Average Daytime Blood Pressure Research Articles

Circulating angiotensin-(1-7) is decreased in patients with isolated nocturnal hypertension.

Isolated nocturnal hypertension (INHT), defined as nighttime elevated blood pressure (BP) with normal daytime BP assessed by ambulatory BP monitoring, is associated with higher cardiovascular morbidity and mortality. We hypothesized that an alteration in the circulating renin-angiotensin system (RAS) contributes to INHT development. We examined circulating levels of angiotensin (Ang) (1-7) and Ang II and ACE2 activity in 26 patients that met the INHT criteria, out of 50 that were referred for BP evaluation (62% women, 45 ± 16 years old). Those with INHT were older, had a higher BMI, lower circulating Ang-(1-7) (P = 0.002) and Ang II levels (P = 0.02) and no change in ACE2 activity compared to those normotensives. Nighttime DBP was significantly correlated with Ang-(1-7) and Ang II levels. Logistic regression showed significant association in Ang-(1-7) and Ang II levels with INHT. Our study reveals differences in circulating RAS in individuals with INHT.

Influence of Recent Standing, Moving, or Sitting on Daytime Ambulatory Blood Pressure.

Background There are no recommendations for being seated versus nonseated during ambulatory blood pressure (BP) monitoring (ABPM). The authors examined how recent standing or moving versus sitting affect average daytime BP on ABPM. Methods and Results This analysis used baseline assessments from a clinical trial in desk workers with office systolic BP (SBP) 120 to 159 mm Hg or diastolic BP (DBP) 80 to 99 mm Hg. ABPM was measured every 30 minutes with a SunTech Medical Oscar 2 monitor. Concurrent posture (standing or seated) and moving (steps) were measured via a thigh-worn accelerometer. Linear regression determined within-person BP variability explained (R2) by standing and steps before ABPM readings. Mean daytime BP and the prevalence of mean daytime BP >135/85 mm Hg from readings after sitting (seated) or after recent standing or moving (nonseated) were compared with all readings. Participants (n=266, 59% women; age, 45.2±11.6 years) provided 32.5±3.9 daytime BP readings. Time standing and steps before readings explained variability up to 17% for daytime SBP and 14% for daytime DBP. Using the 5-minute prior interval, seated SBP/DBP was lower (130.8/79.7 mm Hg, P<0.001) and nonseated SBP/DBP was higher (137.8/84.3 mm Hg, P<0.001) than mean daytime SBP/DBP from all readings (133.9/81.6 mm Hg).The prevalence of mean daytime SBP/DBP ≥135/85 mm Hg also differed: 38.7% from seated readings, 70.3% from nonseated readings, and 52.6% from all readings (P<0.05). Conclusions Daytime BP was systematically higher after standing and moving compared with being seated. Individual variation in activity patterns could influence the diagnosis of high BP using daytime BP readings on ABPM.

CLINICAL SIGNIFICANCE OF ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AS A POTENTIAL INDICATOR OF MASKED HYPERTENSION AMONG THE KOREAN ELDERLY

Objective: Although masked hypertension links to adverse cardiovascular outcomes, it is challenging to distinguish individuals with masked hypertension. Studies have demonstrated a significant association between left ventricular hypertrophy (LVH) and masked hypertension. However, it remains unclear whether electrocardiographic LVH has the predictability for masked hypertension. Design and method: The study participants were 511 Korean elderly with well-controlled blood pressure (BP) or normotension who underwent electrocardiography and ambulatory blood pressure monitoring (ABPM). We categorized them into two groups by presence or absence of electrocardiographic LVH. We conducted Pearson correlation analysis (beta coefficient [95% confidence interval] and logistic regression analysis (odd ratio (OR) [95% CI]) to evaluate the association of electrocardiographic LVH with components of ABPM. The area under the receiver operator curve (AUC) was calculated to assess the predictability of electrocardiographic LVH for 24-hour average masked hypertension. Results: Electrocardiographic LVH significantly correlated with 24-hour mean systolic blood pressure (SBP) (5.83 [2.16-9.51]), daytime SBP (5.0 [1.27-8.72]), and nighttime SBP (7.89 [3.49-12.30]). Electrocardiographic LVH showed the increased OR for masked hypertension in 24-hour average BP (2.18 [1.17-4.07]), in daytime average BP (2.03 [1.09-3.79]), and nighttime average BP (1.83 [0.86-3.88]). The receiver operating curve indicated the significant predictability of electrocardiographic LVH for 24-hour average masked hypertension (area under the curve: 0.706 [0.604-0.809]). Conclusions: Electrocardiographic LVH is potentially effective in distinguishing individuals with masked hypertension.

