Normal Blood Pressure Values Research Articles

The role of a medium-term physical exercise program in improving cardiovascular parameters in hypertensive patients

The objective of our study was to evaluate the changes in cardiovascular parameters in patients with hypertension who completed a 3-month physical exercise program. 229 sub-jects with high normal values of blood pressure and stage 1 hypertension (group 1) and 120 patients with stage 2 hypertension (group 2) followed a 3-month physical exercise program. The following parameters were measured: systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate, pulse wave velocity. For group 1 there were sta-tistically significant differences for all the tested parameters after the 3-month program (decreased systolic blood pressure, heart rate, pulse pressure and pulse wave velocity, p< 0.0001; lower diastolic blood pressure, p=0.018)). In group 2 all the tested parameters had decreased values after the 3-month rehabilitation program. However, only for the pulse wave velocity there was recorded a statistically significant reduction after the exercise program (p< 0.001). There were significant direct correlations between total cholesterol and pulse wave velocity for group 1 at both initial (p=0.024) and final assessments (p=0.03), and for group 2 patients at the 3-month assessment (p=0.001). A medium-term physical exercise program improved the cardiovascular parameters (blood pressure, arte-rial stiffness) in hypertensive patients.

Physical Activity and Urinary Sodium Excretion Circadian Rhythm: A Population-Based Cross-Sectional Pilot Study.

Background/Objectives: Blood pressure (BP) is characterized by a circadian rhythm (Circr) with lower nighttime values, called dipping. Non-dipping is associated with higher CVD risk. The Circr of urinary sodium excretion (NaCle), peaking during the day, is linked to BP patterns. Physical activity (PA) is known to improve BP control and enhance the dipping phenomenon, but its possible effect on NaCle remains unclarified. This study aimed to investigate the correlation between PA and the Circr of NaCle and to determine if the relationship is independent of age, sex, BP values, dipping pattern, and salt intake. Methods: A pilot cross-sectional analysis was conducted using data from the Ticino Epidemiological Stiffness Study, involving 953 participants in Switzerland. Data collection included standardized questionnaires, blood samples, 24 h urine collections, and ambulatory BP monitoring. Participants were categorized into sedentary, partially active, and active. The effect of PA, NaCl intake, and dipping on the day/night NaCle ratio was assessed with multivariable linear regressions. Results: Participants' median age was 49 years, with 78% having normal BP values and 47% exhibiting a dipping pattern; 51% were classified as sedentary and 22% as partially active. The median NaCl intake was 7.9 g/day. The youngest subjects had a higher hourly NaCle ratio compared to older subjects. Higher NaCl intake correlated with increased BP, a phenomenon more pronounced in men and younger subjects. The hourly day/night NaCle ratio positively correlates with dipping; however, PA did not show a significant correlation with the NaCle ratio. Conclusions: This study indicates that while the day/night NaCle ratio correlates with the dipping pattern, PA is unrelated to the circadian rhythm of renal sodium handling. The beneficial effects of PA on BP and cardiovascular health thus appear to be mediated through mechanisms other than NaCle. These are explorative findings only but relativize the need for further investigations on the topic.

Abnormal blood pressure and pediatric obesity phenotype: Red flags for clinical practice

Background and aimssystolic and diastolic blood pressure values identify different subtypes of Primary Hypertension. In pediatric age, hypertension is often related to obesity. Characterization of an individual's Blood Pressure (BP) status needs multiple measurements in the course of time, but this is rarely the case, principally in everyday pediatrics. Thus, the finding of abnormal BP values even in a single routine check visit should need a special attention. The aim of this study was to evaluate if even a single abnormal measurement could be a marker of metabolic risk, according to clinical and/or metabolic phenotype and subtypes of hypertension in a population of overweight/obese children and adolescents. Methods and resultsWe reviewed data from 489 overweight-obese children and adolescents. BP values were classified according to American Academy of Pediatrics Guidelines (2017). Considering study design, we used the term “Abnormal” instead of “High” BP. Data on lipid profile, glucose metabolism and ultrasonographic pattern of the liver were recorded. Mean age was 9.4 ± 2.5 years: 76.9% had normal BP values. Children with Abnormal BP harbored more frequently an unfavorable metabolic profile. Children with Abnormal Systolic-Diastolic BP values had higher BMI z-score and Waist to Height ratio (p = 0.022 and p = 0.032). Hepatic Steatosis was detected in 4.5%, 14.8 % and 17.6 % of children with normal, abnormal systolic and abnormal systo-diastolic blood pressure, respectively. (p < 0.001). ConclusionIdentification of abnormal BP subtypes even in a single measurement could be useful for identification of specific clinical-metabolic phenotypes allowing an individual targeted management of obesity-related comorbidities.

