Ten‐year changes in ambulatory blood pressure: The prognostic value of ambulatory pulse pressure

Blood pressure (BP) changes and risk factors associated with pulse pressure (PP) increase in elderly people have rarely been studied using ambulatory blood pressure monitoring (ABPM). The aim is to evaluate 10‐year ambulatory blood pressure (ABP) changes in older hypertensives, focusing on PP and its associations with mortality. An observational study was conducted on 119 consecutive older treated hypertensives evaluated at baseline (T0) and after 10 years (T1). Treatment adherence was carefully assessed. The authors considered clinical parameters at T1 only in survivors (n = 87). Patients with controlled ABP both at T0 and T1 were considered as having sustained BP control. Change in 24‐hour PP between T0 and T1 (Δ24‐hour PP) was considered for the analyses. Mean age at T0: 69.4 ± 3.7 years. Females: 57.5%. Significant decrease in 24‐hour, daytime, and nighttime diastolic BP (all P < .05) coupled with an increase in 24‐hour, daytime, and nighttime PP (all P < .05) were observed at T1. Sustained daytime BP control was associated with lower 24‐hour PP increase than nonsustained daytime BP control (+2.23 ± 9.36 vs +7.79 ± 8.64 mm Hg; P = .037). The association between sustained daytime BP control and Δ24‐hour PP remained significant even after adjusting for age, sex, and 24‐hour PP at T0 (β=0.39; P = .035). Both 24‐hour systolic BP and 24‐hour PP at T0 predicted mortality (adjusted HR 1.07, P = .001; adjusted HR 1.25, P < .001, respectively). After ROC comparison (P = .001), 24‐hour PP better predicted mortality than 24‐hour systolic BP. The data confirm how ABP control affects vascular aging leading to PP increase. Both ambulatory PP and systolic BP rather than diastolic BP predict mortality in older treated hypertensives.     

高龄老年高血压患者动态血压和动态心电图特点及临床分析

目的分析高血压患者的24h动态血压、心电图的特点，并结合临床分析，为临床高龄老年高血压防治提供可参考依据。方法共入选老年高血压患者214例，按年龄分为两组，A组：高龄老年组（≥80岁）96例；B组：低龄老年组（60～79岁）118例。采用24h动态血压和24h动态心电图同步监测技术，记录血压和心电图变化，同时采集多次住院病历，观察高血压患者治疗过程中血压控制情况，心律失常以及靶器官损害发生情况。结果高龄老年组的大部分患者血压控制良好。24h动态血压水平两组之间仍有明显差异，高龄老年组心律失常、心脑血管事件次数、糖尿病、体重指数、左心室重量指数等均显著高于低龄老年组。结论与低龄老年组相比，80岁以上的高龄老年高血压患者肾损害明显，其24h动态血压水平与动态心电图改变及肾损害之间密切相关。     

动态血压联合家庭血压监测对慢性心力衰竭患者血压变异性及预后的指导意义

目的 对慢性心力衰竭（CHF）患者使用动态血压联合家庭血压监测,观察其对血压变异性（BPV）和预后的指导意义。方法 入选192例CHF患者随机分为联合监测组（n=97）和对照组（n=95）。对所有患者进行为期1年的随访,采用常规的门诊预约随访,随访间隔为1个月。联合监测组患者采用家庭血压监测模式进行CHF的监测随访,每日早晚测量的血压和脉率值通过手机传输给中央系统,由我院心血管内科专人负责中央系统维护和每位患者血压监测观察。当中央系统发现某位患者血压波动异常或脉率波动异常时,将电话通知该位患者增加血压、脉率测量次数或增加门诊随访次数,并及时调整CHF的治疗方案。所有患者在入组前、随访6月行动态血压监测,并收集记录所有数据。观察记录所有患者随访一年中的以下心血管事件：非计划性随访、心源性死亡、恶性心律失常、再次因心力衰竭住院。结果 入组前两组患者杓型血压患者所占比例没有统计学差异（P>0.05）。在随访6个月后,联合监测组患者杓型血压比例明显高于入组前水平（36.08% VS. 13.40%, P=0.004）,且高于随访6个月后对照组杓型血压患者比例（36.08% VS. 16.84%, P=0.012）。24h PR在入组前两组患者没有统计学差异（P>0.05）。在随访6个月后,两组患者的24h PR较入组前均明显降低（P<0.05）。6个月的随访后联合监测组患者24h PR明显低于对照组24h PR（70.14±13.42 VS. 77.02±16.15, P=0.002）。入组前两组患者24hSBPV和24hDBPV没有统计学差异（P>0.05）。随访6个月后联合监测组患者24hSBPV和24hDBPV均低于入组前水平,并低于随访6个月后对照组患者（P均<0.05）。联合监测组患者非计划性随访发生比例（11.34% VS. 24.21%, P=0.032）、再次住院发生比例（6.19% VS. 17.89%, P=0.023）和恶性心律失常发生比例（3.09% VS. 11.58%, P=0.047）明显低于对照组患者。结论 动态血压联合家庭血压监测模式较传统的门诊随访进一步降低血压变异性,增加杓型血压比例,并能改善CHF患者预后,值得临床推广。     

Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network

Hypertension is an important public health issue due to its association with a number of serious diseases, including cardiovascular disease and stroke. The importance of evaluating hypertension taking into account different blood pressure (BP) profiles and BP variability (BPV) is increasingly being recognized, and is particularly relevant in Asian populations given the specific features of hypertension in the region (including greater salt sensitivity and a high rate of nocturnal hypertension). Ambulatory BP monitoring (ABPM) is the gold standard for diagnosing hypertension and assessing 24‐hour BP and provides data on several important parameters that cannot be obtained using any other form of BP measurement. In addition, ABPM parameters provide better information on cardio‐ and cerebrovascular risk than office BP. ABPM should be used in all patients with elevated BP, particularly those with unstable office or home BP, or who are suspected to have white‐coat or masked hypertension. ABPM is also an important part of hypertension diagnosis and monitoring in high‐risk patients. ABPM needs to be performed using a validated device and good practice techniques, and has a role both in hypertension diagnosis and in monitoring the response to antihypertensive therapy to ensure strict BP control throughout the 24‐hour period. Use of ABPM in clinical practice may be limited by cost and accessibility, and practical education of physicians and patients is essential. The ABPM evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for ABPM in Asia.     

Reproducibility of blood pressure variation in older ambulatory and bedridden subjects

OBJECTIVES: We investigated the influence of ambulation on the reproducibility of circadian blood pressure variation in older nursing home residents. DESIGN: Ambulatory blood pressure monitoring was performed twice in 37 older nursing home residents. SETTING: Nursing home in Japan. PARTICIPANTS: Subjects included 18 ambulatory nursing home residents who had no limitation on physical activity and 19 bedridden residents who did not participate in physical activity. MEASUREMENTS: Twenty-four-hour, daytime, and nighttime blood pressure levels and their variability. RESULTS: The 24-hour and daytime variability of systolic blood pressure (SBP) was significantly greater in ambulatory than in bedridden subjects, whereas nighttime variability was similar. Significant correlations in SBP averaged for the whole day, daytime, and nighttime were observed between the two examinations in ambulatory (r =.80-.83) and bedridden (r =.83-.91) subjects, but the variabilities of SBP for the whole day and during the daytime of the first measurement were correlated with those of the second measurement in bedridden (r =.67 and r =.47, respectively) but not in ambulatory (r =.39 and r =.28, respectively) subjects. Significant correlations were found between the nocturnal SBP changes at two occasions in both ambulatory (r =.50) and bedridden (r =.51) subjects, but the dipper versus nondipper profiles, defined as reduction in SBP of greater than 10% versus not, showed low reproducibility in ambulatory subjects; five ambulatory (28%) and one bedridden (5%) subjects showed divergent profiles between the two examinations. CONCLUSIONS: The reproducibility of blood pressure variation in nursing home residents is influenced by ambulation.     

Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients

This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period. ABPM was performed once for 24 h in the absence of dialysis during the final 2 weeks of the study period and was compared to the 2-week dialysis unit BP and home BP. There was a significant difference between dialysis unit systolic blood pressure (SBP) and home SBP over the 9-month period. No significant difference was observed between the 2hr-HD SBP and home SBP. When analyzing 2 weeks of dialysis unit BP and home BP, including ABPM, SBPs were significantly different (dialysis unit BP > home BP > ABPM; P = 0.009). Consistent with the 9-month study period, no significant difference was observed between 2hr-HD SBP and home SBP (P = 0.809). The difference between 2hr-HD SBP and ambulatory SBP was not significant (P = 0.113). In conclusion, the 2hr-HD SBP might be useful for predicting home BP and ABPM in HD patients.     

