Ambulatory Blood Pressure Monitoring Testing Research Articles

ASSESSING WORKFLOW, SATISFACTION, AND POTENTIAL COST REDUCTION WHEN USING A CUFFLESS AMBULATORY BLOOD PRESSURE MONITOR

Objective: Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring (ABPM) is used for the diagnosis of hypertension, however, currently-used devices have several drawbacks complicating their use and accuracy. We tested the workflow of a wearable photoplethysmography (PPG)-based cuffless device when compared to the traditional cuff-based ABPM device. Design and method: Patients were recruited in a single community clinic and randomly assigned to either a cuff-based or a PPG-based 24-hour ABPM test. An assessment team recorded the time to complete each workflow component with each device. Questionnaires on user experience and workflow were filled by physicians, nurses, and recruited patients. Results: Workflow assessment of onboarding patients showed that it was faster with the PPG-based device than with the cuff-based device (301.17±58.39 seconds vs 1185±172.34 seconds on average, respectively). The PPG-based device received a higher score in all aspects of usability. The direct manpower cost reduction was calculated as 108,000 USD per year for 4,500 tests. Conclusions: The PPG-based device has several advantages when compared to the traditional cuff-based ABPM device, potentially increasing both patient and medical staff satisfaction, and as a result, increasing compliance. This could help improve the diagnosis and treatment of hypertension in the community.

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 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 > 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 > 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 Hypertension and Cardiovascular Events at a Buenos Aires City Hospital

Background: Nocturnal Hypertension (NHT) has an impact on cardiovascular morbidity and mortality. Our aim was to evaluate the association between NHT and cardiovascular events. Methods: We carried out a retrospective cohort study including adults which had an ambulatory blood pressure monitoring test between March 2017 and July 2020 at a hospital in Buenos Aires City Argentina, with up to 36 months follow-up. Univariate and multivariate analyzes were performed to identify associated factors. Results: Four hundred and ninety four patients were included in the final analysis, 48% male, average age 58.9 years. Sixty two percent (n=308) presented NHT. A higher incidence of the cardiovascular composite endpoint was found in this group compared to those who did not present it, 10.4% vs 3.8% (p=0.013). In the final multivariate Cox regression analysis NHT was an independent predictor of cardiovascular events (HR= 3.9; 95% CI 1.56–9.81; p= 0.001), even independently of daytime HTN and the different circadian patterns of pressure. Conclusions: In this contemporary cohort from Buenos Aires, NHT was related to cardiovascular events incidence. Different measures should be taken to increase NHT awareness and diagnosis.

Ambulatory blood pressure monitoring: A nurse practitioner run program.

Ambulatory blood pressure monitoring (ABPM) is a standard screening tool for the diagnosis of hypertension in children, adolescents, and adults. However, there is confusion and misunderstanding about which guidelines can provide the most accurate diagnostic values. At a large, free-standing pediatric hospital, ABPM testing was historically being conducted by both nephrology and cardiology departments. The nephrology service was using the American Heart Association (AHA) guidelines, published in 2014 for interpretation of results and for diagnosis of hypertension, whereas the cardiology service depended on the 2004 National High Blood Pressure Education Program (NHBEP) fourth report, which led to discrepancies in diagnosis of hypertension in this patient population. A nurse practitioner-led quality improvement project was designed and implemented to determine the best method of ABPM monitoring and test interpretation based on comparing results of patients using height, gender, and application of either the 2004 NHBEP fourth report or 2014 AHA guidelines. Using a retrospective chart review, ABPM monitoring results from both cardiology and nephrology services were reviewed and compared to identify the most accurate methods and to recommend changes to practice. Accuracy of interpretation for ABPM is best accomplished using the 2014 AHA guidelines. Using a single method of interpretation provides consistent diagnosis and treatment of hypertension in children. Nurse practitioners can apply this knowledge in other settings to manage hypertension and provide similar services in different settings, including primary care.

