Ambulatory Monitoring Research Articles

Reproducibility of daytime hypertension, night-time hypertension, and nocturnal blood pressure dipping patterns in young to middle age patients with stage 1 hypertension.

To investigate the reproducibility of ambulatory BP sub-periods and nocturnal dipping phenotypes assessed twice 3 months apart in young-to-middle-age untreated individuals screened for stage 1 hypertension. We investigated 1096, 18-to-45-year old participants from the HARVEST. Their office BP was 145.8 ± 10.4/93.7 ± 5.7 mmHg. Office BP and 24 h BP were measured at baseline and after 3 months. Office, 24-h, daytime and night-time hypertensions, and nocturnal dipping patterns were defined according to the 2023 ESH guidelines. Between-recording agreement was evaluated with kappa statistics. Reproducibility evaluated with weighted kappa was moderate for both 24 h hypertension (K = 0.48) and daytime hypertension (K = 0.50) and was only fair for night-time hypertension (K = 0.36). Between-measurement agreement was even worse for isolated night-time hypertension (K = 0.24), and was poor for office hypertension (K = 0.14). The better reproducibility of daytime than night-time period was confirmed by the analysis of BP as continuous variable (all between-period differences, P < 0.001). Nondipping was present in 31.8%, and showed a fair agreement (K = 0.28,). Poorer agreement was shown by extreme dipping (K = 0.18) and reverse dipping (K = 0.07). These data show that within the ambulatory sub-periods, daytime hypertension has a better reproducibility than night-time hypertension. This suggests that the better association with adverse outcomes shown by sleep BP compared to wake BP in observational studies is not due to a better reproducibility of the former. The between-measurement agreement is even worse for isolated nocturnal hypertension and dipping patterns, especially for extreme and reverse dipping. Thus, these BP phenotypes should be confirmed with repeat ambulatory BP monitoring.

Hypertension in children and adolescents: perspectives in Japan.

Hypertension in children and adolescents is associated with increased risk of hypertension and cardiovascular disease (CVD) in adulthood. Therefore, preventing hypertension among children and adolescents is an important public health objective worldwide. Although the importance of hypertension in children and adolescents has increasingly been recognized, the field of research is relatively new and evidence for etiologies, prevention and treatment is sparse. This review mainly summarizes the content regarding hypertension in children and adolescents published in Hypertension Research in 2023/24. Highlights include the following: The prevalence of hypertension was higher in female than male Japanese junior high school students (13.7% vs. 4.7%), but there was no significant gender difference among Japanese senior high school students (7.4% vs. 5.4%). Hematological parameters, including red blood cell counts, hemoglobin counts, hematocrit and iron levels, were positively associated with blood pressure (BP) levels in healthy children and adolescents. Higher-risk longitudinal BP trajectories in early life were associated with increased risk of target organ damage (TOD) and higher combined TOD load in midlife. BP phenotypes (e.g., masked hypertension, white-coat hypertension) assessed using office and 24-h ambulatory BP monitoring were not highly reproducible in children. The salt check sheet was a useful tool for evaluating the approximate dietary salt intake in Japanese children and adolescents. It is recommended that healthcare providers screen for hypertension in children and adolescents and recognize the importance of early intervention for those with elevated BP levels. Beginning in childhood, continuous education on hypertension and proper dietary salt intake are key to reducing the risk of hypertension and decreasing the burden of CVD in adulthood.

Left ventricular structure and function in relation to sodium dietary intake and renal handling in untreated Chinese patients.

