Average Blood Pressure Levels Research Articles

WITHDRAWAL OF ANGIOTENSIN ANTAGONISTS IN ELDERLY CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension guidelines worldwide recommend first-line treatment with Angiotensin Convertor Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) in almost all groups of patients. Nevertheless, some population as elderly or CKD patients at high risk to develop renal complications may benefit from avoidance of these commonly used drugs. Design and method: We reviewed our registry of out-hospital patients who had to suspend ACEI or ARBs treatment selecting those without kidney loss, known renal artery stenosis, active neoplasms or drug withdrawal in a condition of Acute Kidney Injury and we performed 12 months follow up. Finally, 36 resulting patients completed the one year period and data of basal, three months and 12-month visits have been compared. A case-control study examining the glomerular filtration rate (GFR), first-day urine albuminuria, blood pressure control and plasmatic potassium has been performed. Results: Baseline characteristics: 17 males and 19 females both with an average age of 78.3 (SD 7.7) years, Charlson's comorbidity index of 6.8 (SD 2), 14 treated previously with ACEI and 22 with ARBs. Comparison of average blood pressure, GFR, proteinuria and potassium levels showed: 1. There were no significant variations in blood pressure at 3 and 12 months. 2. GFR increased at 3 and 12 months from 31.9 (SD 9.4) to 39.6 (SD 14.9) and 43.1 (SD 17.3) ml/min/1.73m2 [p < 0.001] 3. Plasma potassium level decreased at 3 and 12 months from 5.1 (SD 0.6) to 4.7 (SD 0.5) and 4.6 (SD 0.5) mg/dl respectively [p < 0.001] 4. First-day urine albuminuria increased significantly at the 12-month visit in the overall group(from 127.4 (SD 301.8) to 233 (SD 557) mg/g, p < 0.05). Nevertheless, no significant change was observed in the group of 27 patients without significant previous proteinuria (from 13.9 (SD 16.8) to 21.5 (SD 24.8), p = 0.1 NS). Conclusions: Elderly patients with prolonged hypertension are at risk to develop slowly progressive kidney failure associated with the use of ACEI and ARBs, especially if renal atrophy is present. These patients without previous proteinuria would benefit from the first-line use of antihypertensive drugs without suppressive effect over the renin-angiotensin system.

Immediate and 24-h blood pressure-lowering effects of arm crank exercise in patients with traumatic lower-limb amputation: a randomized cross-over study.

This study aimed to investigate the clinic and 24-h postexercise hypotension (PEH) after a moderate-intensity arm crank exercise session in individuals with traumatic lower-limb amputation. Nine men (46±17 years) with unilateral traumatic lower-limb amputation participated in two experimental sessions conducted randomly: an aerobic exercise (EXE: arm crank ergometer, 30 min) or a control session (CON: participants remained seated on the cycle ergometer, 30 min). Clinic and 24-h systolic, diastolic, and mean blood pressure (BP) response were measured after both sessions. The clinical measurements of blood flow and forearm vascular resistance (FVR) were also performed. Compared with the preintervention period, the BP levels did not change in the CON session. However, EXE resulted in a significant hypotensive effect in systolic (-10±0.9 mmHg, P≤0.05), diastolic (-11±1.5 mmHg, P≤0.05), and mean BP (-11±1.2 mmHg, P≤0.05) during the entire postexercise period. The PEH was accompanied by a decreased FVR over the entire postintervention period (P≤0.05). Significant reductions were found for 24-h average systolic, diastolic, and mean BP levels (P=0.03, 0.01, and 0.02, respectively) following EXE compared with the CON session. These results showed, for the first time, that individuals with traumatic lower-limb amputation presented immediate and 24-h PEH after a single bout of arm crank exercise testing. The PEH at the clinic condition was justified, at least in part, by the reduction in peripheral FVR.

