Ambulatory Blood Pressure Monitoring Sessions Research Articles

Ambulatory Blood Pressure Parameters Among Men With Hypogonadism Treated With Testosterone Transdermal Therapy

ObjectiveStudies are needed to examine the effects of testosterone replacement therapy on ambulatory blood pressure (BP) parameters. This study assessed a testosterone transdermal system (TTS) using 24-hour ambulatory BP monitoring. MethodsIn a single-arm, noninferiority trial conducted at 41 US sites, 168 men (mean age: 56.2 years) with hypogonadism not receiving testosterone replacement therapy in the past 6 months were enrolled and received ≥1 study drug dose. Nightly TTS treatment was administered for 16 weeks (starting dose: 4 mg/d; min, max dose: 2, 6 mg/d) to achieve testosterone concentration of 400−930 ng/dL. The primary endpoint was mean change from baseline to week 16 in 24-hour systolic BP (SBP). Noninferiority was determined based on the upper bound of the 2-sided 95% CI <3.0 mmHg. ResultsSixty-two men had ≥85% study drug compliance and a valid week 16 ambulatory BP monitoring session. Mean change from baseline to week 16 in 24-hour average SBP was 3.5 mmHg (95% CI, 1.2−5.8 mmHg; n = 62). Since the upper limit of the CI was >3 mmHg, an effect of TTS could not be ruled out. Mean changes were larger at daytime vs nighttime and in subgroups of men with vs without hypertension. Cardiovascular adverse events were rare (<2%) and nonserious; no major cardiovascular adverse events were reported. ConclusionA meaningful effect of 16-week TTS treatment on 24-hour average SBP among men with hypogonadism could not be ruled out based on the study’s noninferiority criterion. The magnitude of mean changes observed may not be clinically meaningful regarding cardiovascular events.

Relationship of the White Coat Effect with Endpoints and Several Prognostic Indicators in Hypertensive Patients Treated with Regular Antihypertensive Therapy

Aim of the study was to evaluate in a prospective cohort study the relationship between the severity of the white coat effect (WHE) in patients with hypertension, who treated with regular antihypertensive therapy, and the composite endpoint, several prognostic indicators, in a routine clinical practice.Material and Methods. We analyzed the data of a prospective cohort study, which included 125 patients with hypertension who received regular antihypertensive therapy. The study consisted of three visits (baseline, 6 and 12 months) and an outcome data collection period (30.1±7.6 months of follow-up after the third visit). This study included three visits every 3 months: 1 visit – screening, ambulatory blood pressure monitoring (ABPM) session, Echo; 2 – assessment of the patient’s status and the therapy effectiveness; 3- assessment of the patient’s status, ABPM session, Echo (the total number of ABPM was 239, Echo - 240). The primary composite endpoint included death for any reason angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation, secondary - deterioration of the cardiovascular diseases course and tertiary endpoint – deterioration of the arterial hypertension, concomitant diseases course.Results. The study involved 125 patients: 28 men (22%), 97 women (78%), mean age was 62.6±0.8 years, duration of hypertension 11.6±0.8 years, height 163.6±0.7 cm, body weight 83.1±1.4 kg. The baseline mean daytime systolic BP (SBP) was 125.1±9.8 and diastolic (DBP) – 76.1±7.0 mm Hg, age was 62.8±9.0 years, the WCE level for SBP was 16.5±1.4, for DBP 10.9±0.7 mm Hg. We identified a positive correlation between tertiary composite endpoint data and WCE: for systolic WCE (SWCE) (F = 4.7, p&lt;0.031). We found correlations between WCE and Echo parameters: 1) SWCE level had with LVMI (r = 0.16. p&lt;0.017); 2) diastolic WCE (DWCE) had negative relationship with LV contractility parameters.Conclusions. Thus, only systolic WCE level had correlation with composite endpoint data and LVMI. DWCE level had negative associations with echocardiography LV contractility parameters.

