Noninvasive Ambulatory Blood Pressure Research Articles

Blood Pressure Variability and Ocular Vestibular-Evoked Myogenic Potentials Are Independently Associated With Orthostatic Hypotension.

We delineated the association between otolithic dysfunction and blood pressure (BP) variability. We prospectively recruited 145 consecutive patients (age=71 [59-79] years, median [interquartile range]; 76 females) with orthostatic intolerance between December 2021 and December 2023 at a tertiary hospital in South Korea. Each patient underwent evaluations of cervical and ocular vestibular-evoked myogenic potentials (oVEMPs), 24-h noninvasive ambulatory BP monitoring (ABPM), and a head-up tilt-table test using the Finometer device. As measures of BP variability, the standard deviations (SDs) of the systolic BP (SBPSD) and the diastolic BP were calculated based on serial ABPM recordings. Patients were divided into those with orthostatic hypotension (OH, n=68) and those with a normal head-up tilt-table test despite orthostatic intolerance (NOI, n=77) groups. A multivariable logistic regression analysis showed that OH was associated with bilateral oVEMP abnormalities (p=0.021), SBPSD (p=0.012), and female sex (p=0.004). SBPSD was higher in patients with OH than in those with NOI (p<0.001), and was not correlated with n1-p1 amplitude (p=0.491) or normalized p13-n23 amplitude (p=0.193) in patients with OH. The sensitivity and specificity for differentiating OH from NOI were 72.1% and 67.5%, respectively, at a cutoff value of 12.7 mm Hg for SBPSD, with an area under the receiver operating characteristic curve of 0.73. Bilaterally deficient oVEMP responses may be associated with OH regardless of 24-h BP variability, reflecting the integrity of the otolith-autonomic reflex during orthostasis. Alternatively, 24-h BP variability is predominantly regulated by the baroreflex, which also participates in securing orthostatic tolerance complementary to the vestibulo-autonomic reflex.

The systolic to diastolic pressure ratio in non-dipping essential hypertension patients

Nocturnal blood-pressure (BP) decline or dipping is a physiological response in healthy BP-regulation; the lack of this adaptation is frequently observed in patients with essential hypertension (EH) [Chesebro,2020]. Involvement of autonomic dysregulation in EH may result in adrenergic overdrive [Mancia and Grassi,2014; Carthy, 2014]. Heart morphology [Henein, 2011] and systolic to diastolic pressure ratio (SDPR) were previously related to the harmony of the so-called golden ratio (GR = 1.618) [Yetkin, 2015]. We aimed here to identify patterns of circadian dysfunction in newly diagnosed patients with EH compared to individuals with normotensive individuals (NIs) by monitoring them with a non-invasive ambulatory blood pressure monitoring (ABPM) system and evaluating their SDPR.

Abstract WP458: Effect of Olmesartan / Azelnidipine Combination Tablets on Ambulatory Blood Pressure and Cognitive Function in the Post-Stroke Patients

Background and aims: In patients with severe hypertension, or history of stroke, the lower limit of cerebral blood flow (CBF) autoregulation is shifted to a higher blood pressure (BP) than in healthy subjects. The aim of this study was to compare the effects of olmesartan/azelnidipine combination (OLM/AZ) vs high-dose of olmesartan on ambulatory blood pressure (ABPM), cognitive function, and rehabilitation outcome in the post-stroke patients with hypertension. Methods: A total of 36 patients, 20 men and 16 women, aged 58-72 years, with sitting diastolic BP &gt;90mmHg and systolic BP &gt;140mmHg were eligible for participation in the present study. We randomly assigned 36 patients to either the OLM/AZ group or high-dose olmesartan group for 12 weeks. At the end of a 2-week wash-out period and after 12 weeks of active treatment, 24-h noninvasive ambulatory BP monitoring (ABPM) was performed, and cognitive function was evaluated through neuropsychological testing. In addition, rehabilitation outcome measurements were also collected during study period. Results: Both treatments significantly reduced ambulatory BP. However, the OLM/AZ produced a greater reduction in 24-h, day-time and night time ABPM values. High-dose olmesartan did not induce significant changes in any of the cognitive function test scores, whereas at 12 weeks OLM/AZ significantly improved the neuropsychological test score (Digid span test, Token test, Digital symbol test, Trail making test part A and B) (p&lt; 0.01). Patients treated with OLM/AZ showed effective rates of improvement in hand (38.9%), upper extremities (55.6%) and lower extremities (72.2%), measured by Brunnstrom stage; these improvements were significantly different from those in high-dose olmesartan group for the total (P&lt; 0.05) scores. Conclusions: These results suggest that in hypertensive post-stroke patients treatment with OLM/AZ produces a slightly greater reduction in ambulatory BP than high-dose olmesartan, and unlike this latter, improves some of the components of cognitive function, particularly psychomotor speed, attention and mentation. Our results suggest that OLM/AZ may improve cognitive function and rehabilitation outcome in hypertensive stroke patients in whom CBF autoregulation is impaired.

