Office Blood Pressure Monitoring Research Articles

Obesity in Hypertensive Patients Is Characterized by a Dawn Phenomenon in Systolic Blood Pressure Values and Variability.

One of the causes of hypertension is excess weight gain, which can also affect the course of this disease. Both the diagnosis and management of hypertension commonly use ambulatory blood pressure monitoring; the results of which correlate more strongly with cardiovascular diseases and cardiovascular death than office blood pressure monitoring. We evaluated blood pressure values and their variability from hour to hour to see if and when they differed between hypertensive patients with and without obesity. The study included 1345 patients who underwent 24 h ambulatory blood pressure monitoring and then were divided into groups according to body mass index and waist circumference. The obtained data were analyzed according to the subjects' wake-up time, and short-term blood pressure variability parameters were calculated as the mean of the absolute values of the differences between consecutive measurements. The systolic blood pressure in obese subjects was significantly higher between 1 and 5 h before waking than in normal-weighted individuals. In turn, the variability in systolic and diastolic blood pressure was higher with increasing body mass index. The difference in systolic blood pressure values and blood pressure variability was most prominent in the last 5 h of sleep in obese patients.

Experience of sacubitril/valsartan therapy in hypertension

The aim of the review was to analyze the antihypertensive efficacy and safety of sacubitril/valsartan combination, a representative of a new class of angiotensin receptor-neprilysin inhibitors (ARNIs), in patients with hypertension (HTN) according to clinical trials, including randomized, and meta-analyses. Randomized clinical trials conducted in different age, ethnic and clinical cohorts of HTN patients, as well as meta-analyses showed a more significant antihypertensive effect of sacubitril/valsartan compared with monotherapy with angiotensin II receptor blockers, confirmed by office blood pressure (BP) and 24-hour BP monitoring. At grade 1-2 HTN, sacubitril/valsartan showed greater reduction in systolic and diastolic blood pressure by ~5/2 mm Hg compared to valsartan or olmesartan according to 8-12-week studies. A dose-dependent effect of sacubitril/valsartan was established. A favorable experience was obtained with sacubitril/ valsartan use in various clinical variants of HTN (refractory HTN, isolated systolic HTN in the elderly, HTN in combination with heart failure, with chronic kidney disease), as well as the successful use of sac/vals in combination with other antihypertensive drugs. In long-term studies (52 weeks) in elderly patients with HTN, the positive effects of sacubitril/valsartan in reducing central aortic pressure, systolic blood pressure at night and a decrease in pulse pressure have been shown. Several meta-analyses have shown similar tolerability profiles compared to controls and no increased risk of adverse events.

THRESHOLDS FOR WHITE-COAT AND MASKED BLOOD PRESSURE EFFECTS: AN AMBULATORY BLOOD PRESSURE MONITORING STUDY

Objective: The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various thresholds based on the differences (DBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes assumed to carry adverse prognosis. Design and method: This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7,220 [Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH] unique individuals who underwent OBP and ABPM measurements. We compared the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and area under the curve (AUC) of 8 different ↗BP thresholds to detect WCH (↗systolicBP/↗diastolicBP = +28/+17, +20/+15, +20/+10, +16/+11, +15/+9, +14/+9 mmHg and ↗systolicBP = +13 and +10 mmHg) and eight different ↗BP thresholds to detect MH (↗systolicBP/↗diastolicBP = -14/-9, -5/-2, -3/-1, -1/-1, 0/0, +2/+2 mmHg and ↗systolicBP = -5 and -3 mmHg), built from formerly reported criteria in the literature. WCH was defined as OBP> = 140/90mmHg and ABPM < 130/80mmHg, and MH was defined as OBP < 140/90mmHg and ABPM> = 130/80mmHg. Results: The +20/+15 mmHg threshold showed the best AUC (0.804, 95%CI = 0.794 - 0.814) to detect WCH in the Derivation cohort, with sensitivity, specificity, PPV and NPV of 80.6%, 80.2%, 42.3%, and 95.8%, respectively. The +2/+2 mmHg threshold showed the highest AUC (0.741, 95%CI = 0.728 - 0.754) to detect MH, with sensitivity, specificity, PPV and NPV of 78.9%, 69.3%, 22.0% and 96.8%, respectively. Both threshold values also had the best accuracy to detect WCH (0.767, 95%CI = 0.754 - 0.780) and MH (0.767, 95%CI = 0.750 - 0.784) in the Validation cohort. In secondary analyses, these thresholds had the best accuracy to detect WCH and MH in individuals using or not AH, and to detect individuals with higher and lower office-than-home BP stages, respectively, in both cohorts. Conclusions: The +20/+15 and +2/+2 mmHg ↗BP thresholds had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and may be indicators of marked white-coat and masked BP effects.

