Analysis of Association of Brain Natriuretic Peptide Levels and Blood Pressure Variability

Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years. Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history. Results: The study found a significant positive association between BNP levels and blood pressure variability (?=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001). Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.

Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023. Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP. Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ??and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.

Correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline / 中华健康管理学杂志

Objective:To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD).Methods:In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD-Q9 questionnaire was used to self-evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow-up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow-up and were included in this study. According to the MoCA score at the end of follow-up (<26 or ≥26), the patients were divided into progression group (39 cases) and non-progression group (44 cases). The difference of MoCA score between baseline and last follow-up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD-Q9 score in the progression group were tested by multiple linear regression analysis. Results:The 4-year progression rate of SCD patients was 46.99% (39/83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD-Q9 score and MoCA score between the progressive group and the non-progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non-progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P=0.016]. There was no significant difference in 24 h DCV between the two groups ( P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference ( r=-0.368, P=0.021). Conclusion:There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value.

Pulse arrival time: Measurement and clinical applications

Pulse arrival time is the time elapsed between the R-wave of electrocardiogram and systolic peak in peripheral pulse obtained by any of the plethysmographic methods. Similarly, differential pulse arrival time, also known as pulse transit time, is the time elapsed between systolic peaks of proximal and distal peripheral pulse recordings in an extremity. Distance between the proximal and distal site in the extremity (in meters) divided by differential pulse arrival time (in seconds) gives arterial pulse wave velocity in the limb segment. Differential pulse arrival time has been used to discriminate between an aortic or arterial block from generalized atherosclerosis in aortic and arterial occlusive diseases for nearly four decades. All along there have been efforts to monitor beat-to-beat blood pressure with the help of these time intervals and other pulse parameters. Encouraging correlation has been observed with that obtained by Finapres. Recently pulse arrival time has been explored for the prompt detection of sudden hypertensive episodes during laryngeal microsurgery, for detection of mental stress, monitoring of baroreflex sensitivity, and real-time monitoring of blood pressure. This paper briefly describes the measurement technique of pulse arrival time and an overview of its clinical applications.

Study of risk factors associated with prognosis in patients with aortic acute cerebral infarction / 中国综合临床

Objective:To explore the risk factors associated with a three-month prognosis in patients with aortic acute cerebral infarction.Methods:A prospective study was conducted on 191 patients with aorthropathic acute cerebral infarction included in the Department of Neurology from June 2018 to December 2019, and the patients were divided into good prognosis group (153 cases) and poor prognosis group (38 cases) according to the MRS score of the patient's 3-month prognosis, and the general data, past medical history and blood pressure variability evaluation index (BPV) between the two groups were correlated analysis. The t-test was used to compare the measurement data with normal distribution, the χ 2 test was used to compare the counting data, and the Logistic regression analysis was used to analyze the risk factors. Results:The proportion of patients with diabetes history in the poor prognosis group (20.3% (31/153)), admission NIHSS score ((3.03±2.01) points), standard deviation (SD) ((12.06±4.46) mmHg) and coefficient of variation (CV) ((8.61±3.08)%) of systolic blood pressure at 24 h were lower than those in the good prognosis group (47.4% (18/38), (5.61±3.84) points, (14.75±3.46) mmHg, (10.41±2.18)%), the differences were statistically significant (the statistical values were χ 2=11.73, t=4.01, t=3.46, t=3.38; P values were 0.001, <0.001, 0.001, and 0.001, respectively). Because 24 h systolic blood pressure SD and 24 h systolic blood pressure CV had obvious collinearity, they were respectively included in the Logistic regression model. Taking diabetes history, NIHSS score and 24 h systolic blood pressure SD into the variables, the multivariate Logistic regression results of adverse prognostic risk factors in patients with acute cerebral infarction showed that the history of diabetes mellitus ( OR=3.649, 95% CI: 1.545-8.648, P=0.003), NIHSS score ( OR=1.472, 95% CI: 1.247-1.725, P<0.001) and 24 h systolic blood pressure SD ( OR=1.201, 95% CI: 1.085-1.336, P<0.001). Taking diabetes history, NIHSS score and 24 h systolic blood pressure CV into consideration, multivariate Logistic regression results of adverse prognostic risk factors in patients with acute cerebral infarction showed that the history of diabetes mellitus ( OR=4.695, 95% CI: 1.873-11.766, P=0.001), admission NIHSS score ( OR=1.922, 95% CI: 1.513-2.441, P<0.001) and 24 h systolic blood pressure CV ( OR=1.220, 95% CI: 1.045-1.425, P=0.012). All are independent risk factors influencing the prognosis of patients. Conclusion:The effect of 24 h systolic blood pressure SD and 24 h systolic blood pressure CV on patient prognosis was more valuable in clinical prediction, and the prognosis value of controlling blood glucose levels in patients with diabetes was higher in patients with cerebral infarction.