Effects of ABCB1 rs1045642 polymorphisms on the efficacy and safety of amlodipine therapy in Caucasian patients with stage I-II hypertension.

PurposeThe aim of this study was to determine the impact of ABCB1 (MDR1) rs1045642 polymorphisms on the efficacy and safety of amlodipine in Caucasian patients.Patients and methodsThe 12-week study included 100 patients. Patients with the newly diagnosed stage I–II hypertension (HT) were recruited to complete genotyping of the rs1045642 single-nucleotide polymorphism (SNP). The study design did not include a control group. Before treatment, all patients either did not undergo antihypertensive treatment at all or did not receive regular antihypertensive therapy. The initial dose was 5 mg/day. Four office blood pressure measurements, two 24-hour noninvasive ambulatory blood pressure measurements, and questionnaires of Tsvetov were used to evaluate the efficacy and safety of amlodipine.Results and conclusionThe highest antihypertensive effect in combination with the lowest incidence of adverse reactions was observed in the TT group, while patients with the CC genotype showed a low antihypertensive effect and the highest incidence of adverse effects. Patients with the CC genotype presented with adverse effects predominantly in the form of edema. A total of 33 patients reached the target blood pressure (SBP <140 mmHg; DBP <90 mmHg): two patients with the CC genotype (12%); 18 patients with the CT genotype (34%); and 13 patients with the TT genotype (43%). The intergroup differences were: CC vs CT, P=0.02; CC vs TT, P=0.02; and CT vs TT, P=0.05. The results of this study indicate the potential of pharmacogenetic testing for rs1045642 SNP when prescribing amlodipine for the first time in Caucasian patients with stage I–II arterial HT.

Effect of vildagliptin versus glibenclamide on endothelial function and arterial stiffness in patients with type 2 diabetes and hypertension: a randomized controlled trial.

Several trials have reported that dipeptidyl peptidase-4 (DPP-4) inhibitors, used to treat type 2 diabetes (T2DM), improve endothelial function. The current study investigated the effects of vildagliptin, a DPP-4 inhibitor, compared to glibenclamide on endothelial function, arterial stiffness, and blood pressure in patients with T2DM and hypertension. Patients aged over 35years with T2DM and hypertension, but without cardiovascular disease, were randomly allocated to treatment with vildagliptin (n = 25) or glibenclamide (n = 25). Both groups took metformin. Endothelial function was evaluated by peripheral artery tonometry (Endo-PAT 2000) to calculate the reactive hyperemia index (RHI) and arterial stiffness. Primary outcome was change in the RHI after 12 weeks of treatment. Twenty-four-hour non-invasive ambulatory blood pressure monitoring was performed using a Mobil-O-Graph® 24-h PWA monitor. Arterial stiffness was assessed using the augmentation index corrected for 75bpm (AIx75), pulse wave velocity (PWV) and central systolic blood pressure (cSBP). There were no changes in the RHI in the vildagliptin group (before 2.35 ± 0.59; after 2.24 ± 0.60; p value = NS) or in the glibenclamide group (before 2.36 ± 0.52; after 2.34 ± 0.50; p value = NS), with no differences between groups (p value = NS). There was also no difference between vildagliptin and glibenclamide treatment in respect to AIx75 (p value = NS), cSBP (p value = NS) or PWV (p value = NS). Vildagliptin and glibenclamide similarly do not change the endothelial function and arterial stiffness after 12 weeks of treatment in diabetic and hypertensive patients without cardiovascular disease. Thus, vildagliptin has a neutral effect on vascular function. ClinicalTrials.gov: NCT02145611, registered on 11 Jun 2013.

