Search Results (37)

Background: R wave amplitude in the aVL ECG lead (R_aVL) has been identified as a marker of cardiovascular (CV) risk, hypertension-mediated target organ damage (HMOD), and mortality in patients with arterial hypertension (AH), where R_aVL > 1.1 mV suggests left ventricular hypertrophy. However, the exact threshold for identifying high-risk patients has yet to be determined. Therefore, we compared R_aVL values among hypertensive patients with and without hypertensive urgencies (HUs) and healthy subjects, aiming to identify the predictors of elevated R_aVL and to compare its prognostic value with the SCORE 2 model. Methods: This cross-sectional study included 339 participants divided into three groups according to ambulatory blood pressure monitoring results: 100 patients with AH and HU from the emergency department, 134 patients with AH without HU, and 105 healthy subjects recruited from four family medicine practices. Basic laboratory parameters were determined, SCORE 2 risk was calculated, PWV was measured using oscillometry, and a standard 12-lead ECG was recorded in all participants. Results: Participants with AH and HU had the highest R_aVL values compared to those with AH without HU and healthy subjects (averages of 0.76 ± 0.24 mV, 0.49 ± 0.27, 0.22 ± 0.25, respectively; p < 0.001). Significantly higher R_aVL values were observed in males compared to females (0.56 ± 0.31 vs. 0.41 ± 0.34 mV; p < 0.001) and in non-dippers compared to dippers (0.56 ± 0.34 mV vs. 0.41 ± 0.31 in dippers; p < 0.001). Age, mean arterial pressure, PWV, and SCORE 2 were shown as independent predictors of R_aVL. Compared with SCORE 2, individuals with R_aVL > 0.40 mV had high CV risk (sensitivity of 58.16%, specificity of 73.68%; p < 0.001). Conclusions: In this study, R_aVL demonstrated good prognostic value for CV risk stratification. However, larger studies are needed to determine a precise high-risk threshold to improve CV risk estimation and HMOD detection in patients with marginal SCORE 2 CV risk. Full article

Background/Objectives: Laparoscopic sleeve gastrectomy (LSG) treats severe obesity, but data on its effects on 24 h blood pressure (BP) patterns, blood pressure variability (BPV), and cardiac autonomic nervous system (CANS) in obese patients without hypertension or diabetes are limited. We evaluated these parameters before and after LSG. Methods: 78 patients with severe obesity (BMI ≥ 40 kg/m²) without hypertension or diabetes who underwent LSG between January 2016 and December 2019 were included in the study. Patients underwent ambulatory blood pressure monitoring (ABPM), ambulatory electrocardiographic monitoring, and laboratory tests before and six months after surgery. Results: Preoperative ABPM was characterized by a significant proportion of masked hypertension (43.5%), high 24 h BP (mean SBP 138.9 ± 5.5 mmHg, DBP 81.1 ± 4.9 mmHg), high BP load (39% SBP, 38% DBP), and a non-dipper pattern (67.9%). After LSG, significant improvements were observed in mean 24 h SBP, DBP (p < 0.001), BPV, BP load, and non-dipper patterns. HRV parameters (SDANN, RMSSD) increased significantly (p < 0.001) and HRT parameters improved: TO became more negative from −0.54 ± 1.73 to −2.53 ± 1.97, TS increased from 5.98 ± 3.49 to 9.87 ± 4.28 ms/RR (p < 0.001). We found a strong association between decreased body mass index and BP changes. Changes in glucose, HbA1c, and HOMA-IR predicted CANS improvement (β = 0.24–0.38; R² = 20.8–29.7%). Conclusions: Six months after LSG, significant improvements in BP, BPV, and CANS were observed. BP reduction was primarily associated with weight loss, while glucose control was associated with autonomic improvements. LSG was associated with early improvements in surrogate cardiovascular risk markers through combined weight-dependent and metabolic-hormonal mechanisms. Full article

