Blood Pressure Rhythm Research Articles

Heart rate deceleration and acceleration capacities associated with circadian rhythm of blood pressure in essential hypertension

BackgroundThis study aimed to investigate the potential association between the circadian rhythm of blood pressure and deceleration capacity (DC)/acceleration capacity (AC) in patients with essential hypertension.MethodsThis study included 318 patients with essential hypertension, whether or not they were being treated with anti-hypertensive drugs, who underwent 24-hour ambulatory blood pressure monitoring (ABPM). Patients were categorized into three groups based on the percentage of nocturnal systolic blood pressure (SBP) dipping: the dipper, non-dipper and reverse dipper groups. Baseline demographic characteristics, ambulatory blood pressure monitoring parameters, Holter recordings (including DC and AC), and echocardiographic parameters were collected.ResultsIn this study, the lowest DC values were observed in the reverse dipper group, followed by the non-dipper and dipper groups (6.46 ± 2.06 vs. 6.65 ± 1.95 vs. 8.07 ± 1.79 ms, P < .001). Additionally, the AC gradually decreased (-6.32 ± 2.02 vs. -6.55 ± 1.95 vs. -7.80 ± 1.73 ms, P < .001). There was a significant association between DC (r = .307, P < .001), AC (r=-.303, P < .001) and nocturnal SBP decline. Furthermore, DC (β = 0.785, P = .001) was positively associated with nocturnal SBP decline, whereas AC was negatively associated with nocturnal SBP (β = -0.753, P = .002). By multivariate logistic regression analysis, deceleration capacity [OR (95% CI): 0.705 (0.594–0.836), p < .001], and acceleration capacity [OR (95% CI): 1.357 (1.141–1.614), p = .001] were identified as independent risk factors for blood pressure nondipper status. The analysis of ROC curves revealed that the area under the curve for DC/AC in predicting the circadian rhythm of blood pressure was 0.711/0.697, with a sensitivity of 73.4%/65.1% and specificity of 66.7%/71.2%.ConclusionsAbnormal DC and AC density were correlated with a blunted decline in nighttime SBP, suggesting a potential association between the circadian rhythm of blood pressure in essential hypertension patients and autonomic nervous dysfunction.

Assessment of 24h ambulatory blood pressure in women with sheehan syndrome: prevalence of hypertension and disruption of the circadian blood pressure rhythm

Assessment of 24h ambulatory blood pressure in women with sheehan syndrome: prevalence of hypertension and disruption of the circadian blood pressure rhythm

Bmal1 Knockout in Rats Results in Hydrocephalus and Behavioral Defects

Circadian rhythms drive many aspects of physiology including brain water homeostasis with increased cerebral spinal fluid flow and brain parenchyma clearance during periods of sleep. Our group has previously reported maintained diurnal rhythms in blood pressure and renal function in rats lacking the core clock gene, ARNTL, or Bmal1. However, we have also observed a robust increase in brain water content and blood brain barrier permeability in knockout rats compared to wildtype (WT) controls. Patients with normal pressure hydrocephaly (NPH) display a triad of symptoms including memory dysfunction, gait disturbances, and urinary incontinence. We hypothesized that the Bmal1 knockout (Bmal1 KO) rat has behavioral symptoms similar to those seen in NPH patients. In an initial series of behavioral tests, we utilized open field and rotarod testing to measure exploratory behavior and locomotion. Following a training trial, male and female rats were tested over 4 different trials performed on sequential days. In 10 minute open field tests, Bmal1 KO rats had a trend toward decreased total movement compared to WT (1980 ± 185 vs 2369 ± 144 cm; p = 0.1430; n = 5 and 6 respectively). Anxiety-like behavior was pronounced in the Bmal1 KO rats compared to WT as evidenced by lower frequency of entries (3.6 ± 0.7 vs 11.0 ± 2.0 entries; p = 0.0098) and decreased time spent (8.0 ± 2.4 vs 25.4 ± 5.6 seconds; p = 0.0261) in the center zone of the open field. Rotarod testing of ramps from 0 to 16.5 cm/s over 5 minutes uncovered a strong trend towards decreased average distance ran (937 ± 256 vs 1540.0 ± 176 cm; p = 0.0775) and max velocity achieved (11.1 ± 1.5 vs 14.5 ± 0.8 cm/s; p = 0.0666) in Bmal1 KO compared to WT. Bmal1 KO rats also had more falling events on the rotarod compared to WT (0.95 ± 0.04 vs 0.73 ± 0.6 falls/trial; p = 0.0098). These findings indicate that in addition to the overt hydrocephalus phenotype of Bmal1KO rats and increased blood brain barrier permeability, lack of Bmal1 induces behavioral and locomotor symptoms similar to those seen in human patients with NPH. We propose that the Bmal1 KO rat can serve as a pre-clinical model for NPH and other forms of hydrocephalus and will shed light on mechanisms of altered central fluid flow that are present in many neurodegenerative diseases associated with aging. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

