Ambulatory Blood Pressure Research Articles

Serum neutrophil gelatinase-associated lipocalin and cystatin C is associated with blood pressure in ex-preterm children and adolescents.

As preterm birth is a risk factor for hypertension (HTN), biomarkers for early prediction of HTN in childhood is an emerging need. The aims of the study were to evaluate serum biomarkers in ex-preterm children and examine for associations with office peripheral and central SBP (cSBP), ambulatory BP parameters and pulse wave velocity (PWV). This case-control study included children and adolescents born prematurely (ex-preterms) and at full term (controls). All participants underwent office and ambulatory BP monitoring, assessment of cSBP, PWV and serum biomarkers at the same visit. Neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-2, metalloproteinase-9 (MMP-2, MMP-9) and Cystatin C (CysC) were measured using ELISA. The study population included 52 ex-preterm individuals and 26 controls. Mean age was 10.7 ± 3.6 years. NGAL, MMP-2, MMP-9, and CysC levels were similar between the ex-preterm and the control group. In the ex-preterm group, NGAL is associated with office SBP z score (β = 1.007, 95% CI 1.001-0.014, P = 0.049), CysC with office DBP z score (β = 1.003, 95% CI 1.001-0.005, P = 0.018) and cSBP z score (β = 1.003, 95% CI 1.001-0.005, P = 0.006) independently of age, sex and BMI z score. Among ex-preterm children and adolescents 17% had ambulatory HTN and 31% had white-coat HTN. NGAL levels were higher in ex-preterm children with WCH compared with children with normal BP [57.9 (IQR 50.8) versus 34.6 (IQR 46.2)], P = 0.018]. WCH is common in ex-preterm children and adolescents and is associated with higher NGAL levels and CysC presents positive association with cSBP. The findings in this study provides preliminary evidence that NGAL and CysC may have a role in predicting the risk of developing hypertension later in life. Further studies are warranted.

No Difference between the Efficacy of High-Nitrate and Low-Nitrate Vegetable Supplementation on Blood Pressure after 16 Weeks in Individuals with Early-Stage Hypertension: An Exploratory, Double-Blinded, Randomized, Controlled Trial.

Dietary inorganic nitrate lowers blood pressure (BP) in healthy individuals through improved nitric oxide (NO) bioavailability. However, there is limited evidence examining the long-term effects of dietary nitrate for managing hypertension. We aimed to determine whether the sustained intake of dietary nitrate improved BP and cardiovascular disease (CVD) risk factors in individuals with early-stage hypertension. The Dietary Nitrate (NO3) on BP and CVD Risk Factors (DINO3) Trial was a multi-center, double-blinded, parallel, randomized, controlled trial in participants with elevated BP. Participants were supplemented with high-nitrate (HN) (~400 mg nitrate) or low-nitrate (LN) vegetable powder (~50 mg nitrate) on top of their usual diets for 16 weeks. The primary outcome was office systolic BP at 16 weeks. The secondary outcomes were 24 h ambulatory BP, central BP, heart-rate-corrected augmentation index (AIx75), carotid-femoral pulse wave velocity (cf-PWV), lipids, and high-sensitivity C-reactive protein (hs-CRP). Sixty-six participants were randomized at baseline (39M:27F, age: 51.5 ± 10.8 years, BMI:27.9 ± 3.2 kg/m2). In an intention-to-treat analysis, no differences were observed between HN and LN groups in terms of office systolic BP at 16 weeks (3.91 ± 3.52 mmHg, p = 0.27) or secondary outcomes. In this exploratory study, sustained HN vegetable supplementation did not exhibit more favorable vascular effects than LN vegetable supplementation in individuals with elevated BP.

Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation in Chinese Patients With Uncontrolled Hypertension: The Randomized, Sham-Controlled, Multi-Center Iberis-HTN Trial.

Renal denervation (RDN) can lower blood pressure (BP) in patients with hypertension in both the presence and absence of medication. This is the first sham-controlled trial investigating the safety and efficacy of RDN in China. This prospective, multicenter, randomized, patient- and outcome-assessor-blinded, sham-controlled trial investigated radiofrequency RDN in patients with hypertension on standardized triple antihypertensive therapy. Eligible patients were randomized 1:1 to undergo RDN using a multi-electrode radiofrequency catheter (Iberis; AngioCare, Shanghai, China) or a sham procedure. The primary efficacy outcome was the between-group difference in baseline-adjusted change in mean 24-hour ambulatory systolic BP from randomization to 6 months. Of 217 randomized patients (mean age, 45.3±10.2 years; 21% female), 107 were randomized to RDN and 110 were randomized to sham control. At 6 months, there was a greater reduction in 24-hour systolic BP in the RDN (-13.0±12.1 mm Hg) compared with the sham control group (-3.0±13.0 mm Hg; baseline-adjusted between-group difference, -9.4 mm Hg [95% CI, -12.8 to -5.9]; P<0.001). Compared with sham, 24-hour diastolic BP was lowered by -5.0 mm Hg ([95% CI, -7.5 to -2.4]; P<0.001) 6 months after RDN, and office systolic and diastolic BP was lowered by -6.4 mm Hg ([95% CI, -10.5 to -2.3]; P=0.003) and -5.1 mm Hg ([95% CI, -8.2 to -2.0]; P=0.001), respectively. One patient in the RDN group experienced an access site complication (hematoma), which resolved without sequelae. No other major device- or procedure-related safety events occurred through follow-up. In this trial of Chinese patients with uncontrolled hypertension on a standardized triple pharmacotherapy, RDN was safe and reduced ambulatory and office BP at 6 months compared with sham. URL: https://clinicaltrials.gov; Unique identifier: NCT02901704.

