The systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) daily profiles incidence was studied in 53 patients with arterial hypertension. A significant difference in the frequency of occurrence of different types of SBP, DBP and PP daily profile was revealed. In the structure of SBP daily profile «nondipper» and «dipper» types were dominated, DBP - «dipper» and «overdipper» types, PP - «night-picker» type. The conclusion about the need to evaluate not only the SBP circadian pattern, but DBP and PP also to improve the quality of arterial hypertension diagnosis, prognosis and treatment was made

M. Yabluchansky

O. Petrenko

The Journal of V N Karazin Kharkiv National University series Medicine

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Series Medicine . Issue 30 21 UDC 616.12-008.331.1:616-072:612.141:616-035.1 DAILY BLOOD PRESSURE PROFILES IN PATIENTS WITH ARTERIAL HYPERTENSION: IS IT ENOUGH TO USE SYSTOLIC BLOOD PRESSURE ONLY Petrenko O. V., Yabluchansky M. I. V. N. Karazin Kharkiv National University, Kharkiv, Ukraine  The systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) daily profiles incidence was studied in 53 patients with arterial hypertension. A significant difference in the frequency of occurrence of different types of SBP, DBP and PP daily profile was revealed. In the structure of SBP daily profile nondipper  and dipper  types were dominated, DBP - dipper  and overdipper  types, PP - night-picker  type. The conclusion about the need to evaluate not only the SBP circadian pattern, but DBP and PP also to improve the quality of arterial hypertension diagnosis, prognosis and treatment was made. KEY WORDS: ambulatory blood pressure monitoring, systolic blood pressure, diastolic blood pressure, pulse pressure, daily blood pressure        - - -          nondipper  dipper - dipper overdipper  night-picker.        Petrenko O. V., Yabluchansky M. I., 2015 Journal of V. N. Karazin` KhNU. 2015 22INTRODUCTION The assessment of the daily blood pressure (BP) periodicity is an important factor in patients with arterial hypertension (AH) [1, 2]. To characterize it, in most cases, the sleep-time relative systolic blood pressure (SBP) decline is used [3]. Taking into account the different regulatory mechanisms of systolic and diastolic blood pressure (DBP), a variety of target organ damage in their combinations, as well as in relation to cardiovascular risk, there is a hypothesis that the clinical, diagnostic and prognostic value of abnormal BP pattern in patients with AH can have not only SBP, but DBP and pulse pressure (PP) also. Complex researches of circadian SBP, DBP and PP patterns clinical significance in patients with AH in the literature are absent. OBJECTIVE The aim of the study is to compare the frequencies of circadian SBP, DBP and PP profiles in patients with AH to develop and introduction into practice the proposals to improve the quality of AH diagnosis, prognosis and treatment. MATERIALS AND METHODS On the clinical base of the Kharkov city essential hypertension were examined. The study involved 22 men (42 %) and 31 women (58 %). Average age is 58  10 years. The average duration of AH is 8  6 years. Newly diagnosed AH  6 patients (11 %). AH of stage I was diagnosed in 12 patients (23 %), stage II  30 (57 %), stage III  11 (20 %). AH of 1 grade was determined in 23 patients (43 %), grade 2  26 (49 %), grade 3  4 (8 %). Heart failure (HF) was diagnosed in the 40 cases (75 %): HF stage I  31 (58 %), HF stage IIA  in 8 (15 %), HF stage IIB  1 (2 %), I functional class (FC) of HF was determined in 16 patients (30 %), II FC  22 (41 %), III FC - 2 (4 %); coronary heart disease (CHD)  42 cases (79 %): stable angina (I-III FC)  8 (15 %), postinfarction cardiosclerosis (PICS)  3 (6 %), focal atherosclerotic cardiosclerosis (ACS)  33 (62 %). The diagnosis of AH was made according to the recommendations of the Ukraine Association of Cardiologists of (2007), the European Society of Hypertension and the European Society of Cardiology (2013), the Committee of Experts of the World Health Organization (WHO) and the International Society of Hypertension (1999), summarized and expounded in Unified clinical protocol of primary, emergency and secondary (specialized) medical care Arterial Hypertension  (2012) [4]. The diagnosis of CHD and its functional class, as well as the diagnosis of HF and its stage and functional class was made according to the recommendations of Ukrainian Heart Association on classification, diagnosis and treatment of cardiovascular disease (2007) [5]. Exclusion criteria were secondary hypertension, hemodynamically significant valvular heart disease, cardiomyopathies of any origin, heart failure stage III, IV FC, any acute condition (infection, trauma, surgery) within the previous 3 months., chronic decompensated or acute illness, cancer, as well as any circumstances that can hinder the ambulatory blood pressure monitoring (ABPM) implementation. To determine the daily BP profile the ABPM was performed with an automatic oscillometric device Kardiosens  (HAI Medica, Ukraine). ABPM was performed in a patient's normal working day; the cuff was placed at the non-dominant hand. According to the international recommendations of 2013 BP recordings were obtained automatically every 15 minutes throughout a