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Background: The blood pressure load (BPL) is commonly defined as the percentage of readings in a 24-h ambulatory blood pressure monitoring (ABPM) study above a certain threshold, usually the upper normal limit. While it has been studied since the 1990s, the benefits of using this index have not been clearly demonstrated in adults. We present the first review on the associations of BPL with target organ damage (TOD) and clinical outcomes in adults, the major determinants for its role and utility in blood pressure measurement. We emphasize studies which evaluated whether BPL has added benefit to the average blood pressure indices on ABPM in predicting adverse outcomes. Methods: PubMed search for all English language papers mentioning ABPM and BPL. Results: While multiple studies assessed this question, the cumulative sample size is small. Whereas the associations of BPL with various TODs are evident, the available literature fails to demonstrate a clear and consistent added value for the BPL over the average blood pressure indices. Conclusions: There is a need for prospective studies evaluating the role of BPL in blood pressure measurement. The current literature does not provide sound support for the use of BPL in clinical decisions. [ABSTRACT FROM AUTHOR]

Although widely viewed as a urological condition, nocturia has been increasingly recognized to accompany various non-urological conditions such as hypertension and blood pressure (BP) elevation on office determination. Home BP monitoring (HBPM) has been shown superior to office-based readings and provides an opportunity to assess potential relationships between nocturia and novel indices derived from multiple BP recordings including BP load, BP variability, and arterial stiffness, which have prognostic significance. We retrospectively studied 103 home BP logs and nocturia frequencies provided by 61 stable cardiology patients ≥ 21 years without medication change. Nocturnal voids ranged from 0 to 5 voids per night, median: 1.5. Nocturia frequency was significantly correlated with home and office systolic BPs and with BP load, but not with diastolic BPs, BP variability or arterial stiffness. On Poisson regression analysis, the estimated prevalence ratio (PR) for home and office systolic BPs were 1.025 (CI: 1.01, 1.04; p <.001) and 1.01 (CI:1.00, 1.02; p =.019), indicating 2.5% and 1% increases in the risk of nocturia per mmHg increases in BP respectively. In conclusion, higher mean home and office systolic BPs are associated with self-reported nocturia frequency with stronger associations seen for home BP measurement. Nocturia frequency appears unrelated to mean home and office diastolic BPs. Nocturia may be related to BP load, (percentage of elevated BP values), but not to BP variability or arterial stiffness. Future prospective studies using HBPM are needed to confirm these findings and to contribute to the understanding of the elevated BP-nocturia link. [ABSTRACT FROM AUTHOR]

Background: The blood pressure load (BPL) is commonly defined as the percentage of readings in a 24-h ambulatory blood pressure monitoring (ABPM) study above a certain threshold, usually the upper normal limit. While it has been studied since the 1990s, the benefits of using this index have not been clearly demonstrated in adults. We present the first review on the associations of BPL with target organ damage (TOD) and clinical outcomes in adults, the major determinants for its role and utility in blood pressure measurement. We emphasize studies which evaluated whether BPL has added benefit to the average blood pressure indices on ABPM in predicting adverse outcomes. Methods: PubMed search for all English language papers mentioning ABPM and BPL. Results: While multiple studies assessed this question, the cumulative sample size is small. Whereas the associations of BPL with various TODs are evident, the available literature fails to demonstrate a clear and consistent added value for the BPL over the average blood pressure indices. Conclusions: There is a need for prospective studies evaluating the role of BPL in blood pressure measurement. The current literature does not provide sound support for the use of BPL in clinical decisions.

