24-hour Profile Research Articles

SAT296 Ambulatory 24-hour Tissue Microdialysis Of Cortisol And Metabolites, A Tool For Precision Management In Addison’s Disease

Abstract Disclosure: I. Botusan: None. K. Berinder: None. P. Methlie: None. T. Upton: None. E. Zavala: None. K. Simunkova: None. D.A. Vassiliadi: None. I. Marinelli: None. G.M. Russell: None. M.A. Grytaas: None. S. Tsagarakis: None. S.L. Lightman: None. E.S. Husebye: None. O. Kampe: None. M. Oksnes: None. S. Bensing: None. Background: The autoimmune attack on the adrenals in AD (Addison’s disease) results in lack of the vital hormones cortisol and aldosterone, rendering AD patients dependent on life-long hormone replacement therapy. Current therapies cannot replicate the physiological well-tuned, circadian and ultradian hormonal oscillations properly, probably contributing to increased mortality, morbidity and reduced quality of life. No established biomarker for treatment monitoring exists hampering treatment optimization. Ambulatory 24-hour dynamic steroid profiling may represent a novel therapy-monitoring tool, providing new insights in different replacement therapy regimes. Aim: We aimed to assess 24-hour profiles of free cortisol and metabolites in patients with AD on different glucocorticoid replacement therapies (GRT) and compare the results with healthy volunteers (HV). Material and methods: The study includes 41 patients with AD on different GRT regimes (hydrocortisone, cortisone acetate, modified release hydrocortisone) and 214 healthy participants. Twenty minute microdialysis fractions were collected ambulatory from abdominal subcutaneous tissue over 24 hours using a novel and portable microdialysis fraction collector (U-RHYTHM). Steroid hormones were analyzed by ultrasensitive liquid chromatography tandem mass spectroscopy (LC-MS/MS). Dynamic biomarkers were used to define hormone parameters in both healthy and hormone-replaced participants, and to assess the “time in range” for patients on GRT compared with the profiles of healthy controls. Results: Free cortisol and cortisone levels were measurable in all AD patients, while 18- hydroxycortisol, and corticosterone were detected only in a few AD patients suggesting the persistence of residual adrenal function. Lower cortisol levels during night were observed in AD compared with controls. Ambulatory 24-hour dynamic steroid profiling revealed marked interindividual variations partially depending on the type of GRT and dosing-regime. Conclusions: The 24-hour profiles of free cortisol and cortisone differs between patients with AD and healthy volunteers. Ambulatory 24-hour microdialysis samplings may provide a novel dynamic tool to monitor GRT in AD providing opportunity for individual dose adjustment. Presentation: Saturday, June 17, 2023

OR02-03 Twenty-four-hour Tissue Microdialysis Of Aldosterone And Metabolites In Primary Aldosteronism

Abstract Disclosure: M.A. Grytaas: None. P. Methlie: None. I. Marinelli: None. E. Zavala: None. M. Øksnes: None. T. Upton: None. K. Simunkova: None. D.A. Vassiliadi: None. K. Løvås: None. S. Bensing: None. I. Botusan: None. K. Berinder: None. G.M. Russell: None. G. Ueland: None. O. Kampe: None. S. Tsagarakis: None. S.L. Lightman: None. E.S. Husebye: None. Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension but is grossly underdiagnosed. Early detection, accurate discrimination between unilateral and bilateral PA and appropriate treatment are vital to prevent cardiovascular and renal complications. The current workup however is a cumbersome, multistep process that may not detect dynamic aldosterone variability or nocturnal hypersecretion. Furthermore, subtype determination with adrenal venous sampling is invasive and technically challenging. Novel dynamic 24-hour steroid profiling may represent a major step forward in the diagnostics and subtyping of PA. Aim: To assess 24-hour rhythmicity of aldosterone and metabolites in PA, and to develop a novel dynamic diagnostic tool to discriminate PA from healthy subjects (HS), using tissue microdialysis. Material and methods: Twenty-minute frequency microdialysis fractions were collected over 24 hours from 64 ambulatory patients with PA (26 bilateral, 24 unilateral, 14 with undetermined subtype) using the U-Rhythm sampler followed by multiplex hormone assay liquid chromatography tandem mass spectrometry (LC-MS/MS). Sixteen patients subsequently treated with adrenalectomy for unilateral PA had additional postoperative samplings. Microdialysis samplings from 214 HS were used as controls. We calculated statistical distributions of dynamic biomarkers of abnormality, and developed a machine learning classifier that discriminates PA from HS. Results: Although there were large interindividual variations, PA patients did show a disturbed circadian rhythmicity of aldosterone compared with HS, including some with multiple very high ultradian spikes. Unilateral PA had higher aldosterone spikes and more disturbed rhythmicity compared with bilateral PA. A profound reduction of aldosterone levels and normalisation of rhythmicity was seen post adrenalectomy. Applying a Random Forest classifier in a subgroup of 20 PA patients, 82% specificity and 85% sensibility were achieved to discriminate PA from HS. Our analysis also suggests 18-hydroxycortisol as the most discriminative dynamic biomarker. Conclusions: We demonstrate for the first time circadian and ultradian rhythms of aldosterone in a large cohort of PA compared with HS. Based on our preliminary results, dynamic 24-hour samplings may provide a novel method for diagnosing and subtyping PA, and assess biochemical cure after adrenalectomy. Presentation: Thursday, June 15, 2023

