Comparison between casual blood pressure and ambulatory blood pressure monitoring parameters in healthy and hypertensive adolescents

Casual blood pressure measurements were compared with mean ambulatory blood pressure values during wakefulness and sleep in 45 normotensive and 30 hypertensive adolescents of both sexes aged 10-18 years. Two sets of auscultatory casual blood pressure were obtained, one in a pediatric office setting (office blood pressure), performed by the physician, and one in the ambulatory blood pressure monitoring (ABPM) unit, performed by a trained nurse, prior to the initiation of ABPM (pre-ABPM blood pressure). In normotensive and hypertensive subjects of both sexes, the mean office systolic blood pressure (SBP) was lower than the mean pre-ABPM SBP, and the mean office diastolic blood pressure (DBP) was lower than the mean pre-ABPM DBP. In normotensive participants, the mean pre-ABPM SBP/DBP was lower than the mean ABPM SBP/DBP while awake, the mean ABPM SBP/DBP during sleep being lower than the mean ABPM SBP/DBP values while awake and the mean pre-ABPM SBP/DBP. No statistical difference was demonstrated between the mean office SBP and the mean ABPM SBP during sleep, the mean ABPM DBP during sleep being lower than the mean office DBP. The hypertensive adolescents presented a blood pressure profile similar to that of the normotensive group, albeit shifted upwards, with no significant difference between the mean pre-ABPM SBP and the mean ABPM SBP while awake but a higher mean pre-ABPM DBP than mean ABPM DBP while awake. This study suggests that, by evaluating the casual blood pressure in different environment/observer situations, the power of casual blood pressure to predict inadequate blood pressure control, manifested as abnormal ABPM parameters, can be enhanced. Our data indicate ABPM to be the method of choice for the early diagnosis and adequate follow-up of adolescent hypertension.     

高血压病患者运动血压与动态血压关系的研究

目的　探讨高血压病患者运动血压与动态血压的关系。方法　分别以活动平板运动试验中最大运动量时收缩压 (peakSBP)和舒张压 (peakDBP)过度升高和反应正常分组 ,以运动后收缩压(recSBP)和舒张压 (recDBP)恢复慢和恢复正常分组 ,对比分析 30 3例 1、2级高血压病患者的动态血压变化。结果　peakSBP、peakDBP过度升高组动态血压各检测值均显著高于反应正常组 (P <0 0 5或0 0 1) ;recSBP恢复慢组的夜间平均收缩压、舒张压显著高于恢复正常组 (P <0 0 1) ;recDBP恢复慢组白昼舒张压负荷显著高于恢复正常组 (P <0 0 1)。多元逐步回归分析显示 ,对peakSBP、peakDBP、recSBP最具影响的共同参数为夜间平均舒张压。结论　高血压病患者运动试验中 74 2 6 %～ 81 85 %存在运动中血压过度升高和运动后收缩压恢复慢并与动态血压检测值有显著统计意义。     

Ambulatory blood pressure monitoring in hypertensive adolescents

The purpose of this study was to determine the ability of ambulatory blood pressure monitoring to identify youths with chronic blood pressure elevation. Nineteen adolescent boys were studied, ten had 5-year average systolic or diastolic pressures above the 95th percentile, nine had normal pressure. A Del Mar Avionics Pressurometer III system recorded an average of 121 readings on each subject. The coefficients of variation for pressure were similar for hypertensive and normotensive individuals. During classes, eight of the ten hypertensive youths had elevated pressures in over half of the measurements. Also during these classes eight of ten hypertensive boys had average systolic or diastolic pressure above the 95th percentile, whereas only one of nine normotensive boys had average pressures above this level. We suggest that schooltime ambulatory pressures may be most useful in classifying the blood pressure trend in a youth.     

Usefulness of ambulatory blood pressure monitoring in hypertensive patients

Treated or untreated hypertensive patients may have very different blood pressure levels when measured by the doctor in his surgery and when measured by ambulatory monitoring during their usual everyday activities. It is now possible to record blood pressure non-invasively with a portable blood pressure measuring device, the Remler M2000. Using this device, we observed that less than half of the patients referred by their medical practitioner for hypertension had abnormally high blood pressures during their everyday activities. We also noted that the ambulatory blood pressure profile of a given hypertensive patient cannot be predicted from the blood pressure recorded by his or her doctor. Consequently, we concluded that ambulatory blood pressure recordings would appear to be essential for the detection of patients with high blood pressure readings at the doctor's surgery and during everyday activities. These patients probably include the only group which really needs appropriate antihypertensive therapy.     

Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients.Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol.ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients.ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.     

体检人群脉搏波传导速度与动态血压监测指标的相关性研究

目的:脉搏波传导速度与动态血压监测指标的关系。方法:行动态血压监测的体检者582例,根据血压水平分为正常血压组、血压正常高值组和高血压组,分析脉搏波传导速度与动态血压各指标之间的关系。结果:三组间动态血压各指标显著增高;颈股脉搏波传导速度三组间差异有统计学意义(P<0.05);高血压组颈桡脉搏波传导速度显著高于血压正常组。Pearson相关性分析:颈桡脉搏波传导速度与24 h平均SBP/DBP、白天平均SBP/DBP、夜间平均DBP、白天DBP负荷、夜间DBP负荷均呈正相关。颈股脉搏波传导速度与24 h平均SBP、白天/夜间平均SBP、白天/夜间SBP负荷、白天SBP变化标准差均呈正相关。多元线性回归发现颈股脉搏波传导速度与24 h平均SBP独立相关,颈桡脉搏波传导速度与白天平均DBP独立相关。结论:随血压水平程度升高,脉搏波传导速度明显增快。     

24-hour ambulatory blood pressure monitoring in normal and hypertensive subjects

24-hour ambulatory blood pressures (BP) of 172 normal subjects and 167 hypertensive patients recorded by automatic ambulatory monitoring device (A method) and standard mercury sphygmomanometer (B method) were studied. The results show: (1) 66% of normal subjects and 78% hypertensive patients have an evident circadian rhythm BP during 24-hours, BP readings during sleep and noon time are lower. (2) There is no significant difference between times at work and at home readings (P greater than 0.05), but the mean BP during sleeping time is the lowest (P less than 0.01). (3) The correlative coefficient of 24-hour average BP and casual clinic BP is low (r = 0.38-0.74). (4) The validity and accuracy of ambulatory BP monitoring by A and B methods were compared.     

Accuracy of ambulatory blood pressure monitoring in four exercise situations

Although ambulatory blood pressure monitoring (ABPM) is still considered in its investigational stage, the technique has become increasingly popular in recent years. The rationale for its utilization is its ability to continuously monitor blood pressure (BP) response to situational stressors occurring over the course of a 24-hour period which cannot be detected by casual measurements. In addition, ABPM eliminates the so-called white-coat auscultatory BP response. However, the accuracy of ABPM under situations which are at the measurement limits of the technical characteristics and/or capabilities of the ABPM equipment, such as in exercise situations commensurate with daily life activities, has not been fully documented. The purpose of this study was to evaluate the accuracy of the Spacelabs ABPM monitor against auscultatory (AUS) determinations in four exercise situations: walking, stair climbing, cycling and a progressive step test (modified Canadian Aerobic Fitness Test). Analyses of variance (ANOVA) were computed to determine if significant differences occurred between ABPM and AUS measurements for systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) over the resting and four exercise conditions. Results indicate that, particularly at low to moderate levels of exercise intensity, there is no statistically significant difference between ABPM and AUS measurements for SBP and HR. In 20 of the 26 resting and exercise determinations, the difference in SBP was less than 6 mmHg. For HR the variation was no greater than 4 bpm. However, there was no such agreement between ABPM and AUS measurements for DBP. As the intensity of the exercise situations increased, there was a tendency for SBP ABPM measurements to register higher readings than those obtained by AUS. The major drawback in ABPM is its sensitivity to artifacts due to arm movement. It was concluded that ABPM, such as provided by the Spacelabs instrument, can provide reasonably accurate readings of SBP and HR, particularly at low to moderate intensities of exercise while at higher exercise intensities ABPM has a tendency to provide consistently lower SBP values than the AUS measurements. DBP ABPM was totally ineffective under any of the exercise conditions chosen for this study.     

