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Abstracts e225
the daughter (5) 11:00 they call ambulance, BP peaks at 175/115 (6) 11:45 paramedics
arrive, BP decreases to 145/100 and it remains stable afterwards at 150/100.
Conclusions: The patient is stage 2 hypertensive, with normal dipping pattern
during the sleep period. During stressful conditions the blood pressure climbed
and plateued at 175/115 mmHg with no further increases.
PP.16.33 COMPARISON OF SEASONAL CHANGES OF
THE MAIN AMBULATORY BLOOD PRESSURE
PARAMETERS IN TWO RUSSIAN REGIONS
V. Gorbunov, M. Smirnova, D. Volkov, M. Loukianov, A. Deev,
Y. Koshelyaevskaya, S. Boytsov. National Research Center for Preventive
Medicine, Moscow, Russia
Objective: The seasonal changes of ambulatory blood pressure (ABP) in hyperten-
sive patients became the subject of many studies during the past decade. The explo-
ration of this problem in Russia deserves particular interest due to multiplicity of
climate conditions across different regions. The aim of the study was to assess the
particular qualities of seasonal blood pressure variability in two sites of the Russian
Federation – Ivanovo (relative “north’’) and Saratov (relative “south’’).
Design and method: We included patients from the general population who visit-
ed ambulatory clinics for various reasons. The main inclusion criterion was office
BP 130/85–139/89 mm Hg or long-term antihypertensive therapy. All participants
provided written informed consent. The ambulatory blood pressure monitoring
(ABPM) was performed with the BPLab device (Nizhny Novgorod, Russia) twice
in each patient: in winter (December-February 2012–2014) and in summer (June-
August 2012–2014). The interval between ABPMs was 6 months ± 7 days. The
selection criteria for ABPM records were: duration >23.5 hours, absence of data
gaps >1 hour, >55 readings per 24 hours. We analyzed the factors associated with
abnormal levels of the main ABP variables in the whole sample. The stepwise
multivariate logistic regression model was used to select the most valuable factors.
This selection was preliminarily done for the subsets of variables. The analysis
was adjusted for age and sex.
Results: 1,766 patients were enrolled, and 770 of them completed both visits - 499
from Ivanovo (mean age 52 ± 10 years, 181 men), and 271 from Saratov an (mean
age 58 ± 11 years, 151 men). Table. Main results of the logistic regression analysis
in patients who completed the study. SBP - systolic BP; DBP - diastolic BP; d -
daytime; n - night; 24 - 24 hours.
Conclusions: The higher 24-hour and daytime BP levels in winter and in Ivanovo
could reflect insufficient BP control in the cohort with a tendency to masked hyperten-
sion. The nocturnal hypertension and non-dipper tendency were more typical for Sara-
tov residents and may be explained by relatively hot summers and poor sleep quality.
PP.16.34 EFFECT OF SELF-MEASUREMENT OF BLOOD
PRESSURE ON HEMODYNAMICS – THE ANSIA
STUDY
K. Gazzola
1
, M. Honingh
2
, J. Truijen
2
, B.J.H. Van Den Born
2
.
1
Department of
Medical Sciences, University of Ferrara, Ferrara, Italy,
2
Department of Vascular
Medicine, University of Amsterdam, Amsterdam, The Netherlands
Objective: Blood pressure (BP) variability and anxiety responses may influence
BP measurement. We recently showed that ~20% of patients referred for out-of-
office BP measurement have a significantly higher home compared to ambulatory
BP and, in addition, a large difference between office and ambulatory BP in-
dicative of a white coat effect. We hypothesized that these patients may have an
anxiety response upon the self-measurement of BP or ‘auto-cuff’ response. The
objective of the study was to evaluate BP responses during self-BP measurement.
Design and method: We included 50 subjects, 25 (mean age 66.3 ± 10.9 years,
37.5% female) with and 25 (mean age 57.6 ± 10.2 years, 48.0% female) without a
previously established difference between home and ambulatory BP = >10/5 mmHg.
All subjects performed 10 consecutive measurements after at least 10 minutes rest
followed by another resting period of 10 minutes, while receiving continuous non-
invasive monitoring of BP and central hemodynamics. At the end of the self-mea-
surements recording was continued to complete the 30-minute period. Mean BP of
the 60 seconds before the start of the self-measurements was used as baseline and
compared with the first 10 seconds after the beginning of each self-measurement.
