Pattern In Hypertensive Patients Research Articles

Mean Platelet Volume/Platelet Count Ratio and Dipper/Non-Dipper Hypertensive Patients.

There is an interaction between mean platelet volume (MPV), platelet count (PC), inflammation, and platelet reactivity. The present study evaluated the relationship between the MPV/PC ratio and blood pressure (BP) using 24h ambulatory BP monitoring (ABPM). A total of 720 patients (male: 291) were included in the study. Based on the ABPM outcomes, they were divided into two groups: dipper hypertensive (n = 350; male: 136) and non-dipper hypertensive (n = 370; male: 155). Peripheral venous blood samples obtained at admission were used for PC and MPV calculations. Both groups displayed identical clinical characteristics. Non-dipper hypertensives had a higher MPV/PC ratio than dipper hypertensives [0.044; (0.036-0.055); 0.036 (0.030-0.042); P < .001]. According to receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of the MPV/PC ratio for predicting non-dipper patterns in hypertensive patients was 0.040 (area under the curve [AUC]: 0.726, P < .001). Sensitivity was 64.1% and specificity was 64.3%. The MPV/PC ratio may represent mechanisms involved in increasing cardiovascular risk in non-dipper hypertensives compared with dipper hypertensives.

Polypharmacy and medication usage patterns in hypertensive patients: Findings from the Pars Cohort Study

Polypharmacy, defined here as the concomitant use of five or more medications, is a significant health issue, particularly affecting individuals with chronic diseases like hypertension (HTN). To compare individuals with and without HTN in term of polypharmacy, and to investigate correlates of polypharmacy and medication use patterns in individuals with HTN in southwest Iran. This cross-sectional study used the baseline data of 9270 participants of the Pars Cohort Study (PCS) with a mean age of 52.6 ± 9.7 years. Poisson multivariable modeling was applied to identify correlates of polypharmacy, and Lexicomp® was used to assess drug-drug interactions. Anatomical Therapeutic Chemical classification was used to describe the pattern of medication use. The prevalence of polypharmacy in individuals without hypertension was 4.7 % (4.2%–5.2 %) vs. 23.7 % (22.1%–25.3 %) in individuals with hypertension (P < 0.001). Individuals with hypertension from middle-high socioeconomic status (SES) had a 1.51-fold higher prevalence of polypharmacy than vs. low SES. Those with more than three comorbidities had a 5.18 times higher prevalence of polypharmacy than those with isolated hypertension. Calcium channel blockers were the most common antihypertensives (20.9 %). In terms of drug-drug interactions, type C interactions were most prevalent among participants with hypertension and polypharmacy (76.0 %). Our findings imply a fairly high prevalence of polypharmacy and drug-drug interactions among individuals with hypertension; to tackle this issue, we recommend a national pharmacovigilance system, training programs for primary care physicians, public education and awareness campaigns, drug-checking campaigns, targeted screenings to alter modifiable risk factors, and the use of safe combination pills.

Comparison of the K Nearest Neighbor Algorithm with Apriori Algorithm to Analyze Lifestyle Patterns in Hypertensive Patients

Hypertension is one of the most influential cardiovascular diseases that can result in organ disorders such as heart dysfunction or stroke, and hypertension is often found by chance. Hypertension is a condition in which blood pressure increases drastically to above-normal limits and forces the heart to work harder in pumping blood to meet the body's oxygen needs. This disease can interfere with the work of other organs if left untreated, especially the heart and kidneys. Not paying attention to diet, exercise, stress, smoking, and drinking alcohol can all be responsible for an increased risk of hypertension. An a priori algorithm was used in the Sei Semayang Health Center case study to predict hypertensive patients and compare their behavioural patterns and lifestyles. So, the results of rapid-miner using a priori algorithm to analyse the Comparison of the K-Nearest Neighbor Algorithm with the Apriori Algorithm to Analyze Lifestyle Patterns in Hypertensive Patients the results obtained U1, which means that there are hypertensive patients aged 25-38 years who have more hypertension. The result is H2, which means that the community has but does not control the doctor with a pattern style such as consuming alcohol, smoking, lack of exercise, consumption of sugar, consumption of saturated fats and foods that contain much salt and rarely consuming vegetables or fruits and foods that contain mucin, so more. More people have hypertension by way of an unhealthy lifestyle.

