Twenty-four-hour ambulatory blood pressure in community-dwelling elderly men and women,aged 60-102 years

OBJECTIVE: To investigate ambulatory blood pressure in elderly people, including 'old elderly' subjects, aged over 80 years. DESIGN: Cross-sectional study of community-dwelling, elderly subjects. METHODS: Subjects were healthy, self-caring, and living independently. Those who were taking medication affecting blood pressure were excluded. Conventional blood pressure was the mean of two measurements. Ambulatory blood pressure monitoring was performed using the SpaceLabs 90207 device. Daytime and night-time blood pressure were defined by fixed clock intervals. RESULTS: Seventy-five 'young elderly', aged 60-79 years, (39 men, 36 women) and 81 'old elderly' aged 80 years and older (37 men, 44 women) underwent 24-h ambulatory blood pressure monitoring. Systolic blood pressure (SBP) was related to age, correlation coefficients between age and SBP were 0.31, 0.25 and 0.31, respectively, for conventional SBP, daytime SBP and night-time SBP (P < 0.01 for all). There was no correlation between age and diastolic blood pressure. Blood pressure levels were similar in men and women. Mean conventional blood pressure, daytime blood pressure and night-time blood pressure were found to be 149/81, 138/82 and 119/69 mmHg, respectively, in the 'young elderly' and 162/82, 147/83, and 133/71 mmHg, respectively, in the 'old elderly (P < 0.01 for SBP). The night : day SBP ratio was significantly higher in the 'old' elderly compared with the 'young' elderly (0.90 versus 0.86, respectively; P < 0.01). CONCLUSIONS: Ambulatory blood pressure levels in healthy, community-dwelling 'old elderly' are higher than those reported for younger adults and reflect the prominent age-related rise in SBP associated with advanced old age. Advanced old age is associated with a diminished nocturnal dip in blood pressure.     

Differences in ambulatory blood pressure between men and women with mild hypertension

Non-invasive ambulatory blood pressure monitoring was performed in a consecutive series of 87 subjects with recently detected mild uncomplicated hypertension. Obese subjects, diabetics and those with secondary hypertension were excluded. Ambulatory pressures were recorded on a day of usual activity. Average ambulatory systolic and diastolic pressures were significantly lower than referral pressures determined in clinics or screening sites and initial pressures taken by the monitors. Whereas men (57) and women (30) had similar referral and initial pressures, average ambulatory systolic pressure was significantly higher in men; diastolic pressure was not different. Men also had a significantly higher fraction of ambulatory systolic pressures greater than 140 mmHg compared to women. Fifty-six percent of the men and 80% of the women had average ambulatory systolic pressures less than 140 mmHg and diastolic pressures less than 90 mmHg; the difference between the sexes was significant (chi 2 = 6.99, P less than 0.01). Thus, in mild hypertension, women have lower average systolic pressure than men during ordinary daily activity. These results may account for lower long-term cardiovascular morbidity in hypertensive women compared with men.     

Twenty-four-hour ambulatory blood pressure monitoring in the evaluation of antihypertensive drugs: methodological aspects

Ambulatory blood pressure monitoring (ABPM) provides reproducible measurements over 24 h, avoiding the alerting reaction. However, the reproducibility of mean hourly ambulatory values is poorer by far than the whole day average. In phases II and III clinical triams ABPM seems to evaluate the time-course of the antihypertensive effect and helps to determine the trough: peak ratio. The potential advantage of the method could be an increase in statistical power of the trial, with regard to the number of patients to include, according to the study design. ABPM led to the identification of 'white-coat' hypertension with elevated clinic blood pressure measurements and persistently normal ABPM over time. No epidemiological evidence to include patients in trials according to ABPM criteria has been provided to date, but a subsequent stratification on the initial ABPM data has to be performed. Although an insignificant effect on the 24 h mean blood pressure values in short-term trials, the use of placebo seems to be necessary to supply reference blood pressure values for dosing and trough: peak ratio determination. Whether ABPM is able to decrease the number of patients to include remains debated. It has been noted that an increasing number of readings could lead to a decrease in SD and that a decrease in the number of patients required can be expected both in parallel and in cross-over design trials. However, it has been reported that the advantage of the higher reproducibility of ABPM could be lost in parallel design trials and that analysis of the antihypertensive effect of the drug throughout the 24 h could then require more patients. In order to conduct multicentre trials using ABPM, a consensus among investigators is needed for the presentation and analysis of the results. We have to overcome these difficulties in order to avoid a 'centre effect' and to allow for the expected increase in power of the trial. In such a trial the comparability of parallel groups could be jeopardized by a misadherence to the ABPM protocol. How can ABPM modify the doctor-patient relationship?. A pedagogical approach seems necessary, namely to inform the patients concerning technical and medical prerequisites of the method, in order to conform to the 'guidelines'. ABPM might constitute a new determinant of compliance with treatment; but its influence, beneficial or not, remains to be assessed. Compliance evaluation could be combined with ABPM, in order to provide a better evaluation of the antihypertensive effect of the drugs.     

