Ambulatory Blood Pressure Values Research Articles

Twenty-Four-Hour Ambulatory Blood Pressure Monitoring Parameters During Pregnancy: A Pilot Study.

Introduction: Maternal blood pressure (BP) is a critical cardiovascular marker with profound implications for maternal and fetal well-being, particularly in the detection of hypertensive disorders during pregnancy. Although conventional clinic-based BP (CBP) measurements have traditionvally been used, monitoring 24-hour ambulatory BP (ABP) has emerged as a more reliable method for assessing BP levels and diagnosing conditions such as gestational hypertension and preeclampsia/eclampsia. This study aimed to assess the feasibility and acceptability of 24-hour ABP monitoring in pregnant women and report on various ABP parameters, including ambulatory blood pressure variability (ABPV). Method: A prospective cross-sectional study design was employed, involving 55 multipara pregnant women with and without prior adverse pregnancy outcomes (APOs). The participants underwent baseline assessments, including anthropometrics, resting CBP measurements, and the placement of ABP and actigraphy devices. Following a 24-hour period with these devices, participants shared their experiences to gauge device acceptability. Pregnancy outcomes were collected postpartum. Results: Twenty-four-hour ABP monitoring before 20 weeks of gestation is feasible for women with and without prior APOs. Although some inconvenience was noted, the majority of participants wore the ABP monitoring device for the entire 24-hour period. Pregnant women who later experienced APOs exhibited higher 24-hour ABP and ABPV values in the early stages of pregnancy. Conclusion: The study highlights the potential benefits of 24-hour ABP monitoring as a valuable tool in prenatal care, emphasizing the need for further research in this area.

Comparison of Ambulatory and Home Blood Pressure Variability for Cardiovascular Prognosis and Biomarkers.

Although blood pressure variability (BPV) is reported to be associated with cardiovascular prognoses, it has not been established whether ambulatory BPV (ABPV; ie, short-term 24-hour BPV) or home BPV (HBPV; day-to-day BPV) is a superior clinical marker. We analyzed the associations of ABPV and HBPV with cardiovascular prognoses and biomarkers in 1314 hypertensive outpatients who underwent both home and ambulatory BP measurements in the J-HOP study (Japan Morning-Surge Home Blood Pressure). BPV was evaluated by the SD, coefficient of variation, and average real variability of the patients' 24-hour ambulatory and home systolic BP values. During the median 7.0-year follow-up, 109 cardiovascular events occurred. All SD, coefficient of variation, and average real variability values of the HBPV were significantly associated with cardiovascular risk even after adjusting by average 24-hour ambulatory systolic BP and each ABPV value: 1 SD of hazard ratio (95% CI) for the SD, 1.36 (1.14-1.63); coefficient of variation, 1.38 (1.16-1.66); and average real variability 1.29 (1.10-1.51) of HBPV. The ABPV parameters did not exhibit comparable relationships. The cardiovascular risk spline curves showed a trend toward increased risks with increasing HBPV parameters. There were no differences between ABPV and HBPV in the relationships with B-type natriuretic peptide and the urine albumin-creatine ratio. In this comparative analysis of ambulatory and home BP monitoring values in individuals with hypertension, ABPV was not significantly associated with cardiovascular prognosis adjusted by average BP level, and HBPV was suggested to have modest superiority in predicting cardiovascular prognosis compared with ABPV.

Twenty-Four-Month Blood Pressure Results After Renal Denervation Using Endovascular Ultrasound.

BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a large body of evidence for the durability and safety of radiofrequency-based renal denervation, there are a paucity of data for endovascular ultrasound-based renal denervation (uRDN). We aimed to assess the long-term efficacy and safety of uRDN in a single-center cohort of patients. METHODS AND RESULTS Data from 2 previous studies on uRDN were pooled. Ambulatory 24-hour blood pressure measurements were taken before as well as 3, 6, 12, and 24 months after treatment with uRDN. A total of 130 patients (mean age 63±9 years, 24% women) underwent uRDN. After 3, 6, 12, and 24 months, systolic mean 24-hour ambulatory blood pressure values were reduced by 10±12, 10±14, 8±15, and 10±15 mm Hg, respectively, when compared with baseline (P<0.001). Corresponding diastolic values were reduced by 6±8, 6±8, 5±9, and 6±9 mm Hg, respectively (P<0.001). Periprocedural adverse events occurred in 16 patients, and all recovered without sequelae. CONCLUSIONS In this single-center study, uRDN effectively lowered blood pressure up to 24 months after treatment.

