Mean 24-hour Systolic Blood Pressure Research Articles

Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome.

The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes. Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension. We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10). Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion. This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.

Effect of Alcohol-Mediated Renal Denervation on Blood Pressure in the Presence of Antihypertensive Medications: Primary Results from the TARGET BP I Randomized Clinical Trial.

Renal denervation (RDN) has demonstrated clinically relevant reductions in blood pressure among individuals with uncontrolled hypertension despite lifestyle intervention and medications. The safety and effectiveness of alcohol-mediated RDN has not been formally studied in this indication. TARGET BP I is a prospective, international, sham-controlled, randomized, patient- and assessor-blinded trial investigating the safety and efficacy of alcohol-mediated RDN. Patients with office systolic blood pressure (SBP) ≥150 and ≤180 mmHg, office diastolic BP ≥90 mmHg and mean 24-hour ambulatory SBP ≥135 and ≤170 mmHg, despite prescription of 2-5 antihypertensive medications were enrolled. The primary endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 3 months post procedure. Secondary endpoints include mean between-group differences in office and ambulatory BP at additional time points. Among 301 patients randomized 1:1 to RDN or sham control, RDN was associated with a significant reduction in 24-hour ambulatory SBP at 3 months (mean ± standard deviation -10.0 ± 14.2 mmHg versus -6.8 ± 12.1 mmHg, treatment difference -3.2 mmHg, 95% confidence interval [CI] -6.3, 0.0 mmHg; P=0.0487). Subgroup analysis of the primary endpoint revealed no significant interaction across predefined subgroups. At 3 months, the mean change in office SBP was -12.7 ± 18.3 mmHg and -9.7 ± 17.3 mmHg (difference, -3.0, 95% CI -7.0, 1.0; P=0.173), for RDN and sham, respectively. No significant differences in ambulatory or office diastolic BP were observed. Adverse safety events through 6 months were uncommon with 1 instance of accessory renal artery dissection in the RDN group (0.7%). No significant between-group differences in medication changes or patient adherence were identified. Alcohol-mediated RDN was associated with a modest but statistically significant reduction in 24-hour ambulatory systolic BP compared with sham control. No significant differences between groups in office BP or 6-month major adverse events were observed.

Interventions aimed to increase average 24-h systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance.

Systolic blood pressure (SBP) drops recorded by 24-h ambulatory blood pressure (BP) monitoring (ABPM) identify patients with susceptibility to reflex syncope and orthostatic intolerance. We tested the hypothesis that treatments aimed to increase BP (reassurance, education, and lifestyle measures plus pharmacological strategies) can reduce SBP drops. This was a multicentre, observational proof-of-concept study performed in patients with reflex syncope and/or orthostatic intolerance and with SBP drops on a screening ABPM. Among 144 eligible patients, 111 underwent a second ABPM on average 2.5 months after start of treatment. Overall, mean 24-h SBP increased from 114.1 ± 12.1 to 121.4 ± 14.5 mmHg (P < 0.0001). The number of SBP drops <90 and <100 mmHg decreased by 61%, 46% during daytime, and by 48% and 37% during 24-h period, respectively (P < 0.0001 for all). The dose-response relationship between difference in 24-h average SBP increase and reduction in number of SBP drops reached a plateau around ∼15 mmHg increase of 24-h SBP. The reduction in SBP drop rate was consistent and significant in patients who underwent deprescription of hypotensive medications (n = 44) and in patients who received BP-rising drugs (n = 67). In patients with reflex syncope and/or orthostatic intolerance, an increase in average 24-h SBP, regardless of the implemented strategy, significantly reduced the number of SBP drops and symptom burden. A 13 mmHg increase in 24-h SBP appears to represent the optimal goal for aborting the maximal number of SBP drops, representing a possible target for future interventions. ClincalTrials.gov identifier: NCT05729724.

The correlation between ambulatory blood pressure parameters and cardiovascular risk factors in older adults with high-risk hypertension

Objective: To explore the correlation of 24-hour ambulatory blood pressure (BP) monitoring (ABPM) parameters and cardiovascular risk factors in older adults with high-risk hypertension. Material and method: A cross-sectional study was conducted on 96 older adults (≥ 60 years old) with treated high-risk hypertension. Socio-demographic and cardiovascular risk information were gathered. The patients were performed 24-hour ABPM. Results: The mean age was 70.88 ± 7.86 years, and 64.6% were women. The prevalence of cardiovascular risk factors was as follows: dyslipidemia: 80.2%, family history of hypertension: 54.2%, diabetes mellitus: 51%, smoking: 24%, prior stroke: 11.5%. Significant differences in 24-hour, awake, and sleep systolic BP were observed between men and women. There were significant correlations between 24-hour mean systolic BP with age (r = 0.229, p = 0.025), dyslipidemia (r = 0.223, p = 0.029), family history of hypertension (r = 0.214, p = 0.036), BMI (r = 0.212, p = 0.039), waist circumference (r = 0.226, p = 0.027) and creatinine level (r = 0.207, p = 0.043). There were significant correlations between 24-hour mean diastolic BP with BMI (r = 0.289, p = 0.004) and prior stroke (r = -0.224, p = 0.029). There were significant correlations between 24-hour mean BP with BMI (r = 0.268, p = 0.009), waist circumference (r = 0.220, p = 0.032) and prior stroke (r = -0.215, p = 0.036). Conclusion: There were significant correlations between ABPM parameters and cardiovascular risk factors in older adults with high-risk hypertension. Key words: 24-hour ambulatory blood pressure, cardiovascular risk factors, high-risk hypertension, older adults, correlation.

