24-hour Diastolic Blood Pressure Research Articles

Dietary metabolites and blood pressure regulation in dietary feeding interventions: a systematic review

Hypertension, characterised by elevated blood pressure (BP), continues to be a major global public health problem. It is defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmH(1) and is the leading risk factor for cardiovascular diseases(2). Nutritional metabolomics (Nutrimetabolomics) presents an objective approach to explore the interplay between diet and health outcomes(3). Through analysis of intermediate molecules and metabolic byproducts, metabolomic profiles can objectively reflect an individual’s dietary intake and assess variations in metabolism(3). To date, no review has been conducted that investigates the relationship between diet, metabolites and BP regulation. This systematic review aimed to identify and synthesise findings of human dietary feeding intervention studies that have examined the role of metabolites in BP regulation. A comprehensive search was conducted in November 2022 across EMBASE, Medline, CINAHL, PsychINFO, Scopus and Cochrane databases. Search terms were defined using a combination of keywords, including “metabolome”, “diet”, and “blood pressure”. All included intervention studies explored the dietary metabolome from food provision, meals or supplements to a comparator or control intervention and, examined the relationship between dietary-related metabolites and BP in humans and published in English. The initial search identified 1,109 studies, with a final six studies meeting all eligibility criteria and included in the final review. Metabolites were identified in urine (n = 4), plasma (n = 2), or faeces (n = 1). Various analytical techniques were employed, including H-NMR, LC-MS, and GC-MS, while majority of studies used untargeted metabolomics (n = 4). Among included studies, five reported a significant association between individual metabolites and BP or change in BP. These investigations emphasised dietary patterns as the primary focus of analysis. In contrast, one study revealed no relationship between the investigated metabolites and BP. However, this particular study evaluated the impact of a single food product rather than dietary patterns. In total, 39 metabolites were linked to BP, with 36 associated with SBP and 25 with DBP. Several super-pathways involved in blood pressure regulation were identified, across metabolism of amino acids, carbohydrates, cofactors, vitamins, lipids, nucleotides, peptides, and xenobiotics. Within these, 17 distinct sub-pathways were delineated. The only metabolite found to have a significant relationship with BP measures across multiple studies was N-Acetylneuraminate. In one study, it showed a relationship with DBP, while another study linked it to a decrease in both 24-hour DBP and SBP. No other metabolites were consistently replicated between studies. Nutrimetabolomics appears to be a promising field in evaluation of diet and BP reduction. However, further research is required to understand which metabolites influence BP regulation.

Analysis of the Relationship between Recent Small Subcortical Infarcts and Autonomic Nervous Dysfunction.

Autonomic Nervous System (ANS) dysfunction may be involved in the pathogenesis of Cerebral Small Vessel Disease (CSVD). The study aimed to explore the relationship between Recent Small Subcortical Infarct (RSSI) and Blood Pressure Variability (BPV), and Heart Rate Variability (HRV). A total of 588 patients from the CSVD registration research database of Henan Province were included in this study, and were divided into two groups according to the presence of RSSI. Clinical data, including demographic characteristics, disease history, laboratory indexes, 24-hour ambulatory blood pressure and electrocardiogram indicators, and imaging markers of CSVD, were collected. Univariate and binary logistic regression analyses were used to study the relationship between RSSI and indicators of laboratory, HRV and BPV in the CSVD population. Multivariate analysis showed that higher 24-hour mean Diastolic Blood Pressure (DBP)[Odds Ratios (OR)=1.083,95% Confidence Intervals (CI)=(1.038,1.129), p < 0.001], Standard Deviation (SD) of 24-hour DBP [OR=1.059,95%CI=(1.000,1.121), p = 0.049], nocturnal mean Systolic Blood Pressure (SBP) [OR=1.020,95%CI=(1.004,1.035), p = 0.012], nocturnal mean DBP [OR=1.025,95%CI=(1.009,1.040), p = 0.002] were independent risk factors for RSSI. In contrast, the decrease of the standard deviation of N-N intervals (SDNN) [OR=0.994,95%CI=(0.989,1.000), p = 0.035] was beneficial to the occurrence of RSSI. In addition, neutrophil counts [OR=1.138,95%CI=(1.030,1.258), p = 0.011], total cholesterol (TC) [OR=1.203,95%CI=(1.008,1.437), p = 0.041] and High-Density Lipoprotein (HDL) [OR=0.391, 95%CI=(0.195,0.786), p = 0.008] were also independently associated with the occurrence of RSSI. After adjusting for confounding factors, except for TC, the other factors remained associated with the occurrence of RSSI. Increased 24-hour mean DBP, nocturnal mean SBP and DBP, SD of 24-hour DBP and decreased SDNN were independently correlated with RSSI occurrence, suggesting that sympathetic overactivity plays a role in the pathogenesis of RSSI.

