Changes In Ambulatory Blood Pressure Monitoring Research Articles

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters.

Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.

Prospective comparative analysis of the ambulatory blood pressure monitoring changes in patients with hypertension after COVID‑19 in the conditions of the Arctic watch

Objective. To conduct a prospective (2-year) comparative analysis of the dynamics of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with arterial hypertension (HTN) and previous COVID-19 infection working in the conditions of the Arctic watch.Design and methods. In the Medical Unit of Gazprom Dobycha Yamburg LLC (GDY) in the polar shift settlement of Yamburg, 347 patients were examined: 222 men (M) and 125 women (W). All of them underwent ABPM according to the standard protocol in 2019 and 2022. Among them, 261 patients had confirmed COVID-19 between 2020 and 2021 and were treated in the Medical Unit of GDY. Among the examined M and W, according to medical history in 2019, 80 % of M (178 from 222 people) and 66 % of W (82 from 125 people) had elevated blood pressure (BP), p = 0,003. Among patients with HTN, 109 M (61,2 %) and 42 W (51,2 %) survived after COVID-19, p = 0,129. They formed observation group (n = 151). Comparison group included HTN patients without COVID-19 (n = 109).Results. In patients with HTN who had COVID-19, ABPM showed an increase in average daily systolic BP (SBP) values after 2 years: from 134,5 (12,3) to 140,5 (11,8) mmHg (p < 0,0001) and diastolic BP (DBP): from 96,6 (14,0) to 105,1 (13,4) mmHg (p < 0,0001), hypertensive load time indices (TI): TI SBP24 (from 49,5 (29,3) to 61,6 (28,1) mmHg (p < 0,0001) and TI DBP24 from 69,3 (30,5) to 83,4 (21,9) mmHg (p < 0,0001), increase in daytime SBP variability (p = 0,048), decrease in daily SBP indices by 1,2 %: from 7,9 (4,6) to 6,7 (4,3) (p = 0,038) and DBP by 2,0 %: from 9,7 (4,8) to 7,7 (4,7) (p = 0,032). Desynchronization of SBP and DBP rhythms were found by chronobiological analysis.Conclusions. A prospective comparative analysis of the dynamics of ABPM in patients with HTN after COVID-19 in the conditions of the Arctic watch showed an increase in the average daily values of SBP and DBP and their daily variability, deterioration in the daily BP profile with an increase in the “night peaker” phenotype. In patients with HTN who did not have COVID-19, a prospective analysis of ABPM showed a significant increase in DBP and average daily hypertensive load of DBP, which may contribute to further cardiovascular remodeling. In patients with HTN who have recovered from COVID-19, desynchronization processes of SBP and DBP rhythms intensify, which requires an in-depth analysis of the chronobiological structure of the rhythm BP.

Clinical efficacy of a fixed-dose combination of amlodipine/indapamide/perindopril in patients with hypertension and multiple risk factors

Aim. To evaluate the antihypertensive and organ protective efficacy of the triple fixed-dose combination of amlodipine/indapamide/perindopril in patients with hypertension (HTN) who did not achieve target blood pressure (BP) on previous antihypertensive therapy (AHT).Material and methods. The study included 47 patients with HTN and multiple risk factors who did not achieve target blood pressure during previous AHT. They were prescribed triple fixed-dose combination of amlodipine/indapamide/perindopril with preliminary prescription of amlodipine, indapamide and perindopril in the free-dose combination. At baseline and after 3 months of AHT, 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography and arterial stiffness were analyzed.Results. Initially, in patients included in the study, the main ABPM parameters were increased, while non dipper and reduced dipper (66% of patients) patterns prevailed. The results of echocardiography indicated left ventricular (LV) hypertrophy (LVH) by left ventricular mass index (LVMI), left ventricular posterior wall thickness (LVPWT), interventricular septum (IVS) and its diastolic dysfunction by E/A, while an increase in CAVI and biological vascular age reflected an increase in arterial stiffness. After 3 months of AHT, significant (p£0,05) ABPM changes and a predominance of the dipper-type 24-hour BP pattern were recorded in more than half of the patients (53%). A decrease in LVMI, LVPWT and IVS by 7%, 12% and 8%, respectively (p£0,05), while an E/A increase by 12% reflected LVH regression and LV diastolic function improvement. A decrease in arterial stiffness was evidenced by a decrease (p£0,05) in CAVI by an average of 10% and biological vascular age by 4 years.Conclusion. Triple fixed-dose therapy of amlodipine/indapamide/perindopril after 3-month treatment made it possible to achieve target blood pressure in 78% of patients, improved ABPM parameters and ensured pronounced cardioand vasoprotective effects, reflected in LVH regression, improvement of LV diastolic function and reduction of arterial stiffness.

