Ambulatory Monitoring of Blood Pressure and Arrhythmias by non-invasive methods in Hypertensive Patients Treated with Metoprolol

Non-invasive ambulatory monitoring of blood pressure and ECG was employed to assess the 24-hour profile of blood pressure and arrhythmias in 20 out-patients aged 31–69 years. The technique was further used to measure the therapeutic response to 100 mg once daily of the cardioselective beta-blocker metoprolol. The basal ambulatory examinations revealed that all 20 patients had a mean 24-hour blood pressure of >160/90 mm Hg, corresponding to a mean arterial pressure (MAP) of > 113 mm Hg. In 16 of the 20 patients (80%) the mean 24-hour MAP was reduced to below 113 mm Hg. Addition of diuretics in the remaining four patients further decreased the mean 24-hour MAP to < 113 mm Hg, which confirmed by a third ambulatory examination. The ECG recordings in the initial ambulatory study revealed severe degrees of ventricular arrhythmias in 7 patients. After treatment with metoprolol, all of them presented an improved ECG picture.     

Orthostatic Blood Pressure Dysregulation and Polymorphisms of β‐Adrenergic Receptor Genes in Hypertensive Patients

The genetic susceptibility to orthostatic blood pressure dysregulation remains poorly understood. The association between polymorphisms of beta‐adrenergic receptor (β‐AR) genes and orthostatic blood pressure dysregulation in hypertensive patients was investigated. Two polymorphisms of β₁‐AR (Arg389/Gly) and β₂‐AR (Arg16/Gly) were genotyped in untreated hypertensive patients and normotensive patients. In patients with untreated hypertension, the frequency of β₁‐AR Gly389 homozygote was significantly higher in patients with orthostatic hypotension (OH) (P<.0001) and lower in patients with orthostatic hypertension (OHT) (P=.002) as compared with patients with orthostatic normotension (ONT) even after Bonferroni correction. After analysis by sex and adjustment for conventional risk factors, the β₁‐AR Gly389 homozygote conferred about a 3‐fold risk of OH and independently predicted a 6.5 mm Hg greater orthostatic SBP decrease (GG −8.9±13 mm Hg vs CC+CG −2.4±12 mm Hg, P<.001) only in female hypertensive patients. The association of β₂‐AR Arg16/Gly with OH was not significant after adjustment for conventional risk factors. In normotensive patients, no association was identified between these two polymorphisms and OHT or OH. These results indicated that the β₁‐AR Arg389/Gly polymorphism may be associated with increased risk of OH in female hypertensive patients.

Orthostatic blood pressure (BP) change is a common clinical problem in the real world of clinical practice. According to the updated consensus statement by the European Federation of Neurological Societies, orthostatic hypotension (OH) is defined as a sustained reduction in systolic BP (SBP) of at least 20 mm Hg or diastolic BP (DBP) of 10 mm Hg from the supine position to standing.¹ The most commonly used criterion for a diagnosis of orthostatic hypertension (OHT) appears to be an increase of SBP of 20 mm Hg with orthostatic change.² OH has been identified as an independent risk factor for cardiovascular disease,³ arterial stiffness,⁴ and ischemic stroke⁵ as a potential indicator underlying autonomic dysfunction.⁶ OHT is associated with cardiovascular disease,⁷ sustained hypertension,⁸ diabetes mellitus,⁹ and target organ damage.¹⁰ Hypertension, with estimates of heritability ranging from 31% to 68%,¹¹ has been associated with the increased risk of OH and OHT in many epidemiological studies.¹², ¹³ Therefore, better understanding of the underlying pathophysiology and genetic background may predict cardiovascular events and mortality independently of traditional risk factors and might have major clinical significance in hypertensive and normotensive patients.Many genetic variants have been suggested that partly contribute to the variation of BP response to postural change. Past studies indicate that genes on chromosome 13q and 18q are possibly associated with SBP response to postural change.¹⁴, ¹⁵ Some mitochondrial DNA mutations are also associated with idiopathic OH.¹⁶ The sympathetic nervous system (SNS) and the renin angiotensin system (RAS) may be involved in the pathogenesis of orthostatic dysregulation of BP.¹ Although the genetic variants in genes encoding components of the RAS have been associated with hypertension and BP variations, our previous study did not find any evidence for the role of angiotensin‐converting enzyme (ACE) and ACE2 in the genetic predisposition to OH or OHT in hypertensive and normotensive patients.¹⁷ β‐Adrenergic receptor (AR) is the important component of the SNS and it plays a crucial role in BP regulation.¹⁸ There are β₁‐, β₂‐, and β₃‐ARs. β₁‐ and β₂‐AR are the predominate receptors in the human heart.¹⁹ Some genetic variants in the β₁‐ and β₂‐AR genes have been associated with hypertension, OH, and orthostatic intolerance. However, few data are available on the genetic predisposition for OHT.Therefore, we hypothesized that polymorphisms of β₁/β₂‐AR may contribute to OH or OHT in hypertensive patients. To test our hypothesis, we investigated the association of orthostatic BP dysregulation with two common polymorphisms of β₁/β₂‐AR genes in 3630 untreated hypertensive patients and 826 normotensive patients.     

