Showing papers in "Blood Pressure Monitoring in 2006"
TL;DR: The Omron 705 IT appears to be an accurate device for blood pressure measurement in normotensive children and adolescents.
Abstract: BackgroundLimited evidence exists on the accuracy of oscillometric devices for blood pressure measurement in children. This study validated the Omron 705 IT monitor (Omron Healthcare Europe BV, Hoofddorp, The Netherlands) in normotensive children and adolescents.MethodsSimultaneous blood pressure me
170 citations
TL;DR: Overall Datascope Accutorr Plus passed, whereas Welch-Allyn Vital Sign Monitor and Dinamap Procare-120 failed an adapted IP-ESH.
Abstract: AimTo validate Welch-Allyn Vital Sign Monitor, Dinamap Procare-120 and Datascope Accutorr Plus against auscultatory mercury sphygmomanometer in children aged 5–15 years old according to the International Protocol of European Society of Hypertension adapted for validation in children.MethodOne hundre
161 citations
TL;DR: For both tested devices, readings differing by less than 5, 10 and 15 mmHg for systolic and diastolic blood pressure values fulfill the recommendation criteria of the International Protocol as well as the individual analysis.
Abstract: BackgroundTwo electronic devices for self-measurement of blood pressure – a brachial monitor, the Omron M6, and a wrist monitor, the Omron R7 – were evaluated in two separate studies according to the International Protocol of the European Society of Hypertension.DesignThe International Validation Pr
153 citations
TL;DR: There was a positive correlation between blood pressure measured in the C session and blood pressure reduction observed in the E session, showing that blood pressure decrease was greater when blood pressure level was higher.
Abstract: ObjectiveThe present study investigated the effect of a single bout of low-intensity resistance exercise on recovery blood pressure in hypertensive women receiving captopril.MethodsTwelve essential hypertensive women, who were receiving captopril, underwent two experimental sessions: control (C – 40
151 citations
TL;DR: Use of an automated blood pressure recorder can eliminate some of the white-coat effect associated with readings taken by a mercury sphygmomanometer.
Abstract: ObjectiveTo compare blood pressure measurements taken in routine clinical practice using an automated recorder, the BpTRU (VSM MedTech Ltd, Coquitlam, Canada), with readings taken by a conventional mercury sphygmomanometer.MethodsFifty consecutive patients [28 women, 22 men; mean (±SD) age 62±16 yea
86 citations
TL;DR: Another surrogate measure of arterial stiffness derived from ambulatory blood pressure monitoring that may predict cardiovascular mortality over and above pulse pressure is proposed, namely, the dynamic relationship between diastolic and systolic blood pressure over 24 h – the ambulatory arterials stiffness index.
Abstract: ObjectivesIncreased arterial stiffness is associated with the development of cardiovascular disease and may even predict its development at an early stage. Increased pulse pressure is seen as a marker of increased arterial stiffness and can be readily measured by ambulatory blood pressure monitoring
71 citations
TL;DR: The DINAMAP ProCare Monitor can be recommended for clinical use in an adult population and falls within the passing criteria for the Association for the Advancement of Medical Instrumentation Standard (ANSI/AAMI SP-10).
Abstract: Objective Inaccurate blood pressure measurement has serious implications for both the patient and the health service. It results in inappropriate treatment and underestimation of clinical risk. Few automated devices have been shown to be accurate when compared with mercury sphygmomanometery. The DINAMAP ProCare has been developed to be accurate compared with an auscultatory standard. We used the International Protocol of the European Society of Hypertension to assess the accuracy of this device in an adult population. Methods Thirty-eight participants were recruited from outpatient clinics and staff at Groote Schuur Hospital, Cape Town, RSA. Of these, 33 participants who fulfilled the requirements of the International Protocol were selected for final analysis. Demographic data were obtained from each participant, followed by nine sequential same-arm measurements, alternating between two trained observers and the device. The last seven readings were analysed according to the guidelines of the International Protocol. Results The ProCare Monitor achieved all the required criteria of the International Protocol by successfully passing phase 1, phase 2.1 and phase 2.2 of the study protocol. The mean difference (standard deviation) for systolic and diastolic pressures, respectively, were –2.5 (5.4) and 0.5 (4.5) mmHg, which also falls within the passing criteria for the Association for the Advancement of Medical Instrumentation Standard (ANSI/AAMI SP-10). Conclusion The DINAMAP ProCare Monitor can be recommended for clinical use in an adult population.
