Morning Systolic Blood Pressure Research Articles

Antihypertensive effect of esaxerenone and correlation between brachial and wrist home monitoring devices in patients with nocturnal hypertension: A post hoc analysis of the EARLY-NH study.

Adequate management of nocturnal hypertension is crucial to reduce the risk of organ damage and cardiovascular events. The EARLY-NH study was a prospective, open-label, multicenter study conducted in Japanese patients with nocturnal hypertension who received esaxerenone treatment for 12weeks. This post hoc analysis aimed to assess (1) the relationship between changes in morning home systolic blood pressure (SBP), bedtime home SBP, and nighttime home SBP based on changes in SBP and achievement rates of target SBP levels; and (2) the correlation between nighttime home SBP measurements using brachial and wrist home BP monitoring (HBPM) devices. This analysis evaluated 82 patients who completed the 12-week treatment period. Among those who achieved target morning home SBP (<135mmHg) and target bedtime home SBP (<135mmHg), the brachial HBPM device showed achievement rates of 63.6% and 56.4%, respectively, for target nighttime home SBP (<120mmHg). The wrist device showed achievement rates of 66.7% and 63.4%, respectively, for the same targets. Significant correlations were observed between both devices for nighttime home SBP measurements at baseline (r=0.790), Week 12 (r=0.641), and change from baseline to Week 12 (r=0.533) (all, p<.001). In this patient population, approximately 60% of individuals who reached target morning or bedtime home SBP levels <135mmHg exhibited well-controlled nighttime home SBP. Although nighttime home SBP measurements obtained using both brachial and wrist HBPM devices displayed a significant correlation, the wrist device needs to be examined in more detail for clinical use.

BLOOD PRESSURE VALUES ACCORDING TO HOME AND CLINIC MEASUREMENTS AND INTRACRANIAL WAVEFORM ASSESSMENT IN HYPERTENSIVE PATIENTS

Objective: Evaluate the Association between Non-Invasive Intracranial Pressure (ICP) Values and Blood Pressure (BP) Values According to Home and Clinic Measurements Design and method: Cross-Sectional Study evaluating the association of variables, including Age, Gender, Office Systolic Blood Pressure (OSBP), Office Diastolic Blood Pressure (ODBP), Home Blood Pressure Measurements (HBPM), Time since Hypertension Diagnosis, P2P1, TTP, Intracranial Hypertension (IC) (P2P1 &gt;1.2), Office Hypertension (Office BP 140/90mmHg), and HBPM Hypertension (HBPM 130/80mmHg). Data collected from participants and medical records. Data analysis conducted using chi-square test, Mann-Whitney U test, and bivariate correlation analyses. Blood pressure values adjusted for hypertension diagnosis time; P2P1 and TTP values adjusted for age. Confidence interval of 95% and p&lt;0.05. Results: 240 patients were evaluated, with average age of 63.4 years (±11.8), 73.3% were female. The average time of diagnosis of arterial hypertension was 19.1 years (±11.9). Uncontrolled blood pressure - 54.2% (n=130) via HBPM and 42.1% (n=101) in the clinic. The proportion of IC was 67.9%, higher in women (71.6%). There was negative correlation between P2P1 and age (r=-0.261; p=0.037). Correlations between P2P1 and systolic blood pressure (HBPM) (-0.152, p=0.019) as well as with morning systolic blood pressure (HBPM) (-0.175, p=0.006). Correlation between P2P1 and morning systolic blood pressure (HBPM) (rho= -0.192, p=0.011), and evening systolic blood pressure (HBPM) (rho= 0.157, p=0.037) was found only among women. Correlation between TTP and systolic blood pressure (HBPM) (rho= -0.194, p=0.003), The correlation between TTP and clinic diastolic blood pressure (rho= 0.313, p=0.012) was found only among men. Correlation between TTP and systolic blood pressure (HBPM) (rho= -0.201, p=0.007), morning systolic blood pressure (HBPM) (rho= -0.237, p=0.002), clinic diastolic blood pressure (rho= 0.157, p=0.038), and nighttime systolic blood pressure (HBPM) (rho= -0.202, p=0.007) was found only among women. Conclusions: The blood pressure control rates were similar when evaluated by different methods. There was no association between blood pressure control rates and IC. P2P1 and TTP values correlated with home blood pressure values, but only with clinic diastolic blood pressure values. The associations of P2P1/TTP values and home blood pressure measurements exhibited different patterns between men and women.

