Office Blood Pressure Control Research Articles

FOLLOW-UP OF SURVIVAL PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Resistant arterial hypertension (RAH) contributes to high mortality worldwide. Aim of the study: to assess 7-year follow-up survival and development of a composite end point (CEP) in patients with RAH. Design and method: The analysis includes 50 patients with RAH who were discharged from hospital. After 7 years discharge from the hospital, the patients underwent office BP measurement. Adverse events or death were reported as the composite endpoint (CEP). The average age of patients as of 2016 was 57.89 ± 11.81 y.o. 16% had type 2 diabetes (n=8). Results: After 7 years, in 32% (n=16) developed CEP, and 10% (n=5) of them died. The BMI increased from 30.87 ± 6.30 to 33.80 ± 6.90 kg/m2 (p<0.05). 20% had smoke (n=10), but 8% (n=4) (quit smoking after developing CEP). After 7 years, 48.88% of patients (n=22) controlled office blood pressure below 140/90 mmHg and 51.11% did not (n=23). Among patients who reached the target office BP (130.73 ± 6.61/81.59 ± 4.13 mmHg), there was a decrease in the number of drugs from 3.76 ± 0.19 to 2.85 ± 0.14, p<0.05. 45% (n=10) from the group took fixed combinations. Among patients who did not reach target office BP (148.04 ± 7.49/92.17 ± 4.66 mmHg), there was also a decrease in the number of drugs from 3.52 ± 0.18 to 2.50 ± 0.13, p<0.05 – patients decision. After regression analysis the main factors that were associated with the occurrence of CEP in patients with RAH were: the presence of diabetes (β= 5,237, p= 0,032) smoking (β=4,326, p= 0,037), increased body weight (β =3,423, p=0,024), failure to achieve target blood pressure levels (β =4,152, p=0,041) Conclusions: Mortality among patients with RAH were 10% during 7 years. The total composite endpoint were 32%. Did not reach the target office BP in patients with RAH the factors for the development of combined end point was diabetes mellitus, smoking and weight gain.

Efficacy and safety of a single-pill versus free combination of perindopril/indapamide/amlodipine: a multicenter, randomized, double-blind study in Chinese patients with hypertension.

In China, the prevalence of hypertension is high and the use of combination antihypertensive therapy is low, which contributes to inadequate blood pressure (BP) control. The availability of simplified treatments combining complementary BP-lowering agents may help more patients achieve their goals. This Phase III, multicenter, randomized, double-blind, noninferiority study included Chinese adults with mild-to-moderate hypertension. Following a 1-month run-in on perindopril/indapamide bi-therapy, patients with uncontrolled systolic/diastolic BP (≥140/90 mmHg) were randomized to perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg (Per/Ind/Aml) single-pill combination (SPC) or perindopril 4 mg/indapamide 1.25 mg plus amlodipine 5 mg (Per/Ind + Aml) for 6 months. Uptitration was permitted from month 2 onwards. The primary efficacy objective was the noninferiority of Per/Ind/Aml in lowering office systolic BP at 2 months. The secondary objectives included the effectiveness of SPC on diastolic BP, uptitration efficacy, and office BP control (systolic/diastolic <140/90 mmHg). A subgroup of patients participated in 24-h ambulatory BP monitoring (ABPM). A total of 532 patients were randomized: Per/Ind/Aml (n = 262) and Per/Ind + Aml (n = 269). Overall, the mean (±SD) age was 55.7 ± 8.8 years, 60.7% were male, and the mean office systolic/diastolic BP at baseline on Per/Ind was 150.4/97.2 mmHg. Systolic BP decreased in both groups at 2 months from baseline: -14.99 ± 14.46 mmHg Per/Ind/Aml versus -14.49 ± 12.87 mmHg Per/Ind +Aml. A predefined noninferiority margin of 4 mmHg was observed (P < 0.001). The effectiveness of the Per/Ind/Aml SPC was also demonstrated for all secondary endpoints. ABPM demonstrated sustained BP control over 24 h. Both treatments were well tolerated. Per/Ind/Aml is an effective substitute for Per/Ind + Aml, providing at least equivalent BP control over 24 h in a single pill, with comparable safety.

