Higher Ambulatory Blood Pressure Research Articles

Endothelin-1, Extracellular Volume Overload, and Hemodynamics in Hemodialysis Patients.

Extracellular volume (ECV) overload and endothelial cell dysfunction are mortality risk factors in hemodialysis (HD) patients. Endothelin-1 (ET-1), an endothelium-derived vasoconstrictive peptide, is associated with poor outcomes in HD patients. We hypothesized there would be associations between ET-1 and ECV overload in hypertensive HD patients. We obtained pre-HD ET-1, ECV/weight (bioimpedance spectroscopy), pre-HD hemodynamics, and ambulatory blood pressure (BP) in an HD cohort. Following appropriate transformations, we conducted correlation and linear regression analyses idendifying associations between ET-1, ECV overload, total peripheral resistance index (TPRI), cardiac index (CI), and ambulatory BP. Among 66 patients, median ET-1 was 1.93 (1.49-2.56) pg/ml. Median pre-HD ECV/weight, median TPRI, mean CI, and mean systolic ambulatory BP were 0.25 (0.22-0.30) l/kg, 3,161 (2,711-3,642) dynes × s/cm-5/m2, 2.92 (0.6) l/min/m2, and 143 (14) mm Hg, respectively. After reciprocal-transformation, ET-1 correlated with reciprocal-transformed ECV/weight (r = 0.3, P = 0.01), log-transformed TPRI (r = -0.3, P = 0.006), CI (r = 0.3, P = 0.009), and ambulatory BP (r = -0.3, P = 0.02). These associations persisted in linear regression analysis (β = 0.15, P = 0.002; β = -0.8, P = 0.002; β = 0.2, P = 0.002; β = -19, P = 0.03). In hypertensive HD patients, ET-1 associates with ECV overload higher TPRI and ambulatory BP, and lower CI. Further research is necessary to determine if ECV reduction lowers ET-1 or if pharmacologic ET-1 antagonism can improve outcomes in HD patients with refractory ECV overload.

Effect of Aging and Hypertension on Ambulatory Blood Pressure, Arterial Stiffness, and Wave Reflection in Mid-life Adults

Introduction: Age-associated increases in blood pressure are partly due to increased arterial stiffness and wave reflection. How these vascular changes during aging contribute to daily fluctuations in blood pressure and hypertension remain to be elucidated. Therefore, the purpose of this study is to compare ambulatory blood pressure, arterial stiffness, and wave reflection between young healthy adults, mid-life adults without hypertension, and mid-life adults with hypertension. Methods: Twenty-five young (age: 26 ± 4 yr and body mass index [BMI]: 23.9 ± 2.5 kg/m2) and 31 mid-life adults (age: 57 ± 4 yr and BMI: 25.4 ± 2.6 kg/m2), free of obesity and major clinical diseases and non-smokers, were included. Hypertension was defined by the current use of anti-hypertension medications or offce seated blood pressure (BP) ≥ 130/80 mmHg. Young adults with hypertension were excluded. Twenty-four-hour ambulatory BP monitoring (Oscar 2™, SunTech Medical®) and assessment of aortic arterial stiffness and wave reflection (SphygmoCor XCEL, AtCor Medical) were performed in all participants. Results: Daytime, nighttime, and 24-hr systolic BP was similar between young adults (YA) and mid-life adults without hypertension (MA; n=12; P>0.9 vs. YA), while mid-life adults with hypertension (MAHTN; n=19) had higher offce, 24-hr, daytime, and nighttime systolic and diastolic BP compared to YA and MA (p<0.01 vs. YA and MA). Compared to YA, MA had higher nighttime diastolic BP (P=0.02). Aortic arterial stiffness, measured by carotid-to-femoral pulse wave velocity, was the highest in MAHTN (p<0.001 vs. YA and P=0<0.01 vs. MA), followed by MA (p<0.01 vs. YA) and YA. Aortic wave reflection, measured by augmentation index and reflection magnitude, was higher in MA and MAHTN compared to YA but was similar between MA and MAHTN (p<0.001 for MA vs. YA; p<0.001 for MAHTN vs. YA; and P>0.9 for MA vs. MAHTN). Conclusions: Our findings indicate that 1) mid-life adults with hypertension had higher ambulatory BP and arterial stiffness than mid-life adults without hypertension and young adults; 2) despite normal offce blood pressure, mid-life adults without hypertension had higher nighttime diastolic BP and arterial stiffness than young adults; and 3) regardless of hypertension, mid-life adults had higher wave reflection than young adults. These findings suggest that 1) vascular aging may present prior to the diagnosis of hypertension based on offce BP; 2) arterial stiffness, rather than wave reflection, may contribute to the development of hypertension during aging; and 3) compared to offce BP, ambulatory BP may be a more sensitive marker of age-associated increases in blood pressure. NIAAA K99/R00 AA028537 to CLH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Clinical and life style factors related to the nighttime blood pressure, nighttime dipping and their phenotypes in Korean hypertensive patients

