Awake Blood Pressure Research Articles

Sleep blood pressure measured using a home blood pressure monitor was independently associated with cardiovascular disease incidence: the Nagahama study.

Nocturnal blood pressure (BP) is associated with cardiovascular disease independently of awake BP. However, nocturnal BP measured using an ambulatory monitoring device has limited reproducibility because it is a single-day measurement. We investigated the association between sleep BP measured on multiple days using a timer-equipped home BP monitor and cardiovascular diseases in a general population. The study population comprised 5814 community residents. Participants were required to sleep with wrapping cuffs on their upper arm and BP was measured automatically at 0 : 00, 2 : 00, and 4 : 00. Actigraph was used to determine BP measured during sleep. Participants were also measured home morning and evening BP manually using the same device. During the 7.3-year mean follow-up period, we observed 117 cases of cardiovascular diseases. The association between sleep BP (per 10 mmHg hazard ratio = 1.31, P < 0.001) and cardiovascular events remained significant (hazard ratio = 1.22, P = 0.036) even after adjusting for office BP and confounding factors, such as sleep-disordered breathing. Individuals with sleep-only hypertension ( n = 1047; hazard ratio = 2.23, P = 0.005) had a significant cardiovascular risk. Daytime-only hypertension ( n = 264; hazard ratio = 3.57, P = 0.001) and combined sleep and daytime hypertension ( n = 1216; hazard ratio = 3.69, P < 0.001) was associated with cardiovascular events to the same extent. Sleep BP dipping was not identified as a significant determinant of cardiovascular events. Sleep BP measured using a home BP monitor was independently associated with the incidence of cardiovascular disease in a general population.

O105 ISOLATED NOCTURNAL HYPERTENSION AND TARGET ORGAN INJURY IN YOUTH

Background and Objective: New American Heart Association (AHA) recommendations in 2022 for pediatric ambulatory blood pressure monitoring (ABPM) established static blood pressure (BP) cutoffs to define hypertension with an optimal sensitivity-specificity balance to best capture target organ injury (TOI). This increased the prevalence of ABPM hypertension, specifically isolated nocturnal hypertension. We utilized ABPM data from the SHIP-AHOY cohort to describe the epidemiology of INH in youth and to evaluate associations between INH and TOI. Methods: We defined INH as wake BP &lt;130/80 mmHg and sleep BP &gt;110/65 mmHg. INH was also evaluated by the 2014 AHA definition: wake BP &lt;95th percentile with sleep BP &gt;95th percentile. Primary outcome was left ventricular hypertrophy (LVH), defined as left ventricular mass index &gt;38.6 g/m2.7. Cardiovascular risk factor (CVRF) scores described the number of risk factors for cardiovascular disease (dyslipidemia, obesity, hypertension by clinic systolic BP, insulin resistance) fro each participant. Logistic regression models assessed the association of INH with LVH, adjusted for age, sex, CVRF score, and ABPM tolerability. Results: Of 397 participants, 77 had INH, mostly (62%) due to elevated systolic BPs only. Median age and height were higher in INH than normotension (16.1 v 15.1 years, P=0.022) (height z-score 1.13 v 0.23, P=0.039). Other characteristics did not differ significantly between groups (Table 1). Estimated glomerular filtration rate was lower in INH. Among those with INH, 27% (N=19/71) had LVH, a greater proportion than found with 2014 definitions (21%, N=7/33). Children with INH had 2.61-fold adjusted odds of LVH compared to normotension (95%CI [1.20,5.69], P=0.016). Conclusions: Over 20% of the SHIP-AHOY cohort had INH, accounting for &gt;1/3 of hypertension overall. INH was associated with older age and taller height, mostly due to systolic BP. Compared to 2014 guidelines, the 2022 definition of INH captured a higher prevalence of LVH. INH was independently associated with increased odds of LVH. Future studies should follow children with INH longitudinally for potential development of daytime hypertension. Table 1: Demographic, Anthropomorphic, and Clinical Characteristics of Isolated Nocturnal Hypertension vs Normotension

O98 NEW APPROACHES TARGETING THE RENIN-ANGIOTENSIN SYSTEM: BRAIN ACE2 ACTIVATION FOLLOWING BRAIN AMINOPEPTIDASE A BLOCKADE BY FIRIBASTAT IN SALT-DEPENDENT HYPERTENSION

