Prevalence Of Nocturnal Hypertension Research Articles

S-42-4: ISOLATED NOCTURNAL HYPERTENSION IN PATIENTS LIVING WITH HUMAN INMUNODEFICIENCY VIRUS (HIV)

Introduction: People living with HIV (PLHIV) have higher rates of cardiovascular events compared to the general population; however mechanisms behind this discrepancy are poorly understood. High prevalence of hypertension has been proposed as a mechanism underlying cardiovascular events with contradictory results when office blood pressure (BP) is considered. Ambulatory blood pressure measurements (ABPM) have the advantage to measure BP during sleep, a cause of masked hypertension. Additionally, body weight and electrolytes disturbances are common in PLHIV under antiretroviral and antibiotic therapy. We aim to describe the prevalence of isolated nocturnal hypertension (INH) and it characteristics in PLHIV. Material and methods: A random sample of PLHIV from the provincial HIV program in Cordoba, Argentina, underwent clinical and laboratory examination, and 24 h ABPM. Nocturnal hypertension (NH) was defined as nocturnal systolic BP ≥ 120 mmHg and or nocturnal diastolic BP≥70 mmHg. INH was defined in those patients with NH with daytime systolic and diastolic BP< 135/85 mmHg respectively. Results: PLHIV were included in the study: 60% male, mean age was 44.6 (27–69) years old, 87% were receiving antiretroviral therapy. BMI was 25.8 ± 4.8, mean CD4 count was 404.4 ± 289, cells/ml and 86.2% were virologically suppressed. The prevalence of NH was 48.5% [95%CI:36–60%], the vast majority having INH 29/32 (90%), thus the population prevalence of INH was 43.9% [95%CI:32–55,%]. INH patients have an excess of 10.4 and 8 mmHg in 24 hr systolic BP and diastolic BP respectively compared to no INH patients (both p < 0.001). No differences were found regards age, sex, viral load, CD4+ cells and years of HIV history between patients with and without INH. Multiple linear regression (adj-R2 = 0.27, p < 0.001) adjusted by sex and age determined that BMI (β = 0.79, p = 0.02]), plasma uric acid (β = 0.33, p = 0.01) and plasma potassium (β = -9.5, p = 0.03]) independently predicted nocturnal systolic BP in PLHIV. In a multiple logistic regression model adjusted by age and sex, BMI≥30 was associated with INH (OR 4.04 [95%CI: 1.25–13) Conclusion: INH is highly prevalent in PLHIV conferring an excessive hypertension load that may explain the associated high CVS risk. Obesity, increased uric acid, and low plasma potassium are associated with nocturnal systolic BP. Our work suggests the routine use of ABPM and explore metabolic disturbances in obese PLHIV.

PS-C09-3: DETECTION OF NOCTURNAL HYPERTENSION BY SELF-MEASUREMENT OF BLOOD PRESSURE MEASUREMENT

Outside-office BP measurements are recommended for the diagnosis of hypertension because of its better prediction for the cardiovascular (CV) risks compared to that of office BP. Nocturnal hypertension (NH), detectable only by outside-office measurement, is a strong CV risk predictor. However, in the real-world clinical setting, ambulatory blood pressure monitoring is not routinely conducted at least in part because of its annoyance (clinical inertia). In the present study, usefulness of home BP self-measurement, much easier to practice, upon detecting NH was sought. Subjects were patients with hypertension being treated in Ozono Clinc, Internal Medicine and Cardiology (n = 45, mean age72.8 +/-13, M26:F19). BP was self-measured by a sphygmomanometers provided by the clinic (OMRON HEM-7080 IC), which is equipped with timer-triggered BP measuring system at preset times. Patients were asked to record their morning BP (within one hour after getting-up) and evening BP (just before going to the bed). For detection of nocturnal BP, patients were informed to sleep with the cuffs set around their arms, then the recordings were obtained at 2:00. 3:00, 4:00 and 5:00. NH was defined as having the average of the four systolic BPs (SBPs) during sleep exceed 120 mmHg. Among the 45 patients 23 (51%) had NH. Relations between the existence of morning hypertension (SBP > 130 mmHg) or evening hypertension (SBP > 130 mmHg) and the existence of NH was shown in the table. When morning or evening hypertension exist, the prevalence of NH was around 60%. On the other hand, if morning hypertension does not exist, the rate of NH is very low. Interestingly, some patients without evening hypertension develop NH during night. Home blood pressure measurement is a convenient and useful clinical tool to estimate NH.