HYPERTENSION WITH HEALTHY OBESITY IS FAVORABLE IN CIRCADIAN RHYTHM OF BLOOD PRESSURE AND HEART RATE COMPARED WITH PATHOLOGIC OBESITY: KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION (KORHR)

Objective: Metabolically healthy obesity is more advantageous in cardiovascular outcomes than pathologic obesity. This study was to evaluate blood pressure (BP) and heart rate (HR) using 24-hour ambulatory BP monitoring and to compare various types of obesity and non-obesity hypertensives. Design and method: The Korean Registry of Target Organ Damages in Hypertension (KorHR), established in March 2013 was a nationwide prospective observation study including 16 tertiary care hospitals. A total of 1654 hypertensive subjects aged more than 30 years old without a history of obvious cardiovascular disease were divided into 4 groups according to body mass index (BMI) and waist circumference (WC). (table) Office BP and 24-hour ambulatory BP with HR were measured with other laboratory data. Results: A total of 1096 subjects [mean age = 51.4±11.9 years, including 699 (63.8%) male and 524 (47.8%) naïve hypertensives] BMI and WC data were available. There were no significant differences in lipid profile, hs-CRP, and HbA1C levels among various obesity groups (group 1, 2, and 3). However, the 24-hour mean SBP was significantly lower in group 3 compared with other groups. (138.7±15.0 vs. 137.8±12.7 vs. 133.1±17.6∗ vs. 136.5±14.0, ∗p=0.016 vs. other groups) Early morning HR was significantly lower in group 3 (71.1±11.4 vs. 66.2±12.2∗ vs. 66.2±11.8∗ vs. 69.6±11.9 bpm, ∗p=0.026 vs. group 1) and dipper pattern showed a strong tendency of more prevalent in group 3 and 4 with intermediate significance. The results were consistent in both naïve population and patients with anti-hypertensive medications. Conclusions: Healthy obesity hypertensives showed more favorable circadian rhythm in BP and HR than pathologic obesity regardless of metabolic profiles and history of anti-hypertensive medication. This would be a mechanism of advantageous cardiovascular outcomes in healthy obesity hypertensives.

Liver-specific Bmal1 deletion in mice leads to increased aortic stiffness and altered vascular remodeling

