Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectives: Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients. Methods and patients: Prospective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol. Results: From a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients. Conclusion: Ambulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.

Life style patterns and adherence to pharmacotherapy after acute coronary syndrome: one year follow up study from a tertiary care center in Kashmir, India

Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and 44.88% patients at 3, 6 and 12 months follow up. Uncontrolled diabetes at 3, 6 and 12 months was found in 58.82%, 66.17% and 73.52% patients. 5.42%, 15.06% and 21.08% cases continued to smoke at 3, 6 and 12 months respectively. Drug non-compliance overall was noted in 9.61%, 17.69% and 23.84% cases at 3, 6 and 12 month follow up.Conclusions: This study highlights the under prevalence of modifiable risk factor change in practice and drug non-compliance after an acute coronary event.

Comparison of Radiation Exposure in Patients Undergoing Single Vessel PCI (Requiring Single Stent) with and without Clear Stent and Clear Stent Live Technology

Invasive cardiology procedures provide great diagnostic and therapeutic benefit to patients but also subject them to considerable radiation exposure. CLEAR stent Live is the unique real time stent enhancement and gives a clear display of the undeployed stent. Aims & Objectives: To compare the radiation exposure in patients requiring single stent having single vessel coronary artery disease With & Without CLEAR stent and CLEAR stent Live Technology. Methods: It was a non-randomized study and included 246 patients. Group A included 123 patients who underwent Single vessel stenting using Clear stent technology as compared to group B who underwent stenting with conventional flouroscopic imaging. Radiation exposure between the two groups was compared. Results: The mean age of patients in Group A was 57.3±11.87 years while as in Group B it was 58.6±10.72 years (p=0.368). Majority of patients were males [(89(72.4%) vs 94(76.4%) (p=0.46) Group A vs B respectively] in both groups. The fluoro time in Group A was 10.6 minutes vs Group B = 11.2 minutes(p=0.15) The difference in procedure time between two groups(37.8 vs 35.9 min ,Group A vs Group B p=0.2) was statistically insignificant.The number of cine shots was significantly less in Group A as compared with Group B( 26.9 vs 30.1( Group A vs Group B) (p<0.002 ). The mean radiation exposure (mGy) in GroupA was significantly less as compared to Group B(581.7 ±293.6 vs 658.4 ±287.1 p= 0.039). The benefit of less radiation of Clear Stent technology was consistent across all vessels. Conclusion: The present study suggests that in selected patients, compared with conventional X-ray fluoroscopy imaging, the use of live clear stent technology can be performed with less radiation dose to patient.

Profile of patients presenting with sustained ventricular tachycardia in a tertiary care center

Background and aim Ventricular tachycardia (VT) represents the most frequent cause of sudden cardiac death. Information on clinical characteristics, acute management and outcome of patients with sustained VT is limited in our part of world. The aim of this study was to analyze the demography, hemodynamics, ECG features, underlying disease, mode of termination and outcome of patients presenting with VT. Methods This single center cohort study represents total of 107 patients of VT enrolled over 45 months. Results Mean age was 45 years and 59 of the patients were males. Thirty three of these patients were hemodynamically unstable (31%) and 74 were stable (69%) Coronary artery disease was the most common etiological factor accounting for 39% of patients followed by non-ischemic cardiomyopathy. Determinants of hemodynamic instability were VT in course of acute myocardial infarction (8 out of fourteen) and polymorphic pattern of VT (13 out of 26). Spontaneous termination of VT occurred in seven patients, antiarrythmic drugs terminated VT in 53 of 67 patients and in remaining 45 patients VT was terminated with direct current (DC) cardioversion. Total of twenty three patients died during the hospital stay. Factors that contributed to mortality were old age, hemodynamic instability and low ejection fraction. Conclusion Ischemic heart disease remains the leading cause of VT. Hemodynamically unstable VT occurs more frequently in acute myocardial infarction and polymorphic VT. Most effective method of VT termination is DC cardioversion. Old age, hemodynamic instability and ejection fraction contribute to overall mortality in VT.

The effect of percutaneous coronary revascularization on plasma N-terminal pro-B-type natriuretic peptide levels in stable coronary artery disease

Background This study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA). Methods This prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR. Results The mean age of the patients was 61.27 ± 8.87 years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36 ± 218.99 to 168.68 ± 161.61 pg/mL, p = 0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p = 0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p = 0.432). Reduction in NT-proBNP was independent of change in LV systolic functions. Conclusion Successful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.