PP.17.27

sponsorship: The European Union (HEALTH-F7-2011-278249 EU-MASCARA, HEALTH-F7-305507 HOMAGE and the European Research Council Advanced Researcher Grant 294713 EPLORE) and the Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium (G.0881.13 and G.0880.13) currently support the Studies Coordinating Centre (Leuven, Belgium). (European Union|HEALTH-F7-2011-278249 EU-MASCARA, European Union|HEALTH-F7-305507 HOMAGE, European Union (European Research Council)|294713 EPLORE, Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium|G.0881.13, Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium|G.0880.13)

Objective: Seasonal blood pressure (BP) changes has been described in clinic BP. Few studies have examined the seasonal variation in BP and BP variability, assessed by 24-hour ambulatory blood pressure monitoring (ABPM) and it remains uncertain whether the seasonal trend differs between young and elderly hypertensive patients. Design and Method: A total of 1028 untreated essential hypertensive patients (mean age 52 ± 14 years) who underwent 24-hour ABPM between January 2009 and April 2013 were enrolled. Patients were divided into young (age ≤ 70 years, n = 927) and elderly (age > 70 years, n = 101) groups. Results: Compared to elderly group, young age group had higher clinic, 24-hour, daytime and night-time diastolic BP (DBP), higher clinic, 24-hour and daytime heart rate (HR), higher 24-hour and daytime HR variability (HRV), lower night-time systolic BP (SBP) and daytime SBP variability. In young age group, significant seasonal variation of clinic DBP and daytime SBP variability with a peak in autumn, and nighttime DBP and HR with a peak in spring and the increased prevalence of non-dippers in summer were observed. On the other hand, elderly group demonstrated seasonal variation of clinic, 24-hour, daytime and nighttime HR with a peak in autumn, daytime DBP with a peak in winter and night-time SBP variability with a peak in summer. Conclusions: There was an apparent seasonal variation of DBP, HR and SBP variability in both young and elderly hypertensive patients. However, elderly patients showed more pronounced seasonal change in HR compared to younger patients.

Patients with hypertension have a blunted sensitivity of baroreflex control of heart period. In these patients, baroreflex sensitivity is positively related to heart rate variability and inversely related to blood pressure variability. We hypothesized that this relationship would also be evident in healthy normotensive subjects and that individuals with higher baroreflex sensitivity would have lower ambulatory 24-hour blood pressure. Twenty-four-hour ambulatory blood pressure and heart rate were recorded in 50 healthy, normotensive, nonobese individuals (31 women and 19 men). The baroreflex was assessed using sequential bolus administration of sodium nitroprusside and phenylephrine, and baroreflex sensitivity was calculated as the slope of the relation between systolic blood pressure and R-R interval during the resulting blood pressure transients. Baroreflex sensitivity was inversely correlated to 24-hour average mean arterial pressure (R=0.49; P<0.001) and positively related to daytime heart rate variability (R=0.33; P=0.02). In contrast, no relationship was found between baroreflex sensitivity and 24-hour heart rate or blood pressure variabilities. We conclude that the relationship between baroreflex sensitivity and daytime heart rate variability was similar to that reported previously in hypertensive subjects. Furthermore, the inverse relation between baroreflex sensitivity and mean arterial pressure supports the idea that the baroreflex may exert longer-term effects on blood pressure than thought previously.

Ambulatory blood pressure pattern in elderly athletes.

Background: The effects of empagliflozin in addition to standard care, on day-to-day variability of self-measured home blood pressure (BP) and heart rate (HR) at home in patients with type 2 diabetes (T2DM) at high cardiovascular risk are not known. Method: We followed twenty-three consecutive T2DM patients (mean age: 69 years old, 12 men) to add 10 mg of empagliflozin once daily for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. The variability of BP and HR were defined as the standard deviations (SD) of measurements which were performed on seven consecutive days. Results: For home blood pressure, empagliflozin significantly reduced systolic blood pressure (SBP) from 130±11 mmHg at baseline to 126±11 mmHg at the first week(1W) of the administration (P&lt;0.05). SBP achieved the target home BP goal (125±11 mmHg) at the second week(2W) and was maintained during the study (P&lt;0.01). As regards day-to-day variability of SBP, SD decreased from 7.3±3.5 mmHg at baseline to 6.7±2.5 mmHg at 1W (4W: 6.4±2.8 mmHg, 8W: 5.2±2.3 mmHg, P&lt;0.05). In diastolic blood pressure (DBP), there was a significant reduction of SD compared with that at baseline (4.9±1.6 mmHg at baseline, 4W: 4.3±1.6 mmHg, 8W: 3.9±1.8 mmHg, 12W: 4.4±1.6 mmHg, P&lt;0.05); however, there was no change of DPB (71±10 mmHg at baseline, 12W: 71±8 mmHg). Similarly, there was a decreasing trend in SD of HR (3.9±1.0 beats per minute (bpm) at baseline, 4W: 3.3±1.3 bpm, 12W: 3.1±1.3 bpm, P&lt;0.1), although there was no significant change in HR (62±13 bpm at baseline, 12W: 61 ± 12 bpm). Conclusion: Empagliflozin tended to reduce the day-to-day variability of self-measured morning home BP and HR.