Masked uncontrolled hypertension among elderly black sub-saharan africans compared to younger adults: a cross-sectional in-hospital study

BackgroundAlthough aging and being of African descent are well-known risk factors for masked uncontrolled hypertension (MUCH), data on MUCH among elderly black sub-Saharan Africans (BSSA) are limited. Furthermore, it is unclear whether the determinants of MUCH in younger individuals differ from those in the elderly.ObjectiveThis study aimed to determine the prevalence and risk factors associated with MUCH in both elderly and younger BSSA individuals.MethodsIn this study, 168 patients with treated hypertension were assessed for medical history, clinical examination, fundoscopy, echocardiography, and laboratory data. All patients underwent ambulatory blood pressure (BP) monitoring for 24 h. MUCH was diagnosed if the average 24-h mean BP ≥ 130/80 mmHg, the daytime mean BP ≥ 135/85 mmHg, and/or the nighttime mean BP ≥ 120/70 mmHg, despite controlled clinic BP (≤ 140/90 mmHg). Logistic regression analysis was performed to assess independent factors associated with MUCH, including elderly and younger adults separately. P-values < 0.05 were used to indicate statistical significance.ResultsOf the 168 patients aged 53.6 ± 11.6 years, 92 (54.8%) were men, with a sex ratio of 1.2, and, 66 (39%) were aged ≥ 60 years. The proportion of patients with MUCH (27.4% for all patients) was significantly higher (p = 0.002) among elderly patients than among younger patients (45.5% vs. 15.7%). Diabetes mellitus (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI], 1.27–4.46; p = 0.043), anemia (aOR, 3.18; 95% CI, 1.07–5.81; p = 0.043), hypertensive retinopathy (aOR, 4.50; 95% CI, 1.57–5.4; p = 0.043), and left ventricular hypertrophy (aOR, 4.48; 95% CI, 2.26–8.35; p = 0.043) were independently associated with MUCH in the elderly. In younger individuals, male gender (aOR, 2.16; 95% CI, (1.33–4.80); p = 0.029), obesity (aOR, 3.02; 95% CI, (1.26–5.32); p = 0.001), and left ventricular hypertrophy (LVH) (aOR, 3.08; 95% CI, (2.14–6.24); p = 0.019) were independently associated with MUCH were independently associated with MUCH.ConclusionMUCH is more prevalent among elderly than among younger BSSA individuals. Determinants of MUCH vary by age. MUCH prevention and management strategies should be age-specific.

