Non-dipping Blood Pressure Pattern Research Articles

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

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

Pathophysiology of the Nondipping Blood Pressure Pattern.

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

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

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

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

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

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

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

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

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

Masked nocturnal hypertension as a result of high prevalence of non-dippers among apparently well-controlled hypertensive patients with type 2 diabetes mellitus: data from a prospective study

BackgroundAmbulatory blood pressure monitoring (ABPM) in patients with diabetes mellitus (DM) and hypertension (HTN) show the dipping patterns, identify masked uncontrolled hypertension (MUCH), and demonstrate the effectiveness of the blood pressure (BP) treatment. MUCH is associated with a two-fold higher risk of adverse events. Prevalence in patients with DM is between 13.3 and 66.4%. Our study aims to investigate the prevalence of MUCH and the BP patterns in a population of apparently well-controlled hypertensive patients with type 2 DM (T2DM). A second aspect was the assessment of the effectiveness of antihypertensive treatment.MethodsOne hundred and sixty-three consecutively treated hypertensive patients with T2DM and an office BP between 130–139 and 80–89 mmHg performed a 24 h ABPM. The circadian BP variation, the presence of MUCH, and the correlations with the treatment were assessed.ResultsThere were 75 dippers (46.02%), 77 non-dippers (47.23%), 4 reverse dippers (2.45%), and 7 extreme dippers (4.30%). Eighty-one patients (77 non-dippers + 4 reverse dippers; 49.7%) had isolated nocturnal MUCH according to the mean night ABPM criteria. Dippers and extreme dippers (75 dippers + 7 extreme dippers; 51.3%) did not have any MUCH criteria. The patients took, on an average, 3 antihypertensive drugs with no difference between those with controlled HTN and the isolated nocturnal MUCH group. Significant factors associated with isolated nocturnal MUCH and a non-dipping BP pattern included age > 65 years (OR = 1.9), DM duration > 10 years (OR = 1.4), HTN duration > 6.5 years (OR = 1.2), obesity (OR = 1.6), and cardiovascular comorbidities (OR = 1.4).ConclusionsThe current study shows that half of the treated hypertensive patients with T2DM and office clinical normotension are non-dippers or reverse dippers. They experience isolated nocturnal MUCH due to their elevated nocturnal BP values, which comply with the actual definition of masked nocturnal hypertension. Bedtime chronotherapy in those patients could be linked to better effectiveness of antihypertensive treatment during the night with the important goal of reducing cardiovascular and cerebrovascular adverse events. ABPM should be performed in hypertensive patients with DM for better risk stratification and more effective control of HTN.

Triglyceride-to-glucose index to detect a non-dipping circadian pattern in newly diagnosed hypertensive patients.

Introduction: In this investigation, we aimed to explore the relationship between the triglyceride-glucose (TyG) index and the non-dipping blood pressure (BP) pattern in newly diagnosed hypertensive patients. Methods: In this retrospective study, 216 consecutive newly diagnosed hypertensive patients who had undergone 24-hour ambulatory blood pressure (ABPM) monitoring and had not received anti-hypertensive drugs were included. Non-dipping status was evaluated by a 24-h ABPM monitoring in all patients. We categorized the patients into two groups as; dippers (n=104 cases) and non-dippers (n=112 cases). The TyG index was derived from the fasting triglyceride and fasting glucose levels using the formula; ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Results: Non-dipper group had a higher TyG index than the dipper group. The TyG was an independent predictor of non-dipping BP in hypertensive individuals, according to multivariable analysis. The TyG index was negatively associated with a decrease in both systolic and diastolic BP during the nighttime. The ideal cutoff value of the TyG index in detecting non-dipping status was≥9.01 with 74.1% sensitivity and 71.2% specificity. A ROC comparison indicated that the area under the curve value of TyG index was superior to fasting triglyceride, fasting glucose, and homeostasis model assessment of IR (HOMA-IR) in detecting non-dipping BP. Conclusion: The TyG index was an independent predictor of non-dipping status in newly diagnosed hypertensive patients who had undergone 24-hour ABPM monitoring and had not received anti-hypertensive drugs. As a simple and easily obtained parameter, the TyG index can be used to detect such pattern among these patients.

