Non-dipping Pattern Research Articles

Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease.

There is sparsity of studies evaluating blood pressure in children with sickle cell disease (SCD), which have shown inconsistent results. Few of the studies have documented lower office blood pressure (BP) in SCD patients, whereas, others have shown presence of masked hypertension and abnormal ambulatory blood BP monitoring (ABPM). Thus, the present study was conducted to examine 24h ABPM parameters and renal dysfunction in children with SCD and compare them with healthy controls. A cross-sectional study was conducted on 56 children (30 children having SCD and 26 controls). ABPM and evaluation of renal functions including serum creatinine, serum urea, urinary creatinine, urinary protein and specific gravity was performed. Spot urinary protein to creatinine ratio was found to be higher in patients with SCD (63.3%) as compared to controls (p< 0.001). Proteinuria was observed in 1/4th of the SCD patients less than ten years of age. Masked hypertension was present in 2 (6.6%) patients, ambulatory hypertension in 4 (13.3%), ambulatory pre-hypertension in 1 (3.3%) and abnormal dipping in 60%. A statistically significant correlation of BMI for age Z-score and standard deviation score (SDS/Z) of 24h systolic BP (r = 0.56, p= 0.002); estimated glomerular filtration rate (eGFR) with 24h diastolic BP SDS (r = -0.52; p= 0.038) and age with e GFR (r = 0.54; p= 0.025) was found in the present study. The present study corroborates that ABPM abnormalities (ambulatory hypertension, non-dipping pattern, ambulatory prehypertension) and early onset proteinuria are significant findings in patients with SCD. This underscores the importance of regular screening for proteinuria and ABPM in routine care, for early detection and prevention of progressive renal damage in SCD.

Hipertensión arterial y dislipemia

Introduction: cardiovascular disease represents the main cause of death worldwide. A multifactorial approach is essential, by calculating cardiovascular risk. Series worldwide have shown a high association between hypertension and dyslipidemia, in some of them higher than 50%. Our objective is to determine the association between both variables in order to improve the risk stratification of the hypertensive patient.Materials and methods: an analytical, observational, cross-sectional study was carried out, which included all the patients who attended the hypertension polyclinic between March 2, 2015 and October 2, 2019 inclusive.Results: 75.7% (n=78) of the patients presented dyslipidemia. It is noteworthy that 68.9% (n=71) have nocturnal hypertension. A statistically significant association between dyslipidemia and nocturnal hypertension was established, with an OR=3.364. Regarding the lipid profile, mixed dyslipidemia predominates in 37.9%.Conclusions: there is a high relationship between hypertension and dyslipidemia. Nocturnal hypertension and the non-dipper pattern are associated with cardiovascular risk.

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

Blood pressure variability in diabetic patients with or without albuminuria

Introduction: Various studies considered albuminuria as one of the first asymptomatic paraclinical manifestation of the micro-vascular damages in type 2 diabetes mellitus (DM). Hypertension (HTN) is common in type 2 DM, which has a correlation with the greater risks of cardiovascular morbidity and death. Objectives: The present research evaluated the relationship between blood pressure (BP) variability in diabetic patients who have or not albuminuria. Patients and Methods: In this analytical-descriptive research, we divided 90 type 2 diabetic patients into two groups of micro-albuminuric (urinary albumin excretion ≥30 mg/d and &lt;300 mg/d) and the normo-albuminuric (urinary albumin excretion &lt;30 mg/d) diabetic patients. We evaluated systolic and diastolic BP and 24-hour Holter monitor BP and heart rate, with respect to their albuminuric states and glomerular filtration rate (GFR) stages. Results: According to the findings, a considerably greater BMI (body mass index) and retinopathy was observed in microalbuminuric group in comparison with the normoalbuminuric group (P&lt;0.05). Additionally, non-dipping pattern was greater in the microalbuminuric patients (P&lt;0.05). In addition, patients were divided into dippers and non-dippers, the mean daytime and nighttime BP and heart rate were compared. Mean arterial BP (MAP) and nighttime BP and substantially in the subgroup of patients with GFR below 60 mL/min, systolic blood pressure (SBP) were considerably greater in the micro-albuminuric patients (P&lt;0.05). Conclusion: In patients with diabetes, the existence of albuminuria is related to the increase in the incidence of non-dipping pattern compared with patients without albuminuria. According to high levels of SBP in albuminuric patients with low GFR, the pattern of HTN and then albuminuria and the subsequent reduction of renal function can be similar to that of type 1 DM patients. Moreover, 24-hour Holter monitoring and BP should be monitored closely in diabetic patients.