A brief overview of modern approaches to the therapy of resistant arterial hypertension

Resistant hypertension is associated with increased mortality and morbidity. The optimal drug therapy for resistant hypertension has not been fully clarified, there are few studies on this issue in the literature. We compared the efficacy of nebivolol 5 mg, a third-generation beta-blocker, with spironolactone 25 mg in patients with resistant hypertension.&#x0D; 81 patients with resistant hypertension were included in the study. Resistant hypertension was defined as the presence of official blood pressure ≥ 140/90 mm Hg. when patients received 3 or more antihypertensive drugs, including diuretics. Blood pressure was recorded in office and outpatient settings at baseline and after 8 weeks of treatment.&#x0D; Office systolic blood pressure and diastolic blood pressure at 24-hour ambulatory blood pressure monitoring were significantly lower compared to baseline values in the nebivolol and spironolactone groups. The decrease in 24-hour mean systolic and diastolic blood pressure in the nebivolol group was 14.9±19.8 mm Hg. Art. and 9.3±12.7 mm Hg. Art. compared to 19.5±16.4 mm Hg. Art. and 13.7±10.8 mm Hg. Art. in the spironolactone group, respectively. The reduction in 24-hour mean systolic and diastolic blood pressure was not significantly different between the nebivolol and spironolactone groups (P = 0.338 and P = 0.153).&#x0D; Therefore, nebivolol is an effective treatment option for resistant hypertension, and the antihypertensive effect of this drug is similar to low doses of spironolactone.

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.

Effect of vitamin B2, vitamin C, vitamin D, vitamin E and folic acid in adults with essential hypertension: a systematic review and network meta-analysis

ObjectivesThe objective of the current study is to compare the treatment effects of different vitamins on essential hypertension to provide an initial basis for developing evidence-based practices.DesignSystematic review and network...

The correlation between ambulatory blood pressure parameters and cardiovascular risk factors in older adults with high-risk hypertension

Objective: To explore the correlation of 24-hour ambulatory blood pressure (BP) monitoring (ABPM) parameters and cardiovascular risk factors in older adults with high-risk hypertension. Material and method: A cross-sectional study was conducted on 96 older adults (≥ 60 years old) with treated high-risk hypertension. Socio-demographic and cardiovascular risk information were gathered. The patients were performed 24-hour ABPM. Results: The mean age was 70.88 ± 7.86 years, and 64.6% were women. The prevalence of cardiovascular risk factors was as follows: dyslipidemia: 80.2%, family history of hypertension: 54.2%, diabetes mellitus: 51%, smoking: 24%, prior stroke: 11.5%. Significant differences in 24-hour, awake, and sleep systolic BP were observed between men and women. There were significant correlations between 24-hour mean systolic BP with age (r = 0.229, p = 0.025), dyslipidemia (r = 0.223, p = 0.029), family history of hypertension (r = 0.214, p = 0.036), BMI (r = 0.212, p = 0.039), waist circumference (r = 0.226, p = 0.027) and creatinine level (r = 0.207, p = 0.043). There were significant correlations between 24-hour mean diastolic BP with BMI (r = 0.289, p = 0.004) and prior stroke (r = -0.224, p = 0.029). There were significant correlations between 24-hour mean BP with BMI (r = 0.268, p = 0.009), waist circumference (r = 0.220, p = 0.032) and prior stroke (r = -0.215, p = 0.036). Conclusion: There were significant correlations between ABPM parameters and cardiovascular risk factors in older adults with high-risk hypertension. Key words: 24-hour ambulatory blood pressure, cardiovascular risk factors, high-risk hypertension, older adults, correlation.