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 > 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.

IMPACT OF OUTDOOR TEMPERATURE ON BLOOD PRESSURE PHENOTYPES: A LARGE MULTICENTER HOME BLOOD PRESSURE MONITORING STUDY

Objective: Blood pressure (BP) increases in colder seasons, but the impact of outdoor temperature on BP phenotypes derived from office BP (OBP) and home BP monitoring (HBPM) is not is not completely established due to the scarcity of data. This study evaluated the relationship of outdoor temperature with normotension (NT), white-coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a large multicenter Brazilian sample. Design and method: This cross-sectional study evaluated 57,606 individuals [39% men, mean age = 57.4±15.6 years, OBP = 131.4±19.8/83.9±11.8 mmHg, HBPM = 125.0±15.8/79.4±9.6 mmHg, 51% using antihypertensive medications (AH)] from 13 cities/metropolitan regions of the 5 Brazilian regions (North, Northeast, Central-West, Southeast and South) who underwent OBP and HBPM measurements from 2018 to 2022. Data on daily outdoor mean temperature (OMT), wind velocity and atmospheric pressure, and outdoor monthly humidity were collected from meteorological stations located in the studied cities. BP phenotypes were defined as: NT (OBP<140/90mmHg and HBPM<135/85mmHg), WCH (OBP > = 140/90mmHg and HBPM<135/85mmHg), MH (OBP<140/90mmHg and HBPM> = 135/85mmHg) and SH (OBP> = 140/90mmHg and HBPM> = 135/85mmHg). All regression analyses were adjusted for age, sex, BMI, calendar time, region, AH use and city altitude, wind velocity, atmospheric pressure and humidity. Results: Adjusted linear regression analysis showed a direct relationship of OMT with the difference in systolic OBP minus systolic HBPM (beta = 0.153±0.025; p<0.001) and the difference in diastolic OBP minus diastolic HBPM (beta = 0.066±0.015; p<0.001). Adjusted logistic regression analysis showed that each 1oC OMT increase was associated with a higher risk of WCH (OR [95%CI] = 1.011 [1.001–1.021]; p = 0.025) and NT (OR [95%CI] = 1.059 [1.051–1.066; p<0.001], and lower risk of MH (OR [95%CI] = 0.965 [0.950–0.975]; p<0.001) and SH (OR [95%CI] = 0.945 [0.937–0.952]; p<0.001). Conclusions: Higher OMT is associated with greater difference in OBP levels relative to HBPM levels and is related to greater risk of WCH and NT and lower risk of MH and SH. These findings suggest that outdoor temperature should be considered in the evaluation and management of hypertension and BP phenotypes.

DIFFERENTIAL DETERMINANTS OF AMBULATORY VS. HOME MORNING BLOOD PRESSURE MEASURED BY A SINGLE MULTISENSOR BLOOD PRESSURE MONITORING DEVICE: THE HI-JAMP STUDY BASELINE DATA

