Showing papers on "Ambulatory blood pressure published in 2020"
TL;DR: Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control and, most importantly, markedly diminished occurrence of major CVD events.
Abstract: AIMS The Hygia Chronotherapy Trial, conducted within the clinical primary care setting, was designed to test whether bedtime in comparison to usual upon awakening hypertension therapy exerts better cardiovascular disease (CVD) risk reduction. METHODS AND RESULTS In this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio-adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event-of the primary CVD outcome [0.55 (95% CI 0.50-0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34-0.56)], myocardial infarction [0.66 (0.52-0.84)], coronary revascularization [0.60 (0.47-0.75)], heart failure [0.58 (0.49-0.70)], and stroke [0.51 (0.41-0.63)]. CONCLUSION Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and, most importantly, markedly diminished occurrence of major CVD events. TRIAL REGISTRATION ClinicalTrials.gov, number NCT00741585.
269 citations
TL;DR: The key recommendations and changes since 2011 are highlighted, as this is not suitable or tolerated by everyone, home BP monitoring (HBPM) is offered as an alternative.
Abstract: In August 2019, the National Institute for Health and Care Excellence (NICE) released its new hypertension guidelines.1 This article highlights the key recommendations and changes since 2011.
The diagnostic threshold for hypertension remains 140/90 mmHg on clinic blood pressure (BP). As previously, it is recommended that diagnosis is based on out-of-office measurement, given the risk of white-coat hypertension, defined as a difference of >20/10 mmHg between clinic readings and average daytime home or ambulatory measurements. The gold standard is ambulatory BP monitoring (ABPM) but, as this is not suitable or tolerated by everyone, home BP monitoring (HBPM) is offered as an alternative. For HBPM, patients should be advised to take at least two recordings, 1 minute apart, twice a day for 4 to 7 days. The first day of readings should be discounted and the mean of the remaining readings used. If the mean BP is close to the diagnostic threshold, ABPM may be needed to confirm the diagnosis, particularly in younger people (for example, aged <60 years) where the implications of a new hypertension diagnosis may be more significant. The diagnostic threshold for ABPM or HBPM remains 135/85 mmHg. Standing BP should be measured in those with type 2 diabetes, aged ≥80 years, and patients with symptoms of postural hypotension. The standing BP should be measured after the person has been standing for at least 1 minute. Where there …
84 citations
National and Kapodistrian University of Athens1, University of Padua2, University of Florence3, Teikyo University4, University of Milano-Bicocca5, University of Barcelona6, Baker IDI Heart and Diabetes Institute7, Jichi Medical University8, Royal North Shore Hospital9, Sunnybrook Health Sciences Centre10, University of Turku11, National Institute for Health and Welfare12, Shanghai Jiao Tong University13, University College Dublin14
TL;DR: This Consensus Statement by the European Society of Hypertension Working Group on BP Monitoring and Cardiovascular Variability provides a review of the evidence on the seasonal BP variation regarding its epidemiology, pathophysiology, relevance, magnitude, and the findings using different measurement methods.
Abstract: Blood pressure (BP) exhibits seasonal variation with lower levels at higher environmental temperatures and higher at lower temperatures. This is a global phenomenon affecting both sexes, all age groups, normotensive individuals, and hypertensive patients. In treated hypertensive patients it may result in excessive BP decline in summer, or rise in winter, possibly deserving treatment modification. This Consensus Statement by the European Society of Hypertension Working Group on BP Monitoring and Cardiovascular Variability provides a review of the evidence on the seasonal BP variation regarding its epidemiology, pathophysiology, relevance, magnitude, and the findings using different measurement methods. Consensus recommendations are provided for health professionals on how to evaluate the seasonal BP changes in treated hypertensive patients and when treatment modification might be justified. (i) In treated hypertensive patients symptoms appearing with temperature rise and suggesting overtreatment must be investigated for possible excessive BP drop due to seasonal variation. On the other hand, a BP rise during cold weather, might be due to seasonal variation. (ii) The seasonal BP changes should be confirmed by repeated office measurements; preferably with home or ambulatory BP monitoring. Other reasons for BP change must be excluded. (iii) Similar issues might appear in people traveling from cold to hot places, or the reverse. (iv) BP levels below the recommended treatment goal should be considered for possible down-titration, particularly if there are symptoms suggesting overtreatment. SBP less than 110 mmHg requires consideration for treatment down-titration, even in asymptomatic patients. Further research is needed on the optimal management of the seasonal BP changes.
