Non-dipping Blood Pressure Profile Research Articles

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect.

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

Postpartum Detection of Diastolic Dysfunction and Nondipping Blood Pressure Profile in Women With Preeclampsia.

Left ventricular diastolic dysfunction and nocturnal "nondipping" of blood pressure detected via ambulatory blood pressure monitoring are predictors of increased cardiovascular morbidity. A prospective cohort study including normotensive women with a history of preeclampsia in their current pregnancy was conducted. All cases were subjected to 24-hour ambulatory blood pressure monitoring and 2-dimensional transthoracic echocardiography 3 months after delivery. This study included 128 women with a mean (SD) age of 28.6 (5.1) years and a mean (SD) basal blood pressure of 123.1 (6.4)/74.6 (5.9) mm Hg. Among the participants, 90 (70.3%) exhibited an ambulatory blood pressure monitoring profile illustrating nocturnal blood pressure "dipping" (the mean night to day time blood pressure ratio ≤ 0.9), whereas 38 (29.7%) were nondippers. Diastolic dysfunction (impaired left ventricular relaxation) was present in 28 nondippers (73.7%), whereas none of the dippers exhibited diastolic dysfunction. Women with severe preeclampsia were more frequently nondippers (35.5% vs 24.2%; P = .02) and experienced diastolic dysfunction (29% vs 15%; P = .01) than were those with mild preeclampsia. Severe preeclampsia (odds ratio [OR], 1.08; 95% CI, 1.05-10.56; P < .001) and history of recurrent preeclampsia (OR, 1.36; 95% CI, 1.3-4.26; P ≤ .001) were significant predictors for nondipping status and diastolic dysfunction (OR, 1.55; 95% CI, 1.1-2.2; and OR, 1.23; 95% CI, 1.2-2.2, respectively; P < .05). Women with a history of preeclampsia were at higher risk for developing late cardiovascular events. The severity and recurrence of preeclampsia were significant predictors of both nondipping profile and diastolic dysfunction.

Implications of Inflammatory and Oxidative Stress Markers in the Attenuation of Nocturnal Blood Pressure Dipping.

To date, no model has jointly encompassed clinical, inflammatory, and redox markers with the risk of a non-dipper blood pressure (BP) profile. We aimed to evaluate the correlation between these features and the main twenty-four-hour ambulatory blood pressure monitoring (24-h ABPM) indices, as well as to establish a multivariate model including inflammatory, redox, and clinical markers for the prediction of a non-dipper BP profile. This was an observational study that included hypertensive patients older than 18 years. We enrolled 247 hypertensive patients (56% women) with a median age of 56 years. The results showed that higher levels of fibrinogen, tissue polypeptide-specific antigen, beta-2-microglobulin, thiobarbituric acid reactive substances, and copper/zinc ratio were associated with a higher risk of a non-dipper BP profile. Nocturnal systolic BP dipping showed a negative correlation with beta-globulin, beta-2-microglobulin, and gamma-globulin levels, whereas nocturnal diastolic BP dipping was positively correlated with alpha-2-globulin levels, and negatively correlated with gamma-globulin and copper levels. We found a correlation between nocturnal pulse pressure and beta-2-microglobulin and vitamin E levels, whereas the day-to-night pulse pressure gradient was correlated with zinc levels. Twenty-four-hour ABPM indices could exhibit singular inflammatory and redox patterns with implications that are still poorly understood. Some inflammatory and redox markers could be associated with the risk of a non-dipper BP profile.

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.

Порівняння впливу фіксованої комбінації периндоприл/амлодипін на ураження органів-мішеней у пацієнтів з артеріальною гіпертензією з ішемічною хворобою серця та без неї (результати дослідження EPHES)