Circadian rhythms have an important role in cardiovascular physiology. Circadian clock genes are critical for vascular homeostasis. Global loss of the circadian clock gene Bmal1 increases aortic stiffness with impaired vascular function and blood pressure rhythm in mice. We previously found that hepatocyte-specific Bmal1 deletion (HBK) in the liver changes perivascular adipose tissue-mediated vascular function in young adult mice, indicating that liver circadian clock disruption distally affects function in another tissue and potential cross-talk between the liver and vasculature. We hypothesized that liver-specific Bmal1 deletion leads to aortic stiffness and pathological vascular remodeling. Studies were performed in 4- to 6- month old male HBK and flox control mice. Aortic stiffness, measured by pulse wave velocity, was significantly elevated in HBK mice compared to flox control mice (Flox: 1.84 ± 0.1 m/s; HBK: 2.9 ± 0.2 m/s; n = 5, p &lt; 0.01). Systolic blood pressure (tail-cuff) in the light phase was similar in both flox control and HBK mice (Flox: 101 ± 1 mm Hg; HBK: 103 ± 2 mm Hg; n = 3-5, p = 0.35). Aortas and plasma were collected at ZT2 for histological analysis and metabolite measurements. MetaMorph software analysis of Masson’s Trichrome-stained aortic sections revealed significantly increased aortic wall fibrosis in HBK mice (% fibrosis per area, Flox 17.0% ± 3.3%, HBK 27.4% ± 2.1%, p=0.03). The medial cell number in H&amp;E stained-aortic sections was increased in HBK mice compared to flox control mice (Flox: 534.6 ± 31.9; HBK: 1069 ± 90.1; p &lt; 0.01). TUNEL stained apoptotic cells were also counted and more apoptotic cells were observed in young HBK mice aortas compared to flox controls (Flox: 224.4 ± 56.1; HBK: 408.4 ± 20.8; p = 0.02). Aortic wall thickness was not different in young adult HBK mice compared to flox control mice. Aortic levels of the lipid peroxidation marker vascular 4-hydroxynonenal (4-HNE), a measure of oxidative stress, were similar between flox control and HBK mice. In plasma, the oxidative stress marker, 8-hydroxy-2’-deoxyguanosine (8-OHdG), a DNA damage product, and plasminogen activator inhibitor-1 (PAI-1) were not different between genotypes. In conclusion, our findings indicate that liver circadian clock disruption increases aortic stiffness and fibrosis with higher cell numbers as well as aortic apoptosis. These data suggest that altered vascular remodeling in HBK mice may contribute to aortic stiffness resulting in cardiovascular disease. Funded by P01HL136267 to JSP, R21AA026906 to SMB, and AHA 856877 to PP. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

ANALYSIS OF CIRCADIAN RHYTHM AND DETECTION RATE OF EARLY EVENING ELEVATED BLOOD PRESSURE IN HYPERTENSIVE PATIENTS

Objective: The aim of the study is to investigate the circadian rhythm and detection rate of early evening elevated blood pressure (EEE) in treated and untreated hypertensive patients by ambulatory blood pressure monitoring. Design and method: From February 1, 2020 to February 28, 2023, the total of 1413 hypertensivs underwent ambulatory blood pressure monitoring in 13 medical institutions through the National 13th Five Year Plan Major Cooperation Group for Chronic Disease Prevention and Control (Research on the Application of Lifestyle and Nutritional Intervention Techniques and Strategies for Obesity and Hypertension, No. 2016YFC1300100). Among them, 1026 had taken antihypertensive drugs and 387 had not taken antihypertensive drugs. EEE is defined as average systolic blood pressure is higher or equal to 135mmHg or average diastolic blood pressure is higher or equal to 85mmHg from 6PM to 10PM. The definitions of dipper, non-dipper, super-dipper, and reverse-dipper blood pressure refer to the 2020 China Ambulatory Blood Pressure Monitoring Guidelines. Results: 1. The detection rate of EEE in treated hypertensive patients was 60.4% (620 patients), while the detection rate of EEE in untreated hypertensive patients was 70.5% (273 patients); 2. The detection rate of dipper type in treated hypertensive patients was 21.7% (223 patients), while the detection rate of dipper type in untreated hypertensive patients was 21.7% (84 patients); 3. The detection rate of non-dipper type in treated hypertensive patients was 51.4% (527 patients), while the detection rate of non-dipper type in untreated hypertensive patients was 53.5% (207 patients); 4. The detection rate of super-dipper type in treated hypertensive patients was 1.6% (16 patients), while the detection rate of super-dipper type in untreated hypertensive patients was 1.8% (7 patients); 5. The detection rate of reverse-dipper type in treated hypertensive patients was 25.3% (260 patients), while the detection rate of reverse-dipper type in untreated hypertensive patients was 23% (89 patients). Conclusions: The detection rate of EEE is significantly higher than that of traditional non-dipper, super-dipper, and reverse-dipper blood pressure; It is possible that EEE become a new target for antihypertensive treatment.

