Average Blood Pressure Values Research Articles

Early myocardial changes in normotensive children of hypertensive parents: a tissue Doppler study.

The aim of this study was to examine early left ventricular systolic and diastolic changes using tissue Doppler imaging (TDI) in normotensive children of hypertensive parents (NCHP), a risk group for cardiovascular diseases. Ninety-two children characterized as NCHP (age range: 6-18 years) and 90 age-, gender-, height-, weight-, and body mass index-matched children characterized as normotensive children of normotensive parents (NCNP) were included in the study. Left ventricular diastolic parameters were assessed using transmitral flow pulse wave Doppler echocardiography and mitral septal and lateral annular TDI. Left ventricular systolic and diastolic function was evaluated globally using the TDI-derived myocardial performance index (MPI'). Mean systolic, diastolic, and average blood pressure values were found to be higher in the NCHP group than in the NCNP group. Echocardiographic parameters in the NCHP group showed statistically significant differences, including increased interventricular septum end-diastolic wall thickness (p = 0.039), left ventricular end-diastolic posterior wall thickness (p = 0.011), relative wall thickness (p = 0.013), and transmitral flow A velocity (p = 0.003); parameters determined by TDI included a prolonged isovolumetric relaxation time (p < 0.001) and isovolumetric contraction time (p = 0.002), shortened ejection time (p = 0.001), and increased MPI' (p < 0.001) in the NCHP group. Early alterations in myocardial function, indicated by increased MPI' values, had a positive correlation with systolic blood pressure and myocardial thickness. Conversely, they were negatively correlated with the ejection fraction and E/A ratio, which decreases with diastolic dysfunction. The MPI' is considered a repeatable, non-invasive, and low-cost assessment method that can surpass conventional methods in the detection of early left ventricular systolic and diastolic functional changes in the subclinical period of hypertension in children with familial risk.

Role and prognostic value of individual ambulatory blood pressure components in chronic kidney disease.

Hypertension is a key risk factor for chronic kidney disease (CKD), but can also be a detrimental consequence of established CKD. Unsurprisingly, the majority of subjects with abnormal creatinine in the general population are also hypertensive, with a huge toll on national health care systems worldwide due to a staggering increase in the risk of cardiovascular complications and end-stage renal disease requiring renal replacement therapy. In this setting, a comprehensive and careful assessment of the whole 24-h blood pressure (BP) profile could be of paramount importance in ensuring a timely diagnosis of hypertension and an optimal therapeutic control. Hence, ambulatory BP monitoring (ABPM) has the potential to become the preferred method for optimal clinical management of CKD patients. ABPM might better define the relationship between BP, target organ damage (TOD), and clinical outcomes. Current evidence suggests that specific day-night BP components, along with average BP values, may have clinical relevance in such patients, despite the suboptimal statistical power of available studies and inconsistencies on the prognostic value of individual BP components. The main aim of our review is to scrutinize the evidence for the usage of ABPM in CKD patients, including the relationship between ambulatory BP recordings and cardiovascular events, and the distinctive features of ABPM in these subjects.

Isolated systolic hypertension of the young and its association with central blood pressure in a large multi-ethnic population. The HELIUS study.

BackgroundIsolated systolic hypertension (ISH) of the young has been associated with both normal and increased cardiovascular risk, which has been attributed to differences in central systolic blood pressure and arterial stiffness.MethodsWe assessed the prevalence of ISH of the young and compared differences in central systolic blood pressure and arterial stiffness between ISH and other hypertensive phenotypes in a multi-ethnic population of 3744 subjects (44% men), aged <40 years, participating in the HELIUS study.ResultsThe overall prevalence of ISH was 2.7% (5.2% in men and 1.0% in women) with the highest prevalence in individuals of African descent. Subjects with ISH had lower central systolic blood pressure and pulse wave velocity compared with those with isolated diastolic or systolic-diastolic hypertension, resembling central systolic blood pressure and pulse wave velocity values observed in subjects with high-normal blood pressure. In addition, they had a lower augmentation index and larger stroke volume compared with all other hypertensive phenotypes. In subjects with ISH, increased systolic blood pressure amplification was associated with male gender, Dutch origin, lower age, taller stature, lower augmentation index and larger stroke volume.ConclusionISH of the young is a heterogeneous condition with average central systolic blood pressure values comparable to individuals with high-normal blood pressure. On an individual level ISH was associated with both normal and raised central systolic blood pressure. In subjects with ISH of the young, measurement of central systolic blood pressure may aid in discriminating high from low cardiovascular risk.