Whether left ventricular structure and function is associated with sodium dietary intake and renal handling while considering blood pressure (BP) remains unclear. Consecutive untreated patients referred for ambulatory BP monitoring were recruited. Standard echocardiography was performed to measure left ventricular structure and function. Fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa) were calculated as markers of proximal and distal tubular sodium handling, respectively. The 952 participants (51.0% women; mean age, 50.8 years) included 614 (64.5%) ambulatory hypertension and 103 (10.8%) left ventricular hypertrophy. There were significant interactions of urinary sodium excretion with FELi (P ≤ 0.045), but not FDRNa (P ≥ 0.36), in relation to left ventricular posterior wall thickness (LVPW), mass (LVM) and mass index (LVMI), but not functional measurements. Only in tertile 1 of FELi, the multivariate-adjusted regression coefficients for urinary sodium excretion reached statistical significance (P ≤ 0.049), being 0.16 ± 0.05 mm, 4.32 ± 1.48 g, and 1.64 ± 0.83 g/m2 for LVPW, LVM and LVMI, respectively. In mutually adjusted analyses, the regression coefficient for LVMI was statistically significant for FELi, FDRNa and 24-h systolic BP, being -2.17 ± 0.49, -1.95 ± 0.54, and 2.99 ± 0.51 g/m2, respectively (P < 0.001). Multivariable analysis of variance showed that sodium renal handling indexes (P ≥ 0.14), but not sodium urinary excretion (P = 0.007), were similarly as 24-h BP associated with LVMI. Heat maps on left ventricular hypertrophy provided a graphical confirmation of the findings. Sodium dietary intake and renal handling interact to be associated with left ventricular structure. Renal handling indexes were similarly in size as, jointly in action with and independently of 24-h BP.

Resistant Hypertension and Mortality: An Observational Cohort Study.

Resistant hypertension is characterized by elevated blood pressure (BP) despite using 3 antihypertensive agents. Ambulatory BP monitoring (ABPM) detects the presence of white-coat resistant hypertension (24-hour BP <130/80 mm Hg). The aim of the study was to evaluate risks of death in resistant hypertension compared with controlled hypertension, as well as in ABPM-confirmed (24-hour BP ≥130 or 80 mm Hg), versus white-coat resistant hypertension. We selected 8146 patients with controlled hypertension (office BP <140/90 mm Hg while being treated with ≤3 antihypertensive drugs) and 8577 with resistant hypertension (BP ≥140 or ≥90 mm Hg while being treated with ≥3 drugs). All-cause and cardiovascular mortalities (median follow-up, 9.7 years) were compared between groups, as well as between patients with white-coat (3289) and ABPM-confirmed (5288) resistant hypertension. Hazard ratios (HRs) from Cox models after adjustment for clinical confounders were used for comparisons. Compared with controlled hypertension, resistant hypertension was associated with an increased risk in all-cause (HR, 1.21 [95% CI, 1.12-1.30]) and cardiovascular mortalities (HR, 1.33 [95% CI, 1.17-1.51]) in confounder-adjusted models. Compared with white-coat, ABPM-confirmed resistant hypertension was associated with an increased risk of all-cause (HR, 1.45 [95% CI, 1.32-1.60]) and cardiovascular (HR, 1.68 [95% CI, 1.43-1.98]) mortalities. When ABPM-confirmed and white-coat resistant hypertension were separately compared with controlled hypertension, only the former was associated with an increased risk of death and cardiovascular death (HR, 1.36 [95% CI, 1.26-1.48] and 1.56 [95% CI, 1.36-1.79]), respectively. ABPM-confirmed resistant hypertension is associated with an increased risk of death and cardiovascular death with respect to both controlled hypertension and white-coat resistant hypertension.

Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension.

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.

Serum neutrophil gelatinase-associated lipocalin and cystatin C is associated with blood pressure in ex-preterm children and adolescents.

