Non-dipper Patients Research Articles

Blood pressure profile is associated with microalbuminuria and retinopathy in hypertensive nondiabetic patients.

Target organ damage is important for global cardiovascular risk assessment. The aim of this study was to explore the association between the blood pressure profile and end-organ damage in ahypertensive non-diabetic cohort. A total of 560 consecutive hypertensive nondiabetic patients (mean age: 58.2± 13.3 years, 221 men) were included in the study. All patients underwent thorough physical examination including fundoscopic examination. First morning urine samples were obtained from each patient and measurement of the albumin-to-creatinine ratio in first morning urine collection samples was used for diagnosis of microalbuminuria. All patients underwent a24-h ambulatory blood pressure monitoring and were grouped as dippers and non-dippers according to the presence or absence of >10% decrease in blood pressure during the night, respectively. The non-dipper group consisted of 247 patients with a non-dipper blood pressure profile, 31patients with reverse dipping and 4patients with extreme dipping. Non-dipper patients were significantly older. Coronary artery disease, cerebrovascular disease, hypertensive retinopathy and microalbuminuria were significantly more prevalent in the non-dipper patients. Non-dipping hypertension increased the risk of hypertensive retinopathy by 1.89 times (95% confidence interval, CI:1.35-2.65, p< 0.001) and the risk of microalbuminuria by 2.23 times (95% CI:1.49-3.33, p< 0.001). Non-dipping hypertension was still significantly associated with hypertensive retinopathy and microalbuminuria when adjusted by age and sex. Non-dipping hypertension was associated with increased risk of hypertensive retinopathy and microalbuminuria. Blood pressure profiles should also be considered in assessing the risk for hypertensive patients.

Nocturnal diastolic blood pressure decline is associated with higher 25-hydroxyvitamin D level and standing plasma renin activity in a hypertensive population

ABSTRACTPatients with nondipper hypertension are known to carry a high risk of cardiovascular complications. Vitamin D deficiency is associated with hypertension. Because vitamin D deficiency activates the renin–angiotensin–aldosterone system (RAAS), we hypothesized that this vitamin would interact with the RAAS to influence blood pressure (BP) in nondipper hypertensive patients. We performed a cross-sectional analysis of 1,007 outpatients with hypertension (HTN). Dipper and nondipper patterns were detected, and the two groups were matched for clinical, laboratory, 25-hydroxyvitamin D (25OHD) levels, and ambulatory blood pressure recording. Plasma renin activity (PRA), angiotensin II, and plasma aldosterone concentration (PAC) were assessed in 174 patients treated with calcium channel blockers or no medication. The mean 25OHD concentration in the entire study population was 12.3ng/dL, and the prevalence of vitamin D deficiency was 87.0%. Dipper and nondipper HTN were noted in 187 patients (24.6%) and 573 patients (75.4%). 25OHD levels were similar between nondipper and dipper HTN groups. Forward stepwise logistic regression analysis showed that BMI and age were independent predictors of nondipper HTN. Neither 25OHD levels nor RAAS components were included in the model. In correlation analyses, nocturnal decline of diastolic BP was positively associated with 25OHD levels and standing PRA (r = 0.152 p = 0.045, r = 0.165 p = 0.038, respectively). The present study showed that vitamin D deficiency was astonishingly prevalent in hypertensive subjects residing in Xinjiang, China. There may be a weakly association of nocturnal DBP decline with 25OHD levels and standing PRA levels. We found no association between vitamin D deficiency and nondipper HTN.