动态血压与老老年高血压脑白质疏松患者认知功能的关系

目的比较老老年高血压患者不同程度脑白质疏松(leukoaraiosis,LA)的动态血压参数与认知功能的相关性。方法对80例老老年高血压患者行24h动态血压监测,观察24h收缩压变异性(systolic blood pressure variability,SBPV)、24h舒张压变异性(diastolic blood pressure variability,DBPV)、动态动脉硬化指数(ambulatory arterial stiffness index,AASI)、动态脉压指数(ambulatory pulse pressure index,APPI)等;并对患者行简易智能状态检查量表(MMSE)评估。结果与LA 0级比较,1级、2级、3级的24hSBPV、24hDBPV、AASI、APPI增大(P0.05);与LA 1级比较,2级、3级24h-SBPV、24h-DBPV、AASI、APPI增大(P0.05);LA 3级的24h-SBPV、AASI和APPI显著高于2级,差异有统计学意义(P0.05)。与LA 0级、1级比较,2级、3级的记忆力、注意力和计算力、回忆能力、语言能力和总分显著降低,差异有统计学意义(P0.05)。24hSBPV(r=-0.8697,P=0.000)、24hDBPV(r=-0.6709,P=0.002)、AASI(r=-0.8373,P=0.000)、APPI(r=-0.5991,P=0.007)与MMSE呈显著负相关。结论 LA程度越重,24hSBPV、AASI、APPI越大;24hSBPV、AASI可能作为LA、认知功能下降的预测指标。     

Relationship between ambulatory blood pressure monitoring values and future occurrence of ischemic cerebrovascular and coronary events in hypertensive patients.

OBJECTIVES: To evaluate in a prospective study the relationship between 24-hour ambulatory blood pressure monitoring (ABPM) values and the occurrence of nonfatal ischemic cerebrovascular and coronary events in treated hypertensive patients. METHODS: Out of 8780 ABPM recordings we identified 79 hypertensive patients (both genders) who suffered a first nonfatal ischemic event, either cerebrovascular (stroke or transient ischemic attack) (STR/TIA, n = 48) or coronary (myocardial infarction, angina or coronary bypass/PTCA) (COR, n = 31) and 223 control-hypertensive patients (CTR) without any events during the same period who were fully matched (at the time of ABPM) for age, gender, antihypertensive therapy, presence of dyslipidemia or diabetes, and casual blood pressure (BP), in the proportion of 1 STR/TIA to 3 CTR and 1 COR to 6 CTR. Matched groups were compared for various ABPM parameters. RESULTS: On average, the time between ABPM and the occurrence of STR/TIA and COR events was respectively 32.4 (1 to 88) and 28.0 (1 to 73) months. For similar values of matched variables significant differences (p < 0.05) were observed between STR/TIA vs. CTR in 24-hour systolic BP (147.4 +/- 20.6 vs. 140.1 +/- 14.9 mmHg), daytime systolic BP (151.6 +/- 21.8 vs. 144.6 +/- 15.2 mmHg) and nighttime systolic BP (138.5 +/- 21.2 vs. 130.9 +/- 16.0 mmHg), and between COR vs. CTR in 24-hour systolic BP (143.5 +/- 19.5 vs. 135.2 +/- 15.6 mmHg), daytime systolic BP (146.3 +/- 20.5 vs. 139.6 +/- 15.9 mmHg) and nighttime systolic BP (138.1 +/- 19.7 vs. 126.2 +/- 16.4 mmHg), BP on rising (146.2 +/- 31.7 vs. 133.6 +/- 19.9 mmHg) and blunted nighttime BP dipping (5.3 +/- 7.4 vs. 9.60 +/- 6.0%). Versus CTR, STR/TIA showed a lower percentage of dippers (27.7 vs. 44.4%) and a higher percentage of extreme dippers (10.6 vs. 6.3%), nondippers (48.9 vs. 41.7%) and inverted dippers (12.8 vs. 7.6%). Versus CTR, the COR group showed (p < 0.02) a lower percentage of dippers (21.9 vs. 46.8%) and extreme dippers (3.1 vs. 4.3%) and a higher percentage of nondippers (56.3 vs. 43.0%) and inverted dippers (18.8 vs. 5.9%). CONCLUSIONS: This prospective study in treated hypertensive patients shows that both high ABPM values and abnormal daytime/nighttime BP profiles are associated with later occurrence of ischemic cerebrovascular and coronary events independently of casual BP values and other cardiovascular risk factors. This reinforces the idea that ABPM is a powerful predictor of future cardiovascular events.     

