Office Measurements Research Articles

Predictors of blood pressure control in patients with resistant hypertension after intensive management in two expert centres: the Brussels-Torino experience

Background: Management of resistant hypertension (RHTN) is challenging and often implies the use of complex polypharmacy and interventional therapies. The main objectives of this study were (i) to describe the characteristics of patients with RHTN referred to two expert centres; (ii) to identify predictors of blood pressure (BP) control after intensive management.Methods: We reviewed electronic medical files of all patients referred for RHTN to the Brussels and Torino centres, and extracted detailed clinical data, informations on drug adherence and psychological profile. All patients with confirmed diagnosis of RHTN, according to office and ambulatory BP monitoring (ABPM) measurements, were considered eligible.Results: 313 patients (51% men; age: 56 ± 12 years; office BP 177/98 mmHg; 24-hour ABPM 153/90 mmHg) were included. At the end of follow-up (median: 2 years [1–4]), only 26% of patients (n = 81) reached BP control. When compared to patients remaining resistant, patients eventually controlled had lower pulse pressure (71 vs. 82 mmHg, p < 0.001), less often myocardial infarction (6% vs. 20%, p < 0.005) and showed a higher recourse to cognitive reappraisal as far as emotion regulation is concerned (4.8 ± 1.1 vs. 3.9 ± 1.2, p = 0.009; ERQ Questionnaire). In a multivariate analysis looking for predictors of controlled BP, only the psychological characteristic of cognitive reappraisal (i.e., changing one’s thoughts about a potentially emotion-eliciting event) remained significant (OR 2.06 [1.10; 3.84], p = 0.02).Conclusions: Even in expert centres, only a minority of patients with RHTN reached BP control, irrespective of the centre involved or the interventions applied. Patients who eventually responded to therapy had lower arterial stiffness and less cardiac organ damage. Furthermore, besides vascular damage, the single predictor of BP control was the ability to modify the emotional impact of stressful situations.

PREDICTORS OF EVENTUAL BLOOD PRESSURE CONTROL IN PATIENTS WITH RESISTANT HYPERTENSION AFTER INTENSIVE MANAGEMENT IN TWO EXPERT CENTRES

Objective: Management of resistant hypertension (RHTN) is challenging and often implies the use of complex polypharmacy and interventional therapies. The main objectives of this study were (i) to describe the characteristics of patients with RHTN referred to two expert centres; (ii) to identify distinctive features of patients eventually controlled after intensive management in the expert centre compared with those who remained refractory Design and method: We reviewed electronic medical files of all patients referred for RHTN to the Brussels and Turin centres, and extracted detailed clinical data, data on drug adherence and psychological profile. All patients with confirmed diagnosis of RHTN, according to office and ambulatory BP monitoring (ABPM) measurements, were considered eligible. Results: 313 patients (51% men; age: 56 ± 12 years; office BP 177/98 mmHg; 24-hour ABPM 153/90 mmHg) were included. At the end of the follow-up (median: 2 years [1–4]), only 26% of patients (n = 81) reached BP control. When compared to patients remaining resistant, patients eventually controlled had lower pulse pressure (71 vs. 82 mmHg, p < 0.001), less often myocardial infarction (6% vs. 20%, p < 0.005) and showed a higher recourse to cognitive reappraisal as far as emotion regulation is concerned (4.8 ± 1.1 vs. 3.9 ± 1.2, p = 0.009; ERQ Questionnaire). In a multivariate analysis looking for predictors of controlled BP, only the psychological characteristic of cognitive reappraisal (i.e., changing one's thoughts about a potentially emotion-eliciting event) remained significant (OR 1.95 IC 95% [1.11; 3.4], p = 0.019). Conclusions: Even in expert centres, only a minority of patients with RHTN reached BP control, irrespective of the centre involved or the interventions applied. Patients who eventually responded to therapy had lower arterial stiffness and less cardiac organ damage. Furthermore, in agreement with our previous study [Petit G et al. Blood Pressure 2018;27:358–367], besides vascular damage, the single predictor of BP control was the ability to modify the emotional impact of stressful situations.

