Noninvasive central hemodynamic monitoring in the primary care setting: improving prevention and management of cardiovascular diseases.

Background: Although cardiovascular disease (CVD) has markedly declined since the early 1960s due to medical advances and better management, this condition persists as the most critical and preventable cause of death in the US. For that reason, the identification and application of more sensitive, specific, validated, and noninvasive biomarkers of cardiovascular functioning in the primary care setting for the early identification of CVD risk at the subclinical level are warranted. Aim: The goal of the present review is twofold: first, to familiarize the primary care practitioner with noninvasive aortic hemodynamic parameters, including how these could be integrated into primary care services and patient management, and second, to propose a model for earlier detection of CVD based on the noninvasive hemodynamic parameters in the primary care setting. Relevance for Patients: Implementation of noninvasive hemodynamic monitoring in a primary care setting could help in the identification of heart disease risk at the early onset thus preventing the need for expensive treatment or death at later stages.

Updated and revised normal values of aortic pulse wave velocity in children and adolescents aged 3-18 years.

Measurement of aortic pulse wave velocity (PWVao) is recommended for stratifying individual cardiovascular (CV) risk in adults. Diseases in children and adolescents might influence aortic stiffness. It is necessary to exclude overweight (OW), obese (O) subjects, and individuals with increased systolic (SBP) and/or diastolic blood pressure (DBP) from the population, when creating normal values of PWVao in children and adolescents. Body mass index (BMI), SBP/DBP cut-off values have remarkably changed in this population during the last decade. Aims of our study were to expand our previously published PWVao database and to revise it by using the recently determined normal values. PWVao was measured by an occlusive-oscillometric device (Arteriograph, TensioMed Ltd, Budapest, Hungary) in a healthy population aged 3-18 years. 7940 (4374 boys) participants were recruited, 1912 OW/O subjects and 1368 individuals with high SBP/DBP were excluded. Finally, n = 4690 (2599 boys) participants were enrolled. Mean PWVao values increased from 5.4 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in boys and from 5.5 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in girls. Mean PWVao values were significantly lower in our new study, in boys in age groups of 9-16, in girls in age groups of 11-17. This is the largest and widest age-ranged database of PWVao published to date. Due to the change of BMI and SBP/DBP reference values during the last decade, the "old" database of PWVao needed to be revised. As a result of this, normal values of PWVao decreased significantly in both sexes.

Childhood Obesity: Does it Have Any Effect on Young Arteries?

Prevalence of overweight (OW) and obesity (O) in children and adolescents has been increased in the past three decades. Increased arterial stiffness measuring by aortic pulse wave velocity (PWVao) might be detected in OW/O children and adolescents. The aim of our study was to compare the arterial function parameters (AFPs), such as PWVao; aortic augmentation index (Aixao); aortic systolic blood pressure (SBPao) and brachial systolic blood pressure (SBPbrach) measured simultaneously in O/OW patients and healthy subjects. In our study 6,816 subjects (3,668 boys) aged 3-18 years were recruited and categorized by their body mass index (BMI) into normal weight (N), OW and O groups regarding their age and sex. AFPs were measured by a non-invasive, occlusive-oscillometric device. 19.9% (n = 1,356) of the population were OW/O, 911 (516 boys) were OW and 445 (272 boys) were O. After accounting for the effect of covariates, PWVao did not differ significantly between N (5.9 ± 0.8 m/s) and OW patients (5.9 ± 0.8 m/s); and N (6.0 ± 0.7 m/s) and O patients (6.0 ± 0.8 m/s). Aixao was significantly lower in OW (9.3 ± 7.4% vs. 7.6 ± 7.0%, p < 0.00001) and in O patients (9.7 ± 8.1% vs. 6.6 ± 7.2%, p < 0.00001) compared to controls. No significant difference was found regarding SBPao values between controls and OW and O groups (N = 110.7 ± 12.4 mmHg vs. OW = 110.3 ± 11.9 mmHg; N = 115.6 ± 14.0 mmHg vs. O = 114.3 ± 12.8 mmHg). According to our results we may conclude that the unchanged PWVao in O/OW subjects might be due to the compensatory decrease in Aixao, referring to enhanced vasodilatory status in the studied population.

