Average Blood Pressure Levels Research Articles

Characteristic enhancement of blood pressure V-shaped waves in sinoaortic-denervated rats in a conscious and quiet state.

A hemodynamic feature of chronic sinoaortic-denervated (SAD) rats is the increase in blood pressure variability (BPV) without significant changes in the average level of blood pressure (BP). The current study was designed to investigate the changes in BP V-shaped waves (V waves) in SAD rats. Sprague-Dawley (SD) rats were divided into 2 groups: SAD rats and sham-operated rats (n=13). Hemodynamics measurements were obtained in conscious, freely moving rats, four weeks after sinoaortic denervation or sham operation. V wave indices were evaluated in rats in both conscious and quiet states. Additionally, normal and high BPV was simulated by the production of V waves with different amplitudes. The results showed that the V wave amplitude was dramatically increased, with a significantly prolonged duration and reduced frequency in SAD rats. V wave BPV in SAD rats was significantly increased, though BP remained unchanged. The twenty-four hour BPV in all rats was positively correlated with amplitude, duration time and V wave BPV and negatively correlated with frequency. The systolic BP spectral powers in the low frequency range (0.38-0.45 Hz) were significantly reduced in the V waves of SAD rats. Moreover, there was a remarkable increase in mean BPV and a normal mean BP after simulating high BPV in SAD rats. These results suggest that enhancement of V waves might be a waveform character of BP in SAD rats in both the conscious and quiet states. These types of V waves appear to be related to a depression of sympathetic regulation of BP induced by sinoaortic denervation.

Changes in Central Aortic Pressure Levels, Wave Components and Determinants Associated with High Peripheral Blood Pressure States in Childhood: Analysis of Hypertensive Phenotype.

The aims were to determine whether children's high peripheral blood pressure states (HBP) are associated with increased central aortic blood pressure (BP) and to characterize hemodynamic and vascular changes associated with HBP in terms of changes in cardiac output (stroke volume, SV), arterial stiffness (aortic pulse wave velocity, PWV), peripheral vascular resistances (PVR) and net and relative contributions of reflected waves to the aortic pulse amplitude. We included 154 subjects (mean age 11; range 4-16 years) assigned to one of two groups: normal peripheral BP (NBP, n=101), defined as systolic and diastolic BP < 90th percentile, or high BP (HBP, n=53), defined as average systolic and/or diastolic BP levels ≥90th percentile (curves for sex, age and body height). The HBP group included children with hypertensive and pre-hypertensive BP levels. After a first analysis, groups were compared excluding obese and dyslipidemic children. Peripheral and central aortic BP, PWV and pulse wave-derived parameters (augmentation index, forward and backward wave components' amplitude) were measured using gold-standard techniques, applanation tonometry (SphygmoCor) and oscillometry (Mobil-O-Graph). Independent of the presence of dyslipidemia and/or obesity, aortic systolic and pulse BP were higher in HBP than in NBP children. The increase in central BP could not be explained by an increase in the relative contribution of reflections to the aortic pressure wave, higher PVR or by an augmented peripheral reflection coefficient. Instead, the rise in central BP would be explained by an increase in the amplitude of both incident and reflected wave components.

Correlation of quality of life and significant seasonal fluctuations blood pressure in the morning hours in patients with arterial hypertension

The aim of the present study was to identify the relationship between the quality of life of patients with arterial hypertension (AH) and the degree of seasonal fluctuations in blood pressure (BP) in the morning hours in these patients, as well as to trace the seasonal dynamics of the average morning levels of blood pressure in this group of patients. We analyzed the database of various studies carried out in our center between 1996 and 2011, which contained data 953 ambulatory BP monitoring (ABPM). ABPM data were analyzed in patients with hypertension, without serious comorbidities, who conducted blood pressure monitoring on a weekly background of antihypertensive therapy. Results of the study. It has been shown that diastolic blood pressure (DBP) in the morning (at) was the highest in winter (83.5±13.7 mm Hg), at the lowest - in summer (80.2±11.5 mm Hg), which was typical of the seasonal dynamics of blood pressure generally. The systolic blood pressure (SBP) was characterized by the highest level of the fall in blood pressure (133.3±18.7 mm Hg). The smallest - in the winter (131,8 B±17,6 mm Hg). The differences between the seasons are not reliable. When analyzing the results by using generalized linear models (Generalized Linear Models) and calculating the Fisher's exact test (F) The following patterns were identified. Intensity of seasonal increases in blood pressure (compared with the average level of blood pressure) was inversely related to the level of social support of friends, colleagues, relatives (Scale VI Quality of Life Questionnaire) (for F DBP was 4.29 (p

Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke: The Rotterdam Study.

Hypertension is a major modifiable risk factor for stroke. Associations of blood pressure with incident stroke are mostly based on single or average blood pressure levels. However, this approach does not take into account long-term trajectories of blood pressure, which can vary considerably in the elderly. Within the population-based Rotterdam Study, we examined trajectories of systolic blood pressure in 6745 participants (60.0% women) over an age-range from 55 to 106 years and jointly modeled their risk of stroke and competing causes of death using joint latent class mixed modeling. Four trajectories were identified. Class 1 was characterized by blood pressure increasing gradually from on average 120 to 160 mm Hg over 5 decades (n=4938). Compared with this class, class 2, characterized by a similar midlife blood pressure, but a steep increase (n=822, increasing from 120 to 200 mm Hg), and class 4, characterized by a high midlife blood pressure (n=115; average 160 mm Hg) and had a higher risk of stroke and death. Class 3, characterized by a moderate midlife blood pressure (n=870; average 140 mm Hg), had a similar risk of death as class 1, but the highest risk of stroke. Assessing trajectories of blood pressure provides a more nuanced understanding of the associations between blood pressure, stroke, and mortality. In particular, high blood pressure and rapidly increasing blood pressure patterns are associated with a high risk of stroke and death, whereas moderately high blood pressure is only related to an increased risk of stroke. Future studies should explore the potential pathogenic significance of these patterns.

Electrocardiographic abnormalities and dyslipidaemic syndrome in children with sickle cell anaemia.

SummaryBackgroundLipid and electrocardiographic (ECG) abnormalities have been reported in adults with sickle cell anaemia (SCA) and may reflect underlying structural and/ or functional damage. However, the relationship between ECG and lipid abnormalities among children with sickle cell disease is not fully understood.ObjectivesTo compare the steady-state lipid and ECG abnormalities in children with SCA to the controls and examine the hypothesis that lipid abnormalities are closely related to electrocardiographic abnormalities, and therefore are a reflection of cardiac damage among these children.Methods:Clinical, laboratory and ECG profiles of 62 children with SCA and 40 age- and gender-matched haemoglobin AA controls were compared. The influence of clinical characteristics, lipids profiles, markers of haemolysis, and renal and hepatic dysfunction on ECG pattern in children with SCA was then determined.ResultsThe patients had lower average diastolic and mean arterial blood pressure, total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels than the controls, (p = 0.001, 0.002, 0.000 and 0.000, respectively). The mean triglyceride level was significantly higher (p < 0.001), while high-density lipoprotein cholesterol (HDL-C) levels were comparable (p = 0.858). The cases were about six times more likely to have left ventricular hypertrophy than the controls (OR = 6.4, 95% CI = 2.7–15.6, p = 0.000). Haematocrit level had a negative correlation with QTC (r = –0.3, p = 0.016) and QT intervals (r = – 0.3, p = 0.044). Triglyceride levels had a positive correlation with the PR interval (r = 0.3, p = 0.012), while serum alanine transferase (ALT) concentrations had an inverse correlation with PR interval (r = –0.3, p = 0.015). There was no statistical difference in the sociodemographic and clinical characteristics of the SCA children with or without ECG abnormalities. However, the mean triglyceride and serum ALT levels in those with ECG abnormalities were significantly higher than those without (p = 0.007 and 0.045, respectively).ConclusionLipid and ECG abnormalities are common in children with SCA. Elevated triglyceride and serum ALT levels are possible biochemical markers of ECG abnormalities in these patients.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension: A Scientific Statement from the American Heart Association and the American College of Cardiology.

