Ambulatory Blood Pressure Variability Research Articles

Seasonal variation of ambulatory blood pressure in Chinese hypertensive adolescents.

Blood pressure (BP) exhibits seasonal variation with lower levels at higher temperatures and vice versa. This phenomenon affects both sexes and all age groups. So far, only a few research studies have investigated this condition in adolescents and none of them were based on hypertensive population or ever applied ambulatory blood pressure monitor (ABPM). Therefore, we carried out the first study that used ABPM to record seasonal variation of blood pressure in hypertensive adolescents. From March 2018 to February 2019, 649 ABPMs from hypertensive adolescents between 13 and 17 years who were referred to wear an ABPM device in Beijing and Baoding were extracted. Seasonal change in ambulatory BP value, dipping status, and prevalence of different BP phenotypes were analyzed and compared. Mean age of participants was 14.9 ± 1.5 years and 65.8% of them were boys. Of the participants, 75.3% met the criteria of overweight or obesity. From summer to winter, average 24-hour, day-time, and night-time BP showed significant rise, which was 9.8/2.8, 9.8/3.0, and 10.9/3.4 mmHg, respectively. This seasonal effect on BP was not dependent on the obesity degree. In addition, higher prevalence of nondippers and risers existed in winter while white coat hypertension was more frequent in warmer seasons. Hypertensive adolescents showed evident seasonal change in their ABPM results, which was featured by elevated BP level and more frequent abnormal dipping patterns in winter. On the contrary, higher prevalence of white coat hypertension was found in warmer seasons. Physicians should take seasonal variation into consideration when managing adolescent hypertension.

P122 Association between variability of respiratory sleep indices and ambulatory blood pressure

Abstract Study Objectives Respiratory sleep indices are traditionally reported on the basis of the average total sleep time. The relationship between the hour-to-hour variability of these parameters and blood pressure (BP) has not been reported. Methods We evaluated the associations of the hour-to-hour variability of the apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation with the 24-hour ambulatory BP in patients with hypertension and newly diagnosed obstructive sleep apnea. A total of 147 patients underwent polysomnography, based on which obstructive sleep apnea was diagnosed in 106 patients these patients underwent 24-hour ambulatory BP monitoring within the next 30 days. Each polysomnogram was divided into hourly reports to calculate the variability of the respiratory sleep indices. Variability independent of the mean was considered the primary measure of variability. Results The median number of hourly polysomnogram reports was 7 (range, 4–8).The hour-to-hour variability of both AHI and ODI, but not of the lowest oxygen saturation, was correlated with the 24-hour pulse pressure, 24-hour systolic BP, and awake systolic BP (p < 0.05 for all). The fully adjusted linear regression analysis indicated that the hour-to-hour variability of AHI and ODI remained associated with the 24-hour pulse pressure (AHI: β coefficient, 0.264 [95% CI, 0.033–0.495],p =0.026; ODI: β coefficient, 0.450 [95% CI, 0.174 - -0.726],p = 0.002). Conclusions The hour-to-hour variability of AHI and ODI is independently associated with the 24-hour pulse pressure. Further investigations are warranted to evaluate the clinical relevance of this new-found association.

Abstract 14598: Relationship of Ambulatory Blood Pressure Profiles on Progression of Aortic Atheroma in Patients With Stroke

Introduction: Aortic atherosclerotic burden is known to be associated with an increased risk of ischemic stroke. However, longitudinal data and the risk factors about aortic plaque progression are limited. Hypothesis: We hypothesized that ambulatory blood pressure (BP) variables would play a role in progression of aortic atheroma over 2 years in patients with stroke Methods: 115 patients with who underwent serial transesophageal echocardiography (TEE) over 2 years were enrolled. Aortic atheroma was graded as mild (2-3mm), moderate (3-5 mm), severe (>5mm), or complex (ulceration and/or mobile component) using TEE. Progression of aortic atheroma was defined as an increase of maximal plaque thickness by ≥1 grade. Ambulatory BP monitoring (ABPM) was performed when BP was stabilized. The association between ABPM variables and aortic atheroma progression was assessed. Results: During the median follow-up of 25.0 months, 10 (8.7%) were regressed, 13 (11.3%) were progressed, and 92 (80.0%) remained unchanged. Female had more progression of aortic atheroma (p=0.007). However, baseline LDL cholesterol, change of LDL cholesterol, intensity of statin and baseline plaque thickness were not significantly associated with change of aortic plaque. Regarding ABPM variables, systolic ABPM variables including 24 hour, daytime and nighttime mean systolic BP were associated with progression of aortic atheroma, whereas diastolic BP variables were not associated with change of aortic atherosclerosis. 24 hour, daytime and nighttime mean systolic BP were significantly related to plaque progression even after adjusting for clinical parameters (p=0.007 for 24 hour and daytime SBP, p=0.003 for nighttime SBP). Conclusions: Systolic BP variables were associated with progression of aortic atheroma in patients with stroke, which suggests systolic BP control can be a key to suppress progression of aortic plaques.

