24-h SBP Research Articles

Effects of vascular compression on the rostral ventrolateral medulla for blood pressure variability in stroke patients.

Vascular compression of the rostral ventrolateral medulla (RVLM) has been associated with hypertension or blood pressure (BP) variability. For acute ischemic stroke patients, increased BP variability may cause poor functional outcomes. We tested the hypothesis that RVLM compression was associated with increased BP variability or stroke outcome in acute ischemic stroke patients. Acute ischemic stroke patients (n = 622) with 24-h ambulatory BP monitoring during the subacute phase of stroke (median 9 days from onset) were retrospectively studied. Variability in BP was evaluated with the SD and coefficient of variation of SBP and DBP. The morning surge was also evaluated. The presence of RVLM compression was evaluated using time-of-flight three-dimensional MRI. A poor outcome was defined as a modified Rankin Scale score of 3-6 at 3 months. Patients with RVLM compression (n = 213) had significantly higher 24-h SBP mean, 24-h SBP SD, 24-h SBP coefficient of variation, 24-h DBP mean, 24-h DBP SD, and 24-h DBP coefficient of variation values and a higher prevalence of morning surge than those without (n = 409). Multiple regression analysis revealed that RVLM compression was associated with increased SBP variability, DBP variability, and morning surge. Despite the significant association between RVLM compression and BP variability, RVLM compression was not associated with poor stroke outcome. Although RVLM compression was closely associated with BP variability in the subacute ischemic stroke phase, an effect of RVLM compression on stroke outcome was not observed.

4-3RENAL DENERVATION FOR RESISTANT HYPERTENSION POST-SIMPLICITY-3 HTN TRIAL: META-ANALYSIS AND SYSTEMATIC REVIEW

Background: Following the result from SIMPLICITY-3 trial that failed to show the benefit of renal denervation over sham control, the interest on renal denervation had fallen into hibernation. However, there were some authors indicated that SIMPLICITY-3 trial result seemed to have major problems regarding incomplete denervation that led experts to researched and carefully designed studies regarding renal denervation. Since then, there was three carefully-designed, sham-controlled studies published about the issue. However, there was no published meta-analysis on randomized trials after SIMPLICITY-3 era. We aimed to conduct a meta-analysis of RCTs to determine the effect of renal denervation in resistant hypertension. Methods: A search on MEDLINE and EMBASE was conducted in January 2020. Randomized clinical studies comparing renal denervation and sham-controlled trial published after SIMPLICITY-3 trial were included for this meta-analysis. Study selection: only fully published RCT and abstracts of RCT comparing renal denervation and sham control for resistant hypertension published after SIMPLICITY-3 trial was included. Studies which were duplicated and non-randomized were excluded. Results: The analysis included 149 patients from 3 trials with a duration of follow up of 2–6 months. The reduction in 24-h ambulatory SBP was significantly greater in the renal denervation group compared to the sham procedure (WMD −4.74 mmHg, 95% CI −6.5, −2.99; p < 0,001). There was also significant reduction in 24-h DBP (WMD −3.11 mmHg, 95% CI −3.98, −2.23; p < 0,001), office SBP (WMD −7.1 mmHg, 95% CI −9.12, −5.08; p < 0,001), and office DBP (WMD −4,63 mmHg, 95% CI −5.98, −3.28; p < 0,001). Conclusion: Following SIMPLICITY-3 trial, there were positive results regarding renal denervation on resistant hypertension. Renal denervation significantly reduced blood pressure compared to sham control. Our meta-analysis underscores the importance of conducting new well-designed studies to confirm our observed results.

Ambulatory blood pressure variability and risk of cardiovascular events, all-cause mortality, and progression of kidney disease.

