Aortic knob width is associated with non-dipping blood pressure pattern

Background: Non-dipping blood pressure (BP) patterns, characterized by disruption in the circadian BP rhythm with an insufficient nocturnal BP decline in 24-hour ambulatory BP measurements, are associated with poor renal and cardiovascular outcomes. However, data on the prevalence of non-dipping BP patterns among population of northwest Nigeria remains scarce. This study aimed to determine the prevalence of non-dipping BP patterns in this population. Methods: A cross-sectional study was conducted among normotensive patients attending the general outpatient department at Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTHS). Participants underwent 24-hour ABPM to assess nocturnal BP decline. Nondipping was defined as a systolic or diastolic nocturnal BP decline of <10% relative to daytime BP. A reverse BP pattern (nocturnal rise) was also evaluated. Data was analyzed to determine the prevalence of non-dipping BP patterns. Results: Among the participants, 77.4% exhibited either systolic or diastolic nocturnal BP decline <10%, indicating a non-dipping pattern. Isolated systolic non-dipping (<10% decline) was observed in 67.7.9% of patients, while isolated diastolic non-dipping occurred in 54.8%. Combined systolic and diastolic non-dipping (<10% decline in both) was present in (45.2%) of the patients. Additionally, a reverse BP pattern (nocturnal rise) was noted in (22.6%) of the study participants, though its prevalence was lower compared to non-dipping. Conclusion: The study found a high preponderance of non-dipping BP patterns in over half the study participants, indicating insufficient nocturnal BP decline. These findings underscore the necessity for greater awareness and targeted interventions to reduce cardiovascular and renal adverse outcome associated with non-dipping BP patterns in this population. Further research is recommended to explore the determinants and long-term implications of non-dipping BP patterns.

sponsorship: The European Union (HEALTH-F7-2011-278249 EU-MASCARA, HEALTH-F7-305507 HOMAGE and the European Research Council Advanced Researcher Grant 294713 EPLORE) and the Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium (G.0881.13 and G.0880.13) currently support the Studies Coordinating Centre (Leuven, Belgium). (European Union|HEALTH-F7-2011-278249 EU-MASCARA, European Union|HEALTH-F7-305507 HOMAGE, European Union (European Research Council)|294713 EPLORE, Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium|G.0881.13, Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium|G.0880.13)

To evaluate the association between non-dipper blood pressure pattern and subconjunctival hemorrhage (SCH). Twenty-seven consecutive patients with nocturnal SCH and 27 age, sex-matched controls were enrolled. Demographic, blood parameters, office blood pressure measurements, 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Mean diastolic blood pressure (DBP) for nighttime (65.03 ± 7.1 vs. 70.78 ± 10.5, p: 0.22), mean heart rate for nighttime (64.54 ± 8.26 vs. 69.93 ± 9.85, p: 0.034), Minimum Systolic Blood pressure(SBP) and DBP values for nighttime (92.44 ± 9.72 vs. 99.44 ± 10.66, p:0.015 and 51.15 ± 8.31 vs. 57.7 ± 11.2, p: 0.018) were higher, nocturnal fall ratio of SBP and DBP were significantly lower in the SCH ( + ) group compared to SCH (-) group (5.38 ± 8.39 vs. 10.34 ± 6.08, p: 0.016 and 4.26 ± 8.92 vs. 13.78 ± 6.97, p < 0001 respectively). Ten patients (37%) in the SCH (-) group and 18 patients (66.7%) in the SCH ( + ) group were non-dippers (p: 0.029). Mean daytime SBP and DBP were higher compared to office measurements of 4 patients (14.8%) in the SCH (-) group and 11 patients (40.7%) in the SCH ( + ) group (p: 0.033). SCH had a strong association with non-dipper blood pressure pattern, higher nocturnal heart rate and masked hypertension which are precursors of myocardial infarction, stroke and renal failure. So, SCH should be considered as a clue for serious diseases such as coronary artery disease, myocardial infarction, stroke and patients should be evaluated for ABPM.