As preterm birth is a risk factor for hypertension (HTN), biomarkers for early prediction of HTN in childhood is an emerging need. The aims of the study were to evaluate serum biomarkers in ex-preterm children and examine for associations with office peripheral and central SBP (cSBP), ambulatory BP parameters and pulse wave velocity (PWV). This case-control study included children and adolescents born prematurely (ex-preterms) and at full term (controls). All participants underwent office and ambulatory BP monitoring, assessment of cSBP, PWV and serum biomarkers at the same visit. Neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-2, metalloproteinase-9 (MMP-2, MMP-9) and Cystatin C (CysC) were measured using ELISA. The study population included 52 ex-preterm individuals and 26 controls. Mean age was 10.7 ± 3.6 years. NGAL, MMP-2, MMP-9, and CysC levels were similar between the ex-preterm and the control group. In the ex-preterm group, NGAL is associated with office SBP z score (β = 1.007, 95% CI 1.001-0.014, P = 0.049), CysC with office DBP z score (β = 1.003, 95% CI 1.001-0.005, P = 0.018) and cSBP z score (β = 1.003, 95% CI 1.001-0.005, P = 0.006) independently of age, sex and BMI z score. Among ex-preterm children and adolescents 17% had ambulatory HTN and 31% had white-coat HTN. NGAL levels were higher in ex-preterm children with WCH compared with children with normal BP [57.9 (IQR 50.8) versus 34.6 (IQR 46.2)], P = 0.018]. WCH is common in ex-preterm children and adolescents and is associated with higher NGAL levels and CysC presents positive association with cSBP. The findings in this study provides preliminary evidence that NGAL and CysC may have a role in predicting the risk of developing hypertension later in life. Further studies are warranted.

Using an in-office passive leg raise to identify older adults with suboptimal blood pressure control.

Passive leg raise (PLR) is a simple, dynamic maneuver that has been used to increase preload to the heart. We hypothesize that PLR may offer a new and efficient office-based tool for assessing blood pressure (BP) control in older adults. One hundred and three veterans (≥60 years old) without known cardiovascular disease and varying degrees of blood pressure control were included in this cross-sectional cohort study. Twenty-four hour ambulatory BP monitoring identified Veterans with optimal and suboptimal BP control (≥125/75 mmHg). Bioimpedance electrodes (Baxter Medical, Deerfield, Illinois, USA) and brachial BP were used to calculate hemodynamic parameter changes across PLR states [pre-PLR, active PLR (3 min), and post-PLR]. Multiple linear regression was used to assess associations between BP control status with changes in hemodynamic parameters between PLR states. The 24-h ambulatory BP monitoring identified 43 (42%) older Veterans with optimal BP control (mean age of 70.5 ± 7.0 years) and 55 (54%) with suboptimal BP (mean age of 71.3 ± 8.7 years). Veterans with suboptimal BP control had significantly reduced change in total peripheral resistance (ΔTPR) (7.0 ± 156.0 vs. 127.3 ± 145.6 dynes s/cm5; P = 0.002) following PLR compared with Veterans with optimal BP control. Suboptimal BP control (β = -0.35, P = 0.004) had a significant association with reduced ΔTPR, even after adjusting for demographic variables. Measuring PLR-induced hemodynamic changes in the office setting may represent an alternative way to identify older adults with suboptimal BP control when 24-h ambulatory BP monitoring is not available.

Daytime actisensitivity predicts nocturnal dipping patterns and morning surge in blood pressure: the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective study.

Ambulatory blood pressure (BP) is influenced by physical activity and the BP response to physical activity (actisensitivity) differs between individuals. This study investigated associations between daytime actisensitivity and nighttime BP dipping status and morning BP surge. Twenty-four-hour ambulatory BP monitoring (ABPM) with simultaneously monitored physical activity using a multisensor all-in-one device (TM-2441; A&D Company) was performed at baseline in HI-JAMP study participants. Those with complete BP measurements and complete physical activity monitoring data were included in this analysis. Actisensitivity was calculated as the slope of the regression line between daytime SBP and log-transformed physical activity over a 5 min period before each BP reading. Hyper and negative reactivity were defined as actisensitivity greater than 90th and less than 10th percentile, respectively. Data from 2692 individuals (mean age 69.9 ± 11.9 years; mean BMI 24.8 ± 4.1 kg/m2, 53.6% men) were analyzed. Those with hyper reactivity had a high prevalence of the extreme dipper pattern of nighttime BP and exaggerated morning BP surge; those with negative reactivity had higher nighttime BP and a riser pattern of nighttime BP. Results remained significant after adjusting for 24-h physical activity. Differences in diurnal BP variability based on actisensitivity were augmented in individuals aged at least 75 years. This study is the first to investigate associations between actisensitivity and 24-h ambulatory BP profiles using an all-in-one multisensor device in a large real-world population. The associations seen between either hyper or negative actisensitivity and abnormal diurnal BP variability, especially in the elderly, could contribute to increased cardiovascular event risk. University Hospital Medical Information Network Clinical Trials Registry, UMIN000029151 (HI-JAMP study).