Abstract 12632: Relationships Between Circadian Ambulatory Systolic Blood Pressure Variability With Subclinical Atherosclerosis in Healthy Middle-Aged Individuals

Background: Short-term fluctuations in blood pressure (BP) as measured by 24-hr ambulatory BP monitoring (ABPM) is associated with subclinical atherosclerosis in the general population. However, whether short-term blood pressure variability (BPV) in the day versus night-time has differential effects on the development of subclinical atherosclerosis is uncertain. Methods and Results: We investigated the relationship between mean 24-hr BP and BPV parameters with common carotid artery intima-media thickness (CIMT) in 305 middle-aged Chinese (mean age 54±7years, 45% male) free from hypertension, hyperlipidaemia, diabetes or cardiovascular diseases. Subclinical atherosclerosis with elevated CIMT was defined as >75th percentile of CIMT of the overall study cohort. Linear regression models adjusted for age, sex, body mass index and smoking status revealed significant associations between office, day- and night-time mean SBP, day-time SBP standard deviation (SD) and coefficient of variation (CV) with elevated CIMT (all p<0.05). As shown in the Table , logistic regression analysis demonstrated that only ABPM day-time mean SBP (odds ratio [OR]:2.54, 95% confidence interval [95%CI]:1.29-5.00), night-time mean SBP (OR:3.23, 95%CI:1.67-6.22), night-time mean DBP (OR:2.27, 95%CI:1.16-4.42), day-time SBP CV (OR:0.47, 95%CI:0.26-0.86) and night-time SBP SD (OR1.94, 1.05-3.58) predicted the occurrence of subclinical atherosclerosis (all p<0.05). Conclusions: In healthy middle-age individuals without known hypertension, mean day and night-time SBP as measured using ABPM provided the strongest positive predictive value for elevated CIMT. Interestingly, increase day-time SBP CV versus night-time SBP SD have opposite effects on CIMT, suggesting circadian changes in SBP might have distinct contributions to the development of subclinical atherosclerosis.

Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial

The effect of 3 commonly recommended combinations of anti-hypertensive agents-amlodipine plus hydrochlorothiazide (calcium channel blocker [CCB]+thiazide), amlodipine plus perindopril (CCB+ACE [angiotensin-converting enzyme]-inhibitor), and perindopril plus hydrochlorothiazide (ACE-inhibitor+thiazide) on blood pressure variability (V) are unknown. We calculated the blood pressure variability (BPV) in 405 patients (130, 146, and 129 randomized to ACE-inhibitor+thiazide, CCB+thiazide, and CCB+ACE-inhibitor, respectively) who underwent ambulatory blood pressure monitoring after 6 months of treatment in the Comparisons of Three Combinations Therapies in Lowering Blood Pressure in Black Africans trial (CREOLE) of Black African patients. BPV was calculated using the SD of 30-minute interval values for 24-hour ambulatory BPs and for confirmation using the coefficient of variation. Linear mixed model regression was used to calculate mean differences in BPV between treatment arms. Within-clinic BPV was also calculated from the mean SD and coefficient of variation of 3 readings at clinic visits. Baseline distributions of age, sex, and blood pressure parameters were similar across treatment groups. Participants were predominately male (62.2%) with mean age 50.4 years. Those taking CCB+thiazide had significantly reduced ambulatory systolic and diastolic BPV compared with those taking ACE-inhibitor+thiazide. The CCB+thiazide and CCB+ACE-inhibitor groups showed similar BPV. Similar patterns of BPV were apparent among groups using within-clinic blood pressures and when assessed by coefficient of variation. Compared with CCB-containing combinations, ACE-inhibitor plus thiazide was associated with higher levels, generally significant, of ambulatory and within-clinic systolic and diastolic BPV. These results supplement the differential ambulatory blood pressure-lowering effects of these therapies in the CREOLE trial.

Association between Twenty-Four-Hour Ambulatory Blood Pressure Variability and Cerebral Small Vessel Disease Burden in Acute Ischemic Stroke.