Abstract MP35: Automated Office Blood Pressures For Making A Diagnosis Of Hypertension And The Effect Of Attendance And Rest Time

Context: Automated office blood pressure (AOBP) where three to five blood pressures (BP) are taken using an oscillometric device without an attendant in the room may decrease white coat effect. Objective: We evaluated the presence/absence of the attendant and varying amounts of rest time on BP; and the diagnostic performance of AOBP in making a new diagnosis of hypertension compared to daytime ambulatory blood pressure monitoring (ABPM). Methods: Participants included 130 adults aged 18-84 with no hypertension diagnosis or treatment and high BP ( > 140/90) prior to the study. Participants completing ABPM testing in the prior 24-hours were randomized either to Attended AOBP first, unattended second or; Unattended AOBP first, attended second . AOBP was subsequently performed twice, once after 5 minutes of rest and again after 15 minutes. Outcomes included within person difference between attended versus unattended BPs , and between 5 and 15 minutes of rest. Sensitivity and specificity of AOBP for making a new diagnosis of HTN was evaluated. Results: AOBP was significantly lower than mean daytime ABPM regardless of rest or attendance (systolic BP between -3.9 mmHg and diastolic BP -2.9 mm Hg lower). There were no significant within-person differences between AOBPs that were attended versus unattended (mean difference systolic 0.1 mmHg, CI -0.8, 1.1; diastolic 0.2 mmHg, CI -0.5, 0.8) or after five versus 15-minutes of rest (mean difference systolic -0.5 mmHg, CI -1.4, 0.5, diastolic 0.2 mmHg, CI -1.2, 0.0). Using daytime mean ABPM threshold of > 135/85, the sensitivity and specificity of AOBP for making a new diagnosis of hypertension was 71.0% and 54.1%. Conclusion: Neither the presence/absence of an attendant nor rest time significantly impacted AOBP measurement. A single set of AOBP measurements may be insufficient for making a new diagnosis of hypertension.

Comparison of 3 Devices for 24-Hour Ambulatory Blood Pressure Monitoring in a Nonclinical Environment Through a Randomized Trial.

The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. We compared the proportion of valid blood pressure (BP) readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience among three ABPM devices. We randomized a convenience sample of 365 adults to 1 of 3 ABPM devices: Welch Allyn Mobil-O-Graph (WA), Sun Tech Classic Oscar2 (STO) and Spacelabs 90227 (SL). Participants completed sleep quality questionnaires on the nights before and during ABPM testing. The proportions of valid BP readings were not different among the 3 devices (P > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65, 138.09, 127.44 mm Hg; 114.34, 120.34, 113.13 mm Hg; P < 0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: -5.26, -16.24, -5.36 mm Hg; P < 0.0001); diastolic BP mean differences were ~ -6 mm Hg for all 3 devices (P = 0.6). Approximately 55% of participants reported that the devices interfered with sleep; however, there were no sleep differences across the devices (P > 0.4 for all). Most of the participants met the threshold of 70% valid readings over 24 hours. Sleep disturbance was common but did not interfere with completion of measurement in most of the participants.

Patient perceptions of ambulatory blood pressure monitoring testing, tolerability, accessibility, and expense.

Use of 24-hour ambulatory blood pressure monitoring is strongly endorsed by contemporary hypertension guidelines. The objective of this study was to assess patient perceptions of ambulatory blood pressure testing, tolerability, accessibility, and expense. A convenience sample of 50, consenting patients undergoing ambulatory blood pressure monitoring at the University of Alberta Hypertension Clinic in Edmonton, Canada was studied. A 16-item structured questionnaire was administered in person or electronically. Questions regarding the tolerability of ambulatory monitoring were evaluated using a 5-point Likert scale and wait times, expenditures, and willingness to pay were evaluated by direct questioning. Mean age was 53.1±15.4years, 32 (64%) were female, and 23 (46%) were employed. Mean 24-hour ambulatory BP was 134±12/79±8mmHg. Ambulatory monitoring caused discomfort in 40 (80%) patients and disturbed sleep in 39 (78%). Forty-one (82%) patients perceived that the home (vs pharmacy, primary care clinic, and speciality care clinic) would be the easiest venue to access future testing. On average, patients waited 27.3±23.7days for testing; they felt that a wait time of 21.3±12.3days was appropriate. Mean time taken off work was 8.6±10.8hours. Twelve (24%) patients indicated that they would be willing to pay out-of-pocket to undergo testing sooner, at a mean expenditure of $120±69. Nineteen (62%) patients were willing to buy a monitor and felt that a mean purchase cost of $125±89 was appropriate. These findings extend current knowledge of patient perceptions of ambulatory monitoring and may help to refine and optimize future delivery of this essential test.

Patient Barriers and Facilitators to Ambulatory and Home Blood Pressure Monitoring: A Qualitative Study.

Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients' perspectives of the barriers and facilitators to undergoing ABPM or HBPM. Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM. Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference. Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.

