Observou-se a prevalência crescente das doenças cardiovasculares nos dias de hoje e o acometimento cada vez maior da população pediátrica. O objetivo principal no presente estudo foi verificar a associação entre a pressão arterial ambulatorial e variáveis antropométricas em 34 pré-adolescentes e adolescentes na faixa de idade entre 9 e 17 anos de ambos os sexos. Analisamos também se a prática regular de exercícios físicos beneficia, em relação as variáveis concernentes à pressão arterial, este grupo de indivíduos. A avaliação da pressão arterial foi realizada através da monitorização ambulatorial da pressão arterial durante 24 horas por ser uma forma de avaliação que oferece maior reprodutibilidade dos valores e maior detalhamento sobre o comportamento da pressão arterial nos diferentes períodos do dia. Foi utilizada a estatística descritiva para apresentar os resultados obtidos, a correlação de Pearson e Spearman para avaliar as associações entre as variáveis e a regressão linear múltipla para controlar os fatores de confusão e avaliar os preditores das variáveis de desfecho. Conclui-se que o índice de massa corporal se associa diretamente com a pressão arterial ambulatorial sistólica diurna e com a pressão arterial ambulatorial sistólica de 24 horas, independentemente de outras variáveis antropométricas. A estatura e o índice de massa corporal se associam diretamente à pressão arterial ambulatorial sistólica diurna e a pressão arterial ambulatorial média diurna neste grupo de pré-adolescentes e adolescentes. A relação cintura/quadril é significativamente menor naqueles que praticam exercícios físicos regularmente. / We observed the growing incidence and prevalence of cardiovascular diseases nowadays in the pediatric population. The aim of this study was to verify the association betwen ambulatory blood pressure and anthropometrical variables in 34 pre-teenagers and teenagers, ranging from 9 to 17 years old both male and female. We also analyzed if the frequent practice of exercices helps group of individuals in relation to this blood pressures variables. The blood pressure was evaluated by 24-h ambulatory blood pressure monitoring since this offers a better values reproducibility and more details about blood pressure behavior in diferences times of the day. We used descriptive statistics to present the final results and applied Pearson and Spearman tests to evaluated the association betwen the variables. Finally, applied the multivariated regression analisys to control the confusion factors. Our conclusion was that the body mass index is directed associated with the daytime sistolic ambulatory blood pressure and the 24-h sistolic ambulatory blood pressure independently from any other anthropometric variable. The height and the body mass index are directly associated to the daytime sistolic ambulatory blood pressure and the daytime average ambulatory blood pressure in this group. The waist-to-hip relation is smaller in the individuals that practice exercices regularly.

A taxa de controle da hipertensão arterial permanece subótima apesar dos amplos e intensos programas institucionais e o número das novas medicações. A combinação de drogas de diferentes mecanismos de ação vem se tornando uma alternativa para aumentar a redução na pressão arterial (PA) e aumentar seu controle, aumentar aderência ao tratamento e reduzir os eventos adversos. Um estudo fatorial 4X4 foi desenhado para determinar a eficácia e a segurança de telmisartana (T) mais anlodipino (A) em pacientes hipertensos estágios I e II. Pacientes hipertensos adultos (N=1461) estágios I e II (pressão arterial basal 153,212,1 &#8260;101,74,3 mm Hg) foram randomizados