Mean 24-hour Blood Pressure Research Articles

THE EFFECT OF RENAL DENERVATION ON CEREBRAL BLOOD FLOW IN DIABETIC PATIENTS WITH RESISTANT HYPERTENSION

Objective: Long-term and persistent increase in blood pressure (BP) leads to vascular remodeling, which deteriorates cerebral blood flow. The combination of hypertension (HTN) with diabetes mellitus (DM) accelerates the vascular damage and impairs the cerebral blood flow autoregulation, which may be accompanied by an uncompensated decrease in cerebral perfusion in response to a decrease in BP. Renal denervation (RDN) leads to a rapid and sustained decrease in BP, therefore the aim of this study was to assess of changes in cerebral blood flow in patients with resistant HTN (RHTN) and type 2 DM at 6 month after the intervention. Design and method: Evaluation of cerebral blood flow was performed in 21 patients with RHTN and type 2 DM, who were included in single-arm prospective interventional studies (protocol numbers NCT01499810 and NCT02667912 on ClinicalTrials.gov) (mean age 61.4 ± 7.6 years, mean office (systolic/diastolic) BP (SBP/DBP) 167.1 ± 19.4/85.6 ± 15.9 mmHg, HbA1c 7.1 ± 1.3%, 8 men (32%), 19 pts (91%) had atherosclerosis of internal carotid arteries (ICA) with mean values of stenosis 22.2 ± 9.7%). All patients were undergone to ambulatory 24-hour BP, Doppler high-resolution ultrasound of ICA and middle cerebral arteries (MCA) at baseline and 6 month follow-up. The patients were instructed not to change their medication regimen during the study. Results: There was a significant decrease in mean 24-hour BP (systolic/diastolic) (-12.6/-7.3 mmHg, p < 0.05). At the same time, there was no deterioration in blood flow of ICA and MCA at 6 months after RDN. Conclusions: Our data indicate that the significant decrease in BP after RDN does not lead to deterioration of cerebral blood flow and therefore indicates the safety of this procedure for the brain in patients with RHTN with type 2 DM.

PRESCRIBED ANTIHYPERTENSIVE AGENTS IN PATIENTS WITH AND WITHOUT ITS “ESCAPE’’ PHENOMENON

Objective: To identify the percentage of antihypertensive therapy (AHT) groups prescription in patients with and without delayed inefficiency of AHT (“escape’’phenomenon). Design and method: The study included 102 hypertensive patients (52 male, age 54.2 ± 9.8 years), whom were assigned 2–3 agents from various AHT group.In 2–3 weeks after therapy initiation (with the single correction if needed), all participants achieved the target blood pressure (BP). The latter was confirmed by office BP measurement (office BP) (<140/90mmHg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory BP monitoring (ABPM) (mean 24-hour BP < 130/80mmHg, oscillometric method, BPLab, Russia). In 1 and 3 months after inclusion, the efficacy of AHT was reassessed by both measurement methods. The “escape’’ phenomenon was verified when BP became higher target by any method in any reassessment time. Adherence was calculated as the ratio of the number of correct medication intake days to the number of follow-up days multiplied by 100%. Results: 34 patients (33.3%) demonstrated the ‘escape’ phenomenon (Group 1), while BP level in 68 (66.7%) patients remained target (Group 2). There weren’t differences in the cardiovascular (CV) risk factors between groups (Table 1). Both groups received primarily fixed combinations of AHT, which resulted in 1.9 ± 0.7 tablets intake per day. There was comparably high adherence to treatment in groups (89.2 ± 3.8% in group 1, 90.2 ± 5.0% in group 2,p = 0.28). When comparing the percentage of different AHT groups, there was no difference revealed between groups, with the exception of more frequent ARA-II prescription in Group 1 (Table 2). Nevertheless, although in both groups the target BP levels were achieved, the BP in the Group 1 was higher already at the stage of inclusion (Table 2). Moreover, baseline systolic BP was found to be an ‘escape’ phenomenon predictor in univariate logistic regression model (for office BP: systolic BP> 128mmHg (OR 3.43 (95%CI 1.39–8.47,p < 0.00), for ABPM: 24-systolic BP> 124mmHg (OR 25.81 (95%CI 5.61–119.11,p < 0.00). Further studies on ‘escape’ phenomenon issue in patients with ARA-II intake are required. A higher frequency of ARA-II usage in the ‘escape’ group is likely due to overestimation of the continuing BP decline in 2–3 weeks after ARA-II prescription.

