Acute Effects of Citrulline Malate Supplementation on Nocturnal Blood Pressure Dipping After Exercise in Hypertensive Patients: A Randomized, Placebo-Controlled Trial.

BACKGROUND: Citrulline malate (CM), especially when used in conjunction with physical exercise, has demonstrated potential as a non-pharmacological adjunct in the management of hypertension. Nevertheless, its impact on nocturnal blood pressure dipping remains unexplored. OBJECTIVE: Evaluate the impact of a single dose of CM on nocturnal blood pressure dipping after exercise in hypertensive individuals. METHODS: In a double-blind, placebo-controlled, parallel-group clinical trial, twenty hypertensive adults (55 ± 16 years) were randomly assigned to either a CM (6 g) or placebo (6 g of corn starch) group (PLA). Resting blood pressure was measured after a 20-min period of comfortable seating in a calm environment. Both groups underwent 40 min of treadmill running/walking at an intensity of 60-70% of their reserve heart rate, 120 min after ingesting the substances. Ambulatory blood pressure monitoring was employed to measure blood pressure over 24 h. RESULTS: No significant differences in systolic blood pressure values were observed between the CM and PLA groups at rest, during wakefulness, sleep, or over a 24-h period. However, CM exhibited a significant reduction in diastolic blood pressure in several metrics: delta 24 h (-14 mmHg vs -6 mmHg, p = 0.047), delta wakefulness (-12 mmHg vs -4 mmHg, p = 0.024), percent delta 24 h (-16% vs -6%, p = 0.024), and percent delta wakefulness (-14% vs -4%, p = 0.013). No significant differences were found between CM and PLA in terms of systolic and diastolic nocturnal absolute reductions (-13 mmHg vs -12 mmHg, p = 0.808, and -13 mmHg vs -8 mmHg, p = 0.273, respectively) or nocturnal percentage decrease (-9.9% vs -9.4%, p = 0.844, and -15.3% vs -11.7%, p = 0.399, respectively). CONCLUSIONS: The study found no significant changes in the post-exercise nocturnal blood pressure dip following a single dose of CM supplementation. However, a notable reduction in diastolic blood pressure was observed during the waking period and over the average 24-h monitoring period. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE: ClinicalTrials.gov platform (NCT03378596).

What are the ideal metrics for assessing the quality of long-term stabilized "perfect" 24-h BP control after renal denervation?

A significant number of individuals being treated for hypertension still have uncontrolled blood pressure (BP). In Japan, renal denervation (RDN) is being introduced into clinical practice as an adjunctive treatment for hypertension that is uncontrolled despite adequate lifestyle changes and maximal antihypertensive drug therapy. The pivotal SPYRAL ON-MED trial showed that there was a significant reduction in trough office and nighttime ambulatory BP values in the RDN group compared with sham control group, although 24-h and daytime BP values were not significantly different between the two groups. The trough office BP measurement (taken before morning antihypertensive dosing) is similar to guideline recommendations for taking morning home BP before taking the morning antihypertensive drug dose. Recent guidelines recommend the measurement of nighttime BP because nighttime BP is a stronger predictor of cardiovascular event risk than daytime BP. It is particularly important to assess nighttime BP in medicated individuals with hypertension because the up- or down-titration of antihypertensive drug dosing is primarily based on office and daytime BPs in clinical practice. This means that there may be significant risk relating to nocturnal hypertension during longer follow-up. Because RDN results in persistent, "always-on" 24-h BP-lowering effects, the best BP metrics to assess the potential benefit of RDN are nighttime BP (determined using home or ambulatory BP monitoring) and morning BP (determined using home BP monitoring or morning trough office BP measurement). The variability of office, home, and ambulatory BP values is another important metric to assess the quality of RDN-related BP lowering.

Efficacy of angiotensin receptor blockers for nocturnal blood pressure reduction: a systematic review and meta-analysis.

