Ambulatory Blood Pressure Monitoring Criteria Research Articles

Abstract 11584: Prevalence of Isolated Nocturnal Hypertension in Adolescents with Use of Adult Hypertension Criteria

Introduction: The 2017 Blood Pressure Guidelines aligned clinic hypertensive thresholds for children ≥13 years of age with adult BP criteria, increasing the predictive value for adverse cardiovascular outcomes. However, thresholds for adolescents have not been updated for ambulatory blood pressure monitoring (ABPM), a confirmatory test in the diagnosis of hypertension. We examined the impact of using adult ABPM criteria in adolescents, including the contribution of daytime (DH) and isolated nocturnal hypertension (INH), and associations with left ventricular hypertrophy (LVH). Methods: This retrospective study included all ABPMs obtained in 13–16-year-olds at Boston Children’s Hospital (2015-2020). ABPMs were interpreted using both pediatric and adult thresholds. For studies newly classified as hypertensive using adult criteria, available echocardiograms were reviewed for LVH. Independent T-test and Chi-square were used to compare age, gender, BMI, left ventricular mass (LVM), indexed LVM >95 th percentile, and LVM z-score >2 in individuals with INH vs. DH. Results: 347 ABPMs were included in this study; 92 studies (87 unique patients) were reclassified as hypertensive using adult thresholds; 96.7% of these studies were obtained in males. Of the 92 studies, 31 (33.7%) studies had INH and 58 (63.0%) had DH (54/58 had day & night hypertension). There was no difference in age or BMI between INH and DH groups; more studies in the INH group were from females (p=0.05). We reviewed 14 and 42 echocardiograms for the INH and DH groups, respectively. There were no differences in indexed LVM or LVM z-score between the 2 groups. Though a small sample size, we found that 3/14 (21.4%) and 12/42 (28.6%) in the INH and DH groups respectively had an indexed LVM >95 th percentile; there was no significant difference between groups (p=0.601). An LV mass z-score > 2 was not seen in the INH group and was in 4/42 (9.5%) of the DH group. Conclusions: With use of adult ABPM criteria, INH significantly contributed to ABPMs reclassified as hypertensive. Prevalence of LVH was similar in INH and DH groups. Further study is needed to investigate the appropriateness of using adult thresholds for nocturnal hypertension in adolescents, whose sleep patterns may differ from adult counterparts.

Sex differences in ambulatory blood pressure levels, control, and phenotypes of hypertension in kidney transplant recipients.

Ambulatory blood pressure (BP) control is worse in men compared with women with chronic kidney disease (CKD) and this may partially explain the faster CKD progression in men. This is the first study investigating possible sex differences in prevalence, control and phenotypes of hypertension in kidney transplant recipients (KTRs) with office-BP and 24-h ambulatory BP monitoring (ABPM). This cross-sectional study included 136 male and 69 female stable KTRs who underwent office-BP measurements and 24-h ABPM. Hypertension thresholds for office and ambulatory BP were defined according to the 2017 ACC/AHA and 2021 KDIGO guidelines for KTRs. Age, time from transplantation, eGFR and history of major comorbidities did not differ between groups. Office SBP/DBP levels were insignificantly higher in men than women (130.3 ± 16.3/77.3 ± 9.4 vs. 126.4 ± 17.8/74.9 ± 11.5 mmHg; P = 0.118/0.104) but daytime SBP/DBP was significantly higher in men (128.5 ± 12.1/83.0 ± 8.2 vs. 124.6 ± 11.9/80.3 ± 9.3 mmHg; P = 0.032/P = 0.044). No significant between-group differences were detected for night-time BP. The prevalence of hypertension was similar by office-BP criteria (93.4 vs. 91.3%; P = 0.589), but higher in men than women with ABPM (100 vs. 95.7%; P = 0.014). The use of ACEIs/ARBs and CCBs was more common in men. Office-BP control was similar (43.3 vs. 44.4%, P = 0.882), but 24-h control was significantly lower in men than women (16.9 vs. 30.3%; P = 0.029). White-coat hypertension was similar (5.1 vs. 7.6%; P = 0.493), whereas masked hypertension was insignificantly more prevalent in men than women (35.3 vs. 24.2%; P = 0.113). BP levels, hypertension prevalence and control are similar by office criteria but significantly different by ABPM criteria between male and female KTRs. Worse ambulatory BP control in male compared with female KTRs may interfere with renal and cardiovascular outcomes.

