Changes In Blood Pressure Patterns Research Articles

Changes in blood pressure patterns of hypertensive patients at Okcheon-gun public health center before and after the COVID-19 pandemic

Objective: The purpose of this study was to investigate the effect of discontinuation of periodic follow-up at a public health center in Okcheon-gun, Chungcheongbuk-do on the blood pressure management of hypertensive patients who visited the public health center regularly. The outpatient clinic of the public health center was totally shut down from March 1, 2020 to April 21, 2020, and then re-opened from April 22, focusing on chronic disease patients.Methods: The study group was selected among patients who visited the re-opened clinic from April 22 to the end of May, diagnosed with hypertension, and had a regular follow-up in the public health center. Through the health center medical records, the blood pressure of each patient was analyzed before and after the COVID-19 pandemicResults: Out of a total of 573 patients that visited the center, 306 patients (53.4%) were treated for hypertension, and among them, 235 patients were enrolled. The average blood pressure of all subjects was 136.9/78.0mmHg after the COVID-19 pandemic, which is 4.4mmHg higher systolic blood pressure(SBP)(P < 0.001) and 1.7mmHg higher diastolic blood pressure(DBP)(P < 0.05) than the average blood pressure before the COVID-19 pandemic. For the clinical control status of the SBP, 55% of all subjects maintained the status of ‘controlled’ before and after the COVID-19 pandemic, 15% maintained the ‘uncontrolled’ state, 23% changed from ‘controlled’ to ‘uncontrolled’, and 7.7% changed from ‘uncontrolled’ to ‘controlled’ state. The number of patients with uncontrolled state showed a high increase(McNemar’s chi-square test, P < 0.001).Conclusions: The blood pressure of hypertensive patients managed by Okcheon public health center showed a significant increase of 4.4/1.7mmHg after termination of regular follow-up in response to the COVID-19 pandemic for about 2 months. The number of patients with a clinical status of uncontrolled SBP also increased significantly from 23% to 37%.

Abstract 003: Early and Late Post-Kidney Transplant Hypertension and Late Renal Allograft Outcome

Background: Association between pattern of blood pressure (BP) change at different period after kidney transplantation (KTx) and renal allograft function is unclear. We examine the association between changes in BP patterns and long-term allograft function. Methods: Kidney transplant recipients were stratified into 4 groups based on presence (+) or absence (-) of systolic hypertension (SHTN; SBP ≥130 mmHg) both at 1 and 6 mo post-KTx (Gr1 (-,-), Gr2 (-,+), Gr3 (+,-), Gr4 (+,+)). Declined allograft function defined by a decrease in eGFR from baseline eGFR at 1-mo post-KTx during 24 mo of follow-up among 4 different groups is examined by multivariable Cox regression analysis. Results: Of all 70 patients, mean±SD age was 52.7±12 yr and 41% was female. Mean SBP at 1- and 6-mo post-KTx were 130.9±18.3 and 136.2±18.2 mmHg, respectively. Baseline mean eGFR at 1-mo post-KTx was 50.86±18.89 ml/min/1.73 m 2 and were not different among all 4 groups. Among 70 patients, 57 patients (81%) had a decrease in eGFR between 1 and 24 mo post-KTx with a median time to outcome of 6.8 mo (IQR 2.8-19.6) and the incidence rate of 0.075 person-mo. The number of patients (% in each group) with declined eGFR in Gr1, 2, 3 and 4 were 15 (88%), 17 (89%), 7 (78%), and 18 (72%) patients, respectively (x 2 2.8830, p 0.410). Compared to Gr1, Gr2 had higher, but Gr 3 and 4 had lower the risk of declining eGFR but no statistical significance (HR(95% CI): Gr2 1.20 (0.60-2.40); Gr3 0.79 (0.32-1.95); Gr4 0.78 (0.39-1.55)). After adjusted for age, gender, race, types of induction immunosuppression, types of KTx, SBP, DBP, and BMI at the time of KTx, Gr3 became higher risk; otherwise, the direction of the association remains the same for Gr2 and Gr4. Conclusion: Changes in SBP from either normotension to HTN or vice versa between 1 and 6 mo post-KTx appears to be associated with poorer allograft function within 24 mo post-KTx; whereas, maintaining SBP pattern both normotension or HTN from 1 to 6 mo post-KTx may be protective for a decline in allograft function. Very early BP levels during 1 mo post-KTx may be the suitable target SBP for kidney transplant recipients and too liberal or tight BP control in normotensive or hypertensive patients after 1 mo post-KTx may associated with greater risk for worsening long-term allograft outcomes.

