Term Blood Pressure Variability Research Articles

Abstract P106: Association of long term blood pressure variability and Major Cardiovascular events in patients with primary aldosteronism

Objective: Long-term blood pressure variability (BPV) is associated with an increased risk of major cardiovascular events (MACE), but it is rarely reported in patients with primary aldosteronism (PA). We aim to investigate the association between long-term BPV and cardiovascular events in patients with PA. Methods: This was a retrospective cohort study which conducted at the Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region from January 2006 to December 2021. The study included patients with PA aged over 30 years. The primary outcome was the incidence of major cardiovascular events during the follow-up, which extended until June 2023. The BPV index encompassed four parameters: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and maximum and minimum blood pressure difference (MMD). Multivariate analysis using logistic regression was performed, adjusting for demographic variables such as age, sex, body mass index, as well as clinical characteristics including smoking and alcohol consumption. Results: A total of 2,380 patients with PA were ultimately enrolled in this study. Access to clinic blood pressure was ensured at least three times during follow-up visits, with a minimum follow-up interval of 1 month. During a median follow-up of3.6 years, there were 124 cases of MACE. The mean age of the participants was 49.36 years, with men accounting for 1,288 cases. The average blood pressure recorded was 135 mmHg. After adjusting for confounding factors such as age, sex, smoking, alcohol consumption, BMI and cardiovascular risk factors, the systolic BPV (SD, CV, ARV) was found to be significantly associated with MACE (OR= 1.03, CI 1.02-1.05; P<0.05). In the group of mean SBP≥130mmHg, SBP variability had a significant association with MACE (OR: 1.03; CI: 1.01-1.06; P<0.05). However, no significant correlation between SBP variability and MACE in group of mean SBP <130mmHg (P>0 .05). Conclusion: Focusing on long-term systolic BP SD, CV, and ARV in patients with primary aldosteronism may help to prevent the occurrence of cardiovascular events.

Effects of concurrent exercise training on blood pressure variability and values are blunted in subjects with non-dipping blood pressure nocturnal pattern

Abstract Funding Acknowledgements Type of funding sources: None. The purpose of this study was to investigate the effects of 12-weeks concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks patients underwent six minute walk test, ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). After CT exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the nondipping group (between groups changes: -1.0 mmHg and -1.3 mmHg; p 0.02 and p 0.006 respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while were unchanged in the non-dipping group (between groups changes: -7.1 mmHg and -7.8 mmHg; p 0.004 and p 0.0002 respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small not significant changes in both groups. In conclusion: the effects of CT on BPV and BP were blunted in hypertensive subjects with non.dipping BP pattern

S-58-3: HOW COULD CONTINUOUS CUFFLESS AUTOMATED BLOOD PRESSURE MEASUREMENT DEVICES CONTRIBUTE TO HYPERTENSION MANAGEMENT?

Evidence that hypertension is the most importat global risk factor for cardiovascular morbidity and mortality, and demonstration of the cardiovascular protection offered by antihypertensive treatment, have been based on upper-arm cuff blood pressure (BP) measurements. This approach is recommended by current hypertension guidelines for BP measurement in clinical practice, as well as for validation of novel BP measuring devices. However, the spot or intermittent BP measurements in static conditions allowed by arm-cuff devices are unable to identify and track the continuous and rapid BP changes characterizing daily life. Moreover, cuff-based BP measurements are exposed to errors related to cuff size, shape and positioning, and cuff inflation may itself induce an alerting response and produce discomfort in the users during daily activities and in particular during sleep, which may modify the measured BP levels. To face these issues, use of continuous recordings techniques, not based on arm-cuff inflation, would be required. This is possible through intra-arterial recordings, which however are not feasible in daily practice because of their invasiveness. An alternative solution is represented by photoplethysmographic volume-clamp method for finger BP monitoring which, however, is difficult to implement in clinical practice because of its cost and complexity. Technological progress is now offering an increasingly large and heterogeneous series of cuffless BP monitors, which estimate BP based on sensors, signal processing and algorithms embedded in wearable devices, smartphones or pocket devices. These cuffless devices might allow for comfortable and continuous BP recordings, detecting rapid BP changes during day and night sleep, thus offering information on both short, mid and long term BP variability. Cuffless devices might also be useful for continuous non invasive BP monitoring in different clinical settings, including ICUs, during anaesthesia, in patients with arrhythmias, hypotension/syncope, and other transient conditions affecting BP levels and variability. Moreover, cuffless BP measurement devices connected to telemonitoring facilities or smartphones apps may improve patients empowerment, adherence to treatment and long-term BP control. In spite of all these potential advantages, however, cuffless BP devices have to face specific accuracy issues, which would need refinement of specific validation protocols aimed at testing the need of individual calibration, the stability of measurements after calibration and the device actual ability to track BP changes before they might be recommended for clinical use.

