Ambulatory Blood Pressure Levels Research Articles

The relationship between lung MIBG uptake and clinical response to renal denervation

Abstract Background Renal denervation (RDN) reduces the sympathetic overdrive and can optimize blood pressure control in patients with difficult-to-treat hypertension (DTH). However, a substantial proportion of patients undergoing RDN do not show a clinical response to the procedure, making it critical to identify novel and more accurate predictors. The metaiodobenzylguanidine (MIBG) scintigraphy allows non-invasive assessment of sympathetic nerve activity. Yet, studies evaluating the heart and kidney MIBG uptake as predictors of clinical response to RDN provided conflicting results, and a comprehensive evaluation of the MIBG uptake in different organs of DTH patients undergoing RDN is lacking. Purpose To explore if a more comprehensive evaluation of MBG uptake in the kidneys, heart and lungs can predict the clinical response to RDN. Methods Eighteen patients with DTH underwent evaluation of their clinical and pharmacological history, office and ambulatory BP values and levels of cardiovascular risk factors. A rest echocardiography, carotid vascular ultrasound and MIBG scintigraphy were also performed before RDN. The patient’s pharmacological history and office and ambulatory BP values were re-evaluated after 3 months from RDN. We considered responders (R) those subjects with a significant reduction of the office BP values on stable BP-lowering treatment or a reduced burden of BP-lowering medications while maintaining optimal control of the office BP. Results Ten patients could be classified as R (1 woman, mean age 49±10 years), while 7 were non-responders (NR, 2 women, mean age 53±8 years). The reduction in office systolic and diastolic BP (baseline vs 3 months) was significantly larger in R vs NR (p=0.01 for both). The burden of BP-lowering medications after the procedure was reduced by 39% in R, compared to 2% in NR (p<0.01). Responders had a higher baseline HR and prevalence of carotid atherosclerosis than NR (p<0.05 for both). In early MIBG acquisitions, the lung/mediastinum ratio on both sides showed higher MIBG uptake in R vs NR (p<0.05). There was a higher MIBG uptake in the right vs. left lung in the whole population and in R vs NR. In late acquisitions, only the left side showed a significant difference between R and NR (p<0.05). The associations between the lung/mediastinum ratio MIBG uptake and response to RDN remained significant after adjusting for the baseline clinical predictors of the RDN response. All other MIBG scintigraphy parameters were similar between groups. Conclusions Our results suggest that RDN might be less effective in patients with an advanced burden of hypertension-mediated target organ damage and confirm a higher HR as a reliable predictor of the clinical response to the procedure. We also document a novel association between the lung/mediastinum ratio MIBG uptake and response to RDN that, if confirmed in future studies, might provide a novel marker to improve the selection of patients undergoing RDN.

Differences in ambulatory versus home blood pressure levels by ethnicity: data from the United Kingdom and Japan.

This study tested the hypothesis that differences in ethnicity impact the level of agreement between ambulatory blood pressure (ABP) and home BP (HBP) levels. A retrospective analysis of cross-sectional data from the UK and Japan was performed. Participants underwent office BP, daytime ABP, and HBP measurements. The ABP-HBP difference was compared between ethnic groups by multiple linear regression analysis. Diagnostic disagreement was defined as a disparity between the hypertension diagnoses obtained using ABP and HBP, since both measures share common thresholds of 135/85 mmHg for hypertension. Definite diagnostic disagreement was assigned where such a difference exceeded ±5 mmHg for either systolic BP (SBP) or diastolic BP (DBP). A total of 1 408 participants (age 62.1 ± 11.1 years, 48.6% males, 78.9% known hypertensive, White British 18.9%, South Asian 11.2%, African Caribbean 12.0%, Japanese 58.0%) were eligible. More Japanese participants showed higher ABP than HBP compared to White British: SBP + 3.09 mmHg, 95% confidence interval (CI) + 1.14, +5.04 mmHg; DBP + 5.67 mmHg, 95%CI + 4.51, +6.84 mmHg. More Japanese participants than African Caribbean participants exhibited diagnostic disagreement in SBP (33.2% vs. 20.7%, p = 0.006). Furthermore, Japanese participants had a higher percentage of definite diagnostic disagreement in SBP compared to White British (9.3% vs. 4.5%, p = 0.040) and African Caribbean participants (9.3% vs. 3.0%, p = 0.018). In conclusion, Japanese participants showed greater disparity between ABP and HBP compared to White British participants. Complementary use of ABP and HBP monitoring may be more beneficial for assessing cardiovascular disease risk in Japanese participants compared to other ethnic groups.

