Relationship between aortic stiffness and cardiovascular risk factors in a population of normotensives, white-coat normotensives, white-coat hypertensives, sustained hypertensives and diabetic patients.

OBJECTIVE: To evaluate the relationship between carotid-femoral pulse wave velocity (PWV) and office and ambulatory blood pressure (ABP) and other cardiovascular risk factors and to determine the discriminatory value of PWV in a large population including normotensive subjects (NT), white-coat normotensives (masked hypertension) (WCNT), and white-coat hypertensives (WCHT) compared to a group of treated and untreated hypertensive patients. METHODS: The study population included a total of 688 subjects aged from 18 to 80 years, with no previous cardiovascular events, who underwent 24 h ABP monitoring, biochemical evaluation and determination of PWV and left ventricular mass index (LVMI). Subjects were classified as true normotensives (NT, n=132; normal office and ABP values), WCNT (n=39; office BP < 140/90 and daytime BP > or =135 or > or =85 mmHg), WCHT (n=87; office BP > or =140 or > or =90 and daytime BP < 135/85 mmHg). Untreated (UT-HT, n=154) and treated (T-HT, n=171) hypertensive patients and type 2 diabetic patients (DM, n=102) were also studied. RESULTS: Values of PWV (m/s) in all groups were, in ascending order: NT (8.9 +/- 0.2) < WCHT (9.9 +/- 0.2) < T-HT (11.4 +/- 0.2) = WCNT (11.5 +/- 0.4) < UT-HT (11.9 +/- 0.3) < DM (12.6 +/- 0.4) (ANOVA, p = 0.043), and of LVMI (g/m2): NT (59 +/- 2) = WCHT (63 +/- 2) < WCNT (73 +/- 3) = T-HT (75 +/- 3) = UT-HT (77 +/- 3) < DM (84 +/- 4) (ANOVA, p < 0.05). The percentage of subjects with PWV values below the median (10.7 m/s) was higher (p < 0.02) in NT (81.8%) and WCHT (72.6%) than in UT-HT (49.2%), T-HT (43.6%), WCNT (47.6%) and DM (27.7%). In multiple regression analysis, taking PWV as the dependent variable, age (all groups), 24h systolic BP (UT-HT, T-HT, WCNT and DM) and 24h diastolic BP (NT and WCHT) were the variables that independently influenced the PWV value. CONCLUSIONS: Higher values of PWV occur in clinical situations associated with higher cardiovascular risk. This is in agreement with risk stratification based on ABP values but not on office BP values. Lower PWV and LVMI values occur in NT and WCHT subjects, supporting a low cardiovascular risk in these groups. By contrast, higher PWV values were associated with higher ABP values in DM, hypertensive patients and white-coat normotensives, i.e. clinical situations that are associated with higher cardiovascular risk, who in the present study also exhibited higher LVMI than subjects with normal ABP values.     

Clinical prediction of normotension in borderline hypertensive men--a 10 year study

OBJECTIVE: To investigate 24-h ambulatory blood pressure measurements (ABPM) as a tool for long-term prediction of future blood pressure (BP) status in high normal and low stage 1 hypertensives. DESIGN, SETTING AND PARTICIPANTS: A total of 165 men from a population screening program with diastolic BP (DBP) 85-94 mmHg and a systolic BP (SBP) < 150 mmHg performed a 24-h ABPM. Ten years later, 120 participants (73%) returned for renewed measurements. MAIN OUTCOME MEASURES: Blood pressure status at 10 years. RESULTS: At the 10-year follow-up, 53% of the participants were classified as hypertensive (HT) (BP > or = 140/90 or taking anti-hypertensive medication) and 47% were classified as normotensive (NT) (BP < 140/90 mmHg). There was no significant baseline differences in office SBP levels between those who were normotensive or hypertensive at follow-up (136/91 versus 138/92 mmHg), whereas both SBP and DBP night-time levels were significantly lower in the future normotensives as compared to the future hypertensives (107/69 versus 112/74 mmHg, P < 0.01). Using recommended normalcy night-time ABP levels of < 120/75 mmHg in addition to office BP (140/90) at baseline, over 85% of the subjects were correctly classified provided they met both clinic and ambulatory night-time criteria for HT and NT classification at baseline. CONCLUSION: The use of ABPM in addition to office BP's in patients with borderline hypertension greatly increases the possibility of identifying those individuals who are at a very small risk of developing future hypertension. This could potentially lead to considerable savings in both patient anxiety, physician time and resource consumption.     

