Predictor Of Target Organ Damage Research Articles

Supine Blood Pressure, a Better Predictor of Target Organ Damage than Sitting Blood Pressure

Supine Blood Pressure, a Better Predictor of Target Organ Damage than Sitting Blood Pressure

Association between cardio-ankle vascular index and cardiometabolic risk factors in HIV patients in Ghana

ABSTRACT Human immunodeficiency virus (HIV) infection is associated with increased cardiovascular diseases (CVDs) even in patients with viral suppression by combination antiretroviral therapy (cART). Arterial stiffness is an independent predictor of CVDs in diseased individuals and the general population. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that has been shown to predict target organ damage. CAVI is less studied in HIV patients. We compared the levels of arterial stiffness using CAVI and associated factors among cART-treated and cART-naïve HIV patients to those of non-HIV controls. In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls were recruited from a periurban hospital. We collected data on CVD risk factors, anthropometric characteristics, CAVI, and fasting blood samples to measure plasma glucose, lipid profile, and CD4+ cell counts. Metabolic abnormalities were defined using the JIS criteria. CAVI increased in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls (7.8 ± 1.4 vs 6.6 ± 1.1 vs 6.7 ± 1.4 respectively, p < 0.001). CAVI was associated with metabolic syndrome in non-HIV controls [OR (95% CI) = 2.14 (1.04–4.4), p = 0.039] and cART-naïve HIV patients [1.47 (1.21–2.38), p = 0.015], but not in cART-treated HIV patients [0.81 (0.52–1.26), p = 0.353]. In cART-treated HIV patients, a tenofovir (TDF)-based regimen (β = −0.46, p = 0.023) was associated with decreased CAVI and decreased CD4+ cell count (β = −0.23, p = 0.047) was associated with increased CAVI. In a periurban hospital in Ghana, compared to non-HIV controls or cART-naïve HIV patients, cART-treated HIV patients had increased arterial stiffness measured as CAVI. CAVI is associated with metabolic abnormalities in non-HIV controls and cART-naïve HIV patients, but not in cART-treated HIV patients. Patients on TDF-based regimens had decreased CAVI.

Prediabetes, Non-Dipping Profile and Hypertension—A Recipe for Increased Arterial Stiffness

Pulse wave velocity (PWV) is a known predictor of target organ damage, cardiovascular disease and overall mortality. The aim of this study was to compare the PWV values in subjects with prediabetes, a non-dipper profile and arterial hypertension with their values in healthy subjects. A total of 301 subjects, aged 40-70 years, without diabetes mellitus were included in this cross-sectional study (150 with prediabetes). They underwent a 24 h ambulatory blood pressure monitoring (ABPM). Subjects were divided into three hypertension groups (A = healthy, B = controlled hypertension, C = uncontrolled hypertension). Dipping status was determined according to ABPM results, and PWV was measured by an oscillometric device. Prediabetes was defined as having 2 separate fasting plasma glucose (FPG) measurements between 5.6 and 6.9 mmol/L. The highest PWV values were found in group C (9.60 ± 1.34 vs. 8.46 ± 1.01 in group B vs. 7.79 ± 1.10 in group A; p < 0.001), in subjects with prediabetes (8.98 ± 1.31 m/s vs. 8.26 ± 1.22 m/s; p < 0.001) and in prediabetic non-dippers among age groups (p = 0.05). In the multivariate regression model age, blood pressure, nocturnal indices and FPG were shown as independent predictors of PWV values. Significantly higher PWV values were found in subjects with prediabetes and non-dipping profiles in all three examined hypertension groups.