Hypoglossal Nerve Stimulation and Cardiovascular Outcomes for Patients With Obstructive Sleep Apnea

Sham-controlled trials are needed to characterize the effect of hypoglossal nerve stimulation (HGNS) therapy on cardiovascular end points in patients with moderate-severe obstructive sleep apnea (OSA). To determine the effect of therapeutic levels of HGNS, compared to sham levels, on blood pressure, sympathetic activity, and vascular function. This double-blind, sham-controlled, randomized crossover therapy trial was conducted from 2018 to 2022 at 3 separate academic medical centers. Adult patients with OSA who already had an HGNS device implanted and were adherent and clinically optimized to HGNS therapy were included. Participants who had fallen asleep while driving within 1 year prior to HGNS implantation were excluded from the trial. Data analysis was performed from January to September 2022. Participants underwent a 4-week period of active HGNS therapy and a 4-week period of sham HGNS therapy in a randomized order. Each 4-week period concluded with collection of 24-hour ambulatory blood pressure monitoring (ABPM), pre-ejection period (PEP), and flow-mediated dilation (FMD) values. The change in mean 24-hour systolic blood pressure was the primary outcome, with other ABPM end points exploratory, and PEP and FMD were cosecondary end points. Participants (n = 60) were older (mean [SD] age, 67.3 [9.9] years), overweight (mean [SD] body mass index, calculated as weight in kilograms divided by height in meters squared, 28.7 [4.6]), predominantly male (38 [63%]), and had severe OSA at baseline (mean [SD] apnea-hypopnea index, 33.1 [14.9] events/h). There were no differences observed between active and sham therapy in 24-hour systolic blood pressure (mean change on active therapy, -0.18 [95% CI, -2.21 to 1.84] mm Hg), PEP (mean change on active therapy, 0.11 [95% CI, -5.43 to 5.66] milliseconds), or FMD (mean change on active therapy, -0.17% [95% CI, -1.88% to 1.54%]). Larger differences between active and sham therapy were observed in a per-protocol analysis set (n = 20) defined as experiencing at least a 50% reduction in apnea-hypopnea index between sham and active treatment. In this sham-controlled HGNS randomized clinical trial, mean 24-hour systolic blood pressure and other cardiovascular measures were not significantly different between sham and active HGNS therapy. Several methodologic lessons can be gleaned to inform future HGNS randomized clinical trials. ClinicalTrials.gov Identifier: NCT03359096.

Immediate post-ablation renal nerve stimulation predicted blood pressure reductions 6 months following renal denervation

Abstract Background Renal denervation (RDN) has been recognized as an alternative treatment strategy for blood pressure (BP) control. There is no consensus on which intra-procedural parameters could reliably predict BP-lowering responses following RDN, which usually occur months later. Purpose This study aimed to evaluate systolic BP (SBP) changes induced by renal nerve stimulation (RNS) during RDN and its associations with BP-lowering responses 6 months following RDN. Methods Seventeen patients with hypertension who underwent radiofrequency RDN between February 2019 and March 2021 were prospectively included. RNS was performed immediately before and after RDN in bilateral proximal and distal main renal arteries under general anesthesia. The responder was defined as 24-hour SBP reduction of ≥10 mmHg 6 months following RDN. Results RNS-induced SBP changes significantly decreased after RDN in all 4 sites of bilateral main renal arteries (all p&amp;lt;0.05). The mean 24-hour SBP were 144±16 mmHg and 131±15 mmHg at baseline and 6 months after RDN, respectively. Nine (53%) patients were responders. Compared to non-responders, the responders had significantly lower RNS-induced SBP changes in proximal main renal arteries immediately after RDN (right, 15.3±9.6 mmHg vs. 31.6±9.6 mmHg, p=0.005; left, 11.6±6.9 mmHg vs. 27.9±10.2 mmHg, p=0.002). All 7 patients with RNS-induced SBP increases of &amp;lt;20 mmHg after RDN in bilateral proximal main renal arteries were responders. Conclusions An RNS-induced SBP increase of &amp;lt;20 mmHg in bilateral proximal main renal arteries immediately after RDN was associated with significant 24-hour SBP reductions 6 months following RDN. Whether RNS-induced SBP changes could predict or even guide RDN strategies awaits further verifications.

