e61Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e45–e64

are no reference values for children and adolescents, to date. The goal of

the present investigation was a proposal for exercise BP reference values

for adolescents. In the Kiel EX.PRESS. (EXercise and PRESSure) study,

systolic BP at rest and during exercise of 532 young subjects (aged 12-

17 years) were determined. Systolic exercise BP was measured at 1.5

Watt / kg body weight using a standardized cycle ergometer exercise test.

Mean resting BP was 113.1 � 12.8 / 57.2 � 7.1 mmHg, while mean exer-

cise BP was 149.9 � 19.8 / 54.2 � 8.6 mmHg. For the determination of

reference values, the German age-, height- and sex-related reference per-

centiles for resting BP were used. The BP values at the 90th and the

95th percentile were taken to determine the respective percentiles in our

study group. The corresponding percentiles were 87.6 and 92.1, therefore

according to German reference values which are very similar to interna-

tional data 12.4% of the subjects had at least a high normal resting BP

and 7.9% had hypertension. The systolic exercise BP values at these per-

centiles for our sample are proposed as reference values for high normal

exercise BP and exercise hypertension (see table 1). Using these reference

values, 79% of our participants had normal resting and exercise BP values.

7.8% had normal resting but high normal or hypertensive exercise BP

values. 7.4% of the subjects were high normal or hypertensive at rest

but normotensive during exercise. Additional 5.9% had both high normal

or hypertensive resting and exercise BP values.

Exercise BP might be useful to identify white coat hypertension in a sub-

group of young subjects. It is also relevant for the better determination of

cardiovascular risk using the proposed reference values for 12-17 year-old

subjects. As long as prognostic data for reference values in adolescents are

missing, these statistical reference values might be useful in clinical

practice.

Table 1

The Kiel EX.PRESS. study: Calculated percentiles of the distributions

German reference Kiel EX.PRESS. study

values (SBP)

age

(years)

percentiles

SBP-rest

(mmHg)

SBP-exercise

(mmHg)

90th ‘‘high normal’’

12-13 88.3 122.8 162.0

14-15

86.7 128.0 172.0

16-17

88.2 132.0 184.0

total

87.6 128.0 172.0

95th ‘‘hypertensive’’

12-13 93.7 128.0 172.0

14-15

91.3 132.0 176.0

16-17

91.6 134.1 191.3

total

92.1 132.0 180.0

Keywords: exercise blood pressure; reference values; adolescents

P-89

Risk factors and blood pressure variability as determinants of

hypertensive crises

Riccardo Sarzani, Massimiliano Fedecostante, Francesco Spannella,

Federico Giulietti, Emma Espinosa, Paolo Dess�ı-Fulgheri. Polytechnic

University of Marche, IRCCS-INRCA, Ancona, Italy

Hypertensive crises are a frequent cause of Emergency Department (ED)

access. The purpose of this study was to identify independent risk factors

for hypertensive crisis (HC) in the context of blood pressure variability.

In this retrospective case-control study, we analyzed ABPM and clinical

data of 198 consecutive patients referred to our Hypertension Center

from January 2011 to June 2012: cases were 79 patients who presented

during the study period to the ED with the diagnosis of hypertensive ur-

gency, defined as systolic blood pressure (SBP) � 180 mmHg and/or dia-

stolic BP (DBP) � 120 mmHg in the absence of acute target organ

damage. Controls were 119 patients attending BP visit with indications

for ABPM and negative story for HC, matched to cases on the basis of

age, sex, and BMI. Twenty four hour BP variability was evaluated as

average real variability (ARV). Treatment Intensity Score (TIS), calculated

on the basis of drug number and dosages, was used for adjusting results.

Good BP control was defined as 24hBP < 130/80 mmHg.

No significant differences were found between patients with or without HC

regarding the following: age, gender, BMI, diabetes mellitus, TIS, night-

time dipping pattern and diastolic ARV. Twenty four hour SBP, DBP

and systolic ARV were significantly higher in patients with HC whereas

good BP control and eGFR were significantly lower. Factors with a univar-

iate p-value � 0.30 were incorporated into two multivariate logistic regres-

sion analysis models, the first model with eGFR, diabetes mellitus, systolic

ARV, BP control. In the second model, BP control was substituted with

24h SBP and 24h DBP. After adjustment, both systolic ARV and diabetes

mellitus lost their independent relation with HC. The strongest indepen-

dent risk factor for HC was a less successful SBP control with odds ratio

¼ 3.5 (1.7-7.2), p:0.001. The odds were increase by 4% for each mmHg of

higher average 24h SBP.

Even when considering BP variability, less effective outpatient BP control,

as evinced by ABPM, was the most important independent risk factor for

HC leading to an ED access. More aggressive and successful control of hy-

pertension may therefore reduce the odds of hypertensive crisis and may

drastically reduce access to the ED for hypertensive crisis.

Keywords: Hypertensive Crises; blood pressure variability; hypertension

urgency; ABPM

P-90

Sleep-time relative blood pressure decline as prognostic marker of

major cardiovascular events: the Hygia Project

Ana Moya,2 Juan J. Crespo,2 Manuel Dominguez-Sardi~na,2

Sonia M. Gomara,2 Elvira Sineiro,2 Maria T. Rios,2 Artemio Mojon,3

Jose R. Fernandez,3 Diana E. Ayala,3 Ramon C. Hermida,.3,

Hygia Project Investigators 1Servicio Galego de Saude, Pontevedra, Spain;2Servicio Galego de Saude, Vigo, Spain; 3University of Vigo, Vigo, Spain

Previous studies on ambulatory blood pressure (BP) monitoring (ABPM)

have provided inconsistent findings on the prognostic value of the arbi-

trarily defined dipper patterning. For instance, the extent of BP surge

upon awakening has been associated with increased cardiovascular disease

(CVD) risk in some, but not all, studies, leading to the believe patients with

the extreme-dipper BP pattern are at high CVD risk. Numerous studies,

however, have consistently shown an association between elevated sleep-

time BP, characterized by a corresponding diminished morning BP surge,

with increased incidence of CVD events. We evaluated the prognostic

value of both the sleep-time-relative BP decline as a continuous variable

and dipping classification as a categorical one among the participants 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

baseline BP ranging from normotension to sustained hypertension accord-

ing to ABPM criteria, prospectively 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 main-

tained 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 revascularization, heart fail-

ure, and stroke. Using subjects with sleep-time relative systolic BP

(SBP) decline between 12 and 14% as the reference group, the hazard ratio

(HR) of CVD events (adjusted for the influential characteristics of age, sex,

diabetes, chronic kidney disease, cigarette smoking, waist perimeter, and

history of previous CVD event) was consistently and significantly elevated

(P<0.001) in subjects with decline <8% and non-significantly different for

SBP decline above this threshold value. Extreme-dippers have similar HR

than dippers (0.73, [95%CI: 0.45-1.18], P¼0.195 for total CVD outcome;

0.84 [0.36-1.93], P¼0.672 for stroke). Contrary to the current misleading

believe, CVD risk is equivalent in subjects with extreme-dipper and dipper

BP patterning, but highly significantly elevated when the sleep-time rela-

tive SBP decline is <8%, even after adjustment for significant confounding