79 citations
TL;DR: The authors have conducted the first comparison study of BPs measured by a recently developed wrist‐worn watch‐type oscillometric BP monitoring (WBPM) device, the “HeartGuide,” and found the difference between the WBPM and ABPM device was acceptable both in and out of the office.
Abstract: Wearable blood pressure (BP) monitoring devices which measure BP levels accurately both in and out of the office are valuable for hypertension management using digital technology. The authors have conducted the first comparison study of BPs measured by a recently developed wrist-worn watch-type oscillometric BP monitoring (WBPM) device, the "HeartGuide," versus BPs measured by an ambulatory BP monitoring (ABPM) device, A&D TM-2441, in the office (total of 4 readings alternately measured in the sitting position) and outside the office (30-minutes interval measurements during daytime) in 50 consecutive patients (mean age 66.1 ± 10.8 years). The 2 BP monitoring devices were simultaneously worn on the same non-dominant arm throughout the monitoring period. The mean difference (±SD) in systolic BPs (average of 2 readings) between WBPM and ABPM was 0.8 ± 12.8 mm Hg (P = .564) in the office and 3.2 ± 17.0 mm Hg (P < .001) outside the office. The proportion of differences that were within ±10 mm Hg was 58.7% in the office and 47.2% outside the office. In a mixed-effects model analysis, the temporal trend in the difference between the out-of-office BPs measured by the two devices was not statistically significant. In conclusion, the difference between the WBPM and ABPM device was acceptable both in and out of the office.
62 citations
TL;DR: Different exercise training modalities were similarly effective in improving endothelial function but impacts on ambulatory blood pressure appear to be variable in individuals with prehypertension or hypertension.
Abstract: Endothelial dysfunction is a characteristic of systemic arterial hypertension (SAH) and an early marker of atherosclerosis. Aerobic exercise training (AT) improves endothelial function. However, the effects of resistance training (RT) and combined training (CT) on endothelial function remain controversial in individuals with SAH. We determined the effects of AT, RT, and CT on endothelial function and systolic (SBP)/diastolic blood pressure (DBP) in individuals with prehypertension or hypertension. Forty-two participants (54 ± 11 y, resting SBP/DBP 137 ± 9/86 ± 6 mmHg) were randomly allocated into AT (n = 14, 40 min of cycling, 50–75% heart rate reserve), RT (n = 14, 6 resistance exercises, 4 × 12 repetitions, 60% maximum strength) and CT (n = 14, 2 × 12 repetitions of RT + 20 min of AT). All participants performed a 40-minute exercise session twice a week for 8 weeks. Endothelial function was evaluated by brachial artery flow-mediated dilation (FMD). Blood pressure was evaluated through ambulatory monitoring for 24 hours. After 8 weeks of exercise training, blood pressure was reduced in all 3 groups: −5.1 mmHg in SBP (95%CI –10.1, 0.0; p = 0.003) in AT; −4.0 mmHg in SBP (95%CI −7.8, −0.5; p = 0.027) in RT; and −3.2 mmHg in DBP (95%CI −7.9, 1.5; p = 0.001) in CT. All 3 exercise training modalities produced similar improvements in FMD: + 3.2% (95%CI 1.7, 4.6) (p < 0.001) in AT; + 4.0% (95%CI 2.1, 5.7) (p < 0.001) in RT; and +6.8% (95%CI 2.6, 11.1) (p = 0.006) in CT. In conclusion, different exercise training modalities were similarly effective in improving endothelial function but impacts on ambulatory blood pressure appear to be variable in individuals with prehypertension or hypertension.
57 citations
TL;DR: Compared with OBP (3 visits) or 24-h ABP, systolic and diastolic HBP (1 week) were more reliable and more strongly associated with LVMI, suggesting that 1 week of HBP monitoring may be the best approach for diagnosing hypertension.
