Search Results (100)

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as pulse pressure (PP), pulse pressure index (PPI), rate pressure product (RPP), ambulatory arterial stiffness index (AASI), and average real variability (ARV), remains underexplored in the pediatric population, particularly among children with chronic kidney disease (CKD). Objective: To evaluate the correlation between ABPM-derived indices in children, with a subgroup analysis comparing those with and without CKD. Secondary objectives included identifying factors associated with AASI and ARV and assessing their utility in cardiovascular risk stratification. Methods: In this bicentric cross-sectional study, 70 children (41 with CKD and 29 controls) were enrolled. ABPM indices (PP, PPI, RPP, AASI, and ARV) were calculated, and both descriptive and inferential statistical analyses, including linear regression, were performed. Results: Systolic and diastolic hypertension were significant predictors of elevated ARV (p < 0.05), while body mass index (BMI) and glomerular filtration rate (GFR) were positively associated with AASI (p < 0.05). Use of angiotensin-converting enzyme inhibitors (ACEIs) was associated with reduced arterial stiffness (p = 0.02). Significant differences were observed in weight, BMI, PP, and PPI between the CKD and non-CKD groups, with ABPM demonstrating greater sensitivity in detecting vascular health markers. Conclusions: ABPM-derived indices, particularly PP, PPI, and ARV, show promise in improving cardiovascular risk assessment in children. These findings support the broader use of ABPM metrics for refined cardiovascular evaluation, especially in pediatric CKD. Full article

Background/Objectives: The ankle-brachial index (ABI) is a non-invasive diagnostic tool for peripheral artery disease (PAD) and a marker of systemic atherosclerosis, predictive of cardiovascular (CV) events. The ambulatory arterial stiffness index (AASI), derived from 24-h blood pressure monitoring, also predicts CV morbidity and mortality, particularly stroke. However, their combined prognostic utility in acute myocardial infarction (AMI) remains underexplored. This study aimed to assess the predictive value of ABI and AASI in patients with AMI. Methods: We conducted a single-center observational cohort study including 441 consecutive patients with AMI (79% male; mean age 62 years). ABI was measured using an automated device, with ≤0.9 defined as abnormal. AASI was calculated from 24-h blood pressure recordings. The primary endpoint was a composite of all-cause and CV death and major CV events, assessed in-hospital and over a 3-year follow-up. Results: Median ABI was 1.10 (IQR 1.00–1.18); 10.4% had abnormal ABI. Abnormal ABI was associated with a threefold higher risk of in-hospital adverse events (OR 2.93, 95% CI: 1.48–5.81, p = 0.002). In Cox regression, abnormal ABI predicted long-term all-cause mortality (HR 2.88, 95% CI: 1.53–5.42, p = 0.001), independent of traditional risk factors. Each 0.1 increase in AASI was linked to a 21% higher risk of the composite outcome (p = 0.001) and 25% increased risk of recurrent AMI or urgent revascularization (p = 0.001). Conclusions: In this prospective cohort of patients with AMI, ABI and AASI were associated with adverse outcomes, suggesting their potential role in risk stratification. These exploratory findings require validation in larger, multicenter cohorts to assess their incremental prognostic value and generalizability. Full article

