体位对糖尿病患者血压值的影响

目的了解糖尿病患者坐位和平卧位血压测量值的差别,探讨体位改变对糖尿病患者血压测量值的影响。方法用台式水银血压计柯氏音听诊法对356例糖尿病患者进行先坐位后卧位两种体位血压测量,同时测量身高和体质量,检查空腹血糖。结果糖尿病患者卧位血压显著高于坐位血压(P<0.01),收缩压(SBP)增高(3.5±7.6)mm Hg,舒张压(DBP)增高(1.5±4.9)mm Hg。多元线性回归分析结果显示,糖尿病患者坐、卧位SBP 测量值的差别与年龄、空腹血糖值和糖尿病的病程呈正相关(P<0.05),与坐位 SBP 呈负相关(P<0.01);坐、卧位 DBP 测量值的差别与糖尿病的病程呈正相关(P<0.05),与坐位 DBP 呈负相关(P<0.01)。结论糖尿病患者卧位血压高于坐位血压,其坐、卧位血压测量值的差别与年龄、空腹血糖值、糖尿病病程和坐位血压的高低有关。     

体位对糖尿病患者血压值的影响

目的 了解糖尿病患者坐位和平卧位血压测量值的差别,探讨体位改变对糖尿病患者血压测量值的影响.方法 用台式水银血压计柯氏音听诊法对356例糖尿病患者进行先坐位后卧位两种体位血压测量,同时测量身高和体质量,检查空腹血糖.结果 糖尿病患者卧位血压显著高于坐位血压(P＜0.01),收缩压(SBP)增高(3.5±7.6)mm Hg,舒张压(DBP)增高(1.5±4.9)mm Hg.多元线性回归分析结果显示,糖尿病患者坐、卧位SBP测量值的差别与年龄、空腹血糖值和糖尿病的病程呈正相关(P＜0.05),与坐位SBP呈负相关(P＜0.01);坐、卧位DBP测量值的差别与糖尿病的病程呈正相关(P＜0.05),与坐位DBP呈负相关(P＜0.01).结论 糖尿病患者卧位血压高于坐位血压,其坐、卧位血压测量值的差别与年龄、空腹血糖值、糖尿病病程和坐位血压的高低有关.     

坐位和卧位的血压测量

目的 观察健康成人坐位和卧位间接血压测量值的差别,分析性别、年龄、身高、体重指数(BMI)、坐位血压与从坐位改为卧位后收缩压(SBP)和舒张压(DBP)改变程度的关系.方法 2005-06-2006-07对7989例体检者(年龄＞18岁)进行调查,排除慢性疾病(包括心血管疾病)和血压≥140/90 mm Hg体检者,最后用于本文分析的资料为6485例健康成人体检者.采用台式水银血压计柯氏音听诊法分别进行先坐位后卧位两种体位血压测量,同时进行身高和体重的测量,并行年龄段分组,分别进行比较.结果 卧位测量的血压值显著高于坐位测量的血压值,以SBP的增高更明显,卧位SBP增高(4.3±6.1)mm Hg;卧位DBP增高(1.0±4.5)mm Hg.卧位SBP以20～29岁和80岁以上的年龄组明显,分别高(5.3±5.9)、(6.5±8.1)mm Hg,而卧位DBP以80岁以上组明显,高(2.8±6.1)mm Hg.多元回归分析结果显示,从坐位改为卧位后,对SBP改变程度有影响的自变量是年龄,呈负相关(r=-0.06,P＜0.01);对DBP改变程度有影响的自变量是性别、年龄、身高和BMI,与年龄和BMI呈正相关(r=0.08,P＜0.01;r=0.02,P＜0.01),与身高呈负相关(r=-0.08,P＜0.01).坐位血压与卧位血压的改变呈负相关(P＜0.01).结论 1)健康成人间接血压测量时,卧位的SBP、DBP高于坐位的SBP、DBP,以SBP的增高为著.2)老年人、肥胖、身高较矮、妇女、及坐位血压低的人群血压更易受到体位的影响.3)临床工作中,对血压进行评估时应注意体位的影响,并常规进行坐位和卧位血压的测量.     