JS-HR-7: BLOOD PRESSURE VARIABILITY; THERAPEUTIC TARGET FOR THE PREVENTION OF CARDIOVASCULAR DISEASE

In the past three decades, there have been many reports on the associations of various parameters of blood pressure (BP) variability with increased risk of cardiovascular disease (CVD) events; these parameters include short term BP variability (BPV), i.e., beat-by-beat BPV and ambulatory BPV, abnormality of nocturnal BP dipping pattern, and mid- to long-term BPV, i.e., day-by-day BPV, visit-to-visit BPV, and seasonal variations in BP. Several factors that are associated with abnormal BPV, as well as environmental factors such as cold or warm temperatures and seasonal changes in climate, increase fluctuations in BP. Individual intrinsic factors such as sympathetic nervous tone, arterial stiffness, physical activity, and mental stress also contribute to elevated BPV. According to evaluations of BPV abnormalities, out-of-office BP measurements such as ambulatory and home BP monitoring are needed. Although there are issues regarding measurement accuracy, cuffless BP monitoring devices, for example, those using pulse transit time, may be used to estimate nighttime BP levels. Such cuffless BP devices can also evaluate beat-by-beat BPV. Moreover, by using the multisensor-equipped ambulatory BP monitoring device developed by our research group, it is possible to evaluate BPV associated with changes in temperature, physical activity, and/or atmospheric pressure. Based on the mechanism(s) behind a given patients BPV abnormality, several methods may be considered for the management of that abnormality (Figure). For example, improving excessive sympathetic nervous system activation may be useful in the management of BPV abnormality, and renal denervation has been reported to decrease ambulatory BPV. Abnormal nocturnal BP dipping may be treated by decreasing nighttime BP. Moreover, early adjustment of antihypertensive drugs has been reported to be useful in suppressing seasonal variations in BP, leading to a decreased risk of CVD events. Furthermore, housing conditions and room temperature are closely related to BP levels, and adaptive control of room temperature would be useful to suppress winter increases in BP. In clinical practice, we must not forget that BPV parameters are interrelated. For instance, frequent evaluation of BP levels and adjustment of antihypertensive drugs can suppress visit-to-visit BPV, which in turn leads to the suppression of seasonal variations in BP. Over the next decade, greater data on how to manage and control BPV need to be accumulated. Additionally, future studies should be conducted to verify whether the different types of BVP management are useful in preventing CVD events.

887 THE EFFECTS OF CONCURRENT AEROBIC PLUS RESISTANCE EXERCISE ON BLOOD PRESSURE VALUES AND VARIABILITY AND ARE BLUNTED IN HYPERTENSIVE SUBJECTS WITH NONDIPPING NOCTURNAL BLOOD PRESSURE PROFILE

Abstract Background The purpose of this study was to investigate the effects of 12-weeks of concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with nondippper BP nocturnal pattern and underlying coronary artery disease. Methods The study included 64 patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (29 pts) and nondipping (35 pts). Before starting CT and at 12 weeks patients underwent ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). Results after CT Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group (-1.2 mmHg and -1.4 mmHg respectively) while they were unchanged in the nondipping group (-0.2 mmHg and -0.1 mmHg). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group (-8.3 mmHg and -8.5 mmHg respectively) while were unchanged in the nondipping group (-1.2 mmHg and -0.7 mmHg). Nighttime systolic BP and BPV was unchanged in both groups. Conclusion the effects of CT on BP and BPV are blunted in hypertensive subjects with nondipping BP pattern. Further studies are needed in order to find out more effectives training modalities for these patients

Concurrent Aerobic Plus Resistance Training Elicits Different Effects on Short-Term Blood Pressure Variability of Hypertensive Patients in Relation to Their Nocturnal Blood Pressure Pattern.