Parathyroidectomy Is Associated with Reversal in Non-Dipping Heart Rate Which Impact on All-Cause Mortality in Stage 5 Chronic Kidney Disease Patients

Background: Non-dipping heart rate (HR), defined as night/day HR > 0.90, was associated with increased mortality in epidemiological studies. However, its prognostic value in stage 5 chronic kidney disease (CKD5) patients remains unknown. Methods: This case-control study of 162 healthy controls and 502 CKD5 patients, including 316 secondary hyperparathyroidism (SHPT) with parathyroidectomy (PTX) subgroup were enrolled between 2011 and 2018. Each participant underwent 24-hour Holter for HR ratio. Mortality was followed up in CKD5 patients (median time: 46.0 months). Findings: HR ratio in CKD5 patients was higher than controls (0.92±0.08 vs 0.81±0.08, P 500.0 pg/ml). Interpretation: CKD5 patients displayed non-dipping HR pattern which is a prognostic marker of all-cause mortality. PTX for SHPT patients was associated with reversal in non-dipping ratio which may mediate a better outcome. Funding Statement: National Natural Science Foundation of China (81270408, 81570666), International Society of Nephrology Clinical Research Program (18-01-0247), Program of Jiangsu Clinical Research Center (BL2014084), Jiangsu Province Key Medical Personnel Project (ZDRCA2016002). Declaration of Interests: All the authors declared no competing interests. Ethics Approval Statement: All patients and controls participating in the study gave written informed consent, and the study protocol was approved by the Research Ethics Committee of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (Ethics approval number: 2011-SR-072, 2019-SR-368).

Serum interleukin-18 levels are associated with non-dipping pattern in newly diagnosed hypertensive patients.

Interleukin-18 (IL-18), a pro-inflammatory cytokine, increases inflammation in the endothelium. Increased inflammation plays an important role in the development of hypertension (HT). IL-18 level is higher in hypertensives than normotensives. To investigate the relationship between IL-18 level and diurnal blood pressure (BP) variations in newly diagnosed HT patients. This prospective study included 130 subjects referred to outpatient cardiology clinic with an initial diagnosis of HT. The patients were classified as dipper HT (n = 40), non-dipper HT (n = 50), and normotensive (control, n = 40) according to 24-hour ambulatory BP monitoring. All subjects underwent blood sampling after 12 hours of fasting and transthoracic echocardiography. The serum IL-18 level was significantly higher in the patient group compared with the controls (195.17 ± 93.00 mg/dl vs. 140.75 ± 71.11 mg/dl, P < 0.01) and also in the non-dipper group than in the dipper group (217.3 ± 96.90 mg/dl, 167.5 ± 80.79 mg/dl, P = 0.011). IL-18 level was positively correlated both the night-time SBP and DBP levels (r = 0.29, P = 0.02 and r = 0.34, P < 0.01, respectively). On multivariate linear regression analysis, left atrium diameter, left ventricular mass index, and serum IL-18 level were independent predictors of non-dipping pattern in newly diagnosed HT patients. Higher IL-18 level was particularly associated with an increase in the night-time BP levels. IL-18 can be used as a predictor for non-dipper HT in newly diagnosed HT patients.

Whole blood viscosity predicts nondipping circadian pattern in essential hypertension.

Aim: We aimed to investigate the association between whole blood viscosity (WBV) and nondipping pattern in patients with essential hypertension. Materials & methods: A total of consecutive 530 patients who had been evaluated by ambulatory blood pressure monitoring were included. WBV was estimated by using hematocritand plasma total protein levels for both WBV in low shear rate(0.5 s-1) and WBV in high shear rate(208 s-1) according to the de Simone's formula. Results: In the multivariate analysis, low shear rate and high shear rate of WBV were associated independently with nondipping pattern in patients with essential hypertension. Conclusion: As a simple, inexpensive andnoninvasive tool, WBV seems to be a significant predictor of nondipping hypertension.

