24-hr Ambulatory Blood Pressure Research Articles

Excessive Blood Pressure Rise and Cardiovascular Remodeling in Marathon Runners.

Exercise-induced hypertension (EIH) is thought to be associated with increased cardiovascular (CV) risks. However, no previous studies have investigated the effects of EIH on CV systems in marathon runners without CV risk factors using both 24-hr ambulatory blood pressure (BP) monitoring and exercise stress echocardiography (ESE). This study firstly described differences in CV adaptations according to EIH assessed by both exams. Marathon runners between 35 and 64 years of age without CV risk factors were eligible. All the participants underwent both 24-hr ambulatory BP monitoring and ESE. EIH was defined as a maximal exercise systolic BP≥210 mmHg. The EIH group (n=19) had shorter training history and higher exercise intensity compared to the non-EIH group (n=23). The average systolic BP was higher in the EIH group than in the non-EIH group. Left cardiac chamber size and left ventricular mass (LVM) were also higher in the EIH group compared to the non-EIH group. Maximal BP during ESE was positively correlated with both parameters. Exaggerated BP response during exercise needs to be monitored for pre-emptive measurements before it results in progressive cardiovascular maladaptation.

#1550 Incident hypertension: immune biomarkers and vascular phenotypes

Abstract Background and Aims Blood pressure (BP) regulation is mediated by cardiac, vascular, endocrine, renal, and immune system interactions. Hence, hypertension may exist as different phenotypic variants, with different clinical features and susceptibility to target organ damage. We aimed to analyse the circulating protein biomarker ‘signature’ of: 1) untreated hypertension; 2) hypertensive phenotypes identified by arterial and blood pressure parameters. Method 61 patients with hypertension, and 61 controls were assessed using 24hr ambulatory BP monitoring; endothelial function, arterial stiffness, carotid intima-media thickness (CIMT), and cardiovascular variability [1]. Circulating protein biomarkers analysed using Olink® Inflammation plasma biomarker panel, reported as NPX (Normalized Protein eXpression), in Log2 scale. Results 34 biomarkers dominated by cytokines and chemokines differed between normotensive and hypertensive subjects (Fig. 1), though failed to meet Bonferroni-adjusted threshold. Inflammatory biomarkers correlated with BP and arterial stiffness, BP variability, and CIMT, but not endothelial function. Associations were concordant across systolic and diastolic BP; TPP1, CCL7, CCL11, and CCL21 positively correlating; IL18R1, and KYNU negatively. These relationships were more pronounced in hypertensive subgroup, 85 biomarkers correlating including CD molecules (CD200R1, CD22, CD58, CD6, CD70) and cytokines (IL-5, IL-11, IL-15, IL-18, IL-32, IL-1RL2, IL-22RA1, IL-5RA). HGF, AGE, and CCL21 showed greatest between group differences and correlated with multiple BP or vascular parameters. Systolic nocturnal dipping demonstrated negative correlation with biomarkers relating to immune cell interactions and cellular adhesion (CTRC, EPHA1, LGALS4, SIT1, SMOC, IL-18 and TNFSF11). Machine learning techniques identified three phenotypes of hypertension, ‘arterially stiffened’, ‘vaso-protected’, and ‘non-dipper’ [1]. Sixteen of the 85 correlating biomarkers also differed between these phenotypic groups: Conclusion Hypertension is linked to alterations in circulating immune biomarkers. Multiple biomarkers correlated with both arterial stiffness and BP parameters. Some biomarkers are only correlated in the hypertensive group. Many also relate to nocturnal dipping, and differed across the hypertension endotypes. HGF is a promising biomarker for BP and arterial function; warranting further validation.

Abstract 13463: Effect of an Intervention to Reduce Sedentary Behavior on Blood Pressure in Desk Workers: The RESET BP Randomized Clinical Trial (RCT)