Objective: Out-of-office blood pressure (BP) monitoring using ambulatory BP (ABP) monitoring (ABPM) and home BP (HBP) monitoring (HBPM) is recommended for hypertension management. However, BP level measured by ABPM and HBPM may not be consistent even when evaluated the same time-window, morning. This study investigated the determinants of the difference between ABP and HBP in the morning time measured by a multisensor BP monitoring device equipped with a high-sensitivity actigraph and a thermometer. Design and method: Medicated hypertension patients enrolled in the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study consecutively underwent office BP monitoring, 24-h ABPM (with 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same multisensor BP monitoring device (TM-2441; A&D Company, Tokyo). Morning ABP (average of 4 readings within 2-h after waking) and morning HBP (average of HBP readings measured in the morning over a HBPM period) were compared. In addition, this device recorded the wearer's fine-scale physical movement during a 24-h ABPM period and stored temperature data at the time of each BP measurement. Hourly averages of physical activity and temperatures at the time of HBPM (i.e., room temperature) were used for the analysis. Results: Among 2322 patients (males 53.2%, 69.2±11.5 years, average office systolic BP [SBP] 132.8±18.8 mmHg), morning home SBP was 2.4 mmHg higher than morning ambulatory SBP with standard deviation of 15.9 mmHg (ABP < HBP). In a multivariable analysis including conventional risk factors, older age and larger number of antihypertensive agents were significantly associated with [HBP > ABP], while history of cardiovascular disease (CVD) was significantly associated with [ABP > HBP]. In the analysis additionally including physical activity in the morning and room temperature at the morning HBP measurement, higher activity level was significantly contributed to [ABP > HBP] and lower room temperature was significantly contributed to [HBP > ABP]. Conclusions: In treated hypertensive patients, HBPM is recommended especially if the patient is older, taking multiple antihypertensive agents, or living in an environment with lower room temperatures in the winter, while ABPM is recommended if the patient has a history of CVD.

VISUAL ASSESSMENT OF KOROTKOFF SOUNDS FURTHER IMPROVES THE ACCURACY OF A VALIDATED PROFESSIONAL AUTOMATED AUSCULTATORY BLOOD PRESSURE MONITOR – INBODY BPBIO480KV

Objective: A novel automated auscultatory upper-arm cuff blood pressure (BP) monitor for office use (InBody BPBIO480KV, Seoul, S Korea) has been recently validated, which allows healthcare professionals to visually review the Korotkoff sounds curves generated for each BP reading. This study investigated whether this feature could further improve the accuracy of the device by identifying unreliable BP readings. Design and method: Three observers assessed independently the morphology of Korotkoff sound curves generated during a validation study according to the ISO 81060-2:2018 standard, and classified them as having good, fair, or poor signal quality (low signal amplitude or sound intensity, aberrant signal morphology, interference of background noise or other signal artifact, presence of auscultatory gap, or irregular rhythm), separately for the systolic and diastolic BP area. The observers were blinded to the automated and the reference BP measurement results. Disagreement among observers was resolved by a supervisor. Factors associated with poor quality signal were also investigated. Results: A total of 255 Korotkoff sound curves (test BP readings) by 85 participants (mean age 57.3±15.0 years, 53 men) were analyzed. For systolic BP, 82.0/12.2/7.5% were classified as good/fair/poor quality and for diastolic 76.9/12.2/11.0%. Inter-observer agreement in detecting poor quality curves was 84.7/83.1% (systolic/diastolic). Of poor quality curves 10.5/60.7% (systolic/diastolic) clustered in the same individuals. Young age and female sex increased the odds for poor quality signal. ISO validation Criterion 1 (mean BP difference ±SD) was satisfied for readings with good (0.1±4.9/0.3±3.8 mmHg, systolic/diastolic) and fair (-0.4±6.4/0.2±5.0) quality curves, good/fair quality curves (0.1±5.1/0.2±4.0 mmHg, systolic/diastolic), but not for those with poor quality signal (2.7±8.8/3.6±8.1 mmHg). In the ISO validation study, excluding readings with poor quality signal (systolic and/or diastolic area; 40 of 255) Criterion 1 was improved (0.2±4.9/0.2±3.9 mmHg versus 0.3±5.5/0.6±4.7 mmHg). Conclusions: The visual assessment of Korotkoff sounds generated by automated auscultatory BP measurement using the InBody BPBIO480KV professional office BP monitor is useful in identifying unreliable readings and further improves the device accuracy.

Sex differences in arterial stiffness and sympathetic activity in older CKD patients

