Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers

Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.

P1686Natriuretic peptides personifying role in patients with arterial hypertension and chronic heart failure

Aim The aim of research was to study NT-proBNP in patients with arterial hypertension (AH) and chronic heart failure (CHF). Object and methods of research 420 male patients in age from 30 to 60 years old were examined: group 1 (n=180) – patients with AH without CHF, group 2 (n=86) – patients with AH and CHF, group 3 (n=74) – patients with CHF without AH and the group of control (n=80). NT-proBNP, fmol/ml, was measured. Results NT-proBNP had the highest levels in patients of group 3 in comparison with the group of control (p=0.046), group 1 (p=0.037) and group 2 (p=0.046). The duration of AH didn't affect the level of NT-proBNP (r=0.186; p=0.537). In the group with AH, the plasma level of NT-proBNP was lower in patients with 2 and 3 degrees of AH compared with patients with 1 degree of AH (p<0.05). In the group of patients with AH and CHF this pattern wasn't observed (p>0.05). NT-proBNP was interrelated with AH degree in group 1 (r=−0.624; p=0.023). Such a relationship wasn't established in group 2 (r=0.151; p=0.294), NT-proBNP was interrelated with NYHA functional class of CHF (r=0.215; p=0.049). The diagnostic value of changes in the level of NT-proBNP in the diagnosis of grade 1 AH relative to 2–3 degrees of AH in patients without CHF: at the point of separation (cut off) 3.85 fmol/ml, sensitivity 83% and specificity of 71%. ROC-area under curve = 0.81. The quality of the model was very good. NT-proBNP determining diagnostic value analysis to predict the enhancement in NYHA functional class of CHF in patients with AH and CHF: at a separation point of 3.4 fmol/ml specificity of 71%, sensitivity – 76%. ROC-area under curve = 0.74. We investigated the level of NT-proBNP in patients of groups 1 and 2 with different types of circadian blood pressure (BP) profiles. NT-proBNP levels were the highest in patients with “non-dipper”, “night-peaker” circadian blood pressure profile and differed significantly from patients profiles “dipper” and “over-dipper” as for systolic BP and for diastolic BP. Data correlation analysis revealed the inverse relationship between NT-proBNP and SBP (r=−0.498; p=0.035). Since there were no patients with circadian profiles “night-peaker” and “over-dipper” in group 1, and the results of the study reflected the level of NT-proBNP in group 2, we studied the level of these hormones in patients with the same type of circadian profiles in group 1 and group 2. The level of NT-proBNP in patients of group 1 with “non-dipper” profile was reduced in comparison with patients of group 2 and “dipper” circadian profile. Conclusion Determination of natriuretic peptides in patients with AH and CHF personifies the diagnosis and prognosis of cardiovascular complications. Natriuretic peptides are involved in circadian blood pressure profile.