Food consumption pattern for hypertension patient in Klaten Regency, Central Java Province, Indonesia

Hypertension, commonly known as high blood pressure, is a grave medical condition that serves as a catalyst for the onset of various other ailments, each bearing significant consequences that may ultimately lead to fatality. Unhealthy eating habits, such as consuming foods heavy in sugar, sodium, or saturated fat, are the primary cause of elevated incidences of hypertension. This research aimed to determine the relationship between food consumption patterns in hypertensive patients. This study used a cross-sectional study design conducted on outpatients at the Prambanan Health Center, Prambanan District, Klaten Regency, from December 2022 to February 2023. The population used in this study were all patients with hypertension in Klaten Regency, which amounted to 2,884 people from January until December 2021. The research sample was taken randomly with a value a of 5%. Based on the sample calculation, the sample size was 339 hypertension sufferers. Data analysis used in this study was univariate and bivariate analysis using the chi-square test with a degree of confidence of 95%. The results of this study indicate that the level of salt, fiber, and fat consumption is not related to sufferer hypertension. Maintaining a nutritious diet and engaging in physical activity as part of a healthy lifestyle may also help lower blood pressure. This study supports the hypothesis that dietary variety might be important for the future. Future research endeavors ought to delve into the intricate relationship between dietary practices and blood pressure across diverse cultural contexts, elucidating how variations in dietary habits influence blood pressure levels. Furthermore, it is imperative to investigate the potential repercussions of elevated blood pressure on various cultural groups, shedding light on tits unique impacts ondifferent societal frameworks.

GAMBARAN POLA MAKAN PADA PASIEN HIPERTENSI DI RUMAH SAKIT SANTA ELISABETH MEDAN TAHUN 2023

Diet is one of the efforts in overcoming hypertension sufferers so they can control their habits by adjusting the amount of food, type of food, meal schedule and balance nutritional intake. A balanced menu needs to be started and well known so that controllable eating habits will be formed. Hypertension is a non-communicable disease that can cause blood pressure to increase where systolic and diastolic are above normal limits. Factors that can cause hypertension are genetic factors (heredity), gender, age. The aim of the study is to find out the eating patterns of hypertensive patients. The research uses a quantitative method where data collection is carried out using a questionnaire of 25 questions so as to be able to dig deeper into the diet of hypertensive patients. The sampling technique uses random sampling of 53 respondents. The data analysis technique uses is descriptive. The results of the study are: eating patterns of hypertensive patients based on the amount of food in good category 45 respondents (84.9%). The eating pattern of hypertensive patients based on the type of food is in good category, 43 respondents (81.1%). The eating pattern of hypertensive patients based on the frequency of eating was in good category, 44 respondents (83.0%). Researcher's suggestion: It can be used as a recommendation for one of the non-pharmacological management of hypertensive patients by providing health education about diet, and used as information to maintain eating patterns in hypertensive patients.&#x0D;

Nocturnal Blood Pressure Patterns in Hypertensive patients with Obstructive Sleep Apnea Syndrome in Angola

The main cardiovascular consequence of Obstructive Sleep Apnea Syndrome (OSAS) is arterial hypertension (AH), considered since 2003 a second cause of AH. This study aimed to evaluate nocturnal blood pressure patterns (BPP) in hypertensive patients with OSAS in Angola. A descriptive, cross-sectional observational study was carried out in a private clinic in Angola. Demographic and clinical variables, polysomnography, and ABPM parameters were included. Patients were classified as a dippers, non-dippers, and reverse dippers. One-way ANOVA test, Kruskal-Walli’s test, and chi-square test were used as appropriate. The sample consisted of 70 individuals: 39(55.7%) were male. The mean age was 53.63±9.14 years and the BMI was 35.82 ± 6.57 kg/m2. An association between patients with a past medical history of hypertension and BPP was found (p&lt;0.05). Mean O2 saturation was significantly lower in the reverse dippers (p=0.25). Although insignificantly, the dippers were younger and less obese. In contrast, the proportion of smokers and diabetics was higher in the reverse dippers. No correlation was found between the apnea-hypopnea index, the mean blood pressure, and the Epworth sleepiness scale. In the present study, the prevalence of non-dipping and reverse dipping patterns was high. It needs to be confirmed with future prospective studies.

Monocyte-to-high-density lipoprotein ratio: an independent predictor of reverse dipper pattern in hypertensive patients.