Circadian blood pressure rhythm and intimal media thickness changes in non-dipper normotensives patients

&lt;p&gt;We investigated 25 &lt;em&gt;non-dipper&lt;/em&gt; normotensive &lt;em&gt;vs &lt;/em&gt;25 &lt;em&gt;dipper &lt;/em&gt;normotensive patients. The aim of our study was to evaluate carotid intimal-medial thickness (IMT) in the two groups. At the admission patients underwent anamnesis and general examination, blood sampling for lipid profile measurement, glycemia, homocysteine, ambulatory blood pressure measurement to assess the circadian blood pressure profile, and Doppler ultrasound to measure carotid intimal-medial thickness (IMT). Our results showed that IMT is significantly higher in the &lt;em&gt;non-dipper &lt;/em&gt;group (P&amp;lt;0.006) &lt;em&gt;vs dippers&lt;/em&gt;. &lt;em&gt;Non-dipper &lt;/em&gt;status has been recognized in several studies a condition with increased risk for target organ damage in hypertensive and normotensive subjects. However, to our knowledge, a possible relationship between IMT and normotensive &lt;em&gt;non-dipper &lt;/em&gt;patients has not yet clearly investigated. Our study instead has clearly demonstrated a significant relationship between IMT and the &lt;em&gt;non-dipper status&lt;/em&gt;.&lt;/p&gt;

Left atrial mechanical function and stiffness in patients with nondipper hypertension: A speckle tracking study

ABSTRACTBackground: Nondipper hypertension is associated with increased cardiovascular morbidity and mortality. Speckle tracking echocardiography is a novel and promising tool for detecting early changes in left atrial (LA) myocardial dysfunction. Our aim was to evaluate the LA mechanical function and stiffness in nondipper hypertensive patients by two-dimensional speckle tracking echocardiography strain parameters. Method: This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 nondipper patients (17 male, mean age 50.6 ± 5.4 years). LA volume indices, mitral annular velocities, and global longitudinal LA strain were measured. The ratio of E/e’ to LA strain was used as an index of LA stiffness. Results: Patients with nondipper hypertension showed increased LA volume indices and decreased LA global strain (25.3 ± 5.5 vs. 39.6 ± 9.9%, P < 0.001). LA stiffness was increased in patients with nondipper than in the dipper subjects (0.41 ± 0.15 vs. 0.19 ± 0.14, P < 0.001), and LA strain and LA stiffness were related to LA volume indices. Conclusion: Patients with nondipper hypertension have decreased LA global strain and increased stiffness, in comparison with dipper group. LA stiffness and LA strain were significantly related to LA volume indices. LA stiffness and LA strain can be used for the assessment of LA function in patients with nondipper hypertension.

Evaluation of the effect of dipping pattern in hypertensive patients on the left ventricular systolic functions by two-dimensional strain analysis.

Nondipping blood pressure pattern carry a high risk of cardiovascular and cerebrovascular complications due to a higher cumulative pressure overload. We aimed to define the role of strain analysis for detecting subclinical left ventricular systolic dysfunction in recently diagnosed nondipper and dipper hypertensive patients with normal left ventricular systolic function. Study population consisted of two groups of patients, Group 1: 45 dipper patients and Group 2: 43 nondipper patients. Global and segmental two-dimensional longitudinal strain analysis were measured by speckle tracking method. The analysis of two-dimensional left ventricular global longitudinal strain and strain rates showed that there was a significant difference between groups (-18.1%±3.1% for nondippers vs -20.5%±2.4% for dippers, P<.001 for global longitudinal strain and -1.2±0.2 1/s for nondippers vs -1.31±0.16 1/s for dippers, P<.001 for global longitudinal strain rate). The nighttime systolic, diastolic, and mean blood pressure measurements were significantly higher in the nondipper group. Nocturnal dipping rates were statistically different between the groups (P<.001). Interventricular septum, posterior wall thickness, relative wall thickness, left atrial dimension, left ventricular mass, and mass index were higher in the nondipper group. Multivariate analysis demonstrated left atrium size, nocturnal dipping rate, daytime mean blood pressure, and nighttime systolic, diastolic, and mean blood pressure as independent predictors of global longitudinal strain. In our study, two-dimensional speckle tracking examination showed that the left ventricular systolic function is impaired even in the subclinical period in recently diagnosed nondipper hypertensive patients with deformational analysis.

