Daytime BP Research Articles

P216 STUDY OF BLOOD PRESSURE VARIABILITY DURING DIFFERENT PHASES OF MENSTRUAL CYCLE IN APPARENTLY HEALTHY FEMALES

Background and Objective: Variability is an intrinsic property of blood pressure and is essential for physiological adaptability, blood pressure variability can be spontaneous and especially striking during physical activity and emotional and hormonal challenges like menstruation. Methods 30 Females in the age group 18 to 35 years having regular ovulatory cycles, not undergoing any medication were included in the study. Blood pressure variability was measured by Ambulatory blood pressure monitoring using ABPM machine (A&D Japan). for 24 hours at midpoint of menstrual, proliferative and luteal phases of menstrual cycle considering ovulation on (X-14) where X is the last day of menstrual cycle. Observation: In the menstrual phase, mean systolic B.P.is 103.8 mm of Hg SD +/- 15.25, proliferative phase mean is 105.41 mm Hg, SD +/- 7.33 luteal phase mean is 124.13 mm Hg, SD +/- 10.6.(P < 0.001). Comparison of mean changes in diastolic blood pressure between menstrual, proliferative and luteal phase shows mean of 63.6 mm Hg SD +/- 15.75, 68.4 mm Hg SD+/- 5.66 and 76.32 mm Hg SD +/- 6.7. (P < 0.001) respectively. Mean arterial pressure (MAP) in the menstrual phase of 78.03 mm Hg, SD +/- 10.95 proliferative phase 79.91 mm Hg SD +/- 6.34 and luteal phase mean is 89.58 mm Hg +/- 5.49(P < 0.001). Results-: This study shows that the systolic B.P. tends to rise in the luteal phase, also the diastolic B.P. rises significantly in the luteal phase. There is marked dipping in the night time blood pressure in all phases when compared to day time blood pressure and the daytime blood pressure is elevated in the luteal phase compared to menstrual and proliferative phases. Conclusion Therefore, we can conclude that in luteal phase, the systolic, diastolic blood pressure and mean arterial pressure was significantly higher than the other two phases. The daytime BP was also high in luteal phase compared to other two phases.

Clinic and ambulatory blood pressures, blood pressure phenotypes and mortality in patients with a previous stroke.

There is scarce evidence of the role of clinic and ambulatory BP indices, as well as blood pressure phenotypes in the prognosis of stroke survivors. We aimed to evaluate the association between ambulatory BP indices and mortality in patients with a previous stroke. Our study was an observational cohort study from individuals included in the Spanish Ambulatory Blood Pressure Registry from March 2004 to December 2014. The Cox model was used to estimate associations between usual clinic and ambulatory BP and mortality, adjusted for confounders and additionally for alternative measures of BP. Two thousand one hundred and eighty-three patients with a previous stroke were included. During a median of 9.2 years, 632 (28.9%) patients died: 236 (10.8%) from cardiovascular causes. In the confounder-adjusted model, clinic systolic BP was not associated with the risk of all-cause or cardiovascular mortality. In contrast, systolic BP indices obtained through ABPM (24 h, day and night) were all associated with all-cause and cardiovascular death. In the simultaneous adjustment of daytime and night-time systolic BP, only night-time systolic BP remained significantly associated with all-cause and cardiovascular death: HR 1.35 (95% CI 01.21-1.51) and 1.44 (1.20-1.72), respectively. For diastolic BP, only night-time BP was associated with all-cause and cardiovascular mortality: HR 1.32 (1.18-1.48) and 1.57 (1.31-1.88), respectively. According to the circadian pattern, a riser pattern was associated with all-cause and cardiovascular mortality: HR 1.49 (1.18-1.87) and 1.70 (1.14-2.52), respectively. In conclusion, in patients who have suffered a stroke, night-time BP is the BP estimate most closely associated with all-cause and cardiovascular mortality.

