Ambulatory Blood Pressure Parameters Research Articles

Twenty-Four-Hour Ambulatory Blood Pressure Monitoring Parameters During Pregnancy: A Pilot Study.

Introduction: Maternal blood pressure (BP) is a critical cardiovascular marker with profound implications for maternal and fetal well-being, particularly in the detection of hypertensive disorders during pregnancy. Although conventional clinic-based BP (CBP) measurements have traditionvally been used, monitoring 24-hour ambulatory BP (ABP) has emerged as a more reliable method for assessing BP levels and diagnosing conditions such as gestational hypertension and preeclampsia/eclampsia. This study aimed to assess the feasibility and acceptability of 24-hour ABP monitoring in pregnant women and report on various ABP parameters, including ambulatory blood pressure variability (ABPV). Method: A prospective cross-sectional study design was employed, involving 55 multipara pregnant women with and without prior adverse pregnancy outcomes (APOs). The participants underwent baseline assessments, including anthropometrics, resting CBP measurements, and the placement of ABP and actigraphy devices. Following a 24-hour period with these devices, participants shared their experiences to gauge device acceptability. Pregnancy outcomes were collected postpartum. Results: Twenty-four-hour ABP monitoring before 20 weeks of gestation is feasible for women with and without prior APOs. Although some inconvenience was noted, the majority of participants wore the ABP monitoring device for the entire 24-hour period. Pregnant women who later experienced APOs exhibited higher 24-hour ABP and ABPV values in the early stages of pregnancy. Conclusion: The study highlights the potential benefits of 24-hour ABP monitoring as a valuable tool in prenatal care, emphasizing the need for further research in this area.

Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea

BackgroundHypertension guidelines recommend diagnosis and treatment of obstructive sleep apnea (OSA) in patients with hypertension. The mandibular advancement device (MAD) is an oral appliance therapy for patients who decline or cannot tolerate continuous positive airway pressure (CPAP). ObjectivesWe compared the relative effectiveness of MAD vs CPAP in reducing 24-hour ambulatory blood pressure (BP). MethodsIn an investigator-initiated, randomized, noninferiority trial (prespecified margin 1.5 mm Hg), 321 participants aged ≥40 years with hypertension and increased cardiovascular risk were recruited at 3 public hospitals for polysomnography. Of these, 220 participants with moderate-to-severe OSA (apnea-hypopnea index ≥15 events per hour) were randomized to either MAD or CPAP (1:1). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and 6 months. ResultsCompared with baseline, the 24-hour mean arterial BP decreased by 2.5 mm Hg (P = 0.003) at 6 months in the MAD group, whereas no change was observed in the CPAP group (P = 0.374). The between-group difference was −1.6 mm Hg (95% CI: −3.51 to 0.24, noninferiority P < 0.001). The MAD group demonstrated a larger between-group reduction in all secondary ambulatory BP parameters compared with the CPAP group, with the most pronounced effects observed in the asleep BP parameters. Both the MAD and CPAP improved daytime sleepiness, with the between-group difference similar (P = 0.384). There were no between-group differences in cardiovascular biomarkers. ConclusionsMAD is noninferior to CPAP for reducing 24-hour mean arterial BP in participants with hypertension and increased cardiovascular risk. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling—Non-inferiority Trial [CRESCENT]; NCT04119999)

Association Between Elevated Body Mass Index and Cardiac Organ Damage in Children and Adolescents: Evidence and Mechanisms.

Although a number of pathophysiological aspects of childhood obesity have been reported, few information are available on obesity-related cardiac organ damage. The present study was aimed at assessing the impact of anthropometric, blood pressure (BP) and metabolic variable on cardiac structure and function in youth. In 78 subjects aged 5-16 years attending the outpatient clinic of cardiovascular risk (Valencia, Spain) anthropometric and metabolic variables, clinic and ambulatory BP and echocardiographic parameters were assessed. Subjects were also classified according to the presence of insulin resistance. Subjects mean age (±SD) amounted to 12.03±2.4 years and males to 53.8%. Ten subjects were normoweight, 11 overweight, 39 obese, and 18 severely obese. No significant difference in office and ambulatory BP was detected among different bodyweight groups. A significant direct correlation was observed between left ventricular mass index (LVMI) and obesity markers [body mass index (BMI): r=0.38, waist circumference (WC): r=0.46, P<0.04 for both]. Left ventricular hypertrophy, relative wall thickness and left atrial diameter were significantly related to BMI and WC. In contrast, office and ambulatory BP were unrelated to other variables, and differences in LVMI among different BP phenotypes were not significant. When partitioning the population by insulin resistance, LVMI, adjusted for confounders, was significantly greater in the insulin-resistant group. In children and adolescents characterized by different body weight patterns, weight factors "per se" and the related insulin resistance state appear to represent the main determinants of LVMI and left ventricular hypertrophy, independently on BP values and BP phenotypes.

