Daytime DBP Research Articles

Endurance exercise beneficially affects ambulatory blood pressure

Exercise is widely recommended as one of the key preventive lifestyle changes to reduce the risk of hypertension and to manage high blood pressure (BP), but individual studies investigating the effect of exercise on ambulatory BP have remained inconclusive. Therefore, the primary purpose of this systematic review and meta-analysis was to determine the effect of aerobic endurance training on daytime and night-time BP in healthy adults. A systematic literature search was conducted using PubMed and Cochrane Controlled Clinical trial registry from their inception to May 2012. Randomized controlled trials of at least 4 weeks investigating the effects of aerobic endurance training on ambulatory BP in healthy adults were included. Inverse weighted random effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 15 randomized controlled trials, involving 17 study groups and 633 participants (394 exercise participants and 239 control participants). Overall, endurance training induced a significant reduction in daytime SBP [-3.2 mmHg, 95% confidence interval (CI), -5.0 to-1.3] and daytime DBP (-2.7 mmHg, 95% CI, -3.9 to -1.5). No effect was observed on night-time BP. The findings from this meta-analysis suggest that aerobic endurance exercise significantly decreases daytime, but not night-time, ambulatory BP.

Administration-Time Differences in Effects of Hypertension Medications on Ambulatory Blood Pressure Regulation

Specific features of the 24-h blood pressure (BP) pattern are linked to progressive injury of target tissues and risk of cardiovascular disease (CVD) events. Several studies have consistently shown an association between blunted asleep BP decline and risk of fatal and nonfatal CVD events. Thus, there is growing focus on ways to properly control BP during nighttime sleep as well as during daytime activity. One strategy, termed chronotherapy, entails the timing of hypertension medications to endogenous circadian rhythm determinants of the 24-h BP pattern. Significant and clinically meaningful treatment-time differences in the beneficial and/or adverse effects of at least six different classes of hypertension medications, and their combinations, are now known. Generally, calcium channel blockers (CCBs) are more effective with bedtime than morning dosing, and for dihydropyridine derivatives bedtime dosing significantly reduces risk of peripheral edema. The renin-angiotensin-aldosterone system is highly circadian rhythmic and activates during nighttime sleep. Accordingly, evening/bedtime ingestion of the angiotensin-converting enzyme inhibitors (ACEIs) benazepril, captopril, enalapril, lisinopril, perindopril, quinapril, ramipril, spirapril, trandolapril, and zofenopril exerts more marked effect on the asleep than awake systolic (SBP) and diastolic (DBP) BP means. Likewise, the bedtime, in comparison with morning, ingestion schedule of the angiotensin-II receptor blockers (ARBs irbesartan, olmesartan, telmisartan, and valsartan exerts greater therapeutic effect on asleep BP, plus significant increase in the sleep-time relative BP decline, with the additional benefit, independent of drug terminal half-life, of converting the 24-h BP profile into a more normal dipping pattern. This is the case also for the bedtime versus upon-awakening regimen of combination ARB-CCB, ACEI-CCB, and ARB-diuretic medications. The chronotherapy of conventional hypertension medications constitutes a new and cost-effective strategy for enhancing the control of daytime and nighttime SBP and DBP levels, normalizing the dipping status of their 24-h patterning, and potentially reducing the risk of CVD events and end-organ injury, for example, of the blood vessels and tissues of the heart, brain, kidney, and retina. (Author correspondence: rhermida@uvigo.es)

High ambulatory blood pressure values associated with non-alcoholic fatty liver in middle-aged adults

Nonalcoholic fatty liver and hypertension are associated with metabolic syndrome. Both conditions increase the risk for cardiovascular morbidity. The objective of this study was to analyze whether 24-h blood pressure (BP) levels and nondipping phenomenon associate with hepatic steatosis defined as liver brightness. Twenty-four hour ambulatory BP measurement (ABPM) and liver brightness were investigated in a population-based cohort of 890 hypertensive (n = 433) and normotensive (n = 457) individuals aged 40-60 years. ABPM was recorded using the fully automatic SpaceLabs90207 oscillometric unit. Fatty liver was associated with male sex, increased alcohol consumption, high BMI, large waist (P < 0.001 for all) and increased prevalence of smoking (P < 0.03). Values of alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), triglycerides and high-sensitivity CRP (hsCRP) were higher and high-density lipoprotein cholesterol lower (P < 0.001 for all) in individuals with fatty liver. After adjustments for BMI, sex and age, fatty liver was associated with 24-h (P < 0.005), daytime (P < 0.02) and night-time (P < 0.005) SBP measurements and DBP at daytime (P < 0.03). The association with nondipping showed only a trend (P = 0.057). Significantly higher ambulatory daytime and night-time SBP levels were seen in individuals with fatty liver. Nondipping does not seem to associate with liver fat. The coexistence of liver fat accumulation and high BP are likely to potentiate the risk for cardiovascular disease.

