Ambulatory Blood Pressure In Patients Research Articles

Effects of vibegron on ambulatory blood pressure in patients with overactive bladder: results from a double-blind, placebo-controlled trial.

To characterize the blood pressure (BP) profile of the new β3-adrenergic receptor agonist, vibegron, in patients with overactive bladder. Patients were randomized to once-daily vibegron 75 mg or placebo for 28 days and underwent ambulatory BP monitoring. The primary endpoint was change from baseline (CFB) to day 28 in mean daytime ambulatory systolic BP (SBP). Secondary endpoints were CFB in mean 24-h SBP and in mean daytime and mean 24-h ambulatory diastolic BP (DBP) and heart rate (HR). Safety was assessed through adverse event reporting. Of 214 patients randomized, 96 receiving vibegron and 101 receiving placebo had evaluable baseline and day 28 measurements. Overall, 39.6 and 30.7% of patients receiving vibegron and placebo, respectively, had preexisting hypertension. The least squares mean difference (LSMD; 90% confidence interval) between vibegron and placebo in CFB in mean daytime SBP was 0.8 (-0.9, 2.5) mmHg. LSMD in CFB in mean daytime DBP and HR was 0.0 mmHg and 0.9 bpm, respectively. No significant differences between treatments were seen in CFB in mean 24-h SBP (LSMD, 0.6 mmHg), DBP (-0.2 mmHg) or HR (1.0 bpm). The most common treatment-emergent adverse event was hypertension, with rates comparable between groups [vibegron: n = 5 (4.7%); placebo: n = 4 (3.7%)]. One patient receiving vibegron took a prohibited medication (phentermine) known to increase BP. Once-daily vibegron had no statistically significant or clinically relevant effects on BP or HR.

Effects of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes complicating hypertension: a meta-analysis

Objective: To analyze the effects of different types of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on 24-hour ambulatory blood pressure in patients with type 2 diabetes mellitus and hypertension. Method: In this meta-analysis, we searched for randomized controlled trials on the effect of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension. Three databases, namely PubMed, Web of Science and Cochrane Library, were searched. The search was organized on the concept of 3 conceptual groups: the first group contained terms used to describe SGLT2i, the second group contained terms related to blood pressure, and the third group contained terms used to describe randomized controlled trials. The search time was from the establishment of the database to December 2020. The inclusion and exclusion criteria were formulated in accordance with the requirements of the Cochrane systematic review. According to whether the heterogeneity of the study was significant or not, a random effect model or a fixed effect model were used to conduct the analysis on the impact of different types of SGLT2i on 24-hour ambulatory blood pressure and day and night blood pressure in patients with type 2 diabetes and hypertension. Further subgroup analysis was performed to define potential factors, which might lead to clinical heterogeneity. Results: Seven clinical trials were finally included. The result of the meta-analysis showed that compared with placebo group, SGLT2i could reduce the 24-hour dynamic systolic blood pressure of patients with type 2 diabetes and hypertension by 4.36 mmHg (1 mmHg=0.133 kPa). Reduction was 4.59, 3.74, 5.06, and 3.64 mmHg by canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin respectively; SGLT2i could reduce the 24-hour dynamic diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.20 mmHg, and the reduction was 2.30, 1.22, 2.00, and 2.69 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin respectively. SGLT2i could reduce the daytime systolic blood pressure of patients with type 2 diabetes and hypertension by 5.25 mmHg, and reduction was 5.38, 4.87, 6.00, and 4.37 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. Simultaneously, SGLT2i could reduce the diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.62 mmHg, and the reduction was 2.56, 2.47, and 2.80 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. SGLT2i could reduce the nighttime systolic blood pressure of patients with type 2 diabetes and hypertension by 3.62 mmHg, and the reduction was 2.09, 2.06, 3.92, and 2.45 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. At the same time, SGLT2i could reduce the nighttime diastolic blood pressure of patients with type 2 diabetes and hypertension by 1.60 and 1.51 mmHg, the reduction was 1.53 and 2.58 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. Conclusion: SGLT2i can reduce 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension.