Mean blood pressure among the adults in China 2010-2012: based on the results of mercury sphygmomanometer and converted electronic sphygmomanometer

Objective: To analyze the average systolic blood pressure (SBP) and diastolic blood pressure (DBP) among adults aged 18 years old and above in China between 2010 and 2012; and to compare the difference in the results measured by mercury sphygmomanometer and converted electronic sphygmomanometer. Methods: The data was collected from Chinese Nutrition and Health Surveillance in 2010-2012. 120 428 adults aged 18 years old and above were selected from 150 survey counties (districts) of 31 provinces in China Mainland, by multi-stage stratified and probability proportion to size (PPS) cluster randomization sampling method. The average blood pressure value was calculated from three systolic and diastolic blood pressure readings measured by mercury sphygmomanometer. The value of Electronic Sphygmomanometer was converted by regression formula. Age-standardized results were calculated incorporating a complex sample weighting using the population data from the National Bureau of Statistics in 2009. Results: The overall adjusted mean of SBP based on the value of mercury sphygmomanometer among Chinese adults aged 18 years old and above was 122 mmHg (1 mmHg=0.133 kPa), 124 mmHg in men and 120 mmHg in women. The average SBP value was separately 115, 127, and 137 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average SBP was 122 mmHg in urban and 122 mmHg in rural areas. Mean DBP was 78 mmHg, 79 mmHg in men and 76 mmHg in women. The average DBP was separately 75, 81, and 81 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was 78 mmHg in urban and 77 mmHg in rural areas. The overall adjusted mean of SBP based on converted electronic device was 129 mmHg,130 mmHg in men and 127 mmHg in women, respectively. The mean of SBP was separately122, 134, and 143 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. Mean SBP was both 129 mmHg in urban and in rural areas. Mean DBP was 76 mmHg, 78 mmHg in men and 75 mmHg in women, respectively. The average DBP was separately 74, 79, and 79 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was both 76 mmHg in urban and rural areas. Conclusion: The average SBP and DBP was different between the mercury sphygmomanometer and converted electronic device. However, the results from both measures showed that the blood pressure was higher in men than in women, the blood pressure increased with the increase of age, and there was no difference between urban and rural areas.

The Effect of Head and Neck Radiotherapy on Blood Pressure and Orthostatic Hypotension in Patients With Head and Neck Tumors.

Radiotherapy (RT) plays a key role in the management of head and neck cancer (HNC), especially in locally advanced disease. Patients undergoing head and neck RT, especially elderly ones, are suffering from low and labile blood pressure (BP) during the treatment. They complain of weakness and fatigue and are prone to recurrent falls. The aim of this study was to characterize BP changes during RT period. Patients with HNC, receiving radiation to the neck, were recruited from Sheba medical center RT unit. Office BP, orthostatic measurements, 24-hour ambulatory BP monitoring, body weight, and metabolic parameters were measured at baseline after 30 days and after 90 days from beginning of therapy. Nineteen patients (17 males), 64 ± 12 years old were recruited. Nine hypertensive patients continued their antihypertensive treatment during the study. Office systolic BP and diastolic BP decreased significantly after 30 days (128 ± 4/80 ± 3 to 122 ± 3/74 ± 3 mm Hg; P < 0.05). Average 24-hour BP values after 30 days of RT decreased from 130 ± 3/76 ± 2 to 123 ± 3/71 ± 2 mm Hg; P < 0.05. A similar trend was observed for day and night BP levels. Decrease in office and ambulatory BP was sustained for several months after RT completion. No orthostasis was observed during the study period. Patient lost weight significantly during the study period. However, BP changes were independent of weight loss. There is a significant and sustained BP reduction after head and neck RT, without orthostatic changes. Clinicians should be aware of this phenomenon and consider treatment adaption accordingly.

