Night SBP Research Articles

Treadmill exercise test as a screening tool in the development of hypertension

Abstract Background Guidelines promote screening people with high normal BP for the presence of end-organ damage because their presence is associated with a 2- to 3-fold increase in the risk of CVD. Purpose Office blood pressure measurements may be unable to detect early subclinical cardiac damage of adverse prognostic significance in subjects with high normal blood pressure. Methods 100 consecutive subjects with high normal BP [systolic BP=130-139mmHg and/or diastolic BP=85-89mmHg] were examined for early signs of hypertension-mediated organ damage (HMOD). They underwent an echocardiographic study, a negative for ischemia treadmill exercise test (Bruce protocol) where the index SBP/MET-slope [(peak SBP—resting SBP)/(peakMET-1)] was used. Arterial stiffness was evaluated based on carotid-femoral pulse wave velocity (PWV). The sympathetic drive was assessed by MSNA. Follow-up was scheduled every 6 months for 3 consecutive years, where BP measurements were assessed in the office and with ambulatory BP monitoring (ABPM). All participants offered lifestyle advice to lower their BP. The endpoint was the development of HTN either with Office BP or ABPM. Results Of 100 subjects (54±8 years, 42 males, baseline office BP: 132/82 mmHg, 24-hour BP: 122/76 mmHg), 40 developed HTN in 3 years. 34 subjects developed Hypertensive Response to Exercise (HRE) (BP >210mmHg in men and >190mmHg in women) and all of them developed HTN. The SBP/MET-slope in future hypertensives was increased in all stages till peak exercise independently of sex type (stage1: 6.7vs4.9 p=0.049, stage2: 8.4vs4.8 p=0.001, peak: 6.7vs4.9, p=0.001). Their exercise capacity was reduced (10vs11.3METs, p=0.002) as well as their maximum exercise heart rate (156vs164, p=<0.0001). Those with HRE had higher 24hSBP (124vs121mmHg, p=0.009), Night SBP (117vs111mmHg, p<0.001), Day SBP (127vs124mmHg, p=0.012) Office Pulse Pressure (51vs47mmHg, p=0.01). Additionally, they had increased PWV (8.3vs7.5m/sec, p=<0.0001), MSNA levels (36vs28 bursts, p=<0.0001), LVMI (38vs34 gr/m2.7, p=0.02), and a statistically significant deterioration of 2021 CKD-EPI eGFR (90 vs 97 mL/min/1.73 m², p=0.02). All of them correlated with development of hypertension (p=0.002), while they did not differ regarding their metabolic profile at the follow-up. Conclusion Detecting exaggerated blood pressure response and specifically an increased SBP/MET-slope in the end of second stage of Bruce protocol at treadmill exercise test is associated with increased systemic vascular resistance and early subclinical HMOD which may upgrade an individual’s cardiovascular disease (CVD) risk as they progress to HTN indicating a need for instituting a BP-lowering strategy.

VITAMIN D AND INDICATORS OF AMBULATORY BLOOD PRESSURE MONITORING IN WOMEN WITH ARTERIAL HYPERTENSION IN THE EARLY POSTMENOPAUSAL PERIOD

Objective: To assess plasma 25(OH)D levels and indicators of ambulatory blood pressure monitoring (ABPM) in women with arterial hypertension (AH) stage II risk 3 in the early postmenopausal period. Design and method: We investigated 52 women with AH stage II risk 3 aged 52 (50; 54) years of age who are in the early postmenopausal period - group I. Serum level of 25(OH)D was determined by the immunoenzymatic assay. The level of 25(OH)D in the blood plasma was determined by enzyme immunoassay. In group I we identified subgroup IB (n=21) with vitamin D deficiency/insufficiency - level of 25(OH)D<30ng/ml and subgroup IA (n=31) without vitamin D deficiency. ABPM was carried out with a Watch BP 03. Statistical analysis was performed by means of «STATISTICA 10.0». Results: The level of 25(OH)D was lower (p<0,05) in subgroup IB (18,2±9,5 ng/ml) than in the comparable to subgroup IA (27,4±10,5 ng/ml). In subgroup IB, compared with subgroup IA, the values of mean night diastolic (DBP) were higher (p<0,05) (73,0 (69,0;79,0) mm Hg versus 68,8±7,4 mm Hg), time index (TI) DBP at night (14,3 (12,5; 33,4)%, versus 12.5 (0,0;12,5)%,), speed of morning rise DBP (16,5(11,0;22,0) mm Hg/hour versus 10,0(8,5;17,3) mm Hg/hour), systolic variability (SBP) during the day (36,0(29,0;43,0) mm Hg versus 25,0(22,0; 38,0) mmHg). TI DBP at night exceeded the threshold value in 42,9% of women in subgroup IB versus 17,2% (p< 0,05) of subjects in subgroup IA. Morning rise speed DBP in subgroup IB did not correspond to the norm in 81% of cases compared to subgroup IA – 37,9% (p = 0,004). Inverse moderate correlations were established in subgroup IB between the level of 25(OH)D in the blood plasma and a number of ABPM indicators: average night SBP (R =-0,37, p=0,004), TI SBP night (R=-0,42, p=0,04), average night DBP (R=-0,43, p=0,03), TI DBP night (R=-0,39, p=0,05). Conclusions: In women with AH stage II risk 3 in the early postmenopausal period, with a deficiency/insufficiency of the level of 25(OH)D in the blood plasma, excess of a number of ABPM indicators was more common than with its optimal level.

Peculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disordersPeculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to reveal the dependence of changes in the cognitive sphere on the peculiarities of the daily profile of blood pressure (BP) and heart activity in patients with arrhythmias. Materials and methods. We examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing, a study of the daily BP profile and heart activity. Hemodynamic status was assessed by daily BP and ECG monitoring. Average daily, average daytime and nighttime systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) were evaluated. The analysis of spectral indicators of heart rate variability was performed to assess the state of the autonomic nervous system. Correlations of hemodynamic indicators with the results of neuropsychological testing were determined. Results. In patients with cognitive disorders (CD), there was an increase in SBP in all periods of the day, most pronounced in patients with moderate CD (p = 0.049). In patients with mild CD and without CD, there were no significant intergroup differences in the level of average daily, daytime and night SBP, DBP and pulse pressure (p > 0.05). Patients with moderate CD had significantly higher SBP and time index of SBP at the expense of average daytime and average night values of these indicators compared to those without CD (p < 0.05). During the active period of the day, time index of DBP was significantly higher in patients with moderate CD (p = 0.002) who also had an increase in average daily, daytime and night SBP variability compared to participants without CD (p = 0.041). The differences between the groups were not significant in terms of DBP variability (р = 0.07). In 61 (54 %) patients with CD, non-dipper SBP prevailed in the structure of disorders of the daily BP profile, with the highest indicators in moderate CD (55.6 %). The presence of adverse daily DBP profiles — night-peaker (6.2 %) and over-dipper (8.8 %), which prevailed in patients with moderate CD, is hidden behind normal indicators of the daily BP index. Increased average SBP24 (odds ratio (OR) = 3.26, 95% confidence interval (CI): 1.45–5.35, p < 0.001), DBP24 (OR = 3.06, 95% CI: 1.41–4.79, p < 0.001), average HR24 (OR = 2.67, 95% CI: 1.32–4.14, p < 0.001), average SBP24 variability (OR = 2.13, 95% CI: 1.11–3.32, p < 0.001) are the main factors of central hemodynamic disorders that increase the risk of developing CD in patients with arrhythmias. Conclusions. The identified associations between cognitive dysfunction, indicators of daily BP monitoring and heart activity are important in the context of their comprehensive accounting for optimizing an individualized approach to patient management and predicting the development of CD.

A blunted nocturnal blood pressure decline is associated with all-cause and cardiovascular mortality.

It has been suggested that a blunted nocturnal blood pressure (BP) decline is associated with a poor prognosis. Nevertheless, it remains unclear if an abnormal dipping is deleterious per se or it merely reflects an elevated BP during sleep. We aimed to assess the prognostic value of nocturnal BP decline, with or without concomitant elevated nocturnal BP. Vital status and cause of death were obtained from death certificates in 59 124 patients, enrolled in the Spanish ABPM Registry between 2004 and 2014 (median follow-up: 10 years). The association between night-to-day ratio (NDR) and dipping patterns (extreme dippers, dippers, reduced dippers, and risers) with all-cause and cardiovascular mortality were evaluated by Cox-proportional models adjusted for clinical confounders and 24 h blood pressure. NDR was associated with all-cause mortality [hazard ratio for 1SD change: 1.15; 95% confidence interval (CI) 1.13-1.17]. Reduced dippers (1.13; 1.06-1.20) and risers (1.41; 1.32-1.51) were associated with an increased risk of all-cause death, whereas extreme dippers (0.90; 0.79-1.02) were not. Elevated NDR (≥0.9) in the absence of elevated night SBP (<120 mmHg) was associated with an increased risk of death (1.13; 1.04-1.22), as well as elevated night SBP but normal NDR (1.38; 1.26-1.50), and the combination of both abnormalities (1.56; 1.46-1.66). Similar results were obtained for cardiovascular mortality. Abnormalities in the circadian pattern are associated with an increased risk of all-cause and cardiovascular mortality. This is maintained even in the absence of nocturnal BP elevation.