Non-dipper hypertension is associated with slow coronary flow among hypertensives with normal coronary angiogram.

SummaryAimA person with a drop of more than 10% in nocturnal arterial blood pressure during the circadian rhythm is referred to as a dipper and one with a smaller decrease is referred to as a non-dipper. In our study, we aimed to compare the thrombolysis in myocardial infarction (TIMI) frame count in non-dipper and dipper hypertensive patient groups who had normal coronary artery angiographyMethodsPatients with normal coronary arteries and with ambulatory blood pressure monitoring follow ups were retrospectively investigated and 60 patients (35%, female) were included in our study. The patients were grouped as dipper (n = 30) and non-dipper (n = 30) hypertensives.ResultsThe TIMI frame counts in all three coronary arteries and the mean TIMI frame count in the dipper hypertensive patient group were significantly lower than those of the non-dipper hypertensives (right coronary artery TIMI frame count: 16.83 ± 3.70; 21.63 ± 3.44, p < 0.001; circumflex artery TIMI frame count: 21.28 ± 3.52; 25.65 ± 3.61, p < 0.001; left anterior descending artery TIMI frame count: 34.20 ± 2.80; 37.05 ± 3.30, p = 0.001; corrected left anterior descending artery TIMI frame count: 20.05 ± 1.63; 21.74 ± 1.95, p = 0.001; mean TIMI frame count: 19.31 ± 2.3; 22.94 ± 2.61, p < 0.001). The body mass index (BMI) was 23.79 ± 2.81 kg/m2 in the dipper patient group, while it was 25.47 ± 2.92 in the non-dippers. BMI was found to be significantly higher in the non-dipper group than in the dipper group (p = 0.027).ConclusionsIn this study, TIMI frame count, which is a simple, productive, objective and reproducible method for determination of microvascular changes, was found to be higher in non-dipper hypertensive patients than in the dipper patients.

Circulating Th1, Th2, and Th17 Levels in Hypertensive Patients.

Background Evidence from experimental studies showed that Th1, Th2, and Th17 play a pivotal role in hypertension and target organ damage. However, whether changes in the circulating Th1, Th2, and Th17 levels are associated with nondipper hypertension and carotid atherosclerotic plaque in hypertension has yet to be investigated. Methods Th1, Th2, and Th17 levels were detected using a flow cytometric analysis, and their related cytokines were measured by enzyme-linked immunosorbent assay in 45 hypertensive patients and 15 normotensive subjects. Results The frequencies of Th1 and Th17 in hypertensive patients, especially in nondipper patients and patients with carotid atherosclerotic plaque, were markedly higher than those in the control group; this was accompanied by higher IFN-γ and IL-17 levels. In contrast, the Th2 frequencies and IL-4 levels in hypertensive patients, especially in nondipper patients and patients with carotid atherosclerotic plaque, were significantly lower than those in the control group. Conclusions The changes in Th1, Th2, and Th17 activity are associated with the onset of the nondipper type and carotid atherosclerotic plaque in hypertensive patients.

PP.01.28] AMBULATORY BLOOD PRESSURE MONITORING (ABPM) AND MYOCARDIUM DEFORMATION PARAMETERS IN PATIENTS WITH HYPERTENSION

