24-hour Daytime Research Articles

Relationship between 24-h Ambulatory Blood Pressure Variability and Degree of Renal Artery Stenosis in Hospitalized Patients with Hypertension.

Blood pressure variability (BPV) is a critical risk factor for cardiovascular outcomes and is associated with atherosclerotic renal artery stenosis (ARAS), which is diagnosed using digital subtraction angiography (DSA). However, the relationship between the degree of renal artery stenosis (d-RAS), diagnosed using renal artery contrast-enhanced ultrasound (CEUS), and 24-hour ambulatory BPV in hospitalized patients with ARAS remains unclear. Hospitalized hypertensive patients were divided into ARAS and non-ARAS groups based RAS diagnoses using CEUS. The ARAS patients were further classified into unilateral and bilateral categories. Quantification of BPV over 24 hours, daytime, and nighttime utilized standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Percentage stenosis was used to evaluate d-RAS. Pearson's and multivariate beta regression analyses were used to assess correlations between BPV and d-RAS. We found that 24-hour systolic BPV (SBPV), presented as SD, CV, and ARV indices, was positively correlated with unilateral d-RAS (R1 = 0.460, p = 0.001; R1 = 0.509, p < 0.001; R1 = 0.677, p < 0.001, respectively). This correlation was consistent with the daytime SBPV (R1 = 0.512, p < 0.001; R1 = 0.539, p < 0.001; R1 = 0.678, p < 0.001, respectively) and daytime diastolic BPV (DBPV) (R1 = 0.379, p = 0.010; R1 = 0.397, p = 0.007; R1 = 0.319, p = 0.033, respectively). Similarly, 24-hour DBPV assessed by SD and CV also correlated positively with unilateral d-RAS (R1 = 0.347, p = 0.019; R1 = 0.340, p = 0.022, respectively), as did nighttime SBPV assessed by ARV indices (R1 = 0.415, p = 0.005). No significant correlations were found between BPV and bilateral d-RAS (p > 0.05). Multivariate beta regression analysis indicated that 24-hour SBPV (odds ratio [OR] = 1.035, 95% confidence interval [CI]: 1.054-1.607, p = 0.035) and daytime SBPV (OR = 1.033, 95% CI: 1.004-1.061, p = 0.023; both evaluated via AVR) were independent risk factors for d-RAS. SBPV is positively correlated with unilateral d-RAS at all time points. Both 24-hour and daytime SBPV (evaluated using ARV indices) were identified as independent d-RAS risk factors.

Systematic Review and Meta-Analysis of Second-Generation Sham-Controlled Randomized Trials of Renal Denervation Therapy for Patients with Hypertension.

Renal denervation has been associated with substantial and sustained blood pressure reduction and is considered to serve as an alternative treatment for patients with resistant hypertension. However, the first published SHAM-controlled trial assessing RDN safety and efficacy showed no difference between groups. We aimed to perform a meta-analysis quantifying the magnitude of blood pressure decrease secondary to renal denervation in patients with resistant hypertension. Databases were searched for RCTs that compared RDN therapy to SHAM procedure and reported the outcomes of (1) 24-hour ambulatory blood pressure; (2) Office systolic blood pressure; (3) Daytime systolic blood pressure; and (4) Night-time systolic blood pressure. Mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I² statistics. P values of < 0.05 were considered statistically significant. Statistical analyses were performed using RStudio 4.2.3. Nine studies and 1622 patients were included. The AMBP [MD -3.72 95%CI -5.44, -2.00 p < 0.001; I²=34%] and DSBP [MD -4.10 95%CI -5.84, -2.37 p < 0.001; I²=0%] were significantly reduced in the RDN arm. ODBP [MD -6.04 95%CI -11.31, -0.78 p = 0.024; I²=90%] and NSBP [MD -1.81 95%CI -3.90, 0.27 p = 0.08; I²=0%] did not reach a statistically significant difference between groups. Renal denervation demonstrates greater efficacy in reducing 24-hour ambulatory and daytime systolic blood pressure in patients diagnosed with resistant hypertension.

