Clinic Blood Pressure Measurements Research Articles

Abstract P163: Blood Pressure Checks And Diagnosing Hypertension: Provider Knowledge, Beliefs, And Practices

Context: The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new diagnosis of hypertension, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common in routine practice. Objective: To evaluate provider knowledge, beliefs, and practices about BP diagnostic tests Methods: The setting was 10 primary care medical centers in a single health care system. E-mails with a link to a survey were sent to 420 providers, with 282 (67%) responding, including 102 medical assistants (MA), 28 licensed practical nurses (LPN), 33 registered nurses (RN), 86 primary care physicians (physician), and 33 advanced practitioners (AP). Outcomes were a descriptive analysis of provider BP measurement and hypertension diagnosis knowledge, beliefs, and practices. Results: Most providers (78.8%) believed that BP measured manually with a stethoscope and ABPM as very or highly accurate way to measure BP when making a new diagnosis of hypertension. In contrast, most providers did not believe that automated clinic BPs, home BP, or kiosk BP measurements were very or highly accurate. Almost all providers reported that they always or almost always relied on clinic BP measurements in making a new diagnosis of hypertension (95.7%), but the majority of physician/APs would prefer using ABPM (60.5%) if it was readily available. Providers were mixed as to whether patients received home BP training and whether home BP monitors were checked for accuracy. Physician/APs reported varying home BP schedules with no schedule the most common response (37.3%), followed by 14 days (19.1%), and 7 days (10.9%). Almost all physicians/APs reported using a clinic BP threshold of 140/90 mmHg for making a new diagnosis of, but a few reported 130/80 mmHg. Very few physician/APs reported guideline concordant home or ABPM diagnostic thresholds, with 140/90 mmHg the most common response. Conclusion: In our study providers did not report following evidence-based guidelines for making a new diagnosis of hypertension, and appeared to have substantial gaps in knowledge, beliefs, and use of recommended practices. Interventions to increase use of evidence-based practices for diagnosing hypertension are needed.

Associated factors with excessive weight gain in pregnant women from Maceió, Northeastern Brazil

This article aims to evaluate the associated factors with excessive weight gain in pregnant women from Maceió, the capital of Alagoas, Northeastern Brazil. Cross-sectional study with pregnant women attended in public health in the city of Maceió in 2014, of which socioeconomic, clinical (glycemia, capillary hemoglobin, and blood pressure measurement), dietary, and anthropometric data, including in the latter gestational weight gain, classified as insufficient, adequate and excessive according to the US Institute of Medicine, were collected. The combination of excessive weight gain with the independent variables was tested using the Poisson regression expressed by the Prevalence Ratio (PR) and a 95% confidence interval (CI95%). We studied 403 pregnant women with a mean age of 24.08 ± 6.01 years, with 19.9% of them displayed insufficient weight gain; 14.1% displayed adequate weight gain, and 66.0% displayed excessive weight gain, that was associated with maternal hyperglycemia (PR = 1.35; CI95% = 1.17 to 1.57; p < 0.001). Excessive weight gain is common among pregnant women evaluated with the association of this variable with maternal hyperglycemia.

Optimizing observer performance of clinic blood Pressure measurement: a position statement from the Lancet Commission on Hypertension GroupOtimização do desempenho do observador na medição clínica da pressão arterial: posicionamento do Grupo da Lancet Commission on Hypertension

RESUMENLa hipertensión arterial es una causa modificable muy prevalente de enfermedades cardiovasculares, accidentes cerebrovasculares y muerte. Medir con exactitud la presión arterial es fundamental, dado que un error de medición de 5 mmHg puede ser motivo para clasificar incorrectamente como hipertensas a 84 millones de personas en todo el mundo. En la presente declaración de posición se resumen los procedimientos para optimizar el desempeño del observador al medir la presión arterial en el consultorio, con atención especial a los entornos de ingresos bajos o medianos, donde esta medición se ve complicada por limitaciones de recursos y tiempo, sobrecarga de trabajo y falta de suministro eléctrico. Es posible reducir al mínimo muchos errores de medición con una preparación adecuada de los pacientes y el uso de técnicas estandarizadas. Para simplificar la medición y prevenir errores del observador, deben usarse tensiómetros semiautomáticos o automáticos de manguito validados, en lugar del método por auscultación. Pueden ayudar también la distribución de tareas, la creación de un área específica de medición y el uso de aparatos semiautomáticos o de carga solar. Es fundamental garantizar la capacitación inicial y periódica de los integrantes del equipo de salud. Debe considerarse la implementación de programas de certificación de bajo costo y fácilmente accesibles con el objetivo de mejorar la medición de la presión arterial.