Wavelet-analysis of central hemodynamics rhythms inpatients with disseminated sclerosis and disturbed cognitive status

The wavelet analysis of rhythm parameters of central hemodynamics in patients with multiple sclerosis (MS) and compromised cognitive status is of great interest for better understanding formation of neurogenic disorders of regulation of blood pressure (BP) associated with organic lesions of brain and higher nervous system at large. Aim. To study circadian hemodynamic parameters in patients with MS depending on cognitive status. Materials and methods. 55 patients with verified diagnosis of disseminated sclerosis (DS) underwent standard neurological examination. A BPLab portable system (Russia) was employed during 24 hours for analysis of diurnal hemodynamic parameters using the BPLab v.2.1 software in combination with the original wavelet analysis for determining the rhythmic structure of individual characteristics and evaluating synchronization and coherence of the described parameters. Results. The observed disturbances of temporal organization of the rhythms of central hemodynamic parameters due to climatic and geographical features of the Northern region in patients with DS manifested themselves as ultradian desynchronosis. In the group of DS patients with cognitive impairment, disintegration of the time structure was characterized by bursts of rhythmic activity in the form of intercalated rhythms with periods of 12, 8 and 6 hours and non-uniform distribution during the diurnal cycle. No increase of the average BP values in the presence of a large number of risk factors for the development of hypertension in the form of non-modifiable and modifiable complications of pathogenetic therapy was documented. Conclusion. The established rigidity of the mechanisms regulating BP in patients with DS may be due to an organic lesion of the autonomic nervous system at the cerebral, spinal or peripheral levels, and even more so to the disturbed higher nervous activity concomitant with impaired cognitive functions. This clinical study may suggest the inverse model of comorbidity (dystrophy) with the abnormal relationship between pressor and depressor mechanisms of BP regulation and leveling the influence of risk factors on the development of arterial hypertension.

Abstract WP446: Increased Nighttime Blood Pressure and Small Vessel Diseases Are Strongly Associated With Cognitive Impairment Increased Nighttime Blood Pressure and Small Vessel Diseases Are Strongly Associated With Cognitive Impairment Ischemic Stroke Patients

Purpose: To explore the relationship between diurnal blood pressure (BP) pattern and small vessel diseases, and cognitive impairment in stroke patients. Methods: Twenty-four hour blood pressure monitoring for every 30 minutes was performed for 415 patients with ischemic stroke in chronic stage. Patients with modified Rankin Scale &gt;2 were excluded. Patients whose Mini Mental State Examination &lt;24 points were diagnosed as having cognitive impairment (CI). Silent lacunae and white matter lesions (WML) on MRI were identified and multiple lacunae and/or confluent WML were estimated as extensive small vessel disease (eSVD). When the nocturnal BP decline, calculated as (daytime BP -nighttime BP) / daytime BP, was more than 1.0, patients were classified as dipper, when 0-1.0 as non-dipper and when less than 0 as riser. Patients were classified into 7 groups. A: single lacuna without CI (n=110), B: multiple lacunae without CI (n=103), C: lacunar infarct with CI (n=70), D: atherothrombotic infarction (ATB) (n=71), E: ATB with CI (n=13), F: cardio embolic infarction (CE) (n=41), G: CE with CI (n=7). Results: Average 24-hour BP values (mmHg) and nocturnal BP decline were calculated. Nocturnal BP decline in the Groups with C, E and G showed significantly lower than group A. The prevalence of riser (%) in the Groups with C, E and G showed significantly higher than group A. The prevalence of eSVD in the Groups with E showed significantly higher than group D (p=0.0011) and groups G showed significantly higher than group F (p= 0.0026). Logistic regression analysis in all patients showed that more than 75 years old (versus less than 65 years old) (OR: 4.0, p=0.0006), eSVD (OR: 23.5, p&lt;0.0001), and non-dipper and riser (versus dipper) (OR: 5.5, p=0.0003 and OR: 16.5, p&lt;0.0001, respectively) were independently associated with CI after adjustment 24-hour averaged systolic blood pressure. Conclusions: Extensive small vessel disease and increased night time blood pressure, especially riser, were strong predictors for cognitive impairment in ischemic stroke patient. In patients with ATB and CE, eSVD was the determinant for cognitive impairment. Nighttime blood pressure, not just daytime blood pressure, should be focused on to prevent post-stroke cognitive impairment.