Background and Objectives: Gestational hypertension (GH) is increasingly recognized as an early manifestation of maternal cardiovascular vulnerability. Ambulatory blood pressure monitoring (ABPM) enables the evaluation of circadian blood pressure behavior, and a non-dipping blood pressure pattern (NDBP), defined as a nocturnal systolic decline of <10%, has been associated with endothelial dysfunction, placental hypoperfusion, and adverse pregnancy outcomes. However, the prognostic value of NDBP for postpartum chronic hypertension (PPCHT) remains insufficiently explored. Materials and Methods: This retrospective observational study included 196 women with gestational hypertension beyond 20 weeks of gestation who underwent ABPM between 2013 and 2025. Patients were classified as dippers (≥10% nocturnal systolic decline) or non-dippers (<10%). The primary outcome was postpartum chronic hypertension, defined as a persistent office blood pressure ≥ 140/90 mmHg or continued antihypertensive therapy at 12-month follow-ups. Secondary outcomes included fetal growth restriction (FGR), preeclampsia, and hypertensive complications. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of PPCHT and FGR. Results: In the cohort, 124 women (63.3%) exhibited a non-dipping blood pressure pattern. At 12 months postpartum, 93 women (47.4%) developed chronic hypertension. Non-dipping was significantly more frequent among women with PPCHT compared with those that remained normotensive (75.3% vs. 52.4%). Non-dippers also demonstrated higher rates of fetal growth restriction and preeclampsia. In multivariable analysis, NDBP remained independently associated with PPCHT after adjustments for age and daytime blood pressure parameters. Furthermore, NDBP and elevated daytime systolic blood pressure were independent predictors of FGR. Conclusions: A non-dipping blood pressure pattern is highly prevalent in gestational hypertension and is independently associated with both fetal growth restriction and postpartum chronic hypertension. Incorporating ABPM-derived circadian blood pressure phenotyping into antenatal assessments may improve risk stratification and support targeted postpartum cardiovascular surveillance strategies. Full article

Background and Objectives: The risk of cardiovascular events rises when hypertensive patients fail to achieve sufficient blood pressure reduction during nighttime hours. This study examined the association between metabolic and inflammatory biomarkers and non-dipper patterns in patients with white-coat hypertension. Materials and Methods: A total of two hundred and forty-four (244) patients with newly diagnosed white-coat hypertension were included in the study. The study used ambulatory blood pressure monitoring to classify patients as dippers (n = 86) and non-dippers (n = 158). The study evaluated metabolic markers through triglyceride–glucose (TyG) index, atherogenic index of plasma (AIP) and uric acid measurements against inflammatory markers including neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and monocyte/lymphocyte ratio. Results: The non-dipper group showed higher levels of uric acid (6.42 mg/dL vs. 5.65 mg/dL; p < 0.001), TyG index (8.82 vs. 8.51; p < 0.001), AIP (0.49 vs. 0.37 **; ** p < 0.001) and body mass index (26.0 kg/m² vs. 24.1 kg/m²; p < 0.001) when compared to the dipper group. The inflammatory markers showed no significant variation between the groups. Uric acid showed the highest discriminative ability (AUC = 0.722). The research showed that each one mg/dL increase in uric acid levels was associated with 89% higher odds of non-dipper status (OR = 1.892; p = 0.002). A one-unit increase in the TyG index was associated with approximately 2.5-fold-higher odds. Conclusions: Levels of TyG index, uric acid, BMI and AIP were higher in patients with the non-dipper pattern compared to the dipper patients. The TyG index, uric acid levels, and BMI were independently associated with the non-dipper pattern in white-coat hypertension patients. These findings suggest that metabolic biomarkers may help identify individuals at higher risk for circadian blood pressure dysregulation. Full article

Introduction: Chronic kidney disease (CKD) is associated with a high risk of cardiovascular complications and mortality. This study aimed to assess the relationship between the diurnal blood pressure (BP) profile, progression of CKD, and hypertension-mediated organ damage (HMOD) in patients with CKD stages 1–3 during a 6-month observation period. Methods: Eighty-seven patients with CKD stages 1–3 underwent 24 h ambulatory blood pressure monitoring (ABPM), echocardiography, carotid intima-media thickness (IMT) assessment, and aortic pulse wave velocity (PWV) measurement at baseline and after 6 months. Serum creatinine and the estimated glomerular filtration rate (eGFR) were evaluated using the CKD-EPI formula. Results: Based on ABPM, patients were classified as dippers/extreme dippers (D/ED, 35.6%), non-dippers (ND, 47.2%), and reverse dippers (RD, 17.2%). At follow-up, the RD group showed a significant decline in the eGFR and a lower left ventricular ejection fraction compared to D/ED. IMT values were consistently higher in RD than in D/ED at baseline and follow-up. No significant differences in PWV were observed. Conclusions: An abnormal diurnal BP profile is common in patients with CKD stages 1–3. The “reverse dipper” profile is associated with faster CKD progression, more advanced vascular remodeling, and reduced left ventricular function. The results of our study support the role of ABPM as a useful tool in assessing risk in the early stages of CKD, providing additional prognostic information beyond office blood pressure measurements. Limitations: The relatively small sample size, short follow-up period, lack of detailed data on treatment modifications, and absence of orthostatic BP assessment may limit the interpretation and generalizability of the results. Full article

