Ambulatory Blood Pressure Monitoring Results Research Articles

Performance of home-based and ambulatory blood pressure monitoring in obese children and their correlation with end organ damage.

The increasing prevalence of childhood obesity has led to a corresponding increase in hypertension among children, necessitating early identification of subclinical target organ damage for accurate cardiovascular risk assessment. However, in the pediatric population, there is a paucity of literature comparing ambulatory and home blood pressure monitoring, and this knowledge gap is exacerbated by limited access to ambulatory blood pressure monitoring (ABPM) facilities, particularly in developing countries, where pediatricians often resort to home blood BP monitoring as the preferred option. In this cross-sectional study with 60 obese children (aged 5-18 years) at a tertiary health care in central India, we aimed to comprehensively characterize blood pressure profiles, including office, ambulatory and home and investigated their correlations with indicators of end-organ damage. Among 60 children, 26 (43.3%) participants were found to be hypertensive based on 24 Hr ABPM evaluation. Masked hypertension and white coat hypertension (WCH) were observed in 21.6% and 13.3% respectively. Surprisingly, 20% of participants were identified as hypertensive through 7-day home BP monitoring (HBPM). A notable discordance of 36.6% was between HBPM and ABPM results. Moreover, 26.7% of the children had end-organ damage, with higher odds associated with night-time systolic ambulatory hypertension in the adjusted regression model (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001). The study highlights 24-hour ABPM's vital role in classifying hypertensive status, especially in high-risk children. The diagnostic performance of HBPM shows poor sensitivity in detecting MH and lower specificity in identifying WCH compared to ABPM. This limitation translates to missed opportunities for early preventive interventions.

Time to Change Our Viewpoints to Assess Renal Risks in Patients with Solitary Kidneys beyond Traditional Approaches?

Solitary functioning kidney (SFK) can be defined as the absence or hypofunction of a kidney due to acquired or congenital reasons. A congenital solitary functioning kidney (cSFK) is more common than is an acquired one (aSFK) and is characterized by the anatomical absence (agenesis) or hypofunction (hypoplasia; hypodysplasia) of one kidney from birth. Among the acquired causes, the most important is nephrectomy (Nx) (due to the donor, trauma or mass resection). Patients with SFK are at risk for the development of chronic kidney disease (CKD) in the long term. This risk potential is also significantly affected by hypertension. The relationship between hypertension and subclinical chronic inflammation is a connection that has not yet been fully clarified pathogenetically, but there are many studies highlighting this association. In recent years, studies examining different fibrosis and inflammation biomarkers in terms of the evaluation and prediction of renal risks have become increasingly popular in the literature. Oxidative stress is known to play an important role in homocysteine-induced endothelial dysfunction and has been associated with hypertension. In our study, we aimed to investigate the relationship between ambulatory blood pressure monitoring (ABPM) and urinary/serum fibrosis and inflammatory markers in patients with SFK. We prospectively investigated the relationship between ABPM results and soluble urokinase plasminogen activator receptor (suPAR), procollagen type III N-terminal peptide (PIIINP), homocysteine and other variables in 85 patients with SFK and compared them between cSFK and aSFK groups. In the etiology of SFK, a congenital or acquired origin may differ in terms of the significance of biomarkers. In particular, the serum homocysteine level may be associated with different clinical outcomes in patients with cSFK and aSFK.

Relationship between ambulatory arterial stiffness index and the severity of angiographic atherosclerosis in patients with H-type hypertension and coronary artery disease