坐位和卧位的血压测量

目的观察健康成人坐位和卧位间接血压测量值的差别,分析性别、年龄、身高、体重指数(BMI)、坐位血压与从坐位改为卧位后收缩压(SBP)和舒张压(DBP)改变程度的关系。方法2005-06-2006-07对7989例体检者(年龄>18岁)进行调查,排除慢性疾病(包括心血管疾病)和血压≥140/90mmHg体检者,最后用于本文分析的资料为6485例健康成人体检者。采用台式水银血压计柯氏音听诊法分别进行先坐位后卧位两种体位血压测量,同时进行身高和体重的测量,并行年龄段分组,分别进行比较。结果卧位测量的血压值显著高于坐位测量的血压值,以SBP的增高更明显,卧位SBP增高(4·3±6·1)mmHg;卧位DBP增高(1·0±4·5)mmHg。卧位SBP以20~29岁和80岁以上的年龄组明显,分别高(5·3±5·9)、(6·5±8·1)mmHg,而卧位DBP以80岁以上组明显,高(2·8±6·1)mmHg。多元回归分析结果显示,从坐位改为卧位后,对SBP改变程度有影响的自变量是年龄,呈负相关(r=-0·06,P<0·01);对DBP改变程度有影响的自变量是性别、年龄、身高和BMI,与年龄和BMI呈正相关(r=0·08,P<0·01;r=0·02,P<0·01),与身高呈负相关(r=-0·08,P<0·01)。坐位血压与卧位血压的改变呈负相关(P<0·01)。结论1)健康成人间接血压测量时,卧位的SBP、DBP高于坐位的SBP、DBP,以SBP的增高为著。2)老年人、肥胖、身高较矮、妇女、及坐位血压低的人群血压更易受到体位的影响。3)临床工作中,对血压进行评估时应注意体位的影响,并常规进行坐位和卧位血压的测量。     

新诊断2型糖尿病患者脉压与颈动脉内膜-中层厚度的关系

目的对新诊断2型糖尿病患者血压及脉压水平与颈动脉内膜-中层厚度(IMT)的关系进行分析,以期为2型糖尿病患者预防早期心脑血管疾病提供临床依据。方法对中国糖尿病并发症防治研究——CDCPSⅠ期及Ⅱ期研究中1567例新诊断2型糖尿病患者(年龄30～70岁,其中女性698例,40.9%)行B超检查测量颈动脉IMT,并通过对血压的测量,分析血压及不同脉压(PP)对颈动脉IMT的影响,同时分析内膜增厚组(IMT≥0.8 mm)与内膜正常组(IMT<0.8 mm)血压和PP水平有无差异结果(1)合并高血压组与不合并高血压组比较,颈动脉IMT显著增厚[高血压组(0.76±0.15)mm,非高血压组(0.74±0.14)mm,差异有统计学意义(P=0.0006)]。(2)直线相关分析发现,颈动脉IMT与年龄(r=0.19548)、BMI(r=0.07252)、LDL(r=0.06523)、SBP(r=0.11173)、DBP(r=0.05962)、PP(r=0.10592)显著正相关(均为P<0.05)。(3)以PP 50mm Hg为界限将患者分为两组,脉压≥50mm Hg组颈动脉IMT(0.77±0.14)mm较脉压<50mm Hg组(0.74±0.15)mm显著增厚(P=0.0006);即使在非高血压患者,脉压≥50mm Hg组的颈动脉IMT(0.75±0.14)mm较脉压<50 mm Hg组(0.73±0.14)mm也有增厚(P=0.046);在<60岁的患者脉压≥50 mm Hg组的颈动脉IMT(0.75±0.15)mm较脉压<50 mm Hg组(0.73±0.14)mm也有显著增厚(P=0.008)(4)颈动脉IMT≥0.8 mm组SBP、PP均较IMT<0.8 mm组显著升高(P值分别为0.001和0.002),而两组间DBPIMT增厚组(78 2±9.8)mm Hg,正常组(79.1±10.0)mm Hg]差异无统计学意义(P=0.075)。结论在新诊断的2型糖尿病患者,PP与颈动脉IMT的正相关性与SBP相近,而强于DBP。对于PP≥50mm Hg的患者要尽早行颈动脉超声检查测量颈动脉IMT以早期发现可能存在的亚临床动脉粥样硬化性疾病,尽早进行干预治疗。     

