Similar Blood Pressure Values Research Articles

Elevated blood pressure-associated cardiometabolic risk factors and biomarkers in 16-23 years old students with or without metabolic abnormalities.

In obesity, cardiometabolic risk markers show worsening trends with increasing blood pressure (BP). We assumed that risk markers show similar trends across BP categories (normotension, high normal BP, hypertension) in metabolic abnormalities-free subjects (without obesity, insulin resistance, atherogenic dyslipidemia, hyperuricemia, microinflammation) and those presenting them. Data from 2547 (48.1% males) subjects aged 16-23 years were analyzed. The prevalence of males increased across BP categories. Forty-seven percent of individuals with elevated BP were metabolic abnormalities-free. Among 1461 metabolic abnormalities-free subjects, 9% had high normal BP, and 4% hypertension; among 1086 individuals presenting metabolic abnormalities, the prevalence reached 13% and 6%, respectively, (p < 0.001). Both groups displayed similar BP values in corresponding BP categories and significant trends in markers of adiposity, insulin resistance, HDL-cholesterol, atherogenic index of plasma, uric acid, adiponectinemia, and antioxidant capacity of plasma across BP categories. In metabolic abnormalities-free individuals, also significant trends in soluble receptors for advanced glycation end products were revealed. Continuous metabolic syndrome score, a measure of cardiometabolic risk, increased across BP categories regardless of presence or absence of metabolic abnormalities. Multivariate regression models selected male gender, fat-free mass, and uric acid as significant independent predictors for determining BP. Our data emphasize that having a BP outside the normal range significantly worsens risk for cardiometabolic disease in young individuals even if the thresholds for any of the risk factors are not exceeded. Longitudinal studies are needed to assess whether in patients with elevated BP the prognosis of adverse outcomes differs between those presenting and not presenting metabolic abnormalities.

UNATTENDED VERSUS ATTENDED AUTOMATED OFFICE BLOOD PRESSURE USING THE SAME DEVICE AND PROTOCOL

Objective: There is increasing interest in unattended automated office blood pressure (OBP) measurement, which gives lower blood pressure values than the conventional auscultatory OBP. Whether unattended automated OBP differs from standardized attended automated OBP performed using the same device and measurement protocol remains uncertain. Design and method: A systematic PubMed and EMBASE search and meta-analysis of studies (aggregate data) comparing unattended vs. attended automated OBP using the same device and measurement protocol (conditions, number of measurements, visits) were performed. Results: Ten eligible studies (n = 1,004, weighted age 60.8 ± 4.2 [SD] years, 55% males) were analyzed. Unattended OBP (pooled systolic/diastolic 133.9 [95% CI: 129.7, 138]/80.6 [95% CI: 77, 84.2] mmHg) did not differ from attended OBP (135.3 [95% CI: 130.9, 139.6]/81 [95% CI: 77.6, 84.3] mmHg); pooled systolic OBP difference −1.3, 95% CI: −4.3, 1.7 mm Hg and diastolic −0.4, 95% CI: −1.2, 0.3 mm Hg. Nine of ten studies achieved high quality score and no publication bias was identified. Meta-regression analysis did not reveal any effect of age, gender, or attended systolic OBP on the unattended-attended systolic OBP difference (P = NS for all), although there was a trend towards higher attended than unattended OBP at higher OBP levels. Conclusions: These data suggest that when the same device and measurement protocol is used, attended automated OBP provides similar blood pressure values as unattended automated OBP. Although unattended automated OBP is theoretically advantageous as it ensures that standardized conditions and measurement protocol are used, carefully standardized attended automated OBP appears to be a reasonable and practical alternative for wide use in clinical practice.

