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Steffen HM, Mahanani MR, Neuhann F, Nhlema A, Kasper P, de Forest A, Chaweza T, Tweya H, Heller T, Chiwoko J, Winkler V, Phiri S. Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study. Clin Res Cardiol 2023; 112:1650-1663. [PMID: 37414923 PMCID: PMC10584708 DOI: 10.1007/s00392-023-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. METHODS Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. RESULTS 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). CONCLUSION Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. TRIAL REGISTRATION NCT02381275.
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Affiliation(s)
- Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Hypertension Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | | | - Florian Neuhann
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrew de Forest
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | | | - Hannock Tweya
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Tom Heller
- Lighthouse Clinic, Lilongwe, Malawi
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | | | - Volker Winkler
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- Lighthouse Clinic, Lilongwe, Malawi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Zhu H, Zheng H, Liang X, Huang C, Sun L, Liu X, Qiu M, Mai W, Huang Y. Prevalence and Related Factors of White Coat Hypertension and Masked Hypertension in Shunde District, Southern China. Front Physiol 2022; 13:936750. [PMID: 35846000 PMCID: PMC9283833 DOI: 10.3389/fphys.2022.936750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background: White coat hypertension (WCH) and masked hypertension (MH) can increase the risk of target organ damage. Home blood pressure monitoring is an important method for detecting WCH and MH. However, the prevalence and related factors of WCH and MH in China have been rarely reported. Objective: To explore the prevalence and related factors associated with white coat hypertension (WCH) and masked hypertension (MH) in Shunde District, Southern China. Methods: This study recruited subjects from the Physical Examination Center in Shunde Hospital, Southern Medical University. Office blood pressure and home blood pressure values were collected using the home blood pressure monitor with telemedicine device and office blood pressure monitor, and the prevalence of WCH and MH was calculated by the values. Multivariate logistic regression was used to explore the related factors for WCH and MH. Results: Four-hundred and sixty-one participants (61% male), with an average age of 49 years, were included. The prevalence of WCH and MH was 5.1 and 15.2%, respectively. Multivariate logistic regression analysis showed that smoking (OR = 4.71, 95% CI = 1.05–21.15) and family history of coronary heart disease (OR = 4.51, 95% CI = 1.08–18.93) were associated with higher odds of WCH. The associated factors for higher odds of MH were smoking (OR = 2.83, 95% CI = 1.11–7.23), family history of hypertension (OR = 2.17, 95% CI = 1.11–4.26) and family history of coronary heart disease (OR = 2.82, 95% CI = 1.07–7.45). Conclusion: WCH and MH are highly prevalent in the Physical Examination Center in Shunde Hospital, Southern Medical University. We found smoking and family history of coronary heart disease were related factors for WCH, and smoking, family history of hypertension and coronary heart disease were associated with the odds of MH. Home blood pressure monitoring with a telemedicine device should be recommended to identity abnormal BP phenotype.
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Affiliation(s)
- Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiaoyan Liang
- Department of Health Check-up Centre, Shunde Hospital, Southern Medical University, Foshan, China
| | - Chunyi Huang
- Department of Health Check-up Centre, Shunde Hospital, Southern Medical University, Foshan, China
| | - Lichang Sun
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiong Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Min Qiu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Weiyi Mai
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
- The George Institute for Global Health, newtown, NSW, Australia
- *Correspondence: Yuli Huang,
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Bo Y, Kwok KO, Chung VCH, Yu CP, Tsoi KKF, Wong SYS, Lee EKP. Short-term reproducibility of ambulatory blood pressure measurements: a systematic review and meta-analysis of 35 observational studies. J Hypertens 2020; 38:2095-2109. [PMID: 32555001 PMCID: PMC7575032 DOI: 10.1097/hjh.0000000000002522] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/11/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A systematic review on the reproducibility of ambulatory blood pressure measurements (ABPM) has not yet been conducted. This meta-analysis compared 24-h/daytime/night-time SBP and DBP mean values and SBP/DBP nocturnal dipping status from ABPMs in participants with or without hypertension. METHODS Ovid MEDLINE, EMBASE, and CINAHL Complete databases were searched for articles published before 3 May 2019. Eligible studies reporting a 24-h ABPM repeated at least once within 1 month were included. The mean daytime/night-time/24-h BP values, percentage of nocturnal dipping, and proportion of nondippers were compared between the first and second day of measurements, and the proportion of participants with inconsistent dipping status were estimated using a random effect model. RESULTS Population-based analysis found a 0-1.1 mmHg difference between the first and second ABPM for 24-h/daytime/night-time SBP and DBP and 0-0.5% for percentage of SBP/DBP nocturnal dipping. The proportion of non-dippers was not different between the first and second ABPM. Intra-individual analysis found that the 95% limit of agreements (LOA) for SBP/DBP were wide and the 95% LOA for daytime SBP, common reference to diagnose hypertension, ranged -16.7 to 18.4 mmHg. Similarly, 32% of participants had inconsistent nocturnal dipping status. CONCLUSION ABPM had excellent reproducibility at the population level, favouring its application for research purposes; but reproducibility of intra-individual BP values and dipping status from a 24-h ABPM was limited. The available evidence was limited by the lack of high-quality studies and lack of studies in non-Western populations.
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Affiliation(s)
- Yacong Bo
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine
| | - Kin-On Kwok
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine
| | | | - Chun-Pong Yu
- Li Ping Medical Library, The Chinese University of Hong Kong, Hong Kong
| | | | | | - Eric Kam-Pui Lee
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine
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Alsharari R, Lip GYH, Shantsila A. Assessment of Arterial Stiffness in Patients With Resistant Hypertension: Additional Insights Into the Pathophysiology of This Condition? Am J Hypertens 2020; 33:107-115. [PMID: 31608357 DOI: 10.1093/ajh/hpz169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/24/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Good understanding of the pathophysiological mechanism(s) of resistant hypertension (RH) and the relationship to vascular dysfunction is important for optimal blood pressure control. METHODS AND RESULTS The aim of this review article is to summarize the available data on the methods of arterial stiffness assessment, and their usefulness in RH. Several studies that provide information on the noninvasive methods of evaluation of arterial stiffness have been discussed; specifically, pulse wave velocity (PWV) and augmentation index (AIx) tests. Increased arterial stiffness, elevated AIx, and impaired endothelial function all act as indicators and predictors of cardiovascular events in patients with hypertension (HTN). CONCLUSION Our review suggests that PWV and AIx are impaired in patients with severe HTN. Early assessment of these characteristics can potentially be of value in patients with RH.
