The relationship between fragmented QRS and non-dipper status in hypertensive patients without left ventricular hypertrophy

Background: Fragmented QRS (fQRS) has been shown to be associated with poor outcome in various cardiovascular diseases. Non-dipper hypertension is also associated with increased cardiovascular mortality. The aim of our study is to investigate the relationship between fQRS and non-dipper status in hypertensive patients without left ventricular hypertrophy (LVH). Methods: This study included 106 hypertensive patients without LVH. Patients were divided into two groups: dipper hypertension and non-dipper hypertension. The presence of fQRS was analyzed from surface electrocardiography. Results: Frequency of fQRS (56% vs. 19.6%, p < 0.001) and mean number of leads with fQRS (1.9 ± 1.7 vs. 0.6 ± 1.0, p < 0.001) were significantly higher in patients with non-dipper hypertension compared to dipper hypertension. In addition, the number of leads with fQRS was positively correlated with systolic (r = 0.334, p < 0.001) and diastolic (r = 0.280, p = 0.004) blood pressures (BP). By a multivariate regression analysis, fQRS (OR: 5.207, 95% CI: 2.195–12.353, p < 0.001) was found to be independent predictor of non-dipper status. Conclusion: fQRS is independent predictor of non-dipper status in hypertensive patients without LVH. Also, the higher number of leads with fQRS is associated with higher sleep systolic and diastolic BPs.     

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension.

Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1?±?10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3?±?12.7 years) had non-dipper hypertension.

Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3?±?0.9 versus 1.8?±?0.5, p?p?=?0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22–7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13–6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%.

Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.     

Serum Urotensin II Levels in Patients with Non-Dipper Hypertension

Hypertension terms “dipper” and “non-dipper” are propounded by the change that occurs during ambulatory blood pressure (BP) monitoring. The purpose of this study is to present whether the serum urotensin II levels are different in patients with dipper and non-dipper hypertension and to put forward the effects causing this difference, if there are any. Patients recently diagnosed with hypertension were included in the study. With ambulatory BP monitoring, 81 patients with high BP were divided into two groups, dipper (n = 40) and non-dipper (n = 41). Serum urotensin II levels were analyzed by ELISA method. Serum urotensin II levels were higher in patients with non-dipper hypertension than in patients with dipper hypertension (204 [106–533] vs. 140 [96–309], P = .004). There was a positive correlation between total systolic BP and serum urotensin II levels (r = 0.408 and P = .009), but the relation in the non-dipper hypertension group was not significant (r = 0.194 and P = .2). In conclusion, serum urotensin II levels were higher in non-dipper HT patients than dipper HT patients. This higher urotensin II level might be responsible for poor prognoses.     

The Relationship Between Neutrophil Lymphocyte Ratio and Non-dipper Hypertension

Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with non-dipper hypertension. In this study, NLR between dipper and non-dipper hypertensive patients was compared.This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 non-dipper patients (17 male, mean age 50.6 ± 5.4 years). Transthoracic echocardiography and ambulatory 24-hour blood pressure monitoring were performed on all patients. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. No statistically significant difference was found between the two groups in terms of basic characteristics. Mean NLR was significantly higher among persons with non-dipper compared with dipper patients (3.1 ± 0.95 vs. 1.8 ± 0.52, P < .001). Additionally, leukocytes and monocytes counts were higher in patients with non-dipper hypertension.In conclusion, our results suggest that higher NLR, an emerging marker of inflammation, has a positive correlation with blood pressure and is elevated in non-dippers compared with dippers.     

The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy

Background: Frontal QRS-T angle is a novel marker of myocardial repolarization, and an increased frontal QRS-T angle associated with adverse cardiac outcomes. Non-dipper hypertension is also associated with adverse cardiac outcomes. This study aimed to investigate the relationship between frontal QRS-T angle and non-dipper status in hypertensive patients without left ventricular hypertrophy (LVH).

Methods: This study included 122 hypertensive patients without LVH. Patients were divided into two groups: dipper hypertension and non-dipper hypertension. The frontal QRS-T angle was calculated from 12-lead electrocardiography.

