Out-of-office blood pressure (BP) measurement is considered an integral component of the diagnostic algorithm and management of hypertension. In the era of digitalization, a great deal of wearable BP ...measuring devices has been developed. These digital blood pressure monitors allow frequent BP measurements with minimal annoyance to the patient while they do promise radical changes regarding the diagnostic accuracy, as the importance of making an accurate diagnosis of hypertension has become evident. By increasing the number of BP measurements in different conditions, these monitors allow accurate identification of different clinical phenotypes, such as masked hypertension and pathological BP variability, that seem to have a negative impact on cardiovascular prognosis. Frequent measurements of BP and the incorporation of new features in BP variability, both enable well-rounded interpretation of BP data in the context of real-life settings. This article is a review of all different technologies and wearable BP monitoring devices.
Exploring T cell response duration is pivotal for understanding immune protection evolution in natural SARS-CoV-2 infections. The objective of the present study was to analyze the T cell immune ...response over time in individuals who were both vaccinated and COVID-19-naive and had undetectable levels of SARS-CoV-2 IgG antibodies at the time of testing.
We performed a retrospective descriptive analysis using data extracted from the electronic medical records of consecutive adult individuals who underwent COVID-19 immunity screening at a private healthcare center from September 2021 to September 2022. The study participants were divided into three groups according to the post-vaccination time period, as follows: group A (up to 3 months), group B (3-6 months), and group C (>6 months). T cell response was evaluated using the IGRA methodology T-SPOT
.COVID.
Of the total number of subjects (n = 165), 60/165 (36.4%) had been vaccinated in the last 3 months (group A), 57/165 (34.5%) between 3 and 6 months (group B), and 48/165 (29.1%) at least 6 months prior to the examination day (group C). T cell positivity was reported in 33/60 (55.0%) of group A, 45/57 (78.9%) of group B, and 36/48 (75%) of group C (
< 0.007). No statistically significant differences were revealed in the spot-forming cell (SFC) count among groups, with mean SFC counts of 75.96 for group A, 89.92 for group B, and 83.58 for group C (Kruskal-Wallis test,
= 0.278).
Our findings suggest that cellular immunity following SARS-CoV-2 vaccination may endure for at least six months, even in the presence of declining or absent IgG antibody levels.
OBJECTIVE:Smokers often hesitate quitting in fear of gaining weight. Smoking is a strong risk factor for coronary artery disease (CAD), while the respective risk of body weight is less clear. We ...studied the prognostic ability for CAD of different combinations of smoking habits and obesity status.
DESIGN AND METHOD:We followed 1700 normal weight to moderately obese treated hypertensive patients, without a history of cardiovascular disease for a mean period of 3.6 ± 1.8 years. Current smoking at the baseline examination was recorded as smoking at least one cigarette daily. Body weight and height were measured with standardized methods and body mass index (BMI) served as the measure of obesity. Obesity was defined as a BMI> or = 30 kg/m. Based on the smoking and obesity status, four groups were identifiednon-obese/non-smokers (n = 888, 52.2% of the total population), obese/non-smokers (n = 404, 23.8%), non-obese/smokers (n = 282, 16.6%) and obese/smokers (n = 126, 7.4%). The follow-up plan involved regular visits for blood pressure and risk factor management. Endpoint of interest was coronary heart disease set as the composite of myocardial infarction or significant coronary artery stenosis revealed by angiography, or coronary revascularization procedure, and non-obese/non-smokers served as the reference group.
RESULTS:Incidence of CAD was 4.7 events per 1,000 patient-years in non-obese/non-smokers, 4.8 events per 1,000 patient-years in obese/non-smokers, 12.2 events per 1,000 patient-years in non-obese/smokers and 13.5 events per 1,000 patient-years in obese/smokers. Multivariate cox regression showed that after introducing both smoking and obesity into a model controlling for traditional risk factors, only smoking was associated with a significantly higher risk of 3.06 (CI:1.60–5.85, p = 0.001) for CAD. Unadjusted as well as adjusted for risk factors cox regression analysis revealed a similar risk for obese/nonsmokers compared to the reference group and a greater risk for non-obese/smokers and obese/smokers (HR:3.01, CI:1.36–6.63, and HR:3.81, CI:1.39–10.44 respectively for the adjusted models).
CONCLUSIONS:In normal weight to moderately obese treated hypertensive patients, smoking, but not obesity, is a strong predictor of CAD. Combination of smoking with a BMI over 30Kg/m2 has the worse prognosis.