EFFECT OF RENAL DENERVATION ON 24H BLOOD PRESSURE PATTERN

Objective: Endovascular renal denervation (DRN) is a therapeutic approach for resistant arterial hypertension (RH). The aim of this study was to assess the effects of RDN on 24h blood pressure. Design and method: A retrospective evaluation of ABPM data at baseline and after 6 months from RDN in patients undergoing DRN between 01/01/2011 and 31/12/2021 in the Arterial Hypertension Center of Turin. Mean 24h, Daytime, Nighttime BP and HR values and short term 24h, daytime and nigthtime BP and HR varability parameters (standard deviation, dipping and coefficient of variation) were calculated. Results: The series included 14 subjects, of which 8 (57%) were female and with an average age 54±10 years. The number of antihypertensive drugs before renal denervation was 5.7±1.0. At baseline office BP was 188/113±22±18 mmHg and ABPM 24h BP was 150/92±21±16 mmHg. Patients were considered as responders if a reduction of least 10 mmHg in systolic blood pressure (PAS) at 24h Blood Pressure Monitoring at six months from RDN was obtained. From a safety point of view, there were no short-term or long-term complications. The responders at six months were 66%. Non-responders showed an increased blood pressure variability compared to responders at baseline and only one was dipper. The responders had a statistically significant redution of SD24h after DRN, an increased average nocturnal blood pressure drop and a lower pressure variability. While in non-responders no redution in SDnight, SDday and coefficient of variation was found, by contrast all of them become dippers because mean daytime SBP increase. Conclusions: In conclusion, pressure variability (SD24h and coefficient of variation) is globally reduced in the denerved patients, this trend is particularly present in responders. The non-responders have an increased BP variability at baseline without decreasing after DRN. These results suggest that, when effective, DRN can reduce both BP levels and BP variability, thus may have an important effect in reducing cardiovascular risk.

DAY-TO-DAY REPRODUCIBILITY OF NOCTURNAL BLOOD PRESSURE FALL (DIPPING) EVALUATED WITH WEARABLE AND HOME DEVICES IN HYPERTENSIVE PATIENTS

Objective: Non-dipping status has been associated with increased risk of heart failure and cardiovascular events. However, its reproducibility when evaluated by means of ambulatory blood pressure monitoring (BPM) is often suboptimal. Wearable devices (WD) and home BPM devices equipped with nocturnal measurement function (HBPMN) offer the opportunity of estimating dipping status over different days thus potentially increasing precision owing to statistical averaging. We aimed to determine the reproducibility of nocturnal BP dipping estimated through a combined use of WD and HBPMN devices for daytime and night-time BP estimation within one week. Design and method: We recruited treated and untreated adult patients with hypertension. Patients underwent one week of home BP monitoring through a HBPMN device (NightView, OMRON Healthcare, HEM9601T-E3) and with an oscillometric WD (HeartGuide, OMRON Healthcare, HEM-6411T-MAE). Patients were asked to measure BP over one week with WD according to ESH-HBPM guidelines for daytime measurements and with HBPMN according to standard device settings for night-time measurements. Interclass correlation coefficient (ICC) was calculated to evaluate reproducibility. Results: 76 patients were included in the study. The main characteristics are summarised as follows: age (61±11.84 years), 32 (42%) females, BMI (28.12±4.90 Kg/m2). Most of them (98%) were treated hypertensives. Office systolic and diastolic BP were 134±4.43 mmHg and 80±4.84 mmHg, respectively. The average one-week systolic BP dipping was 16.14±9.44%. When we considered patients who had dipping assessment over at least the first 5 days (37 patients), intra-individual variability in the categorical definition of dipping status was observed (Figure 1) with a suboptimal reproducibility of average nocturnal BP fall (ICC 0.60). Conclusions: Nocturnal BP dipping estimated as continuous variable through the combined use of WD and HBPMN exhibits suboptimal reproducibility resulting in a variable day-by-day classification of patients according to their dipping status. Whether this reflects technical issues, or rather depends on the physiological variability of BP and sleeping patterns needs to be determined by future studies.

RELATIONSHIP BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE AND MORTALITY IN PATIENTS WITH PREVIOUS STROKE

Objective: The aim of this study was to evaluate the association between clinic and ambulatory BP and mortality in patients with a previous stroke Design and method: Observational cohort study from the Spanish Ambulatory Blood Pressure Registry. Mortality data (date and cause) were ascertained by a computerized search of the vital registry of the Spanish National Institute of Statistics. For each study participant, follow-up was from the date of his or her recruitment to the date of death, or December 31st, 2019, whichever occurred first. Cox models were used to estimate associations between clinic and ambulatory BP and mortality, adjusted for clinical confounders (age, sex, BMI, smoking, diabetes, and dyslipidemia), and additionally for alternative measures of BP. Results: From the 59 124 individuals included in the Registry, we selected 2,183 with a previous stroke. Mean age was 67.5 ± 11.8 years, 43.6% were female. During a median follow-up of 9.7 years (IQR 7.7–11.3), 632 (29.5%) participants died, including 236 from cardiovascular causes (62 ischemic heart disease deaths, 83 stroke deaths, and 28 heart failure deaths). In the confounder-adjusted model, clinic systolic BP was not associated with the risk of all-cause or cardiovascular mortality. In contrast, systolic BP indices obtained through ABPM (24h, day and night) were all associated with all-cause and cardiovascular mortality. In the simultaneous adjustment of daytime and night-time systolic BP, only night-time systolic BP remained significantly associated with all cause and cardiovascular death: OR 1.36 (1.21-1.52) and 1.45 (1.21-1.73), respectively. For diastolic BP, only night-time BP was associated with all-cause and cardiovascular mortality: OR 1.33 (1.18-1.49) and 1.58 (1.32-1.89), respectively. Reverse dipper pattern (risers) was also associated with all-cause mortality: OR 1.56 (1.18-1.86) and cardiovascular mortality: OR 1.81 (1.27-2.57). Conclusions: In patients who have suffered a previous stroke, night-time blood pressure is the BP estimate most closely associated with all-cause and cardiovascular mortality.

