Higher Office Systolic Blood Pressure Research Articles

Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients.

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH.

Abstract 13852: Sex Differences in Blood Pressure Reduction and Cardiovascular Outcomes in Patients With Resistant Hypertension Undergoing Radiofrequency Renal Denervation: Global SYMPLICITY Registry DEFINE

Introduction: Hypertension (HTN) prevalence and outcomes differ by sex. Radiofrequency renal denervation (RF RDN) safely reduces blood pressure (BP) in patients with resistant HTN. Hypothesis: After RF RDN, there are no sex-based differences in BP changes and cardiovascular (CV) outcomes. Methods: The Global SYMPLICITY Registry (GSR) DEFINE is an all-comer registry of patients with uncontrolled BP undergoing RF RDN. BP changes (analysis of covariance [ANCOVA] adjusted for baseline BP and age), CV death, stroke, myocardial infarction (MI) rates at 3yrs were compared between sexes with office systolic BP (OSBP) ≥140mmHg, prescribed ≥3 anti-HTN drugs. Results: Patients enrolled up to March 2023 were included (N=2502, female=1062). Females were older (62 vs 59 y; p&lt;0.0001), less likely to have a history of sleep apnea (12.5 vs 25.0% p&lt;0.0001), cardiac disease (45.2 vs 50.3%; p&lt;0.0012) and smoking (19.1 vs 41.3%; p&lt;0.0001). Body mass index, rates of diabetes and chronic kidney disease, number of anti-HTN drugs (5.1±1.5 in both sexes; p=0.88) and 24-hr SBP were similar by sex. Baseline OSBP was higher in females (174±23 vs 169±19mmHg; p&lt;0.0001). After 3yrs, OSBP significantly decreased in both sexes from baseline (female: -21.5mmHg vs male: -20.4mmHg; ANCOVA adjusted difference: 3.2mmHg [95% CI: 0.5 to 6.0; p=0.021]). There was no difference in 24-hr SBP change (Figure 1A) or number of anti-HTN drugs by sex. CV death rate was significantly higher in females (4.1% vs 2.1% vs p=0.024), but MI rate was significantly lower in females (1.3% vs 3.5%; p=0.007). Stroke rate was similar by sex (Figure 1). Conclusion: Females with resistant hypertension referred for RF RDN were older, had higher OSBP with fewer comorbidities compared to males. Despite similar BP reductions up to 3yrs after RF RDN, CV death rate in females was greater than males. These results suggest the need for sex specific analyses and control of HTN in females.

Association of decreased glomerular filtration rate with renal hemodynamic disorders and inflammatory biomarkers in patients with medically-controlled hypertension of high cardiovascular risk

