24-hour Ambulatory Blood Pressure Measurements Research Articles

How Does Occupational Lifting Affect Ambulatory Blood Pressure, Relative Aerobic Workload and Level of Physical Activity?

Occupational physical activity (OPA), including occupational lifting (OL), seems to increase the risk of cardiovascular disease (CVD). Knowledge about the association between OL and risk of CVD is sparse, but repeated OL is assumed to result in prolonged raised blood pressure and heart rate (HR) eventually augmenting the risk of CVD. To disentangle parts of the mechanisms behind the raised 24-hour ambulatory blood pressure measurement (24h-ABPM), by exposure to OL, this study aimed to explore the acute differences in 24h-ABPM, relative aerobic workload (RAW) and OPA across workdays with and without OL, and secondary to assess the feasibility and rater agreement of direct field observations of the frequency and load of occupational lifting. This controlled cross-over study investigates associations between moderate to high OL and 24h-ABPM, RAW in per cent of heart rate reserve (%HRR) and level of OPA. This included 2x24h monitoring of 24h-ABPM (Spacelabs 90217), PA (Axivity) and HR (Actiheart), comprising a workday containing OL and a workday without. The frequency and burden of OL were directly observed in field. The data were time synchronized and processed in the Acti4 software. Differences across workdays with and without OL in 24h-ABPM, RAW and OPA were evaluated using repeated 2 × 2 mixed-models among 60 blue-collar workers in Denmark.. Exposure to OL was estimated by direct manual field observation, registering burden and frequency of OL. Interrater reliability tests were performed across 15 participants representing 7 occupational groups. Interclass correlation coefficient (ICC) estimates of total burden lifted and frequency of lifts were calculated, based on a mean-rating (k = 2), absolute-agreement, 2 way mixed-effects model, indicating the raters as fixed effects. OL led to non-significant increases in ABPM during work-time (systolic Δ1.79 mmHg, 95%CI -4.49-8.08, diastolic Δ0.43 mmHg, 95%CI -0.80-1.65), and on 24-hours basis (systolic Δ1.96 mmHg, 95%CI -3.80-7.72, diastolic Δ0.53 mmHg, 95%CI -3.12-4.18), significant increases in RAW during work (Δ7.74 %HRR, 95%CI 3.57-11.91) as well as a raised level of OPA (Δ4156.88 steps, 95%CI 1898.83-6414.93, Δ-0.67 hours of sitting time, 95%CI -1.25-0.10, Δ-0.52 hours of standing time, 95%CI -1.03-0.01, Δ0.48 hours of walking time, 95%CI 0.18-0.78). ICC estimates were 0.998 (95% CI 0.995-0.999) for total burden lifted and 0.992 (95% CI 0.975-0.997) for frequency of lift. OL increased both intensity and volume of OPA among blue-collar workers, which supposedly to contributes to an augmented risk of CVD. Although this study finds hazardous acute effects, further investigations are needed to evaluate the long-term effects of OL on ABPM, HR and volume of OPA, also effects of cumulative exposure to OL would be relevant to investigate. OL significantly raised the intensity and volume of OPA. Direct field observation of occupational lifting showed an excellent interrater reliability.

PS-C11-6: SIMULTANEOUS MEASUREMENT OF 24-HOUR AMBULATORY BLOOD PRESSURE IN BOTH ARMS REVEALS CLINICALLY RELEVANT DIFFERENCES: A WAKEUP-CALL FOR HYPERTENSION MANAGEMENT