52 citations
TL;DR: Aerobic exercise is an effective coadjuvant treatment for reducing ABP in medicated patients with hypertension based on evidence from randomized controlled trials.
Abstract: Background Although exercise training reduces office blood pressure (BP), scarcer evidence is available on whether these benefits also apply to ambulatory blood pressure (ABP), which is a stronger ...
49 citations
TL;DR: ABPM had excellent reproducibility at the population level, favouring its application for research purposes; but reproducedcibility of intra-individual BP values and dipping status from a 24-h ABPM was limited.
Abstract: OBJECTIVE A systematic review on the reproducibility of ambulatory blood pressure measurements (ABPM) has not yet been conducted This meta-analysis compared 24-h/daytime/night-time SBP and DBP mean values and SBP/DBP nocturnal dipping status from ABPMs in participants with or without hypertension METHODS Ovid MEDLINE, EMBASE, and CINAHL Complete databases were searched for articles published before 3 May 2019 Eligible studies reporting a 24-h ABPM repeated at least once within 1 month were included The mean daytime/night-time/24-h BP values, percentage of nocturnal dipping, and proportion of nondippers were compared between the first and second day of measurements, and the proportion of participants with inconsistent dipping status were estimated using a random effect model RESULTS Population-based analysis found a 0-11 mmHg difference between the first and second ABPM for 24-h/daytime/night-time SBP and DBP and 0-05% for percentage of SBP/DBP nocturnal dipping The proportion of non-dippers was not different between the first and second ABPM Intra-individual analysis found that the 95% limit of agreements (LOA) for SBP/DBP were wide and the 95% LOA for daytime SBP, common reference to diagnose hypertension, ranged -167 to 184 mmHg Similarly, 32% of participants had inconsistent nocturnal dipping status CONCLUSION ABPM had excellent reproducibility at the population level, favouring its application for research purposes; but reproducibility of intra-individual BP values and dipping status from a 24-h ABPM was limited The available evidence was limited by the lack of high-quality studies and lack of studies in non-Western populations
43 citations
TL;DR: LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages and should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring.
Abstract: In Chronic Kidney Disease (CKD) patients, elevated blood pressure (BP) is a frequent finding and is traditionally considered a direct consequence of their sodium sensitivity Indeed, sodium and fluid retention, causing hypervolemia, leads to the development of hypertension in CKD On the other hand, in non-dialysis CKD patients, salt restriction reduces BP levels and enhances anti-proteinuric effect of renin–angiotensin–aldosterone system inhibitors in non-dialysis CKD patients However, studies on the long-term effect of low salt diet (LSD) on cardio-renal prognosis showed controversial findings The negative results might be the consequence of measurement bias (spot urine and/or single measurement), reverse epidemiology, as well as poor adherence to diet In end-stage kidney disease (ESKD), dialysis remains the only effective means to remove dietary sodium intake The mismatch between intake and removal of sodium leads to fluid overload, hypertension and left ventricular hypertrophy, therefore worsening the prognosis of ESKD patients This imposes the implementation of a LSD in these patients, irrespective of the lack of trials proving the efficacy of this measure in these patients LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages The implementation of LSD should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring
40 citations
TL;DR: Overall, available data support a role for SGLT2i as effective BP-lowering agents in patients with T2DM and poorly controlled HTN, irrespective of baseline glucose control status.
36 citations
TL;DR: Childhood OSA was found to be an independent risk factor for adverse BP outcomes in adulthood, and was associated with higher nocturnal systolic blood pressure and higher risk of hypertension at follow-up.
