Ambulatory Blood Pressure Profiles Research Articles

AMBULATORY BLOOD PRESSURE PROFILE AND BLOOD PRESSURE VARIABILITY IN PERITONEAL DIALYSIS COMPARED TO HEMODIALYSIS AND CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension in ESRD patients is highly prevalent and poorly controlled. Data on ambulatory blood pressure (BP) profile and BP variability (BPV) in peritoneal dialysis (PD) patients are absent. This study examined the BP profile and BPV of patients undergoing PD in comparison to hemodialysis (HD) and pre-dialysis CKD patients. Design and method: Thirty-eight PD patients were matched for age, gender and dialysis vintage with 76 HD patients and for age and gender with 38 patients with CKD stage 2–4. Patients under PD and HD underwent 48-hour and CKD patients 24-hour ambulatory BP monitoring. BP levels and BPV indexes were compared for the 48hour, 1st and 2nd 24hour, daytime and nighttime periods. Two-way mixed ANOVA analysis for repeated measurements was used to evaluate the effect of dialysis modality and time on ambulatory BP in PD and HD. Results: During all periods studied, SBP and DBP were numerically higher but not statistically different in PD than in HD patients. Systolic BP was significantly higher in PD or HD compared with predialysis CKD (PD:138.38 ± 20.97; HD:133.75 ± 15.5; CKD:125.52 ± 13.4, p = 0.003), a difference evident also during daytime and night-time periods. Repeated-measurements analysis showed no effect of dialysis modality on ambulatory BP during all periods studied. All BPV indexes studied were similar between PD and HD patients and higher than CKD individuals (1st-24hour systolic-ARV: PD: 11.86 ± 3.19; HD:11.23 ± 3.45; CKD:9.81 ± 2.49, p = 0.016). Conclusions: Average BP levels and BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. The dialysis modality has no effect on ambulatory BP profile. These results suggest that PD is no better than HD with regards to overall BP control or BP fluctuations over time.

24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda.

Hypertension is diagnosed and treated based on blood pressure (BP) readings obtained in the clinic setting. Positive HIV status is associated with a higher prevalence of abnormal diurnal blood pressure patterns, diagnosed with ambulatory BP monitoring rather than the conventional method of BP measurement. Little is known about ambulatory BP profiles in people living with HIV (PLHIV) in low-income countries, especially within sub-Saharan Africa. In this study, we compared 24-hour ambulatory blood pressure profiles of 140 HIV-positive individuals vs. profiles in 166 HIV negative individuals living in rural Uganda. HIV was well-controlled, with all HIV seropositive participants reporting use of anti-retroviral therapy, and approximately 123 (88%) having undetectable viral load. Most participants reported ART use duration of less than 10 years. Compared to HIV negative participants, HIV positive participants had lower median 24-hour systolic blood pressure (110.4 mmHg (IQR: 105.7, 118.7) vs 117.7 mmHg (IQR: 110.8, 129.8), p<0.001), and 24-hour diastolic blood pressure (69.2 mmHg (IQR: 65.0, 74.9) vs. 71.9 mmHg (IQR: 67.2, 78.1), p=0.004). Adjusted results showed greater percentage systolic nocturnal dipping among PLHIV compared to HIV negative individuals (difference=2.70 (IQR: 0.94, 4.47), p <0.05). Results of the adjusted Poisson regression suggested lower prevalence of 24-hour and night hypertension among HIV positives compared to HIV negative, but were not statistically significant. Our data suggest that continuous 24-hour blood pressure measurements are lower in PLHIV on ART compared to HIV negative individuals.

A comparative analysis of ambulatory BP profile and arterial stiffness between CAPD and APD

