Nighttime blood pressure versus non-dipping for predicting asymptomatic organ damage in young individuals.

Epicardial Fat Thickness and Nighttime Systolic Blood Pressure Variability in Healthy Young Adults

We recognise epicardial fat thickness (EFT) as a biomarker for cardiometabolic risk and blood pressure variability (BPV) as an independent risk factor for cardiovascular morbidity. While studies link them in hypertensive patients, data for healthy young adults are lacking. This study examines the relationship between EFT-BPV in healthy young adults. Demonstrating this relationship in healthy young adults may be important for the early identification of individuals at higher cardiovascular risk and could inform strategies to reduce future cardiovascular events. This study included 172 apparently healthy young adults (18–41 years old) presenting with atypical chest pain but without known chronic disease or abnormal cardiac findings. EFT was measured via transthoracic echocardiography, and a 24-hour Ambulatory blood pressure monitoring (ABPM) was used to assess BPV. Laboratory tests, body mass index (BMI), and fatty liver index (FLI) were evaluated. Correlations and regression analyses were used to explore associations; significance was set at p < 0.05. Power analysis confirmed an adequate sample size (N = 170, f²=0.15, α = 0.05, power = 0.80). EFT was significantly correlated with 24-hour systolic BPV (r = 0.171, p = 0.028), 24-hour diastolic BPV (r = 0.173, p = 0.025), nighttime systolic BPV (r = 0.193, p = 0.012), and nighttime diastolic BPV (r = 0.183, p = 0.018). In multivariable regression analysis, EFT, smoking, and platelet/basophil ratio were independently associated with nighttime systolic BPV (R² = 0.110, p = 0.002). These findings demonstrate an association between EFT and BPV in apparently healthy young adults, with the strongest association observed for nighttime systolic BPV. Longitudinal studies are needed to clarify directionality and causality. Proposed Mechanisms Underlying the Association Between Epicardial Fat Thickness and Nighttime Systolic Blood Pressure Variability. Based on literature, a schematic illustrating proposed mechanisms that may underlie the association between EFT and nighttime systolic BPV in healthy young adults. EFT may be associated with increased BPV through inflammatory pathways and sympathetic overactivity. Abbreviations: EFT epicardial fat thickness, BPV blood pressure variability Proposed Mechanisms Underlying the Association Between Epicardial Fat Thickness and Nighttime Systolic Blood Pressure Variability. Based on literature, a schematic illustrating proposed mechanisms that may underlie the association between EFT and nighttime systolic BPV in healthy young adults. EFT may be associated with increased BPV through inflammatory pathways and sympathetic overactivity. Abbreviations: EFT epicardial fat thickness, BPV blood pressure variability

Short-term blood pressure variability assessed by ambulatory blood pressure monitoring as a predictor of subclinical target organ damage

Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension and subclinical TOD prediction in hypertension is confirmed.

Diagnostic Value of Ambulatory Blood Pressure Monitoring for Hypertension in Private Cardiology Practice in Senegal

Hypertension is a major contributor to cardiovascular morbidity and mortality. Ambulatory blood pressure monitoring (ABPM) complements office blood pressure measurement by detecting white-coat hypertension, masked hypertension, and nocturnal blood pressure abnormalities, and this study aimed to assess its diagnostic value in the management of hypertension in private cardiology practice in Senegal. A prospective, descriptive, and analytical study was conducted from July to September 2024 at Clinique Urgence Cardio in Dakar, including patients aged 18 years or older with a valid 24-hour ABPM recording. Clinical, anthropometric, and treatment data, together with cardiovascular risk factors, were collected; office and ambulatory blood pressure measurements were compared; and logistic regression was used to identify factors associated with discordance between the two methods. Of the 104 patients assessed, 97 had valid ABPM recordings. The mean age was 53.2 ± 14.1 years, and women predominated. Cardiovascular risk factors included abdominal obesity (77.3%), known hypertension (54.6%), physical inactivity (43.3%), dyslipidemia (37.1%), and diabetes (16.5%). Mean office blood pressure was 145.7/91.4 mmHg, compared with 130.5/80.2 mmHg over 24 hours, 134.4/82.4 mmHg during daytime, and 125/75 mmHg during nighttime. ABPM identified sustained hypertension in 53.61% of patients, white-coat hypertension in 18.56%, masked hypertension in 9.28%, and normotension in 18.56%, with overall agreement between office and ambulatory measurements of 72.2%. Among patients with elevated office blood pressure, 25.7% had white-coat hypertension, while 33.3% of those with normal office blood pressure had masked hypertension. Non-dipping and reverse-dipping patterns were observed in 45.4% and 19.6% of patients, respectively, and discordance was independently associated with alcohol consumption (OR = 5.08; p = 0.007). ABPM improves the diagnostic classification of hypertension and reveals a high prevalence of discordant phenotypes and nocturnal blood pressure abnormalities, and wider use of ABPM may help optimize patient management in this setting.

