24-h Ambulatory Blood Pressure Measurements Research Articles

Left ventricular structure and function following renal sympathetic denervation in patients with HFpEF: an echocardiographic 9-year long-term follow-up.

High blood pressure is a major risk factor for cardiac remodeling and left ventricular hypertrophy, increasing cardiovascular risk and leading to heart failure with preserved ejection fraction (HFpEF). Since renal sympathetic denervation (RDN) reduces blood pressure in the long term, we aimed to investigate the long-term effect of RDN in patients with HFpEF in the present analysis. Patients previously enrolled in a local RDN registry who underwent high-frequency RDN with the use of the Symplicity Flex® renal denervation system between 2011 and 2014 were followed up. The patients were assessed by 24-h ambulatory blood pressure measurement, transthoracic echocardiography, and laboratory tests. We used the echocardiographic and biomarker criteria of the Heart Failure Association (HFA)-PEFF (Pre-test assessment, Echocardiography and Natriuretic Peptide Score, Funkctional testing, and Final aetiology) score to identify patients with HFpEF. Echocardiographic assessment was available for 70 patients at a 9-year long-term follow-up. Of these patients, 21 had HFpEF according to the HFA-PEFF score. We found a significant reduction of the HFA-PEFF score from 5.48 ± 0.51 points at baseline to 4.33 ± 1.53 points at the 9-year follow-up (P < 0.01). This decrease was due to a greater reduction in morphological and biomarker subcategories [from 1.95 ± 0.22 to 1.43 ± 0.51 points (P < 0.01) and from 1.52 ± 0.52 to 0.90 ± 0.63 points (P < 0.01), respectively] than in the functional one. Morphologically, there was a reduction in left ventricular hypertrophy and left atrial dilation. The present analysis suggests that RDN may lead to a regression of the extent of HFpEF beyond a reduction in blood pressure and thus possibly contribute to an improvement in prognosis. More detailed information will be provided by ongoing randomized sham-controlled trials.

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study.

Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991-1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping-dipping (n = 152/33.6%), dipping-non-dipping (n = 198/43.8%), non-dipping-dipping (n = 20/4.4%), and non-dipping-non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping-non-dipping group, and lowest (6.6%) in the dipping-dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping-non-dipping pattern with CV events compared with the dipping-dipping pattern remained significant (HR 4.01; 95% CI 1.89-8.67, p < 0.001). In summary, non-dipping-non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

The role of wearable home blood pressure monitoring in detecting out-of-office control status

Ambulatory blood pressure (ABP) and home blood pressure (HBP) monitoring is currently recommended for management of hypertension. Nonetheless, traditional HBP protocols could overlook diurnal fluctuations, which could also be linked with adverse cardiovascular outcomes. In this observational study, we studied among a group of treated hypertensive patients (N = 62, age: 52.4 ± 10.4 years) by using out-of-office ABP and wearable HBP. They received one session of 24-h ABP measurement with an oscillometric upper-arm monitor, and totally three sessions of 7-day/6-time-daily wearable HBP measurement separated in each month with HeartGuide. Controlled hypertension is defined as an average BP <130/80 mmHg for both daytime ABP and HBP. There was substantial reliability (intraclass correlation coefficient, ICC 0.883–0.911) and good reproducibility (Cohen’s kappa = 0.600) for wearable HBP measurement, especially before breakfast and after dinner. Among all patients, 27.4% had both uncontrolled HBP and ABP, 30.6% had uncontrolled HBP only, while 6.5% had uncontrolled ABP only. Female gender and increased numbers of anti-hypertensive agents are correlated with controlled hypertension. Patients with uncontrolled hypertension had a significantly higher maximal daytime blood pressure, which was previously signified as an imperial marker for cardiovascular risk. In conclusion, wearable HBP monitoring in accordance with a dedicated daily-living schedule results in good reliability and reproducibility. Patients with an uncontrolled wearable HBP should benefit from repeated HBP or ABP measurement for risk stratification.

Simultaneous 24-h ambulatory blood pressure measurement on both arms: a consideration for improving hypertension management.