ABSTRACT Objective To investigate coronary artery disease (CAD) and its correlation with the ambulatory arterial stiffness index (AASI) in patients with H-type hypertension (essential hypertension combined with hyper-homocysteinemia) and coronary heart disease (CHD). Methods Patients with essential hypertension and CHD who were undergoing coronary angiography were enrolled. The general clinical data, biochemical indicators, ambulatory blood pressure monitoring results and coronary angiography results of the selected patients were collected, and the AASI and Gensini scores were calculated. According to homocysteine (Hcy) levels, the patients were divided into two groups: a study group and a control group. The differences in general clinical data, biochemical indexes, AASI scores and degree of coronary artery lesions between the two groups were compared. The correlation between the AASI and the Gensini score and the relationship between the AASI and the Gensini score of CAD and various factors were analyzed. Results Compared with the control group, the Hcy level in the study group was significantly increased (8.16 ± 2.33 vs 19.20 ± 2.36, P = .001). The 24-h diastolic blood pressure (DBP) in the study group was significantly lower than that in the control group (76.38 ± 9.33 vs 79.91 ± 9.25, P = .002), and the AASI was significantly higher than in the control group (0.62 ± 0.81 vs 0.420 ± 0.70, P = .001). The number of patients having coronary stenoses with a Gensini score of ≤ 38 was significantly lower in the study group than in the control group (21.3% vs 49.4%, P < .001). The number of patients with a Gensini score of ≥ 51 in the study group was significantly higher than in the control group (22.0% vs 18.8%, P < .001). There was a significant positive correlation between the AASI and the Gensini score in the study group (R = 0.732, P < .001). Hypertension duration (β = 0.168), diabetes history (β = 0.236), 24-h SBP (β = 0.122), 24-h DBP (β = -0.131), low-density lipoprotein cholesterol (β = 0.134) and Hcy (β = 0.233) were the influencing factors for AASI (P < .05). Both Hcy * AASI (β = 0.356) and Hcy × 24-h HR (β = 0.331) had a synergistic effect on the Gensini score (P = .017), with Hcy * AASI having a more significant effect on the Gensini score (P < .001). Conclusion The AASI was significantly increased in patients with H-type hypertension and CHD, which was associated with the severity of CAD. Therefore, Hcy levels and the AASI have a synergistic effect when evaluating the severity of CAD in patients with hypertensive CHD.

Prediabetes, Non-Dipping Profile and Hypertension—A Recipe for Increased Arterial Stiffness

Pulse wave velocity (PWV) is a known predictor of target organ damage, cardiovascular disease and overall mortality. The aim of this study was to compare the PWV values in subjects with prediabetes, a non-dipper profile and arterial hypertension with their values in healthy subjects. A total of 301 subjects, aged 40-70 years, without diabetes mellitus were included in this cross-sectional study (150 with prediabetes). They underwent a 24 h ambulatory blood pressure monitoring (ABPM). Subjects were divided into three hypertension groups (A = healthy, B = controlled hypertension, C = uncontrolled hypertension). Dipping status was determined according to ABPM results, and PWV was measured by an oscillometric device. Prediabetes was defined as having 2 separate fasting plasma glucose (FPG) measurements between 5.6 and 6.9 mmol/L. The highest PWV values were found in group C (9.60 ± 1.34 vs. 8.46 ± 1.01 in group B vs. 7.79 ± 1.10 in group A; p < 0.001), in subjects with prediabetes (8.98 ± 1.31 m/s vs. 8.26 ± 1.22 m/s; p < 0.001) and in prediabetic non-dippers among age groups (p = 0.05). In the multivariate regression model age, blood pressure, nocturnal indices and FPG were shown as independent predictors of PWV values. Significantly higher PWV values were found in subjects with prediabetes and non-dipping profiles in all three examined hypertension groups.

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.

