Chronopharmacokinetics of melatonin in non-dipper spontaneous hypertension rats / 中国临床药理学与治疗学

AIM: To study the chronological pharmacokinetic differences of melatonin (MEL) in non-dipper spontaneously hypertensive rats (SHR). METHODS: The HPLC detection method of MEL was established, and the specificity, precision, recovery rate and stability of the method were examined. Twelve male SD rats were divided into two groups, and a single dose of MEL (20 mg/kg) was given intragastrically at either 08:00 or 20:00, respectively. Plasma samples were collected at 0, 5, 10, 15, 20, 30, 40, 60, 90, 120, 240, 360 min after drug administration, and the plasma MEL concentration was determined by fluorescence HPLC. RESULTS: The specificity, precision, recovery rate and stability of the MEL detection method established in this study were in line with the requirements of the biological analysis method guidelines, proving that the method was mature and reliable. After MEL was administered at 08:00, the T

Therapeutic effect of adjuvant treatment of acupuncture in a period of day from 7:00 am to 9:00 am on non-dipper essential hypertension / 中国针灸

OBJECTIVE@#To compare the infuences on circadian rhythm of blood pressure in the patients with non-dipper essential hypertension between the combined treatment of time acupuncture and western medication and the simple western medication.@*METHODS@#A total of 70 patients with non-dipper essential hypertension were randomized into an acupuncture plus western medication group (35 cases, 2 cases dropped out) and a western medication group (35 cases). In the western medication group, levamlodipine maleate tablets were taken orally, 2.5 mg each time, once daily. In the acupuncture plus western medication group, on the base of the treatment as the western medication group, acupuncture was applied specially in the period of the day from 7:00 am to 9:00 am. The acupoints included Fengchi (GB 20), Zhongwan (CV 12), Tianshu (ST 25), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36), etc. Acupuncture was given once daily, 5 treatments a week. The duration of treatment in the two groups was 4 weeks. The clinic blood pressure before and after treatment, 24 h ambulatory blood pressure and the levels of serum melatonin (MT) and 5-serotonin (5-HT) were observed in the two groups.@*RESULTS@#The total effective rate of anti-hypertension was 75.8% (25/33) in the acupuncture plus western medication group, better than 54.3% (19/35) in the western medication group (<0.05). The 24 h average systolic blood pressure, the daytime average systolic blood pressure, the daytime average diastolic pressure, and the nighttime average systolic blood pressure were all reduced after treatment in the two groups (<0.05). The reduction effect of the aforementioned 4 indexes in the acupuncture plus western medication group was much more obvious as compared with the western medication group (<0.05). After treatment, the serum level of MT was increased and 5-HT decreased in the patients of two groups (<0.05). The serum level of MT in the acupuncture plus western medication group was higher than that in the western medication group and the level of 5-HT was lower than the western medication group (<0.05).@*CONCLUSION@#Time acupuncture therapy in the period of the day from 7:00 am to 9:00 am, combined with western medication effectively reduce blood pressure and regulate the levels of serum MT and 5-HT so as to maintain the circadian rhythm of blood pressure in patients with non-dipper essential hypertension. The therapeutic effect of this combined treatment is superior to simple western medication.

Characterization of circadian blood pressure patterns using non-linear mixed effects modeling

Characterizing the time course of baseline or pre-drug blood pressure is important in acquiring unbiased estimates of antihypertensive drug effect. In this study, we recruited 23 healthy male volunteers and measured systolic (SBP) and diastolic blood pressure (DBP) over 24 hours on an hourly basis. Using a non-linear mixed effects model, circadian rhythm observed in blood pressure measurements was described by incorporating two cosine functions with periods 24 and 12 hours. A mixture model was applied to identify subgroups exhibiting qualitatively different circadian rhythms. Our results suggested that 78% of the study population, defined as ‘dippers’, demonstrated a typical circadian profile with a morning rise and a nocturnal dip. The remaining 22% of the subjects defined as ‘non-dippers’, however, were not adequately described using the typical profile and demonstrated an elevation of blood pressure during night-time. Covariate search identified weight as being positively correlated with mesor of SBP. Visual predictive checks using 1,000 simulated datasets were performed for model validation. Observations were in agreement with predicted values in ‘dippers’, but deviated slightly in ‘non-dippers’. Our work is expected to serve as a useful reference in assessing systematic intra-day blood pressure fluctuations and antihypertensive effects as well as assessing drug safety of incrementally modified drugs.