Oscillometrically Measured Aortic Pulse Wave Velocity Reveals Asymptomatic Carotid Atherosclerosis in a Middle-Aged, Apparently Healthy Population.

BACKGROUND: Asymptomatic atherosclerosis is a common entity even at young age. Studies have suggested a strong relationship between increased arterial stiffness and asymptomatic carotid atherosclerosis (ACA) in general population, particularly in those with high cardiovascular risk, but no data exist from a younger population free from recognized cardiovascular disease. Hypothesis. We hypothesized there is an association between ACA and aortic pulse wave velocity (PWVao) in middle-aged, apparently healthy, normotensive population to reveal increased cardiovascular risk. METHODS: We examined the relationship between ACA and PWVao in 236 apparently healthy, asymptomatic, normotensive, middle-aged subjects (age 47 ± 8 years; 52% women). PWVao was measured with the oscillometric method (Arteriograph). ACA was assessed by carotid artery ultrasonography. RESULTS: ACA was present in 51 subjects. Subjects with ACA were older (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (. CONCLUSIONS: PWVao measured by the Arteriograph proved to be an independent marker of ACA. Our study may reveal high CV risk, detected as increased PWVao, which according to our study is related in a very high probability to asymptomatic carotid atherosclerosis in apparently healthy, young, and middle-aged subjects.

[Prevalence of hypertension in overweight and obese Hungarian children and adolescents]. / A magasvérnyomás-betegség prevalenciája túlsúlyos és elhízott magyar gyermek- és serdülokorú populációban.

Introduction: The prevalence of overweight and obesity is increasing worldwide, which affects not only adults, but children and adolescents as well. Moreover, this condition may lead to several comorbidities, such as elevated or even high blood pressure. Aim: Aim of this study was to assess the prevalence of overweight- and obesity-related elevated and high blood pressure in a population aged 3-18 years in Hungary. Method: Between 2005 and 2018, altogether 8624 (boys = 4719) individuals were enrolled to this study. Normal weight, overweight and obese groups were created on the basis of body mass index. The diagnosis of elevated (systolic and/or diastolic blood pressure is between 90th and 95th percentile) and high blood pressure (systolic and/or diastolic blood pressure is over 95th percentile) was based on detailed examination (laboratory tests, abdominal ultrasonography, paediatric cardiology and 24-hours ambulatory blood pressure monitoring). Results: In this study, the prevalence of overweight and obesity was 23.5% overall, 26.4% in boys and 20% in girls. The prevalence of elevated blood pressure was 9.8% in overweight patients, while it was 4.6% in the obese group. The prevalence of high blood pressure was 8.3% (odds ratio: 1.1%, 95% CI) among overweight subjects, while it was 26.7% (odds ratio: 3.6, 95% CI) in the obese group. Conclusion: To the best of our knowledge, this is the first Hungarian population-based study on the prevalence of overweight- and obesity-related elevated and high blood pressure assessed in a large contemporary cohort of children and adolescents. The cardiovascular risk is increased in this patient group. Hence, it is essential to set up a proper primary prevention strategy. Orv Hetil. 2020; 161(4): 151-160.

Soluble Urokinase-Type Plasminogen Activator Receptor and Arterial Stiffness in Patients with COPD.

INTRODUCTION: Soluble urokinase-type plasminogen activator receptor (suPAR) is upregulated by inflammation and plays a role in the pathogenesis of atherosclerosis. Chronic obstructive pulmonary disease (COPD) is associated with enhanced systemic inflammation and increased risk for atherosclerosis, however, studies analysing the circulating suPAR levels in COPD are contradictory. The aim of the study was to investigate plasma suPAR concentrations together with markers of arterial stiffness in COPD. MATERIALS AND METHODS: Twenty-four patients with COPD and 18 non-COPD, control subjects participated in the study. Plasma suPAR was measured, together with lung volumes, symptom burden, exacerbation history, markers of arterial stiffness and soluble inflammatory biomarkers, such as endothelin-1, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6). RESULTS: Plasma suPAR levels were higher in COPD (2.84 ± 0.67 ng/ml vs. 2.41 ± 0.57 ng/ml, p = 0.03) and were related to lung function measured with FEV1 (r = - 0.65, p < 0.01) and symptom burden determined with the modified Medical Research Council questionnaire (r = 0.55, p < 0.05). Plasma suPAR concentrations correlated with various measures of arterial stiffness in all subjects, but only with ejection duration in COPD (r = - 0.44, p = 0.03). CONCLUSIONS: Plasma suPAR levels are elevated in COPD and relate to arterial stiffness. Our results suggest that suPAR may be a potential link between COPD and atherosclerosis.