Objective: Cuff-based 24-hour ambulatory blood pressure measurement is the gold standard for hypertension diagnosis and treatment monitoring. The clinical value of ambulatory blood pressure (BP) measurement is ubiquitously accepted. This study wants to quantify the measurement discrepancies in simultaneous and synchronized 24-hour ambulatory BP measurements on both arms. Identifying and understanding measurement uncertainties could improve future hypertension management and originate true confidence in alternative, cuff-less systems with equal measurement precision. Methods: We conducted simultaneous 24-hour ambulatory blood pressure measurements on both arms in 52 healthy young adults. The broadly used and validated cuff-devices (BoSo TM-2430) were synchronized to start BP measurement within one second of each other. Further, we recorded, cuff-pressures of both cuff-based devices and the hydrostatic pressure differences between both cuffs. We then scored pressure curves for disturbances (e.g., pressure spikes during deflation) and were able to correct measurements for hydrostatic differences between the arms. This enabled us to not only quantify the extent of measurement uncertainty but to describe its origins and possible countermeasures. Results: Measured BP levels from left and right arm showed limits of agreement in the Bland Altman Plot of > 33 mmHg for systolic and > 30 mmHg for diastolic values over 24 h. Daytime values deviated more than nocturnal values (systolic: > 35 mmHg vs. > 27 mmHg systolic, and diastolic: > 32 mmHg vs. > 24 mmHg). Linear regression retrieved R2 = 0.39 (p < 0.001) for systolic and R2 = 0.20 (p < 0.001) for diastolic values. Exclusion of disturbed cuff pressure curves improved limits of agreement to > 23 mmHg for systolic and > 19mmHg for diastolic measurements. Subsequently, it improved correlation coefficients to R2 = 0.54 (p < 0.001) for systolic and R2 = 0.35 (p < 0.001) for diastolic values. Correction of hydrostatic differences between the arms had an negligible effect on limits of agreement and strength of correlation. Conclusion: Comparison of synchronized 24-hour BP measurements on both arms showed large measurement uncertainties with possible implications on clinical grading of hypertension and dipping pattern. Exclusion of disturbed cuff pressure curves, not detected by the conventional software of BP devices, mitigates the effect but still results in worrying discrepancies. These results are an imperative to further investigate the clinical implications of BP measurement uncertainty. It further inspires the courageous exploration of alternative means of BP measurement which might offer comparable measurement certainty.

S-52-5: MEASURING DRUG LEVELS USING A DRIED BLOOD SPOT COMBINED WITH PERSONALIZED FEEDBACK TO IMPROVE RESISTANT HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL

Introduction: Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this therapeutic drug monitoring is the most reliable method. Objectives: The primary objective of this study is to determine whether drug levels measured with a dried blood spot (DBS) method combined with personalized feedback leads to a decrease in prevalence of RH after 12 months due to an increase in adherence. Design and method: This is a multi-center single-blinded randomized controlled trial (RHYME-RCT, NL6736). Eligible patients based on previous blood pressure readings underwent DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg were randomized to a standard treatment (control) arm or intervention arm. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 (T = 12) months inclusion. At each visit an 24h-ABPM and DBS were performed. Results: A total of 141 patients were measured at baseline, of which 100 patients had blood pressures > 135/85 mmHg and were randomized to the intervention (n = 49) or control arm (n = 51). The adherence rate in the excluded population (n = 41) was 78.0%. The randomized patients had a mean age of 59.4 ± 11 years and were predominantly male (70.0%). The prevalence of RH decreased from 100% in both arms to 73.2% at T = 12 in the intervention arm (p = 0.002, n = 37) and 59.1% at T = 12 in the control arm (p < 0.001, n = 41). Adherence rates improved from 67.3% to 92.1% in the intervention arm (p = 0.021) and 68.6% to 71.4% in the control arm (p = 1.000). This increase in adherence was significantly higher in the intervention arm compared to the control arm (p = 0.018). No statistically significant difference was found after 12 months between the two arms in the degree of RH (p = 0.171), SBP (p = 0.297) or DBP (p = 0.655). Conclusions: Measuring blood pressure and drug levels led to a decrease in the prevalence of RH in both arms and improved non-adherence in the intervention arm. However, the improvements in adherence did not lead to a lower blood pressure and degree of having RH. The fact that one third was excluded at baseline because of normotension suggests that participation in a study already leads to improvement of adherence and thus blood pressure control.