ObjectiveTo explore the association of dipping pattern and blood pressure load with left ventricular hypertrophy (LVH) in pediatric essential hypertension.Materials and MethodsThrough an echocardiography monitor and an ambulatory blood pressure monitor of 425 children and adolescents diagnosed with essential hypertension with no treatment received, we identified 140 cases of LVH. Grouping patients according to LVH (LVH, N = 140; n-LVH, N = 285), we further evaluated their ambulatory blood pressure monitoring (ABPM) parameters by comparing dipping patterns between groups. A multivariable logistic regression analysis was used to determine the effect of blood pressure load on LVH.ResultsNo significant difference was found in systolic or diastolic blood pressure dipping patterns between groups (P = 0.161, P = 0.139). However, compared to the n-LVH group, the LVH group presented significant elevated nighttime systolic blood pressure (SBP) (P < 0.05), while nighttime DBP remained stable (P = 0.391), resulting in higher daytime and nighttime SBP loads, higher nighttime DBP load, and higher 24-h SBP load (P < 0.05). Notably, our multivariable logistic regression has shown that this trend of 24-h SBP load acts independently as a critical risk factor for LVH.ConclusionCollectively, we observed a correlation between BP load and LVH in pediatric hypertension. Our data demonstrated that SBP load has a more significant weight in LVH progression, and 24-h SBP load, in particular, acts as a critical early prognostic parameter for LVH in pediatric hypertension.

Background: Acute high altitude (HA) exposure results in blood pressure (BP) variations in most subjects. Previous studies have demonstrated that higher BP is potentially correlated with acute mountain sickness (AMS). The BP load may be of clinical significance regarding systemic circulation status.Objectives: This study aimed to examine HA-induced BP changes in patients with AMS compared to those in healthy subjects. Further, we provided clinical information about the relationship between variations in 24-h ambulatory parameters (BP level, BP variability, and BP load) and AMS.Methods: Sixty-nine subjects were enrolled and all participants ascended Litang (4,100 m above sea level). They were monitored using a 24-h ambulatory blood pressure device and underwent echocardiography within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS.Results: The AMS group comprised more women than men [15 (65.2%) vs. 13 (28.3%), P < 0.001] and fewer smokers [4 (17.4%) vs. 23 (50.0%), P = 0.009]. The AMS group exhibited significant increases in 24-h BP compared to the non-AMS group (24-h SBP variation: 10.52 ± 6.48 vs. 6.03 ± 9.27 mmHg, P = 0.041; 24-h DBP variation: 8.70 ± 4.57 vs. 5.03 ± 4.98 mmHg, P = 0.004). The variation of mean 24-h cBPL (cumulative BP load) (mean 24-h cSBPL: 10.58 ± 10.99 vs. 4.02 ± 10.58, P = 0.016; 24-h mean cDBPL: 6.03 ± 5.87 vs. 2.89 ± 4.99, P = 0.034) was also obviously higher in AMS subjects than in non-AMS subjects after HA exposure. 24-h mean cSBPL variation (OR = 1.07, P = 0.024) and 24-h mean cDBPL variation (OR = 1.14, P = 0.034) were independent risk factors of AMS. Moreover, variation of 24-h mean cSBPL showed a good correlation with AMS score (R = 0.504, P < 0.001).Conclusions: Our study demonstrated that patients with AMS had higher BP and BP load changes after altitude exposure than healthy subjects. Excessive BP load variations were associated with AMS. Thus, BP load could be an effective indicator regarding systemic circulation status of AMS.

Background: The acute effect of low-intensity walking on blood pressure (BP) is unclear. Purpose: To determine if the acute use of a walking workstation reduces ambulatory blood pressure (ABP) in prehypertensive men and women. Methods: Ten prehypertensive adults participated in a randomized, cross-over study that included a control workday and a walking workstation workday. ABP was measured for 7 hour during the workday and for 6 hour after work. Results: Both systolic BP (SBP) (134 ± 14 vs. 137 ± 16 mmHg; P = .027) and diastolic BP (DBP) (79 ± 10 vs. 82 ± 12 mmHg; P = .001) were lower on the walking workstation day. Postwork hours (4:00 PM-10:00 PM), SBP (129 ± 13 vs. 133 ± 14 mmHg; P = .008), and DBP (74 ± 11 vs. 78 ± 13 mmHg; P = .001) were also lower on the walking workstation day. DBP load was significantly lower during the walking workstation day, with only 14% of the readings above 90 mmHg compared with 22% of the control day readings (P = .037). Conclusion: Accumulation of very-light-intensity physical activity (∼2 METs) over the course of a single work day using a walking workstation may reduce BP burden in prehypertensive individuals. [ABSTRACT FROM AUTHOR]