Дослідження EPHES (Evaluation of influence of fixed dose combination Рerindopril/Amlodipine on target organ damage in patients with arterial HypErtension with or without iSchemic heart di­sease — оцінка впливу фіксованої комбінації периндоприл/амлодипін на ураження органів-мішеней у пацієнтів з артеріальною гіпертензією (АГ) з ішемічною хворобою серця (ІХС) та без неї) мало за мету порівняти ефективність фіксованої комбінації (ФК) периндоприл/амлодипін щодо зниження артеріального тиску (АТ) та динаміки вираженості ураження органів-мішеней у хворих на АГ з ІХС та без неї. Матеріали та методи. У дослідження EPHES було включено 60 пацієнтів з АГ віком старше від 30 років: перша група — 30 пацієнтів без ІХС, друга — 30 пацієнтів, які мали ІХС. Строк спостереження становив 12 місяців. Усім пацієнтам у день рандомізації призначали ФК периндоприл/амлодипін у початковій дозі 5/5 мг один раз на добу. При необхідності (АТ &gt; 140/90 мм рт.ст.) дози компонентів ФК збільшували поступово кожні 2 тижні до 10/10 мг, а після 6 тижнів лікування додавався індапамід 1,5 мг. 66,7 та 96,7 % пацієнтів в першій та другій групах відповідно отримували бета-адреноблокатори. Усім пацієнтам проводили: вимірювання маси тіла та зросту, офісних рівнів систолічного АТ (САТ), діастолічного АТ (ДАТ) та частоти серцевих скорочень (ЧСС), добове моніторування АТ, визначення швидкості поширення пульсової хвилі в артеріях еластичного (ШППХе) та м’язового типів, центрального САТ, стандартизованого до ЧСС 75 уд/ хв індексу аугментації (Аіх75), біохімічне дослідження крові, електрокардіографію, ехокардіографію з допплерографією, вимірювання гомілково-плечового індексу, визначення товщини комплексу інтима-­медіа (ТКІМ). Результати. Встановлено, що призначена терапія на основі ФК периндоприл/амлодипін незалежно від наявності або відсутності ІХС ефективно (до цільових рівнів) та безпечно знижувала офісний, середньодобовий, денний, нічний та центральний АТ. При цьому достовірно зменшувалися початково підвищені денна та нічна варіабельність АТ, величина ранкового підйому САТ та частка пацієнтів з добовим профілем АТ типу «нон-дипер», проте ці показники залишалися достовірно більшими у пацієнтів з ІХС на всіх етапах лікування. Хворі з ІХС та без неї не відрізнялися за початковою величиною АІх75, і на фоні призначеної терапії спостерігалося достовірне зменшення цього показника в обох групах, проте у хворих з ІХС це зменшення АІх75 було достовірно меншим, ніж у групі без ІХС, що, імовірно, було пов’язано з більш частим застосуванням бета-блокаторів. Ефективне щодо зниження АТ лікування призводило в обох групах до достовірного зменшення ураження органів-мішеней — покращення пружно-еластичних властивостей аорти та діастолічної функції лівого шлуночка, зменшення рівня альбумінурії, гіпертрофії лівого шлуночка та розміру лівого передсердя. Ступінь зниження ШППХе був достовірно (Р &lt; 0,005) меншим у пацієнтів без ІХС, ніж у групі з ІХС — 2,5 ± 0,2 м/с проти 4,4 ± 0,5 м/с. Окрім того, незважаючи на однаковий ступінь зменшення індексу маси міокарда лівого шлуночка, покращення діастолічної функції лівого шлуночка (збільшення Е/А та зменшення Е/Е’) у групі хворих з ІХС було більшим — на 64,4 та 54,1 % проти 39,8 та 23,2 % відповідно (Р &lt; 0,05 для обох показників). Максимальна величина ТКІМ достовірно зменшилася лише в пацієнтів з ІХС. Терапія не призводила до достовірних змін біохімічних показників та добре переносилася хворими — побічні явища зареєстровані у 2 (6,5 %) в групі без ІХС та у 3 (10 %) у групі з ІХС (Р = НД між групами). Групи достовірно не відрізнялися за динамікою скарг, і серед пацієнтів з ІХС, які мали стенокардію на початку дослідження, значно зменшилася кількість приступів стенокардії за тиждень — з 2,5 ± 0,4 до 1,2 ± 0,2 (Р &lt; 0,01). Висновки. Отже, лікування АГ на основі ФК периндоприл/амлодипін було ефективним щодо зниження АТ та регресу ураження органів-мішеней незалежно від наявності ІХС. Зміни показників, що характеризують ураження органів-мішеней, дещо відрізнялися в пацієнтів з ІХС та без неї, що необхідно враховувати при виборі тактики лікування.