原发性高血压患者的昼夜血压特点与年龄及性别的研究

目的探讨原发性高血压患者昼夜血压与年龄、性别的关系。方法1 100例原发性高血压患者分为高龄老年组(≥80岁)、老年组(60~79岁)、中老年组(40~59岁)、中青年组(<40岁),分析不同年龄及性别高血压患者的昼夜血压特点。结果夜间血压负荷增高患者的年龄较大(P<0.01)。老年组及高龄老年组的夜间收缩压(SBP)较高,夜间舒张压(DBP)较低(P<0.01)。平均动脉压(MAP)昼夜差值百分比与年龄呈负相关(r=-0.262,P<0.01)。女性患者的夜间DBP较低;夜间血压负荷增高的女性患者夜间SBP较高,夜间DBP较低;非杓型女性患者的夜间SBP、夜间脉压较高(P<0.01)。结论原发性高血压患者的夜间血压、血压昼夜节律与年龄、性别相关。     

HEM-6000手腕式血压计的可靠性

目的采用美国医疗器械检测协会(AAMI)标准,对HEM-6000手腕式血压计的血压测量精确度进行临床验证研究。方法入选对象为18岁以上成年人,共91人。腕部测压结果与听诊法比较。每位受试者用2种方法同时各进行3次坐位血压测量,对91人的273对血压测量值用以下2种方法进行统计分析:(1)先计算出2种测压方法得到的血压测量值误差,再求得误差的平均值和标准偏差。(2)先计算出每位受试者用2种测压方法得到的血压平均值的差值,再求得该差值的平均值和标准偏差。结果根据方法1得到的收缩压(SBP)和舒张压(DBP)的测量误差分别为(0.5±7.1)mm Hg和(-1.6±6.1)mm Hg;根据方法2得到的结果分别(0.5±6.1)mm Hg和(-1.6±5.3)mm Hg。血压值的水平及手腕周长对测量误差无影响。结论HEM-6000手腕式血压计通过AAMI检验标准,可推荐患者用于家庭自我测压。     

国外动态

“很老”的老年高血压病人(年龄≥80岁)血压太低会使死亡率增加J Am Geriatr Soc,2007,55:383-388.该文系回顾性研究10所退伍军人医院5年资料,包括4071名年龄80岁以上老年高血压病人。研究发现血压较高的(SBP达139mm Hg,DBP达89mm Hg)者,比血压较低者死亡较少。SBP每增加10mm Hg(达139mm Hg),DBP每增加10mm Hg(达89mm Hg),危险比分别为0·82与0·85。过度控制血压对这些“很老”的高血压病人,可能是有害的。学者们认为研究结果与目前指南规定符合,即达标血压为140/90mm Hg。“很老”的老年人如出现低血压应密切注意直立性低血压,…     

氨氯地平与阿折地平治疗原发性高血压疗效的比较

目的探讨并比较氨氯地平及阿折地平对轻中度原发性高血压患者的治疗效果。方法入选轻中度高血压患者55名,随机双盲分为两组:氨氯地平组和阿折地平组,两组患者均经过2周的药物洗脱期,分别给予8周的氨氯地平(5～10mg/d)或阿折地平(8～16mg/d)治疗,在治疗前后进行动态血压监测,比较两组患者治疗前后组内及组间血压的差异,并计算其谷峰比值(T/P)和平滑指数(SI)。结果治疗8周后:(1)与服药前比较,氨氯地平组SBP和DBP分别下降(16.1±11.3)mm Hg和(11.9±6.4)mm Hg,差异均有统计学意义(均为P<0.05);阿折地平组SBP和DBP均显著下降(21.2±11.9mm Hg)和(15.4±7.4mm Hg,均为P<0.01)。氨氯地平、阿折地平两组间比较,差异无统计学意义(均为P>0.05)。(2)T/P:氨氯地平组用药后SBP、DBP的T/P分别为63%和92%,阿折地平组SBP与DBP的T/P分别为60%和61%。(3)SI:氨氯地平组分别为SBP(1.27±0.24),DBP(1.33±0.20)。阿折地平组分别为SBP(1.29±0.21),DBP(1.24±0.19)。氨氯地平、阿折地平两组之间进行比较,差异无统计学意义(均为P>0.05)。结论氨氯地平、阿折地平对轻中度原发性高血压患者治疗效果好,两药T/P均符合美国FDA对每天服药1次的抗高血压药T/P>50%的要求。SBP及DBPSI均大于1。     

