Ambulatory Blood Pressure Monitoring Data Research Articles

Ambulatory blood pressure is associated with left ventricular geometry after 10 years in hypertensive patients with continuous antihypertensive treatment.

Both aging and high blood pressure (BP) are associated with a risk of left ventricular concentricity and hypertrophy. We hypothesized that optimal BP management improves left ventricular remodeling beyond aging. Among 558 hypertensive patients on continuous antihypertensive treatment and without concurrent heart disease who were referred to a cardiology clinic with echocardiography and ambulatory BP monitoring data, 142 patients' echocardiographic data was available after 10 years. Baseline BP and changes in left ventricular geometry were evaluated. Mean age at baseline was 71.0 years old. Baseline daytime BP was 129.9/72.4 ± 17.1/10.2 mmHg and nighttime BP was 122.5/67.1 ± 16.9/9.1 mmHg. After 10 years, left ventricular mass index (LVMI) and relative wall thickness (RWT) significantly decreased from 104.5 ± 26.3 to 97.9 ± 26.4 g/m2, p = 0.003 and 0.51 ± 0.09 to 0.47 ± 0.09, p < 0.001, consecutively. Among patients with hypertrophic geometry at baseline, 17.2% reverted to normal geometry at follow-up. Daytime systolic BP (136.9 ± 18.5 mmHg vs 126.2 ± 16.5 mmHg, p = 0.03), nighttime systolic BP (126.2 ± 17.7 mmHg vs 116.3 ± 16.0 mmHg, p = 0.038) and daytime pulse pressure (63.5 ± 17.3 mmHg vs 53.1 ± 14.9 mmHg, p = 0.022) at baseline were higher in patients who remained hypertrophic than those without hypertrophy at follow-up. On logistic regression analysis, daytime, nighttime systolic BP, and daytime pulse pressure were significantly related to the regression of hypertrophy adjusted for age, sex, eGFR, BMI, LVMI, and RWT at baseline. For conclusion, antihypertensive treatment for 10 years improved LV geometry despite aging. Ambulatory BP and pulse pressure at baseline predicted the change of LV geometry after 10 years.

Hemodynamic phenotypes in chronic kidney disease patients based on linear regression of blood pressure parameters.

Classic and non-classic cardiovascular (CV) risk factors accumulate in chronic kidney disease (CKD), contributing to vascular remodeling and hemodynamic abnormalities. This study aimed to determine hemodynamic phenotypes based on linear regression of blood pressure (BP) parameters in stage G3-G4 CKD patients at very high CV risk. 24-h ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) and central BP were obtained from 52 patients (aged 60±11years, BMI 30±6kg/m2) with stage G3-G4 CKD (eGFR 44±12mL/min./1.73m2). Linear BP regression coefficients were generated to determine hemodynamic phenotypes using ABPM data. Coexisting hypertension was present in 45 (86%) patients, out of whom 33 (73%) had BP controlled. 24-h mean systolic/diastolic BP was 128±18/75±12mm Hg. Twenty-six patients demonstrated the harmonious (H) and 26 patients diastolic dysfunctional (D) hemodynamic phenotypes. eGFR was not significantly different between both phenotypes. Compared to phenotype H, patients with phenotype D were older (57±11 vs. 63±10 years, p=.04), had higher PWV (8.2 [7.3-10.3] vs. 9.7 [8.3-10.9]m/s, p=.02), ambulatory arterial stiffness index (AASI) (0.31±0.1 vs. 0.40±0.1, p=.02), systolic BP (128 [122-130] vs. 137 [130-150] mm Hg, p=.001) and systolic BP variability (BPV) (11.7±2.3 vs. 15.7±3.4mm Hg, p<.0001). Our findings suggest that one in two patients with stage G3-G4 CKD demonstrates an unfavorable D hemodynamic phenotype based on a linear regression model, associated with higher PWV, AASI, systolic BP, and systolic BPV. Further studies are required to assess the clinical utility of hemodynamic phenotypes and whether the D phenotype may predict latent circulatory disorders and outcomes.