PS-C35-4: ASSOCIATION OF SODIUM INTAKE WITH ADVERSE LEFT ATRIAL FUNCTION AND LEFT ATRIOVENTRICULAR COUPLING

Objective: In this study, we investigated the relationship between 24-hour urinary sodium (a surrogate for estimating dietary sodium intake), ambulatory blood pressure parameters, cardiac MRI-assessed left atrial function and left atrioventricular coupling, as well as the influence of nighttime blood pressure and body mass index(BMI) on 24-hour urinary sodium and subclinical cardiac function. Design and method: Participants in our study included 398 individuals, all of whom were subjected to 24-hour urine collection, 24-hour ambulatory blood pressure measurement, and cardiac magnetic resonance imaging to determine left atrial function (myocardial strain) as well as left atrioventricular coupling index. LACI is defined as the ratio of left atrial end-diastolic volume divided by left ventricular end-diastolic volume. Our study evaluated the relationship between 24-hour urinary sodium and ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling index, and used mediation analysis to explain the indirect effects of nighttime blood pressure and BMI between 24-hour urinary sodium and left atrial function and left atrioventricular coupling index. Results: It was found that the average age of the participants was 55.70 ± 11.30 years old, with 58% of the participants being male and 47.5% experiencing hypertension. The mean urinary sodium value was 172.01 ± 80.24mmol/24 hours, and the average body mass index was 25.46 ± 3.78 kg/m2. After adjusting for age, gender, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-hour urinary sodium was correlated with multiple ambulatory blood pressure parameters, especially with nighttime diastolic blood pressure. Left atrial structure and function (left atrial reservoir function and left atrial conduit function) and left atrioventricular coupling index were correlated (P < 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-hour urinary sodium and left atrial function (left atrial reservoir function and left atrial conduit function), and 30% of the indirect effect of LACI. Independent of the mediator, 24-hour urinary sodium had a significant direct effect on left atrial reservoir function, left atrial conduit function, and left atrioventricular coupling. Conclusions: Higher 24-hour 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-hour urinary sodium and subclinical left cardiac function, and, more importantly, 24-hour urinary sodium may directly affect the left atrial function and left atrioventricular coupling independent of intermediary factors.

Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis

IntroductionPatients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT)...

JS-HR-10: ADVANCES IN RENAL DENERVATION FOR TREATING HYPERTENSION

Excessive activation of sympathetic nervous system is closely related to the onset and progression of hypertension. Renal nerves are composed of sympathetic efferent and sensory afferent nerves. Activation of the efferent renal sympathetic nerves induces renin secretion, sodium absorption, and increased renal vascular resistance, which lead to increased blood pressure (BP) and fluid retention. Afferent renal sensory nerves, which are densely innervated in the renal pelvic wall, project to the cardiovascular center in the brain to modulate sympathetic outflow to the periphery, including the heart, kidneys, and arterioles. Renal denervation (RDN) is a neuromodulation therapy that partially interrupts both the efferent outputs from the brain to the kidney and the afferent inputs from the kidney to the brain and has attracted attention as a novel device therapy for hypertension. In clinical practice, denervation is performed through the lumen of the renal artery using a catheter. Radiofrequency, ultrasound, and alcohol-based RDN devices are being developed as new second-generation devices. A randomized sham-controlled trials using 24-hour ambulatory BP measurement is required for approval of clinical use of RDN. The SPYRAL HTN OFF-MED pivotal trial showed the superiority of RDN using radiofrequency-based catheter compared with a sham procedure to safely lower 24-hour systolic BP in the absence of antihypertensive medications. The RADIANCE-HTN TRIO trials showed the superiority of RDN using ultrasound-based catheter compared with a sham procedure to safely lower daytime BP in patients with resistant hypertension. The REQUIRE trial is the first trial of ultrasound RDN in Asian patients from Japan and South Korea with resistant hypertension. The study findings were neutral for the primary endpoint, with similar reductions in 24-hour systolic BP in the RDN and sham control groups. Although BP reduction after RDN was similar to other sham-controlled studies, the sham group in this study showed much greater reduction. Japanese Society of Hypertension performed the meta-analysis of nine randomized sham-controlled trials of RDN including these three trials mentioned above. The results showed that RDN significantly reduced a range of office, home and 24-hour BP parameters in patients with resistant, uncontrolled, and drug-naïve hypertension. There were no significant differences in magnitude of BP reduction between radiofrequency-based and ultrasound-based devices. Recently, the efficacy and safety of RDN in the SPYRAL HTN OFF-MED pivotal trial up to 36 months have been reported. In this session, the latest basic and clinical evidence/aspects of RDN will be summarized and discussed, which is about to be introduced into the clinical practice.

