Mean 24-h Systolic Blood Pressure Research Articles

The circadian rhythm of arterial blood pressure in Alzheimer disease (AD) patients without hypertension

Objectives. The circadian rhythm (CR) of arterial blood pressure (ABP) in Alzheimer disease (AD) patients was examined in a case–control clinical study. Methods. This study was constructed using the case–control method and investigates non-hypertensive AD patients, compared with normotensive controls from a primary care setting. Twenty-four-hour ABP was measured with an automatic oscillometric device and recorded every 30 min throughout the day and night. Extreme dipper, dipper, non-dipper and reverse-dipper patterns were defined as those individuals with > 20%, 10–20%, < 10% and no fall in nocturnal ABP relative to daytime values. Results. There were significant differences in ABP dipper status between cases and controls (cases – 16.15%, 60.00%, 17.70% and 6.15% vs controls – 3.19%, 31.9 2%, 42.02% and 22.88% for reverse dipper, non-dipper, dipper and extreme dipper, respectively, df = 3, χ2 = 56.76, p < 0.001). Compared with normal controls, AD patients had significantly higher 24-h mean blood pressure, 24-h mean systolic blood pressure (SBP), night mean SBP, night mean pulse pressure (PP) and 24-h mean PP. There were no significant differences in 24-h mean diastolic blood pressure (DBP), daytime mean DBP or night-time mean DBP, and no significant differences in daytime mean SBP. Conclusions. The circadian rhythm of ABP in AD patents differed from normal controls, perhaps from higher night SBP in AD patents.

Transcatheter renal denervation in patients with resistant arterial hypertension: follow-up study of efficiency and safety

AbstractObjective. To evaluate the effi cacy and safety of transcatheter renal denervation (TRD) in drug-resistant hypertension in a single-institution study (NCT01499810). Design and methods . Subjects with essential hypertension aged 18–80 years with blood pressure (BP) > 160/100 mmHg despite three or more antihypertensive drugs who signed written informed consent were included in the study. Exclusion criteria were: mean 24-h systolic BP < 135 mmHg (ambulatory blood pressure monitoring), estimated glomerular fi ltration rate (eGFR) < 30 ml/min/m 2 , severe concomitant diseases. TRD was performed as 4–8 point radiofrequency (RF) ablations in each renal artery using standard EP catheter 5F. Effi cacy endpoints: changes in offi ce and ambulatory BP at 6 and 12 months after TRD. Safety endpoints: adverse events, changes in renal blood fl ow (ultrasound dopplerography) and renal function (proteinuria, serum creatinine, eGFR) at 1 st week, 6 and 12 months after TRD. Results. Interim analysis was done to monitor safety of TRD. The intervention was performed in 45 patients (aged 52,9 ± 12,2 years, 22 male), 29 patients were examined at 6 months and 16 patients — at 12 months after TRD. Intraoperative angiography showed no damage of renal arteries due to RF ablation. There were 5 minor periprocedural complications: small subcapsular kidney hematoma (80 ml by magnet-resonance tomography), contrast nephropathy, 2 access site pseudoaneurysms, allergy to dye. No additional events, signifi cant changes in renal blood fl ow or renal function were found at 6 and 12 months of follow-up. Offi ce BP fell by -34,8/-17,2 mmHg (p < 0,00001/0,00001) at 6 months and -41,0/-24,1 mmHg (p < 0,0001/0,0001) at 12 months after TRD (systolic/diastolic, respectively). Mean 24-h BP decreased by -11,1/-7,1 (p < 0,001/0,001) and 20,8/-13,1 mmHg (p < 0,0001/0,0001), respectively.

Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial

Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP >135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) ≤15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI ≤15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.

G-protein-coupled receptor kinase 4 polymorphisms predict blood pressure response to dietary modification in Black patients with mild-to-moderate hypertension