S-35-4: PEAK OF NOCTURNAL BLOOD PRESSURE SURGE IN SECONDS IS ASSOCIATED WITH LEFT VENTRICULAR MASS INDEX IN OBSTRUCTIVE SLEEP APNEA PATIENTS

Background: Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage and trigger cardiovascular events. Sec-surges are induced by sleep apnea (SA) or sympathetic nerve activity. However, it is not clear that the severity of sec-surge is different between sec-surges induced by SA (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non-SA factors (rapid eye movement, micro arousal, etc.). Furthermore, it is also not clear whether the sec-surge increases the cardiac overload. Methods and Results: Firstly, we assessed the sec-surge severity between sec-surges induced by SA and those induced by non-SA factors by comparing the sec-surge variables. Secondly, we assessed the association between sec-surges and left ventricular hypertrophy (LVH) independently of conventional BP variables. We assessed these points with 41 patients (mean age 63.2 ± 12.6 years, 29% female) who underwent full PSG, beat-by-beat (BbB) BP, and cuff-oscillometric BP measurement during the night. All patients were included for the analysis comparing sec-surge severity between inducing factors (SA and non-SA factors). There were no significant differences in the number of sec-surges/night, the peak of sec-surges defined as the maximum systolic BP in each sec-surge, and the amplitude of sec-surges defined as peak of sec-surge minus start point systolic BP in each sec-surge between SA-related sec-surges and non-SA-related sec-surges (19.5 ± 26.0 vs. 16.4 ± 29.8 events/night; 148.2 ± 18.5 vs. 149.3 ± 19.2 mm Hg; and 26.0 ± 4.3 vs. 25.8 ± 5.7 mm Hg, respectively). Eighteen subjects who had inspection results of cardiac magnetic resonance imaging out of the 41 patients (mean age 65.0 ± 12.5 years, 33% female) were included for the analysis assessing the association between sec-surges and LVH. The peak of sec-surge was significantly and strongly correlated with left ventricular mass index (LVMI) (r = 0.607, p &lt; .01). As a result of multiple regression analysis (n = 18), the peak of sec-surge was significantly and strongly associated with the LVMI (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (standardized β = -0.04, p = .87). Conclusions: This study suggests that peak of sec-surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.

The Potential of Nocturnal Heart Rate as a Predictor of Target Organ Damage in Individuals Diagnosed with Hypertension

Background: Elevated nocturnal heart rate (NHR) has been linked to an increased risk of cardiovascular events and mortality in hypertensive patients. However, the ability of NHR to predict the occurrence and progression of target organ damage (TOD) in these patients requires further investigation. This study aims to evaluate the predictive value of NHR in forecasting the presence and severity of TOD in hypertensive patients, using a combination of clinical and laboratory parameters. Methods: A total of 145 hypertensive patients were monitored for blood pressure and nocturnal heart rate. Patients were categorized into two groups based on the presence or absence of TOD and their NHR. The left ventricular mass index (LVMI), glomerular filtration rate (GFR), carotid intima media index (CTIM), and left ventricular ejection fraction (LVEF) were measured, and multiple linear regression was used to determine the predictive value of NHR on these indices. Results: The group with TOD had significantly higher NHR than the group without TOD. LVMI, GFR, CTIM, and LVEF varied significantly among the three subgroups, with the NHR3 group showing marked differences compared to the NHR2 and NHR1 groups (p < 0.01 or p < 0.05). Excessively rapid NHR had diverse impacts on all categories of target organs, particularly on LVMI and CTIM. Conclusion: Augmentation of nocturnal heart rate causes heightened harm to the target organs, with the most significant impact observed in LVMI and CTIM. No significant difference in the severity of TOD was observed between patients with an NHR of less than 70 bpm and those with an NHR between 70 and 80 bpm. However, an NHR above 80 bpm resulted in more severe TOD. These findings suggest that monitoring NHR in hypertensive patients may help prevent and manage TOD.

Ambulatory blood pressure monitoring and its utility in management of hypertension in a clinic setting in South India