An elevation of blood pressure (BP) in the systemic circulation (hypertension) is the most common cardiovascular condition in the general population and considered to be the most ubiquitous cardiovascular risk factor in competitive athletes. Competitive athletes include those athletes involved in organized sports that typically occur in schools, communities, and professional leagues, including but not limited to intramural and league sports in which medical supervision is typically required. Although most competitive athletes are between the ages of 20 and 40 years, many younger people now participate in competitive athletics. The 2013 update from the American Heart Association using the National Health and Nutrition Examination (NHANES) data from 2007 to 2010 estimates that 9.1% of men aged 20 to 34 years and 6.7% of women of that age are hypertensive, based on having an elevated BP measurement or answering “yes” to the question, “Are you taking antihypertensive medication or were you told that you had hypertension?”1 The prevalence in children and adolescents is estimated to be ≈3.5%, with higher percentages in older and obese children.2 The diagnosis of hypertension is based on the subject having an elevated BP at or above certain levels measured by routine sphygmomanometry under appropriate conditions on at least 2 separate occasions separated by at least 1 week.3 However, BP measurements in the competitive athlete are typically obtained by different healthcare providers, which makes it particularly necessary that the testing conditions be standardized before the diagnosis of hypertension is made. People >18 years of age with a BP >140 mm Hg systolic and/or >90 mm Hg diastolic are considered to have hypertension.3 In children and adolescents, hypertension is defined as average systolic or diastolic BP levels greater than the 95th percentile for sex, age, and height; however, earlier physical maturation of the competitive athlete leaves …

Is It Daily, Monthly, or Yearly Blood Pressure Variability that Enhances Cardiovascular Risk?

Variability is a phenomenon common to most biological processes that we can measure and is a particular feature of blood pressure (BP). Variability causes concern for many physicians regarding its clinical meaning and potential impact on cardiovascular risk. In this review, we assess the role of different time periods of blood pressure variability (BPV) in cardiovascular risk stratification. We review the indices of BPV derived from ambulatory blood pressure measurement (ABPM), home blood pressure measurement (HBPM), or at the clinic setting with the intention of providing a clear message for clinical practice. BPV, either derived from ABPM or HBPM, does not consistently augment cardiovascular risk prediction over and beyond that of average BP, particularly in low-risk individuals. That said, it would seem that certain medications such as calcium channel blockers may have a beneficial effect on visit-to-visit BPV and perhaps reduce the associated cardiovascular risk. This highlights the benefits in using combination therapy which might couple a number of therapeutic benefits such as the reductions of mean blood pressure and BPV. Overall, we should remain aware that the average BP level remains the main modifiable risk factor derived from BP measurements and continue to improve the control of hypertension and adverse health outcomes.

Built Environment And Physical Activity In Urban Delhi: The Carrs-Gis Study

Objective Cardiometabolic diseases (CMD) are a major cause of mortality and morbidity worldwide. Among South Asians the onset is at a much younger age and involves all sections of the society. A major risk factor for CMD is inadequate physical activity (PA). 'Built environment' plays an important role in influencing participation in PA. However, the relationship between neighbourhood built environment and PA has been sparsely investigated in Low and Middle Incomes Countries. The primary objective of the present study was to objectively assess and study the relationship between Physical activity and Built environment in Urban Delhi. Method The Geographical Information System component of the Centre for Cardiometabolic Risk Reduction for South Asia Surveillance study (CARRS-GIS study) carried out in 3 major South Asian cities; New Delhi, Chennai and Karachi aims to study the relationship between built environment, CMD and their risk factors in South Asia. We located all study households; neighbourhood built environment features and performed GIS analysis of participant data overlaid on geographic data. PA data was measured using a culturally adapted version of the International Physical Activity Questionnaire and transformed to Metabolic Equivalent Task scores. Cluster analysis was carried out using the hotspot tool in ArcGIS. Results As part of the study we geocoded 8423 households from 350 clusters. Preliminary analyses from Delhi show a mixed picture with varying levels of PA in study neighbourhoods. Cluster analysis revealed statistically significant hot and cold spots. High physical activity clusters (hotspots) seemed to have better access to green and open spaces. PA Coldspots were found to be hotspots of higher than average Systolic Blood Pressure and Fasting Blood Glucose levels. Conclusion Exploratory spatial analysis shows that physical activity is related to neighbourhood built environment and other CMD risk factors in urban Delhi.