Myocardial remodeling and fibroblast growth factor in patients with resistant hypertension

Aim. To study the prevalence and severity of left ventricular hypertrophy (LVH), its relationship with fibroblast growth factor (FGF23) in patients with resistant hypertension (RH) depending on the effectiveness of multiagent antihypertensive therapy.Material and methods. The study included 92 patients diagnosed with RH. All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, general laboratory tests, and the serum FGF23 level was determined.Results. According to ABPM results, patients were divided into following groups: 1st — controlled RH (n=44) and 2nd — uncontrolled (n=48) RH. The groups were comparable in sex, age, main clinical and anthropometric parameters. In group 2, the main parameters of ABPM were higher. There were no differences in general laboratory tests, In the group of uncontrolled RH, the level of FGF23 was higher — 11,7 [8,5; 15,4] pmol/ml vs 9,2 [7,1; 11,6] pmol/ml in the 1st group (p=0,0036). According to echocardiography, a comparable violation of left ventricular (LV) diastolic function, an increase in left atrial size, LV mass (LVM) and LVM index were found. In patients of the 2nd group, large values of interventricular septal thickness were revealed — 1,3 [1,2; 1,4] cm vs 1,2 [1,1; 1,3] cm in the 1st group (p=0, 0043) and relative LV wall thickness (LVWT) — 0,50 [0,48; 0,53] vs, 0,45 [0,43; 0,50] in the 1st group (p&lt;0,0001). In the 1st and 2nd groups, concentric LVH was more common (18 (41%) patients in the 1st and 26 (54,1%) in the 2nd (p=0,044) groups) than eccentric LVH (15 (34,1%) and 13 (27,1%) patients in the 1st and 2nd groups, respectively). Correlation analysis revealed a positive relationship between pulse pressure and HTN duration (r=48, p=0,02) and FGF23 level (r=0,62, p=0,004). The LVM index was positively associated with the diastolic pressure-time index (BP) (r=51, p=0,02). A positive correlation was found between relative LVWT and pulse pressure (r=0,64, p=0,02) and a negative relationship with the duration of regular antihypertensive therapy (r=47, p=0,04), A strong relationship was found between LVEF and FGF23 levels (r=0,75, p=0,005).Conclusion. For patients with uncontrolled resistant hypertension, an increase in pulse pressure and myocardial remodeling in the form of concentric hypertrophy are more characteristic. FGF23 is significantly higher in uncontrolled RH and is positively associated with pulse pressure and relative LVWT.

Long-Term Kidney and Cardiovascular Complications in Pediatric Cancer Survivors

The objective of this study was to describe the burden of adverse kidney and hypertension outcomes in patients evaluated by pediatric nephrology in a multidisciplinary survivorship clinic. Retrospective chart review of all patients followed up by nephrology in our multidisciplinary survivorship clinic from August 2013 to June 2021. Data included clinic blood pressure, longitudinal ambulatory blood pressure monitoring (ABPM), echocardiography, serum creatinine, and first-morning urine protein/creatinine ratios. For patients with multiple ABPMs, results of initial and most recent ABPMs were compared. Of 422 patients followed in the multidisciplinary cancer survivorship clinic, 130 were seen by nephrology. The median time after therapy completion to first nephrology visit was 8years. The most common diagnoses were leukemia/myelodysplastic syndrome (27%), neuroblastoma (24%), and Wilms tumor (15%). At the last follow-up, 68% had impaired kidney function, 38% had a clinical diagnosis of hypertension, and 12% had proteinuria. There were 91 ABPMs performed in 55 (42%) patients. Patients with multiple ABPMs (n=21) had statistically significant reductions in overall median blood pressure loads: systolic initial load 37% vs most recent 10% (P=.005) and diastolic load 36% vs 14% (P=.017). Patients with impaired kidney function were more likely to have received ifosfamide. Patients with hypertension were more likely to have received total body irradiation or allogeneic stem cell transplant. History of leukemia/myelodysplastic syndrome, neuroblastoma, and Wilms tumor was frequent among survivors seen by nephrology. There was significant improvement in cardiovascular measures with increased recognition of hypertension and subsequent treatment.

The relationship between nondipper hypertension and triglyceride glucose index.