The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis

Abstract Background Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure. Purpose We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs). Methods We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM. Results After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2). Conclusions Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Особливості добового профілю артеріального тиску у хворих на цукровий діабет залежно від ендотеліальної дисфункції

Актуальність. Цукровий діабет (ЦД) — захворювання, що супроводжується оксидативним стресом, хронічним неспецифічним запаленням, пошкодженням судинної стінки, ендотеліальною дисфункцією. Особливістю перебігу артеріальної гіпертензії у хворих на ЦД є більш раннє формування діабетичної хвороби нирок (ДХН). Сьогодні здійснюється пошук маркерів ендотеліальної дисфункції, що дозволять виявляти ДХН на ранніх стадіях, коли зміни в нирках потенційно оборотні. Метою роботи було дослідити показники добового профілю артеріального тиску у хворих на ЦД та визначити їх взаємозв’язки з показниками швидкості клубочкової фільтрації й ендотеліальної функції за рівнем показників TGF-β1 (transforming growth factor beta-1 — трансформуючий фактор росту бета-1) та VCAM-1 (vascular cell adhesion molecule 1 — васкулярна молекула судинної адгезії 1). Матеріали та методи. У дослідження включені 124 хворі на ЦД, із них 66 пацієнтів із ЦД 1-го типу, 58 — із ЦД 2-го типу. Результати. Рівні показників ендотеліальної функції TGF-β1 та VCAM-1 у хворих на ЦД 1-го та 2-го типів кількісно залежали від показника швидкості клубочкової фільтрації. Між показниками ендотеліальної функції TGF-β1, VCAM-1 та показниками добового моніторування артеріального тиску виявлені сильні та середньої сили кореляційні зв’язки, у зв’язку з чим комплекс показників добового моніторування артеріального тиску та наявність ендотеліальної дисфункції можна вважати ранніми ознаками прогресування ДХН. Висновки. Для добового профілю артеріального тиску у хворих на ЦД на ранніх стадіях діабетичної нефропатії характерне вірогідне порушення циркадних ритмів. Недостатнє нічне зниження артеріального тиску у хворих на ЦД 1-го та 2-го типу характеризує наявність прогресування діабетичної нефропатії за показниками добового індексу артеріального тиску.

Abstract P112: Orthostatic Hypotension, Orthostatic Hypertension And Ambulatory Blood Pressure In Patients With Chronic Kidney Disease: Findings From The Chronic Renal Insufficiency Cohort Study

Background: We recently demonstrated how orthostatic hypotension might be used to identify out-of-office blood pressure phenotypes, including white coat effects and nocturnal non-dipping patterns. However, these findings have not been replicated in a population with chronic kidney disease (CKD). Objective: To examine the association between orthostatic hypotension (OH) or hypertension (OHTN) with ambulatory BP in adults with CKD. Methods: CRIC is a prospective multicenter observation cohort study of participants with CKD. Standing BP at 1 minute and ABPM were obtained on 1467 participants. OH was defined as a 20mmHg drop in systolic BP (SBP) or 10 mmHg drop in diastolic BP (DBP) when changing from seated to standing positions. OHTN was defined as a 20 mmHg or 10mmHg rise in SBP or DBP respectively when changing from seated to standing position. White coat effects, based on ABPM, was defined as the difference between seated clinic and ambulatory BP. Systolic and diastolic night to day ratio was also calculated. Results: Of the 1467 participants (age: 58 ± 10 yrs, 44% female, 39% black) 73 had OH and 165 had OHTN). OH was positively associated with systolic and diastolic white coat effect (β=5.9 [0.9, 10.9] and 4.2 [1.3, 7.1]). OHTN was negatively associated with diastolic white coat effect (-4.9 [-6.9, -3]). OH was positively associated with systolic and diastolic night-to-day ratio (0.03 [0.01, 0.05] and 0.03 [0.01, 0.06] respectively). Conclusions: Clinic-based assessments of OH and OHTN may be useful for identifying BP phenotypes often missed with seated office BP measurements in CKD patients.