Prognosis and risk factors for the adverse course of the disease in patients with arterial hypertension and its resistant form

Arterial hypertension (AH) is expected to contribute to approximately 13% of all deaths worldwide in the coming years. Objective — to perform retrospective analysis of the factors of the adverse course of the disease in patients with hypertension who were treated in a specialized department for secondary and pulmonary hypertension of the «NSC M. D. The Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine » NAMS of Ukraine. Materials and methods. The analysis involved data from 524 patients who underwent the following standard examinations: measurement of office blood pressure (BP), 24h‑hours BP monitoring, echocardiography, electrocardiography. All patients received a questionnaire in five years after discharge from the hospital. It included questions about previous adverse events (myocardial infarction, stroke, unstable angina that required hospitalization, kidney failure, heart failure, newly diagnosed diabetes, hospitalization for another cardiovascular reason (aortic aneurysm, coronary artery bypass grafting, unstable angina pectoris, etc.). In case of death of a patient, relatives filled in the questionnaire. Adverse events or death were considered as a combined end point (CEP) of the study. Results. The following main factors, associated with the CEP occurrence in the examined patients, have been established: the age of the patient, systolic blood pressure level at discharge from the hospital, the level of pulse blood pressure (PBP) at discharge from the hospital, the presence of postinfarction cardiosclerosis, a history of stroke, increased size of the left atrium, reduced ejection fraction of the left ventricle, increased thickness of the interventricular septum, left ventricular myocardial mass index greater than 137 g/m2, disturbed daily profile of diastolic blood pressure (DBP), average daytime PBP level ≥ 64 mm Hg. The following risk factors were independent from other factors of CEP occurrence: the level of office PBP at discharge from the hospital ≥64 mmHg, reduced ejection fraction of the left ventricle ( 40%), thickening of the interventricular septum &gt;1.2 cm, the mass index of the left ventricle &gt; 137 g/m2, a decrease in BP during the night period&lt;10%, average daytime BP during daily monitoring blood pressure ≥64 mmHg. Among the indicated factors, the following factors didn’t depend on the administered therapy: office PBP level ≥64 mmHg at discharge, left ventricular ejection fraction reduced by &lt;40%, violation of the daily blood pressure profile (daily blood pressure index &lt;10%) or average daily blood pressure higher than 64 mm Hg. Factors that significantly increased the CEP risk included systolic blood pressure level ≥160 mmHg (patients with resistant AH) and PBP ≥64 mmHg at discharge from the hospital; the CEP risk was increased by these factors was 84 and 66%, respectively. No significant effects on the frequency of occurrence of the combined end point were established for any group of antihypertensive drugs. Conclusions. Treatment‑resistant hypertension was a determining factor in the development of the combined end point. The degree of arterial pressure decrease was more significant for prognosis than the type of antihypertensive agent that lowered it.

Clinical observation of sacubitril valsartan sodium in the treatment of resistant hypertension: A randomized clinical trial.