Comparison of Pediatric and Adult Ambulatory Blood Pressure Monitoring Criteria for the Diagnosis of Hypertension and Detection of Left Ventricular Hypertrophy in Adolescents

To compare pediatric ambulatory blood pressure monitoring (ABPM) criteria with adult ABPM criteria for the diagnosis of hypertension and detection of left ventricular hypertrophy (LVH) in adolescents. ABPM and echocardiography reports from adolescents age 13-21years from 2015 to 2019 were analyzed. The concordance of hypertension based on pediatric criteria (American Heart Association 2014) was compared with adult criteria from American College of Cardiology/American Heart Association 2017 (overall BP≥125/75mm Hg, wake BP≥130/80mm Hg, sleep BP≥110/65mm Hg) using the Cohen kappa statistic. Logistic regression, adjusted for body mass index z score, and receiver operating characteristic curves (ROCs) compared pediatric criteria vs adult criteria in predicting LVH (left ventricular mass index >95th percentile reference values and left ventricular mass index >51g/m2.7). Of 306 adolescents, 140 (45.8%) had hypertension based on pediatric criteria vs 228 (74.5%) based on adult criteria; the agreement was poor (59.3%, n=137, kappa=0.41). A higher prevalence of LVH was captured by adult criteria only (n=91) compared with pediatric criteria only (n=3). Logistic regression found no significant differences between pediatric and adult criteria in the detection of LVH >95th percentile (OR 1.24, CI 0.66, 2.31, P=.51) or >51g/m2.7 (OR 1.06, CI 0.47, 2.40, P=.89). ROCs for pediatric criteria were not significant for detecting LVH >95th percentile (0.50, P=.91) or >51g/m2.7 (0.55, P=.45), whereas the ROC for adult criteria was significant for detecting LVH >95th percentile (0.59, P=.045) but not >51g/m2.7 (0.63, P=.07). Although all individuals with LVH >51g/m2.7 were hypertensive by adult criteria, 8 of these individuals were missed by pediatric criteria. Adult criteria captured a higher prevalence of LVH and appeared to predict better LVH than pediatric criteria. A consideration to align ABPM criteria for diagnosing hypertension in adolescents with adult guidelines is warranted.

Masked uncontrolled hypertension: Prevalence and predictors.

BackgroundThere are limited data on ‘masked uncontrolled hypertension’ (MUCH) in patients with treated and apparently well-controlled BP is unknown.ObjectivesTo define the prevalence and predictors of MUCH among hypertensive patients with controlled office blood pressure.MethodsOne hundred ninety-nine hypertensive patients presented to the specialized hypertension clinics at two University Hospitals. All patients had controlled office blood pressure (less than 140/90 mmHg). Patients were assessed regarding history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24 h, within a week after the index office visit. MUCH was diagnosed if average 24-h ABPM was elevated (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg) despite controlled clinic BP.ResultsSixty-six patients (33.2%) had MUCH according to 24-h ABPM criteria (mean age 53.5 ± 9.3 years, 60.6% men). MUCH was mostly caused by the poor control of nocturnal BP; with the percentage of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that due to daytime BP elevation (57.3% vs. 27.1%, P < 0.001). The most common predictors of MUCH were smoking, DM and positive family history of DM.ConclusionThe prevalence of masked suboptimal BP control is high. Office BP monitoring alone is thus inadequate to ascertain optimal BP control because many patients have an elevated nocturnal BP. ABPM is needed to confirm proper BP control, especially in patients with high cardiovascular risk profile. Smoking, DM and positive family history of DM were the most common predictors of MUCH.