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Affiliation(s)
- Reem Alsharari
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular technology department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Alena Shantsila
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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Kjeldsen SE, Os I. Poor reproducibility of masked and white coat uncontrolled hypertension: important new information on MUCH and WUCH. Eur Heart J 2019; 41:1572-1574. [DOI: 10.1093/eurheartj/ehz703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Ullevål, and University of Oslo, Institute for Clinical Medicine, Oslo, Norway
| | - Ingrid Os
- Department of Nephrology, Oslo University Hospital, Ullevål, and University of Oslo, Institute for Clinical Medicine, Oslo, Norway
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Lempiäinen PA, Vasunta RL, Bloigu R, Kesäniemi YA, Ukkola OH. Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up. Blood Press 2019; 28:300-308. [PMID: 31092019 DOI: 10.1080/08037051.2019.1615369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Non-dipping blood pressure (BP) pattern has been associated with metabolic changes and cardiovascular events. With regard of diabetes, studies are scarce. Our aim was to investigate if there is an association between changes in dipping patterns and incidence of diabetes. Materials and methods: A 24-h ambulatory BP measurement was recorded in addition to other laboratory measurements, and a questionnaire and physical examination were carried out in the baseline study and after 21-year follow-up among a study population (n = 449) consisting of randomly selected middle-aged Finnish females and males without diabetes. Results: 128 (28.5%) developed diabetes during the follow-up. The incidence of new-onset diabetes was the highest, 41.0%, among those subjects who were non-dippers (their systolic BP declined <10% from daytime to nighttime) in the baseline and also in the follow-up study, while the incidence of diabetes was 19.6% in the dipper - dipper (a nighttime decline of systolic BP 10% or more) group (p = 0.003). The difference remained statistically significant after adjustment with age, sex, body mass index, fasting glucose, triglycerides, and insulin levels, smoking status, 24-h mean systolic BP, high-sensitivity C-reactive protein, estimated glomerular filtration and diuretics use. In logistic regression analysis, the non-dipper - non-dippers were at higher risk of diabetes compared with dipper - dipper group (OR = 2.27, 95% CI: 1.13-4.56, p = 0.022). Conclusions: Our prospective study shows that there is an independent association between non-dipping BP pattern and the incidence of diabetes in a 21-year follow-up.
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Affiliation(s)
- Päivi A Lempiäinen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Riitta-Liisa Vasunta
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Risto Bloigu
- Medical Informatics and Statistics Research Group, University of Oulu , Oulu , Finland
| | - Y Antero Kesäniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
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Wang Y, Zhang DY, Guo QH, Cheng YB, Huang QF, Sheng CS, Xu TY, Wang JG, Li Y. Short-term reproducibility of the 24-h ambulatory monitoring of brachial and central hemodynamics in untreated Chinese. Blood Press 2019; 28:250-257. [PMID: 31056948 DOI: 10.1080/08037051.2019.1612707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: Advanced technology allows non-invasive monitoring of the 24-h brachial and central hemodynamics simultaneously. However, related reproducibility data was limited in White patients. We therefore explored if the novel measurements would be reproducible in Chinese. Methods: From February 2017 to January 2018, 152 untreated patients who were suspected of hypertension and referred for ambulatory blood pressure (BP) monitoring were recruited. Ambulatory BP monitoring was repeated within one month (median, 12.5 days) using the Mobil-O-Graph monitors (IEM, Germany). Reproducibility was assessed as the intra-class correlation coefficient (ICC), coefficient of variation (CV), and repeatability coefficient (RC). Results: The 152 participants (average age, 58.6 years) included 54 men and 98 women. The first and second means of the ambulatory brachial and central BPs, pulse wave velocity (PWV), augmentation pressure, augmentation index (AIx) and AIx at a heart rate of 75 beats per minute (AIx@75) were all similar (p ≥ 0.065), except that the repeated daytime and 24-h brachial and central systolic BPs and pulse pressure slightly differed by approximately 1-2 mmHg (p ≤ 0.011). ICC ranged from 0.70 to 0.94 for all ambulatory BPs and ≥0.91 for the arterial measurements. CV was in the range from 5.0% to 10.3% for all BPs and PWV measurements, and from 15.5% to 22.3% for AIx and AIx@75. RC expressed as percentages of maximal variation was <15% for the PWVs and ranged from 25.5% to 54.7% for BPs, AIx and AIx@75. Conclusions: The 24-h ambulatory brachial and central BPs and arterial measurements were reproducible within a short time period in Chinese, and could therefore be used in clinical practice and research settings.