Blood pressure variability in elderly and senior hypertensive patients

Background. In recent years the deterioration of the demographic situation has been noted in most countries of the world that is due to the steady increase in population of arterial hypertension and the aging of the population. According to the statistical forecast of the UN by 2025, the number of people over 60 will exceed 1 billion which is 15% of the entire global population. In Ukraine, according to epidemiological studies, the prevalence of hypertension among circulatory system diseases in adults (18 years and older) is 46.8% and almost half of patients with circulatory system diseases have elevated blood pressure. In patients aged 65 years and older, the prevalence of hypertension varies in the range of 53-72%. It has long been proven that the risk of cardiovascular and cerebrovascular complications in hypertensive patients depends not only on the absolute blood pressure level but also on fluctuations in blood pressure over different periods that is blood pressure variability. Blood pressure is not a static parameter but rather undergoes continuous fluctuations over time due to the interaction between environmental factors and behaviour on the one hand and the internal regulatory mechanisms of the cardiovascular system on the other hand. Elevated blood pressure may indicate cardiovascular dysregulation and itself may be a cardiovascular risk factor associated with increased all-cause mortality and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease and incidence of dementia. Aim. The study aimed to improve the system of prevention and diagnosis of elderly and senior hypertensive patients at the ambulatory-polyclinic stage due to the study of the contribution of blood pressure variability. Materials and methods. The group of examinees was formed taking into account 27 elderly and senile hypertensive patients including those combined with coronary artery disease. For this purpose, ambulatory blood pressure monitoring was used. Results. Systolic blood pressure variability (SD) in hypertensive patients was higher than in the control group (p&lt;0.001). So, during the study, SD was 17.9±7.1 mm Hg. while in the control group 12.1±2.6 mm Hg. The frequency of high blood pressure variability detection in elderly and senile hypertensive patients was 51.9% (n=14). High blood pressure variability compared to low blood pressure variability and control was associated with a more pronounced systolic blood pressure variability (during the active monitoring period), and it was equalled 23.7±5.2 mm Hg compared to 14.8±6.5 mm Hg (p&lt;0.001) and 12.1±2.6 mm Hg. (p&lt;0.001). In elderly and senile hypertensive patients with high and low blood pressure variability, the non-dipper group prevailed over the dipper group in the structure of daily blood pressure rhythm (71.4% vs. 28.6% and 84.6% vs. 15.4% respectively). According to the ambulatory blood pressure monitoring data high blood pressure variability group compared to low blood pressure variability and controls was characterised by higher average values of the number of blood pressure indicators. In the group of high blood pressure variability patients, the average daily systolic blood pressure exceeded the control value by 10% (р&lt;0.05). The daily index of systolic blood pressure in the group of high blood pressure variability patients was 111% higher than in patients with low blood pressure variability (p&lt;0.05). The daily index of diastolic blood pressure in the group of high blood pressure variability patients was 140% higher than in patients with low blood pressure variability (p&lt;0.05). The daily index of average blood pressure in the group of high blood pressure variability patients was 191% higher than in patients with low blood pressure variability (p&lt;0.01). Conclusions. 1. High blood pressure variability has occurred in 16 out of 27 (51.9%) hypertensive elderly and senile patients. 2. The non-dipper group has predominated in the structure of blood pressure diurnal rhythm in elderly and senile hypertensive patients with high and low blood pressure variability patients. _________________________________________________________________________________________ Keywords: arterial hypertension; essential hypertension; blood pressure variability; high blood pressure variability; low blood pressure variability; elderly and senile hypertensive patients

P016 METAPROTEOMICS ANALYSIS IN HEALTHY INDIVIDUALS REVEALS A HIGH CARDIOVASCULAR RISK PROFILE ACROSS BLOOD PRESSURE, DIET, HUMAN AND MICROBIAL PROTEINS

Background/Objective: The gut microbiota is a crucial link between diet and cardiovascular health by producing beneficial metabolites, such as short-chain fatty acids (SCFAs), through fibre fermentation. However, most studies have focused on microbial DNA to infer microbiota function. Here, we employed metaproteomics, a novel method to capture gut human and microbiota protein expression profiles concurrently. We aimed to investigate the crosstalk between gut microbiota, diet, host gut health, and blood pressure (BP). Methods: Mass spectrometry-based metaproteomic analysis was performed on 61 faecal samples with paired ambulatory BP monitoring, food intake (food frequency questionnaire), and demographic data. Results: We identified 21,594 microbial and 1,072 human proteins. Traditional risk factors (age, BMI, sex, BP) explained only ∼10% of the proteome variance. However, unsupervised clustering analysis of both human and microbial proteome revealed two distinct clusters (low-risk and high-risk) with significantly different 24-hour systolic BP (mean±SD, low-risk 116±13mmHg vs high-risk: 126±15mmHg, P=0.016), women prevalence (72.4% vs 40.6%, P=0.025), and diet quality (assessed as Athlete Diet Index, 61.6±6.7 vs 57.8±7.6, P=0.044). In the human proteome, the low-risk group had lower expression of the VEGFA-VEGFR2 signalling pathway and tight junction proteins and higher SCFA production (particularly propionate), suggesting an anti-inflammatory gut environment. In the microbial proteome, the low-risk group had higher activity of inorganic ion transport and metabolism-related proteins, with increased expression of acetate kinase that produces both the SCFAs acetate and propionate, particularly in primary fibre-fermenting bacteria, including Phocaeicola dorei and Blautia wexlerae. Finally, via co-expression networks, we identified profilin-1 (PFN1), which contributes to hypertension and atherosclerosis, as a crucial human protein associated with several bacteria present in the high-risk group. Conclusions: Employing an unsupervised clustering based on human and microbial proteomics, we identified two groups of participants with varying traditional and emerging cardiovascular risk factors. This was explained by complex interactions among diet, gut microbiota, and BP. This underscores the need for sophisticated models to understand multifactorial risk factors for cardiovascular disease.