黛力新联合氨氯地平治疗有明显白大衣效应的原发性高血压患者的疗效

目的 探讨黛力新联合常规抗高血压治疗对有明显白大衣效应（WCE）的原发性高血压患者的疗效。方法 选取2014年、2015年我院心内科门诊原发性高血压患者130例，先用汉密尔顿焦虑量表（HAMA）对这些患者进行评分，共有83例评分大于7分的患者入选。将入选者随机分成两组：观察组在使用常规降压药物氨氯地平的基础上加用黛力新；对照组使用氨氯地平及安慰剂。观察两组患者诊室血压值、动态血压值、WCE值、HAMA评分以及血压节律的变化。结果 ①两组治疗后诊室血压值、动态血压值分别较治疗前有明显下降（P<0.01）；治疗后两组组间比较，观察组cSBP、cDBP下降较对照组更明显［（139.19±5.24）mm Hg比（150.78±6.50）mm Hg，（87.24±4.96）mm Hg比（92.85±4.73）mm Hg，P<0.01］，观察组nSBP、nDBP较对照组也略有进一步下降［（118.14±4.68）mm Hg比（120.56±5.81）mm Hg，（73.93±3.83）mm Hg比（75.85±4.01）mm Hg，P<0.05］，而两组24 h SBP、24 h DBP、dSBP、dDBP下降程度未见统计学差异（P>0.05）。②治疗后观察组WCE SBP、WCE DBP、HAMA评分均较治疗前明显缩小［（6.81±1.85）mm Hg比（18.36±3.89）mm Hg，（3.93±1.35）mm Hg比（9.31±2.67）mm Hg，（8.52±2.72）分比（19.62±6.25）分，P<0.01］，对照组治疗前、后无明显变化（P>0.05），两组组间比较差异有统计学意义（P<0.01）。③与治疗前比较，治疗后观察组杓型血压节律的发生率明显升高（P<0.01），非杓型血压节律的发生率明显下降（P<0.01），对照组无明显变化（P>0.05），两组组间比较差异有统计学意义（P<0.05）。结论 黛力新联合常规抗高血压治疗能有效缓解有WCE的原发性高血压患者的WCE，改善血压昼夜节律。     

老年男性高血压患者血压变异性与肾功能的相关性分析

目的了解血压控制良好的老年及高龄老年男性高血压患者血压变异性与肾功能的相关性。方法选择老年男性高血压患者413例,根据年龄分为老年组196例(年龄<80岁)和高龄组217例(年龄≥80岁)。给予24h动态血压监测及血液指标检测。血压变异性指标用24h收缩压和舒张压血压标准差表示,肾功能指标由估算的肾小球滤过率(eGFR)表示。将研究人群按照eGFR≥90ml/(min.1.73m2)、60～89ml/(min.1.73m2)、<60ml/(min.1.73m2)分为eGFR 1组89例、eGFR 2组179例和eGFR 3组145例。结果与老年组比较,高龄组年龄、糖尿病和冠心病患病、尿酸、夜间收缩压、24h收缩压负荷水平明显增高,TC、LDL-C、eGFR、24h舒张压、夜间收缩压下降、夜间舒张压下降明显降低(P<0.05,P<0.01)。多因素分析显示,24h收缩压标准差是血压控制良好的老年及高龄老年患者肾功能下降的独立危险因素。结论在血压控制良好的老年男性高血压患者中,只有24h收缩压标准差是肾功能下降的独立危险因素,改善血压变异性是延缓肾功能下降的重要治疗内容。     

Office blood pressures in supine, sitting, and standing positions: correlation with ambulatory blood pressures

