Blood pressure time load formation in patients with arterial hypertension without metabolic syndrome

Relevance . The study of the daily dynamics of blood pressure in arterial hypertension both on the basis of the daily index and on the basis of the time load is a relevant task, since, these indicators are associated in the literature with stable changes in the neurohumoral regulation of the cardiovascular system in arterial hypertension . The aim of the study was to compare data of the time load in patients with arterial hypertension , depending on the nocturnal blood pressure profile, with integrative indicators of the activity of the cardiovascular system in the form of a Circadian index, a structural point of blood pressure, double product. Materials and Methods. The study included 72 patients who were treated at the City Clinical Hospital No 13 in Moscow and signed a voluntary consent to participate in the research and the processing of personal data. Inclusion criteria: arterial hypertension. Exclusion criteria: metabolic syndrome, secondary forms of arterial hypertension and concomitant pathology. Depending on the daily index (DI10% and DI10%) patients were divided into 2 groups: 1 group (N= 32): patients with arterial hypertension without nocturnal decrease in blood pressure (non-dippers and night-pickers100%); Group 2 (N = 40): patients with arterial hypertension who had a nocturnal decrease in blood pressure (dippers and over dippers 100%). All patients and members of the control group (N=15) underwent daily monitoring of blood pressure (24-hour Arterial Blood Pressure Monitoring). The data were statistically processed to determine the 5% level of significance of differences (p0.05) (Students test). In the comparative analysis of integrative indicators at day and at night, a variance analysis was applied. Results and Discussion . As a result of the study, it was found that the values of Circadian Index for blood pressure vary depending on the type of night decrease in blood pressure and the blood pressure time load, while daily index and structural point of blood pressure remain on the same level as a reflection of the hemodynamic allostasis existing in both groups. Conclusion. Reflection of the allostatic load on hemodynamics is change of values of double product and of the structural point of blood pressure compared with the control group. These changes are not associated with the peculiarities of the nocturnal blood pressure profile in patients with hypertension without metabolic syndrome.

Optimizing the timing of highest hydrocortisone dose in children and adolescents with 21-hydroxylase deficiency

Context Hydrocortisone treatment of young patients with 21-hydroxylase deficiency (21OHD) is given thrice-daily, but there is debate about the optimal timing of highest hydrocortisone dose, either mimicking the physiological diurnal rhythm (morning), or optimally suppressing androgen activity (evening). Objective We aimed to compare two standard hydrocortisone timing strategies, either highest dosage in the morning or evening, with respect to hormonal status throughout the day, nocturnal blood pressure, sleep and activity scores. Design and setting Six-week cross-over study. Patients Thirty-nine patients (4-19 years) with 21OHD. Interventions Patients were treated for three weeks with highest hydrocortisone dose in the morning, followed by three weeks with highest dose in the evening (n=21), or vice-versa (n=18). Androstenedione (A4) and 17-hydroxyprogesterone (17OHP) levels were quantified in saliva collected at 5.00am; 7.00am; 3.00pm; and 11.00pm during the last two days of each treatment period. Main outcome measure Comparison of saliva 17OHP and A4 levels between two treatment strategies. Results Administration of the highest dose in the evening resulted in significantly lower 17OHP levels at 5.00am, whereas the highest dose in the morning resulted in significantly lower 17OHP and A4 levels in the afternoon. The two treatment dose regimens were comparable with respect to averaged daily hormone levels, nocturnal blood pressure, and activity- and sleep scores. Conclusion No clear benefit for either treatment schedule was established. Given the variation in individual responses we recommend to individually optimize dose distribution and monitoring disease control at multiple timepoints.

Effect of Maternal Obstructive Sleep Apnea-Hypopnea on 24-Hour Blood Pressure, Nocturnal Blood Pressure Dipping and Arterial Stiffness in Hypertensive Disorders of Pregnancy

Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness.Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses.Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis.Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.