Dopamine via G-protein-coupled receptor kinase 4 (GRK-4) regulates sodium (Na) balance in the proximal tubule of the kidney. Single-nucleotide polymorphisms of GRK-4 have been linked to impaired natriuresis and salt-sensitive hypertension. The purpose of this report was to determine the effect of GRK-4 gene polymorphisms on the blood pressure (BP) responses to dietary intervention. Black subjects aged 50-75 years with mild-to-moderate hypertension were randomised to an 8-week dietary intervention (n=40) or standard diet (n=40). BP was measured at baseline and at 8 weeks using 24-h ambulatory BP. All subjects underwent DNA analysis for the R65L and A142V polymorphisms. Data were analysed using generalised linear models. For the whole group, between-diet differences in mean 24-h ambulatory systolic BP was -4.53 mm Hg (95% confidence interval -9.05 to -0.01, P=0.05). In the intervention arm, the combined CC and CT group of the A142V showed a significant reduction in both systolic and diastolic ambulatory BP (-10 mm Hg, P=0.023 and -6.5 mm Hg, P=0.01, respectively), whereas the TT group demonstrated no reduction. Similarly, the combined GG and GT groups of the R65L showed a significant reduction in ambulatory BP (-10.6 mm Hg for systolic, P=0.004 and 5.8 mm Hg for diastolic, P=0.006). There was no response in the TT group. GRK-4 polymorphisms predict BP response to dietary modification in Black subjects with mild-to-moderate hypertension. These data may provide at least one among a range of clinical tools to target selected hypertensives to dietary intervention.

Ambulatory blood pressure monitoring, 2D-echo and clinical variables relating to cardiac events in ischaemic cardiomyopathy following cardioverter-defibrillator implantation

Evaluation of ambulatory blood pressure monitoring (ABPM), two-dimensional (2D) echo and clinical variables in predicting cardiac death and acute decompensated heart failure in patients with ischaemic cardiomyopathy and receiving a cardioverter-defibrillator implantation. We studied 180 consecutive patients (169 men) on an out-patient basis, with systolic dysfunction (ejection fraction ≤35%) and previous myocardial infarction. All received a cardioverter defibrillator (ICD) (116 dual chamber, 36 monocameral and 28 biventricular), for primary prevention of sudden death and standard medical therapy for heart failure. Mean follow-up was 11.7 months. Two-dimensional echo was performed just before ICD implantation, ABPM and haematological samples 2 weeks later. Age, ejection fraction, creatinine, haemoglobin concentration, mean 24-h systolic blood pressure, mean 24-h diastolic blood pressure, mean 24-h heart rate, brain natriuretic peptide, QRS duration, % paced beats, ventricular scar, biventricular pacing, sex and diabetes were considered. Cox proportional hazards regression analysis was used to explore the relationship between events. ROC curves were built for each independent variable. Events occurred in 47 patients (26%); 7 deaths for refractory heart failure and 40 hospitalizations for acute decompensated heart failure. Low mean 24-h systolic blood pressure [hazard ratio 0.96, 95% confidence interval (CI) 0.93-0.99, P = 0.02], high creatinine (hazard ratio 1.61, 95% CI 1.06-2.47, P = 0.01), low haemoglobin concentration (hazard ratio 0.81, 95% CI 0.65-0.99, P = 0.04) and older age (hazard ratio 1.04, 95% CI 1.01-1.08, P = 0.02) were independent predictors of events. Ambulatory systolic blood pressure, haemoglobin, creatinine and age can stratify risk of death and acute decompensated heart failure in patients with ischaemic cardiomyopathy and ICD in whom 2D-echo ejection fraction is not predictive.

Arterial hypertension in obesity: relationships with hormone and anthropometric parameters

Obesity has been recognized as an independent risk factor for arterial hypertension. This study was addressed to identify parameters predictive of 24-h mean systolic and/or diastolic blood pressure levels in obesity. A cohort of 180 euthyroid overweight and obese patients, 79 women and 101 men, aged 20-63 years, normotensive (n = 62) or with recently developed hypertension (n = 118), and never treated with antihypertensive drugs, was examined. Waist circumference, fasting insulin, thyroid stimulating hormone (TSH), free thyroxine (FT) FT(3), FT(4), glucose, and lipid (cholesterol, high-density lipoprotein cholesterol and triglyceride) serum concentrations, and 24-h urinary aldosterone and catecholamines were measured. Ambulatory blood pressure monitoring (ABPM) was performed and hypertension was confirmed when 24-h mean systolic blood pressure was ≥125 mmHg and/or 24-h mean diastolic blood pressure was ≥80 mmHg, according to the 2007 European Society of Hypertension and European Society of Cardiology Practice Guidelines for the Management of Arterial Hypertension. 24-h noradrenaline (p < 0.01) and adrenaline (p < 0.05) levels were higher in hypertensive than in normotensive subjects. The odds ratio (OR) was determined by several univariate and multivariate logistic regression analyses to evaluate the predictive factors of high 24-h blood pressure mean values. When subjects with high systolic and/or high diastolic blood pressure levels (n = 118) were compared to individuals with normal systolic and diastolic blood pressure levels (n = 62), multivariate analysis showed an independent association of hypertension with male gender and 24-h noradrenaline levels. When subjects with high systolic blood pressure levels (n = 108) were compared with those with normal systolic blood pressure levels (n = 72), multivariate analysis showed an independent association of high systolic blood pressure with noradrenaline levels. Lastly, when subjects with high diastolic blood pressure levels (n = 87) were compared with those with normal diastolic blood pressure levels (n = 93), multivariate analysis showed an independent negative association between high diastolic blood pressure and body mass index. the present study shows that diastolic blood pressure is independently and negatively associated with body mass index in normotensive or with recently discovered hypertension overweight and obese subjects, and never treated with antihypertensive drugs. These results suggest that obesity per se is responsible for a decrease in diastolic blood pressure before hypertensive state becomes stable. This study also confirms that male gender and daily noradrenaline production contribute to hypertension, and to higher systolic blood pressure levels in particular.