Results: Frontal QRS-T angle (47.9° ± 29.7° vs. 26.7° ± 19.6°, P < 0.001) was significantly higher in patients with non-dipper hypertension than in patients with dipper hypertension. In addition, frontal QRS-T angle was positively correlated with sleeping systolic (r = 0.211, P = 0.020), and diastolic (r = 0.199, P = 0.028) blood pressures (BP), even if they were weak. Multivariate analysis showed that the frontal QRS-T angle was independent predictor of non-dipper status (QR: 1.037, 95% CI: 1.019–1.056, P < 0.001).

Conclusion: Frontal QRS-T angle is independent predictor of non-dipper status in hypertensive patients without LVH.     

The relationship between eosinophil and nondipper hypertension

AimsNon-dipper hypertension is associated with increased cardiovascular morbidity and mortality. It is known that eosinophils play an important role in vasoconstriction and thrombosis. We aimed to compare the numbers of eosinophil counts of the patients nondipper versus dipper hypertension.Materials and methodThis study included 70 hypertensive patients. Hypertensive patients were divided into two groups: 35 dipper patients (15 male, mean age 50.94±11.13 years) and 35 non-dipper patients (10 male, mean age 56.11±11.05 years). Concurrent routine biochemical tests and eosinophil count on whole blood count were performed on these patients. These parameters were compared between groups.ResultsNo statistically significant difference was found between two groups in terms of basic characteristics. Baseline characteristics of the study groups were comparable. Nondipper patients had a higher eosinophil and MPV value than dipper patients (148.86±80 vs. 304.57±182 and 7.8±0.12 vs. 9.2±0.2 fl p<0.001, respectively).ConclusionEosinophil count and MPV value are higher in patients with nondipper hypertension when compared to the dippers.     

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension

Aims: Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension.

Materials and method: This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5?±?8 years) and 30 non-dipper patients (17 male, mean age 50.6?±?5.4 years). Tp-e interval and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups.

Results: No statistically significant difference was found between two groups in terms of basic characteristics. In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in non-dipper patients compared to the dippers (39.4?±?11.5 versus 27.3?±?7.5?ms and 37.5?±?9.5 versus 29.2?±?6.5?ms, p?=?0.001 and p?=?0.01, respectively). Tp-e interval and Tp-e/QT ratio were also significantly higher in non-dipper patients (97.5?±?11.2 versus 84.2?±?8.3?ms and 0.23?±?0.02 versus 0.17?±?0.02, all p value <0.001).

Conclusion: Our study revealed that QTd, Tp-e interval and Tp-e/QT ratio are prolonged in patients with non-dipper hypertension.     

Detection of atrial electrical and mechanical dysfunction in non-dipper pre-hypertensive subjects

Introduction: A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients.

Methods: Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid).

Results: Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3?±?3.9 versus 24.1?±?2.3, p?=?0.001; 19.5?±?4.3 versus 13.8?±?2.1, p?=?0.001; and 11.4?±?2.8 versus 8.8?±?1.5, p?=?0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels.

Conclusion: This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias’ in non-dipper pre-hypertensive patients.     

Serum gamma-glutamyl transferase (GGT) levels and inflammatory activity in patients with non-dipper hypertension

Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. We aimed to evaluate serum gamma-glutamyl transferase (GGT) level, which is accepted as a marker for oxidative stress and its relationship with inflammatory activity in patients with non-dipper hypertension. Age and sex matched 43 dipper hypertensive patients, 40 non-dipper patients, and 46 healthy subjects were included into the study. Serum GGT and C-reactive protein (CRP) levels were measured and compared between each of the groups. Serum GGT activity was higher in the non-dipper and the dipper hypertensive groups than in the control group (33.5 ± 11.8 and 28.1 ± 10.1 U/l, respectively, vs. 21.2 ± 6.5 U/l; p < 0.001). There was a statistically significant difference in serum GGT activity between the non-dippers and the dippers (p = 0.021). When compared with the control group, serum CRP levels were significantly increased in both the non-dipper and the dipper hypertensive groups (6.1 ± 2.6 and 5.4 ± 2.1 mg/l, respectively, vs. 2.8 ± 1.7 mg/L; p < 0.001). Increased CRP levels were higher in non-dippers than dippers (p = 0.046). A significant correlation was found between GGT and CRP measurements (r = 0.37, p = 0.002). Serum GGT levels, which are markers of the oxidative stress and CRP levels, are both increased in non-dipper hypertension. Increased GGT activity, found to be correlated with CRP levels, may be one of the reasons behind the non-dipper hypertension related cardiovascular complications.     

