Pressure Profile In Patients Research Articles

Descriptive Study Of The Pressure Profile In Patients Suffering From Swallowing Difficulties (Dysphagia) - The Hospital Based Study

Descriptive Study Of The Pressure Profile In Patients Suffering From Swallowing Difficulties (Dysphagia) - The Hospital Based Study

The severity of chronic heart failure and the parameters of daily blood pressure profile in patients with coronary heart disease

Aim: Although the prevalence of coronary heart disease (CHD) and hypertension which are the most common causes of the development and progression of chronic heart failure (CHF) is high, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with CHF is not mandatory to be performed. The growing number of evidence suggests that excessive decrease in BP which clearly reflects increased BP variability (BPV) affects the survival of patients with heart failure (HF). The objective of the study was to investigate the relationship between the parameters specific to CHF severity and features of daily BP profiles in patients with ischemic CHF and hypertension. Methods: Ninety patients with functional class II–IV of CHF and CHD (the main group) and 50 non-CHF patients with hypertension (the comparative group) were examined. The transthoracic echocardiography (TTE) [atrial end-systolic dimension (ESD), ventricular end-diastolic dimension (EDD), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF)] and 24-hour ABPM (BPV parameters and proportions of hypotensive episodes) were performed. The relationships between the abovementioned parameters were evaluated using the univariate correlation analysis and stepwise multiple linear regression. Results: Higher functional class of CHF is found to be associated with a higher incidence of daytime systolic BP (SBP) decline and nighttime SBP and diastolic BP (DBP) variability while higher LVEF is related to the hypotensive episodes regardless of CHF. Conclusions: It appears that the larger trials involving CHF patients with reduced LVEF should be conducted to clarify the obtained results.

High plasma aldosterone concentration is associated with worse 24-h ambulatory blood pressure profile in patients with primary aldosteronism.

Patients with primary aldosteronism (PA) have a higher risk of cardiovascular disease (CVD) than essential hypertension due to underlying hyperaldosteronism. However, the association between high plasma aldosterone concentrations (PACs) and diurnal blood pressure (BP) variation has not been fully elucidated. Because abnormal ambulatory blood pressure monitoring (ABPM) profiles are associated with increased CVD risk, we investigated the association between PACs and the ABPM profile in 36 patients with PA diagnosed by confirmatory tests who underwent adrenal venous sampling (AVS). The clinical parameters were measured during hospitalization for AVS. The dietary salt intake of hospitalized patients was controlled at 6 g/day. During AVS, blood samples were collected from the inferior vena cava before and 1 h after adrenocorticotropic hormone (ACTH) stimulation to measure the PACs. The post-stimulation PAC had a significant negative correlation with nocturnal BP dipping rates (R = -0.387, p = 0.020), whereas pre-stimulation PAC did not (R = -0.217, p = 0.204). The nocturnal BP dipping rates were significantly lower in the high PAC group (PAC higher than the median) than low PAC group (PAC lower than the median) (p = 0.009). Multiple regression analysis revealed that high PAC was an independent factor contributing to low nocturnal BP dipping rates (β = -0.316, p = 0.038). In conclusion, in patients with PA, hyperaldosteronism is associated with nocturnal hypertension, which is an important risk factor for CVD. Additionally, ACTH stimulation may improve the sensitivity of PACs as a clinical indicator of nocturnal hypertension.

Vascular stiffness, 24-hour blood pressure profile in patients with hypertension and anxiety-depressive disorders in andro- and menopausal periods

Aim. Identification and analysis of the features of vascular stiffness, 24-hour blood pressure (BP) profile, and central aortic pressure (CAP) in patients with hyper­tension (HTN) and anxiety-depressive disorders (ADDs) during andro- and meno­pausal periods.Material and methods. The study included 120 patients with uncontrolled hyper­tension in the andro- and menopausal periods, of which 60 patients with hyper­tension and ADDs (30 men and 30 women) with median age of 58 years (52-64 years), as well as the control group — 60 patients with hypertension without ADD (30 men and 30 women) with median age of 59 years (53-65 years). All persons included in the study underwent 24-hour ambulatory BP monitoring (ABPM) and assessed the arterial stiffness parameters and CAP.Results. Comparative evaluation of ABPM in the group of patients with HTN and ADDs revealed more pronounced pathological changes in the 24-hour BP profile compared to those in the control group. Andro- and menopause with a combination of HTN and ADDs characterized by significantly higher ABPM parameters than HTN without ADDs (regardless of the sex). At the same time, in the group of men with HTN and ADD in andropause, unfavorable changes in the main arterial stiffness parameters and CAP were more significant than in women with HTN and ADD during menopause (p<0,05). In the control men groups, in comparison with women, more pronounced unfa­vo­-rable changes in certain vascular stiffness indicators, CAP and ABPM were recorded.Conclusion. In men and women in periods of andro- and menopause with HTN and ADDs, the features of arterial stiffness, CAP, and 24-hour blood pressure profile were verified in comparison with patients with HTN without ADDs. At the same time, the severity of unfavorable changes in the studied parameters in men with depression in andropause is more significant than in menopausal women.

