Ambulatory Blood Pressure Research Articles

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 <130/80 mmHg and sleep BP >110/65 mmHg. INH was also evaluated by the 2014 AHA definition: wake BP <95th percentile with sleep BP >95th percentile. Primary outcome was left ventricular hypertrophy (LVH), defined as left ventricular mass index >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 >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.

P063 DIFFERENCES IN CARDIOVASCULAR RISK IN THE GENERAL POPULATION OF LOW AND HIGH-ALTITUDE RESIDENTS IN PERU. HIGH ALTITUDE CARDIOVASCULAR RESEARCH – LATIN AMERICA POPULATION STUDY

Background and Objective. Previous data in a convenience sample of highlanders showed an elevated prevalence of masked hypertension. However, comparative studies describing the prevalence of blood pressure (BP) phenotypes in the general population atof different altitudes are lacking. Our aim was to compare the prevalence of BP phenotypes defined by office BP measurement and ambulatory BP monitoring (ABPM) in a population-based sample of Peruvian lowlanders and highlanders. Methods. Sex- and age-stratified random general adult population sample was recruited in urban areas at low (Lima, <500m) and high altitude (Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). Questionnaires, anthropometric data, conventional BP (3 seated measurements with a validated oscillometric device), 24-hour ambulatory BP (A&D TM2430, Japan), and blood analyses were obtained. BP was defined as elevated if either systolic or diastolic BP was: 1) office (OBP) ≥140/90; 2) 24-hour ≥130/80; 3) Daytime ≥135/85; 4) Night-time ≥120/70 (all in mmHg). BP phenotypes were defined as: normotension (NT) – no BP values elevated; white coat hypertension (WCH) – only OBP elevated; masked hypertension (MH) – any ambulatory BP elevated, normal OBP; sustained hypertension (SH) – OBP and any ambulatory BP elevated Results. The analysis included 181 lowlanders and 553 highlanders. Highlanders had slightly lower age (45 vs. 47 years, p=0.005), BMI (26.7 vs. 28.6 kg/m2, p<0.001), and oxygen saturation (88.9 vs. 97.8%, p<0.001) but higher haemoglobin (17.5 vs. 14.4 g/l, p<0.001) than lowlanders. Prevalence of elevated OBP was low at high altitude. Elevated ambulatory BP was much more frequent at both altitudes. Consequently there was a high prevalence of masked hypertension, which was a dominating high BP phenotype among highlanders. Main results are reported in the Table. The altitude of residence remained independently associated with elevated 24-hour BP (p<0.001) in a multiple logistic regression model including age, sex and BMI as covariates. Conclusions. Many individuals in Peru, especially highlanders, are exposed to BP-related risk, which cannot be captured by office measurements alone.

P062 INITIAL EXPERIENCE WITH 24-HOURS AMBULATORY BLOOD PRESSURE MONITORING IN KEFFI NASARAWA STATE

Objective: In the last 30 years or so, the techniques for measuring blood pressure to ascertain wether an individual bas hypertension or not have undergone substantial change. The traditional method of taking blood pressure in the clinic is very useful especially on the population basis but provides poor estimate of risk in an individual subject. Ambulatory blood pressure measurement has been developed to estimate the true blood pressure of an individual over prolonged periods. There is paucity of report on the experience with this technology in Nigeria. We are therefore reporting on our initial experience with ambulatory blood pressure monitoring at cardiac unit of the department of medicine, of the federal medical center keffi. Methods: All the procedures where carried out with Schiller BR - 102 Plus ambulatory pressure monitors and analysis done with Schiller SDS- 200 Computer system. Results: We report different forms of abnormalities: poor blood pressure control, non- keeping patterns, White cost effects, normal blood pressure patterns, blood pressure patterns in autonomic dysfunction etc. Conclusion: Ambulatory blood pressure monitoring is a useful tool in blood pressure management especially in specialized units.