Office measurement vs. ambulatory blood pressure monitoring: associations with mortality in patients with or without diabetes.

Guidelines suggest similar blood pressure (BP) targets in patients with and without diabetes and recommend ambulatory BP monitoring (ABPM) to diagnose and classify hypertension. It was explored whether different levels of ambulatory and office BP and different hypertension phenotypes associate with differences of risk in diabetes and no diabetes. This analysis assessed outcome data from the Spanish ABPM Registry in 59 124 patients with complete available data. The associations between office, mean, daytime, and nighttime ambulatory BP with the risk in patients with or without diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes, i.e. sustained hypertension, white-coat hypertension, and masked hypertension, compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders. A total of 59 124 patients were recruited from 223 primary care centres in Spain. The majority had an office systolic BP >140 mmHg (36 700 patients), and 23 128 (40.6%) patients were untreated. Diabetes was diagnosed in 11 391 patients (19.2%). Concomitant cardiovascular (CV) disease was present in 2521 patients (23.1%) with diabetes and 4616 (10.0%) without diabetes. Twenty-four-hour mean, daytime, and nighttime ambulatory BP were associated with increased risk in diabetes and no diabetes, while in office BP, there was no clear association with no differences with and without diabetes. While the relative association of BP to CV death risk was similar in diabetes compared with no diabetes (mean interaction P = .80, daytime interaction P = .97, and nighttime interaction P = .32), increased event rates occurred in diabetes for all ABPM parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (hazard ratio 0.86; 95% confidence interval 0.72-1.03) and slightly reduced risk for all-cause death in no diabetes (hazard ratio 0.89; confidence interval 0.81-0.98) but without significant interaction between diabetes and no diabetes. Sustained hypertension and masked hypertension in diabetes and no diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no diabetes and CV death risk (interaction P = .26), while some interaction was present for all-cause death (interaction P = .043) and non-CV death (interaction P = .053). Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ambulatory BP. Masked and sustained hypertension confer to the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no diabetes. These results support recommendations of international guidelines for strict BP control and using ABPM for classification and assessment of risk and control of hypertension, particularly in patients with diabetes. Not applicable.

RESIDENCE AT HIGH ALTITUDE IS ASSOCIATED WITH LOWER CONVENTIONAL AND AMBULATORY BLOOD PRESSURE THAN LIVING AT SEA LEVEL IN THE GENERAL POPULATION OF PERU. HIGHCARE-LAPS STUDY

Objective: Acute exposure to hypoxia at high altitude (HA) leads to an increase in blood pressure (BP) in healthy individuals and in hypertensive patients. Little is known, however, about the effect of long-term HA residence on BP. Available data based on conventional BP measurements are inconsistent and no general population studies using 24-h ambulatory BP monitoring (ABPM) have been conducted. Aim of HIGHCARE-LAPS was to compare BP levels and cardiovascular risk profile among population-based samples of subjects residing in Peruvian communities living at different altitudes. BP-related data are reported in this paper. Design and method: Study participants were recruited by sex- and age-stratified random multistage cluster sampling from the general adult population residing permanently in urban areas at different altitudes in Peru (Lima, <500m, Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). In all participants questionnaire-based information, conventional BP (3 seated measurements with a validated oscillometric device, HEM7121 OMRON, Japan), 24-hour ambulatory BP (A&D TM2430, Japan) and laboratory variables were obtained. Results: The study included 206 lowlanders and 595 highlanders. Highlanders were slightly younger, had lower BMI, oxygen saturation and prevalence of antihypertensive medication use and higher haematocrit. In highlanders all conventional and ambulatory BP values were lower and heart rate values higher than in lowlanders. Comparisons between lowlander and highlander samples and for individual sites at different altitudes are reported in the Table. The difference in 24-hour systolic BP between highlanders and lowlanders remained significant (7.2 mmHg, p<0.001) in a linear multiple regression model adjusting for age, sex, BMI, 24-hour heart rate, respiratory rate, and haematocrit. These covariates were selected by LASSO method from a set also including lifestyle-related variables. Conclusions: Permanent residence at high altitude is independently associated with lower conventional and ambulatory BP levels than low altitude residence in the general population of Peru. This relationship does not seem to be explained by lifestyle differences. Mechanisms behind this difference and its impact on cardiovascular risk should be further investigated. Also, comparative studies with other highland populations with different adaptive characteristics would allow to understand better the effects of HA residence on cardiovascular health.