Safety and Efficacy of Renal Denervation in Patients Taking Antihypertensive Medications

BackgroundRenal denervation (RDN) reduces blood pressure (BP) in patients with uncontrolled hypertension in the absence of antihypertensive medications. ObjectivesThis trial assessed the safety and efficacy of RDN in the presence of antihypertensive medications. MethodsSPYRAL HTN-ON MED is a prospective, randomized, sham-controlled, patient- and assessor-blinded trial enrolling patients from 56 clinical centers worldwide. Patients were prescribed 1 to 3 antihypertensive medications. Patients were randomized to radiofrequency RDN or sham control procedure. The primary efficacy endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 6 months between groups using a Bayesian trial design and analysis. ResultsThe treatment difference in the mean 24-hour ambulatory systolic BP from baseline to 6 months between the RDN group (n = 206; −6.5 ± 10.7 mm Hg) and sham control group (n = 131; −4.5 ± 10.3 mm Hg) was −1.9 mm Hg (95% CI: −4.4 to 0.5 mm Hg; P = 0.12). There was no significant difference between groups in the primary efficacy analysis with a posterior probability of superiority of 0.51 (Bayesian treatment difference: −0.03 mm Hg [95% CI: −2.82 to 2.77 mm Hg]). However, there were changes and increases in medication intensity among sham control patients. RDN was associated with a reduction in office systolic BP compared with sham control at 6 months (adjusted treatment difference: −4.9 mm Hg; P = 0.0015). Night-time BP reductions and win ratio analysis also favored RDN. There was 1 adverse safety event among 253 assessed patients. ConclusionsThere was no significant difference between groups in the primary analysis. However, multiple secondary endpoint analyses favored RDN over sham control. (SPYRAL HTN-ON MED Study [Global Clinical Study of Renal Denervation With the Symplicity Spyral Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications]; NCT02439775)

Factors and sex differences associated with intermediate probability of heart failure with preserved ejection fraction in asymptomatic patients working in the Arctic

Aim. To determine additional factors and sex differences associated with the intermediate probability of heart failure (HF) with preserved ejection fraction (HFpEF) in asymptomatic patients working in the Arctic on a rotating basis.Material and methods. In the polar village of Yamburg (68° 21' 40 "N), 99 men and 81 women with grade 1 and 2 hypertension (HTN) and normal blood pressure, comparable by age (p=0,450), length of service in the north (p=0,956), office systolic blood pressure (BP) (p=0,251), diastolic BP (p=0,579) were simultaneously examined. We performed echocardiography and assessed the risk of HFpEF by H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure). A treadmill test, Baevsky index, 24-hour BP monitoring, and biochemical blood tests were performed.Results. Depending on H2FPEF score, participants were divided into groups: from 0 to 1 (group 1 — normal), from 2 to 5 (group 2 — intermediate probability of HFpEF). In men with intermediate probability of HFpEF, the Baevsky index (p=0,0048) and the incidence of resting body reserve dysaptation (p=0,0394) were higher, as well as a rapid BP increase during dosed exercise (p=0,0058) and a decrease in chronotropic reserve (p&lt;0,0001) were noted. The presence of HTN in men increased the intermediate probability of HFpEF by 3,6 times, dyspnea at dosed exercise by 10 times, dysaptation to exercise by 5 times, the presence of left ventricular concentric remodeling by 8-10 times. In females with intermediate probability of HFpEF, dysaptation to exercise at rest (p=0,0120) and lower level of oxygen consumption during dosed exercise was more often determined (p=0,0485). The intermediate probability of HFpEF in women increased with autonomic nervous system dysfunction, an increase in the mean 24-hour systolic BP variability, the presence of dyspnea during dosed exercise (10 times), concentric left ventricular remodeling, and an increase in nonspecific inflammation markers (high-sensitivity C-reactive protein, IL-1β, IL-6).Conclusion. Early identification of additional risk factors for intermediate probability of HFpEF in asymptomatic hypertensive patients has the potential to reduce the risk of subsequent clinical heart failure, allowing focus on prevention and intervention strategies in this group of patients.

Abstract 118: Effects Of Aprocitentan, A Dual Endothelin Receptor Antagonist, On Blood Pressure In Black/African American Patients With Resistant Hypertension: Results From A Randomized, Controlled Study (PRECISION) Including A Withdrawal Phase

