Office Blood Pressure Values Research Articles

Antecedent rest may not be necessary for automated office blood pressure at lower treatment targets.

In SPRINT (Systolic Blood Pressure Intervention Trial), use of the Omron 907XL blood pressure (BP) monitor set at 5minutes of antecedent rest to record BP produced an automated office BP value 7/6mmHg lower than awake ambulatory BP at 27months. The authors studied the impact on automated office BP of setting the Omron 907XL to 0minutes instead of 5minutes of rest in patients with readings in the lower normal BP range, similar to on-treatment BP in the SPRINT intensive therapy group. Patients (n=100) in cardiac rehabilitation were randomized to three BP readings at 1-minute intervals using an Omron 907XL BP device set for 5 or 0minutes of antecedent rest. Mean (±standard deviation) automated office BP (mmHg) after 5minutes of rest (120.2±14.6/66.9±8.6 mm Hg) was lower (P<.001/P<.01) than without rest (124.2±16.4/67.9±9.1 mm Hg). When target BP is in the lower normal range, automated office BP recorded without antecedent rest using an Omron 907XL device should be higher and closer to the awake ambulatory BP, compared with readings taken after 5minutes of rest.

THE EFFICACY OF FIXED TRIPLE COMBINATION THERAPY IN ROUTINE CLINICAL PRACTICE

Objective: Treatment of arterial hypertension reduces cardiovascular mortality and morbidity. Currently, the majority of patients during the treatment does not reach the target blood pressure (BP). One common cause of reaching the target pressure is poor adherence to treatment, which can improve the use of fixed combination therapy. The aim of our work is to analyze the effect on office blood pressure and influence of the number of antihypertensive medications deployment of fixed triple combination therapy (perindopril/indapamide/amlodipine) Design and method: We enrolled 194 patients (122 men, average age 63.9 years). All patients underwent a clinical examination and office blood pressure measurements. It was subsequently modified antihypertensive therapy according to current guidelines ESH/ESC using a fixed combination of perindopril/indapamide/amlodipine. The effect of changes in therapy was evaluate the next clinical control, with an average interval of 15 weeks. Results: Mean baseline office BP values were 168.9 ± 22.1/87.9 ± 12.6 mmHg. Patients received treatment prior to the change was averaged 3.9 ± 1.4 antihypertensive drugs, which represented 3.3 ± 2.0 daily tablet antihypertensive drugs. After adjusting treatment insignificantly increased the number of daily used antihypertensive agent by 0.2 ± 1.0 (p = 0.099) and significantly reduced the number of antihypertensive tablets per day 1.2 ± 1.4 (p < 0.001). Systolic blood pressure after changing average decreased by 23.6 ± 3.7 mmHg (p < 0.001) and diastolic blood pressure by 9.7 ± 2.3 mmHg (p < 0.001). The average office blood pressure achieved after treatment therapies were 132.7/83.0 mmHg. Conclusions: The use of fixed triple combination therapy of arterial hypertension significantly reduced systolic and diastolic office blood pressure. At the same time there is a significant decrease in the number of antihypertensive tablets per day, which probably contributes to better adherence to treatment.

THE PATHOGENESIS OF HYPERTENSIVE HEART IN EXTREME NORTH CONDITIONS

Objective: To study the relationship between the autonomic nervous system dysfunction (ANSD) with circadian BP disorders and structural changes of the heart in patients with AH in Far North conditions. Design and method: 373 patients engaged in monthly round-trip sojourns to the Arctic with arterial hypertension (AH) of 1–2 stages (Gr.1) and 144 inhabitants of moderate climate zone with AH of 1–2 stages (Gr.2) were examined. The groups were matched for age (p = 0.4450), AH experience (p = 0.7333), office SBP (p = 0.3222);DBP (p = 0.0640). All patients underwent ABPM, echocardiography, 24-hour heart rate variability and vegetative status using the questionnaire offered by A.M.Vayne. Results: ANSD was detected significantly more often in Gr.1 compared to Gr.2 according to the survey (p = 0.0279) and according to the physical examination (p = 0.0001). Heart rate (HR) variability (SDNN and SDNN5 indices) in Gr.1 was significantly lower than in the Gr.2 (p = 0.0266) with significantly low circadian index (CI). Higher 24-hour DBP was detected in Gr.1 due to high night-time DBP and day/night BP variability (p < 0.00001). 24 h HR, daytime HR and night-time HR in Gr.1 were significantly higher than in Gr.2. In Gr.1 compared to Gr.2 diurnal SBP and DBP were significant lower as well as CI (p < 0.0001). With equal office BP values in both groups, LVM and LVMI were higher in Gr.1 as compared with Gr.2 (LVM: 281.5 ± 90.4 g., LVMI 130.3 ± 26.2 g. vs 247.5 ± 76.6, p = 0.0002 and 128.8 ± 36.4, p = 0.0024). The most prevalent type of LV structural changes in Gr.1 was concentric LV hypertrophy (p = 0.0014). Higher LVM and LVMI values were due to thicker interventricular septum (p < 0.0001) and LV posterior wall (p < 0.0001) as well as large left atrium (p = 0.0088). Conclusions: Thus, in Arctic monthly round-trip sojourns conditions the influence of exogenous factors can cause in autonomic and neurohumoral BP regulation mechanisms the circadian-dependent changes that modulate the circadian rhythm of BP and structural changes in the heart. As a result, metabolic disorders and hemodynamic alterations towards increasing BP with severe LV hypertrophy occur.

