Follow-up Of Hypertensive Patients Research Articles

EVALUATION OF A DIGITAL THERAPY FOR UNCONTROLLED HYPERTENSIVE PATIENTS FOLLOWED BY GENERAL PRACTITIONERS IN FRANCE

Objective: The digital therapy was designed by hypertension specialists and included - a touch-sensitive tablet (Vodafon smart tab 3G) and an automatic blood pressure, connected via Bluetooth to the tablet (ihealth, BKN-550BT), a web portal developed specifically for the study with access reserved for health professionals involved in the follow-up of hypertensive patients. The health data were hosted on an accredited server. Design and method: The digital therapy was designed by hypertension specialists and included - a touch-sensitive tablet (Vodafon smart tab 3G) and an automatic blood pressure, connected via Bluetooth to the tablet (ihealth, BKN-550BT), a web portal developed specifically for the study with access reserved for health professionals involved in the follow-up of hypertensive patients. The health data were hosted on an accredited server. - as software for the patient, several applications specifically developed to 1) perform home blood pressure monitoring over 3 days 2) monitor treatment compliance (GIRERD questionnaire) 3) detect excessive salt consumption (ExSel questionnaire) for the physician a web interface specifically developed to 1) know the results of the remote monitoring of each patient 2) help to follow the recommendations of the ESH for the associations of antihypertensive drugs 3) obtain if necessary the opinion of a Hypertension specialist after a request written by e-mail. 77 patients treated for uncontrolled primary hypertension at office visit despite the prescription of bi-therapy were randomized into 2 groups: a group in which the physician had access to functions 2 and 3 of the website, and a control group in which the physician did not have access to functions 2 and 3 of the website. All patients were instructed to use the 1 2 3 applications once every 3 weeks for a total of 3 months. Results: The patients included were 63 ± 7 years old. 32.5% of patients used the entire program and completed 4 HBPM and visited the physician again at the final visit. The table shows the main results by randomization group: Conclusions: A digital therapy developed by hypertension specialists is effective in improving hypertension control in patients followed by general practitioners in France.

AMBULATORY BLOOD PRESSURE MONITORING IN HUNGARY: THE FIRST CROSS-SECTIONAL RESULTS OF AN OPEN LABEL, PROSPECTIVE, OBSERVATIONAL STUDY

Objective: Background: Ambulatory blood pressure monitoring (ABPM) is gold standard method in the diagnosis and follow-up of hypertensive patients. There is no systematic assessment on the daily practice of the utilization of ABPM in Hungary. Aim: The goal of the project is to assess the indication and the number of monitoring, and to analyze the blood pressure results. Design and method: This is a multicenter, open-label, observational non-interventional study. Data collection is performed in GPs’ practices and in outpatient clinics of cardiology and internal medicine. Meditech ABPM-06 monitors are used for ABPM measurements. Basic patients’ data are documented in an eCRF and all ABPM data are transferred through a closed online surface into the database for further analysis. Results: 7498 ABPM were performed between 21st of February and 21st of December, 2021. The monitoring was performed mainly by GPs (62%). The average age of the patients was 54.4 years (12–96 years). More than half of the patients (54%) were female. The indication of ABPM was elevated blood pressure (BP) at home (59.7%), labile BP (41.5%), therapy control (17.0%), suspicion of white coat hypertension (13.5%), suspicion of masked hypertension (2.5%), suspicion of nocturnal hypertension (3.2%) and suspicion of secondary hypertension (1.3%). The average duration of hypertension among hypertensive patients was 9.8 years (1–73 years). 32.6% of the patients were newly diagnosed as hypertensive. The average 24-hour systolic blood pressure was 133.9 mmHg, the average diastolic blood pressure was 79.3 mmHg, while the average pulse rate was 73.2 beats/min. The 24-hour average percent time elevation of systolic and diastolic blood pressure was 53.0% and 38.8%, respectively. The average systolic diurnal index was 9.6%, the average diastolic diurnal index was 13.3%. Conclusions: The two most frequent indication for ABPM in the routine practice are elevated home BP and labile BP values. One third of the patients was newly diagnosed as hypertensive subject. ABPM was performed mainly in patients with uncontrolled hypertension. The routine use of ABPM may increase the awareness of hypertension.

