Ambulatory Blood Pressure Monitoring Index Research Articles

Ambulatory Blood Pressure Phenotypes, Arterial Stiffness, and Cardiac Remodeling.

Evidence on the association of arterial stiffness and left ventricular (LV) concentric remodelling/LVH assessed by echocardiography, with abnormal blood pressure (BP) phenotypes, defined by office and ambulatory BP monitoring (ABPM) in the community is scanty. Thus, we investigated this issue in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study. The present study included 491 participants who attended the second and third survey of the PAMELA study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, blood examinations, office, ABPM, echocardiographic and Cardio-Ankle Vascular Index (CAVI) measurements. In the whole study sample (age 66+10 years, 50% males), the prevalence rates of sustained normotension (NT), white coat hypertension (WCH), masked hypertension (MH), sustained hypertension (SH) and non-dipping (ND) were 31.2, 10.0, 24.2, 34.6, and 35.8% and respectively. The likelihood of having SH, the BP phenotype carrying the greatest CV risk, was four times higher (OR= 4.31, CI:2.39-7.76, p<0.0001) in participants with increased CAVI and LV remodelling/LVH compared to their counterparts without organ damage. This association showed an incremental value in discriminating SH compared to both isolated markers of organ damage (OR=1.92,p=0.03 for increased CAVI and OR= 2.02, p=0.02 for LV remodelling/LVH). The presence of isolated but also combined organ damage was unrelated to ND. Our study provides new evidence of the incremental value of looking for both vascular and cardiac target organ damage to optimize the identification and clinical management of SH in the general population.

The role of ultrasonic cardiogram in the diagnosis of hypertension complicated with type 2 diabetes mellitus

ABSTRACT Hypertension diabetes mellitus is one of the serious complications of hypertension. In this study, ambulatory blood pressure monitoring (ABPM) and ultrasonic cardiogram (UCG) were used to investigate the cardiac changes and its influencing factors in hypertensive patients with type 2 diabetes mellitus. The ABPM, UCG, Hemoglobin A1c (HbA1c) and body mass index (BMI) of patients were examined. The comparison of HbA1c, BMI, gender, age, daytime and nighttime blood pressure, left ventricular mass index (LVMI), left ventricular hypertrophy (LVH), isovolumic relaxation time (IVRT) and E/A ratio were made between the two groups. The cardiac function of control group was better than that of group B, while that of group B was better than group A. The cardiac index level in group B was better than that in group A, but lower than that in control group. The LVMI in group A was clearly higher than group B and control group, and the incidence of LVH increased. In group A, the nocturnal systolic blood pressure was higher than control group and group B. Nocturnal diastolic blood pressure, daytime diastolic blood pressure and systolic blood pressure in groups A and B were higher than those the control group. The findings indicated that hypertension complicated with type 2 diabetes mellitus can cause degeneration of the heart, and complicated with type 2 diabetes mellitus can accelerate ventricular remodeling and functional deterioration. Hypertension with type 2 diabetes mellitus are more prone to left ventricular damage.

FEATURES OF AMBULATORY BLOOD PRESSURE MONITORING WITH DIFFERENT BLOOD PRESSURE PROFILES IN PATIENTS WITH HYPERTENSION DISEASE OF MIDDLE AND ELDERLY AGE