Gender differences in the antihypertensive effect after radiofrequency denervation of the renal arteries in resistant arterial hypertension

Objective: evaluation of gender differences in the antihypertensive effect after denervation of the renal arteries based on the results of office and daily measurements of blood pressure in resistant arterial hypertension in a 3-year follow-up.Materials and methods: the study involved 80 patients with resistant arterial hypertension (RAH); Patients were divided by stratification randomization into the interventional treatment group, who continue to receive antihypertensive therapy (AHT) (RDN group) and the MT group (patients on drug therapy only. The study groups were comparable in terms of gender, age, duration of hypertension, the number of antihypertensive drugs taken, the presence of For 12 months, a comparative study was conducted between groups, further analysis of the effectiveness of surgical treatment of RDN PA was carried out at control points of 24 and 36 months, in which laboratory and instrumental examinations were performed.Results: according to the office measurement of blood pressure within the RDN and MT study groups, both in men and women, it turned out to be similar. After 12 months of observation between the comparison groups, the women of the group showed a statistically significant negative dynamics of the office SBP (p&lt;0.01) and office DBP (p&lt;0.05) parameters. According to the analysis of average daily, average daily, average night SBP indicators, after 12 months in the RDN group, a decrease was observed in all main parameters (p&lt;0.001). It is worth paying attention to the fact that in the MT group, among the average daily, average daily, average night ABPM indicators after 12 months, no statistically significant changes were detected. When conducting a gender analysis of ABPM indicators using the Friedman test and correcting the p value for multiple comparisons at visits of 24 and 36 months, a statistically significant decrease in the main average daily indicators in women was demonstrated, while in men such changes were not established.Conclusions: the data obtained indicate a more pronounced antihypertensive effect after radiofrequency denervation of the renal arteries in resistant arterial hypertension in women.

Effect of Fixed-dose Combination Amlodipine/Valsartan in Comparison to Two Drug Combination Nebivolol/Valsartan on 24-Hour Ambulatory Blood Pressure.

Nebivolol has a dual mechanism of action, exerting a moderate b- blockade effect and reducing peripheral arterial resistance, as a result, the antihypertensive effect of nebivolol may be higher than that of a potent vasodilator CCB such as amlodipine. The study evaluated the effect of two nebivolol/valsartan on 24 hour ambulatory blood pressure versus amlodipine/valsartan in grade II or III hypertension patients or having uncontrolled BP despite treatment. Ambulatory blood pressure monitoring is a powerful method to monitor the changes in blood pressure over the 24 hour. A total of 74 from 90 patients continued the study. Fourty patients received amlodipine 10 mg/valsartan 160 mg (group I), and thirty-four patients received nebivolol 5 mg/ valsartan 160 mg (group II). Peripheral blood pressure readings were measured at randomization at 6 and 12 weeks. Ambulatory blood pressure was measured at randomization and 12 weeks. Both drug combinations showed high efficacy in reducing peripheral and 24 hour ambulatory BP. There was no statistically significant difference between the groups in lowering peripheral systolic and diastolic blood pressure at 6 and 12 weeks. Furthermore, both groups failed to show any significant difference in reducing 24 hour SBP and DBP. Regarding day SBP, the blood pressure dropped by -5.63 ± 14.87 in group I and -6.25 ± 11.59 in group II (p = 0.844). Also, group I reduced the day DBP average by -2.53 ± 9.83 and group II by -3.61 ± 9.78 (p = 0.640). In addition, both drug combinations had no statistically significant difference in lowering night SBP and DBP average. Both treatment groups reached the target ambulatory blood pressure, and there was no statistically significant difference between both groups as a regard reduction in all ambulatory blood pressure readings.

FEATURES OF DAILY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE

Objective: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Design and method: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to glomerular filtration rate (eGFR), according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicom-combi device (Russia). Results: Among the examined patients, preserved renal function of CKD C1 was observed in 20.8% (n = 25); CKD C2 – in 50.8% (n = 61); CKD C3A – in 19.2% (n = 23); CKD C3B – in 9.2% (n = 11) p&lt;0.001. CKD C4 and terminal stages were not detected. It was revealed that according to increasing of degree of CKD, values of the average daily SBP (p = 0.013) average daytime SBP (p = 0.04), mean night SBP (p = 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values, p = 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP ⇙2 = 40.62 p&lt;0.01; DBP ⇙2 = 47.21, p&lt;0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKD C3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group ⇙2 = 9.35, p = 0.02. In the group of patients with CKD C3b, individuals with a daily profile of SBP/DBP night-pickers significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP ⇙2 = 32.47 p&lt;0.001, in DBP ⇙2 = 64.25 p&lt;0.001. There was a significant increase in patients with a daily profile of over-dipper according to DBP in patients with CKD C3b:0% vs 4.91% vs 13.04% vs 27.27% ⇙2 = 41.47, p&lt;0.001. Conclusions: AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.