有效控制血压对高危高血压患者左室肥厚的长期影响

目的对“1999WHO/ISH高血压防治指南”危险分层为高危和极高危组的患者单用或联合使用指南推荐的一线降压药,以血压<140/90mmHg作为目标血压,观察有效控制血压对高危高血压患者左室肥厚的长期影响。方法763例患者确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381)。目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止。对照组在普通门诊治疗。测定基线和治疗后的超声心动图。结果两组患者的基线特征无明显差异。在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6/79.7±5.5)mmHg,明显低于对照组(151.7±12.7/87.7±8.0)mmHg,P<0.0001)。共有437例患者复查超声心动图1次以上。目标治疗组(n=270)左室重量指数由124.9降至119.7g/m2,下降4.2%(P=0.007);对照组由131.0增至136.9g/m2,增加4.5%(P=0.05)。233例患者在基线时患有左室肥厚,目标治疗组142例;对照组91例。最后1次测量与基线相比,目标治疗组左室重量指数降低14.8g/m2(10.1%,P<0.0001);对照组下降2.9g/m2(1.8%,P=0.53)。目标治疗组66例左室肥厚消失,左心室肥厚逆转率为46.5%,显著高于对照组的31.9%(91例中29例左室肥厚消失,P=0.03)。在基线没有左室肥厚的204例患者中,目标治疗组(n=128)左室重量指数增加5.3g/m2(5.3%,P=0.03);对照组(n=76)增加16.4g/m2(16.8%,P<0.0001)。复查达到左室肥厚标准者,目标治疗组34例(26.6%);对照组27例(35.5%),两组间无显著差异(P=0.12)。结论与一般治疗相比,长期严格控制血压能降低高血压左室肥厚患者的左心室重量,并显著提高左室肥厚逆转率。     

有效控制血压对高危高血压患者左室肥厚的长期影响

目的对"1999WHO/ISH高血压防治指南"危险分层为高危和极高危组的患者单用或联合使用指南推荐的一线降压药,以血压＜140/90 mm Hg作为目标血压,观察有效控制血压对高危高血压患者左室肥厚的长期影响.方法763例患者确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381).目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止.对照组在普通门诊治疗.测定基线和治疗后的超声心动图.结果两组患者的基线特征无明显差异.在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6/79.7±5.5)mm Hg,明显低于对照组(151.7±12.7/87.7±8.0)mm Hg,P＜0.0001).共有437例患者复查超声心动图1次以上.目标治疗组(n=270)左室重量指数由124.9降至119.7 g/m2,下降4.2%(P=0.007);对照组由131.0增至136.9 g/m2,增加4.5%(P=0.05).233例患者在基线时患有左室肥厚,目标治疗组142例;对照组91例.最后1次测量与基线相比,目标治疗组左室重量指数降低14.8 g/m2(10.1%,P＜0.0001);对照组下降2.9 g/m2(1.8%,P=0.53).目标治疗组66例左室肥厚消失,左心室肥厚逆转率为46.5%,显著高于对照组的31.9%(91例中29例左室肥厚消失,P=0.03).在基线没有左室肥厚的204例患者中,目标治疗组(n=128)左室重量指数增加5.3 g/m2(5.3%,P=0.03);对照组(n=76)增加16.4 g/m2(16.8%,P＜0.0001).复查达到左室肥厚标准者,目标治疗组34例(26.6%);对照组27例(35.5%),两组间无显著差异(P=0.12).结论与一般治疗相比,长期严格控制血压能降低高血压左室肥厚患者的左心室重量,并显著提高左室肥厚逆转率.     