Pulse Wave Analysis in Obese Children with and without Metabolic Syndrome

To compare pulse wave analysis (PWA) of obese children with and without metabolic syndrome (MS) with healthy, non-obese children and to evaluate the association between PWA findings and additional risk factors present in children with MS and obesity. From the obese patients examined between June 2019 and June 2021, 41 patients with MS, 36 obese patients without MS, and 34 healthy non-obese children of similar age and gender were evaluated retrospectively. Anthropometric measurements, biochemical evaluation, 24-hour ambulatory blood pressure (BP) measurement (ABPM), left ventricular mass index (LVMI) and PWA measurements were compared. When the three groups were compared, weight standard deviation score (SDS), height SDS and body mass index SDS were all significantly higher in the MS group (p<0.05). The following measurements were significantly higher in both MS and non-MS obese patients compared to the control group: from ABPM measures, the systolic and mean arterial pressure BP SDSs load; from PWA, the night central systolic BP, 24-hour, day and night pulse pressure values and 24-hour, day and night pulse wave velocity (PWV) rates; and from cardiac evaluations, the LVMI and relative wall thickness measurements (all p<0.05). Furthermore, the 24-hour and daytime central systolic (cSBP) and diastolic BP (cDBP) values were significantly different between the three groups, being the highest in the MS group (p<0.05). Obesity causes higher office, ambulatory and central BP, PWV and LVMI. However our results suggest that additional risk factors associated with MS do not contribute to these parameters, except for 24-hour and daytime cSBP and cDBP values.

Effect of Dietary Sodium on Blood Pressure

Dietary sodium recommendations are debated partly due to variable blood pressure (BP) response to sodium intake. Furthermore, the BP effect of dietary sodium among individuals taking antihypertensive medications is understudied. To examine the distribution of within-individual BP response to dietary sodium, the difference in BP between individuals allocated to consume a high- or low-sodium diet first, and whether these varied according to baseline BP and antihypertensive medication use. Prospectively allocated diet order with crossover in community-based participants enrolled between April 2021 and February 2023 in 2 US cities. A total of 213 individuals aged 50 to 75 years, including those with normotension (25%), controlled hypertension (20%), uncontrolled hypertension (31%), and untreated hypertension (25%), attended a baseline visit while consuming their usual diet, then completed 1-week high- and low-sodium diets. High-sodium (approximately 2200 mg sodium added daily to usual diet) and low-sodium (approximately 500 mg daily total) diets. Average 24-hour ambulatory systolic and diastolic BP, mean arterial pressure, and pulse pressure. Among the 213 participants who completed both high- and low-sodium diet visits, the median age was 61 years, 65% were female and 64% were Black. While consuming usual, high-sodium, and low-sodium diets, participants' median systolic BP measures were 125, 126, and 119 mm Hg, respectively. The median within-individual change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg (IQR, 0-8 mm Hg; P < .001), which did not significantly differ by hypertension status. Compared with the high-sodium diet, the low-sodium diet induced a decline in mean arterial pressure in 73.4% of individuals. The commonly used threshold of a 5 mm Hg or greater decline in mean arterial pressure between a high-sodium and a low-sodium diet classified 46% of individuals as "salt sensitive." At the end of the first dietary intervention week, the mean systolic BP difference between individuals allocated to a high-sodium vs a low-sodium diet was 8 mm Hg (95% CI, 4-11 mm Hg; P < .001), which was mostly similar across subgroups of age, sex, race, hypertension, baseline BP, diabetes, and body mass index. Adverse events were mild, reported by 9.9% and 8.0% of individuals while consuming the high- and low-sodium diets, respectively. Dietary sodium reduction significantly lowered BP in the majority of middle-aged to elderly adults. The decline in BP from a high- to low-sodium diet was independent of hypertension status and antihypertensive medication use, was generally consistent across subgroups, and did not result in excess adverse events. ClinicalTrials.gov Identifier: NCT04258332.