Фактори ризику, що впливають на прогноз у хворих з артеріальною гіпертензією

В аналіз включено 524 пацієнти, яким проводили стандартне обстеження: вимірювання офісного артеріального тиску (АТ), добове моніторування АТ, ехокардіографію, електрокардіографію. Через 5 років після виписки зі стаціонару усім хворим поштою була розіслана анкета, що хворі заповнювали письмово з вказанням, які та коли перенесли несприятливі події (інфаркт міокарда, інсульт, нестабільна стенокардія, серцева або ниркова недостатність, інші серцево-судинні події, що потребували госпіталізації). У разі смерті пацієнта анкету заповнювали родичі. Вплив факторів на частоту виникнення несприятливих подій визначали за допомогою регресійного аналізу. Під час дослідження встановлено, що основними факторами, які були пов’язані з виникненням несприятливих подій (інфаркт, інсульт, нестабільна стенокардія, серцева недостатність, ниркова недостатність, смерть, госпіталізація через інші серцево-судинні події, цукровий діабет) в обстежених хворих, були: вік пацієнта, рівень систолічного АТ при виписці зі стаціонару, рівень пульсового АТ (ПАТ) при виписці зі стаціонару, наявність постінфарктного кардіо-склерозу, інсульту в анамнезі, збільшений порівняно з нормою розмір лівого передсердя, знижена фракція викиду лівого шлуночка, збільшена товщина міжшлуночкової перегородки, індекс маси міокарда лівого шлуночка більше 137 г/м2, наявність ЕКГ-ознак гіпертрофії лівого шлуночка більше 3 балів за критерієм Естеса, порушений добовий профіль діастолічного АТ (ДАТ), рівень середнього денного ПАТ більше 64 мм рт.ст. Незалежними від інших факторів ризику виникнення комбінованої кінцевої точки в обстежених хворих виявилися рівень офісного ПАТ при виписці зі стаціонару 64 мм рт.ст. та більше, значно знижена фракція викиду лівого шлуночка (менше 40 %), потовщення міжшлуночкової перегородки (більше 1,2 см), величина індексу маси міокарда лівого шлуночка 137 г/м2 та більше, кількість балів за Естесом більше 3, зниження ДАТ у нічний період менше 10 %, середній денний ПАТ при добовому моніторуванні АТ 64 мм рт.ст. і більше. Серед них незалежними від терапії, що призначалася, були рівень офісного ПАТ 64 мм рт.ст. і більше при виписці, знижена (менше 40 %) фракція викиду лівого шлуночка, порушення добового профілю АТ (добовий індекс для ДАТ менше 10 %) або середній денний ПАТ вищий від 64 мм рт.ст. Не виявлено достовірного впливу тієї чи іншої групи антигіпертензивних препаратів на частоту виникнення комбінованої точки. Для прогнозу обстежених хворих більше значення мало зниження АТ як такого, особливо ПАТ, а не те, яким антигіпертензивним препаратом вдавалося його знизити.

MO098HUMAN STOOL METABOLOME DIFFERS UPON 24-HOUR BLOOD PRESSURE LEVELS AND THE NON-DIPPING BLOOD PRESSURE PROFILE

Abstract Background and Aims Dysbiosis of gut microbiota (GM) has been involved in the pathophysiology of arterial hypertension (HT), via a putative role of food-derived short chain fatty acids (SCFAs). Among the clinical manifestations of HT, the absence of a significant drop in blood pressure (BP) overnight (i.e. non-dipping BP profile) has been associated with poor cardiovascular outcomes. The link between GM and non-dipping BP profile is unknown. Method After informed consent, 16 male patients and their female partners (n=10) were subjected to 24-hours ambulatory BP monitoring and were categorized in 2 groups: HT (n=7; 6 men) and normotension (NT) (n=19). According to the conventional night–day systolic BP ratio &amp;gt;0.9, 15 individuals (8 men and 7 women) were categorized as non-dippers. Metabolomics using Nuclear Magnetic Resonance was performed on stool samples, including the quantification of the 3 main SCFAs (i.e. acetate, propionate and butyrate). Results Multivariate analysis (principal component analyses (PCA) and partial least squares (PLS-DA)) of stool metabolomics were not able to statistically separate HT versus NT groups. However, this approach discriminated dippers versus non-dippers groups in both male and female cohorts (Q²=0.87 and 0.98, respectively), as well as in the entire cohort (Q²=0.68). As previously described, fecal amounts of acetate, propionate and butyrate were higher in HT patients than in NT patients in the entire cohort (p=0.027; p=0.015 and p=0.015, respectively). Fecal amounts of acetate, propionate and butyrate were also significantly higher in non-dippers versus dippers in the entire cohort (p=0.027; p=0.038 and p=0.036, respectively). Significant correlations between stool metabolomes and the 24h-mean BP levels were found in male and female cohorts (R²=0.63 and 0.79 respectively) as well as in the entire cohort (R²=0.54). Conclusion In conclusion, this 26-patient cohort highlights significant correlations between stool metabolome and (i) BP levels and (ii) non-dipping BP profile in both men and women.

