24-hour Ambulatory Blood Pressure Measurements Research Articles

Abstract TP187: 24-hour Ambulatory Blood Pressure, Cognitive Performance, and Cerebral Microbleeds in the Elderly

Introduction: Multiple studies suggest a role for blood pressure (BP) variability and nocturnal BP dipping in the development of cerebrovascular disease and cognitive impairment. We analyzed cross-sectional data from a cohort of 90+ year-olds to test the hypothesis that BP variables are associated with cognitive function and cerebral microbleeds (CMB). Methods: Study subjects were 121 participants (mean age = 93 years, 63% female) in The 90+ Study , a study of aging in individuals aged 90 years and older from a California retirement community. Participants were given a neuropsychological test battery to determine cognitive status. All subjects underwent 24-hour ambulatory BP measurement with a automatic device. MRI scans were available for 26 participants. Over three time frames (24-hour, daytime, nighttime) and separately for SBP and DBP, we represented BP by mean, minimum, maximum, standard deviation (SD), coefficient of variation, average real variability, percentage of high measurements (≥140 mmHg for SBP and ≥90 mmHg for DBP), percentage of low measurements (<90 mmHg for SBP and <60 mmHg for DBP), and nocturnal dip (% change of mean night BP from mean day BP). Differences in means of BP variables between groups based on cognitive status (normal vs cognitively impaired not demented (CIND)/demented) and presence/absence of CMB were tested using t-tests. Results: Cognitive status was normal in 97 subjects, CIND/demented in 24. Mean nocturnal dips (both SBP and DBP) differed significantly between the two groups, with normal participants having on average greater dip levels (6.6 vs 1.3, p=0.006 for SBP and 11 vs 4.4, p=0.002 for DBP). No other BP variable showed a large or significant difference. Greater nocturnal dips were also related to better performance on cognitive test scores related to language, recent memory, and visual-spatial ability. MRI findings showed subjects with CMB (n=18) had higher SD of daytime SBP than those without (n=8) (20 vs 16, p=0.03). Those with CMB also had a greater proportion of high nighttime DBP (≥90 mmHg) readings (3.6 vs 0, p=0.03). Conclusions: Among 90+ year olds, altered nocturnal BP dipping may have a role in cognitive impairment, while SBP variation and diastolic hypertension may contribute to development of microbleeds.

The Effects of Diet Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: a Randomized Controlled Trial.

Background and ObjectivesSupervised lifestyle interventions, including dietary and exercise programs, may be infeasible to implement in real-world settings. Therefore, this study aimed to evaluate the effectiveness of a home-based lifestyle modification intervention on blood pressure (BP) management.MethodsEighty-five patients aged over 20 years and diagnosed with prehypertension or mild hypertension were randomly assigned to an advice-only comparison group (C group, n=28), a Dietary Approaches to Stop Hypertension (DASH) diet education group (D group, n=30), or a DASH and home-based exercise group (D+Ex group, n=27). The intervention lasted for 8 weeks. The primary outcome was the difference in office systolic blood pressure (SBP) before and after the study period (Trial registry at ClinicalTrials.gov, NCT01637909).ResultsSeventy-two participants (87.8%) completed the trial. The degree of change in office SBP did not significantly differ among the intervention groups; however, the D+Ex group demonstrated a tendency toward decreased SBP. Upon analysis of 24-hour ambulatory BP measurements, daytime ambulatory SBP was significantly lower in the D+Ex group (134 mmHg; 95% confidence interval [CI], 131 to 137; p=0.011) than in the C group (139.5 mmHg; 95% CI, 130.9 to 137), and daytime ambulatory SBP was significantly decreased in the D+Ex group (−5.2 mmHg; 95% CI, −8.3 to −2.1; p=0.011) compared to the C group (0.4 mmHg, 95% CI, −2.5 to 3.3).ConclusionsIn conclusion, lifestyle modification emphasizing both diet and exercise was effective for lowering BP and should be favored over diet-only modifications.

The effects of different physical activities on atrial fibrillation in patients with hypertension and chronic kidney disease.