ASSOCIATION OF CLINIC AND AMBULATORY BLOOD PRESSURE WITH MORTALITY IN PATIENTS WITH AND WITHOUT DIABETES

Objective: To explore whether different levels of ambulatory and office blood pressure (BP) and different hypertension phenotypes associate with differences of risk in diabetes and no-diabetes. Design and method: This analysis assessed outcome data from patients with complete data included in the Spanish Ambulatory BP (ABP) Monitoring Registry. The associations between office BP, mean, daytime and nighttime ABP and the risk in patients with diabetes and no-diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders. Results: A total of 59,124 patients were recruited from 223 primary care centres in Spain. The majority had an office SBP >140 mmHg (36,700 patients), 23,128 (40.6%) patients were untreated. Diabetes was diagnosed in 10,935 patients (19.2%). Cardiovascular (CV) disease was present in 2,521 patients (23.1%) with and 4,616 (10.0%) without diabetes. Twenty-four-hour mean, daytime and nighttime ABP were associated with increased risk in diabetes and no-diabetes, whereas there was no clear association for office BP. While the relative association of BP with CV death risk was similar in diabetes compared to no-diabetes (mean interaction p=0.80, daytime interaction p=0.97 and nighttime interaction p=0.32), increased event rates occurred in diabetes for all ABP monitoring parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (HR 0.86; 95% CI 0.72-1.03) and slightly reduced risk for all-cause death in no-diabetes (HR 0.89; 95% CI 0.81-0.98) but without significant interaction between diabetes and no-diabetes. Sustained hypertension and masked hypertension in diabetes and no-diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no-diabetes (interaction p=0.26) and CV death risk, while, some interaction was present for all-cause death (interaction p=0.043) and non-CV death (interaction p=0.053). Conclusions: Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ABP. Masked and sustained hypertension confer the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no-diabetes.

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study.

Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991-1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping-dipping (n = 152/33.6%), dipping-non-dipping (n = 198/43.8%), non-dipping-dipping (n = 20/4.4%), and non-dipping-non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping-non-dipping group, and lowest (6.6%) in the dipping-dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping-non-dipping pattern with CV events compared with the dipping-dipping pattern remained significant (HR 4.01; 95% CI 1.89-8.67, p < 0.001). In summary, non-dipping-non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

Prognostic impact of hypertension grading

BackgroundMost Hypertension Guidelines grade hypertension according to various cut-off values. We sought to investigate the prognostic impact of Grades 1 (140–159 and/or 90–99 mmHg), 2 (160–179 and/or 100–109 mmHg) and 3 (≥180 and/or ≥110 mmHg). MethodsWe followed for an average of 10 years a cohort of 3,150 initially untreated hypertensive patients (mean age 50 years, 44 % women) with no previous cardiovascular disease at entry. All patients underwent diagnostic tests including 24-hour ambulatory blood pressure (BP) monitoring. ResultsAt entry, average clinic BP was 156/97 mmHg and average 24-hour BP was 137/87 mmHg. During follow-up, 314 patients experienced a first major cardiovascular event (composite of non-fatal myocardial infarction or stroke, cardiovascular death, or hospitalization for heart failure). Event rate was not formally dissimilar between Grade 1 and Grade 2 (0.73 vs 0.95 per 100 patient-years, respectively; p = 0.06). It was higher in Grade 3 (1.93 per 100 patient-years; p < 0.01 vs Grade 1 and Grade 2). After adjustment for a robust set of covariables, the hazard ratio was not dissimilar between Grade 1 and Grade 2 (p = 0.27), and higher in Grade 3 than in Grade 1 (p < 0.01), but the excess risk in Grade 3 was no longer significant (hazard ratio: 1.25, 95 % CI 0.87–1.78; p = 0.22) after adjustment for 24-hour ambulatory systolic BP. ConclusionsWe were unable to find a significant difference in the relative hazard of cardiovascular events tied to hypertension Grades 1 and 2. Conversely, Grade 3 (clinic BP ≥180/110 mmHg) portends a higher cardiovascular risk, which is associated with higher levels of 24-hour ambulatory BP.