Arterial hypertension after age 65: from epidemiology and pathophysiology to therapy Do we know where we stand?

Arterial hypertension is a prevalent disease with great harming potential. After the age of 55 years the remaining lifetime risk of hypertension amounts to 90%. Despite the constant advances some important issues such as the cut-off blood pressure for the initiation of antihypertensive therapy or the therapeutic goal are debated. In this review, we present - based on the available literature - the current concepts concerning the pathophysiology, epi-demiology and antihypertensive therapy in patients aged 65 years or older. The pathophysiology of hypertension in older patients in principle rests on stiffening of large conduit arteries, which leads to greater systolic and lower diastolic blood pressure. This in most older patients results in isolated systolic hypertension. Additionally most of these patients have low-renin hypertension. Data from large-scale clinical trials indicate that therapy of such individuals with thiazide-like diuretics and long-acting dihydropiridine calcium channel blockers as first-line medications reduces risk of complications. Based on results of recently published trials, meta-analyses, and prospective observations, the optimal on-treatment blood pressure values for most older hypertensive patients should be set within the 130-139 mmHg range. At present, lower values of standard office blood pressure in this group of patients have not been shown to be associ-ated with additional benefits, and may be associated with a greater risk of adverse events. In conclusion, we recommend that for most patients aged 65 years or more, standard office systolic blood pressure should be cautiously reduced to within 140 and 130 mmHg, preferably with a thiazide-like diuretic, long acting dihydropiridine calcium channel blocker or their combination.

Abstract P032: Feasibility, safety and efficacy of a modified Dietary Approaches to Stop Hypertension diet for Japanese population

Introduction: The Dietary Approaches to Stop Hypertension (DASH) eating pattern is widely used for lowering blood pressure in the United States. Food preference and intake volume are quite different among American and Japanese diet; therefore, it is necessary to develop a modified version of DASH dietary pattern for Japanese people (JDASH). Hypothesis: The JDASH is feasible, safe and effective among Japanese people. Methods: This crossover pilot study recruited Japanese men and women aged 30 years and over. Participants were randomized to a three week JDASH diet followed by a three week control diet, or the reverse sequence. Intervention periods were separated by two weeks’ washout in which participants returned to their usual diet. The JDASH dietary pattern consisted of higher potassium, magnesium, calcium, dietary fiber, and n-3 fatty acid and lower sodium than Japanese typical diet. The nutrient balance of the control diet was average Japanese diet based on the National Health and Nutrition Survey in Japan. Primary outcome of this trial was a change in 24 hour urine sodium-to-potassium (Na/K) ratios and secondary outcomes were changes in home and office blood pressure values, lipoprotein profiles and body mass index. These outcomes were from 24 hour urine and blood specimens taken measured before and on the last day of each experimental period. The impact on these measurements was calculated with generalized estimating equation model in consideration of the sequences of intervention. Results: The JDASH diet was well tolerated and with no dropouts. No participant reported any adverse effect regarding this intervention diet and no adverse effects were also observed in biological measures. There were no differences in biological measurements between two diets before intervention. A significant difference in 24 hour urine Na/K ratio was observed (-4.33 mol/mol, p&lt;0.001) between the JDASH diet and the control diet. The differences of systolic blood pressure were - 2.1 mmHg (p=0.396) at the office and -0.1 mmHg (p=0.956) at home, respectively. Significant differences in body mass index and low density lipoprotein were -0.4 kg/m 2 (p=0.002) and -11.0 mg/dl (p=0.038), respectively. Conclusion: Developed modified DASH dietary pattern for Japanese were significantly decrease 24 hour urine Na/K ratio. In conclusion, the results of this pilot study showed the feasibility, safety and efficacy.

Blood pressure in children with attention deficit/hyperactivity disorder.

