Office Blood Pressure Control Research Articles

Impact of vascular biomarkers and supine hypertension on cardiovascular outcomes in hypertensive patients: first results from the Cardiovascular Prognostic COUPLING Study in Japan.

The prognostic impact of vascular biomarkers and supine blood pressure (BP) is not well understood. The multicenter, prospective Coupling study determined the prognostic impact of vascular biomarkers and supine BP in outpatients aged ≥30 years with ≥1 cardiovascular risk factor. Occurrence of major cardiovascular events during follow-up was recorded. The primary outcome was time to onset of a major cardiovascular event. Office and supine BP, the cardio-ankle vascular index (CAVI), and the ankle-brachial index (ABI) were determined annually. Of the 5109 participants in the Coupling study, 4716 were analyzed (51.9% male, mean age 68.5 ± 11.4 years); participants mostly had hypertension treated based on seated office/home BP according to relevant guidelines. During a median follow-up of 5.0 years (interquartile range 3.6-5.2), 231 major cardiovascular events occurred. After adjustment for age, sitting office systolic BP, and other covariates, a 1-unit increase in CAVI (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.01-1.24) and a 0.1-unit decrease in ABI (HR 1.41, 95% CI 1.18-1.68) were significantly associated with cardiovascular event risk; risk was greatest when CAVI was ≥8.0 and ABI was ≤1.10. Uncontrolled supine hypertension (≥140/90 mmHg) was also significantly associated with adjusted cardiovascular event risk (HR 1.36, 95% CI 1.02-1.81); seated office BP control was not significantly associated with cardiovascular event risk. Increased arterial stiffness, mildly lower ABI, and supine hypertension are risk factors for cardiovascular events during standard clinical practice. Supine evaluation of BP and vascular biomarkers has highlighted a blind spot in current hypertension management (Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000018474).

Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients.

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH.

P075 IS OFFICE BLOOD PRESSURE MEASUREMENT SUFFICIENT FOR DIAGNOSING HYPERTENSION IN PRIMARY HEALTH CARE?

Background and Objective: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the scope of primary care. Our objective is to assess the degree of agreement between office BP and HBPM, evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and CV risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM &lt; 135 x 85 mmHg and office BP &lt; 140 x 90 mmHg were considered normal, identifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years, of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). In multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times, respectively. Uncontrolled office BP has high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388) Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: Office BP was not a sufficient measurement to diagnose hypertension. HBPM was a useful procedure in this young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN and in those with high normal office BP, especially if they are male or obese for early diagnosis of masked HTN.

Resistant hypertension and the risk of major adverse cardiac and cerebrovascular events in outpatients

Objective: To investigate the prevalence and associated risk of cardiovascular event of resistant hypertension in treated outpatients. Methods: This study was a nationwide multi-center prospective cohort study. The participants were treated outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry study of 42 hospitals in 19 provinces across the country from August 2009 to October 2017. Apparent resistant hypertension was defined as uncontrolled office blood pressure (≥140/90 mmHg, 1 mmHg=0.133 kPa) in spite of the use of three antihypertensive drugs or controlled office blood pressure (<140/90 mmHg) with four antihypertensive drugs or more. Subjects diagnosed with uncontrolled office blood pressure were further subdivided as pseudo-resistant hypertension and true resistant hypertension based on 24 h ambulatory blood pressure monitoring. The primary endpoint was fatal and non-fatal cardiovascular and cerebrovascular events, which was a composite endpoint consisting of cardiovascular and cerebrovascular death, ischemic and hemorrhagic stroke, myocardial infarction, coronary artery revascularization, unstable angina, heart failure, and coronary artery stenosis≥50% confirmed by coronary angiography. Secondary outcomes included fatal and non-fatal stroke or cardiac events. Patients with controlled office blood pressure after taking only 1 or 2 antihypertensive drugs were included as control. Kaplan-Meier survival curves, log-rank test, and Cox proportional risk model were used to evaluate the risk of apparent refractory hypertension in relation to cardiovascular and cerebrovascular prognosis. Results: A total of 2 782 treated hypertensive patients, aged (58.1±12.3) years were enrolled, including 1 403 (50.4%) men. The prevalence of apparent and true resistant hypertension was 15.1% (420/2 782) and 10.5% (293/2 782), respectively. Among patients with apparent resistant hypertension, during a median of 5 years follow-up, the cumulative incidence rate was 28.2, 11.2 and 19.1 per 1 000 person-years for fatal and non-fatal cardiovascular events (n=58), stroke (n=24) and cardiac events (n=40), respectively. The Kaplan-Meier curve and log-rank test showed that those patients with true resistant hypertension, had the highest cumulative incidence rate of fatal and non-fatal cardiovascular events, stroke, and cardiac events. Multivariable Cox regression analyses showed that true resistant hypertension was associated with a significantly higher risk of fatal and non-fatal cardiovascular events (HR=1.73, 95%CI 1.17-2.56, P=0.006) and stroke (HR=2.81, 95%CI 1.53-5.17, P=0.001). Conclusion: Resistant hypertension, especially true resistant hypertension, is associated with a higher risk of fatal and non-fatal cardiac and cerebrovascular events.