Objective This study is aimed at investigating the association between the twenty-four-hour ambulatory blood pressure variability monitoring (ABPM) and cerebral small vessel disease (cSVD) burden in acute ischemic stroke (AIS) patients. Methods 115 AIS patients with demographics, vascular risk factors, 24 h ABPM, and brain magnetic resonance imaging (MRI) were retrospectively enrolled. 3.0 T MRI was used to assess cSVD burden by combining four MRI markers including white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), perivascular spaces (PVS), and lacunes. Correlation analysis was conducted to detect whether ABPM was associated with cSVD burden in AIS patients. Results 115 AIS patients with mean age 68.77 ± 10.26 years and 75.7% male were enrolled in this study. 112 AIS patients (97.4%) had at least one cSVD marker. Spearman correlation analysis indicated that hypertension was positively correlated with cSVD burden (ρ = 0.21, P = 0.07). High-density lipoprotein (HDL) was negatively correlated with cSVD burden (ρ = −0.21, P = 0.02). Blood pressure variability such as 24 h mean SBP (ρ = 0.23, P = 0.01), day mean SBP (ρ = 0.23, P = 0.01), and night mean SBP (ρ = 0.20, P = 0.04) was positively correlated with higher cSVD burden. Ordinal logistic regression analysis demonstrated that higher 24 h SBP SD and day mean SBP were independent risk factors for cSVD after controlling for other confounders. Conclusions Higher BPV was significantly related to total cSVD burden in AIS patients. 24 h SBP SD and day mean SBP were independent risk factors for cSVD burden in AIS patients but not DBP or DBP variability.

Hour-to-hour variability of respiratory sleep indices and ambulatory blood pressure.

Respiratory sleep indices are traditionally reported on the basis of the average total sleep time. The relationship between the hour-to-hour variability of these parameters and blood pressure (BP) has not been reported. We evaluated the associations of the hour-to-hour variability of the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation with the 24-h ambulatory BP in patients with hypertension and newly diagnosed obstructive sleep apnea. A total of 147 patients underwent polysomnography, based on which obstructive sleep apnea was diagnosed in 106 patients; these patients underwent 24-h ambulatory BP monitoring within the next 30 days. Each polysomnogram was divided into hourly reports to calculate the variability of the respiratory sleep indices. Variability independent of the mean was considered the primary measure of variability. The median number of hourly polysomnogram reports was 7 (range, 4-8). The hour-to-hour variability of both AHI and ODI, but not of the lowest oxygen saturation, was correlated with the 24-h pulse pressure, 24-h systolic BP, and awake systolic BP (p < 0.05 for all). The fully adjusted linear regression analysis indicated that the hour-to-hour variability of AHI and ODI remained associated with the 24-h pulse pressure (AHI: β coefficient, 0.264 [95% CI = 0.033-0.495], p = 0.026; ODI: β coefficient, 0.450 [95% CI = 0.174-0.726], p = 0.002). The hour-to-hour variability of AHI and ODI is independently associated with the 24-h pulse pressure. Further investigations are warranted to evaluate the clinical relevance of this new-found association.

Correlation between 24-Hour Ambulatory Blood Pressure Variability and White Matter Lesions in Patients with Cerebral Small Vascular Disease: A Cross-Sectional Study.

Objective The goals of this study are to assess the correlation between 24-hour ambulatory blood pressure (BP) variability and white matter lesions (WML) in patients with cerebral small vascular disease (CSVD) and to provide guidance for the prevention of WML. Methods A total of 136 patients diagnosed with CSVD and essential hypertension were recruited and divided into two groups. The Fazekas scale was used to quantify the severity of WML. The basic information, BP levels, BP variability, and circadian rhythm changes across these groups were recorded and compared. Results The control group consisted of 40 subjects without WML (Fazekas score = 0), and the WML group was composed of 96 patients with WML (Fazekas score ≥ 1). Patients in the WML group were then divided into three subgroups: mild WML (n = 43, Fazekas score = 1), moderate WML (n = 24, Fazekas score = 2), and severe WML (n = 29, Fazekas score = 3–4). Age, history of diabetes, and serum uric acid levels were significantly increased between the WML and control groups (P < 0.05). The levels of 24-hour mean diastolic BP (F = 3.158, P = 0.026) and daytime mean systolic BP (F = 3.526, P = 0.017) were significantly increased between the control and WML groups. There was no significant difference in the rhythmic classification of BP among all groups (P > 0.05). An ordered multinomial logistic regression analysis revealed that age, triglyceride levels, and nondipper BP were independent risk factors in WML. Conclusion Age, history of diabetes, serum uric acid levels, 24-hour mean systolic level, and daily mean systolic BP level were significantly increased between the WML and control groups. Age, triglyceride levels, and nondipper BP were independent risk factors in WML in patients with CSVD, while the 24-hour dynamic blood pressure standard deviation and 24-hour dynamic blood pressure coefficient of variation were not associated with the occurrence of WML.

Association of ambulatory blood pressure with aortic valve and coronary artery calcification.

