Effect of amlodipine,efonidipine, and trichlormethiazide on home blood pressure and upper-normal microalbuminuria assessed by casual spot urine test in essential hypertensive patients

The aim of this study was to assess the effects of irbesartan alone and combined with amlodipine, efonidipine, or trichlormethiazide on blood pressure (BP) and urinary albumin (UA) excretion in hypertensive patients with microalbuminuria (30≤UA/creatinine (Cr) ratio [UACR] <300 mg/g Cr) and upper-normal microalbuminuria (10≤UACR<30 mg/g Cr). This randomized controlled trial enrolled 175 newly diagnosed and untreated hypertensive patients (home systolic blood pressure [SBP]≥135 mmHg; 10≤UACR<300 mg/g Cr of casual spot urine at the first visit to clinic). All patients were treated with irbesartan (week 0). Patients who failed to achieve home SBP ≤125 mmHg on 8-week irbesartan monotherapy (nonresponders, n = 115) were randomized into three additional drug treatment groups: trichlormethiazide (n = 42), efonidipine (n = 39), or amlodipine (n = 34). Irbesartan monotherapy decreased home SBP and first morning urine samples (morning UACR) for 8 weeks (p < 0.0001). At 8 weeks after randomization, all three additional drugs decreased home SBP (p < 0.0002) and trichlormethiazide significantly decreased morning UACR (p = 0.03). Amlodipine decreased morning UACR in patients with microalbuminuria based on casual spot urine samples (p = 0.048). However, multivariate analysis showed that only higher home SBP and UACR at week 8, but not any additional treatments, were significantly associated with UACR reduction between week 8 and week 16. In conclusion, crucial points of the effects of combination therapy on UACR were basal UACR and SBP levels. The effect of trichlormethiazide or amlodipine treatment in combination with irbesartan treatment on microalbuminuria needs to be reexamined based on a larger sample size after considering basal UACR and SBP levels.     

Ambulatory Blood Pressure Variability Is Increased in Diabetic Hypertensives

The purpose of this study was to examine the possible difference in the 24-hr BP profile—including short-term BP variability, assessed as the standard deviation—between diabetic and non-diabetic hypertensives. We measured 24-hr ambulatory BP in 11 diabetic hypertensives (diabetic HT) and 10 non-diabetic hypertensives (non-diabetic HT) who were hospitalized for the educational program in our hospital and were under stable salt intake. Renal function and sleep apnea were also estimated. There were no significant differences in 24-hr systolic BP (141 mmHg vs. 135 mmHg, ns), daytime systolic BP (143 mmHg vs. 138 mmHg, ns), and nighttime systolic BP (135 mmHg vs. 130 mmHg, ns) between diabetic HT and non-diabetic HT. The values of 24‐hr HR (69.7 beats/min vs. 65.2 beats/min, ns) and 24-hr HR variability (9.9 beats/min vs. 10.1 beats/min, ns) were also similar between the groups. Interestingly, diabetic HT had a significantly greater 24-hr systolic and diastolic BP variability than non-diabetic HT (18.2 mmHg vs. 14.5 mmHg, p < 0.05; 11.5 mmHg vs. 9.6 mmHg, p < 0.05, respectively). The values for creatinine clearance, urinary protein excretion, and apnea-hypopnea index were similar between the groups. Bivariate linear regression analysis demonstrated that fasting blood glucose was the primary determinant of 24-hr diastolic BP variability (r = 0.661, p < 0.01). Multiple stepwise regression analysis revealed that fasting blood glucose was a significant and independent contributor to 24-hr systolic BP variability (r = 0.501, p < 0.05). Taken together, these results demonstrate that BP variability is increased in diabetic hypertensives. Furthermore, it is possible that an elevation of fasting blood glucose may contribute to the enhanced BP variability in hypertensives.     

