Number Of Dippers Research Articles

RELATIONSHIP OF DAILY BLOOD PRESSURE PROFILE AND ARTERIAL STIFFNESS

Objective: To study the blood pressure daily profile in patients with hypertension (HNT) depending on the pulse wave velocity (PWV). Design and method: We studied 88 treated patients with HNT. The ambulatory BP monitoring (ABPM) was recorded with a Medicom-combi device (Russia) using the oscillometric method. PWV was determined using the SphygmoCor (AtCor Medical Pty Ltd, Australia). Statistical analysis was performed using the SPSS 24.0 software package. Results: Patients were divided into 2 groups depending on PWV level: the first group had a PWV < 10 m/s, and the second group had a PWV > 10 m/s. The mean PWV in the groups was 7.79±1.38 vs. 14.13±1.85 m/s, respectively (p<0.007). Office SBP and DBP didn’t differ between groups. Patients of the second group had significantly higher mean daily SBP (113.64±16.64 vs 128.23±16.91 mm Hg, p=0.0001), mean daytime SBP (116.77±8.99 vs 129.36±7.8 mm Hg, p=0.0001), and mean nighttime DBP (66.26±9.7 vs 71.64±7.1 mm Hg, p=0.04). The load index (LI) of daytime and nighttime SBP was higher in patients with PWV > 10 m/s. LI of SBP daytime: 9.72±15.82% vs. 27.74±35.24%, respectively, p = 0.001. LI of SBP nighttime: 18.34±26.44% vs. 44.2±38.81%, respectively, p = 0.001. Variability and nocturnal falls of SBP and DBP also didn’t differ between the groups. The number of dippers by SBP and DBP was higher in patients with normal PWV, but not significantly: 18% and 12% vs. 13% and 9%, SBP: χ2 = 0.04, p = 0.83; DBP: χ2 = 0.19, p = 0.45. The number of non-dippers by SBP and DBP was significantly higher in the first group: 65% and 66% vs. 50% and 50%; SBP: χ2 = 4.6, p = 0.032; and DBP: χ2 = 5.25, p > 0.05. However, the number of night-pickers by SBP and DBP significantly prevailed in the second group: 17% and 19% vs. 36.4% and 32%, respectively; SBP: χ2 = 9.2, p = 0.003, DBP: χ2 = 5.58, p = 0.019. There were no over-dippers in both groups. Conclusions: Hypertensive patients with high PWV values had more pronounced disorders in their daily blood pressure profile.

Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

Dipper pattern in arterial hypertension: is there a correlation with ageing?

Abstract Funding Acknowledgements Type of funding sources: None. Dipper pattern in arterial hypertension is there a correlation with aging? Background Systemic arterial hypertension is an important cardiovascular risk factor. Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Purpose Study the effect of aging in the dipper pattern, in patients submitted at 24-Hour Ambulatory Blood Pressure Monitoring. Methods Retrospective study based on patients submitted at 24-Hour Ambulatory Blood Pressure Monitoring on the first trimester of 2020. Patients were divided into categories based on percentage of nighttime blood pressure drop: 0% Reverse Dipper, 0-10% Non-Dipper, 10-20% Dipper e >20% Extreme Dipper. The sample was dived into two groups: group A (GA) with age between 18- and 60-years vs group B (GB) with age between 60- and 90-years. Results This study included 91 hypertensive patients, whom 46.2% were male and with a mean age of 56 ± 15 years. GA represented 60.4% of study sample, whom 43.6% were male and with a mean age of 46 ± 10 years. In the group B, 50% were male with a mean age of 71 ± 6 years. GB patients had more history of diabetes (7.8% vs 26.5%, p = 0.022). No significant difference was found between the two groups in history of kidney chronic disease, obesity or sleep apnea syndrome. In terms of medical treatment, GB had more prescription of loop diuretics (3.9% vs 22.9%, p = 0.010) and angiotensin-converting enzyme (ACE) inhibitors (58.8% vs 88.6%, p = 0.028). No significant differences were found in the prescription of other hypertension therapies or the use of drug combinations. No significant difference was found in the number of Dippers in both groups (63.6% vs 58.3%, p = 0.386). GB had more reverse dippers (1.8% vs 16.7%, p = 0.014). GA had more extreme dippers (12.7% vs 2.8%, p = 0.024). Conclusion There is no difference in the rate of dipper pattern accordingly to age. The prevalence of reverse dippers in older patients was superior, leading to increased risk of cardiovascular events in this group. The younger group had more prevalence of extreme dippers, which, by some authors, can lead to increased risk of a silent cerebrovascular event.

