Ambulatory Blood Pressure Monitoring Measurements Research Articles

Ambulatory Blood Pressure Phenotypes, Arterial Stiffness And Cardiac Remodelling.

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. We investigated this issue in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study. The 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 organ damage to optimize the identification and clinical management of SH in the general population.

Discrimination and hypertension among a diverse sample of racial and sexual minority men living with HIV: baseline findings of a longitudinal cohort study.

Racial and sexual orientation discrimination may exacerbate the double epidemic of hypertension (HTN) and HIV that affects men of color who have sex with men (MSM). This was a cross-sectional analysis of African American, Asian American, Native Hawaiian, or Pacific Islander (NHPI) MSM living with HIV (PLWH) cohort in Honolulu and Philadelphia. Racial and sexual orientation discrimination, stress, anxiety, and depression were measured with computer-assisted self-interview questionnaires (CASI). We examined the associations between racial and sexual orientation discrimination with hypertension measured both in the office and by 24-h ambulatory blood pressure monitoring (ABPM) using multivariable logistic regression. Sixty participants (60% African American, 18% Asian, and 22% NHPI) completed CASIs and 24-h ABPM. African American participants (80%) reported a higher rate of daily racial discrimination than Asian American (36%) and NHPI participants (17%, p < 0.001). Many participants (51%) reported daily sexual orientation discrimination. Sixty-six percent of participants had HTN by office measurement and 59% had HTN by 24-h ABPM measurement. Participants who experienced racial discrimination had greater odds of having office-measured HTN than those who did not, even after adjustment (Odds Ratio 5.0 (95% Confidence Interval [1.2-20.8], p = 0.03)). This association was not seen with 24-h ABPM. Hypertension was not associated with sexual orientation discrimination. In this cohort, MSM of color PLWH experience significant amounts of discrimination and HTN. Those who experienced racial discrimination had higher in-office blood pressure. This difference was not observed in 24-h APBM and future research is necessary to examine the long-term cardiovascular effects.

ASSOCIATION OF OFFICE AND AMBULATORY BLOOD PRESSURE MONITORING WITH COGNITIVE FUNCTION AND DEMENTIA PREVALENCE

Objective: Blood pressure (BP) is an important risk factor for cognitive decline and dementia. However, it is unclear which measures of BP obtained from office and ambulatory BP monitoring assessments are better related with cognition and dementia. Therefore, we evaluated the association of office and ambulatory BP measures with cognitive function and dementia at baseline. Design and method: We included baseline information of 1435 participants aged 50y or older from a population-based study whom underwent 24-h ambulatory BP monitoring, cognitive function, and neurological assessments. Office and ambulatory BP monitoring measures included systolic BP level and short-term variability quantified using the average real variability (ARV) index. Cognitive function examination included the minimental state examination (MMSE) and selective reminder tests ([SRL], total retrieval, long-term retrieval, and delayed recall). Dementia was a clinical dementia rating scale equal or higher than 1. We performed adjusted logistic and linear regression models to evaluate the association of office and ambulatory BP monitoring measures with cognitive function and dementia. Results: The mean age was 63.8±10.3 and 69.1% (n=963) were women. The prevalence of dementia was 3.21 (n=46). In adjusted logistic regression models, only ARV of the 24-h (odds ratios [OR] per +1-standard deviation [SD] increase in ARV, 1.42; 95% confidence interval [CI], 1.07-1.88) and nighttime (OR, 1.37; 95% CI, 1.05-1.78) systolic BP were associated with dementia at baseline. In adjusted linear regression models, only ARV was associated with lower scores in the MMSE and the SRL tests (adjusted-mean scores per +1SD increase in ARV ranged from -0.09 to -0.06 points; P values below 0.027). These associations remained after models were additionally adjusted by the BP level (P values below 0.033) Conclusions: Among office and ambulatory BP monitoring measures, higher short-term variability in the 24-h and nighttime systolic BP was associated with lower cognitive function and dementia independent of the BP level. This is the first epidemiological study showing an association between short-term BP variability and dementia. Future longitudinal studies need to address whether short-term BP variability could be a potential marker for cognitive decline and might help in assessing the risk of dementia.

The 5 Ws of Ambulatory Blood Pressure Monitoring.