OFFICE, HOME AND AMBULATORY BLOOD PRESSURE CONTROL IN PATIENTS WITH HIGH AND VERY HIGH CARDIOVASCULAR RISK – RESULTS FROM BP-PROACTION BG

Objective: Current ESH guidelines emphasize out-of-office blood pressure monitoring in patients requiring antihypertensive therapy. Achieving control within the 24-hour period and during home monitoring is of key importance in patients at high (HR) and very high cardiovascular risk (VHR). Design and method: 220 treated with antihypertensive agents’ patients at high or very high risk were included in BP-proAction BG study. All individuals underwent office BP measurements and 24-hour ambulatory blood pressure monitoring consequently followed by 7-day home BP monitoring. Therapy was modified according to office blood pressure values based on methodical standards and treating physicians’ preferences. The protocol was repeated after 3 month of therapy intensification Results: 19% of enrolled patients experienced a cardiovascular event prior to study enrollment, with a mean SCORE 2/SCORE 2 OP of 17.2% among individuals in the primary prevention setting. Despite treatment with an average of 2.7 medications, the majority of patients had uncontrolled blood pressure at the baseline visit - office 93%, home 72%, 24h ABPM 70%, daytime ABPM 63%, nighttime ABPM 69%. After therapy intensification to average 3.4 medications the frequency of uncontrolled hypertension was reduced to 21%, 38%, 34%, 33% and 37% respectively at month 3. The prevalence of masked uncontrolled hypertension among patients with control of office blood pressure was 17% for home masked hypertension, 15% for ambulatory masked hypertension and 10% for dual MH. The rate of uncontrolled hypertension was significantly lower in patients being treated with fix dose combination alone vs free drugs combination. (Table 1) Conclusions: Among patients with high and very high cardiovascular risk, lack of control of out-of-office blood pressure is a common phenomenon, requiring adequate detection and therapeutic management.

FOLLOW-UP OF SURVIVAL PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Resistant arterial hypertension (RAH) contributes to high mortality worldwide. Aim of the study: to assess 7-year follow-up survival and development of a composite end point (CEP) in patients with RAH. Design and method: The analysis includes 50 patients with RAH who were discharged from hospital. After 7 years discharge from the hospital, the patients underwent office BP measurement. Adverse events or death were reported as the composite endpoint (CEP). The average age of patients as of 2016 was 57.89 ± 11.81 y.o. 16% had type 2 diabetes (n=8). Results: After 7 years, in 32% (n=16) developed CEP, and 10% (n=5) of them died. The BMI increased from 30.87 ± 6.30 to 33.80 ± 6.90 kg/m2 (p&lt;0.05). 20% had smoke (n=10), but 8% (n=4) (quit smoking after developing CEP). After 7 years, 48.88% of patients (n=22) controlled office blood pressure below 140/90 mmHg and 51.11% did not (n=23). Among patients who reached the target office BP (130.73 ± 6.61/81.59 ± 4.13 mmHg), there was a decrease in the number of drugs from 3.76 ± 0.19 to 2.85 ± 0.14, p&lt;0.05. 45% (n=10) from the group took fixed combinations. Among patients who did not reach target office BP (148.04 ± 7.49/92.17 ± 4.66 mmHg), there was also a decrease in the number of drugs from 3.52 ± 0.18 to 2.50 ± 0.13, p&lt;0.05 – patients decision. After regression analysis the main factors that were associated with the occurrence of CEP in patients with RAH were: the presence of diabetes (β= 5,237, p= 0,032) smoking (β=4,326, p= 0,037), increased body weight (β =3,423, p=0,024), failure to achieve target blood pressure levels (β =4,152, p=0,041) Conclusions: Mortality among patients with RAH were 10% during 7 years. The total composite endpoint were 32%. Did not reach the target office BP in patients with RAH the factors for the development of combined end point was diabetes mellitus, smoking and weight gain.