IMPACT OF LONG-TERM USE OF CPAP TREATMENT ON BLOOD PRESSURE AMONG REFRACTORY HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Objective: To assess blood pressure response to long-term continuous positive airway pressure (CPAP) treatment among patients with refractory hypertension (RfHTN) with moderate and severe obstructive sleep apnea (OSA). Design and method: An observational prospective study was performed in 26 patients (35.7% male, average age 59.3 ± 7.9 years) with diagnostic of RfHTN and moderate and severe OSA who were divided in 2 groups to use CPAP (CPAP group, n = 13) or not (control group, n = 15). All of them were submitted to clinical follow-up and their anti-hypertensive medication was adjusted according to the assistant physician. 24-hour ABPM was performed both at the beginning and at the end of the study. Primary outcomes were changes in office and ambulatory blood pressure (BP) and BP control. The comparison between groups of BP changes were calculated by a general linear model with group allocation as a fixed factor and adjusted by its respective BP basal values in addition to gender and age. Results: The median follow-up time was 68 months (IQR: 49–81 months). CPAP and control groups were similar in their baseline demographic, anthropometric, laboratory characteristics, and office and ambulatory BP. They had mean systolic and diastolic 24-hour BP of 142 (15) and 83 (14), respectively. At the end of follow-up, refractory patients using CPAP had a reduction of 8.5 and 5.0 mmHg of office systolic and diastolic BP with an intergroup difference (CPAP and control) of 13.5 (-15.2 – 42.3) mmHg and 10.1 (-7.5 – 5.4) mmHg, respectively. The most important difference between groups was noticed at nighttime with an intergroup difference of 10.0 (-8.6 – 28.7) mmHg of systolic BP and 6.7 (-3.9 – 17.3) mmHg of nighttime diastolic BP. Out of 28 initial refractory patients, 12 are not refractory anymore, being 3 (20%) in control group and 9 (69.2%) in CPAP group with a significant difference between the groups (p = 0.02) Conclusions: Long-term use of CPAP among refractory hypertensive patients with moderate/severe OSA seems to be effective to reduce and control blood pressure measured both in the office BP and 24-hour ABPM, especially lowering nighttime blood pressure.

LEPTIN AS A PREDICTOR OF CARDIOPROTECTIVE EFFICIENCY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: To evaluate serum leptin level before renal denervation (RDN) and to assess whether this baseline metabolic marker predicts cardioprotective efficacy in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM). Design and method: The study included 25 patients with RHTN and T2DM (mean age 60.9 ± 7.1 years, 16 women, mean 24-hour (24-h) blood pressure (BP) (systolic/diastolic) 158.8 ± 16.5/81.1 ± 13.1 mm Hg, mean HbA1c 7.4 ± 1.5%). All patients were enrolled in the prospective interventional study with RDN (NCT02667912 and NCT01499810 at ClinicalTrials.gov). Office BP and ABPM, tissue Doppler echocardiography with assessment of diastolic function, serum leptin level were performed at baseline and 6-months after RDN. Twenty patients completed a 6-month follow-up. Results: RDN led to a significant reduction in systolic and diastolic 24-h BP (-13.4/-7.6 mm Hg, p = 0.001/0.002). The baseline leptin level correlated with the mean E/e ‘ratio at baseline (R = 0.52, p = 0.015) and its dynamics after 6 months (R = 0.71, p = 0.001). Depending on the degree of decrease in average E/e’ ratio, the patients were retrospectively divided into 2 groups: 1st (with improvement) (persons with a decrease in average E/e’ ratio by 1 unit or more, n = 10 (50%)) and 2nd (without improvement) (with a lesser degree of decrease in average E/e’ ratio). Initially, the pts of 1st group not differed from those of 2nd group by age, BP and HbA1c level. At the same time, pts of the 1st group had higher baseline leptin level (60.4 ± 24.05 and 35.8 ± 9.82 ng/ml, p = 0.008) than pts of the 2nd group. A ROC analysis showed that the best cut-off value of the leptin level is 47.4 ng/ml with 70% sensitivity and 85% specificity (AUC: 0.84; 95% CI:0.64–1.04; p = 0.001). Conclusions: Estimation of the leptin allows predicting the cardioprotective efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus.

