Treated Hypertensive Patients Research Articles

Abstract P347: Utility Of Standing Blood Pressure On Blood Pressure Control In Treated Hypertension

Many hypertension (HTN) guidelines have recommended routine measurement of standing BP in HTN adults at risk of orthostatic hypotension, especially in older adults. However, the incremental value of adding standing BP to seated BP in predicting HTN control has not been studied. Accordingly, we assessed BP in both seated and standing positions in 319 HTN adults treated with antihypertensive medications. Adequate BP control was defined as 24-Hr ABPM ≤125/75 or daytime ABPM ≤130/80 mmHg. Area under receiver operator characteristic curve (AUROC) was used to determine accuracy of seated and standing BP in assessing BP control. Bayes factor (BF) was used to assess the significant difference between AUROCs. Sensitivity and specificity of standing BP were derived using cutoffs derived from Youden’s Index. Overall mean age was 64±13 years, with 55% women (176 of 319), and 27% Black (86 of 319). Sensitivity and specificity of seated SBP were 75% and 60%, respectively, when HTN control was defined by 24-Hr ABPM. Optimal cutoffs for standing BP were 138/86 and 142/86 mmHg (based on 24-Hr SBP and daytime SBP as gold standard, respectively). Sensitivity and specificity of standing SBP were 54% and 81%, respectively, when using the cutoff derived from 24-Hr ABPM. The AUROCs of standing SBP and DBP were not significantly different compared to seated when HTN control was defined by 24-Hr or daytime ABPM. Similarly, the addition of standing to seated BP was not significantly different when compared to seated BP based on both references (Figure 1: A-B). In conclusion, routine incorporation of standing office BP did not offer additional value in determining adequacy of BP control among treated HTN patients.

Association between physical activity and resistant hypertension in treated hypertension patients: analysis of the national health and nutrition examination survey

IntroductionCurrent guidelines suggest that regular aerobic training might lower blood pressure in hypertensive individuals. However, evidence linking resistant hypertension (RH) with total daily physical activity (PA), including work-, transport-, and recreation-related PA, is limited. Therefore, this study assessed the association between daily PA and RH.MethodA cross-sectional study was conducted using data acquired from a nationwide survey in the US (the National Health and Nutrition Examination Survey, NHANES). The weighted prevalence of RH was calculated, and moderate and vigorous daily PA was assessed using the Global Physical Activity Questionnaire (GPAQ). A multivariate logistic regression model determined the association between daily PA and RH.ResultsA total of 8,496 treated hypertension patients were identified, including 959 RH cases. The unweighted prevalence of RH among treated hypertension cases was 11.28%, while the weighted prevalence was 9.81%. Participants with RH had a low rate of recommended PA levels (39.83%), and daily PA and RH were significantly associated. PA exhibited significant dose-dependent trends with a low probability of RH (p-trends < 0.05). Additionally, participants with sufficient daily PA had a 14% lower probability of RH than those with insufficient PA [fully adjusted odds ratio (OR) = 0.86; 95% confidence interval (CI) = 0.74–0.99).ConclusionThe present study revealed that RH has an incidence of up to 9.81% in treated hypertension patients. Hypertensive patients tended to be physically inactive, and insufficient PA and RH were significantly associated. Sufficient daily PA should be recommended to reduce the RH probability among treated hypertension patients.

PS-C22-11: EFFICACY OF TRI-COMBINATION ACEI PLUS AMLODIPINE AND INDAPAMIDE VERSUS ARB AMLODIPINE AND THIAZIDE IN DIABETES WITH HYPERTENSION PATIENTS