Application of Optical Coherence Tomography Angiography Macular Analysis for Systemic Hypertension. A Systematic Review and Meta-analysis.

Microvascular rarefaction due to hypertension has been linked to disease severity and end-organ complications. Optical coherence tomography angiography (OCTA) has been explored as a potential tool to evaluate the retinal microvascular network in hypertensive patients. PubMed, Scopus, Web of Science, and Cochrane were systematically searched to 10th of September of 2021, along with a manual search. Studies that used OCTA as a primary diagnostic method to evaluate the macular microvasculature of hypertensive patients were included. Meta-analysis was performed using a random-effects model. Primary outcomes were macular vessel density (VD) and foveal avascular zone (FAZ) at the superficial and deep capillary plexus. Of 947 screened articles, 9 were found eligible for qualitative and quantitative analysis. VD in hypertensive patients was reduced when compared with controls in the fovea (0.93, 95% confidence interval [CI] 0.87-0.99, P = 0.023) and the parafovea (0.95, 95% CI 0.93-0.97, P < 0.001) of the superficial capillary plexus. FAZ was larger in the deep plexus of hypertensive patients (1.10, 95% CI 1.03-1.18, P = 0.003). VD reduction was found in patients with worsening blood pressure control in 3 studies and prolonged disease in 2 studies. Microvascular rarefaction of the macula is found in hypertensive patients with a reduction of foveal and parafoveal VD and an increase of FAZ area. Disease duration and severity might be related to a microvascular rarefaction. OCTA could offer a novel tool for the assessment and follow-up of hypertensive patients.

Cardiovascular prognosis in patients admitted to an emergency department with hypertensive emergencies and urgencies.

At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to emergency departments. The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted to the emergency departments of Brescia Hospital (Northern Italy) with hypertensive emergencies or urgencies from 1 January to 31 December 2015. Medical records of patients aged more than 18 years, admitted to the emergency department with SBP values at least 180 mmHg (SBP) and/or DBP values at least 120 mmHg (DBP) were collected and analysed (18% of patients were classified as 'hypertensive emergency' and 82% as 'hypertensive urgency'). Data in 895 patients (385 men and 510 women, mean age 70. 5 ± 15 years) were analysed; the mean duration of follow-up after admission to the emergency department was 12 ± 5 months. During the follow-up, 96 cardiovascular events (28 fatal) occurred (20 cardiac events, 30 cerebrovascular events, 26 hospital admission for heart failure, 20 cases of new onset kidney disease). In 40 patients (4.5%), a new episode of acute blood pressure rise with referral to the emergency department was recorded. Cardiovascular mortality and morbidity were greater in patients with a previous hypertensive emergency (14.5 vs. 4.5% in patients with hypertensive emergency and urgency, respectively, chi-square, P < 0.0001). Similar results were obtained when the occurrence of cerebrovascular or renal events were considered separately. Admission to the emergency department for hypertensive emergencies and urgencies identifies hypertensive patients at increased risk for fatal and nonfatal cardiovascular events. Our findings add some new finding suggesting that further research in this field should be improved aiming to define, prevent, treat and follow hypertensive urgencies and emergencies.

CARDIOVASCULAR RISK AND OUTCOME IN PATIENTS WITH HYPERTENSIVE EMERGENCIES AND URGENCIES IN AN EMERGENCY DEPARTMENT. AN ITALIAN GREEK COLLABORATION

Objective: Background: at present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Design and method: Methods: medical records of patients aged &gt; 18 yrs, admitted to the ED with blood pressure values &gt; = 180 mmHg (SBP) and/or &gt; = 120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76 % as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70 + 13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5 + 7 months years. Results: Results: During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22 %) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7 %, chisquare p = 0.0001 and 5.8 vs 1.2% chisquare p &lt; 0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions: Conclusions: admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.