BACKGROUND: Nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients. OBJECTIVE: Nocturnal BP control is of great importance for cardiovascular risk reduction. This systematic review and meta-analysis aimed to explore the efficacy of angiotensin receptor blockers (ARBs) for nocturnal BP reduction in patients with mild to moderate hypertension. METHODS: PICOS design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R. RESULTS: Seventy-seven studies with 13,314 participants were included. The overall analysis indicated that nocturnal BP drop varied considerably among different ARBs. Allisartan (13.04 [95% CI (-18.41, -7.68)] mmHg), olmesartan (11.67 [95% CI (-14.12, -9.21)] mmHg), telmisartan (11.11 [95% CI (-12.12, -10.11)] mmHg) were associated with greater reduction in nocturnal systolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1. While, the variation tendency of last 4-6 h ambulatory BP was basically consistent with nocturnal BP. Additionally, allisartan showed improvement effect in the proportion of patients with dipping BP pattern. CONCLUSIONS: This study demonstrates that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nighttime BP more than daytime BP and improve the dipping pattern.

This meta-analysis explores the efficacy of Angiotensin II AT1 receptor antagonists (ARBs) on nocturnal blood pressure (BP) reduction in mild to moderate hypertension.The results demonstrate that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs.Allisartan can reduce nighttime BP more effectively than daytime BP, which also improve the dipping pattern.

Assessment of Nocturnal Blood Pressure: Importance of Determining the Time in Bed-A Pilot Study.

Objectives: Nocturnal blood pressure (BP) monitoring is essential for evaluating cardiovascular risk and guiding treatment decisions. However, the standardized narrow-fixed nighttime period between 10 p.m. and 6 a.m. may not accurately reflect individual sleep schedules. This pilot study aimed to investigate the comparability between the standardized nighttime period and actual time in bed (TIB) regarding BP assessment. Further, our goal was to evaluate the clinical relevance of the observed BP differences. Methods: A total of 30 participants underwent 24 h ambulatory blood pressure monitoring (ABPM). Patient-specific TIB was precisely assessed through an accelerometer and a position sensor from the SOMNOtouch NIBP™ (SOMNOmedics GmbH, Randersacker, Germany). We analysed the effect of considering individual TIB as nighttime instead of the conventional narrow-fixed interval on the resulting nocturnal BP levels and dipping patterns. Results: We observed differences in both systolic and diastolic BP between the standardized nighttime period and the TIB. Furthermore, a notable percentage of patients (27%) changed their dipping pattern classification as a function of the nighttime definition adopted. We found strong correlations between the start (r = 0.75, p < 0.01), as well as the duration (r = -0.42, p = 0.02) of TIB and the changes in dipping pattern classification. Conclusions: Definition of nocturnal period based on the individual TIB leads to clinically relevant changes of nocturnal BP and dipping pattern classifications. TIB is easily detected using a body position sensor and accelerometer. This approach may thus improve the accuracy of cardiovascular risk evaluation and enhance treatment strategies.

Development of beat-by-beat blood pressure monitoring device and nocturnal sec-surge detection algorithm.

The nocturnal blood pressure (BP) surge in seconds (sec-surge) is defined as a brief, acute transient BP elevation over several tens of seconds, triggered by obstructive sleep apnea (OSA) and sympathetic hyperactivity. Sec-surge imposes a significant strain on the cardiovascular system, potentially triggering cardiovascular events. Quantitative evaluation of sec-surge level could be valuable in assessing cardiovascular risks. To accurately measure the detailed sec-surge, including its shape as BP rises and falls, we developed a beat-by-beat (BbB) BP monitoring device using tonometry. In addition, we developed an automatic sec-surge detection algorithm to help identify sec-surge cases in the overnight BbB BP data. The device and algorithm successfully detected sec-surges in patients with OSA. Our results demonstrated that sec-surge was associated with left ventricular hypertrophy and arterial stiffness independently of nocturnal BP level or variability. Sec-surge would be worth monitoring for assessing cardiovascular risks, in addition to nocturnal BP level. Nocturnal blood pressure (BP) surge in seconds (sec-surge) places heavy load on the cardiovascular system and can trigger cardiovascular events. To identify sec-surges, we developed a beat-by-beat BP monitoring device and a sec-surge detection algorithm. Furthermore, sec-surge was more related to cardiovascular risks than conventional nocturnal BP parameters.

Association between nocturnal blood pressure phenotype and adverse cardiovascular prognosis in patients with coronary heart disease and hypertension.