PP.16.16] REGULAR BENZODIAZEPINES CONSUMPTION ASSOCIATED WITH LOWER BLOOD PRESSURE IN AMBULATORY BLOOD PRESSURE MONITORING

Objective: It has been previously demonstrated that benzodiazepines can help reduce acute elevation of blood pressure in hypertensive patients. However, the effect of regular benzodiazepine use on blood pressure has not been documented. In the current study, we aimed to evaluate whether benzodiazepine use (for at least 3 months) can be associated to the results of ambulatory blood pressure monitoring (ABPM). Design and method: A retrospective analysis of the ABPM database between 2009 and 2015 was performed. The study groups were divided according to benzodiazepine treatment at least 3 months before an ABPM. Multivariate analysis using Generalized estimating equation (GEE) linear model was conducted to estimate the association between benzodiazepine treatment and ABPM test measurements: 24 h, daytime, and nighttime systolic and diastolic blood pressure. Results: A total of 5020 ABPM studies were included in final analysis, including 713 ABPM of benzodiazepine-treated patients, and 4307 of untreated patients. The benzodiazepine-treated group was significantly older, with a predominance of female patients, comprised more diabetic patients and patients who consumed more antihypertensive medications. After adjustment for age, gender, diabetes mellitus, and number of antihypertensive medications taken, benzodiazepine treatment was independently associated with significantly lower systolic blood pressure over 24 h, during the daytime, and during the night [−2.176 mmHg (−3.377;−0.974); −2.040 mmHg (−3.268;−0.812) and −2.11 mmHg (−3.486;−0.733) respectively] as well as with significantly lower diastolic blood pressure over 24 h, during the daytime and during the night [−1.802 mmHg (−2.558;−1.047); −1.720 mmHg (−2.502;−0. 939), and −1.788 mmHg (−2.610;−0.966) respectively]. Analysis stratified by age of 60 revealed that benzodiazepine consumption was associated with lower ABPM measurements only in the elderly group. Conclusions: Use of benzodiazepines was independently associated with lower diastolic and systolic blood pressure in all parameters of ABPM in patients 60 years old and older, while not among younger patients.

Chronotherapy’s opportunities of a fixed combination of perindopril 10 mg/indapamide 2.5 mg in patients with a lack of night reduction in blood pressure

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP&gt;140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p

Изучение возможностей хронотерапии при назначении фиксированной комбинации периндоприла 10 мг и индапамида 2,5 мг (Нолипрел А Би-форте) у пациентов с недостаточной степенью снижения артериального давления в ночное время

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP>140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p<0.01), the average ambulatory diastolic BP (DBP) during wakefulness - from 94.7±12.3 mm Hg to 78.3±8.6 mm Hg (ns), ambulatory SBP during sleep - from 146.6±16.1 mm Hg to 121.8±15.7 mm Hg (p<0.01), ambulatory DBP during sleep - from 86.2±9.2 mm Hg to 70.3±6.5 mm Hg (p<0.01). The reduction of nighttime SBP increased from 1.9±5.8% to 6.2±9.3% (p<0.05), the reduction of nighttime DBP from 6.2±3.9% to 9.6±8.2% (ns). ABPM measurements of "non-dipper" sub-groups, who received treatment in the evening or in the morning after 2 months had no significant difference, except the variability of DBP during wakefulness (p<0.05). We didn’t observe statistically significant difference in terms of the nighttime BP reduction. However, nighttime BP reduction was higher in the evening dosing group: SBP - 4.1±11.1% (morning group), 7.8±7.9% (evening group) and DBP - 8.9±11.0 (morning group) and 10.2±5.5 (evening group). Blood tests were in the normal range during the whole study. Conclusion. A fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) is effective and safe in patients with both normal and with insufficient degree of reduction in BP at night. Prescription of medication in the evening in non-dipper patients can have the added benefit on the BP profile. Further research is needed.

Who is the Patient with Suspected White Coat Hypertension?