To investigate the effectiveness and safety of sacubitril valsartan sodium in the treatment of resistant hypertension (RH). This study is a single-center, prospective, randomized controlled study. According to the inclusion and exclusion criteria, patients with RH who met the criteria were screened, and all patients adjusted their drug treatment (valsartan 80 mg, amlodipine 5 mg, and hydrochlorothiazide 12.5 mg). After 4 weeks of drug elution, the random envelope method was used for random grouping. The treatment group took sacubitril valsartan sodium 200 mg, amlodipine 5 mg, hydrochlorothiazide 12.5 mg, and the control group took valsartan 80 mg, amlodipine 5 mg, and hydrochlorothiazide 12.5 mg for 8 weeks. The 24 h ambulatory blood pressure (BP) and the echocardiography index using the office sphygmomanometer were observed in the patients. A total of 100 patients with RH were included in the two groups, with 50 cases in each group. There were no significant differences in sex, age, or comorbid diseases between the two groups. During the 8-week follow-up, the office BP of the research group were significantly decreased (24.78/17.86 mmHg) compared with those of the control group. In the research group the 24 h average BP, daytime average BP, and nighttime average BP were 144.84/79.82, 147.10/82.06, and 138.67/76.31 mmHg at baseline, and reduced to 128.96/73.32, 131.50/74.94, and 122.11/69.27 mmHg at week 8, which were significantly decreased (P < 0.05 or P < 0.01), and the left ventricular ejection fraction was significantly increased (P < 0.05), compared with the control group. Sacubitril valsartan sodium can effectively reduce BP and improve cardiac function in RH.

Glutamatergic Activity in the Nucleus of the Solitary Tract contributes to the Circadian Regulation of Blood Pressure

Cardiorespiratory parameters including blood pressure are governed by a 24‐hour circadian rhythm. Blood pressure follows a circadian cycle and dips during the resting/sleeping period while peaking during the active/awake period. During sleep blood pressure is 10%‐20% lower than average daytime blood pressure, a phenomenon described as “dipping”. The brain regions and mechanisms by which the circadian rhythm of blood pressure is controlled are not fully understood. To address this knowledge gap, we examined the nucleus of the solitary tract (nTS). The nTS is the first central site for integration and modulation of reflexes including the baroreflex. The nTS receives sensory information through glutamate release from baroreceptors that sense changes in blood pressure, eliciting reflex responses in the nTS to maintain BP homeostasis. Previous studies have shown that injections of glutamate or increases of extracellular glutamate decrease blood pressure. Due to its integral role in the autonomic system, we hypothesized that the nTS is involved in circadian blood pressure regulation through alterations in glutamate. Specifically, the present study sought to identify if decreased glutamate raised blood pressure during the active period and if increased glutamate reduced blood pressure in the inactive period. To address this, we used 7‐week‐old male Sprague Dawley rats and a combination of electrophysiology, molecular methods, immunohistochemistry, and 24/7 telemetry. Rats acclimated for 2 weeks prior to telemetry recordings. Measurements were compared at four different time points in one day (6 hours apart) except for electrophysiological recordings which were taken 12 hours apart. During the active period, blood pressure significantly increased in comparison to the inactive period. We next examined the relationship between changes in blood pressure and changes in glutamatergic activity. We first determined if activation of glutamatergic neurons differed across the 4 time periods. We took 30 µm of coronal slices containing the nTS (at the level of area postrema) from perfused animals. Active glutamatergic neurons (denoted by cFos expression) significantly decreased during the active period in comparison to the inactive period. To examine if this increase in glutamatergic neuronal cFos expression correlated with channel expression, we used western blot and found that the expression of AMPA receptors (GluA1 subunit) also decreased during the active period. During the active period, the resting membrane potential of nTS neurons were hyperpolarized in comparison to the inactive period. This lead to a significant decrease in spontaneous excitatory post‐synaptic currents in nTS neurons during the active period. The data indicate that glutamatergic activity decreased during the active period when blood pressure was higher in comparison to the inactive period. Taken together, these results suggest that nTS glutamatergic activity may have a circadian pattern and may contribute to the circadian blood pressure rhythm.

Effectiveness of triple fixed-dose combination in patients with inadequate blood pressure control