Abstract: Background Current literature supports cross-sectional association between childhood obstructive sleep apnoea (OSA) and elevated blood pressure (BP). However, long-term cardiovascular outcomes in children with OSA remain unexplored. Objective To evaluate the associations of childhood OSA with BP parameters in a prospective 10 year follow-up study. Methods Participants were recruited from a cohort established for our previous OSA epidemiological study. They were invited to undergo clinical examination, overnight polysomnography and 24-hour ambulatory BP monitoring. Multivariate linear regression was used to assess the associations of baseline childhood OSA with BP outcomes at follow-up. Multivariable log-binomial regression was used with inverse probability weighting to assess the adjusted associations of childhood OSA with hypertension and non-dipping of nocturnal BP in adulthood. Results 243 participants (59% male) attended the follow-up visit. The mean age was 9.8 (SD ±1.8) and 20.2 (SD ±1.9) years at baseline and follow-up respectively, with a mean follow-up duration of 10.4 (SD ±1.1) years. Childhood moderate-to-severe OSA was associated with higher nocturnal systolic blood pressure (SBP) (difference from normal controls: 6.5 mm Hg, 95% CI 2.9 to 10.1) and reduced nocturnal dipping of SBP (−4.1%, 95% CI −6.3% to 1.8%) at follow-up, adjusted for age, sex, Body Mass Index and height at baseline, regardless of the presence of OSA at follow-up. Childhood moderate-to-severe OSA was also associated with higher risk of hypertension (relative risk (RR) 2.5, 95% CI 1.2 to 5.3) and non-dipping of nocturnal SBP (RR 1.3, 95% CI 1.0 to 1.7) at follow-up. Conclusion Childhood OSA was found to be an independent risk factor for adverse BP outcomes in adulthood.
TL;DR: Healthcare providers should continue to emphasize aerobic training for hypertension management given the established role of nitric oxide, endothelin-1 and chronic low-level inflammation in the pathogenesis of cardiovascular disease.
Abstract: OBJECTIVE The current randomized controlled trial tested the hypothesis that both aerobic training and dynamic resistance training will improve inflammation, endothelial function and 24-h ambulatory blood pressure (ABP) in middle-aged adults with hypertension, but aerobic training would be more effective. METHODS Forty-two hypertensive patients on at least one antihypertensive medication (19 men/23 women; 30-59 years of age) were randomly assigned to 12 weeks of supervised aerobic training (n = 15), resistance training (n = 15) or a nonexercise control (n = 12) group. Inflammation, endothelial function, 24-h ABP and related measures were evaluated at pre and postintervention. RESULTS We found that aerobic training and resistance training were well tolerated. Both aerobic training and resistance training reduced daytime systolic ABP (-7.2 ± 7.9 and -4.4 ± 5.8 mmHg; P < 0.05) and 24-h systolic ABP (-5.6 ± 6.2 and -3.2 ± 6.4 mmHg; P < 0.05). aerobic training and resistance training both improved brachial artery flow-mediated dilation by 1.7 ± 2.8 and 1.4 ± 2.6%, respectively (7.59 ± 3.36 vs. 9.26 ± 2.93 and 7.24 ± 3.18 vs. 8.58 ± 2.37; pre vs. post P < 0.05). However, only aerobic training decreased markers of inflammation (C-reactive protein, monocyte chemoattractant protein-1, vascular cell adhesion molecule-1 and lectin-like oxidized LDL receptor-1) and endothelin-1 and increased nitrite and nitrate levels (P < 0.05). CONCLUSION Healthcare providers should continue to emphasize aerobic training for hypertension management given the established role of nitric oxide, endothelin-1 and chronic low-level inflammation in the pathogenesis of cardiovascular disease. However, our study demonstrates that resistance training should also be encouraged for middle-aged hypertensive patients. Our results also suggest that even if patients are on antihypertensive medications, regular aerobic training and resistance training are beneficial for blood pressure control and cardiovascular disease risk reduction.
TL;DR: It is suggested that long working hours are an independent risk factor for masked and sustained hypertension, and place strategies targeting longWorking hours could be effective in reducing the clinical and public health burden of hypertension.