Prevalence of Overweight and Obesity in Hungarian Children and Adolescents.

BACKGROUND/AIMS: The prevalence of overweight and obesity in children and adolescents is increasing worldwide, and this condition is a risk factor for cardiovascular mortality. The aim of this study was to assess the prevalence of overweight and obesity among the 3-18-year-old population in Szolnok City and the surrounding areas. METHODS: Anthropometric data from healthy, white individuals recruited from nursery, elementary, and secondary schools were used to assess the prevalence of obesity and overweight in Szolnok City and the surrounding area, Jász-Nagykun-Szolnok county, Hungary. Healthy subjects numbering 6,824 (54% boys) were included; overweight and obesity were defined according to the relevant guidelines. RESULTS: Overweight individuals constituted 13.4% of the population and 6.6% were obese. The total prevalence was higher in boys (21.6%) than in girls (18.1%). The peak of the prevalence was observed at age 10 in both sexes (boys 33%, girls 27%) followed by a gradual decrease, which was more significant in the case of girls. CONCLUSIONS: On the basis of the recent Hungarian data, we have not detected any changes in overweight and obesity in the age group 3-9 years and we have found a significant decrease in the age group 7-14 years. Prevention of overweight and obesity in early childhood is essential.

Cystatin C is better than albuminuria as a predictor of pulse wave velocity in hypertensive patients.

INTRODUCTION: Arterial stiffness is important in the evaluation of the cardiovascular risk in both general population and hypertensive patients. In this study, we aimed to investigate the associations of both serum cystatin C levels and albuminuria with arterial stiffness in healthy controls and hypertensive patients. PATIENTS AND METHODS: Seventy-six healthy controls (male/female = 44/32) and 76 hypertensive patients (male/female = 43/33) were enrolled. Arterial stiffness parameters such as augmentation index (AIx) and pulse wave velocity (PWV) were non-invasively measured with the Arteriograph (Tensiomed Ltd., Budapest, Hungary). RESULTS: AIx (31.92 ± 14.31 vs. 27.95 ± 11.03, p = 0.03) and PWV (9.84 ± 1.62 vs. 8.87 ± 2.04, p < 0.001) were significantly higher in hypertensive patients compared to healthy controls. Patients with microalbuminuria had significantly higher AIx (43.47 ± 9.91 vs. 30.37 ± 14.13, p = 0.002) and higher serum cystatin C levels [0.76 (0.67-0.95) vs. 0.68 (0.62-0.78) mg/L, p = 0.03]. In the hypertensive group, AIx was significantly correlated with PWV (r = 0.519, p < 0.001), glomerular filtration rate (cystatin C) (r = -0.438, p = 0.003), mean arterial pressure (MAP) (r = 0.288, p = 0.015) and urinary albumin-creatinine ratio (ACR) (r = 0.386, p = 0.004). PWV was associated with serum cystatin C (r = 0.442, p = 0.003) and MAP (r = 0.377, p = 0.001). In the linear regression analysis (model r = 0.577, p = 0.006) for the prediction of PWV in hypertensive patients, MAP, urinary ACR, age and serum cystatin C levels were included as independent variables. Cystatin C was found to be the significant determinant of PWV in hypertensive patients. CONCLUSION: Multivariate analysis revealed that serum cystatin C but not albuminuria was significantly associated with PWV in hypertensive patients. Serum cystatin C may be better than albuminuria as a predictor of arterial stiffness in hypertensive patients.

Evaluation of arterial stiffness for predicting future cardiovascular events in patients with ST segment elevation and non-ST segment elevation myocardial infarction.

BACKGROUND: Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). METHODS: Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph. RESULTS: Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure (P = 0.007). There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE. CONCLUSIONS: Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI.

