Evening Systolic Blood Pressure Research Articles

FEASIBILITY OF WATCH-TYPE CUFF-LESS BLOOD PRESSURE MEASUREMENT DEVICE IN DAILY BLOOD PRESSURE MONITORING

Objective: Cuff-less blood pressure (BP) measurement devices integrated into smartwatches have gained prominence for daily monitoring, yet limited studies provide the analysis of real-world BP data collected by such devices. In this study, we evaluated the feasibility of photoplethysmographic BP measuring smartwatch by analyzing data collected in real-world. Design and method: The campaign, “Smartwatch Blood Pressure Monitoring Challenge with Korean Hypertension Society”, was held in June 1-14, 2023 and 896 participants reported 35592 BP values measured by smartwatch (Samsung Galaxy Watch 6, approved in Korean Ministry of Food and Drug Safety). Participants were instructed to measure BP daily, in the morning (5AM-8AM) and evening (6PM-9PM) for two weeks, with initial calibration and re-calibration after the first week. We evaluated 1) BP difference between before and after re-calibration, and 2) difference in morning and evening BP. We also evaluated the determining factors of the BP differences. Results: Morning and evening BP values showed significant difference, higher in the evening by 1.42±5.25 mmHg (p<0.05). However, the diurnal variation was much smaller than reported in other studies using conventional BP monitoring devices. ANOVA identified significant variables for evening-morning differences, including basal metabolic rate, skeletal muscle mass, total body water, average systolic BP (SBP), diastolic BP (DBP), and heart rate in the morning (p < 0.01 in both ITT and PP). Participants who have evening-morning difference higher than the third quartile, where evening SBP was significantly higher than morning SBP, exhibited smaller variable sizes. Turkey’s Honest Significant Difference showed that this relationship is statistically significant between Q1-Q4 and Q2-Q4 in all variables. The calibration stability was assessed by the difference in average BP before and after calibration, resulting in an SBP difference of 4.64±4.73 mmHg and DBP of 3.66±3.62 mmHg, smaller than a 2021 campaign (6.8±5.6mmHg). When the difference of average was measured between same period of time (morning versus morning and evening versus evening), SBP of 5.39±5.22 mmHg and DBP of 4.3±3.99 mmHg. Conclusions: In conclusion, watch-based devices may not detect clinical-level BP variability, but refining calibration protocols offers improvement potential.

BLOOD PRESSURE VALUES ACCORDING TO HOME AND CLINIC MEASUREMENTS AND INTRACRANIAL WAVEFORM ASSESSMENT IN HYPERTENSIVE PATIENTS

Objective: Evaluate the Association between Non-Invasive Intracranial Pressure (ICP) Values and Blood Pressure (BP) Values According to Home and Clinic Measurements Design and method: Cross-Sectional Study evaluating the association of variables, including Age, Gender, Office Systolic Blood Pressure (OSBP), Office Diastolic Blood Pressure (ODBP), Home Blood Pressure Measurements (HBPM), Time since Hypertension Diagnosis, P2P1, TTP, Intracranial Hypertension (IC) (P2P1 >1.2), Office Hypertension (Office BP 140/90mmHg), and HBPM Hypertension (HBPM 130/80mmHg). Data collected from participants and medical records. Data analysis conducted using chi-square test, Mann-Whitney U test, and bivariate correlation analyses. Blood pressure values adjusted for hypertension diagnosis time; P2P1 and TTP values adjusted for age. Confidence interval of 95% and p<0.05. Results: 240 patients were evaluated, with average age of 63.4 years (±11.8), 73.3% were female. The average time of diagnosis of arterial hypertension was 19.1 years (±11.9). Uncontrolled blood pressure - 54.2% (n=130) via HBPM and 42.1% (n=101) in the clinic. The proportion of IC was 67.9%, higher in women (71.6%). There was negative correlation between P2P1 and age (r=-0.261; p=0.037). Correlations between P2P1 and systolic blood pressure (HBPM) (-0.152, p=0.019) as well as with morning systolic blood pressure (HBPM) (-0.175, p=0.006). Correlation between P2P1 and morning systolic blood pressure (HBPM) (rho= -0.192, p=0.011), and evening systolic blood pressure (HBPM) (rho= 0.157, p=0.037) was found only among women. Correlation between TTP and systolic blood pressure (HBPM) (rho= -0.194, p=0.003), The correlation between TTP and clinic diastolic blood pressure (rho= 0.313, p=0.012) was found only among men. Correlation between TTP and systolic blood pressure (HBPM) (rho= -0.201, p=0.007), morning systolic blood pressure (HBPM) (rho= -0.237, p=0.002), clinic diastolic blood pressure (rho= 0.157, p=0.038), and nighttime systolic blood pressure (HBPM) (rho= -0.202, p=0.007) was found only among women. Conclusions: The blood pressure control rates were similar when evaluated by different methods. There was no association between blood pressure control rates and IC. P2P1 and TTP values correlated with home blood pressure values, but only with clinic diastolic blood pressure values. The associations of P2P1/TTP values and home blood pressure measurements exhibited different patterns between men and women.