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

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

CORRELATION OF CAROTID INTIMA-MEDIA THICKNESS AND PULSE WAVE VELOCITY WITH HEMATOCRIT, PLATELET COUNT AND FIBRINOGEN LEVELS IN DIPPER AND NON-DIPPER HYPERTENSIVE PATIENTS

Objective: Carotid intima-media thickness (IMT) and pulse wave velocity (PWV) are the two most widely recognized methods for the assessment of arterial stiffness. The aim of this study was to verify whether there is a correlation between them and some blood parameters in dipper and non-dipper hypertensive patients. Design and method: This was a cross-sectional study that included patients with arterial hypertension (AHT) who were greater than 18 years old. Demographic and epidemiological variables were collected. Blood pressure (BP) parameters were assessed by office BP measurements and 24-hour ambulatory BP monitoring (24 h ABPM). We collected blood samples for biochemistry, blood count and coagulation variables. Individuals were divided into two groups: dipper and non-dipper patients. Quantitative normally distributed variables were nalysed using the Student’s t-test while non-normally distributed variables were nalysed using the Mann–Whitney U-test. A Chi-square test was used for categorical variables to test differences between groups. This study was approved by the center Ethics Committee of Clinical Research, and it adhered to the ethical standards that were outlined in the Declaration of Helsinki. All subjects provided informed consent. Results: There were 563 patients (47% women) with a mean age of 54 years who were included in this study. One third of patients suffered from diabetes and two out of three had plasma lipid abnormalities. There were differences in age, frequency of diabetes, dyslipidemia and antihypertensive therapy between dipper and non-dipper patients. After an adjustment for those variables, we observed a relevant correlation of PTC (Pearson correlation coefficient [r] -0.215, P = 0.002) and hematocrit (r 0.215 P = 0.002) with IMT in patients with a dipper profile while individuals with a non-dipper BP pattern showed a correlation of PWV with PTC (r -0.149, P = 0.031) and fibrinogen levels (r 0.238, P = 0.031). Uric acid levels were correlated with IMT in both groups of patients. Conclusions: It seems that some blood parameters could be linked to the development of arterial stiffness in both dipper and non-dipper patients. This was a preliminary retrospective, single-center study that could open the door to the investigation of new analytical indices in arterial stiffness.

Relationship between C-reactive protein/albumin ratio and dipper/nondipper pattern in normotensive individuals.

Nondipper blood pressure pattern plays an important role in cardiovascular events even in normotensive individuals. The relationship between CRP (C-reactive protein)/albumin ratio (CAR), a valuable marker of inflammation and cardiovascular diseases, has been studied for a long time. We aimed to investigate the relationship between CAR and dipper/nondipper pattern in normotensive subjects. A total of 78 dipper and 78 nondipper participants, based on ambulatory blood pressure monitoring (ABPM), were retrospectively included in our study. CAR and other parameters of all participants were collected from blood samples taken at the time of monitoring. CAR was significantly higher in the nondipper group than dipper group ( P = 0.001). CAR was negatively and significantly correlated with nocturnal SBP fall ratio and nocturnal DBP fall ratio ( P < 0.001). CRP/albumin ratio was found significantly and independently associated with the nondipper pattern ( P = 0.002). We found that normotensive individuals with nondipping pattern tend to have increased CAR. Increased inflammatory response could contribute to increase in the atherosclerotic risk in nondippers compared with dippers even in a normotensive profile.

Hemodiyaliz Hastalarında Yüksek Serum Ürik Asit/HDL-Kolesterol Oranı Kardiyovasküler Risk ile İlişkilidir

