Masked Hypertension In Patients Research Articles

Masked hypertension is highly prevalent among patients with high-normal office blood pressure - based on the results of the Hungarian ABPM Registry

Abstract Background Current European guidelines recommend initiating antihypertensive treatment for patients with high-normal office blood pressure (HNOBP) if their cardiovascular (CV) risk is very high.1 Ambulatory blood pressure monitoring (ABPM) is a recommended tool to identify whitecoat- (WCH) and masked hypertension (MH), and both conditions can be present in patients with HNOBP. Purpose The purpose of our study was to assess the prevalence of white-coat and masked hypertension in patients with HNOBP, the proportion of very high CV risk, and to identify the predictors of WCH and MH. Methods We collected data from the Hungarian ABPM Registry, which is an ongoing, multicenter, open-label, observational study including 38720 adult patients. ABPMs were performed with validated Meditech ABPM-06 monitors. We analyzed the ABPM curves of 4389 HNOBP patients. In the diagnosis of hypertension, 24 hour-, daytime- and nighttime mean BP values were each considered separately. OBP measurements and ABPMs were performed by GPs, internists and cardiologists. 89 patients were excluded due to missing data. Results ABPM recordings confirmed MH in 67.4%(n=2899) of the cases, while WCH in 15.3%(n=659). In 17.3%(n=742) BP was in HN category both in the office and with ABPM (apparent high-normal blood pressure /appHNBP/). WCH patients (57.11±17.47) were older, than appHNBP (54.54±16.9), and MH patients (53.38±16.70)(p<0.001). WCH (19.4%, n=489) and appHNBP (19.4%, n=488) were more frequent among females, than in males (14.3%, n=254; 9.6%, n=170, respectively, p<0.001). However, MH was more prevalent in males compared to females (76.2%(n=1355) vs 61.2%(n=1544), respectively, p<0.001). Snoring, obesity and diabetes mellitus were more frequent in MH than in appHNBP and WHC patients (Snoring: 30.6%(n=887) vs. 25.7%(n=191) vs. 20.8%(n=137), p<0.001; Obesity: 22.9%(n=663) vs. 16.0%(n=119) vs. 13.4%(n=88), p<0.001;Diabetes mellitus: 12.1%(n=350) vs. 8.9%(n=66) vs. 9.9%(n=65), respectively, p=0.025). Independent predictors of WCH were age (OR=1.01[1.003;1.02]), female sex (OR=1.50[1.19;1.89]) and snoring (OR=0.76[0.59;0.97]). Independent predictors of MH were male sex (OR=1.69[1.43;2.00]), snoring (OR=1.27[1.06;1.53]) and obesity (OR=1.55[1.25;1.92]). 76% of all patients received antihypertensive treatment irrespective of the BP groups (WCH: 76.2%(n=502), appHNBP: 76.3%(n=566), MH: 76.5%(n=2217), p=NS). 11.7%(n=502) of all patients had very high CV risk and only 2.5%(n=25) did not receive antihypertensive treatment. Similar results were found among WCH, appHNBP and MH patients (very high CV risk: 13.8%(n=91) vs. 11.2%(n=83) vs.11.7%(n=328), p=NS; no treatment: 1.9%(n=3) vs. 1.7%(n=3) vs. 2.8%(n=19), p=NS). Conclusions In patients with HNOBP, MH is highly prevalent. MH might be suspected in young, obese, male patients with diabetes mellitus and snoring. WCH was more frequent in older females. Based on our data, the majority of patients with HNOBP and very high CV risk are treated.

Antihypertensive treatment of masked hypertension guided by ambulatory blood pressure monitoring: a double-blind, placebo-controlled trial