Objective To investigate the therapeutic effect of TiaoduXifeng acupuncture and Western medicine during 3-5 pm for patients with ascendent hyperactivity of liver yang type non-dipper hypertension. Methods Sixty patients with ascendent hyperactivity of liver yang type non-dipper hypertension were randomly divided into the control group and the treatment group. The patients in the control group were given Lamlodipine maleate 2.5 mg, once a day, and served in the morning. The patietns in the treatment group were given orally-administered levamlodipine maleate ( method with the control group) combined with the treatment of TiaoduXifeng acupuncture, the treatment time was 3 to 5 pm, 1 time/d, 5 times/ week, and 2 weeks/course. Both groups were treated for 4 weeks. The dynamic blood pressure of the two groups was monitored before and after treatment, the rate of nocturnal blood pressure of the two groups was calculated, the proportion of patients in dipper hypertension of the two groups was monitored. The blood pressure and morning blood pressure peak (MBPS) were monitored, and the radioimmunoassay method was used to detect the plasma endothelin ( ET) , and the nitrate reduction method for detecting NO. Results The dynamic blood pressure of the two groups after treatment were lower than that before treatment (P<0.05). The nighttime mean systolic blood pressure (nMSBP) and the nighttime mean diastolic blood pressure (nMDBP) were lower in the treatment group than in the control group ( both P<0.05). The rate of nocturnal blood pressure decreased in both groups after treatment (P <0.05) , and the rate in the treatment group was higher than that in the control group (P<0.05). The proportion of non-dipper blood pressure in the treatment group after treatment was higher than that in the control group (P<0.05). The blood pressure load and MBPS of the two groups after treatment were lower than those before treatment (both P <0.05). The nighttime systolic blood pressure load (nSBPL) , the nighttime diastolic blood pressure load (nDBPL) , and MBPS of the treatment group were lower than those of the control group (all P<0.05). Compred with the control group, the treatment group had lower level of ET and higher level of serum NO after treatment (both P<0.05). Conclusions TiaoduXifeng acupuncture and Western medicine during 3-5 pm for patients with ascendent hyperactivity of liver yang type non-dipper hypertension can reverse the structure of non-dipper type hypertension, reduce blood pressure load, MBPS, and improve blood pressure circadian rhythm and vascular endothelial function. [ABSTRACT FROM AUTHOR]

The present study was designed to analyze the occurrence of increased blood pressure load in adolescent boys with different circadian blood pressure patterns. Healthy adolescent boys with normal values of both office and mean ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) had 3 types of circadian blood pressure profile: "dippers", "non-dippers", "over-dippers". The occurrence of increased blood pressure load was the highest in the groups with a nocturnal over-dipping pattern for both SBP and DBP.

Background/Aims: Ambulatory blood pressure monitoring (ABPM) in chronic kidney disease (CKD) patients has been extensively studied, but few investigations have attempted to relate ABPM with CKD stages. The objectives of this article were to compare ABPM parameters for the diagnosis and treatment determination of CKD with daytime clinic blood pressure (BP) measurements. We also investigated BP and renal injury in combined hypertension and CKD. We supposed ABPM was important in combined hypertension and CKD. Methods: We compared ABPM in hypertension patients, including 152 patients with combined hypertension and CKD. Patients with combined hypertension and CKD were grouped according to severity into stages 1 through 3 (Stage 1-3) and stages 4 and 5 (Stage 4-5). Results: In the Stage 4-5 group, systolic BP (SBP) (daytime, nighttime and 24 h mean), diastolic BP (DBP), pulse pressure and SBP standard deviations (SD) (daytime and 24 h) were higher. SBP and DBP loads were significantly higher in the Stage 4-5 group. The nighttime load was higher than the daytime load. Mean arterial pressure (MAP) was higher and heart rates (HR) were faster in the Stage 4-5 group. Conclusions: BP load should be a component employed in ABPM to determine cardiovascular risk stratification. MAP and HR might be associated with risk to develop end-stage renal disease.