Blood pressure variability in elderly and senior hypertensive patients

Background. In recent years the deterioration of the demographic situation has been noted in most countries of the world that is due to the steady increase in population of arterial hypertension and the aging of the population. According to the statistical forecast of the UN by 2025, the number of people over 60 will exceed 1 billion which is 15% of the entire global population. In Ukraine, according to epidemiological studies, the prevalence of hypertension among circulatory system diseases in adults (18 years and older) is 46.8% and almost half of patients with circulatory system diseases have elevated blood pressure. In patients aged 65 years and older, the prevalence of hypertension varies in the range of 53-72%. It has long been proven that the risk of cardiovascular and cerebrovascular complications in hypertensive patients depends not only on the absolute blood pressure level but also on fluctuations in blood pressure over different periods that is blood pressure variability. Blood pressure is not a static parameter but rather undergoes continuous fluctuations over time due to the interaction between environmental factors and behaviour on the one hand and the internal regulatory mechanisms of the cardiovascular system on the other hand. Elevated blood pressure may indicate cardiovascular dysregulation and itself may be a cardiovascular risk factor associated with increased all-cause mortality and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease and incidence of dementia. Aim. The study aimed to improve the system of prevention and diagnosis of elderly and senior hypertensive patients at the ambulatory-polyclinic stage due to the study of the contribution of blood pressure variability. Materials and methods. The group of examinees was formed taking into account 27 elderly and senile hypertensive patients including those combined with coronary artery disease. For this purpose, ambulatory blood pressure monitoring was used. Results. Systolic blood pressure variability (SD) in hypertensive patients was higher than in the control group (p&lt;0.001). So, during the study, SD was 17.9±7.1 mm Hg. while in the control group 12.1±2.6 mm Hg. The frequency of high blood pressure variability detection in elderly and senile hypertensive patients was 51.9% (n=14). High blood pressure variability compared to low blood pressure variability and control was associated with a more pronounced systolic blood pressure variability (during the active monitoring period), and it was equalled 23.7±5.2 mm Hg compared to 14.8±6.5 mm Hg (p&lt;0.001) and 12.1±2.6 mm Hg. (p&lt;0.001). In elderly and senile hypertensive patients with high and low blood pressure variability, the non-dipper group prevailed over the dipper group in the structure of daily blood pressure rhythm (71.4% vs. 28.6% and 84.6% vs. 15.4% respectively). According to the ambulatory blood pressure monitoring data high blood pressure variability group compared to low blood pressure variability and controls was characterised by higher average values of the number of blood pressure indicators. In the group of high blood pressure variability patients, the average daily systolic blood pressure exceeded the control value by 10% (р&lt;0.05). The daily index of systolic blood pressure in the group of high blood pressure variability patients was 111% higher than in patients with low blood pressure variability (p&lt;0.05). The daily index of diastolic blood pressure in the group of high blood pressure variability patients was 140% higher than in patients with low blood pressure variability (p&lt;0.05). The daily index of average blood pressure in the group of high blood pressure variability patients was 191% higher than in patients with low blood pressure variability (p&lt;0.01). Conclusions. 1. High blood pressure variability has occurred in 16 out of 27 (51.9%) hypertensive elderly and senile patients. 2. The non-dipper group has predominated in the structure of blood pressure diurnal rhythm in elderly and senile hypertensive patients with high and low blood pressure variability patients. _________________________________________________________________________________________ Keywords: arterial hypertension; essential hypertension; blood pressure variability; high blood pressure variability; low blood pressure variability; elderly and senile hypertensive patients

Using an in-office passive leg raise to identify older adults with suboptimal blood pressure control.

Passive leg raise (PLR) is a simple, dynamic maneuver that has been used to increase preload to the heart. We hypothesize that PLR may offer a new and efficient office-based tool for assessing blood pressure (BP) control in older adults. One hundred and three veterans (≥60 years old) without known cardiovascular disease and varying degrees of blood pressure control were included in this cross-sectional cohort study. Twenty-four hour ambulatory BP monitoring identified Veterans with optimal and suboptimal BP control (≥125/75 mmHg). Bioimpedance electrodes (Baxter Medical, Deerfield, Illinois, USA) and brachial BP were used to calculate hemodynamic parameter changes across PLR states [pre-PLR, active PLR (3 min), and post-PLR]. Multiple linear regression was used to assess associations between BP control status with changes in hemodynamic parameters between PLR states. The 24-h ambulatory BP monitoring identified 43 (42%) older Veterans with optimal BP control (mean age of 70.5 ± 7.0 years) and 55 (54%) with suboptimal BP (mean age of 71.3 ± 8.7 years). Veterans with suboptimal BP control had significantly reduced change in total peripheral resistance (ΔTPR) (7.0 ± 156.0 vs. 127.3 ± 145.6 dynes s/cm5; P = 0.002) following PLR compared with Veterans with optimal BP control. Suboptimal BP control (β = -0.35, P = 0.004) had a significant association with reduced ΔTPR, even after adjusting for demographic variables. Measuring PLR-induced hemodynamic changes in the office setting may represent an alternative way to identify older adults with suboptimal BP control when 24-h ambulatory BP monitoring is not available.

The association of sex differences in ambulatory blood pressure with cardiovascular events and mortality in dialysis patients.

Male patients with pre-dialysis chronickidneydisease(CKD) have worse ambulatory blood pressure(BP) control than females; this is associated with higher mortality. Male hemodialysis patients have higher ambulatoryBP levels than females. This analysis aimed to investigate the association of sex differences in ambulatory BP with cardiovascular events and mortality in hemodialysis individuals. 129 male and 91 female hemodialysis patients with valid 48-h BP monitoring were followed for 53.4 ± 31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpointwas a composite of cardiovascular death, non-fatal myocardialinfarction, non-fatal stroke, resuscitation after cardiacarrest, heartfailure-hospitalization, coronary or peripheral revascularization. Cumulativefreedom from the primary endpoint was lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between-groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher in women (HR = 1.613, 95% CI[1.037, 2.509]). The crude risk for the combined endpoint was not different between the two groups (HR = 0.918, 95% CI[0.638, 1.320]). After adjusting for major risk factors (age, diabetes, dialysis vintage, coronary disease and hemoglobin) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.295 (95% CI[0.808, 2.078]), secondary: HR = 0.763 (95% CI[0.521, 1.118])). After additional adjustment for 44-h systolicBP the above relationships did not alter (primary: HR = 1.329 (95% CI [0.826, 2.137]), secondary: HR = 0.808 (95% CI [0.551, 1.184])). In conclusion, female hemodialysis patients have higher crude but similar adjusted cardiovascular mortality rates compared to male counterparts. In contrast to pre-dialysis CKD, the neutral relationship between gender and adverse cardiovascular outcomes in hemodialysis is not further affected by ambulatory BP.

