Normal Ambulatory Blood Pressure Monitoring Research Articles

Ambulatory blood pressure monitoring in children and adolescents post-hematopoietic stem cell transplantation.

One of the long-term complications after hematopoietic stem cell transplantation (HSCT) is hypertension (HT). Previous studies showed that 10-15% of children post-HSCT had office HT, but onlya few studies used ambulatory blood pressure monitoring (ABPM). The present study was aimed at exploring the frequency and factors associated with ABPM HT in children post-HSCT. Patients aged ≥ 6years who survived ≥ 2years after HSCT were enrolled. Clinical and ABPM data were reviewed. ABPM HT was defined according to the 2022 American Heart Association guidelines. Factors associated with HT were analyzed by logistic regression. Ninety-eight (60 males) patients with a mean age of 15.1years and a median follow-up time at 4.5years after HSCT were included. Fifteen patients (15.3%) had ABPM HT (2 ambulatory HT and 13 masked HT). The ABPM HT group had a significantly older age (19 vs. 14years), a higher proportion of males (87% vs. 57%), a higher office systolic BP index (0.93 vs. 0.85), a higher office diastolic BP index (0.96 vs. 0.82) and a higher proportion of current use of prednisolone and tacrolimus than those in the normal ABPM group. Multivariate analysis revealed that office diastolic BP index was associated with ABPM HT. Left ventricular mass index was significantly correlated with ABPM but not with office BP parameters. HT in children post-HSCT was not uncommon and most could not be detected with office BP measurement. A diastolic BP index can be used as a screening tool for HT. A higher resolution version of the Graphical abstract is available as Supplementary information.

Waist-to-height-ratio is associated with sustained hypertension in children and adolescents with high office blood pressure.

Waist-to-height-ratio (WHtR) has been proposed as another indicator for cardiometabolic risk factors including hypertension. Normally, hypertension can be diagnosed in the office setting by detecting high blood pressure for three occasions. However, patients with high office blood pressure may not exhibit high blood pressure outside the office. Ambulatory blood pressure monitoring (ABPM) is a procedure to measure blood pressure over 24-h. Sustained hypertension is characterized as hypertension detected by both office measurement and ABPM. This study aimed to evaluate the performance of WHtR in the diagnosis of sustained hypertension in patients with high office blood pressure. Demographic data, height, body weight, body mass index (BMI), and waist circumference were retrospectively reviewed in children and adolescents who underwent ABPM due to persistently high office blood pressure. Patients were separated into two groups: a sustained hypertension group and a normal ABPM group. BMI was adjusted to z-score using the WHO Anthroplus software. WHtR was calculated by the formula: waist circumference (cm)/height (m). The performances of different parameters were analyzed using the receiver operating characteristic (ROC) curve and multivariate logistic regression. Sixty patients (63% male) with a mean age of 12.9 ± 3.7 years had persistently high office blood pressure. Twenty-nine (48.3%) had high ambulatory blood pressure parameters so-called "sustained hypertension." The sustained hypertension group had a higher mean BMI z-score (2.32 vs. 1.31, p = 0.01) and a higher mean WHtR (57.7 vs. 49.2 cm/m, p < 0.001) than those of the normal ABPM group. For the diagnosis of sustained hypertension, the ROC analysis revealed that WHtR had a greater area under the ROC curve (AUC) than that of BMI z-score (0.772 vs. 0.723). WHtR remained associated with sustained hypertension (OR 1.2, 95% CI 1.022-1.408, p = 0.026) after adjusting for age, gender, and BMI z-score. Apart from being a more user-friendly metric, WHtR tended to outperform BMI z-score in predicting sustained hypertension in children and adolescents with persistently high office blood pressure.

Evaluation of myocardial work in patients with resistant arterial hypertension.

