Average 24-hour Blood Pressure Research Articles

Histone β-hydroxybutyrylation-mediated Chromatin Remodeling Upregulates β-oxidation of Fatty Acids and Attenuates Metabolic Syndrome

Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo, Toledo, OH Introduction: Metabolic syndrome (MetS) is a cluster of metabolic dysregulations including high blood pressure (BP), dyslipidemia, central obesity, hyperglycemia, and insulin resistance. Regular exercise is one of the lifestyle modifications known to prevent MetS by the generation of ketone bodies. Precisely how ketone bodies operate to lower MetS is largely unknown. Previously, we demonstrated that the ketone body, β-hydroxybutyrate, is a potent anti-hypertensive metabolite. β-hydroxybutyrate has been recently recognized to epigenetically modify histones by β-hydroxybutyrylation. Using assay for transposase-accessible chromatin with sequencing and chromatin immunoprecipitation assays, we found that histone β-hydroxybutyrylation causes chromatin remodeling and exposes regions for transcription of genes for β-oxidation of fatty acids. Therefore, we hypothesized that β-hydroxybutyrate alleviates MetS via histone β-hydroxybutyrylation-mediated transcriptional upregulation of β-oxidation of fatty acids. To test this hypothesis, we examined the epigenetic effect of increasing systemic β-hydroxybutyrate in a genetic rat model of MetS inbred in our laboratory, the low-capacity runner (LCR/Tol) rats. Methods: Randomly selected two groups of six months old female LCR/Tol rats (n=5/group) were surgically implanted with radiotelemetry transmitters for BP measurement. The control group was given water, whereas the experimental group was given water containing 20% v/v of 1,3-butanediol (1,3-BD), which is a precursor of β-hydroxybutyrate for 10 weeks. Following euthanasia, sera and tissues were harvested. Histones were isolated and subjected to western blotting for quantitation of β-hydroxybutyrylation. Results: Compared to the control group, rats given 1,3-BD had a significantly increased circulating β-hydroxybutyrate (mean 1.98 mM vs 0.71 mM, p<0.05), lower body weight (mean 231.6 gm vs 248.4 gm, p<0.05), lower fasting glucose (mean 79.60 mg/dl vs 100.8 mg/dl, p<0.05) and lower 24-hour average systolic BP (116±2 mmHg vs. 120±2 mmHg, p<0.05). Interestingly, histones isolated from the experimental group with higher circulating β-hydroxybutyrate also displayed a marked increase in β-hydroxybutyrylation (mean 0.82 vs 0.22, p<0.01). Further, the target transcriptional genes of histone β-hydroxybutyrylation, 3-hydroxy-3-methylglutaryl-CoA synthase 2 (Hmgcs2) and cytochrome P450 family 2 subfamily d polypeptide 4 (Cyp2d4) were both significantly upregulated in the experimental group (p<0.01). However, markers of liver injury, alanine transaminase, alkaline phosphatase, aspartate transaminase, and total bile acid levels, were comparable between the two groups, indicating no liver damage. Conclusion: This is the first study to demonstrate that enhanced systemic β-hydroxybutyrate attenuates MetS by histone β-hydroxybutyrylation-mediated chromatin remodeling to upregulate the transcription of Hmgcs2 and Cyp2d4 to promote β-oxidation of fatty acids. Further, our results demonstrate that for individuals with MetS who may be unable to exercise, utilizing 1,3-BD could serve as an alternate source to combat the MetS ameliorating benefits of the ketone body β-hydroxybutyrate. Funding Sources: Authors acknowledge the National Institutes of Health for funding support to Bina Joe (R01HL1430820). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Prognostic impact of hypertension grading