Background. Insufficient night-time reduction of blood pressure (BP) and night hypertension are associated with an increased risk of death regardless of the average daily BP. The study of daily BP profiles is very relevant in patients with hypertension of different age categories due to the high risk of thrombotic complications.&#x0D; Aim: of the study was to determine the peculiarities of ambulatory blood pressure monitoring (ABPM) indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.&#x0D; Materials and methods. ABPM indicators were determined in 125 patients who were divided into 2 groups. 1st group (n=82) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old). In the groups of middle-aged and elderly subjects 2 groups of daily BP profiles were distinguished: "dipper" and "non-dipper".&#x0D; Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily systolic BP (SBP) (mm Hg), the average daly diastolic BP (DBP) (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP.&#x0D; Results. The baseline BP level in the average daily SBP and DBP in middle-aged patients of dipper group was significantly higher by 49,6% and corresponded to 155,9±12,0 mm Hg (p&lt;0,001) and 50,4% and was 97,3±6,1 mm Hg (p&lt;0,01). Similar results are observed in the average BP and the maximal daily SBP and the maximal daily DBP values which were significantly higher than the control group by 21,5% (p&lt;0,05) and equaled 110,0±3,6 mm Hg and 21,3% and amounted to 176,3±23,5 mm Hg (p&lt;0,05) and 23,6% and amounted to 117,0±19,2 mm Hg (p&lt;0,05). The baseline BP level in the average daily and maximal SBP, the average daily DBP and the average BP in patients of non-dipper group was significantly higher by 50,8% (p&lt;0,01) and corresponded to 157,1±12,9 mm Hg and 27,4% and equal to 176,9±24,0 mm Hg (p&lt;0,05), 63,8% and amounted to 106,0±1,0 mm Hg (p&lt;0,05) and 44% and was 124,3±6,8 mm Hg (p&lt;0,05) too. In the surveyed elderly patients only the average daily DBP was significantly different from the corresponding control indicator and was lower by 21,4% (p&lt;0,05) and amounted to 91,5±0,7 mm Hg in dipper and 23,1% (p&lt;0,01) and was 93,5±0,7 mm Hg in non-dipper group.&#x0D; Conclusion. Non-dipper group predominates in the structure of daily BP rhythm in elderly hypertensive patients (62,8% versus 37,2%). The average BP decreases in elderly patients of non-dipper group by 11,1% (p&lt;0,05) reliably to patients of middle age.

Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an all-in-one BP monitoring device: The HI-JAMP study.

Masked hypertension is defined by office blood pressure (BP) in the controlled-BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled range. However, diagnosis of masked hypertension may differ if assessed by different out-of-office BP indices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indices (ABPM-MUHT) and HBPM indices (HBPM-MUHT) using the same all-in-one device (TM2441; A&D Company). The present study enrolled a total of 2322 treated hypertensive patients (males 53.2%, average age 69.2 ± 11.5 years) from the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study, who consecutively underwent office BP monitoring, 24-h ABPM (at 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device. When out-of-office BP control status was assessed only by 24-h average SBP or by the average of morning and evening SBP, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7% among the 445 patients with any type of MUHT. When out-of-office BP indices in each time-window were simultaneously assessed, the diagnostic agreement increased to 40-45.7%. Our results indicated the importance of assessing BPs at various times of day, especially morning hours, for perfect hypertension management. Diagnosis of masked hypertension only by an averaged BP index, without considering specific time-windows, might underestimate cardiovascular risk.

PECULIARITIES OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING INDICES IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

Relevance. Until now, there is an ongoing debate about the value of different indicators of blood pressure (BP) − systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse blood pressure (PBP) as predictors of essential hypertension (EH). In this regard the issue of target BP levels in patients of different ages remains studied incompletely. Objective is to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups. Materials and methods. ABPM indicators were determined in 130 patients who were divided into 4 groups. 1st group (n=57) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old); 3rd group (n=15) – middle-aged patients without EH – control for the 1st group; 4th group (n=15) − elderly patients without EH − control for the 2nd group. Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily SBP (mm Hg), the average daly DBP (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP. Results. In group 1 the average and maximal DBP were lower than in group 2 by 7,4% (p&lt;0,001) and 13,1% (p&lt;0,05), respectively. In group 1, the average daily and maximal SBP decreased by 3,8% and 4,1%, respectively; average heart rate by 3,8%; DI of SBP by 7,8% and DI of average BP by 5,8% but the data were unreliably smaller compared to the data of middle-aged patients. In group 1, the maximal DBP, DI SBP and DBP were not significantly different from the corresponding indicators in the control group. The maximal DBP was higher by 29,3% and amounted to 115,6±21,0 mm Hg and DI SBP and DI DBP are lower by 11,1% and 17,9%, respectively; and were equal to 9,6±7,4 and 13,8±8,1, respectively. In the 2nd group the following parameters decreased unreliably (p&gt;0,05): heart rate by 8,6% and was 63,0±9,1/min., DI SBP by 17,6% and was 8,9±5,5%; DI DBP by 16,1% and was 14,1±7,1%; DI of average BP– by 20,4% and was equal to 11,3±6,1%. Conclusions. It is found that with the age DBP decreases with steadily increased SBP in hypertensive patients. The average daily and the maximal daily DBP are significantly less by 7,4% (p&lt;0,001) and 13,1% (p&lt;0,05) accordingly in elderly patients compared with the middle-aged.