Abstract P202: The Effects of Sodium (Na) Reduction and the Dash Diet on Ambulatory Blood Pressure in Black and Non-Black Individuals: Results From the DASH-Na Trial

Background: Black individuals compared to White individuals tend to have higher nighttime BP. It has been hypothesized that lifestyle changes will reduce and potentially eliminate this disparity. Objectives: To determine the effect of reduced Na and the DASH diet, alone and combined, on ambulatory blood pressure (ABP) in Blacks (B) and Non-Blacks (NB, mostly white). Methods: Participants (n=335, 58% B) were randomly assigned to eat a control diet or the DASH diet. On their assigned diet, each participant had three, randomly ordered, 30d feeding periods with different Na levels (low, medium, and high). ABP was measured at the end of each period. Results: Before feeding, mean office SBP was similar in B and NB (135.5 and 134.5 mmHg, respectively). On the reference diet (control diet with high Na), daytime and nighttime SBP were higher in B than NB adults (Table). Compared to the ref diet, reducing Na and consuming the DASH diet, alone and combined, substantially lowered daytime and nighttime systolic ABP in Black and Non-Black individuals. The DASH diet combined with low Na reduced daytime SBP in B and NB with no significant B-NB difference, i.e. no racial disparity in daytime SBP; otherwise, B-NB differences were present in daytime SBP for Na reduction alone and DASH diet alone. For nighttime SBP, there was a consistent pattern such that Na reduction alone, DASH diet alone, and the DASH diet with low Na reduced nighttime SBP in B and NB, but in each case, B had significantly higher nighttime SBP levels than NB. For DBP, Na reduction alone, DASH diet alone, and combined DASH with low Na reduced daytime and nighttime BP in B and NB, but significant B-NB differences persisted (data not shown). Conclusions: Reducing dietary Na and consuming the DASH diet, alone and combined, substantially lowered ABP in Black and Non-Black individuals. However, racial disparities in ABP mostly persisted. These results highlight the importance of implementing both the DASH diet and Na reduction as a means to reduce BP throughout the day, regardless of racial background.

Effect of Accessory Renal Arteries on Essential Hypertension and Related Mechanisms.

This case-control study aimed to determine whether there were differences between patients with essential hypertension with accessory renal arteries (ARAs) and those without ARAs. The enrolled patients with essential hypertension were divided into the ARA group (n=200) and control group without ARAs (n=238). After propensity matching, 394 patients (197 in each of the 2 groups), were included. The 24-hour BP (4.33/2.43 mm Hg) and daytime BP (4.48/2.61 mm Hg) of patients in the ARA group were significantly higher than those of the control group (P<0.05). The flow-mediated dilation was lower in the ARA group (5.98±2.70 versus 5.18±2.66; P<0.05). In correlation analysis, the horizontal plasma aldosterone concentration had the highest correlation with 24-hour, daytime, and nighttime systolic BP (r=0.263, 0.247, and 0.243, respectively; P<0.05) and diastolic BP (r=0.325, 0.298, and 0.317, respectively; P<0.05). As for multivariate regression analysis, plasma aldosterone concentration was a significant risk factor for elevated 24-hour, daytime, and nighttime systolic BP (β=0.249 [95% CI, 0.150-0.349], 0.228 [95% CI, 0.128-0.329], and 0.282 [95% CI, 0.187-0.377], respectively; P<0.05) and elevated diastolic BP (β=0.289 [95% CI, 0.192-0.385], 0.256 [95% CI, 0.158-0.353], and 0.335 [95% CI, 0.243-0.427], respectively; P<0.05). Direct renin concentration was also a risk factor for 24-hour and daytime BPs, whereas heart rate was a risk factor correlated with 24-hour, daytime, and nighttime diastolic BP (all P<0.05). For the mixed-effects model for repeated measures, the results were similar to results of the multivariate regression analysis (all P<0.05). ARAs could contribute a higher BP of patients with essential hypertension and might promote the development of essential hypertension. The mechanism might be related to overactivation of the renin-angiotensin-aldosterone system and sympathetic nervous system.