Novel Approaches in Primary Cardiovascular Disease Prevention: The HOPE-3 Trial Rationale, Design, and Participants' Baseline Characteristics

BackgroundCholesterol and blood pressure (BP) can be effectively and safely lowered with statin drugs and BP-lowering drugs, reducing major cardiovascular (CV) events by 20%-30% within 5 years in high-risk individuals. However, there are limited data in lower-risk populations. The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating whether cholesterol lowering with a statin drug, BP lowering with low doses of 2 antihypertensive agents, and their combination safely reduce major CV events in individuals at intermediate risk who have had no previous vascular events and have average cholesterol and BP levels. MethodsA total of 12,705 women 65 years or older and men 55 years or older with at least 1 CV risk factor, no known CV disease, and without any clear indication or contraindication to the study drugs were randomized to rosuvastatin 10 mg/d or placebo and to candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 × 2 factorial design) and will be followed for a mean of 5.8 years. The coprimary study outcomes are the composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke and the composite of CV death, nonfatal MI, nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial revascularization. ResultsParticipants were recruited from 21 countries in North America, South America, Europe, Asia, and Australia. Mean age at randomization was 66 years and 46% were women. ConclusionsThe HOPE-3 trial will provide new information on cholesterol and BP lowering in intermediate-risk populations with average cholesterol and BP levels and is expected to inform approaches to primary prevention worldwide (HOPE-3 ClinicalTrials.govNCT00468923).

Trends in Population Blood Pressure and Prevalence, Awareness, Treatment, and Control of Hypertension Among Middle Aged and Elderly in Rural Area of Riau Archipelago, Indonesia from 2007 to 2015

Backgroud: Prevention and control of hypertension are critical in reducing morbidity and mortality attributable to cardiovascular diseases. Awareness of hypertension is a pre-condition for control and prevention. Objectives: To assess trends in average blood pressure levels and prevalence, awareness, treatment, and control of hypertension among middle aged and elderly in a rural area of Riau Archipelago. Design: Population-based study among individual aged 45 years and over in Bintan Island, Riau Archipelago, Indonesia. Methods: Blood pressure was measured in dominant arm two times and treatment assessed. Follow up was done in primary health care. Results: The final working sample was 326 people, consisted of 232 female (71.2%), 94 male (28.8%). Mean age was 62.15 (SD 8.28). Average blood pressure in the population has increased since 2007 from 82.94 mm Hg to 84.05 mm Hg in 2015 (diastolic) and from 134.11 to 137.55 mm Hg (systolic). Prevalence of hypertension increased from 45.7% in 2007 to 50.6% in 2015. From 50.6% with hypertension, 49.5% were aware of their hypertension, 74,5% were treated with antihypertensive drugs, but only 41.0% had a good controlled of hypertension (blood pressure under 140/90). Women were more frequently aware of their hypertension, more frequently treated, and more frequently controlled than men. Controlled hypertension was strongly associated with awareness (p < 0.0001) and also with treated patients (p < 0.05). Conclusions: Average blood pressure levels and the prevalence of hypertension among middle aged and elderly in rural areas of Riau Archipelago have increased since 2007. However, awareness, treatment and control rates remain low.