HUMAN STOOL METABOLOMES DIFFER UPON 24-HOUR BLOOD PRESSURE LEVELS AND THE NON-DIPPING BLOOD PRESSURE PROFILE

Objective: Dysbiosis of gut microbiota (GM) has been implicated in the pathophysiology of arterial hypertension (HT), via a putative role of food-derived short chain fatty acids (SCFAs) and other metabolites. Among the clinical manifestations of HT, the absence of a significant drop in blood pressure (BP) overnight (i.e. the non-dipping BP profile) has been associated with poor cardiovascular outcomes. The link between GM and the non-dipping BP profile is unknown. Design and method: After informed consent, 16 male patients (mean age = 52.3 ± 12.4 years; 1 patient under beta blocker) and their female partners (n = 10; mean age = 46.5 ± 13.2 years; 1 patient under thiazide diuretic and angiotensin-converting-enzyme inhibitor) were subjected to 24-hour ambulatory BP monitoring and categorized in 2 groups: HT (n = 6 men and 1 woman) and normotension (n = 19). According to the conventional night/day BP ratio &gt;0.9, 15 individuals (n = 8 men and 7 women) were categorized as non-dippers. Metabolomics using Nuclear Magnetic Resonance was performed on stool samples, including the quantification of the 3 main SCFAs (i.e. acetate, propionate and butyrate). Results: Principal component analyses (PCA) discriminated HT versus normotensive individuals on the basis of the stool metabolomes of the entire cohort (Q2 = 0.10). PCA also discriminated dippers versus non-dippers upon the stool metabolomes of the male and female cohorts (Q2 = 0.76 and 0.98, respectively) or the entire cohort (Q2 = 0.27). Significant correlations between stool metabolomes and the mean 24-hour BP levels were highlighted in male and female cohorts (R2 = 0.63 and 0.79, respectively), as well as in the entire cohort (R2 = 0.54). Interestingly enough, a higher variation between stool metabolomes (represented by the measure of inertia) was found in couples with a different BP status (51.4% of inertia) compared to the couples in whom both individuals presented with the same BP status (37.5% of inertia). The propionate/butyrate ratio was higher in the stools of male HT patients versus male normotensive patients (p = 0.03), but no difference was observed in the female cohort or in the entire cohort. Conclusions: In conclusion, this 26-patient cohort highlights significant correlations between the stool metabolome and (i) BP levels and (ii) the non-dipping BP profile in both genders.

HYPERTENSION CAUSED WITH LONG-TERM UNCONTROLLED USING OF NASAL DECONGESTANTS. HOW SAFE ARE OVER-THE-COUNTER DRUGS FOR SELF-MEDICATION?