The role of home monitoring of blood pressure in evaluating the susceptibility to drugs for treatment essential hypertension

The objective: analysis of the informative value of home blood pressure monitoring (BP) in comparison with complex monitoring of blood pressure (daily, office and home) in determining sensitivity to antihypertensive drugs.Materials and methods. An open prospective comparative study was conducted with the participation of 120 patients aged 45-74 with essential stage II arterial hypertension (AH). Most patients have a high risk of cardiovascular and cerebrovascular complications. The average duration of hypertension was 8.3±2.4 years. The average level of systolic blood pressure was 162.4±5.5 mm Hg, the diastolic blood pressure was 103.3±4.8 mm Hg. All patients were examined according to the Unified Protocol, identifying the risks of cardiovascular and cerebrovascular complications.Results. In the article, the informative value of home blood pressure monitoring was determined in comparison with the complex monitoring of blood pressure (daily, office and home) in determining sensitivity to antihypertensive drugs.The conclusion. The analysis shows that home monitoring of blood pressure (BP) by informative value is not inferior to complex AO monitoring, but it brings less inconvenience to the patient. Due to certain limitations in the use of daily monitoring of blood pressure or complex monitoring of blood pressure, home monitoring of blood pressure can be recommended as a less informative method in determining sensitivity to antihypertensive drugs in the practice of a family doctor.

Glaucomatous Optic Neuropathy Associated with Nocturnal Dip in Blood Pressure: Findings from the Maracaibo Aging Study

To determine which nocturnal blood pressure (BP) parameters (low levels or extreme dipper status) are associated with an increased risk of glaucomatous damage in Hispanics. Observational cross-sectional study. A subset (n= 93) of the participants from the Maracaibo Aging Study (MAS) who met the study eligibility criteria were included. These participants, who were at least 40 years of age, had measurements for optical tomography coherence, visual field (VF) tests, 24-hour BP, office BP, and intraocular pressure <22 mmHg. Univariate and multivariate logistic regression analyses under the generalized estimating equations (GEE) framework were used to examine the relationships between glaucomatous damage and BP parameters, with particular attention to decreases in nocturnal BP. Glaucomatous optic neuropathy (GON) based on the presence of optic nerve damage and VF defects. The mean age was 61.9 years, and 87.1% were women. Of 185 eyes evaluated, 19 (26.5%) had signs of GON. Individuals with GON had significantly lower 24-hour and nighttime diastolic BP levels than those without. However, results of the multivariate GEE models indicated that the glaucomatous damage was not related to the average systolic or diastolic BP levels measured over 24 hours, daytime, or nighttime. In contrast, extreme decreases in nighttime systolic and diastolic BP (>20% compared with daytime BP) were significant risk factors for glaucomatous damage (odds ratio, 19.78 and 5.55, respectively). In this population, the link between nocturnal BP and GON is determined by extreme dipping effects rather than low nocturnal BP levels alone. Further studies considering extreme decreases in nocturnal BP in individuals at high risk of glaucoma are warranted.

ПСИХОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПОДРОСТКОВ С ЭССЕНЦИАЛЬНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ

Background. The inconsistency of data about psychological profile of adolescents with essential arterial hypertension (EH), as one of the most important factor in the pathogenesis of this disease, causes the relevance of searching the relationship between psychological traits and features of the circadian blood pressure (BP).organization. The aim of this study was to study the association between personality characteristics and parameters of 24-hour blood pressure monitoring in adolescents with EH. Materials and methods. We carried out an investigation of 14-17 year old (15.92 ± 1.12) Caucasian male patients with EAH (n = 110) in clinic Scientific Centre for Family Health and Human Reproduction Problems. Psychological testing and ambulatory blood pressure monitoring (ABPM) have been carried. Results. In our study were determined some most significant psychological features which associated with different ABPM parameters and EH stabilization. Increased hypertension, manifested in excessive activity, irritability, anger and intractability, is associated with the stabilization of EH in adolescents. The ability to express emotions verbally or physically (including a constructive way) protects the cardiovascular system from excessive fluctuations of night blood pressure. Psychological profile with the leading pattern of anxiety-aggressive affect suppression (irritation, touchiness, anxiety, introversion) mainly influence to the time of hypertension and average daily level of blood pressure. Conclusion. Adolescents with EH with certain emotional and personal characteristics need to be treated by the differentiated psychotherapeutic interventions. These conditions are necessary for early prevention of complications of cardiovascular circadian organization disorders.