Individuals with resistant arterial hypertension are particularly at risk of developing target organ damage and cardiovascular events. The advanced echocardiography technique called myocardial work (MW), through the analysis of the left ventricular pressure-strain loop, is among the possibilities for evaluating these individuals. Our study was designed to describe the behavior of MW indices in individuals with resistant arterial hypertension (RH), controlled hypertension (CH), and normal arterial pressure (N). Seventy-one patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and were characterized into three groups after a medical consult: RH (subjects with hypertension on four or more antihypertensive medications despite having controlled blood pressure); CH (subjects with hypertension on up to two antihypertensive medications); and N (individuals with normal ABPM; not using any medications). Echocardiographic analysis was performed using the Vivid E95 ultrasound system and blood pressure was measured at the time of the examination and subsequently used to determine myocardial work indices. RH demonstrated lower global work efficiency (GWE, mean=.95%; p=.005) and higher global wasted work (GWW, mean=114mm Hg%; p=.011) compared to other groups. Left ventricular mass measured by three-dimensional echocardiography, systolic wall stress, relative wall thickness and peak systolic dispersion were inversely correlated to GWE. No difference was observed between CH and N groups regarding MW indices. On multivariate analysis, only systolic wall stress remained as an independent predictor of GWE, when controlled by 3D mass index, relative wall thickness, peak systolic dispersion, and the hypertension group. Individuals with resistant hypertension have lower global work efficiency and higher global wasted work, compared to individuals with controlled hypertension and without arterial hypertension.

Nighttime mean arterial pressure is associated with left ventricular hypertrophy in white-coat hypertension.

White‐coat hypertension (WCH) is associated with increased cardiovascular risks. To investigate the relationship between WCH and left ventricular hypertrophy (LVH), the authors recruited 706 participants who underwent anthropometric measurements, blood laboratory analysis, 24h ambulatory blood pressure monitoring (ABPM), and echocardiography. The authors defined WCH as elevated office BP but normal ABPM over 24h, daytime, and nighttime periods. The authors compared the proportion of LVH between the true normotension (NT) and the WCH population, and further assessed the associations between BP indexes and LVH in the two groups, respectively. The proportion of LVH was significantly higher in the WCH group than in NT participants (19.70% vs. 13.12%, P = .036). In the NT group, 24h SBP, 24h PP, daytime SBP, daytime PP and SD of nighttime SBP were associated with LVH after adjustment for demographic and blood biochemical data (all P < .05). In the WCH population, LVH was associated with 24h SBP, nighttime SBP, nighttime MAP, and office SBP after adjustment (all P < .05). However, on forward logistic regression analysis with all the BP indexes listed above, only 24h SBP (OR = 1.057, 1.017–1.098, P < .001) in the NT group, and nighttime MAP (OR = 1.114, 1.005–1.235, P < .05) and office SBP (OR = 1.067, 1.019–1.117, P < .001) in the WCH group were still significantly associated with LVH. Our study suggests that the proportion of LVH is higher in WCH patients than in the NT population. Furthermore, elevated nighttime MAP and office SBP may play critical roles in the development of LVH in the WCH population.

FOREARM COPMARED TO UPPER ARM BLOOD PRESSURE READINGS

Objective: Studies comparing forearm and upper-arm blood pressure (BP) readings have given varied results. It is likely that higher blood pressure readings are obtained with forearm measurement when compared with upper-arm blood pressure readings. In order to evaluate values of forearm blood pressure in population we nalysed sample of patients with normal ambulatory blood pressure monitoring (ABPM) values. Design and method: Two hundred and fifty-seven patients with normal ABPM values were studied. Mean body mass index was 23 +/-6 kg/m2. Patients had three upper-arm and three forearm BP taken by Microlife validated device. Appropriate cuff was used. Mean BP was calculated from three BP consecutive measurements. Student’s t-test was used to analyze the data. Results: The mean age was 42.4+/-11.6 years. There were 127 females. Mean forearm and upper- arm systolic BPs were 142.7 +/- 16.5 mmHg, and 122.3 +/- 16.6 mmHg. Mean forearm, and upper- arm diastolic BPs were 86.8 +/- 13.4 mmHg, and 72.8 +/- 11.6 mmHg. Systolic and diastolic upper-arm BP measurements were significantly lower than forearm BP measurements. Conclusions: This study revealed that we need forearm blood pressure reference values because there is significant difference between forearm and upper-arm BP measurements. The increasing number of obese people presents a very serious clinical challenge to doctors being faced with the inaccurate measuring blood pressure (BP) in patients with very large arms.