Relationship among long-term aircraft noise exposure, blood pressure profile, and arterial stiffness.

To assess the impact of long-term exposure to aircraft noise on blood pressure (BP), prevalence of arterial hypertension, and indices of asymptomatic organ damage. Using acoustic maps, we selected and further compared people living (average 35 years) in areas exposed to high, more than 60 dB (n = 101), and low aircraft noise, less than 55 dB (n = 100). Medical history taking, office BP measurement, ambulatory BP monitoring, and echocardiographic and arterial stiffness measurements were performed. Exposure to aircraft noise did not increase the prevalence of arterial hypertension (50%, both groups) but was associated with higher office (88.3 ± 11.4 vs. 79.8 ± 8.6 mmHg, P < 0.001) and night-time DBP (66.6 ± 9.5 vs. 63.6 ± 7.3 mmHg, P < 0.01). Participants exposed to a high aircraft noise level had a higher carotid-femoral pulse wave velocity (PWV) (10.3 ± 1.8 vs. 9.4 ± 1.4 m/s, P < 0.01) and lower early mitral annulus velocity (e') (8.4 ± 2.9 vs. 9.2 ± 3.4 cm/s, P = 0.047). These differences were independent of age, sex, BMI, education, time spent at home, smoking status, alcohol consumption, and antihypertensive treatment. Higher office and night-time DBP, PWV, and e' values were explicitly observed in exposed normotensive participants. PWV in aircraft noise-exposed normotensive participants was equal to that of two decades older unexposed normotensive participants and was significantly associated with noise annoyance. Long-term aircraft noise exposure is related to higher office and night-time DBP, more advanced arterial stiffness, and unfavourable left ventricle diastolic function changes. Accelerated arterial stiffening was observed in those exposed to aircraft noise, even normotensive participants, to a degree depending on noise annoyance.

THE IMPACT OF LONG-TERM TREATMENT WITH SYMPATHETIC NERVOUS SYSTEM BLOCKERS ON BLOOD PRESSURE VALUES IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: Comparative evaluation of influence of sympathetic nervous system blockers on blood pressure values for the long-term treatment in patients with resistant hypertension. Design and method: 100 patients with essential HTN gr.3 without comorbidities after a 3-week treatment with standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized in two groups, depending on the medication supplemented to the previously administered: group I – selective I1-imidazoline agonist Moxonidine and group II – cardioselective beta-blocker Bisoprolol. All patients were evaluated by ambulatory blood pressure monitoring (ABPM) and office measurement of blood pressure at baseline, three, six and twelve months follow up. Results: At baseline office SBP and DBP values constituted 188,0 ± 3,1 mmHg and 111,2 ± 2,4 mmHg in group I versus 193,3 ± 3,2 mmHg and 114,6 ± 1,7 mmHg in group II, without differences between groups (p > 0,005). Both treatment regimens demonstrated a statistically significant comparable antihypertensive effect already after the third month of continuous medication, the benefit being maintained until the end of the study (Tab. 1). Similar dynamics were noted in the analyses of the mean SBP and DBP on ABPM measurement: statistical authenticity occurs in both groups at 3 months of medication without differences in the comparative analysis between batches. At 12 months of follow-up, Moxonidine exhibits superior antihypertensive effect over Bisoprolol, resulting in statistically significant differences in mean SBP / 24-hour reductions between groups (Tab.2).Conclusions: Medication with SNS blockers Moxonidine and Bisoprolol resulted in a statistically significant reduction in SBP and DBP values assessed in office and by ABPM starting with the 3rd month of medication, the beneficial effect being maintained until the end of the monitoring period, but without achievement of BP goal values. The Moxonidine treatment group demonstrates a superior net potency in ameliorating these parameters. Thus, Moxonidine can be recommended as an effective remedy in the treatment of resistant HTN.

