bluuebunny/crossref_metadata_2025 huggingface dataset:
BLOOD PRESSURE CONTROL RATES PREVIOUS AND DURING THE COVID-19 PANDEMIC IN BRAZIL
Authors: Lima Lucas , Vitorino Priscila , Silva Suelen , Sousa Ana , Barroso Weimar
Published: June 2022

Objective:

to compare the previous blood pressure control rates with those assessed during the COVID-19 pandemic.

Design and method:

two cross-sectional studies (march to November 2019 and march to November 2020). Participated patients from health centers of five Brazilian regions that used the TeleMRPA platform to report tests on people diagnosed with and under control of arterial hypertension, aged between 18 and 100 years, included. Data from patients with duplicate or inaccurate information excluded. Blood pressure control measures < or = 140/90 mmHg considered for casual measurements and/or < or = 130/80 for residential measurements.

Results:

38.698 patients evaluated, 54.7% in 2019 and 43.9% from northeastern Brazil. There was an increase in patients not using antihypertensive drugs from 52.5% in 2019 to 61.3% in 2020 (p < 0.001) and BMI from 28.1 (± 4.5) to 28.3 (± 4.5) p = 0.010. We did not identify differences in the comparison of SBP (office and MRPA) between the two periods evaluated. There was an increase in DBP both in the office from 83.8 (±11.8) to 84.5 (±11.9), p < 0.001 as that obtained by the MRPA from 79.25 (±9.58) to 79.57 (±9.68), p = 0.001. The variability of DBP reduced from 5.9 (±2.49) to 5.9 (±2.43), p < 0.001, and the mean Pulse Pressure was 50.7 (±14.4) in 2019 to 50.3 (±14.3) in 2020, p = 0.009. There was no change in the control rates considering the office measure which was from 68.9% to 68.6% and the MRPA from 52.4% to 51.4% from 2019 to 2020.

Conclusions:

blood pressure control remained stable during the COVID-19 pandemic when compared to the previous year. Assessing and monitoring blood pressure control through telemonitoring using home blood pressure monitoring is a simple, easy-to-access, and effective method.
SUBCLINICAL MAGNETIC RESONANCE IMAGING MARKERS OF CEREBRAL SMALL VESSEL DISEASE IN RELATION TO AMBULATORY BLOOD PRESSURE MEASUREMENTS
Authors: Melgarejo Jesus , Maestre Gladys E. , Gutierrez Jose , Thijs Lutgarde , Mena Luis , Gaona Ciro , Reinier Leendertz , Lee Joseph , Chavez Carlos , Calmon Gustavo , Silva Egle , Wei Dongmei , Terwilliger Joseph , Vanaasche Thomas , Janssens Stefan , Verhamme Peter , Bos Daniel , Zhang Zhenyu
Published: June 2022

Objective:

24-h and nighttime blood pressure (BP) levels are the strongest BP measurements associated with cardiovascular risk. However, it remains undocumented which of the ambulatory BP measurements have the strongest association and predictive information in relation to the presence of cerebral small vessel diseases (CSVD).

Design and method:

A subset of Maracaibo Aging Study with 429 participants [aged 40 years or older (women, 73.7%; mean age, 59.3y)] underwent baseline brain magnetic resonance imaging to visualize CSVD, which included log-transformed white matter hyperintensities (log-WMH), the presence (yes/no) of silent brain infarcts (SBI), cerebral microbleeds (CMB), or enlarged perivascular spaces (EPVS). Linear and logistic regression models were applied to examine the association between CSVD and each + 10 mmHg increment in the office and ambulatory systolic BP. Improvement in the fit of nested logistic models was assessed by the log-likelihood ratio and the generalized R2 statistic.

Results:

Office and ambulatory systolic BP measurements were related to log-WMH (beta correlation coefficients above 0.08; P < 0.001). SBI and CMB were only associated with ambulatory systolic BP measurements (odds ratios [OR] ranged from 1.31 [95% confidence interval, 1.10 1.55] to 1.46 [1.17–1.84], P < 0.003). Accounted for daytime systolic BP, both the 24-h (beta correlation, 0.170) and nighttime (beta, 0.038) systolic BP measurements remained related to log-WMH. When accounted for 24-h or daytime systolic BP levels, the nighttime systolic BP retained the significant association with SBI (ORs, 1.05–1.06; 95% CIs, > = 1.01to< = 1.13), whereas the 24-h and daytime systolic BP levels were not associated with SBI after adjustments for nighttime systolic BP (ORs, < = 0.88; 95% CI, > = 0.77to< = 1.14). On top of covariables and office systolic BP, ambulatory systolic BP measurements significantly improved model performance (R2<3.82%). Compared to 24-h and daytime SBP, nighttime systolic BP had the strongest improvement in the model performance; for WMH (1.46% vs. 1.05%) and SBI (3.06% vs. below 2.05%).

Conclusions:

24-h and nighttime systolic BP were the more robust BP measurements associated with CSVD, but for log-WMH and SBI, the nighttime systolic BP level had the strongest association. Controlling ambulatory BP levels might provide additional improvement in the prevention of CSVD
EFFECT OF MENTAL RELAXATION ON OFFICE BLOOD PRESSURE MEASUREMENT BY OSCILLOMETRY
Authors: Gupta Sanjay , Gupta Sangeeta , Gupta Kashish
Published: June 2022

Objective:

Automated office Blood pressure (AOBP) has become the standard of care method of measuring blood pressure. ESC/ESH Clinical Practice Guidelines for the management of arterial hypertension 2018 specifies that Patients should be seated comfortably in a quiet environment for 5 min before beginning BP measurements. However, a variety of visual and auditory stimuli during this period can still result in higher BP recordings. Mental Relaxation induced by reducing visual stimuli and soothing sounds can potentially have an effect on the AOBP recordings. The study aims to evaluate this effect and compare it to the standard protocol of BP measurement.