24-hour arterial stiffness profile in asthma patients with obesity

Obesity is an important comorbidity in patients with asthma, and this combination is associated with increased cardiovascular risk.The aim of the study was to evaluate 24-hour arterial stiffness in asthma patients with excess body weight and obesity.Methods. The study included 100 patients with asthma who were divided into three groups according to their body mass index (BMI). The first group included 36 patients with normal BMI, the second – 40 patients with excess body weight, the third – 24 patients with obesity. The vascular stiffness parameters were evaluated in all patients using BPlab. Аоrtic pulse wave velocity, augmentation index, and arterial stiffness index were also assessed.Results. The 24-hour arterial stiffness, daytime and nighttime arterial stiffness values were increased in the patients with asthma and obesity. More than 80% of the asthma patients with obesity have higher pulse wave velocity in the daytime.Conclusion. Patients with bronchial asthma with obesity represent the risk of developing cardiovascular diseases and their complications.

Association of body composition with ambulatory blood pressure among Chinese youths

BackgroundFor youths, abnormalities in ambulatory blood pressure (ABP) patterns are known to be associated with increased cardiovascular disease risk and potential target organ damage. Body composition, including indicators such as lean mass index (LMI), fat mass index (FMI), and visceral fat level (VFL), plays a significant role in blood pressure (BP) regulation. However, little is known about the association between these body composition indicators and ABP. Therefore, the present study examined the association between these body composition indicators and BP among Chinese youths.MethodsA total of 477 college students aged 17 to 28 years old (mean ± Standard deviation = 18.96 ± 1.21) from a university in Changsha, Hunan Province, China, were included in this study. Body composition indicators were measured with a bioelectrical impedance body composition analyzer, and 24-hour ambulatory blood pressure monitoring (ABPM) was conducted. Multivariable logistic regression was performed to assess the relationship between body composition indicators and abnormal ABP.ResultsThe prevalence of abnormal BP, including 24-hour BP, daytime BP, nighttime BP, and clinic BP, were 4.8%, 4.2%, 8.6%, and 10.9%, respectively. After adjusting for potential covariates, LMI [abnormal 24-hour BP (OR = 1.85, 95%CI:1.31, 2.62), abnormal daytime BP (OR = 1.76, 95%CI:1.21, 2.58), abnormal nighttime BP (OR = 1.64, 95%CI:1.25, 2.14), abnormal clinic BP (OR = 1.84, 95%CI:1.38, 2.45)], FMI [abnormal 24-hour BP (OR = 1.20, 95%CI:1.02, 1.41), abnormal daytime BP (OR = 1.30, 95%CI:1.07, 1.57), abnormal nighttime BP (OR = 1.24, 95%CI:1.10, 1.39), abnormal clinic BP (OR = 1.42, 95%CI:1.22, 1.65)], and VFL [abnormal 24-hour BP (OR = 1.22, 95%CI:1.06, 1.39), abnormal daytime BP (OR = 1.29, 95%CI:1.10, 1.51), abnormal nighttime BP (OR = 1.24, 95%CI:1.12, 1.39), abnormal clinic BP (OR = 1.38, 95%CI:1.21, 1.57)] are positively linked to abnormal BP. Additionally, there were significant sex differences in the association between body composition and abnormal BP.ConclusionsOur findings suggested maintaining an individual’s appropriate muscle mass and fat mass and focusing on the different relations of males’ and females’ body composition is crucial for the achievement of appropriate BP profiles.

Abstract P362: The Associations of Neighborhood Social and Built Environments with Ambulatory Blood Pressures in Young Adults of the Georgia Stress and Heart Cohort

Ambulatory blood pressure monitoring (ABPM) is an assessment method in which BP measurements are taken at regular intervals when individuals are awake and asleep, during a typical 24-hour period. Thus, ABPM is an accurate and effective way to measure BP. Neighborhood social and built environments play an important role in health, which were previously associated with cardiovascular risk factors. However, the effects of neighborhood social and built environments on ABPM is understudied, particularly among young adults and African Americans. The current study aimed to investigate the cross-sectional associations between neighborhood social and built environments and ABPM in our Georgia Stress and Heart Cohort consisting of 543 participants, aged 29.1 ± 3.6 years, 49.7% African American and 51.2% female. There were found to be consistent positive associations of neighborhood social and built environments with 24-hour systolic BP (SBP), 24-hour diastolic BP (DBP), daytime SBP, daytime DBP, nighttime SBP, and nighttime DBP ( p ≤0.01, respectively), after the adjustment for age, race and sex. Neighborhood factors such as Median Household Income and College Graduation held the negative associations with measurements of 24-hour SBP, 24-hour DBP daytime SBP, daytime DBP, nighttime SBP, nighttime DBP, and 24-hour SBP ( p ≤0.01, respectively). This study is one of the first to report the relationship between neighborhood social and built environments and ABP, particularly in young adults and African Americans residing in the US southeastern region. Future longitudinal studies are warranted to further support the findings of the current study.

