Systolic Blood Pressure Load Research Articles

P1825ANALYSIS OF LATE RENAL COMPLICATIONS AND RISK FACTORS IN CHILDREN WITH HEMATOPOIETIC STEM CELL TRANSPLANTATION

Abstract Background and Aims The aim of the study is to investigate the incidence and risk factors of hypertension (HT) and chronic kidney disease (CKD) in patients who had hematopoietic stem cell transplantation (HSCT) during their childhood. Method Patients who had HSCT between January 2010-2019 with a minimum follow-up period of 6 months were included in the study. Data regarding renal complications were collected from the medical records of the patients. Guidelines of European Society of Hypertension (ESH) and American Academy of Pediatrics (APA) were used for the evaluation of hypertension. 24-hr ambulatory blood pressure monitoring (ABPM) was performed in children older than 5 years of age (68 patients). Ambulatory hypertension is diagnosed when systolic and/or diastolic blood pressure (BP) load is higher than 25%. Ambulatory prehypertension is diagnosed when mean systolic and/or diastolic BP is less than 95th percentile with systolic and/or diastolic BP load higher than 25%. Results A total of 72 patients (41 males and 31 females) were included in the study. The mean age of the patients at last visit was 10.8±4 years. ABPM revealed ambulatory HT in 6 patients (8.8%) and ambulatory prehypertension in 12 patients (17.6%). Office BP revealed HT in 3 patients (4.2%) and increased BP in four patients (5.6%) according to APA guideline (2017). In cohort, 12 patients with normal office BP (according to APA guideline) had ambulatory prehypertension or hypertension with ABPM. Office BP revealed HT in 1 patient (1.4%) and high-normal BP in 3 patients (4.2%) according to ESH guideline. In cohort, 15 patients with normal office BP (according to ESH guideline) had ambulatory prehypertension or hypertension with ABPM (Table 1). After a mean follow-up period of 4.4±2.5 years, CKD developed in 8 patients (11.1%). Patients with chronic graft-versus-host disease, with HLA-mismatched HSCT and/or transplantation of peripheric or cord blood hematopoietic stem cells had increased risk of CKD (p=0.041, p=0.033 and p=0.002, respectively). Conclusion Patients with HSCT should be regularly followed for the development of HT and ABPM should be used on regular basis. Patients with risk factors should be closely monitored for the development of CKD.

Circulating chemerin level may be associated with early vascular pathology in obese children without overt arterial hypertension - preliminary results.

Background Elevated chemerin level is observed in patients with arterial hypertension. The aim of the study was to determine the relationship between chemerin level, and parameters of blood pressure and arterial stiffness in children and adolescents with obesity but without arterial hypertension. Methods In 23 children with obesity (13 girls, mean age 9.3, SD 1.9, mean BMI SDS 3.9, SD 1.7) 24h ABPM (Spacelabs 90,217, USA), common carotids and abdominal aorta intima media thickness measurements (Voluson 730, GE Medical System 8.5 and 3.5MHz probes), body composition analysis (Tanita BC 418SMA, Tokyo, Japan) were performed. Glucose, triglycerides, total, LDL and HDL cholesterol, liver enzymes, uric acid, creatinine, sodium, insulin and chemerin levels were assessed in blood sample taken after a 12-h fasting period. Results There was a significant correlation of circulating chemerin level with systolic blood pressure load in ABPM (r=0.5, p<0.05). Conclusion Elevated chemerin level may be associated with increased systolic blood pressure in obese children.

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.

Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD.

Elevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs. We studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters. Overall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load. BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3.

Ambulatory Blood Pressure Phenotypes in Children and Adolescents

Ambulatory Blood Pressure Phenotypes in Children and Adolescents

The Association between Nitric Oxide Pathway, Blood Pressure Abnormalities, and Cardiovascular Risk Profile in Pediatric Chronic Kidney Disease.