Aim. To assess markers of chronic kidney disease (CKD) in patients with medically-controlled hypertension (HTN) (&lt;140/90 mm Hg), as well as to analyze potential association of decreased glomerular filtration rate (GFR) &lt;60 ml/min/1,73 m2 with clinical data and therapy; to establish significant determinants of GFR decrease in this category of patients.Material and methods. The study included 70 patients with HTN and office blood pressure (BP) &lt;140/90 mm Hg aged 64 (57; 68) years (men, 48,6%), of whom 40 patients were examined within the Russian multicenter CHRONOGRAPH program. Office BP was 130 (120; 140)/80 (72; 82) mm Hg. GFR and albuminuria were assessed. Twenty-four-hour BP monitoring and Doppler ultrasound of renal blood flow with estimation of resistance indices (RI) were performed. The content of highsensitivity C-reactive protein (hsCRP), interleukins (IL) 1β, 6, 10 and lipid transport function parameters was determined.Results. CKD markers were detected in 31,4% of patients (in 27,1% — a decrease in GFR &lt;60 ml/min/1,73 m2; in 12,9% — pathological albuminuria). Patients with CKD markers were older, had higher office systolic BP and nocturnal pulse pressure, higher blood hsCRP and RI levels throughout the renal flow, and lower high-density lipoprotein cholesterol levels. In the presence of CKD markers, calcium channel blockers, aldosterone receptor antagonists and statins were used more often. The results of correlation analysis were used to determine the determinants of GFR decline. In the general group, GFR values had inverse correlations with age (Rs=-0,58, p&lt;0,0001), segmental intrarenal artery RI (Rs= -0,4232, p=0,0005), blood hsCRP (Rs=-0,3998, p=0,0007), IL-1β (Rs=-0,3139, p=0,0086), office BP and some 24-hour BP parameters. In the presence of CKD markers, a direct association of GFR and IL-10 was determined (Rs=0,4293, p=0,046). In the absence of such markers, GFR had an inverse correlation with IL-1β content (Rs=-0,3110, p=0,0333). A multiple linear regression model included following independent determinants of GFR: age, blood hsCRP and RI in the segmental intrarenal arteries.Conclusion. Among patients with medically-controlled HTN of high cardiovascular risk, a high prevalence of CKD markers was revealed (31,4%). Compared with patients with preserved renal function, in the presence of CKD markers, there were higher levels of office systolic BP, nocturnal pulse pressure, blood hsCRP, and intrarenal artery RI. Associations were established between GFR and the levels of hsCRP, IL-1β and IL-10, which confirms the pathological role of inflammatory biomarkers in developing renal dysfunction in high-risk HTN. Age, elevated blood hsCRP levels, and intrarenal artery RI are independent determinants of decreased GFR in patients with medically-controlled HTN of high and very high cardiovascular risk. The data obtained shows the need for early prescription of combination antihypertensive therapy with nephro- and vasoprotective effects in this category of patients, as well as with an ability to depress the chronic subclinical inflammation.

High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Abstract Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium &amp;gt;140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

BackgroundDipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction.ObjectivesTo estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients.MethodsThis was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures.ResultsThe prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40).ConclusionThere was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes.Trial registration ClinicalTrials.gov (NCT02742467).

MULTIPLE MYELOMA PATIENTS UNDERGOING CARFILZOMIB: VALIDATION OF A MANAGEMENT PROTOCOL FOR CARDIOVASCULAR RISK ASSESSMENT AND A NEW SCORE FOR EVENTS PREDICTION

Objective: Cardiovascular adverse events (CVAEs) are closely related to Carfilzomib (CFZ) therapy in multiple myeloma (MM), however no validated management protocols are available. This perspective study investigated the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment. A risk score to predict CVAEs was developed and the type and incidence of CVAEs were assessed. Design and method: 116 MM patients scheduled for CFZ underwent a baseline evaluation including office and out-of-office blood pressure measurements, ECG, echocardiography (included GLS) and arterial stiffness estimation. The repeated evaluations every 3–6 months allow CVAEs detection. Results: During a median of 10.8 months of follow-up, 62 patients (53.4%) experienced one or more CVAEs: 17 (14.7%) had major CVEAs (41.2% arrhythmias, 23.5% acute ischemic cardiopathy as most frequent) and 45 (38.7%) had hypertensive CVAEs. 51.9% of CVAEs occurred within the first 3 months, with 30.9% grade 3 or greater in severity. At baseline the prevalence of uncontrolled blood pressure values (51.7%) and of subclinical organ damage, were substantial. Five baseline parameters have proved to be independent predictors for CVAEs: higher office systolic blood pressure (p = 0.003), higher 24-hours blood pressure variability (p = 0.004), left ventricular hypertrophy (p = 0.021), higher pulse wave velocity value (p = 0.002) and global longitudinal strain impairment (p = 0.033). The resulting CVAEs risk score allows to define a low- and high-risk group, obtaining a sensibility of 94% in detecting CVAEs in the high-risk (AUC 0.76). Conclusions: CFZ therapy is closely linked to CVAEs developing in MM patients. The application of the EMN protocol and the use of the CVAEs risk score might be useful to correctly estimate the cardiovascular risk profile and to identify the higher risk patients, enabling risk mitigation strategies.