Plasma and Urinary Platelet Factor 4 as Biomarkers for Cardiovascular Risk in Children with Chronic Kidney Disease.

Children suffering from chronic kidney disease (CKD) have a high risk of cardiovascular disease (CVD). The early detection and diagnosis of subclinical CVD in pediatric CKD can reduce mortality later in life. Plasma factor 4 (PF4) is a chemokine released by activated platelets. We examined whether or not PF4 in the plasma and urine, its kidney function normalized ratio, and fractional excretion have differential associations with CVD risk markers in 139 youths aged 3 to 18 years old with CKD stages G1-G4. Significant negative correlations were observed between plasma PF4 and cardiovascular surrogate markers, such as the left ventricular mass index (LVMI), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV). The plasma PF4/creatinine (Cr) ratio was lower in CKD children with a high daytime BP and 24 h BP, high BP load, and nocturnal non-dipping status. After adjusting for confounders, the plasma PF4 and plasma PF4/Cr ratio still independently predicted an abnormal ABPM profile. In addition, both the plasma PF4 and plasma PF4/Cr ratio presented a negative correlation with the L-arginine and asymmetric dimethylarginine ratio. These findings provide convincing evidence supporting the link between PF4 and CVD markers in pediatric CKD. Our study highlights the importance of further research to assess the performance of PF4-related biomarkers in predicting CVD events and CKD progression in children with CKD.

SFlt-1/PIGF ratio positive associated with non-dipper type change in ambulatory blood pressure monitoring(ABPM) for preeclampsia development.

In order to explore relationship of ambulatory blood pressure monitoring (ABPM) and soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) in suspected preeclampsia(PE), suspected PE participants in 28 + 0 to 33 + 6 weeks underwent ABPM and sFlt-1/PlGF from July 2020 to July 2022 were included(N = 476) in study. ABPM parameters were compared between sFlt-1/PlGF ≥38 and <38 groups. Correlation analysis was performed between ABPM and sFlt-1/PlGF, and logistic regression was used to explore prediction value for PE in 2 weeks. One hundred eighteen cases developed PE in 2 weeks with 114 from sFlt-1/PlGF ≥38 group. Daytime and nighttime BP were all increased,with increased non-dipper (58.4% vs. 30.3%), riser (22.1% vs. 13.1%) and and decreased Dipper (15.4% vs. 45.9%) type of ABPM in sFlt-1/PlGF ≥38 groups (P < 0.05).The riser group had the highest sFlt-1 and lowest PlGF. sFlt-1/PlGF and sFlt-1 were all positively correlated with systolic (SBP) & diastolic blood pressure(DBP)(P < 0.01), in which correlation coefficients of daytime and nighttime BP with sFlt-1 were β = 150.05 & 157.67 for SBP, β = 234 and 199.01 for DBP, respectively. However, PlGF was only negatively associated with nighttime SBP and DBP(P < 0.05), with no correlation with daytime BP (P > 0.05).Combining sFlt-1/PlGF and ABPM model, showed sFlt-1/PlGF (aOR = 2.01 (1.69-2.36)), Nighttime DBP (aOR = 1.14 (1.02-1.28)) contributed to preeclampsia prediction, and had improved predictive value compared to ABPM or sFlt-1/PlGF models alone(P < 0.05). sFlt-1/PlGF ratio was positively correlated with BP parameters, whereas PIGF was only negatively correlated with nocturnal BP and increased non-dipper type change in ABPM, which had a synergistic effect with sFlt-1/PlGF on PE prediction.

Ambulatory blood pressure monitoring in pediatric patients with sickle cell anemia.