Cumulative blood pressure load and hypertensive nephropathy in Han Chinese hypertensive patients.

The study aims to assess the relationship between cumulative blood pressure load (cBPL) and the risk of renal function decline in hypertensive patients and determine the blood pressure (BP) threshold required to prevent hypertensive nephropathy. A single-center prospective cohort study was conducted on hypertensive patients. The cBPL was defined as the proportion of area beyond variable BP cutoffs under ambulatory BP monitoring. Renal events were defined as>25% (minor) or>50% (major) decline of baseline estimated glomerular filtration rate (eGFR). Cox regression analysis was conducted between cBPL, other ambulatory BP parameters, and renal events. The results revealed a total of 436 Han Chinese hypertensive patients were eligible for enrollment. During an average follow-up period of 5.1±3.3 years, a decline of>25% and>50% in eGFR was observed in 77 and eight participants, respectively. Cox regression analysis revealed that cSBPL140 (hazard ratio [HR], 1.102; 95% confidence interval [CI], 1.017-1.193; p=.017), cSBPL130 (HR, 1.076; 95% CI, 1.019-1.137; p=.008), and cSBPL120 (HR, 1.054; 95% CI, 1.010-1.099; p=.015) were independently associated with minor renal events. Similarly, cSBPL140 (HR, 1.228; 95% CI, 1.037-1.455; p=.017), cSBPL130 (HR, 1.189; 95% CI, 1.045-1.354; p=.009), and cSBPL120 (HR, 1.155; 95% CI, 1.039-1.285; p=.008) were independently associated with major renal events. In conclusion, cBPL is associated with renal function decline in hypertensive patients. Minimizing cBPL120 may decrease the risk of hypertensive nephropathy.

Are ambulatory blood pressure parameters associated more with central adiposity than with total adiposity? Results of the ELSA-Brasil study.

Worldwide obesity has a high prevalence, as well as carries a high risk of several chronic diseases, including hypertension. Studies of the association between obesity and ambulatory blood pressure (BP) are scarce and most use only body mass index (BMI) as indicator of adiposity. Thus, we aimed to examine for associations between total and central adiposity and ambulatory BP parameters (BP means and variability, nocturnal dipping and morning surge) among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). This cross-sectional study (2012-2014) used a subsample of participants (n = 812) of ELSA-Brasil who underwent 24-hour ambulatory BP monitoring to assess systolic and diastolic BP (SBP and DBP, respectively) over 24-hour periods and sub-periods. Indicators for total adiposity were BMI and body fat (BF) and, for central adiposity, waist circumference (WC) and waist-to-height ratio (WHR). Associations were tested using crude and adjusted gamma and logistic regression. Overweight (BMI) and abdominal obesity (WC and WHR) associated positively with mean 24-hour (Coef = 2.71, 3.09 and 4.00, respectively), waking (Coef = 2.87, 3.26 and 4.16, respectively), and sleeping (Coef = 2.30, 2.74 and 3.50, respectively) SBP; mean DBP associated with high WHR in these three periods (Coef = 2.00, 2.10 and 1.68, respectively) and with WC in the waking period (Coef = 1.44). Overweight and abdominal obesity (WC and WHR) were positively associated with SBP variability over 24 h (Coef = 0.53, 0.45 and 0.49, respectively) and in sleep (Coef = 0.80, 0.74 and 0.59, respectively), and with DBP variability in 24 h (Coef = 0.64, 0.73 and 0.58, respectively), wakefulness (Coef = 0.50, 0.52 and 0.52, respectively) and sleep (Coef = 0.53, 0.45 and 0.49); excess BF associated positively with DBP variability over 24 h (Coef = 0.43) and in wakefulness (Coef = 0.38). Lastly, high WHR and excess BF were associated with higher odds of extreme dipping (OR = 1.03 for both), while high WC and WHR associated with higher odds of exacerbated diastolic morning surge (OR = 3.18 and 3.66, respectively). Indicators of adiposity were associated with the BP means and variability, nocturnal dipping and morning surge, with more substantial results for indicators of central adiposity that the others.

The correlation between ambulatory blood pressure parameters and cardiovascular risk factors in older adults with high-risk hypertension