Objective: The aim of the study was to examine the association between ambulatory blood pressure monitoring (ABPM) indices and left ventricular (LV) and left atrium (LA) remodelling in patients with hypertension (HT). Design and method: 60 patients (males – 40) with HT aged (59,5 ± 2,8) years were divided into 2 groups after 24 h ABPM. Patients with decrease BP during the night (night-day BP ratio < 0.9) defined as ’dippers’, composed the 1st group (n = 33) and patients without sufficient nocturnal BP drop (nondippers) composed the 2nd group (n = 27). Using M-,2D- and speckle-tracking echocardiography with ultrasound scanner Aplio Artida we studied LV hypertrophy (LVH), values of LV longitudinal global systolic strain (LGSS) and LGSS rate, also left atrium (LA) systolic deformation (SD), early diastolic deformation rate (EDDR) and late diastolic deformation rate (LDDR) as a parameters of accordingly LA reservoir, conduit and contractile function. Results: In the 2nd as compared to the 1st group pts had more severe LVH: more common concentric (60,0% vs 40,0%) and eccentric (66,7% vs 33,3%) LVH. In the 2nd group we found 17,4 and 13,5 % reduced absolute values of LGSS and LGSS rate accordingly (P < 0.05) as compared to the 1st group. The insufficient decline of nighttime BP was associated with a 21,0 % decrease of LA EDDR and 16,9 % decrease of LA SD (P < 0.05) in the 2nd vs the 1st group, this indicated the impairment in conduit and reservoir LA function in nondipper patients. The inverse correlation was found in the 2nd group between 24 h BP and values of LGSS (r = -0,40, p < 0.01) and LGSS rate (r = -0,31, p < 0.05), also with decreased LA EDDR (r = -0,33, p < 0.05). Decreased values of LA LDDR associated with systolic (r = -0,44, p < 0.01) and diastolic (r = -0,37, p < 0.01) BP variability at nighttime. Conclusions: In nondipper HT patients it was rotined more expressed decrease in LV global systolic deformation and impairment of LA reservoir, conduit and contractile function compared to the dipper pts. A strong relationship between ABPM indices, insufficient nighttime BP reduction and the structural and functional state of the left heart was found.

PP.LB01.13] AMBULATORY BLOOD PRESSURE MONITORING (ABPM) AND MYOCARDIUM DEFORMATION PARAMETERS IN PATIENTS WITH HYPERTENSION

Objective: The aim of the study was to examine the association between ambulatory blood pressure monitoring (ABPM) indices and left ventricular (LV) and left atrium (LA) remodelling in patients with hypertension (HT). Design and method: 60 patients (males – 40) with HT aged (59,5 ± 2,8) years were divided into 2 groups after 24 h ABPM. Patients with decrease BP during the night (night-day BP ratio <0.9) defined as ’dippers’, composed the 1st group (n = 33) and patients without sufficient nocturnal BP drop (nondippers) composed the 2nd group (n = 27). Using M-,2D- and speckle-tracking echocardiography with ultrasound scanner Aplio Artida we studied LV hypertrophy (LVH), values of LV longitudinal global systolic strain (LGSS) and LGSS rate, also left atrium (LA) systolic deformation (SD), early diastolic deformation rate (EDDR) and late diastolic deformation rate (LDDR) as a parameters of accordingly LA reservoir, conduit and contractile function. Results: In the 2nd as compared to the 1st group pts had more severe LVH: more common concentric (60,0% vs 40,0%) and eccentric (66,7% vs 33,3%) LVH. In the 2nd group we found 17,4 and 13,5 % reduced absolute values of LGSS and LGSS rate accordingly (P < 0.05) as compared to the 1st group. The insufficient decline of nighttime BP was associated with a 21,0 % decrease of LA EDDR and 16,9 % decrease of LA SD (P < 0.05) in the 2nd vs the 1st group, this indicated the impairment in conduit and reservoir LA function in nondipper patients. The inverse correlation was found in the 2nd group between 24 h BP and values of LGSS (r = −0,40, p < 0.01) and LGSS rate (r = −0,31, p < 0.05), also with decreased LA EDDR (r = −0,33, p < 0.05). Decreased values of LA LDDR associated with systolic (r = −0,44, p < 0.01) and diastolic (r = −0,37, p < 0.01) BP variability at nighttime. Conclusions: In nondipper HT patients it was rotined more expressed decrease in LV global systolic deformation and impairment of LA reservoir, conduit and contractile function compared to the dipper pts. A strong relationship between ABPM indices, insufficient nighttime BP reduction and the structural and functional state of the left heart was found.