Blood pressure on arising, morning blood pressure surge and blood pressure variability in white coat hypertensives and in matched normotensives and sustained hypertensives.

INTRODUCTION: It is still controversial whether subjects with white-coat hypertension (WCHT) exhibit higher cardiovascular risk compared to normotensive subjects (NT). In subjects with WCHT it is not known whether the abnormal blood pressure (BP) reaction in the office also occurs at other times of day, particularly on arising and immediately after waking, i.e. the times at which the majority of cardiovascular events are reported to occur. OBJECTIVE AND METHODS: To evaluate with 24h ambulatory BP measurement the values of morning BP surge, BP on arising and BP variability in subjects with WCHT in comparison with age-, gender- and weight-matched normotensives (BP) and untreated sustained hypertensives (BP). RESULTS: Groups of BP, WCHT and BP were matched for age, gender and body weight: BP: n=69, age 49 +/- 7 years, 54 % female, BMI 26 +/- 1, casual BP 126/79 +/- 5/4 mmHg, daytime BP 124/80 +/- 6/6 mmHg; WCHT: n=74, age 52 +/- 8 years, 57% female, BMI 26 +/- 2, casual BP 152/95 +/- 7/7 mmHg, daytime BP 126/80 +/- 5/6 mmHg; HT: n=79, age 53 +/- 7 years, 56% female, BMI 27 +/- 2, casual BP 154/97 +/- 9/8 mmHg, daytime BP 143/89 +/- 12/10 mmHg. Of the three groups, subjects with WCHT exhibited BP on arising (121/81 +/- 13/8 mmHg) similar to that of NTs (120/80 +/- 13/9 mmHg, NS), both significantly lower than that of HTs (137/92 +/- 17/10 mmHg, p < 0.01), suggesting the absence of an alerting BP reaction in WCHT at that time. By contrast, subjects with WCHT showed higher values of systolic morning BP surge vs. NTs (25 +/- 10 vs. 22 +/- 11 mmHg, p < 0.05), both lower than that observed in hypertensives (33 +/- 11 mmHg, p < 0.01 vs. NT and WCHT) and greater daytime variability (systolic BP standard variation), i.e. 12 2 vs. 10 +/- 2 mmHg, p < 0.05, both lower than that observed in hypertensives (14 +/- 3 mmHg, p < 0.01 vs. NT and WCHT). CONCLUSIONS: Although subjects with WCHT did not show any alerting blood pressure reaction on arising, morning BP surge and BP variability were greater in these subjects than in control normotensives, although lower than sustained hypertensives. Although this is still speculative, we cannot exclude the possibility that even a slight increase in morning BP surge might in the long term constitute an additional load on the circulation that could increase cardiovascular risk in subjects with WCHT compared to matched normotensives.     

Study of flow-dependent vasodilation of the femoral artery in hypertensive and normal subjects

Flow dependent vasodilation of brachial artery is not significantly different in hypertensives as compared to normotensives. Since, in vitro, changes in vasomotor tone of large arteries in response to endothelial stimulation may differ depending on the territory, we re-examined phenomenon of flow-dependent vasodilation at the level of the femoral artery in 10 normotensives (NT) and 12 age matched (45 +/- 9 vs 43 +/- 4 yrs) hypertensives (HT). Systolo-diastolic variations of femoral artery diameter (D) were recorded using an original echo-tracking system based on doppler shift while blood flow velocity was measured at the same level using a bidimensional pulsed doppler system (V). A 10 min period of leg ischemia did not induce any significant change in D and V in each group but decreased foot skin blood flow (laser doppler). This decrease occurred to the same extent in NT and HT. During reactive hyperemia following release of the pneumatic cuff, V increased (from 2.1 +/- 0.3 to 12.5 +/- 2.4 cm/s in NT) and returned to control level at the 3rd min. Diastolic diameter (Dd) increased (max: 2nd min) in NT (9.3 +/- 0.8 vs 8.8 +/- 0.9 mm; p less than 0.001) and in HT (9.5 +/- 1.2 vs 8.4 +/- 1.2 mm; p less than 0.01). Dd increased to a greater extent in HT than in NT while reactive hyperemia (laser doppler) did not differ. Thus, a non-invasive method is able to demonstrate a flow-dependent vasodilation at the level of the femoral artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypertensive target-organ damage in the very elderly