Blood pressure phenotypes and hypertension-associated cardiac damage.

BACKGROUND The aim of this study was to characterize hypertension-associated cardiac damage in the blood pressure (BP) phenotypes sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT) and sustained hypertension (SHT). METHODS In a population-based study, 4115 individuals were examined with office and home BP measurement, computed tomography, coronary computed tomography angiography and echocardiography. The odds ratios of hypertension-associated cardiac damage in the BP phenotypes were analysed with SNT and SHT as references, respectively, for coronary artery calcium score (CACS) at least 100 and at least 300, Segment Involvement Score (SIS) at least 4, any significant (>50%) coronary stenosis, left ventricular ejection fraction (LVEF) less than 50%, E/e΄ ratio (E/e΄) at least 14, and global longitudinal strain (GLS) greater than -17 (men) or greater than -18 (women). RESULTS The odds of having hypertension-associated cardiac damage were significantly higher for WCHT than for SNT [LVEF < 50%: OR 1.83 (1.17-2.86), CACS ≥ 100: OR 1.58 (1.19-2.11)], and for SHT than for SNT [LVEF < 50%: OR 2.34 (1.53-3.57), CACS ≥ 100: OR 1.52 (1.14-2.02)]. The odds of having hypertension-associated cardiac damage were also significantly higher for MHT than for SNT (LVEF < 50%: OR 2.68 (1.41-5.10), CACS ≥ 100: OR 2.15 (1.37-3.38) and CACS ≥ 300: OR 2.34 (2.21-4.52)]. CONCLUSION The prevalence of hypertension-associated cardiac damage was higher in WCHT and in MHT compared to SNT. WCHT and MHT should therefore be considered when assessing cardiovascular risk, and BP should be measured both in the office and at home when diagnosing and monitoring hypertension.

Association between nocturnal blood pressure dipping patterns and left atrial reservoir strain in untreated adults with office-defined grade 1 essential hypertension

Background Abnormal nocturnal blood pressure (BP) profiles may expose the left atrium to persistent hemodynamic load before overt remodeling occurs. This study evaluated the association between nocturnal systolic blood pressure (SBP) dipping patterns and left atrial reservoir strain (LARS) in untreated adults with office-defined grade 1 essential hypertension. Methods This single-center retrospective cross-sectional study enrolled 315 adults who underwent 24-h ambulatory blood pressure monitoring (ABPM) and transthoracic echocardiography within 7 days. BP dipping patterns were classified as dipper, non-dipper, reverse-dipper, or extreme-dipper. Continuous LARS was the primary outcome; low LARS (<35%) was the operational secondary outcome. The primary model was adjusted for age, sex, body mass index (BMI), 24-h SBP, fasting plasma glucose, natural-log-transformed triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and estimated glomerular filtration rate (eGFR). Results There were 126 dippers (40.0%), 124 non-dippers (39.4%), 45 reverse-dippers (14.3%), and 20 extreme-dippers (6.3%); 300 participants (95.2%) met ambulatory criteria for sustained hypertension, and 100 (31.7%) had low LARS. LARS differed across patterns (P < 0.001). Compared with dippers, non-dippers and reverse-dippers had lower adjusted LARS [β = −3.44, 95% confidence interval (CI) −4.68 to −2.20; β = −5.92, 95% CI −7.80 to −4.04] and higher odds of low LARS [non-dippers odds ratio (OR) = 3.68, 95% CI 1.83–7.39; reverse-dippers OR = 8.12, 95% CI 3.00–21.98; both P < 0.001]. Extreme-dipping was not associated with either outcome. When nighttime SBP replaced 24-h SBP, the associations were attenuated but remained statistically significant; the direction of association did not change in analyses restricted to participants with complete sleep diaries or sustained hypertension. Restricted cubic spline (RCS) analysis suggested nonlinearity. Conclusion Non-dipping and reverse-dipping BP patterns were associated with lower LARS and a higher likelihood of low LARS. Prospective multicenter studies are needed to determine prognostic and incremental clinical value.

NON-DIPPER AND RELATED FACTORS IN ELDER HYPERTENSIVE MEN