Introduction: Global Burden of Disease (GBD) Study has estimated that Hypertension leads to 1.6 million deaths and 118 million disability-adjusted life years in INDIA1 40% of diagnosed Hypertension patients are treated1. The poor control rates among treated Hypertension patients are around 40% in Indian3. Plausible reasons for poor Hypertension control rates in INDIA. This is mainly because most treated patients only receive monotherapy despite guidelines recognizing that most patients require combination therapy 2 and 3. ISH 2020 guidelines support initiating with A+C SPC in Hypertension patients For patients uncontrolled on two drugs, recommended approaches are to increase doses as step 2 and add a third drug as step 3. 4 Every third Hypertension patient needs three or more drugs to reach the BP Perindopril + Amlodipine + Indapamide offers better blood pressure control. In studies such as the ADVANCE CCB study5. Active treatment with Perindopril + Indapamide + CCB reduced the relative risk of death by -28%. -The recent Mazza et al. study provides evidence for Cardiovascular risk reduction with Perindopril + Indapamide + Amlodipine combination. Left ventricular hypertrophy (LVH) regression was greater in the SPC group of Perindopril+ Indapamide+ Amlodipine vs. the FCT group (43.5% vs. 30.4%, P &lt; 0.05).6 In our Indian study from 2019 to 2022, 110 patients with Diabetes with Moderate to severe Hypertension on Perindopril with Amlodipine and Indapamide were able to achieve a blood pressure target of &lt; 130/80 mmHg with Minimum 6 months to a maximum of 2 years on this combination therapy, whereas Target of &lt; 130/80 mmHg with ARB with Amlodipine and thiazide were achieved in 54% only, which was significant (Figure 1). Indian patients are well Tolerated with triple single Pill, and adherence to therapy was Good.

REVERSE WHITE-COAT EFFECTS ACCORDING TO THE ACHIEVED BLOOD PRESSURES BELOW THE TARGET BLOOD PRESSURES FOR INTENSIVE BLOOD PRESSURE CONTROL

Objective: In the application of nalysedd controlled trial data for intensive blood pressure (BP) control into clinical practice, the corresponding BPs among office, home, and ambulatory BPs were suggested to be similar if achieved clinic systolic BP (SBP) become 130 mmHg or lower. But the magnitude and its clinical implication of reversed white-coat effect (WCE) was not clearly reported. Design and method: From the 1843 data of treated hypertension patients in Korean ambulatory blood pressure monitoring (Kor-ABP) registry, WCE were calculated according to the range of achieved clinic SBPs, &lt; 120 mmHg (group1), 120~130 mmHg (group2), 130–140 mmHg (group3), and &gt; = 140 mmHg (group4). The factors related to WCE were nalysed using multivariable regression analysis. WCE was defined by clinic SBP minus daytime ambulatory SBP. Results: Mean age was 59 years and the proportion of female was 55%. Significant factors for the WCE were BMI (beta = -0.342), smoking (beta = -3.394), good sleep quality (beta = 0.872 per each 4 point likert scale), and clinic SBP(beta = 0.578). Mean SBPs for group 1 to 4 were 111.4 mmHg, 124.0 mmHg, 134.1 mmHg, and 157.5 mmHg, respectively. WCEs for the group were -8.3 mmHg for group1, -4.5 mmHg for group2, -1.9 mmHg for group3, and 9.9 mmHg for group4. The difference in WCEs between the group 4 and untreated hypertension patients (SBP, 155.6 +/-13.6) was not statistically significant (9.9 +/- 16.1 mmHg 9.0 +/-16.8, p = 0.2). Conclusions: Reverse WCE should be considered to estimate the safety of intensive BP control when SBP lowered below 120 mmHg. The presence of reverse WCE instead of WCE highlights more reassuring aspect than previously thought when the patient is asymptomatic or tolerable.

Stroke Risk Factors of Stroke Patients in China: A Nationwide Community-Based Cross-Sectional Study.