Prior studies have associated automated peritoneal dialysis (APD) with less effective volume and blood pressure (BP) control as compared with continuous ambulatory peritoneal dialysis (CAPD). Our study aimed to compare the volume status, ambulatory BP profile and severity of arterial stiffness between patients treated with CAPD versus APD. In a case-control design, 28 CAPD patients were matched in 1:1 ratio with 28 controls receiving APD for age, gender and diabetic status. Body composition was assessed with the method of bioimpendence spectroscopy. Twenty-four hours ambulatory BP monitoring with the Mobil-O-Graph device (IEM, Germany) was performed to determine peripheral and central hemodynamic parameters, heart rate-adjusted augmentation index (AIx75) and pulse wave velocity (PWV). Standardized office BP, antihypertensive medication use and extracellular-to-total body water ratio did not differ between CAPD and APD groups. Twenty-four hours brachial systolic BP (129.0 ± 17.3 vs. 128.1 ± 14.2 mmHg, P = 0.83) and 24-h aortic systolic BP (116.9 ± 16.4 vs. 116.4 ± 11.6 mmHg, P = 0.87) were similar in patients treated with CAPD versus APD. Similarly, there was no significant difference between PD modalities in severity of arterial stiffness, as assessed with 24-h AIx75 (24.8 ± 8.9 vs. 22.5 ± 9.1, P = 0.36) and 24-h PWV (9.1 ± 2.4 vs. 8.8 ± 2.1 m/s, P = 0.61). The present study suggests that there is no difference in peripheral and central hemodynamic parameters as well as in the severity of arterial stiffness between CAPD and APD. However, these observations should be interpreted within the context of clinical characteristics of patients included in this case-control study. The comparative effectiveness of these 2 PD modalities warrants further investigation in larger longitudinal studies.

Effect of Sleep Disturbances on Blood Pressure.

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

Ambulatory Blood Pressure Monitoring and Endothelial Dysfunction in Hypertensive Patients with Diabetes Mellitus Type 2

Aim: Diabetic hypertensive patients have pronounced changes in ambulatory blood pressure profile and endothelial function. But the correlation between the parameters of ambulatory blood pressure monitoring (ABPM) and endothelial dysfunction in diabetic hypertensive patients have not been fully clarified. We studied ABP and endothelial function in a group of diabetic hypertensive patients. Methods: Patients with a glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m(2) were excluded. 120 patients were included into the research. Of these, the first (basic) group made up diabetic hypertensive patients in which there were 34 males and 26 females, the mean age was 56.1±1.3 years, the duration of arterial hypertension (AH) was 12.3±2.1 years and the duration of type 2 diabetes mellitus (DM2) was 4.4±0,7 years. The second (control) group made up 60 non-diabetic hypertensive patients in which there were 27 males and 33 females, the mean age was 55.2±1.2 year and duration of AH was 11.1±0.9 years. The patients in both groups were similar in age, duration of AH. Results:The analysis of the results of the 24-hour ABPM revealed that the number of patients with increased 24 hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability was more among diabetic hypertensive patients than in non-diabetic hypertensive patients (76.7 % versus 21.1 and 70.0 % versus 22.5 %, respectively, p <0,05). There were not any significant changes in pulse rate, SBP and DBP. The amount of non-dipper and night-peaker patients was significantly higher in the basic group than in the control one (60.0 % versus 25.4 %, respectively, p <0,05). It was established that the number of patients with DBP daily value <10 was more significant in diabetic hypertensive patients versus non- diabetic hypertensive patients (33.3 % versus 18.2 %, respectively). We also determined nitric oxide metabolites concentration (nitrites and nitrates (NO)) and endothelin (ET-1) in serum and in 24 h-urine collection to assess endothelial function. So, the concentration of ET-1 in serum was significantly higher in diabetic hypertensive patients compared with non-diabetic hypertensive patients (2.49±0.01 pg/ml versus 1.5±0.07 pg/ml, respectively, p <0,05). NO metabolites concentration in serum and urine was significantly lower in the basic group than in the control group (12.7±1.5 uM versus 19,9±1,8 uM and 428.2±27.9 uM versus 792.1±39.4 uM, respectively, p <0,05). The direct association between SBP, DBP and ET-1 in urine were determined in diabetic hypertensive patients (r = 0.7, r = 0.99, respectively, p < 0.001). The correlation between daily index of SBP and ET-1 in urine (r = -0.58, p < 0.001), daily index of DBP and ET-1 in serum (r = -0.47, p < 0.001) were established in the basic group. Conclusion: The correlation between the parameters of ABPM and endothelial dysfunction in diabetic hypertensive patients were established in this study.

Ambulatory blood pressure profile and stroke recurrence

ObjectivesTo establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients.MethodsThe prospective...

Ambulatory Blood Pressure Profiles and Correlation with Cardiovascular Risk Factors in a Sample of 390 University Employees in Tanzania.