Abstract Background Masked hypertension, office normotension combined with out-of-office hypertension, is associated with target organ damage (TOD), but whether antihypertensive treatment guided by out-of-office blood pressure (BP) would reduce TOD is unproven. Purpose To assess TOD change on antihypertensive treatment guided by ambulatory BP monitoring. Methods We conducted a double-blind, placebo-controlled randomized trial at 15 Chinese hospitals. Enrolment started on February 14, 2017 and follow-up ended on October 31, 2021. Patients of either sex, aged 30-70 years, not on antihypertensive drugs were eligible, if at two screening visits 1-week apart office BP was <140/<90 mm Hg and the 24 hour, daytime or nighttime ambulatory BP was ≥130/≥80, ≥135/≥85, or ≥120/≥70 mm Hg, respectively. Patients had ≥1 sign of TOD: ECG left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5 mg/mmol in women and ≥2.5 mg/mmol in men. Active antihypertensive treatment consisted of allisartan starting at 80 mg/day to be increased to 160 mg/day at month 2 and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint included normalization of baPWV, ACR or LVH or ≥20% reduction in baPWV or ACR. Results Of 320 patients (43.1% women; mean age 54 years), 153 were randomized to active antihypertensive treatment and 167 to placebo. At baseline, office BP averaged 130/81 mm Hg and the 24 hour BP 136/84 mm Hg. The prevalence of elevated baPWV, ACR and LVH was 97.5%, 12.5%, and 7.8%. The 24-hour systolic/diastolic decreased by 9.0/5.6 mm Hg (95% CI: 7.5-10.5/4.8-6.5 mm Hg) on active treatment and by 1.4/1.0 mm Hg (-0.1-2.8/0.2-1.8 mm Hg) on placebo. Regression of TOD, the primary outcome, occurred more frequently in patients randomized to active treatment than in those assigned to placebo with 1 year rate of 45.8% (95% CI: 37.9-53.7%) and 25.8% (19.1-32.4%), respectively (P<.001 for between-group differences in BP and TOD). Per-protocol and subgroup analyses were confirmatory. Conclusions Masked hypertensive patients require antihypertensive treatment guided by out-of-office BP monitoring before subclinical TOD progresses to major cardiovascular complications.

White-coat effect and masked hypertension in patients with high-normal office blood pressure: results of the Hungarian ABPM Registry.

Blood pressure (BP) lowering therapy in hypertension can markedly reduce the risk of cardiovascular diseases. In case of high-normal office blood pressure (oBP), the initiation of antihypertensive medication is recommended by guidelines in patients with very high cardiovascular risk. The aims of this study were to evaluate the presence of white-coat high-normal BP (WhHNBP) and masked hypertension in high-normal oBP and to explore the prevalence of untreated very high cardiovascular risk patients. Data of the Hungarian Ambulatory Blood Pressure Monitoring (ABPM) Registry between September 2020 and November 2023 were used in our analysis. From 38 720 uploaded ABPM curves with clinical data, 4300 individuals were categorized as having high-normal oBP. Among those, 3285 (76.4%) were on antihypertensive treatment. Based on the ABPM recordings, high-normal BP was confirmed in 20.5% ( n = 881), while WhHNBP was present in 27.6% ( n = 1188) and masked hypertension in 51.9% ( n = 2231). Similar results were found in treated and untreated subjects or patients as well. Independent predictors of WhHNBP were age [odds ratio (OR) 1.02 (95% confidence interval, 95% CI: 1.01-1.02), P < 0.001], female sex [OR: 1.59 (1.32-1.92), P < 0.001] and snoring [OR: 0.70 (0.57-0.86), P < 0.001]. Independent predictors of masked hypertension were male sex [OR: 1.31 (1.12-1.54), P < 0.001] and obesity [OR: 1.71 (1.39-2.09), P < 0.001]. Five hundred and two individuals had very high cardiovascular risk with high-normal oBP and only 25 of them were untreated. In high-normal oBP, WhHNBP or masked hypertension is present in three out of four individuals. Most of the patients with high-normal oBP and very high cardiovascular risk are already treated with antihypertensive drugs.

Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis.

Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.

The prevalence of masked hypertension in patients with lone atrial fibrillation: a cross sectional analytical study