Resort treatment of patients with arterial hypertension using transcranial magnetic therapy

Purpose of the study. Development of a new medical technology for the resort treatment of patients with arterial hypertension (AH) with the combined use of transcranial magnetic therapy (TMT). Material and methods. The study involved 60 patients with stage 1 AH, divided into 4 groups in accordance with the simple fixed randomization procedure. The patients in the control group (CG; n=30 people) received a basic complex of resort treatment (nebivolol, exercise therapy, group psychotherapy), while in the main group (MG; n=30 people), the patients were additionally prescribed TMT. The criteria for evaluating the effectiveness were as follows: the dynamics of indicators of daily blood pressure monitoring (DBPM), heart rate variability, and the parameters of the microcirculatory tissue system. Results. The dynamics of DBPM indicators shows that the positive changes in the estimated parameters in the MG were more pronounced and significantly different from the dynamics of the control group. The hypotensive effect of the course use of TMT in patients with stage 1 hypertension manifested itself in a decrease in SBP and DBP by an average of 10.2 % and 12.8 %, respectively (p&lt;0.05), as well as a decrease in mean blood pressure by 13.2 % (p&lt; 0.05). In general, as a result of the TMT course use, a significant decrease in the average daily and average night SBP levels was achieved. The evaluation of the clinical and functional state of the patients with hypertension 6 months after the end of resort treatment based on the combined TMT use proves the superiority of the proposed technique over the basic treatment regimen by 33 %. Conclusion. The use of TMT in the resort treatment of patients with stage 1 hypertension contributes to a significant increase in therapeutic measures: the hypotensive effect of the course use manifested itself in a decrease in SBP and DBP by 10.2 % and 12.8 %, respectively (p&lt;0.05), as well as a decrease in mean blood pressure by 13.2 % (p&lt;0.05).

PS-C09-6: FEATURES OF DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE

Purpose of the study: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Materials and methods of the study: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicomcombi device (Russia). Results of the study: Among the examined patients, preserved renal function of CKDC1 (eGFR&gt; 90 ml/min/1.73 m2) was observed in 20.8% (n = 25); CKDC2 (eGFR 60–89 ml/min/1.73m2) in 50.8% (n = 61); CKDC3A (eGFR 45–59 ml/min/1.73m2) in 19.2% (n = 23); CKDC3B (eGFR 30–44 ml/min/1.73m2) in 9.2% (n = 11) p &lt; 0.001. CKDC4 and terminal stages were not detected. When analyzing ambulatory blood pressure monitoring (ABPM), it was revealed that according to increasing of degree of CKD, values of the average daily SBP (122.52 ± 9.25 vs 122.13 ± 12.30 vs 121.74 ± 9.43 vs 134.36 ± 15.32 mm Hg, p &lt; 0.013) average daytime SBP (123.56 ± 8.99 vs. 124.00 ± 611.89 vs 123.74 ± 9.73 vs 134.27 ± 15.12 mmHg, p &lt; 0.04), mean night SBP (119.80 ± 13.39 vs 116.75 ± 14.59 vs 116.09 ± 12, 04 vs 135.09 ± 16.66 mm Hg, p &lt; 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values. Index of SBP daytime: 13.00 ± 14.05 vs 15.43 ± 21.22 vs 10.70 ± 15.04 vs 35.10 ± 34.14% respectively, p &lt; 0.01. Index of SAP nighttime were 33.75 ± 29.35 vs 26.04 ± 31.07 vs 26.58 ± 27.87% vs 66.10 ± 36.05% respectively,p &lt; 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP p &lt; 0.01; DBP p &lt; 0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKDC3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group, p &lt; 0.02. In the group of patients with CKDC3b, individuals with a daily profile of SBP/DBP “night-pickers” significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP p &lt; 0.001, in DBP p &lt; 0.001. There was a significant increase in patients with a daily profile of “over-dipper” according to DBP in patients with CKDC3b:0% vs 4.91% vs 13.04% vs 27.27% p &lt; 0.001. Conclusion: AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.

Arterial stiffness and nocturnal hypertension in preterm children and adolescents.

Preterm birth has been associated with increased risk for developing hypertension and other chronic diseases during childhood and adulthood. The aim of the current prospective case-control study was to investigate the associations of preterm birth with ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence. The study population included 52 children and adolescents born preterm and 26 healthy children born full term with similar age. The participants underwent ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV). Preterm children presented higher night SBP z score values compared to controls, but did not differ in other ABPM parameters, office peripheral and central SBPs. Nocturnal hypertension was found in 78% (7/9) of ex-preterm children with ambulatory BP hypertension. Preterm birth was an independent predictor of PWV z score adjusted for heart rate. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95% confidence interval [CI] 0.431-0.975 versus -0.19, 95% CI -0.574-0.536, respectively, P = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score. Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Increased awareness for detection of hypertension and prevention of obesity in childhood could prevent future adverse cardiovascular outcomes in preterm individuals.

HYPERTENSION AND ARTERIAL STIFFNESS IN PRETERM CHILDREN AND ADOLESCENTS

Objective: The aim of the current study was to investigate the association between preterm birth and ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence. Design and method: In this prospective case control study we included children and adolescents born preterm (cases) and children born full-term (controls) aged 5–19 years old. The participants underwent measurement of somatometric characteristics, office BP, central systolic BP, ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV). According to the Body Mass Index (BMI), the study population was classified as preterm-normal BMI, preterm-overweight/obese, full term- normal BMI and full term-overweight/obese. Results: Overall, 74 children participated in the study with a mean age of 10.7 (±3.63) years old out of which 52 were preterm and 22 were full-term children. Preterm children presented higher night SBP z score values compared to controls (p &lt; 0.05), but did not differ in other BP parameters. Preterm birth and BMI z score were predictors of night SBP z score. Preterm children also presented marginally higher PWV z score values (p = 0.06). Prematurity was an independent predictor of PWV z score. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95%CI 0.431–0.975 versus -0.19, 95%CI -0.574–0.536, respectively, p = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score. Conclusions: Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Early detection of hypertension and prevention of obesity in childhood could prevent future adverse health outcomes in individuals born preterm.