Analysis of blood pressure in children and adolescents reporting siesta during ambulatory blood pressure monitoring

BACKGROUND: In adults, a siesta yields a blood pressure profile similar to that seen in nocturnal sleep. It is therefore stressed that siestas should not be included in daytime blood pressure measurement. OBJECTIVES: To evaluate blood pressure profiles in pediatric and adolescent patients who reported a siesta during 24 h ambulatory blood pressure monitoring (ABPM). METHODS: Patients' diaries of actual sleep times were used to determine the periods of sleep (night-time and siesta) and daytime wakefulness. Ambulatory systolic and/or diastolic daytime and/or night-time hypertension was determined by comparing patients' measurements with normal values taken from published standards for healthy children and adolescents. Data obtained from 12 patients with ambulatory normotension and 12 patients with ambulatory hypertension, who were referred for an evaluation of hypertension or management of known hypertension, were analysed separately. RESULTS: Mean systolic (SBP) and diastolic (DBP) blood pressure values during the daytime awake period were significantly higher than the mean values for the period of daytime, including the siesta, both in patients with ambulatory normotension and in those with ambulatory hypertension (P<0.001 and P<0.01 for SBP and DBP, and P<0.001 and P<0.001 for SBP and DBP, respectively). The percentage night-time falls in SBP and DBP were 12.9+/-0.5 and 19.1+/-1.4 in patients with ambulatory normotension, and 7.1+/-1.5 and 12.9+/-2.2 in patients with ambulatory hypertension. These values were significantly higher when the siesta was excluded from the analysis in both groups (13.9+/-0.5% and 20.7+/-1.5%, P<0.001 and P<0.01 for SBP and DBP in patients with ambulatory normotension; 8+/-1.6% and 14.8+/-2.4%, P<0.001 and P<0.001 for SBP and DBP in patients with ambulatory hypertension, respectively). CONCLUSIONS: By ignoring the effect of the siesta, both the calculation of daytime blood pressure values and the analysis of day-night variability in children and adolescents undergoing ABPM may be erroneously interpreted.     

Sleep disturbance during ambulatory blood pressure monitoring of hypertensive patients

BACKGROUND: Hypertensive patients who fail to exhibit a normal fall in blood pressure at night may have a greater risk of target-organ damage. Sleep, with associated cessation of physical activity, is the principal determinant of nocturnal blood pressure 'dip'. OBJECTIVE: To ascertain whether hypertensive patients, who experience the discomfort of higher cuff-inflation pressures during ambulatory blood pressure monitoring, experience more interference with sleep, manifested by greater nocturnal physical activity. DESIGN: A retrospective case- control study. METHODS: Subjects were selected from a database of 475 patients who had undergone simultaneous 24 h ambulatory blood pressure monitoring and monitoring of physical activity with a wrist-mounted piezoelectric accelerometer. Sixty-one hypertensives (average daytime systolic blood pressure >/= 150 mmHg) were age matched to 61 subjects with average daytime systolic blood pressures 相似文献   

动态血压监测对老年高血压病人预后的评价

目的：确定动态血压是否比诊室血压能更好地预测经治老年高血压患靶器官的损害。方法：根据24小时收缩压（SBP）的水平将69例病人分为3组（＜130mmHg、130－139mmHg,≥140mmHg)进行回顾性分析。结果：I组患的靶器官损害发生率明显低于后两组。结论：24小时SBP＞130mmHg和／或PP≥60mmHg可作为老年高血压患危险分层的指标。     

Significance of the unexpected hypertensive response to exertion. Correlation with ambulatory blood pressure monitoring and echocardiography]

The aim of this study was to analyse the meaning of unexpected hypertensive response during treadmill stress test in resting normotensive individuals without any evidence of cardiovascular pathology. The study group of 52 persons who fulfil the inclusion criteria was compared with a homogenous control population composed by 200 individuals with a suitable blood pressure response to stress. The adopted criteria for hypertensive response were the presence of blood pressure greater than or equal to 180/100 mmHg after 6 stress, in maximal stress greater than or equal to 210/110 mmHg and after 5' recovering greater than or equal to 150/90 mmHg. 74% of patients with hypertensive response appeared to be hypertensive according to the criteria of ambulatory blood pressure monitoring--day blood pressure greater than or equal to 140/90 mmHg and night blood pressure greater than or equal to 120/80 mmHg. After echocardiographic study to define the index of left ventricular mass, 68% of individuals with hypertensive stress response showed left ventricular hypertrophy with a medium index of 145 + 17 g/m2 (P less than or equal to 0.01) in most cases with a concentrical hypertrophy type. The appearance of tensional response of hypertensive type ascertains the probability of hypertensive disease. The analysis of tensional response to stress is an integrant part of a methodology of approaching patients suspect of high blood pressure.     