SYSTEMIC VASCULAR RESISTANCE AS A PREDICTOR OF ANTIHYPERTENSIVE EFFICIENCY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: To identify predictors of the antihypertensive efficacy of renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) based on the results of a 12-month follow-up. Design and method: The study included 56 patients with RHTN and T2DM (mean age 60.1 ± 7.9 years, 32 women, mean 24-hour (24-h) blood pressure (BP) (systolic/diastolic) 156.8 ± 15.2/82.2 ± 12.1 mm Hg, mean HbA1c 7.2 ± 1.5%). The prospective interventional study with RDN (NCT02667912 and NCT01499810 at ClinicalTrials.gov) enrolled all patients. Office BP and ABPM, calculation of systemic vascular resistance (SVR) assessment were performed at baseline and 12-months after RDN. Forty-one patients completed a 12-month follow-up. Results: RDN led to a significant reduction in systolic and diastolic 24-h BP (-10.6/-6.4 mm Hg, p = <0.001/<0.001). Depending on the degree of decrease in 24-h systolic BP, the patients were retrospectively divided into 2 groups: “responders’’ (persons with a decrease in 24-h SBP by 10 or more mmHg) and “non-responders’’ (with a lesser degree of decrease in 24-h SBP). The proportion of respondents to the intervention was 68.3%. Initially, the group of “responders’’ not differed from the group of “non-responders’’ by age, BP and HbA1c level. At the same time, responders had higher SVR indicators (2.22 ± 0.44 and 1.73 ± 0.28 dyn × s × cm-5, p = 0.001) than non-responders. A ROC analysis showed that the best cut-off value of the SVR is 19,7 dyn × s × cm-5 with 71% sensitivity and 85% specificity (AUC: 0.82; 95% CI: 0.68–0.95; p < 0.001). Conclusions: Estimation of the systemic vascular resistance allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus after a year of intervention.

Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial.

The long-term effect of continuous positive airway pressure (CPAP) on 24-hour blood pressure (BP) in patients at high risk with obstructive sleep apnea (OSA) is uncertain. We aimed to determine the effect of CPAP treatment on ambulatory BP in individuals with moderate or severe OSA and cardiovascular disease or multiple cardiovascular disease risk factors without severe sleepiness. In this randomized, controlled, parallel group study, 169 participants were randomly assigned to CPAP treatment or the control group. The primary outcome was the change in mean 24-hour systolic BP between groups from baseline to the average of 6- and 12-month measurements using mixed-effect linear regression models. The 24-hour systolic BP did not significantly differ by group, although there was a trend of decrease in the CPAP group (treatment effect -2.7 mm Hg [95% confidence interval -5.9 to 0.6]; P = .105) compared with control. CPAP had the greatest effect on nighttime systolic BP (treatment effect -5.9 mm Hg [95% confidence interval -9.9 to -1.9]; P = .004). Similar improvements in other nocturnal BP indices were observed. In patients at high risk with moderate-severe OSA without severe sleepiness, CPAP resulted in modest BP improvements over 6 to 12 months of follow-up, with possibly larger effects for nocturnal BP. Use of office blood pressure may underestimate the effect of CPAP on BP profile in patients with OSA. Registry: ClinicalTrials.gov; Title: Sleep Apnea Intervention for Cardiovascular Disease Reduction; Identifier: NCT01261390; URL: https://clinicaltrials.gov/ct2/show/NCT01261390. Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial. J Clin Sleep Med. 2022;18(8):1899-1907.