Abstract 140: The Effects of Modest Dietary Salt Reduction on Vascular Function and Blood Pressure in Overweight and Obese Adults

Short term sodium restriction improves endothelial function as measured by flow-mediated dilatation (FMD), however the longer term effects of a modest reduction in dietary salt intake on vascular endothelial function in overweight and obese persons is unknown. Our objective was to determine the effects of a reduction in dietary sodium to 100mmol Na/day compared with 160mmol Na/day on measures of vascular function, and plasma and urinary nitrate/nitrite concentrations and 24hr ambulatory blood pressure in overweight and obese subjects. In a 6 week randomised cross-over trial of 100 Na mmol/day compared to 160mmol Na/day (achieved by giving sodium tablets) overweight and obese subjects had measurements of flow-mediated dilatation (FMD), 24hr BP, augmentation index (AIx), pulse wave velocity (PWV) and plasma and urinary nitrate/nitrite concentrations at the end of each intervention. Twenty five overweight and obese subjects aged 57±7 years (BMI 31.58±3.93kg/m 2 ; SBP 128±11mmHg; DBP 76±5mmHg) completed the intervention. Urinary sodium decreased from 155±58mmol/24hr to 113±45mmol/24hr (p=0.002). Weight and 24hr urinary potassium excretion were not different between interventions (p&gt;0.05) as planned. Following sodium reduction there was a significant improvement in FMD from 3.54±2.83% to 5.63±2.79% (p&lt;0.001). Daytime DBP decreased from 77±6mmHg to 75±7mmHg (p=0.087) with sodium reduction. Endothelium-independent vasodilatation, AIx, PWV and plasma and urinary nitrate/nitrite concentration were not significantly different between treatments (p&gt;0.05). Change in FMD was significantly related to the urinary sodium to creatinine ratio (R = -0.470 P=0.018). Modest sodium reduction has beneficial effects on vascular function in overweight and obese subjects but does not alter nitrate/nitrite concentration in the urine or plasma. Further work is needed to explore the mechanisms by which salt affects vascular function in overweight and obese adults.

Summer does not always mean lower

Evaluation of seasonal influences on ambulatory blood pressure monitoring (ABPM) values in a very large population living in a mild-climate geographic area. Among patients referred to our Hypertension Center between September 2002 and January 2011 with a reliable ABPM, we considered those in the two hottest (July and August) vs. those in the two coldest (January and February) months. Seven hundred and forty-two men (53.2%) and 653 women (46.8%) were studied; 1245 (89.3%) were hypertensive patients of which 795 (63.9%) were drug-treated. In winter, mean daytime SBP and DBP were higher (P = 0.001 and P < 0.001, respectively), but only 24-h DBP was significantly higher (P = 0.012). On the contrary, higher night-time SBP and pulse pressure were recorded in summer (P = 0.005 and P = 0.023, respectively). Uncontrolled hypertensive patients had the highest mean difference between winter and summer night-time SBP (127.1 ± 13.4 vs. 131.0 ± 12.6 mmHg; P = 0.001). In winter a dipping pattern was prevalent (58.2%), whereas in summer a nondipping pattern prevailed (61.9%; P < 0.001). Isolated nocturnal hypertension (INH) was present in 9.8% in winter vs. 15.2% in summer (P = 0.003). Our data on a very large ABPM sample confirmed that hottest summer months are associated with lower daytime BP and also lower 24-h DBP. However, we found an inverse relationship regarding night-time BP, dipping pattern, and INH that were higher or more common in summer. These findings were even more evident in treated patients, especially when not at target. Different sleeping behaviors or improper dose reduction of drug therapy in summer may explain the findings.

Comparison of the Effects of Energy Drink Versus Caffeine Supplementation on Indices of 24-Hour Ambulatory Blood Pressure

Cardiovascular events associated with energy drink consumption have been reported, but few data exist to delineate the hemodynamic effects of energy drinks. To compare the effects of an energy drink versus caffeine supplementation on blood pressure (BP) indices as measured by 24-hour ambulatory BP monitoring (ABPM). Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy drink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each dose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800, 1100, 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent nocturnal dipping were compared between study periods. Nine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly higher during energy drink supplementation versus caffeine supplementation. Daytime DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded with energy drink supplementation versus caffeine supplementation. Nighttime SBP and DBP loads were significantly higher with the energy drink, but nocturnal dipping did not differ significantly between study periods. Single-day energy drink supplementation increased mean 24-hour and daytime BP compared to caffeine control in this pilot study. Additional research is warranted to better understand the hemodynamic effects of energy drink consumption.