BackgroundAtrial fibrillation (AF) is highly common, and is most frequently observed in individuals with hypertension and structural cardiac disease. Sympathetic hyperactivity plays a fundamental role in the progression, maintenance and aggravation of arrhythmia. Endurance exercise training clearly lowers sympathetic activity in sympathoexcitatory disease states, and is well-tolerated by patients with chronic kidney disease (CKD).MethodsWe assessed 50 CKD patients with hypertension. Each patient provided a complete medical history and underwent a physical examination. We used an implantable cardiac monitor over a 3-year follow-up period to evaluate the effects of high-intensity interval training (HIIT) and moderate exercise (ModEx) physical activity protocols on AF occurrence, and determined the effectiveness of these protocols in improving renal function. Subjects were followed up every 6 months after the beginning of the intervention.ResultsDuring the 3-year follow-up, AF onset was higher in CKD patients who engaged in HIIT (72%) than in those who engaged in ModEx (24%) (hazard ratio, 3.847; 95% confidence interval, 1.694–8.740, P = 0.0013 by log-rank test). Both groups exhibited significant intra-group changes in the mean systolic 24-hour ambulatory blood pressure measurements (ABPM) between baseline and 12, 24, and 36 months. There were also significant differences in the mean systolic 24-hour ABPM between the groups at the same time points.ConclusionIn CKD patients with hypertension, improvements in AF onset, renal function and some echocardiographic parameters were more evident in subjects who engaged in ModEx than in those who engaged in HIIT during 3 years of follow-up.

Salt intake and blood pressure response to percutaneous renal denervation in resistant hypertension.

The effect of lowering sympathetic nerve activity by renal denervation (RDN) is highly variable. With the exception of office systolic blood pressure (BP), predictors of the BP-lowering effect have not been identified. Because dietary sodium intake influences sympathetic drive, and, conversely, sympathetic activity influences salt sensitivity in hypertension, we investigated 24-hour urinary sodium excretion in participants of the SYMPATHY trial. SYMPATHY investigated RDN in patients with resistant hypertension. Both 24-hour ambulatory and office BP measurements were end points. No relationship was found for baseline sodium excretion and change in BP 6months after RDN in multivariable-adjusted regression analysis. Change in the salt intake-measured BP relationships at 6months vs baseline was used as a measure for salt sensitivity. BP was 8mmHg lower with similar salt intake after RDN, suggesting a decrease in salt sensitivity. However, the change was similar in the control group, and thus not attributable to RDN.

Impact of Age and Target-Organ Damage on Prognostic Value of 24-Hour Ambulatory Blood Pressure.

Markers of target-organ damage and 24-hour ambulatory blood pressure (BP) measurement improve cardiovascular risk stratification. The prevalence of target-organ damage and raised BP increases with aging. The study aim was to evaluate the impact of age and target-organ damage on the prognostic value of ambulatory BP. Markers of target-organ damage and ambulatory BP were measured in 1408 healthy people aged 41 or 51 (middle-aged group), and 61 or 71 (older group) years. The primary outcome was cardiovascular events after 16 years of follow-up, with data obtained from national registries. The prognostic value of BP was evaluated with Cox regression models, adjusted for traditional risk factors and target-organ damage, including left ventricular mass, pulse wave velocity, carotid plaques, and urine albumin/creatinine ratio. A total of 323 events were observed. In comparison with traditional risk factors, adding systolic BP and presence of target-organ damage improved risk stratification by increasing concordance index from 0.711 to 0.728 (P=0.01). In middle-aged subjects with target-organ damage, increment in pulse pressure (hazard ratio, 1.70; 95% confidence interval, 1.31-2.21; P<0.01) and increment in average real variability (hazard ratio, 1.29; 95% confidence interval, 1.05-1.59; P=0.02) were associated with a greater risk of cardiovascular disease compared with subjects without target-organ damage: hazard ratio, 1.04 (95% confidence interval, 0.74-1.46; P=0.81); P for interaction, 0.02; and hazard ratio, 0.89 (95% confidence interval, 0.69-1.14; P=0.36); P for interaction, 0.01. Target-organ damage may be a marker of individual susceptibility to the harmful effects of pulse pressure and BP variability on the cardiovascular system in middle-aged individuals.