Predictors of cardiovascular and renal complications in patients with resistant arterial hypertension during long-term follow-up

The aim – to evaluate the incidence of cardiovascular and renal complications and its predictors in resistant hypertensive (RH) patients during the long-term follow-up.Materials and methods. The frequency of cardiovascular and renal events was studied in 240 true resistant hypertensive patients. The duration of observation was 5.1±0.1 years. The comparison group consisted of 228 patients with controlled arterial hypertension (CAH) on a triple combination antihypertensive therapy. Cardiovascular endpoints included stroke/transient ischemic attack, myocardial infarction, cardiovascular death, myocardial revascularization, development of atrial fibrillation, hospitalization due to heart failure, and lower limb arterial disease. Kidney outcomes included dialysis or GFR decline by 40 % or greater. All the endpoints formed a composite primary endpoint. New cases of type 2 diabetes mellitus were also estimated.Results and discussion. The patients with resistant hypertension on multi-component antihypertensive therapy and significant reduction in arterial blood pressure (BP) levels (achievement of controlled office BP in 49.6 % of patients, office and ambulatory BP in 34.2 % of patients), maintained a higher risk of cardiovascular and renal events compared to patients with controlled arterial hypertension. It was found that the frequency of occurrence of the composite primary endpoint in resistant hypertensive patients was four times higher than in the group of patients with controlled hypertension – 30.0 % (72/240) versus 7.0 % (16/228) (p=0.001). The frequency of new cases of type 2 diabetes mellitus in patients with RH exceeded compared to CAH patients by 3.7 times (p=0.03).Conclusions. Independent predictors of the risk of cardiovascular and renal complications in patients with RH were the initial indicators of circulating endothelial progenitor cells if their concentration in the blood was ≤ 1818 cells/ml (HR 0.41; 95 % CI (0.21–0.79); p=0.007), the content of citrulline in the blood is more than 68 μmol/l (HR 1.13; 95 % CI (1.07–1.20); p&lt;0.001); value of initial average daily systolic BP &gt; 163 mm Hg (HR 1.10; 95 % CI (1.03–1.18); p=0.008).

Prevalence and factors associated with masked hypertension in chronic kidney disease.

Optimal blood pressure (BP) control is key to prevent cardiovascular complications in patients with chronic kidney disease (CKD). We described the prevalence and factors associated with masked hypertension in CKD. We analyzed 1113 ambulatory 24-h BP monitoring (ABPM) records of 632 patients referred for kidney function evaluation. Masked hypertension was defined as office BP less than 140/90 mmHg but daytime BP at least 135/85 mmHg or nighttime BP at least 120/70 mmHg. Factors associated with masked hypertension were assessed with mixed logistic regression models. At inclusion, 424 patients (67%) had controlled office BP, of whom 56% had masked hypertension. In multivariable analysis conducted in all visits with controlled office BP ( n = 782), masked hypertension was positively associated with male sex [adjusted OR (95% confidence interval) 1.91 (1.16-3.27)], sub-Saharan African origin [2.51 (1.32-4.63)], BMI [1.11 (1.01-1.17) per 1 kg/m 2 ], and albuminuria [1.29 [1.12 - 1.47] per 1 log unit), and was negatively associated with plasma potassium (0.42 [0.29 - 0.71] per 1 mmol/L) and 24-h urinary potassium excretion (0.91 [0.82 - 0.99] per 10 mmol/24 h) as well as the use of renin-angiotensin-aldosterone (RAAS) blockers (0.56 [0.31 - 0.97]) and diuretics (0.41 [0.27 - 0.72]). Our findings support the routine use of ABPM in CKD, as more than half of the patients with controlled office BP had masked hypertension. Weight control, higher potassium intake (with caution in advanced CKD), correction of hypokalemia, and larger use of diuretics and RAAS blockers could be potential levers for better out-of-office BP control.

Kidney subclinical lesions in hypertension phenotypes defined by Home Blood Pressure Monitoring among young adults enrolled in a Family Health Strategy unit