Effects of Telmisartan Combined with Finasteride on Blood Pressure Rhythm in Non-dipper Type Hypertensive Patients with Prostatic Hyperplasia / 中国药房

OBJECTIVE: To study the effects of telmisartan combined with finasteride on blood pressure rhythm (BPR) in non-dipper type hypertension patients with benign prostatic hyperplasia (BPH). METHODS: From Jul. 2015 to Dec. 2016, medical information of 190 patients with non-dipper type hypertension complicated with BPH were retrospectively collected from Halison International Peace Hospital, and then divided into control group (n=82) and observation group (n=108) according to therapy plan. Control group was given telmisartan 40 mg, qd; observation group was additionally given finasteride 5 mg, qd, on the basis of observation group. Both groups were treated for 12 months, and followed up once every 3 months. The changes of blood pressure (24 hSBP, 24 hDBP, 24 hPP, dSBP, dDBP, dPP, nSBP, nDBP, nPP), morning blood pressure surge, prostate volume, nocturia times, the changes of BPR (the rate of non-dipper type blood pressure change) were observed in 2 groups. The occurrence of ADR was observed. RESULTS: Before treatment, there was no statistical significance in blood pressure, morning blood pressure surge, prostate volume or nocturia times between 2 groups (P>0. 05). After treated for 3, 6, 12 months, blood pressure, morning blood pressure surge, prostate volume, nocturia times and the rate of non-dipper type blood pressure change in 2 groups were decreased significantly; the observation group was significantly lower than the control group, with statistical significance (P>0. 05). There was no statistical significance in the incidence of ADR between 2 groups (P>0. 05). CONCLUSIONS: Telmisartan combined with finasteride show significant effects on non-dipper hypertension complicated with BPH, effectively reduce the level of blood pressure, prostate volume, nocturia times and improve BPR with good safety. The effect of two-drug is better than that of telmisartan.

Clinical study on blood glucose level and blood pressure variability in hypertensive patients / 天津医药

Objective To explore the relationship between blood glucose level and blood pressure variability in hypertensive patients. Methods A total of 125 hypertensive patients hospitalized in the department of cardiology in our hospital during May 2015 to October 2016 were retrospectively analyzed. Patients were divided into hypertension with diabetes mellitus group (n=59) and hypertension without diabetes mellitus groups (n=66). Data of blood pressure, blood pressure variability and blood glucose levels were analyzed in the two groups. Results (1) Hyperlipidemia, low density lipoprotein and cholesterol levels were significantly lower in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group. Level of glycosylated hemoglobin (HbA1c), 24 h diastolic pressure variability coefficient (24 hDBPCV), daytime systolic blood pressure variability coefficient (dSBPCV), and daytime diastolic pressure variability coefficient (dDBPCV) were significantly higher in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group (P<0.05). (2) Spearman correlation analysis showed that hypertension with diabetes mellitus was positively correlated with 24 hDBPCV, dSBPCV and dDBPCV. (3) ROC curves of HbA1c for diagnosis of non-dipper blood pressure in hypertensive patients showed that the cut-off value of HbA1c was 5.85%and the area under curve was 0.692 (P<0.05). The sensitivity was 71.1% and the specificity was 63.7%. Conclusion The present results demonstrate that blood pressure variability is increased in hypertension patients with higher blood glucose. HbA 1c level has potential clinical value for diagnosis of non-dipper blood pressure in hypertensive patients.

