Non-dipping Pattern Research Articles

Association between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test

It is known that, a not physiological blood pressure (BP) circadian pattern has been associated with increased risk of organ damage and cardiovascular (CV) event. The aim of this study was to assess the association between circadian BP pattern and glucometabolic phenotypes occurring after oral glucose tolerance test (OGTT). We recruited 810 hypertensive Caucasian patients. All participants underwent to OGTT, laboratory test and 24-h ambulatory BP monitoring (ABPM). The analysis of collected data allowed classifying patients based on nocturnal BP profiles into four categories: dippers, non-dippers, extreme dippers, and reverse dippers. Considering the dipping pattern, the proportion of non-dippers in normal glucose tolerance patients with 1-h glucose ≥ 155 mg/dL (NGT ≥ 155) (36.4%) was higher than NGT < 155 (29.6%) and impaired glucose tolerance (IGT) (34.8%), but lower than type 2 diabetes group (T2DM) (52.6%) (p = 0.001). The proportion of dippers was lower in NGT ≥ 155 (47%) and T2DM (34.6%), when compared with NGT < 155 (53.8%) and IGT (51.2%) (p = 0.017). From logistic regression analysis, 1-h glucose ≥ 155 increased the risk of a pathological nocturnal drop in BP by 74%, (OR = 1.740, 95% CI 1.254–2.415, p < 0.0001). In addition, the improvement in 1 unit of Matsuda was responsible for a 3.5% risk decrease (OR = 0.965, 95% CI 0.958–0.971, p < 0.0001), while e-GFR determined a 0.9% risk reduction of nocturnal BP drop (OR = 0.991, 95% CI 0.984–0.999, p = 0.020). Our data demonstrated the existence, in newly diagnosed hypertensive patients, of an association between circadian BP profile and altered glycemic response during OGTT, in particular NGT ≥ 155 subjects are associated with a non-dipper BP pattern, this is clinically relevant because may explain, at least in part, the increased CV risk in this setting of patients.

Cognitive impairment in heart failure patients: association with abnormal circadian blood pressure rhythm: a review from the HOPE Asia Network.

Cognitive impairment (CI) is frequently a comorbid condition in heart failure (HF) patients, and is associated with increased cardiovascular events and death. Numerous factors contribute to CI in HF patients. Decreased cerebral blood flow, inflammation, and activation of neurohumoral factors are all thought to be factors that exacerbate CI. Hypoperfusion of the brain due to decreased systemic blood flow, cerebral venous congestion, and atherosclerosis are the main mechanism of CI in HF patients. Abnormal circadian BP rhythm is one of the other conditions associated with CI. The conditions in which BP does not decrease sufficiently or increases during the night are called non-dipper or riser BP patterns. Abnormal circadian BP rhythm worsens CI in HF patients through cerebral congestion during sleep and atherosclerosis due to pressure overload. Interventions for CI in HF patients include treatment for HF itself using cardiovascular drugs, and treatment for fluid retention, one of the causes of abnormal circadian rhythms. Proposed pathways of cognitive impairment in heart failure through abnormal circadian blood pressure rhythm.

The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure.

Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05. The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions. MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Non dipping pattern frequency and metabolic syndrome relationship according to two different metabolic syndrome diagnostic methods in newly diagnosed hypertensive individuals

Aim: The literature presents conflicting data regarding whether the non dipping pattern (NDP) in patients with metabolic syndrome (MS) compared to those without. In our study, we aimed to investigate the MS effect of the NDP in individuals with hypertension.&#x0D; Methods: This prospective study included 117 newly diagnosed hypertensive patients (79 women and 38 men) who were not receiving any anti-hypertensive treatment. MS was evaluated according to the currently used the US National Cholesterol Education Programme Adult Treatment Panel-III definition criteria (MS-ATP-III) and a new diagnostic scoring method (MS-Score). NDP defined, nocturnal blood pressure (BP) fell by

The relationship between the prognostic nutritional index and non-dipping blood pressure pattern in patients with newly diagnosed hypertension

Aims: It has been suggested that immuno-nutritional status may play a role in blood pressure (BP) variations. This study aimed to investigate whether prognostic nutritional index (PNI) values differ between normotensive individuals and patients with newly diagnosed untreated hypertension (NDHT) and to clarify the relationship between the PNI and circadian BP patterns in NDHT patients.&#x0D; Methods: This retrospective study included 328 adult participants, comprising 164 NDHT patients and 164 normotensive individuals. The non-dipper BP pattern (NDP) was defined as a nighttime decline in BP of less than 10%. The PNI was calculated using the following formula: PNI=([10 × serum albumin (g/dL)] + [0.005 × total lymphocyte count]).&#x0D; Results: The mean PNI value was lower in the NDHT group than the normotensive group (53.6±6.1 vs. 58.2±5.3, p

The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients.

Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was>639.73with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.

Nocturnal systolic blood pressure dipping and progression of chronic kidney disease.

The relationship between declining nocturnal blood pressure (BP) and adverse cardiovascular outcomes is well-recognized. However, the relationship between diurnal BP profile and the risk of chronic kidney disease (CKD) progression is unclear. Herein, we examined the association between nocturnal systolic SBP (SBP) dipping and CKD progression in 1061 participants at the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI). The main exposure was diurnal systolic BP (SBP) profile and diurnal SBP difference ([nighttime SBP-daytime SBP] × 100/daytime SBP). The primary outcome was CKD progression, defined as a composite of ≥ a 50% decline in the estimated glomerular filtration rate from baseline or the initiation of kidney replacement therapy. During 4749 person-years of follow-up (median, 4.8 years), the composite outcome occurred in 380 (35.8%) participants. Compared to dippers, the hazard ratios (HRs) for the risk of adverse kidney outcomes were 1.02 (95% confidence interval [CI], 0.64-1.62), 1.30 (95% CI, 1.02-1.66), and 1.40 (95% CI, 1.03-1.90) for extreme dipper, non-dipper, and reverse dipper, respectively. In a continuous modeling, a 10% increase in diurnal SBP difference was associated with a 1.21-fold (95% CI, 1.07-1.37) higher risk of CKD progression. Thus, decreased nocturnal SBP decline was associated with adverse kidney outcomes in patients with CKD. Particularly, patients with non-dipping and reverse dipping patterns were at higher risk for CKD progression than those with a dipping pattern.

The Impact of Timing of Fixed Dose Triple Antihypertensive Combinations on Ambulatory Blood Pressure Monitoring Parameters

ABSTRACT Introduction Re-establishing “dipping” physiology significantly reduces cardiovascular events. The aim was to investigate the effect of timing of fixed dose triple antihypertensive combinations on blood pressure (BP) control. Methods One hundred sixteen consecutive patients (62.7 ± 10.7 years, 38 men) with grade II hypertension were randomized into four groups. Group 1 and Group 2 patients were given angiotensin converting enzyme inhibitor-based triple antihypertensive pills to be taken in the morning or evening, respectively while Group 3 and Group 4 patients were given angiotensin receptor blocker (ARB) based triple antihypertensive pills to be taken in the morning or evening, respectively. All patients underwent 24-h ambulatory BP monitoring 1 month after the initiation of treatment. Results There were not any significant differences in the characteristics, BP values and loads among groups. All patients in each group had good BP control. Dipping pattern in systolic BP was observed significantly less in Group 3 patients taking ARB in the morning (3 patients) compared to other groups (12 patients) in each group, [P = .025]. Similarly, dipping pattern in diastolic BP was observed significantly less in Group 3 patients (4 patients) compared to others (13 patients) in Group 1 and 15 patients in Group 2 and Group 4, [P = .008]. Nondipping pattern was significantly associated with taking ARB in the morning, even when adjusted by age, sex, and other comorbidities. Conclusion Fixed dose triple antihypertensive drug combinations enable good BP control regardless of the timing of drug while ARB-based ones may be taken in the evening to ensure dipping physiology.

A Narrative Review of the Association of Obstructive Sleep Apnea with Hypertension: How to Treat Both When They Coexist?

Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances. There is mounting evidence of a relationship between OSA and HT. In patients with OSA, HT is predominantly nocturnal and characterized by high diastolic blood pressure and usually by a nondipping pattern. Optimizing the blood pressure control is recommended in the current guidelines as the first treatment option in hypertensive patients with OSA. Continuous positive airway pressure (CPAP) therapy may reduce blood pressure, albeit only slightly as a stand-alone treatment. CPAP, as an add-on treatment to antihypertensive medication, appears to be an efficient treatment modality when both conditions coexist. This narrative review aims to summarize the current perspectives on the association of OSA with HT and the treatment options available for adults with OSA-related HT.