Biochemical, Pharmacological, and Therapeutic Effects of Triple Antihypertensive Therapy with Amlodipine, Valsartan and Hydrochlorothiazide in Elderly Hypertensive Patients with Calcium Phosphate Nephrolithiasis

Antihypertensives are widely prescribed in the geriatric population and could influence kidney stone risk but many aspects are still unknown. Thiazides are used to control lithogenic factors and recurrences in patients with calcium lithiasis. The aim of our study was to evaluate the relationship between essential arterial hypertension and stone disease, by studying the pharmaco-therapeutic effects of a fixed-dose combination of amlodipine + valsartan + hydrochlorothiazide (Aml + Val + HCTZ) 10/320/25 mg, on the urinary stone risk in a study group of hypertensive geriatric patients. A longitudinal, randomized, three years follow-up clinical and experimental study was conducted during June 1, 2014 - July 31, 2017. A number of 60 eligible geriatric patients, treated only with a fixed-dose combination of Aml + Val + HCTZ 10/320/25 mg, as a single-tablet, were enrolled in the study. All the patients were stone formers, with more than three episodes of crystalluria in the last two years. The patient�s age ranged between 55 and 65 years. Exclusion criteria: patients with heart failure, kidney chronic diseases, use of drugs known to affect renal function, patients with multi-morbidities. All patients had similar blood pressure values, and tension was well controlled throughout the whole study period. In the elderly patients, the treatment with 25 mg/day of hydrochlorothiazide (from the combination of Aml + Val + HCTZ 10/320/25 mg) has a beneficial and prolonged efficacy in treatment of recurrences in patients with calcium oxalate and phosphate lithiasis Our study reveals that in the elderly patients with hypertension and nephrolithiasis as a comorbidity, thiazides - 25 mg/day of hydrochlorothiazide (from the combination of Aml + Val + HCTZ 10/320/25 mg) has a beneficial effect in order to control lithogenic factors and recurrences in patients with calcium phosphate lithiasis.

Nocturnal blood pressure measured by home devices: evidence and perspective for clinical application.

: Studies using ambulatory blood pressure (BP) monitoring have shown that BP during night-time sleep is a stronger predictor of cardiovascular outcomes than daytime ambulatory or conventional office BP. However, night-time ambulatory BP recordings may interfere with sleep quality because of the device cuff inflation and frequency of measurements. Hence, there is an unmet need for obtaining high quality BP values during sleep. In the last two decades, technological development of home BP devices enabled automated BP measurements during night-time. Preliminary data suggest that nocturnal home BP measurements yield similar BP values and show good agreement in detecting nondippers when compared with ambulatory BP monitoring. Thus, nocturnal home BP measurements might be a reliable and practical alternative to ambulatory BP monitoring to evaluate BP during sleep. As the use of home BP devices is widespread, well accepted by users and has relatively low cost, it may prove to be more feasible and widely available for routine clinical assessment of nocturnal BP. At present, however, data on the prognostic relevance of nocturnal BP measured by home devices, the optimal measurement schedule, and other methodological issues are lacking and await further investigation. This article offers a systematic review of the current evidence on nocturnal home BP, highlights the remaining research questions, and provides preliminary recommendations for application of this novel approach in BP management.

AUTOMATED BLOOD PRESSURE MEASUREMENT IN PATIENTS WITH HYPERTENSION AND ATRIAL FIBRILLATION. DATA FROM THE ESH RESEARCH PROJECT “MANAGEMENT OF ARTERIAL HYPERTENSION IN PATIENTS WITH HIGH BLOOD PRESSURE AND ATRIAL FIBRILLATION”