Novel Pulse Waveform Index by Ambulatory Blood Pressure Monitoring and Cardiac Function: A Pilot Study

BackgroundA simple ambulatory measure of cardiac function could be helpful for monitoring heart failure patients. ObjectivesThe purpose of this paper was to determine whether a novel pulse waveform analysis using data obtained by our developed multisensor-ambulatory blood pressure monitoring (ABPM) device, the 'Sf/Am' ratio, is associated with echocardiographic left ventricular ejection fraction (LVEF). MethodsMultisensor-ABPM was conducted twice at baseline in 20 heart failure (HF) patients with HF-reduced LVEF or HF-preserved LVEF (median age 66 years, male 65%) and over a 6- to 12-month follow-up after patient-tailored treatment. We assessed the changes in the pulse waveform index Sf/Am and LVEF that occurred between the baseline and follow-up. The Sf/Am consists of the area of the ejection part in the square forward wave (Sf) and the amplitude of the measured wave (Am). We divided the patients into the recovered (n = 11) and not-recovered (n = 9) groups defined by a ≥10% increase in LVEF. ResultsAlthough the ambulatory BP levels and variabilities did not change in either group, the Sf/Am increased significantly in the recovered group (baseline 21.4 ± 4.5; follow-up, 25.6 ± 3.7, P = 0.004). The not-recovered group showed no difference between the baseline and follow-up. The follow-up/baseline Sf/Am ratio was significantly associated with the LVEF ratio (r = 0.469, P = 0.037). The Sf/Am was significantly correlated with the LVEF in overall measurements (n = 40, r = 0.491, P = 0.001). ConclusionsThese results demonstrated that a novel noninvasive pulse waveform index, the Sf/Am measured by multisensor-ABPM is associated with LVEF. The Sf/Am may be useful for estimating cardiac function.

Comparative characteristics of lifestyle, office and ambulatory blood pressure among students from Tropical Africa, India and Russia

Aim. To study the dependence of office and ambulatory blood pressure (BP) level in students with their ethnicity.Material and methods. A total of 110 students were examined as follows: 35 from Russia, 34 from Tropical Africa and 41 from India. Lifestyle was studied using a standardized questionnaire. All students underwent measurement of office blood pressure and 24-hour ambulatory blood pressure monitoring (ABPM) using the BPLabH system (Russia).Results. Students from Russia were more likely to lead a sedentary lifestyle than from Africa (p=0,001) or India (p=0,027). Students from Tropical Africa added salt to food more often than Indians (p=0,03). Office blood pressure measured in the first half of the day was within the normal range for all subjects and did not differ between different ethnic groups. According to ABPM, there were no intergroup differences in systolic blood pressure during the daytime and 24 hours. Diastolic blood pressure of Africans during the daytime (p=0,029) and 24 hours (p=0,002) was higher than in Russians. Nighttime systolic and diastolic blood pressure of African students was significantly higher than in Russian (p=0,006 and p&lt;0,0001, respectively) or Indians (p=0,008 and p=0,006, respectively). Africans showed a smaller blood pressure decrease at night and were more likely to have masked hypertension at night than Russians (p=0,004) or Indians (p=0,046).Conclusion. Office BP did not vary by ethnicity. With ABPM, no differences in blood pressure levels were found between Indian and Russian students. African students had higher blood pressure at night, including masked hypertension, than students from India or Russia.

