Ambulatory Blood Pressure Monitoring Device Research Articles

Validation of the Meditech ABPM-06 24-hour blood pressure monitoring system in a pediatric population according to International Organization for Standardization Protocol 81060-2:2018.

Ambulatory blood pressure monitoring (ABPM) devices play a crucial role in diagnosing hypertension, not only in adults but also in pediatric patients. ABPM-06, the latest oscillometric device from Meditech Ltd. (Budapest, Hungary), is the focus of this study. The objective was to validate the ABPM-06 device using the International Organization for Standardization (ISO) 81060-2 : 2018 standard. A total of 86 healthy patients, consisting of 34 males and 52 females, aged between 3 and 17 years, were enrolled in this study. During the ambulatory phase, a total of 50 patients were enrolled, with 35 patients falling within the 3- to 12-year-old age range and 15 patients aged between 12 and 17 years. Additionally, for the dynamic test, 36 patients were selected, comprising of 10 individuals aged 3-12 years and 26 patients aged 12-17 years. These patients were recruited from the outpatient clinics of the Department of Pediatrics at Albert Szent-Györgyi University in Szeged, Hungary. The validation process involved utilizing the same-arm sequence protocol, both in resting positions and during stress testing. The ABPM-06 performed well in both clinical and ambulatory validations. In terms of validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was -1.3 ± 3.5 mmHg for systolic and -0.1 ± 2.3 mmHg for diastolic, in children under the age of 12 years. For those over the age of 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Regarding the ambulatory validation, for children under 12 years old, the mean ± SD of the differences was -1.3 ± 3.5 mmHg for systolic and -0.1 ± 2.3 mmHg for diastolic. In the age group above 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Both tests successfully met the established criteria regarding the mean and SD values of the differences between the device readings and the observed SBP and DBP measurements. The ABPM-06 oscillometric device fully adheres to the ISO 81060-2 : 2018 standard requirements for ABPM determination in the pediatric population (ages 3-17 years). Consequently, this ABPM device proves to be suitable for effectively managing hypertension in children and adolescents.

Effects of phentermine / topiramate extended-release, phentermine, and placebo on ambulatory blood pressure monitoring in adults with overweight or obesity: A randomized, multicenter, double-blind study

BackgroundA fixed-dose combination of phentermine and extended-release topiramate (PHEN/TPM - approved for weight management) has demonstrated in-clinic reduction of blood pressure (BP). Ambulatory BP monitoring (ABPM) may be a better predictor of cardiovascular disease risk than in-clinic BP. MethodsThis randomized, multicenter, double-blind study enrolled 565 adults with overweight/obesity. Inclusion criteria included participants willing to wear ABPM device for 24 h. Exclusion criteria included screening blood pressure >140/90 mmHg and antihypertensive medications not stable for 3 months prior to randomization. Participants received placebo (n = 184), phentermine 30 mg; (n = 191), or PHEN 15 mg/TPM 92 mg; (n = 190). 24-hour ABPM was performed at baseline and at week 8. The primary endpoint was mean 24-h systolic BP (SBP) as measured by ABPM, in the per protocol population. ResultsParticipants were mostly female (73.5 ​%) and White (81.6 ​%), with a mean age of 53.4 years; 32.4 ​% had no hypertension diagnosis or treatment, 62.5 ​% had hypertension using 0 to 2 antihypertensive medications, and 5.1 ​% had hypertension using ≥ 3 antihypertensive medications. Baseline mean SBP/diastolic BP (DBP) was 123.9/77.6 ​mmHg. At week 8, mean SBP change was −0.1 ​mmHg (placebo), +1.4 ​mmHg (phentermine 30 ​mg), and −3.3 ​mmHg (PHEN/TPM). Between-group difference for PHEN/TPM versus placebo was −3.2 ​mmHg (95 ​% CI: -5.48, -0.93 ​mmHg; p ​= ​0.0059). The between-group difference for PHEN/TPM versus phentermine 30 ​mg was −4.7 ​mmHg (95 ​% CI: −6.96, −2.45 ​mmHg; p ​< ​0.0001). Common (>2 ​% in any treatment group) adverse events (i.e., dry mouth, constipation, nausea, dizziness, paresthesia, dysgeusia, headache, COVID-19, urinary tract infection, insomnia, and anxiety) were mostly mild or moderate. ConclusionsIn this randomized, multicenter, double-blind ABPM study, PHEN/ TPM reduced SBP compared to either placebo or phentermine 30 mg (Funding: Vivus LLC; ClinicalTrials.gov: NCT05215418).

Feasibility and Effectiveness of a Ring-Type Blood Pressure Measurement Device Compared With 24-Hour Ambulatory Blood Pressure Monitoring Device.

