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1.
Medicine (Baltimore) ; 98(10): e14817, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30855506

ABSTRACT

Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline.In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (<135/85 mm Hg, <130/85 mm Hg, and <130/80 mm Hg) has been determined.The patients with HT experienced an increase in cardiovascular risk and death higher than the normotensive patients (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.8-16.2 for sustained HT; and OR 3.5, 95% CI 1.6-7.4 for WCH). This was observed for all the cut-off thresholds analyzed. In white-coat hypertensive patients (cut-off <135/85 mm Hg) with TOD, the risk was higher than in normotensive patients (OR 4.5; 95% CI 1.9-10.6). Using a self-monitoring blood pressure cut-off threshold of <130/80 mm Hg without TOD at baseline, the WCH cases exhibited no differences in risk to the normotensive patients (OR 2.0, 95% CI 0.5-7.7).The decisions being taken for patients with WCH based on the presence of TOD and a self-administered home monitoring blood pressure measurement cut-off point probably lower than the one that is currently recommended.


Subject(s)
Blood Pressure Determination , Hypertension/diagnosis , Self Care , Adolescent , Adult , Aged , Blood Pressure , Blood Pressure Determination/methods , Cohort Studies , Female , Humans , Hypertension/epidemiology , Male , Middle Aged , Risk , Young Adult
2.
J Hypertens ; 36(8): 1656-1662, 2018 08.
Article in English | MEDLINE | ID: mdl-29570512

ABSTRACT

OBJECTIVE: To evaluate the effect of effervescent paracetamol on office and ambulatory blood pressure (BP) compared with noneffervescent paracetamol in hypertensive patients. DESIGN: This was a multicenter open crossover randomized clinical trial. SETTING: Primary care centers in Catalonia and the Basque Country. PARTICIPANTS: Inclusion criteria were office BP 150/95 mmHg or less and daytime ambulatory BP 140/90 mmHg or less, stable pharmacologic or nonpharmacologic antihypertensive treatment, and concomitant chronic osteoarticular pain. INTERVENTIONS: Baseline randomized assignment to 3-week periods of effervescent paracetamol (1 g three times a day) first and noneffervescent paracetamol later, or inversely, during a 7-week study period. At the start and end of each treatment period, 24-h ambulatory BP monitoring was performed. MAIN OUTCOME MEASURES: Differences in 24-h SBP between baseline and end of both treatment periods. The main analyses were performed according to the intention-to-treat principle. RESULTS: In intention-to-treat analysis, 46 patients were analyzed, 21 were treated with paracetamol effervescent and noneffervescent later, and 25 followed the opposite sequence. The difference in 24-h SBP between the two treatments was 3.99 mmHg (95% confidence interval 1.35-6.63; P = 0.004), higher in the effervescent paracetamol treatment period. Similarly, the per-protocol analysis showed a difference in 24-h SBP between the two groups of 5.04 mmHg (95% confidence interval 1.80-8.28; P = 0.004), higher in the effervescent paracetamol treatment period. Self-reported pain levels did not differ between groups and did not vary by treatment period. No serious adverse events were reported in either study arm. CONCLUSION: Effervescent paracetamol tablets are responsible for a significant daytime and overall increase in ambulatory 24-h SBP. TRIAL REGISTRATION: NCT: 02514538 EudraCT: 2010-023485-53.


Subject(s)
Acetaminophen/pharmacology , Analgesics, Non-Narcotic/pharmacology , Blood Pressure/drug effects , Chronic Pain/drug therapy , Dosage Forms , Hypertension/complications , Acetaminophen/administration & dosage , Aged , Analgesics, Non-Narcotic/administration & dosage , Antihypertensive Agents/therapeutic use , Blood Pressure Monitoring, Ambulatory , Chronic Pain/etiology , Cross-Over Studies , Female , Humans , Intention to Treat Analysis , Male , Middle Aged , Osteoarthritis/complications
3.
Am J Hypertens ; 25(12): 1256-63, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22914254