White coat effect in patients with hypertension

The article is devoted to various aspects of white coat effect (WCE) in patients with hypertension (HTN). WCE is due to the patient’s anxious response to office blood pressure (BP) measurement and is characterized by a BP increase. In patients with HTN, WCE is detected with a high frequency. Pronounced WCE in hypertensive patients is associated with worsening the HTN course and the prognosis of all-cause and cardiovascular mortality. In addition, BP increase in these patients during a doctor’s visit may lead to additional prescription of antihypertensive drugs, increasing costs and side effects. To identify WCE, a large number of methods are used, which can be divided into following groups: I – data from clinical and daytime ambulatory blood pressure measurement, II – clinical and home BP assessment, III – only ambulatory BP measurement, IV – clinical and laboratory BP data, and V – only clinical BP measurement. There are following WCE in patients with HTN: female sex, age, never smoking, as well as anxiety, introversion, etc. WCE is due to the patient’s anxiety state during office BP measurement and a conditioned reflex BP increase associated both with the physician presence and medical background. Severe WCE in some groups of patients with HTN may be associated with a worse prognosis compared with other hypertensive patients as follows: in individuals with a significant difference between clinical and ambulatory blood pressure levels or between the first and third BP office data, with a combination of resistant HTN and WCE, with WCE increasing from visit to visit, etc.

Abstract 093: Does Ambulatory Blood Pressure Variability Predicts Target Organ Damage In Youth? The Ship Ahoy Study

Altered BP and HR variability are associated with abnormalities of cardiac structure and function in adults. Our aim was to determine if BP and HR variability increase prediction of subclinical cardiac changes in youth after adjustment for mean ambulatory BP (ABP) measures. We measured anthropometrics and performed echocardiography for left ventricular mass index (LVMI), LV systolic strain and LV diastolic function (e’/a’). ABP was measured with an oscillometric device and ABP mean percentiles were calculated per pediatric guidelines to adjust mean ABP for differences in age-, height- and sex. ABP and HR coefficients of variation (CV) were calculated as SD/mean. HR dipping was day mean HR - night mean HR. General linear models were used to determine if ABP and HR CV measures remained significant determinants of cardiac measures in models containing mean ABP levels, age, sex, race/ethnicity, BMIz, HR. Mean age was 15.6 ± 1.7 years (63% white, 59% male) with mean casual BP 122.7/71.6 mmHg ±12.3/10.5, mean daytime ABP 124.2/72.0 ± 11.3/7.7 mmHg. In linear models, DBP day CV, DBP nite CV and HR dip remained significant determinants of LVMI even after adjustment for covariates and ABP percentile (R 2 0.36, p &lt; 0.0001). HR nite CV was a determinant of e’/a’ after adjustments (R 2 0.16, p &lt; 0.0001). No BP or HR variability parameters enter the model for LV systolic strain. When stratified by ABP phenotype, participants with white coat HTN (WCH) had higher 24-hour BP, HR variability and HR dipping compared to other phenotypes. Measures of BP and HR variability which may represent altered autonomic tone, may affect LVM and diastolic function in youth especially those with WCH.

#3042 AMBULATORY BLOOD PRESSURE LEVELS AFFECT THE ASSOCIATION OF INTRADIALYTIC HYPERTENSION WITH ADVERSE CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Patients with intradialytic hypertension (IDH) display also higher ambulatory blood pressure (BP) levels during the whole 44-h interdialytic interval compared to patients without the phenomenon. Sustained high 44-h ambulatory BP levels is a potential risk factor for cardiovascular events and mortality in these individuals. The aim of this study is to evaluate the influence of elevated 44-h BP levels on the high cardiovascular risk of individuals with IDH. Method A total of 242 hemodialysis patients with valid 48-h ABPM with Mobil-O-Graph-NG had an extended follow up for a median of 57.8 months. IDH was defined as: rise in SBP greater or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater or equal to 150 mmHg. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. The secondary endpoint was cardiovascular mortality. Results 5 patients with and 197 without were included in this prospective analysis. Cumulative freedom from the primary and secondary endpoint was significantly lower for patients with IDH (logrank-p = 0.019), while freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.321). Patients with IDH presented a significantly higher risk for the composite endpoint (HR = 1.651, 95%CI[1.083, 2.516]), without, however, showing a significant difference in the risk for cardiovascular mortality (HR = 1.320, 95%CI[0.762, 2.288]). After adjustment for 44-h SBP, the association of IDH with the primary endpoint slightly attenuated, while the association with the secondary outcome had no significant changes (HR = 1.421, 95%CI[0.906, 2.228] and HR = 1.270, 95%CI[0.708, 2.276], for primary and secondary outcome respectively). Conclusion IDH is associated with higher risk for adverse cardiovascular outcomes. High ambulatory BP during the interdialytic interval contributes to the excess cardiovascular risk observed in this population.