Prognostic Impact of On-Treatment Cumulative Ambulatory Blood Pressures for Adverse Macro- and Microvascular Outcomes in Individuals With Type 2 Diabetes: The Rio de Janeiro Type 2 Diabetes Cohort.

The prognostic value of on-treatment mean cumulative ambulatory blood pressures (BPs) in type 2 diabetes has never been investigated. We aimed to assess it in a prospective cohort of 647 individuals with type 2 diabetes. Clinic-office and ambulatory BPs were measured at baseline and serially during follow-up. Multivariable Cox analyses assessed the associations between baseline and mean cumulative BPs with the occurrence of cardiovascular events, major adverse cardiovascular events, all-cause and cardiovascular mortality, and microvascular outcomes (microalbuminuria, renal failure, retinopathy, and peripheral neuropathy). C statistics and the integrated discrimination improvement (IDI) index evaluated the improvement in risk discrimination by using cumulative ambulatory BPs instead of baseline BPs. Over a median follow-up of 10.6 years, there were 202 cardiovascular events (163 major adverse cardiovascular events), 254 all-cause deaths (118 cardiovascular); 125 individuals had microalbuminuria development/progression, 104 developed advanced renal failure, 159 had retinopathy, and 174 individuals had peripheral neuropathy development/progression. The risks associated with mean cumulative ambulatory BPs were in general higher than those associated with baseline BPs, particularly for cardiovascular (HR, 1.42 versus 1.25 for increments of 1 SD in 24-hour systolic blood pressure) and mortality outcomes (1.56 versus 1.26). Compared with cumulative clinic BPs, mean cumulative ambulatory BPs improved risk discrimination for most outcomes, with IDIs from 11% to 14% for major adverse cardiovascular events and mortality up to 24% to 26% for microalbuminuria and neuropathy. Compared with clinic-office BPs, mean cumulative ambulatory BPs during follow-up improve risk discrimination for most complications and mortality in individuals with type 2 diabetes. Serial ambulatory BP monitoring shall be more widely used in clinical management.

New-onset hypertension is not associated with systemic changes in inflammatory cytokine levels

IntroductionRecent studies have suggested that hypertension develop�ment may be associated with an altered immune system. However, there is a paucity of data evaluating the association between blood pressure values and inflammatory markers in patients with new-onset hypertension.Material and methodsWe evaluated 61 subjects, including 24 healthy indi�viduals and 37 newly diagnosed hypertensive patients (aged 45 ±9.6 vs. 43.8 ±11.9 years; SBP_24hours 114 ±7.1 vs. 134.2 ±9.5 mm Hg; DBP_24hours 71.2 ±4.7 vs. 85.8 ±9.3 mm Hg, respectively) without prior antihypertensive treatment. The diagnosis of hypertension was based on 24-hour ambulatory blood pressure monitoring (ABPM). We analysed the association between blood pressure values and levels of individual inflammatory markers (ITAC, GM-CSF, fractalkine, IFN-g, IL-10, MIP-3a, IL-12, IL-13, IL-17A, IL-1b, IL-2, IL-21, IL-23, IL-5, IL-6, IL-7, IL-8, MIP-1a, MIP-1b, TNF-a, and IL-15) sepa�rately, as well as in clusters of inflammatory mediators (factor 1 – proin�flammatory: IL-1β, IL2, IL-6, IL-7, IL-12, IL-6, IL-21, TNF-α, IFN-γ; and factor 2 – anti-inflammatory: IL-13, IL-5).ResultsOur study did not show any differences in concentrations of inflam�matory markers between patients and controls. Plasma levels of inflamma�tory markers were not associated with 24-hour ambulatory blood pressure values in patients with new-onset hypertension.ConclusionsPatients with new-onset hypertension did not differ from healthy subjects regarding the levels of plasma inflammatory markers. Our findings demonstrate the need for larger, more comprehensive studies on this topic to further elucidate the relationship between hypertension and inflammation.

