scholarly journals High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Prossie Merab Ingabire ◽  
◽  
Dike B. Ojji ◽  
Brian Rayner ◽  
Elijah Ogola ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Secondary Analysis ◽  
Uncontrolled Hypertension ◽  
African Countries ◽  
Night Time ◽  
Black Africans ◽  
Long Term Outcome ◽  
Black African ◽  
High Prevalence

Abstract Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).

scholarly journals High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P M Ingabire ◽  
D B Ojji ◽  
B Rayner ◽  
E Ogola ◽  
A Damasceno ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Secondary Analysis ◽  
The United States ◽  
Public Institution ◽  
Uncontrolled Hypertension ◽  
P Value ◽  
Black Africans ◽  
Long Term Outcome ◽  
Black African ◽  
High Prevalence

Abstract Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium >140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1

ABPM Comparison of the Anti-Hypertensive Profiles of Telmisartan and Enalapril in Patients with Mild-to-Moderate Essential Hypertension

2002 ◽  
Vol 30 (6) ◽  
pp. 543-552 ◽  
Author(s):  
J Amerena ◽  
S Pappas ◽  
J-P Ouellet ◽  
L Williams ◽  
D O'Shaughnessy
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Blood Pressure Monitoring ◽  
Study Drug ◽  
Pressure Control ◽  
Moderate Essential Hypertension ◽  
Open Label ◽  
Night Time ◽  
Once Daily

In this multicentre, prospective, randomized, open-label, blinded-endpoint (PROBE) study, the efficacy of 12 weeks' treatment with once-daily telmisartan 40–80 mg and enalapril 10–20 mg was evaluated using ambulatory blood pressure monitoring (ABPM) in 522 patients with mild-to-moderate essential hypertension. Patients were titrated to the higher dose of study drug at week 6 if mean seated diastolic blood pressure (DBP) was ≥ 90 mmHg. The primary endpoint was the change from baseline in ambulatory DBP in the last 6 h of the 24-h dosing interval after 12 weeks' treatment. Telmisartan and enalapril produced similar reductions from baseline in DBP and systolic blood pressure (SBP) over all ABPM periods evaluated (last 6 h, 24-h, daytime and night-time). Telmisartan produced a significantly greater reduction in mean seated trough DBP, measured unblinded with an automated ABPM device in the clinic, amounting to a difference of −2.02 mmHg ( P < 0.01). A significantly greater proportion of patients achieved a seated diastolic response with telmisartan than enalapril (59% versus 50%; P < 0.05), also measured with the same ABPM device. Both treatments were well tolerated. Compared with telmisartan, enalapril was associated with a higher incidence of cough (8.9% versus 0.8%) and hypotension (3.9% versus 1.1%). Therefore, telmisartan may provide better long-term compliance and, consequently, better blood pressure control than enalapril.

scholarly journals P0150EFFECT OF SEROTONIN REUPTAKE INHIBITORS (SSRIS) AND SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) ON BLOOD PRESSURE VARIABILITY USING 24 HOURS AMBULATORY BLOOD PRESSURE MONITORING

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nabeel Aslam ◽  
Sobia Memon ◽  
Hani Wadei ◽  
Shehzad Niazi
Keyword(s):  
Blood Pressure ◽  
Linear Regression ◽  
Ambulatory Blood Pressure ◽  
Psychiatric Diagnosis ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Night Time ◽  
Group 2 ◽  
Adverse Cardiovascular Outcome ◽  
Group 1