BackgroundNon-dipping or reverse dipping patterns are known to be associated with adverse cardiovascular prognosis among the general population and clinical cohort. Few large sized studies have explored factors including sleep duration and sleep quality related to nighttime blood pressure (BP) and nocturnal dipping patterns.MethodsAmong 5,360 patients enrolled in Korean multicenter nationwide prospective Registry of ambulatory BP monitoring (KORABP), 981 subjects with complete data on sleep duration, sleep quality assessed using a 4-point Likert scale, and clinical variables were included in the analysis. Phenotypes of nighttime BP pattern were categorized as extreme dipper, dipper, non-dipper, and reverse dipper. Hypertension was defined as a 24-h ambulatory BPs were 130/80 mmHg or higher.ResultsAmong 981 subjects, 221 were normotensive, 359 were untreated hypertensive, and 401 were treated hypertensive. Age of the participants were 53.87 ± 14.02 years and 47.1% were female. In overall patients, sleep duration was 431.99 ± 107.61 min, and one to four points of sleep quality were observed in 15.5%, 30.0%, 30.4%, and 24.2%, respectively. Of the 760 hypertensive patients, extreme dipper, dipper, non-dipper, and reverse dipper were observed in 58 (7.63%), 277 (36.45%), 325 (42.76%), and 100 (13.16%), respectively. In multiple linear regression analysis, sleep duration (β = 0.0105, p < 0.001) and sleep quality (β = -0.8093, p < 0.001) were associated with nighttime systolic BP and sleep quality was associated with extent of nighttime systolic BP dipping (β = 0.7622, p < 0.001) in hypertensive patients. In addition, sleep quality showed positive association with dipper pattern (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 1.03–1.30) and showed negative association with reverse dipper pattern (OR = 0.73, 95% CI = 0.62–0.86) in multiple logistic regression analyses.ConclusionWhen adjusted covariates, less sleep duration and poor sleep quality were positively associated with nighttime systolic BP. Additionally, sleep quality was the independent associated factor for dipper and reverse dipper phenotypes. The study also found that male sex, low estimated glomerular filtration rate, high ambulatory BP, low office BP, and poor sleep quality were associated with blunted nighttime SBP dipping.

Associations of Diabetic Retinopathy Severity With High Ambulatory Blood Pressure and Suppressed Serum Renin Levels.

The relationships between serum renin levels, severity of diabetic retinopathy (DR), and 24-hour blood pressure (BP) have not been previously reported. To explore causes for DR and the relationships of 24-hour ambulatory BP, and hormone levels with the severity of DR. The diabetic patients were classified as having no DR, simple DR, or severe DR (preproliferative DR plus proliferative DR) based on funduscopic examination, and we measured 24-hour BP, serum active renin (ARC), aldosterone (SAC), adrenocorticotropic hormone, and cortisol levels in each group. Compared to those with no DR or simple DR, patients with severe DR showed significantly higher 24-hour BPs, including daytime and nighttime systolic and diastolic BP levels, independent of diabetic duration and HbA1c levels. The variability of nighttime systolic BP was greater in patients with severe DR than in those with nonsevere DR, although nocturnal BP reduction was similar between the groups. The ambulatory BPs were significantly inversely associated with ARC. The ARC was significantly lower in severe DR patients than in those with no DR or simple DR (3.2 [1.5-13.6] vs 9.8 [4.6-18.0] pg/mL, P < .05), but there were no differences in SAC in patients taking calcium channel blockers and/or α-blockers. No associations were found between DR severity and other hormone levels. Severe DR was associated with higher 24-hour BPs and suppressed ARC. These findings suggest that mineralocorticoid receptor overactivation may play a role in higher BP levels and severe DR in diabetic patients.