RELATIONSHIP BETWEEN CAROTID INTIMA MEDIA THICKNESS AND PHENOTYPES OF HIGH BLOOD PRESSURE IN ADOLESCENTS

Objective: The aim of this study was to investigate the relationship between the Carotid Intima Media Thickness (cIMT) and high blood pressure phenotypes (HBPP) in a population of Hispanic adolescents. Design and method: It was conducted a cross-sectional study in Maracaibo, Venezuela that included 616 adolescents, 289 males and 327 females, selected from high school institutions (age: 13-18 years old). An ultrasonic study was carried out through high resolution B-mode ultrasound examinations for the measurement of the c-IMT. Also, 24-hs ambulatory blood pressure (ABPM) monitoring was performed to obtain ambulatory BP during 24-hs, awake and asleep periods. Demographic (age, gender), anthropometric data [weight, height, hip circumference, waist circumference (WC)] and office BP were recorded. The HBPP included were: true normotension (TN), sustained (SH), white coat (WCH) and masked (MH) hypertension according the new American Heart Association recommendations. Spearman Correlation was used to estimate the association between c-IMT and HBBPP. Results: The mean c-IMT value was 0.42 mm in all adolescents, 0.43 in males and 0.41 in females (p = 0.01). The HBPP prevalence in all adolescents was: 4. % (n = 26) for SH, 21.6 % (n = 133) for MH, 1.0 % (n = 6) for WCH and 73.2 % (n = 451) for TN. Males showed statistically significant high prevalence of MH and SH than female group [(28.4% vs. 15.6% for MH) and (8.3% vs. 0.6%) for SH. The adolescents with SH showed statistically significant higher values than those with TN in c-IMTI values [0.45±0.05 vs. 0.41.2±0.061 mm, p = 0.01]. There were statistically significant associations between c-IMT values with HBPP (Sperman rho = 0.115, p = 0.01). Conclusions: This study showed important associations between c-IMT values and HBPP in adolescents. Also, there is a very high prevalence of MH and SH; this condition appears to be associated with male gender. It should be important to evaluate c-IMT in those adolescents with office or ambulatory high BP values to investigate possible vascular changes induced by hypertension.

Morning blood pressure surge as a predictor of cardiovascular events in patients with hypertension.

The prognostic value of ambulatory blood pressure (BP) monitoring (ABPM) is poorly understood in Latin American populations. A prospective observational study was conducted on 1339 patients with hypertension who underwent 24-h BP monitoring between 2015 and 2019. The incidence of serious adverse cardiovascular events (MACE) was analysed using a Cox proportional hazards model adjusted for potential confounders. Three previously reported morning surge definitions were evaluated for SBP and DBP using different ABPM components: sleep-through morning surge, pre-awakening, and morning night-time difference. The mean age was 62 years, 52% were female, 32.8% had dyslipidaemia, 27.2% were smokers, and 7.8% had diabetes. During a median follow-up period of 32 months, 197 MACE occurred. In men, the adjusted hazard ratio (HR) was 1.84 [95% confidence interval (CI), 1.35-2.49; P < 0.001). The HR increased to 2.03 (95% CI, 1.89-2.17; P < 0.001) with a cut-off value of 35 mmHg for a 10 mmHg increase in sleep-through morning surge. The increased adjusted HR associated with the morning rise persisted for each secondary endpoint, including 21 cardiovascular deaths [HR: 2.70 (95% CI, 2.03-3.60; P < 0.001)], 78 myocardial infarctions [HR: 1.92 (95% CI, 1.72-2.15; P < 0.001)], 24 hospitalisations for heart failure [HR: 1.77 (95% CI, 1.48-2.12; P < 0.001)], 22 strokes [HR: 2.32 (95% CI, 1.85-2.91; P < 0.001)], and 52 atrial fibrillations [HR: 1.94 (95% CI, 1.71-2.20; P < 0.001)]. The morning BP rise was the most important circadian prognostic factor for MACE in patients with hypertension, which deserves more attention.