Background: Resistant hypertension is prevalent among Black/African American drug-treated hypertensives and may increase cardiovascular risk. We evaluated aprocitentan (APRO) for BP lowering in Black patients with resistant hypertension. Methods: Patients had sitting unattended automated office systolic BP (SBP) ≥140 mmHg despite use of ≥3 antihypertensives of different classes in the year prior. After 4 weeks of combination therapy (amlodipine, valsartan, hydrochlorothiazide), those still hypertensive could enter a 4-week single-blind placebo (PBO) run-in period, followed by a 4-week double-blind period wherein patients were randomized 1:1:1 to APRO 12.5 mg, 25 mg, or PBO. A 32-week single-blind period on APRO 25 mg followed. Patients were then re-randomized 1:1 to APRO 25 mg or PBO in a 12-week withdrawal period. The primary endpoint was change from baseline to Week 4 in mean trough SBP. Changes in SBP from withdrawal baseline (Week 36) to Week 40 and in 24-hour, daytime (09:00-21:00), and nighttime (01:00-06:00) ambulatory BP monitoring (ABPM) measures at Weeks 4 and 40 were also assessed. Results: Eighty-two of 730 patients (11.2%) were Black (APRO 12.5 mg, n = 28; 25 mg, n&amp;nbsp;= 28; PBO, n = 26). At Week 4, APRO and PBO produced similar office SBP reductions (least squares mean difference from PBO, 12.5 mg: 0.63 mmHg; 25 mg: 0.12 mmHg). However, APRO produced pronounced reductions vs PBO in mean 24-hour (12.5 mg: –3.23 mmHg; 25 mg: –7.85 mmHg), daytime (12.5 mg: –6.16 mmHg; 25 mg: –9.13 mmHg), and nighttime (12.5 mg: –2.63 mmHg; 25 mg: –8.53 mmHg) ambulatory SBP. Four weeks after withdrawal, office SBP increased with PBO vs APRO 25 mg (difference: +9.87 mmHg), which was confirmed with ambulatory SBP (difference, 25 mg; 24-hour: +8.13 mmHg, daytime: +3.39 mmHg, nighttime: +9.70 mmHg). Safety in Black patients was comparable to the overall population, with no new signals. During the double-blind period, treatment-emergent adverse events were reported in 6/28 (21.4%), 9/29 (31.0%), and 4/25 (16.0%) patients with APRO 12.5 mg, APRO 25 mg, and PBO. Edema or fluid retention occurred in 3/29 patients (10.3%) on APRO 25 mg, and no patients on APRO 12.5 mg or PBO. Conclusion: APRO was well tolerated and produced clinically relevant reductions in SBP by ABPM in Black patients.

HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY REVEALED THAT HYPERTENSION IS HIGHLY PREVALENT BOTH IN ALREADY DIAGNOSED AND TREATED PATIENTS AND IN SUSPECTED HYPERTENSIVES

Objective: In 2021 the Hungarian Society of Hypertension initiated a program to promote the nationwide use of ambulatory blood pressure (BP) monitoring (ABPM) (Hungarian ABPM Registry) aiming to increase the awareness of high BP and to monitor the efficacy of therapies. The goal was to collect and analyze the ABPM values of treated hypertensive (HT) and newly diagnosed patients (nHT) and assess the influence of other risk factors, comorbidities and patient characteristics. Design and method: Adults (18-100 years old) can be included into this ongoing, multicenter, open-label, observational study. Data collection to an electronic case report form is performed by GPs, internists, and cardiologists. Meditech ABPM-06 monitors are used. Data of the current analysis were collected between 21.02.2021-5.10.2022. 15 835 ABPMs were performed; due to missing data or protocol deviation 1018 patients were excluded from the analysis. Results: 10212 patients were HTs, 4571 were nHTs (69% and 31%, respectively). 76% of nHT patients were untreated during ABPM. Mean 24-hour systolic and diastolic BP was 134.03±14.6 mmHg and 79.3±10.1 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between nHT and HT patients (134.08±14.9 mmHg vs. 133.91±14.6 mmHg, respectively, p = NS). Two-third of the patients (all: 68.2%, HT: 68.5%, nHT: 67.6%) were hypertensive according to ABPM measurements. Obesity (BMI&gt;30 kg/m2) doubled the risk of hypertension in both groups (OR = 2.18 [2.03;2.34] for 24-hour average), but it had a higher impact in nHTs (OR = 2.57[2.22;2.98] for 24-hour average in nHT and OR = 2.12[1.94;2.30] for 24-hour average in HT patients). Snoring increased the risk of hypertension in both group of patients (OR = 1.45[1.34;1.56] for 24-hour average) irrespectively of gender, and – interestingly – it had a greater impact on the daily values of BP (day: OR = 1.51[1.40;1.62] and night: OR = 1.32[1.22;1.42]). Conclusions: The new ABPM Hungary Registry revealed hypertension in the majority of screened individuals, regardless of gender or treatment. In addition, in both gender, obesity, snoring, increased the risk of hypertension. These data underline the importance of ABPM in the screening for and treatment of hypertension leading to the earlier and more effective treatment.