PP.04.23

Objective: To investigate the relationship between arterial elastic property and target organ damage(TOD) in elderly patients with hypertension. Design and method: One hundred and fifty-five elderly hypertensive inpatients divided into A and B two subgroups according to 24 h average blood pressure level were enrolled, sixty-one elderly patients without hypertension during the same period were enrolled as the control(group C).The body mass index(BMI), urinary albumin to creatinine ratio(ACR)and blood biochemical indicators were collected. Twenty-four hour ambulatory blood pressure monitoring(ABPM), carotid intima-media thickness(IMT) measurement and ultrasonic cardiogram(UCG) were recorded. The association between AASI and 24hPP was analyzed. AASI, ambulatory pulse pressure(24hPP), ACR, IMT and LVMI were compared between patients with hypertension and without. And analyzed the correlation between risk factors and ACR, IMT,LVMI and TOD principal component with multiple linear regression analysis. Results: There was a significant association between AASI and 24hPP (r = 0.39,P < 0.01). Compared with the non-hypertensive group, the AASI, 24hPP, ACR, and LVMI were significantly higher in hypertensive patients[0.50vs0.43,57.7vs44.5(mmHg),8.1vs3.7(mg/g),120.4vs96.9(g/m2),P < 0.05 or P < 0.01], and the estimated glomerular filtration rate was lower[84.4vs76.6(ml/min/1.73m2),P < 0.01]. A subgroup analysis in hypertensive patients found that 24 h SBP, AASI, 24hPP, ACR were all higher in group A than those in group B[135.0vs120.5(mmHg)(P < 0.05),0.53vs0.48,64.1vs53.0(mmHg),12.9vs5.5(mg/g)(SNK method)]. The multivariable regression analysis showed that AASI was correlated with LVMI, IMT and TOD principle component(all P < 0.05). Conclusions: High AASI is associated with target organ damage in elderly patients with primary hypertension. AASI can be used as the evaluation index of arterial elastic property.

Adverse childhood experiences and blood pressure trajectories from childhood to young adulthood: the Georgia stress and Heart study.

The purposes of this study were to assess the long-term effect of adverse childhood experiences (ACEs) on blood pressure (BP) trajectories from childhood to young adulthood and to examine whether this relation is explained by childhood socioeconomic status (SES) or risk behaviors that are associated with ACEs. Systolic and diastolic BPs were measured up to 16 times (13 times on average) over a 23-year period in 213 African Americans and 181 European Americans 5 to 38 years of age. Retrospective data on traumatic experiences before 18 years of age were collected, including abuse, neglect, and household dysfunction. Individual growth curve modeling within a multilevel framework was used to examine the relation between exposure to ACEs and BP development. No main effect of ACEs on average BP levels was found. However, a significant interaction of ACE score with age(3) was observed (systolic BP, P=0.033; diastolic BP, P=0.017). Subjects who experienced multiple traumatic events during childhood showed a faster rise in BP levels after 30 years of age than those without ACEs. As expected, a graded association of ACEs with childhood socioeconomic status and negative health behaviors was observed (P<0.001). The ACE-systolic BP relation was not explained by these factors, whereas the ACE-diastolic BP relation was partially mediated by illicit drug use. In this novel longitudinal study, we observed that participants who were exposed to multiple ACEs displayed a greater increase in BP levels in young adulthood compared with their counterparts without ACEs.

Clinical Efficacy of Percutaneous Transluminal Renal Artery Stenting for the Treatment of Renovascular Hypertension Associated with Takayasu Arteritis

This study aims to observe and analyze the clinical efficacy of interventional therapy for patients with Takayasu arteritis (TA) experiencing renovascular hypertension (RH). Eight TA patients with RH underwent percutaneous transluminal renal artery stenting (PTRAS). Patients were followed up 1, 6, 12, and 24months postoperatively for levels of blood pressure, number of antihypertensive drugs being taken, levels of serum creatinine, and the presence of renal artery restenosis. All 8 patients were successfully followed up 1, 6, and 12months postoperatively, but 1 was lost to follow-up at 24months. All patients had significantly lower average blood pressure levels compared with those at baseline (P<0.05); treatment efficacy rates (recovery or improvement) at 1, 6, 12, and 24months were 94%, 90%, 80%, and 80%, respectively. The average number of antihypertensive drugs being taken was 3.5 at baseline, 1.0 at 1month, 0.5 at 6months, 1.0 at 12months, and 1.5 at 24months. Serum creatinine levels during the follow-up period were not significantly different from those at the baseline. No patient developed renal artery restenosis during the follow-up period. PTRAS is a safe and effective treatment for TA-associated RH, with a high technical success rate and a low complication rate. This interventional therapy can effectively control TA-related hypertension and can also preserve and even improve kidney function.