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.

455. SHOULD THE DIAGNOSTIC THRESHOLD FOR PH MONITORING IN GASTROESOPHAGEAL REFLUX DISEASE DIFFER BETWEEN THE EAST AND THE WEST?

Abstract Background The Montreal definition's reliance on troublesome typical symptoms alone is inadequate for diagnosing 'actionable' Gastroesophageal Reflux Disease (GERD). Lyon consensus 2.0 updated conclusive evidence of GERD, incorporating Los Angeles grade B or above esophagitis and Acid Exposure Time (AET) exceeding 6% in ambulatory reflux monitoring. The Seoul Consensus 2020 presents varied opinions on applying the same standards to the Asian population. A meta-analysis determined the Asian upper limit of AET as 3.2%. This study aims to compare Lyon 1.0 and 2.0 consensus compositions and assess the sensitivity and specificity of different AET thresholds in predicting Grade B or above esophagitis. Methods Patients with refractory GERD symptoms or considering anti-reflux surgery underwent objective GERD workup, including 24-hour catheter-based or 96-hour wireless ambulatory pH monitoring, High-Resolution Manometry, and upper endoscopy. This retrospective cohort study analyzed patient data from 2011-2023, excluding those with prior anti-reflux surgery, bariatric surgery, or myotomy for achalasia. Patients were categorized based on Lyon Consensus 1.0 and 2.0 as 'Non-GERD,' 'Borderline GERD,' 'Borderline GERD with evidence,' and 'Conclusive GERD.' Sensitivity, specificity, and Area-Under-Curve (AUC) were calculated using AET thresholds of 3.2%, 4%, 6%, and 7.2% to predict Grade B or above esophagitis. Results Between July 2011 and August 2023, 257 patients underwent pH monitoring and were included in the analysis, with 247 (93.8%) being ethnic Chinese. The number of patients categorized as conclusive GERD was significantly higher in Lyon 2.0 (134, 52.1%) compared to Lyon 1.0 (109, 42.4%), p &amp;lt; 0.001. Sensitivity and specificity for predicting Grade B or above esophagitis were as follows: AET 3.2% (83.3%, 48.8%), AET 4% (65.3%, 52.4%), AET 6% (73.8%, 66%), AET 7.2% (69.0, 72.1%). AET 7.2% demonstrated the highest AUC of 70.6% (Figure 1). Among patients classified as conclusive GERD, 67 (50%) underwent antireflux surgery. Conclusion Using the Asian threshold of AET 3.2% yields the highest sensitivity for detecting Grade B or above esophagitis. Additionally, the AUC is higher compared to using AET 4.0%. However, it is important to note that AET alone should not be the sole parameter for diagnosing actionable GERD, as even with the lowest AET threshold of 3.2%, 16.7% of patients with Grade B or above esophagitis would be missed.

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&amp;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&lt;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&lt;0.001). Conclusions: Sf/Am, which is obtained by ABPM, is associated with echocardiographic LVEF.