Objectives: The aim of this study is to establish the profile of individuals with suspected white coat hypertension (WCH) submitted to ambulatory blood pressure monitoring (ABPM), assessing gender, age and pressure behavior during monitoring. Material and method: Between May 2007 and May 2014, a total of 14216 ABPM tests were performed in our department. Of this total, the indication for evaluation of suspected white coat hypertension occurred in 262 tests, which constitute the study sample. The oscillometric method with Dyna-MAPA equipment was used in the study. We have used in statistics: chi-square test of equal proportions and Analysis of Variance (ANOVA). Results: The sample consists of 262 patients, 121 (46.2%) men and 141 (53.8%) women. The mean age of male patients was 41.9 years and of females, 52.5 years. The largest group of patients was the one with abnormal results (113 patients, 43.2%). For patients with abnormal report, the proportion of men is significantly higher than that of women. For patients with normal reports, the proportion of women is significantly higher than men. There is no difference in proportion among genders in the group of patients with borderline report. The mean age of the patients classified as normal (49.9) or borderline (49.6) is significantly older than that of patients diagnosed as abnormal (44.7). Conclusions: 1) Most patients with suspected WCH actually had persistent hypertension at the ABPM; 2) A little over a third of patients with suspected WCH had the diagnosis confirmed by ABPM; 3) The standard patient with WCH in our sample was female and mean age of 50 years.

Efficacy and safety of different regimens of fixed combinationof perindopril 10 mg/indapamide 2.5 mg in patients with arterial hypertension

Objective: The most common strategy to improve blood pressure (BP) control is improving compliance with once daily administration of antihypertensive therapy. Aim: To assess the efficacy, tolerability, safety of different regimes of prescription of combination of perindopril 10 mg and indapamide 2.5 mg.Design and methods. We included 31 patients (56±9.3 years, BMI 30.5±5.3 kg/m2, duration of arterial hypertension - 7.1±5.8 years), on two-component therapy (except combination of perindopril and indapamide) with BP&gt;140/90 mmHg. At baseline ambulatory blood pressure monitoring (ABPM), blood tests were performed in 20 men and 10 women, then, patients were randomized into two groups: morning and evening regimes. Previous therapy was canceled and prescribed a combination of perindopril 10 mg and indapamide 2.5 mg. After 8 weeks of treatment, ABPM and blood tests were re-conducted. Results. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the whole group - 148.4±10.0/95.6±10.7 mm Hg. After 1 and 2 months of treatment Noliprel-A bi-forte SBP/DBP decreased to 131.4±8.4/86.6±5.7 mm Hg and to 133.4±11.2/84.5±8.8 mm Hg respectively. ( p

PP.03.26

Objective: Blood Pressure Variability (BPV) is a novel marker of cardiovascular risk and a significant contributor to target-organ-damage for hypertensive patients. The aim of the study was to investigate the relation between short-term BPV, expressed as Standard Deviation (SD) and assessed by noninvasive 24-hour Ambulatory Blood Pressure Monitoring (ABPM), and the number of oral antihypertensive drugs used, as an index of difficulty in controlling essential hypertension. Design and method: 64 hypertensive patients (mean age 59.8 ± 10.2 years, 42 women) underwent 24-hour ABPM and blood sample testing, and their medicinal history was recorded. 30 hypertensive patients were uncontrolled and 34 were well-controlled. 28.1% of patients received monotherapy, 29.7% received two-drug therapy, 18.8% received at least three-drug therapy, while 23.4% were newly diagnosed hypertensives and did not receive any medication. Daytime, nighttime and 24 h BP and BPV, both systolic and diastolic, were measured for the patients under none (D0), one (D1), two (D2) or three or more (D3) antihypertensive drugs. ANOVA statistical test between groups was performed (by SPSS 19). Results: 32.8% of patients were on ACE-inhibitors, 31.3% on ARB, 39.1% on CCB, 20.3% on diuretic and 28.1% on b-blocker. Mean 24 h systolic BP was 129.8 ± 13.8 mmHg, mean 24 h diastolic BP was 74.3 ± 8.1 mmHg, mean daytime systolic BP was 133.9 ± 14.3 mmHg, mean daytime diastolic BP was 77.4 ± 8.6 mmHg, mean nighttime systolic BP was 121.7 ± 16.5 mmHg and mean nighttime diastolic BP was 68.2 ± 9.5 mmHg. Statistical differences between groups were recorded regarding daytime diastolic BPV (D0 = 6.33 ± 2.2, D1 = 7.50 ± 2.2, D2 = 6.26 ± 1.9, D3 = 8.83 ± 1.9, p = 0.005), nighttime systolic BPV (D0 = 9.67 ± 4.0, D1 = 8.44 ± 3.4, D2 = 10.32 ± 2.7, D3 = 12.3 ± 3.6, p = 0.030) and nighttime diastolic BPV (D0 = 7.07 ± 3.0, D1 = 6.33 ± 2.2, D2 = 6.74 ± 1.9, D3 = 9.00 ± 3.1, p = 0.042). The D3 group developed constantly higher BP and BPV compared with the rest of the groups, regarding systolic and diastolic and daytime, nighttime and 24 h ABPM measurements respectively. Conclusions: These findings suggest that BPV is a vital component of the difficulty in controlling essential hypertension particularly in patients that need at least a three-drug combination therapy for achieving normal BP values.