EFFECT OF ELECTRONIC CIGARETTE SMOKING ON BLOOD PRESSURE IN HYPERTENSIVE PATIENTS. EVALUATION BY NON-INVASIVE CONTINUOUS AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: The electronic cigarettes (EC) is a device that heats a liquid containing nicotine and flavors into an aerosol for inhalation. There is some evidence from controlled trials that electronic cigarette (EC) may help to stop smoking long-term. However, a large proportion of smokers who successfully quit cigarette smoking continue to use EC for unlimited time, switching from an addiction to another. There is a clear similarity between the detrimental vascular effects of EC and conventional cigarette. Little is known about the acute influence on blood pressure (BP) of nicotine inhalation by EC and it's duration of action in hypertensive subjects. Aim of this study was to evaluate the magnitude and time-course of BP changes during EC smoking. Design and method: This is a randomized, cross-over and placebo controlled study. We evaluated 30 mild-to-moderate hypertensive patients on pharmacological treatment and adequate BP control (< 140/90 mmHg). Patients (22 males, mean age 54 ± 21 years) were former smokers, who quitted tobacco cigarette in favor of EC at least 6 months before. BP and heart rate (HR) were measured by continuous non-invasive ambulatory BP and ECG monitoring (SOMNOtouch NIBP). BP and HR were monitored during a 30 minute rest in the sitting position; during other 30 minutes after smoking EC (inhalation equivalent to 0.8 mg of nicotine of a regular cigarette) or placebo EC (same device, same flavor but no nicotine in the solution). Results: EC vaping was accompanied by significant increase blood pressure, which lasted about 30 minutes (average 28 ± 11 minutes). Compared to placebo the EC smoking increased systolic BP by 9,6 ± 4,1 mmHg, diastolic BP by 7.1 ± 3.9 mmHg and heart rate by 16,4 ± 13 beat per minute. All the differences resulted statistically significant (Student's t test P < 0.05). Conclusions: Under these experimental conditions, EC smoking caused a statistically significant increase in BP and HR in hypertensive patients. This effect seems also clinically relevant since the duration of BP increase was relatively long (28 minutes) and the daily number of inhalations, in EC smokers, is usually high (> 20).

Exploration and validation of alternate sensing methods for wearable continuous pulse transit time measurement using optical and bioimpedance modalities.

In this work we explore the viability of a multimodal sensing device that can be integrated in a wearable form factor for daily, non-invasive ambulatory blood pressure (BP) monitoring. A common approach in previous research has been to rely on measuring the pulse transit time (PTT), which has been shown to be correlated with the BP. In this work, we look into the feasibility of measuring PTT using sensors separated by a small distance on one arm so that any eventual realization of the system is convenient to wear and use over long periods of time. Moreover, we investigate the combined use of two different modalities for cardiovascular measurement: the optical photoplethysmogram (PPG) as well as the bio-potential based impedance (Bio-Z) measurement. These two modalities have been previously only studied on their own or in conjunction with the electrocardiogram (ECG) for the purpose of estimating PTT. We measure the PTT from the wrist to the finger using Bio-Z and PPG sensors, and compare it to the conventional PTT measured from the ECG to PPG at the finger, in order to prove that it can be an effective replacement for existing PTT measurement strategies. Moreover, successful measurement of PTT with two different modalities of sensors at close proximity will allow designs with multiple heterogeneous sensors on a more versatile wearable sensing platform that is optimized for power and is more robust to environmental or skin contact changes. This will enable the next generation of smart watches that capture PTT and BP. Experiments were conducted in vivo with simultaneous ECG, Bio-Z and PPG sensors, and results indicate that the PTT calculated from the Bio-Z and PPG sensors placed at a close distance correlates well with the more established PTT measurement using the ECG in conjunction with PPG, with correlation coefficient as high as 0.92.