Blood pressure (BP) measurement is affected by multiple variables which influence clinical management decisions and patient outcomes. Around 24-hour ambulatory blood pressure monitoring (ABPM) avoids incorrect diagnosis of hypertension (HT), and unnecessary treatment and provides the best prediction of cardiovascular (CV) risk. Clinically important phenotypes of HT such as masked HT (masked HT), white coat HT (white coat HT), and nocturnal HT (nocturnal HT) may be missed by not incorporating ambulatory BP monitoring in practice. However, lack of device availability, operational difficulties, and cost remain barriers to its widespread acceptance in India. In this review, we discuss the when, what, who, why, and where (5Ws) relevant to ABPM measurement.

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.

Isolated Nocturnal Hypertension in People Living With Human Immunodeficiency Virus: A Cross-Sectional Study.

Nocturnal hypertension (NH) is a potent cardiovascular risk factor described frequently in people with HIV (PWH). Isolated NH (INH) is less well reported in PWH because of the need for ambulatory blood pressure monitoring (ABPM) in office normotensive patients. We aim to document the prevalence of NH and INH and the clinical factors associated with these phenotypes. Cross-sectional study from an HIV program in Argentina. Office and ABPM measurements, as well as clinical and laboratory exploration, were performed. We defined INH as NH with daytime normotension in patients with office normotension. We obtained ABPM in 66 PWH, 60% male, aged 44.7 (IQR 27-69) years; 87% receiving antiretroviral therapy, and 86.2% virologically suppressed. ABPM-based hypertension prevalence was 54.7% (95% CI: 42.5-66.3). The prevalence of NH was 48.5% (32/66), while the INH prevalence was 19.7% (95% CI: 11.7-30.9). No differences were found regarding sex, HIV viral load, CD4+ T lymphocytes count, or years of infection between normotensive and INH patients. Multiple linear regression model adjusted for sex and age determined that body mass index (β = 0.93, P < 0.01), plasma uric acid (β = 0.25, P = 0.04), plasma potassium (β = -10.1, P = 0.01), and high-sensitivity C-reactive protein (hs-CRP) (β = 0.78, P = 0.02) independently predicted nocturnal systolic blood pressure (BP) in PWH. In a multiple logistic regression model adjusted for age and sex, the presence of sedentariness, plasma potassium <4 mEq/L, BMI, and hs-CRP levels were predictors of INH. INH is highly prevalent in PWH. Metabolic and inflammatory markers predict nocturnal SBP in PWH.

DETERMINANTS OF ELASTIC AND STIFFENING PULSE PRESSURE COMPONENTS: RESULTS OF THE NEW HUNGARIAN ABPM REGISTRY

Objective: Pulse pressure (PP) received relative less attention in the guidelines regarding its potential role in the hypertension-mediated target organ damage. Recently it has been proposed that PP can be divided into two components: elastic PP (elPP) and stiffening PP (stPP). Thus the aim of our study was to explore the determinants of 24-hour, daytime and nighttime elPP and stPP in a new national ambulatory blood pressure monitoring (ABPM) database. Design and method: ABPM data were collected from the Hungarian ABPM Registry between February 2021 and August 2022. The Hungarian ABPM Registry is a an ongoing multicenter, open-label, observational non-interventional study. Meditech ABPM-06 monitors were used for ABPM measurements. Basic patients’ data were documented in electronic case report forms and were later analyzed together with ABPM data. elPP and stPP were calculated according to Gavish et al (DOI:10.1097/HJH.0000000000003258). Results: 14817 ABPM data were analyzed. The average age of the subjects was 55.29 ± 15.1 years, 7845 (48.9%) of them were men. 24h, daytime and nighttime elPP were 47.42 ± 8.89, 46.45 ± 9.34 and 45.93 ± 10.94 mmHg, respectively. 24h, daytime and nighttime stPP were 8.51 ± 5.86, 9.15 ±6.56 and 8.62 ± 7.81 mmHg, respectively. Under the age of 50 years all elPPs were significantly lower in women compared to men, while all stPPs were lower in both sexes in age under 50 (p&lt;0.05). Independently from age and sex, obesity increased all elPPs, while under the age of 50 years nighttime stPP was elevated only in obese women (p&lt;0.05). The independent determinants of daytime and nighttime elPPs were age, systolic blood pressure (sBP), obesity and diabetes with adding ischemic heart disease in case of 24h elPP. The independent determinants of 24h and daytime stPPs were age, sBP and diabetes, while in case of nighttime stPP age, sBP and sex. Conclusions: The new Hungarian ABPM Registry underline the importance of PP and its elastic and stiffening components. The evaluation of their determinants can help to better understand the pathomechanisms responsible for the development of hypertension-mediated target organ damage.