Nondipper hypertensive patients have an increased incidence of damage to end organs, including the brain, heart, and kidney, and a worse cardiovascular prognosis. The triglyceride glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to the traditional risk factors of cardiovascular disease. To the best of our knowledge, whether there is a relationship between the TyG index and impaired diurnal blood pressure (BP) has not been investigated. This study aimed to compare the TyG index between normotensive, nondipper, and dipper hypertensive patients. A total of 1037 patients grouped according to the results of ambulatory BP monitoring were included, with group 1 including dipper hypertensive ( n = 368), group 2 including nondipper hypertensive ( n = 496), and group 3 including normotensive control ( n = 173) patients. In both the univariate and multivariate logistic regression analyses, TyG index [odds ratio (OR), 4.656; 95% confidence interval (CI), 3.014-7.193; P < 0.001], age (OR, 1.011; 95% CI, 1.002-1.021; P = 0.018), and glomerular filtration rate (GFR) (OR, 0.979; 95% CI, 0.971-0.987; P < 0.001) were independent predictors of nondipper hypertension (HT). In the ROC analysis, a TyG index cutoff value of at least 4.74 predicted nondipper hypertensive patients with a sensitivity of 59.7%, and a specificity of 59.9% [area under the curve = 0.647 (0.614-0.680); 95% CI; P < 0.001]. We showed that TyG index, age, and GFR are independent predictors in patients with nondipper HT. TyG index, a simple, cost-effective, and rapid tool can predict the nondipper pattern in essential HT.

Abstract 086: Impact Of Ambulatory Blood Pressure Monitoring On Hypertension Diagnosis In Primary Care

Introduction: Hypertension (HTN) screening guidelines recommend using ambulatory blood pressure monitoring (ABPM) to exclude white coat HTN prior to newly diagnosing HTN. Yet, little is known about the impact of ABPM testing on HTN diagnosis decisions in primary care. Unfamiliarity with how to interpret ABPM results could lead to overtreatment or diagnostic inertia, the failure to diagnose a disease despite clinical evidence. Methods: We examined medical records of primary care patients with elevated office BP (≥140/90 mmHg) who were referred to an ABPM testing service. Patients were eligible for analysis if they were ≥18 years old, had elevated office BP without a HTN diagnosis and not prescribed BP medications, were referred by a primary care clinician from clinics affiliated with Columbia University Medical Center, and completed ABPM testing between 2016-2019. Using mean awake BP of 135/85 mmHg as the threshold for elevated ABPM, we compared the BP testing outcome (white coat HTN, in which only office BP was elevated, or sustained HTN, in which both office and ambulatory BP were elevated) to the physician’s action at the subsequent scheduled primary care visit (diagnosed or did not diagnose HTN per manual review of electronic medical records). Results: Overall, 111 patients with newly elevated office BP completed ABPM testing during the analysis period. Patients were referred by 60 physicians (50% trainees) from 6 clinics. Patients had a mean (SD) age of 53 (15) years; 73% were women. Fifty-nine patients (53%) had white coat HTN, and 52 (88%) were not diagnosed with HTN at their next primary care visit. The remaining 52 patients (47%) had sustained HTN, and 44 (85%) were diagnosed with HTN at their next visit. Medication was started for 31 of these 44 (70%). Overall, physicians diagnosed HTN concordantly with ABPM results for 96/111 patients (86%). Conclusions: More than half of primary care patients with elevated office BP referred for ABPM had white coat HTN. There was high concordance between ABPM results and physician HTN diagnoses, suggesting that ABPM reduces but does not eliminate overdiagnosis and diagnostic inertia in HTN. More research is needed to understand the reasons for discordance and how to optimize the implementation of ABPM testing into primary care.