We aimed to investigate the effect of ambulatory blood pressure (BP) on aortic valve calcification (AVC) and coronary artery calcification (CAC), which are subclinical atherosclerotic diseases. In this population-based, cross-sectional study, we assessed office BP, mean ambulatory BP (24-h, awake, and asleep), and variability of ambulatory BP, as determined by the coefficient of variation (awake and asleep). AVC and CAC were quantified using an Agatston score (>0) based on computed tomography scanning. We calculated relative risks (RRs) and 95% confidence intervals (CIs) with a 1-standard deviation increment in each BP index for the presence of AVC and CAC using a multivariate-adjusted Poisson regression with robust error variance. Of 483 participants (mean age: 66.8 years), 154 (31.9%) and 310 (64.2%) had AVC and CAC, respectively. The presence of AVC was associated with office systolic BP (SBP; RR, 1.15; 95% CI, 1.03-1.28), awake diastolic BP (DBP) variability (RR, 1.12; 95% CI, 1.01-1.25), and asleep SBP variability (RR, 1.14; 95% CI, 1.03-1.27). The presence of CAC was associated with office SBP (RR, 1.08; 95% CI, 1.01-1.15), mean 24-h SBP (RR, 1.10; 95% CI, 1.04-1.16), mean awake SBP (RR, 1.11; 95% CI, 1.04-1.17), mean asleep SBP (RR, 1.07; 95% CI, 1.01-1.13), and asleep SBP variability (RR, 1.07; 95% CI, 1.01-1.13). These findings highlight the association of ambulatory BP indices with both AVC and CAC, but with different effects on their presences.

Ambulatory blood pressure trajectories and blood pressure variability in kidney transplant recipients: a comparative study against chronic kidney disease patients.

BackgroundHypertension is a major cardiovascular risk factor in both kidney transplant recipients (KTRs) and patients with chronic kidney disease (CKD). Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard method for hypertension management in these subjects. This is the first study evaluating the full ambulatory blood pressure (BP) profile and short-term BP variability (BPV) in KTRs versus CKD patients without kidney replacement therapy.MethodsNinety-three KTRs were matched with 93 CKD patients for age, sex, and estimated glomerular filtration rate. All participants underwent 24-hour ABPM. Mean ambulatory BP levels, BP trajectories, and BPV indices (standard deviation [SD], weighted SD, and average real variability) were compared between the two groups. ResultsThere were no significant between-group differences in 24-hour systolic BP (SBP)/diastolic BP (DBP) (KTRs: 126.9 ± 13.1/79.1 ± 7.9 mmHg vs. CKD: 128.1 ± 11.2/77.9 ± 8.1 mmHg, p = 0.52/0.29), daytime SBP/DBP and nighttime SBP; nighttime DBP was slightly higher in KTRs (KTRs: 76.5 ± 8.8 mmHg vs. CKD: 73.8 ± 8.8 mmHg, p = 0.04). Repeated measurements analysis of variance showed a significant effect of time on both ambulatory SBP and DBP (SBP: F = [19, 3002] = 11.735, p < 0.001, partial η2 = 0.069) but not of KTR/CKD status (SBP: F = [1, 158] = 0.668, p = 0.42, partial η2 = 0.004). Ambulatory systolic/diastolic BPV indices were not different between KTRs and CKD patients, except for 24-hour DBP SD that was slightly higher in the latter group (KTRs: 10.2 ± 2.2 mmHg vs. CKD: 10.9 ± 2.6 mmHg, p = 0.04). No differences were noted in dipping pattern between the two groups.ConclusionMean ambulatory BP levels, BP trajectories, and short-term BPV indices are not significantly different between KTRs and CKD patients, suggesting that KTRs have a similar ambulatory BP profile compared to CKD patients without kidney replacement therapy.

The Influence of 24-h Ambulatory Blood Pressure on Cognitive Function and Neuropathological Biomarker in Patients With Alzheimer's Disease.

