e60 Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e45–e64

treatment was adjusted based on ABPM) thereafter, ambulatory BP and

physical activity (wrist actigraphy) were simultaneously monitored for

48h to accurately derive the awake and asleep BP means. The Cox propor-

tional-hazard model, adjusted for significant confounding variables, was

used to estimate hazard ratios (HR) for the risk of developing diabetes

associated with sleep-time-relative BP decline and dipping classification.

During a 5.6-year median follow-up, 190 participants developed diabetes.

The diminished sleep-time relative BP decline was a highly significant pre-

dictor of new-onset diabetes in a Cox proportional-hazard model adjusted

for the significant influential variables of age, waist perimeter, glucose, and

chronic kidney disease (for each 1-SD elevation, HR¼0.77, [95%CI: 0.68-

0.88], P<0.001). Based on the baseline ABPM evaluation per participant,

the adjusted HR was similar in extreme-dippers and dippers (P¼0.882),

but significantly greater in non-dippers (P¼0.002) and risers (P<0.001).

Based on the data of the last 48h ABPM profile per participant, compared

to dippers the adjusted HR of new-onset diabetes was lower in extreme-

dippers (P¼0.029) and significantly higher in non-dippers and risers

(P<0.001). The risk of developing diabetes decreased in extreme-dippers

during follow-up, in which nighttime hypotension was avoided by proper

use of ABPM-based pharmacotherapy. The HR of new-onset diabetes was

significantly greater in non-dippers and, to a larger extent in risers. Results

seem to indicate a blunted sleep-time relative BP decline predicts, rather

than being a consequence, the development of diabetes.

Keywords: Ambulatory blood pressure monitoring; Diabetes; Asleep

blood pressure; Dipper patterning

P-86

Prognostic value of asleep and awake blood pressure for

cardiovascular risk assessment according to gender: the Hygia

Project

Ramon C. Hermida,5 Ana Moya,4 Juan J. Crespo,4 Alfonso Otero,1

Carmen Casti~neira,4 Maria T. Rios,4 Manuel Dominguez-Sardi~na,4

Artemio Mojon,5 Jose R. Fernandez,5 Diana E. Ayala,.5,Hygia Project Investigators 1Complejo Hospitalario Universitario, Orense,

Spain; 2Servicio Galego de Saude, Lugo, Spain; 3Servicio Galego de

Saude, Pontevedra, Spain; 4Servicio Galego de Saude, Vigo, Spain;5University of Vigo, Vigo, Spain

Previous results have shown gender differences in the pathophysiology of

hypertension and treatment responses to medication. Typically, men

exhibit higher blood pressure (BP) than women, the differences being

greater for systolic (SBP) than for diastolic BP (DBP). However, wheter

the prognostic value of ambulatory BP monitoring (ABPM) for cardiovas-

cular (CVD) risk assessment differs by gender in unclear. We evaluated the

contribution to CVD risk of awake and asleep BP in men and women par-

ticipants in the Hygia Project, designed to evaluate prospectively CVD risk

by ABPM in primary care centers of Northwest Spain. This study involved

11255 subjects, 6028 men/5227 women, 58.9�14.5 years of age, with

ambulatory BP ranging from normotension to sustained hypertension, pro-

spectively evaluated throughout a 4.0-year mean follow-up. BP was

measured at 20-min intervals from 07:00 to 23:00h and at 30-min intervals

at night for 48h. During monitoring, subjects maintained a diary listing the

times of going to bed at night and awakening in the morning. The CVD

outcome was defined as the composite of CVD death, myocardial infarc-

tion, coronary revascularization, heart failure, and stroke. Participants of

each gender were divided into four groups of awake/asleep-normal/

elevated BP using established ABPM thresholds of 135/85 mmHg for

awake SBP/DBP means and 120/70 mmHg for asleep SBP/DBP means.

Independent of gender, results indicate: (i) equivalent adjusted hazard ratio

(HR) of participants with normal asleep BP whether the awake BP mean is

normal or elevated (P¼0.615 for men; P¼0.403 for women); (ii) equiva-

lent HR in subjects with elevated asleep BP, independent of awake BP

mean (P¼0.520 for men; P¼0.528 for women); and (iii) higher adjusted

HR of CVD events in subjects with elevated asleep BP mean than partic-

ipants with normal asleep BP, independent of awake BP mean and gender

(P<0.001). Asleep, but not awake BP mean, is a highly significant and in-

dependent prognostic marker of CVD events, both in men and women.