para 1 de 16 grupos de tratamento com T 0, 20, 40, 80 mg e A 0, 2.5, 5, 10 mg por oito semanas. A maior redução na média das pressões sistólica e diastólica foram observadas com T 80 mg mais A10 mg (- 26,4 &#8260;20,1 mm Hg; p<0,05 comparados com as monoterapias). A taxa de controle da PA foi também maior no grupo T 80mg mais A 10mg (76,5% [controle total] e 85,3% [controle da PA diastólica ]), e taxa de controle da PA >90% com esta combinação. O edema periférico maleolar foi o evento adverso mais frequente e ocorreu no grupo A 10mg (17,8%), porém, esta taxa foi marcadamente menor quando A foi usada associada com T: 11,4% (T20+A10), 6,2% (T40+ A10), e 11,3% (T80+A10). Um subestudo utilizando a monitorização ambulatorial da pressão arterial (MAPA) foi realizado na fase basal e após oito semanas de tratamento. A maior redução média das pressões nas 24 horas a partir do período basal foi registrada para a combinação de telmisartana 80 mg e anlodipino 10 mg e encontrou-se queda de 22,4/14,6 mmHg, de 11,9/6,9 mmHg para anlodipino 10 mg monoterapia e de 11,0/6,9 mmHg para telmisartana 80 mg (p< 0,001). Além disso, resultados relevantes foram também constatados numa análise post hoc de subgrupos incluindo idosos, obesos, diabéticos tipo 2 e hipertensão sistólica. A resposta anti-hipertensiva da combinação foi semelhante, independente de qualquer característica de cada subgrupo. Estes dados demonstram que telmisartana e anlodipino em combinação oferecem substancial redução e controle nas 24 horas superior às respectivas monoterapias em hipertensos estágios I e II. / The rate of control of hypertension remains suboptimal despite widespread educational programs and the increasing number of novel medications. The combination of drugs with different mechanism of action has become an alternative to improve blood pressure reduction and control, enhance adherence to the treatment and reduce adverse events. This randomized 4X4 factorial study determined the efficacy and safety of telmisartan (T) plus amlodipine (A) in hypertensive patients. Adults (N=1461) with stage 1 or 2 hypertension (baseline blood pressure (BP) 153.212.1 &#8260;101.74.3 mm Hg) were randomized to 1 of 16 treatment groups with T 0, 20, 40, 80 mg and A 0, 2.5, 5, 10 mg for 8 weeks. The greatest leastsquare mean systolic &#8260; diastolic BP reductions were observed with T80 mg plus A10 mg (- 26.4 &#8260;20.1 mm Hg; P<.05 compared with both monotherapies). BP control was also greater in the T80-mg plus A10-mg group (76.5% [overall control] and 85.3% [diastolic BP control]), and BP response rates >90% with this combination. Peripheral edema was most common in the A10-mg group (17.8%); however, this rate was notably lower when A was used in combination with T: 11.4% (T20 &#8260; A10), 6.2% (T40 &#8260; A10), and 11.3% (T80 &#8260; A10). Ambulatory BP monitoring (ABPM) was performed, at baseline and after 8 weeks of treatment; the endpoints of interest were the changes from baseline in 24-hour systolic and diastolic BP. Mean reductions from baseline in 24-hour BP for the combination of the highest doses of telmisartan 80 mg and amlodipine 10 mg were -22.4/-14.6 mmHg versus -11.9/-6.9 mmHg for amlodipine 10 mg and -11.0/-6.9 mmHg for telmisartan 80 mg (p< 0.001 for each comparison. This study also presents most of the relevant results in hypertensive patients and a post hoc analysis of subgroups including elderly, diabetics type 2, systolic hypertension and obese patients. These findings demonstrate that telmisartan and amlodipine in combination provide substantial 24 hour BP efficacy that is superior to either monotherapy in patients with stages 1 and 2 hypertension.