Abstract 134: Blood Pressure Control And Hypertension Diagnosis Six Months After Completing Ambulatory Blood Pressure Diagnostic Testing

Importance: Undiagnosed hypertension contributes to excess morbidity and mortality. Objective: To examine the effect of hypertension diagnostic testing on hypertension diagnoses and blood pressure (BP) control months at 6 months. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85 without diagnosed hypertension with elevated BP in clinic and at baseline, conducted from 2017 to 2019 in primary care centers of an integrated healthcare system. Participants were randomization to one of three diagnostic regimens: (1) Clinic BP, (2) Home BP, or (3) Kiosk BP. All participants completed 24-hour ambulatory blood pressure monitoring (ABPM) at 3 weeks. ABPM results were sent to participants and their primary care providers and uploaded into the electronic health records (EHR). Main Outcomes and Measures: The primary outcomes were BP control and receipt of a new hypertension diagnosis at 6 months. We further examined whether changes in patient-reported outcomes relating to health behaviors or 6-month health attitudes were associated with BP control or a new hypertension diagnosis. Results: Mean baseline BP was 150/88 mmHg. Among 467 study participants completing ABPM, 335 (72%) were confirmed to have hypertension. At 6 months, 47% (156/335) of participants with hypertension achieved BP &lt;140/90 mmHg and 41% (137/335) had a new hypertension diagnosis recorded in the EHR with no differences by randomized group. Participants with a new hypertension diagnosis (n=137) experienced significantly greater reductions from baseline in systolic and diastolic BP (mean difference, -4.9 mmHg [95% CI: -7.8,-2.1]) and diastolic BP (-2.3 mmHg [-4.3, -0.4]) compared to individuals with undiagnosed hypertension (n=198). Significantly higher proportions of participants with adequate BP control and diagnosed hypertension felt sharing home BP readings with their provider was helpful or very helpful in managing their BP. Conclusion and Relevance: Most participants with high BP on screening and ABPM diagnostic testing did not achieve adequate BP control or receive a hypertension diagnosis within 6 months. New strategies are needed to increase diagnosis of hypertension in clinical practice

Abstract P242: Psychological Distress Related To Hypertension Diagnostic Testing And Diagnosis

Background: Little information is available as to whether undergoing hypertension diagnostic testing or receiving a new diagnosis of hypertension leads to psychological distress. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85. Participants had elevated BP in clinic at baseline but no previously diagnosed hypertension. The trial was conducted from 2017 to 2019 in primary care centers of an integrated healthcare system. Participants were randomized to one of three diagnostic regimens: (1) Clinic BP, (2) Home BP, or (3) Kiosk BP. All participants completed 24-hour ambulatory blood pressure monitoring (ABPM) at 3 weeks. ABPM results were sent to participants and their primary care providers and uploaded into the electronic health record. This analysis includes a subset of participants (n=255) who completed psychological distress questionnaires at baseline, and at least one follow-up (after completing their diagnostic regimen and 6 months after randomization) Main Outcomes and Measures: The primary outcomes were within-person change in psychological distress (impact of events and state anxiety scales, BP worry Likert 5-point scale) comparing baseline to 3 weeks and 6 months post-enrollment. Results: Participants were half female (127/255), mostly &gt; age 50 (78%), and White race (83%). Baseline mean BP was 150 mmHg systolic and 80 mmHg diastolic; 63.9% had hypertension on ABPM (daytime average &gt; 135/85 mmHg). There was no significant change in impact of events or state anxiety at either follow-up. BP worry was significantly increased at 3 weeks (mean change 0.22 (0.13-0.30), but not at 6 months. Six month outcomes were not influenced by ABPM test results or receiving a hypertension diagnosis. Conclusion and Relevance: The hypertension diagnostic process increased hypertension worry short term, but not longer-term. It had little impact on other measures of psychologic distress. The risk of psychologic distress after hypertension diagnostic testing and receipt of a hypertension diagnosis appears to be low, reinforcing the importance of timely hypertension diagnoses. Additional studies with more diverse patient populations are needed.

