Objective: To analyze the prevalence of Masked hypertension (MHT) and their associated predictive factors in non-hypertensive subjects with high normal BP values. Design and method: 453 subjects with office BP values between 130–139mmHg of systolic BP (SBP) and / or 85–89 mmHg for diastolic BP (DBP) underwent 24-h ambulatory BP monitoring (ABPM), medical history, physical examination, EKG and laboratory investigations. Nocturnal Hypertension (NHT) was defined as BP higher or equal to 135 mmHg for SBP and / or higher or equal to 85 mmHg for DBP during day-time. Results: Mean age was 49.79 years ± 10.28 years, with a 51% of women. MHT prevalence was 41.5%. It was more frequent in younger subjects (48.5 ± 10.6 vs 50.7 ± 9.9 years; p = 0.024), with a higher proportion of males (48.2% vs 35.1%, p = 0.005) and a higher office SBP and DBP (135.1 ± 3.5 / 85.1 ± 3.4 vs 133 5 ± 5.0 / 83.7 ± 4.7 mmHg; p < 0.001). As for the laboratory and EKG investigations higher values of plasma creatinine (0.82 ± 0.17 vs 0.78 ± 0.1 mg / dl; p = 0.012) and increased left ventricular enlargement determined by the R voltage in aVL (0.49 ± 0.42 vs 0.2 ± 2.7 mV; p = 0.015) were found. Conclusions: Masked hypertension affects more than a half of prehypertensive subjects, mainly in younger males. We found in this group more target organ damage as worse renal function and increased left ventricular enlargement.

Aim: To investigate the number of office Blood Pressure (BP) readings that best correlate with 24-h ambulatory blood pressure monitoring (ABPM) to detect masked (MHT) and isolated clinical hypertension (ICH) Patients and methods: Observational, cross-sectional, multicenter study in treated hypertensive patients attended by Spanish hypertension units. After 5 minutes rest, six BP readings were performed at 1 minute intervals. 24-h ambulatory BP (ABPM) and laboratory investigations were also made. The mean of the first 2 readings (P2), first 3 readings (P3), all 6 readings (P6), and last 3 readings (L3) were compared with mean daytime ABPM. MHT was defined as office BP < 140/90 mmHg and daytime BP ≥ 135/85 mmHg. White coat HT (ICH) was defined as office BP ≥ 140/90 mmHg and daytime BP < 135/85 mmHg. Results: 498 treated hypertensives were consecutively included (mean age 60±13 years; 48.6% males), BMI 29.1±4.4 kg/m2, 12.2% smokers, 26% type 2 DM, 29.3% previous CV disease. Mean office BP measurements were: (P2) 142/83; (P3) 141/82; (P6) 139/81 and (L3) 137/80 mmHg. Mean daytime ABPM was 131/78 mmHg and the correlation coefficients for SBP/DBP were (P2) 0.47/0.49; (P3) 0.48/0.51; P6 0.50/0.54; and (L3) 0.51/0.56 (p < 0.001). Based on office readings, BP control was (P2) 43.17%, (P3) 43.98%, (P6) 51.61% and (L3) 55.22%. The highest MHT prevalence ("false negative") and lowest ICH ("false positive") were observed with the last 3 office BP readings, 15.06% and 17.47%, respectively, which showed the best diagnostic concordance of all the four possibilities (67.49%; kappa 0.34). Conclusions: The greater the number of office BP readings, the higher the prevalence of masked HT and the lower the prevalence of isolated clinical hypertension. The most reliable BP control rates were observed with the last 3 BP readings. Discarding the first office BP readings and using the mean of the last 3 readings seems to be the most accurate method for decision making when only office BP is measured in treated hypertensive patients.

Camafort, M.; Sobrino, J.; Domenech, M.; Vinyoles, E.; Segarra, A.; Lopez-Paz, J. E.; Saban, J.; Cuadrado, L. M.; Gamazo, F.; Vicente, A.; Adrian, M. J.; Felip, A.; Vila, J.; Coca, A. On Behalf of The Esthen Study Group Author Information

Objective: Evaluate differences on office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) between normotensive men and women on a working age range (18–65 years). Matherial and Methods: We analyzed the data of OBP and ABPM of normotensive subjects included on a ESTHEN 2 study (J Hypert 2009; 27(suppl 4):S45-S46), that include several hypertension's Unit working personal, in Spain. Results: We included 407 subjects (246 F/161 M) with a similar age range in two groups (F: 42,6 ± 12,3 vs M 42,1 ± 11,3 years; p = 0,65). The women showed a clearly lower blood pressure values than men in both methodology (OBP and ABPM) in all of different periods after adjusted for age, BMI, smoking and consumption of alcohol). Table 1. We not observed any difference in night/day index on SBP (that was 0.89) and correlation between OBP and ABPM values in two groups, although women showed strongly correlation than men ((r = 0,56 vs 0,45). Women presented a significantly prevalence of no-dipper pattern than men (47,4% vs 35,8%; p = 0,026). Conclusions: Women presented lower blood pressure values than men independently of methodology used but with a worse circadian blood pressure.