IMPACT OF NON-DIPPING PATTERN AND NOCTURNAL HYPERTENSION ON LEFT VENTRICULAR MASS INDEX IN UNTREATED WHITE-COAT HYPERTENSIVE SUBJECTS

Objective: Several studies have demonstrated that subjects with white-coat hypertension (WCH) have an increased risk of adverse cardiovascular outcome and target organ damage (TOD) progression compared to normotensives. The potentially detrimental effect of non-dipping or nocturnal hypertension on TOD has not been fully elucidated in subjects with WCH. The aim of our study was to investigate the impact of both dipping status and nocturnal hypertension on the left ventricle mass index (LVMI) of WCH individuals. Design and method: A total of 387 untreated WCH subjects underwent echocardiographic measurements. LVM was estimated using Devereux's formula according to the Penn Convention Protocol. LVMI was defined as LVM divided by the body surface area. The study population was divided into dippers (blood pressure (BP) nocturnal fall &gt;10%) and non-dippers (BP nocturnal fall &lt;10%) as well as into nocturnal hypertensives (nighttime systolic BP&gt; = 120mmHg or nighttime diastolic BP&gt; = 70mmHg) and nocturnal normotensives (nighttime systolic BP&lt;120mmHg and nighttime diastolic BP&lt;70mmHg). Statistical analysis was performed by means of independent-samples t-test, chi-square test and linear regression. Results: The percentages of non-dippers and nocturnal hypertensives in WCH subjects were 49% and 28%, respectively. The variables associated with LVMI in the univariate analyses were: age, male gender, body mass index, 24-hour diastolic BP and non-dippers. The multivariate regression analyses demonstrated significant associations of LVMI with the following factors: age (B = 5.760, 95% CI: 3.282 to 8.239; p&lt;0.001), male gender (B = 10.941, 95% CI: 5.756 to 16.125; p&lt;0.001), body mass index (B = 0.685, 95% CI: 0.138 to 1.232; p = 0.014), 24-hour diastolic BP (B = -6.634, 95% CI: -11.212 to -1.456; p&lt;0.011) and non-dippers (B = 8.415, 95% CI: 3.449 to 13.380; p = 0.001). Non-dipping pattern was correlated to an increase of 8.415 g/m2 in the LVMI in WCH subjects. Conclusions: Non-dipping status is positively and independently associated with LVMI in untreated WCH patients. In contrast, statistically significant association between nocturnal hypertension and LVMI was not observed.

COGNITIVE COMPLAINT IN HYPERTENSIVE PATIENTS

Objective: To describe the prevalence of CC in hypertensive patients and its link to an increased cardiovascular risk (CVR) profile. Design and method: Observational, descriptive, analytical and cross-sectional study. Inclusion criteria: hypertensive patients over 18 years old presenting Montreal Cognitive Assessment (MoCA). Exclusion criteria: motor or sensory difficulties, psychiatric disease, illiteracy. Qualitative variables are presented as absolute and relative frequencies. Chi-square test was used for association analysis. Differences were studied through Student's t-test for independent samples. A significance level of alpha = 0.05 was set. The statistical software used was STATA v.17.0. Results: This study included 111 patients, with a 1:4 women:men rate and an average of 60 years old. Cognitive complaint was present in 45.9% of patients. Of all patients, 81% presented grade 3 arterial hypertension according to 2018 ESC guidelines, 31.5% having been diagnosed at least 20 years prior. 35.1% showed a non-dipper pattern and 45.9% nocturnal hypertension. Around 52.3% of patients had less than 8 years of studies and 33.3% had a MoCA score higher than 23. Dyslipidemia was present in 34.2% of patients, 72.1% were overweight/obese and 36% were smokers. 40.5% of patients had established heart disease (HD). The cognitive complaint patient group was associated with those with non-dipper pattern (p = 0.034), coronary artery disease and ischemic cardiopathy, with p-values of 0.019 and 0.045 respectively. This study observed a link between CC and transient ischemic cerebrovascular stroke (p = 0.027). Out of all patients suffering CC (51), 58.8% (30) presented unaltered MoCA, while association to an altered MoCA was significant (p = 0.039). Conclusions: Cognitive Complaint is related to a cardiovascular risk profile in hypertensive patients. Association with an altered MoCA in patients suffering CC highlights the risk of evolution towards Mild Cognitive Decline and dementia.

