Clinic blood pressure measurements versus ambulatory blood pressure monitoring

To compare clinic [office] blood pressure [BP] measurement and ambulatory blood pressure monitoring [ABPM] in the clinical evaluation of hypertensive subjects. Hundred middle aged and pharmacologically untreated hypertensive subjects were studied [80 men and 20 women]. All subjects were referred fro m outpatient clinic in Farwania Hospital with BP greater than 140/90 mmHg. Resting ECG and echocardiography were done to assess left ventricular hypertrophy [LVH]. In order to exclude patients with ischemia an exercise ECG was done. Ambulatory blood pressure was recorded with an auscultatory device. There was a non -significant difference between the three clinical sessions in the measurement of the office systolic and diastolic BPreadings, [P= NS]. There was no significant intra-recording variation between the first and the second ABPM recordings when considering awake Aly M Hegazy, Bader AAbdel Kader Department of Medicine, Farwania Hospital, Kuwait and asleep maximum SBP, minimum systolic BP, maximum diastolic BP and minimum diastolic BP [P = NS]. Stepwise logistic analysis showed that ambulatory sleeptime and 24-hour systolic blood pressure had a significant relation to the presence of left ventricular hypertrophy [P < 0.05]. There was a good agreement between clinic BP readings and ambulatory daytime systolic and diastolic BP recordings as there was a good distribution of values between upper and lower limits of a g reement [mean +/- 2SD]. There was a significant c o r relation between office systolic BPreadings and awake systolic ABPM recordings [r = 0.954, P < 0.01]. Measured by non-physicians, clinic BP is as reliable as ambulatory BP monitoring in the clinical evaluation of untreated hypertensive patients. Asleep ABP, 24-hour ambulatory BP and daytime systolic BP variability were also shown to be good indicators of left ventricular hypertrophy

Decreased vagal dependent time-domain heart rate variability in hypertensive patients with left ventricular diastolic dysfunction

To evaluate the role of the autonomic nervous system in determining the appearance of diastolic ventricular dysfunction in patients with previously unrecognized and untreated essential hypertension. We studied 100 middle-aged and pharmacologically untreated hypertensive subjects [88 men and 12 women] and 50 normotensive subjects [44 men and 6 women] as a control group [group I]. A l l patients were referred from the outpatient clinic in Farwania Hospital with blood pressure more than 140/90 mmHg as detected by ambulatory blood pressure monitoring with an auscltatory device. Echocardiography was done to assess left ventricular diastolic function. Exercise ECG test was done to exclude patients with ischemic heart disease. Holter ECG monitor was done for all subjects to assess heart rate variability. Hypertensive patients were classified into two groups: group II included 50 patients with diastolic dysfunction and group III included 50 patients with normal ventricular diastolic function. With respect to age, gender, left ventricular mass index and left ventricular systolic function there were no significant difference between all groups of study [P = NS]. The hypertensive patients of group II had a significant decreased E/A ratio [P < 0.05], a significant decreased r-MSSD and p-NN50 [P < 0.05] and a significant increased daytime and nighttime heart rate [P < 0.05] than subjects and patients of groups I and III. There was a significant correlation between vagal dependent parameter [r-MSSD] and E/A ratio [r = 0.875, P < 0.05]. Stepwise logistic analysis revealed no significant relation between age, gender and ambulatory systolic and diastolic blood pressure and the presence of left ventricular diastolic dysfunction in hypertensive patients. Left ventricular diastolic dysfunction in hypertensive patients without left ventricle hypertrophy is related to reduced parasympathetic activity and this supports the use of non-pharmacologic treatment that increases diastolic vagal tone