Abstract 07: Ambulatory Blood Pressure Variability, Progression of Kidney Disease, and Cardiovascular Outcomes in the Chronic Renal Insufficiency Cohort

Background: Visit-to-visit blood pressure variability is strongly associated with adverse kidney and cardiovascular outcomes in a wide range of patient populations. Patients with chronic kidney disease (CKD) have abnormal circadian blood pressure patterns which may affect 24-hour ambulatory blood pressure variability (ABPV). Methods: We used ambulatory blood pressure monitoring (ABPM) data from participants in the Chronic Renal Insufficiency Cohort (CRIC). Blood pressures were obtained every 30 minutes during day and night. We assessed 24-hour, daytime and nighttime systolic ABPV using average real time variability (ARV); the sum of the absolute differences between consecutive BP readings divided by the total number of readings minus one. Cox proportional hazards models were used to evaluate the association of ARV with the development of 50% reduction in eGFR or end stage kidney disease or adverse cardiovascular (CV) events (myocardial infarction, stroke, peripheral artery disease, new atrial fibrillation, and heart failure). Results: There were 1502 CRIC participants included in the analysis of whom 44% were female and mean age was 63 years (standard deviation 10). Anthropometric and clinical factors associated with higher tertile of ARV included older age, higher BMI, higher urine protein to creatinine ratio, lower estimated glomerular filtration rate, diabetes, hypertension, dyslipidemia and atherosclerotic heart disease. In unadjusted Cox proportional hazard models, 24-hour systolic ARV was associated with both adverse kidney (Hazard Ratio [HR] 1.16 95% confidence interval [CI] 1.06-1.27) and CV events (HR 1.35 95%CI 1.22-1.50). However, in adjusted models that included clinical and sociodemographic factors, there were no statistically significant associations of 24-hour systolic ARV with either adverse kidney (HR 1.02, 95%CI 0.91-1.14) or CV events (HR 0.93, 95%CI 0.84 -1.04). Similarly, daytime and nighttime ARV were not statistically significantly associated with kidney and CV events in adjusted analyses. Conclusions: In a large cohort of patients with CKD, ABPV was not associated with adverse kidney and CV outcomes in adjusted models. Thus, in the context of the many cardiometabolic risk factors present in patients with CKD, ABPV is not an independent mechanism of adverse clinical outcomes in this high-risk population.

O105 ISOLATED NOCTURNAL HYPERTENSION AND TARGET ORGAN INJURY IN YOUTH

Background and Objective: New American Heart Association (AHA) recommendations in 2022 for pediatric ambulatory blood pressure monitoring (ABPM) established static blood pressure (BP) cutoffs to define hypertension with an optimal sensitivity-specificity balance to best capture target organ injury (TOI). This increased the prevalence of ABPM hypertension, specifically isolated nocturnal hypertension. We utilized ABPM data from the SHIP-AHOY cohort to describe the epidemiology of INH in youth and to evaluate associations between INH and TOI. Methods: We defined INH as wake BP &lt;130/80 mmHg and sleep BP &gt;110/65 mmHg. INH was also evaluated by the 2014 AHA definition: wake BP &lt;95th percentile with sleep BP &gt;95th percentile. Primary outcome was left ventricular hypertrophy (LVH), defined as left ventricular mass index &gt;38.6 g/m2.7. Cardiovascular risk factor (CVRF) scores described the number of risk factors for cardiovascular disease (dyslipidemia, obesity, hypertension by clinic systolic BP, insulin resistance) fro each participant. Logistic regression models assessed the association of INH with LVH, adjusted for age, sex, CVRF score, and ABPM tolerability. Results: Of 397 participants, 77 had INH, mostly (62%) due to elevated systolic BPs only. Median age and height were higher in INH than normotension (16.1 v 15.1 years, P=0.022) (height z-score 1.13 v 0.23, P=0.039). Other characteristics did not differ significantly between groups (Table 1). Estimated glomerular filtration rate was lower in INH. Among those with INH, 27% (N=19/71) had LVH, a greater proportion than found with 2014 definitions (21%, N=7/33). Children with INH had 2.61-fold adjusted odds of LVH compared to normotension (95%CI [1.20,5.69], P=0.016). Conclusions: Over 20% of the SHIP-AHOY cohort had INH, accounting for &gt;1/3 of hypertension overall. INH was associated with older age and taller height, mostly due to systolic BP. Compared to 2014 guidelines, the 2022 definition of INH captured a higher prevalence of LVH. INH was independently associated with increased odds of LVH. Future studies should follow children with INH longitudinally for potential development of daytime hypertension. Table 1: Demographic, Anthropomorphic, and Clinical Characteristics of Isolated Nocturnal Hypertension vs Normotension