67 citations
TL;DR: Although BpTRU reduces white-coat effect andwhite-coat hypertension, blood pressure is underestimated by the device, leading to misclassification of hypertension.
Abstract: ObjectivesBpTRU (VSM MedTech Ltd, Vancouver, Canada) is an automated oscillometric device that provides serial blood pressure measurements in an office setting in the absence of a healthcare professional. We sought to determine whether the white-coat effect is reduced by a blood pressure measurement
58 citations
TL;DR: The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs and adequate blood pressure control mediated by the change in the diagnostic method from clinic to homeBlood pressure measurement would improve the prognosis for hypertension.
Abstract: Objectives To investigate the economic consequences resulting from introduction of home blood pressure measurement in diagnosis of hypertension instead of casual clinic blood pressure measurement. Methods We constructed a decision tree model using data from the Ohasama study and a Japanese national database. The Ohasama study provided the prognostic value of home blood pressure as compared with clinic blood pressure measurement. Results It is predicted that the use of home blood pressure for hypertension diagnosis results in a saving of 9.30 billion US dollars (1013.6 billion yen) in hypertension-related medical costs in Japan. Most of this was attributable to medical costs saved by avoiding the start of treatment for untreated individuals who were diagnosed as hypertensive by clinic blood pressure but whose blood pressures were in the normal range when based on home blood pressure; that is, the so called white-coat hypertension. Furthermore, it could be expected that adequate blood pressure control mediated by the change in the diagnostic method from clinic to home blood pressure measurement would improve the prognosis for hypertension. We estimated that the prevention of hypertensive complications resulted in a reduction of annual medical costs by 28 million US dollars (3.0 billion yen). In addition, stroke prevention due to adequate blood pressure control based on home blood pressure measurement reduced annual long-term care costs by 39 million US dollars (4.2 billion yen). A per-person break-even cost for introducing home blood pressure monitoring was calculated as 409 US dollars (44,580 yen). Conclusions The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs.
52 citations
TL;DR: The present study conforms with most published results, and indicates superiority of radial to carotid tonometry in clinical practice.
Abstract: ObjectiveTo evaluate the clinical use of radial and carotid artery applanation tonometry as an independent supplement to cuff sphygmomanometry.MethodsIn 44 patients, radial and carotid tonometric pressure recordings were taken at short intervals apart by two persons who had prolonged experience with
44 citations
TL;DR: The results suggest that, in patients with poorly controlled hypertension at the clinic, home blood pressure represents a complementary test rather than an alternative to ambulatory blood pressure, and correlates with several target-organ damage markers.
Abstract: Objectives(1) To assess whether home blood pressure measurement is a reliable alternative to ambulatory blood pressure monitoring for the evaluation of treated patients with inadequate blood pressure control at the clinic; and (2) to evaluate the relationship between home blood pressure and several
TL;DR: The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor and ambulatory blood pressure monitoring continues to be the test of choice for this indication.
Abstract: ObjectiveTo determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program.Material and methodsOne hundred and ninety nontreated patients recently diagnosed with mild–moderate hypertension, selected consecutively at four primary h
TL;DR: The Omron 637IT wrist blood pressure device passed according to the International Protocol criteria and can be recommended for use in adults and obese adults.
Abstract: ObjectiveWrist blood pressure devices are becoming popular for the self-measurement of blood pressure. Despite widespread use of these devices, there is limited published evidence for their accuracy and reliability. In this study, we assessed the accuracy of the Omron 637IT wrist blood pressure devi
TL;DR: The filter alters the shape of oscillometric pulses causing a shift in the oscillometric pulse amplitude envelope Drawn from the filtered pulses compared with that drawn from the unfiltered pulses in human subjects, but not the test simulator.