MEASUREMENT OF BLOOD PRESSURE IN THE ARM AND FOREARM: IS THERE A DIFFERENCE?

Objective: Obtain an accurate measurement of blood pressure (BP) is of fundamental importance for the diagnosis and follow-up of hypertensive patients. It is known that in some patients, such accuracy is not possible due to the anatomical changes in the musculature of the arm, obesity, and dysmorphisms. Objective: To evaluate and compare blood pressure values using the traditional method of measuring blood pressure in the arm with the values measured in the forearm in hypertensive patients for validation of this technique in obese patients and/or with the arm dysmorphisms. Design and method: Were included 70 patients of both sexes, aged between 30 and 90 years of hypertension outpatient clinic of the State Medical School of São José doRio Preto FAMERP - SP. The BP was measured by the oscillometric method using two electronic devices, with clamp standard for adults with arm circumference between 220 mm and 420 mm and automatic inflation and deflation of air, with pressure variation of 0–280 mmHg (appliance, MICROLIFE BP3AC1–1 model PC) obeying the VII Brazilian Guidelines for the treatment of hypertension. The anthropometric data were obtained at the beginning of the research for sample characterization, as well as information on gender and age. Results: In accordance with the statistical analysis of the data measured blood pressure could observe that the linear correlation values are &gt;80%, which corresponds to an excellent correlation between the measurements of arm and forearm for both systolic and diastolic BP, me, an BP and pulse pressure. Conclusions: Both measurements of systolic and diastolic blood pressure were equivalent in arm and forearm, in such a way that can be considered effective measurement of BP in the forearm in hypertensive patients being of particular usefulness in obese patients or who present arms dysmorphisms.

Comparison of the Chemiluminescence Immunoassay LIAISON® with the Radioimmunoassay for Aldosterone and Renin Measurement.

Determination of renin plasma levels is useful in the diagnosis of hypertension and in the therapeutic follow-up of hypertensive patients. Plasmatic concentration of renin decreases in patients with hypertension due to a primary hyperaldosteronism, contrary to renovascular hypertension where concentrations of renin and aldosterone are both elevated. Blood samples (serum, EDTA plasma) were analysed using two different chemiluminiscent methods CLIA LIAISON® and radioimmunoassay for aldosterone (IMMUNOTECH Beckman Coulter) and renin (Cisbio Bioassay) measurements were compared. We used both methods to ascertain the correlation between serum vs. EDTA plasma levels of aldosterone (RIA, CLIA) and renin (IRMA, CLIA) and to compare aldosterone to renin ratios for CLIA and for radioimmunoassay: serum aldosterone to plasma renin and plasma aldosterone to plasma renin. We compared serum aldosterone CLIA vs. RIA (rP=0.933, P&lt;0.001) and plasma renin determined using CLIA vs. IRMA (rP=0.965, P=0.062). Furthermore, we used both methods to establish the correlation between the serum vs. plasma levels of aldosterone: RIA (rP=0.980, P&lt;0.001); CLIA (rP=0.994, P=0.353) and serum vs. plasma levels of renin: IRMA (rP=0.948, P&lt;0.001); CLIA (rP=0.921, P=0.011). Aldosterone (serum, plasma) to plasmatic renin ratios for CLIA (rP=0.999, P=0.286) and for radioimmunoassay (rP=0.992, P=0.025). Our data demonstrate that renin and aldosterone concentrations obtained using CLIA correlate with renin and aldosterone concentrations using radioimmunoassay methods. Correlation coefficients of pair results ranged from 0.921 to 0.994. Aldosterone (serum, EDTA plasma) to plasmatic renin ratios are comparable and any of them can be used with no significant differences found.