Nocturnal blood pressure and nighttime dipping patterns are associated with the occurrence of cardiovascular events. However, there is few research on whether riser pattern is associated with the poor prognosis of patients with coronary heart disease (CHD) and hypertension independent of nighttime systolic blood pressure (SBP). This prospective and observational clinical study included 568 hospitalized patients with CHD and hypertension. All patients underwent 24-h ambulatory blood pressure (BP) monitoring during their hospitalization. Multivariate adjusted Cox proportional hazard models were utilized to examine the associations of nocturnal blood pressure and dipping status with primary endpoint events. Additionally, Harrell's C-statistics were employed to compare the discriminative ability of each model. During the 1-year follow-up period, 64 (11.3%) primary endpoint events were recorded, including 55 (9.7%) atherosclerotic cardiovascular disease (ASCVD) events. After adjusting for demographic and clinical risk variables, nighttime SBP was significantly related to the risk of incident primary endpoint events [per 20 mm Hg increase: hazard ratio (HR) = 1.775, 95% confidence interval (CI) 1.256-2.507]. The riser pattern group exhibited a significantly higher risk for primary endpoint events compared to the dipper pattern group, even after adjusting for office SBP (HR: 2.687, 95% CI: 1.015-7.110, p = .047). Furthermore, the addition of nighttime SBP or dipping status to the base model yielded statistically significant increments in C-statistic values (p = .036 and p = .007). However, adding both nighttime SBP and dipping status did not significantly enhance the model's performance in predicting the risk of primary endpoint events and ASCVD events according to the C-index (p = .053 and p = .054), which meant that the riser pattern group did not exhibit a significantly higher risk for primary endpoint events compared to the dipper pattern group after adjusting for nighttime SBP. In conclusion, nocturnal SBP and riser pattern demonstrated an association with adverse prognosis in patients with CHD and hypertension. Notably, nocturnal SBP proved to be a more reliable predictor than dipping status.

Nocturnal Blood Pressure Estimation from Sleep Plethysmography Using Machine Learning.

BACKGROUND: Elevated nocturnal blood pressure (BP) is a risk factor for cardiovascular disease (CVD) and mortality. Cuffless BP assessment aided by machine learning could be a desirable alternative to traditional cuff-based methods for monitoring BP during sleep. We describe a machine-learning-based algorithm for predicting nocturnal BP using single-channel fingertip plethysmography (PPG) in healthy adults. METHODS: Sixty-eight healthy adults with no apparent sleep or CVD (53% male), with a median (IQR) age of 29 (23-46 years), underwent overnight polysomnography (PSG) with fingertip PPG and ambulatory blood pressure monitoring (ABPM). Features based on pulse morphology were extracted from the PPG waveforms. Random forest models were used to predict night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: Our model achieved the highest out-of-sample performance with a window length of 7 s across window lengths explored (60 s, 30 s, 15 s, 7 s, and 3 s). The mean absolute error (MAE ± STD) was 5.72 ± 4.51 mmHg for SBP and 4.52 ± 3.60 mmHg for DBP. Similarly, the root mean square error (RMSE ± STD) was 6.47 ± 1.88 mmHg for SBP and 4.62 ± 1.17 mmHg for DBP. The mean correlation coefficient between measured and predicted values was 0.87 for SBP and 0.86 for DBP. Based on Shapley additive explanation (SHAP) values, the most important PPG waveform feature was the stiffness index, a marker that reflects the change in arterial stiffness. CONCLUSION: Our results highlight the potential of machine learning-based nocturnal BP prediction using single-channel fingertip PPG in healthy adults. The accuracy of the predictions demonstrated that our cuffless method was able to capture the dynamic and complex relationship between PPG waveform characteristics and BP during sleep, which may provide a scalable, convenient, economical, and non-invasive means to continuously monitor blood pressure.

High plasma aldosterone concentration is associated with worse 24-h ambulatory blood pressure profile in patients with primary aldosteronism.