Abstract: Objective Oscillometric noninvasive blood pressure measurement devices determine the pressures by analysing the relationship between the pressure in an occluding cuff and low-amplitude pressure pulses (oscillometric pulses) induced in the cuff by the arterial pressure wave. This paper examines the effects on the pulses and oscillometric pulse amplitude envelope of the filters that extract the pulses from the cuff pressure. Methods The cuff pressure and oscillometric pulses extracted by the filter were recorded from a Critikon DINAMAP and a Datex Cardiocap, chosen because of accessibility of the filtered and unfiltered signals. The unfiltered oscillometric pulses were determined by subtracting the cuff pressure from a baseline constructed to represent either the Critikon's step deflation cuff pressure or the Datex's gradual pressure decrease. Waveforms were recorded from a noninvasive blood pressure test simulator and three volunteers. Conclusions The filter alters the shape of oscillometric pulses causing a shift in the oscillometric pulse amplitude envelope drawn from the filtered pulses compared with that drawn from the unfiltered pulses in human subjects, but not the test simulator. The pulse shape distortion is dependent on the filter characteristics and the oscillometric pulse shape. Further work is required to explore whether this may help explain why simulators with artificial waveforms cannot validate noninvasive blood pressure monitors and why noninvasive blood pressure monitors may not be accurate in all patient groups.
TL;DR: Daytime ambulatory blood pressure monitoring is a much better prognostic indicator of all-cause mortality than clinic blood pressure, both in patients taking medication and those not taking medication at the time of monitoring.
Abstract: ObjectivesTo assess the prognostic value of daytime ambulatory blood pressure compared with routine clinic blood pressure in determining mortality.MethodsProspective multicentre study in 48 general practices in Oxfordshire, a hypertension clinic in Oxford and a hypertension clinic in London.ResultsA
TL;DR: Ambulatory arterial stiffness index is a novel measure of arterIAL stiffness, which can be readily determined from ambulatory blood pressure recordings and which independently predicts cardiovascular mortality.
Abstract: Objectives We hypothesized that one minus the slope of diastolic on systolic blood pressure in individual 24-h ambulatory blood pressure recordings (ambulatory arterial stiffness index) might reflect arterial stiffness and predict cardiovascular mortality. Methods In volunteers and a population recruited in China, we studied concordance between ambulatory arterial stiffness index and established indexes of arterial stiffness. We assessed the predictive value of ambulatory arterial stiffness index in relation to cardiovascular outcome in Irish hypertensive patients. Results In 166 healthy volunteers, aged 22-83 years, the correlation coefficient between ambulatory arterial stiffness index and pulse wave velocity was 0.51 (P<0.001). In 348 randomly recruited Chinese, the correlations between ambulatory arterial stiffness index and both the central and peripheral systolic augmentation indexes were significantly stronger than those for 24-h ambulatory pulse pressure, particularly in study participants younger than 40 years. Among normotensive participants, the 95th percentile of the ambulatory arterial stiffness index was 0.55 in 234 Chinese and 0.57 in 1617 Europeans enrolled in the International Database on Ambulatory Blood Pressure Monitoring. The upper boundary of the 95% prediction interval of the ambulatory arterial stiffness index in relation to age ranged from 0.53 at 20 years to 0.72 at 80 years. In 11 291 patients enrolled in the Dublin Outcome Study, both ambulatory arterial stiffness index and 24-h ambulatory pulse pressure significantly predicted cardiovascular mortality. Ambulatory arterial stiffness index was a strong predictor of fatal stroke in normotensive participants, whereas pulse pressure better predicted heart attack in hypertensive patients. Conclusion Ambulatory arterial stiffness index is a novel measure of arterial stiffness, which can be readily determined from ambulatory blood pressure recordings and which independently predicts cardiovascular mortality.
TL;DR: Using the 24-h blood pressure as a standard, home blood pressure was superior to office blood pressure in estimating blood pressure control in renal transplant patients with deteriorating graft function, substantiated by the use of receiver-operating characteristic curve analysis.
Abstract: ObjectiveAs hypertension is an important risk factor for renal allograft failure, we aimed to assess blood pressure control in renal transplant patients with deteriorating graft function using different methods of blood pressure measurements.MethodsForty-nine patients with a graft survival of >1 yea
TL;DR: Whatever the mechanism, young patients with prehypertension have impaired aortic elasticity compared with healthy controls, which has suggested that the development of overt hypertension may be prevented or delayed by using the agents that have the ability to reduce arterial stiffness by regressing and/or preventing functional and structural changes on the arterial wall.