In people aged >80 years, the so-called very elderly, there is uncertainty about the relation between hypertension and cardiovascular morbidity. The aims of this study were to investigate whether hypertension in people aged >80 years is associated with target-organ damage, over and above the effects of age, and to determine whether ambulatory blood pressure monitoring (ABPM) could improve on conventional blood pressure monitoring (CBPM) in predicting target-organ damage. Investigations included echocardiographic measurement of left ventricular mass index (LVMI), brain magnetic resonance imaging assessment of periventricular hyperintensity (PVH), urinary albumin-creatinine ratio (ACR), aortic pulse wave velocity (PWV), and 24-hour ABPM. Forty-three subjects, at a mean age 84.3 years, were studied, 22 normotensive (NT) and 21 hypertensive (HT). CBP was 184/89 and 145/76 mm Hg in the HT and NT groups, respectively. In men, LVMI was significantly greater in HT subjects, 157+/-37 vs 123+/-15 g/m2 in NT subjects (P<0.05). In women, LVMI was similar in both groups. Urinary ACR was greater in HT than in NT subjects (log ACR, 1.21+/-0.50 vs 0.95+/-0.23; P<0.05). Cerebral PVH grade was higher in the HT subjects (2.6+/-0.8 vs 2.2+/-0.9), although this difference was not significant. Aortic PWV did not differ between the 2 groups. ABPM was positively associated with urinary ACR and cerebral PVH, independent of its correlation with CBPM. In advanced old age, HT is associated with evidence of target-organ damage. ABPM can improve on CBPM in predicting very elderly subjects with HT target-organ damage.     

Antihypertensive treatment can normalize the geometry and the arterial function in the aged patient]

The aging process and the elevation of arterial blood pressure (BP) have synergistic effects on the modifications of the arterial system. The effects of the treatment on these modifications are unknown. Our objective was to study the consequences of anti-hypertensive treatment on the geometry and function of the arteries in men over 70 years old. In 89 men aged 74 +/- 2 years, we measured internal diameter and intima-media thickness (IMT) of carotid and radial arteries using high resolution echography (WALL TRACK SYSTEM and NIUS-02), and carotid-femoral pulse wave velocity (PWV) by COMPLIOR. The BP was measured in supine position by Dinamap. In 28 subjects the BP was more than 140/90 mmHg (poor controlled hypertensives-HTpc); in the subjects where BP < 140/90 mmHg, 44 were normotensives (NT) without treatment and 17 were well controlled hypertensives (HTwc) on use of at least one antihypertensive. [table: see text] The PWV was increased in HTpc (20.1 m/s) in comparison with NT (14.6 m/s) and HTwc (16.1 m/s) (p < 0.05). The operational distensibility of radial artery was similar in the three groups. In conclusion, in elderly men aged more than 70 years, the anti-hypertensive treatment can normalize the functional properties and the geometry of muscular and elastic arteries. These results indicate that the arterial modifications observed in elderly hypertensives are consequence of the high blood pressure per se and not only consequent the modifications due to the aging.     

Left ventricular mass and glomerular hyperfiltration in essential hypertension

OBJECTIVE: to assess the early involvement to target organs in never treated essential hypertensives (HT). METHODS: effective renal plasma flow (ERPF, 131I-Hippurate) and glomerular filtration rate (GFR, 99mTc-DTPA) were estimated in 80 mild HT. Left ventricular mass (LVM, M-mode echocardiography), sodium intake (24h UNaV) and urinary kallikrein (Kall) were also measured. Hyperfiltering patients (HF, GFR = 155 +/- 3 ml/min: 1.73 m2, n = 21) were defined by comparison with age-matched normotensive. HF patients were pair-matched for age, sex and blood pressure level with normofiltering hypertensives (NF, GFR = 112 +/- 3, n = 21). RESULTS: are expressed as mean +/- sem [table: see text] CONCLUSION: These results suggest that a high Na intake is associated with hyperfiltration and higher LVMI in subjects with never treated essential hypertension of short duration.     