Design and method:

198 consecutive patients were evaluated in the outpatient department. BP was measured by oscillometric method using Microlife BP device following the ESC/ESH guidelines. Patients were seated in a comfortable posture with back and feet supported for a period of 15 minutes before BP measurement. Mental relaxation was induced by reducing visual stimuli using eye shades and ear phones playing soft natural sounds and second set of BP and pulse recordings were done at the end of 5 minutes of relaxation time. Unpaired t test and Chi-Square test were utilized for the statistical analysis.

Results:

There were 96 males and 102 females with mean age of 53.13 ± 13.95 yrs

History of hypertension was present in 105 subjects

Using standard BP measurement protocol the mean systolic BP was 142.33 ± 18.85 mm hg, mean diastolic BP was 83.22 ± 8.5 mm hg and mean pulse rate was 84.55 ± 15.27 per minute.

The mean change after Mental relaxation augmented period was 6.71 ± 13.66 mm hg in systolic BP (p value 0.0001), 2.85 ± 7.67 mm hg in diastolic BP (p value 0.0001) and 2.81 ± 8.71 per minute in pulse rate (p value 0.0001)

Conclusions:

Mental relaxation augmented physical rest before measurement of BP by oscillometric method in outpatient clinic results in significant reduction in BP (both systolic and diastolic) and pulse rate compared to standard BP measurement protocol. These values may be more realistic as they are likely to have reduced white coat effect and environmental influences.
ADVANTAGES AND LIMITATIONS OF USING THE AKTIIA CUFFLESS BRACELET FOR A HYPERTENSION SPECIALIST
Authors: Girerd Xavier , Boualit Robert , Pathak Atul , Perruchod David , Sola Josep
Published: June 2022

Objective:

The AKTIIA bracelet was the first cuffless blood pressure monitor available in Europe over the counter. While published medical data show the validity of the measurement system compared to traditional blood pressure measurements, the objective of this preliminary study was to assess the value of the AKTIIA bracelet in the care of treated hypertensive patients.

Design and method:

Two bracelets were provided by the manufacturer to university cardiologist, specialist in hypertension. They were assigned to two hypertensive patients treated with antihypertensive drugs: one 62 years old treated with nebivolol 5 mg for 1 month and then with nebivolol 5 mg + candesartan 4 mg for the following 2 months, the other 52 years old treated with irbesartan 150 mg for 3 months. They were instructed to wear the bracelet for 3 consecutive months and following the manufacturer’s instructions to perform a calibration on 3 occasions. The patients performed also home blood pressure monitoring for 3 days with 6 measures per day once a month while wearing the bracelet on the other arm.

Results:

Over the same time periods, SYS/DIA values were accurately comparable between the AKTIIA bracelet and HBPM

Conclusions:

The AKTIIA bracelet, the first cuffless blood pressure monitor available in Europe over the counter, is currently proposed for blood pressure monitoring in healthy subjects. Its technological properties make it possible to use it for the follow-up of patients treated for hypertension. Some evolutions are desirable to facilitate its use by hypertension specialists. The cuffless method which allows blood pressure measurements without disturbing sleep constitutes a breakthrough in the management of hypertensive patients.
CLOSE VERSUS LOOSE CONTACT BETWEEN PHYSICIAN AND PATIENT DURING ATTENDED OFFICE BLOOD PRESSURE MEASUREMENT: DOES IT PLAY A ROLE?
Authors: Filipovsky Jan , Seidlerova Jitka Mlikova , Kordikova Veronika
Published: June 2022

Objective:

Compared to unattended office blood pressure measurement (uOBP), attended office blood pressure measurement (aOBP) gives higher blood pressure (BP) values. It is not known, however, to what extent the distance between physician and patient during aOBP influences BP.

Design and method:

Participants were stable hypertensive patients, followed in the university hospital-based out-patient centre. During a session, automated office BP was measured three times after a pre-set five-minute pause, using Omron 907 device; both aOBP and uOBP were done, in a random order. Simultaneously, beat-to-beat BP measurement (bbBP) was done using Finapress device. During aOBP, some participants were in close contact with the physician: he placed the stethoscope to the cubital fossa, thus imitating the auscultatory measurement; other patients were in “loose’’ contact where the doctor was sitting in the room, about two meters apart. One year later, the second session with the same protocol was organized, but the close and loose contact were interchanged. The data were analysed using a paired t-test.

Results:

Complete data were collected in 32 patients (53% males, age 66.2 ± 8.1 years, uOBP 122.8 ± 14.8 / 69.5 ± 11.7 mmHg, treatment with 2.7 ± 1.0 antihypertensive drugs). Systolic and diastolic aOBP with close contact was higher by 4.6 ± 6.9 and 1.9 ± 3.4 mmHg (p < 0.0007 and 0.0039, respectively), while aOBP with loose contact was not different from uOBP.

bbBP increased during aOBP by up to 6.5 ± 8.5 / 3.3 ± 4.8 mmHg, as compared to baseline BP values measured before the physician entered the office. The increase persisted during all the three aOBP measurements (p < 0.001 for all systolic and diastolic BP values); the results were similar for close and loose contact. The peak increase during uOBP was of similar magnitude as during aOBP but it lasted shorter: it increased highly significantly (p < 0.001) only during the first uOBP measurement.

