Weekly Variation of Home and Ambulatory Blood Pressure and Relation Between Arterial Stiffness and Blood Pressure Measurements in Community-Dwelling Hypertensives

Although blood pressure (BP) is a major determinant of pulse wave velocity (PWV), some treatments have independent effects on BP and arterial stiffness. Although both ambulatory BP (ABP) and self-measured BP at home (HBP) have become important measures for the diagnosis and management of hypertension, single day recordings may be insufficient for a proper diagnosis of hypertension or the evaluation of treatment efficacy. To evaluate weekly variations in BP using 7-day HBP and 7-day ABP monitoring and to determine the relation between arterial stiffness and BP measurements in community-dwelling patients with hypertension. We enrolled 68 community-dwelling hypertensive subjects in this study. Significant weekly variations in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found in the awake ABP data (p < .01, respectively), while no significant weekly variations in the asleep ABP or the morning and evening HBP data were observed. In untreated subjects, significant correlations were obtained between the brachial-ankle PWV and the average awake SBP, the average asleep SBP and the average SBP measured by HBP in the evening. In treated subjects, only the average SBP measured by HBP in the morning was significantly correlated with the baPWV. Differences in the weekly variations in BP were observed between HBP and ABP monitoring. In addition, the morning systolic HBP was not correlated with arterial stiffness in untreated subjectswith hypertension but was correlated in treated subjects. Relations between the morning HBP and arterial stiffness might be attributed to morning surges in BP and/or trough levels of antihypertensive drugs.     

Assessment of the diurnal blood pressure profile and detection of non-dippers based on home or ambulatory monitoring

BackgroundA unique advantage of ambulatory blood pressure (ABP) monitoring is the assessment of nocturnal blood pressure (BP) and the detection of non-dippers. This study assessed nocturnal BP and non-dippers using a novel home BP (HBP) monitor.MethodsEighty-one hypertensives performed within 2 weeks ABP (24-h, Microlife WatchBP O3) and HBP monitoring (Microlife WatchBPN) during daytime (6 days, duplicate morning and evening measurements) and nighttime (automated asleep measurements, 3 nights, 3 readings/night). Patients' preference in using ABP or HBP was assessed by a questionnaire.ResultsStrong associations were found between ABP and HBP (intraclass correlation coefficients for awake systolic/diastolic 0.75/0.81; asleep 0.87/0.85). No statistically significant difference was found between HBP and ABP (mean difference ± SD awake systolic/diastolic 1.5 ± 10.1/-1.1 ± 6.0 mm Hg, P = 0.20/0.09; asleep -0.4 ± 7.8/-1.0 ± 5.3, P = 0.63/0.09). There was substantial agreement (74%, kappa 0.2) between ABP and HBP in the detection of non-dippers, which was similar to the previously reported test-retest reproducibility of repeated ABP monitoring in the diagnosis of non-dippers. Moderate to severe disturbance from ABP monitoring was reported by 18% of the participants and severe restriction of their daily activities by 9, vs. 3 and 1.5%, respectively for HBP (P < 0.001/ <0.01, for comparisons respectively). Nighttime BP monitoring and cuff discomfort were the main complaints for ABP (46 and 32%, respectively) and HBP (34 and 28%), whereas 89% reported more nighttime sleep disturbance by ABP than HBP (P < 0.001).ConclusionsHBP monitoring appears to be a reliable and well accepted by users alternative to ABP for the assessment of nocturnal BP and the detection of non-dippers.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.82.     