BackgroundMost Hypertension Guidelines grade hypertension according to various cut-off values. We sought to investigate the prognostic impact of Grades 1 (140–159 and/or 90–99 mmHg), 2 (160–179 and/or 100–109 mmHg) and 3 (≥180 and/or ≥110 mmHg). MethodsWe followed for an average of 10 years a cohort of 3,150 initially untreated hypertensive patients (mean age 50 years, 44 % women) with no previous cardiovascular disease at entry. All patients underwent diagnostic tests including 24-hour ambulatory blood pressure (BP) monitoring. ResultsAt entry, average clinic BP was 156/97 mmHg and average 24-hour BP was 137/87 mmHg. During follow-up, 314 patients experienced a first major cardiovascular event (composite of non-fatal myocardial infarction or stroke, cardiovascular death, or hospitalization for heart failure). Event rate was not formally dissimilar between Grade 1 and Grade 2 (0.73 vs 0.95 per 100 patient-years, respectively; p = 0.06). It was higher in Grade 3 (1.93 per 100 patient-years; p < 0.01 vs Grade 1 and Grade 2). After adjustment for a robust set of covariables, the hazard ratio was not dissimilar between Grade 1 and Grade 2 (p = 0.27), and higher in Grade 3 than in Grade 1 (p < 0.01), but the excess risk in Grade 3 was no longer significant (hazard ratio: 1.25, 95 % CI 0.87–1.78; p = 0.22) after adjustment for 24-hour ambulatory systolic BP. ConclusionsWe were unable to find a significant difference in the relative hazard of cardiovascular events tied to hypertension Grades 1 and 2. Conversely, Grade 3 (clinic BP ≥180/110 mmHg) portends a higher cardiovascular risk, which is associated with higher levels of 24-hour ambulatory BP.

Cardiovascular risk progression into atrial fibrillation tracked with wearables: a report from mAFA II extension cohort

Abstract Background Cardiovascular risk, e.g. obstructive sleep apnea (OSA), hypertension, frequent ectopic, are susceptible to atrial fibrillation (AF). Smartwearable-based detection for OSA, ectopics, AF and blood pressure have been tested in mobile health technology supported screening and integrated care for atrial fibrillation (mAFA II programme). Objective The present study aimed to investigate the AF occurrence after the cardiovascular risk identified with wearables. Method The risk factors which were monitored by wearables are as follows: i) OSA: more than 80% monitoring measures with 15 &amp;lt; apnea-hypopnea index (AHI) &amp;lt; 30 during sleep (intermediate risk）or with AHI ≥ 30 (high risk); ii) ectopics: the proportion of the premature beats among total monitored heart beats: 0.5%-10% among over heart beats (intermediate risk) or &amp;gt;10% premature beat (high risk); iii) High-risk blood pressure (BP): average 24-hour BP &amp;gt;130/80 mm Hg, reverse-dippers of BP, and pulse pressure over 60mmHg. Subjects aged over 18 years old, who used smart watch/wristband (Huawei Technologies Co., Ltd., Shenzhen, China) across China were enrolled into present study analysis between October 26, 2018 to Dec 14, 2022. The first detection AF episode were analyzed since the subjects were identified with high risk for AF, that was, intermediate- or high risk-OSA, high risk-blood pressure, intermediate- or high risk-ectopic by the wearables. Results There were 4.37 million subjects (78.6% male, mean age, SD, 37 ± 13 years) involving in the screening programme of mAFA II extension cohort. Among these, 611495 intermediate-risk ectopic, 5037 high-risk ectopic, 43777 intermediate-risk OSA, 22886 high-risk OSA, and 25892 high-risk blood pressure were identified (Figure 1). The rates of progressed into AF from identified cardiovascular risk were as follows: 0.97% (5936/611495) of 611495 intermediate-risk ectopic, 4.80% (242/5037) of high-risk ectopic, 1.09% (478/43777) of intermediate-risk OSA, 1.51% (345/22886) of high-risk OSA, and 1.74% (450/25892) of high-risk blood pressure, respectively. Subjects identified with high-risk blood pressure were much likely to be early monitored with AF episode than other risk, with time to first AF (median, interquartile) of 10 (3-56) days (p&amp;lt;0.05). However, the above cardiovascular risk was possibly progressed into AF episode during five months. Conclusion Smartwearables facilitated the detection of risk factors, OSA, hypertension, frequent ectopic, which might progressed into AF during five months, calling for the effective proactive management on cardiovascular risk to reduce AF burden.Subjects involving in risk screening pro

24-hour blood pressure profile and systemic inflammation in patients with stable coronary artery disease with obstructive sleep apnea