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

PS-C11-6: SIMULTANEOUS MEASUREMENT OF 24-HOUR AMBULATORY BLOOD PRESSURE IN BOTH ARMS REVEALS CLINICALLY RELEVANT DIFFERENCES: A WAKEUP-CALL FOR HYPERTENSION MANAGEMENT

Objective: Cuff-based 24-hour ambulatory blood pressure measurement is the gold standard for hypertension diagnosis and treatment monitoring. The clinical value of ambulatory blood pressure (BP) measurement is ubiquitously accepted. This study wants to quantify the measurement discrepancies in simultaneous and synchronized 24-hour ambulatory BP measurements on both arms. Identifying and understanding measurement uncertainties could improve future hypertension management and originate true confidence in alternative, cuff-less systems with equal measurement precision. Methods: We conducted simultaneous 24-hour ambulatory blood pressure measurements on both arms in 52 healthy young adults. The broadly used and validated cuff-devices (BoSo TM-2430) were synchronized to start BP measurement within one second of each other. Further, we recorded, cuff-pressures of both cuff-based devices and the hydrostatic pressure differences between both cuffs. We then scored pressure curves for disturbances (e.g., pressure spikes during deflation) and were able to correct measurements for hydrostatic differences between the arms. This enabled us to not only quantify the extent of measurement uncertainty but to describe its origins and possible countermeasures. Results: Measured BP levels from left and right arm showed limits of agreement in the Bland Altman Plot of &gt; 33 mmHg for systolic and &gt; 30 mmHg for diastolic values over 24 h. Daytime values deviated more than nocturnal values (systolic: &gt; 35 mmHg vs. &gt; 27 mmHg systolic, and diastolic: &gt; 32 mmHg vs. &gt; 24 mmHg). Linear regression retrieved R2 = 0.39 (p &lt; 0.001) for systolic and R2 = 0.20 (p &lt; 0.001) for diastolic values. Exclusion of disturbed cuff pressure curves improved limits of agreement to &gt; 23 mmHg for systolic and &gt; 19mmHg for diastolic measurements. Subsequently, it improved correlation coefficients to R2 = 0.54 (p &lt; 0.001) for systolic and R2 = 0.35 (p &lt; 0.001) for diastolic values. Correction of hydrostatic differences between the arms had an negligible effect on limits of agreement and strength of correlation. Conclusion: Comparison of synchronized 24-hour BP measurements on both arms showed large measurement uncertainties with possible implications on clinical grading of hypertension and dipping pattern. Exclusion of disturbed cuff pressure curves, not detected by the conventional software of BP devices, mitigates the effect but still results in worrying discrepancies. These results are an imperative to further investigate the clinical implications of BP measurement uncertainty. It further inspires the courageous exploration of alternative means of BP measurement which might offer comparable measurement certainty.

S-04-1: CURRENT EVIDENCE AND ISSUES ON AOBP FROM JAPAN

The potential ability of unattended office blood pressure (AOBP) has been acknowledged worldwide, including Japan, although much resource consumption makes it less feasible to use AOBP in clinical practice. We reported that the three consecutive AOBP measurement values in each patient were almost identical, with high correlations (r ≥ 0.90), and the AOBP and conventional attended office blood pressure were moderate to highly correlated. We therefore interpret that AOBP can be an alternative that is more stable than the conventional attended blood pressure value despite with the average shifted to some extent, e.g., 10.4/4.2 mmHg based on the same study. In contrast, there is a fundamental discrepancy between the similarity in average values and the poor agreement in individuals when we compare AOBP versus self-measured home blood pressure, as the systolic blood pressure difference was 0.9 mmHg with a 95% agreement limit was -34.0 to + 35.8 mmHg. The vast wide range of difference indicates that we cannot estimate home as well as ambulatory blood pressure values by AOBP measurements in each patient, and vice versa. AOBP has another advantage regarding the elimination of white-coat effect by the presence of medical staff. Nevertheless, because AOBP measurement is performed at a clinic or in a screening setting where participants cannot be relaxed like at their own home, such a clinic effect still affects AOBP readings. In this session, the current evidence on AOBP based on our Japanese studies and others will be summarized and issues which remain to be investigated for the assessment of a variety of blood pressure conditions, unattended and attended office, and out-of-office blood pressures will be discussed.

Association of Home and Ambulatory Blood Pressure With Cardiovascular Prognosis in Practice Hypertensive Outpatients.