Background and Objectives: The purpose of this study was to investigate the effects of a 12-week concurrent training (CT) (i.e., aerobic plus resistance exercise) on short-term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. Material and Methods: The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks, patients underwent the six minute walk test, ergometric test, assessment of 1-repetiton maximum (1 RM), and 24/h BP monitoring (24-h ABPM). Results: After CT, exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the non-dipping group (between groups changes: -1.0 ± 0.4 mmHg and -1.3 ± 0.9 mmHg; p = 0.02 and p = 0.006, respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while they were unchanged in the non-dipping group (between groups changes: -7.1 ± 2.6 mmHg and -7.8 ± 2.4 mmHg; p = 0.004 and p = 0.002, respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small but not significant changes in both groups. Conclusions: The effects of CT on BPV and BP were blunted in hypertensive subjects with a non-dipping BP pattern.

Short term blood pressure variability and diastolic function in middle-aged normotensive individuals

Objective: Blood pressure variability (BPV), a non-conventional blood pressure parameter, has been shown to contribute hypertensive target organ damage but its association with diastolic dysfunction is unknown. The present study investigates the association of BPV and left ventricular diastolic dysfunction (LVDD) in middle-aged normotensive individuals.
 Materials and Methods: 264 normotensive patients aged between 45 and 65 were enrolled. 24-hour ambulatory blood pressure monitoring were performed and BPV was defined as the standard deviation of systolic blood pressure measurements. Patients were divided into 3 groups according to BPV tertiles. Echocardiographic and tissue doppler diastolic function parameters were compared among the groups.
 Results: Mean age of the patients were 50.41 and similar among groups. Mitral inflow E/A (Tertile 1 vs 2 vs 3: 1.10[0.33] vs 1.05 [0.22] vs 1.02 [0.30], p=0.02) and average tissue doppler mitral annular E’ velocity (12 [2] vs 10.5 [1.85] vs 10 [1.55], p=0.02) were highest in the tertile 1 and lowest in the tertile 3. Average E/E’ (Tertile 1 vs 2 vs 3: 7.2 [2.2] vs 8.1 [3.2] vs 9.3 [2.9], p<0.001) was lowest in the tertile 1 and highest in the tertile 3. In addition, there was a positive correlation between BPV and Average E/E’ (Rs =0.401, p<0.001). In contrary, E/A (Rs =- 0.286, p<0.001) and average E’ (Rs =- 0.451, p<0.001) were negatively correlated with BPV.
 Conclusion: BPV is positively correlated with average E/E’ and negatively correlated with E/A and average E’. Further studies are required to elucidate the relationship of BPV and LVDD.

The association between long term blood pressure variability with incident dementia and cognitive impairment: A systematic review and meta‐analysis

AbstractBackgroundDementia cases continues to grow in the era of ageing population, with its number approaching 50 million. Accumulating evidence has shown that high blood pressure increases the risk of dementia and cognitive decline. In recent decades, some studies demonstrate that blood pressure variability (BPV) may contribute to cognitive decline and incident dementia independent of the blood pressure level. However, due to the inconsistence of statistical results and clinical methodology, the magnitude of this relationship remains ambiguous. A clear understanding of the role of BPV in dementia may shed light to etiology and early prevention of dementia. This study aims to assess the association between BPV with incident dementia and cognitive impairment.MethodWe searched MEDLINE, Embase, PsycINFO, CINAHL and Web of Science from December 2020 for articles describing trials, retrospective and prospective cohort studies in adults that assessed the association of long‐term BPV (measured through clinic blood pressure monitoring) with incident dementia and cognitive impairment. 5681 papers were identified and eventually 12 articles with full text and 3 abstracts with enough information were included in the quantitative analysis. Of these 15 studies, 2 articles report both dementia and cognitive decline or dysfunction as outcomes, while 5 studies report dementia as an outcome and 8 studies report cognitive decline or dysfunction.ResultHazard Ratio and linear regression coefficient were converted to a standardized one. We found that increased long‐term variability in systolic blood pressure was associated with higher risk of all‐cause dementia [pooled standardized HR of 1.1 (95%CI, 1.01, 1.19)]. Compared to people in lower BPV group, people in higher BPV group was 1.17 times more likely to develop dementia [pooled HR 1.17 (95%CI,1.12, 1.22)]. Cognitive decline was associated with higher SBPV [pooled linear coefficient for MMSE score is ‐0.11(95%CI, ‐0.17, ‐0.05)],which means MMSE score decreases by 0.11 per SD increase in SBPV.ConclusionOur findings suggested that higher long‐term blood pressure variability increases both the risk for incident dementia and cognitive decline.