Hipertensión nocturna aislada en individuos con el virus de la inmunodeficiencia humana

IntroductionIsolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. MethodologyA retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. ResultsOne hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV.There were no adjusted risk differences between the different categories of office normotensives. ConclusionsIsolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension.

Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes

AimsPeople with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes. MethodsFrom 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions. ResultsParticipants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24–44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09–4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23–3.00), p = 0.004). ConclusionsNon-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.

THE PREVALENCE OF WHITE-COAT EFFECT AND REVERSE WHITE-COAT EFFECT IN TREATED HYPERTENSIVE PATIENTS

Objective: In hypertensive population are patients whose office blood pressure measurements differ from those in 24-hour ambulatory blood pressure measurements. They are patients with the white-coat effect (office blood pressure is higher than office measurements) and with the reverse white-coat effect (ambulatory measurements are higher than office blood pressure measurements). The cardiovascular risk and the prevalence of organ damages in both phenomena are unclear. There are studies showing that these phenomena could be clinically significant. The aim of the study was to assess the prevalence of white-coat effect and reverse white-coat effect in treated hypertensive patients, depending on gender and age. Design and method: The office and 24-hour ambulatory blood pressure measurements data were collected from 1465 hypertensive patients (771 men) with mean age 55.9 ± 15.2. The reverse white-coat effect was defined as: office systolic blood pressure – daytime systolic blood pressure mean &lt; -10 mmHg. The white-coat effect was defined as: office systolic blood pressure – daytime systolic blood pressure mean &gt; = 20 mmHg and/or office diastolic blood pressure – daytime diastolic blood pressure mean &gt; = 10 mmHg. Patient data were sorted in accordance with gender and divided into age decades every 10 years. Statistica software (StatSoft) and Microsoft Excel were used to calculate phenomena prevalence. Results: 300 (20.5%) patients met the reverse and 286 (19.5%) white-coat effect criteria. The prevalence of both phenomena was similar in the treated hypertensive population. The white-coat effect was more common in older patients, with the highest prevalence in the 65–74 age decade (26.3%). The reverse white-coat effect referred to younger patients - predominating was 25–34 age decade (31.9%). Depending on gender, the white-coat effect was dominant among women aged 75–84 (27.4%) and among men aged 65–74 (27.1%). The reverse white-coat effect was dominant among women and men aged 25–44 (appropriate 43.5% and 26.1%). Conclusions: The reverse white-coat effect occurs the most often in women and men in the 25–34 age decade. The white-coat effect is the most common among women in 75–84 and among men in the 65–74 age decade.