Evaluation of prehypertension and masked hypertension rate among clinically normotensive patients

Background: The present cross-sectional study was aimed to identify pre-hypertension and masked hypertension rate in clinically normotensive adults in relation to socio-demographic, clinical and laboratory parameters. Methods: A total of 161 clinically normotensive adults with office blood pressure (OBP) <140/90?mmHg without medication were included in this single-center cross-sectional study. OBP, home BP (HBP) recordings and ambulatory BP monitoring (ABPM) were used to identify rates of true normotensives, true pre-hypertensives and masked hypertensives. Data on sociodemographic and clinical characteristics were collected in each subject and evaluated with respect to true normotensive vs. pre-hypertensive patients with masked hypertension or true pre-hypertensive. Target organ damage (TOD) was evaluated in masked hypertensives based on laboratory investigation. Results: Masked hypertension was identified in 8.7% of clinically normotensives. Alcohol consumption was significantly more common in masked hypertension than in true pre-hypertension (28.6 vs. 0.0%, p?=?0.020) with risk ratio of 2.7 (95% CI 1.7–4.4). Patients with true pre-hypertension and masked hypertension had significantly higher values for body mass index, waist circumference, systolic and diastolic OBP and HBP (p?<?0.05 for each) compared to true normotensive subjects. ABPM revealed significantly higher values for day-time and night-time systolic and diastolic BP (p?=?0.002 for night-time diastolic BP, p?<?0.001 for others) in masked hypertension than true pre-hypertension. Conclusions: Given that the associations of pre-hypertension with TOD might be attributable to the high prevalence of insidious presentation of masked hypertension among pre-hypertensive individuals, ABPM seems helpful in early identification and management of masked hypertension in the pre-hypertensive population.     

Masked nocturnal hypertension and target organ damage in hypertensives with well-controlled self-measured home blood pressure.

It has been reported that masked hypertension, a state in which patients show normal clinic blood pressure (BP) but elevated out-of-clinic BP by self-measured home BP, is a predictor of cardiovascular morbidity much like sustained hypertension. In addition, nocturnal BP is closely associated with cardiovascular disease. This might mean that ambulatory and self-measured home BP monitoring each provide independent information. We performed ambulatory BP monitoring, self-measured home BP monitoring, echocardiography and carotid ultrasonography in 165 community-dwelling subjects. We subclassified the patients according to the ambulatory and self-measured home BP levels as follows: in the masked nocturnal hypertension group, the self-measured home BP level was <135/85 mmHg and the ambulatory nocturnal BP level was >or=120/75 mmHg; in the normotensive group, the self-measured home BP level was <135/85 mmHg and the ambulatory nocturnal BP level was <120/75 mmHg. The intima-media thickness (IMT) and relative wall thickness (RWT) were greater in the masked nocturnal hypertension group than in the normotensive group (IMT: 0.76+/-0.20 vs. 0.64+/-0.14 mm, p<0.05; RWT: 0.50+/-0.14 vs. 0.41+/-0.10, p<0.05). Even in hypertensives with well-controlled self-measured home BP, elevated ambulatory nocturnal BP might promote target organ damage. We must rule out masked hypertension using self-measured home BP monitoring, and we might also need to rule out nocturnal masked hypertension using ambulatory BP monitoring.     

Relationship between lactate dehydrogenase and albuminuria in Chinese hypertensive patients

Lactate dehydrogenase (LDH) has been reported to be positively correlated with albuminuria assessed by urinary albumin‐to‐creatinine ratio (UACR) in patients with sickle cell disease; both LDH and albuminuria are positively associated with the severity of hypertension (HTN). Here, a cross‐sectional study was performed to investigate the association between LDH and albuminuria in Chinese hypertensives. A total of 1169 Chinese individuals (aged 58.0 ± 11.5 years, 60.4% male), who were admitted to our hospital, were included in this study. Based on the level of LDH, all hypertensives (n = 802) were divided into three groups: HTN1 (lowest tertile of LDH, n = 264), HTN2 (mediate tertile of LDH, n = 268), and HTN3 (highest tertile of LDH, n = 270). Hypertensives with hyperhomocysteinemia were defined as hypertensives with homocysteine ≥15μmol/L. Meanwhile, 367 normotensives served as controls. Compared with normotensives, the levels of LDH and UACR were significantly higher in hypertensives (p < .05). There was an increasing trend of albuminuria (UACR ≥30 mg/g) from control, HTN1, HTN2 to HTN3 group (4% vs. 12.1% vs. 14.9% vs. 19.6%, χ² = 38.886, p < .001). Stepwise multiple regression analysis showed an independent association between LDH and UACR in patients with HTN (β = 0.085, p < .05), but not in normotensives. After further stratification in hypertensive patients, this correlation remained in the male (β = 0.161, p < .001), elderly (age ≥65 years, β = 0.174, p < .001) and especially hypertensives with hyperhomocysteinemia (β = 0.402, p < .001). LDH combined with white blood cell (WBC) counts was observed to have better discrimination for albuminuria than creatinine united with cystatin C in hypertensives according to receiver operation characteristic curves (area under curve: 0.637 vs. 0.535, z = 2.563, p = .0104). In conclusion, the level of LDH was associated with albuminuria in Chinese patients with HTN, particularly in hypertensives with hyperhomocysteinemia. LDH combined with WBC provided better prediction of albuminuria than routine renal function assessment in hypertensives. Further studies are needed to confirm LDH as an early marker for the risk of kidney involvement among hypertensives.     