The reaction of the circulatory system to stress and electromagnetic fields emitted by mobile phones - 24-h monitoring of ECG and blood pressure

Experimental studies have shown cardiovascular effects of electromagnetic fields (EMF) emitted by mobile phones (e.g., prolonged QTc interval and abnormal blood pressure [BP] values). Also, stress may have an impact on the cardiovascular function. However, there are practically no data regarding the joint effect of exposure to stress and EMF, with both factors pertaining, e.g., to employees of mobile network operators. Out of 208 subjects who had taken part in survey research, 55 workers agreed to undergo resting ECG, 24-h ECG and ambulatory blood pressure monitoring (ABPM). Their health condition, occupational and life-stress levels and EMF exposure were also assessed. Among the workers using mobile phones for more than 60 min daily, the systolic BP values in office measurement and at night-time in ABPM were significantly higher than among the workers spending less time talking on mobile phones (p = 0.04 and p = 0.036, respectively). The workers with the highest level of occupational stress showed significantly higher systolic 24-h BP (p = 0.007) and at day-time (p = 0.002), both during work (p = 0.010) and after work (p = 0.005), and higher diastolic BP values at day-time (p = 0.028). Cardiovascular response was strongly gender-related: males showed more BP abnormalities while females displayed more impairments in ECG records. The heart rate from 24 h was significantly correlated with the level of occupational stress, after adjusting for gender, life-stress and EMF. The findings obtained thus far have indicated the need to conduct in-depth studies on the impact of stress and EMF emitted by mobile phones on the health effects, in order to clarify the observed gender-related differences in cardiovascular response to the combined exposure to stress and EMF. Med Pr. 2019;70(4):411-24.

Home Blood Pressure Monitoring in Children and Adolescents: Systematic Review of Evidence on Clinical Utility.

For the accurate diagnosis and management of hypertension, out-of-office blood pressure evaluation using ambulatory (ABPM) or home monitoring (HBPM) is currently recommended. In children, there is considerable evidence on the clinical utility of ABPM, whereas the evidence on HBPM is limited. This systematic review presents (i) the benefits of HBPM in children; (ii) the evidence on normal range, diagnostic accuracy, and relationship with preclinical organ damage; and (iii) guidance for devices, monitoring schedule, and interpretation. HBPM is a useful adjunct to the conventional office measurements for the evaluation of children with suspected or treated hypertension. HBPM is feasible in children and has good reproducibility, diagnostic accuracy and acceptability by users, and relatively low cost. Thus, it has greater potential for widespread and long-term use than ABPM, which is more expensive and often not available or not tolerated. Automated monitors that have been clinically validated specifically in children should be used with appropriate cuff size. HBPM for 7days (minimum 3) with duplicate morning and evening measurements (minimum 12 readings) should be performed in children with suspected or treated hypertension before each office visit. Until more data become available, in case of diagnostic disagreement between office blood pressure and HBPM, treatment decisions should be based on ABPM. HBPM is clinically useful in children with hypertension. More research is needed on its clinical application, and more automated devices need to be clinically validated in this population.

Determination of optimal on-treatment diastolic blood pressure range using automated measurements in subjects with cardiovascular disease-Analysis of a SPRINT trial subpopulation.

Automated office blood pressure measurement (AOBPM) is recommended for diagnosing hypertension; however, optimal treatment targets using this method are not established. Discrepancies between automated and office measurements of blood pressure have been described, producing uncertainty regarding the use of AOBPM in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) results improved our understanding of target AOBPM systolic blood pressure (SBP) levels; however, diastolic blood pressure (DBP) targets remain unknown. Therefore, we sought to determine the optimal on-treatment DBP range. The analysis was performed on the participants of the SPRINT trial who had hypertension and prior cardiovascular disease. We analyzed the data of 1470 participants (mean age 70.3±9.3years, 24.1% female) selected from the SPRINT trial database of National Heart, Lung and Blood Institute. The mean achieved SBP and DBP were 127.9±10.7 and 68.3±9.4mmHg, respectively. Most of the participants (57.4%) had a DBP lower than 70mmHg, while only 11.7% had DPB ≥80mmHg. Clinical composite endpoint was defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. There were 159 (10.8%) clinical endpoint events. The participants with on-treatment AOBPM DBP range of 68.6-78.6mmHg showed the lowest hazard risk of a clinical composite endpoint. These results correspond to the office DBP range of 70-80mmHg recommended in ESC guidelines. This is the first attempt to determine the range of optimal DBP values using population-based AOBPM in patients with prior cardiovascular disease.

