Nocturnal Blood Pressure Patterns Research Articles

The relationship of erectile dysfunction severity with nocturnal blood pressure pattern and RDW

The relationship of erectile dysfunction severity with nocturnal blood pressure pattern and RDW

Comparison of Nocturnal Blood Pressure Patterns between Parkinson’s Disease, Cerebrovascular, and Other Neurological Diseases

Background: The rise in average systolic blood pressure at night compared with daytime is called reverse dipping. Reverse dipping is one of the indicators of autonomic dysfunction in Parkinson’s disease (PD). Reverse dipping may increase cardiovascular mortality. We aimed to document nocturnal blood pressure patterns of patients with Parkinson’s Disease, cerebrovascular diseases, and other neurological diseases. Method: Patients who applied to the neurology department between 2012 and 2016 and had 24-h ambulatory blood pressure monitoring were enrolled. Patients without an MRI examination were excluded. Patients in the cerebrovascular disease group had ischemic stroke, transient ischemic attack, vascular parkinsonism, and/or vascular dementia. The patients who did not have PD or cerebrovascular disease were assigned to the other neurological diseases group. Nocturnal blood pressure patterns were examined and categorized into two as dipping/non-dipping and reverse dipping. Dipping/non-dipping and reverse dipping rates were compared between groups. The difference between the groups was evaluated using the chi-square test. Results: A total of 126 patients were enrolled, 59% (n:74) of them were female while 41% (n:52) were male. The median age was 62 (18 - 88) years. The rates of dipping, non-dipping, and reverse dipping were as follows; 5.3%, 57.9%, 36.8% in the PD, 37%, 40.7%, 22.2% in the cerebrovascular disease, and 37.5%, 51.2%, and 11.3% in the other neurological diseases group. The rate of reverse dipping was significantly higher in the PD group (p=0.024), while it was lower in other neurological disease group (p=0.029). The rates in the cerebrovascular disease group were not statistically different. Conclusion: Reverse dipping is an important yet unnoticed autonomic dysfunction feature which can increase cardiovascular mortality in PD patients.

Nocturnal Blood Pressure Patterns in Hypertensive patients with Obstructive Sleep Apnea Syndrome in Angola

The main cardiovascular consequence of Obstructive Sleep Apnea Syndrome (OSAS) is arterial hypertension (AH), considered since 2003 a second cause of AH. This study aimed to evaluate nocturnal blood pressure patterns (BPP) in hypertensive patients with OSAS in Angola. A descriptive, cross-sectional observational study was carried out in a private clinic in Angola. Demographic and clinical variables, polysomnography, and ABPM parameters were included. Patients were classified as a dippers, non-dippers, and reverse dippers. One-way ANOVA test, Kruskal-Walli’s test, and chi-square test were used as appropriate. The sample consisted of 70 individuals: 39(55.7%) were male. The mean age was 53.63±9.14 years and the BMI was 35.82 ± 6.57 kg/m2. An association between patients with a past medical history of hypertension and BPP was found (p<0.05). Mean O2 saturation was significantly lower in the reverse dippers (p=0.25). Although insignificantly, the dippers were younger and less obese. In contrast, the proportion of smokers and diabetics was higher in the reverse dippers. No correlation was found between the apnea-hypopnea index, the mean blood pressure, and the Epworth sleepiness scale. In the present study, the prevalence of non-dipping and reverse dipping patterns was high. It needs to be confirmed with future prospective studies.

NOCTURNAL HYPERTENSION IS ASSOCIATED WITH HEART FAILURE RE-HOSPITALIZATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION

Objective: Nocturnal hypertension is reported as a risk factor for cardiovascular disease. This study was to explore the potential association between nocturnal hypertension and heart failure (HF) rehospitalization in patients with HF and preserved ejection fraction(HFpEF). Design and method: Totally, 538 patients with HFpEF were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study. Cox regression analysis was used to reveal the potential association between nighttime blood pressure (BP) levels, nocturnal hypertension and nocturnal BP patterns and HF rehospitalization. Kaplan-Meier curve was used to assess the cumulative events free rate between groups. Results: The mean age of the study population was 77.14±8.68 years, and 41.2% was men. After a median follow up duration of 10.93 (4.19, 21.13) months, 176 (32.7%) patients with HFpEF were readmitted for HF. Cox analyse had revealed that nighttime systolic blood pressure (BP) level (Hazards ratio(HR):1.018, 95% confidence interval(CI): 1.008-1.028, p = 0.001), nightime diastolic BP level (HR:1.024, 95%CI:1.007-1.042, p = 0.007), nocturnal hypertension (HR:1.688, 95%CI:1.229-2.317, p = 0.001) were associated with HF rehospitalizaiton. Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower events free rate (Log rank test, p<0.001). Furthermore, patients with a riser pattern had a higher risk of HF rehospitalization (HR:1.828, 95%CI:1.055-3.166, p = 0.031) and lower events free rate (Log rank test, p = 0.003) than those with a dipper pattern. Conclusions: Nighttime BP levels, nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF. Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.

Nocturnal hypertension and riser pattern are associated with heart failure rehospitalization in patients with heart failure with preserved ejection fraction.

Nocturnal hypertension is reported as a risk factor for cardiovascular disease. This study aimed to explore the potential association between nocturnal hypertension and heart failure (HF) rehospitalization in patients with HF with preserved ejection fraction (HFpEF). A total of 538 patients with HFpEF from May 2018 to December 2021 were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study. Cox regression analysis was used to reveal the potential association between nighttime blood pressure (BP) levels, nocturnal hypertension and nocturnal BP patterns and HF rehospitalization. Kaplan-Meier curve was used to assess the cumulative event-free survival rate between groups. There were 537 patients with HFpEF were included in the final analysis. The mean age of the study population was 77.14 ± 8.68 years, and 41.2% of patients were men. After a median follow-up duration of 10.93 (4.19-21.13) months, 176 patients (32.7%) with HFpEF were readmitted for HF. Cox regression analysis had revealed that nighttime systolic BP level [hazards ratio (HR) = 1.018, 95% CI: 1.008-1.028, P = 0.001], nighttime diastolic BP level (HR = 1.024, 95% CI: 1.007-1.042, P = 0.007), nocturnal hypertension (HR = 1.688, 95% CI: 1.229-2.317, P = 0.001) were associated with HF rehospitalization. Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower event-free survival rate (log-rank P < 0.001). Furthermore, patients with a riser pattern had a higher risk of HF rehospitalization (HR = 1.828, 95% CI: 1.055-3.166, P = 0.031) and lower event-free survival rate (log-rank P = 0.003) than those with a dipper pattern. These findings were also confirmed in patients with HFpEF and hyperuricemia. Nighttime BP levels, nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF, and prominently in patients with HFpEF and hyperuricemia. Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.

BLOOD PRESSURE VARIABILITY AND CIRCADIAN PATTERN AFTER RENAL DENERVATION - CROATIAN REAL-LIFE STUDY

Objective: Recent trials confirmed the lowering effect of renal denervation (RDN) on blood pressure (BP). We aimed to analyze the impact of RDN on BP variability and circadian rhythm. Design and method: Out of 31 truly resistant patients whose secondary forms of hypertension were ruled out and were enrolled into the Croatian Spyral RDN registry, 18 (10 m, 8 w, average age 49.3) were eligible for analyses. Office BP, ABPM, central BP, and PWV were measured with Omron M6, Mobilograph, and Sphygmocor devices. Sympathetic/parasympathetic activity was measured with ANX-3.0 ANSAR device. All RDN procedures (Spyral Medtronic) were done by one physician (average number of ablation spots was 41/procedure). Patients were examined the day before and that day, 1,3,6, and 12 months after the RDN. The response was a drop of office systolic BP by 10 mmHg or more 6 months after RDN. There were no differences in the RDN procedure between responders and non-responders. Results: Office and ABPM values dropped the day after RDN and remained significantly lower at the end of the follow-up (6.5/-5.5 and -16.2/9 mmHg, respectively). We failed to find changes in BP variability (SD) after RDN. However, a significant decrease in morning BP surge was observed immediately the day after RDN (-12.4) and was even lower at the end of the follow-up (-18.8 mmHg). Substantial number of patients who had an abnormal nocturnal BP pattern became dippers. Central systolic BP and PWV decreased (-6.3 mmHg and -0.72 m/s, respectively). LFa/RFa decreased the day after RDN and reminded lower during the follow-up period. After RDN morning BP surge remained stable and normal in responders; however, in non-responders, it decreased immediately after RDN (-21.2) and remained lower during the follow-up till the last visit (-33.3). Conclusions: Significant improvements in circadian rhythm and several parameters of central hemodynamics were observed after RDN indicating that RDN might be considered as a pathway to the complete, so-called perfect 24-hour BP control. Observed beneficial effects run in parallel with the observed decrease in sympathetic activity. Importantly, even in non-responders, RDN had a beneficial effect on morning BP surge.