Acute aerobic exercise reduces ambulatory blood pressure in borderline hypertensive men and women

Ambulatory blood pressure (BP) monitoring was undertaken on two days in 31 men and women (11 with elevated resting and ambulatory BP and 20 who were normotensive), once following each of these treatment conditions: 20 min of moderate aerobic bicycle orgometry, and an equivalent control rest period. The two monitoring days were conducted within a 72 h period with the order of treatments counterbalanced across subjects. Mean BP and heart rate (HR) levels were calculated for each individual on an hourly basis and for work, home, and sleep periods. In the elevated BP group, the exercise day compared to the control day was associated with lower BP at work. Hour-by-hour analyses confirmed that the BP-lowering effect of exercise was significant for 5 h and diminished in magnitude between hours 6 and 9. These effects were not attributable to any marked differences in mood, total daily stress, posture, or activities between test days. Exercise was not associated with any appreciable differences in sleep BP or in the 24-h HR profile. No differences in BP or HR as a function of exercise were seen in the normotensive group; however, the exercise-induced reduction in mean arterial BP (MAP) for hours 2 through 5 was significantly positively correlated with control day MAP levels at work in the total sample. Thus, moderate aerobic exercise, when engaged in prior to the stresses of daily living, seems to confer a protective reduction in ambulatory BP, particularly in individuals with elevated BP.     

Changes in postural stability in women aged 20 to 80 years

BACKGROUND: A study of postural stability was undertaken to identify the relationship between vision and support surface across age decades. Understanding when reliance on vision for postural stability emerges and the support conditions contributing to this instability may provide the evidence required to introduce falls-prevention strategies in younger age decades. METHODS: We measured postural stability in 453 women aged 20 to 80 years using the Balance Master force-plate system while the women performed the modified Clinical Test for the Sensory Interaction and Balance (firm and foam surfaces, eyes open and closed) and the Single-Limb Stance Test (eyes open and closed). RESULTS: Women in their 60s and 70s were more unstable than younger women in bilateral stance on a firm surface with the eyes closed. This instability was evident from the 50s when a foam surface was introduced and from the 40s when single-limb stance was tested with eyes closed. A further decline in stability was demonstrated for each subsequent decade when the eyes were closed in single-limb stance. CONCLUSIONS: Age, visual condition, and support surface were significant variables influencing postural stability in women. Reliance on vision for postural stability was evident for women from the 40s when single-limb stance was tested, from the 50s when bilateral stance on foam was tested, and from the 60s when a firm surface was used. The cause(s) of this decline in stability requires further investigation, and screening for postural instability between the ages of 40 and 60 is advocated.     

Spironolactone and altizide used in combination with enalapril: Twenty-four-hour ambulatory recording of blood pressure

The addition of enalapril or acebutolol to a regimen of altizide + spironolactone in patients with moderate hypotension was investigated in a multicenter study of S3 patients. The patients underwent semiambulatory 24-hour blood pressure monitoring, especially to observe hypotensive episodes. In the 25 patients uncontrolled with altizide + spironolactone alone, enalapril and acebutolol were about equally effective in reducing blood pressure. The incidence of hypotension was low and comparable for both treatment groups, provided that the initial dose of angiotensin-converting enzyme inhibitor was low (5 mg).     