Aim. To evaluate 24-hour blood pressure (BP) profile and systemic inflammation in patients with coronary artery disease (CAD) depending on the presence of obstructive sleep apnea (OSA).Material and methods. This cross-sectional cohort study included 132 patients with CAD aged 62,3±6,9 years. Depending on OSA, all patients were divided into 2 groups: group 1 (n=60) — without OSA, group 2 (n=72) — with OSA. Systemic inflammation was assessed using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), Systemic immune-inflammation index (SII) — platelets´neutrophils/lymphocytes. Blood pressure was monitored with assessment of average daily values, circadian rhythm, and variability.Results. Patients with OSA had higher nighttime blood pressure values (p&lt;0,05) and 24-hour variability (p&lt;0,05). In group 2 patients, a pathological blood pressure profile was detected in 66,7% of cases, while in group 1 — in 36,7%. The systemic inflammation indices were significantly higher in patients with OSA than in the group without OSA — NLR by 18,8% (p&lt;0,01), PLR by 22,5% (p&lt;0,01), MLR by 19,0% (p&lt;0,01), SII by 41,0% (p&lt;0,001).Conclusion. We established that patients with coronary artery disease and OSA have more pronounced systemic inflammation, more often have a pathological 24-hour BP profile ("non-dipper", "night-peaker"), BP variability, higher values of average 24-hour, daytime and nighttime BP compared with patients without OSA.

Abstract 120: Greater 24-hour Blood Pressure Variability Is Associated With Higher Retinal Microvascular Resistance And Smaller Lumen Diameter In Healthy Normotensive Adults

Introduction: Elevated blood pressure (BP) is associated with damage to high flow, low resistance target organs such as the retina. Recent evidence suggests that 24-hour BP variability (BPV) is a novel risk factor for cardiovascular disease, independent of 24-hour average BP. However, whether 24-hour BPV is related to concentric retinal arteriole remodeling in healthy adults is unknown. Thus, the purpose of our study was to determine the degree to which 24-hour BPV is associated with retinal lumen diameter and vascular resistance in healthy young/middle-aged adults, independent of 24-hour average BP. Methods: Healthy, normotensive adults aged 25 to 60 years (n=40; 50% female) underwent measurements of retinal arteriole diameter and flow using laser speckle flowgraphy. 24-hour brachial BP was determined using ambulatory BP monitoring. BPV was calculated as the standard deviation of all BP recordings for systolic and diastolic BP. Retinal vascular resistance was calculated as ocular perfusion pressure divided by mean retinal flow across 4 arterioles. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV). Results: Higher 24-hour systolic and diastolic average BP were associated with smaller retinal lumen diameter and elevated vascular resistance (P&lt;0.05). Although both systolic BPV (r=0.391, P=0.012) and diastolic BPV (r=0.315, P=0.048) were associated with higher retinal vascular resistance, only diastolic BPV was associated with smaller retinal arteriole lumen diameter (r=-0.393, P=0.012). The association of greater diastolic BPV with smaller retinal arteriole lumen diameter (β=-0.363, P=0.01) and higher retinal vascular resistance (β=0.395, P=0.007) remained after adjusting for age, body mass index, cfPWV, and 24-hour average diastolic BP. Conclusion: Higher diastolic BPV may contribute to adverse remodeling of retinal arterioles in healthy normotensive adults independent of arterial stiffness and traditional cardiovascular disease risk factors. Future studies could utilize local metabolic vasodilation via diffuse luminance flicker to examine whether retinal arteriole autoregulatory mechanisms are impaired in individuals with higher BPV.

CLINICAL SIGNIFICANCE OF ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AS A POTENTIAL INDICATOR OF MASKED HYPERTENSION AMONG THE KOREAN ELDERLY

Objective: Although masked hypertension links to adverse cardiovascular outcomes, it is challenging to distinguish individuals with masked hypertension. Studies have demonstrated a significant association between left ventricular hypertrophy (LVH) and masked hypertension. However, it remains unclear whether electrocardiographic LVH has the predictability for masked hypertension. Design and method: The study participants were 511 Korean elderly with well-controlled blood pressure (BP) or normotension who underwent electrocardiography and ambulatory blood pressure monitoring (ABPM). We categorized them into two groups by presence or absence of electrocardiographic LVH. We conducted Pearson correlation analysis (beta coefficient [95% confidence interval] and logistic regression analysis (odd ratio (OR) [95% CI]) to evaluate the association of electrocardiographic LVH with components of ABPM. The area under the receiver operator curve (AUC) was calculated to assess the predictability of electrocardiographic LVH for 24-hour average masked hypertension. Results: Electrocardiographic LVH significantly correlated with 24-hour mean systolic blood pressure (SBP) (5.83 [2.16-9.51]), daytime SBP (5.0 [1.27-8.72]), and nighttime SBP (7.89 [3.49-12.30]). Electrocardiographic LVH showed the increased OR for masked hypertension in 24-hour average BP (2.18 [1.17-4.07]), in daytime average BP (2.03 [1.09-3.79]), and nighttime average BP (1.83 [0.86-3.88]). The receiver operating curve indicated the significant predictability of electrocardiographic LVH for 24-hour average masked hypertension (area under the curve: 0.706 [0.604-0.809]). Conclusions: Electrocardiographic LVH is potentially effective in distinguishing individuals with masked hypertension.