Efficacy and safety of a single-pill versus free combination of perindopril/indapamide/amlodipine: a multicenter, randomized, double-blind study in Chinese patients with hypertension.

In China, the prevalence of hypertension is high and the use of combination antihypertensive therapy is low, which contributes to inadequate blood pressure (BP) control. The availability of simplified treatments combining complementary BP-lowering agents may help more patients achieve their goals. This Phase III, multicenter, randomized, double-blind, noninferiority study included Chinese adults with mild-to-moderate hypertension. Following a 1-month run-in on perindopril/indapamide bi-therapy, patients with uncontrolled systolic/diastolic BP (≥140/90 mmHg) were randomized to perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg (Per/Ind/Aml) single-pill combination (SPC) or perindopril 4 mg/indapamide 1.25 mg plus amlodipine 5 mg (Per/Ind + Aml) for 6 months. Uptitration was permitted from month 2 onwards. The primary efficacy objective was the noninferiority of Per/Ind/Aml in lowering office systolic BP at 2 months. The secondary objectives included the effectiveness of SPC on diastolic BP, uptitration efficacy, and office BP control (systolic/diastolic <140/90 mmHg). A subgroup of patients participated in 24-h ambulatory BP monitoring (ABPM). A total of 532 patients were randomized: Per/Ind/Aml ( n = 262) and Per/Ind + Aml ( n = 269). Overall, the mean (±SD) age was 55.7 ± 8.8 years, 60.7% were male, and the mean office systolic/diastolic BP at baseline on Per/Ind was 150.4/97.2 mmHg. Systolic BP decreased in both groups at 2 months from baseline: -14.99 ± 14.46 mmHg Per/Ind/Aml versus -14.49 ± 12.87 mmHg Per/Ind +Aml. A predefined noninferiority margin of 4 mmHg was observed ( P < 0.001). The effectiveness of the Per/Ind/Aml SPC was also demonstrated for all secondary endpoints. ABPM demonstrated sustained BP control over 24 h. Both treatments were well tolerated. Per/Ind/Aml is an effective substitute for Per/Ind + Aml, providing at least equivalent BP control over 24 h in a single pill, with comparable safety.

Predictors of cardiovascular and renal complications in patients with resistant arterial hypertension during long-term follow-up