Daytime actisensitivity predicts nocturnal dipping patterns and morning surge in blood pressure: the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective study.

Ambulatory blood pressure (BP) is influenced by physical activity and the BP response to physical activity (actisensitivity) differs between individuals. This study investigated associations between daytime actisensitivity and nighttime BP dipping status and morning BP surge. Twenty-four-hour ambulatory BP monitoring (ABPM) with simultaneously monitored physical activity using a multisensor all-in-one device (TM-2441; A&D Company) was performed at baseline in HI-JAMP study participants. Those with complete BP measurements and complete physical activity monitoring data were included in this analysis. Actisensitivity was calculated as the slope of the regression line between daytime SBP and log-transformed physical activity over a 5 min period before each BP reading. Hyper and negative reactivity were defined as actisensitivity greater than 90th and less than 10th percentile, respectively. Data from 2692 individuals (mean age 69.9 ± 11.9 years; mean BMI 24.8 ± 4.1 kg/m2, 53.6% men) were analyzed. Those with hyper reactivity had a high prevalence of the extreme dipper pattern of nighttime BP and exaggerated morning BP surge; those with negative reactivity had higher nighttime BP and a riser pattern of nighttime BP. Results remained significant after adjusting for 24-h physical activity. Differences in diurnal BP variability based on actisensitivity were augmented in individuals aged at least 75 years. This study is the first to investigate associations between actisensitivity and 24-h ambulatory BP profiles using an all-in-one multisensor device in a large real-world population. The associations seen between either hyper or negative actisensitivity and abnormal diurnal BP variability, especially in the elderly, could contribute to increased cardiovascular event risk. University Hospital Medical Information Network Clinical Trials Registry, UMIN000029151 (HI-JAMP study).

P078 EVALUATION OF THE FREQUENCY AND GEOGRAPHICAL DISTRIBUTION OF THE USE OF AMBULATORY BLOOD PRESSURE MONITORING IN COLOMBIA

Background and Objectives: Hypertension is the main modifiable cardiovascular risk factor. However, 46% of adults with hypertension are unaware of their diagnosis. Ambulatory blood pressure monitoring (ABPM) can be very helpful in the identification of white coat and masked hypertension, offering advantages when compared to in-office measurement. Unfortunately, this method is not available at all levels of care. Particularly in Colombia, there is no information regarding the frequency of use or geographic distribution; however, it's inferred that it's more available in the most developed regions. Therefore, the purpose of this study is to evaluate the frequency of use, geographic distribution, and demographic characteristics of patients who underwent ABPM in Colombia. Methods: Cross sectional study, carried out through the review of the SISPRO records of Colombians aged 18 years or older, with indication of performing ABPM between 2019 and 2023. Results: 405,396 individuals in Colombia underwent ABPM (7.7 ABPMs per 1000 inhabitants per year). 63.1% were females. The departments with the highest number of ABPM studies were Bogotá (71,709 ABPMs – 9.9 ABPMs per 1000 inhabitants per year), followed by Antioquia (45,097 ABPMs - 7.5 ABPMs per 1000 inhabitants per year) (Figure 1). Concerning age groups, the highest number of ABPM requests was between 70 and 74 years (50,103 patients), followed by the 55-59 years group (46,944 patients). 72.25% of the requests were for patients older than 50 years. Conclusions: Although Colombia has improved in the implementation and use of ABPM at the national level, its use predominates in women, patients aged between 70 and 74 years, and at the level of the 2 largest cities in the country. Collective efforts are required at national level to improve the implementation and registration of the ABPM.

O20 CURRENT 24-HOUR AMBULATORY BLOOD PRESSURE TECHNOLOGIES SHOULD BE RECONSIDERED AS THE REFERENCE STANDARD FOR VALIDATION OF CUFFLESS BLOOD PRESSURE DEVICES