OP.3A.06] PROGRESSIVE DISRUPTION OF AMBULATORY BLOOD PRESSURE REGULATION WITH SEVERITY STAGE OF CHRONIC KIDNEY DISEASE

Objective: Sleep-time hypertension and the non-dipper blood pressure (BP) patterning determined by ambulatory BP monitoring (ABPM) are highly prevalent in chronic kidney disease (CKD), and both factors have been consistently associated with the elevated cardiovascular disease (CVD) risk of such patients. We have assessed the prevalence of these alterations in ambulatory BP regulation as a function of the severity stage of CKD among the participants of the Hygia Project, a research network presently composed of 292 investigators of 40 clinical sites, primarily designed, among other objectives, to evaluate the prognostic value of ABPM to predict CVD risk. Design and method: This cross-sectional investigation involved 7,452 patients with CKD (estimated glomerular filtration rate [eGFR] <60, albuminuria, or both, at least twice within 3 months), 4,325 men/3,127 women, 65.3 ± 13.8 years of age, with BP, according to ABPM criteria, ranging from normotension to sustained hypertension. Ambulatory BP was measured for 48 consecutive hours. Results: There was a highly significant (P < 0.001) progressive increase in the asleep systolic BP (SBP) mean with increasing severity of CKD. The awake SBP mean, however, did not changed consistently throughout the different stages of CKD. Accordingly, the sleep-time relative SBP decline was progressively and significantly (P < 0.001) attenuated towards a more non-dipper BP patterning with diminishing eGFR. Most important, the proportion of patients with the riser BP pattern (asleep SBP mean greater than awake SBP mean) significantly and progressively increased from 5.8% of the participants with stage-1-CKD to a very high 33.7% of the participants with stage-5-CKD. Conclusions: This study, the largest reported so far on CKD patients evaluated by highly-reproducible 48 h ABPM, documents the high prevalence of alteration in sleep-time BP regulation in this condition. Most important, prevalence of the riser BP pattern, associated with highest CVD risk, is also very high, from 20% in stage-3-CKD to 34% in end-stage-renal-disease. Collectively, these findings indicate ABPM should be mandatory for proper CVD risk stratification in CKD, as well as a means to establish the most adequate therapeutic scheme to properly control sleep-time BP and decrease CVD risk.

Nocturnal Hypertension and Altered Night-Day BP Profile and Atherosclerosis in Renal Transplant Patients.

The clinical relevance of ambulatory blood pressure monitoring (ABPM) for risk stratification in renal transplant patients still remains poorly defined. We investigated the association between clinic and ABPM with an established biomarker of atherosclerosis (intima-media thickness [IMT] by echo-color Doppler) in a large, inclusive survey (n = 172) in renal transplant patients at a single institution. Forty-two patients (24%) were classified as hypertensive by ABPM criteria and 29 (17%) by clinic blood pressure (BP) criteria. Average daytime and nighttime BP was 126 ± 12/78 ± 9 mm Hg and 123 ± 13/74 ± 10 mm Hg, respectively. Forty-five patients (26%) were classified as hypertensive by the daytime criterion (>135/85 mm Hg) and a much higher proportion (n = 119, 69%) by the nighttime criterion (>120/70 mm Hg). Sixty-two patients (36%) had a night-day ratio of 1 or greater, indicating clear-cut nondipping. The average nighttime systolic BP (r = 0.24, P = 0.001) and the night-day systolic BP ratio (r = 0.23, P = 0.002) were directly related to IMT, and these associations were much more robust than the 24-hour systolic BP-IMT relationship (r = 0.16, P = 0.04). Average daytime BP and clinic B were unrelated to IMT. In a multiple regression analysis adjusting for confounders, the night-day systolic BP ratio maintained an independent association with IMT (β = 0.14, P = 0.04). In renal transplant patients, the prevalence of nocturnal hypertension by far exceeds the prevalence of hypertension as assessed by clinic, daytime, and 24-hour ABPM. Nighttime systolic BP and the night-day ratio but no other BP metrics are independently associated with IMT. Blood pressure during nighttime may provide unique information for the assessment of cardiovascular risk attributable to BP burden in renal transplant patients.