Objective: Elevated blood pressure is known to increase the cardiovascular risks. High blood pressure (BP) can be both a consequence of incorrect drug use and other forms of hypertension. Over-the-counter (OTC) drugs can carry a potential risk, but still in a number of countries the OTC drugs can be bought without a doctor‘s prescription. Design and method: A 46-year-old man presented with headache, palpitation, high BP of 160/100 mmHg. These symptoms worsened during last month. The patient was working as a coal miner for 23 years. Bad habits: smoking for 10 years with pack of cigarettes a day. He was diagnosed essential hypertension five years ago and asthma four years ago. He referred to a physician. Mono-therapy of losartan 25 mg twice a day was prescribed, but there was no persistent effect of it. Physical examination: BMI 30.7 kg/m2, office BP 150/100 mmHg, heart rate 92/minute. By chemistry: creatinine 109.11 mkmol/l, GFR 95.4 ml/min (CKD-EPI), total cholesterol 3,86 mmol/l, triglycerides 3.09 mmol/l, HDL 0.88 mmol/l, VLDL 1.4 mmol/l, LDL 1.4 mmol/l. Blood count with a normal range. Ambulatory BP measurements for 24 hours on monotherapy of losartan: the mean pressure per day 143/87 mmHg, a non-dipping BP profile. Both eyes hypertension retinopathy was revealed. He did not have a left ventricular hypertrophy on echocardiogram. The patient revealed the use of OTC nasal decongestants for 20 years to treat the presence of chronic nonallergic rhinitis. The patient was advised to exclude the nasal decongestants. The office BP was 115/80 mm/Hg in the morning and 125/85 mm/Hg in the evening since 10 days after exclusion of nasal drops. Results: A nasal septal deviation was recently revealed. Septoplasty led to successful reduce of his nasal symptoms. On follow-up visit the patient had normal BP level without any antihypertensive therapy. Conclusions: This clinical case demonstrates the importance of drug regulation and potential harm for the OTC drugs use by the general population without of medical appointments. Notably, the importance of using a proper talk with patients suffering hypertension and to suggest a questionnaire aimed at detection of secondary reasons.

24-HR AMBULATORY BLOOD PRESSURE MONITORING &amp; 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 &lt; 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 &lt; 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.

ARYL HYDROCARBON RECEPTOR ANTAGONISTS - A NEW ENTRY IN ANTIHYPERTENSIVE ARMAMENTARIUM OF OBSTRUCTIVE SLEEP APNEA?

Objective: To investigate aryl hydrocarbon receptor (AhR) metabolic circuitry as a druggable target in chronic intermittent hypoxia (CIH) induced hypertension (HTA). Design and method: This study was approved by Nova Medical School's Ethics Committee and followed national and international regulations. We used a rat model of CIH-induced HTA to disclose the hypothesis that the aryl hydrocarbon receptor (AHR) is activated by IH, once it shares the same binding partner of HIF-1alpha and promotes pro-oxidant, pro-inflammatory (NF-kB) and pro-fibrotic events in common with CIH. AhR activation was measured by the mRNA and protein levels of its hallmark target gene Cyp1a1. Blood pressure, heart rate and locomotor activity were measured daily by radiotelemetry. A CIH paradigm of 21% to 5% of O2, 5.6 cycles/h, 10.5 h/day was used in their inactive/sleep period. Results: Upon established hypertension (21 days exposure to IH), we observed an increase in Cyp1a1 mRNA (hallmark of AhR activation) in kidney cortex (6-fold), kidney medulla (3-fold) and liver (3-fold), but not in other tissues. Increased renal expression of Ahr and markers of inflammation (Rela), epithelial to mesenchymal transition markers, the rate-controlling step of gluconeogenesis, Pepck1, and members of HIF-pathway, namely, Hif-3alpha were also observed. The ratio kynurenin/tryptophan (inflammatory index) was also increased in the kidney. The chronicity of IH increased the protein levels of cyp1a1 protein (western blot). Daily administration (14 days) of AHR antagonist, CH-223191 (5 mg.kg-1.day-1, gavage), simultaneously to CIH prevented the increase in systolic blood pressure (SBP) by 53 ± 12% and in diastolic blood pressure (DBP) by 44 ± 16%. Moreover, this AhR antagonist administration upon already established HTN reversed the increase in SBP by 52 ± 12%. Despite the antihypertensive effect seen in the rats’ active phase, in the inactive period, CH22319 did not revert the non-dipping blood pressure profile associated to CIH. Conclusions: CIH caused an activation of AHR signaling particularly in the kidney and its pharmacological blockade had a significant impact reverting already established HTN. This first evidence inspires innovative research opportunities for the understanding and treatment of this particular type of HTN.