Aim. In routine clinical practice, to evaluate the antihypertensive efficacy, 24-hour blood pressure (BP) control, tolerability and effect on arterial stiffness of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril according to office and 24-hour ambulatory BP monitoring (ABPM) in patients with uncontrolled hypertension (HTN) using previous therapy.Material and methods. The study included 78 both sex outpatients over 18 years of age with essential HTN. The main inclusion criterion was HTN with inadequate BP control against the background of previous combination therapy including amlodipine, indapamide and perindopril as part of free- or fixed-dose combinations of antihypertensive drugs. All patients were prescribed triple FDC of amlodipine/ indapamide/perindopril (Triplixam) in accordance with the medication instruc tions. The patient’s condition was assessed during four follow-up visits: visit 1 — inclu- sion visit, visit 2 — after 4 weeks, visit 3 — after 12 weeks, visit 4 — after 24 weeks. At each visit, achievement of the target BP levels &lt;140/90 mm Hg and &lt;130/80 mm Hg was assessed, as well as the 24-hour BP profile. The dynamics of BP decrease, achievement of target BP values, 24-hour BP profile, and the effect of therapy on arterial stiffness according to ABPM were also assessed.Results. In the analyzed group of patients, the initial office BP was 160,8± 10,3/91,5±8,1 mm Hg. After 24 weeks, there was a significant BP decrease to 121,3±3,5/73,6±4,2 mm Hg (p&lt;0,001). According to ABPM, an average daytime BP significantly (p&lt;0,001) decreased from 153,9±9,04/8,38±9,18 to 120,3±4,7/73,4±4,7 mm Hg after 24 weeks of amlodipine/indapamide/perindopril FDC therapy. Similar patterns were also found for the average values of nighttime BP. Target BP &lt;140/90 mm Hg after 4 weeks reached the majority (87,2%) of patients, and after 12 weeks, the proportion of pa tients who reached the target BP was 100%.Conclusion. In hypertensive patients with previous ineffective multiagent therapy, the triple FDC of amlodipine/indapamide/perindopril (Triplixam) provided high antihypertensive efficacy, good tolerability and adherence to therapy, and also demonstrated additional organ protection.

Supine blood pressure normalised by daytime series values is independently associated with ischaemic wake-up stroke

Purpose Wake-up stroke constitutes up to 1/4 of all ischaemic strokes; however, its pathomechanisms remain largely unknown. Although low nocturnal blood flow may be the underlying cause, little is known about blood pressure (BP) characteristic of wake-up stroke patients. The aim of our study was to look for differences in BP variables between wake-up stroke and known-onset stroke patients and to seek BP indices which could distinguish wake-up stroke patients from other stroke patients. Materials and Methods In the study, we included ischaemic stroke patients in whom office BP measurement and Ambulatory BP monitoring (ABPM) were recorded at day 7, after acute hypertensive response. The daytime period was defined as the interval from 6 a.m. to 10 p.m. From ABPM, we obtained parameters of BP variability. Additionally, we calculated the BP percentage differences defined as (supine office BP–average daytime BP)/average daytime BP for systolic, diastolic, and mean blood pressure. We calculated analogous indices for night-time. The univariate and multivariate relationships between BP variables and wake-up stroke were analysed. Results Among the recruited 120 patients (aged 61.6 ± 12.3; 88 [73%] males; the baseline National Institutes of Health stroke scale score 4 [3–8]), 36 (30%) had wake-up stroke. In a univariate analysis, the systolic and mean daytime and night-time BP differences were significantly lower in patients with wake-up stroke [(−1.92 (−11.55 to 3.95) vs 4.12 (−2.48 to 11.31), p = 0.006 and −6.20 (−12.32 to 7.42) vs 2.00 (−6.86 to 11.65), p = 0.029 for daytime, respectively; 0.00 (−9.79 to 11.82) vs 9.84 (0.00 to 18.25), p = 0.003 and 0.51 (−8.49 to 12.08) vs 7.82 (−2.47 to 20.39), p = 0.026, for night-time, respectively]. After adjustment for possible confounders, the systolic BP difference remained significantly associated with wake-up stroke (odds ratio = 0.96, 95% confidence interval = 0.92–1.00, p = 0.039). Conclusion The subacute office-ambulatory BP difference including the dynamic (systolic BP), but not static BP component was independently associated with wake-up stroke.