Introduction: High sedentary behavior (SB) is associated with cardiovascular (CV) risk in cohort studies, yet definitive data from RCTs of SB reduction on CV risk factors is lacking. Hypothesis: A 3-month SB reduction intervention would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. Methods: We recruited desk workers with systolic BP (SBP) 120-159 mmHg or diastolic BP (DBP) 80-99 mmHg, not on antihypertensives, and reporting low physical activity. Participants were randomized 1:1 to a 3-month SB reduction intervention or control. The intervention targeted replacing sitting with standing and stepping via health coaching, a wrist-worn activity prompter, and a height-adjustable workstation. All day and work-specific SB, standing, stepping, and steps were measured by a thigh-worn triaxial accelerometer. Protocolized office SBP (primary outcome), DBP, and HR were measured in duplicate on two occasions at each baseline and 3 months; 24-hr ambulatory BP and carotid-femoral PWV via tonometry were also measured. Changes in outcomes were compared across groups using analysis of covariance and mixed models. Results: Participants (n=271) had mean age 45 y and BP 129/83 mmHg; 60% were female and 82% were non-Hispanic White. Retention was 97%. Intervention participants reduced SB during work (-1.3 hr/day) and across all waking hours (-1.1 hr/day) compared to controls (both p<0.001). Intervention participants increased work-specific standing (1.2 hr/day), stepping (5 min/day) and steps (398/day) and all day standing (1.0 hr/day), stepping (7 min/day) and steps (528/day) compared to control (all p<0.05). Yet, the intervention did not yield a greater reduction in BP or PWV vs. controls (all p>0.05). Differences in changes were office SBP -0.24 mmHg (p=0.793), DBP 0.08 mmHg (p=0.894), and heart rate -2.75 (p=0.190). Findings were similar for 24-hr, daytime, and nighttime ambulatory BP averages (all <1.2 mmHg; p>0.05). Differences in PWV were higher (opposite from the hypothesized direction) in intervention vs. control and approached significance (0.18 m/s, p=0.07). Conclusions: In sedentary desk workers with mild-moderate untreated BP, this 3-month intervention reduced daily SB by about one hour but did not improve BP or PWV.

LONG TERM EFFECT OF RENAL DENERVATION ON 24 HOUR ABPM AND BLOOD PRESSURE LOAD IS LARGELY DEPENDENT OF BASELINE ARTERIAL STIFFNESS

Objective: The aim of the study was to evaluate the long term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension depending of the baseline arterial stiffness status. Design and method: Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP >135 mmHg or diastolic BP >85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. Cardio ankle vascular index (CAVI) was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex™ catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol. Results: The study included 32 patients with treatment-resistant hypertension and performed successful RSD. CAVI was measured before the intervention and the results of the procedure on 24h daytime, nighttime and 24 blood pressure and systolic and diastolic BP load were evaluated by serial ABPM measurements. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. Along with reduction of all ABPM parameters more profound and clinically meaningful change of BP load during daytime, nighttime and 24h period was also noticed in this group of patients. (Table 1) Conclusions: The long term effect of renal denervation on 24h ABPM and BP load is largely dependent of baseline arterial stiffness. The results of the present study justify the incorporation of arterial stiffness evaluation in clinical decision workout of the procedure.

PS-P01-10: MASKED HYPERTENSIVE EFFECT AND GROWTH DIFFERENTIATION FACTOR 15

Background: Growth differentiation factor 15 [GDF15], a possible biomarker of mitochondrial function related to ageing was reported to be associated an increased risk of cardiovascular events. However, there were no previous data that investigated the relationship between masked hypertensive effect and serum GDF15 level. Methods: In outpatients clinic in which evaluated frailty in elderly patients, we evaluated clinic, home and 24-hr ambulatory BP, and serum GDF15 level in 116 hypertensive patients. Clinic BP was automatically measured twice in a sitting position [HBP-9035, Fukuda-Colin, Japan]; home BP [HBP], 3 times in the morning and evening for 5 days [HEM-7080IC, Omron, Japan]; and ambulatory BP [ABP], at 30-minute intervals for 24 hours [TM-2441, A&D, Japan]. Results: Mean age was 77.6 ± 7.3 years [male 37.1 percent]. Clinic BP was 132.9 ± 18.7 / 73.9 ± 12.7 mmHg, and pulse rate 77.2 ± 14.4 bpm. GDF15 had a skewed deviation, and median GDF15 was 1.53 [25–75 percentile, 1.25–2.08] ng/ml. Natural log-transformed GDF15 [LnGDF15] was negatively related to clinic BP [systolic BP, r = -0.338, P < 0.001; diastolic BP, r = -0.335, P < 0.001], but not to home systolic BP [r = -0.112, P = 0.252] or awake ambulatory systolic BP [r = -0.080, P = 0.426]. LnGDF15 was significantly related to masked hypertensive effect assessed by ABP [SBP r = 0.273, P = 0.006] and that by home BP [SBP r = 0.382, P < 0.001]. In tertile analysis of GDF15, masked hypertensive effect assessed by ABP and HBP were significantly increased across tertile of GDF15. Masked hypertensive effect was significantly greater across tertile of GDF15 even after adjustment for age, sex, BMI, antihypertensive medication use, diabetes, dyslipidemia, smoking habit, alcohol drinking habit. Conclusion: An increased GDF15 can be associated with an increased masked hypertensive effect in elderly hypertensive patients.

