Results Of Blood Pressure Monitoring Research Articles

Features of arterial pressure dynamics according to results of blood pressure monitoring in elderly patients

All over the world, special attention is paid to cardiovascular diseases in patients. According to epidemiological studies, a large contribution to mortality from them is high blood pressure, effective normalization of blood pressure will lead to an increase in life expectancy. The purpose of the study: to study the features of the daily blood pressure profile in elderly patients with hypertension. It was revealed that hypertension in elderly patients is more severe and has significantly higher rates of rise in systolic and diastolic pressure during the day and night hours, high variability, and insufficient (non-dipper) night-time decrease in blood pressure.Therefore, sick groups have a high risk of developing target organ damage, which is a predictor of the development of cardiovascular complications.

ARTERIAL HYPERTENSION AMONG MEDICAL WORKERS. ANALYSIS. EVALUATION

The aim. To examine the impact of individual medical and social factors, including work experience, lifestyle and living conditions, excess body weight, metabolic syndrome, types of circadian rhythms of blood pressure, and heredity, on the frequency of arterial hypertension (hypertensive disease - HD) formation.
 Materials and methods. The study involved the collection of anamnestic data, conducting interviews, performing objective examinations, and monitoring blood pressure in 391 medical workers, predominantly from therapeutic, surgical, and intensive care backgrounds. The obtained data were statistically processed using probability assessment criteria, risks assessed through odds ratio (OR), and ROC analysis.
 The results. The study revealed that only 33% of medical workers have a normal body weight. The risk of developing hypertensive disease (HD) is 3.24 times higher in the group with excess body weight and 8.72 times higher in the group with obesity compared to the examined subjects with normal body weight (p<0.0001). Daily blood pressure monitoring results showed a statistically significant difference in 12 out of the 21 studied parameters (p<0.05) between patients with HD, with and without metabolic syndrome. This indicates that the presence of metabolic syndrome affects the severity of hypertensive disease. Additionally, a statistically significant difference (p<0.05) was observed in the distribution of circadian rhythm types of blood pressure between groups with and without hypertension. It was established that there is a predominance of unfavorable types of circadian blood pressure rhythm in medical worker groups experiencing high professional psycho-emotional stress (78.1-85.5%). Recognizing the risk factors for HD occurrence in medical workers can significantly enhance the effectiveness of a comprehensive hypertensive disease prevention program, leading to reduced blood pressure levels and a lower frequency of complications.
 Conclusions. It has been established that excess body weight is a risk factor for the development of hypertensive disease (HD) in medical personnel. The presence of metabolic syndrome has been proven to affect the severity of the hypertensive disease course. There is a certain association between disruptions in circadian blood pressure rhythms, professional psycho-emotional stress, and the development of arterial hypertension in medical workers of certain specialties. The prognostically significant threshold level of work experience for the formation of a group at an increased risk of developing HD is 11 years.

Relationship between ambulatory arterial stiffness index and the severity of angiographic atherosclerosis in patients with H-type hypertension and coronary artery disease

