Nighttime Ambulatory Blood Pressure Research Articles

ASSOCIATION OF CLINIC AND AMBULATORY BLOOD PRESSURE WITH MORTALITY IN PATIENTS WITH AND WITHOUT DIABETES

Objective: To explore whether different levels of ambulatory and office blood pressure (BP) and different hypertension phenotypes associate with differences of risk in diabetes and no-diabetes. Design and method: This analysis assessed outcome data from patients with complete data included in the Spanish Ambulatory BP (ABP) Monitoring Registry. The associations between office BP, mean, daytime and nighttime ABP and the risk in patients with diabetes and no-diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders. Results: A total of 59,124 patients were recruited from 223 primary care centres in Spain. The majority had an office SBP >140 mmHg (36,700 patients), 23,128 (40.6%) patients were untreated. Diabetes was diagnosed in 10,935 patients (19.2%). Cardiovascular (CV) disease was present in 2,521 patients (23.1%) with and 4,616 (10.0%) without diabetes. Twenty-four-hour mean, daytime and nighttime ABP were associated with increased risk in diabetes and no-diabetes, whereas there was no clear association for office BP. While the relative association of BP with CV death risk was similar in diabetes compared to no-diabetes (mean interaction p=0.80, daytime interaction p=0.97 and nighttime interaction p=0.32), increased event rates occurred in diabetes for all ABP monitoring parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (HR 0.86; 95% CI 0.72-1.03) and slightly reduced risk for all-cause death in no-diabetes (HR 0.89; 95% CI 0.81-0.98) but without significant interaction between diabetes and no-diabetes. Sustained hypertension and masked hypertension in diabetes and no-diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no-diabetes (interaction p=0.26) and CV death risk, while, some interaction was present for all-cause death (interaction p=0.043) and non-CV death (interaction p=0.053). Conclusions: Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ABP. Masked and sustained hypertension confer the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no-diabetes.

Seasonal effects on blood pressure variability in treated hypertensive patients assessed by office, home, and ambulatory measurements.

This study investigated the seasonal effect on blood pressure (BP) variability. Patients on stable antihypertensive drug treatment were assessed with office (OBP), home (HBP), and ambulatory BP (ABP) measurements in winter, next summer, and in next winter. Fifty-eight participants with full data for winter and summer were analyzed (mean age 65.2 ± 7.9 [SD], 64% males). OBP, HBP and ABP (24-h; daytime) were lower in summer than in winter (P < 0.01), whereas nighttime ABP was unchanged (p = NS). Standard deviation (SD), coefficient of variation (CV) and average real variability (ARV) for systolic OBP were higher in winter than summer (p < 0.01/ < 0.05/ < 0.01, respectively). These indices for HBP and ABP measurements did not differ in winter and summer (p = NS). Forty participants had complete data for winter-summer-next winter and HBP/ABP variability indices did not differ for both winters versus summer. These preliminary data suggest that BP variability is unaffected by seasonal changes in contrast to average BP levels.

Blood pressure reduction after renal denervation in patients with or without chronic kidney disease.

Renal denervation (RDN) has emerged as an adjacent option for the treatment of hypertension. This analysis of the Erlanger registry aimed to compare the blood pressure (BP)-lowering effects and safety of RDN in patients with and without chronic kidney disease (CKD). In this single-center retrospective analysis, 47 patients with and 127 without CKD underwent radiofrequency-, ultrasound- or alcohol-infusion-based RDN. Office and 24-h ambulatory BP and estimated glomerular filtration rate (eGFR) were measured at baseline, and after 6 and 12months. A total of 174 patients with a mean age of 59.0±10years were followed up for 12months. At baseline, mean eGFR was 55.8±21mL/min/1.73 m2 in patients with CKD and 87.3±13mL/min/1.73 m2 in patients without CKD. There was no significant eGFR decline in either of the groups during 12months of follow-up. In patients without CKD, office systolic and diastolic BP were reduced by -15.3±17.5/-7.9±10.8mmHg 6months after RDN and by -16.1±18.2/-7.7±9.6mmHg 12months after RDN. In patients with CKD, office systolic and diastolic BP were reduced by -10.7±24.0/-5.8±13.2mmHg 6months after RDN and by -15.1±24.9/-5.9±12.9mmHg 12months after RDN. Accordingly, in patients without CKD, 24-h ambulatory systolic and diastolic BP were reduced by -7.2±15.8/-4.9±8.8mmHg 6months after RDN and by -9.0±17.0/-6.2±9.8mmHg 12months after RDN. In patients with CKD, 24-h systolic and diastolic BP were reduced by -7.4±12.9/-4.2±9.9mmHg 6months after RDN and by -8.0±14.0/-3.6±9.6mmHg 12months after RDN. There was no difference in the reduction of office and 24-h ambulatory BP between the two groups at any time point (all P>.2). Similar results have been found for the 6months data. With exception of rare local adverse events, we did not observe any safety signals. According to our single-center experience, we observed a similar reduction in 24-h, day and night-time ambulatory BP as well as in-office BP in patients with and without CKD at any time point up to 12months. We conclude that RDN is an effective and safe treatment option for patients with hypertension and CKD.