Background: Although there has been an improvement in the survival rates of patients following heart transplantation, many complications, such as hypertension, continue to develop. The aim of the study was to assess the 24-hour blood pressure profile and hypertension treatment among patients after heart transplantation and comparison to the control group. Methods: A retrospective data analysis included 26 male patients post-heart transplantation and 39 male patients in the control group. During a routine visit, the following data were collected: 24-hour blood pressure monitoring, laboratory tests, and medical history. Results: Hypertension was diagnosed in 76.9% of heart transplant recipients (HTXr) and in 56.4% of the control group (Cx). During the night-time rest period, diastolic blood pressure values ≥ 70 mmHg were observed in 76.9% of HTXr (vs. 33.33% Cx, p = 0.001). The average daytime systolic/diastolic blood pressure did not differ significantly between the groups. It was also observed that the groups differed in circadian blood pressure (Chi²ML = 15.87, p < 0.001), as there were significantly more reverse dippers in HTXr than in the control group (30.8% (8) vs. 10.3% (4)). The same proportions were also noted in HTXr and the control group in terms of isolated nocturnal hypertension. Conclusions: Heart transplant recipients require a tailored approach to hypertension management, including a variety of medications and appropriate chronotherapy. Full article

The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily accessible, cost-effective biomarker reflecting systemic inflammation. Chronic low-grade inflammation plays a pivotal role in the pathogenesis and progression of metabolic and cardiovascular disorders including chronic kidney disease (CKD), hypertension, diabetes mellitus, and cardiovascular disease (CVD). This review critically evaluates the current evidence on NLR as a prognostic marker across these interconnected conditions. A comprehensive literature search was conducted focusing on clinical and epidemiological studies investigating the association between NLR and CKD, hypertension, diabetes, and cardiovascular outcomes. Mechanistic insights into inflammation-driven pathophysiology and the predictive utility of NLR in disease progression and adverse events were synthesized. Elevated NLR is consistently associated with increased risk and severity of CKD, correlating with glomerular filtration decline, proteinuria, and mortality. In hypertension, higher NLR levels are linked to non-dipper blood pressure patterns, arterial stiffness, and increased cardiovascular risk. Among diabetic patients, NLR correlates with poor glycemic control and vascular complications. In cardiovascular disease, elevated NLR predicts major adverse cardiovascular events (MACE) and all-cause mortality, reflecting underlying immune dysregulation and endothelial dysfunction. Despite promising findings, direct comparisons with established inflammatory biomarkers remain limited, and heterogeneity exists across populations. NLR represents a simple yet powerful inflammatory biomarker with significant prognostic value in CKD, hypertension, diabetes, and cardiovascular disease. Its integration into clinical risk stratification models could enhance personalized medicine approaches. Future research should focus on longitudinal studies, validation in diverse cohorts, and comparative analyses with other inflammatory markers to fully delineate NLR’s clinical utility. Full article

Background: The association between blood pressure (BP) dipping profiles and kidney function among chronic kidney disease (CKD) patients has been well established within the literature, but studies conducted on kidney transplant (KT) patients remain limited. Individual KT studies have small sample sizes and conflicting results. Meta-analysis overcomes these limitations by pooling data to increase statistical power and provide robust clinical guidance. This meta-analysis systematically assesses the impact of BP patterns on KT and CKD populations, aiming to highlight improved BP management strategies in these populations. Materials and methods: A comprehensive search was conducted up to September 9th, 2024, using multiple electronic databases. Results: The current study included 7 studies with a total of 788 patients. KT recipients showed a higher prevalence of non-dipper blood pressure profile than CKD patients. Also, those with a dipper profile had a significantly higher estimated glomerular filtration rate (eGFR) compared to non-dippers and reverse dippers, implying better graft function. No significant differences were observed in acute rejection risk, proteinuria, renal resistive index, cholesterol, or triglycerides across blood pressure profiles. Conclusions: These findings reveal a high prevalence of non-dipping blood pressure profiles in KT and CKD patients, linked to worse renal and cardiovascular outcomes, while also highlighting the need for ambulatory blood pressure monitoring and tailored BP management strategies in these high-risk populations to potentially improve outcomes. However, the observational nature of available studies limits causal inference, and further prospective research is required to establish definitive therapeutic recommendations. Full article