The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Levels and Incidence of Heart Arrhythmias

Furosemide is a diuretic and is often used in the treatment of hypertension. This medicine is very good when it comes to lowering the blood pressure, and this is also a drug of choice when it comes to the stage of hypertensive urgencies and emergencies. It can be administered intravenously, and the effects reach a maximum within 30 minutes. Due to the fact that this medicine causes a loss of potassium ions it can also affect the reduction of insulin in the blood, and thus the increase in blood glucose and arrhythmias. A prospective random study was carried out in Emergency Medical Service of Public Health Institution Center “Zivinice’’, where we analyzed 120 patients which were suffering from hypertension heart disease, and diabetes. We included all 120 patient whom suffering from hypertension and diabetes starting February till end of July 2016. Data for analysis: age, gender, bodymass index, analysis of the arterial blood pressure value, characteristic laboratory changes, analysis of electrocardiography. Looking at all the three groups of patients, it can be noticed that the maximum value of arterial blood pressure upon arrival at the Emergency Medical service had patients suffering from hypertension and diabetes, where the average value of arterial blood pressure was 173/113 mmHg. According to analysis for all three observed groups of patients, after treatment with furosemide there is no statistical significance in the incidence of arrhythmias between the groups where. Looking at the summary for all three groups of patients, the average value increase of blood glucose after treatment with furosemide is 0.7 mmol/l. Furosemide is safe for the treatment of hypertension in diabetic patients. It does not cause an increase in blood glucose levels.

Comportamiento de los parámetros hemodinámicos evaluados por el monitoreo ambulatorio de presión arterial de 24 horas

ObjetiveTo describe the behavior of hemodynamic parameters in a group of individuals undergoing ambulatory blood pressure monitoring. Material and methodsDescriptive, observational study on the behavior of hemodynamic parameters in ambulatory blood pressure monitoring of a group of patients assisted in two institutions in Medellín. ResultsA total of 108 patients were analysed, assisted between September 2012 and October 2013. Average 24-hour systolic and diastolic blood pressure values were 128.34±12.79mmHg and 75.87±8,74mmHg, respectively. Average pulse pressure was 52.47±11.12mmHg. Day and night blood pressure values were 96.23±9.5mmHg and 85.19±10.23mmHg, respectively. Heart rate was 71.4±10.03 beats per minute, it was 39.38±27.80% for the systolic load and 26.26±24.32% for the diastolic load. ConclusionsAmbulatory monitoring of blood pressure is considered nowadays to be the most reliable and exact method for diagnosing and assessing arterial hypertension. Not only does it allow diagnosis and control of the behavior of blood pressure levels in hypertensive patients, but also assesses other variables, like the ones shown in this study, with results being similar to those of other local studies.

Prevalence of hypertension in a sample of schoolchildren in the Belgrade district.