OBSERVED EFFECTS OF BODY MASS INDEX ON BLOOD PRESSURE DIPPING PATTERN, IN A PRIVATE HOSPITAL IN ABUJA, NIGERIA

During a normal 24-hour ambulatory blood pressure monitoring (ABPM), there should be a more than 10% drop in average nighttime blood pressure (BP), compared to the average daytime BP. This is called the normal ABPM dipping pattern. Abnormal dipping patterns occur when the average night-time blood pressure drop is lower than 10%. A high body mass index has been described as a contributing factor for unusual ABPM dipping patterns, which predisposes an individual to a higher likelihood of developing cardiovascular disease. The goal of this research was to assess the link between the body mass index (BMI) and the dipping pattern during ABPM in the adult population who underwent ABPM at Cardiocare Abuja. Anthropometric data from 100 patients who had done ABPM were used, together with data obtained from the CONTEC ABPM50 device. The BMI was calculated with the weight and height, and they were grouped into weight classes using their BMI. The proportions of the various dipping patterns were then determined within each class. Majority of the participants involved in the study had BMI between 30-39 kg/m2. Those who presented with higher BMI classes were also discovered to have unusual dipping patterns, indicating a link with relation to the BMI and the ABPM dipping pattern. In the morbidly obese class, with BMI &gt;40 kg/m2 there was a trend of the reverse dipping. It concluded that ABPM should be done routinely for persons with a high BMI for early detection of unusual dipping patterns and prompt intervention.

Renal artery denervation in patients with resistant arterial hypertension: clinical and organ-protective effect

Aim. To assess the clinical efficacy of renal artery denervation (RAD) in treatment of patients with resistant arterial hypertension (RAH) compared to patients taking drug therapy (DT) at long-term follow-up and the possibility of RAD impact on target organs (heart, kidneys).&#x0D; Materials and methods. 80 RAH patients were examined (mean age 54.3010.19 years). Patients were divided in two groups: the basic group was comprised of 40 RAH patients taking antihypertensive DT, who underwent RAD (gr. 1) and comparison group was composed of 40 RAH patients taking only antihypertensive DT (gr. 2). Gender and age differences between groups were statistically insignificant (p0.05). Mean duration of AH was 18.638.96 years. The follow-up was carried out during one year.&#x0D; Results. In RAD group there was confirmed decrease not only in the office, but also in the average day-time and night-time blood pressure (BP), changes were more significant in systolic BP (SBP) indicators: the overall daytime SBP was 17.369.31 mmHg (p0.001), the average day-time SBP was 17.1810.53 mmHg (p0.001), the average night-time SBP was 19.2210.76 mmHg (p0.001). At the same time, in DT group changes in values of overall, maximum, minimum, average day-time and average night-time SBP and diastolic BP were not statistically significant in 12 months. RAD in RAH was accompanied by decrease in left ventricular hypertrophy with initial hypertrophy (p0.05), decrease in microalbuminuria (p0.05), decrease in velocity in segmental (p0.05) and interlobar renal arteries (p0.01).&#x0D; Conclusion. RAD in patients with RAH had not only antihypertensive effect but also positive effect on target organs of AH (heart, kidneys).

ASSOCIATION OF AMBULATORY BLOOD PRESSURE WITH FRONTAL CORTICAL THICKNESS AND HIPPOCAMPAL VOLUME

Objective: In the elderly, the effect of blood pressure on brain structure or cognitive function has not been clear. However, there are limitations in that most of studies was done using serial change in clinic blood pressure. We sought to determine the association of the ambulatory blood pressure over time with the brain structural alterations and cognitive function Design and method: In this study, we sought to examine the association between blood pressure and brain structure/cognitive function in the elderly over the age of 60 by using the 24-hour ambulatory blood pressure information at 2 different visits (mean time interval is 3.4 years). From October 2018, we included participants performed Korean Mini Mental State Exam; older than 60 years old among the participants in Cardiovascular and Metabolic Disease Etiology Research Center-High Risk Cohort. Results: When we divided the 170 participants into two groups according to the control of cumulative average daytime blood pressure, the cortical thickness of frontal lobe was thinner and the average hippocampal volume was smaller in the uncontrolled group (P = 0.002, P = 0.01 respectively). In multivariate linear analysis, the uncontrolled group for cumulative average daytime blood pressure was associated with thinner cortical thickness of frontal lobe and smaller average hippocampal volume (P = 0.007, P = 0.024 respectively). However, the baseline daytime blood pressure had no associations with brain structure or cognitive function. Conclusions: Our observations suggest that serial measurements of 24-hour ambulatory blood pressure may be important to assess the cumulative pressure load and the association with structural changes of the brain.

