Treatment of patients with essential hypertension using bifunctional 24-hour blood pressure and ECG monitoring

The results of 24-hour blood pressure monitoring (BPM) help to divide patients into therapeutic groups according to the leading hemodynamic mechanism offorming essential arterial hypertension (EAH). In patients with a mean day heart rate of > or =73 bpm antihypertensive therapy should begin with beta1-adrenoblockers when not contraindicated. In patients with a mean day heart rate of < or =73 bpm antihypertensive therapy may be started with preparations of other pharmaceutical groups. In this study, Plendil or Concor was administered as a chronotherapy; later their combination was used, and diuretics or ACE inhibitors were added when necessary. At any stage of the study, starting from the second week of therapy, if blood pressure (BP) was normal and there were ischemic episodes according to matched 24-hour BPM and ECG, Cardiket and, when not contraindicated, Aspirin, were added. The offered algorithm of choice of therapy made it possible to achieve a good antihypertensive effect in 84% of patients and a satisfactory effect in 7% of patients, which was accompanied by a tendency towards the shortening of total ischemia duration and lowering the frequency of myocardial hypokinesia. The effect of the therapy was poor only in 9% of patients, 2% of whom one left the study due to adverse reactions before BP was normalized. BP was normalized on the 8th week of treatment in 75% of patients. It is appropriate to include matched 24-hour BPM and ECG in the follow-up of patients with EAH and coronary artery disease upon discharge under the conditions of routine physical load. According to 24-hour BPM, mean day heart rate and total length of ischemia grow during this period due to an increase in physical and emotional load, which requires correction of the therapy.     

Clinical use of 24-hour ambulatory blood pressure monitoring

Knowing a patient's continuous 24-hour blood pressure measurements can be useful to the nurse practitioner in evaluating the hypertensive patient. Recent studies have demonstrated end-organ damage to have a higher degree of correlation with 24-hour blood pressure readings than with more periodic blood pressure readings. Previously, 24-hour ambulatory blood pressure determinations were evaluated primarily in research settings. The ability to obtain these readings for diagnostic information applicable to clinical situations is becoming readily available. The historical background leading to the development of the ambulatory blood pressure monitors for clinical use is reviewed. The indications for obtaining 24-hour ambulatory pressures, interpretation of specific graphs and patient outcome are explained.     

Comparing differences and correlation between 24-hour ambulatory blood pressure and office blood pressure monitoring in patients with untreated hypertension

ObjectiveWe assessed differences and correlations between 24-hour ambulatory blood pressure (ABP) and office blood pressure (OBP) monitoring.MethodsWe conducted an observational study among 85 untreated patients with essential hypertension and measured 24-hour ABP, OBP, target organ damage (TOD) markers, and metabolism indexes. Variance analysis and the Pearson method were used to compare differences and correlation between the two methods. The Spearman or Pearson method was applied to compare the correlation between TOD markers, blood pressure index, and metabolism index. Linear regression analysis was applied to estimate the quantitative relationship between the blood pressure index and TOD markers.ResultsThere were significant differences in the mean and variance of systolic blood pressure (SBP) and diastolic blood pressure and a positive correlation between ABP and OBP. Correlations between the left ventricular mass index (LVMI) and average ambulatory SBP, daytime ambulatory SBP, nighttime ambulatory SBP, and fasting blood glucose were significant. Correlations between left intima-media thickness (IMT) and average ambulatory SBP, nighttime ambulatory SBP, right IMT, and nighttime ambulatory SBP were significant. In linear regression analysis of the LVMI (y) and ambulatory SBP (x), the equation was expressed as y = 0.637*x.ConclusionNighttime ambulatory SBP may be an optimal predictor of TOD.     