Efficacy of Angiotensin-Converting Enzyme Inhibitors in Coronary Microvascular Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Coronary microvascular dysfunction (CMD) is becoming increasingly recognized as an important contributor to the development of ischemic heart diseases. Without obstructive coronary artery disease, the physiological function of the coronary microcirculation can be altered by structural, functional, and molecular factors, leading to myocardial ischemia. CMD can significantly impact the quality of life and prognosis and imposes a huge financial burden on healthcare systems and people. This meta-analysis aims to investigate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) for treating CMD. A systematic literature review identified randomized controlled trials (RCTs) comparing ACEIs with placebo in CMD patients. Review Manager, 5.3 for Windows, was utilized. Using the Mantel-Haenszel (M-H) method, improvement in coronary flow reserve (CFR) and systolic blood pressure events was pooled as mean difference (MD) in a meta-analysis model with a fixed effect model, whereas the number of chest pain episodes was pooled as MD with a random effect model. Five randomized controlled trials involving 209 patients were included in the analysis. The analysis demonstrated a statistically significant improvement in CFR in the ACEIs group compared to the placebo group (MD -0.3, 95% CI -0.61 to 0.01, P = 0.05). However, there was no significant difference in the number of chest pain episodes between the ACEIs and placebo groups (MD 1.79, 95% CI -3.99 to 7.58, P = 0.54). Similarly, no significant difference in blood pressure change was observed between the two groups (MD 4.02, 95% CI -3.25 to 11.28, P = 0.28). In conclusion, the appropriate treatment for CMD is a source of contention because adequate data is lacking. Our findings suggest that ACEIs may have a positive effect on improving CFR in patients with microvascular angina. However, ACEIs did not demonstrate a significant impact on the number of chest pain episodes or systolic blood pressure in this patient population. Further research, including RCTs with larger sample sizes and longer follow-up durations, is warranted to provide more conclusive evidence on the role of ACEIs in CMD management.

TEKANAN DARAH SISTOLIK LEBIH TINGGI PADA SORE DARIPADA PAGI HARI PADA USIA 45-65 TAHUN

Blood pressure is the pressure of the blood pumped by the heart against the walls of the arteries and is divided into systolic and diastolic. Blood pressure decreases 10% in the evening at normal circadian rhythms and rises again in the morning. Insomnia is one of the factors that can affect blood pressure. This study aims to look at differences in morning and evening blood pressure at the age of 45–65 years. The research method uses observational analytic with a cross sectional approach. Collecting samples using consecutive non-probability sampling. Subjects aged 45–65 were 301 people. Blood pressure was measured in the morning and evening. Insomnia data obtained based on a questionnaire. The statistical test used paired t test with a significance of p <0.05. The results showed a significant difference between morning and evening systolic blood pressure (P = 0,023), but there was no difference between morning and evening diastolic blood pressure (P = 0,224). There is a relationship between insomnia and morning blood pressure (p=0,001). The conclusion from the research results is that systolic blood pressure in the afternoon is higher than in the morning. Morning blood pressure is associated with difficulty sleeping at night.