Using Predicted Atherosclerotic Cardiovascular Disease Risk for Discrimination of Awake or Nocturnal Hypertension.

Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40-79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015-2016 (n = 716) and the baseline Jackson Heart Study exam in 2000-2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

24-h ambulatory blood pressure versus clinic blood pressure as predictors of cardiovascular risk: a systematic review and meta-analysis of prospective studies.

There is uncertainty about the usefulness of ambulatory blood pressure (ABP) in predicting cardiovascular disease (CVD) risk. Our objective was to compare the prognostic value of ABP versus clinic blood pressure (BP) in CVD. We conducted electronic searches on Medline, Embase, and the Cochrane library up to July 2018. We included prospective longitudinal studies that compared 24-h ABP with clinic BP measurement in adults. Our main outcomes were all-cause mortality, CVD mortality, and/or CVD events. We assessed study quality based on four domains and pooled data using a random effects model of STATA for meta-analyses. We included 13 studies comprising 81 736 participants. The overall quality of the studies was moderate. Both systolic and diastolic 24-h ABP as well as systolic clinic BP significantly predicted all-cause mortality, CVD mortality, and CVD events. Systolic 24-h ABP was significantly better than systolic clinic BP at predicting future risk of CVD events: combined hazard ratio for 24-h ABP = 1.27 (95% confidence interval 1.21-1.34) per 10 mmHg increase in SBP compared with 1.13 (1.06-1.21) for clinic BP (interaction test P = 0.02). After adjusting for clinic BP, both systolic and diastolic 24-h ABP measurements were significantly better than their corresponding clinic measurements at predicting all-cause mortality, CVD mortality, and CVD events (P = 0.001 and P = 0.000, respectively). Systolic 24-h ABP is a better predictor of future CVD events than systolic clinic BP. Future studies should incorporate the use of individual patient data to assess the prognostic value of 24-h ABP.

Prevalence and factors associated with adherence to anti-hypertensives among adults with hypertension in a developed Asian community: A cross-sectional study

Introduction: Poor adherence to anti-hypertensive medications (AHM) results in hypertension treatment failure. Understanding and addressing the factors associated with adherence to AHM may potentially improve health outcomes. This study aimed to assess the prevalence and factors associated with patients’ adherence to AHM in a developed Asian community. Methods: An assistant-administered questionnaire survey was conducted on multi-ethnic Asian adults aged 31–80 years with essential hypertension based on their electronic health records (EHR) at a public primary-care clinic. Data on their demographic characteristics, clinical measurements of blood pressure and body mass index, co-morbidities and prescriptions from the EHR, along with the Medication Adherence Report Scale-5 scores were collated, audited and analysed. A MARS-5 score of &lt;25 indicated poor adherence. Logistic regression was used to identify factors associated with adherence to AHM. Results: Data of 395 patients were analysed. Of these, 179 (45.3%) had poor adherence to at least one AHM. Bivariate analysis showed that poor adherence was significantly associated with lower mean age (59 years old vs. 63 years old), higher mean clinic diastolic blood pressure (76 mmHg vs. 73 mmHg) and higher mean weight (70.4 kg vs. 67.4 kg). Logistic regression showed that patients with no co-morbidities (such as diabetes mellitus, dyslipidaemia, stroke and ischaemic heart disease) had better medication adherence (MA; odds ratio=1.98; 95% confidence interval 1.14–3.45; p=0.02). There was no significant MA difference between the classes, dose frequency and number of AHM. Conclusion: Almost half of the patients had poor adherence to at least one AHM. Co-morbidity significantly influenced their MA. Attention should be directed to patients with co-morbidities to assess their AHM adherence.