The Efficacy of Renal Denervation in Treating Resistant Hypertension: A Systematic Review.

Resistant hypertension is blood pressure (BP) that is persistently above target in spite of the maximally tolerated usage of at least three anti-hypertensives simultaneously. The sympathetic nervous system is instrumental in blood pressure (BP) regulation. Renal (sympathetic) denervation involves using ablative energy to disrupt the sympathetic nerves in renal arteries. This systematic review examines the efficacy of this treatment modality. Abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted an extensive literature search in five databases, Cochrane Library, Google Scholar, PubMed, PubMed Central (PMC), and ScienceDirect, to retrieve studies that are free, open access, and published in English done within the past four years. Nineteen articles passed critical appraisal. These articles were randomized controlled trials (RCT), a case report, a cross-sectional study, a cohort study, and previous reviews. Renal denervation (RDN) was generally superior to sham control in patients with resistant hypertension for reducing various systolic blood pressure (SBP) measures, including 24-hour ambulatory, daytime, and nighttime SBP. The efficacy was highest in patients whose baseline SBP was higher. BP reduction was sustained for years post-procedure. The procedure had a good safety profile with no severe complications. Future studies should compare the efficacy of different types of renal denervation, such as ethanol ablation versus radiofrequency ablation, and renal denervation against other procedure-based treatment modalities,such as carotid baroreceptor stimulation and transcranial direct current stimulation.

Relation between blood pressure time in range and composite cardiovascular outcomes in patients with primary aldosteronism: a retrospective case study.

To investigate the association between blood pressure (BP) time in range (TIR) and composite cardiovascular outcomes in patients with primary aldosteronism (PA). Between January 2019 and December 2021, 47 patients with PA were recruited from the First Affiliated Hospital of Xiamen University. Twenty-four-hour ambulatory BP monitoring (ABPM) and cardiovascular outcomes were assessed in all patients during the first diagnosis of PA. The mean age of the patients was 48.8 ± 11.4 years. Compared to PA without composite cardiovascular outcomes, the nighttime systolic BP TIR [31.2% (6.2%, 81.2%) vs. 11.5% (0.0%, 29.7%), p = 0.02] and defined daily dose (DDDs) of antihypertensive medication [2.0 (1.0, 2.8) vs. 1.0 (1.0, 2.0), p = 0.03] were lower in PA patients with composite cardiovascular outcomes, while higher glucose (5.0 ± 1.0 mmol/L vs. 5.9 ± 1.5 mmol/L) and prevalence of a history of alcohol intake was higher in PA patients with composite cardiovascular outcomes. There were no differences in age, sex, BMI, smoking, duration of hypertension, lipid levels, aldosteronism, clinic BP, 24-hour mean BP, daytime or nighttime BP, percentage of nocturnal SBP or DBP decline, 24-hour BP TIR, daytime BP TIR, or nighttime DBP TIR between the two groups. After adjusting for confounding factors, nighttime systolic BP TIR was significantly associated with composite cardiovascular outcomes (adjusted OR = 0.92 [95% CI 0.86, 0.99]) in multiple logistic regression analysis. Nighttime systolic BP TIR was significantly associated with composite cardiovascular outcomes in patients with PA.

Association of a Healthy Lifestyle With Ambulatory 24-Hour Blood Pressure Among Chinese Youths: A Cross-Sectional Study.

This study aims to explore the association between a healthy lifestyle and abnormal ambulatory blood pressure (ABP) in Chinese youths. A school-based sample of 1,296 college students was investigated. A lifestyle score was calculated by synthesizing 5 lifestyle factors, including smoking, alcohol consumption, diet, physical activity, and sleeping. The total score ranged from 0 to 5, with a higher score indicating a healthier lifestyle. This score was then divided into 3 categories representing low adherence to a healthy lifestyle (0-2), medium adherence (3), and high adherence (4-5). Abnormal 24-hour blood pressure (BP) was defined as systolic BP (SBP) ≥ 130 mm Hg and/or diastolic BP (DBP) ≥ 80 mm Hg. Abnormal daytime BP was determined as daytime SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg, while abnormal nighttime BP was characterized as nighttime SBP ≥ 120 mm Hg and/or DBP ≥ 70 mm Hg. We assessed the associations using the binomial regression model. Mean age was 18.81 years, and 74.5% were women. The prevalence of abnormal 24-hour BP, daytime BP, and nighttime BP are 4.2%, 3.7%, and 9.0%, respectively. We found that participants with a high level of adherence to a healthy lifestyle had a significantly lower prevalence of abnormal 24-hour BP [prevalence ratios (PR) = 0.15, 95% CI: 0.05, 0.48] and abnormal daytime BP (PR = 0.16, 95%CI: 0.05, 0.52), when compared to those with a low level of adherence and after adjusting for the potential covariates. A healthier lifestyle is associated with a better ambulatory BP profile among youths.