Age-related patterns of ambulatory blood pressure in a large cohort of individuals referred to Italian community pharmacies: results from the templar project.

Ambulatory blood pressure monitoring (ABPM) provides extensive information on several BP parameters other than the average BP during daily life. Through this analysis of the TEMPLAR study, we sought to understand better the features of age-related changes in ABP patterns and phenotypes. ABPMs were obtained in 53 350 individuals visiting 866 Italian community pharmacies (age 3-101 years, 54.3% female individuals). ABPM patterns were assessed across 10-year age categories. SBP steadily increased with age. DBP increased from the youth to the middle adulthood and then declined. Daytime BP was higher than night-time BP, but the difference narrowed with aging, reducing the prevalence of dippers. An enhanced SBP morning surge and increased prevalence of abnormal morning rise were observed with aging. SBP and DBP variabilities increased with age with a typical U or J shape, more evident in the case of DBP. The proportion of participants with ambulatory hypertension increased with age. However, an elevated daytime BP was more common in younger individuals and elevated night-time hypertension in older individuals. The prevalence of white-coat hypertension remained stable or slightly declined through the age groups, whereas that of masked hypertension steadily increased. Our results confirm that ABP patterns interplay and change in a complex way with age. Such changes, particularly the age-related increase in BP variability and prevalence of nocturnal hypertension, nondipping, enhanced morning rise, and masked hypertension, may increase the risk of cardiovascular events and must be carefully considered by the physician when managing BP in the elderly.

Nocturnal hypertension in acute heart failure patients: 24 hours blood pressure pattern

Abstract Funding Acknowledgements Type of funding sources: None. Background It is well defined the prognosis value of the abnormalities in the circadian variation in hypertensive patients. In the phisiopathology of heart failure, neurohumoral mechanism plays an important role. Nevertheless, the circadian variation in nonhypertensive heart failure patients has not been well evaluated. Purpose Our aim was to evaluate 24-h blood pressure patterns and the prevalence of nocturnal hypertension in patients admitted with acute heart failure. Methods We studied 122 patients with a clinical diagnosis of AHF. We permormed a 24-h ambulatory blood pressure monitoring as well as an echocardiogram and anaytical test. Results 122 patients. Mean age: 63 ± 10. Males: 75%. Mean BMI: 30 ± 6 Kg/m2. Associated risk factors: 56,6% hypertension, 40 % dyslipidemia, 34,7% Diabetes, 29,3% obesity, 22,9% smoking. The etiology of HF: ischemic 41,2%;hypertensive 22,7%; dilated cardiomyopathy 20,9%;valvular 8,3%; others 6,9%.Therapeutic regimen applied: RAS blockers 93,4%; betablockers 85,7%; loop diuretic 81%; spironolactone 42,3%; statins 68,4%; antiplatelet/anticoagulant drugs 89%. The 24 h ABPM measurements are in table 1 The majority of AHF patients (80,4%) have an abnormal pattern of ABPM: Dipper 19,6%, non-dipper 51,1%, riser 0%.The prevalence of nocturnal hypertension was 22,8%. Conclusions In our area, AHF patients have optimal control of BP , however, the normal circadian variation in blood pressure is altered in most of them. In addition, nocturnal hypertension is very common in heart failure patients. Ambulatory blood pressure monitoring may be helpful in identified this altered patterns (which could be unrecognized) and may be used to optimise heart failure therapy, and could be a prognosis marker in this patient group. Table 124 hoursDaytimeNightimeSysolic BP107,7 ± 13,8109,6 ± 14,2104,5 ± 14,5Diastolic BP64,4 ± 7,866,4 ± 8,860,4 ± 7,6

Extreme Dipping: Always Means Nocturnal Hypotension?