Extended Ambulatory ECG Monitoring Enhances Identification of Higher-Risk Ventricular Tachyarrhythmias in Patients With Hypertrophic Cardiomyopathy

BackgroundIn hypertrophic cardiomyopathy (HCM), 48-hour ambulatory monitoring has been standard practice to detect nonsustained ventricular tachycardia (NSVT), a sudden death risk marker. Extended-wear ambulatory electrocardiographic (ECG) devices have more recently used for monitoring patients with HCM. ObjectiveWe aimed to evaluate NSVT burden identified with continuous ambulatory monitoring for up to 2 weeks compared with initial 48 hours. MethodsThere were 236 consecutive patients with HCM (49 ± 12 years) who underwent 14-day continuous ambulatory monitoring (Zio XT, iRhythm Technologies, San Francisco, CA); diagnostic yield of NSVT compared for initial 48 hours vs extended for 14 days. ResultsOf 236 patients, 114 (48%) had ≥ 1 runs of NSVT (median 2) over 14 days. Median length of NSVT was 7 beats (range: 3 to 67) at rates of 120 to 240 beats per minute (bpm) (median, 167 bpm). In 42 of the 114 patients (37%), initial NSVT occurred ≤ 48 hours and in 72 (63%) only during the extended monitoring period (3 to 14 days). Diagnostic yield for detecting NSVT over 14 days was 2.7-fold greater than ≤ 48 hours (P < .001). NSVT judged at higher risk (≥ 8 beats, > 200 bpm, ≥ 2 runs in consecutive 2-day period) was identified more frequently during extended monitoring, diagnostic yield 3-fold greater than ≤ 48 hours (P < .001). ConclusionIn HCM, NSVT episodes are frequent; however, in most patients, both NSVT and higher-risk NSVT were not detected during initial 48 hours and were confined solely to extended monitoring period. These data support additional clinical studies to evaluate the significance of NSVT on extended monitoring on sudden death risk in HCM.

P101 LEFT VENTRICULAR MASS INDEX (LVMI) IS UNLIKELY TO NORMALISE WITH TREATMENT USING CURRENTLY RECOMMENDED BLOOD PRESSURE TARGETS

Background and Objectives: LVMI is one of the strongest predictors of cardiovascular events. However, it's unclear whether current blood pressure (BP) targets normalise LVMI relative to a truly normotensive population. We therefore compared achieved LVMI in a younger cohort of hypertensive patients (&lt; 55 years) treated for one year to conventional blood pressure targets (&lt; 140/90 mmHg) versus the LVMI of a truly normotensive age-matched healthy population from the UK Biobank (BP ≤ 120/80 mmHg). Methods: The normotensive cohort comprised 101 treatment-naïve men (mean ± SD age: 52 ± 2 years, BP: 112 ± 7/68 ± 7 mmHg) from 77,983 UK Biobank participants who had undergone cardiac Magnetic Resonance Imaging (cMRI) to determine LVMI. The treated hypertensive cohort comprised 44 men from the TREAT CASP study* (mean age: 49 ± 6 years) who achieved mean BP of 129 ± 10/78 ± 8 mmHg after one-year treatment. LVMI in both cohorts was measured accurately via automated analysis of cMRI and manually reviewed for accuracy. Results: LVMI in Biobank cohort was 51.3 ± 6.0 g.m-2 (95% CI: 50.1 to 52.4 g.m-2). In the hypertensive cohort, after one year of treatment, LVMI was reduced (59.2 ± 7.0 versus 56.0 ± 7.0 g.m-2, P &lt;0.001) but remained higher than the Biobank cohort (56.0 ± 7.0 versus 51.3 ± 6.0 g.m-2, P &lt;0.001). Mean LVMI of treated-hypertensive patients achieving truly normotensive BP (≤ 120/80 mmHg) was 52.7 ± 5.7 g.m-2 (95% CI: 48.9 to 56.4 g.m-2; n = 9). Conclusions: This study identified optimal cMRI LVMI for healthy middle-aged men. Antihypertensive treatment reduces but does not restore LVMI to normal levels, suggesting much lower BP targets than currently recommended are likely to be necessary to normalise LVMI in hypertensive patients. *Reference: Lacy, P. S., Jedrzejewski, D., McFarlane, E., &amp; Williams, B. (2023). Blood pressure measurement modalities and indexed left ventricular mass in men with low-risk hypertension confirmed by ambulatory monitoring. Journal of Hypertension, 41(6), 941-950.

