Office Systolic Blood Pressure Research Articles

OBSTRUCTIVE SLEEP APNEA AND TARGET BP VALUE IN NON-OBESE HYPERTENSIVE PATIENTS

Objective: To assess obstructive sleep apnea impact on the target blood pressure (BP) value achievement in non-obese hypertensive patients. Design and method: In this prospective cross-sectional study were included 305 patients (mean age 60.0 years old [48.0; 67.0], 203 men) with different stages and grades of arterial hypertension (AH). All patients have been receiving antihypertension therapy, prescribed by their cardiologist, for at least 3 weeks before inclusion in the study. During the study, office systolic and dyastolic blood pressure (SBP and DBP resp.) were assessed (oscillometric method, Omron, Japan) and home sleep respiratory monitoring (SomnoChek, Weinmann, Germany) was done in all patients. Results: Two groups were formed: non-target BP group (BP>140/90 mm Hg, n=164) and target BP group (BP<140/90 mm Hg, n=141). Comparative data analysis included such indicators as: age, body mass index (BMI), apnea/hypopnea index (AHI), desaturation index (DI) and minimum oxygen saturation (min SaO2), revealed only differences between age (61.0 years old [50.0; 68.0] versus 57.0 years old [47.0; 66.0] resp., p=0.03) and BMI (32.5 kg/m2 [29.7; 38.1] vs. 31.6 kg/m2 [27.8; 35.5] resp., p=0.02). The analysis of non-obese patients’ data (BMI <30 kg/m2, n=100) didn’t reveal differences by age, but a higher value of AHI and DI were determined in patients with non-target BP, as well as higher BMI; similar differences were not found in obese patients (BMI>30 kg/m2, n=205) (Table 1). In two-factor logistic regression analysis (included AHI and BMI) AHI was the only predictor of non-target BP in patients without obesity, while BMI had no predictive value (Table 2). Conclusions: Even mild or moderate obstructive sleep apnea may be an important negative factor in achieving BP targets in non-obese patients, unlike the other clinical cases with AH.

DAY-TO-DAY REPRODUCIBILITY OF NOCTURNAL BLOOD PRESSURE FALL (DIPPING) EVALUATED WITH WEARABLE AND HOME DEVICES IN HYPERTENSIVE PATIENTS

Objective: Non-dipping status has been associated with increased risk of heart failure and cardiovascular events. However, its reproducibility when evaluated by means of ambulatory blood pressure monitoring (BPM) is often suboptimal. Wearable devices (WD) and home BPM devices equipped with nocturnal measurement function (HBPMN) offer the opportunity of estimating dipping status over different days thus potentially increasing precision owing to statistical averaging. We aimed to determine the reproducibility of nocturnal BP dipping estimated through a combined use of WD and HBPMN devices for daytime and night-time BP estimation within one week. Design and method: We recruited treated and untreated adult patients with hypertension. Patients underwent one week of home BP monitoring through a HBPMN device (NightView, OMRON Healthcare, HEM9601T-E3) and with an oscillometric WD (HeartGuide, OMRON Healthcare, HEM-6411T-MAE). Patients were asked to measure BP over one week with WD according to ESH-HBPM guidelines for daytime measurements and with HBPMN according to standard device settings for night-time measurements. Interclass correlation coefficient (ICC) was calculated to evaluate reproducibility. Results: 76 patients were included in the study. The main characteristics are summarised as follows: age (61±11.84 years), 32 (42%) females, BMI (28.12±4.90 Kg/m2). Most of them (98%) were treated hypertensives. Office systolic and diastolic BP were 134±4.43 mmHg and 80±4.84 mmHg, respectively. The average one-week systolic BP dipping was 16.14±9.44%. When we considered patients who had dipping assessment over at least the first 5 days (37 patients), intra-individual variability in the categorical definition of dipping status was observed (Figure 1) with a suboptimal reproducibility of average nocturnal BP fall (ICC 0.60). Conclusions: Nocturnal BP dipping estimated as continuous variable through the combined use of WD and HBPMN exhibits suboptimal reproducibility resulting in a variable day-by-day classification of patients according to their dipping status. Whether this reflects technical issues, or rather depends on the physiological variability of BP and sleeping patterns needs to be determined by future studies.

