any definition) did not significantly predict an eGFR<45ml/min/1.73m2 at a median follow-up of 10years postdonation, though there was a borderline association with ambulatory blood pressure≥130/80mmHg predicting a 40% decline in eGFR (OR=1.53, 1.00-2.36; p=.051). Proteinuria was predicted by office blood pressure≥140/90mmHg and by nondipper profile on nocturnal ambulatory blood pressure measurements. At the time of donation, larger glomeruli and arterial hyalinosis on biopsy were associated with hypertension defined by either ≥140/90 or ≥130/80mmHg (by office or ambulatory measurements). Nocturnal nondipper status was associated with larger glomeruli size but not arteriolar hyalinosis when compared to dippers. In programs that accept donors with controlled hypertension, various definitions of hypertension are associated with histological findings in the donated kidney, but none predict a clinically significant decline in kidney function 10years after donation. These data support allowing healthy individuals with controlled hypertension to donate a kidney. However, donors with office hypertension (≥140/90mmHg) and nondippers (regardless of hypertension status) are at greater long-term risk for proteinuria, and particularly for these donors, longer follow-up is warranted.

Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial

BackgroundThere is an emerging body of evidence that links exposure to shift work to cardiovascular disease (CVD). The risk of coronary events, such as myocardial infarction, is greater among night shift workers compared to day workers. There is reason to believe that repeated exposure to shift work, especially night shift work, creates alterations in normal circadian patterns of blood pressure (BP) and heart rate variability (HRV) and that these alterations contribute to increased risk of CVD. Recent data suggest that allowing shift workers to nap during night shifts may help to normalize BP and HRV patterns and, over time, reduce the risk of CVD. The risk of CVD related to shift work is elevated for emergency medical services (EMS) shift workers due in part to long-duration shifts, frequent use of night shifts, and a high prevalence of multiple jobs.MethodsWe will use a randomized crossover trial study design with three study conditions. The targeted population is comprised of EMS clinician shift workers, and our goal enrollment is 35 total participants with an estimated 10 of the 35 enrolled not completing the study protocol or classified as lost to attrition. All three conditions will involve continuous monitoring over 72 h and will begin with a 36-h at-home period, followed by 24 total hours in the lab (including a 12-h simulated night shift), ending with 12 h at home. The key difference between the three conditions is the intra-shift nap. Condition 1 will involve a simulated 12-h night shift with total sleep deprivation. Condition 2 will involve a simulated 12-h night shift and a 30-min nap opportunity. Condition 3 will involve a simulated 12-h night shift with a 2-h nap opportunity. Our primary outcomes of interest include blunted BP dipping and reduced HRV as measured by the standard deviation of the inter-beat intervals of normal sinus beats. Non-dipping status will be defined as sleep hours BP dip of less than 10%.DiscussionOur study will address two indicators of cardiovascular health and determine if shorter or longer duration naps during night shifts have a clinically meaningful impact.Trial registrationClinicalTrials.gov NCT04469803. Registered on 9 July 2020

Reproducibility study of nocturnal blood pressure dipping in patients with high cardiovascular risk.

It has been shown that in most people there is a physiological reduction in blood pressure during nighttime sleep, it falling by approximately 10% compared to daytime values (dippers). On the other hand, in some people, there is no nighttime reduction (non‐dippers). Various studies have found an association between being a non‐dipper and a higher risk of cardiovascular disease, but few have assessed whether the nocturnal pattern is maintained over time. From the database of the TAHPS study, data were available on 225 patients, each of whom underwent 24‐hour ambulatory blood pressure monitoring (ABPM) on four occasions over a period of 5 months. We studied the reproducibility of the nocturnal BP dipping pattern with mixed linear analysis and also calculated the concordance in the classification of patients as dippers or non‐dippers. The intraclass correlation coefficients between the different ABPM recordings were 0.482 and 0.467 for systolic and diastolic blood pressure, respectively. Two‐thirds (67%) and 70% of the patients classified, respectively, as dippers or non‐dippers based on systolic and diastolic blood pressure readings in the first ABPM recording were found to have the same classification based on the subsequent recordings. We conclude that the reproducibility of nocturnal dipping patterns and concordance of dipper vs non‐dipper status in individual patients is modest and therefore that we should be cautious about recommending treatments or interventions based on these patterns.