Sex-specific role for the clock protein PER1 in renal ET-1 regulation in salt-sensitive hypertension

Global knockout (KO) of the clock protein PERIOD1 (PER1) in male, but not female, C57BL/6J mice displayed both blunted blood pressure and urinary endothelin-1 (ET-1) rhythms. More recently, we showed that Dahl salt-sensitive (SS) Per1 KO male rats had exacerbated SS hypertension, alongside increased renal injury, renal ET-1 gene ( Edn1) expression, and ET-1 peptide expression from kidneys collected during the rat’s inactive period (2 PM). Additionally, we see increased long non-coding RNA EDN1-AS, which has been suggested to modulate ET-1 production. However, it is unknown whether PER1 regulates rhythms of ET-1 in SS rats and whether PER1 regulates ET-1 in a sex-dependent way. The study objective was to test the hypothesis that PER1 negatively regulates renal EDN1-AS and Edn1 to modulate ET-1 in a sex- and time-dependent manner. To test this hypothesis, kidneys were collected during rat’s active period (2 AM) from male and female SS Per1 KO and SS control rats on a normal salt (0.4% NaCl) or 3 weeks high salt (4% NaCl) diet ( N=5-6). Renal ET-1 protein levels were measured by ELISA and semi- and quantitative PCR was performed to quantify the levels of EDN1-AS and Edn1. Renal ET-1 levels were significantly higher at 2 AM than our previously reported data at 2 PM in both SS Per1 KO and control male rats ( p&lt;0.0001). Renal ET-1 levels were significantly increased in male SS Per1 KO rats following a high salt diet ( p=0.0362) but not in females ( p=0.9522). This was also reflected in the Edn1 mRNA levels (male, p=0.0005; female, p=0.0814). EDN1-AS levels were also increased in males ( p=0.0123) but not in females. Interestingly, significant sex differences were seen in EDN1-AS levels, where EDN1-AS levels were higher in males than females following both low and high salt diets, suggesting a potential novel sex-dependent mechanism for ET-1 regulation. Together, these data suggest sex-specific action of PER1 in the regulation of ET-1 in a model of salt-sensitive hypertension. Future work aims to investigate blood pressure and renal injury in female SS Per1 KO rats and whether this apparent negative regulation of ET-1 by PER1 contributes to the SS hypertensive and renal injury phenotype seen in male SS Per1 KO rats. This work was supported by the National Institutes of Health grants R35 HL135749 (to A.S.), R01 342 DK109570 (to M.G. and A.S.), and Department of Veteran Affairs grants I01 BX004024 (to A.S.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

THE EFFECT OF COVID-19 ON NOCTURNAL BLOOD PRESSURE ELEVATION IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: to evalute the effect of COVID-19 on the degree of nocturnal decrease in blood pressure (BP) against the background of antihypertensive therapy (AHT) in patients with arterial hypertension (AH). Design and method: 74 male and female patients with I-III degree of AH(ESH/ESC, 2018) were studied. The mean age of patients was 53.54±1.92 years,duration of AH was 8.61 years. 2 groups of patients were identified: I – patients with AH who had suffered COVID19, (n=42) and 2nd group – patients with AH who had not suffered COVID-19 (n=32). All patients before and 6 months of therapy measured office BP and DBPM. The daily rhythm of blood pressure was determined based on the degree of nocturnal decrease in SBP (DND SBP). Based on the DND SBP data, patients were divided into: “dippers”, “non-dippers”, “over-dippers”, “night pickers”. All patients were prescribed dual or triple AHT. The results are presented as M±SD. Results: Significant improvement in the circadian rhythm of BP with a high degree of reliability in 2nd group of patients initially amounted to 5.31±5.88% in dynamics - 11.6±3.81% (p&lt;0.001). In 1nd group DND SBP initially was 4.8±5.8% versus– 6.3±4.4% (p &gt; 0.01). In 1st group of patients, the number of non-dippers predominated - 53.8%, while night pickers were 15.40%, dippers - 30.8%. A similar picture was observed in group II of patients: 50.0%: 20.0%: 30.0%. Intergroup differences were not significant (χ2=0.086, p=0.958). Analysis of the dynamics of DND SBP in both groups during therapy revealed that 1st in group of patients the number of non-dippers increased significantly, amounting to 77%, while the number of dippers decreased to 23%. On the contrary, in group II of patients, the number of non-dippers and non-dippers decreased slightly to 40%, and the number of dippers significantly increased by 2 times, amounting to 60% of patients. At the same time, the intergroup difference approached significance (χ2 = 3.23, p = 0.072) Conclusions: The previous COVID-19 made a negative contribution to the antihypertensive effectiveness in terms of the dynamics of the degree of nocturnal reduction in BP.