Conclusions:

Compared to uOBP, aOBP values were higher with close, but not with loose contact between physician and patient. These differences were, however, not detected by bbBP measurement.
24-HOUR AMBULTORY BLOOD PRESSURE MEASUREMENT USING A NOVEL NON-INVASIVE, CUFF-LESS, WIRELESS DEVICE
Authors: Eisenkraft Arik
Published: June 2022

Objective:

Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for the diagnosis and treatment of hypertension. Technical limitations, low compliance, and complex procedures limit their use. The aim of the present study was to test the accuracy of a new photoplethysmography (PPG)-based, wearable device (Wrist-monitor) as compared to the standard cuff-based ABPM device.

Design and method:

24H ABPM was performed in parallel for both devices on volunteers aged 18–65 years while documenting their daily activities. The level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between devices. Receiver Operating Characteristic (ROC) curve analysis was used to classify hypertension based on the average Wrist-monitor measurements as compared to a cuff-based ABPM device.

Results:

The study included 28 subjects (18 men) mean age of 41.5 ± 16.2 years. The Bland-Altman analysis resulted in a 24H bias of -1.1 mmHg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was -1.9 mmHg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mmHg for DBP and SBP respectively). ROC curve analysis yielded a mean area under the curve (AUC) of 1 for SBP and 24H BP measurements. AUCs of 0.994 and 0.955 were found for the daytime DBP and night DBP, respectively. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared to the cuff-based device (p < 0.001).

Conclusions:

The cuff-less device provides comparable measurements to those obtained with the currently used cuff-based ABPM device, with significantly less inconvenience to the subject.
BLOOD PRESSURE AWARENESS AND CONTROL IN SWISS PHARMACIES DURING MMM17–18 CAMPAIGNS
Authors: Damianaki Katerina , Menetre Gerald , Burnier Michel , Wuerzner Gregoire
Published: June 2022

Objective:

May Measurement Month (MMM) is a worldwide hypertension awareness campaign. The objective was to determine the usefulness of pharmacies in the detection of high blood pressure (BP) using the ESH 2018 and the ESH 2021 proposed threshold for diagnosis of hypertension in pharmacies.

Design and method:

Forty-one pharmacies in the Canton of Vaud (Switzerland) evaluated the participants during MMM17 campaign and 271 pharmacies in Switzerland evaluated the participants during MMM18 campaign. After obtaining inform consent form, BP and a short questionnaire focusing on basic demographic and clinical information were recorded. ESH 2018 threshold of 140/90mmHg and ESH 2021 pharmacy-threshold of 135/85mmHg were used for our analysis. Descriptive statistics and t-test were used appropriately.

Results:

2060 participants had their BP measured in pharmacies. Mean age was 48.5 ± 19 years and almost ¾ of the participants were women (71.6% p < 0.001). BP measurement in pharmacies was associated with a first measure effect of 2.8 ± 0.17 mmHg on SBP and 0.9 ± 0.13 mmHg on DBP.

689 (33.5%) and 840 (40.8%) participants presented a high BP based on ESH 2018 threshold and ESH 2021 pharmacy-based threshold respectively. In treated participants, 56.9% had average BP lower than 140/90mmHg.

Conclusions:

Mainly female participants had their BP measured in pharmacies. Screening for high BP in pharmacies is feasible and recruits mainly female participants. Based on pharmacy thresholds, the prevalence of hypertension was higher than expected for Switzerland. A first measure effect was also present in pharmacies, suggesting that three measures should be performed at pharmacies and the first one should be discarded from the mean BP calculation.
REPRODUCIBILITY OF WHITE COAT HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Antza Christina , Farmakis Ioannis , Doundoulakis Ioannis , Akrivos Evangelos , Stalikas Nikolaos , Zafeiropoulos Stefanos , Kostopoulos Georgios , Stabouli Stella , Giannakoula George , Kotsis Vasilios
Published: June 2022

Objective:

The aim of this study was to investigate the reproducibility of white coat hypertension (WCH) either with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM).

Design and method:

PubMed, Cochrane Library and Web of Science were searched to identify studies with paired baseline office BP and ABPM or HBPM measurements at two timepoints. The outcome of the analysis was the individual phenotype reproducibility between the baseline and follow-up timepoints. The used effect measure was Cohen’s kappa coefficient.

Results:

We found 15 studies eligible for the meta-analysis (5729 patients). The reproducibility of WCH with both methods was low, indicating slight agreement. Kappa reliability test was slightly better with ABPM (k: 0.27, 95%CI: 0.12–0.41) than with HBPM (k: 0.18, 95%CI: 0.08–0.27).

Conclusions:

This systematic review and meta-analysis show a slight reproducibility of WCH assessed either through HBPM or ABPM. Considering that poor reproducibility may be a result of office BP measurements, an ABPM/HBPMnbased strategy should be established for the evaluation and treatment of patients with WCH.
PSYCHOLOGICAL AND QUALITY OF LIFE SCALE SCORES CORRELATED WITH THE WINTER INCREASE OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Andreeva Galiya , Deev Alexander , Gorbunov Vladimir
Published: June 2022

Objective:

The aim of study was to define correlations between winter blood pressure (BP) increase and psychological, quality of life (QL), demographic factors in patients with arterial hypertension (AH) (Moscow region).