Resistant hypertension must be defined by ambulatory blood pressure and pulse pressure is best predictor of new cardiovascular events

Abstract Introduction Resistant Hypertension (RH) defined by Ambulatory blood pressure monitoring (ABPM) isn't so common. Prognostic CV by ABPM of RH is uncertain. Objective RH Population defined by ABPM, followed 5.9±5.0 years and prognostic value of ABPM for new CV events (CVe). Design and method ABPM-collected 1999–2019. Identified RH patients by ABPM. Obtained anthropometric, clinic, laboratorial data from the patient and clinical records. CVe defined by: stroke (ST) (Ischemic (STisq), haemorrhagic (SThs)), Coronary Event (CD), Other CV events (OCV) (acute heart failure (HF), peripheral arterial disease (PAD). Follow-up finished with event, last evaluation of the patient or death. Results 258 patients, follow-up – 5.9±5.0 years,158 males, mean age – 60.4±11 years. Diabetes Mellitus (DM) 45.3%, Dyslipidaemia 74.4%, Obesity 45.3%, Chronic Kidney Disease 37.2%, previous CVe (PCVe) 34.5%. Observed 68 CVe: 26 ST (21 STisq, 5 SThs), 21 CD, 21 OCV (15 HF, 6 PAD). 18 death (8 unknown, 1 infection, 2 cancer, 1 sudden death, 2 STisq, 1 CD, 3 HF). When compared those with event vs no-event (fig. 1), in T student to independent samples, those with event had larger left atrium (42.6±5.7 vs 40.2±4.7, p&amp;lt;0.05), lower creatinine clearance (mL/min/1.73m2) (63.6±34 vs 74.5±33). PCVe was significantly more prevalent on those with event (c 9.8, p&amp;lt;0.01). In a multivariate Cox analysis for the risk of CVe (adjusted to age, gender, DM, PCVe, glycemia, creatinine, number of antihypertensive), Day Pulse Pressure with cut-off 60mmHg was statically significant (HR 2.46 (95% CI 1.26–4.83), p&amp;lt;0.01). In Kaplan-Meier survival curve free of events, the best CV predictor obtained was the cut-off 60mmHg of PP (24h, Day, night PP), mostly Day PP-60mmHg (log rank 9.27, p&amp;lt;0.01) (fig. 2A). When analyzed for those who had Stroke, in the multivariate Cox analysis 24h SBP (p&amp;lt;0.05, HR 1.04 (95% CI 1.00–1.07), and night SBP (p&amp;lt;0.05, HR 1.03 (95% CI 1.00–1.06) were statically significant on top of age, gender, DM, PCVe, glycemia, creatinine, number of antihypertensive. In Kaplan-Meier survival curve free of events, the best CV predictor obtained was the cut-off 60mmHg PP, mostly Day PP 60mmHg (log rank 8.5 p&amp;lt;0.01) (fig. 2B). For those who had CD in the multivariate Cox analysis, adjusted for other variables, 24h SBP (p&amp;lt;0.05, HR 1.04 (95% CI 1.00–1.07), and night SBP (p&amp;lt;0.05 HR1.03 (95% CI 1.00–1.06) were statically significant. In Kaplan-Meier survival curve free of events, night PP 60mmHg predicted CD events (log rank 4.42 p&amp;lt;0.05) (fig. 2C). For OCV the multivariate Cox analysis, adjusted for other variables, 24h PP (p&amp;lt;0.05, HR 1.04 (95% CI 1.00–1.07) and night SBP (p&amp;lt;0.05, HR 1.03 (95% CI 1.00–1.06) were statically significant for new OCV. In Kaplan-Meier survival curve free of events, best predictor was mostly night PP 60mmHg (log rank 19, p&amp;lt;0.001) (fig. 2D). Conclusion In our sample of RH the definition by ABPM is essential. PP is the key prognosis for future CVe, special if analysed by the cut of PP-60 mmHg. Funding Acknowledgement Type of funding sources: None. Kaplan-Meier survival curves

Cinnamon effects on blood pressure and metabolic profile: A double-blind, randomized, placebo-controlled trial in patients with stage 1 hypertension.