DIRECTLY OBSERVED ADMINISTRATION OF ANTI-HYPERTENSIVE MEDICATION PRIOR TO AMBULATORY BLOOD PRESSURE MONITORING – A USEFUL TOOL FOR INVESTIGATING ‘RESISTANT HYPERTENSION’

Objective: Non-adherence to anti-hypertensive medication is a well-recognized cause of apparent ‘resistant hypertension’. We investigated whether directly observed administration (DOA) of anti-hypertensive medications, immediately prior to 24-hour ambulatory blood pressure monitoring (ABPM), would help exclude ‘treatment resistance’ potentially caused by medication non-adherence. Design and method: Resistant hypertension was defined (as per UK guidelines) as a mean daytime blood pressure (BP) of 135/85 or more despite the use of three or more anti-hypertensives. All patients had 24-hour ABPM immediately after a morning clinic appointment. Patients attending our nurse-led hypertension clinic were requested in advance to not take their prescribed anti-hypertensives on the morning of their appointment, but to bring their medications with. Patients were then observed taking their medications prior to ABPM. Patients that did not follow these instructions or who had ABPM organised from a different clinic (without DOA) formed the control group. Proportions were compared with Chi-squares tests. Data analysis was performed using Microsoft EXCEL 2010. Results: From November 2018 – October 2019, 53 patients had DOA before ABPM and were compared with 136 controls (see Table 1 for characteristics of each group). In the DOA group the average daytime BP was 138/83 with 38% having BP &lt;135/85. In the control group average daytime BP was 141/86 with 27% having BP &lt; 135/85. In total 54 patients were taking three or more anti-hypertensive medications. Table 2 compares the characteristics of these patients that underwent DOA (n = 14) compared with those that did not (n = 40). Of these patients, 50% that underwent DOA had a mean daytime BP of &lt;135/85 compared with 20% in the control group (p = 0.03). Conclusions: Eliminating any effect of medication non-adherence by directly observed administration of prescribed anti-hypertensives immediately prior to ABPM leads to a lower rate of ‘resistant hypertension’ diagnoses. This strategy may therefore negate the need for further treatment and/or investigation in some patients.

Nocturnal blood pressure is associated with sympathetic nerve activity in patients with chronic kidney disease.

Elevated nocturnal blood pressure (BP) and nocturnal non‐dipping are frequently observed in patients with chronic kidney disease (CKD) and are stronger predictors of cardiovascular complications and CKD progression than standard office BP. The sympathetic nervous system (SNS) is thought to modulate diurnal hemodynamic changes and the vascular endothelium plays a fundamental role in BP regulation. We hypothesized that SNS overactivity and endothelial dysfunction in CKD are linked to elevated nocturnal BP and non‐dipping. In 32 CKD patients with hypertension (56 ± 7 years), office BP, 24‐hr ambulatory BP, muscle sympathetic nerve activity (MSNA) and endothelial function via flow‐mediated dilation (FMD) were measured. Participants were subsequently divided into dippers (nighttime average BP > 10% lower than the daytime average BP, n = 8) and non‐dippers (n = 24). Non‐dippers had higher nighttime BP (p < .05), but not office and daytime BP, compared to dippers. MSNA burst incidence (81 ± 13 versus 67 ± 13 bursts/100 HR, p = .019) was higher and brachial artery FMD (1.7 ± 1.5 versus 4.7 ± 1.9%, p < .001) was lower in non‐dippers compared to dippers. MSNA and FMD each predicted nighttime systolic (β = 0.48,‐0.46, p = .02, 0.07, respectively) and diastolic BP (β = 0.38,‐0.47, p = .04, 0.03, respectively) in multivariate‐adjusted analyses. Our novel findings demonstrate that unfavorable nocturnal BP profiles are associated with elevated SNS activity and endothelial dysfunction in CKD. Specifically, CKD patients with higher nighttime BP and the non‐dipping pattern have higher MSNA and lower FMD. These support our hypothesis that SNS overactivation and endothelial dysfunction are linked to the dysregulation of nighttime BP as well as the magnitude of BP lowering at nighttime in CKD.