Abstract 12960: Differential Pulse Arrival Time: A Novel Approach to Continuous Cuff-less Blood Pressure Monitoring

Introduction: Blood pressure (BP) is a continuous and dynamic physiologic variable. The sphygmomanometer has forced clinicians to rely on singular snapshots of BP to make clinical decisions about BP control. Ambulatory cuff-based BP monitoring has demonstrated superiority over the conventional, single-point office-based cuff measurement and has unveiled the important concept of nocturnal BP dipping; however, it is plagued by poor compliance leading to limited use. Thus, there is an unmet need for an unobtrusive continuous ambulatory BP monitor. Current methods for continuous, non-invasive ambulatory BP monitoring include the use of vascular unloading and pulse transit time. However, both of these techniques have limitations. We therefore propose a novel method—differential pulse arrival time (DPAT)—to continuously estimate BP non-invasively. We hypothesized that continuous DPAT-derived BP correlates well with cuff-based measurement of BP at rest and during a cold-pressor maneuver. Methods: Normotensive subjects were fitted with a DPAT device and a Finapres Nova ambulatory BP monitor. Each subject underwent a standardized protocol consisting of 2 minutes at rest, 2 minutes cold pressor at 40 o F, and 2 minutes at rest. The raw data from the DPAT device was then time-matched and compared with the Finapres BP trend. Results: Over 100 million DPAT data points were collected from 12 normotensive subjects (age range 20-50). DPAT correlated with Finapres blood pressures with a correlation coefficient of 0.8 and there was no evidence of bias on Bland-Altman plot. (Figure 1). The root mean square error for the predicted blood pressure was ±4.76 mmHg for systolic BP and ±4.03 mmHg for diastolic BP. Conclusions: Differential pulse arrival time obtained by an optical-sensor based system is a viable approach to monitoring continuous BP in normotensives. Future studies in elderly, hypertensive individuals are warranted.

Twelve-week randomized study to compare the effect of vildagliptin vs. glibenclamide both added-on to metformin on endothelium function in patients with type 2 diabetes and hypertension.

BackgroundVildagliptin, a DPP-4 inhibitor widely used for the treatment of type 2 diabetes mellitus (T2DM), shows beneficial effects on endothelial function. This study aims to evaluate the effect of vildagliptin on endothelial function and arterial stiffness in patients with T2DM and hypertension.MethodsFifty over 35-year-old patients with T2DM and hypertension, without cardiovascular disease, will be randomly allocated to two groups: group 1 will receive vildagliptin added-on to metformin and group 2, glibenclamide added-on to metformin. Biochemical tests (glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine, alanine aminotransferase, ultrasensitive C-reactive protein, and microalbuminuria), 24-h non-invasive ambulatory blood pressure monitoring, and assessment of endothelial function and arterial stiffness will be performed in both groups before and after 12 weeks of treatment. The endothelial function will be assessed by peripheral arterial tonometry, which measures the reactive hyperemia index (vasodilation), and arterial stiffness will be evaluated by applanation tonometry. All analysis will be performed using SPSS Statistical Software. For all analysis, a 2-sided P < 0.05 will be considered statistically significant.ResultsThe study started in December 2013 and patient recruitment is programed until October 2015. The expected results are that vildagliptin will improve the endothelial function in patients with T2DM and hypertension compared to glibenclamide treatment, independently of glycemic control.ConclusionsIt is expected that this DPP-4 inhibitor will improve endothelial function in patients with T2 DM.Trial registration: Clinical Trials NCT02145611, registered on 11 Jun 2013

Use of Ambulatory Blood Pressure Monitoring to Guide Hypertensive Therapy

With the advent of noninvasive 24-hour ambulatory blood pressure monitoring (ABPM), clinicians have access to a wealth of individualized data for the hypertensive patient. This has led to a greater understanding of the pathophysiology of hypertension and its complications. This tool has provided more precise diagnostic criteria for hypertension and helped discover those with white coat and masked hypertension. Patterns noted on ABPM and correlated with outcomes have allowed for more accurate identification of patients at high risk of cardiovascular (CV) events, and have offered an additional prognostic tool. In addition, ABPM allows for the assessment of the efficacy and adequacy of blood pressure treatment. In the current paper, we will describe the essential components of ABPM, review the evidence detailing the prognostic information that can be derived from its use, highlight clinical scenarios wherein ABPM can offer invaluable diagnostic information, and describe applications of ABPM that evaluate the efficacy of treatment of the hypertensive patient.

