Reduction In Nighttime Blood Pressure Research Articles

AMBULATORY BLOOD PRESSURE MONITORING BEFORE AND AFTER TREATMENT IN SECONDARY FORMS OF HYPERTENSION

Objective: Studies using ambulatory blood pressure (BP) monitoring (ABPM) have reported that in some secondary forms of hypertension the normal nocturnal BP decrease is blunted. Design and method: The aim of our study was to compare the nocturnal BP decrease in patients with secondary hypertension before and after treatment. ABPM was performed using the validated Meditech ABPM-06. ABPM readings were obtained at 30-minute intervals for 24-hour in patients with secondary hypertension before and after treatment. The diagnosis of secondary hypertension was based on the history and laboratory data: plasma and urinary electrolytes, renal function, calcium-phosphorus system, the renin-angiotensin-aldosterone system, urinary free cortisol, suppressibility of cortisol after 1 mg dexamethasone, plasma adrenocorticotropic hormone, plasma D4 androstenedione, plasma dehydroepiandrosterone sulphate, plasma 17-alpha hydroxyprogesterone, plasma testosterone, and urinary metanephrine. BP decrease were studied in the following groups: 42 patients with primary aldosteronism (19 men and 23 women; mean age, 44±12 years), 25 patients with adrenal pheochromocytoma (11 men and 14 women; mean age, 42±13 years), and 55 patients with Cushing's syndrome (18 men and 37 women, mean age, 43±13 years). Results: Average systolic/diastolic BP decrease was: before 2/1 mmHg and after 8/6 mmHg treatment in patients with primary aldosteronism. Average systolic/diastolic BP decrease was: before 4/5 mmHg and after 9/12 mmHg treatment in patients with adrenal pheochromocytoma. Average systolic/diastolic BP decrease was: before 3/2 mmHg and after 11/9 mmHg treatment in patients with Cushing's syndrome. All differences in systolic/diastolic BP decrease were statistically significant, with a P value <.001 Conclusions: The results of our study confirm that secondary causes of hypertension lead to a reduced decrease in blood pressure during sleep. After proper treatment reduction in nighttime BP normalizes. A detailed analysis of ABPM can lead us to find the accurate etiology of hypertension.

SKIN SODIUM CONTENT AS A PREDICTOR OF BLOOD PRESSURE RESPONSE TO RENAL DENERVATION

Objective: In patients with treatment resistant hypertension (TRH), renal denervation (RDN) emerged as an adjacent therapeutic option. It has been detected that patients with TRH have elevated Sodium (Na) content in muscle and skin. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN. Design and method: Radiofrequency device based endovascular RDN was performed in 53 patients with uncontrolled TRH (office BP> = 140/90 mmHg and diagnosis confirmed by 24-h ambulatory BP monitoring) in our certified RDN center. Office and 24-h ambuatory BP were measured at baseline and after 6 months. To assess tissue Na content 23Na-MRI was performed at baseline prior to RDN. We splitted the study cohort based on the median systolic 24-h ambulatory BP reduction after 6 months into responders and non-responders and compared tissue Na content and baseline characteristics between these groups. The study was registered at http://www.clinicaltrials.gov (NCT01687725). Results: 53 patients were followed up for at least 6 months. Office systolic and diastolic BP were reduced by -12.9±21.1 mmHg and -7.7±12.5 mmHg and 24-h ambulatory systolic and diastolic BP were reduced by -8.6±14.0 mmHg and -4.7±9.5 mmHg after 6 months. Responder could be characterized as patients with low tissue sodium content in skin, more female patients, patients with aldosteron-antagonists, high baseline 24-h night-time heart rate and high LDL-cholesterol (see table, only p<0.10 are shown). This results remained significant after adjustment for baseline 24-h SBP. Similar results were obtained if the two groups were created based on the median of 24-h day-time and night-time BP reduction after 6 months. Conclusions: We identified Na in skin, sex, 24-h night-time heart rate, aldosterone antagonists and LDL-cholesterol as predictors of the systolic BP response. We conclude that 23Na-MRI may assist to select patients with uncontrolled TRH who will have a clinically meaningful BP reduction following RDN treatment.

