Diastolic Blood Pressure Variability Research Articles

BLOOD PRESSURE VARIABILITY IN TWO CONSECUTIVE BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE AND NON-HYPERTENSIVE PATIENTS

Objective: The aim of this study was to compare blood pressure variability (BPV) in two consecutive blood pressure measurements in hypertensive and non-hypertensive patients. Design and method: A total of 92 patients from an outpatient clinic underwent two consecutive blood pressure measurements. The first one was using a calibrated aneroid sphygmomanometer and the second the HBP-1100 automatic blood pressure monitor. Auscultatory measurement was simultaneously performed by two trained observers using a dual-head teaching stethoscope and one supervisor who checked if differences between observers were less than or equal to 4 mmHg. Interval between measurements was at least 30 and at most 60 seconds. Blood pressure variability was defined as the standard deviation around the mean of the two systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. The paired sample t-test was used to determine whether there is a difference between the mean SBP and DBP variability in two observation sets, defined as hypertensive and non-hypertensive patients. Results: A total population of 92 from an outpatient clinic [66.3% female; mean age: 39.18 years; 32.61% hypertensives] underwent two consecutive blood pressure measurements in different methods. 184 valid blood pressure measurements were performed. Mean auscultatory SBP and DBP was 114.13 ± 17.95/ 69.48 ± 14.08 mmHg, respectively. Using the oscillometric method, mean SBP and DBP was 119.26 ± 16.94/71.89 ± 14.047 mmHg. Mean SBP difference between the two measurements was 5.13 ± 8.57 and 2.402 ± 6.85. SBP variability in hypertensive patients is statistically significantly higher (p = 0.01), whereas for DBP there is no significant difference (p = .0.78). Blood pressure variability in hypertensive patients with altered body mass index (BMI) was not statistically different (p = 0.30 and p = 0.56 for SBP and DBP, respectively). Conclusions: Increased SBP variability between two measurements was identified in hypertensive patients, regardless of BMI. As blood pressure variability is a recognized risk factor for cardiovascular events, its investigation should be included in the management of hypertensive care even in the interval between two blood pressure measurements.

THE INFLUENCE OF RENAL DENERVATION ON BLOOD PRESSURE VARIABILITY IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: Comparative evaluation of the impact of renal denervation versus pharmacological treatment with sympathetic nervous system (SNS) blockers on blood pressure variability in patients with resistant hypertension. Design and method: 75 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized into three groups, depending on medication supplimented to the previously administred: group I M - selective I1-imidazoline agonist Moxonidine, group II B – cardioselective beta-blocker Bisoprolol, group III D – renal artery denervation (RDN). Blood pressure variability assessed by ambulatory blood pressure monitoring (ABPM) were determined at baseline, 3 and 6 months follow-up. Results: The media/day and media/night systolic blood pressure (SBP) variability increased at the baseline in all three groups was reduced statistically significant from 3 months of monitoring, reaching the maximum effect towards the end of the study, when its normal values were recorded in all observational groups. Although treatment group supplimented with Moxonidine demonstrated an effect superior to that with Bisoprolol, and RDN - superiority to both, all three schemes had an authentic dynamics in improving SBP at 6 months of evaluation (p < 0,001) (Fig.1). The evolution of diastolic blood pressure (DBP) media/day and media/night variability noted a beneficial effect, starting with 3 months, the improvement of this parameter being maintained until the end of the study. Although the reduction of DBP variability was statistically authentic in all three groups at all stages of evaluation, the Bisoprolol treatment group noted a smaller effect in improving this parameter, the higher net effect being manifested by the RDN patients group (p < 0,001) (Fig.2). Conclusions: RDN in patients with resistant hypertension reduced statistically significant SBP and DBP variability starting with 3 months of follow-up and reaching maximum effect at the end of the study, simultaneously demonstrating superiority over treatment with SNS blockers.