Twenty-four hour non-invasive ambulatory blood pressure and heart rate monitoring in Parkinson's disease.

Non-motor symptoms are now commonly recognized in Parkinson’s disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., “dipper” vs. non-“dipper”). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM.

Когнітивні порушення у ранньому відновному періоді ішемічного інсульту

The aim was to study prevalence and peculiarity of cognitive impairments in patients with ischemic stroke. 76 patients with stroke were examined in early restorative period of disease. Neurologic status of the patients was examined with NIHSS scale, Renkin scale was employed for measuring the degree of disability, MMSE and FAB was used to estimate cognitive functions. 24-hour, non-invasive ambulatory blood pressure (BP) monitoring was used to reveal arterial hypertension and impairment of circadian rhythm of ABP. Considerable prevalence of cognitive impairments was shown. 34,2 % patients suffered from dementia. The most impaired cognitive functions were memory, calculation, repetition and writing. Risk factors of cognitive impairments in patients with ischemic stroke were advanced age, severe neurological impairments, increasing SBP, minimal DBP. Examination cognitive function after stroke is necessary to plan treatment, prevention and reablement.

Masked hypertension delaying diagnosis in Gordon's syndrome

ordon syndrome or familial hyperkalemic hyperG tension (MIM #145260) is a heterogeneous Mendelian syndrome. The hallmarks of this condition are arterial hypertension, hyperkalemia, normal anion gap metabolic acidosis, normal renal function and correction of the abnormalities by low doses of thiazide diuretics, which inhibit the Naþ-Cl cotransporter in the distal nephron [1]. In Gordon syndrome volume-dependent hypertension, hyperkalemia and metabolic acidosis are caused by an activated thiazide-sensitive Naþ-Cl cotransporter in the distal nephron. Mutations in either the WNK1 or the WNK4 kinase, two proteins that modulate the thiazidesensitive Naþ-Cl cotransporter, were disclosed approximately 10 years ago in some Gordon patients [2], but very recent data indicate that the condition often results from mutations in kelch-like 3 or cullin 3 [3]. We recently made the diagnosis of Gordon syndrome in a 25-year-old man with normal office blood pressure, who had been referred for diagnostic work up of lower limb muscle cramps and mild-to-moderate hyperkalemia. He was affected with chronic schizophrenia and on long-term medication with the antipsychotic drug olanzapine 10mg/day. Body weight was 76.8 kg, height 1.83 m, BMI 22.9 kg/m, blood pressure 120/85 mmHg or less, heart rate 70 beats per min and the clinical examination normal. The diagnostic work up disclosed normonatremia (141 mmol/l; reference: 135–145), hyperkalemia (7.1 mmol/l; reference: 3.5–5.0), acidosis (pH 7.29; reference: 7.38–7.42), hypobicarbonatemia (HCO3 19mmol/l; reference: 21–28), hyperchloremia (113 mmol/l; reference: 98–106), a lownormal uric acid level (201mmol/l; reference: 200–400), normal plasma creatinine (75mmol/l; reference: 106 or less), estimated glomerular filtration rate (111ml/min/ 1.73 m) and normal urinalysis and urinary calcium excretion (urinary calcium/creatinine ratio 0.16 mol/mol; reference: 0.32 or less). Plasma renin was normal (8.5 mU/l; reference: 1.8–9.6) and plasma aldosterone elevated (1.04 nmol/l; reference: 0.08–0.45). The presentation, with the exception of normal blood pressure, was considered consistent with the diagnosis of Gordon syndrome. Automated, intermittent, noninvasive ambulatory blood pressure monitoring over a 24-h period revealed both daytime (140/95 mmHg; min. 105/55 mmHg; max. 180/120mmHg) and night-time (130/80 mmHg; min. 110/70 mmHg; max. 160/110mmHg) arterial hypertension without nocturnal systolic dip, further supporting the suspected diagnosis of Gordon syndrome. Intermittent ambulatory blood pressure monitoring and blood potassium normalized on monotherapy with chlorthalidone 25mg/day (later 12.5 mg/day). Daytime blood

