M. Smirnova

[PP.06.18] SEASONAL BLOOD PRESSURE CHANGES IN HIGH NORMAL, NORMAL AND OPTIMAL BLOOD PRESSURE PATIENTS WITHOUT ANTIHYPERTENSIVE MEDICATION

Objective: Many investigators supposed that seasonal blood pressure (BP) changes are one of the reasons of fatal and nonfatal cardiovascular events. These studies included mainly the patients with arterial hypertension and the division of patients into groups with high normal (HNBP) or normal and optimal BP was not done. The aim of study was to estimate the seasonal differences in clinical (CBP) and ambulatory BP (ABP) in patients with HNBP and normal and optimal BP. Design and method: The ambulatory patients from the ABP monitoring database (>2000 patients) were selected according to the following criteria: absence of any antihypertensive treatment, availability of CBP and ABPM records in winter or summer, CBP<140 and 90 mmHg. Standard statistical methods were used. Results: The preliminary data of the on-going study are demonstrated. We selected 355 patients: 206 with HNBP and 149 with normal and optimal BP. The main characteristics of groups and seasonal BP changes are presented in Table. In patients with HNBP only systolic CBP was significantly higher in winter than in summer. We found similar tendency for ABP data in these patients despite relatively small differences. In patients with normal and optimal BP only diastolic ABP was higher in winter; in contrast, nighttime systolic BP was higher in summer. At the same time, average values of CBP and ABP in the normal and optimal BP group did not exceed threshold limits. Figure. No caption available. Conclusions: Some of the ABP parameters in patients with HNBP without antihypertensive medication are increased in winter and exceed normal values. This factor may contribute to the increase of cardiovascular events incidence in winter. The problem should be studied in prospective investigations.

[LB.01.17] SEASONAL ARTERIAL STIFFNESS CHANGES IN TREATED HYPERTENSIVE PATIENTS WITH DIFFERENT BLOOD PRESSURE PHENOTYPES

Objective: It is known that blood pressure (BP) is generally higher in winter (W) than in summer (S). But the studying of seasonal BP changes mechanisms is incomplete. Some scientists supposed that one of the mechanisms is seasonal dynamics of arterial stiffness (AS). The seasonal BP and AS changes are probably interrelated with seasonal dynamics of cardiovascular morbidity and mortality. We supposed, the relation between ambulatory BP (ABP) and clinical BP (CBP) [BP phenotypes; BPPh] might also depend on the season and AS. The aim of our study was to estimate the seasonal differences in AS parameters in treated hypertensive patients (THP) with different BPPh. Design and method: The ambulatory patients from the ABP monitoring database were selected according with criteria: antihypertensive treatment (>2 weeks; AHT), CBP and ABPM records in W and S. ABPM was performed by the device with algorithm for AS calculation. BPPh definitions: normotension (NT), masked uncontrolled hypertension (MUH), uncontrolled hypertension (UH). AS parameters (mean for 24 h): pulse wave velocity (PWV), maximum rate of BP increase (Dp(dt)), central augmentation index (AIxao) and peripheral (AIx). Results: 469 patients were selected. The main characteristics of BPPh are presented in the Table1. The antihypertensive therapy did not differ significantly in 3 groups. The seasonal dynamics of mean AS parameters with sex and age adjustment in BPPh differed slightly. We compared AS parameters (in quintiles from min to max) between BPPh. Figure. No caption available. The upper (3–5th) quintiles of the most AS indices (Dp(dt), AIx, AIxao) in MUH and UH were significantly higher than in NT(p < 0.05). But this pattern was found for the S only. The 4th quintiles of PWV was higher in UH vs. NT in W and S (p < 0.005). We found no substantial differences in AS parameters in UH vs. MUH Conclusions: Our study confirms seasonal changes in some of AS parameters in THP with different BPPh. The significant differences of AS parameters in NT vs. MUH and the absence of these AS differences in most of the parameters in MUH vs. UH may be one of the confirmations of the high cardiovascular risk in MH.

