Time points for obtaining representative values of 24-hour blood pressure in chronic kidney disease

BACKGROUND/AIMS: Ambulatory blood pressure (BP) monitoring has been widely recommended for evaluating the status of BP, but is lacking in practicality. Determination of the specific time points for BP measurement that are representative of 24-hour mean BP could be useful and convenient in hypertensive patients with chronic kidney disease (CKD). METHODS: A total of 1,317 patients for whom 24-hour ambulatory BP monitoring was performed were enrolled in a multicenter study on hypertensive CKD. We analyzed the time points at which systolic blood pressure (SBP) values exhibited the smallest differences from 24-hour mean SBP (mSBP). We included office mSBP and analyzed the relationships between SBPs at the office and the time points with the smallest differences from 24-hour mSBP using several methods. RESULTS: The time points with the smallest differences from 24-hour mSBP were 7:00 AM, 2:00 PM, and 9:30 PM. In regression analysis, SBPs at 7:00 AM and 9:30 PM were better correlated with 24-hour mSBP than SBPs at 2:00 PM and the office. The proportions of patients with SBPs within 30% of 24-hour mSBP were higher at 7:00 AM and 9:30 PM. The best consistency between the uncontrolled hypertensive groups, defined as > or = 135 mmHg of 24-hour mSBP and higher values of SBPs corresponding to 135 mmHg of 24-hour mSBP, were observed at the 7:00 AM and 9:30 PM time points. CONCLUSIONS: The specific time points for SBPs that correlated well with 24-hour mSBP in hypertensive CKD patients were 7:00 AM and 9:30 PM.

Monitorização ambulatorial de pressão arterial em gestantes normotensas / Ambulatory blood pressure monitoring in normotensive pregnant women

As controvérsias sobre os padrões pressóricos durante a gravidez normal justificam a realização de estudos para melhor entender a questão. O objetivo deste estudo foi conhecer as variações normais da pressão arterial (PA), através da monitorização ambulatorial da pressão arterial (MAPA), em gestantes saudáveis numa capital da região norte do Brasil. Foram estudadas 89 gestantes normotensas, nulíparas ou multíparas, de 3 centros obstétricos da cidade de Belém (PA). As gestantes foram divididas em três grupos, segundo a idade gestacional: Grupo 1, composto por 25 grávidas, entre 6 e 13 semanas de gestação; Grupo 2, por 32 grávidas, entre 14 e 25 semanas; e Grupo 3, por 32 grávidas, entre 28 e 38 semanas de gestação. As 89 gestantes apresentavam idade entre 18 e 35 anos (mediana de 24 anos). Não houve diferenças significantes entre o número de nulíparas e multíparas (p = 0,5555). Quanto às variáveis da MAPA analisadas (média de 24 horas) houve diferenças estatisticamente significantes apenas em três delas: PA sistólica no Grupo 3 (aumento), PA diastólica no Grupo 2 (redução) e descenso noturno diastólico no Grupo 1 (aumento). Podemos concluir que em grávidas normotensas, os parâmetros da MAPA avaliados tiveram comportamento similar aos padrões de normalidade considerados para a população geral.

Controversies regarding blood pressure patterns during normal pregnancy justify studies for their better understanding. The objective of this study was to verify normal blood pressure (BP) variations by means of ambulatory blood pressure monitoring (ABPM) in healthy pregnant women in the capital of a northern Brazilian state. A total of 89 normotensive nulliparous or multiparous pregnant women from 3 obstetric centers in the city of Belém ­ State of Pará, were studied. The pregnant women were divided into three groups, according to their gestational age: Group 1, comprising 25 pregnant women between 6 and 13 weeks of gestation; Group 2, with 32 pregnant women between 14 and 25 weeks of gestation; and Group 3, with 32 pregnant women between 28 and 38 weeks of gestation. The ages of the 89 pregnant women ranged from 18 to 35 years (median of 24,0 years). There was no significant difference between the number of nulliparae and multiparae (p = 0.5555). As regards the ABPM variables analyzed (mean of 24 hours), statistically significant differences were observed in only three of them: systolic BP in Group 3 (increase); diastolic BP in Group 2 (decrease), and diastolic nocturnal dip in Group 1 (increase). In conclusion, in normotensive pregnant women the variation of the ABPM parameters analyzed was similar to the normal patterns observed in the general population.

Evaluation of Antihypertensive Effects of Amlodipine in Patients with Essential Hypertension Using 24 Hour Ambulatory Blood Pressure Measurement : A Single Placebo-Controlled Study

BACKGROUND: Amlodipine ; 2--4-(2-chlorophenyl)-3-ethoxycarbonyl-5-methoxycarbonyl-6-methyl-1,2, dihydropyridine) is a novel calcium channel antagonist of long half-life and steady state blood levels. However, its blood pressure lowering effect throughout the day has not been well documented especially in Korean patients with essectial hypertension. Therefore, antihypertensive effect of amlodipine in Korean patients with mild to moderate hypertension was evaluated with using 24 hour ambulatory blood pressure measurement(ABPM) as well as office blood pressure measurement. METHODS: Total 25 subjects(M;F=13:12, mean age;53.4+/-7.3 yrs) with mild-to-moderate essectial hypertension had completed the study. After 2 weeks of placebo, amlodipine was mediciated for 12 weeks. Initially, amlodipine was given as 5mg once a day and the daily dose was increased to 10mg/day if diastolic blood pressure in over 90mmHg at the 8th week of medication. The blood pressure level was measured every 4weeks during medication in sitting position('office blood pressure level') and 24 hour ambulatory blood pressure monitoring(ABPM) was done at the placebo run-in phase and at the 8th week of medication. RESULTS: In the view of' office blood pressure lever', the blood pressure lowering effect of amlodipine was already impressive at 4 weeks after medication. The systolic(placebo; 165.3+/-16.9mmHg, arter 4 wk of medication; 136.1+/-16.0mmHg, 8 wk; 136.0+/-12.9mmHg, 12wk; 133.2+/-10.7mmHg) and diastolic blood pressure(placebo; 104.1+/-11.0mmHg,after 4 wk of medication; 87.4+/-6.8mmHg, 8 wk; 86.0+/-6.5mmHg, 12 wk; 84.7+/-5.4mmHg)fell significantly, and most patients had both satisfactory systolic(<160mmHg) and diastolic(<90mmHg) blood pressure levels. And such antihypertensive effects were main tained throughout study period. In contrast, the heart rate did not change significantly. The blood pressure lowering effects assessed by 24 hour AVPM were slightly milder, but absolute systolic and diastolic blood pressures by ABPM after 8 weeks of meddication were as low as those of office measurement. The blood pressure lowering effect was maintained throughout the day including morning periods without either rebound blood pressure elevation or reflex tachycardia. The percent reduction of systolc and diastolic vlood pressure with amlodipine were 17% in office blood pressure measurement and 10% in ABPM. During medication, neither significant side effects nor discomforts that lead to discontinuation of the drug has not been observed. Mild edmatous feeling in 3 subjects, flushing in one and palpitation in one were reported. CONCLUSION: Amlodipine is an effective antihypertensive drug that can control the elevated blood pressure in most patients with mild-to-moderate essential hypertension by monotherapy of once a day regimen without serious side effects.