Blood pressure phenotypes in young patients with type 1 diabetes

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p&lt;0,05.Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP &lt;140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients. Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

Ambulatory blood pressure measurement and assessment of arterial stiffness in individuals with diabetes mellitus

Background: Ambulatory BP monitoring (ABPM) might be more accurate than clinical BP measurement. It allows detection of nocturnal BP and dipping patterns, and can reduce false-positive results by detecting white-coat hypertension and false-negative results by detecting masked hypertension. Objective: Assessing the use of ambulatory BP monitoring (ABPM) in individuals with diabetes mellitus to identify the presence of hypertension and its association with arterial stiffness. Patients and Methods: The study included 100 diabetic patients in addition to 20 apparently healthy individuals. Results: In comparison with healthy subjects, patients with diabetes were found to have hypertension using ABPM. ABPM appeared to be useful in the detection of hypertension in patients with diabetes. Comparison between patients and control showed statistically significant difference according to average day, average night and allover average readings. Arterial stiffness also found to be increased in patients with hypertension with statistically significant difference between studied groups according to stiffness index. Conclusion: ABPM analysis revealed that about one-third of the participants with diabetes had masked hypertension. Those individuals cannot be detected by office BP alone. Moreover, arterial stiffness increased in individuals with masked hypertension. These findings supported the use of ABPM to identify individuals at risk of cardiovascular disease.

Ambulatory blood pressure measurement and assessment of arterial stiffness in individuals with diabetes mellitus

Background: Ambulatory BP monitoring (ABPM) might be more accurate than clinical BP measurement. It allows detection of nocturnal BP and dipping patterns, and can reduce false-positive results by detecting white-coat hypertension and false-negative results by detecting masked hypertension. Objective: Assessing the use of ambulatory BP monitoring (ABPM) in individuals with diabetes mellitus to identify the presence of hypertension and its association with arterial stiffness. Patients and Methods: The study included 100 diabetic patients in addition to 20 apparently healthy individuals. Results: In comparison with healthy subjects, patients with diabetes were found to have hypertension using ABPM. ABPM appeared to be useful in the detection of hypertension in patients with diabetes. Comparison between patients and control showed statistically significant difference according to average day, average night and allover average readings. Arterial stiffness also found to be increased in patients with hypertension with statistically significant difference between studied groups according to stiffness index. Conclusion: ABPM analysis revealed that about one-third of the participants with diabetes had masked hypertension. Those individuals cannot be detected by office BP alone. Moreover, arterial stiffness increased in individuals with masked hypertension. These findings supported the use of ABPM to identify individuals at risk of cardiovascular disease.

Abstract P487: Network Stressors, Personal Stressors, And Sustained Hypertension In African American Women

Introduction: Stressful life events (SLE) have been associated with poor cardiovascular health but most studies have focused on stressors that directly impact the individuals under study, or personal stressors. Research suggests that women, particularly African-American women, may actually be more vulnerable to network stressors (e.g. SLE that impact important others, such as children, spouses and friends). However, few studies have examined this phenomenon. Hypothesis: We tested the hypothesis that greater exposure to network, versus personal stressors, would be associated with elevated clinic blood pressure (BP) as well as BP in daily life, assessed via 48-hour ambulatory monitoring. Methods: Participants were 395 African-American women aged 30-45 (Mean= 39.5 ±4.6 yrs) from a range of educational backgrounds recruited from a large southeastern metropolitan area. SLE were assessed using a 22-item Stressful Life Events checklist and further classified into personal (e.g. “major accident/assault/robbery happened to you”) or network (e.g. “serious physical illness, injury or drug/alcohol problem in someone family member/friend”) stressors and summed. Clinic and 48-hr ambulatory BP measurements were assessed and sustained hypertension (HTN) was defined as both clinic (≥130/80mmHg) and ambulatory HTN (≥130/80mmHg), using 2017 AHA/ACC guidelines. Logistic regression analyses were used to examine the associations between types of stressors and sustained HTN after adjusting for age, education, body mass index, and BP meds. Results: Approximately 51.2% (N=211) of women had clinic HTN and 29.9% (N=123) of women had sustained HTN (elevated in both clinic and in daily life). In unadjusted multivariable logistic regression analyses, each additional network stressor was associated with a greater likelihood of having elevated clinic (OR-1.21 [1.04-1.40]) and sustained HTN (OR- OR-1.22 [1.04-1.43]). Findings for clinic (OR-1.25, [1.06-1.48]) and sustained HTN (OR-1.23, [1.04-1.46]) remained significant after adjustment for covariates. There were no significant associations between reports of personal stressors and either clinic, or sustained HTN in unadjusted or adjusted analyses. Discussion: Network, but not personal stressors, were associated with elevated rates of HTN, both in clinic and daily life for African-American women. Future research is needed to determine whether interventions targeting stress management for network stressors specifically might impact BP in this high-risk population.