Objective: Atrial fibrillation (AF) is a frequent complication of long lasting hypertension, and carries a high risk of morbidity and mortality as well as of cardiovascular events. AF is also responsible for possible errors in blood pressure (BP) measurement. Limited information is available on the accuracy of blood pressure measurements when automated oscillometric (OSC) devices are used instead of the standard auscultatory approach (AUSC). The aim of this analysis was to compare blood pressure values measured using either a mercury sphygmomanometer or an automated electronic device in patients with AF. The analysis was limited to 353 patients (mean CHA2DSVA2SC score 3.9), enrolled in the international multicenter ESH Research Project on arterial hypertension and atrial fibrillation, in whom BP was measured 4 times with the standard AUSC approach (according to Guidelines) and 4 times with an OSC device. Results mean age was 72 ± 11 (range 20–94), BMI 28 ± 5, mean CHA2S2VASC 3.9. Mean BP values were 130.3 ± 19.5 for AUSC-SBP and 131.5 ± 20.1 for OSC-SBP and 75.8 ± 11.4 for AUSC-DBP and 76.5 ± 12.3 for OSC-DBP. Correlation coefficients between automated and manual blood pressure measurements were: r = 0.917 for SBP and r = 0.856 for DBP (p < 0.0001). The difference between the oscillometric and manual measurement was on average of 1.2 mmHg for systolic BP (SBP) and of 0.7 mmHg for diastolic BP (DBP). The standard deviations (SD) of the differences were, respectively, 8.07 and 6.39, and progressively increased wen 4, 3, 2 or 1 measurements were used. At Bland-Altman analysis the limits of agreement were −17 to 14.7 mmHg for SBP and -13.3 to 11.8 for DBP. Conclusions: In patients with hypertension and AF measurement of BP values with oscillometric devices provides similar BP values, with SD at the upper limit of AAMI criterion for the validation of devices, at least when 4 BP measurements are performed.

PP.20.12] SYSTOLIC AND DIASTOLIC DYSFUNCTION AMONG TREATED HYPERTENSIVE PATIENTS

Objective: Uncontrolled as well as apparent resistant hypertension (aRHT) are clinical conditions that deserve a thorough evaluation of heart function to assess the relevant risk profile. We investigated echocardiographic characteristics of patients without symptoms of heart failure with respect to their blood pressure (BP) control status. Design and method: We studied 1094 asymptomatic, treated hypertensives (mean age 58 ± 11 years, 48% males) without a history of cardiovascular disease. Clinical data were collected and patients underwent routine blood testing and additional workup for exclusion of secondary causes of RHT. Uncontrolled HT was defined as office BP > or = 140 and/or 90 mmHg and aRHT as uncontrolled HT under at least 3 drugs including a diuretic. A 2D and Doppler echocardiographic study was performed in all patients and left ventricular mass was calculated and indexed for body surface area (LVMI). Tissue Doppler imaging was performed for calculation of myocardial velocities. Patients were divided into 3 groups depending on BP control and presence of aRHT; 243 (22%) patients with controlled HT, 557 (51%) patients with uncontrolled HT and 294 (27%) patients with RHT. Results: Mean BP was 124 ± 9 mmHg in the controlled HT group while patients with uncontrolled and aRHT had similar BP values (149 ± 13 vs 153 ± 19 mmHg, p = NS). There was no significant difference in the ejection fraction among groups. LVMI was higher in patients with aRHT compared to those with uncontrolled and controlled HT (94 ± 22 vs 87 ± 20 and 85 ± 20 g/m2, p < 0.001 for all). Concentric hypertrophy/remodelling was more often in patients with aRHT compared to the other groups (25% compared to 12% and 8%, p < 0.001). Patients with aRHT compared to patients with uncontrolled HT had lower values of E/A (0.93 ± 0.24 vs 0.98 ± 0.26 m/sec, p = 0.025), lower values of E’ (7.2 ± 2.4 vs 7.8 ± 2.4, p = 0.05) and higher values of E/E’ (11.6 ± 4.2 vs 10.3 ± 3.3 cm/sec, p < 0.01). A value of E/E’ above 13 was more prevalent in patients with aRHT (26%) compared to those with uncontrolled (21%) and controlled HT (20%). Conclusions: Among asymptomatic treated hypertensives, patients with aRHT exhibit measures of a worse diastolic function compared to patients with uncontrolled hypertension despite similar values of BP.

The association between home vs. ambulatory night-time blood pressure and end-organ damage in the general population.