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management

Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum. Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months. Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care. The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure. Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was -5.80 mm Hg (95% CI, -7.40 to -4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was -6.51 mm Hg (95% CI, -8.80 to -4.22; P < .001). In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK. ClinicalTrials.gov Identifier: NCT04273854.

Evening anti-hypertensive dosing, blood pressure and cardiovascular events in hypertensive: Updated meta-analysis of 41 trials in 65,271 patients

Abstract Introduction In 2022, the International Society of Hypertension and World Hypertension League released a position paper noting that there is limited evidence on the impact of bedtime versus other time dosing of antihypertensives on 24-h BP profile and on cardiovascular morbidity and mortality. Since then, the Treatment In Morning versus Evening (TIME) trial results which enrolled over 20 thousand participants was published. This study aims to update our prior meta-analysis in 2020 (Sunjaya et al. EHJ. Vol. 41:S2) in light of this new results. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and February 2023. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 41 randomized controlled trials, representing 65,271 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 21,104 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = -1.09, 95% CI -1.97 to -0.20, p = 0.02) and 24-hour diastolic blood pressure (Mean difference = -1.05, 95% CI -1.60 to -0.51, p = 0.0002). Significant reduction in cardiovascular events were found in the evening dosing group (RR = 0.53, 95% CI 0.38 to 0.73, p = 0.0001). Discussion: While evening administration was found to result in significantly lower systolic and diastolic blood pressure, both reductions were found to not be clinically meaningful (At least 5 mmHg for systolic and at least 3 mmHg as per 2022 Hypertension Academic Research Consortium consensus). Few studies have reported the impact on cardiovascular events (7 studies), mostly contributed by one research group (Hermida et al. 4 studies). Sensitivity analyses conducted removing studies conducted by this research group resulted in a non-significant pooled risk being found, though with result from only 3 studies. Conclusion For patients with hypertension, current evidence suggests no significant impact on blood pressure levels. While a reduction in the risk for cardiovascular events was found, this result was strongly contributed by that from one setting. Further studies remain required to answer this important question due to its possible widespread impact on clinical practice.Figure 1MACEFigure 2Systolic Blood Pressure

Effect of initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy on ambulatory blood pressure indices

Abstract Background The QUARTET trial showed that a combination of four ultra-low-dose blood pressure (BP) medications lowered mean unattended office BP more effectively than initial monotherapy. Purpose To investigate the effects of a combination of four ultra-low-dose blood pressure (BP) medications on ambulatory BP changes. Methods Australian adults (≥18 years) with hypertension who were untreated or on monotherapy were eligible for participation in the QUARTET study. Overall, 591 participants were randomly assigned to receive either the quadpill (containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). The difference in 24-hour, daytime and night-time systolic and diastolic ambulatory BP at 12 and 52 weeks were pre-defined secondary outcomes. Reported parameters for this analysis were derived from ambulatory BP recordings of 576 participants that fulfilled pre-defined validation criteria. Results Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At baseline, 24-h systolic/diastolic BP was 139.2/81.0 mmHg in the monotherapy vs. 139.8/81.3 in the quadpill group, daytime BP was 142.5/83.5 vs 143.4/84.0 mmHg, and night-time BP was 125.1/70.7 vs. 125.4/70.7 mmHg. At 12 weeks, mean 24-h ambulatory systolic and diastolic BP were 7.7 (95%CI: 9.6, 5.8) and 5.3 (95%CI: 6.5, 4.1) mmHg lower in the quadpill versus monotherapy group (p&amp;lt;0.001 for both). Similar reductions were observed for daytime (8.1/5.7 mmHg lower in quadpill compared to montherapy group) and night-time (6.3/4.0 mmHg lower in quadpill compared to monotherapy group) BP (all p&amp;lt;0.001) at 12 weeks. The reduction in systolic and diastolic ambulatory BP variability were more pronounced in the quadpill group at 12 weeks, the 24-h standard deviation was reduced by -1.2 (-1.8, -0.5) mmHg for systolic and -0.9 (-1.5, -0.4) mmHg diastolic BP. The rate of BP control (24 hours BP ≥130 and/or ≥80 mmHg) at 12 weeks was higher in the quadpill group (77% vs 50%; p&amp;lt;0.001). These effects were maintained at 52 weeks. Conclusion A quadruple quarter-dose combination compared to monotherapy resulted in greater ambulatory BP lowering across the entire 24-hour period with higher ambulatory BP control rates at both 12 and 52 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy – which has been previously shown not to increase the rate of side effects - and extends it to ambulatory BP measurements.