Objective: To explore the correlation of 24-hour ambulatory blood pressure (BP) monitoring (ABPM) parameters and cardiovascular risk factors in older adults with high-risk hypertension. Material and method: A cross-sectional study was conducted on 96 older adults (≥ 60 years old) with treated high-risk hypertension. Socio-demographic and cardiovascular risk information were gathered. The patients were performed 24-hour ABPM. Results: The mean age was 70.88 ± 7.86 years, and 64.6% were women. The prevalence of cardiovascular risk factors was as follows: dyslipidemia: 80.2%, family history of hypertension: 54.2%, diabetes mellitus: 51%, smoking: 24%, prior stroke: 11.5%. Significant differences in 24-hour, awake, and sleep systolic BP were observed between men and women. There were significant correlations between 24-hour mean systolic BP with age (r = 0.229, p = 0.025), dyslipidemia (r = 0.223, p = 0.029), family history of hypertension (r = 0.214, p = 0.036), BMI (r = 0.212, p = 0.039), waist circumference (r = 0.226, p = 0.027) and creatinine level (r = 0.207, p = 0.043). There were significant correlations between 24-hour mean diastolic BP with BMI (r = 0.289, p = 0.004) and prior stroke (r = -0.224, p = 0.029). There were significant correlations between 24-hour mean BP with BMI (r = 0.268, p = 0.009), waist circumference (r = 0.220, p = 0.032) and prior stroke (r = -0.215, p = 0.036). Conclusion: There were significant correlations between ABPM parameters and cardiovascular risk factors in older adults with high-risk hypertension. Key words: 24-hour ambulatory blood pressure, cardiovascular risk factors, high-risk hypertension, older adults, correlation.

Clinical features and risk factors of left ventricular hypertrophy in children with primary hypertension

Objective: To assess the clinical features and relative factors of left ventricular hypertrophy (LVH) in children with primary hypertension. Methods: In this retrospective cohort study, 430 children diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics from January 2019 to September 2022 were enrolled. Their clinical data was analyzed and LVH was assessed by echocardiography. According to left ventricular geometry, these children were assigned to the LVH group and normal geometry group. General conditions, laboratory indicators and ambulatory blood pressure parameters between two groups were compared by independent sample t-test or Mann-Whitney U test. Spearman correlation coefficient was used to analyze the correlation between LVH and clinical indicators including blood pressure, biochemical and metabolic indicators. The independent risk factors of LVH were analyzed by multivariable logistic regression. The receiver operating characteristic (ROC) curve was used to explore the value of risk factors in the diagnosis of LVH. Results: Among the 430 children with primary hypertension, 342 (79.5%) were males and 88 (20.5%) females. Their age was (12.6±2.3) years, and 123 children (28.6%) of them had LVH. Body mass index (BMI) ((30.0±5.2) vs. (26.2±4.3) kg/m2), ratio of stage 2 hypertension (75.6% (93/123) vs. 59.6% (183/307)), 24-hour systolic blood pressure (24 h SBP)((131±10) vs. (128±10) mmHg,1 mmHg=0.133 kPa), daytime systolic blood pressure (SBP) ((135±11) vs. (131±11) mmHg), nighttime SBP ((128±11) vs. (123±10) mmHg), cholesterol level ((4.0±0.7) vs. (3.9±0.7) mmol/L), serum uric acid level ((447±81) vs. (426±91) μmol/L) and incidence of hyperinsulinemia (69.9% (86/123) vs.59.0% (181/307)) were significantly elevated in the LVH group compared with those in the normal geometry group (all P<0.05). There were more patients with a disease course over 5 years in the LVH group than in the normal geometry group, with a statistically significant difference (χ2=8.90,P=0.031). Spearman correlation analysis showed that BMI, 24 h SBP, daytime SBP, nighttime SBP, triglyceride, uric acid, and serum sodium level were positively correlated with LVMI (r=0.43, 0.20, 0.18, 0.18, 0.18, 0.16, and 0.12, all P<0.05). BMI, hyperinsulinemia, and cholesterol level were positively correlated with relative wall thickness (RWT) (r=0.22, 0.12, and 0.16, all P<0.05). The multivariate logistic regression analysis showed that BMI (OR=1.17, 95%CI 1.10-1.25) and 24 h SBP (OR=1.04, 95%CI 1.01-1.08) were the independent risk factors for LVH (both P<0.05). The area under the receiver operator characteristic curve, combined with BMI and 24 h SBP, was 0.72 (95%CI 0.67-0.77, P<0.05), with a sensitivity and specificity of 71.5% and 64.8%, respectively. Conclusions: BMI and 24 h SBP are the independent risk factors for LVH in children with primary hypertension, and the combination of BMI and 24 h SBP has an acceptable diagnostic value for LVH. Early monitoring of these indexes is necessary to predict preclinical cardiac damage.