Increased Nocturnal Arterial Stiffness is Associated with a Higher Risk of Stroke in LVAD Patients

<h3>Purpose</h3> Increased arterial stiffness is associated with an increased risk of stroke in the general population. Despite recent technological improvements, left ventricle assist device (LVAD) patients retained a high risk of stroke. In this study, we aimed to investigate whether increased arterial stiffness is associated with a higher risk of stroke in LVAD patients. <h3>Methods</h3> We prospectively studied 28 patients who underwent HeartMate II (HMII) LVAD implantation between November 2011 and June 2018 at a single large-volume center. 24-hour blood pressure was recorded using the Mobil-O-Graph device, an ambulatory blood pressure monitor validated in HMII patients that can reliably estimate central blood pressure. Augmentation Index @ 75, an established index of arterial stiffness, was calculated by means of a generalized transfer function utilizing frequency-domain methods. <h3>Results</h3> Four (14%) patients experienced a stroke (all ischemic stroke) during LVAD support. Baseline demographics, LVAD parameters, and mean 24-hour blood pressure values are presented in Table 1. All patients with stroke had a prior history of pump thrombosis compared to 9 (38%) patients without stroke (P=0.035). Diurnal augmentation index @ 75 was not different between the two groups (26 [19-29] vs 25 [18-29], P=0.874), while nocturnal augmentation index @ 75 was higher in patients with stroke vs without (35 [25-44] vs 25 [16-29], P=0.05). Nocturnal augmentation index @75 was significantly associated with a higher rate of stroke (HR= 1.125; 95% CI 1.007-1.256). <h3>Conclusion</h3> Increased nocturnal arterial stiffness is associated with a higher risk of stroke in LVAD patients. Further studies are warranted to validate our findings, investigate their prognostic implications and, eventually, test the impact of medical interventions on arterial stiffness in LVAD patients.

Abstract P117: Association Of Ambulatory Blood Pressure Monitoring Parameters With Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-based Studies

Objectives: Ambulatory blood pressure (BP) monitoring (ABPM) parameters beyond mean BP may be useful for identifying individuals at high risk for cardiovascular end-organ damage. We examined the association between ABPM parameters, including 24-hour BP load, peak BP, peak increase in BP, and mean BP with left ventricular hypertrophy (LVH). Methods: Data were pooled from five US-based studies in which participants underwent ABPM for 24 hours (n=2,892). We defined systolic BP (SBP) load as the weighted average of the percent awake SBP readings ≥ 130 mm Hg and asleep SBP readings ≥ 110 mm Hg; peak SBP as the weighted average of awake and asleep 90 th percentile of SBP; peak increase as the difference between the peak SBP and mean SBP. These parameters were then categorized into quartiles. LVH was assessed by 2D-echocardiography. Analyses were stratified by mean 24-hour BP &lt; 130/80 and ≥ 130/80 mm Hg. Results: Among participants with mean 24-hour BP &lt; 130/80 mm Hg, the prevalence of LVH increased from the lowest to the highest quartile for SBP load, peak SBP, peak increase in SBP, and mean SBP ( Table ). The adjusted prevalence ratio (PR) for the association of the highest versus the lowest quartile with LVH was 1.82 (95%CI: 1.08-3.05) for SBP load, 2.00 (95%CI: 1.18-3.38) for peak SBP, 1.38 (95%CI: 0.85-2.23) for peak increase in SBP, and 1.51 (95%CI: 0.98-2.32) for mean SBP. Among participants with mean 24-hour BP ≥ 130/80 mm Hg, the prevalence of LVH increased for all ABPM parameters from the lowest to the highest quartile. The multivariable-adjusted PR for the association of the highest versus the lowest quartile with LVH was 1.39 (95%CI: 0.98-1.97) for SBP load, 1.66 (95%CI: 1.09-2.53) for peak SBP, 1.08 (95%CI: 0.76-1.53) for peak increase in SBP, and 1.88 (95%CI: 1.24-2.83) for mean SBP. Conclusion: The 24-hour SBP load and peak SBP were associated with a higher prevalence of LVH when mean 24-hour BP was &lt; 130/80 mm Hg. The 24-hour peak SBP and mean SBP were associated with a higher prevalence of LVH when mean 24-hour BP was ≥ 130/80 mm Hg.