Diagnostic accuracy of home vs. ambulatory blood pressure monitoring in untreated and treated hypertension

Several studies with relatively small size and different design and end points have investigated the diagnostic ability of home blood pressure (HBP). This study investigated the usefulness of HBP compared with ambulatory monitoring (ABP) in diagnosing sustained hypertension, white coat phenomenon (WCP) and masked hypertension (MH) in a large sample of untreated and treated subjects using a blood pressure (BP) measurement protocol according to the current guidelines. A total of 613 subjects attending a hypertension clinic (mean age 53±12.4 (s.d.) years, men 57%, untreated 59%) had measurements of clinic BP (three visits, triplicate measurements per visit), HBP (6 days, duplicate morning and evening measurements) and awake ABP (20-min intervals) within 6 weeks. Sustained hypertension was diagnosed in 50% of the participants by ABP and HBP (agreement 89%, κ=0.79), WCP in 14 and 15%, respectively (agreement 89%, κ=0.56) and MH in 16% and 15% (agreement 88%, κ=0.52). Only 4% of the subjects (27/613) showed clinically significant diagnostic disagreement with BP deviation >5?mm?Hg above the diagnostic threshold (for HBP or ABP). By taking ABP as reference, the sensitivity, specificity, positive and negative predictive value of HBP in detecting sustained hypertension were 90, 89, 89 and 90%, respectively, WCP 61, 94, 64 and 94% and MH 60, 93, 60 and 93%. Similar diagnostic agreement was found in untreated and treated subjects. HBP appears to be a reliable alternative to ABP in the diagnosis of hypertension and the detection of WCP and MH in both untreated and treated subjects.     

Agreement between community pharmacy and ambulatory and home blood pressure measurement methods to assess the effectiveness of antihypertensive treatment: the MEPAFAR study

The usefulness of the community pharmacy blood pressure (CPBP) method in the diagnosis or treatment of hypertension has not been adequately addressed in controlled studies. The authors' aim was to assess the agreement between awake ambulatory blood pressure (ABP), home blood pressure (HBP), and CPBP in treated hypertensive patients. This was a cross-sectional study carried out in 169 patients in which blood pressure (BP) was measured at the pharmacy (4 visits), at home (4 days), and by 24-hour ABP monitoring. Lin correlation-concordance coefficient (CCC) and Bland-Altman plots were used to evaluate quantitative agreement. The qualitative agreement to establish the degree of BP control was evaluated using κ coefficient. The agreement was acceptable between HBP and CPBP (CCC=0.80 for systolic BP [SBP] and 0.80 for diastolic BP [DBP]; κ=0.62) and moderate between awake ABP and CPBP (CCC=0.74/0.67, respectively; κ=0.56). The Bland-Altman plots also showed lowest mean differences (0.5/0.3 for SBP and DBP, respectively) for the comparison between CPBP and HBP. The CPBP has a better agreement with HBP than with awake ABP. Thus, the CPBP measurement method could be a good alternative to HBP monitoring, whereas it cannot be used as a screening test to assess the degree of BP control by awake ABP.     

厄贝沙坦联合维生素D对老年高血压患者晨峰血压及动脉僵硬度的影响

目的 探讨厄贝沙坦联合维生素D对老年高血压患者晨峰血压及动脉僵硬度的影响.方法 选择我院2020年1月至6月期间收治的老年高血压病患者80例,随机分为对照组(40例)和观察组(40例).对照组口服厄贝沙坦片治疗,观察组在此基础上肌注维生素D3治疗.比较两组治疗前后24h平均收缩压(24h SBP)、平均舒张压(24h ...     

Rate of morning increase in blood pressure is elevated in hypertensives

BACKGROUND: We applied a new logistic curve fitting procedure to ambulatory blood pressure (ABP) recordings to determine whether the rate of increase in systolic (SBP), mean (MBP) and diastolic blood pressure (DBP) and heart rate (HR) in the morning is related to the level of BP in subjects. METHODS: The rate of transition in the morning and evening period was determined using a six-parameter double-logistic equation applied to 528 ABP recordings from a cardiovascular risk assessment clinic. Based on daytime BP (MBP, SBP, or DBP), the upper quartile (UQ, n = 132) and lower quartile (LQ) were compared. RESULTS: Subjects in the UQ of daytime MBP were hypertensive and showed greater day-night differences compared to normotensive subjects in the LQ (29 +/- 1 mm Hg for MBP compared to 20 +/- 1 mm Hg). The rate of morning increase in SBP and DBP was 42% and 30% greater in UQ subjects compared to the LQ subjects (P < .05). The rates of evening decrease in all BPs were 69% to 84% greater in the subjects in the UQ. Similar results were obtained if subjects were divided according to daytime SBP or DBP. The rate of morning increase in MBP was correlated with daytime BP, but not night-time or 24 h MBP. CONCLUSIONS: The rate of morning increase in BP is greater in those subjects with the highest daytime BP. The exaggerated rate of morning increase in BP in this group, which were all hypertensive, may also be important for greater cardiovascular risk.     

Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension

This study was conducted to compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the diagnosis of hypertension in primary care. The study subjects were 411 patients with average CBP > or =140 mmHg systolic or > or =90 mmHg diastolic, who performed telemedical HBP measurement (5 days, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. CBP was much higher than daytime ABP and average HBP (P<0.001) with no difference between the latter two. The correlation between CBP and ABP was weak (systolic: r=0.499, diastolic: r=0.543), whereas strong correlations existed between HBP and ABP (systolic: r=0.847, diastolic: r=0.812). A progressive improvement in the strength of the linear regression between average HBP of single days and ABP was obtained from day 1 to day 4, with no further benefit obtained on the fifth day. The HBP readings taken at noon and in the afternoon showed significantly stronger correlations with ABP than the blood pressures measured in the morning and in the evening. In conclusion, the accuracy of telemedical HBP measurement was substantially better than that of CBP in the diagnosis of hypertension in primary care. HBP most accurately reflected ABP on the fourth day of monitoring, and the readings at noon and in the afternoon seemed to be most accurate.     

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

Blood pressure (BP) is one of the most important contributing factors to pulse wave velocity (PWV), a classic measure of arterial stiffness. Although there have been many non-invasive studies to show the relation between arterial stiffness and BP, the results are controversial. The aim of this study is to evaluate the role of BP as an influencing factor on PWV using invasive method. We observed 174 normotensive and untreated hypertensive subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by pressure wave at the right common femoral artery. From univariate analysis, age, diabetes mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-to-high-density lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) showed significant association with PWV. To avoid multiple colinearity among SBP, PP and MAP, we performed multiple regression analysis predicting PWV thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the first and third modules, compared to age, SBP and MAP were less strong predictors, respectively. However, PP was the stronger predictor than age and DM in the second module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the significance of MAP was lost. This is the first invasive study to suggest that PP has the strongest correlation with PWV among a variety of BP parameters.     

Reproducibility of home and ambulatory blood pressure in children and adolescents

OBJECTIVE: To evaluate the reproducibility of blood pressure measured at home (HBP) in comparison with ambulatory (ABP) and clinic blood pressure (CBP) in children and adolescents. PARTICIPANTS AND METHODS: Individuals aged 8-17 years who had been referred for elevated CBP were included. CBP was measured at two visits, HBP on 5 days and ABP for 24 h. A second session including all the above measurements was performed after 8 weeks. The reproducibility of CBP (second visit of each session), HBP (average of days 2-5 of each session) and ABP (average 24-h, awake and asleep) was quantified using test-retest correlations coefficients (r) and the standard deviation of differences (SDD) between repeated measurements. RESULTS: Sixteen individuals were included [mean age 13.3+/-2.9 (SD)] years, range 8-17, nine boys]. According to Task Force CBP criteria, eight were classified as hypertensives, three as high normal and five as normotensives. The reproducibility of HBP (systolic/diastolic r, 0.74/0.82, SDD 7.0/4.3) was superior to that of CBP (r, 0.63/0.80, SDD 10.4/6.3). However, ABP appeared to provide the most reproducible values (r, 0.87/0.84, SDD 5.5/4.3 for 24-h ABP; r, 0.85/0.76, SDD 5.9/5.0 for awake; r, 0.76/0.79, SDD 7.0/5.0 for asleep ABP). Aspects of the diurnal ABP variation were poorly reproducible (r, 0.62/0.14, SDD 6.8/5.5 for awake-asleep ABP difference; r, 0.55/0.26, SDD 0.07/0.11 for awake : asleep ratio). CONCLUSION: These data suggest that in children and adolescents home blood pressure measurements are more reproducible than clinic measurements. However, 24-h ambulatory monitoring appears to provide the most reproducible blood pressure values.     