S-46-5: THE INTRA-WEEK VARIABILITY ON HOME BLOOD PRESSURE WITH OR WITHOUT ANTIHYPERTENSIVE MEDICATION: NOSE STUDY

Objective: Few studies have investigated weekly variations in long-term home blood pressure (BP) measurement. The aim of this study was to examine the intra-week variability and the difference in the day of the week on long-term home BP with or without antihypertensive medication. Design and method: This study was based on an ongoing community-based intervention study in Nose, Osaka, which was designed to assess the effect of home BP measurement on prolonging healthy life expectancy. The study included 510 participants aged 40–91 years. Participants measured their BP with an electronic oscillometric device (HEM-7281; Omron Healthcare CO., Ltd) and wrote the value on the recording book twice in morning and evening for about six months to a year. The intra-week variability in home BP were calculated as maximum minus minimum BP (MMD: maximum-minimum difference). Home BP recording for 62916 days were obtained by extracting weeks in which BP were measured on 7 consecutive days. The participants were divided into 2 groups according to with or without antihypertensive medication. The mean BP values according to the day of the week of home BP measurement were compared by one-way analysis of variance. MMD means were compared with the t-test. To identify the factors influencing on the intra-week variability in home BP, Multiple linear regression models were applied to examine. Results: Among participants without antihypertensive medication, morning systolic BP(SBP) was lowest on Saturday (p < 0.001) as compared with all other days of the week and evening SBP tends to be highest on Sunday. Among participants with antihypertensive medication, morning SBP tends to be lowest on Saturday and evening SBP was highest on Sunday (p < 0.001). The characteristics of the day of the week were similar for the two groups. Antihypertensive medication was not significantly associated with MMD in morning SBP in the multiple linear regression model. MMD in morning SBP had significant positive relationships with female(β = 0.05) and age(β = 0.07), measurement in winter(β = 0.04), morning SBP means(β = 0.25), respectively by p < 0.001. Conclusions: Evening SBP was highest on Sunday regardless of antihypertensive medication. This may be related with clinical evidence that cardiovascular events occur more frequently in the morning on Monday. Considering a variety of factors associated with the intra-week variability in home BP with or without antihypertensive medication, this observation suggested that treatment decisions against hypertension may be based on long-term home BP measurements.

PS-R01-8: BLOOD PRESSURE CONTROL WAS IMPROVED BY A CHANGE IN THE TIMING OF ANTIHYPERTENSIVE MEDICATION IN A PATIENT WITH NOCTURNAL HYPERTENSION

A 75-year-old-man was referred to our outpatient clinic due to inadequate blood pressure control despite antihypertensive drug treatment. He had dyslipidemia, type 2 diabetes mellitus, and a history of carotid artery stenosis, bilateral central retinal artery occlusion, and lower extremity artery disease. He took losartan potassium 50 mg, hydrochlorothiazide 12.5 mg, cilnidipine 10 mg, and nifedipine CR 40 mg in the morning. Home blood pressure monitoring was performed by using a cuff oscillometric device that could be set to measure blood pressure automatically during sleep. The patient was instructed to measure his morning blood pressure twice after waking, evening blood pressure twice before bedtime, and night-time systolic blood pressure (2:00, 3:00, 4:00, and 5:00 AM) for 7 consecutive days. Mean values were 161 mmHg for morning systolic blood pressure, 134 mmHg for evening systolic blood pressure, and 141 mmHg for night-time systolic blood pressure. After the home blood pressure monitoring, the timing of administration of nifedipine CR 40 mg was shifted from morning dosing to bedtime dosing. One month later, home blood pressure monitoring was performed again using the same schedule as before. Mean values were decreased from 161 mmHg to 135 mmHg for morning systolic blood pressure and from 141 mmHg to 127 mmHg for nigh-time systolic blood pressure. Blood pressure control was improved only by altering the timing of the administration of one antihypertensive drug from morning dosing to bedtime dosing without increasing the dosage of antihypertensive drug or adding a new antihypertensive drug class.

Within-week variability of the home blood pressure in the NOSE study.

Objective: Few studies have investigated weekly variations in long-term home blood pressure (BP) measurement. The aim of this study was to examine the within-week variability and the difference in the day of the week on long-term home BP with or without antihypertensive medication. Design and method: This study was based on an ongoing community-based intervention study in Nose, Osaka, which was designed to assess the effect of home BP measurement on prolonging healthy life expectancy. The study included 618 participants aged 40-91 years. Participants measured their BP with an electronic oscillometric device (HEM-7281; Omron Healthcare CO., Ltd) and wrote the value on the recording book twice in morning and evening for about six months to a year. The participants were divided into 2 groups according to with or without antihypertensive medication. The within-week variability in home BP were calculated as maximum minus minimum BP (maximum-minimum difference [MMD]) by each week. The mixed model computed the last-squares means of morning and evening systolic BP (SBP) according to the category and tested the differences between all days of the week after Tukey-Kramer adjustment. Repeated-measures liner mixed model was used to analyze the factors associated with within-week variability. Results: Morning SBP was highest on Thursday (without antihypertensive medication, 128.2 mmHg; with antihypertensive medication, 134.9 mmHg) and lowest on Saturday (127.6 mmHg, 134.1 mmHg), Evening SBP was highest on Sunday (120.7 mmHg, 127.3 mmHg) regardless of antihypertensive medication. Days of the week with the highest frequency of maximum SBP was Monday in the morning (19.4%, 22.2%) and Sunday in the evening (20.7%, 25.0%) regardless of antihypertensive medication. MMD in home SBP and DBP had significant positive relationships with age, measurement in winter, mean home BP, respectively by P<0.001, regardless of antihypertensive medication. And among participants without antihypertensive medication, MMD in home morning DBP had significantly negative relationships with BMI (coefficient = -0.01, P<0.05), and MMD in home evening SBP had significantly negative relationships with present of diabetes (coefficient = -3.42, P<0.001). Conclusions: Evening SBP was highest on Sunday and days of the week with the highest frequency of maximum SBP was Monday in the morning and Sunday in the evening regardless of antihypertensive medication. These may be related with clinical evidence that cardiovascular events occur more frequently in the morning of Monday, but further analysis is needed to clarify these associations.