Cinnamon effect on blood pressure remains controversial. The present pilot study assessed cinnamon effect on blood pressure, and metabolic profile of stage 1 hypertension patients (S1HTN). This double-blind placebo-controlled randomized trial was conducted between June and October 2019, in Mashhad, Iran. Study inclusion criteria comprised S1HTN diagnosis, based on 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were randomly assigned to two groups: cinnamon group (capsule, 1500 mg/day, 90 days) and placebo group. On days 0 and 90, ABPM derived systolic and diastolic blood pressure (SBP and DBP, respectively), blood lipid profile, and fasting blood sugar (FBS) were recorded. The two groups did not differ significantly regarding vascular risk factors, educational status, lipid profile and blood pressure at baseline, except for lower HDL-c in cinnamon group (p=0.03). On day 90, there was no significant difference between two study groups for lipid profile and blood pressure. A statistically significant decrease in mean 24-hr SBP and mean day SBP was observed in the cinnamon group, while mean night SBP and mean night DBP were decreased significantly in the placebo group after 90 days. A statistically significant decrease in mean change of day value of SBP was found in the cinnamon group, compared to the placebo. On day 90, FBS remained practically unchanged but a significant increase in HDL-c (5.8 unit; p=0.01) and a significant decrease in LDL-c levels (17.7 unit; p=0.009) were observed in the cinnamon group compared to placebo group. Cinnamon caused a statistically significant decrease in mean ambulatory SBP but in a clinically moderate way, and lipid profile was significantly improved. Therefore, cinnamon might be considered a complementary treatment in subjects with S1HTN.

Short-term blood pressure variability, arterial stiffness, and cardiovascular events: results from the Bordeaux cohort.

Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness. Population: Bordeaux cohort of hypertensive patients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15' day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included. In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association. Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensive patients, independently of average 24-h BP and arterial stiffness.

P2645Cardiovascular risk in patients with essential hypertension and nonalcoholic fatty liver disease comorbidity

Abstract Very often acute myocardial infarction and stroke are recorded among patients with essential hypertension (EH) and non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatosis (NASP), comorbidity. The aim of the study was to improve cardiovascular risk assessment in patients with combination of second stage EH and NASP, using the metabolism indexes, structural-functional indicators of heart and blood vessels. According to the study results of 170 patients with second stage of EH (98 (57.6%) were women and 72 (42.4%) - men), mean age 49.3±0.5) it was found that NASP was confirmed in 109 (64.1%) patients (SteatoTest - 0.41 units (S1-S2)). Total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL); very low (LDL) and low density (LDL) lipoproteins; atherogenic index (IA); lipoprotein (a) (Lp (a)), insulin, HOMA index, tumor necrosis factor α (TNFα)), adiponectin were determined among all patients. The instrumental examination included electrocardiography, echocardiography, daily blood pressure monitoring (DBPM), carotid arteries ultrasound, calculation of endothelial dysfunction index (EDI) (as the ratio of endothelial-dependent to endothelial-independent vasodilation) and arterial wall stiffness (AS). Statistical processing of the results was conducted by Microsoft Excel, STATISTICA for Windows 10.0 programs. The proaterogenic lipid spectrum changes (TC (7.7%, p=0.0009), TG (19.8%, p=0.02), LDL (11,8%, p=0.0009), IA (8,8%, p=0.04), increased levels of Lp (a) (58.0%, p=0.0007) TNFα (51.4%, p=0.01), insulin resistance (HOMA index - 3.3 units), decreased adiponectin level (44.3%, p=0.0002) were reported in patients with II stage EH and NASP comorbidity compared to patients with EH without fatty liver infiltration (p&lt;0.05). Higher systolic (SBP) and pulse arterial pressure (PBP) (both office measurement and DBPM), daily SBP index “nondipper” (63.3% of patients, p&lt;0.05); increased by 2 times the frequency of the registration of atherosclerotic plaques in both carotid arteries (p&lt;0.05), increase in AS (15.7%, p=0.002) and EDI reduction (−12.5%, p=0.01) were determined in patients with II stage EH and concomitant NASP compared with EH patients without NASP. True (p&lt;0.ehz748.096601) direct correlation bonds were established between the NASP and the level of TC (rs=0.38), TG (rs=0.31), LDL (rs=0.31), Lp (a (rs=0.51), insulin resistance (rs=0.47), TNF-α (rs=0.49), night SBP and PBP (rs=0.33 and rs=0.29), variability night SBP, AS (rs=0.41), reverse – with the level of adiponectin (rs=−0.48) and EDI (rs=−0.58). Thus, in patients with second stage EH NAFLD is associated with negative metabolic changes and structural and functional desorders of heart and blood vessels and can be considered as an additional factor of the overall cardiovascular risk increasing in patients with EH.