Association between blood pressure (BP) variability and cardiovascular outcome remains unclear in patients with chronic kidney disease (CKD). We evaluated this association between ambulatory BP variability and cardiovascular events, mortality, and kidney disease progression in patients with CKD. From the Cardiovascular and Metabolic Disease Etiology Research Center-HIgh Risk study (2013-2018), a total of 470 patients with CKD were analyzed. Ambulatory BP variability was assessed using average real variability (ARV). Primary outcome was composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. The secondary outcome was rapid kidney function decline [estimated glomerular filtration rate (eGFR), >3 ml/min per 1.73m per year]. During a median follow-up of 51.8 (40.5-56.2) months, the incidences of all-cause death and composite outcomes were higher in the high SBP-ARV group than in the low SBP-ARV group. The Kaplan-Meier analysis showed that a high SBP-ARV, but not a high DBP-ARV and heart rate-ARV, was associated with higher composite outcome risks. In multivariable Cox analysis, a high SBP-ARV correlated with increased composite outcome risks (hazard ratio, 4.53; 95% confidence interval, 1.41-14.58). When subgroup analysis was performed (low vs. high 24-h SBP), this association was only significant in the high 24-h SBP group. The risk stratification for composite outcomes by adding SBP-ARV into the basic model and 24-h SBP, improved by 1.3%. Furthermore, the mean eGFR decline rate was faster, and the rapid eGFR decline risk was 1.68-fold higher in the high SBP-ARV group. Greater ambulatory SBP variabilities were associated with increased risks for nonfatal cardiovascular diseases, all-cause mortality, and rapid kidney function decline in patients with CKD.

P1831ABPM DIFFERENCE BETWEEN OBESE AND NON OVERWEIGHT HYPERTENSIVE CHILDREN

Abstract Background and Aims The goal of our study was to analyze the difference in ABPM pattern in overweight and non overweight hypertensive children Method The ABPM were performed using Spacelab 90207 and recorded over 24h.Readings were taken every 15 minutes while awake,and every 20 minutes while asleep. In both groups were evaluated the 24h MAP,daytime MAP,nocturnal MAP, systolic and diastolic load,mean 24h SBP and DBP. A total of 108 pts were enrolled. Pts were divided in two groups.In the first group 54 pts non overweight with primary hypertension:33 male and 21 female with mean age of 10.4 y. In the second group the obese hypertensive children, with mean age of 10.5 y, were divided into two subgroups according to BMI Z-scores:subgroup 1 BMI Z-score >2<3 n 40 pts (17 f;21m); subgroup 2 BMI Z-score >3 n (4f;10m). Results Systolic load was significantly higher in obese group (p 0,0409).In obese group n.12 were dipper (22,2%).Obese with BMI zscore >3 was all non dipper (n14 ;100%). In the lean group n 26 was dipper (48.1%),and 28 (51.8%) non dipper. 24 h MAP, Systolic and Diastolic load were significantly higher (p 0,0001) in the obese with BMI z score >3 compared to the lean group. Conclusion The statistically significant pathological pattern among obese is the increase inmean PAS and systolic load, as well as the absence of night dipping in severe obese. The increase in systolic load is already evident in obese mild.This gives a significant predictive value of cardiovascular damage to ABPM which increases with the severity of obesity worse.

The effect of Mid-Day Sleep on blood pressure levels in patients with arterial hypertension

Study objectivesLifestyle changes decrease blood pressure (BP) levels by 3-5 mmHg in hypertensive patients. We assessed the effect of mid-day sleep on BP levels in hypertensive patients. MethodsWe prospectively studied two hundred and twelve hypertensive patients. Mid-day sleep duration, lifestyle habits, anthropometric characteristics, office BP, ambulatory BP monitoring, pulse wave velocity (PWV), augmentation index (AI) were recorded. A standard echocardiographic evaluation was performed. Results53.8% were females, mean age was 62.5±11.0 years and mean body mass index was 28.9±5.4kg/m2. Mean average 24h systolic and diastolic BP (SBP & DBP) was 129.9±13.2/76.7±7.9 mmHg respectively. The majority was non-smokers (70.3%) and did not have diabetes (74.7%). The mean midday sleep duration was 48.7±54.3 min. Average 24h SBP (127.6±12.9 mmHg vs 132.9±13.1 mmHg), average daytime SBP & DBP were lower in patients who sleep at midday, compared to those who do not (128.7±13/76.2±11.5 vs 134.5±13.4/79.5±10.4 mmHg) (p<0.005). The effect was not correlated to the dipping status. Midday sleep duration was negatively correlated with average 24h SBP & daytime SBP. In a linear regression model, for every 60 min of midday sleep, 24h average SBP decreases by 3 mmHg (p<0.001). There were no differences in the number of antihypertensive medications, PWV, AI or echocardiographic indices between study groups. ConclusionsMid-day sleep significantly decreases average 24h and daytime SBP/DBP in hypertensives. Its effect seems to be as potent as other well-established lifestyle changes and is independent of dipping status.

