Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring

Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out‐of‐office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1‐week interval. Each set of measurements included three office BP readings and a 4‐day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6‐67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2‐31.5). The reproducibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002‐0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ = 0.21 (95% CI: 0.03‐0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29‐0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM‐based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.     

The Bedtime Administration of Doxazosin Controls Morning Hypertension and Albuminuria in Patients with Type-2 Diabetes: Evaluation Using Home-Based Blood Pressure Measurements

The control of high blood pressure (BP) after awakening in the morning (morning hypertension) as determined by home BP (HBP), as well as BP control throughout the day, may prevent diabetic vascular complications. We examined the effect of an α-adrenergic blocker (doxazosin) on BP measurements taken by HBP after awakening and during clinic visits (CBP) in 50 patients with type-2 diabetes and morning hypertension. We evaluated the urinary albumin excretion rate as an indicator of nephropathy. Doxazosin was taken orally once at bedtime for 1 to 3 months. The mean (± SD) dose was 2.9 ± 2.1 mg/day (1 to 8 mg/day). The BP was measured monthly at the clinic during the day and at home after awakening in the morning. In this short-term trial (2.8 ± 0.4 months), the systolic HBP decreased significantly from 164 ± 17 mmHg before treatment to 146 ± 19 mmHg after treatment, and the diastolic HBP decreased significantly from 85 ± 14 mmHg before treatment to 80 ± 9 mmHg after treatment. The systolic, but not the diastolic CBP, decreased significantly after treatment. There was no significant difference in the systolic or diastolic values between the HBP and the CBP after treatment. The percentage change in the systolic HBP after treatment was three times greater than for the systolic CBP. The median (interquartile) urinary albumin excretion rate decreased significantly (P < 0.001) from 62 (25–203) mg/g creatinine before treatment to 19 (9–76) mg/g creatinine after treatment. On multiple regression analysis, the decrease in the systolic HBP with treatment positively correlated with the reduction in urinary excretion of albumin. The control of morning hypertension reduced the albuminuria found in both untreated and treated hypertensive patients with type-2 diabetes. Bedtime administration of doxazosin appears to be safe and effective in reducing morning hypertension as measured by HBP. This finding also demonstrates that HBP taken in the morning has a stronger predictive power for the albuminuria level than does CBP.     

Lipid profiles and the risk of new-onset hypertension in a Chinese community-based cohort

Background and aimsDyslipidemia and hypertension, key risk factors for cardiovascular disease, may share similar pathophysiological processes. A longitudinal association was reported between dyslipidemia and new-onset hypertension, but few data were published in Asian. We aimed to investigate the association of lipid profiles with new-onset hypertension in a Chinese community-based non-hypertensive cohort without lipid-lowering treatment (n = 1802).Methods and resultsNew-onset hypertension was defined as any self-reported history of hypertension, systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or receiving antihypertensive medications at follow-up. Logistic regression models were used to evaluate the associations. Participants were aged 53.97 ± 7.49 years, 31.19% were men, and 64.54% with dyslipidemia. During a median of 2.30 years follow-up, the incidence of new-onset hypertension was 12.99%. Multivariate adjusted risks of new-onset hypertension increased with triglyceride increases (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.03–1.27) and high-density lipoprotein cholesterol (HDL-C) decreases (OR = 0.47, 95% CI: 0.29–0.76) for one unit. However, threshold effects were observed for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and non-HDL-C. Compared with subjects with hyperlipidemia, in those with normal concentrations of TC, LDL-C, and non-HDL-C increased risks of new-onset hypertension were observed with OR (95% CI) of 1.65 (1.10–2.46), 1.58 (1.07–2.33), and 1.57 (1.15–2.15) for one unit increasement, respectively, after adjusting for all covariates.ConclusionHigher TG and lower HDL-C increased the risk of new-onset hypertension, but for TC, LDL-C and non-HDLC, the risk of new-onset hypertension was increased only at normal concentrations in a Chinese community-based cohort.     