Background and Objective: In the brain, aminopeptidase A (APA), a membrane-bound zinc metalloprotease, generates angiotensin III from angiotensin II. Brain angiotensin III exerts a tonic stimulatory effect on the control of blood pressure (BP) in hypertensive rats and increases vasopressin release. Blocking brain angiotensin III formation by the APA inhibitor prodrug RB150/firibastat normalizes arterial BP in hypertensive deoxycorticosterone acetate (DOCA)-salt rats. Ang II and Ang III have similar affinities for AT1 receptors and blocking brain AngIII formation by RB150 decreases arterial BP without inducing Ang II accumulation. Methods: We therefore hypothesized that another metabolic pathway of brain angiotensin II, such as the conversion of angiotensin II into angiotensin 1-7 (Ang 1-7) by angiotensin-converting enzyme 2 (ACE2) might be activated following brain APA inhibition. To answer this question, we use surgical animal models that could allow us to monitor awake blood pressure responses to intracerebroventricular (icv) injections and measure enzymatic activity. Results: We found that the intracerebroventricular administration of RB150/firibastat in conscious DOCA-salt rats both inhibited brain APA activity and induced an increase in brain ACE2 activity. Then, we showed that the decreases in BP and vasopressin release resulting from brain APA inhibition with RB150/firibastat were reduced if ACE2 was concomitantly inhibited by MLN4760, a potent ACE2 inhibitor, or if the Mas receptor (MasR) was blocked by A779, a MasR antagonist. Conclusions: Our findings suggest that in the brain, the increase in ACE2 activity resulting from APA inhibition by RB150/firibastat treatment, subsequently increasing Ang 1-7 and activating the MasR while blocking angiotensin III formation, contributes to the antihypertensive effect and the decrease in vasopressin release induced by RB150/firibastat. RB150/firibastat treatment constitutes an interesting therapeutic approach to improve BP control in hypertensive patients by inducing in the brain renin-angiotensin system, hyperactivity of the beneficial ACE2/Ang 1-7/MasR axis while decreasing that of the deleterious APA/Ang II/Ang III/ATI receptor axis.

Neural-Cardiovascular Responses to Orthostasis Following 8-Weeks of Home-Based Lower Leg Heating in Older Women with Hypertension

Background: Hypertension remains a significant health problem for older women (≥60 y). Though effective blood pressure (BP) interventions exist (e.g., exercise, medication), adherence to these options is low. Lower leg heat therapy represents a promising and easily implementable adjuvant treatment that may offer cardioprotective benefits. However, no studies have investigated lower leg heat therapy’s effects on BP and neural-cardiovascular function, let alone in older women with hypertension. Accordingly, we hypothesized that 8-weeks of home-based lower leg heat therapy in older women with hypertension would 1) reduce ambulatory BP and 2) reduce muscle sympathetic nerve activity (MSNA) while augmenting cardiac output and stroke volume during graded head-up tilt (HUT). Methods: Forty older women with hypertension (69 ± 5 y [mean±SD]) were randomized to either heat therapy (INT, 42°C; n = 20) or a thermoneutral control (CON, 35°C; n = 20). Each woman completed 8 wks of at-home sessions (~4/wk; 45 min/session) immersing their legs ~33 cm in a portable spa bath. 24-h ambulatory BP was measured pre- (PRE) and post-intervention (POST). A subset of women (n = 18 for each group) completed supine rest and 5 min of 30° and 60° HUT at each time point, whereby laboratory heart rate, systolic and diastolic BP, MSNA burst frequency and incidence (microneurography), cardiac output (acetylene rebreathing), and stroke volume (cardiac output/heart rate) were measured. Results: Between INT and CON, PRE ambulatory awake systolic BP (140 ± 7 vs. 142 ± 6 mmHg; P = 0.34) and diastolic BP (80 ± 6 vs. 79 ± 6 mmHg; P = 0.51) were not different, nor were PRE supine systolic BP, diastolic BP, or heart rate (all P &gt; 0.05). PRE supine resting MSNA burst frequency (36 ± 13 vs. 33 ± 16 bursts/min), MSNA burst incidence (54 ± 19 vs. 51 ± 22 bursts/100 heartbeats), cardiac output (4.9 ± 0.9 vs. 5.1 ± 1.0 L/min), and stroke volume (72 ± 15 vs. 76 ± 15 mL/beat) were not different between groups (all P &gt; 0.05). From PRE to POST neither ambulatory awake systolic nor diastolic BP differed between groups (all P &gt; 0.05). Despite this, POST laboratory systolic and diastolic BP were greater in INT (both P &lt; 0.05) but not in CON (both P &gt; 0.05) during HUT. POST laboratory heart rate was reduced in INT ( P = 0.025), and trended greater in CON ( P = 0.065) across HUT. Neither MSNA burst frequency nor burst incidence changed during HUT PRE to POST (all P &gt; 0.05). Despite no PRE to POST differences in cardiac output in either group (all P &gt; 0.05), INT had a greater overall POST stroke volume throughout HUT ( P = 0.011), while CON had a reduced stroke volume during 60° HUT ( P = 0.036). Conclusions: Contrary to our hypotheses, 8-weeks of home-based lower leg heat therapy did not improve ambulatory BP or HUT MSNA and cardiac output in older women with hypertension. However, women completing INT appeared to have a greater stroke volume and lower heart rate during HUT. Accordingly, these data suggest that 8-weeks of lower leg heat therapy in older women with hypertension may improve cardiac function during orthostasis without significant changes in sympathetic outflow or ambulatory BP. Supported by the National Institutes of Health (R01AG059314 and F32HL167556). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Habitual Sleep Duration and Sleep Effciency Do Not Mediate the Relationship Between Race and Nocturnal Blood Pressure Dipping in Young Black and White Women