This study aimed to evaluate the applicability and precision of a ring-type cuffless blood pressure (BP) measurement device, CART-I Plus, compared to conventional 24-hour ambulatory BP monitoring (ABPM). Forty patients were recruited, and 33 participants were included in the final analysis. Each participant wore both CART-I Plus and ABPM devices on the same arm for approximately 24 hours. BP estimation from CART-I Plus, derived from photoplethysmography (PPG) signals, were compared with the corresponding ABPM measurements. The CART-I Plus recorded systolic blood pressure (SBP)/diastolic blood pressure (DBP) values of 131.4±14.1/81.1±12.0, 132.7±13.9/81.9±11.9, and 128.7±14.6/79.3±12.2 mmHg for 24-hour, daytime, and nighttime periods respectively, compared to ABPM values of 129.7±11.7/84.4±11.2, 131.9±11.6/86.3±11.1, and 124.5±13.6/80.0±12.2 mmHg. Mean differences in SBP/DBP between the two devices were 1.74±6.69/-3.24±6.51 mmHg, 0.75±7.44/-4.41±7.42 mmHg, and 4.15±6.15/-0.67±5.23 mmHg for 24-hour, daytime, and nighttime periods respectively. Strong correlations were also observed between the devices, with r=0.725 and r=0.750 for transitions in SBP and DBP from daytime to nighttime, respectively (both p<0.001). The CART-I Plus device, with its unique ring-type design, shows promising accuracy in BP estimation and offers a potential avenue for continuous BP monitoring in clinical practice. ClinicalTrials.gov Identifier: NCT06084065.

COMPARISON OF BLOOD PRESSURE MEASUREMENT WITH A CUFFLESS TONOMETRIC WRIST-WORN DEVICE AND CONVENTIONAL BRACHIAL CUFF SPHYGMOMANOMETRY FOR AMBULATORY BLOOD PRESSURE MONITORING

Objective: Ambulatory blood pressure monitoring (ABPM) is used for confirmation of diagnosis of hypertension. However, conventional cuff-based blood pressure (BP) measurement involves the obtrusive procedure of cuff inflation, making multiple measurements over extended periods uncomfortable. This study aims to compare BP measurement using the unobtrusive procedure of radial applanation tonometry with that of the conventional brachial cuff sphygmomanometer for ABPM. Design and method: ABPM (24 hour) was conducted in 16 participants (53±14 years, 4 female) using validated brachial cuff devices (Microlife WatchBPO3, n = 6; BPLab, n = 10) with BP measurements every 15 minutes during daytime and every 30 minutes during nighttime. BP measurements were obtained with a wrist-worn tonometric device (BPro, Healthstats) every 15 minutes, using an initial calibration obtained with the ABPM device. Results: Averaged over 24 hours, tonometric BP estimates correlated with brachial cuff systolic BP (SBP, r = 0.89, p&lt;0.001) but not with diastolic BP (DBP, r = 0.48, p = 0.059) with mean differences (bias) of -4±14 mmHg (SBP) and 16±17 mmHg (DBP). Daytime and night-time correlations and mean difference were, day: SBP (r = 0.92, p&lt;0.001), -1±13 mmHg; DBP (r = 0.44, p = 0.089), 18±21 mmHg; night: SBP (r = 0.66, p = 0.007), 6±22 mmHg; DBP (r = 0.64, p = 0.010); 15±13 mmHg. Over 24 hours, the total number of successful readings from the tonometric device was 52% less than that from the brachial cuff devices. The average correlation between SBP and DBP using only cuff readings was 0.29±0.40 (range -0.47 to 0.86). The average correlation between SBP and DBP for the tonometric device was 0.99±0.01 (range 0.97 to 1.00). Conclusions: The cuffless tonometric method employed in the BPro device enables unobtrusive monitoring of BP. In comparison to conventional cuff ABPM devices, the BPro device showed low mean differences for SBP but large differences in DBP in both day and night measurements with consistently low precision. The large differences for DBP may be due to the high correlation between tonometric DBP and SBP, suggesting that waveform features are used for SBP estimation only, from which DBP is directly calculated.

ASSESSING WORKFLOW, SATISFACTION, AND POTENTIAL COST REDUCTION WHEN USING A CUFFLESS AMBULATORY BLOOD PRESSURE MONITOR

Objective: Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring (ABPM) is used for the diagnosis of hypertension, however, currently-used devices have several drawbacks complicating their use and accuracy. We tested the workflow of a wearable photoplethysmography (PPG)-based cuffless device when compared to the traditional cuff-based ABPM device. Design and method: Patients were recruited in a single community clinic and randomly assigned to either a cuff-based or a PPG-based 24-hour ABPM test. An assessment team recorded the time to complete each workflow component with each device. Questionnaires on user experience and workflow were filled by physicians, nurses, and recruited patients. Results: Workflow assessment of onboarding patients showed that it was faster with the PPG-based device than with the cuff-based device (301.17±58.39 seconds vs 1185±172.34 seconds on average, respectively). The PPG-based device received a higher score in all aspects of usability. The direct manpower cost reduction was calculated as 108,000 USD per year for 4,500 tests. Conclusions: The PPG-based device has several advantages when compared to the traditional cuff-based ABPM device, potentially increasing both patient and medical staff satisfaction, and as a result, increasing compliance. This could help improve the diagnosis and treatment of hypertension in the community.