Effects of intranasal mometasone furoate on blood pressure in patients with allergic rhinitis.

Background: Nasal congestion as the main symptom in patients with allergic rhinitis can impair nasal breathing. It causes hypoxia and concomitant sympathetic system activation, which may also lead to increased blood pressure levels in these patients. Objective: We postulated that appropriate therapy, including intranasal steroids, decreases blood pressure levels in patients with allergic rhinitis. Methods: In our study, we investigated the effect of intranasal steroid (4 weeks of mometasone furoate) on blood pressure changes in 45 patients with allergic rhinitis whose main complaint was nasal congestion. We used ambulatory monitoring for determining blood pressure levels before and after intranasal steroid therapy. None of the patients had any other systemic diseases. Results: We found a significant decrease of daytime systolic and diastolic blood pressures and mean blood pressure values (daytime systolic blood pressure: 120 vs. 117 mmHg, p = 0.024; daytime diastolic blood pressure: 73 vs. 71 mmHg, p = 0.027; daytime mean blood pressure: 86 vs. 83 mmHg, p = 0.007). Although insignificant, we also found lower night-time systolic and mean blood pressure values (nighttime systolic blood pressure: 109 vs. 107 mmHg, p = 0.182; nighttime mean blood pressure 77 vs. 73 mmHg, p = 0.116). Conclusions: We found that post-treatment daytime average systolic, diastolic, and mean arterial blood pressure levels were significantly lower compared to values obtained during exacerbation of allergic rhinitis. Decrease in blood pressure with treatment of allergic rhinitis and nasal congestion suggests that nasal congestion and impaired nasal respiration may affect blood pressure and potentially cause serious problems in hypertensive patients with allergic rhinitis.

Long-term follow-up of intensive glycaemic control on renal outcomes in the Veterans Affairs Diabetes Trial (VADT).

We conducted an analysis of data collected during the Veterans Affairs Diabetes Trial (VADT) and the follow-up study (VADT-F) to determine whether intensive (INT) compared with standard (STD) glycaemic control during the VADT resulted in better long-term kidney outcomes. VADT randomly assigned 1791 veterans from 20 Veterans Affairs (VA) medical centres who had type 2 diabetes mellitus and a mean HbA1c of 9.4±2% (79.2mmol/mol) at baseline to receive either INT or STD glucose control for a median of 5.6years (randomisation December 2000 to May 2003; intervention ending in May 2008). After the trial, participants received routine care through their own physicians within the VA. This is an interim analysis of the VADT-F (June 2008 to December 2013). We collected data using VA and National databases and report renal outcomes based on serum creatinine, eGFR and urine albumin to creatinine ratio (ACR) in 1033 people who provided informed consent to participate in the VADT-F. By the end of the VADT-F, significantly more people who received INT treatment during the VADT maintained an eGFR >60mlmin-1 1.73m-2 (OR 1.34 [95% CI 1.05, 1.71], p=0.02). This benefit was most evident in those who were classified as at moderate risk (INT vs STD, RR 1.3, p=0.03) or high risk (RR 2.3, p=0.04) of chronic kidney disease on the Kidney Disease Improving Global Outcomes (KDIGO-CKD) at the beginning of VADT. At the end of VADT-F, significantly more people from the INT group improved to a low KDIGO risk category (RR 6.1, p=0.002). During the VADT-F there were no significant differences between INT and STD for average HbA1c, blood pressure or lipid levels. After just over 11years of follow-up, there was a 34% greater odds of maintaining an eGFR of >60mlmin-1 1.73m-2 and of improving the KDIGO category in individuals with type 2 diabetes who had received INT for a median of 5.6years. VADT clinical trials.gov number: NCT 00032487.

Treating Visit-to-Visit Blood Pressure Variability to Improve Prognosis: Is Amlodipine the Drug of Choice?