PS-C10-9: EFFECTIVENESS OF AMLODIPINE ON 24-HOUR AMBULATORY BLOOD PRESSURE IN ADULT PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION: A MULTICENTRE OBSERVATIONAL, REAL-WORLD STUDY

Objective: Inadequate 24-hour blood pressure control could cause complications, especially in high-risk hypertensive individuals. Hence, it is recommended that the targeted blood pressure levels be maintained round the clock. This prospective, observational study assessed the 24-hour ambulatory blood pressure (ABP) control with 8-week amlodipine therapy 5/10 mg/day in patients with hypertension. Methods: Adult patients (62 m, 42 f) with mild-to-moderate essential hypertension received oral amlodipine 5 mg/day (n = 68) or 10 mg/day (n = 36) for 8 weeks. The study was approved by the independent ethics committee and informed consent was obtained from all participants. Primary outcome was change at 8 weeks from baseline in mean 24-hr ABP (systolic and diastolic), and secondary outcomes were change from baseline in mean morning, daytime, night-time, and last 6-hr dosing interval ABP. A repeat measures analysis of covariance (ANCOVA) was done for changes in ABP over 8 weeks, with age, gender, BMI and associated comorbidities as covariates. Nocturnal dippers were assessed as those greater than or equal to 10% reduction in ABP at 8 weeks. Sub-groups were created based on age, duration of hypertension, occupation, baseline BMI and amlodipine dose. Safety was evaluated based on clinical adverse events and 12-lead electrocardiogram. Results: Of the 104 patients from 2 study centers, 49 completed 8-weeks therapy and were included for per-protocol analysis. Significant reductions in the mean 24-hr blood pressure were seen for both SBP and DBP (figure 1). The mean 24-hr. reduction was -10.82 and -6.25 mmHg with 5 mg amlodipine and -19.81 and -11.19 mmHg with 10 mg amlodipine for SBP and DBP respectively (p < 0.0001). The mean morning, daytime, night-time, and last 6-hr reductions in SBP were -14.06, -18.63, -20.42, and -13.51 respectively (p < 0.0001), and DBP reductions were -7.78, -10.27, -11.07, and -6.44 respectively (p < 0.0001). Significant reduction in ABP was seen in all sub-groups (p < 0.0001). Greater reduction in SBP and DBP were observed in patients with stage-2 hypertension. At baseline, there were 30 (61.2%) non-dippers which decreased to 18 (36.7%) at 8 weeks. At the end of the study, 40% of non-dippers were converted to dippers by Amlodipine, whereas none of the dippers were converted to non-dippers. No adverse effects were reported. Conclusion: Amlodipine significantly reduces the 24-hr. mean morning, daytime, night-time, and last 6-hr. ABP and converted non dippers to dippers in adult patients with mild to moderate essential hypertension. The Study highlights the consistent effects of amlodipine on both quantity and quality of 24 hours BP control which is important for associated CV risk reduction.

PS-P04-2: 24 HOUR AMBULATORY BLOOD PRESSURE PROFILE OF HYPERTENSIVE AND PRE-HYPERTENSIVE HEALTHCARE WORKERS IN A PHILIPPINE TERTIARY HOSPITAL

Objectives: To determine the blood pressure profile and phenotypes of hypertensive health care workers and its association to BP control dipping status. Design and Methods: This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM). Clinical profile, and ABPM data were also evaluated Results: 181 patients were included with majority from 50–59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The most frequent anti-hypertensive drug was an angiotensin receptor blocker (ARB, most cited was Losartan), comprising 62% among those on antihypertensive medication followed by calcium channel blockers (CCB- 23%). Majority or 73% were on mono therapy. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%). Healthcare workers who work > 9 hours were 2.05 times more likely to be non-dippers compared to healthcare workers who works up to 9 hours. Conclusion: Among health care workers, 24 hour blood pressure were uncontrolled more in females 50–59years old, with association on working hours> 8 hours, without association to shift work, and job classification. There is a significant association of longer work hours and nocturnal dipping pattern. This study highlights the importance of 24-hour ABPM to detect 24-hr pattern and identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients on maintenance medications.