CORRELATION ANALYSIS BETWEEN VASCULAR OVERLOAD INDEX AND LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSION

Objective: The vascular overload index (VOI) is commonly used to assess the’overload’phenomenon induced by hypertension,and vascular overload is one of the pathogenic mechanisms for left ventricular hypertrophy(LVH)associated with hypertension. The left ventricular mass index (LVMI) is the most frequently used diagnostic indicator for LVH. Research has found that VOI derived from office blood pressure readings is correlated with LVH,but it doesn’t evaluate the relationship between vascular load during different periods of the day and LVH. This study aims to investigate the correlation between VOI obtained from 24-hour ambulatory blood pressure and LVH. Design and method: A total of 591 hypertensive patients hospitalized from July 2020 to July 2022 were included. Echocardiography was performed in each patient,and the LVMI was calculated; The 24-hour VOI(VOI24h=1.33×SBP24h-0.33×DBP24h-133.3mmHg),daytime VOI(VOId),and nighttime VOI(VOIn)were calculated based on the 24-hour ambulatory blood pressure results. A multivariate logistic regression was utilized to explore the correlation between VOI at different times and LVH,adjusting for covariates such as gender,age,BMI,triglycerides,cholesterol,HDLand LDL. Results: The age of the 591 hypertensive patients was 63.8±13.3years and BMI was 25.7±3.6Kg/m2.Univariate linear regression analysis showed that VOI24h,VOId,and VOIn were positively correlated with LVMI(P&lt;0.001). After adjusting,all of VOI remained correlated with LVMI. Compared with the lowest tertile of VOI24h, the highest tertile had β (95%CI) of 9.25(6.09∼12.4). For VOId,the highest tertile compared to the lowest had β (95%CI) of 8.70(5.55∼11.86),and for VOIn,it was 9.48(6.32∼12.64).Univariate logistic regression analysis indicated that all of VOI were significantly associated with LVH(P&lt;0.001),and after adjusting for confounders,all of VOI still correlated with LVH,with OR(95%CI)respectively being 1.04(1.02∼1.07),1.04(1.02∼1.07),and 1.03(1.01∼1.05). Subgroup analysis revealed that regardless of the comorbidity of the hypertensive patients,all of VOI were all related to LVH.However, when analyzed by season,VOI24h and VOId were significantly associated with LVH in summer and winter, but not in spring and autumn; VOIn was only associated with LVH in winter. Conclusions: In the hypertensive patients,VOI derived from 24-hour ambulatory blood pressure is significantly correlated with LVH. Compared to spring and autumn,vascular load during summer and winter is significantly associated with LVH. Therefore,not only should steady blood pressure control over 24 hours be emphasized,but also pay attention to the impact of vascular load on LVH during summer and winter.

Effect of Accessory Renal Arteries on Essential Hypertension and Related Mechanisms.

This case-control study aimed to determine whether there were differences between patients with essential hypertension with accessory renal arteries (ARAs) and those without ARAs. The enrolled patients with essential hypertension were divided into the ARA group (n=200) and control group without ARAs (n=238). After propensity matching, 394 patients (197 in each of the 2 groups), were included. The 24-hour BP (4.33/2.43 mm Hg) and daytime BP (4.48/2.61 mm Hg) of patients in the ARA group were significantly higher than those of the control group (P<0.05). The flow-mediated dilation was lower in the ARA group (5.98±2.70 versus 5.18±2.66; P<0.05). In correlation analysis, the horizontal plasma aldosterone concentration had the highest correlation with 24-hour, daytime, and nighttime systolic BP (r=0.263, 0.247, and 0.243, respectively; P<0.05) and diastolic BP (r=0.325, 0.298, and 0.317, respectively; P<0.05). As for multivariate regression analysis, plasma aldosterone concentration was a significant risk factor for elevated 24-hour, daytime, and nighttime systolic BP (β=0.249 [95% CI, 0.150-0.349], 0.228 [95% CI, 0.128-0.329], and 0.282 [95% CI, 0.187-0.377], respectively; P<0.05) and elevated diastolic BP (β=0.289 [95% CI, 0.192-0.385], 0.256 [95% CI, 0.158-0.353], and 0.335 [95% CI, 0.243-0.427], respectively; P<0.05). Direct renin concentration was also a risk factor for 24-hour and daytime BPs, whereas heart rate was a risk factor correlated with 24-hour, daytime, and nighttime diastolic BP (all P<0.05). For the mixed-effects model for repeated measures, the results were similar to results of the multivariate regression analysis (all P<0.05). ARAs could contribute a higher BP of patients with essential hypertension and might promote the development of essential hypertension. The mechanism might be related to overactivation of the renin-angiotensin-aldosterone system and sympathetic nervous system.