Blood pressure (BP) levels are linearly associated with cardiovascular risk, and hypertension is the most common modifiable risk factor for cardiovascular disease.1 Moreover, antihypertensive treatment-induced BP lowering has been associated with reduction in all outcomes (stroke, heart failure, coronary events, cardiovascular, and all-cause mortality).2 Apart from the established knowledge regarding the importance of hypertension and its effective treatment, during the last years, there has been an increasing interest in the possibility that BP variability (BPV) might carry an additional contribution to cardiovascular risk, on top of the impact of mean BP levels. BP fluctuates constantly and its variability not only may have diagnostic implications regarding the accurate assessment of hypertension but also seems to exert additional stress on the cardiovascular system over and above average BP levels.3 Different components of BPV have been identified, characterized by BP fluctuations between hours, days, or months/years, respectively, termed as short-, mid-, and long-term components.3 All these types of BPV have been shown to carry an independent prognostic value in terms of cardiovascular events and all-cause and cardiovascular mortality.4–10 Three interesting articles have been recently published in this journal regarding long-term visit-to-visit BPV (VVV). Tedla et al11 showed that an increased VVV among 1122 untreated individuals was predictive of arterial stiffness progression after 10 years of follow-up. The 2 remaining papers reported data on the prognostic value of systolic VVV coming from 2 major trials: the observational extension of the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation)12 and the SPRINT (Systolic Blood Pressure Intervention Trial).13 However, it seems that at the present time, despite the accumulating evidence on the clinical relevance of VVV, the latter still remains a research tool failing to provide clinical application in …

PP.16.11] RELATIONSHIP BETWEEN BLOOD PRESSURE VARIABILITY AND COGNITIVE FUNCTION IN ELDERLY PATIENTS WITH STRICT BLOOD PRESSURE CONTROL

Objective: Although higher blood pressure (BP) level and BP variability has been associated with decline cognitive function, data are sparse regarding to the relationship between BP variability and cognitive function in elderly patients with strict BP control. The aim of this study is to test the hypothesis whether BP variability using ABPM would be associated with cognitive function assessed by MoCA in the population who has already achieved strict home BP control from DCAP Netwrok. Design and method: We analyzed 232 patients from the Disaster CArdiovascular Prevention (DCAP) network, which developed a web-based home BP monitoring to achieve BP control for the support in disaster area after East Japan Earthquake. All patients were performed ambulatory BP monitoring and the Japanese version of Montreal Cognitive Assessment (MoCA-J). Results: The mean age was 77.7 years, 33.6% were male, and 85.3% were administrated anti-hypertensive drug. Average 24-hour BP level was 118.7 ± 10.0/68.3 ± 6.4 mmHg. When we divided weighted standard deviation of systolic BP (SBP) as measure of BP variability into quartiles, the top quartile group was significantly lower total MoCA-J score (15.4 [95% confidence interval 14.2–16.7] vs. 17.9 [17.2–18.6]) and its domains, visuoexecutive (2.2 [1.9–2.6] vs. 2.8 [2.6–2.9]), abstraction (1.0 [0.7–1.2] vs. 1.3 [1.1–1.4]), attention (2.8 [2.4–3.1] vs. 3.6 [3.4–3.8]), and naming (2.1 [1.9–2.3] vs. 2.5 [2.4–2.6]) than the group of other quartiles after adjusted by age and 24-hr SBP. These associations were not found in the quartiles of 24-hour SBP. Conclusions: In elderly patients with strict ambulatory BP control, higher BP variability, not average ambulatory BP level, was associated with cognitive decline.

Relationship Between Blood Pressure Variability and Cognitive Function in Elderly Patients With Good Blood Pressure Control.