228 Blood pressure in HIV-infected patients

Objectifve To determine the prevalence of hypertension in a cohort of HIV-infected patients (HIV+). Methods HIV+ patients were enrolled consecutively at ambulatory cardiology consultation. We evaluated: cardiovascular risk factors, office blood pressure, 24 hours ambulatory blood pressure monitoring (ABPM). We identified patients with known hypertension, masked hypertension and white-coat effect. Results 258 HIV+ patients (mean age 49 ± 7 ans, 91% men) were consecutively included in this study between 2005 and 2009. Cardiovascular risk factors were as follows: 52% had dyslipidemia, 51% were active smokers, 40% with known hypertension and 9% were diabetics. Body mass index of the entire cohort was 24 ± 4 kg/mΣ and 89% were under antiretrovirals. Data on blood pressure are depicted in Table 1. 19% (29) were discovered to have hypertension. Conclusion Hypertension is frequent in HIV-infected patients and more and more common with aging. The number of non-dipper HIV+ was high in this cohort. Studies on the impact of HIV infection and antiretrovirals on the autonomic nervous system should be performed. Parameters N = 258 Office systolic BP, mmHg 131 ± 19 Office diastolic BP, mmHg 81 ± 10 Mean 24h-systolic BP, mmHg 125 ± 13 Mean 24-diastolic BP, mmHg 77 ± 9 Daytime systolic BP, mmHg 129 ± 13 Daytime diastolic BP, mmHg 80 ± 9 Nighttime systolic BP, mmHg 115 ± 17 Nighttime diastolic BP, mmHg 68 ± 10 BP profile in known hypertensive patients N = 103 Number of patients with appropriate BP control, % 45% Number of patients with white-coat effect, % 17% Non dipper, % 43% in known hypertensive patients 39% in unknown hypertensive patients

Effects of Concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension

Consumption of flavonoid-containing foods may be useful for the management of hypertension. We investigated whether 100% Concord grape juice lowers blood pressure in patients with prehypertension and stage 1 hypertension. We conducted a double-blind crossover study to compare the effects of grape juice (7 mL · kg⁻¹ · d⁻¹) and matched placebo beverage on 24-h ambulatory blood pressure, stress-induced changes in blood pressure, and biochemical profile. Participants consumed each beverage for 8 wk with a 4-wk rest period between beverages. They ceased consumption of grapes and other flavonoid-containing beverages throughout the study. We enrolled 64 otherwise healthy patients taking no antihypertensive medications (31% women, 42% black, age 43 ± 12 y). Baseline mean (± SD) cuff blood pressure was 138 ± 7 (systolic)/82 ± 7 (diastolic) mm Hg. No effects on the primary endpoint of 24-h mean systolic blood pressure, diastolic blood pressure, or stress-induced changes in blood pressure were observed. A secondary endpoint was nocturnal dip in systolic pressure. At baseline, nocturnal pressure was 8.3 ± 7.1% lower at night than during daytime. The mean nocturnal dip increased 1.4 percentage points after grape juice and decreased 2.3 percentage points after placebo (P = 0.005). Fasting blood glucose was 91 ± 10 mg/dL at baseline for the entire cohort. Glucose decreased 2 mg/dL after consumption of grape juice and increased 1 mg/dL after consuming the placebo (P = 0.03). We observed no effect of grape juice on ambulatory blood pressure in this cohort of relatively healthy individuals with modestly elevated blood pressure. Secondary analyses suggested favorable effects on nocturnal dip and glucose homeostasis that may merit further investigation. This trial was registered at clinicaltrials.gov as NCT00302809.