OR30-03 High Resolution Daily Profiles Of Tissue Adrenal Steroids By Portable Automated Collection

Abstract Disclosure: T. Upton: None. E. Zavala: None. P. Methlie: None. M. Oksnes: None. M.A. Grytaas: None. K. Simunkova: None. S. Bensing: None. I. Botusan: None. K. Berinder: None. D.A. Vassiliadi: None. O. Kampe: None. S. Tsagarakis: None. E.S. Husebye: None. G.M. Russell: None. S.L. Lightman: None. Background: Rhythms are intrinsic to endocrine systems, and disruption of these hormone oscillations occurs at very early stages of disease. Since adrenal hormones are secreted with both circadian and ultradian periods, conventional single time point measures provide limited information about rhythmicity, and crucially do not provide information during sleep when many hormones fluctuate from nadir to peak concentrations. If blood sampling is attempted overnight this necessitates admission to a clinical research unit, can be stressful and disturbs normal sleep. Aim: To obtain automated ambulatory 24-hour profiles of adrenal steroids in healthy human subcutaneous tissue to characterize healthy variability without blood sampling. Methods: We used microdialysis, an ambulatory fraction collector and liquid-chromatography mass-spectrometry to obtain 72-point profiles of tissue free adrenal steroids over 24 hours in n=214 healthy volunteers. For validation, we compared tissue against plasma measurements in n=7 inpatient healthy volunteers. We used stationery statistics, time series analyses, and mathematical methods to characterise interindividual and intraindividual variability of these hormones at different times of the day. Results: There were no serious adverse events, and the method was well tolerated, allowing almost all normal activities to continue. In addition to cortisol, we identified daily and ultradian variation in free cortisone, corticosterone, 18-OHF, aldosterone, THF, and aTHF. Rhythmic hormones were highly correlated when measured across the day, especially cortisol with 18OHF (rs = 0.99), cortisol with cortisone (rs = 0.96) and cortisol and 18-OHF with corticosterone (rs = 0.96-0.97). There was a very strong correlation between mean values of cortisol and 18OHF with aldosterone (rs = 0.91-0.93), but aldosterone profiles were characterized by high interindividual variability. Tissue 18-OHF was the most highly correlated with plasma cortisol (rs 0.89, range 0.74—0.97, p<0.001), and 18-OHF phase was advanced with respect to tissue cortisol. The ratio of tissue cortisol:cortisone exhibited a stronger daily rhythm than in plasma, with cortisol concentrations often falling below cortisone in the late afternoon and early part of sleep.Using the data, we computed mathematically defined metrics (“dynamic biomarkers”) stratified by sex, age, and BMI to quantify individual variability of hormone rhythms. Provisional analysis suggests no evidence for an effect of sex on cortisol or 18OHF, but evidence for a small effect of BMI on total 24-hour cortisol, 18OHF, corticosterone, and aldosterone. Conclusions: These data provide, for the first time, an insight into the dynamics of adrenal steroids in tissue in real world setting and will serve normative reference data for establishing novel and improved biomarkers of endocrine disease. Presentation: Sunday, June 18, 2023

Effects of reducing free sugars on 24-hour glucose profiles and glycemic variability in subjects without diabetes.