Although higher blood pressure (BP) levels and BP variability have been associated with cognitive impairment, data are sparse regarding the relationship between BP variability and cognitive function in elderly patients with well BP control. We analyzed 232 ambulatory patients with one or more cardiovascular risk factors. All patients underwent ambulatory BP monitoring and the Japanese version of the Montreal Cognitive Assessment (MoCA-J). The mean age was 77.7 ± 8.3 years; 33.6% were male, and 85.3% were taking antihypertensive drugs. The average 24-hour BP level was 118.7 ± 10.0/68.3 ± 6.4 mm Hg. When we divided the weighted SD of systolic BP (SBP) as a measure of BP variability into quartiles, the top quartile group (≥19.6 mm Hg) had a significantly lower total MoCA-J score (15.4 [95% confidence interval 14.2-16.7] vs. 17.9 [17.2-18.6], P = 0.001) and lower scores on several domains, visuoexecutive (2.2 [1.9-2.6] vs. 2.8 [2.6-2.9], P = 0.012), abstraction (1.0 [0.7-1.2] vs. 1.3 [1.1-1.4], P = 0.015), attention (2.8 [2.4-3.1] vs. 3.6 [3.4-3.8], P = 0.001), and naming (2.1 [1.9-2.3] vs. 2.5 [2.4-2.6], P = 0.001) than quartiles 1 through 3 combined, after adjustment for age and 24-hour SBP. These associations were not found in the quartiles of 24-hour SBP. In elderly patients with well ambulatory BP control, higher BP variability but not average ambulatory BP level was associated with cognitive impairment.

Role of ambulatory blood pressure monitoring for the management of hypertension in Asian populations.

Out-of-clinic blood pressure (BP) measurement, eg, ambulatory BP monitoring, has a strong association with target organ damage and is a powerful predictor of cardiovascular events compared with clinic BP measurement. Ambulatory BP monitoring can detect masked hypertension or various BP parameters in addition to average 24-hour BP level. Short-term BP variability assessed by standard deviation or average real variability, diminished nocturnal BP fall, nocturnal hypertension, and morning BP surge assessed by ambulatory BP monitoring have all been associated with target organ damage and cardiovascular prognosis. Recently, the authors compared the degree of sleep-trough morning BP surge between a group of Japanese and a group of Western European untreated patients with hypertension and found that sleep-trough morning BP surge in Japanese persons was significantly higher than that in Europeans. Although Asian persons have been known to have a higher incidence of stroke than heart disease, the difference in characteristics of BP indices assessed by ambulatory BP monitoring might be the cause of racial differences in stroke incidence between Asian and Western populations. This review focuses on Asian characteristics for the management of hypertension using ambulatory BP monitoring.

Prevalence of arterial hypertension in the Krasnoyarsk Krai (Siberia, Russia)

BackgroundTo estimate the prevalence, awareness, treatment and control of arterial hypertension among adult inhabitants of Krasnoyarsk Krai using the data from Russian multicenter epidemiological study ESSE-RF (Epidemiological Survey of cardiovascular diSEases in different regions of the Russian Federation).MethodsThe study included 1603 subjects 25 to 64 years old selected by means of systemic multistage stratified randomization among urban and rural inhabitants of Krasnoyarsk Krai recruited between February 2014 and June 2014. Office blood pressure (BP) was measured twice with “Omron” automated BP device on the right arm in the sitting position in presence of medical personnel. Arterial hypertension (HTN) was defined as systolic BP of at least 140 mmHg and/or diastolic BP of at least 90 mmHg or self-reported previous elevated BP registration or use of antihypertensive treatment. Treatment efficacy was defined as percentage of patients achieved the target BP level among those who received antihypertensive medications, and HTN control as percentage of people achieved the target BP level among all hypertensives.ResultsThe gender distribution was 652 males (39.4%) and 951 females (60.6%). The average level of systolic BP was 133.4 ± 0.5 mmHg, diastolic BP – 82.9 ± 0.3 mmHg. The average prevalence of HTN was estimated at 49.4% and appeared to be higher than similar parameter based on the data of 10 regions from the ESSE-RF study (44%). The average prevalence of HTN was estimated at 56.3% in males and 43.7% in females. The HTN prevalence in rural community was significantly higher in comparison with urban community (63.4 ± 2.4 vs. 44.2 ± 1.5%, p < 0.01). The average rate of HTN awareness in Krasnoyarsk Krai was 77.9% (average Russian value from ESSE-RF study was 73.1%). The average use of antihypertensive treatment, its efficacy and HTN control in Krasnoyarsk Krai were estimated at 59.5%, 31.6% and 18.8%, respectively.ConclusionsEstimated prevalence of HTN in Krasnoyarsk Krai is higher than the average Russian parameter. The average HTN prevalence among men is higher than in women. The rural inhabitants are more likely to have hypertension compared with urban inhabitants. Despite high levels of HTN awareness and antihypertensive medication intake, the antihypertensive treatment efficacy in Krasnoyarsk Krai appeared to be lower in comparison with average Russian ESSE-RF values.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION: VASCULAR WALL AS THE TARGET ORGAN IN COMORBID PATIENTS