原发性高血压患者血同型半胱氨酸与24小时血压变异性的关系

目的：探讨原发性高血压患者血同型半胱氨酸(Hcy)与24小时血压变异性(BPV)(收缩压、舒张压)之间的关系。方法河南省人民医院住院的原发性高血压患者208例,按照血 Hcy 水平的不同,分为3组：A 组85例(血 Hcy<15.0μmol/L),B 组72例(15μmol/L≤Hcy<20.0μmol/L),C 组51例(≥20μmol/L)。分别测定24小时动态血压,计算24小时收缩压及舒张压标准差(SD)。结果3组原发性高血压患者,随着血 Hcy 水平增高,患者的24小时 BPV 亦升高,组间差异有统计学意义(P <0.05)。相关性分析提示血 Hcy 水平与24小时 BPV(收缩压、舒张压)之间存在相关性(r =0.570,0.512,P <0.01)。结论原发性高血压患者合并高 Hcy 血症可增加其 BPV,应该在关注血压水平的同时,关注血 Hcy 及 BPV,从而更好地管理高血压患者。     

24-hour ambulatory blood pressure monitoring in male children receiving stimulant therapy

OBJECTIVE: To determine whether cardiac indices are altered as assessed by 24-hour ambulatory blood pressure monitoring (ABPM) in male children receiving either chronic methylphenidate or dextroamphetamine/levoamphetamine (Adderall) therapy. METHODS: Boys 7-11 years old who were receiving methylphenidate or Adderall for a minimum of 2 months were asked to participate. Subjects wore ambulatory blood pressure monitors for 24-hour periods both off and on stimulant therapy. RESULTS: Subjects (n = 17; 8 methylphenidate, 9 Adderall) were well matched. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate differed between off and on stimulant therapy (p < 0.05). DBP load calculated from ABPM reference data was increased significantly (9.0% +/- 5.6% on and 4.8% +/- 4.5% off therapy; p < 0.05) while subjects were taking Adderall. There was a trend toward a greater elevation in blood pressure load during awake hours and a more pronounced decrease during the asleep hours for periods on compared with off-stimulant therapy. This trend resulted in significant (p < 0.05) nocturnal dipping on-stimulant phases compared with off-stimulant therapy for both SBP and DBP (Adderall) and SBP (methylphenidate). Two subjects (1 Adderall, 1 methylphenidate) met the criteria to be considered hypertensive based both on mean awake and 24-hour blood pressure load assessments during their on-treatment period. One additional subject receiving Adderall therapy met the criteria to be considered hypertensive based on blood pressure load criteria while off therapy only. Positive correlation coefficients (p < 0.05) were found when comparing stimulant dose (mg/kg) with the percent change of mean SBP, DBP, and heart rate between off and on therapy (r = 0.56, 0.61, and 0.58, respectively). CONCLUSIONS: These preliminary data suggest that blood pressure and heart rate appear to be altered in male patients while receiving stimulant therapy for attention-deficit hyperactivity disorder. Blood pressure and heart rate screening and monitoring during stimulant therapy to determine whether alterations become clinically significant is encouraged.     

Comparative efficacy of valsartan and olmesartan in mild-to-moderate hypertension: Results of 24-hour ambulatory blood pressure monitoring

The aim of this prospective, randomized, open-label, blinded endpoint (PROBE) study was to compare the antihypertensive efficacy of 2 angiotensin II (AII) receptor antagonists with different pharmacologic profiles, valsartan and olmesartan, in patients with mild-to-moderate essential hypertension. After an initial 2-week washout period, 114 patients (64 men, 50 women; aged 35–70 years) were randomly assigned to receive valsartan 160 mg or olmesartan 20 mg once daily for 8 weeks. After the washout period and after 2 and 8 weeks of treatment, 24-hour ambulatory blood pressure monitoring (ABPM) was performed using a noninvasive device, and casual blood pressure (BP) and heart rate were measured. Both olmesartan and valsartan had a clear-cut antihypertensive effect. However, significantly earlier and more pronounced antihypertensive activity was achieved with valsartan than with olmesartan, as demonstrated by (1) significantly lower 24-hour, daytime, and nighttime ABPM values after 2 weeks with valsartan (P < .01); (2) significantly lower percentage of abnormal BP readings with valsartan; (3) significantly higher trough-peak ratio and smoothness index with valsartan, suggesting a more prolonged and homogeneous antihypertensive effect; and (4) lower 24-hour postdose clinic systolic and diastolic BP values versus olmesartan. These findings show that pharmacodynamic and pharmacokinetic differences between All receptor antagonists, at clinically comparable dosages, may be associated with differences in anti hypertensive efficacy.     