Arterial hypertension is one of the common treatment goals in today's medicine. 24-h ambulatory blood pressure measurement (ABPM) performed by oscillometric cuff-based devices is considered as the gold standard in hypertension diagnostics. This study aims at examining the measurement accuracy of a widely used, ABPM device. Fifty-two young and healthy participants underwent simultaneous 24-h ABPM on the left and the right upper arm using two Boso/A&D TM-2430 oscillometric cuff-based devices. Pressure curves of the cuffs, as well as hydrostatic pressure difference between the cuffs were recorded. The mean differences between both simultaneous measurements were 1.16 mmHg with limits of agreement of 36.23 mmHg for SBP and 1.32 mmHg with limits of agreement of 32.65 mmHg for DBP. Excluding measurements where the pressure curves were disturbed and correcting for hydrostatic pressure difference between the cuffs, reduced the measurement error. However, limits of agreement remained around 20 mmHg. There were large differences in hypertension grading and dipping pattern classification between simultaneous measurements on the left and right arm. The cuff-based ABPM device reveals notable measurement uncertainties, influencing hypertension grading, dipping pattern classification and blood pressure variability. These effects are attributed in part to disturbances during cuff deflation and hydrostatic influences. Nonetheless, ABPM has shown its clinical values in several studies, while this study underscores its still unlocked potential to improve hypertension management.

The effects of Olmesartan/amlodipine administered in the Morning or At Night on nocturnal blood pressure reduction in Chinese patients with mild-moderate essential hypertension (OMAN Trial): study protocol for a prospective, multicenter, randomized, open-label clinical trial {1}

IntroductionHypertension increases the risk of cardiovascular disease. Uncontrolled nocturnal blood pressure is prevalent in patients taking antihypertensive medication, with an incidence rate of 30–60%. Although chronotherapy with antihypertensive agents may provide a new direction for effective control of nocturnal blood pressure, the clinical evidence base remains controversial. This research is presently underway to compare the effects of morning and bedtime administration of antihypertensive medication on nocturnal reduction and circadian rhythm of blood pressure in patients with hypertension.Methods and analysisThis study is being performed as a randomized, multicenter, open-label, parallel-group, clinical trial in which 720 participants are to undergo 24-h ambulatory blood pressure measurement (ABPM) and office blood pressure measurement (OBPM) at baseline before being randomly assigned to a morning (6–10 am) or a bedtime (6–10 pm) administration group. Each participant receives one 20/5-mg tablet of olmesartan/amlodipine (OA) daily for 4 weeks and is then followed up at 4-week intervals for a total of 12 weeks. During follow-up, the OA dosage is adjusted according to the ABPM and OBPM results. Patients with uncontrolled hypertension at the first follow-up visit will receive an increase in OA dosage to 1.5 tablets/day. For patients with blood pressure that is still uncontrolled after a further 4 weeks, the dosage of OA can be increased to 2 tablets/day. The primary objective is the reduction in mean nocturnal systolic blood pressure between baseline and week 12. The secondary objectives are the reduction in ambulatory blood pressure at weeks 4 and 12 and the blood pressure control rate at weeks 4, 8, and 12.DiscussionAntihypertensive chronotherapy remains controversial. A superiority test hypothesis design has been adopted for this trial, in which all participants will be taking the same antihypertensive medication. We anticipate that our findings will determine if nocturnal blood pressure control in Chinese patients with essential hypertension varies according to whether antihypertensive medication is taken in the morning or at bedtime. This study may provide scientific evidence for the application of chronotherapy in clinical practice.Trial registrationChiCTR2200059719. Registered on 10 May 2022(http://www.chictr.org.cn/edit.aspx?pid=169782&htm=4) {2a,2b}

Long term effect of renal denervation on 24 hour abpm blood pressure variability and blood pressure load parameters

The aim of the study was to evaluate the long-term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension. The study included 32 patients with treatment-resistant hypertension and performed successful RSD. The effect of renal denervation was significant both in terms of daytime, nighttime and 24-hour arterial pressure, with the most pronounced effect on nocturnal blood pressure. In addition to mean BP reduction we found out a significant improvement of weighted 24 h SD and BP load during follow-up. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mm Hg at month 12, was found in 22 patients (68.8%). In multivariate regression analysis, two parameters remained predictive for successful renal denervation &amp;ndash; higher nighttime systolic blood pressure (OR 0.9, 95% CI 0.8-1.005, p = 0.05) and lower pulse pressure (OR 1.13, 95% CI 1.01-1.26, p = 0.03).&amp;nbsp;

Ambulatory and home blood pressure monitoring for cardiovascular disease risk evaluation: a systematic review and meta-analysis of prospective cohort studies.