P146 EFFECT OF HOME BLOOD PRESSURE TELE-MONITORING PATHWAY WITH PHARMACIST CASE MANAGEMENT TO SUPPORT PATIENTS DISCHARGED FROM EMERGENCY DEPARTMENT WITH ASYMPTOMATIC HYPERTENSION: A STUDY PROTOCOL FOR MULTICENTRE RANDOMIZED CONTROLLED TRIAL (TEC4HOME-BP)

Background and Objectives: Severely elevated blood pressure (BP) in the emergency department (ED) has recently been associated with undiagnosed hypertension and adverse cardiovascular outcomes, regardless of the initial reason (e.g.: pain or anxiety) for the ED visit. Clinical uncertainty exists on how best to manage severe asymptomatic BP post-discharge from the ED. In this study protocol, we propose home BP telemonitoring with pharmacist case management intervention on participants discharged from the ED with severe asymptotic hypertension. The overall purpose of this trial is to evaluate whether home BP telemonitoring and pharmacist case management can improve BP management in participants discharged from the ED with severe asymptotic hypertension and whether participants find this intervention to be acceptable. Methods: The study is a multi-centre, randomized controlled trial of 408 participants discharged from the ED with severe hypertension (defined as average of 3 readings systolic blood pressure [SBP] ≥ 160 mm Hg and/or diastolic blood pressure [DBP] ≥ 100 mm Hg over 3 readings). Participants will be randomized to either usual care or home BP telemonitoring and pharmacist case management for 12-months. The primary outcome is proportion achieving disease specific SBP control using 24 h ambulatory BP monitoring (ABPM) at 12-months. Secondary outcomes are change in SBP and DBP based on 24 h ABPM and home BP averages at 6- and 12-months. Patient acceptability and satisfaction will be assessed using EuroQoL 5-level EQ5 version and patient Satisfaction Questionnaire Short Form. Exploratory outcomes include adverse events, prescription of anti-hypertensive medications, fidelity of interventions and health care utilization. Conclusions: Results from this study will advise the integration of home blood pressure telemonitoring and pharmacist case management pathway as key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with asymptomatic severe hypertension in the ED. Trial registration: ClinicalTrials.gov: NCT 06303206

Evaluating Blood Pressure Variability in Type 2 Diabetic Patients: An Insight into Non-Dipping Patterns and Their Clinical Implications.

Hypertension (HTN) is prevalent in individuals with type 2 Diabetes Mellitus (T2DM), doubling the risk of developing chronic complications. Despite normal routine checks, many patients with diabetes exhibit abnormal blood pressure (BP) profiles identified by 24-hour ambulatory Blood Pressure monitoring (ABPM). This study aimed to analyse blood pressure variability in patients with diabetes to enhance current knowledge and improve clinical practice. This cross-sectional study obtained ethical approval from Jazan University and involved 58 patients with type 2 Diabetes Mellitus (T2DM) who adhered to the strict inclusion and exclusion criteria. Comprehensive clinical and laboratory data, including demographic, clinical, and essential laboratory parameters, were collected using a standardized form. Blood Pressure (BP) was meticulously monitored using the Sun Tech Oscar 2 ABPMR device, with measurements commencing between 8 am and 10 am, extending over 24hours. The study calculated averages and evaluated systolic and diastolic percentage dipping during 24-hour, daytime, and night-time intervals. Participants classified as "dippers" experienced a BP reductions of at least 10%. Fifty-eight normotensive T2DM patients, with a mean age of 45.51 ± 6.7 years, were monitored over 24 months. Among the 58 individuals assessed using ABPM, a non-dipping pattern was observed in 45 participants (77.58%), whereas 13 (22.41%) exhibited a dipping pattern. Postprandial and fasting blood sugar levels were distinct; the dipper group demonstrated better post-meal glucose control (p=0.02), whereas the non-dipper group had superior fasting glucose control (p=0.04). The dipper group showed a higher 24-hour average systolic BP (p=0.00) and increased dipping percentages for systolic and diastolic BP during sleep. Over 77% of ABPM-evaluated individuals showed non-dipping patterns, with a higher BMI being strongly associated. Laboratory findings revealed distinct variations in the postprandial and fasting blood sugar levels, suggesting a potential genetic predisposition.

Interplay of race and neighborhood deprivation on resting and ambulatory blood pressure in young adults.