ABSTRACT Objective To investigate coronary artery disease (CAD) and its correlation with the ambulatory arterial stiffness index (AASI) in patients with H-type hypertension (essential hypertension combined with hyper-homocysteinemia) and coronary heart disease (CHD). Methods Patients with essential hypertension and CHD who were undergoing coronary angiography were enrolled. The general clinical data, biochemical indicators, ambulatory blood pressure monitoring results and coronary angiography results of the selected patients were collected, and the AASI and Gensini scores were calculated. According to homocysteine (Hcy) levels, the patients were divided into two groups: a study group and a control group. The differences in general clinical data, biochemical indexes, AASI scores and degree of coronary artery lesions between the two groups were compared. The correlation between the AASI and the Gensini score and the relationship between the AASI and the Gensini score of CAD and various factors were analyzed. Results Compared with the control group, the Hcy level in the study group was significantly increased (8.16 ± 2.33 vs 19.20 ± 2.36, P = .001). The 24-h diastolic blood pressure (DBP) in the study group was significantly lower than that in the control group (76.38 ± 9.33 vs 79.91 ± 9.25, P = .002), and the AASI was significantly higher than in the control group (0.62 ± 0.81 vs 0.420 ± 0.70, P = .001). The number of patients having coronary stenoses with a Gensini score of ≤ 38 was significantly lower in the study group than in the control group (21.3% vs 49.4%, P < .001). The number of patients with a Gensini score of ≥ 51 in the study group was significantly higher than in the control group (22.0% vs 18.8%, P < .001). There was a significant positive correlation between the AASI and the Gensini score in the study group (R = 0.732, P < .001). Hypertension duration (β = 0.168), diabetes history (β = 0.236), 24-h SBP (β = 0.122), 24-h DBP (β = -0.131), low-density lipoprotein cholesterol (β = 0.134) and Hcy (β = 0.233) were the influencing factors for AASI (P < .05). Both Hcy * AASI (β = 0.356) and Hcy × 24-h HR (β = 0.331) had a synergistic effect on the Gensini score (P = .017), with Hcy * AASI having a more significant effect on the Gensini score (P < .001). Conclusion The AASI was significantly increased in patients with H-type hypertension and CHD, which was associated with the severity of CAD. Therefore, Hcy levels and the AASI have a synergistic effect when evaluating the severity of CAD in patients with hypertensive CHD.

Poorer Self-Reported Physical Health and Higher Anxiety Trait in Young Adults With Previous Coarctation Repair

Little is known about the impact of a coarctation repair on the functional outcomes of young adults. This study aimed to determine (1) the functional and mental health status in young adults with previous coarctation repair, and (2) the impact of late hypertension on their quality of life. A cross-sectional study using validated self-reported questionnaires (Short Form 36 version 2 [SF-36v2], Beck Depression Inventory [BDI], and State-Trait Anxiety Inventory [STAI]) was performed in 54 patients aged 15-47 years with previous paediatric coarctation repair. Questionnaire scores were compared to healthy age- and gender-matched controls. Patients' previously published 24-hour blood pressure monitoring results were included. Late hypertension was present in 64% (34/54) at a mean of 29±8 years after coarctation repair. SF-36v2 mean physical component summary score was significantly lower in coarctation patients compared with controls (53.1±6.8 vs 56.0±4.7, p=0.02), but there was no significant difference in mean mental component summary score (p=0.2). SF-36v2 mean role emotional score tended to be associated with 10 mmHg increases in mean 24-hour systolic blood pressure (regression coefficient 4.3 p=0.06). STAI mean trait anxiety score tended to be higher in coarctation patients compared with controls (36.6±9.0 vs 33.5±7.8, p=0.06). There was no significant difference in BDI scores between patients and controls. Young adults with previous coarctation repair report poorer physical health and tended towards higher anxiety trait compared to healthy controls. Strategies to improve self-reported physical health and anxiety should be explored. Long-term assessment of quality of life outcomes in coarctation patients is warranted.

The association between nondipper pattern and perioperative hypertension in patients with controlled hypertension.

Perioperative hypertension is a frequent complication even in preoperatively normotensive or controlled hypertensive patients and there is a lack of data regarding the effect of nondipping pattern on perioperative hypertension. In this study, we aimed to investigate the possible effect of nondipping blood pressure pattern on the risk of perioperative hypertension. 234 hypertensive patients who underwent surgery with general anesthesia were evaluated prospectively. The study enrolled patients with well-controlled preoperative blood pressure. The 24-h ambulatory blood pressure monitoring results were used to classify patients as dippers and nondippers. Perioperative hypertension is defined as a systolic/diastolic arterial blood pressure greater than or equal to 160/90 mmHg or systolic blood pressure elevated by more than 20% from the patient's baseline level for more than 15 min perioperatively. There were 61 (26%) nondipper patients [mean age: 62.1 ± 7.1 years, 25 (40.9%) men] and 173 (74%) dipper patients [mean age: 61.4 ± 8.1 years, 83 (47.9%) men]. In the nondipper group, perioperative hypertension was observed in 31 (51.3%) patients, whereas in the dipper group, 33 (19.3%) patients experienced a hypertensive attack (P < 0.001). The independent predictors of perioperative hypertension were the presence of the nondipping pattern [odds ratio (OR) 3.084; 95% confidence interval (CI) 1.831-5.195; P < 0.001], the presence of diabetes mellitus (OR 2.059; 95% CI 1.215-3.490; P = 0.007), and the number of drugs (OR 2.317; 95% CI 1.102-5.097; P = 0.027). The frequency of perioperative hypertension was higher in preoperative normotensive and known hypertensive patients who were identified as nondippers. In addition, diabetes mellitus and number of drugs were found to be predictors of perioperative hypertension.

