Long-term effects of 3-month telemetric blood pressure intervention in patients with inadequately treated arterial hypertension.

BACKGROUND AND AIM: We have shown that better blood pressure (BP) control can be achieved by using 3-month telemetric BP measurement (TBPM) in comparison with a standard-care control group (C-G). The present analysis should clarify if this will also lead to a better middle- and long-term BP control. SUBJECTS AND METHODS: Fifty-seven patients finished the main study. After the 3 months no TBPM was performed. For 40 patients, 18 from the TBPM group (TBPM-G) and 22 from the C-G, we obtained ambulant BP measurements (ABPMs) with a mean follow-up of 20 months. Seventeen patients were lost to follow-up. BP target values were defined as ABPM ≤130/80 or ≤125/75 mm Hg with diabetes or renal failure. RESULTS: At the end of the follow-up, the systolic BP was 121.2±11.2 mm Hg in TBPM-G and 130.7±10.4 mm Hg in C-G, and the diastolic BP was 72.8±10.9 versus 77.0±7.1 mm Hg, respectively. Fifty-six percent in TBPM-G versus 40% in C-G (p=0.024) had a controlled BP as defined by ABPM criteria. CONCLUSIONS: TBPM helps achieve BP target values in patients with previously inadequately treated arterial hypertension, and the benefit is sustained. Beyond its immediate application, in comparison with standard treatment, TBPM allows for a better BP adjustment in the long term as well.

Body weight telemetry is useful to reduce interdialytic weight gain in patients with end-stage renal failure on hemodialysis.

Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate.

Association of Cheyne-Stokes respiration and cardiac cachexia in congestive heart failure.

In patients with congestive heart failure (CHF) cachexia as well as Cheyne-Stokes respiration (CSR) are well known disorders. The relationship between CSR and cardiac cachexia however, remains unclear so far. Clinical as well as full-night polysomnographic data from 12 cachectic patients were compared to 13 non-cachectic patients with CHF. The non-cachectic patients did not differ significantly in age (57.3+/-11.6 vs 64.8+/-14.5 years), body mass index (26.4+/-4.0 vs 25.2+/-3.2 kg m-(2)) or ejection fraction (21.8+/-5 vs 23.3+/-7%) from cachectic patients. The weight loss was 2.1+/-2.3 kg in non-cachectic vs 11.5+/-2.7 kg in cachectic patients (p<0.0001). A significant difference was detected for the prevalence CSR (5 vs 10 patients, p<0.03). In this study a high prevalence of sleep breathing disorders, in particular of CSR in CHF patients with cachexia was detected.

Influence of obstructive sleep apnoea in coronary artery disease: A 10-year follow-up.

In patients with coronary artery disease (CAD) the prevalence of obstructive sleep apnoea (OSA) is found to be about 14-65%. In this study, the influence of OSA in 50 patients with CAD was prospectively compared during a follow-up period of 10 years. In the follow-up period 4 of 25 patients with OSA and 5 of the 25 without OSA died by cardiovascular complications. The proportion survival curve showed no significant difference for patients with CAD and with versus without OSA. The results of this rather small 10-year follow-up study failed to give further evidence for an increased mortality in patients with CAD and OSA.