Avaliação de Padrões Pressóricos Dipper e Não-Dipper e Qualidade de Vida entre Pacientes com Doença Pulmonar Obstrutiva Crônica

BackgroundNon-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life.ObjectiveThe aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD.MethodsA cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant.ResultsAs a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR:1.123; 95% CI:1.016;1.242), augmentation index (OR: 1.057; 95% CI: 1.011;1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001;1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009;1.777).ConclusionNon-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)     

Poor sleep is responsible for the impaired nocturnal blood pressure dipping in elderly hypertensive: A cross-sectional study of elderly

Objective: This study was aimed to assess whether sleep disorder was associated with an increased risk of less nocturnal blood pressure (BP) dipping in elderly patients with hypertension.

Methods: Cases were 1006 patients, aged >60 years, who were admitted to hospital with diagnosed hypertension during 2016–2017, and were divided into three groups with the systolic nocturnal BP dipping of 10%, and 0% as the cut-off value. The patients’ sleep was evaluated by Pittsburgh sleep quality index (PSQI).

Results: Compared to non-dipper BP rhythm patients (n = 382) and dipper BP rhythm patients (n = 132), reverse dipper patients (n = 492) exhibited higher PSQI score and had higher scores on six components with the exception of use sleep drug (p < 0.05). Multivariate logistic regression indicated that poor sleep, which was defined as high score of PSQI or its seven components, was associated with prevalence of reverse dipper in elderly hypertensive (odds ratio (OR) = 1.17, (95% confidence interval (CI), 1.13–1.21, p < 0.05) after adjusting for risk factors of hypertension. Multiple linear regression analysis showed that there was a significant negative correlation between PSQI score (include its seven components) and nocturnal BP dipping value after adjusting for risk factors of hypertension (β = ?0.584, p < 0.001).

Conclusions: In elderly patients with hypertension, poor sleep quality individuals were more prone to reverse dipper BP rhythm. Even adjusting for the effect of known risk factors of hypertension, poor sleep may contribute to attenuated BP dipping in elderly hypertensive.     

Differences in exercise blood pressure response between dipper and non-dipper elderly patients with essential hypertension

We evaluated the circadian variation and exercise stress response patterns of blood pressure (BP) in elderly patients with essential hypertension. Ambulatory BP monitoring for 48 hours every 30 minutes, and treadmill exercise test using a Bruce protocol at PM 3 to 5 were performed in 49 untreated patients with hypertension. Mean daytime (awake), and night-time (sleeping) systolic BP (SBP) and diastolic BP (DBP) values were analyzed by reviewing the patients' diaries, and the nocturnal reduction rate (NRR) of SBP and DBP were calculated according to the following formula. NRR (%) = [(daytime mean-nighttime mean)/daytime mean] x 100. The patients were divided into two groups according to the presence (dipper, n = 25) or absence (non-dipper, n = 24) of a reduction in both SBP and DBP during the night by an average of more than 10% of the daytime BP. Mean values of SBP and DBP measured over 48 hours in the dipper and non-dipper groups were similar. Responses of SBP to dynamic exercise at 2 to 5 minutes in the non-dipper group were significantly smaller than those in the dipper group (p < 0.05). Non-dipper patients with hypertension responded to dynamic exercise stress with smaller increases in SBP than did those in the dipper group. The differences in BP responses to exercise may affect the circadian blood pressure profile in dipper and non-dipper elderly patients with essential hypertension.     