In healthy individuals, blood pressure (BP) levels are expected to decrease by 10-20% during sleep hours, which is defined as the dipping pattern. On the other hand, the presence of a BP rise at night in hypertensive patients is defined as a reverse dipper hypertensive pattern (RDHT). RDHT has been associated with stroke and cardiovascular mortality. Similarly, the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has been associated with the prognosis of cardiovascular disease. We, therefore, aimed to assess the relationship between MHR and RDHT in patients with hypertension. A total of 363 patients were enrolled in the study, all of whom had undergone 24-hour ambulatory BP monitoring. The patients were analyzed in three groups: RDHT (n: 92), dipper hypertensive (DHT) (n: 124), and normotensive controls (n: 147). Univariable and multivariable analyses were performed to identify factors that could be used to predict RDHT presence. The RDHT group was compared with the DHT and normotensive groups. A high MHR (p = 0.014, OR: 1.110, CIs: 1.021-1.206) and low daytime diastolic BP (p = 0.026, OR: 0.951, CIs: 0.910-0.994) were found to be independent factors that differentiated RDHT from DHT. Additionally, high MHR (p < 0.001, OR: 1.244, CIs: 1.140-1.357), body mass index (p = 0.005, OR: 1.143, CIs: 1.042-1.255), and C-reactive protein (p = 0.009, OR: 1.166, CIs: 1.039-1.308) were found to be independent factors that could differentiate patients with RDHT from controls. We demonstrated that MHR, a novel inflammatory marker, independently predicts RDHT. This easily applicable and inexpensive marker can be used to predict RDHT in patients with hypertension.

5. Nocturnal Dipping Pattern in Hypertensive Patients as a Risk Factor for Cerebral Small Vessel Disease (CSVD): A Systematic Review and Meta-Analysis

Background: Cerebral small vascular disease (CSVD) is one of the most prevalent cerebral vascular pathologies encountered by middle-aged and older people, which can be observed by magnetic resonance imaging (MRI). The most important modifiable risk factor for CSVD is hypertension. Abnormal circadian blood pressure (BP) variability has been reported to significantly damage hypertensive patients’ target organs. Moreover, in many studies, controlling sleep blood pressure has been shown to exert greater protection against stroke and cardiovascular events. Objective: We aim to assess the nocturnal dipping pattern of blood pressure with the findings of cerebral small vessel disease. Method: We performed a comprehensive search on topics that assess nocturnal blood pressure monitoring and cerebral small vessel disease findings through imaging from inception up until November 2022. Result: There were a total of 2674 patients from 5 studies. The outcome of this study reported that reverse dipping and dipping BP patterns were significantly associated with the prevalence of CSVD. Meta-analysis showed that the reverse dipping BP pattern was associated with a higher risk for CSVD (OR 2.18 [1.80, 2.64], p = 0.64; I2: 0%, p &lt; 0.00001), meanwhile dipping pattern had a lower risk for CSVD (OR 0.51 [0.42, 0.63], p = 0.04; I2: 59%, p &lt; 0.00001). There was no association between the non-dipping pattern and CSVD (OR 0.92 [0.77, 1.10], p = 0.70; I2:0%, p = 0.35). Conclusion: Nocturnal BP pattern and CSVD were shown to be associated, with the reverse dipping BP pattern having a higher risk and dipping having a lower risk.

Relationships between Easily Available Biomarkers and Non-Dipper Blood Pressure Pattern in Patients with Stable Coronary Artery Disease.

Chronic inflammation plays an essential role in the pathophysiology of both arterial hypertension (HTN) and coronary artery disease (CAD), and is more pronounced in individuals with a non-dipper circadian blood pressure (BP) pattern. A non-dipping BP pattern is in turn is associated with increased cardiovascular morbi-mortality, and a higher risk of atherosclerotic events. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) are readily available predictors of systemic inflammation and cardiovascular risk. The purpose of our study is to evaluate whether NLR, MLR and PLR can be used as cost-effective predictors of a non-dipping blood pressure pattern in hypertensive patients with stable CAD. We performed a cross-sectional retrospective analysis that included 80 patients with hypertension and stable CAD (mean age 55.51 ± 11.83 years, 71.3% male) referred to a cardiovascular rehabilitation center. All patients underwent clinical examination, 24 h ambulatory blood pressure monitoring (ABPM) and standard blood analysis. Baseline demographic characteristics were similar in both groups. Patients with non-dipper pattern had significantly higher NLR (median = 2, IR (2-3), p < 0.001), MLR (median = 0.31, IR (0.23-0.39), p < 0.001) and PLR (median = 175, IR (144-215), p < 0.001) compared to dippers. Our results suggest that MLR and PLR are inexpensive and easily accessible biomarkers that predict a non-dipping pattern in hypertensive patients with stable CAD.