The variability of casual (office) blood pressure according to position at the time of measurement was investigated in 168 untreated patients with a history of mild to moderate essential hypertension. Two measurements were made in the supine, sitting, and standing positions on each of 2 consecutive days, and 24-hour ambulatory blood pressure monitoring was performed. The mean supine, sitting, and standing blood pressures were 146 +/- 15/91 +/- 7, 144 +/- 15/96 +/- 8, and 149 +/- 17/103 +/- 7 mm Hg, respectively. Diastolic blood pressures were significantly different from each other (P less than 0.0001). Supine and sitting systolic blood pressures were not different, but they were different from standing blood pressure (P less than 0.0001). The mean of all three positions (overall blood pressure) was 146 +/- 15/96 +/- 7 mm Hg. Supine, sitting, standing, and overall diastolic blood pressure means were 90 mm Hg or more in 88, 133, 164, and 133 patients, respectively. The mean awake ambulatory and 24-hour ambulatory blood pressures were 143 +/- 16/95 +/- 7 and 138 +/- 16/92 +/- 8 mm Hg, respectively, and diastolic blood pressures were 90 mm Hg or more in 121 and 88 patients, respectively. The correlation of office blood pressure with ambulatory blood pressure varied according to office position and was 0.76 to 0.82 (P less than 0.0001) for systolic blood pressure and 0.60 to 0.69 (P less than 0.0001) for diastolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension

Sympathetic hyperactivity and parasympathetic withdrawal may cause and sustain hypertension. This autonomic imbalance is in turn related to a reduced or reset arterial baroreflex sensitivity and chemoreflex-induced hyperventilation. Slow breathing at 6 breaths/min increases baroreflex sensitivity and reduces sympathetic activity and chemoreflex activation, suggesting a potentially beneficial effect in hypertension. We tested whether slow breathing was capable of modifying blood pressure in hypertensive and control subjects and improving baroreflex sensitivity. Continuous noninvasive blood pressure, RR interval, respiration, and end-tidal CO2 (CO2-et) were monitored in 20 subjects with essential hypertension (56.4+/-1.9 years) and in 26 controls (52.3+/-1.4 years) in sitting position during spontaneous breathing and controlled breathing at slower (6/min) and faster (15/min) breathing rate. Baroreflex sensitivity was measured by autoregressive spectral analysis and "alpha angle" method. Slow breathing decreased systolic and diastolic pressures in hypertensive subjects (from 149.7+/-3.7 to 141.1+/-4 mm Hg, P<0.05; and from 82.7+/-3 to 77.8+/-3.7 mm Hg, P<0.01, respectively). Controlled breathing (15/min) decreased systolic (to 142.8+/-3.9 mm Hg; P<0.05) but not diastolic blood pressure and decreased RR interval (P<0.05) without altering the baroreflex. Similar findings were seen in controls for RR interval. Slow breathing increased baroreflex sensitivity in hypertensives (from 5.8+/-0.7 to 10.3+/-2.0 ms/mm Hg; P<0.01) and controls (from 10.9+/-1.0 to 16.0+/-1.5 ms/mm Hg; P<0.001) without inducing hyperventilation. During spontaneous breathing, hypertensive subjects showed lower CO2 and faster breathing rate, suggesting hyperventilation and reduced baroreflex sensitivity (P<0.001 versus controls). Slow breathing reduces blood pressure and enhances baroreflex sensitivity in hypertensive patients. These effects appear potentially beneficial in the management of hypertension.     

Baroreflex function in elderly hypertensives

Baroreflex function was assessed in elderly hypertensive patients and compared with that observed in young hypertensives and young normotensives. Mean arterial pressure was reduced by 20% using intravenous nitroprusside infusion in 10 elderly hypertensive patients (older than 65 years and diastolic pressures over 95 mm Hg), in 10 young hypertensives (under 60 years and diastolic pressures over 95 mm Hg), and in seven young normotensive subjects (under 60 years and diastolic pressures under 95 mm Hg). Elderly subjects demonstrated greater sensitivity (p less than 0.005) and greater variability of response (p less than 0.025) to nitroprusside than either young group. There was no significant difference between the slight heart rate increases observed in the supine position in the three groups. However, in the erect position, heart rate increases were significantly less in the elderly hypertensive group than in the young hypertensive group (p less than 0.01) or the young normotensive group (p less than 0.005). Furthermore, the slope of the regression line relating change in blood pressure with change in R-R interval was less for the elderly patients than for the young hypertensives (p less than 0.05) or the young normotensives (p less than 0.025). We conclude that the heart rate component of the baroreflex is impaired in elderly hypertensives, and anticipate that the clinical response to antihypertensive drugs will be altered.     