Although nocturnal hypotension is considered the key factor responsible for the increased cardiovascular risk associated with the extreme dipping (ED) pattern, no information is available on its prevalence in this setting. Therefore, we have assessed this topic in a cohort of patients referred to a single out-patient hypertension center. A large database of individual 24-hour ambulatory BP recordings from untreated individuals with a history of hypertension and treated individuals with hypertension was analyzed. A total of 339 of 7,074 patients (4.5%) exhibited an ED pattern (207 had a nighttime reduction in both systolic and diastolic BP ≥ 20% compared to daytime values and 132 a nighttime reduction in diastolic BP ≥ 20%). Among patients with ED, the prevalence of nocturnal hypotension varied from 9.1% to 45.0% depending on the criteria used (i.e., mean nighttime BP < 90/50 mm Hg or < 100/60 mm Hg), and the prevalence of nocturnal hypertension (i.e., mean nighttime BP ≥ 120/70 mm Hg) was 19.5%. Compared with untreated patients, those taking antihypertensive drugs were more likely to have nocturnal hypotension and less likely to have nocturnal hypertension. Our findings support the view that ED pattern is a condition not always associated with nocturnal hypotension because a large fraction of ED patients has normal or elevated mean BP nocturnal values.

Abstract 131: Racial Differences in Nocturnal Hypertension and Non-dipping Blood Pressure: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Risk factors for nocturnal hypertension are more common among blacks compared with whites. We hypothesized nocturnal hypertension and nocturnal non-dipping BP are more common among blacks compared with whites. We analyzed data for 781 participants of the population-based Coronary Artery Risk Development in Young Adults (CARDIA) study who completed ambulatory blood pressure (BP) monitoring (ABPM) in 2015-2016. Awake and sleep periods were defined using actigraphy and self-report. Nocturnal hypertension was defined as mean sleep systolic BP (SBP)/diastolic BP (DBP) ≥ 120/70 mm Hg. Non-dipping SBP and DBP, separately, were defined as a decline in mean sleep BP, relative to mean awake BP &lt; 10%. The mean age of participants was 54.7 years, 21.1% were white women, 38.5% were black women, 16.8% were white men and 23.6% were black men. The prevalence of nocturnal hypertension was 18.2% and 44.5% among white and black women, respectively, and 35.9% and 59.8% among white and black men, respectively. After multivariable adjustment, the prevalence of nocturnal hypertension was higher among black women, white men and black men, each compared with white women (Table). The prevalence of non-dipping SBP was 21.2% and 40.9% among white and black women, respectively, and 19.8% and 37.5% among white and black men, respectively. After multivariable adjustment, non-dipping SBP was more common among black women and black men compared with white women. There were no statistically significant differences in non-dipping DBP across race-gender after multivariable adjustment. Nocturnal hypertension and non-dipping SBP are more common among blacks compared with whites even after adjustment for mean BP.

Nocturnal Hypertension and Altered Night-Day BP Profile and Atherosclerosis in Renal Transplant Patients.