Studies of endothelial dysfunction in patients with respiratory diseases have become relevant in recent years. Perhaps endothelial dysfunction and high arterial stiffness bind bronchopulmonary and cardiovascular diseases. Aim . To reveal features of disturbances of arterial wall vasoregulatory function in patients with chronic obstructive pulmonary disease (COPD) in the presence and absence of arterial hypertension (HT). Material and methods . The study included 50 patients with COPD with normal blood pressure (BP) and 85 patients with COPD and HT. Control group was presented by 20 practically healthy men comparable in age with COPD patients. Tests with reactive hyperemia (endothelium-dependent dilation) and nitroglycerin (endothelium-independent dilation) were performed in order to evaluate endothelium function. The number of desquamated endotheliocytes in the blood was determined. Results . In patients with COPD and HT in comparison with COPD patients without HT and healthy individuals more pronounced damages of the vascular wall, endothelium vasoregulatory function disturbances and a tendency to the reduction in endothelium-dependent vasodilation were determined both during COPD exacerbation and remission. These differences were most pronounced during the COPD exacerbation. In patients with COPD and HT in comparison with COPD patients without HT the damage of the vascular wall was more pronounced during the remission and endothelium-dependent dilatation disorder – during the exacerbation. The revealed disorders in patients with COPD and HT were associated with smoking status (r=0.61, p<0.01), severity of bronchial obstruction (r=-0.49, p<0.05), and hypoxemia (r=-0.76, p<0.01). We noted relationships between the parameters of 24-hour BP monitoring and remodeling of the brachial artery (r=0.34, p<0.05), endothelium lesion (r=0.25, p<0.05), and impairment of its vasoregulating function (r=-0.58, p<0.05). At that, the following parameters were important: the average systolic and diastolic BP levels, the BP load and variability indices, the time and rate of morning surge in systolic BP, and the circadian rhythm of BP. Conclusion . The obtained data show the aggravation of the severity of the vascular wall damages and the reduction in the endothelium vasoregulating activity in patients with COPD after development systemic HT. This effect is more evident during the exacerbation of bronchopulmonary disease.

Abstract 13936: The Role of Telehomecare in Blood Pressure Monitoring for Heart Failure Patients

Introduction: Introduced in 2007 by the Ontario Telemedicine Network, the Telehomecare program provides monitoring of patient’s parameters and coaching sessions. To date, no study evaluated the effect of Telehomecare on patient clinical monitoring parameters in Ontario. Hypothesis: We hypothesized that blood pressure (BP) would be improved among heart failure patients participating in the Telehomecare. Methods: We applied a time series study design to analyze patients’ BP values, transmitted via telemonitoring devices on a daily basis. The cohort included heart failure patients enrolled in the Telehomecare program from July 2012 to July 2015. The outcome of interest was the change in average (biweekly) systolic and diastolic BP levels over the 6-month program duration. The baseline BP levels were defined as the average of daily measurements for the first 2-week period after enrolment. Data was analysed by repeated measures with generalized linear mixed model procedures in SAS. Sensitivity analyses were conducted for per-protocol cohort, defined as those who had fully completed 6-month program duration. Results: Overall we analyzed data for 2186 heart failure patients (50% women) with average age of 76.0±11.4 years. At baseline, the systolic and diastolic BP levels were 129.2 ±19.8 and 70.4 ±12.7 mm Hg respectively. Over 6-month period systolic BP decreased by -3.5 mm Hg (95% CI: -4.2 to -2.8) and diastolic by -2.5 mm Hg (95% CI: -3.0 to -2.0). At baseline, one third of the patients (n=721) had elevated BP with an average systolic BP of 150.9±10.15 mm Hg and diastolic BP of 78.3±14.1 mm Hg. In a subgroup analyses of this population the reduction in systolic BP was -12.3 mm Hg (95% CI: -13.4 to -11.1) and in diastolic BP was -6.9 mm Hg (95% CI: -7.8 to -6.0) adjusted for age and gender. Similar changes were observed in per-protocol cohort. Conclusions: The systolic and diastolic BP levels significantly decreased in patients with heart failure enrolled in the Telehomecare program. These changes were more pronounced in patients with uncontrolled BP at program entry. Hence Telehomecare program might be a promising tool to help patients in BP management

