Influence of stress induced by the first announced state of emergency due to coronavirus disease 2019 on outpatient blood pressure management in Japan

To prevent further spread of coronavirus disease 2019 (COVID-19), the Japanese government announced a state of emergency, resulting in major stress for the population. The aim of this study was to investigate a possible association between changes in daily stress and blood pressure (BP) in Japanese patients. We retrospectively investigated 748 patients with chronic disease who were treated by the Sagamihara Physicians Association to determine changes in stress during the COVID-19 state of emergency from 7 April to 31 May 2020. During the state of emergency, office BP significantly increased from 136.5 ± 17.5/78.2 ± 12.0 to 138.6 ± 18.6/79.0 ± 12.2 (p < 0.001 and p = 0.03, respectively). In contrast, home BP significantly decreased from 128.2 ± 10.3/75.8 ± 8.8 to 126.9 ± 10.2/75.2 ± 9.0 (p < 0.001 and p = 0.01, respectively), and the ratio of white coat hypertension was significantly increased (p < 0.001). Fifty-eight percent of patients worried about adverse effects of hypertension as a condition contributing to the severity and poor prognosis of COVID-19; decreased amounts of exercise and worsened diet compositions were observed in 39% and 17% of patients, respectively. In conclusion, a significant increase in office BP with the white coat phenomenon was observed during the state of emergency, as well as an increase in related stress. To prevent cardiovascular events, general practitioners should pay more attention to BP management during stressful global events, including the COVID-19 pandemic.

Prevalence and risk factors of white-coat hypertension and masked hypertension in Shunde District,Southern China:Observational Study (Preprint)

BACKGROUND White-coat hypertension (WCH) and masked hypertension (MH) can increase the risk of target organ damage. Home blood pressure monitoring is an important method for detecting WCH and MH. However, the prevalence and risk factors of WCH and MH in China has been rarely reported. OBJECTIVE To explore the prevalence and risk factors associated with white coat hypertension (WCH) and masked hypertension (MH) in Shunde District, Southern China. METHODS This study recruited subjects from the Physical Examination Center in Shunde Hospital, Southern Medical University. Office blood pressure and home blood pressure values were collected. The prevalence of WCH and MH was calculated by combining the office blood pressure and home blood pressure values. Multivariate logistic regression was used to explore the related risk factors for WCH and MH. RESULTS Four-hundred and sixty-one participants (61% male), with an average age of 49 years, were included. The incidence of WCH and MH was 5.1% and 15.2%, respectively. Multivariate logistic regression analysis showed that smoking (OR=4.71, 95%CI=1.05-21.15) and family history of coronary heart disease (OR=4.51, 95%CI=1.08-18.93) were associated with higher odds of WCH. The associated factors for higher odds of MH were smoking (OR=2.83, 95%CI=1.11-7.23), family history of hypertension (OR=2.17, 95%CI=1.11-4.26) and family history of coronary heart disease (OR=2.82, 95%CI=1.07-7.45). CONCLUSIONS WCH and MH are highly prevalent in the health check-up population in Southern China. Out-of-office blood pressure monitoring, especially home blood pressure monitoring with a telemedicine device should be recommended to identity abnormal BP phenotype. CLINICALTRIAL It has been registered in the Chinese Clinical Trial Registry(ChiCTR1800018515)

Follow-Up of Blood Pressure, Arterial Stiffness, and GFR in Pediatric Kidney Transplant Recipients

Pediatric renal transplant recipients (RTx) were studied for longitudinal changes in blood pressure (BP), arterial stiffness by pulse wave velocity (PWV), and graft function.Patients and Methods: 52 RTx patients (22 males) were included; office BP (OBP) and 24 h BP monitoring (ABPM) as well as PWV were assessed together with glycemic and lipid parameters and glomerular filtration rate (GFR) at 2.4[1.0–4.7] (T1) and 9.3[6.3–11.8] years (T2) after transplantation (median [range]).Results: Hypertension was present in 67 and 75% of patients at T1 and T2, respectively. Controlled hypertension was documented in 37 and 44% by OBP and 40 and 43% by ABPM. Nocturnal hypertension was present in 35 and 30% at T1 and T2; 24 and 32% of the patients had masked hypertension, while white coat hypertension was present in 16 and 21% at T1 and T2, respectively. Blood pressure by ABPM correlated significantly with GFR and PWV at T2, while PWV also correlated significantly with T2 cholesterol levels. Patients with uncontrolled hypertension by ABPM had a significant decrease in GFR, although not significant with OBP. Anemia and increased HOMAi were present in ~20% of patients at T1 and T2.Conclusion: Pediatric RTx patients harbor risk factors that may affect their cardiovascular health. While we were unable to predict the evolution of renal function based on PWV and ABPM at T1, these risk factors correlated closely with GFR at follow-up suggesting that control of hypertension may have an impact on the evolution of GFR.