Children with attention deficit/hyperactivity disorder (ADHD) are frequently treated with psycho-stimulant agents causing a modest but significant increase in blood pressure and heart rate. The objective of this study was to define blood pressure characteristics in children with ADHD treated with a variety of medications in a community setup. Children registered at a large paediatric clinic in Calgary, AB with documented histories of ADHD were randomly contacted. Consenting participants had standardized office BP measurements, ambulatory blood pressure monitoring (ABPM) studies and were asked to complete the sleep disturbance scale for children (SDSC) questionnaire. Findings were compared with data from the Canadian Health Measures Survey (CMHS). Fifty-five children (47 males) aged 7 to 17 years (average 11.6 ± 2.5 years) with an average BMI z-score of -0.37 ± 1.22 completed the study. All children were medicated, the majority (82%), with various types of stimulant agents. Elevated office BP values were more prevalent than in the CMHS; >90th percentile in 5 (9.1%) and >95th percentile in 3 (5.5%). ABPM confirmed 'white coat hypertension' in 3 (5.5%), masked hypertension in 2 (3.6%) and nondipping in 28 (51%). The SDSC score suggested that 43 (78%) children had disturbed sleep. Logistic regression modelling indicated that nondipping correlated with disturbed sleep. The 'white coat' phenomenon may be responsible for increased prevalence of elevated rest/office BP values in children with ADHD. Prevalent sleep 'non-dipping' in this population is associated with sleep disturbances but clinical significance of this finding requires further investigation.

Clinical Implications

HomeHypertensionVol. 71, No. 2Clinical Implications Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBClinical Implications Originally published1 Feb 2018https://doi.org/10.1161/HYPERTENSIONAHA.117.10771Hypertension. 2018;71:217Metabolic Predictors of Vascular Change (p 237)Download figureDownload PowerPointAortic stiffness increases with age and contributes to the pathogenesis of hypertension and cardiovascular disease. In previous cross-sectional studies, metabolic traits were associated with aortic stiffness and mean arterial pressure. We examined whether metabolic traits at baseline and their changes over time were associated with changes in vascular function longitudinally. Vascular and metabolic traits were examined in 5779 middle-aged participants attending sequential examinations of the Framingham Heart Study cohorts (mean follow-up, 5.9±0.6 years). Multivariable regression was used to relate changes in vascular measures to changes in body mass index, serum lipids, and blood glucose. Aortic stiffness measures and pressure pulsatility increased, whereas mean arterial pressure decreased, suggesting that factors other than distending pressure may have contributed to the increase in aortic stiffness. Interindividual variation in the longitudinal changes of arterial stiffness (carotid-femoral pulse wave velocity) and mean arterial pressure were explained more by changes in metabolic traits than by baseline metabolic trait levels, consistent with the concept that modification of metabolic factors may mitigate arterial stiffness over time.Unattended Blood Pressure Measurement (p 243)Download figureDownload PowerPointDo you remember your reaction when looking at your angry math teacher? Or your reaction meeting the most beautiful girl in class on the schoolyard? In both cases, your blood pressure (BP) probably increased. The person that measures someone’s BP—either frightening or attractive—affects BP as well. The technique of unattended BP measurement is intended to minimize this alert reaction. Although the protocol did not really call for it, several study centers in the SPRINT study (Systolic Blood Pressure Intervention Trial) measured BP in an unattended manner, leading to a controversial discussion on the generalizability of the trial’s findings. The discussion was heated by an article from Filipovský et al reporting a 16 mm Hg difference in measurement techniques in a hypertension center. It is noteworthy that there is convincing evidence from the 80s that BP substantially decreases from the first visit of a new doctor to the following ones. So, what about the disparity of unattended versus attended BP in a familiar medical environment? Our study shows that the difference between measurements is low in a general practitioner setting. These findings make it improbable that the BP values in SPRINT substantially underestimate office BP values in primary care. It is currently being discussed whether unattended BP measurement should serve as the new gold standard for the assessment of office BP. The differences of the present data and those of Filipovský et al suggest that it may indeed be wise to implement this approach in secondary or tertiary care institutions, whereas it is dispensible in a general practitioner setting.sFlt-1/PlGF Ratio in Prediction of Preeclampsia (p 306)Download figureDownload PowerPointA substantial body of evidence suggests that angiogenic factors (sFlt-1 [soluble FMS-like tyrosine kinase-1] and PlGF [placenta growth factor]) could be useful biomarkers for prediction, diagnosis, and prognosis of preeclampsia from 24 to 37 weeks gestation. In this group, the sFlt-1/PlGF ratio has a very high negative predictive value for ruling out preeclampsia and its positive predictive value, whereas lower than the negative predictive value, outperforms current clinical tools. We conducted a meta-analysis of studies using sFlt-1/PlGF ratio to predict development of preeclampsia. The pooled sensitivity was 80% (95% confidence interval [CI], 0.68–0.88); pooled specificity 92% (95% CI, 0.87–0.96); and area under the curve 0.94 (95% CI, 0.91–0.95). With positive and negative likelihood ratios of 10.5 (95% CI, 6.2–18.0) and 0.22 (95% CI, 0.13–0.35), respectively, the probability of developing preeclampsia increased to 78% with a positive test compared with 7% with a negative test. Importantly, all included studies showed a high negative predictive value (10/15 studies reporting negative predictive value >98.5%). These results have important clinical implications. A low sFlt-1/PlGF ratio is a strong negative predictor of disease <37 weeks, allowing safe discharge or decreased surveillance. Concomitantly, a high sFlt-1/PlGF ratio could help prioritize patient care (transfer to tertiary centers or increased surveillance). The use of angiogenic factors for ruling out preeclampsia is used throughout Europe and was recently approved for pregnancies <35 weeks in the United Kingdom. The effective segregation of patients in a disease with an unpredictable course, which has substantial maternal and fetal morbidity and mortality, could have important clinical benefits. Previous Back to top Next FiguresReferencesRelatedDetails February 2018Vol 71, Issue 2 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.117.10771 Originally publishedFebruary 1, 2018 PDF download Advertisement

Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative.

Observational data have described the association of blood pressure (BP) with mortality as 'J-shaped', meaning that mortality rates increase below a certain BP threshold. We aimed to analyse the associations between BP and prognosis in a population of acute myocardial infarction (MI) patients with heart failure (HF) and/or systolic dysfunction. The datasets included in this pooling initiative are derived from four trials: CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT. A total of 28 771 patients were included in this analysis. Arithmetic means of all office BP values measured throughout follow-up were used. The primary outcome was cardiovascular death. The mean age was 65 ± 11.5 years and 30% were female. Patients in the lower systolic BP (SBP) quintiles had higher rates of cardiovascular death (reference: SBP 121-128 mmHg) [adjusted hazard ratio (HR) 2.49, 95% confidence interval (CI) 2.26-2.74 for SBP ≤112 mmHg, and HR 1.29, 95% CI 1.16-1.43 for SBP 113-120 mmHg]. The findings for HF hospitalization and MI were similar. However, stroke rates were higher in patients within the highest SBP quintile (reference: SBP 121-128 mmHg) (HR 1.38, 95% CI 1.11-1.72). Patients who died had a much shorter follow-up (0.7 vs. 2.1 years), less BP measurements (4.6 vs. 9.8) and lower mean BP (-8 mmHg in the last SBP measurement compared with patients who remained alive during the follow-up), suggesting that the associations of low BP and increased cardiovascular death represent a reverse causality phenomenon. Systolic BP values <125 mmHg were associated with increased cardiovascular death, but these findings likely represent a reverse causality phenomenon.

Implementing ABPM into Clinical Practice.

To review the data supporting the use of ambulatory blood pressure monitoring (ABPM), and to provide practical guidance for practitioners who are establishing an ambulatory monitoring service. ABPM results more accurately reflect the risk of cardiovascular events than do office measurements of blood pressure. Moreover, many patients with high blood pressure in the office have normal blood pressure on ABPM-a pattern known as white coat hypertension-and have a prognosis similar to individuals who are normotensive in both settings. For these reasons, ABPM is recommended by the US Preventive Services Task Force to confirm the diagnosis of hypertension in patients with high office blood pressure before medical therapy is initiated. Similarly, the 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline advocates the use of out-of-office blood pressure measurements to confirm hypertension and evaluate the efficacy of blood pressure-lowering medications. In addition to white coat hypertension, blood pressure phenotypes that are associated with increased cardiovascular risk and that can be recognized by ABPM include masked hypertension-characterized by normal office blood pressure but high values on ABPM-and high nocturnal blood pressure. In this review, best practices for starting a clinical ABPM service, performing an ABPM monitoring session, and interpreting and reporting ABPM data are described. ABPM is a valuable adjunct to careful office blood pressure measurement in diagnosing hypertension and in guiding antihypertensive therapy. Following recommended best practices can facilitate implementation of ABPM into clinical practice.