681-P: Effect of 3-Month Therapy with SGLT2 Inhibitors and GLP-1 Agonists on Ambulatory Blood Pressure in Patients with Type 2 Diabetes Mellitus

Background and Aims: It is known that SGLT-2 inhibitors and GLP-1 agonists show a favorable profile in the reduction of body weight as well as blood pressure (BP). Therefore, the purpose of this study is to evaluate the effect of SGLT-2 inhibitors and GLP-1 agonists on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Materials and Methods: A total of 74 patients with T2D: 42 on GLP-1 agonists (group Α) [20 men, mean age (±standard deviation) 60.6±9.4 years, HbA1c 8.5±1,1%, body mass index (BMI) 37.1±5.3 Kg/m2, T2D duration 10.1±4.3] and 32 on SGLT-2 inhibitors (group Β) [16 men, mean age 64.8±7.1 years, HbA1c 8.2±1.3%, BMI 32,1±9,2 Kg/m2]. All patients underwent a complete clinical and laboratory examination. Ambulatory BP recording at baseline and three months after initiation of treatment with the oscillometric Mobil-O-Graph NGW 24-hour ambulatory BP and PWA monitor (IEM; Stolberg, Germany). Results: At baseline, mean daytime systolic and diastolic BP in group A were: 128.0±11.2 and 77.2±11.0 mmHg and in group B: 129.6±14.8 and 78.1±9.9 mmHg, respectively (P=0.78 and P=0.81, respectively, for the comparison between the study groups). Regarding the nighttime recordings of BP in group A, mean systolic and diastolic BP were: 127.5±12.6 and 73.7±14.2 mmHg. In group B, mean systolic and diastolic BP were: 126.3±12.5 and 74.1±8.7 mmHg (P=0.57 and P=0.67, respectively, for the comparison between the study groups). After 3-month therapy, mean systolic BP (group A versus B) was 124.0±7.8 versus 128.2±10.4 mmHg (P=0.04) and mean diastolic BP, 73.5±7.8 versus 78.3±7.8 mmHg (P=0.05). Regarding nighttime systolic BP was 118.6±11.1 (group Α) versus 117.4±9.3 mmHg (group Β) (P=0.54) and for mean diastolic BP 68.1±9.8 (group Α) versus 69.6±7.1 mmHg (group Β) (P=0.69). Conclusion: Three-month therapy with GLP-1 agonists had a favorable effect of ambulatory systolic and diastolic BP compared to SGLT-2 inhibitors. Disclosure A. Papazafiropoulou: None. S. S. Papantoniou: None. M. Rallatou: None. A. J. Melidonis: None. S. Antonopoulos: None.

Effect of essential fatty acid blend on circadian variations of ambulatory blood pressure in patients with essential hypertension and coronary artery disease risk markers.

Flaxseed oil is an excellent source of alpha-linolenic acid ALA known for its antihypertensive action. Flaxseed oil is unstable and its dose is not achievable in our conventional diet hence blending of natural flaxseed oil with palm oil, containing high flavonoids may be a better strategy, to stabilize the blend and provide proper balance of essential fatty acids and potential antioxidant effects. Aim of this study was to access the effect of blended flaxseed oil on 24 h 7-day circadian variations of blood pressure in subjects with essential hypertension. Assessment of CHAT (circadian hyper amplitude tension) using ABPM is the best marker for cardiovascular function. We registered 50 subjects with CAD (Group 1) and 50 subjects with Essential hypertension HT (Group 2) and 52 control subjects with CAD/Hypertension. Group 1 and 2 participant was supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of 24 weeks, while control group administered available oils sunflower in identical containers, for a follow-up period of 24 weeks. Twenty four hour seven days continuous ambulatory blood pressure monitoring was done initially and after six months of BFO supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that blended flaxseed oil administration can be a potent natural vegetarian antihypertensive supplement which helps in synchronization of cardiac rhythms, and can be used as a preventive treatment of hypertension and as effective vegetarian source of maintaining Omega 3 and omega 6 ratios of essential fatty acids in the body.