LEFT VENTRICULAR GLOBAL FUNCTION INDEX AND BLOOD PRESSURE PARAMETERS IN UNTREATED PATIENTS WITH HYPERTENSION

Objective: The left ventricular global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance.Typically, LVGFI is assessed with MRI, but recently proposed a technique for calculating this index by echocardiography. It was previously shown that a decrease in LVGFI may be a predictor of adverse outcomes in young patients with hypertension and a preserved ejection fraction. The study aimed to elucidate the association between LVGFI and the features of the daily profile of blood pressure in untreated patients with essential hypertension (EH). Design and method: We included in the study 104 patients with EH (51 men (49%) and 53 women (51%)). Mean age 58,7 ± 11,73 years. All patients had no history of blood pressure-lowering treatment. All patients underwent echocardiography and ambulatory blood pressure monitoring (ABPM). LVGFI (%) was defined as left ventricular (LV) stroke volume/LV global volume∗100% where LV global volume was calculated as the sum of the LV mean cavity volume ((LV end-diastolic volume + end-systolic volume)/2) and myocardium volume (LV mass/density). End-diastolic and end-systolic volume were obtained using Teichholz method. Results: The mean LVGFI was 30,21 ± 7,32%. We performed a correlation analysis of the main clinical characteristics and parameters of ABPM with LVGFI. We found slight correlation between age (r = -0,215, p = 0,028) and body mass index (r = -0,378, p < 0,0001) with the LVGFI. There were no significant associations between office blood pressure and echocardiography parameters. Also mean daily, daytime and night systolic and diastolic blood pressure were not correlated with LVGFI. The most significant associations were found between ABPM systolic (r = -0,307, p = 0,002) and diastolic (r = -0,355, p < 0,0001) blood pressure variability. Patients with the impaired circadian rhythm of blood pressure by type of over-dipper had the lowest LVGFI (26,84 ± 3,301%) compared with patients with normal circadian rhythm (32,43 ± 6,908%) and non-dipper patients (30,49 ± 7,773%), p = 0,041. Conclusions: Lowering of LVGFI is associated with high blood pressure variability and over-dipper circadian rhythm of blood pressure.

RED BLOOD CELL DISTRIBUTION IS INDEPENDENTLY ASSOCIATED WITH DAILY DIASTOLIC BP VARIABILITY

Objective: Previously it was shown that in a large cohort of unselected outpatients there was a strong independent association between elevated red blood cell distribution width (RDW) and increased incidence of cardiovascular events which may be associated with inflammation. The aim of our analysis was to evaluate whether RDW was independently associated with any of proven cardiovascular diagnostic markers. Design and method: We included 171 patients with arterial hypertension who had underwent all diagnostic procedures: office BP measurement, ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (cfPWV), cardio-ankle vascular index (CAVI), haematology test with RDW, vascular ultrasound and echocardiography. The results of Spearman correlation was after that tested in a multivariant regression model. Results: Results. Mean age of our patients was 52,9 ± 1,1 y/o, mean BP was 154,4 ± 2,4/93,3 ± 1,3 mmHg, mean hear rate (HR) 78,3 ± 1,3 bits per min, 37% men and 63% women, mean RDW was 14,8 ± 0,7%. Among all the parameters we have obtained, RDW was significantly inversely associated only with office systolic and diastolic BP (r = -0,189, p = 0,023 and r = -0,206, p = 0,013 respectively), daily diastolic BP (DBP) variability (r = -0,270, p = 0,02) and daily HR variability (r = -0,314, p = 0,027). Moreover, the association RDW with DBP variability remained significant even after the adjustment for office DBP, hemoglobin and erythrocytes level (beta = -0,587, p = 0,022), but correlation of RDW with HR variability after the adjustment for office HR and hemoglobin was not significant (beta = -0,437, p = 0,116) which underlines that HR variability is more associated with blood hemoglobin level. Also we did not find any significant correlations of RDW with any of arterial stiffness, vessel wall thickness, echocardiographic left ventricle mass index and other parameters. Conclusions: A significant correlation of RDW with office systolic and diastolic BP, but more an independent correlation of RDW with DBP variability may demonstrate is role as a potential interesting biomarker which may be used in future studies.