The impact of dipper and non-dipper characteristics in the fluctuation of arterial blood pressure. A study of a population of 484 diabetic patients

Abnormal pattern of circadian blood pressure variations carries a high risk of cardiovascular complications. The aim of this study was to assess the frequency of abnormal blood pressure rhythm in diabetes and its consequences on micro and macrovascular complications. 484 diabetes mellitus patients were submitted to 24-h ambulatory blood pressure monitoring. They were divided into two groups according to the absence (non-dipper: group 1; n = 167) or presence (dipper: group 2; n = 317) of nocturnal BP reduction = 10% of daytime BP. Following data were collected and compared between these two groups: body mass index, glycated haemoglobin, urinary albumin excretion, research of retinopathy by fundoscopy, tests for presence of a macrovascular disease. There were no significant differences among the two groups in sex, body mass index, type and duration of diabetes and glycemic control. Clinical SBP and DBP did not differ from significant manner between non-dipper and dipper (140 +/- 18/81 +/- 1 versus 138 +/- 19/81 +/- 10 mmHg). Non-dipper 24-h SBP and 24-h DBP were higher than those of dipper (129 +/- 16/76 +/- 9 versus 122 +/- 15/73 +/- 8 mmHg; p < 0.001). Non-dipper were older than dipper (59.9 +/- 13 versus 55.8 +/- 15 years; p < 0.001) and there was more hypertensive patients in group 1 than in group 2 (50% versus 39%; p < 0.01). Macro- and microvascular diabetes complications were more common in non-dipper. In conclusion high blood pressure is frequently observed in diabetic patients. Its association with a diminished nocturnal BP fall could explain a higher risk of complications, especially retinopathy, nephropathy and cardiac events.     

Hypertensive response to exercise in dipper and non-dipper normotensive diabetics

Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5?±?7 and 10 male) in group 1 and 37 patients (mean age 53.1?±?10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p?=?0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r?=?0.611, p?r?=?0.266, p?=?0.002) and age (r?=?0.321, p?=?0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080–1.313; p?p?=?0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.     

Depression and anxiety in children and adolescents with familial Mediterranean fever

Familial Mediterranean fever (FMF) is the most common autoinflammatory disease which requires a lifelong treatment. The aim of this study was to evaluate the depression and anxiety in pediatric FMF patients. The Children’s Depression Inventory and the Screen for Child Anxiety-related Emotional Disorders were the instruments used. Forty-three patients with FMF and 53 healthy controls were compared. Both study and control groups were divided into two age groups, 7–12 and 13–18 years. The depression scores of patients with FMF were significantly higher than their healthy peers (p = 0.001). However, there was no significant difference between patients with FMF and control group regarding the anxiety scores (p = 0.78). The disease duration was not significantly correlated with depression and anxiety scores. There was a significant correlation between depression score and FMF severity score (p = 0.01). The mean depression and anxiety scores of the FMF patients were positively correlated with the number of attacks (p = 0.000 and p = 0.001, respectively).This study suggested that patients with FMF were considerably more depressed than their healthy peers and that the depression scores were negatively affected from disease severity score and number of attacks. Psychosocial assessment of children with FMF has potential clinical implications and individualized counseling and interventions are needed.     

Oxidative stress in patients with essential hypertension: A comparison of dippers and non-dippers

BackgroundOxidative stress seems to play an important role in the pathophysiology of essential hypertension. We aimed to examine serum MDA, NO, 8-OHdG, ADMA, NT, CoQ10 and TAC as biomarkers of oxidative stress in dipper and non-dipper hypertensive patients.MethodsEighteen dipper hypertensives, 20 non-dipper hypertensives and 22 healthy control subjects were included in the study. Clinical assessment and ambulatory blood pressure monitoring were performed in patients. Serum MDA, TAC and NO levels were measured by using spectrophotometric methods. CoQ10 levels were measured by HPLC method. 8-OHdG, ADMA and NT were quantitated by ELISA methods.ResultsMDA levels were significantly higher in dipper and non-dipper groups compared to controls (p < 0.05 and p < 0.01, respectively). TAC levels were found at low level in patients dipper and non-dipper patients compared to control group (p < 0.01). Higher ADMA and NT levels but lower CoQ10 levels were found in non-dipper group compared to healthy controls (p < 0.01, p < 0.05, and p < 0.05, respectively). ADMA levels were found higher in non-dipper group than those of dipper group (p < 0.01).DiscussionIncreased ADMA, NT levels and decreased CoQ10 levels in non-dipper hypertensive patients might indicate more severe oxidative stres compared with dipper hypertensive patients, which plays an important role in the development of cardiovascular diseases. Increased MDA and reduced TAC levels might be considered as prospective prognostic markers of the development of cardiovascular diseases in dipper and non-dipper hypertensive patients.     