CLINICAL SIGNIFICANCE OF ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AS A POTENTIAL INDICATOR OF MASKED HYPERTENSION AMONG THE KOREAN ELDERLY

Objective: Although masked hypertension links to adverse cardiovascular outcomes, it is challenging to distinguish individuals with masked hypertension. Studies have demonstrated a significant association between left ventricular hypertrophy (LVH) and masked hypertension. However, it remains unclear whether electrocardiographic LVH has the predictability for masked hypertension. Design and method: The study participants were 511 Korean elderly with well-controlled blood pressure (BP) or normotension who underwent electrocardiography and ambulatory blood pressure monitoring (ABPM). We categorized them into two groups by presence or absence of electrocardiographic LVH. We conducted Pearson correlation analysis (beta coefficient [95% confidence interval] and logistic regression analysis (odd ratio (OR) [95% CI]) to evaluate the association of electrocardiographic LVH with components of ABPM. The area under the receiver operator curve (AUC) was calculated to assess the predictability of electrocardiographic LVH for 24-hour average masked hypertension. Results: Electrocardiographic LVH significantly correlated with 24-hour mean systolic blood pressure (SBP) (5.83 [2.16-9.51]), daytime SBP (5.0 [1.27-8.72]), and nighttime SBP (7.89 [3.49-12.30]). Electrocardiographic LVH showed the increased OR for masked hypertension in 24-hour average BP (2.18 [1.17-4.07]), in daytime average BP (2.03 [1.09-3.79]), and nighttime average BP (1.83 [0.86-3.88]). The receiver operating curve indicated the significant predictability of electrocardiographic LVH for 24-hour average masked hypertension (area under the curve: 0.706 [0.604-0.809]). Conclusions: Electrocardiographic LVH is potentially effective in distinguishing individuals with masked hypertension.

Machine Learning-Based prediction of Post-Treatment ambulatory blood pressure in patients with hypertension

Purpose. Pre-treatment prediction of individual blood pressure (BP) response to anti-hypertensive medication is important to determine the specific regimen for promptly and safely achieving a target BP. This study aimed to develop supervised machine learning (ML) models for predicting patient-specific treatment effects using 24-hour ambulatory BP monitoring (ABPM) data.Materials and Methods. A total of 1,129 patients who had both baseline and follow-up ABPM data were randomly assigned into training, validation and test sets in a 3:1:1 ratio. Utilising the features including clinical and laboratory findings, initial ABPM data, and anti-hypertensive medication at baseline and at follow-up, ML models were developed to predict post-treatment individual BP response. Each case was labelled by the mean 24-hour and daytime BPs derived from the follow-up ABPM.Results. At baseline, 616 (55%) patients had been treated using mono or combination therapy with 45 anti-hypertensive drugs and the remaining 513 (45%) patients had been untreated (drug-naïve). By using CatBoost, the difference between predicted vs. measured mean 24-hour systolic BP at follow-up was 8.4 ± 7.0 mm Hg (% difference of 6.6% ± 5.7%). The difference between predicted vs. measured mean 24-hour diastolic BP was 5.3 ± 4.3 mm Hg (% difference of 6.8% ± 5.5%). There were significant correlations between the CatBoost-predicted vs. the ABPM-measured changes in the mean 24-hour Systolic (r = 0.74) and diastolic (r = 0.68) BPs from baseline to follow-up. Even in the patients with renal insufficiency or diabetes, the correlations between CatBoost-predicted vs. ABPM-measured BP changes were significant.Conclusion. ML algorithms accurately predict the post-treatment ambulatory BP levels, which may assist clinicians in personalising anti-hypertensive treatment.

Prevalence of pharmacological control of arterial hypertension by ambulatory blood pressure measurement (ABPM) findings

Introduction: Arterial hypertension (AHT) is one of the most prevalent chronic non-transmittable diseases and the main cause of cardiovascular death worldwide (World Health Organization, 2021). Adequate control of blood pressure levels is the best therapeutic measure to manage and prevent hypertension-related complications. In the Dominican Republic, there is insufficient and unreliable data related to pharmacological control through ambulatory blood pressure measurement (ABPM). Methods: Cross-sectional and retrospective study, in which the results of 380 patients, who underwent an ABPM, were analyzed to determine if their blood pressure levels were within therapeutic control. The study was conducted between March 2022 and May 2022. The diagnostic criteria to determine blood pressure control were used from the guidelines of the Specialized Diagnostic Center (CEDISA), and included being older than 18 and having a study duration longer than 18 hours. Likewise, we excluded pregnant patients, patients diagnosed with heart failure, or patients taking triple antihypertensive therapy. For the data summary, we used mean and standard deviation. For statistical testing, we performed a Shapiro-Wilk normality test, and a two-tailed Student's t-test was used to assess the mean difference for which a value of p&lt;0.05 was chosen to demonstrate significance. We performed a Bonferroni correction to adjust the significance value using the mean blood pressure in the repeated measures for the t-test, which reduced the significance from 0.05 to 0.016. Results: The point prevalence of adequate pharmacological control was 44.2% (95% CI 39.21% to 49.19%). The mean systolic blood pressure of controlled patients was 117.8 (±7.5), while that of un-controlled patients was 140.8 (±14.5). Between controlled and uncontrolled patients, the drugs most frequently used for managing hypertension were angiotensin II, receptor antagonists. There is a statistically significant difference between the mean 24-hour and daytime systolic blood pressure between males and females (p. 0.0016 and p. 0.0007, respectively) and 24-hour, daytime, and nighttime systolic blood pressure between controlled and uncontrolled patients (p. 0.000, p. 0.000, p 0.000, respectively) Discussion: The prevalence of adequate pharmacological control in patients suffering from arterial hypertension encompasses 168 patients of the 380 studied, so it is evident that the remaining 212 patients, even when diagnosed, have not managed to obtain controlled blood pressure levels. The study was limited by not being able to investigate the treatment specifications and other risk factors. Regardless of these issues, the study obtained the desired sample size; therefore, it can establish the study’s reported AHT control prevalence as a direct measure of hypertensive patients in the Dominican Republic not being adequately controlled.

