Ambulatory Measurements Research Articles

COMPARISON OF INFLUENCE OF OFFICE PULSE WAVE VELOCITY AND 24-HOUR AMBULATORY RECORDING OF AORTIC PULSE WAVE VELOCITY ON TARGET DAMAGE IN HYPERTENSION

Objective: Arterial stiffness, as measured by pulse wave velocity (PWV), is a significant determinant of target organ damage (TOD). The aim of this study was to assess the potential use of office PWV and 24-hour PWV for prediction of subclinical TOD in a hypertensive cohort. Design and method: We evaluated associations of TOD with office carotid-femoral pulse wave velocity (O-cf-PWV) by radial tonometry (SphygmoCor) and 24-hour ambulatory PWV measurements (24h-PWV, including day-PWV and night-PWV) by brachial oscillometry (Mobil-O-Graph 24h PWA Monitor) in 636 hospital inpatients (age 54 ± 13 years, 465 males) with primary hypertension. Subclinical TOD was defined as left ventricular hypertrophy (LVH) obtained by echocardiography, carotid intima-media thickness (IMT) >0.9mm and chronic kidney disease (CKD) including urine albumin/creatinine ratio (ACR) >3.5 mg/mmol in females and >2.5 mg/mmol in males or estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. Results: After adjusting for confounding factors, both O-cf-PWV and 24h-PWV or night-PWV showed significant association with LV mass index (p<0.05). Only day-PWV was associated with eGFR (p = 0.039). When O-cf-PWV and 24h-PWV, including other confounding factors, were forced into the same logistic regression model, only O-cf-PWV (OR = 1.117, 95% CI:1.009-1.236, p = 0.033) remained significant determinants of increased LVH. Each 1 m/s increase in 24-h-PWV and day-PWV was associated with decreased risk of eGFR (odds ratio [OR] = 0.340 and 0.43, respectively). Only each increase in night-PWV was associated with risk of carotid IMT > 0.9 mm (OR = 1.360, 95% CI: 1.004 -1.843, p = 0.047). For ACR, neither 24-h-PWV nor O-cf-PWV was significant. Conclusions: O-cf-PWV improved prediction of LVH compared to ambulatory 24h-PWV under ambulatory conditions. Day-PWV may improve prediction of eGFR decline.

EFFECTS OF THE DUAL ENDOTHELIN ANTAGONIST APROCITENTAN ON AMBULATORY BLOOD PRESSURE INDICES IN PATIENTS WITH RESISTANT HYPERTENSION. RESULTS FROM THE PRECISION STUDY

Objective: The phase-3 PRECISION trial demonstrated both the safety and the efficacy of aprocitentan to lower office blood pressure (BP) in patients with resistant hypertension. Here, we report on the effects on relevant indices of ambulatory BP measurements (ABPM). Design and method: A total of 730 patients with resistant hypertension were randomized to aprocitentan 12.5 mg (n = 243), 25 mg (n = 243), or placebo (n = 244). Paired ABPM results at baseline and week 4 of double-blind treatment were available for n = 174, n = 182, and n = 178 patients, respectively. Changes in 24h ABPM from baseline to week 4 were pre-defined as a secondary endpoint. Here, we analyzed effects on 24h average BP, daytime BP, night-time BP, nocturnal dipping, and BP load. Statistical significance was assessed using the Wilcoxon rank-sum test. Results: At week 4, after placebo correction, aprocitentan decreased 24-hour ambulatory SBP (-4.2 mmHg; 95% CI: –6.2, –2.1 for the 12.5-mg dose and –5.9 mmHg; 95% CI: –7.9, –3.8 for the 25-mg dose). The placebo-corrected SBP-lowering was more pronounced during night-time (–5·1 and –7·4 mmHg) compared with daytime (–3·8 and –5·3mmHg) for the 12.5 and 25mg doses, respectively. At baseline, non-dipper rates were 66%, 62%, and 60% for the 12.5mg, 25mg of aprocitentan, and placebo groups, respectively. Non-dippers had a particularly pronounced reduction in night-time systolic BP compared with dippers for both 12.5mg (-11.25 vs -2.79mmHg; p < 0.01) and 25mg of aprocitentan (-13.12 vs -6.29mmHg; p < 0.01). After 4 weeks of treatment, the proportion of non-dippers who had normalization of their dipping pattern was 44%, 40% and 31% for 12.5mg, 25mg of aprocitentan, and placebo, respectively. The change in BP load for both daytime and night-time was more pronounced with both doses of aprocitentan (-18.7/-24.5% for 12.5mg; -20.7/-21.1% for 25mg) compared to placebo (-9.2/-6.6 %; p < 0.001 for all comparisons). Conclusions: In patients with resistant hypertension, aprocitentan resulted in substantial ambulatory BP lowering, particularly during night-time. This was associated with reduction in non-dipping rates and BP load. These findings further support the likely clinical benefit of aprocitentan in resistant hypertension.