Abstract P363: Prevelance of Hypertension in Kidney Transplant Recepients as Determined by Ambulatory BP Monitoring (ABPM)

Background: Cardiovascular disease remains the most common cause of death among kidney transplant recipients, with hypertension being one of the most prevalent risk factors. Understanding the current prevalence of hypertension in this population is critical to help shape post-transplant care policies and guidelines and ensure proper management of CVD risk. Methods: We included all kidney transplant recipients who received their transplant between 2019 and 2023 at our center and who completed 24-hour ABPM at 12 months post-transplant. We reported data in mean (SD) unless noted otherwise. BP was categorized per AHA guidelines. This study was deemed exempt by the IRB. Results: A total of 940 patients were included in this study. Detailed results are seen in Figure 1 and Table 1. Notable to mention that 60% of the patients had blood pressure &gt; 130/80 mmHg at 12 months post kidney transplant, with the majority being stage 1. Patients with more severe hypertension tended to be older, had lower eGFR, and had more comorbidities. They also had lower diastolic blood pressure than stage 1 HTN patients, consistent with older age. Night-time BP was significantly higher among stage 2 HTN patients. Conclusion: Hypertension remains a prevalent condition post-kidney transplant despite the majority of patients having satisfactory kidney allograft function. Ongoing BP monitoring and assessment of out-of-office BP post-kidney transplantation is critical to ensure control of this important cardiovascular risk factor. 24-hour ABPM has several advantages in this group, including accurate measurement of out-of-office BP and detection of nocturnal hypertension, an independent risk factor for cardiovascular events. Additional studies are needed to describe the hypertension subphenotypes (e.g., sustained vs. masked) and to identify predictors of severe uncontrolled hypertension in this patient population.

The impact of the COVID-19 Pandemic on hypertension phenotypes (ESH ABPM COVID-19 study)

ObjectiveThe COVID-19 pandemic had a major impact on medical care. This study evaluated the influence of the pandemic on blood pressure (BP) control and hypertension phenotypes as assessed by office and 24-hour ambulatory BP monitoring (ABPM). Design and MethodsData were collected from 33 centers including Excellence Centers of the European Society of Hypertension. Two groups of patients with treated hypertension were compared. Pandemic group: including participants who had ABPM twice - at visit 2 during the COVID-19 pandemic and visit 1 performed 9–15 months prior to visit 2. Pre-pandemic group: had ABPM at two visits, performed before the pandemic within 9–15 months interval. We determined the following hypertension phenotypes: masked hypertension, white coat hypertension, sustained controlled hypertension (SCH) and sustained uncontrolled hypertension (SUCH). We analyzed the prevalence of phenotypes and their changes between visits. ResultsData of 1419 patients, 616 (43 %) in the pandemic group and 803 (57 %) in the pre-pandemic group, were analyzed. At baseline (visit 1), the prevalence of hypertension phenotypes did not differ between groups. In the pandemic group, the change in hypertension phenotypes between two visits was not significant (p = 0.08). In contrast, in the pre-pandemic group, the prevalence of SCH increased during follow-up (28.8 % vs 38.4 %, p < 0.01) while the prevalence of SUCH decreased (34.2 % vs 27.8 %, p < 0.01). In multivariable adjusted analysis, the only factor influencing negative changes of hypertension phenotypes was the COVID-19 pandemic period. ConclusionThese results indicate a negative impact of the COVID-19 pandemic on BP control assessed by hypertension phenotypes.

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.

