High Prevalence Of Masked Hypertension Research Articles

P063 DIFFERENCES IN CARDIOVASCULAR RISK IN THE GENERAL POPULATION OF LOW AND HIGH-ALTITUDE RESIDENTS IN PERU. HIGH ALTITUDE CARDIOVASCULAR RESEARCH – LATIN AMERICA POPULATION STUDY

Background and Objective. Previous data in a convenience sample of highlanders showed an elevated prevalence of masked hypertension. However, comparative studies describing the prevalence of blood pressure (BP) phenotypes in the general population atof different altitudes are lacking. Our aim was to compare the prevalence of BP phenotypes defined by office BP measurement and ambulatory BP monitoring (ABPM) in a population-based sample of Peruvian lowlanders and highlanders. Methods. Sex- and age-stratified random general adult population sample was recruited in urban areas at low (Lima, <500m) and high altitude (Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). Questionnaires, anthropometric data, conventional BP (3 seated measurements with a validated oscillometric device), 24-hour ambulatory BP (A&D TM2430, Japan), and blood analyses were obtained. BP was defined as elevated if either systolic or diastolic BP was: 1) office (OBP) ≥140/90; 2) 24-hour ≥130/80; 3) Daytime ≥135/85; 4) Night-time ≥120/70 (all in mmHg). BP phenotypes were defined as: normotension (NT) – no BP values elevated; white coat hypertension (WCH) – only OBP elevated; masked hypertension (MH) – any ambulatory BP elevated, normal OBP; sustained hypertension (SH) – OBP and any ambulatory BP elevated Results. The analysis included 181 lowlanders and 553 highlanders. Highlanders had slightly lower age (45 vs. 47 years, p=0.005), BMI (26.7 vs. 28.6 kg/m2, p<0.001), and oxygen saturation (88.9 vs. 97.8%, p<0.001) but higher haemoglobin (17.5 vs. 14.4 g/l, p<0.001) than lowlanders. Prevalence of elevated OBP was low at high altitude. Elevated ambulatory BP was much more frequent at both altitudes. Consequently there was a high prevalence of masked hypertension, which was a dominating high BP phenotype among highlanders. Main results are reported in the Table. The altitude of residence remained independently associated with elevated 24-hour BP (p<0.001) in a multiple logistic regression model including age, sex and BMI as covariates. Conclusions. Many individuals in Peru, especially highlanders, are exposed to BP-related risk, which cannot be captured by office measurements alone.

Prevalence and associated factors of masked hypertension in nursing professionals working in oncology

Introduction: Considering the process linked to working conditions, nursing professionals are exposed to situations that can increase the risk of cardiovascular diseases. Objective: To evaluate the prevalence and factors associated with masked hypertension (MHT) in nursing professionals. Methods: This was a cross-sectional study of 182 nursing professionals. Office blood pressure measurement and 24-hour Ambulatory Blood Pressure Monitoring (ABPM) were applied during a usual workday using Spacelabs 90207. An interview was conducted to evaluate biopsychosocial related to work and life habits variables. Fasting venous blood was drawn for biochemical analysis. MHT was defined as office blood pressure (SBP/DBP) ≤140/90 mmHg and mean daytime ABPM ≥ 135/85 mmHg and non-use of antihypertensive treatment. Poisson regression with robust variance was used to examine the relationship of MHT with associated factors. Results: The prevalence of MHT was 19.8% (95% confidence interval:15.67-23.93). The nursing professionals with masked hypertension had significantly higher than no MH: mean 24-hour, daytime, and nighttime systolic/diastolic BP in the ABPM. HMT was associated with age (1.06; 95%; confidence interval: 1.03-1.10) and shift work (2.18; 95%; confidence interval: 1.10-4.31). Conclusions: There was a high prevalence of MHT, and these outcomes were associated with age and shift work.

Role of hypertension in progression of pediatric CKD.