Abstract: Objectives Although hypertension has been shown to be one of the most important predictors of reduced arterial elasticity, there is not enough data about aortic elastic properties in patients with prehypertension. Accordingly, the current study was designated to evaluate aortic elastic features in young patients with prehypertension. Material and methods The study population consisted of 25 newly diagnosed prehypertensive individuals (18 men, mean age =34±6 years) and 25 healthy controls (16 men, mean age =33±6 years) eligible for the current study. Aortic strain, distensibility index and stiffness index β were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. Results Prehypertensive patients were detected to have significantly lower aortic distensibility and strain indexes than the controls: (5.77 ± 1.91 vs. 8.63 ± 2.67 cm -2 dyn -1 x 10 -6 , respectively, P<0.001; strain index: 13.81 ±4.50 vs. 17.47 ±4.25%, respectively, P= 0.005). Aortic stiffness index β of the prehypertensive group, however, was significantly higher than that of the control group (3.73 ± 1.41 vs. 2.97 ± 0.82, P= 0.02). Conclusion Whatever the mechanism, young patients with prehypertension have impaired aortic elasticity compared with healthy controls. This finding has suggested that the development of overt hypertension may be prevented or delayed by using the agents that have the ability to reduce arterial stiffness by regressing and/or preventing functional and structural changes on the arterial wall.
TL;DR: Men have greater ambulatory blood pressure values and target organ damage than women of the same age and men had greater carotid intima–media thickness than women in all ages and significantly higher differences in ages between 30 and 80 years.
Abstract: Objective The objective of the present study was to investigate the effect of age and sex in the ambulatory blood pressure measurements, and target organ damage. Methods A total of 1596 patients (50.6% male and 49.4% female), aged 10–87 years, referred to our Hypertension Center for borderline hypertension, underwent 24-h ambulatory blood pressure monitoring, left ventricular echocardiography and measurement of intima–media thickness of carotid arteries. Results Adolescent girls had higher mean 24-h and clinic systolic and diastolic blood pressure values than adolescent boys. Men aged 20–60 years had higher mean 24-h and clinic systolic and diastolic blood pressure values than women of the same age. Men older than 60 years had higher mean 24-h systolic and diastolic blood pressure values than women of the same age, but women older than 60 years had higher clinic systolic and diastolic blood pressure values. White-coat effect increased with age in both sexes, but the magnitude of the white-coat effect was higher in women than in men at older ages. Men had higher left ventricular mass corrected for body surface area or height than women in all ages and significantly higher differences in ages between 30 and 80 years. In addition, men had greater carotid intima–media thickness than women in all ages and significantly higher differences in ages between 30 and 80 years. Conclusions Men have greater ambulatory blood pressure values and target organ damage than women of the same age.
TL;DR: Different arm positions below heart level have significant effects on blood pressure readings, and leading guidelines about arm position during blood pressure measurement are not in accordance with the arm position used in the Framingham study.
Abstract: OBJECTIVE: Determining the influence of the position of the arm on blood pressure measurement in the sitting position. METHODS: Blood pressure of 128 individuals (the majority being treated hypertensive patients) visiting the outpatient clinic was measured simultaneously on both arms with arms in two different positions. First, both arms were placed at the chair support level and blood pressure was measured three times on both arms after 10 min of rest. Subsequently, while still remaining in the same sitting position, five blood pressure measurements were made simultaneously at both arms with one arm placed on the desk and one arm placed and supported at heart level (mid-sternal). The arm placed at heart level served as the reference arm. The choice of which arm was placed at desk level and which arm was placed at heart level was randomized. RESULTS: Both at desk level and at chair support level, mean (+/-SD) systolic and diastolic blood pressures were higher than blood pressure at heart level by 6.1/5.7+/-4.6/3.1 and 9.3/9.4+/-5.4/3.4 mmHg, respectively. The effect of the height differences between the arm positions on the blood pressure readings was smaller than predicted (0.49 mmHg/cm systolic and 0.47 mmHg/cm diastolic). No significant correlation was found between blood pressure difference in the different arm positions (desk and heart level) and age, sex, weight or baseline blood pressure. CONCLUSIONS: Different arm positions below heart level have significant effects on blood pressure readings. The leading guidelines about arm position during blood pressure measurement are not in accordance with the arm position used in the Framingham study, the most frequently used study for risk estimations.