Influence of posttraumatic blood pressure variability on post-traumatic stress disorder / 中华危重病急救医学

Objective:To investigate the relationship between blood pressure variability (BPV) and incidence of post-traumatic stress disorder (PTSD) in trauma patients.Methods:Patients admitted to the department of emergency medicine of the Affiliated Hospital of Xuzhou Medical University for acute trauma from January 2018 to December 2021 were enrolled. The clinical data and blood pressure at admission (T1), 10 minutes before anesthesia (T2), 60 minutes after surgery (T3), and 24 hours after surgery (T4) were collected. Coefficient of variation of blood pressure variation [CV-BP, including coefficient of variation of systolic blood pressure (CV-SBP), coefficient of variation of diastolic blood pressure (CV-DBP), coefficient of variation of mean arterial pressure (CV-MAP)] and its quartile were calculated. Patients were divided into Q1 group (CV-MAP ≤ 7.27), Q2 group (7.27 < CV-MAP ≤ 9.50), Q3 group (9.50 < CV-MAP ≤ 14.05) and Q4 group (CV-MAP > 14.05) according to CV-MAP quartile. The PTSD symptoms of the patients were evaluated using the PTSD scale (PCL-5) one month later, and the patients were divided into the PTSD group and the non-PTSD group according to whether PCL-5 score higher than 38. Then the differences of the above indicators were compared and analyzed. Spearman correlation analysis was used to analyze the relationship between each index and PCL-5 score; the risk factors of PTSD were analyzed by univariate binary Logistic regression. Variables with P < 0.05 were included in the multivariate binary Logistic regression model. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of CV-MAP on the incidence of PTSD. Results:A total of 112 patients were enrolled, including 24 in PTSD group and 88 in non-PTSD group. Compared with non-PTSD group, the proportion of women, T1 shock index, proportion of intraoperative and postoperative blood transfusion in PTSD group was higher. Besides, PTSD group also had longer PT, more intraoperative and postoperative blood transfusion, and lower postoperative hemoglobin (Hb) level (all P < 0.05). The T1 SBP, DBP, MAP and T4 MAP of patients in PTSD group were significantly lower than those in non-PTSD group [T1 SBP (mmHg, 1 mmHg≈0.133 kPa): 105.0 (86.3, 121.3) vs. 122.0 (112.0, 132.8), T1 DBP (mmHg): 62.5 (50.0, 77.3) vs. 76.0 (68.5, 82.8), T1 MAP (mmHg): 77.8 (60.4, 91.3) vs. 93.3 (82.5, 99.0), T4 MAP (mmHg): 83.8±9.1 vs. 88.7±10.4, all P < 0.05], CV-SBP, CV-DBP and CV-MAP were higher than those in the non-PTSD group [CV-SBP: 12.80 (10.12, 19.16) vs. 9.30 (6.07, 12.95), CV-DBP: 16.62±6.47 vs. 12.40±5.61, CV-MAP: 14.10 (9.25, 18.85) vs. 8.90 (6.93, 13.29), all P < 0.05]. Spearman correlation analysis showed that there was a positive correlation between CV-MAP and PCL-5 scores in patients with acute trauma ( r = 0.429, P < 0.001); multivariate binary Logistic regression analysis showed that only CV-MAP [odds ratio ( OR) = 1.128, 95% confidence interval (95% CI) was 1.015-1.254, P = 0.025] and CV-DBP ( OR = 1.114, 95% confidence interval (95% CI) was 1.016-1.221, P = 0.022) was the risk factor for PTSD in acute trauma patients. Compared with Q1 group, Q4 group was significantly more likely to develop PTSD ( OR = 18.6, 95% CI was 1.9-179.1, P = 0.012). CV-SBP, CV-DBP and CV-MAP had certain predictive value on PTSD diagnosis in patients with acute trauma according to ROC curve analysis results [area under the ROC curve (AUC) was 0.713, 0.682 and 0.726, respectively], among which CV-MAP has the highest predictive value. When the cut-off value of CV-MAP was 12.158, the sensitivity was 75.0% and the specificity was 69.3%. Conclusion:Higher BPV after trauma is a risk factor for PTSD. Maintaining stable blood pressure in trauma patients is of great significance for prevention and treatment of PTSD.