Cardiovascular disease (CVD) is common in chronic kidney disease (CKD), while major CV events are rare in young CKD patients. In addition to nitric oxide (NO)-related biomarkers, several surrogate markers have been assessed to stratify CV risk in youth with CKD, including 24-h ambulatory blood pressure monitoring (ABPM), carotid artery intima-media thickness (cIMT), pulse wave velocity (PWV), ABPM-derived arterial stiffness index (AASI), flow-mediated dilatation (FMD), and left ventricular mass index (LVMI). The aim of this study was to identify subclinical CVD through the analysis of indices of CV risk in children and adolescents with CKD. Between 2016 and 2018, the prospective observational study enrolled 125 patients aged 3 to 18 years with G1–G4 CKD stages. Close to two-thirds of young patients with CKD exhibited blood pressure (BP) abnormalities on ABPM. CKD children with abnormal office BP showed lower plasma arginine levels and arginine-to-asymmetric dimethylarginine (ADMA) ratio, but higher ratios of ADMA-to-symmetric dimethylarginine (SDMA) and citrulline-to-arginine. High PWV and AASI, indices of arterial stiffness, both strongly correlated with high BP load. Additionally, LV mass and LVMI exhibited strong correlations with high BP load. Using an adjusted regression model, we observed the citrulline-to-arginine ratio was associated with 24-h systolic and diastolic BP, systolic blood pressure (SBP) load, and diastolic blood pressure (DBP) load. Early assessments of NO-related parameters, BP load abnormalities, arterial stiffness indices, and LV mass will aid in early preventative care toward decreasing CV risk later in life for children and adolescents with CKD.

Relationship between systolic blood pressure load and sleep stability in patients with essential hypertension

Objective: To explore the relationship between blood pressure load and sleep stability in hypertensive patients by cardiopulmonary coupling monitoring (CPC) and 24-hour ambulatory blood pressure monitoring. Methods: One hundred and fifty-five patients with essential hypertension were divided into high load group and low load group according to whether the blood pressure load was higher than 50%. The relationship between sleep stability and systolic blood pressure load was analyzed by logistic regression. Results: After adjusting for sex, age and body mass index (BMI), logistic regression analysis showed that stable sleep was the protective factor (OR=0.736,P=0.047) for the decrease of nocturnal blood pressure load, and unstable sleep was the risk factor for increasing day time blood pressure load (OR=1.336, P=0.037) in patients with hypertension. Conclusions: The effect of sleep stability on blood pressure load is different between day and night. Stable sleep is the protective factor of nocturnal systolic blood pressure load decrease, and unstable sleep is the harmful factor of daytime systolic blood pressure load increase. Increasing sleep stability helps to reduce systolic blood pressure load.

Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension.

Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular (LV) function in hypertensive and white coat hypertensive overweight children and teenagers. The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the LV mass and function were performed in all participants. Using ABPM hypertension was confirmed in 20 (27%) children. In the 54 (73%) remaining children white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher LV mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and white coat hypertension-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic blood pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. In overweight children the diagnosis of hypertension should be confirmed in ABPM because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased SBPL and decreased systolic nocturnal deep because of the possibility of LV function impairment.

SAT-325 RELATIONSHIP AND PATTERN BETWEEN AMBULATORY BLOOD PRESSURE MONITORING PARAMETERS AND ESTIMATED GLOMERULAR FILTRATION RATE IN CHILDREN WITH GLOMERULAR AND NON-GLOMERULAR CONDITIONS