Ambulatory blood pressure monitoring changes in hypertensive patients

The aim of the study was to determine the peculiarities of ABPM indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.
 Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. The control group consisted of 15 patients for every of the surveyed categories (group III - middle-aged and group IV – elderly respectively) matched with basic by age and gender.
 Results. We have shown that one of the factors that determines the change in hemodynamics in patients with essential hypertension is age, with the age patients experience the decrease in diastolic blood pressure with steadily increased systolic blood pressure, that should be considered in the prescription of antihypertensive treatment. With age, a gradual increase in systolic blood pressure is associated with the increased aortic stiffness, partially with the increase in collagen and the decrease in elastic fibrils and the formation of isolated systolic hypertension. Thus, it is proved that in the formation of isolated hypertension the growth of pulse blood pressure for more than 60 mm Hg is unfavorable in a development of cerebrovascular events. Pulse arterial blood pressure was stronger risk factor than systolic blood pressure and diastolic blood pressure or average arterial pressure in the elderly. Recently, taking into account age characteristics, all three indices were recognized as comparable predictors at the age of 50-59 years as the transitional period, and at the age of 60-79 years diastolic blood pressure adversely affecting the cardiovascular risk, increased pulse blood pressure prognostically above the level of systolic arterial pressure.

Estimated Dietary Acid Load Is Not Associated with Blood Pressure or Hypertension Incidence in Men Who Are Approximately 70 Years Old ,

AbstractBackground: Dietary acid load affects acid–base homeostasis, which may be associated with blood pressure (BP). Previous research on dietary acid load and BP in the community has provided conflicting results, which may be confounded by underlying kidney function with inability to eliminate acid excess.Objective: The objective of this study was to determine whether dietary acid load is associated with blood pressure or the incidence of hypertension in older men taking into account each individual’s kidney function.Methods: We included 673 men aged 70–71 y and not receiving antihypertensive medication from the Uppsala Longitudinal Study of Adult Men. Of those, 378 men were re-examined after 7 y. Dietary acid load was estimated at baseline by potential renal acid load (PRAL) and net endogenous acid production (NEAP), based on nutrient intake assessed by 7-d food records at baseline. Ambulatory blood pressure monitoring (ABPM) was performed at both visits. Cystatin C–estimated kidney function allowed identification of underlying chronic kidney disease.Results: Median estimated PRAL and NEAP were 3.3 and 40.7 mEq/d, respectively. In cross-section, PRAL was in general not associated with ABPM measurements (all P > 0.05, except for the 24-h diastolic BP). During follow-up, PRAL did not predict ABPM changes (all P > 0.05). When individuals with baseline hypertension (ABPM ≥ 130/80 mm Hg) or nondippers (with nighttime-to-daytime systolic BP ratio > 0.9) were excluded, PRAL was not a predictor of incident cases (P > 0.30). Kidney function did not modify these null relations. Similar findings were obtained with the use of NEAP as the exposure.Conclusion: Our analyses linking estimated dietary acid load with BP outcome measurements both cross-sectionally and after 7 y in community-based older Swedish men of similar age did not reveal an association between dietary acid load and BP.

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE (OM/HCTZ) 40/25MG PROVIDES GREATER AMBULATORY BLOOD PRESSURE-LOWERING VS OM/HCTZ 20/25MG IN ELDERLY AND SEVERE PATIENTS UNCONTROLLED BY OM: PP.5.203

Objective: To compare the efficacy of OM/HCTZ 40/25 mg versus 20/25 mg, as assessed by ambulatory blood pressure monitoring (ABPM), in elderly and hypertension severity subgroups in patients whose BP was inadequately controlled by OM 40 mg. Design and Methods: This was a subgroup analysis of a 16-week study in patients aged >/=18 years. The study consisted of 2 periods, each 8 weeks long. Eligible patients received 8 weeks' open-label OM 40 mg (Weeks 0–8). At Week 8 (baseline), patients with inadequate BP control (mean trough seated BP 140–180/90–115mmHg, mean 24-h diastolic BP [DBP] >/=80mmHg and >/=30% of daytime DBP readings >85mmHg) were randomised to a further 8 weeks' double-blind treatment with OM/HCTZ 40/25 or 20/25 mg (Weeks 8–16). Changes in ABPM from Week 8 to Week 16 were evaluated in patients aged >/=65 years (N=184) and in patients with moderate (160–179/100–109mmHg; N=679) or severe (>/=180/110mmHg; N=263) hypertension using a Spacelabs90207 device. Analyses were performed on the FAS OC. Results: In elderly patients OM/HCTZ 40/25 mg provided greater reductions in mean 24-h, daytime and night-time systolic BP (SBP) compared with 20/25 mg (15.4, 15.8 and 14.1mmHg vs 13.7, 14.0 and 13.5mmHg, respectively; Figure), while ambulatory DBP reductions were similar for both treatments. In patients with moderate hypertension, OM/HCTZ 40/25 mg provided greater mean 24-h (Figure), daytime and night-time ABP reductions than OM/HCTZ 20/25 mg (14.6/9.4 vs 11.4/7.4, 15.0/9.6 vs 11.7/7.4, and 13.4/8.5 vs 10.1/6.8mmHg, respectively). In patients with severe hypertension, ABP reductions were more pronounced with OM/HCTZ 40/25 mg than 20/25 mg for 24-h (Figure), daytime and night-time SBP (14.5 vs 13.8, 14.7 vs 14.2 and 13.4 vs 12.4mmHg, respectively), and for 24-h and night-time DBP (8.8 vs 8.4 and 8.8 vs 7.6mmHg, respectively). Conclusions: Elderly patients and individuals with more severe hypertension are harder to treat. OM/HCTZ 40/25 mg provides further incremental reductions in ABP compared with OM/HCTZ 20/25 mg in these subgroups, which may be of clinical relevance.