PS-R01-3: TM2441 ABPM AS A PROMPT IN PATIENT WITH DILATED CARDIOMYOPATHY,HYPERTENSION AND ASYMPTOMATIC VENTRICULAR ARRHYTHMIA

38 years old patien male height176sm,weight81 kg was admitted to the ICU of RIC 03.05.2022 with ACS Cor muffled heart sounds, blood pressure of 150,160/110 mm Hg,Ps110 120 beat/min, rhythmic ECG sinus rhythm,p mitrale,moderate positive T wave in V1 two phase T wave in V2 and negative T wave in I V3 V6. TroponinI level 01ng/ml (ref.0 0,3) 04.05.2022 and 0,14ng/ml 05.05.2022. Laboratory tests 04.05.2022 lab.test revealed decreased WBC4,21x10^3/ml, significantly decreased LYM 0,62x10^3/ml,LYM#%14,8%,increased NEUT%76,8%,slitghtly decreased MON#10^3/ml. RBC increased slightly 6,07x10^6/ml, increased RDWCV% 16,4%,MCV decreased72,9fL,MCH23,1pg decreased. PLT was significantly decreased 94x10^3/mL,P LSR was incresed47,3%. CREATININE was high 2,92 mg/dl,urea increased level 79,18 mg/dl,BUN37 mg/dl,AST non significantly slightly increased 55IU/L 04.05.2022. ECHOKG 05.05.2022 LVIDd66 mm,LVIDs53 mm,LVPW12 mm. LVEF35%Left ventricle wall motion abnormalities, diffuse hypo kinesis. Doppler EXOKG Mitral regurgitation II. 06.05.2022. Ultrasound examination no any abnormalities, only left kidney size 128 x 50 was 8 mm longer than normal length. Because of two negative results of troponin I (ACS was excluded) and result of ECHOKG patient transfered to Heart failure department with diagnosis:DCM,Hypertension. Despite of creatinin level of .2,92 mg/dl, previously administered carvedilol 6,125 mg was substitute to ramipril 5 mg/day because of high blood pressure 150/90 mm.Hg. 07.05.2022, TM2441,A&amp;D Company Ambulatory Blood Pressure Monitoring Device were used in this patient. Monitoring revealed non dipping,.despite of daytime systolic and diastolic blood pressure was in normal range, (5)Awake BP: Sleep BP SYS(&gt; 135 mmHg) 0,00% SYS(&gt; 120 mmHg) 16,67% DIA(&gt; 85 mmHg) 16,67% DIA(&gt; 70 mmHg) 83,33% (6) Circadian Rhythm:SBP drop at night 2,27% DBP drop at night 4,73% . Ambulatory blood pressure monitoring by TM 2141 allowed to suspect significant epizodes of arrhythmia. Dissemination of big number of signs of indicators of arrhythmia (IHB and Pulse error) during the monitoring pointed on serious rhythm disorders. After these findings 10.05.2022 Holter ECG were used in this patient.22 hours 26 min ECG monitoring revealed 2 episodes of VT,33 duplet PVC and 434 monomorphic PVC on background on atrial fibrillation. No any episodes of sinus rhythm were revealed. MRTno CHD,no infiltration 18,05.2022 repeat 24 hours ECG monitoring were performed in this patient. Result: During of 23 hours and 47 min.sinus rhythm were observed. No any epizodes of ventricle tachycardia,PVC or SVC were revealed.19.05.2022 6MWT perfomed on discharge day. Result: Patient overcome 420 meters.no any dispnia at stop. BP before start140/97 mm.Hg,PS73 b/min,BP at stop157/98 mm/Hg,PS77b/min, On comparison to previous 6MWT result (performed 11,05.2022) patient walked 47,4meters more. Patient was discharged from hospital 19.05.2022 with diagnosis: Dilated cardiomyopathy (DCM) Heart Failure NYHA III fc,EF33%,VT,AF,Hypertension stage II,high risk,CKD MDRD stage III. 25.05.2022 NTproBNP2608,9pg/ml,Vit D 13,21ng/dl,Ca9 mg/dl,Cr2,21 mg/dl,DImer500ng/ml,Hb11,8 g/dl

PS-C09-5: AUSCULTATORY AND OSCILLOMETRIC AMBULATORY BLOOD PRESSURE MONITORING: METHODS COMPARISON IN ADULT PATIENTS

Background/Introduction: Ambulatory blood pressure monitoring (ABPM) is an out-of-office method of blood pressure (BP) detection in usual patients activities via oscillometric or auscultatory recording devices. Correct measurement is crucial as for diagnosis, as treatment purpose. There are different rules for each method exist, however, they are not respected much for ABPM. The aim of the study was to compare a combined (oscillometric and auscultatory) ABPM device in adult individuals. Methods: One-hundred twenty-two patients had 24-hour clock-based definitions (nighttime: 01:00 to 05:59) ABPM patterns (mean age, 62 [95% CI, 60–63] years, 44% men) performed with a combined (oscillometric and AUSCULTATORY) device. Analyzing reading numbers in awake and night periods (not-valid: &lt; 20 and &lt; 7 readings, respectively) the validity was verified. Arterial hypertension was evaluated according to diurnal ABPM. Results: Twenty-four-hour systolic and diastolic BP were equal using auscultatory and oscillometric monitoring (140.3 and 139.6 mmHg, 77.2 and 79.0, respectively, NS). In hypertensions, 9.5% systolic and 4.0% diastolic BP patterns were outside the limits of agreements according to Bland-Altman analysis. Meanwhile, in normotensive individuals, 6.4% both for systolic and diastolic (for the population, 7.4% systolic and 5.0% diastolic BP). Conclusion: Using the oscillometric and auscultatory methods for ABPM show the same level of diurnal systolic and diastolic BP, but with the hypertension misclassification along with systolic BP rises in adults.