Blunted nocturnal blood pressure (BP) dipping, defined as less than 10% reduction in BP during sleep as compared to wake, independently predicts cardiovascular disease. Short and disturbed sleep associate with less nocturnal BP dipping in young adults, and Black women (BLW) demonstrate less nocturnal BP dipping and poorer sleep health compared to White women (WHW) as early as young adulthood. However, not known is if habitual, objectively estimated sleep metrics mediate the relationship between race and BP dipping in young women. Thus, this study sought to evaluate the mediating effect of objectively estimated habitual sleep duration and sleep effciency on the relationship between race and nocturnal BP dipping in apparently healthy, young BLW and WHW. We hypothesized that BLW would have lower nocturnal systolic and diastolic BP dipping than WHW, but that the relationship between race and nocturnal BP dipping would be at least partly mediated by sleep duration and sleep effciency. Participants were 18-29 years, female, normotensive, nonobese, without evidence of clinical sleep disorders, and self-identified their race as Black or White. Systolic and diastolic BP dipping were each derived from 24-hour ambulatory BP monitoring by subtracting mean asleep BP from mean awake BP, divided by mean awake BP, *100. Sleep duration (total sleep time between sleep onset and offset) and sleep effciency (total sleep time divided by total time in bed dedicated to sleep, *100) were measured via wrist actigraphy for 14 consecutive nights, and means were generated. Race differences in BP dipping and habitual sleep metrics were assessed via independent-samples t-tests. The standard mediation model as proposed by Baron and Kenney (1986) was used to assess the mediating effect of habitual sleep duration and sleep effciency on the relationship between race and systolic and diastolic BP dipping. Participants included 20 BLW (22±3 years) and 17 WHW (25±3 years). Systolic BP dipping (BLW: 9.5±5.9%, WHW: 13.9±5.1%, p=0.02) and diastolic BP dipping (BLW: 16.3±7.3%, WHW: 21.9±5.5%, p=0.01) were lower among BLW. Sleep duration was not different between races (BLW: 6.7±0.5 hrs, WHW: 7.0±0.7 hrs, p=0.14), though sleep effciency was lower among BLW (BLW: 81.6±4.4%, WHW: 86.0±3.1%, p&lt;0.01). In contrast to our hypothesis, neither habitual sleep duration nor sleep effciency significantly mediated the relationship between race and BP dipping (all indirect effects p&gt;0.38). Habitual sleep metrics did not explain race differences in nocturnal BP dipping between young BLW and WHW; thus, future work should consider other physiological, social, or environmental determinants of BP dipping in young BLW. University of Delaware Research Foundation — Strategic Initiative Grant (MAW/FP) and AHA Award #831488 (EH). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Diagnostic Accuracy of Office Blood Pressure Measurement and Home Blood Pressure Monitoring for Hypertension Screening Among Adults: Results From the IDH Study.

Using high awake blood pressure (BP; ≥130/80 mm Hg) on ambulatory BP monitoring (ABPM) as a reference, the purpose of this study was to determine the accuracy of high office BP (≥130/80 mm Hg) at an initial visit and high confirmatory office BP (≥130/80 mm Hg), and separately, high home BP (≥130/80 mm Hg) among participants with high office BP (≥130/80 mm Hg) at an initial office visit. The accuracy of office BP measurements using the oscillometric method for detecting high BP on ABPM was determined among 379 participants with complete office BP and ABPM data in the IDH (Improving the Detection of Hypertension) study. For detecting high BP on ABPM, the accuracy of high confirmatory office BP using the oscillometric method and, separately, high home BP was also determined among the subgroup of 122 participants with high office BP at an initial visit and complete home BP monitoring data. High office BP had moderate sensitivity (0.61 [95% CI, 0.53-0.68]) and high specificity (0.85 [95% CI, 0.80-0.90]) for high awake BP. High confirmatory office BP and high home BP had moderate sensitivity (0.69 [95% CI, 0.59-0.79] and 0.79 [95% CI, 0.71-0.87], respectively) and low and moderate specificity (0.44 [95% CI, 0.27-0.61] and 0.72 [95% CI, 0.56-0.88], respectively). Many individuals with high BP on ABPM do not have high office BP. Confirmatory office BP and home blood pressure monitoring also had limited ability to identify individuals with high BP on ABPM.

Abstract 16605: Differential Impact of Nighttime Home Blood Pressure on Between Patients With and Without Subclinical Heart Failure