Serum Malondialdehyde and Lipid Profile Levels of Young Patients "Haven’t a Family History of Hypertension": A New Study for Cases in the Civic Society

This study was designed to evaluate the effect of the oxidative stress in sera of young patients without a family history of hypertension, then find the relation of it to lipid profile. The study involved 56 young healthy (30.5 ± 4.7 years) and 23 healthy elderly volunteers (66.3 ± 3.5 years), these individuals were compared with 67 patients (28.6 ± 5.0 years), attending the Gastro Intestinal and Liver Centre at Al Sader Medical City and several specialized clinics in Najaf government. Malondialdehyde level was measured by TBARS assay as reflection to the oxidative stress effect. Using standard enzymatic assays, TG, TC, HDL-C, VLDL- -C, and LDL-C values were measured for patients and controls on the same day of sample obtainment. Levels of serum MDA, TG, VLDL-C, and LDL-C were significantly raised (p<0.005) in hypertensive patients group when compared with young and elderly controls, while non significant variations were obtained when the control groups were compared together. Daytime SBP and DBP were both strong positive correlated (r=0.82, p<0.005 for SBP, and r=0.95, p<0.005 for DBP) with the MDA in hypertensive patients, but in elderly controls only the correlation between SBP and MDA levels was statistically significant (r=0.61, p<0.005). Sera TG, VLDL-C, and LDL-C levels showed the same of MDA results when they were correlated to SBP and DBP, while correlations between blood pressure with sera TC were moderate positively in the study groups. In spite of; HDL-C levels in hypertensive patients were within the levels of those of two control groups, HDL-C levels showed negatively correlation with both SBP and DBP. Notably, there was a positive correlation (r=0.60, p<0.005) between serum LDL-C levels and SBP of elderly controls, no such correlations were observed when the relation was between Daytime SBP and DBP and VLDL-C or LDLC of young controls the highly significant positive correlation (r = 0.94 at p<0.005) of MDA and TG of the hypertensive patients. Significant positive correlations were also observed for MDA with VLDL-C (r = 0.74 at p<0.005), and with LDL-C (r = 0.71 at p<0.005). It is well known that the endogenous female sex hormones have significant effect on lipid levels, according to that, testing the gender effect was occurred. MDA level in the study subgroups revealed a significant increase (p<0.005) in male patients when compared to females, while, student's t-test failed to exhibit significant changes among male and female subgroups in the control groups. Except for the significantly variation (p<0.005) of TG in the patient subgroups, all the other lipid profile parameters showed no significant differences between male and female subgroups. Concerning the controls’ subgroups, TG, TC, HDL-C, VLDL-C, and LDL-C were comparabltween male and female subgroups. Finally, treatment for hypertension is similar for all demographic groups, but socioeconomic factors and lifestyle may be barriers to BP control in some patients, therefore; dealing with transitory hardships and arrangement of food style may be consider as a prim factors in the hypertension treatment.

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE (OM/HCTZ) 40/25MG PROVIDES GREATER AMBULATORY BLOOD PRESSURE-LOWERING VS OM/HCTZ 20/25MG IN MODERATE-TO-SEVERE PATIENTS UNCONTROLLED BY OM: PP.5.207

Objective: To compare the efficacy of OM/HCTZ 40/25 mg versus 20/25 mg in terms of 24-h, daytime and night-time BP lowering, as assessed by ambulatory BP monitoring (ABPM), in patients whose BP was inadequately controlled by OM 40 mg. Design and Methods: This was a 16-week study in patients aged >/=18 years. The study consisted of 2 periods, each 8 weeks long. Eligible patients (N=1404) received 8 weeks' open-label OM 40 mg (Weeks 0–8). At Week 8 (baseline), patients with inadequate BP control (mean trough seated BP [SeBP] 140–180/90–115 mmHg, mean 24-h diastolic BP [DBP] >/=80 mmHg and >/=30% of daytime DBP readings >85 mmHg) were randomised to a further 8 weeks' double-blind treatment with OM/HCTZ 40/25 mg (N=502) or OM/HCTZ 20/25 mg (N=508) (Weeks 8–16). Changes in mean 24-h, daytime and night-time ABPM from Week 8 to Week 16, were measured as secondary parameters using a Spacelabs90207 device. Analyses were performed on the FAS (LOCF) using an ANCOVA model. Results: At baseline, mean patient age was 54.6 years and mean SeBP was 153.4/96.9 mmHg. By Week 16, significantly greater reductions in mean 24-h, daytime and night-time ambulatory DBP and SBP were achieved with OM/HCTZ 40/25 mg compared with OM/HCTZ 20/25 mg (Treatment differences for DBP reductions were: –1.6, –1.6 and –1.5 mmHg, respectively, in favour of OM/HCTZ 40/25 mg; p = 0.0016, 0.0031 and 0.0073, respectively. Treatment differences for SBP reductions were: –2.3, –2.3 and –2.0 mmHg, respectively, in favour of OM/HCTZ 40/25 mg; p = 0.0021, 0.0031 and 0.0104, respectively; Figure). Both doses of OM/HCTZ were well tolerated. Conclusions: ABPM provides reliable information on 24-h BP and is an accurate predictor of cardiovascular risk. In patients with moderate-to-severe hypertension, OM/HCTZ 40/25 mg produced further incremental significantly greater reductions in 24-h, daytime and night-time ambulatory BP compared with OM/HCTZ 20/25 mg, which may be of clinical relevance. A significant reduction in night-time BP is important to avoid stroke in the early morning hours.