Chronic kidney disease (CKD) is characterized by sympathetic nervous system overactivity that contributes to increased arterial stiffness and cardiovascular risk. While premenopausal females are relatively protected from cardiovascular disease in healthy individuals, older postmenopausal females without kidney disease have similar degrees of sympathetic overactivity, vascular stiffness and cardiovascular risk compared to older age-matched males in the general population. However, in the CKD population, cardiovascular mortality risk remains higher in older males compared to age-matched females and whether sex differences in neural and vascular function exist in older CKD patients is unknown. Therefore, we tested the hypothesis that compared to older females, older males with CKD have higher baseline sympathetic activity that is related to increased arterial stiffness. In 207 CKD patients (N=90 females, 62 ± 9 years; and N=117 males, 60 ± 9 years), we measured resting sympathetic nerve activity directed to muscle (MSNA) by microneurography at the peroneal nerve. At a separate visit, arterial stiffness was determined by carotid-to-femoral pulse wave velocity (PWV) using transcutaneous Doppler flow velocity (SphygmoCor®). Office blood pressure (BP) and 24-hour ambulatory BP monitoring (ABPM; Spacelabs) were performed using standard techniques. Resting MSNA was higher in males versus females with CKD (43 ± 10 vs 31 ± 14 bursts/min; p= 0.039). Both office and 24-hour ambulatory diastolic BP (79 ± 11 vs 67 ± 14 mmHg, p<0.001) and mean arterial pressure (96 ± 10 vs 88 ± 13 mmHg, p<0.001) were also higher in males versus females. PWV was not different between male and female groups (p= 0.157). There was no association between PWV and resting MSNA in males, while in females, there was an inverse relationship between PWV and MSNA burst frequency (r2=0.271; p=0.039) and burst incidence (r2=0.310; p=0.025). Older male CKD patients have higher resting MSNA, office and ambulatory BP compared to older females with CKD. In contrast, there were no differences in arterial stiffness measured as PWV between sexes. In males, increased MSNA was not associated with increased arterial stiffness, while MSNA was negatively correlated with PWV in females. Sex differences in neural and vascular function may impact cardiovascular outcomes in older patients with CKD. Supported by NIH grants R01HL135183, R33AT010457. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The effect of ambient air pollution on office, home and 24-h ambulatory blood pressure measurements.

Air pollution has recently been linked to a number of cardiovascular diseases, particularly hypertension (HT). In our study, we aimed to evaluate the association between air pollution and BP and compare the relationship BP measurement results obtained using different methods (office, home, and 24-h ambulatory BP monitoring (24-h ABPM)). This retrospective nested panel study performed with prospective Cappadocia cohort data investigated the relationships between particulate matter (PM) 10 and sulfur dioxide (SO2) and concurrent home, office, and 24-h ABPM data at each control performed over a two-year period. A total of 327 patients in the Cappadocia cohort were included in this study. On the day of office blood pressure measurement, there was an increase of 1.36 mmHg in SBP and 1.18 mmHg in DBP for every 10 µm/m3 rise in SO2 values. A mean three-day 10 µm/m3 increase in SO2 was linked to an increase of 1.60 mmHg in SBP and 1.33 mmHg in DBP. A 10 µm/m3 rise in mean SO2 on the day of 24-hour ABPM measurement was found to be associated with an increase of 1.3 mmHg in SBP and 0.8 mmHg in DBP. SO2 and PM 10 had no effect on home measurements. In conclusion, increased SO2 levels, during winter months in particular, can be association with an elevation in office BP values. Our study findings show that air pollution in the setting in which BP is measured may be associated with the results.

53. Clinical Uses of Cuffless Blood Pressure Monitoring Devices Using Photoplethysmography as A Promising Ambulatory Telemonitoring Tool: A Systematic Review and Meta-Analysis

Introduction: As check-ups in healthcare facilities are much arduous during the pandemic including blood pressure (BP) control, an alternative is urgently needed to replace the use of disturbing cuff-based office and ambulatory BP monitoring (BPM) devices. With the advancement of telemedicine, real-time checking and reporting of blood pressure may be potentially achieved using photoplethysmography (PPG) technology in cuffless devices. Therefore, this study evaluated the accuracy of these devices compared to the cuff-based BPM devices. Methods: This systematic review and meta-analysis was conducted based on the PRISMA 2020 guideline through multiple databases using Rayyan according to the prearranged inclusion and exclusion criteria, yielding six clinical studies to be included in the final review and analysis. Results: Overall fixed-effect meta-analysis of all studies (total of 319 subjects) presented small differences between cuffless and cuff-based devices, showing promising accuracy according to the current medical instrumentation guideline both in measuring systolic BP (SMD: 0.23 mmHg [95% CI: 0.07–0.39], p = 0.004; I2 = 0%, p = 0.55) and diastolic BP (SMD: 0.27 mmHg [95% CI: 0.11–0.43], p = 0.0007; I2 = 39%, p = 0.14). Discussion: PPG itself is a noninvasive technology, consisting of an infrared-emitting light source and a photodetector to measure the blood-reflected light intensity. Despite its ease in equipment, it measures BP accurately without being influenced by various positions and activities. Moreover, the data can be accessed real-time by both users and healthcare providers. Conclusion: In summary, cuffless PPG BPM devices have the potential in becoming a telemonitoring device for ambulatory patients for its accuracy. Its presence may be the answer to current restriction towards healthcare access during the COVID-19 pandemic. Therefore, in order to further confirm our findings, more clinical studies with various settings are encouraged to be held.