Maximum home blood pressure and cardiovascular outcomes in patients with type 2 diabetes: KAMOGAWA-HBP study.

The maximum blood pressure was reported as a possible marker of organ damage. We previously showed that maximum home blood pressure was significantly associated with development of diabetic nephropathy. In the same cohort of patients with diabetes as in the previous study, this study aimed to evaluate the prognostic blood pressure values for the onset of first cardiovascular events. This retrospective cohort study included 1082 patients with type 2 diabetes (47.0% female, median age 65.0) without a history of macrovascular complications. Blood pressure measurements were performed in triplicates every morning and evening for 14 consecutive days from the start of the study. Cox hazards model was used to evaluate the risk of primary endpoint, which was defined as the onset of first major cardiovascular event. The primary endpoint occurred in 119 patients (incidence rate, 15.7/1000 person-years) during an average of 7.0-year follow-up. The adjusted hazard ratios (95% confidence interval [CI]) of maximum morning systolic blood pressure (SBP) and maximum evening SBP for cardiovascular events were 1.12 (1.01-1.24) and 1.19 (1.07-1.31), respectively, adjusted by sex, duration of diabetes, body mass index, hemoglobin A1c, low density lipoprotein cholesterol, smoking status, and use of antihypertensive medications. The cutoff values of maximum blood pressure for the events were 150 mmHg in the morning (hazard ratio, 1.73; 95% CI, 1.07-2.81) and 157 mmHg in the evening (hazard ratio, 2.30; 95% CI, 1.46-3.61), using the Youden's index. Maximum home blood pressure is a predictor of subsequent cardiovascular events in patients with type 2 diabetes.

DIFFERENCES OF BLOOD PRESSURE MEASURED AT CLINIC VERSUS AT HOME IN THE MORNING AND IN THE EVENING IN EUROPE AND ASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Although the comparison of clinic blood pressure (BP) and home BP has been investigated, the differences between clinic BP and home morning/evening BP were poorly explored. Thus, we perform the systematic review to determine the quantitative differences of BP measured at clinic versus at home in the morning and in the evening in Europe and Asia. Design and method: PubMed, Embase and Scopus databases were searched up to October 2021. Studies that compared clinic BP with home morning and (or) home evening BP with detailed BP values in European and Asian populations were included. Random effect model was applied to pool the differences between clinic BP and home morning/evening BP. Results: Thirty-five studies, for a total of 49432 patients, were included in the meta-analysis. Mean clinic systolic BP (SBP) values were significantly higher than home morning SBP values by 3.79 mmHg (95% CI, 2.77–4.80). The differences were much larger in Europe [(6.53 mmHg (95% CI, 4.10–8.97)] than in Asia [(2.70 mmHg (95% CI, 1.74–3.66)], and region was a significant predictor for the differences. Mean clinic SBP values were also significantly higher than home evening SBP values by 6.59 mmHg (95% CI, 4.98–8.21). The differences were much smaller in Europe [5.85 mmHg (95% CI, 3.24–8.45)] than in Asia [7.13 mmHg (95% CI, 4.92–9.35)], while age and clinic SBP might contribute to it. Conclusions: The difference between clinic and home morning SBP was much larger in European than Asian populations, whereas the difference between clinic and home evening SBP was the opposite. The differing characteristics of region, ethnic, age and clinic BP might explain the diversities.

Differences of blood pressure measured at clinic versus at home in the morning and in the evening in Europe and Asia: A systematic review and meta-analysis.