CHRONOPHARMACOLOGY OF ASPIRIN ON BLOOD PRESSURE IN TREATED HYPERTENSIVE PATIENTS: PP.16.104

Low-dose aspirin (ASP) has been shown to reduce 24-h ambulatory BP when administered at bedtime, as opposed to upon awakening, in untreated hypertensive patients. We have tested this hypothesis in high cardiovascular risk treated hypertensive patients already taking ASP for cardiovascular prevention. In this multicenter crossover study, 75 subjects were randomly allocated to take successively one month ASP in the morning and then one month ASP at bedtime or conversely. The sample size was computed to evidence a difference of 4 mmHg (SD=12 mmHg) for mean 24-h SBP with an alpha risk of 5% and a power of 80%. Main characteristics of the patients were: age: 65 ± 9 years, duration of hypertension: 12 ± 10 years, mean ASP dose: 106 ± 50 mg/day, men: 70% and diabetics: 33%. Patients were instructed not to change their antihypertensive drug regimen (mean drug intake 2.8/day). Ambulatory BP was measured using a Spacelabs 90207 device. Administration-time dependent of ASP had no effect on 24-h SBP. When taken in the morning, mean 24-h SBP was 128 ± 13 mmHg vs. 128 ± 12 mmHg when taken at bedtime. 24-h DBP, daytime and nighttime SBP and DBP were also not different between ASP administration-time. Our results do not favor to routinely recommend low-dose bedtime ASP for its antihypertensive efficacy in high risk treated hypertensive patients.

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE (OM/HCTZ) 40/25MG PROVIDES GREATER AMBULATORY BLOOD PRESSURE-LOWERING VS OM/HCTZ 20/25MG IN ELDERLY AND SEVERE PATIENTS UNCONTROLLED BY OM: PP.5.203

Objective: To compare the efficacy of OM/HCTZ 40/25 mg versus 20/25 mg, as assessed by ambulatory blood pressure monitoring (ABPM), in elderly and hypertension severity subgroups in patients whose BP was inadequately controlled by OM 40 mg. Design and Methods: This was a subgroup analysis of a 16-week study in patients aged >/=18 years. The study consisted of 2 periods, each 8 weeks long. Eligible patients received 8 weeks' open-label OM 40 mg (Weeks 0–8). At Week 8 (baseline), patients with inadequate BP control (mean trough seated BP 140–180/90–115mmHg, mean 24-h diastolic BP [DBP] >/=80mmHg and >/=30% of daytime DBP readings >85mmHg) were randomised to a further 8 weeks' double-blind treatment with OM/HCTZ 40/25 or 20/25 mg (Weeks 8–16). Changes in ABPM from Week 8 to Week 16 were evaluated in patients aged >/=65 years (N=184) and in patients with moderate (160–179/100–109mmHg; N=679) or severe (>/=180/110mmHg; N=263) hypertension using a Spacelabs90207 device. Analyses were performed on the FAS OC. Results: In elderly patients OM/HCTZ 40/25 mg provided greater reductions in mean 24-h, daytime and night-time systolic BP (SBP) compared with 20/25 mg (15.4, 15.8 and 14.1mmHg vs 13.7, 14.0 and 13.5mmHg, respectively; Figure), while ambulatory DBP reductions were similar for both treatments. In patients with moderate hypertension, OM/HCTZ 40/25 mg provided greater mean 24-h (Figure), daytime and night-time ABP reductions than OM/HCTZ 20/25 mg (14.6/9.4 vs 11.4/7.4, 15.0/9.6 vs 11.7/7.4, and 13.4/8.5 vs 10.1/6.8mmHg, respectively). In patients with severe hypertension, ABP reductions were more pronounced with OM/HCTZ 40/25 mg than 20/25 mg for 24-h (Figure), daytime and night-time SBP (14.5 vs 13.8, 14.7 vs 14.2 and 13.4 vs 12.4mmHg, respectively), and for 24-h and night-time DBP (8.8 vs 8.4 and 8.8 vs 7.6mmHg, respectively). Conclusions: Elderly patients and individuals with more severe hypertension are harder to treat. OM/HCTZ 40/25 mg provides further incremental reductions in ABP compared with OM/HCTZ 20/25 mg in these subgroups, which may be of clinical relevance.

ARE THERE DIFFERENCES BETWEEN ZOFENOPRIL AND NEBIVOLOL EFFECT ON BLOOD PRESSURE, SERUM LEPTIN, ADIPONECTIN AND ENDOTHELIN-1 IN OBESE HYPERTENSIVE PATIENTS?: PP.33.330