Nondipping blood pressure pattern predicts cardiovascular events and mortality in patients with atherosclerotic peripheral vascular disease.

Patients with peripheral vascular disease (PVD) are often underdiagnosed and undertreated. Nocturnal nondipping blood pressure (BP) pattern, as diagnosed by ambulatory BP monitoring (ABPM), is associated with increased cardiovascular risk, but has not been studied in patients with PVD. We aimed to investigate if a nondipping BP pattern predicts cardiovascular events or all-cause death in outpatients with PVD. Consecutive outpatients with carotid or lower-extremity PVD were examined with 24-hour ABPM (n = 396). Nondipping was defined as a < 10% fall in systolic BP level during night-time. We used Cox regression models adjusting for potential confounders. We also evaluated the incremental prognostic value of dipping status in the COPART risk score. Our primary composite outcome was cardiovascular events or all-cause death. In the cohort (mean age 70; 40% women), 137 events occurred during a 5.1-year median follow-up; incident rate of 7.35 events per 100 person-years. Nondipping was significantly associated with outcome (hazard ratio 1.55, 95% CI 1.07-2.26, p = 0.021) in a fully adjusted model. When adding nondipping to the risk markers in the COPART risk score, the model fit significantly improved (χ2 7.91, p < 0.005) and the C-statistic increased from 0.65 to 0.67. In a cohort of outpatients with PVD, nondipping was an independent risk factor for future cardiovascular events or mortality and seemed to be a strong predictor in patients with carotid artery disease but not in lower-extremity PVD. Additional studies are needed to evaluate the clinical utility of ABPM for improved prevention in these high-risk patients. (ClinicalTrials.gov Identifier: NCT01452165).

5. Nocturnal Dipping Pattern in Hypertensive Patients as a Risk Factor for Cerebral Small Vessel Disease (CSVD): A Systematic Review and Meta-Analysis

Background: Cerebral small vascular disease (CSVD) is one of the most prevalent cerebral vascular pathologies encountered by middle-aged and older people, which can be observed by magnetic resonance imaging (MRI). The most important modifiable risk factor for CSVD is hypertension. Abnormal circadian blood pressure (BP) variability has been reported to significantly damage hypertensive patients’ target organs. Moreover, in many studies, controlling sleep blood pressure has been shown to exert greater protection against stroke and cardiovascular events. Objective: We aim to assess the nocturnal dipping pattern of blood pressure with the findings of cerebral small vessel disease. Method: We performed a comprehensive search on topics that assess nocturnal blood pressure monitoring and cerebral small vessel disease findings through imaging from inception up until November 2022. Result: There were a total of 2674 patients from 5 studies. The outcome of this study reported that reverse dipping and dipping BP patterns were significantly associated with the prevalence of CSVD. Meta-analysis showed that the reverse dipping BP pattern was associated with a higher risk for CSVD (OR 2.18 [1.80, 2.64], p = 0.64; I2: 0%, p &lt; 0.00001), meanwhile dipping pattern had a lower risk for CSVD (OR 0.51 [0.42, 0.63], p = 0.04; I2: 59%, p &lt; 0.00001). There was no association between the non-dipping pattern and CSVD (OR 0.92 [0.77, 1.10], p = 0.70; I2:0%, p = 0.35). Conclusion: Nocturnal BP pattern and CSVD were shown to be associated, with the reverse dipping BP pattern having a higher risk and dipping having a lower risk.