PROGRESSION OF HYPERTENSION-MEDIATED ORGAN DAMAGE IN PATIENTS WITH AND WITHOUT NONALCOHOLIC FATTY LIVER DISEASE

Objective: Nonalcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease and is associated with an increased risk of cardiovascular death. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening measure of hepatic steatosis. The purpose of the study was to compare the progression of hypertension-mediated organ damage (HMOD) in hypertensive patients with and without NAFLD. Design and method: Hypertensive patients (n = 60) without a history of cardiovascular disease participated in the study (mean age, 52 years; males, 55%; baseline clinic BP, 145/92 mmHg) and were followed for one year. In the baseline visit, FLI was calculated, and patients were divided into two groups by FLI below 60 or 60 or above (i.e., high-risk of NAFLD). All patients underwent clinic and 24-hour ambulatory BP measurements, echocardiographic examination, nailfold capillaroscopy, pulse wave velocity, and urinary albumin excretion assessment (albumin to creatinine ratio, [ACR]). Left ventricular mass index (LVMI) was also calculated using the Devereux formula. Results: In baseline visit, patients with FLI > or = 60 (n = 32) compared to the control group had higher values of ACR (26.5±57mg/g vs. 9.6±6.3 mg/g, p = 0.02) and lower values of capillary densities (75±18cap/mm2 vs. 86±12cap/mm2, p = 0.002), whereas there was no relative difference in PWV and LVMI. At the end of follow-up, patients with FLI > or = 60 had higher values of ACR (12.6±11.9 mg/g vs. 6.8±5.3 mg/g p = 0.025), PWV (9.9±2m/sec vs. 8.8±1.3 m/sec, p = 0.02), LVMI (81.4±13.2 g/m2 vs. 72.5±13.2 g/m2, p = 0.02) but lower number of capillaries (65.1±8.8 cap/mm2 vs. 79.6±7.5 cap/mm2, p<0.001). Linear regression analysis revealed that FLI > or = 60 was an independent determinant of follow-up ACR, PWV, LVMI, and the number of capillaries. Conclusions: Increased FLI may adversely modify the progression of HMOD in hypertension.

ASSOCIATION OF AMBULATORY AND HOME BLOOD PRESSURE VARIABILITY FOR CARDIOVASCULAR OUTCOMES

Objective: Although blood pressure (BP) variability (BPV) is reportedly associated with cardiovascular prognosis, there is no evidence that either ambulatory BPV (ABPV) or home BPV (HBPV) is a superior clinical marker. Design and method: We analyzed the association of ABPV and HBPV with cardiovascular prognosis in 1,319 hypertensive outpatients who underwent both home and ambulatory BP measurements in the Japan Morning Surge-Home Blood Pressure (J-HOP) study. BPV is evaluated by standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24-h ambulatory and average morning and evening home systolic BP. Results: During the median 6.9 years of follow-up, 109 cardiovascular events occurred. All SD, CV, and ARV of HBPV were significantly associated with cardiovascular risk even after adjusted by ABPV (1-SD of HR [95%CI] in SD, CV, and ARV of HBPV: 1.47 [1.23–1.75]; 1.48 [1.24–1.75]; and 1.33 [1.14–1.54]). In the model improvement using goodness-of-fit, HBPV values significantly improved the model predictability when adding to the model including confounding factors and mean 24-h ambulatory SBP and ABPV values. However, these relationships were not shown in ABPV parameters. Conclusions: Based on the findings from this study using both ambulatory and home BP monitoring in the same individuals, HBPV, i.e., day-to-day BPV, was suggested to have superiority in predicting for cardiovascular incidence compared to ABPV, i.e., short-term BPV through 24-hours.

CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements. Design and method: We collated clinic and 24 hour ambulatory BP data of 100 patients aged > 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021). Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical. We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods. Results: The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients. Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P <0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P <0.001; r = 0.566; Curve B). Conclusions: The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension

SHORT-TERM AIR POLLUTION EXPOSURE AND MEASURES OF ARTERIAL STIFFNESS AND CENTRAL HAEMODYNAMICS IN HEALTH YOUNG ADULTS

Objective: The practice of outdoor physical exercise is increasingly present in modern societies, as the increasing levels of health literacy corresponds to greater awareness about the positive impact of physical activity. Notwithstanding, the exposure to polluted urban environments during outdoor activities may have deleterious biological effects that should not be overlooked. In particular, the effects of exposure to air pollution in vascular function has been reported in several studies, even though the current evidence is still inconsistent. Objective: To study the effect of outdoor short-term exposure to air pollution in arterial stiffness and central haemodynamics in healthy young adults. Design and method: Twenty young and healthy participants (20 and 25 years) were enrolled in an observational study. Participants performed a mild outdoor walk (1 hour duration) in two ecological settings: green environment (control) and urban environment (experimental). The activities were performed in random order and with at least two weeks interval. Carotid-femoral pulse wave velocity was measured with the Complior device at baseline and at the end of the outdoor walk. Pulse wave analysis (PWA) was performed at baseline and with 15 minute intervals during the outdoor walk with the Mobil-o-Graph device. Air pollution was measured with appropriate devices, including ambulatory measurements of particulate matter (PM). Results: As expected, significant differences were observed in the measures of air pollution between control and experimental settings for all the major air components, particularly for PM1.0, PM2.5 and PM10 (mean difference, respectively, 18.71 ± 2.18 μg/m3, 19.53 ± 2.19 μg/m3 and 26.32 ± 2.66 μg/m3; p<.001). PWV was significantly higher after the exposure in the experimental setting (mean increase of 0.2 ± 0.02 m/s; p<.001), with no variation occurring in the control situation. Also brachial and central blood pressure (BP) depicted greater magnitude of increase during the outdoor walk in the urban setting, as compared with the green environment. Conclusions: Short-term exposure to air pollution during an outdoor walk was shown to be associated with arterial stiffness. The deleterious association of air pollution with vascular function is further buttressed by its hemodynamic impact, particularly increasing brachial and central BP.

PRETERM BIRTH IS ASSOCIATED WITH INCREASED CENTRAL SYSTOLIC PRESSURE IN PRIMARY HYPERTENSION - SINGLE CENTER EXPERIENCE

Objective: Preterm birth (PB) and lower birth weight (LBW) are associated with higher risk for hyprtension, chronic kidney disease and cardiovascular (CV) morbidity and mortality in adulthood. Our aim In this study was to analyze the association of PB and LBW with the parameters of arterial stiffness obtained during 24h measurement, with special focus on parameters of central hemodynamic (central aortic pressure). Design and method: In this study we included 154 adult patients (mean age 32, predominantly women (69.5%) with primary hypertension. In all of them we collected the data about term of birth and birth weight, and different antropological paramaters were measured. We determined various different laboratory data. Parameters of arterial stifness were measured in the office using Sphygmocor, and during the 24h using Mobil-o-Graph and Arteriograph. Results: In the whole group, 39 patients (25.5%) were born before the term. The corellation between pulse wave velocity (measured in office ambulatory during 24h) and term of birth was not found. The term of birth had low negative and statistically significant correlations with systolic central aortic pressure measured by Arteriograph during the night (r = -0.164, p < 0.05), as well as measured by Mobil-o-Graph during 24h (r = -0.167, p < 0.05), day (r = -0.172, p < 0.05) and night (r = -0.186, p < 0.05). Conclusions: Our findings suggest that preterm born is associated with increased systolic aortic pressure. We found this association fot the night time using two different devices. It could be speculated that this association might contribute to the global CV and kidney risk in subjects born before term. Further results are needed to answer whether ambulatory measurement of central hemodynamics have clinical importance.