WHITE COAT EFFECT LEVEL CORRELATED WITH THE ECHOCARDIOGRAPHIC PARAMETERS AND COMPOSITE ENDPOINT DATA IN TREATED PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of our study was to determine relationship between echocardiography (Echo) left ventricular mass index (LVMI), composite endpoint data and white coat effect (WCE) level in treated patients with arterial hypertension (AH). Design and method: We nalysed database (treated AH patients (n = 125) with concomitant chronic diseases without exacerbation or in compensation stage). This study was prospective and included three visits every 3 months: 1 visit - screening, ambulatory blood pressure monitoring (ABPM) session, Echo; 2 - assessment of the patient’s status and the therapy effectiveness; 3- assessment of the patient’s status, ABPM session, Echo (the total number of ABPM was 239, Echo - 240). We assessed composite endpoint after 30.1 ± 7.6 months from the screening visit (the primary composite endpoint included death for any reason angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation, secondary - deterioration of the cardiovascular diseases course and tertiary endpoint - deterioration of the arterial hypertension, concomitant diseases course). We used ANOVA for statistical analysis. Results: The baseline mean (M ± m) daytime systolic BP (SBP) was 125.1 ± 9.8 and diastolic (DBP) - 76.1 ± 7.0 mm Hg, age was 62.8 ± 9.0 years. We identified a positive correlation between tertiary composite endpoint data and WCE: for systolic WCE (SWCE) (F = 4.7, p &lt; 0.031). We found correlations between WCE and Echo parameters: 1) SWCE level had with LVMI (r = 0.16, p &lt; 0.017); 2) diastolic WCE (DWCE) had negative relationship with end-diastolic (EDD) and systolic (ESD) diameters (r = -0.181, p &lt; 0.007 and r = -0.187, p &lt; 0.005); with ejection fraction (EF) and posterior wall thicknesses (PWT) (r = -0.176, p &lt; 0.008 and r = -0.142, p &lt; 0.033). In addition, we have identified that age and duration of AH were associated with SWCE, height and body mass index (BMI) had negative correlations with DWCE (see table). Thus, SWCE level had positive correlation with tertiary composite endpoint results (F = 4.7, p &lt; 0.031) and LVMI (r = 0.16, p &lt; 0.017). DWCE level had negative relationships with Echo LV contractility indices (ESD, EDD, EF). Conclusions: Thus, only systolic WCE level had correlation with composite endpoint data and LVMI. DWCE level had negative associations with echocardiography LV contractility parameters.

THE WHITE COAT EFFECT LEVEL CORRELATED WITH LIFESTYLE COMPONENTS AND SOCIO-DEMOGRAPHIC DATA IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of study was to define if the lifestyle components and socio-demographic data of patients with arterial hypertension (AH) may correlate with white coat effect (WCE) level. Design and method: We nalysed ambulatory blood pressure monitoring (ABPM) data of 125 AH patients, who were treated with regular antihypertensive therapy. This study was prospective and included three visits every 3 months: 1 visit - screening, ABPM session; 2 - assessment of the patient’s status and the therapy effectiveness; 3- assessment of the patient’s status, ABPM session (the total ABPM number was 239). The WCE level was assessed as the difference between clinical BP measurement and mean daytime BP. We used ANOVA for statistical analysis. Results: The initial mean daytime BP was (M ± SD): systolic (SBP) - 123.2 ± 11.2; diastolic (DBP) - 73.0 ± 6.9 mm Hg. The mean age of the patients was 62.2 ± 8.7. We found relationships between the lifestyle components and WCE: 1) alcohol intake level had negative correlations with systolic WCE (SWCE) (F = -5.7 p &lt; 0.0002) and diastolic WCE (DWCE) (F = -4.0, p &lt; 0.001) levels; 2) smoking intensity had negative correlations with SWCE (F = -4.9 p &lt; 0.001) and DWCE (F = -3.1 p &lt; 0.002). We have identified that age and duration of AH were associated with SWCE (r = 0.23, p &lt; 0.0003 and r = 0.14, p &lt; 0.03 respectively), also height and body mass index (BMI) had negative correlations with DWCE (r = -0.27, p &lt; 0.01) levels. Education level (F = 2.7, p &lt; 0.042 for SWCE and F = 4.7, p &lt; 0.003 for DWCE), marital status (F = 2.4, p &lt; 0.048 for SWCE,) and gender (F = 5.8, p &lt; 0.016 for SWCE and F = 9.2, p &lt; 0.003 for DWCE) were correlated with WCE: WCE was higher in women, widowers and unmarried persons without higher education (see table). Conclusions: Thus, increase of the alcohol intake and smoking intensity can lead to WCE reduction and the masked hypertension manifestation. Height and body mass index had negative correlations with WCE, age and duration of AH had positive association with WCE. Also, WCE was higher in women, widowers and unmarried persons without higher education. Probably, married young tall men with higher education have a tendency to the masked hypertension manifestation.