Purpose: To compare the effect of zofenopril (Z) and nebivolol (N) on blood pressure (BP), serum leptin, adiponectin and endothelin-1 in obese hypertensive patients. Methods: 61 pts (f – 27, m – 34, mean age 51,6 ± 9,7 years) with essential hypertension (EH) and obesity (body mass index 34,3 ± 4,8 kg/m2) were enrolled in randomized, open-labeled study. We performed the oral glucose tolerance test, the office measurement and 24-hours ambulatory blood pressure monitoring (ABPM), test of serum leptin, adiponectin, endothelin-1 before and after 12 weeks therapy by Z (30 mg/day, 31 pts) and N (5 mg/day, 29 pts). Results: In obese hypertensives mean office BP was 150,2 ± 14,6/92,1 ± 10,8 ììHg before treatment. According ABPM there was abnormal circadian profile of BP in 63,9% of pts. The impaired glucose tolerance was revealed in 47,5% of pts. The endothelin-1 hyperactivity was defined in obese hypertensives in comparison with control group (normal weight hypertensives, n = 20) - 0,38 (0,25; 0,89) and 0,30 (0,25; 0,59) fmol/ml accordingly (p < 0,05). Office BP was decreased on 16,3/5,8 mmHg (p < 0,05) and 16,4/11,4 ììHg (p < 0,05) after 12 weeks of Z (37,5 mg/d) and N (7,5 mg/d) treatment. ABPM parameters have significantly improved: mean daytime SBP on 8,0 and 5,0 ììHg, mean daytime DBP on 4,3 and 6,2 ììHg, mean nighttime SBP on 12,3 and 6,0 ììHg, mean nighttime DBP on 7,2 and 5,0 ììHg, mean daily SBP on 9,0 and 5,1 ììHg, mean daily DBP on 4,5 and 5,4 ììHg (p<0,05 in al cases) with improvement of circadian BP profile. The serum leptin was decreased from 18,7 to 17,5 ng/ml (p < 0,05) in Z group, the serum adiponectin was increased from 10,4 to 13,6 mcg/ml (p < 0,05). The serum endothelin-1 was decreased significantly in N on 0,10 fmol/ml (p<0,05) and non significantly in Z group. Conclusions: In obese hypertensives both the angiotensin-converting enzyme inhibitor zofenopril and β1-adrenoblocker nebivolol demonstrates similar antihypertensive activity but different beneficial effects on adipokynes profile.

ADDING HYDROCHLOROTHIAZIDE PROVIDES DOSE-DEPENDENT SEATED BLOOD PRESSURE REDUCTIONS IN PATIENTS WITH MODERATE-TO-SEVERE HYPERTENSION NOT CONTROLLED BY OLMESARTAN MEDOXOMIL 40MG: PP.5.205

Objective: To evaluate the efficacy of olmesartan/hydrochlorothiazide (OM/HCTZ) 40/12.5 and 40/25 mg in comparison to OM 40 mg monotherapy in reducing seated blood pressure (SeBP) in patients with moderate-to-severe hypertension not adequately controlled by OM 40 mg. Design and Methods: This was a prespecified pooled analysis of data from two similar clinical studies. Both studies consisted of an 8-week, open-label period during which patients received OM 40 mg alone (Weeks 0–8). Uncontrolled patients (seated diastolic BP [SeDBP] 90–115mmHg, seated systolic BP [SeSBP] 140–180mmHg, and 24-h mean ambulatory DBP >/=80mmHg with >/=30% of daytime DBP readings >85mmHg) were randomised to 8 weeks' double-blind treatment with OM 40 mg or OM/HCTZ 40/12.5, 40/25 or 20/12.5 mg (study 1) or OM/HCTZ 40/25 or 20/25 mg (study 2) (Weeks 8–16). Changes in mean SeDBP (primary efficacy parameter) and SeSBP from Week 8 to Week 16 were measured. This analysis concentrates on the OM/HCTZ 40/12.5 mg (N=277) and 40/25 mg (N=642) and OM 40 mg (N=274) comparisons only. Statistical analyses were performed using ANCOVA. Results: At baseline, mean SeBP was 155.6/97.3, 154.0/97.5 and 153.8/97.2mmHg for the OM 40, OM/HCTZ 40/12.5 and OM/HCTZ 40/25 mg groups, respectively. After 8 weeks of randomised treatment, all combination doses tested achieved significantly greater reductions in SeDBP and SeSBP compared with OM 40 mg (Treatment differences for SeDBP reductions: –3.4mmHg for OM/HCTZ 40/12.5 mg vs OM 40 mg; –5.5mmHg for OM/HCTZ 40/25 mg vs OM 40 mg. Treatment differences for SeSBP reductions: –5.3mmHg for OM/HCTZ 40/12.5 mg vs OM 40 mg; –9.0mmHg for OM/HCTZ 40/25 mg vs OM 40 mg. p < 0.0001 for all comparisons. Figure). The largest BP reductions were achieved with OM/HCTZ 40/25 mg. These findings were confirmed by the response rates achieved with OM 40 mg and OM/HCTZ 40/12.5 and 40/25 mg (24.8, 39.7 and 40.2%, respectively). Conclusions: In patients with moderate-to-severe hypertension not controlled by OM 40 mg, adding HCTZ produces significant and clinically relevant SeBP reductions and improved response rates compared with continuation with OM 40 mg monotherapy. The benefits observed with OM/HCTZ are dose-dependent.