Ambulatory blood pressure monitoring in pediatric patients with sickle cell anemia.

Sickle cell anemia (SCA) is a hemoglobinopathy presenting severe endothelial damage associated with increased prevalence of hypertension (HTN). Few studies have used ambulatory blood pressure monitoring (ABPM) in pediatric patients with SCA. The aim of this study was to characterize the ABPM profile in children with SCA. A retrospective cross-sectional study was conducted on all subjects <18 years of age with SCA who presented at a medical reference center in the city of Cartagena, Colombia. Anthropometric, clinical laboratory, treatment, and ABPM parameters, including ambulatory arterial stiffness index (AASI) were registered. The study included 79 patients, of these, 23 (29%) children had normal BP, 49 (62%) had abnormal BP and 7 (9%) had HTN. Mean age was 10.5 ± 3.6 years and 44 (56%) cases were male. Forty-eight (60%) patients had pre-HTN. Masked HTN was present in 6 (8%) patients. One (1%) had ambulatory HTN, and another one (1%) had white coat HTN. The HTA group exhibited significantly higher systolic BP and diastolic BP compared to the other groups in 24-hour BP readings, daytime BP, and night-time BP ABPM parameters ( P < 0.05), except for daytime DBP ( P = 0.08). Mean AASI was 0.4 ± 0.2. The HTN group had the highest AASI value compared to the other groups ( P = 0.006). Significant alterations in ABPM parameters are frequently observed in pediatric patients with SCA. The incorporation of ABPM, along with the assessment of AASI, is recommended for a comprehensive evaluation of cardiovascular and renal risk in SCA patients.

Effects of chlorthalidone plus amiloride compared with amlodipine on short-term blood pressure variability in individuals with hypertension and obstructive sleep apnea: a randomized controlled trial.

To compare the effects of chlortalidone plus amiloride and amlodipine on blood pressure (BP) variability in patients with hypertension and obstructive sleep apnea syndrome (OSA). A randomized, controlled, double-blind trial enrolled men and women aged 40 years or older with a diagnosis of OSA (apnea-hypopnea index 10-40 apneas/h of sleep) confirmed by overnight laboratory polysomnography and systolic BP 140-159 mmHg or diastolic BP 90-99 mmHg. Participants were randomized to receive chlortalidone 25 mg plus amiloride 5 mg daily or amlodipine 10 mg daily for 8 weeks. BP variability was calculated from 24-hour ambulatory BP monitoring at baseline and follow-up using the following indices: SD, coefficient of variation, average real variability (ARV), time-rate index, and variability independent of the mean (VIM). The study included 65 patients, with 33 assigned to the chlortalidone plus amiloride group and 32 to the amlodipine group. Participants in both groups had similar baseline characteristics. Short-term BP variability decreased within groups for SD and ARV indexes for 24-hour systolic BP and daytime systolic BP, but statistically significant time*group interactions were found for sleep systolic SD and VIM, with greater reduction in patients treated with amlodipine. In brief, our study has shown that the use of chlorthalidone in combination with amiloride and amlodipine produces comparable effects on short-term BP variability in patients with hypertension and OSA. Therefore, our findings suggest that BP variability may not be a significant factor when choosing between these medications for the treatment of hypertension and OSA.