The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension

Intermittent fasting is a phenomenon which can be observed in most humans. The effect of intermittent fasting on blood pressure variability (BPV) has not previously been investigated. The purpose of this study was to assess the effect of fasting on blood pressure (BP) (with office, home, central, and ambulatory blood pressure monitoring [ABPM]) and on BPV. Sixty individuals were included in the study. Office, home, ABPM, and central BP measurements were performed before and during intermittent fasting. Standard deviation and coefficient variation were used for office and home BPV measurement, while the smoothness index was used to calculate ABPM variability. Patients’ BP and BPV values before and during intermittent fasting were then compared. Intermittent fasting resulted in a significant decrease in office BP values and ABPM measurements but caused no significant change in home and central BP measurements. Twenty-four hour urinary sodium excretion decreased. Smoothness values obtained from ABPM measurements were low; in other words, BPV was greater. BPV was higher in patients who woke up to eat before sunrise, but BPV was low in patients with high body mass index. Intermittent fasting produced a significant decrease in BP values in terms of office and ABPM measurements in this study but caused no significant change in central BP and home measurements. We also identified an increase in BPV during intermittent fasting, particularly in patients who rose before sunrise.

The relation between blood pressure components and left atrial volume in the context of left ventricular mass index

Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP).The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume.The mean age of 205 patients (136 females—66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P < .001) and ratio of early diastolic mitral peak flow velocity to early diastolic mitral annulus mean velocity in tissue Doppler imaging (E/e′) (r = 0.24, P = .04).In the group of LVMI below the median, LAVI correlated with pulsatile and steady BP components. LAVI was independently predicted by mean arterial pressure (MAP) obtained from both ambulatory (MAP24h, β= 0.15; P = .045) and office measurements (MAPoffice, β = 0.35; P = .004), but not by pulse pressure.LV mass and function are the main determinants of LAVI. However, in persons with lower LV mass, LAVI depends on the steady component of blood pressure, but not pulsatile one. Increased LAVI reflects early changes in response to systemic blood pressure elevation.

PP.29.27] EXAGGERATED BLOOD PRESSURE VARIABILITY IN BOTH OFFICE AND AMBULATORY BLOOD PRESSURE MONITORING ARE ASSOCIATED WITH COGNITIVE DYSFUNCTION IN EXTREMELY ELDERLY PATIENTS

Objective: The objective of this study is to assess the association between cognitive dysfunction and blood pressure (BP) variability in extremely elderly patients, over 80 years. Design and method: This cross-sectional study were performed on 520 extremely very elderly outpatients (mean age: 83.2 ± 3.2 years, 44.0% male). These patients had normal activities of daily living. We evaluated cognitive function, office BP values during 1 year and BP values measured by 24-hour ambulatory BP monitoring. Cognitive function was evaluated by a visual working memory test consisted of three figures. The number of figures recalled was counted as the test score. We divided patients into two groups, 0 or 1 score as group 1, and 2 or 3 score as group 2. We used standard deviation (SD), coefficient of variation (CV), weighted SD, average real variability (ARV) and the maximum and minimum BP difference (MMD) to assess the BP variability. Results: A total of 70 patients (mean age: 84.0 ± 3.6 years, 35.7% male) constituted group 1, while the remaining 450 patients (mean age: 83.0 ± 3.1 years, 45.3% male) constituted group 2. There were no significant differences in office and 24-hour ambulatory systolic/diastolic BP levels between two groups. However, visit-to-visit systolic BP variability and all 24-hour ambulatory systolic/diastolic BP variability parameters in group 1 were significantly higher than those in group 2 even after adjusting for age (Table 1). Conclusions: Exaggerated visit-to-visit BP variability and 24-hour ambulatory BP variability were related to cognitive dysfunction in extremely elderly patients.

PP.18.11] INFLUENCE OF CPAP THERAPY ON ENDOTHELIAL FUNCTION IN PATIENTS WITH TYPE 2 DIABETES ACCORDING TO FLOW-MEDIATED VASODILATION