PSYCHOLOGICAL AND QUALITY OF LIFE SCALE SCORES CORRELATED WITH THE WINTER INCREASE OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of study was to define correlations between winter blood pressure (BP) increase and psychological, quality of life (QL), demographic factors in patients with arterial hypertension (AH) (Moscow region). Design and method: We assessed 980 ambulatory blood pressure monitoring (ABPM) data AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period (at 8.30–12.00 am). We defined daytime period as 8.00–22.00, nighttime – 0.00–6.00, evening – 21.00–23.00, morning – 6.00–8.00 and workplace period as 11.00–19.00. After ABPM session patients completed the QL questionnaire. (J.Siegrist et all.). The systolic and diastolic (SBP and DBP) winter increase BP was assessed for: daytime (BPd), nighttime (BPn), evening (BPe), morning (BPm), workplace (BPw) and 24-hours period (BP24). We used General Linear Model (GLM) Procedure for statistical analysis adjustment for age, sex and duration of AH and Fisher’s (F) test. Results: We have identified the following QL factors that were significantly associated with the SBP winter increase: 1) VI scale scores of QL questionnaire (reflects the level of social support of family, friends, colleagues) with SBPn (F = -6,62 p &lt; 0,01), SBPd (F = -11,12, p &lt; 0,001), SBPw (F = -9,33, p &lt; 0,003), SBPm (F = -10,59 p &lt; 0,001), SBPe (F = -5,4, p &lt; 0,02); 2) IV scale scores (negative psychological well-being) with SBPw (F = 9,33, p &lt; 0,003). The following factors were significantly associated with the DBP winter increase: 1) VI scale scores with DBPd (F = 4,06, p &lt; 0,04), SBPm (F = 4,29 p &lt; 0,004). Thus, such QL components as the social support from family, friends, colleagues, (VI scale scores) and the negative emotions (IV scale scores) have been associated with the winter BP increase (negative and positive correlation respectively). Conclusions: The new preventive strategy for reducing winter BP may include the increase communication with family and friends and to reduce the impact of negative emotions in the workplace in Moscow region patients with AH.

THE PSYCHOLOGICAL COMPONENT OF THE QUALITY OF LIFE WAS RELATED TO COMPOSITE ENDPOINT IN TREATED PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of our study was to determine association between composite endpoint and quality of life (QL) scale scores in treated patients with arterial hypertension (AH). Design and method: We analyzed database of treated AH patients (n = 125) with concomitant chronic diseases without exacerbation. We assessed relationships between the initial ambulatory blood pressure monitoring (ABPM) data, socio-demographic indicators, QL scale scores, Asthma Control Questionnaire (ACQ) indices and composite endpoint (death for any reason, angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation) after 30.1 ± 7.6 months from the inclusion visit. QL questionnaires (J.Siegrist et al.), ACQ (45 patients had asthma) was completed initially, after 6 months and after 12 months, the ABPM session was performed initially and after 12 months, antihypertensive therapy was corrected at all visits. We analyzed the following QL scale scores: 0 scale: mood at the doctor's visit, I scale: physical well-being; II scale: physical performance; III scale: positive psychological well-being; IV scale: negative psychological well-being; V scale: psychological performance; VI scale: social well-being; VII scale: social performance. We used ANOVA for statistical analysis. Results: The baseline mean daytime systolic BP (SBP) was 125.1 ± 10.5; diastolic (DBP) - 76.1 ± 7.3 mm Hg. We found negative correlations between composite endpoint and: III scale scores (positive psychological well-being) (F = -5.3, p &lt; 0.05); 0 scale (mood at the doctor's visit) (F = -5.6, p &lt; 0.05). We identified a positive correlation between endpoint data and V scale scores (psychological performance) (F = 12.2, p &lt; 0.001). The composite endpoint was not correlated with sex, age, BMI, smoking, ambulatory and clinical blood pressure, the number of drugs in concomitant therapy, pulmonary forced vital capacity. At the end of the study, we registered 21 cases included in the composite endpoint: death (2), transient ischemic attack (1), arterial revascularization (4), frequent ventricular extrasystole (3), atrial fibrillation (8), angina pectoris (3). Conclusions: Thus, psychological QL component such as good mood at the doctor's visit (scale 0), positive psychological well-being (scale III) had negative relationship with composite endpoint, at the same time the psychological performance (scale V) had positive correlation with composite endpoint results.

DIFFERENCE BETWEEN CLINICAL AND AMBULATORY BLOOD PRESSURE LEVELS CORRELATES WITH EMOTIONAL INTELLIGENCE SCALE SCORES IN PATIENTS WITH HYPERTENSION

Objective: The aim of study was to define relationships between emotional intelligence, quality of life (QL) scale scores and the difference between clinical and ambulatory blood pressure (BP) in patients with hypertension. Design and method: We assessed 90 ambulatory blood pressure monitoring (ABPM) data of patients with stable hypertension and white coat hypertension without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–23.00, nighttime – 23.00–6.00. The clinical-ambulatory BP discrepancy was assessed as the difference between mean clinical BP and mean daytime BP levels. After ABPM session patients completed the emotional intelligence questionnaire (EmIn) (Lyusin D.) and QL questionnaire (J. Siegrist et al.). We analyzed the following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V- management of others’ emotions. We used Pearson correlation coefficient for statistical analysis. Results: The initial mean (M ± SD) daytime systolic BP (SBP) was 140.1 ± 12.8; diastolic (DBP) - 86.1 ± 10.5 mm Hg, age - 51,3 ± 15,3 years. We found the following significant negative correlations between III scale scores (control of emotional expression scale, of EmIn) and the difference between clinical and ambulatory BP for SBP (r = -0,25, p &lt; 0,05). QL components did not correlate with the difference between clinical and ambulatory BP. Conclusions: The emotional self-control scores (III scale of EmIn) was negatively associated with the difference between clinical and ambulatory BP levels. Probably, a high level of the emotional expression self-control may prevent blood pressure rise at the doctor's visit, and as a result can reduce the clinical BP level and decrease of the clinical- ambulatory BP difference.