Blood Pressure–lowering Effect of Fimasartan Versus Comparators: A Cross-inference With a Systematic Review and Meta-analysis Through a Quality-management System

Fimasartan, one of the newest angiotensin receptor blockers (ARBs) available worldwide, has been investigated extensively since its initial development. Our study group conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating fimasartan and comparators for their blood pressure (BP)-lowering effect. Moreover, we employed a cross-inference (frequentist and Bayesian inference) system, which has never been used in the medical field, to confirm the results of our study. In addition, a quality management system was integrated throughout the study for data quality. PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalKey, and ClinicalTrial.gov were searched for RCT studies from March 1998 to March 2022. In each study, the mean differences (MDs) and 95% CIs were identified for reductions in clinic sitting systolic and diastolic BP (SiSBP/SiDBP) or 24-hour mean systolic BP and diastolic BP by ambulatory BP monitoring (ASBP/ADBP) from baseline between the fimasartan and comparator groups, followed by meta-analysis. A subsequent meta-analysis was performed with frequentist and Bayesian inference as a tool in the cross-checking system. Eleven RCTs with a total of 2459 subjects were included in the study. The clinic SiSBP/SiDBP-lowering effect of fimasartan was significantly greater relative to those of comparators (MD for clinic SiSBP, -2.58 mm Hg [95% CI, -4.35 to -0.81; P=0.004]; MD for clinic SiDBP, -2.13 mm Hg [95% CI, -2.96 to -1.30; P=0.00001]). The ASBP/ADBP-lowering effect of fimasartan was also significantly greater relative to those of comparators (MD for ASBP, -3.58 mm Hg [95% CI, -5.74 to -1.43; P=0.001]; MD for ADBP, -1.99 mm Hg [95% CI, -3.34 to -0.63; P=0.004]). Fimasartan seems to be more effective in lowering BP than its comparators, including other ARBs. Although there is a limited amount of data and a minuscule number of study subjects available, the results of cross-inference (frequentist+Bayesian) were fairly consistent with the meta-analysis results through our quality management system.

Obstructive sleep apnea syndrome and cardiovascular risk factors in the antihypertensive therapy "escape" phenomenon

To assess the role of obstructive sleep apnea and other cardiovascular (CV) risk factors in the development of the antihypertensive therapy (AHT) efficacy "escape" phenomenon in patients with arterial hypertension (AH). The data of 75 patients with AH stage I-II, grades 1-3 were proceeded. All patients included in the study underwent night respiratory monitoring. After AHT prescription, blood pressure (BP) was monitored by three measurement methods (office, daily monitoring and self-control of blood pressure) - initially, in 1, 3 and 6 months after the inclusion - in order to confirm the initial therapy efficacy and to identify or exclude the "escape" phenomenon. In 36.0% of patients, the "escape" phenomenon was diagnosed in 1 or 3 months of observation. When comparing the group with the "escape" phenomenon, an initially higher level of systolic BP was revealed according to office measurements, 24-hour monitoring and self-control BP monitoring (134.0±4.7 mmHg vs 126.0±8.5 mmHg; 129.0±2.3 mmHg vs 121.0±7.7 mmHg; 131.0±8.2 mmHg vs 121.5±6.2 mmHg resp.; р<0,05). There were no differences in sleep apnea and CV risk factors between the groups. However in patients with a minimal SpO2≤85% during sleep, there were a higher levels of office systolic BP both before the AHT prescription, and during its use (157.6±10.4 mmHg vs 152.4±8.1 mmHg resp., р<0,05; 132.0±6.8 vs 127.1±8.9 mmHg resp.; р<0,05), and mean 24-hour systolic BP (125.7±5.9 vs 121.6±8.2 mmHg resp.; р<0,05) - compared with patients with a minimum SpO2>85%. The higher BP level in patients with lover nocturnal hypoxemia does not allow us to exclude the delayed negative impact of obstructive sleep apnea, especially severe, on the BP profile in case of initially successful AH control.