Endothelial Nitric Oxide Synthase 3 (eNOS3) Gene Polymorphisms and Essential Hypertension in Javanese Ethnic Group

Hypertension is still a major public health problem in Indonesia and in several other countries. This disease is caused by multi factorial components involving both environmental and genetic factors. eNOS3 gene is one of the enzymes related to the high prevalence of hypertension. This gene expresses the NOS enzyme which regulates the synthesis of NO. NOS enzyme causes vasodilatation which decreases peripheral resistance and lowers blood pressure. This cross sectional study compared hypertension patients to those with normal blood pressure in the age group of 40-80 years old. The main purpose of this study is to evaluate the influence of eNOS3 gene Glu298Asp allele expression in Javanese ethnic group patients with hypertension. The samples consist of 50 respondents with hypertension and 50 respondents with normotension as control. Data of eNOS3 gene polymorphisms and NO plasma levels from the respondents were analyzed using t-test and chi-square test. Glu298Asp allele genotype variation in eNOS3 gene was detected by PCR-FRLP using primers G894TF and G894TR and the PCR products were cut using Mbol restriction enzymes. Sequencing result of each polymorphism band shows a typical nucleotide sequence compared to the nucleotide sequence of eNOS3 gene in Gen Bank. The results of this study showed no connection between Glu298Asp allele polymorphism in eNOS3 gene with hypertension in Javanese. There was also no relation between eNOS3 gene polymorphisms with high levels of respondents' NO plasma. Average NO plasma level of hypertension patients is 34,53 µmol/L, whereas average NO level of normal blood pressure is 32,5 µmol/L.Keywords: Allele Glu298Asp, eNOS3 gene, G894T, hypertension, Javanese ethnic, NO plasma levelÂ

OP-032 Comparison of CETP Mass and Activity Levels Between Patients with Coronary Atherosclerosis and Healthy Subjects Although Having Higher HDL-C Levels

A B S T R A C T S the leading disease, follow by arrhythmia, then congestive heart failure. Congestive heart failure was diagnosed in 19,6% cases. Congenital heart diseases was diagnosed in 5,9% of studied population. The most diagnosed pathology was isolated ventricular septal defect and tetralogy of Fallot. Post-rheumatic valvulopathies and congenital heart diseases are the first aetiological factor of congestive heart failure in young. Results: Patients with severe hypertension, congestive heart failure, symptomatic arrhythmias were admitted for more investigations and proper care. After the compensation drug treatment, patient needed surgery, underwent surgical procedure. The hospital mortality rate was 0,2%. The poor compliance and limited finances gives the follow-up difficult. Conclusion: This study confirms that rheumatic heart disease still accounts for a major proportion of all cardiovascular diseases in children and young adults in African countries. Rapid urbanization and transition from agrarian life to the wage-earning economy of city life continue to fuel increases in average blood pressure levels and prevalence of hypertension.