Hypertension management before and under the COVID-19 pandemic: lessons and future directions.

Hypertension is a significant risk factor for cardiovascular diseases. The prevalence of hypertension and its complications is increasing yearly, yet it remains inadequately controlled worldwide. It has already been recognized that self-management, including self-measured blood pressure monitoring at home, is more important than office blood pressure monitoring. The practical application of telemedicine using digital technology was already underway. COVID-19 has promoted the popularization of these management systems in primary care, although the COVID-19 pandemic disrupted lifestyle and healthcare access. At the beginning of the pandemic, we were at the mercy of information on whether certain antihypertensive drugs, for example, might pose a risk of infection in the face of unknown infectious diseases. Over the past three years, however, much knowledge has been accumulated. It has been scientifically proven that there is no serious problem in managing hypertension in the same way as before the pandemic. That is to control blood pressure mainly through home blood pressure monitoring and continuing conventional drug therapy while modifying lifestyle. On the other hand, in the New Normal era, it is necessary to accelerate digital hypertension management and the establishment of new social networks and medical systems to prepare for the re-emergence of future pandemics while continuing to protect against infection. This review will summarize the lessons and future directions we learned from the impact of the COVID-19 pandemic on hypertension management. The COVID-19 pandemic has disrupted our daily life, restricted access to healthcare, and altered some of the conventional management of hypertension.

Current practice of blood pressure measurement in Germany: a nationwide questionnaire-based survey in medical practices

PurposeDiscrepancies exist between guideline recommendations and real-world practice of blood pressure (BP) measurements. The aim of this study was to assess, with a nationwide, questionnaire-based survey, the current practice of BP measurement and associated BP values in German medical practices.Material and methodsA nationwide survey in German medical practices was performed in the period from 10 May 2021 to 15 August 2021. The questionnaire was divided into five sections. The current office BP (OBP) values as well as the current drug therapy were recorded. In addition, the implementation of office BP (OBP) and home BP monitoring (HBPM) was queried. For analysis, questionnaires were scanned and automatically digitised.ResultsA total of 7049 questionnaires were analysed, the majority of which came from general practitioners (66%) and internal medicine practices (34%). The average OBP (SD) was 140.0 (18)/82.7 (11) mmHg. 40.8% of treated patients had OBP in the controlled range, with monotherapy (34.7%) or dual combination therapy (38.2%) prescribed in most cases. OBP was taken from a single measurement in 66.3% of cases, and in 21.8% from 23 measurements. OBP was mostly measured after a rest period (87.1%) and in a separate room (80.4%). HBPM was performed in 62.3% of patients; however, in 24.9% of the participants HBP measurements were recorded once a week or less.ConclusionIn this nationwide survey in German medical practices, BP control remains at below 50%, while monotherapy is prescribed in around one third of patients. Moreover, office measurements and HBPM are often not performed according to current guideline recommendations.

Withdrawal of antihypertensive medication in young to middle-aged adults: a prospective, single-group, intervention study