Abstract P172: Orthostatic Hypotension And 24-hr Ambulatory Blood Pressure Monitoring In The Sprint Trial

Background: Clinic blood pressure (BP) is measured in the seated position, which can miss important home BP phenotypes such as low ambulatory BP (white coat effects) or high supine BP (nocturnal non-dippers). Orthostatic hypotension (OH) is determined based on BP measurements in both seated (or supine) and standing positions, and thus could theoretically identify these important phenotypes in clinic. Objective: To determine the association of OH with white coat effects or night-to-daytime systolic BP (SBP) Methods: SPRINT was a randomized trial testing the effects of intensive (&lt;120 mmHg) or standard (&lt;140 mmHg) SBP treatment strategies in adults at higher risk of cardiovascular disease. OH was assessed at 6, 12, or 24-mths and defined as a decrease in standing and mean seated SBP ≥20 or DBP ≥10 mmHg after 1 min of standing. White coat effects, based on 24-hr ambulatory BP monitoring performed at the 27-mth visit (every 30-minutes), were defined as the difference between 27-mth seated clinic and ambulatory BP ≥ 20/≥10 mmHg. SBP dipping ratio was defined as the ratio of night-to-daytime SBP &gt;0.9. Results: Of 897 adults (mean age 71.5 [SD, 9.5] yrs, 28.7% female, 28.0% black), 128 had OH at least once. Among those with OH, 14.8% had white coat effects versus 7.2% among those without OH. Moreover, 68.8% of those with OH demonstrated non-dipping patterns versus only 52.0% of those without OH. OH was positively associated with both white coat effects (OR=2.24; 95% CI: 1.28, 4.27) and higher night-to-daytime SBP (β=0.04; 95% CI: 0.02, 0.06) ( Table ). Conclusions: Clinic-based assessments of OH may be a useful tool for identifying BP phenotypes often missed with traditional seated BP assessments.

Relationship of Non-Dipper and Reverse-Dipper Pattern with Sleep Quality in Normotensive Patients

Relationship of Non-Dipper and Reverse-Dipper Pattern with Sleep Quality in Normotensive Patients

Ambulatory blood pressure abnormalities in children with migraine.

Although there are data showing that the frequency of hypertension increases in adults with migraine, there has been no study on this subject in children. In this study, we aimed to evaluate the presence of hypertension in children with migraine by performing ambulatory blood pressure monitoring (ABPM). Thirty-seven children diagnosed with migraine and 30 healthy controls were evaluated between January 2015 and March 2016. Demographic data, clinical and laboratory features, and physical examination findings were recorded for both groups. Office blood pressure was measured for all children, and each also underwent ABPM. The two groups were compared in terms of ambulatory blood pressure parameters. The mean age was 13.3 and 13.1 years and the proportion of females was 73% and 60% in the migraine and control groups, respectively. Although the frequency of hypertension was not higher, abnormal ABPM patterns were found to be significantly more frequent in the migraine group (migraine, 45.9%; control, 16.7%; p, 0.018). Nighttime mean arterial blood pressure, nighttime diastolic blood pressure, and non-dipping pattern were higher in children with migraine than those in the control group (p < 0.05). These results suggest that ambulatory blood pressure abnormalities may be present in almost half of patients with migraine. Therefore, we suggest that ABPM should be performed even if the office blood pressure measurements of children diagnosed with migraine are normal.

THU0126 COMBINATION OF NON-DIPPING PROFILE WITH ELEVATION OF NIGHTTIME SYSTOLIC BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK

Background:Nocturnal hypertension (HTN) and non-dipping profile are important predictors of adverse cardiovascular (CV) outcomes. Their associations with subclinical vascular damage in rheumatoid arthritis (RA) are still a matter of investigation. It was shown that 10-year atherosclerotic CV disease risk (rASCVD) may be more accurate in CV risk prediction in RA than SCORE. Associations of impaired 24-h BP phenotypes with CV risk in RA are not well-studied yet.Objectives:To assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with arterial stiffness and CV risk assessed by rASCVD in patients with RA.Methods:Study group included 90 patients with RA (females 78.7%, age 59.5±14.2 years, HTN 64%, median (med) HTN duration 6.4 years, RA duration – 7.2 years, seropositive RA 66%, mean DAS-28(CRP) 3.8±1.0) and control group (45 patients matched by gender, age and risk factors). All patients with HTN received antihypertensive therapy. Office BP was measured with a validated oscillometric device, 24-hour ABPM was performed with BPLab Vasotens, carotid-femoral PWV was assessed by applanation tonometry. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn&lt;120 mmHg (G2), non-dippers with SBPn≥120 (G3). CV risk in RA group was calculated as 10-year rASCVD. Risk≥7.5% was considered as high. p&lt;0.05 was considered significant.Results:Median rASCVD was 6.3%. Rate of BP control was 60% in RA and 66% in the controls (p=0.5). Patients with RA vs controls had higher mean SBPn (124±16 vs 110±8 mmHg, p=0.003), lower diurnal index (DI) (med 3.8 vs 8.1%, p=0.02), higher rate of night HTN (49.6 vs 12.2% (p=0.0002). The RA and control groups didn`t differ by dipping patterns, although RA patients more often had non-dipping profile (DI &lt;10%): 83.9 vs 61.3%, (p=0.02). RA patients with SBPn ≥120 mmHg had higher age (63.7±12.5 vs 52.9±14.5 years), office SBP (143±17 vs 122±13 mmHg), HTN duration (med 5.4 vs 0.5 years), PWV (10.3±3.0 vs 7.9±2.5 m/s) and rASCVD (12 vs 3.4%), p&lt;0.001 for trend. Analysis in hypertensive RA group confirmed significant differences in PWV (11.3±3.1 vs 9.1±3.2 m/s, p=0.02) and rASCVD (med 13.5 vs 10.5%, p=0.045). Patients with DI&lt;10% had higher age (60.9±13.8 vs 54.3±11 years, p=0.04) and rASCVD (med 8.5 vs 3.1%, p=0.02). Patients with rASCVD ≥7.5% compared to &lt;7.5% had higher SBPn (133±11 vs 112±8 mmHg), lower median DI (0 vs 6%), more often had masked HTN (43 vs 16%) and night HTN (48 vs 16%), p&lt;0.01 for trend. SBPn significantly correlated with age (r=0.6), office SBP (r=0.5) and DBP (r=0.4), PWV (r=0.6), rASCVD (r=0.6); non-dipping pattern – with age (r=0.2), and rASCVD (r=0.3). After adjustment by SBPn, no differences were observed between G2 and G3. Patients in G3 vs G1 had higher PWV (10.4±3.1 vs 7.6±1.7 m/s, p=0.004), CRP (med 15.7 vs 7.8 mg/l, p=0.03), rASCVD (med 12.8 vs 3.1%) (p&lt;0.001); in G3 vs G2 – higher PWV (10.8±3.1 vs 8.2±2.3 m/s), rASCVD (med 12.8 vs 2.7%) and ESR (med 45 vs 21 mm/h, p&lt;0.01 for trend).Conclusion:Patients with RA had higher incidence of non-dipping pattern and SBPn elevation. Combination of high SBPn and non-dipping was associated with higher arterial stiffness and CV risk – this may be mediated by inflammation. Higher CV risk was associated with masked and night HTN. This may help in defining indications for ABPM in this population.

P1698MULTI- NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH MILD HYPERTENSION