Facteurs associés à un mauvais contrôle tensionnel chez les patients hypertendus marocains

Study aimHypertension is a major public health concern worldwide and non-controlling it can lead to various cardiovascular complications. Controlling blood pressure and reducing overall cardiovascular risk are two main goals of treatment. Thus, this study aimed to determine the proportion and factors associated with uncontrolled hypertension in hypertensive patients living in the Beni Mellal city.Patients and methodsThe cross-sectional survey took place between June and March 2019. It involved 580 hypertensive patients attending the primary health care facilities in Beni Mellal city, using systematic sampling.ResultsA total of 580 hypertensive patients were recruited, with a mean age of 55.78 (± 10.82 years) and of which 66.89% were female. The proportion of poor blood pressure control was 74.1% and was associated in multivariate analysis with a family history of hypertension(OR = 1.60; 95% CI = [1.02-2.50]), dyslipidemia (OR = 2.05; 95% CI = [1.32 -3.20]), non-adherence to a regular BP measurement (OR = 4.13; 95% CI = [2.49 -6.86]), to treatment (OR = 3.64; 95% CI = [2.34-5.65]) and regular biological monitoring (OR = 2.45; 95% CI = [1.46-4.08]).ConclusionDespite the free and available of treatment, the proportion of uncontrolled hypertension was high. This might be linked to a lack of awareness and education concerning disease self-management.     

Changing relationship between home and office blood pressure with increasing age in children: the Arsakeion School study

BACKGROUND: Home blood pressure (HBP) monitoring is being used in children. However, there is no information on the relationship between HBP and office measurements (Office BP (OBP)) in this population. METHODS: This school-based study investigated the effect of age on the difference between HBP and OBP in 765 healthy subjects aged 6-18 years (mean age 12 +/- 3 (SD years)). HBP (3 days, 12 readings) and OBP (2 visits, 6 readings) were measured using electronic devices validated in children (Omron 705IT). RESULTS: Average OBP was slightly lower than HBP by 0.6+/- 7.0 mm Hg (95% confidence intervals (CI) 0.1, 1.1, P=0.01) systolic and 1+/- 6 mm Hg (95% CI 0.7, 1.6, P<0.0001) diastolic, whereas pulse rate was higher in the office by 7+/- 10 beats/min (95% CI 6.2, 7.6, P<0.0001). Age was significantly correlated with the OBP-HBP difference (r = 0.13/0.24 for systolic/diastolic, P< 0.001). In the younger children (6-12 years), both diastolic and systolic HBP were higher than OBP, whereas pulse rate was higher in the office. In older children and adolescents, the BP difference was eliminated whereas the pulse rate difference was reduced but remained significant. These changes with age were similar in boys and girls. CONCLUSIONS: In the pediatric population OBP appears to be higher than HBP. This difference is reduced with advancing age and eliminated after the age of 12 years. These data should be taken into account in the assessment of HBP in children and adolescents.     

Detection of masked hypertension by home blood pressure measurement: is the number of measurements an important issue?

BACKGROUND: Office blood pressure (OBP) and home blood pressure (HBP) enable the identification of patients with masked hypertension. Masked hypertension is defined by normal OBP and high HBP and is known as a pejorative cardiovascular risk factor. OBJECTIVE: The objective was to evaluate in the SHEAF study the influence of the number of office or home blood pressure measurements on the classification of patients as masked hypertensives. METHODS: Patients with OBP <140/90 mmHg (mean of six values: three measurements at two separate visits, V1 and V2) and HBP >135/85 mmHg (mean of all valid measurements performed over a 4-day period) were the masked hypertensive reference group. The consistency of the classification was evaluated by using five definitions of HBP values (mean of the 3, 6, 9, 12 and 15 first measurements) and two definitions of OBP values (mean of three measurements at V1 and mean of three measurements at V2). RESULTS: Among the 4939 treated hypertensives included in the SHEAF study, 463 (9.4%) were classified as masked hypertensives (reference group). By decreasing the number of office or home measurements, the prevalence of masked hypertension ranged from 8.9-12.1%. The sensitivity of the classification ranged from 94-69% therefore 6-31% of the masked hypertensives were not detected. The specificity ranged from 98-94% therefore 1-6% of patients were wrongly classified as masked hypertensives. CONCLUSION: A limited number of home and office BP measurements allowed the detection of masked hypertension with a high specificity and a low sensitivity. A sufficient number of measurements (three measurements at two visits for OBP and three measurements in the morning and in the evening over 2 days for HBP) are required to diagnose masked hypertension.     