#3042 AMBULATORY BLOOD PRESSURE LEVELS AFFECT THE ASSOCIATION OF INTRADIALYTIC HYPERTENSION WITH ADVERSE CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Patients with intradialytic hypertension (IDH) display also higher ambulatory blood pressure (BP) levels during the whole 44-h interdialytic interval compared to patients without the phenomenon. Sustained high 44-h ambulatory BP levels is a potential risk factor for cardiovascular events and mortality in these individuals. The aim of this study is to evaluate the influence of elevated 44-h BP levels on the high cardiovascular risk of individuals with IDH. Method A total of 242 hemodialysis patients with valid 48-h ABPM with Mobil-O-Graph-NG had an extended follow up for a median of 57.8 months. IDH was defined as: rise in SBP greater or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater or equal to 150 mmHg. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. The secondary endpoint was cardiovascular mortality. Results 5 patients with and 197 without were included in this prospective analysis. Cumulative freedom from the primary and secondary endpoint was significantly lower for patients with IDH (logrank-p = 0.019), while freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.321). Patients with IDH presented a significantly higher risk for the composite endpoint (HR = 1.651, 95%CI[1.083, 2.516]), without, however, showing a significant difference in the risk for cardiovascular mortality (HR = 1.320, 95%CI[0.762, 2.288]). After adjustment for 44-h SBP, the association of IDH with the primary endpoint slightly attenuated, while the association with the secondary outcome had no significant changes (HR = 1.421, 95%CI[0.906, 2.228] and HR = 1.270, 95%CI[0.708, 2.276], for primary and secondary outcome respectively). Conclusion IDH is associated with higher risk for adverse cardiovascular outcomes. High ambulatory BP during the interdialytic interval contributes to the excess cardiovascular risk observed in this population.

AMBULATORY BLOOD PRESSURE LEVELS AFFECT THE ASSOCIATION OF INTRADIALYTIC HYPERTENSION WITH ADVERSE CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Objective: Patients with intradialytic hypertension (IDH) display also higher ambulatory blood pressure (BP) levels during the whole 44-h interdialytic interval compared to patients without the phenomenon. Sustained high 44-h ambulatory BP levels is a potential risk factor for cardiovascular events and mortality in these individuals. The aim of this study is to evaluate the influence of elevated 44-h BP levels on the high cardiovascular risk of individuals with IDH. Design and method: A total of 242 hemodialysis patients with valid 48-h ABPM with Mobil-O-Graph-NG had an extended follow up for a median of 57.8 months. IDH was defined as: rise in SBP greater or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater or equal to 150 mmHg. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. The secondary endpoint was cardiovascular mortality. Results: 45 patients with and 197 without were included in this prospective analysis. Cumulative freedom from the primary and secondary endpoint was significantly lower for patients with IDH (logrank-p = 0.019), while freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.321). Patients with IDH presented a significantly higher risk for the composite endpoint (HR = 1.651, 95%CI[1.083, 2.516]), without, however, showing a significant difference in the risk for cardiovascular mortality (HR = 1.320, 95%CI[0.762, 2.288]). After adjustment for 44-h SBP, the association of IDH with the primary endpoint slightly attenuated, while the association with the secondary outcome had no significant changes (HR = 1.421, 95%CI[0.906, 2.228] and HR = 1.270, 95%CI[0.708, 2.276], for primary and secondary outcome respectively). Conclusions: IDH is associated with higher risk for adverse cardiovascular outcomes. High ambulatory BP during the interdialytic interval contributes to the excess cardiovascular risk observed in this population.

