Evaluation of a short home blood pressure measurement in an outpatient population of hypertensives

Current guidelines suggest the use of home blood pressure monitoring (HBPM) as a method complementary to ambulatory blood pressure monitoring (ABPM) for the identification of arterial hypertension. A cross-sectional study was conducted to evaluate the accuracy of a short HBPM schedule compared with ABPM, and to evaluate to what extent HBPM can replace ABPM. A total of 310 patients who performed ABPM in our hypertension clinic were enrolled between November 2011 and June 2015. They performed a 4-day HBPM schedule, with two readings in the morning and two readings at night. Results showed a moderate correlation between HBPM and ABPM (r = 0.59 for systolic blood pressure (SBP) and r = 0.72 for diastolic blood pressure (DBP)) and moderate diagnostic agreement (area under curve: 0.791 for SBP and 0.857 for DBP). No significant difference was found between first-day average and those of days 2–4. Diagnostic agreement between the two techniques was moderate, supporting the notion that HBPM cannot replace ABPM in the general population. However, we identified two HBPM thresholds, 123/75 and 144/87 mm Hg, through which subjects who may not require further ABPM can be identified.     

吸烟对正常血压者24小时动态血压的影响

目的为了阐明吸烟对正常血压者血压的影响。方法对６６例吸烟的男性正常血压者与６２例年龄、体重指数及偶测血压相同的不吸烟正常血压者进行２４小时动态血压监测。结果吸烟组２４小时、白昼、夜间平均血压及血压负荷均高于不吸烟组，白天血压及血压负荷相差非常显著（Ｐ≤０．００５）；从２４小时血压波动曲线图显示，吸烟者２４小时ＳＢＰ、ＤＢＰ均高于不吸烟组，分为白天相差显著、夜间无显著性差异及开始吸烟和停止吸烟后的血压不稳定三个阶段；吸烟组心率快于不吸烟组，２４小时及白昼相差显著，而夜间相差不显著。结论吸烟可引起正常血压者血压升高及心率加快，尤其是白天吸烟后血压升高和心率加快更明显。     

The effect of 24 h blood pressure levels on early neurological recovery after stroke

OBJECTIVES: To assess the influence of 24 h blood pressure (BP) levels on functional recovery 1 week after stroke and the effect of antihypertensive therapy on 24 h BP levels. DESIGN: Prospective study of patients admitted to hospital over 1 year with first in a lifetime stroke who underwent 24 h BP and casual measurements. Setting. Medical wards in a teaching hospital. Subjects. Of 160 patients, 72 patients admitted to hospital within 24 h of stroke onset were investigated. Patients with conditions and therapy that interfered with autonomic and sympathetic function were excluded. Interventions. All subjects underwent 24 h BP and casual recordings on admission to hospital and at day seven after stroke. The mean 24 h, day and night systolic BP (SBP) and diastolic BP (DBP) and their differences (nocturnal BP dip) were recorded. Patients were divided into three groups according to whether they were taking antihypertensive therapy during the first week: (i) no therapy, (ii) therapy continued after stroke, and (iii) new therapy introduced. Main outcome measures. Functional recovery (Rankin Scale 0-1) and neurological improvement [Scandinavian Stroke Scale (SSS) >/=3 points] by 1 week of stroke. Change in circadian 24 h BP over 1 week. RESULTS: For each 10 mmHg difference between day and night time DBP, the odds for making a complete recovery were 4.63 (95% CI: 1.57-13.7, P=0.01). For each 10 mmHg difference between day and night SBP, the odds for making an improvement in neurological status was 2.24 (95% CI: 1.16-4.32; P=0.016). Significant falls in 24 h DBP (P=0.01), daytime SBP (P=0.005) and mean arterial BP (MABP) (P=0.04) over 1 week were demonstrated in patients who had just commenced antihypertensive therapy (P=0.001). CONCLUSION: An increase in day to night time BP change is favourable in short-term outcome after acute stroke. Significant falls in BP are more likely in patients started on antihypertensive therapy for the first time. Further research is required to understand the effects of circadian BP rhythm on stroke outcome.     