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,...

Aortic knob width is associated with non-dipping blood pressure pattern

Background: Aortic knob width (AKW) is the measurement of the radiographic configuration composed of the foreshortened aortic arch and a part of the descending aorta. We investigated the relationship between the nondipper pattern and AKW. Material and methods: All patients’ office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of less than 10% was defined as non-dipping. The patients were grouped into Group 1; dipper pattern (37 patients; 22F, and mean age 49.2 ± 11.7 yrs) and Group 2; non-dipper pattern (64 patients; 37F, and mean age 53.7 ± 13.1 yrs). On posteroanterior chest radiography, the widest point of the aortic knob was measured along the straight imaginary line from the lateral edge of the trachea to the left lateral wall of the aortic arch. Results: AKW was significantly higher in Group 2 compared to group 1 (36.7 ± 5.7 vs. 30.7 ± 4.5 mm, p &lt; 0.001). The mean daytime and night-time systolic blood pressures, the mean night-time diastolic blood pressure levels, 24-hour mean blood pressure and mean pulse pressures were higher; percentage of nocturnal drops was significantly lower in Group 2 compared to Group 1. AKW was determined to be the parameter that was mostly related to the non-dipper pattern. A ROC analysis revealed that the area under the curve values for AKW values of non-dippers were 0.796 (95% CI: 0.707–0.884, p &lt; 0.001). Conclusion: AKW is significantly higher in non-dipper individuals compared to dippers. AKW values above 32.6 mm on the chest radiograph may be associated with non-dipper pattern especially in hypertensive individuals.

Predictors of antihypertensive efficiency of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus

Abstract Background Currently, one of the actively studied interventional methods for the treatment of resistant hypertension (RHTN) is renal denervation (RDN). Despite the safety of the procedure and the long-lasting antihypertensive effect, a significant decrease in systolic blood pressure (SBP) ≥10 mmHg is observed only in 60–80% of patients. According to the Global SYMPLICITY Registry (GSR) study, patients with diabetes mellitus could benefit from lower blood pressure after renal denervation due to initially higher sympathetic activity. The indicators associated with the processes of sympathetic hyperactivation include impaired diastolic function and total peripheral resistance (TPR), reflecting the resistance of arterioles (resistive vessels) to blood flow. Purpose To identify predictors of the antihypertensive efficacy of renal denervation in patients with RHTN and type 2 diabetes mellitus (DM) based on the results of a six-month follow-up. Methods The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4±6,4 years, 14 men, mean 24-hour (24-hr) blood pressure (BP) (systolic/diastolic) 158,6±15,2/79,8±12,7 mmHg, mean HbA1c 7,2±1,2%). The prospective interventional study with renal denervation (NCT02667912 and NCT01499810 at ClinicalTrial.gov) enrolled 30 patients. Office BP and ABPM, diastolic function and TPR assessment were performed in all patients at baseline and 6 months after RDN. 29 patients completed 6-month follow-up. Results RDN led to a significant reduction in systolic and diastolic 24-hr BP (−10.9/−5.7 mmHg, p=0.002/0.003). Depending on the degree of decrease in 24-hr systolic BP, the patients were retrospectively divided into 2 groups: “responders” (persons with a decrease in 24-hr SBP by 10 or more mmHg) and “non-responders” (with a lesser degree of decrease in 24-hr SBP). The proportion of respondents to the intervention was 48.3%. Initially, the group of “responders” differed from the group of “non-responders” by higher average E/e' values (15.1 and 11.9, respectively, p=0.049) and TPR indicators (2.39±0.45 and 1.93±0.35 dyn s cm–5, respectively, p=0.003). These indicators were included in a logistic model to predict the antihypertensive efficacy of renal denervation. The sensitivity was 78.6% (11 correct predictions out of 14 cases), specificity – 80% (12 correct predictions out of 15 cases), (p=0.020). Conclusion Estimation of the total peripheral resistance and the average ratio E/e' allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

Long-Term Results up to 12 Months After Catheter-Based Alcohol-Mediated Renal Denervation for Treatment of Resistant Hypertension

[Figure: see text].

