ABSTRACT
Background: Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. Methods: We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. Results: Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of whitecoat hypertension was greater among older participants than younger participants. Most respondents in the 5059 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. Conclusion: Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, followup data are needed to determine the prognostic significance of these data in this population
Subject(s)
Humans , Male , Female , Aged, 80 and over , Blood Pressure , Aged, 80 and over , Blood Pressure Monitoring, Ambulatory , HypertensionABSTRACT
Objective:To analyze the control status of ambulatory blood (BP) pressure and influencing factors among hypertensive patients in Shanghai Fengpu community.Methods:From April 2020 to February 2022, 318 hypertensive patients in Shanghai Fengpu community were enrolled in the study. The basic information and thropometric indicators of patients, course of hypertension, the medication, complications, life habits, and biochemical indicators as well as the ambulatory BP monitoring (ABPM) data were collected. Multivariate analysis was used to evaluate the risk factors for lack of 24-hour BP control.Results:Among 318 patients, 63 cases (19.8%) had an average 24-hour BP controlled; the control rate of daytime BP and nighttime BP was 23.3% (74 cases) and 15.7% (50 cases), respectively. The proportion of combined medication in the control group and non-control group was 46.0% (29/63) and 51.8% (132/255), respectively (χ 2=0.66, P=0.415). There were significant differences in gender, proportion of patients with hypertension>10 years, the office blood pressure control rate, the abnormal diastolic circadian rhythm, abdominal obesity, the level of fasting blood glucose, diabetes, physical activity levels, and smoking and drinking (all P<0.05) between the control group and non-control group. Multivariate analyses showed that male gender ( OR=2.00, 95 %CI:1.07-3.76) and abdominal obesity ( OR=2.04, 95 %CI:1.10-3.76) were risk factors for uncontrolled ambulatory BP. Conclusions:The control rate of ambulatory BP in patients with hypertension is relatively low in Shanghai Fengpu community. The ABPM should be enhanced and the management for hypertensive patients with abdominal obesity and lack of physical activity should be strengthened in the community.
ABSTRACT
Caso clínico de VNS, 23 anos, sexo feminino, branca, solteira, estudante, natural e procedente de São Paulo- SP com queixa de "pressão alta" há 4 anos. A paciente foi encaminhada para consulta ambulatorial após ter sido atendida em pronto-socorro (PS) com cefaleia, tonturas e pressão arterial (PA) 210x110 mm Hg e medicada com losartana 50 mg a cada 12 horas e hidroclorotiazida 25 mg ao dia. Na avaliação ambulatorial relatava episódios prévios de cefaleia holocraniana de forte intensidade, latejante, de início gradual há 4 anos com piora há 2 anos, que a levava ao pronto-socorro (PS) com muita frequência. Além disso, referia aumento de peso e fraqueza generalizada. Ao exame físico apresentava-se com níveis elevados da PA 160x100 mm Hg em uso das medicações prescritas no PS, obesidade grau III (IMC 41), adiposidade localizada (giba), acantose nigricans e estrias violáceas abdominais. Foi diagnosticada a doença de Cushing associada à hipertensão arterial não controlada, realizados ajustes dos agentes anti-hipertensivos (associado anlodipino 5 mg a cada 12 horas) e solicitados exames laboratoriais. A monitorização ambulatorial da PA (MAPA) de 24 horas caracterizou a hipertensão resistente, as dosagens de cortisol (cortisol salivar = 8h:172; após 23h:280, supressão com dexametasona =<2,5) e a ressonância nuclear magnética evidenciou um macroadenoma da hipófise confirmando o diagnóstico da doença de Cushing com base nos achados do exame físico, laboratorial e de imagem. A paciente foi tratada clinicamente com cetoconazol via oral sem sucesso e após isso submetida a ressecção transesfenoidal do macroadenoma de hipófise. Após o tratamento cirúrgico, houve perda de peso e resolução da hipertensão confirmada pelas medidas ambulatoriais de consultório e pela MAPA.