Heart Rate Acceleration and Deceleration Capacities Associated With 24-Hour Circadian Blood Pressure Variation of Hypertension Patients

Abstract OBJECTIVE To observe the relationship between 24-hour ambulatory blood pressure circadian rhythm and heart rate acceleration (AC), deceleration capacities (DC) in patients with hypertension. METHODS A total of 198 patients with essential hypertension were included and were monitored by 24-hour ambulatory blood pressure. Based on the nocturnal decline rate of systolic blood pressure, patients were divided into 2 groups: dippers (decline rate 10%–20%, n = 58) and non-dippers (decline rate &amp;lt;10%, n = 140). DC and AC values were calculated based on dynamic electrocardiogram data and compared between 2 groups. Pearson correlation analysis was used to analyze the correlation between DC, AC, and blood pressure and circadian blood pressure variation. Multivariate logistic regression analysis was used to analyze the influencing factors of non-dippers. RESULTS Compared with dippers, AC increased, while DC, standard deviation of normal R–R intervals (SDNN), percentage of heart beats with difference between adjacent normal RR intervals &amp;gt;50 ms in the total number of NN intervals (PNN50%) decreased in non-dippers (P &amp;lt; 0.05). Pearson analysis showed that AC was positively correlated to nighttime systolic blood pressure (r = 0.297), slowest heart rate (r = 0.221) and negatively correlated to SDNN (r = −0.233) and PNN50 (r = −0.238), while DC was negatively correlated to nighttime systolic blood pressure (r = −0.300), 24-hour average heart rate (r = −0.144), slowest heart rate (r = −0.213), and positively correlated to SDNN (r = 0.230), PNN50 (r = 0.267) (all P &amp;lt; 0.05). Multivariate logistic regression analysis showed that in the model included AC, AC (odds ratio [OR] = 1.320, 95% confidence interval [CI] 1.102–1.580, P = 0.003), age (OR = 1.029, 95% CI 1.001–1.057, P = 0.039), and 24-hour average heart rate (OR = 1.062, 95% CI 1.010–1.116, P = 0.02) were independent risk factors for non-dippers, while in the model included DC, DC (OR = 0.824, 95% CI 0.709–0.956, P = 0.011), age (OR = 1.027, 95% CI 1.001–1.055, P = 0.046), and 24-hour average heart rate (OR = 1.058, 95% CI 1.007–1.113, P = 0.025) were independent risk factors for non-dippers. CONCLUSIONS AC increases and DC decreases in patients with non-dipper hypertension. Nighttime systolic blood pressure positively correlates with AC and negatively correlates with DC. AC and DC are independent risk factors for abnormal circadian rhythm of blood pressure in hypertensives.

Hypertension: Causes and Consequences of Circadian Rhythms in Blood Pressure.