PS-BPR02-3: NOVEL PULSE WAVEFORM INDEX OBTAINED BY ABPM DEVICE COULD ESTIMATE CARDIAC FUNCTION IN A PATIENT WITH FULMINANT MYOCARDITIS

Introduction: In this case report regarding a patient with fulminant myocarditis who underwent mechanical hemodynamic support including extracorporeal membrane oxygenation (ECMO), our developed novel hemodynamic index calculated from pulse waveform obtained by ambulatory blood pressure monitoring (ABPM) device was useful for estimation of the improvement of cardiac function. We obtained volumetric pulse waveform from diastolic phase of BP measurement by our recently developed device, a Multisensor-ABPM device (TM-2441, A&amp;D Co., Tokyo). This pulse waveform is divided into ejection wave and reflex wave. The area of the ejection part is square forward pulse wave (Sf), which is related with cardiac ejection volume. Second, amplitude measured pulse wave (Am) of the pulse waveform is a parameter defined by central artery compliance, peripheral artery properties, and cuff compliance. We then calculated Sf/Am as follows: Sf was divided by Am to eliminate the effect of arterial and cuff compliance from the area of the ejection wave, which would indicate left ventricular ejective function. Case report: A 43-year-old Asian female presented dyspnea and fever and developed cardiogenic shock. She was transferred from the primary hospital to our intensive care unit. Laboratory test and chest x-ray revealed elevated c-reactive protein, creatine kinase MB, and N-terminal-pro-brain natriuretic peptide and pulmonary edema. Electrocardiogram showed an ST-elevation and there was no stenosis in coronary artery on cardiac catheter examination. Based on these findings, she was diagnosed as viral myocarditis. Her echocardiographic left ventricular ejection fraction (LVEF) decreased less than 20% and hemodynamics were disrupted. Then, she was urgently initiated mechanical support including management of ECMO and intraaortic balloon pumping (IABP). During six-days initiating these mechanical supports, her cardiac function was improved, i.e., LVEF was improved from 6% (almost akinesis) to 64%, and she was able to withdraw from ECMO. We prospectively assessed the changes in the cuff waveform index Sf/Am from during the management of ECMO and IABP. The values of Sf/Am increased in parallel with the improved of LVEF (Figure). Conclusion: This case report highlighted that the novel cuff pulse waveform index Sf/Am obtained by the recent our developed Multisensor-ABPM device was useful for estimation of cardiac function in a patient with fulminant myocarditis who had severe cardiac dysfunction and were needed full mechanical support including ECMO. This case indicated that BP measurement device using the cuff-oscillometric method is useful for evaluation of cardiac function even in intensive care settings.

PS-C02-3: GREATER BLOOD PRESSURE VARIABILITY MEASURED BY 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING PREDICTS THE RECURRENCE AFTER ATRIAL FIBRILLATION CATHETER ABLATION

Objective: Atrial fibrillation (AF) is an important prognostic factor even in the general population, and its clinical importance is increasing with the aging of the population. In recent years, catheter ablation (CA) of AF has become a common treatment modality, but recurrence of AF is observed in some patients. Especially, hypertension is an important risk factor for recurrence of AF after CA. Regarding blood pressure measurement, ambulatory blood pressure monitoring (ABPM) is known to provide a better prediction of cardiovascular events compared to conventional clinical BP measurement. However, the association between ambulatory BP variables (BPV) and AF recurrence after CA remains unclear. The purpose pf this study is to identify the association between BPV measured by 24-Hour ABPM device and recurrence after CA for AF. Design and method: All patients were admitted in Osaka metropolitan university hospital to undergo CA of AF, and were measured 24-hour BP monitoring using an ambulatory BP device (Mobil-O-Graph) after CA between August 2017 and April 2021. Twenty four-hour mean peripheral and central systolic/diastolic BP were separately calculated. BPV was calculated as coefficient of variation (standard deviation/mean BP). Results: A total of 107 patients were included in this study. After a median follow-up period of 563 days, AF recurrence was documented in 23 of 107 patients (21.5%). In univariate analysis, patients with AF recurrence tended to have higher age (OR = 1.08, 95%CI = 1.02–1.14, p &lt; 0.01), serum BNP (OR = 1.00, 95%CI = 1.00–1.01, p = 0.01), CHADs2 VASc score (OR = 1.67, 95%CI = 1.22–2.29, p &lt; 0.01), left atrial volume index (OR = 1.07, 95%CI = 1.04–1.10, p &lt; 0.01), E/e’ (OR = 1.11, 95%CI = 1.02–1.21, p = 0.02) than those of non-AF recurrence. In ABPM variables, greater 24-hour mean peripheral and central systolic/diastolic BPV were associated with AF recurrence after CA, whereas any indices of 24-hour mean BP variables were not (Table 1.). Multivariate cox regression analysis after adjustment for relevant variables, 24-hour mean peripheral and central systolic/diastolic BPV were independently associated with AF recurrence after CA (Table 1.). Conclusions: Greater BPV measured by ABPM, either in peripheral or central, were indicated to be predictors of AF recurrence after CA. Our data suggest that BP control to aim at minimizing BPV attenuates the risk of AF recurrence after CA.