The faecal abundance of short chain fatty acids is increased in men with a non-dipping blood pressure profile

Background and aims Gut microbiota (GM) has been involved in the pathophysiology of hypertension (HT), notably via short chain fatty acids (SCFAs). Among the clinical manifestations of HT, the absence of a significant drop in night-time blood pressure (BP) (also known as the non-dipping BP profile) has been associated with poor renal and cardiovascular outcomes. The putative link between GM-derived metabolites and BP dipping status is still unknown. Methods Male volunteers (n = 44) were prospectively subjected to 24-hour ambulatory blood pressure monitoring, stool sample collection and a medical questionnaire. Metabolomics analyses of stool samples were conducted using Nuclear Magnetic Resonance (NMR). Results Higher amounts of acetate, butyrate and propionate were found in the stools of non-dippers (n = 12) versus dippers (n = 26) (p = 0.0252, p = 0.0468, and p = 0.0496, respectively; n = 38 in toto). NMR spectral data were not interpretable in 5 dippers and 1 non-dipper. A similar significant association was found when including only patients without anti-HT medications (p = 0.0414, p = 0.0108, and p = 0.0602, respectively; n = 21 in toto). A not significant trend was observed when focussing only on HT patients without anti-HT medications (p = 0.0556; n = 14 in toto). Conclusion Our pilot study highlights a putative link between GM-derived SCFAs and the BP dipping status, independently of the BP status itself or the anti-hypertensive medications.

Abnormal diurnal blood pressure profile and hypertension-mediated organ damage in nondiabetic chronic kidney disease G1-G3b patients.

Chronic kidney disease (CKD) is associated with high cardiovascular risk. Prevalence of hypertension and hypertension-mediated organ damage (HMOD) increases with CKD progression. Nocturnal blood pressure (BP) is a strong predictor of cardiovascular complications. This cross-sectional study investigated the link between the diurnal BP profile and HMOD in nondiabetic CKD G1-G3b patients. We investigated 109 CKD patients and 41 apparently healthy persons as controls. All subjects underwent 24-ambulatory blood pressure monitoring (ABPM), echocardiography with left ventricular mass index (LVMI) calculation and pulse wave velocity (PWV) measurement. Hypertension was present in 84% of CKD patients. SBP-24 and DBP-24, SBP-day and DBP-day did not differ between CKD and controls. Significant differences were found in SBP-night and DBP-night. The nondipping BP profile (SBP-night/SBP-day ratio ≥0.9) was found in 62% of CKD patients and 32% of controls (P < 0.005). Nocturnal hypertension was found in 56% of CKD patients. LVMI was higher in CKD compared to controls, higher in nondipping than dipping CKD patients, and higher in patients with nocturnal hypertension than without nocturnal hypertension. Abnormal left ventricular geometry was found in 72% nondipping and 43% dipping CKD patients. PWV was higher in CKD than in controls, in patients with nocturnal hypertension than without nocturnal hypertension but did not differ between CKD nondippers and dippers. The nondipping BP profile and nocturnal hypertension are associated with HMOD in G1-G3b CKD patients. Hence, there is a need for more extensive use of ABPM for individual risk assessment and personalization of antihypertensive treatment in CKD patients.

SERUM LIPID PROFILE AND ARTERIAL STIFFNESS IN NON-DIPPERS

Background. A non-dipping blood pressure profile (NDP) is associated with increased arterial stiffness and other cardiovascular target organ damage. Serum lipid profiles have been shown to be important determinants of arterial stiffness. &#x0D; Objective. The aim of the research was to assess serum lipid profiles and arterial stiffness in non-dippers. &#x0D; Methods. This cross-sectional study was conducted involving 796 (288 males and 508 females) participants of black African origin. A twenty-four-hour ambulatory BP monitoring was done using a Spacelabs 90207 (Spacelabs Inc., Redmond, Washington, USA) monitor. Carotid-Femoral pulse wave velocity measurements were performed using a high fidelity SPC-301 micromanometer (Millar instruments Inc., Houston, TX).&#x0D; Results. Of the 288 males, 140 were classified as non-dippers. Of the 508 females, 273 were classified as non-dippers. In the general population, males had higher triglycerides when compared with females 1.46±0.96 vs 1.13±1.02, p&lt;0.0001. Additionally, dipper males had higher serum TRGL when compared with dipper females 1.32±0.98 vs 1.06±0.58, p = 0.0012. Non-dipper males also had higher serum TRGL when compared with non-dipper females 1.61±2.05 vs 1.19±1.14, p=0.0078. Serum HDLc was lower in the non-dipper male group when compared to the non-dipper female group (p=0.008). In both male and female groups, non-dippers had higher CFPWV when compared with dippers; 7.53±3.60 vs 5.74±2.47, p&lt;0.0001 and 6.64±2.52 vs 5.98±2.23, p=0.0021 respectively. However, non-dipper males had significantly higher CFPWV when compared with non-dipper females (7.53±3.60 vs 6.64±2.52, p=0.0031). &#x0D; Conclusions. Therapies targeting a reduction of serum triglycerides levels might be beneficial in improving arterial compliance with or without the presence of non-dipping.