Вплив гіпотиреозу на добовий профіль артеріального тиску у хворих на артеріальну гіпертензію за результатами амбулаторного моніторування артеріального тиску

Мета: вивчити особливості добового профілю артеріального тиску у хворих на артеріальну гіпертензію (АГ) у поєднанні з гіпотиреозом за даними амбулаторного моніторування артеріального тиску. Матеріали та методи. У дослідження ввійшли 50 хворих на АГ із супутнім гіпотиреозом. Залежно від рівня тиреотропного гормону (ТТГ) в сироватці крові хворі були розподілені на дві групи по 25 пацієнтів із компенсованим (І група) і декомпенсованим гіпотиреозом (ІІ група). Критерієм компенсації вважали рівень ТТГ 4,4 мМО/л. Контрольну групу становили 30 пацієнтів з АГ, у яких була виключена дисфукція щитоподібної залози. Виконано співставлення основних показників амбулаторного моніторування артеріального тиску залежно від компенсації гіпотиреозу, оцінка добового індексу систолічного артеріального тиску. Проведений регресійний аналіз для виявлення зв’язку клініко-анамнестичних чинників і показників з розвитком діастолічної дисфункції за Е/А. Результати. За результатами оцінки показників амбулаторного моніторування артеріального тиску встановлено, що хворі зі зниженою функцією щитоподібної залози мали більш значущі зміни добового профілю артеріального тиску, тоді як середні значення офісного артеріального тиску не мали вірогідних відмінностей між групами. Для хворих з артеріальною гіпертензією і супутнім гіпотиреозом характерне недостатнє зниження артеріального тиску в нічний час, про що свідчить більш питома вага пацієнтів з рівнем добового індексу менше 10 серед цих пацієнтів (р = 0,001). Згідно з результатами ROC-аналізу, тривалість замісної гормональної терапії &gt; 6 років дозволяє прогнозувати зниження добового індексу систолічного артеріального тиску з чутливістю 82,1 % і специфічністю 57,1 %. При зниженні добового індексу (9,12) у хворих на артеріальну гіпертензію у поєднанні з гіпотиреозом частіше можливий розвиток діастолічної дисфункції (показник Е/А), про що свідчать результати ROC-аналізу з чутливістю 86,4 % та специфічністю 46,2 %. Висновки. Таким чином, хворим з артеріальною гіпертензією і супутнім гіпотиреозом показано проведення амбулаторного моніторування артеріального тиску для виявлення нічної гіпертензії і корекції антигіпертензивної терапії. З урахуванням отриманих результатів антигіпертензивна терапія має бути спрямована не лише на зниження артеріального тиску, але й на нормалізацію добового індексу.

24-hour blood pressure monitoring and renal function evaluation at the predicted term of delivery in prematurely born children.