The effect of psychological stress and physical activity on ambulatory blood pressure variability detected by a multisensor ambulatory blood pressure monitoring device.

Psychological stress and physical activity contribute to blood pressure (BP) variability, which is a significant and independent risk factor for cardiovascular events. We examined the effects of physical activity level in the 5 min before each BP measurement and psychological stress on ambulatory BP and pulse rate variability in daily life. During a 24 h monitoring period, BP and pulse rate were measured by a multisensor ABPM device (TM-2441; A&D Co.) at 30 min intervals, and physical activity was continuously recorded by an actigraph built into the ABPM device. Psychological stress was assessed from negative emotions or worksite location in the participants' situational information at each BP measurement, which was self-reported on a paper pad immediately (or as soon as possible) after the measurement. A total of 642 ABPM readings with corresponding situational information were obtained from 50 high-risk patients and showed that BP and pulse rate were significantly associated with actigraph-recorded physical activity (increase against the physical-activity-above-walking level: 4.2 ± 2.0 mmHg, p = 0.036 for SBP; 5.4 ± 1.1 bpm, p < 0.001 for pulse rate). When self-reported situational factors were additionally included in the analysis model as variables, negative emotions (7.4 ± 2.5 mmHg, p = 0.003 for SBP) and worksite location (5.8 ± 2.1 mmHg, p = 0.005 for SBP) were significantly associated with BP increase, while the association between BP and physical activity was weakened (p > 0.05). The pulse rate increased against the physical-activity-above-walking level but did not change for negative emotions. In conclusion, the effect of negative emotions on BP was greater than that of physical activity, whereas no similar effect on pulse rate was found. Simultaneous monitoring of BP, pulse rate, and actigraph-recorded physical activity could detect psychological stress-induced BP elevation.

Beneficial effects of celery seed extract (Apium graveolens), as a supplement, on anxiety and depression in hypertensive patients: a randomized clinical trial.

Anxiety and depression are crucial public health issues, affecting the rising in hospitalizations and death. Anxiety and depression can worsen hypertension and vice versa. The current study has investigated the effects of celery seed extract, as a drug supplement, with the active ingredient of 3-n-butylphthalide, on mental problems primarily anxiety and secondary depression in hypertensive patients. The current study was a randomized, triple-blind, placebo-controlled, cross-over, 4-week clinical trial with a 4-week washout period. Fifty hypertensive patients received 4 placebo or celery seed extract capsules (1.34g per day) for 4weeks as a supplement to their usual medication regimen. The blood pressure parameters were assessed using 24-h ambulatory blood pressure monitoring device. Anxiety and depression and their wide range of symptoms were evaluated using Beck anxiety and depression inventories (BAI and BDI). In the celery treatment step, the mean reduction in BAI and BDI scores were 6.78 (P < 0.001) and 3.63 (P < 0.01), respectively. Some symptoms of anxiety including unable to relax, nervousness, numbness, dizziness, flushed face, sweating, and breathing difficulty were significantly improved by celery consumption (P < 0.001). Celery could decrease symptoms of depression such as sadness, crying, loss of energy, insomnia, irritability, fatigue, loss of interest in sex, and punishment feeling (P < 0.01). The mean reduction in blood pressure parameters was also significant during celery therapy (P < 0.001). The psychometric properties of anxiety and depression were investigated and the results were promising. The results indicated the anti-anxiety and anti-depressive properties of celery seed extract as a supplement in hypertensive patients. Registry name: Iranian Registry of Clinical Trials (IRCT), Registration number: IRCT20130418013058N8, Registration link: https://www.irct.ir/trial/30021 . The study was carried out between 2018-09-21 and 2020-07-20.

Effect of Celecoxib and Diclofenac on Blood Pressure, Renal Function and Vasoactive Prostanoids in Young Early Subjects

Objective: Determination of celecoxib and diclofenac effects in early young subjects. Study design: Randomized study designed Methodology: All the participants received celecoxib 225 mg two times/day and diclofenac 80mg two times/day. First 21 days all participants received celecoxib treatment, before the start of the following medicine diclofenac 3.5 weeks gap was given. The blood pressure (BP) of patients was measured using the ambulatory blood pressure monitoring device (space labs model 90217A). Results: Group one consisted of young participants had a mean ± SD age 29 ± 3.4 while group 2 elderly had a mean ± SD age 55 ± 5.5. The mean body mass index was (group 1) 21.7 ± 1.8 kg/m2 and for group 2 = 27.3 ± 1.0 kg/m2. Group one had 5 (38.46%) females and 8 (61.53%) males while group 2 had 4 (30.76%) females and 9 (69.23%) males. The celecoxib medication baseline BP shows that there was no significant difference found in systolic blood pressure. Similar results for diastolic (mm Hg) for day and night time. Mean arterial pressure was higher in the elderly group -2 than in young group 1, Plasma renin activity was less in group 2 on day one compared to group 1. Plasma renin activity and concentration were decreased after 7 days of celecoxib and diclofenac treatment. A non-significant result was obtained. Group 1 Aldosterone serum (ng/l) for celecoxib received patients 11 ± 2.2 (ng/l) value for day one, day 7 = 13.2 ± 3.2, day 14 = 14.2 ± 3.4. Similarly in the case of diclofenac, the Aldosterone serum (ng/l) value for day one = 11.3 ± 21, day 7= 12.2 ± 2.3, and day 14 = 12.3 ± 2.1. A decrease in values was observed in both groups for aldosterone serum. For group-2 celecoxib, day one=15 ± 2.2, day 7= 14 ± 2.4*. day14= 14 ± 1.4. For diclofenac day one 15 ± 2.2, 7day= 15 ± 1.5, and 14 days = 14 ± 5.1. The comparison of both groups shows that the sodium and potassium decrease in both treatments in both groups. Conclusion: Overall, we got a non-significant response of both drugs on renal function and blood pressure. Keywords: blood pressure, renin angiotensin aldosterone system, non-steroidal anti-inflammatory drugs (NSAIDs)