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Affiliation(s)
- Ying Wang
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Dong-Yan Zhang
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Qian-Hui Guo
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Yi-Bang Cheng
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Qi-Fang Huang
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Chang-Sheng Sheng
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Ting-Yan Xu
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Ji-Guang Wang
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Yan Li
- a Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
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Tosun V, Korucuk N, Kılınç AY, Uygun T, Altekin RE, Güntekin Ü, Ermiş C. Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P-wave dispersion and P terminal force. Echocardiography 2018; 35:1318-1325. [DOI: 10.1111/echo.14041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Veysel Tosun
- Department of Cardiology; Sanliurfa Education and Research Hospital; Sanliurfa Turkey
| | - Necmettin Korucuk
- Department of Cardiology; Private Medical Park Hospital; Antalya Turkey
| | - Ali Yaşar Kılınç
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Turgut Uygun
- Department of Cardiology; Sanliurfa Education and Research Hospital; Sanliurfa Turkey
| | - Refik Emre Altekin
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Ünal Güntekin
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Cengiz Ermiş
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
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Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS) : Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH). Clin Auton Res 2018; 28:355-362. [PMID: 29766366 PMCID: PMC6097730 DOI: 10.1007/s10286-018-0529-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which falls in the upright position owing to impaired autonomic regulation. A committee was formed to reach consensus among experts on the definition and diagnosis of nSH in the context of cardiovascular autonomic failure. METHODS As a first and preparatory step, a systematic search of PubMed-indexed literature on nSH up to January 2017 was performed. Available evidence derived from this search was discussed in a consensus expert round table meeting in Innsbruck on February 16, 2017. Statements originating from this meeting were further discussed by representatives of the American Autonomic Society and the European Federation of Autonomic Societies and are summarized in the document presented here. The final version received the endorsement of the European Academy of Neurology and the European Society of Hypertension. RESULTS In patients with neurogenic orthostatic hypotension, nSH is defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, measured after at least 5 min of rest in the supine position. Three severity degrees are recommended: mild, moderate and severe. nSH may also be present during nocturnal sleep, with reduced-dipping, non-dipping or rising nocturnal BP profiles with respect to mean daytime BP values. Home BP monitoring and 24-h-ambulatory BP monitoring provide relevant information for a customized clinical management. CONCLUSIONS The establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.
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Kjeldsen SE, Stenehjem A, Os I, Van de Borne P, Burnier M, Narkiewicz K, Redon J, Agabiti Rosei E, Mancia G. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25:333-336. [PMID: 27644446 DOI: 10.1080/08037051.2016.1236329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The European Society of Hypertension recommend the following main rules for treatment of hypertension in elderly and octogenarians: 1) In elderly hypertensives with SBP ≥ 160 mmHg there is solid evidence to recommend reducing SBP to between 140 mmHg and 150 mmHg. 2) In fit elderly patients less than 80 years old treatment may be considered at SBP ≥ 140 mmHg with a target SBP < 140 mmHg if treatment is well tolerated. 3) In fit individuals older than 80 years with an initial SBP ≥ 160 mmHg it is recommended to reduce SBP to between 150 mmHg and 140 mmHg. 4) In frail elderly patients, it is recommended to base treatment decisions on comorbidity and carefully monitor the effects of treatment. 5) Continuation of well-tolerated antihypertensive treatment should be considered when a treated individual becomes octogenarian. 6) All hypertensive agents are recommended and can be used in the elderly, although diuretics and calcium antagonists may be preferred in isolated systolic hypertension.
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Affiliation(s)
- Sverre E Kjeldsen
- a Departments of Cardiology and Nephrology , Oslo University Hospital , Ullevål.,b Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Aud Stenehjem
- a Departments of Cardiology and Nephrology , Oslo University Hospital , Ullevål
| | - Ingrid Os
- a Departments of Cardiology and Nephrology , Oslo University Hospital , Ullevål.,b Faculty of Medicine , University of Oslo , Oslo , Norway
| | | | - Michel Burnier
- d Service of Nephrology and Hypertension , Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Krzysztof Narkiewicz
- e Department of Hypertension and Diabetology , Medical University of Gdansk , Poland
| | - Josep Redon
- f Department of Internal Medicine , Hospital Clinico, University of Valencia , Valencia , Spain
| | - Enrico Agabiti Rosei
- g Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
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Comment on 'Time of administration important? Morning versus evening dosing of valsartan'. J Hypertens 2016; 33:663. [PMID: 25629365 DOI: 10.1097/hjh.0000000000000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Sarafidis PA, Lazaridis AA, Imprialos KP, Georgianos PI, Avranas KA, Protogerou AD, Doumas MN, Athyros VG, Karagiannis AI. A comparison study of brachial blood pressure recorded with Spacelabs 90217A and Mobil-O-Graph NG devices under static and ambulatory conditions. J Hum Hypertens 2016; 30:742-749. [DOI: 10.1038/jhh.2016.11] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/17/2015] [Accepted: 10/14/2015] [Indexed: 11/09/2022]
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13
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Çağlı K, Turak O, Canpolat U, Özcan F, Tok D, Mendi MA, Öksüz F, Siriopol D, Veisa G, Covic A, Kanbay M. Association of Serum Uric Acid Level With Blood Pressure Variability in Newly Diagnosed Essential Hypertension. J Clin Hypertens (Greenwich) 2015; 17:929-35. [PMID: 26252718 PMCID: PMC8031696 DOI: 10.1111/jch.12641] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/22/2015] [Accepted: 05/29/2015] [Indexed: 11/30/2022]
Abstract
Serum uric acid (UA) is independently associated with hypertension and blood pressure (BP) variability (BPV) is associated with cardiovascular events and mortality in hypertensive patients. The aim of the present study was to assess the association of serum UA with BPV in 300 untreated essential hypertension patients (mean age 57.3±13.6 years). BPV was quantified as the standard deviation (SD) of the 24-hour, daytime, and nighttime mean values obtained by using ambulatory BP monitoring. In correlation analysis, log UA values were found to be positively correlated with 24-hour systolic BPV and nighttime systolic and diastolic BPV (Pearson coefficients of 0.246, 0.280, and 0.353, respectively; P<.001 for all). In multivariate analysis, log UA had an independent association with 24-hour systolic BPV and nighttime systolic and diastolic BPV. This study show for the first time that increased serum UA is independently associated with BPV in untreated essential hypertension patients.