Characteristics and control of the 24-hour ambulatory blood pressure in patients with metabolic syndrome.

Asian countries are facing an increasing prevalence of metabolic syndrome (MetS), which may aggravate the burden of cardiovascular diseases in this region. MetS is closely associated with ambulatory blood pressure (BP). Patients with MetS, compared to those without, had a twofold higher risk of new‐onset office, home, or ambulatory hypertension. Furthermore, the risk of new‐onset MetS in patients with white‐coat, masked and sustained hypertension was also doubled compared to normotensives. High‐risk masked hypertension and blunted nighttime BP dipping are common in patients with MetS, suggesting perfect 24‐hour BP control with long‐acting antihypertensive drugs and early initiation of combination therapy might be especially important for patients with MetS.

Exercise Reduces Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BackgroundAlthough exercise training reduces office blood pressure (BP), scarcer evidence is available on whether these benefits also apply to ambulatory blood pressure (ABP), which is a stronger predictor of cardiovascular disease and mortality. The present study aims to assess the effects of exercise training on ABP in patients with hypertension based on evidence from randomized controlled trials.Methods and ResultsA systematic search of randomized controlled trials on the aforementioned topic was conducted in PubMed and Scopus (since inception to April 1, 2020). The mean difference between interventions (along with 95% CI) for systolic BP and diastolic BP was assessed using a random‐effects model. Sub‐analyses were performed attending to (1) whether participants were taking antihypertensive drugs and (2) exercise modalities. Fifteen studies (including 910 participants with hypertension) met the inclusion criteria. Interventions lasted 8 to 24 weeks (3–5 sessions/week). Exercise significantly reduced 24‐hour (systolic BP, −5.4 mm Hg; [95% CI, −9.2 to −1.6]; diastolic BP, −3.0 mm Hg [−5.4 to −0.6]), daytime (systolic BP, −4.5 mm Hg [−6.6 to −2.3]; diastolic BP, −3.2 mm Hg [−4.8 to −1.5]), and nighttime ABP (systolic BP, −4.7 mm Hg [−8.4 to −1.0]; diastolic BP, −3.1 mm Hg [−5.3 to −0.9]). In separate analyses, exercise benefits on all ABP measures were significant for patients taking medication (all P<0.05) but not for untreated patients (although differences between medicated and non‐medicated patients were not significant), and only aerobic exercise provided significant benefits (P<0.05).ConclusionsAerobic exercise is an effective coadjuvant treatment for reducing ABP in medicated patients with hypertension.

Comparison of ambulatory blood pressure between patients with primary aldosteronism and other forms of hypertension.

Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure-matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end-organ damage. However, PA is currently substantially under-diagnosed. The standard screening test for PA, the aldosterone-to-renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening. Patients with PA (n=55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n=389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM. In this study, PA patients were younger and had higher 24-h, day, and night-time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day-night blood pressure variability between the two groups. An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.

Treatment effect of lacidipine and amlodipine on clinic and ambulatory blood pressure and arteria stiffness in a randomised double-blind trial