The effect of Ramadan fasting on ambulatory blood pressure in treated hypertensive patients using diuretics.

The influence of the Ramadan fasting on blood pressure (BP) in patients taking diuretics therapy has not been addressed specifically yet. The aim of this study was to examine the effect of long Ramadan fasting on BP with ambulatory BP monitoring in hypertensive patients using diuretics. This prospective, observational study was done on 129 hypertensive patients and was carried out in two groups: 73 treated hypertensive patients were assigned to the diuretic group and 56 treated hypertensive patients were allocated to the non-diuretic group. Twenty-four-hour ambulatory BP monitoring was performed during and after Ramadan. Mean overall, daytime and nighttime BP were measured and compared in both groups. The differences in mean SBP and DBP were recorded between the two monitoring periods. In diuretic group, 24-h SBP decreased from 128.2 ± 17.9 to 119.3 ± 9.5 mmHg during Ramadan (8.9 units; P < 0.001). DBP decreased from 79.4 ± 10.9 to 75.3 ± 7.6 mmHg (4.1 units; P < 0.001). On the other hand, SBP and DBP were lower insignificantly in the non-diuretic group. The reduction in SBP was significantly higher in the diuretic group (overall: P = 0.005, daytime: P = 0.011, nighttime: P = 0.022). Thiazide-like diuretics lowered BP more than thiazide-type diuretic despite an insignificant difference. This study suggested that Ramadan fasting might cause significant reductions in mean SBP and DBP measurements in patients using diuretics. Despite decreasing in BP, diuretics generally well tolerated and can be safe in well-controlled hypertensive patients during Ramadan fasting.

Left ventricular mass and incident out-of-office hypertension in a general population.

Findings regarding the association of left ventricular mass (LVM) and new-onset hypertension are based on blood pressure measured in the office. We sought to assess the value of LVM in predicting in-office and out-of-office incident hypertension in members of the general population enrolled in the Pressioni Monitorate E Loro Associazioni study. The study included participants with normal office (n = 792), home (n = 714) and 24-h (n = 825) ambulatory blood pressure (ABP) at baseline evaluation who had a readable echocardiogram at entry and at the end of follow-up. Each normotensive group was divided into quartiles of LVM indexed (LVMI) to height. Over a follow-up of 148 months cumulative incidence of new office, home and 24-h ABP hypertension were 35.9, 30.7 and 36.1%, respectively. In fully adjusted models (including age, sex, BMI change during follow-up, baseline serum glucose, creatinine, total cholesterol office, home and 24-h SBP and DBP). higher LVMI values (i.e. the highest vs. the lowest quartile) were independently associated with an increased risk of home [odds ratio (OR) = 2.14, 95% confidence interval (CI) 1.21-3.77, P = 0.008] and 24-h ABP hypertension (OR = 1.70, 95% CI 1.05-2.76, P = 0.03). This was not the case for new-onset office hypertension (OR = 1.61, 95% CI 0.94-2.74, P = 0.07). Our study provides the first evidence that in normotensive individuals the magnitude of LVMI is independently associated with the risk of incident out-of-office hypertension.

Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry.

In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD). In 646 hypertensive patients (mean age 52 ± 16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intima-media thickness (vascular damage, n = 368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, n = 388). Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), P = 0.001] and PP [1.042 (1.015, 1.069), P = 0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), P = 0.070] over brachial PP [1.031 (1.000, 1.062), P = 0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage. In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.

Once versus twice daily antihypertensive medications for the control of nocturnal blood pressure: a comparative study