Visit-to-visit blood pressure variability, average BP level and carotid arterial stiffness in the elderly: a prospective study.

In a cross-sectional study, visit-to-visit blood pressure (BP) variability was shown to be associated with artery remodelling. Here, we investigated the impact of visit-to-visit BP variability and average BP on the carotid artery remodelling progression in high-risk elderly according to different classes of antihypertension medication use/non-use. BP measurements and carotid ultrasound were performed in the common carotid artery in 164 subjects (mean age 79.7 years at baseline, 74.7% females) with one or more cardiovascular risk factors. Based on 12 visits (1 × /month for 1 year), we calculated visit-to-visit BP variability expressed as the standard deviation (s.d.), coefficient of variation (CV), maximum BP, minimum BP and delta (maximum-minimum) BP. We measured mean intima-media thickness (IMT) as well as stiffness parameter β were measured at baseline and at the mean 4.2-year follow-up. In a multiple regression analysis, the maximum, minimum, s.d. and average of systolic BP (SBP) were significantly associated with a change in β-values between the baseline and follow-up after adjustment for age, smoking, lower high-density lipoprotein level, baseline β-value and follow-up period. There were no significant associations between the visit-to-visit BP variability measures and the change in mean IMT. Significant associations of maximum, minimum, s.d. and average SBP were found with increased β-values in the subjects without calcium channel blocker (CCB) use and in the subjects using renin-angiotensin system inhibitors (RASIs). Thus, exaggerated visit-to-visit SBP variability and a high average SBP level were significant predictors of progression in carotid arterial stiffness in high-risk elderly without CCBs use and in those using a RASI.

LBPS 03-05 CHANGE IN BLOOD PRESSURE FOLLOWING NEPAL'S EARTHQUAKE

Objective: On 14th June 2015, a famous media house in Nepal published an article suggesting that blood pressure decreased followed the recent Nepal earthquake. According to the article, two cardiologists were reporting a 50 percent decrease in blood pressure following the earthquake in circa 900 patients. To address this apparent paradox we had the opportunity to contrast blood pressure in the community the earthquake and nine-days after the earthquake. Design and Method: This study is part of a baseline study of a larger community-based cluster randomized controlled trial being conducted in Nepal (NCT02428075). We compared 505 randomly selected respondents whose blood pressure was measured before the earthquake with additional randomly selected 505 respondents whose blood pressure was measured 9 days after the initial earthquake from the same study area. The pre quake and post quake difference in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was estimated through regression analysis in two cross sectional populations, adjusting for sex, age, tobacco, alcohol, body mass index, and fruit and vegetable servings a day. Results: Average Blood Pressure (BP) before and after the earthquake were 125.56/82.24 mmHg and 123.04/80.49 mmHg respectively. The average blood pressure difference at 9 days post earthquake compared to the before 9 days was −0.83 (95% CI: − 2.88; 1.22) mmHg / -−0.74 (95% CI: -−2.02; 0.52) mmHg. In a separate analysis among hypertensive participants (>=120/80 mmHg), SBP and DBP differences were 2.02 (95% CI: -−1.78; 5.83) mmHg and 1.11 (95% CI: -−1.03; 3.26) mmHg respectively after the earthquake. Conclusions: The above results showed no statistically significant difference on the average BP level before and after the earthquake for two randomly selected cross-sectional populations (p > 0.05). The claims by the national daily from Nepal of changes in blood pressure may have been based on other factors that we cannot account for.

Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability.

Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).

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