Numerous studies have indicated that there might be great differences among different populations in Europe and Asia in terms of home morning and evening blood pressure (BP). Thus, the authors performed a systematic review to determine the quantitative differences of BP measured at clinic versus at home in the morning and in the evening in Europe and Asia. PubMed, Embase, and Scopus databases were searched up to October 2021. Studies that compared clinic BP with home morning and (or) home evening BP in European and Asian populations were included. A random effect model was applied to pool the differences between clinic BP and home morning/evening BP. Thirty‐five studies, for a total of 49 432 patients, were included in this meta‐analysis. Mean clinic systolic blood pressure (SBP) values were significantly higher than home morning SBP values by 3.79 mmHg (95% CI, 2.77–4.80). The differences were much larger in Europe [(6.53 mmHg (95% CI, 4.10–8.97)] than in Asia [(2.70 mmHg (95% CI, 1.74–3.66)], and the region was a significant predictor for the differences. Mean clinic SBP values were also significantly higher than home evening SBP values by 6.59 mmHg (95% CI, 4.98–8.21). The differences were much smaller in Europe [5.85 mmHg (95% CI, 3.24–8.45)] than in Asia [7.13 mmHg (95% CI, 4.92–9.35)], while age and clinic SBP might contribute to it. Our findings showed that the difference between clinic and home morning SBP was much larger in European than Asian populations, whereas the difference between clinic and home evening SBP was the opposite. The differing characteristics of the region, ethnic, age, and clinic BP might explain the diversities.

Associations of office brachial blood pressure, office central blood pressure, and home brachial blood pressure with arterial stiffness.

Accurate blood pressure (BP) measurement is necessary for the evaluation and treatment of hypertension to prevent the progression of subclinical vascular disease, including arterial stiffness. We investigated the associations between brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, and each of office brachial systolic BP (SBP) with and without an observer present (attended or unattended office brachial SBP), attended or unattended office central SBP, and home brachial SBPs (specifically, the means of morning, evening, or morning-evening home brachial SBP) in patients being treated for hypertension. Measurements were performed among 70 adults (mean age, 67.0 ± 9.4 years; women, 51.4%) with a mean attended office brachial SBP of 127.6 ± 14.5 mmHg and mean baPWV of 16.3 ± 2.8 m/s. Univariate analysis showed that higher attended office brachial SBP, morning home brachial SBP, and morning-evening home brachial SBP were each statistically significantly associated with higher baPWV (r = 0.25, P = 0.04; r = 0.37, P = 0.002; and r = 0.32, P = 0.006, respectively). Multiple linear regression analysis with adjustments for traditional cardiovascular risk factors showed that only morning home brachial SBP was statistically significantly associated with baPWV [β = 0.06, 95% confidence interval (0.01-0.11), P = 0.02). In conclusion, higher morning home brachial SBP - but none of the office-measured SBP values - was associated with arterial stiffness.

Abstract 10138: Evening Blood Pressure and Heart Rate: An Age-Specific Association of Nocturia in the Japanese at High-Risk of Cardiovascular Disease

Background: Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established in relation to heart rate (HR). Hypothesis: We hypothesized that blood pressure (BP), HR, and the class of antihypertensive agent might be associated with severity of nocturia in the Japanese at high-risk of cardiovascular disease. In addition, these associations were hypothesized to be moderated by age. Methods: In the Japan Morning Surge-Home Blood Pressure Study, measurements of home BP as well as HR at evening (mean 11.2 days) were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used. Results: The mean levels of evening systolic BP (SBP) and HR were 130±15mmHg and 70±9.6bpm, respectively. According to the number of nocturia, we divided into the three groups (no void: n= 2382; one void: n=847; &gt; 2 voids per night: n=1082). In the multinomial logistic regression analysis adjustment for confounders including age, gender, smoking, total cholesterol, fasting blood glucose, HbA1c, log B-type natriuretic peptide, beta-adrenergic blockade use, clinic SBP and clinic HR, the use of diuretics (OR, 1.23, 95%CI, 1.01-1.50, p&lt;0.05) was significantly associated with one nocturnal void, while evening SBP (OR per 1SD, 1.14, 95%CI, 1.05-1.24, p&lt;0.01) and evening HR (OR per 1SD, 1.12, 95%CI: 1.02-1.24, p&lt;0.05) were significantly associated with multiple nocturnal voids. In the lower aged group (&lt;66yrs), only evening HR remained significant (p=0.003), while only evening SBP remained significant for multiple nocturnal voids in the higher aged group (66yrs &lt; ) (p=0.007). A significant interaction was found between age and evening HR for multiple nocturnal voids (p&lt;0.05). Conclusions: In this study, evening SBP and evening HR were significant indicators of multiple nocturnal voids in the high-risk Japanese population. Increased evening HR was specifically associated with severe nocturia in the lower aged group. Age-stratified approach to reduce BP and HR burdens might be important to improve sleep disturbance caused by nocturia.

