Daytime Blood Pressure Values Research Articles

What are the ideal metrics for assessing the quality of long-term stabilized "perfect" 24-h BP control after renal denervation?

A significant number of individuals being treated for hypertension still have uncontrolled blood pressure (BP). In Japan, renal denervation (RDN) is being introduced into clinical practice as an adjunctive treatment for hypertension that is uncontrolled despite adequate lifestyle changes and maximal antihypertensive drug therapy. The pivotal SPYRAL ON-MED trial showed that there was a significant reduction in trough office and nighttime ambulatory BP values in the RDN group compared with sham control group, although 24-h and daytime BP values were not significantly different between the two groups. The trough office BP measurement (taken before morning antihypertensive dosing) is similar to guideline recommendations for taking morning home BP before taking the morning antihypertensive drug dose. Recent guidelines recommend the measurement of nighttime BP because nighttime BP is a stronger predictor of cardiovascular event risk than daytime BP. It is particularly important to assess nighttime BP in medicated individuals with hypertension because the up- or down-titration of antihypertensive drug dosing is primarily based on office and daytime BPs in clinical practice. This means that there may be significant risk relating to nocturnal hypertension during longer follow-up. Because RDN results in persistent, "always-on" 24-h BP-lowering effects, the best BP metrics to assess the potential benefit of RDN are nighttime BP (determined using home or ambulatory BP monitoring) and morning BP (determined using home BP monitoring or morning trough office BP measurement). The variability of office, home, and ambulatory BP values is another important metric to assess the quality of RDN-related BP lowering.

AN UPDATED REPORT FROM THE HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY

Objective: Ambulatory blood pressure monitoring (ABPM) is recommended by current European guidelines for the early diagnosis of hypertension and to monitor the efficacy of antihypertensive treatments. The Hungarian Society of Hypertension has initiated a 5-year, nationwide program in 2021 to promote the routine use of ABPM and to improve the motivation of doctors and patients. This is an updated report on the Hungarian ABPM Registry. Design and method: This is an ongoing, multicenter, open-label, observational study. Adult (age >18 years) patients with known hypertension(HT), or with suspected/newly diagnosed hypertension(nHT) can be involved in the study. ABPM monitoring is performed by GPs, internists, and cardiologists using validated Meditech ABPM-06 monitors. Current report analyzed ABPM data between 21.02.2021-16.11.2023, that were collected into an electronic case report. Overall, 40621 ABPMs were performed, due to protocol deviation 1901 patients were excluded from the analysis. Results: 26315 patients were HTs(68.3%), 12193 patients were nHTs(31.5%). In the HT group 95.5%, in the nHT group 21.5% were treated. 63.6% of all patients were hypertensives according to the 24-hour average blood pressure(BP) values. Mean 24-hour systolic and diastolic BP was 133.84±14.5 mmHg and 79.2±10.3 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between HT and nHT patients (133.75±13.96mmHg vs. 133.86±14.72mmHg, respectively, p=NS). Obesity(BMI >30 kg/m2) increased the risk of hypertension(OR=1.82[1.73;1.92]for 24-hour average). Coffee consumption(more than 3/day)(OR=1.22[1.16;1.29]for 24-hour average), snoring(OR=1.39[1.33;1.46]for 24-hour average)and smoking(OR=1.10[1.03;1.18]for 24-hour average)all increased the risk of hypertension, primarily affecting more the daytime BP values(OR=1.24[1.18;1.31]for daytime in coffee consumption, OR=1.13[1.07;1.19]for nighttime in coffee consumption; OR=1.42[1.36;1.49]for daytime in snoring, OR=1.31[1.25;1.38]for nighttime in snoring; OR=1.09[1.01;1.16]for daytime in smoking, OR=1.01[0.94;1.08]for nighttime in smoking (NS)). Lack of regular sport(less than 3x30 minutes weekly)increased the risk of hypertension(OR=1.11[1.05;1.18]for 24-hour average), primarily affecting more the nighttime values(OR=1.19[1.12;1.26]for nighttime, OR= 1.02[0.96;1.07]for daytime(NS)). Conclusions: Hypertension is highly prevalent in both HT and nHT patients, irrespectively of gender or treatment. Obesity, lack of regular sport, coffee consumption, snoring and smoking are all significant risk factors in developing hypertension, latter ones affecting more the daytime BP values, whereas lack of regular sport affects more the nighttime BP values.