Assessment of Hypertension in Children with Autosomal Dominant Polycystic Kidney Disease; Single-Center Experience

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary renal cystic diseases. Althoughits clinical manifestations usually occur in adulthood, hypertension (HT) is known to develop in most patients before the decline inrenal function and it is associated with faster progression to end stage kidney disease (ESKD). We investigated ambulatory bloodpressure monitoring (ABPM) results of 23 patients with ADPKD, followed up in the Pediatric Nephrology Clinic of Ondokuz MayısUniversity Medical Faculty Hospital. Patients’ demographic characteristics, laboratory and ultrasonography (US) results, officeblood pressure, and ABPM measurements were evaluated. The parameters of gender, age, increased kidney size, proteinuria,glomerular filtration rate (GFR) was compared in hypertensive and non-hypertensive group. Twenty three patients (13 girls, tenboys) with a mean age of 11.94±4.01 (min-max: 4.6-18) years and a female/male ratio of 1.3/1 were examined. Ultrasound revealedincreased kidney sizes in 12 patients (52.2%) and multiple cysts in the bilateral kidneys in 20 patients (87%). Mild to moderateproteinuria was detected in 7 patients (30.4%). The HT ratio of patients was 52.2% and 39.1% when assessed with office bloodpressure (BP) measurement and ABPM respectively. A non-dipper pattern was established in 14 patients (60.9%). Gender, age,increased kidney size, proteinuria, GFR did not differ significantly between ADPKD patients with and without ambulatory HT. Thisstudy shows that nearly half of children with ADPKD have HT by ABPM. BP should be regularly screened by ABPM in all pediatricADPKD patients.

PS-C28-9: AMBULATORY BP DERIVED SALT SENSITIVITY INDEX AS A PREDICTOR OF THE BP RESPONSE TO RENAL DENERVATION

Objective: Renal denervation (RDN) has been consistently shown in recent sham-controlled clinical trials to reduce clinic and ambulatory blood pressure (BP). Salt sensitivity is a critical factor in hypertension pathogenesis and severity, but cumbersome to assess by gold-standard methodology. 24-hour average heart rate and mean arterial pressure dipping, taken by ambulatory blood pressure monitoring (ABPM), can stratify patients into high, moderate and low salt sensitivity index (SSI) risk categories. Here we aimed to assess whether ABPM-derived SSI risk could predict the systolic blood pressure reduction at long-term follow-up in a real-world cohort of RDN patients. Design and Methods: 60 participants (70.0 ± 10.3 years, 76.3% male) had repeat ABPM assessment as part of a renal denervation long-term follow and compared to their pre-RDN baseline for calculating systolic BP changes. Average time since RDN was 8.7 years ± 1.09 years. Participants were stratified into low, moderate and high SSI Risk groups, respectively. MAP dipping less than 10% and heart rate (HR) greater than 70 indicated high-risk, MAP dipping greater than 10% and HR less than 70 indicated low risk. Remaining participants were classified as moderate risk. Systolic BP changes in risk groups were compared by One-way ANOVA. Multiple regression was computed for systolic BP response, baseline SBP and High SSI Risk status. Results: One-way ANOVA indicated a significant treatment effect (p = 0.03) between low, moderate and high salt-sensitivity index risk calculated by ABPM measures with systolic BP reduction of 9.64 ± 3.74 mmHg, 8.41 ± 3.48 mmHg, and 28.20 ± 9.55 mmHg, respectively. Baseline SBP was not significantly different between SSI Risk groups (p = 0.18), but trended upward with increasing SSI. High SSI risk independently correlated with systolic BP reduction (p = 0.02). Conclusions: Our preliminary investigation indicates that SSI risk may serve as a simple and easily accessible measure for prediction of the BP response to RDN. However, the influence of pharmacological therapy on these participants is an important extraneous variable requiring testing in prospective or drug-naive RDN cohorts.

PS-C10-1: BLOOD PRESSURE PROFILE AND CARDIO-VASCULAR FEATURES OF WOMEN WITH A PAST HISTORY OF PREECLAMPSIA

Introduction: Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. Hypertensive phenotypes such as masked hypertension, sustained hypertension, white coat hypertension and an adverse systolic night-today blood pressure (BP) ratio are often unnoticed and can only be detected with ambulatory BP monitoring (ABPM). This study aimed to determine the prevalence of hypertension using ABPM and office measurements. Methods: We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants. Results: 101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure. Conclusion: Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.

Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Hypertension after Renal Transplantation

Objective: To evaluate the behavior of blood pressure (BP) to ambulatory blood pressure monitoring (ABPM) in stable renal transplant recipients (LTx), comparing their findings with manual measurements. Method:Cross-sectional study including 44 recipients of LTx from quaternary public hospital, with stable renal function, between the 3th and 6th months after LTx. Agreement analyses between conventional measurement and ABPM were performed considering two limits of normality: limits I: ambulatory BP &lt; 130/80 mmHg and mean total ABPM &lt; 125/75 mmHg; limits II: ambulatory BP &lt; 140/90 mmHg and mean total ABPM &lt; 130/80 mmHg. Results: There was a predominance of men (54.5%) with a mean age of 44 years, taking antihypertensives (75%). The prevalence of maskedsystemic arterial hypertension (SAH) considering the limits I was 15.9% when compared to the closest measurement to the ABPM, and 31.8% when compared to the average of the three measurements prior to the ABPM. Considering the limits II, masked SAH occurred in 22.7% when compared with the closest measurement to the ABPM and in 38.6% when the average of the measurements was used. Nocturnal descent impairment occurred in 40 (90.9%) patients. Considering ABPM as the gold standard, the accuracy of manual gauging closest to monitoring was 72.7% for limits I. When considering the average of the measurements, the accuracy was 56.8% for the same limits. The accuracy according to the limits II was 68.2% and 54.6% for the closest measurement to the ABPM and for the average of the measurements, respectively. There was poor diagnostic agreement between ABPM and ambulatory measures (Kappa = 0.095 to 0.374). The linear coefficient (R) values for systolic pressures were 0.609 and 0.671 for the first measurement closest to the MAP and for the average of the measurements, respectively. These coefficients for diastolic pressures were 0.521 and 0.454, respectively. Conclusion: There was low agreement between manual measurements and ABPM, especially for diastolic BP. Most patients had an altered nocturnal descent. These data indicate the usefulness of ABPM in addressing hypertension in this population, as well as providing additional information regarding the circadian behavior of BP.

The accuracy of 8-hour ambulatory blood pressure monitoring, adjusted to seasons.

Ambulatory blood pressure monitoring (ABPM) is considered the most reliable and accurate measurement of blood pressure (BP). However, the use of ABPM has some limitations, which make it difficult to complete for the entire 24 h. We aimed to establish in which part of the day BP measurements are in highest correlation with full ABPM (over 24 h) results. We performed a retrospective cross-sectional study which included 3113 full ABPM. Each ABPM was divided into 6- and 8-hour segments, and mean BP in each time segment was calculated. Linear mix models for describing BP by BP in each time segment were performed. A total of 3113 ABPM measurements carried out on 2676 patients (mean age 57.78 ± 14.74) were included in the study. Linear mix models demonstrated significant association between mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in full ABPM, and SBP and DBP between 2-10 PM, respectively (SBP: β = 0.902, p < 0.001; DBP: β = 0.839, p < 0.001), adjusted for gender, age, season, and relevant interactions. This section had higher coefficient correlations than other sections which were examined. The study findings indicate high correlation between BP between 2-10 PM, and BP in full-ABPM, by each season. This time segment may be ideal for short-term BP monitoring as an initial screening test and for patients who are unable to complete full ABPM. However, since this time segment does not include nighttime hours, there is a risk of underdiagnosis of non-dipper.

Association between Cardio-Ankle Vascular Index and Masked Uncontrolled Hypertension in Hypertensive Patients: A Cross-Sectional Study.