Purpose: This study aimed to compare ambulatory blood pressure (ABP) response to accumulated standing (STAND), cycling (CYCLE), and walking (WALK) to a sitting-only (SIT) day in adults. Methods: Nine overweight or obese (body mass index, 28.7 ± 2.7 kg⋅m-2 adults (30 ± 15 yr) participated in this randomized crossover full-factorial study. Four conditions (WALK, STAND, CYCLE, and SIT) were randomly performed 1 wk apart. WALK, STAND, and CYCLE conditions consisted of progressively increasing activity time to accumulate 2.5 h during an 8-h simulated workday. WALK (1.0 mph) and STAND (0.0 mph) were completed on a treadmill placed underneath a standing-height desk. During CYCLE, participants pedaled on a Monark cycle ergometer at a cadence and energy expenditure equivalent to WALK. Participants remained seated during the SIT condition. Participants wore an ABP cuff from 0800 h until 2200 h on all conditions. Linear mixed models were used to test condition differences in systolic (SBP) and diastolic (DBP) blood pressure. Chi-square was used to detect frequency difference of BP load. Results: There was a whole-day (during and after work hours) SBP and DBP treatment effect (P < 0.01). Systolic blood pressure during STAND (132 ± 17 mm Hg), WALK (133 ± 17 mm Hg), and CYCLE (130 ± 16 mm Hg) were lower compared with that during SIT (137 ± 17 mm Hg) (all P < 0.01). CYCLE was lower than STAND (P = 0.04) and WALK (P < 0.01). For DBP, only CYCLE (69 ± 12 mm Hg) was lower than SIT (71 ± 13 mm Hg; P < 0.01). Compared with SIT, WALK, STAND, and CYCLE reduced SBP load by 4%, 4%, and 13%, respectively (all P < 0.01). Conclusions: Compared with sitting, accumulating 2.5 h of light-intensity physical activity or standing during an 8-h workday may reduce ABP during and after work hours. [ABSTRACT FROM AUTHOR]

Background/Aims: Ambulatory blood pressure monitoring (ABPM) in chronic kidney disease (CKD) patients has been extensively studied, but few investigations have attempted to relate ABPM with CKD stages. The objectives of this article were to compare ABPM parameters for the diagnosis and treatment determination of CKD with daytime clinic blood pressure (BP) measurements. We also investigated BP and renal injury in combined hypertension and CKD. We supposed ABPM was important in combined hypertension and CKD. Methods: We compared ABPM in hypertension patients, including 152 patients with combined hypertension and CKD. Patients with combined hypertension and CKD were grouped according to severity into stages 1 through 3 (Stage 1-3) and stages 4 and 5 (Stage 4-5). Results: In the Stage 4-5 group, systolic BP (SBP) (daytime, nighttime and 24 h mean), diastolic BP (DBP), pulse pressure and SBP standard deviations (SD) (daytime and 24 h) were higher. SBP and DBP loads were significantly higher in the Stage 4-5 group. The nighttime load was higher than the daytime load. Mean arterial pressure (MAP) was higher and heart rates (HR) were faster in the Stage 4-5 group. Conclusions: BP load should be a component employed in ABPM to determine cardiovascular risk stratification. MAP and HR might be associated with risk to develop end-stage renal disease. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: High prevalence of masked hypertension as well as persistent hypertension was observed in the Chronic Kidney Disease Japan Cohort (CKD-JAC) study. We proposed a novel indicator of blood pressure (BP) load, hyperbaric area index (HBI), calculated from ambulatory blood pressure monitoring (ABPM) data. The characteristic of this index and its relationship with kidney function were also evaluated. Methods: The CKD-JAC study, enrolled 2,977 patients, is a prospective observational study started in September 2007. ABPM was conducted in a sub-group from September 2007 to April 2010 and baseline ABPM data of 1,075 subjects (63.4 % male, 60.7 years old) were analyzed. Results: Mean systolic HBI of male and female patients were 242.3 and 176.5 mmHg×h, respectively. HBI sensitively reflected sex (54.7 mmHg×h higher in males than in females), seasonal effects (51.6 mmHg×h higher in winter than in summer), and advancing CKD stage [(16.5 mmHg×h higher) per −10 mL/min/1.73 m in eGFR]. The HBI was a significant factor to associate with reduced kidney function, after adjusting with nocturnal BP change (NBPC), sex, and other variables ( p value <0.001). Conclusions: Our findings suggested that HBI might be a novel sensitive indicator for the reduction of kidney function, independent of patterns of NBPC. [ABSTRACT FROM AUTHOR]