Daytime blood pressure measurements performed by a cuffless blood pressure monitor compared to 24-hour ambulatory blood pressure monitor: preliminary comparative results of a single-centre study

Abstract Background Ambulatory blood pressure (BP) monitors (ABPM) measure systolic and diastolic BP (SBP, DBP), limited to 24-48-hour snapshots, using uncomfortable cuff-based oscillometric sphygmomanometers. Some cuffless BP devices overcome these limitations, supporting continual BP monitoring. There is currently intense debate whether cuffless devices generate data comparable to ABPM. Purpose Here, we present preliminary results of daytime BP measurements performed by a validated and commercially available cuffless BP monitor compared to 24-hour ABPM. Methods 52 out of 63 estimated total patients (NCT04548986, age 53.2±7.1 years, 18.9% female, arm circumference 28.5±2 cm) had been enrolled in a 12-week cardiac rehabilitation (CR) program. The patients used a validated, CE-marked, over-the-counter optical cuffless wrist BP monitor during the entire CR program, while 24-hour cuff-based ABPM was performed on the first and last day of the CR program. For each patient, average daytime (9am-9pm) SBP and DBP were calculated – and compared – for 1 day of ABPM and 7 days of cuffless monitor (session 1: ABPM first day vs. cuffless monitor first week; session 2: ABPM last day vs. cuffless monitor last week). Only sessions that had 20 or more valid daytime measurements on both modalities were included in the study. Results 50 patients (35 in session 1, 15 in session 2) had 20 or more valid daytime measurements on both modalities, and were included in the study. Bias between the cuffless monitor and ABPM for daytime DBP was (mean ± SD [95% CI] ) -2.2±8.0 [-4.5, 0.1] mmHg, R2 = 0.66 (Figure 1A), with agreements of 78% and 96% within ±10 mmHg (dark grey) and ±15 mmHg (light grey) regions of interest (ROI), respectively. Bias between the cuffless monitor and ABPM for daytime SBP was 1.6±10.5 [-1.5, 4.6] mmHg, R2 = 0.70 (Figure 1B), with agreements of 60% and 84% within the ±10/±15 mmHg ROI, respectively. Conclusions The results suggest that 1-week monitoring with the investigated cuffless monitor yields equivalent daytime BP values to 24-h ABPM, which supports the use of cuffless BP monitor for long-term, continual daytime BP monitoring. The present preliminary study is limited by the partially recruited population and daytime measurements only. Night-time analysis will be covered in subsequent studies.Figure 1

DAYTIME BLOOD PRESSURE MEASUREMENTS PERFORMED BY AKTIIA CUFFLESS MONITOR AND 24-H AMBULATORY BLOOD PRESSURE MONITOR: PRELIMINARY COMPARATIVE RESULTS OF A SINGLE-CENTRE STUDY

Objective: Ambulatory blood pressure (BP) monitors (ABPM) measure systolic and diastolic BP (SBP, DBP), limited to 24-48-hour snapshots, using uncomfortable cuff-based oscillometric sphygmomanometers. Some cuffless BP devices overcome these limitations, supporting continual BP monitoring. However, there is intense debate whether cuffless devices generate data comparable to ABPM. Here, we present preliminary results of daytime BP measurements performed by Aktiia cuffless BP monitor (Aktiia SA, Switzerland) compared to 24-hour ABPM. Design and method: 52 out of 63 estimated total patients (NCT04548986, age 53.2±7.1 years, 18.9% female, arm circumference 28.5±2 cm) had been enrolled in a 12-week cardiac rehabilitation (CR) program (Réseau Hospitalier Neuchâtelois, Switzerland). The patients used the Aktiia monitor during the entire CR program, while 24-hour ABPM (Dyasis 3, Novacor, France) was performed on the first and last day of the CR program. For each patient, average daytime (9am-9pm) SBP and DBP were calculated – and compared – for 1 day of ABPM and 7 days of Aktiia monitor (session 1: ABPM first day vs. Aktiia first week; session 2: ABPM last day vs. Aktiia last week). Only sessions that had 20 or more valid daytime measurements on both modalities were included in the study. Results: 50 patients (35 in session 1, 15 in session 2) had 20 or more valid daytime measurements on both modalities, and were included in the study. Bias between Aktiia monitor and ABPM for daytime DBP was (mean ± SD [95% CI]) -2.2±8.0 [-4.5, 0.1] mmHg (Figure 1A), with agreements of 78% and 96% within ±10 mmHg (dark grey) and ±15 mmHg (light grey) regions of interest (ROI), respectively. Bias between Aktiia monitor and ABPM for daytime SBP was 1.6±10.5 [-1.5, 4.6] mmHg (Figure 1B), with agreements of 60% and 84% within the ±10/±15 mmHg ROI, respectively. Conclusions: The results suggest that 1-week Aktiia monitor yields equivalent daytime BP values to 24-h ABPM, which supports the use of Aktiia monitor for long-term, continual daytime BP monitoring. The present preliminary study is limited by the partially recruited population and daytime measurements only. Night-time analysis will be covered in subsequent studies.