ASSOCIATION BETWEEN SHORT TERM BLOOD PRESSURE VARIABILITY AND ARTERIAL STIFFNESS IN SUSPECTED HYPERTENSIVES

Objective: To evaluate the association between arterial stiffness and short term blood pressure variability (BPV). Design and method: Four hundred fifty-five suspected hypertensive patients were referred to record a 24-hours ambulatory blood pressure monitoring (ABPM), and also were randomly enrolled from a population. They performed an oscillometric pulse wave analysis, using Mobil-O-Graph (I.E.M., Stolberg, Germany), following recommendations of Expert Consensus Document on the Measurement of Aortic Stiffness-2012. They also had a 24- hour of ABPM recorded. ABPM was made following protocols of European Guidelines. Short term BPV was evaluated by systolic or diastolic BP with: the standard deviation (SD) of 24 hs BP (24hBP-SD), Daytime BP-SD, Nighttime BP-SD, the 24 hs BP coefficient of variation (24hs CV), the weighted 24-h BP-SD and average real variability of 24-hour BP (ARV 24-h BP). Statistical Analysis: the Pearson correlation coefficient (r) was calculated by an univariate way comparing all systolic and diastolic BPV measures with brachial pulse wave analysis (bPWV). Partial correlation was adjusted to age and gender, and then for age, gender, 24 hs BP, and office BP do to avoid statistic influence of such confounders. Results: Data from 455 patients were analyzed. Clinical characteristics of the sample: age 48.8 ± 13.93 – women (41.9%), white people (69.5%), treated hypertensives (36%), diabetes (12.7%), statin use 22%, body mass index 28. 6 ± 5.8, smokers (8.6%), obese (36.3%). The findings are showed in table 1. All BPV variables had a significant correlation with bPWV. Daytime BP-SD and weighted 24-h BP-SD showed the best association. The worst results of the correlation were found, in systolic, in nighttime BP-SD, and in diastolic, in 24 hs CV. However, the comparison of diastolic 24hBP-SD and bPWV showed a negative correlation. Conclusions: Our data indicated an association between short blood pressure variability and oscillometric pulse wave velocity. A moderate correlation was demonstrated by systolic BPV and weak by diastolic. The best results of the association between the studied variables were shown in Daytime BP-SD and in weighted 24-h BP-SD.

Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases.

Blood pressure (BP) is characterized by continuous dynamic and spontaneous oscillations occurring over lifetime and defining the so-called blood pressure variability (BPV). BPV has been associated with target organ damage, cardiovascular (CV) risk and death, suggesting the use of BPV as a new target in hypertension management in addition to mean BP values lowering. The purpose of the review is to focus on the therapeutic implications of BPV and summarize the effects of different drug classes on various types of BPV. Despite most first-line antihypertensive medications contribute to reduce both short and long term BPV, calcium channel blockers (CCBs) as monotherapy or fixed-combination therapy appear to be the most effective on BPV control. Further randomized interventional trials are needed to investigate which drug combinations are most appropriate according to patient CV risk stratification, in order to improve their CV outcomes.

Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre monitorización ambulatoria de la presión arterial (MAPA) 2019

Conventional blood pressure (BP) measurement in clinical practice is the most used procedure for the diagnosis and treatment of hypertension (HT), but is subject to considerable inaccuracies due to, on the one hand, the inherent variability of the BP itself and, on the other hand biases arising from the measurement technique and conditions, Some studies have demonstrated the prognosis superiority in the development of cardiovascular disease using ambulatory blood pressure monitoring (ABPM). It can also detect “white coat” hypertension, avoiding over-diagnosis and over-treatment in many cases, as well detecting of masked hypertension, avoiding under-detection and under-treatment. ABPM is recognised in the diagnosis and management of HT in most of international guidelines on hypertension.The present document, taking the recommendations of the European Society of Hypertension as a reference, aims to review the more recent evidence on ABPM, and to serve as guidelines for health professionals in their clinical practice and to encourage ABPM use in the diagnosis and follow-up of hypertensive subjects. Requirements, procedure, and clinical indications for using ABPM are provided. An analysis is also made of the main contributions of ABPM in the diagnosis of “white coat” and masked HT phenotypes, short term BP variability patterns, its use in high risk and resistant hypertension, as well as its the role in special population groups like children, pregnancy and elderly. Finally, some aspects about the current situation of the Spanish ABPM Registry and future perspectives in research and potential ABPM generalisation in clinical practice are also discussed.

