Microalbuminuria and blood pressure daily profile in patients with metabolic syndrome

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Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e35–e48

Objectives: Facing the era of non-mercury sphygmomanometer, oscillometric device is more and more widely used. But in an epidemiologic survey, oscillometric device underestimates diastolic blood pressure and the prevalence of hypertension. Non-mercury device using auscultation method (AD) is also available being not so popular. The application of AD in epidemiologic survey may be more accurate alternative to the mercury device (MD). Methods: In Korean National Health and Nutrition Examination Survey (KNHANES), 76 males and 109 female subjects were measured alternatively with mercury device and AD three times for each method. The first device was selected in random order. Average value of the second and third measurement was used for analyses. Mean difference, error, and reliability test using kappa index were analyzed. Error was defined as the absolute value of the difference between AD and MD. Results: Age was 54.5
15.6 years for male and 55.0
15.6 years for female. Arm circumferences was 27.7
2.3 cm for male and 26.8
1.8 cm for female. Systolic blood pressure (SBP) was 116.2
17.9 vs 115.7
18.1 mmHg, for MD and AD, respectively (p¼ 0.0809) and diastolic blood pressure (DBP) was 72.6
9.6 vs 72.8
9.8 mmHg, for MD and AD, respectively (p¼ 0.3766). The correlation coefficients for SBP and DBP were 0.97 and 0.93. The prevalence of hypertension defined by 140/90 mmHg was 13.5% vs 15.1% for MD and AD, respectively (p¼0.6554). The kappa index for hypertension diagnosis was 0.802. The sensitivity for hypertension diagnosis by AD was 0.88 and specificity was 0.96. Conclusion: In this study, Greenlight 300 showed substantial agreement for the hypertension diagnosis. Greenlight 300 may be useful or more accurate for epidemiologic survey in terms of avoiding underestimation of hypertension prevalence when choosing non-mercury device. Keywords: Blood pressure measurement; Non-mercury device; Korotkoff sound P-67 Microalbuminuria and blood pressure daily profile in patients with metabolic syndrome Nigora Srojidinova, Ravshanbek Kurbanov. Republic Specialized Centre of Cardiology, Tashkent, Uzbekistan Aim: to evaluate influence of microalbuminuria (MAU) on blood pressure (BP) daily profile in hypertensive patients with metabolic syndrome (MetS). Methods: We have examined 130 hypertensive men with MetS. Mean age 47.7
10.5 yr. MetS was defined according to IDF recommendations, 2005. Ambulatory 24h BP monitoring was recorded with TONOPORT V using oscillometric method. MAU was defined as an albumin urinary excretion between 20-200mg/ml. Results: MAU has been determined in 46 (35.9%) patients. Patients were divided for 2 groups regarding MAU. Groups were adjusted by age, hypertension duration, BMI and waist circumference. Mean albumin excretion in patients with normoalbuminuria was 9,4
4,1 mg/l, in those with MAU was 51,3
47,2 mg/l. Patients with MAU had significantly higher office SBP (167,0
15,2 mm Hg vs 155,5
15,0 mm Hg, p¼0,00006), DBP (106,8
8,4 mm Hg vs 99,9
8,9 mm Hg, p¼00003) and HR (81,5
8,6 beats/ min vs 77,1
8,8 beats/min, p¼0,018) as compared with patients with normoalbuminuria. BP daily profile analysis detected that patients with MAU had higher average daily SBP (157,3
17,3 mm Hg vs 144,7
16,0 mm Hg, p¼0,0003), average daily DBP (106,5
15,3 mm Hg vs 97,2
10,6 mm Hg, p¼0,0004), as well as daytime SBP (158,9
16,7 mm Hg vs 147,9
15,2 mm Hg, p¼0,0008), daytime DBP (107,1
11,6 mm Hg vs 100,4
10,8 mm Hg, p¼0,004), nighttime SBP (152,7
22,2 mm Hg vs 137,1
17,1 mm Hg, p¼0,0001), nighttime DBP (100,1
15,5 mm Hg vs 88,7
13,1 mm Hg, p¼0,0001) in comparison with patients with normoalbuminuria. Moreover, load index of SBP and