Atrial fibrillation (AF) is prevalent in individuals with essential hypertension (HTN). Masked hypertension occurs in up to 15% of the general population and is associated with adverse clinical outcome. The aim of the current study was to evaluate the prevalence of masked hypertension in apparently normotensive individuals with lone AF. A cross sectional analytical study performed at the Rabin Medical Center included all patients > 18 years who visited the emergency department (ED) in the years 2018–2021 with idiopathic AF, had normal blood pressure (BP) values during their ED visit and did not have a history of hypertension or current use of anti-hypertensives. Ambulatory blood pressure monitoring (ABPM) was performed in all eligible patients within 30 days from ED visit. Data collected included information from the ED visit and data extracted from the monitoring device. A total of 1258 patients were screened for eligibility, of which 40 were included in the analysis. The average age was 53.4 ± 16 years, 28 patients (70%) were males. Overall, 18 individuals (46%) had abnormal BP values according to the 2017 ACC/AHA guidelines for the diagnosis of hypertension. Of these, 12 had abnormal 24-h BP average (≥ 125/75 mmHg), one had isolated daytime abnormal average (≥ 130/80 mmHg) and 11 had isolated night time abnormal average (≥ 110/65 mmHg). Masked hypertension is prevalent in patients with lone AF without a diagnosis of HTN and performing ABPM in such individuals should be strongly considered.

PREDICTIVE FACTORS OF MASKED HYPERTENSION IN TYPE 2 DIABETES

Objective: - Primary objective: to identify masked hypertension predictive risk factors in normotensive type 2 diabetic patients in clinical measurement. Design and method: This was a case-control study. We performed 24-hour ambulatory BP in 358 type 2 diabetic patients normotensive in clinical measurement. We compared both Masked Hypertension and Normotensive groups according to clinical/laboratory parameters and target organ damage, and identify MH predictor risk factors among diabetic population Results: The percentage of participants with masked hypertension was 30,7%, in 54,5% of the cases, it is a noctural hypertension. 38,2% of the masked hypertension patients has normal high blood pressure in routine office measurement, 53,63 % of our MH are obese, 64,5% had metabolic syndrome as classified by NCEP/ATP III. Predictors of masked hypertension are: Normal high blood pressure in consultation, the presence of left ventricular hypertrophy and a microalbuminuria. In this hypertensive masked population, target organs achievement is frequent: 6,8% have peripheral arterial disease, 64,8% have left ventricular hypertrophy, 48% have microalbuminuria, 72,9% have intima-media thickness &gt; 0,9 and 56,3% have arterial stiffness evidence by a PWV&gt; 10 m/sec. Conclusions: Predictive factors assessment for masked hypertension helps to better assess cardiovascular risk in normotensive type 2 diabetic patients in routine practice.

White Coat Effect: Is It Because of the Hospital Setting, or Is It Physician-Induced?

White coat hypertension (WCH) patients are those individuals who have high blood pressure (BP) in the medical environment but are normal during their daily activities. White coat hypertensive patients with normal daytime ambulatory blood pressure monitoring (ABPM) rapidly progress to sustained hypertension. WCH is mainly treated with non-pharmacological methods. Alpha-1 agonists and beta blockers are logical treatment choices for patients with fixed hypertension with the White Coat Effect (WCE). Masked hypertension patients are those individuals who have normal values at the doctor's office but elevated BP at home or during 24-hour ABPM (24-hour or daytime). ABPM is a more practical and reliable method for detecting patients with WCH. This observational study was conducted at Dayanand Medical College & Hospital, Ludhiana, over the course of one year (December 2015 to November 2016). The primary objective of the study was to determine whether there was a difference in blood pressure readings between the home setting and the hospital setting. The secondary objective was to determine whether the difference, if present, between the hospital and home readings was due to the hospital setting, physician presence, or a combination of both. Patients with stage 1 hypertension were included in the study, irrespective of antihypertensive treatment. Patients with ischemic heart disease, chronic liver failure, and chronic kidney disease who could not follow protocol instructions were excluded. In our study, the mean age of patients was 53.91±12.86 years. The patient's mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings at the hospital were higher than their home readings (p-0.012; p-0.001, respectively). Mean hospital SBP and DBP readings recorded by the physician were higher than readings recorded by patients alone at home (p-0.002; p-0.014, respectively) and alone at the hospital (p-0.004; p-0.001, respectively). BP readings taken by the physician with a manual sphygmomanometer were significantly lower than those taken with a digital sphygmomanometer by patients and physicians in all settings (p<0.05). The mean rise in BP was significant in both the physician's presence and the hospital environment (p<0.05 for both), and this rise was more significantly associated with the hospital effect than the physician effect (p<0.05). Misdiagnosis of hypertension results in inappropriate prescription and overuse of antihypertensive medications for individuals who are not persistently hypertensive. So it is very important to rule out WCH in both the hospital setting and the physician's presence, more precisely by ABPM. WCH can be diagnosed with regular BP monitoring by a digital sphygmomanometer at home.