[PP.01.20] SEASONAL DIFFERENCES IN BLOOD PRESSURE PHENOTYPES: EFFICACY OF ANTIHYPERTENSIVE TREATMENT

Objective: The substantial seasonal (winter [W] vs. summer [S]) difference in cardiovascular mortality and morbidity call for further research of its causes including the blood pressure (BP) phenotypes (BPPh) assessment. The aim of this study was to investigate BPPh in medicated hypertensive patients in W and in S. Design and method: The patients from the 2012–2014 database of the two regions of Russian Federation (Ivanovo [Iv] and Saratov [Sa], “northern” and “southern” regions respectively, n = 1630) were selected on the following criteria: antihypertensive treatment for two weeks or more (1–3 drugs), availability of clinical (CBP) and ambulatory BP (ABP) monitoring records in W and in S. BPPh definitions: normotension (NT; CBP<140/90 and ABP24<130/80 and ABPday<135/85 and ABPnight<120/80 mmHg), masked hypertension (MH; CBP<140/90 and ABP24>129/79 and/or ABPday>134/84 and/or ABPnight>119/79 mmHg), uncontrolled hypertension (UH; CBP>140/90 and ABP24>119/79 and/or ABPday>134/84 and/or ABPnight>119/79 mmHg) and white coat hypertension (WCH; CBP>139/89 and ABP24<130/80 and ABPday<135/85 and ABPnight<120/80 mmHg). Results: The total number of the patients was 237 in Iv and 245 in Sa: 73% vs. 44% men (p<0.0001), mean age 53.5 ± 9.3 vs. 58.6 ± 11.6 years (p < 0.0001), BMI 28.7 ± 4.3 vs. 28.0 ± 4.5 kg/m2, CBP 121.7 ± 7.9 and 74.4 ± 7.2 vs. 127.5 ± 14.9 and 75.6 ± 10.3 mmHg (p < 0.0001 for systolic BP, SBP), respectively. BPPh in Iv (W/S,%): NT–24/28, MH–66/66, UH–9/6, WCH–1/1 (ns). BPPh in Sa (W/S,%): NT–20/19, MH–37/52, UH–40/28, WCH–3/2 (p = 0.007). NT and MH patients seasonal differences in two regions are in table. Figure. No caption available. Conclusions: The high MH prevalence in treated patient with normal CBP in both regions may influence the overall prognosis. The increase of MH prevalence in Sa in S may create a false impression of adequate BP control. Both items identify the need for more intensive use of ABP measurement.

[PP.01.24] BLOOD PRESSURE PHENOTYPES IN HYPERTENSIVE PATIENTS WITH CHRONIC RESPIRATORY DISEASES

Objective: The blood pressure (BP) phenotypes (Ph) and comorbidities in hypertensive patients are associated with cardiovascular prognosis. The aim of this study was to investigate BPPh in medicated hypertensive patients with asthma (A) and chronic obstructive lung disease (COPD). Design and method: The patients with hypertension (H) and A, and patients with H and COPD from routine cardiology ambulatory practice were included into the pilot study data analysis (n=63). All participants received standard antihypertensive treatment (AHT) and inhaler therapy of A/COPD. BPPh definitions: normotension (NT; clinical BP (CBP)<140/90 and ambulatory BP (ABP) 24<130/80 and ABP day<135/85 and ABP night<120/80 mmHg), masked hypertension (MH; CBP<140/90 and ABP24>129/79 and/or ABP day>134/84 and/or ABP night>119/79 mmHg), uncontrolled hypertension (UH; CBP>140/90 and ABP24>119/79 and/or ABP day>134/84 and/or ABP night>119/79 mmHg) and white coat hypertension (WCH; CBP>139/89 and ABP24<130/80 and ABP day<135/85 and ABP night<120/80 mmHg). Results: The number of patients with H+A was 43 (14% men, mean age 63.8 ± 9.4, CBP 142,9 ± 16,7/90,1 ± 9,8 mmHg), the number of patients with H+COPD was 20 (70% men, mean age 68.3 ± 8.1, CBP 160,3 ± 19,5/91,2 ± 11,2 mmHg). BPPh in patients with H+A: NT 30%, MH 9.3%, WCH 30%, UH 32.6%. BPPh in patients with H+COPD: NT 10%, MH 0, WCH 40%, UH 50%. Conclusions: The hypertensive patients with COPD in routine cardiology ambulatory practice are predominantly men and they older than patients with A. These patients have high CBP in 90% and may have optimal effect of AHT only in 10%. These results may indicate the poor cardiovascular prognosis of hypertensive patients with COPD in comparison patients with A.