Effects of daily walking on office,home and 24-h blood pressure in hypertensive patients

Abstract

Aerobic exercise has been recommended in the management of hypertension. However, few studies have examined the effect of walking on ambulatory blood pressure (BP), and no studies have employed home BP monitoring. We investigated the effects of daily walking on office, home, and 24-h ambulatory BP in hypertensive patients. Sixty-five treated or untreated patients with essential hypertension (39 women and 26 men, 60?±?9 years) were examined in a randomized cross-over design. The patients were asked to take a daily walk of 30–60?min to achieve 10?000 steps/d for 4 weeks, and to maintain usual activities for another 4 weeks. The number of steps taken and home BP were recorded everyday. Measurement of office and ambulatory BP, and sampling of blood and urine were performed at the end of each period. The average number of steps were 5349?±?2267/d and 10?049?±?3403/d in the control and walking period, respectively. Body weight and urinary sodium excretion did not change. Office, home, and 24-h BP in the walking period were lower compared to the control period by 2.6?±?9.4/1.3?±?4.9?mmHg (p?<?0.05), 1.6?±?6.8/1.5?±?3.7?mmHg (p?<?0.01), and 2.4?±?7.6/1.8?±?5.3?mmHg (p?<?0.01), respectively. Average 24-h heart rate and serum triglyceride also decreased significantly. The changes in 24-h BP with walking significantly correlated with the average 24-h BP in the control period. In conclusion, daily walking lowered office, home, and 24-h BP, and improved 24-h heart rate and lipid metabolism in hypertensive patients. However, the small changes in BP may limit the value of walking as a non-pharmacologic therapy for hypertension.     

Clinical prediction of normotension in borderline hypertensive men--a 10 year study

OBJECTIVE: To investigate 24-h ambulatory blood pressure measurements (ABPM) as a tool for long-term prediction of future blood pressure (BP) status in high normal and low stage 1 hypertensives. DESIGN, SETTING AND PARTICIPANTS: A total of 165 men from a population screening program with diastolic BP (DBP) 85-94 mmHg and a systolic BP (SBP) < 150 mmHg performed a 24-h ABPM. Ten years later, 120 participants (73%) returned for renewed measurements. MAIN OUTCOME MEASURES: Blood pressure status at 10 years. RESULTS: At the 10-year follow-up, 53% of the participants were classified as hypertensive (HT) (BP > or = 140/90 or taking anti-hypertensive medication) and 47% were classified as normotensive (NT) (BP < 140/90 mmHg). There was no significant baseline differences in office SBP levels between those who were normotensive or hypertensive at follow-up (136/91 versus 138/92 mmHg), whereas both SBP and DBP night-time levels were significantly lower in the future normotensives as compared to the future hypertensives (107/69 versus 112/74 mmHg, P < 0.01). Using recommended normalcy night-time ABP levels of < 120/75 mmHg in addition to office BP (140/90) at baseline, over 85% of the subjects were correctly classified provided they met both clinic and ambulatory night-time criteria for HT and NT classification at baseline. CONCLUSION: The use of ABPM in addition to office BP's in patients with borderline hypertension greatly increases the possibility of identifying those individuals who are at a very small risk of developing future hypertension. This could potentially lead to considerable savings in both patient anxiety, physician time and resource consumption.     