BackgroundAlthough antihypertensive drug therapy is commonly believed to be a life-long therapy, several recent guidelines have suggested that antihypertensive medications can be gradually reduced or discontinued for some patients whose blood pressure (BP) is well-controlled for an extended period. Thus, this pilot study aimed to describe the success rate of antihypertensive drug discontinuation over 6 months among young and middle-aged patients with hypertension.MethodsThis was a prospective, single-group, intervention study. Patients were eligible for inclusion if their cardiologist judged them to be appropriate candidates for this study, their BP had been controlled both in the office (< 140/90 mmHg) and 24-h ambulatory BP monitoring (< 135/85 mmHg) for at least 6 months with a single tablet dose of antihypertensive medication. A total of 16 patients withdrew their antihypertensive medications at baseline after they received the education, and were followed up over 6 months. After the follow-ups, six patients participated in the in-depth interview.ResultsThe likelihood of remaining normotensive at 30, 90, 180, and 195 days was 1.00, 0.85, 0.51, and 0.28, respectively. There were also no significant differences in baseline characteristics and self-care activities over time between normotensive (n = 8) and hypertensive groups (n = 8). In the interview, most patients expressed ambivalent feelings toward stopping medications. Psychological distress (e.g., anxiety) was the primary reason for withdrawal from this study although the patients’ BP was under control.ConclusionsWe found that only a limited portion of antihypertensive patients could stop their medication successively over 6 months. Although we could not identify factors associated with success in maintaining BP over 6 months, we believe that careful selection of eligible patients may increase success in stopping antihypertensive medications. Also, continuous emotional support might be essential in maintaining patients’ off-medication.

JS-HR-5: APPROPRIATE BLOOD PRESSURE ASSESSMENT METHODS FOR THE PREVENTION OF HYPERTENSION COMPLICATIONS BY NEW TECHNOLOGIES

Blood pressure (BP) values can vary and fluctuate widely depending on the method and the environment of BP measurement. Appropriate measurement and interpretation of BP values enable us to make an accurate diagnosis and treatment of hypertension. The BP measuring approach is shifting from traditional methods (office BP, ambulatory and home BP monitoring) to wearable devices and technology. Self-measured BP as well as BP measured by wearable devices gives us frequent BP values, which allows us to detect high risk population and to reduce cardiovascular risks. In this session, we will introduce the latest papers on “Hypertension management and device” in the “Hypertension Research up-to-date 2021. ∼ Current topics of hypertension journals.∼” This session will also introduce the significance of blood pressure measurement and the latest blood pressure measurement technologies.

PS-BPC03-4: DIAGNOSTIC AGREEMENT OF MASKED UNCONTROLLED HYPERTENSION DETECTED BY AMBULATORY BP AND HOME BP MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE

Objectives: Masked hypertension is a phenomenon in which office blood pressure (BP) is in the controlled BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled BP range. Out-of-office BP control status may differ if defined by different BP indexes or measured under different conditions (resting or ambulatory), over different time-windows, or with different devices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indexes (ABPM-MUHT) and HBPM indexes (HBPM-MUHT) using the same all-in-one device. Methods: Medicated hypertension patients enrolled in the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study between 2017 and 2020 consecutively underwent office BP monitoring, 24-h ABPM (with 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device (TM-2441; A&amp;D Company, Tokyo). Controlled BP ranges for each BP index were as follows: office systolic BP [SBP] &lt; 140 mmHg; morning home, evening home, or morning-evening (ME) average SBP &lt; 135 mmHg; 24-h average SBP &lt; 130 mmHg; daytime SBP &lt; 135 mmHg; and nighttime SBP &lt; 120 mmHg. Results: Of 2322 patients (males 53.2%, average age 69.2 ± 11.5 years, average office SBP 132.8 ± 18.8 mmHg), the prevalences of ABPM-MUHT and HBPM-MUHT were 11.0% and 13.9%, respectively, when MUHT was defined only by 24-h average SBP or ME average SBP. Among the 445 patients with any MUHT according to this definition, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7%. The prevalences of HBPM-MUHT defined by morning SBP and evening SBP were 22.4% and 11.6%, respectively, and those of ABPM-MUHT defined by daytime SBP and nighttime SBP were 11.8% and 13.8%. When MUHT was defined by any time-window index (ABPM: daytime, nighttime, and 24-h average SBP; HBPM: morning, evening, ME average SBP), the prevalences of ABPM-MUHT and HBPM-MUHT were 19.8% and 25.0%, respectively, and the diagnostic agreement of MUHT detected by ABPM and HBPM in patients with any MUHT (n = 743) increased to 40.1%. Conclusion: Even in treated patients with well-controlled office BP, the prevalence of MUHT in the morning and nighttime was high. Assessment of BP control status only by ME average or 24-h average SBP, without considering specific time-windows, might underestimate cardiovascular risk.

Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an all-in-one BP monitoring device: The HI-JAMP study.

Masked hypertension is defined by office blood pressure (BP) in the controlled-BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled range. However, diagnosis of masked hypertension may differ if assessed by different out-of-office BP indices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indices (ABPM-MUHT) and HBPM indices (HBPM-MUHT) using the same all-in-one device (TM2441; A&D Company). The present study enrolled a total of 2322 treated hypertensive patients (males 53.2%, average age 69.2 ± 11.5 years) from the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study, who consecutively underwent office BP monitoring, 24-h ABPM (at 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device. When out-of-office BP control status was assessed only by 24-h average SBP or by the average of morning and evening SBP, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7% among the 445 patients with any type of MUHT. When out-of-office BP indices in each time-window were simultaneously assessed, the diagnostic agreement increased to 40-45.7%. Our results indicated the importance of assessing BPs at various times of day, especially morning hours, for perfect hypertension management. Diagnosis of masked hypertension only by an averaged BP index, without considering specific time-windows, might underestimate cardiovascular risk.

Platelet-derived extracellular vesicles correlate with therapy-induced nocturnal blood pressure changes.

Elevated nocturnal blood pressure (BP) is closely associated with increased risk of cardiovascular (CV) events. Circulating extracellular vesicles (EVs) have been proposed as a potential CV risk biomarker and shown to correlate with BP. The present study aimed to assess whether a reduction in BP is paralleled by respective changes in EVs. Fifty-five hypertensive patients (age: 57.7 ± 14.1 years) were included in the study. EVs and BP were assessed at baseline and at 12 weeks follow-up. Interventions to lower BP included advice on life-style modification only or life-style advice combined with additional pharmacotherapy. EVs were evaluated by flow cytometry (CD41+/Annexin V+) and BP by unobserved automated office BP and ambulatory BP monitoring. Nocturnal systolic BP correlated with EV levels at baseline ( P = 0.01). Multivariable regression models showed that changes in nocturnal systolic BP (adjusted R2 = 0.23; P = 0.01) and diastolic BP (adjusted R2 = 0.18; P = 0.02) were associated with respective changes in EV levels. Furthermore, intervention-induced improvement of systolic dipping was associated with a reduction in EVs in the univariate analysis (adjusted R2 = 0.06; P = 0.03). In contrast, systolic office, 24 h- and daytime-BP did not show significant associations with EVs. Patients whose medication was up-titrated at baseline showed a trend towards lower EV levels at follow-up (absolute change of -1.7 ± 1.3 EV/μl; P = 0.057). Circulating platelet-derived EVs were positively associated with nocturnal BP and therapy-induced changes over a 12-week treatment period. EVs may provide an integrated measure of BP changes achieved with pharmacotherapy.

Long-term follow-up of patients undergoing renal sympathetic denervation

ObjectivesRenal denervation (RDN) proved to significantly lower blood pressure (BP) at 2–6 months in patients on and off antihypertensive drugs. Given a lack of longer-term follow-up data, our aim was to assess the safety and efficacy of RDN up to five years taking into account antihypertensive drug regimen changes over time.MethodsIn the present single-center study, patients underwent RDN for (therapy resistant) hypertension. Patients underwent protocolized yearly follow-up out to five years. Data were collected on 24-h ambulatory BP and office BP monitoring, renal function, antihypertensive drug regimen, and safety events, including non-invasive renal artery imaging at 6/12 months. Efficacy analyses were performed using linear mixed-effects models.ResultsSeventy-two patients with mean age 63.3 ± 9.5 (SD) years (51% female) were included. Median follow-up time was 3.5 years and Clark’s Completeness Index was 72%. Baseline ambulatory daytime BP was 146.1/83.7 ± 17.4/12.2 mmHg under a mean number of 4.9 ± 2.7 defined daily doses (DDD). At five years, ambulatory daytime systolic BP as calculated from the mixed model was 120.8 (95% CI 114.2–127.5) mmHg and diastolic BP was 73.3 (95% CI 69.4–77.3) mmHg, implying a reduction of -20.9/-8.3 mmHg as compared to baseline estimates (p < 0.0001). The number of DDDs remained stable over time (p = 0.87). No procedure-related major adverse events resulting in long-term consequences were observed.ConclusionsThe BP-lowering effect of RDN was safely maintained at least five years post-procedure as reflected by a significant decrease in ambulatory daytime BP in the absence of escalating antihypertensive drug therapy over time.Graphical abstract

Prevalence and Related Factors of White Coat Hypertension and Masked Hypertension in Shunde District, Southern China.