Nighttime blood pressure (BP) and BP dipping (daytime-nighttime BP) are prognostic for cardiovascular disease. When compared with other racial/ethnic groups, Black Americans exhibit elevated nighttime BP and attenuated BP dipping. Neighborhood deprivation may contribute to disparities in cardiovascular health, but its effects on resting and ambulatory BP patterns in young adults are unclear. Therefore, we examined associations between neighborhood deprivation with resting and nighttime BP and BP dipping in young Black and White adults. We recruited 19 Black and 28 White participants (23 males/24 females, 21 ± 1 yr, body mass index: 26 ± 4 kg/m2) for 24-h ambulatory BP monitoring. We assessed resting BP, nighttime BP, and BP dipping (absolute dip and nighttime:daytime BP ratio). We used the area deprivation index (ADI) to assess average neighborhood deprivation during early and mid-childhood and adolescence. When compared with White participants, Black participants exhibited higher resting systolic and diastolic BP (Ps ≤ 0.029), nighttime systolic BP (114 ± 9 vs. 108 ± 9 mmHg, P = 0.049), diastolic BP (63 ± 8 vs. 57 ± 7 mmHg, P = 0.010), and attenuated absolute systolic BP dipping (12 ± 5 vs. 9 ± 7 mmHg, P = 0.050). Black participants experienced greater average ADI scores compared with White participants [110 (10) vs. 97 (22), P = 0.002], and select ADI scores correlated with resting BP and some ambulatory BP measures. Within each race, select ADI scores correlated with some BP measures for Black participants, but there were no ADI and BP correlations for White participants. In conclusion, our findings suggest that neighborhood deprivation may contribute to higher resting BP and impaired ambulatory BP patterns in young adults warranting further investigation in larger cohorts.NEW & NOTEWORTHY We demonstrate that young Black adults exhibit higher resting blood pressure, nighttime blood pressure, and attenuated systolic blood pressure dipping compared with young White adults. Black adults were exposed to greater neighborhood deprivation, which demonstrated some associations with resting and ambulatory blood pressure. Our findings add to a growing body of literature indicating that neighborhood deprivation may contribute to increased blood pressure.

O104 OPTIMAL NIGHTTIME BLOOD PRESSURE MONITORING SCHEDULE USING HOME MONITORS IN CHILDREN AND ADOLESCENTS: ASSOCIATION WITH AMBULATORY BLOOD PRESSURE AND PRECLINICAL TARGET-ORGAN DAMAGE

Background and Objective: To evaluate the optimal schedule for nighttime blood pressure (BP) assessed using home monitors (HBP) in terms of agreement with nighttime ambulatory BP (ABP) and association with indices of preclinical organ damage in children and adolescents. Methods: Apparently healthy children and adolescents (6-18 years) referred for elevated BP were subjected to (i) 24-hour ABP monitoring using a validated upper-arm cuff oscillometric device (Microlife WatchBP O3), (ii) HBP monitoring during daytime (7 days, duplicate morning and evening measurements) and nighttime (automated measurements, 3 nights, 3 hourly measurements/night) using a validated upper-arm cuff oscillometric device (total of 9 nighttime readings, Microlife WatchBP HOME N), (iii) carotid intima-media thickness (cIMT) measurement (ultrasonography), (iv) carotid-femoral pulse wave velocity (cfPWV) (Complior device; duplicate measurements), and (v) echocardiographic determination of left ventricular mass index (LVMI). Results: Forty-nine individuals were included (mean age 13.4±2.7 years, 51% males). There were no differences in nighttime HBP among individual readings or the average of different nights (night 1: 109.7±10.9/60.8±7.3 mmHg, systolic/diastolic BP; night 2: 109.1±11.7/59.7±8.6 mmHg; night 3: 109.1±11.5/60.4±8.4 mmHg, p=NS for all comparisons). By averaging an increasing number of nighttime systolic HBP readings, there was a consistent trend towards a stronger association of nighttime HBP with nighttime ABP (correlation coefficients r increased from 0.65 to 0.81), and with indices of preclinical organ damage (LVMI: 0.21 to 0.30; cIMT: 0.38 to 0.57; cfPWV: 0.60 to 0.69). There was no further improvement in these associations by averaging >4 nighttime readings. The diagnostic agreement between the two methods in detecting nocturnal hypertension was progressively improved by averaging more nighttime HBP readings with near plateau at 4 measurements. Conclusions: A two-night HBP monitoring schedule (6 readings) appears to be the minimum requirement for a reliable assessment of nighttime HBP in children and adolescents, which provides reasonable agreement with nighttime ABP and association with preclinical organ damage.