Introduction: High blood pressure (BP) is an important risk factor for cardiovascular diseases. The association of short-term BP variability (BPV) with target organ damage (TOD) is not clearly established. We conducted this observational study to evaluate the degree of concordance between Office BP measurements (OBPM) and ambulatory BP monitoring (ABPM) and to study the association of ABPM parameters on TOD. Materials and Methods: Patients attending clinics of the authors between January 2018 and August 2019 were enrolled. Their BP status was determined by OBPM and ABPM and the degree of concordance analyzed. ABPM parameters between those with TOD and without TOD were compared using appropriate statistical measures. Results: Data from 968 subjects (males 61.5%, mean age 59.39 ± 14.86 years) were analyzed. Masked hypertension (HTN) and white coat HTN were seen in 138 (14.3%) and 50 (5.2%) participants, respectively. There was moderate concordance between ABPM and OBPM readings (Cohen's κ =0.571, 95% confidence interval [CI]: 0.445, 0.595, P < 0.001). There were 530 (54.8%) nondippers and 189 (19.5%) reverse dippers. High morning surge (MS) was seen in 193 patients (19.9%) and TOD was seen in 378 patients (39%). Among all the ABPM parameters which were significantly associated with TOD on univariate analysis, only BPV (P = 0.04, odds ratio [OR]: 1.04, 95% CI: 1.00, 1.08) and systolic BP in active phase (P = 0.01, OR: 1.02, 95% CI: 1.00, 1.04) were found to be predictors of TOD after multiple logistic regression analysis. Dipping status and MS were not associated with TOD. Conclusions: ABPM is a useful tool for diagnosis and accurate categorization of HTN. The analysis of ABPM parameters helps to identify the patients with BPV which has important implications for the prevention of TOD. ABPM is recommended in all individuals with cardiometabolic risk profile or with established TOD even with normal office BP readings.

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index.

Nocturnal blood pressure (BP) surge in seconds (sec‐surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage. However, it is not clear that the severity of sec‐surge is different between sec‐surges induced by sleep apnea (SA) (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non‐SA factors (rapid eye movement, micro arousal, etc.), and sec‐surge variables associate with left ventricular hypertrophy (LVH) independently of conventional BP variables. The authors assessed these points with 41 patients (mean age 63.2±12.6 years, 29% female) who underwent full PSG, beat‐by‐beat (BbB) BP, and cuff‐oscillometric BP measurement during the night. All patients were included for the analysis comparing sec‐surge severity between inducing factors (SA and non‐SA factors). There were no significant differences in the number of sec‐surges/night between SA‐related sec‐surges and non‐SA‐related sec‐surges (19.5±26.0 vs. 16.4±29.8 events/night). There were also no significant differences in the peak of sec‐surges, defined as the maximum systolic BPs (SBPs) in each sec‐surge, between SA‐related sec‐surges and non‐SA‐related sec‐surges (148.2±18.5 vs. 149.3±19.2 mm Hg). Furthermore, as a result of multiple regression analysis (n = 18), the peak of sec‐surge was significantly and strongly associated with the left ventricular mass index (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (β = −0.04, p = .87). This study suggests that peak of sec‐surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.

Renal Resistive Index as An Indicator of Atherosclerotic Changes and Renal Damage in Hypertension and Its Role in Therapeutic Intervention

Background: Renal resistive index (RRI) was suggested as an indicator of renal atherosclerotic changes in hypertensive patients with possible prognostic role in treatment. Objectives: This study aimed to assess RRI in hypertensive subjects, its relation to other predictors of target organ damage and prognostic usefulness in management, specifically, with different antihypertensive drugs. Patients and methods: The study included 100 newly diagnosed hypertensive adult subjects, who underwent abdominal ultrasound with Doppler to assess RRI, which was correlated with their clinical parameters including estimated glomerular filtration rate (eGFR) and other subclinical atherosclerosis markers as carotid intima-media thickness (IMT) and aortic knob width (AKW) calculated from chest radiograph. Another 50 non hypertensive subjects were assessed for their RRI as a control group. In addition, some of hypertensive patients were followed up one year after starting treatment was done and effects of different antihypertensive agents on their RRI were compared. Results: The mean baseline RRI in hypertensive patients (0.71 ± 0.04) was significantly higher compared to control group (0.60 ± 0.02) and was positively significantly correlated with their clinical parameters (age, systolic, diastolic, pulse pressure and eGFR) and with their atherosclerotic parameters (IMT and AKW). In addition, ACE/ARBs treatment was associated with significant decrease of RRI compared to other drugs [beta blocker (BB) and calcium channel blocker (CCB)], indicating their more renal protective effect. Conclusion: Assessment of RRI in patients with primary hypertension not only reflecting intrarenal perfusion changes, but it indicates systemic atherosclerotic changes, so it can be useful as prognostic parameter in addition to its possible therapeutic implications.