ВЛИЯНИЕ УРОВНЯ АЛЬДОСТЕРОНА КРОВИ НА РЕМОДЕЛИРОВАНИЕ СЕРДЦА И СОСУДОВ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2 ТИПА И АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ

256 patients with type 2 diabetes and arterial hypertension (AH) were examined. The blood aldosterone level was determined in all patients, 24-hour blood pressure monitoring (BPM) and echodopplercardiography were performed, and the parameters of arterial vascular stiffness were studied. Results. In patients with type 2 diabetes and hypertension, the level of aldosterone in the blood ranged from 25 to 186 pg / ml, which corresponded to the reference norm. Patients with a level of aldosterone less than 25 percentile accounted for 15% of the examined - group I; Group II - patients with middle aldosterone levels (25-75 percentiles) - 46%; with a level more than 75 percentile - 39%, were included in group III. In the studied groups, office blood pressure (BP) did not depend on the level of aldosterone, however, in patients with both aldosterone levels above the 75th percentile and below the 25th percentile, an increase in the average daily pulse BP and an insufficient degree of nighttime BP reduction were revealed during BPM. Similarly, in groups I and III, there was a statistically significant increase in arterial stiffness indicators, compared with individuals with an average level of aldosterone. Disorders of diastolic function and LV hypertrophy were also more pronounced in groups of patients with aldosterone levels less than the 25th and more than 75th percentile. Conclusion. In patients with type 2 diabetes, the level of blood aldosterone less than the 25th and more than 75th percentile within the reference norm is associated with a greater severity of myocardial and arterial vessel remodeling processes.

LEFT VENTRICULAR HYPERTROPHY REGRESSION DURING ANTIHYPERTENSIVE TREATMENT IN RESISTANT HYPERTENSION PATIENTS

Objective: Objective: to determine the predictors of regression of left ventricular hypertrophy (LVH) in treated resistant hypertensive (RH) patients after 2.1 ± 0.1 years of follow-up. Design and method: We studied 51 patients with RH confirmed by the office and ambulatory blood pressure (BP) monitoring despite the use of 3 antihypertensive medications for at least 3 months. During 2 years-period patients had been treated to 12-week rotations of oral daily treatment with spironolactone, nebivolol, torsemide, eplerenone, moxonidine in addition to their baseline triple-combination. Then participants continued to receive the personal most effective fourth-line agent. Patients were divided into 2 groups: 17 patients had LV mass index (LVMI) which was increased or stayed stable after 2 years (1st group), 34 patients with a reduction of LVMI in 2 years (2nd group). Results: Initially there were no significant differences in sex, duration of hypertension, body mass index, office and average 24-h ambulatory BP between the 2 groups. Compared with the 1st group patients from the 2nd group had a higher prevalence of non-dippers (24.3 vs 65 %, P < 0.001, respectively) and larger baseline LVMI (127.3 ± 4.1 vs 147.8 ± 6.5 g/m2, P < 0.01, respectively). Patients with persistent LVH included more subjects with coronary artery disease, chronic kidney disease and had less baseline active renin concentration (all P < 0.05). After 2 years in both groups office and average 24-h BP levels have been reduced, but goal rates were achieved at 28.6 % patients of the 1st group and 44.1 % patients of the 2nd group (P < 0.05). Reduction in nighttime BP was greater in the 2nd group. Initial higher LVMI (β = 0.655; P < 0.0001), baseline 24-h urinary albumin excretion (β = - 0.475; P < 0.0001), active renin concentration (β = 0.442; P = 0.005) were predictors of δ LVMI in multivariate modeling. Conclusions: Regression of LVH is possible in patients with RH in case of BP control, especially at night. Baseline higher LVMI, an increase of active renin concentration, decline of urinary albumin excretion are factors that determine reversibility LVH.

Short- and Long-Term Reproducibility of Nighttime Blood Pressure Phenotypes and Nocturnal Blood Pressure Reduction.

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Evaluation of Dipper and Non-dipper Blood Pressure Patterns and Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease.