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Affiliation(s)
- Kumral Çağlı
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Osman Turak
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Uğur Canpolat
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Fırat Özcan
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Derya Tok
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Mehmet Ali Mendi
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Fatih Öksüz
- Cardiology ClinicTürkiye Yuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center‘C.I. PARHON’ University Hospital, and ‘Grigore T. Popa’ University of MedicineIasiRomania
| | - Gabriel Veisa
- Nephrology Clinic, Dialysis and Renal Transplant Center‘C.I. PARHON’ University Hospital, and ‘Grigore T. Popa’ University of MedicineIasiRomania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center‘C.I. PARHON’ University Hospital, and ‘Grigore T. Popa’ University of MedicineIasiRomania
| | - Mehmet Kanbay
- Division of NephrologyDepartment of MedicineKoc University School of MedicineIstanbulTurkey
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Fadl Elmula FEM, Hoffmann P, Larstorp AC, Fossum E, Brekke M, Kjeldsen SE, Gjønnæss E, Hjørnholm U, Kjær VN, Rostrup M, Os I, Stenehjem A, Høieggen A. Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension. Hypertension 2014; 63:991-9. [DOI: 10.1161/hypertensionaha.114.03246] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Fadl Elmula M. Fadl Elmula
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Pavel Hoffmann
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Anne C. Larstorp
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Eigil Fossum
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Magne Brekke
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Sverre E. Kjeldsen
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Eyvind Gjønnæss
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Ulla Hjørnholm
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Vibeke N. Kjær
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Morten Rostrup
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Ingrid Os
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Aud Stenehjem
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Aud Høieggen
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
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2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2014; 31:1281-357. [PMID: 23817082 DOI: 10.1097/01.hjh.0000431740.32696.cc] [Citation(s) in RCA: 3280] [Impact Index Per Article: 328.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mena LJ, Maestre GE, Hansen TW, Thijs L, Liu Y, Boggia J, Li Y, Kikuya M, Björklund-Bodegård K, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Filipovsky J, Lmai Y, Wang J, O'Brien E, Staessen JA. How many measurements are needed to estimate blood pressure variability without loss of prognostic information? Am J Hypertens 2014; 27:46-55. [PMID: 23955605 DOI: 10.1093/ajh/hpt142] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Average real variability (ARV) is a recently proposed index for short-term blood pressure (BP) variability. We aimed to determine the minimum number of BP readings required to compute ARV without loss of prognostic information. METHODS ARV was calculated from a discovery dataset that included 24-hour ambulatory BP measurements for 1,254 residents (mean age = 56.6 years; 43.5% women) of Copenhagen, Denmark. Concordance between ARV from full (≥80 BP readings) and randomly reduced 24-hour BP recordings was examined, as was prognostic accuracy. A test dataset that included 5,353 subjects (mean age = 54.0 years; 45.6% women) with at least 48 BP measurements from 11 randomly recruited population cohorts was used to validate the results. RESULTS In the discovery dataset, a minimum of 48 BP readings allowed an accurate assessment of the association between cardiovascular risk and ARV. In the test dataset, over 10.2 years (median), 806 participants died (335 cardiovascular deaths, 206 cardiac deaths) and 696 experienced a major fatal or nonfatal cardiovascular event. Standardized multivariable-adjusted hazard ratios (HRs) were computed for associations between outcome and BP variability. Higher diastolic ARV in 24-hour ambulatory BP recordings predicted (P < 0.01) total (HR = 1.12), cardiovascular (HR = 1.19), and cardiac (HR = 1.19) mortality and fatal combined with nonfatal cerebrovascular events (HR = 1.16). Higher systolic ARV in 24-hour ambulatory BP recordings predicted (P < 0.01) total (HR = 1.12), cardiovascular (HR = 1.17), and cardiac (HR = 1.24) mortality. CONCLUSIONS Forty-eight BP readings over 24 hours were observed to be adequate to compute ARV without meaningful loss of prognostic information.
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Affiliation(s)
- Luis J Mena
- Departamento de Informática, Universidad Politécnica de Sinaloa, Mazatlán, México
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Kjeldsen SE, Narkiewicz K, Oparil S, Hedner T. Blood pressure lowering effect of renal sympathetic denervation or placebo? - building expectations for Symplicity-HTN 3. Blood Press 2013; 22:279-81. [DOI: 10.3109/08037051.2013.840445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Fadl Elmula FEM, Hoffmann P, Fossum E, Brekke M, Gjønnæss E, Hjørnholm U, Kjær VN, Rostrup M, Kjeldsen SE, Os I, Stenehjem AE, Høieggen A. Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure. Hypertension 2013; 62:526-32. [PMID: 23836798 DOI: 10.1161/hypertensionaha.113.01452] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatment-resistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treatment-resistant hypertension was defined as office systolic BP>140 mm Hg, despite maximally tolerated doses of ≥ 3 antihypertensive drugs, including a diuretic. In addition, ambulatory daytime systolic BP>135 mm Hg was required after witnessed intake of antihypertensive drugs to qualify. RDN (n=6) was performed with Symplicity Catheter System. The mean office and ambulatory BPs remained unchanged at 1, 3, and 6 months in the 6 patients, whereas there was no known change in antihypertensive medication. Two patients, however, had a fall in both office and ambulatory BPs. Our findings question whether BP falls in response to RDN in patients with true treatment-resistant hypertension. Additional research must aim to verify potential BP lowering effect and identify a priori responders to RDN before this invasive method can routinely be applied to patients with drug-resistant hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.
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Affiliation(s)
- Fadl Elmula Mohamed Fadl Elmula
- Section for Cardiovascular and Renal Research, Department of Cardiology, Medical Clinic, Oslo University Hospital, Ullevål, Oslo, Norway
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Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159-219. [PMID: 23771844 DOI: 10.1093/eurheartj/eht151] [Citation(s) in RCA: 3168] [Impact Index Per Article: 288.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Giuseppe Mancia
- Centro di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca, Milano, Italy.
