Awake Blood Pressure Research Articles

COMPARISON OF BLOOD PRESSURE VALUES FROM SEQUENTIAL CONVENTIONAL AND AVERAGE MODE MEASUREMENT

Objective: To compare blood pressure (BP) values from conventional sequential measurements against average mode measurements. Design and method: We selected two samples of individuals with non-treated suspected hypertension. A trained nurse filled a standardized questionnaire with demographic, clinical data, measured BP, weight, height, and waist circumference, and installed an AMBP. We conducted sequential measurements in both. In one, we used an automatic device without average mode (Microlife-BP3BTOA (Onbo Electronics Co., Shenzhen, China). The individuals measured their BP in a conventional way (group-1); seven times, with an interval of 1 minute between them. Unlike the other (group-2), a device with average mode (Micro life- BP3AC1–1PC - Onbo Electronics Co., Shenzhen, China) measured blood pressure twice (BP1–3, BP4–6); in each measurement, and automatically took 3 BP every 15 seconds and delivered a mean. We calculated in group-1 the mean of tree first measures (BP1–3) and from four to six (BP4–6). We calculated proportions and means to characterize the samples and the t-test and chi-squared to show a significant difference between them. Also, the Bland Altman plot considered the agreement BP1–3 and BP4–6 with awake BP (ABP) in two groups. Results: Table 1 shows the main clinical characteristics and BP values of both groups. The proportion of women was higher in group-2 than group-1. Diastolic BP4–6 from group-2 87.8 ± 10.7 mmHg was significant higher than group-1 85.0 ± 10.7 mmHg (P = 0.0001). There wasn’t any difference for other comparisons. Figure 1 shows the Bland Altman plot of the agreement between BP1–3, BP4–6, and ABP in two groups. The BP1–3 and BP4-6 indicate a good agreement with ABP in both groups. Conclusions: Our data shows that the BP values delivered in the average mode are as precise as those in a conventional method. And spend less time to conclude the measurements.

Evaluating novel approaches for estimating awake and sleep blood pressure: design of the Better BP Study – a randomised, crossover trial

IntroductionFor many people, blood pressure (BP) levels differ when measured in a medical office versus outside of the office setting. Out-of-office BP has a stronger association with cardiovascular disease (CVD)...

0150 Afternoon Napping Does Not Impact Autonomic Function in Healthy Adults

Abstract Introduction Proper overnight sleep is important for autonomic nervous system function. However, less is known about the effects of daytime napping on wake autonomic regulation. In the present study, we assessed autonomic function following a daytime nap. We hypothesized that a 90-minute afternoon nap would significantly improve wake heart rate variability (HRV) and blood pressure (BP). Methods Fourteen participants (7 female, 24±1 years, 24 ±1 kg/m2) took part in the study. Subjects completed an autonomic function test after no nap (control condition) or a 90-minute nap opportunity (nap condition) on separate days using a randomized, crossover design. During the autonomic test, participants were fitted with three-lead electrocardiography (ECG), continuous beat-to-beat blood pressure (Finapres NOVA, Netherlands), and respiratory monitoring (pneumobelt). The autonomic function test consisted of 5-minutes of spontaneous breathing, 5-minutes of controlled breathing (15 breaths/min), and a 2-minute cold pressor test (CPT). Frequency-domain HRV in the low (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) components were determined via Fast Fourier transformation. Time-domain HRV was quantified using RMSSD and pNN50. Paired sample t-tests were completed between the control and nap sessions. Results Mean total sleep time (TST) for the nap session was 74±5 minutes. Contrary to our hypothesis, an afternoon nap did not change wake heart rate (HR, Control: 70±3 vs. Nap: 68±3 bpm, p = .31) or mean arterial pressure (MAP, Control: 77±3 vs. Nap: 83±3 mmHg, p = 0.70). Similarly, no differences were observed in HF (Control: 2632±628 vs. Nap: 2150±494 ms2, p = .33), LF (Control: 1702±373 vs. Nap: 1345±257 ms2, p = .20), or LF/HF (Control: 92±16 vs. Nap: 92±17%, p = .97) between conditions. RMSSD (Control: 82±12 vs. Nap: 79±11 ms, p = .723) and pNN50 (Control: 43±6 vs. Nap: 47±6%, p = .30) were not impacted by a daytime nap. Lastly, changes in HR (Control: ∆14±3 vs Nap: ∆18±3 bpm, p = .114) and MAP (Control: ∆23±4 vs. ∆Nap: 27±4 mmHg, p = .28) during CPT were not different between conditions. Conclusion An afternoon nap does not appear to significantly influence autonomic function at rest or during CPT in young healthy adults. Support (If Any)