Background: Stroke is the leading cause of death in China, and its burdens are rapidly increasing. The prevalence and control of stroke risk factors among stroke patients in China are unknown. Objective: We investigated the stroke risk factors of stroke patients in China. Design: We examined stroke risk factors in 6580 stroke patients aged 18 years or older in the China National Chronic Diseases and Nutrition Surveillance of Adults (2015–2017). With regard to the basic characteristics of the study participants, categorical variables were described as frequency (percent). The chi-square test was used to analyze the difference between men and women. The multivariate logistic regression model was used in the multivariate analysis. Results: Among the 6580 stroke patients, hypertension was the most common stroke risk factor identified in most cases (78.51%), followed by overweight or obesity (61.58%), dyslipidemia (54.38%), smoking (24.04%), diabetes (21.75%), family history of stroke (17.43%), lack of exercise (16.35%), and atrial fibrillation (4.47%). Drinking stroke patients had a lower rate of hypertension, diabetes, and dyslipidemia. Patients with hyperuricemia had a higher rate of hypertension and dyslipidemia than no-hyperuricemia patients. The hypertension awareness, treatment, and control rates among hypertension stroke patients were 73.62%, 70.19%, and 17.79%, respectively. The diabetes awareness, treatment, and control rates among diabetes patients were 69.74%, 65.83%, and 34.59%, respectively. The dyslipidemia awareness, treatment, and control rates among dyslipidemia patients were 42.37%, 29.4%, and 20.07%, respectively. Among treated hypertension patients, the rates of taking medicine as medically advised, controlled diet, increased exercise, and blood pressure monitoring were 91.31%, 58.88%, 45.78%, and 73.99%, respectively. Among treated diabetes patients, the rates of oral antidiabetic medications, insulin injection, diet control, and blood glucose monitoring were 78.24%, 34.71%, 85.77%, and 78.24%, respectively. Among treated dyslipidemic patients, the rate of taking medicine as medical advice, controlled diet, increased exercise, and regular blood lipid monitoring was 80.61%, 77.57%, 56.46%, and 40.3%, respectively. Conclusions: The most common risk factors for community stroke patients in China are hypertension, dyslipidemia, and overweight or obesity. The stroke community patients’ suboptimal awareness and treatment of hypertension, and suboptimal awareness, treatment, and control of diabetes, and dyslipidemia are significant problems in China.

Is Lone Hypertension a Risk Factor for More Severe COVID-19 Outcomes?

Background:Based on current evidence, it is not clear whether lone hypertension increases the risk for severe illness from COVID-19, or if increased risk is mainly associated with age, obesity and diabetes. The objective of the study was to evaluate whether lone hypertension is associated with increase mortality or a more severe course of COVID-19, and if treatment and control of hypertension mitigates this risk.Methods:This is a prospective multi-center observational cohort study with 30-day outcomes of 9,531 consecutive SARS-CoV-2 PCR-positive patients ≥ 18 years old (41.9 ± 9.7 years, 49.2% male), Uzbekistan, June 1-September 30, 2020. Patients were subclassified according to JNC8 criteria into six blood pressure stages. Univariable and multiple logistic regression was conducted to examine how variables predict outcomes.Results:The 30-days all-cause mortality was 1.18% (n = 112) in the whole cohort. After adjusting for age, sex, history of myocardial infarction (MI), type-2 diabetes, and obesity, none of six JNC8 groups showed any significant difference in all-cause mortality. However, age was associated with an increased risk of 30-days all-cause mortality (OR = 1.09, 95%CI [1.07–1.12], p < 0.001), obesity (OR = 7.18, 95% CI [4.18–12.44], p < 0.001), diabetes (OR 4.18, 95% CI [2.58–6.76], p < 0.001), and history of MI (OR = 2.68, 95% CI [1.67–4.31], p < 0.001). In the sensitivity test, being ≥ 65 years old increased mortality 10.56-fold (95% CI [5.89–18.92], p < 0.001). Hospital admission was 12.4% (n = 1,183), ICU admission 1.38% (n = 132). The odds of hospitalization increased having stage-2 untreated hypertension (OR = 4.51, 95%CI [3.21–6.32], p < 0.001), stage-1 untreated hypertension (OR = 1.97, 95%CI [1.52–2.56], p < 0.001), and elevated blood pressure (OR = 1.82, 95% CI [1.42–2.34], p < 0.001). Neither stage-1 nor stage-2 treated hypertension patients were at statistically significant increased risk for hospitalization after adjusting for confounders. Presenting with stage-2 untreated hypertension increased the odds of ICU admission (OR = 3.05, 95 %CI [1.57–5.93], p = 0.001).Conclusions:Lone hypertension did not increase COVID-19 mortality or in treated patients risk of hospitalization.