Background and Objective: Recommendations for the validation of cuffless blood pressure (BP) devices were recently released by the European Society of Hypertension (ESH). In this recommendation, 24-hour ambulatory BP monitoring (ABPM) is the reference standard for a newly proposed ‘awake-asleep’ accuracy test. However, this reference standard may be inappropriate because ABPM is subject to measurement insecurities, and it is unknown if it would pass the awake-asleep test. Therefore, the aim of this study was to determine if ABPM itself would pass the awake-asleep test recommended for validation of cuffless BP devices. Methods: Dual arm, simultaneous ABPM were recorded using two identical cuff-based devices (TM-2430, A&amp;D, Japan) among 46 healthy adults (22±2.3 years; 54% female). The awake-asleep test was defined as the difference between the left arm ABPM minus right arm ABPM for assessing the change in BP between awake-asleep time (ESH recommendations: mean difference ± SD ≤5±8 mmHg, correlation r&gt;0.7 for test and reference values; awake-asleep BP components calculated based on personalized sleeping times). Measurement artefacts were identified by analysis of the cuff deflation pressure curves and hydrostatic pressure differences (body position) between the cuffs. Results: ABPM did not pass the awake-asleep test due to higher than acceptable measurement variability for systolic BP, -0.1±8.6 mmHg, r=0.69 and partially met requirements for diastolic BP, -0.7±5.9 mmHg, r=0.63. After correction for measurement artefacts and hydrostatic pressure differences, ABPM passed the awake-asleep test for systolic BP (-1.7±5.0 mmHg, r=0.76) but still did not meet requirements for diastolic BP due to insufficient correlation (r=0.64). Conclusion: In this analysis, ABPM itself did not meet the awake-asleep test criteria recommended by the ESH. Using current ABPM technologies as a reference standard for cuffless BP validation protocols may need to be reconsidered and they need improvement before use for this purpose. Improving ABPM through better measurement artefact detection could be an initial solution which would also improve its value for clinical decision making.

Abstract P324: Masked Hypertension Mimicking Migraine: A Case Report with Diagnostic Odyssey

Introduction: Masked hypertension (MH) involves normal office blood pressure but elevated readings outside clinical settings, increasing cardiovascular and neurological risks. About 10-30% of the population may have MH, often undiagnosed. This case highlights the importance of considering MH. Case Presentation: A 42-year-old woman had recurrent headaches for six months: bilateral, pulsating pain in the temples, with dizziness and occasional vomiting, lasting 2-4 hours, worsening after work. Diagnosed with migraines and treated with sumatriptan without relief. Medical history included a caesarean section; otherwise, she was healthy. Physical exam showed normal vital signs, including blood pressure at 130/80 mmHg. Neurological and ophthalmological evaluations were normal. Lab investigations were unremarkable. The patient had a normal BMI of 21.3. Further workup, including ECG, MRI, CT scan, and neck radiography, all normal. Ambulatory blood pressure monitoring (ABPM) revealed elevated blood pressure during evening hours (post work), starting around 4 pm and rising until 8-9 pm. Thereafter, blood pressure normalized to 110-130 mmHg systolic and 70-80 mmHg diastolic. To rule out nephrogenic hypertension, an ultrasound of the kidneys, renal function tests, urinalysis, and plasma metanephrine tests were negative. Following the exclusion of other causes, a diagnosis of MH was established. The patient started on Telmisartan 20 mg daily, with lifestyle modifications. Follow-up ABPM showed normalized blood pressure, and the patient reported no further headaches. Discussion: MH affects many but often remains undiagnosed due to normal clinic readings. Ambulatory or home blood pressure monitoring is essential for diagnosis. Timely diagnosis of MH is crucial, given its association with heightened risks of stroke and cardiovascular disease. Studies have revealed significantly elevated left ventricular mass index, maximal intima-media thickness, and urinary albumin levels. Consequences include left ventricular hypertrophy, carotid atherosclerosis, and albuminuria. Conclusion: Early recognition and management of MH are vital for preventing complications. Diagnosis can be achieved by home blood pressure monitoring (HBPM) or 24-hour ambulatory blood pressure. This case stresses considering MH in patients with normal office readings but persistent symptoms, advocating for regular monitoring and patient education for optimal health outcomes.

P121 ROLE OF AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN THE EVALUATION OF PATIENTS WITH SUSPECTED SLEEP APNEA

Background and Objective: Obstructive sleep apnea (OSA) often coexists with hypertension. Ambulatory blood pressure monitoring (ABPM) is essential for detecting significant blood pressure fluctuations, especially during nighttime. This study seeks to assess the role of ABPM in identifying OSA. Methods: We analyzed a database of patients with suspected OSA using the STOP-BANG questionnaire at a cardiology center from July 2020 to April 2024. Anthropometric characteristics, blood pressure behavior through ABPM, and sleep patterns via polysomnography were evaluated. The influence of risk predictors on OSA development was assessed using multinomial logistic regression. Results: The study included 38 men (50.6%) and 37 women (49.3%); 48 hypertensive patients (64%) and 27 without hypertension (27%). The average STOP-BANG score was 3.8. Of these, 92% had some degree of OSA. The mean age was 60±13.2 years. Neck circumference (NC) and total apnea-hypopnea index were 37.5 cm and 19.7 events/hour, respectively, with a predominance of REM OSA. Only NC and nocturnal diastolic pressure were significant variables. For the development of moderate OSA, NC showed significant relative risk ratios (RRR) (p=0.045). Severe OSA development was influenced by mean nocturnal diastolic blood pressure (MNDAP) and NC, with significant RRRs (p=0.007 and p=0.041, respectively). This means that for each mmHg increase in nocturnal diastolic pressure, the risk of severe OSA increases by 1.3 times compared to healthy patients, predominantly during REM sleep. Conversely, increased daytime diastolic pressure decreases this risk by 25%. Conclusions: An increase in mean nocturnal diastolic pressure measured by ABPM is a significant predictor of severe OSA development. This underscores ABPM's importance in evaluating patients with suspected OSA. While the STOP-BANG questionnaire is useful for initial OSA suspicion, it has limitations in identifying the most severe cases, necessitating tools like ABPM for more accurate assessment. The use of ABPM improves accuracy in detecting severe OSA and enhances understanding of hypertension phenotypes’ pathophysiology. Table 1. Obstructive Sleep Apnea (OSA) Severity Classification and Its Correlation with Mean Nocturnal Diastolic Blood Pressure (MNDAP), Mean Daytime Diastolic Blood Pressure (MDDAP), and Neck Circumference (NC)