Patients with primary aldosteronism (PA) have a higher risk of cardiovascular disease (CVD) than essential hypertension due to underlying hyperaldosteronism. However, the association between high plasma aldosterone concentrations (PACs) and diurnal blood pressure (BP) variation has not been fully elucidated. Because abnormal ambulatory blood pressure monitoring (ABPM) profiles are associated with increased CVD risk, we investigated the association between PACs and the ABPM profile in 36 patients with PA diagnosed by confirmatory tests who underwent adrenal venous sampling (AVS). The clinical parameters were measured during hospitalization for AVS. The dietary salt intake of hospitalized patients was controlled at 6 g/day. During AVS, blood samples were collected from the inferior vena cava before and 1 h after adrenocorticotropic hormone (ACTH) stimulation to measure the PACs. The post-stimulation PAC had a significant negative correlation with nocturnal BP dipping rates (R = -0.387, p = 0.020), whereas pre-stimulation PAC did not (R = -0.217, p = 0.204). The nocturnal BP dipping rates were significantly lower in the high PAC group (PAC higher than the median) than low PAC group (PAC lower than the median) (p = 0.009). Multiple regression analysis revealed that high PAC was an independent factor contributing to low nocturnal BP dipping rates (ß = -0.316, p = 0.038). In conclusion, in patients with PA, hyperaldosteronism is associated with nocturnal hypertension, which is an important risk factor for CVD. Additionally, ACTH stimulation may improve the sensitivity of PACs as a clinical indicator of nocturnal hypertension.

Twenty-Four-Hour Blood Pressure-Lowering Efficacy of Sacubitril/Valsartan Versus Olmesartan in Japanese Patients With Essential Hypertension Based on Nocturnal Blood Pressure Dipping Status: A Post Hoc Analysis of Data From a Randomized, Double-Blind Multicenter Study.

Background Nighttime blood pressure (BP) and an abnormal nocturnal BP dipping profile are important cardiovascular risk factors in patients with hypertension. This post hoc analysis investigated the effects of sacubitril/valsartan on 24-hour BP in patients with mild-to-moderate hypertension and in patient subgroups based on nocturnal BP dipping status. Methods and Results Data from a randomized clinical trial comparing the BP-lowering effects of 8 weeks of treatment with sacubitril/valsartan (200 or 400 mg/d) and olmesartan (20 mg/d) in Japanese patients with mild-to-moderate hypertension were analyzed. The primary end point was change in 24-hour, daytime, and nighttime BP in patient subgroups based on nocturnal BP dipping status (dipper, nondipper). Six hundred thirty-two patients with baseline and follow-up ambulatory BP data were included. Both sacubitril/valsartan dosages reduced 24-hour, daytime, and nighttime systolic BP, and 24-hour and daytime diastolic BP, to a significantly greater extent than olmesartan in the dipper and nondipper groups. However, between-group differences in nighttime systolic BP were more significant in the nondipper group (difference [95% CI] for sacubitril/valsartan 200 and 400 mg/d versus olmesartan 20 mg/d: -4.6 [95% CI, -7.3 to -1.8] and -6.8 [95% CI, -9.5 to -4.1] mm Hg, respectively; P<0.01 and P<0.001). Between-group differences in the BP control rate were greatest in the nondipper subgroup (systolic BP control rate of 34.4% and 42.6% with sacubitril/valsartan 200 and 400 mg/d versus 23.1% with olmesartan 20 mg/d). Conclusions This analysis highlights the value of sacubitril/valsartan therapy in patients with a nondipper profile of nocturnal BP and confirms this agent's potent 24-hour BP-lowering effect in Japanese populations with hypertension. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01599104.

Nocturnal blood pressure surge in seconds is associated with arterial stiffness independently of conventional nocturnal blood pressure variability in suspected obstructive sleep apnea patients.

Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds is induced by obstructive sleep apnea (OSA) and OSA-related sympathetic hyperactivity. The authors assessed the relationship between sec-surge and arterial stiffness in 34 nocturnal hypertensive patients with suspected OSA (mean age 63.9 ± 12.6 years, 32.4% female). During the night, they had beat-by-beat (BbB) BP and cuff-oscillometric BP measurements, and brachial-ankle pulse wave velocity (baPWV) was assessed as an arterial stiffness index. Multiple linear regression analysis revealed that the upward duration (UD) of sec-surge was significantly associated with baPWV independently of nocturnal oscillometric systolic BP variability (ß = .365, p = .046). This study suggests that the UD of sec-surge, which can only be measured using a BbB BP monitoring device, may be worth monitoring in addition to nocturnal BP level.

Subjective social status and nocturnal blood pressure dipping.