S-32-3: RECENT IDACO ANALYSIS ON THE RISK OF PROGRESSION TO SUSTAINED HYPERTENSION FROM WHITE-COAT HYPERTENSION OR MASKED HYPERTENSION

In the general population, the cardiovascular risk is increased in patients with masked hypertension (MH), whereas in individuals with white-coat hypertension (WCH) it is virtually the same as in the normotensive individuals. However, no conclusive evidence exists as to whether WCH and MH are accompanied by a greater rate of development of a sustained hypertensive state, i.e. hypertension both in and outside the clinical environment. We investigated the risk of progression to sustained hypertension in initially untreated participants of cohort studies included in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) study. Within the IDACO, 5 populations comprising 1081 individuals had ambulatory (ABP) and conventional (CBP) blood pressure measured at baseline and at follow up. We excluded from the analysis subjects on BP-lowering treatment at baseline (n = 252) and individuals with untreated sustained hypertension at baseline (n = 80), leaving 749 subjects included in the current analysis. The cut-off value for elevated CBP was &gt; = 140/90 mm Hg and for daytime ABP &gt; = 135/85 mm Hg. At baseline, 110 individuals (14.7%) was defined as MH, 64 subjects as WCH (8.5%), and 575 (76.8%) as normotensives. MH patients were older (50 vs 45 years compared to normotensives, P &lt; 0.01) and more frequently male (50.9 vs 31.5% compared to normotensives, P &lt; 0.01). During median follow-up of 9.7 years, there were 264 incident cases of sustained hypertension. In the analyses adjusted for cohort, sex, age, body mass index, smoking and drinking, both MH (HR 2.23, 95%CI 1.57 to 3.17) and WCH (HR 1.84, 95%CI 1.37 to 2.47) significantly increased risk of progression to sustained hypertension. In conclusion, long-term risk of progression to sustained hypertension is 2-fold higher in individuals with masked hypertension or white coat hypertension at baseline as compared to normotensive subjects at baseline. However, this observation might be due to more frequent initiation of antihypertensive therapy in both groups.

Unmasking left ventricular systolic dysfunction in masked hypertension: looking at myocardial strain. A review and meta-analysis.

A growing body of evidence supports the view that masked hypertension (MH) (i.e. normal office and elevated out-of-office BP) is a blood pressure (BP) phenotype associated with increased risk of subclinical organ damage, cardiovascular disease and death as compared to true normotension. Whether left ventricular (LV) systolic function is impaired in individuals with MH is still a poorly defined topic. Therefore, we aimed to provide a new piece of information on LV systolic dysfunction in the untreated MH setting, focusing on speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of systolic function than conventional LV ejection fraction (LVEF). A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until June 30, 2022. Full articles reporting data on LV GLS in MH, as assessed by ambulatory BP monitoring (ABPM), and normotensive controls were considered suitable for the purposes of review and meta-analysis. A total of 329 untreated individuals with MH and 376 normotensive controls were included in six studies. While pooled average LVEF was not different between groups [64.5 ± 1.5 and 64.5 ± 1.3%, respectively, standard means difference (SMD): -0.002 ± 0.08, confidence interval (CI): 0.15/-0.15, P = 0.98), LV GLS was worse in MH patients than in normotensive counterparts (-18.5 ± 0.70 vs. -20.0 ± 0.34%, SMD: 0.68 ± 0.28, CI: 0.12/1.24, P < 0.01). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the MH setting can be unmasked by STE and that its implementation of STE in current practice may improve the detection of subclinical organ damage of adverse prognostic significance.