Metabolic effects of ramipril and indapamide in hypertensive patients with non-alcoholic fatty liver disease

Objective. To assess the effects of combined antihypertensive therapy with ramipril and indapamide on insulin resistance, carbohydrate, lipid and purine metabolism, as well as the structure and function of the liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD).Design and methods. In a pre-post study, we included 30 patients with hypertension (HTN) 1–2 degrees in combination with NAFLD (Fatty Liver Index (FLI) &gt; 60) aged 45 to 65 years. Patients discontinued antihypertensive therapy 5–7 days before the initial examination. After that one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) were prescribed along with the lifestyle and weight reduction recommendations (the Mediterranean type of diet, a decrease in calorie intake by 500–1000 kcal from baseline, and physical aerobic exercise at least 150 minutes per week). All patients underwent clinical examination, measurement of office blood pressure (BP), ambulatory BP monitoring (ABPM), anthropometric parameters, assessment of the visceral obesity index (VAI), anthropometric parameters, VAI, the degree of adipose tissue dysfunction (ATD), the percentage of visceral and subcutaneous fat by the bioelectrical impedance method. We also assessed lipid, carbohydrate, purine metabolism and the structural and functional state of the liver before and after the treatment.Results. After 24-week therapy with a fixed combination of ramipril and indapamide (average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) HTN patients with NAFLD achieved target BP. There was a decrease in both office systolic BP (SBP) (p &lt; 0,001) and office diastolic BP (DBP) (p = 0,007) in 100 % of patients, as well as in ABPM indices. We observed a decrease in waist and hip circumferences (p ≤ 0,001 and p ≤ 0,001, respectively), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,002) fat. The number of patients with normal ATD increased (p = 0,030), while the proportion of patients with dysfunction decreased (p = 0,039). There was also a significant increase in high-density lipoprotein cholesterol (p = 0,027) and a decrease in insulin resistance (p = 0,002) and metabolic index (p = 0,030). We also found an improvement in carbohydrate metabolism with no change in purine metabolism. There was a favorable effect on the liver structure and function, and the number of patients with high alaninaminotransferase &gt; 40 U/L decreased (5 (16,7 %) vs 0, p = 0,026).Conclusions. Twenty-fourweek treatment with a fixed combination of ramipril and indapamide, together with recommendations for lifestyle changes and weight loss, led to a significant decrease in BP levels, the severity of insulin resistance, and visceral obesity. In addition, the treatment had a beneficial effect on the parameters of carbohydrate and lipid metabolism, as well as liver structure and function (decreased severity of steatosis and fibrosis).

Effect of cardiac resynchronization therapy on ambulatory blood pressure monitoring indices in patients with heart failure and hypertension.

Blood pressure (BP) variability is associated with increased mortality in patients with hypertension and heart failure. The aim of our study was to evaluate the effect of cardiac resynchronization therapy (CRT) on different parameters of 24-h ambulatory blood pressure monitoring (ABPM) in patients with hypertension and heart failure. Patients with heart failure and hypertension who were candidate for CRT implantation were enrolled in our study. Twenty-four hour ABPM was performed before, and 6 months after CRT implantation. BP variables and average real variability (ARV) were compared in all patients. Sixteen consecutive patients entered our study. There was a significant increase in ARV following CRT implantation (P value = 0.009). CRT implantation is associated with increased ARV, but the effect of this improvement on cardiovascular outcome needs more investigation.