ResumoFundamento O padrão pressórico não-dipper é definido por uma redução inferior a 10% na pressão arterial noturna e está associado a doenças cardiovasculares. Acredita-se que a inflamação desempenhe um papel na patogênese da doença pulmonar obstrutiva crônica (DPOC) e no padrão pressórico não-dipper e ambas as doenças estão associadas a uma qualidade de vida mais baixa.Objetivo O objetivo deste estudo foi o de investigar os efeitos do padrão pressórico não-dipper em pacientes com DPOC.Métodos Foi realizado um estudo transversal incluindo 142 pacientes com DPOC. O Questionário Respiratório de Saint George e a Escala de Qualidade de Vida Euro foram utilizados para a coleta de dados. Para entender a rigidez arterial, o índice de aumento e a velocidade da onda de pulso foram medidos; subsequentemente, foi realizada a monitorização ambulatorial da pressão arterial de 24 horas. Foi aplicado um modelo de regressão logística multivariável para entender a relação entre as diferentes variáveis independentes e o padrão pressórico. Foram considerados estatisticamente significativos valores de p inferiores a 0,05.Resultados Como resultado, 76,1% (n = 108) dos pacientes apresentaram o padrão pressórico não-dipper. Os pacientes com padrão não-dipper apresentaram valores mais altos de proteína C reativa (OR: 1,123; IC 95%: 1,016;1,242), índice de aumento (OR: 1,057; IC 95%: 1,011;1,105) e pontuação total no Questionário Respiratório de Saint George (OR: 1,021; IC 95%: 1,001;1,042), em comparação com os pacientes com padrão dipper. Adicionalmente, com o aumento do número de pessoas que habitavam o domicílio, verificou-se que o padrão pressórico não-dipper era mais frequente (OR: 1,339; IC 95%:1,009;1,777).Conclusão O padrão pressórico não-dipper pode aumentar o risco cardiovascular ao desencadear a inflamação e pode afetar adversamente o prognóstico da DPOC diminuindo a qualidade de vida relacionada à doença. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?

Nocturnal hypertension has been recognized as a significant risk factor for cardio- and cerebrovascular diseases. Blood pressure (BP) monitoring significantly increased our awareness of nocturnal hypertension and studies revealed its influence on target organ damage. Nocturnal hypertension is associated with nonphysiological 24-h BP patterns, which consider inadequate drop or even increment of nighttime BP in comparison with daytime BP (nondipping and reverse dipping). Nevertheless, investigations showed that nocturnal hypertension was a predictor of adverse outcome independently of circadian BP pattern. There are still many uncertainties regarding diagnosis, mechanisms and treatment of nocturnal hypertension. There is a small difference between American and European guidelines in cutoff values defining nocturnal hypertension. Pathophysiology is also not clear because many conditions such as diabetes, metabolic syndrome, obesity, sleep apnea syndrome, and renal diseases are related to nocturnal hypertension and nonphysiological circadian BP pattern, but mechanisms of nocturnal hypertension still remain speculative. Therapeutic approach is another important issue and chronotherapy provided the best results so far. There are studies which showed that some groups of antihypertensive medications are more effective in regulation of nocturnal BP, but it seems that the timing of drug administration has a crucial role in the reduction of nighttime BP and conversion of circadian patterns from nonphysiologic to physiologic. Follow-up studies are necessary to define clinical benefits of nocturnal BP reduction and restoring unfavorable 24-h BP variations to physiological variant.

Association of increased arterial stiffness with diastolic dysfunction in ischemic stroke patients: the Norwegian Stroke in the Young Study.