Contribution of the renin-angiotensin and kallikrein-kinin systems to short-term variability of blood pressure in two-kidney, one-clip hypertensive rats

To investigate the association between cardiovascular mortality and short-term variabilities in blood pressure and heart rate, we performed a long-term prospective study of ambulatory blood pressure monitoring in Ohasama, Japan, starting in 1987. We obtained ambulatory blood pressure and heart rate in 1542 subjects >/=40 years of age. Blood pressure and heart rate variabilities were estimated as a standard deviation measured every 30 minutes by ambulatory monitoring. There were 67 cardiovascular deaths during the follow-up period (mean=8.5 years). The Cox proportional hazards model, adjusted for possible confounding factors, demonstrated a significant increase in cardiovascular mortality, with an increase in daytime systolic ambulatory blood pressure variability. A similar trend was observed in daytime diastolic and nighttime ambulatory blood pressures. Cardiovascular mortality rate increased linearly, with a decrease in daytime heart rate variability. Subjects in whom the daytime systolic ambulatory blood pressure variability was larger than third quintile and the daytime heart rate variability was lower than the mean-SD were at extremely high risk of cardiovascular mortality. The blood pressure and heart rate variabilities obtained every 30 minutes by ambulatory blood pressure monitoring were independent predictors for cardiovascular mortality in the general population.

The increasing use of ambulatory blood pressure monitoring (ABPM) devices in the investigation of hypertension has allowed detailed study of the circadian rhythm of blood pressure variability, the assessment of resistant hypertension, and the syndrome of “white coat” hypertension. The relevance of ABPM to target-organ damage and the complications of hypertension, such as heart attacks and strokes, has only recently gained prominence. There are more than 30 cross-sectional studies that have linked ABPM to hypertensive target-organ damage, including left ventricular hypertrophy (LVH),1 2 microalbuminuria,3 hypertensive retinal changes, and cerebrovascular disease.4 The majority of these studies have consistently reported that patients with an absent or reduced fall in blood pressure at night (referred to as “nondippers”) have more severe target-organ damage, including LVH5 and cerebrovascular disease,4 6 when compared with patients who demonstrate a normal nocturnal fall in blood pressure. For example, Verdecchia et al,7 in a prospective cohort of over 1100 hypertensive patients, reported higher mortality rates both in nondippers and “reverse dippers” and higher cardiovascular morbidity rates in female nondippers compared with dippers.8 In addition, Yamamoto et al9 recently reported that progressive cerebrovascular disease, including silent ischemic lesions and symptomatic stroke, was associated with a reduced nocturnal blood pressure fall in patients with a history of lacunar infarction. In a cross-sectional study of patients admitted with acute stroke (ictus <12 hours), Lip at al10 reported that such patients could generally be classed as nondippers, with higher blood pressures recorded using ABPM (but not using casual manual measurements) in black/Afro-Caribbean patients and also in patients with hemorrhagic stroke. These studies therefore suggest the potential usefulness of ABPM in epidemiological, cohort, or cross-sectional studies and the assessment of ethnic differences, stroke subtypes, and prognosis. A nondipper status …

We examined the acute and chronic effects of a nutritionally balanced, moderately hypocaloric diet on 24-hour ambulatory blood pressure, heart rate and heart-rate variability in mildly-to-moderately obese patients with essential hypertension. We enrolled 16 obese patients with essential hypertension [age: 51–76 years, body mass index (BMI): 26–32 kg/m2]. For the initial week, a standard diet of 2,000 kcal/day was given, followed by a 3-week of a hypocaloric diet of 850 kcal/day. In the last period of the standard diet and in the first and the last periods of the hypocaloric diet, each subject's 24-hour ambulatory blood pressure, heart rate and R-R intervals of the electrocardiogram were recorded, and electrolytes and catecholamines in 24-hour urine samples were also measured. A power spectral analysis of the heart-rate variability was performed over a 24-hour period based on the autoregressive method. The subjects lost 3.7 ± 0.3 kg (mean ± s. e. m.) of body

The independent prognostic significance of ambulatory blood pressure variability in the elderly is incompletely clear. We investigated the prognostic value of average real variability of 24-hour blood pressure in elderly treated hypertensive patients. The occurrence of a combined end-point including stroke, coronary events, heart failure requiring hospitalization and peripheral revascularization was evaluated in 757 elderly treated hypertensive patients. According to tertiles of average real variability of 24-hour systolic blood pressure patients were classified as having low (≤8.66 mmHg; n = 252), medium (8.67-10.05 mmHg; n = 252) or high (>10.05 mmHg; n = 253) average real variability. During the follow-up (6.9 ± 3.4 years, range 0.4-12.9 years), 195 events occurred. The event rate of the population was 3.74 per 100 patient-years. After adjustment for age, sex, previous events, diabetes, estimated glomerular filtration rate, left ventricular hypertrophy, left atrial enlargement, asymptomatic left ventricular systolic dysfunction at baseline, 24-hour systolic blood pressure, non-dipping and dipping with high morning surge of blood pressure, patients with high average real variability were at higher cardiovascular risk than those with low average real variability (hazard ratio 1.64, 95% confidence interval 1.12-2.40). In elderly treated hypertensive patients, high average real variability of 24-hour systolic blood pressure is associated with higher cardiovascular risk independently of other risk markers, average 24-hour systolic blood pressure and circadian blood pressure changes.