Purpose In a randomised, double-blind trial, we investigated effects of lacidipine on clinic and ambulatory blood pressure (BP) and arterial stiffness in patients with mild-to-moderate hypertension, as compared with amlodipine. Materials and methods Previously untreated and treated patients (n = 269, 50–80 years of age) with clinic hypertension (a clinic systolic/diastolic BP 140–180/<110 mmHg and <160/100 mmHg, respectively) were randomly assigned to double-dummy treatment with lacidipine (4–6 mg/day) or amlodipine (5–7.5 mg/day) for 20 weeks. The primary efficacy variable was the change in 24-h ambulatory systolic BP at 20 weeks of treatment. Arterial stiffness was measured as brachial-ankle pulse wave velocity (PWV). Results After 20 weeks of treatment, 24-h systolic BP decreased from 141.3 ± 14.0 and 138.3 ± 12.8 mmHg at baseline, respectively, in the lacidipine (n = 134) and amlodipine groups (n = 135), by a least square mean (±SE) change of 15.2 ± 1.3 and 15.5 ± 1.3 mmHg, respectively, with a between-group difference (95% confidence interval [CI]) of 0.3 mmHg (−3.4 to 4.1, p = 0.86). Similar results were observed for other ambulatory BP components and clinic BP. Clinic and ambulatory pulse rate did not significantly change in either group (p ≥ 0.21). PWV decreased significantly (p < 0.001) from baseline in both groups, with a non-significant between-group difference of 0.24 m/s (p = 0.45). The incidence rate of adverse events was 30.3% (n = 40) and 27.5% (n = 36) in the lacidipine and amlodipine groups, respectively (p = 0.61). No serious adverse event occurred in the trial. Conclusions Lacidipine effectively lowers clinic and ambulatory BP in patients with mild-to-moderate hypertension and significantly improves arterial stiffness, similarly as amlodipine.

Ambulatory blood pressure in patients with systemic lupus erythematosus: Association with markers of immune activation.

Objectives: Ambulatory blood pressure monitoring measures 24-hour blood pressure, night-time blood pressure, and impaired dipping of nocturnal blood pressure, parameters that better predict cardiovascular risk than standard office blood pressure measurements. Systemic lupus erythematosus is characterized by immune system hyperactivity, elevated cardiovascular risk and high prevalence of hypertension; however, little is known about ambulatory blood pressure in lupus patients and its relationship to immune activation. Methods: We studied 26 patients with lupus and 26 control subjects. We obtained ambulatory 24-hour blood pressure measurements and report plasma concentrations of 77 markers of immune activation using a multiplex immunoassay and assessed their association with blood pressure measurements. Results: Despite similar office blood pressure measurements in patients with lupus and controls, lupus patients had higher 24-hour systolic [median (interquartile range) 129 (113 - 140) vs. 116 (111 - 121) mmHg, p = 0.03] and diastolic blood pressure [80 (69 - 86) vs. 72 (64 - 75) mmHg, p = 0.006] as well as less nocturnal dipping [7.8% (5.1 - 14.2%) vs. 12.0% (8.1 20.0%)] p = 0.03], compared to controls. In patients with lupus, markers of the innate (monocyte chemotactic protein-3) and adaptive immune systems [CUB domain-containing protein-1 and Interleukin-15 receptor subunit-α,] were associated with nocturnal blood pressure measurements and attenuated nocturnal dipping. In conclusion, 24-hour systolic and diastolic blood pressure was higher and nocturnal blood pressure dipping was attenuated in patients with lupus compared to control subjects. Conclusion: In patients with SLE, nocturnal blood pressure and attenuated nocturnal blood pressure dipping were significantly associated with several innate and adaptive immune system biomarkers.

Use of fixed double and triple combinations in achievement of target level of ambulatory blood pressure in patients with arterial hypertension