Clinical case of VNS, 23 years old, female, white, single, student, born and living in São Paulo-SP, complaining of "high blood pressure" 4 years ago. The patient was referred to an outpatient clinic after being seen in the emergency room (ER) with headache, dizziness and blood pressure (BP) 210x110 mm Hg and medicated with losartan 50 mg every 12 hours and hydrochlorothiazide 25 mg daily. In the outpatient evaluation, she reported previous episodes of severe, throbbing holocranial headache, which started gradually over 4 years and worsened over 2 years ago, which took her to the ER very often. In addition, she reported weight gain and generalized weakness. On physical examination, he presented with high BP levels 160x100 mm Hg using the medications prescribed in ER, obesity grade III (BMI 41), localized adiposity (gib), acanthosis nigricans and abdominal violet streaks. Cushing's syndrome was diagnosed associated with uncontrolled arterial hypertension, adjustments were made to antihypertensive agents (associated with amlodipine 5 mg every 12 hours) and laboratory tests were requested. 24-hour ambulatory BP monitoring (ABPM) characterized resistant hypertension, cortisol levels (salivary cortisol = 8:00 am: 172; after 11:00 pm: 280, dexamethasone suppression = <2.5) and magnetic resonance imaging revealed a macroadenoma of the pituitary gland confirming the diagnosis of Cushing's disease based on the findings of the physical, laboratory and imaging exam. The patient was clinically treated with oral ketoconazole and underwent transphenoid resection of the pituitary macroadenoma. After the surgery the patient was no longer hipertensive, without use of antihypertensive medications, outpatient office measurements were normal, as were measurements outside the office by ABPM
Subject(s)
Humans , Female , Adult , Pituitary Gland/surgery , Pituitary Gland/pathology , Pituitary ACTH Hypersecretion/diagnosis , Hypertension/therapyABSTRACT
A anormalidade da pressão arterial durante o período de sono identificada como médias ≥ 120 x 70 mm Hg, por meio de registros da Monitorização Ambulatorial da Pressão Arterial de 24 horas (MAPA), está relacionada a pior prognóstico e maior risco de eventos. Essa alteração pode ser decorrência de vários fatores, mas, geralmente, independentemente da causa está fortemente relacionada a maior probabilidade de eventos e mortalidade cardiovasculares. Ainda restam dúvidas, embora evidências começam a ser oferecidas, se o tratamento medicamentoso desse estado de comportamento peculiar da pressão arterial nas 24 horas deva ser instituído. Nessa revisão esses aspectos são amplamente discutidos com base nas melhores evidências disponíveis
The abnormality of blood pressure during the sleep period identified as means ≥ 120 x 70 mm Hg, through 24-hour Ambulatory Blood Pressure Monitoring (ABPM) records, is related to a worse prognosis and greater risk of events. This change can be due to several factors, but, generally, regardless of the cause, it is strongly related to a higher probability of cardiovascular events and mortality. Doubts remain, although evidence is beginning to be offered, whether drug treatment of this peculiar behavioral state of blood pressure within 24 hours should be instituted. In this review, these aspects are widely discussed based on the best available evidence
Subject(s)
Humans , Sleep , Blood Pressure Monitoring, Ambulatory , Arterial Pressure/physiology , Hypertension/physiopathologyABSTRACT
Resumen Introducción: la hipertensión arterial es un problema de salud pública que aumenta la mortalidad en todos los escenarios clínicos, pero es, además, el principal factor de riesgo modificable. Es una enfermedad altamente prevalente; cerca de un cuarto de la población del mundo la padece. Pocos pacientes la conocen y pocos están tratados de manera óptima. Objetivo: evaluar las características de pacientes a quienes se les realizó una monitorización ambulatoria de la presión arterial en un Hospital Universitario, con miras a describir el perfil clínico y demográfico. Métodos: estudio descriptivo retrospectivo, llevado a cabo en pacientes sometidos a monitorización ambulatoria de la presión arterial de 24 horas durante los meses de octubre y noviembre de 2015. Resultados: se confirmó hipertensión (de reciente diagnóstico o conocida) en el 75% de los estudios realizados. Se descartó hipertensión arterial en el 31% de los pacientes previamente clasificados como hipertensos. El 61% de los pacientes que se encontraban bajo tratamiento estaban bien controlados, la mayoría de ellos con un solo medicamento, principalmente antagonistas del receptor de angiotensina II. El patrón circadiano más prevalente en esta cohorte de pacientes fue el dipper (48%) seguido por el patrón de non-dipper (29%). Conclusiones: el monitorización ambulatoria de la presión arterial permite evaluar con exactitud el estado de la presión arterial de los pacientes con sospecha de hipertensión arterial. Esto aclara si los pacientes son realmente normotensos o hipertensos y discrimina las condiciones de la bata blanca y la hipertensión enmascarada, con lo cual se evitan tratamientos innecesarios y se favorece un mejor control de la presión arterial.