Эффективность и безопасность разных режимов назначения фиксированной комбинации периндоприла 10 мг и индапамида 2,5 мг у пациентов с артериальной гипертензией

Objective: The most common strategy to improve blood pressure (BP) control is improving compliance with once daily administration of antihypertensive therapy. Aim: To assess the efficacy, tolerability, safety of different regimes of prescription of combination of perindopril 10 mg and indapamide 2.5 mg.Design and methods. We included 31 patients (56±9.3 years, BMI 30.5±5.3 kg/m2, duration of arterial hypertension - 7.1±5.8 years), on two-component therapy (except combination of perindopril and indapamide) with BP>140/90 mmHg. At baseline ambulatory blood pressure monitoring (ABPM), blood tests were performed in 20 men and 10 women, then, patients were randomized into two groups: morning and evening regimes. Previous therapy was canceled and prescribed a combination of perindopril 10 mg and indapamide 2.5 mg. After 8 weeks of treatment, ABPM and blood tests were re-conducted. Results. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the whole group - 148.4±10.0/95.6±10.7 mm Hg. After 1 and 2 months of treatment Noliprel-A bi-forte SBP/DBP decreased to 131.4±8.4/86.6±5.7 mm Hg and to 133.4±11.2/84.5±8.8 mm Hg respectively. ( p <0.001 vs baseline). No additional antihypertensive drugs were added. The combination of perindopril 10 mg and indapamide 2.5 mg effectively reduces BP by ABPM data. There was no difference in terms of BP in morning and evening regime groups. Statistically significant changes in blood indices were not detected. Tolerability was assessed by The combination of perindopril 10 mg and indapamide 2.5 mg effectively reduces BP by ABPM data. There was no difference in terms of BP in morning and evening regime groups. Statistically significant changes in blood indices were not detected. Tolerability was assessed by patients as good to very good.Conclusion. The combination of 10 mg perindopril and indapamide 2.5 mg is effective in achieving and maintaining a target BP levels. The dosing regimen does not affect the efficacy and tolerability and does not cause additional adverse effects when administered in the evening.

Left ventricular mass and diastolic function in obese children and adolescents

Our aims were to assess left ventricular structure and diastolic function in obese subjects stratified according to ambulatory blood pressure status, and to investigate independent predictors of the left ventricular mass (LVM) index. Obese subjects aged 9-19 years referred for ambulatory blood pressure monitoring (ABPM) were evaluated in the cross-sectional study. In addition to biochemical and anthropometric measurements, subjects underwent ABPM, Doppler echocardiography, and treadmill exercise test. According to ABPM results, 103 subjects with obesity (mean age 14.1 ± 2 years) were split in two groups: 49 hypertensive, and 54 without hypertension. Left ventricular hypertrophy was found in 16.3 % of hypertensive, and 5.6 % of normotensive. Variables included in stepwise regression analysis as potential determinants of LVM index were age, body mass index z score, waist circumference, peak systolic blood pressure on exercise test, 24-h heart rate, and night heart rate. Peak systolic blood pressure (adjusted R(2) = 0.051, β = 0.245, p = 0.013) remained as the independent predictor of LVM index. Diastolic function evaluated by mitral E/A ratio was decreased in both obese groups. Early markers of cardiac disease including hypertrophy and diastolic dysfunction of the left ventricle are present in youths with obesity prior to the development of sustained hypertension.