The Blood Pressure Lowering Effect of Lactotoripeptides and Salt Intake in 24-H Ambulatory Blood Pressure Measurements

It is well known that the sour milk containing lactotripeptides has a blood pressure lowering effect The aim of this study was to evaluate the blood pressure (BP) lowering effect of lactotripeptides by monitoring home blood pressure, 24-h ambulatory measurements (ABPM), and daily urinary salt excretion.A total of 30 volunteers were given 200 ml of sour milk twice a day for 8 weeks after a 1-week run-in period. This preparation contained the lactotripeptides valine-proline-proline 2.66 mg and isoleucine-proline-proline 1.38 mg. The study participants had daily measurements of urinary salt excretion determined by an electric salt sensor and home blood pressure for each week during the run-in period, before the 4-and 8-week time points. 24-h ABPM was measured at the end of each week. Mean systolic blood pressure (SBP) during night sleep including base BP at 4 and 8 weeks were significantly lower than baseline values. Mean SBP and diastolic blood pressure (DBP) during night sleep of the 22 participants who belonged to the criteria of hypertension by 24-h ABPM was significantly decreased at 4 and 8 weeks. The change in 24-h mean SBP significantly correlated with mean urinary salt excretion over the three measurement periods. The 22 hypertensive subjects without taking lactotripeptides did not show significant change of blood pressure during 24 hours at 4 and 8 weeks. Our study confirmed the BP lowering effect of lactotripeptides during night-time sleep and showed that a lower intake of salt may increase the BP lowering effect of lactotripeptides through 24 hours in hypertensive subjects.

PREVALENCE OF MASKED HYPERTENSION IN SUBJECTS WITH HIGH NORMAL BLOOD PRESSURE: PP.3.98

Objective: To estimate the prevalence of masked hypertension in subjects with high normal blood pressure (BP). Methods: We analyzed data from untreated individuals included in the Spanish Society of Hypertension ABPM Registry (whole sample number 68,045). High normal BP was defined following current guidelines when office systolic BP was 130–139 mmHg and diastolic BP was 85–89 mmHg. A series of demographic and clinical variables were collected. Definitions and risk stratification followed 2007 ESH-ESC guidelines. ABPM was performed under standardized conditions. Masked hypertension was diagnosed when mean 24-h systolic BP = or > 130 mmHg and/or 24-h diastolic BP = or >80 mmHg. Results: We identified 3,199 untreated subjects with high normal BP. Mean (SD) age was 51.2 (15.1) years, 53.6% were men, and 26.4% were obese (body mass index ≥30 kg/m2). Mean (SD) office BP was 132.5 (5.2)/81.5 (6.3) mmHg and mean (SD) 24-h ambulatory BP was 123.9 (10,4)/75.8 (8,2) mmHg. Prevalence (95%CI) of masked hypertension was 39.5% (37.8–41.2). Subjects with masked hypertension showed a 24.5 % prevalence of high cardiovascular risk. With respect to individuals with ambulatory normotension, subjects with masked hypertension were overweighted, more frequently smokers, and showed a higher prevalence of a riser profile of nocturnal BP (p < 0.05 for all comparisons). Prevalence of documented target organ damage and established cardiovascular disease was similar in patients with masked hypertension and subjects with ambulatory normotension. Conclusions: Masked hypertension was present in 4 of 10 subjects with high-normal BP. This proportion and the potential high-risk profile of these individuals should encourage the detection of masked hypertension in subjects with high-normal BP.