Racial Differences Affecting Night Time Blood Pressure Dipping Groups in Hypertensive Patients

Normal blood pressure (BP) follows a circadian rhythm, with dipping of BP at night. However, little has been done to show how the dipping groups vary amongst the White and Asian population at different periods of the year. This study aims to examine the pattern of nocturnal dipping between the White and Asian population, as well as to compare it to the different timings of the year, between summer and winter. Ambulatory Blood Pressure Monitor recordings were obtained from 220 patients, half were White patients obtained from Mercy University Hospital, Cork, Ireland and half were Asian patients from National Heart Centre, Singapore during the summer period from May to June and the winter period from October to December. Both the Irish and Singaporeans exhibit a decrease in total number of reverse dipper from summer to winter. However, the redistribution of reverse dipper was mainly to the dippers in Singapore, while in Ireland it was to both the extreme dipper and dipper. Irish seasonal changes also resulted in an increase in nocturnal diastolic pressure (95% CI, 0.72 to 6.03, 3.37 mm Hg; p<0.05) and a change in the duration of dipping at night (95% CI, 0.045 to 1.01, 0.53 Hours; p<0.05). Regardless of race or temperature, reverse dippers seem to decrease in winter. However, the racial differences dictate the redistribution of the fall in number of dippers. This has implications on how reverse dippers should be treated at different periods of the year.

Can Acupuncture Affect the Circadian Rhythm of Blood Pressure? A Randomized, Double-Blind, Controlled Trial

The objective of the study was to investigate the effect of acupuncture on the circadian rhythm of blood pressure (BP) in patients with hypertension. The study was designed as a randomized, double-blind, controlled trial. Subjects were randomly divided into an active acupuncture group and a sham acupuncture group. Each patient received real or sham acupuncture treatment twice a week for 8 weeks. Acupuncture needles were inserted at bilateral ST 36 plus PC 6; placebo points. Thirty-three (33) patients with essential hypertension were the subjects. Twenty-four (24)-hour ambulatory BP was assessed before and after treatment. After the treatment period, there was a significant increase in nocturnal diastolic BP dipping compared to that at baseline (10.20±7.56 mm Hg versus 5.21±10.19 mm Hg, p=0.038) in the active acupuncture group but not in the sham acupuncture group. The nocturnal diastolic BP dipping response to active acupuncture treatment was significantly different from the response seen with the sham acupuncture treatment (p=0.041). The number of dippers also increased from 4 to 8 in the active acupuncture group. Average systolic and diastolic BP was not changed significantly except for nighttime diastolic BP (90.32±11.47 mm Hg to 87.83±9.16 mm Hg, p=0.041). It is suggested that acupuncture treatment could be useful for improving the circadian rhythm of BP in patients with hypertension.

EFFICACY AND SAFETY OF BISOPROLOL IN YOUNG MEN WITH ARTERIAL HYPERTENSION AND OBESITY

Aim. To evaluate effect of bisoprolol on circadian blood pressure (BP) profile, autonomic cardiovascular regulation, lipid and carbohydrate metabolism in young patients with arterial hypertension (HT) and obesity. Materials and methods. 36 men aged 18 to 35 years with HT 1-2 degrees, obesity 1-2 degrees and signs of sympathetic over activity were examined. In addition to standard clinical examination assessment of heart rate variability (HRV) during orthostatic test with spectral analysis, ambulatory BP monitoring, evaluation of lipid profile, oral glucose tolerance test, determination of immunoreactive insulin, insulin resistance index and functional activity of beta-cells were performed. Anthropometric measurements included body mass index and waist circumference. Bisoprolol in the initial dose of 5 mg QD orally for 12 weeks was assigned to all patients. After 12 weeks of bisoprolol treatment repeated examination was performed. Results. Significant changes in HRV after 12 weeks of treatment with bisoprolol was found. Parasympathetic influence of autonomic nervous system increased during orthostatic test. Contribution of the slow and very slow waves, which reflect sympathetic and neurohumoral activity , reduced. Total spectral power was significantly increased. Initial tachycardia reduced. Target BP values were achieved after 12 weeks of treatment with bisoprolol 5 mg QD. Increase in a number of dippers and decrease in a number of nondippers in terms of both systolic and diastolic BP was observed. Heart rate and HRV was significantly decreased. No adverse events in terms of lipid or carbohydrate metabolism were found during treatment with bisoprolol. Conclusion. Bisoprolol 12 week treatment resulted in sympathetic activity decrease and parasympathetic activity increase, achievement of BP target levels, improvement of BP circadian profile. Bisoprolol therapy in dose of 5 mg/day demonstrated metabolic neutrality in patients with risk factors of cardiovascular diseases and type 2 diabetes.