RESISTANT HYPERTENSION IMPROVED AFTER 3 AND 6 MONTHS BY MEASURING DRUG LEVELS TO IDENTIFY NON-ADHERENCE

Objective: Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this measuring drug levels is the most reliable method. The primary objective of this analysis is to determine whether drug levels measured with a dried blood spot (DBS) sampling method combined with personalized feedback leads to a decrease in prevalence of RH after 3 and 6 months due to an increase in adherence. Design and method: This is a multi-center single-blinded randomized controlled trial (RHYME-RCT, NL6736). Patients went to an eligibility visit, where DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) was performed simultaneously. Patients with a daytime systolic blood pressure (SBP) &gt; 135 and/or diastolic blood pressure (DBP) &gt; 85 mmHg were randomized to standard treatment (control) or intervention. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 months after the eligibility visit. At each visit an ABPM and DBS were performed. Results: A total of 78 patients (mean age of 59 ± 11 years, 75.6% male) with at least six months of follow-up were included. The prevalence of RH decreased from 100% in both arms to 60.0% in the intervention arm (p &lt; 0.001, n = 35) and 58.1% in the control arm (p &lt; 0.001, n = 43) after 6 months of follow-up. Adherence rates also improved over time, but only significantly improved in the intervention group after 3 months (p = 0.020). Furthermore, no statistically significant differences were found after six months between the two groups in the degree of RH (p = 0.868), SBP (p = 0.759) or adherence (p = 0.841). Conclusions: Measuring blood pressure and drug levels led to a decrease in the prevalence of RH. However, this improvement could not be linked to the actual intervention or improvement of adherence. Note: In June 2022 data from the 12 months follow-up will also be complete and presented.

Short-term Effects of Losartan on Cardiovascular Risk and Allograft Injury Biomarkers in Kidney Transplant Recipients

There is a controversy over the renoprotective and cardioprotective effects of renin-angiotensin-aldosterone system blockade in kidney transplant recipients (KTRs). The aim of the study was to evaluate the short-term effects of losartan on allograft injury, cardiovascular risk biomarkers and safety of the treatment in KTRs. An interim analysis of a prospective, open, multicenter, controlled clinical trial CELART (Cardiovascular Effects of Losartan After Renal Transplantation) was performed. KTRs were allocated to losartan (L) 50 to 100 mg or standard hypotensive treatment (ST) group to reach target blood pressure (BP) <140/90 mm Hg. The short-term effects of the therapy were evaluated after 6 months: estimated glomerular filtration rate (eGFR), albuminuria, the intrarenal fibrosis biomarkers: urine excretion of transforming growth factor β-1 (TGFβ-1) and procollagen type III amino terminal propeptide (PIIINP), cardiac biomarker: serum concentration of N-terminal-pro-B-type natriuretic peptide (NT-proBNP), 24-hour ambulatory BP measurement, and hemoglobin and potassium concentrations. At baseline the groups did not differ with respect to age, primary nephropathy, comorbidity, immunosuppressive therapy, albuminuria, and graft function. A total of 61 (L group) and 73 (ST group) patients reached the target BP and completed protocol at 6 months. After 6 months of therapy there were no significant differences in changes of eGFR, albuminuria, hemoglobin and potassium concentrations, urine excretion of PIIINP, and TGFβ-1 between groups. There was a trend in the L group to decrease the concentration of serum NT-proBNP. Losartan shows minimal adverse effects and no influence on graft function and biomarkers of graft fibrosis. It may have a positive effect on cardiovascular risk in KTRs. Further interim analyses of the CELART study will be conducted.

Associations between toxic elements and blood pressure parameters in adolescents

BackgroundBoth exposure to toxic elements and hypertension (HT) are a global health problem. We planned to examine the associations between some toxic elements in urine, and blood pressure (BP) and its diurnal changes in adolescents. MethodsIn this cross-sectional study, 48 adolescents who were newly diagnosed with HT and 38 adolescents with age-appropriate BP and normal physical examination were included. Anthropometric measurements, urinary toxic elements, carotid intima media thickness (cIMT), and office and 24-hour ambulatory BP measurements (ABPM) of participants were taken. Urinary elements levels were studied with ICP-MS. Elements were grouped in tertiles according to urinary levels. Logistic regression analyses were performed to show the interactions. ResultsUrinary cadmium, mercury, lead, and arsenic were found to be at detectable level in 90.7%, 69.8%, 91.9% and 100% of the participants, respectively. Univariate analyses showed that elevated daytime systolic and/or diastolic BP was associated with urinary cadmium and mercury. No association between urinary toxic elements and nighttime BP was found. When height and body mass index z-scores adjusted for, age, gender, and all four urinary creatinine-corrected toxic elements analyzed, multiple logistic regression revealed that there was an association between mercury (high vs. low; AOR:3.85) and office HT, and mercury (high vs. low; AOR:6.18) and cadmium (middle vs. low; AOR: 13.38) were associated with “elevated 24-hour systolic BP and/or diastolic BP”, and “elevated 24-hour mean arterial BP” in ABPM. ConclusionThere are complex relationships between toxic elements and BP parameters in adolescents, and more studies are needed to define the evolution of these relations.