THE IMPACT OF COVID-19 PANDEMIC ON BLOOD PRESSURE CONTROL IN PATIENTS WITH TREATED HYPERTENSION. RESULTS OF EUROPEAN SOCIETY OF HYPERTENSION STUDY (ESH ABPM COVID-19 STUDY)

Objective: We aimed to assess the impact of the COVID-19 pandemic on blood pressure (BP) control assessed by office and ambulatory blood pressure monitoring (ABPM) in patients with treated hypertension. Design and method: Clinical and BP data were collected from 32 centres including Excellence Centres of the European Society of Hypertension. Two groups of patients were compared. Group1 (‘pandemic’) consisting of participants who have undergone two ABPM recordings (visits): visit-2 during the COVID-19 pandemic, and visit-1 performed 9 - 15 months prior to visit-2. Participants in Group2 (‘pre-pandemic’) had two repeated ABPMs, both performed before the pandemic within 9 - 15 months interval between visits. Results: Overall, 3384 ABPMs were collected from 1692 patients (50.5% men). 759 patients constituted Group1 and 933 patients Group2. Study groups did not differ regarding sex, age, or body weight. The duration of hypertension and frequency of first-line antihypertensive drug use at visit-1 were also similar in both groups. Beta-blockers were the only class of drugs with a significant decrease between visits (difference between visit-2 and visit-1) in Group1. At visit-1, there were no differences in all BP phenotypes (office and ABPM values) or hypertension control rates (27% vs 26.6%; p = 0.62) between study groups. At visit-2 significantly higher office BP was observed in Group1 compared to Group2, with a mean difference of +2.09 mmHg (p = 0.028) and +1.39 mmHg (p = 0.026) for systolic (SBP) and diastolic (DBP) BP, respectively. Moreover, on visit-2, higher 24-hour daytime and nighttime SBP and DBP were observed in Group1 as compared to Group2. Of note, the prevalence of uncontrolled hypertension (when considering both office and ABPM) was also higher at visit-2 in Goup1 than in Group2 (25.8% vs 20.0%; p = 0.005). Both SBP and DBP, regardless of the measurement method, dropped between visit-1 to visit-2, but to a lesser extent in Group1. Thus, the magnitude of BP decrease between visits was smaller in Group1 (delta24SBP: -1.04 vs -3.2 mmHg; p &lt; 0.001 and delta24DBP: -1.22 vs -1.93 mmHg; p = 0.038). Conclusions: The results of the study indicate a negative impact of the COVID-19 pandemic on BP control both in office and during ABPM.

Correlation between 24-Hour Ambulatory Blood Pressure Variability and White Matter Lesions in Patients with Cerebral Small Vascular Disease: A Cross-Sectional Study.

Objective The goals of this study are to assess the correlation between 24-hour ambulatory blood pressure (BP) variability and white matter lesions (WML) in patients with cerebral small vascular disease (CSVD) and to provide guidance for the prevention of WML. Methods A total of 136 patients diagnosed with CSVD and essential hypertension were recruited and divided into two groups. The Fazekas scale was used to quantify the severity of WML. The basic information, BP levels, BP variability, and circadian rhythm changes across these groups were recorded and compared. Results The control group consisted of 40 subjects without WML (Fazekas score = 0), and the WML group was composed of 96 patients with WML (Fazekas score ≥ 1). Patients in the WML group were then divided into three subgroups: mild WML (n = 43, Fazekas score = 1), moderate WML (n = 24, Fazekas score = 2), and severe WML (n = 29, Fazekas score = 3–4). Age, history of diabetes, and serum uric acid levels were significantly increased between the WML and control groups (P < 0.05). The levels of 24-hour mean diastolic BP (F = 3.158, P = 0.026) and daytime mean systolic BP (F = 3.526, P = 0.017) were significantly increased between the control and WML groups. There was no significant difference in the rhythmic classification of BP among all groups (P > 0.05). An ordered multinomial logistic regression analysis revealed that age, triglyceride levels, and nondipper BP were independent risk factors in WML. Conclusion Age, history of diabetes, serum uric acid levels, 24-hour mean systolic level, and daily mean systolic BP level were significantly increased between the WML and control groups. Age, triglyceride levels, and nondipper BP were independent risk factors in WML in patients with CSVD, while the 24-hour dynamic blood pressure standard deviation and 24-hour dynamic blood pressure coefficient of variation were not associated with the occurrence of WML.

Greater adherence to healthy dietary patterns is associated with lower diastolic blood pressure and augmentation index in healthy, young adults