BackgroundBlood pressure (BP) shows short-term variability within the 24 h, which can only be assessed with 24-h ambulatory blood pressure monitoring (ABPM). It is of utmost importance to control BP throughout the night to reduce incidence of hypertension complications. The purpose of this study is to evaluate the effect of timing and frequency of antihypertensive medications on the average nighttime and 24-h blood pressure control.ResultsThe study enrolled 199 hypertensive patients with controlled office blood pressure; 135 (67.8%) patients were on once daily antihypertensive medication (group 1) while 64 (32.2%) patients were on twice daily doses (group 2). The mean office SBP was 128.7 ± 7.8 mmHg in group 1 vs 129.6 ± 6.6 mmHg in group 2, (p = 0.421). ABPM readings for both groups were as follows: mean daytime SBP was 125.4 ± 11.6 mmHg vs 130.1 ± 12.9, p = 0.011; mean nighttime SBP was 117.0 ± 12.4 mmHg vs 123.1 ± 13.9 mmHg, p = 0.002, and mean 24-h SBP was 122.7 ± 10.6 mmHg vs 127.5 ± 12.0, p = 0.005. The prevalence of non-dipping was 68.9% in group 1 vs 70.3% in group 2 patients, p = 0.8 (the mean dipping ratio was 0.93 ± 0.08 in group 1 vs 0.95 ± 0.07 in group 2, p = 0.198). The prevalence of masked hypertension was higher in group 2 (28.1% vs 43.8%, p = 0.029).ConclusionTaking an extra antihypertensive pill at night did not show a decrease in the nighttime or the average 24H blood pressure in hypertensive patients with controlled office BP. On the contrary, patients who used twice daily antihypertensive medications seem to have higher nighttime and 24-h SBP, although the dipping ratio was comparable in both groups.

The association between 24-h blood pressure patterns and left ventricular mechanics.

We sought to investigate left ventricular (LV) mechanics in the recently diagnosed hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). The current cross-sectional study included 209 hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive two-dimensional echocardiographic examination including multilayer strain analysis. There was no difference in 24-h and daytime BP values between four groups. Night-time BP significantly and gradually increased from extreme dippers, across dippers and nondippers, to reverse dippers. LV global longitudinal and circumferential strains were greater in dippers and extreme dippers than in nondippers and reverse dippers. This was also found for endocardial and epicardial LV longitudinal and circumferential strains. Multivariate logistic regression analysis demonstrated that nondipping and reverse dipping patterns were associated with reduced LV longitudinal strain [odds ratio (OR) 1.71 (95% confidence interval (CI): 1.10-5.61) and OR 2.50 (95% CI: 1.31-6.82), respectively] independently of age, sex, 24-h SBP, LV mass index and E/è. Only the reverse dipping BP pattern was independently of clinical and echocardiographic parameters related with reduced LV circumferential strain [OR 1.90 (95% CI: 1.10-4.80)]. Nondipping and reverse dipping BP patterns had stronger impact on LV mechanics compared with patients with dipping and extreme dipping BP patterns in hypertensive population. LV functional and mechanical remodeling deteriorated from extreme dippers and dippers, to nondippers and reverse dippers.

Do estimated 24-h pulse pressure components affect outcome? The Ohasama study.

Twenty-four-hour ambulatory pulse pressure (PP) is a powerful predictor of outcome. We attempted to apply the recently described PP components, an elastic (elPP), and systolic stiffening (stPP) components from 24-h ambulatory blood pressure (BP) monitoring (AMBP), and examine their influence on outcome in the Ohasama study population. Included were participants of the Ohasama study without history of cardiovascular disease (CVD), who were followed-up for total and CVD mortality, and for stroke morbidity. The PP components were derived from 24-h SBP and DBP using a model based on the nonlinear pressure--volume relationship in arteries expressing pressure stiffness relationship. Outcome predictive power was estimated by Cox regression models; hazard ratio with 95% confidence interval (CI), applied to elPP, and stPP, adjusted for age, sex, BMI, smoking, alcohol drinking, diabetes mellitus, total cholesterol, antihypertensive treatment, and mean arterial pressure (MAP), whenever appropriate. Of 1745 participants (age 61.4 ± 11.6, 65% women), 580 died, 212 of CVD, and 290 experienced a stroke during 17 follow-up years. PP was strongly correlated with elPP (r = 0.89) and less so with stPP (r = 0.58), and the correlation between the two components was weak (r = 0.15). After the adjustment, hazard ratio of PP per 1 SD increment for total mortality, CVD mortality, and stroke morbidity were 1.095 (95% CI 0.973-1.232), 1.207 (1.000-1.456), and 0.983 (0.829-1.166), respectively. Corresponding hazard ratios and 95% CIs were nonsignificant for elPP, and stPP. However, among participants with median pulse rate 68.5 bpm or less (median, n = 872), total (327 deaths) and CVD (131 deaths) mortality were predicted by elPP (per 1 SD increment), hazard ratio 1.231 (95% CI, 1.082-1.401), and 1.294 (95% CI, 1.069-1.566), respectively. In the subgroup of treated participants with hypertension and pulse rate 68.5 or less bpm (n = 309), total (177 deaths) and CVD (77 deaths) mortality were predicted by elPP, hazard ratio of 1.357 (95% CI, 1.131-1.628), and 1.417 (95% CI, 1.092-1.839), respectively. Stroke morbidity was not predicted by either PP or the PP components. In a rural Japanese population, elPP but not stPP was predictive of total and CVD mortality even when adjusted for MAP and conventional risk factors in the subpopulation with slower pulse rate. This was mostly among the treated hypertensive patients.