ASSOCIATION OF AMBULATORY BLOOD PRESSURE PARAMETERS WITH CAROTID DAMAGE IN PATIENTS WITH TYPE-2 DIABETES/PRE-DIABETES AND HYPERTENSION

Objective: This study investigated the association between ambulatory blood pressure (ABP) parameters and carotid damage in patients with type-2 diabetes/pre-diabetes and hypertension. Design and method: Adults with hypertension and type-2 diabetes/prediabetes were subjected to (i) 24-hour ABP monitoring (20 min intervals, Microlife WatchBPO3) and (ii) estimation of preclinical carotid damage (ultrasound carotid intima-media thickness [cIMT] and carotid plaque score [CPS]). BP variability was quantified using the standard deviation (SD) and coefficient of variation (CV). Results: Seventy individuals were analyzed [age 65.2±9.7 years, 47 men, body mass index (BMI) 31.6±4.8 kg/m2, HbA1c 6.6±0.8%, 86% diabetics, average 24-hour ABP (systolic/diastolic) 123±12/69±7 mmHg, cIMT 0.8±0.2 mm, CPS 5.4±4.7 mm]. There was a significant correlation between 24-hour/daytime systolic ABP and cIMT (r = 0.34/0.34 respectively, p&lt;0.01) and CPS (r = 0.26/0.25 respectively, p&lt;0.05). 24-hour/daytime/nighttime pulse pressure was associated with cIMT (r = 0.39/0.41/0.28 respectively, p&lt;0.05) and CPS (r = 0.26/0.28/0.23, p&lt; = 0.05). No significant association was found between indices of carotid damage and SD or CV of systolic ABP. Stepwise multivariable regression analysis with age, sex, BMI, smoking and daytime pulse pressure as independent variables, revealed that cIMT was determined by the daytime pulse pressure and age (R2 = 0.27), whereas CPS was determined by daytime pulse pressure and smoking (R2 = 0.23). Conclusions: These preliminary data suggest that in patients with type-2 diabetes/pre-diabetes and hypertension ambulatory pulse pressure might have a critical role in the development of carotid damage.

Timing of Antihypertensive Drug Therapy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus evening. A PubMed, EMBASE, and clinicaltrials.gov databases search for randomized clinical trials of antihypertensive therapies where patients were randomized to morning versus evening dosing. The outcomes were ambulatory blood pressure (BP) parameters (day-time, night-time, and 24/48-hour systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and cardiovascular outcomes. Of 72 randomized controlled trials included, evening dosing significantly reduced ambulatory BP parameters: 24/48-hour SBP (mean difference [MD]=1.41 mm Hg; [95% CI, 0.48-2.34]), DBP (MD=0.60 mm Hg [95% CI, 0.12-1.08]), night-time SBP (MD=4.09 mm Hg [95% CI, 3.01-5.16]), DBP (MD, 2.57 mm Hg [95% CI, 1.92-3.22]), with a smaller reduction in day-time SBP (MD=0.94 mm Hg [95% CI, 0.01-1.87]), and DBP (MD=0.87 mm Hg [95% CI, 0.10-1.63]), and numerically lower cardiovascular events compared with morning dosing. However, when controversial data by Hermida (23 trials, 25 734 patients) were omitted (Pheterogeneity<0.05 for most outcomes), the above effect of evening dosing attenuated with no significant effect on 24/48-hour ambulatory blood pressure, day-time BP, and major adverse cardiac event and smaller reduction in night-time ambulatory SBP and DBP. Evening dosing of antihypertensive drugs significantly reduced ambulatory BP parameters and lowered cardiovascular events but the effect was mainly driven by trials by Hermida group. Unless the intention is to specifically lower night-time BP, antihypertensive drugs should be taken at a time of day that is convenient, optimizes adherence, and minimizes undesirable effects.

34. Efficacy and Safety of Sacubitril Valsartan in Managing Hypertension Compared with Angiotensin Receptor Blockers: A Systematic Review and Meta-analysis

Background: Sacubitril/Valsartan has shown promising result in the management of heart failure with reduced ejection fraction patients. However, it also withhold the potential as antihypertensive agent. Thus, its effectiveness in reducing high blood pressure (BP) compared with Angiotensin Receptor Blockers (ARBs) needs to be determined. Objective: This study aimed to compare the efficacy and safety of Sacubitril/Valsartan and ARBs in managing hypertension patients. Methods: We searched for the studies from Pubmed, Proquest, Google Scholar and Cochrane Library databases which compare the BP reduction effect of Sacubitril/Valsartan and ARBs. The main outcomes were mean office and ambulatory BP reduction. The safety profile was determined by the incidence of adverse events (AEs). Results: 5114 adult patients with hypertension from 10 RCTs were included. Sacubitril/Valsartan provided significant mean reduction of office systolic BP (mean difference: –4.66; 95%CI: –5.13 to –4.20; p &lt; 0.001), office diastolic BP (mean difference: –3.23; 95%CI: –3.54 to –2.92; p &lt; 0.001), ambulatory systolic BP (mean difference: –3.42; 95%CI: –5.13 to –1.17; p &lt; 0.001), and ambulatory diastolic BP compared with ARBs (mean difference: –1.50; 95%CI: –2.15 to –0.85; p &lt; 0.001). There was no significant difference in the incidence of AEs between the two groups (RR: 1.04; 95%CI: 0.95 to 1.14; p = 0.35). The BP reduction and incidence of AEs were consistent in the subgroup analysis (Olmesartan and Valsartan treatment group), except in comparison with Olmesartan treatment group for ambulatory systolic BP parameter (mean difference: –2.62; 95% CI: –5.30 to 0.07; p: 0.06). Conclusion: Sacubitril/Valsartan is more potent in reducing BP to ARBs, with similar safety profile.