Effect of prescription medication on circadian rhythm of blood pressure in non-dipper hypertensive patients / 实用医学杂志

Objective To explore the effect of combined prescription medication on non-dipper hyperten sive patients.Methods 76 patients with non-dipper hypertensive patients were randomly divided into group A (n =38) and group B (n =38).Telmisartan tablets,hydrochlorothiazide tablets and levamlodipine tablets were given in two groups.Patients in group A take oral medicine at 8 pm,and patients in group B take oral medicine at 8 pm.The levels of plasma angiotensin Ⅱ,plasma endothelin-1 (ET-1),plasma renin,matrix metalloproteinase9 (MMP-9) and Chemerin protein were observed in both groups.Results After treatment,24 h SBP,dSBP and nSBP in group B were significantly lower than those in group A (P ＜ 0.05).The dipper value of group B was significantly higher than that of group A (P ＜ 0.05).The diversion rate of group B was significantly higher than that of group A (P ＜ 0.01).The levels of renin,angiotensin Ⅱ,ET-1,MMP-9 and Chemerin in group B were significantly lower than those in group A at 6 AM and 0:00 (P ＜ 0.05).The degree of change in group B at 0:00 was more significant than that in 6:00 AM (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion The efficacy of telmisartan,hydrochlorothiazide combined with levamlodipine in patients with non-dipper hypertensive patients performs better if patients take medicine at 8 pm other than at 8 pm.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

BACKGROUND: In this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. METHODS: A total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group. RESULTS: The mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors. CONCLUSION: EFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

The correlation of uric acid level and the circadian rhythm of blood pressure in hypertensive patients / 中国医师进修杂志

Objective To investigate the correlation of uric acid(UA) level and the circadian rhythm of blood pressure in hypertensive patients. Methods Among the individuals who presented to the cardiology clinic, 70 patients who had hypertension and were diagnozed with non- dipper hypertension (non-dipper hypertension group) by 24 h ambulatory blood pressure monitoring (ABPM), 70 patients with dipper hypertension patients (dipper hypertension group), and 52 normotensive individuals (control group) were enrolled in this study. Peripheral venous blood samples were collected from all the patients in order to evaluate the hematological and biochemical parameters. All the assessed parameters were compared among three groups. Results The level of UA in non-dipper hypertension group was the highest, in dipper hypertension group was higher and in contrl group was the lowerst:(393.57 ± 53.52), (280.57 ± 41.64), (267.66 ± 59.38) μmol/L, and there were significant differences (P<0.01). Multivariate Logistic regression analysis revealed that the level of UA was an independent risk factor for non-dipper circadian rhythm of blood pressure (P = 0.003, OR = 2.26, 95% CI: 1.34- 3.89). Conclusions The higher level of UA may be a risk factor for non-dipper circadian rhythm of blood pressure in hypertension patients.

Hipertensión matinal y comportamiento non-dipper en embarazadas con hipertensión de guardapolvo blanco / Morning Hypertension and Non-dipper Behavior in Pregnant Women with White Coat Syndrome