Parameters of 24-hour blood pressure monitoring, and cardiovascular remodeling in patients with primary arterial hypertension

The aim of the investigation was to study correlations between 24-hour blood pressure (BP) values and structural and functional remodeling of the cardiovascular system in patients with primary arterial hypertension (AH), in men and women separately. The subjects of the study were 158 patients with primary AH aged 39 to 68 years, including 84 males and 74 females. Twenty-four hour BP monitoring, two-dimensional Doppler echo CG, and duplex scanning of the carotids were performed. Linear correlation was used for statistical analysis. The data evidence a correlation between average 24-hour BP (ABP), one the one hand, and ABP time index, interventricular septum thickness (IVST), posterior left ventricular wall thickness (PLVT), and carotid intima-media complex thickness (CIMTC), on the other, in women. There was a reverse correlation between pulse BP and ejection fraction (EF), and a direct one with parameters of heart and vascular remodeling, such as IVST, PLVT, LV myocardial mass (MM), LVMM index, and IMTC in women. In men, changes in such 24-hour BP parameters, as BP variability and the degree of nocturnal BP decrease, leads to earlier myocardial remodeling with a decrease in contractility vs. women.     

Effects of chronic nitrendipine on casual (office) and 24-hour ambulatory blood pressure

To assess the clinical efficacy of chronic nitrendipine therapy in mild to moderate essential hypertension, we studied blood pressure (BP) and heart rate responses in 22 subjects receiving maintenance nitrendipine therapy. Ten subjects (45%) whose hypertension was controlled with chronic monotherapy had an 11/12 mm Hg decrease in supine BP (P less than 0.05) with a mean (+/- SD) dose of 71 +/- 15 mg/day. The 12 (55%) subjects whose hypertension was not controlled with monotherapy had a comparatively higher baseline BP than the other 10 (156/105 +/- 10/6 compared with 150/98 +/- 15/4 mm Hg; P less than 0.05). Eight of the 10 subjects demonstrating office BP control with chronic nitrendipine monotherapy who also had full-time employment underwent continuous ambulatory BP monitoring before and after maintenance monotherapy. Nitrendipine induced a reduction in the mean 24-hour BP and mean BP at home, but did not reduce the BP during work or while asleep. These data suggest that nitrendipine lowers BP when assessed by casual office methods. The ambulatory BP monitor data demonstrate that the hypotensive response to chronic nitrendipine is modified during work periods, which are generally associated with increased adrenergic activity. Ambulatory BP monitoring may be superior to office (casual) monitoring in the assessment of the overall efficacy of antihypertensive drugs.     

Comparative efficacy of perindopril and enalapril once daily using 24-hour ambulatory blood pressure monitoring

ACE inhibitors are important therapeutic agents in controlling hypertension, correcting some of its pathophysiological derangement and improving its prognosis. While there are many such agents, there may be some important differences between them. This placebo run-in, double blind, crossover study, using 24-hour ambulatory blood pressure monitoring, compares the efficacy of perindopril 4-8 mg and enalapril 10-20 mg as once daily antihypertensive agents on 32 patients. For diastolic blood pressure (DBP), perindopril had a placebo-corrected peak (P) reduction of blood pressure (BP) of -6.4 +/- 1.3 mmHg vs its placebo-corrected trough (T) of -5.2 +/- 1.7 mmHg. Enalapril had a reduction in DBP of -8.5 +/- 1.3 mmHg (P) and -5.7 +/- 1.7 mmHg (T). For systolic blood pressure (SBP), perindopril had a reduction of -7.5 +/- 1.6 mmHg (P) vs -7.3 +/- 2.2 mmHg (T) compared to enalapril with -10.8 +/- 1.6 mmHg (P) vs -8.3 +/- 2.3 mmHg (T). Placebo-corrected trough-to-peak ratio (SBP/DBP) for perindopril was 0.97/0.81 vs 0.77/0.67 for enalapril. There was no difference noted in 24-hour mean BP, area under the curve or post-dose casual BP measurements. Both perindopril and enalapril were well tolerated and the two treatment groups had similar safety profiles. Perindopril thus had a predictable and sustained blood pressure effect giving a 24-hour cover for the patient without excessive peak effect or poor trough effect.     