Young and middle-aged ischemic stroke survivors have a high prevalence of hypertension, increased arterial stiffness and abnormal left ventricular (LV) geometry, which all are associated with the presence of LV diastolic dysfunction. However, the prevalence and covariates of diastolic dysfunction in these patients have not been reported. To explore diastolic dysfunction in ischemic stroke patients aged 15-60 years included in the Norwegian Stroke in the Young Study. Data from 260 patients with acute ischemic stroke was analyzed. Diastolic dysfunction was assessed by combining transmitral peak early flow (E), early diastolic mitral annular velocity (e'), E/e' ratio, left atrial volume index and peak tricuspid regurgitant jet velocity, following current European guidelines. Carotid-femoral pulse wave velocity at least 10 m/s by aplanation tonometry was defined as increased arterial stiffness. Prevalent diastolic dysfunction was found in 20% of patients (13% with diastolic dysfunction grade 1 and 7% with diastolic dysfunction grades 2-3). Patients with diastolic dysfunction were older and more likely to have hypertension, overweight, increased arterial stiffness, higher LV mass and less percentage nightly reduction in mean blood pressure (BP) (all P < 0.001). In a multivariable logistic regression analysis, diastolic dysfunction was associated with increased arterial stiffness [odds ratio 2.86 (95% confidence interval 1.05-7.79), P < 0.05] independent of age more than 45 years, overweight, hypertension, night-time BP reduction and LV mass. Among young and middle-aged ischemic stroke survivors, diastolic dysfunction was found in 20%. The presence of diastolic dysfunction was associated with increased arterial stiffness independent of higher age, overweight, hypertension, night-time BP reduction and LV mass.

СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ДИГНОСТИКИ И ЛЕЧЕНИЯ СИСТЕМНЫХ ВАСКУЛИТОВ С ПОРАЖЕНИЕМ ПОЧЕК У ДЕТЕЙ: СОБСТВЕННЫЕ ДАННЫЕ (ЧАСТЬ 2)

The aim of the study was to analyze clinical, laboratory, immunological, morphological data of children with systemic vasculitis (SV) with kidney involvement to assess mediators of the formation and progression of the disease, as well as factors affecting prognosis. Methods. 20 children (15 girls, 5 boys) with morphologically verified nephritis due to SV (age from 5 to 17 yrs, median 13.5), were under observation at the "2nd Children's Clinical Hospital" Minsk from 2012 -2020. The features of the onset of the disease in childhood are presented, the analysis of clinical, laboratory, immunological (serum concentration of T- and B-lymphocyte activation markers (RANTES and BAFF), proinflammatory (caspase 1, IL1β and TNFα), vascular (VEGF) and tissue (TGF1β) growth factors), metabolic parameters (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes, and factors affecting the course and outcome. Statistics was carried out using the Statistica 10.0, SPSS. Results. A significant increase in the concentration of markers of activation of T and B lymphocytes (RANTES, BAFF), proinflammatory (caspase 1, TNFα, IL1β) and markers of endothelial dysfunction (VEGF and TGF1β) in children with nephritis due to SV in comparison with healthy children, as well as a decrease in the above mentioned molecules during remission, allows them to be used as markers of disease activity. High frequency of arterial hypertension during the period of active manifestations of the disease (85%) and on the multicomponent hypotensive therapy (70%), presence of nocturnal hypertension and/or insufficient nighttime blood pressure reduction in all patients, signs of cardiac remodeling (40%), pro-atherogenic metabolic disorders make it possible to classify patients with nephritis in SV as a high-risk group of early development of cardiovascular disorders, which requires careful monitoring and correction. Conclusion. SV in childhood is associated with severe organ damage and mortality (5%). Nephritis significantly adverse outcome of the disease, impaired renal function at the onset of the SV is noted in 65%, progression to end stage chronic kidney disease in 35% of cases. Recurrent course, persistent nephrotic proteinuria, serum creatinine, VEGF, adyponectin and obestatin, decrease in estimated glomerular filtration rate at the onset of the disease is associated with progression of nephritis in SV.

Ambulatory Blood Pressure Reduction In Response To Supramaximal Interval Exercise; Interactions With Antihypertensive Medication.