The concentration of tumor necrosis factor in the blood serum and in the urine and selected early organ damages in patients with primary systemic arterial hypertension.

Arterial hypertension is considered to be an inflammatory condition with low intensity. Therefore, an elevated concentration of inflammatory cytokines can be expected in patients with systemic arterial hypertension, including tumor necrosis factor (TNF).The study included a group of 96 persons aged 18 to 65 years: 76 patients with primary arterial hypertension and 20 healthy individuals (control group). Blood pressure was measured in all individuals using the office and ambulatory blood pressure monitoring (ABPM) measurement, blood was collected for laboratory tests [tumor necrosis factor (TNF), tumor necrosis factor receptor 1 (TNFR1)], and 24-hour urine collection was performed in which albuminuria and TNF concentration were assessed. Moreover, assessment of the intima-media thickness (IMT) in ultrasonography and left ventricular mass index (LVMI) in echocardiography were carried out.Statistically elevated TNF concentration in the blood serum (P = .0001) and in the 24-hour urine collection (P = .0087) was determined in patients with hypertension in comparison with the control group. The TNF and TNFR1 concentration in the serum and TNF in the 24-hour urine in the group of patients with arterial hypertension and organ damages and without such complications did not differ statistically significantly.We observed a positive and statistically significant correlation between TNFR1 concentration in the serum and TNF urine excretion in patients with hypertension (r = 0.369, P < .05)Patients with arterial hypertension are characterized by higher TNF concentrations in blood serum and higher TNF excretion in 24-hour urine than healthy persons.TNF and TNFR1 concentration in blood serum and TNF excretion in 24-hour urine in patients with early organ damages due to arterial hypertension do not differ significantly from those parameters in patients with arterial hypertension without organ complications.There is a positive correlation between TNFR1 concentration in the serum and TNF urine excretion in patients with hypertension.

Cognitive impairment in patients with coronary arteries disease and diastolic dysfunction

Aim of the study – to assess the prevalence of cognitive impairment in patients with coronary heart disease and determine the relationship between the presence of cognitive impairment and left ventricular diastolic dysfunction.Materials and methods. 110 patients with a history of acute myocardial infarction, unstable angina, or revascularization of the coronary arteries were included. Depending on the diastolic function, the patients were divided into three groups: Group I – normal diastolic function; Group II – diastolic dysfunction, impaired relaxation; Group III – pseudonormalization or restriction patterns of diastolic dysfunction. The level of cognitive functions was determined according to the MMSE, MoCA scales, and the frontal assessment battery (FAB) scale.Results. The were no significant differences in age, duration of cardiovascular diseases, the levels of systolic and diastolic blood pressure in office measurement, lipidogram indices between groups. A significant difference between in the left ventricular mass index, diameter and left atrium volume index, end-diastolic and end-systolic volume indexes between groups was noted. The left ventricular ejection fraction was significantly higher in group I compared with groups II and III. Assessment of cognitive function by the MMSE scale showed, that 17.6 % of patients have no cognitive impairment. Mild cognitive impairment was detected in 51.9 % of patients, mild dementia was detected in 25 %, and moderate dementia - in 5.5 % of the examined. On the MoCA scale, cognitive impairment was observed in 74 % of patients. In the first group, the average score on the MMSE scale was 25.45±2.62, in the second - 24.95±2.69, in the III - 22.30±3.17 (p1.3 &lt;0.0001, p2.3 &lt;0.0005). On the MoCA scale, the corresponding values were 15.66±1.95, 15.47±2.30, 14.35±3.45 (p1.3=0.01, p2.3 &lt;0.05). Average scores on the FAB scale did not differ significantly between groups. A significant negative correlation of the average degree between the indicator E/e’ and scores on the MMSE, MoCA and FAB scales was found (r=-0.51, r=-0.42, r=-0.41, respectively).Conclusions. Cognitive impairment occurs in 92.4 % of patients with coronary artery disease. The presence of diastolic dysfunction of pseudonormalization or restriction patterns is associated with significantly worse indicators of cognitive function, while the indicator E/e’, that reflects left ventricle filling pressure, significantly correlates with scores on the scales of cognitive impairment.

Comparison of the association of brachial arterial pressure and parameters of central aortic pressure with left ventricular hypertrophy in the general population of Novosibirsk

Aim.There is evidence that central aortic blood pressure (BP) is more associated with left ventricular myocardial hypertrophy than brachial BP. The purpose of this work is to compare the association of brachial and central aortic BP with electrocardiographic parameters of left ventricular hypertrophy in the general population of Novosibirsk.Material and methods. We examined 327 people: 155 men and 172 women aged 25-44 years from a representative sample from the general population of Novosibirsk. The study program included anthropometry, BP measurement, electrocardiography, biochemical blood analysis. Radial artery applanation tonometry and pulse wave analysis were performed using the SphygmoCor system. Left ventricular hypertrophy was determined by electrocardiographic parameters.Results.In the general population of Novosibirsk, central aortic BP is more associated with left ventricular myocardial hypertrophy than brachial BP. Central pulse pressure, in contrast to brachial BP, is significantly associated with the R+S index (p=0,0085), as well as RI (p=0,0038) and RaVL (p=0,0039) wave amplitude. Central systolic aortic BP, in contrast to brachial systolic BP, is significantly associated with RI (p=0,042) and RaVL (p=0,029) wave amplitudes. Amplification parameters of central aortic BP, regardless of brachial BP, are associated with indices of left ventricular hypertrophy. Pulse pressure amplification in groups with or without left ventricular hypertrophy, standardized for age, gender, height, waist circumference, heart rate, triglyceride levels, high density lipoprotein cholesterol, low density lipoprotein cholesterol, blood glucose, and brachial pulse pressure, was 13,3 mm Hg and 12,5 mm Hg, respectively (p=0,035).Conclusion.The results of this study substantiate the relevance of the practical use of central aortic BP parameters in addition to the office measurement of brachial BP.

High dietary intake of whole milk and full-fat dairy products does not exert hypotensive effects in adults with elevated blood pressure

Regular consumption of low- and nonfat dairy products reduces blood pressure (BP) in adults with elevated BP. Currently, it is unknown if conventional full-fat dairy products exert similar hypotensive effects. We hypothesized that adding full-fat dairy products to the normal routine diet would reduce seated office and ambulatory BP (primary outcome) in adults with elevated BP when compared with a no dairy control. Using a randomized controlled crossover design, 60 adults with elevated systolic BP (systolic/diastolic BP: 120-159/<99 mm Hg) participated in a 4-week high-dairy (4 servings a day of full-fat dairy products + regular diet) and a 4-week no-dairy condition (plant-based food items + regular diet) separated by a 2-week washout period. Data were analyzed based on time, condition, and sex. Seated office systolic BP did not change significantly in either condition. There were no changes in systolic BP in male or female participants across either dietary period. Ambulatory (24-hour) systolic BP did not change significantly in the high-dairy (133 ± 2 vs 131 ± 1 mm Hg) or no-dairy conditions (132 ± 2 vs 131 ± 1 mm Hg). No significant changes were observed for diastolic BP or pulse pressure during condition for office or ambulatory measures. The solitary addition of full-fat dairy products to the normal routine diet does not exert hypotensive effects in adults with elevated BP when compared to the no-dairy control.

Markers of subclinical vascular damages associate with indices of adiposity and blood pressure in obese children.