Abstract P129: White Coat Effect Causes Excessive Antihypertensive Treatment in Low Risk Patients

Office recording blood pressure (BP) gives at best a rough estimate of a person’s usual BP, and it is controversial that a few office BP determinations govern the diagnosis and treatment guidelines for hypertension. In this context it acquires importance the white coat effect (WCE), which is a significant fall in ambulatory BP compared with that measured in a clinical setting.Despite the introduction of ambulatory pressure, specially 24h BP monitoring (ABPM) has had a great impact on both the decision to treat or not a patient (P) with hypertension, it has not been considered either in fundamental studies such as the Sprint or in the diagnostic and treatment recent guidelines for hypertension.In our country, primary care physicians have taken new objectives of BP treatment very seriously based only on their office records.Hypertensive P with visión déficits, from the neuroophthalmology section of our hospital, are periodically referred to our Laboratory for screening of hypertension and vascular complications. In the last two years 62 P were evaluated.In low risk (LR) P, who do not have hypertensive target organ damage or chronic symptoms, we observed a temporal relationship between ocular symptoms and the start or increase of antihypertensive treatment So we decide to carry out a preliminary prospective study including LR hypertensive P between Sep 2017 to Mar 2019. P older than 80 and those who had secondary hypertension were excluded. All were studied with ABPM to compare ambulatory and office BP values, day and night time BP.BP was recorded when they were derived and in a subsequent visit a week later where the ambulatory monitor pressure was also placed.The results showed in LR group significantly higher office systolic (S) BP values (143±11 mm Hg) compared with ambulatory BP: 24h SBP 117±8 mm Hg (p&lt;0.01), daytime SBP 120±9 mm Hg (p&lt;0.01) and nigthtime SBP 94±8 mm Hg (p&lt;0.01), and we observed WCE in 18 of 30 P (56%). Under estimating or not detecting WCE can lead to excessive antihypertensive treatment and cause ocular and other tissues hypoflux. Conclusions: In low risk P office BP values should be corroborated with ambulatory BP values, either systematic ambulatory monitoring or with 24 h ABPM before starting or before increasing the antihypertensive treatment.

Prolonged Heightened Blood Pressure Following Mechanical Thrombectomy for Acute Stroke is Associated with Worse Outcomes.

Most data evaluating the relationship of post-mechanical thrombectomy (MT) blood pressure (BP) management and outcomes of patients with large vessel occlusion (LVO) focus on early BP control within the first 24h. We investigated the correlation of daily BP trends up to the third day following MT with patient outcomes. We retrospectively reviewed our prospectively maintained database for LVO patients treated with MT from February 2015 to December 2017. Recorded BP values for 72h post-reperfusion were reviewed. Daily peak systolic and diastolic blood pressures (SBP, DBP) were extracted for each day post-procedure. The association and importance between BP increments of 10mmHg and mortality, hemorrhage, and functional independence (FI = mRS ≤ 2) was analyzed in a multivariable logistic regression and random forest (RF) analyses modeling. A total of 212 thrombectomies were included. An increase in peak 24-h SBP was independently associated with higher likelihood of symptomatic hemorrhage (OR 1.2, p = 0.048) and decreased functional independence (OR 0.85, p = 0.03). Higher day 2 and day 3 peak SBP was strongly correlated with decreased functional independence and higher mortality. Third day SBP < 140 was independently associated with higher likelihood of functional independence (OR 4.3, p = 0.0004). Post-MT patients with and without functional independence demonstrated a similar relative decrease in peak SBP between the first 2days following thrombectomy (p = 0.26); however, those without functional independence experienced a significant rebound increase in peak SBP on the third day following MT (mean change from day 2 to 3: FI - 3.5mmHg, non-FI + 3.9mmHg; p = 0.005). High daily maximum SBP and a rebound SBP on the third day following MT is independently associated with increased likelihood of functional dependence.