Background: The effect of uric acid on nocturnal dipping in hypertensive patients is unknown. We analyzed the specific relationship between uric acid and nocturnal dipping status in newly diagnosed essential hypertensive patients with normal renal function. Methods: Two hundred fifteen patients with newly diagnosed essential hypertension underwent 24-hour ambulatory blood pressure monitoring, biochemistry analysis and 24-hour urine testing. Results: Patients were classified as either dippers (157 patients) or nondippers (58 patients). Uric acid levels were higher in nondippers than in dippers (345.0 ± 65.4 μmol/L vs. 270.6 ± 59.5 mmol/L, p&amp;lt;0.0001) and positively correlated with the following blood pressure (BP) values: average nighttime ambulatory systolic BP (r=0.325, p&amp;lt;0.0001), average nighttime ambulatory diastolic BP (r=0.203, p=0.003), nighttime mean arterial BP (r=0.285, p&amp;lt;0.0001) and mean 24-hour arterial BP (r=0.197, p=0.004). Uric acid was also positively correlated with nighttime heart rate (r=0.293, p=0.001). Univariate logistic regression analysis showed that a high serum uric acid level (odds ratio [OR] = 3.566; 95% confidence interval [95% CI], 2.397-5.303; p&amp;lt;0.0001) and smoking (OR=2.294; 95% CI, 1.155-4.498; p=0.018) increased the risk of nocturnal nondipping. The results of multivariate analysis showed that serum uric acid levels (OR=3.453; 95% CI, 1.466-8.134; p=0.005) together with fasting blood glucose (OR=1.148; 95% CI, 1.028-1.281; p=0.014) were associated with the nondipping pattern. Conclusions: This study is the first to demonstrate that increased serum uric acid levels are associated with nondipping blood pressure patterns in patients with essential hypertension.

Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991–1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping–dipping (n = 152/33.6%), dipping–non-dipping (n = 198/43.8%), non-dipping–dipping (n = 20/4.4%), and non-dipping–non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping–non-dipping group, and lowest (6.6%) in the dipping–dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping–non-dipping pattern with CV events compared with the dipping–dipping pattern remained significant (HR 4.01; 95% CI 1.89–8.67, p < 0.001). In summary, non-dipping–non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atherosclerosis in hypertensive patients. In this study on diagnostic accuracy, 374 consecutive hypertensive patients with at least one cardiovascular risk factor were enrolled. AKW was measured on chest X-ray. Cardio-ankle vascular index (CAVI) was measured by VaSera-1000 CAVI instrument. The diagnostic value of AKW was assessed using ROC analysis. There was a significant correlation between aortic knob width and CAVI (r=0.45, p<0.001), age (0.39, p<0.001), systolic (r=0.17, p<0.001), diastolic (r=0.23, p<0.001) and mean (r=0.2, p<0.001) blood pressures. In linear regression analysis CAVI (β=0.3, 95% CI 0.33-0.98, p<0.001), age (β=0.3, 95% CI 0.09 - 0.21, p<0.001) and diastolic blood pressure β=0.2, 95% CI 0.08-1.9, p<0.001) were independently associated with AKW. It was significantly higher in patients with subclinical atherosclerosis (CAVI ≥9) than borderline (8 ≤CAVI <9) (41.4±5.5 versus 36.7±5.3 mm, p<0.001) and healthy (CAVI <8) subjects (41.4±5.5 versus 35.5±4.3 mm, p<0.001). Analysis using the ROC curve has demonstrated that aortic knob of 41 mm constitutes the cut-off value for the presence of subclinical atherosclerosis with 71% sensitivity and 77% specificity (AUC-0.67, 95% CI 0.51-0.82). Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis.

Objective. Epicardial fat tissue reflects visceral adiposity and is a suggested cardiometabolic risk factor. Patients with abdominal obesity have an increased prevalence of the non-dipper blood pressure (BP) pattern, but it is unclear whether the same is true of patients with increased epicardial fat thickness (EFT). The association between EFT and circadian BP changes in patients with recently diagnosed essential hypertension was examined. Methods. Sixty hypertensive patients underwent echocardiography, treadmill stress testing, and 24 hours of ambulatory BP monitoring. Epicardial fat thickness and left ventricular mass (LVM) index were measured by using transthoracic echocardiography. The patients were categorized into two groups according to their BP pattern (group 1, non-dippers; group 2, dippers). Results. The mean EFT and LVM of patients in group 1 (n = 24) (EFT, 7.6 ± 2.1 mm; LVM, 130 ± 31.2 g/m2) were significantly greater than those of group 2 (n = 36) (EFT, 5.5 ± 1.2 mm, P = .0001; LVM, 107 ± 23.7 g/m2, P = .002). The average systolic BP over 24 hours (BPs 24) and average diastolic BP over 24 hours (BPd 24) of group 1 (BPs 24, 151.1 ± 17.6 mm Hg; BPd 24, 94.1 ± 16.5 mm Hg) were significantly higher than those of group 2 (BPs 24, 136.7 ± 11.9 mm Hg, P = .0001; BPd 24, 84.6 ± 10.6 mm Hg; P = .008). Multivariate backward logistic regression analysis demonstrated that the non-dipper BP pattern was associated with EFT (standardized β coefficient = 0.87, P = .005) and LVM (standardized β coefficient = 0.43, P = .016). An EFT ≥ 7 mm was associated with the non-dipper BP pattern with 44% sensitivity and 94% specificity (receiver operating characteristic area under curve of 0.72, 95% CI [0.59–0.83], P = .0007). Conclusions. Epicardial fat thickness was above average in newly diagnosed, untreated hypertensive patients with non-dipper BP pattern. The echocardiographic measurement of EFT may be used to indicate increased risk of hypertension-related adverse cardiovascular events.