Although international guidelines for hypertension management recommend home and ambulatory blood pressure (BP) monitoring, few studies have assessed which is more useful in predicting cardiovascular incidence in hypertensive outpatients. We analyzed the association of home and ambulatory BP with cardiovascular prognosis in 1336 practice outpatients with hypertension who underwent both home and ambulatory BP measurements in the J-HOP study (Japan Morning Surge-Home Blood Pressure). During the median 6.9 years of follow-up, 111 cardiovascular events occurred. Both home and ambulatory systolic BP (SBP) were associated with cardiovascular risk independent of office SBP (hazard ratio [95% CI] per 20 mm Hg of average morning and evening home SBP, 1.46 [1.11-1.93]; 24-hour ambulatory SBP, 1.41 [1.02-1.94]). Moreover, average morning and evening home SBP was also associated with cardiovascular risk even adjusted by 24-hour ambulatory SBP (hazard ratio [95%CI] per 20 mm Hg, 1.38 [1.01-1.87]), but 24-hour ambulatory SBP was not associated with cardiovascular risk adjusted by average morning and evening home SBP. Regarding this relationship, the model-fit was significantly improved by using the analysis of likelihood ratio, but that was not significant in the analysis using C statistics. Additionally, even in patients with well-controlled 24-hour ambulatory BP, uncontrolled morning home BP was associated with cardiovascular risks (hazard ratio [95% CI], 2.15 [1.02-4.50]). In patients with well-controlled average morning and evening home BP, uncontrolled ambulatory BP was not associated with cardiovascular risks. This study demonstrated the prognostic values of home and ambulatory BP in practice hypertensive outpatients. Our findings indicated the modest superiority of home BP compared to ambulatory BP to predict cardiovascular prognosis.

The first software as medical device of evidence-based hypertension digital therapeutics for clinical practice.

In 2021, the open-label randomized HERB-Digital Hypertension 1 (HERB-DH1) trial showed for the first time that hypertension digital therapeutics (a hypertension treatment app) successfully reduced blood pressure (BP) in patients with hypertension. Patients in the digital therapeutics group who used the app and home BP monitoring (HBPM) showed significant and persistent decreases in office, home and ambulatory BP values compared with the control group (who were under physician management using HBPM and lifestyle modifications). The results of the pivotal study led to the first global approval of this app for the treatment of hypertension in Japan in 2022, including medical insurance reimbursement. As a result, this hypertension app is expected to become widely used in the clinical management of all stages of hypertension. The most important remaining research issues include the identification of patients likely to respond to this therapeutic approach and the development of clinical efficacy indices. In addition, guidelines for the appropriate use of hypertension apps in the treatment of hypertension are needed. Next steps include the development and research of digital tools to facilitate the behavioral modifications required to prevent hypertension.

Consistency among Office, Home, and Ambulatory Blood Pressure Values in Women with Chronic Hypertension and History of Eclampsia or Preeclampsia.

Adequate control of blood pressure (BP) is essential to prevent complications in pregnant women with a history of eclampsia or pre-eclampsia. However, the importance of office (OBPM), home (HBPM), and ambulatory (ABPM) BP measurements for proper control and prognosis in high-risk pregnancy is unknown. The present study aimed to compare BP values obtained during these three different BP measurements in women with a history of eclampsia or pre-eclampsia. This study included 79 pregnant women with chronic hypertension and a documented history of eclampsia or pre-eclampsia in previous pregnancy/pregnancies. Every fifth week of the study, all participants underwent ABPM, HBPM and OBPM. BP values from the 10th, 25th, and 37th weeks of pregnancy were evaluated. Therapy was intended to meet the ABPM treatment goal of <130/80 mmHg. Day, night, and 24 h ABPM systolic BP values were lower than HBPM and OBPM values at each study visit. Night and 24 h ABPM diastolic BP values were lower than HBPM and OBPM values, while day 24 h ABPM values were slightly higher than HBPM and OBPM values. ABPM provides different BP values than OBPM and HBPM. Target BP for ABPM in high-risk pregnancy hypertension should be estimated based on the predictive value of adverse pregnancy outcomes.

HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS BASED ON COMBINED OR ISOLATED ELEVATION OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS AND ASSOCIATION WITH ORGAN DAMAGE