Effect of continuous positive airway pressure in patients with true refractory hypertension and sleep apnea: a post-hoc intention-to-treat analysis of the HIPARCO randomized clinical trial.

Continuous positive airway pressure (CPAP) can significantly reduce blood pressure (BP) levels in patients with resistant hypertension and sleep apnea (OSA); however, the effect on patients with refractory hypertension (RfH) is not known. This study seeks to evaluate the effect of CPAP treatment on BP levels in patients with OSA and RfH, compared with those with OSA and resistant hypertension. Post-hoc analysis of the HIPARCO randomized clinical trial on the effect of CPAP treatment on BP levels in patients with resistant hypertension. Those patients with uncontrolled 24-h ambulatory BP monitoring readings (>130 and/or >80 mmHg) in SBP or DBP were considered to have resistant hypertension (if they were taking three or four antihypertensive drugs) or RfH (if they were taking at least five drugs). OSA patients were randomized to receive CPAP or usual care for 3 months. They underwent a second 24-h ambulatory BP monitoring study to establish the effect of CPAP treatment on BP levels in both groups. A total of 98 patients were randomized to CPAP (19 RfH/79 resistant hypertension) and 96 to usual care (21 RfH/75 resistant hypertension). BP readings dropped more marked in patients with RfH than resistant hypertension, in both 24-h SBP (-9 vs. -1.6 mmHg, P = 0.021) and 24-h DBP (-7.3 vs. -2.3 mmHg, P = 0.074), especially at night (-11.3 vs. -3.8, P = 0.121 and -8.8 vs. -2.2, P = 0.054) respectively. Adjusted difference between groups was statistically significant in 24-h SBP levels (-7.4 mmHg, P = 0.021). CPAP lowers BP levels in both resistant hypertension and RfH patients although the degree of this reduction is higher in those with RfH especially during the night.

Limited contribution of insulin resistance and metabolic parameters to obesity-associated increases in ambulatory blood pressure in a black African community

Although accounting for a striking proportion of obesity effects on blood pressure (BP) in other populations, the extent to which obesity-associated increases in BP are explained by insulin resistance and metabolic changes in populations of African ancestry is uncertain. We determined the contribution of insulin resistance and associated metabolic abnormalities to variations in office or ambulatory BP in a black African community with prevalent obesity and hypertension. In 1225 randomly selected participants of black South African ancestry (age>16years, 43.1% obese, 47.4% abdominal obesity), we assessed adiposity indexes, the homeostasis model of insulin resistance (HOMA-IR) and associated metabolic abnormalities and office or ambulatory (n ​= ​798) BP. In separate models, waist circumference (p ​< ​0.0005-<0.0001) and HOMA-IR (p ​< ​0.51–0.005), were independently associated with office, 24 ​h, day or night systolic (SBP) or diastolic (DBP) BP. However, whilst a one standard deviation increase in waist circumference translated into a 1.47–3.08 ​mm Hg increased in office, 24-h SBP or DBP, in mediation analysis HOMA-IR accounted for only 0.12–0.30 ​mm Hg of the impact of a one standard deviation effect of waist circumference on office, and 24-h SBP and 0.003–0.17 ​mm Hg of the impact of a one standard deviation effect of waist circumference on office and 24-h DBP. In conclusion, in a black African community, insulin resistance accounts for a negligible proportion of the impact of obesity on office or ambulatory BP.

Regression to the mean of repeated ambulatory blood pressure monitoring in five studies.