Sickle cell anemia (SCA) is a hemoglobinopathy presenting severe endothelial damage associated with increased prevalence of hypertension (HTN). Few studies have used ambulatory blood pressure monitoring (ABPM) in pediatric patients with SCA. The aim of this study was to characterize the ABPM profile in children with SCA. A retrospective cross-sectional study was conducted on all subjects <18 years of age with SCA who presented at a medical reference center in the city of Cartagena, Colombia. Anthropometric, clinical laboratory, treatment, and ABPM parameters, including ambulatory arterial stiffness index (AASI) were registered. The study included 79 patients, of these, 23 (29%) children had normal BP, 49 (62%) had abnormal BP and 7 (9%) had HTN. Mean age was 10.5 ± 3.6 years and 44 (56%) cases were male. Forty-eight (60%) patients had pre-HTN. Masked HTN was present in 6 (8%) patients. One (1%) had ambulatory HTN, and another one (1%) had white coat HTN. The HTA group exhibited significantly higher systolic BP and diastolic BP compared to the other groups in 24-hour BP readings, daytime BP, and night-time BP ABPM parameters ( P < 0.05), except for daytime DBP ( P = 0.08). Mean AASI was 0.4 ± 0.2. The HTN group had the highest AASI value compared to the other groups ( P = 0.006). Significant alterations in ABPM parameters are frequently observed in pediatric patients with SCA. The incorporation of ABPM, along with the assessment of AASI, is recommended for a comprehensive evaluation of cardiovascular and renal risk in SCA patients.

Abstract 118: Effects Of Aprocitentan, A Dual Endothelin Receptor Antagonist, On Blood Pressure In Black/African American Patients With Resistant Hypertension: Results From A Randomized, Controlled Study (PRECISION) Including A Withdrawal Phase

Background: Resistant hypertension is prevalent among Black/African American drug-treated hypertensives and may increase cardiovascular risk. We evaluated aprocitentan (APRO) for BP lowering in Black patients with resistant hypertension. Methods: Patients had sitting unattended automated office systolic BP (SBP) ≥140 mmHg despite use of ≥3 antihypertensives of different classes in the year prior. After 4 weeks of combination therapy (amlodipine, valsartan, hydrochlorothiazide), those still hypertensive could enter a 4-week single-blind placebo (PBO) run-in period, followed by a 4-week double-blind period wherein patients were randomized 1:1:1 to APRO 12.5 mg, 25 mg, or PBO. A 32-week single-blind period on APRO 25 mg followed. Patients were then re-randomized 1:1 to APRO 25 mg or PBO in a 12-week withdrawal period. The primary endpoint was change from baseline to Week 4 in mean trough SBP. Changes in SBP from withdrawal baseline (Week 36) to Week 40 and in 24-hour, daytime (09:00-21:00), and nighttime (01:00-06:00) ambulatory BP monitoring (ABPM) measures at Weeks 4 and 40 were also assessed. Results: Eighty-two of 730 patients (11.2%) were Black (APRO 12.5 mg, n = 28; 25 mg, n&amp;nbsp;= 28; PBO, n = 26). At Week 4, APRO and PBO produced similar office SBP reductions (least squares mean difference from PBO, 12.5 mg: 0.63 mmHg; 25 mg: 0.12 mmHg). However, APRO produced pronounced reductions vs PBO in mean 24-hour (12.5 mg: –3.23 mmHg; 25 mg: –7.85 mmHg), daytime (12.5 mg: –6.16 mmHg; 25 mg: –9.13 mmHg), and nighttime (12.5 mg: –2.63 mmHg; 25 mg: –8.53 mmHg) ambulatory SBP. Four weeks after withdrawal, office SBP increased with PBO vs APRO 25 mg (difference: +9.87 mmHg), which was confirmed with ambulatory SBP (difference, 25 mg; 24-hour: +8.13 mmHg, daytime: +3.39 mmHg, nighttime: +9.70 mmHg). Safety in Black patients was comparable to the overall population, with no new signals. During the double-blind period, treatment-emergent adverse events were reported in 6/28 (21.4%), 9/29 (31.0%), and 4/25 (16.0%) patients with APRO 12.5 mg, APRO 25 mg, and PBO. Edema or fluid retention occurred in 3/29 patients (10.3%) on APRO 25 mg, and no patients on APRO 12.5 mg or PBO. Conclusion: APRO was well tolerated and produced clinically relevant reductions in SBP by ABPM in Black patients.