PP.26.09] 24-HOUR AMBULATORY BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR RISK

Objective: The correlation of antithrombin III (ANT-III) levels to 24-hour blood pressure variability in hypertensive patients. Design and method: 137 hypertensive patients both treated and untreated (average age: 63.3 yrs, average SBP/DBP: 140/85 mmHg, average heart rate: 73 bpm, average BMI: 29.2), were subjected to 24-hour ambulatory blood pressure monitoring and measurement of their antithrombin III plasma levels. The degree of SBP/DBP 24-hour variability >15 mmHg or <15 mmHg was correlated against them.Conclusions: In hypertensive patients the higher degree of 24-hour diastolic pressure variability relates to lower plasma levels of antithrombin III, thus suggesting a greater risk of thrombotic events in this group of patients.

Relationship between subendocardial viability ratio and hemoglobin in patients with chronic kidney disease.

Pulse wave analysis (PWA) uses the technique of applanation tonometry to obtain a peripheral pulse pressure waveform from which central hemodynamic information is derived. Using PWA, subendocardial viability ratio (SEVR) can be measured. SEVR represents a noninvasive measure of myocardial perfusion. It is related to the work of the heart, the oxygen consumption, and the energy supply of the heart. Anemia is a common complication of chronic kidney disease (CKD). A complex relationship exists between CKD, cardiovascular disease (CVD), and anemia. The aim of our study was to assess the relationship between SEVR and hemoglobin in non-dialysis CKD patients. We examined the associations between PWA hemodynamic parameters, 24-hour ambulatory blood pressure (BP) measurements, and laboratory variables including hemoglobin, cardiac biomarkers troponin I, NT-proBNP, and hs-CRP in a cohort of 91 nondialysis CKD patients. PWA was assessed by radial applanation tonometry (SphygmoCor, Atcor, Sydney, Australia). The patients were divided into two groups according to the median value of hemoglobin. Mean age of included patients was 60.2 years, 67% were men, 44% were smokers, 25.3% had diabetes. A significant correlation between hemoglobin and SEVR was found (r=0.26; p=0.012). With multivariate regression analysis, SEVR as dependent variable turned out to be statistically significantly associated with hemoglobin (β=0.344, p=0.013) and with troponin I (β=-0.217, p=0.037). Patients in the group with lower hemoglobin had statistically-significantly higher serum creatinine, cystatin C, NT-proBNP, and 24-hour ambulatory systolic BP and lower e-GFR, SEVR, and office diastolic BP. Results of our study show that SEVR is independently associated with hemoglobin in nondialysis CKD patients. CKD patients with lower hemoglobin have lower SEVR. .

Feasibility of catheter ablation renal denervation in "mild" resistant hypertension.

Renal denervation (RDN) has been proposed as a novel interventional antihypertensive technique. However, existing evidence was mainly from patients with severe resistant hypertension. The authors aimed to evaluate the efficacy of RDN in patients with resistant hypertension with mildly elevated blood pressure (BP). Studies of RDN in patients with mild resistant hypertension (systolic office BP 140-160mm Hg despite treatment with three antihypertensive drugs including one diuretic, or mean systolic BP by 24-hour ambulatory BP measurement [ABPM] 135-150mm Hg) were included. Two observational and one randomized cohort were identified (109 patients in the RDN group and 36 patients in the control group). Overall, the mean age of patients was 62±10years, and 69.7% were male. Before-after comparison showed that RDN significantly reduced ABPM as compared with the baseline systolic ABPM, from 146.3±13mm Hg at baseline to 134.6±14.7mm Hg at 6-month follow-up and diastolic ABPM from 80.8±9.4mm Hg at baseline to 75.5±9.8mm Hg at 6-month follow up (both P<.001). This significant effect was not observed in the control group. Between-group comparison showed a greater change in ABPM in the RDN group as compared with that in the control group (change in systolic ABPM: -11.7±9.9mm Hg in RDN vs -3.5±9.6mm Hg in controls [P<.001]; change in diastolic ABPM: -5.3±6.3mm Hg in RDN vs -2.1±5.5mm Hg in control [P=.007]). RDN was also associated with a significantly decreased office systolic/diastolic BP and reduced number of antihypertensive medications. No severe adverse events were found during follow-up. RDN seems feasible to treat patients with mild resistant hypertension.