B a c k g r o u n d: The cause of the increased risk of hypertension in children born prematurely is still unclear. The aim of this study was to analyze the results of blood pressure monitoring and the levels of variety of kidney function markers at the 40-42 weeks postmenstrual age in children born prematurely and to compare them with the values obtained from full-term newborns. The analysis of the differences in the observed parameters could be used to assess the risk of developing hypertension in preterm infants in the following years of life. M e t h o d o l o g y: Prospective cohort study included 37 children born prematurely (<35 weeks of gestation) and 20 full-term newborns. The 24-hour ambulatory blood pressure measurement, serum cystatin C and thrombomodulin levels, urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) concentration, renal ultrasound and bioelectrical impedance were performed. R e s u l t s: Analysis of the blood pressure monitoring reveled lower values of diastolic (DBP) and mean blood pressure (MAP) in the preterm group (DBP: 47.69 ± 4.79 vs. 53.96 ± 5.3 mmHg; p <0.01; MAP 64 ± 6.7 vs. 68 ± 6 mmHg; p = 0.02), however the preterm children were significantly smaller at the time of evaluation. Moreover, the pulse pressure was significantly higher in the preterm group (44 ± 7.8 vs. 39.4 ± 5.7 mmHg; p = 0.017). In the preterm group serum cystatin C level was lower (1.397 ± 0.22 vs. 1.617 ± 0.22 mg/l; p <0.01) and NGAL urine concentration was higher (57 ± 84 vs 15 ± 21 ng/ml; p = 0.04). There was substantial difference in body composition between groups - the total body water was lower in the preterm group (75.6 ± 13 vs. 82 ± 8%; p = 0.015). C o n c l u s i o n: At the predicted date of birth, preterm newborns show significant differences in blood pressure profile, body weight composition, and levels of cystatin C and NGAL compared to full-term babies.

Анализ показателей суточного профиля артериального давления у больных с артериальной гипертензией и сопутствующим гипотиреозом в зависимости от степени его компенсации

Цель работы заключалась в изучении характеристик суточного профиля артериального давления у пациентов с артериальной гипертензией и сопутствующим гипотиреозом на основании результатов амбулаторного мониторинга артериального давления. В исследование были включены 50 пациентов с артериальной гипертензией и сопутствующим гипотиреозом. В зависимости от сывороточного уровня тиреотропного гормона пациенты были разделены на две группы, по 25 пациентов в каждой: с компенсированным (группа 1) и декомпенсированным гипотиреозом (группа 2). Уровень тиреотропного гормона 4,4 мМЕ/л считали критерием компенсации. Конт­рольная группа состояла из 30 пациентов с артериальной гипертензией и исключенной дисфункцией щитовидной железы. Проведено сравнение основных показателей амбулаторного мониторинга артериального давления в зависимости от компенсации гипотиреоза. Для выявления взаимосвязи клинических и анамнестических факторов и показателей ночного систолического давления был проведен регрессионный анализ.

Interpretation of ambulatory blood pressure monitoring results

Interpretation of ambulatory blood pressure monitoring results

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.

Comparison of Chronic Hemodialysis Patients under Strict Volume Control with respect to Cardiovascular Disease.

Background The objective of this study was to determine the effects of strict volume control and nondipper situation on cardiovascular disease in chronic hemodialysis patients. Methods This study is an observational and cross-sectional study including 62 patients with normotensive chronic hemodialysis using no antihypertensive drugs. A series of measurements including ambulatory blood pressure monitoring, left ventricular mass index by echocardiography, common carotid artery intima-media thickness by ultrasound, and body fluids by bioimpedance analysis were conducted for all subjects. Results The patients were divided into two groups as dippers and nondippers according to their ambulatory blood pressure monitoring results. Average 48 h systolic, diastolic, and mean arterial blood pressure and nocturnal systolic, diastolic, and mean arterial blood pressure were significantly different between the dipper and nondipper groups (p<0.05). Before and after dialysis, extracellular fluid/intracellular fluid and extracellular fluid/dry body weight ratios were significantly higher in the nondipper group. Left ventricle mass index and interventricular septum thickness were significantly higher in the nondipper group (p<0.05). Left ventricle ejection fraction was significantly lower and common carotid artery intima-media thickness was higher in the nondipper group with a statistical significance (p<0.05). A two-predictor logistic model was fitted to the data to predict the comparability of dippers and nondippers. Conclusion According to logistic regression analysis, the odds ratio for daytime diastolic blood pressure indicates that nondippers are 0.45 times more likely to have high blood pressure than dippers in daytime. But in night time, nondippers are about 2.55 times more likely to have high blood pressure comparing to dippers. An important finding of this study is that nondipping pattern is associated with cardiac hypertrophy and lower left ventricle ejection fraction in dialysis of patients with no hypertension. The results also suggest that applying strict volume control to achieve a normal blood pressure alone is not sufficient to reduce the risk of cardiovascular morbidity and mortality if the patients do not have a dipper status of nocturnal blood pressure.