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Waist-to-height-ratio is associated with sustained hypertension in children and adolescents with high office blood pressure.

Waist-to-height-ratio (WHtR) has been proposed as another indicator for cardiometabolic risk factors including hypertension. Normally, hypertension can be diagnosed in the office setting by detecting high blood pressure for three occasions. However, patients with high office blood pressure may not exhibit high blood pressure outside the office. Ambulatory blood pressure monitoring (ABPM) is a procedure to measure blood pressure over 24-h. Sustained hypertension is characterized as hypertension detected by both office measurement and ABPM. This study aimed to evaluate the performance of WHtR in the diagnosis of sustained hypertension in patients with high office blood pressure. Demographic data, height, body weight, body mass index (BMI), and waist circumference were retrospectively reviewed in children and adolescents who underwent ABPM due to persistently high office blood pressure. Patients were separated into two groups: a sustained hypertension group and a normal ABPM group. BMI was adjusted to z-score using the WHO Anthroplus software. WHtR was calculated by the formula: waist circumference (cm)/height (m). The performances of different parameters were analyzed using the receiver operating characteristic (ROC) curve and multivariate logistic regression. Sixty patients (63% male) with a mean age of 12.9 ± 3.7 years had persistently high office blood pressure. Twenty-nine (48.3%) had high ambulatory blood pressure parameters so-called "sustained hypertension." The sustained hypertension group had a higher mean BMI z-score (2.32 vs. 1.31, p = 0.01) and a higher mean WHtR (57.7 vs. 49.2 cm/m, p < 0.001) than those of the normal ABPM group. For the diagnosis of sustained hypertension, the ROC analysis revealed that WHtR had a greater area under the ROC curve (AUC) than that of BMI z-score (0.772 vs. 0.723). WHtR remained associated with sustained hypertension (OR 1.2, 95% CI 1.022-1.408, p = 0.026) after adjusting for age, gender, and BMI z-score. Apart from being a more user-friendly metric, WHtR tended to outperform BMI z-score in predicting sustained hypertension in children and adolescents with persistently high office blood pressure.

P05-15 Effects on heart rate, physical activity and ambulatory blood pressure from occupational physical activity with and without lifting among farmers in Denmark

BackgroundHigh levels of occupational physical activity associate to increased risk of cardiovascular disease. However, knowledge regarding the acute effects of different components of the occupational physical activity, such as lifting, on risk factors for cardiovascular disease remains uninvestigated during every day work. Thus, the aim was to investigate the acute effects from exposure to occupational physical activity with and without lifting on heart rate, physical activity and ambulatory blood pressure.MethodsA randomized cross-over study among 18 farming workers in Denmark, all working in the stables of pig- producing farms. Workday measurements of heart rate (Actiheart), physical activity (Axivity placed at front thigh and upper back) and ambulatory blood pressure (Spacelabs 90217, measuring every 20th minute) were collected at a workday with and a workday without occupational lifting. The wash out period between the measurements was 48 hours. Data were processed in the Acti4 software.ResultsDuring workdays with lifting compared to workdays without lifting we observed higher intensity of occupational physical activity (Δ 6.57% heart rate reserve, 95% CI -1.34 – 14.47), number of steps/workday (Δ 4,965 steps, 95% CI -0.01 – 0.01), standing/walking activities (Δ 83 min/workday, 95% CI 2.49 – 168.97), as well as higher heart rate (Δ 9.10 bpm, 95% CI -4.66 – 22.85) and higher ambulatory blood pressures, both systolic (Δ 3.77 mmHg, 95% CI -2.64 – 10.18) and diastolic (Δ 1.37 mmHg, 95% CI -2.52 – 5.26). The average burden of the occupational lifting were 2,425 kg/workday and amount of lifts/workday were 239 lifts.ConclusionsThis pilot project indicated that occupational lifting are adding strenuousness on top of the general occupational physical activity, and influence blood pressure and heart rate at clinically relevant magnitudes. Disentangling the potential relations between one component of occupational physical activity, such as lifting, and risk for cardiovascular disease is key in the development of initiatives for specific prevention, exposure recommendations and vocational rehabilitation.

Prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea.

Approximately 29% of Korean adults have hypertension; however, the prevalence of primary aldosteronism among the hypertensive population is largely unknown. The aim of our study was to evaluate the prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. We retrospectively analyzed 1173 patients with newly diagnosed or preexisting hypertension who were referred to our tertiary-care hospital between January 2013 and December 2018. Patients were screened for primary aldosteronism with the aldosterone-renin ratio and underwent a saline infusion test for diagnostic confirmation. Adrenal computed tomography and adrenal venous sampling were performed for subtype classification for primary aldosteronism. Among the 1173 patients (mean age, 51.8 years; women, 53.2%), 360 (30.7%) had positive screening-test results, of whom 71 (6.1%) were finally diagnosed with primary aldosteronism. Conclusive subtype differentiation was made in 55 patients, of whom 15 (27%) had an aldosterone-producing adenoma, 4 (7%) had unilateral adrenal hyperplasia, and 36 (66%) had bilateral adrenal hyperplasia. Patients with primary aldosteronism had a higher ambulatory blood pressure, left ventricular mass index, and urinary albumin-to-creatinine ratio than those without. Moreover, the primary aldosteronism group had a higher prevalence of left ventricular hypertrophy and albuminuria than the non-primary aldosteronism group. Primary aldosteronism may be more common (6.1%) among Korean patients with hypertension than generally recognized. Primary aldosteronism was associated with a higher degree and prevalence of target organ damage and a higher blood pressure level. Wide application of screening tests for primary aldosteronism may be beneficial in detecting this potentially curable cause of hypertension.

Abstract P033: Higher Ambulatory Sbp Is Associated With Increasing Number Of Target Organ Abnormalities In Youth: The Ship Ahoy Study

Hypertension is associated with elevated left ventricular mass index (LVMI), cardiac dysfunction and increased arterial stiffness in adults which predict cardiovascular (CV) events. The extent to which elevated BP in youth is associated with subclinical CV target organ damage (TOD) is not known. We explored the relation between BP level and number of TOD abnormalities (nTOD). We measured clinic and ambulatory BP (ABP), anthropometrics, and nTOD in 244 adolescents (mean 15.5 + 1.8 years, 67% white, 60% male). Subjects were recruited as low-risk (L=98, SBP%&lt;80 th %), mid-risk (Mid=60, SBP% 80-&lt;90 th %); and high-risk (H=86, SBP% &gt;=90 th %) based on mean of 6 aneroid clinic BPs by age-, sex- and height-specific cut-points. 24-hour ABP was measured with an oscillometric device per pediatric guidelines. Four measures of TOD were: LVMI &gt; 38.6 g/m 2.7 ; LV systolic strain (Strain %) &gt; -18; LV diastolic function (E/e’) &gt; 8; pulse wave velocity (PWV) &gt; 5.8 m/sec. ANOVA was used to evaluate differences in CV risk factors and chi square for differences in nTOD across groups. Logistic regression models were used to determine if clinic and/or ABP was an independent predictor of nTOD after adjustment for age, sex, race, and BMI z-score. BP groups did not differ in BMI z-score. Clinic and ABP systolic and diastolic BP increased across BP groups. The distribution of nTOD was shifted towards higher BP group with most nTOD= 0 (47%) in the L and all (100%) nTOD = 4 in the H group (X 2 = 0.08) and became significant when L (clinic SBP&lt;75 th %) was compared to M+H (clinic SBP &gt; 80 th %; X 2 =0.04). Daytime ABP index (subject daytime systolic ABP/95 th % for daytime systolic ABP) and BMI z-score (both p &lt; 0.003) were significantly associated with nTOD in a model containing clinic SBP, age, sex and race (other covariates NS; full model p &lt; 0.0001, R 2 =0.22). We conclude that higher ABP is associated with a greater number of cardiac and vascular abnormalities in youth. ABP should be applied in youth with elevated BP to evaluate need for intensification of therapy to prevent CV TOD.