Hypertension is frequent in children with chronic kidney disease (CKD). Its prevalence varies according to CKD stage and cause. It is relatively uncommon in children with congenital kidney disease, while acquired kidney disease is associated with a higher prevalence of hypertension. Studies in children with CKD utilizing ambulatory blood pressure monitoring also showed a high prevalence of masked hypertension. Uncontrolled and longstanding hypertension in children is associated with progression of CKD. Aggressive treatment of high blood pressure should be an essential part of care to delay CKD progression in children.

Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension.

The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension. Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP. Although both groups had similar office SBP (132 ± 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 ± 14 vs. 126 ± 13; P < 0.001) and daytime ambulatory SBP (142 ± 16 vs. 130 ± 13; P < 0.001), and less nocturnal dipping (-3 ± 5 vs. -9 ± 4; P < 0.001). The COA group also had a higher prevalence of masked hypertension [36 (31%) vs 14 (12%); P < 0.001), and worse arterial function indices. These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating essential hypertension guidelines recommendations to the treatment of COA. It also provides the rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.

Paradoxical increase in ambulatory systolic blood pressure in coarctation of aorta as compared to idiopathic hypertension

Abstract Background The relationship between office vs ambulatory blood pressure (BP) indices is well-studied in patients with idiopathic hypertension, and based on these data, it is known that average 24-hour ambulatory BP is typically lower than office BP. However, emerging data show that office systolic BP (SBP) underestimates arterial afterload in patients with coarctation of aorta (COA), and minimal increase in stroke volume during low intensity exercise results in exaggerated rise in SBP as compared to those with idiopathic hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with idiopathic hypertension. Methods Case-control study of 118 COA patients and 118 patients with idiopathic hypertension matched by age, sex, body mass index and office SBP. Results Although both groups had similar office SBP (132±17 mmHg) by design, the COA group had paradoxical increases in 24-hour ambulatory SBP (135±14 vs 126±13, p&amp;lt;0.001) and daytime ambulatory SBP (142±16 vs 130±13, p&amp;lt;0.001), and less nocturnal dipping (−3±5 vs −9±4, p&amp;lt;0.001). The COA group also had a higher prevalence of masked hypertension (36 [31%] vs 14 [12%], p&amp;lt;0.001), and worse arterial function indices. Conclusion These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating idiopathic hypertension guidelines recommendations to the treatment of COA. It also provides rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population. Funding Acknowledgement Type of funding sources: None.

WHITE-COAT HYPERTENSION AND MASKED HYPERTENSION IN HYPERTENSIVE KIDNEY TRANSPLANT RECIPIENTS

Objective: Patients suffering from chronic kidney disease (CKD) have inadequate control of blood pressure (BP) ranging between 30 to 40%. In addition 35% of them have white-coat hypertension or masked hypertension. Recent epidemiologic data in the general population associate both of the aforementioned BP patterns with poor outcomes. The objective of this study is to examine the prevalence of these hypertension phenotypes in hypertensive kidney transplant recipients. Design and method: 150 kidney transplant recipients were included in this study. They underwent 24-hour ABPM with the Mobil-O-Graph NG device. Hypertension was defined as: (1) office BP (oBP) &gt; or = 140/90 mmHg or use of antihypertensive agents, (2) ambulatory BP &gt; or = 130/80 mmHg or use of antihypertensive agents. Patterns of BP control were defined as follows: (1) truly controlled BP (oBP &lt; 140/90 and 24-hr BP &lt; 130/80mmHg), (2) uncontrolled hypertension (oBP &gt; or = 140/90 and 24-hr BP &gt; or = 130/80mmHg), (3) white-coat hypertension (oBP &gt; or = 140/90 and 24-hr BP &lt; 130/80mmHg), (4) masked hypertension (oBP &lt; 140/90 and 24-hr BP &gt; or = 130/80mmHg). Results: The prevalence of hypertension was 88.0% according to office BP readings and 93.3% according to ABPM (p = 0,112). 125 individuals (89,3% of the total) were hypertensives receiving antihypertensive agents. Among them, according to office BP readings and 24-hr ABPM, 44 (31,0%) hypertensive patients had BP control and 30 (21,1%) had uncontrolled hypertension. Moreover, among the hypertensive patients, 10 (7,0 %) had the white-coat hypertension phenotype and 58 (40,8%) had masked hypertension (Fig 1). Conclusions: The use of ABPM in kidney transplant recipients reveals low control of BP, low prevalence of white-coat hypertension and markedly high prevalence of masked hypertension. The last finding is particularly important, considering the established association between masked hypertension and increased cardiovascular risk.