Nomogram based on clinical features at a single outpatient visit to predict masked hypertension and masked uncontrolled hypertension: A study of diagnostic accuracy

Patients with masked hypertension (MH) and masked uncontrolled hypertension (MUCH) are easily overlooked, and both cause target organ damage. We propose a prediction model for MH and MUCH patients based on clinical features at a single outpatient visit. Data collection was planned before the index test and reference standard were after. Thus, we retrospectively collect analyzed 804 subjects who underwent ambulatory blood pressure monitoring (ABPM) at Renmin Hospital of Wuhan University. These patients were divided into normotension/controlled hypertension group (n = 121), MH/MUCH (n = 347), and sustained hypertension (SH)/sustained uncontrolled hypertension group (SUCH) (n = 302) for baseline characteristic analysis. Models were constructed by logistic regression, a nomogram was visualized, and internal validation by bootstrapping. All groups were performed according to the definition proposed by the Chinese Hypertension Association. Compared with normotension/controlled hypertension, patients with MH/MUCH had higher office blood pressure (BP) and were more likely to have poor liver and kidney function, metabolic disorder and myocardial damage. By analysis, [office systolic blood pressure (OSBP)] (P = .004) and [office diastolic blood pressure (ODBP)] (P = .007) were independent predictors of MH and MUCH. By logistic regression backward stepping method, office BP, body mass index (BMI), total cholesterol (Tch), high-density lipoprotein cholesterol (HDL-C), and left ventricular mass index are contained in this model [area under curve (AUC) = 0.755] and its mean absolute error is 0.015. Therefore, the prediction model established by the clinical characteristics or relevant data obtained from a single outpatient clinic can accurately predict MH and MUCH.

The importance of ambulatory blood pressure monitoring for diagnosing masked hypertension in patients with renal parenchymal scarring.

The most well-known and common long-term complication in children with renal parenchymal scarring (RPS) is hypertension (HT). The present study aimed to evaluate the presence of HT in children with RPS based on ambulatory blood pressure monitoring (ABPM) and to compare the patients' blood pressure (BP) to that in healthy controls matched for age, gender, and BMI. The study included 55 patients aged < 18years diagnosed with RPS who were followed up for ≥ 1year and 48 healthy controls matched for age, gender, and BMI. Mean age in the RPS group was 12.8 ± 3.3years, and 49.1% of the group were female. Among the RPS patients, 28 were diagnosed with HT based on ABPM, of which 18 (32.7%) had an office BP < 90th percentile for age, gender, and height; seven had an office BP between the 90-95th percentiles for age, gender, and height; and three had an office BP > 95 percentile for age, gender, and height. The difference in detection of HT based on ABPM between the two groups was significant (P = 0.00). Early diagnosis of HT via ABPM can help prevent development of kidney failure and cardiovascular disease in patients with RPS, significantly reducing the rates of morbidity and mortality. All children with RPS should be evaluated via ABPM, even if office BP measurements are normal. "A higher resolution version of the Graphical abstract is available as Supplementary information".

The relationship of masked hypertension with autonomic dysfunction and cardiometabolic parameters: a case-control study.

Masked hypertension (MH) is associated with cardiovascular events and mortality. Data on the association between exaggerated blood pressure response (EBPR) to exercise, heart rate recovery (HRR), which are indicators of autonomic dysfunction, and MH are lacking. This study aimed at evaluating the association between EBPR, HRR, and MH. Between January 2020 and January 2021, 130 MH (57 male, median age = 52.8 years) and 60 healthy (28 male, median age = 40.8 years) subjects were included in this single-center, case-control, and cross-sectional study. Office blood pressure measurement, 24-hour ambulatory blood pressure monitoring, treadmill test, echocardiography, and specific biochemical parameters were evaluated. The frequency of blunted HRR (73 subjects, 56.2%) and EBPR (40 subjects, 30.8%) were significantly higher in patients with MH (p < 0.001). Patients with MH had higher serum uric acid levels and frequency of hyperlipidemia (p < 0.05). Diameters of the left atrium (LA), aortic root, and ascending aorta were significantly higher in MH patients (p < 0.05). Thirty-two (24.6%) patients with MH had left ventricular hypertrophy and 33 (25.4%) had diastolic dysfunction (p < 0.001). Multivariate analysis identified the presence of blunted HRR as an independent predictor factor of MH as well as smoking, hyperlipidemia, GFR, LA diameter, and aortic root diameter were other independent factors. The frequency of blunted HRR and EBPR were significantly higher in the MH group compared to the control group, suggesting a close relationship between MH and autonomic dysfunction.

Ambulatory Blood Pressure Patterns in Children, Adolescents, and Young Adults With Childhood-Onset Systemic Lupus Erythematosus and Normal Office Blood Pressure.