OBSERVED EFFECTS OF BODY MASS INDEX ON BLOOD PRESSURE DIPPING PATTERN, IN A PRIVATE HOSPITAL IN ABUJA, NIGERIA

During a normal 24-hour ambulatory blood pressure monitoring (ABPM), there should be a more than 10% drop in average nighttime blood pressure (BP), compared to the average daytime BP. This is called the normal ABPM dipping pattern. Abnormal dipping patterns occur when the average night-time blood pressure drop is lower than 10%. A high body mass index has been described as a contributing factor for unusual ABPM dipping patterns, which predisposes an individual to a higher likelihood of developing cardiovascular disease. The goal of this research was to assess the link between the body mass index (BMI) and the dipping pattern during ABPM in the adult population who underwent ABPM at Cardiocare Abuja. Anthropometric data from 100 patients who had done ABPM were used, together with data obtained from the CONTEC ABPM50 device. The BMI was calculated with the weight and height, and they were grouped into weight classes using their BMI. The proportions of the various dipping patterns were then determined within each class. Majority of the participants involved in the study had BMI between 30-39 kg/m2. Those who presented with higher BMI classes were also discovered to have unusual dipping patterns, indicating a link with relation to the BMI and the ABPM dipping pattern. In the morbidly obese class, with BMI &gt;40 kg/m2 there was a trend of the reverse dipping. It concluded that ABPM should be done routinely for persons with a high BMI for early detection of unusual dipping patterns and prompt intervention.

Fat Mass Index Associated with Blood Pressure Abnormalities in Children with Chronic Kidney Disease.

Cardiovascular disease (CVD) risk factors are present early in life in children with chronic kidney disease (CKD), consequently cardiovascular morbidity presents in early adulthood. However, risk factors of CVD have been rarely addressed in children with early stage of CKD. This study included 63 children and adolescents aged 8- to 18 years-old with CKD stage G1–G4. Cardiovascular assessments consisted of 24-h ambulatory blood pressure monitoring (ABPM), arterial stiffness index, and echocardiography. We also applied dual-energy x-ray absorptiometry (DXA) scanning to analyze percentage body fat (PBF), lean body mass index (LBMI), fat mass index (FMI), and the android to gynoid fat ratio (A/G ratio). Up to 63.5% of CKD children had abnormal changes in BP detected by ABPM. CKD children with abnormal ABPM were older, had higher numbers of CKD stage G2 to G4, hyperuricemia, obesity, and higher FMI z-score and A/G ratio compared to individuals with normal ABPM (all p < 0.05). Among these factors, only FMI z-score showed an independent association with abnormal ABPM using multivariate logistic regression analysis (p = 0.037). Our data highlight that body fat plays a key role for an abnormal ABPM in CKD children. The assessment of FMI may have clinical utility in discriminating CV risk in children and adolescents with early stages of CKD.

Non-dipping phenomenon effects in monosymptomatic nocturnal enuresis treatment?

Monosymptomatic enuresis nocturna patients are shown to have disrupted blood-pressure regulation accompanying polyuria. In our study, we aimed to research the desmopressin response of enuresis patients with blood-pressure regulation problems. The study included 175 patients, aged from 6-15years, with a diagnosis of monosymptomatic enuresis nocturna. Before treatment, 24 h ambulatory blood-pressure monitoring (ABPM) was used to identify 52 non-dipper patients and 73 patients with normal results. The responses to desmopressin treatment and clinical and demographic characteristics affecting response were compared. The response to desmopressin treatment was found to be significantly low in the patients who were non-dippers on 24 h ABPM before treatment compared to those with normal ABPM results (P < 0.05). Similarly, the waking problems in the non-dipper group were found to be high by a significant degree (P < 0.05). In the non-dipper group, the systolic non-dipping rate was higher. Before desmopressin use, assessment of patients with a 24 h ABPM may be beneficial to select the method to be used for treatment.

What happened after birth to pregnant women undergoing ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension?