The effect of mountaineering on the association between blood pressure and physical activity: A new multi-sensor ambulatory blood-pressure monitoring device. The Mount Fuji Study.

It has not been fully investigated whether the response of blood pressure (BP) to activity at high altitudes differs from that at low altitudes or how temperature is involved in these differences. The author compared BP response to accelerometer measurements during mountaineering and daily living. In 15 healthy people (mean age 33 ± 6 years), a new multi‐sensor ambulatory BP monitoring (ABPM) device equipped with barometer, thermometer, and accelerometer was used to measure BP responses to activity during a trip to Mt. Fuji and during daily living. Associations between physical activity (log‐transformed 5‐min average values of accelerometer just before each ambulatory BP) and the corresponding BP were obtained from 843 and 676 readings during the Mt. Fuji trip and daily living, respectively. All ambulatory systolic BP (SBP) parameters were significantly higher during the Mt. Fuji trip than during daily living (all p < .01). There were significant positive correlations between physical activity and corresponding BPs in both mountaineering and daily living (all p < .01), and there was an interaction between BPs and physical activity according to the two conditions (p < .01). On Mt. Fuji, multivariate regression analysis showed increased physical activity and lower temperature were associated with increased 24‐h SBP and diastolic BP (DBP) (all p < .05). The goodness‐of‐fit values of the association between activity and 24‐h SBP or DBP were improved by adding temperature to the model of both 24‐h SBP and DBP. However, these associations were not found in the daily living model. BP response to activity was more pronounced during mountaineering than daily living.

RELATIONSHIP OF 24-HOUR AMBULATORY BLOOD PRESSURE VARIABILITY WITH MICRO- AND MACROVASCULAR PARAMETERS AND HYPERTENSION STATUS

Existing evidence shows that increased values of blood pressure variability (BPV) are associated with a higher risk of subclinical organ damage and cardiovascular events, independently of elevated average BP values. We sought to investigate the relation of novel BPV indices with micro- and macrovascular parameters that have not all been previously studied and to identify differences according to hypertension status.We evaluated the relationship between BPV indices and micro- and macrovascular parameters in a selected population of 344 individuals (233 never-treated, newly diagnosed hypertensive and 111 normotensive individuals).Using data from 24-h ambulatory blood pressure monitoring device, BPV was assessed by average real variability (ARV) during 24-hours, daytime and nighttime and as systolic weighted standard deviation (wSD). Nonmydriatic retinal photography was used to assess retinal microvascular diameters. Arterial stiffness was evaluated by measurement of pulse wave velocity(PWV) and aortic augmentation index (AIx). Myocardial perfusion was evaluated using subendocardial variability ratio (SEVR).The carotid intima-media thickness (cIMT) was measured by ultrasound. We performed a multiple regression analysis for all the parameters which were statistically significant in the univariate analyses.After adjusting for potential confounders, all vascular parameters [venular retinal diameter (p = 0.036), PWV (p < 0.007), cIMT (p < 0.06)], except for SEVR were independently associated with ARV components in the total population. Further analysis based on hypertension status showed that in hypertensives only macrocirculation indices such as PWV and cIMT were independently associated with ARV (for PWV: 24-h systolic, p = 0.025, nighttime systolic, p = 0.001 and nighttime diastolic, p = 0.012 respectively; and for cIMT, p = 0.001 for both 24-h and daytime systolic). In normotensive individuals, venular diameter was associated with 24-h systolic and diastolic and daytime systolic and diastolic ARV (p = 0.004, p = 0.002, p = 0.001 and p = 0.049 respectively). The arteriovenous ratio was associated with daytime systolic ARV (p = 0.022), and AIx was associated with daytime diastolic ARV (p = 0.022). None of the univariate correlations between vascular parameters and wSD remained significant after adjustment for potential confounders.We concluded that short-term BPV represented by ARV is independently associated with macrovascular parameters in untreated hypertensive patients and microvascular parameters in normotensives.