Relationship between the Atherogenic Index of Plasma and Nondipping Circadian Pattern in Hypertensive Patients

Background: Hypertension is a major cause of cardiovascular diseases. Many studies have pointed out that the atherogenic index of plasma (AIP), which demonstrates plasma atherogenicity, is correlated with all-cause mortality, cardiovascular morbidity, atherosclerosis, and severity of coronary artery disease. Within this context, we tried to evaluate the correlation between nondipping circadian pattern and AIP. Methods: We enrolled 1,030 hypertensive patients (mean age: 53.6 ± 11.4) as part of the target population, separated into different groups based on the circadian blood pressure (BP) pattern taken from dipper and nondipper groups subsequent to 24-h ambulatory blood pressure monitoring (ABPM). We calculated the level of AIP using the log transformation of the ratio of triglyceride to high-density lipoprotein cholesterol. Results: The AIP observed in the nondipper group was remarkably higher than those of the dipper group (p < 0.001). After measuring the 24-h ABPM, we determined that AIP had a weak but significant correlation with nighttime systolic BP (r = 0.090, p = 0.004) and nighttime diastolic BP (r = 0.073, p = 0.019). As for the analysis based on the multivariate logistic regression, high AIP and age were found to be independently associated with the presence of the nondipping pattern. Conclusion: AIP levels are higher in patients with nondipping pattern compared to dipper patients. Additionally, higher levels of AIP are independently associated with the presence of the nondipping pattern in hypertensive patients.

Specific deformation pattern in hypertensive patients with septal bulge and preserved systolic function.

A wide range of subclinical changes in left ventricular (LV) geometry and function can be observed, even in the early course of arterial hypertension (HTN). Aim of the study was to investigate if the appearance of isolated basal septal hypertrophy (BSH, septal bulge) in asymptomatic young and middle-aged adults with HTN could be a marker of incipient LV systolic dysfunction when other measures of global LV function are still normal. A total of 138 patients with primary arterial hypertension, aged less than 65years, with no comorbidities and with preserved LV ejection fraction (EF) were included. Complete 2D transthoracic echocardiography study was preformed according to standardized protocol, as well as deformation study using speckle tracking echocardiography. Global and regional longitudinal strain was measured in apical 4-, 2- and 3-chamber views according to 18-segments model. Global and regional circumferential and radial strains were measured in short axis view. Average was taken from each of the six basal, middle and apical LV segments. Patients were divided into two groups according to BSH presence and values were compared. Basal septal hypertrophy was found in half of the patients (53.6%). The whole cohort had altogether normal LV global systolic function, as well as global indices of radial strain (GRS 43.86 ± 10.75%) and longitudinal strain (GLS - 19.73 ± 2.19%), while global circumferential strain (GCS) was mildly reduced (GCS - 19.5 ± 2.81%). BSH patients had more expressed LV geometry changes (LV mass: 89.19 ± 24.59g/m2 vs 109.15 ± 25.33g/m2, p < 0.001; relative wall thickness: 0.3 ± 0.08 vs 0.38 ± 0.11, p < 0.001) and also revealed a specific pattern of longitudinal deformation impairment in three LV segments (basal and mid interventricular septum, basal anteroseptum). "Strain gradient" from LV base to apex (basal < mid < apical) was observed in the whole population for longitudinal and circumferential strain, and it was more pronounced in the BSH group. This group had more impaired basal LS, while apical CS was improved. Subendocardial longitudinal strain was also more impaired in the BSH group. This study brings new meaning to basal septal hypertrophy (BSH) occurrence in hypertensive patients with discrete global concentric remodeling. Regional systolic dysfunction of the basal and mid LV segments is found, while apical segments increase in deformation. This specific "strain gradient" pattern was found to be more pronounced in patients with BSH. The recognition of BHS in apparently healthy hypertensive patients with no impairment in global systolic function may suggest latent target organ damage with regional impairment of systolic function and the need to imply more aggressive treatment approach.