ASSOCIATION OF LOW RENIN ACTIVITY WITH UNCONTROLLED NIGHT-TIME AND MORNING BLOOD PRESSURE AS RESIDUAL RISK IN GOOD BLOOD PRESSURE CONTROLLED ELDERLY SUBJECTS

Objective: To achieve optimal nighttime blood pressure (BP) and morning BP is often challenging especially in elderly subjects. Although low renin revels are seen especially in the elderly, data are sparse about the association between renin-angiotensin-aldosterone (RAA) system and uncontrolled nighttime and morning BP. Design and method: Ambulatory BP (ABP) was assessed in 315 Minamisanriku Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with awake and asleep ABP and hypertension defined by ABP, adjusting for important confounders included the use of RAA inhibitors. We divided them into non-elderly (&lt;80 years, n = 164) and elderly group (&gt;80 years, n = 151). Results: In total participants, 95% was treated hypertension and average 24-hour BP was 114.2±8.9/67.5±5.9 mmHg. The prevalence of uncontrolled 24-hour (&gt;130 mmHg), daytime (&gt;135 mmHg), nighttime (&gt;120 mmHg) and morning systolic BP (SBP) (&gt;135 mmHg) was 5.6%, 7.4%, 8.6%, 26.8%, respectively. In elderly group, Lower log-PRA was associated with higher 24-hour, daytime, nighttime, and SBP (all P&lt;0.01) after adjusted confounders. These associations were also observed in non-elderly group except for nighttime and morning SBP. Lower log-aldosterone was associated with higher 24-hour and daytime SBP only in elderly group (both P&lt;0.01). A 1-unit higher log-PRA was associated with lower odds of uncontrolled nighttime SBP (odds ratio [OD] 0.19 [95%CI, 0.06-0.64) and uncontrolled morning SBP (OR, 0.43 [95%CI, 0.21-0.91]) but not in uncontrolled 24-hour and daytime SBP in elderly group, while these findings were not seen in non-elderly group. Similar results were observed in log-aldosterone. There was no association between aldosterone/PAC ratio and the presence of uncontrolled ABP. Conclusions: Suppressed renin activity and aldosterone were associated with uncontrolled nighttime and morning SBP in treated and good 24-hour BP controlled elderly population. Even in good 24-hour BP, low renin activity may be associated with residual ABP risk in elderly population.

Pathophysiology of the Nondipping Blood Pressure Pattern.

The nondipping blood pressure (BP) pattern corresponds to a disruption in the circadian BP rhythm with an insufficient decrease in BP levels during nighttime sleep as observed using 24-hour ambulatory BP monitoring. Patients with nondipping BP pattern have poorer renal and cardiovascular outcomes, independent of their average 24-hour BP levels. The pathophysiology of nondipping BP is complex and involves numerous mechanisms: perturbations of (1) the circadian rhythm, (2) the autonomic nervous system, and (3) water and sodium regulation. This review provides an outline of the pathways potentially involved in the nondipping BP profile in different conditions. A recent hypothesis is also discussed involving the role of gut microbiota in the dipping/nondipping patterns, via the fecal diet-derived short chain fatty acids.

Serum total bilirubin and new-onset hypertension in perimenopausal women: a cross-sectional study.