SAT-161 TREATMENT OF DIABESITY WITH DIET AND NEWER ANTIGLYCEMIC MEDICATIONS IN PLACE OF INSULIN: EFFECT ON DIABETIC KIDNEY DISEASE

Type 2 diabetes is the result of several years of prediabetes and the metabolic syndrome. The goal of treatment is weight loss to reduce insulin resistance, and to reduce the need for glucose-lowering medications including insulin. Long term data from the Diabetes Control and Complications trial showed that tight HbA1C correction does not lead to better cardiovascular disease (CVD) outcomes, yet tight control does correct microvascular complications. Recent reports suggested that insulin therapy does not treat the biochemical components of metabolic syndrome, whereas the oral antihyperglycemic medications especially metformin, the incretin mimetics (GLP-1 receptor agonists) and the sodium-glucose co-transporter-2 (SGLT2) inhibitors do indeed correct this. Weight loss correction also needs a caloric deficit but this becomes hard with insulin therapy which often causes weight gain. Standards of Medical Care in Diabetes by American Diabetes Association stated that SGLT2 inhibitors and GLP-1 RA should be considered for patients with type 2 diabetes, established atherosclerotic CVD and chronic kidney disease (CKD) who require another drug or cannot tolerate metformin to attain target HbA1C as these agents appear to reduce risks of CKD progression, CVD events, and hypoglycemia. We treated patients of type 2 diabetes and obesity with combined low-carbohydrate diets and intermittent fasting, along with metformin and newer antiglycemic agents, stopping of insulin therapy wherever feasible. The associations between weight loss, improvement in renal function and treatments were reported using correlation coefficient r and probability p value where significant. Total of 60 patients were reviewed between February 2014 and July 2019 in our outpatient clinic. Mean age was 62.5 years with male to female ratio 3:2. The observed average weight loss was 10.74kg, with 13.2kg and 7.06kg loss for male and female patients respectively. Estimated glomerular filtration rate (eGFR) has improved by 3.13ml/min/1.73m2 and proteinuria was reduced by 12.4 units on average, in terms of albumin creatinine ratio. Mean HbA1C reduction was 0.7%. Mean reduction in insulin therapy was by 16 units with a maximum 202 units in one patient. Clinic blood pressure measurement during the follow-up period was largely unchanged. Weight reduction seems to improve eGFR (r 0.2, p 0.0012, 95% CI from 3.6716 to 13.4304). Combined use of SGLT-2 inhibitor and GLP-1 RA seems to have effect on improvement in eGFR (p 0.01) regardless of weight loss.View Large Image Figure ViewerDownload Hi-res image Download (PPT) It seems possible to control blood sugar in type 2 diabetes by combining metformin, SGLT-2 inhibitor and or GLP-1 RA with intermittent fasting and low-calorie diets avoiding extra-insulin therapy, with resultant improvement in renal function (eGFR and proteinuria) along with weight loss. Therefore, oral antihyperglycemic agents with proven cardiovascular benefit and renal protection should be considered earlier to achieve the treatment goals where drug-specific effects are important on the basis of patient factors.