Abstract Introduction The association between kidney lesion, hypertension (HTN) and cardiovascular risk (CV) is well established. Asymptomatic patients with decreased glomerular filtration rate (GFR) and/or increased albuminuria seem to have increased CV risk. The refinement of HTN diagnosis using Home Blood Pressure Monitoring (HBPM) allows to identify individuals with different phenotypes: normotension, sustained HTN (SHT), masked HTN (MHT) and white-coat HTN (WHT), increasing diagnostic accuracy. Objective To assess kidney subclinical lesions among different hypertension (HTN) phenotypes identified by Home Blood Pressure Monitoring (HBPM) in an adult population enrolled in a Family Health Strategy unit. Design and Methods: Cross-sectional, populational study with adults between 20-50 years old enrolled in a Family Health Strategy unit in a metropolis. Sociodemographic, anthropometric and CV risk factors were registered. Office blood pressure (BP) was the average of two consecutive measurements, and HBPM followed a 7-day protocol. HBPM &amp;lt; 135x85 mmHg and office BP &amp;lt; 140x90mmHg were considered normal, identifying four phenotypes: normotension (controlled office BP and HBPM); white-coat hypertension (uncontrolled office BP and controlled HBPM); masked hypertension (controlled office BP and uncontrolled HBPM) and sustained hypertension (uncontrolled office BP and HBPM). Albuminuria was dosed in an isolated urine sample whereas glomerular filtration rate was calculated by CKD Epi formula using serum creatinine. Results A total of 483 individuals were evaluated (39% male; mean age: 37.6 ± 8.8 years). More often, individuals with white-coat hypertension (9.3%) are male, with greater neck circumference and higher prevalence of metabolic syndrome. Individuals with masked hypertension (10%) are more obese, with increased neck and waist circumferences whereas those who present sustained hypertension are predominantly male, more obese, with increased neck and waist circumferences and higher prevalence of diabetes and metabolic syndrome. Analyzing four phenotypes, a progressive albuminuria increase was observed among normotensive patients: white-coat hypertension 4.0 ± 2.2; masked hypertension 5.3 ± 3.4 and sustained hypertension 7.1 ± 1.4 mg/g creatinine. We also observed an increased serum creatinine and decreased GFR: white-coat hypertension 0.74 ± 0.16/132 ± 34; masked hypertension 0.79 ± 0.17/123 ± 28; sustained hypertension 0.81 ± 0.32/120 ± 59, respectively, although without statistical significance. Conclusion The performance of HBPM refined HTN diagnosis and was able to early identify a progressive worsening of kidney function parameters in the different phenotypes.

VISIT-TO-VISIT 24 HOUR BLOOD PRESSURE VARIABILITY VS OFFICE BLOOD PRESSURE VARIABILITY UNDER ANTIHYPERTENSIVE DRUG TREATMENT

Objective: In any treated hypertensive patient office blood pressure (BP) values differ between visits and this variability (V) has an adverse prognostic impact. Almost no information is available on visit-to-visit 24-hour(h) BPV and the consistency of its therapeutic control. Design and method: In 1114 differently treated hypertensive patients of the ELSA and PHYLLIS trials we calculated 24-h BPV by the coefficient of variation of the mean BP from yearly measurements during a 3-4 year treatment period. Calculation was also made of yearly variation of the percentage of patients achieving 24-h BP control (&lt;130/80mmHg). Calculations were extended to day and night BP. Data were compared with office visit-to visit BPV and yearly office BP control (&lt;140/90mmHg) and variations . Results: Visit-to-visit 24-h BPV was 20% to 30% less than office BP variability, similarly for systolic and diastolic BP and consistently for different demographic, clinical and treatment conditions. BPV was considerably greater for the night than for the daytime (%, p &lt; 0.01) . Yearly 24-h BP control was considerably less frequent and variable than yearly office BP control and was considerably than daytime BP control. In the whole study and subgroups there was a linear correlation between office and 24-h but the correlation coefficients were never &gt;0.20, indicating that office BPV does not precisely correspond to it is impossible to precisely predict 24-h BPV from office in individual patients. Conclusions: 24-h BPV across visits is noticeably more stable than across visit office BPV, although with a greater variability of night BP. The correlation between office and 24-h BPV is significant but the low correlation coefficient makes office BPV hardly predictive of the 24-h BP stability across visits.

PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS

Objective: There are limited data in Tunisia on the quality of treated blood pressure (BP) control, and in particular, masked uncontrolled hypertension (MUCH) in treated hypertensive patients defined as controlled office BP but uncontrolled out-of-clinic BP. The objective of the study is to define the prevalence of MUCH in treated hypertensive patients. Design and method: An analytical cross-sectional study including 84 treated hypertensive patients aged &gt; 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion. Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices ( MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The comparisons of percentages were carried out by the Chi-square test. Results: The mean age of our population was 59.37±13.10 years (range 21-92 years), composed of 43 women and 41 men. The prevalence of MUCH was 6% in HBPM and 8.3% in ABPM. The difference between these two methods was not statistically significant for the detection of masked uncontrolled hypertension (p = 0.320). The prevalence of MUCH was higher in women detected by HBPM (11.6% versus 0%; p = 0.055) and by ABPM (14% versus 2.4%; p = 0.110), the difference according to gender was not statistically significant. ABPM detected also masked uncontrolled nocturnal hypertension in 14.3% of cases. Conclusions: Office BP monitoring alone is thus inadequate to ascertain optimal BP control because of BP variation. HBPM and mainly ABPM which can detect elevated nocturnal BP were needed to confirm proper BP control especially in patients with high cardiovascular risk in whom the prevalence of MUCH is higher.