Poorer Self-Reported Physical Health and Higher Anxiety in Young Adults with Previous Coarctation Repair

Background: Little is known about the impact of a coarctation repair on the functional outcomes of young adults. This study aimed to determine (1) the functional and mental health status of young adults with previous coarctation repair, and (2) the impact of late hypertension on their quality of life. Methods: A cross-sectional study using validated self-reported questionnaires (Short Form 36 version 2 [SF-36v2], Beck Depression Inventory [BDI], and State-Trait Anxiety Inventory [STAI]) was performed in 54 patients aged 15–47 years with previous paediatric coarctation repair. Questionnaire scores were compared to healthy age- and gender-matched controls. Patients’ previously published 24-hour blood pressure monitoring results were included. Results: Late hypertension was present in 64% (34/54) at a mean of 29 ± 8 years after coarctation repair. SF-36v2 mean physical component summary score was significantly lower in coarctation patients compared with controls (53.1 ± 6.8 vs. 56.0 ± 4.7, p = 0.02), but there was no significant difference in mean mental component summary score (p = 0.2). SF-36v2 mean role emotional score tended to be associated with 10 mmHg increases in mean 24-hour systolic blood pressure (regression coefficient 4.3, p = 0.06). STAI mean trait anxiety score tended to be higher in coarctation patients compared with controls (36.6 ± 9.0 vs. 33.5 ± 7.8, p = 0.06). There was no significant difference in BDI scores between patients and controls. Conclusion: Young adults with previous coarctation repair report poorer physical health and higher anxiety compared to healthy controls. Strategies to improve self-reported physical health and anxiety should be explored. Long-term assessment of quality of life outcomes in coarctation patients is warranted.

Can neutrophil to lymphocyte ratio and platelet to lymphocyte ratio be used as biomarkers for non-dipper blood pressure?

Aim: Hypertension is a major risk factor for cardiovascular diseases and non-dipper status is associated with increased risk for cardiovascular events. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are related to inflammation and cardiovascular risk. The purpose of the study is to investigate the relationship between NLR and PLR with non-dipper status of hypertensive and normotensive patients. Methods: A total of 482 patients were enrolled for the study. The study was planned as retrospective cohort study. Four groups were formed according to 24-h ambulatory blood pressure monitoring results. Group 1 was defined as hypertensive, non-dipper patients; group 2 as hypertensive, dipper patients; group 3 as normotensive, non-dipper patients and group 4 as normotensive, dipper patients.Results: Mean age of the study population was 50.1±15.5 years, 38.1% were male. According to the statistical analysis of Group 1 (n=165), Group 2 (n=88), Group 3 (n=123) and Group 4 (n=91) NLR was statistically different among groups (p&lt;0.001). Group 1 had significantly higher values compared to Group 2 (p=0.001), Group 3 (p=0.002) and Group 4 (p=0.023). In hypertensive patient group, PLR values of Group 1 was significantly higher than Group 2 (p=0.002). Pearson correlation analysis showed that NLR and PLR were correlated with BP variability (r=-0.188, p&lt;0.001 for NLR and r=-0.182 and p&lt;0.001 for PLR). Regression analysis showed NLR (p=0.040), PLR (p=0.021), age (p=0.006) and hypertension (p&lt;0.001) were independent predictors of BP variability.Conclusion: Our findings suggest that NLR and PLR can be used as inexpensive and easily accessible markers to detect non-dipper status in hypertensive patients.