THE MORNING BLOOD PRESSURE SURGE IN PATIENTS WITH HYPERTENSION

Objective: The aim of study was to definite validity and reliability of the new morning blood pressure surge (MBPS) assessment method in patients with arterial hypertension (AH).Design and method: We assessed 150 ambulatory blood pressure monitoring (ABPM) data of AH patients. ABPM monitor (Spacelabs 90207) was applied after the washout period. The new method determined the MBPS value as the difference between the mean BP during the period from 6 to 8 hours (for this period we determined the maximum rate of BP rise) and the minimum night BP (MBPS6_8/BPnigh_min). Test-re-test reliability (reproducibility) of the new method was determined as the correlation between the measurements of the first and second ABPM sessions carried out during the week (only for MBPS6_8/BPnigh_min indices). Construct validity of the new method was defined as the correlation between the MBPS6_8/BPnigh_min coefficient and left ventricular mass index (LVMI) (only for 98 patients). LVMI was measured using echocardiography (L. Teichholtz et all.). Results: The mean daytime BP was (M ± SD): systolic (SBP) – 141,1 ± 13,9; diastolic (DBP) – 90,1 ± 10,3 mm Hg. We found that the new method of MBPS assessment had a high degree of reliability: coefficient correlation (r) between parameters of the two ABPM sessions were (for MBPS6_8/BPnigh_min): for DBP r = 0,70, for SBP r = 0,83 (table 1). The validity of the new method was high: the MBPS value obtained using new method (MBPS6_8/BPnigh_min) correlated with LVMI (an objective factor of validation) (table 2). Conclusions: We found that the new method of the morning blood pressure surge assessment had a high level of validity and reproducibility (test-re-test reliability). The high reliability of the new method is probably due to the exclusion of subjective factors (patient's diary) in the evaluation of the MBPS value. The reference mean morning BP was determined for a fixed time period, and not by the patient's diary.

Effects of a State- and Use-Dependent Nav1.7 Channel Blocker on Ambulatory Blood Pressure: A Randomized, Controlled Crossover Study.

Vixotrigine is a state‐ and use‐dependent Nav1.7 channel blocker being investigated for the treatment of neuropathic pain conditions. This randomized, double‐blind, placebo‐controlled crossover trial was designed to evaluate changes in blood pressure with the administration of vixotrigine using ambulatory blood pressure monitoring (ABPM). Eligible participants were healthy adults 18 to 65 years of age without evidence of baseline systolic blood pressure (SBP) persistently > 140 mm Hg or diastolic blood pressure (DBP) persistently > 90 mm Hg. Vixotrigine (400 mg [men], 300 mg [women]) or placebo was administered orally twice daily for 36 days. Following a 7‐day washout period, participants crossed over to the other treatment. Each dosing period was preceded by 1 inpatient visit and 1 outpatient baseline visit. Two 14‐hour inpatient ABPM sessions occurred on days 14 and 35, with a return to the clinic the morning of days 15 and 36 for initiation of outpatient ABPM, which assessed blood pressure and heart rate every 15 minutes. Adverse events were collected throughout the study. The primary end point was the change from baseline in 24‐hour mean SBP and DBP on day 36. Sixty participants were enrolled; 10 withdrew from the study owing to adverse events, investigator discretion, or withdrawal of consent. From baseline to day 36, mean changes in average SBP and DBP (vixotrigine treated) were ‐0.33 and 0.20 mm Hg, respectively. Adverse event rates were comparable for vixotrigine and placebo; the most common adverse events were headache, dizziness, and nausea. Vixotrigine administration is not associated with a clinically important increase in blood pressure.