Microalbuminuria, pulse wave velocity and common carotid artery intima-media thickness in type 2 diabetes

The aim of the study was to evaluate pulse wave velocity (PWV) and carotid intima-media thickness (IMT) in type 2 diabetics with microalbuminuria (mualb). The study concerned 37 patients type 2 diabetics, age: 53.4 +/- 6.6, years free of cardiovascular complications. HbA1C was 7.73 +/- 1.39%, waist circumference 104.2 +/- 11.7 cm. 19 patients with BP > 130/85 mmHg were identified as mild hypertensives (17/19 under treatment). All patients underwent ABPM, PWV and IMT measurements. The study population was separated into 2 subgroups according to median of mualb (mg/24 h): 18.9. [table: see text] In patients with mualb > 18.9 mg/24, IMT and PWV were significantly increased (p = 0.06; p < 0.01). After adjustment to BP and age, there was no significant difference in IMT and PWV in the subgroups. In this selected population of type 2 diabetics, microalbuminuria appears associated to a pressure-dependant vascular remodeling.     

Ethnic and gender differences in electrocardiographic QT length and QT dispersion in hypertensive subjects

BACKGROUND: Prolonged QT intervals and/or increased QT dispersion (QTd) are associated with various pathological conditions and predict death in healthy individuals. Among hypertensives, QTd correlates with blood pressure (BP) and left ventricular mass index (LVMI) and QT intervals are prolonged in those with left ventricular hypertrophy (LVH). In normotensives, heart-rate corrected QT length (QTc) is longer in females than males, but QTd is greater in males than females. There are few data comparing QT parameters between different ethnic groups and none specifically in hypertensives. Among normotensives, compared with whites, QTc is reported to be shorter in African-Americans and longer in Chinese. We looked for ethnic and gender differences in QT parameters in hypertensive subjects. METHODS: Untreated hypertensives were selected from a Hypertension Clinic database. Black and white subjects were matched for age, sex, BP and LVMI. Male and female subjects were matched for age, race, BP and the presence or absence of echocardiographic LVH. Maximum QT intervals (QTm), rate-corrected maximum QT intervals (QTc) and QT dispersion (QTd) were measured or calculated from ECGs. Data are presented as mean +/- s.d. Differences in QT parameters were sought between groups using Student's t-tests. RESULTS: No ethnic or gender differences in QT parameters achieved statistical significance. However there was a tendency for QTm and QTc to be prolonged in blacks compared with whites (443 +/- 52 vs 421 +/- 47; P = 0.08 and 480 +/- 65 vs 463 +/- 40: P = 0.24 respectively), and for QTc to be prolonged in females compared with males (479 +/- 52 vs 461 +/- 45 ms; P= 0.13). CONCLUSION: In small groups of matched hypertensives, no ethnic or gender differences in QT parameters achieved statistical significance. However, similar to findings in normotensives, QTc tended to be longer in hypertensive females than males. In hypertensives, we failed to confirm the finding that QTc is shorter in blacks than whites, as seen in US normotensives. Whether this represents a difference between hypertensives and normotensives, or between US and UK blacks requires further investigation. Whether the prognostic significance of QT parameters in hypertensives differs between different gender and ethnic groups needs to be established from prospective studies. Journal of Human Hypertension (2000) 14, 403-405     

Value of nocturnal blood pressure in treated non-insulin-dependent hypertensive patients]