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Kjeldsen SE, Os I, Mahfoud F. Treatment resistant hypertension and renal sympathetic denervation: drug adherence and the consolidation of blood pressure lowering effects. EUROINTERVENTION 2013; 9 Suppl R:R7-9. [DOI: 10.4244/eijv9sra1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Muxfeldt ES, Fiszman R, de Souza F, Viegas B, Oliveira FC, Salles GF. Appropriate Time Interval to Repeat Ambulatory Blood Pressure Monitoring in Patients With White-Coat Resistant Hypertension. Hypertension 2012; 59:384-9. [DOI: 10.1161/hypertensionaha.111.185405] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Resistant hypertension is defined as uncontrolled office blood pressure, despite the use of ≥3 antihypertensive drugs. Ambulatory blood pressure monitoring (ABPM) is mandatory to diagnose 2 different groups, those with true and white-coat resistant hypertension. Patients are found to change categories between controlled/uncontrolled ambulatory pressures without changing their office blood pressures. In this way, ABPM should be periodically repeated. The aim of this study was to evaluate the most appropriate time interval to repeat ABPM to assure sustained blood pressure control in patients with white-coat resistant hypertension. This prospective study enrolled 198 patients (69% women; mean age: 68.9±9.9 years) diagnosed as white-coat resistant hypertension on ABPM. Patients were submitted to a second confirmatory examination 3 months later and repeated twice at 6-month intervals. Statistical analyses included Bland-Altman repeatability coefficients and multivariate logistic regression. Mean office blood pressure was 163±20/84±17 mm Hg, and mean 24-hour blood pressure was 118±8/66±7 mm Hg. White-coat resistant hypertension diagnosis presented a moderate reproducibility and was confirmed in 144 patients after 3 months. In the third and fourth ABPMs, 74% and 79% of patients sustained the diagnosis. In multivariate regression, a daytime systolic blood pressure ≤115 mm Hg in the confirmatory ABPM triplicated the chance of white-coat resistant hypertension status persistence after 1 year. In conclusion, a confirmatory ABPM is necessary after 3 months of the first white-coat–resistant hypertension diagnosis, and the procedure should be repeated at 6-month intervals, except in patients with daytime systolic blood pressure ≤115 mm Hg, in whom it may be repeated annually.
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Affiliation(s)
- Elizabeth S. Muxfeldt
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Fiszman
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabio de Souza
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Viegas
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda C. Oliveira
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gil F. Salles
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Orthostatic hypotension is associated with nocturnal change in systolic blood pressure. Am J Hypertens 2012; 25:159-64. [PMID: 22012209 DOI: 10.1038/ajh.2011.191] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The circadian pattern of blood pressure (BP) has yet to be defined among individuals with orthostatic hypotension (OH). The objective of this study was to evaluate whether OH is associated with nocturnal change in systolic BP. METHODS In a prospective study, we evaluated patients who were referred for 24-h ambulatory blood pressure monitoring (ABPM). All subjects underwent orthostatic BP testing before recording their respective 24-h ABPM. RESULTS The study includes 185 subjects, 114 males, mean age 58 ± 18 years (range 19-89). Participants were classified, based on pattern of systolic BP changes at night, as dippers (greater than 10% decrease; n = 74), nondippers (0-10% decrease; n = 77), and reverse-dippers (increase; n = 34). Nineteen patients (10.3%) had OH. Almost all participants with OH (95%) had an abnormal diurnal BP pattern, and most of them (58%) were reverse-dippers, whereas only 56% of the participants without OH had an abnormal diurnal BP variation, and only 14% were reverse-dippers (P < 0.001). Systolic BP decreased with upright posture by 12 and 2 mm Hg in the reverse-dippers and the nondippers, respectively, and increased by 2 mm Hg in the dippers (P < 0.001). Postural changes in systolic BP were inversely related to the changes between day and night BP readings(r = -0.43; P < 0.01). In a multivariate linear regression analysis, orthostatic BP change, use of ≥2 antihypertensive drugs and female sex were related to nocturnal BP changes. CONCLUSIONS The decrease in BP during upright posture may be a marker of nondipping or reverse-dipping pattern of diurnal BP.
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Abstract
Elevated large artery stiffness and pulse pressure have emerged as important risk factors for cardiovascular disease. The genders differ in large artery biomechanical properties throughout the lifespan with females displaying higher stiffness than males during the prepubertal years and a dramatic increase after menopause. Males on the other hand experience an increase in arterial stiffness postpuberty and a linear increase thereafter, suggesting that females have intrinsically stiffer large arteries than males, but that such effects are mitigated by sex steroids during the reproductive years. This review discusses anthropometric and sex steroid influences on gender differences in large artery stiffness and pressure dynamics from childhood to senescence. In particular, the sex-specific effects of estrogen, progesterone and testosterone on vascular structure and function and how these influence arterial stiffness are explored. These factors may contribute in part to the observed gender differences in the pathophysiology and clinical manifestations of cardiovascular disease.
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Abstract
Blood pressure (BP) assessment may be vulnerable to bias by increased BP variability. Uncertainty in determining BP control is inherent to the clinic setting. We analyzed a registry of 3949 patients referred for ambulatory BP monitoring. The difference between clinic and ambulatory readings was plotted against ambulatory BP variability, assessed by standard deviation. In addition, BP variability of patients with clinic and awake ambulatory hypertension was compared with that of patients with controlled BP and sustained hypertension, respectively. The average clinic-ambulatory systolic BP difference was 5 ± 17/3 ± 9 mm Hg. Patients with >10-mm Hg systolic difference had higher systolic ambulatory BP standard deviation (14.9 ± 4.2 mm Hg) compared to patients with a difference of 0 to 10-mm Hg (standard deviation 12.5 ± 3.7 mm Hg). Patients with masking (negative clinic-ambulatory BP difference) also had comparatively higher standard deviation (14.4 ± 4.9 mm Hg P<0.0001). Greater ambulatory BP variability carried increased risk for both false diagnosis of hypertension (odds ratio (OR): 2.09, 95% confidence interval (CI): 1.58-2.76), and missed clinic diagnosis of hypertension (OR: 1.86, 95% confidence interval: 1.48-2.33). The former was more striking in women, in whom high variability carried greater odds for false diagnosis of hypertension (OR: 2.76, 95% confidence interval: 1.96-3.89). Thus, clinic misjudgment of BP control may stem in part from high BP variability. Women with high BP variability are more susceptible to hypertension misdiagnosis. It is possible that high BP variability contributes to the increased cardiovascular risk related to both masked hypertension and white coat hypertension.
