Ambulatory Blood Pressure Values Research Articles

New Features for Child Metrics: Further Growth References and Blood Pressure Calculations

Many new features have recently been incorporated to ÇEDD Çözüm/Child Metrics, an online and freely accessible scientific toolset. Various auxological assessments can now be made with data of children with genetic diseases (Prader Willi syndrome, Noonan syndrome, Turner syndrome, Down syndrome, and Achondroplasia) and preterm and term newborns. More detailed reports for height, weight, and body mass index data of a given child are now available. Last but not least, office and 24-hour ambulatory blood pressure values can be analyzed according to normative data.

Renal denervation in patients with end-stage renal disease and resistant hypertension on long-term haemodialysis.

Recent randomized controlled trials have confirmed the ability of renal denervation to lower blood pressure (BP) in patients, resistant to the BP-lowering effect of multiple antihypertensive drug administration. Evidence is limited, however, in patients with end-stage renal disease (ESRD) and haemodialysis, a condition in which a persistent BP elevation, despite administration of many antihypertensive drugs, is common. Aim of the present study was to test the BP-lowering efficacy of renal denervation in patients with resistant hypertension and ESRD on haemodialysis. BP was measured repeatedly in the office and over the 24 h during 1-year follow-up. The study was conducted from February 2017 to January 2018 at the Policlinico of Monza, Monza, Italy. We included 24 men and women aged at least 20 years (mean 55 ± 16) who had ESRD, were on long-term haemodialysis and exhibited resistant hypertension, that is, elevated office and ambulatory BP values, despite multidrug antihypertensive treatment (n = 5.4 ± 1). We excluded patients with renal artery stenosis, malignancy, and a probable life expectancy less than 1 year. Twelve patients were included in the renal denervation and 12 in the medical treatment (control) group. All patients underwent office and 24 h ambulatory BP measurements at baseline and at 1, 6 and 12 months during the follow-up. In the renal denervation group, baseline office and 24 h mean SBP were 180 ± 112 and 175 ± 11 mmHg, respectively, the corresponding values in the control group being 181 ± 19 and 181 ± 20 mmHg. Most of the other baseline characteristics were also similar or only slightly different between groups, including the mean number of administered antihypertensive drugs at baseline. SBP showed an early and persistent reduction after renal denervation (office SBP: 165 ± 13; 150 ± 7 and 149 ± 11mmHg; 24 h SBP 163 ± 20, 148 ± 10 and 149 ± 17 mmHg after 1, 6 and 12 months, respectively). The BP-lowering effect was almost always present and statistically significant during both the day and night. DBP changes followed a similar pattern whereas heart rate never showed any significant change. No significant periprocedural complication of renal denervation was seen. The mean number of administered drugs did not show any significant BP change during the study. In ESRD patients under long-term haemodialysis in whom BP was markedly elevated despite administration of many antihypertensive drugs, renal denervation lowered both ambulatory and office BP. The reduction persisted over a 1-year follow-up.

Reduced Postpartum Cognitive Function in Young Women with a History of Preeclampsia: Association with Blood Pressure Variability