Abstract 11619: Cost of Treatment is a Barrier to Hypertension Control in Puerto Rican Adults in Massachusetts

Introduction: Little is known about hypertension (HTN) control among Puerto Ricans living on the U.S mainland. We examined awareness, treatment and control of HTN among Puerto Rican adults living in the Boston area to determine whether cost of treatment is a barrier to control. Methods: We used baseline data (2004-2009) from the Boston Puerto Rican Health Study, a longitudinal study of approximately 1500 Puerto Rican adults. Blood pressure was based on the mean of up to 4 determinations. Awareness, treatment and control among all participants, and those being treated, were defined as in the National Health and Nutrition Examination Survey (NHANES). Perceived cost as a barrier to treatment was based on response to a single item. The association of cost with HTN control was tested in multivariable logistic models, adjusting for covariates suggested in the literature, including BMI, serum, creatinine, diabetes, age, alcohol use, and nonsteroidal anti-inflammatory drugs (NSAIDs) use. Results: Participants with HTN (n= 941) had mean age 58.6 + 7.6 years, and 70% were female. Among these, 83.6%, were aware of their HTN, 77.8% were treated, and 37.0% were controlled. Among those being treated, 47.5% were controlled. Seventeen percent of those with HTN reported cost as barrier to treatment. Among those reporting cost as barrier, 27.6% were controlled compared to 38.9% of those with no cost barrier (p&lt;0.01). Among treated HTN patients, 36.4% of those reporting cost as a barrier to treatment were controlled compared to 49.5% of those with no cost barrier (p&lt;0.01). The odds ratio (95%Cl) for control was 0.63 (0.43, 0.93) for cost as a barrier among all participants with HTN, and 0.60 (0.39, 0.91) among those treated. Conclusion: HTN control in Boston-area Puerto Ricans is lower than reported in NHANES for the general US population. Cost of treatment appears to be an important barrier to achieving control.

Self-Perceived Psychological Stress and Risk of First Stroke in Treated Hypertensive Patients.

We aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and to examine possible effect modifiers among adults with hypertension. A total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial. Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow-up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal). The median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted hazard ratio = 1.40, 95% confidence interval = 1.01 to 1.94) or first ischemic stroke (adjusted hazard ratio = 1.45; 95% confidence interval = 1.01 to 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure <101 mm Hg (median; p-interaction = .004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke. Higher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower mean arterial pressure during the treatment period.

Association of short-term fine particulate matter exposure with pulmonary function in populations at intermediate to high-risk of cardiovascular disease: A panel study in three Chinese cities

BackgroundDecline in pulmonary function contributes to increasing cardiovascular disease (CVD) risk. Although adverse effects of short-term exposure to fine particulate matter (PM2.5) on pulmonary function have been recognized in healthy people or patients with respiratory disease, these results were not well illustrated among people with elevated CVD risk. Materials and methodsA panel study was conducted in three Chinese cities with three repeated visits among populations at intermediate to high-risk of CVD, defined as treated hypertension patients or those with blood pressure ≥ 130/80 mmHg, who met any of the three conditions including abdominal obesity, dyslipidemia, and diabetes mellitus. Individualized PM2.5 exposure and pulmonary function were measured during each seasonal visit. Linear mixed-effect models were applied to analyze the associations of PM2.5 concentrations with pulmonary function indicators, including forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC), maximal mid-expiratory flow (MMF), and peak expiratory flow (PEF). ResultsShort-term PM2.5 exposure was significantly associated with decreased pulmonary function and an increment of 10 μg/m3 in PM2.5 concentrations during lag 12–24 hour was associated with declines of 41.7 ml/s (95% confidence interval [CI]: 7.7–75.7), 0.35% (95% CI: 0.01, 0.69), and 20.9 ml/s (95% CI: 0.5–41.3) for PEF, FEV1/FVC, and MMF, respectively. Results from stratified and sensitivity analyses were generally similar with the overall findings, while the adverse effects of PM2.5 on pulmonary functions were more pronounced in those who were physically inactive. ConclusionsThis study first identified short-term exposure to PM2.5 was associated with impaired pulmonary function and physical activity might attenuate the adverse effects of PM2.5 among populations at intermediate to high-risk of CVD. These findings provide new robust evidence on health effects of air pollution and call for effective prevention measures among people at CVD risk.