PP.16.04] CIRCADIAN BLOOD PRESSURE PROFILE, INFLAMMATORY MARKERS AND EPICARDIAL FAT THICKNESS IN HYPERTENSIVE PATIENTS

Objective: Circadian blood pressure profile is a very important marker in long-term management of hypertensive patients. Epicardial fat tissue may represent a direct cardiovascular risk marker unrelated to obesity. We aimed to investigate the association of inflammation markers and epicardial fat thickness (EFT), in hypertensive patients with high risk circadian blood pressure (BP) profile. Design and method: 45 hypertensive patients with a mean age of 60 ± 12.30 years were evaluated. All patients underwent 24-hour ambulatory BP monitoring (ABPM), epicardial fat tissue was measured using 2D echocardiography, and intima media thickness (IMT) was assessed. hs-CRP was evaluated for all patients. Circadian blood pressure profile was classified according to the ABPM; 22 (48.88%) patients with hypertension with a dipping pattern at night (dippers), 19 (42.22%) patients with hypertension with a non-dipping profile at night (non-dippers) and 4 (8.88%) hypertensive patients with reverse-dipper BP profile. Results: EFT of hypertensive patients was significantly higher in the non-dipper and reverse-dipper group, compared to the dipper, (non-dippers, 7.7 ± 2.6 mm; reverse-dipper, 6.8 ± 1.4 mm; dippers, 5.3 ± 1.9 mm; p < 0.001). When evaluating the inflammatory marker hs-CRP and EFT in hypertensive patients, there was a significantly correlation between increased EFT and hs-CRP in non-dippers and reverse-dippers. EFT and IMT in non-dipper and reverse-dipper hypertensive patients, showed a correlation between the presence of increased EFT (>6,5 mm) and increased IMT with no correlation with BMI. EFT was also significantly correlated with 24-hour mean systolic BP and age. Conclusions: These findings suggest that visceral adiposity, particularly EFT, may be associated with vascular damage, independent of BMI, but related to the circadian hypertension profile. There was also an association between EFT and inflammation markers in non-dipper and reverse-dipper hypertensive patients. Visceral adiposity, particularly EFT, and a specific circadian BP profile associated with increased inflammatory markers may be used to indicate increased risk of hypertension-related adverse cardiovascular events.

PP.16.18] ASSOCIATION BETWEEN HYPERURICEMIA AND ABNORMAL HEART RATE RECOVERY IN HYPERTENSIVE PATIENTS WITH NON-DIPPING PATTERN

Objective: Sympatho-vagal balance, as measured by heart rate recovery (HRR) at the first minute after exercise, is correlated with long-term prognosis in patients with cardiovascular disease. Higher serum uric acid (UA) is an independent risk factor for hypertension; and hyperuricemia is associated with non-dipping pattern (<10% fall in nocturnal blood pressure) among hypertensive patients. Given the importance of nondipper hypertension on cardiovascular outcomes, the present study tested the hypothesis that heart rate recovery is associated with hyperuricemia among hypertensive patients with non-dipping pattern. Design and method: The study included 122 essential hypertensive patients (64% Male, 55 ± 3 years) subdivided into two groups according to 24-hour ABPM resuts: 48 dippers and 74 nondippers. All patients underwent ambulatory blood pressure monitoring and exercise stress testing. HRR was calculated as the difference between the heart rate at peak exercise and after 1-min cooling down. Results: No significant differences in office blood pressure (BP) values were observed between non-dipper and dipper hypertensive patients (Figure 1-2). Compared to dippers, the nocturnal systolic (Figure 3), diastolic (Figure 4), and mean BP levels (Figure 5), were found to be significantly greater among non-dippers, respectively. Non-dippers hypertensive patients showed significantly higher serum UA levels compared to dippers (Figure 6); and high sensitivity C-reactive protein (hsCRP) (Figure 7). Non-dippers hypertensive patients showed significantly lower HRR compared to dippers (Figure 8).Among non-dippers, a significant correlation between UA levels and HRR was observed (r = 0.38, P < 0.001). After adjusting for age, gender, body mass index, smoking habits, creatinine levels, hsCRP and comorbidity, multivariate analysis revealed an independent association between HRR and serum UA levels among non-dippers (ß = 0.312, P = 0.002). Conclusions: Serum UA is independently associated with abnormal heart rate recovery in hypertensive patients with nondipper circadian pattern.