Preeclampsia is a disorder of pregnancy characterized by de novo hypertension and multi‐organ dysfunction in mid to late gestation. After pregnancy, women with a history of preeclampsia (hxPE) are at a two‐ and fourfold increased risk of incident stroke and chronic hypertension respectively. Excessive 24‐hour blood pressure variability (BPV) is exaggerated in age‐related hypertension and associated with the progression of ischemic damage to the cerebral microstructure and cognitive decline independent of average blood pressure (BP). Young women with hxPE exhibit signs of cerebral microvascular damage early after pregnancy, but the degree to which cognitive function is altered remains unknown. Furthermore, the relation between elevated BPV and cognitive function has not been assessed in women with hxPE. Therefore, the purpose of this study was to 1) establish whether cognitive function is reduced early postpartum women with hxPE compared with healthy pregnancy, and 2) determine the extent to which BPV is associated with cognitive function in women with hxPE. Women with hxPE (n=24; 32 ± 1 yrs) and healthy pregnancy controls (n=20; 33 ± 1 yrs) were assessed between 1–3 years postpartum. Participants wore an automated, portable brachial cuff for 24‐hour ambulatory blood pressure monitoring. BPV was expressed as the standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24‐hour ambulatory BP values. Cognitive function was assessed in domains of memory, processing speed, and executive function. Women with hxPE had reduced executive function (−0.26 ± 0.1 vs. 0.32±0.1 Z‐score; F(1,41) = 4.486, p=0.04) and slower processing speed (−0.28 ± 0.2 vs. 0.34 ± 0.2 Z‐score; F(1,41) = 4.135, p=0.050) compared with controls independent of educational attainment. Memory performance did not differ between groups. Women with hxPE had higher 24‐hour systolic BP (121 ± 2 vs. 116 ± 2 mmHg; p=0.052) and diastolic BP (78 ± 1 vs. 74 ± 1 mmHg; p=0.055) compared with controls. However, no indices of systolic or diastolic BPV differed between groups. Greater 24‐hour diastolic BPV was associated with reductions in executive function independent of average diastolic BP, age, body mass index, and education among women with hxPE (SD: r = −0.54, p=0.03; CV: r = −0.52, p=0.04) but not among controls (SD: r = 0.12, p =0.67; CV: r = 0.16, p=0.56). The relation between diastolic ARV and executive function among women with hxPE (r = −0.51, p=0.03) was lost with adjustment for education. Systolic BPV was not associated with cognitive function. Postpartum executive function was reduced and processing speed was slower among young women with hxPE compared with healthy pregnancy. Although BPV did not differ between groups, BPV was associated with reduced executive function only among women with hxPE. These preliminary findings suggest that select cognitive domains early postpartum among young women with hxPE may be more sensitive to 24 hour fluctuations in diastolic BP compared with controls. The physiologic or environmental mechanisms leading to this finding warrant further study.Support or Funding InformationAHA grant 18SCG34350001 and 15SFRN23760002

The association of urinary uric acid excretion with ambulatory blood pressure values in patients with chronic kidney disease

BackgroundTo analyze the association between hypertension and urinary uric acid excretion in patients with chronic kidney disease (CKD).MethodsWe screened 87 patients who had been admitted at the Dept of Nephrology, Huadong hospital between April 2017 to April 2019 who had completed 24-h ambulatory blood pressure monitoring and retained 24-h urine biochemical test specimens, thirty adult patients (age ≤ 65 years) with CKD 1–2 stages were recruited in the study. Pearson’s correlation analysis and multiple linear regression analysis were used to study the correlation of urinary uric acid excretion with ambulatory blood pressure values and the association of morning mean diastolic pressure (mMDP), night mean diastolic pressure (nMDP) and CV of dMSP (coefficient of variation of day mean systolic pressure) with fractional excretion of uric acid (FEua) and uric acid clearance rate (Cur). Independent T test was used to compare the differences of blood pressure values in FEua1 (FEua< 6.0%) and FEua2 (FEua≥6.0%) or Cur1 (Cur < 6.2 ml/min/1.73 m2) and Cur2 (Cur ≥ 6.2 ml/min/1.73m2) groups according to the median of FEua or Cur, respectively.ResultsAfter adjusting for confounding factors, multiple linear regression analysis showed that FEua was positively associated with the mMDP and nMDP, Cur was positively associated with CV of dMSP. Levels of mMDP and nMDP in FEua1 group was lower than that in FEua2 group (both P < 0.05), level of CV of dMSP in Cur2 group were higher than that in Cur1 group (P < 0.01).ConclusionsWe demonstrated that there is a positive correlation of FEua with morning and night mean diastolic pressure separately and Cur is positively related to CV of dMSP in CKD population. Monitoring the trend of urinary uric acid, may have a role in the early detection for hypertension or relative risks in the population of CKD.

Ambulatory Blood Pressure Phenotypes in Children and Adolescents

Ambulatory Blood Pressure Phenotypes in Children and Adolescents

Highlights of the December issue.

Highlights of the December issue.

P116 Post-stroke White Coat Hypertension/Effect is Associated with Greater Arterial Stiffness

ObjectiveWhite coat hypertension/effect (WCH/E) describes an elevated clinic blood pressure (BP) with normal daytime ambulatory BP (ABPM) values. It is not clear whether WCH/E is associated with adverse vascular risk. This study aimed to determine the relationship between WCH/E and arterial stiffness in a cohort of patients who had a transient ischaemic attack (TIA) or lacunar stroke (LS).Design and MethodThe Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, aged over 40 years old, with a confirmed diagnosis of TIA or LS in the preceding 14 days. Patients were grouped by BP. Thirty-four patients were excluded (n = 6 declined ABPM, n = 3 masked hypertension and n = 25 sustained hypertension). Thirty-two patients with normal BP (clinic BP < 140/90 mmHg and day-time ABPM < 135/85 mmHg), and 30 patients with WCH/E (clinic BP > 140/90 mmHg and day-time ABPM < 135/85 mmHg) were recruited. Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV), (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI), (VaSera VS-1500 N®, Fukuda Denshi).ResultsCompared to patients with normal BP, patients with WCH/E were older, had a higher body mass index (BMI) and higher arterial stiffness measured by CAVI (10.3 ± 1.3 vs 9.4 ± 1.7, p = 0.027), and PWV (11.9 ± 3.0 vs 9.6 ± 2.3 ms−1, p = 0.002). The WCH/E cohort had more lacunar strokes (p = 0.039).ConclusionIn this population of post-stroke patients, those with WCH/E had greater arterial stiffness and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.Normotension (N = 32)WCH/E (N = 30)Statistical significanceMale, n (%)21(66)22(73)0.511Age (years)69.9 ± 11.575.7 ± 9.30.033BMI (kg/m2)25 ± 428 ± 40.014Anti-hypertensive use, n (%)19(59)23(77)0.146Clinic systolic BP (mmHg)125 ± 9155 ± 13<0.001Clinic diastolic BP (mmHg)75 ± 781 ± 80.003Daytime systolic ABPM (mmHg)114 ± 10121 ± 100.007Daytime diastolic ABPM (mmHg)73 ± 772 ± 70.586CAVI9.4 ± 1.710.3 ± 1.30.027PWV (ms−1)9.6 ± 2.311.9 ± 3.00.002Stroke typeTIA, n (%)25(78)16(53)0.039Lacunar, n (%)7(22)14(47)Data expressed as mean ± standard deviation or number (percentage). Significance determined by t-test. Chi-squared used for anti-hypertensive use, gender and stroke type.

Efficacy of fixed dose of triple combination of perindopril-indapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study

Background: Arterial hypertension (AH) remains the most common cardiovascular (CV) risk factor worldwide.&#x0D; Methods: Seventy five moderate-to-severe hypertensive patients with abdominal obesity aged from 48 to 66 years (45/30 men and women respectively) were selected from the entire cohort (n = 375) according to the inclusion and exclusion criteria. The patients were divided into two subgroups depending on the arm of antihypertensive therapy lines. The first subgroup of patients (n = 36) received a non-fixed combination of oral antihypertensive agents: perindopril (4–8 mg daily), indapamide (1.25–2.5 mg daily) and amlodopine (5–10 mg daily). The second subgroup of patients (n=39) received fixed-dosed combination of these antihypertensive agents aforementioned in the ranged doses (4 mg/1.25mg/5 mg; 4 mg/1.25mg/10 mg; 8 mg/2.5 mg/5 mg; 8 mg/2.5mg/10 mg) in the same manner. The examinations of the clinical status, office, and ambulatory blood pressure values were carried out at baseline in 3 and 6 months after study entry.&#x0D; Results: The frequencies of BP target levels after treatment were higher in the fixed-dose combination group than in the non-fixed combination (at 3 months: 80% versus 58%, p&lt;0.05 and at 6 months: 85% versus 53%, p&lt;0.05). The adherence to triple fixed-dose combination was also higher in comparison with one to non-fixed combination (at 3 months: 82% versus 64%, p&lt;0.05 and at 6 months: 87% versus 61%, p&lt;0.05). It has been established that low-dose of perindopril/indapamide/amlodopine (4mg/1.25/10mg and 8mg/2.5/5mg) were used frequently in fixed-dose combination cohort of patients than in non-fixed combination (15% versus 0%, P&lt;0.05, and 33% versus 19%, p&lt;0.05, respectively). At the same time, maximum doses of these agents (8mg/2.5mg/10mg) were required for achieving target BP levels in a significantly lower proportion of patients receiving fixed-dose combination as compared to patients receiving non-fixed combination (52% versus 81%, p&lt;0.05). Additionally, the triple fixed-dose combination has proved to be better in restoring ambulatory blood pressure monitoring profile than non-fixed combination.&#x0D; Conclusion: Achievement of target blood pressure levels in patients with uncontrolled arterial hypertension and abdominal obesity was possible at lower doses of perindopril, indapamide, and amlodipine when used as a fixed-dose combination rather than non-fixed (free) combination.&#x0D;

Abstract P129: White Coat Effect Causes Excessive Antihypertensive Treatment in Low Risk Patients

Office recording blood pressure (BP) gives at best a rough estimate of a person’s usual BP, and it is controversial that a few office BP determinations govern the diagnosis and treatment guidelines for hypertension. In this context it acquires importance the white coat effect (WCE), which is a significant fall in ambulatory BP compared with that measured in a clinical setting.Despite the introduction of ambulatory pressure, specially 24h BP monitoring (ABPM) has had a great impact on both the decision to treat or not a patient (P) with hypertension, it has not been considered either in fundamental studies such as the Sprint or in the diagnostic and treatment recent guidelines for hypertension.In our country, primary care physicians have taken new objectives of BP treatment very seriously based only on their office records.Hypertensive P with visión déficits, from the neuroophthalmology section of our hospital, are periodically referred to our Laboratory for screening of hypertension and vascular complications. In the last two years 62 P were evaluated.In low risk (LR) P, who do not have hypertensive target organ damage or chronic symptoms, we observed a temporal relationship between ocular symptoms and the start or increase of antihypertensive treatment So we decide to carry out a preliminary prospective study including LR hypertensive P between Sep 2017 to Mar 2019. P older than 80 and those who had secondary hypertension were excluded. All were studied with ABPM to compare ambulatory and office BP values, day and night time BP.BP was recorded when they were derived and in a subsequent visit a week later where the ambulatory monitor pressure was also placed.The results showed in LR group significantly higher office systolic (S) BP values (143±11 mm Hg) compared with ambulatory BP: 24h SBP 117±8 mm Hg (p&lt;0.01), daytime SBP 120±9 mm Hg (p&lt;0.01) and nigthtime SBP 94±8 mm Hg (p&lt;0.01), and we observed WCE in 18 of 30 P (56%). Under estimating or not detecting WCE can lead to excessive antihypertensive treatment and cause ocular and other tissues hypoflux. Conclusions: In low risk P office BP values should be corroborated with ambulatory BP values, either systematic ambulatory monitoring or with 24 h ABPM before starting or before increasing the antihypertensive treatment.

Ambulatory blood pressure monitoring after one major cardiovascular event to predict a second one

To compare ambulatory blood pressure (ABP) values after a first major cardiovascular event, between patients with and without a second event, and to evaluate if ABP measurements could have a role in the prediction of a second event occurrence. We included 368 hypertensive patients who had ABP measurements after a first major cardiovascular event (acute coronary syndrome or stroke), with a mean age of 69.9 ± 11.8 years, 62.5% of men. One hundred and three patients had a second event during a mean follow-up of 2.8 ± 1.6 years. Twenty-four-hours systolic blood pressure (SBP) values were 135 ± 15 mm Hg in patients with a second event versus 126 ± 13 mm Hg in those with one event ( P = 0.002). Daytime SBP was 139 ± 14 mm Hg and 129 ± 13 mm Hg respectively ( P = 0.002). Night-time SBP was 129 ± 17 mm Hg and 118 ± 16 mm Hg respectively ( P = 0.003). Using Cox model with adjustments for age, sex and systolic office blood pressure, all the three measures: 24 hours SBP (HR: 1.032; CI 95%: 1.005–1.060), Daytime SBP (HR: 1.026; CI 95%: 1.00–1.052) and Night-time SBP (HR: 1.031; CI 95%: 1.007–1.055) significantly associated with a recurrence of a second event. In the 24-hours systolic blood pressure ROC curve analysis, a value of 125 mm Hg was the best cutoff for prediction of a second event, with a sensitivity of 83%. In our population of hypertensive patients with a previous cardiovascular event, higher values of 24 hours, daytime and night-time SBP were predictive of a second event occurrence.

SAT-091 NOCTURNAL HYPERTENSION ON LONGITUDINAL AMBULATORY BLOOD PRESSURE MONITORING AND LEFT VENTRICULAR HYPERTROPHY IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS

Hypertension (HTN) after renal transplantation is known to be associated with cardiovascular morbidity. Indian children with chronic kidney disease (prior to transplantation) have a 3 times higher prevalence of LVH1 compared to western counterparts2. The aims of this observational study in pediatric kidney transplant recipients were to describe the prevalence of masked HTN and LVH, the association between ABPM measurements and left ventricular mass index (LVMI ) and to determine the longitudinal changes in ambulatory blood pressure monitoring (ABPM). ABPM and auscultatory clinic BP were performed in children (2015- 2018), ≥ 3 months post transplant with a stable functioning renal allograft at baseline and repeated in 6-12 months. Mean daytime and sleep ambulatory BPs were calculated. Nocturnal dip (mean sleep BP vs. mean daytime BP) <10% was defined as blunted. Clinic and ABPM mean BPs were indexed to the 95th percentile (HTN present if BP index ≥ 1). ECHO data from a single timepoint performed within 6 months of ABPM was used to calculate LVMI (LVH present if > 95th percentile for age/sex). Masked HTN was defined as clinic BP index <1 and ABPM SBP or DBP index ≥ 1. Isolated nocturnal hypertension was diagnosed if daytime BP indices were <1 but sleep BP indices were ≥ 1. Linear Regression determined the association between LVMI and ABPM indices. Baseline Data: 30 children were included (14 boys, 28 living donor allografts, age 13.2 ±3 yrs, eGFR = 75±32 ml/min/1.73m2, median 18mths post transplant). Masked HTN was present in 16/30 (53%), [Fig 1]; all with masked HTN were treated with increased dose and/or number of BP medications. Clinic BP failed to diagnose 65% of patients with HTN. Isolated nocturnal HTN occurred in 13/25 (52%) of patients with HTN. Sleep SBP and DBP indices were higher than daytime BPs (p < 0.001 for each). Blunted nocturnal dip was present in 80%. LVH and LVMI: 12/21 patients (57%) with echoes had LVH; all with LVH had HTN by ABPM. Elevated sleep SBP and DBP indices as well as sleep BP loads (p < 0.05 for each) were associated with elevated LVMI. Follow-up Data: 18 had follow-up ABPM [Table 1]. Overall, BPM indices (not clinic BPs) decreased on follow-up (all p < 0.05) but sleep BPs remained higher than daytime. Table 1: Ambulatory BP Values on Initial ABPM and Follow UP Prevalence of masked HTN, isolated nocturnal HTN and blunted nocturnal dip was high in this study of children with kidney transplants. Nocturnal BP predicted LVMI. Clinical treatment based on ABPM was associated with improvement in BP, but nocturnal hypertension was persistent. This data confirms the importance of proactive ABPM monitoring of children with kidney transplants as hypertension is not satisfactorily assessed by office evaluation.

POST-STROKE WHITE COAT HYPERTENSION/EFFECT IS ASSOCIATED WITH GREATER ARTERIAL STIFFNESS

Objective: White coat hypertension/effect (WCH/E) describes an elevated clinic blood pressure (BP) with normal daytime ambulatory BP (ABPM) values. It is not clear whether WCH/E is associated with adverse vascular risk. This study aimed to determine the relationship between WCH/E and arterial stiffness in a cohort of patients who had a transient ischaemic attack (TIA) or lacunar stroke (LS). Design and method: The Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, age >40-years-old, with a confirmed diagnosis of TIA or LS in the preceding 14 days. Patients were grouped by BP. Thirty-four patients were excluded (n = 6 declined ABPM, n = 3 masked hypertension and n = 25 sustained hypertension). Thirty-two patients with normal BP (clinic BP < 140/90mmHg and day-time ABPM < 135/85mmHg), and 30 patients with WCH/E (clinic BP >/ = 140/90mmHg and day-time ABPM < 135/85mmHg) were recruited. Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV), (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI), (VaSera VS-1500N®, Fukuda Denshi). Results: Compared to patients with normal BP, patients with WCH/E were older, had a higher body mass index (BMI) and higher arterial stiffness measured by CAVI (10.3 ± 1.3 vs 9.4 ± 1.7, p = 0.027), and PWV (11.9 ± 3.0 vs 9.6 ± 2.3 ms-1, p = 0.002). The WCH/E cohort had more lacunar strokes (p = 0.039).Conclusions: In this population of post-stroke patients, those with WCH/E had greater arterial stiffness and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.

Twenty-four hour ambulatory blood pressure reference values in Africans.

We aimed to establish reference values for 24 h ambulatory blood pressure (ABP) monitoring in an African community. We randomly recruited 1219 participants of African ancestry from Soweto, a township in Johannesburg. Twenty-four hour ABP was measured using ABP monitors (model 90207; Spacelab). Complete 24 h ABP measurements from 530 healthy participants with a mean age of 38 were used to determine thresholds. Twenty-four hour, daytime and night-time systolic and diastolic BP increased significantly with age. The 95th prediction bands of this relation at age 38 years were ∼135/85 mmHg for 24 h, 140/90 mmHg for daytime and 130/80 mmHg for night-time ABP values, respectively. These thresholds and absolute ABP values are similar to those observed in individuals of other demographics. These thresholds increase with age by an average of 1.5 mmHg with each decade's increase in age. Pending authentication in prospective outcome-based studies, these values might be considered preliminary thresholds to diagnose hypertension in individuals of African descent.

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

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

Incident Left Ventricular Hypertrophy in Masked Hypertension.

In the PAMELA study (Pressioni Arteriose Monitorate e Loro Associazioni), clinical variables, an echocardiogram, as well as office and ambulatory blood pressure (ABP) were simultaneously measured at baseline and after a 10-year follow-up. The study design allowed us to assess the value of masked hypertension (MH) as a predictor of new-onset left ventricular hypertrophy (LVH). The present analysis included 803 participants without LVH at baseline (left ventricular mass index <115 g/m2 in men and <100 g/m2 in women). Based on office and 24-hour mean ABP values, subjects were divided into 3 groups: normal subjects (normotensive, office blood pressure [BP] <140/90 mm Hg and 24-hour mean ABP <130/80 mm Hg), MH (office BP, normal, and 24-hour mean ABP, elevated), and sustained hypertension (office and 24-hour BP, both elevated). At entry, 57 of 803 subjects fulfilled diagnostic criteria for MH (7.1%); 182 participants developed LVH (22.6%). Compared with subjects with normal in-office and out-of-office BP, the risk of new-onset LVH was greater in MH (odds ratio, 2.22; CI, 1.11-4.46, P=0.0250) after adjustment for potential confounders. This was also the case for the absolute increase of left ventricular mass index. Our study provides a new piece of evidence that MH, identified by office and ABP values, is associated with an increased risk of new-onset LVH. Moreover, our findings convey the notion that office BP may inaccurately estimate the risk of incident LVH in the general population.

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy.

ObjectiveTo evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs, as monotherapy or dual combination therapy, to improve daytime and nighttime BP control.MethodsWe enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg; daytime mean BP < 135/85 mmHg; and nighttime mean BP < 120/70 mmHg), as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups.ResultsPatients' mean age was 71 years, and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy, and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52, P = 0.05 and OR = 0.41, P = 0.007, respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45, P = 0.004). Compared with RAS/diuretic therapy, BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27, P = 0.45).ConclusionsAntihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP, whereas diuretic-based therapies provided lower nighttime BP, compared with other antihypertensive regimens.

Unattended versus two attended, ambulatory and central blood pressure measurements in hypertensive patients with and without diabetes

Objective: To compare unattended blood pressure (BP) with two attended BP, with 24-h ambulatory (ABPM) and central BP measurements in hypertensive patients with (DMs) and without diabetes (HTs).Methods: In the same hypertension clinic we evaluate 129 consecutive HTs (56% female, 59 + 16 yrs) and 91 DMs (62% female, 64 + 9 yrs) who were referred for 24-h ABPM. During 48 hours they underwent a first attended BP (5 minutes resting, 3 recordings 2 minutes apart), (AT1), an unattended BP (UnAT), 3 measurements 2 minutes apart with a pre-programmed oscillometric Omron M10- IT, a second attended BP (AT2) similar to AT1, a 24-h ABPM and an evaluation of central BP (C) from the aortic wave form (SpygmoCor).Results: BP (mm Hg) and differences (Δ) from UnAT = 135/82 ± 17/10 were 1AT = +13.8/3.9 ± 10.3/5.6, AT2 = +7.3/2.9 ± 7.4/4.9, 24-h = −1.3/−1.7 ± 7.5/7.5 and C = −2.4/1.2 ± 10.3/9.1, all p < .01 vs UnAT. Limits of agreement (2 SDs in Bland-Altman plots) were between AT1 and UnAT systolic BP, +34.2 to −6.8 mm Hg and between AT2 and UnAT BP were +21.7 to −7.0 mm Hg. Unattended systolic BP values were similar to that of 24-h in HTs and to that of daytime in DMs. Intraclass correlation coefficients of systolic BP and diastolic BP between UnAT and AT1 and between UnAT and AT2 were within the range 0.78 to 0.83, all p < .01.Conclusions: In HTs with and without DM the unattended BP significantly underestimates attended BP being more close to ambulatory BP values. These differences should be taken into account since targets based on these BP measurements are not equivalent.

Night-time systolic blood pressure and subclinical cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study.

Although ambulatory blood pressure (BP) is a better predictor of cardiovascular outcomes than office BP, its association with subclinical cerebrovascular disease is not clarified. We investigated the associations of office and ambulatory BP values with subclinical cerebrovascular disease in a population based, predominantly elderly cohort without prior stroke. Eight hundred and twenty-eight participants underwent 24-h ambulatory BP monitoring (ABPM), 2D echocardiography and brain magnetic resonance imaging in the Cardiac Abnormalities and Brain Lesion (CABL) study. Daytime, night-time, and 24-h BPs, nocturnal dipping pattern, morning surge (MS), and 24-h variability were assessed. Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV). The association of BP measures with the presence of SBI and upper quartile of log-WMHV (log-WMHV4) was analysed. SBIs were detected in 111 patients (13.4%). Mean log-WMHV was -0.99 ± 0.94. In multivariable analysis, only night-time systolic BP (SBP) was significantly associated with SBI [odds ratio (OR) 1.15 per 10 mmHg, P = 0.042], independent of cardiovascular risk factors, and pertinent echocardiographic parameters. Although daytime, night-time, 24-h BPs, and non-dipping pattern were all significantly associated with log-WMHV4 (all P < 0.05), night-time SBP showed the strongest association (OR 1.21 per 10 mmHg, P = 0.003) and was the sole independent predictor when tested against the other BP parameters. Office BP measures, MS, and BP variability were not associated with subclinical cerebrovascular disease in adjusted analyses. Elevated night-time SBP is strongly associated with subclinical cerebrovascular disease. Night-time SBP by ABPM allows to identify individuals at higher risk of hypertensive brain injury.

