scholarly journals Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing Liu ◽  
Xiaofeng Su ◽  
Ying Nie ◽  
Zhihuan Zeng ◽  
Hongyan Chen
Keyword(s):  
Arterial Stiffness ◽  
Controlled Trial ◽  
Target Organ Damage ◽  
Antihypertensive Agents ◽  
Organ Damage ◽  
Therapeutic System ◽  
Gastrointestinal Therapeutic System ◽  
Increased Risk ◽  
Before And After ◽  
Long Acting

Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration.Methods: Young and middle-aged adults (18–65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction.Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (−9.9 vs −9.9 mmHg, P > 0.05) or daytime (−11.5 vs. −10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (−10.8 vs. −10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups.Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.

DAILY VARIABILITY OF ARTERIAL STIFFNESS INDEX IN RELATION TO TARGET ORGAN DAMAGE AND SEVERITY OF ARTERIAL HYPERTENSION

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e179
Author(s):  
A. Merezhanova ◽  
E. Tarlovskaya ◽  
K. Mazalov ◽  
M. Mazalova ◽  
N. Kamardina ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Stiffness Index ◽  
Daily Variability ◽  
Arterial Stiffness Index

scholarly journals Circadian blood pressure rhythm and intimal media thickness changes in non-dipper normotensives patients

2017 ◽  
Vol 11 ◽  
Author(s):  
Massimiliano Rocchietti March ◽  
Claudia Maggiore ◽  
Gerardo Salerno ◽  
Agostino De Venanzi ◽  
Elena Scaramucci ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Pressure Profile ◽  
Organ Damage ◽  
Profile Measurement ◽  
Circadian Blood Pressure ◽  
Intimal Medial Thickness ◽  
Carotid Intimal Medial Thickness ◽  
Increased Risk

<p>We investigated 25 <em>non-dipper</em> normotensive <em>vs </em>25 <em>dipper </em>normotensive patients. The aim of our study was to evaluate carotid intimal-medial thickness (IMT) in the two groups. At the admission patients underwent anamnesis and general examination, blood sampling for lipid profile measurement, glycemia, homocysteine, ambulatory blood pressure measurement to assess the circadian blood pressure profile, and Doppler ultrasound to measure carotid intimal-medial thickness (IMT). Our results showed that IMT is significantly higher in the <em>non-dipper </em>group (P&lt;0.006) <em>vs dippers</em>. <em>Non-dipper </em>status has been recognized in several studies a condition with increased risk for target organ damage in hypertensive and normotensive subjects. However, to our knowledge, a possible relationship between IMT and normotensive <em>non-dipper </em>patients has not yet clearly investigated. Our study instead has clearly demonstrated a significant relationship between IMT and the <em>non-dipper status</em>.</p>

scholarly journals THE PARTICULARITIES OF ABPM PARAMETERS IN HYPERTENSIVE PATIENTS WITH NON-DIALYSIS CKD

2017 ◽  
Vol 64 (4) ◽  
pp. 279-283
Author(s):  
Alexandru Minca ◽  
◽  
Mihai Comsa ◽  
Maria Mirabela Manea ◽  
Maria Daniela Tanasescu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Stiffness Index ◽  
Area Index ◽  
Hypertensive Patients ◽  
Arterial Stiffness Index

Chronic kidney disease (CKD) affects approximately two million people (in a population of 20 million) in Romania. Hypertension is often associated with CKD and both (hypertension and CKD) are risk factors for cardiovascular (CV) events. Ambulatory blood pressure monitoring (ABPM) is increasingly used all around the world for the diagnosis and monitoring of BP (blood pressure) because it is proven that the ABPM is superior to office BP measurements in evaluating patients with hypertension, with or without CKD. Reduced nocturnal BP fall (non-dipping or reverse-dipping patterns) is associated with target organ damage, especially kidney disease and the proportion of non-dippers and reverse-dippers patients increases progressively with the reduction of glomerular filtration rate (GFR). Another ABPM parameter, ambulatory arterial stiffness index (AASI), is an index which was recently proposed for the evaluation of arterial stiffness (a better tool than PP). It has prognostic value for cardiac death and stroke and several studies have showed that is negatively related to eGFR and is positively related to albuminuria. Hyperbaric area index (HBI) might be considered a novel sensitive marker [independent of patterns of NBPC (nocturnal BP change)] for the reduction of kidney function. These facts suggest that ABPM offers multiple useful data with impact, not only in future CV and renal outcomes assessment, but also in the treatment and management of hypertensive patients with CKD.