Abstract P362: The Associations of Neighborhood Social and Built Environments with Ambulatory Blood Pressures in Young Adults of the Georgia Stress and Heart Cohort

Ambulatory blood pressure monitoring (ABPM) is an assessment method in which BP measurements are taken at regular intervals when individuals are awake and asleep, during a typical 24-hour period. Thus, ABPM is an accurate and effective way to measure BP. Neighborhood social and built environments play an important role in health, which were previously associated with cardiovascular risk factors. However, the effects of neighborhood social and built environments on ABPM is understudied, particularly among young adults and African Americans. The current study aimed to investigate the cross-sectional associations between neighborhood social and built environments and ABPM in our Georgia Stress and Heart Cohort consisting of 543 participants, aged 29.1 ± 3.6 years, 49.7% African American and 51.2% female. There were found to be consistent positive associations of neighborhood social and built environments with 24-hour systolic BP (SBP), 24-hour diastolic BP (DBP), daytime SBP, daytime DBP, nighttime SBP, and nighttime DBP ( p ≤0.01, respectively), after the adjustment for age, race and sex. Neighborhood factors such as Median Household Income and College Graduation held the negative associations with measurements of 24-hour SBP, 24-hour DBP daytime SBP, daytime DBP, nighttime SBP, nighttime DBP, and 24-hour SBP ( p ≤0.01, respectively). This study is one of the first to report the relationship between neighborhood social and built environments and ABP, particularly in young adults and African Americans residing in the US southeastern region. Future longitudinal studies are warranted to further support the findings of the current study.

Abstract P442: Impact of arterial stiffness on the blood pressure lowering effect of the dual endothelin antagonist aprocitentan in patients with resistant hypertension

Background: The phase-3 PRECISION study demonstrated the efficacy of aprocitentan to lower both office and ambulatory blood pressure (BP) in patients with resistant hypertension. Increased arterial stiffness has been associated with less favorable responses to pharmacologic BP lowering therapies. In this post-hoc analysis, we investigated the impact of arterial stiffness, assessed by the ambulatory arterial stiffness index (AASI), on the BP lowering effect of aprocitentan. Methods: The study included a 4-week double blind period (aprocitentan 12.5 mg, 25 mg, or placebo) and a 32-week single blind period (aprocitentan 25 mg). A total of 730 patients with resistant hypertension were randomized and 633 had available ambulatory BP monitoring (ABPM) results at baseline. The AASI was calculated from ABPM data as 1 minus the regression slope of diastolic on systolic BP. The patient population was dichotomized into two groups according to the baseline median AASI. Results: Patients with higher baseline AASI (≥0.54) tended to be older (63±11 versus 60±10) and to have a higher 24-hour ambulatory systolic BP (140±14 versus 135±14 mmHg) than patients with lower AASI (&lt;0.54). These patients with higher baseline AASI were also more likely to have chronic kidney disease stage 3-4 corresponding to an estimated glomerular filtration rate in the 15 to 60 mL/min/1.73 m 2 range (27% versus 18%). The BP lowering effect of aprocitentan at Week 4 was similar for both the patients with stiffer vasculature who have a higher baseline AASI (≥0.54) and for those with a lower AASI (&lt;0.54) (Table 1). No relevant change in AASI was reported with aprocitentan treatment at Week 4 (end of the double-blind period) or Week 36 (end of the single-blind period). Conclusion: Aprocitentan is an effective BP lowering therapy across the arterial stiffness continuum observed in patients with resistant hypertension. Longer observation times are needed to fully assess the impact of treatment on this structural and functional parameter.