PS 05-30 CIRCADIAN BLOOD PRESSURE PATTERN, EPICARDIAL FAT THICKNESS AND LEFT ATRIAL FUNCTION

Objective: Epicardial adipose tissue reflects visceral adiposity and inflammation which can contribute to the fibrotic remodeling of the atrial myocardium. We aimed to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and left atrial (LA) deformation parameter with diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. Design and method: This cross-sectional study included 511 recently diagnosed hypertensive patients, who underwent echocardiography and 24-hours ambulatory BP monitoring. EFT was measured with echocardiography, and global LA strain was obtained by two-dimensional speckle imaging with automated software. The patients were classified as non-dippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Results: The mean EFT, LA volume index as well as left ventricular (LV) filling pressure (E/Ea) were significantly higher in hypertensive patients, especially in non-dippers (all p < 0.001), whereas global LA strain was significantly lowest in non-dippers (normotensives; 23.2 ± 2.0% vs. dippers = 19.0 ± 3.3% vs. non-dippers = 17.4 ± 3.0%, P < 0.001). Moreover, LA strain was significantly associated with LV filling pressure (r = −0.422, p < 0.001), EFT (r = −0.187, p < 0.001), and 24 hour mean BP variability (r = −0.184, p < 0.001). Conclusions: Non-dipper hypertensive patients were associated with increased EFT and impaired LA deformation. This indicates that these subjects may be more prone to atrial rhythm disturbances.

Relationship between blood pressure and retrobulbar blood flow in dipper and nondipper primary open-angle glaucoma patients.

To evaluate the relationship between retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery, and short posterior ciliary artery and 24-hour blood pressure (BP) measurements in dipper and nondipper patients with primary open-angle glaucoma (POAG). A prospective, cross-sectional, and observational study was conducted on consecutive patients, referred or recruited, attending the outpatient service of our ophthalmology department. Ambulatory BP monitoring, Doppler imaging, and ocular pulse amplitude measurements were performed on the same day. Patients with nocturnal BP decrease up to 10% of the diurnal BP were defined as dippers and those with BP decrease less than 10% were defined as nondippers. A total of 114 patients (36 nondippers and 78 dippers) were included in the study. The end-diastolic velocity was significantly lower and the resistivity index (RI) was significantly higher in the dippers than in the nondippers (p&lt;0.0001 and p&lt;0.0001, respectively). The RI in the OA was significantly correlated with daytime and nighttime systolic BP and with the daytime mean arterial pressure in the dippers. The RI in the OA significantly correlates with BP in patients with POAG with nocturnal BP dips. Additionally, retrobulbar blood flow parameters are reduced in dippers as compared with nondippers with POAG.

Endocan and Non-Dipping Circadian Pattern in Newly Diagnosed Essential Hypertension.

Background and ObjectivesNon-dipper hypertension is frequently accompanied by endothelial dysfunction and activation. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. This study aims to investigate the association between circadian blood pressure (BP) pattern and plasma endocan levels together with high-sensitivity C-reactive protein (hsCRP) in patients with newly diagnosed untreated hypertension.Subjects and MethodsTwenty-four hour ambulatory blood pressure monitoring was recorded in 35 dipper, 35 non-dipper hypertensives and 35 healthy controls. Endocan levels were measured by enzyme-linked immunosorbent assay. Serum levels of hsCRP were also recorded.ResultsDespite similar daytime and 24-hour average BP values between dippers and non-dippers, statistically significant high nocturnal BP was accompanied by a non-dipping pattern (Systolic BP: 132±9 vs. 147±11 mmHg; Distolic BP: 80±7 vs. 91±9 mmHg, respectively, p<0.001 for both). Non-dipper patients demonstrated higher endocan levels compared to dippers and normotensives (367 (193-844) pg/mL, 254 (182-512) pg/mL and 237 (141-314) pg/ml, respectively, p<0.001). HsCRP levels were significantly higher in non-dippers than the other groups (p=0.013). In a multivariate logistic regression analysis, endocan (p=0.021) and hsCRP (p=0.044) were independently associated with a non-dipping pattern.ConclusionElevated endocan levels were found in non-dipper groups. Endocan and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that elevated levels of endocan in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to the possible future role of endocan in selection of hypertensive patients at higher risk or target organ damage.