Pharmacokinetic and Pharmacodynamic Study Determines Factors Affecting Blood Pressure Response to Valsartan

❙ABSTRACT❙ Background: Valsartan is an angiotensin II receptor blocker and is used for patient with hypertension. Although response to valsartan varies each individual, there is no study about factors affecting the variability of valsartan response. Methods: To investigate the effects of valsartan on the baseline characteristics of blood pressure, single group, open label, pre- and postcomparison clinical study was conducted. Total 21 male Korean volunteers were enrolled. Each subject was administered no drugs in first period and valsartan 80 mg (Diovan HCT) in second period. For pharmacodynamic analysis, 24 hours blood pressure changes were monitored by ambulatory blood pressure monitoring. Twenty-four hour blood pressure changes were matched to valsartan concentration and analyzed by correlation analysis. Changes in blood pressure pattern were also analyzed. Subjects were divided into responder, non-responder, and reverse responder according to pre- and post- 24 hours blood monitoring results. For determination of pharmacokinetic parameters, plasma concentration of valsartan was measured by a validated ultra-performance liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters including area under the plasma concentration versus time curve from 0 hour to the last measurable concentration (AUCt), area under the plasma concentration versus time curve extrapolated to infinity, maximum plasma concentration (Cmax), and time required to reach maximum plasma concentration (Tmax) were calculated by noncompartmental models in the BA-CALC 2008 program ver. 1.0.0. Results: There were no significant associations between blood pressure changes and pharmacokinetic parameters of valsartan. Blood pressure pattern change analysis showed significant results. For AUCt, total amount of absorbed valsartan was 25,808 ± 6,863.0 ng․hr/mL , 20,683 ± 8,782.7 ng․hr/mL, and 12,502 ± 5,566.6 ng․hr/mL in responder, non-responder, and reverse responder, respectively (p = 0.041). In Cmax, maximum concentration of valsartan was 4,314 ± 1,522.6 ng/mL, 2,588 ± 1,273.9 ng/mL, and 2,056 ± 1,075.5 ng/mL, respectively. Conclusions: These results showed that response to valsartan was not associated with blood concentration in healthy volunteers and changes in blood pressure patterns to valsartan might be associated with the amount of drugs which are absorbed to subjects. (J Korean Soc Hypertens 2012;18(3):88-96)

Construction and characterisation of a longitudinal clinical blood pressure database for epidemiological studies of hypertension in pregnancy

Blood pressure measurement plays a central role in the screening and management of hypertension during pregnancy. Although descriptions of changes in blood pressure patterns of normotensive and hypertensive pregnancies are plentiful, relatively little is known about how modifiable environmental and lifestyle characteristics, including maternal diet and physical activity, influence blood pressure levels in pregnancy. In this paper we provide a detailed description of the first 2000 subjects enrolled in the Omega Prospective Cohort Study. Our intention is to characterise the cohort and to establish a rigorous data framework that will form the basis for future analyses of the association between blood pressure patterns in pregnancy and modifiable risk factors. We describe the construction of a representative longitudinal blood pressure analysis database drawn from routinely collected measurements. In doing this, we explore possible over- and under-representation of patients and evaluate ways of modifying the database to address areas of possible bias. In addition, we consider questions of data quality which are specific to blood pressure measurements. In an accompanying paper, we use this database to explore the influence of maternal pre-pregnancy adiposity on blood pressure levels across gestation.

Diastolic pressure underestimates age-related hemodynamic impairment.

It has been hypothesized that as large arteries become more rigid with age, the pattern of hypertension changes from diastolic to systolic. Thus, diastolic blood pressure (DBP) may lose its ability to reflect the increase in vascular resistance with age. To assess this, we studied the age-related changes in blood pressure pattern and its steady-state and pulsatile determinants. We performed an epidemiological analysis based on a national survey of 10,462 subjects from Argentina. A hemodynamic analysis (impedance cardiography) was then carried out in 636 consecutive hypertensive patients (age, 25 to 74 years). Whereas the rate of increment in the prevalence of mild to moderate hypertension (MMH) reached a plateau after the sixth decade, isolated and borderline systolic forms of hypertension began a steep and sustained rise. Among patients with MMH, DBP remained stable from the third to the seventh decade, whereas SBP maintained a sustained increase. Despite similar DBP, the systemic vascular resistance index increased 47% (P<.01) and the cardiac index decreased 27% (P<.01), whereas the ratio of stroke volume to pulse pressure, an index of arterial compliance, decreased 45% (P<.01). However, there were no significant differences between older patients with MMH and those with isolated systolic hypertension in the level of SBP, vascular resistance, stroke volume, and cardiac index. Compared with age-matched normotensive control subjects, the ratio of stroke volume to pulse pressure was much more reduced in isolated systolic hypertension (48%) than in MMH (30%). In summary, the present study, carried out in a large sample of hypertensive subjects with a wide age range, showed a simultaneous impairment in vascular resistance and arterial compliance associated with aging in different patterns of hypertension. The magnitude of these changes, with opposite effects on DBP but additive effects on SBP, suggests that a hemodynamic mechanism could determine the transition in the prevalence of diastolic hypertension toward a systolic pattern of hypertension with aging. Also, the results suggest that SBP, but not DBP, is a reliable indicator of the underlying hemodynamic abnormalities (high resistance and low arterial compliance) in the elderly.