More than two-thirds of cardiovascular disease (CVD) deaths worldwide are attributable to dietary factors. Blood pressure variability (BPV), endothelial dysfunction, and arterial stiffness are important CVD risk factors. Although studies show a link between consuming a healthy diet and lower BPV and stiffness and improved endothelial function, research in young, healthy adults is scarce. We hypothesized that, in young, healthy adults, diet quality would be inversely associated with BPV and arterial stiffness and positively associated with endothelial function. This cross-sectional study included 56 healthy young adults (34 women/22 men, age 26.7 ± 0.8 years, body mass index 23.4 ± 0.4 kg/m2, blood pressure [BP] 113/69 mmHg). Three-day diet records were used to calculate two Dietary Approaches to Stop Hypertension (DASH) diet scores, the alternative Mediterranean Diet (aMED) score, and the Healthy Eating Index-2015 (HEI-2015) based on the 2015-2020 Dietary Guidelines for Americans. Twenty-four-hour ambulatory BP data were used to calculate average real variability of systolic and diastolic BP. Endothelial function was assessed by flow-mediated dilation, and arterial stiffness was assessed by pulse wave velocity and augmentation index (AIx). Overall, the HEI-2015 was inversely associated with 24-hour diastolic BP (DBP) and daytime DBP, and the aMED score was inversely associated with AIx. In our exploratory analyses, the Fung DASH score was inversely associated with 24-hour DBP and daytime DBP in women, but not men. These findings suggest that consuming a diet that aligns with the DASH diet, the Mediterranean diet, and/or the 2015-2020 Dietary Guidelines for Americans is associated with cardiovascular benefits in healthy, young adults.

Effect of acetazolamide on obstructive sleep apnoea in highlanders: protocol for a randomised, placebo-controlled, double-blinded crossover trial

IntroductionObstructive sleep apnoea (OSA) is a highly prevalent disease that causing systemic hypertension. Furthermore, altitude-dependent hypobaric hypoxic condition and Tibetan ethnicity have been associated with systemic hypertension independent of OSA,...

Home and ambulatory blood pressure levels below target range and clinical effort to detect this condition: a population-based study in older treated hypertensives.

With implementation of stricter blood pressure (BP) treatment targets, potential for excessive BP lowering becomes an important issue, especially in older patients. Assess the magnitude, indicators and detection effort of BP levels below-target-range (BTR-BP) recommended by the European hypertension guidelines in older treated hypertensive patients (130-139/70-79mmHg). Cross-sectional, retrospective study (Seniors-ENRICA-2 cohort). General population. 1,329 treated hypertensive patients aged ≥65, assessed with three home casual BP measurements and 24-hour ambulatory BP monitoring (ABPM). Based on the European hypertension guidelines and the literature, BTR-BPs were defined as mean BP <130/70, <125/65, <130/70 and <110/55mmHg, for casual BP, 24-hour BP, daytime BP and nighttime BP, respectively, and hypotension as <110/70, <105/65, <110/70 and <90/55mmHg, respectively. Participants' mean age was 72 ± 4.4 (50.3%, women). Based on casual BP, 7.2% of patients were in target range (130-139/70-79mmHg), 44.3% in BTR-BP (<130/70) and 20.8% hypotensive (<110/70). Some 44.9, 54.9 and 22.0% of patients were in BTR-BP for 24-hour BP, daytime BP and nighttime BP, respectively, and 11.0, 21.1 and 5.6%, respectively, were hypotensive. The number of patients needed for ABPM to detect one case of 24-hour-, daytime-, and nighttime-BTR-BP was 3, 2 and 5, respectively, and 10, 5 and 18, respectively, for detecting one hypotensive case. Cardiovascular disease and female sex were associated with both BTR-BP and hypotension, and the number of antihypertensive drugs was only associated with hypotension. BTR-BP levels were common in older treated patients at home and in everyday life, more frequent than many trials report, and daytime ABPM is highly size-efficient for detecting the low ambulatory BP conditions.

AMBULATORY BLOOD PRESSURE VARIABILITY IN YOUNG ADULTS WITH LONG-COVID SYNDROME.