Circadian Rhythm of Blood Pressure of Dipper and Non-dipper Patients With Essential Hypertension: A Mathematical Modeling Approach

Blood pressure in humans presents a circadian variation profile with a morning increase, a small postprandial valley, and a deeper descent during night-time rest. Under certain conditions, the nocturnal decline in blood pressure can be reduced or even reversed (non-dipper), which is related to a significantly worse prognosis than a normal fall pattern (dipper). Despite several advances in recent years, our understanding of blood pressure's temporal structure, its sources and mechanisms is far from complete. In this work, we developed an ordinary differential equation-based mathematical model capable of capturing the circadian rhythm of blood pressure in dipper and non-dipper patients with arterial hypertension. The model was calibrated by means of global optimization, using 24-h data of systolic and diastolic blood pressure, physical activity, heart rate, blood glucose and norepinephrine, obtained from the literature. After fitting the model, the mean of the normalized error for each data point was <0.2%, and confidence intervals indicate that all parameters were identifiable. Sensitivity analysis allowed identifying the most relevant parameters and therefore inferring the most important blood pressure regulatory mechanisms involved in the non-dipper status, namely, increase in sympathetic over parasympathetic nervous tone, lower influence of physical activity on heart rate and greater influence of physical activity and glucose on the systemic vascular resistance. In summary, this model allows explaining the circadian rhythm of blood pressure and deepening the understanding of the underlying mechanisms and interactions integrating the results of previous works.

Yeni Tanı Dipper ve Non-dipper Hipertansif Hastalarda Strain Analiz Metoduyla Sol Ventrikül Global Sistolik Fonksiyonlarının Değerlendirilmesi

Objective: Non-dipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional (2D) strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and Methods: We included 42 newly diagnosed hypertensive patients without a previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non-dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by 2D speckle tracking method. Results: The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of left ventricular (LV) systolic function by GLS showed decreased values in non-dippers compared with dippers (-18.13±2.07 vs. -13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), nighttime systolic and diastolic blood pressures, 24-hr systolic blood pressure, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with LV GLS. Conclusion: An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain.

Vitamin D plasma concentration and VDR gene polymorphisms in patients with non-dipper hypertension

Abstract The study of the effects of vitamin D today has a high interest in the scientific community. We determined the plasma level of vitamin D and the polymorphisms of the vitamin D receptor gene (VDR rs1544410, VDR rs2228570) in patients with non-dipper hypertension. In our clinic, we examined 160 patients aged 30–60, among which a group of hypertensive patients with dipper status included 52 people, a group of hypertensive patients with non-dipper status - 53 people, a control group of 55 people without hypertention, correlating in gender and age with study groups. The 25 OH vitamin D level was lower in the hypertension groups, both dipper status - 20.5 (14.0; 23.3) ng / ml and non-dipper status 15.0 (12.0; 18.0) ng / ml compared with the control group - 26.0 (19.5; 30.5) ng / ml, p=0.003 and p&amp;lt;0.001. The results of genotyping showed the presence of genetic features in hypertensive patients with non-dipper status compared with the hypertensive patients with dipper status and the control group at the rs2228570 locus of the VDR gene, p&amp;lt;0.001. The total frequency of genotypes in the following groups: in the non-dipper group the G / A genotype accounts for 49.1% (26), A/A – 41.5% (22), G/G – 9.4% (5); in the dipper group the G/A genotype was 65.4% (34), A/A – 19.2% (10), G/G – 15.4% (8); in the control group G/A – 47.3% (26), A/A – 10.9% (6), G/G – 41.8% (23) for rs2228570 of the VDR gene. Statistical differences from the dipper group and the control group were not obtained in rs1544410 of the VDR gene. Further studies are needed to clarify the association between rs2228570 of the VDR gene, vitamin D levels and non-dipper status in hypertension. Funding Acknowledgement Type of funding source: None

Interrelationship of inflammatory biomarkers with ambulatory heart rate phenotypes in a cohort of Nigerian chronic kidney disease patients compared with controls; findings from symbolic study