Intracellular sodium and the response to nitrendipine or atenolol in African blacks

The relationship between the hypotensive effect of nitrendipine (N), 20 mg/day (n = 17), or atenolol (A), 100 mg/day (n = 17), and the erythrocyte sodium [( Na]i) and potassium [( K]i) concentrations was investigated in hypertensive African blacks during a randomized double-blind study. After 6 weeks, both treatments significantly reduced supine and standing blood pressures; however, the magnitude of the decrease in supine systolic (-22.0 +/- 2.0 vs -12.1 +/- 3.4 mm Hg) and diastolic (-14.1 +/- 1.3 vs -7.6 +/- 2.1 mm Hg) pressures and in standing diastolic pressure (-16.0 +/- 1.7 vs -9.2 +/- 2.0 mm Hg) was more pronounced (p less than 0.05) in the N-treated than in the A-treated group. Pulse rate, plasma aldosterone, and plasma renin activity were lower (p less than 0.05) in the A-treated patients. Neither treatment had significant influence on [Na]i, [K]i, or ouabain-sensitive sodium efflux. The N-induced changes in supine systolic and diastolic pressure correlated (p less than 0.05) with age (r = -0.65 and r = -0.58, respectively) and pretreatment plasma renin activity (r = 0.71). Multiple regression analysis demonstrated a negative association between pretrial [Na]i and the change in systolic pressure during N treatment that was independent of age, pretreatment blood pressure, and change in pulse rate. Age and the change in supine pulse rate were also independently correlated with the change in diastolic pressure during N treatment. The results show a greater antihypertensive efficacy of N than A in the patients entered in this study and suggest that a higher intracellular sodium concentration could predict a better hypotensive response to N.     

The Fuenlabrada study: arterial pressure in children and adolescents

Blood pressure was studied in 2,153 healthy children of both sexes, from 0 to 18 years of age; 1,115 were males and 1,038 females. Systolic and diastolic blood pressures were measured in the sitting position by the auscultatory method on the right arm with a mercury sphygmomanometer using an appropriate cuff size. Systolic blood pressure was measured on the first sound and diastolic blood pressure in the fourth phase of Korotkoff. In children younger than 3 years blood pressure was measured in the decubitus supine position using the Doppler technique. There were no significant differences in mean systolic and diastolic blood pressure in both sexes. But the percentage of systolic blood pressure greater than or equal to 130 mmHg was higher in males than females (p less than or equal to 0.01). 8.4% of the total population had systolic blood pressure greater than or equal to 130 mmHg, and 1.3% had diastolic blood pressure greater than or equal to 90 mmHg. The annual increase rates of systolic and diastolic blood pressure were 2.31/0.94 mmHg in males and 2/0.97 mmHg in females. Children with blood pressure greater than or equal to the 95th percentile had a higher prevalence of hypertriglyceridemia and obesity. 54% of the variation in systolic blood pressure was explained by the association of weight, subscapular skinfold, body mass index and C-HDL. 30% of the variation in diastolic blood pressure was explained by the association of weight, obesity index, subscapular skinfold and C-HDL.     