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

Uncontrolled hypertension (ie, a 24-hour ambulatory systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg or clinic systolic blood pressure of ≥140 mm Hg and diastolic blood pressure of ≥90 mm Hg) in young adults is a US public health burden. To evaluate the effect of a telephone coaching and blood pressure self-monitoring intervention compared with usual care on changes in systolic and diastolic blood pressures and behaviors at 6 and 12 months. This randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure testing. This was a geographically diverse, multicentered study within 2 large, Midwestern health care systems. Data were collected from October 2017 to February 2022 and analyzed from February to June 2022. The My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control participants received routine hypertension care. The co-primary clinical outcomes were changes in 24-hour ambulatory and clinic systolic and diastolic blood pressure at 6 and 12 months. The secondary outcomes were hypertension control (defined as ambulatory systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg or clinic systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and changes in hypertension self-management behavior. A total of 316 participants were randomized (159 to the control group and 157 to the intervention group) from October 2017 to December 2020. The median (IQR) age was 35 (31-37) years, 145 of 311 participants (46.6%) were female, and 166 (53.4%) were male; 72 (22.8%) were Black, and 222 (70.3%) were White. There were no differences in baseline characteristics between groups. There was no significant difference between control and intervention groups for mean 24-hour ambulatory systolic or diastolic blood pressure or clinic systolic or diastolic blood pressure at 6 or 12 months. However, there was appreciable clinical reduction in blood pressures in both study groups (eg, mean [SD] change in systolic blood pressure in intervention group at 6 months, -4.19 [9.77] mm Hg; P < .001). Hypertension control did not differ between study groups. Participants in the intervention group demonstrated a significant increase in home blood pressure monitoring at 6 and 12 months (eg, 13 of 152 participants [8.6%] checked blood pressure at home at least once a week at baseline vs 30 of 86 [34.9%] at 12 months; P < .001). There was a significant increase in physical activity, defined as active by the Godin-Shephard Leisure-Time Physical Activity Questionnaire, in the intervention group at 6 months (69 of 100 [69.0%] vs 51 of 104 [49.0%]; P = .004) but not at 12 months (49 of 86 [57.0%] vs 49 of 90 [54.4%]; P = .76). There was a significant reduction in mean (SD) sodium intake among intervention participants at 6 months (3968.20 [1725.17] mg vs 3354.72 [1365.75] mg; P = .003) but not 12 months. There were no significant differences in other dietary measures. The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups; however, both study groups had an appreciable reduction in blood pressure. Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension. ClinicalTrials.gov Identifier: NCT03158051.

Urine Uromodulin Is Not Associated With Blood Pressure in the Chronic Kidney Disease in Children Cohort.

Uromodulin regulates activity of the sodium-potassium-two-chloride transporter in the loop of Henle. In adults, higher urine uromodulin levels are associated with greater rise in blood pressure (BP) in response to salt intake. We hypothesized that higher urine uromodulin levels would be associated with higher BP in children with chronic kidney disease, and that there would be an interaction of dietary sodium on this association. In the chronic kidney disease in children Cohort, we utilized univariable and multivariable linear regression models to evaluate the relationship between baseline spot urine uromodulin levels indexed to urine creatinine (Umod/Cr mg/g) and 24-hour mean systolic and diastolic BP, as well as baseline clinic BP. We also tested whether sodium intake (g/day) modified these relationships. Among 436 participants, the median age was 12.4 years (8.9-15.2), median estimated glomerular filtration rate was 50 mL/min per 1.73 m2 (36-62), and median 24-hour mean systolic BP was 112 mm Hg (104-119). The etiology of chronic kidney disease was glomerular disease in 27%. In univariable models, each 2-fold higher Umod/Cr ratio was associated with a 1.66 mm Hg (95% CI, -2.31 to -1.00) lower 24-hour mean systolic and a 1.71 mm Hg (-2.45 to -0.97) lower clinic systolic BP. However, there was no statistically significant association between Umod/Cr and either 24-hour or clinic BP in multivariable models. We did not find a significant interaction between uromodulin and sodium intake in their effect on BP (P>0.05 in all models). Urine uromodulin levels are not associated with BP in the chronic kidney disease in children cohort. Further studies are needed to confirm this finding in healthy pediatric cohorts.