Sex-specific associations of evening blood pressure burden and cardiac load with nocturia severity in the Japanese at high-risk of cardiovascular disease

Abstract Background Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established. We hypothesized that blood pressure (BP) burden, the classes of antihypertensive agents and cardiac load were associated with severity of nocturia, and that these associations might be moderated by gender. Purpose To investigate the relationships of home BP (HBP) level, the class of antihypertensive agent, brain natriuretic peptide (BNP) with nocturia severity, and to investigate these associations stratified by gender in the Japanese at high-risk of cardiovascular disease. Methods In the Japan Morning Surge-Home Blood Pressure Study, measurements of HBP at evening (mean 11.2 days) as well as BNP were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used. Results According to the number of nocturia (no void: n=2382; one void: n=847; &amp;gt;2 voids per night: n=1082), significant associations of systolic BP (SBP) at evening (130 vs 130 vs 132 mmHg, p&amp;lt;0.0001) and logBNP (1.20 vs 1.30 vs 1.42, p&amp;lt;0.0001) were observed with nocturia severity. In the multinomial logistic regression analysis adjustment for confounders including age, smoking, total cholesterol, fasting blood glucose, HbA1c and clinic SBP, the use of diuretics (OR: 1.26, 95% CI: 1.06–1.52, p&amp;lt;0.05) was significantly associated with one nocturnal void, while evening SBP (OR: 1.009, 95% CI: 1.003–1.014, p&amp;lt;0.01) and logBNP (1.43, 95% CI: 1.19–1.73, p&amp;lt;0.001) were significantly associated with multiple nocturnal voids. While no significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in the total population, a significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in females (p&amp;lt;0.05). Conclusions In this study, the use of diuretics was a significant indicator of single nocturnal void, while evening SBP and BNP were those of multiple nocturnal voids in the high-risk Japanese population. Specifically, in the females, treatment to reduce BP burden as well as cardiac overload might be important to improve sleep disturbance caused by nocturia. Funding Acknowledgement Type of funding sources: None.

Symptomatic hypotensive episodes in patients with hypertension. Relationship with blood pressure self-monitoring parameters

Aim.To study the relationship between symptomatic hypotensive episodes (SHEs) and parameters of self-monitoring of blood pressure (SMPB) in patients with hypertension (HTN).Material and methods.A total of 77 patients from 40 to 76 years old with HTN were examined. To identify SHEs, an original questionnaire was used. Patients underwent SMBP in the morning and evening, as well as recorded SHE in the diary. The self-monitoring period lasted 4 weeks. Patients without prior myocardial infarction and/or stroke are conventionally called “uncomplicated” HTN, while with cardiovascular events in history — “complicated” HTN.Results.According to the questionnaire, 48 (62,3%) patients noted SHEs. Uncomplicated HTN was recorded in 19 (51,4%) participants, while complicated one — in 29 (72,5%) (p=0,05). Blood pressure during SHEs was on average higher in patients with complicated HTN than in uncomplicated HTN (103/60 vs 95/60 mm Hg (p=0,05)). With a combination of uncomplicated HTN and SEG, mean systolic blood pressure (SBP) (125,9±10,5 vs 137,9±8,2 mm Hg), evening SBP (125,3±8,1vs 133,3±10,4 mm Hg), maximum SBP (149,8±11,8 vs 161,7±12,1 mm Hg) in the morning, as well as minimum SBP in the evening (101,8±10,8 vs 113,7±9,7 mm Hg) were lower than in patients without SHEs (p&lt;0,05).In complicated HTN, an opposite relationship was observed: patients with SHEs had higher mean SBP (133,49±12,4 vs 118,93±15,3 mm Hg), maximum SBP (162,8±11,6 vs 141,7±12,0 mm Hg), and diastolic blood pressure (DBP) (91,5±5,6 vs 83,5±8,8 mm Hg) in the morning (p&lt;0,05), as well as higher variability of morning (11,8±2,1 vs 8,2±2,7 mm Hg) and evening SBP (11,9±4,2 vs 8,6±3,2 mm Hg) compared with patients without SHEs (p&lt;0,05). There were no significant differences in antihypertensive therapy.Conclusion.More than half of patients with hypertension report SHEs. SHEs in patients without prior myocardial infarction and/or stroke were characterized by lower blood pressure level than in subjects with prior cardiovascular events. Among patients with SHEs without cardiovascular events, the values of morning, evening, and maximum SBP in the morning are lower than in patients without SHEs. In patients with complicated HTN and SHEs, the opposite trend was observed: higher SBP and DBP in the morning, as well as greater variability of morning and evening SBP, in comparison with those without SHEs. These patterns cannot be explained by the antihypertensive drugs taken.