The Western diet, especially beverages and high processed food products, is high in sugars which are associated with the development of obesity and diabetes. The reduction of refined carbohydrates including free and added sugars improves glycemic control in individuals with diabetes, but the data regarding effects in subjects without diabetes are limited. This study aimed to evaluate the effects of reducing free sugar intake on 24-h glucose profiles and glycemic variability using continuous glucose monitoring (CGM). In the randomized controlled study, 21 normal weight and overweight/obese subjects (BMI 18-40 kg/m2) without diabetes were assigned to a 4-week reduced-sugar (RS) diet or control diet after a 2-week baseline phase. During the baseline phase, all participants were advised not to change their habitual diet. During the intervention phase, RS participants were asked to avoid added sugar and white flour products, whereas participants of the control group were requested to proceed their habitual diet. Anthropometric parameters and HbA1c were assessed before and at the end of the intervention phase. Interstitial glucose was measured using continuous glucose monitoring (CGM), and the food intake was documented by dietary records for 14 consecutive days during the baseline phase and for the first 14 consecutive days during the intervention phase. Mean 24-h glucose as well as intra- and inter-day indices of glucose variability, i.e., standard deviation (SD) around the sensor glucose level, coefficient of variation in percent (CV), mean amplitude of glucose excursions (MAGE), continuous overlapping net glycemic action (CONGA), and mean absolute glucose (MAG), were calculated for the baseline and intervention phases. During the intervention, the RS group decreased the daily intake of sugar (i.e., -22.4 ± 20.2 g, -3.28 ± 3.61 EN %), total carbohydrates (-6.22 ± 6.92 EN %), and total energy intake (-216 ± 108 kcal) and increased the protein intake (+2.51 ± 1.56 EN %) compared to the baseline values, whereby this intervention-induced dietary changes differed from the control group. The RS group slightly reduced body weight (-1.58 ± 1.33 kg), BMI, total fat, and visceral fat content and increased muscle mass compared to the baseline phase, but these intervention-induced changes showed no differences in comparison with the control group. The RS diet affected neither the 24-h mean glucose levels nor intra- and inter-day indices of glucose variability, HbA1c, or diurnal glucose pattern in the within- and between-group comparisons. The dietary reduction of free sugars decreases body weight and body fat which may be associated with reduced total energy intake but does not affect the daily mean glucose and glycemic variability in individuals without diabetes. German Clinical Trials Register (DRKS); identifier: DRKS00026699.

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

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

The Association Between 24-Hour Blood Pressure Profiles and Dementia.

Midlife hypertension increases risk for dementia. Around one third of adults have diagnosed hypertension; however, many adults are undiagnosed, or remain hypertensive despite diagnosis or treatment. Since blood pressure (BP) follows a circadian rhythm, ambulatory BP monitoring allows for the assessment of BP over a 24-hour period and provides an important tool for improving the diagnosis and management of hypertension. The measurement of 24-hour BP profiles, especially nocturnal BP, demonstrate better predictive ability for cardiovascular disease and mortality than office measurement. However, few studies have examined 24-hour BP profiles with respect to dementia risk. This is an important topic since improvements in BP management could facilitate the primary prevention of vascular cognitive impairment and dementia. Therefore, this review discusses the evidence linking BP to dementia, with a focus on whether the implementation of 24-hour BP measurements can improve risk prediction and prevention strategies. Pathways linking nocturnal BP to dementia are also discussed as are risk reduction strategies. Overall, limited research suggests an association between 24-hour BP elevation and poorer cognition, cerebral small vessel disease, and dementia. However, most studies were cross-sectional. Further evidence is needed to substantiate 24-hour BP profiles, over and above office BP, as predictors of vascular cognitive impairment and incident dementia.