Hypertension in Children and Adolescents with Turner Syndrome (TS), Neurofibromatosis 1 (NF1), and Williams Syndrome (WS).

Turner syndrome (TS), neurofibromatosis type 1(NF1), and William Syndrome (WS) are 3 genetic conditions that are all associated with a substantial increase in risk of hypertension. In this review, we focus on factors leading to hypertension and on clinical manifestations and management of hypertension in children and adolescents with these genetic conditions RECENT FINDINGS: In most instances, hypertension is secondary. There is a high prevalence of masked hypertension in TS; however, the extent to which control of the BP helps reduce the risk of aortic dissection/aneurysm in TS is not yet fully elucidated. Vasculopathies are the least emphasized but most important manifestation of NF1. Of note, routine screening for pheochromocytoma in NFI is not recommended as it is not cost-effective. Cardiovascular complications are the major cause of death in patients with WBS. ABPM identifies patients without overt aortic or renovascular narrowing. Antihypertensive agents such as ARBs that have direct vascular wall effects and agents that inhibit oxidative stress (minoxidil) should be considered, even in those who do not exhibit overt hypertension. Elevated blood pressure in children and adolescence manifests early with end-organ changes and when left untreated, increases risk for premature onset of cardiovascular disease. Vigilant monitoring of the blood pressure is recommended. Accurate early diagnosis and management of hypertension will delay or prevent target organ damage and ensure a healthier transition to adulthood among children afflicted with these conditions.

Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study

Introduction: Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). Patients and Methods: Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. Results: Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m² (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. Conclusions: ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM.

Office and Ambulatory Arterial Hypertension in Highlanders: HIGHCARE-ANDES Highlanders Study.

Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.

Differences in resting and ambulatory blood pressure data in coarctation of aorta vs idiopathic hypertension

Abstract Background Ambulatory systolic blood pressure (SBP) is more sensitive than resting-SBP in detecting hypertension in patients with coarctation of aorta (COA) and patients with idiopathic hypertension. A recent study showed that compared to patients with idiopathic hypertension with similar resting-SBP, COA patients had lower arterial compliance, and hence experienced higher SBP per unit increase in stroke volume during exercise. The purpose of this study was to compare resting vs ambulatory-SBP relationship between COA patients and non-COA patients (with and without hypertension), and to determine if ambulatory-SBP had better correlation with left ventricular (LV) remodeling as compared to resting-SBP. Methods Case-control study of 106 COA patients and 106 patients with idiopathic hypertension (ControlHTN+ group) matched by age, sex, body mass index and resting-SBP. Resting/ambulatory BP relationship in COA patients and patients with idiopathic hypertension were also compared to that of 19 patients without hypertension (ControlHTN- group). LV remodeling was assessed using LV mass index, e', and E/e'. Results Although the COA and ControlHTN+ groups had similar resting-SBP (by design), the COA group had a higher ambulatory-SBP and a higher prevalence of masked hypertension (30% vs 12%, p&amp;lt;0.001). There was a stronger correlation between ambulatory-SBP (as compared to resting-SBP) and LVMI (r=0.36 vs r=0.55, p=0.042), and average E/e' (r=0.42 vs r=0.59, p=0.046), in the COA group but not the ControlHTN+ group. There was no difference in the resting/ambulatory BP relationship between ControlHTN+ and ControlHTN- groups, but both groups were significantly different from the COA group. Conclusion These results highlight the unique differences in disease pathophysiology between hypertension in patients with COA and those with idiopathic hypertension, and also suggest that ambulatory-SBP may be a more accurate measure of LV pressure overload in COA patients. This underscores the potential limitations of relying on resting-SBP alone for clinical decision making. Funding Acknowledgement Type of funding source: None

Is Masked Hypertension an underlying Cause of Unexplained Left Ventricle Hypertrophy?

