BACKGROUND:To explore associations of clinic and 24-hour ambulatory blood pressure (BP) monitoring (ABPM) with cardiovascular death (CVD), parameters were modeled for age and sex in this large cohort in primary care. METHODS:In the Spanish ABPM Registry, 59.124 patients had complete data on mortality, age, sex, and all ABPM. Office, mean, 24-hour, daytime, and nighttime systolic BP (SBP), diastolic BP, and pulse pressure (PP) were related to CVD according to age and sex and were modelled with restricted cubic splines to get trajectories. During a median of 9.7 years, 2361 patients had CVD (1229 males, 1132 females). RESULTS:Nonlinear relationships for office, 24-hour mean, daytime, and nighttime SBP, diastolic BP, and PP (P<0.0001 for all) for both sexes were observed. Until 75 years, SBP was higher in males than females, but differences were minimized after ≈60 to 70 years (P for interaction <0.0001). High SBP and PP are associated with CVD without heterogeneity between sexes and across aging. The increase of SBP and PP was higher at a higher age for females than males (P for interaction <0.0001). CVD was age-dependent, and ABPM, in particular nighttime BP did more closely associated with risk than office BP in younger than in older individuals. CONCLUSIONS:Twenty-four-hour mean, nighttime BP, and PP were closely associated with risk being higher in elderly females than males after 75 years, corresponding to a rise in BP in older females. Guidelines should continue to mandate the evaluation of 24-hour ABPM data for risk prediction.

Time in target range (TTR) reflects the proportion of time that blood pressure (BP) is within target range over various time points and therefore comprises information on BP variability and control. To examine the association of TTR for systolic BP (SBP) during 24-hour ambulatory BP monitoring (24h-TTR) with all-cause mortality. This analysis utilized data from the Spanish ABPM Registry, including patients from 223 primary care centres across all 17 regions of Spain. Mortality data was obtained from a computerized search of the vital registry of the Spanish National Institute of Statistics. The 24h-TTR was calculated using linear interpolation between two consecutive SBP recordings obtained from ABPM and determined the proportion of time spent in the TTR defined as a SBP of 120-134 mmHg during daytime and SBP of 110-119 mmHg during night-time. Association with all-cause mortality was assessed by Cox regression models adjusted for demographic and clinical. A total of 59,124 patients (47% female, mean age 58.7 years [SD 14.1]) were included in the Spanish ABPM Registry. The mean 24h-SBP was 128.8 mmHg (13.7). The mean 24h-TTR was 30.7% (SD 16.8), ranging from 0% to 87.8% (34.3% [SD 19.9] during waking and 23.7% [SD 19.5] during sleeping periods). During a median follow-up of 9.7 years, 7,174 (12.1%) of 59,124 patients died, including 2,361 (4.0%) from CV causes. Increased 24h-TTR was associated with a lower risk of all-cause death (hazard ratio [HR] 0.83 per 1SD increment [95% CI 0.80-0.85). This association remained significant even after additionally adjusting for mean 24h-SBP (HR 0.89 per 1SD increment [95% CI (0.86-0.92)]. The association of 24h-TTR with all-cause death was not significant in patients with a mean 24h-SBP of <115 mmHg (p=0.5205) but in those with 115-129 mmHg (p<0.0001), and ≥130 mmHg (p=0.0001) (Figure). Increased 24h-TTR was associated with a lower risk of all-cause death, particularly in patients with controlled and elevated mean 24h-SBP.