Conflicting results have been reported in small non-homogenous groups of children with chronic renal failure in terms of casual blood pressure and ambulatory blood pressure monitoring (ABPM) parameters and left ventricular hypertrophy (LVH). The aim of our study was to assess the value of ABPM and hematological and biochemical parameters in predicting LVH in children on chronic peritoneal dialysis (CPD). Echocardiography and 24-h ABPM were performed in addition to routine biochemical and hematological evaluations in 47 children on CPD (26 male, 21 female; mean age 14.74 ± 3.52 years). Mean daytime systolic blood pressure (SBP) and mean daytime diastolic blood pressure (DBP) values were found to be higher than the mean casual SBP and DBP ( p = 0.001) values. Thirty-three (70.2%) children had LVH. The correlations between the left ventricular mass index and ABPM variables were good. Stepwise multiple regression analysis revealed daytime SBP load (β = 0.652; p < 0.01) and hematocrit (β = −0.282; p < 0.01) to be independent predictors of LVH. The sensitivity, specificity, positive predictive value, and negative predictive values for the combination of the SBP load >15% and hematocrit value <31% for predicting LVH were 95 [95% confidence interval (CI) 76–99], 78 (95%CI 45–94), 91 (95%CI 73–98), and 88% (95%CI 69–96%), respectively. We conclude that: (1) LVH is prevalent in children on CPD, and (2) a target hematocrit level >31% and daytime SBP load <15% may be preventive for the progression of LVH in the follow-up of children on CPD. [ABSTRACT FROM AUTHOR]

Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity. [ABSTRACT FROM AUTHOR]

Background: Hypertension is one of the main causes of cardiovascular complications leading to death and allograft dysfunction. The aim of this study was to determine the relationship between the levels of 24 h blood pressure and left ventricular mass index (LVMI) and bi-ventricular tissue Doppler echocardiographic measurements in renal transplant recipients (RTxr) and dialysis patients. Methods: In this cross-sectional study, we evaluated 32 non-diabetic renal transplant recipients (GI) and 18 patients with end-stage renal insufficiency who underwent haemodialysis (GII). Results: The mean follow-up periods were 49.16 ± 38.02 and 56.83 ± 34.14 months in GI and GII, respectively. There were no differences for age, gender, daytime systolic–diastolic blood pressures and loads among the groups. The mean night-time systolic–diastolic blood pressures in GI and GII were 119.77 ± 17.41–77.34 ± 14.46 and 120.23 ± 25.53–76.17 ± 18.77 mmHg, respectively ( P I–II = 0.453–0.72). The mean night-time systolic blood pressure loads in GI and GII were 4.92 ± 7.77 and 6.10 ± 8.16%, respectively ( P I–II = 0.68). The mean night-time diastolic blood pressure loads were 7.79 ± 7.83 and 8.02 ± 8.28% in GI and GII, respectively ( P I–II = 0.55). The mean levels of LVMI in GI and GII were 115.81 ± 28.07 and 128.06 ± 65.72 g/m2, respectively ( P I–II = 0.85). The mean levels of left ventricular Em/Am by tissue Doppler echocardiography were 1.13 ± 0.40 and 0.90 ± 0.29, respectively ( P I–II = 0.127), while the mean levels of right ventricular Em/Am were 0.89 ± 0.37 and 0.88 ± 0.26, respectively ( P I–II = 0.50). Conclusion: After renal transplantation, LVMI and bi-ventricular diastolic dysfunction were not regressed. Daytime and night-time blood pressures and loads were similar in the two groups. We can say that well-controlled daytime blood pressure and load is not sufficient to decrease cardiovascular risk in RTxr. Also, it is important to control of night-time blood pressure and load to reduce cardiovascular risk in RTxr. RTxr should be monitored with ambulatory blood pressure monitoring and tissue Doppler echocardiography. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the level of agreement between central European ambulatory blood pressure monitoring (ABPM) and American Task Force (TF) criteria when applied to blood pressure (BP) measurements collected by ABPM to evaluate patients with hypertension. In 169 patients, we applied both sets of criteria and calculated mean daytime and nighttime BP and daytime BP loads. The frequency of hypertension for daytime systolic BP was significantly higher when TF criteria were used ( p ≤ 0.001). However, the frequency of hypertension for nighttime systolic BP was significantly increased when ABPM criteria were applied ( p ≤ 0.01). Therefore, with daytime ABPM measurements, hypertension was overdiagnosed with TF criteria, while nighttime hypertension was underdiagnosed using TF criteria. In contrast with previous reports, 40% of our patients with essential hypertension showed absence of nighttime dipping, regardless of the criteria used. The number of hypertensive patients was significantly higher using ABPM compared to TF criteria when patients with BP load ≥50% were evaluated ( p ≤ 0.01). Therefore, current recommendations for ABPM use in children such as to define white coat hypertension or as a screening tool to differentiate between primary and secondary hypertension need to be validated using yet to be produced normative ABPM criteria in American children. [ABSTRACT FROM AUTHOR]