EVALUATION OF DIAGNOSTIC ACCURACY OF NOCTURNAL HOME BP MONITORING IN HEMODIALYSIS PATIENTS: A PILOT STUDY

Objective: A unique advantage of ambulatory blood pressure monitoring (ABPM) is that this technique enables the assessment of blood pressure (BP) during the period of sleep, facilitating the diagnosis of nocturnal hypertension. This study aimed to compare ABPM with home BP monitoring (HBPM) performed with a novel device that is designed to obtain daytime and also automated nighttime BP recordings in the assessment of nocturnal hypertension and detection of non-dipping BP pattern among patients on hemodialysis. Design and method: Within a period of 2 weeks, 70 stable patients on thrice-weekly hemodialysis underwent assessment of BP with 2 methods: (i) 44-hour interdialytic ABPM (20-min intervals; Microlife WatchBP O3 device) and (ii) HBPM (duplicate morning and evening BP recordings for 7 days and 3 BP recordings per night for 3 nights over the 3-day interdialytic interval; Microlife WatchBP Home N). Results: The mean age of the patients was 65.3 (±13.3) years; 45 (64%) were males, and 62 (88.7%) were receiving antihypertensive therapy. The average ambulatory daytime and nighttime SBP/DBP were 122.8±15/68.7±10.5 mmHg and 117.2±16.5/63.4±10.2 mmHg, respectively. The mean [95% confidence interval (CI)] difference between home daytime SBP and ambulatory daytime SBP was 8.61 (6.1, 11.2) mmHg. Similarly, the mean (95% CI) difference between home nighttime SBP and ambulatory nighttime SBP was 5.94 (3.5, 8.4) mmHg. In receiver-operating-characteristics (ROC) analysis, the technique of HBPM provided high accuracy for the detection of an average ambulatory daytime SBP equal or higher than 135 mmHg [area under the curve (AUC): 0.934; 95% CI: 0.871-0.996] as well as for the detection of an average ambulatory nighttime SBP equal or higher than 120 mmHg (AUC: 0.876; 95% CI: 0.794-0.957). Of the overall population, 44 patients (63%) were classified as non-dippers by ABPM and 42 (60%) by HBPM. There was acceptable agreement between these 2 techniques in the identification of patients with a non-dipper BP pattern (77%, k-coefficient = 0.324). Conclusions: The present study shows that among patients on hemodialysis, HBPM serves as a reliable alternative to 44-hour interdialytic ABPM for the diagnosis of nocturnal hypertension and detection of non-dipping BP status.

Effects of concurrent exercise training on blood pressure variability and values are blunted in subjects with non-dipping blood pressure nocturnal pattern

Abstract Funding Acknowledgements Type of funding sources: None. The purpose of this study was to investigate the effects of 12-weeks concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks patients underwent six minute walk test, ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). After CT exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the nondipping group (between groups changes: -1.0 mmHg and -1.3 mmHg; p 0.02 and p 0.006 respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while were unchanged in the non-dipping group (between groups changes: -7.1 mmHg and -7.8 mmHg; p 0.004 and p 0.0002 respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small not significant changes in both groups. In conclusion: the effects of CT on BPV and BP were blunted in hypertensive subjects with non.dipping BP pattern

Twenty-four hour ambulatory blood pressure monitoring in patients with stable heart failure. Prevalence and associated factors

Introduction and objectivesHypertension is highly common in heart failure (HF). However, there is limited information on its prevalence, circadian variation, and relationship with the various HF phenotypes. The objective of this study was to describe the prevalence of hypertension and its patterns in HF. MethodsThis was a cross-sectional observational study of patients with optimized stable chronic HF. The patients underwent blood pressure (BP) measurement in the office and 24-hour ambulatory monitoring. We estimated the prevalence of hypertension, and its diurnal (controlled, uncontrolled, white coat, and masked) and nocturnal (dipper, nondipper, and reverse dipper) patterns. We also analyzed the factors associated with the different patterns and HF phenotypes. ResultsFrom 2017 to 2021, 266 patients were included in the study (mean age, 72±12 years, 67% male, 46% with reduced ejection fraction). Hypertension was present in 83%: controlled in 68%, uncontrolled in 10%, white coat in 10%, and masked in 11%. Among patients with high office BP, 51% had white coat hypertension. Among those with normal office BP, 14% had masked hypertension. The prevalence of dipper, nondipper, and reverse dipper patterns was 31%, 43%, and 26%, respectively. Systolic BP was lower in HF with reduced ejection fraction than in HF with preserved ejection fraction (P <.001). ConclusionsAmbulatory BP monitoring in HF identified white coat hypertension in more than half of patients with high office BP and masked hypertension in a relevant percentage of patients. The distribution of daytime patterns was similar to that of the population without HF in the literature, but most of the study patients had a pathological nocturnal pattern.