Background: Several studies have shown that total kidney volume (TKV) measurements may serve as a non-invasive imaging biomarker for monitoring and predicting the progression of autosomal dominant polycystic kidney disease (ADPKD) in children. Methods: This study aimed to evaluate the relationship between height-adjusted TKV (htTKV), estimated glomerular filtration rate (GFR), and blood pressure, assessed using 24 h ambulatory blood pressure monitoring (ABPM), in children with early-stage ADPKD. The study was conducted with 72 children, mean age 12.46 ± 3.76 (5.42–17.92). Results: Hypertension (HT) was diagnosed in (20) 28% of children. ABPM allowed the identification of previously undiagnosed HT in 12 (16.7%) children. Decreased GFR was demonstrated in 10 (14%) children, and hyperfiltration in 5 (7%) children. Significantly higher htTKV and calculated TKV z-score and more frequent decreases in GFR were observed in hypertensive children (p = 0.018; 0.020 and 0.010, respectively). The study demonstrated a significant inverse correlation between htTKV and GFR (r −0.25; p = 0.032). The TKV z-score showed a very good correlation with all ABPM parameters, except for DBP and DBP z-score during the day. Receiver operating curve (ROC) analysis showed that htTKV and TKV z-score had good diagnostic value for predicting a decline in GFR (AUC 0.808, p < 0.001), but were not useful for predicting the onset of HT (AUC 0.697, p = 0.010). Conclusions: There is a relationship between TKV, GFR, and blood pressure parameters in children with early-stage ADPKD. The TKV z-score can be useful for predicting GFR decline. Children with ADPKD and increasing TKV require careful blood pressure monitoring. Full article

Background: In systemic sclerosis (SSc), endothelial dysfunction, inflammation, and reduced nitric oxide levels may disrupt circadian blood pressure (BP) regulation. There are studies showing that inflammatory and certain other cells in diseases like SSc exhibit diurnal rhythms. In our study, we examined the effect of SSc on BP. In particular, the frequency of the non-dipper pattern (lack of nighttime BP reduction) in SSc patients has not been adequately investigated. The aim of this study was to evaluate the 24 h BP profile in SSc patients and to compare the frequency of the non-dipper pattern with that of the non-scleroderma group. Additionally, the identification of disrupted circadian BP patterns in SSc patients aims to contribute to the development of personalized, time-sensitive BP monitoring strategies in the future and to support the applicability of personalized medicine in this context. Methods: A total of 31 SSc patients diagnosed according to the 2013 ACR/EULAR classification criteria and 30 age- and sex-matched individuals without SSc were included in this prospective study. BP changes between day and night were evaluated by measuring BP every 30 min with a 24 h ambulatory blood pressure monitoring (ABPM) device. The non-dipper pattern was defined as a decrease in BP of less than 10% during the night compared to the day. To better assess BP fluctuations during the night, nighttime measurements were divided into two time periods: first, 24:00–04:00, and then 04:00–08:00. Additionally, laboratory and clinical parameters and SSc subtypes were compared between the groups. Results: The ABPM findings were compared between the groups with and without SSc. The non-dipper pattern was significantly more common in the SSc group at all time intervals. The non-dipper pattern was observed in 25.8% of the non-SSc group and 83.9% of SSc patients (p < 0.001). In the period between 24:00 and 04:00, the prevalence was 25.8% in the control group and 71.0% in SSc patients (p < 0.001), and between 04:00 and 08:00, it was 35.5% in the control group and 80.6% in SSc patients (p < 0.001). No significant difference was found in non-dipper patterns between individuals with diffuse and limited cutaneous forms of systemic sclerosis. Conclusions: The non-dipper BP pattern is significantly more common in patients with SSc, indicating the disruption of the circadian rhythm affecting BP. Analysis performed by dividing the night into specific time periods revealed that this deterioration continued throughout the night. The findings highlight the importance of circadian BP monitoring in SSc patients and may contribute to future risk stratification and treatment strategies. Circadian BP analysis in SSc may help to develop strategies that are personalized for these patients and tailored to their physiological rhythm. Full article