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Kanno A, Metoki H, Kikuya M, Terawaki H, Hara A, Hashimoto T, Asayama K, Inoue R, Shishido Y, Nakayama M, Totsune K, Ohkubo T, Imai Y. Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study. Hypertens Res 2010; 33:1192-8. [DOI: 10.1038/hr.2010.139] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Effect of hospitalization on 24-h ambulatory blood pressure of hypertensive patients. Hypertens Res 2010; 33:995-9. [DOI: 10.1038/hr.2010.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Van Berge-Landry HM, Bovbjerg DH, James GD. The reproducibility of ethnic differences in the proportional awake-sleep blood pressure decline among women. Am J Hum Biol 2010; 22:325-9. [PMID: 19844896 DOI: 10.1002/ajhb.20993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A growing body of evidence indicates that African Americans (AA), on average, have a smaller proportional decline in blood pressure (BP) from waking to sleep than European Americans (EA), but this difference is largely based on correlational data from a single assessment day. The persistence of this difference over repeated sampling is not well established. The purpose of this study was to evaluate whether ethnic differences in the awake-sleep BP decline between AA and EA persisted over three monthly assessments. The subjects were 47 AA (age = 39.7 +/- 8.7) and 92 EA (age = 37.4 +/- 9.2) normotensive women. Subjects had 24-h ambulatory BP monitoring done on midweek workdays at 1-month intervals for three consecutive months. The proportional decline in BP was calculated as follows: (average awake - average sleep)/average sleep. The persistence of ethnic differences was evaluated using repeated-measures ANCOVA and by examining Bland-Altman plots. The ANCOVA results revealed that overall, the proportional decline of AA women was less than that of EA women for both SBP (P < 0.038) and DBP (P < 0.083), consistent with previous research, and that there were also no significant ethnic differences by monthly assessment. Bland-Altman plots revealed that overall and by ethnicity, the proportional decline in BP among individual subjects over the 3 months was also reproducible. These results suggest that the ethnic difference in awake-sleep BP between AA and EA women persists over time and that the awake-sleep decline in BP among individuals, whether AA or EA, is also reproducible.
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Affiliation(s)
- Helene M Van Berge-Landry
- Institute for Primary and Preventative Health Care, Department of Anthropology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, USA.
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Manner IW, Baekken M, Oektedalen O, Sandvik L, Os I. Effect of HIV duration on ambulatory blood pressure in HIV-infected individuals with high office blood pressure. Blood Press 2010; 19:188-95. [DOI: 10.3109/08037051.2010.483055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Reproducibility of ambulatory blood pressure in treated and untreated hypertensive patients. J Hypertens 2010; 28:918-24. [DOI: 10.1097/hjh.0b013e3283378477] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yilmaz MB, Yalta K, Turgut OO, Yilmaz A, Yucel O, Bektasoglu G, Tandogan I. Sleep quality among relatively younger patients with initial diagnosis of hypertension: Dippers versus non‐dippers. Blood Press 2009; 16:101-5. [PMID: 17612908 DOI: 10.1080/08037050701343225] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered "non-dippers". We aimed to determine if there was any association between the non-dipping status and sleep quality, designed a cross-sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. METHODS Seventy-five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti-hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. RESULTS There were 42 non-dipper patients (mean age = 47.5+/-11.9 years, 24 male/18 female), as a definition, 31 dipper hypertensive patients (mean age = 48.5+/-12.8 years, 21 male/10 female) and two with white coat hypertension. Daytime systolic and diastolic mean BPs were not significantly different between the two groups. Night-time mean systolic and diastolic BPs were significantly higher in non-dippers compared with dippers. PSQI scores, globally, were significantly higher in non-dippers compared with dippers. Total PSQI score was not correlated with body mass index. It was noticed that, individually, sleep quality, sleep efficiency and sleep disturbance scores were significantly higher in non-dippers. Being a poor sleeper in terms of high PSQI score (total score>5) was associated with 2.955-fold increased risk of being a non-dipper (95% confidence interval 1.127-7.747). CONCLUSION We showed that the risk of having non-dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers. We think that evaluating sleeping status and sleep quality among the hypertensive population may help unmask non-dipper hypertension, enabling physicians to treat appropriately.
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Affiliation(s)
- Mehmet Birhan Yilmaz
- Cumhuriyet University, Faculty of Medicine, Department of Cardiology, Sivas, Turkey.
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Stenehjem AE, Os I. Clinical utility and applicability of smoothness index, normalized smoothness index and individualized RDH index during treatment of essential hypertension. Blood Press 2009; 15:281-90. [PMID: 17380846 DOI: 10.1080/08037050600996628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The purpose of this study was to assess the clinical utility of the smoothness index (SI) and normalized SI (SIn), measures of duration and homogeneity of blood pressure (BP) reduction, during an observation period without antihypertensive therapy followed by a treatment period using dihydropyridines (DHP) in 54 newly diagnosed and previously untreated subjects (age 46.9 +/- 9.1 years) with essential hypertension. In addition, we aimed to describe the reduction-duration-homogeneity (RDH) index for statistical assessment of the BP reduction in the individual patient. Twenty-four-hour BP was lowered during treatment (139.2 +/- 13.9/ 91.0 +/- 7.6 mmHg vs 130.9 +/- 11.3/85.2 +/- 5.2 mmHg, p < 0.001/p = 0.001). SI showed great interindividual variation, and increased from zero to 0.9 +/- 0.8 (systolic BP) and 0.8 +/- 0.7 (diastolic BP) after treatment (p < 0.001 for both), similar results were obtained for SI(n). The RDH index revealed BP reduction in agreement with the change in individual 24-h, daytime and night-time BP. Although SI and SI(n) may add important information regarding the homogeneity of the antihypertensive effect in a group of patients, and the RDH index for the individual patient, conclusions regarding antihypertensive efficacy can be obtained from assessment of the 24-h, daytime and night-time BP changes and ambulatory BP profiles. Based on our findings, we do not recommend the use of SI or RDH index in the clinical practice.