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

0772 Effects Of Solriamfetol On 24-hour Blood Pressure Patterns In Participants With Excessive Daytime Sleepiness Associated With Narcolepsy

Abstract Introduction Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy (75-150 mg/d) or obstructive sleep apnea (37.5-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes, have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of narcolepsy patients with a non-dipping BP profile. Methods Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with narcolepsy (n=236). Results At week 8, increases in BP were apparent in the 150 and 300 mg dose groups from 8 AM until 4 PM and 6 PM, respectively. At baseline, 52% (placebo) and 48% (combined solriamfetol) of participants were non-dippers (defined as &amp;lt;10% decrease in mean arterial pressure [MAP] during sleep). There was no increase in the percentage of non-dippers at week 8 relative to baseline (placebo, 44%; combined solriamfetol, 39%). Results were similar when dipping was defined by changes in systolic BP and diastolic BP. Conclusion The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with narcolepsy at any dose studied. Support Jazz Pharmaceuticals

0693 Effects Of Solriamfetol On 24-hour Blood Pressure Patterns In Participants With Excessive Daytime Sleepiness Associated With Obstructive Sleep Apnea

Abstract Introduction Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with obstructive sleep apnea (OSA; 37.5-150 mg/d) or narcolepsy (75-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of OSA patients with a non-dipping BP profile. Methods Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with OSA (n=474). Results At week 8, increases in BP were apparent in the 75 and 300 mg dose groups from ~6 AM until 8 PM. At baseline, 58% (placebo) and 55% (combined solriamfetol) of participants were non-dippers (defined as &amp;lt;10% decrease in mean arterial pressure [MAP] during sleep). There was no increase in the percentage of non-dippers at week 8 relative to baseline (placebo, 56%; combined solriamfetol, 53%). Results were similar when dipping was defined by changes in systolic BP and diastolic BP. Conclusion The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with OSA at any dose studied. Support Jazz Pharmaceuticals

Uric Acid and Potassium Serum Levels Are Independent Predictors of Blood Pressure Non-Dipping in Overweight or Obese Subjects.

Background: Obesity and sleeping blood pressure (BP) abnormalities are well recognized as some of the main risk factors for hypertension and cardiovascular diseases (CVDs). The primary objective of this study was to evaluate the prevalence of hypertension and non-dipping profile in overweight/obese subjects. Methods: A sample of 100 consecutive healthy overweight/obese subjects, aged 20–69 years and never treated with antihypertensive drugs was examined. Ambulatory 24 h BP monitoring was performed to diagnose hypertension and a non-dipping profile. Anthropometric, metabolic and routine hematochemical parameters were assessed. All subjects underwent ultrasound measurement of common carotid intima–media thickness. Results: Hypertension was demonstrated in 69% (n = 69) and 27% of the sample (n = 27) had a non-dipping profile. Among the hematochemical variables, estimated glomerular filtration rate (eGFR) (p = 0.02) and FT4 (p = 0.01) serum levels were higher in the hypertensive group than in the normotensive group. Lower potassium and uric acid serum levels (p = 0.05) were independent predictive factors of a non-dipping BP profile. Conclusions: This study shows, for the first time, that 1) an unexpectedly high percentage (69%) of overweight/obese subjects is affected by hypertension; 2) early hypertensive subjects have an increased eGFR and higher FT4 serum levels; 3) lower potassium and uric acid levels are independent predictors of pathological nocturnal non-dipping.