The aim – to evaluate the incidence of cardiovascular and renal complications and its predictors in resistant hypertensive (RH) patients during the long-term follow-up.Materials and methods. The frequency of cardiovascular and renal events was studied in 240 true resistant hypertensive patients. The duration of observation was 5.1±0.1 years. The comparison group consisted of 228 patients with controlled arterial hypertension (CAH) on a triple combination antihypertensive therapy. Cardiovascular endpoints included stroke/transient ischemic attack, myocardial infarction, cardiovascular death, myocardial revascularization, development of atrial fibrillation, hospitalization due to heart failure, and lower limb arterial disease. Kidney outcomes included dialysis or GFR decline by 40 % or greater. All the endpoints formed a composite primary endpoint. New cases of type 2 diabetes mellitus were also estimated.Results and discussion. The patients with resistant hypertension on multi-component antihypertensive therapy and significant reduction in arterial blood pressure (BP) levels (achievement of controlled office BP in 49.6 % of patients, office and ambulatory BP in 34.2 % of patients), maintained a higher risk of cardiovascular and renal events compared to patients with controlled arterial hypertension. It was found that the frequency of occurrence of the composite primary endpoint in resistant hypertensive patients was four times higher than in the group of patients with controlled hypertension – 30.0 % (72/240) versus 7.0 % (16/228) (p=0.001). The frequency of new cases of type 2 diabetes mellitus in patients with RH exceeded compared to CAH patients by 3.7 times (p=0.03).Conclusions. Independent predictors of the risk of cardiovascular and renal complications in patients with RH were the initial indicators of circulating endothelial progenitor cells if their concentration in the blood was ≤ 1818 cells/ml (HR 0.41; 95 % CI (0.21–0.79); p=0.007), the content of citrulline in the blood is more than 68 μmol/l (HR 1.13; 95 % CI (1.07–1.20); p&lt;0.001); value of initial average daily systolic BP &gt; 163 mm Hg (HR 1.10; 95 % CI (1.03–1.18); p=0.008).

Prevalence and factors associated with masked hypertension in chronic kidney disease.

Optimal blood pressure (BP) control is key to prevent cardiovascular complications in patients with chronic kidney disease (CKD). We described the prevalence and factors associated with masked hypertension in CKD. We analyzed 1113 ambulatory 24-h BP monitoring (ABPM) records of 632 patients referred for kidney function evaluation. Masked hypertension was defined as office BP less than 140/90 mmHg but daytime BP at least 135/85 mmHg or nighttime BP at least 120/70 mmHg. Factors associated with masked hypertension were assessed with mixed logistic regression models. At inclusion, 424 patients (67%) had controlled office BP, of whom 56% had masked hypertension. In multivariable analysis conducted in all visits with controlled office BP ( n = 782), masked hypertension was positively associated with male sex [adjusted OR (95% confidence interval) 1.91 (1.16-3.27)], sub-Saharan African origin [2.51 (1.32-4.63)], BMI [1.11 (1.01-1.17) per 1 kg/m 2 ], and albuminuria [1.29 [1.12 - 1.47] per 1 log unit), and was negatively associated with plasma potassium (0.42 [0.29 - 0.71] per 1 mmol/L) and 24-h urinary potassium excretion (0.91 [0.82 - 0.99] per 10 mmol/24 h) as well as the use of renin-angiotensin-aldosterone (RAAS) blockers (0.56 [0.31 - 0.97]) and diuretics (0.41 [0.27 - 0.72]). Our findings support the routine use of ABPM in CKD, as more than half of the patients with controlled office BP had masked hypertension. Weight control, higher potassium intake (with caution in advanced CKD), correction of hypokalemia, and larger use of diuretics and RAAS blockers could be potential levers for better out-of-office BP control.

Kidney subclinical lesions in hypertension phenotypes defined by Home Blood Pressure Monitoring among young adults enrolled in a Family Health Strategy unit