Background: White coat hypertension (WCH) and masked hypertension (MH) can increase the risk of target organ damage. Home blood pressure monitoring is an important method for detecting WCH and MH. However, the prevalence and related factors of WCH and MH in China have been rarely reported. Objective: To explore the prevalence and related factors associated with white coat hypertension (WCH) and masked hypertension (MH) in Shunde District, Southern China. Methods: This study recruited subjects from the Physical Examination Center in Shunde Hospital, Southern Medical University. Office blood pressure and home blood pressure values were collected using the home blood pressure monitor with telemedicine device and office blood pressure monitor, and the prevalence of WCH and MH was calculated by the values. Multivariate logistic regression was used to explore the related factors for WCH and MH. Results: Four-hundred and sixty-one participants (61% male), with an average age of 49 years, were included. The prevalence of WCH and MH was 5.1 and 15.2%, respectively. Multivariate logistic regression analysis showed that smoking (OR = 4.71, 95% CI = 1.05–21.15) and family history of coronary heart disease (OR = 4.51, 95% CI = 1.08–18.93) were associated with higher odds of WCH. The associated factors for higher odds of MH were smoking (OR = 2.83, 95% CI = 1.11–7.23), family history of hypertension (OR = 2.17, 95% CI = 1.11–4.26) and family history of coronary heart disease (OR = 2.82, 95% CI = 1.07–7.45). Conclusion: WCH and MH are highly prevalent in the Physical Examination Center in Shunde Hospital, Southern Medical University. We found smoking and family history of coronary heart disease were related factors for WCH, and smoking, family history of hypertension and coronary heart disease were associated with the odds of MH. Home blood pressure monitoring with a telemedicine device should be recommended to identity abnormal BP phenotype.

HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS BASED ON COMBINED OR ISOLATED ELEVATION OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS AND ASSOCIATION WITH ORGAN DAMAGE

Objective: To assess the prevalence of white-coat (WCH) and masked (MH) hypertension detected by only ambulatory or only home blood pressure (BP) monitoring (isolated), or both (dual), and their association with preclinical target organ damage (TOD). Design and method: Young individuals referred for elevated BP and healthy volunteers aged 6–25 years were evaluated with office (2–3 visits; triplicate measurements), home (7 days, duplicate morning and evening measurements) and 24-hour ambulatory BP monitoring. TOD assessment included echocardiographic left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and pulse wave velocity (PWV; Complior). Normotension (NT) was defined as normal office, home and ambulatory BP and sustained hypertension (SH) as all measurements being elevated. WCH and MH phenotypes were identified based on isolated or combined (dual) home and ambulatory BP values. Results: Analysis included 320 individuals (mean age 13.8 ± 3.8 years, 66.6% males, 32.2% children, 55.9% adolescents, 11.9% young adults, BMI 24.1 ± 4.8 kg/m2), of whom 276 had LVMI, 212 IMT and 168 PWV assessment. 182 (56.9%) participants had NT and 39 (12.2%) SH. Among 54 (16.9%) participants with WCH, 35 had dual WCH (64.8%) and 19 (35.2%) isolated ambulatory or home WCH. Among 45 (14.1%) with MH, 17 had dual MH (37.8%) and 28 isolated ambulatory or home MH (62.2%). Participants with dual and isolated intermediate phenotypes didn’t differ according to age, sex and BMI. Individuals with SH had higher LVMI, IMT and PWV than NT (all P &lt; 0.05; Figure). Intermediate phenotypes based on selective or combined elevation of out-of-office BP presented intermediate values of indices of TOD between NT and SH. Isolated ambulatory or home WCH was associated with higher LVMI values than NT (P &lt; 0.05), whereas dual MH was associated with higher IMT than NT (all P &lt; 0.05). Conclusions: These findings suggest that in young individuals intermediate hypertension phenotypes with selective (isolated WCH) or combined elevation of BP (dual MH) in out-of-office measurement methods appear to carry an increased risk of preclinical TOD compared with NT.