Abstract Background and Aims There is variability among transplant centers in the acceptance of living donor candidates with well-controlled hypertension. Increased gestational hypertension and preeclampsia are more common in donors than in the general population especially if the donor is hypertensive at baseline. The purpose of this survey is to form a consensus about the evaluation of marginal live kidney donors (women and men) with hypertension. Method This is a cross-sectional survey of nephrologists and transplant surgeons about Suitability and Acceptance of The Marginal live Kidney Donors. The survey was sent to nephrologists in different countries and it was also distributed through AST &amp; ERA-EDTA. Results A total of 122 practitioners from 22 countries responded to the survey. Of those, (N=96, 80.2%) were nephrologists and (n=23 19.83%) were transplant surgeons. The majority (45%) of the respondents were from USA. Most of the respondents (N=85, 69.7%) would allow a multiparous female (MPW) with mild and controlled hypertension (on a single blood pressure medication) who is not planning to have more children to donate. The rest would either advise against donation unless there is no alternative donor (n=23, 18.85%), or decline it altogether (n=14, 11.5%). In contrast, more respondents would reject a primiparous donor woman (PPW) with the same clinical scenario who considers having children (n=51, 42.2%, P=0.00001 ), or accept it only if there is no alternative donor (n=46, 38.0%, P=0.0009). Furthermore, most would not allow donation of a 20 years old male ( M) with an apparent white coat hypertension if his 24-hour ambulatory blood pressure monitoring shows non-dipping nocturnal pattern (n=67, 54.9%), or only accept it if there is no alternative donor (n=36, 29.5%). When comparing the rejection rate among the three donors: 11% for MPW, 41% for PPW and 54% for M. (P = 0.0001 for MPW vs PPW; P=0.00001 for MPW vs M; P=0.04 for PPW vs M). Conclusion Most of the nephrologists and transplant surgeons will clear mulptiparous women with mild and controlled hypertension for kidney donation as long as there no further plans for pregnancy. However, the majority of respondents will not clear a hypertensive primiparous due to the increased risk of gestational hypertension and preeclampsia after kidney donation. Most would be also reluctant to accept very young male donors if they show indicators of higher risk of developing hypertension in future.

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

This study was designed to investigate the differences in pulsatile hemodynamics, echocardiographic findings, 24-h Holter monitoring and heart rate variability parameters of dipper patterns in children with newly diagnosed essential hypertension. This study included 30 children with newly diagnosed essential hypertension and 30 healthy controls. The essential hypertension cohort was divided into dippers and non-dippers. Physical examinations, 24-hour ambulatory blood pressure monitoring, 24-h Holter monitoring, 24-h heart rate variability, conventional 2-dimensional and Doppler echocardiography, and tissue Doppler imaging were performed. Pulse wave analysis using an oscillometric monitor was conducted to measure augmentation index (AIx) and pulse wave velocity (PWV). In patients with essential hypertension, left ventricular (LV) wall thickness and LV mass index were increased. There were no significant differences in LV mass index and LV wall thickness based on the dipping patterns. Time domain values and the standard deviation of all RR intervals (SDNN) were substantially lower in the essential hypertension group. SDNN values were considerably lower in the non-dipper group compared with the dipper group. In terms of frequency domain measures, low frequency measured in daytime values was much lower in the essential hypertension group compared with the control. The dipper patterns revealed that low frequency measured in nighttime values was also substantially lower in the non-dipper group. Pulse wave analysis and AIx values were notably higher in the essential hypertension patient group and those with non-dipper status. SDNN values, which reflect parasympathetic activity, were markedly lower in children with hypertension and the non-dipper group than healthy controls and the dipper group, respectively. Also, parameters related to arterial stiffness, such as PWV and AIx values were significantly higher in children with hypertension and the non-dipper group. Correlacionar, em crianças com hipertensão essencial (HE) recentemente diagnosticada, as características da onda de pulso, do ecocardiograma, do ECG dinâmico de 24 horas e de parâmetros de variabilidade da frequência cardíaca com os padrões dipper/não dipper. Este estudo incluiu 30 crianças com HE recentemente diagnosticada e 30 controlos saudáveis. As crianças com HE foram também divididas em dois grupos: dippers e não dippers. Foi efetuado exame físico, ecocardiograma modo M. bidimensional e Doppler de fluxo e tecidular, monitoração por Holter de 24 horas, análise da variabilidade da frequência cardíaca (VFC) durante 24 horas e monitoração ambulatória da pressão arterial de 24 horas. Foi igualmente realizada a análise da onda de pulso com equipamento oscilométrico para medir o índice de aumentação (IA) e a velocidade da onda de pulso (VOP). Os doentes com HE apresentaram espessura parietal ventricular esquerda (VE) e índice de massa VE aumentados. Não foram registadas diferenças significativas entre o índice da massa VE e a espessura da parede e os padrões dipper/não dipper. Os valores do domínio temporal, o desvio-padrão de todos os intervalos RR (SDNN) foram significativamente inferiores no grupo com HE. Os valores SDNN foram significativamente inferiores no grupo não dipper quando comparado com o grupo dipper. Relativamente às medidas do domínio da frequência, as medições da baixa frequência (BF) efetuadas durante o dia foram significativamente mais baixas no grupo com HE do que no grupo controlo. De acordo com os padrões dipper, os valores de BF durante a noite foram também significativamente inferiores quando comparados com o grupo não dipper. A VOP e o IA foram significativamente superiores nos doentes com HE e com estado não dipper. Os valores SDNN, que refletem atividade parassimpática, foram significativamente inferiores nas crianças com HE e no grupo não dipper em relaçao ao grupo controle e dipper, respetivamente. Do mesmo modo, os parâmetros relacionados com a rigidez arterial, tais como a VOP e os valores do IA, foram significativamente superiores nas crianças com HT e no grupo não dipper.