Abstract Introduction The association between kidney lesion, hypertension (HTN) and cardiovascular risk (CV) is well established. Asymptomatic patients with decreased glomerular filtration rate (GFR) and/or increased albuminuria seem to have increased CV risk. The refinement of HTN diagnosis using Home Blood Pressure Monitoring (HBPM) allows to identify individuals with different phenotypes: normotension, sustained HTN (SHT), masked HTN (MHT) and white-coat HTN (WHT), increasing diagnostic accuracy. Objective To assess kidney subclinical lesions among different hypertension (HTN) phenotypes identified by Home Blood Pressure Monitoring (HBPM) in an adult population enrolled in a Family Health Strategy unit. Design and Methods: Cross-sectional, populational study with adults between 20-50 years old enrolled in a Family Health Strategy unit in a metropolis. Sociodemographic, anthropometric and CV risk factors were registered. Office blood pressure (BP) was the average of two consecutive measurements, and HBPM followed a 7-day protocol. HBPM &amp;lt; 135x85 mmHg and office BP &amp;lt; 140x90mmHg were considered normal, identifying four phenotypes: normotension (controlled office BP and HBPM); white-coat hypertension (uncontrolled office BP and controlled HBPM); masked hypertension (controlled office BP and uncontrolled HBPM) and sustained hypertension (uncontrolled office BP and HBPM). Albuminuria was dosed in an isolated urine sample whereas glomerular filtration rate was calculated by CKD Epi formula using serum creatinine. Results A total of 483 individuals were evaluated (39% male; mean age: 37.6 ± 8.8 years). More often, individuals with white-coat hypertension (9.3%) are male, with greater neck circumference and higher prevalence of metabolic syndrome. Individuals with masked hypertension (10%) are more obese, with increased neck and waist circumferences whereas those who present sustained hypertension are predominantly male, more obese, with increased neck and waist circumferences and higher prevalence of diabetes and metabolic syndrome. Analyzing four phenotypes, a progressive albuminuria increase was observed among normotensive patients: white-coat hypertension 4.0 ± 2.2; masked hypertension 5.3 ± 3.4 and sustained hypertension 7.1 ± 1.4 mg/g creatinine. We also observed an increased serum creatinine and decreased GFR: white-coat hypertension 0.74 ± 0.16/132 ± 34; masked hypertension 0.79 ± 0.17/123 ± 28; sustained hypertension 0.81 ± 0.32/120 ± 59, respectively, although without statistical significance. Conclusion The performance of HBPM refined HTN diagnosis and was able to early identify a progressive worsening of kidney function parameters in the different phenotypes.

VISIT-TO-VISIT 24 HOUR BLOOD PRESSURE VARIABILITY VS OFFICE BLOOD PRESSURE VARIABILITY UNDER ANTIHYPERTENSIVE DRUG TREATMENT

Objective: In any treated hypertensive patient office blood pressure (BP) values differ between visits and this variability (V) has an adverse prognostic impact. Almost no information is available on visit-to-visit 24-hour(h) BPV and the consistency of its therapeutic control. Design and method: In 1114 differently treated hypertensive patients of the ELSA and PHYLLIS trials we calculated 24-h BPV by the coefficient of variation of the mean BP from yearly measurements during a 3-4 year treatment period. Calculation was also made of yearly variation of the percentage of patients achieving 24-h BP control (&lt;130/80mmHg). Calculations were extended to day and night BP. Data were compared with office visit-to visit BPV and yearly office BP control (&lt;140/90mmHg) and variations . Results: Visit-to-visit 24-h BPV was 20% to 30% less than office BP variability, similarly for systolic and diastolic BP and consistently for different demographic, clinical and treatment conditions. BPV was considerably greater for the night than for the daytime (%, p &lt; 0.01) . Yearly 24-h BP control was considerably less frequent and variable than yearly office BP control and was considerably than daytime BP control. In the whole study and subgroups there was a linear correlation between office and 24-h but the correlation coefficients were never &gt;0.20, indicating that office BPV does not precisely correspond to it is impossible to precisely predict 24-h BPV from office in individual patients. Conclusions: 24-h BPV across visits is noticeably more stable than across visit office BPV, although with a greater variability of night BP. The correlation between office and 24-h BPV is significant but the low correlation coefficient makes office BPV hardly predictive of the 24-h BP stability across visits.

PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS

Objective: There are limited data in Tunisia on the quality of treated blood pressure (BP) control, and in particular, masked uncontrolled hypertension (MUCH) in treated hypertensive patients defined as controlled office BP but uncontrolled out-of-clinic BP. The objective of the study is to define the prevalence of MUCH in treated hypertensive patients. Design and method: An analytical cross-sectional study including 84 treated hypertensive patients aged &gt; 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion. Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices ( MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The comparisons of percentages were carried out by the Chi-square test. Results: The mean age of our population was 59.37±13.10 years (range 21-92 years), composed of 43 women and 41 men. The prevalence of MUCH was 6% in HBPM and 8.3% in ABPM. The difference between these two methods was not statistically significant for the detection of masked uncontrolled hypertension (p = 0.320). The prevalence of MUCH was higher in women detected by HBPM (11.6% versus 0%; p = 0.055) and by ABPM (14% versus 2.4%; p = 0.110), the difference according to gender was not statistically significant. ABPM detected also masked uncontrolled nocturnal hypertension in 14.3% of cases. Conclusions: Office BP monitoring alone is thus inadequate to ascertain optimal BP control because of BP variation. HBPM and mainly ABPM which can detect elevated nocturnal BP were needed to confirm proper BP control especially in patients with high cardiovascular risk in whom the prevalence of MUCH is higher.