Introdução: Parte dos efeitos benéficos das estatinas sobre a prevenção de eventos cardiovasculares podem ser atribuídos a efeitos pleiotrópicos, entre eles, a redução da pressão arterial (PA). Objetivo: Avaliar o efeito da administração de sinvastatina sobre a pressão arterial aferida por monitorização ambulatorial de pressão arterial (MAPA-24h). Métodos: Em um ensaio clínico duplo-cego em paralelo, 79 pacientes hipertensos sem indicação formal para o uso de estatinas foram randomizados para receber 40mg de sinvastatina (n=40) ou placebo (n=39) durante o período da manhã. Dados clínicos, laboratoriais e de MAPA-24h foram coletados no início e após oito semanas de seguimento. A amostra constituiu-se preponderantemente de mulheres brancas com sobrepeso e 80% usava dois ou mais anti-hipertensivos. Resultados: Constatou-se uma redução da pressão arterial no grupo sinvastatina. Houve uma diferença significativa no delta de variação da pressão diastólica (PAD) de 24h após ajuste para pressões basais (2,8 mmHg; IC95%: 0,4-5,1, P=0,02). Os valores correspondentes para a pressão arterial sistólica (PAS) e PAD diurno foram: 4,2 mmHg; (IC95%: 0,1-8,4, P=0,04) e 3,1mmHg (IC95%: 0,4-5,9, P=0,02). Conclusão: A administração de 40mg de sinvastatina durante o período da manhã resulta em redução significativa da PAS e PAD durante o dia cuja magnitude pode ter repercussão clínica. Considera-se que, parte dos benefícios das estatinas na prevenção primária ou secundária de eventos cardiovasculares, demonstrados em importantes ensaios clínicos, podem estar relacionados ao seu efeito na redução da pressão arterial. / Background: Part of the beneficial effects of statins on the prevention of cardiovascular events can be attributed to pleiotropic effects, including reduction of blood pressure (BP). Objective: To evaluate the effect of simvastatin on BP measured by ambulatory blood pressure monitoring (ABPM-24h). Methods: In a double-blind parallel clinical trial 79 hypertensive patients without a formal indication for statin therapy were randomized to receive 40 mg of simvastatin (n = 40) or placebo (n = 39) during the morning. Clinical, laboratory and ABPM-24h data were collected at the baseline and after 8 weeks of follow-up. The sample consisted mainly of white overweight women and 80% used two or more antihypertensive drugs. Results: There was a significant reduction in 24-h diastolic blood pressure (24h-DBP) in the simvastatin group. The ABPM δ-value between the groups after adjustment for baseline BP was 2.8 mmHg (95% CI: 0.4 to 5.1, P = 0.02). The corresponding values for daytime systolic blood pressure (SBP) and daytime DBP were 4.2 mmHg (95% CI: 0.1 to 8.4; P = 0.04) and 3.1 mmHg (95% CI: 0.4 to 5.9; P = 0.02). Conclusion: The administration of 40 mg of simvastatin during the morning period resulted in a significant reduction in daytime SBP and DBP. This effect may have clinical impact. Some of the benefits of statins in primary or secondary prevention of cardiovascular events demonstrated in large clinical trials may be related to its effect in reducing blood pressure.

Objetivo: Investigar o efeito de se distinguir a pressão arterial noturna da pressão arterial no sono pelo registro simultâneo da monitorização ambulatorial da pressão arterial e da polissonografia. Métodos: Recrutaram-se 36 pacientes, 29 homens e 7 mulheres, com suspeita de síndrome das apnéias e hipopnéias obstrutivas do sono (SAHOS), encaminhados à clínica do sono para investigação diagnóstica e que concordaram usar o monitor ambulatorial de pressão arterial (MAPA) Spacelabs 90207 ABP durante a polissonografia (PSG). A média de idade dos indivíduos era 45 ± 11 anos; o índice de massa corporal (IMC), 30,8 ± 5,4 Kg/m2; o índice de apnéias e hipopnéias, 35 ± 29 AH/h. Um microfone acoplado ao monitor ambulatorial de PA registrou os sons característicos de sua atividade em um canal da polissonografia e permitiu determinar, de modo eletrográfico, se a PA foi medida em sono (e-sono) ou vigília (e-vigília).Resultados: Os pacientes encontravam-se dormindo durante (média+DP) 61+24% (variando de 0 a 100%), das 14+1 medidas de pressão arterial durante a noite. Leituras de pressão sistólica e diastólica na MAPA foram significativamente maiores durante o evigília (121 + 12 / 73 + 9 mm Hg) que durante o total do período noturno (119 + 11 / 70 + 8 mmHg) e e-sono (116 + 13 / 68 + 9 mm Hg). Baseado nas medidas do período noturno, 22 pacientes (61%) tinham hipertensão noturna; baseado nas medidas do período de e-sono, 12 pacientes tinham hipertensão noturna (33%; qui-quadrado= 5,54; p= 0,018). Um modelo de regressão linear múltipla mostrou que a percentagem de medidas feitas durante o e-sono foi a única variável que explicou significantemente a diferença entre os valores de PA noturna e PA em e-sono, controlando para gênero, idade, IMC, IAH, e SaO2 mínima. Conclusão: Durante a MAPA as leituras de PA noturnas são mais altas que as leituras durante e-sono. / Objective: Investigate the effect of distinguishing nighttime and sleep on nocturnal blood pressure results in ambulatory blood pressure monitoring (ABPM). Methods: We recruited 36 patients, 28 male, with suspected OSAHS attending a sleep clinic for diagnostic polysomnography (PSG) and who agreed to wear a Spacelabs 90207 ABP monitor during PSG. Their mean age was 45±11 years; body mass index (BMI), 30.8±5.4 kg/m2; apnea-hypopnea index (AHI), 35±29 AH/h; 13 had history of hypertension. A microphone attached to the ABP monitor recorded its sounds in the polygraph and allowed to classify each ABPM measurement as being made in electrographically-determined wake (e-wake) or sleep state (e-sleep). Results: Patients were asleep during (mean±SD) 61±24% (range 0 to 100%) of the 14±1 nighttime BP measurements. Systolic and diastolic ABPM readings were significantly higher during e-wake (121±12 / 73±9 mm Hg) than during total nighttime (119±11/70±8 m Hg) and e-sleep (116±13 / 68±9 mm Hg). Based on nighttime measurements 22 patients (61%) had nocturnal hypertension. Based on measurements made during e-sleep, nocturnal hypertension was diagnosed in 12 patients (33%; chisquare= 5.54; p= 0.018). A multiple linear regression model showed that the percentage of measurements made in e-sleep was the only variable that significantly explained the difference between nighttime and e-sleep BP figures, when controlling for gender, age, BMI, AHI, and lowest SaO2. Conclusion: During ABPM, nighttime BP readings are higher than during e-sleep and this changes dipping and nocturnal hypertension classification.

Objetivo: Investigar o efeito de se distinguir a pressão arterial noturna da pressão arterial no sono pelo registro simultâneo da monitorização ambulatorial da pressão arterial e da polissonografia. Métodos: Recrutaram-se 36 pacientes, 29 homens e 7 mulheres, com suspeita de síndrome das apnéias e hipopnéias obstrutivas do sono (SAHOS), encaminhados à clínica do sono para investigação diagnóstica e que concordaram usar o monitor ambulatorial de pressão arterial (MAPA) Spacelabs 90207 ABP durante a polissonografia (PSG). A média de idade dos indivíduos era 45 ± 11 anos; o índice de massa corporal (IMC), 30,8 ± 5,4 Kg/m2; o índice de apnéias e hipopnéias, 35 ± 29 AH/h. Um microfone acoplado ao monitor ambulatorial de PA registrou os sons característicos de sua atividade em um canal da polissonografia e permitiu determinar, de modo eletrográfico, se a PA foi medida em sono (e-sono) ou vigília (e-vigília).Resultados: Os pacientes encontravam-se dormindo durante (média+DP) 61+24% (variando de 0 a 100%), das 14+1 medidas de pressão arterial durante a noite. Leituras de pressão sistólica e diastólica na MAPA foram significativamente maiores durante o evigília (121 + 12 / 73 + 9 mm Hg) que durante o total do período noturno (119 + 11 / 70 + 8 mmHg) e e-sono (116 + 13 / 68 + 9 mm Hg). Baseado nas medidas do período noturno, 22 pacientes (61%) tinham hipertensão noturna; baseado nas medidas do período de e-sono, 12 pacientes tinham hipertensão noturna (33%; qui-quadrado= 5,54; p= 0,018). Um modelo de regressão linear múltipla mostrou que a percentagem de medidas feitas durante o e-sono foi a única variável que explicou significantemente a diferença entre os valores de PA noturna e PA em e-sono, controlando para gênero, idade, IMC, IAH, e SaO2 mínima. Conclusão: Durante a MAPA as leituras de PA noturnas são mais altas que as leituras durante e-sono. / Objective: Investigate the effect of distinguishing nighttime and sleep on nocturnal blood pressure results in ambulatory blood pressure monitoring (ABPM). Methods: We recruited 36 patients, 28 male, with suspected OSAHS attending a sleep clinic for diagnostic polysomnography (PSG) and who agreed to wear a Spacelabs 90207 