高血压合并冠心病老年患者24-h动态血压监测的意义

目的 通过监测高血压合并冠心病老年患者24 h动态血压,分析相关参数变化的临床意义,为临床治疗提供诊断依据.方法 将试验对象分为三组:高血压合并冠心病组,86例;单纯性高血压组,127例;正常对照组,83例.应用无创动态血压监测系统记录动态血压及相关参数,并作对照分析.结果 高血压合并冠心病组收缩压和舒张压比单纯性高血压患者高(P＜0.05),其血压昼夜节律消失增加(P＜0.05),晨峰出现频率升高(P＜0.05);单纯性高血压患者昼、夜平均收缩压、平均舒张压及24小时血压负荷值均比血压正常组高(P＜0.05).结论 监测和控制高血压合并冠心病老年患者的动态血压,是减少并发症危险的关键环节.     

33例老年收缩期高血压的动态血压监测分析

目的应用24h动态血压监测33例老年收缩期高血压的血压变化特点及规律。方法长期或间断降压治疗的老年收缩期高血压患者33例，分别应用动态血压监测仪对其血压进行24h动态监测（ABPM），观察收缩压最高值、舒张压平均值、压差、血压峰值等。并根据其结果计算血压负荷值、昼夜变化率及昼夜血压分型并加以分析。结果33例患者中仅有4例血压维持正常范围，最高收缩压〉213kPa者23例（697％），压差〉80kPa25例（75.8％），平均舒张压5．3～78kPa 12例（36．4％），8．0～105kPa20例（60．6％），10．6～12．0kPa1例（3．0％）。血压昼夜节律及分型：减弱、非勺型22例（667％），消失、反勺型7例（212％）。结论老年收缩期高血压的特点：①收缩压明显增高，而舒张压明显减低，且脉压差明显增大。②24h昼夜血压多无峰谷变化的特点。③血压昼夜节律以减弱和消失多见，昼夜血压变化分型多为非勺型和反勺型。④老年收缩期高血压降压效果不甚理想。     

维持性血液透析患者24h动态血压与心脏结构功能相关性研究

目的探讨维持性血液透析患者24h动态血压与心脏结构功能的关系。方法研究对象为上海交通大学医学院附属仁济医院肾脏科维持性血液透析患者和慢性肾脏病（CKD）5期非透析患者各31例。采用动态血压计测定各组患者动态血压（ABPM），收集24h平均收缩压（24h-SBP），24h平均舒张压（24h—DBP），24h平均动脉压（24h-MAP），白昼平均收缩压（D-SBP），白昼平均舒张压（D-DBP），夜间平均收缩压（N—SBP）和夜间平均舒张压（N—DBP）以及昼夜节律。用超声心动图测定左心室舒张末内径（LVDd）、左心室收缩末内径（LVDs）、左房内径（LAD）、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）。并收集临床指标。结果比较两组患者左心室肥大（LVH）发生比率，LVDd、LVDs和LVMI值，血液透析组要高于非透析组，而射血分数较低。血液透析组的24h—SBP，24h-DBP，24h—MAP，D—SBP，D-DBP，N-SBP和N-DBP均显著性高于非透析组；并且其非勺型血压比率也显著性增高（90．3％VS64．5％，P=-O．015）。在24h平均白昼、夜间高血压比率及夜间收缩期高血压比率方面，血液透析组也明显高于非透析组。血液透析组24h平均血压〈135／85mmHg的患者中夜间非勺型血压的比率也高达87．5％。血液透析组患者的心脏结构的改变与患者的血压密切相关，尤其与收缩压及夜间非勺型血压呈正相关；另外还与Alb、PTH、透析龄和透析剂量存在相关。结论维持性血液透析患者普遍存在高血压或血压节律改变，夜间非勺型节律以及夜间收缩压升高与这些患者心脏结构和功能改变关系密切。     