COVID-19, hypertension, and renin-angiotensin-aldosterone system inhibitors: Much ado about nothing or real problem to be solved?

COVID-19, hypertension, and renin-angiotensin-aldosterone system inhibitors: Much ado about nothing or real problem to be solved?

Differential Control Rate of Systolic and Diastolic Blood Pressure among Korean Adults with Hypertension: the Sixth Korean National Health and Nutrition Examination Survey, 2013-2015 (KNHANES VI).

Background and ObjectivesDiscrepancy in blood pressure (BP) control rate may be owed to different risk factors associated with elevated systolic and diastolic BP (SBP and DBP).MethodsIn a nationally representative survey of Korean population with BP measurements, a total of 5,100 participants with hypertension was included in the analyses. Three separate types of control rates were calculated: SBP, DBP, and (combined) S&DBP among all participants with hypertension and participants with treated hypertension, separately. Control rates were compared across sex and age groups. Multivariable logistic regression was used to identify demographic factors associated with SBP, DBP, and S&DBP control rates, separately.ResultsIn total, SBP, DBP, and S&DBP control rates were 63.0%, 63.7%, and 42.5% among all hypertension patients, and 77.5%, 87.4%, and 71.6% among treated hypertension patients. Men aged 40–49 years with hypertension and 30–39 years treated for hypertension had the highest SBP control rate (74.6% and 96.2%), which decreased by older age. Inversely, DBP control rate progressively increased with older age. SBP control rate among women with hypertension was the highest in 40–49 years (67.0%) but without linear trend by age group. Interestingly, both combined and DBP control rates were noticeably low among women aged 50–59 years. Women with body mass index ≥25 were at higher odds of having controlled SBP. Lower DBP control rate was observed in men with lower education level, higher household income, and heavy drinkers.ConclusionsSeparate examination of control rates demonstrated different sex- and age-differential trends, which would have been overlooked in combined control rates.

MS02.3 The Prevalence of Resistant Hypertension: A Global Systematic Review and Meta-Analysis of Data From 3.2 Million Treated Hypertensive Patients

MS02.3 The Prevalence of Resistant Hypertension: A Global Systematic Review and Meta-Analysis of Data From 3.2 Million Treated Hypertensive Patients

Serum uric acid and arterial hypertension—Data from Sephar III survey

ObjectivesThis paper aims to evaluate the association between serum uric acid (SUA) levels, arterial hypertension (HT) prevalence, blood pressure values control, kidney function and intima media thickness (IMT), as a surrogate marker of early atherosclerosis, in a representative group of Romanian adult population.Materials and methodsThe study sample consists in 1920 adults included in SEPHAR III (Study for the Evaluation of Prevalence of Hypertension and cArdiovascular Risk in Romania) survey (mean age 48.63 years, 52.76% females) collecting data for SUA levels, blood pressure (BP) measurements, kidney function by estimated glomerular filtration rate (eGFR) and carotid IMT. SUA levels between 2,40–5,70mg/dl in females and 3,40–7,00mg/dl in males respectively were considered normal. HT and HT control were defined according to the current guidelines. IMT evaluation was assessed by B-mode Doppler ultrasound evaluation.ResultsHypertensive subjects had significantly higher values of SUA compared with normotensive subjects, hypertensive patients were 1.713 times more likely to have higher values of SUA. Among treated hypertensive patients, those without optimal BP control had significantly higher SUA levels compared with those with optimal BP control, the presence of hyperuricemia increasing the odds of suboptimal BP control by 1.023. Hyperuricemic subjects had significantly lower eGFR values compared with normouricemic ones, on an average with 14.28ml/min/1.73m2 by Modification of Diet in Renal Disease formula (MDRD) and with 16.64ml/min/1.73m2 by Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI), with an indirect association between SUA levels and eGFR values (rs = -0.319 / -0.347), independent of age. IMT values recorded in hyperuricemic subjects were significantly increased, on an average with 0.08mm, compared with normouricemic subjects, with a direct association between SUA levels and IMT values (rs = 0.263), independent of BP values.ConclusionThe results of our study offers support that increased SUA levels are associated with arterial hypertension and with suboptimal BP control in treated hypertensive subjects. The decline in kidney function, independent of age, and also increased IMT values as a marker of atherosclerosis, were also correlated with elevated SUA values. Hyperuricemia screening may have a role in identifying patients at risk of developing HT and lowering SUA levels may improve not only BP control in treated HT patients but also decrease total cardiovascular mortality by slowing the progression of atherosclerosis and renal failure in hypertensive patients.