Background and Objective: Dietary interventions are the first-line treatment for overweight individuals (OW) and individuals with obesity (OB) with high-normal blood pressure (BP) or grade I hypertension, especially when at low-to-moderate cardiovascular risk (CVR). However, current guidelines do not specify the most effective dietary approach for optimising cardiovascular and metabolic outcomes in this population. This study aimed to compare the effects of a low-calorie, high-protein ketogenic diet (KD) vs. a low-calorie, low-sodium, and high-potassium Mediterranean diet (MD) on BP profiles assessed via ambulatory BP monitoring (ABPM), as well as on anthropometric measures, metabolic biomarkers, and body composition evaluated by bioelectrical impedance analysis (BIA). Methods: This prospective observational bicentric pilot study included 26 non-diabetic adult outpatients with central OW status or OB status (body mass index, BMI > 27 kg/m²) and high-normal BP (≥130/85 mmHg) or grade I hypertension (140–160/90–100 mmHg), based on office BP measurements. All participants had low-to-moderate CVR according to the second version of the systemic coronary risk estimation (SCORE2) and were selected and categorized as either KD (n = 15) or MD (n = 11). Comprehensive blood analysis, BIA, and ABPM were conducted at baseline and after three months. Results: At baseline, no significant differences were observed between the groups. Following three months of dietary intervention, both groups exhibited substantial reductions in body weight (KD: 98.6 ± 13.0 to 87.3 ± 13.4 kg; MD: 93.8 ± 17.7 to 86.1 ± 19.3 kg, p < 0.001) and waist circumference. Mean 24 h systolic BP (SBP) and diastolic BP (DBP) significantly declined in both groups (24 h mean SBP decreased from 125.0 ± 11.3 to 116.1 ± 8.5 mmHg (p = 0.003) and 24 h mean DBP decreased from 79.0 ± 8.4 to 73.7 ± 6.4 mmHg (p < 0.001)). Fat-free mass (FFM) increased, whereas fat mass (FM), blood lipid levels, and insulin concentrations decreased significantly. The ΔFM/ΔFFM correlates with ABP improvements. However, no significant between-group differences were detected at follow-up. Conclusions: The KD and the MD mediated weight loss and body composition changes, effectively improving bio-anthropometric and cardiovascular parameters in individuals with OW status or OB status and high BP. Although more extensive studies are warranted to elucidate potential long-term differences, our findings suggest the manner in which these two different popular dietary approaches may equally confer metabolic and cardiovascular benefits, emphasising the importance of weight and FM loss. Full article

Background: Monitoring pulse rate is fundamental to cardiovascular health management and early detection of rhythm disturbances. While oscillometric blood pressure measurement is well established and validated in clinical practice, its use for pulse rate monitoring, particularly via wrist-worn devices, remains largely unexplored. Objective: This study investigates whether a smartwatch that performs oscillometric blood pressure measurements at the wrist can also deliver reliable pulse rate readings using the same method. Methods: This study compared pulse rates recorded by the Omron HeartGuide smartwatch and conventional ambulatory blood pressure monitors in 50 patients over 24 h. Measurements were taken consecutively, and data were analyzed using intraclass correlation coefficients (ICCs) and Bland–Altman plots. Results: The study showed a high ICC of 0.971, indicating excellent agreement between devices. The average pulse rate difference was 1.5 bpm, with the Omron HeartGuide reporting slightly lower rates, especially in patients with atrial fibrillation. Conclusions: This study demonstrates that oscillometric pulse-rate monitoring at the wrist can achieve a high degree of accuracy, comparable to conventional upper-arm devices. Given that oscillometric smartwatches like the Omron HeartGuide are already used for blood pressure monitoring, the findings suggest that they may also be suitable for pulse rate measurement, potentially enhancing their role in telemetric healthcare, but further research is needed, particularly in patients with arrhythmias. Full article

Background: Calmodulin is a calcium-signaling protein implicated in cardiac remodeling and could be released extracellularly. It was previously identified as differentially expressed in hypertensive pediatric chronic kidney disease (CKD). This study assessed plasma calmodulin as a cardiovascular disease (CVD) biomarker in pediatric CKD and compared it with traditional risk markers. Methods: We conducted a cross-sectional study of 81 children with CKD aged 3–18 years. All underwent clinical assessments and echocardiography; 44 had carotid ultrasound, and 38 completed ambulatory blood pressure monitoring (ABPM). Results: Most participants had preserved renal function (median eGFR, 104.4 mL/min/1.73 m²). Plasma calmodulin levels were significantly associated with early markers of CVD, including interventricular septal thickness, left ventricular mass, carotid intima–media thickness, and ABPM systolic measures (all r > 0.2; p < 0.05). In multivariable analysis, only calmodulin and office systolic blood pressure (BP) independently predicted abnormal BP profiles. Conclusions: Plasma calmodulin may serve as a sensitive, though non-specific, early CVD biomarker in pediatric CKD and could complement conventional screening tools. Full article