Ambulatory Blood Pressure Monitoring (ABPM) in Children with Thalassemia Major (TM).

In TM chronic anemia, blood transfusions and iron over load result in impairments in many organs. Little is known about the changes in blood pressure (BP) patterns of children with TM. To evaluate ABPM changes and associated laboratory and clinical features in children with TM. ABPM was performed in 20 TM patients with no cardiac or renal dysfunction (12M, 8F; 11.3+/−3.8 years), and 20 healthy children (11M, 9F; 11.6+/−2.4 years). Blood and timed urine samples were collected for hematological and biochemical tests. [Dipping: a fall in the mean systolic (diastolic) BP during nighttime of more than 10% of the mean daytime systolic (diastolic) BP]. Mean daytime (8AM–8PM) and nighttime (midnight to 6AM) systolic (SBP) and diastolic (DBP) blood pressures were comparable. No patient in TM and control group had mean 24-h, day time, nighttime SBP or DBP above 90th percentile. SBP and DBP- loads were always less than 20% in control group. In TM group: SBP-load was more than 20% in 1, and 1 patient during daytime and nighttime, respectively; and DBP- load was more than 20% in 1, and 2 patients during daytime and nighttime, respectively. The percentage of systolic (60% vs 35%; p:0.102) and diastolic (30% vs 20%; p:0.118) non-dippers among TM patients were higher, compared to control group. In TM group: the percentage of systolic (80% vs 40%; p:0.063) and diastolic (50% vs 10%; p:0.044) non-dippers among older (12–16 years) patients were higher, compared to younger (5–11 years) patients. There was no association between non-dipping pattern and hemoglobin, ferritin or albuminuria level. Our preliminary results suggest that BP anomalies in TM occur before the development of cardiac or renal dysfunction. There is an association between non-dipping and the age of the patient. Long-term follow-up will make clear whether abnormalities in ABPM patterns have a predictive value in the development of renal and cardiac dysfunction in TM patients.

Comparative antihypertensive efficacy of angiotensin receptor blocker-based treatment in African-American and white patients.

Blood pressure (BP) reductions with agents that block the renin-angiotensin system are regarded as less effective as monotherapy in African Americans than other ethnic groups. This practice-based study compares the efficacy of an angiotensin receptor blocker-based regimen in African-American and Caucasian patients. Included in the 10-week study were 173 African-American and 1296 Caucasian patients. Efficacy was based on differences in 24-hour ambulatory BP. After baseline ambulatory BP monitoring and office BPs were obtained, all patients were started or switched to the angiotensin receptor blocker telmisartan, 40-80 mg daily, plus hydrochlorothiazide 12.5 mg daily (if needed for office BP control: <140/90 mm Hg). More African Americans required the addition of a low-dose thiazide diuretic than Caucasians (47.3% vs. 34.9%; p=0.021). Once patients with white coat hypertension were excluded (i.e., those with baseline ambulatory BP monitoring <130/80 mm Hg), ambulatory BP monitoring changes were similar between groups. A greater proportion of African Americans than Caucasians without white coat hypertension also needed combination therapy (52.1% vs. 39.5%; p=0.04). While achievement of BP goal was similar between groups by office criterion (<140/90 mm Hg), differences were noted by ambulatory BP monitoring (<130/80 mm Hg) (48.0% in African American vs. 63.2% in Caucasians; p=0.01) despite the same BP reductions, reflecting higher baseline values in African Americans. We conclude that an angiotensin receptor blocker as part of a BP-lowering strategy is effective in previously untreated African-American patients, although a higher proportion will require the use of a diuretic compared with Caucasians.

Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension. Systolic Hypertension in Europe (SYST-EUR) Trial Investigators.