IS BP LOAD ON AMBULATORY MONITORING A PREDICTOR OF TARGET ORGAN DAMAGE IN YOUTH? THE SHIP AHOY STUDY

Objective: Ambulatory BP monitoring (ABPM) is increasingly utilized for the diagnosis of hypertension (HTN). Pediatric guidelines consider BP load (% of reading above the ‘normal’ threshold) in risk-stratification of the ABPM phenotype. We sought to determine if load was an independent predictor of target organ damage (TOD) in youth. Design and method: Casual BP, ABPM, anthropometrics, echo for LV mass index (LVMI), systolic strain, diastolic function (E’/e’ ratio) and pulse wave velocity (PWV) for arterial stiffness (PWV) were measured in 367 adolescents (mean 15.6 + 1.7 years, 63% white, 58% male). ABPM was performed with Ontrak device (Spacelabs Inc., Snoqualmie, WA). Subjects were stratified by load (low &lt;25% = 215, mid 25-&lt;50% = 62, high &gt;=50% =47) according to sex- and height-specific pediatric cut points. ANOVA was used to evaluate differences in CV risk factors and TOD across load groups. General linear models were used to evaluate load as an independent predictor of TOD after adjusting age, demographics, body mass index (BMI), and mean daytime SBP on ABPM. Results: There was a graded increase in most clinic and ambulatory BP means and loads across load groups (all p &lt; 0.05). There was only a trend for higher LVMI (p = 0.06) and reduced strain (p = 0.05) in low vs high load groups. Diastolic function (E/e’) was lower in high vs low and mid groups and there was a graded increase in arterial stiffness (PWV) across load groups. Daytime SBP load was an independent determinant of all forms of TOD after adjusting for age and sex but lost significance for LVMI after adjusting for BMI%. Load remained a significant determinant of PWV &amp; E/e’ after adjusting for BMI% and mean daytime ambulatory SBP. Load group was also a significant determinant of PWV and E/e’ even after adjustment for age, sex, BMI% and daytime ambulatory SBP (all p &lt; 0.0001). Conclusions: Daytime SBP load adds to prediction of diastolic dysfunction and arterial stiffness but not LVMI or systolic function. Increased load on ABPM may indicate need for advanced imaging to detect early TOD in youth with HTN.

Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage.

Sparse studies show that ambulatory blood pressure monitoring (ABPM) is superior to office BP (oBP) measurements to predict target organ damage and cardiovascular (CV) events in kidney transplant recipients (KTRs). We performed a systematic review aimed at determining the potential associations between BP recordings by different methods and renal and CV outcomes in this population. Major medical databases were searched for studies enrolling adult KTRs undergoing 24h ABPM compared to office or home BP measurements. Main outcomes were: associations between different BP recordings and renal and CV outcomes. Additionally, any association between the circadian BP pattern (dipping/non-dipping status) and outcomes was assessed. Twenty-two studies (2078 participants) were reviewed. Amongst 12 studies collecting data on renal endpoints, ten studies found that BP assessed by ABPM was a stronger predictor of renal function decline, assessed by serum creatinine (SCr) and/or creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR), than traditional office measurements. Twelve studies analyzed the relation between different BP recordings and CV target organ damages and reported robust correlations between echocardiographic abnormalities [i.e. left ventricular mass index (LVM/LVMI)] and 24h ABPM, but not with office BPs. Furthermore, 24h ABPM correlated better than oBP with markers of vascular damage, such as carotid intima-media thickness (IMT), diffuse thickening, and endothelial dysfunction. Additionally, abnormal circadian BP pattern (non-dippers and reverse dippers) identified a group of kidney recipients at risk for kidney function loss and CV abnormalities. In our systematic review, ABPM reflected target organ damage more closely than oBP in KTRs. Furthermore, altered circadian BP profile associated with renal and CV target organ damages.

Home Blood Pressure Monitoring: Current Status and New Developments.

