Ambulatory Blood Pressure Research Articles

Impact of SGLT2 inhibitors on cardiovascular outcomes and metabolic events in Chinese han patients with chronic heart failure

ObjectiveThis study aimed to evaluate the real-world impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the efficacy, safety, and metabolic profiles of patients with chronic heart failure (CHF), both with and without type 2 diabetes mellitus (T2DM).MethodsA cohort of 1,130 patients with reduced ejection fraction chronic heart failure (HFrEF) was recruited from Zhongnan Hospital of Wuhan University, spanning January 2021 to August 2023. Among these, 154 patients received SGLT2i therapy, while 131 patients were assigned to a non-SGLT2i group, following specified inclusion and exclusion criteria. The association between SGLT2i therapy and the risk of primary and secondary endpoints was analyzed, alongside the effect of guideline-recommended heart failure medications at varying dosages on Major Adverse Cardiovascular Events (MACE).ResultsSGLT2i treatment led to reductions in blood pressure, uric acid, NT-proBNP, and pulmonary artery pressure, while increasing body mass index (BMI) and left ventricular ejection fraction (LVEF) in CHF patients. Multivariate Cox regression analysis revealed that SGLT2i therapy reduced the primary endpoint risk by 40.3% (HR 0.597, 95% CI 0.356–0.973, p = 0.047). Univariate Cox regression indicated that SGLT2i might also reduce the incidence of new diagnoses of atrial fibrillation, non-fatal acute myocardial infarction, and MACE in CHF patients. Moreover, the use of a four-drug combination for heart failure management was associated with a lower risk of MACE compared to monotherapy.ConclusionSGLT2i therapy not only enhances LVEF but also significantly reduces ambulatory blood pressure, uric acid, fasting blood glucose, pulmonary artery pressure, and NT-proBNP levels in CHF patients. Additionally, SGLT2i improves prognosis by lowering the risk of both primary and secondary endpoints. Compared to monotherapy, a four-drug regimen for CHF substantially reduces the risk of MACE, supporting the effectiveness of comprehensive treatment strategies.

The effects of morning vs. evening high-intensity interval exercise on the magnitude of the morning blood pressure surge.

Blood pressure (BP) follows a circadian rhythm, dipping during sleep and surging in the morning. A larger morning BP surge is an independent predictor of cardiovascular events. Acute exercise can produce sustained periods of post-exercise hypotension that lasts up to 24 hrs, however the timing of exercise (morning vs. evening) may influence this response. Whether the timing of exercise influences the morning BP surge remains unknown. The current study investigated the effects of a bout of high-intensity interval exercise (HIIE) performed in the morning vs. evening on the magnitude of the morning BP surge in young healthy adults. Twenty-six young, otherwise healthy adults (23±4 years; 15 females) completed a randomized crossover trial where, on different days, they completed a no exercise control visit or performed either morning (0800-1000 hrs) or evening (1700-1900 hrs) HIIE. Following each visit, ambulatory BP was assessed in 30-min intervals for 24 hrs. HIIE at either time did not alter the magnitude of the morning BP surge compared to control values (control: 22±5 mmHg; morning exercise: 20±8 mmHg; evening exercise: 22±10 mmHg, P=0.40) or when grouped separately by sex (visit x sex P=0.42). A positive correlation existed between Morningness-Eveningness Questionnaire score and the change in nighttime BP following both exercise times (both r=0.42 and P=0.04). These findings suggest that HIIE does not attenuate the morning BP surge in young healthy adults and that chronotype can predict nighttime BP responses following HIIE irrespective of exercise time of day. This study was registered on ClinicalTrials.gov (NCT06702930).

Home Blood Pressure Monitoring.