Blood Pressure Control in Hypertensive Patients, Cardiovascular Risk Profile and the Prevalence of Masked Uncontrolled Hypertension (MUCH).

Introduction:The term masked hypertension (MH) should be used for untreated individuals who have normal office blood pressure but elevated ambulatory blood pressure. For treated patients, this condition should be termed masked uncontrolled hypertension (MUCH).Research Objectives:Masked uncontrolled hypertension (MUCH) has gone unrecognized because few studies have used 24-h ABPM to determine the prevalence of suboptimal BP control in seemingly well-treated patients, and there are few such studies in large cohorts of treated patients attending usual clinical practice. This is important because masked hypertension is associated with a high risk of cardiovascular events. This study was conducted to obtain more information about the association between hypertension and other CV risk factors, about office and ambulatory blood pressure (BP) control as well as on cardiovascular (CV) risk profile in treated hypertensive patients, also to define the prevalence and characteristics of masked uncontrolled hypertension (MUCH) among treated hypertensive patients in routine clinical practice.Patients and methods:In this study 2514 male and female patients were included during a period of 5 years follow up. All patients have ambulatory blood pressure monitoring (ABPM) for at least 24h. We identified patients with treated and controlled BP according to current international guidelines (clinic BP, 140/90mmHg). Cardiovascular risk assessment was based on personal history, clinic BP values, as well as target organ damage evaluation. Masked uncontrolled hypertension (MUCH) was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130mmHg and/or 24-h diastolic BP ≥80mmHg).Results:Patients had a mean age of 60.2+10 years, and the majority of them (94.6%) were followed by specialist physicians. Average clinic BP was 150.4+16/89.9+12 mmHg. About 70% of patients displayed a very high-risk profile. Ambulatory blood pressure monitoring (ABPM) was performed in all recruited patients for at least 24h. Despite the combined medical treatment (78% of the patients), clinic control (<140/90 mmHg) was achieved in only 26.2% of patients, the corresponding control rate for ambulatory BP (<130/80 mmHg) being 32.7%. From 2514 patients with treated BP, we identified 803 with treated and controlled office BP control (<140/90 mmHg), of whom 258 patients (32.1%) had MUCH according to 24-h ABPM criteria (mean age 57.2 years, 54.7% men). The prevalence of MUCH was slightly higher in males, patients with borderline clinic and office BP (130–139/80–89 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension (MUCH) was most often due to poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (22.3 vs. 10.1%, P 0.001).Conclusion:The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. The characteristics of patients with MUCH (male, longer duration of hypertension, obesity, smoking history, and diabetes) indicate that this is a higher-risk group with most to gain from improved BP.

High prevalence of masked uncontrolled hypertension in people with treated hypertension