Previous studies have shown negative associations between total bilirubin (TBIL) and hypertension. However, the association of TBIL with new-onset hypertension in perimenopausal women is unknown. A total of 196 perimenopausal women were included in this cross-sectional study of which 85 had new-onset hypertension. All participants underwent 24-hour ambulatory blood pressure monitoring and a clinical assessment including anthropometrics. Sociodemographic, lifestyle, and menopausal symptoms (modified Kupperman Index [mKI]) were measured by questionnaire. A fasting blood sample was taken to measure a wide range of biomarkers and hormone levels. Restricted cubic spline regression was used to investigate potential nonlinearity. Multivariable logistic and robust linear regression analyses adjusting for minimal sufficient adjustment sets based on directed acyclic graphs were performed to test the association of TBIL with hypertension/blood pressure. We examined mKI-stratified analyses and a TBIL-mKI interaction term to explore potential effect modification by number of menopausal symptoms. Hypertensive women had significantly lower TBIL levels than did normotensive women (11.15 vs 12.55 μmol/L, P = 0.046). Univariate restricted cubic spline regression showed nonsignificant nonlinearity ( P value for nonlinearity, 0.339). Multivariable regression analyses adjusted for minimal sufficient adjustment sets revealed that higher TBIL level was associated with lower odds of hypertension (odds ratio, 0.91 per μmol/L TBIL; 95% confidence interval [CI], 0.84-0.98; P = 0.019). Total bilirubin showed a significant inverse association with average 24-hour diastolic blood pressure ( β = -0.36 mm Hg per μmol/L TBIL; 95% CI, -0.62 to -0.10; P = 0.008) but not with 24-hour systolic blood pressure ( β = -0.37 mm Hg per μmol/L TBIL; 95% CI, -0.79 to 0.06; P = 0.090). Stratified analyses suggested stronger inverse associations of TBIL with hypertension and 24-hour blood pressure in women with fewer menopausal symptoms (mKI ≤10), although the TBIL-mKI interaction was not significant. In perimenopause, TBIL was inversely associated with diastolic blood pressure and new-onset hypertension, diagnosed using 24-hour ambulatory blood pressure monitoring.

Effect of intermittent fasting and chronotherapy on blood pressure control in hypertensive patients during Ramadan

Background: During Ramadan, repeated cycles of fasting, associated with alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are rare, and have provided inconclusive results. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive individuals taking their treatment once daily. Material and methods: The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of Habib Thameur Hospital in Tunis. A 24-hour blood pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. We compared the average values of 24-hour awake and asleep systolic and diastolic blood pressure and 24-hour awake and asleep heart rate. Results: We studied 29 women and 15 men, mean age was 58.7 years. Fifteen patients were diabetics, 20 had dyslipidemia and 7 patients had coronaropathy. Twenty patients were on monotherapy, 19 on dual therapy and 5 on a triple antihypertensive therapy. During Ramadan, 25 patients took their treatment during the dinner (group1), whereas 19 took their treatment during the S’hour (group 2). Average 24-hour blood pressure in the whole group was 129 ± 18/74 ± 10 mm Hg before Ramadan and 129 ± 19/74 ± 10 mm Hg during Ramadan (p &gt; 0.05). Daytime and night-time mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significantly higher values of 24-hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the S’hour (p &lt; 0.05). Conclusions: In this study, there were no significant changes in systolic and diastolic blood pressures or in heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the S’hour is observed.

NEPHROPROTECTIVE EFFECT OF RD ACCORDING TO 5-YEAR FOLLOW-UP

Objective: To evaluate the nephroprotective effect of renal denervation (RD) in the form of anatomical and functional preservation of the kidneys in patients with resistant hypertension (RHT) over 5 years of follow-up. Design and method: The data of 23 patients with RHT (average age 57.6 ± 8.3 years) were analyzed. Initially and 6, 12, 24, 36 and 60 months after RD of observation, all patients were measured office and average 24-hour blood pressure (BP) monitoring, kidney function was assessed by serum creatinine and cystatin C levels and the calculation of glomerular filtration rate (eGFR). Non-contrast MRI of the kidneys (magnetic field strength 1.5 T) was performed at all observation points. RD was performed using a renal ablation electrode Symplicity Flex and an automated RF voltage generator Symplicity G2. Results: The average values of creatinine level corresponded to 80.2 ± 14.8 mmol/L, cystatin C – 684.8 ± 86.2 mg/l. According to MRI data, the volume of the right/left kidneys was 174 ± 41.6/ 194.9 ± 52.7 cm3, the cortical layer of the right/left kidneys was 62.7 ± 19.2/67.8 ± 26.1 cm3, respectively. 5 years after RD, there was a pronounced and significant decrease in the daily systolic BP/diastolic BP by -12.7/ -10.4 mmHg, respectively (p = 0.007), which confirms the effectiveness of RD. There was a statistically significant decrease in the volume of the cortex (right/left -24 cm3/21 cm3, p &lt; 0.001), which was accompanied by a significant increase in creatinine ( 7 mmol/L, p = 0.0003) and cystatin C ( -298 mg/L, p = 0.0003), as well as a decrease in eGFR ( -14 ml/min/1.73 m2, p = 0.0005). Nevertheless, the average rate of decrease in eGFR was -2.8 ml/min/1.73 m2/year, which turned out to be significantly lower than those for the specified cohort according to literature sources (-6 ml/min/1.73 m2/year). In the dynamics of observation, eGFR was directly correlated with the volumes of the renal medulla (r = 0.78, p = ,005). Cystatin C correlated with the volume of the renal parenchyma (r = -0.88, p = ,000). Conclusions: RD is a successful way to reduce blood pressure in patients with RHT, allowing to slow down the rate of reduction in the amount of renal parenchyma and the progression of renal dysfunction during 5 years of follow-up.

Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial

IntroductionNew-onset hypertension affects approximately 10% of pregnancies and is associated with a significant increase in risk of cardiovascular disease in later life, with blood pressure measured 6 weeks postpartum predictive...

Unique Associations of DNA Methylation Regions With 24-Hour Blood Pressure Phenotypes in Black Participants.

Epigenetic marks (eg, DNA methylation) may capture the effect of gene-environment interactions. DNA methylation is involved in blood pressure (BP) regulation and hypertension development; however, no studies have evaluated its relationship with 24-hour BP phenotypes (daytime, nighttime, and 24-hour average BPs). We examined the association of whole blood DNA methylation with 24-hour BP phenotypes and clinic BPs in a discovery cohort of 281 Blacks participants using reduced representation bisulfite sequencing. We developed a deep and region-specific methylation sequencing method, Bisulfite ULtrapLEx Targeted Sequencing and utilized it to validate our findings in a separate validation cohort (n=117). Analysis of 38 215 DNA methylation regions (MRs), derived from 1 549 368 CpG sites across the genome, identified up to 72 regions that were significantly associated with 24-hour BP phenotypes. No MR was significantly associated with clinic BP. Two to 3 MRs were significantly associated with various 24-hour BP phenotypes after adjustment for age, sex, and body mass index. Together, these MRs explained up to 16.5% of the variance of 24-hour average BP, while age, sex, and BMI explained up to 11.0% of the variance. Analysis of one of the MRs in an independent cohort using Bisulfite ULtrapLEx Targeted Sequencing confirmed its association with 24-hour average BP phenotype. We identified several MRs that explain a substantial portion of variances in 24-hour BP phenotypes, which might be excellent markers of cumulative effect of factors influencing 24-hour BP levels. The Bisulfite ULtrapLEx Targeted Sequencing workflow has potential to be suitable for clinical testing and population screenings on a large scale.

C3. A case of extreme discrepancy between office and ambulatory blood pressure: is it true uncontrolled hypertension?

Abstract Background White coat uncontrolled hypertension (WCUH), defined as drug-treated hypertension but with increased blood pressure in the office and normal ambulatory blood pressure, should be assessed in patients with uncontrolled hypertension to prevent overtreatment. We report a case of an extreme WCUH found by ambulatory blood pressure monitoring (ABPM). Case Summary A 66-year-old woman was a regular patient in Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto with uncontrolled hypertension, CAD post-PCI, and insulin-dependent type 2 diabetes mellitus. The patient was overweight (BMI was 24.56 kg/m2) with dyslipidemia and uncontrolled blood glucose. Despite aggressive treatment with ARB, CCB, beta-blockers, diuretic, and clonidine, the patient had persistent hypertension with mean office systolic blood pressure &amp;gt;160/90 mmHg. Echocardiography showed concentric left ventricular hypertrophy. ABPM result found extreme variability of blood pressure with the average 24-hour blood pressure of 93.6/59 mmHg (mean daytime blood pressure was 90/55 mmHg and mean night-time blood pressure was 98.7/65.2 mmHg), intermittent hypotension, and reverse dipper pattern. The blood pressure once dropped to the lowest point of 69/44 mmHg, and the highest was 211/186 mmHg. Based on this result, we classified the patient’s condition as WCUH and adjusted the antihypertensive regiment. Discussion This case emphasizes the need to evaluate the presence of WCUH by ABPM in patients with uncontrolled hypertension so antihypertensive drugs could be adjusted accordingly and prevent hypotension.

C3. A case of extreme discrepancy between office and ambulatory blood pressure: is it true uncontrolled hypertension?