The impact of the COVID-19 Pandemic on hypertension phenotypes (ESH ABPM COVID-19 study)

ObjectiveThe COVID-19 pandemic had a major impact on medical care. This study evaluated the influence of the pandemic on blood pressure (BP) control and hypertension phenotypes as assessed by office and 24-hour ambulatory BP monitoring (ABPM). Design and MethodsData were collected from 33 centers including Excellence Centers of the European Society of Hypertension. Two groups of patients with treated hypertension were compared. Pandemic group: including participants who had ABPM twice - at visit 2 during the COVID-19 pandemic and visit 1 performed 9–15 months prior to visit 2. Pre-pandemic group: had ABPM at two visits, performed before the pandemic within 9–15 months interval. We determined the following hypertension phenotypes: masked hypertension, white coat hypertension, sustained controlled hypertension (SCH) and sustained uncontrolled hypertension (SUCH). We analyzed the prevalence of phenotypes and their changes between visits. ResultsData of 1419 patients, 616 (43 %) in the pandemic group and 803 (57 %) in the pre-pandemic group, were analyzed. At baseline (visit 1), the prevalence of hypertension phenotypes did not differ between groups. In the pandemic group, the change in hypertension phenotypes between two visits was not significant (p = 0.08). In contrast, in the pre-pandemic group, the prevalence of SCH increased during follow-up (28.8 % vs 38.4 %, p < 0.01) while the prevalence of SUCH decreased (34.2 % vs 27.8 %, p < 0.01). In multivariable adjusted analysis, the only factor influencing negative changes of hypertension phenotypes was the COVID-19 pandemic period. ConclusionThese results indicate a negative impact of the COVID-19 pandemic on BP control assessed by hypertension phenotypes.

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters.

Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.

Abstract P312: Comparing Activity Logs in 24-hour Ambulatory Blood Pressure Monitoring

Background: Growing evidence suggests that activities during ambulatory blood pressure monitoring (ABPM) may affect measurement. While activity logs are often used to characterize context of measurements, there is little evidence to inform strategies to optimize the collection of these data from patients. Objective: To compare different log formats and their impact on data collection from activity logs of events occurring during ABPM. Methods: We performed a quality improvement project in our Hypertension Center using three different types of 24-hour ABPM logs (unstructured, semi-structured, and structured). Each log asked patients to record their daily activities including sleep, meals, physical activity, pain or other symptoms, medications, stress, caffeine, and tobacco use. The structured logs requested patients document activities with check boxes, the unstructured logs requested documentation with free text, and the semi-structured log combined check boxes and free text. Over a 12-month period, patients received one of the three versions of the ABPM logs in an alternating non-randomized schedule. We used linear regression models with adjustments for age, sex, and Black race to determine the association between items reported and log structure. Results: Between September 2022-2023, patients returned 47 unstructured, 26 semi-structured, and 31 structured logs (N=104). Patients were an average age of 58.9 years (SD, 17), 63% female and 23% Black. Compared with the unstructured log, the semi-structured log was associated with frequent reports of physical activity (0.05, P = 0.03), while the structured log was associated with more reports of pain (0.03, P =0.037) and stress (0.03, P =0.01). Compared to the semi-structured log, the structured log was associated with more reports of stress (0.03; P =0.032) . Discussion: In this quality improvement project of patients undergoing ABPM, adding structure to the log increased reporting of clinically relevant information related to pain and stress. Whether these data are related to changes in blood pressure should be a focus of subsequent work.

P061 AMBULATORY BLOOD PRESSURE MONITORING (ABPM) CHARACTERIZATION IN PATIENTS CONSULTING A CARE CENTER IN THE CITY OF POPAYÁN, COLOMBIA BETWEEN JANUARY 2019 AND JUNE 2021

Background: Ambulatory blood pressure monitoring (ABPM) provides important information on the circadian behavior of this variable. This measure provides different phenotypes that can be analyzed in more depth than office blood pressure measurement. Several associations have been identified between altered circadian phenotypes, such as non dipper, and adverse cardiovascular outcomes, such as cardiovascular mortality, coronary heart disease, cerebrovascular disease, chronic kidney disease, and hospitalization for heart failure. To date, the behavior of blood pressure according to the MAPA is unknown in the population of the department of Cauca, Colombia. Therefore, our objective was to characterize the arterial hypertension profiles in a sample of this population. Materials and methods: A cross-sectional descriptive study was conducted in patients over 18 years of age, undergoing ambulatory BP monitoring from 2019 to 2021; data were recorded in an instrument containing sociodemographic, clinical, and therapeutic characteristics. The data were analyzed with the SPSS 25 program. Results: A total of 440 blood pressure monitoring (ABPM) records were obtained, of which, 80.4% of the records were found to be compatible with a diagnosis of arterial hypertension. The distribution of the profiles included: normal dipper (55.2%), attenuated dipper (non-dipper) (23.6%), inverted dipper (13.6%) and extreme dipping (1.4%). Most of the overweight and obese patients presented arterial hypertension in the ABPM records, with 41.1% being overweight patients and 25.2% obese. Regarding the arterial hypertension profiles, there were no statistically significant differences in relation to overweight and obesity. Conclusions: Among the BP profiles measured by ABPM in the population studied, the most prevalent was the normal dipper profile, followed by non-dipper, inverted dipper, and extreme dipper. There was a tendency for the overweight and obese population to present abnormal circadian BP profiles more frequently; however, in our study these results were not statistically significant.