ASSOCIATION BETWEEN SHORT TERM BLOOD PRESSURE VARIABILITY AND ARTERIAL STIFFNESS IN SUSPECTED HYPERTENSIVES

Objective: To evaluate the association between arterial stiffness and short term blood pressure variability (BPV). Design and method: Four hundred fifty-five suspected hypertensive patients were referred to record a 24-hours ambulatory blood pressure monitoring (ABPM), and also were randomly enrolled from a population. They performed an oscillometric pulse wave analysis, using Mobil-O-Graph (I.E.M., Stolberg, Germany), following recommendations of Expert Consensus Document on the Measurement of Aortic Stiffness-2012. They also had a 24- hour of ABPM recorded. ABPM was made following protocols of European Guidelines. Short term BPV was evaluated by systolic or diastolic BP with: the standard deviation (SD) of 24 hs BP (24hBP-SD), Daytime BP-SD, Nighttime BP-SD, the 24 hs BP coefficient of variation (24hs CV), the weighted 24-h BP-SD and average real variability of 24-hour BP (ARV 24-h BP). Statistical Analysis: the Pearson correlation coefficient (r) was calculated by an univariate way comparing all systolic and diastolic BPV measures with brachial pulse wave analysis (bPWV). Partial correlation was adjusted to age and gender, and then for age, gender, 24 hs BP, and office BP do to avoid statistic influence of such confounders. Results: Data from 455 patients were analyzed. Clinical characteristics of the sample: age 48.8 ± 13.93 – women (41.9%), white people (69.5%), treated hypertensives (36%), diabetes (12.7%), statin use 22%, body mass index 28. 6 ± 5.8, smokers (8.6%), obese (36.3%). The findings are showed in table 1. All BPV variables had a significant correlation with bPWV. Daytime BP-SD and weighted 24-h BP-SD showed the best association. The worst results of the correlation were found, in systolic, in nighttime BP-SD, and in diastolic, in 24 hs CV. However, the comparison of diastolic 24hBP-SD and bPWV showed a negative correlation. Conclusions: Our data indicated an association between short blood pressure variability and oscillometric pulse wave velocity. A moderate correlation was demonstrated by systolic BPV and weak by diastolic. The best results of the association between the studied variables were shown in Daytime BP-SD and in weighted 24-h BP-SD.

Visit-to-Visit Blood Pressure Variability and Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.

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Peculiar features of arterial hypertension state on the background of atherosclerosis (clinical and instrumental comparisons)

A comparative analysis of the clinical and functional state of patients with arterial hypertension (AH), depending on the presence or absence of arterial sclerotic disease of the arterial bed is represented. 2 groups of 110 and 60 patients respectively were formed. The 1st group included persons with arterial hypertension (AH) and atherosclerotic changes in the arterial bed, the 2nd — with hypertension and without any atherosclerotic changes. It is shown that patients with hypertension and stenotic changes of the vascular bed are characterized by an increase in the levels of diastolic blood pressure and indicators of systolic and diastolic pressure load during the day. They have signs of structural changes in the cardiovascular system, as proved by indicators of arterial stiff ness, myocardium remodeling, circadian rhythms of blood pressure abnormalities, and, in addition, kidney damage in a chronic form of disease, stage 2–3.On the contrary, hypertension without atherosclerotic changes of the vascular bed is characterized by higher values of systolic blood pressure, increased variability of systolic and diastolic blood pressure during the day, and, in addition, atherogenic dislipoproteinemia and hyperuricemy within the metabolic syndrome are present. As a clinical sign of atherosclerotic vascular changes in patients with hypertension, more “severe” blood pressure is observed. It requires combined antihypertensive therapy, consisting of 3 or more groups of medications.

Beat-to-beat blood pressure variability in patients with obstructive sleep apnea.