FEASIBILITY OF WATCH-TYPE CUFF-LESS BLOOD PRESSURE MEASUREMENT DEVICE IN DAILY BLOOD PRESSURE MONITORING

Objective: Cuff-less blood pressure (BP) measurement devices integrated into smartwatches have gained prominence for daily monitoring, yet limited studies provide the analysis of real-world BP data collected by such devices. In this study, we evaluated the feasibility of photoplethysmographic BP measuring smartwatch by analyzing data collected in real-world. Design and method: The campaign, “Smartwatch Blood Pressure Monitoring Challenge with Korean Hypertension Society”, was held in June 1-14, 2023 and 896 participants reported 35592 BP values measured by smartwatch (Samsung Galaxy Watch 6, approved in Korean Ministry of Food and Drug Safety). Participants were instructed to measure BP daily, in the morning (5AM-8AM) and evening (6PM-9PM) for two weeks, with initial calibration and re-calibration after the first week. We evaluated 1) BP difference between before and after re-calibration, and 2) difference in morning and evening BP. We also evaluated the determining factors of the BP differences. Results: Morning and evening BP values showed significant difference, higher in the evening by 1.42±5.25 mmHg (p&lt;0.05). However, the diurnal variation was much smaller than reported in other studies using conventional BP monitoring devices. ANOVA identified significant variables for evening-morning differences, including basal metabolic rate, skeletal muscle mass, total body water, average systolic BP (SBP), diastolic BP (DBP), and heart rate in the morning (p &lt; 0.01 in both ITT and PP). Participants who have evening-morning difference higher than the third quartile, where evening SBP was significantly higher than morning SBP, exhibited smaller variable sizes. Turkey’s Honest Significant Difference showed that this relationship is statistically significant between Q1-Q4 and Q2-Q4 in all variables. The calibration stability was assessed by the difference in average BP before and after calibration, resulting in an SBP difference of 4.64±4.73 mmHg and DBP of 3.66±3.62 mmHg, smaller than a 2021 campaign (6.8±5.6mmHg). When the difference of average was measured between same period of time (morning versus morning and evening versus evening), SBP of 5.39±5.22 mmHg and DBP of 4.3±3.99 mmHg. Conclusions: In conclusion, watch-based devices may not detect clinical-level BP variability, but refining calibration protocols offers improvement potential.

CT-guided ozone-mediated lumbar-renal sympathetic denervation for resistant hypertension treatment: A pilot single-arm clinical trial

BackgroundRenal sympathetic denervation (RDN) reduces blood pressure (BP). MethodsThis single-arm open-label study enrolled patients with resistant hypertension (RH) and treat them by CT-guided ozone mediated lumbar-renal sympathetic denervation (L-RDN). The primary endpoint was to assess the changes of BP over 24-h ambulatory BP monitoring (ABPM) and to evaluate the anti-hypertensive medication burden (AHMB) at 3-month follow-up. This study was registered in Chictr.org.cn (ChiCTR2300071375). Results17 patients (mean age 65.12 ± 10.77 years) with AHMB of 4.12 ± 1.11 were enrolled. After the procedure, 7 patients (46.7 %) matched the criteria for antihypertensive medication reduction. The AHMB decreased to 3.87 ± 0.96 for the whole objectives and from 3.87 ± 0.96 to 3.55 ± 0.78 for patients with normal baseline renal function. On top of the lessened AHMB, L-RDN further reduced morning systolic BP (SBP) by −8.6 ± 4.0 mmHg (p = 0.034) and diastolic BP (DBP) by −4.6 ± 2.1 mmHg (p = 0.032) for all participants and morning SBP by −13.2 ± 3.6 mmHg (p < 0.001), morning DBP by −6.2 ± 2.4 mmHg (p = 0.011) and daytime SBP by −4.1 ± 1.6 mmHg (p = 0.009) for those with normal baseline renal function at 3-month of follow-up. No adverse events were reported intra- and post operation. ConclusionsCT-guided ozone-mediated L-RDN might be an innovative approach of RDN for treating RH. Confirmatory studies are warranted.

High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

Home blood pressure measurement consistency and cognitive impairment.