Hypertension is extremely common, affecting approximately 1 in every 2 adults globally. Chronic hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. Despite considerable efforts to define mechanisms that underlie hypertension, a potentially major component of the disease, the role of circadian biology has been relatively overlooked in both preclinical models and humans. Although the presence of daily and circadian patterns has been observed from the level of the genome to the whole organism, the functional and structural impact of biological rhythms, including mechanisms such as circadian misalignment, remains relatively poorly defined. Here, we review the impact of daily rhythms and circadian systems in regulating blood pressure and the onset, progression, and consequences of hypertension. There is an emphasis on the impact of circadian biology in relation to vascular disease and end-organ effects that, individually or in combination, contribute to complex phenotypes such as cognitive decline and the loss of cardiac and brain health. Despite effective treatment options for some individuals, control of blood pressure remains inadequate in a substantial portion of the hypertensive population. Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.

Unique characteristics of Asians with hypertension: what is known and what can be done?

Hypertension remains the leading modifiable risk factor for cardiovascular disease worldwide. Over the past 30 years, the prevalence of hypertension has been increasing in East and Southeast Asia to a greater extent as compared with other Western countries. Asians with hypertension have unique characteristics. This can be attributed to increased impact of obesity on Asians with hypertension, excessive salt intake and increased salt sensitivity, loss of diurnal rhythm in blood pressure and primary aldosteronism. The impact of hypertension on cardiovascular (particularly strokes) and chronic kidney disease is greater in Asians. These unique characteristics underpinned by the diverse socioeconomic backgrounds pose its own challenges in the diagnosis and management of hypertension in Asia.

Effects of chronotype on sleep, mood and cardiovascular circadian rhythms in rotating night shift medical workers.

Whether chronotype affects the health outcomes of night shift work populations is unknown. This study aimed to assess the influence of different chronotypes in the rotating night shift population on sleep status, mood, blood pressure (BP), and heart rate variability (HRV), as well as the circadian rhythm of BP and HRV. A total of 208 rotating night shift workers were included. All participants completed structured questionnaires to assess chronotype, mood and sleep status. During their daily lives outside of the night shift, they underwent 24-hour Holter electrocardiogram monitoring and 24-hour ambulatory blood pressure monitoring. Day-time and night-time BP and BP dipping were obtained. Day-time and night-time HRV values (SDNN, RMSSD, LF, HF, LF nu, SD1, SD2 and SD2/SD1) were calculated and fitted to the cosine period curve. Three circandian parameters (mesor, amplitude and acrophase) were extracted to quantify the circadian rhythm of the HRV indices. Among all three groups, E-type showed more fatigue and sleepiness. In addition, E-type showed blunted diastolic BP dipping. Notably, E-type showed association with higher RMSSD, LF, HF and SD1 in the night time, and higher mesors of RMSSD and LF and amplitude of SD2/SD1 in circadian analysis. Chronotype is a factor affecting fatigue, sleepiness and cardiovascular circadian rhythms of rotating night shift workers. Chronotype should be taken into consideration for managing night-shift rotation to promote occupational health.

Ghrelin is essential for lowering blood pressure during torpor.

Daily torpor is an active hypothermic phenomenon that is observed in some mammals and birds during fasting. A decrease in blood pressure has also been observed in torpor; however, there remains a lack of knowledge of the underlying mechanism. We have previously reported that ghrelin, an orexigenic hormone, has a hypothermic effect and is essential for the induction and maintenance of torpor. It is also known that the ghrelin secretion is enhanced during fasting and that ghrelin receptors are distributed in the cardiovascular system. Therefore, this study was conducted to test the hypothesis that ghrelin is actively involved in the regulation of blood pressure during torpor induction. Male wild-type and ghrelin gene-deficient mice were generated by homologous recombination as previously reported. Mice, 10 weeks old, were included in this study and housed five per cage. The mice were maintained on a 12-h light/dark cycle (lights on from 7:00 to 19:00) with access to food and water ad libitum. The continuous measurement of blood pressure using a telemetry system showed that induction of torpor by fasting did not decrease blood pressure in ghrelin gene-deficient mice. The analysis of heart rate variability revealed that sympathetic nerve activity was predominant in ghrelin-deficient mice during fasting. Furthermore, these features were cancelled by administration of a ghrelin receptor agonist and were comparable to those in wild-type mice. In this study, we showed that blood pressure was elevated in ghrl-/- mice and that the blood pressure rhythm was abnormal. Furthermore, we showed that the ghrelin gene deficiency does not cause sufficient blood pressure reduction upon entry into the torpor, and that the administration of the ghrelin receptor agonist, GHRP-6, causes blood pressure reduction associated with torpor. Thus, we have shown for the first time that the active role of ghrelin is essential for active blood pressure reduction associated with torpor, and that this action is mediated by the inhibition of sympathetic nerve activity by ghrelin.