Cardiovascular comorbidities in obstructive sleep apnea (OSA) are difficult to treat, perhaps due to autonomic dysfunction. We assessed beat-to-beat blood pressure (BP) variability (BPV) in OSA while considering other markers derived from electrocardiogram and continuous BP signals. We studied 66 participants (33 participants with OSA: respiratory event index [mean ± SEM]: 21.1 ± 2.7 events/h; 12 females, aged 51.5 ± 2.4 years; body mass index: 32.8 ± 1.4 kg/m²; 33 healthy controls: 20 females; aged 45.3 ± 2.4 years; body mass index: 26.3 ± 0.7 kg/m²). We collected 5-minute resting noninvasive beat-to-beat BP and electrocardiogram values. From BP, we derived systolic, diastolic, and mean BP values, and calculated variability as standard deviations (systolic BPV, diastolic BPV, BPV). We also calculated diastole-to-systole time (time to peak). From the electrocardiogram, we derived QRS markers and calculated heart rate and heart rate variability. We performed a multivariate analysis of variance based on sex and group (OSA vs control), with Bonferroni-corrected post hoc comparisons (P ≤ .05) between groups. We calculated correlations of BPV with biological variables. Multivariate analysis of variance showed effects of diastolic BPV and BPV in OSA; post hoc comparisons revealed high diastolic BPV and BPV only in female participants with OSA vs controls. QRS duration was higher in OSA, with post hoc comparisons showing the effect only in males. BPV correlated positively with heart rate variability in controls but not in participants with OSA. BPV correlated positively with time to peak in females with OSA and OSA combined, whereas there was no BPV-time-to-peak correlation in healthy participants. The findings show sex-specific autonomic dysfunction reflected in beat-to-beat BP in OSA. The higher BPV may reflect poor baroreflex control or vascular damage in OSA, which are potential precursors to cardiovascular complications.

Cardiovascular Variability and Reactivity in Major Depressive Disorder

Abstract. This study investigated cardiovascular variability and stress reactivity in major depressive disorder (MDD). While previous research has documented reduced heart rate variability, knowledge about blood pressure variability in MDD remains scarce. Regarding reactivity, a particular focus was placed on the time courses of the cardiovascular responses, which may provide insight into the autonomic mechanisms underlying the hypo-reactivity expected in MDD. In 76 MDD patients and 71 healthy controls, blood pressure was continuously recorded at rest and during mental stress induced by a 3-min serial subtraction task. Compared to controls, patients exhibited lower systolic and diastolic blood pressure, heart rate variability, and systolic and diastolic blood pressure variability. Moreover, smaller stress-related changes in heart rate, systolic and diastolic blood pressure, and sensitivity of the cardiac baroreflex arose in patients. Cardiovascular parameters did not differ between patients using antidepressants and unmedicated patients. According to time-course analysis, reduced hemodynamic modulations in MDD mainly occurred after 50 s of the stress period. Low heart rate variability in MDD reflects deficient top-down integration of the brain mechanisms allowing flexible autonomic and behavioral control; diminished blood pressure variability is indicative of poor homeostatic capacity with respect to the regulation of blood pressure and organ perfusion. Moreover, blunted cardiovascular reactivity implies poor adjustment of energetic resources to internal and environmental demands and may be a correlate of deficient motivational dynamics characterizing MDD. While cardiovascular hypo-reactivity in MDD may be mediated by baroreflex and adrenergic mechanisms, the fast-acting parasympathetic system may play a subordinate role.

Risk factors for hypertension in rheumatoid arthritis patients-A systematic review.