P006 AGE-RELATED DIFFERENCES IN PULSE PRESSURE AND AMBULATORY ARTERIAL STIFFNESS INDEX MEASURED BY AMBULATORY BLOOD PRESSURE MONITORING

Background: Hypertension is a prevalent public health concern, particularly affecting older adults. Beyond optimal blood pressure (BP) control, ambulatory blood pressure monitoring (ABPM) offers valuable insights into additional cardiovascular parameters like pulse pressure (PP), arterial stiffness index (AASI), and heart rate (HR). Studies have shown that PP correlates with systolic blood pressure and predicts cardiovascular mortality in older adults (1). Furthermore, AASI, a readily measured indirect marker of arterial stiffness, has demonstrated predictive power for cardiovascular mortality (2). Objective: This study investigates the differences in PP, AASI, and HR measured through ABPM across age groups (younger than 50 years, 50-65 years, and over 65 years) and between genders. Methods: This cross-sectional descriptive study analyzed ABPM data collected between 2018 and 2024 from a cardiovascular institution in Colombia. Mean systolic and diastolic BP, heart rate, AASI, and PP were evaluated based on age and sex. Normality testing was performed using the Kolmogorov-Smirnov test. For continuous variables, parametric ANOVA tests compared values across age groups. Categorical variables were analyzed using Chi-square tests. Results: A total of 150 patients participated in the study, with females comprising 76 (50.7%) of the group. The age distribution was: 23.3% younger than 50 years, 41.3% between 50-65 years, and 34.0% over 65 years old. Significant differences were found in diastolic BP, PP, AASI, and HR between the age groups. Importantly, no significant differences were observed in these measures based on gender, nor in systolic BP by age or sex. Conclusions: Our findings align with previous research, demonstrating an increase in PP and AASI with advancing age. Given its widespread availability, ABPM offers a valuable tool. Incorporating additional parameters like PP and AASI provides further information potentially linked to cardiovascular mortality risk. 1. Glynn RJ et al. Pulse Pressure and Mortality in Older People. Arch Intern Med. 2000;160(18):2765–2772. 2. Li, Y. et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension, 47(3), 359–364.

Structural And Functional State Of Various Zones Of Skin Microcirculation In Men With Isolated Diastolic Hypertension

The objective of our study was to assess the structural and functional characteristics of various skin microcirculation zones in men with newly diagnosed isolated diastolic hypertension (IDH). Material and Methods — Our study sample included 275 men (aged 30 to 60 years) subjected to the comprehensive medical examination, which included blood tests, videocapillaroscopy (VCS) on the left ring finger, laser Doppler flowmetry (LDF) in the skin of the middle finger tip and forearm at rest, functional tests and photoplethysmography (PPG) on the left forefinger, determination of flow-mediated vasodilation of the brachial artery, echocardiography, ultrasound imaging of extracranial and femoral arteries, and also 24-hour ambulatory blood pressure monitoring (ABPM). According to the ABPM data, an isolated increase in diastolic blood pressure (BP) was noted in 83 subjects who formed the IDH group. The control group (CG) consisted of 90 men with normal BP. Results — VCS and LDF revealed no significant differences between the groups at the scale of capillaries and precapillary arterioles. According to PPG, IDH subjects had significantly higher values of reflection index vs. the CG (35.6% vs. 30.4%, p=0.0013) and lower values of ejection duration (310.5 ms and 319.5 ms, p=0.0159), respectively. Conclusion — The greatest contribution to peripheral vascular resistance in men with IDH most likely comes from large muscle arterioles, in which neurogenic regulation of vascular tone prevails.

Sleep Duration and Blood Pressure in Youth Referred for Elevated Blood Pressure Evaluation.

