Liyuan Peng

Reverse-dipper pattern of blood pressure may predict lacunar infarction in patients with essential hypertension

The fluctuation of circadian blood pressure (BP) is of great diversity in patients with essential hypertension and may provide significant prognostic value for stroke. However, it remains uncertain whether reverse‐dipper pattern of BP influences the incidence of lacunar infarction in hypertensive patients.

Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients.

AbstractNocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated.In this cross-sectional study, a total of 524 hypertensive patients were recruited and evaluated with ambulatory BP monitoring between April 2012 and June 2013. Carotid plaque was classified into Grade 0 (normal or no observable plaque), Grade 1 (mild stenosis, 1%–24% narrowing), and Grade 2 (moderate stenosis, ≥25% narrowing). Multinomial logistic regression was applied to analyze the relationship between different degrees of carotid plaque and ambulatory BP monitoring results.Reverse-dipper pattern of BP was more common in older patients, smokers, and those with elevated fasting glucose. The incidences of coronary artery disease, lacunar infarction, and diabetes were also higher among hypertensive with reverse-dipper pattern. Multinomial logistic regression analysis showed that reverse dipper (odds ratio [OR] 2.500; 95% confidence interval [CI] 1.320–4.736; P = 0.005), age (OR 1.089; 95% CI 1.067–1.111; P < 0.001), smoke (OR 1.625; 95% CI 1.009–2.617; P = 0.046), and diabetes (OR 1.759; 95% CI 1.093–2.830; P = 0.020) were significantly different between mild carotid plaque and normal. Our results also suggested that mild carotid plaque was closely related to reverse-dipper pattern of BP (2.308; 95% CI 1.223–4.355; P = 0.010).Reverse-dipper pattern of BP may be a risk factor for carotid atherosclerosis and play a crucial role in the early formation of carotid plaque.

Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients

Recent studies suggested that nocturnal variations of blood pressure (BP) were closely related to type 2 diabetes. However, little information has been revealed about the relationship between reverse-dipper pattern of BP and type 2 diabetes. In this cross-sectional study, BP variations of 531 hypertensive patients were evaluated with ambulatory BP monitoring (ABPM). Diagnosis of diabetes in Chinese adults was made according to diabetes diagnostic criteria of 2015. Multivariate logistic regression was used to examine the relationships between type 2 diabetes and ABPM results. In the study, patients with reverse-dipper pattern (32.3%) had the highest prevalence of type 2 diabetes compared with dippers (21.4%) and nondippers (23.3%). After multivariate logistic regression, reverse-dipper BP pattern (OR 2.067, P = 0.024) and nondipper BP pattern (OR 1.637, P = 0.039) were found to be correlated with type 2 diabetes compared with dipper pattern. The results of our study also suggested that type 2 diabetes might contribute to the reverse-dipper pattern of BP (OR 1.691, P = 0.023). In addition, fasting glucose was negatively correlated with the decline rate of nocturnal SBP (r = -0.095, P = 0.029). Reverse-dipper pattern of BP in ABPM may be independently associated with type 2 diabetes in patients with hypertension.

Intra-aortic balloon pump may grant no benefit to improve the mortality of patients with acute myocardial infarction in short and long term: an updated meta-analysis.

AbstractIntra-aortic balloon pump (IABP) has been extensively used in clinical practice as a circulatory-assist device. However, current literature demonstrated significantly varied indications for IABP application and prognosis.The objective of the study was to assess the potential benefits or risks of IABP treatment for acute myocardial infarction (AMI) complicated with or without cardiogenic shock.MEDLINE and EMBASE database were systematically searched until November 2014, using the terms as follows: IABP, IABC (intra-aortic balloon counterpulsation), AMI, heart infarction, coronary artery disease, ischemic heart disease, and acute coronary syndrome. Only randomized controlled trials (RCTs) that compared the use of IABP or non-IABP support in AMI with or without cardiogenic shock were included. Two researchers performed data extraction independently, and at the mean time, the risk of bias among those RCTs was also assessed.Of 3026 citations, 17 studies (n = 3226) met the inclusion criteria. There is no significant difference between IABP group and control group on the short-term mortality (relative risk [RR], 0.90; 95% confidence interval [CI], 0.77–1.06; P = 0.214) and long-term mortality (RR, 0.91; 95% CI, 0.79–1.04; P = 0.155) in AMI patients with or without cardiogenic shock. These results were consistent when the analysis was performed on studies that only included patients with cardiogenic shock, both on short-term mortality (RR, 0.91; 95% CI, 0.77–1.08; P = 0.293) and long-term mortality (RR, 0.95; 95% CI, 0.83–1.10; P = 0.492). Similar result was also observed in AMI patients without cardiogenic shock. Furthermore, the risks of hemorrhage (RR, 1.49; 95% CI, 1.09–2.04; P = 0.013) and recurrent ischemia (RR 0.54, 95% CI 0.37 to 0.79; P = 0.002) were significantly higher in IABP group compared with control group.We did not observe substantial benefit from IABP application in reducing the short- and long-term mortality, while it might promote the risks of hemorrhage and recurrent ischemia. Therefore, IABP may be not an optimal therapy in AMI with or without cardiogenic shock until more elaborate classification is used for selecting appropriate patients.