Cardiovascular disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Hypertension (HTN) and nondipping are modifiable risk factors for cardiovascular disease. Limited studies are available for childhood-onset SLE (cSLE). We aimed to assess ambulatory blood pressure monitoring (ABPM) pattern in cSLE patients with normal office blood pressure. This cross-sectional single-center study enrolled 25 patients with cSLE, normal office blood pressure and normal renal function. We performed 24-hour ABPM and echocardiography to assess end-organ damage. Descriptive statistics were obtained, and comparison of variables using Fisher exact test, t test, and Mann-Whitney U test was performed to identify potential risk factors for nondipping. Of the 25 patients, 22 were women; the median age was 18 years (interquartile range, 16-20 years). Median SLE duration was 4.2 years (interquartile range, 2.9-8.1 years); 18 patients had a history of lupus nephritis (LN). Four patients, 3 of whom had LN, had masked HTN. Fourteen patients (56%) were nondipping. The majority of patients without LN (71%) had a nondipping profile. Echocardiography was done for 15 patients. Left ventricular mass index, relative wall thickness, and ejection fraction were normal in all patients. Ambulatory blood pressure monitoring results led to changes in therapy in 5 patients. Our data provide evidence of high prevalence of nondipping and masked HTN in patients with cSLE, even in patients without LN. Identifying ABPM abnormalities in these patients could potentially improve outcomes.

White-coat effect on orthostatic hypotension: a nationwide survey of Japanese general practitioners.

The relationship between the white-coat effect (WCE), defined as white-coat hypertension under treatment, and the frequency of orthostatic hypotension (OH) is not known. We conducted an orthostatic test in patients with WCE to determine the frequency of OH. This was a cross-sectional study of 5631 patients with hypertension visiting general practitioners nationwide, in which 4305 patients with hypertension recorded their home blood pressure (BP) and consented to the orthostatic test. Patients with hypertension were divided into four groups: controlled hypertension (CHT), masked hypertension (MHT), sustained hypertension (SHT), and WCE. The orthostatic test was performed, and BP and pulse rate were measured immediately and 1 min after orthostasis. The OH frequencies immediately after standing in CHT, WCE, SHT, and MHT patients were 7, 11.7, 12.1, and 6.6%, respectively, and those at 1 min after standing were 7.1, 13.1, 11.6 and 6.9%, respectively (Chi-square test, P < 0.01, respectively). Logistic regression analysis was performed to examine the relationship between WCE and the frequency of OH. The frequency of OH immediately after standing was significantly increased [adjusted odds ratio (AOR), 1.702; 95% confidence interval (CI), 1.246-2.326; P < 0.01]. The frequency of OH at 1 min after standing was also significantly higher (AOR, 1.897; 95% CI, 1.396-2.578; P < 0.01). When the standing test was performed for patients with WCE, the frequency of OH increased. Thus, it is important to recognize the possibility of OH in patients with WCE to avoid adverse events associated with excessive hypotension.

MO721: Correlation of Serum BNP Levels with Blood Pressure Variability using ABPM in Patients NAÏVE on Haemodialysis

