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The relationship between visit-to-visit blood pressure variability (BPV) and cardiovascular outcomes remains unclear. Our study assessed the prognostic implications of visit-to-visit BPV in patients after acute myocardial infarction (AMI). The present study enrolled 7,375 patients who underwent percutaneous coronary intervention for AMI and at least five measurements of blood pressure after hospital discharge. Visit-to-visit BPV was estimated as variability independent of mean. The primary endpoint was all-cause mortality. The secondary endpoints were major cardiovascular events (the composite of cardiovascular death, myocardial infarction, and ischemic stroke) and hospitalization for heart failure. During a median follow-up of 5.8 years, adjusted risks of all-cause mortality, major cardiovascular events, and hospitalization for heart failure continuously increased as systolic BPV and diastolic BPV increased. Patients in the highest quartile of systolic BPV (versus lowest) had increased risk of all-cause mortality (adjusted hazard ratio (aHR) 1.51 [95% confidence interval (CI) 1.23-1.85]), major cardiovascular events (aHR 1.31 [95% CI 1.1-1.55]), and hospitalization for heart failure (aHR 2.15 [95% CI 1.49-3.1]). Patients in the highest quartile of diastolic BPV was also associated with all-cause mortality (aHR 1.39 [95% CI 1.14-1.7]), major cardiovascular events (aHR 1.29 [95% CI 1.08-1.53]), and hospitalization for heart failure (aHR 2.01[95% CI 1.4-2.87]). Both systolic and diastolic BPV improved the predictive ability of the GRACE (Global Registry of Acute Coronary Events) risk score for both all-cause mortality and major cardiovascular events. Higher visit-to-visit BPV was associated with increased risks of mortality and cardiovascular events in patients after AMI., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Renal denervation is a promising new non-pharmacological treatment for resistant hypertension. However, there is a lack of data from Asian patients. The REQUIRE trial investigated the blood pressure-lowering efficacy of renal denervation in treated patients with resistant hypertension from Japan and South Korea. Adults with resistant hypertension (seated office blood pressure ≥150/90 mmHg and 24-hour ambulatory systolic blood pressure ≥140 mmHg) with suitable renal artery anatomy were randomized to ultrasound renal denervation or a sham procedure. The primary endpoint was change from baseline in 24-hour ambulatory systolic blood pressure at 3 months. A total of 143 patients were included (72 renal denervation, 71 sham control). Reduction from baseline in 24-hour ambulatory systolic blood pressure at 3 months was not significantly different between the renal denervation (-6.6 mmHg) and sham control (-6.5 mmHg) groups (difference: -0.1, 95% confidence interval -5.5, 5.3; p = 0.971). Reductions from baseline in home and office systolic blood pressure (differences: -1.8 mmHg [p = 0.488] and -2.0 mmHg [p = 0.511], respectively), and medication load, did not differ significantly between the two groups. The procedure-/device-related major adverse events was not seen. This study did not show a significant difference in ambulatory blood pressure reductions between renal denervation and a sham procedure in treated patients with resistant hypertension. Although blood pressure reduction after renal denervation was similar to other sham-controlled studies, the sham group in this study showed much greater reduction. This unexpected blood pressure reduction in the sham control group highlights study design issues that will be addressed in a new trial. CLINICAL TRIAL REGISTRATION: NCT02918305 ( http://www.clinicaltrials.gov )., (© 2021. The Author(s).)

This study aimed to examine the association between obstructive sleep apnea (OSA) and morning blood pressure surge in never-treated patients with essential hypertension. This prospective study included a total of 58 patients (mean age, 51.7 years; 55.2% men) with never-treated essential hypertension. The patients were divided into non-OSA (n=23, 49.3±12.7 years) and OSA (n=35, 53.2±9.8 years) groups. The OSA group was defined as having an apnea-hypopnea index level >5 as measured by the Watch-PAT 200. The authors collected 24-hour ambulatory BP, plasma aldosterone concentration, and plasma renin activity data from all of the patients. The measured sleep-trough morning systolic blood pressure (SBP) increases were higher in the OSA group than in the non-OSA group (28.7±11.8 mm Hg vs 19.6±12.8 mm Hg, P=.008). The sleep-trough morning SBP increase was inversely correlated with the lowest oxygen saturation (r=-0.272, P=.039). OSA known to be associated with increased daytime and nocturnal sympathetic activity was associated with significantly higher sleep-trough morning SBP levels in this study., (©2015 Wiley Periodicals, Inc.)