Design and method:

We assessed 980 ambulatory blood pressure monitoring (ABPM) data AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period (at 8.30–12.00 am). We defined daytime period as 8.00–22.00, nighttime – 0.00–6.00, evening – 21.00–23.00, morning – 6.00–8.00 and workplace period as 11.00–19.00. After ABPM session patients completed the QL questionnaire. (J.Siegrist et all.). The systolic and diastolic (SBP and DBP) winter increase BP was assessed for: daytime (BPd), nighttime (BPn), evening (BPe), morning (BPm), workplace (BPw) and 24-hours period (BP24). We used General Linear Model (GLM) Procedure for statistical analysis adjustment for age, sex and duration of AH and Fisher’s (F) test.

Results:

We have identified the following QL factors that were significantly associated with the SBP winter increase: 1) VI scale scores of QL questionnaire (reflects the level of social support of family, friends, colleagues) with SBPn (F = -6,62 p < 0,01), SBPd (F = -11,12, p < 0,001), SBPw (F = -9,33, p < 0,003), SBPm (F = -10,59 p < 0,001), SBPe (F = -5,4, p < 0,02); 2) IV scale scores (negative psychological well-being) with SBPw (F = 9,33, p < 0,003). The following factors were significantly associated with the DBP winter increase: 1) VI scale scores with DBPd (F = 4,06, p < 0,04), SBPm (F = 4,29 p < 0,004).

Thus, such QL components as the social support from family, friends, colleagues, (VI scale scores) and the negative emotions (IV scale scores) have been associated with the winter BP increase (negative and positive correlation respectively).

Conclusions:

The new preventive strategy for reducing winter BP may include the increase communication with family and friends and to reduce the impact of negative emotions in the workplace in Moscow region patients with AH.
SHORT-TERM BLOOD PRESSURE VARIBILITY AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Vulin Aleksandra , Sucur Nikola , Delic Zorica , Poljak Jelena Pavic , Ljubotina Andrea , Todic Vanja Drljevic , Popov Iva
Published: June 2022

Objective:

To determine the association of short-term blood pressure variability (BPV) with left ventricular diastolic dysfunction (LVDDF) in patients with arterial hypertension.

Design and method:

A retrospective analysis of data from outpatient department of the Institute of cardiovascular diseases of Vojvodina during 2020 was conducted. NYHA I patients, with treated arterial hypertension and preserved left ventricular ejection fraction, without diagnosed cardiovascular disease and diabetes mellitus were included. Indices of short-term BPV standard deviation (SD) and coefficient of variation (CV), and average real variability (ARV) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) during 24 h, daytime and nighttime were calculated from 24 h ambulatory blood pressure monitoring. LVDDF was determined according to the 2016 recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Results:

The study included 108 patients, mean age 60.74 ± 13.20 years, 55 (50.9%) were male. 71 (65.7%) patients had preserved diastolic function, 27 (25%) had stage I DDF, 7 (6.5%) stage II DDF, and stage III DDF 2 (2.8%). There were statistically significant higher daytime diastolic BP AVR with higher LVDDF stages (p = 0.014). Daytime diastolic BP AVR was the independent predictor of LVDDF presence (OR 1.32 95% CI (1.074–1.623); p = 0.008), independent predictor of e’septal velocity < 0.07m/s or e’lateral velocity< 0.1m/s (OR 1.29 95% CI (1.04–1.60); p = 0.020), and the only predictor of TR velocity > 2.8m/s (OR 1.47 95% CI (1.10–1.96); p = 0.009). No examined indices were ssociated with LA Volume index> 34 ml/m2 and E/e’> 14.

Conclusions:

In the examined group of patients with arterial hypertension, daytime diastolic BP AVR was the independent predictor of left ventricular DDF presence, which may suggest that daytime diastolic BP variability could be important for development of heart failure with preserved left ventricular ejection fraction.
SEX DIFFERENCES IN AMBULATORY BLOOD PRESSURE TRAJECTORIES AND BLOOD PRESSURE VARIABILITY IN HEMODIALYSIS PATIENTS
Authors: Theodorakopoulou Marieta , Karagiannidis Artemios , Alexandrou Maria-Eleni , Pella Eva , Karpetas Antonios , Baksiova Afroditi , Tsouchnikas Ioannis , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2022

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/ < 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/< 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.
IDENTIFICATION OF HYPERTENSIVE PATIENTS WITH INCREASED BLOOD PRESSURE VARIABILITY USING DIFFERENT MEASUREMENT METHODS BEFORE AND AFTER TREATMENT: THE REVERENT TRIAL
Authors: Kollias Anastasios , Kyriakoulis Konstantinos , Bilo Grzegorz , Soranna Davide , Liu Chang-Yuan , Pengo Martino , Zambon Antonella , Zhang Wei , Wang Jiguang , Stergiou George , Parati Gianfranco
Published: June 2022

Objective:

Blood pressure (BP) variability (BPV) can be assessed with office (OBP), home (HBP), and ambulatory BP (ABP) measurements. In this analysis, BPV indices assessed using all the three methods were compared before and 10 weeks after administering antihypertensive drug treatment.