ABP monitor during PSG. Their mean age was 45±11 years; body mass index (BMI), 30.8±5.4 kg/m2; apnea-hypopnea index (AHI), 35±29 AH/h; 13 had history of hypertension. A microphone attached to the ABP monitor recorded its sounds in the polygraph and allowed to classify each ABPM measurement as being made in electrographically-determined wake (e-wake) or sleep state (e-sleep). Results: Patients were asleep during (mean±SD) 61±24% (range 0 to 100%) of the 14±1 nighttime BP measurements. Systolic and diastolic ABPM readings were significantly higher during e-wake (121±12 / 73±9 mm Hg) than during total nighttime (119±11/70±8 m Hg) and e-sleep (116±13 / 68±9 mm Hg). Based on nighttime measurements 22 patients (61%) had nocturnal hypertension. Based on measurements made during e-sleep, nocturnal hypertension was diagnosed in 12 patients (33%; chisquare= 5.54; p= 0.018). A multiple linear regression model showed that the percentage of measurements made in e-sleep was the only variable that significantly explained the difference between nighttime and e-sleep BP figures, when controlling for gender, age, BMI, AHI, and lowest SaO2. Conclusion: During ABPM, nighttime BP readings are higher than during e-sleep and this changes dipping and nocturnal hypertension classification.

Introdução: Parte dos efeitos benéficos das estatinas sobre a prevenção de eventos cardiovasculares podem ser atribuídos a efeitos pleiotrópicos, entre eles, a redução da pressão arterial (PA). Objetivo: Avaliar o efeito da administração de sinvastatina sobre a pressão arterial aferida por monitorização ambulatorial de pressão arterial (MAPA-24h). Métodos: Em um ensaio clínico duplo-cego em paralelo, 79 pacientes hipertensos sem indicação formal para o uso de estatinas foram randomizados para receber 40mg de sinvastatina (n=40) ou placebo (n=39) durante o período da manhã. Dados clínicos, laboratoriais e de MAPA-24h foram coletados no início e após oito semanas de seguimento. A amostra constituiu-se preponderantemente de mulheres brancas com sobrepeso e 80% usava dois ou mais anti-hipertensivos. Resultados: Constatou-se uma redução da pressão arterial no grupo sinvastatina. Houve uma diferença significativa no delta de variação da pressão diastólica (PAD) de 24h após ajuste para pressões basais (2,8 mmHg; IC95%: 0,4-5,1, P=0,02). Os valores correspondentes para a pressão arterial sistólica (PAS) e PAD diurno foram: 4,2 mmHg; (IC95%: 0,1-8,4, P=0,04) e 3,1mmHg (IC95%: 0,4-5,9, P=0,02). Conclusão: A administração de 40mg de sinvastatina durante o período da manhã resulta em redução significativa da PAS e PAD durante o dia cuja magnitude pode ter repercussão clínica. Considera-se que, parte dos benefícios das estatinas na prevenção primária ou secundária de eventos cardiovasculares, demonstrados em importantes ensaios clínicos, podem estar relacionados ao seu efeito na redução da pressão arterial. / Background: Part of the beneficial effects of statins on the prevention of cardiovascular events can be attributed to pleiotropic effects, including reduction of blood pressure (BP). Objective: To evaluate the effect of simvastatin on BP measured by ambulatory blood pressure monitoring (ABPM-24h). Methods: In a double-blind parallel clinical trial 79 hypertensive patients without a formal indication for statin therapy were randomized to receive 40 mg of simvastatin (n = 40) or placebo (n = 39) during the morning. Clinical, laboratory and ABPM-24h data were collected at the baseline and after 8 weeks of follow-up. The sample consisted mainly of white overweight women and 80% used two or more antihypertensive drugs. Results: There was a significant reduction in 24-h diastolic blood pressure (24h-DBP) in the simvastatin group. The ABPM δ-value between the groups after adjustment for baseline BP was 2.8 mmHg (95% CI: 0.4 to 5.1, P = 0.02). The corresponding values for daytime systolic blood pressure (SBP) and daytime DBP were 4.2 mmHg (95% CI: 0.1 to 8.4; P = 0.04) and 3.1 mmHg (95% CI: 0.4 to 5.9; P = 0.02). Conclusion: The administration of 40 mg of simvastatin during the morning period resulted in a significant reduction in daytime SBP and DBP. This effect may have clinical impact. Some of the benefits of statins in primary or secondary prevention of cardiovascular events demonstrated in large clinical trials may be related to its effect in reducing blood pressure.