Abstract 15551: Evening Blood Pressure Burden and Cardiac Load: A Sex-specific Association of Nocturia in the Japanese at High-risk of Cardiovascular Disease

Introduction: Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has been unclear. Hypothesis: We assessed the hypothesis that blood pressure (BP) burden and cardiac load might be associated with severity of nocturia. In addition, this association was hypothesized to be moderated by sex. Methods: In the Japan Morning Surge-Home Blood Pressure Study, measurements of home BP (HBP) at evening (mean 11.2 days) as well as brain natriuretic peptide (BNP) were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used. Results: According to the number of nocturia (no void: n= 2382; one void: n=847; ≥ 2 voids per night: n=1082), significant associations of systolic BP (SBP) at evening (130 vs 130 vs 132 mmHg, p&lt;0.0001) and logBNP (1.20 vs 1.30 vs 1.42, p&lt;0.0001) were observed with nocturia severity. In the multinomial logistic regression analysis adjustment for confounders including age, smoking, total cholesterol, fasting blood glucose, HbA1c and clinic SBP, the use of diuretics (OR: 1.26, 95%CI: 1.06-1.52, p&lt;0.05) was significantly associated with one nocturnal void, while evening SBP (OR: 1.009, 95%CI: 1.003-1.014, p&lt;0.01) and logBNP (1.43, 95%CI: 1.19-1.73, p&lt;0.001) were significantly associated with multiple nocturnal voids. While no significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in the total population (p=0.1), a significant interaction was found between evening SBP and logBNP for multiple nocturnal voids only in females (p&lt;0.05). Conclusions: In conclusion, the use of diuretics was a significant indicator of single nocturnal void, while evening SBP and BNP were those of multiple nocturnal voids in the high-risk Japanese population. Specifically, in the females, treatment to reduce BP burden as well as cardiac overload might be important to improve sleep disturbance caused by nocturia.

Relationship between arterial stiffness and variability of home blood pressure monitoring.

Variability of blood pressure (BP) is known as a prognostic value for the subsequent target organ damage in hypertensive patients. Arterial stiffness is a risk factor for cardiovascular morbidity and mortality. The relationship between the arterial stiffness and the BP variability has been controversial. The objective of the present study was to investigate the relationship between arterial stiffness and home BP variability in patients with high normal BP and new onset hypertension (HTN).Four hundred sixty three patients (252 males, 49 ± 12 year-old) with high normal BP or HTN were enrolled. Using radial applanation tonometry, pulse wave analysis (PWA) was performed for evaluation of systemic arterial stiffness. All patients underwent both home BP monitoring (HBPM) and PWA. Home BP variability was calculated as the standard deviation (SD) of 7 measurements of HBPM. Multiple linear regression analysis was performed to estimate and test the independent effects of home BP variability on the arterial stiffness.Mutivariate analysis showed that both systolic and diastolic morning BP variabilities were correlated with arterial stiffness expressed as augmentation pressure (AP, β-coefficient = 1.622, P = .01 and β-coefficient = 1.07, P = .035). The SDs of systolic and diastolic BP of evening were also associated with AP (β-coefficient = 1.843, P = .001 and β-coefficient = 1.088, P = .036). The SDs of morning and evening systolic BP were associated with augmentation index (AI, β-coefficient = 1.583, P = .02 and β-coefficient = 1.792, P = .001) and heart rate (75 bpm) adjusted AI (β-coefficient = 1.592, P = .001 and β-coefficient = 1.792, P = .001).In present study, the variability of systolic BP was closely related with arterial stiffness. The home BP variability might be important indicator of arterial stiffness.

Associations Between Day-by-Day Home Blood Pressure Variability and Renal Function and Albuminuria in Patients With and Without Diabetes.

The phenotype of diabetic kidney disease represents a lower estimated glomerular filtration rate (eGFR) and albuminuria. We investigated the association between day-by-day home blood pressure (BP) variability and the eGFR in subjects with diabetes and compared this association with that in subjects without diabetes. We then attempted to determine whether the association is present in albuminuria. We analyzed 4,231 patients with risk factors of cardiovascular disease (24.4% with diabetes) from the J-HOP (Japan Morning Surge-Home Blood Pressure) study. Home BP was measured in the morning and evening for 14 days. We calculated the SD, coefficient of variation, average real variability (ARV), and variation independent of the mean of the subjects' morning and evening home systolic BP (SBP) as the indexes of day-by-day home BP variability. A multiple linear regression analysis adjusted for covariates showed both average morning and evening SBP were associated with the log-transformed urine albumin-to-creatinine ratio (UACR) with and without diabetes (all P < 0.05), but not with the eGFR except for an association of average evening SBP in the no-diabetes group. None of the indexes of day-by-day morning and evening home SBP variability were associated with the log-transformed UACR except for the association between the ARV of home morning SBP in the diabetes group. All of the indexes of day-by-day morning and evening home SBP variability were associated with the eGFR only in the diabetes group (all P < 0.05). The association between increased day-by-day home BP variability and impaired renal function was unique in diabetes.