Design and method:

Untreated hypertensives (or treated after washout period) with elevated BPV (systolic HBP standard deviation [SD] > 7 mmHg and/or systolic daytime ABP SD > 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). All BPV indices (except for diastolic OBP) presented significant correlations in terms of pre- vs post- treatment, with ABP indices (especially diastolic) achieving the strongest correlations (Table). Moreover, out-of-office BPV indices (especially ABP) presented fair to moderate agreement in detecting participants with high BPV (top quartile of respective distribution) pre- vs post- treatment.

Conclusions:

Untreated hypertensives with high out-of-office BPV retain this classification even after BP lowering therapy, which suggests that BPV is an intrinsic feature of the individuals’ BP.
BLOOD PRESSURE VARIABILITY AT REST AND DURING AEROBIC EXERCISES IN WOMEN WITH ISCHEMIC CARDIAC DISESES
Authors: Siegelova Jarmila , Havelkova Alena , Dusek Jiri , Dunklerova Leona , Pohanka Michal , Dobsak Petr , Cornelissen Germaine
Published: June 2022

Objective:

High visit-to-visit blood pressure (BP) variability increases the risk of cardiovascular disease in hypertension. In some earlier studies there was the hypothesis that exact same doses of exercise evokes the same response of BP and heart rate (HR).

The aim of the study was to compare auscultatory measurements of SBP and DBP during cardiac aerobic exercise training twice a week, lasting three weeks in women with ischemic heart disease.

Design and method:

We examined 12 women with ischemic heart diseases, the age 60 ± 8.9 years, height 166 ± 6.7 cm, weight 78 ± 11.7 kg, ejection fraction was 46 ± 6 %. The cardiac patients were under therapy of betablockers. ACE inhibitors and statins. The intensity of aerobic training was determined individually according spiroergometric examination of the first ventilatory anaerobic threshold. BP measurements were provided using auscultatory measurement of BP at resting values, after warm-up period (10 minutes), at the peak of aerobic training period (40 minutes), at the cool-down period (10 minutes) twice a week, the training lasted 3 weeks.

Results:

Resting average values in the whole group of SBP were 129.0 ± 11.7 mmHg, of DBP 77.7 ± 8.5 mmHg, HR 71.7 ± 7.1 beat per minute.

After warm-up period average values in the whole group of SBP were 126.7 ± 10.4 mmHg, of DBP 76.5 ± 7.0 mmHg, HR 84.4 ± 9.0 beat per minute.

At aerobic peak - average values in the whole group of SBP were 135.1 ± 15.4 mmHg, of DBP 86.7 ± 10.9 mmHg, HR 86.6 ± 10.0 beat per minute.

After cool-down period - average values in the whole group of SBP were 135.6 ± 13.3 mmHg, of DBP 87.8 ± 9.8 mmHg, HR 85.3 ± 11.6 beat per minute.

Our results showed that SBP and DBP varies in resting values before exercise, after warm-up period, at the peak of aerobic exercise on the individual aerobic threshold value of load and after cool-down period from twenty mmHg to less mmHg.

Conclusions:

Aerobic exercise did not influence the values of this BP variability. Variability of the HR is also present at period of aerobic exercise training.
STUDY OF NYCTHEMERAL VARIATIONS IN BLOOD PRESSURE IN PATIENTS WITH NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY
Authors: Gaillard-Groléas Claire , Chiquet Christophe , Aptel Florent , Pepin Jean-Louis , Pollet-Villard Frederic , Ormezzano Olivier
Published: June 2022

Objective:

Non-arteritic anterior ischemic optic neuropathy (NAAION) is the most common acute pathology of the optic nerve in patients over 50 years of age and loss of vision is irreversible in the vast majority of cases. The role of nocturnal arterial hypotension in the occurrence of NAAION remains a topic of debate. Indeed, studies on this subject are rare and the results contradictory. In this study, we ubject the nychthemeral variations in blood pressure (BP) in a large cohort of patients with acute NAAION to determine the presence and extent of nocturnal arterial hypotension in this population, and thus determine whether nocturnal arterial hypotension could be involved in the pathophysiology of NAAION

Design and method:

BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.–6 a.m.; definition 2, 10 p.m.–7 a.m.; and definition 3, 10 p.m.–8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10–20%), mild dippers (0–10%), reverse dippers (< 0%), and extreme dippers (> 20%).

Results:

The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.–6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension (systolic and/or diastolic hypertension) after ABPM. No risk factor for NAAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%).

Conclusions:

In our population of patients who had an episode of NAAION, the proportion of extreme dippers was higher than that usually found in the literature. The definition of the nighttime period used in this study had an impact on the proportion of extreme dippers and might probably explain the contradictory results from the few studies on this ubject.
ORTHOSTATIC HYPOTENSION AND MORTALITY RISK IN GERIATRIC OUTPATIENTS: THE IMPACT OF DURATION AND MAGNITUDE OF THE BLOOD PRESSURE DROP
Authors: Wiersinga Julia H. , Trappenburg Marijke C. , Rhodius-Meester Hanneke F.M. , Peters Mike J.L. , Muller Majon
Published: June 2022

Objective:

Orthostatic hypotension (OH) is a common condition associated with an increased mortality risk. This study investigates this association specifically in geriatric outpatients and additionally ocuses on the duration and magnitude of OH.