Variablilidad de la presión arterial, hipertensión arterial nocturna y su asociación con tabaquismo / Blood pressure variability, nocturnal hypertension and its association with smoking / Variabilidade da pressão arterial, hipertensão arterial noturna e sua associação com o tabagismo

Resumen: Introducción: La hipertensión arterial y el tabaquismo son factores de riesgo independientes para el desarrollo de eventos cardiovasculares. El consumo de tabaco determina una elevación aguda de la presión arterial por acción del sistema simpático. Sin embargo los efectos a largo plazo son contradictorios. El aumento de la variabilidad de la presión arterial y la presencia de hipertensión arterial nocturna se asocia con eventos cardiovasculares adversos independientemente de los niveles de presión arterial. Objetivos: Evaluar la asociación entre tabaquismo e hipertensión arterial diurna, nocturna y variabilidad. Material y Métodos: Estudio analítico, observacional, transversal, multicéntrico, que incluye pacientes hipertensos mayores de 18 años con monitoreo ambulatorio de la presión arterial (MAPA). Resultados: Se incluyeron 391 pacientes, siendo 14.6% fumadores. Se encontraron cifras de presión arterial diurna sistólica y diastólica más elevadas en pacientes tabaquistas (p=0.204, p=0.087, respectivamente). Se observó una asociación significativa entre la hipertensión arterial nocturna y la presencia de diabetes mellitus e índice de masa corporal aumentado. No se encontró asociación entre el consumo de tabaco y los distintos patrones de variabilidad, así como tampoco con la hipertensión arterial nocturna. Conclusiones: El grupo de pacientes fumadores presentó una tendencia a cifras de presión arterial media diurna sistólica y diastólica más elevadas que los no fumadores, lo que podría sugerir que el tabaquismo incide en el control de cifras de presión arterial.

Abstract: Introduction: Hypertension and smoking are independent risk factors for the development of cardiovascular events. Tobacco use causes an acute elevation of blood pressure due to the action of the sympathetic system. However, the long-term effects are contradictory. Increased variability in blood pressure and the presence of nocturnal arterial hypertension are associated with adverse cardiovascular events regardless of blood pressure levels. Objectives: To evaluate the association between smoking and daytime and nighttime arterial hypertension and variability. Material and Methods: Analytical, observational, cross-sectional, multicenter study, which includes hypertensive patients over 18 years of age with ambulatory blood pressure monitoring (ABPM). Results: 391 patients were included, being 14.6% smokers. Higher levels of systolic and diastolic daytime blood pressure were found in smoking patients (p = 0.204, p = 0.087, respectively). A significant association was observed between nocturnal arterial hypertension and the presence of diabetes mellitus and increased body mass index. No association was found between tobacco consumption and the different patterns of variability, as well as with nocturnal arterial hypertension. Conclusions: The group of smoking patients showed a trend towards higher mean daytime systolic and diastolic blood pressure figures than non-smokers, which could suggest that smoking affects the control of blood pressure numbers.

Resumo: Introdução: Hipertensão e tabagismo são fatores de risco independentes para o desenvolvimento de eventos cardiovasculares. O uso do tabaco provoca elevação aguda da pressão arterial devido à ação do sistema simpático. No entanto, os efeitos de longo prazo são contraditórios. O aumento da variabilidade da pressão arterial e a presença de hipertensão arterial noturna estão associados a eventos cardiovasculares adversos, independentemente dos níveis de pressão arterial. Objetivos: Avaliar a associação entre tabagismo e hipertensão arterial diurna e noturna e variabilidade. Materiai e Métodos: Estudo analítico, observacional, transversal, multicêntrico, que inclui hipertensos maiores de 18 anos com monitorização ambulatorial da pressão arterial (MAPA). Resultados: Foram incluídos 391 pacientes, sendo 14,6% tabagistas. Níveis mais elevados de pressão arterial diurna sistólica e diastólica foram encontrados em pacientes fumantes (p = 0,204, p = 0,087, respectivamente). Foi observada associação significativa entre hipertensão arterial noturna e presença de diabetes mellitus e aumento do índice de massa corporal. Não foi encontrada associação entre o consumo de tabaco e os diferentes padrões de variabilidade, bem como com a hipertensão arterial noturna. Conclusões: O grupo de pacientes fumantes apresentou tendência a valores médios de pressão arterial sistólica e diastólica mais elevados do que os não fumantes, o que pode sugerir que o tabagismo afeta o controle dos valores da pressão arterial.