Efficacy and Safety Compared between Chlorthalidone and Hydrochlorothiazide for Reducing Systolic and Diastolic Blood Pressure in Patients with Mild-to- Moderate Hypertension: A Randomized Clinical Trial

Objective: Hypertension is the leading cause of morbidity and mortality, and blood pressure (BP) control is shown to reduce the risk of cardiovascular events. The present study aimed to investigate the efficacy and safety of chlorthalidone and hydrochlorothiazide for reducing systolic and diastolic BP in patients with mild-to-moderate hypertension. Materials and Methods: The present study was a randomized clinical trial. Patients 18 years or older with mild-to-moderate hypertension with or without prior antihypertensive medications were enrolled. Patients were randomly assigned to the chlorthalidone or hydrochlorothiazide group. The dose of study medication could be up-titrated at the 6-week. The primary outcomes were the reduction in systolic and diastolic BP, the rate of office BP control at 12 weeks, and the rate of adverse events. Results: Fifty-six patients (mean age of 49.8±11.1 years) and 42.9% male, were included. Forty-three patients (76.8%) had known hypertension. Mean sitting office systolic BP (SBP) and diastolic BP (DBP) at baseline was 153.2±9.6 and 91.8±9.2 mmHg, respectively. The average daily dose of chlorthalidone and hydrochlorothiazide was 16.1±5.8 and 32.4±11.6 mg. The mean reduction in SBP in the chlorthalidone and hydrochlorothiazide groups was 28.7±12.2 and 22.8±13.7 mmHg (p=0.118), and DBP was 14.4±7.5 and 9.1±6.6 mmHg (p=0.011), respectively. The rate of office BP control was significantly greater in the chlorthalidone group at 91.7% versus 61.5% (p=0.013). There was no significant difference in the rate of adverse events between the groups. Conclusion: Chlorthalidone was shown to be more effective than hydrochlorothiazide for office BP control. There was no difference in adverse events. Trial registration: The trial had been registered with the Thai Clinical Trials Registry (TCTR) which complied with WHO International Clinical Trials Registry Platform dataset. The registration number was TCTR20191006002 (06/10/2019). Keywords: Efficacy; Safety; Chlorthalidone; Hydrochlorothiazide; Reducing; Systolic and diastolic blood pressure; Patients with mild to moderate hypertension

8. Efficacy of Renal Denervation on Office Blood Pressure in Resistant Hypertension: a Systematic Review

Hypertension almost occurs in about a quarter of the world's population and is still increasing, causing a burden in public health. Renal denervation is one of the strategies to treat resistant hypertension. However, studies on the efficacy of renal denervation in patients with resistant hypertension are still limited and not well known. The purpose of this study was to find out the efficacy of renal denervation in patients with resistant hypertension by office blood pressure measurement. This review was conducted on 10–17 December 2022. Two independent researchers systematically extracted data from several databases, such as PubMed Central (PMC), Science Direct, and PUBMED by using MeSH terminology of keywords renal denervation, hypertension, and safety. The extracted studies were then analyzed and selected according to our inclusion criteria such as studies in the last 5 years, cohort studies, and case-control studies. We excluded systematic reviews, meta-analyses, case series, case reports, studies on pregnant women, children, and animals. Research quality was assessed using Newcastle-Ottawa (NOS). From 5 cohort studies (1605 subjects from various countries), all of them showed renal denervation resulted in better and sustained office blood pressure control on long-term follow up; All studies have proven good quality based on NOS. In conclusion, renal denervation showed efficacy by sustained blood pressure reducing effect in patients with resistant hypertension. However, further study is needed to confirm these findings.

Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Efficiency of combined antihypertensive pharmacotherapy in patients with arterial hypertension, combined with type 2 diabetes mellitus and non-alcoholic fatty liver disease

Background. Treatment of patients with arterial hypertension (AH) associated with type 2 diabetes mellitus (DM2) and non-alcoholic fatty liver disease (NAFLD) is a complex clinical challenge. The complementary and aggravating effect of these comorbidities often prevents the realization of the antihypertensive potential of the drugs used and their combinations, and therefore it is necessary to search for additional ways to intensify therapy.Aim. To assess the efficiency of combined pharmacotherapy in patients with AH associated with DM2 and NAFLD, depending on the CYP2C9 gene polymorphism.Materials and methods. The study included 68 patients with uncontrolled AH associated with DM2 and NAFLD (Fatty Liver Index (FLI) &gt; 60) who received prior antihypertensive therapy. All subjects were prescribed a combination of azilsartan medoxomil with amlodipine at doses of 40/5 mg/day. The duration of therapy was 24 weeks. Those included in the study underwent control of office blood pressure (BP) at the initial visit, after 4, 8 and 24 weeks of treatment; 24-hour BP monitoring (ABPM) — initially and after 24 weeks. Venous blood samples were taken from patients, followed by DNA isolation from leukocytes by phenol- chloroform extraction. Determination of polymorphic variants of the CYP2C9 gene was carried out on an amplifier Rotor Gene — Q. The TaqMan method (allele discrimination) and a set of primers and probes were used.Results. As a result of genetic testing, the following distribution of polymorphic variants of the CYP2C9 gene was revealed: *1/*1 was found in 73,5% of patients, *1/*2 in 14,7%, *1/*3 in 11,8%. It was shown that after 4 weeks of therapy with a polymorphic variant of the *1/*1 CYP2C9 gene, the achievement of the target level (TL) of BP was registered in 62% of patients, with polymorphisms *1/*2 and *1/*3 — in 30% and 25%. After increasing the dose of azilsartan medoxomil and amlodipine to 80/10 mg/day, respectively, and 8 weeks from the start of treatment in the *1/*1 group, the number of BP targets achieved increased to 88%, in the *1/*2 groups and *1/*3 — up to 60% and 62,5%. Antihypertensive therapy was intensified with prolonged release indapamide at a dose of 1,5 mg/day, and according to the results of 24 weeks of therapy, patients with a polymorphic variant of the CYP2C9 *1/*1 gene achieved the TLBP in 96% of cases, with *1/*2 and *1/*3 — In 90% and 87,5%, respectively. At the same time, in patients with polymorphism of the CYP2C9 gene *1/*1, *1/*2 and *1/*3, positive dynamics of all ABPM parameters was revealed. However, in the *1/*1 variant, more pronounced positive changes were observed in the systolic BP time index during the day and the diastolic BP time index during the day, and the diastolic BP time index at night.Conclusions. As a result of a 24-week study, the majority of patients who had the polymorphic variant *1/*1 of the CYP2C9 gene showed a more pronounced efficacy of the studied combination of drugs. Patients with *1/*2 and *1/*3 polymorphisms often required triple therapy to achieve TLBP. At the same time, further studies are needed to study the dependence of the antihypertensive effects of drugs on polymorphisms of the corresponding genes, which may help identify groups of patients who need more intensive antihypertensive therapy already at the start of treatment.

Abstract 15741: Is Home Blood Pressure Monitoring Useful in Diagnosing Hypertension in Young Adults in Primary Care?

Introduction: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the younger population and in the scope of primary care. Objective: To assess the degree of agreement between office BP and Home Blood Pressure Monitoring (HBPM), evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and cardiovascular risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM &lt; 135 x 85 mmHg and office BP &lt; 140 x 90 mmHg were considered normal while dentifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years) of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). Through multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times respectively. Uncontrolled office BP had high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388). Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: HBPM was a useful tool in the diagnosis of hypertension in a young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN, and in those with high normal office BP, especially if they were male or obese, for early diagnosis of masked HTN.

Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients. Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol. ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients. ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.

