Short-term blood pressure variability assessed by ambulatory blood pressure monitoring as a predictor of subclinical target organ damage

Ambulatory blood pressure abnormalities and arterial stiffness in children with type 1 diabetes: the role of pulse wave velocity.

Diagnostic Value of Ambulatory Blood Pressure Monitoring for Hypertension in Private Cardiology Practice in Senegal

Hypertension is a major contributor to cardiovascular morbidity and mortality. Ambulatory blood pressure monitoring (ABPM) complements office blood pressure measurement by detecting white-coat hypertension, masked hypertension, and nocturnal blood pressure abnormalities, and this study aimed to assess its diagnostic value in the management of hypertension in private cardiology practice in Senegal. A prospective, descriptive, and analytical study was conducted from July to September 2024 at Clinique Urgence Cardio in Dakar, including patients aged 18 years or older with a valid 24-hour ABPM recording. Clinical, anthropometric, and treatment data, together with cardiovascular risk factors, were collected; office and ambulatory blood pressure measurements were compared; and logistic regression was used to identify factors associated with discordance between the two methods. Of the 104 patients assessed, 97 had valid ABPM recordings. The mean age was 53.2 ± 14.1 years, and women predominated. Cardiovascular risk factors included abdominal obesity (77.3%), known hypertension (54.6%), physical inactivity (43.3%), dyslipidemia (37.1%), and diabetes (16.5%). Mean office blood pressure was 145.7/91.4 mmHg, compared with 130.5/80.2 mmHg over 24 hours, 134.4/82.4 mmHg during daytime, and 125/75 mmHg during nighttime. ABPM identified sustained hypertension in 53.61% of patients, white-coat hypertension in 18.56%, masked hypertension in 9.28%, and normotension in 18.56%, with overall agreement between office and ambulatory measurements of 72.2%. Among patients with elevated office blood pressure, 25.7% had white-coat hypertension, while 33.3% of those with normal office blood pressure had masked hypertension. Non-dipping and reverse-dipping patterns were observed in 45.4% and 19.6% of patients, respectively, and discordance was independently associated with alcohol consumption (OR = 5.08; p = 0.007). ABPM improves the diagnostic classification of hypertension and reveals a high prevalence of discordant phenotypes and nocturnal blood pressure abnormalities, and wider use of ABPM may help optimize patient management in this setting.

Optimizing Home Blood Pressure Monitoring Protocols in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study.

In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each, supporting shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.

Nighttime blood pressure versus non-dipping for predicting asymptomatic organ damage in young individuals.

BACKGROUND Circadian blood pressure (BP) phenotypes are associated with cardiovascular risk, though understudied in youth. This study in young individuals investigated the association of nighttime BP with measures of hypertension mediated organ damage (HMOD), primary endpoint of interest in this low absolute cardiovascular risk population. METHODS Individuals aged 6-25 years were evaluated with 24-h ambulatory BP monitoring (ABPM). HMOD investigation included echocardiographic left ventricular mass index (LVMI) and ultrasonographic common carotid artery intima-media thickness (IMT). RESULTS Two hundred and seventy-six individuals were included (mean age 13.8 ± 3.8 years, 67% males) with ABPM data (23.6% ABPM hypertension, 26.4% nighttime hypertension, 30.4% non-dippers) and LVMI (n = 257) and/or IMT (n = 205). BP and HMOD indices increased with age, whereas non-dipping prevalence was not associated with age. Non-dippers vs. dippers had higher LVMI (30.5 ± 8.2 vs. 28.4 ± 5.95 g/m2.7, P = 0.01) and IMT (0.52 ± 0.05 vs. 0.50 ± 0.05 mm, P = 0.02), adjusted for age, sex, body mass index z-score (BMIz) and 24-h systolic BP (SBP). Individuals with nighttime hypertension vs. nighttime normotension had higher LVMI (32.76 ± 8.02 vs. 27.69 ± 5.65 g/m2.7, P < 0.001) and a trend towards higher IMT (0.52 ± 0.06 vs. 0.50 ± 0.05 mm, P = 0.16), adjusted for age, sex and BMIz. Dippers and non-dippers with nighttime hypertension had higher LVMI than dippers with nighttime normotension (all P < 0.05). In multivariable models, non-dipping independently associated with LVMI/ IMT (β = -2.14/-0.02, all P < 0.05), after adjustment for 24-h SBP, but not for nighttime SBP (β = -0.9/-0.01, for LVMI/IMT, respectively, all P = NS). CONCLUSIONS In young individuals asymptomatic HMOD is associated with both nocturnal hypertension and non-dipping. However, nighttime BP levels seem to have the primary contributing role.

Evaluation of Alysis-001 cuffless blood pressure estimation algorithm against the European Society of Hypertension awake/asleep test criteria in hypertensive patients.

This represents the first evaluation of a Device Type 3 cuffless blood pressure algorithm (automated, wearable, demographic-calibrated, not at heart level) meeting ESH awake/asleep test criteria, suggesting Alysis-001's potential as a clinically viable alternative for ambulatory blood pressure monitoring in hypertensive patients.

Home blood pressure telemonitoring reveals race-specific patterns of target organ damage.

BACKGROUND Racial differences in cardiac and renal target organ damage (TOD) may persist at comparable blood pressure levels. This study compared TOD in high-risk, non-African-American Black and White patients in relation to the home blood pressure (HBP). METHODS UPRIGHT-HTM (NCT04299529) is an ongoing international trial comparing risk stratification strategies in asymptomatic patients, aged 55-75  years, with ≥5 risk factors. Patients engage in HBP telemonitoring (OMRON HEM 9210-T). After 34.7 months (median), 287 Black and 154 White patients underwent echocardiography. At baseline, their chronic kidney disease (CKD) grade was assessed by cross-classification of the race-free estimated glomerular filtration rate and albuminuria (2024 KDIGO guideline). HBP was stratified by the 2024 ESC thresholds. Linear and logistic regression models, including a race-by-HBP interaction term, were applied to assess associations with the home systolic HBP. RESULTS The number of HBP readings was 252 215. Median systolic/diastolic HBP was 127/77 mmHg with 142 patients (32.2%) having home hypertension. Fewer Black patients received statins or combination therapy for hypertension or diabetes. Among nonhypertensive White compared to Black patients, left atrial dimensions, mitral annular s', and stroke volume had a steeper slope in relation to systolic HBP. All patients had concentric left ventricular remodeling, but only 4 Black and 13 White patients had an ejection fraction < 50%. CKD grade was worse in Black than White patients without association with HBP. CONCLUSIONS TOD primarily affects the kidney in Black and the heart in White patients. Intensifying pharmacological treatment in sub-Saharan Africa, including antihypertensives, lipid-lowering agents, antidiabetic medications, and aspirin, should create an opportunity for improved overall cardiovascular and metabolic prevention.