高血压患者动态血压与心肌缺血和左心室肥大的关系

目的监测高血压患者动态血压变化,探讨与心肌缺血(MI)和左心室肥大(LVH)之间的关系。方法对92例高血压患者同步进行动态心电图和动态血压监测,根据有无MI分为:MI组38例和无MI组54例。结果(1)两组间比较24h和夜间平均收缩压(SBP)、平均舒张压(DBP),白天平均DBP差异均显著(P<0.05,t=3.96,3.00,2.76,4.35,4.63);(2)两组间最高SBP和最高DBP均无差异(P<0.05,t=1.04,1.19,0.91,1.19,1.80,0.96);(3)两组间24hSBP负荷、夜间SBP负荷和DBP负荷差异显著(P<0.05,t=2.30,2.50,2.60);(4)伴有MI的患者,血压呈“杓型”变化的发生率明显低于无MI的患者(P<0.005,χ2=9.85);(5)伴有MI的患者,其LVH的发生率明显高于无MI患者的发生率(P<0.005,χ2=13.56)。结论高血压患者持续的血压增高,尤其是夜间持续升高,血压负荷增大,对LVH的发生发展起着重要的作用。     

高血压患者心律失常与24小时动态脉压的相关性研究

目的 探讨原发性高血压患者心律失常与24 h动态脉压(PP)的相关性.方法 随机选择原发性高血压患者106例,同时行动态血压与动态心电图检查,以PP＜60 mm Hg(A组,52例),PP≥60 mm Hg(B组,54例)分为2组,对其进行分析.结果 脉压增加主要因收缩压增加所致;随脉压增加,收缩压负荷增加,复杂性、恶性心律失常的发生率也明显增加.结论 原发性高血压患者心律失常与脉压有关,临床治疗中要注意缩小脉压,并将脉压作为评价高血压危险度和降压效果的重要指标.     

Pulse blood pressure (according to 24-hour monitoring) and left ventricular myocardial structural changes in patients with hypertensive disease

AIM: To study a relationship of the magnitude of structural changes in the left ventricle (LV) to the mean daily pulse blood pressure (PBP) in patients with hypertensive disease (HD). MATERIALS AND METHODS: 70 male patients (mean age 49 +/- 1 years) with stages I (n = 54) to 11 (n = 16) HD. LV mass (LVM) was estimated by echocardiography according to the formula derived by R. B. Devereux et al. and normalized to body surface area [the LVM index (LVMI)]. The relative thickness index (RTI) for the posterior wall (PWRTI) and ventricular septum (VSRTI) was calculated as a ratio of the sum of PWRTI and VSRTI to the LV end-diastolic size. LVMI > 125 g/m2 was considered to be a criterion for LV hypertrophy (LVH). 24-hour blood pressure (BP) monitoring was performed with a Spacelabs-90207 device (USA). According to the 24-hour PBP value, the patients were divided into 2 groups: 1) those (n = 17) having PBP24 > 53 mm HG and 2) those (n = 53) having PBP24 < 53 mm Hg. RESULTS: Group 1 patients were found to have significantly higher LVMI, LV WRTI, and incidence of LVH and a complex of changes in the BP profile as higher values of 24-hour systolic, diastolic and mean BP, PBP, and BP variations. Multiple regression analysis revealed a highly significant contribution of PBP24 to the development of LVH. CONCLUSION: The pedictive value of PBP as an index that characterizes a dynamic pressure load in regard to LV structural changes is higher than that of mean BP as a static load index and a BP variation index.     