PurposeThis study aimed to investigate the influence of 24-h ambulatory blood pressure (BP) on cognitive function and neuropathological biomarkers in patients with Alzheimer's disease (AD) at the stages of mild cognitive impairment (MCI) and dementia.MethodsThe patients with AD were divided into the MCI (AD-MCI) group and the dementia (AD-D) group. Notably, 24-h BP variables, including BP level, coefficient of variation (CV) of BP, and pulse pressure, were collected and compared between the two groups. The correlations between 24-h BP variables and the scores of cognitive domains were analyzed. The independent influencing factors of cognitive domains of patients with AD were investigated. The levels of neuropathological biomarkers of AD, including β amyloid (Aβ)1−42, phosphorylated tau (P-tau), and total tau (T-tau), in cerebrospinal fluid (CSF) were measured and compared between the two groups, and the correlations between 24-h BP variables and the levels of neuropathological biomarkers of AD were analyzed.ResultsDaytime CV of systolic BP (SBP) was significantly increased in the AD-D group compared to that in the AD-MCI group. The 24-h and daytime CV of SBP and ambulatory pulse pressure were significantly and negatively correlated with memory score. The average 24-h and average daytime SBP level and CV of SBP, daytime CV of diastolic BP (DBP), and 24-h, daytime, and night-time ambulatory pulse pressure were significantly and negatively correlated with language score. The average 24-h SBP level, daytime CV of SBP, and 24-h, daytime, and night-time ambulatory pulse pressure were significantly and negatively correlated with attention score. Further analysis indicated that daytime CV of SBP as well as age and course of disease were the independent influencing factors of language. Age was also the independent influencing factor of memory and attention of patients with AD. T-tau level in CSF in the AD-D group was significantly higher than that in the AD-MCI group, but the levels of Aβ1−42, P-tau, and T-tau in CSF were not correlated with 24-h ambulatory BP variables.ConclusionDaytime CV of SBP was the independent influencing factor of language in patients with AD. The AD-D patients had significantly severe neurodegeneration than AD-MCI patients, which was, however, not through the influence of 24-h ambulatory BP variables on neuropathological biomarkers of AD.

Impact of COVID-19 on ambulatory blood pressure in young adults: a cross-sectional analysis investigating time since diagnosis

Previous studies have reported detrimental effects of COVID-19 on the peripheral vasculature. However, reports on blood pressure (BP) are inconsistent, and measurements are made only in the laboratory setting. To date, no studies have measured ambulatory BP. In addition, in previous studies, time since COVID-19 diagnosis among participants varied across a wide range, potentially contributing to the inconsistent BP results. Thus, we aimed to perform a comprehensive assessment of BP and BP variability using ambulatory and laboratory (brachial and central) measurements in young adults who had COVID-19. We hypothesized that ambulatory BP would be elevated post-COVID-19 and that measures of BP would be inversely related with time since diagnosis. Twenty-eight young adults who had COVID-19 [11 ± 6 (range 3-22) wk since diagnosis] and 10 controls were studied. Ambulatory daytime, nighttime, and 24-h systolic BP, diastolic BP, and mean BP were not different between the control and COVID groups (e.g., daytime systolic BP: control, 122 ± 12 mmHg; COVID, 122 ± 10 mmHg; P = 0.937). Similar results were observed for laboratory BPs (all P > 0.05). However, ambulatory daytime, nighttime, and 24-h BPs as well as laboratory brachial BPs were inversely correlated with time since COVID-19 diagnosis (e.g., daytime systolic BP: r = -0.444; P = 0.044, nighttime systolic BP: r = -0.518; P = 0.016). Ambulatory and laboratory-measured BP variability were not different between groups nor correlated with time since diagnosis. Collectively, these data suggest that adverse effects of COVID-19 on BP in young adults are minimal and likely transient.NEW & NOTEWORTHY We report for the first time that ambulatory daytime, nighttime, and 24-h blood pressure (BP), as well as laboratory BP, were not different between control and COVID participants. However, a significant inverse relationship with time since COVID-19 diagnosis was found (i.e., greater BP with more recent infection). Ambulatory and laboratory BP variability were unaffected and not related with diagnosis time. These findings suggest that COVID-19 may exert only short-lasting effects on BP in young adults.

BLOOD PRESSURE VARIABILITY ASSESSED WITH OFFICE, HOME AND AMBULATORY MEASUREMENTS BEFORE AND AFTER ANTIHYPERTENSIVE DRUG TREATMENT: THE REVERENT TRIAL

Objective: Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP) and ambulatory BP (ABP) measurements. In this analysis BPV indices derived using all the three methods were compared before and after 10 weeks of antihypertensive drug treatment. Design and method: Untreated hypertensives (or treated after washout period) with elevated BPV (systolic HBP standard deviation [SD] &gt; 7 mmHg and/or systolic daytime ABP SD &gt; 12 mmHg), were nalysedd to ramipril 10 mg or nifedipine gastrointestinal therapeutic system (GITS) 30 mg once daily, in the context of a multicenter 10-week, prospective, nalysedd, open-label, blinded-end point study. BPV was assessed using SD and coefficient of variation (CV) [weighted SD (wSD) and weighted CV (wCV) for 24h-ABP variability) of individual measurements. Results: Data from 146 participants from three research centers (Athens, Milan, Shanghai) were nalysed (mean age 53 ± 10 [SD] years, males 60%, baseline systolic OBP, HBP and 24h-ABP 143 ± 10, 138 ± 10, and 143 ± 10 mmHg, respectively). Systolic CV assessed by HBP was decreased with treatment, by OBP was unchanged and by ABP increased (p &lt; 0.05). HBP and ABP (not OBP) variability indices presented weak to moderate correlation, which was consistent before and after treatment (Table). HBP and ABP (not OBP) variability indices presented slight to fair agreement in detecting participants with high systolic BPV (top quartile of respective distribution) both before and after treatment (kappa statistic range 0.12–0.27). Conclusions: These data showed a moderate association between out-of-office (but not office) BPV indices both before and after administering BP lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar BPV information than office measurements, both before and after administering antihypertensive drug treatment.