Comparison of automated office blood pressure measurement with 24-hour ambulatory blood pressure measurement

Purpose Although 24-hour ambulatory blood pressure measurement (24-h ABPM) is the most important method to establish true hypertension, in clinical practice often repeated automated office blood pressure (AOBP) measurements are used because of convenience and lower costs. We aimed to assess the agreement rate between a 30 and 60 min AOBP and 24-h ABPM. Materials and methods Patients with known hypertension (cohort 1) and patients visiting the neurology outpatient clinic after minor stroke or transient ischaemic attack (cohort 2) were selected. We performed AOBP for 30–60 min at 5-min intervals followed by 24-h ABPM and calculated average values of both measurements. Agreement between the two methods was studied with McNemar and Bland–Altman plots with a clinically relevant limit of agreement of ≤10 mm Hg difference in systolic BP. Results Our final cohort consisted of 135 patients from cohort 1 and 72 patients from cohort 2. We found relatively low agreement based on the clinical relevant cut-off value; 64.7% of the measurements were within the limits of agreement for 24-h systolic and 50.2% for 24-h diastolic. This was 61.4% for daytime systolic and 56.6% for daytime diastolic. In 73.5% of the patients, both methods led to the same diagnosis of either being hypertensive or non-hypertensive. This resulted in a significant difference between the methods to determine the diagnosis of hypertension (p < 0.0001). Conclusion We conclude that 30–60 min AOBP measurements cannot replace a 24-h ABPM and propose to perform 24-h ABPM at least on a yearly basis to confirm AOBP measurements.

Serum aldosterone and urine electrolytes dynamics in response to DASH diet intervention - An inpatient mechanistic study.

Dietary approach to stop hypertension (DASH) diet reduces blood pressure (BP) as effectively as one antihypertensive drug, yet its mechanism of action was never fully characterized. We designed a translational inpatient trial to elucidate the biological pathway leading from nutritional change, through hormonal response, reversal of urine electrolytes ratio, to BP reduction. A single-center open-label interventional trial. Volunteers were admitted for 14 days, transitioning from an American-style diet to DASH diet. Vital signs, blood, and urine samples were collected daily. Participants completed two 24-hour ambulatory BP measurements (ABPM) and two 24-hour urine collections on days 1 and 10. Nine volunteers completed the protocol. During inpatient stay, serum aldosterone increased from day 0 (mean 8.3 ± 5.0) to day 5 (mean 17.8 ± 5.8) after intervention and decreased on day 11 (mean 11.5 ± 4.7) despite continuous exposure to the same diet (p-value = 0.002). Urine electrolyte ratio ([Na]/[K]) decreased significantly from a mean of 3.5 to 1.16 on day 4 (p < 0.001). BP by 24-hour ABPM decreased by a mean of 3.7 mmHg systolic BP and 2.3 mmHg diastolic BP from day 1 to 10. Shifting from a high-sodium/low-potassium diet to the opposite composition leads to aldosterone increase and paradoxical BP reduction. Urine electrolyte ratio reflects nutritional changes and should guide clinicians in assessing adherence to lifestyle modification.

