A comparison between sphygmomanometer-based and ambulatory blood pressure monitoring in acute salt loading and depletion protocol

INTRODUCTION: Ambulatory blood pressure monitors have been used in salt loading and depletion protocols. However, the agreement between measurements made using ambulatory blood pressure monitors and those made with the sphygmomanometer has not been evaluated. OBJECTIVE: The objective of this study was to compare the concordance of the two methods of blood pressure measurements in protocols of acute salt loading and depletion. METHOD: Systolic blood pressure was measured using a sphygmomanometer at the completion of salt infusion (2 L NaCl 0.9 percent, 4 h) and salt depletion (furosemide, 120mg/day, p.o.) in 18 volunteers. Using the Pearson correlation coefficient (ρ), these readings were compared with the mean systolic blood pressure measured using the ambulatory blood pressure monitoring device during the following periods: 4 h of saline infusion and 12 h of salt depletion; 4 h of saline infusion and the last 6 h of salt depletion; 12 h of salt loading and the last 6 h of depletion; 12 h of salt loading and 12 h of depletion. Salt sensitivity was defined by a difference in the systolic blood pressure between salt loading and salt depletion greater than 10 mmHg when measured with the sphygmomanometer, and the Kappa analysis of concordance (K) was used with a significance level of P<0.05. RESULTS: Only the blood pressure readings obtained using the ambulatory blood pressure device during 4 h of intravenous NaCl and during 12 h of salt depletion showed a high correlation with the variation in the systolic blood pressure measured by the sphygmomanometer, with a full agreement with the salt sensitivity classification (p = 0.71; P = 0.001 and K=1). CONCLUSION: In acute salt loading and depletion protocols, an ambulatory blood pressure monitoring device should be used to record the blood pressure during the 4-h interval of salt infusion and 12-h interval of salt depletion.

Hiperplasia suprarrenal congénita por déficit de 21-hidroxilasa. Presentación de dos casos / Congenital adrenal hyperplasia related to hydroxilase-21 deficiency. A two-case report

Se presentan dos recién nacidos con Hiperplasia Suprarrenal Congénita por déficit de 21-hidroxilasa clásica, diagnosticadas en el Servicio de Endocrinología del Hospital Pediátrico Provincial Docente "Pepe Portilla" de Pinar del Río, Cuba. Se exponen las diferencias clínicas entre los niños afectados en relación con el sexo, evidenciando dificultades diagnósticas en el varón, que lo expone a complicaciones graves por los desequilibrios hidroelectrolíticos que pueden sufrir con elevado riesgo para su vida. Se presenta información sobre la entidad, revisando la genética de la misma y algunos adelantos en su diagnóstico precoz.

Two infants presenting congenital adrenal hyperplasia due to classical 21-hydroxylase deficiency were diagnosed in Endocrinology Service belonging to "Pepe Portilla" Pediatric Teaching Provincial Hospital, Pinar del Río, Cuba. Clinical differences among the infants affected in relation to sex were showed, making evident diagnostic difficulties in male infant, which increase the risk of severe electrolyte imbalance complications for life. Information about the entity was presented, revising its genetics and some advances for its early diagnosis.