Waist-to-height-ratio is associated with sustained hypertension in children and adolescents with high office blood pressure.

Waist-to-height-ratio (WHtR) has been proposed as another indicator for cardiometabolic risk factors including hypertension. Normally, hypertension can be diagnosed in the office setting by detecting high blood pressure for three occasions. However, patients with high office blood pressure may not exhibit high blood pressure outside the office. Ambulatory blood pressure monitoring (ABPM) is a procedure to measure blood pressure over 24-h. Sustained hypertension is characterized as hypertension detected by both office measurement and ABPM. This study aimed to evaluate the performance of WHtR in the diagnosis of sustained hypertension in patients with high office blood pressure. Demographic data, height, body weight, body mass index (BMI), and waist circumference were retrospectively reviewed in children and adolescents who underwent ABPM due to persistently high office blood pressure. Patients were separated into two groups: a sustained hypertension group and a normal ABPM group. BMI was adjusted to z-score using the WHO Anthroplus software. WHtR was calculated by the formula: waist circumference (cm)/height (m). The performances of different parameters were analyzed using the receiver operating characteristic (ROC) curve and multivariate logistic regression. Sixty patients (63% male) with a mean age of 12.9 ± 3.7 years had persistently high office blood pressure. Twenty-nine (48.3%) had high ambulatory blood pressure parameters so-called "sustained hypertension." The sustained hypertension group had a higher mean BMI z-score (2.32 vs. 1.31, p = 0.01) and a higher mean WHtR (57.7 vs. 49.2 cm/m, p < 0.001) than those of the normal ABPM group. For the diagnosis of sustained hypertension, the ROC analysis revealed that WHtR had a greater area under the ROC curve (AUC) than that of BMI z-score (0.772 vs. 0.723). WHtR remained associated with sustained hypertension (OR 1.2, 95% CI 1.022-1.408, p = 0.026) after adjusting for age, gender, and BMI z-score. Apart from being a more user-friendly metric, WHtR tended to outperform BMI z-score in predicting sustained hypertension in children and adolescents with persistently high office blood pressure.

PS-C13-13: BLOOD PRESSURE REACTIVITY AGAINST PHYSICAL ACTIVITY “ACTISENSITIVITY” EVALUATED BY MULTISENSOR-ABPM CHANGES BEFORE AND AFTER TREATMENT OF HEART FAILURE

Introduction: The pathological significance of blood pressure (BP) variability in patients with heart failure (HF) has not been fully elucidated. We propose the term Actisensitivity to describe such BP reactivity in response to physical activity; this new aspect of BP variability can be evaluated using our recently developed device, a multisensor-ambulatory BP monitoring (ABPM) device (TM-2441, A&amp;D Co., Tokyo) equipped with an actigraph that can detect physical movements. Methods: In the present study, actisensitivity is defined as the slope of the regression line that is calculated from ambulatory systolic BP (SBP) with the log-transformed value corresponding 5-min average of physical activity just before each BP measurement. We prospectively assessed the changes in actisensitivity and ambulatory BP (ABP) parameters between patients with and without improved cardiac function during the treatment of HF. We assessed 20 patients with diagnosed HF (mean ± SD age, 63.3 ± 14.1 years; male, 65%; ischemic heart disease, 15%; atrial fibrillation, 25%) just after initial or adjusted treatments, and reassessed the multisensor-ABPM data at follow-up from 6–12 months after tailored treatment. Second, we divided these patients into an improved (n = 11 patients) and a not-improved (n = 9) cardiac-function group; an increase in echocardiographic left ventricular ejection fraction of ≧ 10%. We then compared the changes in actisensitivity and ABP parameters between the two groups. Results: Parameters of ABP variability, i.e., SD, coefficient of variation, and average real variability of SBP, did not change between baseline and follow-up in either group. However, the actisensitivity value tended to increase from baseline to follow-up in the improved group (1.0 ± 3.5 vs. 4.5 ± 3.5, p = 0.065), but not in the not-improved group. The degree of changes in actisensitivity from baseline to follow-up tended to be higher in the improved group than the not-improved group (3.5 ± 5.6 vs. -1.2 ± 4.8, p = 0.059) (Figure). Moreover, in the overall patient group, the change of actisensitivity from baseline to follow-up was significantly related to the changes of LVEF (r = 0.553, p = 0.011). Conclusion: To our knowledge, this is the first study to prospectively observe the changes of novel BP reactivity against physical activity in HF patients using the new multisensor-ABPM device. Our findings should help to elucidate the relationships between BP variability/hemodynamics during physical activity and cardiac function in patients with HF.