CORRELATION BETWEEN EMOTIONAL INTELLIGENCE INDICES AND WORKPLACE AMBULATORY BLOOD PRESSURE LEVEL IN PATIENTS WITH HYPERTENSION

Objective: The aim of our study was to determine correlation relationship between ambulatory blood pressure level in workplace and emotional intelligence (EI) in untreated patient with arterial hypertension (AH). Design and method: We analyzed 200 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00, nighttime – 0.00–6.00, and work period as 11.00–19.00 (BPw). After ABPM session patients completed the PS and EI questionnaire: “Minnesota Multiphase Personality Inventory”(MMPI) and “EmIn Questionnaire” (only for 70 patients), by Lyusin D, 2006. We analyzed following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V - management of others’ emotions. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The mean workplace systolic BP level (SBP) was 141.5 ± 15.5 and diastolic (DBP) - 89.4 ± 11.2 mm Hg (M ± SD). We have found the following correlations (p > 0.05): V scale scores (management of others’ emotions) and II (management of one's own emotions) of EmIn Questionnaire positively correlated with workplace SBP level (r = 0,36 and 0,31 respectively), and V scale scores related with DBP workplace level (r = 0,38). MMPI scale scores (psychological questionnaire) did not correlate with SBP and DBP workplace levels. Thus, V and II scale scores of “EmIn Questionnaire” (management of others’ and one's own emotions) was related with workplace BP level. Conclusions: Management of others’ and one's own emotions (V and II scale scores of “EmIn Questionnaire) was related with workplace SBP and DBP levels.

THE CORRECTION OF PSYCHOLOGICAL STYLE OF BEHAVIOR MAY IMPROVE THE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN THE WORKPLACE IN PATIENTS WITH HYPERTENSION

Objective: The aim of study was to define if the emotional intelligence (EI) of patients with arterial hypertension (AH) may influence the effectiveness of antihypertensive therapy in the workplace.Design and method: We assessed 70 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00, nighttime – 0.00–6.00, and work period as 11.00–19.00. After ABPM session patients completed the emotional intelligence questionnaire (EmIn) by Lyusin D. We analyzed following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V- management of others’ emotions. The patients were randomized to treatment antihypertensive drugs. Then the patients were randomized to the control and intervention groups. In the control group were used standard recommendations for cardiovascular disease patients. In the intervention group, physicians advised to follow both standard recommendations for cardiovascular patients and additional recommendations according to the results of the EmIn questionnaire. The patients were treated with antihypertensive drugs in average therapeutic doses for 3 weeks (amlodipine, metoprolol, enalapril, telmisartan). If the therapy was ineffective, the patient dropped out of the study and began to treatment with the combined therapy. At the end of the three-week therapy was performed EmIn test and ABPM. Results: The mean daytime BP was (M ± SD): systolic (SBP) - 142.1 ± 14.5; diastolic (DBP) - 90.1 ± 10.9 mm Hg. The groups were comparable in baseline BP, sex, age, EmIn characteristics, body mass index and drugs doses. We found that treatment with average therapeutic doses of antihypertensive drugs is not effective (table 1) in the control group. However, in the intervention group, the same doses of the drug leads to the significant BP reduction of workplace and daytime BP levels. Night BP indices in this patients did not decrease significantly (table 2). Conclusions: Thus, lifestyle changes based on both conventional and additional recommendations with regard of the results of the EmIn psychological questionnaire may improve the effectiveness of the antihypertensive therapy in the workplace.

PP.26.28] CORRELATIONS BETWEEN EMOTIONAL INTELLIGENCE AND AMBULATORY BLOOD PRESSURE LEVEL IN WORKPLACE IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of our study was to determine relationship between emotional intelligence (EI) and mean ambulatory blood pressure monitoring level in workplace in untreated patient with arterial hypertension (AH).Design and method: We analyzed 160 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00 (BPd), nighttime – 0.00–6.00 (BPn) and workplace period as 11.00–19.00 (BPw). After ABPM session we assessed EI of patients. They completed the “EmIn Questionnaire” by Lyusin D. (EmIn). We analyzed following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V - management of others’ emotions. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The mean daytime systolic BP (SBP) was 139.1 ± 12.5; diastolic (DBP) −89.1 ± 9.8 mm Hg (M ± SD). We have found the following correlations (p > 0.05): II and V scale scores of EmIn positively correlated with SBPd, SBPw and 24 h SBP. Thus, management of others’ and of one's own emotions (II and V scale scores) was related with workplace SBP and day SBP level, but not with DBP levels. Nighttime BP levels did not correlate with EmIn scores. Conclusions: Thus, management of others’ and of one's own emotions was related with work place SBP level.

