BackgroundObstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea‐hypopnea index, <30).Methods and ResultsIn this 4‐month, double‐blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24‐hour blood pressure measurements were performed at baseline and at follow‐up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0–17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea‐hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7–10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.ConclusionsA mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

The prevalence of hypertension in young adulthood, as well as the clinical characteristics associated with different hypertension subtypes, have been inconsistently described. Our aim was to assess the prevalence, time-trends and characteristics associated with isolated systolic hypertension (ISH), isolated diastolic hypertension and combined systodiastolic hypertension.Methods: Serial cross-sectional analysis, using data from the Swedish conscription registry, including 1701 314 (99.2% male) individuals from 1969 to 2010. Risk factor associations were assessed through multivariable logistic regression. Results:The prevalence of hypertension increased progressively during the study period, from 20.4% in 1969 to 29.3% in 2010, with ISH being the most common subtype (94.3%). ISH was associated with elevated resting heart rate (odds ratio 1.85, 95% confidence interval 1.84-1.86, per SD), increased exercise capacity (1.37, 1.36-1.39) and increased BMI (1.30,. Isolated diastolic hypertension and combined hypertension were also associated with elevated resting heart rate (1.37, 1.32-1.41 and 2.05, 1.99-2.11, respectively) and more strongly associated with increased BMI (1.36,), but inversely associated with exercise capacity (0.79, 0.75-0.83 and 0.90, 0.86-0.95). Conclusion:The prevalence of hypertension in young adulthood has increased substantially over time, predominantly due to an increase in ISH. Risk factor patterns differed between ISH and other forms of hypertension, suggesting potentially different underlying mechanisms.

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Japan) were recruited. Each participant's BP was measured using the novel cuff-less BP monitoring device as well as a standard cuff-based sphygmomanometer under four different conditions: static, BP rising and falling, and reproducible after the one-month interval. The results of measurements under the four conditions were integrated and analyzed. The BP measurements were determined to be comparable between the standard cuff-based sphygmomanometer and the novel cuff-less earphone-type device, if the mean absolute difference (MAD) of the measurements was within 7 mmHg. We also performed Bland-Altman agreement analyses. Results:The participants' characteristics were as follows. Male to female ratio was approximately 50 % in both groups. Age was 27.5 [interquartile (IQR) 24.5-33.0] years old for the healthy subjects and 65.0 [IQR 49.5-74.0] years old for the patients with hypertension (HTN). BMI was 21.2 ] kg/m 2 and 23.8 .9] kg/ m 2 , respectively. MAD between the novel cuffless device and the reference using the standard cuff-based sphygmomanometer among the healthy subjects was 5.8 mmHg for systolic BP (SBP) and 5.3 mmHg for diastolic BP (DBP). MAD in the patients with HTN was 7.8 mmHg for SBP and 4.4 mmHg for DBP. In Bland-Altman agreement analyses, mean difference in the healthy subjects was 2.7 (95% confidence interval [CI] -13.4, 16.8) mmHg for SBP and 2.4 (95% CI -10.7, 15.5) mmHg for DBP. Mean difference in the patients with HTN was 0.9 (95% CI -20.0, 21.9) mmHg for SBP and 0.7 (95% CI -10.9, 12.3) mmHg for DBP. Conclusions:Our newly developed cuff-less earphone-type device based on green reflected photoplethysmography able to predict BP in healthy subjects, but it was difficult to predict SBP in the patients with HTN. Conclusions:Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.