Ambulatory Blood Pressure Monitoring Profile Research Articles

Ambulatory blood pressure monitoring profiles in Asia.

High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.

Ambulatory blood pressure monitoring in pediatric patients with sickle cell anemia.

Sickle cell anemia (SCA) is a hemoglobinopathy presenting severe endothelial damage associated with increased prevalence of hypertension (HTN). Few studies have used ambulatory blood pressure monitoring (ABPM) in pediatric patients with SCA. The aim of this study was to characterize the ABPM profile in children with SCA. A retrospective cross-sectional study was conducted on all subjects <18 years of age with SCA who presented at a medical reference center in the city of Cartagena, Colombia. Anthropometric, clinical laboratory, treatment, and ABPM parameters, including ambulatory arterial stiffness index (AASI) were registered. The study included 79 patients, of these, 23 (29%) children had normal BP, 49 (62%) had abnormal BP and 7 (9%) had HTN. Mean age was 10.5 ± 3.6 years and 44 (56%) cases were male. Forty-eight (60%) patients had pre-HTN. Masked HTN was present in 6 (8%) patients. One (1%) had ambulatory HTN, and another one (1%) had white coat HTN. The HTA group exhibited significantly higher systolic BP and diastolic BP compared to the other groups in 24-hour BP readings, daytime BP, and night-time BP ABPM parameters ( P < 0.05), except for daytime DBP ( P = 0.08). Mean AASI was 0.4 ± 0.2. The HTN group had the highest AASI value compared to the other groups ( P = 0.006). Significant alterations in ABPM parameters are frequently observed in pediatric patients with SCA. The incorporation of ABPM, along with the assessment of AASI, is recommended for a comprehensive evaluation of cardiovascular and renal risk in SCA patients.

Antihypertensive medication nonadherence and target organ damage in children with chronic kidney disease.

Nonadherence is common in children with chronic kidney disease (CKD). This may contribute to inadequate blood pressure control and adverse outcomes. This study examined associations between antihypertensive medication nonadherence, ambulatory blood pressure monitoring (ABPM) parameters, kidney function, and cardiac structure among children with CKD. We performed secondary analyses of data from the CKD in Children (CKiD) study, including participants with treated hypertension who underwent ABPM, laboratory testing, and echocardiography biannually. Nonadherence was defined by self-report of any missed antihypertensive medication 7days prior to the study visit. Linear regression and mixed-effects models were used to assess the association of nonadherence with baseline and time-updated ABPM profiles, estimated glomerular filtration rate (eGFR), urine protein to creatinine ratio (UPCR), and left ventricular mass index (LVMI). Five-hundred and eight participants met inclusion criteria, followed for a median of 2.9years; 212 (42%) were female, with median age 13years (IQR 10-16), median baseline eGFR 49 (33-64) ml/min/1.73m2 and median UPCR 0.4 (0.1-1.0) g/g. Nonadherence occurred in 71 (14%) participants. Baseline nonadherence was not significantly associated with baseline 24-h ABPM parameters (for example, mean 24-h SBP [β - 0.1, 95% CI - 2.7, 2.5]), eGFR (β 1.0, 95% CI - 0.9, 1.2), UCPR (β 1.1, 95% CI - 0.8, 1.5), or LVMI (β 0.6, 95% CI - 1.6, 2.9). Similarly, there were no associations between baseline nonadherence and time-updated outcome measures. Self-reported antihypertensive medication nonadherence occurred in 1 in 7 children with CKD. We found no associations between nonadherence and kidney function or cardiac structure over time. A higher resolution version of the Graphical abstract is available as Supplementary information.

Postpartum Detection of Diastolic Dysfunction and Nondipping Blood Pressure Profile in Women With Preeclampsia.