Rheumatoid arthritis is frequently associated with hypertension, which has been shown to increase the risk of cardiovascular disease in these patients. The aim of this systematic review was to explore demographic, behavioural or clinical factors including medication use, associated with incident hypertension in rheumatoid arthritis. MEDLINE and Scopus were searched for eligible studies that longitudinally investigated incident hypertension or changes in blood pressure (BP) in rheumatoid arthritis patients. Publications were screened by two reviewers according to predetermined inclusion and exclusion criteria. The quality of included studies was assessed via the Newcastle Ottawa Scale and Cochrane Risk of Bias Tool. Fourteen studies were deemed eligible and included in this review. The proportion of female subjects ranged from 12 to 87% and the mean age ranged from 47 to 61years. Regular exercise was associated with a decrease in systolic BP, p=0.021. Methotrexate was associated with decreased risk of hypertension in two studies. LEF was associated with increased BP in two studies. COX-2 inhibitors were associated with systolic BP and diastolic BP variability (p=0.009, 0.039, respectively) in one study. Prednisone was found to increase BP and risk of hypertension in three studies. The risk of hypertension in patients taking biologic disease modifying anti-rheumatic drugs (DMARDs) is unclear as some studies report increased BP while others report no difference for biologic compared to conventional DMARDs. Despite limited longitudinal studies exploring this topic, methotrexate and exercise were shown to protect against risk of hypertension in RA patients, while prednisone and COX-2 inhibitors may increase risk of hypertension.

Study of Inter-arm Variation of Blood Pressure in Normal and Diabetic In-dividual in Out Patient Department of Nepal Medical College

Introduction: Growing incidence of hypertension and its significant association with diabetes mellitus are being observed in both developing and developed countries around globe. Scanty literature is available about the comparative study of inter-arm variation of blood pressure in normal individuals and diabetic among Nepalese population. This research was performed to determine extent of inter-arm variation in normal individuals and diabetics.
 Methods: A descriptive observational study was carried out from 2013 January to 2014 January in a tertiary level teaching hospital of Nepal. After taking the consent and giving necessary instructions, blood pressures were measured in both the arms one after another in sitting posture using mercurial sphygmomanometer and Littman cardiosonic stethoscope. Arterial blood pressure was measured by palpatory method followed by auscultatory method The cuff pressure at which the tap sound were first perceived was noted as systolic blood pressure (SBP). Similarly, diastolic blood pressure (DBP) was noted at the point where the sound disappeared.
 Results: A total of 120 volunteers between ages of 40-80 years were studied. Highly significant inter-arm variation of both SBP and DBP was found in diabetics as compared to normal (p<0.01). Highly significant inter-arm variation was found in diabetic male and female as compared to their normal counter parts (p<0.01).
 Conclusion: This study showed that there was significant inter-arm variation of SBP and DBP in diabetic and normal individual. So, this study encourages to measure blood pressure (BP) in both arms for proper treatment planning of an individuals.

Longitudinal association between sleep and 5-year incident metabolic syndrome in older Chinese adults: a community-based cohort study

PurposeOur aim was to investigate the association between sleep and the development of metabolic syndrome (MetS) in Chinese older adults and to accumulate evidence for the prevention of MetS through sleep management. MethodsThis prospective study followed 3005 participants aged over 60 derived from the Weitang Geriatric Diseases Study who were without MetS at baseline. MetS was defined according to the Adult Treatment Panel III (ATP III) criteria. Logistic regression models were fit to assess the association between sleep and MetS incident and a linear regression model was used to examine the impact of sleep duration on every component of MetS. Data on sleep-related parameters were obtained based on a self-reported questionnaire. ResultsAfter five-year follow-up, 13.51% participants developed MetS, of which 46.86% were women. The incidence of MetS was highest among adults who slept 6 h or less and lowest among those who slept 7 h after adjusted for multiple variables. Subgroup analyses showed no gender specificity. The variation of fasting plasma glucose (FBG) for ≥9 h per night was significantly lower than that for 7.01–7.99 h per night (β = −0.18, P < 0.05). Sleeping for 8–8.99 h also decreased the variation of diastolic blood pressure (DBP) compared to 7.01–7.99 h (β = −0.84, P < 0.05). ConclusionWe conclude that both short and long sleep duration are risk factors for MetS incident in older adults.

Hypertension-mediated organ damage regression associates with blood pressure variability improvement three years after successful treatment initiation in essential hypertension.