Differential Effects of Amlodipine on Ambulatory Blood Pressure in Elderly Hypertensive Patients With Different Nocturnal Reductions in Blood Pressure

Previous studies have discovered that amlodipine given once daily can reduce blood pressure (BP) throughout the day and night. The effects of amlodipine on day and night BP have not been fully investigated in groups of hypertensives with different diurnal variations. In a prospective study, we performed 24-h ambulatory BP monitoring before and after once-daily use of amlodipine in three groups of asymptomatic elderly hypertensive patients with different nocturnal BP reductions, as follows: 10 extreme dippers with nocturnal reduction of systolic BP ≥ 20% of daytime systolic BP, 17 dippers (reduction by ≥ 10% to < 20%), and 23 nondippers (reduction by < 10%). At baseline, the office and the awake BP were similar in all three groups, whereas the nighttime BP was significantly higher in the nondippers than in the dippers and in the dippers than in the extreme dippers. After treatment, the office and the daytime BP were both equally reduced in all three groups. On the other hand, the nighttime BP was significantly reduced both in the nondippers and, to a lesser extent, in the dippers. In the extreme dippers, however, no further reductions of nocturnal BP were found. Significant positive correlations were found between baseline BP levels and the BP reduction after amlodipine therapy was begun. No BP reduction > 10 mm Hg was observed when the baseline systolic/diastolic BP was < 120/70 mm Hg. Multiple linear regression analysis disclosed that the nighttime BP reduction afforded by amlodipine was dependent on the baseline nighttime BP levels, but not on the baseline nocturnal fall of BP. Once-daily use of amlodipine reduced BP levels throughout the day and night in hypertensive patients who show minimal or mild nocturnal BP fall, but it had no effects on nocturnal BP in those who show a substantial nighttime BP reduction. Thus, when we controlled using daytime office BP, amlodipine might not further reduce nocturnal BP to the extent that it accelerates the brain ischemia in some hypertensive patients with marked nocturnal BP reduction.     

Comparison of 44‐Hour and Fixed 24‐Hour Ambulatory Blood Pressure Monitoring in Dialysis Patients

The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44‐hour and 24‐hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24‐hour period that correlated well with the 44‐hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44‐hour ABPM and extracted data for a fixed 24‐hour ABPM. The fixed 24‐hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44‐hour and the fixed 24‐hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24‐hour ABPM and 44‐hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44‐hour ambulatory arterial stiffness index (AASI), but not 24‐hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44‐hour systolic blood pressure, this association disappeared. Fixed 24‐hour ABPM is a good surrogate of 44‐hour ABPM to some extent, while 44‐hour ABPM can provide more accurate and detailed information.     

老年高血压病人血压动态变化与心率变异性关系的研究

目的研究比较老年高血压病人的血压变化与自主神经关系.对象研究组高血压病人100例,男性93例,女性7例,平均年龄73±7(60～90)岁.对照组为同期住院的无高血压病人100例,男性98例,女性2例,平均年龄72±8(60～90)岁.方法动态血压测定24 h血压,动态心电图测定心率变异性反映自主神经功能.结果研究组的心率变异性指标均低于对照组.以24小时平均血压(MAP)为自变量,24 h平均R-R 间期标准差(SD)为应变量,研究组的HRV与血压改变为正相关,SD=0.09MAP+24.75,PNN50=0.10MAP+8.34;对照组的HRV与血压改变为负相关,SD=-0.32MAP+68.87,PNN50=-0.047MAP+21.65.结论老年人中血压正常者其自主神经与血压的关系仍符合正常生理状态.高血压病人的这种自主神经反射机制发生故障,所以表现出一种相反的趋势血压越高,HRV也越高.     