The aim of this work was to systematically review the level of evidence based on prospective cohort studies investigating the role of 24-h ambulatory blood pressure measurement (ABPM) and home blood pressure measurement (HBPM) on cardiovascular disease (CVD) risk prediction. Eight studies were included in the meta-analysis. The Der Simonian and Laird's random-effects model with standard error adjustment using the Knapp-Hartung method was used. SBP from ABPM and HBPM was significantly and positively associated with CVD risk [ combined hazard ratio per 1-SD SBP, 95% confidence interval (95% CI): 1.32, 1.19-1.45, I2 = 35.8%, and 1.30, 95% CI: 1.11-1.49, I2 = 79.1%, respectively], after adjusting for office BP levels and other potential confounders. DBP from both ABPM and HBPM was positively associated with CVD risk ( combined hazard ratio per 1-SD DBP, 95% CI: 1.15, 1.01-1.29, I2 = 73.1% and 1.21, 1.05-1.37, I2 = 84.5%, respectively). BP either from ABPM or HBPM could predict CVD risk. As so, at least one of out-of-office BP measurements have to be taken into account during the evaluation of the hypertensive population.

LONG TERM EFFECT OF RENAL DENERVATION ON 24 HOUR ABPM AND BLOOD PRESSURE LOAD IS LARGELY DEPENDENT OF BASELINE ARTERIAL STIFFNESS

Objective: The aim of the study was to evaluate the long term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension depending of the baseline arterial stiffness status. Design and method: Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP &gt;135 mmHg or diastolic BP &gt;85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. Cardio ankle vascular index (CAVI) was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex™ catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol. Results: The study included 32 patients with treatment-resistant hypertension and performed successful RSD. CAVI was measured before the intervention and the results of the procedure on 24h daytime, nighttime and 24 blood pressure and systolic and diastolic BP load were evaluated by serial ABPM measurements. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. Along with reduction of all ABPM parameters more profound and clinically meaningful change of BP load during daytime, nighttime and 24h period was also noticed in this group of patients. (Table 1) Conclusions: The long term effect of renal denervation on 24h ABPM and BP load is largely dependent of baseline arterial stiffness. The results of the present study justify the incorporation of arterial stiffness evaluation in clinical decision workout of the procedure.

EFFECTS OF THE DUAL ENDOTHELIN ANTAGONIST APROCITENTAN ON AMBULATORY BLOOD PRESSURE INDICES IN PATIENTS WITH RESISTANT HYPERTENSION. RESULTS FROM THE PRECISION STUDY

Objective: The phase-3 PRECISION trial demonstrated both the safety and the efficacy of aprocitentan to lower office blood pressure (BP) in patients with resistant hypertension. Here, we report on the effects on relevant indices of ambulatory BP measurements (ABPM). Design and method: A total of 730 patients with resistant hypertension were randomized to aprocitentan 12.5 mg (n = 243), 25 mg (n = 243), or placebo (n = 244). Paired ABPM results at baseline and week 4 of double-blind treatment were available for n = 174, n = 182, and n = 178 patients, respectively. Changes in 24h ABPM from baseline to week 4 were pre-defined as a secondary endpoint. Here, we analyzed effects on 24h average BP, daytime BP, night-time BP, nocturnal dipping, and BP load. Statistical significance was assessed using the Wilcoxon rank-sum test. Results: At week 4, after placebo correction, aprocitentan decreased 24-hour ambulatory SBP (-4.2 mmHg; 95% CI: –6.2, –2.1 for the 12.5-mg dose and –5.9 mmHg; 95% CI: –7.9, –3.8 for the 25-mg dose). The placebo-corrected SBP-lowering was more pronounced during night-time (–5·1 and –7·4 mmHg) compared with daytime (–3·8 and –5·3mmHg) for the 12.5 and 25mg doses, respectively. At baseline, non-dipper rates were 66%, 62%, and 60% for the 12.5mg, 25mg of aprocitentan, and placebo groups, respectively. Non-dippers had a particularly pronounced reduction in night-time systolic BP compared with dippers for both 12.5mg (-11.25 vs -2.79mmHg; p &lt; 0.01) and 25mg of aprocitentan (-13.12 vs -6.29mmHg; p &lt; 0.01). After 4 weeks of treatment, the proportion of non-dippers who had normalization of their dipping pattern was 44%, 40% and 31% for 12.5mg, 25mg of aprocitentan, and placebo, respectively. The change in BP load for both daytime and night-time was more pronounced with both doses of aprocitentan (-18.7/-24.5% for 12.5mg; -20.7/-21.1% for 25mg) compared to placebo (-9.2/-6.6 %; p &lt; 0.001 for all comparisons). Conclusions: In patients with resistant hypertension, aprocitentan resulted in substantial ambulatory BP lowering, particularly during night-time. This was associated with reduction in non-dipping rates and BP load. These findings further support the likely clinical benefit of aprocitentan in resistant hypertension.