Ambulatory Blood Pressure Variability Is Increased in Diabetic Hypertensives

The purpose of this study was to examine the possible difference in the 24-hr BP profile—including short-term BP variability, assessed as the standard deviation—between diabetic and non-diabetic hypertensives. We measured 24-hr ambulatory BP in 11 diabetic hypertensives (diabetic HT) and 10 non-diabetic hypertensives (non-diabetic HT) who were hospitalized for the educational program in our hospital and were under stable salt intake. Renal function and sleep apnea were also estimated. There were no significant differences in 24-hr systolic BP (141 mmHg vs. 135 mmHg, ns), daytime systolic BP (143 mmHg vs. 138 mmHg, ns), and nighttime systolic BP (135 mmHg vs. 130 mmHg, ns) between diabetic HT and non-diabetic HT. The values of 24‐hr HR (69.7 beats/min vs. 65.2 beats/min, ns) and 24-hr HR variability (9.9 beats/min vs. 10.1 beats/min, ns) were also similar between the groups. Interestingly, diabetic HT had a significantly greater 24-hr systolic and diastolic BP variability than non-diabetic HT (18.2 mmHg vs. 14.5 mmHg, p < 0.05; 11.5 mmHg vs. 9.6 mmHg, p < 0.05, respectively). The values for creatinine clearance, urinary protein excretion, and apnea-hypopnea index were similar between the groups. Bivariate linear regression analysis demonstrated that fasting blood glucose was the primary determinant of 24-hr diastolic BP variability (r = 0.661, p < 0.01). Multiple stepwise regression analysis revealed that fasting blood glucose was a significant and independent contributor to 24-hr systolic BP variability (r = 0.501, p < 0.05). Taken together, these results demonstrate that BP variability is increased in diabetic hypertensives. Furthermore, it is possible that an elevation of fasting blood glucose may contribute to the enhanced BP variability in hypertensives.     

Practical Aspects of Home and Ambulatory Blood Pressure Monitoring

Out-of-office blood pressure (BP) monitoring is becoming increasingly important in the diagnosis and management of hypertension. Home BP and ambulatory BP monitoring (ABPM) are the two forms of monitoring BP in the out-of-office environment. Home BP monitoring is easy to perform, inexpensive, and engages patients in the care of their hypertension. Although ABPM is expensive and not widely available, it remains the gold standard for diagnosing hypertension. Observational studies show that both home BP and ABPM are stronger predictors of hypertension-related outcomes than office BP monitoring. There are no clinical trials showing their superiority over office BP monitoring in guiding the treatment of hypertension, but the consistency of observational data make a compelling case for their preferential use in clinical practice.     

The Role of Ambulatory Blood Pressure Monitoring in the Evaluation of Adolescent Hypertension

We performed 24-hour ambulatory blood pressure monitoring in a group of adolescents with hypertension induced by dynamic exercise and a group of normotensive controls. Ambulatory blood pressure monitoring was performed using a Del-Mar Avionics PIII recorder with readings taken every 7 1/2 minutes. There was little inter-individual variation in mean hourly blood pressure and the difference between mean hourly readings was not significant in hypertensives. Mean 24-hour ambulatory blood pressure was 130.2/80.7 mmHg for hypertensives and 115.2/70.8 in normotensives. Mean 24-hour variability was 18.3/12.9 mmHg in hypertensives and 14.6/11.5 in normotensives. There was no significant change in blood pressure or variability between daytime and evening for hypertensives. Normotensives showed a significant reduction in both BP and variability compared to hypertensives. In adolescents with systolic hypertension, ambulatory blood pressure monitoring confirmed a failure to reduce blood pressure following routine activity. This technique maybe used as a predictive marker of early, adult essential hypertension.     

高血压病人动脉顺应性与家庭偶测血压及动态血压关系

目的　探讨原发性高血压病人家庭测量血压、动态血压与动脉顺应性的关系。方法　共入选 164例受试者 ,其中原发性高血压组 74例 [男 42例 ,女 3 2例 ,平均年龄 ( 4 7 0 5± 10 0 8)岁 ] ;对照组 90例 [男 41例 ,女 49例 ,平均年龄 ( 3 3 81±12 3 5 )岁 ]。对入选者间隔 1～ 3周进行二次家访 ,每次家访由经过专门训练的护士采用汞柱血压计连续测量受试者坐位、左上臂血压 5次 ,每人的家庭测量血压是二次家访、共 10个血压读数的平均值。同时采用SpaceLabs 90 2 0 7动态血压监测仪记录 2 4小时动态血压 ,有效数据应达到 80 %以上。动脉顺应性检查采用动脉脉搏波分析 (PWA)仪。反映大动脉硬化的参数为反射波增强指数 (AIx)。结果　高血压组家庭测量血压及 2 4小时平均收缩压、舒张压、白昼及夜间血压显著高于对照组。与对照组相比 ,高血压组AIx显著升高 ( 2 4 4%± 12 8%vs 12 7%± 18 3 % ,P =0 0 0 0 ) ,经年龄、性别调整后 ,二组间仍有显著性差异 ,提示高血压患者动脉顺应性下降、动脉硬化。将AIx作为因变量 ,年龄、身高、家庭测量血压及动态血压中 2 4小时平均血压、白昼血压、夜间血压、血糖、血酯等作为自变量进行多元回归分析 ,AIx与年龄、家庭血压中的收缩压呈显著的正相关 ,与身高呈负相关     