Abstract 13463: Effect of an Intervention to Reduce Sedentary Behavior on Blood Pressure in Desk Workers: The RESET BP Randomized Clinical Trial (RCT)

Introduction: High sedentary behavior (SB) is associated with cardiovascular (CV) risk in cohort studies, yet definitive data from RCTs of SB reduction on CV risk factors is lacking. Hypothesis: A 3-month SB reduction intervention would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. Methods: We recruited desk workers with systolic BP (SBP) 120-159 mmHg or diastolic BP (DBP) 80-99 mmHg, not on antihypertensives, and reporting low physical activity. Participants were randomized 1:1 to a 3-month SB reduction intervention or control. The intervention targeted replacing sitting with standing and stepping via health coaching, a wrist-worn activity prompter, and a height-adjustable workstation. All day and work-specific SB, standing, stepping, and steps were measured by a thigh-worn triaxial accelerometer. Protocolized office SBP (primary outcome), DBP, and HR were measured in duplicate on two occasions at each baseline and 3 months; 24-hr ambulatory BP and carotid-femoral PWV via tonometry were also measured. Changes in outcomes were compared across groups using analysis of covariance and mixed models. Results: Participants (n=271) had mean age 45 y and BP 129/83 mmHg; 60% were female and 82% were non-Hispanic White. Retention was 97%. Intervention participants reduced SB during work (-1.3 hr/day) and across all waking hours (-1.1 hr/day) compared to controls (both p&lt;0.001). Intervention participants increased work-specific standing (1.2 hr/day), stepping (5 min/day) and steps (398/day) and all day standing (1.0 hr/day), stepping (7 min/day) and steps (528/day) compared to control (all p&lt;0.05). Yet, the intervention did not yield a greater reduction in BP or PWV vs. controls (all p&gt;0.05). Differences in changes were office SBP -0.24 mmHg (p=0.793), DBP 0.08 mmHg (p=0.894), and heart rate -2.75 (p=0.190). Findings were similar for 24-hr, daytime, and nighttime ambulatory BP averages (all &lt;1.2 mmHg; p&gt;0.05). Differences in PWV were higher (opposite from the hypothesized direction) in intervention vs. control and approached significance (0.18 m/s, p=0.07). Conclusions: In sedentary desk workers with mild-moderate untreated BP, this 3-month intervention reduced daily SB by about one hour but did not improve BP or PWV.

Skin sodium content as a predictor of blood pressure response to renal denervation

Patients with treatment resistant hypertension (TRH) are known to have elevated sodium (Na) content in muscle and skin. Renal denervation (RDN) emerged as an adjacent therapeutic option in this group of patients. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN in patients with TRH. Radiofrequency-device based RDN was performed in 58 patients with uncontrolled TRH. Office and 24-h ambulatory BP were measured at baseline and after 6 months. To assess tissue Na content Na magnetic resonance imaging (Na-MRI) was performed at baseline prior to RDN. We splitted the study cohort into responders and non-responders based on the median of systolic 24-h ambulatory blood pressure (ABP) reduction after 6 months and evaluated the association between BP response to RDN and tissue Na content in skin and muscle. The study was registered at http://www.clinicaltrials.gov (NCT01687725). Six months after RDN 24-h ABP decreased by −8.6/−4.7 mmHg. BP-Responders were characterized by the following parameters: low tissue sodium content in the skin (p = 0.040), female gender (p = 0.027), intake of aldosterone antagonists (p = 0.032), high baseline 24-h night-time heart rate (p = 0.045) and high LDL cholesterol (p < 0.001). These results remained significant after adjustment for baseline 24-h systolic BP. Similar results were obtained when the median of day-time and night-time ABP reduction after 6 months were used as cut-off criteria for defining BP response to RDN. We conclude that in addition to clinical factors including baseline 24-h ABP Na-MRI may assist to select patients with uncontrolled TRH for RDN treatment.

Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated Hypertension Based on an "All-in-One" Device.

Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds. Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg). Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively. Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.

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.

BLOOD PRESSURE REDUCTION AFTER RENAL DENERVATION IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: THE ERLANGER EXPERIENCE

Objective: Renal denervation (RDN) has emerged as an adjacent option for the treatment of hypertension. This analysis of the ERLANGER registry aimed of comparing the blood pressure (BP) lowering effects and safety of RDN in patients with and without CKD. Design and method: Radiofrequency, ultrasound or alcohol-infusion device based RDN was performed in 47 patients with and 127 without CKD. Office and 24-h ambulatory BP were measured at baseline, after 6 and 12 months. We splitted the study cohort based on the median systolic 24h ABP reduction after 6 months into responders and non-responders and compared baseline characteristics between these groups. CKD was defined by clinical diagnosis, estimated glomerular filtration rate (eGFR: 15-59 ml/min/1.73m2) or A2 albuminuria (&gt; = 30 mg/g creatinine ). Results: 174 patients with a mean age of 59.0±10 were followed up for at least 12 months. At baseline mean eGFR was 55.8±21 ml/min/1.73m2 in patients with CKD and 87.3±13 ml/min/1.73m2 in patients without CKD according to the CKD-EPI formula. There was no significant eGFR decline in either of the groups during follow up. Office and 24-h systolic and diastolic BP were significantly reduced from baseline in patients with or without CKD at all time points after RDN (all p&lt;0.01). There was no significant difference in the reduction of 24h, day- and nighttime ABP between the 2 groups at any time point (see table below). In addition to 24h baseline systolic ABP we identified several predictors (all p &lt; 0.05): patients with a high baseline office heart rate (HR), without T2D, without diuretic medication and current smokers were more likely to be responders. With exception of rare local adverse events (e.g. haematoma at the puncture site), we had no safety signals, especially in our patients with CKD. Conclusions: According to our single center experience, we observed a similar reduction in 24-h, day and nighttime ambulatory BP as well as in office BP in patients with and without CKD at any time point up to 12 months. We conclude that RDN is an effective and safe treatment option for patients with arterial hypertension and CKD.

SEASONAL EFFECT ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS ASSESSED BY DIFFERENT MEASUREMENT METHODS

Objective: The seasonal variation in temperature is well known to affect the level of blood pressure (BP). However, its impact on BP variability is uncertain. This study investigated the seasonal variation in BP variability in hypertensive patients assessed using office and out-of-office BP measurements. Design and method: Adult hypertensives on stable antihypertensive drug treatment were assessed with office (OBP), home (HBP), and ambulatory BP (ABP) measurements in winter, next summer, and in the next winter. BP variability was quantified using the standard deviation (SD) and coefficient of variation (CV). Results: Fifty-eight participants had complete data for winter and summer (mean age 65.2±7.9 [SD], 64% males, 21% obese, 48% smokers, 11% diabetes, 18% cardiovascular disease, 28% on a single antihypertensive drug, 38% on 2 drugs, 34% on &gt; 2 drugs). OBP, HBP and daytime ABP were lower in summer than in winter (P&lt;0.01), whereas nighttime ABP was unchanged (P = NS) (Figure). SD and CV for systolic OBP were higher in winter than summer (P&lt;0.01/&lt;0.05, respectively). BP variability assessed by HBP and ABP measurement did not differ in winter and summer (Figure). Forty participants had complete data for winter-summer-next winter. OBP, HBP and daytime ABP were higher in the second winter compared with summer excluding any order effect. Respective CV values showed no difference (p = NS). Conclusions: These preliminary data suggest that despite the considerable impact of seasonal changes in temperature on the levels of BP, its variability is not affected. Thus, variability appears to be an intrinsic feature of the individual's BP behaviour, which is largely unaffected by extrinsic seasonal factors.

Daytime Versus Nighttime Ambulatory Blood Pressure Monitoring in Coarctation of Aorta.