Background/Objectives: Type 1 diabetes (T1D) in children is associated with increased cardiovascular risk, partly due to coexisting blood pressure (BP) disturbances. Ambulatory blood pressure monitoring (ABPM) is recommended for detecting subtle BP abnormalities, yet the relationship between glycemic control, T1D duration, and specific BP disturbances remains unclear. This study evaluated associations between HbA1c levels, T1D duration, and ABPM-derived BP parameters in a pediatric population with T1D. Methods: We included 357 children and adolescents (aged 7–18.8 years) with T1D treated at a tertiary center. All participants underwent 24 h ABPM. Glycemic control was assessed using HbA1c; values > 6.5% were considered suboptimal. We analyzed associations between HbA1c, T1D duration, and various BP parameters, including daytime and nighttime systolic and diastolic BP, nocturnal dipping, and hypertension defined by ABPM criteria. Logistic regression analyses were performed to identify independent predictors of elevated HbA1c. Results: Arterial hypertension was confirmed in 10% of patients, and 41% showed a non-dipping BP profile. There were no significant differences in HbA1c or T1D duration between dippers and non-dippers. However, patients with HbA1c > 6.5% had significantly higher 24 h diastolic BP and were more likely to meet hypertension criteria (p = 0.009). In univariate regression, both longer T1D duration (OR = 1.086; p = 0.033) and higher 24 h diastolic BP (OR = 1.065; p = 0.0068) were associated with elevated HbA1c. Both remained significant in multivariate analysis. Conclusions: Impaired glycemic control in children and adolescents with T1D was independently associated with higher 24 h diastolic BP and longer diabetes duration. 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

Objectives: This study aims to show the distribution of angiotensin-converting enzyme (ACE) rs1799752 (I>D) gene insertion/deletion (I/D) polymorphism and angiotensin II receptor type 1 (AGTR1) rs5186 (A>C) gene polymorphism in adolescents with hypertension (HT) and type 1 diabetes (T1D), as well as its association with hypertension and the diurnal variation of mean blood pressure (dipping phenomenon). Methods: A cross-sectional study was conducted involving 118 adolescents diagnosed with T1D who underwent clinical and laboratory investigations, genetic analyses, and 24 h ambulatory blood pressure monitoring. The genotype frequencies were compared between adolescents with HT and those with normal blood pressure. Additionally, the genotype frequencies were compared between dippers and non-dippers. Results: Patients with HT were more likely to be female and exhibited significantly poorer glycemic control and higher triglycerides, along with increased body mass index and daily insulin dosage. The prevalence of ACE rs1799752 genotypes in the hypertensive group was 20% II, 66.7% ID, and 13.3% DD, which did not significantly differ from the normal blood pressure group with 29.1% II, 53.4% ID, and 17.5% DD (p = 0.625). The prevalence of AGTR1 rs5186 genotypes in the hypertensive group was 53.3% AC, 40% AA, and 6.7% CC, which also did not significantly differ from the normal blood pressure group with 39.8% AC, 52.4% AA, and 7.8% CC (p = 0.608). A total of 46% of the patients exhibited non-dipping phenomena. The prevalence of non-dippers among the ACE genotypes was 13% DD, 33.3% II, and 53.7% ID (p = 0.369), while for the AGTR1 genotypes, it was 50% AA, 42.6% AC, and 7.4% CC (p = 0.976). Conclusions: Our results indicate that in our adolescents with T1D, clinical and metabolic factors such as higher body mass index, triglycerides, suboptimal glycemic control, and female gender are more indicative of the development of hypertension than ACE and AGTR1 gene polymorphisms. A potential reason for this finding could be the young age of the patients or the relatively small size of the study group. Future research involving larger sample sizes is needed to further investigate the genetic predisposition for the development of hypertension. Full article

Background and Objectives: Hypertension is typically classified into two main groups, “dipper” and “non-dipper”, based on nocturnal blood pressure decline. The coronary artery calcium score (CACS) is an essential biomarker used to assess the presence and severity of coronary artery disease (CAD). This study aims to demonstrate the relationship between CACS and hypertensive patients with moderate-to-high cardiovascular disease (CVD) risk classified as either dipper or non-dipper. Participants and Methods: A total of 167 patients with moderate-to-high CVD risk were divided into two subgroups: 95 patients with dipper hypertension (HT) and 72 with non-dipper hypertension. CACS was measured using coronary computed tomography angiography. Results: In the dipper HT group, there were 60 females (63.2%) and 35 males (36.8%), whereas the non-dipper HT group included 28 females (38.9%) and 44 males (61.1%) (p = 0.002). The mean age was 57 in the dipper HT group and 62 in the non-dipper HT group (p = 0.011). The mean CACS was 93 in the non-dipper HT group and 10 in the dipper HT group (p < 0.001). A history of coronary artery disease was more common in the non-dipper HT group (p = 0.003). Smoking prevalence was higher in the non-dipper HT group (31 patients, 43.1%) compared to the dipper HT group (25 patients, 26.3%) (p = 0.023). Correlation analysis showed that CACS was positively correlated with age, BMI, and HbA1c and negatively correlated with eGFR. Higher CACS values were also observed in males and patients with a history of coronary artery disease, diabetes mellitus, and hyperlipidemia. In univariate analysis, age, male sex, smoking, CAD, CACS, and elevated creatinine were identified as significant risk factors for non-dipper HT (p < 0.05). However, in multivariate analysis, only CACS emerged as a significant independent risk factor (p = 0.001), while other variables were not significant (p > 0.05). The area under the curve (AUC) for CACS was 0.759, indicating statistically significant and excellent discriminative capability (p < 0.001, 95% CI: 0.680–0.839). Conclusions: It was concluded that non-dipper hypertension is associated with higher CACS and indicates a higher cardiovascular risk for this group. Full article