Different cardiovascular responses to exercise training in hypertensive women receiving β-blockers or angiotensin receptor blockers: A pilot study

ABSTRACT Aim To verify the influence of β-blockers or angiotensin receptor blockers on cardiovascular responses to exercise training in hypertensive post-menopausal women. Methods Postmenopausal women were allocated into: healthy control group (CON; n = 9); angiotensin receptor blockers users (ARB; n = 19); and β-adrenergic blockers users (BB; n = 19). Before and after 12 weeks of combined (aerobic and resistance) exercise training they were evaluated by: heart rate (HR) and its variability (HRV), blood pressure (BP) under stress (Cold pressor and Stroop color tests), and ambulatorial BP and its variability. Results In ambulatorial BP analysis only in ARB group awake systolic BP decreased (p = .011; ARB: From 122 ± 11 to 117 ± 9; BB: From 118 ± 7 to 114 ± 5; CON: From 121 ± 7 to 127 ± 11 mmHg). There were time effects in BP reactivity to stress, where BP reactivity after Stroop color and Cold pressor test decreased in all groups. In BP variability analysis, only BB group has significative decreased values in systolic SD24 (p = .007; ΔARB = −0.3 ± 2.0; ΔBB = −1.3 ± 2.0; ΔCON = 0.8 ± 1.7 mmHg) and SDdn (p = .006; ΔARB = −0.2 ± 1.6; ΔBB = −1.3 ± 2.0; ΔCON = 0.4 ± 2.1 mmHg). HRV analysis demonstrated that post-training, only in BB group LF/HF decreased (p = .001; ΔARB = 0.1 ± 0.8; ΔBB = −0.4 ± 1.5; ΔCON = 1.0 ± 1.7). Conclusion ARB present pronounced responses in awake ambulatorial systolic BP, while β-blockers users present greater responses in BP variability. Besides that, exercise can mitigate BP reactivity to stress with no differences between groups. Lastly, there were no major differences in HRV. Trial registry at “Clinicaltrials.gov” NCT03529838

Impact of Asleep and 24-Hour Blood Pressure Data on the Prevalence of Masked Hypertension by Race/Ethnicity.

We pooled ambulatory blood pressure monitoring data from 5 US studies, including the Jackson Heart Study (JHS), the Coronary Artery Risk Development in Young Adults (CARDIA) study, the Masked Hypertension Study, the Improving the Detection of Hypertension Study, and the North Carolina Masked Hypertension Study. Using a cross-sectional study design, we estimated differences in the prevalence of masked hypertension by race/ethnicity when out-of-office blood pressure (BP) included awake, asleep, and 24-hour BP vs. awake BP alone. We restricted the analyses to participants with office systolic BP (SBP) <130 mm Hg and diastolic BP (DBP) <80 mm Hg. High awake BP was defined as mean SBP/DBP ≥130/80 mm Hg, high asleep BP as mean SBP/DBP ≥110/65 mm Hg, and high 24-hour BP as mean SBP/DBP ≥125/75 mm Hg. Among participants not taking antihypertensive medication (n = 1,292), the prevalence of masked hypertension with out-of-office BP defined by awake BP alone or by awake, asleep, or 24-hour BP was 34.5% and 48.7%, respectively, among non-Hispanic White, 39.7% and 67.6% among non-Hispanic Black, and 19.4% and 35.1% among Hispanic participants. After multivariable adjustment, non-Hispanic Black were more likely than non-Hispanic White participants to have masked hypertension by asleep or 24-hour BP but not awake BP (adjusted odds ratio [OR] 2.14 95% confidence interval [CI] 1.45-3.15) and by asleep or 24-hour BP and awake BP (OR 1.61; 95% CI 1.12-2.32) vs. not having masked hypertension. Assessing asleep and 24-hour BP measures increases the prevalence of masked hypertension more among non-Hispanic Black vs. non-Hispanic White individuals.