In this observational study, we aimed at investigating the influence of excessweight and traditional cardiovascular risk factors on vascular structure and function in a cohortof overweight/obese children. Sixty-six obese and 4 overweight children (age 11.5 ± 2.4 years; female n: 30) underwent office and ambulatory BP measurements (ABPM); ultrasound was used to measure carotid intima-media thickness (cIMT), endothelial function by Flow-Mediated Dilation (FMD) and carotid distensibility (cDC); and digital photopletismography was used to measurestiffness index (SIDVP). Carotid IMT directly correlated with 24-h and nighttime-systolic blood pressure (SBP); while cDC hadinverse correlations with BMI, waist circumference and 24-h BP. Unexpectedly, SIDVP resulted inversely related with several indices of excessweight. Most of these correlations remained significant after adjustment for age, sex, BMI, and BP. In a replication set of 40 obese children, SIDVP but not pulse wave velocity (PWV) remained inversely associated with BMI. These data suggest that arterial structure and elasticity are negatively affected by excess weightand BP levels, even in childhood. Surprisingly, SI may not be a reliable marker of vascular stiffness in obese children, because this measurement islikely confounded by other factors, including vasodilation.

When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension.

An increasing attention has been devoted in the last two decades to masked hypertension (MH), a condition characterized by the fact that classification of a normal blood pressure (BP) status by office measurements is not confirmed by home and/or ambulatory BP monitoring (ABPM). MH definition (i.e., normal office BP, but high out-of-office BP) should be restricted to untreated subjects (true MH) whereas masked uncontrolled hypertension (MUCH) reserved to treated patients previously classified as hypertensives, presenting normal office BP and high ABPM or home values. Both MH and MUCH are associated with metabolic alterations, comorbidities, and hypertension-mediated organ damage (HMOD). Furthermore, the risk of cardiovascular events related to these conditions has been shown to be close or greater than that of sustained hypertension. This review discusses available evidence about MH and MUCH by focusing on its prevalence, clinical correlates, association with HMOD, prognostic significance, and their therapeutic implications.

Long-term blood pressure monitoring by office and 24-h ambulatory blood pressure in renal transplant patients: a longitudinal study.

Renal transplant patients have a high prevalence of nocturnal hypertension, and hypertension misclassification by office blood pressure (BP) is quite common in these patients. The potential impact of hypertension misclassification by office BP on hypertension management in this population has never been analysed. We performed a longitudinal study in a cohort of 260 clinically stable renal transplant patients. In all, 785 paired office and 24-h ambulatory blood pressure monitoring (24-hABPM) measurements over a median follow-up of 3.9 years were available in the whole cohort. A total of 74% of patients had nocturnal hypertension (>120/70 mmHg). Average office BP and 24-hABPM remained quite stable over follow-up, as did the prevalence of nocturnal hypertension, which was 77% at the last observation. However, the global agreement between office BP and average 24 h, daytime and night-time BP was unsatisfactory (k-statistics 0.10-0.26). In 193 visits (25% of all visits) where office BP indicated the need of antihypertensive therapy institution or modification (BP >140/90 mmHg), 24-hABPM was actually normal (<130/80 mmHg), while in 94 visits (12%), 24-hABPM was in the hypertensive range while office BP was normal. Overall, in 37% of visits, office BP provided misleading therapeutic indications. Hypertension misclassification by office BP is a common phenomenon in stable renal transplant patients on long-term follow-up. Office BP may lead to inappropriate therapeutic decisions in over one-third of follow-up visits in these patients.

Ambulatory blood pressure monitoring in young adults with different levels of office blood pressure