To estimate the size of regression to the mean with ambulatory blood pressure (ABP) measurement. Participants from five studies who had repeated blood pressure (BP) measurements using office and ambulatory devices were included. Regression to the mean was calculated following participants being grouped by baseline BP categories. Regression dilution ratio was calculated for groups defined by each baseline BP variable. High baseline ABP readings were substantially lower on long-term follow-up, and low baseline readings tended to be higher. Regression to the mean was observed for all ABP parameters; for systolic and diastolic measures; and for intervention and control groups. For example, among those with baseline 24-h SBP of at least 150 mmHg, mean baseline and follow-up BP was 156 and 141 mmHg, respectively; whereas those with baseline 24-h SBP of less than 120 mmHg, mean baseline and follow-up BP was 113 and 119 mmHg, respectively. Regression to the mean was the greatest for night-time ABP. Regression dilution ratios calculated from control groups were 0.52, 0.53, 0.38 and 0.60 for 24-h, daytime, night-time and office SBP, respectively. Similar results were seen for diastolic measures. ABP is subject to considerable regression to the mean, which has implications for diagnosis and practise; for example, after initiating treatment for hypertension some of the fall in ABP will be because of regression to the mean. Furthermore, associations of ABP with cardiovascular disease will be substantially underestimated if analyses are not adjusted for regression to the mean, especially for night-time ABP. Replication studies are needed to confirm these findings.

Hemodynamic effects of the dipeptidyl peptidase-4 inhibitor linagliptin with renin-angiotensin system inhibitors in type 2 diabetic patients with albuminuria.

Objective:Concomitant treatment with angiotensin-converting enzyme (ACE) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors is increasingly common. Pharmacological studies have suggested a potential adverse drug interaction between ACE inhibitors and DPP-4 inhibitors resulting in unfavorable hemodynamic changes; very few studies have examined such an interaction between angiotensin II receptor blockers (ARBs) and DPP-4 inhibitors. We investigated blood pressure (BP) and heart rate (HR) during treatment with the DPP-4 inhibitor linagliptin in individuals receiving either ACE inhibitors or ARBs in the MARLINA-T2D trial.Methods:In this study, 360 individuals with type 2 diabetes and albuminuria receiving unchanged doses of ACE inhibitors or ARBs were randomized to linagliptin or placebo. Twenty-four-hour ambulatory BP monitoring, an exploratory endpoint, was conducted at baseline and after 24 weeks.Results:Ambulatory BP monitoring data were available for 208 individuals (linagliptin: n = 111; placebo: n = 97). Baseline mean ± SD 24-h SBP and DBP were 132.5 ± 12.4 mmHg and 75.9 ± 9.4 mmHg, respectively; mean 24-h HR was 76.3 ± 10.1 bpm. At week 24, no overall effect of the DPP-4 inhibitor versus placebo was seen on mean 24-h SBP, DBP, or HR. Furthermore, in the subgroups receiving either an ACE inhibitor or an ARB, no effect on these hemodynamic parameters was seen as a result of concomitant DPP-4 inhibitor treatment.Conclusion:Adding linagliptin to treatment with ACE inhibitors or ARBs was not associated with any hemodynamic changes, supporting their concomitant use in individuals with type 2 diabetes and albuminuria.

Circadian hemodynamic characteristics in hypertensive patients with primary aldosteronism.

The present study aimed to compare circadian hemodynamic characteristics in hypertensive patients with and without primary aldosteronism. Circadian hemodynamics, including 24-h brachial and central blood pressure (BP), SBP variability indices, central pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 60 patients with primary aldosteronism (63.4±13.3 years, 47% women) and 120 age-matched and sex-matched patients with essential hypertension. Office SBP, PWV, AIx@75, and BP variability indices were similar between groups; however, 24-h brachial (124 ± 14 vs 130 ± 11 mmHg) as well as central (112 ± 12 vs 120 ± 10 mmHg) SBP was higher (both P < 0.01), and the difference between 24-h brachial and central SBP (11 ± 5 vs 9 ± 3 mmHg, P < 0.05), an index of pressure amplification, was smaller in primary aldosteronism than in essential hypertension. In both groups, cardiac index decreased from daytime to night-time (both P < 0.01), but this decrease was smaller in primary aldosteronism (P < 0.05). During daytime, TVR in primary aldosteronism was higher than that in essential hypertension (P < 0.05), and the significant increase of TVR from daytime to night-time was lost in primary aldosteronism. In a multivariate stepwise regression model, primary aldosteronism emerged as an independent predictor of 24-h central SBP as well as the difference between 24-h brachial and central SBP. Our results demonstrated that circadian hemodynamics in primary aldosteronism patients are characterized by increased central SBP, smaller disparity between brachial and central SBP, and disturbed circadian hemodynamic variation.