Blood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short‐term BPV reduction and hypertension‐mediated organ damage (HMOD) regression in hypertensive patients 3‐year post‐treatment initiation regarding BP control. 24‐h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never‐treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima‐media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP < 130/80 mm Hg based on 2nd ABPM and subsequently, patients were characterized as controlled (n = 119, age = 53 ± 11 years) or non‐controlled (n = 61, age = 47 ± 11 years) regarding their BP levels. In the whole population and the controlled group, 24 h SBP/DBP, sBPV/dBPV, LVMI, and IMT were decreased. Additionally, LVMI improvement was related with both sBPV (p < .001) and dBPV reduction (r = .18, p = .02 and r = .20, p = .03, respectively). In non‐controlled hypertensives, PWV was increased. In multiple linear regression analysis, sBPV and dBPV reduction predicted LVMI improvement in total population and controlled group independently of initial office SBP, mean BP, and 24 h‐SBP levels. In middle‐aged hypertensive patients, a 3‐year antihypertensive treatment within normal BP limits, confirmed by 24‐h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement.

Ambulatory Blood Pressure Monitoring and Endothelial Dysfunction in Hypertensive Patients with Diabetes Mellitus Type 2

Aim: Diabetic hypertensive patients have pronounced changes in ambulatory blood pressure profile and endothelial function. But the correlation between the parameters of ambulatory blood pressure monitoring (ABPM) and endothelial dysfunction in diabetic hypertensive patients have not been fully clarified. We studied ABP and endothelial function in a group of diabetic hypertensive patients. Methods: Patients with a glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m(2) were excluded. 120 patients were included into the research. Of these, the first (basic) group made up diabetic hypertensive patients in which there were 34 males and 26 females, the mean age was 56.1±1.3 years, the duration of arterial hypertension (AH) was 12.3±2.1 years and the duration of type 2 diabetes mellitus (DM2) was 4.4±0,7 years. The second (control) group made up 60 non-diabetic hypertensive patients in which there were 27 males and 33 females, the mean age was 55.2±1.2 year and duration of AH was 11.1±0.9 years. The patients in both groups were similar in age, duration of AH. Results:The analysis of the results of the 24-hour ABPM revealed that the number of patients with increased 24 hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability was more among diabetic hypertensive patients than in non-diabetic hypertensive patients (76.7 % versus 21.1 and 70.0 % versus 22.5 %, respectively, p <0,05). There were not any significant changes in pulse rate, SBP and DBP. The amount of non-dipper and night-peaker patients was significantly higher in the basic group than in the control one (60.0 % versus 25.4 %, respectively, p <0,05). It was established that the number of patients with DBP daily value <10 was more significant in diabetic hypertensive patients versus non- diabetic hypertensive patients (33.3 % versus 18.2 %, respectively). We also determined nitric oxide metabolites concentration (nitrites and nitrates (NO)) and endothelin (ET-1) in serum and in 24 h-urine collection to assess endothelial function. So, the concentration of ET-1 in serum was significantly higher in diabetic hypertensive patients compared with non-diabetic hypertensive patients (2.49±0.01 pg/ml versus 1.5±0.07 pg/ml, respectively, p <0,05). NO metabolites concentration in serum and urine was significantly lower in the basic group than in the control group (12.7±1.5 uM versus 19,9±1,8 uM and 428.2±27.9 uM versus 792.1±39.4 uM, respectively, p <0,05). The direct association between SBP, DBP and ET-1 in urine were determined in diabetic hypertensive patients (r = 0.7, r = 0.99, respectively, p < 0.001). The correlation between daily index of SBP and ET-1 in urine (r = -0.58, p < 0.001), daily index of DBP and ET-1 in serum (r = -0.47, p < 0.001) were established in the basic group. Conclusion: The correlation between the parameters of ABPM and endothelial dysfunction in diabetic hypertensive patients were established in this study.

Visit-to-visit blood pressure variability and sleep architecture.