The clinical relevance of ambulatory blood pressure monitoring (ABPM) for risk stratification in renal transplant patients still remains poorly defined. We investigated the association between clinic and ABPM with an established biomarker of atherosclerosis (intima-media thickness [IMT] by echo-color Doppler) in a large, inclusive survey (n = 172) in renal transplant patients at a single institution. Forty-two patients (24%) were classified as hypertensive by ABPM criteria and 29 (17%) by clinic blood pressure (BP) criteria. Average daytime and nighttime BP was 126 ± 12/78 ± 9 mm Hg and 123 ± 13/74 ± 10 mm Hg, respectively. Forty-five patients (26%) were classified as hypertensive by the daytime criterion (>135/85 mm Hg) and a much higher proportion (n = 119, 69%) by the nighttime criterion (>120/70 mm Hg). Sixty-two patients (36%) had a night-day ratio of 1 or greater, indicating clear-cut nondipping. The average nighttime systolic BP (r = 0.24, P = 0.001) and the night-day systolic BP ratio (r = 0.23, P = 0.002) were directly related to IMT, and these associations were much more robust than the 24-hour systolic BP-IMT relationship (r = 0.16, P = 0.04). Average daytime BP and clinic B were unrelated to IMT. In a multiple regression analysis adjusting for confounders, the night-day systolic BP ratio maintained an independent association with IMT (β = 0.14, P = 0.04). In renal transplant patients, the prevalence of nocturnal hypertension by far exceeds the prevalence of hypertension as assessed by clinic, daytime, and 24-hour ABPM. Nighttime systolic BP and the night-day ratio but no other BP metrics are independently associated with IMT. Blood pressure during nighttime may provide unique information for the assessment of cardiovascular risk attributable to BP burden in renal transplant patients.

OP.1A.04] 24H AMBULATORY BLOOD PRESSURE MONITORING PROFILE IN PARKINSON'S DISEASE WITH AUTONOMIC NEUROPATHY

Objective: Patients with Autonomic Neuropathy (AN) are characterized by orthostatic hypotension (OH), supine hypertension, high blood pressure (BP) variability and reverse dipping pattern on 24 h Ambulatory Blood Pressure Monitoring (24 h ABPM). AN is a common finding in Parkinson's disease (PD), and it is related to a higher motor impairment due to neurogenic OH. Aim of the study was the evaluation of the prevalence of AN and the assessment of the related 24 h ABPM profile in PD patients without known cardiovascular comorbidities. Design and method: 79 patients with PD and without known cardiovascular diseases were studied (mean age 63.2 ± 10.3 years; 67% males). None of the patients suffered from hypertension, diabetes, dyslipidemia, chronic kidney disease, and sleep apnea, and they were not treated with antihypertensive or antihypotensive drugs. Patients underwent cardiovascular autonomic reflex tests (deep breathing, lying to standing, Valsalva maneuver, and postural BP), and AN was defined by the presence of at least two pathological tests. On the same day, they underwent 24 h ABPM. 24 h ABPM dipping patterns were defined according to day-night BP difference (<0%: reverse dipping; 0–10%: non dipping; >10%: dipping). Nocturnal hypertension was defined as night-time systolic and diastolic BP > = 120/70 mmHg. Results: Results. Prevalence of AN was 29%. PD patients with AN were older (68.8 ± 10.1 vs 63.2 ± 10.3 years, p = 0.003) and had a higher prevalence of OH (78% vs 25%, p < 0.001). 24-h mean BP values were similar in patients with and without AN, while night-time BP values were higher (125 ± 17/73 ± 13 vs 111 ± 13/64 ± 11 mmHg, p < 0.05) and prevalence of nocturnal hypertension was higher (65% vs 36%, p = 0.016) in AN. Prevalence of reverse dipping pattern was much higher in patients with AN (74% vs 13%, p < 0.001) and they were characterized by a higher BP variability (SD of night-time SBP: 11.0 ± 4.1 vs 9.0 ± 2.9 mmHg, p = 0.048). Conclusions: PD patients with AN and without known cardiovascular diseases have a high prevalence of reverse dipping pattern and nocturnal hypertension. 24 h ABPM may represent a useful diagnostic tool in the diagnostic management of AN in PD patients.