Ambulatory blood pressure monitoring (ABPM) is an important tool for evaluation of blood pressure (BP) among high risk children including those with renal diseases. Our study aimed to describe and compare the ABPM parameters between children with glomerular and non-glomerular renal conditions, and explore the relationship between the various ABPM parameters and the estimated glomerular filtration (eGFR). We performed a cross-sectional review of the office BP records and ABPM reports of children followed up in the paediatric nephrology clinic of Queen Elizabeth Hospital, Hong Kong from year 2013-2017. ABPM reports with <70% success rate were excluded. Among subjects with ≥1 ABPM reports, only the first available report was included for analysis. The renal diagnosis was categorized into glomerular diseases and non-glomerular disease comprising congenital anomalies of kidney and urinary tract (CAKUT), cystic kidney diseases, renovascular hypertension, neurogenic bladder / bladder dysfunction and other conditions. Altogether there were 67 patients included in the final analysis. The median age (interquartile range) of the cohort was 14.5 (5.4) years and the median BMI was 19.3 (5.0) kg/m2. Glomerular diseases accounted for 23.9% of all renal conditions and the median eGFR of the whole cohort was 96.3 (34.6) ml/min/1.73m (Table 1)2. There were 62.7% of subjects having ABPM hypertension (ABPM systolic or diastolic hypertension in either wake or sleep periods), and 40.3% of subjects were non-dippers (nocturnal dipping <10%). Office BP hypertension was found in 35.9% of subjects and 25% of subjects had masked hypertension. Only 16.7% of subjects with ABPM hypertension were receiving anti-hypertensive medications. The baseline characteristics of subjects with glomerular and non-glomerular diseases showed no significant difference, and the ABPM parameters in both wake and sleep periods were comparable between the two groups (Table 2). Most subjects with non-glomerular diagnoses had no hypertension (35.4%), whereas ambulatory hypertension (both office BP hypertension and ABPM hypertension) was the commonest BP category (37.5%) among those with glomerular conditions (p=0.934) (Figure 1). The median eGFR of children with glomerular and non-glomerular diseases showed no significant difference (p=0.538). All systolic or diastolic BP indices and BP loads in wake and sleep periods showed a significantly inverse relationship with the eGFR among children with glomerular diseases (Table 3). The relationship was stronger for glomerular than non-glomerular conditions. A lower eGFR among children with glomerular disease could be observed in those having wake or sleep ABPM hypertension (systolic or diastolic) or ABPM hypertension, as well as non-dippers. And a significant difference could be found among those with wake period diastolic hypertension (p=0.036) and sleep period systolic hypertension (p=0.044). Masked hypertension and non-dippers were common among children with renal conditions and most children with ABPM hypertension were not receiving anti-hypertensives. Both the wake and sleep period ABPM parameters demonstrated a negative correlation with eGFR among children having glomerular diseases at a relatively normal eGFR. The results indicated that regular ABPM should be performed for children with renal conditions, even without chronic kidney disease.

Differing Impact of Weight Cycling on Ambulatory Blood Pressure Versus Conventional Blood Pressure Assessment: A Possible Explanation to Controversy

BACKGROUND: Weight Cycling (WC) is a widespread behavior associated with deleterious cardiovascular (CV) health, including elevated blood pressure (BP). Yet, a 2010 review analyzing the effects of WC on BP concluded there was not enough quality evidence to draw any sort of decisive conclusions. Ambulatory BP (ABP) monitoring is recognized as a superior method of measurement and predictor of the CV state when compared to traditional laboratory BP assessment. The impact that WC may have on ABP per se is unknown. METHODS: Impact of self-reported WC history on ABP was assessed via a causal comparative non-experimental design. Sixty-five women completed the Weight and Lifestyle Inventory questionnaire (WALI). The WALI has been shown to be a reliable index of WC (r=.87, P<0.001). Subjects were classified as weight cyclers (WC) if they reported a weight loss of ≥ 4.5 kg at least 3 times followed by weight regain. Those who reported less than this were classified as non-weight cyclers (NWC). Main outcome was mean differences between groups on laboratory BP and ABP. RESULTS: WC (n=31) were older (39.7±8.9 vs 33.1±11.3 yr), had a higher percent body fat (47.1±6.2 vs 41.4±7.8 (%)), and were less fit (21.2±5.4 vs 26.7±7.6 ml.kg-1.min-1) than NWC (n=34). No significant differences were found for laboratory BP values. WC women had higher systolic (130.1±13.6 vs 122.0±8.2 mmHg, P=0.006) and diastolic (76.2±8.9 vs 70.0±9.0 mmHg, P=0.011) ABP values than NWC women. Systolic (23% versus 17%, P <0.001) and diastolic (13% versus 9%, P < 0.001) BP load was higher for WC compared to NWC women. CONCLUSION: WC may deleteriously impact BP outcomes that might only be witnessed when ABP monitoring is used.