Efficacy and Safety Compared between Chlorthalidone and Hydrochlorothiazide for Reducing Systolic and Diastolic Blood Pressure in Patients with Mild-to- Moderate Hypertension: A Randomized Clinical Trial

Objective: Hypertension is the leading cause of morbidity and mortality, and blood pressure (BP) control is shown to reduce the risk of cardiovascular events. The present study aimed to investigate the efficacy and safety of chlorthalidone and hydrochlorothiazide for reducing systolic and diastolic BP in patients with mild-to-moderate hypertension. Materials and Methods: The present study was a randomized clinical trial. Patients 18 years or older with mild-to-moderate hypertension with or without prior antihypertensive medications were enrolled. Patients were randomly assigned to the chlorthalidone or hydrochlorothiazide group. The dose of study medication could be up-titrated at the 6-week. The primary outcomes were the reduction in systolic and diastolic BP, the rate of office BP control at 12 weeks, and the rate of adverse events. Results: Fifty-six patients (mean age of 49.8±11.1 years) and 42.9% male, were included. Forty-three patients (76.8%) had known hypertension. Mean sitting office systolic BP (SBP) and diastolic BP (DBP) at baseline was 153.2±9.6 and 91.8±9.2 mmHg, respectively. The average daily dose of chlorthalidone and hydrochlorothiazide was 16.1±5.8 and 32.4±11.6 mg. The mean reduction in SBP in the chlorthalidone and hydrochlorothiazide groups was 28.7±12.2 and 22.8±13.7 mmHg (p=0.118), and DBP was 14.4±7.5 and 9.1±6.6 mmHg (p=0.011), respectively. The rate of office BP control was significantly greater in the chlorthalidone group at 91.7% versus 61.5% (p=0.013). There was no significant difference in the rate of adverse events between the groups. Conclusion: Chlorthalidone was shown to be more effective than hydrochlorothiazide for office BP control. There was no difference in adverse events. Trial registration: The trial had been registered with the Thai Clinical Trials Registry (TCTR) which complied with WHO International Clinical Trials Registry Platform dataset. The registration number was TCTR20191006002 (06/10/2019). Keywords: Efficacy; Safety; Chlorthalidone; Hydrochlorothiazide; Reducing; Systolic and diastolic blood pressure; Patients with mild to moderate hypertension

8. Efficacy of Renal Denervation on Office Blood Pressure in Resistant Hypertension: a Systematic Review

Hypertension almost occurs in about a quarter of the world's population and is still increasing, causing a burden in public health. Renal denervation is one of the strategies to treat resistant hypertension. However, studies on the efficacy of renal denervation in patients with resistant hypertension are still limited and not well known. The purpose of this study was to find out the efficacy of renal denervation in patients with resistant hypertension by office blood pressure measurement. This review was conducted on 10–17 December 2022. Two independent researchers systematically extracted data from several databases, such as PubMed Central (PMC), Science Direct, and PUBMED by using MeSH terminology of keywords renal denervation, hypertension, and safety. The extracted studies were then analyzed and selected according to our inclusion criteria such as studies in the last 5 years, cohort studies, and case-control studies. We excluded systematic reviews, meta-analyses, case series, case reports, studies on pregnant women, children, and animals. Research quality was assessed using Newcastle-Ottawa (NOS). From 5 cohort studies (1605 subjects from various countries), all of them showed renal denervation resulted in better and sustained office blood pressure control on long-term follow up; All studies have proven good quality based on NOS. In conclusion, renal denervation showed efficacy by sustained blood pressure reducing effect in patients with resistant hypertension. However, further study is needed to confirm these findings.

Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Efficiency of combined antihypertensive pharmacotherapy in patients with arterial hypertension, combined with type 2 diabetes mellitus and non-alcoholic fatty liver disease