OP.4D.08] DISORDERED SLEEP BREATHING (SDB) IS THE MAJOR DETERMINANT OF NON-DIPPING AND NOCTURNAL HYPERTENSION IN KIDNEY TRANSPLANT PATIENTS

Objective: In renal transplant patients, the prevalence of nocturnal hypertension by far exceeds that of hypertension as assessed by clinic, daytime, and average 24-hour ABPM and night-time systolic BP (SBP) and the night-day ratio but no other BP metrics are independently associated with IMT in this population (Transplantation 2015 Dec 17). BP during nighttime may provide information for the assessment of CV risk attributable to BP burden in renal transplant patients but the determinants of this phenomenon are still undefined in these patients. Design and method: We recorded 24h-ABPM and performed polysomnography in 215 clinically stable transplant patients. Major classical CV risk factors and CKD-specific risk factors (including phosphate, eGFR, proteinuria and C Reactive Protein) were measured alongside. Our primary goal was to identify the functional correlates of average BP during night-time and of the night/day ratio, a parameter quantifying the BP dipping phenomenon. Results: The Apnea-Hypopnea Index (AHI) exceeded 5 episodes/h in 56 patients and 15 episodes/h in 19. Thus, 17% of patients had mild-to-moderate SDB and 9% severe SDB. In unadjusted analyses, AHI was directly related with night-time SBP (r = 0.19, P = 0.005) and the night/day SBP ratio (r = 0.18, P = 0.01). AHI also associated with average 24h-SBP and DBP (both r = 0.14, P = 0.04). Furthermore, age, gender, BMI, diabetes, phosphate, C-Reactive Protein, and background CV comorbidities were all associated with AHI. In multiple regression analyses adjusting for these parameters as well as for average day-time SBP, Hb, and proteinuria, AHI remained related with average night-time SBP (beta = 0.10, P = 0.02) and with the night/day SBP ratio (beta = 0.17, P = 0.02). In these models, the AHI ranked as the strongest correlate of nigh-time SBP burden. These results did not change also forcing into the model immunosuppressive treatment. Conclusions: In stable transplant patients, sleep disordered breathing is the most powerful functional correlate of nocturnal BP. These relationships are independent of age and comorbidities, eGFR and proteinuria and likely represents irreversible effects of long-term past exposure to kidney failure on the central nervous system.

Abstract 17381: Arousals of Sleep Disorders: The Value of Ambulatory Blood Pressure Monitoring

Background: Ambulatory blood pressure monitoring (ABPM) is important for the diagnosis of hypertension (HTN) as well as variants such as nocturnal HTN (NH), masked HTN and a non-dipping pattern. NH and non-dipping, a failure of the normal circadian drop in blood pressure during sleep, have been associated with all-cause mortality and cardiovascular risk. Obstructive sleep apnea is associated with HTN and a growing body of evidence suggests that limb movement disorders of sleep may also influence cardiovascular morbidity. The present study investigates arousals of sleep disorders, limb movement or respiratory, and their relationship to ABPM measurements. Methods: A retrospective review (January 1, 2010 to December 31, 2014) was performed on patients that underwent both ABPM and polysomnography within a six months of each other. Socio-demographic data, results of 24 hour ABPM and polysomnography, concurrent medication use by class, comorbid conditions and laboratory data were recorded. Patients with incomplete polysomnography or ABPM measurements were excluded. Results: 330 individuals met criterion for inclusion; 59% male, 86% white. 211 (64%) were found to have NH, 106 (32%) had uncontrolled HTN and 202 (61%) had a non-dipping pattern. Patients with NH were more likely to have diabetes, hyperlipidemia and chronic kidney disease. Elevated arousal indices were more prevalent in those with NH, uncontrolled HTN and non-dippers. There was an association of NH with the total number of arousals per hour of sleep (p&lt;0.01), whether related to respiratory disturbances or limb movements. Limb movement index (LMI) was related to age (p&lt;0.0001) and was associated with all type arousals (p&lt;0.0001). Conclusions: ABPM revealed a high prevalence of NH, non-dipping, masked and uncontrolled HTN in patients with sleep disorders. Arousals of all types, whether accompanying respiratory or limb movements, were associated with NH and also with LMI.