动态血压监测的临床应用

高血压已日渐成为严重威胁人类健康的问题。许多研究证实,高血压可导致心、脑、肾等器官的损害,但若早期发现和及时治疗则能延缓及减轻靶器官的损害。     

Limited reproducibility of 24-h ambulatory blood pressure monitoring

Abstract

Results of 24-h ambulatory blood pressure monitoring (ABPM) including average blood pressure, variability, and nocturnal dipping are considered the gold standard for diagnosis and the best predictor of the future end organ damage in chronic hypertension. Here we report on the reproducibility of ABPM results for these three measures over a period of months. A total of 35 hypertensive patients (43% female, mean age 64 years), underwent two separate ABPM recordings within 14 weeks, with unchanged medical treatment and lifestyle in the interim. The day and night average blood pressure, dipping status of systolic pressure, and the standard deviation of systolic and diastolic blood pressure as a measure of variability were compared between the two recordings. Individual values for average systolic and diastolic pressures showed only a modest correlation between the two measurements (r?=?0.56, r?=?0.81, p?<?0.01). Standard deviations of 24-h pressure were also positively but weakly correlated (r?=?0.4, p?<?0.001). The occurrence of dipping was reproducible in 71% of the patients. Average blood pressure, pressure variability, and dipping as assessed by ABPM are only moderately reproducible. Clinical decision-making based on single ABPM datasets should be made with caution, and repetition of ABPM seems justified in some cases.     

动态心电图和动态血压同步监测在缺血性脑卒中患者诊断中的临床价值

目的探讨动态心电图和动态血压同步监测在缺血性脑卒中(ischemic stroke,IS)患者诊断中的临床价值。方法选择2016年12月至2018年11月酒泉市金塔县人民医院接诊的46例IS患者进行研究,设定为IS组,并选取同期在我院进行检查的原发性高血压(高血压)患者32例,设定为无IS组(non-ischemic stroke,NIS)组。对所有患者进行动态心电图(dynamic electrocardiogram,DCG)和动态血压(ambulatory blood pressure,ABP)同步监测。比较两组患者昼夜血压变化、异常心电图比例和心率变异性相关指标,对相关参数进行Logistic多因素回归分析。结果与NIS组相比,IS组患者昼夜平均收缩压和血压昼夜节律消失比例均显著升高,日间平均舒张压显著降低,差异有统计学意义(P<0.05)。IS组DCG监测到房性期前收缩、房性心动过速、短阵心房颤动、室性期前收缩和ST段改变的比例明显高于NIS组,差异有统计学意义(P<0.05)。IS组在窦性R-R间期标准差(standard deviation of normal R-R intervals,SDNN)、窦性R-R间期差值的平方根(root mean square of the successive normal sinus R-R interval difference,rMSSD)和每5 min时段窦性R-R间期平均值标准差(standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours,SDANN)等心率变异性指标上明显低于NIS组,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示昼夜平均收缩压、血压昼夜节律消失、心房颤动与IS呈正相关,日间平均舒张压、SDNN、rMSSD、SDANN与IS呈负相关。结论血压昼夜节律消失、心律失常、心率变异与IS发生关系密切,同步监测高血压患者DCG和ABP对预诊断IS具有较高的临床价值。     

新疆和田地区维吾尔族自然长寿老人动态血压的特点

目的探讨新疆和田地区维吾尔族自然长寿老人动态血压的特点。方法随机选取308例老年人,将年龄≥90岁的和田地区维吾尔族老人100例作为长寿组,年龄65～70岁的和田地区维吾尔族老人106例作为老年组,同期在我院门诊体格检查的60～85岁的汉族老人102例作为对照组,3组进行24 h动态血压监测,分析相关参数指标,并进行统计学分析。结果长寿组老人高血压患病率与其他2组比较,无统计学差异(P>0.05)。长寿组老人的24 h舒张压(DBP)低于老年组,而高于对照组,昼间收缩压(SBP)及DBP均低于老年组和对照组,24 h平均脉压指数高于老年组,而低于对照组。均有统计学差异(P<0.05);长寿组老人24 h SBP和24 h平均脉压均低于老年组和对照组.无统计学差异(P>0.05)。结论新疆和田地区维吾尔族长寿老人高血压患病率有降低趋势,有其自身的动态血压变化的特点,发生靶器官损害的风险亦相对较低,可能是长寿的部分因素。     