Abstract: Previous studies on the effect of long working hours on blood pressure have shown inconsistent results. Mixed findings could be attributable to limitations related to blood pressure measurement and the lack of consideration of masked hypertension. The objective was to determine whether individuals who work long hours have a higher prevalence of masked and sustained hypertension. Data were collected at 3-time points over 5 years from 3547 white-collar workers. Long working hours were self-reported, and blood pressure was measured using Spacelabs 90207. Workplace clinic blood pressure was defined as the mean of the first 3readings taken at rest at the workplace. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension was defined as clinic blood pressure < 140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg. Sustained hypertension was defined as clinic blood pressure ≥140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg or being treated hypertension. Long working hours were associated with the prevalence of masked hypertension (prevalence ratio 49+=1.70 [95% CI, 1.09-2.64]), after adjustment for sociodemographics, lifestyle-related risk factors, diabetes mellitus, family history of cardiovascular disease, and job strain. The association with sustained hypertension was of a comparable magnitude (prevalence ratio 49+=1.66 [95% CI, 1.15-2.50]). Results suggest that long working hours are an independent risk factor for masked and sustained hypertension. Workplace strategies targeting long working hours could be effective in reducing the clinical and public health burden of hypertension.
TL;DR: Higher mean 24-hour systolic BP associated with higher risk of cardiovascular outcome, kidney outcome, and mortality, independent of clinic BP, supports the wider use of ambulatory BP monitoring in the evaluation of hypertension in patients with CKD.
Abstract: Background Whether ambulatory BP monitoring is of value in evaluating risk for outcomes in patients with CKD is not clear. Methods We followed 1502 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study for a mean of 6.72 years. We evaluated, as exposures, ambulatory BP monitoring profiles (masked uncontrolled hypertension, white-coat effect, sustained hypertension, and controlled BP), mean ambulatory BP monitoring and clinic BPs, and diurnal variation in BP-reverse dipper (higher at nighttime), nondipper, and dipper (lower at nighttime). Outcomes included cardiovascular disease (a composite of myocardial infarction, cerebrovascular accident, heart failure, and peripheral arterial disease), kidney disease (a composite of ESKD or halving of the eGFR), and mortality. Results Compared with having controlled BP, the presence of masked uncontrolled hypertension independently associated with higher risk of the cardiovascular outcome and the kidney outcome, but not with all-cause mortality. Higher mean 24-hour systolic BP associated with higher risk of cardiovascular outcome, kidney outcome, and mortality, independent of clinic BP. Participants with the reverse-dipper profile of diurnal BP variation were at higher risk of the kidney outcome. Conclusions In this cohort of participants with CKD, BP metrics derived from ambulatory BP monitoring are associated with cardiovascular outcomes, kidney outcomes, and mortality, independent of clinic BP. Masked uncontrolled hypertension and mean 24-hour BP associated with high risk of cardiovascular disease and progression of kidney disease. Alterations of diurnal variation in BP are associated with high risk of progression of kidney disease, stroke, and peripheral arterial disease. These data support the wider use of ambulatory BP monitoring in the evaluation of hypertension in patients with CKD. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2020_09_24_JASN2020030236.mp3.
TL;DR: Patients with hypertension displaying HR >80 bpm are characterized by a marked sympathetic overdrive, particularly when direct adrenergic markers are used, which suggests that cardiac and peripheral sympathetic activation are involved in the increased cardiovascular risk detected in this group of patients.
Abstract: The recent European Society of Cardiology/European Society of Hypertension hypertension guidelines identify resting heart rate (HR) values >80 bpm as predictors of cardiovascular risk, with the unproven assumption that this might reflect the presence of a sympathetic overdrive In the present study, we tested this hypothesis throughout the use of direct and indirect sympathetic markers In 193 untreated moderate essential hypertensives aged 504±06 years (mean±SEM), we measured clinic and ambulatory blood pressure and corresponding HR, venous plasma norepinephrine (high performance liquid chromatography), and muscle sympathetic nerve traffic (microneurography) We then subdivided the study population into 2 groups according to HR 80 bpm Eighty-four patients displayed resting HR >80 bpm, which was this cutoff value in the remaining 109 patients, the 2 groups showing superimposable age, and sex distribution Clinic and ambulatory blood pressure were similar in the 2 groups, whereas left ventricular mass index was significantly greater in the group with HR >80 bpm Muscle sympathetic nerve traffic values were also significantly greater in this latter group (7277±09 versus vs 3683±13 bursts/min, P 80 bpm are characterized by a marked sympathetic overdrive, particularly when direct adrenergic markers are used This finding suggests that cardiac and peripheral sympathetic activation are involved in the increased cardiovascular risk detected in this group of patients
TL;DR: The estimated BP from this wearable cuff-less device correlated highly with the manual BP and showed good accuracy, suggesting its potential to be used in ambulatory BP monitoring.
