Estimate of nocturnal blood pressure and detection of non-dippers based on clinical or ambulatory monitoring in the inpatient setting

Circadian blood pressure variability and associated factors among chronic kidney disease patients at Nekemte Town public Hospitals, West Oromia, Ethiopia: a comparative cross-sectional study

OBJECTIVE

This study aimed to assess the pattern of circadian blood pressure variability (CBPV) and associated factors among chronic kidney disease (CKD) patients admitted to Nekemte Town public Hospitals.

DESIGN

A hospital-based comparative cross-sectional study was conducted among 130 CKD patients from 01 October to 02 December 2022. Comparisons were performed between the groups using an independent t-test for CBPV (24-hour blood pressure (BP), daytime BP and night-time BP). The dipping pattern was compared by the χ2 test. Multiple logistic regression was used to determine the factors associated with non-dipping patterns in patients with hypertensive CKD (HCKD).

SETTING

Two public hospitals in the Nekemte town, Western Ethiopia.

PARTICIPANTS

The participants were two independent groups. Group I (HCKD=65) and group II (normotensive CKD (NCKD)=65).

RESULTS

The mean 24-hour SD of systolic blood pressure (SBP) was significantly different between HCKD and NCKD patients, 10.17±6.12 mm Hg versus 0.5.4±2.7 mm Hg, respectively (95% CI 0.02 to 1.77, p=0.043). The prevalence of SBP non-dippers was greater among HCKD than NCKD patients (83% vs 63%). Mean 24-hour SBP (95% CI 1.50 (1.15 to 1.96), p=0.003) and estimated glomerular filtration rate (eGFR) (95% CI 2.92 (1.21 to 47.06), p=0.038) were independently associated with non-dipping SBP in HCKD patients.

CONCLUSION

Compared with NCKD patients, HCKD patients had significantly greater CBPV. Compared with dippers, non-dippers had a lower mean eGFR.

Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome

BACKGROUND

Blunted nocturnal blood pressure (BP) reduction, referred to as non-dipper hypertension, is a strong predictor of cardiovascular morbidity and mortality.

OBJECTIVES

This study aimed to investigate the relationship between non-dipper hypertension and the severity and complexity of coronary artery disease using SYNTAX score in hospitalized patients with acute coronary syndrome.

METHODS

A total of 306 consecutive patients with acute coronary syndrome were screened. Patients who were clinically stable and admitted to the intermediate intensive care unit at least 24 hours after angiography and/or successful revascularization. After the exclusion criteria, 141 patients (34 female and 107 male; mean age 61 ± 11 years) were included. Non-dipper hypertension has been defined as a 0% to 10% decrease in average systolic BP at nighttime compared to daytime, measured at hourly intervals using the same automatic BP measuring device on bedside monitors (Vismo PVM-2701; Nihon Kohden Corp., Tokyo, Japan). SYNTAX score was calculated with an online calculator. The independent predictors of SYNTAX score were assessed using multivariable logistic regression analysis. P < 0.05 was considered statistically significant.

RESULTS

The patients with non-dipper hypertension had higher SYNTAX score than the patients with dipper hypertension (11.12 ± 6.41 versus 6.74 ± 6.45, p < 0.0001). In a multivariable logistic regression model, non-dipper hypertension status (odds ratio: 5.159; 95% confidence interval: 2.246 to 11.852, p < 0.001), sex (p = 0.012) and low-density lipoprotein cholesterol (p = 0.008) emerged as independent predictors of high SYNTAX score.

CONCLUSIONS

The results of our study provide a possible additional mechanism linking abnormal circadian BP profile with coronary artery disease severity and complexity in patients with acute coronary syndrome.

Remission of hypertension after surgical cure of Cushing's syndrome

CONTEXT

Hypertension associated with Cushing's syndrome (CS) increases cardiovascular risk. The time-course of improvement after cure is unclear.

OBJECTIVE

To describe the time-course and predictors of blood pressure (BP) normalization during one year after surgical cure of CS.

DESIGN

Retrospective chart review of 75 hypertensive adults cured of CS (72 with ACTH-dependent CS; 3 with adrenal adenoma). Hypertension was defined as current use of antihypertensives, a systolic BP >130 mm Hg, or diastolic BP >80 mm Hg.

MAIN OUTCOME MEASURE(S)

Remission of hypertension: BP ≤130/80 mm Hg and no antihypertensive medications. Improvement in hypertension: BP >130/80 mm Hg and decreased number or dose of medications, or blood pressure ≤130/80 with continued use of medications at constant dose.

RESULTS

At postoperative discharge, 17 (23%, P < .001), 51 (68%, P < .001) and 7 (9%) patients had remission, improvement in hypertension or no change. Twenty-nine had no follow-up. Others achieved remission at 3 (n = 5), 6 (n = 6), or 12-months (n = 5). At the last evaluation, 33/75 (44%) had remission, 36/75 (48%) had improved hypertension and 6 were unchanged. Patients with improvement discontinued a median of one medication (P < .001). At 12-months, 27/42 (64%) patients had normal BP (P < .002). Longer estimated duration of CS (P = .0106), younger age (P = .0022), and lower baseline body mass index (P = .0413) predicted hypertension remission.

CONCLUSIONS

About 80% of CS patients experienced BP normalization or improvement within 10 days of cure, but about half failed to normalize BP by one year. BP should be monitored after cure, and antihypertensive medications adjusted to avoid unwanted cardiovascular effects.

Parenting stress, salivary biomarkers, and ambulatory blood pressure: a comparison between mothers and fathers of children with autism spectrum disorders

Parents of children with autism spectrum disorders (ASD) may experience higher levels of stress and health problems than parents of children with typical development. However, most research has focused on mothers, with emphasis on parent-reported stress and wellbeing. This study compared parenting responsibility, distress, anxiety, depression, cortisol, alpha-amylase, and cardiovascular activity between 19 mother-father dyads of children with ASD. Mothers reported higher parenting responsibility, distress, anxiety, and depression than fathers, while fathers had higher blood pressure and heart rate variability. Mothers and fathers had lower than average morning cortisol levels, suggesting stress effects on the hypothalamic-pituitary-adrenal-axis. Parents of children with ASD may benefit from routine health screening (particularly adrenal and cardiovascular function) and referral for stress reduction interventions or supports.

Parenting stress, salivary biomarkers, and ambulatory blood pressure: a comparison between mothers and fathers of children with autism spectrum disorders

Parents of children with autism spectrum disorders (ASD) may experience higher levels of stress and health problems than parents of children with typical development. However, most research has focused on mothers, with emphasis on parent-reported stress and wellbeing. This study compared parenting responsibility, distress, anxiety, depression, cortisol, alpha-amylase, and cardiovascular activity between 19 mother-father dyads of children with ASD. Mothers reported higher parenting responsibility, distress, anxiety, and depression than fathers, while fathers had higher blood pressure and heart rate variability. Mothers and fathers had lower than average morning cortisol levels, suggesting stress effects on the hypothalamic-pituitary-adrenal-axis. Parents of children with ASD may benefit from routine health screening (particularly adrenal and cardiovascular function) and referral for stress reduction interventions or supports.