Arterial stiffness is related to augmented seasonal variation of blood pressure in hypertensive patients

BACKGROUND: Seasonal variation in blood pressure (BP), a usual tendency of both systolic (SBP) and diastolic BP (DBP) to rise during winter in hypertensive patients, may be related to the higher cardiovascular mortality in winter. However, it is not yet clear what factors are relevant to the seasonal BP changes. We hypothesized that arterial stiffness is related to the BP changes between summer and winter. METHODS AND RESULTS: Eighty-five elderly (>55 years) patients with essential hypertension (33 males, 64+/-6.0 years) were enrolled. Seasonal BP profiles over at least 2 years were studied along with arterial stiffness and clinical variables (age, gender, smoking, duration of hypertension, anti-hypertensive medications and body mass index). Both SBP and DBP were significantly higher during winter compared with three other seasons (spring 128+/-10.0/79+/-7.3 mmHg, summer 127+/-9.8/78+/-7.1 mmHg, autumn 127+/-10.3/78+/-8.0 mmHg, winter 136+/-12.5/81+/-7.6 mmHg; SBP changes; p<0.001, DBP changes; p<0.001). There were no significant seasonal differences among spring, summer and autumn. Pulse wave velocity (PWV), a widely used clinical indicator of arterial stiffness was correlated with winter-summer differences in SBP (r = 0.272, p = 0.012), but not in DBP (r = 0.188, p = 0.085). Age, which was correlated with PWV strongly (p<0.001), was not significantly related to the seasonal changes in BP (SBP changes; p = 0.114, DBP changes; p = 0.298). No other clinical variables had significant correlation with seasonal BP changes. Multivariate regression analysis revealed that PWV is the only significant predictor for winter-summer SBP changes. CONCLUSIONS: Our results established a feasible link between arterial stiffness and seasonal BP variation. These findings may partly explain higher cardiovascular risk in patients with increased arterial stiffness.     

Home blood pressure monitoring in children: how many measurements are needed?

OBJECTIVE: To investigate the minimum schedule of blood pressure (BP) measurements necessary to provide a reliable assessment of home BP (HBP) in children and adolescents. METHODS: Subjects aged 6-18 years referred for elevated BP were assessed with HBP monitoring (6 workdays, duplicate morning and evening measurements) and 24-h ambulatory BP monitoring (ABP). Criteria for HBP reliability were its reproducibility (test-retest correlations and SD of differences (SDDs) between repeated measurements), its stability (average home BP of an increasing number of readings and its SD), and its relationship with ABP. RESULTS: Data from 100 subjects were analyzed (mean age 13 +/- 2.8 (SD) years, 61 boys). The reproducibility of 3-day HBP (r 0.88/0.79, SDDs 5.1/4.9, systolic/diastolic) was superior to that of a single (r 0.79/0.65, SDDs 7.6/7.1) or 2-day HBP (r 0.85/0.72, SDDs 6.1/5.4). By averaging up to 12 readings (3 days), there was a progressive decline in average HBP, with no further decline thereafter. The SD of average HBP was also progressively reduced, with little change after day 3. The association of HBP with ABP was improved by averaging more readings up to 12, with no further improvement when more readings were averaged. The exclusion of first-day measurements slightly increased the SD of average HBP and weakened the correlation with ABP, probably due to reduced number of readings. CONCLUSIONS: In children and adolescents, 3-day monitoring with duplicate morning and evening measurements appears to be the minimum schedule for the reliable assessment of HBP.     