高血压患者不同体位动态血压的监测

目的了解高血压患者仰卧位、侧卧位、坐位、站立位动态血压测量有否不同。方法对51例动态血压监测的高血压患者,选用右上肢肱动脉测压法,分别测量不同体位的血压。结果仰卧位、左侧卧位、右侧卧位、坐位、站立位时的收缩压平均分别是152.10±14.55、129.21±14.92、150.42±15.54、149.87±14.84、147.85±12.67 mm Hg;舒张压平均分别是87.81±6.92、70.83±8.32、88.33±11.52、88.81±9.15、87.25±11.15 mm Hg。与仰卧位时动态血压测量的结果比较,左侧卧位时收缩压平均低22.89 mm Hg,舒张压平均低16.98 mm Hg,P<0.01;右侧卧位时收缩压平均低1.68 mm Hg,舒张压平均高0.52 mm Hg,P>0.05;坐位时收缩压平均低2.23 mm Hg,舒张压平均高1.00 mm Hg,P>0.05;站立位时收缩压平均低4.25 mm Hg,舒张压平均低0.56 mm Hg,P>0.05。结论高血压患者右侧卧位、坐位、站立位时与仰卧位时动态血压测量的结果无明显变化,左侧卧位时动态血压测量的结果显著低于仰卧位时动态血压测量的结果。     

动态血压监测评价硝苯地平控释片对亚急性期脑梗死合并高血压患者血压参数的影响

目的 通过无创性动态血压检测(ABPM)研究硝苯地平控释片对亚急性期脑梗死合并高血压患者血压参数的影响及其降压疗效.方法 应用ABPM观察51例脑梗死合并原发性高血压患者,根据所得数据分析硝苯地平控释片(拜新同)治疗前及治疗后第14天的血压变异性(BPV)、平滑指数、晨峰血压控制及谷峰比值等血压参数的变化.结果 (1)服用硝苯地平控释片(拜新同)后第14天的收缩压(SBP)、日间收缩压(dSBP)、夜间收缩压(nSBP)、舒张压(DBP)、日间舒张压(dDBP)、夜间舒张压(nDBP)较用药前均有明显降低[(144.70±14.89) mm Hg比(163.10±16.48) mm Hg,(145.67±15.20) mm Hg比(164.55±16.81) mm Hg,(140.85±19.46) mm Hg比(156.73±20.55) mm Hg,(81.24±8.88) mm Hg比(89.49±10.06) mm Hg,(81.25±9.40) mm Hg比(90.18±10.64) mm Hg,(81.34±12.10)mm Hg比(86.28±12.11) mm Hg;t值分别为11.01、11.53、5.29、8.71、7.53、2.31,P均＜0.05)];(2)以标准差作为BPV的指标,治疗后第14天收缩压的24h收缩压变异性(SBPV)、日间收缩压变异性(dSBPV)、夜间收缩压变异性(nSBPV)较治疗前有显著下降[(16.52±4.38)mm Hg比(19.78±6.72) mm Hg,(15.45±4.71) mm Hg比(17.88±7.25) mrn Hg,(14.94±5.89) mm Hg比(19.17 ±8.27) mm Hg;t值分别为3.38、2.19、2.99,P均＜0.05)],舒张压的BPV治疗前、后差异无统计学意义;(3)平滑指数与BPV存在负相关(r≤-0.28;P均＜0.05);(4)用药治疗后的收缩压晨峰血压[(22.65±12.77) mm Hg]较治疗前[(31.94±16.36) mm Hg]得以明显控制(t=3.20,P＜0.01);(5)整体法计算24 h的谷峰比值(T/P),收缩压和舒张压分别是0.721和0.676;个体计算法得到的T/P比值,SBP为0.588±0.360,DBP为0.628±0.433.两种方法均＞0.5.结论 有效控制血压及BPV对脑卒中患者有着重要的意义,硝苯地平控释片能恒定释放药物,平稳降压的同时可以有效降低BPV及晨峰血压.