Prevalence, Characteristics and Predictive Factors of Microalbuminuria in Resistant Systemic Arterial Hypertension

The present cross-sectional observational study was made in family medicine offices of Timi� County, Romania. The aim of the study was to investigate the prevalence of urinary microalbumin excretion (MAU) in resistant systemic arterial hypertension (RH), to analyze patients� biochemical and clinical characteristics, and the predictive factors for MAU. From a total number of 347 patients, MAU was detected in 76 cases (21.9%). The microalbuminuria positive patients were older, with significant higher office systolic blood pressure (BP) (155 � 13.50 vs 148 � 12.40 mmHg, p [ 0.0001) and diastolic blood pressure (94 � 12.20 vs 88 � 14.6 mmHg, p = 0.0013), higher prevalence of left ventricular hypertrophy, diabetes mellitus, obesity, ischemic and peripheral arterial disease. MAU positive patients presented statistical significant differences in biochemical data concerning: fasting plasma glucose (FPG) (118.80 � 32.02 vs 108.01 � 26.01 mg/dL, p = 0.003), impaired glucose tolerance (IGT) (10.52 % vs 4.94 %), glycated hemoglobin (HbA1c) (6.56 � 0.98% vs 5.96 � 0.91%, p [ 0.001), reduced estimated glomerular filtration rate (eGFR) (56.10 � 15.4 vs 69.30 � 17.5 ml/min/1.73m2, p [ 0.001) and higher potassium levels (4.71 � 0.43 vs 4.59 � 0.44 mg/dL, p = 0.0378). No significant differences were noticed regarding LDL- and HDL-cholesterol, triglycerides, uric acid and serum creatinine. In a logistic multivariate analysis independent predictors for MAU were: systolic BP (odds ratio, OR = 1.024, 95% confidence interval, CI:1.011-1.039, p [ 0.001), HbA1c (OR = 1.324, 95% CI: 1.078-1.724, p = 0.008) and eGFR (OR = 0.989, 95% CI: 0.977-0.999, p = 0.01). Our findings suggest that an important part of RH patients have microalbuminuria and highlight the importance of controlling its predictors, in order to improve patients� outcome.

Intensity of cardiovascular and behavioral risk factors in masked and stable arterial hypertension in young subjects

Objective. To study the intensity of cardiovascular behavioral and other risk factors of masked arterial hypertension (MHTN) and stable arterial hypertension (SHTN) in young subjects (students of medical university). Design and methods . A full-design screening study included 423 young men and women aged 20–27, mean age 22, 59 % were women and 41 % — men. All subjects underwent clinical examination: physical examination — height, weight, body mass index (BMI), waist and hip circumferences, questionnaires to assess behavioral risk factors and history of the complaints; laboratory and instrumental screening: fasting serum creatinine, lipid profile (total cholesterol, triglycerides, high density lipoproteins, low density lipoproteins), 30‑second breath-hold test, standard 12‑lead electrocardiography (ECG); echocardiography and 24‑hour blood pressure monitoring in HTN subjects (with MHTN and SHTN). Results. MHTN was detected in 12,3 % subjects, SHTN — in 9 %; 78,7 % were normotensives. Subjects with SHTN were overweight — BMI 28,4 (27,4; 29,7) kg/m 2. In MHTN subjects, waist and circumferences tended to increase: 77,2 (65,1; 82) and 98 (93,2; 104) cm, respectively. MHTN patients demonstrated higher office systolic blood pressure as compared to normotensives: 120 (110; 130) versus 108,5 (100; 118) mm Hg. However, they had lower BP compared to subjects with SHTN — 139 (132,3; 140) mm Hg. Family history of early cardiovascular diseases was detected in all MHTN patients (100 %), as well as in 50 % SHTN individuals and in 56 % normotensives. The highest prevalence of behavioral risk factors was found in a group of subjects with MHTN, as compared to those with SHTN and normotensives. Conclusions . Subjects with MHTN and SHTN have prevalent indicators of behavioral and other risk factors for HTN, which form its phenotype. The development of MHTN and SHTN in young subjects is associated with the severity of clinical, genetic and behavioral risk factors.