진단기간에 따른 고혈압 환자의 건강 행위 이행에 영향을 미치는 요인

Purpose: This study was to analyze health behavior adherence and identify affecting factors on the duration of the hypertension diagnosis. Methods: A total of 154 patients of hypertension participated in this study. Data were collected from October to December, 2013 and analyzed using frequency, t-test, ANOVA, multiple linear regression. Results: The scores of health behavior adherence and hypertension knowledge in incidental hypertension patients were 82.23±9.69, 17.86±4.33, respectively. In the treated hypertension patients, the scores of health behavior adherence were 89.30±10.17 and hypertension knowledge were 18.54±3.89. The selected independent variables explained 34% of the health behaviors in the incidental hypertension patients and 36% of the health behaviors in the treated hypertension patients. The regression models were statistically significant (F=4.37, p.001, F=4.45, p.001). Among selected potential influencing factors, age (β=.423, p.001), smoking habit (β=-.227, p=.038), obesity (β=.369, p=.030), hypertension knowledge (β=.281, p=.007), coping strategies (β=.261, p=.015) affect health behavior adherence in the incidental hypertension. In the treated hypertension patients age (β=.362, p=.007), sex (β=-.396, p=.004), smoking habit (β=-.245, p=.022), perceived health status (β=-.238, p=.035) affect health behavior adherence. Conclusion: There was difference about health behavior adherence between newly diagnosed and treated hypertension patients. So different approaches for incidental and treated hypertensive patient need to improve health behavior through tailored nursing intervention.

Coherence and Coupling Functions Reveal Microvascular Impairment in Treated Hypertension.

The complex interactions that give rise to heart rate variability (HRV) involve coupled physiological oscillators operating over a wide range of different frequencies and length-scales. Based on the premise that interactions are key to the functioning of complex systems, the time-dependent deterministic coupling parameters underlying cardiac, respiratory and vascular regulation have been investigated at both the central and microvascular levels. Hypertension was considered as an example of a globally altered state of the complex dynamics of the cardiovascular system. Its effects were established through analysis of simultaneous recordings of the electrocardiogram (ECG), respiratory effort, and microvascular blood flow [by laser Doppler flowmetry (LDF)]. The signals were analyzed by methods developed to capture time-dependent dynamics, including the wavelet transform, wavelet-based phase coherence, non-linear mode decomposition, and dynamical Bayesian inference, all of which can encompass the inherent frequency and coupling variability of living systems. Phases of oscillatory modes corresponding to the cardiac (around 1.0 Hz), respiratory (around 0.25 Hz), and vascular myogenic activities (around 0.1 Hz) were extracted and combined into two coupled networks describing the central and peripheral systems, respectively. The corresponding spectral powers and coupling functions were computed. The same measurements and analyses were performed for three groups of subjects: healthy young (Y group, 24.4 ± 3.4 y), healthy aged (A group, 71.1 ± 6.6 y), and aged treated hypertensive patients (ATH group, 70.3 ± 6.7 y). It was established that the degree of coherence between low-frequency oscillations near 0.1 Hz in blood flow and in HRV time series differs markedly between the groups, declining with age and nearly disappearing in treated hypertension. Comparing the two healthy groups it was found that the couplings to the cardiac rhythm from both respiration and vascular myogenic activity decrease significantly in aging. Comparing the data from A and ATH groups it was found that the coupling from the vascular myogenic activity is significantly weaker in treated hypertension subjects, implying that the mechanisms of microcirculation are not completely restored by current anti-hypertension medications.