ASSOCIATION BETWEEN MASKED NOCTURNAL HYPERTENSION AND DEPRESSION DISORDER IN COVID-19 POSITIVE PATIENTS

Objective: An effect of depression for masked hypertension are scarce. We evaluated the prevalence and clinical characteristics of masked nocturnal hypertension (MNH) under hypertension in COVID 19 positive patients Design and method: The study evaluated 158 hypertensive patients with COVID 19 positive and depression disorder, evaluated by self BP monitoring. Among the participants, classified as masked nocturnal hypertension(MNHT) ( Daytime BP below 135/85 mmHg and night-time BP over 120/70 mmHg. Results: COVID 19 positive patients with depressive symptoms had a significantly higher incidence of hypertension in women compared to men with depressive symptoms. In the logistic regression analysis, the presence of depressive symptom was significantly associated with masked hypertension with COVID 19 positive independently of age, body mass index, education level, and current smoking and drinking status. Conclusions: COVID 19 positive patients with Depressive symptoms were highly associated with the incidence of hypertension among middle aged women and The highly significant predictive risk factor of depression disorder might be high nighttime BP. Comparison of clinic BP with either daytime high BP or awake high BP

Prevalence and Characteristics of Isolated Nocturnal Hypertension and Masked Nocturnal Hypertension in a Tertiary Hospital in the City of Buenos Aires.

Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5-18.2%) and 9.7 (95% CI 7.9-11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources.

PS-C33-9: PSYCHOLOGICAL ABNORMALITIES IN PATIENTS WITH RESISTANT HYPERTENSION FOUND NON-ADHERENT BY DIRECTLY OBSERVED TREATMENT INTAKE

Introduction &amp; aim: We intend to assess the underlying psychological and behavioural factors in patients with resistant hypertension (HTres) confirmed as non-adherents by directly observed treatment intake (DOTI). Methods: We studied with DOTI 68 patients with HTres in outpatient hypertension clinic. 24-h ambulatory BP (ABP) was evaluated before the procedure. In DOTI patients took all medications in the morning for 5 days under the supervision of a technician and performing on the fifth day a second ABP. In some patients a third ABP measurement was repeated 3–6 months after DOTI. All patients responded to appropriate questionnaires evaluating their psychological and behavioural profiles Results: Out of the 68 patients 76% were female and 21% diabetics in average ageing 62 years and BMI 30 Kg/m2. Average antihypertensive agents was 4.6 ± 1.2 drugs/day. After DOTI casual, daytime and night-time BP decreased significantly (24 h from 149/82 + 13/13 to 131/74 + 13/9 mm Hg, p &lt; 0.01). Pts (n = 36, i.e. 52.9%) were classified as non-adherents (false HTres) since after DOTI vs previous 24-h ABP there was a significant reduction of mean 24 h BP to &lt; 130/80 mm Hg or a reduction of both 24 h SBP and 24 h DBP by &gt; 10%). Non-adherents i.e false HTres showed significant worse values of disbelief in the potential benefits of treatment, expression of emotions, hostility, anxiety, paranoid ideation, self-blame, physical mobility, smoking habits and social isolation. Conclusions: DOTI can be a valuable tool to identify the non-adherence to therapy as a cause of HRes. Non-adherence was associate with worse psychological and behaviour profiles.

S-46-3: ANTIHYPERTENSIVE TREATMENT IN MASKED HYPERTENSION FOR TARGET ORGAN PROTECTION (ANTI-MASK): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Objective: Masked hypertension is associated with target organ damage and adverse outcomes. However, up to now there is no interventional evidence that antihypertensive therapy will be beneficial to the patients. Design and methods: The ANTIhypertensive treatment in MASKed hypertension for target organ protection (ANTI-MASK) trial is a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT02893358). Eligible patients were 30 to 70 years old, had untreated masked hypertension and at least one sign of target organ damage (TOD). Masked hypertension was defined as a normal office blood pressure (BP, &lt; 140/90 mmHg) and an elevated 24-hour (&gt; = 130/80 mmHg), daytime (&gt; = 135/85 mmHg) or nighttime BP (&gt; = 120/70 mmHg) at both screening visits. TOD included electrocardiogram diagnosed left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (ba-PWV) &gt; = 1400 cm/s, or a random urinary albumin-to-creatinine ratio (ACR) &gt; = 2.5 mg/mmol in men and &gt; = 3.5 mg/mmol in women. Randomized patients were treated with alisartan 80 mg per day or placebo. If ambulatory BP was uncontrolled, drug dosage was doubled at the 2-month visit, and amlodipine 2.5 mg or matching placebo was added at the 4-month visit. The primary endpoint was the improvement rate of TOD after 12 months treatment, defined as the reverse (yes to no) of TOD or a significant decrease of ba-PWV or ACR by &gt; = 20% of the baseline level. Results: From Feb 2017 to Oct 2020, 317 patients with masked hypertension (43.2% women, mean age 54 years) were randomized in 13 hospitals in China. Overall, baseline office, 24-h, daytime and nighttime BPs averaged 130/81,137/85, 141/87, and 126/77 mmHg, respectively. At baseline, 98% had an elevated ba-PWV, 12% microalbuminuria, and 8% LVH. 252 patients completed the 12-month treatment and 65 (20.5%) withdrew from the trial. In the intention-to-treat analyses, the improvement rate of TOD was significantly higher in the antihypertensive treatment group than the placebo group (47.4% vs 26.1%, P &lt; 0.0001), as well as the decrease of the 24-h systolic/diastolic BPs (-9.1/-5.7 vs -1.5/-1.0 mmHg, P &lt; 0.0001). Conclusions: Antihypertensive treatment was beneficial for patients with masked hypertension in terms of TOD protection.