Blood pressure variability assessed by home measurements: a systematic review

Accumulating evidence suggests that day-by-day blood pressure (BP) variability assessed using self-measurements by patients at home (HBPV) provides useful information beyond that of average home BP. This systematic review summarizes the current evidence on day-by-day HBPV. A systematic literature search (PubMed) revealed 22 eligible articles. Independent prognostic value of day-by-day HBPV for cardiovascular events and total mortality was demonstrated in two outcome studies, whereas novel indices of variability had minimal or no independent prognostic ability. Although findings are not consistent among the studies, the evidence suggests that HBPV has an independent role in the progression of preclinical cardiac, arterial and renal damage and is affected by age, gender, average BP and heart rate level, antihypertensive treatment, antihypertensive drug class and other factors. However, there is large diversity among the available studies in the home BP monitoring protocols, the indices used to quantify HBPV and the end points selected for evaluation. Overall, these preliminary data largely based on heterogeneous studies indicate an important and independent role of day-by-day HBPV in the pathogenesis of hypertension-induced cardiovascular damage. Yet, fundamental questions remain unanswered, including the optimal variability index, the optimal home monitoring schedule required, the threshold that defines increased HBPV and the impact of treatment-induced variability change on organ damage and cardiovascular events. Until these questions are adequately addressed in future studies, HBPV should largely remain a research issue with limited practical value for individual patients.

Relationship between Blood Pressure Variability and the Quality of Life

PurposeBlood pressure variability (BPV) is emerging as an important cardiovascular prognostic factor in addition to average blood pressure level. While there have been some suggestions for the determinants of the blood pressure variability, little is known about the relationship between the blood pressure variability and health-related quality of life (QOL).Materials and MethodsFifty-six men and women with mild hypertension were enrolled from local health centers in Republic of Korea, from April to October 2009. They self-monitored their blood pressure twice daily for 8 weeks. Pharmacological treatment was not changed during the period. Standard deviation and coefficient of variation of blood pressure measurements were calculated as indices of BPV. Measurements of QOL were done at initial and at 8-week follow-up visits.ResultsStudy subjects had gender ratio of 39:41 (male:female) and the mean age was 64±10 years. The mean home blood pressure's at week 4 and 8 did not differ from baseline. Total score of QOL at follow-up visit and change of QOL among two measurements were negatively correlated to BPV indices, i.e., higher QOL was associated with lower BPV. This finding persisted after adjustment for age, gender and the number of antihypertensive agents. Among dimensions of QOL, physical, mental and hypertension-related dimensions were associated particularly with BPV.ConclusionQOL may be a significant determinant of BPV. Improvement of QOL may lead to favorable changes in BPV.

Childhood determinants of blood pressure and prehypertension in adolescents - results from the SAPALDIA youth study

Background: Hypertension has become the leading risk factor contributing to the global disability adjusted life years. Adolescent hypertension is increasing, possibly due to the obesity epidemic, and is known to track into adulthood. The SAPALDIA Youth Study, a nested study within the adult Swiss Air Pollution And Lung and Heart Disease In Adults cohort (SAPALDIA), aims to investigate early life factors and cardiovascular health in adolescents, with a special focus on active tobacco exposure. Methods: 288 SAPALDIA offspring (mean age 15 years, sd 3.5) underwent clinical examination and reported on early life, health and lifestyle, smoking habits and disease history. Parental determinants and disease status were taken from the SAPALDIA adult cohort data. The mean of two blood pressure measurements, following standard protocols, was calculated for analyses. Prehypertension in childhood was defined as average systolic (SBP) or diastolic blood pressure (DBP) levels ≥90th percentile but <95th percentile for gender, age, and height, respectively in adolescents ≥120/80 mmHg (2). Descriptive and multi-level regression analyses were performed to investigate the independent impact of early life determinants on blood pressure and prehypertension. Results: Prehypertensive values were found in 24%. We confirmed the impact of BMI on SBP (1 mmHg/10 percentile points, 95% CI 0.04,0.14, DBP 0.02 mmHg, 95%Ci -0.02; 0.06), and of high physical activity (≥60 min strenuous activity/day, SBP -3mmHg, 95% CI -6.0; 0.1, DBP -2.2 mmHg, -4.5; 0.1) and found a borderline significance for weekly smoking on SBP (SBP 3.6 mmHg; 95% CI -0.82; 8.0; DBP 2.3 mmHg, 95% CI -1.2; 5.7). Additional adjustment for parental education, smoking and cardiovascular risk strengthened the adverse association seen for weekly smoking. Associations with DBP proved less significant. Similar results were found in analyses with prehypertension. Conclusion: A high percentage of youth presented with prehypertension. Considering the impact of modifiable risk factors, and the high risk of prehypertension turning into clinical hypertension, screening for prehypertension and risk factors in youth should be given full attention to reduce the population risk by optimal metabolic control and lifestyle modification. Reference: 1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics 2004