day and every 30 minutes at night [3]. Patients should keep their habitual routine and present a report with the activities done; SBP, DBP, and PP readings were averaged for the day and the night spans waking up and going to bed. All ABPM data were validated in accordance with international Ambulatory Blood Pressure Monitoring Recommendations [3], meaning exclusion the following measurements: SBP > 250 or < 70 mm Hg; DBP > 150 or < 40 mm Hg; PP > 150 or < 20 mm Hg; HR > 200 or < 20 min. In addition, ABPM data series were considered invalid for analysis if:  30 % of the scheduled measurements were absent, BP measurement data were lacking for > 2 consecutive hourly intervals, an irregular rest-activity schedule during consecutive 24-h periods of monitoring was maintained, the nighttime sleep span was <6 h or >12 h [3]. Daily profiles of SBP, DBP and PP were classified using sleep-time relative BP decline, Series Medicine . Issue 30 23 which is defined as the percent decrease in mean BP during nighttime sleep relative to the mean BP during daytime activity, and  asleep BP mean]/awake BP mean) [3]. Depending on this percent ratio, the next 24-hours patterns for SBP, DBP and PP were specified - physiological decrease in BP at night, sleep-time relative BP decline 10-20 - an excessive fall in BP at night, sleep-time relative BP decline > 20 %; - the lack of BP reduction at night, sleep-time relative BP decline <10 %; - - night-time BP higher than the daily one, sleep-time relative BP decline < 0 [3]. The frequency ratios of different circadian BP profiles of SBP, DBP and PP were determined and compared with each other. Calculation of ABPM indices was performed using a computer system Kardiosens Statistical analysis was performed on a personal computer using the  with an estimation of SBP, DBP and PP daily profile types incidence in percentage. RESULTS AND DISCUSSION Fig. shows the frequency ratio of SBP, DBP and PP daily profiles in the studied group of patients. In the structure of SBP daily profile the   %) types were dominant. Their frequencies of occurrence were close to each other and more (6 -  %) incidence. In the structure of DBP daily profile the   %) and  %) types were prevalent, -rare (4 %). Due to divergent frequency ratios of diurnal profiles of SBP and DBP, in the structure of PP -(55  %) types was  %)  %) types frequency of occurrence was rare. The obtained results have showed the different distribution of SBP, DBP and PP circadian pattern incidence in patients with AH, which is explained by the peculiarities of SBP and DBP regulation mechanisms. Taking into account that the AH prognosis and outcomes determined by abnormal daily profile formation not only SBP [6, 7], but DBP also [8-10], as well as high frequency of occu -types of PP 24-hours pattern in patients with AH, revealed in our study, in clinical practice it seems appropriate to monitor the diurnal profiles of all this ABPM indices. Fig. Distribution of the BP profile types incidence, depending on the selected index ABPM Journal of V. N. Karazin` KhNU. 2015 24CONCLUSIONS Frequencies of occurrence distribution of SBP, DBP and PP daily profile types in patients with AH are significantly different.  In the SAD daily profile structure types re dominate, DBP daily profile structure - - -  Different incidence ratio of SBP, DBP and PP daily profiles in patients with AH requires that in its diagnosis and prognosis the changes in each of them should be take into account.  REFERENCES 1. Mahabala C. Antihypertensive therapy. Nocturnal dippers and nondippers. 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Klasif kats ya, standarti d agnostiki ta l kuvannya kard olog chnih hvorih (Cardio-vascular diseses. Classification, standards of diagnonsis and treatment patients with cardio-vascular diseases) / Editors V.M. Kovalenko, M. I. Lutaya, YM S renko // Ukraine Association of cardiologists, 2007, 128 pages. 6. Metoki H. Diurnal blood pressure variation and cardiovascular prognosis in a community-based study of Ohasama, Japan / Hirohito Metoki, Takayoshi Ohkubo, Yutaka Imai // Hypertension Research. - 2010.  Vol. 33.  P.652 656. 7. Roush G.C. Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13 844 patients with hypertension / George C. Roush, Robert H. Fagard, Gil F. Salles [et al.] // Journal of Hypertension.  2014.  Vol. 32. Is. 12.  P. 2332 2340. 8. Ivanovic B. To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure / B.A. Ivanovic, M.V. Tadic, V.P. Celic // Journal of Human Hypertension.  2013.  Vol. 27.  P. 62 70. 9. Albassam T. Management of hypertension in clinical practice: can we forget about diastolic blood pressure? / T. Albassam, A. Coca, S. Filipova [et al.] // Medicographia.  2010.  Vol. 32 (3).  P. 269280. 10. O'Brien, E. Ambulatory blood pressure monitoring: 24-hour blood pressure control as a therapeutic goal for improving cardiovascular prognosis / E. O'Brien // Medicographia.  2010.  Vol. 32 (3).  P. 241249. 

DAILY BLOOD PRESSURE PROFILES IN PATIENTS WITH ARTERIAL HYPERTENSION: IS IT ENOUGH TO USE SYSTOLIC BLOOD PRESSURE ONLY

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DAILY BLOOD PRESSURE PROFILES IN PATIENTS WITH ARTERIAL HYPERTENSION: IS IT ENOUGH TO USE SYSTOLIC BLOOD PRESSURE ONLY

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