Determinants of masked hypertension in hypertensive patients treated in a primary care setting

Recent data suggest that masked hypertension (MH) carries a cardiovascular risk similar to that of uncontrolled hypertension. The objective of this study was to determine the prevalence and determinants of MH in patients treated for hypertension in a Canadian primary care setting. Office blood pressure (OBP) was measured at baseline and after 3 months of valsartan-based therapy in 5636 hypertensive patients who had recorded their home blood pressure monitoring (HBPM) for seven consecutive days at month 3 using an Omron HEM-711 apparatus. MH was defined in nondiabetic patients as an OBP <140/90 mmHg and an HBPM ≥135/85 mmHg, and in those with diabetes as an OBP <130/80 mmHg and an HBPM ≥125/75 mmHg. Of the 5636 patients, 1025 had diabetes. OBP was controlled at 3 months in 268 (26.1%) of them, but 167 (62.3%) had MH. OBP was controlled in 2728 (59.1%) of the 4611 patients without diabetes, and 935 (34.3%) of them had MH. Overall, 1102 patients had MH, representing 36.8% of patients with controlled OBP and 19.6% of the entire hypertensive study population. Stepwise multiple logistic regression analysis in nondiabetic patients with controlled OBP at 3 months revealed that older age, male sex, higher body mass index and higher office systolic blood pressure were determinants of MH. Our results indicate that one of five hypertensive patients and more than one of three with controlled OBP will have MH. MH is associated with other cardiovascular risk factors, such as diabetes, and in nondiabetics, with male sex, older age and obesity.

Obstructive Sleep Apnea, Masked Hypertension, and Arterial Stiffness in Men

Obstructive sleep apnea (OSA) is an established cause of hypertension. However, it is not clear whether the frequency of masked hypertension in patients with OSA and whether OSA have an independent role on arterial stiffness taking into account ambulatory blood pressure (BP) monitoring (ABPM). We evaluated 61 male normotensive participants as determined by casual clinic BP level <140/90 mm Hg without clinical evidence of cardiovascular disease and on no medications (43 patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) > or = 15 events/hour by polysomnography) and 18 age- and body mass index-matched controls without OSA (AHI <5 events/hour)). Pulse wave velocity (PWV), an index of arterial stiffness, and 24-h ABPM were performed in a blinded fashion. Masked hypertension was defined when abnormal daytime ABPM was > or = 135 or > or = 85 mm Hg. The AHI and lowest oxygen saturation were 2.6 +/- 1.6 and 90 +/- 2 vs. 52.8 +/- 21.0 events/hour and 75 +/- 10% for controls and OSA patients, respectively; P < 0.001. Compared with controls, patients with OSA had higher office systolic BP (113 +/- 9 vs. 118 +/- 10 mm Hg; P = 0.05) and a higher unadjusted proportion of masked hypertension (2 controls (11.1%) vs. 13 patients (30.2%); P < 0.05). PWV was 8.7 +/- 0.7, 9.4 +/- 1.0, and 10.6 +/- 1.1 m/s in the control, OSA without and with masked hypertension groups, respectively (P < 0.01 for each comparison). Multiple regression showed that systolic daytime ABPM and the lowest oxygen saturation were independently related to PWV (adjusted R2 = 0.34; P < 0.01). Patients with OSA presented a higher unadjusted rate of masked hypertension than matched controls. Lowest oxygen saturation has an independent association with arterial stiffness.