Cognitive function tends to decline with age, and individuals with mild cognitive impairment (MCI) often have difficulty completing established self-management tasks. The aim of this study was to investigate the association between the number of days within a 5-and-a-half-day period that patients took their home blood pressure (BP) as instructed and MCI assessed by the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in an elderly clinical population. We analyzed 303 ambulatory patients (mean age 77.3 ± 8.2 years) in whom MoCA-J had been assessed, who were instructed to take home BP for 1 evening and twice a day for the next five days, and who had at least one morning home BP measurement. After accounting for patient characteristics including age, sex, body mass index, drinking, smoking, prevalent cardiovascular disease, morning systolic BP and diastolic BP, and the use of antihypertensive drugs, the number of days home BP was measured was independently associated with both total MoCA-J score (estimate, 0.82; 95% confidence interval [CI], 0.43-1.21; P < 0.001) and the lowest quartile of MoCA-J score (13 or below) (odds ratio [OR], 0.72; 95%CI, 0.59-0.87; P = 0.001). Home BP measurement noncompliance (<5 days' measurement) was also independently associated with the total MoCA-J score (estimate, -2.56; 95%CI, -4.09 to -1.03; P = 0.001) and the lowest quartile of MoCA-J score (OR, 3.32; 95%CI, 1.59-6.96; P = 0.001). In conclusion, poor compliance with home BP monitoring was associated with cognitive impairment in elderly cases who had been specifically instructed to perform home BP monitoring during a designated period.

Mediating effect of subclinical inflammation on the process of morning hypertension leading to atrial fibrillation in community-based older adults

ABSTRACT Background The impacts and mechanisms of morning hypertension (MHT) on the risk of new-onset atrial fibrillation (AF) in the elderly have not been clarified. We aimed to investigate an association between MHT and new-onset AF and explore a mediating effect of subclinical inflammation on this association. Methods From 2008 to 2010, 1789 older adults aged ≥60 years were recruited in Shandong area, China. Morning blood pressure (BP) was assessed using 24-hour ambulatory BP monitoring. MHT was defined as BP ≥ 135/85 mm Hg during the period from wake time to 0900 a.m. Subclinical inflammation was assessed by hypersensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and galectin-3. New-onset AF was rated during the follow-up period. Results Over an average 129.0 [standard deviation (SD): 21.58] months of follow-up, the hazard ratio of new-onset AF in MHT patients was 1.39 (95% confidence interval: 1.01 to 1.91) compared with non-MHT participants (Padjusted = 0.027). The risk of new-onset AF was 1.17-fold with one-SD increment of morning systolic BP. Subclinical inflammation was significantly associated with new-onset AF. The hazard ratios of new-onset AF were 2.29, 2.04, 2.08, 2.08, 2.03, and 3.25 for one-SD increment in hsCRP, TNF-α, SII, NLR, PLR, and galectin-3, respectively (Padjusted < 0.001). The analysis showed that hsCRP, TNF-α, SII, NLR, PLR, and galectin-3 separately mediated the process of MHT inducing new-onset AF (Padjusted < 0.05). Conclusions MHT is associated with an increased risk of new-onset AF. The subclinical inflammation might play a mediating role in this association.

Correlation of blood pressure levels at different time periods throughout the day with total CSVD burden and MRI imaging markers.

Hypertension is an important risk factor for atherosclerotic cerebral small vessel disease (CSVD). Higher blood pressure is associated with a higher CSVD burden and the presence of relevant magnetic resonance imaging (MRI) markers. However, the effect of blood pressure level on CSVD burden and imaging markers including white matter hyperintensity (WHM), lacune, enlarged perivascular spaces (EPVS), and cerebral microbleed (CMB) remains unknown. The purpose of this study was to investigate the correlation between blood pressure level and CSVD burden at different time periods throughout the day. In total, 144 in-patients with CSVD (66.4 ± 9.8 years, 50% male) were enrolled and underwent brain MRI, and 24-h ambulatory blood pressure was assessed. Patients were categorized into five groups according to their MRI-evaluated total CSVD burden scores (0-4). Spearman's correlation analysis was performed to examine the correlation between blood pressure levels at different time periods and the total CSVD score or the markers of periventricular WMH, deep WMH, lacune, EPVS, and CMB. Of the 144 patients, 83.3% (120/144) harbored one or more CSVD markers of interest. The systolic blood pressure (SBP) of 24-h, daytime, nighttime, and morning differed significantly among the five groups. The SBP levels increased significantly with the total CSVD scores during 24 h (P = 0.018), daytime (P = 0.018), and nighttime (P = 0.035). Spearman's correlation analysis demonstrated that the SBP of 24 h, daytime, nighttime, and morning and the diastolic blood pressure (DBP) of 24 h and morning positively and significantly correlated with the total CSVD score (P < 0.05). A logistic regression analysis indicated that both morning SBP and DBP were independent risk factors for total CSVD burden (OR = 1.13, 95% CI: 1.02-1.23, P = 0.015; OR = 1.19, 95% CI: 1.06-1.33, P = 0.005). Spearman's correlation analysis indicated a significant positive correlation between morning SBP and higher deep WMH Fazekas score (r = 0.296, P < 0.001), EPVS grade in the basal ganglia (r = 0.247, P = 0.003), and the presence of lacune (r = 0.173, P = 0.038) and CMB (r = 0.326, P < 0.001). Morning DBP only correlated positively with the presence of CMB (r = 0.292, P < 0.001). Higher SBP signficantly correlated with total CSVD burden in patients with atherosclerotic CSVD. Early morning blood pressure level is an important indicator to reflect the severity of CSVD patients.