Abstract: Ambulatory blood pressure (BP) monitoring is recommended to improve the management of hypertension. Here, we investigated the accuracy of BP estimated using a wearable cuff-less device, InBodyWATCH, compared with BP measured using a manual sphygmomanometer. Thirty-five adults were enrolled (age 57.1 ± 17.9 years). The BP was estimated using InBodyWATCH with an individualized estimation based on a neural network model. Three paired sets of BPs from the two devices were compared using correlation analysis and Bland-Altman plots (n = 105 paired BP readings). The correlations for both systolic and diastolic BP (SBP and DBP) between the two devices were high (r = 0.964 and 0.939, both P < 0.001). The mean difference was 2.2 ± 6.1 mmHg for SBP and -0.2 ± 4.2 mmHg for DBP; these were not significant (P = 0.472 for SBP and P = 0.880 for DBP). The proportions of estimated SBP/DBP obtained from the InBodyWATCH within ± 5 mmHg of manual SBP/DBP were 71.4%/83.8%; within ± 10 mmHg they were 86.7%/98.1%; and within ± 15 mmHg they were 97.1%/99.0%. The estimated BP from this wearable cuff-less device correlated highly with the manual BP and showed good accuracy, suggesting its potential to be used in ambulatory BP monitoring.
TL;DR: Donors remain healthy with stable kidney function for the first nine years, but differences in metabolic and vascular parameters could be harbingers of adverse outcomes requiring future interventions.
TL;DR: The results imply that the developed tool is useful in a hospital setting as an automated diagnostic tool, enabling the effortless detection of HPT using ECG signals.
TL;DR: Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults.
Abstract: BackgroundTwenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importa...
TL;DR: This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP) is a predictor of future cardiovascular events.
Abstract: The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring nighttime blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events. We analyzed nighttime blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the J-HOP study (Japan Morning Surge-Home Blood Pressure). During a follow-up period of 7.6±3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive, and 80.7% of participants were using antihypertensive medication. Nighttime home systolic blood pressure (SBP) was higher compared to nighttime ambulatory SBP (123.0±14.6 versus 120.3±14.4 mm Hg, P<0.001). Nocturnal hypertension was defined as nighttime home or ambulatory SBP of ≥120 mm Hg. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events: total cardiovascular events (coronary artery disease and stroke events; 1.78 [1.00-3.15]) and stroke (2.65 [1.14-6.20]), independent of office SBP. These results were absent with nocturnal hypertension defined by ABPM. This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP) is a predictor of future cardiovascular events.
TL;DR: In this paper, the relationship of hypertension and dipping status on WMH volume and neuropsychological test scores in middle-aged and older adults was examined, and it was shown that reverse dipping in the presence of hypertension was associated with particularly elevated periventricular WMH volumes (F2,423 = 3.78, p = 0.024) and with lowered memory scores.
Abstract: Objective To test the hypotheses that hypertension and nocturnal blood pressure are related to white matter hyperintensity (WMH) volume, an MRI marker of small vessel cerebrovascular disease, and that WMH burden statistically mediates the association of hypertension and dipping status with memory functioning, we examined the relationship of hypertension and dipping status on WMH volume and neuropsychological test scores in middle-aged and older adults. Methods Participants from the community-based Maracaibo Aging Study received ambulatory 24-hour blood pressure monitoring, structural MRI, and neuropsychological assessment. Four hundred thirty-five participants (mean ± SD age 59 ± 13 years, 71% women) with available ambulatory blood pressure, MRI, and neuropsychological data were included in the analyses. Ambulatory blood pressure was used to define hypertension and dipping status (i.e., dipper, nondipper, and reverse dipper based on night/day blood pressure ratio 1, respectively). Outcome measures included regional WMH and memory functioning derived from a neuropsychological test battery. Results The majority of the participants (59%) were hypertensive. Ten percent were reverse dippers, and 40% were nondippers. Reverse dipping in the presence of hypertension was associated with particularly elevated periventricular WMH volume (F2,423 = 3.78, p = 0.024) and with lowered memory scores (F2,423 = 3.911, p = 0.021). Periventricular WMH volume mediated the effect of dipping status and hypertension on memory (β = −4.1, 95% confidence interval −8.7 to −0.2, p Conclusion Reverse dipping in the presence of hypertension is associated with small vessel cerebrovascular disease, which, in turn, mediates memory functioning. These results point toward reverse dipping as a marker of poor nocturnal blood pressure control, particularly among hypertensive individuals, with potentially pernicious effects on cerebrovascular health and associated cognitive function.