Abstract Introduction: Arterial hypertension is a public health problem that increases mortality in all clinical situations. It is also the main modifiable risk factor. It is a highly prevalent condition that is suffered by around 25% of the world population. Few patients are aware of it, and few receive the optimum treatment. Objective: To evaluate the characteristics of the patients on whom ambulatory blood pressure monitoring was carried out in a University Hospital, with a view to describing the clinical and demographic profile. Methods: A descriptive retrospective study was conducted on patients subjected to 24-hour ambulatory blood pressure monitoring, during the months of October and December 2015. Results: Hypertension (recently diagnosed or known) was confirmed in 75% of the studies performed. Arterial hypertension was ruled out in 31% of the patients previously classified as hypertensive. Of the patients that were receiving treatment, 61% were well-controlled, with the majority of them with a single drug, mainly an angiotensin II receptor agonist. The dipper was most prevalent circadian pattern, with 48%, followed by the non-dipper pattern in 29%. Conclusions: Ambulatory blood pressure monitoring helps in the evaluation of the blood pressure status accurately in patients with a suspicion of arterial hypertension. This clarifies whether the patients are really normotensive or hypertensive and discriminates between the "white coat" and masked hypertension conditions. This avoids unnecessary treatments and favours a better control of the blood pressure.
Subject(s)
Humans , Male , Female , Middle Aged , Blood Pressure Monitoring, Ambulatory , Hypertension , Receptors, Angiotensin , Pharmaceutical Preparations , Retrospective Studies , Directory , DiagnosisABSTRACT
RESUMEN Introducción: En los cambios de la geometría ventricular en hipertensos influyen el control de la presión arterial durante las 24 horas del día, así como su descenso adecuado en el período nocturno. Objetivo: Describir los patrones geométricos del ventrículo izquierdo en pacientes con y sin hipertensión arterial nocturna. Método: Se realizó monitoreo ambulatorio de la presión arterial (MAPA) y ecocardiograma a 54 pacientes con hipertensión arterial del 2016 al 2017. Se calcularon las variables de MAPA: promedio y cargas de presión diurno, nocturno y 24 horas, y el patrón circadiano. En el ecocardiograma se midieron los diámetros, el tabique interventricular y la pared posterior del ventrículo izquierdo, se calculó su masa e índice de masa, y se determinó su patrón geométrico y de función diastólica. Resultados: La edad promedio fue 55,4±14,1 años y predominaron el sexo femenino (57,4%) y el color de la piel blanco (59,3%). La hipertensión arterial al despertar y nocturna se halló en el 38,9% y 51,9%, respectivamente, y el fenómeno dipper alterado en 68,5% de los pacientes, asociado significativamente al incremento de la presión arterial nocturna (p=0,001). El tabique interventricular fue significativamente mayor en pacientes con hipertensión arterial nocturna en comparación con el grupo que no la presentaba (11,1±2,2 vs. 9,6±1,4 mm; p=0,006). Predominó la geometría alterada (53,7%) a expensas de mayor remodelado concéntrico (40,7%), sin asociación con la hipertensión arterial nocturna. Conclusiones: Los patrones geométricos del ventrículo izquierdo se comportaron de forma similar en pacientes con y sin hipertensión arterial nocturna.
ABSTRACT Introduction: Changes in ventricular geometry in hypertensive patients are influenced by 24-hour control of blood pressure, as well as its adequate decrease during nighttime. Objective: To describe the left ventricle geometric patterns in patients with or without nocturnal hypertension. Method: An ambulatory blood pressure monitoring (ABPM) and an echocardiogram were performed on 54 patients with high blood pressure, from 2016 to 2017. The following ABPM variables were calculated: average and pressure loads of daytime, nighttime, and 24-hour, as well as circadian pattern. In the echocardiogram, the diameters, the interventricular septum and the left ventricular posterior wall were measured; its mass and mass index were calculated, as well as determined its geometric and diastolic function patterns. Results: The average age was 57.4%±14.1 years old. Females (57.4%) and white skin color (59.3%) predominated. Waking and nocturnal hypertension were found in 38.9% and 51.9% respectively, and the altered dipper phenomenon was found in 68.5% of the patients, significantly associated with increased nocturnal blood pressure (p=0.001). The interventricular septum was considerably higher in patients with nocturnal hypertension when compared to the group without it (11.1±2.2 vs. 9.6±1.4 mm; p=0.006). Altered geometry predominated (53.7%) at the expense of higher concentric remodeling (40.7%), without any association with nocturnal hypertension. Conclusions: Left ventricle geometric patterns behaved similarly in patients with and without nocturnal hypertension.