TL;DR: Although the results did not fully match previous clinical validations, these initial results give encouragement that a simulator with sufficient stored waveforms might be able to replace the difficult and expensive clinical evaluation of non-invasive blood pressure devices that has prevented many devices from being fully evaluated.
Abstract: Introduction A simulator has been developed that enables previously recorded clinical oscillometric waveforms to be regenerated for testing oscillometric non-invasive blood pressure measurement devices. Two non-invasive blood pressure devices were evaluated using the simulator with its database of 243 waveforms, to assess the value of a simulator for such evaluations. Methods Two oscillometric non-invasive blood pressure devices, both of which had previously been validated against auscultatory references, were selected. The Omron HEM-907 (Omron, Hoofddorp, The Netherlands) measures the pressure during linear cuff deflation and the GE ProCare 400 (GE Healthcare, Tampa, Florida, USA) measures during step deflation. Each non-invasive blood pressure device was attached to the simulator and pressures were recorded from all 243 waveforms. The differences between the systolic and diastolic pressures measured by each non-invasive blood pressure device and the auscultatory references for each waveform were calculated. These were assessed with the European and American validation standards and with the British Hypertension Society protocol. Results The paired pressure differences (non-invasive blood pressure device minus auscultatory reference) for each device complied partly, but not fully, with the standards or protocol. The means (+/-standard deviation) of the paired systolic and diastolic pressures differences for the Omron were -2.4 mmHg (+/-5.9 mmHg) and -8.9 mmHg (+/-6.5 mmHg), and for the ProCare were -6.5 mmHg (+/-10.4 mmHg) and -2.9 mmHg (+/-7.0 mmHg), respectively. The pressures recorded by the Omron device met the standards for systolic pressures but failed for diastolic pressures and conversely for the ProCare. Conclusion This represents the first evaluation of non-invasive blood pressure devices with a simulator that generates previously recorded clinical oscillometric waveforms. It allowed data from over 100 study participants to be used. Both devices had been previously clinically validated, but their evaluation using the simulator with its regenerated waveforms only partly met the required criteria. Although the results did not fully match previous clinical validations, these initial results give encouragement that a simulator with sufficient stored waveforms might be able to replace the difficult and expensive clinical evaluation of non-invasive blood pressure devices that has prevented many devices from being fully evaluated.
TL;DR: Olmesartan medoxomil therapy was shown to result in a greater proportion of patients achieving specific ambulatory blood pressure goals than therapy with amlodipine besylate, and should be a key efficacy parameter assessed in clinical trials of antihypertensive medications.
Abstract: OBJECTIVE Olmesartan medoxomil is an angiotensin II receptor blocker with similar antihypertensive efficacy as the calcium channel blocker amlodipine besylate in patients with mild-to-moderate hypertension In addition to a drug's ability to lower blood pressure, the effectiveness of the agent in enabling patients to achieve specific blood pressure targets is an important clinical consideration This secondary analysis of a randomized, double-blind study compared the efficacy of olmesartan medoxomil with that of amlodipine besylate in achieving ambulatory blood pressure goals among patients with mild-to-moderate hypertension METHODS Following a 4-week placebo run-in, 440 study participants aged >or=18 years were randomized to olmesartan medoxomil (20 mg/day), amlodipine besylate (5 mg/day), or placebo for 8 weeks The proportion of participants achieving specific systolic and diastolic ambulatory blood pressure goal levels was calculated by dividing the number of participants who had achieved a particular blood pressure goal by the total number of patients in the intent-to-treat population RESULTS After 8 weeks of treatment, a mean 24-h ambulatory blood pressure of <130/80 or <130/85 mmHg was achieved by significantly more participants in the olmesartan medoxomil group (181 and 304%, respectively) than in the amlodipine besylate (70 and 140%, respectively) or placebo (19% for both) groups The target daytime ambulatory blood pressure of <135/85 mmHg was achieved by more participants in the olmesartan medoxomil group than in the amlodipine besylate group (158 vs 58%, respectively; P<001) CONCLUSION In a previous publication of the same study, we demonstrated that starting doses of olmesartan medoxomil and amlodipine besylate produced similar mean reductions in blood pressure In this subanalysis of the blood pressure data from that primary publication, however, olmesartan medoxomil therapy was shown to result in a greater proportion of patients achieving specific ambulatory blood pressure goals than therapy with amlodipine besylate As blood pressure goal attainment may be of more direct clinical relevance than numerical blood pressure lowering, the achievement of blood pressure goals should be a key efficacy parameter assessed in clinical trials of antihypertensive medications
TL;DR: Investigating the prevalence, the risk factors, the hemodynamic triggering mechanisms, the circadian variability of ST segment depression (ST depression) and the effect of day and night fall in blood pressure on the prevalence of ST depression in hypertensive patients concluded that office-based blood pressure measurement was not a useful measuring tool for forecasting the likelihood of ST-segment depression.