Eliminating exogenous insulin therapy in patients with type 2 diabetes by duodenal ablation and GLP-1RA decreases risk scores for cardiovascular events

IntroductionDuodenal Mucosal Resurfacing (DMR) is an endoscopic ablation technique aimed at improving glycaemia and metabolic health in patients with type 2 diabetes mellitus (T2DM). DMR has an insulin sensitizing effect in patients with T2DM. Reducing hyperinsulinemia can improve cardiovascular health. In the INSPIRE trial, we combined a single DMR with a glucagon-like-peptide-1 receptor agonist (GLP-1RA) and demonstrated elimination of insulin treatment in 69% of patients at 6 months and 53% of patients at 18 months while improving glycaemic control and metabolic health. We hypothesized that this treatment approach is associated with improved cardiovascular health, by reducing hyperinsulinemia.MethodsBefore and 6 months after starting the combination treatment to replace insulin, the following assessments were performed to evaluate cardiovascular health: magnetic resonance imaging (MRI) to measure abdominal visceral adipose tissue volume, ambulatory 24 h blood pressure (ABPM) analysis, postprandial insulin and triglycerides, fasting lipid panel and urine microalbumin. The Atherosclerotic Cardiovascular Disease (ASCVD) score was calculated to estimate 10-year risk of cardiovascular disease or stroke and the diabetes lifetime-perspective prediction (DIAL) score was calculated to estimate years free of cardiovascular disease.ResultsSix months after replacing exogenous insulin by DMR and GLP-1RA, visceral adipose tissue decreased significantly by 24%. Postprandial triglyceride and insulin concentrations decreased significantly (p < 0.001), as did total cholesterol (from median 3.64 (IQR 3.34–4.89) to 3.48 (3.18–3.97) mmol/l, p = 0.008), LDL (from median 1.92 (IQR 1.49–2.30) to 1.79 (1.49–2.08 mmol/l, p = 0.044), and urine microalbumin (from median 7 (IQR 3–27) to 4 (3–8) mg/l, p = 0.018). All daytime blood pressure values decreased significantly. The ASCVD 10-year risk score decreased (from median 13.6 (IQR 5.7–26.0) to 11.5 (4.2–22.5) %, p = 0.030)) and the DIAL score increased (from median 82 (IQR 81–83) to 83 (81–84) years, (p = 0.039)).DiscussionThe combination of DMR and GLP-1RA to replace insulin therapy in patients with T2DM is associated with a positive effect on multiple parameters of cardiovascular health. Taken together, they show a pattern of overall improvement in cardiovascular health, as evidenced by decreased risk scores for cardiovascular complications. However, it is not yet clear whether these improvements will translate into a true reduction in cardiovascular events.

UNATTENDED VERSUS ATTENDED BP MEASUREMENT: RELATIONSHIP WITH 24 HOURS BLOOD PRESSURE VALUES

Objective: It has been suggested that measurement of “unattended” or “automated oscillatory” blood pressure(BP) values (AOBP) may provide advantages over conventional BP measurement. More data are needed on the relationship between BP values measured by the conventional approach, by AOBP and values obtained by 24 hours BP monitoring (ABPM). Design and method: In 607 consecutive patients attending the outpatient clinic at an ESH Excellence Centre, BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest. After the measurement of BP by the physician, the patient was left alone in the room, and the device was programmed to automatically perform 3 BP measurements after 5 minutes. ABPM was performed in all subjects. Results: Mean age was 60 ± 13 yrs, 53% females, BMI 26 ± 4, 77 % with a previous diagnosis of hypertension (58 % treated). Unattended systolic BP (SBP) (126.4 ± 14.5) was lower as compared to attended SBP (132.7 ± 15.9mmHg) and to 24 hours daytime BP (129.4 ± 14.5 mmHg). Attended and unattended SBP were similarly correlated to daytime BP (r = 0.649, R = 0.669, P &lt; 0.000, p for the comparison between r ns). The differences (d) between SBP values obtained using the three techniques were 6.3 ± 7.7 mmHg (attended-unattended), 3.5 ± 12.2 mmHg (attended-daytime BP) and – 2.8 ± 11.0 (unattended-daytime). Conclusions: Our findings indicate that “unattended BP” measurement provides values significantly lower as compared to measurements obtained in the presence of the physician and also to 24 hours daytime BP. In our population BP values obtained by the unattended approach are similar to 24 hours daytime BP values. However 24 hours daytime BP was similarly correlated to both attended and unattended BP

Effects of continuous-combined oral drospirenone- estradiol on blood pressure, body weight & lipid profile in early menopausal women.