Изучение возможностей хронотерапии при назначении фиксированной комбинации периндоприла 10 мг и индапамида 2,5 мг (Нолипрел А Би-форте) у пациентов с недостаточной степенью снижения артериального давления в ночное время

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP>140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p<0.01), the average ambulatory diastolic BP (DBP) during wakefulness - from 94.7±12.3 mm Hg to 78.3±8.6 mm Hg (ns), ambulatory SBP during sleep - from 146.6±16.1 mm Hg to 121.8±15.7 mm Hg (p<0.01), ambulatory DBP during sleep - from 86.2±9.2 mm Hg to 70.3±6.5 mm Hg (p<0.01). The reduction of nighttime SBP increased from 1.9±5.8% to 6.2±9.3% (p<0.05), the reduction of nighttime DBP from 6.2±3.9% to 9.6±8.2% (ns). ABPM measurements of "non-dipper" sub-groups, who received treatment in the evening or in the morning after 2 months had no significant difference, except the variability of DBP during wakefulness (p<0.05). We didn’t observe statistically significant difference in terms of the nighttime BP reduction. However, nighttime BP reduction was higher in the evening dosing group: SBP - 4.1±11.1% (morning group), 7.8±7.9% (evening group) and DBP - 8.9±11.0 (morning group) and 10.2±5.5 (evening group). Blood tests were in the normal range during the whole study. Conclusion. A fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) is effective and safe in patients with both normal and with insufficient degree of reduction in BP at night. Prescription of medication in the evening in non-dipper patients can have the added benefit on the BP profile. Further research is needed.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients.

BackgroundIn this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension.MethodsA total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group.ResultsThe mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors.ConclusionEFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

The relationship between vitamin D levels and nondipper hypertension.

Nondipper hypertension is associated with increased cardiovascular morbidity and mortality. Vitamin D deficiency is associated with cardiovascular diseases such as coronary artery disease, heart failure and hypertension. We aimed to evaluate the effect of vitamin D on nondipper hypertension. This study included total 200 essential hypertensive patients. Twenty-four-hour ambulatory blood pressure monitoring was performed for each patient. In addition to routine tests, vitamin D levels were analysed. The study population was divided into two groups: 100 dipper patients (mean age; 50.6±9.9 years, 54 women and 46 men) and 100 nondipper patients (mean age; 49.2±8.2 years, 53 women and 47 men). Clinical blood pressures were significantly higher in nondipper hypertensives than dipper hypertensives (systolic blood pressures 141.2±5.6 vs. 139.1±6.6 mmHg, diastolic blood pressures 88.4±2.6 mmHg vs. 87.4±3.4, P<0.05, respectively). Nondipper patients showed lower levels of vitamin D compared with dippers (21.1±3.5, 31±7.1 ng/ml, P<0.001, respectively). A significant positive correlation was observed between vitamin D and the rate of nocturnal systolic and diastolic blood pressure fall (r=0.525, P<0.001 and r=0.512, P<0.001, respectively) Vitamin D levels are significantly lower in patients with nondipper hypertension than patients with dipper hypertension.