Obesity and daytime pulse pressure are predictors of left ventricular hypertrophy in true normotensive individuals

To investigate predictors of left ventricular mass corrected for height2.7 (LVMI) and left ventricular hypertrophy in patients who were found to be normotensive with both office and 24-h ambulatory blood pressure (BP) measurements. A total of 805 consecutive patients were analyzed. All patients underwent office BP measurements, 24-h ambulatory BP monitoring, laboratory measurements for cardiovascular risk factors and echocardiography. Individuals with both office and ambulatory normotension were characterized as true normotensive. LVMI was found to be 34.5 +/- 10.9 g/m2.7 in normal-weight patients and 48.7 +/- 13.0 g/m2.7 in obese patients (P < 0.0001). LVMI was found to be 41.7 +/- 10 g/m2.7 in overweight patients, significantly lower than the values of obese patients (P < 0.005) and higher than the values of normal-weight patients (P < 0.001). These results remained significant even after adjustment for age, sex, daytime and nighttime SBP, daytime and nighttime DBP, daytime and nighttime BP variability and daytime and nighttime pulse pressure (PP). In a multivariate analysis model, in which LVMI was the dependent variable and office SBP, office DBP, daytime and nighttime SBP and DBP, daytime and nighttime PPs and variabilities, day-night SBP ratio, fasting serum glucose, triglycerides, total cholesterol, age and BMI were inserted as independent variables with weighted least squares regression by sex, the predictors of LVMI were age, BMI and daytime PP (r2 = 0.31). Left ventricular hypertrophy was 17.67 times more likely in obese patients as compared with normal-weight true normotensive individuals. Obesity may represent a significant cardiovascular risk factor even in normotensive individuals. Other predictors of LVMI were ageing and daytime PP.

Effect of Revised UPPP Surgery on Ambulatory BP in Sleep Apnea Patients with Hypertension and Oropharyngeal Obstruction

This study aimed to investigate the value of the surgery of revised uvulopalatopharyngoplasty (UPPP) on ambulatory blood pressure (BP) in obstructive sleep apnea/hypopnea syndrome (OSAHS) patients with hypertension and oropharyngeal obstruction. A retrospective cohort study was performed in 29 patients with OSAHS and hypertension, who received treatment with revised UPPP surgery. After surgery 1 month, the Apnea-hypopna index (AHI) and body mass index (BMI) significantly decreased (P < 0.05), and mini SpO2 and mean SpO2 increased than before (P < 0. 05), but the heart rate showed no significant difference (P > 0.05). In the meantime, compared to pretreatment, nighttime systolic SBP, nighttime diastolic DBP, morning systolic SBP, morning diastolic DBP, 24-h DBP, and 24-h SBP, decreased significantly (P < 0.05), but daytime SBP and daytime DBP showed no significant difference (P > 0.05). The results of this study indicated that the BP in the sleep apnea patients with hypertension might gradually decrease by revised UPPP surgery.

A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood

This study evaluates the tracking stability of office blood pressure (BP), ambulatory BP (ABP), BP variability (BPV) and nocturnal BP drops (dipping) from childhood to early adulthood, and their dependence on ethnicity, gender and family history (FH) of essential hypertension (EH). Generalized estimating equations (GEEs) were used to estimate tracking coefficients for 295 European Americans and 252 African Americans, with a maximum of 12 measurements over a 15-year period. Office BP and ABP had moderate-to-relatively high tracking coefficients (r= 0.30-0.59; P<or=0.001). Twenty-four hour readings tracked better than office readings for diastolic BP (DBP; 0.57 vs. 0.46, P=1.72 x 10(-6)) and pulse pressure (PP) (0.59 vs. 0.51, P=2.70 x 10(-4)), and equally well for systolic BP (SBP; 0.55 vs. 0.54, P=0.805). Daytime readings tracked better than their night-time counterparts for SBP (0.50 vs. 0.37, P=7.62 x 10(-13)), DBP (0.49 vs. 0.30, P=7.98 x 10(-32)) and PP (0.55 vs. 0.50, P=0.0061). All BPV (r=0.08-0.28; P<or=0.001) and dipping measures (r=0.07-0.12; odds ratio, 1.60-1.73; P<or=0.001) had low tracking coefficients. Males had significantly higher tracking stability for office SBP, DBP and ambulatory PP than females (P<0.01). Subjects with a positive FH of EH had significantly higher tracking stability for daytime and night-time DBP and dipping indexed by continuous variables than those with a negative FH (P<0.001). No significant ethnic differences were observed. The high tracking stability of 24-h ABP highlights the importance of using ambulatory BP monitoring in both research and clinical settings.

