Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease

Abstract

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6?±?1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) (r?=?0.23, 0.20; p?=?0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP (r?=?0.19, 0.31; p?=?0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient (β)?=?0.19, 0.34; p?=?0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV.     

Benefits of delapril in hypertensive patients along the cardiovascular continuum

Angiotensin-converting enzyme inhibitors (ACEIs) are the first-line therapy for the treatment of hypertension. However, not all ACEIs are equal. Delapril is a nonsulfhydryl ACEI with unique properties. Delapril has a high lipophilicity and weak bradykinin potentiating action. As a result, delapril has a more potent inhibition capacity of vascular wall angiotensin-converting enzyme activity and a lower incidence of cough than enalapril or captopril. With regard to efficacy, delapril has a long-lasting antihypertensive effect with a trough/peak ratio that is in the upper range of different ACEIs and a positively high smoothness index. Thus, delapril effectively and smoothly reduces blood pressure over 24 h. Moreover, the benefits of delapril are not limited to hypertensive patients, but also in those with microalbuminuria, left ventricular hypertrophy, myocardial infarction or heart failure; delapril appears to be effective and well tolerated.     

Serum uric acid and pre-eclampsia: an update

The association between uric acid (UA) and pre-eclampsia has been known for years, but the prognostic value of UA has been debated. This article will review recent evidences, evaluating UA as a prognostic factor for pre-eclampsia, both in the general population and in women with gestational hypertension, and as a predictor of disease severity and adverse maternal–fetal outcome. Finally, studies investigating UA as a putative pathogenic factor for pre-eclampsia are briefly mentioned.     

Titration of Mechanical Insufflation–Exsufflation Optimal Pressure Combinations in Neuromuscular Diseases by Flow/Pressure Waveform Analysis

IntroductionThe aim of this study was to assess several air-pressure settings for MI–E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40 cmH₂O) in patients with neuromuscular disorders (NMD).MethodsAdults with NMD in whom MI–E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40 cmH₂O or maximum tolerated), and then 4 adding expiratory pressures (?10, ?20, ?30 and ?40 cmH₂O or maximum tolerated) with maximum inspiratory pressure previously achieved.ResultsTwenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40 cmH₂O) were lower than the scored in the individualized steps of the titration protocol (197.7 ± 67 l/min vs 214.2 ± 60 l/min, p < 0.05). Regarding subgroups, mean PCF_max values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6 ± 80 vs 189 ± 66 l/min, p < 0.05).ConclusionThe PCF_max obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI–E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures.     

SHEL事故分析法在ICU获得性压疮预防中的应用研究

目的采用SHEL模式分析ICU医院内获得性压疮发生的原因,以降低其发生率。方法采用SHEL模式分析ICU20例医院内获得性压疮病例并制订对策,比较采取控制措施前、后ICU压疮预防的效果。结果采取控制措施前ICU医院内获得性压疮发生率为6.25%,SHEL模式分析结果为与人员素质和能力有关(S)占30.0%,与硬件有关(H)占20.0%,与临床环境有关(E)占35.0%,与当事人及他人有关(L)占15.0%;采取控制措施后ICU医院内获得性压疮发生率为2.83%,显著低于采取措施前(P<0.05),SHEL模式分析结果为15.4%与S有关、15.4%与H有关、30.8%与E有关、38.4%与L有关。结论应用SHEL模式分析ICU医院内获得性压疮发生的原因,制定有效的措施,对降低ICU医院内获得性压疮的发生率有着积极的意义。     

Physiology of blood pressure relevant to managing hypertension in pregnancy

Purpose: Pregnancy causes physiological changes in maternal organ systems, and blood pressure (BP) is one of the variables affected. This review is focusing on the physiology of BP relevant to the management of hypertension in pregnancy.

Materials and methods: A detailed literature search was performed using electronic databases (including WorldCat, PubMed, MEDLINE, Google Scholar) to retrieve and review reports related to physiology of BP in pregnancy.

Results: During pregnancy, there is vasodilation caused by mediators such as increased levels of progesterone and nitric oxide. The vasodilation leads to a reduction in vascular resistance, BP, and renal blood flow. In compensation, the following postulated events occur: activation of renin-angiotensin-aldosterone axis, resetting of osmotic threshold for thirst, and an increase in the production of vasopressin. Sodium and water conservation ensue to increase the total body water, end-diastolic volume, cardiac output, and BP. The increase in cardiac output incompletely compensates for the decreased vascular resistance, and BP therefore decreases in midpregnancy and returns to prepregnancy level toward term.

Conclusions: An understanding of the physiological changes in BP is essential for appropriate management of pregnancy-related hypertension.