Abstract Background and Aims Hypertension (HTN) and psychiatric disorders frequently co-exist in general population. Serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine re-uptake inhibitors (SNRIs) affect serotonin and norepinephrine and may lead to variation in blood pressure (BP). There is paucity of data on blood pressure variations using 24 hours ambulatory blood pressure monitoring (ABPM) with the use of SSRIs/NSRIs. Method Subjects who underwent psychiatric evaluation and ABPM within six month of each other between 1/1/2012 to 12/31/2016 at Mayo Clinic Florida were identified using billing data. Demographics, co-morbidities, medications, ABPM, and laboratory results were retrospectively collected from medical records. Subjects were divided into groups – subjects with no psychiatric diagnosis and no psychiatric medicine (Group 1) and subjects with psychiatric diagnosis and on SSRIs/NSRIs (Group 2). BP systolic and diastolic levels (day time, night time) were compared between groups controlling for age, sex, race, presence or absence of HTN, diabetes mellitus (DM) and smoking. Single and multivariable linear regression models were used to analyze group differences. Results Total of 367 subjects met inclusion criteria – Group 1=135; Group 2=232. The subjects in group 2 were older (median age 57 yrs vs 47 yrs p&lt;0.001), white (69.8 vs 60% p=0.002), smokers (15.9 vs 3.0% p&lt;0.001), history of HTN (62.5 vs 9.6%), and DM (21.1% vs 0%). ABPM showed that subjects in group 2 had higher median daytime systolic BP (131 vs 124), higher median night time systolic BP (120 vs 110), and higher median night time diastolic BP (68 vs 63). Multivariable linear regression controlling for age, sex, race, presence or absence of HTN, DM, and smoking showed that use of SSRIs/NSRIs (group 2) was significantly associated with higher night time systolic BP (8.36 mm; 95% CI 4.2, 12.5; p &lt;0.0001) and higher night time diastolic BP (4.6 mm, 95% CI 1.9, 7.29, p=0.001). On subgroup analysis comparing subjects with use of SSRIs vs NSRIs, there was no statistically significant difference in the daytime or night time systolic or diastolic BP. Conclusion Use of SSRIs and NSRIs are associated with higher nocturnal systolic and diastolic BP, which can potentially increase the risk of adverse cardiovascular outcome in this population. Higher nocturnal BP may be due to ongoing sympathetic activation during sleep with serotonin and norepinephrine with the use of SRRIs and NSRI. Further well designed prospective studies using ABPM are needed to determine the risk of nocturnal hypertension with the use of SSRIs/NSRIs that could have potential adverse cardiovascular outcome.

Abstract P167: Leveraging The Electronic Health Records System And Home Blood Pressure Monitoring To Optimize Blood Pressure Control

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Elizabeth H Kim ◽  
Eric Luong ◽  
Trevor Trung Nguyen ◽  
Sandy Castillo ◽  
Joseph E Ebinger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Electronic Health Records ◽  
Blood Pressure Monitoring ◽  
Standard Of Care ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Health Records ◽  
Age And Sex

Background: Home blood pressure monitoring (HBPM) devices can now be linked to electronic health records (EHR) systems in ways that could be used to facilitate blood pressure (BP) management; however, their potential feasibility and utility remain unclear. Methods: For our pilot study, we identified N=5 outpatients with uncontrolled hypertension and implemented use of a HBPM device with frequent monitoring and direct linkage to the EHR, whereby real-time data was made available to treating providers. We matched our intervention patients by age and sex with N=50 patients who also had uncontrolled hypertension and underwent standard-of-care treatment. We assessed change over time in BP measures for the intervention and standard-of-care groups. Results: In analyses accounting for differences in the timing and frequency of BP measurements, we observed that the intervention compared to the standard-of-care group had an average systolic BP at 8 weeks that was lower in percent change from baseline (β=-22 mm Hg, P=0.008). We also found a difference between baseline and 8-week systolic BP within the intervention group (mean difference -25.9 mm Hg, P=0.024). Conclusions: In our pilot, intensive remote HBPM appeared to improve BP levels over the short term. While unblinded and not controlled for factors beyond age and sex, this pilot demonstrates feasibility of an EHR-linked HBPM intervention and potential efficacy that may be related to increased patient as well as provider awareness translating to greater patient-provider engagement around hypertension management. More studies are needed to validate and expand from our findings.

P2639The influence of non-dipping pattern of blood pressure in gestational hypertension on early onset of hypertension later in life

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Ilic ◽  
S Stojsic ◽  
J Papovic ◽  
D Grkovic ◽  
T Miljkovic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Left Ventricle ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Gestational Hypertension ◽  
Systolic Function ◽  
Blood Pressure Monitoring ◽  
Night Time ◽  
Lv Mass