Abstract P154: Win Ratio Methodology Demonstrates Consistency Of Benefit Across Different Blood Pressure Reduction Thresholds Following Renal Denervation In The Spyral Htn-on Med Pilot Study

Objective: The win ratio is a statistical methodology to evaluate clinical trial outcomes using multiple hierarchical endpoints. We applied the win ratio to patients in SPYRAL HTN-ON MED pilot study to quantify potential differences in renal denervation (RDN) efficacy utilizing different blood pressure (BP) reduction thresholds. Methods: In the SPYRAL HTN-ON MED pilot study, patients were enrolled with office systolic BP (OSBP) ≥150 mmHg and &lt;180 mmHg, office diastolic BP ≥90 mmHg, and mean 24-hour ambulatory systolic BP (ASBP) ≥140 mmHg and &lt;170 mmHg despite 1 to 3 antihypertensive medications. Patients were randomized 1:1 to RDN or sham procedure. For the win ratio analysis, each RDN patient was compared with every sham control patient in the opposing group first according to ASBP to determine “win”, “lose” or “tie” with a threshold of 5 mmHg. Then, ties from the ASBP comparison underwent the comparison using OSBP with a threshold of 10 mmHg. Any tie for a pair comparing OSBP resulted in comparison of any reduction in anti-hypertensive medication burden. The win ratio analysis was repeated using thresholds of 3.5 mmHg for ASBP change, 5 mmHg for OSBP change and any net change in medication burden. Results: The calculated win ratio favored RDN: 2.78 (95% CI: 1.58, 5.48, p&lt;0.001), using thresholds of 5 mmHg for ASBP change, 10 mmHg for OSBP change, and any net change in medication burden, all at 6 months. To test the sensitivity of the analysis, the BP thresholds were changed to 3.5 mmHg for ASBP and 5 mmHg for OSBP, and the win ratio analysis was repeated, resulting in a win ratio again in favor of RDN of 2.68 [1.58, 5.00], p&lt;0.001. Conclusions: Win ratio methodology applied to the SPYRAL HTN-ON MED pilot study demonstrated that RDN was associated with a 2.6-2.8 times greater likelihood of BP or drug reduction compared with sham patients when evaluated across different BP reduction thresholds at 6 months.

Effects of Decompressive Cervical Surgery on Blood Pressure in Cervical Spondylosis Patients With Hypertension: A Time Series Cohort Study

The blood pressure of cervical spondylosis (CS) patients with hypertension often returns to normal after decompressive cervical surgery (DCS). However, the effect of DCS on the blood pressure of patients with CS has not been rigorously studied. We recruited 50 consecutive CS patients with hypertension from 2014-2017 and investigated the changes in blood pressure after DCS using a time series design. Ambulatory blood pressure monitoring (ABPM) was performed at 3 and 0 days before DCS and at 30 and 90 days after DCS. The primary outcome was mean 24-hour systolic blood pressure (SBP). Secondary outcomes included mean 24-hour diastolic blood pressure (DBP), office blood pressure, and the percentage of patients on antihypertensive medication. Paired t test was used for assessing the changes in blood pressure over time and a McNemar test was used for comparison among different medication groups. The mean 24-hour SBP did not vary significantly among 4 time points (134.5 ± 14.7, 132.8 ± 14.7, 131.5 ± 13.3, and 133.2 ± 14.6, respectively; P = .42). The mean 24-hour DBP showed a similar trend. However, mean office SBP/DBP decreased significantly from 142.5/82.0 mm Hg before surgery to 127.3/76.6 mm Hg after surgery (both P < .01). The corresponding percentage of patients on antihypertensive medication decreased significantly, from 84% to 54% (P < .01). This study confirmed previous findings of reduction in office blood pressure associated with DCS among CS patients with hypertension. However, this was not confirmed by multiple-time series of 24-hour ABPM. 3.

Effects of Experimental Sleep Restriction on Ambulatory and Sleep Blood Pressure in Healthy Young Adults: A Randomized Crossover Study.

[Figure: see text].