The aim of this study was to test the agreement between night-time home and night-time ambulatory blood pressure (BP) and to compare their associations with hypertensive end-organ damage for the first time in the general population. A population sample of 248 participants underwent measurements for night-time home BP (three measurements on two nights with a timer-equipped home device), night-time ambulatory BP, pulse wave velocity (PWV), carotid intima-media thickness (IMT) and echocardiographic left ventricular mass index (LVMI). No significant or systematic differences were observed between mean night-time ambulatory and home BPs (systolic/diastolic difference: 0.7 ± 7.6/0.2 ± 6.0 mmHg, P = 0.16/0.64). All night-time home and ambulatory BPs were positively correlated with PWV, IMT and LVMI (P < 0.01 for all). No significant differences in Pearson's correlations between end-organ damage and night-time home or ambulatory BP were observed (P ≥ 0.11 for all comparisons using Dunn and Clark's Z), except for a slightly stronger correlation between PWV and ambulatory SBP than for home SBP (r = 0.57 vs. 0.50, P = 0.03). The adjusted R of all multivariable-adjusted models for PWV, IMT or LVMI that included night-time home or ambulatory SBP/DBP were within 2/1%. Our study demonstrates that night-time home and ambulatory measurements produce similar BP values that have comparable associations with end-organ damage in the general population even when a clinically feasible measurement protocol is used for measuring night-time home BP. In the future, night-time home BP measurement may offer a feasible and easily accessible alternative to ambulatory monitoring for the measurement of night-time BP.

Brachial and central blood pressure in HIV-infected subjects.

HIV infected subjects present an unfavorable cardiovascular (CV) risk profile that is determined by the infection itself, highly active anti-retroviral therapy (HAART) and other factors, such as chronic kidney disease (CKD). Information is scant and contradictory on whether these factors are associated with arterial stiffness and blood pressure (BP) alteration. Our study aimed to evaluate those parameters in HIV-positive subjects both with and without HAART and with and without CKD, which was defined as the presence of microalbuminuria with a normal glomerular filtration rate. We enrolled 94 HIV-infected subjects without known CV risk factors and compared them with 37 control subjects. We recorded brachial and central BP (pulse wave analysis) and pulse wave velocity ( SphygmoCor). HIV-positive subjects of similar ages and with similar BP values showed central pulse pressure values that were significantly greater than those of controls; this was also the case for the Aix value. Central systolic and pulse pressure values and Aix were significantly greater in HIV-positive subjects with HAART and CKD than in the other HIV-positive subgroups and control subjects. PWV was also superimposable between groups when the data were analyzed relative to the presence of HAART and CKD. Our study shows that the unfavorable CV risk profile associated with HIV infection includes an increase in both central BP and Aix. The central BP increase seems to be favored by renal damage, which apparently has a role in the early stages of the disease.

Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism

Primary aldosteronism (PA), a common cause of high blood pressure (BP), induces left ventricular (LV) hypertrophy and an excess rate of cardiovascular events. Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain. To the aim of assessing the effect of treatment of PA on BP and LV changes, we prospectively recruited 323 patients in a long-term follow-up study entailing serial echocardiography evaluations. Of them, 180 had PA and were assigned to either adrenalectomy (n=110) or medical therapy (n=70) on the basis of the adrenal vein sampling. The remaining 143 were consecutive optimally treated primary hypertensive patients. At baseline, the PA patients had more inappropriate LV mass than PH patients (27.1% versus 16.2%; P=0.020), despite similar BP values. At a median follow-up of 36 months (range, 6-225), BP was lowered (P<0.0001 versus baseline) to similar values in adrenalectomized (135±15/83±9 mm Hg), medically treated PA (133±11/83±7 mm Hg), and PH (139±15/86±9 mm Hg) patients. To this end, the adrenalectomized patients required significantly less drugs than the other groups. In PA patients, the LV mass index and the rate of LV hypertrophy fell through LV inward remodeling to the level of optimally treated PH patients, indicating that the LV work markedly decreased. Findings were similar when long-term (≥5 and ≥10 years) data were examined. Thus, an early diagnosis and a specific treatment of PA warrant normalization of BP and reversal of detrimental LV changes at long term.