Heart Failure Assessment Using Multiparameter Polar Representations and Deep Learning.

Heart failure refers to the inability of the heart to pump enough amount of blood to the body. Nearly 7 million people die every year because of its complications. Current gold-standard screening techniques through echocardiography do not incorporate information about the circadian rhythm of the heart and clinical information of patients. In this vein, we propose a novel approach to integrate 24-hour heart rate variability (HRV) features and patient profile information in a single multi-parameter and color-coded polar representation. The proposed approach was validated by training a deep learning model from 7,575 generated images to predict heart failure groups, i.e., preserved, mid-range, and reduced left ventricular ejection fraction. The developed model had overall accuracy, sensitivity, and specificity of 93%, 88%, and 95%, respectively. Moreover, it had a high area under the receiver operating characteristics curve (AUROC) of 0.88 and an area under the precision-recalled curve (AUPR) of 0.79. The novel approach proposed in this study suggests a new protocol for assessing cardiovascular diseases to act as a complementary tool to echocardiography as it provides insights on the circadian rhythm of the heart and can be potentially personalized according to patient clinical profile information.Clinical relevance- Implementing polar representations with deep learning in clinical settings to supplement echocardiography leverages continuous monitoring of the heart's circadian rhythm and personalized cardiovascular medicine while reducing the burden on medical practitioners.

Pharmacokinetic Data of Dolutegravir in Second-line Treatment of Children With Human Immunodeficiency Virus: Results From the CHAPAS4 Trial.

Dolutegravir (DTG), combined with a backbone of 2 nucleoside reverse transcriptase inhibitors, is currently the preferred first-line treatment for human immunodeficiency virus (HIV) in childhood. CHAPAS4 is an ongoing randomized controlled trial investigating second-line treatment options for children with HIV. We did a nested pharmacokinetic (PK) substudy within CHAPAS4 to evaluate the DTG exposure in children with HIV taking DTG with food as part of their second-line treatment. Additional consent was required for children on DTG enrolled in the CHAPAS4 trial to participate in this PK substudy. Children weighing 14-19.9 kg took 25 mg DTG as dispersible tablets and children ≥20 kg took 50 mg film-coated tablets. Steady-state 24-hour DTG plasma concentration-time PK profiling was done at t = 0 and 1, 2, 4, 6, 8, 12, and 24 hours after observed DTG intake with food. Reference adult PK data and pediatric data from the ODYSSEY trial were used primarily for comparison. The individual target trough concentration (Ctrough) was defined as 0.32 mg/L. Thirty-nine children on DTG were included in this PK substudy. The geometric mean (GM) area under the concentration-time curve over the dosing interval (AUC0-24h) was 57.1 hours × mg/L (coefficient of variation [CV%], 38.4%), which was approximately 8% below the average AUC0-24h in children in the ODYSSEY trial with comparable dosages, but above the adult reference. The GM (CV%) Ctrough was 0.82 mg/L (63.8%), which was comparable to ODYSSEY and adult reference values. This nested PK substudy shows that the exposure of DTG taken with food in children on second-line treatment is comparable with that of children in the ODYSSEY trial and adult references. Clinical Trials Registration.ISRCTN22964075.

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.

CLINICAL EFFECTS OF SINGLE PILL COMBINATION THERAPY OF ANTIHYPERTENSIVES AND STATIN ON BLOOD PRESSURE, LIPID, AND CARDIOVASCULAR RISK PROFILES IN PATIENTS WITH NEWLY DIAGNOSED HYPE