Impact on hypertension reclassification by Ambulatory Blood Pressure Monitoring (ABPM) according to the V Brazilian Guidelines on ABPM

New recommendations on reference values for normal test results in ambulatory blood pressure monitoring (ABPM) were proposed by the V Brazilian Guidelines on Ambulatory Blood Pressure Monitoring, based mainly on the IDACO study. This epidemiological study is aimed at evaluating the impact of adopting these new standards in an arterial hypertension referral center. The results of 1,567 ABPM tests carried out between 2005 and 2010 were analyzed; 481 patients were excluded from the sample for not meeting minimum quality criteria of the test. Reference values from the IV Brazilian Guidelines on ABPM (2005) were used for the classification of these tests regarding the abnormality and compared with the changes proposed by the V Brazilian Guidelines on ABPM (2011). Statistical analysis was performed by Pearson's chi-square method and p values < 0.05 were considered statistically significant. For the 1,086 tests evaluated, there was a significant difference in the proportion of patients with altered ABPM results, especially for the variable systolic pressure in the sleeping period: 49% when adopting the cutoff values of 2005 and 71% when adopting the values of 2011, with statistical significance, p < 0.0001. The recommendations of the new guidelines had a great impact on the hypertension classification by ABPM test results in the study population. The question of thresholds of these tests for therapeutic targets of patients known to be hypertensive is still open and requires further studies, preferably national ones, for better definition of the subject.

Ambulatory Blood Pressure Monitoring in a Cohort of Children Referred with Suspected Hypertension: Characteristics of Children with and without Attention Deficit Hyperactivity Disorder

Childhood hypertension's increasing prevalence has generally been linked to the obesity epidemic. We observed that a significant proportion of children referred to our pediatric center with documented office hypertension are nonobese and have a history of attention deficit hyperactivity disorder (ADHD). To define the extent of this anecdotal observation, we performed a retrospective analysis of ambulatory blood pressure monitoring (ABPM) tests which in our center are routinely performed in newly referred children suspected of hypertension. Twenty-one percent (48 of 227 new referrals) had a history of ADHD, and 81% of them were treated with psychostimulant medications at the time of their ABPM test. Children in this group had a significantly lower average BMI z-score compared with the rest of the children (0.18 versus 0.75) and were significantly more likely to have abnormally elevated wake systolic loads on ABPM (38% versus 4%). The overall proportion of children with any abnormality on ABPM was comparable in both groups (46% versus 40%). Conclusion. A significant proportion of children suspected of hypertension have ADHD which may be related to higher wake systolic BP values. The prevalence of hypertension among children with ADHD will have to be determined in prospective studies.

Abstract 303: Effect of a Resistance Training Period on Blood Pressure, Circulating Levels of Interleukine-6, Quality of Life and Functional Capacities in Elderly Hypertensive Patients

The aging increases susceptibility to hypertension, and also promotes muscle wasting, thereby increasing the risk of falls within the elderly. In contrast, the resistance training (RT) is recommended for increasing or maintaining muscle strength levels in the elderly. However, there is still no consensus in the literature about its effectiveness for hypertension treatment. Therefore, the aim of this study was to verify the effect of RT on blood pressure, circulating levels of Interleukine-6 (IL-6), quality of life and functional capacities in elderly hypertensive patients. Methods 43 subjects were randomized in two groups: sedentary (S) and RT. The RT was practiced during 14 weeks in three non-consecutive days per week, with 50% of 1 maximal repetition of intensity. Before and after experiment period were evaluated blood pressure by ambulatory blood pressure monitoring (ABPM), IL-6 by ELISA kit, quality of life by questionnaire (SF-36) and functional capacities by battery of functional tests. Data were analyzed using ANOVA two-way (p≤0.05). Results The S group showed no statistical differences in ABPM, IL-6, SF-36 and functional testing, pre and post experiment. On the other hand, the RT group had significant reductions in systolic blood pressure within 24 hours (125 ± 2; 120±3 mmHg pre and post, respectively), day-time (127±2; 123±3 mmHg pre and post, respectively) and morning-time (125±4; 118±3 mmHg pre and post, respectively), diastolic blood pressure in 24-hours (69±1; 66±1 mmHg pre and post, respectively), night-time (64±1; 59±1 mmHg pre and post, respectively) and morning-time (69±2; 66±1 mmHg pre and post, respectively), mean blood pressure in 24-hours (91±1; 86±2 mmHg pre and post, respectively), day-time (93±1; 89±2 mmHg pre and post, respectively) and morning-time (87±2; 84±2 mmHg pre and post, respectively). In the SF-36, the RT group improved its results in all categories, which was also observed in the functional tests. The RT group showed a trend towards reduction in IL-6, which was not observed in the S group. Conclusion A period of resistance training lowered blood pressure and improved quality of life and functional capacity of elderly hypertensive patients. Acknowledgements: FAPESP 2011/23830-3