Effects of different blood pressure variables and their variabilities on the development of diabetic nephropathy in patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective:To analyze the effects of different blood pressure variables and their variabilities on diabetic nephropathy(DN)in patients with type 2 diabetes.Methods:This prospective cohort study included 3 050 type 2 diabetic patients without DN at baseline from Lee′s clinic in Taiwan, China. The metabolic parameters of patients were regularly checked, and urine albumin creatinine ratio(UACR)were evaluated annually. The average follow-up period was 7 years(3-10 years). The means and standard deviations(SD)of systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure(PP), and mean arterial pressure(MAP)were calculated. According to whether SBP-Mean was higher or lower than 130 mmHg(1 mmHg=0.133 kPa) and SBP-SD was higher or lower than 11.06 mmHg(average SBP-SD), these patients were divided into four groups: Q1(SBP-Mean<130 mmHg, SBP-SD<11.06 mmHg); Q2(SBP-Mean<130 mmHg, SBP-SD≥11.06 mmHg); Q3(SBP-Mean≥130 mmHg, SBP-SD<11.06 mmHg); Q4(SBP-Mean≥130 mmHg, SBP-SD≥11.06 mmHg). In the same way, according to whether PP-Mean was higher or lower than 80 mmHg(average PP-Mean)and PP-SD was higher or lower than 6.48 mmHg(average PP-SD), the patients were divided into Q1-Q4 groups.Results:After adjusting age, sex, and diabetes duration, Cox regression analysis showed that SBP-Mean, SBP-SD, PP-Mean, and PP-SD were the risk factors of DN. After the stratification according to SBP-Mean and SBP-SD, the patients in Q4 group( HR=1.976, P<0.001)had the highest risk while those in Q1 group displayed the lowest risk for DN. Additionally, the patients in Q3 group( HR=1.614, P<0.001)imposed a higher risk than that in Q2 group( HR=1.408, P<0.001). By stratificating the patients based on PP-Mean and PP-SD, the patients in Q4 group revealed the highest risk of DN( HR=1.370, P<0.001)while those in Q1 group had the lowest risk. In addition, the patients in Q3 group( HR=1.266, P<0.001)had a higher risk of DN compared with those in Q2 group( HR=1.212, P<0.001). Conclusion:SBP and PP variabilities are the predictors of DN in patients with type 2 diabetes.

Association between glycated hemoglobin and ambulatory blood pressure or heart rate in hypertensive patients / 中南大学学报(医学版)

OBJECTIVES@#To determine the association between glycosylated hemoglobin (HbA1c) and ambulatory blood pressure or heart rate in hypertensive patients.@*METHODS@#A total of 585 patients, who performed ambulatory blood pressure monitoring (ABPM) from September 2018 to April 2019 in Xiangya Hospital, Central South University, were enrolled and assigned into 2 groups (470 in a hypertensive group and 115 in a normal group). HbA1c levels were compared. According to the HbA1c level, the hypertensive group was divided into 2 subgroups: A high HbA1c group (HbA1c≥6.1%, @*RESULTS@#The hypertensive group had higher HbA1c level than the normal group [(6.1±1.3)% vs (5.1±1.7)%, @*CONCLUSIONS@#In hypertensive patients, HbA1c is positively correlated with ambulate blood pressure, blood pressure load, and heart rate, and it has no correlation with blood pressure variability, heart rate variability, or morning blood pressure.

Clinical Efficacy of Midified Wendantang and Xueyaping Recipe in Middle Aged and Young People with Hypertension and Phlegm Dampness Retention / 中国实验方剂学杂志

Objective:To discuss the clinical efficacy of modified Wendantang combined with Xueyaping recipe in the middle aged and young people with hypertension and syndrome of phlegm dampness accumulation， and investigate its effect on metabolism. Method:One hundred and twenty patients were divided into control group and observation group averagely. Patients in both groups got lifestyle intervention and bisoprolol maleate tablets， 5-10 mg/time， 1 time/day. Patients in observation group additionally took modified Wendantang combined with Xueyaping recipe， 1 dose/day. Patients in control group addiiotnally got placebo granules Banxia Tianma Wan， 6 g/time， 2 times/day. The treatment was continued for 12 weeks in both groups. Blood pressure was measured at home to measure the compliance rate of blood pressure during the treatment and after the treatment. Before and after treatment， 24 h mean systolic blood pressure （24 h SBP）， 24 h mean pulse pressure （24 h PP）， 24 h mean diastolic blood pressure （24 h DBP）， blood pressure variability （BPV） ［24 h systolic blood pressure standard deviation （24 h SSD）， 24 h diastolic blood pressure standard deviation （24 h DSD）， systolic blood pressure variation coefficient （nSCV）， and diastolic blood pressure variation coefficient （nDCV） were recorded，compare night coefficients］. Scores of syndrome of phlegm dampness accumulation， body mass index （BMI） and waist hip ratio （WHR） were evaluated. Levels of uric acid （UA）， total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterin （HDL-C）， low-density lipoprotein cholesterin （LDL-C）， fasting blood glucose （FBG） and fasting insulin （FINS）， insulin resistance index （HOMA-IR）， homocysteine （Hcy）， Cystatin C （CysC）， angiotensin Ⅱ （Ang Ⅱ） and nuclear factor kappa B （NF-<italic>κ</italic>B） were measured. In addition， the safety was evaluated. Result:Compliance rate of blood pressure in observation group was 94.74%（54/57）， higher than 80.70% （46/57） in control group （<italic>χ</italic>²=5.211， <italic>P</italic><0.05）. Levels of 4 h SBP， 24 h DBP， 24 h PP， 24 h SSD， 24 h DSD， nSCV， nDCV， Hcy， CysC， AngⅡ， and NF-<italic>κ</italic>B in observation group were all lower than those detected from control group （<italic>P</italic><0.01）. Score of syndrome of phlegm dampness accumulation was lower than that in control group （<italic>P</italic><0.01）. Levels of UA， TC， TG， LDL-C and HOMA-IR were lower than those in control group （<italic>P</italic><0.05）， while level of HDL-C was higher than that detected from control group （<italic>P</italic><0.05）. Conclusion:Based on lifestyle and western medicine intervention， Wendantang combined with Xueyaping recipe can further control the blood pressure level， reduce the symptoms of phlegm dampness retention syndrome， improve blood pressure variability， improve the compliance rate of blood pressure， improve the metabolism of patients and reduce the risk factors of ASCVD in middle aged and young people with hypertension.