Background/Objectives: Non-dipper hypertension (HT), a condition in which blood pressure does not drop sufficiently at night compared to daytime, is considered a serious condition that increases the risk of cardiovascular disease, stroke, and organ damage. This study aimed to examine the relationship between dipper and non-dipper blood pressure patterns, hepatosteatosis, and biochemical markers in hypertensive and normotensive individuals. Methods: Demographic, biochemical, and hepatic ultrasonography data from 142 patients who underwent 24 h ambulatory blood pressure measurement (ABPM) were evaluated retrospectively and cross-sectionally in this study. Patients were categorized into four groups based on ABPM results: non-dipper normotensive (NDN), dipper normotensive (DN), non-dipper hypertensive (NDH), and dipper hypertensive (DH). Results: The study results indicate that NDH individuals had markedly elevated levels of hepatosteatosis and uric acid compared with DH and normotensive persons (p < 0.001). The grade of hepatosteatosis showed significant discriminatory capacity in differentiating between dipper and non-dipper hypertensive patients, with an AUC of 0.861, specificity of 94%, and sensitivity of 66%. Individuals with hypertension exhibiting a non-dipper pattern demonstrate a greater prevalence of hepatosteatosis and elevated uric acid levels. Conclusions: The study findings show non-dipper patterns have a higher risk for cardiometabolic diseases. This indicates that not only blood pressure, but also metabolic disorders should be closely monitored and treated in the management of non-dipper HT. Full article

Gestational hypertension (GH) and preeclampsia (PE) are associated with the onset of hypertension. This study aimed to investigate whether the blood pressure (BP) pattern in GH is associated with the prevalence of hypertension later in life. In this prospective cohort study pregnant women screened for GH underwent medical history, laboratory analysis, ambulatory blood pressure monitoring (AMBP), and transthoracic echocardiography (with left ventricular global longitudinal strain (LVGLS)) assessment. Overall, 138 GH (67 non-dippers and 71 dippers), 55 preeclamptic, and 72 normotensive pregnant controls were included. Women were followed in the postpartum period, first after 6 weeks and later on, for the occurrence of hypertension. The median follow-up was 8.97 years (8.23; 9.03). Non-dippers and PE compared with normotensives and dippers had a higher prevalence of hypertension onset (p < 0.01), as well as significantly reduced absolute values of LVGLS during pregnancy, after delivery, and at the time of onset of hypertension during follow-up (p < 0.01). Night-time diastolic BP, LVGLS, age, and left ventricular ejection fraction were the strongest predictors of postpartum onset of hypertension. The non-dipping BP pattern in GH was significantly associated with the onset of hypertension later in life, as well as with decreased systolic function. Full article

The purpose of this study was to investigate the alterations in blood pressure (BP) during midday and the changes in circadian BP patterns in the acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role outcomes within 3 months. A total of 228 AIS patients (a prospective multicenter follow-up study) underwent 24 h ambulatory blood pressure monitoring (ABPM). Mean BP parameters during the day (7:00–22:59), the midday (13:00–16:59), and the night (23:00–6:59), and midday and nocturnal dipping were calculated. Midday SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBCs, and delayed initiation of ABPM compared to risers. There was a reverse relation between midday SBP dipping and both nocturnal dipping and stroke severity. The “double dippers” (midday and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission, the lowest heart rate from ABPM, and a lower risk of an unfavorable outcome, while the “double risers” had the opposite results, by an approximately five-fold risk of death/disability at 3 months. These findings indicate different circadian BP patterns during the acute phase of AIS, which could be considered a marker of stroke severity and prognosis. Full article