2020中国动态血压监测指南

高血压是心脑血管疾病的重要危险因素。动态血压监测已成为识别和诊断高血压、评估心脑血管疾病风险、评估降压疗效、指导个体化降压治疗不可或缺的检测手段。本指南对2015年发表的《动态血压监测临床应用专家共识》进行了更新,详细介绍了动态血压计的选择与监测方法、动态血压监测的结果判定与临床应用、动态血压监测的适应证、特殊人群动态血压监测、社区动态血压监测应用以及动态血压监测临床应用展望,旨在指导临床实践中动态血压监测的应用。     

14例偶测血压正常动态血压升高病人临床分析

背景 长期以来,临床工作者常常只注意偶测血压高而动态血压正常者,即“自大衣高血压”(white coat hyperten-sion),而对偶测血压正常、动态血压升高的病人未予以重视。目的 探讨偶测血压正常、动态血压升高病人(masked hyper-tension)的临床特征与临床意义。方法 89例临床诊断为血压正常的受试者,由受过专门训练的护士在受试者家中测量血压二次,时间间隔为2～3周,二次测量共获得10个读数的平均值作为偶测血压。采用24小时动态血压监测仪记录动态血压。结果 该人群中偶测血压正常、动态血压升高的患病率为15．7％,以男性多见,其中64．3％为偶测血压正常高值者(血压13l～139／85～89mmHg);患者中饮酒的比例、体重指数、血清胆固醇及低密度脂蛋白胆固醇均高于偶测血压及动态血压均正常者。不同日二次测量共10个血压读数的均数与白昼动态血压的相关性好于同日测量、5个读数的均数。结论由于偶测血压的局限性,可使一部分白昼动态血压升高的患者漏诊,后者主要见于偶测血压正常高值者。应对偶测血压正常高值者予以随访检查。     

Ambulatory blood pressure monitoring: is it necessary for the routine assessment of hypertension in people with diabetes?

AIMS: The British Hypertension Society (BHS) has recommended that, for people with diabetes, the target 'clinic' blood pressure should be < 140/80 mmHg. Ambulatory monitoring of blood pressure (ABPM) is used widely in the assessment of hypertension and the BHS has recommended that the target 'awake' ambulatory blood pressure for people with diabetes should be < 130/75 mmHg. The purpose of the present study was to determine the utility of ABPM in the assessment of hypertension in patients with diabetes, over and above a careful 'clinic' measurement of blood pressure. METHODS: The records of 540 patients with diabetes who underwent ABPM (using SpaceLabs monitors) were retrospectively analysed. With respect to current BHS recommendations, the positive and negative predictive values of 'clinic' blood pressure (measured by trained nurses using mercury sphygmomanometers) on 'awake' ambulatory blood pressure (ABP) were calculated. RESULTS: The positive predictive value of the 'clinic' BP, its ability to detect patients whose ABP was above BHS targets, was 99%. The negative predictive value of 'clinic' blood pressure was 27%. CONCLUSIONS: With regard to current BHS guidelines, ABPM is generally unnecessary in the assessment of hypertension in patients with diabetes, provided careful 'clinic' measurements of blood pressure are made.     

Transdermal Clonidine Therapy and Blood Pressure Nocturnal Fall in Mild Hypertensive Male Subjects

Treatment of mild hypertension with an antihypertensive drug administered by means of a transdermal therapeutic system (TTS) could produce favorable results, when compared with a traditional oral regimen. Purpose: Using 24-h ambulatory blood pressure (BP) monitoring (ABPM) in mild hypertensive male subjects, to analyze three aspects which have not been completely clarified: a) whether a latency in the antihypertensive effect may be present, recording BP already from the first day of application of the patch, b) the eventual hazardous enhancement of circadian nocturnal fall in BP values in treated mild hypertensive patients and, c) the possible overlapping of antihypertensive effect between the administration of two consecutive patches. Subjects and methods: In 12 caucasian male outpatients (yrs 55 ± 3 SEM) with uncomplicated essential mild hypertension, a patch containing placebo was applied for the first week (T 0 period). At the end of the T 0 period, a 5 mg TTS-2 clonidine patch was applied for one week, and, subsequently, a new patch of 5 mg TTS-2 clonidine was kept for another week. ABPM was performed on the last day of the placebo period (T 0) and on the 1st day (T1), the 7th day (T2) and the 14th day (T3) of transdermal clonidine therapy. Results: Both systolic and diastolic BP (24 h mean, day-night-time) decreased on the 1st, 7th and 14th day, when compared with T0. However, no significant differences were documented between the BP levels on the 1st and the 7th day of treatment. The incidence of nocturnal fall in systolic and diastolic BP was evaluated and no significant differences were found, when compared with night-time reference values. Conclusions: When compared with the placebo period, TTS-2 clonidine lowers SBP and DBP within the first 24 hours of application. The antihypertensive effect persists at the end of the first week, as well as after 14 days. The lowest values of systolic-diastolic BP documented were not below the levels reported in normotensive men. Therefore, TTS-2 clonidine seems to act as an antihypertensive agent rather than a hypotensive drug since it normalizes BP without lowering it below physiological levels.     