Objective: to assess the dynamics of parameters of endothelial function in patients with type 2 diabetes, suffering from medium to severe obstructive sleep apnea (OSA). Design and method: 42 subjects with diabetes and moderate to severe OSA were examined. During 12 weeks 22 patients (group 1 CPAP) in addition to antihypertensive treatment (AHT) received CPAP-therapy with «SOMNObalance» (Weinmann, Germany). Control group (C) included 20 patients without additional treatment by CPAP. The subjects were matched by age, sex, height, office blood pressure values. All enrolled patients had arterial hypertension 1–2 degrees. Assessment of respiratory disorders during sleep was carried out using cardio-respiratory monitoring device SOMNOcheck2 (Weinmann, Germany). Endothelial function was evaluated by the ultrasonic device MyLab 90 (Esaote, Italy). Index of reactivity (IR), flow-mediated dilation (FMD), the diameter of the common carotid artery (DCCA) and the intima-media thickness (IMT) on the right and left were assessed. Results: Initially there were no significant differences between groups for all parameters of comparison, reflecting endothelial function. In CPAP group baseline values of IR were1,3 ± 0,3, FMD - 8,4 ± 4,9%, DCCA - 7 ± 1,1 mm, IMT - 1,1 ± 0,2 mm. During the CPAP-therapy IR increased to 1,5 ± 0,3 (15,7%; p < 0,05), FMD to 12,2 ± 3,0% (45,2%; p < 0,05). DCCA and IMT values after 12 weeks decreased to 6,95 ± 1,1 mm (ns) and 1,0 ± 0,1 mm, respectively (p < 0,05). In patients of control group the IR at baseline was 1,2 (1,1; 1,4), FMD - 7,5 (5; 9,52)%, DCCA- 6,2 (5,45; 6,5) mm, IMT - 1,0 ± 0,1 mm. In the control group FMD increased to 8,9 ± 5,3% (15,5%; p < 0,05). IR values, IMT and DCCA were not significantly changed in control group, and amounted to 1,5 ± 0,4; 5,7 ± 1,0 mm, and 1,0 ± 0,1 m/s, respectively. Conclusions: the application of CPAP in patients with diabetes and apnea syndrome contributes to a significant improvement in endothelial function according to flow-mediated dilation.

LB.03.11] WOULD DDD, CONTRARY TO THE TOTAL NUMBER OF DRUGS, BE THE BEST TOOL TO EVALUATE THE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY?

Objective: This study evaluated the DDD of the prescribed antihypertensive drugs in relation to the number of drugs as well as the blood pressure levels of hypertensive patients during a mean of 5 years follow-up period. Design and method: A retrospective cohort study was carried out to evaluate the medical records of 120 resistant and mild hypertensive patients with a 5-year follow-up in a specialized outpatient clinic (1999–2016). The antihypertensive medication prescribed at the first and the last visit, as well as the pressure parameters were analyzed. STATISTICS: Paired Student t test comparing the continuous variables of the first and last appointment was used. A multiple linear regression model adjusted for age, sex, race and BMI was used to evaluate the association of 1) DDD of antihypertensive drugs and 2) number of antihypertensive drugs prescribed with outpatient pressure variation over the analyzed years. The level of statistical significance was set at 0.05. Results: DDD and the total number of prescribed antihypertensive drugs increased during the follow-up period (4 ± 3 vs. 5 ± 3, p = 0.02, 3 ± 1 vs. 4 ± 1, p < 0.01, respectively). There was a reduction in office blood pressure values (135/79 vs. 140/87 mmHg, p < 0.01) during the analyzed period. Mean 24 hour ambulatory pressure (77 ± 15 vs. 72 ± 15 mmHg, p = 0.03), daytime (80 ± 13 vs. 76 ± 11 mmHg) and nighttime (72 ± 12 vs .69 ± 12 mmHg p < 0.01) also decreased over time. The multiple regression analysis indicated that the DDD of the total number of antihypertensive drugs prescribed was associated with mean ambulatory diastolic BP reduction (β = −1.24; SE = 0.65; p = 0.04). On the other hand, the total number of antihypertensive drugs used was not able to predict this pressure reduction. Conclusions: Although the total number of drugs is indicated as one of the main tools for therapeutic follow-up, our study suggests the use of DDD as an alternative able to predict therapeutic efficacy in hypertensive patients.

Fixed combinations of perindopril and indapamide in hypertensive high-risk patients: antihypertensive efficacy

Objective.The aim of the study was to compare the antihypertensive efficacy of fixed combinations of perindopril and indapamide in patients with arterial hypertension (HTN) and high cardiovascular risk.Design and methods.We included 65 patients with 1–2 degree of HTN who had not taken the studied drugs before: either perindopril arginine / indapamide 10 mg + 2,5 mg, n = 35), or indapamide / perindopril erbumine K 2,5 mg + 8 mg, n = 30). Clinical efficacy of antihypertensive therapy was evaluated at three different time points. We assessed objective clinical status, blood biochemistry, office blood pressure (BP), and parameters of daily monitoring of BP (MBP).Results.Perindopril arginine plus indapamide vs indapamide plus perindopril erbumine K after 4 and after 12 weeks shows higher antihypertensive effect regarding office BP and provides significantly better control of the daily BP profile based on the MBP results. Therefore, MBP is required in HTN high-risk patients who take indapamide / perindopril erbuminе K in order to assess the reduction in nighttime BP, independently of achieving target office BP values.