Effect of Improving Volume Overload on Home Blood Pressure Variability in Hemodialysis Patients

Blood pressure variability is an independent predictor of adverse clinical events in hemodialysis patients. Volume overload is one of the most important factors affecting blood pressure homeostasis. In the present study, we explored the effects of dry weight reduction on home blood pressure variability in volume overload hemodialysis patients. Hemodialysis patients with volume overload had their dry weight gradually decreased under the guidance of bioimpedance methods, which was represented by calf-bioimpedance ratio (Calf-BR). Home blood pressure was measured on waking up and at bedtime for 1 week at baseline and at the end of the two-month study. Coefficient of variation was used to define home blood pressure variability. Thirty-eight hemodialysis patients had their dry weight significantly decreased from 60.7 ± 11.3 to 59.6 ± 10.7 kg (P = 0.003) accompanied with a significant reduction in calf-BR (0.828 ± 0.023 vs. 0.786 ± 0.020, P<0.001). The systolic and diastolic blood pressure decreased significantly. Moreover, the whole-day, morning, and evening systolic blood pressure variability gradually and significantly decreased by the end of the study (5.6 ± 2.1% versus 4.0 ± 1.7%, P<0.001; 7.7 ± 3.5% vs. 6.3 ± 2.7%, P = 0.005; 7.5 ± 2.8% vs. 5.9 ± 2.3%, P = 0.002, respectively). Diastolic blood pressure variability parameters were unchanged. The interdialytic weight gain and the incidence of adverse events were similar throughout the study period. Gradual dry weight reduction by bioimpedance methods improved home blood pressure variability in hemodialysis patients with chronic fluid overload.

Home blood pressure is associated with cognitive impairment among elderly patients with type 2 diabetes: KAMOGAWA-HBP study.

This cross-sectional study was designed to examine the association between home blood pressure and cognitive impairment in elderly patients with type 2 diabetes. Home blood pressure was measured in the morning and evening for 14 consecutive days in 749 patients with type 2 diabetes. A total of 231 patients were included in the study population. Cognitive function was evaluated using the Mini-Cog test, which is used as a screening for cognitive impairment in elderly patients. We performed a logistic regression analysis and measured the area under the receiver operating characteristic curve and estimated home blood pressure as a marker of cognitive impairment. The adjusted odds ratio (95% confidence interval) of evening systolic blood pressure for cognitive impairment was 1.24 (1.02-1.53). Evening systolic blood pressure showed the highest area under the receiver operating characteristic curve for cognitive impairment in both unadjusted and adjusted models. In all subgroup analyses except gender, home blood pressure showed higher area under the receiver operating characteristic curve than clinic blood pressure. Home blood pressure was associated with cognitive impairment in elderly patients with type 2 diabetes.

Prospective single-arm observational study of human chymase inhibitor Polygonum hydropiper L in subjects with hypertension

ABSTRACTBackground and Purpose: Human chymase (h-chymase) is a serine protease that forms local angiotensin II and has been proven to be related to onset of hypertension, arteriosclerosis, and post myocardial infarction cardiac remodeling. Since no chymase inhibitor was clinically available, an extensive screening for inhibition of h-chymase in three different extracts (water, hot water, and ethanol) of approximately 800 food ingredients had been performed and we identified Polygonum hydropiper L (Polygonum). Using a dried and powdered Polygonum, we conducted a prospective, single-arm, pilot study to investigate its safety and antihypertensive effect in subjects with normal high blood pressure to moderate hypertension.Methods: First, a single oral dose of Polygonum powder (4000 mg) was administered to assess acute toxicity. Then, a pilot study was conducted in 11 subjects using the sequence of placebo and Polygonum for 2 weeks each. The dose of Polygonum was increased sequentially (200–2000 mg/day). Home blood pressure and pulse rate were monitored.Results: Oral administration of Polygonum (4000 mg) did not cause any adverse events. In the dose-escalation phase, evening systolic blood pressure was significantly decreased at 800 mg, 2000 mg doses post-treatment (p < 0.05, and p < 0.05, respectively). Depressor responders to Polygonum intake had significantly higher salt intake in spot urine (p < 0.05). No adverse events or reactions occurred.Conclusion: This was the first investigation that an h-chymase inhibitory Polygonum intake for safety and tolerability was proven and, in addition, chymase inhibitory Polygonum appeared to have depressor effect especially in a hypertensive subject with excessive salt intake.