HomeHypertensionAhead of PrintDaytime Versus Nighttime Ambulatory Blood Pressure Monitoring in Coarctation of Aorta No AccessResearch ArticleRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessResearch ArticleRequest AccessDaytime Versus Nighttime Ambulatory Blood Pressure Monitoring in Coarctation of Aorta Alexander C. Egbe, William R. Miranda, Heidi M. Connolly, Iftikhar J. Kullo and Barry A. Borlaug Alexander C. EgbeAlexander C. Egbe Correspondence to: Alexander Egbe, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905. Email E-mail Address: [email protected] https://orcid.org/0000-0002-8810-3631 Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN. Search for more papers by this author , William R. MirandaWilliam R. Miranda https://orcid.org/0000-0001-8864-8474 Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN. Search for more papers by this author , Heidi M. ConnollyHeidi M. Connolly https://orcid.org/0000-0003-0666-0344 Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN. Search for more papers by this author , Iftikhar J. KulloIftikhar J. Kullo https://orcid.org/0000-0002-6524-3471 Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN. Search for more papers by this author and Barry A. BorlaugBarry A. Borlaug https://orcid.org/0000-0001-9375-0596 Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN. Search for more papers by this author Originally published10 May 2023https://doi.org/10.1161/HYPERTENSIONAHA.123.21124Hypertension. 2023;0FootnotesFor Sources of Funding and Disclosures, see page XXX.Correspondence to: Alexander Egbe, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905. Email egbe.[email protected]edu Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.123.21124PMID: 37161822 Originally publishedMay 10, 2023 Keywordscardiac remodelingoutcomeshypertensionblood pressure monitoringPDF download Advertisement SubjectsHypertension

24-hour ambulatory blood pressure and cryptogenic ischemic stroke in young adults

Background In young patients, up to 40% of ischemic strokes remain cryptogenic despite modern-day diagnostic work-up. There are limited data on blood pressure (BP) behavior in these patients. Thus, we aimed to compare ambulatory blood pressure (ABP) profiles between young patients with a recent cryptogenic ischemic stroke (CIS) and stroke-free controls. Patients and Methods In this substudy of the international multicenter case–control study SECRETO (NCT01934725), 24-hour ambulatory blood pressure monitoring (ABPM) was performed in consecutive 18–49-year-old CIS patients and stroke-free controls. The inclusion criteria were met by 132 patients (median age, 41.9 years; 56.1% males) and 106 controls (41.9 years; 56.6% males). We assessed not only 24-hour, daytime, and nighttime ABP but also hypertension phenotypes and nocturnal dipping status. Results 24-hour and daytime ABP were higher among controls. After adjusting for relevant confounders, a non-dipping pattern of diastolic blood pressure (DBP) was associated with CIS in the entire sample (odds ratio, 3.85; 95% confidence interval, 1.20–12.42), in participants without antihypertensives (4.86; 1.07–22.02), and in participants without a patent foramen ovale (PFO) (7.37; 1.47–36.81). After excluding patients in the first tertile of the delay between the stroke and ABPM, a non-dipping pattern of DBP was not associated with CIS, but a non-dipping pattern of both systolic BP and DBP was (4.85; 1.37–17.10). In participants with a PFO and in those without hypertension by any definition, no associations between non-dipping patterns of BP and CIS emerged. Conclusions Non-dipping patterns of BP were associated with CIS in the absence of a PFO but not in the absence of hypertension. This may reflect differing pathophysiology underlying CIS in patients with versus without a PFO. Due to limitations of the study, results regarding absolute ABP levels should be interpreted with caution. Key Messages Nocturnal non-dipping patterns of blood pressure were associated with cryptogenic ischemic stroke except in participants with a patent foramen ovale and in those without hypertension by any definition, which may indicate differing pathophysiology underlying cryptogenic ischemic stroke in patients with and without a patent foramen ovale. It might be reasonable to include ambulatory blood pressure monitoring in the diagnostic work-up for young patients with ischemic stroke to detect not only the absolute ambulatory blood pressure levels but also their blood pressure behavior.

Seasonality in nighttime blood pressure and its associations with target organ damage.