Introduction: Nighttime blood pressure (BP) has stronger association with cardiovascular events than office BP, 24-hr BP, and awake BP. However, it was not clear whether the impact of nighttime BP is different for patients with or without heart failure (HF). Hypothesis: Nighttime home BP has stronger association with cardiovascular events in patients with HF. Methods: We analyzed the data from the Japan Morning Surge-Home Blood Pressure study with NT-proBNP and nighttime home BP measurement. We enrolled 2494 patients who had at least one cardiovascular risk factor. Morning, evening, and nighttime home BP were measured and cardiovascular events were followed up. Results: During 7.1 years follow-up, 168 events occurred. When NT-proBNP of 125pg/ml was used as cutoff, the patients with NT-proBNP&gt;125pg/ml was higher daytime home SBP and nighttime home SBP than the patients with NT-proBNP≤125pg/ml (137±16 vs 132±13 mmHg, p&lt;0.01, 126±18 vs 120±14 mmHg, p&lt;0.01, respectively). In Cox regression analysis adjusting for significant covariates, daytime and nighttime home SBP were significant predictor for the outcome in the patients with NT-proBNP&gt;125pg/ml (HR 1.02, 95%CI:1.01-1.03, p&lt;0.01, HR 1.02, 95%CI:1.00-1.03, p=0.045, respectively). On the other hands, only nighttime home SBP was remained as a predictor for the outcome in the patients with NT-proBNP≤125pg/ml (HR 1.02, 95%CI:1.00-1.03, p=0.01). Conclusions: Nighttime home BP was associated with prognosis in patients with and without subclinical HF. Daytime home BP was associated with prognosis in patients with subclinical HF but not in the without subclinical HF.

CHANGES IN AMBULATORY BLOOD PRESSURE DURING THE TRANSITION TO RETIREMENT

Objective: Retirement is a major life event characterized by removal of work-related stressors and changes in health behaviours. The association between retirement and changes in blood pressure (BP), and particularly in ambulatory BP, has been scarcely studied. We aimed to examine changes in ambulatory BP during retirement transition. Design and method: Two hundred and fifty ageing workers (mean age 63.2 years, 84% women) from the Finnish Retirement and Aging study participated in annual office BP measurements and 114 (mean age 63.1, 90% women) of them underwent annual ambulatory BP measurements before and after retirement. On average, the participants provided data on ambulatory BP at 2.7 (range 2 - 4) measurements. We used generalized linear models to examine BP changes at retirement. The FIREA study was conducted in accordance with the Helsinki declaration and was approved by the Ethics Committee of Hospital District of Southwest Finland (ETMK: 84/1801/2014). All participants gave written informed consent. Results: Most marked changes in BP during the follow-up were observed for asleep SBP, which decreased before retirement, increased during retirement transition and plateaued after retirement (before retirement vs. retirement transition P = 0.07 and after retirement vs. retirement transition P = 0.02). Awake SBP and 24-h SBP declined with most apparent decrease before retirement (before retirement vs. retirement transition P = 0.07 and P = 0.07). Awake DBP and 24-h DBP showed relatively consistent decline throughout the follow-up with no differences between the time periods. SBP and DBP dipping reduced before and during retirement transition, but not after retirement. Among shift workers, asleep BP increased and BP dipping decreased more than in regular day workers. Conclusions: Retirement was found to associate with beneficial changes in awake BP but unfavourable changes in asleep BP, especially in shift workers.

ABILITY OF A CUFFLESS 24 HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT DEVICE TO TRACK BLOOD PRESSURE CHANGES COMPARED TO A CUFF-BASED DEVICE

Objective: There is an increasing number of cuffless blood pressure (BP) measurement devices on the market. Beneath the absence of generally accepted validation protocols for these devices, the ability of these devices to track changes in BP levels over 24h in relation to an initial calibration BP is unknown. Aim of this study was to analyse this ability in a cuffless 24h BP device using pulse transit time. Design and method: We prospectively enrolled 166 participants for simultaneously performed cuffless (TestBP, Somnotouch NIBP) and cuff-based (RefBP, Spacelabs 90217A or IEM Mobil-o-graph) 24h BD measurements. Main exclusion criteria were atrial fibrillation or an inter-arm difference of &gt;10 mmHg. TestBP calibration was based on initial RefBP measurement (CalibBP). As surrogate parameters for tracking individual changes in BP levels after the CalibBP, we used the difference between CalibBP and mean 24h, awake and asleep BP measured by RefBP and TestBP. Additionally, we analysed the relationship between the difference of CalibBP and RefBP vs the difference between RefBP and TestBP. Results: Mean (±SD) age was 51.2 (15.1) years and 53% were male. Mean (±SD) difference between CalibBP and mean 24h BP by RefBP / TestBP were 7.4 (13.2) versus 1.8 (8.3) mmHg for systolic (p &lt; 0.0001) and 6.6 (6.8) versus 1.6 (5.8) mmHg for diastolic (p &lt; 0.0001). Corresponding ranges for CalibBP-RefBP were -35 – 55 mmHg vs. -14 – 34 for CalibBP-Test BP. Figure 1 shows a near linear relationship between the difference between CalibBP and RefBP and the difference between RefBP and TestBP for systolic and diastolic BP values. Red line indicates the theoretical situation that TestBP follows CalibBP without tracking changes in BP levels, green line an ideal agreement of RefBP and TestBP. Conclusions: This is the first study to show the lower ability of the cuffless BP device to track changes of BP levels after an initial calibration measurement compared to a standard cuff-based device over 24h. Additionally, the difference between the RefBP and the TestBP was nearly linearly associated with the difference between a CalibBP and the changes of the BP level.