The assessment of subclinical atherosclerosis is important in the evaluation of a hypertensive patient, as it provides information on the severity of the hypertension and the cardiovascular risk. The aim of this study was to determine the usefulness of the aortic knob width measured on chest radiography in the assessment of subclinical atherosclerosis in hypertensive patients. A total of 126 consecutive hypertensive patients were enrolled. In univariate analysis, there was a strong correlation between carotid intima media thickness (CIMT) and aortic knob width (r=0.62, P<0.001). In addition, there were statistically significant correlations between CIMT and age (r=0.42, P<0.001), systolic pressure (r=0.27, P=0.02), diastolic pressure (r=0.28, P<0.03), and pulse pressure (r=0.31, P<0.001). In linear regression analysis, the aortic knob width (β=0.5, P<0.001), age (β=0.02, P=0.03), and systolic pressure (β=0.03, P=0.005) were the only independent predictors of CIMT. Observation of aortic knob on chest radiograph in hypertensive patients may provide important predictive information of subclinical atherosclerosis.

Nondipping blood pressure (BP) pattern is a potential independent risk factor for chronic kidney disease (CKD). Bedtime administration of valsartan is considered to normalize circadian rhythm and protect the kidneys and heart in CKD patients. However, more clinical trials are needed to confirm this benefit. Sixty patients with nondipping BP pattern and thirty patients with dipping BP pattern were enrolled in this study, and the patients with nondipping BP pattern were randomly divided into two groups and treated with bedtime or awakening doses of valsartan (80-320 mg). Nondipping BP patients treated with bedtime doses of valsartan showed a greater reduction in 24-hour proteinuria and bedtime proteinuria, a greater delayed decline in estimated glomerular filtration rate, and more protection against myocardial hypertrophy (P<.05) compared with patients with the nondipping BP pattern treated with the awakening dose (P<.05). This was similar to patients with dipping BP. No severe clinical complications were recorded in these patients. Valsartan with bedtime dosing in CKD patients with the nondipping BP pattern have better renal and cardiovascular protection. Antihypertensive "chronotherapy" may be useful in clinical practice for CKD patients.

Introduction: Abnormal blood pressure (BP) dipping patterns are associated with increased cardiovascular risk among Africans. This study determined the association between BP dipping patterns and hypertension-mediated organ damage among patients with newly-diagnosed hypertension.Methods: Ambulatory BP monitoring and echocardiography were carried out on 120 participants. Participants were categorized based on the ratio of night-time to day-time systolic BP into 4 patterns: Normal dipper (≥ 10% but &lt; 20%), non-dippers (≥ 0% but &lt; 10%), reverse dippers (&lt;0%) and extreme dippers (≥ 20%).Result: Fifty-one (42.5%) were males, the mean age and body mass index were 44.2±9.8years and 27.1±4.4kg/m2 respectively. The non-dipping pattern was the most prevalent while the reverse dipping had the lowest mitral E/A ratio. Office systolic blood pressure was the only predictor of left ventricular hypertrophy (OR=1.050, 95% CI=1.004-1.098; p-value = 0.034).Conclusions: The non-dipping pattern was the most prevalent abnormal dipping pattern while the reverse dippers had the highest risk of hypertension-mediated organ damage. Office blood pressure was the only predictor of left ventricular hypertrophy. Hence, office BP measurement as well as ambulatory blood pressure measurements are potentially important tools in risk stratification in resource-poor settings of sub-Saharan Africa.

Aberrant circadian rhythm with persistent nocturnal sympathetic hyperactivity has pointed out malfunctioning autonomic nervous system in fibromyalgia (FM) patients. This is a common pathogenesis shared also by patients with nondipping blood pressure (BP) pattern. Therefore, we aimed to investigate the frequency of nondipping BP pattern in normotensive women with newly diagnosed FM compared with healthy women. Sixty-seven normotensive women with new diagnosis of FM and 38 age-matched healthy volunteer women were recruited into the study. All subjects underwent 24-hour ambulatory BP monitoring on a usual working day. Individuals were defined as "dippers" if their nocturnal BP values decreased by more than 10% compared with daytime values; defined as "nondippers" in case of a decline less than 10%. Serum creatinine, fasting blood glucose, cholesterol levels, albumin, and thyroid-stimulating hormone levels were assessed. Ambulatory measurements showed significantly higher diastolic BP values in patients with FM for both average of 24-hour recordings. Patients with FM had significantly lower systolic (9.1 ± 3.9 vs 11.5 ± 4.9, P = 0.010) and diastolic dipping ratios (12.3 ± 6.1 vs 16.1 ± 6.4, P = 0.004). The number of nondippers in the FM group was significantly higher than that of controls for both systolic (66% vs 34%, P = 0.002) and diastolic BP measurements (42% vs 21%, P=0.031). Patients with FM were 3.68 times more likely to be systolic nondipper and 2.69 times more likely to be diastolic nondipper. We have demonstrated a significant relationship between FM and nondipping BP pattern, and we suggest that nondipping profile, which has been closely associated with cardiovascular morbidity, may appear as an additional risk factor in patients with FM.