The latest Brazilian Guidelines on ambulatory blood pressure monitoring (ABPM) consider an exam as a useful tool during pregnancy, especially during the first half of pregnancy. They also indicate that white coat hypertension as well as masked hypertension may occur in up to one-third of pregnancies. As white coat hypertension has a more favorable diagnosis than gestational hypertension, it remains associated with 50% of pregnancies and is not associated with complications. Elsewhere, 40% of pregnant women develop gestational hypertension. As per the guidelines, the guidance values should be the same for the general population. The aim of this study was to verify the blood pressure behavior after birth in pregnant women who underwent ABPM and whether ABPM in pregnant women may serve as a predictor of preeclampsia and abnormalities in newborns. Between 01 January 2017 and 31 December 2019, 117 ABPM routines in pregnant women were performed at Unicordis. Among them, 40 were requested for the diagnosis of hypertension, and 77 were requested for antihypertensive therapeutic assessment. The study population comprised pregnant women who underwent ABPM for the diagnosis of hypertension. We assessed a population that comprised 31 subjects who underwent ABPM, 17 of whom had normal results and 14 of whom had abnormal results. Of the 14 pregnant women with abnormal blood pressure behavior, only three (21%) had a physiological drop in blood pressure, seven had attenuated descent, and four did not have blood arterial descent. The age of the pregnant women ranged from 21 to 42 years. The gestational age at the beginning of ABPM ranged from 6 to 37 weeks. In the group with normal ABPM, two pregnant women (11.7%) developed preeclampsia during pregnancy. Additionally, in the group with abnormal ABPM, seven pregnant women (50%) developed preeclampsia during pregnancy. In the group with normal ABPM, three newborns had abnormalities (17.6%); in the group with abnormal ABPM, four newborns had abnormalities (28.5%). In the group with normal ABPM, two subjects developed hypertension after birth (11.7%). In the group with abnormal ABPM, ten subjects (71%) remained hypertensive following birth (Table 1). Conclusions: (1) the results show that the proportion of patients who presented with preeclampsia was higher among individuals with abnormal ABPM than that among individuals with normal ABPM. (2) The proportion of subjects with hypertension following birth was higher among individuals with abnormal ABPM than that among individuals with normal ABPM.

Ambulatory blood pressure and carotid intima media thickness in children with type 1 diabetes.

Blood pressure abnormalities may play an important role in macrovascular damage in type 1 diabetes. Little is known about blood pressure abnormalities and macrovascular damage in children with type 1 diabetes. Children with type 1 diabetes (n = 57) for a short (3 months-2 years; n = 24) or long duration (≥5 years; n = 33) and a group of control children without diabetes (n = 29) completed 24-h ambulatory blood pressure monitoring (ABPM). Carotid intima media thickness (cIMT), a subclinical indicator of atherosclerosis, was assessed by carotid ultrasound. ABPM abnormalities were more prevalent (57% vs 24%, respectively), and daytime, nighttime and 24-h systolic, diastolic, and mean arterial blood pressure indices were higher in children with type 1 diabetes compared to control children. The odds estimate of an ABPM abnormality was 6.68 (95% confidence interval: 1.95, 22.9; P = .003) in children with type 1 diabetes compared to controls after adjusting for age, sex, and BMI standardized for age and sex (zBMI). An interaction between ABPM and zBMI on cIMT was observed. In children with type 1 diabetes and ABPM abnormalities, every 1 SD increase in zBMI was associated with a 0.030 mm increase in cIMT (95% confidence interval: 0.002, 0.041; P = .031). This was not observed in control children with ABPM abnormalities or in children with normal ABPM, regardless of type 1 diabetes status. Children with type 1 diabetes have a high prevalence of ABPM abnormalities independent of disease duration and this is related to early indicators of cardiovascular damage.

Office blood pressure values and the necessity of out-of-office measurements in high-risk pregnancies.