PP.26.14] CORRELATIONS BETWEEN PSYCHOLOGICAL STATUS, QUALITY OF LIFE SCORES AND LEFT VENTRICULAR MASS INDEX, AND MEAN AMBULATORY BLOOD PRESSURE VARIABLES IN PATIENTS WITH HYPERTENSION

Objective The aim of our study was to determine correlations between psychological status and quality of life with left ventricular mass index and mean ambulatory blood pressure variables in patients with arterial hypertension (AH). Design and method We analyzed 76 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM device (Spacelabs 90207) was applied after the washout period. After ABPM session patients completed the questionnaires. Left ventricular mass index (LVMI) (L. Teichholtz et al., 1976) was measured using echocardiography. We assessed the following QL scale scores (General Well-Being Questionnaire by J.Siegrist et al.): I - physical well-being, II - physical performance, III - positive psychological well-being, IV - negative psychological well-being, V - psychological performance, VI - social well-being, VII - social performance. We analyzed the following MMPI scale scores (Minnesota Multiphasis Personality Inventory): L – lie scale, F – aggravation scale, K – correction scale, 1 – hypochondria, 2 – depression, 3 – hysteria, 4 – psychopathy, 6 – rigidity of affect, 7 – psychasthenia, 8 – schrizothemia, 9 – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results The mean ambulatory systolic BP (SBP) was 136.1 ± 11.2; diastolic (DBP) −89.1 ± 9.0 mm Hg (M ± SD). LVMI – 122,1 ± 24,9 g/m2. We found the following correlations: 1) 9 MMPI scale scores (energy, optimism, good mood) were negatively correlated with LVMI (r = −0.33, p < 0.05); 2) 9 MMPI scale scores had the negative relationships with clinical and ambulatory SBP levels (r = −0.23, r = −0.24 respectively, p < 0.05) and with SBP load variables (r = −0.25, p < 0.05). There were no significant links between QL scales scores and LVMI, ambulatory BP indices.Thus, energy, optimism, good mood (9 MMPI scale scores) had a negative correlation not only with LVMI, but also to SBP indices. Conclusions It was identified inverse correlation between psychological status (energy, optimism, good mood) and LVMI indices, and also with clinical and ambulatory SBP variables of AH patients. There were no significant links between QL scales scores and LVMI, ambulatory BP indices.

PP.22.21] EMOTIONAL INTELLIGENCE MAY INFLUENCE THE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH HYPERTENSION

Objective: The aim of study was to definite if the emotional intelligence (EI) of patients with arterial hypertension (AH) can influence the effectiveness of antihypertensive therapy.Design and method: We assessed 70 ambulatory blood pressure monitoring (ABPM) data of AH patients. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00, nighttime – 0.00–6.00, and work period as 11.00–19.00. After ABPM session patients completed the emotional intelligence questionnaire (EmIn) by Lyusin D. We analyzed following EmIn scale scores: I emotion self-awareness; II management of one's own emotions; III control of emotional expression; IV understanding others’ emotions; V management of others’ emotions. The patients were randomized to treatment antihypertensive drugs. Then the patients were randomized to the control and intervention groups. In the control group patients were given standard recommendations for cardiovascular disease patients. In the intervention group patients were given standard recommendations and advice on lifestyle change according to the results of the EmIn questionnaire. The patients were treated with antihypertensive drugs in average therapeutic doses for 3 weeks (amlodipine, metoprolol, enalapril, telmisartan). In the absence of the therapy effectiveness, the patients began to treatment with the combined therapy, but these data were not included in the analysis. At the end of the three-week therapy was performed EmIn test and ABPM. Results: The mean daytime BP was (M ± SD): systolic (SBP) - 142.1 ± 14.5; diastolic (DBP) - 90.1 ± 10.9 mm Hg. In each group there were 35 patients who were comparable in baseline BP, sex, age, EmIn characteristics, body mass index and drugs doses. We found that treatment with average therapeutic doses of antihypertensive drugs is not effective (table 1) in the control group. However, in the intervention group, the same doses of the drug leads to the significant BP reduction of workplace and daytime BP levels. Night BP indices in this patients did not significantly decreased (table 2). Conclusions: Thus, lifestyle changes, not only in according to conventional recommendations for cardiovascular patients, but also with regard of test results of emotional intelligence can enhance the effectiveness of antihypertensive therapy.

Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort

BackgroundRepeated exposure to household air pollution may intermittently raise blood pressure (BP) and affect cardiovascular outcomes. We investigated whether hourly carbon monoxide (CO) exposures were associated with acute increases in ambulatory blood pressure (ABP); and secondarily, if switching to an improved cookstove was associated with BP changes. We also evaluated the feasibility of using 24-h ambulatory blood pressure monitoring (ABPM) in a cohort of pregnant women in Ghana.MethodsParticipants were 44 women enrolled in the Ghana Randomized Air Pollution and Health Study (GRAPHS). For 27 of the women, BP was measured using 24-h ABPM; home blood pressure monitoring (HBPM) was used to measure BP in the remaining 17 women. Personal CO exposure monitoring was conducted alongside the BP monitoring.ResultsABPM revealed that peak CO exposure (defined as ≥4.1 ppm) in the 2 hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. Women receiving improved cookstoves had lower post-intervention SBP (within-subject change in SBP of −2.1 mmHg [95% CI: -6.6, 2.4] as compared to control), though this result did not reach statistical significance. 98.1% of expected 24-h ABPM sessions were successfully completed, with 92.5% of them valid according to internationally defined criteria.ConclusionsWe demonstrate an association between acute exposure to carbon monoxide and transient increases in BP in a West African setting. ABPM shows promise as an outcome measure for assessing cardiovascular health benefits of cookstove interventions.Trial registrationThe GRAPHS trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490.