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

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

P0164AMBULATORY BLOOD PRESSURE MONITORING AND CLINICAL SIGNIFICANCE IN PATIENTS WITH GASTROESOPHAGIAL REFLUX DISEASE

Abstract Background and Aims The patients with gastro-esophageal reflux disease (GERD) have distortion of sympathetic and parasympathetic components of the autonomic nervous system. The increase in sympathetic activity results in hyperkinetic circulation with peripheral vasoconstrictor and tachycardia and also regulates blood pressure with increase of renin in kidneys. We aimed to elucidate the patterns of pulse pressure in GERD patients, and also to investigate possible relationship between patterns of pulse pressure and laboratory/urinary parameters in adults Method The ambulatory blood pressure measuring was performed in all cases. Fifty patients in the reflux group and fifty individuals in the control group were included. Blood and urine specimens were examined. The individuals with cardiovascular disease, hypertension, malignancy, asthma disease, gastric peptic ulcer, hepatitis disease, tuberculosis, gastrointestinal disease excluding reflux, cerebrovascular disease, vasculitic disease, chronic alcohol usage, drugs with affect on autonomic system usage were excluded from study. Results We found lower diastolic blood pressure and increased pulse pressure values in reflux group and these were significant statistically. When patients were evaluated separately as men and women, this situation was found to be more pronounced in women. The decrease in serum potassium, chloride levels and the increase in serum LDL cholesterol, triglyceride levels in reflux group considered as statistically significant. Urinary parameters were similar in both groups. Non-dipper pattern found more common in reflux group, but considered as insignificant. The results were summarized in Table 1 and Table 2. Conclusion This study supports the hypothesis that increased vascular risk may be present in patients with GERD. Thus, perhaps a new population at risk for cardiovascular disease will be identified and mortality rates will able to decrease with early clinical evaluation.

The prognostic importance of right ventricular remodeling and the circadian blood pressure pattern on the long-term cardiovascular outcome.

We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients. The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death). During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events. The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.

Diabetes mellitus is associated with high sleep-time systolic blood pressure and non-dipping pattern

ABSTRACT Introduction Compared to clinic blood pressure (BP), sleep-time BP and non-dipping BP pattern are better predictors of target organ damage and cardiovascular sequalae. Aim In a retrospective study, we determined whether diabetes mellitus (DM) status is associated with high sleep-time BP and non-dipping pattern. Methods We analyzed 1092 patients who underwent ambulatory BP monitoring between 2015 and 2017 in a tertiary cardiology institution. During a 24-hour period, BP was automatically measured every 15 minutes between 7:00 AM and 11:59 PM and every 30 minutes thereafter. Results Compared with the non-DM group (n = 910), the DM group (n = 182) had a higher 24-hour systolic BP (137 ± 17 vs. non-DM, 132 ± 14 mmHg, p < 0.001) and sleep-time systolic BP (132 ± 20 vs. 123 ± 16 mmHg, p < 0.001), and was more likely to exhibit non-dipping (63% vs 42%, p˂0.001). The DM group was also less likely to meet the guideline-recommended target of 120/70 mmHg for the sleep-time BP measured via ambulatory monitoring (22% vs. 34%, p = 0.002). After adjusting for the effects of age, sex, body mass index, smoking, urea, eGFR, previous myocardial infarction, previous percutaneous coronary intervention, previous coronary artery bypass surgery, and previous stroke, DM remained a significant independent predictor of a higher 24-hour systolic BP (coefficient: 2.8, 95% confidence interval: 0.1–5.5, p = 0.042) and higher sleep-time systolic BP (coefficient: 4.2, 95% confidence interval: 1.1–7.3, p = 0.008). There was a trend toward more sleep-time non-dipping BP pattern (odds ratio: 1.4, 95% confidence interval: 1.0–2.0, p = 0.087) in the DM group. Conclusion DM is independently associated with suboptimal 24-hour BP control. This association is mainly attributed to a high sleep-time systolic BP.