The objective of the research - to evaluate the therapeutic efficacy of the generic combination (a fixed triple combination of valsartan / amlodipine / hydrochlorothiazide compared with a double fixed combination of valsartan / amlodipine) in the treatment of patients with arterial hypertension II-III degree. The objectives of the study were: to study the therapeutic efficacy on ambulatory BP of a fixed triple and double combination in the treatment of arterial hypertension.Material and methods. The study included 50 patients with 2-3 grade hypertension. The office measurement of BP, ABMP, biochemical blood tests before and after 3 months fixed combination therapy val/aml or val/aml/HTZ. The study included patients with moderate and severe arterial hypertension without diabetes. Patients were divided into 2 groups. The first group (n = 25) received fixed triple combination of 160 mg valsartan / 5 mg amlodipine / 12.5 mg hydrochlorothiazide once daily, in the morning for 1 month. Patients in the second group (n = 25) received a double fixed combination of 160 mg valsartan / 5 mg amlodipine once a day, in the morning for 1 month. When necessary, if there was no achievement of the target level of office blood pressure &lt;140/90 mm Hg, the dose was titrated to a daily dose of 320/10 / 12.5 mg (valsartan / amlodipine / hydrochlorothiazide) on a fixed triple combination and up to 320/10 mg (valsartan / amlodipine) on a fixed double combination. After three months of treatment, therapy was monitored.Results. The average age of patients was 54.9 ± 1.8 (25-75) years. The average BMI was 31.2 ± 0.7 kg / m2. The average of office SBP and DBP at the beginning of the study were 161.7 ± 1.8 mm Hg and 98.5 ± 1.4 mmHg. The average office heart rate was 70.7 ± 1.4 beats / min. The mean 24 blood pressure monitoring was 143.8 ± 1.1 mm Hg for SBP and 92.4 ± 1.2 mm Hg for DBP. The average daily heart rate was 71.5 ± 1.5 beats / min. The decrease in average 24BP was 18.0 / 16.1 mm Hg (p &lt; 0,05) on double combination (val/aml) and 23,8 / 20,7 mm Hg (p &lt; 0,05) on the triple combination (val/aml/HTZ). The decrease mean day time blood pressure was 19.4 / 17.8 mm Hg (p &lt; 0,05) on double (val/aml) and 17,8 / 22,6 mm Hg (p &lt; 0,05) on the triple combination (val/aml/HTZ). Decrease mean nocturnal blood pressure were 17.0 / 12.1 mm Hg. (p &lt; 0,05) on double (val/aml) and 20,5 / 18,2 mm Hg (p &lt; 0,05) on the triple (val/aml/ HTZ) combination. Achievement of target BP at ABPM was 77.3% - in the double (val/aml) combination and 95.2% in the triple (val/aml/HTZ) combination.Conclusions. The triple fixed combination (val/aml/HTZ) was more effective in reducing blood pressure with daily monitoring compared to a double fixed (val/ aml) combination which was not accompanied by an increase in side effects.

443-P: Effect of 3-Month Therapy with Liraglutide on Ambulatory Blood Pressure in Patients with Type 2 Diabetes Mellitus

Background and Aims: Liraglutide, has been found to reduce systolic (SBP) and to a lesser extent diastolic blood pressure (DBP). The purpose of this study is to evaluate the effect of liraglutide on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Materials and Methods: A total of 42 patients (20 men) with T2D, mean age (± standard deviation) 60.6 ± 9.4 years, HbA1c 8.5 ± 1.1%, body mass index 37.1 ± 5.3 Kg/m2, duration of T2D 10.1 ± 4.3 years, were included. All patients underwent a complete clinical examination, laboratory testing, and ambulatory BP recording both on entry into the study and three months after initiation of treatment with liraglutide (background antidiabetic therapy remained stable during the study period). Ambulatory BP was measured with the oscillometric Mobil-O-Graph NGW 24-hour ambulatory BP and PWA monitor (IEM; Stolberg, Germany). Results: At baseline, mean daytime SBP and DBP were 128.0 ± 11.2 and 77.2 ± 11.0 mmHg, respectively. After 3-month liraglutide therapy, daytime SBP and DBP were: 124.0 ± 7.8 and 73.5 ± 7.8 mmHg, respectively. Daytime SBP and DBP, mean change from baseline was -4.0 mmHg (P=0.26) and -3.6 mmHg (P=0.05). Nighttime mean SBP and DBP at baseline, were127.5 ± 12.6 and 73.7 ± 14.2 mmHg. After 3-month therapy, the above values were as follows: 118.6 ± 11.1 and 68.1 ± 9.8 mmHg, respectively. Nighttime SBP and DBP, mean change from baseline was -8.9 mmHg (P=0.009) and -5.6 mmHg (P=0.009). In accordance, pulse pressure change was: 53.9 ± 8.6 (baseline) to 50.6 ± 11.2 mmHg (3 months) and for heart rate: 75.9 ± 10.1 (baseline) to 77.8 ± 14.3 bpm (3 months). Pulse pressure and heart rate change from baseline was -3.2 mmHg (P=0.14) and -1.9 bpm (P=0.36), respectively. Conclusion: In accordance with the existing data, 3-month therapy with liraglutide had a favorable effect of ambulatory BP, in terms of daily DBP and SBP and DBP during the night. In contrast, no significant effect on heart rate was observed despite the existing data. Disclosure A. Papazafiropoulou: None. L. Mpoumi: None. M. Rallatou: None. S.S. Papantoniou: None. A. Kamaratos: None. S. Antonopoulos: None. A. Melidonis: None.