[PP.27.25] SEASONAL DIFFERENCES OF BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND HIGH NORMAL BLOOD PRESSURE

Objective: Blood pressure (BP) levels have tendency to seasonal (winter [W] vs. summer [S]) variability but some aspects of this problem are not studied yet. The aim of our study was to evaluate seasonal and monthly variability of clinical and ambulatory BP (ABP) in patients with arterial hypertension (AH) and high normal BP (HNBP) in S and W in two regions of the Russian Federation with different climate. Design and method: We included patients from the general population who visited ambulatory clinics in Ivanovo (I) and Saratov (S) for various reasons. The main inclusion criteria were clinical BP (CBP) <160/100 mmHg without or on regular antihypertensive drugs intake (ADI) or CBP = 130/85–139/89 mmHg without ADI. The CBP measurements was performed by automatic tonometer (OMRON 705 IT). The ABP monitoring (ABPM) was performed with the BPLab device (Nizny Novgorod, Russia) twice in each patient: in W (Dec-Feb 2012–2014) and in S (Jun-Aug 2012–2014). The interval between ABPMs was 6 months ± 10 days. The selection criteria for ABPM records were the quality adequate for sophisticated analyses: duration >24 h, absence of data gaps >1 h, >55 readings per 24 h. Results: In total, 1630 patients were included: 720 in I and 910 in S. The patients of I (the region with lower average ambient temperature compared to S) had higher mean systolic CBP (CSBP) in W than in S (134.4 ± 13.2 mmHg and 129.7 ± 12.6 mmHg, respectively, p < 0.0001). The CSBP in patients of S was also higher in W (128.9 ± 14.3 mmHg) than in S (125.0 ± 16.0 mmHg, p < 0.0001). Monthly averages of CBP/ABP and ambient temperature were not related in S and W. Figure. No caption available. Conclusions: The seasonal variability of CBP/ABP parameters in patients with AH and HNBP corresponds to the general trend - BP is higher in W than in S. The ambient temperature is not influence on CBP/ABP of patients from two investigated cohort.

PREVALENCE OF MASKED HYPERTENSION IN DIFFERENT GROUPS OF MEDICATED PATIENTS: PP.25.24

Objective: The problem of masked hypertension (MH) in medicated patients is very important due to their high cardiovascular risk. The aim of our study was to determine the prevalence of MH in various patients’ groups. Design and Method: Two groups of patients with the stable hypertension grade 1-2 were compared. Group I included 219 patients with the single measurement of clinical (CBP) and 24h ambulatory blood pressure (ABP) after 4-8 weeks of monotherapy by 9 antihypertensive drugs. Group II included 39 patients from cross-over randomized trial of amlodipine and spirapril. These participants underwent at least 7 visits to the clinic for CBP control. ABP monitoring was performed at the end of each treatment course (4 weeks). The additional diagnostic methods were: ECG (in group II), General Well-Being Questionnaire (GWBQ). MH was determined as CBP<140/90 mm Hg and daytime ABP>=135/85 mm Hg. To summarize the data the analysis of 2x2 contingency tables was done. The multivariate logistic procedure in stepwise mode and Spearman correlation analysis were used for assessment of MH predictors in groups I and II respectively. The analysis models were sex and age adjusted. Results: The prevalence of MH in group I was 11.5%, in group II - 37.5-41.9%. We found initial differences between groups: age (57.7 ± 0.6 and 53.7 ± 1.6 years, p < 0.05), body mass index (BMI; 29.0 ± 0.3 and 30.3 ± 0.8, p < 0.05), GWBQ scale III (7.7 ± 0.3 and 9.1 ± 0.5, p < 0.01) and VI (7.9 ± 0.3 and 9.0 ± 0.5, p < 0.05). MH in group I was associated with: GWBQ scales II, V, VI; intake of metoprolol and amlodipine (positive correlation [+]). MH in group II correlated with: increased orthostatic BP, ECG criteria of left ventricular hypertrophy, GWBQ scales I, IV, VI (+); age, BMI, previous antihypertensive medication, alcohol intake (negative correlation). Conclusions: The prevalence of MH in medicated hypertensive patients may depend on initial patients’ characteristics, prescribed drugs and the factor of repeated visits to the clinic (due to CBP regression to the mean).