P209 A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE PHYSICIANS BY MEANS OF VASCULAR AGE (RIESCO/TOGETHER)

Background and Objective: Estimating arterial stiffness in Community Farmacies (CPh) has been shown to improve hypertension (HTN) management in Portugal, Austria and Spain. TOGETHER aims to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases HTN control, establishing paths of lasting cooperation between Primary Care (PC) doctors and CPh. Methods: TOGETHER is a cluster-randomized, prospective study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered BP measurement and ambulatory BP monitoring (ABPM) for those with high values. CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The therapeutic options of EVA will be explained to patients/PC. HTN will be treated by PC according to usual clinical practice. A second evaluation with ABPM will be performed after 6 months and HTN control will be compared between the arms. The degree of patient-doctor interaction will be determined through validated surveys. Results Five fundamental unmet needs will be addressed by TOGETHER: 1) lack of HTN screening programs; 2) Implementation of the simpler and more informative EVA concept (“Your arteries are 10 years older than you”); 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) Implementation of health educational programs, combined with the concept of EVA; 5) Higher collaboration and development of a team-based approach to HTN care between CPh and PC. Conclusions: The complementary organizational settings and strengths of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.

P007 HIGH PREVALENCE OF HYPOTENSION IN OLDER ADULTS ON AMBULATORY BLOOD PRESSURE MONITORING (ABPM)

Background: Hypertension, a prevalent public health concern, disproportionately affects older adults. Effective blood pressure (BP) control is crucial to preventing cardiovascular complications such as heart attack, stroke, and heart failure. In recent years, there has been a discussion about the optimal BP control strategies in older adults (1). While some studies advocate for intensive BP control, others emphasize the importance of considering individual patient characteristics, such as age and frailty (2,3). Objective: This study aims to describe the prevalence of hypotension in ambulatory blood pressure monitoring (ABPM) in older adult patients compared to younger patients. Methods: This cross-sectional descriptive study analyzed ABPM records from 2018 to 2024 at a cardiovascular institution in Colombia. The difference in systolic (SBP) and diastolic (DBP) blood pressure was evaluated according to the age group (younger or older than 80 years) to determine the presence of hypotension in older adults defined as pressure less than 90/60 mmHg. Normality was assessed using the Kolmogorov-Smirnov test. Comparisons of continuous variables across age categories were performed using the non-parametric Mann-Whitney U test. For categorical variables, the Chi-square test was employed. Results: Among the 653 participants, 57.3% (374) were women. The average age was 63 years, with 60 patients (9.18%) being over 80 years old. Table 1 shows a significant difference in systolic and diastolic blood pressure (SBP and DBP) between the age groups. Notably, 47.5% of patients over 80 had SBP less than 130 mmHg, and a high prevalence (84.7%) had DBP less than 90 mmHg. DBP below 60 mmHg was more common in this age group. Additionally, 20 older adults had SBP between 130-139 mmHg. Conclusions: This study demonstrates a high prevalence of hypotension, especially low DBP, in older adults. Considering these findings, re-evaluating current blood pressure control targets for older adults is crucial to avoid overtreatment and minimize the risk of complications like symptomatic hypotension and falls.

P110 INITIAL TREATMENT WITH A SINGLE CAPSULE CONTAINING HALF-DOSE QUADRUPLE THERAPY VS STANDARD-DOSE DUAL THERAPY IN HYPERTENSIVE PATIENTS (QUADUAL): A RANDOMIZED, BLINDED, CROSSOVER TRIAL