Contrary to several current guidelines, evaluation of CVD risk and diag-

nosis of hypertension should preferably be based on sleep-time BP instead

of daytime clinic BP or even awake BP mean, rendering ABPM a clinical

necessity in the general population.

Keywords: Ambulatory blood pressure monitoring; Cardovascular risk;

Gender differences; Asleep blood pressure

P-87

Prognostic value of clinic and ambulatory blood pressure

measurements in elderly subjects: the Hygia Project

Artemio Mojon,4 Juan J. Crespo,3 Alfonso Otero,1 Ana Moya,3

Maria T. Rios,3 Lorenzo Pousa,3 Pedro A. Callejas,3 Jose R. Fernandez,4

Diana E. Ayala,4 Ramon C. Hermida.4 1Complejo Hospitalario

Universitario, Orense, Spain; 2Servicio Galego de Saude, Pontevedra,

Spain; 3Servicio Galego de Saude, Vigo, Spain; 4University of Vigo, Vigo,

Spain

Some studies have documented a progressive reduction with age in sleep-

time relative blood pressure (BP) decline towards a more non-dipping

patterning and the corresponding increased prevalence of nighttime hyper-

tension, associated with a diminished production of atrial natriuretic pep-

tide, altered endothelium function, and atherosclerosis, among other

factors. We evaluated the combined contribution to cardiovascular disease

(CVD) risk of clinic, awake, and asleep BP among elderly participants in

the Hygia Project, designed to evaluate prospectively CVD risk by ambu-

latory BP monitoring (ABPM) in primary care centers of Northwest Spain.

This study involved 4206 elderly subjects (age �65 years), 2118 men/2088

women, 73.6�5.8 years of age, with baseline ambulatory BP ranging from

normotension to sustained hypertension, prospectively evaluated

throughout a 3.8-year mean follow-up. BP was measured at 20-min inter-

vals from 07:00 to 23:00h and at 30-min intervals at night for 48h. During

monitoring, subjects maintained a diary listing the times of going to bed at

night and awakening in the morning. The CVD outcome was defined as the

composite of CVD death, myocardial infarction, coronary revasculariza-

tion, heart failure, and stroke. The hazard ratios (HR) for each 1-SD eleva-

tion in clinic, awake, and asleep systolic BP (SBP) analyzed separately

(adjusted for, sex, diabetes, chronic kidney disease, and previous CVD

event) were 1.11 [95%CI: 1.03-1.20], 1.18 [1.09-1.27], and 1.35 [1.26-

1.44], respectively (P<0.001). Exploration of their combined contribution

revealed the only significant marker of increased CVD risk was the

elevated asleep SBP (HR¼1.60 [1.44-1.79], P<0.001) but not clinic BP

(1.03 [0.95-1.12], P¼0.502) or awake BP (0.78 [0.69-0.89], P<0.001).

These findings also reflect the enhanced CVD risk associated with

decreased sleep-time relative SBP decline, independent of BP level

(HR¼0.84 [0.77-0.91], P<0.001). Asleep SBP mean and sleep-time rela-

tive SBP decline are the only significant and independent markers of

CVD risk in elderly persons. Daytime clinic BP and ABPM-derived awake

BP mean do not provide any prognostic information when these variables

are corrected by sleep-time BP. These results indicate ABPM is a clinical

requirement to accurately detect abnormal sleep-time BP and assess CVD

risk in the elderly.

Keywords: Ambulatory blood pressure monitoring; Cardovascular risk;

Asleep blood pressure; Elderly

P-88

Reference values for exercise blood pressure in adolescents

Claudia Hacke, Burkhard Weisser. Christian-Albrechts-University, Kiel,Germany

In children and adolescents, office blood pressure (BP) is not very reliable

and has a poor reproducibility. In case of adults, exercise BP correlates

more closely with cardiovascular risk and there are cut-off values for ex-

ercise BP which indicate normal and reference values. However, there