Effect of Isometric Handgrip Training on Ambulatory Blood Pressure in Patients With Hypertension

Effect of Isometric Handgrip Training on Ambulatory Blood Pressure in Patients With Hypertension

The effects of nebivolol and irbesartan on postdialysis and ambulatory blood pressure in patients with intradialytic hypertension: a randomized cross-over study.

Intradialytic hypertension is estimated at 5-15% of hemodialysis patients and is associated with poor prognosis. Studies on therapeutic interventions for this entity are extremely few. We aimed to evaluate the effects of nebivolol and irbesartan on peridialytic, intradialytic, and ambulatory BP in patients with intradialytic hypertension. This is a pilot randomized-cross-over study in 38 hemodialysis patients (age: 60.4 ± 11.1 years, men: 65.8%) with intradialytic hypertension (intradialytic SBP rise ≥10 mmHg at ≥4 over six consecutive sessions]. After baseline evaluation, patients were randomly assigned to nebivolol 5 mg and subsequently irbesartan 150 mg, or vice versa. Nineteen patients received a single drug-dose 1 h before hemodialysis and 19 received the drug for a week before evaluation. A 2-week wash-out period took place before the initiation of the second drug. Patients had three respective 24-h ambulatory BP measurements starting before a midweek session. In total, 20 (52.6%) patients received nebivolol first and 18 (47.4%) received irbesartan. Patients receiving a single dose of either drug had lower postdialysis BP (baseline: 160.2 ± 17.8/93.2 ± 13.6 mmHg; nebivolol: 148.0 ± 20.8/84.5 ± 13.1 mmHg, P = 0.013/P = 0.027; irbesartan 142.9 ± 29.9/87.2 ± 18.1 mmHg, P = 0.003/P = 0.104 for SBP and DBP, respectively). The 24-h BP presented a trend towards reduction, but was significant only for 24-h DBP in the nebivolol arm. Patients on weekly administration of either drug had lower postdialysis BP (baseline: 162.5 ± 16.8/95.4 ± 12.7 mmHg; nebivolol: 146.7 ± 16.3/91.8 ± 12.2 mmHg, P = 0.001/P = 0.235; irbesartan: 146.0 ± 23.9/85.8 ± 12.9 mmHg, P = 0.004/ P = 0.007, respectively), lower intradialytic BP and lower 24-h BP (baseline: 148.3 ± 12.6/90.2 ± 9.0 mmHg; nebivolol: 139.2 ± 10.6/85.0 ± 7.7 mmHg, P < 0.001/P = 0.001; irbesartan: 142.4 ± 16.4/85.1 ± 9.9 mmHg, P = 0.156/P = 0.030). No significant differences were observed in comparisons between the two drugs, with the exception of heart rate, being lower with nebivolol. Both nebivolol and irbesartan reduced postdialysis and 24-h BP in patients with intradialytic hypertension. Weekly administration had greater effect and nebivolol was numerically slightly more potent than irbesartan.

Effect of liraglutide on ambulatory blood pressure in patients with hypertension and type 2 diabetes: A randomized, double-blind, placebo-controlled trial.