脑梗死患者急性期血压监测与预后的初步研究

目的探讨脑梗死患者急性期动态血压的变化及血压与预后的相关性。方法本研究为前瞻性地对发病48h内入院的53例脑梗死患者进行24 h动态血压监测,持续10天,记录其他影响预后的危险因素,并在21天、3个月做近远期神经功能评分。结果脑梗死患者急性期高血压常见,有自发下降的趋势。在入院4天时,收缩压和舒张压分别下降(8.8±7.9)mm Hg(、4.5±5.0)mm Hg(1 mm Hg=0.133 kPa,P<0.05),4~10天时血压下降趋势趋于平缓。脑梗死患者急性期血压与远期预后单因素分析显示呈U型曲线关系,血压的最适水平为收缩压140~160mm Hg,舒张压75~80 mm Hg。但在多因素分析中仅收缩压≥160 mm Hg与140~159.9 mm Hg比较是近期(P=0.024)和远期(P=0.046)预后不良的独立危险因素,收缩压每升高10 mm Hg,近期和远期预后不良的危险性分别增加368.2%和137.2%。结论脑梗死患者急性期血压显著升高(收缩压≥160 mm Hg)提示预后不良。     

Association of ambulatory blood pressure variability with coronary artery calcium

Blood pressure (BP) variability is associated with progression to clinical atherosclerosis. The evidence is inconclusive if BP variability predicts cardiovascular outcomes in low‐risk populations. The aim of this study was to analyze the association of 24‐hour BP variability with coronary artery calcium (CAC) among a group of individuals without coronary artery disease. The Masked Hypertension Study targeted patients with borderline high BP (120?149 mm Hg systolic and/or 80‐95 mm Hg diastolic). Ambulatory blood pressure monitoring (ABPM) was performed at two time‐points, 8 days apart. CAC was measured at exit visit via cardiac CT and reported as Agatston Score. Weighted standard deviations and average real variability were calculated from ABPM. Of the 322 participants who underwent cardiac CT, 26% (84) had CAC present, 52% (168) were female, and 21% (64) were black. BP variability did not differ by CAC group. In this low cardiovascular risk group, CAC was not associated with 24‐hour ambulatory BP variability.     

Assessment of nocturnal hypertension by ambulatory blood pressure monitoring at the forearm in people with morbid obesity

Blood pressure (BP) measurement at the forearm (FA) has been proposed as alternative site to upper arm (UA) in people with morbid obesity (MO). We compared nocturnal BP readings simultaneously taken at FA and UA by ambulatory blood pressure monitoring (ABPM). Fourteen individuals with MO and seven normal‐weight controls underwent nocturnal ABPM with two devices placed at the UA and contralateral FA, respectively. Agreement between FA‐UA BP, diagnosis of nocturnal hypertension, and potential determinants of BP differences were evaluated. BP at the FA was significantly higher than UA in both people with MO and controls. FA‐UA differences in systolic and diastolic BP were similar in people with MO and controls. Nocturnal hypertension was diagnosed in 10 subjects (48%) according to UA BP and in 13 subjects (62%) according to FA BP (concordance 76%, moderate agreement). ΔFA‐UA systolic BP was associated with ratio between FA/UA circumferences (R = 0.45, P < .05) and with cuff‐UA slant angle difference (R = 0.44, P < .05). In conclusions, in people with MO, the agreement between FA and UA nighttime BP measured by ABPM is sub‐optimal. Our results raise uncertainty in using ABPM at the FA as an alternative to UA placement in people with MO for the diagnosis of nocturnal hypertension.     

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio‐/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out‐of‐office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region‐specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus‐based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving “zero” cardiovascular events in Asia.     