Sleep promotion is not specifically recommended as a target for hypertension management. We examined associations of sleep duration and timing with blood pressure parameters in patients referred to pediatric nephrology clinic for elevated blood pressure evaluation. This is a retrospective study of initial ambulatory blood pressure monitoring data and self-report sleep data collected from patients referred to nephrology clinic for the evaluation of elevated blood pressure. Linear and logistic regression modeling determined associations between sleep exposures (duration and timing) and continuous and dichotomous blood pressure outcomes, respectively, adjusted for age, sex, body mass index, and weekday versus weekend status. The study sample included 539 patients with mean age 14.6 years and 56% meeting hypertension criteria. Sleep duration averaged 9.1 hours per night. Average timing of sleep onset and offset were 11:06 pm and 8:18 am, respectively. Longer sleep duration was associated with better daytime blood pressure parameters (eg, every extra hour of sleep duration was associated with a reduced odds of wake hypertension [odds ratio, 0.88; 95% CI, 0.79-0.99]). Later sleep onset was associated with worse daytime blood pressure parameters (eg, each additional hour of later sleep onset was associated with higher wake systolic blood pressure index [mean wake blood pressure/95th percentile]) (β = 0.07; 95% CI, 0.02-0.13). Associations were consistent across sex, age, body mass index, and weekday status. Longer sleep duration and earlier sleep onset were associated with lower blood pressure. This suggests that sleep optimization may be an important target for intervention in hypertension management.

The impact of the COVID-19 pandemic on blood pressure control in patients with treated hypertension-results of the European Society of Hypertension Study (ESH ABPM COVID-19 Study).

We aimed to determine the influence of coronavirus disease 2019 (COVID-19) pandemic on blood pressure (BP) control assessed by ambulatory blood pressure monitoring (ABPM). Office BP and ABPM data from two visits conducted within a 9-15 months interval were collected from patients treated for hypertension. In the prepandemic group, both visits took place before, while in the pandemic group, Visit-1 was done before and Visit-2 during the pandemic period. Of 1811 collected patients 191 were excluded because they did not meet the required ABPM time frames. Thus, the study comprised 704 patients from the pandemic and 916 from the prepandemic group. Groups did not differ in sex, age, duration of hypertension, frequency of first line antihypertensive drug use and mean 24 h BP on Visit-1. The prevalence of sustained uncontrolled hypertension was similar in both groups. On Visit-2 mean 24 h BP, daytime and nighttime systolic BP and diastolic BP were higher in the pandemic compared to the prepandemic group (P < 0.034). The prevalence of sustained uncontrolled hypertension on Visit-2 was higher in the pandemic than in the prepandemic group [0.29 (95% confidence interval (95% CI): 0.26-0.33) vs. 0.25 (95% CI: 0.22-0.28), P < 0.037]. In multivariable adjusted analyses a significant difference in BP visit-to-visit change was observed, with a more profound decline in BP between visits in the prepandemic group. This study using ABPM indicates a negative impact of the COVID-19 pandemic on BP control. It emphasizes the need of developing strategies to maintain BP control during a pandemic such as the one induced by COVID-19.

Nighttime Blood Pressure Abnormalities in Iranian CKD Patients: Necessity to Perform Ambulatory Blood Pressure Monitoring.

Ambulatory blood pressure monitoring (ABPM) is a valuable tool for detecting abnormalities in nighttime blood pressure (BP), including non-dipping and nighttime hypertension. These abnormalities are independent predictors of a poor prognosis in patients with chronic kidney disease (CKD). The aim of our study was to analyze ABPM data and evaluate nighttime BP abnormalities in an Iranian CKD population. This cross-sectional study was conducted on sixty two patients at stages III and IV of CKD who were referred to a nephrology clinic in Tehran, Iran. The patients were classified as either dippers (19.4%) or non-dippers (80.6%), as well as nighttime normotensives (38.7%) or hypertensives (61.3%), based on ABPM data and in accordance with 2023 ESC/ESH guidelines. We compared demographic data, estimated glomerular filtration rate (eGFR), and daytime BP levels among these groups. The mean age of patients was 56.34 years, with 61.1% of them being male. Daytime pulse pressure was significantly greater in non-dippers compared to dippers (52.67 vs. 44 mmHg, P = .02). We found a significant correlation between the extent of BP dipping and eGFR (R = 0.281, P = .02). Systolic and diastolic daytime BP levels were significantly higher in individuals with nighttime hypertension. Diabetic patients were more likely to be non-dippers and have nighttime hypertension. After adjusting for age, diabetes mellitus, and daytime pulse pressure in a multivariable model, we determined that eGFR independently predicted the extent of BP dipping. Our results showed that both non-dipping and nighttime hypertension are highly prevalent in CKD patients, but they have distinct contributing factors. The eGFR was identified as an independent predictor of BP dipping, whereas nighttime BP levels were primarily determined by daytime BP levels. DOI: 10.52547/ijkd.7559.