DBP in daytime and nighttime was also higher in patients with MAU: load index of daytime SBP - 80,2
23,5% vs 64,8
29,2%, p¼0,006 and load index of daytime DBP - 81,89
19,1% vs 71,0
25,1%, p¼0,022; load index of nighttime SBP - 89,4
18,6% vs 75,7
26,4%, p¼0,005 and load index of nighttime DBP - 93,2
12,9% vs 81,9
21,6%, p¼0,004, respectively. It should be noted that nocturnal fall of SBP and DBP was deficient in group with MAU in comparison with one without MAU: nocturnal fall of SBP - 4,7
6,9% vs 7,9
7,2%, p¼0,02, nocturnal fall of DBP - 7,1
8,8% vs 11,6
8,8%, p¼0,014, respectively. Conclusion: Hypertensive patients with MetS and MAU have more expressed abnormalities of BP daily profile. MAU is important prognosis factor in hypertension and MetS. Keywords: BP monitoring; microalbuminuria; metabolic syndrome

P-69 Home blood pressure monitoring in hypertensive patients with chronic kidney disease Xiaojing Ye, Alejandro Negrete, William N. Davis, Salman T. Shafi, Andi M. Negrete, Erdal Sarac, Hilmer O. Negrete. St. Elizabeth Health Center, Youngstown, OH, United States Home blood pressure monitoring (HBPM) has been associated with improved blood pressure (BP) control. The progression of chronic kidney disease (CKD) in hypertensive patients can be delayed by achieving adequate BP control. However, there is limited data on HBPM in hypertensive patients with CKD. The aim of this study was to evaluate factors affecting HBPM in hypertensive CKD patients. We conducted a cross-sectional office-based survey among patients with both CKD and hypertension (HTN) (n¼272). BP was measured during office visits and in some cases (n¼56) by ambulatory BP monitoring (ABPM). BP readings and survey data were compared between patients using HBPM and patients not using HBMP (non-HBPM). Data were analyzed using Student t test and Pearson chi-square test. Among 272 participants, 51.1% were males and 48.9% were females, with a mean age of 74.2 years. There were 67.6% patients using HBPM, compared to 32.3% non-HBPM. Most of HBPM patients used arm cuff (82.9%), instead of wrist monitor (17.1%). Only 29.6% HBPM patients brought their HBPM devices to physician’s office to be checked. About 43.6% HBPM patients measured their BP at least twice per week at home. Based on the average HBPM readings, 74.1% HBPM patients had adequate BP control (BP <140/90 mmHg). CKD stages were similar in both groups, with 82.4% HBPM and 80.0% non-HBPM having stage 3 or higher CKD. In addition, there was no difference in urine protein excretion. Even though no difference in office BP reading was found between the two groups, HBPM patients showed significantly lower diastolic BP (62.3
9.3 vs. 70.0
11.8 mmHg, p ¼0.015) during ABPM. Patients who used HBPM were more compliant with salt restriction, more likely to exercise regularly, believed that HBPM use was helpful in BP control, and took more BP medications (p < 0.05). More patients in the HBPM group (83.6%) were advised by their physician to use HBPM, as compared to that of non-HBPM group (24.4%). There was no difference in educational level, employment status, marital status, smoking history, body mass index (BMI) and comorbidity, including diabetes mellitus (DM), cardiovascular disease (CAD), cerebrovascular disease (CVD), and hyperlipidemia (HLD). Our study indicates that in an outpatient nephrology setting, patient education is the most important factor affecting HBPM use in CKD patients with HTN. Keywords: home blood pressure monitor; hypertension; chronic kidney disease