Factors Associating with Non-Dipping Pattern of Nocturnal Blood Pressure in Patients with Essential Hypertension.

Background: In patients with essential hypertension, a non-dipping blood pressure pattern is a strong risk factor for cardiovascular diseases. However, background factors associating with such a blood pressure pattern remain unknown. Methods: Untreated essential hypertensive patients without chronic kidney diseases who were admitted to our outpatient clinic were included. Blood sampling and 24 h ambulatory blood pressure monitoring were mandatorily performed. Non-dipper status was defined as a maximum decrease in nocturnal systolic blood pressure within 10%. Clinical factors associating with non-dipper status were investigated. Results: A total of 154 patients (56 ± 12 years old, 86 men) were included. Among baseline characteristics, a higher serum uric acid level was independently associated with non-dipper status (odds ratio 1.03, 95% confidence interval 1.00−1.05, p < 0.05). Among those with non-dipper status, a higher high-sensitivity C-reactive protein level tended to be associated with incremental nighttime systolic blood pressure levels (p = 0.065). Conclusions: Hyperuricemia and micro-inflammation might be associated with attenuated nocturnal blood pressure dipping and incremental nighttime systolic blood pressure levels.

Concurrent Aerobic Plus Resistance Training Elicits Different Effects on Short-Term Blood Pressure Variability of Hypertensive Patients in Relation to Their Nocturnal Blood Pressure Pattern.

Background and Objectives: The purpose of this study was to investigate the effects of a 12-week concurrent training (CT) (i.e., aerobic plus resistance exercise) on short-term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. Material and Methods: 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 the six minute walk test, ergometric test, assessment of 1-repetiton maximum (1 RM), and 24/h BP monitoring (24-h ABPM). Results: 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 non-dipping group (between groups changes: -1.0 ± 0.4 mmHg and -1.3 ± 0.9 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 they were unchanged in the non-dipping group (between groups changes: -7.1 ± 2.6 mmHg and -7.8 ± 2.4 mmHg; p = 0.004 and p = 0.002, respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small but not significant changes in both groups. Conclusions: The effects of CT on BPV and BP were blunted in hypertensive subjects with a non-dipping BP pattern.

Classifying nocturnal blood pressure patterns using photoplethysmogram features.

Circadian rhythms in blood pressure (BP) may in some cases be indicative of an increased risk of adverse cardiovascular events. However, current methods for assessing these rhythms can be disruptive to sleep, work, and daily activities. Features of the photoplethysmogram (PPG), which can be non-invasively and unobtrusively recorded, have been suggested as surrogate measures of BP. This work investigates the presence of a circadian rhythm in these features and evaluates their potential to classify nocturnal BP patterns. 742 patients who were discharged home from the ICU were selected from the MIMIC-III database. Our results show that a number of PPG features exhibit a clear and observable circadian rhythm. Of the 19 features evaluated, the circadian rhythms of 5 features outperformed heart rate (HR) in terms of correlation with the circadian rhythm of SBP ( ). We also present evidence that a metric combining the PPG features significantly improves BP phenotype classification accuracy. Clinical Relevance-This work suggests that a combined metric of PPG features may be able to accurately assess an individual's circadian rhythm of BP.

The Association of Nocturnal Blood Pressure Patterns and Other Influencing Factors With Lacunes and Enlarged Perivascular Spaces in Hypertensive Patients.