Tooth Loss Patterns in Hypertensive Patients with Chronic Periodontitis

Aim: The aim of the study is to study the tooth loss pattern in patients with chronic periodontitis and hypertension.&#x0D; Study Design: Retrospective cohort study.&#x0D; Materials and Methods: The case sheet records (DIAS data) of tooth loss pattern in hypertensive patients with chronic periodontitis were extracted. A total of 1318 case sheets were analysed for the study. Age, gender and tooth loss pattern with respect to the region were collected and statistically analysed. Descriptive statistics (Percentage, Mean, Standard deviation) and Inferential test (Chi- square test) were performed to determine the association between age, gender and tooth loss pattern in patients with chronic periodontitis and hypertension.&#x0D; Results: The results showed that that females were affected more with tooth loss with hypertension with chronic periodontitis when compared to males. According to age, patients between 50 to 70 years with chronic periodontitis and hypertension were more affected by tooth loss (p value = 0.001 (p&lt;0.05; Statistically significant)).&#x0D; Conclusion: The present study highlighted a possible relationship between hypertension and tooth loss due to chronic periodontitis. Loss of mandibular posterior teeth were more common and females were more prone to tooth loss than males with hypertension due to chronic periodontitis. However, the underlying mechanism has to be further investigated in a different study design, thus more conclusive findings would be elucidated.

LITERATUR REVIEW : POLA MAKAN PADA PENDERITA HIPERTENSI

ABSTRACT&#x0D; Hypertension is the number one cause of death in the world. An unhealthy lifestyle is an important risk factor for hypertension. One of the things that includes unhealthy lifestyles is one of which is not maintaining a diet. Diet is a way taken by a person or group to choose food and consume every day that is obtained through a daily landing called a serve diet. According to Adi Prasetyo, Donny, et al. 2015 stated in his research entitled "Factors Related to the Occurrence of Hypertension at a Young Age in the Sibela Surakarta Public Health Center Area" that there was a relationship between eating patterns and the incidence of hypertension, so researchers were interested in conducting a literature review about eating patterns in hypertensive patients. This review literature aims to determine dietary patterns in hypertension sufferers. This study uses a systematic literature review method in research on eating patterns in patients with hypertension obtained from the review of scientific research articles from the range of 2011-2019 using google schoolar database. There are 3 scientific studies on eating patterns in hypertensive patients who found that most of the diets in the literature review are not good. This is caused by several factors, namely economic, socio-cultural, educational, and environmental factors. Researchers hope that all people are given health education about diet, especially for people with a history of hypertension, so that eating patterns in people with a history of certain diseases including hypertension can be better.

Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data.

To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods. LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height2.7, height1.7, and height2 recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height2 and for LVM indexed to height1.7, which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height1.7, and height2,7. Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.

59. DIFFERENCES IN EJECTION FRACTION BASED ON LEFT VENTRICULAR GEOMETRIC PATTERN IN HYPERTENSIVE PATIENTS

Background: Left ventricular (LV) geometric patterns and LV ejection fraction (LVEF) have a strong prognostic value in hypertensive patients. However, the differences in EF among various abnormal LV geometric pattern types, including Concentric Remodelling (CR), Concentric Hypertrophy (CH), and Eccentric Hypertrophy (EH), in hypertensive patients is still less studied. Objective: To evaluate the differences in LVEF among various types of abnormal LV geometric patterns in hypertensive patients with reduced EF (&lt;50%). Methods: We collected data from clinical echocardiographic database of patients at DR. M. Djamil Hospital, Padang, in 2019. The inclusion criteria included hypertension, LVH, and LVEF &lt; 50%. Subjects were divided into three groups based on LV geometric patterns, i.e. CR, CH, and EH groups. Statistical analysis was performed by STATA. Results: In this study, 54 hypertensive patients (41 males, 13 females) with mean age of 61.33 ± 13.43 years were included. We found that in hypertensive patients with reduced EF, CH was the most common abnormal LV geometric pattern (50%), followed by EH (44.4%), and CR (5.56%). There was a significant difference in EF among the three groups (p = 0.03), with EH had the lowest EF (35.63 ± 8.79%), followed by CH (41.30 ± 5.44%) and CR (44.67 ± 6.66%). Conclusions: Our study demonstrated that LV eccentric hypertrophy has the lowest ejection fraction compared to the other two of abnormal LV geometric pattern in hypertensive patients with reduced ejection fraction. Thus, we suggested that the prognosis of hypertensive patients is potentially worsened by LV eccentric hypertrophy condition.