Abstract 13660: Endovascular Ultrasound Renal Denervation for Resistant Hypertension: A Systematic Review and Meta-Analysis of Randomized Sham-Controlled Trials

Background: Radiofrequency renal denervation (RDN) is used as a treatment for resistant hypertension, although its efficacy is still under evaluation. Similarly, ultrasound RDN, a less invasive technique, has yielded inconsistent results in this population. Hypothesis: Ultrasound RDN may lower blood pressure in patients with resistant hypertension. Aims: To compare the efficacy of ultrasound RDN versus a sham procedure in treating resistant hypertension. Methods: We systematically searched PubMed, Cochrane Library, and Embase in May 2023 to include randomized sham-controlled trials assessing the efficacy of ultrasound RDN. Statistical analyses were performed using Review Manager 5.4.1 using generic inverse variance weighting to pool mean ± standard deviation and least square mean ± standard error. Results: We included three studies comprising 323 patients with resistant hypertension on ≥ three antihypertensive medications, of whom 51.7% were randomized to RDN. Follow-up at analysis ranged from 8 to 24 weeks. There were no significant differences between groups in terms of change from baseline in 24-hour ambulatory systolic blood pressure (SBP; MD -2.15 mmHg; 95% -5.07, 0.76; p=0.15; Fig. 1A), 24-hour ambulatory diastolic blood pressure (DBP; MD -1.19 mmHg; 95% CI -2.91, 0.53; p=0.18; Fig. 1B) or office SBP (MD -1.71 mmHg; 95% CI -9.62, 6.20; p=0.67; Fig. 1C). Conclusion: In this meta-analysis, ultrasound RDN did not significantly reduce blood pressure in patients with resistant hypertension as compared with a sham procedure.

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.

Efficacy and Safety Comparative of Sacubitril/Valsartan vs. Olmesartan in the Treatment of hypertension: A Meta-analysis of RCTs.

Sacubitril/valsartan (LCZ696) is a widely used drug for hypertension in Asia, popular for its efficacy and safety. However, there has been no comprehensive literature review comparing it with olmesartan. This meta-analysis compared the antihypertensive and adverse effects of sacubitril/valsartan and olmesartan. We conducted a comprehensive search of Pubmed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov databases to identify eligible randomized controlled trials (RCTs). The data were then analyzed and processed using Revman 5.4 and Stata SE14 software. Six RCTs with 4,127 patients were identified, showing that LCZ696 had better blood pressure control than olmesartan; mean sitting systolic and diastolic blood pressure, sitting pulse pressure, 24-hour ambulatory systolic blood pressure, and 24-hour ambulatory diastolic blood pressure were significantly decreased with LCZ696 compared with olmesartan. No significant difference between LCZ696 and olmesartan was observed in the occurrence of the majority of adverse events, with a decreased probability of headache in patients with sacubitril/valsartan compared with olmesartan. The subgroup analysis showed treatment with 400 mg/d LCZ696 was better than olmesartan in reducing serious adverse events. Sacubitril/valsartan was better than olmesartan in controlling blood pressure in patients with hypertension, with relatively higher safety.