OBJECTIVE:The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity and arterial ...stiffening are linked with adverse cardiovascular prognosis. The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP.
DESIGN AND METHOD:42 subjects with high normal office BP defined as office systolic BP = 130–139 mmHg and office diastolic BP = 85–89 mmHg (age53 ± 9 years, 29 males, office BP134/84 mmHg, 24-hour BP114/72 mmHg) with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n = 12) (peak exercise systolic BP > or = 210mmHg in men and > or = 190 mmHg in women) and those without HRE (n = 30). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values. In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography).
RESULTS:Subjects with a HRE compared to those without exhibited higher waist circumference (108.2 ± 5.3 vs 94.7 ± 9.2 cm, p = 0.001) and were characterized by greater levels of carotid to femoral PWV (8.5 ± 0.8 vs 7.0 ± 0.9 m/sec, p < 0.001) and sympathetic nerve traffic as reflected by MSNA levels (41.1 ± 1.5 vs 32.1 ± 1.9 bursts per 100 heart beats, p < 0.001), while did not differ regarding metabolic profile and left ventricular mass index (p = NS). In the total population, peak exercise systolic BP was related to 24-h systolic BP (r = 0.229, p < 0.05), PWV (r = 0.218, p = 0.002), and MSNA (r = 0.214, p < 0.05). Moreover, MSNA was related to waist circumference (r = 0.33, p = 0.004) and office systolic BP levels (r = 0.31, p < 0.05) but there was no association with PWV values (p = NS).
CONCLUSIONS:In subjects with high normal BP, a HRE identifies a state of arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. These finding suggest that exercise testing provides additional clinical information regarding the vascular status and modulation of sympathetic tone in this setting.
OBJECTIVE:Although arterial stiffening is related to atherosclerosis progression, its prognostic role in cerebrovascular events in hypertension is not fully elucidated. The aim of the present study ...was to assess the predictive role of arterial stiffness for the incidence of stroke in a cohort of essential hypertensive patients.
DESIGN AND METHOD:We followed up 1079essential hypertensives (mean age 55.8 years, 572 males, office blood pressure (BP) = 144/91 mmHg)for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent blood sampling for assessment of metabolic profile andarterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method. The distribution of PWV was split by the median (8.1 m/sec) and accordingly subjects were classified into those with high (n = 546) and low values (n = 533). Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by computed tomography and magnetic resonance angiography and/or cerebrovascular angiography findings.
RESULTS:The incidence of stroke over the follow-up period was 2.03%. Hypertensives who had stroke (n = 25) compared to those without stroke at follow-up (n = 1054) were older at baseline (63 ± 8 vs 55 ± 10 years, p = 0.012), had higher office BP levels (155 ± 13 vs 144 ± 16mmHg, p = 0.022) and prevalence of high PWV levels (68% vs 42%, p = 0.019). No difference was observed between hypertensives with stroke and those without stroke with respect to baseline renal function and lipid levels (p = NS for all). In multivariate Cox regression model, baseline age (hazard ratio = 1.098, p = 0.04) and PWV (hazard ratio = 1.105, p = 0.015) but not baseline office BP levels turned out to be independent predictors of stroke.
CONCLUSIONS:In essential hypertensive patients, PWV predicts future development of stroke, independently of established confounders, including BP. These findings support that PWV constitutes a potent prognosticator of cerebrovascular events and its estimation is essential in order to improve risk stratification in hypertension.
OBJECTIVE:Visit-to-visit Blood Pressure Variability (BPV) has been associated with a worse outcome in some but not all studies. Recently, BP Time in Therapeutic Range (TTR) has been introduced as a ...measure of long-term BP control.We examined the prospective association of TTR versus visit-to-visit BPV forcardiovascular outcome among treated hypertensives.
DESIGN AND METHOD:We followed 1408 hypertensive patientsunder treatment (age 60 ± 11 years) for a mean period of6.0 ± 3.3 years. Visit-to-visit BPV was recorded as the coefficient of variation of office systolic BP across up to 5 visits. TheTTR was calculated as the percentage of BP measurements within 120–140 mmHg during follow-up. The outcome studied wasthe composite of stroke and coronary artery disease.
RESULTS:In the entire population mean TTR was 45 ± 29%and mean BPV was 9 ± 5%. The compositeendpointoccurred in 70 patients (5%). Cox regression analysis showed that TTR, but not BPV, was significantly associated with the outcome(HR0.37, 95% CI0.16–0.87). Patients were subsequently stratifiedin quartiles of TTRTTR < or = 25%, 426 patients (30%), TTR 25–39%, 309 patients (22%), TTR 40–67%, 390 patients (28%) and TTR > 67%, 283 patients (20%). Patients in the lowestversus the highestquartile of TTR had a HR:2.1 95% CI1.06–4.15 for cardiovascular events. This pattern overall remained but wasattenuated in different models controlling for risk factors. Such associations werenot observed among quartiles of BPV.
