ABSTRACT
In a sample comprising 51 normotensive subjects and 51 subjects with in-clinic arterial hypertension [blood pressures (BPs) > or = 140/90 mmHg), we investigated the prevalence of target organ damage [left ventricular hypertrophy (LVH) and retinal vasculopathy] in white coat hypertension (WCH) groups defined using: (a) the "optimal ambulatory BP" criterion of the Seventh International Consensus Conference (in-clinic BPs >140/90 mmHg, daytime mean BPs < 130/80 mmHg) and (b) the "normal ambulatory BP" criterion proposed in 1997 by Verdecchia and co-workers (in-clinic BPs >140/ 90 mmHg, daytime mean BPs < 135/85 mmHg), and we compared the results with those obtained for the normotensive group and for a WCH group defined as in a 1996 study of the same data. We found that the newer criteria did not alter the conclusions reached in 1996: namely, that WCH constitutes a state of risk intermediate between normotension and sustained hypertension, which demands in-depth evaluation and active monitoring, if not immediate therapy. We also found that when the WCH group was defined as those patients with in-clinic BPs > or = 140/90 mmHg and 24-h mean BPs < 121/78 mmHg, the prevalence of target organ damage was similar to that found in the control group. We conclude that if WCH status is to imply absence of elevated risk of target organ damage, then the ambulatory BP threshold defining WCH should be lower than the upper limit of ambulatory BPs among subjects who are normotensive in the clinic. The desirability of predicting target organ damage in both hypertensive and normotensive subjects using criteria combining in-clinic BPs, daytime mean ambulatory BPs and night-time mean ambulatory BPs is suggested.
Subject(s)
Hypertension/complications , Hypertension/diagnosis , Hypertrophy, Left Ventricular/etiology , Retinal Vein Occlusion/etiology , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Case-Control Studies , Female , Humans , Hypertension/psychology , Hypertrophy, Left Ventricular/diagnosis , Male , Office Visits , Prevalence , Prognosis , Reference Values , Retinal Vein Occlusion/diagnosisABSTRACT
Retrospectively, we studied 66 consecutive patients in whom we implanted an intravenous DDD pacemaker. The indications were: AV block in 52 patients (79%), sick sinus syndrome in 5 patients (7.5%), both AV block and sick sinus syndrome in 4 patients (6%), and other causes in 5 (7.5%). The venous access route was by subclavian punction in 38 cases (57.5%) and by cephalic vein dissection in 28 (42.5%). With a mean follow-up of 16 months, there were complications in 11 patients (17%), in 9 of them, it was necessary a change in pacing mode different to DDD, and was possible to maintain a DDD pacing mode in 2 patients with a minimal reprogramming. The complications were: A) lost of sense and/or atrial capture in 10 patients (3 of them, had also loss of ventricular capture, one had pacemaker-mediated tachycardia, other had diaphragmatic stimulation and other had a severe infection of the pocket), B) atrial fibrillation appeared in another patient. At the implantation time there were significant differences between patients with and without complications on follow-up, the P wave amplitude was 1.86 +/- 0.75 mV in the first group vs. 3.06 +/- 1.52 mV in the latter group, p < 0.005, and the atrial pacing threshold was 1.10 +/- 1.17 microJ in the first group vs. 0.65 +/- 0.66 microJ in the latter group, p < 0.005. We consider that dual chamber stimulation is a well established form of therapy, although, it requires a more laborious implantation and specialized personal for its follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