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE (OM/HCTZ) 40/25MG PROVIDES GREATER AMBULATORY BLOOD PRESSURE-LOWERING VS OM/HCTZ 20/25MG IN ELDERLY AND SEVERE PATIENTS UNCONTROLLED BY OM: PP.5.203

Objective: To compare the efficacy of OM/HCTZ 40/25 mg versus 20/25 mg, as assessed by ambulatory blood pressure monitoring (ABPM), in elderly and hypertension severity subgroups in patients whose BP was inadequately controlled by OM 40 mg. Design and Methods: This was a subgroup analysis of a 16-week study in patients aged >/=18 years. The study consisted of 2 periods, each 8 weeks long. Eligible patients received 8 weeks' open-label OM 40 mg (Weeks 0–8). At Week 8 (baseline), patients with inadequate BP control (mean trough seated BP 140–180/90–115mmHg, mean 24-h diastolic BP [DBP] >/=80mmHg and >/=30% of daytime DBP readings >85mmHg) were randomised to a further 8 weeks' double-blind treatment with OM/HCTZ 40/25 or 20/25 mg (Weeks 8–16). Changes in ABPM from Week 8 to Week 16 were evaluated in patients aged >/=65 years (N=184) and in patients with moderate (160–179/100–109mmHg; N=679) or severe (>/=180/110mmHg; N=263) hypertension using a Spacelabs90207 device. Analyses were performed on the FAS OC. Results: In elderly patients OM/HCTZ 40/25 mg provided greater reductions in mean 24-h, daytime and night-time systolic BP (SBP) compared with 20/25 mg (15.4, 15.8 and 14.1mmHg vs 13.7, 14.0 and 13.5mmHg, respectively; Figure), while ambulatory DBP reductions were similar for both treatments. In patients with moderate hypertension, OM/HCTZ 40/25 mg provided greater mean 24-h (Figure), daytime and night-time ABP reductions than OM/HCTZ 20/25 mg (14.6/9.4 vs 11.4/7.4, 15.0/9.6 vs 11.7/7.4, and 13.4/8.5 vs 10.1/6.8mmHg, respectively). In patients with severe hypertension, ABP reductions were more pronounced with OM/HCTZ 40/25 mg than 20/25 mg for 24-h (Figure), daytime and night-time SBP (14.5 vs 13.8, 14.7 vs 14.2 and 13.4 vs 12.4mmHg, respectively), and for 24-h and night-time DBP (8.8 vs 8.4 and 8.8 vs 7.6mmHg, respectively). Conclusions: Elderly patients and individuals with more severe hypertension are harder to treat. OM/HCTZ 40/25 mg provides further incremental reductions in ABP compared with OM/HCTZ 20/25 mg in these subgroups, which may be of clinical relevance.

Does the ratio of serum aldosterone to plasma renin activity predict the efficacy of diuretics in hypertension? Results of RENALDO

We hypothesized that the aldosterone: renin ratio (ARR) predicts the antihypertensive response to mineralocorticoid receptor antagonist, spironolactone (SPIRO), when compared with bendroflumethiazide (BFZ). We conducted a randomized, crossover, trial on hypertensive patients with either high ARR (HARR defined as >750 and plasma aldosterone >250 pmol/l) or low ARR (LARR defined as <300 and plasma renin activity <10 ng/ml per h). Each group took SPIRO 50 mg once daily for 12 weeks and BFZ 2.5 mg once daily for 12 weeks in random order separated by 2-week washout. Patients with mean 24-h systolic ambulatory blood pressure (SABP) at least 140 mmHg were included. Primary endpoint was difference in SABP between SPIRO and BFZ in patients with HARR compared with those with LARR. One hundred and eleven patients (60 HARR and 51 LARR) completed the study. SABP at 12 weeks in the HARR group was 129.4 mmHg on SPIRO and 134.4 mmHg on BFZ [difference -5.01; 95% confidence interval (CI) -7.51, -2.52; P < 0.0002]. In the LARR group, SABP was 129.7 mmHg on SPIRO and 133.1 mmHg on BFZ [difference -3.43 (95% CI -6.18, -0.68) P < 0.01]. Difference between groups (HARR vs. LARR) was -1.58 mmHg (95% CI 5.25, -2.08; not significant, P = 0.394). In a secondary analysis of the overall study population of 111 patients, SABP reduction with SPIRO 50 mg was superior to BFZ 2.5 mg [SPIRO -14.8 mmHg, BFZ -10.5 mmHg, difference -4.29 mmHg (95% CI -6.12, -2.46)]. Results were similar for secondary endpoints. Plasma renin activity or aldosterone did not predict blood pressure response to SPIRO. Results were independent of concomitant angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. The ARR did not predict the blood pressure response to SPIRO. SPIRO 50 mg was significantly more effective than BFZ 2.5 mg in lowering SABP irrespective of baseline ARR, plasma renin activity or aldosterone.