CONCLUSIONS:In treated hypertensive patients, the office BP TTR, unlike visit-to-visit BPV, is significantly associated with incident cardiovascular events. Among different levels of TTR, patients with a TTR less than 25% present with the worse cardiovascular outcome.
OBJECTIVE:The impact of blood pressure variability (BPV) on cardiovascular morbidity and mortality has been examined through the prism of heart failure and hypertension, but not in the setting of ...myocardial infarction (MI). The aim of this study is to determine the association between in-hospital short-term BPV and long-term cardiovascular outcomes in MI patients.
DESIGN AND METHOD:A total population of 130 patients 82.2% male; mean age63.8 years; 71.3% hypertensives, 47.3% STEMI underwent 24-h ambulatory BP measurement during hospitalization for MI. At one year a follow-up was scheduled in order to assess major cardiovascular outcomes. These included cardiovascular death, hospitalization for heart failure (HF), stroke, acute coronary syndrome (ACS), ventricular tachycardia, atrial fibrillation. The parameters of BPV analyzed werea) 24-h standard deviation (SD), b) the coefficient of variation (CV) and c) the average real variability (ARV) of systolic and diastolic BP.
RESULTS:Cardiovascular death was independently predicted by SD SBP (HR, 2.406; CI, 0.207–4.604 (P = 0.032) and CV SBP (HR, 3.093; CI, 1.295–4.892 (P = 0.001) in the entire population and separately in STEMI group (HR, 5.674; CI, 2.214–9.135 (P = 0.002) and (HR, 5.669; CI, 2.499–8.838 (P = 0.001) respectively. Regarding overall hospitalizations for cardiovascular events, ARV SBP and ARV DBP demonstrated a significant predictive role in the entire population (HR, 1.045; CI, 0.327–1.762 (P = 0.005) and (HR, 0.991; CI, 0.342–1.640 (P = 0.003) respectively and the STEMI group (HR, 1.161; CI, 0.227–2.095 (P = 0.016) and (HR, 0.964; CI, 0.033–1.896 (P = 0.043) respectively. For NSTEMI group only ARV DBP was a predictor for overall hospitalizations (HR, 1.043; CI, 0.116–1.970 (P = 0.028). Independency of all predictors was confirmed in multivariate models including gender, age, hypertension, DM, smoking, low density lipoprotein (LDL-C) and GFR.
CONCLUSIONS:In the setting of MI, in-hospital BPV was associated with cardiovascular morbidity and mortality during the one-year follow-up. These findings could suggest clinical need for further individualization of BP regulation in the integrative ACS management.
OBJECTIVE:Data are scarce regarding the possible prognostic role of blood pressure variability (BPV) in the setting of acute coronary syndrome (ACS). The aim of this study is to determine the impact ...short-term BPV on in-hospital cardiovascular outcomes and renal function in patients suffering a myocardial infarction (MI).
DESIGN AND METHOD:A total population of 211 MI patients 79.1% male; mean age62.33 years; 67.3% hypertensives underwent 24-h ambulatory BP measurement during their hospitalization. The parameters of BPV analyzed werea) 24-h standard deviation (SD), b) coefficient of variation (CV) and c) average real variability (ARV) of systolic and diastolic BP. The study population was divided into a STEMI (n = 104) and a non-STEMI (n = 107) group. Cardiovascular outcomes includednew onset of ACS, pulmonary edema, hypertensive emergency, life threatening arrhythmias, whereas worsening of renal function (WRF) was defined as a reduction of GFR > or =25% according to the RIFLE criteria. No deaths or strokes occurred.
RESULTS:In the total population a significant association was demonstrated between SBP CV and the incidence of cardiovascular outcomes OR, 0.724; CI, 0.039–1.409 (P = 0.038). After separate analysis in STEMI group SBP CV remained a predictor OR, 1.369; CI, 0.326–2.412 (P = 0.011). Regarding WRF both CV SBP and CV DBP demonstrated a prognostic role OR, 1.654; CI, 0.651–6.657 (P = 0.001) and OR, 2.203; CI, 0.724–3.682 (P = 0.004) respectively in the entire population. Results for STEMI group were similar OR, 3.459; CI, 1.449–5.469 (P = 0.001) and OR, 3.209; CI, 0.486–5.932 (P = 0.021) respectively. However, non-STEMI group failed to demonstrate any significant association. We therefore, conducted multivariate regression models for STEMI group, in which the above BPV indices retained predictive value of cardiovascular outcomes and WRF independently of age, gender, history of hypertension, diabetes mellitus (DM), smoking and low-density lipoprotein (LDL-C).