Prognosis of Masked and White Coat Uncontrolled Hypertension Detected by Ambulatory Blood Pressure Monitoring in Elderly Treated Hypertensive Patients.

Prognosis of masked and white coat uncontrolled hypertension (MUCH and WCUCH, respectively) detected by ambulatory blood pressure (BP) monitoring is incompletely clear in elderly treated hypertensive patients. We evaluated prognosis of MUCH and WCUCH identified by ambulatory BP monitoring in this setting. The occurrence of a composite endpoint was evaluated in 1,191 elderly treated hypertensive patients. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and 24-hour BP <130/80 mm Hg, MUCH as clinic BP <140/90 mm Hg and 24-hour BP ≥130 and/or ≥80 mm Hg, WCUCH as clinic BP ≥140 and/or ≥90 mm Hg and 24-hour BP <130/80 mm Hg and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and 24-hour BP ≥130 and/or ≥80 mm Hg. MUCH was identified in 142 patients (12% of all the population, 34% of those with normal clinic BP) and WCUCH in 230 patients (19% of all the population, 30% of those with high clinic BP). During the follow-up (9.1 ± 4.9 years, range 0.4-20 years), 392 events occurred. After adjustment for various covariates, patients with MUCH (hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.12-2.29, P = 0.01) and SUCH (HR 1.81, 95% CI, 1.35-2.42, P < 0.001) had significantly higher cardiovascular risk than those with CH, whereas those with WCUCH (HR 1.09, 95% CI, 0.74-1.60, P = 0.66) had not significantly higher risk. In elderly treated hypertensive patients evaluated by ambulatory BP monitoring, compared to individuals with CH, those with MUCH have significantly higher risk and those with WCUCH have slightly and not significantly higher risk.

Annexin A5 in treated hypertensive patients and its association with target organ damage.

Annexin A5 (AnxA5) has been previously linked to the presence of carotid and cardiac target organ damage (TOD) in the context of heart failure and rheumatologic patients. However, information is scant in the context of hypertension. Aim of our study was to evaluate AnxA5 in treated hypertension patients compared with normotensive controls and to determine whether it is associated with vascular and heart TOD evaluated as arterial stiffness, carotid plaque and left ventricular hypertrophy. We enrolled 123 consecutive treated hypertension and 124 normotensive controls. TOD was evaluated as pulse wave velocity (PWV, complior), left ventricular hypertrophy (echocardiography) and intima-media thickness and carotid plaque presence (ecographic methods). AnxA5 levels was dosed and compared in patients with and without hypertension and with and without TOD. With similar age hypertension patients showed higher SBP, DBP and AnxA5 levels (13.9 ± 11.1 vs 10.1 ± 8.4 ng/ml, P < 0.001) compared with controls. Regarding TOD hypertension showed higher PWV (8.5 ± 1.8 vs 7.6 ± 1.5 m/s, P < 0.001) and LVMI (121.7 ± 29.3 vs 113.5 ± 21.1 g/m, P < 0.05), whereas carotid intima-media thickness was superimposable. AnxA5 correlates with PWV (r = 0.13, P < 0.05) and DBP (r = 0.15, P < 0.01), whereas it has never been found as a significant independent predictor of TOD in linear regression analysis. Our data have shown that AnxA5 levels are increased in treated hypertension patients. In this condition, it is probably released in the plasma as a defensive mechanism through its anti-inflammatory and anticoagulants effects. We found a significant association with arterial stiffness, but AnxA5 was not found to be a significant predictor of TOD.

A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio.