Home blood pressure monitoring (HBPM) is a reliable, convenient, and less costly alternative to ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. Recognition and use of HBPM have dramatically increased over the last 20 years and current guidelines make strong recommendations for the use of both HBPM and ABPM in patients with hypertension. The accuracy and reliability of home blood pressure (BP) measurements require use of a validated device and standardized procedures, and good patient information and training. Key HBPM parameters include morning BP, evening BP, and the morning–evening difference. In addition, newer semi-automatic HBPM devices can also measure nighttime BP at fixed intervals during sleep. Advances in technology mean that HBPM devices could provide additional relevant data (e.g., environmental conditions) or determine BP in response to a specific trigger (e.g., hypoxia, increased heart rate). The value of HBPM is highlighted by a growing body of evidence showing that home BP is an important predictor of target organ damage, and cardiovascular disease (CVD)- and stroke-related morbidity and mortality, and provides better prognostic information than office BP. In addition, use of HBPM to monitor antihypertensive therapy can help to optimize reductions in BP, improve BP control, and reduce target organ damage and cardiovascular risk. Overall, HBPM should play a central role in the management of patients with hypertension, with the goal of identifying increased risk and predicting the onset of CVD events, allowing proactive interventions to reduce risk and eliminate adverse outcomes.

Is 24 hour central aortic pressure superior to single measurement of central aortic pressure in well controlled hypertensive patients

Abstract Background Non-invasive measurements of 24 h ambulatory central aortic systolic pressure (24hCASP) is now feasible method than single measurement of CASP. There is growing interest in CASP as cardiovascular risk marker beyond conventional brachial blood pressure (BP). Pulse wave velocity estimates arterial stiffness, whereas CASP is representative of the BP in major organs. Purpose To evaluate non- invasive parameters for arterial stiffness using oscillometric method and to compare 24hCASP with single measurement of CASP in well-controlled hypertensive patients to detect target organ damage (TOD). Methods A total 95 patients (57±14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (EA) and ventricular elastance (Ees)) and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo-arterial coupling. EA and Ees were calculated as and – systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Parameters for arterial stiffness – 24hCASP, ambulatory central systolic pressure (CASP), 24-hour pulse wave velocity (PWV24h) and ambulatory PWV were measured non-invasively with oscillometric method by Mobil-O-graph PWA. Results Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo-arterial coupling in comparison with disturbed EA/Ees: 24hCASP (107.64±9.19 vs. 116.64±16.7 mm Hg, p=0.02), CAP (117.45±9.26 vs. 128.42±16.15 mm Hg, p&amp;lt;0.0001). There were no statistically significant differences in PWV and PWV24h. Multiple regression analysis demonstrated that CAP (B=−0.264 p=0.003; 95% CI: −0.003–0.014) is independent predictor of TOD in hypertensive patients, than 24 hour central aortic pressure. Conclusion There is no superiority of 24hCASP than single measurment of CASP. CASP could predict preclinical damage and cardiovascular outcome. Funding Acknowledgement Type of funding source: None

The cumulative blood pressure load and target organ damage in patients with essential hypertension.

The area under the blood pressure curve is associated with target organ damage, but accurately estimating its value is challenging. This study aimed to improve the utility of the area under the blood pressure curve to predict hypertensive target organ damage. This retrospective cohort study comprised of 634 consecutive patients with essential hypertension for >1 year. Target organ damage was defined as the presence of left ventricular hypertrophy and/or carotid artery plaques. We evaluated the associations between the cumulative blood pressure load, which was derived from ambulatory blood pressure monitoring data, and target organ damage. The predictive value of the cumulative blood pressure load for target organ damage was assessed using receiver operating characteristic curves. Left ventricular hypertrophy and carotid artery plaques were present in 392 (61.8%) and 316 (49.8%) patients, respectively. Patients with left ventricular hypertrophy and/or carotid artery plaques had higher 24‐hour blood pressure, nocturnal cumulative systolic blood pressure, and nocturnal cumulative pulse pressure load. The nocturnal cumulative systolic blood pressure load was an independent predictor of left ventricular hypertrophy (odds ratio = 1.002, 95% confidence interval: 1.001‐1.004; P = .000) and carotid artery plaques (odds ratio = 1.003, 95% confidence interval: 1.002‐1.007; P = .007). The nocturnal cumulative systolic blood pressure and cumulative pulse pressure load, relative to mean blood pressure, were superior in predicting hypertensive target organ damage. Hence, the cumulative blood pressure load is a better indicator of blood pressure consequences, and the nocturnal cumulative systolic blood pressure and cumulative pulse pressure loads could predict target organ damage.