#5608 THE INFLUENCE OF AMBULATORY BP ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN DIALYSIS PATIENTS: A PROSPECTIVE COHORT STUDY

Abstract Background and Aims Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals. Method 129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. Results Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])). Conclusion In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.

DIFFERENCES IN AMBULATORY BP LEVELS AND INTENSITY OF ANTIHYPERTENSIVE TREATMENT BETWEEN MEN AND WOMEN UNDERGOING PERITONEAL DIALYSIS

Objective: The aim of the present study was to compare the ambulatory blood pressure (BP) levels and intensity of antihypertensive treatment between men and women with end-stage kidney disease receiving long-term peritoneal dialysis (PD). Design and method: Following a case-control design, 48 male PD patients from Northern Greece were matched for age and history of heart failure with 48 female patients in a 1:1 ratio. All patients underwent 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). The BP-lowering medications actually taken by the patients were prospectively recorded. Results: Age, dialysis vintage and the burden of cardiovascular comorbidities did not differ between men and women. There were no significant sex differences in ambulatory systolic BP (24-hour period: 129.0±17.8 vs. 128.5±17.5 mmHg, P = 0.138; daytime: 129.6±17.5 vs. 129.7±17.4 mmHg, P = 0.991; nighttime: 127.0±19.8 vs. 125.9±18.8 mmHg, P = 0.776). However, the levels of ambulatory diastolic BP were consistently higher in men than in women over the entire 24-hour period (81.5±12.1 vs. 76.8±10.3 mmHg, P&lt;0.05) as well as during daytime (82.5±11.8 vs. 78.1±10.4 mmHg, P&lt;0.05) and during nighttime (78.8±13.9 vs. 73.8±11.1 mmHg, P&lt;0.05). The proportion of patients with 24-hour ambulatory BP &lt;130/80 mmHg was numerically lower in men than in women (35.4% vs. 43.8%), despite the greater intensity of antihypertensive treatment in men. As compared with women, men were receiving a higher average number of BP-lowering medications daily (2.4±1.1 vs. 1.8±1.1, P&lt;0.05) and were being treated more commonly with beta-blockers (85.1% vs. 66.7%, P&lt;0.05) and dihydropyridine calcium-channel-blockers (70.2% vs. 43.8%, P = 0.01). Conclusions: The present study shows that among patients undergoing PD, the ambulatory BP levels and intensity of antihypertensive treatment are higher in men than in women. Prospective observational studies are needed to explore whether these sex differences in the severity of hypertension contribute to a higher risk for adverse health outcomes in men receiving long-term PD.

AMBULATORY BLOOD PRESSURE LEVELS AFFECT THE ASSOCIATION OF INTRADIALYTIC HYPERTENSION WITH ADVERSE CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Objective: Patients with intradialytic hypertension (IDH) display also higher ambulatory blood pressure (BP) levels during the whole 44-h interdialytic interval compared to patients without the phenomenon. Sustained high 44-h ambulatory BP levels is a potential risk factor for cardiovascular events and mortality in these individuals. The aim of this study is to evaluate the influence of elevated 44-h BP levels on the high cardiovascular risk of individuals with IDH. Design and method: A total of 242 hemodialysis patients with valid 48-h ABPM with Mobil-O-Graph-NG had an extended follow up for a median of 57.8 months. IDH was defined as: rise in SBP greater or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater or equal to 150 mmHg. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. The secondary endpoint was cardiovascular mortality. Results: 45 patients with and 197 without were included in this prospective analysis. Cumulative freedom from the primary and secondary endpoint was significantly lower for patients with IDH (logrank-p = 0.019), while freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.321). Patients with IDH presented a significantly higher risk for the composite endpoint (HR = 1.651, 95%CI[1.083, 2.516]), without, however, showing a significant difference in the risk for cardiovascular mortality (HR = 1.320, 95%CI[0.762, 2.288]). After adjustment for 44-h SBP, the association of IDH with the primary endpoint slightly attenuated, while the association with the secondary outcome had no significant changes (HR = 1.421, 95%CI[0.906, 2.228] and HR = 1.270, 95%CI[0.708, 2.276], for primary and secondary outcome respectively). Conclusions: IDH is associated with higher risk for adverse cardiovascular outcomes. High ambulatory BP during the interdialytic interval contributes to the excess cardiovascular risk observed in this population.