The diagnosis and management of hypertension have been based primarily on blood pressure (BP) measurement in the office setting. Higher out-of-office BP is associated with increased risk of cardiovascular disease, independent of office BP. Home BP monitoring (HBPM) consists of the measurement of BP by a person outside of the office at home and is a validated approach for out-of-office BP measurement. HBPM provides valuable data for diagnosing and managing hypertension. Another validated approach, ambulatory BP monitoring (ABPM), has been considered to be the reference standard of out-of-office BP measurement. However, HBPM offers potential advantages over ABPM including being a better measure of basal BP, wide availability to patients and clinicians, evidence supporting its use for better office BP control, and demonstrated efficacy when using telemonitoring along with HBPM. This state-of-the-art review examines the current state of HBPM and includes discussion of recent hypertension guidelines on HBPM, advantages of using telemonitoring with HBPM, use of self-titration of antihypertensive medication with HBPM, validation of HBPM devices, best practices for conducting HBPM in the clinical setting, how HBPM can be used as an implementation strategy approach to improve BP control in the US, health equity in HBPM use, and HBPM use among specific populations. Finally, research gaps and future directions of HBPM are reviewed.

Prescriptive Appropriateness in an Outpatient Primary and Secondary Cardiovascular Prevention Service.

In the absence of appropriateness specific guidelines, one important cause of health resources waste could be overuse of diagnostic procedures. Since arterial hypertension is a very frequent disease there could be such a risk in its management. To evaluate the prescriptive appropriateness of non-invasive diagnostic tests (echocardiography, carotid ultrasound, ECG exercise test, 24h Ambulatory Blood Pressure Monitoring-ABPM) in a primary and secondary prevention outpatient's service. 559 outpatients visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. 449 prescriptions were made (198 echocardiography, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing). General appropriate prescriptions prevalence was 40.3%, 24h ABPM being the most appropriate one (49.4%) followed by echocardiography (43.9%), ECG exercise test, (38.9%) and carotid ultrasound (30.4%). Appropriateness was significantly higher for secondary prevention patients (61.6 vs. 35.3%, p < 0.001) particularly for heart and carotid ultrasound. Significant univariate correlations were identified between age, cardiovascular risk category, degree of prevention (primary vs. secondary), duration of hypertension and the presence of valvular heart disease and prescription appropriateness. However, at multivariate analysis these findings were not confirmed. Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams particularly in the primary prevention setting.

Diagnostic and prognostic yields of ambulatory blood pressure measurements in haemodialysis patients: a 6-year longitudinal study.

Blood pressure (BP) control in haemodialysis (HD) patients is essential. Peri-dialytic BP levels do not accurately diagnose hypertension or predict the cardiovascular (CV) mortality. In this study, we recruited 43 adult patients who had been on chronic HD for ≥3 months. Seven-day home BP monitoring (HBPM) (values of Day1 discarded) and 44-h interdialytic ambulatory BP monitoring (iABPM) were performed. Pre- and post-dialysis BP levels were measured during the 6 dialysis sessions prior to iABPM. A 6-year follow-up was carried out to assess all-cause and CV mortality. In patients considered as normotensive in pre-dialysis (n = 17), masked hypertension was found in 24% and 29% on the basis of iABPM and HBPM, respectively. Conversely, among hypertensive patients in pre-dialysis (n = 26), 'white-coat' hypertension was noted in 23% either by iABPM or HBPM. After a 6-year follow-up, 25 patients were deceased including 6 patients from CV causes. Day-time systolic BP measured by iABPM was associated with all-cause mortality in an adjusted model for age and gender (p = 0.045). In chronic HD patients, 44-h iABPM and 6-day HBPM show a reliable concordance and help to re-classify ∼25% of cases miscategorised based on pre-dialysis measurements. Day-time systolic BP levels using iABPM were significantly associated with 6-year all-cause mortality.

Further observations on reverse-dipper or riser patterns identified with ambulatory blood pressure monitoring

Further observations on reverse-dipper or riser patterns identified with ambulatory blood pressure monitoring

Blood pressure measurement and nocturnal dipping patterns are heavily affected by body posture through changes in hydrostatic pressure between the arm and the heart.