There is some evidence that nighttime blood pressure varies between seasons. In the present analysis, we investigated the seasonal variation in ambulatory nighttime blood pressure and its associations with target organ damage. In 1054 untreated patients referred for ambulatory blood pressure monitoring, we performed measurements of urinary albumin-to-creatinine ratio (ACR, n = 1044), carotid-femoral pulse wave velocity (cfPWV, n = 1020) and left ventricular mass index (LVMI, n = 622). Patients referred in spring (n = 337, 32.0%), summer (n = 210, 19.9%), autumn (n = 196, 18.6%) and winter (n = 311, 29.5%) had similar 24-h ambulatory systolic/diastolic blood pressure (P ≥ 0.25). However, both before and after adjustment for confounding factors, nighttime systolic/diastolic blood pressure differed significantly between seasons (P < 0.001), being highest in summer and lowest in winter (adjusted mean values 117.0/75.3 mm Hg vs. 111.4/71.1 mm Hg). After adjustment for confounding factors, nighttime systolic/diastolic blood pressure were significantly and positively associated with ACR, cfPWV and LVMI (P < 0.006). In season-specific analyses, statistical significance was reached for all the associations of nighttime blood pressure with target organ damage in summer (P ≤ 0.02), and for some of the associations in spring, autumn and winter. The association between nighttime systolic blood pressure and ACR was significantly stronger in patients examined in summer than those in winter (standardized β, 0.31 vs 0.11 mg/mmol, P for interaction = 0.03). In conclusion, there is indeed seasonality in nighttime blood pressure level, as well as in its association with renal injury in terms of urinary albumin excretion. Our study shows that there is indeed seasonal variability in nighttime blood pressure, highest in summer and lowest in winter, and its association with renal injury in terms of urinary albumin excretion varies between summer and winter as well.

PS-C36-8: BLOOD PRESSURE REDUCTION AFTER RENAL DENERVATION IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: THE ERLANGER EXPERIENCE

Background: Hypertension is associated with major cardiovascular and renal adverse events and the 24h-ambulatory blood pressure (BP) is superior than the office BP in predicting these complications. Overactivitiy of the sympathetic nervous system is linked with elevation of systemic BP and is also present in patients with chronic kidney disease (CKD). The aim of this study was to compare the BP lowering effects of renal denervation (RDN) in patients with and without CKD. Methods: Radiofrequency or ultrasound device based renal denervation was performed in 47 patients with and 127 without CKD in our center. Office and 24h-ambulatory BP were assessed after 3, 6 and 12 months by validated devices. CKD was defined by clinical diagnosis or according to the estimated glomerular filtration rate (eGFR: 15–60 ml/min/1.73m2; CKD-EPI formula). Results: Until today, 174 patients with a mean age of 59.0 ± 10 were followed up for at least 12 months. At baseline mean eGFR was 55.8 ± 21 ml/min/1.73m2 in patients with CKD and 87.3 ± 13 ml/min/1.73m2 in patients without CKD. There was no significant eGFR decline in either of the groups during follow up. In patients with CKD eGFR was after 12 months 54.4 ± 23 ml/min/1.73m2 (p = 0.699 vs baseline). Office and 24h-systolic and -diastolic BP were significantly reduced from baseline in patients with or without CKD at all time points after RDN (all p &lt; 0.01). There was no significant difference in the reduction of 24 h, day- and nighttime ambulatory BP between the 2 groups at any time point (see table below). With exception of rare local adverse events (e.g. haematoma at the puncture site), we had no safety signals, especially in our patients with CKD, e.g. there was no dissection, embolism or periprocedural cardiovascular complications. Conclusion: In our single center registry, we observed a similar BP reduction in 24 h, day- and nighttime ambulatory BP as well as in office BP in patients with and without CKD at any time point up to 12 months. There was no safety signal related to RDN. In particular, we did not observe a significant eGFR decline in both CKD positive or negative patients. We conclude that RDN is an effective and safe treatment option for patients with hypertension and chronic kidney disease.

The effect of a low dose hydrogen-oxygen mixture inhalation in midlife/older adults with hypertension: A randomized, placebo-controlled trial.