PS-P03-7: 24 HR-AMBULATORY BLOOD PRESSURE PROFILE AND CLINICAL FEATURES OF HYPERTENSIVE AND PREHYPERTENSIVE HEALTH CARE WORKERS IN A PHILIPPINE TERTIARY CENTER

Background: Hypertension is a leading cause of cardiovascular morbidity, and its prevalence is increasing most rapidly in developing countries like the Philippines, where there is poor hypertension treatment and control ABPM is an important diagnostic tool among patients because it identifies hypertension phenotypes and circadian blood pressure profile that are known to be predictors for target organ damage and increased incidence of future cardiovascular event. Objectives: To determine the blood pressure profile and phenotypes of hypertensive and pre-hypertensive health care workers and its association to BP control and dipping status. Design and Methods: This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM). Results: 181 patients were included with majority from 50–59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%). Conclusion: There was high prevalence of sustained hypertension among healthcare workers included in this study. All those known hypertensives tested had uncontrolled blood pressure despite being on one or more antihypertensive therapy, while there were also newly diagnosed with masked hypertension. The overall prevalence of non-dippers and those with elevated mean 24- hour blood pressure levels was high, and there is significant association of working longer hours and nocturnal dipping pattern. However, there was no significant difference on nocturnal dipping status and blood pressure elevation among those with those with shift work, compared to usual office work hours. This study is one of the few local data on 24hr ambulatory blood pressure measurement of Filipino hypertensive and prehypertensive patients and is one of few data on use of ambulatory blood pressure monitoring among Asians. This also highlights the importance of 24-hour ABPM to identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients according to the locally available maintenance medications.

Abstract 12632: Relationships Between Circadian Ambulatory Systolic Blood Pressure Variability With Subclinical Atherosclerosis in Healthy Middle-Aged Individuals

Background: Short-term fluctuations in blood pressure (BP) as measured by 24-hr ambulatory BP monitoring (ABPM) is associated with subclinical atherosclerosis in the general population. However, whether short-term blood pressure variability (BPV) in the day versus night-time has differential effects on the development of subclinical atherosclerosis is uncertain. Methods and Results: We investigated the relationship between mean 24-hr BP and BPV parameters with common carotid artery intima-media thickness (CIMT) in 305 middle-aged Chinese (mean age 54±7years, 45% male) free from hypertension, hyperlipidaemia, diabetes or cardiovascular diseases. Subclinical atherosclerosis with elevated CIMT was defined as >75th percentile of CIMT of the overall study cohort. Linear regression models adjusted for age, sex, body mass index and smoking status revealed significant associations between office, day- and night-time mean SBP, day-time SBP standard deviation (SD) and coefficient of variation (CV) with elevated CIMT (all p<0.05). As shown in the Table , logistic regression analysis demonstrated that only ABPM day-time mean SBP (odds ratio [OR]:2.54, 95% confidence interval [95%CI]:1.29-5.00), night-time mean SBP (OR:3.23, 95%CI:1.67-6.22), night-time mean DBP (OR:2.27, 95%CI:1.16-4.42), day-time SBP CV (OR:0.47, 95%CI:0.26-0.86) and night-time SBP SD (OR1.94, 1.05-3.58) predicted the occurrence of subclinical atherosclerosis (all p<0.05). Conclusions: In healthy middle-age individuals without known hypertension, mean day and night-time SBP as measured using ABPM provided the strongest positive predictive value for elevated CIMT. Interestingly, increase day-time SBP CV versus night-time SBP SD have opposite effects on CIMT, suggesting circadian changes in SBP might have distinct contributions to the development of subclinical atherosclerosis.

Bladder Paraganglioma Presenting as Post-Micturition Syncope.