Background and Objective: Guidelines recognized the dual combination in initial antihypertensive therapy. Studies demonstrated low-dose quadruple combination antihypertensive was superior to monotherapy. However, whether low-dose quadruple therapy is better than dual combination is unknown. Methods: A randomized blinded crossover trial was conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg + metoprolol 23·75 mg + amlodipine 2·5 mg + indapamide 1·25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg + amlodipine 5 mg) in the initial treatment of patients with mild to moderate hypertension. Patients were randomly assigned in a 1:1 ratio to two crossover sequences. Each sequence received four-weeks of either half-dose quadruple antihypertensives or standard-dose dual antihypertensives, followed by a two-week washout and crossover for four-weeks. Participants and researchers were blinded, except for randomization and drug coding. The primary outcome was the reduction of mean 24-hour systolic blood pressure in ambulatory blood pressure monitoring. Safety outcomes were adverse events and changes in biochemistry after treatment. Analyses were per intention to treat. This trial was prospectively registered on www.clinicaltrials.gov (NCT05377203), and is now complete. Results: A total of 90 eligible participants were randomized between July 13, 2022, and April 20, 2023. The mean age of the population was 43.88 years, and 25.6% were women. The mean baseline 24-h blood pressure was 145.59/93.84 mm Hg. Half-dose quadruple treatment compared with standard-dose dual treatment further reduced mean 24-hour blood pressure by 4.72/4.17 mm Hg (P < 0.001 for both systolic and diastolic blood pressure). Except for fasting blood glucose (P = 0.029) and blood uric acid increased significantly (P < 0.001) in half-dose quadruple group, other adverse events and changes in laboratory values between the two treatments were not statistical different. Conclusions: Initiating treatment with half-dose quadruple combination therapy was more effective in lowering blood pressure than standard-dose dual therapy. The safety of half-dose quadruple therapy was comparable.

Abstract P313: Diastolic to Systolic Arterial stiffening has Greater Prognostic Power than Diastolic Stiffness in 20-60 Years Old Patients Undergoing 24-Hour Ambulatory Blood Pressure Monitoring

The 24-hour ambulatory pulse pressure (PP), can be expressed as a sum of two ‘PP components’: ‘elastic’ PP (elPP) and ‘stiffening’ PP (stPP) associated, respectively, with arterial stiffness at the diastolic pressure (somewhat equivalent to pulse wave velocity being measured in the diastole), and the relative stiffness change from the diastolic- to the systolic pressure. Here we assess and compare the hazard ratio (HR) of elPP and stPP for outcomes in a large cohort of young and middle-age patients. We analyzed adequate quality 24h ambulatory blood pressure monitoring records from the Spanish Ambulatory Blood Pressure Registry. For standard deviation(SD), K=SD(SBP)/SD(DBP), elPP=PPxln(K)/(K-1) and stPP=PP-elPP. HRs were determined for age 20-40, 41-50, and 51-60 years, using Cox regression models applied to standardized elPP & stPP (combined), adjusted for age, sex, BMI, smoking status, diabetes, dyslipidemia, mean DBP, pulse rate, SD(SBP), antihypertensive treatment, and previous cardiovascular disease (CVD). The endpoints were total mortality, and death from CVD, or coronary heart disease (CHD). Of the 24,260 patients mean age (SD) 48.0(9.0) years, 34% male] 845 deaths occurred during period of 9.6(2.2) years. The Table shows that mean elPP slightly decreased from younger to older age, while stPP strongly increased. At age 41-60 years the adjusted HRs of stPP appeared significant and greater than those of elPP for almost all cases. The most contributing adjustors in the Cox regression were smoking, for all age classes, and sex for age over 40 years. Thus, the stiffening component may have greater predictive power than the elastic component for total mortality, and CVD&CHD death, in middle-age patients.