Left ventricular diastolic dysfunction and nocturnal "nondipping" of blood pressure detected via ambulatory blood pressure monitoring are predictors of increased cardiovascular morbidity. A prospective cohort study including normotensive women with a history of preeclampsia in their current pregnancy was conducted. All cases were subjected to 24-hour ambulatory blood pressure monitoring and 2-dimensional transthoracic echocardiography 3 months after delivery. This study included 128 women with a mean (SD) age of 28.6 (5.1) years and a mean (SD) basal blood pressure of 123.1 (6.4)/74.6 (5.9) mm Hg. Among the participants, 90 (70.3%) exhibited an ambulatory blood pressure monitoring profile illustrating nocturnal blood pressure "dipping" (the mean night to day time blood pressure ratio ≤ 0.9), whereas 38 (29.7%) were nondippers. Diastolic dysfunction (impaired left ventricular relaxation) was present in 28 nondippers (73.7%), whereas none of the dippers exhibited diastolic dysfunction. Women with severe preeclampsia were more frequently nondippers (35.5% vs 24.2%; P = .02) and experienced diastolic dysfunction (29% vs 15%; P = .01) than were those with mild preeclampsia. Severe preeclampsia (odds ratio [OR], 1.08; 95% CI, 1.05-10.56; P < .001) and history of recurrent preeclampsia (OR, 1.36; 95% CI, 1.3-4.26; P ≤ .001) were significant predictors for nondipping status and diastolic dysfunction (OR, 1.55; 95% CI, 1.1-2.2; and OR, 1.23; 95% CI, 1.2-2.2, respectively; P < .05). Women with a history of preeclampsia were at higher risk for developing late cardiovascular events. The severity and recurrence of preeclampsia were significant predictors of both nondipping profile and diastolic dysfunction.

JS-NG-7: ASSOCIATION BETWEEN PLASMA ALDOSTERONE CONCENTRATION AND AMBULATORY BLOOD PRESSURE PROFILE IN PATIENTS WITH PRIMARY ALDOSTERONISM

Background: Primary aldosteronism (PA) is a major cause of curable hypertension with its morbidity rate 5–10% in hypertensive patients reported, and thus is highly prevalent in patients with hypertension, a cause of resistant hypertension, and closely associated with target organ damage compared with essential hypertension. Although an altered circadian blood pressure (BP) rhythm estimated by ambulatory blood pressure monitoring (ABPM) has been highlighted as a major contributor of CVD in essential hypertension, there would be very few reports investigating clinical significance of ABPM in PA patients. Therefore, we aimed to examine a possible association between plasma aldosterone concentration (PAC) and ABPM profile in PA patients. Methods: Consecutive 27 PA patients, who had been diagnosed by the functional tests and underwent adrenal venous sampling (AVS) from April 2015 to March 2020, were included in this study. All clinical indexes including 24-hour ABPM were measured during the hospitalization, and all participants received dietary salt restriction with 6 g/day of salt. The 24-hour ABPM was performed from the first day of hospitalization to the next day, and AVS was performed on the third day in the morning. Regarding PAC measurement, we collected blood samples during AVS. After resting for 30 minutes in a supine position, blood samples were collected from inferior vena cava by catheterization. During AVS, we also performed ACTH stimulation, and blood samples were collected essentially 1 hour after the stimulation. Results: We firstly analyzed a correlation between PAC and ABPM profile and found that PAC measured after ACTH stimulation (post-PAC) was negatively correlated with nocturnal dipping rate in both systolic and diastolic BPs (SBP and DBP) (R = -0.430, P = 0.025, and R = -0.431, P = 0.025, respectively), while PAC measured before ACTH stimulation (pre-PAC) was not. Thus, according to the median of post-PAC, we divided participants into lower PAC and higher PAC groups and compared clinical characteristics between the two groups. Compared to the lower PAC group, nocturnal SBP and DBP dipping rates and serum potassium levels were significantly decreased in the higher PAC group (SBP dipping 10.3 ± 6.4 vs 3.5 ± 7.7 %, P = 0.02; DBP dipping 13.6 ± 7.7 vs 5.5 ± 6.3 %, P = 0.01; serum potassium 4.1 ± 0.3 vs 3.7 ± 0.4 mEq/L, P = 0.03). Conclusions: In this cross-sectional study, higher PAC was significantly associated with a non-dipper circadian BP profile characterized by lower nocturnal BP dipping rates in PA patients. Prospective longitudinal study is warranted to seek for a causal relationship between hyperaldosteronism and ABPM profile.

Complement Factor H and Related Proteins as Markers of Cardiovascular Risk in Pediatric Chronic Kidney Disease.