Abstract MP31: Telehealth Versus Self-directed Lifestyle Intervention To Promote Healthy Blood Pressure: A Randomized Controlled Trial

Introduction: Telehealth and web-based applications are increasingly available to promote healthy lifestyle behavior change. However, evidence that these approaches lower blood pressure is limited. Methods: We conducted a randomized controlled trial to compare the efficacy of a self-directed vs. a telehealth-delivered dietitian approach using web-based applications in 187 participants (mean age 54.6 y, 52% female) with 24-hour systolic blood pressure (BP) 120-160 mmHg. Participants were recruited in the Geisinger Health System from 1/2019 to 3/2021. Both study arms received personalized recommendations to improve dietary quality based on web-based food frequency questionnaire, and access to an online comprehensive weight management program. The telehealth arm additionally received weekly telephone calls with a dietitian who used motivational interviewing. The primary outcome was 3-month change in 24-hour systolic BP. Secondary outcomes included changes in awake and sleep BP, self-reported physical activity, healthy eating index (HEI)-2015 score, and weight. Results: Twenty-four hour systolic BP improved in both the telehealth-dietitian arm (-6.5 mmHg, 95% CI: -8.4, -4.6) and the self-directed arm (-4.9, 95% CI: -7.0, -2.8), with no difference between arms (p=0.3). Participants in the telehealth-dietitian arm had significantly greater decreases in sleep systolic BP (mean -6.9 mmHg vs. -1.5; p=0.004) and diastolic BP (-3.3 mmHg vs. 0.7; p=0.001). The telehealth-dietitian arm tended to have greater improvements in self-reported physical activity, weight loss, and HEI-2015 score (Figure). Participant satisfaction with the intervention was higher in the telehealth-dietitian arm (p=0.004). Conclusions: Among individuals with elevated BP, the telehealth-dietitian intervention did not lower 24-hour systolic BP compared to the self-directed arm over 3 months. However, there were encouraging changes in other outcomes, including reduced sleep systolic and diastolic BP and increased physical activity.

Application of ensemble machine learning algorithms on lifestyle factors and wearables for cardiovascular risk prediction

This study looked at novel data sources for cardiovascular risk prediction including detailed lifestyle questionnaire and continuous blood pressure monitoring, using ensemble machine learning algorithms (MLAs). The reference conventional risk score compared against was the Framingham Risk Score (FRS). The outcome variables were low or high risk based on calcium score 0 or calcium score 100 and above. Ensemble MLAs were built based on naive bayes, random forest and support vector classifier for low risk and generalized linear regression, support vector regressor and stochastic gradient descent regressor for high risk categories. MLAs were trained on 600 Southeast Asians aged 21 to 69 years free of cardiovascular disease. All MLAs outperformed the FRS for low and high-risk categories. MLA based on lifestyle questionnaire only achieved AUC of 0.715 (95% CI 0.681, 0.750) and 0.710 (95% CI 0.653, 0.766) for low and high risk respectively. Combining all groups of risk factors (lifestyle survey questionnaires, clinical blood tests, 24-h ambulatory blood pressure and heart rate monitoring) along with feature selection, prediction of low and high CVD risk groups were further enhanced to 0.791 (95% CI 0.759, 0.822) and 0.790 (95% CI 0.745, 0.836). Besides conventional predictors, self-reported physical activity, average daily heart rate, awake blood pressure variability and percentage time in diastolic hypertension were important contributors to CVD risk classification.

Predicting Out-of-Office Blood Pressure in a Diverse US Population.