Observou-se a prevalência crescente das doenças cardiovasculares nos dias de hoje e o acometimento cada vez maior da população pediátrica. O objetivo principal no presente estudo foi verificar a associação entre a pressão arterial ambulatorial e variáveis antropométricas em 34 pré-adolescentes e adolescentes na faixa de idade entre 9 e 17 anos de ambos os sexos. Analisamos também se a prática regular de exercícios físicos beneficia, em relação as variáveis concernentes à pressão arterial, este grupo de indivíduos. A avaliação da pressão arterial foi realizada através da monitorização ambulatorial da pressão arterial durante 24 horas por ser uma forma de avaliação que oferece maior reprodutibilidade dos valores e maior detalhamento sobre o comportamento da pressão arterial nos diferentes períodos do dia. Foi utilizada a estatística descritiva para apresentar os resultados obtidos, a correlação de Pearson e Spearman para avaliar as associações entre as variáveis e a regressão linear múltipla para controlar os fatores de confusão e avaliar os preditores das variáveis de desfecho. Conclui-se que o índice de massa corporal se associa diretamente com a pressão arterial ambulatorial sistólica diurna e com a pressão arterial ambulatorial sistólica de 24 horas, independentemente de outras variáveis antropométricas. A estatura e o índice de massa corporal se associam diretamente à pressão arterial ambulatorial sistólica diurna e a pressão arterial ambulatorial média diurna neste grupo de pré-adolescentes e adolescentes. A relação cintura/quadril é significativamente menor naqueles que praticam exercícios físicos regularmente. / We observed the growing incidence and prevalence of cardiovascular diseases nowadays in the pediatric population. The aim of this study was to verify the association betwen ambulatory blood pressure and anthropometrical variables in 34 pre-teenagers and teenagers, ranging from 9 to 17 years old both male and female. We also analyzed if the frequent practice of exercices helps group of individuals in relation to this blood pressures variables. The blood pressure was evaluated by 24-h ambulatory blood pressure monitoring since this offers a better values reproducibility and more details about blood pressure behavior in diferences times of the day. We used descriptive statistics to present the final results and applied Pearson and Spearman tests to evaluated the association betwen the variables. Finally, applied the multivariated regression analisys to control the confusion factors. Our conclusion was that the body mass index is directed associated with the daytime sistolic ambulatory blood pressure and the 24-h sistolic ambulatory blood pressure independently from any other anthropometric variable. The height and the body mass index are directly associated to the daytime sistolic ambulatory blood pressure and the daytime average ambulatory blood pressure in this group. The waist-to-hip relation is smaller in the individuals that practice exercices regularly.