Cardiovascular disease (CVD) is the main cause of mortality among chronic kidney disease (CKD) patients, both in adults and in children. Hypertension is one of the risk factors of CVD. For early detection of subclinical CVD in pediatric CKD, 24 h ambulatory blood pressure monitoring (ABPM), cardiosonography, and arterial stiffness assessment were evaluated. CAKUT (congenital anomalies of the kidney and urinary tract) are the main etiologies of pediatric CKD. Previously, by a proteomic approach, we identified complement factor H (CFH) and related proteins differentially expressed between children with CAKUT and non-CAKUT CKD. In this study, we aimed to evaluate whether CFH, CFH-related protein-2 (CFHR2), and CFH-related protein-3 (CFHR3) were related to CVD risk in children with CKD. This study included 102 subjects aged 6 to 18 years old. The non-CAKUT group had higher plasma CFHR3 levels than the CAKUT group (p = 0.046). CFHR3 was negatively correlated with LV mass (p = 0.009). CFHR2 was higher in children with CKD with 24 h hypertension in the ABPM profile (p < 0.05). In addition, children with non-CAKUT CKD with day-time hypertension (p = 0.036) and increased BP load (p = 0.018) displayed a lower plasma CFHR3 level. Our results highlight that CFH and related proteins play a role for CVD in children with CKD. Early assessment of CFH, CFHR2, and CFHR3 may have clinical utility in discriminating CV risk in children with CKD with different etiologies.

AMBULATORY BLOOD PRESSURE MONITORING PARAMETERS IN HYPERTENSIVE PATIENTS WITH ABDOMINAL OBESITY IN THE DYNAMICS OF OLMESARTAN/ AMLODIPINE THERAPY

Objective: Study the ambulatory blood pressure monitoring (ABPM) parameters in patients with arterial hypertension (AH) with abdominal obesity (AO) in the dynamics of antihypertensive therapy. Design and method: 60 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: olmesartan and amlodipine once a day in the morning at doses: 20 mg / 5- 40 /10 mg. ABPM was performed according to the standard method before and after 6 months of treatment. Results: 24-hour systolic BP (SBP) and diastolic BP (DBP) in patients were 150 (140–159) / 98 (82–105) mm Hg. 24-hour pulse BP - 58 (50–64) mm Hg. Daytime SBP variability in patients was 19 (12–25) mm Hg, daytime DBP variability was 15 (9–19) mm Hg. SBP variability at night was 15 (9–17) mm Hg, DBP variability at night was 13 (8–15) mm Hg. As a result of treatment, the target BP level was achieved in 80% of patients according to the office BP and in 60% -according to the ABPM. The number of patients with pathological variability of BP decreased from 49% to 23% (p &lt; 0.05). An excessive morning rise in SBP at the beginning of the study was noted in 32% of patients, and at the end of the observation - in 11% (p &lt; 0.05). The number of patients with nocturnal hypertension decreased from 42% to 15% after 6 months of treatment (p &lt; 0.001). The distribution of patients by BP profiles revealed that at the beginning of the study «dipper» was in 40% of the patients, «over-dipper» - in 12%, «non-dipper» - in 38%, and «night-picker»- in 6%. After 6 months of treatment the number of patients with the «dipper» profile of ABPM increased to 88%, and with «over-dipper» decreased to 6%. The number of patients with unfavorable «non-dipper» and «night-picker» profiles of ABPM decreased to 5%(p &lt; 0.05) and 1% (p &gt; 0.05), respectively. Conclusions: The fixed combination of olmesartan/ amlodipine led to the normalization of parameters of the ABPM profile in hypertensive patients with AO.

Cardiovascular Disease Risk in Children With Chronic Kidney Disease: Impact of Apolipoprotein C-II and Apolipoprotein C-III.

Cardiovascular disease (CVD) is an evolving process that begins in the early stages of chronic kidney disease (CKD) in children. Several surrogate markers, such as ambulatory blood pressure monitoring (ABPM), left ventricular (LV) mass, and arterial stiffness assessment, allow for the early detection of subclinical CVD in pediatric CKD. Four groups of plasma samples (n = 3/group) from congenital anomalies of the kidney and urinary tract (CAKUT), as well as non-CAKUT patients with or without BP abnormalities, were studied to screen differentially expressed proteins using isobaric tags for relative and absolute protein quantification (iTRAQ)-based proteomics. As a result, 20 differentially expressed proteins associated with hypertension in children with CKD were discovered. Among them, apolipoprotein C-II (apoC-II) was found to have the highest abundance among the CKD patients with hypertension. As such, we hypothesized that apoC-II and apolipoprotein C-III (apoC-III) levels were related to BP abnormalities and CVD in children suffering from mild-to-moderate CKD. We examined their associations with surrogate markers of CV risk in 88 pediatric patients with CKD stages G1–G4. Children with CKD stages G2–G4 had a higher plasma apoC-II level than G1 patients (6.35 vs. 5.05 mg/dl, p < 0.05). We observed that ABPM abnormalities, LV mass, and arterial stiffness parameters were greater in CKD children who had stages G2–G4 than in those who had stage G1 (all p < 0.05). Plasma levels of apoC-II and apoC-III were positively correlated with total cholesterol, triglyceride, and low-density lipoprotein (LDL) (all p < 0.001). In multivariate linear regression analyses, apoC-II was correlated with a high LV mass index and an abnormal ABPM profile, and apoC-III was correlated with 24-h hypertension (r = 0.303, p = 0.003) and asleep hypertension (r = 0.379, p < 0.001). Early evaluations of apoC-II and apoC-III, ABPM, and surrogate markers of CV risk will aid in early preventative interventions to reduce the risk of CV in youths suffering from CKD.