Abstract BACKGROUND AND AIMS Plasma BNP levels are thought to correlate with blood pressure monitoring in patients on maintenance haemodialysis. An adequate BP control results in decline in mortality rates in these patients. To correlate plasma BNP levels and blood pressure variability using ABPM with echocardiographic findings in non-hypertensive patients with end-stage renal disease naïve on haemodialysis. METHOD Type of study: Institutional-based, a single-centre cross-sectional observational study. Study period : January 2017–2019. Sample size: 80. RESULTS In our study, 75% were males and 25% were females. Out of 80 patients type 2 diabetes mellitus was present in 13 (16.3%), hypertension was present (based on office BP) in 36 (45%), 86.3% of patients had azotemia symptoms at presentation, 72.5% of patients were underweight (BMI &amp;lt; 18.5 kg/m2), 42.5% of patients were categorized as CKD G5A3, hyperuricemia was present in 31.3%. Mean age was 47.6 years, mean height was 165 cm, mean weight was 47.8 kg, mean BMI was 17.54 kg/m2 mean SBP was 129.10 mmHg and mean DBP was 78.05 mmHg. During passive phase ABPM readings, double product was low in 50% of cases, HBI diagnosed hypertension and isolated systolic hypertension, isolated diastolic hypertension in 62.3%, 11.3% and 3.8% of cases, respectively. ABPM diagnosis of non-hypertension or hypertension under control was observed in 22.55 of cases during passive phase. Mean total cholesterol was significantly more in HTN compared with patients without HTN; P &amp;lt; 0.05. Mean BNP was significantly higher in patients with HTN compared with patients without HTN; P &amp;lt; 0.05. There was a significant negative correlation observed between BNP and EF on 2D ECHO, LVH on 2D ECHO and EF (%) on 2D ECHO; P &amp;lt; 0.05. No factor was found to be associated statistically significant with outcome. Comparison of mean BNP levels in relation to dipping status on ABPM in all six groups i.e. HTN group containing three subgroups (non-dippers, normal dippers and reverse dippers) and non-HTN group containing three subgroups (non-dippers, normal dippers and reverse dippers) did not reveal any significance (P &amp;gt; 0.05). Comparison of mean BNP levels in relation to dipping status on ABPM in all six groups, i.e. HTN group containing 3 subgroups (non-dippers, normal dippers and reverse dippers) and non-HTN group containing three subgroups (non-dippers, normal dippers and reverse dippers) did not reveal any significance (P &amp;gt; 0.05). ABPM readings diagnosed underlying masked hypertension in 19 out of 44 (43.1%) patients with normal office BP readings. Subgroup analysis of plasma BNP relation to this masked hypertension patients and actual non-hypertension patients also did not reveal any significant difference in plasma BNP levels (ROC—best cut-off of 23.05 ng/L with sensitivity of 88% and specificity of 26.3%). CONCLUSION ABPM is useful to diagnose significant number of masked hypertension patients in those naïve on dialysis. Plasma BNP level has a low sensitivity and specificity as a screening tool to identify dipping status or to predict outcomes in ESRD patients naïve to haemodialysis.

Analysis of Systolic Blood Pressure Level and Short-Term Variability in Masked Hypertension.

Background Patients with masked hypertension are at an elevated risk of cardiovascular events and all-cause death. This risk is close to that of sustained hypertension. The mean value and short-term variability of systolic blood pressure are considered to be risk factors for organ damage in hypertension. Objective To investigate the mean value and short-term variability of systolic blood pressure in patients with masked hypertension. Methods According to the results of in-clinic and ambulatory blood pressure measurement, participants were divided into four groups: normotension group, controlled hypertension group, masked hypertension group, and sustained hypertension group. The mean value and short-term variability of systolic blood pressure of masked hypertension group were evaluated by comparison with the other three groups. Results A total of 250 subjects were enrolled, with an average age of 65.46 ± 8.76 years, and 166 (66.4%) were male, including 62 in the normotension group, 78 in the controlled hypertension group, 69 in the masked hypertension group, and 41 in the sustained hypertension group. Compared with the normotension group and controlled hypertension group, the mean value, blood pressure load, standard deviation, and coefficient of variation of systolic blood pressure over 24 hours and during the day and night, were all higher in the masked hypertension group (P < 0.05), while the rate of the nocturnal systolic blood pressure decline was lower (P < 0.05). There were no statistically significant differences in the above indexes between the masked hypertension group and sustained hypertension group (P > 0.05). Conclusion There are higher mean value of systolic blood pressure and greater short-term variability in masked hypertension patients. Identification of masked hypertension is an important challenge in the clinic.

Frontal QRS-T angle may predict reverse dipping pattern in masked hypertensives

ABSTRACT Aims The frontal QRS-T (fQRST) angle is associated with worse cardiovascular outcome. The study aimed to assess the effect of reverse dipping pattern on f(QRST) angle in newly diagnosed masked hypertensive (MH) patients. Materials and methods Newly diagnosed 244 consecutive MH patients were included. According to dipping pattern, patients were grouped into three: dipper (n = 114), non-dipper (n = 106), and reverse dipper (n = 24) patterns. The f(QRST) angle, QT and corrected QT interval, and QT dispersion were measured from the 12-lead surface electrocardiogram and compared between groups. Results Of all, 51.2% (n = 125) were male. No gender difference was observed. Reverse dipper MH group had a significantly higher f(QRST) angle than the non-dipper and dipper MH groups (77.9 ± 8.6 vs. 32.4 ± 18.8 and 26.0 ± 18.5, respectively, p < .001). The cutoff value for f(QRST) angle of 51 predicts reverse dipping pattern (AUC: 0.84; 95% CI: 0.77–0.90; p < .001), with a sensitivity of 83% and a specificity of 78%. Conclusion This study revealed that f(QRST) angle is gradually increased starting from the dipper, non-dipper to reverse dipper masked hypertensives. The f(QRST) angle appears as an easy marker for the detection and risk stratification of hypertensive patients.