Ambulatory Blood Pressure Monitoring in Patients with Essential Hypertension Treated with a New Calcium Antagonist, Cilnidipine

Cilnidipine (FRC-8653), a new dihydropyridine calcium antagonist, was given to 14 hospitalized patients with essential hypertension, and 24-hour ambulatory blood pressure (BP) monitoring was performed. Once-daily administration of cilnidipine (5–20 mg) for 1–3 weeks decreased the 24-hour average BP significantly from 149 ± 4/88 ± 2 mmHg to 141 ± 3/82 ± 2 mmHg without any change in the pulse rate. The decrease in ambulatory BP by cilnidipine was evident during the daytime (156 ± 4/93 ± 2 mmHg to 143 ± 5/84 ± 2 mmHg, p > 0.01 for systolic BP and p > 0.01 for diastolic BP), while it was mild during nighttime (141 ± 4/80 ± 2 mmHg to 133 ± 4/76 ± 3 mmHg, p > 0.05 for systolic and ns for diastolic BP). The decrease in the ambulatory BP over the whole day and during the nighttime was significantly correlated with the basal ambulatory BP levels. When the subjects were divided into the high ambulatory BP (n = 7) and low ambulatory BP (n = 7) groups, the BP reduction by cilnidipine was evident throughout 24 hours in the high ambulatory BP group, while it was mild and significant only during daytime in the low ambulatory BP group. In summary, once-daily cilnidipine exerts a sufficient and prolonged reduction of BP without an increase in the pulse rate in patients with hypertension. The potency of cilnidipine to decrease ambulatory BP may depend on the basal ambulatory BP level. Cilnidipine is thus a useful antihypertensive drug that may not cause an excessive decrease in BP or a reflex tachycardia.     

Abnormal Pulsatile Hemodynamics in Hypertensive Patients With Normalized 24‐Hour Ambulatory Blood Pressure by Combination Therapy of Three or More Antihypertensive Agents

It remains uncertain whether intensive antihypertensive therapy can normalize pulsatile hemodynamics resulting in minimized residual cardiovascular risks. In this study, office and 24‐hour ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, carotid‐femoral pulse wave velocity (PWV), and forward (Pf) and reflected (Pb) pressure wave from a decomposed carotid pressure wave were measured in hypertensive participants. Among them, 57 patients whose 24‐hour SBP and DBP were normalized by three or more classes of antihypertensive medications were included. Another 57 age‐ and sex‐matched normotensive participants were randomly selected from a community survey. The well‐treated hypertensive patients had similar 24‐hour SBP, lower DBP, and higher PP values. The treated patients had higher PWV (11.7±0.3 vs 8.3±0.2 m/s, P<.001), Pf, Pb, Pb/Pf, and left ventricular mass index values. After adjustment for age, sex, body mass index, and office SBP, the differences for PWV, Pb, and Pb/Pf remained significant. Hypertensive patients whose 24‐hour SBP and DBP are normalized may still have markedly increased arterial stiffness and wave reflection.     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的　应用动态血压监测 (ABPM )的方法评价贝尼地平治疗原发性高血压的降压疗效、谷 /峰比值及不良反应。方法　采用开放的方法 ,2 0例研究对象经 2周洗脱期 ,服用贝尼地平 4mg/d一次 ,2周末坐位舒张压 (SeDBP)≥ 90mmHg者加量至贝尼地平 8mg/d一次 ,继续服用 6周。于洗脱期末及治疗 8周末各行ABPM和实验室检查一次。结果　ABPM显示 8周末 2 4h、日间、夜间收缩压 (SBP/DBP)较洗脱期末分别下降 (9.4± 5 .4 / 6 .2± 4 .1)mmHg、(10 7± 6 .7/ 6 8± 3 8)mmHg、(6 9± 9 0 / 5 1± 7 7)mmHg。降压T/P值SBP为 5 8% ,DBP为 5 9%。无严重不良反应。 结论　贝尼地平 4～ 8mg/d一次为疗效确切的降压药物。     

Effect of a Novel Calcium Channel Blocker on Abnormal Nocturnal Blood Pressure in Hypertensive Patients