BackgroundHypertension is a major risk factor for cardiovascular morbidity and mortality. Increasingly, evidence suggests that 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is more accurate than clinic BP in predicting cardiovascular risk. However, this association has not been widely studied in subSaharan Africa, especially in Tanzania.AimTo explore the relationship between 24-hour ABPM profiles and cardiovascular risk factors in comparison with clinic BP among Muhimbili University of Health and Allied Sciences (MUHAS) employees.MethodsA descriptive cross-sectional study was conducted from October 2018 to February 2019. Socio-demographic and cardiovascular risk information was gathered. We used an automated ABPM device to record 24-hour ambulatory BP. Correlation between BP profiles and cardiovascular risk factors was done using Pearson’s correlation coefficient, and independent factors for hypertension were determined using logistic regression analysis. P-value of <0.05 was considered statistically significant.ResultsIn total, 390 employees participated. Their mean age was 40.5 ± 8.9 years, and 53.6% were men. The mean office systolic and diastolic BP were 126±12 mmHg and 78±13 mmHg, respectively, while the corresponding values for mean 24-hour ABPM were 122±14 and 75±10 mmHg. The prevalence of hypertension was 23.1%. The prevalence of white coat hypertension was 16.2%, while masked hypertension and nocturnal non-dipping were present in 11.5 and 66.7%, respectively. Overall, the mean 24-hour systolic BP showed the strongest correlations with cardiovascular risk factors while mean office systolic BP showed least. Independent associated factors of hypertension were male gender, age ≥40 years, family history of hypertension, central obesity, raised cholesterol and uric acid levels, all p<0.01.ConclusionCompared to office BP, ABPM measurements had stronger correlations with cardiovascular risk factors in this population, and therefore likely to reflect true BP. ABPM has revealed high proportion of masked, white coat and nocturnal non-dipping, supporting use of ABPM to detect these clinically important BP profiles.

Differences in ambulatory blood pressure profiles between Japanese and Thai patients with hypertension /suspected hypertension.

Ethnic differences in the profiles of hypertension and cardiovascular risk have been reported between Asians and Westerners. However, blood pressure (BP) profiles and the risk factors for cardiovascular disease might differ even among different Asian populations because of the diversity of cultures, foods, and environments. We retrospectively examined differences in 24‐h BP profiles between 1051 Japanese (mean age, 62.5 ± 12.4 years; medicated hypertension, 75.7%) and 804 Thai (mean age, 56.9 ± 18.5 years; medicated hypertension, 65.6%) by using the Japanese and Thai ambulatory BP monitoring (ABPM) databases, in order to check the BP control status in treated hypertensives and to inform the clinical diagnosis of hypertension. The two populations had similar office systolic BP (SBP) (142.7 ± 20.0 vs 142.3 ± 20.6 mm Hg, p = .679). However, the Japanese population had higher 24‐hr average and daytime SBP, and the Thai population had higher nighttime SBP even after adjusting for cardiovascular risk factors (all p < .05). Greater morning BP surge was observed in Japanese (31.2 vs 22.8 mm Hg, p < .001). Regarding nocturnal BP dipping status, the prevalence of riser status (higher nighttime than daytime SBP) was higher in the Thai population (30.5% vs 10.9%). These findings suggest that a substantial difference in 24‐hr BP profiles exists between even neighboring countries in Asia.

Ambulatory blood pressure profile in office normotensive obese children: prevalence of masked hypertension and impact of parental hypertension.

Objectives The objectives of this study were to analyze ambulatory blood pressure (ABP) data in office normotensive obese children, to determine the prevalence and characteristics of masked hypertension (MH) and to investigate the impact of parental hypertension (PH) on ABP. Methods Seventy-nine obese and 35 normal weight children were enrolled. Each weight group was further divided in accordance with the presence of PH. ABP was recorded in an outpatient setting. Results Obese children had higher systolic ABP (p<0.05) and heart rate (p<0.001) compared with normal weight children. In obese children with PH, only nighttime systolic ABP (p=0.01) was higher compared with obese without PH, whereas normal weight children with PH had higher 24h and daytime systolic and diastolic BP (all p<0.05) and nighttime DBP (p<0.001) compared with those without PH. PH but not obesity was associated with nondipping phenomenon. Prevalence of MH in the whole group was 23.6% being significantly higher in obese than in nonobese subjects (31.6 vs. 5.7%; p=0.0026) as well as in obese subjects with PH compared with obese subjects without PH (48.7 vs. 15%; χ2=10.37; p=0.001). MH was diagnosed more frequently in obese with high-normal office BP compared with obese with normal office BP, although it did not reach statistical significance (50 vs. 26.2%; χ2=3.631; p=0.056). In the normal weight group, neither PH nor office BP category had an impact on the prevalence of MH. Conclusions Office normotensive obese children had higher ABP values. MH was associated with obesity, PH and high-normal BP.