Aim: Chronic kidney disease (CKD) is a progressive disease in which frequent cardiovascular (CV) comorbidities. High uric acid to HDL-cholesterol ratio (UHR) results were quite notable in patients receiving peritoneal dialysis. Thus, in this study, we aimed to evaluate the UHR results in dialysis patients.&#x0D; Materials and Methods: This retrospective, multicenter, cross-sectional study was conducted with CKD patients, and the control group consisted of hypertensive patients with a normal glomerular filtration rate (GFR). Patients’ laboratory, ambulatory blood pressure monitoring, and demographic records were obtained from the follow-up cases of two university hospitals’ internal medicine and nephrology departments. The patients' group then were divided into five subsets according to GFR. &#x0D; Results: A total of 124 CKD patients and 127 control participated in this study. All CKD patients were also identified as pre-dialysis and dialysis. The cases of UHR, non-dipper blood pressure pattern, and nocturnal heart rate (HR) were increased in CKD compared to the control group. Per disease progression, the non-dipper HR and nocturnal HR were more significant in patients receiving dialysis with high UHR than in the pre-dialysis subset. In diabetic patients with an on-targeted HbA1c, those with high UHRs still had nocturnal diastolic BP elevations. Finally, there was not an exact stage-specific result for pulse wave velocity.&#x0D; Conclusions: Based on our results, dialysis patients with high UHRs have higher non-dipper PR, nocturnal heart rate, and nocturnal diastole blood pressure, associated with CV risk. Moreover, effective diabetic management might not prevent CV risk in dialysis patients with high UHRs.

Aortic knob width is associated with non-dipping blood pressure pattern

Background: Aortic knob width (AKW) is the measurement of the radiographic configuration composed of the foreshortened aortic arch and a part of the descending aorta. We investigated the relationship between the nondipper pattern and AKW. Material and methods: All patients’ office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of less than 10% was defined as non-dipping. The patients were grouped into Group 1; dipper pattern (37 patients; 22F, and mean age 49.2 ± 11.7 yrs) and Group 2; non-dipper pattern (64 patients; 37F, and mean age 53.7 ± 13.1 yrs). On posteroanterior chest radiography, the widest point of the aortic knob was measured along the straight imaginary line from the lateral edge of the trachea to the left lateral wall of the aortic arch. Results: AKW was significantly higher in Group 2 compared to group 1 (36.7 ± 5.7 vs. 30.7 ± 4.5 mm, p &lt; 0.001). The mean daytime and night-time systolic blood pressures, the mean night-time diastolic blood pressure levels, 24-hour mean blood pressure and mean pulse pressures were higher; percentage of nocturnal drops was significantly lower in Group 2 compared to Group 1. AKW was determined to be the parameter that was mostly related to the non-dipper pattern. A ROC analysis revealed that the area under the curve values for AKW values of non-dippers were 0.796 (95% CI: 0.707–0.884, p &lt; 0.001). Conclusion: AKW is significantly higher in non-dipper individuals compared to dippers. AKW values above 32.6 mm on the chest radiograph may be associated with non-dipper pattern especially in hypertensive individuals.

Fibrosis-4 index: A new marker to predict non-dipper blood pressure pattern in patients with newly diagnosed hypertension

Introduction: Epicardial fat tissue (EFT) is a significant risk factor for cardiovascular diseases. This study aimed to investigate whether there is a relationship between the fibrosis-4 index (FIB-4 index) and EFT in newly-diagnosed hypertensive patients and explore the usability of the FIB-4 index in predicting non-dipper blood pressure (BP) pattern. Materials and methods: Our case–control study consisted of 210 patients in 3 groups according to BP values, namely normotensive, dipper, and non-dipper groups. Transthoracic echocardiography and 24-h ambulatory BP monitoring were performed in all patients. Results: The median FIB-4 index was higher in the non-dipper group [1.56 (1.10-2)] than in the dipper [1 (0.71-1.32)] and normotensive groups [0.96 (0.69-1.32)] (p &lt; 0.001, for both). A positive correlation was observed between EFT and the FIB-4 index (r=0.389, p&lt;0.001). In multivariate logistic regression analysis, EFT (odds ratio (OR): 0.506, 95% confidence interval (CI): 1.288-2.135; p&lt;0.001) and FIB-4 index (OR: 1.099, 95% CI: 1.621–5.556; p&lt;0.001) were found to be independent predictors of non-dipper BP. In the receiver operating characteristic curve analysis, the FIB-4 index had 68% sensitivity and 72% specificity at a value &gt;1.25 (area under the curve: 0.751, 95%CI: 0.679-0.823, p&lt;0.001). Conclusions: In newly-diagnosed hypertensive people, the FIB-4 index is related to non-dipper BP patterns. FIB-4 index appears to be a helpful tool in assessing risk associated with cardiovascular disease.