BACKGROUNDThe PRedicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm accurately predicted out-of-office blood pressure (BP) among adults with suspected high BP in the United Kingdom and Canada. We tested the accuracy of PROOF-BP in a diverse US population and evaluated a newly developed US-specific algorithm (PROOF-BP-US).METHODSAdults with ≥2 office BP readings and ≥10 awake BP readings on 24-hour ambulatory BP monitoring from 4 pooled US studies were included. We compared mean awake BP with predicted out-of-office BP using PROOF-BP and PROOF-BP-US. Our primary outcomes were hypertensive out-of-office systolic BP (SBP) ≥130 mm Hg and diastolic BP (DBP) ≥80 mm Hg.RESULTSWe included 3,058 adults, mean (SD) age was 52.0 (11.9) years, 38% were male, and 54% were Black. The area under the receiver-operator characteristic (AUROC) curve (95% confidence interval) for hypertensive out-of-office SBP was 0.81 (0.79–0.82) and DBP was 0.76 (0.74–0.78) for PROOF-BP. For PROOF-BP-US, the AUROC curve for hypertensive out-of-office SBP was 0.82 (0.81–0.83) and for DBP was 0.81 (0.79–0.83). The optimal predicted out-of-office BP ranges for out-of-office BP measurement referral were 120–134/75–84 mm Hg for PROOF-BP and 125–134/75–84 mm Hg for PROOF-BP-US. The 2017 American College of Cardiology/American Heart Association BP guideline (referral range 130–159/80–99 mm Hg) would refer 93.1% of adults not taking antihypertensive medications with office BP ≥130/80 mm Hg in the National Health and Nutrition Examination Survey for out-of-office BP measurement, compared with 53.1% using PROOF-BP and 46.8% using PROOF-BP-US.CONCLUSIONSPROOF-BP and PROOF-BP-US accurately predicted out-of-office hypertension in a diverse sample of US adults.

To treat or not to treat pulmonary arteries: epinephrine provocation to unmask right ventricular load

BackgroundPulmonary artery stenosis (PAS) is common in congenital heart disease (CHD). The indication for treatment of PAS is primarily based on invasively measured pressure gradients. Anesthetics used during cardiac catheterization cause systemic and pulmonary hypotension. We hypothesize that this leads to underestimation of right ventricular (RV) pressure load and under treatment of PAS. The aim of this study is to describe the use of epinephrine to unmask RV pressure load in patients with PAS. MethodsAll cardiac catheterizations in which epinephrine was administered to evaluate RV load were included. There was an indication for treatment in case of a right to left ventricular (RV:LV) pressure ratio >0.6. The indication for treatment before and after epinephrine was evaluated to determine its role in clinical decision making. ResultsA total of 74 procedures were included. In all procedures the invasively measured LV pressure was below the awake blood pressure. At baseline, 33 patients had a RV:LV ratio >0.6. In 41 patients the baseline RV:LV ratio was <0.6. After epinephrine bolus, the LV pressure was raised up to the awake blood pressure. In 19 of the 41 patients without baseline indication, this resulted in a RV:LV ratio >0.6 thereby revealing the indication for treatment. No epinephrine related complications were registered. ConclusionThe hypotensive properties of anesthetics during cardiac catheterization may lead to underestimation of RV pressure load. Invasive pressure measurements should be performed under conditions similar to awake conditions. Epinephrine provocation prevented under treatment in 25% of our patients.

Defining the awake baseline blood pressure in patients undergoing carotid endarterectomy.