Relative utility of home, ambulatory, and office blood pressures in the prediction of end-organ damage

BACKGROUND: Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and treatment of hypertension. We evaluated the independent value of HBP compared with ambulatory blood pressure (ABP) and office blood pressure (OBP) in the prediction of cardiovascular end-organ damage in normotensive subjects and untreated patients with mild hypertension. METHODS: One hundred sixty-three subjects underwent measurements of OBP, HBP, ABP, and echocardiography. A physician using a mercury-column sphygmomanometer performed three OBP measurements. The ABP was recorded using a noninvasive ambulatory monitor (mean, 35.4 awake readings per subject). Participants took HBP readings with an automatic, oscillometric device over a 10-week period (mean, 277.9 readings per subject). The left-ventricular mass index (LVMI) was calculated from measurements obtained from two-dimensionally guided M-mode or linear tracings on echocardiography. RESULTS: For systolic and diastolic blood pressures (SBP/DBP), the correlation coefficients of the LVMI with OBP, awake ABP, and HBP were 0.29/0.27, 0.41/0.26, and 0.47/0.35, respectively (all P < .01). In a multivariate regression analysis in which age, sex, body mass index, OBP, awake ABP, and HBP were included, only age, sex, and HBP were significant predictors of LVMI. When only the first 12 home readings were used, the superiority of HBP was no longer evident. CONCLUSIONS: In contrast to OBP and ABP, HBP measurements, when averaged over a 10-week period, are independently related to LVMI. The HBP adds prognostic information over and above OBP and ABP in the prediction of cardiovascular end-organ damage, but this relationship appears to depend on the number of readings taken.     

Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes

BACKGROUND: The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM). METHODS: In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 +/- 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP <135, 135-150, and >150 mm Hg), sleep SBP (<120, 120-135, and >135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors. RESULTS: Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic BP did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a approximately 150% increase in risk of CVD, in both groups. CONCLUSIONS: These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.     

Arterial stiffness and orthostatic blood pressure changes in untreated and treated hypertensive subjects

Carotid-femoral pulse wave velocity (PWV), an integrated marker of segmental aortic stiffness, was recently proposed as one of the underlying mechanisms inducing orthostatic hypotension in the elderly with marked arterial rigidity. We examined the relationship between PWV (Complior; Colson, Paris, France) and orthostatic blood pressure (BP) changes, measured repeatedly, over a wide range of age and arterial stiffness. Sixty-nine hypertensive subjects (age, 37 to 76 years; 39 untreated and 30 treated) were studied. BP, in both sitting and erect position, was measured at two occasions a few weeks apart, and in between PWV was assessed by means of pulse wave analysis. In untreated hypertensive subjects, the orthostatic alterations in systolic, but not in diastolic blood pressure (DBP), were inversely related to PWV, independently from age, gender, mean BP, and diabetes mellitus. The greater the aortic stiffness the larger was the systolic blood pressure (SBP) decrease during upraises. On the contrary, no such association was found between PWV and orthostatic changes of BP in treated hypertensive subjects. These results suggest the presence of a pathophysiological association between arterial stiffening and BP postural changes. Antihypertensive drug treatment, as well as other factors that have not been evaluated in the present study, might have modulated this association. However, it might be argued that a causal association between arterial stiffness – disturbed baroreflex sensitivity – postural BP changes, even in subjects without pronounced vascular aging or orthostatic hypotension, is implied.     

Masked Hypertension Assessed by Ambulatory Blood Pressure Versus Home Blood Pressure Monitoring: Is It the Same Phenomenon?