Correlation Between Ambulatory Blood Pressure Monitoring and Office Blood Pressure Measurement in Patients with Hypertension: A Community Study

BackgroundThe current gold standard for blood pressure (BP) measurements is based on office BP measurements (OBPMs) by a sphygmomanometer or a digital device. Ambulatory BP measurement (ABPM) is a noninvasive method for continuous monitoring of BP over a period during routine activities of the patient. Thus, ABPM offers multiple BP readings during the patients’ daily routine as compared to the single reading by OBPM at rest. A good correlation exists between mean 24-hour BP readings and the prediction of cardiovascular events. The present multicenter observational study was aimed to assess the correlation between ABPM and OBPM in patients with newly diagnosed, controlled, or uncontrolled hypertension in the community setting.Our hypothesis was to test if ABPM provides any further value in those hypertensive patients in whom the office blood pressure levels are controlled. A supplementary hypothesis was whether obtaining ABPM in patients with newly diagnosed or uncontrolled hypertension yields any value over and beyond OBPM. Another objective was to find out the applicability of ABPM in the community setting where the medical care is provided by primary care family physicians and not by specialists. Materials and MethodsMaterials and Methods A total of 1000 patients were analysed for this study. Those with controlled hypertension were assigned to Group A, and those with newly diagnosed/untreated hypertension comprised Group B. Group A was followed up during Visit 2 and Group B was followed up during Visit 2 and either Visit 3 or Visit 4 to assess the BP measurements by ABPM and OBPM. ResultsThe correlation between ABPM and OBPM showed minimal variation in the BP readings of Group A subjects at Visit 2. A variation in BP readings was observed in Group B at Visit 2. Furthermore, the correlation was established between ABPM and OBPM noted for Group B subjects during Visit 3, and minimal variation was noted during Visit 4. ConclusionsConclusions A good correlation was observed between ABPM and OBPM during both visits in patients in Groups A and B. However, a notable variation was noted in the diastolic BP readings. Thus, large-scale clinical studies are required to detect the prevalence of hypertension, masked hypertension, and dipping patterns associated with hypertension and other related medical co-morbidities.

Blood pressure variability and night-time dipping assessed by 24-hour ambulatory monitoring: Cross-sectional association with cardiac structure in adolescents.

Greater blood pressure (BP) is associated with greater left ventricular mass indexed to height2.7 (LVMi2.7) in adolescents. This study examined whether greater BP variability and reduced night-time dipping are associated with cardiac remodeling in a general population of adolescents. A cross-sectional analysis was undertaken in 587 UK adolescents (mean age 17.7 years; 43.1% male). BP was measured in a research clinic and using 24-hour ambulatory monitoring. We examined associations (for both systolic and diastolic BP) of: 1) clinic and 24-hour mean BP; 2) measures of 24-hour BP variability: standard deviation weighted for day/night (SDdn), variability independent of the mean (VIM) and average real variability (ARV); and 3) night-time dipping with cardiac structures. Cardiac structures were assessed by echocardiography: 1) LVMi2.7; 2) relative wall thickness (RWT); 3) left atrial diameter indexed to height (LADi) and 4) left ventricular internal diameter in diastole (LVIDD). Higher systolic BP was associated with greater LVMi2.7. Systolic and diastolic BP were associated with greater RWT. Associations were inconsistent for LADi and LVIDD. There was evidence for associations between both greater SDdn and ARV and higher RWT (per 1 SD higher diastolic ARV, mean difference in RWT was 0.13 SDs, 95% CI 0.045 to 0.21); these associations with RWT remained after adjustment for mean BP. There was no consistent evidence of associations between night-time dipping and cardiac structure. Measurement of BP variability, even in adolescents with blood pressure in the physiologic range, might benefit risk of cardiovascular remodeling assessment.