PS-C35-4: ASSOCIATION OF SODIUM INTAKE WITH ADVERSE LEFT ATRIAL FUNCTION AND LEFT ATRIOVENTRICULAR COUPLING

Objective: In this study, we investigated the relationship between 24-hour urinary sodium (a surrogate for estimating dietary sodium intake), ambulatory blood pressure parameters, cardiac MRI-assessed left atrial function and left atrioventricular coupling, as well as the influence of nighttime blood pressure and body mass index(BMI) on 24-hour urinary sodium and subclinical cardiac function. Design and method: Participants in our study included 398 individuals, all of whom were subjected to 24-hour urine collection, 24-hour ambulatory blood pressure measurement, and cardiac magnetic resonance imaging to determine left atrial function (myocardial strain) as well as left atrioventricular coupling index. LACI is defined as the ratio of left atrial end-diastolic volume divided by left ventricular end-diastolic volume. Our study evaluated the relationship between 24-hour urinary sodium and ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling index, and used mediation analysis to explain the indirect effects of nighttime blood pressure and BMI between 24-hour urinary sodium and left atrial function and left atrioventricular coupling index. Results: It was found that the average age of the participants was 55.70 ± 11.30 years old, with 58% of the participants being male and 47.5% experiencing hypertension. The mean urinary sodium value was 172.01 ± 80.24mmol/24 hours, and the average body mass index was 25.46 ± 3.78 kg/m2. After adjusting for age, gender, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-hour urinary sodium was correlated with multiple ambulatory blood pressure parameters, especially with nighttime diastolic blood pressure. Left atrial structure and function (left atrial reservoir function and left atrial conduit function) and left atrioventricular coupling index were correlated (P &lt; 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-hour urinary sodium and left atrial function (left atrial reservoir function and left atrial conduit function), and 30% of the indirect effect of LACI. Independent of the mediator, 24-hour urinary sodium had a significant direct effect on left atrial reservoir function, left atrial conduit function, and left atrioventricular coupling. Conclusions: Higher 24-hour urinary sodium was associated with a greater BMI as well as poor left atrial function and left atrioventricular coupling, and the BMI mediated the relationship between 24-hour urinary sodium and subclinical left cardiac function, and, more importantly, 24-hour urinary sodium may directly affect the left atrial function and left atrioventricular coupling independent of intermediary factors.

Correlation between blood pressure variability and deep cerebral microbleeds in patients with acute ischemic stroke.

To observe the 24-h ambulatory blood pressure characteristics of patients with acute ischemic stroke and explore the correlation between blood pressure variability and strictly deep cerebral microbleeds (CMBs). A convenient sampling method was used to enrol 131 patients with acute ischemic stroke in the Department of Neurology between April 2021 and May 2022. Hospitalised patients with acute ischemic stroke were assessed retrospectively; their ambulatory blood pressure was monitored continuously for 24 h, and the relevant parameters were recorded. Magnetic susceptibility-weighted imaging was used to divide the CMBs into a strictly deep CMB group ( n = 24) and a non-CMB group ( n = 107) according to the location of the CMBs. A logistic regression analysis was performed to determine the independent correlation between the 24-h ambulatory blood pressure parameters and strictly deep CMBs. The receiver operating characteristic (ROC) was further used to analyse the predictive value of the ambulatory blood pressure parameters for strictly deep CMBs in patients with acute ischemic stroke. The results showed that the night systolic blood pressure standard deviation and the night diastolic blood pressure standard deviation (NDBP-SD) in the strictly deep CMB group were higher than those in the non-CMB group ( p < 0.05). The multiple logistic regression analysis indicated that the NDBP-SD (odds ratio [OR] = 1.205, 95% confidence interval [CI]: 1.011-1.436, p = 0.038) was an independent risk factor for strictly deep CMBs in patients. The ROC curve analysis revealed that the area under the curve value of the NDBP-SD was 0.682, and the intercept was 7.81. When NDBP-SD is ≥ 7.81, the occurrence of strictly deep CMBs is closely related (OR = 3.872, 95% CI: 1.347-11.125, p = 0.012). The NDBP-SD is an independent risk factor for strictly deep CMBs in patients with acute ischemic stroke. When NDBP-SD is > 7.81, it may promote the production of strictly deep CMBs.