Abstract 048: Systolic and Diastolic Ambulatory Blood Pressure Affect Target Organ Damage Differently in Adolescents: The SHIP AHOY Study

Hypertensive target organ damage (TOD) is associated with increased risk for CV events. Ambulatory BP (ABP) measures are more strongly related to TOD than casual BP in adults but data in youth are lacking. Our objective was to determine which ABP parameters associated with TOD in adolescents. We evaluated casual BP (mean of 6 measures by auscultation), ABP (Spacelabs OnTrak), anthropometrics, labs, LVM, pulse wave velocity (PWV), diastolic function (E/E’ ratio), and systolic function (global longitudinal strain, GLS) in 132 adolescents (mean 15.8 + 1.4 yrs, 66% white, 57% male). Day, night and 24H SBP and DBP index (mean/95 th %ile for sex and height) and loads (%readings above the 95 th %ile) were defined according to sex and height-specific pediatric cut-points. General linear models were used to determine independent associations between ABP and TOD. Only systolic ABP means and loads were associated with LVMI and diastolic function, while both systolic and diastolic ABP means and loads were associated with PWV. There was a weak association between systolic and diastolic loads and GLS. In multiple regression analysis (full model: demographics, age, BMI, HR, ABP, metabolic profile, CRP) day SBP index was the strongest predictor of LVMI (β=15.2, R 2 0.4, p=0.006) and E/E’ (β=5.2, R 2 0.23, all p=0.007), while day DBP index was the strongest predictor of PWV (β=3.0, R 2 0.37, p&lt;0.0001). Day DBP load was the sole independent ABP predictor of GLS (β=0.05, R 2 0.25, p=0.02). We conclude that during adolescence, systolic and diastolic ABP parameters are differentially associated with TOD: SBP predicted LVMI, while DBP predicted PWV. ABP parameters may be used to evaluate risk for BP-related TOD.

LONG-TERM EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY (CPAP) IN HYPERTENSIVE PATIENTS WITH SLEEP APNEA AND METABOLIC IMPAIRMENT

Objective: Obstructive sleep apnea (OSA) is associated with the high prevalence of cardiovascular diseases, and such disease manifestations as obesity, arterial hypertension (AH), violation of carbohydrate metabolism, dyslipidemia and endothelial dysfunction. However, the effects of Continuous Positive Airway Pressure therapy (Continuous Positive Airway Pressure — CPAP therapy) on the normalization of blood pressure in patients with OAS+AH are poorly understood and poorly studied. The aim of the study was to investigate 12-month effects of long-term CPAP-therapy with auto-adaptation to inhalation and exhalation (A-Flex therapy) on blood pressure in patients with OSA+AH. Methods: To the prospective single-center study were included 177 patients with snoring, metabolic disorders, obstructive sleep apnea, and hypertension with the established drug therapy (138 men [78%] and 37 females [21%]), in age interval of 35-75 years (56,4 ± 9,4) which apnea-hypopnea index (AHI) &gt; 5 event/hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (Sp02 mean) by the rules of American Academy of Sleep Medicine (AASM). Optimal level of A-Flex therapy was adjusted at home. AHI, the level of air leakage, average pressure and compliance to CPAP treatment were established in accordance with international requirements. Results: After 12 months of A-Flex therapy we found a significant decrease of level of systolic and diastolic blood pressure. The group of CPAP-therapy has decreased daytime SBP on -5.9 mmHg (95% Cl from -3.2 to -7.1; P=0.02) and night SBP on -4.1 mmHg (95% Cl from -6.1 to -2.6; P=0.01). Similar dynamics was observed in variations of DBP. The group of CPAP-therapy decreased daytime DBP on -1.1 mm Hg (95% Cl from -2.2 to -0.5; P=0.02) and nighttime DBP on -5.1 mm Hg (95% Cl from -7.2 to -3.5; P=0.01). In addition, the group of CPAP-therapy have clinical changing of excessive daytime sleepiness, expanding physical activity, normalization of night sleep. Conclusions: The 12-month A-Flex therapy in OSA patients with AH has a significant therapeutic effect of stabilization systolic and diastolic blood pressure. The long-term 12-month A-Flex therapy has to reduce the risks of cardiovascular events in moderate and severe OSA patients with acute metabolic manifestations and arterial hypertension.

Prevalence of Circadian Blood Pressure Patterns and Factors Associated with Non-Dipping among Black Patients with Untreated and Treated Hypertension: A Cross-Sectional Study

Objective: To determine the prevalence of circadian BP patterns and to assess factors associated with the non-dipping pattern in untreated and treated hypertensive patients, studied separately. Methods: Clinical data and ABPM were obtained from 52 untreated and 168 treated hypertensive patients referred for ABPM to Monkole Hospital in Kinshasa. Twenty-four ABPM was performed using an oscillometric device. Non-dipping pattern encompasses non-dipping (nocturnal systolic BP dip less than 10% of daytime systolic BP) and reverse dipping (mean night SBP higher than the day SBP). Results: the prevalence of non-dipping pattern was 75% (63.5% non-dipping and 11.5% reverse dipping) and 70% (60.1% non-dipping and 10.1% reverse dipping) in untreated and treated hypertensive patients, respectively. Advanced age (adjusted OR 1.80; 95%CI 1.96 - 3.38; p = 0.015), female sex (adjusted OR 2.28; 95%CI 1.19 - 4.36; p = 0.013), diabetes (adjusted OR 5.06; 95%CI 1.38 - 6.95; p = 0.014), reduced kidney function (adjusted OR 3.10; 95%CI 1.50 - 6.43; p = 0.018), inflammation (adjusted OR 2.65; 95%CI 1.76 - 6.48; p = 0.031), LVH (adjusted OR 4.45; 95%CI 1.78 - 7.67; p = 0.024) and antihypertensive therapy (adjusted OR 0.19; 95%CI 0.12 - 0.64; p = 0.018) emerged as the main independent factors significantly associated with the non-dipping pattern in the study population. Conclusion: the non-dipping pattern was a common finding in studied patients and associated with traditional and emerging risk factors suggesting that this abnormal pattern could be a marker of high cardiovascular risk.