Nocturnal blood pressure dipping is similar in rheumatoid arthritis patients as compared to anormal population.

Rheumatoid arthritis (RA) is asystemic autoimmune inflammatory disorder which further doubles the risk of developing cardiovascular disease. Some studies suggest that in RA patients, the prevalence of hypertension increases due to prednisolone use, clinical status, genetic factors, and physical inactivity. On the other hand, dipper and non-dipper status in RA patients compared to non-RA subjects has not been investigated to our knowledge. Purpose of the study is to investigate whether non-dipper status is more deteriorated in RA patients. Sixty-five RA patients and 61age-sex-matched control patients were evaluated in this cross-sectional study. Patients were classified according to 24-h ambulatory blood pressure monitoring results. Patients with previous hypertension diagnosis, coronary artery disease, and abnormal kidney function were excluded. Mean age of the study sample was 53.7 ± 12.3years and 40.5% were male. There was no significant difference between groups in terms of basic demographic characteristics. Leukocyte counts (p = 0.001), neutrophil counts (p = 0.001), and red cell distribution width (p = 0.000) were significantly higher in the RA group. ABPM results indicate no significant difference between RA patients and the control group in terms of daytime systolic and diastolic blood pressure, nighttime systolic and diastolic blood pressure, and average systolic and diastolic blood pressure results (p > 0.05). There was no statistical difference regarding the non-dipper status of patient groups (p = 0.412). Nocturnal blood pressure dipping was significantly similar between groups (p = 0.980). In conclusion, RA patients have similar values in terms of nocturnal blood pressure dipping and hypertension diagnosis as compared to normal population.

The effect of circadian blood pressure pattern on presence of fragmented QRS complexes in hypertensive subjects

The association of deteriorated circadian blood pressure (BP) variability with presence of fragmented QRS (fQRS) on electrocardiography (ECG) is not clear. The present study aims to evaluate the relationship of BP patterns with presence of fQRS on ECG. A total of 338 consecutive newly diagnosed and never treated hypertensive patients who are without left ventricular hypertrophy and underwent 24-hour ambulatory BP monitoring were enrolled. Patients were classified as dippers, nondippers, and reverse dippers according to ambulatory BP monitoring results. The groups were compared regarding frequency of fQRS on ECG. The frequency of fQRS was significantly higher in reverse dippers compared with dippers (37.7% vs. 20.6%, P = .013). In multivariate logistic regression analysis, nighttime systolic BP was found to be an independent predictor of fQRS on ECG (P < .001, 95% confidence interval = 0.901–0.955). Other predictors of fQRS were daytime diastolic BP and age. Furthermore, fQRS was found to be an independent predictor of reverse dipping BP pattern in hypertensive patients (P = .004, odds ratio: 2.416, 95% confidence interval = 1.327–4.396). In conclusion, as a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful to determine the high-risk hypertensive patients in the absence of left ventricular hypertrophy.

The association of night-time systolic blood pressure with ultrasound markers of subclinical cardiac and vascular disease.

The aim of this study was to examine the association of night-time systolic blood pressure (BP) with subclinical cardiac dysfunction measured by global longitudinal strain (GLS) and subclinical vascular damage measured by carotid intima-media thickness (CIMT) and carotid plaques. GLS was measured by speckle-tracking analysis of echocardiogram images. CIMT was measured at the distal 1 cm of the common carotid artery. The presence of carotid plaques was recorded. Philips QLAB cardiac and vascular ultrasound quantification software was used for analysis. The association of night-time systolic BP with GLS, CIMT and carotid plaques was assessed using linear and logistic regression. Fifty (response rate 63%) individuals took part in this study. In univariable models, night-time systolic BP was significantly associated with GLS [β coefficient 0.85 for every 10 mmHg increase, 95% confidence interval (CI): 0.3-1.4] and carotid plaques (odds ratio 1.9 for every 10 mmHg increase, 95% CI: 1.1-3.2). Univariable analysis of daytime systolic BP did not show any statistically significant associations. In age-adjusted and sex-adjusted models, the association for night-time systolic BP and GLS remained significant (β coefficient 0.68 for every 10 mmHg increase, 95% CI: 0.1-1.3). The association for carotid plaques was no longer statistically significant. In multivariable models, findings were diminished. Our results suggest a trend towards an association between night-time systolic BP and subclinical cardiac and vascular disease. When assessing ambulatory blood pressure monitoring results, the absolute night-time systolic BP seems to be a better prognostic parameter than daytime systolic BP, but ultimately a large randomised controlled trial involving chronotherapy is necessary to fully address this.