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta,and provide clinically useful information for the prevention and treatment of BPV.Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively.According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV),patients were divided into four groups,and clinical data,biochemical indicators and drug use were compared among 4 groups.Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV.Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study.Their dialysis duration was (48.4±36.1) months,and the median of interdialysis SBP-CV was 8.07％ (5.72％,11.34％).According to the quartile of SBP-CV,the patients were divided into four groups:low BPV group (SBP-CV≤5.72％,253 cases),middle BPV group (5.72％ ＜ SBP-CV≤8.07％,252 cases),high BPV group (8.07％ ＜ SBP-CV≤11.34％,253 cases) and extremely high BPV group (SBP-CV ＞ 11.34％,252 cases),and the dialysis duration,diabetes,ultrafiltration,interdialysis weight gain rate (IDWGR),serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P ＜ 0.05).Logistic multiple regression analysis showed that high IDWGR (OR=1.216,95％CI 1.108-1.435,P ＜ 0.001) was an independent risk factors for interdialysis BPV in MHD patients,while high ultrafiltration volume (OR=0.436,95％CI 0.330-0.575,P ＜ 0.001) and calcium channel antagonists used (OR=0.686,95％CI 0.477-0.986,P=0.042) were independent protective factors.Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients,while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.

Effect of acupuncture on blood pressure variability in elderly patients with cerebral infarction complicated with essential hypertension / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of acupuncture on blood pressure variability (BPV) in elderly patients with cerebral infarction complicated with essential hypertension.@*METHODS@#Seventy-six elderly patients with cerebral infraction complicated with essential hypertension were randomized into an observation group and a control group, 38 cases in each group. acupuncture and nifedipin were given in the control group. On the basis treatment in the control group, the and acupuncture was applied at Renying (ST 9), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36) and Taichong (LR 3) in the observation group for 30 min. The treatment was given once a day, 5 times a week for 8 weeks. The 24-hour ambulatory blood pressure was monitored in the two groups. The changes of blood pressure and blood pressure variability were observed before and after 8 weeks of treatment, and the occurrence of adverse reactions during the treatment were recorded.@*RESULTS@#The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), daytime SBP, DBP, nighttime SBP and DBP were reduced in the two groups after 8 weeks of treatment (0.05).@*CONCLUSION@# and acupuncture method can effectively control the blood pressure and blood pressure variability in the elderly patients with cerebral infraction complicated with essential hypertension.

Aerobic exercise combined with mild to moderate circulatory resistance exercise can improve blood pressure variability and other circulatory indexes of persons with hypertension / 中华物理医学与康复杂志

Objective To observe the effect of aerobic exercise combined with impedance training on the blood pressure variability and other blood-related indexes of patients with hypertension. Methods Ninety patients with essential hypertension were randomly divided into group A, group B and group C, each of 30. All were treated with conventional anti-hypertensive drugs. Groups B and C additionally underwent 40 minutes of aerobic training and group C also received resistance training. There were 3 training sessions a week for 12 weeks. Each subject's 24 h systolic blood pressure (24hSBP), 24 h diastolic blood pressure (24hDBP) and their standard deviations were ob-served before and after the 12 weeks. Blood indexes were examined and a plasma arteriosclerosis index was calculated. Results Before the treatment, there were no significant differences in any of the average measurements among the three groups. After the treatment, the average 24hSBP and 24hDBP of all three groups had decreased significantly, but larger decreases were observed in groups B and C. Compared with group B, the average 24hSBP and 24hDBP of group C had decreased significantly more. The average levels of atherogenic index of plasma ( AIP) and lipoprotein phospholipase A2 of groups B and C were significantly lower than before the treatment and also significantly lower than group A's average. The decrease in group C was significantly greater than in group B. Conclusions Anti-hyperten-sive drugs can lower blood pressure, but cannot effectively control blood pressure variation, reduce blood lipids or im-prove the arteriosclerosis index. Long-term, regular aerobic exercise can decrease these indicators and reduce cardio-vascular disease risk in elderly patients with hypertension. Aerobic exercise combined with mild to moderate circulato-ry resistance exercise is more effective than aerobic exercise alone.