To minimize the incidence of intraoperative stroke following carotid endarterectomy (CEA) under general anesthesia, blood pressure (BP) is suggested to be maintained between "awake baseline" BP and 20% above. However, there is neither a widely accepted protocol nor a definition to determine this awake BP. In this study, we analyzed the BP during hospital admission in the days before CEA and propose a definition of how to determine awake BP. In our cohort of 1180 CEA-patients, all noninvasive BP measurements were retrospectively analyzed. BP was measured during preoperative outpatient screening (POS), the last three days before surgery at the ward and in the operating room (OR) directly before anesthesia. Primary outcome was the comparability of all these preoperative BP measurements. Secondary outcome was the comparability of preoperative BP measurements stratified for postoperative stroke within 30 days. POS BP (148±22/80±12 mmHg [mean arterial pressure, MAP: 103±14 mmHg]) and the BP measured on the ward 3, 2, 1 days before surgery and on the day of surgery (146±25/77±13 [MAP: 100±15]), (142±23/76±13 [MAP: 98±15]), (145±23/76±12 [MAP: 99±14]) and (144±22/75±12 mmHg [MAP: 98±14]) were comparable (all P=NS). However, BP in the OR directly before anesthesia was higher, (163±27/88±15 mmHg [MAP: 117±18mmHg]) (P<0.01 vs. all other preoperative moments). A significant higher preinduction systolic BP and MAP was observed in patients suffering a stroke within 30 days compared to patients without (P=0.03 and 0.04 respectively). Awake BP should be determined by averaging available BP values collected preoperatively on the ward and POS. BP measured in the OR directly before induction of anesthesia overestimates "awake" BP; and therefore, it should not be used.

Abstract P190: Antihypertensive Treatment Improves Left Ventricular Geometry After 10 Years Even In Elderly Hypertensive Patients

Introduction: Both ageing and high blood pressure (BP) is associated with a risk of left ventricular hypertrophy; therefore, it is unclear whether antihypertensive treatment for 10 years period reduce cardiac hypertrophy and concentricity beyond the impact of ageing. We assessed the hypothesis that even in elderly patients, BP reduction is effective for left ventricular remodeling. Methods: Among 558 hypertensive patients without concurrent heart disease referred to a cardiology clinic who underwent echocardiography and ambulatory blood pressure monitoring, 151 patients’ data of echocardiography was available after 10 years of follow up period. We evaluated the relation among BP at baseline, antihypertensive medications, and change in echocardiographic parameters of left ventricular geometry. Results: Mean age was 70.8±8.2 years at baseline. 24-hour BP was 127.4±16.4/71.4±9.6mmHg, awake BP was 129.9±17.1/72.4±10.2mmHg, and asleep BP was 122.5±16.9/67.1±9.1 mmHg. After 10 years (mean age 81.0±9.0 years), number of antihypertensive increased from 1.3±1.2 to 2.0±1.1. Left ventricular mass index (LVMI) insignificantly decreased from 115.7 to 98.7mg/m 2 (p=0.167)and relative wall thickness (RWT) significantly decreased from 0.51 to 0.47(p&lt;0.001). There were 12% of patients with normal left ventricular geometry (N), 52% with concentric remodeling (CR), 9% with eccentric hypertrophy (EH), and 27% with concentric hypertrophy (CH) at baseline. Among patients with N or CR at baseline, those who developed to CH or EH had higher night time systolic BP (126.5±17.0 vs 118.9 ±15.4, p=0.037) than those who did not. Neither number nor type of antihypertensive was related to this geometry change. In logistic regression analysis, night time systolic BP was significantly related to the progression of hypertrophy adjusting for age, sex, BMI, LVMI, RWT, and clinic systolic BP at baseline (p=0.04). Conclusions: Even in elderly hypertensive patients, antihypertensive treatment for 10 years improved LV geometry in spite of ageing. Nighttime BP at baseline predicted worsening of LV geometry after 10 years beyond clinic BP.

Cardiovascular responses to physical activity during work and leisure

ObjectivesRecent evidence suggests that occupational physical activity (OPA) is associated with adverse cardiovascular health, whereas leisure time physical activity is protective. This study explored explanatory physiological mechanisms.MethodsNineteen males (68% white,...

Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents.

[Figure: see text].

Association Between Ambulatory Blood Pressure and Coronary Artery Calcification: The JHS.

[Figure: see text].