P1294AMBULATORY BLOOD PRESSURE PROFILE IN PERITONEAL DIALYSIS COMPARED TO HEMODIALYSIS AND CHRONIC KIDNEY DISEASE PATIENTS

Abstract Background and Aims Hypertension is highly prevalent in dialysis patients and is often poorly controlled. Data on the ambulatory blood pressure (BP) profile of patients undergoing peritoneal dialysis (PD) are scarce. The aim of this study is to compare the ambulatory BP profile of PD patients with that of hemodialysis (HD) and to pre-dialysis CKD patients. Method 38 patients undergoing PD were matched in a 1:2 ratio for age, gender and dialysis vintage with 76 HD patients and in a 1:1 ratio for age and gender with 38 CKD stages 2-4 patients. Patients under PD and HD underwent 48-hour and CKD patients 24-hour ambulatory BP monitoring. BP levels were compared for the 48hour, 1st and 2nd 24hour, daytime and nighttime periods. Two-way mixed ANOVA analysis for repeated measurements was used to evaluate the effect of dialysis modality and time on ambulatory BP in PD and HD. Results During all periods studied, SBP and DBP were numerically higher but not statistically different in PD than in HD patients. SBP was significantly higher in PD or HD compared with predialysis CKD (PD:138.38±20.97; HD:133.75±15.5; CKD:125.52±13.4 mmHg, p=0.003; PD vs CKD: p=0.003; HD vs CKD: p=0.041 accordingly); significant differences were also evident during the daytime and nighttime periods. DBP displayed a similar trend in the total period studied (PD:82.34±15.22; HD:80.47±11.13; CKD:76.81±7.82 mmHg, p=0.108), but the difference significant only during the second nighttime period. Repeated-measurements analysis showed no effect of dialysis modality and no interaction between modality and time on ambulatory BP during all periods studied. Conclusion Average BP levels are similar between PD and HD patients, but higher for both groups compared to CKD counterparts. The dialysis modality had no significant effect on ambulatory BP profile.

Renal Functional Reserve Is Related to the Nondipping Phenotype and to the Exercise Heart Rate Response in Patients with Essential Hypertension and Preserved Renal Function

Background: Renal functional reserve (RFR), defined as the difference between stress and resting glomerular filtration rate (GFR), may constitute a diagnostic tool to identify patients at higher risk of developing acute kidney injury or chronic kidney disease. Blunted RFR has been demonstrated in early stages of hypertension and has been attributed to impaired vascular reactivity due to an overactive sympathetic nervous system (SNS). Objective: The purpose of this study was to investigate whether RFR correlates with other phenotypes expressing overactivity of the SNS in patients with essential hypertension and preserved renal function. Methods: Thirty-six patients with untreated essential hypertension and a GFR >60 mL/min/1.73 m² were enrolled. The following parameters were measured: RFR, 24-h ambulatory blood pressure (BP) profile, a treadmill stress test, and an echocardiographic examination. Urine and venous samples were obtained at specific time points for the determination of clinical parameters, and both resting and stress GFR were calculated by using endogenous creatinine clearance for the measurement of RFR after an acute oral protein load (1 g/kg). Results: Twenty-one patients had a RFR <30 mL/min/1.73 m² and 15 had a RFR above this cutoff. A nondipping pattern of 24-h BP was significantly more frequent in patients with low RFR (57.1 vs. 25.0%, p < 0.05 for systolic BP and 52.3 vs. 10.0%, p < 0.02 for diastolic BP). Moreover, patients with lower RFR values showed a blunted heart rate (HR) response to exercise during treadmill test (r = 0.439, p < 0.05). None of the echocardiographic parameters differed between the two groups of patients. Conclusions: In hypertensive patients with preserved GFR, reduced RFR is related to nondipping BP phenotype as well as to attenuated exercise HR response. Overactivity of the SNS may be a common pathway. Since loss of RFR may represent a risk factor for acute or chronic kidney injury, hypertensive patients with blunted RFR might need a more careful renal follow-up.