Introducción: La hipertensión de guardapolvo blanco (HGB) es común en el embarazo, aunque su evolución clínica durante la gestación se conoce poco. La hipertensión matinal y el comportamiento non-dipper, medidos por monitoreo ambulatorio de la presión arterial (MAPA), se asocian con mayor riesgo de eventos cardiovasculares; no obstante ello, son escasos los estudios en la gestación. Objetivos: El objetivo primario del estudio fue evaluar la hipertensión matinal y el comportamiento non-dipper en embarazadas con HGB versus un grupo control de normotensas. Se planteó como objetivo secundario evaluar si la HGB, la hipertensión matinal y el comportamiento non-dipper en el segundo trimestre del embarazo se relacionan con mayor hipertensión sostenida en el tercer trimestre. Material y métodos: Estudio prospectivo en el que se incluyeron 95 primigestas en la semana 20 de gestación, 50 con HGB y 45 normotensas como grupo control. Se registraron laboratorio de rutina, presión de consultorio y MAPA en la inclusión y a las 32 semanas de gestación. La hipertensión matinal y el comportamiento non-dipper se evaluaron por MAPA. Resultados: La edad, la glucemia y la presión diurna y nocturna por MAPA fueron similares en el examen basal en ambos grupos. Por el contrario, las pacientes con HGB presentaron valores significativamente superiores de hipertensión matinal y comportamiento non-dipper, lo cual se asoció en forma independiente con hipertensión sostenida en el tercer trimestre del embarazo. Conclusiones: Las gestantes con HGB en la semana 20 de embarazo presentaron mayor hipertensión matinal y comportamiento non-dipper y evolucionaron con más frecuencia a hipertensión sostenida que el grupo control de normotensas.

Background: White coat syndrome (WCS) is common during pregnancy, although little is known about its clinical outcome during gestation. Morning hypertension and the non-dipper behavior, measured by ambulatory blood pressure monitoring (ABPM), are associated with greater risk of cardiovascular events. However, there are few studies during pregnancy. Objectives: The primary aim of the study was to evaluate morning hypertension and the non-dipper behavior in pregnant women with WCS versus a control normotensive group. A secondary objective was to evaluate whether WCS, morning hypertension and the non-dipper behavior in the second trimester of pregnancy were associated with greater hypertension in the third trimester. Methods: This prospective study included 95 primiparae in the 20th week of gestation, 50 with WCS and 45 as normotensive control group. Routine lab tests, office blood pressure and ABPM at inclusion and in the 32th week of gestation were recorded. Morning hypertension and the non-dipper behavior were evaluated by ABPM. Results: Age, and baseline blood glucose level and daytime and nighttime blood pressure by ABPM were similar in both groups. Conversely, patients presenting WCS had significantly higher values of morning hypertension and non-dipper behavior, which were independently associated with sustained hypertension in the third trimester of pregnancy. Conclusions: Pregnant women with WCS in the 20th week of gestation presented greater morning hypertension and non-dipper behavior and progressed more frequently to sustained hypertension than the control normotensive group.

The Relationship between Ambulatory Arterial Stiffness Index and Target Organ Damage in Patients with Primary Hypertensive / 天津医药

Objective To investigate the relationship between correlative factors of ambulatory arterial stiffness in-dex (AASI) and target organ damage (TOD) in patients with primary hypertensive. Methods A total of 330 hypertensive pa-tients were included in the study and divided into two groups according to the value of AASI:low AASI group (n=167) and high AASI group (n=163). The value of AASI was obtained from 24-hour ambulatory blood pressure monitor (ABPM). The clinical data were collected including general information, the data of ABPM, results of coronary angiography, left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR) and ankle brachial index (ABI) in two groups. Results There were significantly higher values of age (years:64.91 ± 9.70 vs 59.12 ± 10.00), the proportion of diabetes (33.8% vs 14.8%), the proportion of non-dipper patterns of hypertension (65.6%vs 43.7%), 24-hour pulse pressure (PP, mmHg:65.27± 11.31 vs 56.06±10.51), 24-hour diastolic blood pressure standard deviation(DBPSD, mmHg:9.64±2.47 vs 8.31±2.31), the number of coronary artery lesions (1.78±1.10 vs 1.27±1.07), LVMI (g/m2:125.74±29.65 vs 107.69±23.23) and the proportion of peripheral vascular disease (27.3%vs 16.4%) in high AASI group than those in low AASI group (P<0.01). The level of eGFR was significantly lower in high AASI group than that in low AASI group [mL/(min · 1.73 m2):85.31 ± 20.31 vs 99.67 ± 17.76]. There were positive correlation between AASI and coronary lesions (r=0.235), LVMI(r=0.168) and peripheral vascu-lar disease (r=0.167). And there was a negative correlation between AASI and eGFR (r=-0.187). The multiple linear regres-sion analysis showed that age, diabetes, PP, DBPSD and non-dipper patterns of hypertension were the predictors of AASI. Conclusion AASI correlated with age, diabetes, PP, blood pressure variability and non-dipper patterns of hypertension. The higher level of AASI may relate to the development of TOD in patients with primary hypertensive.