Effects of coffee on ambulatory blood pressure in older men and women: A randomized controlled trial

This study assessed the effects of regular coffee drinking on 24-hour ambulatory blood pressure (ABP) in normotensive and hypertensive older men and women. Twenty-two normotensive and 26 hypertensive, nonsmoking men and women, with a mean age of 72.1 years (range, 54 to 89 years), took part in the study. After 2 weeks of a caffeine-free diet, subjects were randomized to continue with the caffeine-free diet and abstain from caffeine-containing drinks or drink instant coffee (5 cups per day, equivalent to 300 mg caffeine per day) in addition to the caffeine-free diet for a further 2 weeks. Change in systolic and diastolic blood pressures (SBP, DBP) determined by 24-hour ambulatory BP monitoring showed significant interactions between coffee drinking and hypertension status. In the hypertensive group, rise in mean 24-hour SBP was greater by 4.8 (SEM, 1.3) mm Hg (P=0.031) and increase in mean 24-hour DBP was higher by 3.0 (1.0) mm Hg (P=0.010) in coffee drinkers than in abstainers. There were no significant differences between abstainers and coffee drinkers in the normotensive group for 24-hour, daytime, or nighttime SBP or DBP. In older men and women with treated or untreated hypertension, ABP increased in coffee drinkers and decreased in abstainers. Restriction of coffee intake may be beneficial in older hypertensive individuals.     

高龄老年人血压管理中国专家共识要点解读

正高血压是动脉粥样硬化性心血管病最重要的危险因素,也是危害老年人健康的重大公共卫生问题。目前我国80岁以上的高龄老年人口已经超过2 300万,并以每年5%的速度递增。由于循证医学证据缺乏,80岁以上高龄老年患者的血压管理仍相对滞后。为此,中国老年医学学会高血压分会邀请国内高血压领域的著名专家,制订了首部《高龄老年人血压管理中国专家共识》[1],该共识全文发表在中国心血管杂志2015年第6期,主要特色和创新点如下:     

Relationship quality: effects on ambulatory blood pressure and negative affect in a biracial sample of men and women

BACKGROUND: Prospective studies link marriage to better cardiovascular health, but marital dissatisfaction and discord predict increased rates of hypertension, higher blood pressure (BP), greater reactivity to stress, and left ventricular mass. OBJECTIVE: To determine and compare effects of partner status and relationship quality on 24-h BP, urinary norepinephrine and cortisol, and self-reported stress and negative affect. METHODS: Ambulatory BP (ABP) and 24-h urine collections were obtained during a typical work day in 325 adults, including 139 African Americans (AAs). Participants cohabiting with a spouse or partner were classified into high, intermediate and low relationship quality (RQ) groups and compared to those without partners (Alone). RESULTS: Mean ABP was nearly identical in participants with versus without partners (125.7/76.9 versus 125.9/76.7 mmHg). High RQ subjects had lower mean waking ABP than intermediate/low RQ and Alone groups [systolic blood pressure (SBP), F=3.45; diastolic blood pressure (DBP), F=3.38, P-values <0.05]. High RQ was related to lower SBP and DBP in African Americans, and to lower SBP in Whites. High RQ was also linked to lower SBP and DBP in men, and to lower SBP in women. High RQ subjects reported less negative affect and stress than all other groups (P<0.05). Norepinephrine was lower in partnered versus Alone women regardless of RQ status. CONCLUSIONS: Relationship quality is a better predictor of daily BP, affect and stress than partner status. High RQ is linked to lower ABP across race and gender. This reduced ABP may be due, in part, to the stress buffering effects of better RQ and/or the stress enhancing effects of poor RQ.     

Geographical differences in blood pressure of male youth aged 17-21 years in China