OBJECTIVES:Because angiotensin (Ang) II is an essential vasoconstrictive peptide, we analyzed the impact of its post-translational modification to pyruvamide-Ang II (Ang P) by pyridoxal-5'-phosphate (PLP) on blood pressure. PLP is a less expensive vitamin B6 derivative and, therefore, could be a cost-effective drug against hypertension. METHODS:Effect of Ang P on calcium ion entry into vascular smooth muscle cells (VSMCs) was analyzed. Binding affinity of Ang P to angiotensin II type 1 receptor (AT1R) was measured. Vasoconstrictive effect of Ang P was investigated using the bioassay of isolated perfused rat kidneys. Spontaneously hypertensive rats (SHR) were administered PLP. Additionally, Wistar Kyoto rats (WKY) received Ang II and PLP. Blood pressure was measured time-dependently. RESULTS:Ang II, incubated with PLP, was post-translationally modified to Ang P. Calcium ion entry in VSMCs was significantly lower with Ang P compared to Ang II. Binding affinity of Ang P to AT1R was lower compared to Ang II. Perfusion pressure of isolated perfused rat kidneys increased less by Ang P than by Ang II. Blood pressure of SHR treated with PLP decreased significantly. Blood pressure of WKY rats treated with Ang II was increased to hypertensive values, whereas blood pressure of WKY rats cotreated with Ang II and PLP was not. CONCLUSION:PLP induces a post-translational modification of Ang II decreasing blood pressure in rats. Assuming that increased PLP intake in the form of vitamin B6 might reduce blood pressure in hypertensive patients, PLP might be a cost-effective drug against hypertension.

BACKGROUND: Quantification of total cardiovascular risk is essential for individualizing hypertension treatment. This study aimed to develop and validate a novel, machine-learning–derived model to predict cardiovascular mortality risk using office blood pressure (OBP) and ambulatory blood pressure (ABP). METHODS: The performance of the novel risk score was compared with existing risk scores, and the possibility of predicting ABP phenotypes utilizing clinical variables was assessed. Using data from 59 124 patients enrolled in the Spanish ABP Monitoring registry, machine-learning approaches (logistic regression, gradient-boosted decision trees, and deep neural networks) and stepwise forward feature selection were used. RESULTS: For the prediction of cardiovascular mortality, deep neural networks yielded the highest clinical performance. The novel mortality prediction models using OBP and ABP outperformed other risk scores. The area under the curve achieved by the novel approach, already when using OBP variables, was significantly higher when compared with the area under the curve of the Framingham risk score, Systemic Coronary Risk Estimation 2, and Atherosclerotic Cardiovascular Disease score. However, the prediction of cardiovascular mortality with ABP instead of OBP data significantly increased the area under the curve (0.870 versus 0.865; P =3.61×10 −28 ), accuracy, and specificity, respectively. The prediction of ABP phenotypes (ie, white-coat, ambulatory, and masked hypertension) using clinical characteristics was limited. CONCLUSIONS: The receiver operating characteristic curves for cardiovascular mortality using ABP and OBP with deep neural network models outperformed all other risk metrics, indicating the potential for improving current risk scores by applying state-of-the-art machine learning approaches. The prediction of cardiovascular mortality using ABP data led to a significant increase in area under the curve and performance metrics.

Journal Article What Is the Relevance of Low Standing Blood Pressure? Get access Felix Buder, Felix Buder Department of Medicine III, Saarland University, Homburg, Germany Search for other works by this author on: Oxford Academic PubMed Google Scholar Felix Mahfoud, Felix Mahfoud Department of Medicine III, Saarland University, Homburg, Germany https://orcid.org/0000-0002-4425-549X Search for other works by this author on: Oxford Academic PubMed Google Scholar Michael Böhm, Michael Böhm Department of Medicine III, Saarland University, Homburg, Germany https://orcid.org/0000-0002-2976-2514 Search for other works by this author on: Oxford Academic PubMed Google Scholar Bernhard Haring Bernhard Haring Department of Medicine III, Saarland University, Homburg, Germany Corresponding author: Bernhard Haring (bernhard.haring@uks.eu). https://orcid.org/0000-0001-6109-431X Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Hypertension, Volume 36, Issue 11, November 2023, Pages 586–587, https://doi.org/10.1093/ajh/hpad074 Published: 11 August 2023 Article history Received: 02 August 2023 Accepted: 08 August 2023 Published: 11 August 2023 Corrected and typeset: 25 August 2023