Pengaruh Pendidikan Kesehatan dengan Media Video terhadap Kepatuhan Diit Hipertensi pada Lansia di Puskesmas Purwokerto Timur 2

Elderly is the final phase of the human journey where there will be changes and decline in organ function due to the aging process. The incidence of hypertension in the elderly is seen to increase from 2013 to 2018 reaching 25.8% and increasing to 34.1% in 2018. Hypertension diet is one of the non-pharmacological therapies to control and maintain normal blood pressure values. Health education is an activity to convey health messages to individuals, groups or communities that aims to improve health using video media. The purpose of this study was to analyze the effect of health education with video media on adherence to hypertension diet in the elderly at Pukesmas Purwokerto Timur 2. This study was a quantitative study with a pre-experimental design one group pre and post test using accidental sampling technique with a total sample of 30 elderly respondents. and using a questionnaire instrument Formular Food Frequency Questionnaire. Analysis using univariate test, bivariate and Wilcoxon test. The results of the Wilcoxon statistical test show that there is an influence between health education and video media on hypertension diet compliance with a p-value of 0.000, so that there is a decrease in the number of daily calories by 141.1 Kcal (5.71%), after being given a video, the average number of calories in the elderly before being given a video was 2470.07 kkl, after being given a video the average was 2328,97 kkl.

Blood pressure in preterm infants with bronchopulmonary dysplasia in the first three months of life

BackgroundNeonatal hypertension is common in preterm infants with bronchopulmonary dysplasia (BPD). Our study aimed to examine blood pressure variation in the first three months of life in preterm BPD patients.MethodsWe conducted a retrospective, single-centre study at the Neonatal Intensive Care Unit of the University of Szeged, Hungary. We collected blood pressure data from 26 preterm infants (born at < 30 weeks gestation) with moderate or severe BPD over three years (2019–2021). We calculated the BPD group's daily average blood pressure values and used previously defined normal blood pressure values from a preterm patient group born at < 30 weeks gestation as a reference. We used 19,481 systolic, diastolic and mean blood pressure measurement data separately to calculate daily average blood pressures.ResultsWe found a statistically significant correlation between the blood pressure values of the BPD patient group and the reference data. The difference between the blood pressure curve of the group with BPD and that of the reference group was also statistically significant. We also analysed individual patients' daily average blood pressure values and found that 11 patients (42%) had hypertensive blood pressure values for three or more days within the first 90 days of life. Within this group, our statistical analysis showed a 25% chance of acute kidney injury.ConclusionThe blood pressure of the BPD group not only correlated with but also significantly differed from the reference data. Hypertension lasting three or more days occurred more frequently in patients with acute kidney injury accompanied by BPD.Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study

Objective The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. Materials and methods Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. Results The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. Conclusion There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.

Defining systolic blood pressure normative values in hospitalized pediatric patients: a single center experience.

Normative blood pressure (BP) values and definition of hypertension (HTN) in children in outpatient setting cannot be reliably used for inpatient therapy initiation. No normative exists to describe HTN in hospitalized pediatric populations. We aimed to study the prevalence of hypertension and produce normative BP values in hospitalized children. Cross sectional observational study of all children hospitalized on acute care floors, ≥2 and <18 years age, at Stanford Children's Hospital, from Jan-01-2014 to Dec-31-2018. Cohort included 7468 hospital encounters with a total of 118,423 automated, oscillometric, BPs measured in the upper extremity during a hospitalization of >24 hours. Overall prevalence of HTN, defined by outpatient guidelines, was 12-48% in boys and 6-39% in girls, stage 1 systolic HTN in 12-38% of boys and 6-31% of girls, stage 2 systolic HTN in 3-10% of boys and 1-8% of girls. Centile curves were derived demonstrating overall higher BP reading for hospitalized patients compared to the outpatient setting. Higher blood pressures are anticipated during hospitalization. Thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances. Hospitalized children have higher blood pressures compared to patients in the ambulatory setting, hence outpatient normative blood pressure values cannot be reliably used for inpatient therapy initiation. No normative exists to describe hypertension in hospitalized pediatric populations. The thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances.