The effects of 1 month antihypertensive treatment with perindopril, bisoprolol or both on the ex vivo ability of monocytes to secrete inflammatory cytokines

Monocytes are key elements in pathogenesis of atherosclerosis and inflammation. The data regarding associations between antihypertensive treatment and monocytes' function are still lacking. The aim of this study was to evaluate the influence of antihypertensive drugs (bisoprolol, perindopril or both) in patients suffering from mild to moderate hypertension. The study population consisted of 67 patients divided into 3 groups (2 consisted of patients with Grade I essential hypertension and one consisted of patients with Grade II essential hypertension). At baseline and 1 month after treatment we performed 24-h ambulatory noninvasive blood pressure monitoring and measured IL-1beta, IL-6, IL-10, MCP-1 and TNF-alpha in a medium derived from LPS-stimulated monocytes' culture. Both monotherapies with bisoprolol or perindopril were equally effective in lowering blood pressure (reduction in mean 24-h systolic blood pressure 12.07 vs. 15.91 mmHg, p = 0.678). Antihypertensive treatment led to significant decrease in IL-1b, IL-6, MCP-1 and TNF-alpha concentration and significant rise in IL-10 level compared to the baseline levels and the decrease was associated with reduction in blood pressure. Bisoprolol and perindopril effectively reduced elevated blood pressure. As a result, an alteration in cytokine net was observed at the end of the study. These results support the concept of possible anti-inflammatory effects of antihypertensive drugs (e.g., perindopril and bisoprolol).

Cognitive performance in hypotensive persons with spinal cord injury

Due to sympathetic de-centralization, individuals with spinal cord injury (SCI), especially those with tetraplegia, often present with hypotension, worsened with upright posture. Several investigations in the non-SCI population have noted a relationship between chronic hypotension and deficits in memory, attention and processing speed and delayed reaction times. To determine cognitive function in persons with SCI who were normotensive or hypotensive over a 24-h observation period while maintaining their routine activities. Subjects included 20 individuals with chronic SCI (2-39 years), 13 with tetraplegia (C4-8) and 7 with paraplegia (T2-11). Individuals with hypotension were defined as having a mean 24-h systolic blood pressure (SBP) below 110 mmHg for males and 100 mmHg for females, and having spent >or=50% of the total time below these gender-specific thresholds. The cognitive battery used included assessment of memory (CVLT), attention and processing speed (Digit Span, Stroop word and color and Oral Trails A), language (COWAT) and executive function (Oral Trails B and Stroop color-word). Demographic parameters did not differ among the hypotensive and normotensive groups; the proportion of individuals with tetraplegia (82%) was higher in the hypotensive group. Memory was significantly impaired (P < 0.05) and there was a trend toward slowed attention and processing speed (P < 0.06) in the hypotensive compared to the normotensive group. These preliminary data suggest that chronic hypotension in persons with SCI is associated with deficits in memory and possibly attention and processing speed, as previously reported in the non-SCI population.

Oral Calcium Supplementation Ambulatory Blood Pressure and Relation to Changes in Intracellular Ions and Sodium-Hydrogen Exchange

Calcium (Ca2+) supplementation has been shown paradoxically to reduce intracellular Ca2+ and induce vascular relaxation. The aim of the study was to assess 24-h blood pressure (BP) change after Ca2+ supplementation and to investigate its relation to changes in intracellular ions and the activity of the first isoform of sodium-hydrogen exchange (NHE-1) in subjects with hypertension and type 2 diabetes. This parallel, randomized controlled, single-blinded trial, consisted of 31 patients with type 2 diabetes, and hypertension who were allocated to receive 1,500 mg of Ca2+ per day (n = 15) or no treatment (n = 16) for 8 weeks. In the Ca2+ group a decrease of 1.7 +/- 2.7 mm Hg (mean +/- SE) P = 0.52 for mean 24-h systolic BP (SBP) and 2.1 +/- 1.5 mm Hg, P = 0.19 for mean 24-h diastolic BP (DBP) was recorded. Whereas in the control group an increase of 1.4 +/- 2.7 mm Hg, P = 0.59 for mean 24-h SBP and 1.2 +/- 2.8 mm Hg, P = 0.83 for mean 24-h DBP was observed. Intraplatelet Ca2+ decreased whereas intraplatelet magnesium (Mg2+) and erythrocyte K+ increased in the intervention group. Change in mean 24-h SBP in the pooled group correlated with both change in intraplatelet Ca2+ (r = 0.49, P < 0.05) and NHE-1 activity (r = 0.6, P < 0.001). The contribution of intraplatelet Ca2+ was attenuated when both parameters were entered in a multivariate regression model. The present study shows a weak, statistically nonsignificant trend towards association of Ca2+ supplementation on 24-h BP in hypertensive subjects with type 2 diabetes. However, our results indicated an interrelation of [Ca2+]i levels and NHE-1 activity on BP in patients with hypertension and type 2 diabetes.