Abstract Background White coat uncontrolled hypertension (WCUH), defined as drug-treated hypertension but with increased blood pressure in the office and normal ambulatory blood pressure, should be assessed in patients with uncontrolled hypertension to prevent overtreatment. We report a case of an extreme WCUH found by ambulatory blood pressure monitoring (ABPM). Case Summary A 66-year-old woman was a regular patient in Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto with uncontrolled hypertension, CAD post-PCI, and insulin-dependent type 2 diabetes mellitus. The patient was overweight (BMI was 24.56 kg/m2) with dyslipidemia and uncontrolled blood glucose. Despite aggressive treatment with ARB, CCB, beta-blockers, diuretic, and clonidine, the patient had persistent hypertension with mean office systolic blood pressure &amp;gt;160/90 mmHg. Echocardiography showed concentric left ventricular hypertrophy. ABPM result found extreme variability of blood pressure with the average 24-hour blood pressure of 93.6/59 mmHg (mean daytime blood pressure was 90/55 mmHg and mean night-time blood pressure was 98.7/65.2 mmHg), intermittent hypotension, and reverse dipper pattern. The blood pressure once dropped to the lowest point of 69/44 mmHg, and the highest was 211/186 mmHg. Based on this result, we classified the patient’s condition as WCUH and adjusted the antihypertensive regiment. Discussion This case emphasizes the need to evaluate the presence of WCUH by ABPM in patients with uncontrolled hypertension so antihypertensive drugs could be adjusted accordingly and prevent hypotension.

24-month results and technical approach of catheter-based renal denervation in patients with resistant hypertension

Abstract Aim Increase in efficiency of catheter-based renal denervation (RDN) for the treatment of resistant hypertension. Methods 108 patients with resistant hypertension (inability to achieve target values after lifestyle changes while taking 3 antihypertensive drugs, one of which is a diuretic), were randomized in three groups. In the first two groups (n=36 in each group), RDN were performed using various devices (“Symplicity Flex”, “Symplicity Spyral” and “Vessix Vascular V2”). The third control group included 36 patients who received only standardized antihypertensive therapy (AHT). The fundamental differences in procedure execution in I and II groups were as follows: 1) patients from the I group - RDN were made only of the proximal segment of the renal artery. In group II ablation performed as the proximal segment and the branches of the second and third order, where they can be safe for the patient to deliver the instrument to the electrodes; 2) the number of ablation points in the group II produced more; 3) In the group II ablation was performed in the extension of the renal arteries, while the first group of upper- and lower-pole renal artery no exposure. Inclusion criteria: patients from 18 to 85 years with refractory true systolic-diastolic hypertension I-II degrees (office SBP ≥145 mm Hg. V., DBP ≥90 mm Hg. and non-optimal drug therapy, against which the average 24-hour blood pressure monitoring of SBP ≥145 and/or &amp;lt;170 mm Hg); standardized triple antihypertensive therapy based at least 50% of the maximum tolerated dose for at least 6 weeks of amid lifestyle changes; appropriate renal artery anatomy for endovascular procedures. The primary endpoints: the achievement of the target SBP level (&amp;lt;140 mm Hg) in the first 12 months after RDN according to the results of 24-hour blood pressure monitoring. Results Compared to the baseline blood pressure and 24 months results, the mean SBP and DBP was −5.9 mm Hg, p&amp;lt;0.05 and −3.8 mm Hg, p&amp;gt;0.05. And the maximum decrease in SBP and DBP was noted after 2 years of observation – −9.2 mm Hg, p&amp;lt;0.05 and −4.3 mm Hg, p&amp;lt;0.05, respectively. Also, there was a significant decrease in the daily average and daily average for SBP and DBP for all time of observation. In group III changes were insignificant for the first year of observation: −1.2/0.5 mmHg, p&amp;gt;0.05. After addition of the fourth component AHT 24 month average of SBP and DBP decreased by −4.9/1.9 mmHg, but the p value is not reached the level of less than 0.05. Conclusions Prolonged application of radiofrequency ablation of renal artery and its branches demonstrated similar safety profile and greater efficacy of treatment of patients with resistant hypertension, compared with denervation only the main trunk of the renal artery. Improving the methods and tools for the RDN is a priority for the further development of surgical treatment of arterial hypertension resistant to optimal medical therapy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100

Patient preferences for ambulatory blood pressure monitoring devices: Wrist-type or arm-type?