To determine if there is an office blood pressure (BP) value below which out-of-office measurements are unnecessary in high-risk pregnant women. We conducted a prospective cohort study in women in the second half of high-risk pregnancies. Office BP measurements and ambulatory blood pressure monitoring (ABPM) was performed. The cohort was divided according to quartiles of office BP and in normotension, white-coat hypertension, masked hypertension and sustained hypertension. The risks for preeclampsia/eclampsia for each category were estimated. Three hundred seventy-three women (30 ± 7 years with 32 ± 4 weeks of gestation) were included; 69 women (18.5%) developed preeclampsia/eclampsia. Risk for preeclampsia/eclampsia increased in a stepwise manner through quartiles of systolic office BP (8.8, 13.4, 19.6 and 32.3%, P < 0.001) and diastolic office BP (6.5, 13.7, 19.6 and 34,4%, P < 0.001). OR increased significantly through quartiles of systolic (P = 0.004) and diastolic (P < 0.001) office BP; the significance becomes evident between the second and third quartile, the cut-off point between these was 125/76 mmHg. Prevalence of white-coat and masked hypertension were 3.8 and 24.7%, respectively. Using ABPM, 14/61 office hypertensive women were reclassified as white-coat hypertension but 92/312 normotensive women as masked hypertension. OR for preeclampsia/eclampsia increased significantly in women with masked hypertension. Absolute risk for preeclampsia/eclampsia in women with office BP less than 125/75 mmHg was similar than that in women with normal ABPM, 7.2 and 7.1%, respectively. Masked hypertension was a prevalent and high-risk condition. Office BP at least 125/75 mmHg in the second half of gestation seems appropriate to indicate out-of-office measurements in high-risk pregnancies.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

Gut Microbiota-Dependent Trimethylamine N-Oxide Pathway Associated with Cardiovascular Risk in Children with Early-Stage Chronic Kidney Disease.

Despite cardiovascular disease (CVD) being the leading cause of morbidity and mortality in chronic kidney disease (CKD), less attention has been paid to subclinical CVD in children and adolescents with early CKD stages. Gut microbiota and their metabolite, trimethylamine N-oxide (TMAO), have been linked to CVD. Ambulatory blood-pressure monitoring (ABPM) and arterial-stiffness assessment allow for early detection of subclinical CVD. We therefore investigated whether gut microbial composition and TMAO metabolic pathway are correlated with blood-pressure (BP) load and vascular abnormalities in children with early-stage CKD. We enrolled 86 children with G1–G3 CKD stages. Approximately two-thirds of CKD children had BP abnormalities on ABPM. Children with CKD stage G2–G3 had a higher uric acid level (6.6 vs. 4.8 mg/dL, p < 0.05) and pulse-wave velocity (4.1 vs. 3.8 m/s, p < 0.05), but lower TMAO urinary level (209 vs. 344 ng/mg creatinine, p < 0.05) than those with stage G1. Urinary TMAO level was correlated with the abundances of genera Bifidobacterium (r = 0.307, p = 0.004) and Lactobacillus (r = 0.428, p < 0.001). CKD children with abnormal ABPM profile had a lower abundance of the Prevotella genus than those with normal ABPM (p < 0.05). Our results highlight the link between gut microbiota, microbial metabolite TMAO, BP load, and arterial-stiffness indices in children with early-stage CKD. Early assessments of these surrogate markers should aid in decreasing cardiovascular risk in childhood CKD.

Association between ambulatory blood pressure values and central aortic pressure in a large population of normotensive and hypertensive patients.

Our aim was to examine the association of ambulatory blood pressure monitoring (ABPM) and central blood pressure (CBP) data in a large set of normotensive and hypertensive patients and its relation with pulse wave velocity (PWV). This cross-sectional study was carried out in a single centre and included 2864 individuals who carried out an ABPM, measurement of CBP from the aortic waveform (SphygmoCor) and carotid-femoral PWV (Complior). In our study, 26.6% of the normotensive individuals and 32.5% of controlled hypertensive patients had abnormal values of at least one or of both ABPM and CBP values, compared with 96.6% of uncontrolled hypertensive patients. In the overall population, normal ABPM and CBP occurred in 25.3% (group 1), abnormal ABPM and CBP occurred in 44.4% (group 4), abnormal ABPM and normal CBP occurred in 10.5% (group 3) and normal ABPM and abnormal CBP occurred in 19.8% (group 2). PWV was significantly superior in group 4 versus group 3; group 4 versus group 1 and group 3 versus group 2 and group 2 versus group 1 (Mann-Whitney U-test; P<0.001). At least 26-32% of patients classified as normotensive or controlled hypertensive patients have abnormal ABPM or CBP associated with target organ damages. When abnormal values of ABPM and CBP coexist, target organ damage (aortic stiffness) is greater than that occurring when only one abnormal ABPM or CBP is present in the absence of the other. Isolated central hypertension entails greater organ damage than both normal ABPM and CBP. These patients may be at higher risk of further target organ damage because of unawareness of their central hypertension.