Metabolic Syndrome (MetS) increases the risk of cardiovascular and all-cause mortality. High blood pressure is the most frequent factor of MetS. General guidelines for hypertension recommend both pharmacological and exercise treatment while their combined effects on blood pressure have not been thoroughly explored yet. PURPOSE: To compare the blood pressure (BP) response to a bout of supramaximal aerobic interval exercise (SIE) alone or in combination with antihypertensive medication in MetS hypertensive patients. METHODS: Twelve patients chronically medicated with angiotensin II receptor 1 blockade antihypertensive medicine (AHM), underwent 3 trials separated by 1 week in a randomized order: a) control trial without exercise and substituting their AHM by a placebo (PLAC); b) placebo medicine and a morning bout of SIE (PLAC+SIE) and c) combining AHM and exercise (AHM+SIE). Acute and ambulatory blood pressure responses were measured for 21-h after treatments. Repeated-measures crossover, double-blind, placebo randomized design was used. RESULTS: Acutely (i.e., 20 min after treatments), systolic blood pressure (SBP) were reduced similarly after PLAC+SIE (- 9.7 ± 6.0 mmHg, P<0.001) and AHM+SIE (-10.4 ± 7.9 mmHg, P=0.001). Chronically, (21-h following treatments) SBP remained reduced after PLAC+SIE (125 ± 12mmHg, P=0.022) and AHM+SIE (122 ± 12 mmHg, P=0.013) in comparison to PLAC (132 ± 16 mmHg). The BP reduction in PLAC+SIE faded out at 4 a.m., whilst in AHM+SIE continued over the complete measurement period (Figure 1). At nighttime BP reduction was larger in AHM+SIE than PLAC+SIE (-5.6 ± 4.0 mmHg, P=0.006). CONCLUSION: Our data show that a bout of supramaximal aerobic interval exercise in combination with antihypertensive medication in the morning elicits a sustained blood pressure reduction that lasts at least 21-h. Exercise potentiates the effects of antihypertensive medicine reducing blood pressure longer and at a larger magnitude than exercise alone.

Fixed combinations of perindopril and indapamide in hypertensive high-risk patients: antihypertensive efficacy

Objective.The aim of the study was to compare the antihypertensive efficacy of fixed combinations of perindopril and indapamide in patients with arterial hypertension (HTN) and high cardiovascular risk.Design and methods.We included 65 patients with 1–2 degree of HTN who had not taken the studied drugs before: either perindopril arginine / indapamide 10 mg + 2,5 mg, n = 35), or indapamide / perindopril erbumine K 2,5 mg + 8 mg, n = 30). Clinical efficacy of antihypertensive therapy was evaluated at three different time points. We assessed objective clinical status, blood biochemistry, office blood pressure (BP), and parameters of daily monitoring of BP (MBP).Results.Perindopril arginine plus indapamide vs indapamide plus perindopril erbumine K after 4 and after 12 weeks shows higher antihypertensive effect regarding office BP and provides significantly better control of the daily BP profile based on the MBP results. Therefore, MBP is required in HTN high-risk patients who take indapamide / perindopril erbuminе K in order to assess the reduction in nighttime BP, independently of achieving target office BP values.

Clinical Implications

Clinical Implications

Изучение возможностей хронотерапии при назначении фиксированной комбинации периндоприла 10 мг и индапамида 2,5 мг (Нолипрел А Би-форте) у пациентов с недостаточной степенью снижения артериального давления в ночное время

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP>140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p<0.01), the average ambulatory diastolic BP (DBP) during wakefulness - from 94.7±12.3 mm Hg to 78.3±8.6 mm Hg (ns), ambulatory SBP during sleep - from 146.6±16.1 mm Hg to 121.8±15.7 mm Hg (p<0.01), ambulatory DBP during sleep - from 86.2±9.2 mm Hg to 70.3±6.5 mm Hg (p<0.01). The reduction of nighttime SBP increased from 1.9±5.8% to 6.2±9.3% (p<0.05), the reduction of nighttime DBP from 6.2±3.9% to 9.6±8.2% (ns). ABPM measurements of "non-dipper" sub-groups, who received treatment in the evening or in the morning after 2 months had no significant difference, except the variability of DBP during wakefulness (p<0.05). We didn’t observe statistically significant difference in terms of the nighttime BP reduction. However, nighttime BP reduction was higher in the evening dosing group: SBP - 4.1±11.1% (morning group), 7.8±7.9% (evening group) and DBP - 8.9±11.0 (morning group) and 10.2±5.5 (evening group). Blood tests were in the normal range during the whole study. Conclusion. A fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) is effective and safe in patients with both normal and with insufficient degree of reduction in BP at night. Prescription of medication in the evening in non-dipper patients can have the added benefit on the BP profile. Further research is needed.