CONCLUSIONS:In the setting of STEMI, assessment of BPV using CV could have a prognostic role of in-hospital cardio-renal outcomes suggesting a clinical need for further individualization of BP regulation in the integrative ACS management.
OBJECTIVE:The aim of the present study was to assess the predictive role of changes inarterial stiffness for the incidence of stroke in a cohort of essential hypertensive patients.
DESIGN AND ...METHOD:We followed up 1082essentialhypertensives (mean age 55.9 years, 562 males, office blood pressure (BP) = 145/91 mmHg)for a mean period of 8 years. All subjects had at least one annual visit and arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method at the initial and last visit. The distribution of baseline PWV was split by the median (8.2 m/sec) and accordingly subjects were classified into those with high (n = 546) and low values (n = 536). Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings.
RESULTS:The incidence of stroke over the follow-up period was 2.2%. Hypertensives who had stroke (n = 24) compared to those without stroke at follow-up (n = 1058) were older at baseline (65 ± 9vs56 ± 12 years, p = 0.032), had higher office BP levels (155 ± 13vs145 ± 15 mmHg, p = 0.014) and prevalence of high PWV levels (67% vs 40%, p = 0.021). No difference was observed between hypertensives with stroke and those without stroke with respect to baseline renal function and lipid levels (p = NS for all). By univariate Cox regression analysis it was revealed that changes in PWV levels between baseline and last visit predicted stroke (hazard ratio = 1.352, p = 0.004). Moreover, in multivariate Cox regression model, baseline age (hazard ratio = 1.087, p = 0.03), changes in PWV (hazard ratio = 1.115, p = 0.024) but not changes in office BP levels turned out to be independent predictors of stroke.
CONCLUSIONS:In essential hypertensive patients, changes in PWV predict future development of stroke, independently of established confounders, including BP. These findings support that PWV constitutes a potent prognosticator of cerebrovascular events and its estimation is essential in order to improve risk stratification in hypertension.
OBJECTIVE:The purpose of our registry was to record the prevalence, clinical characteristics and management of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency ...department and during hospitalization in a Greek General Hospital for a period of 12 months.
DESIGN AND METHOD:The study population consisted of patients presenting at the emergency department with acute increase in blood pressure (BP)systolic BP > or =180 mmHg and/or diastolic BP > or =120 mmHg and depending on the presence or absence of acute hypertension-mediated target organ damage, participants were divided into the HE and the HU group, respectively. In all patients the demographic, clinical and therapeutic parameters were recorded for 12 months.
RESULTS:Out of 38589 patients assessed in the ED during a period of 12 months, 353 (0.91%) had HU and HE, out of which 254 (72%) had HU and 99 (28%) had HE. The mean age of the patients was 67.4 ± 12.9 years, 49% were males and 80% had history of hypertension. Patients with HE compared to those with HU had higher systolic BP levels in the emergency department(200 ± 21 vs 194 ± 18 mmHg, p = 0.024) as well as heart rate(94 ± 20 vs 81 ± 16bpm, p < 0.0001), while there were no differences in diastolic BP (p = NS). Moreover, patients with HE compared to HU were older (72.7 ± 12.1 vs 61.4 ± 12.7 years, p < 0.0001), had lower hematocrit (39.2 ± 5.5 vs 42.5 ± 4.5%, p < 0.0001)and more increased creatinine values (1.5 ± 1.3 vs 0.9 ± 0.3 mg/dl, p < 0.0001). From the total population91 patients with HE and 25with HU were admitted in the hospital and remained for 6.4 ± 5.6 days. During hospitalization there was an increase of serum creatinine by 0.11 ± 0.45 mg/dl, and a decrease of high sensitivity troponin by 99.65 ± 840.15pg/ml. Finally, a reduction in both systolic BP by 12 ± 23 mmHg and diastolic BP by 6 ± 13 mmHg were observed from admission until hospital discharge.
CONCLUSIONS:Our 12 months registry presents the current clinical phenotype of HU and HE as well as the alterations in biochemical and hemodynamic data during hospitalization. These findings emphasize the need for further research in this setting.
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