The relation of work-related factors with ambulatory blood pressure and nocturnal blood pressure dipping among aging workers

ObjectivesIndividuals with reduced nocturnal blood pressure (BP) dipping are at increased risk of cardiovascular disease compared to persons with normal BP dipping. Although the relation of work-related factors and BP has been studied extensively, very little is known of the association between work-related factors and 24-h BP patterns in aging workers. We examined the cross-sectional relation of work-related risk factors, including occupational status, work-time mode, job demands and job control, with ambulatory BP in aging workers, focusing on nocturnal BP dipping.Methods208 workers (mean age 62 ± 3 years; 75% women) from two Finnish population-based cohort studies underwent 24-h ambulatory BP monitoring. Work-related factors were inquired using a questionnaire. Nocturnal BP dipping was calculated as [1 − (asleep BP/awake BP)] × 100.ResultsShift workers demonstrated a higher nocturnal diastolic BP dipping than regular day workers (19% vs. 17%, p = 0.03) and had a significantly higher systolic awake BP than regular day workers (136.5 mmHg vs. 132.5 mmHg, p = 0.03). Participants with high job demands demonstrated a smaller nocturnal systolic BP dipping than participants with low job demands (14% vs. 16%, p = 0.04). We did not observe significant differences in nocturnal systolic or diastolic BP dipping between groups categorized by occupational status or job control.ConclusionsAlthough shift workers have a higher daytime BP than regular daytime workers, they exhibit greater nighttime BP dipping. Participants with high job demand had smaller nighttime BP dipping than participants with low job demand. Job control or occupation did not affect the 24-h ambulatory BP profile of aging workers.

Arterial hypertension with comorbid chronic obstructive pulmonary disease: relationship between tolerance to physical exercise and structural and functional state of the heart.