The aim of this study was to estimate the prevalence of hypertension in a sample of schoolchildren in the district of Vozdovac (Belgrade). This study included 780 pupils from I, III, V and VII classes of a primary school and I and III classes of a high school in the district of Vozdovac (Belgrade). The anthropometric data were obtained from medical records of a regular health survey in 2014-2015. Blood pressure (BP) was measured three times using a mercury sphygmomanometer with a cuff of appropriate size at a 5 min interval. BP values at or above the 95th percentile for age, sex, and height were considered indicative of hypertension. Statistical analysis included descriptive statistics, χ-test, t-test, and correlation analysis. Of the participating students, 15.0% were overweight and 6.7% were obese. A significant negative correlation was observed between BMI categories and age (ρ=-0.126; P<0.01). The average systolic blood pressure values in boys and girls were 105.0±14.1 (range 80.0-150.0) and 102.5±12.3 (range 80-155) mmHg, respectively. The average diastolic blood pressure values in boys and girls were 67.6±8.8 (range 50-100) and 66.2±7.7 (range 50-95) mmHg, respectively. The prevalence of hypertension was 10.5%. A significant positive association was found between the presence of hypertension and age (ρ=0.150, P<0.01) and higher BMI level (ρ=0.115, P<0.01). In our sample of schoolchildren, a high prevalence of hypertension was found. Moreover, elevated BP values correlated strongly with age and BMI.

Efecto de la incorporación de registros adicionales a la presión arterial en la Encuesta Nacional de Salud, Chile 2010

It is of utmost importance to identify hypertensive subjects in a country, in order to use efficiently public resources. The National Health Survey 2009-10 in Chile incorporated a third measurement of blood pressure (BP) during the home visit performed by a nurse, and a second day of measurement in a representative sub-sample. To study the effect of these two additional actions over both the average value of BP and the national prevalence of hypertension. A third blood pressure measurement was carried out in 5,058 subjects, and it was measured in a second day in 930 individuals. The effect of these additional measurements on absolute blood pressure values and the prevalence of hypertension were assessed. A small but statistically significant reduction in mean systolic pressure (0.52 mmHg) and the prevalence of hypertension (1%) was observed after the incorporation of the third blood pressure measurement. No effects in these figures were observed after the measurement performed on a second day. These findings should be considered when designing the new National Health Survey in Chile.

Abstract 06: Long-term Blood Pressure Variability Throughout Young Adulthood and Mid-life Cerebrovascular Structure and Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: In addition to average blood pressure (BP) values, BP variability has been suggested to be associated with lower cognitive function. It is unclear how long-term BP variability throughout young adulthood is associated with cerebrovascular structure (e.g., hippocampus) and function in midlife. Methods: Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which recruited healthy young adults ages 18 to 30 years (mean age 25 years) in 1985-1986, we assessed average BP over visits and visit-to visit BP variability (average real variability [ARV], defined as the absolute differences of BP between successive BP measurements) during 25-year follow-up (8 visits). Normal brain volume, abnormal brain volume, brain integrity assessed by fractional anisotropy, and cerebral blood flow were calculated by 3-Tesla MRI at the Year 25 follow-up (n=557, 52.2 % women, and 34.5 % African Americans). Results: For the 557 participants, mean ARV of SBP was 7.8±3.1 mm Hg. Higher ARV of SBP was associated with lower normal total brain volume, gray matter, and hippocampus after adjustment for covariates including intracranial volume and average BP during follow-up (Table). Higher average SBP during follow-up was associated with higher abnormal brain volume and lower integrity in the whole brain and the white matter, and lower blood flow in the hippocampus. Conclusions: Long-term visit-to-visit BP variability for 25 years beginning in young adulthood was associated with midlife cerebrovascular structural and functional alterations, independent of average BP during follow-up. Focusing not only on BP values alone but also on visit-to-visit BPV may be important to identify younger adults who may be at risk for developing lower cognitive function later.

White coat hypertension in pediatrics.