The prognostic value of arterial stiffness in systolic heart failure.

BACKGROUND: Increased arterial stiffness is an indicator of mortality. This study consists of an 18-month follow-up of the mortality in advanced heart failure patients with increased arterial stiffness. METHODS: The study followed up 98 patients with a diagnosis of heart failure in NYHA class III and IV (76 males, 22 females and mean age of 60 ± 12 years) with a left ventricular ejection fraction ≤ 35% as determined by the Simpson method. Augmentation index (Aix) and pulse wave propagation velocity (PWV) parameters were used as indicators of arterial stiffness. Aix and PWV values were measured by arteriography. RESULTS: 36 patients died. Both Aix and PWV were powerful determinants of mortality, independent of other prognostic variables (p = 0.013, OR: 0.805; p = 0.025, OR: 0.853). A cutoff value for Aix of -14.33 gave 91.2%, 80.3% sensitivity and specificity. A cutoff value for PWV of 11.06 gave 82.4%, 65.4% sensitivity and specificity mortality was predicted. Left ventricular ejection fraction (p = 0.008, OR: 0.859) and B-type natriuretic peptide (p = 0.01, OR: 0.833) was the other independent determinant of mortality. A significant difference was found in both Aix and PWV between the compensated measurements and decompensated heart failure measurements made in 70 patients (p = 0.035, p = 0.048). CONCLUSIONS: Measurement of arterial stiffness is a convenient, inexpensive and reliable method for predicting mortality in patients with advanced heart failure.

Arterial stiffness and pulse wave reflection in young adult heterozygous sickle cell carriers.

OBJECTIVE: Pulse wave velocity (PWV) and aortic augmentation index (AI) are indicators of arterial stiffness. Pulse wave reflection and arterial stiffness are related to cardiovascular events and sickle cell disease. However, the effect of these parameters on the heterozygous sickle cell trait (HbAS) is unknown. The aim of this study is to evaluate the arterial stiffness and wave reflection in young adult heterozygous sickle cell carriers. MATERIALS AND METHODS: We enrolled 40 volunteers (20 HbAS cases, 20 hemoglobin AA [HbAA] cases) aged between 18 and 40 years. AI and PWV values were measured by arteriography. RESULTS: Aortic blood pressure, aortic AI, and brachial AI values were significantly higher in HbAS cases compared to the control group (HbAA) (p=0.033, 0.011, and 0.011, respectively). A statistically significant positive correlation was found between aortic pulse wave velocity and mean arterial pressure, age, aortic AI, brachial AI, weight, and low-density lipoprotein levels (p=0.000, 0.017, 0.000, 0.000, 0.034, and 0.05, respectively) in the whole study population. Aortic AI and age were also significantly correlated (p=0.026). In addition, a positive correlation between aortic PWV and systolic blood pressure and a positive correlation between aortic AI and mean arterial pressure (p=0.027 and 0.009, respectively) were found in HbAS individuals. Our study reveals that mean arterial pressure and heart rate are independent determinants for the aortic AI. Mean arterial pressure and age are independent determinants for aortic PWV. CONCLUSION: Arterial stiffness measurement is an easy, cheap, and reliable method in the early diagnosis of cardiovascular disease in heterozygous sickle cell carriers. These results may depend on the amount of hemoglobin S in red blood cells. Further studies are required to investigate the blood pressure changes and its effects on arterial stiffness in order to explain the vascular aging mechanism in the HbAS trait population. CONFLICT OF INTEREST: None declared.

Reference values of aortic pulse wave velocity in a large healthy population aged between 3 and 18 years.