Nocturnal blood pressure (BP) shows the highest predictive power for cardiovascular events. However, there is a poor reproducibility of personalized dipping patterns in single individuals. We hypothesize that changes in body position during sleep cause variations in hydrostatic pressure,leading to incorrect BP values and dipping classifications. 26 subjects aged 18-30 years, as well as 25 participants aged 50 years and older underwent ambulatory BP measurements on the left arm, as well as determination of the hydrostatic pressure difference between the cuff and heart level during BP measurement. We observed that the BP measurement cuff was above the heart level (negative hydrostatic pressure) mostly through the night. Laying on the right side revealed the largest hydrostatic pressure difference and maximum incorrect BP measurement, with a mean of -9.61 mmHg during sleep. Correcting for hydrostatic pressure led to reclassification of nocturnal hypertension in 14 subjects (27.5%). Dipping patterns changed in 19 participants (37.3%). In total, 25 subjects (49.0%) changed either their nocturnal hypertension and/or their dipping classification. Our findings underscore the importance of accounting for hydrostatic pressure in ambulatory BP monitoring. Changes in body posture during sleep provide a plausible reason for the variability seen in nocturnal dipping patterns. Further research should focus on incorporating hydrostatic pressure compensation mechanisms in 24-h BP measurement. Limiting the noticeable effect of hydrostatic pressure differences could greatly improve hypertension diagnosis, classification, and treatment monitoring.

An Investigation of the Relationship Between Vascular Markers and Cognitive Functions in Early Hypertension

Background/Objectives: Controlling hypertension may reduce the risk of cognitive impairment. A marker for the identification of hypertensive patients who are more likely to suffer cognitive impairment would be of clinical benefit. In our research, 105 patients with newly diagnosed primary hypertension were assessed at the Department of Neurology, the University of Debrecen. Methods: The available data covered detailed medical history and data, the results of different tests, ambulatory blood pressure monitoring, the intima–media thickness, the flow-mediated dilatation, the augmentation index, the pulse wave velocity, and neuropsychological evaluation. Multiple linear regression models were created to evaluate the associations found in simple analyses (Spearman’s rank correlation and Pearson’s chi-squared test). Results: The flow-mediated dilatation showed significant correlations with working memory, attention, learning, and executive functions. The intima–media thickness showed significant correlations with attention and reaction time. The composite flow-mediated dilatation/IMT ratio showed a significant relationship with the overall index of cognitive functions. Based on our results, a flow-mediated dilatation/IMT ratio of 15 represents a cut-off value. The pulse wave velocity showed a significant correlation with working memory and attention. The augmentation index showed significant relationships with reaction time and executive functions. Conclusions: Based on our results, the intima–media thickness, flow-mediated dilatation, and their ratio are suitable for the identification of a particularly vulnerable subgroup of patients for whom a detailed cognitive examination is required for the early detection and treatment of functional disorders. The assessment of attention, executive functions, working memory, and reaction time is required in early hypertension.

Possible Risk Factors Contributing to Atrial Fibrillation Occurrence in Heart Failure With Mildly Reduced Ejection Fraction.

Heart failure (HF) is often accompanied by atrial fibrillation (AF), which significantly worsens the outcome of both diseases. Half of individuals with HF has AF, and HF occurs in more than one-third of individuals with AF. Thus, HF and AF are commonly encountered together and are closely interrelated with similar risk factors. The aim of this study was to investigate the impact of potential risk factors on the occurrence of paroxysmal/persistent AF in patients with heart failure with moderately reduced ejection fraction (HFmrEF). The study included 193 patients with HFmrEF and nonvalvular paroxysmal/persistent AF after successful cardioversion. As a control group the similar 76 patients without AF were examined. All patients underwent the examination, including electrocardiography (ECG), echocardiography, ambulatory blood pressure monitoring and Holter ECG monitoring. Levels of inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and the fibrotic marker transforming growth factor-β1 (TGF-β1) were measured using the enzyme-linked immunosorbent assay (ELISA) method. The obtained results were modeled using binary logistic regression using the odds ratio (OR). It was shown that frequent episodes of hypertensive crisis (HC) and increased body mass index (BMI) were possible risk factors for paroxysmal/persistent AF. An increased OR of diastolic and systolic parameters of the left ventricle was associated with significant atrial and ventricular remodeling. Statistically, higher OR of inflammatory markers levels, such as hs-CRP, IL-6 and TNF-α were associated with an increased risk of paroxysmal/persistent AF occurrence in HFmrEF patients compared to similar patients without AF. An increase of the fibrosis marker TGF-β1 OR was statistically significant in patients with persistent AF. It could be considered that frequency of HC, BMI, atrial and ventricular remodeling, as well as an increase of inflammation markers were possible risk factors for the occurrence of paroxysmal/persistent AF in HFmrEF patients. Moreover, fibrosis factor level significantly increased the likelihood of persistent AF in these patients.