A Prospective, Randomized Open-Label Study for Assessment of Antihypertensive Effect of Telmisartan Versus Cilnidipine Using Ambulatory Blood Pressure Monitoring (START ABPM Study).

The antihypertensive agent telmisartan is an angiotensin II receptor blocker with a terminal elimination half-life of 24 h and has a high lipophilicity, thereby enhancing its bioavailability. Another antihypertensive agent, cilnidipine is a calcium antagonist and has dual mode of action on the calcium channels. This study aimed at determining effect of these drugs on ambulatory blood pressure (BP) levels. A randomized, open-label, single-center study was conducted during 2021 - 2022 on newly diagnosed adult patients with stage-I hypertension, in a mega city of India. Forty eligible patients were randomized to telmisartan (40 mg) and cilnidipine (10 mg) groups, with once daily dose administered for 56 consecutive days. Ambulatory blood pressure monitoring (ABPM) (24 h) was performed pre- and post-treatment, and the ABPM-derived parameters were compared statistically. Statistically significant mean reductions were observed in all BP endpoints in telmisartan group but only in 24-h systolic blood pressure (SBP), daytime and nighttime SBP, and manual SBP and diastolic blood pressure (DBP) in cilnidipine group. The mean change from baseline to day 56 between two treatment groups showed statistical significance in last 6-h SBP (P = 0.01) and DBP (P = 0.014), and morning SBP (P = 0.019) and DBP (P = 0.028). The percent nocturnal drop within and between groups was statistically nonsignificant. Also, the between group mean SBP and DBP smoothness index differed nonsignificantly. Telmisartan and cilnidipine once daily were effective and well tolerated in the treatment of newly diagnosed stage-I hypertension. Telmisartan provided sustained 24-h BP control and may offer advantages over cilnidipine in terms of BP reductions, particularly over the 18- to 24-h post-dose period or critical early morning hours.

THE INFLUENCE OF AMBULATORY BLOOD PRESSURE ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS: A PROSPECTIVE COHORT STUDY

Objective: Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals. Design and method: 129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. Results: Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])). Conclusions: In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.

Machine Learning-Based prediction of Post-Treatment ambulatory blood pressure in patients with hypertension

Purpose. Pre-treatment prediction of individual blood pressure (BP) response to anti-hypertensive medication is important to determine the specific regimen for promptly and safely achieving a target BP. This study aimed to develop supervised machine learning (ML) models for predicting patient-specific treatment effects using 24-hour ambulatory BP monitoring (ABPM) data. Materials and Methods. A total of 1,129 patients who had both baseline and follow-up ABPM data were randomly assigned into training, validation and test sets in a 3:1:1 ratio. Utilising the features including clinical and laboratory findings, initial ABPM data, and anti-hypertensive medication at baseline and at follow-up, ML models were developed to predict post-treatment individual BP response. Each case was labelled by the mean 24-hour and daytime BPs derived from the follow-up ABPM. Results. At baseline, 616 (55%) patients had been treated using mono or combination therapy with 45 anti-hypertensive drugs and the remaining 513 (45%) patients had been untreated (drug-naïve). By using CatBoost, the difference between predicted vs. measured mean 24-hour systolic BP at follow-up was 8.4 ± 7.0 mm Hg (% difference of 6.6% ± 5.7%). The difference between predicted vs. measured mean 24-hour diastolic BP was 5.3 ± 4.3 mm Hg (% difference of 6.8% ± 5.5%). There were significant correlations between the CatBoost-predicted vs. the ABPM-measured changes in the mean 24-hour Systolic (r = 0.74) and diastolic (r = 0.68) BPs from baseline to follow-up. Even in the patients with renal insufficiency or diabetes, the correlations between CatBoost-predicted vs. ABPM-measured BP changes were significant. Conclusion. ML algorithms accurately predict the post-treatment ambulatory BP levels, which may assist clinicians in personalising anti-hypertensive treatment.