The Effects of Natural Antioxidants from Tomato Extract in Treated but Uncontrolled Hypertensive Patients

Purpose  To evaluate the effect of adding tomato extract to the treatment regime of moderate hypertensives with uncontrolled blood pressure (BP) levels. Methods  Fifty four subjects with moderate HT treated with one or two antihypertensive drugs were recruited and 50 entered two double blind cross-over treatment periods of 6 weeks each, with standardized tomato extract or identical placebo. Plasma concentrations of lycopene, nitrite and nitrate were measured and correlated with BP changes. Results  There was a significant reduction of systolic BP after 6 weeks of tomato extract supplementation, from 145.8 ± 8.7 to 132.2 ± 8.6 mmHg (p < 0.001) and 140.4 ± 13.3 to 128.7 ± 10.4 mmHg (p < 0.001) in the two groups accordingly. Similarly, there was a decline in diastolic BP from 82.1 ± 7.2 to 77.9 ± 6.8 mmHg (p = 0.001) and from 80.1 ± 7.9 to 74.2 ± 8.5 mmHg (p = 0.001). There was no significant change in systolic and diastolic BP during the placebo period. Serum lycopene level increased from 0.11 ± 0.09 at baseline, to 0.30 ± 01.3 μmol/L after tomato extract therapy (p < 0.001). There was a significant correlation between systolic BP and lycopene levels (r = −0.49, p < 0.001). Conclusions  Tomato extract when added to patients treated with low doses of ACE inhibition, calcium channel blockers or their combination with low dose diuretics, had a clinically significant effect—reduction of BP by more than 10 mmHg systolic and more than 5 mmHg diastolic pressure. No side-effects to treatment were recorded and the compliance with treatment was high. The significant correlation between systolic blood pressure values and level of lycopene suggest the possibility of cause–effect relationships.     

Self‐measured worksite blood pressure and its association with organ damage in working adults: Japan Morning Surge Home Blood Pressure (J‐HOP) worksite study

The effects of elevations in blood pressure (BP) on worksite stress as an out‐of‐office BP setting have been evaluated using ambulatory BP monitoring but not by self‐measurement. Herein, we determined the profile of self‐measured worksite BP in working adults and its association with organ damage in comparison with office BP and home BP measured by the same home BP monitoring device. A total of 103 prefectural government employees (age 45.3 ± 9.0 years, 77.7% male) self‐measured their worksite BP at four timepoints (before starting work, before and after a lunch break, and before leaving the workplace) and home BP in the morning, evening, and nighttime (at 2, 3, and 4 a.m.) each day for 14 consecutive days. In the total group, the average worksite systolic BP (SBP) was significantly higher than the morning home SBP (129.1 ± 14.3 vs. 124.4 ± 16.4 mmHg, p = .026). No significant difference was observed among the four worksite SBP values. Although the average worksite BP was higher than the morning home BP in the study participants with office BP < 140/90 mmHg (SBP: 121.4 ± 9.4 vs. 115.1 ± 10.4 mmHg, p < .001, DBP: 76.0 ± 7.7 vs. 72.4 ± 8.4 mmHg, p = .013), this association was not observed in those with office BP ≥ 140/90 mmHg or those using antihypertensive medication. Worksite SBP was significantly correlated with the left ventricular mass index evaluated by echocardiography (r = 0.516, p < .0001). The self‐measurement of worksite BP would be useful to unveil the risk of hypertension in working adults who show normal office and home BP.     

Unmasking hypertension in children and adolescents with sickle/beta‐thalassemia

Sickle cell disease (SCD) is associated with increased risk of cardiovascular disease, although blood pressure (BP) levels have been reported to be lower in SCD patients compared to general population. Aims of the present study were to investigate the prevalence of BP phenotypes and levels of arterial stiffness in pediatric patients with SCD and to assess the differences with children at risk for hypertension. We included in the study 16 pediatric SCD (HbS/β‐thalassemia, S/β‐thal) patients and 16 consecutive children at risk for hypertension referred to our hypertension clinic that served as high‐risk controls. All patients underwent ambulatory BP monitoring and measurement of carotid‐femoral pulse wave velocity (PWV). S/β‐thal patients had lower office systolic BP than the high‐risk control group (115.43 ± 10.03 vs 123.37 ± 11.92, P = .05) but presented similar levels of day and night ambulatory BP. Office hypertension was found in 12.5% of the S/β‐thal patients and in 43.8% of the high‐risk controls (P = .06), while 18.8% of the S/β‐thal patients and 25% of the high‐risk controls presented hypertension by ambulatory BP levels (P = .21). All of the S/β‐thal patients with ambulatory hypertension had night hypertension (one combined night and day hypertension) with office normotension (masked hypertension). S/β‐thal patients and high‐risk controls presented equal prevalence of masked hypertension (18.8%). Children and adolescents with S/β‐thal present similar prevalence of BP phenotypes and levels of PWV with children at risk for hypertension. A significant number of children and adolescents with S/β‐thal may have masked nighttime hypertension despite normal office BP levels.     