There are limited data on the quality of treated blood pressure (BP) control during normal daily life, and in particular, the prevalence of 'masked uncontrolled hypertension' (MUCH) in people with treated and seemingly well-controlled BP is unknown. This is important because masked hypertension in 'treatment naïve' patients is associated with a high risk of cardiovascular events. We therefore conducted the first study to define the prevalence and characteristics of MUCH among a large sample of hypertensive patients in routine clinical practice in whom BP was treated and controlled to recommended clinic BP goals. We analysed data from the Spanish Society of Hypertension ambulatory blood pressure monitoring (ABPM) Registry and identified patients with treated and controlled BP according to current international guidelines (clinic BP <140/90 mmHg). Masked uncontrolled hypertension was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130 mmHg and/or 24-h diastolic BP ≥80 mmHg). From 62 788 patients with treated BP in the Spanish registry, we identified 14 840 with treated and controlled clinic BP, of whom 4608 patients (31.1%) had MUCH according to 24-h ABPM criteria (mean age 59.4 years, 59.7% men). The prevalence of MUCH was significantly higher in males, patients with borderline clinic BP (130-9/80-9 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension was most often because of poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (24.3 vs. 12.9%, P < 0.001). The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. Clinic BP monitoring alone is thus inadequate to optimize BP control because many patients have an elevated nocturnal BP. These findings suggest that ABPM should become more routine to confirm BP control, especially in higher risk groups and/or those with borderline control of clinic BP.

Response to Comment on: Hermida et al. Influence of Time of Day of Blood Pressure–Lowering Treatment on Cardiovascular Risk in Hypertensive Patients With Type 2 Diabetes. Diabetes Care 2011;34:1270–1276

We thank Rossen and Hansen (1) for their interest in our article (2). The participants represented a consecutive series of patients fulfilling the exclusion/inclusion criteria who were recruited from those referred to the hospital for evaluation by ambulatory blood pressure monitoring (ABPM) mainly to confirm or reject the diagnosis of hypertension inferred by clinic cuff blood pressure measurement. Diagnosis of hypertension in our trial was based on accepted ABPM criteria, i.e., an awake systolic blood pressure (SBP)/diastolic blood pressure (DBP) mean ≥135/85 mmHg and/or an asleep SBP/DBP mean ≥120/70 mmHg (3). Despite a recommended target goal for clinic SBP/DBP in diabetes of 130/80 mmHg, current guidelines do not provide separate ABPM threshold values for patients with and without diabetes (3). Patients with diabetes in our trial …

Comparison of ambulatory blood pressure and Task Force criteria to identify pediatric hypertension

The aim of this study was to assess the level of agreement between central European ambulatory blood pressure monitoring (ABPM) and American Task Force (TF) criteria when applied to blood pressure (BP) measurements collected by ABPM to evaluate patients with hypertension. In 169 patients, we applied both sets of criteria and calculated mean daytime and nighttime BP and daytime BP loads. The frequency of hypertension for daytime systolic BP was significantly higher when TF criteria were used (p <or= 0.001). However, the frequency of hypertension for nighttime systolic BP was significantly increased when ABPM criteria were applied (p <or= 0.01). Therefore, with daytime ABPM measurements, hypertension was overdiagnosed with TF criteria, while nighttime hypertension was underdiagnosed using TF criteria. In contrast with previous reports, 40% of our patients with essential hypertension showed absence of nighttime dipping, regardless of the criteria used. The number of hypertensive patients was significantly higher using ABPM compared to TF criteria when patients with BP load >or=50% were evaluated (p <or= 0.01). Therefore, current recommendations for ABPM use in children such as to define white coat hypertension or as a screening tool to differentiate between primary and secondary hypertension need to be validated using yet to be produced normative ABPM criteria in American children.

ABPM vs. office blood pressure to define blood pressure control in treated hypertensive paediatric renal transplant recipients

While 24-h ambulatory blood pressure monitoring (ABPM) is an established tool for monitoring antihypertensive therapy in adults, data in children are scarce. We retrospectively analysed whether office blood pressure (BP) is reliable for the diagnosis of BP control in 26 treated hypertensive paediatric renal transplants. Controlled office BP was defined as the mean of three replicate systolic and diastolic BP recordings less than or equal to the 95th age-, sex- and height-matched percentile on the three-outpatient visits closest to ABPM. Controlled ABPM was defined as systolic and diastolic daytime BP < or =95th distribution adjusted height- and sex-related percentile of the adapted ABPM reference. Eight recipients (30%) with controlled office BP were in fact categorized as having non-controlled BP by ABPM criteria. Overall, when office BP and ABPM were compared using the Bland and Altman method, the 95% limits of agreement between office and daytime values ranged from -12.6 to 34.1 mmHg for systolic and -23.9 to 31.7 mmHg for diastolic BP, and the mean difference was 10.7 and 3.9 mmHg respectively. Office readings miss a substantial number of recipients who are hypertensive by ABPM criteria. Undertreatment of hypertension could be avoided if ABPM is applied as an adjunct to office readings.