ABSTRACT Objectives Unexplained left ventricular hypertrophy (ULVH) is defined as increased wall thickness in the absence of conditions that predispose to hypertrophy. The aim of this study was to evaluate the rate of masked hypertension in patient with unexplained left ventricle hypertrophy. Method A total of 120 consecutive unexplained left ventricle hypertrophy patients without overt hypertension and diabetes and 121 healthy control subjects were included in the study. 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, and transthoracic echocardiography. Results Mean age were similar between patients with ULVH and controls. There was no significant difference in total cholesterol, HDL, LDL cholesterol and triglyceride levels, left ventricle ejection fraction, between the groups. Prevalence of Masked hypertension was significantly higher in patients with ULVH than controls (28.3% vs 6.6%, p < .001). Left ventricular mass index (141.9 ± 16.8 g/cm2 vs. 67.3 ± 10.3 g/cm2, p < .001) was significantly higher in masked hypertensive patients with ULVH compared to normotensive ULVH and control subjects. Conclusion In this study, we found high prevalence of masked hypertension in ULVH patients. Patients with ULVH should be screened by ABPM to detect possible masked hypertension.

Ambulatory blood pressure monitoring-based definition of true arterial hypertension.

Daytime office blood pressure measurements (OBPM), still recommended and utilized today for diagnosis and management of hypertension and categorization of cardiovascular disease (CVD) risk, fail to reveal clinically important features of the mostly predictable BP 24 h pattern and leads to a large proportion of individuals being misclassified. Most clinical guidelines now recommend ambulatory BP monitoring (ABPM) be applied to adult patients to confirm the OBPM-based diagnosis of hypertension, based on the high prevalence of masked hypertension and masked normotension plus demonstrated significantly better CVD prognostic value of around-the-clock ABPM than daytime OBPM. Nonetheless, there is yet no consensus of which parameter(s) and ABPM thresholds to utilize to diagnose hypertension. Findings of large prospective ABPM-based CVD outcome trials permit prospective evaluation of treatment and other induced changes in OBPM and ABPM during follow-up on CVD risk by incorporating multiple periodic (at least annual) patient ABPM assessments. They indicate: 1) asleep systolic BP (SBP) mean and sleep-time relative SBP decline (dipping) together are the most significant and only BP-derived prognostic markers of CVD risk; accordingly, around-the-clock ABPM should be the recommended method to diagnose true arterial hypertension and accurately assess CVD risk; and (2) treatment-induced lowering of the asleep SBP mean and rise of the sleep-time relative SBP decline towards the normal dipper BP pattern are both significantly protective against CVD events, thus constituting novel therapeutic targets to substantially better reduce CVD risk compared to the traditional approach that targets control of daytime OBPM or awake BP mean.

Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls?

Cardiovascular morbidity is high in patients with coarctation of aorta even after successful repair. This study aimed to assess the frequency of late hypertension and the relationship between ambulatory hypertension and cardiovascular target organ damage in children and adolescents after early and successful repair of coarctation of the aorta. Twenty-five children and adolescents (mean age 13.5 ± 3.43 years) with repaired coarctation of the aorta (median age at repair 4 months, arm-leg gradient <20 mmHg) and 16 healthy controls were included. Office and ambulatory blood pressure, pulse wave velocity, and left ventricular mass index were assessed. Both day- and night-time systolic blood pressure standard deviation score and left ventricular mass index were significantly higher in patients compared to controls (p ≤ 0.001 for all), whereas pulse wave velocity did not differ. The prevalence of masked hypertension, isolated nocturnal hypertension, and left ventricular hypertrophy were 40, 28, and 24%, respectively. Left ventricular mass index was higher in patients with sustained hypertension, masked hypertension, and normotension compared to controls (p < 0.05). In multivariate analysis, higher night-time systolic blood pressure standard deviation score was the only independent predictor of left ventricular mass index. The present study reveals a high prevalence of masked hypertension, isolated nocturnal hypertension, and left ventricular hypertrophy in children and adolescents with coarctation of the aorta even after early and successful repair. Ambulatory blood pressure monitoring should be considered to diagnose hypertension. All coarctation of aorta patients should be followed up lifelong and encouraged to establish a healthy lifestyle starting from childhood.