BLOOD PRESSURE VARIABILITY AND MIND COGNITION IMPAIRMENT: A SYSTEMIC REVIEW AND META-ANALYSIS

Objective: Blood pressure variability is hypothesized to play important role in development of cognition impairment. We aimed to explore the relationship of blood pressure variability and cognition impairment. Design and method: We searched the following databases, EMBASE, Cochrane Library, Web of Science, up to October 2021 using blood pressure variability, cognition impairment, cognition dysfunction. Randomized double blind and observational trials were included. Dementia and Alzheimer’s disease cases were excluded. Two reviewers confirmed the inclusion of studies and extracted the data independently. STATA V.15.1 was used to synthesize data. Results: We included 23 studies and enrolled 42964 hypertensive patients. All studies assessed cognition function using Mini-Mental State Examination (MMSE) or other cognition function test. Ambulatory blood pressure variability, visit-to-visit blood pressure variability, measure to measure blood pressure variability, day-to-day blood pressure variability and beat-to-beat systolic blood pressure variability were applied in included trials. The variability of systolic blood pressure has significant relationship with cognition impairment (OR,1.747[1.25,2.44], P &lt; 0.01), however, the variability of diastolic blood pressure did not show relationship with decreasing cognition function scale(OR,0.912[0.81,1.03], P&gt; 0.05) by nalysing data which trial used MMSE scale. Results showed higher systolic blood pressure variability had negative relationship with attention (OR,1.63, [1.28,1.98], P &lt; 0.01). In the aspect of memory and language function, blood pressure variability did not show a significant relationship. Higher blood pressure variability in both systolic and diastolic was associated with lower hippocampal volume and cortical infarcts. Conclusions: The variability of systolic blood pressure is dependently risk factor for cognition impairment in older adults with hypertension. For unsuccessfully treated hypertensive individuals (with blood pressured more than 140/90 mmHg),higher variability in both systolic and diastolic blood pressure was associated with cognitive damage, but these associations were not found in those controlled hypertension older adults.

AMBULATORY BLOOD PRESSURE TRAJECTORIES AND BLOOD PRESSURE VARIABILITY IN KIDNEY TRANSPLANT RECIPIENTS: A COMPARATIVE STUDY AGAINST HEMODIALYSIS PATIENTS

Objective: Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (BP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients. Design and method: Two hundred four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP levels, BP trajectories and BPV indices over a 24-hour ambulatory BP monitoring (ABPM) in KTRs were compared against both the 1st and 2nd 24-hour period of a standard 48-hour ABPM in HD. To evaluate the effect of renal replacement treatment and time on ambulatory BP levels, two-way-ANOVA for repeated-measurements was performed. Results: KTRs had significantly lower SBP and pulse pressure (PP) levels compared to HD during all periods studied (24-hour SBP: KTR: 126.5 ± 12.1mmHg; HD 1st 24-hour: 132.0 ± 18.1mmHg, p = 0.006; 2nd 24-hour: 134.3 ± 17.7mmHg, p &lt; 0.001); no significant differences were noted for DBP levels with the exception of 2nd nighttime. Repeated-measurements-ANOVA showed a significant effect of RRT modality and time on ambulatory SBP levels during all periods studied, and a significant interaction between them; the greatest between-group difference in BP (KTRs - HD in mmHg) was observed at the end of the 2nd 24-hour (-13.9mmHg, 95%CI: -21.5 to -6.2, p &lt; 0.001). Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD during all periods studied (24-hour SBP-ARV: KTRs: 9.6 ± 2.3mmHg; HD 1st 24-hour: 10.3 ± 3.0mmHg, p = 0.032; 2nd 24-hour: 11.5 ± 3.0mmHg, p &lt; 0.001). No differences were noted in dipping pattern between the two groups. Conclusions: SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared to age- and gender-matched HD patients during all periods studied. These findings suggest a more avourable ambulatory BP profile in KTRs, in contrast to previous observations.