PREVALENCE AND PREDICTORS OF HYPOTENSION IN NURSING HOME RESIDENTS UNDERGOING AMBULATORY BLOOD PRESSURE MONITORING

Objective: In nursing home (NH) residents, hypotension may predispose to adverse events including falls, fractures and mortality. Yet, evidence on hypotension detected by ambulatory blood pressure monitoring (ABPM) is scarce in this setting. This study aimed to determine the prevalence and the clinical predictors of ambulatory hypotension in NH residents and to analyze its related ABPM profile. Design and method: We retrospectively analysed data from a sample of 100 NH residents undergoing a comprehensive geriatric assessment and ABPM. Ambulatory hypotension was defined as a systolic blood pressure (SBP) drop of 20 mmHg or greater between two consecutive measurements to a minimum SBP &lt; 100 mmHg. Participants with nocturnal hypotension were excluded from the analysis. Predictors of ambulatory hypotension were investigated using multivariate logistic regression adjusted for comorbidities, functional status and hypotensive medications. Results: Among 91 residents (mean age 83, 56% female), 50 showed ambulatory hypotension. They had a higher prevalence of heart failure (p = 0.02) and atrial fibrillation (p = 0.007) and more commonly received digoxin (p = 0.001) and benzodiazepines (p = 0.015). At ABPM they had lower 24 h, daytime and nighttime SBP (p &lt; 0.001) and more frequently showed a white coat effect (p &lt; 0.001) and a reverse-dipping profile (p = 0.013). At multivariate analysis, benzodiazepines (OR 4.040), digoxin (OR 19.987) and creatinine &lt; 1 mg/dl (OR 3.939) were independently associated with ambulatory hypotension. Conclusions: Hypotension is common in NH residents undergoing ABPM and more frequently occurs in subjects with lower ambulatory SBP, a reverse dipping profile and a white coat effect. Benzodiazepines, digoxin and low creatinine are predictors of ambulatory hypotension in NH residents.

Impact of the ambulatory blood pressure monitoring profile on cognitive and imaging findings of cerebral small-vessel disease in older adults with cognitive complaints

We investigated ambulatory blood pressure (BP) monitoring (ABPM) profiles and magnetic resonance imaging (MRI) findings of cerebral small-vessel disease (cSVD) in older adults with cognitive complaints who were grouped as follows: subjective cognitive decline, mild cognitive impairment, and dementia of Alzheimer’s type. Group comparisons and correlation analyses among demographic characteristics, cognitive and MRI findings, and ABPM profiles were performed. Furthermore, multivariate logistic regression analyses for dependent variables of (1) dementia or not and (2) MRI criteria of subcortical vascular dementia (SVaD) or not were conducted with independent variables of dichotomized ABPM profiles. A total of 174 subjects (55 males and 119 females) were included: mean age 75.36 ± 7.13 years; Mini-Mental State Examination (MMSE) score 20.51 ± 6.23. No MRI and ABPM findings except medial temporal atrophy were different between three groups. Twenty-four-hour systolic BP (sBP) was correlated with MMSE score (r = –0.182; p = 0.022) and the severity of white matter hyperintensity (WMH) (r = 0.157; p = 0.048). A higher daytime sBP was associated with dementia (odds ratio (OR): 3.734; 95% confidence interval (CI): 1.041–13.390; p = 0.043) and MRI finding of SVaD (OR: 10.543; 95% CI: 1.161–95.740; p = 0.036). Although there were no differences in ABPM profiles between three groups, a higher BP—especially a higher sBP—correlated with cognitive dysfunction and severity of WMH in older adults. Only higher daytime sBP was an independent predictor for dementia and MRI findings of SVaD. Among various ABPM profiles in this study, a higher BP, especially a higher sBP, may be considered the most important for clinical and MRI findings of cSVD.

Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with high risk for cardiovascular disease (CVD). Gut microbiota-dependent metabolites trimethylamine (TMA), trimethylamine N-oxide (TMAO), and dimethylamine (DMA) have been linked to CKD and CVD. We examined whether these methylamines are correlated with cardiovascular risk in CKD children. A total of 115 children and adolescents with CKD stage G1–G4 were enrolled in this cross-sectional study. Children with CKD stage G2–G4 had higher plasma levels of DMA, TMA, and TMAO, but lower urinary levels of DMA and TMAO than those with CKD stage G1. Up to 53% of CKD children and adolescents had blood pressure (BP) abnormalities on 24-h ambulatory BP monitoring (ABPM). Plasma TMA and DMA levels inversely associated with high BP load as well as estimated glomerular filtration rate (eGFR). Additionally, CKD children with an abnormal ABPM profile had decreased abundance of phylum Cyanobacteria, genera Subdoligranulum, Faecalibacterium, Ruminococcus, and Akkermansia. TMA and DMA are superior to TMAO when related to high BP load and other CV risk factors in children and adolescents with early-stage CKD. Our findings highlight that gut microbiota-dependent methylamines are related to BP abnormalities and CV risk in pediatric CKD. Further studies should determine whether these microbial markers can identify children at risk for CKD progression.

Efficacy of fixed dose of triple combination of perindopril-indapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study

Background: Arterial hypertension (AH) remains the most common cardiovascular (CV) risk factor worldwide.&#x0D; Methods: Seventy five moderate-to-severe hypertensive patients with abdominal obesity aged from 48 to 66 years (45/30 men and women respectively) were selected from the entire cohort (n = 375) according to the inclusion and exclusion criteria. The patients were divided into two subgroups depending on the arm of antihypertensive therapy lines. The first subgroup of patients (n = 36) received a non-fixed combination of oral antihypertensive agents: perindopril (4–8 mg daily), indapamide (1.25–2.5 mg daily) and amlodopine (5–10 mg daily). The second subgroup of patients (n=39) received fixed-dosed combination of these antihypertensive agents aforementioned in the ranged doses (4 mg/1.25mg/5 mg; 4 mg/1.25mg/10 mg; 8 mg/2.5 mg/5 mg; 8 mg/2.5mg/10 mg) in the same manner. The examinations of the clinical status, office, and ambulatory blood pressure values were carried out at baseline in 3 and 6 months after study entry.&#x0D; Results: The frequencies of BP target levels after treatment were higher in the fixed-dose combination group than in the non-fixed combination (at 3 months: 80% versus 58%, p&lt;0.05 and at 6 months: 85% versus 53%, p&lt;0.05). The adherence to triple fixed-dose combination was also higher in comparison with one to non-fixed combination (at 3 months: 82% versus 64%, p&lt;0.05 and at 6 months: 87% versus 61%, p&lt;0.05). It has been established that low-dose of perindopril/indapamide/amlodopine (4mg/1.25/10mg and 8mg/2.5/5mg) were used frequently in fixed-dose combination cohort of patients than in non-fixed combination (15% versus 0%, P&lt;0.05, and 33% versus 19%, p&lt;0.05, respectively). At the same time, maximum doses of these agents (8mg/2.5mg/10mg) were required for achieving target BP levels in a significantly lower proportion of patients receiving fixed-dose combination as compared to patients receiving non-fixed combination (52% versus 81%, p&lt;0.05). Additionally, the triple fixed-dose combination has proved to be better in restoring ambulatory blood pressure monitoring profile than non-fixed combination.&#x0D; Conclusion: Achievement of target blood pressure levels in patients with uncontrolled arterial hypertension and abdominal obesity was possible at lower doses of perindopril, indapamide, and amlodipine when used as a fixed-dose combination rather than non-fixed (free) combination.&#x0D;

Blood Pressure Abnormalities Associated with Gut Microbiota-Derived Short Chain Fatty Acids in Children with Congenital Anomalies of the Kidney and Urinary Tract.