Background. Treatment of patients with arterial hypertension (AH) associated with type 2 diabetes mellitus (DM2) and non-alcoholic fatty liver disease (NAFLD) is a complex clinical challenge. The complementary and aggravating effect of these comorbidities often prevents the realization of the antihypertensive potential of the drugs used and their combinations, and therefore it is necessary to search for additional ways to intensify therapy.Aim. To assess the efficiency of combined pharmacotherapy in patients with AH associated with DM2 and NAFLD, depending on the CYP2C9 gene polymorphism.Materials and methods. The study included 68 patients with uncontrolled AH associated with DM2 and NAFLD (Fatty Liver Index (FLI) &gt; 60) who received prior antihypertensive therapy. All subjects were prescribed a combination of azilsartan medoxomil with amlodipine at doses of 40/5 mg/day. The duration of therapy was 24 weeks. Those included in the study underwent control of office blood pressure (BP) at the initial visit, after 4, 8 and 24 weeks of treatment; 24-hour BP monitoring (ABPM) — initially and after 24 weeks. Venous blood samples were taken from patients, followed by DNA isolation from leukocytes by phenol- chloroform extraction. Determination of polymorphic variants of the CYP2C9 gene was carried out on an amplifier Rotor Gene — Q. The TaqMan method (allele discrimination) and a set of primers and probes were used.Results. As a result of genetic testing, the following distribution of polymorphic variants of the CYP2C9 gene was revealed: *1/*1 was found in 73,5% of patients, *1/*2 in 14,7%, *1/*3 in 11,8%. It was shown that after 4 weeks of therapy with a polymorphic variant of the *1/*1 CYP2C9 gene, the achievement of the target level (TL) of BP was registered in 62% of patients, with polymorphisms *1/*2 and *1/*3 — in 30% and 25%. After increasing the dose of azilsartan medoxomil and amlodipine to 80/10 mg/day, respectively, and 8 weeks from the start of treatment in the *1/*1 group, the number of BP targets achieved increased to 88%, in the *1/*2 groups and *1/*3 — up to 60% and 62,5%. Antihypertensive therapy was intensified with prolonged release indapamide at a dose of 1,5 mg/day, and according to the results of 24 weeks of therapy, patients with a polymorphic variant of the CYP2C9 *1/*1 gene achieved the TLBP in 96% of cases, with *1/*2 and *1/*3 — In 90% and 87,5%, respectively. At the same time, in patients with polymorphism of the CYP2C9 gene *1/*1, *1/*2 and *1/*3, positive dynamics of all ABPM parameters was revealed. However, in the *1/*1 variant, more pronounced positive changes were observed in the systolic BP time index during the day and the diastolic BP time index during the day, and the diastolic BP time index at night.Conclusions. As a result of a 24-week study, the majority of patients who had the polymorphic variant *1/*1 of the CYP2C9 gene showed a more pronounced efficacy of the studied combination of drugs. Patients with *1/*2 and *1/*3 polymorphisms often required triple therapy to achieve TLBP. At the same time, further studies are needed to study the dependence of the antihypertensive effects of drugs on polymorphisms of the corresponding genes, which may help identify groups of patients who need more intensive antihypertensive therapy already at the start of treatment.

Abstract 15741: Is Home Blood Pressure Monitoring Useful in Diagnosing Hypertension in Young Adults in Primary Care?

Introduction: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the younger population and in the scope of primary care. Objective: To assess the degree of agreement between office BP and Home Blood Pressure Monitoring (HBPM), evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and cardiovascular risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM &lt; 135 x 85 mmHg and office BP &lt; 140 x 90 mmHg were considered normal while dentifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years) of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). Through multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times respectively. Uncontrolled office BP had high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388). Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: HBPM was a useful tool in the diagnosis of hypertension in a young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN, and in those with high normal office BP, especially if they were male or obese, for early diagnosis of masked HTN.

Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients. Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol. ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients. ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.

Durability of blood pressure reduction after ultrasound renal denervation: three-year follow-up of the treatment arm of the randomised RADIANCE-HTN SOLO trial.

While the blood pressure (BP)-lowering effect of renal denervation (RDN) has been established, long-term durability is a key prerequisite for a broader clinical implementation. Our aims were to assess the long-term durability of the office BP (OBP)-lowering efficacy, antihypertensive medication (AHM) use, and safety of ultrasound RDN (uRDN). Four weeks after withdrawal of AHM, patients with untreated daytime ambulatory BP ≥135/85 mmHg and <170/105 mmHg were randomised to uRDN (n=74) or sham (n=72) in the RADIANCE-HTN SOLO trial. Initiation of AHM was encouraged for home BP >135/85 mmHg following primary endpoint ascertainment at 2 months. Patients and physicians were unblinded at 6 months. Results: Fifty-one of 74 patients (age: 53.9±11 years; 67% men) originally randomised to uRDN completed the 36-month follow-up. Initial screening OBP upon study entry was 145/92±14/10 mmHg on a mean of 1.2 AHM (range: 0-2.0). Baseline OBP after AHM washout was 154/99±13/8 mmHg. At 36 months, patients were on an average of 1.3 AHM (range: 0-3.0) with 8 patients on no AHM. OBP decreased by 18/11±15/9 mmHg from baseline to 36 months (p<0.001 for both). Overall, OBP control (<140/90 mmHg) improved from 29.4% at screening to 45.1% at 36 months (p=0.059). For patients uncontrolled at screening (n=36), systolic OBP decreased by 10.8 mmHg (p<0.001) at 36 months on similar AHM (p=0.158). The safety and effectiveness of uRDN was durable to 36 months, with reduced OBP and improved OBP control despite a similar starting medication burden. No new uRDN-related long-term safety concerns were identified.