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network.

Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia.

MASKED HYPERTENSION IN NURSING PROFESSIONALS

Objective: The aims of the study were to evaluate the prevalence and factors associated with Masked Hypertension in nursing professionals. Design and method: This was a cross-sectional study of 182 nursing professionals (38.07.5 years, 82.4% women). Office blood pressure measurement and 24-hour Ambulatory Blood Pressure Monitoring (ABPM) were applied in a usual work day. An interview was conducted to evaluate biopsychosocial, related to work and life habits variables. Fasting venous blood was drawn for biochemical analysis. Masked Hypertension was defined as office blood pressure less or equal 140/90 mmHg and mean daytime ABPM greater or equal 135/85 mmHg and non-use of antihypertensive treatment. Poisson regression with robust variance was performed, with values of p < 0.05 being considered statistically significant. Results: The prevalence of Masked Hypertension was 19.8% [95% confidence interval:15.67–23.93). The characteristics of the study sample were: shift work (61.0%), referred stress (44.0%), use of alcoholic beverage (28.6%), problematic consumption of alcohol (34.6%), dyslipidemia (24.2%), high risk for diabetes (20.3%), moderate work-related stress (73.6%), common mental disorders (60.4%), poor sleep quality (91.8%), burnout (41.8%) and had no blood pressure drop during sleep (nondippers) – systolic blood pressure 40.7%, diastolic blood pressure 30.2%). The nursing professionals with masked hypertension, had significantly higher than no masked hypertension: mean 24-hour, daytime and nighttime systolic/diastolic blood pressure in the 24-hour Ambulatory Blood Pressure Monitoring. Participants with masked hypertension were more elderly (age greater or equal 30 years); were married or separated / divorced / widowed or Conjugal/common law relationship; shift work (prevalence ratio: 2.40, [95% confidence interval:1.24–4.64), using drugs to inhibit sleep (prevalence ratio: 5.25, [95% confidence interval: 2.94–9.34), problematic consumption of alcohol (prevalence ratio: 5.19, 95% confidence interval:1.73–15.55) or not consuming alcohol (prevalence ratio: 3.93, 95% confidence interval:1.49–10.38) and referred hypertension (prevalence ratio: 0.24, 95% confidence interval: 0.13–0.44). Conclusions: Nursing professionals presented a high prevalence of Masked Hypertension which was associated with hypertension, variables related to work and habits or lifestyles. The 24-hour Ambulatory Blood Pressure Monitoring should be routine in occupational health checks in health workers, especially shift workers.

Abstract MP65: Maternal Vascular Lesions in the Placenta May Identify Women Susceptible to Masked Hypertension a Decade After Pregnancy