JS-ISH-KSH-4: EPIDEMIOLOGY OF RESISTANT HYPERTENSION IN KOREA: ABPM REGISTRY DATA

Resistant hypertension (RH) may be one of the major challenges in improving the control rate in hypertension (HTN) management. Accurate diagnosis is usually difficult only by measuring office blood pressure(OBP). For 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated when RH was defined as uncontrolled BP by three AHM classes including diuretic or controlled BP by 4 or more classes. Prevalence of RH was 11.9 % (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for OBP versus nighttime BP. Masked uncontrolled HTN was 16.9 % and white-coat uncontrolled HTN was 14.1 %. For nighttime BP control status, odd ratios for smoking (odds ratio(OR), 0.624), drinking (OR, 1.512), coronary artery disease (OR, 0.604), calcium antagonist (OR, 1.705), and loop diuretics (OR, 0.454) were all significant. The prevalence of RH by nighttime BP was significantly higher than using daytime BP criteria.

Age-related patterns of ambulatory blood pressure in a large cohort of individuals referred to Italian community pharmacies: results from the templar project.

Ambulatory blood pressure monitoring (ABPM) provides extensive information on several BP parameters other than the average BP during daily life. Through this analysis of the TEMPLAR study, we sought to understand better the features of age-related changes in ABP patterns and phenotypes. ABPMs were obtained in 53 350 individuals visiting 866 Italian community pharmacies (age 3-101 years, 54.3% female individuals). ABPM patterns were assessed across 10-year age categories. SBP steadily increased with age. DBP increased from the youth to the middle adulthood and then declined. Daytime BP was higher than night-time BP, but the difference narrowed with aging, reducing the prevalence of dippers. An enhanced SBP morning surge and increased prevalence of abnormal morning rise were observed with aging. SBP and DBP variabilities increased with age with a typical U or J shape, more evident in the case of DBP. The proportion of participants with ambulatory hypertension increased with age. However, an elevated daytime BP was more common in younger individuals and elevated night-time hypertension in older individuals. The prevalence of white-coat hypertension remained stable or slightly declined through the age groups, whereas that of masked hypertension steadily increased. Our results confirm that ABP patterns interplay and change in a complex way with age. Such changes, particularly the age-related increase in BP variability and prevalence of nocturnal hypertension, nondipping, enhanced morning rise, and masked hypertension, may increase the risk of cardiovascular events and must be carefully considered by the physician when managing BP in the elderly.

Elevated platelet reactivity in patients with uncontrolled hypertension: the effect of CHA2DS2-VASc score

Abstract Background Hypertension is associated with vascular and endothelial dysfunction that may result in a greater propensity for reactive platelets to cause thrombosis. Purpose The aim of this study was to evaluate multiple platelet activation pathways in hypertensive patients with different level of blood pressure control and cardiovascular risk factors. Methods Thirty nine uncontrolled (office BP &amp;gt;140/90 mmHg and ambulatory daytime BP &amp;gt;135/85 mmHg, 27 males, aged 58±9 years) and 32 well controlled (office BP &amp;lt;140/80 mmHg and ambulatory daytime BP &amp;lt;135/85 mmHg, 21 males, aged 58±8 years) essential hypertensive patients were included in the study. Twenty four healthy individuals (12 males, aged 53±10 years) were served as control group. Blood samples were obtained before and 48 hours after the procedure and platelet aggregation was tested in platelet rich plasma after activation with arachidonic acid (AA), adenosine diphosphate ADP), collagen (Col), epinephrine (Epi) and ristocetin (Risto), by using AggRAM Platelet Aggregation Analyzer. Results Hypertensive patients showed elevated platelet reactivity in all platelet activation pathways compared to normotensive group (AA: 88.8±6.8% versus 79.5±7.3%, ADP: 86.8±9.1% versus 71.5±7.7%, Col: 86.5±5.7% versus 73.9±6.7%, Epi: 92.6±5.4% versus 80.5±5.7%, Risto: 93.8±6.8% versus 79.9±6.3%, p&amp;lt;0.05 for all). Col, Epi and Risto platelet activation pathway showed a statistically significant increase in patients with uncontrolled hypertension compared to the group with well controlled hypertension (AA: 88.8±6.1% versus 89.1±4.1%, ADP: 89.8±4.1% versus 87.5±4.7%, Col: 87.5±4.7% versus 81.9±6.7%, Epi: 93.6±4.4% versus 80.1±5.7%, Risto: 94.8±3.8% versus 80.9±4.3%,). Notably, strong correlations were found between the Col platelet pathway activation and Risto platelet pathway activation and CHA2DS2-VASc score (r=0.57, p&amp;lt;0.001 and r=0.61, p&amp;lt;0.001, respectively) in hypertensive patients. Conclusions Patients with uncontrolled hypertension showed elevated platelet reactivity. Patients with high CHA2DS2-VASc even without atrial fibrillation carry also a higher risk of thrombosis as indicated by the increased platelet aggregation under certain pathways of activation. Funding Acknowledgement Type of funding sources: None.