TL;DR: It is suggested that addressing OSA risk and sleep timing in a clinical trial may improve BP during sleep, and global sleep quality, habitual sleep duration, and sleep efficiency were not associated with either nocturnal hypertension or nondipping SBP.
Abstract: Background Sleep characteristics and disorders are associated with higher blood pressure (BP) when measured in the clinic setting. Methods and Results We tested whether self‐reported sleep characte...
TL;DR: This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy, with differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration.
TL;DR: Implementing appropriate BP measurement in routine practice is feasible and should be incorporated in system-wide efforts to improve the care of patients with hypertension.
TL;DR: This work proposes including sleep-time blood pressure monitoring during sleep studies and including sleep studies in patients undergoing ambulatory blood pressure Monitoring, to better predict cardiovascular outcomes and mortality.
Abstract: Hypertension is a highly common condition with well-established adverse consequences. Ambulatory blood pressure monitoring has repeatedly been shown to better predict cardiovascular outcomes and mortality, compared to single office visit blood pressure. Non-dipping of sleep-time blood pressure is an independent marker for increased cardiovascular risk. We review blood pressure variability and the challenges of blood pressure monitoring during sleep. Although pathological sleep such as obstructive sleep apnea has been associated with non-dipping of sleep-time blood pressure, blood pressure is not routinely measured during sleep due to lack of unobtrusive blood pressure monitoring technology. Second, we review existing noninvasive continuous blood pressure monitoring technologies. Lastly, we propose including sleep-time blood pressure monitoring during sleep studies and including sleep studies in patients undergoing ambulatory blood pressure monitoring.
TL;DR: BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD, and findings were similar with diastolic BP load.
Abstract: Background and objectives Elevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs. Design, setting, participants, & measurements We studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters. Results Overall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load. Conclusions BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3
TL;DR: Results indicate that effective renal denervation can result in significant and clinically meaningful blood pressure reduction, and the second‐generation devices provide better renal nerve ablation.
Abstract: Despite the availability of a numerous antihypertensive agents, hypertension treatment and control rates remain low in many countries. The role of the sympathetic nervous system has long been recognized, but recent sham control renal denervation studies demonstrated conflicting results. In this reviewe paper, the authors performed a systematic review and meta-analysis to examine outcomes of sham-controlled studies utilizing new technologies and procedures. Six published randomized, sham-controlled studies were included in this meta-analysis. Of those, three trials used the first-generation radiofrequency renal denervation device and technique and the other three used second-generation devices and techniques. In total, 981 patients with hypertension were randomized in all 6 trials to undergo renal denervation (n = 585) or sham procedure (n = 396). Overall, renal denervation resulted in a decrease of 24-hours systolic ambulatory blood pressure (ABP) by 3.62 mm Hg (95% CI: -5.28--1.96; I2 = 0%), compared to sham procedure (GRADE: low). Renal denervation also reduced daytime systolic ABP by 5.51 mm Hg (95% CI: -7.79--3.23; I2 = 0%), compared to sham procedure but not nighttime systolic ABP. Office systolic blood pressure was reduced by 5.47 mm Hg (95% CI -8.10--2.84; I2 = 0%), compared to sham control. Further analysis demonstrated that second-generation devices were effective in reducing blood pressure, whereas the first-generation devices were not. These results indicate that effective renal denervation can result in significant and clinically meaningful blood pressure reduction. The second-generation devices provide better renal nerve ablation.