Correlation of blood pressure variability with brachial ankle pulse wave velocity and left ventricular mass index / 上海交通大学学报（医学版）

Objective: To explore the association of blood pressure variability (BPV), especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity (baPWV) and left ventricular mass index (LVMI). Methods: A total of 184 hypertensive patients participated this cross sectional study. Patients were divided into dippers, non-dippers, inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure (SBP) decline. baPWV and LVMI in different groups were compared. Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis. Results: After adjusted by age, BMI, hypertension duration, blood pressure in consulting room, SBP and diastolic blood pressure (DBP) in 24 h, total cholesterol, low density lipoprotein cholesterin, brain natriuretic peptide and ejection fraction, baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group (P=0.000), and LVMI was significantly higher in non-dippers group than in dippers group (P=0.001) and extreme-dippers group (P=0.022). baPWV and LVMI were both significantly correlated to age, 24 h SBP and 24 h DBP, SD value of 24 h SBP and 24 h DBP, daytime SBP and DBP, nocturnal SBP and DBP, SD values of daytime SBP and DBP, SD values of nocturnal SBP and DBP in univariate linear regression models (P<0.05). In multivariate linear regression model, baPWV was independently associated to SD value of nocturnal SBP (β=0.289, P=0.000), nocturnal SBP decline (β=-0.398, P=0.000), daytime SBP (β=0.214, P=0.001) and SD value of daytime DBP (β=0.207, P=0.002), while LVMI was independently associated to 24 h SBP (β=0.348, P=0.000) and SD value of nocturnal SBP (β=0.196, P=0.026). Conclusion: baPWV was independently correlated to SD value of nocturnal SBP, nocturnal SBP decline, daytime SBP and SD value of daytime DBP, while LVMI was independently correlated to 24 h SBP and SD value of nocturnal SBP.

Association between cognitive impairments and blood pressure variability during the day/night cycle in elderly patients treated with hemodialysis / 中华老年医学杂志

Objective To investigate the relationship between cognitive impairments in elderly patients receiving hemodialysis and blood pressure variability during the day/night cycle. Methods A cross-sectional study was performed in 106 hemodialysis patients to evaluate cognitive function with Montreal Cognitive Assessment (MoCA) and blood pressure variability with a 24 h ambulatory blood pressure monitor. A multi-Logistic regression was conducted to analyze potential risk factors associated with cognitive impairments. Results A hundred and six patients had an average age of (73.1 ± 12.9)years.Sixty-nine out of 106 (63.4%) suffered cognitive impairments with MoCA scores lower than 26. Measurements for patients with cognitive impairments versus patients without cognitive impairments included twenty-four-hour ambulatory blood systolic pressure[(151.3 ± 20.1)mmHg vs. (131.1±11.7)mmHg ,P＜ 0.05],day-time average systolic blood pressure[(167.6±28.2)mmHg vs.(139.1 ± 14.2)mmHg ,P ＜ 0.05] ,night-time average systolic blood pressure [(139.9 ± 18.5) mmHg vs.(100.2± 11.3)mmHg ,P＜ 0.05] ,difference in systolic blood pressure between day and night[(167.6 ± 28.2)mmHg vs. (139.1 ± 14.2)mmHg ,P＜ 0.05] ,and coefficient of variation of systolic blood pressure [(8.2 ± 1.6)% vs. (19.9 ± 2.9)%,χ2＝ 44.67 ,P ＜ 0.05].Multi-logistic regression analysis showed that age (OR :1.5 ,95% CI :1.1-2.2 ,P＜0.05) ,education level (OR :1.8 , 95% CI :1.4-2.5 ,P＜0.05) ,anemia (OR :1.7 ,95% CI :1.1-2.6 ,P＜0.05) ,and diabetes (OR :2.1 , 95% CI :1.7-3.1 ,P＜0.05) were associated with cognitive impairments.Moreover ,the coefficient of variation of systolic blood pressure was also independently correlated with cognitive impairments (OR :1.4 ,95% CI :1.1-1.9 ,P＜0.05). Conclusions Cognitive impairment has a high prevalence among elderly hemodialysis patients and is associated with anemia ,age ,education level ,hypertension and diabetes.Besides ,the coefficient of variation of low systolic blood pressure may be an independent risk factor for cognitive impairment.