Objective: To explore the effect of a low-dose hydrogen–oxygen (H2-O2) mixture inhalation in midlife/older adults with hypertension. Methods: This randomized, placebo-controlled trial included 60 participants with hypertension aged 50–70 years who were randomly divided into Air group (inhaled placebo air) or H2-O2 group [inhaled H2-O2 mixture (66% H2/33% O2)]. Participants in both groups were treated 4 h per day for 2 weeks. Four-limb blood pressure and 24-h ambulatory blood pressure were monitored before and after the intervention, and levels of plasma hormones related to hypertension were determined. Results: A total of 56 patients completed the study (27 in the Air group and 29 in the H2-O2 group). The right and left arm systolic blood pressure (SBP) were significantly decreased in H2-O2 group compared with the baseline levels (151.9 ± 12.7 mmHg to 147.1 ± 12.0 mmHg, and 150.7 ± 13.3 mmHg to 145.7 ± 13.0 mmHg, respectively; all p < 0.05). Meanwhile, the H2-O2 intervention significantly decreased diastolic nighttime ambulatory blood pressure by 2.7 ± 6.5 mmHg (p < 0.05). All blood pressures were unaffected in placebo group (all p > 0.05). When stratified by age (aged 50–59 years versus aged 60–70 years), participants in the older H2-O2 group showed a larger reduction in right arm SBP compared with that in the younger group (p < 0.05). In addition, the angiotensin II, aldosterone, and cortisol levels as well as the aldosterone-to-renin ratio in plasma were significantly lower in H2-O2 group compared with baseline (p < 0.05). No significant differences were observed in the Air group before and after the intervention. Conclusion: Inhalation of a low-dose H2-O2 mixture exerts a favorable effect on blood pressure, and reduces the plasma levels of hormones associated with hypertension on renin-angiotensin-aldosterone system and stress in midlife/older adults with hypertension.

Relationship of 24-h ambulatory blood pressure variability with micro and macrovascular parameters and hypertension status.

Increased blood pressure variability (BPV) has been associated with an increased risk of subclinical organ damage and cardiovascular events, independently of elevated average BP values. We aimed to investigate the association of BPV indices with micro- and macrovascular parameters, some of them not previously studied. We evaluated 344 individuals (233 never-treated/newly diagnosed hypertensive and 111 normotensive individuals). BPV was assessed using average real variability (ARV) during 24-h, daytime and night-time ambulatory blood pressure monitoring, and systolic weighted standard deviation (wSD). Retinal microvascular diameter was assessed by nonmydriatic retinal photography. Arterial stiffness was assessed by pulse wave velocity (PWV) and aortic augmentation index (AIx); subendocardial variability ratio (SEVR) was used as an index of myocardial perfusion. Carotid intima-media thickness (cIMT) was measured by ultrasound. Data were analyzed using multiple regression analysis. After adjusting for potential confounders, PWV and cIMT were independently associated with ARV components in the total sample (P < 0.023 and P < 0.014, respectively). Within hypertensives only PWV and cIMT were independently associated with ARV components (P < 0.002 for PWV and P < 0.003 for cIMT). In contrast, within normotensives, only retinal parameters and AIx were associated with ARV components (P < 0.017 and P = 0.013, respectively). None of the univariate correlations between vascular parameters and wSD remained significant after adjustment for potential confounders. Short-term BPV as assessed by ARV is independently associated with macrovascular parameters in untreated hypertensive patients, and with microvascular parameters in normotensive individuals.

The prevalence of masked hypertension and masked uncontrolled hypertension in relation to overweight and obesity in a nationwide registry in China.

Masked hypertension is difficult to identify and is associated with adverse outcomes. How and to what extent masked hypertension is related to overweight and obesity remain unclear. In participants with a clinic blood pressure (BP) < 140/90 mmHg enrolled in a nationwide prospective registry in China, we performed ambulatory and home BP measurements and defined masked hypertension and masked uncontrolled hypertension as an elevated 24-h (≥130/80 mmHg), daytime (≥135/85 mmHg) or nighttime ambulatory BP (≥120/70 mmHg) or an elevated home BP (≥135/85 mmHg). Overweight and obesity were defined as a body mass index of 25.0-29.9 and ≥30.0 kg/m2, respectively. The 2838 participants had a mean (±SD) age of 54.9 ± 13.6 years and included 1286 (45.3%) men and 1065 (37.5%) and 173 (6.1%) patients with overweight and obesity, respectively. Multiple stepwise regression analyses identified that body mass index was significantly (P ≤ 0.006) associated with the prevalence of masked ambulatory and home hypertension in treated (n = 1694, 58.6% and 42.1%, respectively) but not untreated participants (n = 1144, 55.7% and 29.5%, respectively). In categorical analyses, significant associations were observed with overweight and obesity for the prevalence of masked uncontrolled ambulatory and home hypertension (P ≤ 0.02) but not masked ambulatory or home hypertension (P ≥ 0.08). The adjusted odds ratios (95% confidence intervals) for overweight and obesity relative to normal weight were 1.56 (1.27-1.92) and 1.34 (1.09-1.65) for masked uncontrolled ambulatory and home hypertension, respectively. In conclusion, overweight and obesity were associated with a higher prevalence of masked uncontrolled hypertension, indicating that clinic BP might overestimate antihypertensive treatment effects in patients with overweight and obesity.