Predictors of blood pressure control in patients with resistant hypertension.

Uncontrolled resistant hypertension (RH) defined by the mean 24-hour ambulatory blood pressure (ABPM) represents an independent risk factor in hypertensive patients. Predictors of blood pressure (BP) control in RH are not yet clearly defined. To evaluate the predictors of BP control in RH patients with repeated ABPM measurements. 114 consecutive patients from outpatient cardiology office fulfilling criteria for RH (office BP ≥ 140 and/or 90 mmHg, with treatment of ≥ 3 antihypertensive drugs, including diuretic, or controlled BP with > 3 drugs), with two consecutive ABPM studies were compared in clinical characteristics according to BP control assessed by ABPMRESULTS: After the second ABPM, BP was controlled in 25.4 % of patients; the remaining 74.6 % were classified as uncontrolled. In the uncontrolled BP group, systolic office BP was 140.91±16.71 mmHg, diastolic 81.26 ± 10.92 mmHg. In ABPM, systolic was 145.11 ± 13.65 mmHg, diastolic 81.26 ± 10.92 mmHg. Compared to the controlled BP group, in the uncontrolled group the age was higher 72.32 ±10.89 years (p = 0.047), baseline average real variability of systolic BP was lower 12.66 ± 3.08 vs. 14.52 ± 3.53 (p = 0.013), no significant difference in baseline standard deviation of systolic BP changes was found. Higher office BP, older age, and increased short term BP variability were associated with an uncontrolled hypertension. Stronger association was found with baseline average real variability rather than standard deviation. No significant differences were found in the dipping status and other clinical characteristics (Tab. 6, Fig. 1, Ref. 28).

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

Background/Aims: In chronic kidney disease (CKD) patients blood pressure variability (BPV) is associated with poor outcome. Sleep disturbances alter BP profiles in hypertensives but their influence on BPV in CKD patients is unknown. We screened a cohort of CKD/ESRD patients to investigate whether sleep quality impacts on BPV. Methods: Consecutive CKD patients’ sleep quality was assessed using validated questionnaires (Epworth Sleepiness Scale-ESS); International Restless legs scale-IRLS; Functional Outcomes of Sleep Questionnaire-FOSQ: Insomnia Severity Index-ISI; STOP-Bang). All patients underwent ambulatory blood pressure measurement. Results: 104 out of 143 enrolled patients (78.32% stage-3 CKD; 10.49% Stage-4; 11.19% Stage-5; 6.99% ESRD-under dialysis) completed all the questionnaires. 95.8% were hypertensives, 70% were non-dippers and 27.8% had resistant hypertension. STOP-Bang>4 proved sleep disorders in 84.84% of patients. Patients with IRLS>10 had greater diastolic nocturnal standard deviation (DNSD) and a trend (p=0.05) for systolic nocturnal SD (SNSD). Patients with ISI>14 had greater SNSD and in 28.8% FOSQ showed severely impaired sleep quality. Their systolic nocturnal BPV was significantly greater. ISI was independently associated with SNSD. FOSQ and diastolic nocturnal BPV were negatively correlated at the bivariate analysis and FOSQ independently predicts systolic nocturnal BPV at multivariate regression analysis. Conclusions: In CKD patients impaired sleep quality increases BPV, might contribute to their disease progression and worsen prognosis. Searching for sleep problems in CKD patients could help planning their treatment of sleep problems contributing to CV risk reduction. Our data provide the rationale working hypothesis for the need of studies with larger number of patients aimed to demonstrate improved outcome of CKD progression and CV risk with the treatment also of sleep disorders.