Hypertension is one of the most prevalent cardiovascular risk factors in the adult Chinese population. The prevalence distribution of hypertension differs geographically in adults, since hypertension is influenced by environment factors, such as climate, altitude and economic. The aim of the present study was to study the prevalence of hypertension and measure the blood pressure (BP) level, and to compare and observe the geographical distribution of borderline or high BP in Chinese male youth. A cross-sectional survey on constitution and health of Chinese recruit youth was carried out in 2001, using the cluster sampling method. Two to four counties or cantons were selected as survey spots from all the 27 provinces or autonomous regions and four municipalities in China according to its population, geography and economy, except for Hong Kong, Tai Wan and Macao. The total survey spots were 100 counties or cantons. At each survey spot, all the recruit youth aged 17-21 years were surveyed, and data from a total of 81,193 recruits were collected. In the analysis, female youth and male subjects with diseases in heart, kidney, or other organs that could cause high BP were rejected. In all, the analysis sample was 72,895 subjects. Two standardized BP measurements were obtained. According to the P ₉₀ , P ₉₅ centile values of Chinese children and adolescent BP references, and adult's critical hypertension diagnosis standard recommended by the WHO, all the subjects were categorized into seven groups. The relationships between BP and physical indexes, age, heart rate, vital capacity and area were analyzed by using multiple step-wise regression. The prevalence rate of borderline and high BP of male youth in China was 13.3% and 5.0% respectively. There were significant differences in the prevalence rate of relatively high (borderline and high) BP and overall BP among youth from different areas. BP and the prevalence rate of relatively high BP were highest in youth from north China and the northeast areas among the six areas, with a prevalence rate of borderline 25.9% and 14.7%, and the high 10.5% and 5.7% respectively. However, the prevalence rate of relatively high BP of youth from the southwest area was the lowest among the six areas, with a prevalence rate of borderline 5.2% and high 2.3%. The results of multiple step-wise regression analysis showed that height, body mass index, age, heart-rate, vital capacity, economic status were positively correlated with BP, whereas annual mean air temperature, rainfall and altitude were negatively correlated. The results of this study showed that there were significant differences in the prevalence rate of relative high BP in male youth from different areas in China, and that BP was influenced by physical status and living area.     

The influence of abdominal obesity and chronic work stress on ambulatory blood pressure in men and women

OBJECTIVE: To assess the influence of abdominal obesity and work stress (operationalised as low control over work) on ambulatory blood pressure on a working day and evening. PARTICIPANTS AND METHODS: 156 school teachers (58 men and 98 women) carried out ambulatory blood pressure and heart rate monitoring on a work day and evening. Cardiovascular activity was also measured under baseline conditions on another occasion, when body weight, height, waist and hip circumference were assessed. Perceived control over work was assessed by questionnaire, along with mental health, anger expression and social support. 126 participants repeated the protocol after 12 months. Waist/hip ratio was used as the index of abdominal obesity. RESULTS: Baseline blood pressure was positively associated with waist/hip ratio in men, but ambulatory blood pressure and heart rate were not independently related to waist/hip ratio or job control. However, blood pressure and heart rate recorded during the working day and evening were elevated in men with high waist/hip ratio who experienced low job control, independently of age and body weight. Effects for diastolic blood pressure and heart rate were replicated after 12 months. Body mass index was not related to blood pressure or heart rate during the day or evening after adjustment for age and waist circumference. Low job control was associated with poor psychological well-being, negative mood and lack of social support. CONCLUSIONS: The results are consistent with the hypothesis that abdominal obesity in men is characterised by a tendency towards heightened stress-induced physiological activation, but that this tendency will only be manifest in the presence of appropriate environmental challenges such as chronic work stress.     

Exercise test in women and men aged 75-77 years

The purpose of this study was to investigate the physiological response to an exercise test in 75- to 77-year-old women and men. Out of a systematically chosen and representative sample of 1,245 persons from a population at the age of 70, 649 individuals remained available at the age of 75-77 years. An exercise test was performed in 335 participants (52%), 174 women and 161 men. 180 (28%) were excluded because of morbidity. 131 (20%) refused to perform an exercise test. Three persons had to be excluded because of missing data. The maximal heart rate was about 140 beats/min. Heart rates at different submaximal workloads were higher in females than in males. In males there was a significant nonlinear increase in heart rate at increasing work loads while in females this was not significant. The systolic blood pressure increased more in females than in males while working on the loads 30-50 W and 50-75 W. There was a significant nonlinear increase in systolic blood pressure in men without cardiovascular drugs during exercise on 30-75 W, but the corresponding increase was not significant in women. The highest average work load for the whole group measured during at least 4 min of near-maximal exercise on a bicycle was in women 48 W and in men 66 W. Forty-four percent of the women and 22% of the men had a physical working capacity presumably interfering with their ability to perform activities of daily living.     