PP.01.10] TREATMENT WITH BETA-BLOCKERS REDUCES THE DIFFERENCE BETWEEN CLINICAL AND AMBULATORY BLOOD PRESSURE LEVELS IN PATIENTS WITH STABLE ARTERIAL HYPERTENSION

Objective: The aim of our study was to assess the effect of antihypertensive treatment (beta-blockers (BB), angiotensin I receptor antagonists (ARA), calcium antagonists (AC), angiotensin converting enzyme inhibitors (ACEI) on the difference between clinical and ambulatory blood pressure level.Design and method: We analyzed 292 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. The difference between clinical and ambulatory blood pressure level was assessed as the difference between clinical BP measurement and mean daytime BP. The inclusion criteria were: >6-days wash-out period; two ABPM (SpaceLabs 90207) sessions before treatment and during treatment; daytime BP before treatment >140/90 and < 160/110 mmHg; 2–3 months treatment period with mean therapeutic doses. The BB group included metoprolol receiving patients (35), ARA group - losartan and telmisartan (36), ACEI group - captopril and enalapril (35), AC group - amlodipin (40). We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: We found that all antihypertensive drugs significantly decreased systolic and diastolic BP (SBP, DBP) levels. Long-term BB therapy significantly reduced difference between systolic and diastolic clinical and ambulatory blood pressure diastolic. Antihypertensive treatment with other drugs has not significantly reduced the difference between clinical and ambulatory blood pressure (see table). Conclusions: BB decreased difference between clinical and ambulatory blood pressure. Probably BB reduced stress - induced increase of the sympathetic nervous system activity during clinic visit and therefore clinic BP level more significantly than other drugs.

PP.01.30] PSYCHOLOGICAL STATUS SCORES RELATED WITH LEFT VENTRICULAR MASS INDEX AND MEAN AMBULATORY BLOOD PRESSURE VARIABLES IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Objective: The aim of our study was to determine correlations between psychological status and quality of life scores with left ventricular mass index and mean ambulatory blood pressure variables in patients with arterial hypertension (AH). Design and method: We analyzed 76 ambulatory blood pressure monitoring (ABPM) data of AH patients. ABPM monitor (Spacelabs 90207) was applied after the washout period. After ABPM session patients completed the QL questionnaire “General Well-Being Questionnaire” (J.Siegrist et al.). Left ventricular mass index (LVMI) (L. Teichholtz et all., 1976) was measured using echocardiography (Acuson 128XP). We assessed the following QL scale scores: I - physical well-being, II - physical performance, III - positive psychological well-being, IV - negative psychological well-being, V - psychological performance, VI - social well-being, VII - social performance. Also, patients completed the psychological questionnaire “Minnesota Multiphasis Personality Inventory” (MMPI). We analyzed the following MMPI scales: L – lie scale, F – aggravation scale, K – correction scale, 1 (Hs) – hypochondria, 2 (D) – depression, 3 (Hy) – hysteria, 4 (Pd) – psychopathy, 6 (Pa) – rigidity of affect, 7 (Pt) – psychasthenia, 8 (Sc) – schrizothemia, 9 (Ma) – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The mean ambulatory systolic BP (SBP) was 136.1 ± 11.2; diastolic (DBP) - 89.1 ± 9.0 mmHg (M ± SD). LVMI – 122,1 ± 24,9 g/m2. We found the following correlations: 1) 9 MMPI scale scores (energy, optimism, good mood) were negatively correlated with LVMI (r = -0.33, p < 0.05); 2) 9 MMPI scale scores had the negative relationships with clinical and ambulatory SBP levels (r = -0.23, r = -0.24 respectively, p < 0.05) and with SBP load variables (r = -0.25, p < 0.05). There were no significant links between QL scales scores and LVMI, ambulatory BP indices. Thus, energy, optimism, good mood (9 MMPI scale scores) had a negative correlation with LVMI, also to SBP indices. Conclusions: It was identified inverse correlation between energy, optimism, good mood and LVMI indices, and also with clinical and ambulatory SBP variables of AH patients. There were no links between QL scores and LVMI, ambulatory BP indices.

