Electrocardiographic left ventricular hypertrophy criteria and ambulatory blood pressure monitoring parameters in adults.

BACKGROUND: To examine the relationship between ambulatory blood pressure monitoring parameters (ABPM) and electrocardiographic criteria for left-ventricular hypertrophy (LVH) in adults. METHODS: This study analyzed 1,544 subjects from the EVIDENT study (mean age = 55 ± 14 years; 61% women). A standard electrocardiograph (ECG) and 10 criteria were used to detect LVH. Office and ABPM were performed, and we analyzed 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP), percentage of time awake with SBP ≥135 mm Hg, percentage of time asleep with SBP ≥120 mm Hg, and central aortic blood pressure. RESULTS: LVH according to some electrocardiographic criteria was found in 11.30% of the patients (16.60% of men and 7.70% of women). The patients with LVH were older; had higher values for office, 24-hour and, central aortic blood pressure; were more likely to be men; and had a higher prevalence of obesity, diabetes, and antihypertensive or lipid-lowering drug use. In the logistic regression analysis, the association between the parameters of ABPM and LVH, after adjusting for age, sex, body mass index, and heart rate, remained statistically significant. CONCLUSIONS: Twenty-four hour blood pressure, the percentage of time with elevated awake and asleep SBPs, and the central systolic blood pressure are related to the presence of LVH as determined by ECG in adults. These results indicate the potential importance of the monitoring and control of different 24-hour parameters of blood pressure in addition to the standard clinic blood pressure with respect to the development of LVH. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01325064.

Blood pressure circadian pattern and physical exercise assessment by accelerometer and 7-day physical activity recall scale.

BACKGROUND: The relationship between regular physical activity, measured objectively and by self-report, and the circadian pattern of 24-hour ambulatory arterial blood pressure (BP) has not been clarified. METHODS: We performed a cross-sectional study in a cohort of healthy patients. We included 1,345 patients from the EVIDENT study (mean age 55 ± 14 years; 59.3% women). Physical activity was assessed using the 7-day physical activity recall (PAR) questionnaire (metabolic equivalents (MET)/hour/week) and the Actigraph GT3X accelerometer (counts/minute) for 7 days; ambulatory arterial BP was measured with a radial tonometer (B-pro device). RESULTS: The dipper-pattern patients showed a higher level of activity than nondipper patients, as assessed by accelerometer and 7-day PAR. Physical activity measures correlated positively with the percent drop in systolic BP (SBP; ρ = 0.19 to 0.11; P < 0.01) and negatively with the systolic and diastolic sleep to wake ratios (ρ = -0.10 to -0.18; P < 0.01) and heart rate (ρ = -0.13; P < 0.01). In logistic regression, considering the circadian pattern (1, dipper; 0, nondipper) as the dependent variable, the odds ratio of the third tertile of counts/minute was 1.79 (95% confidence interval [CI], 1.35-2.38; P < 0.01) and of MET/hour/week was 1.33 (95% CI, 1.01-1.75; P = 0.04) after adjustment for confounding variables. CONCLUSIONS: Physical activity, as evaluated by both the accelerometer and the 7-day PAR, was associated with a more marked nocturnal BP dip and, accordingly, a lower SBP and diastolic BP sleep to wake ratio. CLINICAL TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01083082.

Comparison of two measuring instruments, B-pro and SphygmoCor system as reference, to evaluate central systolic blood pressure and radial augmentation index.

A comparison is made of central aortic systolic pressure (CASP) and the radial augmentation index (rAIx) estimated with the B-Pro device and SphygmoCor (as reference) in 104 healthy Caucasians without drug treatment, together with an analysis of the relationship between CASP and rAIx, and arterial stiffness. Peripheral and central blood pressure, and the rAIx were measured with B-pro and SphygmoCor, with determination of the central augmentation index (CAIx), pulse wave velocity (PWV), carotid intima-media thickness (IMT) and the ankle-brachial index (ABI). rAIx as determined with B-Pro was greater than measured with SphygmoCor (5.85; 95%CI: 1.75-9.96), in the same way as CASP, estimated from the transfer function (1.47; 95%CI: 0.47-2.47 mm Hg) and with the second peak of the radial wave (4.46; 95%CI: 2.80-6.12 mm Hg). The Pearson correlation coefficient for CASP with B-Pro and SphygmoCor was r = 0.937 (P < 0.01), with an intraclass correlation of 0.972 (95%CI: 0.959-0.981). In the case of rAIx, the correlation coefficient was r = 0.436 (P < 0.01), with an intraclass correlation of 0.599 (95% CI: 0.409-0.728). The correlation of CASP (B-pro) with PWV was r = 0.558 (P < 0.01), with CAIx r = 0.253 (P < 0.01) and with carotid IMT r = 0.442 (P < 0.01). The correlation of rAIx (B-Pro) with age was r = 0.369 (r < 0.01), and with CAIx r = 0.463 (P < 0.001). Central arterial pressure estimated with B-Pro in healthy Caucasians without drug treatment offers adequate validity vs. the reference standard (SphygmoCor). However, in the estimation of rAIx, some differences with respect to the reference standard have been detected, probably related to measurement of the second peak of the radial wave.