ASSOCIATION OF LOW RENIN ACTIVITY WITH UNCONTROLLED NIGHT-TIME AND MORNING BLOOD PRESSURE AS RESIDUAL RISK IN GOOD BLOOD PRESSURE CONTROLLED ELDERLY SUBJECTS

Objective: To achieve optimal nighttime blood pressure (BP) and morning BP is often challenging especially in elderly subjects. Although low renin revels are seen especially in the elderly, data are sparse about the association between renin-angiotensin-aldosterone (RAA) system and uncontrolled nighttime and morning BP. Design and method: Ambulatory BP (ABP) was assessed in 315 Minamisanriku Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with awake and asleep ABP and hypertension defined by ABP, adjusting for important confounders included the use of RAA inhibitors. We divided them into non-elderly (&lt;80 years, n = 164) and elderly group (&gt;80 years, n = 151). Results: In total participants, 95% was treated hypertension and average 24-hour BP was 114.2±8.9/67.5±5.9 mmHg. The prevalence of uncontrolled 24-hour (&gt;130 mmHg), daytime (&gt;135 mmHg), nighttime (&gt;120 mmHg) and morning systolic BP (SBP) (&gt;135 mmHg) was 5.6%, 7.4%, 8.6%, 26.8%, respectively. In elderly group, Lower log-PRA was associated with higher 24-hour, daytime, nighttime, and SBP (all P&lt;0.01) after adjusted confounders. These associations were also observed in non-elderly group except for nighttime and morning SBP. Lower log-aldosterone was associated with higher 24-hour and daytime SBP only in elderly group (both P&lt;0.01). A 1-unit higher log-PRA was associated with lower odds of uncontrolled nighttime SBP (odds ratio [OD] 0.19 [95%CI, 0.06-0.64) and uncontrolled morning SBP (OR, 0.43 [95%CI, 0.21-0.91]) but not in uncontrolled 24-hour and daytime SBP in elderly group, while these findings were not seen in non-elderly group. Similar results were observed in log-aldosterone. There was no association between aldosterone/PAC ratio and the presence of uncontrolled ABP. Conclusions: Suppressed renin activity and aldosterone were associated with uncontrolled nighttime and morning SBP in treated and good 24-hour BP controlled elderly population. Even in good 24-hour BP, low renin activity may be associated with residual ABP risk in elderly population.

A Prospective, Randomized Open-Label Study for Assessment of Antihypertensive Effect of Telmisartan Versus Cilnidipine Using Ambulatory Blood Pressure Monitoring (START ABPM Study).

The antihypertensive agent telmisartan is an angiotensin II receptor blocker with a terminal elimination half-life of 24 h and has a high lipophilicity, thereby enhancing its bioavailability. Another antihypertensive agent, cilnidipine is a calcium antagonist and has dual mode of action on the calcium channels. This study aimed at determining effect of these drugs on ambulatory blood pressure (BP) levels. A randomized, open-label, single-center study was conducted during 2021 - 2022 on newly diagnosed adult patients with stage-I hypertension, in a mega city of India. Forty eligible patients were randomized to telmisartan (40 mg) and cilnidipine (10 mg) groups, with once daily dose administered for 56 consecutive days. Ambulatory blood pressure monitoring (ABPM) (24 h) was performed pre- and post-treatment, and the ABPM-derived parameters were compared statistically. Statistically significant mean reductions were observed in all BP endpoints in telmisartan group but only in 24-h systolic blood pressure (SBP), daytime and nighttime SBP, and manual SBP and diastolic blood pressure (DBP) in cilnidipine group. The mean change from baseline to day 56 between two treatment groups showed statistical significance in last 6-h SBP (P = 0.01) and DBP (P = 0.014), and morning SBP (P = 0.019) and DBP (P = 0.028). The percent nocturnal drop within and between groups was statistically nonsignificant. Also, the between group mean SBP and DBP smoothness index differed nonsignificantly. Telmisartan and cilnidipine once daily were effective and well tolerated in the treatment of newly diagnosed stage-I hypertension. Telmisartan provided sustained 24-h BP control and may offer advantages over cilnidipine in terms of BP reductions, particularly over the 18- to 24-h post-dose period or critical early morning hours.