Background & objectives:Drospirenone (DRSP) is a progestin with antimineralocorticoid and anti-androgenic activity. When administered in combination with estradiol (E2), it relieves menopausal symptoms. The aim of this study was to evaluate the effects of DRSP/E2 on the reduction of cardiovascular risk factors in menopausal women with hypertension.Methods:A retrospective study was conducted at the Clinical Center of Serbia. The participants were 64 menopausal women [mean age=49.19±4.62 yr, mean body mass index (BMI)=25.08±2.94 kg/m2, mean amenorrhoeic period=2.48±2.46 yr]. The effects of DRSP 2 mg/E2 1 mg on 24 h blood pressure (BP) variability, heart rate (HR), anthropometric characteristics and hormone and lipid levels were evaluated in early menopausal women with previously untreated stage 1 hypertension. All analyses were carried out before and after six and 12 months of therapy.Results:DRSP/E2 significantly reduced daytime BP values during six and 12 months of therapy. The reductions in systolic and diastolic BPs ranged from about −4.50 to −8.50 and from −4.00 to −5.00 mmHg, respectively. There were no significant changes in nocturnal 24 h BPs. DRSP/E2 significantly reduced HR daytime and night-time during the follow up period. DRSP/E2 significantly lowered the BMI, concentrations of total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B, while high-density lipoprotein cholesterol and apolipoprotein concentration increased.Interpretation & conclusions:Continuous long-term therapy with DRSP 2 mg/E2 1 mg significantly lowered 24 h systolic and diastolic BPs and reduced the risk of cardiovascular disease in early menopausal women with stage 1 hypertension. Timely initiated menopausal hormone therapy can have beneficial effects on BP and can reduce the incidence of cardiovascular disease in menopausal women.

Comparison of nocturnal blood pressure based on home versus ambulatory blood pressure measurement: The Ohasama Study

ABSTRACT Objectives The nocturnal blood pressure (BP) is a strong predictor of hypertensive target organ damage including that in cardiovascular diseases. The use of ambulatory BP (ABP) monitoring has enabled the evaluation of nocturnal BP and detection of non-dippers. This study compared nocturnal BP values, nocturnal decline in BP, and the prevalence of non-dippers based on ABP and home BP (HBP) measurements in a general population. Methods Data on HBP measured with HEM 747-IC-N (Omron Healthcare Co., Ltd.) and 24-hour ABP measured with ABPM-630 (Nippon Colin) were obtained from fifty-five participants aged ≥ 20 years (mean age: 65.1 years, 78.2% women). To exclude a systematic difference between the two methods, we conducted a validation study for HBP and ABP in another population that consisted of hypertensive outpatients (mean age: 65.4 years, 53.4% women). Results After adjusting for the systematic difference in BP between the two methods calculated in the validation study (3.9 mmHg for systolic and 3.0 mmHg for diastolic), morning and daytime (average of morning and evening) HBP were significantly lower than morning (average of 2 h after waking) and daytime (average of being awake) ABP, respectively. No significant difference was found in nocturnal BP between HBP and ABP monitoring regardless of the quality of sleep during nocturnal HBP measurement. Agreement between HBP and ABP in the detection of non-dippers was low mainly due to the difference in daytime BP values. Conclusion: HBP monitoring may be a reliable alternative to ABP for the assessment of nocturnal BP.

The association between 24-h blood pressure patterns and left ventricular mechanics.

We sought to investigate left ventricular (LV) mechanics in the recently diagnosed hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). The current cross-sectional study included 209 hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive two-dimensional echocardiographic examination including multilayer strain analysis. There was no difference in 24-h and daytime BP values between four groups. Night-time BP significantly and gradually increased from extreme dippers, across dippers and nondippers, to reverse dippers. LV global longitudinal and circumferential strains were greater in dippers and extreme dippers than in nondippers and reverse dippers. This was also found for endocardial and epicardial LV longitudinal and circumferential strains. Multivariate logistic regression analysis demonstrated that nondipping and reverse dipping patterns were associated with reduced LV longitudinal strain [odds ratio (OR) 1.71 (95% confidence interval (CI): 1.10-5.61) and OR 2.50 (95% CI: 1.31-6.82), respectively] independently of age, sex, 24-h SBP, LV mass index and E/è. Only the reverse dipping BP pattern was independently of clinical and echocardiographic parameters related with reduced LV circumferential strain [OR 1.90 (95% CI: 1.10-4.80)]. Nondipping and reverse dipping BP patterns had stronger impact on LV mechanics compared with patients with dipping and extreme dipping BP patterns in hypertensive population. LV functional and mechanical remodeling deteriorated from extreme dippers and dippers, to nondippers and reverse dippers.

Do reverse dippers have the highest risk of right ventricular remodeling?