#4877 THE EFFECT OF NURSE-LED 8-ZONE LUNG ULTRASOUND GUIDED TITRATION OF DRY WEIGHT ON HYPERTENSION IN APPARENTLY EUVOLAEMIC HAEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension related to subclinical volume overload is a common clinical problem in hemodialysis patients. Lung ultrasound (LUS) is a validated technique for minute titration of dry weight, but has limited adoption in clinical practice because it is currently a physician (nephrologist)-led methodology and time consuming with 24-lung zones needing to be imaged. This study aims to show that (1) a simplified 8-zone LUS protocol is effective at dry weight titration in clinically euvolaemic chronic haemodialysis patients, as determined by 24-hour ambulatory blood pressure monitoring (ABPM), and that (2) nurse-led LUS for dry weight titration is feasible and safe. Method This was a 6-week pre and post intervention study in 13 clinically euvolemic haemodialysis patients with chronic hypertension. 4 senior dialysis nurses with at least 4 years of dialysis nursing experience respectively were trained in LUS image acquisition and interpretation via a 1 day workshop by a certified Nephrologist and passed an image interpretation test. 8-zone LUS (which has been described by Volpicelli et al.[1]) was performed midweek, weekly. A Nephrologist reviewed all the acquired LUS images retrospectively. Dry weight was titrated down at a rate not exceeding 0.3 kg per week if LUS Kerley B lines exceeded 3 in any lung zone. All patients underwent 24-hour ABPM at baseline and after 6 weeks. Nurses underwent a post study qualitative survey to elucidate success factors and confidence in LUS technique. Results The study cohort was predominantly male (69%) and diabetic (92%), with an average age of 68 ± 10 years. The average time required for a nurse to complete 1 LUS scan was 3 ± 0.4 minutes. 75% of the cohort had dry weight reduction post-study, which ranged from 0.08 – 0.9% of initial dry weight. Correspondingly, the median number of ultrasonographic B-lines reduced from 4 to 3, although this did not reach statistical significance. Overall, there were reductions in 24-hour systolic BP (146.42±17.03 vs 139.08±12.40 mmHg; p = 0.067) and diastolic BP (72.75±11.79 vs 70.75±11.69 mmHg; p = 0.561). Similarly, there were trends towards improvements in pre- and post-dialysis systolic and diastolic BPs, although only pre-dialysis diastolic BPs showed statistically significant improvement (80±16.05 to 72.33±13.32 mmHg, p = 0.046). This may be related to small sample size. Nil adverse outcomes such as intra-dialytic hypotension, vascular thrombosis, cardiovascular events or fluid overload were reported during the study. 1 patient demised from pneumonia sepsis, which was deemed to be unrelated to the study. All nurses expressed confidence in LUS image acquisition and interpretation following the workshop. Their confidence was further bolstered by the end of the study. They also felt that point-of-care LUS was a useful skill for experienced haemodialysis nurses who were often responsible for day to day adjustment of fluid removal on dialysis. Conclusion We have demonstrated that nurse-led 8-zone LUS can effectively and safely titrate dry weight in chronic haemodialysis patients, as evidenced by improvements in 24-hours ABPM. Importantly, these results are similar to that of randomized controlled trials such as the LUST study where LUS was physician-led. There remains little doubt about the importance of LUS in volume assessment. In-depth studies are required to determine the competencies of, and risk-benefit assessment for nurse-led LUS, to improve the clinical relevance and penetrance of this tool.