A 22-year-old woman presented with a 12-year history of intensifying paroxysms of anxiety, palpitations and recurrent syncope following micturition. The patient was referred to endocrinology upon discovery of hypertension. An extended family history revealed metastatic phaeochromocytoma and paraganglioma in two grand-uncles. Clinical examination revealed hypertension, with a mean 24-hour ambulatory blood pressure of 150/100 mmHg. Supine plasma normetanephrines were markedly elevated with a raised 3-methoxytyramine, while plasma metanephrines were normal. Computed tomography identified a 4.4 cm mass at the right inferolateral margin of the bladder wall. Scintigraphic imaging confirmed unifocal bladder lesion uptake with no additional metastatic lesions. Following pre-operative alpha blockade, the patient underwent a partial cystectomy. Histology confirmed a paraganglioma, and SDHB staining was lost in neoplastic cells consistent with an SDHB-related paraganglioma. Plasma normetanephrine, 3-methoxytyramine and blood pressure returned to normal postoperatively. Genetic screening identified a germline heterozygous SDHB gene variant c.723C>G. Bladder paragangliomas are a rare but important differential to consider when investigating post-micturition syncope. An extended family history should be sought and suspicion for a genetic cause should be raised, especially when the condition presents at a young age. This is the first reported case describing phaeochromocytoma or paraganglioma with the SDHB gene variant c.723C>G.LEARNING POINTSBladder paragangliomas are a rare neuroendocrine tumour which should be considered when assessing patients with haematuria and hypertension, headache, palpitations, sweating and facial pallor with micturition.This case highlights the importance of a thorough clinical history with an extended family history and examination in the setting of micturition syncope, which can rarely occur with bladder paraganglioma.Young age at presentation, a family history of phaeochromocytoma and paraganglioma (PPGL), unusual paraganglioma location, mutifocality and aggressive disease should raise the suspicion for a genetic predisposition to PPGL.

Diurnal changes in blood pressure and heart rate in children with narcolepsy with cataplexy.

The hypocretin neurons in the lateral hypothalamus are connected not only to brain alertness systems but also to brainstem nuclei that regulate blood pressure and heart rate. The premise is that regulation of blood pressure and heart rate is altered and affected by methylphenidate, a stimulant drug in children with narcolepsy with cataplexy. The changes in 24-hr ambulatory systolic and diastolic blood pressure and heart rate were compared among pre-treated narcolepsy with cataplexy patients (40 males, 10 females), with mean age 10.4 ± 3.5 years (M ± SD, range 5-17 years) with values from 100 archival age-sex-body mass index matched controls. Patients had a lower diurnal systolic blood pressure (-6.5 mmHg; p=0.000) but higher heart rate (+11.0bpm; p=0.000), particularly evident in the waketime, while diastolic blood pressure was comparable. With methylphenidate (18 mg sustained release at 08:00 hours), patients with narcolepsy with cataplexy had higher systolic blood pressure (+4.6 mmHg, p=0.015), diastolic blood pressure (+3.3 mmHg, p=0.005) and heart rate (+7.1bpm, p=0.028) during wake time, but nighttime cardiovascular values were unchanged from pre-treated values; amplitude variation in cardiovascular values was unchanged over 24 hr. In conclusion, children with narcolepsy with cataplexy had downregulation blood pressure profile but a higher heart rate, and lesser non-dipping profiles. Daytime methylphenidate treatment increases only waketime blood pressure and further elevated heart rate values.

Highlights of the 2022 Vietnamese Society of Hypertension guidelines for the diagnosis and treatment of arterial hypertension: The collaboration of the Vietnamese Society of Hypertension (VSH) task force with the contribution of the Vietnam National Heart Association (VNHA): The collaboration of the Vietnamese Society of Hypertension (VSH) task force with the contribution of the Vietnam National Heart Association (VNHA).

Hypertension is uncontrolled in over 50% hypertensive population in Vietnam which indicated a compelling need for new hypertension guidelines. The highlights were composed of three parts: the diagnosis of arterial hypertension, the recommendation of home blood pressure monitoring, and the treatment of hypertension. Our guideline applied flexibility based upon the “essential” and “optimal” concepts in the diagnosis and management of hypertensive patients according to the socio‐economic status of Vietnam. Hypertension is defined as an office systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg which is equivalent to a 24‐hr ambulatory blood pressure monitoring average of ≥130/80 mmHg or home blood pressure monitoring average of ≥135/85 mmHg. We established an integrated hypertensive diagnostic algorithm for adults with the optimal option by the role of out‐of‐office blood pressure measurement, especially home blood pressure monitoring, which is fully recommended in this guideline. The threshold and target of hypertension treatment were individualized in safety range and effective evidence‐based medicine. We also update for the management of resistant hypertension, hypertension in diabetic patients, hypertension with heart failure, and with other comorbidities. Vietnam has tried on the best strategy for improving the control of hypertension and recently received several achievements in the world, especially in the Asian region. Because the conditions for conducting our national data have not been fully conducted, we have to adapt from existing guidelines so there are still certain limitations that need to be supplemented and adjusted in the upcoming version.