O20 CURRENT 24-HOUR AMBULATORY BLOOD PRESSURE TECHNOLOGIES SHOULD BE RECONSIDERED AS THE REFERENCE STANDARD FOR VALIDATION OF CUFFLESS BLOOD PRESSURE DEVICES

Background and Objective: Recommendations for the validation of cuffless blood pressure (BP) devices were recently released by the European Society of Hypertension (ESH). In this recommendation, 24-hour ambulatory BP monitoring (ABPM) is the reference standard for a newly proposed ‘awake-asleep’ accuracy test. However, this reference standard may be inappropriate because ABPM is subject to measurement insecurities, and it is unknown if it would pass the awake-asleep test. Therefore, the aim of this study was to determine if ABPM itself would pass the awake-asleep test recommended for validation of cuffless BP devices. Methods: Dual arm, simultaneous ABPM were recorded using two identical cuff-based devices (TM-2430, A&amp;D, Japan) among 46 healthy adults (22±2.3 years; 54% female). The awake-asleep test was defined as the difference between the left arm ABPM minus right arm ABPM for assessing the change in BP between awake-asleep time (ESH recommendations: mean difference ± SD ≤5±8 mmHg, correlation r&gt;0.7 for test and reference values; awake-asleep BP components calculated based on personalized sleeping times). Measurement artefacts were identified by analysis of the cuff deflation pressure curves and hydrostatic pressure differences (body position) between the cuffs. Results: ABPM did not pass the awake-asleep test due to higher than acceptable measurement variability for systolic BP, -0.1±8.6 mmHg, r=0.69 and partially met requirements for diastolic BP, -0.7±5.9 mmHg, r=0.63. After correction for measurement artefacts and hydrostatic pressure differences, ABPM passed the awake-asleep test for systolic BP (-1.7±5.0 mmHg, r=0.76) but still did not meet requirements for diastolic BP due to insufficient correlation (r=0.64). Conclusion: In this analysis, ABPM itself did not meet the awake-asleep test criteria recommended by the ESH. Using current ABPM technologies as a reference standard for cuffless BP validation protocols may need to be reconsidered and they need improvement before use for this purpose. Improving ABPM through better measurement artefact detection could be an initial solution which would also improve its value for clinical decision making.

O93 BRIGHT LIGHT EXPOSURE ATTENUATES BLOOD PRESSURE REDUCTION POSTEXERCISE

Background and objective: A single session of aerobic exercise lowers blood pressure (BP), known as postexercise hypotension (PEH). Bright light (BL) exposure increases BP at rest compared to dim light (DL). However, whether BL exposure can attenuate PEH remains unknown, and this hypothesis was tested in the current study. Methods: Twenty healthy men (27±5 years) underwent two experimental sessions: one under BL (5000 lux) and another under dim light (DL ≤8 lux), performed in random order. In each session, subjects executed an aerobic exercise session on a cycle ergometer for 30 min at 50-60-% heart rate (HR) reserve. BP (oscillometric) and HR (HR monitor) were measured, and rate-pressure-product (RPP) was calculated (systolic BP * HR) pre- and postexercise. Additionally, subjects wore an ambulatory BP monitor (ABPM) for 24 hours after postexercise measurements. Results: Systolic BP decreased similarly postexercise in both sessions, but its levels were higher in BL than DL throughout the experimental session (Figure 1A). Diastolic and mean BPs decreased postexercise only in DL at 30 min, while they increased in BL at 60 and 90 min (Figure 1B and 1C, respectively). HR and RPP increased in both sessions postexercise, but RPP levels were higher throughout the experimental session in BL than DL (Figure 1D and 1E, respectively) and for the first three hours of ABPM. Conclusions: In healthy adult men, BL exposure increased systolic BP and cardiac work and attenuated PEH on diastolic and mean BPs.