Abstract 13446: Rapid Eye Movement Sleep is Associated With Ambulatory Blood Pressure in Hypertension

Introduction: Growing evidence suggests that aberrant sleep architecture is linked to heightened risk of cardiovascular disease independently of sleep apnea. Rapid Eye Movement (REM) sleep is characterized by increased sympathetic activity and blood pressure (BP) compared to non-REM sleep stages. However, whether REM sleep is associated with BP across the 24 hours has not been investigated. Hypothesis: We hypothesized that increased REM sleep would be associated with higher ambulatory BP. Methods: We recruited 137 individuals (58% men, aged 39±14 years, office systolic/diastolic BP [SBP/DBP] 125±14/77±11 mmHg) who completed overnight polysomnography followed by 24-h ambulatory BP monitoring. Sleep was scored according to standard criteria. 24-h, daytime, and nighttime averages were calculated for SBP, DBP and heart rate. REM sleep duration was computed as percentage of total sleep time and used to group participants into tertiles as follows: T1 (REM% ≤18.8), T2 (REM% 18.9-24), and T3 (REM% ≥24.1). Results: Sex ratio, body mass index, and apnea-hypopnea index were similar across REM tertiles, but age increased with increasing tertiles (p=0.029). 24-h SBP (T1 vs T2 vs T3: 121±12 vs 117±7 vs 124±12 mmHg, p=0.015) and DBP (72±7 vs 70±6 vs 76±8 mmHg, p&lt;0.001) differed across REM sleep tertiles, with significantly higher values in those in the highest tertile. Results were consistent when considering daytime SBP (T1 vs T2 vs T3: 126±12 vs 122±8 vs 132±14 mmHg, p&lt;0.001) and DBP (77±7 vs 76±6 vs 83±9 mmHg, p&lt;0.001), and nighttime DBP (65±9 vs 61±7 vs 65±8 mmHg, p=0.047). No differences were noted on nighttime SBP or any heart rate measures. A significant interaction was found between hypertension status and REM sleep in multiple regression analysis, with the observed associations being significant only among hypertensives (n=69). In those with hypertension, REM sleep duration was associated with 24-h mean BP independently of age, sex, body mass index, apnea-hypopnea index and antihypertensive medications (standardized beta 0.22, p=0.041). Conclusions: Longer REM sleep duration is independently associated with elevated ambulatory BP in individuals with hypertension. REM sleep may be a novel cardiovascular risk indicator in this population.

Incidence of intradialytic hypertension in hemodialysis patients in Beheira governorate and effect of high flux versus low flux dialysis on it

Abstract Background Intradialytic hypertension (IDH) is a common complication of hemodialysis (HD) that is under-recognized and its significance is underappreciated. No standard definition of IDH exists. As a unifying criteria for the diagnosis of IDH has not been proposed, the focus of this review will be on systolic blood pressure (SBP) rise = 10 mmHg at = 4 over six consecutive sessions. IDH is estimated at 5–15% of HD patients. IDH has been associated with poor clinical outcomes in HD patients including increased hospitalizations, higher ambulatory blood pressure (BP), cardiovascular morbidity, and mortality. Aim of the Work To detect the incidence of IDH in HD patients in Beheira governorate and to compare the effect of high flux versus low flux dialysis on it. Patients and Methods This study was conducted on 200 patients on maintenance HD from different HD units in Beheira governorate. The patients were divided into two groups: Group 1: 100 patients on HD with high flux dialyzers and Group 2: 100 patients on HD with low flux dialyzers. Results: Incidence of IDH in HD patients in Beheira governorate was 23.5% at the start, 21% after one month and 13% after three months duration. Results of our study demonstrated that there were no significant differences between both groups as regards effect of high-flux vs low-flux dialysis on IDH after one month and at the end of the study (P &amp;gt; 0.05), but there was a significant decrease in number of IDH patients after one month duration and after three months in both high-flux and low-flux dialysis patients. In our study, there was significant improvement in the form of reductions in all of pre-dialysis BUN, post-dialysis BUN, serum creatinine levels and serum IPTH levels at the end of the study in high flux group compared to low flux group. Finally, our results showed significant improvement in serum hemoglobin levels in high flux group by the end of the study in contrast to the low flux group. Conclusion No significant difference in the effect of high flux versus low flux dialysis on IDH, but there was significant improvement in all of pre-dialysis BUN, post-dialysis BUN, serum creatinine levels and serum IPTH levels by the end of the study in the high flux group compared to the low flux group.

Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents

Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1–4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.

Relationship Between Salt Intake and Blood Pressure in Hypertensive Patients in Beijing

Abstract Background To survey the relationship between salt intake and blood pressure in hypertensive patients in Beijing. Methods A cross-sectional survey was used. Essential hypertensive patients were enrolled and divided into three groups (low, medium, and high salt intake) according to their 24 h urinary sodium excretion, which was used to access the salt intake. Blood pressure was measured through office measurement and ambulatory blood pressure monitoring. Results A total of 2,241 patients were enrolled with a mean age of 59.5 ± 13.8 years, mean blood pressure of 141.1 ± 18.5/84.6 ± 12.7 mm Hg, and urinary sodium excretion of 163.9 (95% CI 160.3–167.4) mmol [equal to salt intake 9.59 (9.38–9.79) g/d]. There were 1,544 cases from tertiary hospitals and the other 697 cases from community hospitals. Patients from community hospitals took more salt than patients from tertiary hospitals. Patients with high salt intake were younger than patients with low and medium salt intake. There were more males in high salt intake group than in the other two groups. Ambulatory blood pressure monitoring showed that patients with high salt intake had higher mean blood pressure not only in daytime, but also at night. The diastolic blood pressure in patients with medium salt intake was higher than that in patients with low salt intake. Conclusions Higher salt intake was associated with higher ambulatory blood pressure in hypertensive patients. More effort should be made to lower salt intake to improve blood pressure control rate.

Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes

Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.

Abstract P369: Non-Adherence to Antihypertensive Medications is Associated with Higher BP and Anxiety Levels.

Background: Anxiety has been linked to higher blood pressure (BP) levels and a higher incidence of cardiovascular outcomes. Anxiety is also associated with antihypertensive medication non-adherence assessed indirectly by questionnaires, pill counts or pharmacy refill rates. In this study, we determine the association between anxiety and antihypertensive medication adherence measured directly by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS). Methods: In this prospective study, 237 patients were recruited from the Hypertension Clinic at the University of Alabama at Birmingham. The State-Trait Anxiety Inventory (STAI) questionnaire, 24-hr urine collection for HP LC-MS/MS and 24-hour ambulatory blood pressure monitoring (ABPM) were done in all subjects as part of the study protocol. Patients who did not complete a 24-hr urine collection and/or an STAI questionnaire were excluded from the analysis. Results: Of the 180 patients included in the study, 137 participants were found to be adherent (taking all antihypertensive medications) (76%) and 43 patients were non-adherent to antihypertensive medications (24%). Group comparison using t-test revealed higher state (p=0.043) and trait (p=0.044) anxiety scores and higher ambulatory blood pressure levels (p&lt;0.001) among non-adherent compared to adherent patients (Table 1). Conclusion: This is the first prospective study to demonstrate a strong association between antihypertensive medication adherence, higher anxiety levels and poorly controlled hypertension. These findings highlight the importance of a multidisciplinary approach in the management of hypertensive patients.

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus

ABSTRACTObjectives: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus.Methods: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.Results: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1–5).Conclusion: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Increased masked hypertension prevalence in patients with obesity

ABSTRACTObjectives: Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index.Methods: The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients’ height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.Results: Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight.Conclusion: This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.

Masked Hypertension is Associated With Cognitive Decline in Geriatric Age-Geriatric MASked Hypertension and Cognition (G-MASH-cog) Study.

Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions. One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology. Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant. This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage.