Office Blood Pressure Values Research Articles

Left atrial stiffness index is associated with metabolic syndrome and independently related to urine albumin-creatinine ratio in young subjects with hypertension

Abstract Background and objective Left atrial (LA) functional decline seems to be the earliest sign of hypertension-related heart damage detectable with echocardiography for the moment. Left atrial stiffness index (LASI) is a novel index reflecting both LA function and LA–left ventricular (LV) coupling. Early detection of hypertension-mediated organ damage (HMOD) is critically important in clinical decision making in certain groups of patients, such as young persons with first time diagnosed HTN. We intended to analyze the relations of LASI with office and 24 hours blood pressure levels and HMOD characteristics in subjects with HTN aged of 18 to 45 years. Methods We included 78 young subjects (median of age 23 [21; 25] years, mean BMI 25,9±4,7 kg/m2, median 24 hours systolic blood pressure (SBP) and diastolic blood pressure (DBP) 134,0 [128,8; 143,3] and 79,5 [74,0; 88,0] mm Hg, respectively) with HTN diagnosed with 24-hours ambulatory blood pressure monitoring (ABPM) according to ESH guidelines criteria (2018). Most patients (73%) had masked HTN. We performed routine clinical evaluation, including registration of anthropometric characteristics and blood and urine tests, central pulse wave assessment with applanation tonometry and echocardiography including two-dimensional speckle tracking. LASI was calculated as E/e$'$ to left atrial longitudinal strain during reservoir phase (LASr) ratio. We performed correlation analysis and multiple linear regression analysis to investigate the relationship between LASI, LASr and variables indicating presence of HMOD. Results Correlation analysis did not reveal any significant associations of LASI and LASR with office and ambulatory BP values. Both LASI and LASr were correlated with age, body mass index (BMI), waist circumference (WC) (r=0,312, p<0,05 and (−0,354), p<0,01) and HOMA-IR (r=0,551, p<0,001 and (−0,345), p<0,01). LASI had stronger correlation with albumin-creatinine ratio (ACR) than LASr (r=0,550, p<0,001 vs (−0,288), p<0,05, respectively). Glomerular filtration rate (GFR) was associated with LASI: r=−0,329, p<0,01 but not with LASr. Left ventricular mass index (LVMI) also had a significant correlation with LASI only: r=0,284, p<0,05 as had carotid-femoral pulse wave velocity (cfPWV): r=0,275, p<0,05. We performed multiple linear regression analysis in which LASI remained related to ACR independently of age, sex, BMI, WC, HOMA-IR, GFR and 24 hours SBP and DBP (β=0,306, p<0,05) while LASr lost the association. The link between LASI and other HMOD markers (GFR, cfPWV, LVMI) got insignificant in multiple regression analysis. Conclusion Early left atrial functional impairment is associated with overweight, abdominal obesity and insulin resistance in young never treated patients with HTN, while impact of elevated BP in HTN of low grades seems to be not so important. LASI in contrast with LASr is independently related to albuminuria but not with other HMOD markers Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): RFBRRUDN University program 5-100

Nocturnal hypertension and risk of developing early-onset preeclampsia in high-risk pregnancies.

To test the hypothesis that nocturnal hypertension identifies risk for early-onset preeclampsia/eclampsia (PE), we conducted an historical cohort study of consecutive high-risk pregnancies between 1st January 2016 and 31st March 2020. Office blood pressure (BP) measurements and ambulatory blood pressure monitoring (ABPM) were performed. The cohort was divided into patients without PE or with early- or late-onset PE (<34 and ≥34 weeks of gestation, respectively). The relative risks of office and ABPM hypertension for the development of late- or early-onset PE were estimated with multinomial logistic regression using no PE as a reference category. Four hundred and seventy-seven women (mean age 30 ± 7 years, with 23 ± 7 weeks of gestation at the time of the BP measurements) were analyzed; 113 (23.7%) developed PE, 69 (14.5%) developed late-onset PE, 44 (9.2%) developed early-onset PE. Office and ambulatory BP increased between the groups, and women who developed early-onset PE had significantly higher office and ambulatory BP values than those with late-onset PE or without PE. Hypertension prevalence increased across groups, with the highest values in early-onset PE. Nocturnal hypertension was the most prevalent finding and was highly prevalent in women who developed early-onset PE (88.6%); only 1.6% of women without nocturnal hypertension developed early-onset PE. Additionally, nocturnal hypertension was a stronger predictor for early-onset PE than for late-onset PE (adjusted OR, 5.26 95%CI 1.67-16.60) vs. 2.06, 95%CI 1.26-4.55, respectively). In conclusion, nocturnal hypertension was the most frequent BP abnormality and a significant predictor of early-onset PE in high-risk pregnancies.

ANALYSIS OF FACTORS RELATING TO DAY-TO-DAY HOME BLOOD PRESSURE VARIATION IN HYPERTENSIVE PATIENTS

Objective: In order to prevent cardiovascular events and organ injuries in hypertensive patients, strict blood pressure (BP) control over 24 hours is of primary importance. In addition to the BP level, it has been indicated that the variabilities of blood pressure during a day or between visits also influence the risk of cardiovascular disorders. This study aimed to delineate the factors relating to the variations of office and home BPs throughout a year in hypertensive outpatients under antihypertensive therapy. Design and method: The subjects enrolled in this study were 83 hypertensive out-patients who recorded home blood pressure measurements. Office BP and the home BP records within 7 days before each visit were collected for the analyses calculating the coefficient of variation (CV). In addition to the physical findings such as blood pressure and body mass index, laboratory data of blood and urine samples were collected. Results: The office BP value (131/77mmHg) was comparable to the morning home BP (130/76) and higher than the evening home BP (126/73), however, the CV values were comparable between the office and the morning and evening home BPs. Correlations of BP and CV were stronger between the morning and the evening home BPs than between the office and the home BPs. The CV of systolic office BP was greater in patients with diabetes mellitus than patients without diabetes (7.8 vs 6.1%). In patients with chronic kidney disease, the CVs of diastolic office BP and diastolic evening home BP were greater than patients without chronic kidney disease (8.0 vs 6.2% and 8.1 vs 6.7%, respectively). In addition, The CVs of diastolic morning and evening home BP were positively correlated with serum creatinine and negatively correlated with estimated glomerular filtration rate. Patients with cardiovascular diseases such as stroke and coronary artery disease showed greater CV of diastolic morning home BP than patients without cardiovascular diseases (8.2 vs 6.6%). Conclusions: These results suggest that the home BP exhibits different variability from the office BP and the BP variability is increased in high-risk hypertensive patients with diabetes mellitus, chronic kidney disease and cardiovascular diseases.

CONCORDANCE BETWEEN THE DIAGNOSIS OF HYPERTENSION BY OFFICE BLOOD PRESSURE AND HOME BLOOD PRESSURE MONITORING IN A FAMILY HEALTH CARE UNIT- LAPARC COHORT STUDY

Objective: To evaluate concordance between diagnosis of hypertension by Office Blood Pressure (OBP) and Home Blood Pressure Monitoring (HBPM) in a young adult population. Design and method: A cross-sectional population study enrolled adults between 20 and 50 years registered in a primary healthcare unit in the city of Rio de Janeiro, Brazil. Socio-demographic and anthropometric characteristics were registered at the entrance of the study. Also, the presence of CV risk factors was evaluated. OBP was determined by calculating the mean value of 2 consecutive measurements (Omron-705CP) while the HBPM followed a 7-day protocol with 2 measurements in the morning and 2 in the evening (28 measurements). Measurements of the first day were discarded and the average of the other 6 days was calculated. It was considered normal a Home BP &lt; 135 x 85 mmHg and OBP &lt; 140 x 90 mmHg. Patients were classified into 4 groups: normotension (controlled OBP and HBPM); white coat hypertension (uncontrolled OBP and controlled HBPM); masked hypertension (controlled OBP and uncontrolled HBPM) and sustained hypertension (uncontrolled OBP and HBPM). Results: A total of 462 individuals were evaluated [37.7% males with mean age 37.4 ± 8.8 years]. Sedentary lifestyle (43%), dyslipidemia (38%) and obesity (28%) were the main CV risk factors. By OBP, the prevalence of hypertension was 13.4% while by HBPM was 18.6%. Kappa coefficient demonstrated a low concordance between the two diagnostic methods (kappa = 0.472). After HBPM, 68 individuals (16.9%) changed the diagnosis, being 21 (5.6%) with white coat hypertension and 45 (11.3%) with masked hypertension. The variables that were independently associated with hypertension diagnosed by OBP were male gender (OR 1.83, CI95%, 1.01–3.33, p = 0.04) and increased neck circumference (OR 3.77, CI95%:1.59–8.93, p = 0.003). Hypertension diagnosed by HBPM was associated with obesity (OR 2.18, CI95%, 1.27–3.76, p = 0.005) and increased neck circumference (OR 2.37, CI95%, 1.05–5.33, p = 0.04). Conclusions: Concordance between office BP and HBPM was low in this young adult population. Thus, If the diagnosis was based only in the office BP values, 17.5% of the subjects would have an erroneous diagnosis of hypertension.

ALBUMINURIA IN PATIENTS WITH WHITE COAT EFFECT IS ASSOCIATED WITH OFFICE BLOOD PRESSURE

Abstract Objective: The aim of this study is to investigate whether microalbuminuria observed in subjects with white coat effect (WCE) is a result of higher office blood pressure (BP). Design and method: We analyzed data in untreated and treated subjects assessed by office and ambulatory BP (ABP). Individuals aged &gt; / = 18 years were included. Office BP measurements were taken using a digital oscillometric BP electronic device. ABP was monitored on a routine working day using validated oscillometric arm device. WCE was defined as OBP &gt; / = 140/90 mmHg and 24 h mean ABP &lt; 130/80 mmHg (daytime &lt; 135/85 mmHg and nighttime &lt; 120/70 mmHg). Urine albumin excretion (UAE) was measured in one 24-h urine collection. Results: A total of 151 subjects with WCE and 100 normotensives (mean age 58+/-12 years, 47.8% males) were analyzed. Their characteristics are shown in the Table. Patients with WCE were significantly younger than normotensives (p = 0.035). Subjects with WCE had increased incidence of albuminuria compared to normotensives. Among patients with WCE 7.9% with albuminuria had both higher mean systolic OBP and systolic daytime ABP values compared to those without albuminuria (171+/-24mmHg vs 152+/-13mmHg, p = 0.019 and 127+/-6mmHg vs 123+/-8mmHg, p = 0.038, for the systolic OBP and systolic daytime ABP values, respectively). This association was not present in normotensive individuals. Conclusions: Microalbuminuria observed in subjects with WCE resulted from higher office and ambulatory BP values, underlining that the WCE phenotype is not innocent.

HEMODYNAMIC EVALUATION OF TREATED HYPERTENSIVE PATIENTS WITH IMPEDANCE CARDIOGRAPHY: RESULTS OF IMPEDDANS STUDY

Objective: The prevalence of arterial hypertension (AHT) in Portuguese adult population is higher than 40%. Historically defined by sustained elevation of blood pressure (BP), AHT results from hemodynamic changes characterized by cardiac output, systemic vascular resistance and/or arterial compliance abnormalities, with significant implications for diagnosis, risk stratification and treatment. Impedance cardiography (ICG) is a noninvasive method for hemodynamic profile evaluation. It allows to access risk and optimize therapy. In this study we analyzed the resistant hypertensive patients with controlled blood pressure values in order to evaluate and characterize their hemodynamic profile by ICG. Design and method: Resistant hypertensive patients without heart failure, ischemic heart disease, valvular heart disease or dysrhythmia were prospectively selected. After ICG were classified as: vasoconstrictor (systemic vascular resistance (SVR) &gt; 2500dyn.s.cm-5.m2), hyperdynamic (cardiac index (CI) &gt; 4.2l/min/m2 and/or heart rate (HR) &gt; 80 cycles/min), hypervolemic (thoracic fluid (TFC) &gt; 341/kOhm) or balanced (hemodynamic parameters below the established limit values). All patients underwent transthoracic echocardiography to exclude major changes. In this sub-analysis of patients from the IMPEDDANS study we included only those who, according to international recommendations, had office and outpatient blood pressure values within the therapeutic goals. Results: From 178 initial patients, 52 were included, 57.7% male, with 63 ± 9 years old, under 4 ± 1 antihypertensive agents. The mean hemodynamic values were: systolic blood pressure (BP) 125 ± 12, diastolic BP 75 ± 6, HR 69 ± 11, SVR 2756 ± 527, CI 2.8 ± 0.5, TFC 32 ± 4. According to the hemodynamic profile 63.7% appear to be vasoconstrictors, 13.5% hyperdynamic, 28.7% hypervolemic and 22.9% balanced. Conclusions: These results suggest that, despite polymedicated and with arterial pressure within the recommended values, the majority of patients were not hemodynamically stabilized, confirming that BP is an hemodynamic variable supported by several processes, tendentially redundant, in which inhibition of one element tends to favor the activation of another. ICG is, therefore, an useful method in the evaluation of hypertensive individuals, capable of contributing to adequate therapeutic optimization.

WHICH AMBULATORY BLOOD PRESSURE PARAMETERS ARE RELATED TO COGNITIVE IMPAIRMENT AND DEMENTIA IN HYPERTENSIVE PATIENTS?

Objective: Ambulatory blood pressure monitoring (ABPM) parameters are more accurately linked to target organ damage than office or home blood pressure values. Few studies focus on the relationship between ABPM parameters and cognitive aging. We aimed to investigate the relationship between ABPM parameters and prevalence of cognitive impairment and dementia among hypertensive patients. Design and method: In the present paper, we included 294 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 50–91years (mean age: 68.6 ± 8.8 years; 50.3% female; 49.7% male). After routine clinical assessment all participants had an ABPM recording (on antihypertensive medical treatment), completed the Montreal Cognitive Assessment (MoCA) test used for the detection of cognitive impairment, and the Mini Mental State Examination (MMSE) test for detection of dementia. We divided patients in two groups acording to cognitive status based on these cutoff values: 26 points for MOCA score, respectively 24 points for MMSE score – and compared ABPM parameters of the two groups. Statistical analysis was performed with the IBM SPSS v.20 program. Results: In patients with cognitive impairment (MOCA &lt;26) we found significantly lower mean diastolic (69.9 vs. 72.4 mmHg, p = 0.023), daytime diastolic (72.0 vs. 75.1 mmHg, p = 0.012), nighttime diastolic (64.5 vs. 66.9 mmHg, p = 0.039), and higher pulse pressure values (average pulse pressure 61.5 vs. 55.5 mmHg, p = 0.002, daytime pulse pressure 61.7 vs. 56.6 mmHg, p = 0.003, nighttime pulse pressure (59.8 vs. 55.1 mmHg, p = 0.004). In patients with dementia (MMSE&lt;24) we found significant differences between nighttime systolic values (129.7 vs. 124.5 mmHg, p = 0.04), average pulse pressure (63.5 vs. 58.9 mmHg, p = 0.038), and nighttime pulse pressure (63.5 vs. 57.4 mmHg, p = 0.003), values compared to patients with normal cognitive function. Conclusions: The presence of cognitive impairment was related to lower diastolic values, and higher pulse pressure values, while dementia was associated with higher nighttime systolic values in the studied patient population. Lowering too much diastolic blood pressure leading to higher pulse pressure and insufficient control of systolic blood pressure over night could have deleterious effect on neurocognitive abilities of treated hypertensive patients.

ARTERIAL STIFFNESS IMPROVEMENT IN HYPERTENSIVE TYPE 2 DIABETIC PATIENTS: DISSIMILAR EFFECTS OF CANAGLIFLOZIN AND PERINDOPRIL

Objective: We have shown in hypertensive type 2 diabetic patients (DM) a strong correlation between serum uric acid (SUA) and pulse wave velocity (PWV). Additionally, after 6 months treatment, we found a significant PWV improvement either with perindopril or canagliflozin that, when adjusted for office BP values, the PWV improvement was blunted in the perindopril treated patients while in those receiving canagliflozin a significant effect still remains. Thus, the aim of the present work was to evaluate in normoglycemic diabetic hypertensive patients with normal renal function, the effects and relationships of canagliflozin and perindopril on SUA, 24hs AMBP and carotid femoral PWV. Design and method: For 6 month, 40 hypertensive DM patients, under metformin 2000 mg and amlodipine, received canagliflozin 100–300 mg 10 mg daily (n = 20, 10 females, 59 ± 4y) while other 20 patients (8 females, 62 ± 4y) received perindopril 10 mg on top. Laboratory parameters determined at baseline and after a 6-month treatment were: HbA1C, fasting blood glucose level, glomerular filtration rate, SUA, urine acid uric, 24 h ambulatory blood pressure monitoring (ABPM) and PWV. Results: After 6 months treatment with canagliflozin, a decrease in PWV, (12.29 ± 0.16 to 8.49 ± 0.09m/sec; p &lt; 0.001), HbA1C (8.1 to 7.0%; p &lt; 0.05), SUA (7.87 ± 0.06 to 6.83 ± 0.06 mg/%; p &lt; 0.05), and 24 h ABPM (154 ± 6/96 ± 5 to 141 ± 3/86 ± 4mmHg; p &lt; 0.01) was observed. Similarly, after Perindopril, a decrease in 24hs ABPM (152 ± 7/98 ± 7 to 139 ± 6/84 ± 5mmHg; p &lt; 0.05), PWV (12.53 ± 0.15 to 8.92 ± 0.19m/sec; p &lt; 0.001) and SUA (7.77 ± 0.18 to 7.35 ± 0.11mg%; p &lt; 0.05) was observed. Nevertheless, the SUA reduction induced by canagliflozin (-13.20 ± 0.71%) was greater (p &lt; 0.001) than the induced by Perindopril (-4.98 ± 1.30%). A significant correlation between delta SUA and delta PWV was only observed with canagliflozin (r: 0.82, p &lt; 0.001). Urine uric acid increased from 350 ± 20 to 580 ± 30 mg/24hs (p &lt; 0.05) with canagliflozin, whereas no changes were observed with perindopril. Conclusions: In patients with type 2 DM and hypertension, both canagliflozin and perindopril were able to ameliorate blood pressure and arterial stiffness values. Moreover, canagliflozin improved PWV associated to uric acid reduction. It is suggested that the reduction in SUA and the increase in UA urine excretion seems to have an intrinsic vascular wall effect therefore, it may reduce cardiovascular risk.

Haemodynamic characteristics and blood pressure evolution of hypertension subtypes in young to middle age adults

Abstract Aim The prognostic significance of different hypertension subtypes in young hypertensives, in particular of isolated systolic hypertensives (ISHs) is still debated. The aim of the present study was to investigate clinical and haemodynamic characteristics and blood pressure (BP) evolution of different hypertension subtypes in young stage I hypertensives. Methods We investigated 1206 young subjects from the HARVEST study: 81 normotensives (NTs), 146 ISHs, 281 isolated diastolic hypertensives (IDHs) and 698 systolic-diastolic hypertensives (SDHs) according to office BP values at baseline. Data on baseline haemodynamic and metabolic characteristics, BP and heart rate changes during follow-up (mean 7 years) were collected. ANCOVA analysis was used for all comparisons adjusting for age and sex. Results Males were more frequent among ISHs (90.4%) compared to other categories (70.4, 67.3, 71.5% among NTs, IDHs, SHDs). Moreover, ISHs were younger compared to the others (25.6±6.6 years, p&amp;lt;0.001) and thinner compared to SDHs (24.6±.2.6 vs 25.8±3.6 kg/m2, p=0.028). Heart rate was higher among ISHs (75.7±9.4 bpm) and SDHs (75.8±9.7) compared to other categories (p&amp;lt;0.001). Metabolic characteristics were not significantly different among groups. ISHs were more active in sports (55.5%) and drank less alcohol compared to others (p&amp;lt;0.001, p=0.05 respectively). Systolic white coat effect was higher among ISH (17.6±12.4 mmHg) compared to others (p&amp;lt;0.001), as was cardiac output ISH (6.3±1.2 ml/min) compared to NTs and IDHs (p&amp;lt;0.001); Peripheral resistances were similar in ISHs and NTs and were lower than in IDHs and SDHs (p&amp;lt;0.001). Small and large artery compliance was higher, central systolic BP and augmentation index were lower among NTs and ISHs compared to IDHs and SDHs, even if these differences were not statistically significant. During follow-up systolic BP decreased (−7.6±14.4 mmHg) among ISHs, while it increased among NTs and IDHs (p&amp;lt;0.001). Heart rate decreased in all categories but to a higher extent among ISHs (−3.8±10.9 bpm) and SDHs (−3.4±10.8 bpm) (p=0.002 vs others). Changes in diastolic BP were similar among ISHs and NTs and higher than those observed among IDHs and SDHs (p&amp;lt;0.001). The percent of patients who started pharmacological treatment during follow-up was 70.6% among SDHs, 54.1% among IDHs, 41.1% among ISHs, and 39.5% among NTs (p&amp;lt;0.001). Conclusions ISHs had increased cardiac output and white coat effect and lower peripheral resistances compared to other hypertension subtypes while distensibility parameters did not differ significantly among groups. The percent of patients who developed hypertension needing treatment was lower among ISHs than other hypertensives. This was due to a favourable time course of BP during follow-up. Longer follow-ups are needed to confirm the lower risk profile of ISH of the young Funding Acknowledgement Type of funding source: None

HBPM to refine the diagnosis of hypertension in a Family Health Care Unit in RJ, Brazil - LapARC

Abstract Background The new hypertension (HT) guidelines recommend the use of out-of-office blood pressure (BP) measures for its diagnosis however, in the scope of public health in Brazil, it is still based on office BP (OBP) for logistical and financial reasons. Furthermore, in our country, it is not yet clear whether the use of out-of-office BP would really be more reliable for the diagnosis. Objective To evaluate the importance of using Home Blood Pressure Monitoring (HBPM) in diagnosing HT in a young adult population in primary care in Brazil. Methods A cross-sectional population study enrolled adults between 20 and 50 years in a primary healthcare unit in Rio de Janeiro. Office BP was the mean value of 2 measures, while the HBPM followed a 7-day protocol. It was considered normal a Home BP &amp;lt; 135x85 mmHg and OBP &amp;lt;140x90 mmHg. Patients were classified into 4 phenotypes: normotension (controlled OBP and HBPM); white coat HT (uncontrolled OBP and controlled HBPM); masked HT (controlled OBP and uncontrolled HBPM) and sustained HT (uncontrolled OBP and HBPM). Results A total of 462 individuals were enrolled [38% males; mean age 36±9 years]. Sedentary lifestyle (43%), dyslipidemia (38%) and obesity (28%) were the main CV risk factors. OBP, the prevalence of HT was 13%, HBPM it was 19%, with low concordance between them (kappa=0.472). After HBPM, 17% changed the diagnosis, being 6% of them white-coat HT and 11% masked HT. The variables that were independently associated with HT diagnosed by OBP were male gender (OR 1.83,CI95%:1.01-3.33,p=0.04) and increased neck circumference (OR 3.77,CI95%:1.59-8.93,p=0.003), whilst by HBPM they were obesity (OR 2.18,CI95%:1.27-3.76,p=0.005) and increased neck circumference (OR 2.37,CI95%:1.05-5.33,p=0.04). Conclusions If the diagnosis was based only in the office BP values, 17% of the subjects would've had an erroneous diagnosis of hypertension, suggesting the importance of implementing out-of-office BP measurements in primary care. Key messages Home monitoring blood pressure corrected the diagnosis of hypertension of 17% of patients, allocating them correctly into white-coat HT and masked HT. Increased neck circumference was independently associated with the diagnosis of hypertension by both methods.

Differences between home blood pressure and strictly measured office blood pressure and their determinants in Japanese men.

Conventional office blood pressure (OBP) and home blood pressure (HBP) measurements are often inconsistent. The purpose of this research was (1) to test whether strictly measured OBP values with sufficient rest time before measurement (st-OBP) is comparable to HBP at the population level and (2) to ascertain whether there are particular determinants for the difference between HBP and st-OBP at the individual level. Data from a population-based group of 1056 men aged 40-79 years were analyzed. After a five-min rest, st-OBP was measured twice. HBP was measured after a 2-min rest every morning for seven consecutive days. To determine factors related to ΔSBP (HBP minus st-OBP measurements), multiple linear regression analyses and analyses of covariance were performed. While st-OBP and HBP were comparable (136.5 vs. 137.2 mmHg) at the population level, ΔSBP varied with a standard deviation of 13.5 mmHg. Smoking was associated with a larger ΔSBP regardless of antihypertensive usage, and BMI was associated with a larger ΔSBP in participants using antihypertensive drugs. The adjusted mean ΔSBP in the highest BMI tertile category was 4.6 mmHg in participants taking antihypertensive drugs. st-OBP and HBP measurements were comparable at the population level, although the distribution of ΔSBP was considerably broad. Smokers and obese men taking antihypertensive drugs had higher HBP than st-OBP, indicating that their blood pressure levels are at risk of being underestimated. Therefore, this group would benefit from the addition of HBP measurements.

Automated office blood pressure is in agreement with awake and mean 24-hour ambulatory blood pressure at the lower blood pressure range.

Automated office blood pressure measurement eliminates the white coat effect and is associated with awake ambulatory blood pressure. This study examined whether automated office blood pressure values at lower limits were comparable to those of awake and mean 24-hour ambulatory blood pressure. A total of 552 patients were included in the study, involving 293 (53.1%) men and 259 (46.9%) women, with a mean age 55.0±12.5, of whom 36% were treated for hypertension. Both systolic and diastolic automated office blood pressures exhibited lower values compared to awake ambulatory blood pressure among 254 individuals with systolic automated office blood pressure <130mmHg (119±8mmHg vs 125±11mmHg, P<.0001 and 75±9mmHg vs 79±9mm Hg, P<.0001 for systolic and diastolic BPs, respectively). Furthermore, the comparison of systolic automated office blood pressure to the mean 24-hour ambulatory blood pressure levels also showed lower values (119±8 vs 121±10, P=.007), whereas the diastolic automated office blood pressure measurements were similar to 24-hour ambulatory blood pressure values. Our findings show that when automated office blood pressure readings express values <130/80mmHg in repeated office visits, further investigation should be performed only when masked hypertension is suspected; otherwise, higher automated office blood pressure values could be used for the diagnosis of uncontrolled hypertension, especially in individuals with organ damage.

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: a cross-sectional survey

BackgroundHypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3–5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients.MethodsIn this cross-sectional survey, all doctors registered in the Hong Kong “Primary Care Directory” were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension.ResultsOf the 1738 doctors included from the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while around 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension.ConclusionPrimary Care doctors in Hong Kong prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances.Trial registrationClinicaltrial.gov; ref. no.: NCT03926897.

Blood pressure measurements on a bare arm, over a sleeve or below a rolled-up sleeve: a systematic review and meta-analysis.

Several guidelines call for blood pressure (BP) measurement on a bare arm, which is not always easy. This systematic review aims to synthesize existing evidence concerning the effect of a sleeve on BP measurement. Pubmed and Embase were searched for cross-sectional studies comparing BP values measured on a bare arm, over a sleeve or below a rolled-up sleeve. A meta-analysis was conducted on available data. Thirteen articles were selected from 720 references. All studies reported office BP values, 12 compared measurements on a bare arm and on a sleeve, and four also performed measurements below a rolled-up sleeve, with heterogeneous sleeve types and thicknesses. Most studies had a high risk of bias. Three studies showed a small overestimation of BP measured over a sleeve, but the remaining 10 studies did not find statistically significant differences between measurements. Meta-analysis showed a nonsignificant 0.59 mmHg [95% confidence interval (CI) -0.11 to +1.30; P = 0.10] overestimation of SBP measured over a sleeve when the thinnest sleeve was considered for studies that investigated various thicknesses, a nonsignificant 1.10 mmHg (95% CI -0.21 to +2.40; P = 0.10) overestimation of SBP when the thickest sleeve was considered, and a nonsignificant 2.76 mmHg (95% CI -0.96 to +6.47; P = 0.15) overestimation of SBP measured below a rolled-up sleeve. Measuring BP over a thick sleeve in the office may result in a small overestimation of recorded values but measuring over a thin sleeve does not appear to have a significant impact and, in any case, should be preferred to rolling it up.

Renal denervation in patients with end-stage renal disease and resistant hypertension on long-term haemodialysis.