AN UPDATED REPORT FROM THE HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY

Objective: Ambulatory blood pressure monitoring (ABPM) is recommended by current European guidelines for the early diagnosis of hypertension and to monitor the efficacy of antihypertensive treatments. The Hungarian Society of Hypertension has initiated a 5-year, nationwide program in 2021 to promote the routine use of ABPM and to improve the motivation of doctors and patients. This is an updated report on the Hungarian ABPM Registry. Design and method: This is an ongoing, multicenter, open-label, observational study. Adult (age &gt;18 years) patients with known hypertension(HT), or with suspected/newly diagnosed hypertension(nHT) can be involved in the study. ABPM monitoring is performed by GPs, internists, and cardiologists using validated Meditech ABPM-06 monitors. Current report analyzed ABPM data between 21.02.2021-16.11.2023, that were collected into an electronic case report. Overall, 40621 ABPMs were performed, due to protocol deviation 1901 patients were excluded from the analysis. Results: 26315 patients were HTs(68.3%), 12193 patients were nHTs(31.5%). In the HT group 95.5%, in the nHT group 21.5% were treated. 63.6% of all patients were hypertensives according to the 24-hour average blood pressure(BP) values. Mean 24-hour systolic and diastolic BP was 133.84±14.5 mmHg and 79.2±10.3 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between HT and nHT patients (133.75±13.96mmHg vs. 133.86±14.72mmHg, respectively, p=NS). Obesity(BMI &gt;30 kg/m2) increased the risk of hypertension(OR=1.82[1.73;1.92]for 24-hour average). Coffee consumption(more than 3/day)(OR=1.22[1.16;1.29]for 24-hour average), snoring(OR=1.39[1.33;1.46]for 24-hour average)and smoking(OR=1.10[1.03;1.18]for 24-hour average)all increased the risk of hypertension, primarily affecting more the daytime BP values(OR=1.24[1.18;1.31]for daytime in coffee consumption, OR=1.13[1.07;1.19]for nighttime in coffee consumption; OR=1.42[1.36;1.49]for daytime in snoring, OR=1.31[1.25;1.38]for nighttime in snoring; OR=1.09[1.01;1.16]for daytime in smoking, OR=1.01[0.94;1.08]for nighttime in smoking (NS)). Lack of regular sport(less than 3x30 minutes weekly)increased the risk of hypertension(OR=1.11[1.05;1.18]for 24-hour average), primarily affecting more the nighttime values(OR=1.19[1.12;1.26]for nighttime, OR= 1.02[0.96;1.07]for daytime(NS)). Conclusions: Hypertension is highly prevalent in both HT and nHT patients, irrespectively of gender or treatment. Obesity, lack of regular sport, coffee consumption, snoring and smoking are all significant risk factors in developing hypertension, latter ones affecting more the daytime BP values, whereas lack of regular sport affects more the nighttime BP values.

Control of blood pressure in hypertensive children and adolescents assessed by ambulatory blood pressure monitoring

BackgroundThere have been few studies evaluating the control of hypertension (HT) in children. This study aimed to assess the control of HT using ambulatory blood pressure monitoring (ABPM) and to compare the parameters between the uncontrolled HT and controlled HT groups.MethodsHypertensive patients aged ≥ 5 years who underwent ABPM to assess the control of HT were enrolled. Demographics, office blood pressure (BP), ABPM, and echocardiographic data were collected. Controlled HT was defined using a BP goal recommended by the 2016 European Society of Hypertension guidelines.ResultsThere were 108 patients (64.8% males) with a mean age of 14.3 years and 51.9% had primary HT. Controlled HT was detected in 41.1% and 33.3% by office BP and ABPM, respectively. Based on ABPM, there was a greater prevalence of controlled HT in the primary HT than the secondary HT group (44.6% vs. 21.2%, P = 0.01). In the primary HT group, BMI z-score at the last follow-up had a significant decrease in the controlled HT than the uncontrolled HT group (-0.39 vs. 0.01, P = 0.032). Primary HT was negatively associated with uncontrolled HT by ABPM. In addition, ABPM showed greater sensitivity (77.8% vs. 55.8%) and negative predictive value (80.9% vs. 70.8%) to predict LVH than those of office BP measurement.ConclusionOnly one-third of patients achieved the BP goal by ABPM and most were in the primary HT group. Weight reduction is an important measure of BP control in patients with primary HT to attenuate the risk of LVH.