NIGHT-TIME BLOOD PRESSURE ASSESSED BY HOME VS. AMBULATORY MONITORING IN ADULTS WITH TYPE 2 DIABETES: ASSOCIATION WITH PRECLINICAL TARGET ORGAN DAMAGE

Objective: To evaluate the relationship of night-time blood pressure (BP) assessed by home (HBP) or ambulatory BP (ABP) monitoring with preclinical target organ damage in adults with type 2 diabetes (DM2). Design and method: Hypertensive adults with DM2 or pre-diabetes on stable treatment were subjected to (i) 24 h ABP monitoring (20 min intervals, Microlife WatchBP O3), (ii) HBP monitoring (7 days with duplicate morning/evening measurements and 3 nights with 3 measurements/night, Microlife WatchBP Home-N), and measurement of (iii) echocardiographic left ventricular mass index (LVMI), (iv) carotid intima-media thickness (cIMT), (v) aortic pulse wave velocity (PWV) and ankle-brachial index (ABI), (Microlife PWV/ABI), (vi) urine albumin-creatinine ratio (ACR) in 2 different morning samples. Results: Seventy individuals were analyzed (mean age 65.2 ± 9.7 years, 47 males, body mass index 31.6 ± 4.8 kg/m2, 59 with DM2 and 11 with pre-DM). Daytime HBP was slightly higher than daytime ABP (mean difference 2.4 ± 9.3/0.5 ± 4.9 mmHg, systolic/diastolic, p &lt; 0.05/NS). Similarly, night-time HBP was slightly higher than night-time ABP (2.1 ± 6.5/0.8 ± 5.0 mmHg, p &lt; 0.05/NS). There was strong correlation between ABP and HBP (daytime r = 0.77/0.77 and night-time 0.88/0.80, systolic/diastolic) (all p &lt; 0.05). Night-time ambulatory/home pulse pressure presented the following correlation coefficients with indices of target organ damage: LVMI r = 0.23/0.15; cIMT 0.28/0.28; ABI -0.21/-0.23; PWV 0.04/0.05; ACR 0.57/0.50 (p = NS for HBP-ABP comparisons). The agreement between night-time HBP and ABP in identifying individuals with nocturnal hypertension was 81% (kappa statistic = 0.63) and in detection of non-dippers 73% (kappa = 0.44). Conclusions: Night-time HBP monitoring in hypertensive adults with DM2 is feasible, strongly associated with night-time ABP and gives similar correlations with preclinical target organ damage. These methods also present substantial agreement in identifying individuals with nocturnal hypertension.

Twenty-Four Hour Blood Pressure Response to Empagliflozin and Its Determinants in Normotensive Non-diabetic Subjects.

BackgroundSodium–glucose co-transport 2 inhibitors (SGLT2i) lower blood pressure (BP) in normotensive subjects and in hypertensive and normotensive diabetic and non-diabetic patients. However, the mechanisms of these BP changes are not fully understood. Therefore, we examined the clinical and biochemical determinants of the BP response to empagliflozin based on 24-h ambulatory BP monitoring.MethodsIn this post-hoc analysis of a double-blind, randomized, placebo-controlled study examining the renal effects of empagliflozin 10 mg vs. placebo in untreated normotensive non-diabetic subjects, the 1-month changes in 24 h ambulatory BP were analyzed in 39 subjects (13 placebo/26 empagliflozin) in regard to changes in biochemical and hormonal parameters.ResultsAt 1 month, empagliflozin 10 mg decreased 24-h systolic (SBP) and diastolic (DBP) BP significantly by −5 ± 7 mmHg (p < 0.001) and −2 ± 6 mmHg (p = 0.03). The effect on SBP and DBP was more pronounced during nighttime (resp. −6 ± 11 mmHg, p = 0.004; −4 ± 7 mmHg, p = 0.007). The main determinants of daytime and nighttime SBP and DBP responses were baseline BP levels (for daytime SBP: coefficient −0.5; adj. R2: 0.36; p = 0.0007; for night-time SBP: coefficient −0.6; adj. R2: 0.33; p = 0.001). Although empaglifozin induced significant biochemical changes, none correlated with blood pressure changes including urinary sodium, lithium, glucose and urate excretion and free water clearance. Plasma renin activity and plasma aldosterone levels increased significantly at 1 month suggesting plasma volume contraction, while plasma metanephrine and copeptin levels remained the same. Renal resistive indexes did not change with empagliflozin.ConclusionSGLT2 inhibition lowers daytime and nighttime ambulatory systolic and diastolic BP in normotensive non-diabetic subjects. Twenty-four jour changes are pronounced and comparable to those described in diabetic or hypertensive subjects. Baseline ambulatory BP was the only identified determinant of systolic and diastolic BP response. This suggests that still other factors than sustained glycosuria or proximal sodium excretion may contribute to the resetting to lower blood pressure levels with SGLT2 inhibition.Clinical Trial Registration:[https://www.clinicaltrials.gov], identifier [NCT03093103].