Abstract 17563: Serial ABPM, Antihypertensive Drug Treatment, and Pregnancy Outcomes in Women With Hypertension Found Early During Pregnancy

Introduction: Few data are available on serial ambulatory blood pressure monitoring (ABPM) throughout pregnancyand antihypertensive drug treatment required for good blood pressure (BP) control in hypertensivepregnant women. Hypothesis: Evaluation of BP control, antihypertensive drug treatment intensity, and pregnancy outcomes in patients with hypertension (HTN) found early during pregnancy. Methods: We studied 49 consecutive pregnant patients (mean age 33.4±4.8 years, BMI before pregnancy24.5±3.7 kg/m2) referred for office HTN found early during pregnancy who gave birth to 50 children (1 twin pregnancy) in 2011-2015. Gestational HTN was previouslydiagnosed in 39 women, and 9 women had a history of previous miscarriage or stillbirth, with multipleprevious pregnancies lost in some patients. ABPM was repeated at 5-10-15-20-25-30-33-35-37 weeksof pregnancy. We calculated overall antihypertensive treatment intensity in standard daily drug doses per patient (standard doses: labetalol 200 mg, methyldopa 750 mg, metoprolol 50 mg, nifedipine 20mg, verapamil 120 mg). Statistical analysis was performed using ANOVA. Results: All children were born alive (24 vaginal delivery, 26 cesarean section) and are well at follow-up.Gestational age was 38.0±2.5 (range 29-40) weeks, and birth weight was 3215±653g (range 955-4200). Preeclampsia/eclampsia occurred in 10/3 patients. Four patients had normal BP values by ABPM throughout pregnancy and did not receive antihypertensive drugs. Most patients were treatedwith labetalol and methyldopa. Throughout pregnancy, BP remainedwell controlled (24h mean SBP/DBP 120.3-126.0/75.3-77.1 mmHg), the number of treated patientsincreased from 25 at 5 weeks to 42 at 25-35 weeks, and the average number of daily antihypertensivedrug doses in treated pts increased from 1.82 at 5 weeks to 2.98 at 37 weeks. Conclusions: Serial ABPM-guided antihypertensive drug treatment started early during pregnancywas associated with favorable outcomes. The number of patients requiring treatment increased throughout the pregnancy. No physiological BP fall atthe end of 1 st trimester was observed. Our findings help estimate the expected treatment intensity required in pregnant patients with preexisting hypertension.

Abstract 15280: Does Weight Reduction Drive the Reduction in Blood Pressure in People Living With Obesity Treated With Tirzepatide?: Insights From SURMOUNT-1 Study

Background: Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and in development for chronic weight management. In SURMOUNT-1, in participants with obesity or overweight, TZP 5, 10 and 15 mg reduced body weight (-15 to -20.9%), SBP (-7 to -8.2 mmHg) and DBP (-4.6 to -5.5 mmHg) after 72 weeks of intervention. Aim: To assess the effects of TZP on SBP and DBP by baseline (BL) blood pressure (BP) levels and to evaluate the contribution of weight loss to the effect. Methods: Adults with a BMI ≥30 kg/m2, or ≥27 kg/m2 and ≥ 1 diagnosed weight-related complication, excluding diabetes, received TZP (5, 10, or 15 mg) or placebo (PBO) for 72 weeks. Participants with a valid BL BP value and ≥1 post-BL value were included in the analysis using the efficacy analysis set (excluding off-treatment data). Changes from BL through 72 weeks in SBP and DBP were compared between pooled TZP doses and PBO with mixed models for repeated measures (MMRM) by BL BP levels. The proportion of participants reaching recommended BP thresholds was also evaluated. Post-hoc mediation analyses evaluated the weight-loss dependent, and independent, effects of TZP in SBP and DBP reduction. Results: Regardless of BL BP values, pooled TZP showed consistent SBP and DBP reduction at 72 weeks from BL, relative to PBO (Figure 1a). At 72 weeks, a greater proportion of TZP treated participants achieved recommended SBP and DBP levels than participants treated with PBO (Figure 1b), nearly doubling the proportion of patients with normal BP values. Changes in body weight with SBP (r=0.24) and DBP (r=0.24) were moderately correlated. Mediation analysis indicated that SBP and DBP reductions were primarily mediated through weight loss (77% and 99% respectively). Conclusions: Effects of TZP on blood pressure were consistent regardless of SBP or DBP values at BL, increasing the proportion of patients reaching normal BP levels. Reductions in SBP and DBP were substantially mediated by weight reduction.