Circadian blood pressure patterns in ambulatory hypertensive patients: Effects of age

Circadian blood pressure monitoring was performed in 50 untreated ambulatory hypertensive patients to study the effects of age on the pattern and variability of Mood pressure and heart rate. Casual blood pressure, measured in the morning, was greater than the average of the blood pressures measured at 7.5 minute intervals for 24 hours (148 ± 2/95 ± 2 and 137 ± 2/88 ± 2 mm Hg, p < 0.001). The correlation between casual systolic pressure and the 24 hour average was stronger (p < 0.05) in younger (less than 55 years of age) patients (r = 0.69, n = 24, p < 0.001) than in older patients (r = 0.42, n = 26, p < 0.1). Similarly, diastolic pressures correlated more strongly (p < 0.05) in younger patients (r = 0.71, p < 0.001) than in older patients (r = 0.43, p < 0.05). Variability of systolic pressure, defined as the standard deviation of all readings obtained during 24 hours, was greater than that of diastolic pressure (16.7 and 13.1 mm Hg, respectively, p < 0.001). Moreover, the variability of systolic pressure was greater in older than in younger patients (18.1 and 15.2 mm Hg, respectively, p < 0.01). The variability of diastolic pressure was slightly but not significantly greater in older patients (13.7 and 12.5 mm Hg, not significant). The Circadian pattern of blood pressure, expressed as averages of readings obtained during consecutive 2 hour intervals, was similar in the two age groups. However, the level of systolic pressure was consistently higher (p < 0.01) and that of both diastolic pressure and heart rate consistently tower (p < 0.01) in older patients. Thus, ambulatory circadian blood pressure monitoring reveals significant changes in blood pressure levels and its variability with age; the casual blood pressure does not accurately reflect these changes. Longer periods of Mood pressure monitoring are required for accurate assessment of the characteristics of hypertension in the aged.     

Non-invasive continuous finger blood pressure measurement during orthostatic stress compared to intra-arterial pressure

STUDY OBJECTIVE--The aim of the study was to evaluate whether invasive blood pressure responses to orthostatic stress can be replaced by non-invasive continuous finger blood pressure responses. DESIGN - Intrabrachial and Finapres blood pressures were simultaneously measured during passive head up tilt and during active standing from the supine or sitting position in healthy volunteers. SUBJECTS--Subjects (n = 11) were healthy males aged 22-40 years, mean age 30 years. MEASUREMENTS AND MAIN RESULTS--Beat to beat values of systolic, diastolic, and mean arterial pressures were calculated for both methods of measurement and the differences compared during a 30 s control period before, and during the first 120 s after, the change of posture. In the control period the difference between finger pressure and intra-arterial pressure was +2 (SD11) mm Hg for systolic, -4(8) mm Hg for mean, and -3(7) mm Hg for diastolic pressure. Compared to these control differences, the average finger minus intra-arterial pressure differences for mean and diastolic pressures during the three orthostatic manoeuvres were always within the range -6 to +6 mm Hg. The average systolic deviations were larger, ranging from -10 to +11 mm Hg. Despite these differences the characteristic changes in intra-arterial pressure during the initial phase (first 30 s after change of posture), as well as during the early steady state phase (1-2 min after the change of posture) were well reflected by finger pressure measurements in all subjects. CONCLUSIONS--For the assessment of the continuous blood pressure responses to orthostatic stress similar information can be obtained with non-invasive Finapres blood pressure recordings as with invasive recordings.     

Simultaneous measurements of blood pressures in right and left brachial arteries

The most recent guidelines do not mention which arm to use to measure blood pressure or interarm blood pressure differences. In 357 women and 171 men, mean age 79 +/- 10 years, 2 geriatricians simultaneously measured brachial artery blood pressure (BABP) with the patient in the sitting position. All blood pressure measurements were performed using the same 2 machines, which were calibrated and marked 1 and 2. The machines and cuffs were transferred to the opposite arm for a repeat measurement in all patients and the results of the 2 blood pressures averaged. Patients with conditions that may cause a disparity in blood pressure between the right and left arms were not included in this study. The right systolic BABP was >/= 10 mm Hg higher than the left systolic BABP in 35 of 528 patients (7%), and the left systolic BABP was >/= 10 mm Hg higher than the right systolic BABP in 35 of 528 patients (7%) (P = not significant). The right diastolic BABP was >/= 10 mm Hg higher than the left diastolic BABP in 16 of 528 patients (3%), and the left diastolic BABP was >/= 10 mm Hg higher than the right diastolic BABP in 12 of 528 patients (2%) (P = not significant). There was no significant difference in prevalence of hypertension, atherosclerotic vascular disease, diabetes mellitus, or hypercholesterolemia in patients with or without a >/= 10-mm Hg difference in right and left systolic BABP and in right and left diastolic BABP. Interarm differences of >/=10 mm Hg in systolic BABP were found in 14% of elderly patients and of >/= 10 mm Hg in diastolic BABP in 5% of elderly patients. The higher blood pressure should be used for the diagnosis of hypertension, and the blood pressure in that arm used for all follow-up blood pressure-evaluating therapy.     