Abstract Background Inflammatory biomarkers have been identified as strong independent risk factor for cardiovascular events outcome in chronic kidney disease. The positive effect of the autonomic nervous system on inflammatory biomarkers is also being explored. Using the Heart rate as a representative tool for autonomic activity, the exact heart rate metrics in 24 hours associated with increased level of inflammatory activity in chronic kidney disease needs to be assessed among people of African descent. Purpose This study assessed the associations between inflammatory biomarkers and the Heart Rates phenotypes in a population of chronic kidney disease patients compared with controls. Methods All the participants had a 24-hour ambulatory blood pressure monitoring done using SpaceLabs ABPM (Spacelab's Healthcare, Issaquah, WA) which was placed on the non-dominant hand and Cuff sizes were selected after measuring participants' non-dominant arm circumference. Blood samples were analyzed for fasting plasma glucose, lipid profile, electrolytes, urea and creatinine, C - reactive protein (CRP), White cell counts (WBC) and differentials. CRP group was classified as mild, moderate and severe. Heart rate dipping was estimate using formula (1- night time heart rate/daytime heart rate) x100. Normal dipping of heart rate was defined as &amp;gt;10%. Estimated GFR was calculated using CKD-EPI Creatinine Equation and CKD was defined as eGFR&amp;lt;60ml/min/1.73m2. The association between markers of inflammation, heart rate phenotypes and mortality was determined using univariate analysis. Logistic regression model was fitted to determine predictors of all – cause mortality. Results Four hundred and sixty consented participants comprising 231 (50.2%) women, 195 (42.4%) hypertensive without CKD, 98 (21.3%) normotensive and 167 (36.3%) CKD patients with mean age 49.42±13.54 years were analyzed. Compared with controls, greater proportion of CKD patients were non dippers with highest mean White blood cell count, neutrophil counts, and CRP; p&amp;lt;0.05. The mean 24 Hr, daytime and night time heart rate were significantly highest among CKD patients &amp;lt;0.0001. Non-dipping was associated with higher mean WBC, Neutrophils counts, and CRP. Most non-dippers were associated with moderate and severe CRP risk (72.8% vs 27.2%; P&amp;lt;0.0001. Compared with inflammatory markers (CRP), non-dipping status was an independent determinant of all-cause mortality (OR 16.03, CI 2.57–100.1, p=0.003). Conclusion This study highlights a higher prevalence of heart rate non- dipping and inflammatory activities among people with CKD compared with controls. Non dipping status was associated with higher inflammatory activity and higher risk of death. These observations lend some insight into the roles of autonomic nervous system in the pathophysiological mechanisms that implicate inflammatory biomarkers in cardiovascular risk and event outcomes in chronic kidney disease patients. Funding Acknowledgement Type of funding source: Other. Main funding source(s): International society of hypertension

Severe preeclampsia is associated with postpartum diastolic dysfunction and non-dipping blood pressure profile pattern

Abstract Background Left ventricular diastolic dysfunction and non-dipping profile, detected by ambulatory blood pressure monitoring (ABPM), are two features recorded to be associated with sustained hypertension. Both are predictors of an increased cardiovascular morbidity later in life. Complete normalization of blood pressure (BP) in preeclampsia is detected over a variable period of time. Methods A prospective cohort study was conducted in a tertiary university hospital including normotensive women with a history of preeclampsia in the current pregnancy enrolled within the first week postpartum. All cases were subjected to 24 h-ABPM and 2D trans-thoracic echocardiography three months post postpartum concomitantly with a clinical evaluation. Chi2-test was used to compare the qualitative data while student t-test was used to compare the quantitative data. Multivariate regression analysis was used for prediction of non-dippers and diastolic dysfunction in our cohort. Results Hundred twenty eight women were included in the study. Their mean age was 28.6±5.1 years and the mean basal BP was 123.1±6.4/74.6±5.9 mm Hg. Out of the studied women, 90 (70.3%) women were dippers and 38 (29.7%) women were non-dippers. It was noticed that diastolic dysfunction was presented in 28 (73.7%) of non-dippers while none of dippers had diastolic dysfunction. Women with severe preeclampsia had higher frequency of non-dipper (35.5% vs. 24.2%; P=0.02) and diastolic dysfunction (29% vs. 15%; P=0.01) in comparison to those women with mild preeclampsia. Severe preeclampsia and previous history of preeclampsia were significant predictors for non-dipping status (OR=1.1, 95% CI: 0.05–10.56 and 1.4, 95% CI: 0.30–4.26 respectively, R2 = 0.7; P&amp;lt;0.001). They were also predictors for diastolic dysfunction in our studied population (OR = 1.6, 95% CI: 1.1–2.2 and 1.3, 95% CI: 1.2–2.2 respectively, R2 = 0.6; P&amp;lt;0.05). Conclusion Women with a history of preeclampsia have the risk for developing cardiovascular events later in life. The severity and recurrence of preeclampsia were significant predictors for both non-dipping profile and diastolic dysfunction. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Orman Heart Hospital-Assiut University; Women Health Hospital-Assiut University