NOCTURNAL DIPPING PATTERN IN 24-HOUR AMBULATORY BLOOD PRESSURE RECORDINGS OF HYPERTENSIVE INDIVIDUALS IN THE BAY OF PLENTY (BOP)

Objective: 24-Hour Ambulatory blood pressure monitoring (ABPM) is gold standard for diagnosis/management of hypertension (HT). Untreated and poorly controlled HT leads to increased rates of cerebrovascular, cardiovascular, and renal disease. Data is lacking on dipping patterns in different ethnicities of New Zealand (NZ). The primary aim was to compare nocturnal dipping pattern between Maori and Non-Maori ethnicities. Secondary aims included comparison of nocturnal HT, morning surge index (MSI) and ambulatory arterial stiffness index (AASI) amongst them and comparison as per socio-economic deprivation index (NZDep 2018). Design and method: ABPM data of hypertensive adults &gt; 18 years of age (on antihypertensives) in EBOP was collected retrospectively from Midland Clinical Portal from 1st December 2018 to 31st July 2021. Duplicates or unsuccessful ABPM results were excluded from the analysis. Normal dipping was defined as 10–20%, non-dipping being 0- &lt; 10%, reverse dipping &lt; 0% and extreme dipping &gt; 20%. Statistics were processed using Excel. Results: Of 213 ABPMs nalysed, 20% were of Maori individuals. 39.5% of Maori were non-dippers and 9.3% were reverse dippers. Amongst Non-Maori, 34.1% were non-dippers and 13.5% were reverse dippers (p = 0.840). Uncontrolled nocturnal HT was more likely in Maori (60.5%) as compared to Non-Maori (54.1%), though not significant (p = 0.454). AASI was significantly higher (p = 0.001) in Non-Maoris, though MSI was not different (p = 0.865). Lower socio-economic demographic individuals or Maori are less likely to receive ABPM. Conclusions: There was no statistical difference between dipping status of Maori and Non-Maori. However, it is evident up to 55% of patients in this data set have uncontrolled nocturnal HT suggesting that EBOP is receiving subtherapeutic management of their HT. Therefore, all hypertensives should have ABPM in NZ to manage HT. As HT is more prevalent in Maori, researchers recommend a commitment from Bay of Plenty District Health Board to address this inequity to improve cardiac, cerebrovascular and renal health.

The association between nondipper pattern and perioperative hypertension in patients with controlled hypertension.

Perioperative hypertension is a frequent complication even in preoperatively normotensive or controlled hypertensive patients and there is a lack of data regarding the effect of nondipping pattern on perioperative hypertension. In this study, we aimed to investigate the possible effect of nondipping blood pressure pattern on the risk of perioperative hypertension. 234 hypertensive patients who underwent surgery with general anesthesia were evaluated prospectively. The study enrolled patients with well-controlled preoperative blood pressure. The 24-h ambulatory blood pressure monitoring results were used to classify patients as dippers and nondippers. Perioperative hypertension is defined as a systolic/diastolic arterial blood pressure greater than or equal to 160/90 mmHg or systolic blood pressure elevated by more than 20% from the patient's baseline level for more than 15 min perioperatively. There were 61 (26%) nondipper patients [mean age: 62.1 ± 7.1 years, 25 (40.9%) men] and 173 (74%) dipper patients [mean age: 61.4 ± 8.1 years, 83 (47.9%) men]. In the nondipper group, perioperative hypertension was observed in 31 (51.3%) patients, whereas in the dipper group, 33 (19.3%) patients experienced a hypertensive attack (P < 0.001). The independent predictors of perioperative hypertension were the presence of the nondipping pattern [odds ratio (OR) 3.084; 95% confidence interval (CI) 1.831-5.195; P < 0.001], the presence of diabetes mellitus (OR 2.059; 95% CI 1.215-3.490; P = 0.007), and the number of drugs (OR 2.317; 95% CI 1.102-5.097; P = 0.027). The frequency of perioperative hypertension was higher in preoperative normotensive and known hypertensive patients who were identified as nondippers. In addition, diabetes mellitus and number of drugs were found to be predictors of perioperative hypertension.

Is there a difference between normotensive and hypertensive patients in terms of blood parameters and cardiovascular diseases?

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction. Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated. Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p &amp;lt; 0.001; respectively. MPV and RDW levels were different in all four groups (p &amp;lt; 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p &amp;lt; 0.001). Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups.