Even mild depression is associated with among-day blood pressure variability,including masked non-dipping assessed by 7-d/24-h ambulatory blood pressure monitoring

Abstract

The effect of mild depression on blood pressure (BP) was assessed in 116 Japanese (32–79 years). As compared to non-depressive (Geriatric Depression Scale, GDS-15 score <5) subjects, mild depressives (GDS-15 score: 1–15) had shorter sleep duration (p?=?0.021), lower subjective quality of life (health: p?=?0.016; life satisfaction: p?<?0.001; and happiness: p?<?0.001), and higher 7-d systolic BP (p?<?0.05). “Masked non-dipping” (dipping on day 1, but non-dipping on at least 1 of the following 6?d) was more frequent among depressive than non-depressive normotensives (p?=?0.008). Among-day BP variability may underlie cardiovascular disease accompanying a key component of psychological depression.     

Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24‐hour ambulatory blood pressure database

We previously demonstrated lower diastolic blood pressure (BP) levels under statin therapy in adult individuals who consecutively underwent 24‐hour ambulatory BP monitoring and compared their levels to untreated outpatients. Here we evaluated systolic/diastolic BP levels according to different statin types and dosages. 987 patients (47.5% female, age 66.0 ± 10.1 years, BMI 27.7 ± 4.6 kg/m², clinic BP 146.9 ± 19.4/86.1 ± 12.1 mm Hg, 24‐hour BP 129.2 ± 14.4/74.9 ± 9.2 mm Hg) were stratified into 4 groups: 291 (29.5%) on simvastatin 10‐80 mg/d, 341 (34.5%) on atorvastatin 10‐80 mg/d, 187 (18.9%) on rosuvastatin 5‐40 mg/d, and 168 (17.0%) on other statins. There were no significant BP differences among patients treated by various statin types and dosages, except in lower clinic (P = .007) and daytime (P = .013) diastolic BP in patients treated with simvastatin and atorvastatin compared to other statins. Favorable effects of statins on systolic/diastolic BP levels seem to be independent of types or dosages, thus suggesting a potential class effect of these drugs.     

Evaluation of a new ambulatory blood pressure device

We assessed the OSCILL-IT ambulatory blood pressure (BP) recorder (FIGI srl, Rome, Italy) according to the performance criteria set out by the British Hypertension Society (BHS) protocol. The OSCILL-IT is a portable, noninvasive recorder that uses a process that correlates systolic, mean, and diastolic areas, identified on the oscillations, to the cuff absolute pressure. According to the recommendations of BHS, a large heterogeneous population (100 subjects: 52 men aged from 19 to 79—median 44 and 48 women from 19 to 74—median 54) was recruited in order to assess accuracy and to analyze, in addition, the effects of observer agreement and BP level on the observer–device differences. With reference to BP level, we suggest also a new graphic approach. Four sets of sequential, same arm, comparative BP measurements were obtained, performed by the OSCILL-IT recorder and two skilled clinicians using a mercury column, for each subject. We used a linear combination for the statistical evaluations. We confirmed the observer agreement through the frequency distribution of BP as a function of the observer and through the differences between observers. We compared OSCILL-IT with sphygmomanometric readings: the differences were not significant. A visual inspection, with the addition of regression lines, showed that there were no variations in differences at the changing of BP level. The difference between observers and OSCILL-IT was 0.2 ± 5.3 mm Hg and 0.2 ± 5.8 mm Hg both for systolic BP (SBP) and diastolic BP (DBP). The level of agreement, according to BHS criteria, showed that 64% of all systolic and 70% of all diastolic readings obtained by the OSCILL-IT were within 5 mm Hg of the sphygmomanometric determinations. Therefore, the grade is C for SBP, even if 93% of SBP and 95% of DBP obtained by the OSCILL-IT were within 10 mm Hg of the sphygmomanometric determinations. These analyses demonstrate that the OSCILL-IT satisfies the accuracy parameters and the additional linear regression yields graphics more immediate.     

动态血压监测的临床应用进展

高血压（hypertension）是全球范围的重大公共卫生问题,是最常见的慢性病,也是心脑血管病最主要的危险因素。高血压病具有病程长、发病率高、对人们生活质量影响人的特点,但常常直到发牛靶器官损伤有特殊临床表现时才引起注意;或者是己用药物治疗,但用药与血压监测脱节,导致血压控制不良甚至猝死等事件发生。因此,早期发现高血压,以及在用药过程中系统、规律地监测血压具有十分重要的意义。