OBJECTIVE: Low social status has been linked to cardiovascular disease. Subjective social status (SSS), which represents one's perceived position in a social hierarchy, has been suggested to predict health outcomes beyond objective measures of socioeconomic status. The present study examined if lower SSS is related to reduced nocturnal blood pressure (BP) dipping, a risk factor for cardiovascular disease. METHODS: In this cross-sectional study, a community sample of 53 healthy adults underwent 24-h ambulatory BP monitoring. All participants provided information on SSS and objective measures of socioeconomic status (i.e., education, occupation, and income). SSS was measured in comparison to others in the country (national SSS) as well as in comparison to one's social environment (local SSS) using the German versions of the MacArthur Scales. RESULTS: Analyses found that participants with low local SSS exhibited attenuated nocturnal diastolic blood pressure dipping (ß = 0.29, 95% CI [0.01, 0.57], p = .043) and mean arterial pressure dipping (ß = 0.29, 95% CI [0.01, 0.57], p = .041). These associations remained significant after adjusting for objective socioeconomic status. No significant associations between national SSS and cardiovascular measures were observed. CONCLUSION: In conclusion, one's perceived social position in the social environment (i.e., local SSS) is associated with nocturnal BP dipping. Therefore, local SSS may be an important psychosocial factor linking social inequality and cardiovascular health.

Effects of Continuous Positive Airway Pressure Therapy on Nocturnal Blood Pressure Fluctuation Patterns in Patients with Obstructive Sleep Apnea.

This retrospective study was designed to evaluate the effects of continuous positive airway pressure (CPAP) therapy, a well-established treatment for obstructive sleep apnea (OSA), on nocturnal blood pressure fluctuations (NBPFs) during rapid eye movement (REM) and non-REM sleep, and to evaluate the NBPF patterns in patients with OSA. We included 34 patients with moderate-to-severe OSA who underwent polysomnography using pulse transit time before and at 3−6 months after CPAP therapy. Nocturnal BP and NBPF frequency in REM and non-REM sleep were investigated, as well as NBPF pattern changes after receiving CPAP therapy. CPAP therapy resulted in significant reductions in the apnea−hypopnea index (AHI), arousal index, nocturnal systolic and diastolic BP, and NBPF frequency in REM and non-REM sleep (all p < 0.01). A higher AHI before CPAP resulted in lower nocturnal systolic BP (r = 0.40, p = 0.019) and NBPFs (r = 0.51, p = 0.002) after CPAP. However, 58.8% of patients showed no change in NBPF patterns with CPAP therapy. CPAP therapy significantly improved almost all sleep-related parameters, nocturnal BP, and NBPF frequency in REM and non-REM sleep periods, but NBPF patterns showed various changes post-CPAP therapy. These results suggest that factors other than OSA influence changes in NBPF patterns.

Nocturnal blood pressure rather than night-to-day blood pressure ratio is related to arterial stiffening in untreated young and middle-aged adults with non-dipper hypertension.

Little is known about nocturnal blood pressure (BP) or night-to-day BP ratio, which is a more specific determinant of arterial stiffness in subjects with non-dipper hypertension? This study aims to investigate the correlation of nocturnal BP and brachial-ankle pulse wave velocity (ba PWV), an index of arterial stiffness in untreated young and middle-aged adults with non-dipper hypertension. A cross-sectional analysis of baseline parameters of the NARRAS trial was performed. Twenty-four hour ambulatory BP measurements, ba PWV and routine clinical data collection were performed in all patients. The relationship of 24-h ambulatory BP profiles, biochemical measures as well as demographic parameters and ba PWV were analyzed using Pearson's correlation and multiple stepwise regression analysis. A total of 77 patients (mean age 47.0 ± 11.7 years) with non-dipper hypertension were included. Age, height, weight and nocturnal systolic BP were related to ba PWV in Pearson's correlation analysis. In stepwise regression analysis, age (ß = 10.57, 95% confidence interval (CI): 6.099-15.042, p < 0.001) and weight (ß = -3.835, 95% CI: -7.658--0.013, p = 0.049) are related to ba PWV. Nocturnal systolic BP (ß = 8.662, 95% CI: 2.511-14.814, p = 0.006) was the independent predictors of ba PWV, even after night-to-day systolic BP ratio or 24-h ambulatory BP profile were taken into account. Nocturnal systolic BP rather than night-to-day systolic BP ratio appears to be a more specific determinant for arterial stiffness, as assessed by ba PWV in young and middle-aged adults with non-dipper hypertension. 24-h ambulatory BP measurements are essential for cardiovascular risk evaluation.