Анализ показателей суточного профиля артериального давления у больных с артериальной гипертензией и сопутствующим гипотиреозом в зависимости от степени его компенсации

Цель работы заключалась в изучении характеристик суточного профиля артериального давления у пациентов с артериальной гипертензией и сопутствующим гипотиреозом на основании результатов амбулаторного мониторинга артериального давления. В исследование были включены 50 пациентов с артериальной гипертензией и сопутствующим гипотиреозом. В зависимости от сывороточного уровня тиреотропного гормона пациенты были разделены на две группы, по 25 пациентов в каждой: с компенсированным (группа 1) и декомпенсированным гипотиреозом (группа 2). Уровень тиреотропного гормона 4,4 мМЕ/л считали критерием компенсации. Конт­рольная группа состояла из 30 пациентов с артериальной гипертензией и исключенной дисфункцией щитовидной железы. Проведено сравнение основных показателей амбулаторного мониторинга артериального давления в зависимости от компенсации гипотиреоза. Для выявления взаимосвязи клинических и анамнестических факторов и показателей ночного систолического давления был проведен регрессионный анализ.

Non-dipping phenomenon effects in monosymptomatic nocturnal enuresis treatment?

Monosymptomatic enuresis nocturna patients are shown to have disrupted blood-pressure regulation accompanying polyuria. In our study, we aimed to research the desmopressin response of enuresis patients with blood-pressure regulation problems. The study included 175 patients, aged from 6-15years, with a diagnosis of monosymptomatic enuresis nocturna. Before treatment, 24 h ambulatory blood-pressure monitoring (ABPM) was used to identify 52 non-dipper patients and 73 patients with normal results. The responses to desmopressin treatment and clinical and demographic characteristics affecting response were compared. The response to desmopressin treatment was found to be significantly low in the patients who were non-dippers on 24 h ABPM before treatment compared to those with normal ABPM results (P < 0.05). Similarly, the waking problems in the non-dipper group were found to be high by a significant degree (P < 0.05). In the non-dipper group, the systolic non-dipping rate was higher. Before desmopressin use, assessment of patients with a 24 h ABPM may be beneficial to select the method to be used for treatment.

Which is responsible for target organ damage in masked hypertension? Is it an increase in blood pressure or a disruption of the circadian rhythm?

ABSTRACT Objective Masked hypertension (MH) and non-dipping pattern are conditions associated with target organ damage and cardiovascular risk, which are frequently observed together. We aimed to show the relationship between the target organ damage observed in MH and the deterioration in the dipping pattern. Methods Patients who underwent ambulatory blood pressure monitoring (ABPM) and office blood pressure (BP) <140/90 mmHg were retrospectively screened. In ABPM data, those with daytime BP ≥135/85 mmHg and night BP ≥120/70 mmHg were included in the MH group, while the others were included in the normotensive group. The patients were grouped as dipper, non-dipper and reverse-dipper according to ABPM results. Left ventricular mass index (LVMI), glomerular filtration rate (GFR) and serum creatinine levels were used to determine target organ damage. Results 289 patients [mean age 46.6 ± 12.4 years, 136 (47.1%) males], 154 (53.3%) of whom had MH were included in our study. GFR value was found to be significantly lower, serum creatinine levels and LVMI were significantly higher in patients with MH compared to normotensives (p < .05, for all). When the subgroups were examined, it was found that this difference was associated with the disruption in the dipping pattern. In patients with MH, dipping pattern disruption without change in systolic BP was independently associated with an increase in LVMI (p < .05, for both). Conclusion Target organ damage seen in MH may be due to the deterioration of the dipping pattern.