Both kidney disease and hypertension can originate from early life. Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of chronic kidney disease (CKD) in children. Since gut microbiota and their metabolite short chain fatty acids (SCFAs) have been linked to CKD and hypertension, we examined whether gut microbial composition and SCFAs are correlated with blood pressure (BP) load and renal outcome in CKD children with CAKUT. We enrolled 78 children with CKD stage G1–G4. Up to 65% of children with CAKUT had BP abnormalities on 24 h ambulatory blood pressure monitoring (ABPM). CKD children with CAKUT had lower risk of developing BP abnormalities and CKD progression than those with non-CAKUT. Reduced plasma level of propionate was found in children with CAKUT, which was related to increased abundance of phylum Verrucomicrobia, genus Akkermansia, and species Bifidobacterium bifidum. CKD children with abnormal ABPM profile had higher plasma levels of propionate and butyrate. Our findings highlight that gut microbiota-derived SCFAs like propionate and butyrate are related to BP abnormalities in children with an early stage of CKD. Early assessments of these microbial markers may aid in developing potential targets for early life intervention for lifelong hypertension prevention in childhood CKD.

Gut Microbiota-Dependent Trimethylamine N-Oxide Pathway Associated with Cardiovascular Risk in Children with Early-Stage Chronic Kidney Disease.

Despite cardiovascular disease (CVD) being the leading cause of morbidity and mortality in chronic kidney disease (CKD), less attention has been paid to subclinical CVD in children and adolescents with early CKD stages. Gut microbiota and their metabolite, trimethylamine N-oxide (TMAO), have been linked to CVD. Ambulatory blood-pressure monitoring (ABPM) and arterial-stiffness assessment allow for early detection of subclinical CVD. We therefore investigated whether gut microbial composition and TMAO metabolic pathway are correlated with blood-pressure (BP) load and vascular abnormalities in children with early-stage CKD. We enrolled 86 children with G1–G3 CKD stages. Approximately two-thirds of CKD children had BP abnormalities on ABPM. Children with CKD stage G2–G3 had a higher uric acid level (6.6 vs. 4.8 mg/dL, p < 0.05) and pulse-wave velocity (4.1 vs. 3.8 m/s, p < 0.05), but lower TMAO urinary level (209 vs. 344 ng/mg creatinine, p < 0.05) than those with stage G1. Urinary TMAO level was correlated with the abundances of genera Bifidobacterium (r = 0.307, p = 0.004) and Lactobacillus (r = 0.428, p < 0.001). CKD children with abnormal ABPM profile had a lower abundance of the Prevotella genus than those with normal ABPM (p < 0.05). Our results highlight the link between gut microbiota, microbial metabolite TMAO, BP load, and arterial-stiffness indices in children with early-stage CKD. Early assessments of these surrogate markers should aid in decreasing cardiovascular risk in childhood CKD.

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

ObjectiveTo assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. MethodsA total of 26170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, <0%). ResultsThe population were 52% female, aged 58±15 years, mean body mass index (BMI) 27±5 kg/m2. Using ABPM criteria of normalcy, 22.8% were normotensives (NT), 19.1% were untreated hypertensives, 29.7% were controlled hypertensives and 28.4% were treated but uncontrolled hypertensives. Among NT, 60.7% were white-coat hypertensive. In controlled hypertensives 62.4% had OBP ≥140/90 mmHg. In treated but uncontrolled hypertensives 8.2% had masked uncontrolled hypertension. ABPM values were lower than OBP in all cases. In all subgroups the most common pattern was D (42-50%), followed by ND (35-41%), ED (7-11%) and RD (4-11%). Age and BMI were determinants of attenuation of nocturnal BP fall and ND+RD. The proportion of ND+RD was higher in patients with BMI >30 kg/m2 vs. others (46.5 vs. 42.9%, p<0.01) and in those aged ≥65 vs. <65 years (54.9. vs. 33.1%, p<0.00). Nocturnal BP fall was greater in NT than in hypertensives (11.3±6.7 vs. 9.9±7.9%, p<0.000). ConclusionsThere was a marked discrepancy between office and ABPM values. The rates of control on ABPM were more than double those on OBP. Non-dipping occurred in >43%, including in NT. Age and BMI predicted non-dipping.

Peripheral artery disease and blood pressure profile abnormalities in hemodialysis patients.