Guidance for the Interpretation of Continual Cuffless Blood Pressure Data for the Diagnosis and Management of Hypertension.

Hypertension remains the leading risk factor for death worldwide. Despite its prevalence, success of blood pressure (BP) management efforts remains elusive, and part of the difficulty lies in the tool still used to diagnose, measure, and treat hypertension: the sphygmomanometer introduced by Samuel Siegfried Karl von Basch in 1867. In recent years, there has been an explosion of devices attempting to provide estimates of BP without a cuff, overcoming many limitations of cuff-based BP monitors. Unfortunately, the differences in underlying technologies between traditional BP cuffs and newer cuffless devices, as well as hesitancy of changing a well-implemented standard, still generate understandable skepticism about and reluctance to adopt cuffless BP monitors in clinical practice. This guidance document aims to navigate the scientific and medical communities through the types of cuffless devices and present examples of robust BP data collection which are better representations of a person's true BP. It highlights the differences between data collected by cuffless and traditional cuff-based devices and provides an initial framework of interpretation of the new cuffless datasets using, as an example, a CE-marked continual cuffless BP device (Aktiia BP Monitor, Aktiia, Switzerland). Demonstration of novel BP metrics, which have the potential to change the paradigm of hypertension diagnosis and treatment, are now possible for the first time with cuffless BP monitors that provide continual readings over long periods. Widespread adoption of continual cuffless BP monitors in healthcare will require a collaborative and thoughtful process, acknowledging that the transition from a legacy to a novel medical technology will be slow. Finally, this guidance concludes with a call to action to international scientific and expert associations to include cuffless BP monitors in original scientific research and in future versions of guidelines and standards.

The Association of Nocturnal Blood Pressure Patterns and Other Influencing Factors With Lacunes and Enlarged Perivascular Spaces in Hypertensive Patients.

Purpose: Nocturnal blood pressure dipping patterns have been associated with an increased risk of Cerebral Small Vessel Disease (CSVD), which has not been well-studied. This study is aimed to explore the association of dipping patterns and other factors with lacunes and enlarged perivascular spaces (EPVS) in patients with hypertension. Methods: We enrolled a total of 1,322 patients with essential hypertension in this study. Magnetic resonance imaging (MRI) scans and 24-h ambulatory blood pressure (BP) monitoring were completed. Nocturnal BP decline was calculated, and then dipping patterns were classified. Patients were classified into four groups according to the performance of lacunes and EPVS in the MRI scan for statistical analysis. Results: (1) Nocturnal BP decline showed independent negative correlation with both lacunes and EPVS while mean systolic BP (mSBP) level showed an independent positive correlation with them (P < 0.05). (2) The frequency of reverse-dippers in the control group was significantly lower than that in other groups; the frequency of non-dippers in the lacunes group and EPVS group was significantly lower than that in the control group; the frequency of extreme-dippers in the EPVS group was significantly higher than that in the mixed (lacunes with EPVS) group (P < 0.05). Conclusions: Both mSBP and dipping patterns might play an important role in developing lacunes and EPVS in patients with hypertension.

Management of hypertension in the digital era: Perspectives and future directions.

Information and communication technology (ICT) have advanced remarkably in recent years. In the field of medicine, the problem of hypertension management seems especially well-suited to the application of novel methods. In patients with hypertension, it is important to assess blood pressure (BP) levels throughout the day and night, along with circadian BP variation, using out-of-office BP monitoring. ICT is an attractive tool to facilitate such monitoring and promises to change the current management of hypertension. The combination of self-telemonitoring of BP with lifestyle modification appears to be effective for strict BP control. ICT could be a solution to the challenging problem of nonadherence to antihypertensive medications and could reduce so-called clinical inertia in the treatment of hypertension. ICT approaches would be especially useful in geographically isolated areas or during natural disasters or complex health emergencies such as the ongoing coronavirus pandemic. However, it will be necessary to develop innovative ICT devices for easy and accurate BP measurement in a range of individuals, including the elderly, and to confirm their effectiveness in large scale clinical trials. ICT-based management of hypertension is expected to be pivotal for reducing the public-health burden of cardiovascular diseases and to be widely adopted in daily clinical practice in the future.