Anorectal manometry for the diagnosis of pelvic floor disorders in patients with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome

IntroductionFunctional gastrointestinal disorders (FGID) including impaired rectal evacuation are common in patients with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). The effect of connective tissue pathologies on pelvic floor function in HSD/hEDS remains unclear. We aimed to compare clinical characteristics and anorectal pressure profile in patients with HSD/hEDS to those of age and sex matched controls.MethodsWe conducted a retrospective review of all FGID patients who underwent high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) for evaluation of impaired rectal evacuation. Patients with HSD/hEDS were age and sex matched to a randomly selected cohort of control patients without HSD/hEDS. An abnormal BET was defined as the inability to expel a rectal balloon within 2 minutes. Wilcoxon rank sum test and Fisher’s exact test were used to make comparisons and logistic regression model for predictive factors for abnormal evacuation.ResultsA total of 144 patients (72 with HSD/hEDS and 72 controls) were analyzed. HSD/hEDS patients were more likely to be Caucasian (p < 0.001) and nulliparous. Concurrent psychiatric disorders; depression, and anxiety (p < 0.05), and somatic syndromes; fibromyalgia, migraine and sleep disorders (p < 0.001) were more common in these patients. Rate of abnormal BET were comparable among the groups. HDS/hEDS patients had significantly less anal relaxation and higher residual anal pressures during simulated defecation, resulting in significantly more negative rectoanal pressure gradient. The remaining anorectal pressure profile and sensory levels were comparable between the groups. While diminished rectoanal pressure gradient was the determinant of abnormal balloon evacuation in non HSD/hEDS patients, increased anal resting tone and maximum volume tolerated were independent factors associated with an abnormal BET in HSD/hEDS patients. Review of defecography data from a subset of patients showed no significant differences in structural pathologies between HSD/hEDS and non HSD/hEDS patients.ConclusionsThese results suggest anorectal pressure profile is not compromised by connective tissue pathologies in HSD patients. Whether concurrent psychosomatic disorders or musculoskeletal involvement impact the pelvic floor function in these patients needs further investigation.

Left ventricular global function index and peculiarities of daily blood pressure profile in patients with arterial hypertension

BACKGROUND: The left ventricular global function index (LVGFI), determined using transthoracic echocardiography, is a simple clinical marker of left ventricular dysfunction and has superior prognostic value to the standard ejection fraction-based assessment of cardiac pump function. The methodology for calculating this index was proposed in 2019. Currently, the clinical factors that influence the state of left ventricular global functions are not examined.&#x0D; AIM: This study aimed to assess the association of LVGFI with the peculiarities of daily blood pressure (BP) profile in patients with arterial hypertension (AH).&#x0D; MATERIALS AND METHODS: A total of 104 patients [51 men (49%) and 53 (51%) women] with AH were examined. The mean age of the patients was 58.711.73 years, and disease duration was 6.0310.93 years. AH corresponded to grades 1, 2, and 3 in 47 (45.2%), 26 (25.0%), and 31 (29.8%) patients, respectively. Patients with myocardial infarction or stroke, cardiomyopathies, heart defects, diabetes mellitus, thyroid dysfunction, or chronic kidney disease were not included in the study. All patients underwent daily BP monitoring, echocardiography, carotid artery examination, and biochemical blood tests.&#x0D; RESULTS: A significant inverse weak correlation of LVGFI with age (r=0.215, p=0.028), body mass index (r=0.378, p=0.001), BP variability (r=0.307, p=0.002), and daily mean values of systolic (r=0.223, p=0.026) and diastolic (r=0.237, p=0.018) BP were observed. In the regression analysis, an increase in body mass index, abnormal diurnal BP with excessive BP reduction at night, and high BP variability demonstrated a significant and independent association with decreased LVGFI.&#x0D; CONCLUSIONS: The study revealed an independent association of decreased LVGFI with increased body mass index, excessive BP reduction at night, and high systolic BP variability. These factors should be considered in the possible development of a strategy to prevent target organ damage in AH.