We aimed to evaluate right ventricular (RV) deformation in recently diagnosed untreated hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). This cross-sectional study involved 190 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and a detailed two-dimensional echocardiographic examination, including the assessment of layer-specific strain. We found that 24-h and daytime BP values did not differ between the four groups. Nighttime BP significantly and gradually increased from extreme dippers across dippers and nondippers to reverse dippers. RV structure and systolic and diastolic function did not significantly differ among the four groups. However, RV global and RV free wall longitudinal strains were significantly lower in nondippers and reverse dippers than in dippers and extreme dippers. The endocardial and epicardial RV longitudinal strains of the whole RV and free wall RV were the lowest in reverse dippers and highest in extreme dippers. Multivariate logistic regression analysis demonstrated that only reverse dipping patterns were associated with reduced RV global longitudinal strain [OR 2.9 (95% CI: 1.5-8.2)], independent of age, sex, 24-h systolic BP, LV mass index, RV wall thickness and E/e't. Similarly, the reverse dipping pattern was associated with reduced RV free wall longitudinal strain, independently of the mentioned parameters [OR 3.8 (95% CI: 1.8-8.5)]. In conclusion, in the hypertensive population, the reverse dipping BP pattern had an adverse effect on RV deformation. RV remodeling progressively deteriorated from extreme dippers to reverse dippers, but only the reverse dipping BP pattern was independently associated with the reduction in RV longitudinal strain.

Influence of circadian blood pressure patterns and cardiopulmonary functional capacity in hypertensive patients.

We sought to assess functional capacity in recently diagnosed untreated hypertensive patients with different 24-hour blood pressure (BP) patterns (dipping, non-dipping, extreme dipping, and reverse dipping). This cross-sectional study involved 164 untreated hypertensive patients who underwent 24-hour ambulatory BP monitoring and cardiopulmonary exercise testing. Our findings showed that 24-hour and daytime BP values did not differ between four groups. Nighttime BP significantly and gradually increased from extreme dippers to reverse dippers. There was no significant difference in BPs at baseline and at the peak of exercise among four observed groups. Peak oxygen consumption (peak VO2) was significantly lower in reverse dippers than in dippers and extreme dippers. Heart rate recovery was significantly lower among reverse dippers than in dippers and extreme dippers. Ventilation/carbon dioxide slope (VE/VCO2) was significantly higher in reverse dippers and non-dippers in comparison with dippers and extreme dippers. Non-dipping BP pattern (non-dippers and reverse dippers together) was independently and negatively associated lower heart rate recovery in the first minute and peak VO2. Reverse dipping BP pattern was independently associated not only with heart rate recovery in the first minute and peak VO2, but also with VE/VCO2. In conclusion, untreated hypertensive patients with reverse dipping BP patterns showed significantly worse functional capacity than those with dipping and extreme dipping BP patterns. Circadian BP rhythm is related with functional capacity and should be taken into account in the risk assessment of hypertensive patients.