Abstract 5: White Coat Hypertension Stability In Children And Adolescents: Pediatric Nephrology Research Consortium Study

There is no pediatric data on whether white coat hypertension (WCH) is a precursor of sustained HTN. The objective of this study was to determine diagnosis changes on follow-up ambulatory blood pressure monitoring (ABPM) in children and adolescents diagnosed with WCH on their initial ABPM and to assess for predictive factors of progression to HTN. Retrospective review was conducted at 11 centers to identify patients with WCH diagnosed by ABPM and had repeat ABPM at least 6 months after the first study. Subjects with secondary HTN, on antihypertensive medication, and diabetes mellitus were excluded. Patients with ADHD were included in the study if medications were stable. Chart review included associated risk factors such as BMI, obstructive sleep apnea, and family history of HTN. ABPM phenotype was determined using the 2014 AHA guidelines. The association between abnormal ABPM diagnosis on follow-up and ABPM index and blood pressure load variables was assessed using univariable generalized linear mixed effect models. Significant ABPM index and load variables (based on p &lt; 0.15) were subsequently added to a multivariable model with the following pre-specified covariates: gender, family history of HTN, age, BMI z-score, ADHD, and interval time between ABPMs. One hundred and one patients met criteria for inclusion with a median age of 14 years (80% males) and median interval time of 14 months (range: 6 – 55 months). On follow-up ABPM, 18% and 32% of patients demonstrated HTN and prehypertension respectively (18 and 32 of 101, respectively). In univariable modeling, awake and nocturnal systolic BP index ≥ 0.9 on the first ABPM were found to be significantly associated with progression to abnormal ABPM [unadjusted OR (95% CI) awake: 4.3 (1.2 – 14.6); nocturnal: 3.2 (1.0 – 10.1)]; however, these associations were not significant after adjusting for pre-specified covariates [adjusted OR (95% CI) awake: 2.7 (0.7-10.4); nocturnal: 2.6 (0.7 – 9.2)]. Approximately half of children and adolescents first diagnosed with WCH progressed to an abnormal ABPM phenotype on follow-up, suggesting that longitudinal follow-up with ABPM is indicated in pediatric WCH patients. We were unable to identify ABPM findings that might predict a higher risk for progression.

Correlations between indices of dynamic components of ambulatory blood pressure and renal damage in elderly Chinese male with essential hypertension

ObjectiveTwenty-four-hour ambulatory blood pressure monitoring (ABPM) is an accurate method to document changes in blood pressure (BP) and is more predictive than office and home BP monitoring for cardiovascular outcomes in elderly people. We aimed to determine the relationship between ABPM indices and renal damage in elderly Chinese male patients with essential hypertension.MethodsWe investigated 998 Chinese men (mean age of 78.44 ± 12.02 years) with essential hypertension. Renal function, laboratory testing, and ABPM, including ABP, BP variability, and BP circadian rhythms were investigated. Data were shown according to BP controlling status. The relationships between ABPM indices and renal damage [expressed by urine protein, urine albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN)] were assessed using multiple regression analysis.ResultsAfter adjustments for age, common cardiovascular risk factors, and medications, uACR level was positively associated with 24-h mean systolic blood pressure (SBP), 24-h mean pulse pressure (PP), and 24-h SBP percent time of elevation. eGFR level was negatively associated with the 24-h mean SBP and 24-h mean PP. BUN level was positively correlated with the 24-h mean SBP, 24-h mean PP, and 24-h SBP percent time of elevation, whereas the BUN level was negatively associated with the 24-h DBP SD.ConclusionThe ABPM indices associated with renal damage may be regarded as an early predictive marker for renal function impairment in Chinese elderly male patients with hypertension.