ASSOCIATION BETWEEN PERIRENAL ADIPOSE TISSUE, METABOLIC PARAMETERS AND BLOOD PRESSURE PROFILE IN PATIENTS WITH ABDOMINAL OBESITY

Objective: Perirenal adipose tissue is considered as new marker of cardiometabolic risk, as particular visceral fat depot, can leads to metabolic decoders and organ damage. The aim of study to assess the effects of perirenal adipose tissue on metabolic parameters and 24-hours profile of blood pressure in patients with abdominal obesity. Design and method: The study included 104 patients (37,5% - men, 62.5% - women), mean age 38.59 ± 6.09 years with abdominal obesity (waist circumference (WC) &gt; 80 cm in women and &gt; 94 cm in men), without cardiovascular diseases and diabetes mellitus. Perirenal adipose tissue (PAT) volume was measured by multislice computed tomography (MSCT) (ToshibaAquillion 640, Japan). Blood sampling and measurements of lipid levels, fasting glucose, insulin, HOMA index, 24-hour ambulatory blood pressure monitoring were performed. Results: PAT volume was associated with WC (r = 0,70; p &lt; 0,05) in participants with abdominal obesity. A positive correlation was found between PAT and triglyceride (r = 0,35; p &lt; 0,05), insulin (r = 0,37; p &lt; 0,05), HOMA-index (r = 0,38; p &lt; 0,05); creatinine (r = 0,30; p &lt; 0,05) and a negative correlation - with HDL-cholesterol (r = -0,40; p &lt; 0,05). There was no association between PAT and LDL-cholesterol. PAT was associated with day (r = 0,29; p &lt; 0,05) and night (r = 0,39; p &lt; 0,05) systolic blood pressure and with day (r = 0,30; p &lt; 0,05) and night (r = 0,30; p &lt; 0,05) systolic blood pressure. Conclusions: PAT is associated with metabolic disorders, insulin resistant index and blood pressure profile in patients with abdominal obesity.

Blood pressure time load formation in patients with arterial hypertension without metabolic syndrome

Relevance . The study of the daily dynamics of blood pressure in arterial hypertension both on the basis of the daily index and on the basis of the time load is a relevant task, since, these indicators are associated in the literature with stable changes in the neurohumoral regulation of the cardiovascular system in arterial hypertension . The aim of the study was to compare data of the time load in patients with arterial hypertension , depending on the nocturnal blood pressure profile, with integrative indicators of the activity of the cardiovascular system in the form of a Circadian index, a structural point of blood pressure, double product. Materials and Methods. The study included 72 patients who were treated at the City Clinical Hospital No 13 in Moscow and signed a voluntary consent to participate in the research and the processing of personal data. Inclusion criteria: arterial hypertension. Exclusion criteria: metabolic syndrome, secondary forms of arterial hypertension and concomitant pathology. Depending on the daily index (DI10% and DI10%) patients were divided into 2 groups: 1 group (N= 32): patients with arterial hypertension without nocturnal decrease in blood pressure (non-dippers and night-pickers100%); Group 2 (N = 40): patients with arterial hypertension who had a nocturnal decrease in blood pressure (dippers and over dippers 100%). All patients and members of the control group (N=15) underwent daily monitoring of blood pressure (24-hour Arterial Blood Pressure Monitoring). The data were statistically processed to determine the 5% level of significance of differences (p0.05) (Students test). In the comparative analysis of integrative indicators at day and at night, a variance analysis was applied. Results and Discussion . As a result of the study, it was found that the values of Circadian Index for blood pressure vary depending on the type of night decrease in blood pressure and the blood pressure time load, while daily index and structural point of blood pressure remain on the same level as a reflection of the hemodynamic allostasis existing in both groups. Conclusion. Reflection of the allostatic load on hemodynamics is change of values of double product and of the structural point of blood pressure compared with the control group. These changes are not associated with the peculiarities of the nocturnal blood pressure profile in patients with hypertension without metabolic syndrome.