Facteurs associés à un mauvais contrôle tensionnel chez 253 hypertendus traités

IntroductionHypertension is a major public health problem throughout the world. The blood pressure control and the decrease of global cardiovascular risk are two main goals of the treatment of hypertension. The purpose of this study was to determine the proportion and associated factors of uncontrolled hypertension in hypertensive patients followed by private cardiologists in Oran.Materials and methodsThis study included 253 hypertensive patients followed by 7 private cardiologists in Oran. Was regarded as uncontrolled high blood pressure, a systolic blood pressure (SBP) superior or equal to 140 mmHg and/, or a diastolic blood pressure (DBP) superior or equal to 90 mmHg. A logistic regression analysis was performed to determine the associated factors with poor blood pressure control.ResultsThe proportion of uncontrolled hypertension was 69.6 % (75.8 % of men and 65.8 % of women). Using multivariate analysis, poor blood pressure control was found to be associated with salt consumption (OR_a = 2.71; CI 95 % = [1.42–5.18]).ConclusionNutritional actions are required for better blood pressure control.     

High serum uric acid is associated to poorly controlled blood pressure and higher arterial stiffness in hypertensive subjects

IntroductionSerum uric acid (SUA) has been associated to incident hypertension and increased risk of cardiovascular diseases.Materials and methodsAmong the 2191 subjects enrolled during the last population survey of the Brisighella Heart Study, we identified 146 new cases of arterial hypertension and 394 treated but uncontrolled hypertensive patients with different levels of SUA. Their hemodynamic characteristics have been compared with those of age- and sex-matched normotensive (N. 324) and controlled hypertensive (N. 470) subjects. Then, by logistic regression analysis, we evaluated which factors were associated with a worse BP control under pharmacological treatment.ResultsSUA levels were significantly higher in untreated hypertensive and uncontrolled hypertensive patients when compared to normotensives and controlled hypertensive patients. Pulse wave velocity (PWV) was significantly higher (p < 0.001) in undiagnosed and uncontrolled hypertensive patients, while controlled hypertensive patients had PWV values comparable to normotensive controls. A similar trend has been observed for the augmentation index (AI). A worse BP control was associated with SUA levels (OR 1277, 95% CI 1134–1600 per mg/dL), AI (OR 1066, 95%CI 1041–1092 per unit), and PWV (OR 1201, 95% CI 1089–1423, per m/s), but not with age, body mass index, nor estimated glomerular filtration rate.ConclusionBased on our data, SUA seems to be associated with an inadequate BP control in subjects treated with antihypertensive drugs, and subjects with both uncontrolled BP and relatively high SUA levels have also an increased arterial stiffness that (per se) could be a cause of worse BP control under treatment.     

Association of morning hypertension with chronic kidney disease progression and cardiovascular events in patients with chronic kidney disease and hypertension