ENGAGEMENT AND ATTRITION IN A TELEHEALTH SERVICE FOR HYPERTENSIVE PATIENTS. A SINGLE CENTER EXPERIENCE

Objective: To investigate engagement with blood pressure telemonitoring and counselling (BPTM) in patients with hypertension (HTN) and its predictors. Design and method: Patients with uncontrolled HTN (office systolic (S) BP >140 mm Hg) were recruited consecutively in a large reference center. Only patients who were motivated and willing to participate were included. The telehealth system consisted of a home BP telemonitoring service and an on-demand text chat with the patient's attending physician. The BPTM continued for 3 months with mandatory baseline and follow-up visits, as well as completion of the HYPE (HYpertension imPact quEstionnaire) to assess quality of life. Patients who did not report BP readings for 2 weeks + after 2 alerts were termed ’quit’. Others comprised the ’continued’ group. Results: A total of 92 patients were included in the final analysis (median age 43 years, 69 men, 49 at low-intermediate CVD risk). At baseline, median office SBP was 155 mm Hg (150;162) and office diastolic (DBP) was 95 mm Hg (90;102). Over the 3 months, SBP and DBP decreased significantly (-16 and -11 mm Hg, respectively; p <0.001 for both). There was a greater reduction in SBP at home (-8 mm Hg from 1 week to 3 months, p <0.001). A total of 43 patients continued BPTM and 48 patients discontinued BP telemonitoring (85% of them after 1 month). The groups were well matched for age, sex, and baseline BP. The δSBP did not differ between the two groups, nor did the median number of questions (3 consultations/patient). Higher baseline office SBP (β = 0.03, p = 0.043) and male sex (β = 1.15, p = 0.041) were predictors of high engagement with the telehealth service after adjustment for other covariates. Quality of life at 3 months was higher in the ’continuing’ patients. (δ+8 points HYPE). Conclusions: Telemonitoring and remote counseling are effective in patients with HTN. Even when patients are motivated to use telehealth, more than half of them discontinue during the first months, predominantly female patients with mild uncontrolled HTN. Patients who continue BPTM experience a higher quality of life.

PEAK NOCTURNAL HOME BLOOD PRESSURE AS AN EARLY AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP NOCTURNAL BP STUDY

Objective: Recent evidence suggests a correlation between nighttime blood pressure BP) measured through ambulatory BP monitoring (ABPM), the nocturnal BP dipping phenotype, and cardiovascular risk. However, the clinical implications of elevated peak nighttime home BP are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in outpatients with one or more cardiovascular risk factors. Design and method: In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare) at baseline. Peak nighttime home SBP was defined as average of the highest three values recoded during the 14-night measurement period. Cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) were tracked over a mean 7.1 years’ follow-up period. Results: This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male) with their nighttime home BPs. After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), individuals with peak nighttime home systolic blood pressure (SBP) in the highest quintile (Q5, >=149.0 mmHg) demonstrated a significantly elevated risk of stroke compared to those in the lowest quintile (Q1, <119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with >=6 nighttime home SBP measurements). Even when controlling for average real variability of nighttime BP, peak nighttime home SBP remained an independent predictor of stroke risk. On spline regression analysis, the average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg. Conclusions: We propose exaggerated peak nighttime home SBP determined from >=6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.

Efficacy and safety of a single-pill versus free combination of perindopril/indapamide/amlodipine: a multicenter, randomized, double-blind study in Chinese patients with hypertension.