Central blood pressure and nighttime blood pressure in patients with non-diabetic chronic kidney disease

Introduction. Arterial hypertension is a well-known risk factor of both cardiovascular complications and faster progression of chronic kidney disease (CKD). There is growing evidence that central blood pressure (BP) and nighttime BP may have an advantage in predicting the risk of cardiovascular complications and the progression of CKD in comparison with the traditional office BP measurements. The aim of this study was to evaluate the central BP and nighttime BP in non-diabetic CKD patients with no, or only mild proteinuria i.e. autosomal dominant polycystic kidney disease (ADPKD) or IgA nephropathy (IgAN). Material and methods. Forty patients with CKD stage 3 or 4 were enrolled into the study. In each patient the measurement of peripheral and central BP was conducted, as well as the assessment of pulse wave velocity (PWV) and the 24-hour blood pressure monitoring (ABPM). Results. Despite the lower office and central BP values in patients with IgAN in comparison to patients with ADPKD, both studied groups did not differ in the mean BP in the 24-hour ABPM. In the entire studied group a significant positive correlation was found between the augmentation pressure and age, as well as between the augmentation index - AIx% and age. Moreover, a significant positive correlation between the decrease of nighttime BP and eGFR was observed. Additionally, a significant positive correlation between PWV and age was found. Conclusions. 1. Patients with ADPKD and IgAN, despite the differences in office and central BP do not differ in respect of the mean BP in the 24-hour ABPM. 2. In both groups of patients vascular stiffness increases with age and deteriorating kidney function. 3. Lower decrease of nighttime blood pressure is related to the worse kidney function in patients with non-diabetic CKD.

Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries

BackgroundIn patients who have undergone arterial switch operation (ASO) for d-transposition of the great arteries a gothic aortic arch (GA) morphology has been found and it has been associated with abnormal aortic bio-elastic properties. HypothesisGA is frequent in ASO patients and may have an impact on cardiac mechanics. Our study aims were to assess 1- the occurrence of GA in a large sample of patients after ASO; 2- the association between GA and aortic bio-elastic properties; and 3- the impact of GA on left ventricular (LV) function using speckle tracking echocardiography (STE). MethodsWe studied one hundred and five asymptomatic patients, who have undergone first stage ASO for d-TGA, with normal left ventricular ejection fraction (LVEF ≥53%). ResultsForty-six (44%) patients showed a GA (mean age 11.5±7.2years, 26 males) while fifty-nine (56%) patients (mean age 9.6±6.7years, 37 males) did not present GA. The two groups were comparable for age, sex, BSA, and office blood pressure values. In group GA aortic root was significantly dilated (27.4±7.5mm vs. 21.2±6.9mm, p<0.0001), aortic stiffness index (Group GA=1.8±1.2 vs. 1.4±0.7, p=0.025) was significantly increased, left atrial volume was larger (p=0.0145), global longitudinal strain (Group GA=−18.4±2.5% vs. −20.1±3.3%, p=0.012) and basal LV longitudinal strains (Group GA=−16.9±4.8% vs. −20.4±7.0%, p=0.013) were significantly reduced. ConclusionsAfter ASO the presence of a GA is associated with a significantly dilated aortic root, stiffer aortic wall, larger left atrial volume, and worse LV longitudinal systolic deformations, well known predictors of cardiovascular morbidity and mortality.

A randomised study of the impact of the SGLT2 inhibitor dapagliflozin on microvascular and macrovascular circulation

BackgroundThe sodium–glucose cotransporter 2 inhibitor, dapagliflozin, has been shown to improve diabetic control and reduce blood pressure in patients with type 2 diabetes mellitus. Its effects on micro- and macrovascular structure and function have not yet been reported.MethodsThis was a prospective, single-centre, placebo-controlled, double-blind, randomised crossover phase IIIb study conducted between March 2014 and February 2015. After a 4-week run-in/washout phase, patients (N = 59) received 6 weeks of either dapagliflozin 10 mg or placebo once daily. They then underwent a 1-week washout before crossing over to the other treatment. Changes in retinal capillary flow (RCF) and arteriole remodelling were evaluated using scanning laser Doppler flowmetry, while micro- and macrovascular parameters in the systemic circulation were assessed using pulse wave analysis.ResultsSix weeks of dapagliflozin treatment resulted in improvements in diabetes control, including blood glucose and insulin resistance, and reduced office and 24-h ambulatory blood pressure values. RCF decreased from 324 AU at baseline to 308 AU after treatment with dapagliflozin (p = 0.028), while there was little difference after the placebo (318 AU; p = 0.334). Furthermore, the arteriole remodelling that was seen after the placebo phase was not evident after the dapagliflozin phase. Central systolic and diastolic blood pressure values were significantly lower after 6 weeks of dapagliflozin, by 3.0 and 2.2 mmHg, respectively (p = 0.035 and 0.020, respectively vs. baseline).ConclusionsSix weeks of dapagliflozin treatment resulted in numerous beneficial effects. In addition to achieving superior diabetes control and blood pressure, parameters associated with the early stages of vascular remodelling were also improved.Trial registrationhttp://www.clinicaltrials.gov (NCT02383238)