Efficacy of azilsartan medoxomil in patients with hypertension and stable coronary artery disease in combination with type 2 diabetes

Aim. To study the effect of azilsartan medoxomil (AZL-M) on the 24-hour blood pressure (BP) profile in patients with hypertension (HTN), type 2 diabetes (T2D) and stable coronary artery disease (CAD).Material and methods. A total of 183 patients with CAD in combination with HTN and T2D took part in the study (100 men (54,64%), 83 women (45,36%)). All patients were previously prescribed a statin, antiplatelet therapy, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). At baseline, the proportion of people taking ARBs and ACEIs was 30% and 70%, respectively. All study participants were discontinued from a previously prescribed ARBs or ACE inhibitors and were prescribed 6-month AZL-M (Edarbi®) therapy. During this period, according to the study plan, patients visited the medical center to assess the effectiveness and safety of therapy and blood pressure changes.Results. The mean age of the patients was 65,0 years (60-69 years), while the mean body mass index (BMI) — 31,24 kg/m2. The mean age of female participants was higher than the mean age of males: 66,35±6,59 vs 62,72±8,82 years (p=0,002). The mean BMI in women was higher and was 33.08 kg/m2, while in men it was 30,74 kg/m2 (p=0,001). Six-month AZL-M therapy decreased 24-hour BP values. Thus, the time index of systolic blood pressure (SBP) hypertension in the daytime decreased from 63% to 12%, while at night from 70% to 10%, and the time index of diastolic blood pressure (DBP) hypertension in the daytime from 18% to 10%, and at night from 44% to 8%. The main result is confirmation of AZL-M effectiveness in relation to BP control, as well as good drug tolerability. At the visit after 1-month AZL-M therapy, target BP values were recorded in 45,4% of participants, and after six months — the proportion of people with normal 24-hour BP values was 69,9%.Conclusion. Edarbi® therapy in patients with HTN in combination with T2D and stable CAD leads to 24-hour BP normalization. At the same time, the drug has a good safety profile, since the reported adverse events were not related to the drug.

Blood pressure normative values in preterm infants during postnatal transition.

The normative blood pressure values in preterm infants still not well defined during postnatal transition. We aimed to create normative blood pressure (BP) reference values in preterm infants <29 weeks gestational age recorded hourly during the postnatal transition. We included only data from hemodynamically stable newborns. Only BP values measured by umbilical arterial catheter (UAC) were included. The regression model showed that only gestational age and postnatal age in hours determine the BP. We included 206 out of 547 admitted preterm infants. The BP increases with increasing gestational ages and overtime during the postnatal transition. We constructed 5 BP centile values for each gestational group. BP histograms show that the BP most of the time fluctuated between the 5th and 75th centile values, particularity during day one of life. The BP trend values gradually increase in stable preterm infants during the postnatal transition, and preterm infants who do not follow this trend might require hemodynamics assessment. The normative blood pressure is increasing gradually during the first 3 days after birth and is different with gestational ages. This is first normative blood pressure centile values in stable preterm infant and based on invasive blood pressure monitoring. The data enable more accurate monitoring of hemodynamics in preterm infants during postnatal transition.

Verification of the effect of an exercise programme using walking and diet adjustment in hypertension