Background and aimAssociations of morning hypertension with chronic kidney disease are rarely investigated in prospective studies. We aim to investigate the predictive value of uncontrolled morning hypertension (UMH) to chronic kidney disease (CKD) progression and cardiovascular (CV) events in patients with CKD and hypertension.Methods and resultsIn this prospective two-center observational study, 304 hypertensive patients with CKD were enrolled. Time to total mortality, CKD progression and CV events was recorded; Kaplan–Meier survival function estimates and Multivariable Cox proportional hazard model were used to investigate associations between UMH and outcomes. The study protocol was approved by the Institutional Review Board (http://www.thaiclinicaltrials.org; TCTR20180313004). After a follow-up for median 30 months, 23 (7.6%) patients died, 34 (11.2%) had CKD progression, and 95 (31.3%) occurred new-onset CV events, respectively. UMH was shown to be a strong predictor of CKD progression [hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.22–4.94] and CV events (HR 1.69, 95% CI 1.12–2.53). When morning hypertension was analyzed as a continuous variable, morning systolic blood pressure (per 10 mmHg) was also shown to be predictive to CKD progression (HR 1.28, 95% CI 1.07–1.53, P < 0.01) and CV events (HR 1.15, 95% CI 1.03–1.28, P < 0.01).ConclusionsUMH is strongly associated with CKD progression and CV events in patients with CKD and hypertension. UMH in CKD patients deserves further attentions.     

Are metabolic risk factors and target organ damage more frequent in masked hypertension than in white coat hypertension?

Patients with masked hypertension (MH) tend to have a higher risk than those with white-coat hypertension (WCH). Therefore, we evaluated the characteristics of MH and WCH in Korean patients receiving medical treatment for hypertension. We enrolled 1019 outpatients (56 ± 10 y, 488 males) with diagnosed hypertension who had not changed oral anti-hypertensive medication for 6 months. Clinic blood pressure (CBP) was checked by a nurse and doctor twice per visit. Home BP (HBP) was checked every morning and evening for 1 week. In the MH patients, mean CBP was 130/80 mmHg, whereas HBP was 137/86 mmHg. In the WCH patients, mean CBP was 149/86 mmHg by physician and 143/85 mmHg by nurse and mean HBP was 124/75 mmHg. Age and gender did not differ between the groups. Waist and hip circumferences and the level of fasting glucose were higher in patients with MH than in patients with WCH (p = 0.008, 0.016, 0.009, respectively). Metabolic risk factors were more frequent in patients with WCH, MH, and uncontrolled hypertension than in patients with controlled hypertension. The incidence of metabolic risk factors, however, did not differ between patients with WCH and MH. Heart damage was more frequent in MH than in WCH (p = 0.03). The incidence of metabolic risk factors did not differ between patients with WCH and those with MH. Target organ damage was more closely related to MH than to WCH. Home BP measurement was a useful tool for discriminating WCH and MH in patients with hypertension.     

Prevalence,risk factors,and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AimsThis research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia.MethodsA hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension.ResultsOf 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656).ConclusionThe extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.     

Long-term follow-up after aortic coarctation repair: The unsolved issue of exercise-induced hypertension

IntroductionDespite successful repair of aortic coarctation (AC), systemic hypertension (HTN) can persist in a significant percentage of patients. Exercise-induced HTN is also common in these patients, although its clinical significance is still unclear. In this study we aimed to assess the prevalence of exercise-induced HTN in adult patients with repaired AC.MethodsWe retrospectively reviewed the clinical records of patients aged >18 years with repaired AC followed at an adult congenital heart disease outpatient clinic in a tertiary care center. Demographic and clinical data including age at intervention, blood pressure (BP) at rest and on exercise, transthoracic echocardiogram (TTE) and treadmill exercise test results were evaluated. Exercise-induced HTN was defined as peak systolic BP ≥210 mmHg for men and ≥190 mmHg for women.ResultsWe analyzed 65 patients (40 [61.5%] male; mean age at follow-up 30±8 years). Median age at AC repair was 7 years (P25-P75: 4-20) and mean follow-up was 20±7 years. Only one patient had diabetes and 10 (15.4%) had dyslipidemia. The majority of patients had controlled BP at rest and only nine (18%) were under antihypertensive medication. Forty-nine patients performed a treadmill exercise test. The mean duration of exercise was 10.7±3.1 minutes and mean peak heart rate was 166±18 beats per minute. Eleven (22%) patients had a hypertensive response, among whom only three (33%) had uncontrolled BP at rest. In our study treatment with angiotensin-converting enzyme inhibitors (ACEI) (OR 4.0 [95% CI 1.9–18.1]) and the peak instantaneous gradient in the descending aorta by TTE (OR 8.2 [95% CI 1.8–37.0]) were predictors of a hypertensive response with exercise. Age at surgery and type of AC repair were not associated with a hypertensive response on exercise.ConclusionsIn this study we found a significant prevalence of exercise-induced HTN in adult patients after successful AC repair despite adequate BP control at rest. Exercise-induced HTN was significantly related to higher peak gradient in the descending aorta and treatment with ACEI. These results highlight the complexity of the adult AC population and show that, even after a good surgical result, several patients remain at high cardiovascular risk and require long-term follow-up.     