In China, the prevalence of hypertension is high and the use of combination antihypertensive therapy is low, which contributes to inadequate blood pressure (BP) control. The availability of simplified treatments combining complementary BP-lowering agents may help more patients achieve their goals. This Phase III, multicenter, randomized, double-blind, noninferiority study included Chinese adults with mild-to-moderate hypertension. Following a 1-month run-in on perindopril/indapamide bi-therapy, patients with uncontrolled systolic/diastolic BP (≥140/90 mmHg) were randomized to perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg (Per/Ind/Aml) single-pill combination (SPC) or perindopril 4 mg/indapamide 1.25 mg plus amlodipine 5 mg (Per/Ind + Aml) for 6 months. Uptitration was permitted from month 2 onwards. The primary efficacy objective was the noninferiority of Per/Ind/Aml in lowering office systolic BP at 2 months. The secondary objectives included the effectiveness of SPC on diastolic BP, uptitration efficacy, and office BP control (systolic/diastolic <140/90 mmHg). A subgroup of patients participated in 24-h ambulatory BP monitoring (ABPM). A total of 532 patients were randomized: Per/Ind/Aml ( n = 262) and Per/Ind + Aml ( n = 269). Overall, the mean (±SD) age was 55.7 ± 8.8 years, 60.7% were male, and the mean office systolic/diastolic BP at baseline on Per/Ind was 150.4/97.2 mmHg. Systolic BP decreased in both groups at 2 months from baseline: -14.99 ± 14.46 mmHg Per/Ind/Aml versus -14.49 ± 12.87 mmHg Per/Ind +Aml. A predefined noninferiority margin of 4 mmHg was observed ( P < 0.001). The effectiveness of the Per/Ind/Aml SPC was also demonstrated for all secondary endpoints. ABPM demonstrated sustained BP control over 24 h. Both treatments were well tolerated. Per/Ind/Aml is an effective substitute for Per/Ind + Aml, providing at least equivalent BP control over 24 h in a single pill, with comparable safety.

Primary Arterial Hypertension Associated with Cognitive Dysfunction in Young Adults: Results from a Cross-Sectional Controlled Study.

Despite evidence of primary hypertension (PH)-associated cognitive dysfunction in pediatric, middle-aged, and older adult populations, respective data in young adults remains scarce. We aimed to define differences in cognitive performance between individuals with PH and healthy controls in early adulthood. A convenience sample of young adults (age 18-45 years) with PH and their healthy sex, age, education, and household income matched counterparts were cross-sectionally tested for verbal fluency, verbal memory, general intelligence, reaction speed, attention, visual memory, and executive functioning. Between-group differences were determined using Student's t and Mann-Whitney U tests. Sensitivity analysis was performed by adjusting for body mass index (BMI) in analysis of covariance (ANCOVA) and regression models. Thirty-three adults with PH (22, 66.7% male, median age 38.8, interquartile range (IQR) = 33.2-41.6 years) and twenty-two healthy controls (9, 40.9% male, median age 36.1, IQR = 27.5-39.8 years) completed the neuropsychological assessment. Participants with PH performed worse on computerized tasks of reaction time (median response time (Z = -2.019, p = 0.044), median time for release of response button (Z = -2.509, p = 0.012)) and sustained attention (signal detection measure, RVPA (t = 2.373, p = 0.021), false alarms ÷ (false alarms + correct rejections), RVPPFA (Z = -2.052, p = 0.040)). The group variable was not a statistically significant predictor of performance in these domains after adjustment for BMI (p > 0.05). In regression analyses, high office systolic blood pressure (oSBP) was independently associated with poor sustained attention (βSBP(st.) = -0.283, multiple R2 = 0.252 (RVPA), βSBP(st.) = 0.551, multiple R2 = 0.386 (RVPPFA)). Young adults with PH were found to perform worse in tasks of response speed and sustained attention. While the difference between neuropsychological evaluation results in PH and control groups was confounded by BMI, oSBP measures were independently related to sustained attention. The selectivity of PH-associated cognitive profile in young adults has to be confirmed in larger trials.

Effect of Alcohol-Mediated Renal Denervation on Blood Pressure in the Presence of Antihypertensive Medications: Primary Results from the TARGET BP I Randomized Clinical Trial.

Renal denervation (RDN) has demonstrated clinically relevant reductions in blood pressure among individuals with uncontrolled hypertension despite lifestyle intervention and medications. The safety and effectiveness of alcohol-mediated RDN has not been formally studied in this indication. TARGET BP I is a prospective, international, sham-controlled, randomized, patient- and assessor-blinded trial investigating the safety and efficacy of alcohol-mediated RDN. Patients with office systolic blood pressure (SBP) ≥150 and ≤180 mmHg, office diastolic BP ≥90 mmHg and mean 24-hour ambulatory SBP ≥135 and ≤170 mmHg, despite prescription of 2-5 antihypertensive medications were enrolled. The primary endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 3 months post procedure. Secondary endpoints include mean between-group differences in office and ambulatory BP at additional time points. Among 301 patients randomized 1:1 to RDN or sham control, RDN was associated with a significant reduction in 24-hour ambulatory SBP at 3 months (mean ± standard deviation -10.0 ± 14.2 mmHg versus -6.8 ± 12.1 mmHg, treatment difference -3.2 mmHg, 95% confidence interval [CI] -6.3, 0.0 mmHg; P=0.0487). Subgroup analysis of the primary endpoint revealed no significant interaction across predefined subgroups. At 3 months, the mean change in office SBP was -12.7 ± 18.3 mmHg and -9.7 ± 17.3 mmHg (difference, -3.0, 95% CI -7.0, 1.0; P=0.173), for RDN and sham, respectively. No significant differences in ambulatory or office diastolic BP were observed. Adverse safety events through 6 months were uncommon with 1 instance of accessory renal artery dissection in the RDN group (0.7%). No significant between-group differences in medication changes or patient adherence were identified. Alcohol-mediated RDN was associated with a modest but statistically significant reduction in 24-hour ambulatory systolic BP compared with sham control. No significant differences between groups in office BP or 6-month major adverse events were observed.