Covariates of non-dipping and elevated night-time blood pressure in ischemic stroke patients: the Norwegian Stroke in the Young Study*

Abnormal night-time blood pressure (BP) reduction is associated with increased cardiovascular risk in hypertension. Little is known about the prevalence and covariates of night-time BP reduction in ischemic stroke patients. Clinic and ambulatory BP measurements were recorded in 268 stroke survivors aged 15–60 years. The degree of night-time dipping was calculated from the difference between day-time and night-time mean BP, and defined as non-dipping if < 10%. Aortic stiffness was derived from carotid–femoral pulse-wave velocity (PWV) by applanation tonometry and carotid intima–media thickness (cIMT) by ultrasound. A non-dipping pattern was found in 38%. Non-dippers had higher PWV, mean cIMT and night-time BP, and included more patients with history of hypertension, diabetes and high for age PWV compared to dippers (all p < 0.05). In multivariate logistic regression analyses, non-dipping was associated with high for age PWV [odds ratio (OR) = 2.28; 95% confidence interval (CI) 1.06–4.92, p < 0.05] independent of history of hypertension and other confounders, while elevated night-time BP was associated with increased cIMT (OR = 3.83; 95% CI 1.01–14.50, p < 0.05) independent of non-dipping status, male gender, obesity, antihypertensive treatment and high for age PWV. In conclusion, in the Norwegian Stroke in the Young Study, non-dipping BP pattern was common and associated with increased aortic stiffness.

Indicators of blood pressure according to the daily monitoring of elderly patients with paratraumatic eczema, concomitant varicose and hypertension

Relevance. At the present stage varicose eczema incidence in the population is very common, but the data on mechanisms of paratraumatic eczema (varicose) with concurrent hypertension is not enough. Aim. In order to clarify the mechanisms of paratraumatic (varicose veins) eczema in 40 patients of elderly age with concomitant varicose symptoms and hypertension circadian rhythm of blood pressure (BP) was studied by means of bifunctional daily monitoring device. Methods and results. Increase of systolic blood pressure was found in 73,3%±0,5% (р<0,05), diastolic blood pressure – in 93,3%±1,2% (р<0,05) of patients. Conclusions. This shows a statistically significant increase of the group of patients with low nighttime blood pressure reduction «Non-dippers» in SBP – 53,3% (р<0,05) in the comparison group – 10,0% (p <0,05); for DBP – along with an increase in the number of patients «Non-dippers», there was a significant increase in the group «Night-peakers» – 40,0%, in the comparison group – 10,0% (p <0,05).

PP.24.07

Objective: Alteration of diastolic function including left atrial volume (LAV), left ventricular mass (LVM) and E/E’ considered a sensitive means for detecting changes in the normal cardiac adaptation to pregnancy. However, only a few study have assessed the influence of dipping pattern of nocturnal blood pressure on diastolic function in pregnancy. The aim of this study is to know the association between dipping pattern of nocturnal blood pressure and diastolic function in pregnancy. Design and method: We analyzed the results of 24 hour ambulatory blood pressure monitoring (ABPM) and echocardiography of 125 women with pregnancy. All of the tests were done in late third trimester of pregnancy. We exclude the pregnant patients with antihypertensive medication or past history of hypertension. Degree of night BP reduction was calculated as (1- (Mean SBP in night time/Mean SBP in day time) x 100. Results: The mean gestational age at the time of test was 29 ± 3 weeks. Mean blood pressure of 24 hour ABPM was 123.4 ± 16.5 / 84.5 ± 11.2 mmHg (day time mean: 126.3 ± 18.3/84.1 ± 9.8 mmHg, night time mean: 117.5 ± 15.7/75.6 ± 7.9 mmHg). Mean degree of night time blood pressure reduction was 8.8 ± 6.1. In echocardiography, mean left ventricular ejection fraction and E/E’ was 61.8 ± 10.1% and 8.9 ± 3.9, respectively. In addition, mean LAV index and LVM index were 29.3 ± 10.1 mL/m2 and 114.9 ± 22.5 g/ m2. Mean deceleration time (DT) was 192.4 ± 31.2 ms. Regarding to the relation between nocturnal blood pressure and diastolic function, LVM index was not correlated with degree of nocturnal blood pressure reduction, However, E/E’ was negatively correlated with degree of nocturnal blood pressure reduction(r = -0.257, p = 0.004). In addition, LAV index showed negative correlation with degree of nocturnal blood pressure reduction (r = -0.637, p < 0.001). Conclusions: In late third trimester of pregnancy, abnormal dipping pattern of nocturnal blood pressure might be associated with enlargement of LAV