The article summarizes current information on blood pressure changes in children during clinic visit. White coat as a general dressing of physicians and health care personnel has been widely accepted at the end of the 19th century. Two problems can be associated with the use of white coat: white coat phenomenon and white coat hypertension. Children often attribute pain and other unpleasant experience to the white coat and refuse afterwards cooperation with examinations. Definition of white coat hypertension in the literature is not uniform. It has been defined as elevated blood pressure in the hospital or clinic with normal blood pressure at home measured during the day by ambulatory blood pressure monitoring system. White coat effect is defined as temporary increase in blood pressure before and during visit in the clinic, regardless what the average daily ambulatory blood pressure values are. Clinical importance of white coat hypertension is mainly because of higher risk for cardiovascular accidents that are dependent on end organ damage (heart, vessels, kidney). Current data do not allow any clear recommendations for the treatment. Pharmacological therapy is usually started in the presence of hypertrophic left ventricle, changes in intimal/medial wall thickness of carotic arteries, microalbuminuria and other cardiovascular risk factors. Nonpharmacological therapy is less controversial and certainly more appropriate. Patients have to change their life style, need to eliminate as much cardiovascular risk factors as possible and sustain a regular blood pressure monitoring.

Influence of smoking cessation drugs on blood pressure and heart rate in patients with cardiovascular disease or high risk score: real life setting.

BackgroundSmoking is the most important reversible cardiovascular risk factor. It is well established that quitting smoking reduces coronary events. However, on several occasions, the cardiovascular safety of smoking cessation drugs has been questioned. Our goal is to evaluate the effects of smoking cessation drugs on blood pressure and heart rate in patients from a smoking cessation service in a cardiology hospital.MethodsWe examined the PAF database (Smoking Cessation Assistance Program database) between January 2008 and March 2014. We analyzed data from 900 patients who were compliant with the treatment (50.5 % male, average age 53 ± 17 years). The most frequent clinical diagnoses were coronary artery disease (25.2 %), hypertension (57.2 %), and diabetes (13.4 %). Blood pressure, heart rate, and carbon monoxide (CO) concentration in exhaled air were analyzed at consecutive visits during the first 45 days of treatment (mean visits - 3). Analysis of repeated measures was used for the statistical analysis (p < 0.05).ResultsTwo hundred seventy one patients used nicotine replacement therapy (NRT) alone, 81 used bupropion alone, 154 used varenicline alone, 283 used NRT plus bupropion and 111 used bupropion plus varenicline. For all smoking cessation drugs, used alone or in combination, no increase occurred in the average value of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Significant reductions in CO concentrations occurred in all smoking cessation drug groups.ConclusionSmoking cessation drugs used in monotherapy or in combined regimens did not influence systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in this group of patients during the observation period.

Endocan and Non-Dipping Circadian Pattern in Newly Diagnosed Essential Hypertension.

Background and ObjectivesNon-dipper hypertension is frequently accompanied by endothelial dysfunction and activation. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. This study aims to investigate the association between circadian blood pressure (BP) pattern and plasma endocan levels together with high-sensitivity C-reactive protein (hsCRP) in patients with newly diagnosed untreated hypertension.Subjects and MethodsTwenty-four hour ambulatory blood pressure monitoring was recorded in 35 dipper, 35 non-dipper hypertensives and 35 healthy controls. Endocan levels were measured by enzyme-linked immunosorbent assay. Serum levels of hsCRP were also recorded.ResultsDespite similar daytime and 24-hour average BP values between dippers and non-dippers, statistically significant high nocturnal BP was accompanied by a non-dipping pattern (Systolic BP: 132±9 vs. 147±11 mmHg; Distolic BP: 80±7 vs. 91±9 mmHg, respectively, p<0.001 for both). Non-dipper patients demonstrated higher endocan levels compared to dippers and normotensives (367 (193-844) pg/mL, 254 (182-512) pg/mL and 237 (141-314) pg/ml, respectively, p<0.001). HsCRP levels were significantly higher in non-dippers than the other groups (p=0.013). In a multivariate logistic regression analysis, endocan (p=0.021) and hsCRP (p=0.044) were independently associated with a non-dipping pattern.ConclusionElevated endocan levels were found in non-dipper groups. Endocan and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that elevated levels of endocan in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to the possible future role of endocan in selection of hypertensive patients at higher risk or target organ damage.