C‐Reactive Protein Levels and Blood Pressure Loads with Training

Blood pressure (BP) load is the percentage of BP readings above a particular threshold within a given period. Elevated BP loads translate to organ exposures to high pressures for greater amounts of time. Because of this, BP load was heralded as a strong predictor of target organ damage (TOD). However, recent evidence has not confirmed its prognostic value above 24 hr ambulatory blood pressure monitoring (ABPM). Although questioned, it is incorporated in AHA ABPM guidelines for children and adolescents. Newer evidence in chronic kidney disease and untreated hypertensives has shown an independent association of BP load with various measures of TOD. Additionally, a marker of systemic inflammation (neutrophil‐to‐lymphocyte ratio) has been shown to correlate with BP load.ObjectiveThis analysis investigated the relationship between classic inflammatory biomarker C‐Reactive Protein (CRP) and debated measure BP Load in a high‐risk population for cardiovascular diseases (CVD).MethodsSedentary, middle‐to‐older age African Americans free of disease underwent aerobic exercise training (AEXT) 3x/week for 24 weeks. Intensity targets progressed to sustain 60% VO2 max. Because of the strong relationship between BMI and BP, participants were required to maintain a constant weight. ABPM was conducted before and after training, and BP loads determined. Fasted blood draws were utilized at these times to measure circulating CRP and categorize future CVD risks based on baseline CRP levels. Slightly less conservative thresholds for BP readings were used because of this known high‐risk population.ResultsWith training, daytime SBP and DBP loads decreased for those only in the low risk CRP group (p=.047 and p=.036, respectively). Nighttime values, however, did not change for either CRP group with training. For daytime values at baseline and final, there was no difference in SBP load (&gt;124 mmHg) for those classified as at low (&lt;1mg/L), average (1–3mg/L) or high (&gt;3mg/L) risk for CVD based on CRP levels. When a more conservative threshold was utilized (SBP &gt;139 mmHg) there was a difference between CRP groups after training (p&lt;.05). There was a similar trend for DBP load (DBP&gt;74 mmHg), with a difference appearing after training (p&lt;.05). Nighttime DBP load did not differ between groups either before or after training. SBP load, however, differed between CRP groups at baseline when a more (&gt;119 mmHg, p&lt;.05), but not less (&gt;104 mmHg) conservative threshold was used. Groups after training showed no SBP load difference.ConclusionsCRP levels may contribute to BP loads and resultant TOD. These may be a specific indicator of the response to AEXT, especially in those considered low‐risk. Because nighttime BP load did not change with training in either category, but daytime values did decrease, the reasons for this need to be further examined. It is possible that a different stimulus may be necessary to cause changes in nighttime values. This is especially important since recent evidence has shown nighttime values to be a greater indicator of clinical events and cardiovascular outcomes than daytime BP values. Additionally, BP load thresholds may need to be adjusted for various populations. Future studies are needed to confirm the independent effect of BP load in this high‐risk population, and its relationship to inflammation.Support or Funding InformationNIH Grant #R01 HL085497‐01A1 Systolic (&gt;139 mmHg) and Diastolic (&gt;74 mmHg) Blood Pressure load decreased after training in low‐risk subjects. SBP Load showed between group differences only after, but not before training.* p&lt;.05 within groups. # p&lt;.05 between groupsimageSystolic (&gt;139 mmHg) and Diastolic (&gt;74 mmHg) Blood Pressure load decreased after training in low‐risk subjects. SBP Load showed between group differences only after, but not before training.* p&lt;.05 within groups. # p&lt;.05 between groups Neither Systolic (&gt;104 mmHg) nor Diastolic (&gt;64 mmHg) Blood Pressure load decreased after training for subjects. SBP (&gt;119) Load showed between group differences before, but not after training. # p&lt;.05 between groupsimageNeither Systolic (&gt;104 mmHg) nor Diastolic (&gt;64 mmHg) Blood Pressure load decreased after training for subjects. SBP (&gt;119) Load showed between group differences before, but not after training. # p&lt;.05 between groupsThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Beneficial response of blood pressure to short-term continuous positive airway pressure in Chinese patients with obstructive sleep apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is common in people with hypertension and cardiac rhythm disorder. The objectives of this study were to determine the effect of short-term continuous positive airway pressure (CPAP) on blood pressure (BP) and cardiac rhythm in Chinese patients with moderate to severe OSAHS. Eligible patients in the two hospitals were consecutively enrolled into the prospective study. Ambulatory BP monitoring and Holter monitoring were both performed for 24 h in 214 patients who previously encountered a full night polysomnography. Ambulatory BP was measured again in the follow-up of 59 patients with OSAHS who underwent home CPAP for 30 days, whereas Holter was repeated within 2-3 days after institution of CPAP therapy in 15 patients with OSAHS. Fifty-one patients with OSAHS with hypertension who used CPAP for at least 4 h/night received 30 days of CPAP treatment. Added CPAP on usual antihypertension treatment showed that systolic BP, diastolic BP, and mean arterial BP were significantly reduced at night (5.08, 3.05, and 3.73 mmHg, respectively), in the morning (6.31, 4.83, and 5.32 mmHg, respectively), and during the whole a day (3.09, 2.60, and 2.76 mmHg, respectively). There were no significant changes in daytime BP values but did reduce daytime BP by 2.09, 2.37, and 2.28 mmHg, respectively. In addition, CPAP therapy resulted in abolition of most sinus pauses and atrioventricular block in the 15 patients with OSAHS having coexisting pathologically rhythm disturbances, whereas the effect on other types of arrhythmia was not effective enough. Short-term CPAP reduced BP modestly in patients with OSAHS with hypertension, especially in the morning and at night-time.

Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review.

Reverse or inverted dipping (ie, the phenomenon characterized by higher nighttime compared with daytime blood pressure values) is an alteration of circadian blood pressure rhythm frequently documented in hypertension, type 2 diabetes mellitus, chronic kidney disease, and sleep apnea syndrome, and generally regarded as a harmful condition. Available literature on the clinical and prognostic implications of reverse dipping is scanty. The present article will review a number of relevant issues concerning reverse dipping, in particular: (1) its possible mechanisms; (2) prevalence and clinical correlates, (3) concomitant cardiac and extracardiac subclinical organ damage; (4) association with acute and chronic cardiovascular diseases; (5) prognostic value in predicting cardiovascular events and mortality; and (6) therapeutic interventions aimed at reverting this abnormal circadian blood pressure rhythm.