Abstract: IntroductionThe objective of the present study was to investigate the prevalence, the risk factors, the hemodynamic triggering mechanisms, the circadian variability of ST segment depression (ST depression) and the effect of day and night fall in blood pressure on the prevalence of ST depression in h
TL;DR: The Omron 637IT wrist blood pressure device passed according to the International Protocol criteria and can be recommended for use in the elderly and is evaluated for accuracy and reliability in the different patient groups.
Abstract: Objective The market for wrist devices for self-measurement is growing and these devices are becoming popular among the patients. Despite widespread use of these devices, there is limited published evidence for their accuracy and reliability in the different patient groups. The objective of this study was to evaluate the accuracy of the Omron 6371T (Omron Healthcare Europe B.V, Hoofddorp, Netherlands) wrist blood pressure device against the mercury sphygmomanometer in the elderly according to the International Protocol criteria. Methods Seventy-six patients older than 65 years of age were studied and classified on the basis of the range of the International Protocol. Blood pressure measurements at the wrist with the Omron 6371T were compared with the results obtained by two trained observers using a mercury sphygmomanometer. Nine sequential blood pressure measurements were taken. A total of 33 participants with arm circumference distributed randomly were selected for the validation study. During the validation study, 99 measurements were obtained for comparison in the 33 participants. The first phase was performed on 15 participants, and if the device passed this phase, 18 more participants were selected. Results Mean discrepancies and standard deviations of the sphygmomanometer device were - 0.3 ± 6.5 mmHg for systolic blood pressure and 2.8 ± 4.8 mmHg for diastolic blood pressure in the study group. The device passed phase 1 in 15 participants. In phase 2.1, from the total 99 comparisons, 66,87, and 95 for systolic blood pressure and 69, 92, and 97 for diastolic blood pressure were <5, <10, and < 15 mmHg, respectively. In phase 2.2, 24 participants had at least two of the differences within 5 mmHg and three participants had no differences within 5 mmHg for systolic blood pressure. For diastolic blood pressure, 24 participants had at least two of the differences within 5 mmHg and three participants had no differences within 5 mmHg. The Omron 637 IT passed the phase 2.1 and 2.2 in the elderly group. Conclusion The Omron 637IT wrist blood pressure device passed according to the International Protocol criteria and can be recommended for use in the elderly.
TL;DR: Objective sleep quality as assessed by wrist actigraphy is not significantly altered by ambulatory blood pressure monitoring, whereas subjective sleep quality is adversely affected in good sleepers.
Abstract: Objective To determine whether ambulatory blood pressure monitoring affects objective and subjective sleep quality in patients tested at home. Methods Seventy consecutive patients (40 women and 30 men, aged 53 ± 15 years), having ambulatory blood pressure monitoring to monitor the efficacy of antihypertensive treatment or to distinguish between hypertension or white-coat hypertension had an evaluation of their sleep quality on a first night with ambulatory blood pressure monitoring and the three following nights without ambulatory blood pressure monitoring. Ambulatory blood pressure monitoring was performed with an auscultatory device with a measure every 15 min during 24 h. Sleep evaluation criteria were both subjective (sleep quality score and sleep questionnaire) and objective (wrist actigraphy monitoring). Sleep parameters during night 1 with ambulatory blood pressure monitoring were compared with those during night 4 without ambulatory blood pressure monitoring. Usual quality of sleep of the patients was assessed by the mean sleep quality score over 7 consecutive days. Results The sleep quality score was significantly higher for night 4 than for night 1 (7.3 ± 2.1 vs. 5.3 ± 2.3; P<0.0001). In contrast, actigraphy parameters (actual sleep time, mean activity score, and fragmentation index) were similar on night 1 and night 4 (6.7 ± 1.2 vs. 6.9 ± 1.2, 13.2 ± 9.8 vs. 12.1 ± 8.4, and 31.0 ± 14.5 vs. 29.9 ± 14.3, respectively). Subjective sleep quality was significantly altered by ambulatory blood pressure monitoring in good sleepers (mean sleep quality score ≥ 7, 73% of patients) but not in poor sleepers. The effect of ambulatory blood pressure monitoring on subjective sleep quality did not differ between dippers and nondippers. Conclusions Objective sleep quality as assessed by wrist actigraphy is not significantly altered by ambulatory blood pressure monitoring, whereas subjective sleep quality is adversely affected in good sleepers.