The authors examined the effect of cilnidipine, a unique L/N‐type calcium channel blocker, on abnormal nocturnal blood pressure (BP) dipping in Japanese hypertensive patients in the real world. The Ambulatory Blood Pressure Control and Home Blood Pressure (Morning and Evening) Lowering by N‐Channel Blocker Cilnidipine (ACHIEVE‐ONE), a large‐scale clinical study, was designed to evaluate the effects of cilnidipine in daily medical practice. Among the study, 24‐hour ambulatory BP data were obtained from 615 patients and classified according to their nocturnal dipping status as extreme dippers, dippers, nondippers, or risers. A 12‐week treatment with cilnidipine significantly reduced 24‐hour BP in all groups (P<.001). Changes in nocturnal systolic BP (SBP) from baseline were −17.9 mm Hg from 154.6 mm Hg in risers and −11.9 mm Hg from 142.1 mm Hg, −6.6 mm Hg from 128.5 mm Hg, and 0.1 mm Hg from 115.8 mm Hg in nondippers, dippers, and extreme dippers, respectively. Changes from baseline in nocturnal SBP reduction rate were 8.2% in risers (P<.001) but −7.0% in extreme dippers (P<.001), while no change was observed in the nighttime SBP reduction rate for the total patients (−0.2%±9.6%, P=.617). Cilnidipine partially, but significantly, restored abnormal nocturnal dipping status toward a normal dipping pattern in hypertensive patients.

A number of studies have demonstrated that nocturnal nondipping¹, ², ³ and extreme dipping of blood pressure (BP)⁴, ⁵, ⁶ are associated with organ damage. A lack of nocturnal dipping has also been related to risk of cardiovascular events,⁷, ⁸, ⁹, ¹⁰, ¹¹ even if BP measured at the clinic or at home is normal. Diuretics, angiotensin‐converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone antagonists are partially effective in restoring normal BP dipping.¹², ¹³, ¹⁴ However, evidence‐based studies of antihypertensive medication for the treatment of abnormal nocturnal dipping are lacking. In current daily medical practice, antihypertensive medication for reducing 24‐hour BP as well as normalizing dipping status need to be individualized and optimized in each hypertensive patient with different backgrounds such as age and comorbidities.Cilnidipine is a unique L/N‐type calcium channel blocker (CCB) that inhibits norepinephrine release at sympathetic nerve endings by blocking N‐type calcium channels and directly dilates vascular vessels by blocking L‐type calcium channels.¹⁵, ¹⁶, ¹⁷, ¹⁸ Recently, we demonstrated that cilnidipine reduced BP and pulse rate (PR) in patients with morning hypertension suggested to be characterized by increased sympathetic activity using data measured at home obtained from the Ambulatory Blood Pressure Control and Home Blood Pressure (Morning and Evening) Lowering by the N‐Channel Blocker Cilnidipine (ACHIEVE‐ONE) trial.¹⁹ The investigation is a large‐scale clinical study designed to evaluate the effects of cilnidipine in daily medical practice on BP and PR in patients with essential hypertension measured at the clinic and at home. In a portion of these patients, measurement was performed by 24‐hour ambulatory BP (ABP) monitoring (ABPM).In the present study, we examined the effects of cilnidipine on abnormal nocturnal dipping in hypertensive patients.     

Sex‐Specific Differences in Cardiovascular Risk Factors and Blood Pressure Control in Hypertensive Patients

Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high‐density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events.     

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

The authors aimed to investigate the blood pressure (BP)–lowering ability of eplerenone in drug‐resistant hypertensive patients. A total of 57 drug‐resistant hypertensive patients whose home BP was ≥135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flow‐mediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148±15 vs 140±15 mm Hg) and evening systolic BP (137±16 vs 130±16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24‐hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug‐resistant hypertension, add‐on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP.     

The Impact of Cigarette Smoking on 24‐Hour Blood Pressure,Inflammatory and Hemostatic Activity,and Cardiovascular Risk in Japanese Hypertensive Patients

The aim of the study was to assess the impact of current smoking on 24‐hour blood pressure (BP) and inflammatory and hemostatic activity and thereby the incidence of cardiovascular disease (CVD) in Japanese hypertensive patients. A total of 810 hypertensive patients (mean age 72 years; 38% men) were prospectively followed‐up (2799 person‐years). During the follow‐up, 66 cases of CVD occurred (stroke, 55; myocardial infarction, 7; both, 4). At baseline, the current smokers (n=166) had higher levels of high‐sensitivity C‐reactive protein (hs‐CRP) (0.21 mg/dL vs 0.14 mg/dL) and plasminogen activator inhibitor‐1 (PAI‐1) (46.1 ng/mL vs 37.8 ng/mL; both P=.001), but not of 24‐hour BP, compared with nonsmokers. Using a Cox regression analysis, current smoking was independently associated with an increased risk of CVD (hazard ratio [HR], 2.6; P<.01), and the risk was substantially higher in women (HR, 6.1; P<.001) than in men (HR, 1.4; P=.41). The CVD risk of current smokers was magnified when it was accompanied with high hs‐CRP (highest quartile range, ≥0.40 mg/L) or PAI‐1 levels (≥58.9 ng/mL) compared with that in smokers with low hs‐CRP or PAI‐1 levels (both P<.05). Among hypertensive patients, current smokers had increased risk of CVD events, and the increase was more prominent when accompanied by circulatory inflammatory and hemostatic abnormalities. J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc.     