Detection of masked uncontrolled hypertension (MUCH) that was defined for treated hypertensive individuals who had normal office blood pressure (BP) but elevated ambulatory BP remains largely challenging. Arterial stiffness is one of the leading risk markers for hypertension and can be clinically assessed by the cardio-ankle vascular index (CAVI). This study aimed to evaluate the association between CAVI and MUCH. A total of 155 hypertensive patients were included with their office BP levels and ambulatory BP monitoring measurements, which were divided into controlled hypertension (CH), MUCH, and sustained uncontrolled hypertension (SUCH) groups, respectively. There were 48 patients with CH, 56 patients with MUCH, and 51 patients with SUCH. Both MUCH and SUCH groups had a significantly higher CAVI than the CH group (9.05 (8.20-9.91) vs. 8.33 (7.75-9.15), p = 0.017, and 9.75 (8.35-10.50) vs. 8.33 (7.75-9.15), p = 0.002, respectively). There was no significant difference in CAVI values between the MUCH and SUCH groups. Multinomial logistic regression analysis exhibited that compared with the CH group, increased CAVI levels were positively associated with the presence of MUCH and SUCH (OR 2.046, 95% CI (1.239-3.381), p = 0.005; OR 2.215, 95% CI (1.310-3.747), p = 0.003) after adjusting for confounders. However, there was a similar trend of the CAVI in the MUCH and SUCH groups (OR 0.924, 95% CI (0.629-1.356), p = 0.686). In summary, our findings support, for the first time, the novel notion that CAVI as an arterial stiffness parameter is an independent risk factor for MUCH, being equally important to MUCH and SUCH. When the assessed CAVI is high in hypertensive patients with normotensive office BP levels, it is necessary to further investigate with a 24 h ambulatory BP monitoring to estimate the longstanding BP control. CAVI may be used as a noninvasive indicator to identify patients with MUCH earlier.

Reproducibility of sequential ambulatory blood pressure and pulse wave velocity measurements in normotensive and hypertensive individuals.

Errors in blood pressure (BP) measurement account for a large proportion of misclassified hypertension diagnoses. Ambulatory blood pressure monitoring (ABPM) is often considered to be the gold standard for measurement of BP, but uncertainty remains regarding the degree of measurement error. The aim of this study was to determine reproducibility of sequential ABPM in a population of normotensive and well controlled hypertensive individuals. Individual participant data from three randomized controlled trials, which had recorded ABPM and carotid-femoral pulse wave velocity (PWV) at least twice were combined ( n = 501). We calculated within-individual variability of daytime and night-time BP and compared the variability between normotensive ( n = 324) and hypertensive ( n = 177) individuals. As a secondary analysis, variability of PWV measurements was also calculated, and multivariable linear regression was used to assess characteristics associated with blood pressure variability (BPV). Within-individual coefficient of variation (CoV) for systolic BP was 5.4% (day) and 7.0% (night). Equivalent values for diastolic BP were 6.1% and 8.4%, respectively. No statistically significant difference in CoV was demonstrated between measurements for normotensive and hypertensive individuals. Within-individual CoV for PWV exceeded that of BP measurements (10.7%). BPV was associated with mean pressures, and BMI for night-time measurements. PWV was not independently associated with BPV. The variability of single ABPM measurements will still yield considerable uncertainty regarding true average pressures, potentially resulting in misclassification of hypertensive status and incorrect treatment regimes. Repeated ABPM may be necessary to refine antihypertensive therapy.

Twenty-Four-Hour Central Hemodynamic Load in Adults With and Without a History of COVID-19.

BACKGROUNDAlthough hypertension is an established risk factor for severe COVID-19 illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared to brachial BP measures taken at a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM.METHODSCross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29±13 years, 22 females) and 43 adults without a history of COVID-19 (28±12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR).RESULTSParticipants who tested positive for COVID-19 experienced 6±4 COVID-19 symptoms, were studied 122±123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in any of our 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (p > 0.05 for all).CONCLUSIONSNo differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load.

Ambulatory blood pressure monitoring using telemedicine: proof-of-concept cohort and failure modes and effects analyses

Background: The COVID-19 pandemic has accelerated adoption of remote consulting in healthcare. Despite opportunities posed by telemedicine, most hypertension services in Europe have suspended ambulatory blood pressure monitoring (ABPM). Methods: We examined the process and performance of remotely delivered ABPM using two methodologies: firstly, a Failure Modes and Effects Analysis (FMEA) and secondly, a quantitative analysis comparing ABPM data from a subgroup of 65 participants of the Screening for Hypertension in the INpatient Environment (SHINE) diagnostic accuracy study. The FMEA was performed over seven sessions from February to March 2021, with a multidisciplinary team comprising a patient representative, a research coordinator with technical expertise and four research clinicians. Results: The FMEA identified a single high-risk step in the remote ABPM process. This was cleaning of monitoring equipment in the context of the COVID-19 pandemic, unrelated to the remote setting. A total of 14 participants were scheduled for face-to-face ABPM appointments, before the UK March 2020 COVID-19 lockdown; 62 were scheduled for remote ABPM appointments since emergence of the COVID-19 pandemic between November 2020 and August 2021. A total of 65 (88%) participants completed ABPMs; all obtained sufficient successful measurements for interpretation. For the 10 participants who completed face-to-face ABPM, there were 402 attempted ABPM measurements and 361 (89%) were successful. For the 55 participants who completed remote ABPM, there were 2516 attempted measurements and 2214 (88%) were successful. There was no significant difference in the mean per-participant error rate between face-to-face (0.100, SD 0.009) and remote (0.143, SD 0.132) cohorts (95% CI for the difference -0.125 to 0.045 and two-tailed P-value 0.353). Conclusions: We have demonstrated that ABPM can be safely and appropriately provided in the community remotely and without face-to-face contact, using video technology for remote fitting appointments, alongside courier services for delivery of equipment to participants.