Analysis on Blood Pressure Variability and Its Influencing Factors of Hypertensive Patients with Different TCM Syndromes / 中国中医药信息杂志

Objective To investigate the TCM syndrome type distribution of hypertensive patients; To analyze the correlation of blood pressure variability (BPV) parameters and its influence factors. Methods The data of 515 hypertensive patients including demographic information, laboratory test parameters, risk factors and clinical symptoms were collected for correlation analysis and the patients were divided to different TCM syndromes. BPV parameters of 515 hypertensive patients were acquired by 24 h ambulatory blood pressure, then our study analyzed and compared the differents of 24 h MSBP, 24 h MDBP, 24 h MSCV, 24 h MDCV, DMSBP, DMDBP, DMSCV, DMDCV, NMSBP, NMDBP, NMSCV, NMDCV between different TCM syndromes. Results There were 160 cases with hyperactivity of yang due to yin deficiency syndrome, 136 cases with turbid phlegm and blood stasis syndrome, 83 cases with overabundant liver-fire syndrome, 69 cases with deficiency of kidney qi, and 67 cases with abundant phlegm-dampness syndrome. The difference of gender and age was statistically significant between different TCM syndromes (P<0.05). Compared with the group of hyperactivity of yang due to yin deficiency syndrome, the level of 24 h MSBP, 24 h MDBP, DMSBP, DMDBP, NMSBP, NMDBP, 24 h MSCV, 24 h MDCV, DMSCV, DMDCV, NMSCV and NMDCV had statistical significance in the groups of turbid phlegm and blood stasis syndrome, overabundant liver-fire syndrome, deficiency of kidney qi and abundant phlegm-dampness syndrome (P<0.05). Logistic regression analysis showed that the factors including gender (female), insomnia (time<6 h), sodium salt intake, emotion and educational level were positively correlated to hyperactivity of yang due to yin deficiency, and other factors including gender (female), age, sodium salt intake and educational level positively correlated with turbid phlegm and blood stasis syndrome. And the study also showed that age, sodium salt intake, family history of hypertension and educational level were positively correlated to abundant phlegm-dampness syndrome. Conclusion The BPV parameters and blood pressure are significantly increased d in the group of hyperactivity of yang due to yin deficiency than other groups, but decrease in the group of abundant phlegm-dampness syndrome. Hyperactivity of yang due to yin deficiency syndrome, abundant phlegm-dampness syndrome and turbid phlegm and blood stasis syndrome are closely related to the influencing factors that lead to cardiovascular and cerebrovascular events.

Blood pressure variability and its clinical significance in patients with acute cerebral infarction combined with H type hypertension / 中国医学装备

Objective:To investigate the blood pressure variability and its clinical significance in patients with acute cerebral infarction who combined with H type hypertension.Methods: 95 patients with acute cerebral infarction who combined with H type hypertension were enrolled in the perspective study. According to the homocysteine(Hcy) level of patients, they were divided into observation group ( Hcy ≥10mmol/L, 51cases) and control group (Hcy<10mmol/L, 44cases). The blood pressure variability and main clinical features of these patients in the two groups in 24h were observed. At the same time, the correlation between blood pressure variability and main clinical feature in observation group were analyzed.Results: The 24h systolic pressure variability, 24h diastolic pressure variability, carotid intima-media thickness and national institute of health stroke scale (NIHSS) of observation group were 14.57±4.62, 18.57±5.38, 13.39±4.85 mm and 1.27±0.17, respectively. While they were 12.48±3.78, 16.12±5.74, 11.34±4.32 mm and 1.09±0.13 in the control group, respectively. And the differences of them between the two groups were statistical significance (t=2.389,t=2.146,t=2.160,t=5.725,P<0.05). Besides, there was obvious positive correlation between 24h systolic pressure variability and NIHSS of patients with acute cerebral infarction (r=0.254,P<0.05), and there was also obvious positive correlation between 24h systolic pressure variability and thickness of carotid intima-media (r=0.256,P<0.05).Conclusion: Increased blood pressure variability in patients with acute hypertensive cerebral infarction combined with H type hypertension may be related to poor prognosis of patients and vascular intima thickness.