Background: African Americans (AA) are disproportionally affected by hypertension (HTN). Gut microbiome metabolites (e.g., butyrate) may mediate the relationship between the microbiome and blood pressure (BP). Previous research reports a consistent indirect relationship between gut butyrate, a product of gut microbial nutrient fermentation, and BP. Thus, this study assessed the relationship between individual diet intake on BP changes after a butyrate treatment. Methods: AA aged 30–50 with HTN underwent treatment with a blinded placebo (5 mmol) and butyrate enema (80 mmol) with a one-week washout period. Ambulatory BP monitors collected measures up to 24 h post-enema. The Nutrition Data System for Research was used to assess diet and Healthy Eating Index (HEI-2015) scores from diet records. Paired t-tests and Kendall’s correlation tests determined group differences and relationships between variables (p < 0.05). Results: Positive correlations were found between other vegetables and 24 h diastolic BP (r = 0.64), daytime diastolic BP (r = 0.68), and MAP (r = 0.72). Positive correlations were also found between 24 h systolic BP and HEI-2015 greens and beans sub-scores (r = 0.64) and 24 h DBP and total vegetables (r = 0.64). Negative correlations were found between nighttime arterial stiffness and total grain intake (r = −0.71). Conclusion: These data suggest diet impacts BP measures in response to acutely increasing gut butyrate. These results provide preliminary evidence linking food groups, not individual nutrients, with BP outcomes and gut butyrate availability. Full article

Botulinum neurotoxin (BoNT) intoxication is a rare but severe condition that is characterized by autonomic and neuromuscular dysfunction. This study aimed to evaluate autonomic impairment and blood pressure variability in patients with botulinum intoxication during an outbreak, compared to healthy controls, and to assess their progression over a six-month follow-up period. Methods: Twenty (n = 20) male patients diagnosed with BoNT intoxication and 34 age- and sex-matched healthy controls were enrolled. At baseline, all subjects underwent 24 h ambulatory blood pressure monitoring (ABPM), and clinostatic and orthostatic blood pressure measurements. Autonomic function parameters, including mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), SBP and DBP variability, SBP and DBP load, pulse pressure (PP), blood pressure variability ratio (BPVR), and morning surge, were analyzed. Follow-up assessments were conducted after six months. Results: Patients with botulinum intoxication exhibited significantly lower SBP, DBP, and blood pressure variability parameters compared to healthy controls. Orthostatic hypotension was present in 55% of patients at baseline, improving to 5% at follow-up. Respiratory failure occurred in 40% of cases, necessitating non-invasive ventilation in 35% and intubation in 20%. At six-month follow-up, mean SBP, DBP, heart rate, and blood pressure variability parameters increased significantly, indicating partial recovery of autonomic control. However, residual abnormalities in autonomic regulation persisted. Conclusions: BoNT intoxication leads to notable autonomic dysfunction, marked by impaired blood pressure regulation and a high prevalence of orthostatic hypotension. Although partial recovery occurs, long-term autonomic impairment persists, highlighting the necessity for ongoing cardiovascular monitoring and further research to accelerate autonomic recovery through targeted therapeutic interventions. Full article