Mat Pilates training reduces blood pressure in both well-controlled hypertensive and normotensive postmenopausal women: a controlled clinical trial study

ABSTRACT Aim The aim of this study was to compare the Mat Pilates training-induced responses in resting and ambulatory blood pressure monitoring (ABPM), blood pressure variability (BPV), and heart rate variability (HRV) in well-controlled hypertensive and normotensive postmenopausal women. Methods Forty-seven postmenopausal women were allocated in well-controlled hypertensive (HT) and normotensive (NT) groups. The exercise program was performed three times a week for 12 weeks. Before and after the intervention resting, blood pressure (BP), ABPM, HRV, and BPV were analyzed. Results Student’s t-test showed no difference in baseline anthropometric and resting BP values between groups. The generalized estimation equation (GEE) showed no interactions (group*time), but time (p < .05) reductions in resting systolic, diastolic and mean BP after training in both groups. Sleep ambulatory systolic, diastolic and mean BP were higher overall in the HT group (p < .05 in group effect). We also found a time effect (p < .05) with significant increases in BPV in the mean diurnal and nocturnal deviations weighted for the duration of the daytime and nighttime interval (SDdn) in systolic, diastolic and mean BP, and in the average real variability (ARV) in diastolic and mean in both groups. In addition, HRV increases (p < .05 in time effect) through the percentage of pairs of adjacent RR intervals with a difference of at least 50 ms (pNN50) after training in both groups. Conclusion Both normotensive and well-controlled hypertensive postmenopausal women may have similar Mat Pilates exercise training-induced responses in ambulatory BP, BPV and HRV.

SEX DIFFERENCES IN AMBULATORY BLOOD PRESSURE TRAJECTORIES AND BLOOD PRESSURE VARIABILITY IN HEMODIALYSIS PATIENTS

Objective: Ambulatory blood pressure (BP) control is worse in men than in women with chronic kidney disease (CKD) and this may partially explain the faster CKD progression in men. The aim of this study is to investigate possible sex-differences in ambulatory BP levels, BP trajectories, and BP variability (BPV) in hemodialysis patients. Design and method: 129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Ambulatory BP levels over the 2-day interdialytic interval (including two daytime and two nighttime periods) were recorded. We calculated the standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP with validated formulas. Results: Age, dialysis vintage, antihypertensive treatment and history of major comorbidities did not differ between men and women. Pre-dialysis SBP levels did not differ between men and women (145.1 ± 22.7 vs 145.9 ± 25.7mmHg, p = 0.808), but DBP was marginally higher in men (87.6 ± 14.0 vs 84.0 ± 13.7mmHg, p = 0.055). 48-h SBP/DBP (137.2 ± 17.4/81.9 ± 12.1mmHg vs 132.2 ± 19.2/75.9 ± 11.7mmHg, p = 0.045/ &lt; 0.001) as well as DBP during the 1st and SBP/DBP during the 2nd 24-h period were significantly higher in men than in women. Similarly, daytime SBP/DBP was significantly higher in men (138.3 ± 17.5/83.2 ± 12.3mmHg vs 131.9 ± 19.4/76.4 ± 11.5mmHg. p = 0.011/&lt; 0.001). No significant between-group differences were detected for nighttime SBP. All SBP variability indices were similar between men and women; DBP-SD, DBP-wSD and DBP-ARV were higher in men (44-h DBP-ARV 9.4 ± 1.8 vs 8.6 ± 1.9, p = 0.002). No significant differences were revealed in the dipping pattern between men and women. Conclusions: Ambulatory BP levels and trajectories, as well as DBP variability indices are higher in men than women hemodialysis patients. This worse ambulatory BP profile in male compared to female patients may impact on the incidence of cardiovascular events.

MO086: Sex Differences in Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Ambulatory blood pressure (BP) control is worse in men than in women with chronic kidney disease (CKD), and this may partially explain the faster CKD progression in men. The aim of this study is to investigate possible sex-differences in ambulatory BP levels, BP trajectories and BP variability (BPV) in hemodialysis patients. METHOD 129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Ambulatory BP levels over the 2-day interdialytic interval (including two daytime and two nighttime periods) were recorded. We calculated the standard deviation (SD), weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP with validated formulas. RESULTS Age, dialysis vintage, antihypertensive treatment and history of major comorbidities did not differ between men and women. Pre-dialysis SBP levels did not differ between men and women (145.1 ± 22.7 versus 145.9 ± 25.7 mmHg, P = 0.808), but DBP was marginally higher in men (87.6 ± 14.0 versus 84.0 ± 13.7 mmHg, P =0.055). About 48-h SBP/DBP (137.2 ± 17.4/81.9 ± 12.1 mmHg versus 132.2 ± 19.2/75.9 ± 11.7 mmHg, P = 0.045/&amp;lt;0.001) as well as DBP during the first and SBP/DBP during the second 24-h period were significantly higher in men than in women. Similarly, daytime SBP/DBP was significantly higher in men (138.3 ± 17.5/83.2 ± 12.3 mmHg versus 131.9 ± 19.4/76.4 ± 11.5 mmHg, P = 0.011/&amp;lt;0.001). No significant between-group differences were detected for nighttime SBP. All SBP variability indices were similar between men and women; DBP-SD, DBP-wSD and DBP-ARV were higher in men (44-h DBP-ARV 9.4 ± 1.8 versus 8.6 ± 1.9, P = 0.002). No significant differences were revealed in the dipping pattern between men and women. CONCLUSION Ambulatory BP levels and trajectories, as well as DBP variability indices are higher in men than women hemodialysis patients. This worse ambulatory BP profile in male compared to female patients may impact on the incidence of cardiovascular events.