PERFORMANCE OF STANDARD, IMMEDIATE AND DELAYED UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENTS DURING HOUSEHOLD-BASED SCREENING IN RURAL AFRICA: A DIAGNOSTIC ACCURACY STUDY

Objective: The World Health Organization's STEPwise approach to surveillance (STEPS) recommends three standard blood pressure measurements over five minutes (SBPM) to monitor trends of hypertension in low-income countries. The objective of this study was to assess the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24hr ambulatory measurement (24h-ABPM) as reference during a population-based prevalence survey in Lesotho. Design and method: Participants with elevated SBPM (> = 140/90 mmHg) and age- and sex-matched participants with normal SBPM during a household-based survey were recruited. For SBPM and uABP, participants sat and rested for 5 minutes before three measurements were taken each 2 min apart. For both, the mean of second and third measurements was taken as final blood pressure. 1st uABP readings were obtained on survey day. Afterwards participants received a 24h-ABPM device. 2nd uABP readings were taken 24h later after retrieval of the 24h-ABPM. Discrimination was determined for all screening measurements (SBPM, 1st, 2nd uABP) using area under the receiver operating characteristic curve (AUROC), and 24h-ABPM as reference. Results: We enrolled 275 participants [mean age 58 years, 163 (59%) female], 183 with elevated and 92 with normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference: -12 mmHg; 95%CI: -14 to -9). Mean difference between diastolic daytime ABPM and diastolic SBPM was -2 mmHg (95%CI: -3 to -0.7), whereas no difference was found for mean diastolic 1st uABP (mean difference: -0.6 mmHg; 95%CI: -1.9 to 0.6); and mean diastolic 2nd uABP (mean difference: 1.0 mmHg; 95%CI: -0.4 to 2.4). Misclassification as having hypertension (Figure 1) was highest with SBPM (55 [20%]), followed by 1st uABP (27 [9.8%]) and 2nd uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as reference, the uABPs had higher AUROC (1st uABP: 87% [95%CI: 83-91]; 2nd uABP: 88% [95%CI: 84-92]); SBPM: (79% [95%CI: 74-85]). This difference was significant between 1st uABP and SBPM (p = 0.002), and between 2nd uABP and SBPM (p<0.001). Conclusions: uABP measurements had better diagnostic performance compared to SBPM. Integration of uABP into the STEPS protocol should be considered.

0670 Examination of neighborhood disadvantage and sleep in a sample of PTSD-diagnosed Veterans with trauma nightmares

Abstract Introduction The nature of sleep can leave sleepers vulnerable to environmental threats, requiring a balance between the demands for vigilance and the physiological requirement for sleep. Understanding the sleeping context is particularly relevant to understanding the dynamics of sleep disturbance observed in individuals with posttraumatic stress symptoms (PTSS) because of subsequent increased vigilance to threats. This study examined the associations between neighborhood disadvantage, sleep respiratory sinus arrhythmia (RSA), fear of sleep, and nightmare frequency in a sample of trauma-exposed Veterans. Methods Baseline data from an ongoing study examining sleep with trauma nightmares using ambulatory sleep measurement in a sample of U.S. military Veterans were analyzed. Participants completed assessments of nightmare frequency and fear of sleep, and slept on a mattress actigraphy system for at least seven nights, which captured sleep-period RSA as an index of autonomic activation. Neighborhood disadvantage was assessed with the Area Deprivation Index (ADI), a census-based socioeconomic index. For this study, participants’ zip codes were linked to 2020 ADI scores using the Neighborhood Atlas, and the census-block groups were ranked into state-level 1 to 10 deciles (split into halves- low and high). Higher ADI scores indicate greater disadvantage. The differences between the least and most disadvantaged groups were analyzed with binary logistic regression models. Results Data were available from 33 Veterans. The mean state-level ADI was 6.2 (SD = 2.7). Low and high state-level ADI scores were 4.3 (SD = 2, n = 19) and 8.7 (SD = 0.8, n = 14), respectively. Residing in zip codes with greater neighborhood disadvantage was associated with elevated fear of sleep (OR = 1.2, p = 0.04), and a trend for reduced sleep-period RSA (OR = 0.4, p = 0.05). No differences were observed for past week nightmare frequency. Conclusion In this sample of Veterans, living in the most disadvantaged neighborhoods was significantly associated with greater fear of sleep, and may be associated with reduced RSA. Sleep context may increase hypervigilance in turn serving as a mechanism by which trauma-induced sleep disruptions are maintained. Support (if any) Funded by the U.S. Department of Veterans Affairs, Veterans Health Administration Clinical Science Research and Development Service - IK2 CX001874.