Background/Objectives: Parkinson’s disease (PD) and hypertension are often coexistent conditions that interact in entwined ways at various levels. Cardiovascular autonomic dysfunction (CAD), a non-motor feature of PD occurring across all stages, alters blood pressure (BP) regulation. Methods: We conducted a cross-sectional study enrolling patients with PD and primary hypertension, without diabetes mellitus or other causes of secondary CAD, aiming to characterize BP profiles/patterns by ambulatory BP monitoring. We also sought associations between different CAD phenotypes and PD characteristics, disability, and cardiovascular comorbidities. Results: We included 47 patients with a median age of 71 years, PD duration of 9 years, and Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III score of 40. Diurnal and nocturnal BP values were within the reference range, but BP load was excessive. Almost one-third had neurogenic orthostatic hypotension (OH) and 80% were non-dippers. The overall burden of non-motor symptoms was significant in these phenotypes. Patients with neurogenic OH were more prone to constipation, anxiety, and urinary problems, whereas gustatory dysfunction, loss of libido, and erectile dysfunction were more frequently reported by non-dippers. No significant differences with regard to cognitive decline were identified in subjects with and without neurogenic OH. Neurogenic OH was symptomatic in 78% of the cases, whereas 56% of those with orthostatic symptoms did not have OH at repeated measurements. Conclusions: Neurogenic OH is an independent predictor of disability in patients with PD and hypertension, after adjusting for PD duration, Hoehn and Yahr stage, levodopa equivalent daily dose (LEDD), and Montreal Cognitive Assessment (MoCA) score. Full article

Cardiology and sleep societies recommend 7–9 h sleep/night for adults (7–8 h for seniors) and more for youngsters; nonetheless, short sleep duration (SSD) of <7 h/night is epidemic. We searched PubMed for representative investigations, including those cited by meta-analyses, that reported association between SSD and long sleep duration (LSD) of >9 h/night and blood pressure (BP) levels to assess shortcomings of their methods. Studies indicate both SSD and LSD negatively impact BP despite major deficiencies, such as (i) reliance mainly on cross-sectional rather than longitudinal protocols, (ii) inclusion of participants diagnosed with hypertension (HTN) and/or taking antihypertension medications, (iii) assessment of BP and diagnosis of HTN performed by single wake-time office measurement rather than multiple measurements performed by 24 h ambulatory BP monitoring (ABPM), and (iv) determination of SD by subjective recall, single-night polysomnography, or diary recordings rather than objective wrist actigraphy of sufficient duration. The limited number of ABPM-based studies, despite evidencing major shortcomings, particularly (i) assessment for 24 h rather than preferred ≥48 h and (ii) inclusion of subjects diagnosed with HTN and/or taking antihypertension medications, also report association between abnormal SD and elevated 24 h ‘daytime’/wake-time diastolic and systolic (SBP) means plus ‘nighttime’/sleep-time SBP mean and dipping—the latter two indices, in combination, the strongest predictors of major adverse cardiovascular events. Full article

Growing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer’s disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia. Full article

Background and Objectives: Metabolic syndrome (MetS) is considered a global epidemic, and its diagnosis is crucial, allowing early intervention and management. The main aim of this study was to examine any possible blood pressure (BP) differences based on office and out-of-office measurements in patients with and without MetS, and to investigate if any of these measurements correlated better with MetS. The secondary aim was to investigate any possible cardiovascular risk differences. Materials and Methods: The study population consisted of individuals attending the outpatient hypertension clinic. Office and out-of-office BP measurements were recorded in all of the patients, as well as different cardiovascular risk scores and echocardiography. MetS was defined according to ACC/AHA criteria. Results: A total of 282 (39.9% men) individuals (56.8 ± 15.8 years) were analyzed; 60.8% of them had MetS. The patients with MetS had a significantly higher systolic BP (SBP) in all of the BP measurements, higher ASCVD risk (22% vs. 12%), Framingham risk scores (11.8% vs. 6.9%), a significantly higher prevalence of LVH (49.2% vs. 22.7%) and early vascular aging (54.8% vs. 27.4%) compared with the patients without MetS (p < 0.05 for all). In a univariate analysis, MetS was significantly correlated with the average 24h SBP, daytime and nighttime ambulatory SBP, office SBP, and home SBP in the morning (p < 0.05). No significant differences were observed for any of the DBP measurements. Finally, 50.5% of the MetS patients had sustained hypertension, 15.2% masked hypertension, and 11.5% white-coat hypertension based on ABPM, and these values were 45.1%, 19.3%, and 13.6%, respectively, based on HBPM. Furthermore, most of the MetS patients had non-dipping hypertension (56.4%). Conclusions: The present findings highlight the importance of out-of-office BP measurements in the diagnosis of MetS, since both a high office and out-of-office SBP were significant features of the syndrome (whereas this was not the case with DBP). This is further supported by the increased prevalence of different hypertension phenotypes observed in the MetS patients. Higher ASCVD risk scores and LVH and EVA prevalence were also related to MetS, thus strongly supporting the necessity for early detection and treatment. Full article

