Correlation Between Ambulatory Blood Pressure Monitoring and Target Organ Damage in Children

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

Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension and subclinical TOD prediction in hypertension is confirmed.

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.

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.

Hidden hypertension and early cardiac alterations: insights from ambulatory blood pressure monitoring in children and adolescents

Hypertension is increasingly recognized as a significant health concern among children and adolescents, often associated with obesity and lifestyle choices. Early-onset hypertension can elevate the risk of cardiovascular diseases in adulthood, making early detection crucial. As it is often asymptomatic, routine screening is essential. Schools serve an effective environment for identifying at-risk students. Accurate diagnosis requires standardized protocols because blood pressure (BP) can vary based on age, sex, and height. Addressing pediatric hypertension is key to reducing long-term cardiovascular morbidity and mortality. The study included 354 students: 234 primary grade 3 students (8–9 years) and 120 secondary grade 9 students (~ 15 years). Assessments included medical history, physical examination (weight, height, BMI, and BP). BP was measured using standardized methods and classified by established percentiles. Ambulatory Blood Pressure Monitoring (ABPM) was performed for students with elevated BP to analyze 24-hour readings, dipping status, and pulse pressure, and to classify hypertension. Echocardiography was performed on all students with elevated BP. Significant differences were observed in BMI and hypertension prevalence between Grade 3 and Grade 9. In Grade 3, 45.7% were underweight, 31.9% had normal BMI, and 22% were overweight or obese; in Grade 9, 81.5% were overweight or obese. Clinic-based hypertension was higher in Grade 3 (15.4%) compared to Grade 9 (12.5%), sustained hypertension was confirmed by ABPM to rule out white-coat hypertension, results correlated with BMI Z scores and lifestyle. Despite being asymptomatic, cardiac changes were observed: the mean interventricular septal thickness (IVSd) was 0.75 cm in Grade 3 versus 1.07 cm in Grade 9. ABPM is crucial for accurate diagnosis of hypertension in schoolchildren and adolescents, clarifying the relationship between obesity, lifestyle, and elevated BP. The study underscores that early cardiac remodeling was already present in asymptomatic children, emphasizing the need for early interventions, including weight management and lifestyle modifications, to reduce hypertension and future cardiovascular risk. This study delivers one of the first comprehensive community-based assessments of pediatric blood pressure in our region, revealing a high burden of hidden hypertension and early cardiovascular alterations, and underscoring the urgent need for routine screening as obesity-related health risks continue to rise among children and adolescents.

Continuous assessment and research on enhanced blood pressure control – CareBP study

The results of the CareBP study show the extended value of 14 days of individual blood pressure monitoring and underline the relevance of this approach for cardiovascular disease prevention.

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