Gender-Related Differences in the Levels of Ambulatory BP and Intensity of Antihypertensive Treatment in Patients Undergoing Peritoneal Dialysis.

Prior studies have shown that among patients with chronic kidney disease not yet on dialysis, the faster progression of kidney injury in men than in women is, at least partly, explained by sex differences in ambulatory blood pressure (BP) control. The present study aimed to investigate potential differences in the levels of ambulatory BP and intensity of antihypertensive treatment between men and women with end-stage kidney disease undergoing long-term peritoneal dialysis (PD). In a case-control design, 48 male PD patients were matched for age and heart failure status with 48 female patients in a 1:1 ratio. Ambulatory BP monitoring was performed with an oscillometric device, the Mobil-O-Graph (IEM, Stolberg, Germany). The BP-lowering medications actually taken by the patients were prospectively recorded. No gender-related differences were observed in 24 h systolic BP (129.0 ± 17.9 vs. 128.5 ± 17.6 mmHg, p = 0.890). In contrast, 24 h diastolic BP was higher in men than in women (81.5 ± 12.1 vs. 76.8 ± 10.3 mmHg, p = 0.042). As compared with women, men were being treated with a higher average number of antihypertensive medications daily (2.4 ± 1.1 vs. 1.9 ± 1.1, p = 0.019) and were more commonly receiving calcium-channel-blockers (70.8% vs. 43.8%, p = 0.007) and β-blockers (85.4% vs. 66.7%, p = 0.031). In conclusion, the present study shows that among PD patients, the levels of ambulatory BP and intensity of antihypertensive treatment are higher in men than in women. Longitudinal studies are needed to explore whether these gender-related differences in the severity of hypertension are associated with worse cardiovascular outcomes for male patients undergoing PD.

24-hour ambulatory blood pressure and cryptogenic ischemic stroke in young adults

Background In young patients, up to 40% of ischemic strokes remain cryptogenic despite modern-day diagnostic work-up. There are limited data on blood pressure (BP) behavior in these patients. Thus, we aimed to compare ambulatory blood pressure (ABP) profiles between young patients with a recent cryptogenic ischemic stroke (CIS) and stroke-free controls. Patients and Methods In this substudy of the international multicenter case–control study SECRETO (NCT01934725), 24-hour ambulatory blood pressure monitoring (ABPM) was performed in consecutive 18–49-year-old CIS patients and stroke-free controls. The inclusion criteria were met by 132 patients (median age, 41.9 years; 56.1% males) and 106 controls (41.9 years; 56.6% males). We assessed not only 24-hour, daytime, and nighttime ABP but also hypertension phenotypes and nocturnal dipping status. Results 24-hour and daytime ABP were higher among controls. After adjusting for relevant confounders, a non-dipping pattern of diastolic blood pressure (DBP) was associated with CIS in the entire sample (odds ratio, 3.85; 95% confidence interval, 1.20–12.42), in participants without antihypertensives (4.86; 1.07–22.02), and in participants without a patent foramen ovale (PFO) (7.37; 1.47–36.81). After excluding patients in the first tertile of the delay between the stroke and ABPM, a non-dipping pattern of DBP was not associated with CIS, but a non-dipping pattern of both systolic BP and DBP was (4.85; 1.37–17.10). In participants with a PFO and in those without hypertension by any definition, no associations between non-dipping patterns of BP and CIS emerged. Conclusions Non-dipping patterns of BP were associated with CIS in the absence of a PFO but not in the absence of hypertension. This may reflect differing pathophysiology underlying CIS in patients with versus without a PFO. Due to limitations of the study, results regarding absolute ABP levels should be interpreted with caution. Key Messages Nocturnal non-dipping patterns of blood pressure were associated with cryptogenic ischemic stroke except in participants with a patent foramen ovale and in those without hypertension by any definition, which may indicate differing pathophysiology underlying cryptogenic ischemic stroke in patients with and without a patent foramen ovale. It might be reasonable to include ambulatory blood pressure monitoring in the diagnostic work-up for young patients with ischemic stroke to detect not only the absolute ambulatory blood pressure levels but also their blood pressure behavior.