Smartwatch-Based Blood Pressure Measurement Demonstrates Insufficient Accuracy.

BackgroundNovel smartwatch-based cuffless blood pressure (BP) measuring devices are coming to market and receive FDA and CE labels. These devices are often insufficiently validated for clinical use. This study aims to investigate a recently CE-cleared smartwatch using cuffless BP measurement in a population with normotensive and hypertensive individuals scheduled for 24-h BP measurement.MethodsPatients that were scheduled for 24-h ambulatory blood pressure monitoring (ABPM) were recruited and received an additional Samsung Galaxy Watch Active 2 smartwatch for simultaneous BP measurement on their opposite arm. After calibration, patients were asked to measure as much as possible in a 24-h period. Manual activation of the smartwatch is necessary to measure the BP. Accuracy was calculated using sensitivity, specificity, positive and negative predictive values and ROC curves. Bland-Altman method and Taffé methods were used for bias and precision assessment. BP variability was calculated using average real variability, standard deviation and coefficient of variation.ResultsForty patients were included. Bland-Altman and Taffé methods demonstrated a proportional bias, in which low systolic BPs are overestimated, and high BPs are underestimated. Diastolic BPs were all overestimated, with increasing bias toward lower BPs. Sensitivity and specificity for detecting systolic and/or diastolic hypertension were 83 and 41%, respectively. ROC curves demonstrate an area under the curve (AUC) of 0.78 for systolic hypertension and of 0.93 for diastolic hypertension. BP variability was systematically higher in the ABPM measurements compared to the smartwatch measurements.ConclusionThis study demonstrates that the BP measurements by the Samsung Galaxy Watch Active 2 show a systematic bias toward a calibration point, overestimating low BPs and underestimating high BPs, when investigated in both normotensive and hypertensive patients. Standards for traditional non-invasive sphygmomanometers are not met, but these standards are not fully applicable to cuffless devices, emphasizing the urgent need for new standards for cuffless devices. The smartwatch-based BP measurement is not yet ready for clinical usage. Future studies are needed to further validate wearable devices, and also to demonstrate new possibilities of non-invasive, high-frequency BP monitoring.

AMBULATORY BLOOD PRESSURE MONITORING IN HUNGARY: THE FIRST CROSS-SECTIONAL RESULTS OF AN OPEN LABEL, PROSPECTIVE, OBSERVATIONAL STUDY

Objective: Background: Ambulatory blood pressure monitoring (ABPM) is gold standard method in the diagnosis and follow-up of hypertensive patients. There is no systematic assessment on the daily practice of the utilization of ABPM in Hungary. Aim: The goal of the project is to assess the indication and the number of monitoring, and to analyze the blood pressure results. Design and method: This is a multicenter, open-label, observational non-interventional study. Data collection is performed in GPs’ practices and in outpatient clinics of cardiology and internal medicine. Meditech ABPM-06 monitors are used for ABPM measurements. Basic patients’ data are documented in an eCRF and all ABPM data are transferred through a closed online surface into the database for further analysis. Results: 7498 ABPM were performed between 21st of February and 21st of December, 2021. The monitoring was performed mainly by GPs (62%). The average age of the patients was 54.4 years (12–96 years). More than half of the patients (54%) were female. The indication of ABPM was elevated blood pressure (BP) at home (59.7%), labile BP (41.5%), therapy control (17.0%), suspicion of white coat hypertension (13.5%), suspicion of masked hypertension (2.5%), suspicion of nocturnal hypertension (3.2%) and suspicion of secondary hypertension (1.3%). The average duration of hypertension among hypertensive patients was 9.8 years (1–73 years). 32.6% of the patients were newly diagnosed as hypertensive. The average 24-hour systolic blood pressure was 133.9 mmHg, the average diastolic blood pressure was 79.3 mmHg, while the average pulse rate was 73.2 beats/min. The 24-hour average percent time elevation of systolic and diastolic blood pressure was 53.0% and 38.8%, respectively. The average systolic diurnal index was 9.6%, the average diastolic diurnal index was 13.3%. Conclusions: The two most frequent indication for ABPM in the routine practice are elevated home BP and labile BP values. One third of the patients was newly diagnosed as hypertensive subject. ABPM was performed mainly in patients with uncontrolled hypertension. The routine use of ABPM may increase the awareness of hypertension.