ABSTRACT

BACKGROUND: To determine the prognostic value of various self-blood pressure (BP) monitoring (SBPM) cutoff at the time of diagnosis. METHODS: Cohort of 466 newly diagnosed and never-treated hypertensive patients. At baseline and at 1 year, the patients underwent a physical examination, clinic BP (CBP), SBPM, and ambulatory BP monitoring (ABPM), fasting blood and urine analysis, electrocardiogram (ECG), and retinography. The diagnosis of hypertension was made based on CBP average of two readings, separated by 2 min, taken over three different days, with results ≥ 140/90 mm Hg. At 1-year follow-up, target organ damage (TOD) evolution was classified as favorable or unfavorable. RESULTS: Mean age was 57.4 years, 56.8% were men. Adjusted multivariate analysis showed that hypertensive patients with baseline SBPM <135/85 mm Hg had a more favorable evolution of left ventricular hypertrophy (LVH) (odds ratio (OR): 1.9; 95% confidence interval (CI): 1.5-2.5), high urinary albumin excretion rate (UAER) (OR: 6.9; 95% CI: 3.4-14.4), and more favorable amount of TOD evolution (OR: 1.7; 95% CI: 1.4-2.0) than those with baseline SBPM ≥ 135/85 mm Hg. Patients with baseline SBPM <130/80 mm Hg, or <125/80 mm Hg had a more favorable evolution of the amount of TOD (OR: 2.7; 95% CI: 2.0-3.6, and OR: 2.9; 95% CI: 2.1-4.1, respectively) at 1 year than those with baseline SBPM <135/85 mm Hg. CONCLUSIONS: Baseline SBPM values <130/80 mm Hg is associated with better evolution of amount of TOD than SBPM values <135/85 mm Hg. These results would support a clinical trial to test a SBPM threshold <130/80 as an optimal pressure not needing pharmacological treatment among those with CBP ≥ 140/90.


Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Hypertension/diagnosis , Aged , Albuminuria/epidemiology , Albuminuria/physiopathology , Blood Chemical Analysis , Electrocardiography , Female , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Hypertrophy, Left Ventricular/epidemiology , Hypertrophy, Left Ventricular/physiopathology , Kidney Diseases/epidemiology , Kidney Diseases/physiopathology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Predictive Value of Tests , Prevalence , Prognosis , Prospective Studies , Retinal Diseases/epidemiology , Retinal Diseases/physiopathology , Risk Factors , Spain/epidemiology , Time Factors , Urinalysis
4.
Blood Press Monit ; 16(1): 11-5, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21183853

ABSTRACT

UNLABELLED: Self-blood pressure (BP) measurement (SBPM) and ambulatory BP measurement (ABPM) are suitable for the isolated clinical hypertension (ICH) or 'white-coat' hypertension diagnosis. However, patients with ICH have a different cardiovascular risk according to the measurement technique used for the diagnosis. OBJECTIVE: To describe baseline cardiovascular risk of patients with hypertension and with ICH according to SBPM and daytime ABPM. METHODS: Six hundred and sixty-four newly diagnosed and never treated patients with hypertension and with an average age of 59.3 years (standard deviation=12.0) were included (52% men) in this study. Clinical data, analytical data with urinary albumin excretion rate, estimated glomerular filtration rate, retinography, SBPM, and ABPM were performed. Cardiovascular risk was estimated from the European Society of Hypertension and Systemic Coronary Risk Evaluation tables. RESULTS: ICH prevalence varies according to the ambulatory measurement technique used: SBPM=24.2%, daytime ABPM=8.1, and 5.2% if criteria are required from both techniques. In the 403 patients with hypertension and who had SBPM and ABPM, the percentage of patients with high or very high baseline cardiovascular risk, falls progressively from 31.2% of patients with sustained hypertension to 20.0% of patients with ICH measured using SBPM, to 15.1% of patients with ICH measured using ABPM-day and to 9.5% of patients who present ICH using both techniques (P<0.005 for trend). CONCLUSION: The baseline results show that patients with hypertension and with ICH using SBPM and daytime ABPM are those who have a lower baseline cardiovascular risk and allow ICH to be defined on the basis of normal ambulatory readings using both techniques.