Diabetes mellitus is associated with high sleep-time systolic blood pressure and non-dipping pattern

ABSTRACT Introduction Compared to clinic blood pressure (BP), sleep-time BP and non-dipping BP pattern are better predictors of target organ damage and cardiovascular sequalae. Aim In a retrospective study, we determined whether diabetes mellitus (DM) status is associated with high sleep-time BP and non-dipping pattern. Methods We analyzed 1092 patients who underwent ambulatory BP monitoring between 2015 and 2017 in a tertiary cardiology institution. During a 24-hour period, BP was automatically measured every 15 minutes between 7:00 AM and 11:59 PM and every 30 minutes thereafter. Results Compared with the non-DM group (n = 910), the DM group (n = 182) had a higher 24-hour systolic BP (137 ± 17 vs. non-DM, 132 ± 14 mmHg, p < 0.001) and sleep-time systolic BP (132 ± 20 vs. 123 ± 16 mmHg, p < 0.001), and was more likely to exhibit non-dipping (63% vs 42%, p˂0.001). The DM group was also less likely to meet the guideline-recommended target of 120/70 mmHg for the sleep-time BP measured via ambulatory monitoring (22% vs. 34%, p = 0.002). After adjusting for the effects of age, sex, body mass index, smoking, urea, eGFR, previous myocardial infarction, previous percutaneous coronary intervention, previous coronary artery bypass surgery, and previous stroke, DM remained a significant independent predictor of a higher 24-hour systolic BP (coefficient: 2.8, 95% confidence interval: 0.1–5.5, p = 0.042) and higher sleep-time systolic BP (coefficient: 4.2, 95% confidence interval: 1.1–7.3, p = 0.008). There was a trend toward more sleep-time non-dipping BP pattern (odds ratio: 1.4, 95% confidence interval: 1.0–2.0, p = 0.087) in the DM group. Conclusion DM is independently associated with suboptimal 24-hour BP control. This association is mainly attributed to a high sleep-time systolic BP.

Abstract MP42: Do Adult Ambulatory BP Cut-points Predict Target Organ Damage Better Than Pediatric ABP Percentiles?

Ambulatory hypertension (HT) is more strongly related to cardiac target organ damage (TOD) than clinic BP. Therefore, correct classification of ambulatory blood pressure (ABP) phenotype is needed to determine which patients to refer for imaging. Pediatric ABPM interpretation is based on percentiles of ABP while adult ABPM interpretation is based on static cut-points. We sought to determine which ABP classification system was the best predictor of TOD in adolescents. We measured adiposity, LV mass index (LVMI), systolic and diastolic function (strain, E/e’ ratio) in 315 adolescents (15.9 + 1.4 years, 64% white, 59% male). BP phenotype was determined by mean of 6 casual aneroid SBPs, and 24-hour SBP on ABP (Spacelabs Inc., Snoqualmie, WA) 1) by age, sex and height specific pediatric cut-points and 2) by adult ABPM cut-points (day &lt;130, night &lt; 110, 24-hour &lt; 125 mmHg). We evaluated concordance in classification and prevalence of TOD with Chi square and kappa statistic for agreement. For daytime SBP, 5% of all subjects (16 of 315) reclassified from normotensive (NT) to masked hypertension (MH) and 8% (24 of 315) reclassified from white coat (WC) to HT. Results were similar for night and 24-hour ABP. Fewer NT and WC subjects had any form of TOD by adult vs pediatric cut-point (NT 32 vs 36%, WC 8 vs 13%; chi square &lt; 0.0001, kappa 0.73). The only significant differences in cardiac TOD by ABP phenotype were found using adult ABP cut-points (LVMI higher and strain lower HT vs NT, diastolic E/e’ higher HT and MH vs NT all p &lt;=0.05). We conclude that classification of ABP by adult cut-points is superior in identifying adolescents at risk for cardiac TOD. These findings may inform future pediatric ABP guidelines.