Cardiovascular risk and outcome in patients with hypertensive emergencies and urgencies in an emergency department. an italian greek collaboration

Abstract Background At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Methods Medical records of patients aged &amp;gt;18 yrs, admitted to the ED with blood pressure values ≥180 mmHg (SBP) and/or ≥120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76% as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70±13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5±7 months years. Results During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22%) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7%, chi-square p=0.0001 and 5.8 vs 1.2% chisquare p&amp;lt;0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions Admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies. Funding Acknowledgement Type of funding source: None

The magnitude of high blood pressure and its risk factors in the western region of Algeria

Objectives: The objective of this study was to evaluate the follow-up of hypertensive patients with or without associated cardiovascular risk factors in western Algeria. And to establish a biological and epidemiological profile. Methods: This is a descriptive cross-sectional study. Two hundred patients aged 40 years and over followed up for the HTA were collected among the population of patients seen in consultation at the hospital of Mascara and Saida (two cities in western Algeria) from November 15, 2017 to February 15. The questionnaire, anthropometric parameters, biological assessments and treatments were noted. Results: Among the 200 hypertensive subjects recorded, 60% were women and 40% men. The participants had been hypertensive for an average of 10 years. There were more men with diabetes than women: 71.25% vs. 65% for women. About a third of them were type 1 (30% of men and 12.5% of women, p=0.228). Both sexes were almost equally represented, with regard to dyslipidemia: 57.5% of women vs. 60% of men. Conclusion: High blood pressure is a disease that is progressing rapidly in Algeria. The risk factors associated with hypertension are: Age, BMI, diabetes and dyslipidemia... These data confirm the importance of this pathology in terms of public health.

An analysis of ambulatory blood pressure monitoring using multi-label classification.

Ambulatory blood pressure monitoring (ABPM) involves measuring blood pressure by means of a tensiometer carried by the patient for a duration of 24h, it currently occupies a central place in the diagnosis and follow-up of hypertensive patients, it provides crucial information which allows to make a specific diagnosis and adapt therapeutic attitude accordingly. The traditional analysis process suffers from different problems: it requires a lot of time and expertise, and several calculations should be performed manually by the expert, who is generally very busy. In this work, we attempt to improve the analysis of ABPM data using multi-label classification methods, where a record is associated with more than one label (class) at the same time. Seven algorithms are experimentally compared on a new multi-label ABPM-dataset. Experiments are conducted on 270 hypertensive patient records characterized by 40 attributes and associated with six labels. Results show that the multi-label modeling of ABPM data helps to investigate label dependencies and provide interesting insights, which can be integrated into the ABPM devices to dispense automatically detailed reports with possible future complications.

NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATIO ARE INDEPENDENT PREDICTORS FOR BLOOD PRESSURE VARIABILITY

Objective: Hypertension is a major risk factor for cardiovascular diseases. Ambulatory blood pressure monitoring is used for detection, follow-up of hypertensive patients and also demonstrates the diurnal variability of the blood pressure. Decreased blood pressure variability is associated with hypertensive target organ damage and higher risk for cardiovascular events. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are also related to inflammation and increased cardiovascular risk. The purpose of the study is to investigate the relationship between NLR and PLR with non-dipper status of hypertensive and normotensive patients.Design and method: A total of 482 patients were evaluated retrospectively. Patients with previous hypertension diagnosis, acute coronary syndrome, serious valve regurgitation or stenosis, coronary artery disease, echocardiographic findings of reduced left ventricular ejection fraction (LVEF < 55%), congenital heart diseases, abnormal kidney function, chronic liver disorders, chronic inflammatory disease, patients who had a recent history of acute infection were excluded. Results: Mean age of the study population was 50.1 ± 15.5 years, 38.1% were male. Four groups were formed according to hypertension diagnosis, dipper and non-dipper patterns. Group 1 was consisted of 165 patients with hypertensive and non-dipper status; group 2 was consisted of 88 patients with hypertensive and dipper status; group 3 was consisted of 123 patients with normotensive and non-dipper status; and group 4 was consisted of 91 patients with normotensive and dipper status. Neutrophil lymphocyte ratio was statistically different among groups (p = 0.000). Group 1 had significantly higher values compared to Group 2 (p = 0.001), Group 3 (0.002) and Group 4 (p = 0.023). In hypertensive patient group, PLR values of Group 1 was significantly higher than Group 2 (p = 0.002). Pearson correlation analysis showed that NLR and PLR were correlated with BP variability between night and day (r = -0.188, p = 0.000 for NLR and r = -0.182 and p = 0.000 for PLR). Regression analysis showed NLR (p = 0.040), PLR (p = 0.021), age (p = 0.006) and hypertension (p = 0.000) were independent predictors of BP variability. Conclusions: In conclusion NLR and PLR can be used as easily accessible and inexpensive markers for non-dipper status especially in hypertensive patients.