ПОКАЗАТЕЛИ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ У МУЖЧИН С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ В ЗАВИСИМОСТИ ОТ НАЛИЧИЯ ПСОРИАЗА

The study aims to examine blood pressure indicators in men with arterial hypertension, their dependance on psoriasis, and identification of endothelium dysfunction, with vascular endothelial growth factor in combination of these diseases. The study included 168 male patients who were on outpatient treatment for stage 2 hypertension, of which 86 patients had a progressive stage of moderate severity. All patients underwent daily blood pressure monitoring and a blood test for the content of vascular endothelial growth factor. It was revealed that the level of vascular endothelial growth factor was statistically significantly higher (160.3 ± 49.9 pg/ml, p = 0.0002) in patients with a combination of hypertension and psoriasis than in those with hypertension without psoriasis. In patients with hypertension and psoriasis, statistically significantly (p &lt; 0.05) higher variability of systolic arterial hypertension in the daytime and at night, as well as the rate of morning rise in systolic and diastolic blood pressure were noted. Also, in patients with hypertension and psoriasis, the normal daily blood pressure rhythm (dipper) was recorded more rarely (χ2 = 3.97, p = 0.046) – in 30.2 % of cases, while in patients with hypertension, the dipper daily rhythm was registered in 45 % of cases. The presence of psoriasis aggravates the course of arterial hypertension, a patient with hypertension and psoriasis requires more attention from a general physician, cardiologist and dermatovenerologist.

Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study.

Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.

Circadian blood pressure dysregulation in children with obstructive sleep apnea.

Obstructive sleep apnea (OSA) adversely affects normal blood pressure (BP) and may disrupt circadian BP patterns. We sought to examine 24-hour circadian BP rhythms in children with OSA and healthy controls. Children 5-14 years with OSA and healthy controls underwent 24-hour BP monitoring and actigraphy to quantify sleep. Shape invariant statistical models compared circadian BP patterns (e.g. times of BP peaks, time arrived at peak BP velocity [TAPV]) in the OSA and control groups. The analytic sample included 219 children (mild OSA: n = 52; moderate-to-severe OSA (MS-OSA): n = 50; controls: n = 117). In the morning, the MS-OSA group had earlier TAPV for DBP than controls (51 minutes, p < 0.001). TAPV in the evening was earlier for the MS-OSA group than controls (SBP: 95 minutes, p < 0.001; DBP: 28 minutes, p = 0.028). At mid-day, SBP and DBP velocity nadirs were earlier for the MS-OSA group than controls (SBP: 57 minutes, p < 0.001; DBP: 38 minutes, p < 0.01). The MS-OSA group reached most BP values significantly earlier than controls; the largest differences were 118 minutes (SBP) and 43 minutes (DBP) (p < 0.001). SBP and DBP were elevated in the MS-OSA group (hours 18-21 and 7--12, respectively, p < 0.01) compared to controls. The MS-OSA group was prone to "non-dipping" compared to controls (SBP: odds ratio [OR] = 2.16, 95% CI: 1.09, 4.29; DBP: OR = 3.45, 95% CI: 1.21, 10.23). Children with MS-OSA had changes in circadian BP patterns, namely earlier TAPV and BP peaks and nadirs than controls. Circadian disturbances in BP rhythms may be key to mapping the natural history of BP dysregulation in children with OSA.