Diurnal Blood Pressure Variation in the Retinal Vein Occlusion

PURPOSE: The purpose of this study was to determine the diurnal blood pressure variation with retinal vein occlusion (RVO) using 24-hour ambulatory blood pressure monitoring (24-hour ABPM). METHODS: The subjects in this study visited the department of ophthalmology from May 2012 to December 2012 and were diagnosed with RVO but had no history of hypertension (HTN). Non-dipper was defined as a nocturnal systolic blood pressure (SBP) decrease less than 10%. These values were used to compare the 24-hour ABPM values of the RVO and the control groups. RESULTS: The 24-hour ABPM values, with the exception of the mean nightly SBP, were statistically different whne the RVO group was compared with the control group. The odds of an RVO patient being a non-dipper compared to dipper were 1.81 times greater than in the control. Additionally, the clinical SBP and DBP in the RVO group were not significantly different when the HTN group and the non-HTN group were compared. In contrast, the mean 24-hour SBP and the mean DBP were significantly different in regard to HTN. CONCLUSIONS: Patients with RVO have a tendency to maintain high BP throughout the day and also during the night. A patient with non-dipper status can be at risk for RVO, even if the patient does not have HTN. Therefore, 24-hour ABPM is an effective management approach for HTN in addition to strict BP control in patients with RVO.

Tratamiento antihipertensivo diurno y nocturno: efecto en la función endotelial de pacientes con patrón non-dipper / Day and night antihypertensive treatment: effect on endothelial function in patients with non-dipper pattern

Analizar el efecto del tratamiento antihipertensivo diurno y nocturno sobre la función endotelial en pacientes con patrón non-dipper identificados en la consulta de la Unidad Cardiometabólica del Departamento de Medicina Interna del Hospital Militar Dr. Carlos Arvelo durante el segundo cuatrimestre (Mayo – Agosto) del año 2012. Se realizó un estudio abierto, prospectivo, descriptivo y analítico durante un período de 8 semanas comparando la respuesta de la hiperemia reactiva y microalbuminuria con el horario de administración del tratamiento antihipertensivo, independientemente del tipo y número de drogas utilizadas. La muestra fue constituida por pacientes hipertensos con patrón non-dippersin otras comorbilidades que fueron diagnosticados en la Unidad Cardiometabólica del Hospital Militar Dr. Carlos Arvelo durante el segundo cuatrimestre del año 2012. La media de edades fue 57,84 ± 5,01DE para el grupo diurno y 55,07 ± 3,77DE para el grupo nocturno. Predominó el sexo femenino 69,23% y 92,3% respectivamente. Se observó mayor caída sistólica y mayor cambio de patrón non-dipper a dipper en el grupo con tratamiento nocturno que en aquel con tratamiento diurno (p=0,016 y p=0,011 respectivamente). No se observaron diferencias significativas con el resto de las variables. Se demostró una relación estadísticamente significativa entre la administración nocturna del tratamiento antihipertensivo y la caída nocturna de presión sistólica, condicionando el cambio del patrón non-dipper a dipper.