Clinical usability of morning surge blood pressure for predicting future hypertension in a young population

Objective Early diagnosis of hypertension (HT) is a critical issue for physicians. This study was conducted to determine if morning surge blood pressure (MSBP) could be used to predict future HT. The study also examined which demographic data in a regression model might help to detect future HT without any invasive procedure.Material and methods A young population between 18 and 40 yrs of age was included in the study. MSBP and demographic data were used to determine an optimal model for predicting future HT by using Bayesian information criteria and binary logistic regression.Results 1321 patients with 24 hr ambulatory blood pressure monitoring were included in this study. The odds ratio of 10 units of increase in diastolic MSBP was 1.173511 in the model, which indicates that a 10 mmHg increase in diastolic MSBP increases the odds of future HT in the patient by 17.4 %. The odds ratio of age was 1.096365, meaning that at each age above 18 yrs, the patients' odds of future HT rise by 9.6 %. The odds ratios for gender (male) and previous HT were 1.656986 and 3.336759, respectively. The odds of future HT in males were 65 % higher than for females, and a history of HT implies that the odds of future HT were higher by 230 %.Conclusion Diastolic MSBP can be used to predict HT in young individuals. In addition, age, male gender, and previous HT add more predictive power to diastolic MSBP. This statistically significant, predictive model could be useful in lessening or preventing future HT.

LONG-TERM RESULTS FROM THE SPYRAL HTN-ON MED TRIAL: RENAL DENERVATION INCREASES TIME IN BLOOD PRESSURE TARGET RANGE OVER 36 MONTHS

Objective: Six-month results from the SPYRAL HTN-ON MED pilot trial showed that patients with antihypertensive medications that underwent renal denervation (RDN) had a significantly greater reduction in 24-hr ambulatory and office systolic blood pressure (BP) from baseline compared to sham control. However, the effect of RDN on BP burden over time has not been established. Time in target range (TTR) analysis estimates the percent of time since procedure spent in a preferred systolic BP range as an indicator of BP control. An increase in TTR is associated with significantly lower risk of major cardiovascular events. In this analysis, we evaluate the long-term safety and efficacy of RDN in the SPYRAL HTN-ON MED pilot trial. Design and method: Eligible patients were enrolled in SPYRAL HTN-ON MED with an office systolic BP (OSBP) of 150 to < 180 mmHg, office diastolic BP > = 90 mm Hg, and a 24-hr mean ambulatory systolic BP (ASBP) of 140 to < 170 mmHg. Successive follow-up BP measures over 36 months were linearly interpolated to estimate TTR over time. BP target range was defined as 24-hr ASBP < = 140 mmHg and OSBP < = 140 mmHg. TTR was calculated for each patient as the proportion of time spent in the target BP range since the procedure, including the baseline BP measurement. At 24 months (RDN, n = 34; control, n = 17) there were fewer patients with follow-up measures in the control group due to protocol requirements and the option for patients to crossover. For sham control patients who later crossed over to RDN before their 36-month follow-up (n = 13), the last measure prior to RDN was imputed at 36 months. Results: Long-term, 36-month safety and efficacy outcomes of the first 80 patients andomised 1:1 into the RDN (n = 38) and sham control arms (n = 42) will be presented at ESH 2022, in addition to a time in blood pressure target range analysis. Conclusions: Thirty-six month results evaluating the long-term efficacy and durability of RDN compared to a sham control in SPYRAL HTN-ON MED for patients with uncontrolled hypertension will be presented at ESH 2022.