The effect of ambient air pollution on office, home and 24-h ambulatory blood pressure measurements.

Air pollution has recently been linked to a number of cardiovascular diseases, particularly hypertension (HT). In our study, we aimed to evaluate the association between air pollution and BP and compare the relationship BP measurement results obtained using different methods (office, home, and 24-h ambulatory BP monitoring (24-h ABPM)). This retrospective nested panel study performed with prospective Cappadocia cohort data investigated the relationships between particulate matter (PM) 10 and sulfur dioxide (SO2) and concurrent home, office, and 24-h ABPM data at each control performed over a two-year period. A total of 327 patients in the Cappadocia cohort were included in this study. On the day of office blood pressure measurement, there was an increase of 1.36 mmHg in SBP and 1.18 mmHg in DBP for every 10 µm/m3 rise in SO2 values. A mean three-day 10 µm/m3 increase in SO2 was linked to an increase of 1.60 mmHg in SBP and 1.33 mmHg in DBP. A 10 µm/m3 rise in mean SO2 on the day of 24-hour ABPM measurement was found to be associated with an increase of 1.3 mmHg in SBP and 0.8 mmHg in DBP. SO2 and PM 10 had no effect on home measurements. In conclusion, increased SO2 levels, during winter months in particular, can be association with an elevation in office BP values. Our study findings show that air pollution in the setting in which BP is measured may be associated with the results.

The effect of combining therapeutic drug monitoring of antihypertensive drugs with personalised feedback on adherence and resistant hypertension: the (RHYME-RCT) trial protocol of a multi-centre randomised controlled trial

BackgroundAdherence to antihypertensive drugs (AHDs) is important for adequate blood pressure control. Not taking these drugs as prescribed is one of the main underlying causes for resistant hypertension (RH), which in turn leads to an increased risk of cardiovascular events, stroke and kidney damage. Therefore, correct identification of patients that are non-adherent to AHDs is crucial to improve clinical outcome. For this goal, therapeutic drug monitoring is the most reliable method. The primary objective of this trial is to investigate whether monitoring of drug concentrations with a dried blood spot (DBS) sampling method combined with personalised feedback leads to a decrease in prevalence of RH after 12 months due to an increase in adherence. Secondary objectives include the difference over time in the number of required AHDs as well as the defined daily dose (DDD). Lastly, the cost-utility of SoC versus the intervention in RH is determined.MethodsThis is a multi-centre single-blinded randomised controlled trial (RHYME-RCT). First, at an eligibility visit, DBS sampling, to monitor drug concentrations in blood, and a 24-h ambulatory blood pressure measurement (24-h ABPM) are performed simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg are randomised to SoC or intervention + SoC. The intervention is performed by the treating physician and includes information on drug concentrations and a comprehensive personalised feedback conversation with the use of a communication tool. The follow-up period is one year with visits at 3, 6 and 12 months randomisation and includes 24-h ABPM and DBS sampling.DiscussionThis will be the first trial that focusses specifically on patients with RH without taking into account suspicion of non-adherence and it combines monitoring of AHD concentrations to identify non-adherence to AHDs with a comprehensive feedback to improve non-adherence. Furthermore, if this trial shows positive outcomes for the intervention it can be directly implemented in clinical practice, which would be a great improvement in the treatment of RH.Trial registration. RHYME-RCT is registered in the Dutch Trial Register on 27/12/2017 (NTR6914) and can be found in the International Clinical Trials Registry Platform.

Association of sodium intake with adverse left atrial function and left atrioventricular coupling in Chinese.