In recent years, the traditional nuclear family, as defined by social role theory with mother at home and father in the workplace, is no longer the norm. Nearly three out of every four women with children under the age of 18 are part of the workforce. Mothers are frequently juggling multiple roles as well as most of the responsibilities that are inherent in these roles. The current project examined diurnal ambulatory blood pressure influences associated with the responsibility of having a greater number of roles. We investigate differences between a self-reported healthy population of 112 married stay-at-home and 112 married employed mothers, all of whom have children under the age of 18 currently living in the home. Using a mixed multilevel model analysis, we found that the perception of equity in the division of childcare responsibilities between mothers and their husbands significantly contributed to lower systolic ambulatory blood pressure. We also found that married couples in relationships containing high positivity and low negativity had lower systolic ambulatory blood pressure than those which contained simultaneously high positivity and negativity. Additionally, there was a crossover interaction between these variables such that effect of relationship quality on both systolic and diastolic ambulatory blood pressure was moderated by the perception of equity in the division of childcare responsibilities between spouses. Lastly, we found that there were no ambulatory blood pressure differences between the employed and SAH mother conditions. These findings have applicable implications regarding dynamics and processes within marital relationships. These results demonstrate important social and relational influences on mothers' cardiovascular health.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Ambulatory blood pressure (BP) monitoring (ABPM) remains a reference standard but the number of readings required to make the measurement valid has not been empirically validated. Methods: Among 360 patients with chronic kidney disease and 38 healthy controls, BP was recorded 2 per hour during the night and 3 per hour during the day over 24h using a validated ABPM device; all had at least 90% of the expected readings. From this full set of ABPM recording, a variable number of BP measurements were selected and we compared the performance of the selected readings against that of the full sample using random or sequential selection schemes. To address the question whether random or sequential selection schemes affect the diagnostic performance in diagnosing hypertension control we compared the diagnostic decisions reached with the subsample and the full sample using area under the receiver operating-characteristic curves (AUC ROC). To answer the question regarding the number of readings needed to achieve over 90% coverage of the mean BP of the full ABPM sample we ascertained the point and confidence interval (CI) estimates based on the selected data. Results: To diagnose hypertension control, the number of readings randomly drawn to establish lower bound with 2.5% error of area under the receiver operating-characteristic curve (AUC ROC) of 0.9 was 3, 0.95 was 7, and 0.975 was 13 . In contrast, the corresponding number of readings with serial selections was 18, 30 and 39 respectively. With a random selection scheme, 18 readings provided 80% coverage of the 90th percentile of CI of the true systolic BP mean, for 90% coverage, 26 readings were needed, for 95% coverage 33. With serial selections, the number of readings increased to 42, 47, and 50 respectively. Similar results emerged for diastolic BP. Conclusions: For diagnosing hypertension control 3 random measurements or 18 serial measurements is sufficient. For quantitative analysis, the minimal sufficient number of 24h ambulatory BP is 26 random recordings or 42 serial recordings.

<p>Decentering can be defined as one’s ability to detach from emotional thoughts and adopt a non-judgmental view. Prior studies on 8-week mindfulness-based stress reduction (MBSR) courses have demonstrated that as the ability to decenter increases, anxiety levels decrease. Our recent work has demonstrated that a higher ability to decenter is associated with lower arterial stiffness, however, it is unknown how decentering affects blood pressure patterns. The purpose of this study was to observe if decentering has an effect on nocturnal blood pressure dipping. Twenty- eight adults (age 25±1 years; BMI 26±1 kg/m2) volunteered for this study. All participants had a BMI <30 kg/m2, and reported no history of diabetes, smoking, or taking cardiovascular medication. Participants completed an 11-item decentering questionnaire that quantified their ability to disconnect from their emotions, then were asked to wear an ambulatory blood pressure monitor (ABPM) and actigraphy watch for 24-hours. Brachial blood pressures were measured by the ABPM every 20 minutes while awake and every 30 minutes while asleep. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) dipping percentages were calculated by Spacelabs software from the mean values of both daytime and nighttime arterial blood pressure recordings, after adjusting sleep and wake times based on actigraphy data. Questionnaire data was analyzed using Exploratory Factor Analysis (EFA) and a reliability analysis. This revealed a three-factor structure that explained 71.53% of the variance, consisting of meta-awareness, disidentification, and nonreactivity. Nine items remained in the final questionnaire, after deleting two items which cross-loaded. Multiple linear regression analyses indicate disidentifcation as a significant predictor of SAP dipping (𝛽𝛽 = 3.333, p = 0.032) and DAP dipping (𝛽𝛽 = 3.898, p = 0.049). Preliminary results suggest that greater disidentifcation, as a component of decentering, may be associated with lower cardiovascular risk (greater SAP and DAP dipping). These findings provide promising insight into the benefits of MBSR and decentering on ambulatory blood pressure patterns, with the potential benefits of lowering overall risk for cardiovascular disease (CVD).</p>