Subject(s)
Echocardiography , Blood Pressure Monitoring, Ambulatory , Pulmonary Arterial HypertensionABSTRACT
Entende-se como hipertensão mascarada (HM) a existência de níveis pressóricos aumentados fora do consultório em pessoas supostamente normotensas e não tratadas. A hipertensos medicados, aplica-se a denominação de "hipertensão mascarada não controlada" (HMNC). Estas condições expõem expressivo contingente de indivíduos a um risco não identificado para eventos cardiovasculares. O presente trabalho teve como objetivo realizar uma revisão sistemática da literatura a fim de identificar os principais estudos de associação entre HM, HMNC e o risco de eventos cardiovasculares. De um total de 566 estudos, 19 foram incluídos na revisão. Dentre estes, apenas 4 não documentaram associação entre HM/HMNC e maior risco cardiovascular. Um estudo observou apenas associação com risco de infarto agudo do miocárdio (IAM) e outro apenas com o risco de acidente cerebrovascular (AVC). Os demais 13 estudos mostraram relação entre presença de HM e/ou HMNC e maior risco de eventos cardiovasculares como AVC, IAM e/ou morte. Em conclusão, existe associação entre a presença de hipertensão mascarada e o aumento no risco de eventos cardiovasculares. Alguns fenótipos especialmente vulneráveis e possíveis estratégias diagnósticas são também objeto de discussão.
Masked hypertension (MH) is defined as a normal ambulatory blood pressure, though elevated in the outpatient setting, in supposedly normotensive patients. For hypertensive patients, the term "uncontrolled masked hypertension" (MUCH) applies. Previous data suggest that subjects who present either MH or MUCH may be exposed to higher cardiovascular risk. The authors sought to carry out a systematic review of the literature regarding the association between MH, MUCH and risk of cardiovascular events. Among 566 studies retrieved,19 were included in the review. Only 4 studies did not document an association between MH/MUCH and risk of cardiovascular events. One study found an association only with the risk of acute myocardial infarction (AMI) and another with the risk of cerebrovascular events. The remaining 13 studies revealed a relationship between the presence of MH/MUCH and a higher risk of cardiovascular events such as stroke, AMI and/or death. In conclusion, there is an association between the presence of MH/MUCH and an increased risk of cardiovascular events. Some especially vulnerable phenotypes as well as possible diagnostic strategies are also discussed.
Subject(s)
Humans , Blood Pressure Monitoring, Ambulatory , Heart Disease Risk Factors , Hypertension/diagnosis , Hypertension/prevention & controlABSTRACT
Background: White coat hypertension (WCH) is a common and well recognized phenomenon. It is also very prevalent amongst pregnant women and is often diagnosed as chronic/ gestational hypertension leading to unnecessary medications during pregnancy. ABPM is the gold standard for diagnosis of WCH. SBPM is an easy effective and reliable method to measure blood pressure but its efficacy needs to be tested and compared with ABPM in cases of WCH. It is important to compare the two methods in assessing WCH so SBPM can be utilized in cases of WCH, if found useful and efficacious.Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for ambulatory blood pressure monitoring (ABPM) for 24 hours and SBPM on 6 hourly bases for 5 days.Results: The ABPM and SBPB readings were noted, tabulated and compared. It was found that the prevalence of ‘WCH’ in this study using ABPM and SBPM were 47.368% (27/54) and 45.614% (26/54) respectively.Conclusions: The results in diagnosing WCH using ABPM and SBPM were comparable.
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Objective@#To evaluate the effects of office blood pressure(OBP)combined with ambulatory blood pressure monitoring(ABPM)on the diagnosis of hypertension.@*Methods@#The residents aged 35-79 years without hypertension history,whose casual OBP were 120~159 mm Hg/80~99 mm Hg,were enrolled from 4 communities of Hangzhou and Zhuji from 2015 to 2018. They were performed OBP measurements on other two days in 4 weeks and ABPM in a week. There were 2 criteria of OBP as elevated OBP on the first day or in 3 different days,and 4 criteria of ABPM as elevated mean BP in 24 hours, daytime, nighttime and either of the above time. Receiver operating characteristic(ROC)curve was employed to evaluate the effects of different OBP criteria combined with ABPM criteria on the diagnosis of masked hypertension(MH)and white-coat hypertension(WCH).@* Results@#Taking 3-day-OBP as a golden standard,the 1-day-OBP with 4 ABPM criteria had the areas under the ROC curve(AUC)of 0.79-0.81,sensitivity of 57.58%-62.77% and specificity of 100.00% in MH;had the AUC of 0.95-0.98,sensitivity of 100.00% and specificity of 88.96%-96.80% in WCH. The Kappa values were all less than 0.6,known as low consistency. Taking either time of ABPM as a golden standard,24 hours,daytime and nighttime ABPM criteria with OBP had the AUC of 0.90-0.92,sensitivity of 79.17%-83.90% and specificity of 100.00% in MH(all Kappa>0.6),when with 1-day-OBP,the Kappa values were all more than 0.8,known as high consistency;had the AUC of 0.95-1.00,sensitivity of 100.00% and specificity of 89.54%-99.37% in WCH,the Kappa values of daytime ABPM were all more than 0.6,known as high consistency. @* Conclusions @# If limited by options, 1-day-OBP could be used instead of 3-day-OBP for detection of WCH or exclusion of MH yet with less accuracy; 24 hours or daytime ABPM instead of either time of ABPM was reliable.