OP.8B.03] EFFECT OF CPAP THERAPY ON CENTRAL PRESSURE AND RIGIDITY IN PATIENTS WITH TYPE 2 DIABETES

Objective: To evaluate the effect of CPAP therapy on central (aortic) pressure and vascular stiffness in patients with type 2 diabetes mellitus (DM), suffering from moderate to severe obstructive sleep apnea (OSA). Design and method: The study involved 42 people with diabetes combined with hypertension 1–2 degrees and of moderate-to-severe OSA. 22 patients (group 1 CPAP) in addition to antihypertensive treatment (AHT) received a 12-week CPAP-therapy by device «Somnobalance e» (Weinmann, Germany). The 2nd (control - C) group consisted of 20 patients with diabetes who were on drug therapy without additional treatment by CPAP. The subjects were matched by age, sex, height, office blood pressure values. Assessment of respiratory disorders during sleep was carried out using cardiorespiratory monitoring SOMNOcheck2 (Weinmann, Germany). Biochemical parameters were determined by the Olympus AU 400 instrument (Olympus Corporation, Japan). In addition, the values of aortic pressure (SBPao, DBPao) during the night were evaluated by the technology Vasotens (Peter Telegin, Russia). Results: Capillary blood glucose levels in patients in group 1 were 8,8 ± 1,9 mmol/l, HbA1C - 8,1 ± 0,8%; in subjects in group 2 - 8,2 ± 1,6 mmol/l and 0,9 ± 7,9%, respectively (p > 0,05). Fasting glycemia in CPAP group after 12 weeks decreased by 12.5% (p < 0,01), HbA1C - 4% (p < 0,05); in patients of control group, respectively, 4,9% and 1,3% (p > 0,05). According to the daily monitoring in group 1 the initial values of SBPao and BPao were 124,5 (119,5; 135,5) and 78 ± 5,9 mmHg, in group 2 - 123,1 ± 9,7 mmHg, and 78,9 ± 9,2 mmHg (ND). Against the background of the 12-week treatment in CPAP group the values of SBPao decreased by 9,4%, (p < 0,01), DBPao - by 15,3% (p < 0,01). In the control group dynamic of SBPao was 5,1% (p < 0,05), DBPao - 7,3% (p < 0,01). Conclusions: The use of CPAP in patients with type 2 diabetes mellitus combined with hypertension and apnea contributes to a more pronounced decline in the central (aortic) pressure and the effective control of parameters of carbohydrate metabolism.

PS 05-72 CENTRAL PRESSURE AND VASCULAR STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC DISORDERS ACCORDING TO DAILY MONITORING

Objective: To conduct a comparative assessment of central (aortic) pressure and vascular stiffness in patients with diabetes mellitus type 2 (DM) and those with metabolic syndrome (MS) in combination with arterial hypertension (AH) 1–2 degrees. Design and Method: Study included 91 subjects. Group 1 consisted of 46 patients with diabetes, the group 2 included 45 patients with MS. Patients were matched for age, sex, height, BMI, office BP values. Structural and functional properties of the great arteries were measured using the technology Vasotens (“Peter Telegin”, Russia). The mean daily values of the central (aortic) pressure parameters were determined: SBPao, DBPao, PPao; pulse wave velocity in the aorta (PWVao), the propagation time of the reflected wave. Results: at a comparable level of office blood pressure patients with DM and MS differed on parameters of DBPao and PPao according to daily monitoring. In patients with diabetes DBPao values were significantly lower – 80.9 ± 8.8 mmHg, in the comparison group – 88.5 ± 7.9 mmHg (p < 0.01). PPao in the comparative groups was 46 (41; 53) and 40 (37; 43) mmHg, respectively (p < 0.01). Patients of both groups did not differ on the SBPao level: Group 1–126 (119; 139) mmHg in group 2–129.2 ± 8.9 mmHg (NS). Parameter RWTT in diabetic patients was 128.7 ± 11.0 ms, in patients with MS - 138,5 (132; 149) ms (p < 0.01). Aortic PWV (PWVao) in group 2 was significantly lower (8.2 ± 0.8 m/s) compared with group 1 (9.03 ± 0.9) (p < 0.01). Conclusions: On the parameters of ambulatory monitoring of aortic pressure and vascular stiffness, patients with diabetes mellitus and arterial hypertension were significantly different from those with the metabolic syndrome, which is probably due to the acceleration of atherosclerosis in large arteries on the background of hyperglycemia.