Objectiveof our study was to assess the ambulatory blood pressure monitoring (ABPM) in young people with different office blood pressure (BP).Design and methods. We included 981 students of a medical university at the age of 20–29 years (536 men, 445 women). ABPM was performed using the device “Kardiotekhnika 4000” (Inkart, Russia), the data were processed using the program “KT Result2” (Inkart, Russia).Results. The optimal BP during office measurement was recorded in 220 patients (22,4 %, group 1), normal — in 488 (49,8 %, group 2), high normal — in 134 (13,6 %, group 3), hypertension (HTN) 139 (14,2 %, group 4). The proportion of males was significantly higher in groups 3 and 4 (96,6 % and 85,6 %) compared with groups 1 and 2 (47,7 % and 40,2 %, respectively, p &lt; 0,001). The median systolic BP (SBP) was 123 (110; 126) mm Hg, diastolic BP (DBP) — 85 (84; 87) mm Hg. According to the ABPM, the parameters of SBP and DBP correlated with the corresponding office BP parameters. A strong direct correlation was found for both SBP (rs= 0,87) and DBP (rs= 0,85). Daytime variability of SBP was significantly higher in individuals with high normal BP and HTN (15,9 ± 2,6 and 17,2 ± 4,2 mm Hg) compared to groups 1 and 2 (9,2 ± 4,4 and 9,9 ± 3,0, respectively, p &lt; 0,05). The majority of young people had normal BP decrease at night (dipper), non-dipper profile was also frequent. Over-dipper and night-peaker profiles were rarely recorded. In the groups 3 and 4, a larger number of non-dipper patients were observed compared with groups 1 and 2 (23,9 % and 34,6 %, compared with 10,0 % and 11,1 %, respectively, p &lt; 0,001). The prevalence of white-coat hypertension (WCH) among the young people was 0,31 % (95 % CI 0,06–0,75 %), among subjects with office HTN 2,2 % (95 % CI 0,4–5,3 %). The prevalence of masked hypertension (MHTN) in the studied population was 1,4 % (95 % CI 0,8–2,3 %), among normotensive subjects — 1,7 % (95 % CI 0,9–2,6 %), among subjects with high normal BP — 10,4 % (95 % CI 5,8–16,2 %).Conclusions. ABPM in young hypertensive patients is characterized by higher variability of daytime SBP. The majority (56,1 %)of HTN subjects had normal BP decrease at night. The prevalence of WCH among young people is 0,31 % (95 % CI 0,06–0,75 %). The prevalence of MHTN among young people is 1,4 % (95 % CI 0,8–2,3 %).

85. Is home blood pressure monitoring in Hypertensive Disorders of Pregnancy consistent with clinic recordings?

Objectives To assess the agreement of home blood-pressure monitoring (HBPM) and office blood pressure measurements in a cohort of pregnant women with Hypertensive Disorders of Pregnancy (HDP). Methods This was a cohort study at St George’s Hospital. The inclusion criteria were chronic hypertension, gestational hypertension or high risk of developing preeclampsia, no significant proteinuria and no hematological or biochemical abnormalities. The blood pressure measurements at home and the corresponding hospital visit for that gestational age were coupled for analysis. Differences between home and office blood pressure measurements were tested using Wilcoxon signed rank test or paired t-test and they were also visually assessed with Bland-Altman plots. Subgroup analyses were performed in the following gestational age windows: Results A total of 294 blood pressure measurements from 147 women were included in the analysis. The systolic HBPM measurements were significantly lower than office measurements [median (IQR): 132.0 mmHg (123.0–140.0 mmHg) vs 138.0 mmHg (132.0–146.5 mmHg), p Conclusions HBPM has the potential to reduce unnecessary medical interventions in women with HDP, but this must be carefully weighed against the risk of increasing adverse outcomes. Prospective studies investigating the use of HBPM in pregnant women are urgently needed to determine the relevant thresholds and monitoring frequency.

Extracellular Fluid Volume Is an Independent Determinant of Uncontrolled and Resistant Hypertension in Chronic Kidney Disease: A NephroTest Cohort Study.