BackgroundAmbulatory blood pressure monitoring (ABPM) is important in evaluating average 24-hour blood pressure (BP) levels, circadian rhythm, sleeping BP and BP variability but many patients are reluctant to use standard ABPM devices.MethodsWe compared two validated ABPM devices, the BPro tonometric wrist monitor and the A&D TM-2430 oscillometric upper arm monitor, for agreement of recordings and acceptability in 37 hypertensive patients (aged 55±9 years).ResultsSuccessful BP measurements were less frequent with the wrist-type than the arm-type device during the sleeping (66.3% vs. 92.9%, P <0.01) and awake periods (56.2% vs. 86.5%, P <0.01). Comparable paired readings showed no significant difference in systolic BP but diastolic BP (DBP) values were higher with the wrist compared to the arm monitor (24-hour 89±13 vs. 85±14 mmHg, P <0.01) with similar differences awake and sleeping. Bland-Altman analysis showed some large discrepancies between individual arm and wrist monitor measurements. More patients found the wrist monitor more comfortable to use than the arm monitor.ConclusionsDespite the difference in individual BP measurements and the systematic overestimation of DBP values with the BPro device, wrist monitors with good patient acceptability may be useful to facilitate ABPM in some patients to provide additional information about cardiovascular risk and response to antihypertensive therapies.

Morning Surge in Blood Pressure and Stroke Events in a Large Modern Ambulatory Blood Pressure Monitoring Cohort: Results of the JAMP Study.

Morning Surge in Blood Pressure and Stroke Events in a Large Modern Ambulatory Blood Pressure Monitoring Cohort: Results of the JAMP Study.

Twenty-Four-Hour Blood Pressure Variability Is Associated With Lower Cognitive Performance in Young Women With a Recent History of Preeclampsia.

Women with a history of preeclampsia (hxPE) exhibit sustained arterial stiffness and elevated blood pressure postpartum. Aortic stiffness and 24-hour blood pressure variability (BPV) are associated with age-related cognitive decline. Although hxPE is related to altered cognitive function, the association between aortic stiffness and BPV with cognitive performance in young women with hxPE has not been investigated. The objectives of this study were to (i) test whether cognitive performance is lower in young women with hxPE and (ii) determine whether aortic stiffness and BPV are associated with cognitive performance independent of 24-hour average blood pressure. Women with hxPE (N = 23) and healthy pregnancy controls (N = 38) were enrolled 1-3 years postpartum. Cognitive performance was assessed in domains of memory, processing speed, and executive function. Twenty-four-hour ambulatory blood pressure monitoring and carotid-femoral pulse wave velocity (cfPWV) were used to measure BPV and aortic stiffness, respectively. Women with hxPE had slower processing speed (-0.56 ± 0.17 vs. 0.34 ± 0.11 Z-score, P < 0.001) and lower executive function (-0.43 ± 0.14 vs. 0.31 ± 0.10 Z-score, P = 0.004) compared with controls independent of education, whereas memory did not differ. BPV and cfPWV (adjusted for blood pressure) did not differ between women with hxPE and controls. Greater diastolic BPV was associated with lower executive function independent of 24-hour average blood pressure and education in women with hxPE (r = -0.48, P = 0.03) but not controls (r = 0.15, P = 0.38). Select cognitive functions are reduced postpartum in young women with a recent hxPE and linked with elevated 24-hour diastolic BPV.

Ramadan and blood pressure: importance of chronotherapy

Abstract Funding Acknowledgements Type of funding sources: None. Background During Ramadan, alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive subjects taking their treatment once daily. Methods The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of our Hospital. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. Results We studied 29 women and 15 men, mean age was 58.7 years. 34% of the patients were diabetics and 16% had coronaropathy. 46% of the patients were on monotherapy, 43% on dual therapy and 11% on a triple antihypertensive therapy. During Ramadan, 57% of the patients took their treatment during the dinner (group1), whereas 43% took their treatment during the Shour (group 2). Average 24hour blood pressure in the whole group was 129 ± 18/74 ± 10 mmHg before Ramadan and 129 ± 19/74 ± 10 mmHg during Ramadan (p &amp;gt; 0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significant higher values of 24 hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the shour (p &amp;lt; 0.05). Conclusion In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the shour is observed. Average values of BP and heart rate Group 1 Group 2 p 24 hour SBP (mmHg) 134 ± 23 122 ± 6 0.017 24 hour DBP (mmHg) 76 ± 12 70 ± 5 0.052 Awake SBP (mmHg) 138 ± 23 125 ± 6 0.012 Awake DBP (mmHg) 79 ± 12 73 ± 5 0.044 Asleep SBP (mmHg) 127 ± 26 114 ± 12 0.030 Asleep DBP (mmHg) 71 ± 13 65 ± 7 0.045 24 hour average heart rate (bpm) 71 ± 7 70 ± 6 0.524 Awake average heart rate (bpm) 76 ± 7 74 ± 7 0.322 Asleep average heart rate (bpm) 65 ± 7 65 ± 7 0.931 Average values of blood pressure and heart rate in both groups Abstract Figure. 24hour course of blood pressure