Isolated nocturnal hypertension in relation to host and environmental factors and clock genes.

Isolated nocturnal hypertension (INH) is a special type of out‐of‐office hypertension. Its determinants and pathophysiology remain unclear. In a nested case‐control study, we intend to investigate the host, environmental, and genetic factors in relation to INH. Among 2030 outpatients screened from December 2008 till June 2015, 128 patients with INH were identified, and then 128 normotensives were matched according to sex and age. INH was an elevated nocturnal blood pressure (BP ≥120/70 mmHg) in the presence of a normal daytime BP (< 135/85 mmHg). Host factors included age, sex, body mass index, smoking and drinking, sleep time and duration, heart rate, serum lipids, and serum creatinine. Environmental cues encompassed season, ambient temperature, atmospheric pressure, humidity, and wind speed, and genetic cues 29 single‐nucleotide polymorphisms (SNPs) in 12 clock genes. Daytime and nighttime BPs averaged 124.9/80.7 and 114.5/73.7 mmHg, respectively, in the INH patients and 121.0/76.5 and 101.8/63.3 mmHg in the normotensive controls. Stepwise logistic regression analyses revealed that INH was associated with nighttime heart rate (P = .0018), sleep duration (P = .0499), and relative humidity (P = .0747). The odds ratios (95% CI) for each 10 beats/min faster nighttime heart rate and 10% lower relative humidity were 1.82 (1.25‐2.65) and 0.82 (0.67‐1.00), respectively. Irrespective of the genetic models, no significant association was observed between INH and the SNPs (P ≥ .054). In conclusion, INH was associated with host and environmental factors rather than genetic markers.

Hipotensión en hipertensos mayores tratados. Carga epidemiológica y eficiencia de su detección

Hypertension (systolic/diastolic blood pressure [SBP/DBP] ≥140 and/or ≥90 mmHg) is a very common condition in older people (prevalence &gt;60%) and one of the leading causes of death and disability worldwide. The cardiovascular, cerebrovascular, and renal benefits of treating it properly are abundantly supported by clinical trials. However, an excessive reduction in BP (e.g., postural or pharmacological), especially if it is sustained over time, is less known but apparently more frequent than expected and clinically-efficient to detect (e.g., with ambulatory monitoring [ABPM] or home-BP self-measurement). Some studies have associated hypotension with a greater risk of fatigue, dizziness, imbalance, falls, cardiovascular disease, kidney damage, and dementia. In older and frail patients with treated hypertension, some proposed safety margins are SBP/DBP of 130-139 (if tolerated)/70-79 mmHg and, in general, BP should not be reduced below these values. Orthostatic hypotension (&gt;20/10 mmHg fall in SBP/DBP within 3 minutes of erect standing) and ambulatory hypotension (mean daytime BP &lt;110/70 mmHg) can be detected measuring standing BP in the office and with 24-hour ABPM, respectively. Several studies suggest that there may not be a single treatment goal for all patients because the BP/outcome relation seems to be modified by the patient’s age, co-morbidities, drugs, etc., and ignorance of this can lead to hypotension and other deleterious effects. The balance between efficacy and safety of the drug treatment of hypertension can be reasonably achieved by the good doctor practicing personalized medicine, individualizing the treatment of each of his older patients (who are genetic, demographic, physiological, metabolic, psychological, and culturally different), combining the updated scientific evidence, his/her experience and comprehensive knowledge of the patient (age, co-morbidities, etc), and the preferences of the patient or their caregiver. Most of this review is supported by some recent clinical practice guidelines.