The aim of the study was to establish the relationship between tolerance to exercise, oxygen saturation, and structural and functional cardiac status in patients with hypertension in combination with COPD. This study included 120 patients with primary arterial hypertension of stage I-II, grade 1, 2, and 3 in combination with COPD of grades 2 and 3 and clinical groups A, B, C, D, consisting group 1; group 2 – 30 patients with primary hypertension, and group 3 – 30 patients with COPD; group 4 – 30 practically healthy people representative by age and sex. Research methods included general clinical examination (collection of complaints, anamnestic data) and instrumental research methods: electrocardiography (ECG), echocardiography, measurement of ambulatory blood pressure (BP) profile (ABPM), spirometry, pulsoxymetry (SpO2), 6-minutes walking test (6MWT). On examination of 120 patients with stage I-II, grade 1 hypertension was established in 19 (15.8%), grade 2 was in 83 (69.2%) and grade 3 was in 18 (15%) patients, respectively. COPD in clinical group A was diagnosed in 10 (8.3%), B – in 51 (42.5%), C – in 18 (15%) and D - in 41 (34.2%) patients, respectively. The most common was AH stage 2 with COPD in clinical group B – 35 (29.2%) cases and D – 31 (25.8%) cases. The 24-hour average systolic BP (SBP) in patients of the main group was 165 [144;178] mmHg, and the diastolic BP (DBP) was 103 [94;111] mmHg. The daytime average SBP was 160 [140;180] mmHg, and the DBP was 105 [93;117] mmHg accordingly. The night-time average SBP was 165 [155;175] mmHg, DBP – 100 [95;105] mmHg, heart rate (HR) – 83 [76;88] minutes, respiration rate (RR) – 21 [19;24] minutes. Decreases in index of chronotropic reserve (ICR) and the index of inotropic reserve (IIR) and load index indicate an increase in myocardial oxygen demand during exercise. There was an inverse correlation of IIR with SBP at rest (r= –0.42; p˂0.05) and a direct correlation with age (r=0.28; p˂0.05), which is significantly different from the control group. A direct correlation was found between the double product (DP) before and after exercise (r=0.43; p˂0.05), which indicated an increase in consumption of oxygen by the myocardium. We found a direct correlation between left atrium (LA) and the ratio of expiratory volume per 1 sec (FEV1) to the forced lung capacity (FEV) – FEV1/FVC (r=0.32; p˂0.05), which indicates the effect of the severity of bronchial obstruction on the level of left ventricular (LV) overload in patients with hypertension combined with COPD. The inverse correlation between thickness of the posterior wall of the LV (RVWT) and FEV1/FVC (r= -0.32; p˂0.05) indicates the contribution of disorders of bronchial patency and intrathoracic pressure with the level of BP to the development of concentric remodeling and LV hypertrophy. The inverse correlation between SV and COPD Assessment Test (CAT) (r= -0.32; p˂0.05) indicates an additional effect of COPD clinical severity on central hemodynamics in patients with hypertension. This relationship between the ventilatory and hemodynamic parameters is confirmed by the inverse correlation of HR and FVC (r= –0.33; p˂0.05)), left ventricular internal dimension (LVEDD) of LV and CAT (r= –0.24; p˂0.05)), stroke volume (SV) and Modified British Medical Research Questionnaire (mMRC) (r= –0.42; p.00.05), CAT and pack years (r=0.33; p˂0.05), inverse correlation between CAT and mMRC and FEV1, FVC and FEV1/FVC (r= -0.40;p˂0.05 and r= -0.45; p˂0.05), respectively. Linear regression analysis showed that changes in SV LV, LVEDD and SpO2 were dependent predictors of patient’s worsening state according to CAT (p˂0.05). The direct correlation was established between the desaturation (ΔSpO2) and ΔDP (r=0.48) and the inverse of ΔSBP (r= -0.29), 6MWT (r= -0.45), ICR (r= -0.34) and IIR (r= -0.29), which indicates a pronounced effect of hypoxemia on hemo­dynamics in patients with hypertension in combination with COPD. Comprehensive determination of cardiorespiratory reserve by 6-minute walk test, pulse oximetry and ambulatory blood pressure monitoring in patients with hypertension in combination with COPD makes it possible to establish disadaptation of the body to physical activity due to hypoxemia, decrease in the index of chrono- and inotropic reserves, which is an indication for administering appro­priate therapy. In patients with hypertension combined with COPD, the degree of desaturation, stroke volume, end-diastolic parameters of the left ventricle, maximal size and volume of the left atrium, as well as remodeling of the left heart sections in the concentric direction can be considered as independent predictors of prognosis. The 6-minute walk test with desaturation can be used as an additional method of personalizing rehabilitation measures in patients with hypertension in combination with COPD.

Masked hypertension during prehypertension and anthropometric indices: Prospective study

Analysis of the ambulatory blood pressure profile of patients with prehypertension (PHT) and the assessment of their cardiovascular risk have rarely been studied. Our work aimed to establish the link between masked hypertension (MH) and the cardiovascular risk factors (CVR) associated with prehypertension. From 2015 to 2016, a cross-sectional study was conducted in primary care consultation in Algiers on a sample of 1086 adults, without known hypertension. They were screened for PHT (defined by the JNCVII as systolic BP between 120 and 139 mmHg or diastolic BP between 80 and 89 mm Hg). Pre-hypertensive patients were assessed for their anthropometric indices (height, weight and waist circumference) and an ambulatory blood pressure measurement (ABPM). The Pearson correlation test was used to investigate the relationship between MH and the major CVR factors in these patients. Three hundred and ninety-nine pre-hypertensive patients were identified (prevalence: 36.7%), concerning more men than women (50.0 vs. 31.5%, P < 0.001). ABPM was performed in 273 patients, and MH was treated in 52.4% of cases, affecting men and women equally ( P = 0.29). Nighttime MH (≥ 120/70 mmHg) was significantly more frequent than daytime MH (≥ 135/85 mmHg) (57% vs. 36%, P = 0.0005). Patients with MH were older than those with normal ABPM (46 ± 13.33 vs. 42 ± 14.36 years, P = 0.01), had higher body mass index (BMI) (29.47 ± 5.507 vs. 26.6 ± 4.985 kg/m 2 , P = 0.00001) and more frequent android obesity (64% vs. 43%, P = 0.0006). In MH patients, we found a positive correlation between daytime pressure and weight ( r = 0.361), BMI ( r = 0.283) and waist circumference ( r = 0.374). This positive relationship was also valid for the night pressure values ( r = 0.379, 0.399 and 0.410 respectively). Masked hypertension is a recognized source of increased CVR, thus we suggest to record and monitor the ambulatory pressure in pre-hypertensive subjects, especially as they are overweight.