PS-C23-1: EFFECT OF OMEGA3,6,9 BLENDED OIL ON CIRCADIAN VARIATIONS OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND CAD

Flaxseed oil is considered to be a rich source of Alpha-Linolenic Acid(ALA), along with Lignans, fibers, protein, vitamins,s, and minerals. A number of studies have proved the beneficial role of ALA, EPA, and DHA found in flaxseed on health. Besides providing nutrition, they have anti-inflammatory, antihypertensive and cardioprotective properties. However pure flaxseed oil does not have oxidative stability due to which it could not be stored for long-term edible use. The blending process can be an alternative method for Partial hydrogenation, therefore we used this process to reduce the percentage of unsaturated linoleic and linolenic acids of Flaxseed oil with Palm oil in a stabilized ratio which helps in maintaining the overall oxidative stability and proper ratio of Omega 3, omega 6 and omega 9 content in the Blended product. Aim of this study was to access the effect of blended flaxseed oil on 24 hour seven day circadian variations of blood pressure in subjects with essential hypertension. Many Studies have proved that Chronobiological analysis of blood pressure by four to Seven-day continuous ambulatory blood pressure monitoring and assessment of CHAT (circadian hyper amplitude tension) is the best marker for cardiovascular function. We registered 100 subjects with Coronary Artery Disease (Group1) and Essential hypertension (Group2) and 100 control subjects with CAD/ Hypertension. Group 1 and 2 participants were supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of six months while the control group was not given any BFO (They were using their routine edible oil). Twenty-four hour seven days continuous ambulatory blood pressure monitoring was done initially, after three months and after six months of supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that optimized doses of blended flaxseed oil have the required amount of ALA and essential fatty acids as per guidelines of AHA, Blended flaxseed oil administration can be a potent antihypertensive and helps in the synchronization of cardiac rhythms, and an effective vegetarian source in maintaining Omega 3 and omega 6 ratios.

PS-C25-3: THE EFFECT OF MOUNTAINEERING ON THE ASSOCIATION BETWEEN BLOOD PRESSURE AND PHYSICAL ACTIVITY. THE MOUNT FUJI STUDY

Objective: It has not been fully investigated whether the response of blood pressure (BP) to activity at high altitudes differs from that at low altitudes or how temperature is involved in these differences. We hypothesized the BP response to activity during mountaineering would be increased compared to that in daily living, and conducted this study to compare physiological BP response to accelerometer measurements during mountaineering and daily living. Design and method: In 15 healthy people (mean age 33 ± 6 years), a new multi-sensor ambulatory BP monitoring (ABPM) device equipped with barometer, thermometer, and accelerometer was used to measure blood pressure responses to activity during a trip to Mt. Fuji and during daily life at low altitudes on another day. Associations between physical activity (log-transformed 5-min average values of accelerometer just before each ambulatory BP) and the corresponding BP were obtained from 843 and 676 readings during the Mt. Fuji trip and daily living, respectively. Result: All ambulatory systolic BP (SBP) parameters were significantly higher during the Mt. Fuji trip than during daily living at low altitudes (all p &lt; 0.01). There were significant positive correlations between physical activity and corresponding BPs in both mountaineering and daily living (all P &lt; 0.01), and there was an interaction between BPs and physical activity according to the two conditions (P &lt; 0.01). On Mt. Fuji, multivariate regression analysis showed that increased physical activity and lower temperature were associated with increased 24-hr SBP and diastolic BP (DBP) (all P &lt; 0.05). The goodness-of-fit values of the association between activity and 24-hr SBP or DBP were improved by adding temperature to the model of both 24-hr SBP and DBP. However, these associations were not found in the daily living model. Conclusions: BP response to activity was more pronounced during mountaineering than daily living. Lower temperature compounded the BP response to activity in the mountains but not in daily living.

Association of sodium intake with adverse left atrial function and left atrioventricular coupling in Chinese.

High sodium intake is strongly associated with hypertension and obesity. This study aims to investigate the relationship between 24-h urinary sodium (a surrogate measure of sodium intake), ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling. Further, we intend to examine whether blood pressure and BMI might be mediators of the relationship between 24-h urinary sodium and subclinical cardiac function. Our study had 398 participants, all of whom were subjected to 24-h urine collection, 24-h ambulatory blood pressure measurement, and cardiac magnetic resonance imaging. The average age of the participants was 55.70 ± 11.30 years old. The mean urinary sodium of the participants was 172.01 ± 80.24 mmol/24 h. After adjusting for age, sex, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-h urinary sodium was correlated with multiple ambulatory blood pressure parameters, BMI, left atrial function, and the left atrioventricular coupling index (LACI) (P < 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-h urinary sodium and left atrial function and 30% of the indirect effect of LACI. Independent of the mediator, 24-h urinary sodium had a significant direct effect on left atrial function and left atrioventricular coupling. Higher 24-h urinary sodium was associated with a greater BMI as well as poor left atrial function and left atrioventricular coupling, and the BMI mediated the relationship between 24-h urinary sodium and subclinical left cardiac function. Furthermore, and more importantly, 24-h urinary sodium may have directly affected the left atrial function and left atrioventricular coupling independent of intermediary factors.