Knowledge on arterial hypertension in general population: Results from a community pharmacy screening program

Backgrounds and aimsHypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers.Methods and resultsA questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03).ConclusionKnowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.     

Hypertensive Exposure Markers by MRI in Relation to Cerebral Small Vessel Disease and Cognitive Impairment

ObjectivesThis study sought to investigate the extent of hypertensive exposure as assessed by cardiovascular magnetic resonance imaging (MRI) in relation to cerebral small vessel disease (CSVD) and cognitive impairment, with the aim of understanding the role of hypertension in the early stages of deteriorating brain health.BackgroundPreserving brain health into advanced age is one of the great challenges of modern medicine. Hypertension is thought to induce vascular brain injury through exposure of the cerebral microcirculation to increased pressure/pulsatility. Cardiovascular MRI provides markers of (subclinical) hypertensive exposure, such as aortic stiffness by pulse wave velocity (PWV), left ventricular (LV) mass index (LVMi), and concentricity by mass-to-volume ratio.MethodsA total of 559 participants from the Heart-Brain Connection Study (431 patients with manifest cardiovascular disease and 128 control participants), age 67.8 ± 8.8 years, underwent 3.0-T heart-brain MRI and extensive neuropsychological testing. Aortic PWV, LVMi, and LV mass-to-volume ratio were evaluated in relation to presence of CSVD and cognitive impairment. Effect modification by patient group was investigated by interaction terms; results are reported pooled or stratified accordingly.ResultsAortic PWV (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 1.05 to 1.30 in patient groups only), LVMi (in carotid occlusive disease, OR: 5.69; 95% CI: 1.63 to 19.87; in other groups, OR: 1.30; 95% CI: 1.05 to 1.62]) and LV mass-to-volume ratio (OR: 1.81; 95% CI: 1.46 to 2.24) were associated with CSVD. Aortic PWV (OR: 1.07; 95% CI: 1.02 to 1.13) and LV mass-to-volume ratio (OR: 1.27; 95% CI: 1.07 to 1.51) were also associated with cognitive impairment. Relations were independent of sociodemographic and cardiac index and mostly persisted after correction for systolic blood pressure or medical history of hypertension. Causal mediation analysis showed significant mediation by presence of CSVD in the relation between hypertensive exposure markers and cognitive impairment.ConclusionsThe extent of hypertensive exposure is associated with CSVD and cognitive impairment beyond clinical blood pressure or medical history. The mediating role of CSVD suggests that hypertension may lead to cognitive impairment through the occurrence of CSVD.     