Abstract Background It is known that gestational hypertension (GH) and preeclampsia have been associated with the onset of hypertension later in life. We wondered if the blood pressure (BP) pattern affects the incidence of hypertension in the future. Purpose The aim of this study was to determine whether hypertension occurs more frequently if a non-dipping pattern was registered during GH, but also if non-dipping pattern in GH afects deterioration of systolic function of the left ventricle (LV) later in life. Methods This longitudinal study included 56 pregnant women with gestational hypertension (of which 28 met criteria for non-dipping pattern of BP, according to the values registrated by the ambulatory blood pressure monitoring (ABPM) – non-dippers, while other 28 were classified in dippers) and 27 normotensive pregnant women, as control. All of women became normotensive after delivery, but they continued to be periodically controlled in term of values of blood pressure. The function and morphology of the left ventricle (LV) were analyzed by echocardiography exam in the third trimester of pregnancy and 5 years after delivery, as well as ABPM, while 2D longitudinal strain (LS) was performed only after delivery in order to evaluate systolic function of the LV. All echo and ABPM parameters recorded during pregnancy, also as parameters of pregnancy outcome – intrauterine growth restriction (IUGR) and preterm delivery, were analyzed, in order to relate them with later onset of hypertension. Results After, average 5 years, diagnosis of hypertension was determined in 8 women (2 from dipper group – during pregnancy – 7,1%, and 6 from non-dipper group 21,4%). Those 8 hypertensive women had significantly reduced LS: −18,12±1,3 compared to normotensive −19,9±1,4 (p=0,001). It is very interesting that, 5 years after delivery, values of 2D LS were, although in reference values, significantly reduced in women who were non-dippers (−19,32±1,38) during GH, compared with both, normotensive (−20,69±1,18; p<0,0005) and dippers (−20,10±1,29; p=0,026). Univariate regression analysis revealed that higher values of day and night BP, the mean arterial BP, LV mass index, preterm delivery and IUGR were associated with onset of hypertension later in life, while parameters of systolic and diastolic function of the LV during pregnancy, didn't affect occurrence of it. As revealed by multivariate regression analysis, the peak value of night-time diastolic blood pressure during pregnancy (p=0,016; OR=1,127; 95% CI: 1,022–1,242) and the LV mass index, also during pregnancy (p=0,041; OR=1,099; 95% CI: 1,004–1,203) had strong relation with hypertension in future life. Conclusion The non-dipping pattern of blood pressure in gestationl hypertension is significant associate with onset of hypertension later in life, but also with decreased systolic function of the left ventricle. Acknowledgement/Funding Provincial Secretariat for Health of the Autonomous Province of Vojvodina

scholarly journals Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring

2019 ◽  
Vol 21 (7) ◽  
pp. 877-883
Author(s):  
Jessica Barochiner ◽  
María Lourdes Posadas Martínez ◽  
Rocío Martínez ◽  
Diego Giunta
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring

scholarly journals Dynamics of blood pressure indicators in patients with diabetes mellitus after planned percutaneous coronary intervention

2021 ◽  
Vol 17 (1) ◽  
pp. 12-20
Author(s):  
A. M. Kochergina ◽  
O. L. Barbarash
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Effective Control ◽  
Pressure Monitoring ◽  
Night Time ◽  
Percutaneous Coronary ◽  
History Of ◽  
Pressure Indicators