Body Mass Index and other Demographic Data in Relation to Daily Ambulatory Blood Pressure Parameters

Objective: In patients with and without a diagnosis of hypertension, we sought to ascertain if body mass index (BMI) and other demographic information affected dipper/non dipper and pulse pressure/pulse pressure index.&#x0D; Method: Ambulatory blood pressure monitoring (ABPM) analysis of 56 patients with hypertension and 91 patients without hypertension was evaluated. We defined dipper as a drop in mean nocturnal blood pressure (BP) of &gt;10% as compared with mean daytime values (non-dipper percentage 0.05). Diastolic dipper was observed in 46.4% of male patients and 39.3% of female patients in the hypertension group, and there was no statistically significant difference between them (p&gt;0.05). In examination cases (group 2), Although the incidence of systolic dipper and diastolic dipper in male subjects (46.5% and 60.5%, respectively) was higher than in female subjects (27.1% and 39.6%, respectively), this difference was close to significance, but not statistically significant (p&gt;0.05). There was no statistically significant difference between the mean age and BMI of systolic dipper and non-dipper cases (p&gt;0.05). Besides, the mean age of the diastolic non dipper cases was statistically significantly higher than the diastolic dipper cases (p:0.048), and the mean BMI of the diastolic non dipper cases was statistically significantly higher than the diastolic dipper cases (p:0.034).&#x0D; Conclusion: It may be beneficial to include the mean pulse pressure/pulse pressure index in the evaluation of general, awake, and asleep pulse pressure while evaluating the ABPM result.

The effect of mountaineering on the association between blood pressure and physical activity: A new multi-sensor ambulatory blood-pressure monitoring device. The Mount Fuji Study.

It has not been fully investigated whether the response of blood pressure (BP) to activity at high altitudes differs from that at low altitudes or how temperature is involved in these differences. The author compared BP response to accelerometer measurements during mountaineering and daily living. In 15 healthy people (mean age 33 ± 6 years), a new multi‐sensor ambulatory BP monitoring (ABPM) device equipped with barometer, thermometer, and accelerometer was used to measure BP responses to activity during a trip to Mt. Fuji and during daily living. Associations between physical activity (log‐transformed 5‐min average values of accelerometer just before each ambulatory BP) and the corresponding BP were obtained from 843 and 676 readings during the Mt. Fuji trip and daily living, respectively. All ambulatory systolic BP (SBP) parameters were significantly higher during the Mt. Fuji trip than during daily living (all p < .01). There were significant positive correlations between physical activity and corresponding BPs in both mountaineering and daily living (all p < .01), and there was an interaction between BPs and physical activity according to the two conditions (p < .01). On Mt. Fuji, multivariate regression analysis showed increased physical activity and lower temperature were associated with increased 24‐h SBP and diastolic BP (DBP) (all p < .05). The goodness‐of‐fit values of the association between activity and 24‐h SBP or DBP were improved by adding temperature to the model of both 24‐h SBP and DBP. However, these associations were not found in the daily living model. BP response to activity was more pronounced during mountaineering than daily living.

Ambulatory central BP and arterial stiffness in patients with and without intradialytic hypertension.

Increased arterial stiffness is suggested to be involved in the pathogenesis of intradialytic-hypertension (IDH). Ambulatory pulse-wave-velocity (PWV) is an independent predictor for all-cause-mortality in haemodialysis and its prognostic power is better than office PWV. This is the first study examining ambulatory central blood pressure (BP) and arterial stiffness parameters in patients with and without IDH. This study examined 45 patients with IDH (SBP rise ≥10 mmHg from pre- to post-dialysis and post-dialysis SBP ≥150 mmHg) in comparison with 197 patients without IDH. All participants underwent 48-h ABPM with Mobil-O-Graph-NG; parameters of central haemodynamics, wave reflection and PWV were estimated. Age, dialysis vintage and interdialytic weight gain did not differ between-groups. IDH patients had higher 48-h cSBP (131.7 ± 16.2 vs. 119.2 ± 15.2 mmHg, p < 0.001), 48-h cDBP (86.7 ± 12.7 vs. 79.6 ± 11.5 mmHg, p < 0.001) and 48-h cPP (45.5 ± 10.4 vs. 39.8 ± 10.0 mmHg, p=0.001) compared to patients without IDH. Similarly, during day- and nighttime periods, cSBP/cDBP and cPP levels were higher in IDH-patients compared to non-IDH. Forty-eight-hour augmentation pressure and index, but not AIx(75) were higher in IDH patients; 48-h PWV (10.0 ± 2.0 vs. 9.2 ± 2.1m/s, p=0.017) was significantly higher in patients with IDH. The two study groups displayed different trajectories in central BP and PWV over the course of the recording; IDH patients had steadily high values of the above variables during the 2 days of the interdialytic-interval, whereas non-IDH patients showed a gradual elevation, with significant increases from the 1st to 2nd 24 h. IDH patients have significantly higher levels of ambulatory central BP and arterial stiffness parameters and a different course over the 48-h period compared with non-IDH patients. Increased arterial stiffness could be a prominent factor associated with the high burden of cardiovascular disease in this population.