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Introduction: Assessment of fluctuation of blood pressure in atime range from minutes to hours is possible through the use ofintermittent, noninvasive 24 h ambulatory blood pressuremonitoring (ABPM).This study was conducted with the Aimsand Objectives of determining BP variability and nocturnaldipping in primary hypertensive patients.Materials and Methods: The present observational study wasconducted at a tertiary care hospital after getting approval fromEthics Committee with 80 patients between August 2016 toOctober 2017. Schiller BR-102 plus 24 hour ambulatory BloodPressure Recorder was the equipment used for our study.Statistical analysis of data derived from patients was done.Results: Out of 80 patients studied, 53 patients had one ormore of Target Organ Damage and there was no evidence ofTarget Organ Damage in 27 patients. In the present study, nosignificant difference has been found in nocturnal dipping andblood pressure variability in patients with and without targetorgan damage.
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Resumen La medición de la presión arterial en el brazo continúa siendo la técnica patrón de referencia para el diagnóstico de hipertensión arterial sistémica. Sin embargo, las formas de medir la presión arterial han dado mucho de qué hablar en años recientes. Si bien los aparatos de medición con mercurio han sido desplazados por los digitales, ahora el cuestionamiento es dónde debe medirse la presión. A saber está la forma de medición en consultorio y los métodos fuera de él: medición intermitente domiciliaria o, bien, monitoreo ambulatorio de la presión arterial. Estos dos últimos han dado la oportunidad de identificar mejor el patrón de comportamiento y su variabilidad biológica, lo que acerca aún más al médico al conocimiento del comportamiento de las variaciones de presión en los sujetos con hipertensión arterial y prehipertensión. En esta revisión se discuten los alcances y limitaciones de cada forma de medición de la presión arterial.
Abstract The measurement of blood pressure in the arm continues to be the standard technique for the diagnosis of systemic arterial hypertension. However, the way to measure blood pressure has given much to talk about in recent years. While mercury-containing measuring have been displaced by digital devices, now questioning is where the pressure must be measured. To know this form of measurement in practice and methods outside the office: Home intermittent measurement or ambulatory blood pressure monitoring. These last two have given the opportunity to better identify the pattern of behavior and biological variability, what further approaches the medical knowledge of the behavior of the pressure variations in arterial hypertension and prehypertension subject carriers. In this review, we will discuss the scope and limitations of each form of measurement of blood pressure.
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Abstract Background: Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients. Objectives: The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients. Methods: Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients. Results: According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936). Conclusions: We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.
Resumo Fundamento: A fragmentação do QRS (fQRS) é um sinal de eventos cardiovasculares adversos em várias doenças cardiovasculares. É associado também à pressão arterial elevada e à ausência de descenso da pressão arterial durante o sono (non-dipping) em pacientes pré-hipertensos. Objetivos: O objetivo do estudo presente é investigar a relação entre fQRS e ausência de descenso da pressão arterial durante o sono em pacientes pré-hipertensos. Métodos: Duzentos e dezesseis pacientes elegíveis, recém-diagnosticados com pré-hipertensão, que foram submetidos a monitorização ambulatorial da pressão arterial (MAPA) durante 24 horas para avaliação mais aprofundada da pressão arterial entre junho de 2015 e julho de 2016, foram incluídos no estudo. De acordo com os resultados da MAPA, os pacientes foram divididos em três grupos: normotensos, pré-hipertensos com descenso da pressão arterial durante o sono (padrão dipping) e pré-hipertensos com ausência de descenso da pressão arterial durante o sono (padrão non-dipping). Os grupos foram comparados quanto à presença de fQRS no eletrocardiograma. Adicionalmente, utilizou-se a análise de regressão logística multinomial para determinar a relação entre a fQRS e o padrão de pressão arterial em pacientes pré-hipertensos. Resultados: De acordo com os registos da MAPA, 61 pacientes apresentavam padrão de pressão arterial normotenso (pressão arterial sistólica < 120 mmHg e pressão arterial diastólica < 80 mmHg). Dos 155 pacientes pré-hipertensos, 83 tinham padrão dipping e 72 tinham padrão non-dipping. Os pacientes pré-hipertensos com padrão non-dipping tinham uma frequência significativamente mais alta de fQRS em comparação com os pacientes normotensos (p = 0,048). Além disso, a análise de regressão logística multinomial revelou que fQRS é um preditor independente do padrão non-dipping de pressão arterial em pacientes pré-hipertensos (p = 0,017, OR: 4,071, 95 % CI: 1,281-12,936). Conclusões: Verificamos que a fQRS é um preditor do padrão non-dipping em pacientes pré-hipertensos. Como marcador de fibrose e aumento na carga fibrótica do miocárdio, a fQRS pode ser útil na identificação de pacientes pré-hipertensos de alto risco antes do desenvolvimento da hipertensão.