0821 Nighttime Average and Dipping Blood Pressure Can Differ Based on the Temporal Distribution of Ambulatory Measurements at Nighttime

Abstract Introduction Ambulatory blood pressure (BP) monitoring is recommended in preference to office BP as it enables BP assessments across the night and quantification of the degree of nocturnal BP dipping (dipping” = nighttime/daytime BP of < 0.9; non-dipping = ≥0.9). Both nighttime BP and dipping% are independent predictors of adverse cardiovascular events. Standard guidelines recommend at least ≥20/7 daytime/nighttime measurements for reliable ambulatory BP monitoring, but newer reports suggest ≥8/4 daytime/nighttime measurements are sufficient. Considering BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. To test whether this new recommendation holds for extreme examples of temporal distribution, we compared average nighttime BP and dipping% when using BP measurements only in the first (1st-half) vs. only in the second half (2nd-half) of the night. Methods Seventeen females and twenty-six males (50±10 years [mean±SD]) without cardiovascular disease or severe sleep disorders wore an ambulatory BP monitor for 24 hours, programmed to measure BP every 20 minutes when awake and every 30 minutes during a self-selected 8-hour time-in-bed for nighttime. We compared the nighttime BP averages and the calculated dipping% when using the first four measurements from the 1st-half of the nighttime, from the 2nd-half of the nighttime, and all measurements during the nighttime (All nighttime, AN). Repeated measures ANOVA was conducted with significance set as p< 0.05. Results Systolic BP was higher using 1st-half than 2nd-half but similar to AN (111±9 vs.107±11 vs. 109±9 mmHg, p< 0.01), while systolic BP dipping% using 1st-half was lower than 2nd-half and AN (9.7±7.4 vs.13.0±7.6 vs. 11.4±6.7 %, p< 0.01, respectively). Diastolic BP and diastolic dipping% were similar among the 1st-half, 2nd-half, and AN segment (63±6 vs. 63±7 vs. 62±7 mmHg, p=0.19) and (17.2±7.6 vs. 17.2±8.8 vs. 18.4±8.8 %, p=0.16), respectively. Conclusion In adults without cardiovascular disease or severe sleep disorders, nighttime BP and dipping% may depend upon when BP measurements are taken. The minimum threshold of 4 measurements for a reliable nighttime BP readout should be used cautiously. Support (if any) NIH F32-HL131308, R01HL163232, R01HL125893, R35HL155681, Medical Research Foundation, and OHSU OFDIR fellowship.

The Community Rehabilitation Assessment: patient and clinician-reported outcomes in ambulatory rehabilitation.

The interRAI Community Rehabilitation Assessment (CRA) is a comprehensive health assessment designed to collect essential health and function information for rehabilitation care planning, benchmarking, and evaluation of clinic and home-based programs. A portion of the CRA is completed through patient self-report. The objective of this study was to demonstrate how the CRA can be used to describe the baseline clinical characteristics of patients participating in ambulatory rehabilitation programs and measure change across numerous domains of function, health, and wellbeing over time. Cohort study. In total, 709 patients were assessed with the CRA across 25 ambulatory clinics in Ontario, Canada between January 1st, 2018, to December 31st, 2018. We examined sub-groups of patients receiving rehabilitation following stroke (n = 82) and hip or knee total joint replacement (n = 210). Frequency responses and means were compared between admission and discharge from the ambulatory rehabilitation programs. Measures of interest included self-reported difficulty in completing instrumental activities of daily living, locomotion, fear of falling, and pain. Significant improvement relative to at admission was detected for the overall cohort and both sub-samples on individual instrumental activities of daily living, stair difficulty, use of mobility aides, distance walked, fear of falling, and pain. The standardized and comparable information collected by the CRA is expected to provide clinicians, clinic, and health system administrators with essential health and function information that can be used for care planning, benchmarking, and evaluation.

Chronotype and mental health: timing seems to matter, but how, why, and for whom?

Chronotype and mental health: timing seems to matter, but how, why, and for whom?