PurposeNocturnal blood pressure dipping patterns have been associated with an increased risk of Cerebral Small Vessel Disease (CSVD), which has not been well-studied. This study is aimed to explore the association of dipping patterns and other factors with lacunes and enlarged perivascular spaces (EPVS) in patients with hypertension.MethodsWe enrolled a total of 1,322 patients with essential hypertension in this study. Magnetic resonance imaging (MRI) scans and 24-h ambulatory blood pressure (BP) monitoring were completed. Nocturnal BP decline was calculated, and then dipping patterns were classified. Patients were classified into four groups according to the performance of lacunes and EPVS in the MRI scan for statistical analysis.Results(1) Nocturnal BP decline showed independent negative correlation with both lacunes and EPVS while mean systolic BP (mSBP) level showed an independent positive correlation with them (P < 0.05). (2) The frequency of reverse-dippers in the control group was significantly lower than that in other groups; the frequency of non-dippers in the lacunes group and EPVS group was significantly lower than that in the control group; the frequency of extreme-dippers in the EPVS group was significantly higher than that in the mixed (lacunes with EPVS) group (P < 0.05).ConclusionsBoth mSBP and dipping patterns might play an important role in developing lacunes and EPVS in patients with hypertension.

Inflammation and Nocturnal Pattern of Blood Pressure in Normotensives

Background: In most healthy individuals, blood pressure (BP) shows a circadian rhythm. Being non-dipper increases cardiovascular risk in normotensive and hypertensive individuals. Nocturnal dipping shows a correlation with the state of inflammation. Objetive: To investigate the relationship between inflammation-based indexes and nocturnal BP pattern in normotensive individuals. Method: This is a retrospective study that included patients evaluated with ambulatory BP monitoring (ABPM). A total of 131 normotensive individuals were included and grouped as dippers and non-dippers. The normality of [...]

Abstract 066: Association Between Nocturnal Blood Pressure Dipping Magnitude And Chronic Kidney Disease Risk Among Patients With Controlled Office Blood Pressure

Although abnormal diurnal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their risks are yet unquantified by BP dipping magnitude. We assessed chronic kidney disease risk across nocturnal BP dipping spectrum among patients with controlled hypertension without prior advanced kidney disease. Ambulatory BP measurements were collected from 995 middle-aged patients with controlled office BP (&lt;140/90 mmHg). The magnitude of dipping was defined as the difference between daytime and nighttime systolic BP divided by daytime systolic BP. Accordingly, patients were categorized as extreme-dipper (≥20%) dipper (10-&lt;20%), non-dipper (0-&lt;10%), or reverse-dipper (&lt;0%). We cross-sectionally analyzed continuous and categorical associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (&lt;60 ml/min/1.73m 2 ), adjusting for office/ambulatory BP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior. The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% (134 of 995) extreme-dippers, 43.1% (429 of 995) dippers, 34.7% (345 of 995) non-dippers, and 8.7% (87 of 995) reverse-dippers. In reference to dippers, odds ratios (95% confidence interval) for albuminuria were 1.73 (1.04-2.60) in reverse-dippers, 1.67 (1.20-2.32) in non-dippers, and 0.62 (0.38-1.04) in extreme-dippers; this reflects significantly lower risk (0.77, 0.55-0.95) per 10% dipping. Likewise, persons presenting reduced and reverse-directional dipping were at higher risk for decreased estimated glomerular filtration rate: reverse-dippers 2.02 (1.06-3.84); non-dippers 1.98 (1.07-3.08); extreme-dippers 0.69 (0.20-1.17), with lower risk (0.74, 0.22-1.02) per every 10%. In short, monitoring nocturnal BP patterns may identify chronic kidney disease risk otherwise overlooked based on office BP.

Non-dipping pattern of nocturnal blood pressure as a risk factor for macular ischemia in branch retinal vein occlusion

Branch retinal vein occlusion (BRVO) is ocular vascular disease affecting approximately 14 million people worldwide, and is closely associated with high blood pressure (BP). Although macular ischemia is a critical factor in the visual prognosis of BRVO, the relationship between macular ischemia and different patterns of nocturnal BP is unknown. Here, we investigated whether a dipping pattern of nocturnal BP is associated with the development of macular ischemia in patients with BRVO. A total of 273 patients were reviewed; of these, 86 (86 eyes) patients were included. All recruited patients had a macular thickness map by optical coherence tomography and underwent 24-h ambulatory BP monitoring. According to their dipping patterns, the participants were divided into dipper and non-dipper groups. The non-dipper group had worse visual outcomes at the initial and 6-month visits (P = 0.014 and P = 0.003, respectively). Five of 32 eyes (15.6%) in the dipper group and 32 of 54 (59.3%) in the non-dipper group had macular ischemia. In a multivariate analysis, the night-to-day systolic BP ratio was associated with the degree of macular ischemia (β = − 0.313, P = 0.004). Thus, a non-dipping pattern may be a risk factor for macular ischemia in patients with BRVO.