OBJECTIVE: The measurement of aortic pulse wave velocity (PWV(ao)) is an accepted marker in stratifying individual cardiovascular risk in adults. There is an increasing volume of evidence concerning impaired vascular function in different diseases in paediatric populations, but, unfortunately, only a few studies are available on the measurement of normal PWV(ao) values in children. The aim of our study was to determine the reference values of PWV(ao) in a large healthy population using a newly developed technique. METHODS: Three thousand, three hundred and seventy-four healthy individuals (1802 boys) aged 3-18 years were examined by an invasively validated, occlusive, oscillometric device. RESULTS: The mean PWV(ao) values increased from 5.5 ± 0.3 to 6.5 ± 0.3 m/s (P < 0.05) in boys and from 5.6 ± 0.3 to 6.4 ± 0.3 m/s (P < 0.05) in girls. The increase, however, was not constant, and the values exhibited a flat period between the ages of 3 and 8 years in both sexes. The first pronounced increase occurred at the age of 12.1 years in boys and 10.4 years in girls. Moreover, between the ages of 3 and 8 years, the brachial SBP and mean blood pressures increased continuously and gradually, whereas the PWV(ao) remained unchanged. By contrast, beyond the age of 9 years, blood pressure and aortic stiffness trends basically moved together. CONCLUSION: Our study provides the largest database to date concerning arterial stiffness in healthy children and adolescents between the ages of 3 and 18 years, and the technology adopted proved easy to use in large paediatric populations, even at a very young age.

Comparison of aortic and carotid arterial stiffness parameters in patients with verified coronary artery disease.

BACKGROUND: Arterial stiffness parameters are commonly used to determine the development of atherosclerotic disease. The independent predictive value of aortic stiffness has been demonstrated for coronary events. HYPOTHESIS: The aim of our study was to compare regional and local arterial functional parameters measured by 2 different noninvasive methods in patients with verified coronary artery disease (CAD). We also compared and contrasted these stiffness parameters to the coronary SYNTAX score in patients who had undergone coronary angiography. METHODS: In this study, 125 CAD patients were involved, and similar noninvasive measurements were performed on 125 healthy subjects. The regional velocity of the aortic pulse wave (PWVao) was measured by a novel oscillometric device, and the common carotid artery was studied by a Doppler echo-tracking system to determine the local carotid pulse wave velocity (PWVcar). The augmentation index (AIx), which varies proportionately with the resistance of the small arteries, was recorded simultaneously. RESULTS: In the CAD group, the PWVao and aortic augmentation index (Alxao) values increased significantly (10.1 ± 2.3 m/sec and 34.2% ± 14.6%) compared to the control group (9.6 ± 1.5 m/sec and 30.9% ± 12%; P < 0.05). We observed similar significant increases in the local stiffness parameters (PWVcar and carotid augmentation index [Alxcar]) in patients with verified CAD. Further, we found a strong correlation for PWV and AIx values that were measured with the Arteriograph and those obtained using the echo-tracking method (r = 0.57, P < 0.001 for PWV; and r = 0.65, P < 0.001 for AIx values). CONCLUSIONS: Our results indicate that local and regional arterial stiffness parameters provide similar information on impaired arterial stiffening in patients with verified CAD.

Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study.

BACKGROUND: Self blood pressure monitoring at home may improve blood pressure control and patients' compliance with treatment, but its implementation in daily practice faces difficulties. Teletransmission facilities may offer a more efficient approach to long-term home blood pressure monitoring. METHODS: Twelve general practitioners screened 391 consecutive uncontrolled mild-moderate hypertensive patients (80% treated), 329 of whom (58 +/- 11 years, 54% men) were randomized to either usual care on the basis of office blood pressure (group A, n = 113) or to integrated care on the basis of teletransmitted home blood pressure (group B, n = 216). Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline and after 6 months, during which treatment was optimized according to either office (group A) or home (group B) blood pressure values. We compared differences between groups in the rate of daytime ambulatory blood pressure normalization (<130/80 mmHg), need of treatment changes during follow-up, quality of life scores, and healthcare costs. RESULTS: Baseline office blood pressures were 149 +/- 12/89 +/- 9 and 148 +/- 13/89 +/- 7 mmHg in groups A (n = 111) and B (n = 187) respectively, the corresponding daytime values being 140 +/- 11/84 +/- 8 and 139 +/- 11/84 +/- 8 mmHg. The percentage of daytime blood pressure normalization was higher in group B (62%) than in group A (50%) (P < 0.05). There were less frequent treatment changes in group B than in group A (9 vs. 14%, P < 0.05). Quality of life tended to be higher and costs lower in group B. CONCLUSION: Patients' management based on home blood pressure teletransmission led to a better control of ambulatory blood pressure than with usual care, with a more regular treatment regimen.