Similar Blood Pressure Values Across Racial and Economic Groups: Baseline Data from a Group Randomized Clinical Trial

This paper examines baseline characteristics from a prospective, cluster-randomized trial in 32 primary care offices. Offices were first stratified by percentage of minorities and level of clinical pharmacy services and then randomized into 1 of 3 study groups. The only differences between randomized arms were for marital status (P=.03) and type of insurance coverage (P<.001). Blood pressures (BPs) were similar in Caucasians and minority patients, primarily blacks, who were hypertensive at baseline. On multivariate analyses, patients who were 65 years and older had higher systolic BP (152.4 ± 14.3 mm Hg), but lower diastolic BP (77.3 ± 11.8 mm Hg) compared with those younger than 65 years (147.4 ± 15.0/88.6 ± 10.6 mm Hg, P<.001 for both systolic and diastolic BP). Other factors significantly associated with higher systolic BP were a longer duration of hypertension (P=.04) and lower basal metabolic index (P=.011). Patients with diabetes or chronic kidney disease had a lower systolic BP than those without these conditions (P<.0001). BP was similar across racial and socioeconomic groups for patients with uncontrolled hypertension in primary care, suggesting that patients with uncontrolled hypertension and an established primary care relationship likely have different reasons for poor BP control than other patient populations.

Elevation of Angiotensin-II Type-1-Receptor Autoantibodies Titer in Primary Aldosteronism as a Result of Aldosterone-Producing Adenoma

The mechanisms of excess aldosterone secretion in primary aldosteronism (PA) remain poorly understood, although a role for circulating factors has been hypothesized for decades. Agonistic autoantibodies against type-1 angiotensin-II receptor (AT1AA) are detectable in malignant hypertension and preeclampsia and might play a role in PA. Moreover, if they were elevated in aldosterone-producing adenoma (APA) and not in idiopathic hyperaldosteronism (IHA), they might be useful for discriminating between these conditions. To test these hypotheses, we measured the titer of AT1AA in serum of 46 patients with PA (26 with APA, 20 with IHA), 62 with primary hypertension (PH), 13 preeclamptic women, and 45 healthy normotensive blood donors.We found that the AT1AA titer was higher (P<0.05) in both PA and PH patients (2.65 ± 1.55 and 1.86 ± 0.63, respectively) than in normotensive subjects (1.00 ± 0.20). In APA, it was 2-fold higher than in IHA patients (3.43 ± 1.20 versus 1.64 ± 1.39, respectively, P<0.001), despite similar blood pressure values. Of note, it allowed effective discrimination of APA from either PH or IHA, as shown by Receiver Operator Characteristics curve analysis. Moreover, after captopril challenge, plasma aldosterone concentration fell more in AT1AA-positive than in AT1AA-negative PA patients (-32.4% [21.1-42.9] versus 0.0% [0.0-22.6], P=0.015), suggesting an agonistic role for these autoantibodies. Thus, a higher serum AT1AA titer in patients with APA than in IHA and PH patients can be useful in differentiating APA patients from either PH or IHA, and thus in selecting PA patients to be submitted to adrenal vein sampling.

Pressão arterial obtida pelos métodos oscilométrico e auscultatório antes e após exercício em idosos