Urinary angiotensinogen as a potential biomarker of severity of chronic kidney diseases

We previously reported that urinary excretion rates of angiotensinogen (AGT) provide a specific index of the activity of the intrarenal renin-angiotensin system in angiotensin II-dependent hypertensive rats. Meanwhile, we have recently developed direct enzyme-linked immunosorbent assays (ELISAs) to measure plasma and urinary AGT in humans. This study was performed to test a hypothesis that urinary AGT levels are enhanced in chronic kidney disease (CKD) patients and correlated with some clinical parameters. Eighty patients with CKD (37 women and 43 men, from 18 to 94 years old) and seven healthy volunteers (two women and five men, from 27 to 43 years old) were included. Plasma AGT levels showed a normal distribution; however, urinary AGT-creatinine ratios (UAGT/UCre) deviated from the normal distribution. When a logarithmic transformation was executed, Log(UAGT/UCre) levels showed a normal distribution. Therefore, Log(UAGT/UCre) levels were used for further analyses. Log(UAGT/UCre) levels were not correlated with age, gender, height, body weight, body mass index, systolic blood pressure, diastolic blood pressure, serum sodium levels, serum potassium levels, urinary sodium-creatinine ratios, plasma renin activity, or plasma AGT levels. However, Log(UAGT/UCre) levels were significantly correlated positively with urinary albumin-creatinine ratios, fractional excretion of sodium, urinary protein-creatinine ratios, and serum creatinine, and correlated negatively with estimated glomerular filtration rate. Log(UAGT/UCre) levels were significantly increased in CKD patients compared with control subjects (1.8801 ± 0.0885 vs. 0.9417 ± 0.1048; P = .0024). These data confirmed our earlier report and showed that a new ELISA assay is a valid approach for measuring urinary AGT.     

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

Objective

To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients.

The effect of Mid-Day Sleep on blood pressure levels in patients with arterial hypertension

Study objectivesLifestyle changes decrease blood pressure (BP) levels by 3-5 mmHg in hypertensive patients. We assessed the effect of mid-day sleep on BP levels in hypertensive patients.MethodsWe prospectively studied two hundred and twelve hypertensive patients. Mid-day sleep duration, lifestyle habits, anthropometric characteristics, office BP, ambulatory BP monitoring, pulse wave velocity (PWV), augmentation index (AI) were recorded. A standard echocardiographic evaluation was performed.Results53.8% were females, mean age was 62.5±11.0 years and mean body mass index was 28.9±5.4kg/m². Mean average 24h systolic and diastolic BP (SBP & DBP) was 129.9±13.2/76.7±7.9 mmHg respectively. The majority was non-smokers (70.3%) and did not have diabetes (74.7%). The mean midday sleep duration was 48.7±54.3 min. Average 24h SBP (127.6±12.9 mmHg vs 132.9±13.1 mmHg), average daytime SBP & DBP were lower in patients who sleep at midday, compared to those who do not (128.7±13/76.2±11.5 vs 134.5±13.4/79.5±10.4 mmHg) (p<0.005). The effect was not correlated to the dipping status. Midday sleep duration was negatively correlated with average 24h SBP & daytime SBP. In a linear regression model, for every 60 min of midday sleep, 24h average SBP decreases by 3 mmHg (p<0.001). There were no differences in the number of antihypertensive medications, PWV, AI or echocardiographic indices between study groups.ConclusionsMid-day sleep significantly decreases average 24h and daytime SBP/DBP in hypertensives. Its effect seems to be as potent as other well-established lifestyle changes and is independent of dipping status.     