Objective: Hypertension and dyslipidemia are the major risk factors for athersclerotic cardiovascular disease (ASCVD). The single pill combination (SPC) covering these risk factors are commonly used but has little data. The clinical effect of these SPCs on blood pressure and lipid profile with ASCVD risk change were evaluated in middle aged borderline risk group. Design and method: Seventy-two patients (age: 53.6±10 years) who were simultaneously diagnosed with hypertension and dyslipidemia were randomized to the two SPC groups: amlodipine 5 with atorvastatin 20 (AA) versus (vs.) olmesartan20 with rosuvastatin 10mg (OR). Before and after medication for six months under the active life style change, 24-hour ambulatory blood pressure (BP) monitoring (ABPM), lipid profile, carotid ultrasonography, ankle-brachial index (ABI), and ASCVD risk parameters including glucose profiles were also compared. Results: Baseline 24-hr mean systolic BP were higher in OR group (AA vs. OR: systolic BP 142.8±8.9 vs. 148.3±8.8mmHg, p = 0.039). The level of LDL cholesterol were slightly higher without significance in OR group (LDL 121.3±31.2 vs. 136.4±26.6mg/dL, p = 0.091). Follow-up mean BP were similar on 24-hr ABPM (systolic BP 127.3±9.4 vs. 125.1±7.3mmHg, p = 0.416; diastolic BP 85.6±6.6 vs. 81.4±7.8mmHg, p = 0.083). The changes in reduction of mean systolic BP markedly greater in OR group (systolic BP -15.1±11.5 vs -22.8±11.7, p = 0.048). Reduction of LDL cholesterol were similar (-53.1±24.7 vs. -62.5±29.1 mg/dL, p = 0.331). The level of fasting glucose was increased in only OR group and those of hemoglobin A1c were increased at both group and its changes were greater in OR group (0.12±0.30 vs. 0.23±0.28%, p = 0.048). The carotid intima-media thicknesses were slightly reduced in both group while ABI were not changed. ASCVD risk score were decreased after treatment (5.3 to 2.9 vs. 6.9 to 3.8%) with its similar rate between both group (45.3 vs 45.6%). Conclusions: In treating the middle aged patients with newly diagnosed hypertension and dyslipidemia using SPCs of AA and OR, OR is beneficial in blood pressure control while AA is advantageous to glucose control. After 6-months simultaneous treatment of hypertension and dyslipidemia, their grades of ASCVD risks were shifted from borderline to lower group.

Effect of dapagliflozin on 24-hour glycemic variables in Japanese patients with type 2 diabetes mellitus receiving basal insulin supported oral therapy (DBOT): a multicenter, randomized, open-label, parallel-group study

IntroductionThis study aimed to evaluate the impacts of dapagliflozin on 24-hour glucose variability and diabetes-related biochemical variables in Japanese patients with type 2 diabetes who had received basal insulin supported...

Comparative antihypertensive efficacy of combinations of azilsartan medoxomil or olmesartan medoxomil with amlodipine in patients with arterial hypertension, type 2 diabetes mellitus and non-alcoholic fatty liver disease

Оbjective : to compare the effectiveness of the effect of two combination therapy options on office blood pressure (BP), 24-hour blood pressure monitoring (ABPM) and 24-hour BP profile (DAP) in patients with arterial hypertension (AH) associated with type 2 diabetes mellitus (T2D) and non-alcoholic fatty liver disease (NAFLD). Materials and methods: 137 patients with uncontrolled hypertension combined with DM2 and NAFLD were examined. After randomization by the "envelope" method, patients of the 1st group were assigned a combination of azilsartan medoxomil (Az-M) with amlodipine (Aml), the 2nd group a combination of olmesartan medoxomil (Ol-M) with Aml. At baseline, at 4, 8, 12, and 24 weeks, office BP was measured, and ABPM and DAP were analyzed at baseline and at 24 weeks of the study. Results : after 12 weeks in the 1st and 2nd groups, 86,8% and 84,1% of patients, respectively, reached the target level (TA) of blood pressure, which was maintained until the end of the study. After 24 weeks, both groups showed a statistically significant improvement in ABPM parameters and optimization of DAP. At the same time, taking the Ol-M/Aml combination was accompanied by more pronounced positive dynamics of some prognostically important ABPM indicators. Conclusion : despite the significant antihypertensive effect on the background of the use of both combinations, the effect on individual parameters of ABPM Ol-M/Aml was more pronounced.