Patients undergoing chronic hemodialysis (HD) are at increased risk for peripheral artery disease (PAD). Both ankle-brachial index (ABI) and ambulatory blood pressure monitoring (ABPM) in the interdialytic period have been shown to be strong predictors of all-cause mortality. This cross-sectional study investigated the relationship between ABPM profile and ABI in 81 HD patients. ABPM was measured throughout a 44-h midweek interdialytic period. Pre-dialysis ABI was evaluated with a BOSO ABI device. An ABI value <0.9 or ≥1.3 was defined as abnormal. In the whole study group (72% males, mean age 67±14years), there was an increase in BP (p<0.05) and in systolic BP night/day ratio (n/dSR, p=0.01) during the interdialytic period. Patients with abnormal ABI (n=29) more frequently had a positive history for cerebrovascular accident and PAD and higher proBNP values than those with normal ABI (n=52). No difference was detected among ABPM-derived components except for the n/dSR (p=0.02). Patients with abnormal ABI showed a significantly increased n/dSR (p=0.02) and ambulatory arterial stiffness index (AASI) (p=0.006) on the second day compared to the first. Patients with n/dSR >1 during day 2 (n=34) were older, showed significantly higher proBNP and AASI and were more likely to reveal abnormal ABI compared to those with a lower n/dSR (p=0.006). Abnormal ABI in HD patients is associated to changes in interdialytic ABPM pattern, namely higher n/dSR on day 2. These data may indicate the pathophysiological mechanisms underlying the worse outcome observed in HD patients.

Ambulatory Blood Pressure Monitoring Profile of Chronic Hemodialysis Patient in Hemodialysis Unit MRCCC Hospital Siloam Semanggi

Background: The leading cause of morbidity and mortality in hemodyalisis patients is Cardiovascular disease. Hypertension is the single most important factor for the development of cardiovascular complications. Diagnosing hypertension in hemodyalisis patients is not easy, it's because fluid retension effect, office hypertension, and ultrafiltration after hemodyalisis session. Gold standard for diagnosing hypertension in hemodialysis patient is interdialytic blood pressure measurment with Ambulatory Blood Pressure Monitoring (ABPM). Objective: To determine the ABPM profile of Chronic Hemodialysis Patient In MRCCC(Mochtar Riady Comprehensive Cancer Center) Siloam Hospital Hemodialysis Unit. Method: A cross sectional study design was conducted in five adult patients with chronic hemodialysis. Patients who fulfilled inclusion criteria were recruited for measuring their blood pressure using 24 hours ABPM. Result: Mean age of our patient is 54.8 years, 60% were men and 40% were women. Sistolic blood pressure from ABPM result is 147 mmHg (24.83), and diastolic blood pressure from ABPM result is 85 mmHg (13.72). The prevalence of hypertension in this study among chronic hemodialysis patient in MRCCC Siloam Hospital Hemodialysis Unit is 80%. From 5 of our patients 2(40%) have DM, 3(60%) without DM. We also found that 1(20%) patients have dipping pattern during night and 4(80%) patients without dipping pattern during night. In two of our diabetic patients all of them (100%) without dipping pattern during night. Conclusion: Hypertension is frequent in chronic hemodialysis patient, in diabetic patients non-dipping pattern more frequently seen, hypertension more accurately diagnose by ABPM in patient with chronic hemodialysis.

