ABSTRACT
UNLABELLED: The aim was to find an objective indicator in order to evaluate white coat effect (WE). The first hour average values after placing an ambulatory blood pressure recorder (15 mn intervals) were compared to those of the 4 following hours of diurnal activity. A first hour systolic arterial blood pressure (SBP 1H) increase of 10 mmHg or more was considered as an ambulatory WE positive (AWE+) and was compared to clinical WE (CWE). CWE+ was observed in 78 pts and AWE+ in 72 among a group of 172 unselected pts referred for hypertension. RESULTS: the correlation between AWE and CWE is weak (r = 0.49) but significant (p < 0.001). There was no difference between the two groups in age, sex, clinical blood pressure, heart rate or ambulatory BP after the first hour (table). There was a significant difference in SBP between the 2 groups (p < 0.001) during the first hour only. [table: see text] CONCLUSION: Ambulatory blood pressure recording is able to recognize and evaluate the white coat effect. We suggest to consider independently the first hour of each recording and to compare it with the mean pressure measured during the period of diurnal activity.
Subject(s)
Blood Pressure , Adult , Aged , Ambulatory Care , Blood Pressure Determination/methods , Female , Humans , Male , Middle Aged , Physician-Patient Relations , Prognosis , Reproducibility of ResultsABSTRACT
Systolic and diastolic arterial blood pressures (SBP, DBP) were measured in 181 consecutive patients (pts) by non-invasive method (oscillometric recorder SpaceLabs 90202). Hospitalised pts (N = 54) and ambulatory pts (N = 127) did not differ significantly in 24 hrs mean SBP, diurnal SBP, DBP nor heart rate (HR): respectively 132.9 vs 136.1 137.6 vs 138.2 86.2 vs 84.4 mmHg 79.6 vs 77.1 bpm. The circadian variation of HR was identical in the 2 groups. During night (0-6 hr AM) pressures decreased significantly less in hospitalised pts than in outpatients: respectively SBP - 6.4 vs - 17.9 p. cent DBP - 5.7 vs - 17 p. cent SBP day/SBP night ratio 1.06 vs 1.17 (p less than 0.001). This "equalization" was observed since the first day of hospitalisation, even if pts were not restricted to bed (pts in intensive care unit were excluded). It did not depend on age, sex, mean SBP nor antihypertensive treatments. Heart work, as evaluated by HR.SBP product, did not differ significantly during the day in the 2 groups. In hospitalised pts it decreased twice less and remains at a significantly higher level than in outpatients: respectively - 166 vs - 300 906 vs 792 cmHg/min (p less than 0.001). The standard deviation of SBP was significantly correlated with the SBP day/SBP night ratio (r = 0.64 p less than 0.001). The chronology of the circadian variations of HR and SBP are identical, but their amplitude differed in hospitalised pts suggesting that the regulatory mechanisms of HR and SBP are different.
Subject(s)
Blood Pressure , Circadian Rhythm , Hospitalization , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Monitoring, PhysiologicABSTRACT
Cloth-covered Starr-Edwards prosthesis, was used to replace either the aortic valve (54 cases) or the mitral valve (71 cases), between 1968 and 1978, in an attempt to reduce the incidence of thrombo-embolic complications. Comparative studies using a silastene ball prosthesis during the same period showed that after aortic replacement, the mortality rate during the first month (12 p. cent), late deaths (actuarial survival curves), and most complications (including thrombo-embolin) were not significantly different in the two groups. Hemolysis is significantly greater after the two groups. Hemolysis is significantly greater after replacement with the metallic ball prosthesis; in one patient there was a mechanical change in the material. After mitral replacement, hospital mortality rates (6 p. cent) and the survival curves, after silastene or cloth-covered prostheses, did not differ significantly. Cloth covered mitral valve cause a significantly higher, but compensated rate of hemolysis, a metallic noise heard by 22 p. cent of the patients, and a significant reduction (about 1/5) in the incidence of thromboembolic complications.