24-HOUR AMBULTORY BLOOD PRESSURE MEASUREMENT USING A NOVEL NON-INVASIVE, CUFF-LESS, WIRELESS DEVICE

Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for the diagnosis and treatment of hypertension. Technical limitations, low compliance, and complex procedures limit their use. The aim of the present study was to test the accuracy of a new photoplethysmography (PPG)-based, wearable device (Wrist-monitor) as compared to the standard cuff-based ABPM device.24H ABPM was performed in parallel for both devices on volunteers aged 18-65 years while documenting their daily activities. The level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between devices. Receiver Operating Characteristic (ROC) curve analysis was used to classify hypertension based on the average Wrist-monitor measurements as compared to a cuff-based ABPM device.The study included 28 subjects (18 men) mean age of 41.5 ± 16.2 years. The Bland-Altman analysis resulted in a 24H bias of -1.1 mmHg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was -1.9 mmHg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mmHg for DBP and SBP respectively). ROC curve analysis yielded a mean area under the curve (AUC) of 1 for SBP and 24H BP measurements. AUCs of 0.994 and 0.955 were found for the daytime DBP and night DBP, respectively. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared to the cuff-based device (p < 0.001).The cuff-less device provides comparable measurements to those obtained with the currently used cuff-based ABPM device, with significantly less inconvenience to the subject.

BLOOD PRESSURE IN ATRIAL FIBRILLATION AND IN SINUS RHYTHM DURING 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING: DATA FROM THE TEMPLAR PROJECT

Hypertension is the most common risk factor for atrial fibrillation (AF), and accounts for a worse prognosis. Blood pressure (BP) control is accordingly essential in AF. However, the interpretation of BP levels is difficult in AF, since differences may be dependent on rhythm, particularly when using automated oscillometric devices. We used data from the TEMPLAR project to compare oscillometric ambulatory BP monitoring (ABPM) intra-individually in AF and sinus rhythm (SR).Among the 4398 individuals in TEMPLAR > 65 years investigated with ABPM and Afib Microlife detector (rhythm indicated with each BP measurement), those with > 30% of readings indicating AF were selected (as previously recommended), and episodes > 30 mins for AF and SR were chosen. Systolic and diastolic BP, mean arterial pressure (MAP), pulse pressure (PP), averaged real variability (ARV), and its coefficient of variation (CV) were assessed for AF and SR, separated for 24 h, daytime, night-time, and for heart rate (HR) < = 90 and > = 90 bpm.We included 430 individuals (mean age 78 ± 7 years, 57% females, 77% with hypertension and 72% on treatment, 4% with previous AF). Mean BP of all measurements included were 124.2/69.0, 126.3/71.1, and 119.5/64.0 mmHg, for 24 h, daytime, and night-time, respectively. There were no differences in MAP for AF vs SR (p = 0.47). Systolic BP tended to be lower in AF (24 h 123.6 ± 13.9 vs 124.7 ± 16.1 mmHg in SR, p = 0.05), and night-time diastolic BP was higher in AF (64.6 ± 10.9 vs 63.3 ± 10.4 mmHg in SR, p = 0.01). PP was lower in AF (24 h 54.6 ± 10.9 vs 55.7 ± 12.8 mmHg in SR, p = 0.002). Diastolic, but not systolic BP variability (ARV and CV) was higher in AF (24 h, p < 0.001). Results were similar with HR < = 90 and > = 90 bpm.Using an oscillometric ABPM device, our results suggest that MAP is similar and reliable in both AF and SR. Lower systolic and higher diastolic BP in AF affects PP, which together with a high variability might impact arterial structure. However, differences in absolute numbers are small, and do not imply different BP strategies and target values in AF.

MO705: Factors Associated with Uncontrolled Ambulatory Hypertension in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS Hypertension among patients on long-term peritoneal dialysis (PD) is common and remains often inadequately control (Cocchi et al. Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study. Nephrol Dial Transplant. 1999; 14(6): 1536–40; Vaios et al.. Assessment and management of hypertension among patients on peritoneal dialysis. Clin J Am Soc Nephrol. 2019; 14(2): 297–305). The aim of the present study was to describe the epidemiology of hypertension using the ‘gold-standard’ method of ambulatory blood pressure monitoring (ABPM) and to identify determinants of inadequate ambulatory blood pressure (BP) control in this high-risk population. METHOD In 140 stable patients receiving PD in four centers of Northern Greece, we performed 24-h ABPM using the oscillometric Mobil-O-Graph device (IEM, Stolberg Germany) (Franssen and Imholz. Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria. Blood Press Monit. 2010; 15(4): 229–31). Hypertension was defined as 24-h ambulatory BP ≥ 130/80 mmHg or current use of at least 1 BP-lowering medication (Williams et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953–2041). The volume status of study participants was assessed with the method of bioimpedance spectroscopy (Fresenius Medical Care, Bad Homburg, Germany). Univariate and multivariate binary logistic regression analysis was performed to identify factors that were independently associated with uncontrolled ambulatory hypertension. RESULTS Ambulatory hypertension was diagnosed in 95% of the patients enrolled in the study. Despite the fact that 96.9% of hypertensives were being treated with an average of 2.4 BP-lowering medications daily, adequate control of 24-h ambulatory BP was achieved in only 38.3% of them. In univariate regression analysis, there was a significant interaction of uncontrolled ambulatory hypertension with the mode of PD, history of cardiovascular disease and smoking status. In multivariate analysis, among variables inserted in the model, the higher overhydration index in bioimpedance spectroscopy [odds ratio (OR): 1.308; 95% confidence interval (CI): 1.023–1.673/L higher overhydration] and the history of cardiovascular disease (OR: 3.069; 95% CI: 1.157–8.140) were the two factors that were associated with higher odds of uncontrolled ambulatory hypertension. In contrast, the presence of residual diuresis ≥ 0.5 L/24 h (OR: 0.304; 95% CI: 0.105–0.881) was the only parameter associated with lower odds of inadequate ambulatory BP control. CONCLUSION Among patients on PD, ambulatory hypertension is highly prevalent and remains often poorly controlled, despite the extensive use of antihypertensive drug therapy. Achievement of adequate volume control and long-term preservation of residual kidney function appear to be two attractive non-pharmacological strategies for optimization of the management of hypertension in this high-risk population.