Absence of Alarm Reactions with use of Non-Invasive Blood Pressure Monitoring Devices

We have previously shown that blood pressure measurement by a doctor or a nurse is often accompanied by an alarm reaction and a marked blood pressure rise which leads to an overestimation of patients’ daily blood pressure. To determine whether this phenomenon occurs to some extent also during automatic or semiautomatic measurements of blood pressure, we have studied 20 subjects in which blood pressure was recorded invasively for 24 hours by the Oxford method. During the day time of the recording the arm contralateral to the one used for the invasive procedure was equipped with a non-invasive blood pressure recorder (Vita-Stat 901) the blood pressure measurements being performed automatically (2 hours) or semiautomatically (2 hours) at intervals of 10 minutes. The analysis of the intra-arterial blood pressure trace during the periods preceding and following the beginning of the cuff inflations that started the non-invasive measurements showed that these procedures had caused no increment in systolic and diastolic blood pressure. In nearly all subjects this applied not only to the mean data for all automatic or semiautomatic measurements, but also to the individual observations including those made in the first part of each 2 hour period, when the emotional component might have been greater. It can be concluded that non-invasive blood pressure monitoring does not induce an alarm reaction and a blood pressure rise either when performed automatically and semiautomatically. Thus this approach does not overestimate patients' blood pressure, which adds to its reliability for the diagnosis of hypertension.     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的　应用动态血压监测 (ABPM )的方法评价贝尼地平治疗原发性高血压的降压疗效、谷 /峰比值及不良反应。方法　采用开放的方法 ,2 0例研究对象经 2周洗脱期 ,服用贝尼地平 4mg/d一次 ,2周末坐位舒张压 (SeDBP)≥ 90mmHg者加量至贝尼地平 8mg/d一次 ,继续服用 6周。于洗脱期末及治疗 8周末各行ABPM和实验室检查一次。结果　ABPM显示 8周末 2 4h、日间、夜间收缩压 (SBP/DBP)较洗脱期末分别下降 (9.4± 5 .4 / 6 .2± 4 .1)mmHg、(10 7± 6 .7/ 6 8± 3 8)mmHg、(6 9± 9 0 / 5 1± 7 7)mmHg。降压T/P值SBP为 5 8% ,DBP为 5 9%。无严重不良反应。 结论　贝尼地平 4～ 8mg/d一次为疗效确切的降压药物。     

妊娠高血压综合征动态血压监测及其意义

目的探讨妊娠高血压综合征动态血压监测的特征变化。方法用动态血压仪测定３２例妊娠高血压患者的血压，并和２０例正常妊娠和２０例正常相当年龄的健康妇女作对照。结果正常孕妇ＡＢＰＭ各参数均高于同龄健康妇女；妊娠高血压ＡＢＰＭ各参数均高于正常孕妇。妊娠高血压蛋白尿阳性者的昼夜血压比值及血压负荷数均较无蛋白尿者明显增高，且与病情严重度相关。结论正常中、晚期妊娠的收缩压有增高趋势，舒张压升高对妊娠高血压更具特征性。ＡＢＰＭ测定所出现的血压昼夜节律变化和血压负荷增高和病情的严重度相关。     

动态血压监测观察苯那普利的降压疗效

目的观察苯那普利的降压效果及对肝、肾功能的影响。方法４４例高血压患者用药前进行２４ｈ动态血压监测，并检查肝、肾功能及血糖，然后口服苯那普利１０～２０ｍｇ／ｄ，４周后再行动态血压监测并复查肝、肾功能及血糖，比较治疗前后各项指标的变化。结果Ⅰ、Ⅱ期高血压患者血压呈白天高、夜间低的变化规律；Ⅲ期患者舒张压失去昼夜变化规律；苯那普利对昼夜血压均显示良好的降压效果，对肝、肾功能无不良影响。结论苯那普利具有良好的降压效果，对肝肾功能及血糖无不良影响。