Quantitative evaluation of white matter hyperintensities in patients with heart failure using an innovative magnetic resonance image analysis method: Association with disrupted circadian blood pressure variation.

White matter hyperintensities (WMHs) are risk factors for future cognitive impairment and are associated with an abnormal circadian blood pressure (BP) rhythm in patients with hypertension. However, whether this association exists in patients with heart failure (HF) is unclear. We performed a cross‐sectional study of hospitalized patients with HF who underwent ambulatory BP monitoring and brain magnetic resonance imaging (MRI). A non‐dipper BP pattern was defined as a < 10% nocturnal BP decline. WMHs on brain MRI scans were quantitated using a novel image analysis software (FUSION: FUsed Software for Imaging Of Nervous system). We enrolled 28 hospitalized patients with HF (age: 70.0 ± 9.8 years, 64.3% men). In the brain MRI analysis, the non‐dipper group had higher WMH volume (18.9 ± 19.8 vs. 7.7 ± 8.3 mL, P = .047) and percentage of WMH/total brain volume (1.31 ± 1.28% vs. 0.55 ± 0.58%, P = .04) than the dipper group. In conclusion, using the newly developed MRI analysis software, we successfully quantitatively measured the volume of WMHs and found that the WMH volume increased 2.4 times in patients with a non‐dipper pattern of nocturnal BP compared with those with a normal dipper pattern.

Defining the nocturnal period in 24-h ambulatory blood pressure monitoring: a comparison of three methods.

The purpose of our study was to compare three definitions of ambulatory blood pressure (BP) nocturnal period and to assess their agreement in determining nocturnal BP dipping patterns. We investigated 69 subjects with metabolic syndrome, aged 50-55 years. In all subjects, we assessed 24-h BP monitoring, electrocardiogram and actigraphy profiles. The nocturnal period was defined in three ways: as a fixed narrow nighttime period from 01:00 to 06:00, as a self-reported sleeping period and as a disappearance and onset of physical activity recorded by the actigraph. Our study revealed a significant discrepancy between the self-reported and actigraphy-based nocturnal periods (P < 0.001). In addition, different definitions of the nighttime yielded significant differences in determining nondipping, extreme dipping and dipping BP patterns, the identification of the latter being affected the most. The actigraphy-based approach best aligned with the fixed-time determination of the nocturnal period: Cohen's kappa coefficient for the nondipping pattern was 0.78 (0.58-1), for the dipping pattern 0.75 (0.59-0.91) and for the extreme dipping pattern 0.81 (0.65-0.97). In comparison to the self-reported determination of the nocturnal period, using the actigraphy-based approach resulted in reclassifying the nocturnal BP pattern in 20.3% of subjects. The lack of agreement between fixed-time, self-reported and actigraphy-based determinations of the nighttime period affects the identification of the nocturnal BP patterns. In comparison to the self-reported nocturnal period estimation, the actigraphy-based approach results in the reclassification of BP dipping status in every fifth subject.

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.

Dipping pattern of nocturnal blood pressure in hypertensive patients treated with azilsartan