Metabolism of quantity elements and essential trace elements in patients with essential arterial hypertension in different ecological settings

Aim. To study the specifics of lead, zinc, copper, magnesium and calcium metabolism in children and adolescents with essential arterial hypertension living in different ecological settings. Methods. 100 children and adolescents aged 13-17 years with arterial hypertension, living in «industrial» (52 patients) and «residential» (48 patients) areas were examined in cardiology ward. 33 healthy children and adolescents comparable by age and gender were included as healthy controls. According to 24-hour blood pressure monitoring, groups with stable, labile arterial hypertension and «white coat hypertension» were formed. The levels of elements in 24-hour urine and in serum were measured by atomic absorption spectrophotometry. Results. In children and adolescents with stable arterial hypertension living in industrial areas, parameters of 24-hour blood pressure monitoring (mean 24-hour and mean daytime systolic blood pressure values, time of systolic hypertension, mean 24-hour and mean daytime blood pressure values) were higher compared to the same parameters in children from residential areas, the difference was statistically significant. The study of elements metabolism revealed increased lead exposure in children with essential arterial hypertension living in industrial areas, and misbalance of essential elements in those patients compared to the same parameters in children from residential areas. Conclusion. Results suggest increased exposure to arterial hypertension and marked misbalance of essential elements in children and adolescents with essential arterial hypertension living in industrial areas.

Is daytime blood pressure adequate in cardiovascular risk assessment in patients with coronary atherosclerosis?

Objectives. The goal of our study was to estimate the impact of abnormal night-time blood pressure (BP) on cardiovascular (CV) mortality in hypertensive patients with significant atherosclerosis established in coronary angiography. Method. We enrolled 891 patients, 63.7 ± 9.4 years of age. They were divided into patients with normal daytime BP values, and patients with abnormal daytime BP values. During a follow-up period of 4.7 years in total, all-cause mortality and both CV and non-CV mortality were assessed. Results. In the group with normal daytime BP, a clinic BP value ≥ 140/90 mmHg was observed in 25.7% (n = 161) of patients, and a night-time BP value ≥ 120/70 mmHg was observed in 37.8% (n = 236) of patients. In the group of patients with normal daytime BP in comparison with those with abnormal daytime BP, there was lower CV mortality (5.6% vs 9.8%, p < 0.02). Abnormal daytime BP was associated with a hazard ratio of CV mortality of 1.80 (95% CI 1.08–3.00, p < 0.02), and abnormal night-time BP with a hazard ratio of 1.63 (95% CI 1.03–2.66, p < 0.04). Conclusion. Assessment of both daytime and night-time BP is essential and superior over clinic BP in CV risk evaluation in patients with coronary artery disease confirmed in coronary angiography.

Masked hypertension in renal transplant recipients

Purpose: Arterial hypertension is a risk factor affecting graft function in renal transplant recipients (RTRs). In pediatric RTRs, high prevalence of masked and nocturnal hypertension was reported. Most of the RTRs had a history of hypertension and some of them were normotensive at outpatient visits whereas home blood pressure (BP) levels were higher. Masked hypertension (MHT) is defined as a normal office BP but an elevated ambulatory BP. Previous reports have demonstrated the detrimental role of MHT in clinical outcomes in hypertensive patients. However, the true prevalence of MHT in RTRs is yet to be defined. Methods: A total of 113 RTRs (mean age 44 ± 16 years, 72 males, 41 females) with normal office BP (< 140/90 mmHg) were enrolled to the study from the outpatient renal transplantation clinic. Ambulatory BP monitoring (ABPM) was performed in all participants for a 24-h period. Average daytime BP values above 135 mmHg systolic and 85 mmHg diastolic were defined as MHT. Results: The prevalence of MHT in our cohort was 39% (n = 45). Fasting glucose and C-reactive protein levels were higher in patients with MHT compared with normal BP group (p = 0.02 and p = 0.04, respectively). RTRs with deceased donor type had higher prevalence of MHT than RTRs with living donor (40% vs 19%, p = 0.003). In multivariate analysis, deceased donor type could predict the MHT independent of age, gender, office systolic BP level, diabetes mellitus, serum creatinine, C-reactive protein, and glucose levels (OR = 3.62, 95% CI 1.16–11.31, p = 0.03). Conclusion: We demonstrated an increased prevalence of MHT in a typical renal transplant cohort. In addition, transplantation from a deceased donor may be a predictor of MHT. The prevalence of MHT may help to explain high rate of cardiovascular events in RTRs. Therefore, routine application of ABPM in RTRs may be plausible, particularly in RTRs with deceased donor type.