The relationship between red blood cell distribution width and blood pressure abnormal dipping in patients with essential hypertension: a cross-sectional study

Objective To investigate whether red blood cell distribution width (RDW) is associated with the blood pressure (BP) reverse-dipper pattern in patients with hypertension. Design Cross-sectional study. Setting Single centre. Participants Patients with essential hypertension were included in our study (n=708). The exclusion criteria included age <18 or >90 years, incomplete clinical data, night workers, diagnosis of secondary hypertension, under antihypertensive treatment, intolerance for the 24 h ambulatory BP monitoring (ABPM) and BP reading success rate <70%. Measurement Physical examination and ABPM were performed for all patients in our study. The value of RDW was measured using an automated haematology analyser. Statistical methods The distribution of RDW in patients with hypertension among different circadian BP pattern groups was analyzed using analysis of variance (ANOVA). Multinomial logistic regression was applied to explore the associations of RDW and other relevant variables with ABPM results. Results There was significantly increased RDW in reverse dippers (13.52±1.05) than dippers (13.25±0.85) of hypertension (p=0.012). Moreover, multinomial logistic regression analysis showed that RDW (OR 1.325, 95% CI 1.037 to 1.692, p=0.024) and diabetes mellitus (OR 2.286, 95% CI 1.380 to 3.788, p=0.001) were significantly different when comparing the reverse-dipper BP pattern with the dipper pattern. However, there was no difference of RDW between the non-dipper pattern and the reverse-dipper pattern (OR 1.036, 95% CI 0.867 to 1.238, p=0.693). In addition to this, RDW was negatively correlated with the decline rate of nocturnal systolic BP (r=−0.113; p=0.003) and diastolic BP (r=−0.101; p=0.007). Conclusions Our results suggested that RDW might associate with the abnormal dipper BP patterns of either reverse dipping or non-dipping homogeneously examined with 24 h ABPM.

Novel Association Between the Reverse-Dipper Pattern of Ambulatory Blood Pressure Monitoring and Metabolic Syndrome in Men But Not in Women.

AbstractThe aim of this study was to investigate the relationships between nocturnal variations in blood pressure (BP) and metabolic syndrome (MetS) in different gender.This cross-sectional study involved 509 hypertensive patients (254 males and 255 females, 45 to 75 years old) from September 2013 to March 2014. BP values were acquired from ambulatory BP monitoring (ABPM). The dipper pattern of BP was defined as 10% to 20% reduction of the mean systolic BP (SBP) values at night compared with the daytime values. The diagnosis of MetS was made according to NCEP ATP-III definition. Multivariate logistic regression analyses were used to explore the relationships between ABPM results and MetS.In our study, MetS were observed in 29.1% of male and 18.4% of female participants. The prevalence of MetS was higher in the patients with reverse-dipper pattern than in others. After multivariate logistic regression analysis, the reverse-dipper pattern of BP (odds ratio 2.298; P = 0.006) and 24-SBP (odds ratio 1.063; P = 0.021) were independently correlated with MetS in males. However, there was no association between MetS and BP reverse dipping in females.Our cross-sectional study showed that the reverse-dipper pattern of BP is associated with MetS in male, while the underlying mechanism deserves further investigation.

The relationship between blood pressure dipping status and carotid plaque in senior essential hypertensive individuals of different sexes: a cross-sectional study.

ObjectiveTo investigate the associations of the blood pressure (BP) dipping status with carotid plaque in senior essential hypertensive patients of different sexes. Participants and methodsA total of 512 patients (275 men and 237 women) with essential hypertension who underwent ambulatory BP monitoring and carotid ultrasound assessment were recruited in our study. Binary logistic regression was used to analyze the associations of multiple risk factors with carotid plaque. ResultsAbnormal dipping [odds ratio (OR)=2.138, 95% confidence interval (CI) 1.170–3.908, P<0.05] and circadian decline rate of systolic BP (SBP) (OR=0.925, 95% CI 0.884–0.968, P<0.01) were found to be associated with carotid plaque in men. The level of night-time SBP (OR=1.022, 95% CI 1.003–1.042, P<0.05) and carotid plaque were associated with each other in women. In addition, as for all the patients in our study, abnormal dipping (OR=1.743, 95% CI 1.114–2.725, P<0.05), circadian decline rate of SBP (OR=0.950, 95% CI 0.922–0.980, P<0.01), the level of night-time SBP (OR=1.030, 95% CI 1.014–1.047, P<0.001), and the level of daytime diastolic BP (OR=0.971, 95% CI 0.946–0.998, P<0.05) were associated with carotid plaque, respectively. ConclusionOur results suggested that the abnormal dipping status of BP and circadian decline rate of SBP might serve as independent risk factors for carotid plaque, respectively, in men, as does night-time SBP in women. Therefore, personalized BP management may be necessary for hypertensive patients.