Results: We observed a significant increase in BP during self-measurement com-
pared to baseline, which was greater in subjects with a large difference between
home and ambulatory BP (135.0 ± 23.6/74.1 ± 14.2 vs 141.0 ± 26.1/78.2 ± 12.7
mmHg, p < 0.001) compared to those without (134.5 ± 20.3/77.4 ± 10.9 vs
138.9 ± 25.0/80.0 ± 12.7 mmHg, p = 0.028/0.019). The increase in BP was ac-
companied by an increase in cardiac output (5.2 ± 1.5 vs 5.4 ± 1.5 lpm, p = 0.018
and 5.4 ± 1.5 vs 5.6 ± 1.5 lpm, p = 0.019, respectively) and heart rate (67.0 ± 14.5
vs 71.0 ± 14.9 bpm, p = 0.005 and 71.0 ± 13.2 vs 74.3 ± 13.4 bpm, p < 0.001). No
attenuation could be observed in BP responses between the first three and the last
three self-measurements.
Conclusions: Our results support the existence of an ‘auto-cuff’ response during
self-BP measurement. BP responses did not attenuate during repeated measure-
ments. In addition, anticipation of self-BP measurement appears to contribute to
the increase in BP.
PP.16.35 AUTOMATED OFFICE BLOOD PRESSURE IN
STABLE HYPERTENSIVE PATIENTS: RESULTS OF A
MULTICENTRE STUDY
J. Filipovsky
1
, J. Seidlerova
1
, M. Hronova
1
, J. Ceral
2
, P. Vysocanova
3
, J. Spac
3
,
J. Vaclavik
4
, M. Soucek
3
, E. Kocianova
4
, J. Bruthans
5
, I. Rihacek
3
, P. König
1
,
H. Rosolova
1
.
1
Charles University Medical Faculty, Plzen, Czech Republic,
2
Charles University Medical Faculty, Hradec Kralove, Czech Republic,
3
Masaryk
Medical Faculty, Brno, Czech Republic,
4
Palacky Medical Faculty, Olomouc,
Czech Republic,
5
Thomayer Hospital, Prague, Czech Republic
Objective: Automated office blood pressure (AOBP), measured in the absence of
health care professionals, may eliminate white-coat effect. In the SPRINT study,
blood pressure was measured with this method, and therefore, it is important to
study its relationships to manually measured office blood pressure (OBP) which
is crucial for clinical decision making as it was used in the vast majority of other
prospective studies in hypertension.
Design and method: Stable treated hypertensive subjects were included in this
study which was performed in six Czech hypertension centres. AOBP was mea-
sured with the BPTru device (six measurements, average of 2nd to 6th measure-
ment is considered); after AOBP, blood pressure (BP) was measured six times
in the office (three times with auscultatory method by the physician followed by
three oscilometric measurements). 24-hour ambulatory BP monitoring (ABPM)
was performed within one week from the clinical visit.
Results: Data on 191 subjects aged 64 ± 12 years with OBP 127.3 ± 12.2
/77.5 ± 10.0 mm Hg are reported. AOBP was by 9.6 ± 19.2/3.2 ± 12.6 mm
Hg lower than OBP and the difference was relatively homogeneous in all the
centres. The AOBP-OBP difference was independent of age, number of anti-
hypertensive drugs, presence of diabetes, lipid disorders or kidney disease;
the interval from the morning drug intake had no influence either. We further
compared the 4th to 6th BPTru measurement and 4th to 6th OBP measurement
(i.e., only oscilometric measurements without and with presence of physi-
cian); it was 8.0/2.0 mm Hg. 24-hour mean BP was by 4.2/3.4 mm Hg lower
than OBP and by 4.3/0.5 mm Hg higher than AOBP; the correlation coef-
ficients of 24-hour mean BP with OBP and with AOBP did not differ (p for
difference >0.10).
Conclusions: AOBP gives comparable results in different clinical centres and thus,
it can be introduced in clinical practice as a supplementary method to classic OBP.
AOBP values are systematically lower than classic OBPand this phenomenon may
partly explain the SPRINT results. Interindividual variability of the AOBP-OBP
difference is large. The prediction of ABPM by AOBP is not better than by OBP.