Comparative effectiveness of chlorthalidone with hydrochlorothiazide using two ratios of potency in a real world managed care population

Patients with hypertension whose blood pressure (BP) does not reduce during the nighttime period (non-dippers) are at increased risk of cardiovascular events. Antihypertensive therapies that improve the dip in BP from daytime to nighttime could improve outcomes beyond overall BPlowering. We investigated the efficacy of LCZ696 (Japanese Adopted Name: Sucabitril Valsartan Sodium Hydrate), a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in sub-populations of patients with hypertension classified as dippers ( 10% decrease in mean ambulatory [ma] systolic blood pressure [SBP] at nighttime vs. daytime) and non-dippers (<10% decrease in maSBP at nighttime vs. daytime) at baseline. This double-blind, placebo-controlled study was conducted in 389Asian patients with mild to moderate hypertension (mean sitting [ms] diastolic blood pressure [DBP] 95 and<110 mmHg and msSBP 140 and<180 mmHg) randomized to 8 weeks’ treatment with LCZ696 100, 200 or 400 mg, or placebo.Changes frombaseline in 24-h and nighttime (10 pm-6 am)maSBPand maDBP were assessed at Week 8 in dippers and non-dippers. Of 362 patients who completed the study, baseline characteristics (mean age 51.5 yrs [11% 65 yrs]; 72% male; BMI 25.9 kg/m) and baseline maBP (maSBP/maDBP) were similar between dippers (143.6/93.8 mmHg) and non-dippers (147.4/96.4 mmHg). 319 dippers or non-dippers had evaluable maBP measurements at baseline and post-baseline. All doses of LCZ696 provided significantly greater reductions in mean 24-h and nighttime maSBP and maDBP vs. placebo, with a trend (NS) for the greatest benefit observed with the two higher doses of LCZ696 in non-dippers (Table). Overall incidence of adverse events was similar between each treatment group (37.5-38.0%) and placebo (32.6%). These results suggest that the ARNI LCZ696 is an effective treatment for Asian patients with hypertension, reducing BP throughout the 24-h period and restoring nighttime BP reduction in non-dippers.

Comparison of new-onset gout incidence in adults prescribed hydrochlorothiazide versus chlorthalidone

Patients with hypertension whose blood pressure (BP) does not reduce during the nighttime period (non-dippers) are at increased risk of cardiovascular events. Antihypertensive therapies that improve the dip in BP from daytime to nighttime could improve outcomes beyond overall BPlowering. We investigated the efficacy of LCZ696 (Japanese Adopted Name: Sucabitril Valsartan Sodium Hydrate), a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in sub-populations of patients with hypertension classified as dippers ( 10% decrease in mean ambulatory [ma] systolic blood pressure [SBP] at nighttime vs. daytime) and non-dippers (<10% decrease in maSBP at nighttime vs. daytime) at baseline. This double-blind, placebo-controlled study was conducted in 389Asian patients with mild to moderate hypertension (mean sitting [ms] diastolic blood pressure [DBP] 95 and<110 mmHg and msSBP 140 and<180 mmHg) randomized to 8 weeks’ treatment with LCZ696 100, 200 or 400 mg, or placebo.Changes frombaseline in 24-h and nighttime (10 pm-6 am)maSBPand maDBP were assessed at Week 8 in dippers and non-dippers. Of 362 patients who completed the study, baseline characteristics (mean age 51.5 yrs [11% 65 yrs]; 72% male; BMI 25.9 kg/m) and baseline maBP (maSBP/maDBP) were similar between dippers (143.6/93.8 mmHg) and non-dippers (147.4/96.4 mmHg). 319 dippers or non-dippers had evaluable maBP measurements at baseline and post-baseline. All doses of LCZ696 provided significantly greater reductions in mean 24-h and nighttime maSBP and maDBP vs. placebo, with a trend (NS) for the greatest benefit observed with the two higher doses of LCZ696 in non-dippers (Table). Overall incidence of adverse events was similar between each treatment group (37.5-38.0%) and placebo (32.6%). These results suggest that the ARNI LCZ696 is an effective treatment for Asian patients with hypertension, reducing BP throughout the 24-h period and restoring nighttime BP reduction in non-dippers.