Investigation of major genetic polymorphisms in the Renin-Angiotensin-aldosterone system in subjects with young-onset hypertension selected by a targeted-screening system at university

Although polymorphisms in renin-angiotensin-aldosterone (RAA) system genes for angiotensinogen (AGT M235T), angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AT1 A/C1166), and aldosterone synthase (CYP11B2-344T/C) have been major targets for genetic investigation in association with essential hypertension (EH), the influence of these genetic factors is still to be determined. Because patients with young-onset EH are thought to possess a stronger genetic background than EH patients who show elevated BP relatively late in life, the targeted screening of hypertensive students in Tohoku University was completed for the selection of subjects for genetic investigation. Out of 16,434 students (12,794 males and 3,670 females) younger than 30, 22 students showed a high blood pressure (BP) (systolic and diastolic BP of 140 and/or 90 mmHg or greater, respectively, on two occasions and more than 135 and/or 85 mmHg, respectively, at a third measurement during casual BP measurements at the Tohoku University Health Center. These 22 students were asked to measure their BP at home (HBP). Six of the students had a systolic HBP of more than 135 mmHg and/or a diastolic HBP of more than 85 mmHg, and these students subsequently received medical examinations at Tohoku University Hospital and were diagnosed with EH. Genotyping for the four major genetic polymorphisms mentioned above was performed on the six students with EH and on 12 of the remaining 16 students whose HBP was within the normal range (white coat hypertension: WCH). Neither the EH nor the WCH students showed a different distribution of genotypes and allelic frequencies, compared to those found in the general Japanese population. Hence, the present study suggests that none of the major genetic polymorphisms in the RAA system strongly influence the onset of EH.     

Unattended versus attended automated office blood pressure: Systematic review and meta‐analysis of studies using the same methodology for both methods

There is increasing interest in unattended automated office blood pressure (OBP) measurement, which gives lower blood pressure values than the conventional auscultatory OBP. Whether unattended automated OBP differs from standardized attended automated OBP performed using the same device and measurement protocol remains uncertain. A systematic review and meta‐analysis of studies (aggregate data) comparing unattended vs attended automated OBP using the same device and measurement protocol (conditions, number of measurements, visits) was performed. Ten eligible studies (n = 1004, weighted age 60.8 ± 4.2 [SD] years, 55% males) were analyzed. Unattended OBP (pooled systolic/diastolic 133.9 [95% CI: 129.7, 138]/80.6 [95% CI: 77, 84.2] mm Hg) did not differ from attended OBP (135.3 [95% CI: 130.9, 139.6]/81 [95% CI: 77.6, 84.3] mm Hg); pooled systolic OBP difference −1.3, 95% CI: −4.3, 1.7 mm Hg and diastolic −0.4, 95% CI: −1.2, 0.3 mm Hg. Nine of ten studies achieved high quality score and no publication bias was identified. Meta‐regression analysis did not reveal any effect of age, gender, or attended systolic OBP on the unattended‐attended systolic OBP difference (P = NS for all). However, there was a trend toward higher attended than unattended OBP at higher OBP levels. These data suggest that, when the same device and measurement protocol are used, attended automated OBP provides similar blood pressure values as unattended automated OBP. Although unattended automated OBP is theoretically advantageous as it ensures that standardized conditions and measurement protocol are used, attended automated OBP, if carefully performed, appears to be a reasonable and practical alternative.     

Escherichia coli bacteriuria in female adults is associated with the development of hypertension

ObjectiveTo investigate whether Escherichia coli bacteriuria is associated with the development of hypertension during a long-term follow-up.MethodsA prospective cohort study was performed among the participants of two population-based studies. Between 1974 and 1986 all women aged 39 to 68 years old, who lived in Utrecht, the Netherlands, were invited to participate in a breast cancer screening program. The participants completed a questionnaire, underwent a medical examination, and collected a morning urine sample that remained stored. From 1993 to 1997 another population-based study was performed. We performed a full cohort analysis for 444 women who participated in both studies. E. coli bacteriuria was diagnosed by a real-time PCR. Hypertension was defined as the use of antihypertensive medication and/or a measured systolic blood pressure of at least 160 mmHg or a diastolic blood pressure of 95 mmHg or higher. The mean follow-up was 11.5 ± 1.7 years.ResultsForty women (9%) had E. coli bacteriuria at baseline. Women who had bacteriuria at baseline had a mean blood pressure at study endpoint of 133 ± 20 mmHg systolic and 78 ± 11 mmHg diastolic, and women without bacteriuria had values of 129 ± 20 and 78 ± 11 mmHg, respectively (p-values for difference 0.33 and 0.88). Although E. coli bacteriuria was not associated with the blood pressure as a continuous variable, it was associated with the development of hypertension during follow-up (OR 2.8, 95% CI 1.4–5.5).ConclusionE. coli bacteriuria may increase the risk of future hypertension.     