Monocyte to high density lipoprotein cholesterol ratio (MHR) is generally understood to be a candidate marker of inflammation and oxidative stress. Therefore, we aimed to assess the association between MHR and aortic elastic properties in hypertensive patients. A total of 114 newly-diagnosed untreated patients with hypertension and 71 healthy subjects were enrolled. Aortic stiffness index, aortic strain and aortic distensibility were measured by using echocardiography. Patients with hypertension had a significantly higher MHR compared to the control group (p < 0.001). Also, aortic stiffness index (p < 0.001) was significantly higher and aortic distensibility (p < 0.001) was lower in the hypertensive group. There was a positive correlation of MHR with aortic stiffness index (r = 0.294, p < 0.001) and negative correlation with aortic distensibility (r = -0.281, p < 0.001). In addition, MHR and high sensitivity C-reactive protein have a positive correlation (r = 0.30, p < 0.001). Furthermore, MHR was found to be an independent predictor of aortic distensibility and aortic stiffness index. In patients with newly-diagnosed untreated essential hypertension, higher MHR was significantly associated with impaired aortic elastic properties.

Prognostic Value of Nondipping and Morning Surge in Elderly Treated Hypertensive Patients With Controlled Ambulatory Blood Pressure.

The independent prognostic significance of nondipping and morning surge (MS) of blood pressure (BP) in treated hypertensive patients with controlled ambulatory BP is not yet clear. We investigated the association between the aforesaid ambulatory BP parameters and cardiovascular risk in elderly treated hypertensive patients with normal achieved ambulatory BP. The occurrence of a composite end-point (stroke, coronary events, heart failure, and peripheral revascularization) was evaluated in 391 elderly treated hypertensive patients (age range 60-90 years) with controlled ambulatory BP (both daytime BP <135/85 mm Hg and nighttime BP <120/70 mm Hg). According to nighttime change and MS of systolic BP, subjects were divided in dippers with normal or high MS (>23 mm Hg) and nondippers. During the follow-up (9.3 ± 4.6 years, range 0.5-20 years), 76 events occurred. The event-rate was 2.09 per 100 patient-years. After adjustment for age, gender, left ventricular (LV) hypertrophy, asymptomatic LV systolic dysfunction at baseline and left atrial enlargement, dippers with high MS (hazard ratio 2.45, 95% confidence interval 1.27-4.73, P = 0.007) and nondippers (hazard ratio 2.04, 95% confidence interval 1.18-3.53, P = 0.01) were at higher cardiovascular risk than dippers with normal MS. In elderly treated hypertensive patients with normal achieved ambulatory BP, dippers with high MS and nondippers are at increased cardiovascular risk.

Predictive Performance of Echocardiographic Parameters for Cardiovascular Events Among Elderly Treated Hypertensive Patients.

Hypertension leads to cardiac structural and functional changes, commonly assessed by echocardiography. In this study, we assessed the predictive performance of different echocardiographic parameters including left ventricular hypertrophy (LVH) on future cardiovascular outcomes in elderly hypertensive patients without heart failure. Data from LVH substudy of the Second Australian National Blood Pressure trial were used. Echocardiograms were performed at entry into the study. Cardiovascular outcomes were identified over short term (median 4.2 years) and long term (median 10.9 years). LVH was defined using threshold values of LV mass (LVM) indexed to either body surface area (BSA) or height(2.7): >115/95g/m(2) (LVH-BSA(115/95)) or ≥49/45g/m(2.7) (LVH-ht(49/45)) in males/females, respectively, and ≥125g/m(2) (LVH-BSA(125)) or ≥51g/m(2.7) (LVH-ht(51)) for both sexes. In the 666 participants aged ≥65 years in this analysis, LVH prevalence at baseline was 33%-70% depending on definition; and after adjusting for potential risk factors, only LVH-BSA(115/95) predicted both short- and long-term cardiovascular outcomes. Participants having LVH-BSA(115/95) (69%) at baseline had twice the risk of having any first cardiovascular event over the short term (hazard ratio, 95% confidence interval: 2.00, 1.12-3.57, P = 0.02) and any fatal cardiovascular events (2.11, 1.21-3.68, P = 0.01) over the longer term. Among other echocardiographic parameters, LVM and LVM indexed to either BSA or height(2.7) predicted cardiovascular events over both short and longer term. In elderly treated hypertensive patients without heart failure, determining LVH by echocardiography is highly dependent on the methodology adopted. LVH-BSA(115/95) is a reliable predictor of future cardiovascular outcomes in the elderly.