MO081: Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Kidney Transplant Recipients: A Comparative Study Against Chronic Kidney Disease Patients

Abstract BACKGROUND AND AIMS Hypertension is a major cardiovascular risk factor in both kidney transplant recipients (KTRs) and patients with chronic kidney disease (CKD). Ambulatory blood pressure monitoring (ABPM) is considered the gold standard method for hypertension management in these subjects. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus CKD patients without kidney replacement therapy. METHOD 93 KTRs were matched with 93 CKD patients for age, sex and eGFR. All participants underwent 24 h ABPM; mean ambulatory BP levels, BP trajectories and BPV indices [standard deviation (SD), weighted-SD and average real variability] were compared between the two groups. RESULTS There were no significant between-group differences in 24-h SBP/DBP (KTRs:126.9 ± 13.1/79.1 ± 7.9 versus CKD:128.1 ± 11.2/77.9 ± 8.1 mmHg, P = 0.522/0.293), daytime SBP/DBP and nighttime SBP; nighttime DBP was slightly higher in KTRs (KTRs:76.5 ± 8.8 versus CKD:73.8 ± 8.8 mmHg, P = 0.040). For both ambulatory SBP/DBP, repeated-measurements-ANOVA showed a significant effect of time (SBP: F = [19, 3002]=11.735, P &amp;lt; 0.001, partial η2 = 0.069) but not of KTR/CKD status (SBP: F = [1, 158] = 0.668, P = 0.415, partial η2 = 0.004). Ambulatory systolic/diastolic BPV indices were not different between KTRs and CKD patients, except for 24-h DBP-SD that was slightly higher in the latter (KTRs: 10.2 ± 2.2 versus CKD: 10.9 ± 2.6 mmHg, P = 0.041). No differences were noted in dipping pattern between the two groups. CONCLUSION Mean ambulatory BP levels, BP trajectories and short-term BPV indices are not significantly different between KTRs and CKD patients, suggesting that KTRs have a similar ambulatory BP profile compared with CKD patients without kidney replacement therapy.

MO087: Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Kidney Transplant Recipients: A Comparative Study Against Hemodialysis Patients

Abstract BACKGROUND AND AIMS Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (ΒP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients. METHOD Two hundred four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP levels, BP trajectories and BPV indices over a 24-h ambulatory BP monitoring (ABPM) in KTRs were compared against both the first and second 24-h period of a standard 48-h ABPM in HD. To evaluate the effect of renal replacement treatment and time on ambulatory BP levels, two-way-ANOVA for repeated-measurements was performed. RESULTS KTRs had significantly lower SBP and pulse-pressure (PP) levels compared with HD during all periods studied (24-h SBP: KTR: 126.5 ± 12.1 mmHg; HD first 24-h: 132.0 ± 18.1 mmHg, P = 0.006; second 24-h: 134.3 ± 17.7 mmHg, P &amp;lt; 0.001); no significant differences were noted for DBP levels with the exception of second nighttime. Repeated-measurements-ANOVA showed a significant effect of RRT modality and time on ambulatory SBP levels during all periods studied, and a significant interaction between-them; the greatest between-group difference in BP (KTRs—HD in mmHg) was observed at the end of the second 24-h (−13.9 mmHg, 95%CI: −21.5 to −6.2, P &amp;lt; 0.001). Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD during all periods studied (24-h SBP-ARV: KTRs: 9.6 ± 2.3 mmHg; HD first 24-h: 10.3 ± 3.0 mmHg, P = 0.032; second 24-h: 11.5 ± 3.0 mmHg, P &amp;lt; 0.001). No differences were noted in dipping pattern between the two groups. CONCLUSION SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared to age- and gender-matched HD patients during all periods studied. These findings suggest a more favorable ambulatory BP profile in KTRs, in contrast with previous observations.