BackgroundHypertension is highly prevalent during chronic kidney disease (CKD) and, in turn, worsens CKD prognosis. We aimed to describe the determinants of uncontrolled and resistant hypertension during CKD.Methods and ResultsWe analyzed baseline data from patients with CKD stage 1 to 5 (NephroTest cohort) who underwent thorough renal explorations, including measurements of glomerular filtration rate (clearance of 51Cr‐EDTA) and of extracellular water (volume of distribution of the tracer). Hypertension was defined as blood pressure (BP; average of 3 office measurements) ≥140/90 mm Hg or the use of antihypertensive drugs. In 2015 patients (mean age, 58.7±15.3 years; 67% men; mean glomerular filtration rate, 42±15 mL/min per 1.73 m2), prevalence of hypertension was 88%. Among hypertensive patients, 44% and 32% had uncontrolled (≥140/90 mm Hg) and resistant (uncontrolled BP despite 3 drugs, including a diuretic, or ≥4 drugs, including a diuretic, regardless of BP level) hypertension, respectively. In multivariable analysis, extracellular water, older age, higher albuminuria, diabetic nephropathy, and the absence of aldosterone blockers were independently associated with uncontrolled BP. Extracellular water, older age, lower glomerular filtration rate, higher albuminuria and body mass index, male sex, African origin, diabetes mellitus, and diabetic and glomerular nephropathies were associated with resistant hypertension.ConclusionsIn this large population of patients with CKD, a lower glomerular filtration rate, a higher body mass index, diabetic status, and African origin were associated with hypertension severity but not with BP control. Higher extracellular water, older age, and higher albuminuria were independent determinants of both resistant and uncontrolled hypertension during CKD. Our results advocate for the large use of diuretics in this population.

Review: In hypertension, intensive BP goals reduce CV events; self vs office BP measures do not improve BP at 12 mo

Source Citation Reboussin DM, Allen NB, Griswold ME, et al. Systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and ...

Home blood pressure monitoring in pediatric hypertension: the US perspective and a plan for action

The 2017 US guidelines for pediatric hypertension place considerable emphasis on blood pressure measurements, which are the cornerstone for hypertension diagnosis and management. It is recognized that when the diagnosis of hypertension is based solely on office blood pressure measurements, many children are misclassified (over- or underdiagnosed). Therefore, out-of-office blood pressure evaluations using ambulatory or home blood pressure monitoring are often necessary to obtain an accurate diagnosis. Strong evidence for the diagnostic and clinical value of ambulatory blood pressure monitoring in children has justified its central role in decision making in recent pediatric recommendations. However, ambulatory blood pressure monitoring is not widely accessible in primary care. There is little evidence for home blood pressure monitoring in children, yet this method is widely available and feasible for the evaluation of elevated blood pressure in children. This article presents a case for using home blood pressure monitoring for the management of children with suspected or treated hypertension in clinical practice in comparison to using office measurements or ambulatory blood pressure monitoring, as well as its optimal application. More research on home blood pressure monitoring in children is urgently needed.

Are there any new reliable markers to detect renal injury in obese children?

Aim: The aim of this study was to examine the serum and urine levels of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), matrix metalloproteinase-9 (MMP-9), and serum Cystatin-C to determine the renal effect of obesity in obese children. Methods: Seventy-two obese and 35 non-obese healthy children were included in this study. Blood pressure (BP) was evaluated with office measurement. Creatinine, cystatin C, lipids, fasting glucose, and insulin levels were measured, and homeostasis model assessment -insulin resistance (HOMA-IR) was calculated. The urine albumin/creatinine ratio was calculated. The serum and urine KIM-1, NGAL, OPN, and MMP-9 levels were measured. Results: Serum cystatin-C, triglyceride, and homeostasis model assessment-insulin resistance (HOMA-IR) index were found to be significantly higher in the obese group (p = .0001), and high-density lipoprotein (HDL) cholesterol was found to be significantly lower (p = .019) in the obese group. No significant differences were found in serum KIM-1, NGAL, OPN or MMP-9 levels between groups (p > .05). No significant differences were found in urine KIM-1 and MMP-9 levels (p > .05), Urine NGAL, and OPN levels were found significantly higher in obese groups (p < .05). Conclusions: According to our results, although serum KIM-1, NGAL, OPN, MMP-9, and urine MMP-9, urine KIM-1 do not appear to be ideal markers to evaluate renal injury in the early period of obesity, the serum levels of cystatin C and urine NGAL, urine OPN can be used as a good marker for assessing the renal effect of obesity which can lead end stage renal disease in pediatric population.