One of the leading risk factors for cardiovascular disease is hypokinesis. Therefore, an exercise regimen is emphasized for the prevention and control of hypertension, while at the same time aiming to reduce overall cardiovascular risk in addition to achieving normal blood pressure values.&#x0D; The aim of this study was to verify the effect of an exercise programme using walking and dietary modification on the reduction of blood pressure values in hypertension, while the effect of the intervention on weight reduction and change in body composition was also studied.&#x0D; The research method in our work was case study. The proband was a physically inactive overweight woman, age 55 years, treated hypertensive, whose blood pressure at entry to the program reached the values of mild hypertension even with treatment. Baseline data were resting blood pressure values measured for 7 days in the morning and evening, a two-day record of physical activity, a seven-day record of diet, diagnosis and analysis of body composition with the InBody device, and calculation of the WHR index. The proband developed a physical activity intervention program using walking for 12 weeks, a minimum of 5 times per week, at moderate intensity, with a gradual increase in daily walking time from 30 to 60 min/day. As an adjunct to the exercise intervention, she was recommended a dietary modification. At the end of the follow-up period, blood pressure values were measured in the same way, a diagnostic and body composition analysis was performed with the InBody device, and the WHR index was calculated. The intervention program was also evaluated in relation to overweight and body composition as important factors in hypertension.&#x0D; After 12 weeks of the intervention programme, the mean reduction in systolic blood pressure was 6,29 mmHg in the morning and 4,86 mmHg in the evening. The average reduction in diastolic blood pressure was 4,57 mmHg in the morning and 3,14 mmHg in the evening. There was also a decrease in heart rate by an average of 4,07 beats per minute. At the same time, the intervention program led to a reduction in the proband's body weight (by 7,2 kg), a decrease in BMI (from 27,8 to 25,5 kg/m2), a decrease in body fat percentage (by 3,9 %) and a decrease in WHR index (from 0,91 to 0,88).&#x0D; These results confirmed that regular physical activity and dietary modification play an important role in the treatment of high blood pressure and verified the effectiveness of expert recommendations in hypertension. They also confirmed the positive effect of these recommendations on weight reduction and body composition. In summary, this work verified the beneficial effects of walking supported by dietary modification on the following risk factors for cardiovascular disease - high blood pressure, overweight, body fat, and central obesity.

The prevalence of masked hypertension in patients with lone atrial fibrillation: a cross sectional analytical study

Atrial fibrillation (AF) is prevalent in individuals with essential hypertension (HTN). Masked hypertension occurs in up to 15% of the general population and is associated with adverse clinical outcome. The aim of the current study was to evaluate the prevalence of masked hypertension in apparently normotensive individuals with lone AF. A cross sectional analytical study performed at the Rabin Medical Center included all patients > 18 years who visited the emergency department (ED) in the years 2018–2021 with idiopathic AF, had normal blood pressure (BP) values during their ED visit and did not have a history of hypertension or current use of anti-hypertensives. Ambulatory blood pressure monitoring (ABPM) was performed in all eligible patients within 30 days from ED visit. Data collected included information from the ED visit and data extracted from the monitoring device. A total of 1258 patients were screened for eligibility, of which 40 were included in the analysis. The average age was 53.4 ± 16 years, 28 patients (70%) were males. Overall, 18 individuals (46%) had abnormal BP values according to the 2017 ACC/AHA guidelines for the diagnosis of hypertension. Of these, 12 had abnormal 24-h BP average (≥ 125/75 mmHg), one had isolated daytime abnormal average (≥ 130/80 mmHg) and 11 had isolated night time abnormal average (≥ 110/65 mmHg). Masked hypertension is prevalent in patients with lone AF without a diagnosis of HTN and performing ABPM in such individuals should be strongly considered.

Rapidly reversible acute neurological, renal, and cardiac impairment during malignant hypertension