IMPACT OF NON-DIPPING PATTERN AND NOCTURNAL HYPERTENSION ON LEFT VENTRICULAR MASS INDEX IN UNTREATED WHITE-COAT HYPERTENSIVE SUBJECTS

Objective: Several studies have demonstrated that subjects with white-coat hypertension (WCH) have an increased risk of adverse cardiovascular outcome and target organ damage (TOD) progression compared to normotensives. The potentially detrimental effect of non-dipping or nocturnal hypertension on TOD has not been fully elucidated in subjects with WCH. The aim of our study was to investigate the impact of both dipping status and nocturnal hypertension on the left ventricle mass index (LVMI) of WCH individuals. Design and method: A total of 387 untreated WCH subjects underwent echocardiographic measurements. LVM was estimated using Devereux's formula according to the Penn Convention Protocol. LVMI was defined as LVM divided by the body surface area. The study population was divided into dippers (blood pressure (BP) nocturnal fall &gt;10%) and non-dippers (BP nocturnal fall &lt;10%) as well as into nocturnal hypertensives (nighttime systolic BP&gt; = 120mmHg or nighttime diastolic BP&gt; = 70mmHg) and nocturnal normotensives (nighttime systolic BP&lt;120mmHg and nighttime diastolic BP&lt;70mmHg). Statistical analysis was performed by means of independent-samples t-test, chi-square test and linear regression. Results: The percentages of non-dippers and nocturnal hypertensives in WCH subjects were 49% and 28%, respectively. The variables associated with LVMI in the univariate analyses were: age, male gender, body mass index, 24-hour diastolic BP and non-dippers. The multivariate regression analyses demonstrated significant associations of LVMI with the following factors: age (B = 5.760, 95% CI: 3.282 to 8.239; p&lt;0.001), male gender (B = 10.941, 95% CI: 5.756 to 16.125; p&lt;0.001), body mass index (B = 0.685, 95% CI: 0.138 to 1.232; p = 0.014), 24-hour diastolic BP (B = -6.634, 95% CI: -11.212 to -1.456; p&lt;0.011) and non-dippers (B = 8.415, 95% CI: 3.449 to 13.380; p = 0.001). Non-dipping pattern was correlated to an increase of 8.415 g/m2 in the LVMI in WCH subjects. Conclusions: Non-dipping status is positively and independently associated with LVMI in untreated WCH patients. In contrast, statistically significant association between nocturnal hypertension and LVMI was not observed.

24HOUR, HOME AND CLINIC BLOOD PRESSURE FOR THE PREDICTION OF LEFT VENTRICULAR HYPERTROPHY IN UNTREATED HYPERTENSIVE POPULATION

Objective: The aim of this study was to investigate which way of measuring blood pressure (BP), clinic, home or 24h-ABPM, can predict better left ventricular hypertrophy in the untreated hypertensive population. Design and method: 175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day. Home BP monitor was provided to all patients for 7 days, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography. Results: In the univariate analysis, only home systolic and diastolic BP were independently associated with left ventricular hypertrophy, while both clinic and 24hour systolic and diastolic BP found not to be. From ROC curves for left ventricular hypertrophy, AUC of home systolic BP monitor (0.758, p&lt;0.05) was larger than that of 24h (0.538, p&gt;0.05) and clinic BP (0.497, p&lt;0.05). As regards DBP, the ROC curves suggest no discrimination for the different ways of BP measurement. Conclusions: Home systolic BP can be a better predictor of left ventricular hypertrophy in untreated population, when compared to 24h and office systolic BP. This result shows the importance of home monitoring for the prediction of left ventricular hypertrophy, even in the untreated population.

HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY REVEALED THAT HYPERTENSION IS HIGHLY PREVALENT BOTH IN ALREADY DIAGNOSED AND TREATED PATIENTS AND IN SUSPECTED HYPERTENSIVES