Safety and efficacy of once-daily dexfadrostat phosphate in patients with primary aldosteronism: a randomised, parallel group, multicentre, phase 2 trial

Primary aldosteronism (PA) is caused by autonomous aldosterone overproduction and characterised by uncontrolled hypertension. There are currently no treatments that targetaldosterone synthesis. We evaluated the safety and efficacy of a novel aldosterone synthase inhibitor, dexfadrostat phosphate, in patients with PA. This multi-centre, randomised, phase 2 trial was conducted between November 2019 and May 2022 (NCT04007406; EudraCT code 2019-000919-85). Adults with PA and an office systolic blood pressure of 145-190mmHg were included. After a 2-week single-blind placebo run-in period, participants were randomised 1:1:1 to receive oral dexfadrostat phosphate 4, 8, or 12mg once daily for an 8-week double-blind treatment period, followed by a 2-week single-blind placebo withdrawal period. Randomisation was conducted centrally and stratified by centre and sex. At the beginning and end of the treatment period, 24h ambulatory systolic blood pressure (aSBP) was recorded. Blood samples were taken every 2 weeks. Primary endpoints were the change in aldosterone-to-renin ratio (ARR) and mean 24h aSBP from baseline to the end of the treatment period in the combined dose group of all participants receiving any dose of dexfadrostat phosphate. Safety endpoints were the occurrence of treatment-emergent adverse events (TEAEs) and serious adverse events over the entire study in all randomised participants who received at least one dose of dexfadrostat phosphate. In total, 35 participants received dexfadrostat phosphate and all participants completed the study. Twenty-six participants (74.3%) were male, the mean age was 51.9 years (SD 8.7), and most were White (n=32, 91.4%). The median ARR and the mean 24h aSBP significantly decreased from the beginning to the end of the treatment period in the combined dose group (ARR: 15.3 vs 0.6, least-squares mean [LSM] change in log-normal values-2.5, p<0.0001; aSBP: 142.6 vs 131.9mmHg, LSM change-10.7mmHg, p<0.0001). There were no safety concerns; all TEAEs were mild or moderate and there were no serious TEAEs. Dexfadrostat phosphate corrected the ARR and aSBP and was well tolerated in patients with PA, demonstrating the benefit of pharmacologically targeting the source of hyperaldosteronism. DAMIAN Pharma AG.

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study.

Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991-1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping-dipping (n = 152/33.6%), dipping-non-dipping (n = 198/43.8%), non-dipping-dipping (n = 20/4.4%), and non-dipping-non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping-non-dipping group, and lowest (6.6%) in the dipping-dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping-non-dipping pattern with CV events compared with the dipping-dipping pattern remained significant (HR 4.01; 95% CI 1.89-8.67, p < 0.001). In summary, non-dipping-non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

A novel, proof-of-concept radiofrequency renal denervation strategy to improve procedural efficiency: 12-month results from the SPYRAL DYSTAL pilot study