Measuring the efficacy of antihypertensive therapy by ambulatory blood pressure monitoring in the primary care setting

Traditional clinical trials in hypertension measure the efficacy of antihypertensive drugs but may not fully assess their effectiveness in clinical practice. Community-based trials can provide this information but are limited because usually they are of open-label design and potentially subject to observer bias. Therefore, we used ambulatory blood pressure monitoring (ABPM), an automated and objective measure of blood pressure (BP) to overcome these shortcomings in a large community-based trial. Patients with hypertension, either untreated or currently on treatment, were started on, or switched to, the angiotensin receptor blocker telmisartan 40 mg daily; after 2 weeks, if office BP remained > or = 140/85 mm Hg, the dose was increased to 80 mg, and if necessary, hydrochlorothiazide 12.5 mg was added after a further 4 weeks and continued for the final 4-week period. Baseline and treatment ABPM measurements were completed in 940 previously untreated patients and 675 previously treated patients. The average reduction of the entire cohort was -10.7/-6.5 mm Hg (P < .0001; mean 24-hour BPs were reduced by 12/8 and 8/5 mm Hg in the untreated and previously treated patients, respectively). In contrast, the office BPs fell by an average of 23/12 and 17/10 mm Hg in previously untreated and treated patients. In 401 patients whose baseline 24-hour BP was > or = 130/85 mm Hg, the mean decrease in 24-hour BP was 16.8/11.4 mm Hg. Based on ABPM criteria, the BP was fully controlled (< 130/85 mm Hg) in 70% of patients, and based on office measurement criteria (< 140/90 mm Hg), in 79%. Ambulatory BP monitoring demonstrated excellent control rates by telmisartan monotherapy or in combination with hydrochlorothiazide. Observer and measurement bias was substantial based on the changes from baseline by clinical measurements in contrast to ambulatory BP recordings. The successful use of this procedure in primary care research will create further opportunities to define the effectiveness of treatment in the environment in which it is customarily prescribed.

24-hour blood pressure monitoring in children with chronic renal insufficiency

Hypertension is a frequent complication in children with chronic renal insufficiency (CRI). To better assess hypertension in pediatric patients with CRI we performed 24-hour ambulatory blood pressure monitoring (ABPM) in 19 children, mean age 12.7±4.6 years. BP was measured every 20 minutes during the day and every 30 minutes at night. The median observation time was 24 hours, the mean number of reading was 54±15, and the mean percentage of successful reading was 82±16%. In addition, we evaluated the relationship between ABPM parameters and left ventricular hypertrophy (LVH), the marker of hypertensive end-organ injury. Hypertension was defined as 1) systolic BP (SBP) or diastolic BP (DBP) >95% for age, sex and height and 2) 24-hour SBP load > 35% or 24-hour DBP load > 25%. LVH was defined as left ventricular mass (LVM) index > 95% for age and sex. Nine (47%) patients were taking angiotensin converting enzyme inhibitors (ACEI). SBP or DBP >95% for age, sex and height were found in 5 (26%) patients by either casual BP or ABPM. Mean 24-hour SBP load was 36.1±28.2% and mean 24-hour DBP load was 26.8±22.8%. SBP mean 24-hour, daytime and nighttime load >35% was demonstrated in 8 (42%), 11 (58%) and 9 (47%) patients respectively. DBP mean 24-hour, daytime and nighttime load >25% was seen in 8 (42%), 9 (47%) and 6 (32%) patients respectively. Mean dipping was 7.9±7.8% for SBP and 12.3±9.4% for DBP. Nondipping pattern was found in 10 (53%) patients for SBP and in 5 (26%) patients for DBP. Three children had higher sleep SBP and DBP than awake BP. Lower SBP dipping was associated with lower glomerular filtration rate (r=0.44, p=0.05). LVH was found in 6 (32%) patients. There was no significant relationship between ABPM data and LVM but children with higher mean 24-hour SBP had a tendency to have higher LVM index (r=0.40, p=0.06). No significant difference in ABPM data and LV indexes were found between children on ACEI and without BP medications. These results confirm the high prevalence of hypertension using ABPM criteria in children with CRI. Worse CRI is associated with less of nighttime decline in blood pressure. A higher mean 24-hour SBP may be associated with increased LVM.