Monitoring with wearable devices will clarify the association between indoor temperature and blood pressure.

The association of blood pressure and temperature is well known in seasonal observation, and low temperature in the winter season is often considered a cause of high blood pressure. The current evidence for short-term studies of temperature and blood pressure is based on the daily observation, however continuous monitoring with wearable devices will allow us to evaluate the rapid effect of cold temperature exposure on blood pressure. In a Japanese, prospective intervention study from 2014 to 2019 (the Smart Wellness Housing survey), approximately 90% of Japanese lived in cold houses (indoor temperature less than 18 °C). Importantly, the indoor temperature was associated with the increase of morning systolic blood pressure. We recently addressed the sympathetic nervous activation of individuals in both their houses and a highly insulated and airtight model house in the winter season using portable electrocardiography equipment. A few subjects showed a morning surge in sympathetic activity, which was more intense at their cold houses, which suggests the importance of the indoor environment in the management of early morning hypertension. In near future, real-time monitoring with wearable devices will provide important information for a better life-environment, leading to risk reduction of morning surge and cardiovascular events.

S-35-6: LONG-TERM REDUCTION IN MORNING AND NIGHTTIME BLOOD PRESSURE AFTER RENAL DENERVATION: 36-MONTH RESULTS FROM SPYRAL HTN-ON MED PILOT TRIAL

Objective: Elevated morning and nighttime blood pressures (BP) are associated with increased risk of cardiovascular events such as stroke. Furthermore, those with resistant hypertension (hypertension despite &gt; = 3 antihypertensive medications) are at particular risk. We compared the long-term changes in morning, daytime and nighttime blood pressure (BP) in patients prescribed &gt; = 3 antihypertensive medications 36 months after radiofrequency renal denervation (RDN) vs. sham control in the SPYRAL HTN-ON MED pilot trial. Design and method: The SPYRAL HTN-ON MED pilot trial enrolled patients with uncontrolled hypertension and office systolic BP (SBP) between 150 and &lt; 180 mmHg, office diastolic BP &gt; = 90 mmHg and mean ambulatory SBP between 140 and &lt; 170 mmHg, with 1–3 prescribed antihypertensive medications. Patients were randomized 1:1 to RDN or sham control. Long-term safety and efficacy of the RDN procedure was assessed at 36 months through collection of adverse events and BP assessment. Differences in BP changes were compared between RDN and sham control using ANCOVA, adjusting for baseline measurements. Results: There were 80 patients randomized to RDN (N = 38) or sham control (N = 42). The number of antihypertensive medications at baseline was 2.13 ± 1.40 for RDN vs 1.98 ± 1.14 for sham control (p = 0.59). At 36 months, RDN patients were prescribed 3.03 ± 1.20 antihypertensive medications compared to 3.05 ± 1.43 in sham control (p = 0.76). Major adverse events through 36 months were rare in both groups, and there were no renal artery re-interventions or major vascular complications. Baseline morning (7:00–9:00 AM), daytime (9:00AM-9:00PM) and night-time (1:00–6:00 AM) SBP measurements for patients prescribed 3 or more antihypertensive medications at 36 months were similar between RDN and sham control (Figure). However, morning and night-time SBP were significantly reduced from baseline for the RDN group compared to sham control (morning SBP: -23.9 vs. -8.0 mmHg, p = 0.029; night-time SBP: -20.8 vs. -7.2 mmHg, p = 0.001; (Figure). Difference in daytime SBP was not significantly different between groups (-19.6 vs. -13.7 mmHg, p = 0.13). Additional analyses of BP reduction in patients with varying antihypertensive medication burden will be presented for the first time at ISH 2022. Conclusions: Morning and nighttime SBP were significantly reduced in patients prescribed at least 3 antihypertensive medications at 36 months in the SPYRAL HTN-ON MED pilot trial after RDN compared to sham control. The results suggest RDN has significant benefit when the risk of cardiovascular events is highest.