Predictive power of home blood pressure indices at baseline and during follow-up in hypertensive patients: HOMED-BP study.

We compared the predictive power for a major adverse cardiovascular event (MACE) of four home blood pressure (BP) indices (systolic BP, diastolic BP, mean BP, and pulse pressure (PP)) obtained at baseline before treatment and during the on-treatment follow-up period in 3147 patients with essential hypertension (women: 50.1%, mean age: 59.5 years). Associations between MACE and each index were determined using Cox proportional hazard models and the likelihood ratio (LR) test. During a median follow-up of 5.4 years, 46 patients experienced MACE, which was a composite of cardiovascular death, non-fatal stroke, and non-fatal myocardial infarction. The LR test showed that systolic, diastolic, and mean BP during follow-up was more closely associated with cardiovascular risk than the corresponding indices at baseline (LR χ2 for baseline versus follow-up: systolic BP, (6.0, P = 0.014) versus (11.3, P = 0.0008); diastolic BP, (0.4, P = 0.53) versus (12.4, P = 0.0004); mean BP, (3.2, P = 0.074) versus (15.0, P = 0.0001)), whereas neither PP at baseline nor that during follow-up was significantly associated with MACE risk. Among home BP indices during follow-up, mean BP further improved prediction models in which systolic or diastolic BP was already included (P ≤ 0.042), but neither systolic nor diastolic BP improved models with mean BP (P = 0.80). In addition to home systolic and diastolic BP, mean BP during follow-up period provides essential information in predicting future cardiovascular diseases, whereas its utilization should be further assessed by an intervention trial targeting mean BP levels.

LB.01.15] DECREASE OF CARDIOVASCULAR RISK IN HYPERTENSIVE AND HYPERTENSIVE-DIABETIC PATIENTS AFTER A PROGRAM OF PHARMACEUTICAL INTERVENTION

Objective: To determine the effectiveness of a pharmaceutical care plan by reducing CVR in a sample with moderate-high or high CVR in a rural community pharmacy. Design and method: Clinical trial with an intervention group and a control group with a previous non-probabilistic sampling of consecutive cases followed by a probabilistic one by simple randomization in 2 groups stratified by age and sex. Were included patients who came to the pharmacy office with cardiovascular prescriptions and moderate-high or high CVR. The pharmaceutical care plan includes group talk about CVR and an individual strategy through a plan of modification of lifestyles, all through interviews and follow-ups allowing to detect non-compliances, safety problems or problems of effectiveness. The Framingham score was determined and, on the other hand, CVR in percentage at the beginning and at the end of the study, calculated with the D ’Agostino formula. Results: Comparison of Framingham (%) CVR and score between groups at baseline in hypertensive patients with and without diabetes is presented. No comparison showed statistically significant differences. We also present a comparison of Framingham VR (%) and score between groups at the end of follow-up in hypertensive patients with and without diabetes. There was a decrease in CVR and score in each of the variables, with a significant reduction in the mean of the Framingham score in hypertensive patients with diabetes. The mean score decreased 2.3 points (17.8 vs 20.1, P < 0.05) in the range of 23.9% and 26.5% probability of having a cardiovascular event in the next 10 years. We present the measure of the percentage change in the CVR or its score at the end of the study, between groups in hypertensive patients with and without diabetes. The mean score decreased by 10.1% (-3.7% vs +6.4%, p < 0.05) in diabetic hypertensive patients, a similar tendency presents the CVR data with a tendency to significance. Conclusions: The application of a pharmaceutical care plan has a positive influence on the decrease of the CVR in the hypertensive population with and without diabetes, showing a statistically significant decrease in the diabetic-hypertensive population.