Prognostic Value of Blood Pressure Variability and Average Blood Pressure Levels in Patients With Hypertension and Diabetes

Elevated blood pressure (BP) is a major risk factor for cardiovascular (CV) events and mortality (1) and a leading contributor to the global disease burden (2). Overwhelming evidence is now available showing that BP measured in the office shows a linear relationship with a number of CV and renal outcomes as well as with overall mortality and that lowering of office BP (OBP) with treatment is effective in reducing morbidity and mortality (3,4). However, application over the last 40 years of techniques for out-of-office BP monitoring including home BP monitoring (HBPM) and 24-h ambulatory BP monitoring (ABPM) has led to further important findings. In particular, 1 ) average BP measured in everyday life conditions may be an even better predictor of CV outcomes than isolated OBP readings and 2 ) the extent of fluctuations of BP over time may provide additional, independent prognostic information compared with both isolated office readings and average ambulatory BP (ABP) levels, respectively. These findings are of upmost relevance in the case of diabetic patients who are characterized by a significantly higher risk of CV events compared with nondiabetic individuals, with diabetes itself currently considered a CV disease equivalent (5,6). The aim of the present article is to review the available evidence on the prognostic importance of BP mean levels and of BP variability (BPV) estimates and to critically evaluate whether antihypertensive treatment strategies should be targeted at reducing not only average BP levels but also the degree of BPV in order to optimize CV protection in diabetic patients. ### Prognostic value of OBP values Consistent evidence from observational studies has indicated that the risk of CV morbidity and mortality has a strong and continuous relationship with OBP levels (3), without any evidence of a threshold down to at least 115/75 mmHg (4). Furthermore, large meta-analyses of major interventional trials …

Abstract 384: Association of Insulin Resistance With Ambulatory Blood Pressure in Normotensive and Prehypertensive Patients

Introduction Hypertension and insulin resistance are well established risk factors for atherosclerosis. Accumulated evidence also suggests that insulin resistance plays a contributory role in the development of essential hypertension. Previous studies have focused on patients with established hypertension, using clinic blood pressure (BP) measurements. Ambulatory Blood Pressure Monitoring (ABPM) records BP at 20-30 minute intervals over 24 hours, providing an average BP exposure over time. We tested the hypothesis that insulin resistance and blood pressure are associated in normotensive and prehypertensive patients, using ABPM to quantify average BP. Methods Data were collected for 140 subjects (87 female, 53 male; 117 non-black, 23 black). In addition to clinic BP, ABPM was used to obtain average SBP and DBP over 24 hours. Insulin resistance (IR) was quantified using the QUantitative Insulin sensitivity ChecK Index (QUICKI), calculated from fasting glucose and insulin levels with the formula QUICKI = 1/(log [Fasting insulin in mU/l] + log [Fasting plasma glucose in mg/dl]). Multiple linear regression was used to assess IR as a predictor of ABPM-derived BP measures, controlling for BMI, gender, age, and race. Results In the entire cohort using ABPM, there was a significant association of IR with DBP24 (p=0.012) but not SBP24 (p=0.11). The association between IR and clinic SBP was marginally significant (p=0.09); DBP NS (p=0.33). After stratifying by gender, IR was significantly associated with SBP24, Daytime SBP (p=0.064, 0.044), DBP24 and Daytime DBP (p=0.02 and p=0.015) in males; no association was found in females. Conclusions This study demonstrates a significant association of IR with average 24-hour DBP in males and females combined. Stratified by gender, our finding using ABPM of a significant association of IR with SBP in males but not in females supports previous findings using clinic BP in the NHANES cohort. In conclusion, these data demonstrate the presence of IR in prehypertension, and lend support to the theory that IR may contribute to later development of sustained hypertension, particularly in males. Additionally, our study highlights the importance of further research using ABPM for a more precise estimate of average BP level.