STK39 variation predicts the ambulatory blood pressure response to losartan in hypertensive men

Large-scale genome-wide association studies (GWASs) have identified significant associations of common genetic variants with blood pressure (BP) levels. To obtain more evidence for the role of these variants in BP regulation, we studied their association with BP responses to four different antihypertensive drug monotherapies. We selected 19 single-nucleotide variants based on data from five GWASs. The study group consisted of more than 200 hypertensive Finnish men from the GENRES study. Ambulatory BP responses to 4-week treatments with losartan, bisoprolol, hydrochlorothiazide and amlodipine were the primary targets of the study. Secondarily, baseline indicators of the activity of the renin-angiotensin-aldosterone system were studied. After correction for multiple comparisons, the variant rs6749447 in the STK39 gene was significantly associated with BP responses. Thus, the minor rs6749447 allele was associated with a lower systolic and diastolic BP response to losartan (P=0.0005 and 0.0002, respectively). rs6749447 minor allele homozygotes had marginally higher serum aldosterone/plasma renin activity (PRA) ratios (P=0.04) than those without this allele. In a replication study on aldosterone and renin levels, another cohort of hypertensive patients (n=311) showed a similar trend. When the two cohorts were combined, the aldosterone level (P=0.02) and the aldosterone/PRA ratio (P=0.01) were higher in subjects homozygous for the minor rs6749447 allele than in other subjects. The present study shows that pharmacogenetic approaches may provide evidence that complements systematic genome-wide strategies by identifying gene loci that not only affect the BP level but also might modify its response to pharmacologic interventions.     

Twenty-four-hour ambulatory blood pressure monitoring efficacy of perindopril/indapamide first-line combination in hypertensive patients: the REASON study

BACKGROUND: Circadian blood pressure (BP) measurements provide more information on hypertensive complications than office BP measurements. The purpose of this study was to analyze the efficacy of the first-line combination of perindopril 2 mg plus indapamide 0.625 mg versus atenolol 50 mg on BP parameters and variability over 24 h in patients with hypertension. METHODS: A double-blind, randomized, controlled, 12-month study comparing perindopril/indapamide and atenolol was performed in 201 patients (age 55.0 years) with uncomplicated sustained essential hypertension. Ambulatory BP measurements (ABPM) were done every 15 min over 24 h. RESULTS: After 1 year of treatment, the decrease in systolic BP was significantly greater for perindopril/indapamide than for atenolol during the entire 24-h period (-13.8 v -9.2 mm Hg), the daytime and the nighttime periods (P <.01). Diastolic blood pressure (DBP) variations were comparable for the two groups (-7.2 v -8.3 mm Hg, NS). Pulse pressure (PP) reduction was also significantly greater for perindopril/indapamide than for atenolol (for the whole 24 h, -6.6 v -0.9 mm Hg, P <.001). The through to peak (T/P) BP ratio and the smoothness index were comparable in the two groups for DBP. For systolic blood pressure (SBP), higher values of the T/P ratio (0.80 v 0.59) and the smoothness index (1.45 v 0.98; P <.02) were achieved for the perindopril/indapamide combination than for atenolol. CONCLUSIONS: The perindopril/indapamide first-line combination decreased SBP and PP more effectively than atenolol. Moreover, the BP control effect was smooth and consistent throughout the 24-h dosing interval and BP reduction variability was lower than the one induced by atenolol.     

Estradiol with or without progesterone and ambulatory blood pressure in postmenopausal women.

The purpose of this study was to determine whether transdermal estradiol and intravaginal progesterone given in doses to mimic the premenopausal state would lower blood pressure (BP) in postmenopausal women. Fifteen healthy postmenopausal women were studied in each of 3 conditions: on placebo, after 8 weeks of transdermal estradiol 0.2 mg twice per week, and again 2 weeks after addition of intravaginal progesterone 300 mg/d. Women were studied at each point after 2 days of 100 mmol/d sodium intake. Twenty-four-hour ambulatory BP monitoring was performed, and blood was assayed for estradiol, progesterone, and hormones of the renin-angiotensin-aldosterone system (RAAS). ANOVA with pairwise comparisons was used for analysis. Urinary sodium excretion was similar at each time point. Levels of estrogen and progesterone similar to those in premenopausal women were achieved. On estradiol, nocturnal systolic BP (110+/-3 mm Hg), diastolic BP (63+/-2 mm Hg), and mean BP (77+/-2 mm Hg) fell significantly (P<0.02) compared with placebo systolic BP (116+/-2 mm Hg), diastolic BP (68+/-2 mm Hg), and mean BP (82+/-2 mm Hg). Daytime BP followed the same trend but was significantly lower only for mean BP. There was no activation of the RAAS. The addition of progesterone resulted in no further fall in BP but a significant activation of the RAAS. Thus, contrary to what is often assumed, administration of estradiol with or without progesterone not only did not raise BP but rather substantially lowered BP. This BP-lowering effect may be responsible for the lower incidence of hypertension in premenopausal than in postmenopausal women.     