Effects of hemodialysis on blood pressure rhythm and toxic metabolites in patients with end-stage renal disease complicated by hypertension.

Effects of hemodialysis on blood pressure rhythm and toxic metabolites in patients with end-stage renal disease complicated by hypertension.

Cardiovascular rhythmicity in overweight and obese children.

Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts. We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms. Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms. The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications.

Features of Allostatic Load in Patients with Essential Hypertension without Metabolic Syndrome Depending on the Nature of Nighttime Decreases in Blood Pressure

Changes in the activity of the renin–angiotensin–aldosterone system are responsible for a stable shift in the regulation of the cardiovascular system in essential hypertension (EH). They can be characterized as hemodynamic allostasis. The purpose of our study was to determine the role of hemodynamic parameters in allostatic load in patients with EH without metabolic syndrome. Twenty-four hours of ambulatory blood pressure monitoring was performed, followed by linear and non-linear rhythm analysis. Based on the daily index, patients with EH were divided into two groups: group 1—patients with no significant nighttime decrease in blood pressure (BP); group 2—patients who had a nocturnal decrease in BP. The control group included healthy persons aged 25 to 69 years. A linear analysis was used to determine the mean values of systolic and diastolic BP, heart rate (HR), time load of BP, circadian index, and structural point of BP. Non-linear analysis was applied to determine the mesor, amplitude, range of oscillations and % rhythm of BP and HR. The allostatic load index (ALI) was also calculated on the basis of the corresponding biomarkers. It was found that ALI was significantly higher in groups 1 and 2 in comparison with the control group. The hemodynamic mechanisms of this increase were different.

The effects of Olmesartan/amlodipine administered in the Morning or At Night on nocturnal blood pressure reduction in Chinese patients with mild-moderate essential hypertension (OMAN Trial): study protocol for a prospective, multicenter, randomized, open-label clinical trial {1}

IntroductionHypertension increases the risk of cardiovascular disease. Uncontrolled nocturnal blood pressure is prevalent in patients taking antihypertensive medication, with an incidence rate of 30–60%. Although chronotherapy with antihypertensive agents may provide a new direction for effective control of nocturnal blood pressure, the clinical evidence base remains controversial. This research is presently underway to compare the effects of morning and bedtime administration of antihypertensive medication on nocturnal reduction and circadian rhythm of blood pressure in patients with hypertension.Methods and analysisThis study is being performed as a randomized, multicenter, open-label, parallel-group, clinical trial in which 720 participants are to undergo 24-h ambulatory blood pressure measurement (ABPM) and office blood pressure measurement (OBPM) at baseline before being randomly assigned to a morning (6–10 am) or a bedtime (6–10 pm) administration group. Each participant receives one 20/5-mg tablet of olmesartan/amlodipine (OA) daily for 4 weeks and is then followed up at 4-week intervals for a total of 12 weeks. During follow-up, the OA dosage is adjusted according to the ABPM and OBPM results. Patients with uncontrolled hypertension at the first follow-up visit will receive an increase in OA dosage to 1.5 tablets/day. For patients with blood pressure that is still uncontrolled after a further 4 weeks, the dosage of OA can be increased to 2 tablets/day. The primary objective is the reduction in mean nocturnal systolic blood pressure between baseline and week 12. The secondary objectives are the reduction in ambulatory blood pressure at weeks 4 and 12 and the blood pressure control rate at weeks 4, 8, and 12.DiscussionAntihypertensive chronotherapy remains controversial. A superiority test hypothesis design has been adopted for this trial, in which all participants will be taking the same antihypertensive medication. We anticipate that our findings will determine if nocturnal blood pressure control in Chinese patients with essential hypertension varies according to whether antihypertensive medication is taken in the morning or at bedtime. This study may provide scientific evidence for the application of chronotherapy in clinical practice.Trial registrationChiCTR2200059719. Registered on 10 May 2022(http://www.chictr.org.cn/edit.aspx?pid=169782&htm=4) {2a,2b}