S-46-5: THE INTRA-WEEK VARIABILITY ON HOME BLOOD PRESSURE WITH OR WITHOUT ANTIHYPERTENSIVE MEDICATION: NOSE STUDY

Objective: Few studies have investigated weekly variations in long-term home blood pressure (BP) measurement. The aim of this study was to examine the intra-week variability and the difference in the day of the week on long-term home BP with or without antihypertensive medication. Design and method: This study was based on an ongoing community-based intervention study in Nose, Osaka, which was designed to assess the effect of home BP measurement on prolonging healthy life expectancy. The study included 510 participants aged 40–91 years. Participants measured their BP with an electronic oscillometric device (HEM-7281; Omron Healthcare CO., Ltd) and wrote the value on the recording book twice in morning and evening for about six months to a year. The intra-week variability in home BP were calculated as maximum minus minimum BP (MMD: maximum-minimum difference). Home BP recording for 62916 days were obtained by extracting weeks in which BP were measured on 7 consecutive days. The participants were divided into 2 groups according to with or without antihypertensive medication. The mean BP values according to the day of the week of home BP measurement were compared by one-way analysis of variance. MMD means were compared with the t-test. To identify the factors influencing on the intra-week variability in home BP, Multiple linear regression models were applied to examine. Results: Among participants without antihypertensive medication, morning systolic BP(SBP) was lowest on Saturday (p &lt; 0.001) as compared with all other days of the week and evening SBP tends to be highest on Sunday. Among participants with antihypertensive medication, morning SBP tends to be lowest on Saturday and evening SBP was highest on Sunday (p &lt; 0.001). The characteristics of the day of the week were similar for the two groups. Antihypertensive medication was not significantly associated with MMD in morning SBP in the multiple linear regression model. MMD in morning SBP had significant positive relationships with female(β = 0.05) and age(β = 0.07), measurement in winter(β = 0.04), morning SBP means(β = 0.25), respectively by p &lt; 0.001. Conclusions: Evening SBP was highest on Sunday regardless of antihypertensive medication. This may be related with clinical evidence that cardiovascular events occur more frequently in the morning on Monday. Considering a variety of factors associated with the intra-week variability in home BP with or without antihypertensive medication, this observation suggested that treatment decisions against hypertension may be based on long-term home BP measurements.

PS-C04-4: ASSOCIATIONS OF OFFICE BRACHIAL BLOOD PRESSURE, OFFICE CENTRAL BLOOD PRESSURE, AND HOME BRACHIAL BLOOD PRESSURE WITH ARTERIAL STIFFNESS

Accurate blood pressure (BP) measurement is necessary for the evaluation and treatment of hypertension to prevent the progression of subclinical vascular disease, including arterial stiffness. We investigated the associations between brachial ankle pulse wave velocity (baPWV), a measure of arterial stiffness, and each of office brachial systolic BP (SBP) with and without an observer present (attended or unattended office brachial SBP), attended or unattended office central SBP, and home brachial SBPs (specifically, the means of morning, evening, or morning and evening home brachial SBP) in patients being treated for hypertension. Measurements were performed among 70 adults (mean age, 67.0 ± 9.4 years; women, 51.4%) with a mean attended office brachial SBP of 127.6 ± 14.5 mmHg and mean baPWV of 16.3 ± 2.8 m/s. Univariate analysis showed that higher attended office brachial SBP, morning home brachial SBP, and morning and evening home brachial SBP were each statistically significantly associated with higher baPWV (r = 0.25, P = 0.04; r = 0.37, P = 0.002; and r = 0.32, P = 0.006, respectively). Multiple linear regression analysis with adjustments for traditional cardiovascular risk factors showed that only morning home brachial SBP was statistically significantly associated with baPWV [beta = 0.06, 95% confidence interval (0.01 to 0.11), P = 0.02). In conclusion, higher morning home brachial SBP, but none of the office measured SBP values, was associated with arterial stiffness.