Improvement of albuminuria after renal denervation

Objectives

The primary objective of this study was the effect of renal denervation (RDN) on elevated urinary albumin-to-creatinine ratio (UACR) in treatment-resistant hypertensive patients. In addition, patients were stratified according their UACR at baseline into micro- (30–300 mg/g, n = 37) and macroalbuminuria (≥ 300 mg/g, < 2200 mg/g, n = 22).

Background

Increased albuminuria indicates cardiovascular and renal damage in hypertension. RDN emerged as an innovative interventional approach to reduce blood pressure (BP) and may thus reduce albumin urinary excretion.

Methods

Fifty-nine treatment-resistant hypertensive patients with elevated UACR at baseline underwent catheter-based RDN using the Symplicity Flex™ catheter (Medtronic Inc., Santa Rosa, CA).

Results

In the whole and pre-specified subgroups both office and 24-h ambulatory BP were significantly reduced 6 months after RDN. In parallel, a significant reduction in UACR occurred in all patients (160 (65–496) versus 89 (29–319) mg/g creatinine, p < 0.001) and in both subgroups (microalbuminuria: 83 (49–153) versus 58 (17–113) mg/g creatinine, p = 0.001; macroalbuminuria: (536 (434–1483) versus 478 (109–1080) mg/g creatinine, p < 0.001). In accordance, the prevalence of micro- and macroalbuminuria decreased significantly. Regression analysis revealed a modest positive relationship between the decrease of UACR and the fall of systolic BP (β = 0.340, p = 0.039) independent of renal function. Renal function remained unchanged after RDN.

Conclusions

In summary, following RDN, the magnitude of albuminuria as well as the prevalence of micro- and macroalbuminuria decreased in treatment-resistant hypertensive patients. Since albuminuria is an independent renal and cardiovascular risk factor, our findings suggest a reduction of renal and cardiovascular risk in these patients.     

The relation between urinary angiotensinogen and proteinuria in renal AA amyloidosis patients

Objective: The aim of this study was to evaluate the relationship of local intrarenal renin angiotensin system (RAS) with proteinuria in patients with renal AA amyloidosis. Methods: Thirty-two patients with renal AA amyloidosis (19 male, mean age: 45?±?13 years) and sixteen healthy controls (5 male, mean age: 32?±?5 years) were included in this study. Spot urine samples were obtained to measure urinary angiotensinogen (AGT) using human AGT-ELISA, urinary creatinine and protein levels. Logarithmic transformations of urinary AGT-creatinine ratio log(UAGT/Ucre) and urinary protein-to-creatinine ratio (UPCR) were done to obtain the normal distributions of these parameters. Results: Log(UAGT/UCre) was significantly higher in patients compared with the controls (1.88?±?0.92 µg/g vs. 1.25?±?0.70 µg/g; p?=?0.023). Importantly a significantly positive correlation was found between log(UAGT/Ucre) and logUPCR in patients (r?=?0.595, p?=?0.006). Conclusions: Urinary AGT levels are higher in renal AA amyloidosis patients than in controls. Also, there is a significant positive correlation between urinary AGT and proteinuria in renal AA amyloidosis.     

Blood Pressure Targets in CKD: Lessons Learned from SPRINT and Previous Observational Studies

Hypertension management is one of the most common clinical tasks in the care of patients with chronic kidney disease (CKD). Elevated blood pressure (BP) is associated with greater risk of all-cause mortality, cardiovascular (CV) disease, and CKD progression in this population. However, it is still debated, to what target(s) BP should be lowered in patients with signs of kidney damage. The Systolic Blood Pressure Intervention Trial (SPRINT) provided new and important information about the effects of lowering systolic BP to a target of <120 mmHg, which is lower than the levels currently recommended by the most guidelines (<140/90 mmHg). The SPRINT results were not only exciting but also surprising for many clinicians because evidence from well-conducted observational studies in CKD patient showed increased mortality in patients with CKD whose office systolic BP levels were <120 mmHg, as compared with systolic BP in 120–139 mmHg range. In the present review, we will discuss whether a systolic BP goal of <120 mmHg that was found to be beneficial for CV and all-cause mortality outcomes in the SPRINT can be generalized to the entire CKD population.     