Prognostic value of ambulatory blood pressure in chronic kidney disease

Background: Hypertension control is essential to prevent macro vascular complications in patients with chronic kidney disease. Ambulatory Blood Pressure Monitoring (ABPM) is the recognized gold standard for the assessment of hypertension and hence in this study ABPM assessment was done in 50 patients with dialysis dependant CKD to evaluate the adequacy of BP control and prevent adverse events.Methods: This study is a prospective observational study conducted at Aarupadai Veedu Medical College and Hospital, Pondicherry among hypertensive patients with dialysis dependant CKD patients as per standard criteria. A total of 50 patients participated in this study of both gender after obtaining written consent. Patients with coronary artery disease, diabetes mellitus, acute kidney injury were excluded from this study.Results: Out of the total 50 patients included in this study 72% had early morning dipping in BP and remaining 28% had non-dipping in systolic and diastolic pressure. The mean systolic pressure reached a maximum of 160.95mmHg to a minimum of 113.38mmHg and the mean diastolic pressure with a maximum of 98.47 to a minimum of 62.71mmHg on an overall 24 hours ABPM monitoring. The mean systolic and diastolic pressure was found to be more in the active period than in the passive period.Conclusions: Nocturnal BP is superior to day time BP in predicting CVD outcomes. This study shows both systolic and diastolic pressure variability over 24hrs maximum during night hours (nocturnal hypertension) and non-dipping of early morning BP. Both non-dipping status and nocturnal hypertension are associated with target organ damage and CV risk.

Blood pressure differences between home monitoring and daytime ambulatory values and their reproducibility in treated hypertensive stroke and TIA patients

Guidelines recommend ambulatory or home blood pressure monitoring to improve hypertension diagnosis and monitoring. Both these methods are ascribed the same threshold values, but whether they produce similar results has not been established in certain patient groups. Adults with mild/moderate stroke or transient ischemic attack (N = 80) completed 2 sets of ambulatory and home blood pressure monitoring. Systolic and diastolic blood pressure values from contemporaneous measurements were compared, and the limits of agreement were assessed. Exploratory analyses for predictive factors of any difference were conducted. Daytime ambulatory blood pressure values were consistently lower than home values, the mean difference in systolic blood pressure for initial ambulatory versus first home monitoring was -6.6 ± 13.5 mm Hg (P≤.001), and final ambulatory versus second home monitoring was -7.1 ± 11.0mm Hg (P≤.001). Mean diastolic blood pressure differences were -2.1 ± 8.5mm Hg (P=.03) and -2.0 ± 7.2mm Hg (P=.02). Limits of agreement for systolic blood pressure were -33.0 to 19.9mm Hg and -28.7 to 14.5mm Hg for the 2 comparisons and for DBP were -18.8 to 14.5mm Hg and -16.1 to 12.2mm Hg, respectively. The individual mean change in systolic blood pressure difference was 11.0 ± 8.3mm Hg across the 2 comparisons. No predictive factors for these differences were identified. Daytime ambulatory systolic and diastolic blood pressure values were significantly lower than home monitored values at both time points. Differences between the 2 methods were not reproducible for individuals. Using the same threshold value for both out-of-office measurement methods may not be appropriate in patients with cerebrovascular disease.