Impaired nocturnal blood pressure dipping in patients with type 2 diabetes mellitus with microvascular complications

Hypertension is a common comorbidity of type 2 diabetes mellitus (T2DM). Both conditions are associated with an increased cardiovascular risk, which is reduced by tight blood pressure (BP) and glycemic control. However, non-dipping BP status continues to be an enduring cardiovascular risk factor in T2DM. This study aimed to investigate the association between microvascular complications of diabetes and nocturnal dipping of BP. We compared 13 type 2 diabetic patients with (DM+) and 67 diabetic patients without (DM−) manifest microvascular disease. BP dipping status was assessed from 24-hour ambulatory BP measurements. DM+ patients were older 60.3 ± 8.7 years vs. 58.3 ± 10.4 years ( P = 0.47). There was no significant difference between the two groups in diabetes control, clinical systolic BP and clinical diastolic BP. Dyslipidemia was significantly more present in DM+, 84.7% vs. 47.8% ( P = 0.015). DM+ patients had significantly higher daytime and 24-hour mean SBP than DM− patients with P = 0.02 and 0.023 respectively. Pulse pressure was significantly ( P = 0.03) higher in DM+. The nocturnal blood pressure profile in DM+ was “non-dipper” and “reverse dipper” respectively in 69% and 15% of patients versus 27% and 11% in DM− ( P = 0.003; P = 0.026). Our findings once again highlighted the importance of ambulatory BP monitoring and targeted antihypertensive therapy directed toward to restore normal circadian BP in patients with T2DM.

24-hour ambulatory blood pressure measurement using a novel non-invasive, cuff-less, wireless device

Abstract Background Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for diagnosis and treatment of hypertension. Technical limitations, low compliance and complex procedures limit their use. Purpose The aim of the present study was to test the accuracy of a new technique of 24H ABPM using a photoplethysmography (PPG)-based, wearable device (Wrist-monitor) as compared to the standard cuff-based ABPM device. Methods In this prospective observational study, 24H ABPM was performed in parallel for both devices on volunteers aged 18–65 years, while documenting their daily activities. Level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between devices. Receiver Operating Characteristic (ROC) curve analysis was used to assess the capability of the Wrist-monitor to identify abnormal BP values. Results The study included 28 subjects (18 men) mean age 41.5±16.2 years. Bland-Altman analysis resulted in 24H bias of −1.1 mmHg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was −1.9 mmHg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mmHg for DBP and SBP respectively). ROC curve analysis on all BP readings (n=2381) yielded a mean area under the curve (AUC) for 24H of 0.965 for both SBP and DBP. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared to the cuff-based device (p&amp;lt;0.001). Conclusions The cuff-less device provides comparable measurements to those obtained with the currently used cuff-based ABPM device, with significantly less inconvenience to the subject. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The ABPM devices were given for free by BioBeat LTD. Petach-Tikva, Israel. No other support was given.

Resistant hypertension improved after 3 months by measuring drug levels to identify non-adherence

Abstract Introduction Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this therapeutic drug monitoring is the most reliable method. Purpose The primary objective of this analysis is to determine whether drug levels measured with a dried blood spot (DBS) method combined with personalized feedback leads to a decrease in prevalence of RH after 3 months due to an increase in adherence. Methods This is a multi-centre single-blinded randomized controlled trial (RHYME-RCT, NL6736). Patients went to an eligibility visit, where DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) was performed simultaneously. Patients with a daytime systolic blood pressure (SBP) &amp;gt;135 and/or diastolic blood pressure (DBP) &amp;gt;85 mmHg were randomized to standard treatment (control) or intervention. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 months after the eligibility visit. At each visit an ABPM and DBS were performed. Results A total of 53 patients (mean age of 59±11 years, 78.7% male) with at least three months of follow-up were included. The prevalence of RH decreased from 100% in both arms to 75.0% in the intervention arm (p=0.014, n=24) and 58.6% in the control arm (p=0.001, n=29). No improvements were seen in adherence rates over time. Furthermore, no significant differences were found after three months between the two groups in the degree of RH (p=0.214), SBP (p=0.551) or adherence (p=0.746). Conclusion Measuring blood pressure and drug levels led to a decrease in the prevalence of RH. However, this improvement could not be linked to the actual intervention or improvement of adherence. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMW

Unattended automated office blood pressure measurement — current evidence and the role in clinical practice

Arterial hypertension is a leading preventable cardiovascular risk factor. The definition and thresholds for the diagnosis of hypertension vary between European and American guidelines. That is mainly due to the widely known SPRINT trial in which unattended automated blood pressure measurements were used. This technique of blood pressure estimation requires a patient to be left alone in an office and then a programmed device measures blood pressure automatically. The absence of a health professional during the measurement helps to reduce or eliminate the “white coat” effect; therefore, values of blood pressure may be lower than in conventional office blood pressure measurements. There are premises that this technique can be a solid substitution for 24-hour ambulatory blood pressure measurements and that it can predict hypertension-mediated organ damage more accurately than standard techniques. However, due to the many methods in which measurement can be carried out, no universal protocol exists. More research is needed to evaluate the usefulness of unattended automated office blood pressure measurements in clinical practice.

24-hour blood pressure monitoring and renal function evaluation at the predicted term of delivery in prematurely born children.

B a c k g r o u n d: The cause of the increased risk of hypertension in children born prematurely is still unclear. The aim of this study was to analyze the results of blood pressure monitoring and the levels of variety of kidney function markers at the 40-42 weeks postmenstrual age in children born prematurely and to compare them with the values obtained from full-term newborns. The analysis of the differences in the observed parameters could be used to assess the risk of developing hypertension in preterm infants in the following years of life. M e t h o d o l o g y: Prospective cohort study included 37 children born prematurely (<35 weeks of gestation) and 20 full-term newborns. The 24-hour ambulatory blood pressure measurement, serum cystatin C and thrombomodulin levels, urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) concentration, renal ultrasound and bioelectrical impedance were performed. R e s u l t s: Analysis of the blood pressure monitoring reveled lower values of diastolic (DBP) and mean blood pressure (MAP) in the preterm group (DBP: 47.69 ± 4.79 vs. 53.96 ± 5.3 mmHg; p <0.01; MAP 64 ± 6.7 vs. 68 ± 6 mmHg; p = 0.02), however the preterm children were significantly smaller at the time of evaluation. Moreover, the pulse pressure was significantly higher in the preterm group (44 ± 7.8 vs. 39.4 ± 5.7 mmHg; p = 0.017). In the preterm group serum cystatin C level was lower (1.397 ± 0.22 vs. 1.617 ± 0.22 mg/l; p <0.01) and NGAL urine concentration was higher (57 ± 84 vs 15 ± 21 ng/ml; p = 0.04). There was substantial difference in body composition between groups - the total body water was lower in the preterm group (75.6 ± 13 vs. 82 ± 8%; p = 0.015). C o n c l u s i o n: At the predicted date of birth, preterm newborns show significant differences in blood pressure profile, body weight composition, and levels of cystatin C and NGAL compared to full-term babies.

Neutrophil-to-lymphocyte ratio in patients with white-coat hypertension

Introduction: White coat hypertension (WCH), a distinct phenotype of hypertension, is defined as elevated office blood pressure (BP) measurements during repeat visits with normal out-of-office BP measurements. The association of WCH with cardiovascular risk remains unclear; however, current data support an association between untreated WCH and the risk for cardiovascular events, cardiovascular mortality, and all-cause mortality. Increased inflammatory processes may explain the underlying pathophysiology of the increased risk for cardiovascular events in WCH; therefore, we evaluated the neutrophil-to-lymphocyte ratio (NLR) of patients with WCH compared with matched normotensive controls. &#x0D; Material and Method: Forty-five eligible subjects with WCH and 45 age, sex, and BMI matched healthy and normotensive subjects were included in the study. The subjects were assessed by office arterial BP and 24-hour ambulatory BP measurements. An automated blood count analyzer measured the NLR values. &#x0D; Results: The mean NLR in the patients-with-WCH group was significantly higher than that in the control group (2.67±0.27 vs. 2.46±0.34, p