Clinical characteristics of two groups commonly referred to an Irish hypertension service-patients with resistant hypertension and young adults with hypertension.

The management of hypertension is primarily performed in primary care settings in many health systems. However, two groups of patients often require specialist input: patients with resistant hypertension (RH) and young adults with hypertension. To elucidate these groups by examining the characteristics of patients attending an Irish hypertension service, thus informing future management of hypertension. Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Following patient consent, patient data were recorded to identify patient characteristics as well as the results of investigations, blood pressure (BP) measurements and the anti-hypertensive treatment of the study participants which were then analysed. Two hundred thirty-six patients were included in the study. Compared to those without RH, the RH group were more likely to be obese (OR 2.59 [95% CI 1.06 to 6.33]), to have cardiovascular disease (OR 3.07 [95% CI 1.56 to 6.02]) and to have a non-dipping BP pattern (OR 3.86 [95% CI 1.57 to 9.47]). Young adults comprised 27% of the cohort. Forty-seven percent of these patients were obese, 15.9% had hypertension in pregnancy and 22.2% had chronic headaches. Despite being prescribed less anti-hypertensives (1.41 vs 2.28; p < 0.05), the majority of young patients had a BP less than 140/90mmHg, comparing favourably with older patients (OR 2.25 [95% CI 1.20 to 4.27]). This contemporary study highlights the high prevalence of obesity among RH patients and young adults with hypertension. Findings suggest that programs to combat hypertension must include interventions to address obesity.

Association of nocturnal subconjunctival hemorrhage and non-dipper blood pressure pattern: A benign clue for serious diseases.

To evaluate the association between non-dipper blood pressure pattern and subconjunctival hemorrhage (SCH). Twenty-seven consecutive patients with nocturnal SCH and 27 age, sex-matched controls were enrolled. Demographic, blood parameters, office blood pressure measurements, 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Mean diastolic blood pressure (DBP) for nighttime (65.03 ± 7.1 vs. 70.78 ± 10.5, p: 0.22), mean heart rate for nighttime (64.54 ± 8.26 vs. 69.93 ± 9.85, p: 0.034), Minimum Systolic Blood pressure(SBP) and DBP values for nighttime (92.44 ± 9.72 vs. 99.44 ± 10.66, p:0.015 and 51.15 ± 8.31 vs. 57.7 ± 11.2, p: 0.018) were higher, nocturnal fall ratio of SBP and DBP were significantly lower in the SCH ( + ) group compared to SCH (-) group (5.38 ± 8.39 vs. 10.34 ± 6.08, p: 0.016 and 4.26 ± 8.92 vs. 13.78 ± 6.97, p < 0001 respectively). Ten patients (37%) in the SCH (-) group and 18 patients (66.7%) in the SCH ( + ) group were non-dippers (p: 0.029). Mean daytime SBP and DBP were higher compared to office measurements of 4 patients (14.8%) in the SCH (-) group and 11 patients (40.7%) in the SCH ( + ) group (p: 0.033). SCH had a strong association with non-dipper blood pressure pattern, higher nocturnal heart rate and masked hypertension which are precursors of myocardial infarction, stroke and renal failure. So, SCH should be considered as a clue for serious diseases such as coronary artery disease, myocardial infarction, stroke and patients should be evaluated for ABPM.