Association of a Disrupted Dipping Pattern of Blood Pressure with Progression of Renal Injury during the Development of Salt-Dependent Hypertension in Rats.

The aim of the present study is to investigate whether a disruption of the dipping pattern of blood pressure (BP) is associated with the progression of renal injury in Dahl salt-sensitive (DSS) hypertensive rats. Seven-week-old DSS rats were fed a high salt diet (HSD; 8% NaCl) for 10 weeks, followed by a transition to a normal salt diet (NSD; 0.3% NaCl) for 4 weeks. At baseline, NSD-fed DSS rats showed a dipper-type circadian rhythm of BP. By contrast, HSD for 5 days caused a significant increase in the difference between the active and inactive periods of BP with an extreme dipper type of BP, while proteinuria and renal tissue injury were not observed. Interestingly, HSD feeding for 10 weeks developed hypertension with a non-dipper pattern of BP, which was associated with obvious proteinuria and renal tissue injury. Four weeks after switching to an NSD, BP and proteinuria were significantly decreased, and the BP circadian rhythm returned to the normal dipper pattern. These data suggest that the non-dipper pattern of BP is associated with the progression of renal injury during the development of salt-dependent hypertension.

Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients.

We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients. This retrospective, cross-sectional study included adult heart transplant recipients at least 6months post-transplant. Ambulatory BP measurements were recorded over 24hours. Nondippers were defined as a decline in average nighttime BP≤10% compared with daytime. Primary outcomes were the presence of end organ damage, that is, microalbuminuria, chronic kidney disease, and/or left ventricular hypertrophy. Secondary outcomes were measures of diastolic dysfunction (ie, mitral valve deceleration time, e/e', E/A, and isovolumetric relaxation time), microalbumin/creatinine ratio, eGFR, interventricular septal thickness, and left ventricular posterior wall thickness. Of 30 patients, 53.3% (n=16) were systolic nondippers and 40% (n=12) were diastolic nondippers. Diastolic nondippers had three times higher urine microalbumin/creatinine ratios than diastolic dippers (P=.03). Systolic nondippers had 16.3% lower mitral valve deceleration time (P=.05) than systolic dippers, while diastolic nondippers had 20.4% higher e/e' (P=.05) than diastolic dippers. There were no significant relationships between BP dipping status and any of the primary outcomes. These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients.

QTc Interval Predicts Disturbed Circadian Blood Pressure Variation.

BackgroundThe relationship between electrocardiographic evaluation and circadian blood pressure (BP) variation in young and middle-aged hypertensive patients remains unknown.MethodsA total of 171 hypertensive patients were included in the study. First, patients were divided into a young and middle-aged group and an elderly group. The two groups were then separately classified into three subgroups on the basis of circadian variation of BP as dippers, non-dippers and reverse-dippers. The electrocardiographic evaluation was calculated from 12-lead electrocardiography (ECG).ResultsQTc intervals were shortest in the dippers and longest in the reverse-dippers in the young and middle-aged group (QTc dipper: 416.53±18.37ms; non-dipper: 438.30±29.71ms; reverse-dipper: 444.93±25.47ms; for dipper vs non-dipper, and dipper vs reverse-dipper P<0.05). QTc interval was found to be an independent risk factor for the non-dipper BP pattern (Odds ratio 1.049; 95% CI 1.01-1.089; P=0.012) and reverse-dipper BP pattern (Odds ratio 1.051; 95% CI 1.007-1.098; P=0.023) in young and middle-aged hypertensive patients. No significant differences in other ECG parameters were found among the three subgroups in the young and middle-aged group.ConclusionOur study suggested that QTc interval might serve as a risk factor for non-dipper BP pattern and reverse-dipper BP pattern in young and middle-aged hypertensive patients.