Взаємозв’язок добового ритму артеріального тиску з надлишковою масою тіла у пацієнтів з артеріальною гіпертензією та остеоартрозом

&lt;p&gt;&lt;strong&gt;Резюме.&lt;/strong&gt; Важливим фактором у поєднанні остеоартрозу та артеріальної гіпертензії є те, що лікування першого захворювання у багатьох випадках призводить до прогресування іншого. А за наявності ще й надлишкової маси тіла гормони та цитокіни, які утворює жирова тканина, взаємодіють на рівні нейрональних систем, спричиняючи гіперактивацію симпатичної активності, зростання рівня артеріального тиску. Добове моніторування артеріального тиску – єдиний неінвазивний метод артеріального тиску впродовж доби.&lt;strong&gt; &lt;/strong&gt;Отже, у пацієнтів з поєднаним перебігом артеріальної гіпертензії та остеоартрозу відмічається більш істотне збільшення середньодобових значень артеріального тиску, що може бути пов’язане з цілим рядом причин. На підставі аналізу змін показників добового моніторування артеріального тиску виявлено, що при коморбідному перебігу артеріальної гіпертензії та остеоартрозу реєструються достовірно вищі середньодобові значення систолічного артеріального тиску та діастолічного артеріального тиску, збільшується його варіабельність, причому всі наведені зміни прогресують зі збільшенням індексу маси тіла.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;strong&gt;Ключові слова:&lt;/strong&gt; артеріальна гіпертензія, ожиріння, остеоартроз, добове моніторування артеріального тиску, індекс маси тіла.

Abstract P255: Age and Structural Alterations in Subcutaneous Small Resistance Arteries of Hypertensive Patients

Background: It was proposed that early vascular ageing may be an important mechanism of vascular damage in large conductance arteries. However it is not known whether aging may also affect small resistance artery morphology. Patients and Methods: For this reason, we investigated 100 patients with essential hypertension. Secondary forms of hypertension were excluded according to standard clinical evaluations and biochemical or instrumental assessments. In all patients, an evaluation of small resistance arteries morphology was performed by a wire micromyographic approach (Mulvany’s technique). A small amount of subcutaneous tissue was obtained by local biopsy or during election surgery and subcutaneous small resistance arteries were dissected and mounted on a myograph; the media to lumen ratio (M/L) was then measured. Results: The age range of our populaton was 22-81 years, with a mean value of 57±12 years; 14% of them were current smokers, 32% had alterations in lipid patterns, none of them had diabetes mellitus, 58 were males and average blood pressure values were 156/95±19/12 mmHg. We found a significant correlation between M/L and age (r=0.30, p=0.002): the statistical significance of the correlation persisted after correction for counfounding variables (gender, serum cholesterol, smoking status, serum glucose, systolic or diastolic blood pressure values). A statistically significant inverse correlation was also observed between internal diameter and age (r=-0.20, p=0.046), while the correlation beween age and media thickness did not reach statistical significance (r=0.09, p=0.37). Conclusion: Our data suggest that age may affect microvascular structure in hypertensive patients. It is also possible that hypertension may anticipate the effects of physiological aging, and this should be explored in a relatively large population of normotensive subjects.