0843 Identifying the Minimum Number of Ambulatory Blood Pressure Measurements to Classify a Reliable Blood Pressure Dipping Status

Abstract Introduction Ambulatory blood pressure monitoring (ABPM) is recommended over office BP assessment as it enables quantification of the degree of nocturnal BP dipping (classifications: “dipping” = nighttime/daytime BP of < 0.9; “non-dipping” = ≥0.9), a robust predictor of future adverse events. However, ABPM can cause discomfort jeopardizing adherence to the 24-hour assessment. Current guidelines recommend at least 20/7 daytime/nighttime BP measurements for reliable classification of nocturnal dipping status, but recent reports suggest 8/4 daytime/nighttime measurements may be sufficient. This threshold for classification can reduce patient burden and potentially enhance clinical practice. We aimed to identify the minimum number of ambulatory BP measurements to determine a reliable dipping status. Methods Forty-three ostensibly healthy participants (50±10 years [mean±SD]) wore an ambulatory BP monitor for 24 hours with measurements every 20/30 minutes during the daytime/nighttime, respectively (maximum 48/16 daytime/nighttime measurements). We calculated each participant's dipping status using all available systolic BP measurements. We randomly selected 20-daytime plus 8-nighttime measurements, identified dipper statuses from all possibilities of 1-20 daytime and 1-8 nighttime measurements separately, and calculated the proportion of participants whose dipping status remained unchanged. We then evaluated all possible combinations starting with a minimum of 8 daytime/5 nighttime for consistency with participants’ full data set using a second random selection of 20/8 measurements Results We found that using 8-daytime (plus all available nighttime) measurements was sufficient for unchanged dipper status in 90% of possible combinations, and using 5-nighttime (plus all available daytime) measurements was sufficient for unchanged dipper status in 92% of possible combinations. Confirmatory analyses revealed that 8/5 daytime/nighttime combinations correctly identified dipper status in 84% of the >7 million combinations. 10/8 daytime/nighttime combination improved this to 86%, similar to 87% returned from the guidelines’ recommended combination of 20/7 daytime/nighttime measurements. Conclusion In ostensibly healthy people, current thresholds for ambulatory BP monitoring recommendation could result in ~13% misclassifications of dipping status compared to full datasets. However, considering that this measurement can cause discomfort and that dipping statuses can be unstable in 30% of individuals, 10/8 daytime/nighttime measurements may be a reliable alternative. Support (if any) NIH F32HL131308, R01HL163232, R01HL125893, R35HL155681, OHSU MRF and OFDIR.

Influence of Hydration Status and Plasma Copeptin on Ambulatory Blood Pressure in Healthy Young Adults

BACKGROUND: Adequate hydration is essential for regulating various physiological systems and may influence blood pressure (BP). Hypohydration is linked with elevated copeptin (surrogate of arginine vasopressin), which is associated with elevated cardiovascular disease risk. However, there is limited information on the influence of hydration and copeptin on ambulatory BP measures in young adults. Therefore, we sought to investigate associations between hydration, copeptin, and ambulatory BP. METHODS: We studied 41 participants (19 M/22 F, 24 White/17 Black, age 21±1 years, body mass index 26±5 kg/m 2 , screening BP 111± 10/67±8 mmHg; Mean ± SD) who provided a 24-hour urine sample. We measured urine specific gravity (USG), urine osmolality (OSM), and plasma copeptin as biomarkers of hydration. We used ambulatory BP monitoring (Suntech Oscar2) to assess BP during daytime (1000-2000) and nighttime (0000-0600). Our primary outcomes were plasma copeptin (pmol/L) and night-to-day BP dip ratio (nighttime/daytime BP) in dehydrated (USG >1.020 or OSM >800 mOsm/kg) vs euhydrated participants. Statistical procedures included Student’s t-tests and Mann-Whitney U tests. We also used Spearman’s rho correlation (controlling for BMI, sex, and race). We set α at ≤0.05. RESULTS: Copeptin concentration was elevated in dehydrated compared with euhydrated participants (USG: 6.6±2.9 vs 4.3±2.0 pmol/L, p<0.005; OSM: 6.6±2.7 vs 4.1±2.0 pmol/L, p<0.001). After controlling for BMI, sex, and race, copeptin was associated with USG (rho=0.44, p=0.005) and OSM (rho=0.51, p=0.001). Systolic and diastolic BP dip ratios did not differ by hydration status for either USG or OSM ( ps>0.179). Additionally, adjusted BP dip ratios were not correlated with OSM or USG ( ps>0.149). Plasma copeptin was not associated with BP dip ratios ( ps>0.155) but was associated with absolute nocturnal systolic (rho=-0.34, p=0.036) and diastolic BP dip (rho=-0.33, p=0.041). When we split participants by low and high copeptin concentration (median split), higher copeptin was associated with a lower (i.e., worse) systolic BP dip ratio (0.87±0.06 vs 0.90±0.06, p=0.048) and lower absolute nocturnal systolic and diastolic BP dip ( ps<0.01). CONCLUSIONS: Hydration biomarkers were correlated with plasma copeptin, but not ambulatory BP. The significance of our findings are that higher copeptin was associated with blunted nocturnal BP dipping in younger adults, which could predispose them to increased future cardiovascular disease risk. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hypertension: Who to treat, to what extent and how?