Impact of home blood pressure monitoring on blood pressure control in older individuals: a French randomized study.

Home blood pressure (BP) monitoring is one of the tools recommended in hypertension management. However, its influence in older adults is seldom investigated. We aimed to assess whether regular home BP monitoring leads to a reduction of BP and an improvement in hypertension control in older adults. In a 24-month trial, individuals aged 73-97 years were randomized in a control (office and home BP measured at 0, 12, and 24 months) or an intervention (office measured at 0, 12, and 24 months; home BP measured every 3 months) group. The primary outcome was the difference in means office BP over 24 months in hypertensive patients. Secondary outcomes included differences in mean home BP over follow-up in hypertensive patients, and frequency of hypertension and of drug use at 24 months in the total sample. Intention-to-treat analyses comprised 1733 persons, among which 1043 were hypertensive. Hypertensive patients in the intervention group experienced a significantly greater fall in office systolic BP (SBP) [mean between-group difference -2.1 mmHg, 95% confidence interval (CI) -4.1; -0.2, P = 0.03], home SBP (mean between-group difference -3.4, 95% CI -4.8; -2.1, P < 0.0001), and home diastolic BP (mean between-group difference -1.1, 95% CI -1.8; -0.4, P = 0.002) than those in the control group, in the main model. No overall differences were observed for office diastolic BP (P = 0.74), frequency of hypertension (P = 0.92), or drug use (P = 0.51) over time. Similar results were observed after adjustment for known predictors of BP though attenuated for office SBP (P = 0.07). Regular home BP monitoring every 3 months without co-intervention results in small but greater reductions of BP over time. Further research in large trials focused on older adults is needed to confirm the effectiveness of this intervention in a variety of settings.

PP.LB01.08] PREDICTORS OF STROKE IN HYPERTENSIVE PATIENTS ACCORDING TO THE FIVE-YEAR OBSERVATION

Objective: Investigate the possible predictors of stroke, according to a five-year follow-up in hypertensive patients. Design and method: Eighty essential hypertensive patients aged between 30–59 years were observed within 5 years. General clinical investigation, 24-h ABPM and brain MRI were performed in all patients at the onset of the study and after 5 years observation. Presence of increased subarachnoidal spaces (SS) and lateral ventricles (LV) of a brain, periventricular leucoaraiosis (PL), lacuna infarcts (LI) and focal white matter lesions (FWML) were evaluated in all patients. Results: 13,7% of patients during 5 years experienced stroke. This patients (I group - 13,7 %) were compared to group of hypertensive patients without stroke (II group – 86,3 %) with regard to baseline data. At patients with insults on initial brain tomograms authentically were more often registered FWML (75% vs 42%; chi square = 4,49, p = 0,046), LA (75% vs 44%; chi square = 5,04, p = 0,024) and LI (50% vs 6%;chi square = 17,04, p = 0,000). At baseline, 24-h systolic (170.7 ± 18.09 vs 149.8 ± 15.02, p = 0,000), diastolic (106.8 ± 9,70 vs 97.9 ± 10,73, p = 0.003) blood pressure and the number of night-pikkers (45.5% vs 15.9%; chi square = 5,14, p = 0,025) were higher at patients of I group. In multiple regression model including clinical data, baseline MRI signs and BP parameters, daytime systolic blood pressure (R = 0,38, p = 0,002), daytime systolic BP load (R = 0,41; p = 0.002), LA (R = 0,42; p = 0,025) and FWML (R = 0,39; p = 0,012) were best predictors of stroke. Significance of Multiple linear regression model: R = 0,53; R2 = 0,28; p = 0,0007. Conclusions: Our study demonstrates that systolic BP, focal white matter lesions and leucoaraiosis are independent predictors of stroke in hypertensive patients. Thus, ABPM and brain MRI early may significantly improve risk stratification in hypertensive patients.