7D.03

Objective: It was proposed that early vascular ageing may be an important mechanism of vascular damage in large conductance arteries. However it is not known whether aging may also affect small resistance artery morphology. Design and method: For this reason, we investigated 100 patients with essential hypertension. Secondary forms of hypertension were excluded according to standard clinical evaluations and biochemical or instrumental assessments. In all patients, an evaluation of small resistance arteries morphology was performed by a wire micromyographic approach (Mulvany's technique). A small amount of subcutaneous tissue was obtained by local biopsy or during election surgery and subcutaneous small resistance arteries were dissected and mounted on a myograph; the media to lumen ratio (M/L) was then measured. Results: The age range of our population was 22–81 years, with a mean value of 57 ± 12 years; 14% of them were current smokers, 32% had alterations in lipid patterns, none of them had diabetes mellitus, 58 were males and average blood pressure values were 156/95 ± 19/12 mmHg. We found a significant correlation between M/L and age (r = 0.30, p = 0.002): the statistical significance of the correlation persisted after correction for counfounding variables (gender, serum cholesterol, smoking status, serum glucose, systolic or diastolic blood pressure values). A statistically significant inverse correlation was also observed between internal diameter and age (r = -0.20, p = 0.046), while the correlation between age and media thickness did not reach statistical significance (r = 0.09, p = 0.37). Conclusions: Our data suggest that aging may affect microvascular structure in hypertensive patients. It is also possible that hypertension may anticipate the effects of physiological aging, and this should be explored in a relatively large population of normotensive subjects.

Telemonitoring Blood Pressure by Secure Message on a Patient Portal: Use, Content, and Outcomes.

Secure messages on a patient portal allow patients to asynchronously communicate with their healthcare teams. Patients can use this mode of communication to transmit data such as home blood pressure (BP) measurements. In this retrospective study, we examined 52,373 secure messages for content related to home BP monitoring. Text searches of the messages were followed by manual message review to identify BP-related messages. Two physicians independently reviewed a sample of these messages and the provider responses. Of 19,545 total message users, there were 4,412 message users with a diagnosis of hypertension and 365 who sent BP-related messages. Of the 52,373 secure messages, 624 messages (1.2%) contained information about home BP. Providers responded to messages with a change in medication dose or a prescription in 17%. When new medications were recommended, providers needed more pharmacy information in 53%. Messages contained a concern about high BP in 27% and concern about low BP in 8.5%. BP data in patient messages only attained American Heart Association-endorsed measurement criteria in 7% of messages. Patient-generated secure messages with BP data often result in message responses from providers for a BP medication dose change or a new prescription. Despite its increasing use, BP management by secure message has significant limitations and might be better served by BP virtual visits (e-visits) containing specific data requirements such as an average BP value from at least 12 readings and a preferred pharmacy for a prescription.

Trends in cohort effects of cardiovascular disease mortality in Japan, 1950-2010

The average systolic blood pressure value among Japanese individuals has decreased rapidly from a peak in 1965 to 1990, and cardiovascular disease mortality has correspondingly decreased. The age-adjusted ischemic heart disease mortality rate has also decreased. However, the westernized lifestyle, with its associated effects on development of cardiovascular disease, is increasing rapidly in Japan. Consequently, there are concerns that the current reduction in the cardiovascular disease mortality rate will cease and actually increase in the near future. We used an age-period-cohort (APC) model to decompose cardiovascular disease mortality trends into individual effects of age, period, and cohort to analyze the cohort effects of cardiovascular disease. We used 5-year interval vital statistical data from 1950-2010 to create 13 classes. Subjects aged 30-89 years were divided into 5-year age groups to create 12 classes. Birth cohorts in this analysis included individuals born from 1861 to 1865, which corresponded to individuals aged, 85 to 89 years in 1950, up to individuals born from 1976 to 1980, who were 30 to 34 years old in 2010. A total of 24 groups were created. We estimated the effect of each characteristic using the sequential method in APC analysis with the assumption that age effects are predominant. The period effects of cardiovascular disease mortality declined consistently. However, the cohort effects, which declined until the cohort born in 1988, stopped declining or increased slightly in men and women born around 1938 and 1943, respectively. The results showed a consistent decline in period effects on cardiovascular mortality, which presumably reflect improved living, healthcare, and medical environments. However, analysis of cohort effects did not show a steady decline in younger generations. Decreased average systolic blood pressure among Japanese citizens is associated with reduced risk of cardiovascular disease. If a westernized lifestyle also plays a part in the cohort effects and is associated with the observed slowdown or cessation of reduced systolic blood pressure, it is possible that the number of cardiovascular deaths may increase in younger generations. This possibility needs to be taken into consideration in future implementation of public health activities.