HIGHER PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION WITH NEW EUROPEAN BLOOD PRESSURE TARGETS IN AN ELDERLY PRIMARY CARE POPULATION

Objective: The aim of this study was to examine the distribution and clinical characteristics of hypertension phenotypes among patients aged 65 years or older, in a primary care setting, applying the new lower blood pressure targets, of 140/80 mmHg for office blood pressure measurement and 130/75 for ambulatory measurement, proposed by the European Society of Hypertension in 2018. Design and method: This is a cross-sectional analysis of 77 subjects previously diagnosed with hypertension who used at least one antihypertensive drug in a primary care setting in south-east Sweden. Data was collected between May 2012 and May 2016. All subjects were examined regarding general clinical characteristics, office blood pressure and ambulatory blood pressure (Spacelabs ABP monitor 90217). The participants were grouped based on office blood pressure target achievement. Furthermore, subjects were categorized in four groups based on hypertension phenotype. These groups were defined based on office- and ambulatory blood pressure target achievement; Sustained controlled hypertension i.e. concordant goal achievement, Sustained uncontrolled hypertension i.e. non-achievement, Masked uncontrolled hypertension i.e. controlled office blood pressure with uncontrolled ambulatory blood pressure and White coat uncontrolled hypertension i.e. uncontrolled office blood pressure with controlled ambulatory blood pressure. Lastly, shifts in the distribution of hypertension phenotypes using current and previous blood pressure targets respectively were examined. Results: Obesity related parameters (i.e. BMI and waist circumference) were significantly lower in the group with controlled hypertension based solely on current office blood pressure targets, with BMI (kg/m2) of 25.5 ± 3.9 vs. 28.8 ± 4.9 (p &lt; 0.01) and waist circumference (cm) of 91.0 ± 12.1 vs. 100.3 ± 12.7 (p &lt; 0.01). Among subjects with controlled office blood pressure, the prevalence of masked uncontrolled hypertension was higher (14/29 or 48%) when new office- and ambulatory blood pressure targets were applied than when older targets were applied (14/43 or 33%). Conclusions: The main finding of this observational study was that the prevalence of masked uncontrolled hypertension among subjects with controlled office blood pressure was higher applying new instead of old blood pressure targets. We believe that regular ambulatory blood pressure monitoring can facilitate optimized antihypertensive treatment.

KIDNEY SUBCLINICAL LESIONS IN HYPERTENSION PHENOTYPES DEFINED BY HOME BLOOD PRESSURE MONITORING AMONG YOUNG ADULTS ENROLLED IN A FAMILY HEALTH STRATEGY UNIT

Objective: To assess kidney subclinical lesions among different hypertension (HTN) phenotypes identified by Home Blood Pressure Monitoring (HBPM) in an adult population enrolled in a Family Health Strategy unit Design and method: Cross-sectional, populational study with adults between 20–50 years old enrolled in a Family Health Strategy unit in a metropolis. Sociodemographic, anthropometric and CV risk factors were registered. Office blood pressure (BP) was the average of two consecutive measurements, and HBPM followed a 7-day protocol. HBPM &lt; 135x85 mmHg and office BP &lt; 140x90mmHg were considered normal, identifying four phenotypes: normotension (controlled office BP and HBPM); white-coat hypertension (uncontrolled office BP and controlled HBPM); masked hypertension (controlled office BP and uncontrolled HBPM) and sustained hypertension (uncontrolled office BP and HBPM). Albuminuria was dosed in an isolated urine sample whereas glomerular filtration rate was calculated by CKD Epi formula using serum creatinine. Results: A total of 483 individuals were evaluated (39% male; mean age: 37.6 ± 8.8 years). More often, individuals with white-coat hypertension (9.3%) are male, with greater neck circumference and higher prevalence of metabolic syndrome. Individuals with masked hypertension (10%) are more obese, with increased neck and waist circumferences whereas those who present sustained hypertension are predominantly male, more obese, with increased neck and waist circumferences and higher prevalence of diabetes and metabolic syndrome. Analyzing four phenotypes, a progressive albuminuria increase was observed among normotensive patients: white-coat hypertension 4.0 ± 2.2; masked hypertension 5.3 ± 3.4 and sustained hypertension 7.1 ± 1.4 mg/g creatinine. We also observed an increased serum creatinine and decreased GFR: white-coat hypertension 0.74 ± 0.16/132 ± 34; masked hypertension 0.79 ± 0.17/123 ± 28; sustained hypertension 0.81 ± 0.32/120 ± 59, respectively, although without statistical significance. Conclusions: The performance of HBPM refined HTN diagnosis and was able to early identify a progressive worsening of kidney function parameters in the different phenotypes.

Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

Nighttime hypertension is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD), but nighttime hypertension, a subtype of masked uncontrolled hypertension (MUCH), is often undetected among patients with controlled office blood pressure. Little attention has been paid to patients with CKD and nighttime MUCH. To investigate the prevalence of nighttime MUCH and its associations with cardiovascular and kidney outcomes in patients with CKD who were not receiving dialysis. This retrospective cohort study included patients with nondialysis CKD and hypertension, enrolled in Shanghai, China, from July 2012 through November 2020 and followed up for a median of 39 months. Participants were classified as having controlled hypertension, sustained hypertension, and MUCH, which was further divided into isolated nighttime MUCH and day-night MUCH, assessed by office and ambulatory blood pressure monitoring. Left ventricular hypertrophy (LVH) was determined by echocardiography. The composite kidney outcome consisted of end-stage kidney diseases (ESKD) and a reduction of estimated glomerular filtration rate (eGFR) by 50% or more. Logistic and Cox regression assessed the associations of hypertension subtypes with LVH and kidney outcomes. The 675 patients (425 [63.0%] men; mean [SD] age, 50.8 [15.9] years; mean [SD] eGFR, 61.6 [29.4] mL/min/1.73 m2) included 125 (19.3%) with controlled hypertension, 244 (37.6%) with MUCH, and 280 (43.1%) sustained hypertension. Among patients with MUCH, 2 (0.8%) had isolated daytime MUCH, 154 (63.1%) had isolated nighttime MUCH, and 88 (36.1%) had day-night MUCH. During a median (IQR) follow-up of 39 (19-64) months, 130 composite kidney events, including 97 ESKD events, occurred. Compared with controlled hypertension, MUCH and sustained hypertension were associated with LVH (eg, MUCH: odds ratio [OR], 2.94; 95% CI, 1.18-7.34; P = .02) and the composite kidney outcome (eg, MUCH: hazard ratio [HR], 4.12; 95% CI, 1.75-9.73; P = .001) after adjustment for age, sex, proteinuria, eGFR, and other baseline risk factors. Multivariate-adjusted associations were also significant between day-night MUCH and LVH (OR, 3.26; 95% CI, 1.15-9.25) and between isolated nighttime MUCH and the composite kidney outcome (HR, 4.27; 95% CI, 1.69-10.77). In this cohort study, nighttime MUCH was common and associated with LVH and poor kidney outcomes among patients with hypertension and nondialysis CKD. These findings suggest that ambulatory blood pressure monitoring was inadequately used in patients with CKD and hypertension, calling for more widespread use, even in patients with controlled office hypertension.

MO090: Diagnostic Performance of Pre-Dialysis And Ambulatory Blood Pressure Levels in Men and Women Hemodialysis Patients

Abstract BACKGROUND AND AIMS Ambulatory blood pressure (BP) control is worse in men than in women with chronic kidney disease or kidney transplantation. So far no study assessed in parallel possible effects of sex differences on the prevalence, control and BP phenotypes according to pre-dialysis and 48-h ABPM in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of pre-dialysis BP levels in men and women hemodialysis patients. METHOD 129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Hypertension was defined as follows: (1) pre-dialysis BP ≥ 140/90 mmHg or use of antihypertensive agents, (2) 48-h BP ≥ 130/80 mmHg or use of antihypertensive agents. RESULTS The prevalence of hypertension was not different between men and women with the use of pre-dialysis BP (92.2% versus 92.3%, P = 0.987, respectively) or 48-h ABPM (92.2% versus 89%, P = 0.411). With the use of pre-dialysis BP men had significantly lower control rates than women (18.5% versus 32.1%, P = 0.025); a similar pattern of worse control in men was apparent with the use of ABPM, but the difference was not statistically significant (22.7% versus 28.4%, P = 0.360). The rate of patients with concordant lack of control by pre-dialysis and ABPM readings was significantly higher in men than women (65.3% versus 49.4%, P = 0.023); white-coat (14.9% versus 17.6%, P = 0.593) and masked hypertension (10.7% versus 18.8%, P = 0.101) did not differ between groups. However, the misclassifation rate with the use of pre-dialysis BP was lower in men than women. There was moderate or at best fair agreement between pre-dialysis and ambulatory BP with regards to the prevalence (men: κ-statistics = 0.39, P &amp;lt; 0.001 and women: 0.27, P = 0.011) and control rates (κ-statistics = 0.25, P = 0.005 and 0.17, P = 0.124, respectively). Pre-dialysis BP ≥ 140/90 mmHg had sensitivity/specificity of 85.9%/51.4% in men and 72.4%/54.5% in women for the diagnosis of 48-h BP ≥ 130/80 mmHg. Receiver-operating-curve analyses confirmed this poor diagnostic performance. CONCLUSION The prevalence of hypertension is similar between men and women hemodialysis patients, but men have worse rates of office BP control. The diagnostic accuracy of pre-dialysis BP levels was equally poor in men and women hemodialysis patients.