Erratum

Cardiovascular TherapeuticsVolume 26, Issue 3 p. 233-233 Free Access Erratum This article corrects the following: Clinical Effects of Torasemide Prolonged Release in Mild-to-Moderate Hypertension: A Randomized Noninferiority Trial Versus Torasemide Immediate Release Alex Roca-Cusachs, Joaquín Aracil-Vilar, Carlos Calvo-Gómez, José-Vicente Vaquer-Pérez, Félix Laporta-Crespo, María-José Rojas-Serrano, Antonio Guglietta, Savion Gropper, , Volume 26Issue 2Cardiovascular Therapeutics pages: 91-100 First Published online: June 28, 2008 First published: 13 August 2008 https://doi.org/10.1111/j.1755-5922.2008.00056.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In [1], there were several errors found in the text and are listed below. On page 95, right column, second paragraph, line 6, the text should read (Fig. 2) instead of (Fig. 3). The correct sentence is printed below: Changes in SBP after 12 weeks of treatment were also similar in both study arms, with a mean reduction of 17.3 ± 11.2 mmHg (95% CI 15.7–18.2) in the torasemide-PR group compared to 17.2 ± 10.8 mmHg (95% CI 15.7–18.6) in the torasemide-IR group (ANCOVA, P= 0.713) (Fig. 2). On page 95, right column, third paragraph, line 7, the text should read p= 0.013 instead of p= 0.031. The correct sentence is printed below: The percentage of patients with adequate control of BP, defined as SBP <140 mmHg and/or DBP <90 mmHg, was significantly higher among those who received torasemide-PR compared to torasemide-IR, both after 8 weeks (69.4% vs. 58.4%, Fisher exact test, P= 0.025) and 12 weeks (63.9% vs. 51.3%, Fisher exact test, P= 0.013) of treatment (Fig. 5). On page 96, the legends for figures 2 and 3 have been transposed. The correct legends have been printed below. Figure 2 Mean changes in DBP and SBP from baseline to 12 weeks of treatment with torasemide-PR and torasemide-IR (PP-LOCF population). Figure 3 Sensitivity analysis of differences in DBP reduction between torasemide-PR and torasemide-IR after 12 weeks of treatment in the PP-LOCF, PP, FAS, and FAS-LOCF populations. On page 97, left column, second paragraph, line 1, the text should read 83.5% instead of Eighty-five percent. The correct sentence is printed below: 83.5% of patients treated with torasemide-PR and 88% of those treated with torasemide-IR completed the 12-week study period. On page 98, in Table 2, Daytime MBP should be 105.84 (8.08) in the Torasemide-PR column and 107.54 (8.24) in the Torasemide-IR column. Night time MBP should be 90.98 (9.44) in the Torasemide-PR column and 91.97 (8.45) in the Torasemide-IR column. The corrected table is printed below: Table 2. ABPM: Mean SBP, DBP and MBP values at baseline in the Torasemide-PR and Torasemide-IR study groups. ABPM (mmHg) Torasemide-PR Mean (SD) Torasemide-IR Mean (SD) Daytime SBP 139.45 (12.71) 141.79 (9.88) Night time SBP 123.14 (14.83) 125.60 (11.28) Daytime DBP 87.69 (6.98) 89.67 (9.12) Night time DBP 73.08 (7.68) 74.26 (8.40) Daytime MBP 105.84 (8.08) 107.54 (8.24) Night time MBP 90.84 (9.44) 91.97 (8.45) Reference 1 Roca-Cusachs A, Aracil-Villar J, Calvo-Gómez C, Vaquer-Pérez JV, Laporta Crespo F, Rojas-Serrano MJ, Guglietta A, Gropper S & the Torasemide-PR in Hypertension Clinical Trial Investigators Group. Clinical effects of torasemide prolonged release in mild-to-moderate hypertension: a randomized noninferiority trial versus torasemide immediate release. Cardiovasc Ther 2008; 26: 91– 100. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume26, Issue3Fall 2008Pages 233-233 ReferencesRelatedInformation

Laboratory-based blood pressure recovery is a predictor of ambulatory blood pressure

The recovery phase of the stress response is an individual difference characteristic that may predict cardiovascular risk. The purpose of this study was to examine whether laboratory-based blood pressure (BP) recovery predicts ambulatory BP (ABP). One hundred and eighty-two participants underwent a standard laboratory stress protocol, involving a 20-min baseline rest period, and four stressors presented in a counterbalanced order, each followed by a 10-min recovery period. Participants also wore an ABP monitor for 24 h during a typical workday. Hierarchical regression analyses showed that BP recovery accounted for significant additional variance for daytime SBP ( p < 0.001), nighttime SBP ( p < 0.001), daytime DBP ( p < 0.001), and nighttime DBP ( p < 0.001), after controlling for baseline and reactivity BP. Results suggest that persistence of the BP response following stress may be a more salient characteristic of the stress response in understanding its potential impact on longer term cardiovascular regulation.