BACKGROUND: Masked hypertension is defined as normal clinic blood pressure (CBP) and elevated out-of-clinic blood pressure assessed using either self-monitoring of blood pressure (BP) by the patients at home (HBP) or ambulatory BP (ABP) monitoring. This study investigated the level of agreement between ABP and HBP in the diagnosis of masked hypertension. METHODS: Participants referred to an outpatient hypertension clinic had measurements of CBP (two visits), HBP (4 days), and ABP (24 h). The diagnosis of masked hypertension based on HBP (CBP <140/90 mm Hg and HBP > or =135/85) versus ABP (CBP <140/90 and awake ABP > or =135/85) was compared. RESULTS: A total of 438 subjects were included (mean age +/- SD, 51.5 +/- 11.6 years; 59% men and 41% women, 34% treated and 66% untreated). Similar proportions of subjects with masked hypertension were diagnosed by ABP (14.2%) and HBP (11.9%). In both treated and untreated subjects, the masked hypertension phenomenon was as common as the white coat phenomenon. Among 132 subjects with normal CBP, there was disagreement in the diagnosis of masked hypertension between the HBP and the ABP method in 23% of subjects for systolic and 30% for diastolic BP (kappa 0.56). When a 5-mm Hg gray zone for uncertain diagnosis was applied to the diagnostic threshold, the disagreement was reduced to 9% and 6% respectively. CONCLUSIONS: Similar proportions of subjects with masked hypertension are detected by ABP and HBP monitoring. Although disagreement in the diagnosis between the two methods is not uncommon, in the majority of these cases the deviation of the diagnostic BP above the threshold in not clinically important. Both ABP and HBP monitoring appear to be appropriate methods for the detection of masked hypertension.     

Normal ambulatory blood pressure: a clinical practice-based comparison of two recently published definitions

The European Society of Hypertension (ESH) has issued guidelines for the detection and treatment of hypertension. According to these guidelines, normal 24-h ambulatory blood pressure (ABP) is defined as lower than 125/80 mmHg. Another publication of ESH recommendations for blood pressure (BP) measurement defines normal awake and asleep blood pressure as lower than 135/85 and 120/70 mmHg, respectively. Our aim was to investigate the compatibility of these two recently proposed ABP cutoffs in clinical practice. We analysed 1495 consecutive ABP measurements. In all, 56% of the subjects were female; age 58 +/- 16 years; body mass index 27 +/- 4 kg/m(2); clinic BP 151+/-22/84 +/- 13 mmHg. Two-thirds were treated for hypertension, and 11% for diabetes. Subjects were classified as having normal 24-h BP if the corresponding value was <125/80 mmHg. Normal awake-sleep BP was diagnosed if awake BP was <135/85 mmHg and sleep BP was <120/70 mmHg. Concordance between the cutoffs was found in 93% of the subjects. Among the 7% discordant subjects, 4.5% were hypertensive applying the 24 h, but not awake-sleep, BP values, whereas only 2.5% were hypertensive according to awake-sleep, but not 24 h, BP values (P < 0.005). In Conclusion, in real-life ABP measurement, a good agreement was found between two recently issued ABP normality definitions. However, some subjects are classified as hypertensive only according to one of these methods, more often by the 24-h cutoff of 125/80. This discordance may be significant in large-scale clinical BP monitoring.     

Tele-monitoring of home blood pressure in treated hypertensive patients

AIM: To compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the assessment of antihypertensive effect. METHODS: 362 patients on antihypertensive medication performed HBP measurement (5 days, duplicate measurements, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. RESULTS: CBP was much higher than ABP and average HBP (p < 0.001). There was a progressive decline in HBP over the course of the study, achieving the level of daytime ABP on the last 2 monitoring days. The correlation between CBP and ABP was weak (systolic: r = 0.343, diastolic r = 0.430), whereas strong correlations existed between HBP and ABP (systolic r = 0.804, diastolic r = 0.776). A progressive improvement in the strength of the correlation between average HBP of single days and ABP was obtained over the 5 monitoring days. The HBP readings taken in the afternoon showed a stronger correlation with ABP than the values measured in the morning, at noon and in the evening. Averaging more HBP readings taken on succeeding days resulted in a progressive improvement in the agreement with ABP with a further benefit when readings of day 1 were included. CONCLUSIONS: The accuracy of telemedical HBP measurement is substantially better than that of CBP. The results suggest, that HBP should be measured for 5 days, and afternoon measurements should be preferred in assessing control of hypertension.     

