Subject(s)
Coronary Vasospasm/diagnosis , Coronary Vasospasm/physiopathology , Hypertension/diagnosis , Hypertension/physiopathology , Blood Pressure/drug effects , Blood Pressure Determination/instrumentation , Blood Pressure Determination/methods , Coronary Vasospasm/classification , Coronary Vasospasm/drug therapy , Humans , Hypertension/classification , Hypertension/drug therapyABSTRACT
Ambulatory blood pressure (ABP) monitoring is recommended as a standard method for the evaluation of resistant hypertension (RH). This study assessed the diagnostic value of home blood pressure (HBP) monitoring in RH. Subjects on stable treatment with ≥3 antihypertensive drugs were included. Clinic RH (CRH) was defined as elevated clinic blood pressure and true RH (TRH) as elevated ABP. The diagnosis of CRH was verified by ABP and HBP monitoring. The diagnostic value of HBP was assessed by taking ABP as reference method. Threshold for hypertension diagnosis was ≥135/85 mm Hg (systolic and/or diastolic) for HBP and awake ABP and ≥140/90 mm Hg for clinic blood pressure. Among 73 subjects on ≥3 antihypertensive drugs, 44 (60%) had CRH and 40 (55%) TRH. There was agreement between ABP and HBP in diagnosing CRH in 82% of the cases (26 subjects (59%) with CRH and 10 (23%) without CRH; kappa 0.59). Regarding the diagnosis of TRH, there was agreement between ABP and HBP in 74% of the cases (36 subjects (49%) with TRH and 18 (25%) without TRH; kappa 0.46). The sensitivity, specificity, and positive and negative predictive values of HBP in detecting CRH were 93%, 63%, and 81% and 83%, respectively, and TRH were 90%, 55%, and 71%, and 82%, respectively (ABP taken as reference method). These data suggest that HBP is a reliable alternative to ABP in the evaluation of RH. These methods are necessary in both uncontrolled and controlled subjects on triple therapy to detect the white coat phenomenon and also masked RH.
Subject(s)
Blood Pressure Monitoring, Ambulatory/methods , Coronary Vasospasm/classification , Coronary Vasospasm/diagnosis , Hypertension/classification , Hypertension/diagnosis , Aged , Antihypertensive Agents/pharmacology , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Blood Pressure/physiology , Coronary Vasospasm/drug therapy , Female , Humans , Hypertension/drug therapy , Male , Masked Hypertension/classification , Masked Hypertension/diagnosis , Masked Hypertension/drug therapy , Middle Aged , Retrospective Studies , Sensitivity and Specificity , White Coat Hypertension/classification , White Coat Hypertension/diagnosis , White Coat Hypertension/drug therapySubject(s)
Coronary Vasospasm , Arrhythmias, Cardiac/etiology , Arteriosclerosis/complications , Autonomic Nervous System/physiopathology , Calcium Channel Blockers/therapeutic use , Coronary Vasospasm/classification , Coronary Vasospasm/diagnosis , Coronary Vasospasm/drug therapy , Coronary Vasospasm/etiology , Death, Sudden, Cardiac/etiology , Electrocardiography, Ambulatory , Humans , Myocardial Ischemia/etiology , Myocardium/metabolism , Nitric Oxide/deficiency , Nitro Compounds/therapeutic use , Oxygen Consumption , PrognosisABSTRACT
Plasminogen activator inhibitor activity was higher in 18 patients with multivessel spasm than in 20 patients with 1-vessel spasm and in 22 control patients. Tissue plasminogen activator antigen was also higher in patients with multivessel spasm than in those with 1-vessel spasm and control patients. The increased plasminogen activator inhibitor activity in patients with multivessel spasm indicates that the fibrinolytic system is more impaired in such patients than in those with 1-vessel coronary spasm; this may be related to the higher incidence of refractory angina during hospitalization and cardiac events during the follow-up period.