Detection of orthostatic hypotension with ambulatory blood pressure monitoring in parkinson's disease.

We sought to test the accuracy of 24-hours ambulatory blood pressure (BP) monitoring (ABPM) for the detection of orthostatic hypotension (OH) in Parkinson's disease (PD). A total of 113 patients referred for autonomic testing between January 2015 and June 2017 underwent ABPM and office BP measurements in supine and standing positions. The study population consisted of 81 males and 32 females with PD duration of 6.5 ± 4.1 years and Hoehn and Yahr staging of 1 (13.3%), 1.5 (20.4%), 2 (27.4%), 2.5 (23.9%), 3 (13.3%), and 4 (1.8%). Motor fluctuations were present in 44% of patients. The data from office BP recordings were compared to selected ABPM parameters, and the results showed an association between OH and (a) ABPM-detected hypotensive episodes (Hypo-ep) and (b) ABPM-detected awakening hypotension (Hypo-aw). Having 2 or more Hypo-ep episodes ≤15 mmHg (systolic) compared to average 24-h systolic BP [Formula: see text] yielded 75% diagnostic accuracy for OH, while the presence of at least one [Formula: see text] within 90 min after getting up [Formula: see text] yielded 93% specificity for OH. A diagnostic accuracy of 87.6% was achieved when including daytime and nighttime ABPM values, weighted BP variability, systolic and diastolic BP loads, nocturnal dipping, and postprandial hypotension in a computerized prediction algorithm. In conclusion, our findings suggest that selected ABPM parameters, such as the number of hypotensive episodes and the presence of awakening hypotension, may be used to screen patients for OH, while using a computerized prediction algorithm that includes all ABPM parameters provides the greatest diagnostic accuracy.

Left ventricular cardiac geometry and ambulatory blood pressure in children.

Limited information is available regarding the relationship between ambulatory blood pressure monitoring (ABPM) and cardiac geometry in hypertensive children. ABPM and 2D-echocardiography were retrospectively reviewed in children and adolescents <21years old with primary hypertension. A total of 119 participants (median age 15.0 [IQR 12, 16] years) with hypertension were included. Left ventricular hypertrophy was diagnosed in 39.5% of participants. Normal geometry was found in 47.1%, concentric remodeling (CR) in 13.4%, concentric hypertrophy (CH) in 15.1%, and eccentric hypertrophy (EH) in 24.4% of children. After adjustment for age, sex, and body mass index z-score, awake systolic blood pressure (BP) index (BPi) (OR 1.07, 95% CI: 1.001-1.14, P=0.045), awake diastolic BPi (OR 1.04, 95% CI: 1.00-1.09, P=0.048), awake systolic BP load (OR 1.02, 95% CI: 1.000-1.04, P=0.047), and sleep systolic BP load (OR 1.02, 95% CI: 1.001-1.04, P=0.03) were directly associated with CH. No ABPM parameters were significant predictors of EH. In conclusion, ABPM parameters were found to be independent predictors of cardiac geometry, specifically CH.

Effect of " Huoxue Sanfeng acupuncture" auxiliary therapy on morning blood pressure and blood pressure load in elderly patients with stroke complicated with hypertension