OP.4C.05] IMPACT OF ACHIEVED SYSTOLIC BLOOD PRESSURE ON RENAL FUNCTION IN HYPERTENSIVE PATIENTS

Objective: We aimed to investigate the relationship of glomerular filtration rate (GFR) and change in GFR over time to lower achieved systolic BP (SBP) in hypertensive patients undergoing treatment. Design and method: Baseline estimated GFR (eGFR) and change in eGFR during follow-up were examined in relation to average on-treatment SBP in 8778 hypertensive patients with ECG left ventricular hypertrophy (LVH) randomly assigned to losartan- or atenolol-based treatment. GFR was estimated using the Modification of Diet in Renal Disease study equation. Patients with average on-treatment SBP < = 130 mmHg (lowest quintile at last measurement) and average SBP between 131 and 141 mmHg were compared with patients with average SBP >=142 mmHg (median SBP at last measurement). Results: Patients with an average on-treatment SBP <=130 mmHg had significantly lower baseline eGFR than those with average SBP between 131 and 141 or average SBP >=142 mmHg (65.5 ± 14.3 vs. 69.3 ± 14.3 vs. 69.0 ± 14.5 ml/min/1.73 m2, p<0.001 using analysis of covariance adjusting for age, sex, race, randomized treatment, prior antihypertensive treatment, history of diabetes, myocardial infarction, ischemic heart disease or heart failure, smoking status, baseline serum glucose, total and HDL cholesterol, albuminuria and baseline LVH by Cornell product and Sokolow-Lyon voltage). However, the decrease in eGFR between baseline and year-4 was significantly lower among patients with average SBP < = 130 mmHg (−6.3 ± 10.3 vs. −7.9 ± 11.1 vs. −9.2 ± 10.6 ml/min/1.73 m2, p = 0.001 when adjusting for the same variables and for change in Cornell product and Sokolow-Lyon voltage between baseline and year-4). These differences in eGFR change persisted even after adjusting for baseline eGFR and there were no significant interactions with randomized treatment, sex, race or baseline presence of proteinuria. Conclusions: Lower average on-treatment SBP (< = 130 mmHg) was associated with a lower baseline eGFR but with a slower reduction in eGFR during 4-year follow-up in hypertensive patients with ECG LVH, independent of other possible risk factors for decreased GFR. Further study is necessary to determine whether randomized treatment to lower SBP goals is more protective of renal function than treatment to standard SBP goals.

Association among Systolic Blood Pressure Variation, Inflammation and Arterial Rigidity in Essential Hypertension

Objective: To assess the relationship among systolic blood pressure variation (BPV), inflammation and arterial rigidity in essential hypertension. Methods: This study enrolled 80 patients with essential hypertension, who were started on blood pressure control treatment with medications and lifestyle modification, and 18 normotensive healthy controls. At enrollment and 1-year follow-up, systolic BPV was evaluated by coefficient of variation (CV) in ambulatory blood pressure monitoring; arterial rigidity by brachial-ankle pulse wave velocity (ba-PWV) using ColinVP-1000; and inflammation by high-sensitivity plasma C-reactive protein (hs-CRP) level using rate nephelometry; electrocardiography, blood glucose, lipid profile, creatinine, blood urea nitrogen, and liver and renal function also were assessed. Results: There were no significant differences in demographics, clinical or biochemical profiles between patients and normotensive controls, except for blood pressure at enrollment but not 1-year follow-up, reflecting effectiveness of blood pressure control measures, with significant decreases in CV, ba-PWV and hs-CRP between enrollment and 1-year follow-up in hypertensive patients; change in CV significantly correlated with those in ba-PWV and hs-CRP (both P<0.001, adjusted by SBP d). Conclusion: The effect of systolic BPV on arterial rigidity could be mediated by its influence on the onset and progression of inflammation.