Effect of short-term exposure to indoor particulate matter on noctunal blood pressure dipping among hypertensive adults in ibadan: a pilot study

Abstract Introduction While blunted nocturnal blood pressure is a major risk factor for cardiovascular events, limited information exist on the association between indoor particulate and circadian blood pressure variation. We report the association of short-time exposure to PM2.5 and PM10 with blunted nocturnal blood pressure among hypertensive adults in Ibadan. Purpose This study was to determine the association between short time exposure to air particulates and blunted nocturnal blood pressure among people of African descent. Methods We conducted a cross-sectional study among fifty hypertensive cases attending our University College Hospital. A 24-hours blood pressure (BP) monitoring was carried out at the same time as indoor particulate matter monitoring in their homes. Exposure to indoor fine particles (PM2.5) and thoracic particles (PM10) was estimated using a real-time particle counter and compared to the World Health Organization (WHO) 24-hours threshold of 25 μg/m3 and 50 μg/m3 for PM2.5 and PM10 respectively. All monitoring was carried out over a 24-hours period during the wet season. Linear regression model was fitted to determine predictors of non-dipping hypertension. Results Of the 50 hypertensive patients studied, 5 (10.0%), 39 (78.0%), 6 (12.0%) were reverse dippers, non-dippers and dippers respectively. The mean indoor PM2.5 (44.17±19.18 μg/m3) and PM10 (60.10±27.13 μg/m3) among the non-dippers were significantly higher than values obtained among dippers (PM2.5 = 22.97±10.19 μg/m3; PM10 = 29.51±12.74 μg/m3); p&amp;lt;0.0001, and the WHO threshold limit. More non-dippers than dippers (54.5% vs 37.8%) used unimproved fuel such as firewood for cooking. PM10 was an independent predictors of non-dipping status in our regression analysis. Conclusion Short-term exposure to indoor PM air pollution was associated with blunted nocturnal blood pressure. Therefore air pollution reduction strategies through improved cooking pattern is advocated in order to prevent future cardiovascular events. Funding Acknowledgement Type of funding source: None

Blood pressure variability in normotensive perimenopausal women: Non-dipping status, maximum blood pressure and arterial stiffness

BackgroundPostmenopausal women are more likely to have uncontrolled hypertension and are at higher risk of cardiovascular disease compared with age-matched men. Blood pressure variability is emerging as a predictor of adverse cardiovascular outcomes and may be implicated in the relationship between menopause and worsened vascular health in women. We conducted an observational study, BRAVE (Blood pRessure And Vascular hEalth around menopause) to study this relationship. MethodNormotensive perimenopausal women were recruited. Blood pressure variability was measured through 24-h blood pressure monitoring. Vascular health was assessed through arterial stiffness (carotid-femoral pulse wave velocity), carotid intima-media thickness and endothelial function (reactive hyperemic index). Multivariate models were performed to identify factors associated with blood pressure variability and arterial stiffness in perimenopausal women. ResultsForty-nine healthy women (mean age 52.9 ± 4.0, 63% postmenopausal) were recruited. There was a high prevalence (40%) of night non-dipping, a measure of an abnormal pattern of blood pressure variability. Aside from night dipping, other measures of blood pressure variability were similar between premenopausal and postmenopausal women. In the multivariate analysis, body mass index was the only factor associated independently with different measures of blood pressure variability, including the maximum overnight blood pressure (ß = 1.95, p < 0.01). The latter was also significantly associated with arterial stiffness (ß = 0.035, p = 0.048). Finally, poor sleep was independently associated with an increase in arterial stiffness. ConclusionsAbnormal blood pressure variability, particularly night non-dipping, is common in normotensive perimenopausal women. Maximum overnight blood pressure is independently associated with arterial stiffness and may identify women at higher cardiovascular risk.

Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti-hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial.