Hronotherapy Aspects of Efficiency Azilsartan Medoxomil in Combination Therapy in Patients With Hypertension and Metabolic Syndrome

Determination of the effectiveness and safety of different dosing regimens during the day (in the morning or at bedtime) combination therapy including azilsartan medoxomil in patients with essential hypertension and metabolic syndrome (MS). The study included 60 patients with uncontrolled hypertension and MS (age median - 59 (54-65) years). Patients were randomized in two groups: group 1 (n=30) received azilsartan medoxomil 40 mg/day, and indapamide retard 1,5 mg/day in the morning; group 2 (n=30)- azilsartan medoxomoil 40 mg at bedtime and indapamide retard 1,5 mg in the morning. All patients at baseline, and after 4 and 12weeks assessed levels of office blood pressure (BP), heart rate (HR); at baseline and after 12 weeks was conducted ambulatory BPmonitoring (ABPM). Evaluated the main indicators of circadian blood pressure profile, as well as the central aortic pressure (CAP) and the rigidity of the vascular wall: systolic, diastolic, and mean arterial pressure in the aorta, aortic augmentation index, pulse wave velocity in the aorta, the augmentation index. Study results were processed using the program Statistica 6.1 by methods nonparametric statistics. Regardless of the regimen used azilsartan destination as part of combination therapy after 4 weeks showed a significant (p<0.05) reduction in SBP and DBP. After 12 weeks of observation target blood pressure was recorded 27 (90%) patients of group 1 and 29 (96.7%)- group2. As a result of ABPM after 12 weeks of treatment in both groups showed a statistically significant (p<0.05) improvement in all parameters investigated. However, positive changes such indicators as an index time of hypertension in the day and night hours, SBP, DBP, and BP variability during the night, the morning rise of systolic as well as the speed of morning rise in SBP and DBP were more pronounced in the appointment azilsartan medoxomil at bedtime compared to morning reception. The use of both treatment regimens provided significant (p<0.05) increase frequency registration profile dippear and reduction - non-dipper. Importantly, irrespective of the time of taking the drugs in both groups occurred significant (p <0.05), and a comparable improvement in rigidity and CAP vascular wall. When combined with essential hypertension and MS azilsartana use of combination drug therapy provided achievement of the target values of blood pressure in the majority of patients, a significant improvement in the main indicators of ABPM, CAP, and the rigidity of the vascular wall, as well as the normalization of daily profile of blood pressure in the majority of patients, regardless of dosing regimen during the day. However, the combination of indapamide retard morning - azilsartan medoxomil at bedtime accompanied by a significantly greater positive changes most ABPM parameters, especially at night.

ARTERIAL HYPERTENSION ASSOCIATED WITH METABOLIC SYNDROME: FOCUS ON DAILY PROFILES OF CENTRAL AORTIC PRESSURE AND VASCULAR STIFFNESS

Purpose: to evaluate the parameters of the central aortic pressure and arterial stiffness during the day in patients with arterial hypertension (AH) with metabolic syndrome (MS) Material and methods: The study included 48 subjects divided into 2 groups: 23 (47,9%) subjects with AH, 25 (52,1%) subjects with AH with MS (AH+MS). Control group (CG) were 22 practically healthy subjects. All the subjects underwent examination ABPM with oscillometric sensor (BPLabVasotens, Russia) with assessment CAP (systolic blood pressure, SBPao; diastolic blood pressure DBPao; pulse pressure,PPao; Augmentation index, Alxao; amplification of pulse pressure, PPA) and arterial stiffness (pulse wave velocity, PWVao; Reflected Wave Transit Time, RWTT; Arterial Stiffness Index, ASI; Augmentation index, AIx). Results: Analysis of CAP demonstrated significant differences between the day / night SBP ao, DBP ao., mean BP ao in AH and AH + MS groups compared to the CG. No significant differences in the parameters of pulse pressure (PP) during the day in these groups are not mentioned, but PP is higher in AH + MS group. Augmentation Index for 24 hours significantly higher, amplification of pulse pressure was significantly lower in the AH + MS compared to CG and AH group. Evaluation of daily arterial stiffness parameters revealed significantly higher rates in PWVao in AH + MS group comparison with the CG and AH group. RWTT statisticaly significant lower in AH + MS and AH groups compared to CG. Conclusion: 24-hour monitoring of CAP and AS revealed a deterioration of the elastic properties of central arteries in hypertensive subjects with metabolic syndrome. Thus, the results of our study confirm the importance of the study of arterial stiffness and the CAP and in the long term could be considered as markers in hypertensive patients, especially in the presence of comorbid pathology.