0007 Later circadian phase and increased sleep variability are associated with overnight blood pressure dipping in chronic shiftworkers

Abstract Introduction Nighttime shift work is associated with adverse cardiovascular outcomes, including hypertension. Increased sleep variability and circadian disruption may increase sympathetic activity and waking blood pressure (BP), potentially constraining typical BP reductions during overnight sleep. However, the relationships between circadian phase, sleep variability, and overnight BP reduction (dipping) among day vs. chronic nightshift workers is unknown. Methods Ambulatory BP was monitored for up to 48-hours among 10 dayshift (mean□SD; age 33.1□7.0y; BMI 26.3□5.4 kg/m2) and 10 chronic (9.3□6.8y of shiftwork) nightshift workers (age 32.7□9.1y; BMI 27.9□7.6 kg/m2). Overnight BP dipping was calculated from the sleeping/waking systolic BP ratio. Variability in sleep timing was defined as the SD of self-reported daily-diary sleep onset across 1-week. Circadian phase was determined by salivary dim-light melatonin onset (DLMO; 3pg/ml threshold). Differences between groups were assessed using independent t-tests and linear mixed-effects models with group and time-from-sleep-onset or circadian phase as fixed-effects, and participant as a random effect. Relationships between overnight BP dipping and DLMO, sleep onset timing variability, and phase angle of entrainment (DLMO to sleep onset during ambulatory BP) were assessed using Pearson correlation analyses. Results Chronic nightshift workers had reduced overnight BP dipping (-9.3□1.5 % vs -13.4□4.4 %; p=0.04), later DLMO timing (21:08□0:53 vs 19:21□1:02; p=0.001), smaller phase angle of entrainment (3.7□1.0 h vs 5.0□0.90 h; p=0.02), and greater variability in sleep onset timing (3.2□1.5 h vs 0.87□0.34 h; p&amp;lt; 0.001). Significant group effects for higher systolic BP across circadian phase and time from sleep onset in the nightshift group were observed compared to dayshift (both p&amp;lt; 0.05). DLMO (r=0.49; p=0.04) and phase angle of entrainment (r=0.53; p=0.02) were associated with overnight BP dip magnitude (later circadian phase correlated with less dipping). Sleep onset timing variability was negatively correlated with magnitude of overnight BP dipping in nightshift (r= -0.76; p=0.04) but not dayshift workers (r=0.26; p=0.61). Conclusion Attenuated overnight BP dipping among chronic nightshift workers may be indicative of increased cardiovascular risk. Chronic circadian disruptions (i.e., smaller phase angle of entrainment) as a function of higher sleep variability among nightshift workers may mechanistically contribute to poorer health outcomes compared to dayshift workers. Support (if any) R01HL105495, K01HL146992

0473 Multi-outcome of mandibular advancement device in Obstructive Sleep Apnea with different polysomnographic phenotype

Abstract Introduction The association of mandibular advancement device (MAD) treatment response and polysomnographic phenotype in patients with obstructive sleep apnea (OSA) has not been fully elucidated. We hypothesized MAD response would be associated with two polysomnographic phenotypes, including sleep stage and positional dependency in treatment-naïve patients with moderate-severe obstructive OSA. Methods This retrospective study recruited OSA patients with AHI ≥15/h, aged 20 to 80, treatment naïve, and received MAD treatment for more than three months. Positional phenotype included supine predominant (supine-p) and non-positional OSA. Sleep stage phenotype included REM-predominant (REM-p), NREM-predominant (NREM-p), and stage-independent (SI) OSA. MAD response was defined as criterion 1: residual AHI&amp;lt; 5/h with &amp;gt;50% reduction, and criterion 2: residual AHI&amp;lt; 10/h with &amp;gt;50% reduction. Outcomes included the change in PSG parameters, habitual latency of sleep onset and sleep hour, Epworth sleepiness scale, excessive daytime sleepiness, depression, physical, vitality and mental health domain of SF-36, and in-lab bedtime and wake blood pressure (BP). Results 379 patients with median age of 52.2 years, BMI of 26 kg/m2, 78.1% of men, and AHI of 28.2/h were recruited. Supine-p and REM-p OSA had lower baseline AHI and desaturation. The overall response rate were 34.7% (criterion 1 ) and 56% (Criterion 2). Supine-p OSA had higher response rate than non-positional OSA (criterion 1: 42.2% vs. 20.3%; criterion 2: 64.3% vs. 32.5%), while NREM-p OSA had lower response rate than REM-p and SI (REM-p vs. NREM-p vs. SI: criterion 1: 43.9% vs. 9.7% vs. 34.2%; criterion 2: 54.5% vs. 41.9% vs. 53.3%). Despite the more reduction in AHI, desaturaiotn, and arousal in responders, there was no differences in change of ESS, EDS, sleep pattern, depression, SF 36 domain, and BP between responders and non-responders which remained unchanged after stratified with sleep stage and position phenotypes. Conclusion Non-positional and NREM-predominant OSA had lower responses rate to MAD treatment. There were no differences in non-breathing outcomes between responders and nonresponders regardless of sleep stage and positional phenotype. Support (if any) The work was supported by grants from the National Science and Technology Council, Taiwan (NSTC 111-2314-B-002-293); Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-252); National Taiwan University Hospital (NTUH 107-19, 111-X0033, 111-S0298)