DIFFERENCE IN BLOOD PRESSURE VALUES FROM OBSERVED AND NO OBSERVED BLOOD PRESSURE MEASUREMENTS WITH AWAKE BLOOD PRESSURE

Objective: Evaluate the correlation and agreement of blood pressure (BP) values from observed and non-observed measurements with awake blood pressure (ABP). Translate the results of the difference between observed and awake BP into SPRINTb Ambulatory Blood Pressure Study. Design and method: Two hundred seventy-eight patients over eighteen years old were eligible. After 5 minutes on rest, a nurse collected clinical characteristics, took three sequential observed (OBP) and non-observed (N-OBP) BP measurements (Microlife- BP 3AC1–1PC), in an alternate order, every fifteen seconds. Also, was recorded twenty-four hours of ABPM (DynaMAPA). BP measurements and ABPM recording followed recommendations of European Guidelines. We calculated Cardiovascular (CV) risk using the SCORE system. aa well as, the average of OBP, N-OBP, awake BP (ABP), and the difference OBP-ABP. We assessed the relationship of observed or non-observed BP values with ABP by calculating the Pearson coefficient (r), and the agreement using a Bland–Altman plot. The significance of differences between average BP values was evaluated using analysis of covariance and Student's T-Test into variance in OBP-ABP. Results: Among 278 patients, 48.6% performed non-observed BP measurements firstly. Demographic and main clinical characteristics were demonstrated in table 1, as well as, all BP media and the differences between OBP-ABP in four subgroups of the studied population. The table below shows p values p values to compared of BP average and differences on BP. Figure 1 shows a Bland Altman plot of the agreement between tested BP against ABP. Figure 2 shows the results of the correlation between the tested BP and ABP. The red marks on X-axis are the ABP values on standard (S - 138.8/78.6) and intensive (I - 126.5/72.0) groups at the end of 27 months of the ABP SPRINT Study, and those on Y-axis the corresponding values of OBP and N-OBP, according to the differences with ABP found in this study. Conclusions: In conclusion, the findings of this study showed a strong correlation and a significant difference to both observed, no observed BP values with awake BP. Our results could be useful in interpreting the ABP SPRINT Study.

HOW MANY BLOOD PRESSURE VALUES WE SHOULD USE TO PREDICT OUT-OF-OFFICE BLOOD PRESSURE ON PROOF-BP ALGORITHM. IS THE MORE BETTER THAN THE LESS ?

Objective: Compare the performance of 3 or 6 sequential blood pressure (BP) measurements to predict awake BP (ABP) values by Predicting Out of Office Blood Pressure in the clinic (PROOF BP). Design and method: This study is a secondary analysis of published research. A nursey collected clinical characteristics, in all participants, taking six sequential observed BP measurements, with a 1-minute interval (Microlife-BP3BTOA). Also, it was recorded ABPM (DynaMAPA). We selected 426 suspected people having hypertension. We estimated out-of-office BP on an algorithm from first to third BP (PROOF BP 1–3) and fourth to sixth (PROOF BP 4–6). We classified the patients in four BP categories, such as true hypertension (HT), true normotension (NT), masked hypertension (MH), and white coat hypertension (WCT). The office standard average considered the first three measurements as office BP (cut off – 140/90) and ABP as a reference standard, and for ABP and tested BP, the cut off was 135/85. We correctly compared the proportion of classified patients, coefficient of correlation (r), receiver operating characteristic curve (AUC), and Bland–Altman plot. The differences of proportions were evaluated using the chi-square test for media analysis of covariance. Results: Among 446 patients, 40.1% were classified as HT, 17.4% (MH), 11.7% (WCH) and 30.8% (NT), age 43.3 ± 13.3, women (44.6%), white people (67.8%), diabetes (2.6%), dyslipidemia (19.2%), obese (39.9%), body mass index 28. 9 ± 5.3, smokers (8.6%). The algorithm recommended AMBP in 41.07%. The proportion of HT was 40.1% MH 17.4%, WCH 11.7%, and NT 30.8%. The main clinical characteristics were age 43.3 ± 13.3, women (44.6%), white people (67.8%), diabetic (2.6%), dyslipidemia (19.2%), obese (39.9%), body mass index 28. 9 ± 5.3, smokers (8.6%). The mains results are in Table 1. Figure 1 shows a Bland and Altman plot of PROOF BP 1–3 and 4–6 against ABP. Conclusions: In conclusion, this secondary analysis data reinforce that the algorithm correctly classifies the vast majority of hypertensive patients and recommends ABPM in less than half of patients. It also adds that six sequential measurements no longer add accuracy to the ambulatory BP prediction tool.