Urinary albumin excretion is associated with true resistant hypertension

Resistant (or refractory) hypertension (RH) is a clinical diagnosis based on blood pressure (BP) office measurements. About one third of subjects with suspected RH have indeed pseudo-resistant hypertension and 24-h ambulatory-blood pressure-monitoring aids to precisely identify them. Our aim was to determine those clinical, laboratory or echocardiographic variables that may be associated with subjects with sustained hypertension (namely true RH). We carried out a cross-sectional analysis of 143 patients consecutively enrolled with the clinical diagnosis of RH. All patients underwent clinical-demographic, laboratory evaluation, 2D-echocardiography and 24-h ambulatory-blood pressure-monitoring. Pseudo-resistant hypertension or white-coat RH was defined if office BP was > or =140 and/or 90 mm Hg and 24-h BP <130/80 mm Hg. One-hundred and three (72%) patients had true RH and 40 (28%) patients had white-coat RH. True RH patients had significantly higher diabetes prevalence and higher office-systolic blood pressure (SBP) levels. Regarding target organ damage, left ventricular mass index (LVMI) and 24-h urinary albumin excretion (UAE) were also higher in true RH after adjustment for possible confounders (P=0.031 and P=0.012, respectively). In a logistic regression analysis, only office-SBP (multivariate OR (95%CI): 1.030 (1.003-1.057), P=0.030) and UAE (multivariate OR (95% CI): 2.376 (1.225-4.608), P=0.010) were independently associated with true RH. We conclude that true resistant hypertension is associated with silent target organ damage, especially UAE. In patients with suspected RH, assessment of 24 h ambulatory BP is the most accurate way to detect a population with high risk for target-organ damage.

Abstract 2998: Aortic Stiffness Is Correlated With Albuminuria and Glomerular Filtration Rate in Essential Hypertension: The Hippokration Hellenic Hypertension (3H) Study

Introduction: Arterial stiffness is an established marker of cardiovascular risk, whereas albuminuria and impaired renal function are associated with atherosclerosis progression. Hypothesis: Arterial stiffness may be associated with urinary albumin excretion, expressed as the albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) in a large cohort of hypertensives. Methods: A total of 893 consecutive essential hypertensives [482 men, mean age = 56 years, office blood pressure (BP) = 145/90 mmHg] that were included in the Hippokration Hellenic Hypertension (3H) Study, an ongoing Greek registry of hypertension-related target organ damage, were considered for analysis. In all participants, ACR values were determined as the mean of two non-consecutive morning spot urine and eGFR was calculated using the Modification of Diet in Renal Disease equation. Moreover, aortic stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method (Complior SP). The distribution of PWV was split by the median (8 m/sec) and accordingly subjects were stratified into those with high and low values. Results: Hypertensive patients with high PWV (n = 414) compared to those with low PWV values (n = 479) were older (61 ± 10 vs 51 ± years, p &lt; 0.0001), had higher office systolic BP (150 ± 9 vs 142 ± 6mmHg, p &lt; 0.0001) and left ventricular mass index (107.7 ± 16 vs 99 ± 13 g/m 2 , p &lt; 0.0001). Moreover, hypertensives with high PWV compared to those with low PWV exhibited higher ACR (18.7 ± 9.5 vs 14.8 ± 7.5 mg/g, p &lt; 0.05), whereas had lower eGFR (76 ± 17 vs 82 ± 17 ml/min/1.73m 2 , p = 0.006). In the total population, PWV was related to age (r = 0.525, p &lt; 0.0001), office systolic BP (r = 0.242, p = 0.0001), ACR (r = 0.012, p &lt; 0.001) and negatively associated with eGFR (r = −0.221, p &lt; 0.0001). Analysis of covariance revealed that ACR and eGFR levels remained significantly different between groups after adjustment for confounders (p &lt; 0.05). Conclusions: In essential hypertension, heightened PWV values are associated with pronounced albuminuria and impaired kidney function. These findings further support that aortic stiffening is a hallmark of diffuse renal and vascular atherosclerotic disease.

Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study

To diagnose resistant hypertension using self-measured blood pressure (BP) at home and office BP, and to evaluate the characteristics of resistant hypertensive patients. The subjects were 528 hypertensive patients taking at least three or more different antihypertensive drugs. Subjects were classified into four groups (controlled hypertension, isolated office resistant hypertension, isolated home resistant hypertension and sustained resistant hypertension) on the basis of the cut-off values of home BP (135/85 mmHg) and office BP (140/90 mmHg). The relationship between each resistant hypertension group and various factors was analysed using univariate and multivariate analyses. Of the 528 patients, 17.8% were classified with controlled hypertension, 16.1% with isolated office resistant hypertension, 23.5% with isolated home resistant hypertension and 42.6% with sustained resistant hypertension. The presence of hypercholesterolemia was found to have a significant and independent association with isolated office resistant hypertension. Higher office systolic blood pressure (SBP), a past history of ischaemic heart disease, and a lower prescription rate of potassium-sparing diuretics were found to have a significant and independent association with isolated home resistant hypertension. Patients with sustained resistant hypertension had a significantly lower prescription rate of potassium-sparing diuretics than those with controlled hypertension. The present study demonstrated that resistant hypertension is mediated at least partly by the white-coat effect. Home BP measurements and other relevant factors associated with resistant hypertension, such as relatively higher office SBP, type of drugs prescribed, and cardiovascular complications, should be taken into account for the diagnosis and treatment of resistant hypertension.

Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study

To evaluate the current status of blood pressure (BP) control as measured at home and in the office, as well as to clarify and compare the prevalence and characteristics of isolated uncontrolled hypertension as measured at home (home hypertension) and in the office (office hypertension). A cross-sectional study. Primary care offices in Japan. A sample of 3400 patients with essential hypertension (mean age, 66 years; males, 45%) receiving antihypertensive treatment. Overall, the mean home systolic BP (SBP)/diastolic BP (DBP) was 140/82 mmHg, and the mean office SBP/DBP was 143/81 mmHg. Of the 3400 subjects, 19% had controlled hypertension (home SBP/DBP < 135/85 mmHg and office SBP/DBP < 140/90 mmHg), 23% had isolated uncontrolled home hypertension (home SBP/DBP >/= 135/85 mmHg and office SBP/DBP < 140/90 mmHg), 15% had isolated uncontrolled office hypertension (home SBP/DBP < 135/85 mmHg and office SBP/DBP < 140/90 mmHg), and 43% had uncontrolled hypertension (home SBP/DBP >/= 135/85 mmHg and office SBP/DBP >/= 140/90 mmHg). Compared to controlled hypertension, factors associated with isolated uncontrolled home hypertension included obesity, relatively higher office SBP, habitual drinking, and the use of two or more prescribed antihypertensive drugs. Compared to uncontrolled hypertension, factors associated with isolated uncontrolled office hypertension included female gender, lower body mass index, and relatively lower office SBP. The use of all four, three of four, or all three predictive factors might be useful for the clinician to suspect isolated uncontrolled home or office hypertension.

Supernormal left ventricular performance in young subjects with mild hypertension: an alerting response to the echocardiographic procedure?

1. To assess the clinical significance of supernormal left ventricular systolic function in the initial phase of hypertension, 635 never-treated 18-45-year-old borderline to mild hypertensive subjects (477 males, 158 females) were studied. All subjects underwent echocardiography, 24 h ambulatory blood pressure monitoring and 24 h urine collection for catecholamine dosage. 2. Subjects whose left ventricular shortening-stress relationship was above the 95% confidence intervals of 50 normotensive subjects of similar age and sex distribution were defined as having supernormal function. 3. Age, duration of hypertension and left ventricular mass were similar in the hypertensive subjects with normal (85%) and supernormal (15%) ejective performance. Subjects with supernormal function showed higher office systolic blood pressure (P < 0001), office heart rate (P = 0.03) and cardiac index (P < 0001). Conversely, 24 h systolic blood pressure, 24 h heart rate and 24 h catecholamine output did not differ according to left ventricular function. 4. In conclusion, the greater white-coat effect and the normal baseline sympathetic tone exhibited by the patients with increased performance suggest that supernormal left ventricular pump function is only a marker of the alerting reaction elicited by the echocardiographic examination.