TL;DR: Clinical features of insomnia and poor sleep quality are associated with nondipping BP, and these findings suggested nondipping might be one possible mechanism by which poorSleep quality was associated with worse cardiovascular outcomes.
Abstract: Aims Nondipping blood pressure (BP) is associated with higher risk for hypertension and advanced target organ damage. Insomnia is the most common sleep complaint in the general population. We sought to investigate the association between sleep quality and insomnia and BP nondipping cross-sectionally and longitudinally in a large, community-based sample. Methods A subset of the Wisconsin Sleep Cohort (n = 502 for cross-sectional analysis and n = 260 for longitudinal analysis) were enrolled in the analysis. Polysomnography measures were used to evaluate sleep quality. Insomnia symptoms were obtained by questionnaire. BP was measured by 24-h ambulatory BP monitoring. Logistic regression models estimated cross-sectional associations of sleep quality and insomnia with BP nondipping. Poisson regression models estimated longitudinal associations between sleep quality and incident nondipping over a mean 7.4 years of follow-up. Systolic and diastolic nondipping were examined separately. Results In cross-sectional analyses, difficulty falling asleep, longer waking after sleep onset, shorter and longer total sleep time, lower sleep efficiency and lower rapid eye movement stage sleep were associated with higher risk of SBP and DBP nondipping. In longitudinal analyses, the adjusted relative risks (95% confidence interval) of incident systolic nondipping were 2.1 (1.3-3.5) for 1-h longer waking after sleep onset, 2.1 (1.1-5.1) for 7-8 h total sleep time, and 3.7 (1.3-10.7) for at least 8-h total sleep time (compared with total sleep time 6-7 h), and 1.9 (1.1-3.4) for sleep efficiency less than 0.8, respectively. Conclusion Clinical features of insomnia and poor sleep quality are associated with nondipping BP. Our findings suggested nondipping might be one possible mechanism by which poor sleep quality was associated with worse cardiovascular outcomes.
TL;DR: The prognostic impact of MUCH defined according to various ambulatory BP definitions may be different, and it is unclear whether different definitions of MUCH have similar prognostic information.
TL;DR: In a pSLE cohort with low disease activity, isolated nocturnal BP non-dipping is prevalent and associated with endothelial dysfunction and atherosclerotic changes, and ABPM has a promising role in risk stratification and understanding heterogeneous mechanisms of cardiovascular disease in pSle.
Abstract: Loss of the normal nocturnal decline in blood pressure (BP), known as non-dipping, is a potential measure of cardiovascular risk identified by ambulatory blood pressure monitoring (ABPM). We sought to determine whether non-dipping is a useful marker of abnormal vascular function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus (pSLE). Twenty subjects 9–19 years of age with pSLE underwent ABPM, peripheral endothelial function testing, carotid-femoral pulse wave velocity/analysis for aortic stiffness, and carotid intima-media thickness. We assessed the prevalence of non-dipping and other ABPM abnormalities. Pearson or Spearman rank correlation tests were used to evaluate relationships between nocturnal BP dipping, BP load (% of abnormally elevated BPs over 24-h), and vascular outcome measures. The majority (75%) of subjects had inactive disease, with mean disease duration of 3.2 years (± 2.1). The prevalence of non-dipping was 50%, which occurred even in the absence of nocturnal or daytime hypertension. Reduced diastolic BP dipping was associated with poorer endothelial function (r 0.5, p = 0.04). Intima-media thickness was significantly greater in subjects with non-dipping (mean standard deviation score of 3.0 vs 1.6, p = 0.02). In contrast, higher systolic and diastolic BP load were associated with increased aortic stiffness (ρ 0.6, p = 0.01 and ρ 0.7, p < 0.01, respectively), but not with endothelial function or intima-media thickness. In a pSLE cohort with low disease activity, isolated nocturnal BP non-dipping is prevalent and associated with endothelial dysfunction and atherosclerotic changes. In addition to hypertension assessment, ABPM has a promising role in risk stratification and understanding heterogeneous mechanisms of cardiovascular disease in pSLE.