Arterial stiffness and the non-dipping pattern in type 1 diabetes males with and without erectile dysfunction

Arterial stiffness (AS) and non-dipping pattern are early predictors of cardiovascular diseases but are not used in clinical practice. We aimed to assess if AS and the non-dipping pattern are more prevalent in the erectile dysfunction (ED) group than in the non-ED group among subjects with type 1 diabetes (T1DM). The study group consisted of adults with T1DM. Aortic pulse wave velocity (PWV Ao)—a marker of increased AS, central systolic blood pressure, and heart rate (HR) were measured with a brachial oscillometric device (Arteriograph 24). Erectile dysfunction (ED) was assessed by the International Index of Erectile Function-5. A comparison between the groups with and without ED was performed. Of 34 investigated men with T1DM, 12 (35.3%) suffered from ED. The group with ED had higher mean 24 h HR (77.7 [73.7–86.5] vs 69.9 [64.0–76.8]/min; p = 0.04, nighttime PWV Ao (8.1 [6.8–8.5] vs 6.8 [6.1–7.5] m/s; p = 0.015) and prevalence of non-dipping SBP Ao pattern (11 [91.7] vs 12 [54.5]%; p = 0.027) than individuals without ED. The presence of ED detected a central non-dipping pattern with a sensitivity of 47.8% and a specificity of 90.9%. The central non-dipping pattern was more prevalent and the nighttime PWV was higher in T1DM subjects with ED than in those without ED.

Correlation of diabetes complications with blood pressure variability

ABSTRACT Introduction: India is suffering from an epidemic of noncommunicable diseases. Type 2 diabetes and hypertension are two lifestyle diseases which are often coexistent. The present study aimed to assess whether blood pressure (BP) variability has any correlation with the prevalence of chronic complications of diabetes. Materials and Methods: In a hospital-based cross-sectional study, 116 patients of newly diagnosed type 2 diabetes were enrolled. Ambulatory BP monitoring (ABPM) for 24 h duration was performed in all the study participants. The abnormal patterns of BP were analyzed. Results: Out of 100 patients with valid ABPM data, 62% of patients had masked hypertension, 45% had nondipping pattern, and 13% had reverse dipping pattern. The prevalence of diabetes complications both macrovascular and microvascular was significantly higher in patients who had abnormal dipping patterns. Conclusion: Our findings highlight the importance of ABPM which detects masked hypertension, white-coat hypertension, and abnormal BP patterns which are related to complications of diabetes.

"Arterial stiffness is not associated with changes in the circadian pattern of blood pressure in patients with type 1 diabetes mellitus and cardiovascular autonomic dysfunction".

Cardiovascular autonomic neuropathy (CAN) associates an abnormal circadian pattern in blood pressure (BP) regulation that might be aggravated by the coexistence of arterial stiffness. We aimed to evaluate the effect of arterial stiffness in the circadian rhythm of BP in patients with type 1 diabetes and CAN. Cross-sectional study including 56 consecutive patients with type 1 diabetes and CAN, with (n = 28) or without (n = 24) arterial stiffness as defined by an ankle-brachial index above 1.2. CAN was diagnosed by BP and heart rate responses to active standing and cardiovascular autonomic reflex tests. Absence of nocturnal decrease in BP-"non-dipping" pattern- was defined by a daytime to nighttime decrease in mean BP smaller than 10%. The study's subjects mean age was 40 ± 11 years-old, their mean duration of diabetes was 22 ± 10 years, and their mean A1c was 7.9 ± 1.5%. A "non-dipping" pattern was observed in 28 patients (54%) regardless of the presence or absence of arterial stiffness. Age, waist circumference, body mass index, and A1c, were introduced as independent variables into a multiple regression analysis. The stepwise model (R2: 0.113, p = 0.016) retained only A1c levels (β: ‒ 0.333, 95% confidence interval [CI]: -3.10 to -0.33) as significant predictor of the percentage of nighttime decrease in mean BP. A non-dipping pattern in BP is very common in patients with type 1 diabetes presenting with subclinical CAN and is associated with a poorer metabolic control. On the contrary, coexistence of arterial stiffness is not associated with abnormalities in circadian BP regulation.