High sodium intake is strongly associated with hypertension and obesity. This study aims to investigate the relationship between 24-h urinary sodium (a surrogate measure of sodium intake), ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling. Further, we intend to examine whether blood pressure and BMI might be mediators of the relationship between 24-h urinary sodium and subclinical cardiac function. Our study had 398 participants, all of whom were subjected to 24-h urine collection, 24-h ambulatory blood pressure measurement, and cardiac magnetic resonance imaging. The average age of the participants was 55.70 ± 11.30 years old. The mean urinary sodium of the participants was 172.01 ± 80.24 mmol/24 h. After adjusting for age, sex, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-h urinary sodium was correlated with multiple ambulatory blood pressure parameters, BMI, left atrial function, and the left atrioventricular coupling index (LACI) (P < 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-h urinary sodium and left atrial function and 30% of the indirect effect of LACI. Independent of the mediator, 24-h urinary sodium had a significant direct effect on left atrial function and left atrioventricular coupling. Higher 24-h urinary sodium was associated with a greater BMI as well as poor left atrial function and left atrioventricular coupling, and the BMI mediated the relationship between 24-h urinary sodium and subclinical left cardiac function. Furthermore, and more importantly, 24-h urinary sodium may have directly affected the left atrial function and left atrioventricular coupling independent of intermediary factors.

The relationship of left ventricular outflow tract presystolic wave and 24-h ambulatory blood pressure measurements.

Left ventricular outflow tract (LVOT) presystolic wave is a novel marker for several cardiac conditions. It is shown to be related to several cardiac conditions. The aim of this study is to investigate the relationship between LVOT presystolic wave and 24-h ambulatory blood pressure measurements. A total of 194 patients who came to the cardiology outpatient clinic were prospectively enrolled in the study. After demographic and clinical inquiry, blood biochemistry and hemogram tests were performed. Each patient was evaluated with echocardiography and 24-h ambulatory blood pressure measurement. The patients were divided into hypertensive and nonhypertensive groups regarding their ambulatory blood pressure measurements and the LVOT presystolic wave of the groups on echocardiography was compared. The hypertensive group was significantly older (59.34 ± 11.15 vs. 49.89 ± 15.43; P < 0.001). Presystolic wave presence (96.2 vs. 29.5%; P < 0.001) and velocity (62.23 vs. 29.42; P < 0.001) were higher in patients with hypertension. Blood pressure values and LVOT amplitudes showed a positive correlation ( P < 0.001; r = 0.326). In multivariable logistic regression analysis; age, BMI and the presystolic wave were independently associated with hypertension (odds ratio: 8.09; P < 0.001). LVOT presystolic wave is associated with systemic hypertension and it could be used as a predictor for systemic hypertensive patients.

Update on Renal Sympathetic Denervation for the Treatment of Hypertension.

Hypertension is a leading risk factor for all-cause mortality in adults; however, medication non-adherence and intolerance present an enormous treatment challenge. Given the critical role of renal sympathetic nerves in neurogenic control of blood pressure and pathophysiology of hypertension, renal sympathetic denervation (RDN) has been explored as a therapeutic strategy in hypertension treatment over the last 15years. In this review, we will discuss the role of renal sympathetic nerves in the pathophysiology of hypertension, provide an update on the available evidence regarding the short- and long-term safety and effectiveness of RDN in the treatment of hypertension, and consider its future perspectives. RDN is a percutaneous endovascular catheter-based neuromodulation approach that enables ablation of renal sympathetic nerve fibers within the adventitial layer of the renal arteries using radiofrequency (most extensively studied), ultrasound energy, or neurolytics (e.g., alcohol). In the last decade, advancements in procedural techniques and well-designed sham-controlled trials utilizing 24-h ambulatory blood pressure measurements have demonstrated that RDN has an excellent safety profile and results in a modest reduction of blood pressure, in a wide range of hypertensive phenotypes (mild to resistant), irrespective of antihypertensive drug use and this effect is sustained over a 3-year period. Superiority of a particular RDN modality has not been yet established. Despite strong evidence demonstrating efficacy and safety of RDN, current data does not support its use as a primary approach in the treatment of hypertension due to its modest treatment effect and concerns around long-term sustainability. Perhaps the best utility of RDN is in hypertensives intolerant to antihypertensive medications or as an adjunct to aldosterone antagonists in the management of resistant hypertension. Patient selection will be critical to demonstrate a meaningful benefit of RDN. Future well-designed studies are necessary to determine predictors and measures of response to RDN, long-term efficacy given question of renal nerve regeneration, comparison of available technologies, safety in patients with advanced kidney disease, and improvement in patient quality of life measures.