Different methods of measuring blood pressure (BP) have been used in clinical and scientific evaluations. However, the methods employed have constraints and peculiarities to be considered.To evaluate whether similar BP values are obtained in elderly hypertensive patients undergoing resistance exercises when using the oscillometric (Omron-HEM-431) and auscultatory methods (mercury sphygmomanometer).Sixteen elderly hypertensive patients underwent three randomized experimental sessions with different volumes: control (C: 40 minutes), exercise 1 (E1: 20 minutes) and exercise 2 sessions (E2: 40 minutes). BP was measured simultaneously through two methods every 5 minutes for 20 minutes before the sessions and during 60 minutes after them.In the pre-intervention period, there was concordance between systolic blood pressure (SBP) and diastolic blood pressure measurements (DBP) obtained through two methods, as well as a high overall concordance after the sessions (Lin's concordance coefficient = 0.82 and 0.81, respectively). Greater concordance in DBP was found after the control session than after exercise sessions. The difference between the measurements obtained between the two methods was greater for DBP than for SBP after all sessions (p < 0.001). Regardless of the method, SBP and DBP fell in the first 60 minutes after the exercises.The auscultatory and oscillometric methods were consistent before and after the control and exercise sessions. However, greater differences were found in DBP than in SBP. The latter was very similar between methods.

Influence of Concurrent Obesity and Low Birth Weight on Blood Pressure Phenotype in Youth

The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those subjects with low birth weight who became obese. The lowest BP values were present in nonobese subjects in the absence of low birth weight. In the middle, with similar BP values, were nonobese subjects with low birth weight and obese subjects in the absence of low birth weight. No interaction existed between obesity and low birth weight in the office (P=0.165) or ambulatory (P=0.603) systolic BP values. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in the nonobese low birth weight group when compared with the other groups after controlling for height, heart rate, and diastolic BP. A significant interaction between low birth weight and obesity (P<0.005) existed. In conclusion, although the low birth weight children who become obese have the highest systolic BP values, the presence of obesity blunts the increment of the reflecting wave observed in low birth weight subjects.

Genetic model of myocardial hypertrophy without elevated blood pressure in rats

A population of fourth-, fifth-, and sixth-generation hybrids obtained by crossing SI IR and WKY rats was studied. These hybrids were a basis for obtaining a genetic model of myocardial hypertrophy (МH) without elevated blood pressure (BP). To reveal the given phenotype (MH without elevated BP), the degree of MH was noninvasively estimated by vectorocardiography in combination with noninvasive BP measurement on the caudal artery. Systolic BP in male hybrids of die fourth and fifth generation was 127 ± 3 and 123 ± 3 mm Hg, respectively, which was much lower than that in male rats of the progenitor line SHR (183 ±5 mm Hg) and practically equal to that in rats of the progenitor line WKY (128 ± 3 mm Hg). The similar BP values were also observed in female rats of the study populations. The weight of the heart of male hybrids F4. F5, and F6 was more than that in the WKY group (1,17 ± 0,03, 1,01 ± 0,04, and 1,19 ± 0,03 g, respectively, and 0,89 ± 0303 g, at p < 0,05 in WKY rats), but less than the values for the SHR group (1,38 ± 0,11 g, p < 0,05). The experimental model may be interesting and useful in solving a variety of physiological, genetic, and pharmacological problems.

Elastic behaviour of the carotid artery in intact spontaneously hypertensive rats.

Intact spontaneously hypertensive rats (SHR) were studied to assess the effect of prolonged antihypertensive treatment on the elastic behaviour of the external carotid artery. Thirty-week-old SHR received the ACE inhibitor captopril, the arteriolar dilator hydralazine or their vehicle for 6 weeks. These rats were compared to normotensive, vehicle treated WKY rats. The internal diameter of the carotid artery was measured continuously in halothane-anaesthetized rats using an echo-tracking device, and intra-arterial pressure was also monitored continuously, on the contralateral side. Captopril- and hydralazine-treated SHR as well as normotensive controls had similar blood pressure values. No significant shift in the distensibility-pressure curves was observed among vehicle-treated SHR and WKY rats or the SHR which had received captopril or hydralazine. Histological examination of the carotid artery fixed ex vivo with paraformaldehyde showed a significant increase in cross-sectional area in vehicle-treated SHR as compared to their normotensive counterparts. These results therefore suggest that the elastic behaviour of elastic arteries is not necessarily altered by the structural changes developing in response to hypertension.