Blood pressure-lowering efficacy of LCZ696 in non-dipper patients with hypertension

Patients with hypertension whose blood pressure (BP) does not reduce during the nighttime period (non-dippers) are at increased risk of cardiovascular events. Antihypertensive therapies that improve the dip in BP from daytime to nighttime could improve outcomes beyond overall BPlowering. We investigated the efficacy of LCZ696 (Japanese Adopted Name: Sucabitril Valsartan Sodium Hydrate), a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in sub-populations of patients with hypertension classified as dippers ( 10% decrease in mean ambulatory [ma] systolic blood pressure [SBP] at nighttime vs. daytime) and non-dippers (<10% decrease in maSBP at nighttime vs. daytime) at baseline. This double-blind, placebo-controlled study was conducted in 389Asian patients with mild to moderate hypertension (mean sitting [ms] diastolic blood pressure [DBP] 95 and<110 mmHg and msSBP 140 and<180 mmHg) randomized to 8 weeks’ treatment with LCZ696 100, 200 or 400 mg, or placebo.Changes frombaseline in 24-h and nighttime (10 pm-6 am)maSBPand maDBP were assessed at Week 8 in dippers and non-dippers. Of 362 patients who completed the study, baseline characteristics (mean age 51.5 yrs [11% 65 yrs]; 72% male; BMI 25.9 kg/m) and baseline maBP (maSBP/maDBP) were similar between dippers (143.6/93.8 mmHg) and non-dippers (147.4/96.4 mmHg). 319 dippers or non-dippers had evaluable maBP measurements at baseline and post-baseline. All doses of LCZ696 provided significantly greater reductions in mean 24-h and nighttime maSBP and maDBP vs. placebo, with a trend (NS) for the greatest benefit observed with the two higher doses of LCZ696 in non-dippers (Table). Overall incidence of adverse events was similar between each treatment group (37.5-38.0%) and placebo (32.6%). These results suggest that the ARNI LCZ696 is an effective treatment for Asian patients with hypertension, reducing BP throughout the 24-h period and restoring nighttime BP reduction in non-dippers.

Assessment of the reductions in night-time blood pressure and dipping induced by antihypertensive medication using a home blood pressure monitor

Night-time blood pressure (BP) is strongly associated with hypertensive target organ damage; however, no previous studies have compared home BP monitor measurements of the reduction in night-time BP induced by antihypertensive medications with those obtained with ambulatory BP monitors. As part of the Japan Morning Surge-Target Organ Protection study, in which candesartan (thiazide diuretics were added, if needed) was administered to hypertensive patients in the morning or at bedtime, 50 hypertensive patients had their night-time home and ambulatory BP successfully measured at the baseline and 6 months. In addition, three night-time home BP readings were taken during sleeping hours (at 2, 3, and 4 o'clock) for 6 months. The mean reduction in night-time BP did not differ significantly between home and ambulatory BP monitoring (10.4 ± 17.9/6.0 ± 12.0 vs. 13.3 ± 14.6/7.6 ± 8.9 mmHg, P = 0.219/0.344), but the differences varied among individual patients. The reduction in night-time BP according to home BP monitoring was significantly correlated with the value obtained with ambulatory BP monitoring (r = 0.51/0.38, P < 0.001/=0.006). The reduction in night-time SBP according to home BP monitoring was significantly correlated with the reductions in left ventricular mass index (r = 0.385, P = 0.013, N = 41) and Sokolow-Lyon voltage (r = 0.335, P = 0.035, N = 40). Home BP monitoring produces estimates of mean night-time BP reductions comparable to those from ambulatory monitoring, while the differences varied among individual patients. The reduction in night-time home BP according to home BP monitoring is significantly correlated with the reduction in left ventricular hypertrophy.