Pharmacological Monotherapy versus Renal Artery Denervation in Controlled Hypertensive Patients

&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;The aim of this prospective observational non-inferiority study was to compare the capacity for control of essential hypertension between renal sympathetic denervation (RSD) and either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and results&lt;/strong&gt;: Seventy-four previously controlled essential hypertensive patients on ACEI/ARB monotherapy were evaluated; eleven patients agreed to proceed with RSD and had their antihypertensive agent withdrawn on the day of the procedure. During the six months of follow-up, there was no significant change in mean 24-hour ambulatory blood pressure measurements (ABPM) from baseline to three and sixmonths in the ACEI/ARB group (118±8/80±3 &lt;em&gt;vs.&lt;/em&gt; 116±8/79±3 and 115±8/79±4 mmHg, respectively). No change was also observed in the RSD group (117±8/81±2 &lt;em&gt;vs.&lt;/em&gt; 115±6/80±2 and 114±7/79±3 mmHg, respectively). There were no differences between groups at interval time points. There were also no changes in renal function or echocardiographic parameters, during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; For the first time, this study reports possible non-inferiority of RSD when compared to ACEI or ARB monotherapy in the control of essential hypertension. A randomized trial with appropriate concealment of treatment, more patients and an extended follow-up period is needed to evaluate the potential benefits of RSD in comparison to ACEI/ARB use in patients with controlled hypertension.&lt;/p&gt;

Wady zastawkowe serca i różne profile dobowe ciśnienia tętniczego.

Introduction. Valvular heart diseases (VHD) increase the risk of cardiovascular morbidity and mortality. Little is known about the correlation between circadian blood pressure profile (CBPP) and VHD. The study aimed to clarify the association between CBPP and VHD prevalence. Material and methods. 103 consecutive patients (male: 50.5%), who underwent 24-hour ambulatory blood pressure measurement (ABPM) and Holter electrocardiography simultaneously were analysed. Patients were divided into 3 groups: dipping was defined as 10–20% (28.2%), non-dipping as < 10% (50.5%) fall in nocturnal blood pressure (BP) and reverse-dipping as higher nocturnal than diurnal BP (21.4%). VHD was assessed by transthoracic echocardiography and described as mild, moderate or severe regurgitation or stenosis accordingly. Further, the severity of VHD, nocturnal fall pattern and ABPM features in all groups were compared. Results. The authors found no statistically significant association between severity of VHD and dipping status. The presented study showed some correlations between VHD severity and different ABPM parameters. Conclusions. Though severity of VHD did not influence dipping status obtained by ABPM, there were associations between VHD and ABPM outcomes. Further studies are needed.

Pulmonary vein isolation alone and combined with renal sympathetic denervation in chronic kidney disease patients with refractory atrial fibrillation

BackgroundAtrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Our goal was to compare the impact of PVI + RSD with that of PVI alone in patients with concurrent AF and CKD. MethodsThis was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-second recurrence of AF recorded by the pacemaker, 24-hour ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD. ResultsNo patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI + RSD group or between the PVI + RSD and PVI groups throughout the study. Significantly more patients in the PVI + RSD group than in the PVI group were free of AF at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, whereas these parameters improved in the PVI + RSD group. ConclusionPVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.

PP.01.18] COMPARISON OF A NEW FIRST-LINE TREATMENT VERSUS DIFFERENT FIRST-LINE STRATEGIES USING 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING

Objective: 24-hour ambulatory blood pressure measurement (ABPM) is superior to office blood pressure measurement (OBPM) in assessing the blood pressure (BP) lowering efficacy of antihypertensive medication. ABPM was used to assess the efficacy of a new first-line treatment recently approved in Europe (perindopril/amlodipine (P/A) 3.5 mg/2.5 mg and P/A 7 mg/5 mg) versus a range of first-line monotherapy strategies. Design and method: ABPM data were analyzed in 886 hypertensive subdivided into different therapeutic subgroups from three international, double-blind, parallel-group, randomized controlled trials. P/A 3.5/2.5 and 7/5 was compared to a range of first-line treatment strategies with an angiotensin receptor blocker (ARB) at 1 month and at 3 months, and with an angiotensin converting enzyme inhibitor (ACEi) at 2 months. Results: In these comparisons, P/A demonstrated superior BP-lowering efficacy on ABPM. After 1 month, P/A 3.5/2.5 (n = 67) there was a greater reduction from baseline in mean 24-hour systolic BP (SBP)/diastolic BP (DBP): -11.3 ± 10.5/-6.4 ± 6.3 mmHg (P < 0.002), in comparison with irbesartan 150 mg (n = 77): -6.7 ± 8.4/-3.6 ± 5.2 mmHg (P < 0.006). After 2 months, P/A 3.5/2.5 (n = 174) there was a greater decrease in mean 24-hour SBP/DBP (-8.5 ± 11.8/-5.8 ± 8.3; P < 0.001) than perindopril 5 mg (n = 187) (-4.9 ± 12.2/-3.6 ± 7.8; P < 0.001), estimate of the difference: -3.8/-2.4 mmHg. After 3 months, the mean 24-hour SBP/DBP reduction was -13.3 ± 10.3/-8.1 ± 6.6 mmHg and -9.1 ± 10.2/-6.0 ± 6.5 mmHg for patients on P/A 3.5/2.5 and on P/A 7/5 (n = 214) and for patients on valsartan 80 mg or valsartan 80 mg and 160 mg (n = 167), respectively (estimate of the difference -2.3; p < 0.001). When the treatment was prolonged to 6 months, the mean 24-hour SBP/DBP reduction was also significantly greater with the first-line single-pill strategy (-12.5 ± 11.1/-7.6 ± 7.3 mmHg vs. -9.2 ± 11.7/-6.2 ± 7.4 mmHg, estimate of the difference: -1.9; P = 0.007). No difference in safety profile was observed with any of the different monotherapy strategies. Conclusions: The new first-line single-pill perindopril/amlodipine strategy produces greater clinically relevant reductions in 24-hour SBP/DBP than various other first-line strategies, without any safety concern.

MPS 10-02 Relationship between office blood pressure and 24-hour ambulatory blood pressure measurements in patients with persistent atrial fibrillation versus sinus rhythm

MPS 10-02 Relationship between office blood pressure and 24-hour ambulatory blood pressure measurements in patients with persistent atrial fibrillation versus sinus rhythm

MPS 05-04 IMPAIRED NOCTURNAL BLOOD PRESSURE DECLINE IN TYPE 2 DIABETES MELLITUS

Objective: Hypertension is a common comorbidity of type 2 diabetes mellitus (T2DM) and both are associated with increased cardiovascular risk, which is reduced by tight blood pressure (BP) and glycemic control. However the non-dipping BP status, defined as a nocturnal BP decline of less than 10% compared with daytime BP, is common in T2DM and remains an enduring cardiovascular risk factor. Cardiovascular autonomic neuropathy and endothelial dysfunction have been proposed as potential mechanisms. We hypothesized that the degree of microvascular disease rather than cardiovascular autonomic neuropathy interferes with the normal nocturnal reduction in BP. Design and Method: Cardiovascular autonomic function and time-domain baroreflex sensitivity (xBRS) were determined in 22 diabetic patients with (DM+) and 23 diabetic patients without (DM−) manifest microvascular disease. BP dipping status was determined from 24-hour ambulatory BP measurements. Sixteen non-diabetic subjects served as controls (CTRL). Results: None of the subjects demonstrated parasympathetic or sympathetic cardiovascular dysfunction. xBRS was lower in DM− patients compared to CTRL (7.7 ± 3.3 vs. 12.3 ± 8.3 ms·mmHg−1; P < 0.05), and further reduced in DM+ patients (4.6 ± 2.0 ms·mmHg−1; P < 0.01 vs. DM− and CTRL). The nocturnal decline in systolic and diastolic BP in DM− was blunted (12% and 14% vs. 17% and 19% in CTRL; P < 0.05) and even more so in DM+ (8% and 11%; P < 0.05 vs. DM− and P < 0.001 vs. CTRL). The percentages of non-dippers were 37%, 70% and 86% respectively in the CTRL, DM− and DM+ group. A nocturnal reduction in pulse pressure was observed in CTRL and DM− but not in DM+ patients (P < 0.05 vs. DM− and P < 0.01 vs. CTRL). Conclusions: In T2DM patients, the degree of microvascular disease rather than CAN interferes with the normal nocturnal reduction in BP with a persistently increased pulse pressure, and coincides with reduced baroreflex sensitivity, contributing to their increased cardiovascular risk.