White-Coat Hypertension: Pathophysiological and Clinical Aspects: Excellence Award for Hypertension Research 2020

Few issues of modern cardiovascular medicine have been as controversial as the relationship between white-coat hypertension (WCH), that is, a common condition in which office blood pressure is elevated while out-of-office blood pressure (ambulatory blood pressure or home blood pressure) is normal. While earlier studies showed no increased risk of cardiovascular events in WCH compared with the normotensive state, more recent studies have changed this conclusion by showing that an increased cardiovascular risk represents a trait of this hypertensive phenotype. The present article will review a number of issues related to WCH, that is, its definition, pathophysiological background, clinical alterations, and prognostic significance. This will be done by considering the available evidence published during the last decades, with special focus on the data collected in PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni)—a research project performed with a cross-sectional and longitudinal design, which has provided a series of novel clinical information on WCH throughout the years. The final part of the article will discuss the therapeutic implications of the abovementioned evidence, as well as some controversial or still undefined issues related to WCH, whose investigation will be an important goal to pursue by future research.

White Coat Hypertension in Aircrew: Diagnosis and Clinical Implications

Introduction: When there is a difference of patient's blood pressure (BP) which is measured in a physician's office and patient’s home, it is said to have White Coat Hypertension (WCH). Prevalence of WCH is very much common among aircrew, because they need to face everyday preflight medical checkup. Objective: To find out the incidence of WCH among the aircrew of Bangladesh Air Force (BAF) as well as to ascertain the long-term clinical implications of WCH. Materials and Methods: This cross-sectional observational study was conducted among 150 aircrew, reported to Central Medical Board (CMB), Bangladesh Air Force (BAF) for periodical medical evaluation, during the period January 2014 to December 2018. Study subjects were selected purposively with age range 25-50 years; those who did not have any history of hypertension or received any anti-hypertensive medication but were detected elevated BP having clinical recording of BP ≥ 140/90 mm of Hg. Ambulatory blood pressure monitoring (ABPM) was performed on them for 24 hours in order to distinguish between those who were truly hypertensive and those who were suffering from WCH. To exclude secondary causes of hypertension as well as to assess for evidence of target organ damage (TOD), a thorough clinical and laboratory examination as well as regular follow-up were also performed. Results: White Coat Hypertension was observed in 26.7% of the aircrew. There was no evidence of target organ involvement, such as left ventricular dysfunction, left ventricular hypertrophy, hypertensive retinopathy or renal involvement. Conclusion: WCH is comparatively common among the aircrew. This highlights the importance of the requirement for regular follow up of all cases of WCH, over the normotensive subjects with a view to identify early organ involvement and therapeutic intervention are often initiated as and once needed. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 14-17

BLOOD PRESSURE VARIATION IN CHILDREN AT 5 MINUTE INTERVAL FOR IDENTIFICATION OF WHITE COAT HYPERTENSION

White-coat hypertension is a condition when a person’s blood pressure tends to increase only when they are at the doctor's office. In children, blood pressure between the 90th and 95th percentile is labelled as pre-hypertension and above the 95thcentile it is classified as hypertension. The difference between 90th and 95th centiles for both systolic and diastolic blood pressure is only 4 mm of Hg. Methods: Children between ages 5 to 10 years admitted in the children ward of Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India from February to April 2020 included in the study. We record blood pressure by oscillometer 4 times a day, over 4 days of hospital stay and each time two readings were taken at 5 minute intervals. Results: During 4 days of hospital stay blood pressure varied widely. In addition second reading of BP were always less than the first reading BP, but second readings data also varied widely just as first readings. Conclusion: White coat’ hypertension is the phenomenon where BP is exaggerated by act of measuring BP. This is initiated by anxiety. Children are particularly susceptible and distressed by the circumstances of hospitalization, stranger anxiety and fear to painful intervention. We should take multiple readings before reach a conclusion of hypertension. Key words: Blood pressure, White-coat Hypertension, Ambulatory BP, Hypertension