A Differential Response to Antihypertensive Therapy in African Men and Women: Insights From the CREOLE Trial.

We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa. We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across sub-Saharan Africa who completed baseline and 6-month profiling according to their randomly allocated antihypertensive treatment. Overall, 442/635 (69.6%) participants achieved an office BP target of <140/90 mm Hg at 6 months; comprising more women (286/72.0%) than men (156/65.5%) (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.07-2.39; P = 0.023). Women randomized to amlodipine-hydrochlorothiazide (HCTZ) (adjusted OR 3.03, 95% CI 1.71-5.35; P < 0.001) or amlodipine-perindopril (adjusted OR 2.62, 95% CI 1.49-4.58; P = 0.01) were more likely to achieve this target compared with perindopril-HCTZ. Among men, there were no equivalent treatment differences-amlodipine-HCTZ (OR 1.54, 95% CI 0.76-3.12; P = 0.23) or amlodipine-perindopril (OR 1.32, 95% CI 0.65-2.67; P = 0.44) vs. perindopril-HCTZ. Among the 613 participants (97%) with 24-hour ambulatory BP monitoring, women had significantly lower systolic (124.1 ± 18.1 vs. 127.3 ± 16.9; P = 0.028) and diastolic (72.7 ± 10.4 vs. 75.1 ± 10.5; P = 0.007) BP levels at 6 months compared with men. These data suggest clinically important differences in the therapeutic response to antihypertensive combination therapy among African women compared with African men.

Антигіпертензивна ефективність препарату Хітен (периндоприл) у хворих із м’якою та помірною артеріальною гіпертензією

Мета: вивчити антигіпертензивну ефективність і переносимість препарату Хітен (периндоприл) виробництва компанії «Ауробіндо Фарма Лімітед», Індія, у хворих з м’якою й помірною артеріальною гіпертензією. Методи. У дослідження були включені 53 пацієнти. Здійснювався контроль офісного артеріального тиску (АТ) і частоти серцевих скорочень, ефективності проведеної терапії, реєструвалися випадки розвитку побічних реакцій, проводилися амбулаторне моніторування АТ, контроль біохімічних показників сироватки крові, загальний аналіз крові. Хітен у дозі 4–8 мг 1 раз на день призначався протягом 30 днів. У випадках, коли не було досягнуто цільового рівня офісного АТ, при необхідності додавався гідрохлортіазид у дозі 12,5 мг 1 раз на день. Загальний курс лікування для одного пацієнта становив 6 місяців. Середній вік хворих становив 51,38 ± 1,40 року, індекс маси тіла — 29,50 ± 0,59 кг/м2. Вихідний рівень офісного середнього систолічного АТ (САТ) і діастолічного АТ (ДАТ) у цілому по групі становив 156,77 ± 0,66 мм рт.ст. і 95,19 ± 0,98 мм рт.ст. Результати. Встановлено, що у хворих із м’якою і помірною артеріальною гіпертензією лікування Хітеном (периндоприлом) у дозі 4–8 мг (одним або в комбінації з гідрохлортіазидом) забезпечує достовірне зниження як офісного САТ — на 28,67 мм рт.ст. і ДАТ — на 14,57 мм рт.ст., так і середньодобового САТ — на 14,14 мм рт.ст. і ДАТ — на 7,55 мм рт.ст., а також зниження індексів часу й тиску. Цільовий АТ за даними офісного вимірювання (&lt; 140/90 мм рт.ст.) було досягнуто у 88 %, за даними добового моніторування АТ (&lt; 130/80 мм рт.ст.) — у 78 % випадків. Відміна препарату була в 3 пацієнтів (5,6 %). Висновок. Результати проведеного дослідження свідчать про високу антигіпертензивну ефективність і добру переносимість лікування Хітеном (периндоприлом) як монотерапії, так і в комбінації з гідрохлортіазидом у хворих з м’якою та помірною АГ.