Clinical Implications

HomeHypertensionVol. 63, No. 3Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Mar 2014https://doi.org/10.1161/HYPERTENSIONAHA.114.03138Hypertension. 2014;63:421Standard Versus Tight Blood Pressure Control (page 475)Download figureDownload PowerPointAn aggressive approach towards blood pressure (BP) reduction has been tempered by studies, suggesting that an excessive BP lowering may be dangerous, particularly in patients with coronary artery disease (the so called J-shaped curve phenomenon). In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), we randomized 1111 non-diabetic patients with systolic BP ≥150 mm Hg to 2 different systolic BP targets (<140 mm Hg [standard control] or <130 mm Hg [tight control]). In this post hoc analysis, we stratified patients by the absence or presence of established cardiovascular disease at entry. The primary study outcome, ECG left ventricular hypertrophy 2 years after randomization, occurred less frequently in the tight than in the standard control group to a similar extent in the subgroups without and with established cardiovascular disease at entry (P for interaction=0.82). A composite of cardiovascular events and all-cause death (main secondary outcome) also occurred less frequently in the tight than in the standard control group in patients without and with previous cardiovascular disease. Thus, an intensive antihypertensive strategy with systolic BP goal <130 mm Hg reduces left ventricular hypertrophy and improves clinical outcomes to a similar extent in hypertensive patients with and without established cardiovascular disease. These results may remove the fear that a systolic BP target <130 mm Hg would be potentially dangerous in hypertensive patients with established coronary or cerebrovascular disease.Blood Pressure and Target Organ Damage in Polycystic Ovary Syndrome (page 624)Download figureDownload PowerPointThe polycystic ovary syndrome (PCOS) affects 5% to 10% of premenopausal women worldwide. Besides cutaneous and reproductive abnormalities, these women gather a constellation of cardiovascular risk factors from early ages in relation to their androgen excess and to the frequent association with insulin resistance and obesity. Nonetheless, whether these patients present with abnormalities in the blood pressure regulation is still controversial. To provide answer to this important issue, we compared the office and ambulatory blood pressure monitoring profiles and echocardiographic parameters of a cohort of women with PCOS with those of non-hyperandrogenic women and men. We showed that several blood pressure recordings of the patients with PCOS and weight excess resembled those of men and were increased compared with those of non-hyperandrogenic women. Furthermore, overweight patients with PCOS had frequencies of undiagnosed hypertension mirroring those of men with weight excess. Undiagnosed hypertension in women with PCOS was accompanied by an increase in left ventricular mass, suggesting early target organ damage as well. The main determinants of these disturbances in patients with PCOS were obesity, sympathetic overactivation, and hyperandrogenemia. These findings may have important clinical implications in a highly prevalent condition, such as PCOS, warranting a comprehensive cardiovascular evaluation in these women to identify, treat, and prevent cardiovascular events at the long term.Refractory Hypertension: Prevalence, Risk Factors (page 451)Download figureDownload PowerPointRefractory hypertension refers to a phenotype of antihypertensive failure. The initial description of this hypertensive subgroup was based on a retrospective analysis of patients referred to a hypertension specialty clinic. In this prior analysis, refractory hypertension was diagnosed if blood pressure remained uncontrolled after a minimum of 6 months of treatment by a hypertension specialist. Of 308 consecutive patients evaluated for resistant hypertension, 29, or ≈10%, were refractory to treatment, despite treatment with an average of 6 medications, including chlorthalidone and spironolactone. In this issue of Hypertension, the prevalence, risk factors, and comorbidities of patients with refractory hypertension were evaluated in a population-based cohort, the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study (n=30 239). Of the 49% of participants with hypertension, 14.5% had resistant hypertension (blood pressure >140/90 mm Hg on ≥3 classes of antihypertensive agents or <140/90 mm Hg on ≥4 classes), whereas only 78% or 0.5% were refractory to treatment defined as blood pressure >140/90 mm Hg on ≥5 classes of agents, which included a diuretic in all cases. Compared with all hypertensive participants, refractory hypertension was associated with black race, men, living in the stroke belt or buckle, higher body mass index, chronic kidney disease, diabetes mellitus, and history of stoke or coronary artery disease. These findings indicate that refractory hypertension, or antihypertensive failure, is extremely rare. Previous Back to top Next FiguresReferencesRelatedDetails March 2014Vol 63, Issue 3 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.114.03138 Originally publishedMarch 1, 2014 PDF download Advertisement

High Citrulline-to-Arginine Ratio Associated With Blood Pressure Abnormalities in Children With Early Chronic Kidney Disease

Nitric oxide (NO) is involved in hypertension and chronic kidney disease (CKD). NO synthase can metabolize L-arginine (ARG) to generate NO and L-citrulline (CIT). Two methylated ARG derivatives, asymmetric and symmetric dimethylarginine, are also involved in NO deficiency. Thus it was hypothesized that their combined ratios relate to blood pressure (BP) abnormalities in children with early CKD. The relationship between these ARG metabolites in plasma was examined using 24-h ambulatory BP monitoring (ABPM) profile in children and adolescents with CKD stages 1-3 (n=44). Approximately 20.4% (9/44) of children with CKD stages 1-3 were diagnosed with hypertension on clinical BP measurement, and 77.3% (33/44) had BP abnormalities on ABPM, including increased BP load, nocturnal BP non-dipping, and nocturnal hypertension. Children with CKD stages 2-3 were more prevalent with abnormal BP on ABPM, and had a higher level of CIT and CIT-to-ARG ratio than those with stage 1. Furthermore, high CIT-to-ARG ratio was significantly correlated with abnormal ABPM profile, including nocturnal hypertension, increased diastolic BP load, and nocturnal BP non-dipping. Higher CIT level was significantly correlated with increased diastolic BP load and overall ABPM profile. Plasma CIT-to-ARG ratio may serve as a useful marker of cardiovascular outcome in children with early CKD.