Design and method:

In this observational prospective cohort study with geriatric outpatients from the Amsterdam Ageing cohort, we differentiated OH in Early OH (EOH) and delayed/prolonged OH (DPOH). The magnitude of drop in both systolic and diastolic blood pressure (BP) after either 1 or 3 minutes was quantified. Mortality data was obtained from the Dutch municipal register. Cox proportional hazard models were used to determine the association between OH and mortality, adjusted for sex and age (model 1), additionally adjusted for OH-inducing drugs and SBP (model 2) and the presence of cardiovascular disease and diabetes (model 3). Stratified analyses in patients with geriatric deficits were performed.

Results:

We included 1240 patients (mean age 79.4 ± 6.9years, 52.6% females). Prevalence of OH was 443 (34.9%); 148 (11.9%) patients had EOH and 285 (23.0%) DPOH. DPOH was associated with a higher mortality risk (HR,95%CI: 1.69(1.28–2.22)) whereas EOH was not associated with mortality risk. This association did not differ in patients with geriatric deficits. Furthermore, the magnitude of drop in both systolic and diastolic BP was associated with a higher mortality risk (see figure for results of SBP).

Conclusions:

The presence of DPOH and the magnitude of both systolic and diastolic OH are related to an increased mortality risk in geriatric outpatients. Whether the duration of OH and magnitude of the drop in blood pressure is causally related to mortality risk or whether it is a sign of decreased resilience remains to be elucidated.
HYPERTENSION FOLLOWING LIVING KIDNEY-DONATION: BETTER SAFE THAN SORRY. A SINGLE-CENTER STUDY
Authors: Mojaat Malek , Ben Salah Manel , Salem Mariem Ben , Handous Insaf , Hamouda Mouna , Letaief Ahmed , Aloui Sabra , Skhiri Habib
Published: June 2022

Objective:

Evaluate the incidence of hypertension among living kidney-donors.

Design and method:

This is a retrospective, mono-centric and analytical study. Blood pressure was categorized as per the ACC/AHA hypertension guidelines 2021. Herein, we report the results among 40 living kidney-donors.

Results:

The study included 40 living kidney donors. The median age was 42 years [34 – 53]s. 75% were female. 62,5% were married. 80% of donors were related to the recipient. Parents and siblings accounted for 37,5 % and 35% respectively. 20% were spouses. 3 donors had a family history of CKD. 4 and 6 donors had a family history of hypertension and diabetes respectively. Neither diabetes nor CKD was found among donors’ personal history. One donor had a history of hypertension that was well-controlled on monotherapy. Median follow-up was 9 years [6 - 12] with a total period of follow-up ranging from 3 to 32 years. Median systolic and diastolic blood pressures at baseline (SBP, DBP) were 112,5 and 70 mmHg respectively. During follow-up, we noticed two peaks for the median SBP at six months and three years after nephrectomy reaching a maximal value of 120 mmHg and subsequently decreasing. The comparison with the baseline value did not show a statistically significant difference except at three years (median SBP before nephrectomy:112,5 mmHg, median SBP at three years after nephrectomy:120 mmHg, p = 0,03). The median DBP was relatively stable at 70 mmHg during follow-up. However, the comparison with the baseline value has shown a statistically significant elevation compared to baseline starting at two years (p = 0,002) and remained thereafter. After five years of follow-up, 12.5% and 7.5% of our patients developed stage one and two hypertension respectively. Non-pharmacologic management was enough for stage 1 hypertensive kidney donors but stage 2 patients required pharmacologic agents. Neither cardiovascular complications nor death were encountered during the study period.

Conclusions:

Our results showed that kidney donation is relatively safe unless a meticulous screening prior to nephrectomy is performed. Regular follow-up allows an early diagnosis of hypertension and prompt initiation of treatment, therefore avoiding severe complications
OPEN-ANGLE GLAUCOMATOUS OPTIC NEUROPATHY IS RELATED TO DIPS RATHER THAN INCREASES IN THE MEAN ARTERIAL PRESSURE OVER 24-H
Authors: Melgarejo Jesus , Eijgen Jan V. , Maestre Gladys E. , Al-Aswad Lama A. , Thijs Lutgarde , Mena Luis J. , Terwilliger Joseph D. , Petitto Michele , Chavez Carlos A. , Brito Miguel , Calmon Gustavo , Silva Egle , Wei Dong-Mei , Cutsforth Ella , Keer Karel V. , De Moraes Gustavo , Vanassche Thomas , Janssens Stefan , Stalmans Ingeborg , Verhamme Peter , Staessen Jan A. , Zhang Zhen-Yu
Published: June 2022

Objective:

Mean arterial pressure (MAP) drives ocular perfusion. Excessive 24-h MAP variability relates to glaucoma, however, whether this is due to dips or increases in the blood pressure (BP) is undocumented. We investigated the association of open-angle glaucoma (OAG) in relation to the five largest MAP dips/increases over 24-h, henceforth called dips/blips.

Design and method:

In the Maracaibo Aging Study (MAS), 93 participants aged 40y or older (women, 87.1%; mean age, 61.9y) underwent baseline ophthalmological and 24-h ambulatory BP monitoring assessments. OAG was the presence of optic nerve damage and visual field defects. Statistical methods included logistic regression and the generalized R2 statistic. For replication, 48 OAG cases at the Leuven Glaucoma Clinic were matched with 48 controls recruited from Flemish population.