Assessment of arterial rigidity and daily profile of arterial pressure in women with newly detected breast cancer

Research objective: to evaluate arterial stiff ness indicators and its correlation with parameters of 24-hour ambulatory blood pressure monitoring (ABPM) in women with newly diagnosed breast cancer (BC).Material and methods: a prospective cohort study in 158 women aged 27 to 64 years with a median age of 45.4 years and newly diagnosed BC at stage IIA–IIIB before chemotherapy was conducted. The first group included 109 patients with normal or high-normal office blood pressure (BP), and the second group included 49 women with previously diagnosed stage 1– 2 essential hypertension (EH) with low or moderate cardiovascular risk. All patients underwent indirect arteriography and ABPM. Results. According to ABPM data, “masked” arterial hypertension (MAH) was diagnosed in 54 (49.5%) women in the fi rst group. In patients with MAH, the mean daily level and diastolic BP time index exceeded the corresponding indicators in EH, and the magnitude of the morning rise in systolic BP was significantly lower. In 35.4% of the examined patients with EH, the pulse wave velocity (PWV) was increased, and in 17.4% it was pathological. With MAH, these changes were recorded in 28.5% and 14.1% of cases, respectively. The odds ratio showed that in women with normal BP, the probability of an increase in PWV &gt;10 m/s increased by 1.6 times, and in the presence of comorbidity with MAH and EH, it increased by 2.2 and 2.4 times, respectively. The risk of an increase in central systolic BP &gt;125 mm Hg and pulse BP &gt;60 mm Hg was highest in patients with EH.Conclusion: Among young and middle-aged women with newly diagnosed BC, a significant number of cases of MAH and EH are detected, which determines the need to evaluate arterial stiff ness and daily BP profiles before starting antitumor therapy.

Retracted: A Joint Model for Unbalanced Nested Repeated Measures with Informative Drop-Out Applied to Ambulatory Blood Pressure Monitoring Data.

[This retracts the article DOI: 10.1155/2022/4452158.].

Assessing Machine Learning for Diagnostic Classification of Hypertension Types Identified by Ambulatory Blood Pressure Monitoring

BackgroundInaccurate blood pressure (BP) classification results in inappropriate treatment. We tested whether machine learning (ML), using routine clinical data, can serve as a reliable alternative to ambulatory BP monitoring (ABPM) in classifying BP status. MethodsThis study employed a multicentre approach involving 3 derivation cohorts from Glasgow, Gdańsk, and Birmingham, and a fourth independent evaluation cohort. ML models were trained using office BP, ABPM, and clinical, laboratory, and demographic data, collected from patients referred for hypertension assessment. Seven ML algorithms were trained to classify patients into 5 groups, named as follows: Normal/Target; Hypertension-Masked; Normal/Target-White-Coat (WC); Hypertension-WC; and Hypertension. The 10-year cardiovascular outcomes and 27-year all-cause mortality risks were calculated for the ML-derived groups using the Cox proportional hazards model. ResultsOverall, extreme gradient boosting (using XGBoost open source software) showed the highest area under the receiver operating characteristic curve of 0.85-0.88 across derivation cohorts, Glasgow (n = 923; 43% female; age 50.7 ± 16.3 years), Gdańsk (n = 709; 46% female; age 54.4 ± 13 years), and Birmingham (n = 1222; 56% female; age 55.7 ± 14 years). But accuracy (0.57-0.72) and F1 (harmonic mean of precision and recall) scores (0.57-0.69) were low across the 3 patient cohorts. The evaluation cohort (n = 6213; 51% female; age 51.2 ± 10.8 years) indicated elevated 10-year risks of composite cardiovascular events in the Normal/Target-WC and the Hypertension-WC groups, with heightened 27-year all-cause mortality observed in all groups, except the Hypertension-Masked group, compared to the Normal/Target group. ConclusionsML has limited potential in accurate BP classification when ABPM is unavailable. Larger studies including diverse patient groups and different resource settings are warranted.

Effect of Body Composition on Graft Function and Cardiovascular Outcomes in Normotensive Renal Transplant Recipients.