Vascular stiffness, 24-hour blood pressure profile in patients with hypertension and anxiety-depressive disorders in andro- and menopausal periods

Aim. Identification and analysis of the features of vascular stiffness, 24-hour blood pressure (BP) profile, and central aortic pressure (CAP) in patients with hyper­tension (HTN) and anxiety-depressive disorders (ADDs) during andro- and meno­pausal periods.Material and methods. The study included 120 patients with uncontrolled hyper­tension in the andro- and menopausal periods, of which 60 patients with hyper­tension and ADDs (30 men and 30 women) with median age of 58 years (52-64 years), as well as the control group — 60 patients with hypertension without ADD (30 men and 30 women) with median age of 59 years (53-65 years). All persons included in the study underwent 24-hour ambulatory BP monitoring (ABPM) and assessed the arterial stiffness parameters and CAP.Results. Comparative evaluation of ABPM in the group of patients with HTN and ADDs revealed more pronounced pathological changes in the 24-hour BP profile compared to those in the control group. Andro- and menopause with a combination of HTN and ADDs characterized by significantly higher ABPM parameters than HTN without ADDs (regardless of the sex). At the same time, in the group of men with HTN and ADD in andropause, unfavorable changes in the main arterial stiffness parameters and CAP were more significant than in women with HTN and ADD during menopause (p<0,05). In the control men groups, in comparison with women, more pronounced unfa­vo­-rable changes in certain vascular stiffness indicators, CAP and ABPM were recorded.Conclusion. In men and women in periods of andro- and menopause with HTN and ADDs, the features of arterial stiffness, CAP, and 24-hour blood pressure profile were verified in comparison with patients with HTN without ADDs. At the same time, the severity of unfavorable changes in the studied parameters in men with depression in andropause is more significant than in menopausal women.

Position of 24-hour ambulatory blood pressure monitoring in modern practice

Currently, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is the gold standard for diagnosing hypertension (HTN) and evaluating the effectiveness of antihypertensive therapy. The method provides information about some BP parameters that cannot be obtained in any other way. ABPM is reasonable in any patient with a documented increase in BP, especially if specific BP phenotypes are suspected: white coat HTN and masked HTN. Antihypertensive therapy under the ABPM, on average, is more economical and is not associated with overprescribing of drugs and their combinations. Based on the ABPM data, calculating a number of additional indicators of the 24-hour BP profile is possible, but their scope is still limited to the research field. In the conclusion on ABPM data, the results of office BP measurement and antihypertensive therapy should be indicated.

24-hour blood pressure monitoring in patients with polycythemia vera

Aim. To study the parameters of 24-hour blood pressure monitoring in patients with polycythemia vera and to determine their informational value for the diagnosis of heart damage.Materials and methods. Blood pressure parameters were monitored daily in 63 patients with I–IIB stage polycythemia vera and 52 healthy individuals to determine the occurrence of their pathological types. The sensitivity and specificity of the studied parameters were evaluated using ROC analysis for early diagnosis of heart damage in polycythemia patients. The obtained information was processed in Statistica 25.0.Results. An analysis of blood pressure load showed that 47.6%, 30.1% and 34.9% of polycythemia patients suffer from systolic arterial hypertension (p = 0.012), daytime diastolic arterial hypertension (p = 0.03), and nocturnal diastolic arterial hypertension (p = 0.001), respectively. In comparison with healthy individuals, polycythemia patients experienced a higher variability of systolic (p<0.002) and diastolic (p<0.001) blood pressure, as well as the morning surge of systolic pressure (p = 0.014), more frequently. In 69.8% of polycythemia patients, pathological types of 24-hour blood pressure profile – with either insufficient or excessive nocturnal reduction – were observed. Informative parameters of heart damage in polycythemia patients were found to include blood pressure load, minimum daytime systolic and diastolic blood pressure, and the rate of nocturnal decrease in diastolic pressure.Conclusions. (1) Systolic-diastolic arterial hypertension was detected in half of polycythemia patients, with pathological types of 24-hour blood pressure profile observed in the majority of patients. (2) The parameters of 24-hour blood pressure monitoring can be used for early diagnosis of heart damage in patients with polycythemia vera.