COMPARATIVE EVALUATION OF THE ANTIHYPERTENSIVE EFFECT OF PERINDOPRIL AND LOSARTAN POTASSIUM IN PATIENTS WITH ARTERIAL HYPERTENSION AND STENOTIC CORONARY ATHEROSCLEROSIS BEFORE REVASCULARIZATION: AN OPEN RANDOMIZED COMPARATIVE STUDY

Aim. To compare effects of perindopril and losartan potassium on the parameters of the ambulatory blood pressure (BP) monitoring (ABPM) and circadian BP profile in patients with arterial hypertension (HT) and stenotic coronary atherosclerosis before myocardium revascularization. Material and methods. 59 patients with HT degree 2-3 at the age of 35-69 were examined. ABPM was performed in all patients. Daily profile was assessed by the degree of nocturnal BP reduction. Patients were randomized to receive perindopril or losartan potassium. Perindopril was administered at dose of 4 mg/day with subsequent rising up to 8 mg/day in next 7 days. The initial dose of losartan potassium was 25 mg with subsequent rising up to 50 mg 2 times a day. Duration of observation was 8 weeks. Results. Perindopril reduced 24-hour and daytime systolic BP (SBP) by 17.2% (p&lt;0.0001), nighttime SBP - by 22.5% (p&lt;0.0001), 24-hour and daytime diastolic BP (DBP) - by 18.3% and 17.6% (p&lt;0.0001), respectively , nighttime DBP - by 27.2% (p&lt;0.0001). Losartan potassium reduced 24-hour SBP by 25.7% (p&lt;0.0001), daytime SBP - by 23.6% (p&lt;0.0001), night-time SBP – by 25.5% (p&lt;0.0001), 24-hour DBP - by 27.4%, daytime DBP - by 26.3%, nighttime DBP - by 18.5% (p=0.003). Perindopril decreased in number of non-dippers by 24,3% and night-peakers by 5.4% as well as increased in number of dippers by 27% and over-dippers by 2.7%. A number of patients with SAD profile corresponding to non-dipper type was 45.5% more in losartan taking than this when perindopril receiving (p=0.027). Conclusion. In patients with HT and stenotic coronary atherosclerosis perindopril therapy increases a number of patients with normal BP profile before myocardium revascularization.

Different classifications of nocturnal blood pressure dipping affect the prevalence of dippers and nondippers and the relation with target-organ damage

We assessed how different definitions of the awake and asleep periods and use of various blood pressure (BP) indices affect the extent of the nocturnal BP dip, the prevalence of dippers and nondippers, their respective reproducibilities and the relation of nondipping with target-organ damage. We performed 24-h ambulatory BP monitoring twice and determined the left ventricular mass index and urinary albumin excretion as indices of target-organ damage in 150 hypertensive patients (off-medication). Awake and asleep periods were assessed using fixed and diary time methods, covering all readings available (wide) or excluding morning and evening transition hours (narrow). Nondipping (BP dip < 10%) was established for systolic BP and diastolic BP, their combinations (and/or), and mean arterial pressure. The different awake-asleep definitions caused significant variation in both the extent of the BP dip and the number of dippers and nondippers in comparison with the wide diary definition (i.e. use of actual awake and sleep periods). The prevalences of dippers and nondippers also varied significantly with the BP index. Reproducibility analyses of the BP dip and the dipping status yielded repeatability coefficients (expressed as percentages of nearly maximal variation) between 42.39 and 48.71%, and kappa values between 0.323 and 0.459, respectively. Some classifications, but not all, discriminated significantly between consistent dippers and nondippers in terms of left ventricular mass index or urinary albumin excretion. Use of different definitions of awake-asleep and BP indices affects significantly the classification of nocturnal BP dipping and its relation with hypertensive target-organ damage.

From treatment to organ damage; A 5‐year follow‐up study of ambulatory blood pressure in essential hypertension. Diversity between development of left ventricular hypertrophy and urinary albumin excretion

This study aimed to assess blood pressure (BP) profile, BP control, left ventricular hypertrophy (LVH) and albumin/creatinine ratio (ACR) in urine after 5 years of antihypertensive treatment in subjects with newly diagnosed essential hypertension. Fifty‐four subjects were included and prescribed calcium‐channel blocker in monotherapy during an 8‐week period, and later 46 subjects (34 men, 12 women, 53.1±8.6 years) attended a 5‐year follow‐up visit at the hypertension clinic. They underwent 24‐h ambulatory BP monitoring (ABPM), ECG and ACR at baseline and after 5 years. Echocardiography performed after 5 years revealed LVH in 54% of the subjects, while there was no change in Cornell product, an ECG criterion for LVH. BP control assessed by office BP was 33%, and only 20% using 24‐h ABP. Night‐time fall in BP was significantly attenuated from 13.2±5.9% to 10.7±6.0%, p = 0.01 for systolic BP and from 13.3±6.9% to 9.8±6.8%, p = 0.004 for diastolic BP. The number of dippers decreased after 5 years, but this did not reach statistical significance. In contrast to the lack of change in Cornell product, there was a significant decrease in ACR, and 93% of the subjects had ACR<1.5 mg/mmol after 5 years compared with 57% at baseline (p<0.001). Thus, ABPM should be encouraged in the follow‐up of all hypertensive subjects as it reveals better inadequate BP control than office BP and gives information about night‐time fall, as this may explain the high prevalence of LVH. The diversity in development of LVH and ACR during antihypertensive treatment needs to be verified.