Abstract P182: Microangiopathic Complications In Malignant Hypertension: An Under-appreciated Form Of Target Organ Damage

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Akhil Jain ◽  
Bhumika Singhal ◽  
Rishabh Jindal ◽  
Chinmay Jani ◽  
Puneet K Gupta
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Pooled Analysis ◽  
Target Organ ◽  
Malignant Hypertension ◽  
Forest Plot ◽  
Significant Heterogeneity ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Hematological Changes

Fig 1: Summary of Malignant Hypertension Studies having Microangiopathic Complications along with Forest Plot Microangiopathic Complications in Malignant Hypertension: An underappreciated form of Target Organ Damage Background: Renal thrombotic microangiopathy is a clinically important complication of malignant hypertension (MHT), but its incidence in MHT has been sparsely studied. Our aim was to study the incidence of microangiopathic changes (MaC) in MHT. Methods: We searched Google Scholar database studies directly reporting MaC (mentioning either microangiopathic hemolytic anemia or thrombotic angiopathy) in presence of MHT. We used OpenMeta[Analyst] for the pooled analysis. Results: From 1967 to 2019, 9 studies were included. Maximum likelihood random-effects method showed pooled proportion estimate of having MaC in MHT to be 0.4 (95 CI: 0.3, 0.5; p<0.1). Significant heterogeneity with I 2 =82.56%, p <0.1 was found. Subgroup analysis showed pooled proportion of MaC in MHT to be 0.5 (95 CI: 0.4,0.7, p<0.1) for studies before 2000; whereas 0.2 (95 CI: 0.2, 0.3, p<0.1) for studies after 2000. Sex-wise distribution was reported in 7 studies, risk ratio of having MaC in MHT in female was found to be 1.24 compared to male. Conclusion: Our analysis suggests decreasing incidence of MaC in MHT over the past couple of decades and increased risk of this complication in females, although significant heterogeneity exists among studies reporting microangiopathic changes in malignant hypertension. More prospective observational studies are needed to better define the epidemiology of the hematological changes that occur in MHT since they have important therapeutic implications.

scholarly journals Interrelations Between Arterial Stiffness, Target Organ Damage, and Cardiovascular Disease Outcomes

2019 ◽  
Vol 8 (14) ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Meghan I. Short ◽  
Teemu J. Niiranen ◽  
Vanessa Xanthakis ◽  
Charles DeCarli ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Arterial Stiffness ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Disease Outcomes

P3833Low heart rate variability is associated with future arrhythmic events in hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Terentes-Printzios ◽  
C Vlachopoulos ◽  
L Korogiannis ◽  
G Christopoulou ◽  
P Xydis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Primary Endpoint ◽  
Target Organ Damage ◽  
Roc Curves ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Increased Risk

Abstract Background/Introduction Cardiac autonomic dysfunction and target organ damage are associated with increased cardiovascular mortality and arrhythmias. Purpose The aim of the study was to investigate the effect of heart rate variability (HRV) and markers of target organ damage in the prognosis of future arrhythmic events. Methods We studied 292 untreated at baseline hypertensives (mean age 53±13, 153 males). Cardiac autonomic function was evaluated by analysis of short-term HRV measures over 24-h using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. Aortic stiffness was assessed with carotid-femoral pulse wave velocity (cfPWV) and wave reflections with aortic augmentation index corrected for heart rate (Alx@75). Patients were followed up for a median period of 13 years. The primary endpoint was a composite of atrial/ventricular tachycardias, symptomatic multiple premature ventricular contractions, second and third-degree heart blocks and pacemaker/defibrillator placement. Results In comparison without events, patients with the primary endpoint (n=37, 13%) had lower 24-h daytime HRV (9.6 beats per minute vs. 11.1 beats per minute, p=0.005), higher systolic blood pressure (168 mmHg vs. 163 mmHg, p=0.003), higher cfPWV (8.4 m/s vs. 7.7 m/s, p=0.005), higher LVMI (133 g/m2 vs. 122 g/m2, p=0.002) and higher AIx@75 (29.0% vs. 26.3%, p=0.043). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of HRV, cfPWV, LVMI and AIx@75 to discriminate subjects with arrhythmic events. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC=0.35 (95% CI: 0.26–0.44, p=0.003) for HRV, AUC=0.64 (95% CI: 0.54–0.73, P<0.006) for cfPWV, AUC=0.67 (95% CI: 0.58–0.75, P=0.001) for LVMI and AUC=0.55 (95% CI: 0.47–0.64, P=0.298) for AIx@75 (Figure). In Cox regression analysis, only HRV was associated with increased risk of arrhythmic events (Hazard ratio per 1 unit =0.87, 95% Confidence intervals 0.76 to 0.995, p=0.043) when adjusted for age, gender, cfPWV, LVMI and AIx@75. ROC curves of HRV & target organ damage Conclusions Low heart rate variability is associated with increased risk of future arrhythmic events suggesting an early sympathovagal imbalance that could lead to future events in hypertension.

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