The current state of blood pressure measurement and emerging technologies

Office blood pressure measurement has been the primary means of diagnosing and treating hypertension for almost a century. Increasingly, guidelines recommend out-of-office measurements (ambulatory or home blood pressure measurement) to confirm the diagnosis of hypertension and to follow treated patients. Ambulatory blood pressure measurement includes nocturnal measurement and provides a 24-hour blood pressure profile, enabling calculation of overall blood pressure, daytime mean, and nocturnal mean. Home blood pressure monitoring is a method of blood pressure measurement that is convenient and accessible. Blood pressure telemonitoring is a complementary and emerging technology that enhances the effectiveness of out-of-office blood pressure measurement and has the potential to improve the health of end users through engagement, efficiency, and enhanced communication with the care team. Blood pressure measurements can be obtained remotely, effectively transmitted to their health care team via telemonitoring for interpretation, and then a care plan can be developed and implemented. However, care must be taken to ensure that these emerging technologies record and transmit accurate blood pressure information in a secure and reliable manner.

ASSOCIATIONS BETWEEN SLEEP AND REST: ACTIVITY CHARACTERISTICS AND METABOLOMIC PROFILES IN OLDER MEN

Abstract The association of sleep and rest-activity rhythms (RAR) with metabolic health is not fully understood. Previous studies have identified multiple metabolite markers in amino acid and lipid pathways associated with various characteristics of sleep. However, most of the studies used self-reported sleep, and limited studies have examined 24-hour RAR profiles, a more complete picture of activity. We studied 950 older men and measured metabolomics from fasting blood samples. We identified numerous metabolomic markers that were cross-sectionally associated with actigraphy-based measures of sleep (total sleep time, sleep efficiency, sleep timing) and RAR (amplitude, acrophase, mesor and overall rhythmicity). The majority of the associated metabolites were amino acids and lipids from a wide range of pathways, including metabolism pathways of branched chain amino acid metabolism, fatty acids, and gamma-glutamyl amino acids. Our preliminary findings suggest that sleep and RAR are widely involved in human metabolism.

Changes in 24-Hour Movement Behaviors From Early to Late Pregnancy in Individuals With Prepregnancy Overweight or Obesity.

Understanding how sleep, sedentary behavior (SED), and physical activity (PA) (24-h movement profile) changes across pregnancy in individuals with prepregnancy overweight or obesity and how parity (previous births) impacts these changes can help inform interventions. In 155 participants, movement was measured using wrist-worn accelerometers, and sleep was self-reported in early (8-15wk) and late (29-38wk) pregnancy. The 24-hour movement profiles were analyzed using compositional analyses. Nulliparous participants (no previous births) spent 33.95%, 38.14%, 25.32%, and 2.58% of the 24-hour day in early pregnancy in sleep, SED, light-intensity PA, and moderate/vigorous-intensity PA, respectively. Multiparous participants (≥1 previous birth) spent 2.50 percentage points less in SED (mean log-ratio difference = -0.068; 95% confidence interval [CI], -0.129 to -0.009) and 2.73 percentage points more in light-intensity PA (mean log-ratio difference = 0.102; 95% CI, 0.035 to 0.180). From early to late pregnancy, participants decreased the proportion of the 24-hour day spent asleep by 1.67 percentage points (mean log-ratio difference = -0.050; 95% CI, -0.092 to -0.011) and increased light-intensity PA by 1.56 percentage points (mean log-ratio difference = 0.057; 95% CI, 0.003 to 0.108), with no change in other behaviors. Nulliparous and multiparous individuals with prepregnancy overweight or obesity both had high levels of SED, with no change across pregnancy, and may require interventions to reduce SED.

ODP004 Glucose Profiles and Insulin Sensitivity in Adults with Overweight/Obesity Participating in a Weight Loss Intervention based on Early Time-Restricted Eating plus Daily Caloric Restriction vs Daily Caloric Restriction Alone