The purpose of the study was to evaluate the loss of nocturnal (N) decline in blood pressure (BP) in type II treated hypertensive diabetics. The study concerned 36 hypertensive diabetics 59 +/- 10 years old, 20 men and 16 women, with poor metabolic control (HbA1C: 9.6 +/- 3%), without dysautonomia; 14 had macroproteinuria and/or microalbuminuria (mu alb) (< 30 micrograms/min). An ambulatory BP monitoring (Spacelabs 90207) was performed in all patients. Left ventricular mass index (LVMI) and E/A were determined by Doppler-echocardiography. Two groups (G) were individualized: G1 (n = 17), with a normal circadian rhythm (diurnal and N.BP significantly different); G2 (n = 19) with a loss of N decline in systolic (S) and diastolic (D) BP or both; and compared to non diabetic treated hypertensive controls (G3). There was no difference neither in LVMI (125 +/- 43 g/m2), E/A (0.7), 24 h-mean (M) BP in the three groups, nor in HbA1C levels and mu alb occurrence in G1 and G2. Mean N.SBP and mean N.DBP were more closely related to LVMI in G2 than in G1 and G3. [table: see text] Half of these hypertensive diabetics, with bad metabolic control, have an altered circadian BP pattern; the prognostic value of nocturnal BP, related to LVMI despite the antihypertensive treatment, is suggested.     

Role of ambulatory blood pressure monitoring in the assessment and prognosis of patients with borderline hypertension

The role of ambulatory blood pressure (ABP) monitoring in the assessment of mild/borderline hypertension (BHT) is unclear. The aim of this study was to test the hypothesis that measurement of ABP in borderline hypertensives differentiates patients with true mild hypertension from those with isolated clinic hypertension (raised office BP but normal ABP) and that a raised ABP identifies a subgroup who are more likely to progress to and require treatment over 1 year. Consecutive untreated patients with BHT (n = 127, 44 +/- 13 years, 45% male) were divided into two groups according to awake ABP: Group 1 (normal ABP < or = 136/86, n = 48), and Group 2 (abnormal ABP > 136/86, n = 79). Left ventricular mass index (LVMI) was greater (116 +/- 30 vs 101 +/- 25 g/m2, p < 0.01) and the proportion of patients with an increased LVMI was significantly higher (34% vs 17%, p = 0.05) in Group 2. During 1 year of follow-up, significantly more patients in Group 2 (34%) required antihypertensive treatment compared with Group 1 (8%, p = 0.01). ABP monitoring usefully discriminates between patients with true BHT and those with isolated clinic hypertension. An elevated awake ABP on initial assessment is associated with a higher LVMI and a greater likelihood of progression to moderate hypertension requiring pharmacological treatment.     

White coat effect in treated and untreated patients with high office blood pressure. Relationship with pulse wave velocity and left ventricular mass index.

OBJECTIVE: To evaluate in hypertensive patients whether the white coat effect is associated with target-organ damage and whether it is modified by anti-hypertensive therapy. METHODS: In a cross-sectional study we evaluated blood pressure (BP) measured in the office and by 24-h ambulatory blood pressure monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) as an index of aortic stiffness, and left ventricular mass index (LVMI) in 88 subjects (aged 49 +/- 2 years) with white-coat hypertension (WCH, office BP > 140/90, daytime BP < 130/84 mmHg), 31 under antihypertensive therapy, 57 untreated, and in 115 patients with office and ambulatory hypertension (HT, aged 51 +/- 2 years, office BP > 140/90, daytime BP > 135/85), 65 under antihypertensive therapy, 50 untreated. In a longitudinal study in 15 patients with HT and in 11 patients with WCH we evaluated the influence of antihypertensive therapy (> 6 months) on office and ambulatory BP and on PWV. RESULTS: The intensity of the white coat effect (office BP-daytime BP) was greater in WCH than in HT. Taking all subjects, the white coat effect did not correlate with PWV (r = 0.08, ns) or with LVMI (r = 0.01, ns), whereas daytime BP correlated significantly with PWV (r = 0.41, p < 0.01) and with LVMI (r = 0.32, p < 0.05). WCH subjects showed lower PWV and LVMI than HT subjects. Treated and untreated WCH, with similar office and daytime BP, showed similar values of PWV and LVMI. Treated and untreated HT showed similar office BP values but treated HT showed lower daytime BP and PWV values. In the longitudinal study, antihypertensive therapy significantly reduced daytime BP and PWV values in the 15 HTs, whereas in the 11 WCH it did not alter daytime BP or PWV values. CONCLUSIONS: 1. In both WCH and HT (treated and untreated) the intensity of the white coat effect does not reflect either the severity of hypertension measured by target organ damage or the efficacy of antihypertensive treatment. 2. In WCH antihypertensive therapy does not improve either ambulatory BP values or damage to target organs.     