徐州市12-17岁青少年高血压患者的血压变异性

摘要：目的 了解徐州市12-17岁青少年高血压患者血压波动的特征。方法 2018年10月至11月,采用整群随机抽样调查纳入徐州市12-17岁青少年高血压患者697例（男性451例,女性246例）,进行24 h动态血压监测（24hABPM）,获取血压变异系数（CV）、晨峰血压以及血压昼夜节律等数据。结果 青少年高血压患者白天收缩压变异系数（SBPCV）大于及夜间（P＜0.05）。与非晨峰高血压组比较,晨峰高血压组的白天心率[81.7±9.0比80.1±7.7次/min]更快;24h收缩压变异系数（24hSBPCV）[12.1%（10.7%~13.6%）比10.7%（9.3%~12.27%）]、24h舒张压变异系数（24hDBPCV）[19.5%（16.2%~21.5%）比17.2%（14.9%~20.4%）]、夜间收缩压变异系数（nSBPCV）[10.5%（8.7%~12.8%）比8.2%（6.3%~10.8%）]、夜间舒张压变异系数（nDBPCV）[16.1%（12.9%~20.1%）比14.4%（11.2%~18.2%）]更大,差异有统计学意义（P＜0.01）。血压昼夜节律呈杓型者最多（349例,50.1%）,其次为非杓型（292例,41.9%）,反杓型（34例,4.9%）和超杓型（22例,3.2%）较少。多元线性回归分析结果显示,年龄（B=-0.186、-0.178）和肥胖（B=0.532、0.736;均P＜0.05）是24hSBPCV和白天SBPCV的影响因素;年龄（B=0.314、0.451;P＜0.05）是夜间SBPCV和夜间DBPCV的影响因素;性别（B=-0.786、-0.945）、年龄（B=-0.697、-0.534）及肥胖（B=1.213、1.729;均P＜0.05）是24hDBPCV和白天DBPCV的影响因素。结论 晨峰高血压者的白天心率更快。青少年高血压的昼夜节律以杓型、非杓型为主。年龄、性别、肥胖为青少年血压变异系数的影响因素。 关键词： 青少年; 血压变异系数; 晨峰血压; 血压昼夜节律     

Ambulatory blood pressure and heart rate at 60 +/- 5 years. Differences between men and women

Ambulatory measurements of systolic and diastolic arterial pressures and heart rate were performed during daytime in 68 subjects (37 men and 31 women) of mean age 55 +/- 5 years. These subjects had no history of cardiovascular or cerebral disease and no clinical or biochemical abnormalities. Bar charts for ages showed unimodal distribution with a 59-year mode in both sexes. Hourly profiles of arterial pressures and heart rate from 09:00 to 22:00 h were established in both groups. Throughout that time ambulatory arterial pressures were constantly higher in men than in women, especially in the morning (about 09:00 - 10:00 h; p less than 0.01), late in the afternoon and in the evening (17:00 to 22:00 h; p less than 0.01). In contrast, women always had a higher heart rate than men, the difference being greatest in the morning till early afternoon (10:00 to 15:00 h; p less than 0.01) and in the late evening (22:00 h; p less than 0.01). A difference in arterial pressures between men and women has already been recognized in younger subjects. It would be interesting to find out whether it increases or decreases in subjects older than those of the present study.     

Less difference between office and ambulatory blood pressure in women than in men both before and during antihypertensive treatment

In 199 subjects (56% women) with a diastolic blood pressure (BP) of 95-115 mmHg, 5 mg of either amlodipine or felodipine extended release (ER) was given for 4 weeks following 4 weeks of placebotreatment. BP was measured by conventional clinic BP technique and by 24-h ambulatory BP monitoring (Spacelab 90202/90207). Men and women had identical clinic BP at baseline and it was lowered equally much by 4 weeks of treatment (men: 158/101 and 147/93, women: 159/102 and 149/93 mmHg, respectively). However, ambulatory BP was higher in women than in men both before and after treatment (men: 145/91 and 134/85, women: 149/95 and 140/89 mmHg, respectively, p