BackgroundCatheter-based renal sympathetic denervation (RDN) reduced blood pressure (BP) in multiple randomized sham-controlled trials of patients with uncontrolled hypertension (HTN). We tested proof-of-concept for a more selective treatment strategy, exclusively targeting these areas to improve the efficiency of the procedure. MethodsThe SPYRAL DYSTAL Pilot study was designed to mirror the SPYRAL HTN-OFF MED Pivotal study, enabling comparison with a propensity score adjusted active-control group. Patients were antihypertensive medication-free for one month before undergoing BP assessment. Those with office BP of 150–180/>90 mmHg and with an ambulatory systolic BP of 140–170 mmHg were selected to undergo open label treatment, delivering energy only to the distal main renal arteries and first order branches. Patients from DYSTAL were compared with patients who underwent maximized RF RDN treatment in the prior randomized OFF MED trial at 3 months. After 3 months, patients resumed antihypertensive medications as indicated. Safety and efficacy outcomes were assessed post hoc through 12 months. ResultsThe SPYRAL DYSTAL Pilot study treated 56 HTN patients. Baseline office systolic BP (OSBP) and 24-h ambulatory systolic BP (ASBP) were similar between DYSTAL and OFF MED patient groups. The number of ablations (32.3 ± 8.0 vs 46.6 ± 15.3, p < 0.001), procedure time (67 ± 21 min vs 99 ± 36 min; p < 0.001), and contrast volume (173 ± 77 cc vs 208 ± 96 cc; p = 0.014) were significantly lower with the simplified treatment strategy. OSBP and ASBP changes compared with baseline were −9.0 and −1.4 mmHg at 3 months, −20.3 and −13.9 mmHg at 6 months, and −20.3 and −16.6 mmHg at 12 months, respectively. During the medication up-titration phase, BP reductions among DYSTAL patients were similar to reductions observed in OFF MED through 12 months, with comparable number of drugs (1.4 and 1.5 medications, respectively (P=NS)). Two adverse events related to guidewire placement were reported. ConclusionIn this pilot study, focusing ablation treatment on the distal main and proximal branch renal arteries was performed, resulting in fewer RF lesions, and reduced contrast volume and procedure time. Whether BP reductions are similar between a selective vs. maximized RDN approach requires further prospective study.

Serum isolevuglandin IgG antibody concentrations are increased in patients with systemic lupus erythematosus and associated with lower 24-hour blood pressure

ObjectiveHypertension is frequent in patients with systemic lupus erythematosus (SLE) and is a major contributor to increased cardiovascular risk. Isolevuglandins (IsoLGs) are downstream products of oxidative stress that drive hypertension and SLE disease activity in animal models. Antibodies to IsoLGs (anti-IsoLGs) are present in human SLE and associated with disease activity, but it is not known if concentrations are higher compared to control subjects or if they are associated with blood pressure (BP).MethodsWe measured serum anti-IsoLG IgG antibody concentrations by sandwich ELISA in 23 patients with SLE and 30 controls who had participated in a cross-sectional 24-hour ambulatory BP study. We examined the association between anti-IsoLG IgG antibodies and BP measurements in patients with SLE and controls by Spearman Rho (rs) and linear regression analysis.ResultsSerum anti-IsoLG IgG antibody concentrations were higher in patients with SLE than controls (P = 0.007) and inversely associated with BP in SLE but not controls. In patients with SLE antibody concentrations were inversely associated with office (rs = −0.418) and diurnal systolic BP (rs = −0.421); the relationship was stronger among patients not taking anti-hypertensives (office: rs = −0.740, diurnal systolic BP: rs = −0.802) and every 20% increase in antibody concentration was associated with 10 mmHg decrease in 24-hour systolic BP (P = 0.004).ConclusionSerum anti-IsoLG IgG antibody concentrations are higher in patients with SLE than controls and are inversely associated with 24-hour BP measurements. Since IsoLGs promote hypertension, it is possible that in SLE, IsoLG antibodies could help clear these hypertension-inducing antigens.

Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study

Objective The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. Materials and methods Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. Results The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. Conclusion There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.

Association between baseline office blood pressure level and the incidence and development of long-term frailty in the community-dwelling very elderly with hypertension.