Recent randomized controlled trials have confirmed the ability of renal denervation to lower blood pressure (BP) in patients, resistant to the BP-lowering effect of multiple antihypertensive drug administration. Evidence is limited, however, in patients with end-stage renal disease (ESRD) and haemodialysis, a condition in which a persistent BP elevation, despite administration of many antihypertensive drugs, is common. Aim of the present study was to test the BP-lowering efficacy of renal denervation in patients with resistant hypertension and ESRD on haemodialysis. BP was measured repeatedly in the office and over the 24 h during 1-year follow-up. The study was conducted from February 2017 to January 2018 at the Policlinico of Monza, Monza, Italy. We included 24 men and women aged at least 20 years (mean 55 ± 16) who had ESRD, were on long-term haemodialysis and exhibited resistant hypertension, that is, elevated office and ambulatory BP values, despite multidrug antihypertensive treatment (n = 5.4 ± 1). We excluded patients with renal artery stenosis, malignancy, and a probable life expectancy less than 1 year. Twelve patients were included in the renal denervation and 12 in the medical treatment (control) group. All patients underwent office and 24 h ambulatory BP measurements at baseline and at 1, 6 and 12 months during the follow-up. In the renal denervation group, baseline office and 24 h mean SBP were 180 ± 112 and 175 ± 11 mmHg, respectively, the corresponding values in the control group being 181 ± 19 and 181 ± 20 mmHg. Most of the other baseline characteristics were also similar or only slightly different between groups, including the mean number of administered antihypertensive drugs at baseline. SBP showed an early and persistent reduction after renal denervation (office SBP: 165 ± 13; 150 ± 7 and 149 ± 11mmHg; 24 h SBP 163 ± 20, 148 ± 10 and 149 ± 17 mmHg after 1, 6 and 12 months, respectively). The BP-lowering effect was almost always present and statistically significant during both the day and night. DBP changes followed a similar pattern whereas heart rate never showed any significant change. No significant periprocedural complication of renal denervation was seen. The mean number of administered drugs did not show any significant BP change during the study. In ESRD patients under long-term haemodialysis in whom BP was markedly elevated despite administration of many antihypertensive drugs, renal denervation lowered both ambulatory and office BP. The reduction persisted over a 1-year follow-up.

The challenge of simplifying blood pressure screening in children and adolescents.

Simplified methods of blood pressure screening could facilitate the clinical routine of the primary care physicians and may increase adherence to pediatric hypertension guidelines. Blood-pressure-to-height ratios are appealing for the simplicity of data needed to evaluate a child's blood pressure status, including only office blood pressure values and height. In several epidemiological studies around the world blood-pressure-to-height ratios showed good predictive power in identifying children with high blood pressure in terms of area under the curve and sensitivity compared to the gold standard National High Blood Pressure Education Program blood pressure tables, but low positive predictive values meaning a high rate of false-positive cases and possibly increased subsequent work load for primary physicians. Finally, blood-pressure-to height ratios seem to be dependent to age, sex, and weight status. In conclusion, blood-pressure-to-height ratios need to be further improved and validated in different pediatric populations before routine clinical use.

Prevalence of isolated nocturnal hypertension according to 2018 European Society of Cardiology and European Society of Hypertension office blood pressure categories.

To estimate the prevalence of isolated nocturnal hypertension (INH) and its relationships with office blood pressure (BP) categories defined by 2018 ESC/ESH guidelines. We conducted a prospective cohort study in consecutive patients referred to perform an ambulatory blood pressure monitoring (ABPM) for diagnosis or therapeutic purposes. Office BP measurements and ABPM were performed in the same visit. The cohort was divided according to office BP in optimal, normal, high-normal and hypertension. The prevalence and adjusted risk for combined daytime and nocturnal hypertension and INH were estimated for each category. We evaluated 1344 individuals, 59.3% women (51 ± 14 years old) and 40.7% men (52 ± 15 years old). 61.5% of the individuals had nocturnal hypertension, 12.9% INH and 48.7% combined daytime and nocturnal hypertension. Prevalence of combined daytime and nocturnal hypertension increased through office BP categories (P < 0.001). Conversely, prevalence of INH was lower in individuals with hypertension than in normotensives (7.4 vs. 17.2%, P < 0.001) and similar between nonhypertensive office BP categories, 16.6, 15 and 19.4% for optimal, normal and high-normal BP, respectively (P < 0.399). In individuals with office BP values less than 140/90 mmHg, the prevalence of masked hypertension phenotypes were 8.6, 17.2 and 30.2% for daytime, INH and combined daytime and nocturnal hypertension, respectively. Adjusted risk for combined daytime and nocturnal hypertension increased significantly through office BP categories; conversely, the risk for INH was similar in all nonhypertensive office BP categories. Nocturnal hypertension was the more prevalent phenotype of masked hypertension and more than one-third of the individuals with nocturnal hypertension had INH. The risk for INH was not related to nonhypertensive office BP categories.