To analyze the effect of diurnal and nocturnal anti-hypertensive treatment on endothelial function in patients with a non-dipper pattern identified at the Cardio-metabolic Unit of the Internal Medicine Department, Military Hospital Dr. Carlos Arvelo, Caracas, Venezuela during the second quarter (May – August) of 2012. An open-label, prospective, descriptive and analytical study, was conducted over a period of 8 weeks comparing the reactive hyperemia and microalbuminuria to the schedule of administration of the anti-hypertensive treatment, regardless of the type and number of drugs used. The sample was composed of hypertensive patients with a non-dipper pattern without other comorbidities who consulted at the Cardiometabolic Unit of the Internal Medicine Department at the Military Hospital Dr. Carlos Arvelo during the second quarter of 2012. The average age was 57.84 ± 5.01SD for the day-time group and 55.07 ± 3.77SD for the nocturnal group. Females were predominant over males with 69.23% and 92.3% respectively. There was a greater systolic drop and a greater change from non-dipperto a dipper pattern in the group receiving nocturnal treatment than in the diurnal group (p=0.016 and p=0.011 respectively). No significant differences were observed in the rest of the variables. There was a statistically significant relationship between the nocturnal administration of anti-hypertensive treatment and the night systolic pressure drop, conditioning a change from non-dipper to a dipper pattern.

Relationship between homocysteine and non-dipper pattern in patients with type 2 diabetes mellitus / Relação entre a homocisteína e a condição não dipper em pacientes com diabetes melito tipo 2

OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. SUBJECTS AND METHODS: We compared 50 patien­ts (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males ) in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. RESULTS: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher in non-dipper (respectively 13.4 ± 8.1 µmol/L and 11.8 ± 5 µmol/L) than in dipper subjects (respectively, 11.8 ± 5.8 µmol/L and 10.1 ± 4.2 µmol/L), but there was no significant difference between the two groups (respectively, p = 0.545, p = 0.294). CONCLUSION: In both groups, homocystein levels were higher in non-dipper than in dipper participants, but there was no significant difference between the groups. High homocystein levels and the non-dipper pattern increases cardiovascular risk. Therefore, the relationship between nocturnal blood pressure changes and homocystein levels should be investigated in a larger study.

OBJETIVO: A taxa de redução da pressão arterial noturna (PAN) é menor em pacientes com diabetes melito tipo 2 (DM tipo 2). A hiper-homocisteinemia (HHC) perturba a estrutura e a função vascular, independentemente das causas subjacentes. O risco de desenvolvimento de doenças vasculares é maior em pacientes diabéticos com hiper-homocisteinemia do que em pacientes com níveis normais de homocisteína. O objetivo deste estudo foi investigar se há diferenças entre os níveis de homocisteína em pacientes com DM2 em condição dipper ou não dipper. SUJEITOS E MÉTODOS: Comparamos 50 pacientes (33 mulheres, 17 homens) com DM tipo 2 e 35 indivíduos saudáveis (18 mulheres, 17 homens), usados como grupo controle. A monitorização ambulatorial da pressão arterial (MAPA) e os níveis de hemocisteína foram medidos em todos os pacientes. RESULTADOS: Observamos que a porcentagem de não dipper foi de 72% em pacientes com DM tipo 2 e 57% no grupo controle. Em indivíduos diabéticos e controle, os níveis de homocisteína foram mais altos em indivíduos não dipper (respectivamente 13,4 ± 8,1 µmol/L e 11,8 ± 5 µmol/L) do que em indivíduos dipper (respectivamente, 11,8 ± 5,8 µmol/L e 10,1 ± 4,2 µmol/L), mas não houve diferença significativa entre os dois grupos (respectivamente, p = 0,545, p = 0,294). CONCLUSÃO: Em ambos os grupos, os níveis de homocisteína foram mais altos nos indivíduos não dipper do que nos indivíduos dipper, mas não houve diferença significativa entre os grupos. Altos níveis de homocisteína e a condição não dipper aumentam o risco cardiovascular. Portanto, a relação entre as alterações da pressão arterial noturna e os níveis de homocisteína deve ser investigada em um estudo mais amplo.