Objective: To explore the association of dipping pattern and blood pressure load with left ventricular hypertrophy (LVH) in pediatric essential hypertension., Materials and Methods: Through an echocardiography monitor and an ambulatory blood pressure monitor of 425 children and adolescents diagnosed with essential hypertension with no treatment received, we identified 140 cases of LVH. Grouping patients according to LVH (LVH, N = 140; n-LVH, N = 285), we further evaluated their ambulatory blood pressure monitoring (ABPM) parameters by comparing dipping patterns between groups. A multivariable logistic regression analysis was used to determine the effect of blood pressure load on LVH., Results: No significant difference was found in systolic or diastolic blood pressure dipping patterns between groups ( P = 0.161, P = 0.139). However, compared to the n-LVH group, the LVH group presented significant elevated nighttime systolic blood pressure (SBP) ( P < 0.05), while nighttime DBP remained stable ( P = 0.391), resulting in higher daytime and nighttime SBP loads, higher nighttime DBP load, and higher 24-h SBP load ( P < 0.05). Notably, our multivariable logistic regression has shown that this trend of 24-h SBP load acts independently as a critical risk factor for LVH., Conclusion: Collectively, we observed a correlation between BP load and LVH in pediatric hypertension. Our data demonstrated that SBP load has a more significant weight in LVH progression, and 24-h SBP load, in particular, acts as a critical early prognostic parameter for LVH in pediatric hypertension., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wu, Shi, Lin and Zheng.)

Background: Acute high altitude (HA) exposure results in blood pressure (BP) variations in most subjects. Previous studies have demonstrated that higher BP is potentially correlated with acute mountain sickness (AMS). The BP load may be of clinical significance regarding systemic circulation status. Objectives: This study aimed to examine HA-induced BP changes in patients with AMS compared to those in healthy subjects. Further, we provided clinical information about the relationship between variations in 24-h ambulatory parameters (BP level, BP variability, and BP load) and AMS. Methods: Sixty-nine subjects were enrolled and all participants ascended Litang (4,100 m above sea level). They were monitored using a 24-h ambulatory blood pressure device and underwent echocardiography within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS. Results: The AMS group comprised more women than men [15 (65.2%) vs. 13 (28.3%), P < 0.001] and fewer smokers [4 (17.4%) vs. 23 (50.0%), P = 0.009]. The AMS group exhibited significant increases in 24-h BP compared to the non-AMS group (24-h SBP variation: 10.52 ± 6.48 vs. 6.03 ± 9.27 mmHg, P = 0.041; 24-h DBP variation: 8.70 ± 4.57 vs. 5.03 ± 4.98 mmHg, P = 0.004). The variation of mean 24-h cBPL (cumulative BP load) (mean 24-h cSBPL: 10.58 ± 10.99 vs. 4.02 ± 10.58, P = 0.016; 24-h mean cDBPL: 6.03 ± 5.87 vs. 2.89 ± 4.99, P = 0.034) was also obviously higher in AMS subjects than in non-AMS subjects after HA exposure. 24-h mean cSBPL variation (OR = 1.07, P = 0.024) and 24-h mean cDBPL variation (OR = 1.14, P = 0.034) were independent risk factors of AMS. Moreover, variation of 24-h mean cSBPL showed a good correlation with AMS score ( R = 0.504, P < 0.001). Conclusions: Our study demonstrated that patients with AMS had higher BP and BP load changes after altitude exposure than healthy subjects. Excessive BP load variations were associated with AMS. Thus, BP load could be an effective indicator regarding systemic circulation status of AMS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chen, Ye, Sun, Yang, Zhang, Gao, Liu, Ke, He, Yuan, Lv, Yang, Cheng, Tan and Huang.)