In newly diagnosed hypertensive children,increased arterial stiffness and reduced heart rate variability were associated with a non-dipping blood pressure pattern

ObjectivesThis study was designed to investigate the differences in pulsatile hemodynamics, echocardiographic findings, 24-h Holter monitoring and heart rate variability parameters of dipper patterns in children with newly diagnosed essential hypertension.MethodsThis study included 30 children with newly diagnosed essential hypertension and 30 healthy controls. The essential hypertension cohort was divided into dippers and non-dippers. Physical examinations, 24-hour ambulatory blood pressure monitoring, 24-h Holter monitoring, 24-h heart rate variability, conventional 2-dimensional and Doppler echocardiography, and tissue Doppler imaging were performed. Pulse wave analysis using an oscillometric monitor was conducted to measure augmentation index (AIx) and pulse wave velocity (PWV).ResultsIn patients with essential hypertension, left ventricular (LV) wall thickness and LV mass index were increased. There were no significant differences in LV mass index and LV wall thickness based on the dipping patterns. Time domain values and the standard deviation of all RR intervals (SDNN) were substantially lower in the essential hypertension group. SDNN values were considerably lower in the non-dipper group compared with the dipper group. In terms of frequency domain measures, low frequency measured in daytime values was much lower in the essential hypertension group compared with the control. The dipper patterns revealed that low frequency measured in nighttime values was also substantially lower in the non-dipper group. Pulse wave analysis and AIx values were notably higher in the essential hypertension patient group and those with non-dipper status.ConclusionSDNN values, which reflect parasympathetic activity, were markedly lower in children with hypertension and the non-dipper group than healthy controls and the dipper group, respectively. Also, parameters related to arterial stiffness, such as PWV and AIx values were significantly higher in children with hypertension and the non-dipper group.     

老年高血压昼夜节律及颈动脉粥样硬化与认知功能损害的关系

目的探讨老年高血压患者24h动态血压节律及颈动脉粥样硬化对认知功能损害的影响。方法依据WHO/ISH高血压诊断标准、动态血压及颈动脉超声监测,将428例受试者按24h动态血压节律类型及有无颈动脉硬化分为4组:杓型高血压组(105例);杓型高血压加颈动脉硬化组(108例);非杓型高血压组(106例);非杓型高血压加颈动脉硬化组(109例)。用简易智能状态检查表(MMSE)对所有受试者进行认知功能调查,MMSE总分范围0～30分。结果非杓型高血压加颈动脉硬化组MMSE(24.7±1.6)分与杓型高血压加颈动脉硬化组(26.4±1.4)分及非杓型高血压组(26.6±1.3)分比较,差异有显著性意义(P<0.05),非杓型高血压加颈动脉硬化组与杓型高血压组(28.9±0.9)分比较,差异有显著性意义(P<0.01)。结论血压昼夜节律减弱或消失与老年高血压患者的认知功能损害相关,颈动脉粥样硬化的形成对认知功能损害有协同作用。     

Sleep quality among relatively younger patients with initial diagnosis of hypertension: dippers versus non-dippers