Subject(s)
Humans , Male , Female , Middle Aged , Electrocardiography/methods , Prehypertension/physiopathology , Hypertension/physiopathology , Reference Values , Time Factors , Blood Pressure/physiology , Case-Control Studies , Logistic Models , Predictive Value of Tests , Risk Factors , Analysis of Variance , Statistics, NonparametricABSTRACT
Objective To study the application value of dynamic monitoring of blood pressure in the prevention and treatment of elderly hypertension. Methods 519 hypertensive patients from December 2017 to December 2018 were monitored with ambulatory blood pressure monitoring, and were divided into the elderly group (≥60 years old, 264 cases) and the control group (<60 years old, 255 cases). The results of ambulatory blood pressure monitoring in two groups were analyzed, which inclued the circadian rhythm of blood pressure, blood pressure, pulse pressure, coefficient of variation of blood pressure, blood pressure load value, average heart rate and morning blood pressure surge. Results The incidence of abnormal circadian rhythm of ambulatory blood pressure in the elderly group was 76.5%. Compared with the control group, there were differences in the indexes of diastolic blood pressure (DBP), diastolic blood pressure load value (DBPLV), pulse pressure (PP), 24 h average heart rate (24 hAHR), systolic blood pressure coefficient of variation (SBPCV), 24 h diastolic blood pressure coefficient of variation (24 h DBPCV) and morning diastolic blood pressure surge (MDBPS) between the two groups(all P<0.05). There were differences in 24 h systolic blood pressure (24hSBP), night systolic blood pressure (nSBP), night diastolic blood pressure (nDBP), night pulse pressure (nPP), day systolic blood pressure load value (dSBPLV), ninght systolic blood pressure load value (nSBPLV), 24 h SBPCV, 24 h dDBPCV and other indicators among different blood pressure types in the elderly group (all P<0.05). Conclusion Ambulatory blood pressure monitoring indicators have important guiding value for the prevention and treatment of elderly hypertension.
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BACKGROUND: Automated office blood pressure (AOBP) machines measure blood pressure (BP) multiple times over a brief period. We aimed to compare the results of manual office blood pressure (MOBP) and AOBP methods with ambulatory BP monitoring (ABPM) in patients with chronic kidney disease (CKD). METHODS: This study was performed on 64 patients with CKD (stages 3–4). A nurse manually measured the BP on both arms using a mercury sphygmomanometer, followed by AOBP of the arm with the higher BP and then ABPM. Mean BP readings were compared by paired t test and Bland–Altman graphs. RESULTS: The mean ± standard deviation (SD) age of participants was 59.3 ± 13.6. The mean ± SD awake systolic BP obtained by ABPM was 140.2 ± 19.0 mmHg, which was lower than the MOBP and AOBP methods (156.6 ± 17.8 and 148.8 ± 18.6 mmHg, respectively; P < 0.001). The mean ± SD awake diastolic BP was 78.6 ± 13.2 mmHg by ABPM which was lower than the MOBP and AOBP methods (88.9 ± 13.2 and 84.1 ± 14.0 mmHg, respectively; P < 0.001). Using Bland–Altman graphs, MOBP systolic BP readings showed a bias of 16.4 mmHg, while AOBP measurements indicated a bias of 8.6 mmHg compared with ABPM. CONCLUSION: AOBP methods may be more reliable than MOBP methods for determining BP in patients with CKD. However, the significantly higher mean BPs recorded by AOBP method suggested that AOBPs may not be as accurate as ABPM in patients with CKD.