Objective: To assess the prevalence of white-coat (WCH) and masked (MH) hypertension detected by only ambulatory or only home blood pressure (BP) monitoring (isolated), or both (dual), and their association with preclinical target organ damage (TOD). Design and method: Young individuals referred for elevated BP and healthy volunteers aged 6–25 years were evaluated with office (2–3 visits; triplicate measurements), home (7 days, duplicate morning and evening measurements) and 24-hour ambulatory BP monitoring. TOD assessment included echocardiographic left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and pulse wave velocity (PWV; Complior). Normotension (NT) was defined as normal office, home and ambulatory BP and sustained hypertension (SH) as all measurements being elevated. WCH and MH phenotypes were identified based on isolated or combined (dual) home and ambulatory BP values. Results: Analysis included 320 individuals (mean age 13.8 ± 3.8 years, 66.6% males, 32.2% children, 55.9% adolescents, 11.9% young adults, BMI 24.1 ± 4.8 kg/m2), of whom 276 had LVMI, 212 IMT and 168 PWV assessment. 182 (56.9%) participants had NT and 39 (12.2%) SH. Among 54 (16.9%) participants with WCH, 35 had dual WCH (64.8%) and 19 (35.2%) isolated ambulatory or home WCH. Among 45 (14.1%) with MH, 17 had dual MH (37.8%) and 28 isolated ambulatory or home MH (62.2%). Participants with dual and isolated intermediate phenotypes didn’t differ according to age, sex and BMI. Individuals with SH had higher LVMI, IMT and PWV than NT (all P &lt; 0.05; Figure). Intermediate phenotypes based on selective or combined elevation of out-of-office BP presented intermediate values of indices of TOD between NT and SH. Isolated ambulatory or home WCH was associated with higher LVMI values than NT (P &lt; 0.05), whereas dual MH was associated with higher IMT than NT (all P &lt; 0.05). Conclusions: These findings suggest that in young individuals intermediate hypertension phenotypes with selective (isolated WCH) or combined elevation of BP (dual MH) in out-of-office measurement methods appear to carry an increased risk of preclinical TOD compared with NT.

DIFFERING EFFECTS OF RENAL DENERVATION ON BLOOD PRESSURE AND SYMPATHETIC NERVE TRAFFIC: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Whether and to what extent the reported BP lowering effects of renal denervation (RD) are mediated by a sympathetic deactivation induced by the procedure is still largely undefined. We examined this issue by performing a meta-analysis of the microneurographic studies published so far based on the evaluation of the blood pressure (BP) and muscle sympathetic nerve traffic (MSNA) responses to RD. Design and method: The meta-analysis was based on 12 studies including a total of 394 patients with resistant hypertension underwent RD and followed up to 12 months. Evaluation was extended to the relationships of MSNA with heart rate (HR) and clinic or ambulatory blood pressure (BP) values (expressed such as mean and 95% confidence interval). Results: Baseline MSNA values amounted to 48.25 (43.86–52.64) bursts/minute, clinic HR to 66.35 (65.02–67.67) beats/minute and systo/diastolic clinic BP to 167.3 (157.6–177.01) and 90.54 (84.81–96.27) mmHg. RD caused a significant BP reduction at 3/6/12 months following the procedure amounting to 12.6 mmHg for systolic (range 20.9 to 4.39 mmhg, p = 0.003) and to 6.4 mmHg for diastolic BP (range -11.9 t0 0.9 mmHg, p = 0.02) respectively. No significant change in MSNA (-2.65, range -6.7 to 1.4 bursts/minute, P = NS) and HR (-0.58, range -3.98 to 2.81 b/min, P = NS) were concomitantly observed. No relationship was found between the number of renal ablations and the magnitude of the blood pressure or MSNA changes, this being the case also for HR. Conclusions: This meta-analysis, the first ever done on the MSNA responses to RD, shows that in a consistent number of patients underwent RD, the BP lowering effects of the procedure are not accompanied by any significant change in 2 adrenergic markers, i.e. MSNA and HR, and thus appear not to be mediated by any sympathetic deactivation.

Insights From Matched Office and Ambulatory Blood Pressure in Youth: Clinical Relevance.

Information on the relationship between ambulatory blood pressure (ABP) and concurrently office blood pressure (BP) values in youth still suffers from limitations. We provide information on the differences between office BP and ABP, the factors related, and the clinical implications. Three thousand six hundred ninety matched measurements of office BP and ABP on the same day, from 2390 children, aged 5 to 15 years, of both sexes were eligible. Office BP was measured using an oscillometric device (Omron 705 IT) and 24-hour ABP using oscillometric SpaceLabs 90207. Average of office, 24-hour, daytime, nighttime, systolic, and diastolic BP and heart rate was calculated. BP categories according to the European guidelines and phenotype of mismatch office BP versus ABP were defined. Both daytime systolic and diastolic BP were higher than office BP with a progressive reduction of the differences from 5 to 15 years. The office minus daytime BP differences were the largest in normotensive subjects, less at high-normal, and reversed in hypertensive ones, independently of age and weight status. White coat and masked hypertension covered no more than 13.6% at all ages. In youth, it is inaccurate to obtain reference values for ABP by extrapolating from office BP values. The differences between office BP and ABP are minimal in children with office BP values in the range of hypertension, reinforcing the recommendation to use ABP measurement at the time to confirm hypertension.

Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients

Introduction and objectivesPrevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. Materials and methodsTwenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. ResultsIn donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. ConclusionsAfter transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.

AMBULATORY BLOOD PRESSURE VARIABILITY IN YOUNG ADULTS WITH LONG-COVID SYNDROME.

The aim: To perform an overall assessment of BP and BP variability using ambulatory measurements in young adults with long COVID syndrome. Materials and methods: We enrolled young patients with diagnosed long-COVID syndrome (n = 58, mean age 23.07 ± 1.54 years), compared with an age-matched healthy subjects who had not suffered from COVID-19 (n = 57, mean age 22.9 ± 1.83 years). Patients with long-COVID syndrome had recovered from mild/moderate illness and none had required hospitalization. Ambulatory 24 hours blood pressure (AMBP) parameters (mean BP, daytime BP, nighttime BP, pulse pressure, nocturnal systolic BP dipping, dipper status) were measured in all participants. The variability of systolic BP (SBP) and diastolic BP (DBP) values was assessed by the following common metrics, including the average real variability (ARV), the coefficient of variation (CV), the standard deviation (SD), and the weighed SD of SBP and DBP. Results: The average values of 24-hour ambulatory blood pressure, mean BP, daytime and nighttime systolic BP, diastolic BP and pulse pressure were found to be significantly different among patients with long COVID syndrome and control group. Group analyses showed that this difference was in SBP mean values (127.1 ± 6.65 mmHg and 115.93 ± 6.24 mmHg respectively) and DBP mean values (73.31 ± 5.30 mmHg and 68.79 ± 5.5 mmHg respectively) mainly at night. PP values at daytime were almost similar among groups, but PP values at nighttime were higher in patients with long-COVID syndrome (53.8 (52.44- 55.14) mmHg and 47.14 (46.45 - 47.88) mmHg respectively). Nocturnal SBP dipping was better in control group than in patients with long-COVID syndrome ( 5.3 ± 5.68 and 3.1 ± 3.79 mmHg respectively). Only 13 (22.4%) patients with long-COVID syndrome had normal dip-per status while more than half - 38 (66.7%) in healthy subjects. The values of ARV of SBP and DBP over 24-hour, awake, and asleep time frames were found to be greater in patients with long COVID syndrome than healthy controls (p < 0.05). Conclusions: Patients with long- COVID syndrome have higher BP mean values of 24-hour ABPM particularly at nightime, significant blood pressure BP variability, which increases the risk of cardiovascular events in future. Nevertheless, the further prospective investigations is warranted to investigate the potential mechanisms and causality associations.

Abstract 12778: A High Physiological Stress Response is Dependent on Call Type in Firefighters

Introduction: CVD and impaired cardiovascular health is noticeably more prevalent in firefighters (FF) than the general population, with over 50% of line-of-duty deaths being cardiovascular related. Many FF have hypertension but less than 25% have their BP under control. The BP and HR response to different calls and job activity in FF is unknown. Thus, we aimed to evaluate and quantify the physiological stress resulting from different types of calls and job activity (fire, medical, riding apparatus) through ambulatory blood pressure (ABP) monitoring. Hypothesis: We hypothesize that fire calls will result in the largest BP surge in FF compared to other types of calls and work conditions. Methods: FF (n=41; 37M, 4F) wore an ABP monitor for at least 12-hours while working. BP was measured every 30 min during daytime and 60 min during nighttime, if worn overnight. Data was analyzed when &gt; 70% of readings were captured. FF were instructed to force an ABP reading when the pager sounded and whenever they felt they entered a stressful situation. Activity and call type were documented on a log sheet for each measurement. Results: The FF were experienced (16.9 ± 11.9 yrs as FF), overweight (BMI: 30.3 + 4.6 kg/m 2 ), middle aged (41.2 ± 13.1 yrs), and hypertensive with average ABP over the 12 hr shift at 131 ± 13.4 / 79.3 ± 8.8 mmHg and HR 75.7 ± 8.8 bpm. Systolic BP surged 19.2 ± 12.2 with fire calls and 18.7 ± 8.1 mmHg with medical calls. Diastolic BP surged 10.5 ± 9.9 with fire and 16.5 ± 10.5 mmHg with medical calls. There were no differences in BP, HR, or BP surge levels ( P &gt;0.05 for all) between the types of measurements (fire, medical, apparatus, alarms). Compared to average ABP values, the response was higher with fire calls (143.9/85.5 mmHg, 85.5 bpm) than medical calls (139.0/87.0 mmHg, 90.5 bpm). Physiological responses were also high when FF rode apparatus (139.8/83.7 mmHg, 81.9 bpm) and received false alarms (137.6/82.6 mmHg, 83.4 bpm). Conclusion: Fire and medical calls resulted in the greatest CV response. On average, fire calls resulted in a 9% increase in systolic BP and medical calls a 9% increase in diastolic BP and a 16% increase in HR. Further investigation in a larger population is warranted to substantiate these results as well as study other variables that may affect BP and HR responses in FF.