Capillary vascular density in the retina of hypertensive patients is associated with a non-dipping pattern independent of mean ambulatory blood pressure.

A nocturnal non-dipping pattern has been associated with hypertension-mediated organ damage (HMOD), morbidity and mortality. Retinal imaging through application of modern technologies including optical coherence tomography angiography (OCT-A) can provide detailed insights into early vascular damage. In this observational study, we investigated the relationship of microscopic vascular density in the retina measured with OCT-A and nocturnal blood pressure (BP) dipping. Retinal OCT-A and ambulatory BP monitoring (ABPM) data prospectively obtained from 142 patients referred to a tertiary hypertension clinic were analysed with regression models for associations between BP night-time dipping and retinal capillary vascular density in three different zones around the fovea. More pronounced nocturnal SBP and DBP dipping was significantly associated with increased vascular density in the central foveal area of the retina. These associations were robust to adjustment for other available risk factors including mean daytime BP. Parafoveal and whole image vascular density did not show equivalent significant associations with nocturnal BP dipping. The results were reproducible when assessed in a subgroup of patients who had concomitant type 2 diabetes. Foveal vascular density was associated with the nocturnal BP dipping pattern in hypertensive patients. These associations were robust to adjustment of relevant factors such as daytime BP. Our findings highlight the importance of nocturnal BP features reflected in ambulatory BP monitoring in the assessment of HMOD. Whether routine assessment of retinal damage markers may improve risk management of hypertensive patients remains to be determined.

MACHINE LEARNING BASED MODELS FOR PREDICTING WHITE-COAT AND MASKED PATTERNS OF BLOOD PRESSURE

Objective: Blood pressure (BP) is inherently variable. White-coat (WC) and masked hypertension are manifestations of this variability making office BP (OBP) unreliable with direct implications on diagnosis and management. Whilst the causes for this phenomenon are not fully known, predicting whether an individual's BP has WC or masked pattern will improve efficiencies in overall BP management. In this study, we used machine learning (ML) methods which are powerful in finding generalisable predictive patterns to develop models for accurate prediction of different BP patterns. Design and method: Data from patients referred from primary care to the specialist Glasgow BP clinic, all of whom underwent ambulatory blood pressure monitoring (ABPM) were analysed. The independent variables included a range of conventional clinical parameters included in the referral letter along with OBP. Missing data were imputed using K nearest neighbours, an ML algorithm that approximates a point value based on the nearest available point values. Following this, four ML algorithms (support vector machine, decision tree, random forest (RF) and extreme gradient boosting (XGBoost)) were applied to the dataset, split into 70% training and 30% validation subsets. Performance of models was reported using area under the curve, accuracy, precision (fraction of relevant instances among the retrieved instances) and recall (fraction of the total amount of relevant instances that were actually retrieved) measures. Results: There were 926 patients – average age 51 ± 16 years, 43%-female, 49% were new presentation for investigation of hypertension, 38% were not on any BP lowering therapy, 1.1% had type 2 diabetes and 5.2% had eGFR &lt; 60. The proportion of different BP patterns were – Normal BP:8.1%, Normal BP-masked:3.7%, Normal BP-whitecoat: 30.7%, Hypertension-whitecoat:23.3% and Hypertension:34%. Of the four predictor models, the highest classification accuracies were obtained for the XGBoost algorithm (accuracy:85%, precision:85%) followed by the RF classifier (accuracy:84%, precision:84%). Figure-1 demonstrates the multiclass AUC and leading predictors using the XGBoost model. Conclusions: ML models are able to predict WC and masked patterns in hypertensive patients and those suspected of having hypertension with relatively high accuracy and this warrants validation in larger cohorts.

The Effect of Mean Platelet Volume/Platelet Count Ratio on Dipper and Non-Dipper Blood Pressure Status.