Objectives: It has been shown that blood pressure (BP) values measured in obese subjects are higher than the individuals with normal weight, even in normotensive limits. However, data concerning the Ambulatory Arterial Stiffness Index (AASI) and blood pressure load in normotensive obese subjects is lacking. This study was aimed to compare the ambulatory arterial stiffness index and blood pressure load in normotensive obese and healthy controls., Methods: One hundred normotensive obese and one hundred normal weight subjects were included in this study. All subjects underwent 24-hour ambulatory blood pressure monitoring. Ambulatory arterial stiffness index was calculated from 24-hour ambulatory blood pressure monitoring records. Ambulatory arterial stiffness index was defined as one minus the regression slope of unedited 24-h diastolic on systolic blood pressures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) load values were calculated from 24-hour ambulatory blood pressure monitoring analysis., Results: Ambulatory arterial stiffness index of the obese subjects was significantly higher than the healthy controls (0.48±0.2 vs. 0.33±0.11, p<0.001). 24-hours systolic blood pressure and diastolic blood pressure loads were significantly higher in obese subjects. Logistic regression analysis revealed that body mass index (BMI) was an independent predictor for an abnormal ambulatory arterial stiffness ındex (≥0.50) (OR: 1.137, 95% CI: 0.915-1.001, p=0.004)., Conclusion: Blood pressure load and ambulatory arterial stiffness index are increased in normotensive obese patients. Moreover, body mass index is an independent predictor for an abnormal ambulatory arterial stiffness index. Our results indicate that obese subjects are at higher risk for future cardiovascular events despite normal office BP levels., (© 2021 Efe FK et al.)

Objectives: To determine the association between glycosylated hemoglobin (HbA1c) and ambulatory blood pressure or heart rate in hypertensive patients., Methods: A total of 585 patients, who performed ambulatory blood pressure monitoring (ABPM) from September 2018 to April 2019 in Xiangya Hospital, Central South University, were enrolled and assigned into 2 groups (470 in a hypertensive group and 115 in a normal group). HbA1c levels were compared. According to the HbA1c level, the hypertensive group was divided into 2 subgroups: A high HbA1c group (HbA1c≥6.1%, n =142) and a normal HbA1c group (HbA1c<6.1%, n =328). Whole basic data and ABPM parameter were compared among the groups. Pearson/Spearman correlation analysis was applied to study the association between HbA1c and BPV. Multivariate logistic regression was used to explore the influential factors for HbA1c (≥6.1%) and continuous increase of HbA1c in different hypertensive populations, respectively., Results: The hypertensive group had higher HbA1c level than the normal group [(6.1±1.3)% vs (5.1±1.7)%, P <0.05]. In hypertensive patients, nocturnal systolic blood pressure [(131.1±19.2) mmHg vs (122.5±19.2) mmHg], nocturnal systolic blood pressure load [62.5% (15.5%-100%) vs 28.6% (0-75%)], and daytime heart rate [(74.3±11.6) min -1 vs (71.2±11.4) min -1 ] of the high HbA1c group were higher than those in the normal HbA1c group (all P <0.05). Pearson/Spearman correlation analysis showed that HbA1c was positively correlated with systolic blood pressure and blood pressure load (both P <0.05). Logistic regression analysis showed that nocturnal systolic pressure load was the risk factor for the increase of HbA1c level (OR=1.025, 95% CI 1.003 to 1.048, P <0.05). Multiple linear regression showed that nocturnal systolic pressure load was still positively correlated with HbA1c in total, tertiary, and hypertensive patients without treatment (β=0.155, β=0.171, β=0.384, respectively, all P <0.05)., Conclusions: In hypertensive patients, HbA1c is positively correlated with ambulate blood pressure, blood pressure load, and heart rate, and it has no correlation with blood pressure variability, heart rate variability, or morning blood pressure.