Frailty is the most important risk factor causing disability in the elderly. Hypertension is one of the most common chronic diseases in the elderly and is closely related to frailty, but there is still controversy about the association between blood pressure and frailty. To explore the association between baseline blood pressure level and the incident and development of long-term frailty in the community-dwelling very elderly (i.e., over 80 years old [1]) with hypertension, in order to provide a basis for scientific blood pressure management of very elderly hypertension. In this study, very elderly hypertensive patients who received comprehensive geriatric assessment from January to June 2019 and with complete data were included, and follow-up was conducted from January 1 to February 14, 2023. A total of 330 very elderly individuals with hypertension were enrolled in this study. FRAIL scale was used to evaluate frailty. Binomial logistic regression analysis was used to calculate the OR and 95%CI between baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) levels and long-term incident and development of frailty. The dose-response relationship between baseline office SBP, DBP or PP levels and incident frailty and its development was analyzed by Generalized Additive Model (GAM) using smooth curve fitting and threshold effect analysis. Smooth curve fitting and threshold effect analysis showed that the relationship between baseline office SBP level and incident frailty was U-shaped, with the nadir of the U-shaped curve at 135 mmHg after adjustment. Baseline office SBP, PP level and development frailty was U-shaped and the nadir was 140 mmHg and 77 mmHg. In the community-dwelling very elderly with hypertension, baseline office SBP level had a relationship with long-term incident frailty and its development and PP level had a relationship with long-term development of frailty.

Ultra-long-term efficacy and safety of catheter-based renal denervation in resistant hypertension: 10-year follow-up outcomes

BackgroundRandomized sham-controlled trials have confirmed the efficacy and safety of catheter-based renal denervation in hypertension. Data on the very long-term effects of renal denervation are scarce.AimsThis study evaluates the 10-year safety and efficacy of renal denervation in resistant hypertension.MethodsThis prospective single-center study included patients with resistant hypertension undergoing radio-frequency renal denervation between 2010 and 2012. Office blood pressure, 24-h ambulatory blood pressure, antihypertensive medication, color duplex sonography, and renal function were assessed after 1-, 2- and 10-years.ResultsThirty-nine patients completed the 10-year follow-up (mean follow-up duration 9.4 ± 0.7 years). Baseline office and 24-h ambulatory systolic blood pressure were 164 ± 23 mmHg and 153 ± 16 mmHg, respectively. After 10 years, 24-h ambulatory and office systolic blood pressure were reduced by 16 ± 17 mmHg (P < 0.001) and 14 ± 23 mmHg (P = 0.001), respectively. The number of antihypertensive drugs remained unchanged from 4.9 ± 1.4 to 4.5 ± 1.2 drugs (P = 0.087). The estimated glomerular filtration rate declined within the expected range from 69 (95% CI 63 to 74) to 60 mL/min/1.73m2 (95% CI 53 to 68; P < 0.001) through 10-year follow-up. Three renal artery interventions were documented for progression of pre-existing renal artery stenosis in two patients and one patient with new-onset renal artery stenosis. No other adverse events were observed during the follow-up.ConclusionRenal denervation was safe and sustainedly reduced ambulatory and office blood pressure out to 10 years in patients with resistant hypertension.Graphical abstractLeft panel, Change in 24-h and office SBP. Right panel, eGFR over time. SBP, systolic blood pressure; eGFR, estimated glomerular filtration rate.

Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability.

Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.

A brief overview of modern approaches to the therapy of resistant arterial hypertension

Resistant hypertension is associated with increased mortality and morbidity. The optimal drug therapy for resistant hypertension has not been fully clarified, there are few studies on this issue in the literature. We compared the efficacy of nebivolol 5 mg, a third-generation beta-blocker, with spironolactone 25 mg in patients with resistant hypertension.&#x0D; 81 patients with resistant hypertension were included in the study. Resistant hypertension was defined as the presence of official blood pressure ≥ 140/90 mm Hg. when patients received 3 or more antihypertensive drugs, including diuretics. Blood pressure was recorded in office and outpatient settings at baseline and after 8 weeks of treatment.&#x0D; Office systolic blood pressure and diastolic blood pressure at 24-hour ambulatory blood pressure monitoring were significantly lower compared to baseline values in the nebivolol and spironolactone groups. The decrease in 24-hour mean systolic and diastolic blood pressure in the nebivolol group was 14.9±19.8 mm Hg. Art. and 9.3±12.7 mm Hg. Art. compared to 19.5±16.4 mm Hg. Art. and 13.7±10.8 mm Hg. Art. in the spironolactone group, respectively. The reduction in 24-hour mean systolic and diastolic blood pressure was not significantly different between the nebivolol and spironolactone groups (P = 0.338 and P = 0.153).&#x0D; Therefore, nebivolol is an effective treatment option for resistant hypertension, and the antihypertensive effect of this drug is similar to low doses of spironolactone.