Introduction: Women with placentally mediated pregnancy complications such as preeclampsia have excess hypertension and cardiovascular disease later in life, but the underlying pathophysiology linking these conditions is unknown. Hypothesis: We considered that histological examination of the placenta may reveal maternal vascular impairments that identify a group susceptible to blood pressure (BP) elevations a decade after delivery, including elevations that may only be detectable using out of office BP measurement. Method: Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years after delivery (n=248). Pregnancy features and placental pathology were abstracted from medical records. Women with placental vasculopathy (several related lesions arising from impaired remodeling of maternal myometrial and decidual arteries, n=24) or infarcts (n=32) were compared to women with neither lesion (n=192). Clinic BP was measured three times by trained research staff using a standard protocol and a validated home BP device. Women were trained to measure their BP twice daily for 7 days using the same device mentioned above. Subsequently, time and date stamped BP measures were downloaded (mean 12.2 measures ± 4.5). BP status (elevated, stage 1, stage 2) was identified using the 2018 ACC/AHA guidelines for clinic and home BP measures. Sustained normotensive, white coat, masked, and sustained hypertension status were classified. Results: Women were, on average, 37 years of age at measurement. In analysis controlled for age and race (p-value &lt; 0.05) those with placental vasculopathy had higher mean diastolic BP in clinic and at home (80.5 ± 13.3 mmHg, 79.9 ± 10.4, respectively) than women without vascular lesions in the placenta (75.4 ± 9.8 mmHg and 74.3 ±8.6, respectively). In addition, women with placental vasculopathy had a higher prevalence of masked hypertension (higher elevated BP status measured at home vs. in clinic; 37.5% vs. 14.1%) that persisted after accounting for maternal age and race (adjusted OR 4.7, 95% confidence interval 1.6, 13.8). Vasculopathy associations were similar after excluding women with preeclampsia (n=42), the pregnancy complication most strongly associated with placental vascular pathology. There were modest, non-significant associations between placental infarcts and all measures of maternal blood pressure. Conclusions: Irrespective of prior preecclampsia, women with placental evidence of vasculopathy have excess hypertension and particularly masked hypertension in the decade after pregnancy. Our results emphasize the value of out of office blood pressure measurement, and indicate that placental vasculopathy may be pathophysiologically related to development of hypertension before age 50.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

A16036 Large Discrepancy between Unobserved Automated Office Blood Pressure and Ambulatory Blood Pressure in a High Cardiovascular Risk Cohort

Objectives: Recently, automated office blood pressure (AOBP) has been shown to eliminate the white-coat effect and to be more concordant with ambulatory blood pressure monitor (ABPM) and home blood pressure (BP) measurements. The purpose of this study was to compare BP measured by AOBP with that by ABPM in high cardiovascular risk patients. Methods: The study participants were recruited from a prospective cohort study (Cardiovascular and Metabolic Disease Etiology Research Center–High Risk Cohort [CMERC-HI]; clinicaltrials.gov: NCT02003781). 1,208 participants who had undergone both AOBP and ABPM within 7days of each measurement were analyzed for this study. Results: The 95% limits of agreement between systolic AOBP and daytime ABPM systolic blood pressure (SBP) were − 34.78 to 20.19 mmHg (mean difference = − 7.30 ± 14.0). The mean differences in quintiles of AOBP distributions increased with decreasing AOBP measurements [ − 17.8 ± 11.2 (Q1, systolic AOBP < 113), − 10.9 ± 11.1 (Q2, systolic AOBP 113–121), − 8.5 ± 10.7 (Q3, systolic AOBP 121–128), − 4.2 ± 11.8 (Q4, systolic AOBP 128–137), 4.9 ± 14.2 (Q5, systolic AOBP > 137), p < 0.001]. The prevalence of masked uncontrolled hypertension was 310 (25.7%), and the prevalence of white-coat effects was 102 (8.4%). Large discrepancy was significantly associated with lower systolic AOBP, higher ASCVD risk score, and history of cardiovascular disease. Conclusion: Lower range of systolic AOBP showed a large discrepancy with daytime ABPM SBP and a high prevalence of masked hypertension in high-risk patients. The status of BP control should be confirmed by out-of-office BP measurements, even when using AOBP as a clinical BP of reference in high-risk patients.

Abstract P234: Obstructive Sleep Apnea is More Common in Patients With Masked Uncontrolled Hypertension