The nondipping blood pressure (BP) pattern corresponds to a disruption in the circadian BP rhythm with an insufficient decrease in BP levels during nighttime sleep as observed using 24-hour ambulatory BP monitoring. Patients with nondipping BP pattern have poorer renal and cardiovascular outcomes, independent of their average 24-hour BP levels. The pathophysiology of nondipping BP is complex and involves numerous mechanisms: perturbations of (1) the circadian rhythm, (2) the autonomic nervous system, and (3) water and sodium regulation. This review provides an outline of the pathways potentially involved in the nondipping BP profile in different conditions. A recent hypothesis is also discussed involving the role of gut microbiota in the dipping/nondipping patterns, via the fecal diet-derived short chain fatty acids.

Objective: Blood pressure (BP) in humans normally follows a circadian dipping pattern with a decline from day (active) to a night (inactive) period. Such dipping pattern is altered to a non-dipping pattern in salt-sensitive hypertension (SSH), the pathophysiological mechanism of which is not yet clearly understood. Angiotensin II (AngII) induced SSH associated with increased intrarenal AGT generation, which can be suppressed by tumor necrosis factor-alpha (TNFa) formation. We examined the hypothesis that AngII-induced TNF and AGT generation follows an inverse circadian pattern with a decrease in TNF during inactive period that facilitates increased AGT generation leads to non-dipping pattern in SSH. Design and method: Experiments were performed in mice (C57BL6 strain) chronically treated with or without AngII (25 ng/min; osmotic mini-pump) and high salt (HS; 4% NaCl) containing diets for 4 weeks. BP was measured at day and night periods by tail-cuff method. Circadian rhythm in urinary parameters in these nocturnal animals was assessed by 12 hour urine collections using metabolic cages during the active period (7PM to 7AM) and the inactive period (7 AM to 7 PM). Results: In untreated rats (n = 6), mean BP showed dipping pattern (90 ± 3 to 78 ± 2 mmHg from active to inactive period) AngII + HS treatment (n = 6) induced a non-dipping pattern of SSH (109 ± 2 to 106 ± 3 mmHg from active to inactive period). In untreated mice, urinary excretion of TNFa (uTNFa) was higher (0.5 ± 0.2 vs 0.13 ± 0.08 pg/hour) but urinary excretion of AGT (uAGT) was lower (0.28 ± 0.18 vs 0.46 ± 0.14 ng/hour) during the active period compared to that during the inactive period. This inverse relationship between uTNFa and uAGT was exaggerated in AngII+HS treated mice. There were marked increases in uTNFa during active periods (44.6 ± 14.6 pg/hour) which were less during inactive periods (12.1 ± 4.7 pg/hour). Interestingly, uAGT increment was lower during active periods (1.42 ± 0.97 ng/hour) than that in inactive periods (3.98 ± 1.67 ng/hour). Conclusions: TNFa generation suppresses intra-renal AGT formation during active periods but this phenomenon is inversed during inactive periods. The increase in AGT during the inactive period may facilitates a non-dipping BP pattern in SSH.

Association of polycystic ovary syndrome and a non-dipping blood pressure pattern in young women

INTRODUCTION: Ambulatory blood pressure (BP) monitoring (ABPM) is useful for the assessment of hypertension and nighttime blood pressure (BP) patterns. This study aims to determine the prevalence of abnormal nocturnal BP patterns among Filipinos and its associated risk factors. METHODS: This was a cross-sectional study of patients (n=304) who underwent ABPM. Age, sex, BMI (≥25 kg/m2 ) hypertension, diabetes, smoking, lipid profile, creatinine, fasting glucose, previous MI and stroke were recorded. The degree of relationship of clinico-demographic factors with dipping and non-dipping BP patterns was determined. RESULTS: Assessing for risk factors associated with abnormal nocturnal BP, only age (55 years, p=0.009) and diabetes (27.22%, p=0.038) were statistically significant. Age was a significant predictor of abnormal nocturnal BP, explaining 1.69% in the variation of nocturnal BP pattern (p=0.008). For every one-year increase in age, the odds of an abnormal nighttime BP pattern increase by approximately 2.5% (p=0.009). CONCLUSION: There is a statistically significant association of age and diabetes with dipping and non-dipping BP patterns.