Autonomic modulation in hypertension without hypertrophy

Objectives Cardiac autonomic modulation and baroreflex sensitivity are altered in individuals with essential hypertension. Hypertension is considered as a strong and independent risk factor for supraventricular and ventricular arrhythmias. The aim of the present study was to evaluate cardiac autonomic control and the arrhythmogenic risk by using 24-h heart rate variability (HRV) and heart rate turbulence (HRT) analysis in essential hypertension without left ventricular hypertrophy (LVH).Methods Fifty-eight newly diagnosed untreated hypertensive patients without LVH (mean age 51 ± 12 years, 26 women) and 56 adult, healthy volunteers (mean age 49 ± 12 years, 24 women) were included in the study. Subjects with secondary causes of hypertension or autonomic dysfunction were excluded. The diagnosis of hypertension was based on ambulatory blood pressure monitoring results. Time-domain HRV parameters and HRT parameters were calculated from 24-hour Holter recordings.Results Values of SDNN and SDANN in the hypertension group were significantly lower than in the control group (P < 0.01 and P < 0.01, respectively). At least one of the turbulence onset (TO) and turbulence slope (TS) values were found abnormal in 10 of 32 hypertensive patients and in 5 of 24 control individuals (P = 0.38). There was no significant difference between HRT parameters, TO and TS (P = 0.67 and P = 0.12, respectively).Conclusions Sympathetic tone begins to increase in hypertension before LVH develops. However, the impact of this increase on HRT is not clear. There is a need for further research to investigate the impact of hypertension and LVH on HRT.

The efficacy offixed combination of bisoprolol and amlodipine in patients with arterial hypertension, ischemic heart disease and metabolic syndrome

The aim of the studyis to evaluate the efficacy of the fixed combination of beta adrenergic receptor blocking agents (β-AB) bisoprolol and dihydropyridine calcium channel inhibitor (CCI) amlodipine in patients with uncontrolled arterial hypertension (AH), stableischemic heart disease (IHD) and metabolic syndrome (MS) in actual clinical practice.Material and methods. The study enrolled 61 patients with uncontrolled AH, stable IHD and MS in the open prospective randomized study. The patients were randomized into 2 groups, using opaque and sealed envelopes. Patients in group 1 (n =30) had been receiving angiotensin-converting enzyme inhibitor (ACE inhibitor or ACE-i) - ramipril in dose of 10 mg/day (Hartil, Egis), fixed combination of bisoprolol and amlodipine (Concor AM, Takeda) in different doses. Patients in group 2 (control, n=31) should have been treated at the discretion of the doctor, necessarily the treatment should have included the free combination of ACE inhibitors, generic b-AB and dihydropyridine CCI. Initially, and after 12 weeks of treatment we conducted 24-hour ambulatory blood pressure monitoring (APBM) with the assessment of key indicators of 24-hour blood pressure monitoring results, the parameters of the blood vessel hardness and central blood pressure. The Statistical analyses of the results were carried out using the software package Statistica 6.1 (StatSoft Inc., United States).Results. After 12 weeks of therapy, the target level of BP was - 96,7% in the 1st group and 87,1% in the 2nd group of patients. The application of Concor AM was accompanied by significant improvements of the indicators of APBM and of the blood vessel hardness and central blood pressure characteristics. In addition, the usage of Concor AM provides the normalization of 24-hour ambulatory blood pressure monitoring results in 73% of patients. In the control group we determined the positive, but less significant changes in the indicators of APBM and rarer normalization of 24-hour ambulatory blood pressure monitoring results than in the group of patients, administrating Concor AM.Conclusion. In patients with AH, IHD and MS the administration of Concor AM is provided a significant antihypertensive and vasoprotective effects, which are more effective by the side of using free combination of β-AB and dihydropyridine CCI.

Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients.

Nocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated. In this cross-sectional study, a total of 524 hypertensive patients were recruited and evaluated with ambulatory BP monitoring between April 2012 and June 2013. Carotid plaque was classified into Grade 0 (normal or no observable plaque), Grade 1 (mild stenosis, 1%-24% narrowing), and Grade 2 (moderate stenosis, ≥25% narrowing). Multinomial logistic regression was applied to analyze the relationship between different degrees of carotid plaque and ambulatory BP monitoring results. Reverse-dipper pattern of BP was more common in older patients, smokers, and those with elevated fasting glucose. The incidences of coronary artery disease, lacunar infarction, and diabetes were also higher among hypertensive with reverse-dipper pattern. Multinomial logistic regression analysis showed that reverse dipper (odds ratio [OR] 2.500; 95% confidence interval [CI] 1.320-4.736; P = 0.005), age (OR 1.089; 95% CI 1.067-1.111; P < 0.001), smoke (OR 1.625; 95% CI 1.009-2.617; P = 0.046), and diabetes (OR 1.759; 95% CI 1.093-2.830; P = 0.020) were significantly different between mild carotid plaque and normal. Our results also suggested that mild carotid plaque was closely related to reverse-dipper pattern of BP (2.308; 95% CI 1.223-4.355; P = 0.010). Reverse-dipper pattern of BP may be a risk factor for carotid atherosclerosis and play a crucial role in the early formation of carotid plaque.

Эффективность фиксированной комбинации бисопролола и амлодипина у пациентов с артериальной гипертонией, ишемической болезнью сердца и метаболическим синдромом

The aim of the studyis to evaluate the efficacy of the fixed combination of beta adrenergic receptor blocking agents (β-AB) bisoprolol and dihydropyridine calcium channel inhibitor (CCI) amlodipine in patients with uncontrolled arterial hypertension (AH), stableischemic heart disease (IHD) and metabolic syndrome (MS) in actual clinical practice.Material and methods. The study enrolled 61 patients with uncontrolled AH, stable IHD and MS in the open prospective randomized study. The patients were randomized into 2 groups, using opaque and sealed envelopes. Patients in group 1 (n =30) had been receiving angiotensin-converting enzyme inhibitor (ACE inhibitor or ACE-i) - ramipril in dose of 10 mg/day (Hartil, Egis), fixed combination of bisoprolol and amlodipine (Concor AM, Takeda) in different doses. Patients in group 2 (control, n=31) should have been treated at the discretion of the doctor, necessarily the treatment should have included the free combination of ACE inhibitors, generic b-AB and dihydropyridine CCI. Initially, and after 12 weeks of treatment we conducted 24-hour ambulatory blood pressure monitoring (APBM) with the assessment of key indicators of 24-hour blood pressure monitoring results, the parameters of the blood vessel hardness and central blood pressure. The Statistical analyses of the results were carried out using the software package Statistica 6.1 (StatSoft Inc., United States).Results. After 12 weeks of therapy, the target level of BP was - 96,7% in the 1st group and 87,1% in the 2nd group of patients. The application of Concor AM was accompanied by significant improvements of the indicators of APBM and of the blood vessel hardness and central blood pressure characteristics. In addition, the usage of Concor AM provides the normalization of 24-hour ambulatory blood pressure monitoring results in 73% of patients. In the control group we determined the positive, but less significant changes in the indicators of APBM and rarer normalization of 24-hour ambulatory blood pressure monitoring results than in the group of patients, administrating Concor AM.Conclusion. In patients with AH, IHD and MS the administration of Concor AM is provided a significant antihypertensive and vasoprotective effects, which are more effective by the side of using free combination of β-AB and dihydropyridine CCI.