Introduction: Elevated blood pressure (BP) is associated with damage to high flow, low resistance target organs such as the retina. Recent evidence suggests that 24-hour BP variability (BPV) is a novel risk factor for cardiovascular disease, independent of 24-hour average BP. However, whether 24-hour BPV is related to concentric retinal arteriole remodeling in healthy adults is unknown. Thus, the purpose of our study was to determine the degree to which 24-hour BPV is associated with retinal lumen diameter and vascular resistance in healthy young/middle-aged adults, independent of 24-hour average BP. Methods: Healthy, normotensive adults aged 25 to 60 years (n=40; 50% female) underwent measurements of retinal arteriole diameter and flow using laser speckle flowgraphy. 24-hour brachial BP was determined using ambulatory BP monitoring. BPV was calculated as the standard deviation of all BP recordings for systolic and diastolic BP. Retinal vascular resistance was calculated as ocular perfusion pressure divided by mean retinal flow across 4 arterioles. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV). Results: Higher 24-hour systolic and diastolic average BP were associated with smaller retinal lumen diameter and elevated vascular resistance (P&lt;0.05). Although both systolic BPV (r=0.391, P=0.012) and diastolic BPV (r=0.315, P=0.048) were associated with higher retinal vascular resistance, only diastolic BPV was associated with smaller retinal arteriole lumen diameter (r=-0.393, P=0.012). The association of greater diastolic BPV with smaller retinal arteriole lumen diameter (β=-0.363, P=0.01) and higher retinal vascular resistance (β=0.395, P=0.007) remained after adjusting for age, body mass index, cfPWV, and 24-hour average diastolic BP. Conclusion: Higher diastolic BPV may contribute to adverse remodeling of retinal arterioles in healthy normotensive adults independent of arterial stiffness and traditional cardiovascular disease risk factors. Future studies could utilize local metabolic vasodilation via diffuse luminance flicker to examine whether retinal arteriole autoregulatory mechanisms are impaired in individuals with higher BPV.

Objective To investigate the association between visit-to-visit variability in blood pressure and cognitive function in old age (>70 years). Design Prospective cohort study.Setting PROSPER (PROspective Study of Pravastatin in the...

PD66-11 EFFECTS OF VIBEGRON ON AMBULATORY BLOOD PRESSURE IN PATIENTS WITH OVERACTIVE BLADDER: RESULTS FROM A DOUBLE-BLIND STUDY

Heart rate and blood pressure variabilities are increased in pregnancy-induced hypertension

Objective: To investigate the impacts of amlodipine, valsartan and the two drugs combination on blood pressure variability(BPV) and pulse wave velocity(PWV) Design and method: It's a prospective,open, parallel control study.119 participants who were newly diagnosed essential hypertension or receiving single antihypertensive drug were recruited and divided into three groups (amlodipine, valsartan and two drugs combination treatment). Each patient's relevant demographic data and laboratory indicators were collected, in line with his/her 24 hours ambulatory blood pressure monitoring and brachial ankle pulse wave velocity monitoring taken. All participants were given treatment respectively for 10 weeks, and then rechecked the baseline indicator, comparing their effects on BPV and PBV. Results: Amlodipine can most effectively reduce 24-hour systolic blood pressure variability and diurnal systolic blood pressure variability. Amlodipine is the most effective and valsartan is the least in terms of reducing 24-hour diastolic blood pressure variability(P < 0.05).Three kinds of antihypertensive scheme can reduce arterial stiffness (baPWV), degree from strong to weak is: valsartan, two drug combination, amlodipine. The relationship between baPWV and 24 h average systolic blood pressure, 24 h systolic/diastolic blood pressure variability, 24 h average pulse pressure, daytime highest/average systolic blood pressure, daytime systolic/diastolic blood pressure variability, daytime highest diastolic blood pressure, daytime average pulse pressure, nighttime minimum systolic blood pressure are all positively correlated (P < 0.05 or P < 0.01).Between baPWV and nocturnal systolic blood pressure drop rate is a positive correlation (P < 0.05). The relationship between baPWV and nighttime diastolic blood pressure drop rate, however, has no statistical significance. Conclusions: Three treatments can all effectively control blood pressure. Amlodipine has the strongest antihypertensive effect and can effectively reduce BPV. Valsartan has independent effect in improving arterial stiffness. Arterial stiffness is associated with blood pressure levels and BPV, and its relationship between systolic blood pressure is greater than diastolic blood pressure.