Left atrial stiffness index is associated with metabolic syndrome and independently related to urine albumin-creatinine ratio in young subjects with hypertension

Abstract Background and objective Left atrial (LA) functional decline seems to be the earliest sign of hypertension-related heart damage detectable with echocardiography for the moment. Left atrial stiffness index (LASI) is a novel index reflecting both LA function and LA–left ventricular (LV) coupling. Early detection of hypertension-mediated organ damage (HMOD) is critically important in clinical decision making in certain groups of patients, such as young persons with first time diagnosed HTN. We intended to analyze the relations of LASI with office and 24 hours blood pressure levels and HMOD characteristics in subjects with HTN aged of 18 to 45 years. Methods We included 78 young subjects (median of age 23 [21; 25] years, mean BMI 25,9±4,7 kg/m2, median 24 hours systolic blood pressure (SBP) and diastolic blood pressure (DBP) 134,0 [128,8; 143,3] and 79,5 [74,0; 88,0] mm Hg, respectively) with HTN diagnosed with 24-hours ambulatory blood pressure monitoring (ABPM) according to ESH guidelines criteria (2018). Most patients (73%) had masked HTN. We performed routine clinical evaluation, including registration of anthropometric characteristics and blood and urine tests, central pulse wave assessment with applanation tonometry and echocardiography including two-dimensional speckle tracking. LASI was calculated as E/e$'$ to left atrial longitudinal strain during reservoir phase (LASr) ratio. We performed correlation analysis and multiple linear regression analysis to investigate the relationship between LASI, LASr and variables indicating presence of HMOD. Results Correlation analysis did not reveal any significant associations of LASI and LASR with office and ambulatory BP values. Both LASI and LASr were correlated with age, body mass index (BMI), waist circumference (WC) (r=0,312, p&amp;lt;0,05 and (−0,354), p&amp;lt;0,01) and HOMA-IR (r=0,551, p&amp;lt;0,001 and (−0,345), p&amp;lt;0,01). LASI had stronger correlation with albumin-creatinine ratio (ACR) than LASr (r=0,550, p&amp;lt;0,001 vs (−0,288), p&amp;lt;0,05, respectively). Glomerular filtration rate (GFR) was associated with LASI: r=−0,329, p&amp;lt;0,01 but not with LASr. Left ventricular mass index (LVMI) also had a significant correlation with LASI only: r=0,284, p&amp;lt;0,05 as had carotid-femoral pulse wave velocity (cfPWV): r=0,275, p&amp;lt;0,05. We performed multiple linear regression analysis in which LASI remained related to ACR independently of age, sex, BMI, WC, HOMA-IR, GFR and 24 hours SBP and DBP (β=0,306, p&amp;lt;0,05) while LASr lost the association. The link between LASI and other HMOD markers (GFR, cfPWV, LVMI) got insignificant in multiple regression analysis. Conclusion Early left atrial functional impairment is associated with overweight, abdominal obesity and insulin resistance in young never treated patients with HTN, while impact of elevated BP in HTN of low grades seems to be not so important. LASI in contrast with LASr is independently related to albuminuria but not with other HMOD markers Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): RFBRRUDN University program 5-100