Modification of the daily blood pressure profile in hypertensive patients with type 2 diabetes mellitus

Objective. To evaluate the effect of combinations azilsartan medoxomil / chlorthalidone (Az-M/Chl) vs. perindopril / indapamide (Pr / Yn) regarding the modification of the daily blood pressure profile (BP) and augmentation index level in hypertensive patients (hypertension 2 nd degree, HTN), the blood pressure profile “nondipper” or “night-peaker” and type 2 diabetes mellitus (DM). Design and methods . The study included 51 HTN (mean age 73 ± 11,7 years) patients (25 patients in the group Az-M / Chl and 26 patients in the group Pr / Yn, the groups were comparable by the main clinical parameters) with blood pressure profile “non-dipper” or “night-peaker”, DM (compensation stage). All patients have been receiving stable but ineffective antihypertensive therapy for at least 3 months before inclusion. The level of salt consumption was defined by the questionnaire “Charlton: SaltScreener”. Ambulatory 24-hour blood pressure monitoring (ABPM) was performed using BPLab® device (software Vasotens, Russia) which enables analysis of central hemodynamics. Statistica 10.0 software and software R using readxl, psych, ggplot2, ggpubr, gridExtra packages were used for statistical data processing. Results. Twenty-seven (53 %) patients reported consumption of more than 6 g of salt per day: 14 (56 %) patients in the Az-M / Chl group, and 13 (50 %) patients in the Pr / Yn group. Mean daily BP was 161,2 / 102 ± 8,77 / 9,31 mm Hg in the Az-M / Chl group, and 158,3 / 96,7 ± 10,4 / 7,21 mm Hg in the group Pr / In (p > 0,05); mean daily systolic BP (MAP) was 161,2/102,0 ± 8,8 / 9,3 mm Hg and 158,3 / 96,7 ± 10,4 / 7,2 mm Hg, respectively (p > 0,05); aortic augmentation index — 4,88 ± 15,9 % and 2,7 ± 10,9 %, respectively (p > 0,05). At randomization (baseline), the non-dipping BP profile was found in 86,3 % (n = 44) patients, and the night-peaker profile — in 13,7 % (n = 7) patients. At the final visit, all patients achieved target BP level; mean daily systolic BP was 130,2 ± 8,8 and 139,9 ± 8,2 mm Hg in the Az-M/Chl and Pr / In groups, respectively (W = 140, p-value = 0.000497). The Az-M / Chl group demonstrated a more significant reduction in arterial stiffness. In addition, in the AZ-M / Chl group, 18 (72 %) patients showed change to a dipping BP profile, while only 5 (19 %) patients demonstrated the change in the Pr / Yin group. Conclusion . The combination of azilsartan medoxomil/chlorthalidone showed a more significant compared with the combination of perindopril/indapamide: (1) a decrease in mean blood pressure per day; (2) the effect on the modification of the daily profile of blood pressure; (3) alteration of GI in aorta.

The characteristics of 24-hour ambulatory blood pressure monitoring and its relationship with cardiovascular target organ damage in Chinese Han patients with concomitant type 2 diabetes and hypertension.

The objective of this study was to investigate the characteristics of 24-hour ambulatory blood pressure monitoring and its relationship with cardiovascular target organ damage (left ventricular hypertrophy and carotid atherosclerosis) in Chinese Han patients with concomitant type 2 diabetes mellitus and hypertension. A total of 830 hypertensive patients with or without type 2 diabetes mellitus were divided into four groups according to blood pressure patterns. Clinical characteristics and 24-hour ambulatory blood pressure monitoring indexes were compared among the four groups. Multivariable logistic regression was used to identify the associations among clinical characteristics, blood pressure variability and cardiovascular target organ damage. The prevalence of the non-dipper blood pressure profile (51.32% vs. 24.33%) was higher in patients with type 2 diabetes mellitus and hypertension than in those without type 2 diabetes mellitus. Logistic regression analysis showed that glycosylated haemoglobin A1c, 24hSBP, 24hSSD, dSBP, nSBP and nSSD were independently associated with the non-dipper blood pressure pattern. Type 2 diabetes mellitus patients with the non-dipper blood pressure pattern showed a higher occurrence of target organ damage compared to patients in the other three groups. Multivariate regression analyses revealed that duration of hypertension, fasting blood glucose, dDBP and nDSD were associated with left ventricular hypertrophy. Age, haemoglobin A1c, LDL-C, nSBP and HDL-C were independently related to carotid atherosclerosis. In the Chinese Han population, patients with concomitant type 2 diabetes mellitus and hypertension showed a remarkably high prevalence of non-dipper blood pressure patterns. Abnormal systolic blood pressure level and hyperglycemia were significantly associated with a non-dipper blood pressure pattern. Non-dipper blood pressure pattern, hyperglycemia and dyslipidemia were closely related to left ventricular hypertrophy and carotid atherosclerosis.