P153 NATIONAL SURVEY OF ARGENTINE DOCTORS ON HYPERTENSION

Background and Objective: Hypertension (HTN) is the leading cardiovascular risk factor, yet its control remains low. Identifying factors influencing diagnosis, potential clinical inertia, and the measuring devices used is crucial. Objective: This study aims to understand factors in medical practice affecting HTN knowledge and control, and to assess the availability and use of blood pressure (BP) measurement devices. Methods: This observational, cross-sectional study is based on a 25-question self-administered survey by the Argentine Society of Hypertension (SAHA) and the Argentine Society of Medicine (SAM), targeting doctors treating HTN patients in Argentina. This report focuses on BP measurement. Results: A total of 1,042 responses were received, with women comprising 45.8% (n:471). Responses came from 430 cardiologists (41.7%), 380 internists (36.8%), 68 HTN specialists (6.6%), 54 primary care physicians (5.2%), and 100 from other specialties (9.7%). An own validated automatic arm BP monitor was used by 44.5%, a manual aneroid by 36.5%, an institution's validated automatic arm monitor by 10.9%, and a fixed wall aneroid by 8.2%. BP was measured in all patients by 89% of respondents, sometimes by 8.5%, and only if the patient was hypertensive by 1.7%. Ambulatory blood pressure monitoring (ABPM) was always requested before treatment by 25.2%, sporadically by 34%, never by 4.1%, and only for BP between 130/85 mmHg and 159/99 mmHg by 36.7%. The 24-hour ABPM values for initiating pharmacological treatment were >140/90 mmHg (40.9%), >135/85 mmHg (39%), and >130/80 mmHg (20.1%). Conclusions: Discrepancies exist in HTN patient care. Only 20% of doctors start pharmacological treatment at 24-hour ABPM values above 130/80 mmHg. Enhancing education and information could improve HTN control strategies.

Abstract P217: The Prevalence And Clinical Characteristics Of Apparent And True Resistant Hypertension

Objective: We enrolled patients with essential hypertension at 15 medical centers and design a prospective clinical study to investigate the prevalence and clinical characteristics of apparent and true resistant hypertension(ATRH). In addition, we explored the effect of duration of diuretic use on blood pressure(BP) control in ATRH patients. This study aims to provide evidence for further exploring the diagnosis and treatment of ATRH. Methods: At the beginning, the patient who met the inclusion criteria were included in the study and took one tablet of O/A (20/5mg) every day. Thereafter, ambulatory blood pressure monitoring(ABPM) were completed every four weeks. During the follow-up, the drug dose of patients with controlled BP remained unchanged. Patients with uncontrolled BP were given additional drugs, and so on, until the BP controlled. The longest follow-up period was 24 weeks. Statistical analysis was performed using SPSS26. Depending on the data distribution, baseline data were evaluated using Student's t test, Mann-Whitney U test, or χ2 test. Binary logistic regression was used to further analyze the independent risk factors of ATRH. Results: A total of 772 patients were screened in this study, and finally, 545 patients' completed follow-up datas were obtained. We conluded that the incidence of ATRH was 5.13%, and only 3.18% of the patients failed to control BP after further extension of diuretic use to 3 months. A baseline comparison showed that the proportion of males, overweight (25.68±3.22 kg/m2 vs 28.85±3.32 kg/m2, P < 0.001) and eGFR < 60% were higher in the ATRH group; the patients in the ATRH group had a higher BMI, RBC count, CREA, UR concentrations and a lower HDL-C concentrations; ATRH patients exhibited higher ABPM, SBP load and nighttime DBP load than the non-ATRH group; the non-ATRH group had a more obvious BP dipping at night, and the BP rhythm was more regular. Further binary logistic regression analysis found that BMI (OR 1.25, 95% CI 1.10-1.42) and a < 10% decrease in nocturnal DBP (OR 3.24, 95% CI 1.19-8.79) were independent risk factors for ATRH. Conclusion: Under the stepwise titration of the standard treatment regimen, the prevalence of ATRH in the our study was 5.13%, and prolongs the duration of diuretic use can further promote the BP control of patients. ATRH is more common in male patients with obesity and kidney failure. Patients with a higher ABPM, BMI and a < 10% decrease in nocturnal DBP were more likely to develop ATRH.