The effect of acute alcohol ingestion on systemic hemodynamics and sleep architecture in young, healthy men.

Objective Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort of male. METHODS: Subjects (n = 17) underwent acute alcohol ingestion reaching a breath alcohol content of 0.08. Each subject endured a battery of hemodynamic tests and had their sleep architecture and nocturnal blood pressure monitored pre- and post-ingestion. Results: Systolic blood pressure (SBP) increased both 30 minutes and 12 hours after alcohol. Ambulatory nocturnal SBP significantly increased after alcohol compared to baseline measures. Minutes of total, rapid eye movement, and light sleep all increased after alcohol ingestion, while a decrease was observed for sleep latency. Conclusions: An acute bout of heavy alcohol consumption may attenuate nocturnal BP dipping that, in turn, may hasten the progression of hypertension-related cardiovascular disease.

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index.

Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage. However, it is not clear that the severity of sec-surge is different between sec-surges induced by sleep apnea (SA) (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non-SA factors (rapid eye movement, micro arousal, etc.), and sec-surge variables associate with left ventricular hypertrophy (LVH) independently of conventional BP variables. The authors assessed these points with 41 patients (mean age 63.2±12.6 years, 29% female) who underwent full PSG, beat-by-beat (BbB) BP, and cuff-oscillometric BP measurement during the night. All patients were included for the analysis comparing sec-surge severity between inducing factors (SA and non-SA factors). There were no significant differences in the number of sec-surges/night between SA-related sec-surges and non-SA-related sec-surges (19.5±26.0 vs. 16.4±29.8 events/night). There were also no significant differences in the peak of sec-surges, defined as the maximum systolic BPs (SBPs) in each sec-surge, between SA-related sec-surges and non-SA-related sec-surges (148.2±18.5 vs. 149.3±19.2 mm Hg). Furthermore, as a result of multiple regression analysis (n = 18), the peak of sec-surge was significantly and strongly associated with the left ventricular mass index (standardized ß = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (ß = -0.04, p = .87). This study suggests that peak of sec-surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.

Nocturnal blood pressure and nocturnal blood pressure fluctuations: the effect of short-term CPAP therapy and their association with the severity of obstructive sleep apnea.

STUDY OBJECTIVES: We determined the relationship of cardiovascular risk factors, cardiovascular diseases, nocturnal blood pressure (NBP), and NBP fluctuations (NBPFs) with the severity of obstructive sleep apnea (OSA). We also investigated the effect of short-term continuous positive airway pressure therapy on NBP parameters. METHODS: This retrospective study included 548 patients from our cardiac clinic with suspected OSA. Patients underwent polysomnography and continuous NBP measurement using the pulse transit time. According to their apnea-hypopnea index (AHI), patients were subclassified as controls (AHI < 5 events/h), mild (AHI 5 to < 15 events/h), moderate (AHI 15 to < 30 events/h), and severe OSA (AHI ≥ 30 events/h); 294 patients received continuous positive airway pressure therapy. RESULTS: Analysis of covariance showed that NBP and the frequency of NBPFs were the highest in severe followed by moderate and mild OSA (all P < .001). Multivariable regression analysis revealed a significant association of NBPFs with AHI, body mass index, systolic NBP, and lowest SpO2. The severity of OSA is also associated with the frequency of obesity, hypertension, diabetes mellitus, atrial fibrillation, heart failure (all P < .001), and coronary artery disease (P = .035). Short-term continuous positive airway pressure decreased the frequency of NBPFs in all OSA groups and the systolic NBP in severe and moderate but not in mild OSA. CONCLUSIONS: The severity of OSA is associated with an increase in NBP and NBPFs. Continuous positive airway pressure reduces NBP parameters already after the first night. In addition to BP, the diagnosis and therapy of NBPFs should be considered in patients with OSA. CLINICAL TRIAL REGISTRATION: Registry: German Clinical Trials Register; Name: Nocturnal blood pressure and nocturnal blood pressure fluctuations associated with the severity of obstructive sleep apnea; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024087; Identifier: DRKS00024087. CITATION: Picard F, Panagiotidou P, Tammen A-B, et al. Nocturnal blood pressure and nocturnal blood pressure fluctuations: the effect of short-term CPAP therapy and their association with the severity of obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):361-371.