BLOOD PRESSURE CONTROL-RATES THROUGH MONOTHERAPY WITH FOUR DIFFERENT ANTIHYPERTENSIVE AGENTS IN TREATMENT-NAÏVE PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Four different antihypertensive agent classes are equivalently recommended in the guidelines for first-line treatment of arterial hypertension (AHT). However, it is unclear, if one of these agents is more potent than the others to reach blood pressure (BP) control. We sought to compare response rates and BP control in these four classes. Design and method: Patients with newly diagnosed grade 1 or 2 AHT on 24h-BP measurements (ABPM) were randomized in a 1:1:1:1 fashion to either perindopril (ACE), olmesartan (ARB), amlodipin (CCB) or hydrochlorothiazide (HCT). ABPM were checked at baseline (BL), after 4 weeks of half dose (TP1) and after 4 weeks of full dose (TP2), if BP control was not reached after TP1. Patients were classified as controlled if mean BP was &lt; 130/80 mmHg, awake BP &lt; 135/85 mmHg and night BP &lt; 120/70 mmHg. Results: 80 patients were randomized: 20 (25.0%) to ACE, 20 (25.0%) to ARB, 21 (26.3%) to CCB, and 19 (23.8%) to HCT. Mean age was 48 (±14) years, mean BMI 26.5 (±3.7) kg/m2. Mean 24 h systolic BP (sBP) was 141.8 (± 9.1) mmHg, diastolic BP (dBP) 87.8 (± 7.6) mmHg (Table). Mean decrease from BL to TP1 was -5.8 (± 10.9) and -2.7 (± 5.6) mmHg, from BL to TP2 -11.6 (± 11.2) and -5.6 (± 6.7) mmHg, from TP1 to TP2 -5.8 (± 12.0) and -2.8 (± 5.4) mmHg, for mean 24 h sBP and dBP, respectively. After TP1, 21 patients (26.3%) had a controlled BP overall (Figure). After TP2, the number of controlled patients increased to 24 patients (30.0%, p = 0.250, Figure). Control rates were significantly lower for HCT in comparison to the other agents for diastolic values after TP1 (p = 0.013) and after TP1 and TP2 (p = 0.003). Conclusions: Half dose of the most common antihypertensive treatments lead to BP control in 26% of patients with grade 1 or 2 AHT. Control rates were not significantly improved when increasing to full dose. HCT was the least effective, whereas ACE, ARB and CCB were comparably effective.

SHORT-TERM BLOOD PRESSURE VARIABILITY WAS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Objective: We previously reported that abnormal circadian blood pressure (BP) rhythm, a riser BP rhythm in which nocturnal BP exceeds awake BP was associated with cognitive impairment (CI) in heart failure (HF) patients. However, it is not clear that the short-term BP variability (BPV) was associated with cognitive impairment (CI) in HF patients. Design and method: We enrolled 416 hospitalized HF patients and performed ambulatory BP measurement (ABPM) and mini-mental state examination (MMSE). Cognitive impairment (CI) was defined as MMSE score &lt;26. Results: HF with CI was significantly older, higher frequency of female, lower BMI, higer prevalence of HFpEF, higher LVM index than HF without CI. With regard to BP parameters, HF with CI was significantly higher BP variability than HF without CI. In multivariable logistic regression analysis to investigate the association between CI and BP variability, riser BP pattern and SD of sleep DBP (per 5mmHg) were significantly associated with CI (Odds ratio 2.58, 95%CI 1.51–4.43, p &lt; 0.01, Odds ratio 1.45, 95%CI 1.12–1.87, p &lt; 0.01, respectively). Conclusions: Nocturnal short-term BPV and riser BP pattern were associated with CI in HF patients. Hemodynamic abnormality during night should be paid attention not to impaired cognitive function in HF.