Abstract P258: Global Stress and Masked Hypertension in African-Americans: The Jackson Heart Study

Background: Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office, but few data are available on the association of chronic stress with BP measured outside of the office setting. Methods: We analyzed data from 473 African-American adults enrolled in the Jackson Heart Study with office BP &lt; 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress related to jobs, relationships, neighborhoods, caregiving, legal problems, medical problems, racism and discrimination, and meeting basic needs experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). We grouped participants by tertile of the composite GPSS score. Any MHT was defined as awake BP ≥ 130/80 mm Hg, asleep BP ≥ 110/65 mm Hg, or 24-hour BP ≥ 125/75 mm Hg. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication (mean age 53 years), the prevalence of any MHT was 59.0%, 75.0% and 61.8% for the low (GPSS score ≤ 3), middle (GPSS score 4 - 6), and upper tertiles of the GPSS score (GPSS score &gt; 6), respectively. Among those taking antihypertensive medication (mean age 61 years), the prevalence of any MHT was 77.4%, 80.7%, and 77.9% for participants in the low, middle, and upper tertile of the GPSS score, respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low tertile of the GPSS score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication (Table). Conclusion: No association was present between chronic stress and MHT among African Americans in the Jackson Heart Study.

PS-C08-11: RELATIONSHIP OF AMBULATORY WAKE SYSTOLIC BLOOD PRESSURE AND COGNITIVE FUNCTIONING IN CHILDREN AND ADOLESCENTS: THE SHIP-AHOY STUDY

Objective: 24-Hour Ambulatory blood pressure monitoring (ABPM) has been shown to be associated with cognitive functioning in both adults and children with hypertension. Few studies have examined this relationship in youth with normal to mildly elevated blood pressure (BP). We aimed to address this gap in the literature by examining the relationship between average wake systolic BP and targeted cognitive abilities in children and adolescents with normal to mildly elevated BP. Design: Cross-sectional cohort study across six academic centers in the United States. Methods: Participants were part of the SHIP AHOY Project examining target organ damage in children and adolescents with normal to mildly elevated BP. Patients were recruited from pediatric nephrology and/or cardiology clinics and had BP levels &gt; 75th percentile to &gt; 95th percentile). Ascertainment was designed to balance BMI across this BP range by actively recruiting normotensive subjects with obesity. Exclusion criteria included stage 2 hypertension, use of antihypertensive or lipid-lowering medication in the past 6 months, diabetes mellitus (type 1 or 2), kidney disease, or other chronic medical conditions. The primary exposure for this study was average wake Systolic BP. Cognitive variables included the Test of Nonverbal Intelligence, Woodcock-Johnson-V Verbal Attention, and Conners Continuous Performance Test-3 Errors of Omission and Errors of Commission. Preliminary analyses comprised the use of unadjusted linear regressions for the entire sample, with follow-up analyses planned to include key covariates for any significant findings. Results: We recruited 397 adolescents, ages 11–19 years (M∼15.5 yrs.), who comprised approximately 60% males and 53% white. About 25% of the participants had caregivers with a high school degree or less. About 40% of the sample had elevated BP (&gt; 90th percentile). There was a significant relationship between wake average systolic BP and Verbal Attention (p &lt; .009); and wake average systolic BP and Errors of Commission (p &lt; .026). All findings were in the expected direction with higher average wake BP being related to lower performance on the attention-related variables. SBP and Errors of Omission approached significance (p &lt; .07), while Nonverbal IQ was nonsignificant (p &lt; .34). Conclusions: Higher average wake BP, even in adolescents with BP below the hypertensive range, is associated with lower performance on tests of attention regulation and response inhibition. These findings suggest that efforts to minimize associated neurocognitive dysfunction in the late adolescence and young adult years should begin before the presence of hypertension.

PS-BPC03-2: NIGHTTIME HOME BLOOD PRESSURE WAS ASSOCIATED WITH ADVERSE OUTCOMES IN SUBCLINICAL HEART FAILURE PATIENTS

Objective: Nighttime blood pressure (BP) has stronger association with target organ damage and cardiovascular outcome than office BP, 24-hr BP, and awake BP in hypertensives. However, clinical significance of nocturnal BP, especially home nocturnal BP, was not established in heart failure (HF) patients. We hypothesized that nighttime home BP was associated with adverse outcome and investigated the association between nighttime home BP and the outcome in subclinical HF patients. Design and method: We analyzed 394 patients with NT-proBNP &gt; 125pg/ml from a practitioner-based population with at least one cardiovascular risk factor who underwent home BP monitoring in the Japan Morning Surge-Home Blood Pressure study. Morning, evening and nighttime home BP were measured by validated, automatic, and oscillometric home BP devices, and cardiovascular events were followed up. Results: During a mean follow-up of 4.2 years, 43 cardiovascular events occurred. Morning home SBP, evening home SBP and nighttime home SBP were higher in event group than in non-event group (150 ± 23 vs 140 ± 17 mmHg, p = 0.01, 142 ± 22 vs 131 ± 16 mmHg, p &lt; 0.01, 133 ± 22 vs 125 ± 17 mmHg, p &lt; 0.01, respectively). In multivariate Cox regression analysis adjusting for significant variables, average of evening home SBP, and nighttime home SBP were significant predictors of the outcome (HR 1.02, 95%CI: 1.01–1.04, p = 0.01, HR 1.02, 95%CI: 1.01–1.04, p = 0.03, respectively). When nighttime home SBP of 120mmHg was used as cutoff, nighttime home SBP &gt; 120mmHg was significantly associated with the outcome (HR 2.46, 95%CI 1.06–5.68, p = 0.04). Conclusions: Elevated nighttime home BP was significant predictor of cardiovascular outcomes in subclinical HF patients.