Determinants of microvascular dysfunction in normotensive offsprings of hypertensive parents

Objective: Microvascular dysfunction usually precedes the onset of hypertension. We hypothesized that offspring of offsprings of hypertensive parents (OHP) would have coronary microvascular dysfunction. Yet, the determinants of microvascular dysfunction in OHP are not fully determined. We, therefore, studied coronary flow reserve (CFR) in OHP in relation to ambulatory blood pressure and lipid profiles. Subjects and Methods: One hundred and twenty-five healthy normotensive offsprings with family history of hypertension and 40 age- and sex-matched healthy normotensive offsprings without family history of hypertension (ONP) were enrolled for the study. All participates underwent transthoracic color Doppler echocardiography at rest and during adenosine (0.14 mg/kg) infusion. CFR was calculated as the ratio between hyperemic diastolic coronary flow to the resting diastolic coronary flow. All participates had ambulatory blood pressure monitoring. In addition, lipid profile was obtained, and triglycerides (TGs)/high-density lipoprotein cholesterol (HDL-C) was calculated. Results: CFR was significantly reduced among OHP compared with ONP (P

IMPAIRED ANKLE BRACHIAL INDEX AND UNFAVORABLE AMBULATORY BLOOD PRESSURE PROFILE IN PATIENTS WITH HOSPITALIZED FOR MYOCARDIAL INFARCTION

Objective: The aim of the present study was to assess the vascular status as assessed by ankle brachial index (ABI) and ambulatory blood pressure (BP) profile in patients hospitalized for myocardial infarction. Design and method: We studied 75 patients (76% males, age 65 ± 13 years) who were hospitalized because of ST-elevation myocardial infarction (STEMI) and Non ST–elevation myocardial infarction (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Moreover, ABI was measured according to established methodology and patients underwent 24-hour ambulatory BP monitoring during the third day of hospital stay. Results: From the total population, 20% had family history of cardiovascular events, 72% were hypertensives, 32% had diabetes, 51% were smokers and 32% had previous history of coronary artery disease. Regarding the type of myocardial infarction, 37% were admitted for STEMI and 55% had coronary revascularization. Focusing on the ABI the levels in the entire population was 1.04 ± 0.25, while 36% of patients had impaired ABI < 0.9. Mean 24-h BP was 1156/69 mmHg, while 59 patients (78%) presented a non-dipping profile. Conclusions: Patients admitted for STEMI and NSTEMI are characterized by impaired ABI and high prevalence of non-dipping of BP during nighttime. These findings may explain the unfavorable overall cardiovascular prognosis of these patients.

Effect of occupational activity on ambulatory blood pressure profile in university teachers

Hypertension (HBP), a key risk factor for cardiovascular diseases, is strongly associated with behavioral and environmental aspects of living. Professional activities, amongst others that take place throughout the day, are responsible for important blood pressure (BP) variations and may increase it. This study aims at ascertaining the blood pressure profile and variation in teachers, during a typical teaching session. Ambulatory Blood Pressure Monitoring (ABPM) was performed in a cohort of 21 university teachers during a typical professional day, comprising the following periods: 24-hour period, day period, night period, morning period, 2 hours before class, during class, 2 hours after class, aerobic exercise period and 1 hour after exercise period. Teachers demonstrated higher BP ??during the occupational activities (137.71 / 88.57 mmHg) compared to the period before (128.81 / 82.43 mmHg) and after the class (132.38 / 85.19 mmHg) (p &lt;0.05). It was found that systolic BP has the greatest variability across the considered activities and time periods. In a gender analysis, men had higher systolic BP ??compared to women (141.55 mmHg / 133.50 mmHg, respectively), and demonstrated greater variability across activities. The results clearly demonstrated the existence of important variations in BP due to different daily activities. The occupational period produced a significant increase in the different components of BP and heart rate. Long-term effects of repeated exposure to this increase in BP related with the occupational contexts remains to be demonstrated