Arterial hypertension difficult to control in the elderly patient. The significance of the "white coat effect"]

OBJECTIVE: Previous studies have revealed a high prevalence of white coat effect among treated hypertensive patients. The difference between clinic and ambulatory blood pressure seems to be more pronounced in older patients. This abnormal rise in blood pressure BP in treated hypertensive patients can lead to a misdiagnosis of refractory hypertension. Clinicians may increase the dosage of antihypertensive drugs or add further medication, increasing costs and producing harmful secondary effects. Our aim was to evaluate the discrepancy between clinic and ambulatory blood pressure in hypertensive patients on adequate antihypertensive treatment and to analyse the magnitude of the white coat effect and its relationship with age, gender, clinic blood pressure and cardiovascular or cerebrovascular events. POPULATION AND METHODS: We included 50 consecutive moderate/severe hypertensive patients, 58% female, mean age 68 +/- 10 years (48-88), clinic blood pressure (3 visits) > 160/90 mm Hg, on antihypertensive adequate treatment > 2 months with good compliance and without pseudohypertension. The patients were submitted to clinical evaluation (risk score), clinic blood pressure and heart rate, electrocardiogram and ambulatory blood pressure monitoring (Spacelabs 90,207). Systolic and diastolic 24 hour, daytime, night-time blood pressure and heart rate were recorded. We considered elderly patients above 60 years of age (80%). We defined white coat effect as the difference between systolic clinic blood pressure and daytime systolic blood pressure BP > 20 mm Hg or the difference between diastolic clinic blood pressure and daytime diastolic blood pressure > 10 mm Hg and severe white coat effect as systolic clinic blood pressure--daytime systolic blood pressure > 40 mm Hg or diastolic clinic blood pressure--daytime diastolic blood pressure > 20 mm Hg. The patients were asked to take blood pressure measurements out of hospital (at home or by a nurse). The majority of them performed an echocardiogram examination. RESULTS: Clinic blood pressure was significantly different from daytime ambulatory blood pressure (189 +/- 19/96 +/- 13 vs 139 +/- 18/78 +/- 10 mm Hg, p < 0.005). The magnitude of white coat effect was 50 +/- 17 (8-84) mm Hg for systolic blood pressure and 18 +/- 11 (-9 +/- 41) mm Hg for diastolic blood pressure. A marked white coat effect (> 40 mm Hg) was observed in 78% of our hypertensive patients. In elderly people (> 60 years), this difference was greater (50 +/- 15 vs 45 +/- 21 mm Hg) though not significantly. We did not find significant differences between sexes (males 54 +/- 16 mm Hg vs 48 +/- 17 mm Hg). In 66% of these patients, ambulatory blood pressure monitoring showed daytime blood pressure values < 140/90 mm Hg, therefore refractory hypertension was excluded. In 8 patients (18%) there was a previous history of ischemic cardiovascular or cerebrovascular disease and all of them had a marked difference between systolic clinic and daytime blood pressure (> 40 mm Hg). Blood pressure measurements performed out of hospital did not help clinicians to identify this phenomena as only 16% were similar (+/- 5 mm Hg) to ambulatory daytime values. CONCLUSIONS: Some hypertensive patients, on adequate antihypertensive treatment, have a significant difference between clinic blood pressure and ambulatory blood pressure measurements. This difference (White Coat Effect) is greater in elderly patients and in men (NS). Although clinic blood pressure values were significantly increased, the majority of these patients have controlled blood pressure on ambulatory monitoring. In this population, ambulatory blood pressure monitoring was of great value to identify a misdiagnosis of refractory hypertension, which could lead to improper decisions in the therapeutic management of elderly patients (increasing treatment) and compromise cerebrovascular or coronary circulation.