P122 Association between variability of respiratory sleep indices and ambulatory blood pressure

Abstract Study Objectives Respiratory sleep indices are traditionally reported on the basis of the average total sleep time. The relationship between the hour-to-hour variability of these parameters and blood pressure (BP) has not been reported. Methods We evaluated the associations of the hour-to-hour variability of the apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation with the 24-hour ambulatory BP in patients with hypertension and newly diagnosed obstructive sleep apnea. A total of 147 patients underwent polysomnography, based on which obstructive sleep apnea was diagnosed in 106 patients these patients underwent 24-hour ambulatory BP monitoring within the next 30 days. Each polysomnogram was divided into hourly reports to calculate the variability of the respiratory sleep indices. Variability independent of the mean was considered the primary measure of variability. Results The median number of hourly polysomnogram reports was 7 (range, 4–8).The hour-to-hour variability of both AHI and ODI, but not of the lowest oxygen saturation, was correlated with the 24-hour pulse pressure, 24-hour systolic BP, and awake systolic BP (p &amp;lt; 0.05 for all). The fully adjusted linear regression analysis indicated that the hour-to-hour variability of AHI and ODI remained associated with the 24-hour pulse pressure (AHI: β coefficient, 0.264 [95% CI, 0.033–0.495],p =0.026; ODI: β coefficient, 0.450 [95% CI, 0.174 - -0.726],p = 0.002). Conclusions The hour-to-hour variability of AHI and ODI is independently associated with the 24-hour pulse pressure. Further investigations are warranted to evaluate the clinical relevance of this new-found association.

Increased Prevalence of Blood Pressure Instability Over Twenty-Four Hours in Chronic Spinal Cord Injury.

Spinal cord injury (SCI) leads to cardiovascular dysregulation, including persistent low blood pressure (BP), orthostatic hypotension, and autonomic dysreflexia, leading to daily BP instability that may not be adequately recognized. We compared mean systolic BP, diastolic BP, and heart rate from awake and asleep measurements over a 24-h period among persons with chronic SCI (n = 33; 30 cervical injuries and three upper thoracic injuries), ambulatory/non-injured (Ambulatory-NI; n = 13), and non-injured (NI) in a wheelchair (n = 9). Stability of awake BP was evaluated by deviation of systolic BP from 115 mmHg and percent of systolic BP measurement within and outside of 90-140 mmHg. Variability over 24 h was compared using coefficient of variation and average real variability. Awake hyper- and hypotensive events (change in systolic BP ±20 mmHg from the median) were compared to symptoms reported by the participants corresponding to BP events. Participants with SCI had a lower percentage of awake systolic BP measurements within 90-140 mmHg than Ambulatory-NI and a greater deviation below 115 mmHg. Coefficient of variation and successive differences of awake systolic and diastolic BP were greater in SCI than Ambulatory-NI. Finally, all SCI participants had hyper- and/or hypotensive events and 88% experienced the BP events asymptomatically. In conclusion, participants with SCI had significantly greater BP instability compared with NI, with many hyper- and hypotensive events occurring without symptoms. Clinical management of BP instability, regardless of symptoms, should be a priority after SCI to reduce the risk of cardiovascular disease and improve quality of life.

Changes in ambulatory blood pressure during the transition to retirement.

Retirement is a major life event characterized by removal of work-related stressors and changes in health behaviours. The association between retirement and changes in blood pressure (BP), and particularly in ambulatory BP, has been scarcely studied. We aimed to examine changes in ambulatory BP during retirement transition. Two hundred and fifty ageing workers (mean age 63.2 years, 84% women) from the Finnish Retirement and Aging study participated in annual office BP measurements and 114 (mean age 63.1, 90% women) of them underwent annual ambulatory BP measurements before and after retirement. On average, the participants provided data on ambulatory BP at 2.7 (range 2-4) measurements. We used generalized linear models to examine BP changes at retirement. Most marked changes in BP during the follow-up were observed for asleep SBP, which decreased before retirement, increased during retirement transition and plateaued after retirement (before retirement vs. retirement transition P = 0.07 and after retirement vs. retirement transition P = 0.02). Awake SBP and 24-h SBP declined with most apparent decrease before retirement (before retirement vs. retirement transition P = 0.07 and P = 0.07). Awake DBP and 24-h DBP showed relatively consistent decline throughout the follow-up with no differences between the time periods. SBP and DBP dipping reduced before and during retirement transition, but not after retirement. Among shift workers, asleep BP increased and BP dipping decreased more than in regular day workers. Retirement was found to associate with beneficial changes in awake BP but unfavourable changes in asleep BP, especially in shift workers.