Subject(s)
Blood Pressure Monitoring, Ambulatory/methods , Hypertension/diagnosis , Hypertension/physiopathology , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Risk Factors
7.
Aten Primaria ; 38(4): 212-8, 2006 Sep.
Article in Spanish | MEDLINE | ID: mdl-16978558

ABSTRACT

OBJECTIVE: To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). DESIGN: Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. SETTING: Four primary health care centres. PARTICIPANTS: A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. METHODS: The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). RESULTS: Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P< .001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). CONCLUSIONS: The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP.


Subject(s)
Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Hypertension/diagnosis , Female , Humans , Male , Mathematics , Middle Aged , Office Visits
8.
Aten. prim. (Barc., Ed. impr.) ; 38(4): 212-218, sept. 2006. ilus, tab
Article in Es | IBECS | ID: ibc-051483

ABSTRACT

Objetivo. Describir las variaciones que se producen en el rendimiento de la automedida de la presión arterial domiciliaria (AMPAd) al emplear diferentes sistemas para calcular la media, en el diagnóstico de la hipertensión de bata blanca (HBB). Diseño. Estudio multicéntrico, descriptivo y comparativo para evaluar el rendimiento diagnóstico de una prueba. Emplazamiento. Cuatro centros de atención primaria. Participantes. Se seleccionó a 157 pacientes con hipertensión leve-moderada, recién diagnosticados y sin tratamiento farmacológico, que presentaron las 18 lecturas de AMPAd. Métodos. A cada paciente se le realizó una AMPAd (3 días consecutivos con lecturas por triplicado mañana-noche) y una monitorización ambulatoria de la presión arterial (MAPA) empleado, como prueba de referencia. Resultados. Los valores de presión arterial sistólica y diastólica del primer día y de la primera lectura (mañana-noche) eran mayores que los restantes días y lecturas (tendencia lineal p < 0,001). Al emplear todas las lecturas para calcular la media los parámetros de rendimiento diagnóstico obtenidos fueron: sensibilidad (S) 47,6%, especificidad (E) 77,4%, valores predictivos positivo y negativo 58,8 y 68,6%, coeficientes de probabilidad positivo y negativo (CPP y CPN) 2,10 y 0,67, respectivamente. Al eliminar las lecturas con mayor reacción de alerta (primer día y primera lectura mañana-noche) se incrementaba la S (61,9%) a expensas de un descenso excesivo de la E (64,5%), sin que mejorara el CPP (1,74). Conclusiones. La AMPAd en el diagnóstico de la HBB obtiene un bajo rendimiento que no mejora con el empleo de diferentes sistemas para calcular la media de presión arterial


Objective. To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). Design. Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. Setting. Four primary health care centres. Participants. A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. Methods. The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). Results. Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P<.001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). Conclusions. The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP


Subject(s)
Humans , Hypertension/diagnosis , Blood Pressure Determination/methods , Self Care/statistics & numerical data , Self-Examination/statistics & numerical data , Multicenter Studies as Topic , Blood Pressure Monitoring, Ambulatory
9.
Nephron Clin Pract ; 97(1): c17-22, 2004.
Article in English | MEDLINE | ID: mdl-15153763