BackgroundMalignant hypertension is a model of the rapid changes that a high afterload and renin-angiotensin levels can induce on target organs such as the heart. We present a case of a young man affected by malignant hypertension with multi-organ involvement who showed quick remission after adequate antihypertensive treatment.Case summaryA 41-year-old jazz pianist with a family history of coronary artery disease presented to the emergency department for asthenia and epigastric pain, associated with right eye visual impairment. No neurological symptoms. An echocardiogram showed left ventricular hypertrophy with severe impairment of ejection fraction (22%) due to global hypokinesia. There was renal insufficiency (creatinine 2.51 mg/dl, eGFR 34 ml/min, HS Troponin T 127 pg/dl, NT pro-BNP 22,672 pg/ml, CRP 32 mg/L, sodium 129 mEq/L with normal kaliemia. The following day, anterior T wave inversion was observed in the electrocardiogram. At a cardiac magnetic resonance. Concentric hypertrophy of the left ventricle was observed with normal myocardial T1 mapping values (1100 ± 38 ms), ruling out Fabry’s disease. There was no obvious myocardial edema at T2 weighted. The viral panel for acute myocarditis resulted in negative. After the exclusion of all possible secondary causes, malignant essential hypertension was the final diagnosis, and additional tests confirmed multi-organ damage. An ophthalmological examination demonstrated hypertensive retinopathy with hemorrhages, cottony exudates, and macular lipid exudation, especially in the right eye. A brain MRI showed small areolas of T2 hyperintensity in the white matter of both cerebral hemispheres, suggestive of chronic microangiopathy, and left nuclear micro lacunar ischemia.The patient was treated with full-dose calcium channel blockers (amlodipine 10 mg), beta-blockers (bisoprolol 10 mg), alpha2 agonists (slow-release clonidine patch), selective a1 blocker (doxazosine 16 mg), and furosemide 50 mg. After the exclusion of renal stenosis and improvement of renal function, Ramipril was added up to a final dose of 10 mg daily. In parallel with the achievement of a satisfactory blood pressure control, visual impairment disappeared with a reduction of retinal ischemic exudates and hemorrhages at the ophthalmological follow-up assessment.At the time of discharge, an echocardiographic re-evaluation confirmed concentric hypertrophy of the left ventricle with markedly reduced wall thicknesses, with a partial recovery in left ventricular ejection function (EF 44%).Six months after discharge, the patient is in good general condition under optimal medical therapy (without furosemide) with normalized blood pressure values (130–140/80 mmHg). At 6 months from discharge, creatinine was only mildly increased (1.5 mg/dl, eGFR 59.5 ml/min) and NT-pro BNP nearly normalized (452 pg/ml).DiscussionMalignant hypertension is a cardiovascular emergency and requires immediate and careful intervention to lower blood pressure and reduce organ injury. It is an exclusion diagnosis that can be advanced once the causes of secondary hypertension have been excluded. Remission of organ injury is possible and might be rapid under adequate antihypertensive treatment, but patients require a close follow-up.

THE RELATIONSHIP BETWEEN LEFT VENTRICULAR HYPERTROPHY AND HYPERTENSION PHENOTYPES IN UNTREATED HYPERTENSIVE POPULATION

Objective: The aim of this study was to investigate which hypertension phenotype can be better correlated with left ventricular hypertrophy in the untreated hypertensive population. Design and method: 175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography. Results: Regarding patients with left ventricular hypertrophy, 45% of the population were confirmed hypertensives and 36, 7% were masked hypertensives. Only 10% presented a white coat phenotype and 8.3% normal values of blood pressure. Of those presenting a non-dipping status, 55.3% found to have left ventricular hypertrophy, while of those presenting a dipping status, only 33.3% found to have left ventricular hypertrophy. Conclusions: These results indicate that the confirmed and masked hypertensive population as well as the non-dipping population present higher percentages of left ventricular hypertrophy. This population have to be monitored and followed up more often to prevent heart failure.

EARLY DIAGNOSIS OF HYPERTENSIVE DISEASE IN YOUTH WITH NORMAL SYSTOLIC AND DIASTOLIC BLOOD PRESSURE LEVELS

Objective: Hypertensive cardiovascular disease can develop functional and/or structural organ damage by the increase of the volume/pressure and arterial stiffness, even before the current cut-off level of the systolic/diastolic blood pressure. The aim of this study was to evaluate in a young population with normal blood pressure levels if they presented any cardiovascular risk factors, arterial stiffness, signs, and symptoms of hypertensive disease. Design and method: This is a retrospective cross-sectional study developed between the years 2007/2022 from 9,600 non-invasive applanation tonometry, females-males 200-103 were entered, with an age range of 18 and 30 years old, and an average age of 24 years. Patients made their first cardiology visit without a previous diagnosis of arterial hypertension or decompensated associated diseases with a blood pressure not higher than 130/80 mmHg. Anthropological data, systolic/diastolic blood pressure, and heart rate were registered. Central Haemodynamics Parameters were measured with a SphygmoCor-PVX device (AtCor, Australia), a validated system employing the high-fidelity technique of applanation tonometry according to established protocols. Results: The average systolic/diastolic blood pressure among female-male was 112.9/72.4 mmHg-119.8/73.9 mmHg, respectively. Also, the Central Aortic Pressure in the female-male groups was 100.0 mmHg/103.7 mmHg, while the maximum values are 101.5 mmHg/106.0 mmHg, but the differences between the observed values and the normal levels of the Augmentation Index (a surrogate measure of arterial stiffness) were higher than normal in female-male 3.6%-4.6% indicating an incipient arterial stiffness. Into the female-male groups, were observed hyperlipidemia 10%-10%, smoking 26%-20%, minimal-mitral regurgitation 5%-8%, headache 46%-26%, palpitations 33%-25%, asthenia 22%-14%, sweating 9%-14%, and chest-pain 16%-27%, respectively. The percentage of women who had a history the polycystic ovarian syndrome was 19%, and the women in current or former estrogen-progesterone therapy were 17%-12%, respectively. Among the female-male groups that do not register any risk factor, symptoms, signs, or arterial stiffness were 8.5%-10%. Conclusions: In young people with normal blood pressure values, it is important to know the risk factors, symptoms, signs, and arterial stiffness of hypertensive disease for early diagnosis and to be able to optimize the time to start therapy.