Background and Objectives: The mean platelet volume (MPV) represents a possible marker of platelet activation. There is an association between the platelet count (PC) and inflammation and platelet reactivity. We assessed the association between the MPV/PC ratio and circadian alterations in blood pressure (BP). Material and Methods: One hundred and twenty subjects in total, 80 hypertensive subjects and 40 healthy subjects (controls), were enrolled in the study group. Twenty four hour ambulatory BP monitoring (ABPM) was applied to all subjects. According to ABPM results, the hypertensive subjects were separated into two groups, such as dippers (n = 40) and non-dippers (n = 40). In all subjects, the collection of venous peripheral blood samples was performed on admission for PC and MPV measurements. Results: The two groups exhibited similar clinical baseline characteristics. A significantly higher MPV/PC ratio was determined in non-dippers compared to that in dippers and normotensives. The higher MPV/PC ratio was observed in non-dippers in comparison with that in dippers and normotensives (0.046 ± 0.007 to 0.032 ± 0.004 fL/[109/L]; 0.046 ± 0.007 to 0.026 ± 0.004 fL/[109/L], p < 0.001, respectively). A receiver operating characteristic (ROC) curve analysis showed that the optimum cut-off value of the MPV/PC ratio for predicting non-dipping patterns in hypertensive patients was 0.036 (area under the curve [AUC]: 0.98, p < 0.001). According to the cut-off value, sensitivity and specificity were found to be 95% and 95%, respectively. Conclusions: The higher MPV/PC ratio was determined in non-dipper hypertensive subjects in comparison with that in dipper hypertensive subjects. An elevation of platelet activity and an increase in thrombus burden are reflected by an increase in the MPV/PC ratio. The MPV/PC ratio may underlie the increase in cardiovascular risk in non-dippers compared to that in dippers.

Differential blood pressure response tocontinuous positive airway pressure treatment according to the circadian pattern in hypertensive patients with obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) has a heterogeneous effect on blood pressure (BP) in hypertensive patients. However, the effect of CPAP on BP in hypertensive subjects regarding circadian BP pattern has never been explored. This study aimed to assess the effect of CPAP on BP, taking into consideration the circadian BP pattern in untreated hypertensive patients.This study is a post hoc analysis of the Spanish Cohort for the Study of the Effect of CPAP in Hypertension (CEPECTA), a multicentre, randomised trial of CPAP versus sham-CPAP in patients with new-onset systemic hypertension and an apnoea-hypopnoea index >15 events·h-1 We included patients for whom 24-h ambulatory BP monitoring (ABPM) data were available at baseline and 12 weeks after the intervention. Subjects were classified based on the dipping ratio (dipper/non-dipper). We evaluated the effect of CPAP on ABPM parameters after 12 weeks of treatment.Overall, 272 hypertensive subjects were included in the analysis (113 dippers and 159 non-dippers). Baseline clinical and polysomnographic variables were similar between the groups. CPAP treatment in non-dipper patients was associated with reductions in 24-h ambulatory BP variables and night-time ambulatory BP measurements. However, a nonsignificant effect was reported in the dipper group. The differential effects of CPAP between the groups were -2.99 mmHg (95% CI -5.92-- -0.06 mmHg) for the mean 24-h ambulatory BP and -5.35 mmHg (95% CI -9.01- -1.69 mmHg) for the mean night-time ambulatory BP.Our results show a differential effect of CPAP treatment on BP in hypertensive patients depending on the circadian pattern. Only non-dipper patients benefited from CPAP treatment in terms of BP reduction.

Prevalence of left ventricular geometric patterns in hypertensive patients in Angola

The aim of the present study is to evaluate the prevalence of left ventricular geometric patterns in hypertensive patients in Angola. Methodology: cross-sectional descriptive observational study performed in two diagnostic centers in Luanda. We included all hypertensive patients who underwent transthoracic echocardiographic study in the 2nd quarter of 2012 in both centers. The echocardiographic study was performed according to the ASE recommendations. The relative wall thickness and the presence or absence of echocardiographic left ventricular hypertrophy were used to determine the various geometric patterns Results: 84 patients were included, 33 males and 51 females, the mean age was 52.7 (± 13.4) years. 49% had concentric hypertrophy, 20% had eccentric hypertrophy, and 17% concentric remodeling and 14% had normal geometry. Regarding left ventricular function 87% of had normal systolic function, 64% had diastolic dysfunction. Conclusion: The results show that concentric and eccentric hypertrophy is the most frequent geometric patterns. Diastolic dysfunction is present in majority of the patients. The need for longitudinal studies assessing the prognostic value of geometric patterns in hypertensive patients in Angola, as well as their relationship with left ventricular function is imperative.