Circadian Variation of Blood Pressure Is Impaired in Normotensive Pregnant Women with Gestational Diabetes Mellitus

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP – sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m2 vs. 90.67 ± 15 g/m2, P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

Increased ambulatory arterial stiffness index correlated with monocyte chemoattractant protein-1 in prehypertensives

ObjectiveTo investigate increased ambulatory arterial stiffness index correlated with plasma level and expression of monocyte chemoattractant protein-1.Methods108 subjects with prehypertension and 101 optimism mormotensive subjects were eligible to be enrolled....

Increased ambulatory arterial stiffness index correlated with monocyte chemoattractant protein-1 in prehypertensives

ObjectiveTo investigate increased ambulatory arterial stiffness index correlated with plasma level and expression of monocyte chemoattractant protein-1.MethodsOne hundred and eight subjects with prehypertension and 101 optimal normotensive subjects were eligible...

Defining intra‐operative hypotension – a pilot comparison of blood pressure during sleep and general anaesthesia*

The scientific justification for particular values of intra-operative hypotension is poorly substantiated. To provide a rationale for appropriate values we recorded blood pressure measurements at home for 24 h using an automated non-invasive ambulatory blood pressure measurement device. These blood pressures were compared with blood pressure measured before and during general anaesthesia in 18 subjects undergoing elective day surgery. We confirmed that a pre-operative reading taken upon admission to hospital is significantly elevated compared to a usual daytime blood pressure in the same patient. The median (IQR [range]) increases in systolic and mean arterial pressures were 10 (2-15 [-5 to 59]) mmHg, p = 0.003 and 10 (5-14 [-5 to 35]) mmHg, p = 0.002, respectively. When using this admission blood pressure measurement as a 'baseline', systolic and mean arterial pressures decreased during sleep by 41 (30-46 [6-83]) mmHg and 34 (26-36 [6-58]) mmHg, respectively (p = 0.001). This decreased even further intra-operatively: systolic blood pressure by 49 (36-64 [15-96]) mmHg and mean arterial pressure by 36 (26-46 [8-66]) mmHg (p = 0.001).

NOCTURNAL BLOOD PRESSURE FALL: DOES IT REALLY MATTERS: PP.14.39

Objective: Ambulatory blood pressure (ABP) permits blood pressure (BP) measurement during daytime and nighttime. In some patients, the nocturnal BP fall may be absent or reversed (non-dippers). We examined the incidence of cardiac arrhythmias and left ventricular hypertrophy (LVH) in untreated dipper and non-dipper (ND) hypertensive patients. Methods: Eighty newly diagnosed untreated hypertensive patients were enrolled. All patients underwent 24 hours BP monitoring using a noninvasive automatic ABP monitoring system, 48 hours continuous ECG recording and standard echocardiography. Patients were considered hypertensive if the mean BP was 135 or more for systolic, and/or 85 or more mmHg for diastolic BP on ABP monitoring. ND patients were identified by absence of significant (>10%) nocturnal BP fall. Results: Fifty patients (62.5%) of the study population were ND. No differences were noted in the mean 24 hour systolic and diastolic BP (137.4 ± 6.1 vs. 135.4 ± 3.7 and 81.4 ± 8.6 vs. 79.7 ± 3.3), or in diurnal systolic and diastolic BP (144 ± 9.3 vs. 145 ± 3.8 and 83.9 ± 8.2 vs. 84.9 ± 5.1 mmHg) in ND and dippers respectively, p = NS. However, mean nocturnal systolic and diastolic BP were significantly higher in the ND group (139.7 ± 13.2 vs.125.4 ± 5 and 79.4 ± 10.1 vs.74.6 ± 3.3 mmHg, p < 0.05). LVH was observed in 47 patients (58.7%): 42 (84%) in the ND group, compared to only 5 (16.6%) in the dipper group, P < 0.01. Mean septal and posterior wall thickness was 1.25 ± 0.12 and 1.22 ± 0.1 vs. 0.89 ± 0.16 and 0.91 ± 0.24 cm in ND and dippers respectively, P < 0.01. No lethal arrhythmias were observed, with more prevalent ventricular and supraventricular ectopics in the ND group (38(76%), vs. 5(16.6%) patients), of which ventricular ectopics were the most significant: 32(64%) vs. 4(13.3%) patients, P<0.01. Arrhythmias were more prevalent in patients who had LVH compared to those with normal LV wall thickness: 36(76.5%) vs. 8(24.2%) patients, P < 0.01. Conclusions: Non-dipper hypertensive patients are more prone to have ventricular arrhythmias and to develop LVH compared with dipper hypertensive patients. Significant correlation was observed between LVH and arrhythmia occurrence in this study.