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

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

Bariatric surgery blunts nitrate-mediated improvements in cardiovascular function of overweight women by interfering with gastric S-nitrosothiol formation.

Inorganic nitrate (NO3-) and nitrate-rich foods have been shown to exert antioxidative effects and lower blood pressure in experimental animal models and human clinical studies. The specific handling of nitrate, including its enterosalivary recirculation, secretion into saliva, oral microbial reduction to nitrite (NO2-), and the pH-dependent nitrosative capacity in the stomach have all been recognized as being important for nitrate's beneficial effects. Obesity is of major health concern worldwide and associated with increased cardiovascular risk; whether nitrate lowers blood pressure and improves endothelial function in this setting has not been investigated. We here tested the hypotheses that i) nitrate elicits cardiovascular benefits in overweight women; and ii) these beneficial effects would be diminished in women who underwent bariatric Roux-en-Y gastric bypass (RYGB) surgery. Our controlled clinical trial included 15 women with prior RYGB surgery and 15 overweight female controls. All participants received a single dose of 0.1mmol/kg/day nitrate in the form of a beetroot extract for 14 days. Blood collection, 24-h ambulatory blood pressure measurements and endothelial function tests were performed before and after nitrate treatment. Plasma nitrite, nitrate, and S-nitrosothiol (RSNO) concentrations were determined by ozone-based reductive chemiluminescence while thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC) were measured using plate-reader based assays. Nitrate reduced blood pressure and improved endothelial function in controls, but not in women with prior bariatric surgery. Nitrate also increased circulating nitrate/nitrite and RSNO levels in controls, but the latter was blunted following RYGB surgery despite even larger increases in nitrite concentrations. Similarly, nitrate increased antioxidant responses in controls but not in women with prior bariatric surgery. This is the first study to show that nitrate exerts beneficial cardiovascular effects in obesity and that the morphological/functional modifications elicited by RYGB surgery abrogates nitrate's effectiveness by preventing gastric RSNO formation.

Short-term effects of denervation in the treatment of hypertension: A meta-analysis excluding drug interferences.

To evaluate the short-term efficacy of denervation in treating hypertension with the exclusion of drug-interfering factors. An electronic search was conducted across 8 databases, including MEDLINE, PubMed, Cochrane Library, and EMBASE, for articles on denervation in the treatment of medication-naïve hypertension published from inception to May 2024. All data were meta-analyzed using RevMan 5.3 software. Four studies, comprising a total of 752 subjects, were screened according to the inclusion and exclusion criteria. Meta-analysis indicated that, compared to the sham-operated group, the denervation group showed a significant reduction in short-term 24-hour ambulatory systolic blood pressure and office systolic blood pressure (OSBP) as well as office diastolic blood pressure (ODBP). No significant safety events were identified. Denervation has the potential to reduce blood pressure in the short-term for patients with medication-naïve hypertension, demonstrating an acceptable safety profile. This offers hope for patients who are intolerant to drug therapy or unwilling to take lifelong medication. However, its long-term effects require further study. Future research should focus on expanding the sample size and prolonging the follow-up period to further solidify its role in the treatment of hypertension.

Resistance exercise has an antihypertensive effect comparable to that of aerobic exercise in hypertensive patients: a meta-analysis of randomized controlled trials.