109-POS

Objectives Blunted nocturnal dip of blood pressure (BP) and reversed circadian rhythm have been described in preeclampsia (PE). Non-dipper status and preeclampsia are both associated with an increased risk of cardiovascular disease later in life. Complete recovery of BP in PE is reported to occur over a variable period of time. Twenty-four hours-ambulatory blood pressure measurement (ABPM) in the post-partum follow-up after a PE has not been described. The aim of this study was to assess 24 h-ambulatory blood pressure pattern after a PE and to determine the prevalence of non-dipper status, nocturnal hypertension, white coat hypertension and masked hypertension. Methods This is an observational, prospective study on women who suffered from a preeclampsia. A 24 h-ABPM was done 6 weeks post-partum at the Hypertension Unit of the University Hospitals of Geneva, concomitantly with a clinical and biological evaluation. Results Forty-five women were included in a preliminary analysis. Mean age was 33 ± 6 years, 57.3% were Caucasian, mean BMI before pregnancy was 24 ± 5 kg/m2. Office and ambulatory BP are shown in Table 1. Prevalence of nocturnal hypertension was high and half of the women had no nocturnal dipping. The diagnosis of hypertension based on office BP was discordant with the diagnosis based on ABPM in 25% of women. Conclusions The prevalence of increased nighttime BP and abnormal BP pattern is high at 6 weeks post-partum in preeclamptic women. Early assessment of BP with ABPM after preeclampsia allows an early identification of women with persistent circadian abnormalities who might be at increased risk. It also provides a more accurate assessment than office BP. Disclosures A. Ditisheim: None. B. Ponte: None. G. Wuerzner: None. M. Burnier: None. M. Boulvain: None. A. Pechere-Bertschi: None.

Prevalence of masked and nocturnal hypertension in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is considered as a risk factor for the development and worsening of compensation of arterial hypertension and other cardiovascular diseases. Prevalence of masked and nocturnal hypertension can have a significant negative impact on these patients and these prevalences are not well known. AimTo evaluate the prevalence of masked and nocturnal hypertension in patients with OSA. Materials and methodsIn this study, 97 (88 men) patients were enrolled, average age 53.9±9.7 years. OSA was diagnosed with polysomnography and the continuous positive airway pressure therapy has been indicated according to current guidelines. Then were evaluated parameters of OSA (apnea-hypopnea index (AHI), oxygen desaturation index (ODI), % of sleep time <90% SpO2, average night SpO2). Patients also underwent physical examination including office blood pressure measurement, 24h blood pressure monitoring (ABPM) and measurement of anthropometric parameters. ResultsFollowing average values were present in OSA patients (mean value and standard deviation): AHI 54.6±22.7, ODI 58.3±24, % of sleep time<90% SpO2 35.4±25.1, average night SpO2 88.8±5. Masked hypertension was present in 55 (56.7%) patients, nocturnal hypertension in 79 (81.4%) patients. Arterial hypertension was appropriately compensated in only 15 (15.5%) patients. Results have not shown any statistically significant correlation between prevalence of nocturnal hypertension and AHI (p=0.059), % of sleep time <90% SpO2 (p=0.516), average night SpO2 (p=0.167). ODI was significantly higher in patients with nocturnal hypertension (p=0.002). No correlation between prevalence of masked hypertension and AHI (p=0.841), ODI (p=0.137), average night SpO2 (p=0.991) and % of sleep time <90% SpO2 (p=0.896) has been present. ConclusionThis study has demonstrated high prevalence of masked and nocturnal hypertension in patients with OSA, which can considerably increase risks of cardiovascular diseases in these patients.

Nocturnal Medications Dosing: Does It Really Make a Difference in Blood Pressure Control Among Patients with Chronic Kidney Disease?