Oral Magnesium Supplementation Reduces Ambulatory Blood Pressure in Patients With Mild Hypertension

Accumulating evidence implicates a role of Mg(2+) in the pathophysiology of essential hypertension. Previous studies evaluating the antihypertensive efficacy of Mg(2+) supplementation gave contradictory results. This study aimed to investigate the effect of oral Mg(2+) supplementation on 24-h blood pressure (BP) and intracellular ion status in patients with mild hypertension. A total of 48 patients with mild uncomplicated hypertension participated in the study. Among them, 24 subjects were assigned to 600 mg of pidolate Mg(2+) daily in addition to lifestyle recommendations for a 12-week period and another 24 age- and sex-matched controls were only given lifestyle recommendations. At baseline and study-end (12 weeks) ambulatory BP monitoring, determination of serum and intracellular ion levels, and 24-h urinary collections for determination of urinary Mg(2+) were performed in all study subjects. In the Mg(2+) supplementation group, small but significant reductions in mean 24-h systolic and diastolic BP levels were observed, in contrast to control group (-5.6 +/- 2.7 vs. -1.3 +/- 2.4 mm Hg, P < 0.001 and -2.8 +/- 1.8 vs. -1 +/- 1.2 mm Hg, P = 0.002, respectively). These effects of Mg(2+) supplementation were consistent in both daytime and night-time periods. Serum Mg(2+) levels and urinary Mg(2+) excretion were significantly increased in the intervention group. Intracellular Mg(2+) and K(+) levels were also increased, while intracellular Ca(2+) and Na(+) levels were decreased in the intervention group. None of the intracellular ions were significantly changed in the control group. This study suggests that oral Mg(2+) supplementation is associated with small but consistent ambulatory BP reduction in patients with mild hypertension.

Effects of force-titrated valsartan/hydrochlorothiazide versus amlodipine/hydrochlorothiazide on ambulatory blood pressure in patients with stage 2 hypertension: the EVALUATE study

Previous studies using the combination of angiotensin-receptor blockers and hydrochlorothiazide (HCTZ) have shown superior ambulatory blood pressure (ABP) reduction in study participants with stage 2 hypertension compared with monotherapy. This multicenter, double-blind, parallel group, forced-titration study of individuals with stage 2 hypertension, compared the efficacy of valsartan and amlodipine in combination with HCTZ on ABP reduction. After a 2-week washout period, participants (n=482) with mean office sitting systolic BP >or=160 mmHg and <or=200 mmHg were randomized to receive treatment with either valsartan 160 mg (n=241) or amlodipine 5 mg (n=241), force-titrated to a maximum dose of valsartan/HCTZ 320/25 mg or amlodipine/HCTZ 10/25 mg over 6 weeks and continued through week 10. The primary endpoint was change in mean 24-h ambulatory systolic BP from baseline to week 10. At week 10, changes from baseline in mean office BP were significantly (P<0.0001) decreased by both valsartan/HCTZ (-34.2/-14.2 mmHg) and amlodipine/HCTZ (-34.1/-14.7 mmHg). Changes from baseline in mean 24-h ABP were significantly (P<0.0001) decreased by both valsartan/HCTZ (-21.1/-12.5 mmHg) and amlodipine/HCTZ (-18.1/-9.9 mmHg). However, treatment with valsartan/HCTZ provided significant additional systolic BP (-3.8 mmHg; P=0.0042) and diastolic BP (-2.7 mmHg; P=0.0002) reduction compared with the amlodipine/HCTZ group. The proportion of individuals reaching the office goal BP (<140/80 mmHg) were similar in the valsartan/HCTZ (55.3%) versus amlodipine/HCTZ (54.9%) group, ABP control rates for the recommended ABP goal (<130/80 mmHg) were greater (P=0.0170) in the valsartan/HCTZ group (54.3%) than the amlodipine/HCTZ group (42.7%). Both treatments were well tolerated. On the basis of ABP monitoring but not office measurements, the fixed-dose combination of valsartan/HCTZ is a significantly more effective treatment regimen than amlodipine/HCTZ, with similar tolerability.