We evaluated the effects of body composition on graft function and cardiovascular outcomes in normotensive renal transplant recipients. In this cross-sectional study, we analyzed ambulatory blood pressure monitoring data from 136 renal transplant recipients with stable allograft function after living related donor transplant. We enrolled 87 normotensive recipients. We analyzed left ventricular mass index, renal resistive index, and body composition of recipients. We divided recipients into 2 groups according to mean lean body mass, defined by bioimpedance analysis, with 38 in group 1 (lean body mass <47 kg) and 49 in group 2 (lean body mass ≥47 kg). Mean time posttransplant was 35.0 ± 23.3 months. Mean renal resistive index, left ventricular mass index, lean body mass, body mass index, and fat mass were 0.67 ± 0.1, 195.0 ± 118.5 g/m2, 47.3 ± 9.1 kg, 25.9 ± 5.0 kg, and 44.6±10.5 kg,respectively. Lean body mass was positively correlated to sex (r = 0.36, P = .03), body mass index (r = 0.04, P = .416),renalresistive index (r = 0.495, P = .01), and left ventricular mass index (r = 0.713, P = .02) but negatively correlated to serum albumin levels (r=-0.343, P=0.04). Lean body mass was significantly higher in males than in females (P = .03). Patients in group 2 had significantly higher left ventricular mass index (P = .01) and renal resistive index (P = .03). In multiple regression analysis, lean body mass (P = .01) and left ventricular mass index (P = .01) were predictors of renal resistive index. Lean body mass significantly influences left ventricular mass index and renal resistive index. Hence, body composition analysis could be an early predictor of graft function and cardiovascular outcomes in normotensive renal transplant recipients.

GENETIC VARIANTS ASSOCIATED WITH BLOOD PRESSURE PHENOTYPES IN OLDER ADULTS

Abstract African Americans (AAs) suffer from higher rates of uncontrolled HTN even when receiving commonly prescribed classes of antihypertensive medications. Variation in blood pressure (BP) in older adults is known to be associated with a variety of cardiovascular endpoints, yet our understanding of underlying mechanisms is limited. This study aimed to determine if HTN genetic variants influence blood pressure variation within a population of AA older adults taking antihypertensives. Community-dwelling older adults from the Translational Approaches to Personalized Health (TAPH) cohort were recruited to enroll in a 24-hour ambulatory BP monitoring (ABPM) phenotyping study. The Quant Studio 12-K Flex system was used for genotyping participants for three previously established CACNA1C and CACNB2 genetic risk alleles (rs758173, rs2228645, and rs2357790). 69 participants had ABPM data that passed the minimum 80% successful readings threshold: age=68□6, Female=50.3%, Black=73%, White=21%, and Other=6%. ABPM revealed 50.7% controlled HTN, 27.5% Sustained uncontrolled HTN, 14.5 % White coat uncontrolled HTN and 7.2% Masked uncontrolled HTN. ANOVA and Linear regression models found that the CACNB2 genetic risk allele rs2228645 broadly impacts ABPM Phenotypes (C/C SBP= 120.8+/-12.9 mmHg, C/T SBP= 125.73+/-13.5, and T/T SBP= 140+/-34.8 mmHg, p=0.011), mean awake 24-hour SBP (C/C SBP= 124+/-12.7 mmHg, C/T SBP= 133.5+/-14.8, and T/T SBP= 143.7+/-25.6 mmHg, p=0.012), and mean sleep SBP (C/C SBP= 114+/-16 mmHg, C/T SBP= 125.4+/-15, and T/T SBP= 136+/-50 mmHg, p=0.024). CACNA1C and CACNB2 genetic variants influence blood pressure phenotypes in older AAs. Determining genetic variants that affect antihypertensive effectiveness could lead to improved antihypertensive therapy for individuals with HTN/CVD.

Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics

ABSTRACT The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan–Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.

Sleep Variability, Sleep Irregularity, and Nighttime Blood Pressure Dipping.

Circadian rhythm regulates many important biological functions in humans. The goal of this study is to explore the impact of day-to-day deviations in the sleep-wake cycle on nighttime blood pressure (BP) dipping and further examine whether the ethnic difference in day-to-day deviations in sleep patterns can explain the ethnic difference in nighttime BP dipping. Twenty-four-hour ambulatory BP monitoring and 7-day accelerometer data were obtained from 365 adult participants (age range, 18.7-50.1 years; 52.6% Black participants and 47.3% European Americans; 64.1% females). Systolic BP dipping level was used to represent nighttime BP dipping. The SD of sleep duration was calculated as the index of sleep variability, and the SD of sleep midpoint was calculated as the index of sleep irregularity. A 1-hour increase in the SD of sleep midpoint was associated with a 1.16% decrease in nighttime BP dipping (P<0.001). A 1-hour increase in the SD of sleep duration was associated with a 1.39% decrease in nighttime BP dipping (P=0.017). The ethnic difference in the SD of sleep midpoint can explain 29.2% of the ethnicity difference in BP dipping (P=0.008). Sleep variability and sleep irregularity are associated with blunted BP dipping in the general population. In addition, data from the present investigation also demonstrate that the ethnic difference in sleep irregularity could partly explain the ethnic difference in BP dipping, an important finding that may help reduce the health disparity between Black participants and European Americans.