SAT-091 NOCTURNAL HYPERTENSION ON LONGITUDINAL AMBULATORY BLOOD PRESSURE MONITORING AND LEFT VENTRICULAR HYPERTROPHY IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS

Hypertension (HTN) after renal transplantation is known to be associated with cardiovascular morbidity. Indian children with chronic kidney disease (prior to transplantation) have a 3 times higher prevalence of LVH1 compared to western counterparts2. The aims of this observational study in pediatric kidney transplant recipients were to describe the prevalence of masked HTN and LVH, the association between ABPM measurements and left ventricular mass index (LVMI ) and to determine the longitudinal changes in ambulatory blood pressure monitoring (ABPM). ABPM and auscultatory clinic BP were performed in children (2015- 2018), ≥ 3 months post transplant with a stable functioning renal allograft at baseline and repeated in 6-12 months. Mean daytime and sleep ambulatory BPs were calculated. Nocturnal dip (mean sleep BP vs. mean daytime BP) <10% was defined as blunted. Clinic and ABPM mean BPs were indexed to the 95th percentile (HTN present if BP index ≥ 1). ECHO data from a single timepoint performed within 6 months of ABPM was used to calculate LVMI (LVH present if > 95th percentile for age/sex). Masked HTN was defined as clinic BP index <1 and ABPM SBP or DBP index ≥ 1. Isolated nocturnal hypertension was diagnosed if daytime BP indices were <1 but sleep BP indices were ≥ 1. Linear Regression determined the association between LVMI and ABPM indices. Baseline Data: 30 children were included (14 boys, 28 living donor allografts, age 13.2 ±3 yrs, eGFR = 75±32 ml/min/1.73m2, median 18mths post transplant). Masked HTN was present in 16/30 (53%), [Fig 1]; all with masked HTN were treated with increased dose and/or number of BP medications. Clinic BP failed to diagnose 65% of patients with HTN. Isolated nocturnal HTN occurred in 13/25 (52%) of patients with HTN. Sleep SBP and DBP indices were higher than daytime BPs (p < 0.001 for each). Blunted nocturnal dip was present in 80%. LVH and LVMI: 12/21 patients (57%) with echoes had LVH; all with LVH had HTN by ABPM. Elevated sleep SBP and DBP indices as well as sleep BP loads (p < 0.05 for each) were associated with elevated LVMI. Follow-up Data: 18 had follow-up ABPM [Table 1]. Overall, BPM indices (not clinic BPs) decreased on follow-up (all p < 0.05) but sleep BPs remained higher than daytime. Table 1: Ambulatory BP Values on Initial ABPM and Follow UP Prevalence of masked HTN, isolated nocturnal HTN and blunted nocturnal dip was high in this study of children with kidney transplants. Nocturnal BP predicted LVMI. Clinical treatment based on ABPM was associated with improvement in BP, but nocturnal hypertension was persistent. This data confirms the importance of proactive ABPM monitoring of children with kidney transplants as hypertension is not satisfactorily assessed by office evaluation.

THE DYNAMICS OF BLOOD PRESSURE OF DIFFERENT AGE PATIENTS GROUPS WITH HYPERTENSION AND DIABETES TYPE II AFTER CORRECTION OF CAROTID STENOSIS

Introduction: hypertension and diabetes remain the main risk factors for stroke, which leads to premature disability and mortality. The aim: To study the dynamics of blood pressure (BP) in patients of different age groups with hypertension and diabetes type II before and after carotid endarterectomy. Materials and methods: 90 patients with hypertension and diabetes type II were selected for CE. Patients are divided into two age groups: up to 65 years (group 1) and after 65 years (group 2). We assessed the dynamics of ambulatory blood pressure monitoring (ABPM). The examination was carried out 2 days before and 6 months after surgery. CE was conducted under local anaesthesia. Results: Before operation in patients in group 2, there was a significantly higher level of average systolic BP per 24 hours (p <0.02), per day (p <0.01), per night (p <0.01) and diastolic BP per night (p <0,01). At the preoperative stage, there was a significant increase in the parameters of the variability of BP, but the increase in the variability of BP with age was not fixed. After surgery, patients with Group 1 observed a more significant positive dynamics of ABPM indices than patients in Group 2. In two age groups, the percentage of patients with an insufficient reduction of BP at night was prevalent. Conclusions: Surgical treatment of carotid stenosis is associated with a steady decrease in BP in the distant period after CE. Significant regression of BP is characteristic for patients of the younger age group.

Peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups

The aim of the study was to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices of patients with essential hypertension, stage II of different age groups.&#x0D; Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. The control group consisted of 15 patients for every of the surveyed categories (group III - middle-aged and group IV – elderly respectively) matched with basic by age and gender.&#x0D; Results. We have shown that one of the factors that determines the change in hemodynamics in patients with essential hypertension is age, with the age patients experience the decrease in diastolic blood pressure with steadily increased systolic blood pressure, that should be considered in the prescription of antihypertensive treatment. With age, a gradual increase in systolic blood pressure is associated with the increased aortic stiffness, partially with the increase in collagen and the decrease in elastic fibrils and the formation of isolated systolic hypertension. Thus, it is proved that in the formation of isolated hypertension the growth of pulse blood pressure for more than 60 mm Hg is unfavorable in a development of cerebrovascular events. Pulse arterial blood pressure was stronger risk factor than systolic blood pressure and diastolic blood pressure or average arterial pressure in the elderly. Recently, taking into account age characteristics, all three indices were recognized as comparable predictors at the age of 50-59 years as the transitional period, and at the age of 60-79 years diastolic blood pressure adversely affecting the cardiovascular risk, increased pulse blood pressure prognostically above the level of systolic arterial pressure.

RISK ASSESSMENT OF CARDIOVASCULAR COMPLICATIONS IN “WHITE COAT” HYPERTENSION

Objective . To detect the frequency of “white coat” hypertension (WCH) in 40–49-year old men and its association with the indicators of cardiovascular remodeling and cardiovascular risk factors. design and methods. In a single-step study, we assessed cardiovascular risk in 350 men (40–49 years old) with different levels of blood pressure (BP) based on the 24-hour ambulatory BP monitoring (ABPM). Results. Prevalence of left ventricular hypertrophy (LVH) was 8 % in patients with WCH, and 26 % in patients with high BP (χ 2 = 4,9, p < 0,05). The rate of increased intima-media thickness more than 0.9 mm was 11 % in WCH group, compared to 28 % among patients with verified arterial hypertension (HTN) (χ 2 = 3,9; p < 0,05). Compared with healthy cohort, left ventricular myocardial mass index and carotid artery wall thicknesses were significantly higher in patients with LVH. Conclusions . The prevalence of the WCH among 40–49-year-old hypertensive men was 36 %. The prevalence of risk factors, lipid metabolic disorders is lower in patients with WCH compared to patients with high BP verified by ABPM. Normal ABPM indices are associated with lower LVH frequency and vascular remodeling. Hypertensive remodeling is more profound in patients with WCH compared

PP.01.28] AMBULATORY BLOOD PRESSURE MONITORING (ABPM) AND MYOCARDIUM DEFORMATION PARAMETERS IN PATIENTS WITH HYPERTENSION

Objective: The aim of the study was to examine the association between ambulatory blood pressure monitoring (ABPM) indices and left ventricular (LV) and left atrium (LA) remodelling in patients with hypertension (HT). Design and method: 60 patients (males – 40) with HT aged (59,5 ± 2,8) years were divided into 2 groups after 24 h ABPM. Patients with decrease BP during the night (night-day BP ratio < 0.9) defined as ’dippers’, composed the 1st group (n = 33) and patients without sufficient nocturnal BP drop (nondippers) composed the 2nd group (n = 27). Using M-,2D- and speckle-tracking echocardiography with ultrasound scanner Aplio Artida we studied LV hypertrophy (LVH), values of LV longitudinal global systolic strain (LGSS) and LGSS rate, also left atrium (LA) systolic deformation (SD), early diastolic deformation rate (EDDR) and late diastolic deformation rate (LDDR) as a parameters of accordingly LA reservoir, conduit and contractile function. Results: In the 2nd as compared to the 1st group pts had more severe LVH: more common concentric (60,0% vs 40,0%) and eccentric (66,7% vs 33,3%) LVH. In the 2nd group we found 17,4 and 13,5 % reduced absolute values of LGSS and LGSS rate accordingly (P < 0.05) as compared to the 1st group. The insufficient decline of nighttime BP was associated with a 21,0 % decrease of LA EDDR and 16,9 % decrease of LA SD (P < 0.05) in the 2nd vs the 1st group, this indicated the impairment in conduit and reservoir LA function in nondipper patients. The inverse correlation was found in the 2nd group between 24 h BP and values of LGSS (r = -0,40, p < 0.01) and LGSS rate (r = -0,31, p < 0.05), also with decreased LA EDDR (r = -0,33, p < 0.05). Decreased values of LA LDDR associated with systolic (r = -0,44, p < 0.01) and diastolic (r = -0,37, p < 0.01) BP variability at nighttime. Conclusions: In nondipper HT patients it was rotined more expressed decrease in LV global systolic deformation and impairment of LA reservoir, conduit and contractile function compared to the dipper pts. A strong relationship between ABPM indices, insufficient nighttime BP reduction and the structural and functional state of the left heart was found.