Hypertension increases the risk of cerebrovascular disease and death. In addition to aerobic exercise, which is currently recommended for its antihypertensive effects, recent studies have suggested that dynamic and isometric resistance exercises also have antihypertensive effects. However, the magnitude of the antihypertensive effect of such resistance exercises is not well known. To clarify the differences in these effects, we conducted an umbrella review of a meta-analysis of randomized controlled trials (RCTs). A systematic search was performed on the Ovid MEDLINE and Cochrane Library, covering the period from inception to August 1, 2023. Eligible studies were RCTs comparing the effects of exercise and non-exercise on office, home, or ambulatory blood pressure (BP) in hypertensive patients aged 18 years or older. A random effects model meta-analysis was performed to estimate the effect size across multiple studies. A sub-analysis determined outcomes by the type of exercise (aerobic exercise, dynamic resistance exercise, isometric resistance exercise, and combined exercise). Eighty-four RCTs with 5065 hypertensive patients were included in the study. All exercise significantly reduced systolic BP (SBP) and diastolic BP (DBP) compared to non-exercise (SBP:-7.52 mmHg, 95% confidence interval [CI] -8.77 to -6.27, p < 0.001; DBP: -4.36 mmHg, 95% CI - 5.15 to -3.57, p < 0.001). There were no significant differences in the magnitude of the reduction in BP between the types of exercise (p for interaction = 0.815 for SBP, p = 0.417 for DBP). These data from 84 RCTs showed that exercise intervention significantly reduced BP and that resistance exercise has a similar antihypertensive effect to aerobic exercise in hypertensive patients. This meta-analysis showed that exercise significantly reduced blood pressure in hypertensive patients. There were no significant differences in the magnitude of this reduction in BP between the types of exercise.

Reallocations of Time Between Sleep, Sedentary Behavior, and Physical Activity and their Associations with 24-Hour Blood Pressure.

The 24-hour activity cycle (sleep, sedentary behavior, light physical activity, moderate to vigorous physical activity) may have deleterious or beneficial associations with 24-hour blood pressure. Estimate the short-term associated changes in 24H-BP with acutely replacing 30min/d from one behavior of the 24H-ACT to other behaviors in employed adults. Participants (N=659) wore an ambulatory blood pressure monitor and two accelerometers (waist and wrist) to measure 24-hour blood pressure and the 24-hour activity cycle. Replacing 30 minutes of sedentary behavior with 30 minutes of sleep was associated with lower 24-hour mean systolic [ß=-0.32 mmHg per 0.5hr (95% CI: -0.58, 0.06)] and diastolic [ß=-0.31 mmHg per 0.5hr (95% CI: -0.50, -0.12)] blood pressure. Replacing 30 minutes of light physical activity with 30 minutes of sleep was associated with lower 24-hour mean systolic [ß=-0.30 mmHg per 0.5hr (95% CI: -0.62, 0.03,)] and diastolic blood pressure [ß=-0.34 mmHg per 0.5hr (95% CI: -0.58, -0.11,)]. No other time reallocations between 24-hour activity cycle behaviors were associated with changes in 24-hour blood pressure. Replacing time in sedentary behavior or light physical activity with sleep may provide small short-term reductions in that day's 24-hour blood pressure.

Minimal changes in sleep parameters during overnight ambulatory blood pressure monitoring do not affect outcomes.

Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for assessing blood pressure; however, its use may potentially disrupt sleep. Previous studies have produced mixed results on the impact of ABPM on sleep parameters and used actigraphy as the evaluating tool. To date, no studies have investigated the effects of ABPM on sleep parameters evaluated through polysomnography. This study aimed to examine the effects of ABPM on objectively assessed sleep parameters. We evaluated five women and five men (age: 38.0 ± 15.0 years; BMI: 27.0 ± 3.5kg/m²) using full polysomnography over two nights in a sleep laboratory-one night with ABPM and one night without it, with nocturnal assessments every 30min. The order of the conditions was randomized, with intervals between nights ranging from 3 to 10 days. N2 sleep was significantly longer during the night with ABPM compared to the night without it (66.4 ± 12.4% vs. 57.7 ± 11.3%, p < 0.003). Conversely, the apnea-hypopnea index was higher on the night without ABPM (13.1 ± 21.2 vs. 10.5 ± 19.8 events/hour, p < 0.005). Participants did not rate the night with ABPM as worse than the night without, and no significant differences were observed in total sleep time, sleep latency, sleep efficiency, number of awakenings, or time awake after sleep onset. ABPM does not appear to adversely affect significant objective sleep parameters or subjective evaluations of sleep quality.

"Clinical prediction model for masked hypertension diagnosed by 24-h ambulatory blood pressure measurements in a sample from specialized hospital."