CORRELATION OF COGNITIVE STATUS WITH IMPAIRED SKIN MICROVASCULAR REACTIVITY IN NEWLY DIAGNOSED UNTREATED HYPERTENSIVES

Objective: Untreated hypertension (HT) in the early midlife is strongly correlated with mild cognitive impairment (MCI) later on, in the elderly. HT is also associated with significant microvascular alterations in several vascular beds including skin. Skin microcirculation has been correlated with microvascular alterations in other beds and has been proposed as a model of generalized microvascular dysfunction. We sought to estimate the prevalence of MCI in newly diagnosed untreated hypertensive patients (UHTs) and compare it to normotensive healthy individuals (NTs). We also investigated possible associations between MCI and parameters of skin microvascular reactivity by using a novel laser technique, namely Laser Speckle Contrast Imaging (LSCI). Design and method: We consecutively enrolled 51 individuals including 31 UHTs and 20 NTs. All patients were free from diabetes mellitus or any cardiovascular disease. Diagnosis of HT was based on conventional office BP and 24h-Ambulatory Blood Pressure Measurement (24h-ABPM) criteria, according to standard guidelines. The Montreal Cognitive Assessment test (MoCA test) was used to assess cognitive function with a score equal to or lower than 26 being suggestive of MCI for all participants. The LSCI technique combined with post-occlusive reactive hyperemia (PORH) protocol was used to assess skin microvascular reactivity. Skin microvascular results are expressed as percentage increase of cutaneous perfusion from baseline to peak condition (base to peak flux, %). Results: Base to peak flux was significantly lower in UHTs compared to NTs (211.0 ± 53.1 vs 154.0 ± 53.0 %, p &lt; 0.01). Although the prevalence of MCI did not differ between UHTs and NTs, there was also a significant positive correlation between the MoCA test score and base to peak flux in the UHTs group (r = 0.491, p = 0.02). Conclusions: Although UHTs did not present impaired cognitive status compared to NTs, they do present impaired skin microvascular reactivity which is strongly correlated with their cognitive status from the very early stages of hypertension. Early and effective treatment of essential hypertension may contribute to the prevention of MCI and the improvement of skin microvascular function in hypertensive patients.

HERA3 STUDY: CAN PRESSURE-FLOW MEASUREMENTS AND COMPUTATIONAL FLOW SIMULATIONS GUIDE US WHEN TO TREAT RENAL ARTERY STENOSIS?

Objective: To stent or not to stent remains a difficult decision in patients with renal artery stenosis (RAS). Up to date, no diagnostic test that reliably identifies patients that will benefit from endovascular intervention has been established. Our goal is to develop and validate an image-based flow simulation method for predicting blood pressure improvement after renal arterial revascularization. Design and method: In total 30 patients scheduled for percutaneous renal transluminal angioplasty (PTRA) for atherosclerotic RAS or fibromuscular dysplasia RAS will be included in the HERA-3 study. Baseline imaging consists of computed tomography angiography (CTA). Before and after PTRA duplex ultrasound, renography and 24-h ambulatory blood pressure (ABPM) measurements are obtained. Based on the pre-operative CTA and duplex-imaging, personalized flow simulations are performed using computational fluid dynamics (CFD). During PTRA, pressure-flow measurements are obtained with a 0.014” Combowire (Philips-Volcano) before and after intrarenal dopamine administration. A non-invasive renal fractional flow reserve (rFFR) –the pressure gradient during vasodilation- is derived from the CFD simulation and compared to the invasively measured rFFR for validation. In addition, the renal flow reserve (RFR) -the relative increase in flow during vasodilation relative to resting condition- is obtained. Results: Twelve patients have been included in the study so far. Preliminary results show an encouraging agreement between the CFD-based and invasively measured rFFR. Second, in select cases with an anatomically moderate RAS (65% diameter reduction), a low RFR was found before PTRA, which markedly increased after PTRA. This suggests that a subset of RAS lesions cause a stronger flow impediment than can be expected on anatomic lesion grading. Conclusions: In patients with RAS, it is feasible to obtain the functional flow metrics rFFR and RFR during angiography. Second, preliminary data suggest that the rFFR can be non-invasively estimated using computational flow analysis based on CTA and ultrasound imaging. Future analysis can establish the predictive value of these metrics for predicting blood pressure improvement after PTRAS.