Abstract P168: A Novel Protocol Using Ambulatory Blood Pressure Monitoring To Assess The Impact Of Prescription Stimulants On Blood Pressure In Adults

Background: Prescription stimulant medications are an important cause of secondary hypertension (HTN) and use is increasing in US adults. Although stimulants are known to increase blood pressure (BP), a systematic approach to assess impact in individual patients is lacking. Further, treating HTN secondary to stimulant use may differ from treatment of essential HTN. Objective: To develop a protocol using ambulatory blood pressure monitoring (ABPM) to differentiate HTN secondary to stimulant use from essential HTN. Methods: We used ABPM to evaluate pre- and post-stimulant systolic blood pressure (SBP) and diastolic blood pressure (DBP) for patients referred to the BIDMC Hypertension Center. Patient charts were reviewed by a clinical pharmacist to ensure the safety of holding the stimulant medication and to determine the duration of action. Average daytime BP on day 1 (off stimulant) was compared to day 2 (on stimulant) to assess the impact of stimulant on BP. We defined normotension as BP &lt;135/&lt;85 on both days, sustained HTN as BP ≥135/≥85 on both days and stimulant-induced HTN as BP &lt;135/&lt;85 on Day 1 and ≥135/≥85 on Day 2. We also defined an increase of SBP≥10 and/or DBP≥ 5 while taking the stimulant as a clinically significant effect on BP. Results: Eleven patients were assessed (see Table). Four had sustained normotension, six had sustained HTN, and one had stimulant-induced HTN. In addition, four of the patients had a clinically significant increase in their BP while on a stimulant. Overall, average increase in SBP was 6.7 mmHg and average increase in DBP was 3.2 mmHg. Conclusion: This novel ABPM protocol was useful for differentiating secondary HTN from stimulant use from essential HTN.

Twenty-Four-Hour Ambulatory Blood Pressure Monitoring.

The diagnosis, management, and estimated mortality risk in patients with hypertension have been historically based on clinic or office blood pressure readings. Current evidence indicates that 24-hour ambulatory blood pressure monitoring should be an integral part of hypertension care. The 24-hour ambulatory monitors currently available on the market are small devices connected to the arm cuff with tubing that measure blood pressure every 15 to 30 minutes. After 24 hours, the patient returns, and the data are downloaded, including any information requested by the physician in a diary. The most useful information includes the 24-hour average blood pressure, the average daytime blood pressure, the average nighttime blood pressure, and the calculated percentage drop in blood pressure at night. The most widely used criteria for 24-hour measurements are from the American Heart Association 2017 guidelines and the European Society of Hypertension 2018 guidelines. Two important scenarios described in this document are white coat hypertension, in which patients have normal blood pressures at home but high blood pressures during office visits, and masked hypertension, in which patients are normotensive in the clinic but have high blood pressures outside of the office. The Centers for Medicare and Medicaid Services has made changes in its policy to allow reimbursement for a broader use of 24-hour ambulatory blood pressure monitoring within some specific guidelines. Primary care physicians should make more use of ambulatory blood pressure monitoring, especially in patients with difficult to manage hypertension.

Screening for Hypertension in the INpatient Environment(SHINE): a protocol for a prospective study of diagnostic accuracy among adult hospital patients

IntroductionA significant percentage of patients admitted to hospital have undiagnosed hypertension. However, present hypertension guidelines in the UK, Europe and USA do not define a blood pressure threshold at which...

Songling Xuemaikang capsules for patients with low-to-medium risk hypertension: study protocol for a randomized controlled trial

BackgroundHypertension is a major risk factor for cardio-cerebrovascular disease. Songling Xuemaikang capsules (SXC), a formulation of Chinese herbal patent medicine, has been used as a complementary medicine with conventional western medicine to treat patients with hypertension since 1994 in mainland China. However, the efficacy of treatment with SXC alone against hypertension remains unclear.Methods/designThis is a multicenter, placebo-controlled, double-blinded, randomized controlled clinical trial. A total of 570 patients with low-to-medium risk hypertension are randomized in a 1:1 ratio to receive SXC or placebo three times daily for eight weeks. The primary outcomes are 24-h average systolic blood pressure and average diastolic blood pressure. The secondary outcomes are daytime average blood pressure, night-time average blood pressure, fluctuation of blood pressure, hypertension control rate, traditional Chinese medicine (TCM) syndrome scores, and quality-of-life scores.DiscussionThis is the first multicenter trial conducted to evaluate the efficacy and safety of TCM in patients with low-to-medium risk hypertension. Our study will provide evidence-based results of a complementary preventive measure for hypertension.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-17011383. Registered on 12 May 2017.