Visit‐to‐visit blood pressure (BP) variability (BPV) is an independent risk factor of cardiovascular disease (CVD). Sleep architecture characterizes the distribution of different stages of sleep and may be important in CVD development. We examined the association between visit‐to‐visit BPV and sleep architecture using in‐lab polysomnographic data from 3,565 patients referred to an academic sleep center. BPV was calculated using the intra‐individual coefficient of variation of BP measures collected 12 months before the sleep study. We conducted multiple linear regression analyses to assess the association of systolic and diastolic BPV with sleep architecture—rapid eye movement (REM) and non‐rapid eye movement (NREM) sleep duration.Our results show that systolic BPV was inversely associated with REM sleep duration (p = .058). When patients were divided into tertile groups based on their BPV, those in the third tertile (highest variability) spent 2.7 fewer minutes in REM sleep than those in the first tertile (lowest variability, p = .032), after adjusting for covariates. We did not find an association of systolic BPV with other measures of sleep architecture. Diastolic BPV was not associated with sleep architecture either. In summary, our study showed that greater systolic BPV was associated with lower REM sleep duration. Future investigation is warranted to clarify the directionality, mechanism, and therapeutic implications.

The differential impact of aerobic and isometric handgrip exercise on blood pressure variability and central aortic blood pressure.

Blood pressure variability and central SBP are independent markers of cardiovascular risk. Data on lifestyle-interventions to reduce these parameters are sparse. The present work reports the differential effects of aerobic vs. isometric handgrip exercise on blood pressure variability and central SBP in a prospective randomized trial. Seventy-five hypertensive patients were randomized to one of the following 12-week programs: isometric handgrip training five times weekly; 'Sham-handgrip training' five times weekly; aerobic exercise training (30 min three to five times/week). Blood pressure variability was assessed by the coefficient of variation in 24-h ambulatory blood pressure monitoring (ABPM). Central SBP was measured noninvasively by the SphygmoCor device (AtCor Medical, Australia). The aerobic exercise program significantly decreased systolic daytime variability (12.1 ± 2.5 vs. 10.3 ± 2.8, P = 0.04), whereas diastolic daytime blood pressure variability was not significantly altered (P = 0.14). Night-time variability was not significantly affected (P > 0.05). Central SBP was reduced from 145±15 to 134 ± 19 mmHg (P = 0.01). Isometric handgrip and sham-handgrip exercise did not significantly affect blood pressure variability (P > 0.05 each). Isometric exercise tended to reduce central SBP (142 ± 19 to 136 ± 17 mmHg, P = 0.06). ANCOVA revealed significant intergroup differences for the change of daytime SBP and DBP variability (P = 0.048 and 0.047, respectively). Aerobic exercise reduces blood pressure variability and central SBP. Isometric handgrip exercise does not reduce blood pressure variability but tends to lower central SBP in this hypertensive population.

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

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

Analyzing Trio-Anthropometric Predictors of Hypertension: Determining the Susceptibility of Blood Pressure to Sexual Dimorphism in Body Stature.

Background Several studies had suggested that complex body stature could be a risk factor of hypertension. Objectives We aim to correlate body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR) of rural dwellers in Afikpo community, Ebonyi State, Nigeria, with blood pressure parameters. Furthermore, we aim to ascertain how each of the anthropometric variables affects blood pressure in men and women, respectively. Materials and Methods A sample of 400 (200 males and 200 females) adults aged 18–89 years were selected for the correlation cross-sectional study. Data for weight, height, waist, and hip circumferences were collected by means of anthropometric measurement protocol with the aid of a calibrated flexible tape and health scale and mercury sphygmomanometer for measurement of blood pressure. A participant was classified as being hypertensive if systolic blood pressure (SBP) was >140 mmHg and diastolic blood pressure (DBP) >90 mmHg. Pulse pressure was recorded as the numeric difference of SBP and DBP. Results The result revealed that male BMI and WHR were higher than those of females while female WHtR was higher than that of males (P < 0.01). The prevalence of hypertension failed to correlate with sex among participants in the study (χ2 = 0.567; P < 0.05). Variation in SBP and DBP of both sexes was dependent on BMI, WHtR, and waist and hip circumference, but not on WHR. The SBP of both sexes and female pulse pressure did correlate with age (P < 0.001). Waist circumference, BMI, and WHtR correctly predicted the variations in SBP, DBP, and pulse pressure. Conclusion The strength of association of BMI, WHtR, and waist girth with SBP and DBP of both sexes was robust and similar, but inconsistent with WHR. Thus, a simple estimation of the trio-anthropometric predictors could serve as a means for routine check or preliminary diagnosis of a patient with hypertension.