Ambulatory Hypertension in a Pediatric Cohort of Sickle Cell Disease

▪Background and Objectives: Hypertension is an established risk factor for subsequent cardiovascular and renal disease in children as well as adults. Sickle Cell Disease (SCD) is a genetic disorder associated with anemia with the major manifestation of vaso-occlusive crises. While this disease entity involves most organ systems causing vascular and pulmonary injury, little is known about blood pressure (BP) levels or prevalence of hypertension in children and adolescents with SCD.Methods: We enrolled 41 children with severe genotypes of SCD (39 with Hb SS disease and 2 with Hb Sβ0 thalassemia). Study participants underwent 24-hour ambulatory blood pressure monitoring (ABPM). Clinical information regarding duration of SCD, SCD-related complications, requirement for chronic blood transfusion and chronic hydroxyurea therapy were obtained. Baseline characteristics obtained on each participant included age, gender, weight, height, body mass index (BMI) percentile, BMI-Z score and clinic BP. Serum creatinine and cystatin C were obtained to assess estimated glomerular filtration rate (eGFR) with age-based formulas. A random urine sample was obtained for standard urinalysis, albumin and creatinine estimation, to calculate urine albumin to creatinine ratio.Results: Based on ABPM study results participants were categorized into three groups as normal ABPM, abnormal ABPM, or hypertension ABPM (ambulatory hypertension, masked hypertension or severe ambulatory hypertension). The term abnormal ABPM designated participants who did not have normal ABPM or hypertension, but had other abnormal parameters on ABPM (presence of pre-hypertension and/or lack of normal nocturnal dipping). SCD children in the three groups were similar with respect to distribution of age, BMI z-scores, renal function, urine albumin excretion, urine osmolality, hemoglobin, history of chronic blood transfusion, and hydroxyurea therapy. Twelve participants (29.3%) met criteria for hypertension based on ABPM. Of the 12 hypertensive participants, three had clinic hypertension with ambulatory hypertension; and nine had masked hypertension detected on ABPM. Youngest child with ABPM confirmed hypertension was six years of age. Another 18 participants (43.9%) had some abnormal ABPM parameters that were largely present in the sleep period of ABPM.Conclusions: Findings from our study indicate that BP abnormalities are not uncommon in SCD children. Overall, the distribution of confirmed hypertension, largely manifested by masked hypertension, is high in pediatric participants with SCD; as young as 6 years of age. The underlying cause for the relatively high prevalence of masked hypertension and abnormal ABPM parameters including absence of nocturnal BP dip in children with SCD is unclear. Based on our findings more attention should be given to monitoring and management of BP in children with SCD. Early identification of hypertension in SCD children can confer benefit because hypertension is an important modifiable risk factor for progression of cardiovascular and renal disease.Acknowledgment: Research reported in this publication was supported by the National Institute Of General Medical Sciences of the National Institutes of Health under Award Number P20GM109021; National Kidney Foundation Young Investigator Grant and DE-CTR-ACCEL grant number U54-GM104941 (PI: Binder-Macleod). [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

PP.16.02] ASSOCIATION BETWEEN AMBULATORY BLOOD PRESSURE VALUES AND CENTRAL AORTIC PRESSURE IN LARGE POPULATION OF NORMOTENSIVE AND HYPERTENSIVE SUBJECTS