Ambulatory blood pressure monitoring versus self-measurement of blood pressure at home: correlation with target organ damage

OBJECTIVE: Ambulatory blood pressure (BP) monitoring and home blood pressure measurements predicted the presence of target organ damage and the risk of cardiovascular events better than did office blood pressure. METHODS: To compare these two methods in their correlation with organ damage, we consecutively included 325 treated (70%) or untreated hypertensives (125 women, mean age = 64.5 +/- 11.3) with office (three measurements at two consultations), home (three measurements morning and evening over 3 days) and 24-h ambulatory monitoring. Target organs were evaluated by ECG, echocardiography, carotid echography and detection of microalbuminuria. Data from 302 patients were analyzed. RESULTS: Mean BP levels were 142/82 mmHg for office, 135.5/77 mmHg for home and 128/76 mmHg for 24-h monitoring (day = 130/78 mmHg; night = 118.5/67 mmHg). With a 135 mmHg cut-off, home and daytime blood pressure diverged in 20% of patients. Ambulatory and Home blood pressure were correlated with organ damage more closely than was office BP with a trend to better correlations with home BP. Using regression analysis, a 140 mmHg home systolic blood pressure corresponded to a 135 mmHg daytime systolic blood pressure; a 133 mmHg daytime ambulatory blood pressure and a 140 mmHg home blood pressure corresponded to the same organ damage cut-offs (Left ventricular mass index = 50 g/m, Cornell.QRS = 2440 mm/ms, carotid intima media thickness = 0.9 mm). Home-ambulatory differences were significantly associated with age and antihypertensive treatment. CONCLUSION: We showed that home blood pressure was at least as well correlated with target organ damage, as was the ambulatory blood pressure. Home-ambulatory correlation and their correlation with organ damage argue in favor of different cut-offs, that are approximately 5 mmHg higher for systolic home blood pressure.     

Evaluation of the Relationship Between Arterial Blood Pressure,Aortic Stiffness and Serum Endothelin-1 Levels in Patients with Essential Hypertension

This study has attempted to evaluate the relationship between aortic stiffness, blood pressure (BP) and serum endothelin-1 (ET-1) levels in patients with essential HT. Totally 152 subjects, consisting of 103 patients diagnosed with HT at least 1 year previously and 49 healthy individuals, were enrolled in this study. They were subdivided, on the basis of BP measurements made at home, into three groups as the hypertensives with dysregulated BP (n = 56), the hypertensives with regulated BP (n = 47) and the normotensive controls (n = 49). Statistically significant differences were observed between the three groups with respect to aortic elasticity parameters (p < 0.01 for aortic strain, aortic distensibility and aortic stiffness). Serum ET-1 levels in the three groups were similar (p = 0.101), but a significant correlation was observed between the ET-1 values and the aortic elasticity parameters (p = 0.004). Alteration of the aortic elasticity parameters in patients with HT not only correlates with the serum ET-1 levels indicating endothelial dysfunction but also gives direct clues about status of BP regulation.     

Gender Differences in Office and Ambulatory Control of Hypertension

Background

Gender differences in hypertension control have not been explored fully.

Methods

We studied 15,212 white men and 13,936 white women with treated hypertension who were drawn from the Spanish Ambulatory Blood Pressure Registry. For each participant, we obtained office blood pressure (BP) (average of 2 readings) and 24-hour ambulatory BP (average of measurements performed every 20 minutes during day and night).

Results

Only 16.4% of women and 14.7% of men had both office (<140/90 mm Hg) and ambulatory (<130/80 mm Hg) BP controlled (P < .001). Women had a lower frequency of masked hypertension (office BP < 140/90 mm Hg and ambulatory BP ≥ 130/80 mm Hg) than men (5.9% vs 7.9%, P < .001). Women had a higher frequency of isolated office hypertension (office BP ≥ 140/90 mm Hg and ambulatory BP < 130/80 mm Hg) (32.5% vs 24.2%, P < .001). Although office BP control (office BP < 140/90 mm Hg, regardless of ambulatory values) was similar in women and men (22.3% vs 22.6%, P = .542), ambulatory BP control (ambulatory BP < 130/80 mm Hg, regardless of office values) was higher in women than in men (48.9% vs 38.9%, P < .001). After adjustment for age, number of antihypertensive drugs, hypertension duration, and risk factors, gender differences in BP control remained practically unchanged.

Conclusion

Ambulatory BP control was higher in women than in men. This may be due to the higher frequency of isolated office hypertension in women, and it is not explained by gender differences in other important clinical characteristics.