Results:

In MAS, 26 had OAG. OAG compared to non-OAG participants experienced longer and deeper dips (116.5 vs. 102.7 minutes; to 60.3 vs. 66.6 mmHg; 21.0 vs. 18.0 mmHg absolute or 0.79 vs. 0.81 relative dips compared to the preceding reading). The adjusted odds ratios associated with dip measures ranged from 2.25 (95% confidence interval [CI], 1.31–4.85; P = 0.009) to 3.39 (95% CI, 1.36 8.46; P = 0.008). On top of covariables and 24 MAP level/variability, the dip measures increased the model performance (P values below 0.025). Blips did not associate with OAG. The case-control study replicated the MAS observations.

Conclusions:

Dips rather than increases in the 24-h MAP level were associated with increased risk for OAG. An ophthalmological examination combined with 24-h BP monitoring might be precautious steps required in normotensive and hypertensive patients at risk of OAG.
IMPACT OF BLOOD PRESSURE VARIABILITY ON CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Manousopoulos Konstantinos , Spiliopoulou Sotiria , Tsoutsoura Nefeli , Lykka Aikaterini , Dimitriou Athina , Manios Efstathios
Published: June 2022

Objective:

It is well known that blood pressure (BP) variability is associated with development of target-organ damage and adverse cardiovascular outcome in hypertensive patients. However, the impact of BP variability (BPV) on cardiovascular outcome in chronic kidney disease patients (CKD) is unclear. Aim of the study was to examine the impact of home BPV on cardiovascular mortality in chronic kidney disease patients.

Design and method:

A total of 137 CKD patients, referred for evaluation at the Hypertension Unit of our department, underwent home BP monitoring. Participants were instructed to take duplicate morning and evening measurements in the sitting position, after 5-min sitting rest and with 1 min between measurements for 7 working days. The average home BP value of the morning, evening and all measurements was analyzed. Home BPV was quantified by using standard deviation (SD), coefficient of variation (CV) and morning minus evening BP values. Median follow-up for fatal cardiovascular events was 3 years. Statistical analysis was performed by means of cox regression analysis.

Results:

The study population consisted of 102 men (75%). Mean age was 70 years, mean office BP was 142/76 mmHg and mean home BP was 137/74 mmHg. During follow-up, there were 12 fatal cardiovascular events. The multivariate Cox regression analyses revealed that the SD of systolic home BP was an independent predictor of cardiovascular mortality (HR: 1.19, 95%CI 1.02–1.38, p = 0.022) after adjustment for age, sex, history of diabetes mellitus and hyperlipidemia, smoking, antihypertensive treatment and mean systolic home BP.

Conclusions:

Home BPV is an independent predictor of cardiovascular mortality in CKD patients
ANALYSIS OF AMBULATORY BLOOD PRESSURE MONITORING AND BLOOD PRESSURE MANAGEMENT IN A GERIATRIC REHABILITATION UNIT
Authors: Lennon Sarah-Jane , Connell Liam O. , Delos Re Juliana , Dolan Eamon
Published: June 2022

Objective:

Blood pressure variability (BPV) has proven prognostic importance. Research has shown that controlling BPV in addition to overall reduction of BP in hypertension improves cardiovascular risk. Patients with diagnosed hypertension have an increased association with wider BPVs. Ambulatory blood pressure monitoring (ABPM) is the gold standard in diagnosis of HTN and measuring BPV. We aimed to analyse ABPM data on rehabilitation inpatients and assess hypertension (HTN) management.

Design and method:

A retrospective analysis of ABPM data of 32 patients sequentially admitted to a geriatric rehabilitation unit in an orthopaedic hospital from Jan 2019 – Jan 2020. We measured the change in medication, quantifying it by escalation and de-escalation (addition/reduction in antihypertensives) or no change if nothing was done. In addition we measured OH. We also analysed BPV by subdividing patients into three groups – High, Medium, and Low daytime BPV based on the standard deviation of daytime SBP.

Results:

Patient demographics summary (Table 1). There was increased OH detected in the High variability compared to the Low group this had borderline significance (High 75% vs Low 29%, P – 0.06). 37.5% of patients on anti-HTN treatment had an average SBP > 140mmHg. 66.6% of patients with an average SBP > 140mmHg had postural hypotension. 34% of the cohort had OH. 44% of patients with an SBP > 140mmHg had no previous diagnosis of HTN. In this cohort 87% were non night-time dippers. Increased frequency of OH detected in the High variability compared to the Low. (High 75% vs Low 29%, P – 0.06). The High variability also had a significantly higher eGFR when compared to the Low variability (High 88 vs Low 60, P – 0.04) (Table 2).

Conclusions:

These results show that a significant sub-group of rehabilitation inpatients in our unit had inadequate blood pressure control, underdiagnosed HTN/BPV. This study has shown that ABPM is an effective method for detecting PBV, HTN and sustained night-time HTN in a geriatric rehab population. ABPM should be used as standard of care to detect BPV and OH so that labile BP can be effectively treated and falls risk reduced.
AMBULATORY BLOOD PRESSURE TRAJECTORIES AND BLOOD PRESSURE VARIABILITY IN KIDNEY TRANSPLANT RECIPIENTS: A COMPARATIVE STUDY AGAINST CHRONIC KIDNEY DISEASE PATIENTS
Authors: Korogiannou Maria , Theodorakopoulou Marieta , Sarafidis Pantelis , Alexandrou Maria Eleni , Pella Eva , Xagas Efstathios , Argyris Antonis , Protogerou Athanase , Papagianni Aikaterini , Boletis Ioannis N. , Marinaki Smaragdi
Published: June 2022

Objective:

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.