Non-dipping and nocturnal hypertension are commonly found during ABPM in pediatric kidney transplant recipients. These entities are independently associated with increased cardiovascular disease risk in adults. Kidney transplant recipients aged 5-21years with eGFR>30mL/min/1.73m2 and ABPM demonstrating non-dipping status and normal daytime BP were randomized to intervention (short acting BP medication added in the evening) or control (no medication change) in this pilot, randomized, open-label, blinded end-point clinical trial. ABPM, echocardiography, and PWV were performed at baseline, 3months, and 6months. The trial included 17 intervention and 16 control participants. Conversion to dipper status occurred in 53.3% vs 7.7% (P=.01) at 6months for intervention and controls, respectively. Systolic dip was greater in the intervention group compared to controls (10.9±4.5 vs 4.2±4.6, P=.001), and average systolic nighttime BP was significantly lower in the intervention group (106±8.3 vs 114.9±9.5mmHg, P=.01) at 6months. There were no significant differences in LVMI, PWV, or eGFR between groups. Within-group changes in the intervention group demonstrated improvements in non-dippers, dipping, systolic nighttime BP and nighttime BP load. Restoration of nocturnal dip and improvement in nocturnal BP were observed in the population following chronotherapy. Future studies are needed with larger sample sizes over a longer period of time to delineate the long-term effect of improved nocturnal dip on target organ damage.

Association between non-dipping status and carotid intima-media thickness in patients with elevated blood pressure category

Association between non-dipping status and carotid intima-media thickness in patients with elevated blood pressure category

P0165HYPERTENSION IN OVERWEIGHT AND OBESE CHILDREN: IMPACT ASSESMENT OF ABPM PARAMETERS

Abstract Background and Aims We describe the relationship between overweight and obesity and Hypertension on ABPM. Method We conducted a cross-sectional study using a database of patients aged 6-16 years, who had undergone 24h ABPM from December 2002 through December 2016. ABPM were performed using the validated device Spacelab 90217. Were evaluated the 24h MAP, daytime MAP, nocturnal MAP, systolic and diastolic load, MAP Systolic and Diastolic. Subjects were grouped by BMI Z-score into overweight (&amp;gt;1&amp;lt;2), obese (BMI Z-score &amp;gt;2&amp;lt;3) and severe obese (BMI Z-score &amp;gt;3). A total of 1016 patients were enrolled and recorded n.1210 ABPMs. Obese pts were 202 (19.8%); 126 M;76F;median age 10,2 y. Overweight childrens were 97 (11.9%);52 M;45F;median age 8,4y. Results Among overweight childrens (BMI Z-Score &amp;gt;1&amp;lt;2): 12 (12.3%) had hypertension, 22 (22.6%) pre-hypertension, 15 (15.4%) MH; non dipping pattern was recorded in 26 (52%). 48 were normotensive. Among obese childrens, 122 had hypertension (60.3%): 24 pts had Masked Hypertension (19.6%); 72 (59.0%) had severe ambulatory hypertension with BMI z-score &amp;gt;3 (mean 3.8) ,and in this category all pts were both systolic and diastolic non dipping. 32 (64%) obese with BMI z-score &amp;gt;2, &amp;lt;3 were non-dipping. Diastolic load was significantly higher (p&amp;gt;0,0001) in severe obese. 28 pts had ambulatory prehypertension (13.8%), 11 pts had White Coat Hypertension (4.9%).41 pts had normotension (20.2%). Conclusion The severity of ambulatory hypertension increased with increased BMI Z-score. The non-dipping status is associated, not only with higher BMI Z-score, but was present in overweight and obese with BMI z-score &amp;gt;2&amp;lt;3 also. ABPM is an effective tool that should become routine in all obese patient, but also in overweight childrens, which may lead to better treatments and prevention methods.

In newly diagnosed hypertensive children, increased arterial stiffness and reduced heart rate variability were associated with a non-dipping blood pressure pattern