Objective: To observe the effect of acupuncture at Renying (ST 9) on morning blood pressure, daytime peak blood pressure and 24-hour blood pressure load in patients with ischemic stroke complicated with essential hypertension., Methods: A total of 80 patients (3 cases dropped off) were randomized into an observation group (39 cases) and a control group (38 cases). Xingnao Kaiqiao acupuncture and nifedipine were given in the control group. On the basis of treatment in the control group, acupuncture at Renying (ST 9) was applied in the observation group, once a day, 6 times a week for 4 weeks. The changes of morning blood pressure, daytime peak blood pressure and blood pressure load were observed before and after treatment in the two groups., Results: Compared before treatment, morning blood pressure, daytime peak blood pressure and blood pressure load after treatment were reduced in the two groups (all P <0.05). The change of morning systolic pressure in the observation group was not significant as compared with that in the control group ( P >0.05); the changes of morning diastolic pressure, daytime peak blood pressure and blood pressure load in the observation group were larger than those in the control group (all P <0.05)., Conclusion: On the basis of Xingnao Kaiqiao acupuncture and nifedipine, acupuncture at Renying (ST 9) can effectively reduce morning blood pressure, daytime peak blood pressure and blood pressure load in patients with ischemic stroke complicated with essential hypertension.

Objective: To observe the effects of " Huoxue Sanfeng acupuncture" auxiliary therapy on neurological function, blood pressure load and morning blood pressure in elderly patients with stroke complicated with hypertension, on the basis of " Xingnao Kaiqiao acupuncture" combined with nifedipine., Methods: Seventy patients with stroke complicated with hypertension were randomly divided into an observation group and a control group, 35 cases in each group. " Xingnao Kaiqiao acupuncture" and conventional nifedipine controlled release tablets were given in the control group. Regarding regaining consciousness with acupuncture, the main acupoint is Shuigou (GV 26), combined with Neiguan (PC 6) and Sanyinjiao (SP 6), retaining needle for 20 min, additionally, the quick needling technique was applied to Shangjiquan (Extra), Chize (LU 5) and Weizhong (BL 40) of the affected side, nifedipine controlled release tablets were orally administered 30 mg once a day for a total of 6 weeks. The " Huoxue Sanfeng acupuncture" was added on the basis treatment in the observation group, the acupuncture was applied at Renying (ST 9) as the main acupoint, combined with Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3). The strict manipulation quantitative acupuncture was used and the needle was retained for 20 min. Both acupuncture methods were performed once a day, 5 times a week, and continued treatment at intervals of 2 days, 10 times for one course, and a total of 3 courses were needed. The morning blood pressure and 24 h blood pressure load were measured before and after treatment. The National Institute of Health stroke scale (NIHSS) score and the Barthel index (BI) classification were observed before and after treatment., Results: The systolic and diastolic blood pressures were significantly lower than those before treatment in the two groups (all P <0.01), and the systolic and diastolic blood pressures in the observation group were lower than those in the control group (both P <0.01). There was no significant difference between the difference of systolic blood pressure before and after treatment in the two groups ( P >0.05), and the difference of the diastolic blood pressure before and after treatment in the observation group was higher than that in the control group ( P <0.01). The systolic and diastolic pressures load in the two groups were lower than those before treatment (all P <0.01), and the systolic and diastolic pressures load in the observation group were lower than those in the control group (both P <0.05), the difference of systolic and diastolic pressure load before and after treatment in the observation group were higher than those in the control group (both P <0.05). After treatment, the NIHSS scores in the two groups were lower than those before treatment (both P <0.01). The NIHSS scores in the observation group were lower than those in the control group ( P <0.05). The difference of NIHSS scores before and after treatment in the observation group was higher than that in the control group ( P <0.01). After treatment, the BI grading was better than that before treatment in the two groups (both P <0.05), and the BI grading in the observation group was superior to that in the control group ( P <0.05)., Conclusion: On the basis of " Xingnao Kaiqiao acupuncture" combined with nifedipine controlled release tablets in the treatment of elderly patients with stroke complicated with hypertension, " Huoxue Sanfeng acupuncture" can further improve the function of nerve and limbs, effectively reduce the morning blood pressure level of elderly patients, especially diastolic blood pressure, and significantly improve systolic blood pressure and diastolic blood pressure load.