24-hour ambulatory blood pressure and cryptogenic ischemic stroke in young adults

Background In young patients, up to 40% of ischemic strokes remain cryptogenic despite modern-day diagnostic work-up. There are limited data on blood pressure (BP) behavior in these patients. Thus, we aimed to compare ambulatory blood pressure (ABP) profiles between young patients with a recent cryptogenic ischemic stroke (CIS) and stroke-free controls. Patients and Methods In this substudy of the international multicenter case–control study SECRETO (NCT01934725), 24-hour ambulatory blood pressure monitoring (ABPM) was performed in consecutive 18–49-year-old CIS patients and stroke-free controls. The inclusion criteria were met by 132 patients (median age, 41.9 years; 56.1% males) and 106 controls (41.9 years; 56.6% males). We assessed not only 24-hour, daytime, and nighttime ABP but also hypertension phenotypes and nocturnal dipping status. Results 24-hour and daytime ABP were higher among controls. After adjusting for relevant confounders, a non-dipping pattern of diastolic blood pressure (DBP) was associated with CIS in the entire sample (odds ratio, 3.85; 95% confidence interval, 1.20–12.42), in participants without antihypertensives (4.86; 1.07–22.02), and in participants without a patent foramen ovale (PFO) (7.37; 1.47–36.81). After excluding patients in the first tertile of the delay between the stroke and ABPM, a non-dipping pattern of DBP was not associated with CIS, but a non-dipping pattern of both systolic BP and DBP was (4.85; 1.37–17.10). In participants with a PFO and in those without hypertension by any definition, no associations between non-dipping patterns of BP and CIS emerged. Conclusions Non-dipping patterns of BP were associated with CIS in the absence of a PFO but not in the absence of hypertension. This may reflect differing pathophysiology underlying CIS in patients with versus without a PFO. Due to limitations of the study, results regarding absolute ABP levels should be interpreted with caution. Key Messages Nocturnal non-dipping patterns of blood pressure were associated with cryptogenic ischemic stroke except in participants with a patent foramen ovale and in those without hypertension by any definition, which may indicate differing pathophysiology underlying cryptogenic ischemic stroke in patients with and without a patent foramen ovale. It might be reasonable to include ambulatory blood pressure monitoring in the diagnostic work-up for young patients with ischemic stroke to detect not only the absolute ambulatory blood pressure levels but also their blood pressure behavior.

Circadian rhythm of blood pressure in patients with drug-resistant mesial temporal lobe epilepsy

ObjectiveTo determine whether patients with drug-resistant mesial temporal lobe epilepsy present with an alteration in the autonomic circadian regulation of blood pressure. MethodsA prospective case‒control study was designed, with a case group comprising patients with drug-resistant mesial temporal lobe epilepsy and a control group comprising healthy volunteers. Twenty-four-hour outpatient blood pressure monitoring was performed to assess the existence of a normal (dipping) or altered (non-dipping) circadian pattern. In addition, analytical and ultrasound parameters (carotid intima-media thickness) of vascular risk and sleep quality were evaluated. ResultsTwenty-four subjects were recruited in each study group, amongst whom no demographic differences or history of vascular risk were observed. A higher percentage of participants with a non-dipping pattern was observed in the group of patients with epilepsy (62.5% vs. 12.5, p = 0.001). In the case group, significant differences were also observed in carotid intima-media thickness, with a greater probability of presenting with pathological values (p = 0.022). ConclusionThe results suggest a disorder of the central autonomic control of blood pressure in patients with drug-resistant mesial temporal lobe epilepsy, with a greater probability of developing an alteration of the circadian rhythm of blood pressure. This dysfunction may be a factor involved in the increased cardiovascular risk in this population.

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 1. How to correctly measure blood pressure in children and adolescents.

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.