Predictors of Uncontrolled Blood Pressure in Treated Hypertensive Individuals: First Population‐Based Study in Lebanon

Arterial hypertension is a leading risk factor for cardiovascular disease and stroke. This study aimed to assess the predictors of uncontrolled systolic and diastolic blood pressure (BP) in Lebanon among treated hypertensive individuals. The authors included 562 participants 40 years and older. The potential predictors included sociodemographic characteristics, self‐reported health information, and medication adherence. Prevalence of uncontrolled systolic and diastolic BP reached 43.1% and 24.9%, respectively. Independent predictors of uncontrolled systolic BP were older age, male sex, and low and medium medication adherence level. Predictors of uncontrolled diastolic BP were younger age, obesity, and low medication adherence level. Married individuals and patients taking statins had better diastolic BP control. Uncontrolled BP is a major public health problem in Lebanon. The authors identified low adherence as a major modifiable risk factor for systolic and diastolic BP control and obesity as a major modifiable risk factor for diastolic BP control.     

Obstructive Sleep Apnea Using Watch‐PAT 200 Is Independently Associated With an Increase in Morning Blood Pressure Surge in Never‐Treated Hypertensive Patients

This study aimed to examine the association between obstructive sleep apnea (OSA) and morning blood pressure surge in never‐treated patients with essential hypertension. This prospective study included a total of 58 patients (mean age, 51.7 years; 55.2% men) with never‐treated essential hypertension. The patients were divided into non‐OSA (n=23, 49.3±12.7 years) and OSA (n=35, 53.2±9.8 years) groups. The OSA group was defined as having an apnea‐hypopnea index level >5 as measured by the Watch‐PAT 200. The authors collected 24‐hour ambulatory BP, plasma aldosterone concentration, and plasma renin activity data from all of the patients. The measured sleep‐trough morning systolic blood pressure (SBP) increases were higher in the OSA group than in the non‐OSA group (28.7±11.8 mm Hg vs 19.6±12.8 mm Hg, P=.008). The sleep‐trough morning SBP increase was inversely correlated with the lowest oxygen saturation (r=−0.272, P=.039). OSA known to be associated with increased daytime and nocturnal sympathetic activity was associated with significantly higher sleep‐trough morning SBP levels in this study.

Obstructive sleep apnea (OSA) is a common disorder characterized by episodes of upper airway obstruction during sleep. The prevalence of OSA (apnea±hypopnea index [AHI] ≥5) in adults 30 to 69 years is estimated at 17%, increasing to 23% to 35% in relatively unselected hypertensive populations.¹, ² OSA is associated with endothelial dysfunction, metabolic syndrome, atherosclerosis, and cardiovascular disorders.³, ⁴, ⁵, ⁶, ⁷ Morning blood pressure (BP) surge (MS) is a normal physiological phenomenon; however, extreme MS is a risk factor for stroke and cardiovascular mortality.⁸, ⁹, ¹⁰ Sympathetic activity is suspected to play a role as an underlying mechanism in OSA and MS.⁷, ¹¹, ¹², ¹³ Few studies have evaluated the association between OSA and MS.¹⁴, ¹⁵ Peripheral arterial tone (PAT) is based on the pulsatile plethysmographic signal that is measured on a finger, which could serve as a single noninvasive substitute for sympathetic activity.¹⁶ This study aimed to examine the association of sleep parameters with WATCH^‐PAT 200 (WP200; (Itamar Medical Ltd, Caesarea, Israel) based on measurements of PAT variations and MS in never‐treated patients with essential hypertension.¹⁶, ¹⁷, ¹⁸, ¹⁹