PREVALENCE OF WHITE-COAT AND MASKED HYPERTENSION AT DIFFERENT OFFICE BLOOD PRESSURE LEVELS IN UNTREATED SUBJECTS

Objective: The European Guidelines for the management of arterial hypertension support the use of out-of-office blood pressure (BP) measurements for confirming the diagnosis of hypertension and detecting BP phenotypes such as white-coat hypertension (WCH) and masked hypertension (MH), especially in patients with grade 1 hypertension and subjects with high normal BP. However, it is not clear enough, whether out-of-office blood pressure measurements should be performed in patients with higher grades of hypertension as well as in subjects with normal or optimal BP. The aim of our study was to investigate the prevalence of WCH in untreated patients with grade 1, grade 2 and grade 3 hypertension as well as the prevalence of MH in never treated subjects with high normal, normal and optimal BP values. Design and method: A total of 2357 untreated subjects referred to our Hypertension Unit for evaluation underwent 24-h ambulatory BP monitoring. According to their office BP levels were divided into 6 categories: optimal (&lt;120/80mmHg), normal (120/80 – 129/84mmHg), high normal (130/85 – 139/89mmHg), grade 1(140/90 – 159/99mmHg), grade 2 (160/100 – 179/109mmHg) and grade 3 (&gt; = 180/110mmHg). Subjects with office BP&gt; = 140/90mmHg and 24-h BP&lt;130/80mmHg were defined as WCHs and patients with office BP&lt;140/90mmHg and 24-h BP&gt; = 130/80mmHg as MHs. Statistical analysis was performed by means of chi-square test and one-way ANOVA. Results: The percentages of WCH were 53%, 31% and 24% for patients with grade 1, grade 2 and grade 3 hypertension, respectively. The percentages of MH were 34%, 29% and 17% for patients with high normal, normal and optimal BP, respectively. Conclusions: The prevalence of WCH is significantly higher in grade 1 hypertension, however patients with grade 2 and 3 hypertension present also high rates of WCH. Similarly, MH is more common in subjects with high normal BP, however high percentages are observed in subjects with normal and optimal BP. Our results support that out-of-office BP measurements should be performed across all office BP range for the optimal detection of WCH and MH.