ABSTRACT

BACKGROUND/AIM: The treatment of hyperphosphataemia is of major importance in the management of patients on dialysis. Traditional phosphate binders can be associated with undesirable effects. Recently, a new non-absorbable phosphate-binding polymer, sevelamer hydrochloride, has been available. Clinical information is scarce, and its cost could be a limiting factor for its wider use. No studies have evaluated its usefulness in uncontrolled hyperphosphataemic patients. METHODS: We identified 34 patients with a maintained serum phosphorus concentration >6.5 mg/dl and/or toxicity related to standard phosphorus-binding treatment (aluminium or calcium based). Sevelamer was added and titrated up fortnightly to achieve phosphorus control. Previous phosphate binders were decreased, whenever possible. The period of the study was 6 months. RESULTS: Thirteen patients (38%) dropped out because of side effects, mainly related to the gastro-intestinal tract. The efficacy analysis disclosed that the phosphorus concentration decreased from 2.39 +/- 0.48 to 1.84 +/- 0.48 mmol/l (p < 0.001). The mean dose of sevelamer was stabilised at 3.4 +/- 1.8 g/day. The amount of calcium- and aluminium-based phosphate binders could be decreased from 5.1 +/- 3.5 to 3.1 +/- 2.7 g/day (38% decrease) and from 2.4 +/- 1.5 to 1.5 +/- 1.7 g/day (36% decrease), respectively. The Ca x P product was significantly decreased from 5.83 +/- 1.19 to 4.36 +/- 1.12 mmol/l2 (p < 0.001). The total cholesterol concentration decreased from 4.34 +/- 0.9 to 3.98 +/- 0.9 mmol/l (p < 0.01) and the low-density lipoprotein cholesterol level from 2.61 +/- 0.98 to 2.20 +/- 0.77 mmol/l (p < 0.03). CONCLUSIONS: Sevelamer is an effective phosphate binder that allows a better serum phosphorus control, while allowing a decrease in the dose of calcium- and aluminium-based phosphate binders in these difficult patients. The drawbacks are the high intolerance rate and the price of the product.


Subject(s)
Epoxy Compounds/therapeutic use , Kidney Failure, Chronic/complications , Phosphorus Metabolism Disorders/drug therapy , Polyethylenes/therapeutic use , Renal Dialysis , Adult , Aged , Calcium/blood , Cholesterol/blood , Female , Humans , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapy , Male , Middle Aged , Phosphorus/blood , Phosphorus Metabolism Disorders/blood , Polyamines , Sevelamer
11.
Inorg Chem ; 37(26): 6746-6750, 1998 Dec 28.
Article in English | MEDLINE | ID: mdl-11670808

ABSTRACT

The first cyclic monothioether derivative of [C(2)B(9)H(12)](-) has been synthesized from 1-(SH)-1,2-C(2)B(10)H(11). Reaction of the latter with (n)BuLi and 1,3-dibromopropane leads to 1,2-&mgr;-(S(CH(2))(3))-1,2-C(2)B(10)H(10). Partial degradation leads to [7,8-&mgr;-(S(CH(2))(3))-7,8-C(2)B(9)H(10)](-). Reaction of [7,8-&mgr;-(S(CH(2))(3))-7,8-C(2)B(9)H(10)](-) with [PdCl(2)(PRR'(2))(2)] leads to different sets of compounds depending on the nature of R and R'. If R = R' = (t)Bu, a closo compound with one vertex occupied by "[Pd(P(t)Bu(3))(2)]" is obtained. When aryl groups are present in the starting phosphine complex, the zwitterionic non-metal-containing compounds are obtained. The crystal structure of one of them has been determined, and the compound has been proven to be 7,8-&mgr;-(S(CH(2))(3))-11-PPh(3)-7,8-C(2)B(9)H(9). The reaction of [7,8-&mgr;-(S(CH(2))(3))-7,8-C(2)B(9)H(10)](-) with [RhCl(PPh(3))(3)] leads to [Rh(7,8-&mgr;-(S(CH(2))(3))-7,8-C(2)B(9)H(10))(PPh(3))(2)]. An agostic B-Hright harpoon-up Rh interaction has been produced, identified by a (1)H{(11)B} NMR resonance at -4.78 ppm. In this instance the cluster is connected to "Rh" via the thioether and B(11)-H. The reaction of [7,8-&mgr;-(S(CH(2))(3))-7,8-C(2)B(9)H(10)](-) with [RuCl(2)(PPh(3))(3)] leads to a compound with two B-Hright harpoon-up Ru interactions. Contrarily to its noncyclic analogues, it seems that only one isomer has been obtained.

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