Clinical Significance of the Blood Pressure Changes from Day to Night

Blood pressure (BP) decreases by 10% to 20% from day to night. However, in 25% to 35% of hypertensive subjects there is some reduction in the day-night BP decline. In 3% to 5% of uncomplicated hypertensive subjects there is actually an increase, not a decrease, in BP from day to night. Many studies from independent centers showed that not only left ventricular hypertrophy, but also ventricular arrhythmias, silent cerebrovascular disease, microalbuminuria and progression of renal damage are more advanced in subjects with blunted or abolished fall in BP from day to night than in those with normal day-night BP difference. There is also evidence from longitudinal studies that a blunted, abolished or even reversed BP drop from day to night is associated with an increase in the risk of serious cardiovascular complications. However, if the quantity or quality of sleep is poor during overnight BP monitoring, night-time BP rises and its prognostic significance is no longer reliable. Studies which compared the prognostic value of daytime BP with that of night-time BP inevitably found the superiority of the latter for predicting prognosis. The exciting potential therapeutic implication that the control of night-time BP could be more rewarding, in terms of prevention of cardiovascular disease, than that of daytime BP has yet to be addressed in appropriately designed intervention trials. Of note, 24-hour ABP monitoring is the only practical way to assess the day-night rhythm of BP. Keywords: Hypertension, ambulatory blood pressure, circadian blood pressure rhythm, myocardial infarction, stroke, epidemiology, PIUMA, nondippers, brain arteriosclerosis

Factors Influencing White-coat Effect

The transient blood pressure (BP) rise during clinical visits is usually referred to as white-coat effect (WCE). The aim of the present study was to investigate factors that may influence the WCE. A total of 2004 subjects underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM) on the same day. The WCE was estimated as the difference between office and average daytime ambulatory BP (ABP). According to the office and daytime BP values, the study population was divided into normotensives (NTs), white-coat hypertensives (WCHs), masked hypertensives (MHTs), and sustained hypertensives (SHTs). Statistical analyses were performed using one-way analysis of variance and multiple linear regression models. The mean systolic and diastolic WCE was 9 +/- 16 and 7 +/- 12 mm Hg, respectively. In the entire group of patients, multiple linear regression models revealed independent determinants of systolic WCE in the following rank order: office systolic BP (SBP) (beta = 0.727; P < 0.001), female gender (beta = 0.166; P < 0.001), daytime SBP variability (beta = 0.128; P < 0.001), age (beta = 0.039, P = 0.020), and smoking (beta = 0.031, P = 0.048). A 1.0 mm Hg increase in daytime SBP variability correlated with an increment of 0.589 mm Hg (95% confidence intervals, 0.437-0.741) in the systolic WCE. The regression analyses for diastolic WCE revealed the same factors as independent determinants. A 1.0 mm Hg increase in daytime diastolic BP (DBP) variability was independently associated with an increment of 0.418 mm Hg (95% confidence intervals, 0.121-0.715) in the diastolic WCE. Factors such as gender, age, smoking, office BPV and daytime BPV may exert an important influence on the magnitude of the WCE.

How reliable is isolated clinical hypertension defined by a single 24-h ambulatory blood pressure monitoring?

Isolated clinical hypertension (ICH) is characterized by a persistently elevated clinic blood pressure in the presence of a normal day-time or 24-h ambulatory blood pressure (ABP). This definition is based on a single ABP monitoring (ABPM) and little attention has been focused on the reproducibility of this condition. To investigate the reliability of the criteria currently recommended by major hypertension guidelines to detect ICH based on a single 24-h ABPM session. A total of 611 never-treated grade 1 and 2 hypertensive patients (mean age 46 +/- 12 years) referred for the first time to our out-patient clinic, underwent repeated clinic blood pressure measurements, routine investigations, two 24-h periods of ABPM 1-4 weeks apart, cardiac and carotid ultrasound examinations. ABPM was always performed over a working day and the same daily activities were recommended during the two periods. ICH was diagnosed by the following criteria: (i) mean daytime values < 135/85 mmHg or (ii) mean 24-h blood pressure values < 125/80 mmHg during the first ABPM. The overall prevalence of ICH was 7.1% according to criterion (i) and 5.4% according to criterion (ii). Twenty (46.6%) of the 43 patients with mean daytime blood pressure values < 135/85 mmHg during the first ABPM, exceeded this cut-off value during the second ABPM period. Twenty-two (66.6%) of the 33 patients with mean 24-h blood pressure values < 120/80 mmHg during the first ABPM did not confirm a normal blood pressure profile during the second ABPM recording. Cardiovascular involvement was significantly lower in subjects with persistent normal ABP compared to those with non-reproducible ICH pattern or sustained hypertensives. These findings clearly indicate that: (i) the classification of ICH on the basis of a single ABPM, using the cut-offs suggested by major hypertension guidelines, has a limited short-term reproducibility and (ii) repeated ABPM recordings should be recommended to correctly diagnose patients with ICH and improve cardiovascular risk stratification.