The relationship between renal and retinal parameters in uncomplicated hypertension in middle-aged people

Background. Controlled arterial hypertension (HTN) does not mean complete regression of preclinical target organ damage. Objective. To study the relationship between indicators characterizing the structural and functional state of the kidneys and retina in middle-aged patients with uncomplicated HTN, receiving combination antihypertensive therapy (AHT) and having office systolic (SBP) and diastolic (DBP) blood pressure levels &lt; 140 and &lt; 90 mmHg. Design and methods. We examined 87 patients (65 males and 22 females, average age 50,5 ± 4,87 years) with stage I and II HTN without clinically significant concomitant pathology taking double combined AHT (group average office level of SBP and DBP 134 ± 12,3 and 84 ± 14,5 mmHg, respectively). For at least the previous 12 months, patients had regularly received voluntary dual combination AHT based on pharmacological blockade of the renin-angiotensin-aldosterone system. HTN patients underwent a comprehensive assessment of the structural and functional state of the kidneys and fundus of the eye. To assess the relationships between biomarkers of kidney and retinal damage in the examined individuals within the entire set of studied parameters, correlation analysis and comparative analysis of the same quantitative (renal or retinal) indicators were used in subgroups of individuals divided according to a conditionally selected qualitative characteristic corresponding to the norm or deviation from the norm (value central retinal arterial equivalent (CRAE ≥ or &lt; 145 μm), central retinal venous equivalent (CRVE ≥ or &lt; 227 μm), albumin-creatinine ratio (ACR ≥ or &lt; 10 mg/g), foveal avascular zone area (FAZ ≥ or &lt; 0,36 mm²). Statistical processing of data was carried out using the Basic Statistics / Tables modules of the application package Statistica for Windows (version 12). The relationship between quantitative renal and retinal indicators was studied using the Pearson r correlation coefficient. Comparative analysis of quantitative parameters within the examined group, conditionally subdivided according to a certain qualitative criterion, was performed using the nonparametric Mann-Whitney U-test. Results. CRVE values directly correlated with ACR (r = 0,30; p = 0,037), FAZ area — with ACR (r = 0,40; p = 0,005), subfoveal choroidal thickness (SCT) — with estimated glomerular filtration rate (eGFR) (r = 0,45; p = 0,001); CRAE values inversely correlated with serum urea (r = –0,34; p = 0,019), SCT — with serum creatinine (r = –0,36; p = 0,011). Patients with ACR ≥ 10 mg/g compared with patients with ACR &lt; 10 mg/g were characterized by significantly lower values of the retinal arteriovenous ratio (0,646 ± 0,09 and 0,689 ± 0,08, respectively, p = 0,016). Patients with FAZ area ≥ 0,36 mm² compared with those with FAZ area &lt; 0,36 mm² had higher proteinuria values (0,101 ± 0,13 and 0,075 ± 0,14 mg/g, respectively, p = 0,01). Conclusions. Middle-aged patients with uncomplicated HTN without clinically significant concomitant pathology, receiving double combined AHT, demonstrate significant associations of indicators characterizing the structural and functional state of the kidneys and retinal microcirculation in terms of their preclinical damage.

Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension

Prehypertension increases the risk of developing hypertension and other cardiovascular diseases. Early and effective intervention for patients with prehypertension is highly important. To assess the efficacy of Tai Chi vs aerobic exercise in patients with prehypertension. This prospective, single-blinded randomized clinical trial was conducted between July 25, 2019, and January 24, 2022, at 2 tertiary public hospitals in China. Participants included 342 adults aged 18 to 65 years with prehypertension, defined as systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic BP (DBP) of 80 to 89 mm Hg. Participants were randomized in a 1:1 ratio to a Tai Chi group (n = 173) or an aerobic exercise group (n = 169). Both groups performed four 60-minute supervised sessions per week for 12 months. The primary outcome was SBP at 12 months obtained in the office setting. Secondary outcomes included SBP at 6 months and DBP at 6 and 12 months obtained in the office setting and 24-hour ambulatory BP at 12 months. Of the 1189 patients screened, 342 (mean [SD] age, 49.3 [11.9] years; 166 men [48.5%] and 176 women [51.5%]) were randomized to 1 of 2 intervention groups: 173 to Tai Chi and 169 to aerobic exercise. At 12 months, the change in office SBP was significantly different between groups by -2.40 (95% CI, -4.39 to -0.41) mm Hg (P = .02), with a mean (SD) change of -7.01 (10.12) mm Hg in the Tai Chi group vs -4.61 (8.47) mm Hg in the aerobic exercise group. The analysis of office SBP at 6 months yielded similar results (-2.31 [95% CI, -3.94 to -0.67] mm Hg; P = .006). Additionally, 24-hour ambulatory SBP (-2.16 [95% CI, -3.84 to -0.47] mm Hg; P = .01) and nighttime ambulatory SBP (-4.08 [95% CI, -6.59 to -1.57] mm Hg; P = .002) were significantly reduced in the Tai Chi group compared with the aerobic exercise group. In this study including patients with prehypertension, a 12-month Tai Chi intervention was more effective than aerobic exercise in reducing SBP. These findings suggest that Tai Chi may help promote the prevention of cardiovascular disease in populations with prehypertension. Chinese Clinical Trial Registry Identifier: ChiCTR1900024368.