O105 ISOLATED NOCTURNAL HYPERTENSION AND TARGET ORGAN INJURY IN YOUTH

Background and Objective: New American Heart Association (AHA) recommendations in 2022 for pediatric ambulatory blood pressure monitoring (ABPM) established static blood pressure (BP) cutoffs to define hypertension with an optimal sensitivity-specificity balance to best capture target organ injury (TOI). This increased the prevalence of ABPM hypertension, specifically isolated nocturnal hypertension. We utilized ABPM data from the SHIP-AHOY cohort to describe the epidemiology of INH in youth and to evaluate associations between INH and TOI. Methods: We defined INH as wake BP &lt;130/80 mmHg and sleep BP &gt;110/65 mmHg. INH was also evaluated by the 2014 AHA definition: wake BP &lt;95th percentile with sleep BP &gt;95th percentile. Primary outcome was left ventricular hypertrophy (LVH), defined as left ventricular mass index &gt;38.6 g/m2.7. Cardiovascular risk factor (CVRF) scores described the number of risk factors for cardiovascular disease (dyslipidemia, obesity, hypertension by clinic systolic BP, insulin resistance) fro each participant. Logistic regression models assessed the association of INH with LVH, adjusted for age, sex, CVRF score, and ABPM tolerability. Results: Of 397 participants, 77 had INH, mostly (62%) due to elevated systolic BPs only. Median age and height were higher in INH than normotension (16.1 v 15.1 years, P=0.022) (height z-score 1.13 v 0.23, P=0.039). Other characteristics did not differ significantly between groups (Table 1). Estimated glomerular filtration rate was lower in INH. Among those with INH, 27% (N=19/71) had LVH, a greater proportion than found with 2014 definitions (21%, N=7/33). Children with INH had 2.61-fold adjusted odds of LVH compared to normotension (95%CI [1.20,5.69], P=0.016). Conclusions: Over 20% of the SHIP-AHOY cohort had INH, accounting for &gt;1/3 of hypertension overall. INH was associated with older age and taller height, mostly due to systolic BP. Compared to 2014 guidelines, the 2022 definition of INH captured a higher prevalence of LVH. INH was independently associated with increased odds of LVH. Future studies should follow children with INH longitudinally for potential development of daytime hypertension. Table 1: Demographic, Anthropomorphic, and Clinical Characteristics of Isolated Nocturnal Hypertension vs Normotension

P006 AGE-RELATED DIFFERENCES IN PULSE PRESSURE AND AMBULATORY ARTERIAL STIFFNESS INDEX MEASURED BY AMBULATORY BLOOD PRESSURE MONITORING

Background: Hypertension is a prevalent public health concern, particularly affecting older adults. Beyond optimal blood pressure (BP) control, ambulatory blood pressure monitoring (ABPM) offers valuable insights into additional cardiovascular parameters like pulse pressure (PP), arterial stiffness index (AASI), and heart rate (HR). Studies have shown that PP correlates with systolic blood pressure and predicts cardiovascular mortality in older adults (1). Furthermore, AASI, a readily measured indirect marker of arterial stiffness, has demonstrated predictive power for cardiovascular mortality (2). Objective: This study investigates the differences in PP, AASI, and HR measured through ABPM across age groups (younger than 50 years, 50-65 years, and over 65 years) and between genders. Methods: This cross-sectional descriptive study analyzed ABPM data collected between 2018 and 2024 from a cardiovascular institution in Colombia. Mean systolic and diastolic BP, heart rate, AASI, and PP were evaluated based on age and sex. Normality testing was performed using the Kolmogorov-Smirnov test. For continuous variables, parametric ANOVA tests compared values across age groups. Categorical variables were analyzed using Chi-square tests. Results: A total of 150 patients participated in the study, with females comprising 76 (50.7%) of the group. The age distribution was: 23.3% younger than 50 years, 41.3% between 50-65 years, and 34.0% over 65 years old. Significant differences were found in diastolic BP, PP, AASI, and HR between the age groups. Importantly, no significant differences were observed in these measures based on gender, nor in systolic BP by age or sex. Conclusions: Our findings align with previous research, demonstrating an increase in PP and AASI with advancing age. Given its widespread availability, ABPM offers a valuable tool. Incorporating additional parameters like PP and AASI provides further information potentially linked to cardiovascular mortality risk. 1. Glynn RJ et al. Pulse Pressure and Mortality in Older People. Arch Intern Med. 2000;160(18):2765–2772. 2. Li, Y. et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension, 47(3), 359–364.