SAT-327 AMBULATORY BLOOD PRESSURE MONITORING PRIOR TO KIDNEY DONATION

In kidney transplantation, the requirements for organ donation has been extended to older donors or those with a history of cardiovascular disease that previously have been considered as contraindications. Living kidney donors should have no pathologic conditions which can involve the kidney in the future. But hypertension (HT) have recently be considered not to contraindicate kidney donors under some conditions. This study aims to determine the interest of ambulatory blood pressure monitoring (ABPM) prior to kidney donation for diagnosis of blood pressure or diagnosis of HT and for diagnosis of medication-controlled HT. Our report is about a descriptive retrospective study of 6 living kidney donors who underwent casual clinic and ABPM prior to kidney donation. In our series of 73 living donor, in 67 among them, the hemodynamic evaluation of kidney donors was limited to clinic blood pressure levels (91%). ABPM was performed in 6 donors ABPM (8.2%): indications: donors known to have HT, donors with high blood pressure on clinic evaluation). The remaining 6 donors underwent Subjects were between the ages of 48 and 56, with a mean of body mass index of 26,5 kg/m² [22 -29,5 kg/m²]. The clinic systolic blood pressure (SBP) average was 138,5 mmHg [114 – 150]. For 4 cases with clinic HT the ABPM was used to diagnose high blood pressure. The diagnosis of hypertension was rejected in 2 patients aged <50 y.o with a clinic BP at 140/90 mmHg and an ABPM daytime BP <135/85 mmHg and also in 2 patients aged > 50 y.o with normal BP in clinic BP measurement. The ABPM was used to check the blood pressure balance in 2 patients whom were treated by calcium channel blocker associated to an angiotensin II receptor antagonists in one case and confirmed a well-controlled hypertension assessed by ABPM <130/85 mmHg under treatment but one of them had a non-dipper hypertension. All donors had nephrectomy for successful kidney transplantation in the recipient with a good kidney function and simple operative follow-up for the donors. In HT donors, HT was well controlled after 3 years follow up with no organ involvement. ABPM revealed white coat effect hypertension and confirm well- controlled HT. It should be more frequently used before and after kidney donation. the Amsterdam Forum recommend the use of an ABPM considers that, if donors whose blood pressure exceeds 140/90 mmHg should be generally challenged, some candidates over 50y.o whose hypertension is easily controlled without visceral repercussions may to be considered as donors.

ASSESSMENT OF THE INTEGRATION OF AUTOMATED OFFICE BLOOD PRESSURE MONITORING IN AN AMBULATORY CARDIOLOGY CLINIC

Automated office blood pressure monitoring (AOBP) has been introduced as an alternative to traditional clinic blood pressure (CBP) measures. Evidence and practice guidelines support AOBP use based on improved prediction of end-organ damage and white coat effect versus CBPs. This evaluation was a

The Association Between Selected Molecular Biomarkers and Ambulatory Blood Pressure Patterns in African Chronic Kidney Disease and Hypertensive Patients Compared With Normotensive Controls: Protocol for a Longitudinal Study.