Abstract Background Emerging literature suggests that short-term (<1 week) time restricted eating (TRE) may improve glucose tolerance and insulin sensitivity, but few studies have evaluated the longer-term effects of TRE on glycemic outcomes. The aim of this study was to compare 24-hour glucose profiles and insulin sensitivity in participants enrolled in a 12-week behavioral weight loss intervention based on early TRE plus daily caloric restriction (E-TRE+DCR) or DCR alone. Methods Eighty-one adults with overweight or obesity (age 18-50 years, BMI 27-45 kg/m 2) were randomized to E-TRE (10-hour eating window starting within 3 hours of waking) plus DCR (35% daily caloric restriction) or DCR alone for 12 weeks. Each participant wore a continuous glucose monitor (CGM, Freestyle Libre Pro) for 7 days at baseline and week 12. Fasting glucose and insulin levels were drawn for assessment of insulin sensitivity by homeostasis model assessment-estimated insulin resistance (HOMA-IR) at baseline and week 12. Analysis of Covariance (ANCOVA) was used to assess whether there were differences in glucose measures by randomized group. Between-group differences in minutes spent over glucose of 120 mg/dL and excursions over glucose of 120 mg/dL were assessed using either negative binomial or Poisson regression. All models were adjusted for the change in weight from baseline to week 12. Results Of the 81 adults randomized, 45 participants had valid CGM data and 40 had valid glucose, insulin and HOMA-IR data at baseline and 12 weeks (missing data due to COVID-19 related restrictions on in person research). There were no significant differences in sex, age, BMI or percent with prediabetes between groups (88% female, age 39.2 +/- 6.9 years, BMI 33.8 +/- 5.7 kg/m 2, 17% with prediabetes). After adjusting for weight loss, there were no between-group differences in overall average sensor glucose, minutes spent above 120 mg/dL, number of glucose excursions above 120 mg/dL, daytime or nighttime average sensor glucose, mean amplitude of glycemic excursions, or standard deviation or coefficient of variation of glucose levels. There was a significant difference in week 12 day-night sensor ratio between the two groups, with those in the E-TRE+DCR group having day-night sensor ratio mean 0.27 (95% confidence interval -0.53, -0. 00) units lower on average than those in the DCR group at week 12, adjusting for baseline. There were no between-group differences in fasting glucose, insulin, or HOMA-IR. Conclusions While the E-TRE+DCR group had a slightly lower day-to-night sensor ratio compared to the DCR group, this difference is likely not clinically meaningful because there were no observed differences in day or night average sensor glucose. Because participants with diabetes were excluded and only 17% of participants had prediabetes, our ability to detect changes in glucose profiles and insulin sensitivity may have been limited. Presentation: No date and time listed

Association of Ambulatory Blood Pressure and Other Factors With Intraocular Pressure-Related 24-Hour Contact Lens Sensor Profile in Untreated Glaucoma.

PurposeTo investigate the association of diurnal blood pressure (BP) and other factors with the intraocular pressure (IOP)–related 24-hour contact lens sensor (CLS) profile of patients with untreated glaucoma.MethodsThe prospective study included 82 patients with untreated normal-tension glaucoma. CLS measurements and ambulatory BP monitoring were performed simultaneously for 24 hours. The association between the mean arterial pressure (MAP) and CLS profile was examined for the daytime and nocturnal periods using linear regression analysis. The associations between other factors and the CLS profile were also examined.ResultsMultivariate analysis of data from 63 eligible patients showed that higher average MAPs were significantly associated with larger average nocturnal CLS values (β coefficient = 0.273; P = 0.023); a larger increase in the last CLS value (β coefficient = 0.366; P = 0.003); larger standard deviations (SDs) of CLS values for the daytime, nocturnal, and 24-hour periods (β coefficient = 0.407, 0.293, and 0.375; P < 0.001, P = 0.032 and 0.002, respectively); and higher average ocular pulse frequencies for the daytime, nocturnal, and 24-hour periods (β coefficient = 0.268, 0.380, and 0.403; P = 0.029, 0.002, and 0.001, respectively). Thicker subfoveal choroids and shorter axial length were significantly associated with larger SDs and larger average CLS values, respectively. Smaller anterior chamber volume and lower corneal hysteresis were associated with larger SDs or larger average ocular pulse amplitude.ConclusionsAmbulatory BP and several ocular parameters were significantly associated with various parameters of the 24-hour CLS profile.Translational RelevanceAmbulatory BP and ocular parameters may be modifiers of the 24-hour IOP-related profile of CLS.