ACUTE AEROBIC EXERCISE-INDUCED DECREASE IN BLOOD PRESSURE IS ASSOCIATED WITH CHRONIC BLOOD PRESSURE CHANGES IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: The acute blood pressure (BP) decrease after an exercise training session seems to correlate with the chronic BP reductions following exercise training programs in participants with pre-hypertension; yet, among patients with resistant hypertension (RH) it is unknown. This study aims to investigate the association between the magnitude of BP decrease after acute exercise and the change in 24-hr ambulatory blood pressure (ABP) after an aerobic exercise intervention in patients with RH. Design and method: EnRicH trial was a randomized clinical trial assessing the effects of a 12-week moderate-intensity aerobic exercise program in participants with RH. In the present study, twenty-six patients (mean age 59.3 ± 8.2 years, 58.3% male) with RH that participated in the intervention arm of the EnRicH trial were included. Office and ABP measurements were obtained before and after the 12-week aerobic exercise training program. To assess the acute effect, resting BP measures were assessed before and 10 minutes after each exercise session of the third week of the exercise program. Exercise sessions were supervised, occurred three times per week, and included 40 min of aerobic exercise at 50% to 70% of VO2max and a 10-minute cooldown. Results: Resting systolic (-9.4 ± 7.0, p < 0.001) and diastolic BP (-1.9 ± 3.4, p = 0.10) were significantly reduced after acute exercise. 24hr systolic (-6.2 ± 12.1, p = 0.015) and diastolic BP (-4.42 ± 6.1, p = 0.001) an office systolic (-10.9 ± 15.2, p = 0.001) and diastolic BP (-5.9 ± 11.1, p = 0.013) were significantly decreased after the exercise program. The acute changes were correlated with the chronic decrease in 24hr ambulatory systolic (r = 0.556, p = 0.003) and diastolic (r = 0.484, p = 0.012) BP, and office systolic (r = 0.478, p = 0.014) and diastolic BP (r = 0.452, p = 0.020). Multiple regression analysis revealed that the acute effect of exercise was an independent predictor of the chronic effect on systolic BP (ß = 0.556, adjusted r2 = 0.280, p = 0.003) BP. Conclusions: The magnitude of the acute effect of exercise in BP correlates with the chronic decrease in both office and 24hr BP effects. These results suggest that it is possible to predict those patients that are less likely to improve BP with an exercise training program without the burden of a period of several months of intervention.

EFFECT OF RENAL DENERVATION ON CARDIO ANKLE VASCULAR INDEX IN SUBJECTS WITH RESISTANT HYPERTENSION

Objective: The aim of the study was to determine the clinical characteristics of patients with increased arterial stiffness (AS) undergoing renal sympathetic denervation (RSD) and to examine the role of CAVI measurement as a surrogate for AS in predicting the outcome of RSD. Design and method: Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, between January 2014 and December 2020 were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP = > 135 mmHg or diastolic BP = > 85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. CAVI was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol. Results: The study included 62 patients with treatment-resistant hypertension, after out of office blood pressure measurement and intensification of therapy, renal denervation was performed in 32 (51.6%). Patients with increased arterial stiffness, defined as CAVI> median of 8.3, were older, with a larger waist circumference and previous cardiovascular events. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). The median of the observed reduction of the 24-hour systolic blood pressure was -16 mmHg at 95% confidence interval -9.1 to -21 mmHg. Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. In contrast, the effect of the procedure was clinically insignificant among patients with baseline CAVI values above 8.3. Conclusions: These findings hold the promise that AS might be used as a selection criterion for RSD, thereby improving outcome following RSD.

Effect of celery (Apium graveolens) seed extract on hypertension: A randomized, triple‐blind, placebo‐controlled, cross‐over, clinical trial

In the present work, the antihypertensive effects of celery seed extract (Apium graveolens) with active ingredients, such as 3-n-butylphthalide, were studied as a drug supplement in the treatment of hypertension. This study was a randomized, triple-blind, placebo-controlled, cross-over clinical trial. Fifty-two patients were divided into two groups (celery and placebo) and completed the two-step clinical trial. Four celery seed extract capsules (totally 1.34 g per day) or 4 placebo capsules per day were administered to the patients during a 4-week clinical trial. The blood pressure was assessed using a 24-hr ambulatory blood pressure monitoring method. In celery group, systolic blood pressure changed from 141.2± 5.91 to 130.0± 4.38 mmHg (p< .001) while diastolic blood pressure changed from 92.2± 5.74 to 84.2± 4.87 mmHg (p< .001). Moreover, the mean arterial blood pressure changed from 108.5± 5.76 to 99.5± 4.66 mmHg (p< .001), and pulse pressure decreased from 49.0± 6.21 to 45.8± 6.01 mmHg (p< .01). However, no significant changes were observed in placebo group in terms of the above-mentioned parameters (p> .05). Furthermore, no significant side effect was reported in the celery group, compared to the placebo group (p> .05). The results were promising and indicated the therapeutic effects of celery seed extract as a supplement in the management of hypertension.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Validation of an ambulatory blood pressure monitoring device employing a novel method to detect atrial fibrillation.

