In Sook Kang

Association between central obesity and circadian parameters of blood pressure from the korean ambulatory blood pressure monitoring registry: Kor-ABP registry.

Central obesity has been reported as a risk for atherosclerosis and metabolic syndrome. The influence of central obesity on diurnal blood pressure (BP) has not been established. In this study, we investigated the influence of central obesity on the circadian parameters of BP by 24 hr ambulatory BP monitoring. Total 1,290 subjects were enrolled from the Korean Ambulatory BP registry. Central obesity was defined as having a waist circumference≥90 cm in males and ≥85 cm in females. The central-obese group had higher daytime systolic BP (SBP), nighttime SBP and diastolic BP (DBP) than the non-obese group (all, P<0.001). There were no differences in nocturnal dipping (ND) patterns between the groups. Female participants showed a higher BP mean difference (MD) than male participants with concerns of central obesity (daytime SBP MD 5.28 vs 4.27, nighttime SBP MD 6.48 vs 2.72) and wider pulse pressure (PP). Central obesity within the elderly (≥65 yr) also showed a higher BP MD than within the younger group (daytime SBP MD 8.23 vs 3.87, daytime DBP 4.10 vs 1.59). In conclusion, central obesity has no influence on nocturnal dipping patterns. However, higher SBP and wider PP are associated with central obesity, which is accentuated in women.

Predictive value of CHADS2 score for cardiovascular events in patients with acute coronary syndrome and documented coronary artery disease.

Background/Aims: The CHADS2 score, used to predict the risk of ischemic stroke in atrial fibrillation (AF) patients, has been reported recently to predict ischemic stroke in patients with coronary heart disease, regardless of the presence of AF. However, little data are available regarding the relationship between the CHADS2 score and cardiovascular outcomes. Methods: This was a retrospective study on 104 patients admitted for acute coronary syndrome (ACS) who underwent coronary angiography, carotid ultrasound, and transthoracic echocardiography. Results: The mean age of the subjects was 60.1 ± 12.6 years. The CHADS2 score was as follows: 0 in 46 patients (44.2%), 1 in 31 (29.8%), 2 in 18 (17.3%), and ≥ 3 in 9 patients (8.7%). The left atrial volume index (LAVi) showed a positive correlation with the CHADS2 score (20.8 ± 5.9 for 0; 23.2 ± 6.7 for 1; 26.6 ± 10.8 for 2; and 30.3 ± 8.3 mL/m2 for ≥3; p = 0.001). The average carotid total plaque area was significantly increased with CHADS2 scores ≥ 2 (4.97 ± 7.17 mm2 vs. 15.52 ± 14.61 mm2; p = 0.002). Eight patients experienced cardiovascular or cerebrovascular (CCV) events during a mean evaluation period of 662 days. A CHADS2 score ≥ 3 was related to an increase in the risk of CCV events (hazard ratio, 14.31; 95% confidence interval, 3.53 to 58.06). Furthermore, LAVi and the severity of coronary artery obstructive disease were also associated with an increased risk of CCV events. Conclusions: The CHADS2 score may be a useful prognostic tool for predicting CCV events in ACS patients with documented coronary artery disease.

Higher Blood Pressure Variability in White Coat Hypertension; from the Korean Ambulatory Blood Pressure Monitoring Registry

Background and Objectives Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. Subjects and Methods We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. Results Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). Conclusion From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed.

824 INFLUENCE OF AGE TO THE DIURNAL BLOOD PRESSURE PATTERN FROM KORABP REGISTRY

Background: Blunted diurnal blood pressure have been associated with increasing risk of cardiovascular disease and target organ damage. The influence of age to the diurnal blood pressure pattern has not been established. Methods: Total 1706 subjects who performed the ambulatory blood pressure monitoring were evaluated the blood pressure pattern from the Korean Ambulatory Blood Pressure (KorABP) registry. They were divided into three groups: the young-aged (< 40 years, n = 282), the middle-aged ( 65 years, n = 966) and the elderly group (> or = 65 years, n = 458). Systolic nocturnal dipping (SNP) was defined as {daytime systolic BP (SBP) - nocturnal SBP)}/daytime SBP. Diastolic nocturnal dipping (DNP) was calculated as {daytime diastolic BP (DBP) - nocturnal DBP)}/daytime DBP. Results: Day and night SBP were similar between three groups (p = 0.345, p = 0.889). SNP had significant difference between the three groups (p = 0.012). Day and night DBP were significantly different between three groups (p < 0.001, p < 0.001). Diastolic nocturnal dipping (DNP) also had significance (p < 0.001) between three groups. In multivariate analysis with subgroups, between the middle-aged and elderly groups had significant difference in SNP (1.62 ± 0.56, p = 0.015), day DBP (7.06 ± 0.64, p < 0.001), night DBP (5.22 ± 0.74, p < 0.001) and DNP (1.84 ± 0.57, p = 0.006). Conclusions: The result indicated that even the elderly group had similar day and night SBP to other groups, this group had blunted SNP and lower day and night time DBP and blunted DNP. Relationship of age related nocturnal dipping pattern especially DNP and cardiovascular outcome needs to be investigated.

854 REGISTRY FOR EVALUATION OF THE PROGNOSTIC CUT-OFF VALUES IN PATIENTS WITH HYPERTENSION

Background: Ambulatory blood pressure monitoring (ABPM) is superior to clinic blood pressure in predicting cardiovascular prognosis. Previous ABPM registries were based on the patients with low cardiovascular risk from community or primary physicians. We set up Korean Ambulatory Blood Pressure monitoring registry (KorABP) for evaluation of the prognostic cut-off values in patients with hypertension including high cardiovascular risk. Methods: Total 43 referral hospitals started to enrol the data from all patients underwent ABPM who gave informed consent from 2009. The primary endpoints were fatal and nonfatal stroke and coronary events including death, acute myocardial infarction, and any revascularization procedures. Sample size was calculated as low risk group, moderate group, high group, very high group respectively need 255, 253, 1,149, 1,130 samples from WHO/ISH risk stratification. Total sample size was 20,000 persons after adjusted for dropout rate. Results: The first year data were delivered at 2011 January with 1707 patients. The devices used in this registry were A&D(51%) and Tonoport V from GE(32%) and others(17%). Mean daytime blood pressure and nighttime blood pressure were 136.4 ± 16.4/85.8 ± 11.7, 127.2 ± 18.6/79.2 ± 13.2 mmHg with 66% of nondipper. The white-coat and masked hypertension were more prevalent in untreated group than treated group (15.1% vs 13.6%, 17.7% vs 12.7% respectively) Conclusions: KorABP registry is enrolling high risk patients high risk and very high risk patients(44%) which showed higher nondipper group. It also showed higher white-coat and masked hypertension in non-treated group compared treated group. Larger and longer follow up data will show prognostic cut-off value in various cardiovascular risk groups.