Objective: Ambulatory blood pressure monitoring (ABPM) and central aortic blood pressure (CBP) are well known predictors of cardiovascular outcome. Our aim was to examine the association of ABPM and CBP data in a large set of normotensive and hypertensive subjects and its relation with pulse wave velocity (PWV). Design and method: Study was done in a single centre and included 2108 subjects (53% female, 85% hypertensives patients, ageing 54+15years, BMI 28+5 Kg/m2) who carried out a 24 h ambulatory BP monitoring (ABPM), measurement of central BP from the aortic wave form (SphygmoCor) and carotid –femoral PWV (Complior). Results: Age, systolic blood pressure (SBP) of 24 h, daytime and nighttime, central BP, augmentation index (Aix) were correlated significantly to each other and all with PWV (R between 0.110–0.367, p < .001). Subjects were divided according to the presence of normal or abnormal values of ABPM and CBP and the correspondent PWV values were determined. Normal ABPM and CBP occurred in 16.5% (G1) and abnormal ABPM and CBP occurred in 58.9% (G4). Abnormal ABPM and normal CBP occurred in 4.1% (G2) and normal ABPM and abnormal CBP in 41.1% (G3). PWV (m/s) significantly increased (ANOVA p < 0.001) from G1 (9.1+2.1), G2 (9.3+2.5), G3 (10.3+2.7) to G4 (11.1+3.0). Sprurious hypertension (isolated systolic, ISH) occurred in 18% of subjects < 50 years. Versus systo-diastolic hypertension (HT), ISH had higher central-peripheral amplification (13+8 v 11+6, p < 0.05) but higher Aix (26+17 vs 22+14%) and PWV (10+3 v 9+2 m/s) than normotensives (both p < 0.05). Conclusions: When abnormal values of ABPM and CBP coexist target organ damage (aortic stiffness) is greater than that occurring when only one is present in the absence of the other. Isolated systolic hypertension in young and middle age associates with higher aortic stiffness and reflected waves suggesting that may not be a benign condition.

Abstract P479: Stability of Ambulatory Blood Pressure Patterns Over Time in Children and Adolescents

Little is known about the stability of ambulatory blood pressure (ABP) patterns in children and adolescents undergoing evaluation for high blood pressure (HBP). It is possible that children with initially normal ABP may progress to hypertension (HT) or pre-hypertension (PHT), or that those with initial PHT or HT may be normal on repeat. Our objective was to assess stability of ABP patterns over time in children with HBP. We analyzed changes in ABP classification in patients undergoing a minimum of 2 ABP monitoring (ABPM) studies at least 0.5 years (yrs) apart. Exclusion criteria included known secondary HT, therapy with antihypertensive medication and inadequate recordings. ABPM were interpreted according to the 2014 AHA guidelines using BP thresholds of 95 th % for sex and height for children ≤17 yrs. For those &gt; 18 yrs awake and sleep thresholds were 140/85 and 120/70, respectively. Dipping was considered normal if &gt; 10%, blunted if &lt;10% and reversed if &lt; 0%. For those with &gt; 2 ABPM the difference between the 1 st and last were analyzed. Two hundred ABPM on 100 patients (76 males; median age 14.6 yrs at 1st ABPM) were analyzed. Median interval between ABPM was 1.5 yrs. ABP classification was stable in 53% (53/100). As shown in the table 50% (9/18) of those with normal ABPM showed progression to PHT or HT on follow up. PreHT progressed in 31% (8/26) and improved in 38% (10/26). HT improved in 43% (20/46). Dipping designation was stable in 70% (70/100); but blunted dipping normalized in 48% (10/21). In our population ABP patterns were not stable over time, supporting the need for follow up studies even with normal initial ABPM. If confirmed in larger studies, these findings support greater use of repeat ABPM.

OP.7D.05] NEED FOR FOREARM BLOOD PRESSURE REFERENCE VALUES AT HEART LEVEL

Objective: The increasing number of obese people presents a very serious clinical challenge to doctors being faced with the inaccurate measuring blood pressure (BP) in patients with very large arms. Studies comparing forearm and upper-arm cuff occlusion have given conflicting results. It is likely that higher BP readings are obtained with forearm measurement. Our clinic took part in the International Ambulatory Blood Pressure Registry: Telemonitoring of Hypertension and Cardiovascular Risk Project (ARTEMIS). In order to obtain normal values of forearm blood pressure at heart level in population we analyzed sample of patients with normal ambulatory blood pressure monitoring (ABPM) values. Design and method: Two hundred and fifty-eight patients with normal ABPM values were studied from the ARTEMIS project. Mean body mass index was 24 +/−7 kg/m2. Before positioning the Meditech ABPM 05 device patients had three upper-arm and three forearm BP taken by Meditech ABPM 05 device using extra measurement option. Arm was supported at heart level and appropriate cuff was used. Mean BP was calculated from three BP consecutive measurements. Student's t-test was used to analyze the data. Results: Systolic and diastolic upper-arm BP measurements were significantly lower than forearm BP measurements. The measurements obtained by ABPM were significantly lower than those found for forearm systolic and diastolic blood pressures. The mean age was 36.4+/−12.6 years. There were 152 females. Mean forearm, upper- arm and ABPM systolic BPs were 132.6 +/−18.5 mmHg, 127.3 +/−17.4 mmHg and 123.3 +/−15.6 mmHg respectively. Mean forearm, upper- arm and ABPM diastolic BPs were 84.8 +/−13.4 mmHg, 79.6 +/−12.4 mmHg and 74.8 +/−14.6 mmHg respectively. Conclusions: This study showed that we need forearm blood pressure reference values at heart level because there is significant difference between forearm and upper-arm BP measurements. More often doctors are faced with the inaccurate measuring BP in patients with very large arms.