A3993 Myocardial flow reserve assessed by Cardiac 82Rb PET/CT is associated with albumin excretion in patients with type 1 diabetes

Objectives: To evaluate 1) myocardial flow reserve (MFR) and coronary artery calcium (CAC) in patients with type 1 diabetes (T1D) with or without albuminuria and in non-diabetic controls; 2) MFR and CAC in patients with T1D and retinopathy. MFR reflects the function of large epicardial arteries and myocardial microcirculation. CAC represents structural aspects of atherosclerosis. Methods: Cross-sectional study in T1D, stratified by normo- (n = 30) and macroalbuminuria (n = 30), and 30 controls. MFR and CAC was evaluated by cardiac 82Rb PET/CT. Results: MFR was similar in normoalbuminurics and controls (3.1 ± 0.8 vs 3.0 ± 0.79; p = 0.74). Macroalbuminurics had lower MFR compared to normoalbuminurics (2.1 ± 0.9 vs 3.1 ± 0.8; p < 0.0001). CAC score (median[IQR]) was higher in normoalbuminurics compared to controls (72[22–247] vs 0[0–81], p = 0.018), and comparable between macro- and normoalbuminurics. MFR was comparable in T1D with simplex retinopathy (n = 24) compared to no retinopathy (n = 12; p = 0.11), but lower in proliferative (n = 23) compared to simplex retinopathy (p = 0.02). CAC score was comparable between groups of retinopathy. Lower MFR was associated with higher CAC, UACR, age, 24-h SBP and lower eGFR. In multivariate regression lower MFR was associated with higher UACR and age, lower eGFR and smoking (R2 = 0.39). Higher CAC was associated with lower MFR, higher age and 24-h SBP (R2 = 0.34). Conclusion: Myocardial microvascular function was comparable in controls and patients with T1D and normoalbuminuria; but impaired in the presence of macroalbuminuria and/or proliferative retinopathy. Coronary calcification was also high, but not explained by albuminuria. This signifies that functional aspects of atherosclerosis correlate to albuminuria and retinopathy to larger extent than the structural.

A14860 Differential Effects of Aliskiren/Amlodipine Combination and High-dose Amlodipine Monotherapy on Ambulatory Blood Pressure and Target Organ Protection in Hypertensives and its Inadequate Blood Pressure Response in those who with Diabetes

Objectives: The first aim was to compare an aliskiren/amlodipine (ALI/AML) combination with high-dose amlodipine monotherapy on ambulatory blood pressure (ABP) reduction and target organ protection. The second aim was to compare the BP lowering effect of antihypertensive medication on ABP and clinic BP (CBP) between diabetes mellitus (DM) and non-DM patients. Methods: We performed a prospective, randomized, open-label trial in essential hypertensives: 105 patients (mean age: 77.1; male: 41.0%) with CBP over 140/90 mmHg with AML 5 mg were randomly allocated to ALI (150–300 mg) /AML (5 mg) (ALI/AML, n = 53) or high-dose amlodipine (10 mg) (h-dAML, n = 52), and were treated for 16 wks. To the next, we performed a subanalysis, dividing the 86 patients who completed the treatment period into the Non-DM (n = 75) and DM (n = 11), and compared reductions on ABP and CBP. Results: The ALI/AML and h-dAML group showed similarly reduced 24-h SBP, daytime SBP, nighttime SBP, and brachial-ankle pulse wave velocity. The urine albumin-to-creatinine ratio reduction was significantly greater in the ALI/AML (p = 0.02). However, ALI/AML was significantly less effective in reducing early-morning BP (4.0 ± 21.2 vs. − 10.8 ± 22.1 mmHg, p = 0.002) and morning BP surge (10.0 ± 23.2 vs. − 5.4 ± 20.3 mmHg, p = 0.001) compared to h-dAML. The Non-DM and DM group's CBP reduction was similar. However, 24-h SBP reduction (p = 0.01) and daytime SBP reduction (p = 0.01) were significantly smaller in DM compared to Non-DM patients. Conclusion: ALI/AML provided better renal protection than h-dAML. Although ALI/AML and h-dAML showed almost equal reduction on ABP, ALI/AML was significantly less effective in reducing early-morning BP and morning BP surge compared to h-dAML. The ABP reduction was weakened in DM patients.