The aim: To perform an overall assessment of BP and BP variability using ambulatory measurements in young adults with long COVID syndrome. Materials and methods: We enrolled young patients with diagnosed long-COVID syndrome (n = 58, mean age 23.07 ± 1.54 years), compared with an age-matched healthy subjects who had not suffered from COVID-19 (n = 57, mean age 22.9 ± 1.83 years). Patients with long-COVID syndrome had recovered from mild/moderate illness and none had required hospitalization. Ambulatory 24 hours blood pressure (AMBP) parameters (mean BP, daytime BP, nighttime BP, pulse pressure, nocturnal systolic BP dipping, dipper status) were measured in all participants. The variability of systolic BP (SBP) and diastolic BP (DBP) values was assessed by the following common metrics, including the average real variability (ARV), the coefficient of variation (CV), the standard deviation (SD), and the weighed SD of SBP and DBP. Results: The average values of 24-hour ambulatory blood pressure, mean BP, daytime and nighttime systolic BP, diastolic BP and pulse pressure were found to be significantly different among patients with long COVID syndrome and control group. Group analyses showed that this difference was in SBP mean values (127.1 ± 6.65 mmHg and 115.93 ± 6.24 mmHg respectively) and DBP mean values (73.31 ± 5.30 mmHg and 68.79 ± 5.5 mmHg respectively) mainly at night. PP values at daytime were almost similar among groups, but PP values at nighttime were higher in patients with long-COVID syndrome (53.8 (52.44- 55.14) mmHg and 47.14 (46.45 - 47.88) mmHg respectively). Nocturnal SBP dipping was better in control group than in patients with long-COVID syndrome ( 5.3 ± 5.68 and 3.1 ± 3.79 mmHg respectively). Only 13 (22.4%) patients with long-COVID syndrome had normal dip-per status while more than half - 38 (66.7%) in healthy subjects. The values of ARV of SBP and DBP over 24-hour, awake, and asleep time frames were found to be greater in patients with long COVID syndrome than healthy controls (p < 0.05). Conclusions: Patients with long- COVID syndrome have higher BP mean values of 24-hour ABPM particularly at nightime, significant blood pressure BP variability, which increases the risk of cardiovascular events in future. Nevertheless, the further prospective investigations is warranted to investigate the potential mechanisms and causality associations.

Paradoxical increase in ambulatory systolic blood pressure in coarctation of aorta as compared to idiopathic hypertension

Abstract Background The relationship between office vs ambulatory blood pressure (BP) indices is well-studied in patients with idiopathic hypertension, and based on these data, it is known that average 24-hour ambulatory BP is typically lower than office BP. However, emerging data show that office systolic BP (SBP) underestimates arterial afterload in patients with coarctation of aorta (COA), and minimal increase in stroke volume during low intensity exercise results in exaggerated rise in SBP as compared to those with idiopathic hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with idiopathic hypertension. Methods Case-control study of 118 COA patients and 118 patients with idiopathic hypertension matched by age, sex, body mass index and office SBP. Results Although both groups had similar office SBP (132±17 mmHg) by design, the COA group had paradoxical increases in 24-hour ambulatory SBP (135±14 vs 126±13, p&amp;lt;0.001) and daytime ambulatory SBP (142±16 vs 130±13, p&amp;lt;0.001), and less nocturnal dipping (−3±5 vs −9±4, p&amp;lt;0.001). The COA group also had a higher prevalence of masked hypertension (36 [31%] vs 14 [12%], p&amp;lt;0.001), and worse arterial function indices. Conclusion These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating idiopathic hypertension guidelines recommendations to the treatment of COA. It also provides rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population. Funding Acknowledgement Type of funding sources: None.

P1287A COMPARATIVE STUDY OF BLOOD PRESSURE VARIABILITY INDICES BETWEEN PATIENTS UNDERGOING PERITONEAL DIALYSIS AND THOSE UNDER HEMODIALYSIS OR WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Blood pressure variability (BPV) indices have been independently associated with cardiovascular events and mortality in hemodialysis (HD) patients. Data on short-term BPV in patients on peritoneal dialysis (PD) are totally absent. This study examined short-term BPV parameters of patients undergoing PD in comparison to HD and pre-dialysis chronic kidney disease (CKD) patients. Method 38 PD patients were matched for age, gender and dialysis vintage with 76 HD in 1:2 ratio patients and for age and gender with 38 patients with CKD stage 2-4 in 1:1 ration. BPV parameters [standard deviation (SD), weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were calculated from data from 48hour (PD, HD) and 24hour (CKD) ambulatory BP monitoring according to validated formulas. Results There were no significant differences in BPV indexes studied between PD and HD patients but all BPV indexes in these patients were numerically higher than those in CKD patients. Systolic ARV was significantly higher in PD or HD compared with predialysis CKD during the first and the second interdialytic 24hour periods, both daytime period and nighttime 2 (1st 24hour period: PD:11.86±3.19; HD:11.23±3.45; CKD:9.81±2.49, p=0.016, 2nd 24hour period: PD: 12.18±4.11; HD: 12.96±4.57; CKD: 9.81±2.49, p&amp;lt;0.001). Analysis of diastolic ARV and systolic and diastolic wSD showed similar results. Τhere were no differences with regards to dipping pattern and systolic and diastolic CV during all periods studied. Conclusion BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. Despite what was theoretically expected, PD patients demonstrate high fluctuations in BP in the absence of abrupt shifts in volume.