The 24-h blood pressure measurement may predict mortality and cardiovascular events in hypertensive patients with coronary artery disease

The aim of this prospective study was to evaluate the relationship between 24-h blood pressure (BP) values and cardiovascular events in hypertensive patients with coronary artery disease in the long-term observation. Two hundred and seventy-four patients (mean age 56.9+/-9.3 years, 197 male, 77 female) who underwent coronary and renal angiography were investigated. Baseline characteristics included clinical and biochemical evaluations, 24-h BP measurement and standardized auscultatory readings - clinic BP. The composite end-point of death from all causes, nonfatal acute myocardial infarction, coronary revascularization and stroke were assessed at mean 40 months follow-up. Patients with the composite end-point had higher mean 24-h systolic BP (SBP) and diastolic BP (DBP) levels (124/74 vs. 117/71 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively), higher mean daytime SBP and DBP (127/76 vs. 119/72 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively) and higher night-time SBP and DBP (121/69 vs. 111/65 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively) at baseline. There were no differences in systolic and diastolic clinic BP levels between patients with and without the combined end-point. Multivariate Cox model revealed that only a number of coronary arteries stenosed and 24-h systolic BP level were independent predictors of occurrence of the composite end-point. In conclusion, our results indicate that 24-h BP measurement made in hospital but not the clinic standardized auscultatory readings predicts cardiovascular risk.

Association of an Abnormal Blood Glucose Level and Morning Blood Pressure Surge in Elderly Subjects With Hypertension

We previously reported that morning blood pressure (BP) surge (MBPS) was an independent risk factor for stroke. We evaluated the determinants of MBPS in hypertensive patients. We analyzed 24-h ambulatory BP monitoring (ABPM) records in 458 hypertensive patients (mean: 72.2 +/- 8.5 years). The MBPS was calculated as the mean systolic BP (SBP) over 2 h after waking minus mean SBP during the hour of sleep that included the lowest nighttime BP. The cutoff value for identifying the top decile (the MBPS group) was defined as > or =55 mm Hg. The MBPS was associated with age, fasting plasma glucose, and 24-h SBP, and they were independent and significant determinants of MBPS in multivariate analysis (age, P = 0.01; fasting plasma glucose, P < 0.01; 24-h SBP, P = 0.04) after adjustment for confounding factors of gender, body mass index (BMI), and smoking status. The subjects in the MBPS group (n = 45) were older in age (76.4 years vs. 71.8 years, P < 0.01) and had higher fasting plasma glucose (97.6 mg/dl vs. 91.4 mg/dl, P = 0.04) than those in the non-MBPS group. In logistic regression analysis, the MBPS group was associated with older age (10 years older: odds ratio (OR) 1.85, 95% confidence interval (CI) 1.26-2.72, P < 0.01) and higher fasting plasma glucose (10-mg/dl increase: OR 1.16, 95% CI 1.01-1.33, P = 0.03). In addition to older age and higher mean 24-h SBP, higher fasting plasma glucose was associated with MBPS.

Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease

A significant number of children with chronic kidney disease (CKD) have eccentric left ventricular hypertrophy (LVH), suggesting the role of preload overload. Therefore, we hypothesized that increased cardiac output (CO) might be a contributing factor for increased left ventricular mass index (LVMI) in these children. Patients aged 6-20 years with CKD stages 2-4 were enrolled. Echocardiograms were performed to assess LV function and geometry at rest and during exercise. Heart rate, stroke volume, and CO were also assessed at rest and during exercise. Twenty-four-hour ambulatory blood pressure (AMBP) monitoring was performed. Of the patients enrolled in this study, 17% had LVH. Increased stroke volume and CO were observed in patients with LVH compared to patients without LVH. Univariate analysis revealed significant positive associations between LVMI and CO, stroke volume, body mass index, pulse pressure from mean 24-h AMBP, and mean 24-h systolic BP load. No association with heart rate, age, parathyroid hormone, glomerular filtration rate, or anemia was observed. Only CO (beta = 1.98, p = 0.0005) was independently associated with increased LVMI in multivariate modeling (model R (2) = 0.25). The results of this study suggest that increased CO might predispose to increased LVMI in pediatric patients with CKD. Adaptations may be required to meet increased metabolic demand in these patients.