OP.6B.06] EVALUATION OF RELATIONSHIP BETWEEN CARDIO-ANKLE VASCULAR INDEX AND 24H AMBULATORY BLOOD PRESSURE VARIABLES

Objective: CAVI has been defined as a blood pressure (BP) independent index of arterial stiffness, when considering clinic BP values. Arterial stiffness measured with CAVI has also been shown to be a comprehensive indicator of arteriosclerosis, and it would thus be important to explore its relation with daily life BP patterns. Aim of our study was to assess this aspect in a group of treated essential hypertensive patients. Design and method: 368 caucasian hypertensive patients aged 17–81, consecutively referred to our outpatients Hypertension Center, underwent a thorough clinical evaluation, 24 h ABPM (AND 2430) and CAVI assessment (VaSera Fukuda Denshi). The relation of CAVI with office BP and with 24 h, day and night ABP mean values and variability was investigated. Results: No relation was found between CAVI and all office BP parameters (p NS). Conversely CAVI in univariate analysis showed a significant relation with ambulatory PP (day R = 0,23 p < 0,01-night R = 0,23 p < 0,01- 24 h R = 0,22 p < 0,01) but not with the corresponding ambulatory DBP; a weak correlation was found between CAVI and ambulatory SBP (p < 0.05). The relation between CAVI and ambulatory PP lost significance (p = NS) after accounting for age, the strongest predictor of CAVI (r = 0,59; p < 0,0001). We also observed a relation between CAVI and daytime or 24 h heart rate (HR) (respectively R = 0.23 and R = 0.22; p < 0.01). These relationships remained significant even after accounting for age although not after correction for beta blocker therapy. Concerning short term BP variability we observed only a weak relation of CAVI with 24 h weighted systolic BP standard deviation (R = 0.12; p < 0.05) which lost significance after correction for age. Conclusions: These data confirm the independence of CAVI from BP values obtained at the time of measurement and offer new information on its association with ABP parameters, suggesting its independence also from the daily blood pressure profile. This support the suggestion that CAVI could have a role in the evaluation of cardiovascular risk independently, at variance from other arterial stiffness indices, from BP levels.

68 Acute blood pressure response to antihypertensives during anaesthesia in an experimental model of preeclampsia

Introduction Increased blood pressure (BP), especially sudden, unexpected and severe rises in women with preeclampsia considerably increases the risk of peripartum complications. These risks are even more acute in the context of general anaesthesia. Objectives To assess the effects of antihypertensive drugs on short and long term blood pressure variability when used concurrently with propofol and ketamine anaesthesia. Methods Blood Pressure was measured during anaesthesia in six, pregnant Papio hamadryas (baboons) with experimental preeclampsia (EPE). Animals were given antihypertensives commonly used to manage preeclampsia (labetalol, methyldopa and hydralazine) at equipotent doses equivalent to mild starting dose rates commonly used in women with preeclampsia. Results When anaesthetised with ketamine (most commonly used anaesthetic agent in EPE), systolic BP increased significantly by 4.9 mmHg when animals were on labetalol (n = 3, p Conclusion These results show that in the two anaesthetic agents studied so far the greatest reduction in BP was achieved with hydralazine during ketamine anaesthesia and methyldopa during propofol anaesthesia. It is likely that antihypertensive treatment affects blood pressure during anaesthesia, and that the interaction between antihypertensive and anaesthetic agent is of clinical importance in managing sudden, unexpected and severe rises in BP in women with preeclampsia.

Long-Term and Ultra Long–Term Blood Pressure Variability During Follow-Up and Mortality in 14 522 Patients With Hypertension

Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be an independent cardiovascular risk predictor. The implication of this variability in hypertension clinical practice is unclear. BPV as average real variability (ARV) was calculated in 14,522 treated patients with hypertension in 4 time frames: year 1 (Y1), years 2 to 5 (Y2-5), years 5 to 10 (Y5-10), and years >10 (Y10+) from first clinic visit. Cox proportional hazards models for cause-specific mortality were used in each time frame separately for long-term BPV, across time frames based on ultra long-term BPV, and within each time frame stratified by mean BP. ARV in systolic blood pressure (SBP), termed ARV(SBP), was higher in Y1 (21.3±11.9 mm Hg) in contrast to Y2-5 (17.7±9.9 mm Hg), Y5-10 (17.4±9.6 mm Hg), and Y10+ (16.8±8.5 mm Hg). In all time frames, ARV(SBP) was higher in women (P<0.01) and in older age (P<0.001), chronic kidney disease (P<0.01), and prevalent cardiovascular disease (P<0.01). Higher long-term and ultra long-term BPV values were associated with increased mortality (all-cause, cardiovascular, and noncardiovascular mortality; P for trend, <0.001). This relationship was also evident in subgroups with mean SBP<140 mm Hg in all time frames. Monitoring BPV in clinical practice may facilitate risk reduction strategies by identifying treated hypertensive individuals at high risk, especially those with BP within the normal range.

Influence of salt loading and potassium supplement on short term blood pressure variability in salt-sensitivity adults

Influence of salt loading and potassium supplement on short term blood pressure variability in salt-sensitivity adults