To observe the effects of "Huoxue Sanfeng acupuncture" auxiliary therapy on neurological function, blood pressure load and morning blood pressure in elderly patients with stroke complicated with hypertension, on the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine. Seventy patients with stroke complicated with hypertension were randomly divided into an observation group and a control group, 35 cases in each group. "Xingnao Kaiqiao acupuncture" and conventional nifedipine controlled release tablets were given in the control group. Regarding regaining consciousness with acupuncture, the main acupoint is Shuigou (GV 26), combined with Neiguan (PC 6) and Sanyinjiao (SP 6), retaining needle for 20 min, additionally, the quick needling technique was applied to Shangjiquan (Extra), Chize (LU 5) and Weizhong (BL 40) of the affected side, nifedipine controlled release tablets were orally administered 30 mg once a day for a total of 6 weeks. The "Huoxue Sanfeng acupuncture" was added on the basis treatment in the observation group, the acupuncture was applied at Renying (ST 9) as the main acupoint, combined with Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3). The strict manipulation quantitative acupuncture was used and the needle was retained for 20 min. Both acupuncture methods were performed once a day, 5 times a week, and continued treatment at intervals of 2 days, 10 times for one course, and a total of 3 courses were needed. The morning blood pressure and 24 h blood pressure load were measured before and after treatment. The National Institute of Health stroke scale (NIHSS) score and the Barthel index (BI) classification were observed before and after treatment. The systolic and diastolic blood pressures were significantly lower than those before treatment in the two groups (all P<0.01), and the systolic and diastolic blood pressures in the observation group were lower than those in the control group (both P<0.01). There was no significant difference between the difference of systolic blood pressure before and after treatment in the two groups (P>0.05), and the difference of the diastolic blood pressure before and after treatment in the observation group was higher than that in the control group (P<0.01). The systolic and diastolic pressures load in the two groups were lower than those before treatment (all P<0.01), and the systolic and diastolic pressures load in the observation group were lower than those in the control group (both P<0.05), the difference of systolic and diastolic pressure load before and after treatment in the observation group were higher than those in the control group (both P<0.05). After treatment, the NIHSS scores in the two groups were lower than those before treatment (both P<0.01). The NIHSS scores in the observation group were lower than those in the control group (P<0.05). The difference of NIHSS scores before and after treatment in the observation group was higher than that in the control group (P<0.01). After treatment, the BI grading was better than that before treatment in the two groups (both P<0.05), and the BI grading in the observation group was superior to that in the control group (P<0.05). On the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine controlled release tablets in the treatment of elderly patients with stroke complicated with hypertension, "Huoxue Sanfeng acupuncture" can further improve the function of nerve and limbs, effectively reduce the morning blood pressure level of elderly patients, especially diastolic blood pressure, and significantly improve systolic blood pressure and diastolic blood pressure load.

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 VARIABILITY- THE HIGHER THE WORST?

Objective: Our goal was to establish a normal range for blood pressure variability (BPV) defined by average real variability (ARV) and to assess whether it can be considered as an additional cardiovascular risk factor. Design and method: In contrast to one of our previously published study, which included 110 patients, we selected 80 inefficiently treated hypertensive patient, admitted to County Clinical Hospital Turgu Mures, Romania to adjust hypertensive treatment. The definition of hypertension was based on 24-hour ambulatory BP monitoring (ABPM), by using a validate device (ABPM 05, Meditech Ltd, Hungary®), defined as mean 24-hour BP > 130 and/or > 80 mmHg. After calculating BP variability defined as average real variability (ARV), the median value was used to divide the study population in low (LV) or high variability (HV) group. We compared ABPM derived BP parameters, assessed if there is any correlation between pressure overload and variability. Results: In both groups awake systolic BP was nearly equal 143.7 ± 10.5 mmHg, versus 142.4 ± 12.2 mmHg, p = 0.89. Nighttime diastolic BP was significantly higher in the in the LV group 74.09 ± 8.33 versus 69.02 ± 10.22 mmHg, p = 0.017. In the LV group pressure overload expressed as percent time elevation (PTE%) of systolic and diastolic values were 75.2 ± 15.6/45.21 ± 29 % vs. 67.51 ± 18.21/36.13 ± 25.61% in the HV group, p < 0.0001. The systolic BP load was 322.2 ± 195.7 mmHgxh vs. 314.6 ± 183.7 mmHgxh in the HV group, p < 0.0001. The diastolic BP load was 126.2 ± 112.9 mmHgxh vs. 93.02 ± 101.9 mmHgxh in the HV group, p < 0.0001. No correlation was found between BP variability and systolic PTE or BP load in any of the groups, p > 0.05. Conclusions: We found that patients with low variability presented higher BP values and greater pressure overload. High variability is not necessary a dangerous phenomenon if it is accompanied by low BP values without pressure overload. To appreciate the real efficacy of the antihypertensive treatment, a comprehensive assessment of BP values, variability and pressure overload parameters should be included.