10271 How The Kidney Reacts to Nutritional Changes?

ABSTRACT IMPACT: Understanding the mechanism underlying the DASH diet may shed light on the physiologic process by which nutrition influences blood pressure and potentially lead the way to new therapeutics that target ion channels. OBJECTIVES/GOALS: Hypertension is a disease of the westernized world, as it stems from lifestyle habits. Lower salt consumption reduces blood pressure, yet DASH diet is much more effective, lowering blood pressure as efficiently as one anti-hypertensive drug. The precise mechanism through which DASH achieves its effect is not understood, and this is the project goal. METHODS/STUDY POPULATION: We hypothesize that exposing hypertensive volunteers to a high potassium and low sodium DASH diet will change the composition of renal ion channel in an aldosterone-dependent manner, leading to excretion of both sodium and potassium and a reduction in blood pressure. To assess how the nutritional change changes ion channel composition in the kidneys’ epithelium in aldosterone-induced manner, we will monitor urine exosomes, which contain epithelial cell membranes. We designed an in-hospital nutritional studies recruiting 20 volunteers. Patients will consume carefully designed menu, and measurements will be collected daily: blood pressure, biologic samples including blood and urine electrolytes, aldosterone, and urine for exosomes. RESULTS/ANTICIPATED RESULTS: We have collected data from 5 research volunteers so far.following exposure to the high potassium diet, Aldosterone blood levels increased while blood level of both potassium and sodium was maintained within normal limits. Urinary ratio of electrolytes, sodium:potassium was reversed 5-7 days following nutritional change from 6 to 1. Both manual and automated 24-hour blood pressure measurements confirmed blood pressure reduction following nutritional change. The following illustrates the impact the diet had on a participant’s 24-hour ambulatory blood pressure. Daily mean blood pressure was reduced from 120/76 mmHG to 112/68, mean awake blood pressure was reduced from 125/80 mmHG to 117/72 mmHG, and mean sleep blood pressure was reduced from 112/69 to 103/60 mmHG DISCUSSION/SIGNIFICANCE OF FINDINGS: Understanding the mechanism underlying the DASH diet may shed light on the physiologic process by which nutrition influences blood pressure and potentially lead the way to new therapeutics that target ion channels. By introducing our participants to a healthier lifestyle, they could maintain lower blood pressure without requiring medication.

Improved agreement and diagnostic accuracy of a cuffless 24-h blood pressure measurement device in clinical practice

A cuffless blood pressure (BP) device (TestBP) using pulse transit time is in clinical use, but leads to higher BP values compared to a cuff-based 24 h-BP reference device (RefBP). We evaluated the impact of a recent software update on BP results and TestBP’s ability to differentiate between normo- and hypertension. 71 individuals had TestBP (Somnotouch-NIBP) and RefBP measurements simultaneously performed on either arm. TestBP results with software version V1.5 were compared to V1.4 and RefBP. Mean 24 h (± SD) BP for the RefBP, TestBP-V1.4 and TestBP-V1.5 were systolic 134.0 (± 17.3), 140.8 (± 20) and 139.1 (± 20) mmHg, and diastolic 79.3 (± 11.7), 85.8 (± 14.1) and 83.5 (± 13.0) mmHg, respectively (p-values < 0.001). TestBP-V1.5 area under the curve (95% confidence interval) versus RefBP for hypertension detection was 0.92 (0.86; 0.99), 0.94 (0.88; 0.99) and 0.77 (0.66; 0.88) for systolic and 0.92 (0.86; 0.99), 0.92 (0.85; 0.99) and 0.84 (0.74; 0.94) for diastolic 24 h, awake and asleep BP respectively. TestBP-V1.5 detected elevated systolic/diastolic mean 24 h-BP with a 95%/90% sensitivity and 65%/70% specificity. Highest Youden’s Index was systolic 133 (sensitivity 95%/specificity 80%) and diastolic 87 mmHg (sensitivity 81%/specificity 98%). The update improved the agreement to RefBP. TestBP was excellent for detecting 24 h and awake hypertensive BP values but not for asleep BP values.