Arterial hypertension (AH) is a common modifiable cardiovascular risk factor. Despite the wide choice of antihypertensive drugs, according to epidemiological studies, just over 20% of patients demonstrate effective control of hypertension. Failure to achieve the target values of blood pressure (BP) determines a high probability of developing cardiovascular events, which is also true for patients undergoing percutaneous coronary interventions (PCI). However, there is evidence that individuals who have undergone PCI show a higher percentage of achieving the target blood pressure levels. Aim of the study was to evaluate the dynamics of blood pressure indicators in patients with stable coronary artery disease (CAD) and diabetes mellitus, depending on the fact of performing PCI.Material and methods. The study was conducted at federal state budgetary scientific institution research institute of complex issues of cardiovascular diseases as a prospective, open, not comparative. The study included 75 patients with stable CAD and type 2 diabetes who regularly received therapy for at least 1 month prior to the start of participation in this study. The majority of patients 45 (60%) are represented by males. The median age was 52.64±6.96 years. 44 patients (58.81%) had a history of myocardial infarction, and 46 patients (61.33%) had previously undergone myocardial revascularization, history of stroke had 5 patients (6.66%). All patients according to the daily blood pressure monitoring at the 1st visit had average daily blood pressure values above 130/80 mmHg. Participants were divided into 2 groups: 43 patients had indications for routine PCI at the time of inclusion in the study, 32 patients had no indications for revascularization. The groups did not have significant differences in clinical and anamnestic characteristics, and regular significant differences were noted in relation to previously undergone revascularization (46.51 and 81.25%, respectively, p=0.0022) and the SYNTAX Score (14.39±9.20 and 6.13±8.28, respectively, p=0.0001). During 4 visits (1 visit, 1 month, 3 months, 6 months), ambulatory blood pressure monitoring (ABPM) was performed using the BiPiLAB system.Results. Initially according ABPM parameters group without the alleged PCI had greater variability in systolic blood pressure (SBP) in the daytime, higher values of mean diastolic blood pressure (DBP) at night, more time index of hypertension DBP at night. After 1 month of follow — up (for the group with PCI 1 month after the procedure), there were significant differences in the average daily SBP and DBP, the index of the time of hypertension DBP in the daytime, and the average daily SBP. Patients who underwent revascularization had lower ABPM values. The previously described differences in the night time DBP and the index of hypertension time at night were preserved. After 3 months of follow-up, significant differences were observed only in the indicators of night time SAD and DBP. At the end of the study (6 months of follow-up), the groups had differences only in the indicators of mean diastolic pressure at night.Conclusion. Patients who underwent PCI for 1 month after the procedure have a significant tendency to normalize (compared to the group without revascularization) blood pressure indicators. However, over time, the effect «escapes». Most likely, the short-term improvement in blood pressure is due to a temporary improvement in treatment adherence after an invasive procedure.

scholarly journals Biochemical and Chemical Lipid Profile and Blood Pressure Assessment in Arterial Hypertension with Chronic Kidney Disease

2020 ◽  
Vol 71 (7) ◽  
pp. 425-435
Author(s):  
Teim Baaj ◽  
Ahmed Abu-Awwad ◽  
Mircea Botoca ◽  
Octavian Marius Cretu ◽  
Elena Ardeleanu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Lipid Profile ◽  
Blood Pressure Monitoring ◽  
Hdl Cholesterol ◽  
Night Time ◽  
Hypertensive Patients ◽  
Lipid Disorders

Accelerated atherosclerosis and cardiovascular diseases are frequent complications in hypertensive patients with chronic kidney disease (CKD), being mainly driven by cardiovascular risk factors as lipid disorders and an unfavorable blood pressure profile. The objectives of the study were to evaluate the lipid profile and to assess the characteristics of blood pressure (BP) in patients with primary arterial hypertension associating chronic kidney disease (CKD) in a primary care population in Timis County, Romania. Lipid disorders were highly prevalent in hypertensive patients with CKD, consisting in hyper LDL-cholesterolemia in 50.3%, hypertriglyceridemia in 52%, low HDL-cholesterol levels in 35.8%. More than 2 lipid abnormalities were present in 68.8% of CKD hypertensive. CKD hypertensive patients, compared with those without CKD, presented a BP profile with higher systolic and diastolic office BP. On ambulatory blood pressure monitoring they also registred higher systolic and diastolic BP, the systolic BP (SBP), both for 24 h SBP, day-time and night-time SBP being statistically significant higher than in hypertensive patients without CKD. The circadian 24 h BP profile demonstrated in the CKD hypertensive population an unfavourable nocturnal profile in 67%, consisting of a high prevalence of the non-dipping profile and of nocturnal riser pattern.

scholarly journals Guest Editorial: Challenges in Resistant Hypertension

2016 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Thomas Kahan ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Premature Death ◽  
Pressure Control ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
Caregiver Support ◽  
The Individual

Hypertension is the major risk factor for disease and premature death. Although the efficacy of antihypertensive therapy is undisputed, few patients reach target blood pressure. Steps to improve treatment and control include assessment of global cardiovascular risk for the individual patient, improving caregiver support, education and organisation, increasing treatment persistence, using out of office blood pressure monitoring more often, detecting secondary hypertension forms, and referring patients with remaining uncontrolled hypertension to a specialist hypertension centre. In conclusion, there is room for improvement of blood pressure control in hypertensive patients. The clinical benefit of improved blood pressure control may be considerable. This may be particularly true for patients with resistant hypertension.

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