Clinical Significance of Nighttime Blood Pressure / 대한내과학회지

It was impossible to measure the nighttime blood pressure in patients with hypertension for more than one hundred years. The introduction of ambulatory blood pressure monitoring made it possible to evaluate the nighttime blood pressure and clinical significances in recent 40 years. There are tremendous evidences for proving that the nighttime blood pressure is the more powerful predictor in cardiovascular morbidity and mortality than conventional office and ambulatory daytime blood pressure. The cardiovascular mortality can be reduced when 5% of nighttime blood pressure decreased from Ohasama registry report. So investigators should reevaluate the antihypertensive drugs in the view points of nighttime blood pressure reduction. And changing the administration schedule of antihypertensive drugs, so called chronotherapy, is effective for controlling the nighttime blood pressure and modifying the blood pressure circadian rhythm. Korean Ambulatory Blood Pressure (KORABP), nationwide ambulatory blood pressure monitoring registry in Korea, may answer unproved questions for controlling nighttime blood pressure.

The Relationship between Anxiety, Depression and 24-hour Ambulatory Blood Pressure in Hotel Employees / 農村醫學 地域保健

OBJECTIVES: Anxiety and depression are known to be associated with hypertension, and blood pressure can vary spontaneously throughout the day. The aim of this study was to evaluate anxiety, depression and 24-hour ambulatory blood pressure (24-h ambulatory BP) in employees at their worksite. METHODS: A total of 107 volunteers among 136 employees at a hotel in Gyeongju, Korea were enrolled in this study between December 2009 and March 2010. The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used to assess anxiety and depression, respectively. Blood pressure was measured using a 24-h ambulatory BP monitoring system. RESULTS: No significant differences in either BAI or BDI scores were found when hypertensive individuals were compared to normotensive individuals. The frequency of diastolic non-dipper was significantly higher in individuals with depressive symptoms compared to those without (p<0.05). Depression was significantly associated with diastolic non-dipper (OR: 6.85, 95% CI: 1.50-30.01). CONCLUSIONS: The results of this study indicate that depression should be considered when deciding upon blood pressure control regimens, and appropriate additive psychotherapy may be beneficial in the treatment of hypertensive patients.

The Relation of Circadian Blood Pressure Variation to Left Ventricular Mass, Diastolic Function, and Dynamic QT Dispersion

BACKGROUND AND OBJECTIVES: A non-dipping pattern in hypertensive patients has been shown to be associated with a greater left ventricular (LV) hypertrophy, LV diastolic impairments and prolonged ventricular repolarization. The dynamic parameters of the QT dispersion (QTd) have been highlighted as markers of ventricular repolarization heterogeneity. The aim of this study was to demonstrate if the extent of nocturnal blood pressure (BP) fall was related to the LV mass, LV diastolic function and dynamic parameters of the QTd. SUBJECTS AND METHODS: 122 subjects, receiving electrocardiography, 24-hour ambulatory BP monitoring, 12 lead-24hr Holter monitoring and 2-dimensional Doppler echocardiography examinations, were enrolled. The subjects were classified as normotensive, dipper and non-dipper. The LV mass (LVM) and LV diastolic indices were measured. Using the QT Guard software, with 12 lead-24hr Holter monitoring, the QTd, mean QTd, QTd variation (the difference between the maximum minus the minimum QTd value observed over the recording time), QTd maximum (the maximum difference of QTd between consecutive beats) and QTd variability (QTd standard deviation) were analyzed. RESULTS: Of the 122 patients, 39 and 40 were placed in the dipper and non-dipper groups, respectively. The non-dipper group had a greater LVM index (LVMI) than the dipper group (p<0.01). The non-dipper group had greater increases in their A velocity (p<0.01), and more prolonged deceleration (p<0.01) and isovolumic relaxation (p<0.01) times than the dipper group. There were no significant differences in the QT and QTc interval between the 3 groups, but the QTd was much more increased in the non-dipper than the dipper and normotensive groups (p<0.01). For the dynamic parameters of the QTd, the QTd variation, QTd maximum and QTd variability were significantly increased in the non-dipper compared to the dipper and normotensive groups (p<0.05). Comparing the dipper and normotensive groups, there were no significant differences in the LVMI, LV diastolic indices, QTd and dynamic parameters of the QTd. CONCLUSION: The non-dipper group of hypertensive patients had a greater LVMI, more impaired LV diastolic function and greater increases in their QTd and dynamic parameters of the QTd compared to the dipper and normotensive groups, suggesting the possibility of a much greater chance of cardiovascular events, and their complications, in the non-dipper compared to the dipper group.