TL;DR: White-coat hypertension may alter left ventricular diastolic function and aortic elastic properties, however, these alterations might not be as remarkable as those caused by sustained hypertension.
Abstract: Objectives Although white-coat hypertension may be present in 25% or more of hypertensive individuals, its prognostic significance and predisposition to end organ damage is unknown. To evaluate whether white-coat hypertension is associated with end organ damage, we compared prognostically relevant measures of target-organ damage among 35 individuals with white-coat hypertension and age and sex-matched groups of sustained hypertension and normotensive individuals classified by clinical and 24-h ambulatory blood pressures. Methods We evaluated left ventricular diastolic function and aortic elastic properties of 35 individuals with white-coat hypertension, 50 patients with sustained hypertension, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. None of the study participants with sustained hypertension and white-coat hypertension, who were newly diagnosed and never treated, had any systemic disease or coronary risk factor except hypertension. Results Age, sex, and body mass indexes were similar among the three groups. Left ventricular diastolic function was more significantly impaired in the sustained hypertension and white-coat hypertension groups than in the control group, but it was not significantly different between the white-coat hypertension and sustained hypertension groups. Aortic distensibility was significantly lower, and aortic stiffness index was significantly higher in the sustained hypertension group than in the white-coat hypertension and control groups. Furthermore, aortic elastic properties were slightly impaired in the white-coat hypertension group compared with those in the control group. We also found a significant correlation between aortic elastic properties and left ventricular diastolic function. Conclusions White-coat hypertension may alter left ventricular diastolic function and aortic elastic properties. These alterations, however, might not be as remarkable as those caused by sustained hypertension. In this respect, individuals with white-coat hypertension are not at such a risk for end organ damage as patients with sustained hypertension.
TL;DR: It is suggested that the superiority of ambulatory blood pressure as a predictor of target organ damage, compared with physician measurements, cannot be adequately/fully explained by the impact of the larger number of measurements obtained with ambulatory monitoring.
Abstract: BackgroundAmbulatory blood pressure is a better predictor of target organ damage and the risk of adverse cardiovascular events than office measurements. Whether this is due to the greater reliability owing to the larger number of measurements that are usually taken using ambulatory monitoring, or th
TL;DR: The reproducibility of the postural changes of blood pressure found in hypertensive elderly patients in primary care is poor and should be taken into account when making diagnoses of orthostatic hypotension in this type of patient.
Abstract: Objective To determine the reproducibility of postural changes of blood pressure among hypertensive elderly patients in a primary care setting. Methods Measurements of blood pressure were carried out in 60 community-dwelling hypertensive patients aged 65 years or more, in a sitting position and after 1 -min and 3-min standing, and were repeated not more than 10 days later. Results A significant (P<0.05) fall in systolic and diastolic sitting blood pressure was observed between the first visit (151.1 ± 20.8/79.7 ± 10.1 mmHg) and the second visit (143.5 ± 20.6/76.8 ± 10.9 mmHg). The intraclass correlation coefficients of the repeated measurements were 0.46 (Cl: 0.23-0.65) and 0.42 (Cl: 0.17-0.61) for the changes in systolic blood pressure after 1- and 3-min standing, and 0.55 (Cl: 0.34-0.71) and 0.40 (Cl: 0.16-0.60) for diastolic blood pressure after 1- and 3-min standing, respectively. The repeatability coefficients were greater for the orthostatic changes of blood pressure (54-65%), which indicates lower reproducibility, than for the blood pressure levels on both visits (31-44%). Conclusions The reproducibility of the postural changes of blood pressure found in hypertensive elderly patients in primary care is poor. This should be taken into account when making diagnoses of orthostatic hypotension in this type of patient.