Evaluation of Cardiac Autonomic Functions in Older Parkinson's Disease Patients: a Cross-Sectional Study.

In Parkinson's disease (PD), non-motor symptoms may occur such as autonomic dysfunction. We aimed to evaluate both parasympathetic and sympathetic cardiovascular autonomic dysfunction in older PD cases. 84 PD cases and 58 controls, for a total of 142, participated in the study. Parasympathetic tests were performed using electrocardiography. Sympathetic tests were assessed by blood pressure measurement and 24-hour ambulatory blood pressure measurement. The prevalence of orthostatic hypotension in PD patients was 40.5% in PD patients and 24.1% in the control group (p> 0.05). The prevalence of postprandial hypotension was 47.9% in the PD group and 27.5% in the controls (p <0.05). The prevalence of impairment in heart rate response to deep breathing was 26.2% in the PD group and 6.9% in the control group (p <0.05). The prevalence of postprandial hypotension in PD with orthostatic hypotension was 94% and 16% in PD patients without orthostatic hypotension (p <0.05). The prevalence of impairment in heart rate response to deep breathing was 52.9% in PD patients with orthostatic hypotension and 8% in PD cases without orthostatic hypotension (p<0.05). The prevalence of impairment in heart rate response to postural change was 41% in PD cases with orthostatic hypotension and 12% in PD cases without orthostatic hypotension (p <0.05).Although there are tests for assessing cardiovascular autonomic function that are more reliable, they are more complicated, and evaluation of orthostatic hypotension by blood pressure measurement and cardiac autonomic tests by electrocardiography are recommended since these tests are cheap and easy.

The association of resting state heart rate variability and 24-hour blood pressure variability in spinal cord injury

Patients with high cervical complete spinal cord injuries (tetraplegia) sustain damage to the autonomic neural pathways that influence cardiovascular functioning and produce variability in the heart rate (HR) and blood pressure (BP). In non-injured individuals, an inverse relationship exists between resting autonomic control of the heart (as evidenced by HR variability (HRV)) and BP variability (BPV). This study examined the relationship between HRV, BP and BPV in individuals with tetraplegic (n=10) and paraplegic (n=10) spinal cord injuries, and a group of healthy controls (n=14). Resting HRV at baseline and 24-hour ambulatory BP measurements were collected from electrocardiogram measures of each participant. HRV was quantified using time- and frequency-domain measures. The standard deviation of the BP measurements was used as an index of BPV. Multivariate analyses of variance were performed to examine group differences for laboratory-based and 24-h dependent variables. The MANOVAs for HRV parameters (λ(14,50)=.352, p=.010, η2=.407) and for BP indices and HR (λ(16,48)=.318, p=.013, η2=.436) were significant. Furthermore, in line with existing evidence, we found that vagally mediated HRV was inversely related to BPV in healthy controls. However, this relationship did not hold for the tetraplegia group (ρ<|.42|), and mixed results were found for the paraplegia group (e.g., ρ<|.29| for time domain HRV, ρ>|.65| for low-frequency power). These results support the conclusion that the damage to the spinal sympathetic pathways to the heart found in people with tetraplegia causes a significant disruption in baroreflex control of BP.