: Wednesday, June 16, 2004: POSTER SESSIONS: Poster Session 43: BP Measurements and Hemodynamics

Domenech, M.; Sobrino, J.; Buges, J.; Mir, N.; Barcelo, X.; Diez, S.; Adrian, M. J.; Casañas, L.; Morata, E. Author Information

Sobrino-Martinez, Javier; Vila, J.; Modol, J.; Pelegri, A; Pou, G.; Minguez, A; Domenech, M.; Adrian, M.; Felip, A; Plana, J. Author Information

The World Health Organization/International Society of Hypertension on 1999, recommended to start pharmacological treatment with anyone of 6 groups of antihypertensive treatments. However, preliminary results of ALLHAT study, seems to refute that, due to one of this six therapeutics groups, seems to be relationship to produce heart failure. To determinate if any pharmacological group of antihypertensive treatments is relationated with development of heart failure. Multicenter case-control study. For one side, we analyzed as case-patients, all hypertensive patients hospitalized for heart failure during 1997–2000 in community hospitals of Catalonia and, on the other side, we considered as a control patients, all hypertensive patients hospitalized at the same time, for any complication relationed with hypertension (stroke, myocardial ischemia or infarction) but without heart failure. We analyzed 596 hypertensive patients that required hospitalization for heart failure (case group) and 716 hypertensive patients that hospitalized for several vascular diseases relationated with hypertension (control group). The two groups are significantly different for previously hospitalized antihypertensive therapy, for diuretics 68.6% in case group vs 36,8% in control group, OR 3.75 (CI of 95% 2.98–4.37; p < 0,001), for beta blockers 3.4% in case group vs 9.8% in control group, OR 0.32 (CI of 95% 0.19–0.53; p < 0.001), for calcium antagonists 13.6% in case group vs 19.1% in control group, OR 0.66 (CI of 95% 0.49–0.90; p = 0.08), for ACE inhibitors 46.1% in case group vs 37.6% in control group, OR 1.41 (CI of 95% 1.13–1.76; p = 0.002), for angiotensin receptor blockers 8.2% in case group vs 6.3% in control group, OR 1.33 (CI of 95% 0.87–2.03; p = 0.17), and for alpha blockers 4.5% in case group vs 3.9% in control group, OR 1.16 (CI of 95% 0.67–2.0; p = 0.57). The use of alpha-blockers as antihypertensive treatment seems not to increase the risk for hospitalization due to heart failure in hypertensive patients treated with this pharmacological group.

The aim of the study was to determinate the impaired cognitive function in elderly patients with uncontrolled hypertension. We analyse the cognitive status in hypertensive patients who were aged more than 65 year old. To evaluate cognitive function we used Mini-Mental Status Examination (MMSE). Eighty-six hypertensive patients were included, 44 women and 42 men, mean age 67.4±4.4 years. Mean systolic BP was 164.42±12.43 mmHg, mean diastolic BP 96.22±6.16 mmHg and pulse pressure 68.19±13.01mmHg. According to the grade of hypertension 20.9% were patients with mild hypertension (grade 1) according to the OMS criteria; 60.5% moderate hypertension (grade 2) and 18.6% severe hypertension (grade 3). Other cardiovascular risk factors were, 19.8% smokers, 45.3% hyperlipidemics, 17.4% diabetics and 7% presents a history of cardiovascular disease. The values observed in MMSE was 22-35 with a mean 31.27±3.6 and median 32. Only 8% patients showed MMSE < 25. The patients with mild hypertension presents a higher values of MMSE than patients with moderate and severe hypertension. We found a negative correlation between values of MMSE and values of systolic BP, r= - 0.316, p= 0.003, values of diastolic BP, r= - 0.269, p= 0.012, and the age of the patients, r = - 0.316, p=0.001. No significant correlation was observed with pulse pressure and heart rate. We conclude that only 8% of patients shows a deterioration of cognitive status, showed by MMSE, in that old population, with no control of BP. However, a relationship between MMSE and blood pressure could be shown. The severity of the hypertension and higher BP, shows a decreased cognitive function.

Sobrino, J.; Plana, J.; Felip, A.; Pladevall, M.; Casas, M.; Soler, J.; Roma, J.; Ribera, L.; Adrian, M. J.; Domenech, M.; Coca, A. Author Information

AustraLiaArthritis is relatively common in older hypertensive patients and they require non steroidal anti-inflammatory drags (NSAID).This may lead to loss of hypertensive control due in part to sodium retention.Dihydropyridine calcium channel blocking drugs' effects are relatively independent of sodium status and NSAID may not have this adverse effect in people treated with amlodipine.Twentythree patients (IgM, 5F) age 60-80 (mean 69y) with essential hypertension well controlled on amledipine (5 or 10 mg/d) completed a double blind, crossover study comparing the effect of placebo or indomcthacin (50 mg twice daily) over a 3 week period on BP.BP was measured at the clinic (24 hours post dose) and by ambulatory BP monitoring for 27 hours.At the end of the double blind placebo period clinic BP was 153 ± 3/81 ± 1.5 mmHg and at the end of the indomethacin period 156 ± 3/82 ± 19 mmHg (n = 23, p >0.2).The mean 24 hour BP on placebo was 141 ± 2/76.8 ± 1.4 and on indomethacin was 142 ±2/77.2± 1.2 (n = 23, p >0.4).There were no differences in daytime, night time or early morning BP (see Table).The power to detect a difference of 2 mmHg or more was 95% Blood Pressurre mmHg Placebo lndomethacin Sys Diast Sys Diast p 24h mean 141±2 76.8±1.4 142±2 77.2±1.2 >0.4 day mean 143±2 78.4_+1.4145±2 79.3±1.3 >0.3 night mean 128±3 67.5±1.8 130±3 67.6±1.2 >0.4 morning mean 149±3 82.2_+1.7 149±3 81.5±1.7 >0.8 Weight rose by 0.64 ± 0.28 Kg (p < 0.05).Plasma renin and aldosterone were not altered.lndomethaein can be given to people controlled on amlodipine without causing a rise in BP and is a preferred treatment for hypertensive patients with associated arthritis.