Ambulatory blood pressure (BP) monitoring is superior to clinic BP monitoring in predicting long-term consequences of hypertension. This has raised interest in diurnal variation in BP and elevation in nighttime BP as a prognostic and therapeutic target. Several studies have identified prevalence of nocturnal hypertension in patients with accelerated progression of chronic kidney disease and target organ damage. Some studies suggest that nocturnal BP can be lowered by changing administration of antihypertensive medication to bed time; whether that results in retarding kidney disease progression is not very clear. Further research is needed to determine if certain classes of medications or interventions are superior in controlling nocturnal hypertension, and protocols need to be developed to screen patients for monitoring nocturnal BP. Further studies are needed to evaluate long-term renal outcomes of evening dosing in patients with nocturnal hypertension and chronic kidney disease.

A controlled clinical trial of the effect of gastric bypass surgery and intensive lifestyle intervention on nocturnal hypertension and the circadian blood pressure rhythm in patients with morbid obesity

Nocturnal hypertension, increased night-to-day systolic blood pressure (BP) ratio and nondipper status (night-to-day systolic BP ratio > 0.9) are associated with an increased risk of cardiovascular disease. Our aim was to compare the 1-year effect of Roux-en-Y gastric bypass (RYGB) versus a program of intensive lifestyle intervention (ILI) only on nocturnal hypertension and circadian BP rhythm. The study participants were part of a 1-year, controlled clinical trial comparing the effect of RYGB or ILI on obesity-related comorbidities. Ninety participants (49 in the RYGB group) successfully completed 24-hour ambulatory BP monitoring at baseline and follow-up and were eligible subsequently for analysis. A total of 71 subjects (79%) had nocturnal hypertension at baseline. The number of subjects with nocturnal hypertension decreased from 42 to 14 in the RYGB group (P ≤ .001) and from 29 to 27 (P = .791) in the ILI group. Subjects in the RYGB group had a lesser adjusted odds ratio (OR) of nocturnal hypertension at follow-up (OR 0.15; 95% confidence interval, 0.05-0.42; P ≤ .001); however, after further adjustment for weight loss, there was no additional beneficial effect of RYGB (P = .674). No differences between groups regarding improvement in the night-to-day systolic BP ratio were found after adjustment for 24-hour systolic pressure (P = .107). Both interventions showed a decrease in the proportion of subjects classified as nondippers, namely, 44% (P ≤ .001) and 28% (P = .002) in the RYGB and ILI groups, respectively. Only RYGB was associated with a decrease in the prevalence of nocturnal hypertension. Both interventions showed an improvement in dipper status, although RYGB was more effective.

Masked hypertension and hidden uncontrolled hypertension after renal transplantation

Arterial hypertension is a risk factor affecting graft function in pediatric kidney transplants. Recent pediatric studies reported a high prevalence of hypertension, especially nocturnal hypertension in this population. Data regarding the prevalence of masked hypertension in pediatric patients with kidney transplants are still scarce. The aim of this cross-sectional study was to assess the prevalence of masked and hidden uncontrolled hypertension after renal transplantation. A total of 41 patients (25 males) with stable functioning renal graft were included in the study. Their median age was 14.5 years with the median interval since transplantation of 2.5 years (range 0.3 to 20.6). Spacelabs 90207 was used to measure ambulatory blood pressure (BP) during a 24-h period. Ambulatory hypertension was defined as mean systolic and/or diastolic BP index at day-time or nighttime >or=1. Masked hypertension was defined as normal office BP but daytime ambulatory hypertension in patients without antihypertensive medications. Hidden uncontrolled hypertension was defined as daytime ambulatory hypertension undetected by office BP measurements in treated patients. Antihypertensive medications were prescribed to 58%. Prevalence of nocturnal hypertension was 68%. On the basis of combination of office and ABPM masked hypertension and hidden uncontrolled hypertension was detected in 24% and 21% of the study population, respectively. Regular use of ambulatory blood pressure monitoring in transplanted patients enables detection of masked and hidden uncontrolled hypertension.