Neurocognitive Function in Children with Primary Hypertension after Initiation of Antihypertensive Therapy

To determine the change in neurocognitive test performance in children with primary hypertension after initiation of antihypertensive therapy. Subjects with hypertension and normotensive control subjects had neurocognitive testing at baseline and again after 1 year, during which time the subjects with hypertension received antihypertensive therapy. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed, and parents completed rating scales of executive function. Fifty-five subjects with hypertension and 66 normotensive control subjects underwent both baseline and 1-year assessments. Overall, the blood pressure (BP) of subjects with hypertension improved (24-hour systolic BP load: mean baseline vs 1 year, 58% vs 38%, P < .001). Primary multivariable analyses showed that the hypertension group improved in scores of subtests of the Rey Auditory Verbal Learning Test, Grooved Pegboard, and Delis-Kaplan Executive Function System Tower Test (P < .05). However, the control group also improved in the same measures with similar effects sizes. Secondary analyses by effectiveness of antihypertensive therapy showed that subjects with persistent ambulatory hypertension at 1 year (n = 17) did not improve in subtests of Rey Auditory Verbal Learning Test and had limited improvement in Grooved Pegboard. Overall, children with hypertension did not improve in neurocognitive test performance after 1 year of antihypertensive therapy, beyond that also seen in normotensive controls, suggesting improvements with age or practice effects because of repeated neurocognitive testing. However, the degree to which antihypertensive therapy improves BP may affect its impact upon neurocognitive function.

Complete blood count-derived inflammatory markers in adolescents with primary arterial hypertension: a preliminary report.

Aim of the studyThe aim of our study was to evaluate selected inflammatory markers in children with untreated primary hypertension and to establish the relation between inflammatory markers and 24-hour ambulatory blood pressure monitoring (ABPM) and clinical and biochemical parameters.Material and methodsIn 54 children (15.12 ±2.02 years) with untreated primary hypertension, with excluded overt inflammation, we evaluated: neutrophils (NEU; 1000/μl), lymphocytes (LYM; 1000/μl), platelets (PLT; 1000/μl), mean platelet volume (MPV; fl), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), ABPM (OSCAR 2 SUNTECH), and selected clinical and biochemical parameters. The control group consisted of 20 healthy children (15.55 ±2.27 years).ResultsChildren with primary hypertension had (p < 0.01) higher 24-hour systolic, diastolic and mean blood pressure, systolic and diastolic blood pressure loads, and pulse pressure. Hypertensive children did not differ in inflammatory indicators (NEU, LYM, PLT, MPV, NLR, PLR) from the control group. In 54 hypertensive children we found the following correlations: between office systolic and diastolic blood pressure and MPV (r = 0.35, p = 0.011, r = 0.36, p = 0.008), between 24-hour ambulatory mean arterial pressure Z-score and NLR (r = 0.30, p = 0.030), 24-hour systolic blood pressure load and NLR (r = 0.38, p = 0.005), plasma renin activity and neutrophil count, NLR, PLR (r = 0.47, p = 0.016, r = 0.64, p < 0.001, r = 0.42, p = 0.033), urinary albumin loss and neutrophil count, NLR (r = 0.46, p = 0.001 and r = 0.42, p = 0.003). Multivariate analysis revealed that office SBP Z-score was related to MPV (β = 0.35, p = 0.008) and albuminuria to neutrophil count (β = 0.62, p = 0.018).ConclusionsIn children with primary arterial hypertension there may be a relation between blood pressure, urinary albumin loss, and subclinical inflammation.