We evaluated the accuracy of a 24-hr ambulatory blood pressure monitoring (ABPM) device with a new irregular heartbeat (IHB) algorithm for detecting atrial fibrillation (AF) during each BP measurement. Ninety patients with a history of elevated BP and some type of arrhythmia (mean age 63.2 ± 10.3 years; 94% with hypertension; 81% with previously diagnosed AF) simultaneously underwent evaluation by 24-hr ABPM with the IHB algorithm and 24-hr Holter electrocardiography (ECG). Among the 3,347 valid readings, 843 readings were considered to indicate an IHB. Among these IHB readings, 195 readings were found to have an AF rhythm by 24-hr Holter ECG. The IHB algorithm showed 100% sensitivity and 79.4% specificity for accurately detecting AF rhythm. An IHB was detected in 12.1% of the measurements during normal rhythm, 48.8% of those during atrial premature complex, and 54.4% of those during ventricular premature complex. The percentage of IHBs detected during normal rhythm was higher in the daytime than at nighttime (16.3% vs. 4.5%, respectively), suggesting that daytime physical activity sometimes induces a false detection of IHBs. The optimal IHB parameters for suggesting potential AF were (1) an IHB burden defined as a percentage of IHB-positive readings in total valid BP measurements >22.5% (84.6% sensitivity, 85.1% specificity; AUC 0.906, p < 0.0001) and (2) 2.5 or more consecutive IHBs during 24-hr ABPM (84.6% sensitivity, 83.0% specificity; AUC 0.881, p < 0.0001). The novel 24-hr ABPM device with the IHB algorithm assessed herein could contribute to the future comprehensive management of hypertensive patients, with the main goal of preventing cerebrovascular events.

Impact of COVID‐19 on Ambulatory Daytime and Nighttime Blood Pressure in Young Otherwise Healthy Adults

BackgroundCOVID‐19 has been shown to cause impairments in vascular function and elevations in resting sympathetic nerve activity in young otherwise healthy adults. Notably, our laboratory recently reported that persistence of COVID‐19 symptoms beyond the acute phase of the illness (i.e., beyond 4 weeks) was accompanied by macro‐ and micro‐ vascular dysfunction as measured by flow mediated dilation and reactive hyperemia, respectively. Interestingly, despite consistent reports of vascular alterations, no studies have reported changes in resting blood pressure (BP) following COVID‐19. One caveat is that BP has only been measured in the laboratory setting. Indeed, to date, no studies have assessed the effect of COVID‐19 on ambulatory BP, which allows for a complete assessment of daytime and nighttime BP without the potential for well known “white coat” effects on BP. Thus, we aimed to investigate the effect of COVID‐19 on 24‐hr ambulatory BP in young adults diagnosed with COVID‐19 within the preceding 6 months. We hypothesized that ambulatory BP would be greater in individuals who had COVID‐19 compared to controls who never had COVID‐19, and that those with symptoms would have higher BP compared to those who were asymptomatic at the time of testing.MethodsWe studied 21 young healthy adults who had a positive laboratory diagnosis of COVID‐19 (COVID: 23 ± 1 years [Mean ± SE]; 12 ± 1 [range: 4 to 22] weeks since diagnosis; 13 females) and 10 controls (23 ± 1 years, 6 females) who never had COVID‐19. Eleven individuals who had COVID‐19 were asymptomatic at the time of testing while 10 were symptomatic. Ambulatory BP was measured using the Oscar 2 oscillometric monitor (Sun Tech Medical). Participants were instructed to perform normal daily activities but not to perform any exercise during the 24‐hr period. Measurements were obtained every 20 min during daytime and every 30 min during nighttime. Average daytime, nighttime and 24‐hr systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were calculated.ResultsDaytime, nighttime, and 24‐hr BPs were not different between control and COVID subjects (P > 0.05 for all comparisons). Similarly, there were no differences in any of the BP assessments between control, asymptomatic or symptomatic COVID subjects (e.g., daytime SBP: control 122 ± 4; asymptomatic 119 ± 4; symptomatic 125 ± 2 mmHg, P = 0.451). Interestingly, in the COVID group, daytime, nighttime, and 24‐hr SBP, DBP, and MAP were inversely correlated with time since diagnosis (P < 0.05 for all with medium to large effect size). Multiple linear regression showed that after accounting for age, BMI, and physical activity (reported average exercise minutes/week), time since diagnosis was a significant predictor of daytime and 24‐hr SBP, DBP, and MAP (e.g., daytime SBP: P = 0.028, β coefficient = ‐0.697). For nighttime BP, time since diagnosis was a significant predictor only for SBP.ConclusionThese preliminary data suggest that the effect of COVID‐19 on ambulatory BP in young adults may be dependent on the time since diagnosis with higher daytime and nighttime BP present closer to the onset of the infection, which appeared to be independent of symptomology. Longitudinal follow up studies are warranted.