24 hour circadian pattern of blood pressure and its related target organ damage in hypertensive subjects / 대한내과학회지

OBJECTIVE: Pattern with essential hypertension generally shows the same circadian pattern as the normothensive person with a night-time reduction or "DIP" in blood pressure in sleep. The definition of "Dipper" and "Non-dipper" are assigned according to arbitrary criteria e.g. a night time average blood pressure which is at least 10% less than the average daytime blood pressure. Prospective evidence that the absence of an overnight dip is a strong adverse prognostic indicator for target organ damage .Thus we investigate circardian rhythm of blood pressure, related target organ damage, its frequency & drug in hypertensive subjects. Method : 24hr ambulatory blood pressure monitoring, history taking, physical examination, fundoscopy, ECG, chest X ray, dipstick urinanlysis, serum creatinine level are performed in essential hypertensive subjects. Exclusion criteria are duration of hypertension over 5 years, DM, renovascular hypertension & heart failure. RESULTS: Total 42 patients performed study.17 subjects classify dipper group,25 subjects classify non-dipper group. Between dipper & non-dipper group shows no significantly difference at stroke history, C/T ratio over 0.5 in chest X-ray, left ventrcular hypertrophy in ECG,ST-T change in ECG, proteinuria & serum creatinine level. Non-dipper group shows significantly difference to dipper group in frequency of hypertensive retinopathy and number of combined drug used subjects. CONCLUSION: Number of hypertensive retinopathy is significantly frequency in non-dipper group. Hypertensive retinopathy is atherosclerotic complication, thus we predict other target organ damage, therefore non-dipper type circardian rhythm of blood pressure is adverse prognostic factor for target organ damage of hypertensive subjects.

Effect of Highly Concentrated Carbon Dioxide-Bathing on Circadian Blood Pressure Variations in Drug-refractory Hypertensive, Specially Non-dipper Patients / 日本温泉気候物理医学会雑誌

Using a highly concentrated CO₂-bathing, authors studied an effect of the bathing (CO₂: 1, 000ppm, for 10min at 40°C) on circadian blood pressure in six cases of antihypertensive drug-refractory hypertension. The patients were females, ranging from 62 to 70 years old (mean age: 65.8±2.6). All of the patients were diagnosed as the III stage of essential hypertension (according to WHO criteria) and have been treated with captopril, nifedipine or α-methyl DOPA since three to ten years ago. Out of six cases five showed non-dipper pattern in circadian blood pressure. All bathings were done at 16:30 and comparative study of circadian blood pressure between plain water and CO₂-bathing was carried out.<br>The results obtained were as follows.<br>1) In five cases of non-dippers CO₂-bathing exerted the therapeutic effect upon the high blood pressure at night and resulted in the significant decrease in hyperbaric indici of systolic, mean and diastolic blood pressure, comparing with plain water-bathing. However, no significant difference of heart rate was observed between plain water and CO₂-bathing.<br>2) In a case of good responder to antihypertensive drug, a relatively low blood pressure continued all day after CO₂-bathing.<br>From these results it is expected that a highly concentrated CO₂-bathing is useful as supportive therapy to essential hypertension, specially to non-dipper.