Cost Effectiveness of Endovascular Ultrasound Renal Denervation in Patients with Resistant Hypertension.

Resistant hypertension (rHTN) is defined as blood pressure (BP) of ≥ 140/90mmHg despite treatment with at least three antihypertensive medications, including a diuretic. Endovascular ultrasound renal denervation (uRDN) aims to control BP alongside conventional BP treatment with antihypertensive medication. This analysis assesses the cost effectiveness of the addition of the Paradise uRDN System compared with standard of care alone in patients with rHTN from the perspective of the United Kingdom (UK) health care system. Using RADIANCE-HTN TRIO trial data, we developed a state-transition model. Baseline risk was calculated using Framingham and Prospective Cardiovascular Münster (PROCAM) risk equations to estimate the long-term cardiovascular risks in patients treated with the Paradise uRDN System, based on the observed systolic BP (SBP) reduction following uRDN. Relative risks sourced from a meta-analysis of randomised controlled trials were then used to project cardiovascular events in patients with baseline SBP ('control' patients); utility and mortality inputs and costs were derived from UK data. Costs and outcomes were discounted at 3.5% per annum. Modelled outcomes were validated against trial meta-analyses and the QRISK3 algorithm and real-world evidence of RDN effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs). A mean reduction in office SBP of 8.5mmHg with uRDN resulted in an average improvement in both absolute life-years (LYs) and quality-adjusted life-years (QALYs) gained compared with standard of care alone (0.73 LYs and 0.67 QALYs). The overall base-case ICER with uRDN was estimated at £5600 (€6500) per QALY gained (95% confidence interval £5463-£5739 [€6341-€6661]); modelling demonstrated > 99% probability that the ICER is below the £20,000-£30,000 (€23,214-€34,821) per QALYs gained willingness-to-pay threshold in the UK. Results were consistent across sensitivity analyses and validation checks. Endovascular ultrasound RDN with the Paradise system offers patients with rHTN, clinicians, and healthcare systems a cost-effective treatment option alongside antihypertensive medication.

Stress coping strategies — novel markers in the diagnosis of masked hypertension in young people

Aim. To establish the prevalence and markers of masked hypertension (HTN) in apparently healthy young people.Material and methods. The cross-sectional study included young people (20-30 years old) with health group I or II, with clinical blood pressure (BP) &lt;140/90 mm Hg. All participants underwent 24-hour blood pressure monitoring, assessment of traditional cardiovascular risk factors and ways of coping with stress.Results. A total of 347 participants were included (mean age, 22 (21-23) years; male, 101 (29,1%)). After 24-hour blood pressure monitoring, masked HTN was detected in 46 (13,3%) participants. Multivariate analysis found following markers of masked HTN: office systolic blood pressure (adjusted odds ratio (AOR) 1,109; p&lt;0,001), resting heart rate (AOR 1,051; p=0,021), body mass index ≥25 kg/m2 (AOR 2,345; p=0,039), two models of coping with stress — distancing (AOR 1,071; p=0,001) and self-control (AOR 0,951; p=0,012). These parameters are included in the formula for calculating the masked HTN probability.Conclusion. Masked HTN occurs in 13,3% of apparently healthy young people. Associations of masked HTN with strategies for coping with stress have been established, which allows them to be regarded as novel markers of masked HTN. The method described in the article makes it possible to identify masked HTN with a high probability in young people.