Beta-blockade mitigates exercise blood pressure in hypertensive male patients.

OBJECTIVES: The purpose of this study was to determine the antihypertensive agent(s) more likely to mitigate an exaggerated rise in exercise blood pressure (BP) in hypertensive patients. BACKGROUND: An exaggerated rise in exercise BP is associated with increased cardiovascular risk. There are no recommendations for treating such response. METHODS: Participants were hypertensive men (n = 2,318; age 60 +/- 10 years), undergoing a routine exercise test at the Veterans Affairs Medical Center, Washington, DC. Antihypertensive therapy included angiotensin-converting enzyme inhibitors (n = 437), calcium-channel blockers (n = 223), diuretics (n = 226), and combinations (n = 1,442), beta-blockers alone (n = 201) or in combination with other antihypertensive agents (n = 467), and none (n = 208). Exercise BP, heart rate (HR) and rate-pressure product (RPP) at maximal and submaximal workloads were assessed. RESULTS: After adjusting for covariates, patients treated with beta-blockers or beta-blocker-based therapy had significantly lower BP, HR, and RPP at 5 and 7 metabolic equivalents (METs) and peak exercise than those treated with any other antihypertensive agent or combination (p < 0.05). The likelihood of achieving an exercise systolic BP of >/=210 mm Hg was 68% lower (odds ratio = 0.32, 96% confidence interval 0.2 to 0.53) in the beta-blocker-based therapy versus other medications. African Americans exhibited higher BP and HR than Caucasians at all exercise workloads regardless of antihypertensive therapy and had over a 90% higher likelihood for an abnormal exercise BP response. This risk was attenuated by 35% with a beta-blocker-based therapy. CONCLUSIONS: Significantly lower exercise BP, HR, and RPP levels are achieved with beta-blocker-based therapy than with other antihypertensive agents regardless of race. However, BP was better controlled in Caucasians than in African Americans regardless of antihypertensive therapy.     

Relationship between blood pressure response during exercise and tendency to left ventricular hypertrophy

From among subjects who were examined by submaximal exercise testing in 1987, 54 were selected in order to examine the relationship between the blood pressure response during exercise and the tendency to develop left ventricular hypertrophy. Only those subjects having resting systolic blood pressure values between 120 mmHg and 140 mmHg were selected. The maximum systolic blood pressure during submaximal exercise was highly correlated with the sum of the R wave amplitude in V5 and the S wave amplitude in V1 of the resting ECG (r = 0.496, p less than 0.001, n = 54), as well as with the left ventricular mass normalized for body surface area (r = 0.609, p less than 0.005, n = 23). The maximum systolic blood pressure measured during submaximal exercise did not correlate with age or exercise duration. These results suggest that a greater blood pressure response during exercise is related to the tendency to develop left ventricular hypertrophy.     

老年男性原发性高血压患者动态血压及血压变异性与踝臂指数的关系探讨

目的评价老年男性原发性高血压患者动态血压及血压变异性(BPV)与踝臂指数(ABI)的关系。方法入选老年男性原发性高血压患者160例,按照ABI分为正常ABI组(ABI>0.90)104例和低ABI组(ABI≤0.90)56例,比较并分析其24 h动态血压参数和BPV参数。结果低ABI组较正常ABI组24 h平均脉压[(62.4±13.8)mm Hg比(53.0±13.0)mm Hg]、日间平均脉压[(67.3±17.0)mm Hg比(55.4±20.0)mm Hg]和夜间平均脉压[(63.0±16.0)mm Hg比(52.9±13.6)mm Hg]均高(P<0.01),同时夜间收缩压最大值[(146.5±17.4)mm Hg比(135.5±17.1)mm Hg]、夜间收缩压标准差[(12.4±4.0)mm Hg比(10.1±4.2)mm Hg]均大(P<0.05)。结论老年男性原发性高血压患者夜间收缩压最大值、夜间收缩压标准差、日间平均脉压、夜间平均脉压和24 h平均脉压升高可能是低ABI的危险因素。