Diurnal changes in pulse pressure amplification in normotensive, hypertensive dipper and hypertensive non-dipper patients

Diurnal changes in pulse pressure amplification in normotensive, hypertensive dipper and hypertensive non-dipper patients

Abstract 12837: Nondipper Pulse Rate Pattern is Associated With Cardiovascular Events, but Night Pulse Rate is Not: Japan Morning Surge Home Blood Pressure (J-HOP) Study

Introduction: Nondipper patterns of pulse rate (PR) as well as blood pressure (BP) have been associated with cardiovascular events. High night PR is also associated cardiovascular events. Hypothesis: We assessed the hypothesis that a nondipper PR pattern was independently associated with cardiovascular events in patients with cardiovascular risk factors, adjusting for night pulse rate. Methods: Ambulatory BP monitoring was conducted at baseline in 1443 patients who had one or more cardiovascular risk factors. PR nondipping status was defined as (awake PR - sleep PR)/awake PR &lt; 0.1. Results: The nondipper PR patients (N=339) were older (66.8±10.6 vs. 63.9±11.8, p&lt;0.001) and had a higher night PR (65.5±9.6 vs. 58.9±7.3/min, p&lt;0.001) than the dipper PR patients (N=1104). The mean follow-up period was 60±30 months; in that time 50 patients (4.5%) in the dipper PR group and 34 patients (10.0%) in the nondipper PR group suffered primary endpoints (log rank 22.2, p&lt;0.001). On the Cox proportional hazards model including age, gender and night systolic blood pressure, nondipper PR was an independent predictor of cardiovascular event (hazard ratio 2.38, 95% confidence interval 1.51-3.74, p&lt;0.001), but night PR was not (p=0.50). We analyzed four groups according to BP and PR dipping status, the combination of nondipper BP and nondipper PR constituted a higher risk of cardiovascular events and stroke than the sum of the other three combination risks (Log rank= 39.2, p&lt;0.001, figure). When we added the nondipper BP pattern in the model, nondipper PR remained an independent predictor of cardiovascular events (hazard ratio 2.29, 95% confidence interval 1.50-3.51, p&lt;0.001). After excluding patients who took beta blockers (N=1003), nondipper PR was an independent predictor of cardiovascular events (hazard ratio 2.16, 95% confidence interval 1.22-3.82, p=0.008). Conclusions: The nondipper PR pattern was associated with cardiovascular events, but night pulse rate was not.

Non-dipping blood pressure patterns and arterial stiffness parameters in patients with Behcet's disease.

Behcet's disease is a multisystemic vasculitis involving veins and arteries of various sizes. Non-dipping status, augmentation index and pulse wave velocity are important determinants of cardiovascular mortality and morbidity. We investigated the non-dipping status and arterial stiffness in patients with Behcet's disease. In this cross-sectional study, we examined the vascular parameters of 96 patients with Behcet's disease (53% female) and 60 age- and sex-matched control subjects. The non-dipping status and arterial distensibility were assessed using a Mobil-O-Graph Arteriograph, an automatic oscillometric device. In total, 65.6% of 96 patients were systolic non-dippers, and 34.4% exhibited high augmentation indices. Ten percent of the control subjects were systolic non-dippers, and 11.7% exhibited high augmentation indices. Nocturnal decreases in systolic blood pressure correlated with central systolic blood pressure and diastolic blood pressure, as well as nocturnal decreases in diastolic blood pressure. Furthermore, non-dipper patients with Behcet's disease exhibited higher nocturnal cardiac outputs than did dipper patients with Behcet's disease. Augmentation index correlated negatively with C-reactive protein and correlated positively with both 24 h and nocturnal peripheral resistance, as well as 24 h pulse wave velocity. The patients with high augmentation indices exhibited lower creatinine clearance, as well as lower nocturnal cardiac outputs, higher 24 h peripheral resistance and higher 24 h pulse wave velocities. Non-dipping status and arterial stiffness may exacerbate the harmful cardiovascular effects of the other. In addition to conventional risk factors, non-dipping status and arterial stiffness should be examined during the follow-up evaluations of patients with Behcet's disease.