AMBULATORY BLOOD PRESSURE MONITORING: ADVANTAGES AND OPPORTUNITIES

Objective: Ambulatory Blood Pressure Monitoring (ABPM) is a procedure used to diagnose hypertension, detect white-coat effect, masked hypertension and monitor blood pressure (BP) control. It offers additional and important data in opposite to office BP, such as the dipping status and circadian variability of ambulatory BP, and it is a better predictor of cardiovascular outcomes and morbid or fatal events. In our country, ABPM has limited availability in Primary Health Care. With that in mind, the health care team of our Primary Health Care Unit created an ABPM protocol in August 2017 in order to provide this procedure to its patients. Design and method: Descriptive, cross-sectional and observational study. Data collected from August 2017 to December 2019 regarding the results of ABPM and patient data. The ABPM protocol was designed following the most recent European Society of Hypertension guidelines. Results: In the described period, our unit performed 136 ABPM exams. The average age of patients submitted to ABPM was 53 years and 54% were of the male gender. The majority (67%) were referred for diagnosis purposes and 33% to monitor BP control. With the ABPM protocol we were able to diagnose 60 patients with sustained hypertension and 36 patients with uncontrolled hypertension, from which 10 presented resistant hypertension. Regarding the dipping status, 55% were dipper, 23% extreme dipper, 19% non-dipper and 3% reverse dipper. In 63% of cases, the ABPM results led to direct clinical decision-making by the family physician, such as pharmacology intervention, clinical investigation and lifestyle advice. Conclusions: Overall the ABPM is an accurate, cost-effective protocol that provides important information for the prediction of cardiovascular risk. Consequently, ABPM protocol implementation has been observed to have a direct positive impact in the diagnosis, monitoring and clinical decision-making ability of the physician regarding hypertension. With this presentation we wish to share the positive impact of ABPM usage on our Health Care Unit and to inspire and motivate others to create a similar protocol.

FIXED HIGH-DOSE TRIPLE COMBINATION ANTIHYPERTENSIVE MEDICATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Objective: to evaluate efficacy and safety use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system and a thiazide diuretic with a maximal dose for 3 months in patients with long uncontrolled hypertension. Design and method: We studied 117 patients with uncontrolled hypertension which was confirmed by the office and 24-h ambulatory blood pressure monitoring (ABPM). All patients used 3.6 ± 0.1 antihypertensive drugs in free combinations. The adherence was moderate or low in 80 % of patients by the Morisky-Green test. After baseline examination patients have started treatment with the 3-component fixed-dose combination (FDC) of valsartan 320 mg/ hydrochlorothiazide 25 mg/ amlodipine 10 mg daily. The mean baseline systolic/diastolic BP was 170.2 ± 1.6/98.8 ± 1.2 mmHg and 24-h ambulatory BP was 160.3 ± 1.3/93.3 ± 1.1 mmHg. Results: After 3 months of treatment with triple combination pill, BP target was achieved in 57.3 % of patients according to the results of office and ABPM. In controlled hypertension (HTN) patients there was attenuated prevalence of non-dipping at the final evaluation (37 % vs 19 %, P &lt; 0.01). The other 50 patients were classified as patients with resistant hypertension (RH). Patients with RH had a longer duration of hypertension, higher plasma aldosterone and 24-h urinary metanephrines, higher 24–h urinary sodium and were included more subjects with obesity, diabetes mellitus, chronic kidney disease (CKD), coronary artery disease than HTN patients (all P &lt; 0.05). During the study, there were no adverse events such as dizziness, presyncope, or syncope, and headache. At the end of treatment, in HTN patients without initial CKD, creatinine level increased by 12.8% (P = 0.003), and GFR decreased by 10.0% (P = 0.004). Conclusions: The use of the fixed high-dose triple combination of antihypertensive drugs normalizes office and 24-hour BP in 57 % patients and differentiates the patients with true RH among the patients with low adherence to treatment and ineffective previous multicomponent therapy. BP lowering in patients without CKD has shown an increase in creatinine level and possibly refers to hemodynamic changes rather than renal damage; it requires observation.

Interpretation of ambulatory blood pressure monitoring results

Interpretation of ambulatory blood pressure monitoring results