Ambulatory blood pressure monitoring using telemedicine: proof-of-concept cohort and failure modes and effects analyses.

Background: The COVID-19 pandemic has accelerated adoption of remote consulting in healthcare. Despite opportunities posed by telemedicine, most hypertension services in Europe have suspended ambulatory blood pressure monitoring (ABPM). Methods: We examined the process and performance of remotely delivered ABPM using two methodologies: firstly, a Failure Modes and Effects Analysis (FMEA) and secondly, a quantitative analysis comparing ABPM data from a subgroup of 65 participants of the Screening for Hypertension in the INpatient Environment (SHINE) diagnostic accuracy study. The FMEA was performed over seven sessions from February to March 2021, with a multidisciplinary team comprising a patient representative, a research coordinator with technical expertise and four research clinicians. Results: The FMEA identified a single high-risk step in the remote ABPM process. This was cleaning of monitoring equipment in the context of the COVID-19 pandemic, unrelated to the remote setting. A total of 14 participants were scheduled for face-to-face ABPM appointments, before the UK March 2020 COVID-19 lockdown; 62 were scheduled for remote ABPM appointments since emergence of the COVID-19 pandemic between November 2020 and August 2021. A total of 65 (88%) participants completed ABPMs; all obtained sufficient successful measurements for interpretation. For the 10 participants who completed face-to-face ABPM, there were 402 attempted ABPM measurements and 361 (89%) were successful. For the 55 participants who completed remote ABPM, there were 2516 attempted measurements and 2214 (88%) were successful. There was no significant difference in the mean per-participant error rate between face-to-face (0.100, SD 0.009) and remote (0.143, SD 0.132) cohorts (95% CI for the difference -0.125 to 0.045 and two-tailed P-value 0.353). Conclusions: We have demonstrated that ABPM can be safely and appropriately provided in the community remotely and without face-to-face contact, using video technology for remote fitting appointments, alongside courier services for delivery of equipment to participants.

Lymphocyte to monocyte ratio and blood pressure variability in childhood hypertension-a pilot study.

The investigation of inflammatory background of hypertension (HTN) concentrates mainly on patients with primary HTN. The aim of the study was to analyze the role of new parameters of inflammation-lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR), in the population of children with primary (pHTN) and secondary renal hypertension (rHTN). The study group consisted of 70 children with pHTN, 46 patients with rHTN, and 30 age-matched normotensive controls. The retrospective analysis focused on the evaluation of LMR, NLR, and PLR values in relation to blood pressure (BP) parameters from in-office and ambulatory BP monitoring measurements. Twenty-four hours, daytime, and nighttime periods were evaluated. Blood pressure variability (BPV) was defined by standard deviation and coefficient of variation of analyzed values. LMR and NLR values in HTN patients differed significantly vs. controls. Dippers with pHTN demonstrated significant correlations between LMR, NLR, PLR, and markers of BPV, in 24 h and daytime diastolic BP and mean arterial pressure. In dippers with rHTN such correlations concerned only LMR. LMR may become a promising marker of BPV, useful in children with primary and secondary hypertension. Lymphocyte to monocyte ratio is a novel marker of blood pressure variability, connected to target-organ damage, in children with primary and secondary renal hypertension. Our study analyzes for the first time the connections between blood cell count-driven inflammatory markers (lymphocyte to monocyte, neutrophil to lymphocyte, and platelet to lymphocyte ratios) and parameters of blood pressure variability, and compares those ratios in children with primary and secondary hypertension. The increasing incidence of hypertension among children urges the search for simple methods of assessment of its complications. LMR may be of added value in the analysis of the inflammatory background of hypertension.