24-Hour blood pressure profile in patients with adrenal insufficiency

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

24-Hour blood pressure profile in patients with adrenal insufficiency

24-Hour blood pressure profile in patients with adrenal insufficiency

Вплив важкості ожиріння на структуру добового профілю артеріального тиску та ефективність його корекції засобами фізичної терапії на фоні різного рівня терапевтичного альянсу

In recent years, obesity has become one of the most common non-communicable diseases, affecting the population around the world, regardless of age, gender, social status. Weight gain is associated with an increased risk of death from any cause, primarily from cardiovascular disease. The main clinical complication of obesity is arterial hypertension. Purpose: to determine the effect of the severity of obesity on the structure of the daily blood pressure profile and the effectiveness of its correction by means of physical therapy against the background of different levels of therapeutic alliance. Materials and methods. The study involved 213 people with obesity of I-III degree, diagnosed by body mass index. According to the results of the definition of the therapeutic alliance, they were divided into two groups. The comparison group consisted of individuals with a low level of therapeutic alliance who refused to actively participate in the program of weight loss. The main group consisted of patients with a high level of therapeutic alliance, they underwent a correction program using dietary and lifestyle modifications, therapeutic exercises, massage, acupuncture, psychocorrection lasting one year. The control group consisted of 32 people with normal body weight. Daily monitoring of blood pressure was carried out to determine its profile by the types "diрper", "non-dipper", "over-dipper", "night-peaker". Results. In patients with grade I-III obesity, changes in the structure of the daily profile of systolic and diastolic blood pressure were revealed: a decrease in the number of individuals with an optimal "diрper" profile, an increase - with unfavorable profiles "non-dipper", "over-dipper", "night-peaker" ", the number of which increased in direct proportion to the degree of obesity. The use of kinesiоtherapy against the background of a decrease in body weight as part of a physical therapy program allows to normalize the daily blood pressure profile. A low level of therapeutic alliance leads to unsatisfactory fulfillment or non-fulfillment of the recommendations provided (aimed at reducing body weight and increasing physical activity) in obese patients, which is associated with a lack of improvement in the functioning of the cardiovascular system in the context of normalizing the daily blood pressure profile. Conclusions. It is advisable to prescribe physical therapy means to correct the indicators of the daily blood pressure profile in patients with obesity of I-III severity, which will prognostically reduce the risk of cardiovascular accidents in them

Gender Differences in Vascular Stiffness Indicators and Daily Blood Pressure Profile in Patients with Arterial Hypertension and Depressive Disorders.

Aim To study gender-related characteristics of vascular wall stiffness (VWS), central blood pressure (CBP), and BP diurnal profile in patients with arterial hypertension (AH) and depression.Material and methods This prospective, noninterventional study enrolled 161 patients, including 98 patients with AH and depression (50 (51 %) men and 48 (49 %) women) and 63 patients with AH without depression (32 (50.8 %) men and 31 (49.2 %) women. The 24-h BP monitoring (24-h BPM) with a BPLab Vasotens hardware system was performed for all patients. The following indexes were evaluated: mean diurnal, mean daytime, and mean nighttime systolic and diastolic BP (SBP and DBP); daytime and nighttime SBP and DBP time index; SBP and DBP variability; and suite of metrics characterizing VWS and CBP. Depression was diagnosed with the Hospital Anxiety and Depression Scale (HADS) and the Zung Self-Rating Depression Scale. Statistical analyses were performed using the STATISTICA 12 software.Results In the patient group with AH and depression, practically all indexes of 24-h BPM were higher for men than for women (р&lt;0.05). Most 24-h BPM parameters did not differ in groups of men and women without depression. Independent of gender, 24-h BPM parameters were significantly higher in patients with both AH and depression than in AH patients without depression. Adverse changes in major indexes of VWS and CBP, were more pronounced in men than in women with AH and depression (р&lt;0.05). Adverse changes in most VWS and CBP indexes were more statistically significant for men with AH and depression than for men without depression.Conclusion The presence of depression in men and women with AH was associated with significant pathological changes in both BP diurnal profile and CBP and VWS parameters. Furthermore, adverse changes in indexes were more pronounced for men with depression than for women. The study results should be taken into account in administration of antihypertensive and psychocorrective drug therapy to personalize the treatment and provide not only optimization of diurnal BP profile but also vasoprotection.

Abnormal Balloon Expulsion Test in Patients with Fecal Incontinence.