Hypertension is the modifiable risk factor causing the largest loss in healthy life-years. The risk of cardiovascular events increases exponentially with the level of blood pressure (BP), starting from 115mmHg for systolic BP. Out-of-office BP measurements (self-measurements or ambulatory BP measurements) are now preferred for the diagnosis and follow up. In the absence of a preferred indication, antihypertensive treatment is based on thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These treatments are associated with a significant reduction in morbidity and mortality in people with office BP≥140/90mmHg (self-measurements≥135/85mmHg). For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP≥130/80mmHg is also beneficial (self-measurements≥130/80mmHg as well). It is now common to start treatment with half-dose dual therapy, which is more effective and better tolerated than full-dose monotherapy. The clinical effect is assessed at 4weeks and intensification, if required, is then usually done by switching to the same dual therapy at full-dose for both components.

Continuous cuffless blood pressure monitoring with a wearable ring bioimpedance device

Smart rings provide unique opportunities for continuous physiological measurement. They are easy to wear, provide little burden in comparison to other smart wearables, are suitable for nocturnal settings, and can be sized to provide ideal contact between the sensors and the skin at all times. Continuous measuring of blood pressure (BP) provides essential diagnostic and prognostic value for cardiovascular health management. However, conventional ambulatory BP measurement devices operate using an inflating cuff that is bulky, intrusive, and impractical for frequent or continuous measurements. We introduce ring-shaped bioimpedance sensors leveraging the deep tissue sensing ability of bioimpedance while introducing no sensitivity to skin tones, unlike optical modalities. We integrate unique human finger finite element model with exhaustive experimental data from participants and derive optimum design parameters for electrode placement and sizes that yields highest sensitivity to arterial volumetric changes, with no discrimination against varying skin tones. BP is constructed using machine learning algorithms. The ring sensors are used to estimate arterial BP showing peak correlations of 0.81, and low error (systolic BP: 0.11 ± 5.27 mmHg, diastolic BP: 0.11 ± 3.87 mmHg) for >2000 data points and wide BP ranges (systolic: 89–213 mmHg and diastolic: 42–122 mmHg), highlighting the significant potential use of bioimpedance ring for accurate and continuous estimation of BP.

Implementation and results of a standardized process for identifying ambulatory pharmacy clinical outcome measures.

Given the variation in clinical practice, a clinician-centric, standardized process to implement and validate clinical pharmacy outcome measures was developed. Four specialty clinics with embedded clinic-based pharmacists underwent an iterative process to define, refine, and implement the build of electronic health record functionality for outcome measure data collection and reporting. Starting with a list of identified measures, clinic workgroups met to discuss each measure and identify gaps in measure implementation. Information technology experts created electronic documentation forms with discrete data and reports based on criteria specified by the clinic workgroups. Of 32 outcome measures identified as priorities for demonstrating pharmacists' impact in previous research, 29 were implemented for routine monitoring through this project. Implementation strategies included identification through existing reporting, development of discrete documentation tools within the electronic health record, and development of new reporting tools from available discrete data fields. Time to implementation decreased from the first to the last pilot clinic implementation, as demonstrated through a 9-day reduction in electronic documentation form development and 31-day reduction in report development turnaround time. A standardized and reproducible process was developed for the implementation of clinical pharmacy outcomes measures for 4 specialty clinics. The process was successfully utilized to develop measurable outputs for a variety of oncology and nononcology specialty disease states based upon multidisciplinary stakeholder input.

Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.

Associations of air pollution mixtures with ambulatory blood pressure: The MobiliSense sensor-based study

Air pollution is acknowledged as a determinant of blood pressure (BP), supporting the hypothesis that air pollution, via hypertension and other mechanisms, has detrimental effects on human health. Previous studies evaluating the associations between air pollution exposure and BP did not consider the effect that air pollutant mixtures may have on BP. We investigated the effect of exposure to single species or their synergistic effects as air pollution mixture on ambulatory BP. Using portable sensors, we measured personal concentrations of black carbon (BC), nitrogen dioxide (NO2), nitrogen monoxide (NO), carbon monoxide (CO), ozone (O3), and particles with aerodynamic diameters below 2.5 μm (PM2.5). We simultaneously collected ambulatory BP measurements (30-min intervals, N = 3319) of 221 participants over one day of their lives. Air pollution concentrations were averaged over 5 min to 1 h before each BP measurement, and inhaled doses were estimated across the same exposure windows using estimated ventilation rates. Fixed-effect linear models as well as quantile G-computation techniques were applied to associate air pollutants’ individual and combined effects with BP, adjusting for potential confounders. In mixture models, a quartile increase in air pollutant concentrations (BC, NO2, NO, CO, and O3) in the previous 5 min was associated with a 1.92 mmHg (95% CI: 0.63, 3.20) higher systolic BP (SBP), while 30-min and 1-h exposures were not associated with SBP. However, the effects on diastolic BP (DBP) were inconsistent across exposure windows. Unlike concentration mixtures, inhalation mixtures in the previous 5 min to 1 h were associated with increased SBP. Out-of-home BC and O3 concentrations were more strongly associated with ambulatory BP outcomes than in-home concentrations. In contrast, only the in-home concentration of CO reduced DBP in stratified analyses. This study shows that exposure to a mixture of air pollutants (concentration and inhalation) was associated with elevated SBP.

Exploring the effects of a wearable biocueing app (Sense-IT) as an addition to aggression regulation therapy in forensic psychiatric outpatients.

Preventing and reducing violence is of high importance for both individuals and society. However, the overall efficacy of current treatment interventions aimed at reducing aggressive behavior is limited. New technological-based interventions may enhance treatment outcomes, for instance by facilitating out-of-session practice and providing just-in-time support. Therefore, the aim of this study was to assess the effects of the Sense-IT biocueing app as an addition to aggression regulation therapy (ART) on interoceptive awareness, emotion regulation, and aggressive behavior among forensic outpatients. A combination of methods was used. Quantitatively, a pretest-posttest design was applied to explore group changes in aggression, emotion regulation, and anger bodily sensations associated with the combination of biocueing intervention and ART. Measures were assessed at pretest, after 4 weeks posttest, and after one-month follow-up. During the 4 weeks, a single-case experimental ABA design was applied for each participant. Biocueing was added in the intervention phase. During all phases anger, aggressive thoughts, aggressive behavior, behavioral control, and physical tension were assessed twice a day, and heart rate was measured continuously. Qualitative information regarding interoceptive awareness, coping, and aggression was collected at posttest. 25 forensic outpatients participated. A significant decrease in self-reported aggression was found between pre- and posttest. Furthermore, three-quarters of participants reported increased interoceptive awareness associated with the biocueing intervention. However, the repeated ambulatory measurements of the single-case experimental designs (SCEDs) did not indicate a clear effect favoring the addition of biocueing. On group level, no significant effects were found. On the individual level, effects favoring the intervention were only found for two participants. Overall, effect sizes were small. Biocueing seems a helpful addition to increase interoceptive awareness among forensic outpatients. However, not all patients benefit from the current intervention and, more specifically, from its behavioral support component aimed at enhancing emotion regulation. Future studies should therefore focus on increasing usability, tailoring the intervention to individual needs, and on integration into therapy. Individual characteristics associated with effective support by a biocueing intervention should be further investigated, as the use of personalized and technological-based treatment interventions is expected to increase in the coming years.