Home Blood Pressure Monitoring: A Few minutes of Rest Before Measurement May Not Be Appropriate

Home blood pressure measurement (HBPM) is recommended for the diagnosis and follow-up of hypertensive patients. While measurement protocols emphasize a rest period before taking the measurement, this directive has not been supported by any specific study to date. This analysis aimed to determine whether the respect or nonrespect of rest before HBPM could introduce a difference between daytime ambulatory blood pressure measurement (ABPM) and HBPM; whether this rest is observed "in real life" among educated hypertensive patients. In this open, prospective study we compared HBPM, with and without rest, and ABPM among 52 office/clinically controlled hypertensive patients. HBPM was performed during 3 days (French HAS instructions); 24-hour ABPM was performed within 3 days of HBPM. All patients who regularly performed HBPM before the study were asked how they practiced HBPM in real life. There was a differential impact of rest on differences observed in daytime ABPM and HBPM. Systolic HBPM decreased with rest, while diastolic HBPM did not significantly increase. HBPM systolic BP (SBP) without rest was not significantly different from daytime ABPM SBP (P = 0.27). HBPM SBP without rest was lower than daytime and 24-hour systolic ABPM. Diastolic HBPM after rest was not significantly different from daytime diastolic ABPM (P = 0.09). None of the 38 patients who regularly performed HBPM were compliant with a period of rest before beginning the measurements. Rest before HBPM induces a bias that underestimates SBP vs. daytime ABPM and perhaps complicates patient adherence to HBPM protocols.

Non-compliance and inertia in hypertensive Spaniards at high cardiovascular risk: CUMPLE study

Objective:To assess non-compliance (NC) and therapeutic inertia (TI) after 6 months of follow-up in hypertensive patients with poorly controlled blood pressure and high cardiovascular risk.Research design and methods:Longitudinal, multicentre study; 3900 uncontrolled hypertensive patients were recruited from 585 primary healthcare centres. Tablets were counted during visits at baseline, 1, 3 and 6 months. A tablet count between 80–100% was considered as compliant. Multivariate logistic regression was performed to determine variables associated with NC and TI.Results:A total of 3636 patients completed, mean age was 64.8 (SD 10.8) years, 53.7% being male. After one month, 61.8% (60.2–63.4) had uncontrolled blood pressure, 39.5% (37.9–41.1) were NC and 52.3% (50.2–54.4) had TI. At the end of follow-up, uncontrolled blood pressure was 34.6% (33.1–36.1) (p < 0.05), NC was 46.8% (45.2–48.4) (p < 0.05) and TI was 34.2% (31.6–36.8) (p < 0.05). The variable associated with NC was greatest number of antihypertensive treatments (OR 1.09, 95% CI 1.05–1.13, p < 0.001), and variables associated with TI were least number of antihypertensive drugs (OR 0.88, 95% CI 0.84–0.98, p < 0.001) and least number of diseases suffered (OR 0.95, 95% CI 0.92–0.98, p = 0.002).Limitations:Due to the complexity of measuring compliance, we have to assume measurement bias.Conclusions:Among uncontrolled hypertensive patients, after completing 6 months follow-up, approximately one out of two patients were NC and one out of three physicians committed TI.

GW24-e2905 Eight years follow-up of hypertensive patients

ObjectivesEight years of follow-up studies of 163 hypertensive patients, comparing the different medication used, frequency of exercise and analysing their correlation factors. The death rate and cardiovascular events in this...