Functional defecatory dysfunction is attributed to the pathophysiology of fecal incontinence (FI) in some patients. We hypothesized that patients with FI and abnormal balloon expulsion test (BET) have distinct manometric characteristics as compared to the patients with FI and normal BET. We aimed to compare the anorectal pressure profile in patients with FI, with or without abnormal BET and to identify risk factors associated with abnormal BET in FI. We performed a retrospective review of 77 consecutive patients with ROME IV FI. Wilcoxon rank sum test, t-test, and Fisher exact tests were performed for comparison. Multivariable logistic regression was performed to identify factors associated with abnormal BET. Thirty-two percent of patients had abnormal BET. Demographics and surgical history and clinical symptoms, except for sensation of incomplete evacuation (p=0.02) and abdominal pain (p=0.03), were comparable in both groups. Anorectal pressure profile except for the median rectal propulsive pressures were similar between groups. Rectal propulsive pressures at simulated defecation were significantly lower in patients with abnormal BET (p=0.02). Mean sensory threshold for first sensation was also significantly higher in patients who had abnormal BET (p=0.03). Rectal propulsive pressures (OR: 1.03, 95% CI: 1.00-1.06, p=0.032) and rectal sensory threshold for first sensation (OR:0.94, 95% CI: 0.90-0.99, p=0.02) were able to predict abnormal BET independently. In patients with FI and similar clinical and anal pressure profile, rectal sensory threshold and rectal propulsive pressures at simulated defecation can determine normal BET.

The effect of three-component antihypertensive treatment on the structural and functional state of the heart and daily blood pressure profile in patients with hypertension grade 3

Aim. To study the effect of a fixed combination of perindopril arginine (10 mg) + indapamide (2.5 mg) + amlodipine (5 mg) on the daily profile of blood pressure and the structural and functional state of the heart in patients with hypertension grade 3.&#x0D; Methods. 80 patients with hypertension receiving various variants of treatment [50 patients (experimental group) receiving fixed combination of perindopril arginine (10 mg) + indapamide (2.5 mg) + amlodipine (5 mg) and 30 patients (control group) receiving combination of lisinopril with hydrochlorothiazide (10/12.520/25 mg) and amlodipine (5 mg)] underwent electrocardiography, Doppler echocardiography, daily monitoring of blood pressure at there points: at the beginning, after 2 weeks and 6 months of the treatment. Statistical significance of the indicators was determined by Students t-test. To compare the double changes, 2 was used. Statistical difference between the groups was considered significant if p 0.05.&#x0D; Results. In 86% of patients from the experimental group, a decrease in systolic blood pressure by 20 mm Hg or more and/or diastolic blood pressure by 10 mm Hg was noted, which persisted for 6 months. After 6 months of treatment, according to daily monitoring of arterial pressure, the average daily systolic and diastolic blood pressure significantly decreased by 15.9 and 18.6% (р 0.001), and the values of variability of average systolic and average diastolic pressure at night and daytime by 4 and 4.2%, respectively (р 0.001). A decrease in the morning rise rate of systolic and diastolic blood pressure was also achieved (р 0.001). During treatment, a number of patients with a daily curve of the dipper type increased due to a decrease in non-dippers and night pickers (р 0.001).&#x0D; Conclusion. Positive antihypertensive result after treatment with a combination of perindopril arqinine + indapamide + amlodipin was achieved in the early stages of treatment and was observed as a long-term stable hypotensive effect; a number of patients with normal daily rhythm of blood pressure increased, decrease of the severity of hypertrophy and size of the left ventricle was observed and its diastolic function became normal.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

Analysis of indicators of daily blood pressure profile in patients wi th type 1 diabetes, depending on the course of the disease