Subject(s)
Humans , Arm , Bias , Blood Pressure Monitoring, Ambulatory , Blood Pressure , Hypertension , Methods , Reading , Renal Insufficiency, Chronic , SphygmomanometersABSTRACT
Resumen: ANTECEDENTES El monitoreo ambulatorio de la presión arterial (MAPA) predice de forma más precisa el riesgo de complicaciones cardiovasculares que la presión arterial en el consultorio. El parámetro del MAPA que se asocia de forma más estrecha es el promedio de presión arterial nocturna. OBJETIVO Determinar la prevalencia y los factores asociados de las alteraciones en los parámetros del monitoreo ambulatorio de la presión arterial (MAPA) de 24 horas en pacientes diabéticos. MATERIAL Y MÉTODO Estudio descriptivo, transversal, realizado de enero a junio de 2017 en pacientes con diabetes mellitus tipo 2 con o sin antecedente de hipertensión arterial. Se realizó evaluación clínica y de laboratorio para la identificación de factores de riesgo cardiovascular. Para el monitoreo ambulatorio de la presión arterial se utilizaron monitores Watch BP 03. RESULTADOS Se incluyeron 127 pacientes. Se encontró hipertensión de 24 horas en 46.5% e hipertensión diurna en 35.4%. La prevalencia de hipertensión nocturna fue de 66.1% y de hipertensión nocturna aislada de 32.3%. La prevalencia de patrón no dipper fue de 49.6%, del patrón riser de 24.4%, dipper 22.8% y dipper extremo 3.1%. Los factores asociados de forma significativa con la hipertensión nocturna fueron tabaquismo, tiempo de evolución de la diabetes mellitus, edad y concentración de creatinina sérica. CONCLUSIONES Se encontró prevalencia elevada de alteraciones nocturnas de la presión arterial.
Abstract: BACKGROUND Ambulatory blood pressure monitoring (ABPM) more accurately predicts the risk of cardiovascular complications than blood pressure in the office. The ABPM parameter that is associated most closely is the average nighttime blood pressure. OBJECTIVE To determine the prevalence and factors associated of alterations in the ABPM parameters of 24 hours in diabetic patients. MATERIAL AND METHOD A descriptive, cross-sectional study was done from Ja-nuary to June 2017 in patients with type 2 diabetes mellitus with or without a history of arterial hypertension. A clinical and laboratory evaluation was carried out to identify cardiovascular risk factors. For ABPM, Watch BP 03 monitors were used. RESULTS 127 patients were included. 24-hours hypertension was found in 46.5% and daytime hypertension in 35.4%. The prevalence of nocturnal hypertension was 66.1% and of isolated nocturnal hypertension of 32.3%. The prevalence of non-dipper pattern was 49.6%, Riser pattern 24.4%, Dipper 22.8% and extreme Dipper 3.1%. The factors significantly associated with the presence of nocturnal hypertension were smoking, time of evolution of diabetes mellitus, age and serum creatinine concentration. CONCLUSIONS A high prevalence of nocturnal alterations in blood pressure was found.
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O objetivo deste estudo foianalisar o comportamento da pressão arterial ambulatorial de adoles-centes obesos após uma sessão de exercício intervalado de alta intensidade (HIT) na esteira ergo-métrica. Trata-se de uma pesquisa com delineamento cross-over randomizado, realizada com nove adolescentes do sexo masculino de 15 a 18 anos de idade. Os voluntários realizaram dois protocolos experimentais, com intervalo mínimo de 48 horas: controle e HIT. O protocolo HIT foi constituído de cinco séries a 85 95% do VO2pico por um minuto, intercalados por três minutos de recuperação a 40 50% do VO2pico. Antes e após os protocolos, frequência cardíaca, pressão arterial sistólica (PAS), pressão arterial diastólica e pressão arterial média foram mensuradas na posição sentada. A medida ambulatorial da pressão arterial foi realizada nos dois protocolos por meio de um monitor automá-tico da marca SpaceLabs 90207, programado para realizar medidas a cada 20 minutos, das 12:00 às 22:00 horas. Os efeitos dos protocolos experimentais nas respostas hemodinâmicas foram testados por meio da análise de variância para medidas repetidas, considerando-se os fatores (controle e HIT) e tempo (pré-sessão e pós-sessão). Os resultados apontaram diferença significativa entre as médias da PAS nos protocolos controle e HIT na primeira hora após o final do exercício (133,66 ± 7,56 vs 125,88 ± 7,20 mmHg, respectivamente; p = 0,005), indicando hipotensão pós-exercício induzida pelo HIT. O protocolo HIT empregado promoveu efeito hipotensor de moderada magnitude e curta duração sobre a PAS