Determinants of masked hypertension in hypertensive patients treated in a primary care setting

Background: Recent data suggest that masked hypertension (MH) carries a cardiovascular risk similar to that of uncontrolled hypertension. Aims: The objective of this study was to determine the prevalence and determinants of MH in patients treated for hypertension in a Canadian primary care setting. Methods: Office blood pressure (OBP) was measured at baseline and after 3 months of valsartan‐based therapy in 5636 hypertensive patients who had recorded their home blood pressure monitoring (HBPM) for seven consecutive days at month 3 using an Omron HEM‐711 apparatus. MH was defined in nondiabetic patients as an OBP <140/90 mmHg and an HBPM ≥135/85 mmHg, and in those with diabetes as an OBP <130/80 mmHg and an HBPM ≥125/75 mmHg. Results: Of the 5636 patients, 1025 had diabetes. OBP was controlled at 3 months in 268 (26.1%) of them, but 167 (62.3%) had MH. OBP was controlled in 2728 (59.1%) of the 4611 patients without diabetes, and 935 (34.3%) of them had MH. Overall, 1102 patients had MH, representing 36.8% of patients with controlled OBP and 19.6% of the entire hypertensive study population. Stepwise multiple logistic regression analysis in nondiabetic patients with controlled OBP at 3 months revealed that older age, male sex, higher body mass index and higher office systolic blood pressure were determinants of MH. Conclusion: Our results indicate that one of five hypertensive patients and more than one of three with controlled OBP will have MH. MH is associated with other cardiovascular risk factors, such as diabetes, and in nondiabetics, with male sex, older age and obesity.     

Investigation of Major Genetic Polymorphisms in the Renin-Angiotensin-Aldosterone System in Subjects with Young-Onset Hypertension Selected by a Targeted-Screening System at University

Although polymorphisms in renin-angiotensin-aldosterone (RAA) system genes for angiotensinogen (AGT M235T), angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AT1 A/C¹¹⁶⁶), and aldosterone synthase (CYP11B2–344T/C) have been major targets for genetic investigation in association with essential hypertension (EH), the influence of these genetic factors is still to be determined. Because patients with young-onset EH are thought to possess a stronger genetic background than EH patients who show elevated BP relatively late in life, the targeted screening of hypertensive students in Tohoku University was completed for the selection of subjects for genetic investigation. Out of 16,434 students (12,794 males and 3,670 females) younger than 30, 22 students showed a high blood pressure (BP) (systolic and diastolic BP of 140 and/or 90 mmHg or greater, respectively, on two occasions and more than 135 and/or 85 mmHg, respectively, at a third measurement during casual BP measurements at the Tohoku University Health Center. These 22 students were asked to measure their BP at home (HBP). Six of the students had a systolic HBP of more than 135 mmHg and/or a diastolic HBP of more than 85 mmHg, and these students subsequently received medical examinations at Tohoku University Hospital and were diagnosed with EH. Genotyping for the four major genetic polymorphisms mentioned above was performed on the six students with EH and on 12 of the remaining 16 students whose HBP was within the normal range (white coat hypertension: WCH). Neither the EH nor the WCH students showed a different distribution of genotypes and allelic frequencies, compared to those found in the general Japanese population. Hence, the present study suggests that none of the major genetic polymorphisms in the RAA system strongly influence the onset of EH.     

Masked uncontrolled hypertension: Prevalence and predictors

Background

There are limited data on ‘masked uncontrolled hypertension’ (MUCH) in patients with treated and apparently well-controlled BP is unknown.