Durability of blood pressure reduction after ultrasound renal denervation: three-year follow-up of the treatment arm of the randomised RADIANCE-HTN SOLO trial.

While the blood pressure (BP)-lowering effect of renal denervation (RDN) has been established, long-term durability is a key prerequisite for a broader clinical implementation. Our aims were to assess the long-term durability of the office BP (OBP)-lowering efficacy, antihypertensive medication (AHM) use, and safety of ultrasound RDN (uRDN). Four weeks after withdrawal of AHM, patients with untreated daytime ambulatory BP ≥135/85 mmHg and <170/105 mmHg were randomised to uRDN (n=74) or sham (n=72) in the RADIANCE-HTN SOLO trial. Initiation of AHM was encouraged for home BP >135/85 mmHg following primary endpoint ascertainment at 2 months. Patients and physicians were unblinded at 6 months. Results: Fifty-one of 74 patients (age: 53.9±11 years; 67% men) originally randomised to uRDN completed the 36-month follow-up. Initial screening OBP upon study entry was 145/92±14/10 mmHg on a mean of 1.2 AHM (range: 0-2.0). Baseline OBP after AHM washout was 154/99±13/8 mmHg. At 36 months, patients were on an average of 1.3 AHM (range: 0-3.0) with 8 patients on no AHM. OBP decreased by 18/11±15/9 mmHg from baseline to 36 months (p<0.001 for both). Overall, OBP control (<140/90 mmHg) improved from 29.4% at screening to 45.1% at 36 months (p=0.059). For patients uncontrolled at screening (n=36), systolic OBP decreased by 10.8 mmHg (p<0.001) at 36 months on similar AHM (p=0.158). The safety and effectiveness of uRDN was durable to 36 months, with reduced OBP and improved OBP control despite a similar starting medication burden. No new uRDN-related long-term safety concerns were identified.

HIGHER PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION WITH NEW EUROPEAN BLOOD PRESSURE TARGETS IN AN ELDERLY PRIMARY CARE POPULATION

Objective: The aim of this study was to examine the distribution and clinical characteristics of hypertension phenotypes among patients aged 65 years or older, in a primary care setting, applying the new lower blood pressure targets, of 140/80 mmHg for office blood pressure measurement and 130/75 for ambulatory measurement, proposed by the European Society of Hypertension in 2018. Design and method: This is a cross-sectional analysis of 77 subjects previously diagnosed with hypertension who used at least one antihypertensive drug in a primary care setting in south-east Sweden. Data was collected between May 2012 and May 2016. All subjects were examined regarding general clinical characteristics, office blood pressure and ambulatory blood pressure (Spacelabs ABP monitor 90217). The participants were grouped based on office blood pressure target achievement. Furthermore, subjects were categorized in four groups based on hypertension phenotype. These groups were defined based on office- and ambulatory blood pressure target achievement; Sustained controlled hypertension i.e. concordant goal achievement, Sustained uncontrolled hypertension i.e. non-achievement, Masked uncontrolled hypertension i.e. controlled office blood pressure with uncontrolled ambulatory blood pressure and White coat uncontrolled hypertension i.e. uncontrolled office blood pressure with controlled ambulatory blood pressure. Lastly, shifts in the distribution of hypertension phenotypes using current and previous blood pressure targets respectively were examined. Results: Obesity related parameters (i.e. BMI and waist circumference) were significantly lower in the group with controlled hypertension based solely on current office blood pressure targets, with BMI (kg/m2) of 25.5 ± 3.9 vs. 28.8 ± 4.9 (p &lt; 0.01) and waist circumference (cm) of 91.0 ± 12.1 vs. 100.3 ± 12.7 (p &lt; 0.01). Among subjects with controlled office blood pressure, the prevalence of masked uncontrolled hypertension was higher (14/29 or 48%) when new office- and ambulatory blood pressure targets were applied than when older targets were applied (14/43 or 33%). Conclusions: The main finding of this observational study was that the prevalence of masked uncontrolled hypertension among subjects with controlled office blood pressure was higher applying new instead of old blood pressure targets. We believe that regular ambulatory blood pressure monitoring can facilitate optimized antihypertensive treatment.