The aim: to study the features of daily profile and circadian rhythm of blood pressure (BP) in groups of patients with type 1 diabetes mellitus (T1DM), depending on glycemic control. Materials and methods: 63 patients with T1DM, age: 18-45 years without hypertension were examined. Patients were divided into groups: Group 1 — HbA1c≤7.0% (n=21), Group 2 — HbA1c&gt;7.0% (n=42). 10 sex- and agematched healthy controls were included. Results: Patients with T1DM had a significantly higher pulsatile blood pressure (PBP) per night, higher daily systolic blood pressure (SBP) variability, compared with healthy controls, and significantly higher daily SBP area index (SPAI24), daily SBP time index (SPTI24), daily diastolic blood pressure (DBP) area index (DPAI24), daily DBP time index (DPTI24). The double product (DP) was higher in patients with T1DM in the daytime and within 24 hours compared to control (p=0.002) and (p=0.001) respectively. Pathological profiles of daily blood pressure were found. In group 1, according to the dipping in SBP 28.57% of patients were non-dippers, 4.76% were extreme dippers. In group 2, the non-dipper profile had 33.33%, the reverse dipper had 2.38%, and extreme dipper had 11.90% of patients. According to the dipping in DBP: in group 1 33.33% were non-dippers, and 9.53% were extreme dippers. In group 2 non-dippers — 19.04%, extreme dippers — 2.38%, extreme dippers — 38.10%. HbA1c directly correlates with: (DPAI24) (ρ=0,301; р=0,014), DPAI night (ρ=0,292; р=0,010), DPTI24 (ρ=0.292; p=0.012), DPTI night (ρ=0.268; p=0.018). Conclusions. The daily blood pressure profile in patients with T1DM without arterial hypertension is characterized by insufficient decrease in BP at night, an increase in the average daily DBP, PBP, as well as DPAI24, DPTI24, DP and the variability of the average daily SBP. Poor glucose control led to led to an increase in hemodynamic load. It is the risk factor cardiovascular complications in patients with T1DM.

Abstract P195: Blood Presure is Related to Glucose Fluctuation in Longstanding Type 1 Diabetes

Mechanisms underlying relationship between hypertension and metabolic abnormalities are well established in type 2 diabetes. Much less is known about this link in type 1 diabetes. None of the previous studies has assessed relationship between glucose variability and diurnal blood pressure profile in patients with longstanding type 1 diabetes (DM1). The Aim: to investigate the possible association of glucose fluctuation with BP levels in longstanding DM1. Design and Methods: We examined 36 patients with longstanding (&gt;20 years) history of DM1 (without overt cardiovascular disease, including hypertension) and episodes of hyperglycemia &gt;160 mg/dL during 24-hour continuous glucose monitoring (CGM). In all patients simultaneous 24-hour CGM and ambulatory blood pressure monitoring (ABPM) were performed. Intima-media thickness (IMT) of the common carotid artery was also assessed. Patients were divided into two groups: with and without severe hypoglycemia &lt;50 mg/dL (n=18 in each group). Results: Compared to patients with hypoglycemia, patients without hypoglycemia had a significantly lower day-time SBP variability expressed as standard deviation (12.6 ± 2.5 and 10.9 ± 3.0 mmHg, respectively, p&lt;0.05). In patients without hypoglycemia, mean amplitude of glycemic excursion both up and down was associated with increase in DBP (r=0.49, p&lt;0.05 and r=0.59, p&lt;0.05, respectively), whereas in patients with hypoglycemia it was associated with increase in SBP (r=0.53, p&lt;0.05). In patients without hypoglycemia, time of hyperglycemia was associated with increase in DBP (r=0.57, p&lt;0.05) and in patient with hypoglycemia – with increase in SBP (r=0.67, p&lt;0.05). Furthermore, in patients with short hypoglycemic episodes, time of hypoglycemia was associated with increase in SBP (r=0.57, p&lt;0.05). In patients with hypoglycemia, SBP level had also positive correlation with IMT (r=0.50, p&lt;0.05). Conclusions: In patients with longstanding DM1, BP is related to glucose fluctuation. While the change in glucose levels towards hypoglycemia is associated with an increase in SBP, hyperglycemia is linked to an increase in DBP. The mechanisms underlying these associations remain to be determined.

Polysomnography-derived sleep parameters as a determinant of nocturnal blood pressure profile in patients with obstructive sleep apnea.

Obstructive sleep apnea causes blood pressure (BP) surges during sleep, which may lead to increased sleep-onset cardiovascular events. The authors recently developed an oxygen-triggered nocturnal BP monitoring system that initiates BP measurements when oxygen desaturation (SpO2 ) falls below a variable threshold. The association between nocturnal BP parameters obtained by nocturnal BP monitoring and simultaneously examined polysomnography-derived sleep parameters in 116 patients with obstructive sleep apnea (mean age 57.9years, 85.3% men) was studied. In multivariable analysis with independent factors of age, body mass index, sex, and polysomnography-derived measures (apnea-hypopnea index, apnea index, arousal index, lowest SpO2 , and SpO2 <90%), apnea-hypopnea index (β=.26, P=.02) and lowest SpO2 (β=-.34, P<.001) were independent determinants of hypoxia-peak systolic BP (SBP), defined as the maximum SBP value measured by nocturnal BP monitoring. Similarly, apnea-hypopnea index (β=.21, P=.04) and lowest SpO2 (β=-.49, P<.001) were independent determinants of nocturnal SBP surge, defined as the difference between the hypoxia-peak SBP and the average of the SBP values within 30minutes before and after the hypoxia-peak SBP, measured by the fixed-interval function in the manner of conventional ambulatory BP monitoring. In conclusion, in polysomnography-derived parameters, lowest SpO2 , defined as the minimum SpO2 value during sleep, is the strongest independent determinant of hypoxia-peak SBP and nocturnal SBP surge measured by nocturnal BP monitoring. Our findings suggest that the severity of the decrease in SpO2 and the frequency of such decreases would be important indicators to identify high-risk patients who are likely to develop cardiovascular events specifically during sleep.