The relationship between the nitric oxide synthase gene and the risk of hypertension defi ned according to ambulatory blood pressures

Although nitric oxide (NO) plays an important role in blood pressure (BP) control, whether variation of genes involved in regulating the synthesis of NO infl uences BP is uncertain. As the heritability of BP is stronger for ambulatory than it is for conventional BP, we assessed the independent association of the well described functional exon 7 Glu298Asp variant of the eNOS gene with the presence of hypertension in 511 randomly selected normotensive control participants and 503 hypertensives with a diagnosis of hypertension confi rmed with 24-hour ambulatory BP profiles whilst off therapy. We also assessed the relationship between eNOS genotype and 24 hour ambulatory BP. Comparisons of genotype and allele frequencies indicated a lack of association of the exon 7 Glu298Asp gene variant with hypertension (Odds ratio of genotype predicting the presence of hypertension=0.97, confidence interval=0.70-1.30, p=0.92). However, patients with the Glu/Glu genotype of the Glu298Asp variant (n=424) had increased 24-hour systolic and diastolic blood pressures (152±1/97±1 mm Hg) in comparison to patients heterozygous for the Glu298Asp variant or homozygous for the 298Asp allele (n=79) (145±1/94±1 mm Hg, p‹0.005 for systolic BP and p‹0.001 for diastolic BP after multiple adjustments including age, gender, body mass index and the presence of diabetes mellitus). Differences in systolic and diastolic BP between genotype groups were noted during the day as well as at night. The association of eNOS genotype with ambulatory BP translated into an increased risk of more severe grades of hypertension in patients with the Glu/Glu genotype (grade II and III vs. grade I, Odds ratio=2.20, confidence interval=1.34-3.59, p‹0.0002). In conclusion, a functional gene variant (Glu298Asp) at the eNOS locus contributes ~1.4-2.5% to the variation in ambulatory blood pressure within hypertensives, but is not associated with the presence of hypertension in patients in whom the diagnosis has been confirmed by 24-hour ambulatory BP values. The relationship between eNOS genotype and 24-hour ambulatory BP and the severity of hypertension warrants further study.

Changes in the expression of α1B-adrenoceptor in peripheral mononuclear cells correlates with blood pressure and plasmatic homocysteine.

Human peripheral mononuclear cells (HPMC) have been suggested as a practical surrogate for myocardial or vascular cells. Present work analyses if changes in the expression of α1-adrenoceptors (ARs) in HPMC are related to the hypertensive state and its clinical consequences. Quantitative RT-PCR was employed to evaluate the mRNA levels of the three α1-ARs (α1A, α1B, α1D) in HPMC isolated from normotensive and hypertensive patients, and also in tissues from two animal models of hypertension: spontaneously hypertensive rats (SHR) and hypertension induced by chronic treatment with L-NAME. In patients, 24-h ambulatory blood pressure and serum biochemical profile were also recorded. We found that α1B-AR expression was higher in HPMC from hypertensive patients and correlated with blood pressure and plasmatic homocysteine. A rise in the α1B-AR expression in kidneys, but not in heart from hypertensive animal models was also found. α1D-AR did not change in HPMC, not in rat heart or kidney, but a significant correlation with plasmatic aldosterone was found. In conclusion, we have proved that α1-ARs mRNA expression in HPMC correlates with clinical variables and could be used as a potential biomarker in hypertensive patients.

Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications.

The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure (ABPM) is seen as standard to assess blood pressure (BP) regulation. We evaluated 24-hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure (PP) and blood pressure variability (BPV) on microalbuminuria (MA) and diabetic retinopathy (DR). BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score (SDS) day: systolic BP (SBP) +0.06, mean arterial pressure (MAP) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP (SDS -0.2) and dipping of SBP and MAP were reduced (SBP -1.1 SDS, MAP 12.4% vs 19.4%), PP showed reverse dipping (-0.7 SDS). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR. Reverse dipping of PP was more pronounced in the children with MA (-5.1% vs -0.8%) and DR (-2.6% vs -1.0%). BP alteration was stronger in girls and increased with age. There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.