To assess the effect of liraglutide on 24-hour ambulatory blood pressure and heart rate in patients with hypertension (pre- and stage 1 hypertension) and inadequately controlled Type 2 diabetes (glycated haemoglobin 7%-10% [53-86 mmol/mol]). Eligible patients for this investigator-initiated, parallel-group, randomized, double-blind trial were on stable background antihyperglycaemic therapy excluding insulin, glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors. Participants were centrally randomized in a 1:1 ratio to daily liraglutide 0.6 mg, titrated to 1.2 mg after the first week, or placebo for 5 weeks. The primary outcome was change in 24-hour ambulatory systolic blood pressure (SBP), and secondary outcomes included change in ambulatory diastolic blood pressure (DBP) and heart rate. We also assessed renal sodium handling. Of 87 patients assessed for eligibility, 62 (66.1% men) with a mean age of 60.2 years were randomized to liraglutide (n = 31) or placebo (n = 31). All participants received background therapy with metformin, whilst 35.5% were treated concomitantly with sulphonylureas and 14.5% with pioglitazone. Compared with placebo, liraglutide reduced 24-hour SBP by -5.73 mm Hg (95% confidence interval [CI] -9.81 to -1.65) and had a neutral effect on 24-hour DBP (mean difference - 1.42 mm Hg; 95% CI -4.25 to 1.40), whilst increasing 24-hour heart rate by 6.16 beats/min (95% CI 3.25 to 9.07). Findings were consistent for daytime and night-time measurements. Liraglutide did not increase urine sodium excretion. Based on 24-hour ambulatory measurements, short-term treatment with liraglutide had a favourable effect on SBP whilst increasing heart rate.

A15696 short-term effect of Yoga lifestyle on Ambulatory Blood Pressure in patients with high normal blood pressure (Prehypertension)

Objectives:study the short-term effect of Yoga lifestyle on Ambulatory Blood Pressure in patients with high normal blood pressure (PrehypertensionMethods:A randomized controlled study which enrolled 60 apparently healthy prehypertensive individuals to assess the effects of 3 months and 6 months of Y

A10778 Effect of optimized dosage of flaxseed Blended oil on circadian variations of Ambulatory Blood Pressure in Patients with Essential Hypertension

A10778 Effect of optimized dosage of flaxseed Blended oil on circadian variations of Ambulatory Blood Pressure in Patients with Essential Hypertension

Masked hypertension incidence and risk factors in a prospective cohort study.

Masked hypertension may affect up to 30% of the general population and is associated with a high cardiovascular disease risk. No previous study has examined the incidence of masked hypertension and its risk factors. The study aim was to determine the incidence of masked hypertension and to examine its related risk factors. This is a cohort study including 1836 initially normotensive participants followed up on average for 2.9 years. Blood pressure was measured using Spacelabs 90207. Manual blood pressure was defined as the mean of the first three readings taken at rest. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension incidence at follow-up was defined as manual blood pressure less than 140 and less than 90 mmHg and ambulatory blood pressure at least 135 or at least 85 mmHg. Generalised estimating equations were used. The cumulative incidence of masked hypertension was 10.3% and was associated with male gender (relative risk (RR) 1.51, 95% confidence interval (CI) 1.18-1.94), older age (RR40-49 years 1.56, 95% CI 1.16-2.11, RR≥50 years 1.50, 95% CI 1.06-2.10), higher education (RRcollege 1.31, 95% CI 1.03-1.65), body mass index (RR≥27 1.43, 95% CI 1.11-1.85), smoking (RR 1.51, 95% CI 1.09-2.010) and alcohol intake (RR≥6/week 1.65, 95% CI 1.13-2.03). The present study is the first to identify risk factors for the incidence of masked hypertension. Current guidelines for hypertension detection recommend ambulatory blood pressure in patients with an elevated blood pressure reading at the clinic. As it is impractical to measure ambulatory blood pressure in all normotensive patients, factors identified in the present study should be considered for the screening of at-risk individuals and for primary prevention of masked hypertension.