O88 REDUCTION IN SYSTOLIC BLOOD PRESSURE FOLLOWING DIETARY FIBRE INTERVENTION IS DEPENDENT ON BASELINE GUT MICROBIOTA COMPOSITION

Background/Objective: Dietary interventions high in fibre have been shown to lower blood pressure (BP). This effect is via the gut microbiota, via fermentation of fibre and production of metabolites called short-chain fatty acids (SCFAs). Not all patients respond to dietary fibre interventions for unclear reasons. We aimed to determine if we can identify fibre-responders based on their gut microbiota and production of SCFAs. Methods: We performed a phase II cross-over placebo-controlled randomised clinical trial in untreated hypertensive patients. Twenty treatment-naive participants with hypertension received 40 g per day of fermentable fibre delivered as acetylated and butyrylated high amylose maize starch (HAMSAB) or the placebo for 3 weeks. Blood pressure was monitored at baseline and endpoint by ambulatory BP monitoring, with those experiencing a reduction of ≥2 mmHg in systolic BP classified as responders. The microbiota was determined by sequencing the V4-V5 region of the 16S rRNA gene in baseline stool samples. The relationship between baseline gut microbiota and response to dietary intervention was assessed with the MaAsLin2 package. Plasma SCFAs levels were quantified by mass spectrometry. Results: We observed a placebo-subtracted mean 24-hour systolic BP of –6.1 mmHg (p=0.03, reported in Jama et al., 2023 Nature Cardiovascular Research), with 14 (70%) individuals classified as responders and 6 (30%) as non-responders. Genera significantly enriched in responders included Dialister (β=1.29, q=1.921x10-134), Coprococcus (β=1.26, q=3.282x10-121), Bifidobacterium (β=1.67, q=1.11x10-81), Ruminococcus (β=0.161, q=1.11x10-8), and Roseburia (β=0.82, q=4.275x10-2). Responders also produced higher levels of the SCFAs butyrate (mean±SEM, non-responders 4.95±2.4 vs responders 51.15±14.7, p=0.0096), but no difference in other SCFAs. Conclusions: Participants who experienced a decrease in systolic BP following a dietary fibre intervention had increased bacterial genera known to contain species that produce SCFAs (Bifidobacterium, Roseburia, Ruminococcus) at baseline, and were able to produce more butyrate. These data suggest that baseline microbiota composition contributes to the response to dietary fibre intervention trials in people with hypertension, likely via increased capacity to produce butyrate.

O59 INFLUENCE OF CIRCADIAN BLOOD PRESSURE PATTERN ON RIGHT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSIION

Background and Objective: It is well proven, that arterial hypertension affects left side of the heart and causes its remodeling and functional changes. Since heart works as a unit and has ventricular interdependence, aim of the study was to assess influence of hypertension and circadian blood pressure (BP) profile on a right ventricular structure and function. Methods: 75 hypertensive patients (57.13±7.27 y/o) and 25 normotensive control subjects (57.56±7.55 y/o) were involved in a study. All of them were males without history of coronary artery disease, cerebrovascular or peripheral artery disease, obstructive lung disease, significant valvular heart disease or heart failure. All of them were either lifetime nonsmokers, or stopped smoking more than 5 years. All the patients underwent to 24-hour ambulatory BP monitoring and heart ultrasound with tissue doppler imaging. Results: Hypertensive patients with dipper circadian BP profile had higher TAPSE (19±1.586 vs 17.708±2.857; P&lt;0.05), higher right ventricular ejection fraction (55.103±4.597 vs 47.829±14.605; P&lt;0,005) and lower right ventricular outflow tract diameter (29.985±3.932 vs 32.639±3.510; P&lt;0/05). None of the echo parameters were different between normotensive subjects with different circadian BP pattern. Trans tricuspid valve early diastolic (E) and late diastolic (A) peak velocities were significantly lower in hypertensive patients (1.416±0.130 vs 0.897±1.49; P&lt;0.005). Hence, non-dipper hypertensives had significantly lower tricuspid E/A ratio in comparison with dippers (0.812±0.094 vs 1.048±0.101; P&lt;0.00001). Interventricular septum and posterior wall diameters were higher in non-dipper hypertensives (1.134±0.131 vs. 1.322±0.138; P&lt;0.00001 and 1.072±0.175 vs. 1.254±0.135; P&lt;0.001; respectively). Conclusion: Study data show increased interdependence between two ventricles. Patients with arterial hypertension have systole-diastolic dysfunction, which especially well is present in patients with non-dipper circadian BP profile.