Office versus Ambulatory (OvA) recording of blood pressure, a European multicenter study: inclusion and early follow-up characteristics.

Only a few large prospective trials intended to address the question of whether management of hypertensive patients should be guided by office (OBP) or ambulatory blood pressure (ABP) and whether fatal and nonfatal cardiovascular events are better predicted by ABP than they are by OBP are going on. Office versus Ambulatory (OvA) recording of blood pressure, a European multicenter study, is a multicenter prospective, 10 000 patient-years follow-up study of treated essential hypertension designed to correlate blood pressure to prognosis, blood pressure being defined either by ABP or OBP. Early in 1997, inclusion was stopped (n = 2224 inclusions, 48.3% women, aged 56.8 +/- 13.1 years) because the required number had been exceeded. Inclusion data reveal that OBP (152.9 +/-21.2/92.7 +/- 10.9 mmHg) of a large portion of patients remains high, although patients had been treated for at least 3 months with antihypertensive drugs. Mean 24 h ABP averaged 133.3 +/-15.9/84.0 +/-11.0 mmHg and 24 h blood pressure and heart rate profiles, large differences in drug treatment, apparatus, type of patients, and patients' activities notwithstanding, were like those expected from well-controlled studies. Risk profile was not particularly high. Evolution of OBP, ABP and electrocardiographic and echocardiographic indices of left ventricular hypertrophy indicate that reeductions of the OBP, ABP, and electrocardiographic indices of left ventricular hypertrophy had occurred after 12 months, after 24 months follow-up there was no longer any further change for most parameters. In conclusion, analysis of inclusion and preliminary follow-up data indicates that the OvA study is running well and that it is likely that final analysis of the data and events from the OvA study will lead to an answer to the study question of whether ABP monitoring is better suited than is OBP to deal with management of the treated hypertensive patient.

Blood pressure pattern in the recovery period after coronary artery bypass grafting.

BACKGROUND: Data on ambulatory blood pressure profiles after coronary artery bypass grafting (CABG) are largely lacking in the literature. OBJECTIVE: To examine the ambulatory blood pressure profile and its short- and long-term variability (daytime, night-time and 24 h) 1, 6 and 14 weeks after CABG in 15 patients (14 men, one woman) who remained uncomplicated postoperatively and during the 14 weeks' follow-up. Therapy remained unchanged over the study period. METHODS: Short-term blood pressure and heart rate variability were assessed by power spectral analysis of a sample length of 256 beats of these parameters obtained with subjects supine and having stood for 30 min, using the Finapres device 1, 6 and 14 weeks after CABG. The low-frequency (0.04-0.15 Hz): high-frequency (0.15-0.40 Hz) ratio of the R-R interval variability was considered a study parameter for the autonomic balance. RESULTS: During the rehabilitation period office and mean ambulatory blood pressure parameters were within the normotensive range. There was a progressive increase in 24 h and daytime systolic and diastolic blood pressures from 1 (121+/- 11/72+/-9 and 124+/-11/74+/-9 mmHg, respectively) to 14 weeks (129+/- 11/79+/-10 and 134+/-11/82+/- 11 mmHg, respectively) after CABG. The nocturnal blood pressure dip was restored progressively but incompletely 14 weeks after CABG. In parallel there was a progressive but also incomplete restoration of the sympathicovagal balance. CONCLUSION: Our results indicate an incomplete recovery of the autonomic nervous system and 24 h blood pressure variation 14 weeks after CABG. Further studies are required to examine whether incomplete restoration of the nocturnal blood pressure dip and sympathicovagal balance have independent prognostic implications for the CABG patient.

Why do we need to perform ambulatory blood pressure monitoring?. Conversation with the patient.

Ambulatory blood pressure monitoring (ABPM) has become one of the major clinical tools used to investigate the hypertensive patient. The technique is still cumbersome and embarassing for the patient, both during daily activities and during nightly rest. Nonetheless, the information to be obtained can be very useful for diagnosis and eventually for treatment of the patient. Therefore, it is important to convince the patient to give his permission for the recording to be performed. The recording should be performed under the best possible conditions. In the following, some of the arguments used in the hypertensive clinics will be outlined.