Morning blood pressure (BP) surge (MS) has been known to be a predictor of cardiovascular events. Currently, few studies have evaluated the underlying mechanism underlying MS, which may include neurohormonal factors and the renin-angiotensin-aldosterone system (RAAS). This study aimed to examine plasma aldosterone concentration (PAC) and plasma renin activity (PRA) and BP parameters with or without MS in never-treated subjects with essential hypertension. This cross-sectional study included a total of 261 patients (mean age: 48.8 years; 60.5% male) with never-treated essential hypertension who were registered in a working group at The Catholic University of Korea. The patients were divided into the MS group, which was defined as having the highest quartile of morning BP increase from sleep (>31 mmHg; n = 66) and the non-MS group (≤31 mmHg; n = 195). We collected 24-h ambulatory BP, pulse wave velocity, ankle brachial index, PAC and PRA from all patients. The measured PAC and PRA were lower in the MS group than in the non-MS group (PAC: 9.0 ± 5.4 ng/dl versus 12.2 ± 8.7 ng/dl, p < 0.001; PRA: 1.7 ± 1.3 ng/ml/h versus 2.6 ± 3.6 ng/ml/h, p = 0.002). The MS group had greater variations in daytime, nighttime and 24-h systolic blood pressure (SBPs) than the non-MS group (24-h SBP: 15.6 ± 4.4 mm Hg for the non-MS group and 18.9 ± 4.9 mmHg for the MS group; p < 0.001 for each). It is generally accepted that the sympathetic nervous system plays a major role in the regulation of BP variability. Therefore, further studies on sympathetic nervous system activation in hypertensives with extreme MS are needed. MS in enrolled patients who were at relatively low risk in this study may be less affected by the RAAS.

The efficacy of renal sympathetic denervation in end-stage renal disease patients under hemodialysis Chan Joon Kim, Kiyuk Chang, Daewon Kim, Manwon Park, Jung Sun Cho, Sung-Ho Her Introduction: The end-stage renal disease (ESRD) patients who are under under renal replacement therapy, have often have uncontrolled, resistant hypertension. Renal sympathetic denervation (RDN) with radiofrequency ablation catheter has shown promising results in resistant hypertension. The purpose this pilot study is to assess the efficacy of RDN in resistant hypertension in ESRD patients. Method: Patients who are under renal hemodialysis and inter-dialytic SBP > 160 mmHg despite of three or more antihypertensives were eligible for enrollment. 8 patients were allocated to either medical therapy group or RDN group by randomization. RDN was performed with Symplicity RDN catheter (Medtronic®).The primary outcome was change in SBP change in an inter-dialytic day in 3 months. The secondary outcome was change in DBP in 3 months, left ventricular mass index (LVMI). Results: The baseline SBP/DBP were 172.2 ± 9.5/ 88.7 ± 12.1 mmHg for the intervention group and 164.0 ± 6.9/84.7 ± 13.4 for medical group. Baseline ambulatory SBP was 164.8 ± 4.4 for the intervention group and 162 ± 8.4 mmHg for medical therapy group. The 3 month SBP/DBP were 155.5 ± 12.2/80.2 ± 7.7 for the intervention group and 167.5 ± 10.3/83.6 mmHg for medical therapy group. The mean change in SBP was 18.4 ± 4.5 mmHg for the intervention group and 2.8 mmHg ± 3.8 mmHg for the medical group (p =0.03). The mean LVMI 194.3 ± 10.4 g/m2 for the intervention group and 187.4 ± 11.5 g/m2 for the medical therapy group. The mean change in LVMI was 41.4 ± 3.5 g/m2 for the intervention group and 1.1 g ± 4.4 g/m2 for the medical group (p =0.03). Conclusion: This pilot study suggests that RDN may have therapeutic effect in resistant hypertension in ESRD patients and may have a role in regression in left ventricular hypertrophy. [ABSTRACT FROM AUTHOR]