Ambulatory Blood Pressure Phenotypes in Children and Adolescents

Ambulatory Blood Pressure Phenotypes in Children and Adolescents

Abstract P2056: Effect of Ambulatory BP Load on Target Organ Damage in Youth

Ambulatory BP (ABP) is increasingly used for diagnosis of hypertension (HTN). Pediatric but not adult guidelines consider BP load (%readings above 95th%) in risk-stratification of the ABP phenotype. We evaluated load as a predictor of target organ damage (TOD) in youth. We measured casual BP, ABPM (Spacelabs Inc., Snoqualmie, WA), body mass index (BMI), LV mass index (LVMI), systolic and diastolic function (E’/e’ ratio) and pulse wave velocity (PWV) in 367 adolescents (15.6 +/- 1.7 years, 63% white, 58% male). Subjects were stratified by load (&lt;25% Low=215, 25-&lt;50% Mid=62, &gt;=50% High=47) by sex- and height-specific pediatric cut-points. ANOVA was used to evaluate differences in CV risk factors and TOD across groups. General linear models were used to determine if load was an independent predictor of TOD after adjustments. There were no differences in age, demographics or BMI by group. There was a graded increase in most clinic and ambulatory BP means and loads across groups (all p ≤0.05). There was only a trend for higher LVMI (p=0.06) and reduced strain (p=0.05) in low vs high groups. Diastolic function (E/e’) was lower in high vs low and mid groups and there was a graded increase in arterial stiffness (PWV) across groups. Daytime SBP load was an independent determinant of all forms of TOD after adjusting for age and sex but lost significance for LVMI after adjusting for BMI%. Load percent and load group remained significant determinants of PWV &amp; E/e’ after adjusting for age, sex, BMI% and mean daytime ambulatory SBP (all p ≤ 0.0001). We conclude that daytime SBP load adds to prediction of diastolic dysfunction and arterial stiffness but not LVMI or systolic function.

Abstract 110: Association of Blood Pressure Phenotype With Measures of Target Organ Damage

Ambulatory hypertension (HT) and masked hypertension (MH, normal in clinic, high on ambulatory BP monitoring, ABPM) are associated with target organ damage (TOD) in adults, while white coat hypertension (WC, high in clinic, normal on monitor) is felt to be benign. We sought to determine if BP phenotype is associated with TOD in youth. We measured casual BP, ABPM, adiposity, LV mass index (LVMI), systolic and diastolic function (E/e’ ratio) and pulse wave velocity (PWV) in 365 adolescents (15.6 + 1.7 years, 63% white, 58% male). BP phenotype was determined by mean of 6 casual aneroid SBPs, and 24-hour SBP on ABPM (Spacelabs Inc., Snoqualmie, WA) by age, sex and height specific pediatric cut-points (normotensive, NT=224; WC=90; MH=23; HT=28). ANOVA was used to evaluate differences in CV risk factors and TOD across ABP phenotypes. General linear models were used to determine if BP phenotype was an independent predictor of TOD after adjusting for age, demographics, and adiposity. There were no differences in age, race/ethnicity. MH had more females, HT were heavier than NT. There was no difference in dipping but 24-hour SBP load (%readings above 95 th %ile) increased across groups (NT=12, WC=18, MH=55, HT=64, p≤0.02). There was no difference in LVM index (NT=31.8, WC=33.5, MH=32.6, HT=33.1 g/m 2.7 ). WC had reduced strain compared to MH (-19.5 vs -23%). There were significant differences in diastolic function, and arterial stiffness. BP phenotype remained a significant determinant of E/e’ and PWV after adjustment for age, sex and BMI z-score (p≤0.0006). We conclude that 24-hour BP phenotype adds to prediction of diastolic dysfunction and arterial stiffness but not LVMI or systolic function.