Efficacy of angiotensin receptor neprilysin inhibitor in Asian patients with refractory hypertension

Sacubitril/valsartan, simultaneously inhibits neprilysin and angiotensin II receptor, showed an effect in reducing blood pressure (BP). The authors aimed to study whether it can be used as an antihypertensive agent in patients with refractory hypertension who have already been treated. A total of 66 Chinese patients with refractory hypertension were enrolled. Patients received sacubitril/valsartan 200 instead of angiotensin II receptor blocker or angiotensin converting enzyme inhibitor while other agents continued. If BP was uncontrolled after 4 weeks, sacubitril/valsartan was increased to 400 mg. The BP reduction was evaluated by office BP and ambulatory BP monitoring after 8‐week treatment. The baseline office BP and mean arterial pressure (MAP) were 150.0/95.0 mmHg and 113.3 mmHg. BP and MAP reduced to 130.6/83.2 mmHg and 99.0 mmHg at week 8. Office BP and MAP reductions were 19.4/11.8 mmHg and 14.3 mmHg at endpoint (all p < .001). The 24‐h, daytime and nighttime ambulatory BP were 146.2/89.1, 148.1/90.3, and 137.5/83.7 mmHg, respectively at baseline, and BP reduced to 129.6/79.8, 130.6/81.1, and 121.7/75.8 mmHg, respectively at week 8. The 24‐h, daytime and nighttime ambulatory BP reductions were 16.6/9.3, 17.5/9.2, and 15.8/7.9 mmHg, respectively at endpoint (all p < .001). Sacubitril/valsartan significantly reduced office and ambulatory BP in refractory hypertension patients. Our study provided new evidence for sacubitril/valsartan in refractory hypertension.

Ambulatory Blood Pressure Variability after Adenotonsillectomy in Childhood Sleep Apnea.

To investigate the influence of adenotonsillectomy (T&A) on ambulatory blood pressure (BP) variability in children with obstructive sleep apnea (OSA). Prospective, interventional study. Children with OSA symptoms were recruited from a tertiary center. After OSA diagnosis was confirmed (ie, apnea-hypopnea index [AHI] > 1), these children underwent T&A for treatment. We performed polysomnography and 24-hour recordings of ambulatory BP before and 3 to 6 months postoperatively. Ambulatory BP variability was presented as the standard deviation of mean blood pressure in the 24-hour monitoring of ambulatory BP. Differences in BP variability among different subgroups were tested using a multivariable linear mixed model. A total of 190 children were enrolled (mean age: 7.8 ± 3.3 years; 73% were boys; 34% were obese). The AHI significantly decreased from 12.3 ± 17.0 to 2.7 ± 5.5 events/hr after T&A. Overall, daytime, and nighttime ambulatory BP did not significantly change postoperatively, and overall, daytime, and nighttime ambulatory BP variability did not differ significantly preoperatively and postoperatively. In the subgroup analysis, children aged <6 years demonstrated a significantly greater decrease in ambulatory BP variability postoperatively than those aged >6 years (nighttime diastolic BP variability: 9.9 to 7.7 vs. 8.9 to 9.4). Children with hypertension also showed a significantly greater decrease in ambulatory BP variability than those without hypertension. We concluded that overall ambulatory BP variability does not significantly change after T&A in children with OSA. Moreover, young-aged and hypertensive children demonstrate a significant decrease in BP variability after T&A. 4 Laryngoscope, 132:2491-2497, 2022.