The present analysis was undertaken to evaluate postprandial (PP) changes in blood pressure (BP) assessed with ambulatory BP monitoring (ABPM) in elderly subjects with isolated systolic hypertension (ISH) on conventional measurement. A total of 530 patients (335 women and 195 men, aged 60-100 years, median 70 years) who performed an ABPM during the placebo run-in period of the Syst-Eur trial were included into the analysis. The PP changes in BP and heart rate (HR) were calculated by subtracting the mean systolic BP (SBP), diastolic BP (DBP) and HR in the 2 h preceding the main meal from the corresponding means covering the 2 h after the meal. The reproducibility of the postprandial fall in BP and heart rate (PPH) was assessed by contrasting the first and second ABPM in a subgroup of 147 patients who performed two ABPM's during the placebo run-in period. The mean SBP and DBP decreased and reached the nadir 2 h after the main meal while HR did not change. When PPH was assessed by comparing BP in the 2 h before and after the meal, both SBP and DBP decreased significantly (respectively -6.6 mm Hg, -5.4 mm Hg; P < 0.001). In 67.6% of all patients a decrease in SBP was observed and in 24.1% it exceeded 16 mm Hg. The corresponding values for DBP were 71.3% and 24.5% (DBP decreased more than 12 mm Hg). A greater fall in DBP was associated with a greater decrease in HR (r = 0.20, P < 0.001), while changes in SBP and HR were not interrelated. Regression analysis did not identify any significant covariate of PPH. Group means of PPH could be reproduced without significant changes in their values, but the within-subject reproducibility of the PP changes was low. There were no differences in PPH according to the place of residence of the patients. In conclusion, the descriptive analysis of the meal-induced changes in ABPM in elderly subjects with ISH showed that in every day circumstances most of them experience falls in both SBP and DBP within 2 h after the meal.

Ambulatory Blood Pressure Monitoring in Insulin-Dependent Diabetes Mellitus Adolescents With and Without Microalbuminuria

The aim of our study was to compare ambulatory blood pressure monitoring (ABPM) measures (mean systolic/diastolic blood pressure, diurnal rhythm, and pressure burden) in matched normo- and microalbuminuric (IDDM) adolescents and healthy controls. Twenty-four hour monitoring was undertaken in 39 normotensive (normal clinic blood pressure measurements) IDDM adolescents (22 normo- and 17 microalbuminuric subjects) and 23 controls. Subjects were matched for age, body-mass index, gender, and IDDM duration. Microalbuminuria was diagnosed on the basis of a urinary albumin excretion rate greater than 15 but less than 200 μg/min in two of the three 24-h urine collections. The microalbuminuric patients differed from the normoalbuminuric subjects and controls in having higher mean 24-h and overnight systolic pressure, loss of systolic diurnal rhythm and increased systolic and diastolic pressure burden. There were no differences between the three groups in diastolic blood pressure. The normoalbuminuric group differed from the controls only with respect to an increased systolic pressure burden. Microalbuminuric IDDM adolescents show similar, albeit milder changes in ABPM, to those reported in adults with microalbuminuria. We postulate that these milder changes represent an earlier phase to that observed in the adult population and that taken together, the adolescent and adult data suggests a specific order in the development of ABPM changes in diabetic subjects.

The efficacy and safety of once-daily nifedipine administered without food: the coat-core formulation compared with the gastrointestinal therapeutic system formulation in patients with mild-to-moderate hypertension

A parallel-group, randomized, double-blind, forced-titration, multicenter study was done to compare the efficacy and safety of once-daily nifedipine coat-core (NIF CC) and once-daily nifedipine gastrointestinal therapeutic system (NIF GITS) dosed in the fasting state in patients with mild-to-moderate essential hypertension. Both formulations have been shown to effectively and safely lower blood pressure in placebo-controlled trials. After a 4-week placebo run-in period, 228 patients were randomized to 4 weeks of treatment with either NIF CC 30 mg daily or NIF GITS 30 mg daily. This period was followed by a forced-titration period to nifedipine 60 mg daily for an additional 4 weeks of double-blind therapy. After the 30-mg treatment period (the primary time point), there were no statistically significant differences between treatment groups in mean change from baseline in trough supine diastolic blood pressure, the primary efficacy variable (NIF CC patients, −7.0 mm Hg; NIF GITS patients, −8.4 mm Hg; P = 0.139). Also, because the upper bound of the treatment difference confidence interval was <3.0 mm Hg, equivalence—as defined in the protocol—was established. After the 60-mg treatment period, the change from baseline in trough supine diastolic blood pressure was significant greater for patients treated with NIF GITS than for patients treated with NIF CC (NIF GITS patients, −12.0 mm Hg; NIF CC patients, −8.4 mm Hg; P < 0.001). Because the upper bound of the confidence interval was >3 mm Hg, equivalence cannot be claimed. No statistically significant differences were noted for the comparison of mean 24-hour ambulatory blood pressure monitoring changes. Both formulations were well tolerated.