Hour-to-hour variability of respiratory sleep indices and ambulatory blood pressure.

Respiratory sleep indices are traditionally reported on the basis of the average total sleep time. The relationship between the hour-to-hour variability of these parameters and blood pressure (BP) has not been reported. We evaluated the associations of the hour-to-hour variability of the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation with the 24-h ambulatory BP in patients with hypertension and newly diagnosed obstructive sleep apnea. A total of 147 patients underwent polysomnography, based on which obstructive sleep apnea was diagnosed in 106 patients; these patients underwent 24-h ambulatory BP monitoring within the next 30 days. Each polysomnogram was divided into hourly reports to calculate the variability of the respiratory sleep indices. Variability independent of the mean was considered the primary measure of variability. The median number of hourly polysomnogram reports was 7 (range, 4-8). The hour-to-hour variability of both AHI and ODI, but not of the lowest oxygen saturation, was correlated with the 24-h pulse pressure, 24-h systolic BP, and awake systolic BP (p < 0.05 for all). The fully adjusted linear regression analysis indicated that the hour-to-hour variability of AHI and ODI remained associated with the 24-h pulse pressure (AHI: β coefficient, 0.264 [95% CI = 0.033-0.495], p = 0.026; ODI: β coefficient, 0.450 [95% CI = 0.174-0.726], p = 0.002). The hour-to-hour variability of AHI and ODI is independently associated with the 24-h pulse pressure. Further investigations are warranted to evaluate the clinical relevance of this new-found association.

Comparison of the association of masked hypertension defined by the 2017 ACC/AHA BP guideline versus the JNC7 guideline with left ventricular hypertrophy.

Background:Compared with the Seventh Report of the Joint National Committee (JNC7), the 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower BP thresholds to define hypertension and BP control.Methods:We pooled data from five US-based studies to compare the association of masked hypertension (MHT) and masked uncontrolled hypertension, defined using the 2017 ACC/AHA guideline (n = 1653 without high office BP; <130/80 mmHg) versus the JNC7 guideline (n = 2451 without high office BP; <140/90 mmHg), with left ventricular hypertrophy (LVH). MHT and masked uncontrolled hypertension were defined using office BP and awake BP alone and awake, asleep, or 24-h BP. LVH was assessed by echocardiography.Results:Among participants without high office BP not taking antihypertensive medication, the prevalence of MHT defined by the JNC7 guideline and the 2017 ACC/AHA BP guideline was 25.0 and 33.5% using awake BP only and 37.1 and 52.0% when using awake, asleep, or 24-h BP. The adjusted prevalence ratios for LVH associated with MHT versus sustained normotension defined by the JNC7 and 2017 ACC/AHA BP guidelines were 1.72 [95% confidence interval (CI): 1.12–2.64] and 1.56 (95% CI: 0.97–2.51), respectively, when using awake BP only and 2.16 (95% CI: 1.36–3.44) and 1.03 (95% CI: 0.58–1.82), respectively, when using awake, asleep or 24-h BP. There was no evidence that masked uncontrolled hypertension was associated with LVH when defined using the BP thresholds in either the JNC7 or the 2017 ACC/AHA BP guideline.Conclusion:The association of MHT with LVH may depend on the BP thresholds used.

Association of ambulatory blood pressure with aortic valve and coronary artery calcification.

We aimed to investigate the effect of ambulatory blood pressure (BP) on aortic valve calcification (AVC) and coronary artery calcification (CAC), which are subclinical atherosclerotic diseases. In this population-based, cross-sectional study, we assessed office BP, mean ambulatory BP (24-h, awake, and asleep), and variability of ambulatory BP, as determined by the coefficient of variation (awake and asleep). AVC and CAC were quantified using an Agatston score (>0) based on computed tomography scanning. We calculated relative risks (RRs) and 95% confidence intervals (CIs) with a 1-standard deviation increment in each BP index for the presence of AVC and CAC using a multivariate-adjusted Poisson regression with robust error variance. Of 483 participants (mean age: 66.8 years), 154 (31.9%) and 310 (64.2%) had AVC and CAC, respectively. The presence of AVC was associated with office systolic BP (SBP; RR, 1.15; 95% CI, 1.03-1.28), awake diastolic BP (DBP) variability (RR, 1.12; 95% CI, 1.01-1.25), and asleep SBP variability (RR, 1.14; 95% CI, 1.03-1.27). The presence of CAC was associated with office SBP (RR, 1.08; 95% CI, 1.01-1.15), mean 24-h SBP (RR, 1.10; 95% CI, 1.04-1.16), mean awake SBP (RR, 1.11; 95% CI, 1.04-1.17), mean asleep SBP (RR, 1.07; 95% CI, 1.01-1.13), and asleep SBP variability (RR, 1.07; 95% CI, 1.01-1.13). These findings highlight the association of ambulatory BP indices with both AVC and CAC, but with different effects on their presences.