A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods.

INTRODUCTION: Pulse wave velocity (PWV) and augmentation index (AIx) are parameters of arterial stiffness and wave reflection. PWV and AIx are strong indicators for cardiovascular risk and are used increasingly in clinical practice. Previous systems for assessment of PWV and AIx are investigator dependent and time consuming. The aim of this study was to validate the new oscillometric method (Arteriograph) for determining PWV and AIx by comparing it to two clinically validated, broadly accepted tonometric and piezo-electronic systems (SphygmoCor and Complior). DESIGN AND METHOD: PWV and AIx were measured up to five times in 51 patients with the SphygmoCor, Complior and Arteriograph. In 35 patients, the measurements were repeated after 1 week in a second session using the same protocol. RESULTS: The correlations of the PWV as assessed with the Arteriograph with the values obtained using the SphygmoCor (r = 0.67, P < 0.001) and the Complior (r = 0.69, P < 0.001) were highly significant. Variability and reproducibility for PWV were best for the Arteriograph, followed by Complior and SphygmoCor. AIx (SphygmoCor versus Arteriograph) were very closely correlated (r = 0.92, P < 0.001). PERSPECTIVES: The Arteriograph is a new, easy-to-use and time-effective method for assessing arterial stiffness and wave reflection.

The virtual hypertension clinic.

Despite increasing financial and human resources invested, the disappointing rate of hypertension (HT) control continues to pose a challenge to health care providers in the civilized world. Low HT control is associated with the poor patient compliance. Nowadays, SBPM is an accepted method to improve the patient compliance as well as HT control. However SBPM has several limitations such as:By using telemedicine in the SBPM, a virtual HT clinic can be built up. In our developed system (TensioPhone/TensionCare) we remind the patient the BP measurement and pill intake, and SBP data are automatically transferred to the center for analysis. The analysed and structured data are then sent to the physician and the patient as a printed report. Regular communication between the health care team and the patient can contribute to make the virtual hypertension clinic become a reality and to substantially improve HT control rates.

Blood pressure measurement in research.

OBJECTIVE: The aim of this paper is to summarize the issues raised during a consensus conference on the role of different blood pressure (BP) monitoring techniques in research, including pathophysiological studies, clinical outcome trials and clinical pharmacology trials. METHODS: This review includes the contribution of the participants in a task force at the Eighth Consensus Conference on Ambulatory BP Monitoring (October 28-31, 2001, Sendai, Japan) and the results of a discussion open to all conference participants. Individual contributions have been summarized together with the points raised during the subsequent discussion, and the main statements are also presented in a table format. POINTS OF CONSENSUS: (1) BP monitoring in pathophysiological studies. The essential role played by continuous BP monitoring in this field had been acknowledged, and further development of non-invasive beat-by-beat monitoring techniques has been advocated. (2) BP monitoring in clinical trials. In clinical trials automated ambulatory BP monitoring (ABPM) and self BP measurements (SBPM) at home share similar advantages, with specific features that make these approaches not alternative solutions but rather approaches able to complement each other. A few examples of application of ABPM and SBPM in clinical trials include the Treatment of Hypertension according to Home or Office Blood Pressure (THOP) trial and the Trial of Preventing Hypertension (TROPHY). (3) Use of ABPM in clinical pharmacology studies. Use of ABPM is now an established routine, aimed at describing the 24-h effect of new antihypertensive drugs. An example of these applications that was discussed in the conference is the use of ABPM in the evaluation of a new long-acting calcium channel blocker (Barnidipine) (J-MUBA study). (4) Specific models for the analysis of BP fluctuations. The features characterizing the chronobiological approach to description of 24-h BP profiles and its limitations (mainly consisting of the high risk of data over-modelling) are discussed. Also the possible occurrence of a circaseptan (approximately with a 7-day period) rhythm in BP has been addressed, although repeated performance of 24-h ABPM over a week obviously faces a number of practical problems. (5) Progress in technology: BP monitoring and telemedicine. The possibility to implement an interactive telemonitoring system of home SBPM values and the perspectives for a clinical application of this technology in the Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) trial is discussed.