Association of urine phthalate metabolites, bisphenol A levels and serum electrolytes with 24-h blood pressure profile in adolescents

BackgroundAmong the possible causes of hypertension in adolescence, electrolyte imbalances and environmental pollutants are drawing increasing attention. We aimed to examine the relationship between bisphenol A (BPA), phthalate metabolites, and serum electrolytes and blood pressure.MethodsEighty-six participants aged 12–15 years were included in the study. Body mass index (BMI), office blood pressure and 24-h ambulatory blood pressure measurements (ABPM), and carotid intima-media thickness were determined. Blood samples were taken for hemogram, renal function tests, and serum electrolytes. Free- and total-BPA and phthalate metabolites were analyzed from urine samples.ResultsOf the participants, 34 were evaluated as normal blood pressure profile, 33 as white-coat hypertension (WCHT), and 19 as ABPM-hypertension. Adolescents in ABPM- hypertension groups had higher BMI-standard deviation score (SDS), leucocyte, platelet count; but lower serum chloride, compared to the normal blood pressure profile group. The percentage of adolescents with detectable urinary mono-benzyl phthalate (MBzP) was higher in ABPM-hypertension (42.1%) and WCHT groups (33.3%), compared to the normal blood pressure profile group (5.9%, p = 0.004). Associations between MBzP and ABPM- hypertension and WCHT were remained after confounding factor adjustment. Adolescents with detectable MBzP levels had also higher “albumin-corrected calcium” and lower serum phosphate and “albumin-corrected calcium x phosphate product” compared to others. Adolescents with detectable urinary MBzP levels had higher blood pressure profiles in some 24-h (mean arterial pressure-SDS, systolic blood pressure-SDS), daytime (systolic blood pressure-SDS), and night-time (mean arterial pressure-SDS, systolic blood pressure-SDS, and diastolic blood pressure-SDS) measurements, compared to others. WCHT was found to be associated negatively with monomethyl phthalate and the sum of dibutyl phthalate metabolites and ABPM-HT with MCPP. There was no significant association between blood pressure profiles and free- and total-BPA status.ConclusionMBzP was associated with adverse blood pressure profiles in adolescence. Additive follow-up studies are necessary for cause-effect relations.

Effects of Oral Bicarbonate Supplementation on the Cardiovascular Risk Factors and Serum Nutritional Markers in Non-Dialysed Chronic Kidney Disease Patients.

Background and Objectives: Kidneys play a key role in maintaining the acid–base balance. The aim of this study was to evaluate the effect of a 3-month oral sodium bicarbonate administration on arterial wall stiffness, arterial pressure and serum nutritional markers in non-dialysed patients with chronic kidney disease (CKD) stages 3–5 and metabolic acidosis. Methods: Eighteen CKD patients with eGFR < 45 mL/min/1.73 m2 and capillary blood bicarbonate (HCO3) < 22 mmol/L were enrolled in this single-centre, prospective study. Anthropometric parameters, pulse wave velocity, 24-h ambulatory blood pressure measurements, blood and urine parameters were assessed at the beginning and at the end of the study. The patients received supplementation with 2 g of sodium bicarbonate daily for three months. Results: A significant increase of pH: 7.32 ± 0.06 to 7.36 ± 0.06; p = 0.025, HCO3 from 18.7 mmol/L (17.7–21.3) to 22.2 mmol/L (20.2–23.9); p < 0.001 and a decrease in base excess from −6.0 ± 2.4 to −1.9 ± 3.1 mmol/L; p < 0.001 were found. An increase in serum total protein from 62.7 ± 6.9 to 65.8 ± 6.2; p < 0.013 and albumin from 37.3 ± 5.4 to 39.4 ± 4.8; p < 0.037 but, also, NT-pro-BNP (N-Terminal Pro-B-Type Natriuretic Peptide) from 794.7 (291.2–1819.0) to 1247.10 (384.7–4545.0); p < 0.006, CRP(C Reactive Protein) from 1.3 (0.7–2.9) to 2.8 (1.1–3.1); p < 0.025 and PTH (parathyroid hormone) from 21.5 ± 13.7 to 27.01 ± 16.3; p < 0.006 were observed, as well as an increase in erythrocyte count from 3.4 ± 0.6 to 3.6 ± 0.6; p < 0.004, haemoglobin from 10.2 ± 2.0 to 11.00 ± 1.7; p < 0.006 and haematocrit from 31.6 ± 6.00 to 33.6 ± 4.8; p < 0.009. The mean eGFR during sodium bicarbonate administration did not change significantly: There were no significant differences in pulse wave velocity or in the systolic and diastolic BP values. Conclusion: The administration of sodium bicarbonate in non-dialysed CKD patients in stages 3–5 improves the parameters of metabolic acidosis and serum nutritional markers; however, it does not affect the blood pressure and vascular stiffness.