P216 STUDY OF BLOOD PRESSURE VARIABILITY DURING DIFFERENT PHASES OF MENSTRUAL CYCLE IN APPARENTLY HEALTHY FEMALES

Background and Objective: Variability is an intrinsic property of blood pressure and is essential for physiological adaptability, blood pressure variability can be spontaneous and especially striking during physical activity and emotional and hormonal challenges like menstruation. Methods 30 Females in the age group 18 to 35 years having regular ovulatory cycles, not undergoing any medication were included in the study. Blood pressure variability was measured by Ambulatory blood pressure monitoring using ABPM machine (A&D Japan). for 24 hours at midpoint of menstrual, proliferative and luteal phases of menstrual cycle considering ovulation on (X-14) where X is the last day of menstrual cycle. Observation: In the menstrual phase, mean systolic B.P.is 103.8 mm of Hg SD +/- 15.25, proliferative phase mean is 105.41 mm Hg, SD +/- 7.33 luteal phase mean is 124.13 mm Hg, SD +/- 10.6.(P < 0.001). Comparison of mean changes in diastolic blood pressure between menstrual, proliferative and luteal phase shows mean of 63.6 mm Hg SD +/- 15.75, 68.4 mm Hg SD+/- 5.66 and 76.32 mm Hg SD +/- 6.7. (P < 0.001) respectively. Mean arterial pressure (MAP) in the menstrual phase of 78.03 mm Hg, SD +/- 10.95 proliferative phase 79.91 mm Hg SD +/- 6.34 and luteal phase mean is 89.58 mm Hg +/- 5.49(P < 0.001). Results-: This study shows that the systolic B.P. tends to rise in the luteal phase, also the diastolic B.P. rises significantly in the luteal phase. There is marked dipping in the night time blood pressure in all phases when compared to day time blood pressure and the daytime blood pressure is elevated in the luteal phase compared to menstrual and proliferative phases. Conclusion Therefore, we can conclude that in luteal phase, the systolic, diastolic blood pressure and mean arterial pressure was significantly higher than the other two phases. The daytime BP was also high in luteal phase compared to other two phases.

Abstract 07: Ambulatory Blood Pressure Variability, Progression of Kidney Disease, and Cardiovascular Outcomes in the Chronic Renal Insufficiency Cohort

Background: Visit-to-visit blood pressure variability is strongly associated with adverse kidney and cardiovascular outcomes in a wide range of patient populations. Patients with chronic kidney disease (CKD) have abnormal circadian blood pressure patterns which may affect 24-hour ambulatory blood pressure variability (ABPV). Methods: We used ambulatory blood pressure monitoring (ABPM) data from participants in the Chronic Renal Insufficiency Cohort (CRIC). Blood pressures were obtained every 30 minutes during day and night. We assessed 24-hour, daytime and nighttime systolic ABPV using average real time variability (ARV); the sum of the absolute differences between consecutive BP readings divided by the total number of readings minus one. Cox proportional hazards models were used to evaluate the association of ARV with the development of 50% reduction in eGFR or end stage kidney disease or adverse cardiovascular (CV) events (myocardial infarction, stroke, peripheral artery disease, new atrial fibrillation, and heart failure). Results: There were 1502 CRIC participants included in the analysis of whom 44% were female and mean age was 63 years (standard deviation 10). Anthropometric and clinical factors associated with higher tertile of ARV included older age, higher BMI, higher urine protein to creatinine ratio, lower estimated glomerular filtration rate, diabetes, hypertension, dyslipidemia and atherosclerotic heart disease. In unadjusted Cox proportional hazard models, 24-hour systolic ARV was associated with both adverse kidney (Hazard Ratio [HR] 1.16 95% confidence interval [CI] 1.06-1.27) and CV events (HR 1.35 95%CI 1.22-1.50). However, in adjusted models that included clinical and sociodemographic factors, there were no statistically significant associations of 24-hour systolic ARV with either adverse kidney (HR 1.02, 95%CI 0.91-1.14) or CV events (HR 0.93, 95%CI 0.84 -1.04). Similarly, daytime and nighttime ARV were not statistically significantly associated with kidney and CV events in adjusted analyses. Conclusions: In a large cohort of patients with CKD, ABPV was not associated with adverse kidney and CV outcomes in adjusted models. Thus, in the context of the many cardiometabolic risk factors present in patients with CKD, ABPV is not an independent mechanism of adverse clinical outcomes in this high-risk population.