老老年人群动态血压参数与动脉僵硬度的相关性

目的探讨老老年人群动态血压参数与动脉僵硬度的相关性。方法筛选年龄≥80岁的老老年人238例,以血压≥160/95 mm Hg(1 mm Hg=0.133 kPa)为标准,分为高血压组(134例)和对照组(104例),并进行臂-踝脉搏传导速度(baPWV)和24 h动态血压监测。用Pearson分析动态血压各参数与动脉僵硬度的相关性。结果高血压组baPWV高于对照组(P<0.05)。高血压组偶测收缩压,24 h、昼间和夜间收缩压、舒张压、脉压,收缩压负荷及舒张压负荷均高于对照组.夜间收缩压下降率、舒张压下降率低于对照组,差异有统计学意义(P<0.05,P<0.01)。baPWV与偶测血压;24 h收缩压、舒张压、脉压;昼间收缩压、舒张压、脉压、心率;夜间收缩压、舒张压、脉压;收缩压负荷、舒张压负荷呈正相关(P<0.05,P<0.01),而与夜间收缩压下降率呈负相关(P<0.01)。结论高血压是老老年人群动脉僵硬度增加的一个重要因素,动脉僵硬度与动态血压、脉压、心率及血压负荷相关。     

Arterial stiffness and central hemodynamics in treated hypertensive subjects according to brachial blood pressure classification

BACKGROUND: International recommendations have classified brachial blood pressure (BP) in subgroups enabling better cardiovascular risk stratification. Central BP is an independent predictor of cardiovascular risk, differing from brachial BP through the predominant influence of arterial stiffness and wave reflections. Central BP has never been studied in relation to international guidelines for brachial BP classification. METHODS: In 580 chronically treated hypertensive subjects we measured: carotid-femoral pulse wave velocity (PWV), carotid artery augmentation index (AI) and carotid blood pressures, using applanation tonometry and pulse wave analysis, and using brachial BP for carotid pressure wave calibration. RESULTS: For each given brachial value, carotid systolic blood pressure (SBP) and PP were significantly lower than the corresponding brachial SBP and PP. This pressure amplification was significantly lower in the 'optimal' and 'normal' BP ranges (6.8-7.4 mmHg) than in the higher BP ranges (10.1-11.3 mmHg), mainly depending on heart rate (HR) and PWV levels. PWV gradually increased as a function of brachial BP classification and was a significant predictor of this classification independently of age, drug treatment, atherosclerotic lesions and even mean BP. Finally, PWV was a highly sensitive marker of the effective BP control throughout all decades of age. CONCLUSION: Under chronic antihypertensive therapy, central BP does not strictly parallel the corresponding brachial BP classification, depending on differences in aortic stiffness and HR. Whether aortic PWV might predict the brachial BP classification and/or the presence of effective BP control, as suggested in this study, needs further confirmation.     

Variability of direct arterial blood pressure in essential hypertension--relationships between the fall of blood pressure during sleep and awake resting hemodynamic parameters

The relationship of continuous ambulatory intra-arterial blood pressure over a 24-hour period and awake resting hemodynamic parameters measured by echocardiography was studied in 21 patients with essential hypertension (WHO stage I & II): Left ventricular wall thickness at end-diastole correlated strongly with average SBP and weakly with average DBP during both waking and sleeping periods. Variability of blood pressure taken during waking and sleeping periods was not significantly correlated with any hemodynamic parameters measured by echocardiography. Variability of SBP during sleep had a significant correlation with age; however the fall of blood pressure during sleep had no significant correlation with age. Fall of blood pressure during sleep was significantly correlated to resting awake TPR. In patients with essential hypertension, the above results demonstrate that subjects with thicker left ventricular wall have higher average continuous blood pressure over 24-hours and suggest that there is a tendency for greater falls in blood pressure during sleep to occur in subjects with higher TPR and that older subjects have greater variabilities of SBP during sleep.