The conventional assessment of the relationship between arterial hypertension (AH) and cardiovascular damage has predominantly relied on office measurements. However, the diagnostic significance of ambulatory and home measurements has gained prominence, particularly in identifying distinct AH phenotypes like masked hypertension (MH), characterized by normal office values but elevated readings outside the clinical setting, carrying comparable risks to sustained AH. Current guidelines advocate for Ambulatory Blood Pressure Monitoring (ABPM) in individuals with office values exceeding 130/85 mmHg. This study aims to develop a clinical prediction model to identify masked hypertension in individuals with normal office blood pressure and to create a clinical score.A cross-sectional study was conducted in a secondary level hospital, including patients aged 18-85 years with average office blood pressure <140/90 mmHg who underwent a valid ABPM on the same day. Pregnant and postpartum women were excluded. A multivariable logistic regression model with calibration, discrimination, and stability parameters was applied to predict masked hypertension. 506 individuals with valid ABPM were analysed. The prevalence of masked hypertension was 30.8%. The selected variables were: diastolic blood pressure, pulse pressure, waist diameter and sex. The model calibrated adequately (Hosmer-Lemeshow test p = 0.35), with an AUC of 0.72 (95% CI, 0.67-0.77). Significant differences existed between the traditional and the new models (p < 0.001). A user-friendly clinical model was developed, with a clinical score achieving 90% specificity using an estimated probability of 0.4 with a 10-point score.A novel model, performed with easily collectable clinical variables, showed robust calibration, stability, and discrimination. It outperforms sole reliance on office blood pressure, exhibiting high specificity (~90%) for masked hypertension detection. Its internal validity suggests a potential for enhanced masked hypertension identification.

Pregnancy-onset obstructive sleep apnea and ambulatory blood pressure.

Elevated nocturnal blood pressure (BP) increases the risk for hypertensive disorders of pregnancy (HDP). Though obstructive sleep apnea (OSA) increases the risk for HDP, data on OSA and 24-hour ambulatory blood pressure monitoring (ABPM) in pregnancy are scarce. We aim to examine the BP profile of women with pregnancy-onset OSA. Pregnant women with overweight / obesity and snoring were recruited at <13 weeks gestation and underwent level III home sleep apnea testing and 24-hour ABPM at enrollment and at 31-34 weeks' gestation. Women with OSA at enrollment were excluded . Mean differences in nocturnal BP and 24-hour BP measurements, between women with pregnancy-onset OSA and women without OSA, were computed by multivariable linear regression. 40 / 101 participants had pregnancy-onset OSA (respiratory event index (REI) >5 events per hour) in the third trimester. Despite no significant differences in baseline BP, nocturnal systolic and diastolic BP were significantly higher in women with pregnancy-onset OSA compared to women without OSA, after adjusting for multiple covariates (mean difference 5.49 (1.45-9.52) and 3.89 (0.19-7.60), respectively). Differences in systolic BP persisted into the daytime in the OSA group. Lack of nocturnal dipping was highly prevalent in both groups, but the difference was not significant in the adjusted model. Pregnancy-onset OSA in the 3rd trimester is associated with elevated nocturnal BP and daytime systolic BP. The lack of nocturnal dipping irrespective of REI cut-off in pregnant women at risk for SDB further demonstrates limitations of REI in defining pathology in pregnancy.

Intradialytic Hypertension in Maintenance Hemodialysis.

To summarize the current evidence regarding epidemiology, clinical pathophysiology, and latest therapeutic approaches for the management of intradialytic hypertension (IDH). IDH is a rather common complication of dialysis, affecting 10-15% of the patient population and significantly increasing the cardiovascular risk. Its pathophysiology involves multiple mechanisms, including volume and sodium overload, sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) overactivity, endothelial dysfunction, and arterial stiffness. IDH management requires a combination of nonpharmacological and pharmacological interventions. The first mainly focus on volume control through dry weight optimization and modification of dialysate sodium, as studies show that strict volume control or low dialysate sodium can significantly reduce intradialytic and ambulatory blood pressure (BP). Pharmacological interventions have also been examined in research studies. Beta-blockers, particularly those with vasodilatory properties, can effectively target mechanisms such as SNS overactivity and endothelial dysfunction, and have shown some promising results reducing both intradialytic and ambulatory BP. Other drugs classes have also been explored as potential therapeutic options for IDH management, though further research is needed to clarify the efficacy of these interventions. A tailored approach addressing both the underlying pathophysiological mechanisms and individualized patient is warranted for improving BP control and cardiovascular outcomes in this high-risk population.