ObjectivesThis study was designed to investigate the differences in pulsatile hemodynamics, echocardiographic findings, 24-h Holter monitoring and heart rate variability parameters of dipper patterns in children with newly diagnosed essential hypertension. MethodsThis study included 30 children with newly diagnosed essential hypertension and 30 healthy controls. The essential hypertension cohort was divided into dippers and non-dippers. Physical examinations, 24-hour ambulatory blood pressure monitoring, 24-h Holter monitoring, 24-h heart rate variability, conventional 2-dimensional and Doppler echocardiography, and tissue Doppler imaging were performed. Pulse wave analysis using an oscillometric monitor was conducted to measure augmentation index (AIx) and pulse wave velocity (PWV). ResultsIn patients with essential hypertension, left ventricular (LV) wall thickness and LV mass index were increased. There were no significant differences in LV mass index and LV wall thickness based on the dipping patterns. Time domain values and the standard deviation of all RR intervals (SDNN) were substantially lower in the essential hypertension group. SDNN values were considerably lower in the non-dipper group compared with the dipper group. In terms of frequency domain measures, low frequency measured in daytime values was much lower in the essential hypertension group compared with the control. The dipper patterns revealed that low frequency measured in nighttime values was also substantially lower in the non-dipper group. Pulse wave analysis and AIx values were notably higher in the essential hypertension patient group and those with non-dipper status. ConclusionSDNN values, which reflect parasympathetic activity, were markedly lower in children with hypertension and the non-dipper group than healthy controls and the dipper group, respectively. Also, parameters related to arterial stiffness, such as PWV and AIx values were significantly higher in children with hypertension and the non-dipper group.

Prognostic Value of a Riser Pattern of Nighttime Blood Pressure in Very Elderly Adults of ≥80 Years: A General Practice-Based Prospective SEARCH Study.

We examined our hypothesis that participants with higher mean nighttime blood pressure (BP) levels and/or those with a riser BP pattern, both measured by ambulatory blood pressure (BP) monitoring (ABPM), would show higher risk for cardiovascular disease (CVD) events compared to those with normal nighttime BP levels or a normal dipper BP pattern of circadian BP rhythm, even in very elderly participants in a general practice population. This prospective observational study enrolled 485 very elderly outpatients of ≥80 years (mean age: 83.2 ± 3.3 years; 44.7% male; 89.3% using antihypertensive medications). The prevalences of extreme dipper, dipper, nondipper, and riser status were 15.5%, 38.6%, 32.2%, and 13.8%, respectively. During a mean follow-up of 3.9 years (1,734 person-years), 41 CVD events occurred. The participants with a riser pattern (higher nighttime systolic BP [SBP] than daytime SBP) showed a significantly higher risk for CVD events with adjustment for covariates: hazard ratio (HR), 2.61; 95% confidence interval (CI), 1.03-6.62. Even after adjusting for covariates and mean nighttime SBP level, the CVD risks in participants with a riser pattern remained significant: HR, 3.11; 95% CI, 1.10-8.88. On the other hand, all BP variables showed no significant risks for CVD events. In addition, when we divided study participants into quartiles by their ambulatory BP levels, none of the ambulatory BP variables showed a J- or U-shaped relationship with CVD event risk. In very elderly general practice outpatients, a riser BP pattern was significantly associated with CVD events independently of mean nighttime BP.

Heart rate acceleration and deceleration capacities associated with circadian blood pressure variation.

BackgroundHeart rate acceleration and deceleration capacities are novel parameters that can quantify sympathetic and vagal modulation. However, how acceleration and deceleration capacities associated with circadian blood pressure (BP) variation remains unknown.MethodsA total of 141 patients with essential hypertension were included in our study. Based on the nocturnal decline rate of systolic BP (SBP), patients were divided into two groups, as dippers and nondippers. Baseline demographic characteristics, ambulatory blood pressure monitoring (ABPM) parameters, Holter recordings, and echocardiographic parameters were collected.ResultsThe absolute values of acceleration capacity (AC) (−7.75 [−8.45 ~ −6.3] ms vs. −6.6 [−8.25 ~ −5.2] ms, p = .047) and deceleration capacity (DC) (7.35 [6.1 ~ 8.1] ms vs. 6.3 [5.1 ~ 7.6] ms, p = .042) were significantly higher in dippers than in nondippers. By multivariate logistic regression analysis, left atrial diameter (LAd) was found to be an independent risk factor for nondipper status in acceleration capacity model (odds ratio 1.174, 95% confidence interval 1.019–1.354, p = .027) and deceleration model (odds ratio 1.146, 95% confidence interval 1.003–1.309, p = .045). Sleep SBP was positively correlated to acceleration capacity (r = .256, p = .002) and negatively correlated to deceleration capacity (r = −.194, p = .021).ConclusionsThe absolute values of acceleration capacity and deceleration capacity were higher in patients with dipper hypertension than in patients with nondipper hypertension. However, acceleration and deceleration capacities were not independent risk factors for blunted BP variation. Sleep SBP seemed to be better correlated to the impairment of autonomic nervous system (ANS) function than other ABPM parameters.