S-01-3: SMART WELLNESS HOUSING AND BLOOD PRESSURE CONTROL

Objective: Mortality due to cardiovascular diseases (CVDs) rises sharply in winter, a phenomenon known as excess winter mortality. It is partially explained by cold exposure induced hypertension. Nevertheless, existing countermeasures for the prevention of hypertension and CVDs place emphasis only on improving lifestyle habits. Improving life environment has attracted attention recently because people spend 60–70% of their time at home. Therefore, we aimed to quantitatively evaluate the relationship between housing thermal environment and blood pressure (BP) in a real-world setting. Design and method: We conducted a nationwide prospective intervention study named the Smart Wellness Housing survey in Japan, as a nonrandomized controlled trial. The intervention was the thermal insulation retrofitting of homes. Participants were recruited by construction companies throughout all 47 prefectures of Japan. Home BP and indoor temperature were measured for 2 weeks before and after the intervention in winter (November-March) of FY 2014 to 2019. Results: Cross-sectional analyses before intervention involving about 2900 participants (1840 households) showed that systolic blood pressure (SBP) in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mmHg increase/10°C decrease) than that in the evening (6.5 mmHg increase/10°C decrease) in participants aged 57 years (mean age in this survey). Interaction terms between age/women and indoor temperature were significant, indicating that SBP in older residents and women was vulnerable to indoor temperature change. The association between BP variability and indoor temperature instability was also analyzed using the morning-evening (ME) difference as an index of diurnal variability and the standard deviation (SD) of 2-week data as an index of day-by-day variability. The analyses showed that the ME difference in indoor temperature was closely correlated with the ME difference in SBP (0.85 mmHg/°C). The SD of indoor temperature was also associated with the SD of SBP (0.61 mmHg/°C). In the comparison of before and after intervention, insulation retrofitting significantly reduced morning SBP by 3.1 mmHg. In addition, there was heterogeneity in the effect of insulation retrofitting on morning SBP in hypertensive patients compared with normotensive occupants (-7.7 versus -2.2 mmHg). Conclusions: Hypertension might be not only lifestyle diseases but also life-environment diseases. Residents should keep the indoor temperature high to reduce BP level and keep it stable to reduce BP variability through strategies such as installing high thermal insulation. We expect that these results will be useful to prevent excess winter mortality due to CVDs.

S-37-1: PROGNOSTIC UTILITY OF MORNING BLOOD PRESSURE SURGE

Morning blood pressure surge (MBPS), defined as the difference between morning systolic blood pressure and the lowest nighttime systolic blood pressure, is a normal physiological phenomenon of diurnal blood pressure variability (BPV). Exaggerated MBPS is associated with morning hypertension and has been associated with adverse cardiovascular and cerebrovascular events, especially hemorrhagic stroke. However, MBPS has low reproducibility and there is an ethnic difference in the amplitude of MBPS and its prognostic value. More evidence is needed to prove its clinical usefulness in the management of hypertension. Since the risk of MBPS is mainly attributable to the elevated morning blood pressure, the focus therefore has shifted from MBPS to the control of morning hypertension. Because MBPS focuses only on the amplitude rather than the rate of blood pressure rise, we calculated the MBPS rate as the slope of linear regression of sequential systolic blood pressure measures on the time intervals within the MBPS period. We found the reproducibility for the MBPS rate was better than the MBPS amplitude. The MBPS rate was a more sensitive and reliable prognostic factor of long term mortality than the MBPS amplitude. The prognostic values of MBPS rate were comparable in subjects with or without morning and nocturnal hypertension. Because the MBPS rate can easily be calculated from the ambulatory blood pressure monitoring data, it could become a routine parameter in daily practice in conjunction with other routinely derived parameters including MBPS amplitude.

Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.

The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.

PS-R01-8: BLOOD PRESSURE CONTROL WAS IMPROVED BY A CHANGE IN THE TIMING OF ANTIHYPERTENSIVE MEDICATION IN A PATIENT WITH NOCTURNAL HYPERTENSION

A 75-year-old-man was referred to our outpatient clinic due to inadequate blood pressure control despite antihypertensive drug treatment. He had dyslipidemia, type 2 diabetes mellitus, and a history of carotid artery stenosis, bilateral central retinal artery occlusion, and lower extremity artery disease. He took losartan potassium 50 mg, hydrochlorothiazide 12.5 mg, cilnidipine 10 mg, and nifedipine CR 40 mg in the morning. Home blood pressure monitoring was performed by using a cuff oscillometric device that could be set to measure blood pressure automatically during sleep. The patient was instructed to measure his morning blood pressure twice after waking, evening blood pressure twice before bedtime, and night-time systolic blood pressure (2:00, 3:00, 4:00, and 5:00 AM) for 7 consecutive days. Mean values were 161 mmHg for morning systolic blood pressure, 134 mmHg for evening systolic blood pressure, and 141 mmHg for night-time systolic blood pressure. After the home blood pressure monitoring, the timing of administration of nifedipine CR 40 mg was shifted from morning dosing to bedtime dosing. One month later, home blood pressure monitoring was performed again using the same schedule as before. Mean values were decreased from 161 mmHg to 135 mmHg for morning systolic blood pressure and from 141 mmHg to 127 mmHg for nigh-time systolic blood pressure. Blood pressure control was improved only by altering the timing of the administration of one antihypertensive drug from morning dosing to bedtime dosing without increasing the dosage of antihypertensive drug or adding a new antihypertensive drug class.

Cerebral microangiopathy in men with obstructive sleep apnea syndrome

To determine factors associated with the development of small vessel disease (SVD) in patients with obstructive sleep apnea syndrome (OSA). One hundred and fifty-two patients with risk factors for the development of cerebrovascular diseases were examined. Based on the results of polysomnography, patients were divided into groups with- (n=84) and without (n=68) OSA. The groups were matched by age, prevalence of arterial hypertension and diabetes mellitus. SVD was diagnosed using brain MRI. Laboratory tests included an assessment of parameters of lipid metabolism, glucose metabolism, concentration of C-reactive protein (CRP), levels of homocysteine and creatinine with the calculation of glomerular filtration rate (GFR). Patients with OSA, compared with those without OSA, were characterized by a statistically significant number of gliosis foci, with their large sizes, more frequent changes on the Fazekas scales and the Hassan scale. The most severe degree of damage according to the Hassan scale in patients with OSA was detected more often (55 (66%) and 27 (39%) OR=2.89, 95% CI 1.47-5.67, p=0.002). More pronounced atrophic changes in the brain, an increase in the size of the III ventricle and the index of the anterior horns, significantly lower GFR and higher levels of CRP were noted in the OSA group. Patients with OSA and duration of nocturnal hypoxia for more than 2 minutes were more likely to have hyperintensity of subcortical regions. In patients with OSAS, pronounced manifestations of SMD were associated with a significantly higher level of morning systolic blood pressure (MAP): 140 [120; 150] vs. 127 [120; 130] p=0.029; increased levels of blood homocysteine: 14 [11; 17.8] vs. 13 [9.7; 12.5] p=0.049; a decrease in GFR: 79 [71; 87.3] vs. 89.8 [80.3; 94] p=0.002, respectively. OSA and intermittent nocturnal hypoxia are independent risk factors for SMD. A more severe micro-focal vascular lesion in OSA is associated with a decrease in renal filtration function, an increase in morning blood pressure and an elevation in homocysteine level.

Association of home hypertension subtypes with glucose metabolism.

Objective: This study was performed to investigate the association of home and office hypertension with glucose metabolism among the Japanese general population. Methods: The study involved 646 residents without treatment for hypertension or a history of diabetes from Ohasama, a rural Japanese community, who underwent an oral glucose tolerance test measuring blood glucose (BG) and insulin levels at fasting and 30, 60 and 120 min. Hypertension subtypes [normotension (NT), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH)] were defined based on home and office systolic and diastolic blood pressure (HBP and OBP, respectively). The estimated means of blood glucose (BG)-related indices among the groups were compared by analysis of covariance adjusted for possible confounding factors. In addition, the association between continuous HBP and OBP (as independent variables) and BG-related indices (as dependent variables) were assessed by multiple linear regression analysis. Results: Mean age was 62.4 years. Of participants, 29% were men. No estimated mean BG-related indices were different among the morning HBP-defined hypertension subtypes, although morning systolic BP and BG at 120 min were significantly positively associated. Participants with evening HBP-defined ISH had a significantly higher estimated mean BG at 120 min (146 vs 127 mg/dl), higher homeostasis model assessment-insulin resistance (HOMA-IR) (1.29 vs 1.02), and lower Matsuda–DeFronzo index (6.55 vs 8.06) than participants with NT. In addition, evening systolic BP levels with BG at 60 and 120 min and HOMA-IR and diastolic BP levels with fasting BG were significantly positively associated. Participants with OBP-defined SDH had significantly higher estimated means of fasting BG (101 vs 94 mg/dl), BG at 30 min (177 vs 158 mg/dl), 60 min (181 vs 157 mg/dl), and 120 min (145 vs 125 mg/dl); and HOMA-IR (1.30 vs 0.98) and a lower Matsuda–DeFronzo index (6.26 vs 8.30) than participants with NT. Both office systolic and diastolic BP levels were associated with BG levels at all time points, HOMA-IR and Matsuda–DeFronzo index. Conclusion: Evening HBP and OBP were clearly associated with BG-related indices. Participants with evening HBP-defined ISH and OBP-defined SDH had higher BG levels and insulin resistance than participants with correspondingly defined NT. However, morning HBP were not obviously associated, compared with evening HBP and OBP. These findings suggest the importance of measuring evening HBP and OBP for early detection of coexisting hypertension and diabetes.