Objective: In 2021 the Hungarian Society of Hypertension initiated a program to promote the nationwide use of ambulatory blood pressure (BP) monitoring (ABPM) (Hungarian ABPM Registry) aiming to increase the awareness of high BP and to monitor the efficacy of therapies. The goal was to collect and analyze the ABPM values of treated hypertensive (HT) and newly diagnosed patients (nHT) and assess the influence of other risk factors, comorbidities and patient characteristics. Design and method: Adults (18-100 years old) can be included into this ongoing, multicenter, open-label, observational study. Data collection to an electronic case report form is performed by GPs, internists, and cardiologists. Meditech ABPM-06 monitors are used. Data of the current analysis were collected between 21.02.2021-5.10.2022. 15 835 ABPMs were performed; due to missing data or protocol deviation 1018 patients were excluded from the analysis. Results: 10212 patients were HTs, 4571 were nHTs (69% and 31%, respectively). 76% of nHT patients were untreated during ABPM. Mean 24-hour systolic and diastolic BP was 134.03±14.6 mmHg and 79.3±10.1 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between nHT and HT patients (134.08±14.9 mmHg vs. 133.91±14.6 mmHg, respectively, p = NS). Two-third of the patients (all: 68.2%, HT: 68.5%, nHT: 67.6%) were hypertensive according to ABPM measurements. Obesity (BMI&gt;30 kg/m2) doubled the risk of hypertension in both groups (OR = 2.18 [2.03;2.34] for 24-hour average), but it had a higher impact in nHTs (OR = 2.57[2.22;2.98] for 24-hour average in nHT and OR = 2.12[1.94;2.30] for 24-hour average in HT patients). Snoring increased the risk of hypertension in both group of patients (OR = 1.45[1.34;1.56] for 24-hour average) irrespectively of gender, and – interestingly – it had a greater impact on the daily values of BP (day: OR = 1.51[1.40;1.62] and night: OR = 1.32[1.22;1.42]). Conclusions: The new ABPM Hungary Registry revealed hypertension in the majority of screened individuals, regardless of gender or treatment. In addition, in both gender, obesity, snoring, increased the risk of hypertension. These data underline the importance of ABPM in the screening for and treatment of hypertension leading to the earlier and more effective treatment.

CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements. Design and method: We collated clinic and 24 hour ambulatory BP data of 100 patients aged &gt; 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021). Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical. We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods. Results: The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients. Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P &lt;0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P &lt;0.001; r = 0.566; Curve B). Conclusions: The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension

CIRCADIAN BLOOD PRESSURE PROFILE IN RELATION TO LOW BACK PAIN DISABILITY INDEX

Objective: Cross-sectional observations within population cohorts have linked low back pain with hypertension in men, but not in women. The aim of the current study was to analyze 24-hour blood pressure profile in hypertensive men and women reporting low back pain. Design and method: The study group included 85 hypertensive patients (29 M/56 F, mean age 60.6 +/- 8.3 years) with episodes of low back pain during 3 weeks before examination. All patients received antihypertensive medications in the scheme of combination therapy and none of them was on chronic painkillers. Standardized questionnaire was used to collect information on life style factors. Twenty-four hour blood pressure monitoring was provided (Spacelabs 90207) and values of 24h, daytime and nighttime blood pressure were calculated, as well as nighttime blood pressure dipping. Oswestry Low Back Pain Disability Questionnaire was used to calculate disability index. Multivariable regression was used to asses the association between blood pressure an disability index, while accounting for covariates. Results: In the whole study population, no association was found between disability index and 24-hour systolic (parameter estimate: -0.053 +/- 0.23 mm Hg per 1 point increase in disability index, p = 0.86) or diastolic blood pressure (-0.018 +/ 0.14 mm Hg per 1 point increase, p = 0.90). When analyzing men and women separately, we observed in women increased daytime diastolic blood pressure with increasing disability index (+0.29 +/- 0.16 mm Hg, p = 0.044), that resulted in more prominent day-night difference with increasing disability index (+0.42 +/- 0.14% per 1 point increase in disability index). Blood pressure values over 24 hours or nighttime blood pressure was not associated with disability index. None of associations between blood pressure values and low back pain disability index were not found in men. Conclusions: Low back pain, as assessed by standardized questionnaire of disability index, is associated with elevated daytime blood pressure in hypertensive women, that might lead to more difficulties in achieving target blood pressure in this group of patients.