0785 Cardiovascular Outcomes For Obstructive Sleep Apnea With HGNS Therapy

Abstract Introduction Obstructive sleep apnea (OSA) is linked to cardiovascular disease, particularly when left untreated. Hypoglossal nerve stimulation (HGNS) is a novel and promising PAP alternative as it is well-tolerated and reduces OSA severity; however, its effect on mitigating cardiovascular risk secondary to OSA is unknown. The aim of this study is to evaluate the effect of HGNS on sympathetic and vascular function. Our hypothesis is mean 24-hour systolic blood pressures (SBP) will be improved at “active” levels of HGNS. Methods This study is a double-blinded, sham-controlled, randomized controlled therapy crossover trial. Subjects are randomized for four weeks in each arm to either “active” HGNS or “sham” HGNS, with “sham” HGNS being defined as the lowest voltage at which HGNS was sensed by the patient and/or visualized by the principal investigator. Included patients had already been implanted with the Inspire® device. Patients were excluded for active PAP therapy use, recent automobile accidents, a minimum difference (&amp;lt;30%) between “active” and “sham” voltages, and pregnancy. Results 53 patients met all inclusion criteria. Overall, the study cohort was older (mean [SD] age 66.8 [10.2]), overweight (BMI 28.8 [4.36]), 60% male, and predominantly of white race. There was no significant difference in mean 24-hour SBP between “active” and “sham” HGNS (122.4 mmHg [12.2] vs. 122.4 mmHg [11.2], respectively). Further, there was no significant difference in mean SBP during sleep between “active” and “sham” HGNS (115.0 mmHg [15.2] vs. 115.2 mmHg [14.4], respectively). Conclusion This is a randomized controlled trial evaluating cardiovascular outcomes in patients with OSA using HGNS therapy. The HGNS system permits a unique investigation of the therapy “on/off” effect on measures of the sympathetic nervous system and vascular health. “Active” HGNS levels, compared to “sham” HGNS levels, do not appear to reduce mean systolic blood pressure during wake or sleep periods. Support (If Any) Raj C. Dedhia, MD, MSCR is supported by the American Heart Association and the American Sleep Medicine Foundation.

Specifics of daily blood pressure monitoring in patients with systemic hypertension and obstructive sleep apnoea: a case-control study

Background. The comorbidity of arterial hypertension (AH) and obstructive sleep apnea syndrome (OSA) is becoming increasingly common in clinical practice. However, the priority strategy for selecting antihypertensive therapy in such patients is yet to be defined. 24-hour blood pressure monitoring is important for determining an approach to controlling hypertension.Objectives. To study specific features of 24-hour blood pressure monitoring in comorbid AH– OSA patients.Methods. A total of 130 AH patients were surveyed. The main cohort (1) included AH–OSA patients (n = 90, mean age 54.93 ± 1.04 years), control cohort (2) — non-OSA AH patients (n = 40, mean age 57.92 ± 1.29 years). All patients had a general clinical examination with 24-hour blood pressure monitoring. OSA was verified in overnight respiratory polygraphy using an Alice PDx diagnostic appliance (USA).Results. The following specific features of 24-hour blood pressure monitoring were identified in the comorbid patients: a statistically significant growth of mean 24-hour systolic and average BP, as well as mean nocturnal systolic, diastolic and average BP; a statistically significant growth of mean 24-hour systolic, diastolic and average BP load indices. In addition, the AH-OSA patients had the statistically higher pulse pressure, systolic and average BP variability, as well as morning BP surge rate. The 24-hour BP dynamics in OSA patients had predominant morbid profiles and higher non-dipper and night-peaker rates compared to the control cohort.Conclusion. The identified specific features reflect a high risk of adverse cardiovascular events in AH–OSA comorbid patients, an earlier damage of target organs and negative prognosis of comorbidity, which warrants a further analysis of AH-specific clinical picture and personalisation of blood pressure control measures in such patients.

Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial.

The long-term effect of continuous positive airway pressure (CPAP) on 24-hour blood pressure (BP) in patients at high risk with obstructive sleep apnea (OSA) is uncertain. We aimed to determine the effect of CPAP treatment on ambulatory BP in individuals with moderate or severe OSA and cardiovascular disease or multiple cardiovascular disease risk factors without severe sleepiness. In this randomized, controlled, parallel group study, 169 participants were randomly assigned to CPAP treatment or the control group. The primary outcome was the change in mean 24-hour systolic BP between groups from baseline to the average of 6- and 12-month measurements using mixed-effect linear regression models. The 24-hour systolic BP did not significantly differ by group, although there was a trend of decrease in the CPAP group (treatment effect -2.7 mm Hg [95% confidence interval -5.9 to 0.6]; P = .105) compared with control. CPAP had the greatest effect on nighttime systolic BP (treatment effect -5.9 mm Hg [95% confidence interval -9.9 to -1.9]; P = .004). Similar improvements in other nocturnal BP indices were observed. In patients at high risk with moderate-severe OSA without severe sleepiness, CPAP resulted in modest BP improvements over 6 to 12 months of follow-up, with possibly larger effects for nocturnal BP. Use of office blood pressure may underestimate the effect of CPAP on BP profile in patients with OSA. Registry: ClinicalTrials.gov; Title: Sleep Apnea Intervention for Cardiovascular Disease Reduction; Identifier: NCT01261390; URL: https://clinicaltrials.gov/ct2/show/NCT01261390. Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial. J Clin Sleep Med. 2022;18(8):1899-1907.