IMPACT OF AMBULATORY BLOOD PRESSURE MONITORING ON SLEEP QUALITY AND BLOOD PRESSURE: PP.3.127

Objective: During nocturnal non-invasive ambulatory blood pressure monitoring (ABPM), inevitably an undesirable external stimulus due to pump noise and pressure produced by cuff inflation may affect the quality of sleep, influence the physiological nocturnal blood pressure fall and consequently affect dipping status. We sought to investigate whether blood pressure monitoring provokes awakenings and changes in sleep quality, blood pressure and/or heart rate. Design and Method: The study population consisted of 108 consecutive subjects with stage I-II essential hypertension (aged 54 ± 9 years, 59 male, office BP = 148/97 mm Hg). Participants were divided into two groups according to whether they underwent ambulatory blood pressure monitoring (group A, n = 60), or not (group B, n = 48). Repeated measurements of blood pressure were registered with non-invasive automatic blood pressure monitors (Spacelabs 90207, Welch Allyn 6100S devices) every 20 min. Self-reported data regarding the quality of sleep, numbers and duration of arousal were obtained via standardized questionnaire. Results: Group A compared to group B demonstrated a small but significant increase in the number of nocturnal awakenings (2.8 vs 1.2, p = 0.045), although their duration did not significantly differ (p = NS). However, the two groups exhibited similar mean values of nocturnal blood pressure and heart rate (121/73 vs 119/71 mm Hg, 67 vs 65 beats/min, p = NS in both cases). The reported sleep quality did not differ between the two groups but both sleep quality and higher numbers of awakenings (>3) were associated with non-dipping status (p < 0.05, in both cases). Conclusions: Our findings indicate that even though ambulatory blood pressure monitoring induces modest sleep disturbances, it can accurately evaluate night time blood pressure profile and heart rate, without affecting sleep efficiency and quality. Sleep evaluation may be particularly useful in essential hypertension, as poor quality of nocturnal sleep was associated with non-dipping status.

Efficacy and safety of acarbose in the treatment of elderly patients with postprandial hypotension

Postprandial hypotension (PPH) occurs frequently in elderly people and may lead to syncope, falls, dizziness, weakness, angina pectoris, and stroke. Some studies suggest that the magnitude of the postprandial fall in blood pressure (BP) is influenced by the rate at which glucose enters the small intestine. We hypothesized that acarbose (alpha-glucosidase inhibitor), a hypoglycemic agent that decreases the rate of glucose absorption in the small intestine, would attenuate PPH in the elderly, and would be safe in the treatment. Forty-three elderly in-patients with PPH were recruited. All of them were in relatively stable conditions. They had semi-liquid standard meals without and with acarbose for the two following days: screening day and intervention day. Blood pressure and heart rate (HR) were recorded at baseline and every 15 minutes for 120 minutes using a non-invasive ambulatory blood pressure monitoring system during the study, and ejection fraction (EF) and fractional shortening (FS) were measured by two dimensional echocardiography. Compared with the screening day, the falls in systolic, diastolic and mean arterial blood pressure (SBP, DBP, MAP) (all P < 0.05) were significantly attenuated after taking acarbose during breakfast, so were MAP (P < 0.05) during lunch, DBP (P < 0.05) and MAP (P < 0.05) during supper. The change of HR was not statistically significant after taking acarbose in three meals. EF and FS were positively correlated with the relief rate. The effective power was 63%, and the incidence of adverse drug reaction (ADR) was 9%. Acarbose is effective and safe in the treatment of elderly patients with PPH.