Left Atrial Size and Strain in Hypertensive Children Compared to Age-, Sex-, and Race/Ethnicity-Matched Controls.

Left atrial (LA) volume and peak longitudinal strain (LA strain) are indicators of left ventricular (LV) diastolic function in adults, but little is known about LA volume and strain in pediatric patients with hypertension (HTN). We evaluated LA volume and strain in pediatric cases with HTN compared to age-, sex-, and race/ethnicity-matched controls. This was a retrospective matched case-control study of patients who presented to the HTN clinic at CHOP from 12/2011 to 9/2018. Coarctation of the aorta, cardiomyopathy or heart transplantation cases were excluded. HTN was defined by an abnormal ambulatory blood pressure result. LA volume was measured by biplane area-length method and indexed to body surface area (BSA). LA strain and strain rate were measured using TOMTEC® software. Left ventricular mass index (LVMI) was measured by M-mode and the 5/6 area-length method indexed to height2.7. LV global longitudinal strain (LV GLS) was measured during the echocardiographic examination on the GE ultrasound machine for cases and offline using TOMTEC® software for controls. Measurements were compared using Chi-square, McNemar, or Wilcoxon signed rank tests. We included 47 cases and 47 controls. There was no difference in LA volume z-scores (-1.9 vs. -0.9, p = 0.068), LA strain (37.8% vs. 38.0%, p = 0.735) or LA strain rate (1.4 vs. 1.5, p = 0.852) in cases compared to controls. LVMI by M-mode and 5/6 area-length method was higher in cases compared to controls (40.0 vs. 33.7g/m2.7, p < 0.001 and 29.9 vs 24.4g/m2.7, p = < 0.001, respectively). LV GLS was decreased (less negative) in cases compared to controls. In summary there was no difference in LA volume or LA strain in cases compared to controls. In cases, LVMI was significantly elevated and LV GLS was significantly decreased, which may be the first response to HTN, prior to affecting LA size.

The Relation Between Ambulatory Blood Pressure, Age and Gender

Introduction: Ambulatory blood pressure (ABP) monitoring offers an extensive evaluation of blood pressure (BP) fluctuations over a 24-hour period, facilitating a more profound comprehension of the impact of demographic variables such as age and gender. This study seeks to examine the correlation among age, gender, and arterial blood pressure (ABP), specifically emphasizing systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) variability. Comprehending these relationships is essential for formulating individualized methods for hypertension therapy.Methodology: The methodology employed was cross-sectional observational research conducted at NAWAT ALMUSTAKBAL .AZAWEA LIBYA from 2022 to 2024. Continuous 24-hour blood pressure and heart rate data were obtained by ambulatory cardiovascular monitoring (ABPM) technology at Nawat Almostaqbal Clinic. Participants engaged in a standardized preparatory phase, which included a 5-minute acclimatization period, succeeded by three baseline measures of blood pressure and heart rate. Participants were then equipped with ABPM devices to continually monitor blood pressure during their routine daily activities and sleep.Results: The findings indicate that age significantly influences systolic blood pressure, with elevated readings observed in older individuals. Nevertheless, age appeared to exert minimal influence on diastolic blood pressure. Conversely, gender significantly influenced diastolic blood pressure, with males demonstrating elevated levels of lean BP during wakefulness, but no notable variations in systolic blood pressure were observed between the genders. The research indicated that wake/sleep status significantly affected SBP due to circadian rhythms, but did not notably alter DBP variability or HR variability. Age, gender, and circadian state did not significantly influence heart rate variability or the fluctuation of diastolic blood pressure.Conclusion: The findings from the research indicate that although age significantly influences SBP, gender exerts a far greater impact on DBP levels. The diurnal cycle significantly affects the variation of SBP, indicating that physicians should take the time of day into account while managing a patient with hypertension. The conclusion is evident regarding the necessity for physicians to employ distinctive treatment options for patients.