Background: Parkinson’s disease (PD) is the second-most prevalent neurodegenerative disorder, often resulting in blood pressure abnormalities due to autonomic dysfunction. The early morning rise in blood pressure, referred to as the morning surge, has been associated with various cardiovascular diseases when exaggerated. This study aims to investigate the relationship between morning blood pressure surge (MBPS) and inflammatory markers in patients with PD. Methods: In this retrospective study, we employed 24 h ambulatory blood pressure monitoring alongside the fibrinogen-to-albumin ratio and high-sensitivity C-reactive protein (hs-CRP) as inflammatory markers. The study included fifty idiopathic PD patients and fifty age- and sex-matched control subjects. MBPS was defined as the difference between morning blood pressure (measured two hours after awakening) and the lowest recorded nighttime blood pressure. Body mass index (BMI) was considered as an independent variable. Results: Our study found that morning blood pressure surge (MBPS) levels were significantly higher in Parkinson’s disease (PD) patients compared to the control group, suggesting possible autonomic involvement. Conclusions: MBPS may indicate autonomic involvement, potentially contributing to cardiovascular and cerebral morbidity and mortality in PD patients. Longitudinal studies with larger sample sizes are warranted to further elucidate this relationship. Full article

Background/Objectives: Considering the physiological analogies between the eye and the kidney, this study aimed to investigate the potential relationship between retinal vascular density, assessed using Optical Coherence Tomography Angiography (OCT-A), and the renal resistive index (RRI) in patients with arterial hypertension. Methods: A total of 82 hypertensive patients (mean age 48 ± 13) were enrolled in the study. Participants underwent routine biochemical evaluations, office-based blood pressure measurement, 24 h ambulatory blood pressure monitoring, OCT-A imaging, and renal Doppler ultrasound examinations. Results: The mean RRI in the study population was 0.616 ± 0.06. Participants were divided into two groups based on the 75th percentile threshold of the RRI distribution (0.66, 95% CI 0.64–0.68). The group with RRI > 75th percentile, which appeared to have a higher number of smokers, exhibited significantly higher mean triglyceride and urinary albumin excretion (UAE) levels and a significantly reduced estimated glomerular filtration rate (eGFR) as compared to the group with RRI < 75th percentile. Among the hemodynamic parameters, 24 h pulse pressure (PP), daytime and nighttime PP, and nighttime systolic blood pressure (SBP) were significantly higher in the group with RRI > 75th percentile. Regarding retinal vascular density indices, the only significant difference was observed in the deep foveal vascular plexus, which displayed a reduced density in the group with RRI > 75th percentile. Logistic regression analysis revealed that RRI > 75th percentile was independently associated with increased nighttime mean pulse pressure (OR = 1.13, 95% CI: 1.049–1.221, p = 0.0014) and reduced deep foveal vascular density (OR = −0.5026, 95% CI: 1.0493–1.2211, p = 0.0044). Conclusions: Our findings demonstrate that ocular microvascular alterations are associated with RRI, a marker with a well-established prognostic value for renal disease progression and systemic macrovascular dysfunction. These results further substantiate the close relationship between renal and ocular microcirculation. Full article