Visit-to-visit blood pressure variability is associated with arterial stiffness in Chinese adults: A prospective analysis.

Blood pressure (BP) variability may have its effect on the development of vascular disease. The authors aimed to examine the association between the visit‐to‐visit variability (VVV) of BP and arterial stiffness in Chinese adults. The authors included 1407 participants from a prospective cohort study of community residents who were ≥40 years, without a history of myocardial infarction or stroke, and with data at the baseline, the second and the third visits in 2008, 2009, and 2013. The VVV of BP was defined as the standard deviation (SD), the coefficient of variation (CV), the average successive variability (ASV), and the variability independent of the mean (VIM) in BP levels at the 3 visits. Arterial stiffness was measured by brachial‐ankle pulse wave velocity (ba‐PWV) at the 2nd and the 3rd visits. Levels of ba‐PWV change and the occurrence of an elevated ba‐PWV increased significantly in the highest tertile of VVV measures of systolic BP (SBP) and pulse pressure (PP) compared with the lowest tertile, respectively. The multivariable regression analysis revealed that VVV measures of SBP and PP were significantly associated with levels of ba‐PWV change and the risks of developing an elevated ba‐PWV. The odds ratios (ORs) and 95% confidence intervals (CIs) for the risk were 2.12 (1.57–3.12) and 1.92 (1.38–2.68) in participants with the highest versus the lowest tertile of SBP‐SD and PP‐SD, respectively. No significant association was found for diastolic BP variability measures. The increased long‐term variabilities of SBP and PP were associated with an increased risk of arterial stiffness.

Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders

PurposeIn neuromuscular disorders (NMD), inspiratory muscle weakness may cause sleep-related hypoventilation requiring non-invasive ventilation (NIV). Alternatively, nasal high flow therapy (NHF) may ameliorate mild nocturnal hypercapnia (NH) through washout of anatomical dead space and generation of positive airway pressure. Ventilatory support by NIV or NHF might have favourable short-term effects on sympathovagal balance (SVB). This study comparatively investigated the effects of NHF and NIV on sleep-related breathing and SVB in NMD patients with evolving NH.MethodsTranscutaneous CO2 (ptcCO2), peripheral oxygen saturation (SpO2), sleep outcomes and SVB (spectral analysis of heart rate, diastolic blood pressure variability) along with haemodynamic measures (cardiac index, total peripheral resistance index) were evaluated overnight in 17 patients. Polysomnographies (PSG) were randomly split into equal parts with no treatment, NIV and NHF at different flow rates (20 l/min vs. 50 l/min). In-depth analysis of SVB and haemodynamics was performed on 10-min segments of stable N2 sleep taken from each intervention.ResultsCompared with no treatment, NHF20 and NHF50 did not significantly change ptcCO2, SpO2 or the apnea hypopnea index (AHI). NHF50 was poorly tolerated. In contrast, NIV significantly improved both gas exchange and AHI without adversely affecting sleep. During daytime, NHF20 and NHF50 had neutral effects on ventilation and oxygenation whereas NIV improved ptcCO2 and SpO2. Effects of NIV and NHF on SVB and haemodynamics were neutral during both night and daytime.ConclusionsNHF does not correct sleep-disordered breathing in NMD patients with NH. Both NHF and NIV exert no immediate effects on SVB.