Relationship between Fragmented QRS and Microvascular Dysfunction in Masked Hypertension

Aim: The aim of this study was to investigate the presence of fQRS and its association with subclinical systolic and microvascular dysfunction in patients with masked hypertension (MH). Methods: The study population consisted of 95 (mean age 48.9 ± 11.3, 61% males) subjects with MH and 80 age- and gender-matched healthy individuals who served as a control group. Coronary flow reserve (CFR) using transthoracic echocardiography and for left ventricular global longitudinal strain (LVGLS) using speckle-tracking strain imaging were performed. Patients with MH were stratified into two groups according to the presence of fQRS on surface electrocardiogram. Results: Fragmented QRS was more common among MH patients compared with controls (38.9% vs. 6.25%, p < 0.003). CFR was significantly lower in patients with fQRS compared with those without fQRS and controls (p < 0.001). Likewise, LVGLS values were lower in MH patients with fQRS (p < 0.001) compared with subjects without fQRS and controls. Fragmented fQRS was significantly correlated with systolic blood pressure, CFR, and LVGLS. Multivariate analysis showed that the presence of fQRS, number of leads, and CFR were independent predictors of subclinical systolic dysfunction. With ROC cure analysis, number of leads with fQRS ≥4 was the optimal value for predicting the presence of subclinical systolic dysfunction in subjects with MH. Conclusions: Fragmented QRS is more frequent among subjects with MH compared with controls. The presence of fQRS is related with pronounced subclinical left ventricular systolic dysfunction. Furthermore, CFR was significantly reduced in subjects with MH, a finding supposed that microvascular dysfunction to be a mechanistic link.

Skin microvascular function, as assessed with laser speckle contrast imaging, is impaired in untreated essential and masked hypertension.

Skin microcirculation has been proposed as a model of generalized microvascular function. Laser speckle contrast imaging (LSCI) is a novel, noninvasive method to assess skin microvascular function (SMF). To date, SMF data in hypertension are conflicting, and no study with LSCI exists. In addition, the application of LSCI in masked hypertension is scarce. We assessed SMF with LSCI coupled with postocclusive reactive hyperemia (PORH) in patients with newly diagnosed untreated essential hypertension (UHT) and masked hypertension (MH) compared to healthy normotensive (NT) individuals. We enrolled consecutive UHT and MH patients and NT individuals matched for age, sex, body mass index, and smoking status. All participants underwent SMF assessment by LSCI coupled with PORH (PeriCam PSI system, Perimed, Sweden). Correlation analyses were performed between SMF and common cardiovascular risk factors and BP parameters. In total, 70 UHT patients, 20 MH patients and 40 NT individuals were enrolled. UHT and MH patients exhibited significantly impaired SMF compared to NT individuals (UHT patients: base-to-peak flux (p < 0.001)), PORH amplitude (p < 0.001); MH patients: base-to-peak flux (p = 0.013), PORH amplitude (p = 0.022). MH patients did not differ compared to UHT patients. SMF was negatively associated with office, ambulatory and central BP. SMF was negatively associated with blood lipids and smoking. Hypertensive status was the single most important predictor of SMF. UHT and MH patients exhibit impaired SMF compared to NT individuals. MH patients did not differ compared to UHT patients. SMF is negatively associated with BP and cardiovascular risk factors. LSCI could be implemented as a useful tool to investigate SMF in hypertension.

Frequency of masked hypertension in patients with nonfunctioning adrenal incidentalomas with normal and high normal blood pressure

Frequency of masked hypertension in patients with nonfunctioning adrenal incidentalomas with normal and high normal blood pressure