Assessment of a diurnal blood pressure profile in patients with acute Lyme borreliosis

Aim. The purpose of the study was to investigate the character of changes in daily blood pressure profiles and to evaluate the influence of Borrelia burgdorferi infection on the course of essential hypertension in patients with acute stage of Lyme disease.Methods. 37 patients with an acute stage of Lyme disease were examined and broken down in two groups. The first group included 18 patients without essential hypertension. 19 patients with stage II of essential hypertension were included into group II. The group of comparison consisted of 32 patients with stage II of essential hypertension without Lyme disease. 26 healthy volunteers of the control group were comparable in gender and age.Results. A significant difference of the average diastolic blood pressure index during night time in patients with acute stage of Lyme disease and essential hypertension 90.0 (68.5–100.0) mm Hg versus the control group 77.0 (65.0–86.0) mm Hg at p = 0.03 was observed. When determining a type of daily blood pressure profile, some features of a blood pressure circadian rhythm were found in all groups of patients. There were ‘Dipper’ (77.7%) and ‘Non-Dipper’ (22.3%) profiles in the group of patients with acute stage of Lyme disease without essential hypertension. No ‘Over-Dipper’ and ‘Night-Peaker’ profiles were recorded in this group. 'Dipper’ (20.0%), ‘Non-Dipper’ (73.4%) and ‘Night-Peaker’ (6.6%) blood pressure profiles were typical for patients with acute stage of Lyme disease and essential hypertension. Conclusion. A 22.3% decrease in the number of patients with a ‘Dipper’ blood pressure daily profile and an equal increase in the number of ‘non-dipper’ patients are characteristic of an acute stage of Lyme disease. The number of ‘Non-Dipper’ patients with essential hypertension and acute stage of Lyme disease increases up to 73.4%. Thus, acute Lyme disease and essential hypertension tend to burden the each other’s course.Received 10 May 2017. Revised 7 September 2017. Accepted 25 September 2017.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: A.V. Sandugei, M.V. Ilyin, O.A. Khrustalev, N.S. Baranova. Data collection and analysis: A.V. Sandugei, O.A. Khrustalev, N.V. Emanuilova. Statistical data analysis: A.V. Sandugei, N.V. Emanuilova, O.Yu. Churakov.Drafting the article: A.V. Sandugei, N.V. Emanuilova, V.V. Neusypin. Critical revision of the article: A.V. Sandugei, N.V. Emanuilova, V.V. Neusypin.Final approval of the version to be published: A.V. Sandugei, M.V. Ilyin, O.A. Khrustalev, N.S. Baranova, N.V. Emanuilova, O.Yu. Churakov, V.V. Neusypin

Comparative analysis of daily blood pressure profile in patients with recurrent and primary ischemic stroke

To conduct a comparative analysis of daily blood pressure profile in patients with recurrent and primary ischemic stroke. We were examined 124 patients, of which 94 patients with ischemic stroke in acute period, which came to the hospital in up to 2 days after the onset of the disease and were observed in the neurological department. The control group consisted of 30 patients with hypertensive encephalopathy. The conducted analysis of daily blood pressure monitoring in patients with recurrent and primary ischemic stroke indicates the importance of using this diagnostic method as a reliable difference in many indicators of arterial pressure is obtained. The difference averages of daily monitoring of blood pressure for all periods day informative confirms the difference in blood pressure in patients with primary and repeated ischemic stroke, as observed significant difference of values: the day indices of systolic, diastolic, blood pressure pulse heart rate parameters. The study allowed to increase the effectiveness of the diagnosis of recurrent ischemic stroke by studying the characteristics of central hemodynamics.