Introduction: Masked uncontrolled hypertension (MUCH) is defined as controlled automated office blood pressure (AOBP) in clinic, but uncontrolled out-of-clinic BP by 24-hr ambulatory blood pressure monitoring (ABPM). Prior studies indicate that the prevalence of masked hypertension in patients with newly diagnosed obstructive sleep apnea (OSA) is nearly 30%. In addition, patients with OSA have a higher prevalence of masked hypertension than patients without OSA. Aim: Prospective determination of the prevalence and severity of OSA in patients with MUCH. Methods: In this prospective evaluation, 167 treated hypertensive patients were recruited from the University of Alabama at Birmingham Hypertension Clinic after having controlled BP at three or more clinic visits. All patients were evaluated by AOBP with the BpTRU device, ABPM, and diagnostic polysomnography (PSG) to determine the presence and severity of OSA based on the apnea-hypopnea index (AHI). Out of 153 who completed ABPM, 58 patients were controlled by AOBP and by ABPM, indicating true controlled hypertension and the remaining 95 patients were controlled by AOBP, but uncontrolled by ABPM, indicative of MUCH. 49 true controlled hypertensive and 69 MUCH patients completed PSG. Results: MUCH patients had a mean AHI of 10.3±13.3 compared to 4.5±10.2 events/hr in true controlled hypertension (p =0.045). Overall, the prevalence of OSA was 48.5% in patients with MUCH compared to 26.5% in true controlled hypertension (p = 0.01). Conclusion: MUCH has significant higher prevalence and severity of OSA compared to true controlled hypertension. These findings suggest that untreated OSA may contribute to the development of MUCH.

Ambulatory Hypertension in a Pediatric Cohort of Sickle Cell Disease

▪Background and Objectives: Hypertension is an established risk factor for subsequent cardiovascular and renal disease in children as well as adults. Sickle Cell Disease (SCD) is a genetic disorder associated with anemia with the major manifestation of vaso-occlusive crises. While this disease entity involves most organ systems causing vascular and pulmonary injury, little is known about blood pressure (BP) levels or prevalence of hypertension in children and adolescents with SCD.Methods: We enrolled 41 children with severe genotypes of SCD (39 with Hb SS disease and 2 with Hb Sβ0 thalassemia). Study participants underwent 24-hour ambulatory blood pressure monitoring (ABPM). Clinical information regarding duration of SCD, SCD-related complications, requirement for chronic blood transfusion and chronic hydroxyurea therapy were obtained. Baseline characteristics obtained on each participant included age, gender, weight, height, body mass index (BMI) percentile, BMI-Z score and clinic BP. Serum creatinine and cystatin C were obtained to assess estimated glomerular filtration rate (eGFR) with age-based formulas. A random urine sample was obtained for standard urinalysis, albumin and creatinine estimation, to calculate urine albumin to creatinine ratio.Results: Based on ABPM study results participants were categorized into three groups as normal ABPM, abnormal ABPM, or hypertension ABPM (ambulatory hypertension, masked hypertension or severe ambulatory hypertension). The term abnormal ABPM designated participants who did not have normal ABPM or hypertension, but had other abnormal parameters on ABPM (presence of pre-hypertension and/or lack of normal nocturnal dipping). SCD children in the three groups were similar with respect to distribution of age, BMI z-scores, renal function, urine albumin excretion, urine osmolality, hemoglobin, history of chronic blood transfusion, and hydroxyurea therapy. Twelve participants (29.3%) met criteria for hypertension based on ABPM. Of the 12 hypertensive participants, three had clinic hypertension with ambulatory hypertension; and nine had masked hypertension detected on ABPM. Youngest child with ABPM confirmed hypertension was six years of age. Another 18 participants (43.9%) had some abnormal ABPM parameters that were largely present in the sleep period of ABPM.Conclusions: Findings from our study indicate that BP abnormalities are not uncommon in SCD children. Overall, the distribution of confirmed hypertension, largely manifested by masked hypertension, is high in pediatric participants with SCD; as young as 6 years of age. The underlying cause for the relatively high prevalence of masked hypertension and abnormal ABPM parameters including absence of nocturnal BP dip in children with SCD is unclear. Based on our findings more attention should be given to monitoring and management of BP in children with SCD. Early identification of hypertension in SCD children can confer benefit because hypertension is an important modifiable risk factor for progression of cardiovascular and renal disease.Acknowledgment: Research reported in this publication was supported by the National Institute Of General Medical Sciences of the National Institutes of Health under Award Number P20GM109021; National Kidney Foundation Young Investigator Grant and DE-CTR-ACCEL grant number U54-GM104941 (PI: Binder-Macleod). [Display omitted] DisclosuresNo relevant conflicts of interest to declare.