BackgroundChronic kidney disease (CKD) is a burgeoning epidemic in sub-Saharan Africa. Abnormal blood pressure variations are prevalent in CKD and potentiate the risk of cardiovascular morbidity and mortality. Certain genetic variants (angiotensin II receptor type 1 1166 A>C and angiotensin-converting enzyme insertion and deletion polymorphisms) and biomarkers such as interleukin–6, tumor necrosis factor, soluble (s) E-selectin, homocysteine, and highly sensitive C-reactive protein have been shown to affect blood pressure variability among non-African CKD, hypertensive. and nonhypertensive CKD population. However, the contributions of the pattern, genetic, and environmental determinants of ambulatory blood pressure in African CKD have not been characterized. Understanding these interactions may help to develop interventions to prevent major cardiovascular events among people with CKD.ObjectiveThe overarching objective of this study is to identify, document, and develop approaches to address related phenomic, genetic, and environmental determinants of ambulatory blood pressure patterns in African CKD and non-CKD hypertensive patients compared with normotensive controls.MethodsThis is a longitudinal short-term follow-up study of 200 adult subjects with CKD and 200 each of age-matched hypertensives without CKD and apparently healthy controls. Demographic information, detailed clinical profile, electrocardiography, echocardiography, and 24-hr ambulatory blood pressure measurements will be obtained. Blood samples will be collected to determine albumin-creatinine ratio, fasting plasma glucose, lipid profile, electrolytes, urea and creatinine, C-reactive protein, serum homocysteine, fibroblast growth factor–23, and complete blood count, while 2 mL blood aliquot will be collected in EDTA (ethylenediaminetetraacetic acid) tubes and mixed using an electronic rolling system to prevent blood clots and subsequently used for DNA extraction and genetic analysis.ResultsA total of 239 participants have been recruited so far, and it is expected that the recruitment phase will be complete in June 2020. The follow-up phase will continue with data analysis and publications of results.ConclusionsThis study will help stratify Nigerian CKD patients phenotypically and genotypically in terms of their blood pressure variations with implications for targeted interventions and timing of medications to improve prognosis.International Registered Report Identifier (IRRID)DERR1-10.2196/14820

Seasonal Indicators of Blood Pressure, Data of Asthma Control Questionnaires and Quality of Life in Hypertensive Patients with Bronchial Asthma

Aim. To study the seasonal indicators of quality of life and control of bronchial asthma in hypertensive patients with bronchial asthma, observed by a cardiologist of the state outpatient institution.Material and methods. Data from a prospective cohort study of hypertensive patients, some of which had bronchial asthma without exacerbation, were analyzed. Patients who were observed by a cardiologist at a state outpatient clinic took part in the study. There were other concomitant diseases that occurred in the participants, in addition to hypertension and bronchial asthma. Two groups of patients were formed: the control group (n=85) included patients with hypertension only, the main group (n=40) included hypertension and bronchial asthma. Patients had 3 visits: initial one, and after 6 and 12 months and then data on outcomes (30.1Ѓ}7.6 months of follow-up) were collected. The first and third visits included clinical measurements of blood pressure (BP), 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, a standard survey, survey with questionnaires evaluating the control of bronchial asthma (Asthma Control Questionnaire; ACQ) and the patients quality of life (General Well-Being Questionnaire; GWBQ). The second visit included clinical BP and ACQ and GWBQ questionnaires. A comparison of the average indicators from the total number of observations carried out in winter, spring, summer and autumn periods has been performed.Results. Hypertensive patients with/without bronchial asthma (n=125; 28 men, 97 women, average age 62.6Ѓ}8.8 years, duration of hypertension – 11.6Ѓ}8.6, duration of bronchial asthma – 9.3Ѓ}11.9 years) took part in the study. Outpatient BP levels throughout the study period were maintained at target values in both groups. It was shown that seasonal BP levels do not differ in the compared groups, except for winter indicators: winter daytime systolic BP levels were higher in the main group (p=0.03). Seasonal fluctuations in BP were not detected in the control group, however, they were present in the patients of the main group: winter daytime levels of diastolic BP and average daily levels of diastolic BP and systolic BP were higher than summer ones, and winter daytime systolic BP values (p&lt;0.05) and clinical diastolic BP (p=0.004) – higher than autumn levels. Seasonal quality of life indicators in the main group were worse than in the control group in all seasons. Significant seasonal dynamics of quality of life indicators in patients in two groups was not detected. The ACQ questionnaire showed that asthma control changed in different seasons in accordance with the ACQ total score: in winter and spring – uncontrolled bronchial asthma (total score &gt;1.5), in summer and autumn – partially controlled (total score ≤1.5). During the analysis of various factors associated with the combined primary endpoint (death, transient ischemic attack, angina pectoris, cardiac arrhythmias, arterial revascularization), relationships with quality of life indicators were revealed: negative connections – with indicators characterizing positive psychological health, mood at visit, positive correlations – with psychological abilities.Conclusion: Seasonal fluctuations in ambulatory BP levels were not found in the control group and were found in the main group. The quality of life indicators for patients of the main group were significantly worse than in the control group for all components in all seasons. The control of asthma changed in different seasons in accordance with the ACQ total score: uncontrolled bronchial asthma occurred in winter and spring, partially controlled – in summer and autumn. Correlations of the combined primary endpoint with quality of life indicators were found after analyzing various factors.