RISK ASSESSMENT OF CARDIOVASCULAR COMPLICATIONS IN “WHITE COAT” HYPERTENSION

Objective . To detect the frequency of “white coat” hypertension (WCH) in 40–49-year old men and its association with the indicators of cardiovascular remodeling and cardiovascular risk factors. design and methods. In a single-step study, we assessed cardiovascular risk in 350 men (40–49 years old) with different levels of blood pressure (BP) based on the 24-hour ambulatory BP monitoring (ABPM). Results. Prevalence of left ventricular hypertrophy (LVH) was 8 % in patients with WCH, and 26 % in patients with high BP (χ 2 = 4,9, p < 0,05). The rate of increased intima-media thickness more than 0.9 mm was 11 % in WCH group, compared to 28 % among patients with verified arterial hypertension (HTN) (χ 2 = 3,9; p < 0,05). Compared with healthy cohort, left ventricular myocardial mass index and carotid artery wall thicknesses were significantly higher in patients with LVH. Conclusions . The prevalence of the WCH among 40–49-year-old hypertensive men was 36 %. The prevalence of risk factors, lipid metabolic disorders is lower in patients with WCH compared to patients with high BP verified by ABPM. Normal ABPM indices are associated with lower LVH frequency and vascular remodeling. Hypertensive remodeling is more profound in patients with WCH compared

MPS 10-09 Degree of nocturnal blood pressure in pregnancy might be associated with enlargement of the left atrial volume

Objective: Few studies have been accessed the association between diastolic function and dipping pattern in pregnancy. The aims of this study access the association between diastolic function and dipping pattern in pregnancy. Design and Method: The study was a retrospective analysis of the findings in 125 pregnant patients performed 24hr ambulatory blood pressure monitoring (ABPM) and echocardiography. All pregnant patients were referred for initial evaluation of high BP and dyspnea in late third trimester of pregnancy. We enrolled the pregnant patients with normal ABPM result (mean ABPM < 130/80 mmHg) between 20 and 34 years. We exclude the pregnant patients with antihypertensive medication or past history of hypertension. Degree of night BP reduction was calculated as (1- (Mean SBP in night time/Mean SBP in day time) x 100. Results: The patients were mean gestational age of 29 ± 3 months. Mean ABPM was 123.4/84.5 mmHg (mean day ABPM: 126.3/84.1 mmHg, mean night ABPM: 117.5/75.6 mmHg). Mean degree of night BP reduction was 8.8 ± 6.1. In echocardiography, mean left ventricular ejection fraction and E/E′ was 61.8% and 8.9, respectively. In addition, mean LAV index and LVM index were 29.3 mL/m2 and 114.9 g/ m2. And mean E/E′ and deceleration time (DT) were 8.9 and 192.4 ms. In relation of diastolic function and degree of night BP reduction, LVM index was not correlated with degree of night BP reduction, However, E/E′ was mildly negative correlation with degree of night BP reduction. (r = −0.257, p = 0.004) DT was mildly positive correlation with degree of night BP reduction. (r = 0.236, p = 0.009) In addition, LAV index was strongly negative correlation with degree of night BP reduction. (r = −0.637, p < 0.001). Conclusions: In late third trimester of pregnancy, degree of nocturnal blood pressure in pregnancy might be associated with enlargement of the LAV.