Design and 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-hour SBP/DBP (KTRs:126.9 ± 13.1/79.1 ± 7.9 vs CKD:128.1 ± 11.2/77.9 ± 8.1mmHg, p = 0.522/0.293), daytime SBP/DBP and nighttime SBP; nighttime DBP was slightly higher in KTRs (KTRs:76.5 ± 8.8 vs CKD:73.8 ± 8.8mmHg, p = 0.040). For both ambulatory SBP/DBP, repeated-measurements-ANOVA showed a significant effect of time (SBP: F = [19, 3002] = 11.735, p < 0.001, partial 2 = 0.069) but not of KTR/CKD status(SBP: F = [1, 158] = 0.668, p = 0.415, partial 2 = 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 (KTRs:10.2 ± 2.2 vs CKD:10.9 ± 2.6mmHg, p = 0.041). No differences were noted in dipping pattern between the two groups.

Conclusions:

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 to CKD patients without kidney replacement therapy.
INFLUENCE OF SYSTOLIC BLOOD PRESSURE CONTROL IN ELDERLY PATIENTS WITH CHRONIC HFPEF
Authors: Qin Jiwei Chen , Sanchez Marcos Sanchez , Esmel Esther Viñas , Mas Miriam Costafreda , Babkowski Miguel Camafort
Published: June 2022

Objective:

Heart failure is a major public health problem and one of the leading causes of ospitalisation and death. Since HFPEF increases with age, it is an increasingly worrisome health problem in countries with higher life expectancies. Since the influence of BP is essential in HFPEF, and its control in the outpatient is not clear, we propose to evaluate this variable in a retrospective cohort.

Design and method:

Retrospective study of patients with HFPEF, older than 80 years, followed up in outpatient consultation after ospitalisation for HF, in a Teaching Hospital. Data were obtained from electronic medical records with prior authorization from the Ethics Committee.

Results:

106 patients were included. For analysis we use a cut-off point of SBP (measured in the office at the first visit) below 90 mmHg, between 90 and 139 mmHg and equal or above 140 mm Hg. For DBP we used a a cut-off point of DBP od 70 mmHg. As for the characteristics the only differences were that those with Low SBP had significantly lower LVEF as those with normal or high SBP (54% vs 59 p 0.035). As for DBP, those with low DBP had significantly lower Heart Rate than those with High DBP (72 bpm vs 79 bpm, p 0.039) There were no mortality differences between those with low SBP, normal SBP and high SBP, neither on those with low DBP or Normal High DBP. Kaplan Meier curve showed a non-significant trend to higher mortality on those with lower BP

Conclusions:

In our study, we have not observed differences in mortality between those patients with BP with good control versus those with poor control.

Although there may be a selection bias and this is a retrospective study, more studies are needed to assess the influence of BP controls on the evolution of HF in octogenarian patients
TWO-YEAR RESPONSES OF HEART RATE AND HEART RATE VARIABILITY TO FIRST OCCUPATIONAL LEAD EXPOSURE
Authors: Yu Yuling , Thijs Lutgards , Yu Caiguo , Yang Wenyi , Melgarejo Jesus , Wei Dongmei , Wei Fangfei , Nawrot Tim , Verhamme Peter , Roels Harry , Staessen Jan , Zhang Zhenyu
Published: June 2022

Objective:

Because of the falling lead exposure, the literature relating autonomous nervous function to blood lead has limited relevance.

Design and method:

In the longitudinal Study for Promotion of Health in Recycling Lead (URL: https://www.clinicaltrials.gov; Unique identifier: NCT02243904), we recorded the 2-year responses of heart rate, heart rate variability (Cardiax, International Medical Equipment Developing, Budapest, Hungary), and median nerve conduction velocity (Brevio, NeuMed, West Trenton, NJ), a routine test in occupational medicine, to first lead exposure in 195 newly hired workers (91.3% men; mean age, 27.8 years). High- and low-frequency heart rate variability power and orthostatic heart rate variability responses were derived from 5-minute eletrocardiograms in the supine and standing positions by Fourier transform and autoregression. Blood lead was determined by inductively coupled plasma mass spectrometry.

Results:

From baseline to follow-up, blood lead increased from 4.22 to 14.1 ug/dL and supine/standing HR from 63.6/75.5 to 67.1/78.8 beats per minute. In analyses stratified by fourths of blood lead changes, trends in heart rate and Fourier/autoregressive heart rate variability did not reveal a dose-response curve (0.074< = P< = 0.98). In multivariable-adjusted mixed models, heart rate, Fourier/autoregressive heart rate variability, and nerve conduction velocity changes were unrelated to blood lead except for a weak inverse association between supine heart rate and blood lead changes (-0.55%; P = 0.029). The expected associations between heart rate variability and heart rate changes were preserved with no differences at baseline/follow-up. Analyses ichotomised by baseline median blood lead or cumulative blood lead index (4.30 ug/dL or 32.1 ug/dL × year) suggested an heart rate variability increase versus decrease in the low versus high baseline exposure group.

Conclusions:

Thus, a > 3-fold blood lead increment did not affect autonomous neural function as captured by heart rate variability.