C‐Reactive Protein Levels and Blood Pressure Loads with Training

Blood pressure (BP) load is the percentage of BP readings above a particular threshold within a given period. Elevated BP loads translate to organ exposures to high pressures for greater amounts of time. Because of this, BP load was heralded as a strong predictor of target organ damage (TOD). However, recent evidence has not confirmed its prognostic value above 24 hr ambulatory blood pressure monitoring (ABPM). Although questioned, it is incorporated in AHA ABPM guidelines for children and adolescents. Newer evidence in chronic kidney disease and untreated hypertensives has shown an independent association of BP load with various measures of TOD. Additionally, a marker of systemic inflammation (neutrophil‐to‐lymphocyte ratio) has been shown to correlate with BP load.ObjectiveThis analysis investigated the relationship between classic inflammatory biomarker C‐Reactive Protein (CRP) and debated measure BP Load in a high‐risk population for cardiovascular diseases (CVD).MethodsSedentary, middle‐to‐older age African Americans free of disease underwent aerobic exercise training (AEXT) 3x/week for 24 weeks. Intensity targets progressed to sustain 60% VO2 max. Because of the strong relationship between BMI and BP, participants were required to maintain a constant weight. ABPM was conducted before and after training, and BP loads determined. Fasted blood draws were utilized at these times to measure circulating CRP and categorize future CVD risks based on baseline CRP levels. Slightly less conservative thresholds for BP readings were used because of this known high‐risk population.ResultsWith training, daytime SBP and DBP loads decreased for those only in the low risk CRP group (p=.047 and p=.036, respectively). Nighttime values, however, did not change for either CRP group with training. For daytime values at baseline and final, there was no difference in SBP load (&gt;124 mmHg) for those classified as at low (&lt;1mg/L), average (1–3mg/L) or high (&gt;3mg/L) risk for CVD based on CRP levels. When a more conservative threshold was utilized (SBP &gt;139 mmHg) there was a difference between CRP groups after training (p&lt;.05). There was a similar trend for DBP load (DBP&gt;74 mmHg), with a difference appearing after training (p&lt;.05). Nighttime DBP load did not differ between groups either before or after training. SBP load, however, differed between CRP groups at baseline when a more (&gt;119 mmHg, p&lt;.05), but not less (&gt;104 mmHg) conservative threshold was used. Groups after training showed no SBP load difference.ConclusionsCRP levels may contribute to BP loads and resultant TOD. These may be a specific indicator of the response to AEXT, especially in those considered low‐risk. Because nighttime BP load did not change with training in either category, but daytime values did decrease, the reasons for this need to be further examined. It is possible that a different stimulus may be necessary to cause changes in nighttime values. This is especially important since recent evidence has shown nighttime values to be a greater indicator of clinical events and cardiovascular outcomes than daytime BP values. Additionally, BP load thresholds may need to be adjusted for various populations. Future studies are needed to confirm the independent effect of BP load in this high‐risk population, and its relationship to inflammation.Support or Funding InformationNIH Grant #R01 HL085497‐01A1 Systolic (&gt;139 mmHg) and Diastolic (&gt;74 mmHg) Blood Pressure load decreased after training in low‐risk subjects. SBP Load showed between group differences only after, but not before training.* p&lt;.05 within groups. # p&lt;.05 between groupsimageSystolic (&gt;139 mmHg) and Diastolic (&gt;74 mmHg) Blood Pressure load decreased after training in low‐risk subjects. SBP Load showed between group differences only after, but not before training.* p&lt;.05 within groups. # p&lt;.05 between groups Neither Systolic (&gt;104 mmHg) nor Diastolic (&gt;64 mmHg) Blood Pressure load decreased after training for subjects. SBP (&gt;119) Load showed between group differences before, but not after training. # p&lt;.05 between groupsimageNeither Systolic (&gt;104 mmHg) nor Diastolic (&gt;64 mmHg) Blood Pressure load decreased after training for subjects. SBP (&gt;119) Load showed between group differences before, but not after training. # p&lt;.05 between groupsThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.