P196 UNVEILING THE LINK BETWEEN ISOLATED NOCTURNAL ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA

Background and Objective: Isolated nocturnal hypertension (INH), characterized by elevated nighttime blood pressure alongside normal daytime readings, often correlates with obstructive sleep apnea (OSA). However, understanding this association remains limited. This study aims to elucidate the relationship between OSA and INH, facilitating early interventions and optimizing patient outcomes. Methods: A convenience sample of patients diagnosed with INH via ambulatory blood pressure monitoring (ABPM), regardless of prior hypertension diagnosis, was included. Polysomnography assessed the presence of OSA. Patient demographics were analyzed, and OSA patterns within this cohort were described. Results: Forty-three participants with an average age of 60.6±13.54 were enrolled, comprising 30 individuals with hypertension and 13 without hypertension, with 24 males and 19 females included in the analysis. Polysomnography findings revealed obstructive sleep apnea (OSA) in 97.64% of participants (n=42) across all severity levels. Specifically, severe OSA was observed in 10 subjects, moderate in 20, and mild in 12. Interestingly, the distribution of OSA severity was similar between hypertensive and non-hypertensive subjects. Conclusions: This study found a close correlation between nocturnal arterial hypertension and the presence of obstructive sleep apnea in both hypertensive and non-hypertensive subjects. Therefore, INH is a strong predictor of OSA, and it could be better than other predictive tests.

P005 CHILDREN WITH REPAIRED COARCTATION OF THE AORTA: FOLLOW-UP AND HYPERTENSIO5

Background and objective: Coarctation of the aorta (CoA) is a congenital heart disease with high morbidity and mortality due to cardiovascular disease even after adequate therapeutic management. A fundamental factor is the development of high blood pressure over the years. The objective of this work is to analyze the blood pressure phenotype of the population under follow-up in a high blood pressure clinic. Methods: Retrospective review of medical records of patients aged 0 to 22 years with CoA corrected by surgery or interventional catheterizations, which were followed up between January 2017 and February 2023 in the high blood pressure clinic of a pediatric center. Variables to analyze: age at the time of correction, technique, time since correction, associated cardiac or extracardiac pathologies, office blood pressure, left ventricular hypertrophy. In patients with adequate height and tolerance to the procedure: Ambulatory Blood Pressure Monitoring (ABPM) and pulse wave velocity study were performed. Results: 142 medical records were reviewed (see table 1). Two groups were formed according to the age of the patients due to the possibility of performing ABPM. There were no significant differences between the age of surgical approach and the association with complex heart diseases between the groups. The younger population presented a greater number of extended terminal anastomosis technique and increased concentric remodeling. The prevalence of hypertension and overweight obesity increased over the years. The older group had 25% masked hypertension and 25% increased pulse wave velocity Conclusion: Our population has 28% of hypertension among those under 8 years of age and it increases to 46% among the eldest, coinciding with international reports that indicate that the evolution towards arterial hypertension in this population is progressive. Lifelong follow-up of these patients with corrected CoA is important to detect recoarctation or the development of hypertension and act accordingly to improve morbidity and mortality.

Abstract P320: Novel Pulse Waveform Index Obtained by Ambulatory Blood Pressure Monitoring is Associated with Echocardiographic Ejection Fraction in Patients with Heart Failure

Introduction: Simple, non-invasive assessment of cardiac function is useful in the management of heart failure (HF). Hypothesis: We hypothesized that pulse waveform analysis from oscillometric cuff blood pressure (BP) measurement can estimate cardiac function. The aim of this study is to investigate the association of the pulse waveform index we developed from ambulatory BP monitoring, which represents cardiac systolic function in the ambulatory setting, with echocardiographic left ventricular ejection fraction (LVEF) in patients with HF. Methods: A cuff volumetric waveform was obtained from the diastolic phase of each BP measurement with a multisensor ABPM (TM-2441, A&D). The area of the ejection portion is the square forward pulse wave (Sf), which is related to the cardiac ejection. The amplitude (Am) of the waveform represents arterial and cuff compliance. Sf is divided by Am, i.e., Sf/Am, to eliminate the effect of arterial and cuff compliance, which represents left ventricular systolic function ( Figure) . Results: Patients with HF who were clinically stable in the inpatient or outpatient setting (n=195) underwent both measurements of the multisensor-ABPM and echocardiography. LVEF was determined by the modified Simpson’s method. Patient characteristics were as follows: mean age, 72.1±14.7 years; male, 57%; and atrial fibrillation (AF), 39%. Sf/Am was associated with LVEF (r=0.44, p<0.001) ( Figure ). This association was also significant in the multivariable linear regression model including age, sex, body mass index, use of HF medications, coronary artery disease, and AF (β=0.43, p<0.001). Conclusions: Sf/Am, which is obtained by ABPM, is associated with echocardiographic LVEF.