Telemonitoring of 24-Hour Blood Pressure in Local Pharmacies and Blood Pressure Control in the Community: The Templar Project.

The analysis of ambulatory blood pressure monitorings (ABPMs) performed in 639 Italian pharmacies in the context of a telehealth-based service allowed to evaluate the level of blood pressure (BP) control in the community. Twenty-four-hour ABPMs were performed by a clinically validated, automated, upper-arm BP monitor. Recordings were uploaded on a certified web-based telemedicine platform (www.tholomeus.net) and remote medical reporting provided. In each subject, an automatic BP measurement was obtained in the pharmacy and clinical information collected before starting the ABPM. A total of 20,773 subjects (mean age 57 ± 15 years; 54% females; 28% receiving antihypertensive medications, 31% with any cardiovascular [CV] risk factor) provided valid ABPMs. BP control was poor, but better in ambulatory conditions (24-hour BP <130/80 mm Hg 54% vs. pharmacy BP < 140/90 mm Hg 43%; P < 0.0001) and in drug-treated subjects. Sustained normotension was reported in only 28% subjects. Isolated nocturnal hypertension (16%; nighttime BP ≥120/70 mm Hg with normal daytime BP) was more common (P < 0.0001) than isolated daytime hypertension (9%; daytime BP ≥ 135/85 mm Hg with normal nighttime BP). Sustained hypertension (43%) was more common in younger males at the lowest CV risk, with daytime hypertension. White-coat hypertension (14%) was more common in females. Masked hypertension was not uncommon (15%) and more often observed in older males with an elevated nocturnal BP. A telemedicine-based service provided to community pharmacies may facilitate access to ABPM, thus favoring a more accurate hypertension screening and detection. It may also help describe the occurrence of different 24-hour BP phenotypes and personalize the physician's intervention.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

A3464 The clinical effect and contrast evaluation of office blood pressure,ambulatory blood pressure mornitoring on treatment of Yinxu-Yangkang type of primary hypertensives by TCM of Tianma Gouteng Yin

Objectives: To observe the clinical curative effect and contrast evaluation of office blood pressure,ambulatory blood pressure monitoring on treatment of Yinxu-Yangkang type of primary hypertensives by TCM of Tianma Gouteng Yin. Methods: Total of 106 cases of Yinxu-Yangkang type of primary hypertension patients diagnosed by CBP and ABPM were randomly selected to take Tianma gouten Yin with 150 ml (tid) for 4 weeks, Then, the clinical curative effect, changes in CBP and 24 hours ABP were compared. Results: The clinical symptoms of patients were improved significantly and side effects were less; The DBP reducing at night was not significant difference (p > 0.05);All of blood pressure variability, nocturnal blood pressure drop rate and heart rate were not significant difference before and after treatment (p > 0.05); ***All of 24-hour average blood pressure, daytime and nighttime (only SBP) mean blood pressure,daytime and nighttime (only SBP) blood pressure load values had significant difference (p < 0.01 or p < 0.05) before and after treatment (p < 0.01 or p < 0.05);The office blood pressure is higher than the mean ambulatory blood pressure after treatment. Conclusion: It had better improving efficacy of clinical symptoms and tolerability, and less side effects in treatment of hypertension patients byTianma gouten Yin; The reasons and possiblities of lower antihypertension effect for DBP in nighttime of Tianma gouten Yin on ambulatory blood pressure may be follows:The evidence of dose-effect relation of evidence-based medicine is still short of; blood drug concentration is not easy to keep constant in nighttime;or the bioavailability is differences obviously. To explore some new taking ways of traditional Chinese medicine in treatment of hypertension are necessary.