Fragmented QRS and blood pressure pattern in normotensive individuals with a history of preeclampsia

Background/Aim: Hypertension is well defined in preeclamptic individuals and those with a history of preeclampsia. However, the relationship between blood pressure pattern and fragmented QRS on electrocardiography (ECG) has not been elucidated in normotensive patients with a history of preeclampsia. This study aimed to investigate the frequency of non-dipper blood pressure (BP) patterns in normotensive individuals with a history of preeclampsia and to evaluate the relevance of this pattern to fragmented QRS (fQRS). Methods: Sixty-three normotensive (office BP measurement) patients with a history of preeclampsia were included in this study between August 2020 and January 2021. These individuals underwent 24-hour ambulatory BP monitoring. The patients were divided into two groups as dipper and non-dipper, according to their BP patterns. The two groups were compared in terms of echocardiographic parameters, laboratory values, and QRS fragmentation on ECG. Results: Left ventricular diastolic dysfunction (LVDD) diagnosed by echocardiography (P= 0.015) and fQRS on ECG (P=0.002) were significantly higher in the non-dipper group than in the dipper group. Tricuspid regurgitation velocity (P=0.004) and average E/e' ratio (P

The association between nondipper pattern and perioperative hypertension in patients with controlled hypertension.

Perioperative hypertension is a frequent complication even in preoperatively normotensive or controlled hypertensive patients and there is a lack of data regarding the effect of nondipping pattern on perioperative hypertension. In this study, we aimed to investigate the possible effect of nondipping blood pressure pattern on the risk of perioperative hypertension. 234 hypertensive patients who underwent surgery with general anesthesia were evaluated prospectively. The study enrolled patients with well-controlled preoperative blood pressure. The 24-h ambulatory blood pressure monitoring results were used to classify patients as dippers and nondippers. Perioperative hypertension is defined as a systolic/diastolic arterial blood pressure greater than or equal to 160/90 mmHg or systolic blood pressure elevated by more than 20% from the patient's baseline level for more than 15 min perioperatively. There were 61 (26%) nondipper patients [mean age: 62.1 ± 7.1 years, 25 (40.9%) men] and 173 (74%) dipper patients [mean age: 61.4 ± 8.1 years, 83 (47.9%) men]. In the nondipper group, perioperative hypertension was observed in 31 (51.3%) patients, whereas in the dipper group, 33 (19.3%) patients experienced a hypertensive attack (P < 0.001). The independent predictors of perioperative hypertension were the presence of the nondipping pattern [odds ratio (OR) 3.084; 95% confidence interval (CI) 1.831-5.195; P < 0.001], the presence of diabetes mellitus (OR 2.059; 95% CI 1.215-3.490; P = 0.007), and the number of drugs (OR 2.317; 95% CI 1.102-5.097; P = 0.027). The frequency of perioperative hypertension was higher in preoperative normotensive and known hypertensive patients who were identified as nondippers. In addition, diabetes mellitus and number of drugs were found to be predictors of perioperative hypertension.

The Effects of Secondary Hyperparathyroidism on Circadian Blood Pressure in Hemodialysis Patients.

To determine the relationship between secondary hyperparathyroidism (sHPT) and circadian blood pressure (BP) rthym among patients undergoing hemodialysis treatment. A descriptive and prospective cohort study. Department of Nephrology, Firat University Hospital, Turkey, between June and December 2019. Eighty-five patients, undergoing hemodialysis three times a week, were included. The BP parameters and circadian blood pressure rhythm were measured by the mobil-o-graph sphygmomanometer. Non-dipper blood pressure phenomenon was defined as a night-time mean artery pressure (MAP) decrease of <10% from the daytime MAP; sHPT was defined as parathormone >300 pg/ml. Of the 85 participants, mean age was 57.07 ± 14.46 years. In cohort, sHPT rate 58.8% (n =50) and non-dipper blood pressure pattern rate was 64.7% (n = 55). Systolic blood pressure (p=0.001), diastolic blood pressure (p=0.001), and mean arterial blood pressure (p<0.001) were higher in participants with sHPT. sHPT (p = 0.003) was an independent risk factor for non-dipper blood pressure pattern (odds ratio [OR] 0.065, 95% CI: 0.11-0.390). A negative correlation was identified between parathormone and the reduction in night blood pressure (r = -0.346, p=0.001). Secondary hyperparathyroidism can cause non-dipper blood pressure pattern by reducing the reduction in night blood pressure. Treatment of sHPT is important in the control of blood pressure and normal circadian blood pressure rhythm in tertiary protection in hemodialysis patients. Key Words: Blood pressure, Circadian rhythm, Hyperparathyroidism secondary, Hemodialysis, Chronic kidney diseases.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.