Abstract 10357: The Usefulness of Home Blood Pressure Measurement in the Diagnosis of Hypertension: A Prospective Multicenter Study

Introduction: The major hypertension guidelines suggest methods for diagnosing hypertension by measuring the 24-hour ambulatory blood pressure (ABP) or home blood pressure (HBP) if hypertension is suspected. Hypothesis: there is no consensus of cut off values for HBP as the criterion for hypertension and also optimal duration of home blood pressure measurement (HBPM). Methods: 319 suspected hypertension patients (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, average value of three times measurements of blood pressure in the office) were included in four university hospital. The blood pressure (BP) measurement taken by patients in his/her home with HBPM device (Watch BP Home, Microlife, Swiss) and measured three times with one minute interval at morning and evening for 7 days. The 24-hour ambulatory blood pressure measurement (ABPM) was performed by Mobil-O-Graph (IEM. GmbH, Germany). The device was set to obtain BP readings at 30-minute intervals during the day and night. The definition of hypertension was as follows, SBP ≥135 mmHg or DBP ≥85 mmHg for HBPM and SBP ≥130 mmHg or DBP ≥85 mmHg for ABPM. For the analysis for diagnostic accuracy of HBPM, we used ABPM as a reference standard for the diagnosis of hypertension. Results: We decided to exclude 53 patients due to dropout or lack of valid BP measurement (valid leadings &lt;70% of tried measurements of ABPM and less than 5-days HBPM). Finally we analyzed BP measurement data of 266 patients. Dropout or invalid BP measurement was more common in ABPM than HBPM. HBP was measured at least 6 days in more than 90% patients and white coat hypertension was diagnosed more frequently in the HBPM. HBPM had a more than 98.6% positive predictive value and 46.8% negative predictive value for the diagnosis of hypertension when put the criteria on ABPM. There are no difference of diagnostic accuracy for the diagnosis of hypertension according to the 5-day, 6-day and 7-day HBPM. Conclusions: A 5-day HBPM is enough for the diagnosis of hypertension considering ABPM as a reference. The cut off value of hypertension in HBPM is same to the current guideline values (135/85 mmHg) in this study. HBPM is an effective and available method for the diagnosis of hypertension in suspected hypertensive patients.

Assessment of Mean Platelet Volume in Patients with Resistant Hypertension, Controlled Hypertension and Normotensives.

Patients with resistant hypertension are at increased risk for cardiovascular events. Mean platelet volume (MPV) is an accepted biomarker of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV levels are higher in resistant hypertensive (RHTN) patients than in controlled hypertensive (CHTN) patients and healthy normotensive controls. 279 consecutive patients were included in this study. Patients were divided into three groups: Resistant hypertension patient group [n=78; mean age 56.8±9.8; 42 males (53.8%)]; controlled hypertension patient group [n=121; mean age 54.1±9.6; 49 males (40.5%)]; and normotensive control group [n=80; mean age 49.8±8.5; 34 males (42.5%)]. Physical examination, laboratory work-up, and 24-hour ambulatory blood pressure measurement (ABPM) were performed in all participants. The mean platelet volume levels were significantly higher in RHTN group than in the CHTN and normotensive groups (p<0.001). In correlation analysis office systolic and diastolic blood pressure was positively correlated with MPV. Our study demonstrated that MPV, as an important indicator of platelet activation, was statistically higher in RHTN patients than in CHTN and in normotensive subjects. Elevated MPV levels may help to determine a high risk group for atherosclerosis in RHTN patients.

GW26-e0676 The impact of different periods of dynamic pulse pressure index on the target organ damage in hypertensive patients

To explore the impact of different periods the dynamic pulse pressure index (PPI) on hypertensive target organ damage (TOD). 553 hypertensive patients were enrolled. 24-hour, day and night PPI were calculated based on 24-hour ambulatory blood pressure measurement results. Each period of PPI were

Implementation of Out-of-Office Blood Pressure Monitoring in the Netherlands: From Clinical Guidelines to Patients' Adoption of Innovation.

Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients’ and physicians’ acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations.Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD.ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients’ feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients’ self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients’ acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians.In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the method. We found that physicians’ positive attitude to ABPM enabled the use of the method by patients which, in turn, impeded the diffusion of HBPM. For patients, the acceptance process of HBPM can only begin after the physician has adopted the innovation. Physicians are in a position to encourage as well as hinder out-of-office BP monitoring and self-management.