The relationship between mean platelet volume and reverse dipping blood pressure pattern in patients with essential hypertension

ABSTRACT Objective An association between increased mean platelet volume (MPV) and cardiovascular events is well established. Recent studies suggest that a nondipper blood pressure pattern is closely related to increased MPV. Because little information has been revealed about the relationship between reverse dipper hypertension (RDHT) and MPV, we aimed to investigate this relation. Methods A total of 317 patients were retrospectively evaluated by analyzing the records of ambulatory blood pressure monitoring (ABPM). Patients were categorized into three groups according to their ABPM values as RDHT (n = 63), non-dipper hypertension (NDHT) (n = 95), and dipper hypertension (DHT) groups (n = 159). MPV and biochemical analyses were recorded from the hospital database. Results The largest MPV was found in patients with RDHT, followed by patients with NDHT and DHT group (9.1 ± 0.4 fl, 8.8 ± 0.6 fl, and 8.6 ± 0.5 fl, respectively, for all p < .05). MPV was positively correlated with mean 24-hour systolic blood pressure (SBP), mean 24-hour diastolic blood pressure (DBP), mean daytime SBP, mean nighttime SBP and mean nighttime DBP. In multivariate logistic regression analysis, MPV (OR 1.761, 95% CI 1.329 to 2.334, p = .001) and age (OR 1.065, 95% CI 1.019 to 1.113, p = .001) were found to be associated with RDHT. ROC curve analysis of MPV for prediction of RDHT showed that at the cutoff value of >9,1 fl with a sensitivity of 60% and specificity of 69%, respectively (AUC = 0.696 ± 0.035, 95% CI: 0.627–0.764). Our data show that the RDHT pattern is associated with increased MPV values in patients with essential hypertension.

Twenty-four-hour and office blood pressure measurement in a comprehensive assessment of the effectiveness of 12-week therapy with a triple fixed-dose combination of amlodipine/indapamide/perindopril in hypertensive patients in actual clinical practice

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (&lt;100/60 and &lt;90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; &gt;20%), as well as those without nocturnal BP decrease (&gt;0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of &lt;130/80 and &lt;140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p&lt;0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p&lt;0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

Long-term outcomes of renal denervation and related sex characteristics: data from a three-year follow-up

Aim. To study the long-term outcomes of renal denervation (RDN) within 3-year follow-up with an assessment of blood pressure (BP) changes, the severity of target organ damage and the levels of pro- and anti-inflammatory cytokines in patients with resistant hypertension (RH), taking into account sex characteristics.Material and methods. A total of 42 patients with RH were examined at baseline, 1, 2, and 3 years after RDN on the background of antihypertensive therapy. Twenty-four-hour BP monitoring, echocardiography, assessment of creatinine level and estimated glomerular filtration rate (eGFR), as well as determination of some cytokines (interleukin (IL)-1β, 6, 10, tumor necrosis factor-α) were performed.Results. There was a persistent BP decrease in men and women for three years compared with the initial level by an average of 17 [4; 31]/10 [0; 18] mm Hg (p&lt;0,05). Decrease in BP variability from 17,9±5,1 to 15,2±3,6 mm Hg was observed mainly by means of women, while the decrease in left ventricular mass from 250,4±64,0 to 229,3±61,9 g was mainly by means of men. Creatinine level was unchanged, while eGFR decreased from 78,8±16,1 to 74,5±20,3 ml/ min/1,73 m2 over 3 years; the mean eGFR decline was 1,4 ml/min/1,73 m2 in year. All studied cytokines tended to decrease regardless of sex: tumor necrosis factor-α — from 2,1 [1,2; 77] to 2,1 [1,7; 2,6] pg/ml (p=0,022); IL-1β — from 2,2 [1,5; 2,4] to 1,6 [1,1; 1,5] pg/ml (p=0,034); IL-6 — from 3,8 [1,6; 4,9] to 2,8 [1,8; 3,0] pg/ml (p&gt;0,05), IL-10 — from 5,8 [3,2; 8,2] to 2,8 [2,6; 2,9] pg/ml (p=0,000), correlating with IL-6 dynamics.Conclusion. Three years after RDN, there is a persistent decrease in mean 24-hour BP, regardless of sex. In women, a more pronounced BP variability decrease is observed, while in men — regression of left ventricular mass. There is no significant decrease in eGFR in the long-term period. The decrease in proinflammatory cytokines maintains, and in some cases becomes more pronounced within three years after RDN.