Validation of an ambulatory blood pressure monitoring device employing a novel method to detect atrial fibrillation.

We evaluated the accuracy of a 24-hr ambulatory blood pressure monitoring (ABPM) device with a new irregular heartbeat (IHB) algorithm for detecting atrial fibrillation (AF) during each BP measurement. Ninety patients with a history of elevated BP and some type of arrhythmia (mean age 63.2 ± 10.3 years; 94% with hypertension; 81% with previously diagnosed AF) simultaneously underwent evaluation by 24-hr ABPM with the IHB algorithm and 24-hr Holter electrocardiography (ECG). Among the 3,347 valid readings, 843 readings were considered to indicate an IHB. Among these IHB readings, 195 readings were found to have an AF rhythm by 24-hr Holter ECG. The IHB algorithm showed 100% sensitivity and 79.4% specificity for accurately detecting AF rhythm. An IHB was detected in 12.1% of the measurements during normal rhythm, 48.8% of those during atrial premature complex, and 54.4% of those during ventricular premature complex. The percentage of IHBs detected during normal rhythm was higher in the daytime than at nighttime (16.3% vs. 4.5%, respectively), suggesting that daytime physical activity sometimes induces a false detection of IHBs. The optimal IHB parameters for suggesting potential AF were (1) an IHB burden defined as a percentage of IHB-positive readings in total valid BP measurements >22.5% (84.6% sensitivity, 85.1% specificity; AUC 0.906, p < 0.0001) and (2) 2.5 or more consecutive IHBs during 24-hr ABPM (84.6% sensitivity, 83.0% specificity; AUC 0.881, p < 0.0001). The novel 24-hr ABPM device with the IHB algorithm assessed herein could contribute to the future comprehensive management of hypertensive patients, with the main goal of preventing cerebrovascular events.

Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring for South Asian Children (ASHA): A Clinical Research Protocol.

Background:The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations.Objective:The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements.Design:Cross-sectional study, quasi-representative sample.Setting:Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia.Participants:We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives.Measurements:Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data.Methods:Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child’s habitual movement behaviors and ABPM measures.Limitations:Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias.Conclusions:Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.

Cognition and elevated blood pressure in community‐dwelling older adults with subjective cognitive decline: A cross‐sectional exploratory study

AbstractBackgroundThe impact of blood pressure (BP) on cognition in older adults remains equivocal. We investigated the relationships between cognition (global and domain‐specific) and ambulatory blood pressure in older adults with subjective cognitive decline (SCD).MethodWe conducted a cross‐sectional exploratory analysis of data collected from 230 community‐dwelling older adults (age mean [SD]: 69.3 [7.2], 57.8% female) with self‐reported SCD. We assessed global cognitive functioning, memory, concentration, planning, and reasoning using the computer‐based Cambridge Brain Sciences battery. Assessment of 24‐hour BP was performed using an automated, ambulatory BP monitoring device (SpacelabsModel 90207). Ambulatory BP was measured every 30 minutes between 6am and 10pm, and hourly between 10pm and 6am. We employed hierarchical regression models to examine associations between 24‐hour systolic BP and cognition. Further, we conducted ANCOVAs exploring dose‐response relationships by stratifying our sample using clinical cut‐offs for normal (≤120 mmHg, n = 52), preclinical (121 to 135 mmHg, n = 119), and hypertensive (&gt;135 mmHg, n = 59) BP. All analyses were adjusted for age, sex, MoCA, years of education, and diagnosis of diabetes and/or hypertension.ResultIn our sample, 24‐hour systolic BP was negatively associated with reasoning scores (unstandardized B [95% CI] = ‐0.008 [‐0.016 to ‐0.001], R2Change = 0.016, p = 0.028). The dose‐response analysis revealed a main group effect (F[2,221] = 3.6, p = 0.029, ηp2= 0.032), with post‐hocpairwise comparisons indicating that individuals with normal BP levels outperformed those with preclinical (mean difference [95% CI] = 0.280 [0.068 to 0.492], p = 0.010), and hypertensive (0.265 [0.021 to 0.508], p = 0.034) BP levels. The tasks adopted to assess reasoning targeted specifically grammatical reasoning, conflict resolution, and deductive reasoning, which fall under the overall scope of executive function tasks. No other relevant associations or interactions were found.ConclusionIn this sample of older adults with SCD, 24‐hour systolic BP levels above optimal clinical parameters were negatively associated with cognitive reasoning performance. Future research should investigate whether interventions that target BP control could mitigate impairment on reasoning performance.