Non‐dipping Blood Pressure in the Metabolic Syndrome Among Arabs of the Oman Family Study

The objective was to examine the circadian changes in blood pressure and their relation to the metabolic syndrome and its components in Omani Arabs. Ambulatory blood pressure (ABPM) was recorded in 1124 subjects from 5 large, extended, consanguineous, and young Arab pedigrees. According to the International Diabetes Federation's definition, 264 subjects had the metabolic syndrome, a prevalence of 23%. Subjects were defined as non-dippers when their nocturnal systolic blood pressure (SBP) fell by <10% from daytime SBP. Non-dippers with the metabolic syndrome were 131 of 264 (50%), compared with 265 of 860 (31%) without the metabolic syndrome. Of the non-dippers, 99 of 131 (76%) were females and 32 of 131 (24%) were males. Daytime and nighttime SBP and DBP and nighttime pulse pressure were significantly higher in non-dipper subjects with the metabolic syndrome. The important determinants of a non-dipping BP in this cohort were high BMI and high serum triglycerides. We hypothesize that obesity and nocturnal volume-dependent hypertension may be involved in the pathophysiology of non-dipping in the metabolic syndrome. This study showed that non-dipping BP was common in subjects with the metabolic syndrome. Higher 24-hour blood pressure load may add to the indices of the overall cardiovascular burden already associated with the metabolic syndrome.

P394 Sleep onset insomnia in sleep apnea patients: Influence on acceptance of nCPAP treatment

increases in sympathetic activity. However, previous studies on antihypertensive effects of CPAP therapy have yielded inconsistent results. We postulated that good CPAP compliance is needed for BP reduction. Objective: To examine the effect of CPAP on BP in OSAHS patients and compare the outcomes based on CPAP compliance. Methods: A retrospective review of patients diagnosed to have OSAHS during the period September 2003 to June 2005 was performed. These patients were divided into two groups based on CPAP compliance. Consistent users (CG) reported daily CPAP usage while intermittent users (IG) skipped CPAP use one or more nights each week. Daytime systolic (SBP), diastolic (DBP) and mean arterial BP (MAP) were measured before and after 11 months’ CPAP use. Hypertensive patients were excluded if their anti-hypertensive regimens were changed. Paired T test was used to test for differences. Data are presented as mean values ± SD. Results: Forty patients were consistent CPAP users while 34 used CPAP intermittently (3.7 ± 1.9 days per week). Among CG patients, SBP decreased significantly from 138 ± 17.9 mm Hg to 127 ± 15.6 mm Hg (p < 0.01), DBP reduced from 83.2 ± 11.4 mm Hg to 76.5 ± 9.9 mm Hg (p < 0.01) and MAP reduced from 101 ± 12.6 mm Hg to 93.6 ± 10.7 mm Hg (p < 0.01). Among IG patients, SBP remained unchanged (133 ± 15.1 mmHg at baseline and 130 ± 15 mm Hg after CPAP, p = 0.35), DBP decreased significantly from 85.1 ± 9.4 mmHg to 81.1 ± 8.1 mm Hg (p = 0.01) and MAP decreased from 101 ± 9.8 mm Hg to 97.6± 9.8 mm Hg (p = 0.03). SBP reduction was significantly greater among CG patients compared to IG patients (p = 0.02). Conclusion: This retrospective review showed that daytime DBP and MAP of OSAHS patients were reduced after 11 months’ CPAP usage in both groups of patients while SBP was reduced among consistent CPAP users. Regularity of CPAP usage was the sole criterion for good compliance in this study as hours of CPAPusagemight be overestimated in subjective reporting. Prospective studies using objective monitoring of hours of CPAP used at effective pressure are needed to further evaluate the importance of CPAP compliance on BP reduction.

Hypertension and Left Ventricular Hypertrophy in Pediatric Peritoneal Dialysis Patients: Ambulatory Blood Pressure Monitoring and Echocardiographic Evaluation

Background: Hypertension is a frequent complication of end-stage renal disease and left ventricular hypertrophy (LVH) is common in patients with poorly controlled hypertension. The aim of this study was to evaluate hypertension in pediatric peritoneal dialysis (PD) patients, to compare casual and ambulatory blood pressure (BP) measurements and to evaluate the impact of BP parameters on LVH. Methods: The study comprised 25 PD patients (9 M, 16 F; mean age 14.14 ± 3.32 years) that have been followed in outpatient clinics. Medical records were reviewed for demographic features; casual BP measurements, ambulatory blood pressure monitoring (ABPM) and echocardiographic evaluation were applied to all patients. Results: The mean 24-hour and daytime systolic blood pressure (SBP) values were found to be higher than casual SBP (p < 0.001). Significant difference was present in the frequency of hypertension between casual SBP (32%) and the mean daytime SBP (56%) (p < 0.05). Nighttime systolic hypertension was detected in 14 (56%) and diastolic hypertension in 16 (64%) patients. Elevated daytime SBP load and DBP load were detected in 64 and 76% of the patients, respectively. Elevated nighttime SBP load and DBP load were detected in 72% of the patients. Seventeen (68%) patients had attenuated dipping for SBP. The mean left ventricular mass index (LVMI) was 52.65 ± 18.17 g/m^2.7 and 13 (52%) patients had LVH. LVMI was significantly correlated with casual BP measurements and the majority of ABPM parameters. Conclusion: The majority of pediatric PD patients had BP abnormalities in which severity was most accurately assessed with ABPM. Casual BP and majority of ABPM parameters were found to be significantly correlated with LVMI. Ambulatory blood pressure monitoring should be performed in all pediatric PD patients.