PP.LB01.13] AMBULATORY BLOOD PRESSURE MONITORING (ABPM) AND MYOCARDIUM DEFORMATION PARAMETERS IN PATIENTS WITH HYPERTENSION

Objective: The aim of the study was to examine the association between ambulatory blood pressure monitoring (ABPM) indices and left ventricular (LV) and left atrium (LA) remodelling in patients with hypertension (HT). Design and method: 60 patients (males – 40) with HT aged (59,5 ± 2,8) years were divided into 2 groups after 24 h ABPM. Patients with decrease BP during the night (night-day BP ratio <0.9) defined as ’dippers’, composed the 1st group (n = 33) and patients without sufficient nocturnal BP drop (nondippers) composed the 2nd group (n = 27). Using M-,2D- and speckle-tracking echocardiography with ultrasound scanner Aplio Artida we studied LV hypertrophy (LVH), values of LV longitudinal global systolic strain (LGSS) and LGSS rate, also left atrium (LA) systolic deformation (SD), early diastolic deformation rate (EDDR) and late diastolic deformation rate (LDDR) as a parameters of accordingly LA reservoir, conduit and contractile function. Results: In the 2nd as compared to the 1st group pts had more severe LVH: more common concentric (60,0% vs 40,0%) and eccentric (66,7% vs 33,3%) LVH. In the 2nd group we found 17,4 and 13,5 % reduced absolute values of LGSS and LGSS rate accordingly (P < 0.05) as compared to the 1st group. The insufficient decline of nighttime BP was associated with a 21,0 % decrease of LA EDDR and 16,9 % decrease of LA SD (P < 0.05) in the 2nd vs the 1st group, this indicated the impairment in conduit and reservoir LA function in nondipper patients. The inverse correlation was found in the 2nd group between 24 h BP and values of LGSS (r = −0,40, p < 0.01) and LGSS rate (r = −0,31, p < 0.05), also with decreased LA EDDR (r = −0,33, p < 0.05). Decreased values of LA LDDR associated with systolic (r = −0,44, p < 0.01) and diastolic (r = −0,37, p < 0.01) BP variability at nighttime. Conclusions: In nondipper HT patients it was rotined more expressed decrease in LV global systolic deformation and impairment of LA reservoir, conduit and contractile function compared to the dipper pts. A strong relationship between ABPM indices, insufficient nighttime BP reduction and the structural and functional state of the left heart was found.

Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease.

Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3–5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population.

Cross-sectional study of indices of dynamic components of ambulatory blood pressure and cardiac damage in elderly male patients with essential hypertension

Blood pressure control is closely related to target organ damage in elderly patients with hypertension. The aim of this study was to determine the relationship between ambulatory blood pressure monitoring (ABPM) indices and cardiac damage in elderly male patients with treated essential hypertension (EH). This study included 998 Chinese men (mean age, 78.44 ± 12.02 years) with EH. Participants underwent cardiac function assessment, laboratory testing, and ABPM, including ABP, BP variability, BP circadian rhythms, and hypertensive or hypotensive time indices. The relationships between ABPM indices and cardiac damage (expressed by shape and function) were assessed using ridge regression analysis. Ridge regression analysis revealed the following after adjustments for age, common cardiovascular risk factors, disease, and medications: N-terminal fragment pro-B-type natriuretic peptide was negatively correlated with the diastolic blood pressure nocturnal fall rate; the peak early/atrial velocity (E/A) ratio E/A ratio was negatively correlated with the 24 h mean systolic blood pressure (24 hmSBP), daytime SBP (dSBP), and nocturnal SBP (nSBP); and ejection fraction (EF) was negatively correlated with 24 h SBP percent time of elevation (24 hSBP PTE %) and 24 h DBP percent time of elevation (24 hDBP PTE %). Left ventricular mass (LVM) was positively correlated with the 24 hmSBP, dSBP, nSBP, 24 h mean pulse pressure (24 hmPP), day mean pulse pressure, and nocturnal mean arterial pressure, whereas LVM was negatively correlated with the NDBPF. Our study showed that the ABPM indices associated with cardiac damage may be regarded as an early predictive marker for cardiac function impairment in elderly male patients with EH.