TL;DR: Diabetes mellitus and poststroke functional independency are the main factors contributing to inadequate blood pressure control among hypertensive stroke survivors.
Abstract: Background We compared the sensitivity of office blood pressure and ambulatory blood pressure monitoring recordings in evaluating the effectiveness of antihypertensive treatment and identified factors related to inadequate blood pressure control among hypertensive stroke survivors. Methods Office blood pressure and ambulatory blood pressure monitoring measurements were performed at 120±30 days after ictus in 187 first-ever consecutive hypertensive stroke survivors who were receiving blood pressure-lowering medications according to international guidelines. Handicap was assessed by the modified Rankin Scale. Blood pressure was regarded as controlled if office and daytime ambulatory systolic and diastolic blood pressure values were <140/90 and <135/85 mmHg, respectively. Patients were subclassified according to the degree of their nocturnal systolic blood pressure fall [(mean daytime values - mean night-time values) 100/mean daytime values] as dippers (≥ 10%), nondippers (≥ 0% and< 10%) and reverse dippers (<0%). Results Effective blood pressure control was documented in significantly (P<0.001) fewer patients using ambulatory blood pressure monitoring (32.1%) than those using office recordings (43.3%), whereas in 16% of the study population a masked lack of per-treatment blood pressure control (elevated ambulatory blood pressure in the presence of normal office blood pressure levels) was identified. The distribution of dipping patterns differed significantly (P=0.01) between controlled hypertensive individuals (normal office and ambulatory measurements) and patients with isolated ambulatory hypertension (dippers: 31.3 vs. 10.0%; nondippers:56.9 vs. 53.3%; reverse dippers: 11.8 vs. 36.7%). Logistic regression analysis revealed diabetes mellitus and functional independency (modified Rankin Scale score <2) as independent predictors of inadequate blood pressure control. Conclusion Ambulatory blood pressure monitoring detects a substantial number of treated hypertensive stroke survivors with a masked lack of per-treatment blood pressure control, who present a higher prevalence of abnormal circadian blood pressure patterns (reverse dipping). Diabetes mellitus and poststroke functional independency are the main factors contributing to inadequate blood pressure control.
TL;DR: Indexes of arterial distensibility are impaired in the white-coat hypertensive group and similar to those in the sustained hypertension group, indicating that early changes in the arterial wall can occur inwhite-coat hypertension.
Abstract: Background Conflict still exists over whether patients with white-coat hypertension are at increased risk of developing target organ damage compared with normotensive individuals. Methods We studied vascular distensibility in 117 young-to-middle age patients with white-coat hypertension, 174 patients with sustained hypertension, and 51 normotensive controls. To obtain a measure of compliance, a model was used that divides the total systemic compliance into large artery (C 1 ) and small artery (C 2 ) compliance. With this aim, radial arterial pulse waves were recorded with a tonometer sensor array by means of an HDI CR2000 device (Eagan, Minnesota, USA). Moreover, pulse wave velocity and the augmentation index were measured using the Specaway DAT system (St Pauls, Sydney, Australia). Results Patients with sustained hypertension had a greater body mass index than patients with white-coat hypertension (P=0.04) or the normotensive individuals (P=0.01). C 1 and C 2 were decreased in the two hypertensive groups as compared with those in the normotensive group (P=0.0002 and 0.03, respectively, versus sustained hypertension; P=0.00007 and 0.0004, respectively, versus white-coat hypertension). Pulse wave velocity and aortic augmentation index were increased in the white-coat hypertension patients compared with the normotensive individuals (P= 0.02 and 0.004, respectively). Aortic augmentation index (P= 0.008) but not pulse wave velocity was increased in the sustained hypertensive patients compared with that in the normotensive individuals. All indexes of arterial distensibility were similar in the two hypertensive groups. Conclusions Indexes of arterial distensibility are impaired in the white-coat hypertensive group and similar to those in the sustained hypertensive group, indicating that early changes in the arterial wall can occur in white-coat hypertension. This may account for the higher risk of stroke that has been described in this condition.