BACKGROUND: Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered "non-dippers". We aimed to determine if there was any association between the non-dipping status and sleep quality, designed a cross-sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. METHODS: Seventy-five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti-hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. RESULTS: There were 42 non-dipper patients (mean age = 47.5+/-11.9 years, 24 male/18 female), as a definition, 31 dipper hypertensive patients (mean age = 48.5+/-12.8 years, 21 male/10 female) and two with white coat hypertension. Daytime systolic and diastolic mean BPs were not significantly different between the two groups. Night-time mean systolic and diastolic BPs were significantly higher in non-dippers compared with dippers. PSQI scores, globally, were significantly higher in non-dippers compared with dippers. Total PSQI score was not correlated with body mass index. It was noticed that, individually, sleep quality, sleep efficiency and sleep disturbance scores were significantly higher in non-dippers. Being a poor sleeper in terms of high PSQI score (total score>5) was associated with 2.955-fold increased risk of being a non-dipper (95% confidence interval 1.127-7.747). CONCLUSION: We showed that the risk of having non-dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers. We think that evaluating sleeping status and sleep quality among the hypertensive population may help unmask non-dipper hypertension, enabling physicians to treat appropriately.     

Effects of dipper and non-dipper status of essential hypertension on left atrial mechanical functions

AIM: This study was designed in order to investigate the effects of dipper and non-dipper status of hypertension on left atrial mechanical (reservoir, conduit and booster pump) functions with left atrial volume measurements by means of two-dimensional echocardiography in untreated systemic hypertensive patients. METHOD: A total of 27 untreated dipper hypertensive patients, group I (15 female, 12 male, mean age 57+/-12 years); 23 untreated non-dipper hypertensive patients, group II (12 female, 11 male, mean age: 53+/-18 years); and 25 voluntary healthy individuals, group III (13 female, 12 male, mean age 53+/-10 years) were included into the study. Twenty-four hour blood pressure (BP) measurement was performed by the cuff-oscillometric method to evaluate the nocturnal decrease of BP. The patients whose night time mean blood pressure measurements were found 10% or more lower compared to mean day time measurements were classified as dipper hypertensive patients and the ones with a decrease of less than 10% were classified as non-dipper hypertensive patients. Left atrial (LA) volumes were measured echocardiographically according to biplane area-length method in apical four-chamber and two-chamber views. LA maximal volume (V(max)) was recorded at the onset of mitral opening, LA minimal volume (V(min)) was recorded at the onset of mitral closure and LA presystolic volume (V(p)) was recorded at the beginning of the atrial systole (p wave on ECG). All volume measurements were corrected to body surface area, and following LA emptying functions parameters were calculated: LA passive emptying volume (LAPEV)=V(max)-V(p), LA passive emptying fraction (LAPEF)=LAPEV/V(max), Conduit volume (CV)=left ventricular output volume-(V(max)-V(min)), LA active emptying volume (LAAEV)=V(p)-V(min), LA active emptying fraction (LAAEF)=LAAEV/V(p), LA total emptying volume (LATEV)=V(max)-V(min), LA total emptying fraction (LATEF)=LATEV/V(max). RESULTS: LA volume indexes, V(max), V(min), and V(p), were significantly increased in the hypertensive subgroups (groups I and II) than in controls (p<0.001, p<0.001, p<0.001, respectively), but no significant difference was found in the V(p) values between group I and group II. V(max) and V(min) were larger in non-dipper hypertensive group than in dipper hypertensive group (p<0.05 and p<0.05, respectively). LAPEV and LAPEF were observed to be significantly reduced in both dipper and non-dipper hypertensives than in control (p<0.001 and p<0.05, respectively), and this difference was more obvious in non-dipper than dipper cases (p<0.001). Conduit volume was significantly lower in hypertensive groups than controls (p<0.05). LA active emptying volume (p<0.001) and LAA active emptying fraction (p<0.001) were significantly greater in hypertensive cases than in controls. Furthermore, LA active emptying volume in non-dipper hypertensive subjects was significantly greater than dipper hypertensive cases (p<0.05). Left atrial total emptying volume and left atrial total emptying fraction in both hypertensive groups were similar to control (p>0.05). CONCLUSIONS: Atrial reservoir and booster pump functions increase in hypertensive patients, but this result is more prominent in non-dipper hypertensives than in dipper hypertensive patients.