3C.06

Objective: The aim of our study was to determine relationship between emotional intelligence (EI), psychological status (PS) and mean ambulatory blood pressure monitoring (ABPM) level, white coat effect (WCE) in untreated patients with arterial hypertension (AH). Design and method: We analyzed 150 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00 (BPd), nighttime – 0.00–6.00 (BPn). After ABPM session patients completed the PS and EI questionnaire: “Minnesota Multiphase Personality Inventory” (MMPI) and “EmIn Questionnaire” (by Lyusin D.). We assessed following EmIn scale scores: I - emotion self-awareness; II- management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V - management of others’ emotions. We used Spearman Partial Coefficient for correlation (r) analysis adjusted for age, sex and duration of AH. Results: The mean daytime systolic BP (SBP) was 139.1 ± 12.7, diastolic (DBP) - 83.1 ± 9.9 mm Hg (M ± SD). We found the following correlations (p > 0.05): 1) 9 MMPI scale scores (energy, optimism, good mood) with WCE for SBP (r = -0.28) and mean clinical SBP (r = -0.25); 2) III scale scores (control of emotional expression) with WCE for DBP (r = -0.24); 3) I scale scores (emotion self-awareness) with mean clinical SBP (r = 0.27); 4) IV scale scores (understanding others’ emotions) with mean clinical DBP and SBP (r = 0.34, r = 0.31) and with mean ambulatory DBP and SBP. For mean 24 hours SBP, SBPd r = 0.25 and r = 0.25, for 24 hours DBP, DBPd, DBPn r = 0.30, r = 0.29, r = 0.24 respectively. Energy, optimism, good mood (9 MMPI scale scores) and good emotion self-control levels (I scale scores) had a negative correlation with WCE levels and mean clinical SBP. Perception of own or other people's emotions (II and IV scale scores) positively correlated with levels of clinical and ambulatory BP. Conclusions: Energy, optimism, good mood and good emotion self-control in AH patients at the clinic may reduce WCE and mean clinical SBP levels. Excessive perception of their own or other people's emotions (II and IV scale scores) can lead to increased clinical and ambulatory BP levels.

Hypotensive response magnitude and duration in hypertensives: continuous and interval exercise.

BackgroundAlthough exercise training is known to promote post-exercise hypotension, there is currently no consistent argument about the effects of manipulating its various components (intensity, duration, rest periods, types of exercise, training methods) on the magnitude and duration of hypotensive response.ObjectiveTo compare the effect of continuous and interval exercises on hypotensive response magnitude and duration in hypertensive patients by using ambulatory blood pressure monitoring (ABPM).MethodsThe sample consisted of 20 elderly hypertensives. Each participant underwent three ABPM sessions: one control ABPM, without exercise; one ABPM after continuous exercise; and one ABPM after interval exercise. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and double product (DP) were monitored to check post-exercise hypotension and for comparison between each ABPM.ResultsABPM after continuous exercise and after interval exercise showed post-exercise hypotension and a significant reduction (p < 0.05) in SBP, DBP, MAP and DP for 20 hours as compared with control ABPM. Comparing ABPM after continuous and ABPM after interval exercise, a significant reduction (p < 0.05) in SBP, DBP, MAP and DP was observed in the latter.ConclusionContinuous and interval exercise trainings promote post-exercise hypotension with reduction in SBP, DBP, MAP and DP in the 20 hours following exercise. Interval exercise training causes greater post-exercise hypotension and lower cardiovascular overload as compared with continuous exercise.

Arterial stiffness and 24 h ambulatory blood pressure monitoring in young healthy volunteers: The early vascular ageing Aristotle University Thessaloniki Study (EVA–ARIS Study)

Differences in 24h blood pressure (BP) monitoring parameters such as average 24h BP, day to night BP ratio and BP variability could have an impact in arterial stiffness. The study hypothesis was that despite similar average BP values in ambulatory blood pressure monitoring subjects with increased 24h BP variability may have increased arterial stiffness.The study population consisted of 115 consecutive young healthy volunteers. Carotid–femoral PWV was measured in all subjects. Clinic BP was measured and an appropriate cuff was fitted on the non-dominant arm of each subject for a 24h ambulatory blood pressure monitoring session. Waist to hip ratio as well as BMI was measured. Family history and smoking habits were recorded. In univariate analysis, estimated carotid–femoral PWV showed a significant correlation with age, weight, waist circumference, height, clinic systolic and diastolic BP, 24-h systolic and diastolic BP, 24-h pulse pressure, 24-h systolic and diastolic BP variability, daytime systolic and diastolic BP, daytime pulse pressure, daytime systolic and diastolic BP variability, nighttime systolic BP, nighttime pulse pressure and nighttime systolic BP variability. In multivariate regression analysis, age (B=0.95, P<0.001) and 24h systolic BP variability (B=0.28, P<0.001) were independent determinanats of arterial stiffness.In conclusions, increased 24h systolic BP variability is associated with arterial stiffness in young healthy volunteers. Pulse wave velocity in a young healthy population is useful to identify determinants of premature arterial stiffness, thus further elucidating the aspects of early vascular ageing.