Relationship Between the Systolic Blood Pressure Variability and Glomerular Filtration Rate in the Elderly / 中国循环杂志

Objectives:To investigate the correlation between the systolic blood pressure variability and glomerular filtration rate in the elderly. Methods:From retired employees who participated in the third time physical examination of Kailuan group to underwent 24-hour ambulatory blood pressure monitoring. A total of 3 064 subjects aged over 60 years were recruited by cluster sampling method. 2 464 participants who met the inclusion were included and tested the renal function, with estimated glomerular filtration rate (eGFR) as indicators of renal function evaluation. Finally, 1 382 cases up to the standard. Multiviate regression models were performed to analyze the correlataion beteen short-term MMD and eGFR. Results:The mean age of 1 382 participants was (67.16±5.86) years, and 905 individuals (65.5%) were male. Levels of eGFR decreased with the increased of MMD (P＜0.05). Pearson correlation analysis indicated that eGFR was positively correlated with 24 hr-MMD、day-MMD and night-MMD(P＜0.05). Multivarite linear regrsssion analysis indicated that 24 hr-MMD、day-MMD were correlated with eGFR. Conclusions:24 hr-MMD、day-MMD are correlated with eGFR.

The effects of isometric resistance training conducted using handgrip exercise on blood pressure variability in hypertensive patients with minor ischemic stroke / 中国实用护理杂志

Objective The present study aimed to evaluate the effects of isometric resistance training(IRT)conducted using handgrip exercise on blood pressure variability (BPV) and heart rate variability (HRV) in hypertensive patients with minor ischemic stroke (MIS).Methods One hundred and twenty-five hypertensive patients with MIS were included in the present study. Patients were randomized into two groups with random number table. Patients in the control group (n=60) were nursed in the routine care in department of neurology, while patients in the experimental group (n=65) received the IRT.The 24-hour ambulatory blood pressure-monitoring assessment was performed using validated oscillometric recorders (A&D TM- 2430, A&D Inc.,Tokyo,Japan).The 24- hour ambulatory electrocardiography measurement was performed using electrocardiocorder(PI200A-A, QunTian Inc.,Shanghai,China).The BPV ratio and the HRV ratio were assessed in the two groups. Results 24 hours after the intervention, intervention group 24 hours systolic blood pressure variation coefficient and diastolic blood pressure variation coefficient were(10.16 ± 1.95)％,(12.6 ± 7.15)％,the control group, respectively (12.92 ± 2.79)％, (17.38±4.49)％, two groups compare the difference was statistically significant (t=6.450, 4.435, P<0.05). Intervention group of normal sinus R- R period between the standard deviation, to the phase difference between adjacent R- R , root mean square value of the whole difference in more than 50 ms continuous period of percentage between normal R-R and triangle Index were (173.3±58.5) ms, (115.9±74.4), (54.8± 24.1)％, (53.3 ± 15.1).The control group was(128.7 ± 40.2)ms, (82.1 ± 35.2),(39.9 ± 17.1)％, (30.6 ± 14.9), and the difference between the two groups was statistically significant(t=-8.439--3.207, all P<0.05). Conclusions Isometric resistance training conducted using handgrip exercise could increase the HRV and decrease the BPV in hypertensive patients with MIS. These results indicated that the IRT may improve the life quality of hypertensive patients with MIS.

Correlation of blood pressure variability with brachial ankle pulse wave velocity and left ventricular mass index / 上海交通大学学报（医学版）

Objective·To explore the association of blood pressure variability (BPV),especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity (baPWV) and left ventricular mass index (LVMI).Methods· A total of 184 hypertensive patients participated this cross sectional study.Patients were divided into dippers,non-dippers,inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure (SBP) decline.baPWV and LVMI in different groups were compared.Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis.Results· After adjusted by age,BMI,hypertension duration,blood pressure in consulting room,SBP and diastolic blood pressure (DBP) in 24 h,total cholesterol,low density lipoprotein cholesterin,brain natriuretic peptide and ejection fraction,baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group (P=0.000),and LVMI was significantly higher in non-dippers group than in dippers group (P=0.001) and extreme-dippers group (P=0.022).baPWV and LVMI were both significantly correlated to age,24 h SBP and 24 h DBP,SD value of 24 h SBP and 24 h DBP,daytime SBP and DBP,nocturnal SBP and DBP,SD values of daytime SBP and DBP,SD values of nocturnal SBP and DBP in univariate linear regression models (P＜0.05).In multivariate linear regression model,baPWV was independently associated to SD value of nocturnal SBP (β=0.289,P=0.000),nocturnal SBP decline (β=0.398,P=0.000),daytime SBP (β=0.214,P=0.001) and SD value of daytime DBP (β=0.207,P=0.002),while LVMI was independently associated to 24 h SBP (β=0.348,P=0.000) and SD value of nocturnal SBP (β=0.196,P=0.026).Conclusion· baPWV was independently correlated to SD value of nocturnal SBP,nocturnal SBP decline,daytime SBP and SD value of daytime DBP,while LVMI was independently correlated to 24 h SBP and SD value of nocturnal SBP.