Therapeutic Phlebotomy in Patients with Grade 1 Hypertension: A Randomized-Controlled Trial.

Aim: Study aim was to investigate the effects of therapeutic phlebotomy on ambulatory blood pressure in patients with grade 1 hypertension. Methods: In this randomized-controlled intervention study, patients with unmedicated hypertension grade 1 were randomized into an intervention group (phlebotomy group; 500 mL bloodletting at baseline and after 6 weeks) and a control group (waiting list) and followed up for 8 weeks. Primary endpoint was the 24-h ambulatory mean arterial pressure between the intervention and control groups after 8 weeks. Secondary outcome parameters included ambulatory/resting systolic/diastolic blood pressure, heart rate, and selected laboratory parameters (e.g., hemoglobin, hematocrit, erythrocytes, and ferritin). Resting systolic/diastolic blood pressure/heart rate and blood count were also assessed at 6 weeks before the second phlebotomy to ensure safety. A per-protocol analysis was performed. Results: Fifty-three hypertension participants (56.7 ± 10.5 years) were included in the analysis (n = 25 intervention group, n = 28 control group). The ambulatory measured mean arterial pressure decreased by -1.12 ± 5.16 mmHg in the intervention group and increased by 0.43 ± 3.82 mmHg in the control group (between-group difference: -1.55 ± 4.46, p = 0.22). Hemoglobin, hematocrit, erythrocytes, and ferritin showed more pronounced reductions in the intervention group in comparison with the control group, with significant between-group differences. Subgroup analysis showed trends regarding the effects on different groups classified by serum ferritin concentration, body mass index, age, and sex. Two adverse events (AEs) (anemia and dizziness) occurred in association with the phlebotomy, but no serious AEs. Conclusions: Study results showed that therapeutic phlebotomy resulted in only minimal reductions of 24-h ambulatory blood pressure measurement values in patients with unmedicated grade 1 hypertension. Further high-quality clinical studies are warranted, as this finding contradicts the results of other studies.

Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension

ABSTRACT Objectives Immune system activation plays a role in resistant hypertension (RHTN) pathogenesis. The clinical effect of the prognostic nutritional index (PNI) on patients with RHTN remains unclear. The aim of this study investigated the possible correlation between PNI and RHTN. Methods In this cross-sectional study, we enrolled 180 adult subjects. In patients were classified into three groups according to their office and ambulatory blood pressure measurements (ABPM): RHTN (n = 60), controlled hypertension (CHTN, n = 60), and normotension-control (NT-C, n = 60). RHTN was defined as BP ≥140/90 mm Hg while taking ≥3 antihypertensive medications or BP <140/90 mm Hg while taking ≥4 medications. The PNI was calculated from the 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (/μL) formula. Results Office and ABPM were significantly higher in patients with RHTN. Patients in the RHTN (46.1 ± 5.3) had significantly lower PNI than that in the CHTN (54.9 ± 6.7) (P = .032), and PNIs of both hypertensive groups were significantly lower than the NT-C group (P = .019, for both). The ROC curve analysis performed to assess the predictive value of PNI for RHTN and using 50.9 optimal cutoff value of PNI for RHTN gave a sensitivity of 77% and a specificity of 68.5% (AUC = 0.73, 95% CI 0.69–0.96). Multivariate analysis indicated diabetes, 24-h ABPM SBP, CRP, pill burden, and PNI (<51.6) as independent predictors of RHTN. Conclusion This study showed that the level of PNI was significantly lower in patients with RHTN compared to patients with CHTN. PNI is independently related to RHTN.