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Affiliation(s)
- Aud-E Stenehjem
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway.
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A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood. Hypertens Res 2009; 32:404-10. [PMID: 19325561 DOI: 10.1038/hr.2009.32] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluates the tracking stability of office blood pressure (BP), ambulatory BP (ABP), BP variability (BPV) and nocturnal BP drops (dipping) from childhood to early adulthood, and their dependence on ethnicity, gender and family history (FH) of essential hypertension (EH). Generalized estimating equations (GEEs) were used to estimate tracking coefficients for 295 European Americans and 252 African Americans, with a maximum of 12 measurements over a 15-year period. Office BP and ABP had moderate-to-relatively high tracking coefficients (r= 0.30-0.59; P<or=0.001). Twenty-four hour readings tracked better than office readings for diastolic BP (DBP; 0.57 vs. 0.46, P=1.72 x 10(-6)) and pulse pressure (PP) (0.59 vs. 0.51, P=2.70 x 10(-4)), and equally well for systolic BP (SBP; 0.55 vs. 0.54, P=0.805). Daytime readings tracked better than their night-time counterparts for SBP (0.50 vs. 0.37, P=7.62 x 10(-13)), DBP (0.49 vs. 0.30, P=7.98 x 10(-32)) and PP (0.55 vs. 0.50, P=0.0061). All BPV (r=0.08-0.28; P<or=0.001) and dipping measures (r=0.07-0.12; odds ratio, 1.60-1.73; P<or=0.001) had low tracking coefficients. Males had significantly higher tracking stability for office SBP, DBP and ambulatory PP than females (P<0.01). Subjects with a positive FH of EH had significantly higher tracking stability for daytime and night-time DBP and dipping indexed by continuous variables than those with a negative FH (P<0.001). No significant ethnic differences were observed. The high tracking stability of 24-h ABP highlights the importance of using ambulatory BP monitoring in both research and clinical settings.
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Different classifications of nocturnal blood pressure dipping affect the prevalence of dippers and nondippers and the relation with target-organ damage. J Hypertens 2008; 26:691-8. [PMID: 18327078 DOI: 10.1097/hjh.0b013e3282f4225f] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed how different definitions of the awake and asleep periods and use of various blood pressure (BP) indices affect the extent of the nocturnal BP dip, the prevalence of dippers and nondippers, their respective reproducibilities and the relation of nondipping with target-organ damage. METHODS We performed 24-h ambulatory BP monitoring twice and determined the left ventricular mass index and urinary albumin excretion as indices of target-organ damage in 150 hypertensive patients (off-medication). Awake and asleep periods were assessed using fixed and diary time methods, covering all readings available (wide) or excluding morning and evening transition hours (narrow). Nondipping (BP dip < 10%) was established for systolic BP and diastolic BP, their combinations (and/or), and mean arterial pressure. RESULTS The different awake-asleep definitions caused significant variation in both the extent of the BP dip and the number of dippers and nondippers in comparison with the wide diary definition (i.e. use of actual awake and sleep periods). The prevalences of dippers and nondippers also varied significantly with the BP index. Reproducibility analyses of the BP dip and the dipping status yielded repeatability coefficients (expressed as percentages of nearly maximal variation) between 42.39 and 48.71%, and kappa values between 0.323 and 0.459, respectively. Some classifications, but not all, discriminated significantly between consistent dippers and nondippers in terms of left ventricular mass index or urinary albumin excretion. CONCLUSIONS Use of different definitions of awake-asleep and BP indices affects significantly the classification of nocturnal BP dipping and its relation with hypertensive target-organ damage.
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Intensified monitoring of circadian blood pressure and heart rate before and after intravitreous injection of bevacizumab: preliminary findings of a pilot study. Int Ophthalmol 2008; 29:213-24. [DOI: 10.1007/s10792-008-9221-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
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Stenehjem AE, Bjørnerheim R, Os I. From treatment to organ damage; a 5-year follow-up study of ambulatory blood pressure in essential hypertension. Diversity between development of left ventricular hypertrophy and urinary albumin excretion. Blood Press 2007; 16:87-94. [PMID: 17612906 DOI: 10.1080/08037050701287703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study aimed to assess blood pressure (BP) profile, BP control, left ventricular hypertrophy (LVH) and albumin/creatinine ratio (ACR) in urine after 5 years of antihypertensive treatment in subjects with newly diagnosed essential hypertension. Fifty-four subjects were included and prescribed calcium-channel blocker in monotherapy during an 8-week period, and later 46 subjects (34 men, 12 women, 53.1+/-8.6 years) attended a 5-year follow-up visit at the hypertension clinic. They underwent 24-h ambulatory BP monitoring (ABPM), ECG and ACR at baseline and after 5 years. Echocardiography performed after 5 years revealed LVH in 54% of the subjects, while there was no change in Cornell product, an ECG criterion for LVH. BP control assessed by office BP was 33%, and only 20% using 24-h ABP. Night-time fall in BP was significantly attenuated from 13.2+/-5.9% to 10.7+/-6.0%, p = 0.01 for systolic BP and from 13.3+/-6.9% to 9.8+/-6.8%, p = 0.004 for diastolic BP. The number of dippers decreased after 5 years, but this did not reach statistical significance. In contrast to the lack of change in Cornell product, there was a significant decrease in ACR, and 93% of the subjects had ACR<1.5 mg/mmol after 5 years compared with 57% at baseline (p<0.001). Thus, ABPM should be encouraged in the follow-up of all hypertensive subjects as it reveals better inadequate BP control than office BP and gives information about night-time fall, as this may explain the high prevalence of LVH. The diversity in development of LVH and ACR during antihypertensive treatment needs to be verified.