Twenty-four-hour blood pressure management in India: A position statement by Indian College of cardiology

Blood pressure (BP), even in healthy normotensive individuals, is dynamic, varies with a circadian periodicity, and is influenced by physiological and environmental factors. Abnormal 24-h BP patterns have been observed in many patients with hypertension (HTN), which may be overlooked if evaluations are based only on office BP measurements. Out of office BP measurements, such as Ambulatory Blood Pressure Monitoring and Home Blood Pressure Monitoring (ABPM and HBPM) is important for optimal BP management and are better predictors of adverse outcomes. However, HTN diagnosis and management are often based on relatively few clinic BP measurements, and there are no recommendations to guide clinicians managing patients with abnormal 24-h BP patterns in India. Thus, the present consensus statement aims to provide uniform evidence-based recommendations for the diagnosis and management of abnormal 24-h BP patterns. Strategies for screening for HTN based on the current prevalence trends in India have been suggested. Further, recommendations on the appropriate use of ABPM and HBPM in diagnosis and management of HTN are provided.

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia.

Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction. We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences. Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels. Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.

Role of HbA1c in diagnosis of gestational diabetes mellitus.

To evaluate glycated haemoglobin as a biomarker for diagnosing gestational diabetes mellitus while keeping the oral glucose tolerance test as the gold standard. The cross-sectional study was conducted from Januray, 2016, to January, 2018, at PNS Hafeez Hospital, Islamabad, Pakistan and comprised of pregnant subjects who were first subjected to 2-hour oral glucose tolerance test along with the first evaluation of glycated haemoglobin. Clinical evaluation, including history and measurements of anthropometric indices and blood pressure, were also done. On the basis of the results, the subjects were grouped as those having gestational diabetes mellitus (group A) and those without it (group B). Data was analysed using SPSS 15. Of the 280 subjects, gestational diabetes mellitus was found in 50(17.85%). Differences in glycated haemoglobin between the groups was significant (p<0.002). Glycated haemoglobin test provided sensitivity of 70% and specificity of 84.78%. With due adjustments, glycated haemoglobin testing can help in reducing the frequency of oral glucose tolerance test.

Interaction Between Slow Wave Sleep and Obstructive Sleep Apnea in Prevalent Hypertension.

Due to frequent abnormal breathing events and their effects on sleep architecture, patients with obstructive sleep apnea (OSA) exhibit decreased amounts of slow wave sleep (SWS). Reduced SWS has been linked to hypertension in community-based studies. We sought to investigate whether SWS percentage modifies the association between OSA and prevalent hypertension. We studied 7107 patients with OSA and 1118 primary snorers who underwent in-laboratory polysomnography. Patients were classified into quartiles of percent SWS. Hypertension was defined based either on clinic blood pressure measures or on physician diagnosis. Multivariable logistic regression model showed a significant interaction effect of OSA and SWS on prevalent hypertension (P=0.002). Decreased SWS was associated with higher odds for hypertension in OSA but not in primary snoring, with patients with OSA exhibiting <0.1% SWS (OR, 1.44 [95% CI, 1.21-1.70]; P=0.001) and those with 0.1% to 4.8% SWS (OR, 1.20 [95% CI, 1.03-1.40]; P=0.02) being more likely to have hypertension compared with those with >11.1% SWS. In analysis stratified by OSA severity, significant associations between percent SWS and blood pressure emerged only in moderate and severe OSA. Effect modifications by sex (P=0.040) and age (P=0.007) were also only evident in OSA, indicating that decreased SWS was associated with hypertension only in men and in patients <60 years old. Decreased SWS is associated with a dose-dependent increase in odds of prevalent hypertension in patients with OSA. The effects of SWS are likely to be modulated by OSA severity. SWS may be implicated in the heightened risk of cardiovascular diseases exhibited by patients with OSA.

Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.

Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.