Impact of rest on office blood pressure in patients with hypertension and diabetes at the national obesity centre of Yaounde: a cross-sectional study in Sub-Saharan Africa

Background: Hypertension is the most important cardiovascular risk factor. Enhancing the accuracy of blood pressure (BP) measurement would be helpful for controlling hypertension. The importance of rest before measuring BP in the office is known, but the magnitude of the change in BP with the duration of rest is not known. We aim to evaluate the magnitude of the fall in BP after a prolonged rest in diabetic and hypertensive patients and identify the associated factors. Methods: We carried out a cross-sectional study between January and February 2016 at the National Obesity Centre of Yaounde. Were included all consenting patients with diabetes and hypertension, of both sexes, aged ≥18 years. Sitting BP was measured after resting for 15 minutes (BP15), 30 minutes (BP30), and 45 minutes (BP45). All the BP were measured by the same investigator using an electronic BP device. BP Results: We included 80 (53 women) participants with mean age of 62.4±8.4 years. Mean BP15 was 152.3±26.3 for systolic BP (SBP) and 88.5±15.1 mmHg for diastolic BP (DBP). Compared to BP15, there was a significant reduction of 8.3 (−6.5%) mmHg (P Conclusions: Resting for 45 minutes rather than the recommended 5 to 10 minutes reduce SBP/DBP of 8.3/3.1 mmHg at 30 and 13.5/5.5 mmHg at 45 minutes and may improve the reliability of the office blood pressure values.

High blood pressure in adult patients with sickle cell disease: New insight from an ambulatory blood pressure monitoring pilot study

Sickle cell disease (SCD) is a common genetic disorder leading to severe hematologic and cardiovascular complications. Increasing lifespan of patients is associated with increased prevalence of cardiovascular diseases, especially high blood pressure (BP). However, the clinical and epidemiological characteristics of high BP in these patients remain poorly defined. Notably, the usefulness of 24h-ambulatory blood pressure monitoring (ABPM) has not been assessed in adults, and specific cut-off for BP values are still debated. To analyze office blood pressure and 24-h ABPM values in SCD adult patients. A prospective pilot study with systematic ABPM readings of SCD adult patients from October 2017 to April 2018, conducted in the SCD reference center of Martinique. Consistent Hypertension was defined as office BP ≥ 140/90 mm Hg and 24-h mean BP ≥ 130/80 mm Hg. Masked hypertension was defined as office BP < 140/90 mm Hg and 24-h mean BP ≥ 130/80 mm Hg. High Office BP was defined as SBP between 130–139 mm Hg and DBP between 85-89 mm Hg. White coat hypertension was defined as office BP ≥ 140/90 mm Hg and 24-h mean BP < 130/80 mm Hg. We enrolled twenty-one patients age 50.9 years (± 14.3). Hypertension was diagnosed in 10 patients (47.6%) of which 7 (70% of the hypertensive, 33.3% of the entire group) had consistent hypertension and 3 had masked hypertension (30%, 14.3% respectively). All the patients with masked hypertension had high office BP. One patient (4.8%) was found to have white coat hypertension. In univariate analysis, age, weight and SC genotype were positively associated with presence of hypertension (all P < 0.05). This pilot study shows an unexpected high frequency of hypertension, involving nearly one out of two adult patients with Sickle Cell Disease. It underscores the high frequency of masked hypertension, and underlines the need of ABPM in the clinical management of patients with sickle cell disease.

Prognostic value of office blood pressure measurement in patients with atrial fibrillation on anticoagulation therapy: systematic review and meta-analysis.

In patients with atrial fibrillation (AF), the clinical relevance of office blood pressure (OBP) measurement in terms of predicting morbidity and mortality is questionable, mainly because such measurements in these patients are variable and uncertain. This study reviewed the evidence on the prognostic value of OBP in AF. A systematic PubMed/Embase search was performed for prospective trials in AF patients on oral anticoagulants, reporting OBP measurements or hypertension diagnosis and outcome. A meta-analysis of the predictive ability of OBP values or hypertension diagnosis for stroke/systemic embolism, major haemorrhage and all-cause mortality was performed. The meta-analysis included nine studies (n = 65 637; 126 926 person-years). There was considerable heterogeneity in the OBP methodology, which was not standardized in most studies. Five studies reported baseline OBP or hypertension diagnosis, two average OBP control during follow-up, and two both baseline and follow-up OBP control. Meta-analysis of six studies (n = 61 055; 105 373 person-years) showed elevated vs. low OBP or hypertension vs. normotension to predict stroke and/or systemic embolism [hazard ratio (HR) 1.29; 95% confidence intervals (CI) 1.12, 1.47]. Meta-analysis of three studies (n = 29 233, 51 528 person-years) showed a worse follow-up OBP control to predict higher stroke/systemic embolism risk (HR 1.79, 95% CI 1.38, 2.32). OBP and hypertension diagnosis did not appear to predict major haemorrhagic events (HR 1.10; 95% CI 0.97, 1.25) or all-cause mortality (HR 0.96; 95% CI 0.89, 1.05). In AF patients, OBP and hypertension diagnosis predict stroke or systemic embolism, and follow-up OBP control appears to have even stronger predictive ability.