INHOSPITAL DETECTION OF ELEVATED BLOOD PRESSURE (INDEBP): PRELIMINARY RESULTS OF A RETROSPECTIVE ANALYSIS

Objective: Elevated blood pressure (BP) values are commonly reported in hospitalized patients. Previous retrospective studies have shown that adaptions of BP medication are associated with a worse outcome. Objective of this study was to analyze the prevalence of elevated BP values in medical non-cardiac inpatients and to assess the proportion of patients with treatment modifications in response to elevated BP values during the hospital stay. Design and method: Retrospective analysis of randomly selected non-cardiac medical inpatients in a tertiary hospital in 2019 and 2021. Exclusion criteria were cardio-vascular hospitalization, missing general consent or age &lt;18 years. Routine BP measurements from clinical checks were recorded, elevated BP defined as &gt; = 140 and/or &gt; = 90 mmHg. Antihypertensive treatment at admission was compared to that at discharge. Complications during hospitalization were a compound of myocardial injury, intracerebral bleedings, ischemic stroke/TIA, acute kidney injury, falls/syncope and death. Data were extracted from electronic health records. Categorical data was analyzed with a Fisher's exact test, continuous data with a Mann-Whitney-U-test. Results: 301 patients were included, 101 (33.6%) in 2019, and 200 (66.4%) in 2021, 130 (43.2%) were female, median age was 66 years (IQR 55.5 – 76). 152 (50.5%) had a history of hypertension. 47 patients (15.6%) had exclusively normal BP values during a median of 10 days (IQR 5 – 21) of hospitalization. Of those 254 patients (84.4%) with elevated BP during the hospitalization, 105 (41.3%) had their antihypertensive treatment adapted: 54/254 patients (21.3%) had &gt; = 1 new antihypertensive, 18/254 patients (7.1%) had the antihypertensive dose increased, 11/254 (4.3%) had the antihypertensive agent exchanged, 47/254 (18.5%) had an antihypertensive stopped, and 22 (8.7%) had the dose decreased (multiple answers possible). Patients with treatment modifications had significantly more complications (22.9 vs 10.3%), p-value 0.012. Differences between patients with and without treatment adaptions are shown in the Table. Conclusions: Elevated BP is a frequent and significant clinical problem during hospitalization. Nearly half of the patients with elevated BP had their medications adapted during hospitalization. Modification of antihypertensive therapy was associated with more complications, whereby no statement can be made about causality.

Head Phantom for the Acquisition of Pulsatile Optical Signals for Traumatic Brain Injury Monitoring

(1) Background: Tissue phantoms can provide a rigorous, reproducible and convenient approach to evaluating an optical sensor’s performance. The development, characterisation and evaluation of a vascular head/brain phantom is described in this study. (2) Methods: The methodology includes the development of mould-cast and 3D-printed anatomical models of the brain and the skull and a custom-made in vitro blood circulatory system used to emulate haemodynamic changes in the brain. The optical properties of the developed phantom were compared to literature values. Artificial cerebrospinal fluid was also incorporated to induce changes in intracranial pressure. (3) Results: A novel head model was successfully developed to mimic the brain and skull anatomies and their optical properties within the near-infrared range (660–900 nm). The circulatory system developed mimicked normal arterial blood pressure values, with a mean systole of 118 ± 8.5 mmHg and diastole of 70 ± 8.5 mmHg. Similarly, the cerebrospinal fluid circulation allowed controlled intracranial pressure changes from 5 to 30 mmHg. Multiwavelength pulsatile optical signals (photoplethysmograms (PPGs)) from the phantom’s cerebral arteries were successfully acquired. Conclusions: This unique head phantom technology forms the basis of a novel research tool for investigating the relationship between cerebral pulsatile optical signals and changes in intracranial pressure and brain haemodynamics.

Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials.

To inform digital health design by evaluating diagnostic test properties of antenatal blood pressure (BP) outputs and levels to identify women at risk of adverse outcomes. Planned secondary analysis of cluster randomised trials. India, Pakistan, Mozambique. Women with in-community BP measurements and known pregnancy outcomes. Blood pressure was defined by its outputs (systolic and/or diastolic, systolic only, diastolic only or mean arterial pressure [calculated]) and level: normotension-1 (<135/85 mmHg), normotension-2 (135-139/85-89 mmHg), non-severe hypertension (140-149/90-99 mmHg; 150-154/100-104 mmHg; 155-159/105-109 mmHg) and severe hypertension (≥160/110 mmHg). Dose-response (adjusted risk ratio [aRR]) and diagnostic test properties (negative [-LR] and positive [+LR] likelihood ratios) were estimated. Maternal/perinatal composites of mortality/morbidity. Among 21 069 pregnancies, different BP outputs had similar aRR, -LR, and +LR for adverse outcomes. No BP level (even normotension-1) was associated with low risk (all -LR ≥0.20). Across outcomes, risks rose progressively with higher BP levels above normotension-1. For each of maternal central nervous system events and stillbirth, BP ≥155/105 mmHg showed at least good diagnostic test performance (+LR ≥5.0) and BP ≥135/85 mmHg at least fair performance, similar to BP ≥140/90 mmHg (+LR 2.0-4.99). In the community, normal BP values do not provide reassurance about subsequent adverse outcomes. Given the similar performance of BP cut-offs of 135/85 and 140/90 mmHg for hypertension, and 155/105 and 160/110 mmHg for severe hypertension, digital decision support for women in the community should consider using these lower thresholds.