The objective of this study was to analyze the behavior of ambulatory blood pressure of obese adolescents after a session of high intensity interval exercise (HIT) on treadmill. This was a randomized cross-over study with nine male adolescents between 15 and 18 years of age. The volunteers performed two experimental pro-tocols with a minimum interval of 48 hours: control and HIT. The HIT protocol consisted of five series at 85 95% of VO2peak for one minute, interspersed by three minutes of recovery at 40 50% of VO2peak. Before and after the protocols, heart rate, systolic blood pressure (SBP), diastolic blood pressure and mean arterial pres-sure were obtained in the seated position. Ambulatory blood pressure measurement was performed in both protocols through an automatic monitor of the mark SpaceLabs 90207, programmed to perform measure-ments every 20 minutes from 12:00 to 22:00 hours. The effects of the experimental protocols on hemodynamic responses were tested through analysis of variance for repeated measures, considering the factors (control and HIT) and time (pre-session and post-session). The results showed a significant difference between the means of SBP in the control and HIT protocols in the first hour after the end of the exercise (133.66 ± 7.56 vs 125.88 ± 7.20 mmHg, respectively, p = 0.005), indicating post-exercise hypotension induced by HIT. The HIT protocol employed promoted a moderate magnitude and short duration hypotensive effect on SBP
Subject(s)
Exercise , Blood Pressure Monitoring, Ambulatory , Adolescent HealthABSTRACT
Objective: To explore the association of blood pressure variability (BPV), especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity (baPWV) and left ventricular mass index (LVMI). Methods: A total of 184 hypertensive patients participated this cross sectional study. Patients were divided into dippers, non-dippers, inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure (SBP) decline. baPWV and LVMI in different groups were compared. Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis. Results: After adjusted by age, BMI, hypertension duration, blood pressure in consulting room, SBP and diastolic blood pressure (DBP) in 24 h, total cholesterol, low density lipoprotein cholesterin, brain natriuretic peptide and ejection fraction, baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group (P=0.000), and LVMI was significantly higher in non-dippers group than in dippers group (P=0.001) and extreme-dippers group (P=0.022). baPWV and LVMI were both significantly correlated to age, 24 h SBP and 24 h DBP, SD value of 24 h SBP and 24 h DBP, daytime SBP and DBP, nocturnal SBP and DBP, SD values of daytime SBP and DBP, SD values of nocturnal SBP and DBP in univariate linear regression models (P<0.05). In multivariate linear regression model, baPWV was independently associated to SD value of nocturnal SBP (β=0.289, P=0.000), nocturnal SBP decline (β=-0.398, P=0.000), daytime SBP (β=0.214, P=0.001) and SD value of daytime DBP (β=0.207, P=0.002), while LVMI was independently associated to 24 h SBP (β=0.348, P=0.000) and SD value of nocturnal SBP (β=0.196, P=0.026). Conclusion: baPWV was independently correlated to SD value of nocturnal SBP, nocturnal SBP decline, daytime SBP and SD value of daytime DBP, while LVMI was independently correlated to 24 h SBP and SD value of nocturnal SBP.
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Objective·To explore the association of blood pressure variability (BPV),especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity (baPWV) and left ventricular mass index (LVMI).Methods· A total of 184 hypertensive patients participated this cross sectional study.Patients were divided into dippers,non-dippers,inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure (SBP) decline.baPWV and LVMI in different groups were compared.Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis.Results· After adjusted by age,BMI,hypertension duration,blood pressure in consulting room,SBP and diastolic blood pressure (DBP) in 24 h,total cholesterol,low density lipoprotein cholesterin,brain natriuretic peptide and ejection fraction,baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group (P=0.000),and LVMI was significantly higher in non-dippers group than in dippers group (P=0.001) and extreme-dippers group (P=0.022).baPWV and LVMI were both significantly correlated to age,24 h SBP and 24 h DBP,SD value of 24 h SBP and 24 h DBP,daytime SBP and DBP,nocturnal SBP and DBP,SD values of daytime SBP and DBP,SD values of nocturnal SBP and DBP in univariate linear regression models (P＜0.05).In multivariate linear regression model,baPWV was independently associated to SD value of nocturnal SBP (β=0.289,P=0.000),nocturnal SBP decline (β=0.398,P=0.000),daytime SBP (β=0.214,P=0.001) and SD value of daytime DBP (β=0.207,P=0.002),while LVMI was independently associated to 24 h SBP (β=0.348,P=0.000) and SD value of nocturnal SBP (β=0.196,P=0.026).Conclusion· baPWV was independently correlated to SD value of nocturnal SBP,nocturnal SBP decline,daytime SBP and SD value of daytime DBP,while LVMI was independently correlated to 24 h SBP and SD value of nocturnal SBP.
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PURPOSE: Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS: A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction < 50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS: In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p < 0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION: There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.