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Affiliation(s)
- Aud-E Stenehjem
- Department of Nephrology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
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Abstract
PURPOSE OF REVIEW The limitations affecting office blood pressure readings have spurred the development of techniques for measuring blood pressure out of a clinical environment. The increasing use of home and ambulatory blood pressure monitoring has allowed the identification of specific blood pressure patterns related either to a discrepancy between office and out-of-office blood pressure or to alterations in the 24-h blood pressure profiles. This review offers an update on the most recent data published on the above issues. RECENT FINDINGS A critical overview is provided on recent data published on blood pressure patterns suggested to have clinical relevance. These include white coat hypertension, the so-called masked hypertension, enhanced overall blood pressure variability over 24 h, a steeper morning blood pressure surge and a blunted or an excessive blood pressure fall at night. SUMMARY All of these different conditions have been variably reported to carry prognostic implications, and may represent specific targets for antihypertensive treatment. Their identification and management require information on out-of-office blood pressure, which suggests that self blood pressure monitoring at home or 24-h ambulatory blood pressure monitoring should be used more frequently in clinical practice, following the indications issued in recent guidelines.
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Affiliation(s)
- Gianfranco Parati
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
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Verberk WJ, Kroon AA, Thien T, Lenders JWM, van Montfrans GA, Smit AJ, de Leeuw PW. Prevalence of the white-coat effect at multiple visits before and during treatment. J Hypertens 2006; 24:2357-63. [PMID: 17082716 DOI: 10.1097/01.hjh.0000251894.17132.54] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence and persistence of the white-coat effect (WCE) and white-coat hypertension (WCH) on multiple blood pressure measurement occasions in hypertensive patients with and without treatment. DESIGN Essential hypertensive patients in whom we took office blood pressure measurements (OBPM) at eight visits (three readings per visit) performed self blood pressure measurements (SBPM) for 1 week prior to each visit (42 readings per week) over a period of 1 year. All measurements were performed with the same automatic device (Omron 705CP). In addition, 24-h ambulatory blood pressure monitoring (ABPM) was performed at the start and at the end of the study. At the start, patients did not use any medication but on subsequent visits they were treated on the basis of their SBPM values. WCH was defined as an OBPM-value > or = 140 and/or 90 mmHg and a SBPM or daytime ABPM value < 135/85 mmHg. This definition was used irrespective of treatment. We also determined the prevalence of a substantial WCE (OBPM 20 mmHg systolic or 10 mmHg diastolic higher than SBPM or daytime ABPM). SETTING Patients were recruited at hospital or general practice. PATIENTS A total of 163 mild-to-moderate essential hypertensive patients with a mean age of 56 years (56% males). RESULTS At eight blood pressure (BP) measurement occasions, 75% of all patients had a substantial WCE at least once, while 57% had WCH at least once. One-third of the patients consistently had a substantial WCE and 14% consistently had WCH on three or more occasions The magnitude of the WCE was significantly related to the height of blood pressure in treated but not in untreated patients. CONCLUSION In some patients, WCH or a substantial WCE occurs consistently on multiple OBPM visits. Especially in untreated patients, the magnitude of the WCE varies widely among individuals. These results support the incorporation of SBPM and/or ABPM into optimal management of hypertension, not only to prevent misdiagnosis in untreated patients but also to determine the need for adjusting antihypertensive therapy in treated subjects.
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Affiliation(s)
- Willem J Verberk
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University and Department of Internal Medicine, University Hospital Maastricht, Nijmegen, The Netherlands
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Sundaram B, Holley D, Cornélissen G, Naik D, Hanumansetty R, Singh R, Otsuka K, Halberg F. Circadian and circaseptan (about-weekly) aspects of immigrant Indians' blood pressure and heart rate in California, USA. Biomed Pharmacother 2005; 59 Suppl 1:S76-85. [PMID: 16275512 PMCID: PMC2576448 DOI: 10.1016/s0753-3322(05)80014-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Time structurally (chronomically) interpreted half-hourly monitoring of blood pressure (BP) and heart rate (HR) for at least 7 days and preferably for 17 days is recommended, separately for a diagnosis of BP disorders and when necessary again for the same or longer spans for treatment, whenever a positive diagnosis of a disorder is made. In this study, 30 clinically healthy subjects underwent 7-day monitoring and provided a series of findings, including the detection of Circadian Hyper-Amplitude-Tension (CHAT), that is blood pressure overswinging, which carries a high risk of hard cardiovascular events. The results specifically bear upon south-east Asian-Indian immigrants. They show that cardiovascular disease risk increases with age, with a positive family history of hypertension and/or other cardiovascular diseases and even with the duration of stay in the USA. A relation to body mass index is also shown. Such monitoring for prehabilitation may eventually reduce the need for rehabilitation.
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Affiliation(s)
- B. Sundaram
- Department of Biological Sciences, San Jose State University, San Jose, CA, USA
| | - D.C. Holley
- Department of Biological Sciences, San Jose State University, San Jose, CA, USA
| | - G. Cornélissen
- Halberg Chronobiology Center, University of Minnesota MMC 8609, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - D. Naik
- Department of Biological Sciences, San Jose State University, San Jose, CA, USA
| | - R. Hanumansetty
- Department of Biological Sciences, San Jose State University, San Jose, CA, USA
| | - R.B. Singh
- Medical Hospital and Research Center, Center of Nutrition and Heart Research, Moradabad, India
| | - K. Otsuka
- Daini Hospital, Tokyo Women’s Medical University, Tokyo, Japan
| | - F. Halberg
- Halberg Chronobiology Center, University of Minnesota MMC 8609, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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