Behavior of Blood Pressure Variables in Children and Adolescents with Duchenne Muscular Dystrophy.

BackgroundDuchenne muscular dystrophy is an X-chromosome-linked genetic disorder (locus Xp21). Involvement of the cardiovascular system is characterized by fibrous degeneration/replacement of myocytes with consequent ventricular hypertrophy and arterial hypertension.ObjectiveTo assess, by using 24-hour ambulatory blood pressure monitoring, the behavior of blood pressure variables in children and adolescents with a confirmed diagnosis of Duchenne muscular dystrophy.MethodsProspective observational cohort study, which selected 46 patients followed up on an outpatient basis, divided according to age groups. Blood pressure was classified according to the age percentile. The monitoring interpretation includes systolic and diastolic blood pressure means, systolic and diastolic blood pressure loads, and nocturnal dipping. The blood pressure means were calculated for the 24-hour, wakefulness and sleep periods. Nocturnal dipping was defined as a drop in blood pressure means during sleep greater than 10%. The significance level adopted was p < 0.05.ResultsNocturnal dipping for systolic blood pressure was present in 29.9% of the participants. Approximately 53% of them had attenuated nocturnal dipping, and 15%, reverse nocturnal dipping. The age groups of 9-11 years and 6-8 years had the greatest percentage of attenuation, 19.1% and 14.9%, respectively. Regarding diastolic blood pressure, nocturnal dipping was identified in 53.2% of the children, being extreme in 27.7% of those in the age group of 6-11 years.ConclusionsThe early diagnosis of blood pressure changes can allow the appropriate and specific therapy, aimed at increasing the life expectancy of patients with Duchenne muscular dystrophy.

Показатели суточного мониторирования артериального давления как предиктор наличия апноэ во сне у пациентов с цереброваскулярными заболеваниями

The study sample comprised 75 patients, median age 66 years (43 [57,3%] women), admitted within 24 hours after ischemic stroke onset. Breathing during sleep was monitored with an ambulatory device, which monitors nasal airflow and pulse oximetry. We selected patients at sleep apneaverified by respiratory monitoring to the first group (n=54) and patients without sleep - disordered breathing to the second group (n=21). Subgroup analysis found, among other things that a reverse dipper pattern does not change according to AHI. But the results indicate increased systolic BP load and low saturations associated with increased AHI in patients with stroke.

Comparison of ambulatory blood pressure monitoring and office blood pressure measurements in obese children and adolescents

Background: Obesity in adults has been related to hypertension and abnormal nocturnal dipping of blood pressure, which are associated with poor cardiovascular and renal outcomes. Here, we aimed to resolve the relationship between the degree of obesity, the severity of hypertension and dipping status on ambulatory blood pressure in obese children.Methods: A total 72 patients with primary obesity aged 7 to 18 years (mean: 13.48 ± 3.25) were selected. Patients were divided into three groups based on body mass index (BMİ) Z-score. Diagnosis and staging of ambulatory hypertension based on 24-h blood pressure measurements, obtained from ambulatory blood pressure monitoring.Results: Based on our ambulatory blood pressure data, 35 patients (48.6%) had hypertension, 7 (20%) had ambulatory prehypertension, 21 (60%) had hypertension, and 7 patients (20%) had severe ambulatory hypertension. There was a significant relationship between severity of hypertension and the degree of obesity (p < 0.05). Thirty-one patients (88.6%) had isolated nighttime hypertension, and 53 patients (73.6%) were non-dippers. All systolic blood pressure results and loads were similar between groups. Diastolic and mean arterial blood pressure levels during the night, diastolic blood pressure loads, and heart rate during the day were significantly higher in Group 3 (p < 0.05). Nocturnal non-dipping was not associated with severity of obesity.Conclusion: Obesity was associated with severity of hypertension, higher diastolic blood pressure at night, mean arterial pressure at night, diastolic blood pressure loads and heart rate at day. Increase in BMI Z-score does not a significant impact on daytime blood pressure and nocturnal dipping status.