Impact of Blood Pressure Control on Prevalence of Left Ventricular Hypertrophy in Treated Hypertensive Patients

Aim: The aim of the present study was to evaluate (1) the prevalence and patterns of left ventricular hypertrophy (LVH) and (2) the impact of blood pressure (BP) control, assessed by clinical and 24-hour ambulatory BP monitoring (ABPM) criteria on the persistence of LVH in a representative sample of treated patients attending our Hypertension Clinic. Methods: One hundred consecutive essential hypertensives (61 m/39 f, age 56± 9 years) regularly followed up by the same medical team (average period 52 months, 12–156 months) were included in the study and underwent 24-hour ABPM and complete echocardiographic examination. Results: Twenty-eight of the 100 patients were found to have LVH [left ventricular mass index (LVMI) >125 g/m² in men and >110 g/m² in women]; LVH was eccentric in 20 patients and concentric in the remaining 8. LVMI did not correlate with clinical BP values but only with ABPM values (mean 24 h systolic r = 0.34, p <0.01; diastolic r = 0.37, p <0.01). The prevalence of LVH in patients controlled according to clinical BP criteria (n = 43, BP <140/90 mm Hg) was 19%, in patients controlled according to ABPM criteria (n = 30, BP during daytime <132/85 mm Hg) 17%, and in those controlled with both criteria (n = 16) 6% (p <0.01). Conclusions: The results of this study suggest that the eccentric type of LVH is the prevalent pattern in chronically treated patients. The persistence of LVH is significantly dependent on BP levels achieved during treatment; indeed the prevalence of LVH is very low in patients with an optimal BP control, whereas it is elevated (37%) in uncontrolled patients.

Antihypertensive effect of isradipine administered once or twice daily on ambulatory blood pressure

The antihypertensive efficacy of sustained-release isradipine administered once daily compared to the immediate-release formulation administered twice daily was assessed by ambulatory blood pressure (BP) monitoring in a double-blind randomized crossover study in 76 mild-to-moderate hypertensive patients. Conventional BP and heart rate parameters were evaluated after a 4-week placebo period and patients qualified for entry if sitting diastolic BP was between 95 and 114 mm Hg. Ambulatory BP monitoring was measured at baseline and after active treatment with both formulations. The 2 regimens induced a significant and almost identical reduction (p < 0.001) in the mean 24-hour BP without affecting heart rate. Isradipine was more effective in patients whose clinical hypertension was confirmed by ambulatory BP monitoring (35) than in patients who remained normotensive by ambulatory BP monitoring criteria (41). The isradipine-treated ambulatory hypertensive group experienced significantly greater decreases in BP during 24-hour, work, awake and sleep periods than did the ambulatory normotensive group. These data suggest that sustained-release isradipine has a sustained antihypertensive effect throughout 24 hours comparable to that of isradipine given twice daily and may improve compliance with long-term treatment. In addition, the results confirm the usefulness of ambulatory BP monitoring in determining truly hypertensive patients likely to respond to drug administration.