Ambulatory blood pressure monitoring and blood pressure control in patients with coronary artery disease-A randomized controlled trial

Office blood pressure (OBP) is used for diagnosing and treating hypertension but ambulatory blood pressure measurement (ABPM) associates more accurately with patient outcome. BP control is important in secondary prevention but it is unknown whether the use of APBM improves BP-control in this setting. Our objective was to investigate whether physician awareness of ABP after percutaneous coronary intervention (PCI) improved BP-control. Methods: A total of 200 patients performed ABPM before and after their PCI follow-up visit. Patients were randomized to open (O) or concealed (C) ABPM results for the physician at the follow-up visit. The change in ABP and antihypertensive medication in relation to baseline ABP was compared between the two groups. Results: The average OBP (O and C: 128/76 mmHg) and ABP (O: 123/73 mmHg, C: 127/74 mmHg) was well controlled and did not change between the first and second measurement. A slight increase in systolic ABP during night time was observed in the open arm compared to the concealed arm. Among patients with high ABP (>130/80 mm Hg) at baseline more patients in the C compared to O group remained with a high ABP at the end of study 34/44 (77%) vs 19/34 (56%), p = 0.045. There was a positive correlation between baseline systolic ABP and ABP change in both the O (r = 0.41, p < 0.001) and the C (r = 0.24, p = 0.014) groups but the association was steeper in the open group (p = 0.035). In patients with low ABP an increase and in patients with high ABP a decrease in ABP was observed in the O group where more changes in medication were done. Conclusions: ABPM did not lower blood pressure in patients with CAD apart from in those with elevated ABP but led to more relevant changes in antihypertensive treatments. Further studies are needed to answer whether patient outcome is affected.

Improvement of blood pressure control and physicians' management over time in patients with coronary artery disease

BACKGROUND

Patients with coronary artery disease (CAD) are at high risk for secondary CV events. Few studies have been performed concerning the physicians' reactions to high BP in patients with manifest CAD.

AIMS

To compare the prevalence and management of high BP after percutaneous coronary intervention (PCI) in 2011-2012 with that in 2004.

MATERIAL AND METHODS

We identified 300 consecutive patients from 2011-2012 and 167 from 2004 with a follow-up visit after PCI at a University hospital in Sweden. Their medical records were reviewed to collect BP values and physicians' actions in response to an elevated BP at the follow-up visit.

RESULTS

The proportion of patients who had their BP documented increased in 2011-2012 (91%) as compared to 2004 (79%). The proportion of patients with a BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic at the follow-up visit decreased from 55% in 2004 to 42% in 2011-2012 (p = 0.014).

CONCLUSION

BP documentation and control improved from 2004 to 2011-2012 with more patients reaching target BP levels. One of the reasons for the improvements may be the introduction of a secondary preventive unit with cardiovascular specialised nurses who participate in a national quality registry.

Crystallization and crystal packing of recombinant 3 (or 17) beta-hydroxysteroid dehydrogenase from Comamonas testosteroni ATTC 11996

The enzyme 3 (or 17) beta-hydroxysteroid dehydrogenase from Comamonas testosteroni was crystallized. Crystals, of up to 0.6 mm in their longest dimension and suitable for a crystallographic analysis have been obtained by the vapour diffusion method. They belong to the orthorhombic lattice type and diffract to a maximum resolution of 0.23 nm. A final data set obtained by merging data from three crystals resulted in a completeness of 90% with an Rmerge of 6%. A molecular replacement search carried out by using 3 alpha (or 20 beta)-hydroxysteroid dehydrogenase from Streptomyces hydrogenans as a search model allowed us to assign I222 as the correct space group and to propose a model for the crystal packing, with one monomer per asymmetric unit. Thus, the whole unit cell contains two tetramers. The R-factor after rigid body refinement is 48.1%.