Sex differences in salt-sensitivity risk approximated from ambulatory blood pressure monitoring and mortality

Salt-sensitivity is difficult to assess with salt diet. : Salt-sensitivity risk was estimated from ambulatory blood pressure monitoring indices, patient data, and 20-year all-cause mortality. Tracings of 2064 untreated patients from our clinical monitoring service were evaluated for the prevalence and associations of salt-sensitivity risk, which was considered low in patients with both mean arterial pressure dipping more than 10% and 24-h heart rate less than 70 bpm; high in patients with dipping 10% or less and 24-h heart rate at least 70 bpm; and intermediate in patients with the other combinations. Low, intermediate, and high salt-sensitivity categories were predicted for 33% (366/1099), 57% (624/1099), and 10% (109/1099) of men and 18% (177/965), 67% (630/965), and 16% (158/965) of women, respectively (χ(2) < 0.0001). Positive linear trends were noted between salt-sensitivity and BMI, clinic and 24-h ambulatory blood pressure, awake and sleep ambulatory heart rate and awake and sleep blood pressure variability, and negative trend with heart rate dipping (all P < 0.005). Kaplan-Meier analyses revealed increased mortality in association with salt-sensitivity in men but not in women (P < 0.02). With low and intermediate salt-sensitivity as reference, adjusted Cox proportional hazard ratios for all-cause mortality associated with high sensitivity were 1.96 (95% confidence interval 1.07-3.62) in men and 1.02 (0.51-2.07) in women. To the extent that ambulatory blood pressure-derived estimation of salt-sensitivity is feasible, analysis of our database suggests increased mortality risk in men but not in women, in whom salt-sensitivity was more common.

THE EFFECT OF THERAPEUTIC LIFESTYLE INTERVENTION ON THE CIRCADIAN RHYTHM OF AMBULATORY BLOOD PRESSURE

ObjectivesTo investigate the effect of therapeutic lifestyle intervention on the restored of circadian rhythm of ambulatory blood pressure.Methods200 hypertensive patients were randomly divided into two groups: therapeutic lifestyle intervention group...

EFFICACY AND SAFETY OF COMBINED ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH RENOPARENCHYMAL ARTERIAL HYPERTENSION IN ACTUAL CLINICAL PRACTICE

Aim. To evaluate efficacy and safety of combined antihypertensive therapy based on ramipril, metoprolol tartrate, amlodipine bensilate and rilmenidine dihydrogen phosphate in hypertensive patients with chronic glomerulonephritis (CGN) and normal renal function. Material and methods. 136 patients (39,2±14,6 y.o.) with hypertensive type of primary CGN and with normal renal function were examined. Clinical blood pressure (BP) and 24-hour ambulatory BP monitoring (ABPM) were evaluated initially and in 12 months of antihypertensive therapy. Results. Significant decrease of clinical BP was observed in 12 months of therapy in all patients. Target BP level was reached in 37 % of patients. ABPM indices were also improved: average BP levels and hypertensive burden time decreased, speed of morning BP raise was slow down, there was a tendency to 24-hour BP rhythm improvement. Tolerability of combined therapy was good. Conclusion. The combined antihypertensive therapy based on ramipril, metoprolol tartrate, amlodipine bensilate, rilmenidine dihydrogen phosphate showed good efficacy and safety in hypertensive patients with CGN and normal renal function.