Aim: On average, blood pressure (BP) is found to be low during night than during day by approximately 10%–20%. In addition, BP decreases by >20% in some hypertensives or lowered by 140 mmHg; diastolic BP [DBP] >90 mmHg) were enrolled to performed ABPM and clinic BP monitoring with ongoing treatment with azilsartan. Statistical Analysis: Data are expressed as mean ± standard deviation. Statistical comparisons to test differences between two independent groups were by Student's t-test or Mann–Whitney's U-test as appropriate. Results: All patients monitored for 24-h BP measurement and reported to had SBP 133.76 ± 15.97 mmHg and DBP 76.16 ± 10.86 mmHg. Pulse rate was found to be 76.18 ± 11.82 bpm. BP variability was found to be high in 23.41% patients. Overall, study showed 34.17% dipper, 3.16% extreme dipper, 51.26% nondippers and 11.39% patients with reverse dipping pattern. In the present study, the dippers are classified to have 18.9% reduction in SBP, whereas 12.5% reduction in DBP. In the dippers group, only 4 patients had normal BP variation (2.53%), whereas high BP variation was found in 50 patients of the group (31.64%). Conclusions: ABPM had revealed higher SBP, BP variability (in almost one-fourth patients), dipping pattern and slightly higher pulse rates in hypertensive patients receiving azilsartan treatment. Around one-third of hypertensive patients were found to be dippers and more than half patients were non-dippers. Azilsartan has potent antihypertensive effect over 24 h and can be preferred in high-risk hypertensive patients.

P275 Uncontrolled post-clinic blood pressure readings can identify nocturnal non-dipping blood pressure pattern

Abstract Funding Acknowledgements Aga Khan University Faculty of Health Sciences Research Committee (#80096) On Behalf PC BP (Post Clinic Blood Pressure) Study Group Background Nocturnal non-dipping increases cardiovascular morbidity and mortality in both hypertensive and normotensive subjects. Ambulatory blood pressure monitoring(ABPM) can identify nocturnal blood pressure(BP) dipping patterns but clinic BP cannot. We previously showed that 15-minute post-clinic BP correlates well with 24- hour ABPM. Purpose We aimed to determine if 15-minute post-clinic BP reading helped to identify patients with nocturnal non-dipping pattern. Methods A cross-sectional study involving 150 participants, as part of the Post Clinic-Ambulatory Blood Pressure(PC-ABP) study, was conducted in cardiology clinics. Participants aged ≥18 years, with hypertension or those referred for its assessment, were included. Pregnant females were excluded. Post-clinic BP was taken 15 minutes after the patient-physician encounter in the clinic using an automated, validated BP device by a research assistant. All the participants were then referred for 24-hour ABPM. Patterns of nocturnal dipping were studied amongst groups of controlled(&amp;lt;140 mmHg) and uncontrolled(≥140mmHg) post-clinic systolic BP(SBP). Fischer exact test was used to determine the difference in dipping patterns amongst the two groups. Results The mean age of participants was 60.3 ± 11.9 years. Of 150 participants, 49% were male and of all, 76% were hypertensive. Mean nighttime SBP(±SD) was 121.9(±18) mmHg(p-value &amp;lt;0.001). Mean nighttime DBP(±SD) was 68.7(± 8.7) mmHg(p &amp;lt; 0.001). Patterns of nocturnal dipping amongst patients with mean post-clinic SBP &amp;lt;140mmHg versus ≥140mmHg has been shown in Table 1. The difference in nocturnal dipping patterns between the two groups was statistically insignificant(p-value 0.071). Pearson correlation coefficient between post-clinic SBP and nighttime SBP for patients with loss of dip was higher (0.64; p &amp;lt; 0.001) whereas it was 0.56(p-value &amp;lt;0.001) for those with preserved dip. Conclusion Uncontrolled post-clinic BP can help in identifying patients with nocturnal non-dipping. Larger studies can help determine the prognostic value of post-clinic BP amongst patients with nocturnal non-dipping. Nocturnal Dipping Amongst The Two Groups Controlled PC SBP &amp;lt;140mmHg (n = 80) Uncontrolled PC SBP ≥140mmHg (n = 70) Preserved Nocturnal Dipping (10 to 20% nocturnal drop in SBP) 61.2% (n = 49) 47.1% (n = 33) Loss of Dip (&amp;gt;0% to &amp;lt;10% of nocturnal drop in SBP) 33.8% (n = 27) 48.6% (n = 34) Reversed Dip (≤0% drop in SBP) 5% (n = 4) 1.4%(n = 1) Excessive Dip (&amp;gt;20% drop in SBP) 0 2.9% (n = 2) Table 1 shows the patterns of nocturnal dipping amongst patients with controlled (&amp;lt;140mmHg) and uncontrolled (≥140mmHg) 15-minute post-clinic systolic blood pressure (PC SBP).