A system for non-invasive measurement of arterial pulse velocity in different vascular territories]

Blood pulse wave velocity (PWV) is a known index of arterial rigidity and its measurement has proved its usefulness in the study of some cardiovascular pathologies. In this study we describe the design and implementation of a system for noninvasive PWV determination in the aorto-braqui-humero-radial (A-->h), aorto-ileo-femoro-pedial (A-->f) and aorto-carotid (A-->c) regions. This system was examined with 36 normotensives (NT) and 34 hypertensives (HT) patients with (LVH, n = 20) and without (WLVH, n = 14) left ventricular hypertrofy. The equipment consist of a personal computer with an analog to digital converter and hardware and software items adapted to take simultaneously the electrocardiogram (ECG), two photopletismographic pulses and one oscilometric pulse. The Q-pP interval (time between a Q ECG wave and distal blood pulse) and the distance to the register sites are taken into account to calculate the beginning of cardiac prexpulsive period (time zero of pulse trip) which allow the determination of the PWV (in meters/second) from the aortic root to the distal point of the via. PWV was significant higher (p < 0.001) in HT vs. NT (A-->h: 9.3 +/- 2.6 vs. 7.2 +/- 0.8, A-->c: 9.5 +/- 2.8 vs. 6.0 +/- 1.9 and A-->f: 9.5 +/- 1.8 vs. 7.2 +/- 0.9) in each evaluated arterial region. Same thing occurred in cases with LVH vs. WLVH (A-->h: 10.5 +/- 1.6 vs. 8.0 +/- 1.9, A-->c: 10.2 +/- 1.9 vs. 8.0 +/- 1.9 and A-->f: 10.5 +/- 2.0 vs. 8.6 +/- 1.2) (p < 0.025). This is consistent with the relationship more pressure [symbol: see text] more rigidity and with other reports. This method may have clinical application.     

Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives

BACKGROUND: In hypertensives, nondippers are more likely than dippers to suffer silent, as well as overt, hypertensive target organ damage. In this study, we investigated whether a nondipper status was associated with target organ damage in normotensives. METHODS: We performed ambulatory blood pressure (BP) monitoring, echocardiography, and carotid ultrasonography and measured natriuretic peptides and urinary albumin (UAE) in 74 normotensive subjects with the following criteria: 1) clinical BP <140/90 mm Hg; 2) average 24-h ambulatory BP <125/80 mm Hg. RESULTS: The left ventricular mass index (LVMI) and the relative wall thickness (RWT) measured by echocardiography were greater in nondippers than dippers (LVMI: 103 +/- 26 v 118 +/- 34 g/m(2), P <.05; RWT: 0.38 +/- 0.07 v 0.43 +/- 0.09, P <.01). Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were higher in nondippers than dippers (ANP: 14 +/- 10 v 36 +/- 63 pg/mL, P <.01; BNP: 16 +/- 12 v 62 +/- 153 pg/mL, P <.05). There were no significant differences in UAE and intima-media thickness measured by carotid ultrasonography. CONCLUSIONS: Normotensive nondipping may not reflect renal damage, but may have a predominant effect on cardiac damage. Nondipping of nocturnal BP seems to be a determinant of cardiac hypertrophy and remodeling, and may result in a cardiovascular risk independent of ambulatory BP levels in normotensives.     

Kinetics of circadian variations in ambulatory arterial blood pressure and cardiovascular sequelae]

OBJECTIVE: To study the relationships between evolution of changes in blood pressure (BP) over the 24 hour cycle and their cardiac and vascular consequences in mild to moderate hypertensive (HT) subjects (WHO criteria). MATERIAL AND METHODS: 151 patients presenting with mild to moderate essential HT (Age 49 +/- 12 yrs, 63 M 44W)--ambulatory measurement of BP over 24 hours (Spacelabs 90207) automatic determination of the diurnal cycle by Fourier analysis (5 harmonics) and calculation of the slope of BP variation (mmHg/hr) at the point of transition from day to night (nocturnal dip slope (NDS)), and at the change from night to day (morning rise slope (MRS). Patients with inversion of the day-night cycle were excluded, day-night being arbitrarily defined as 7 to 22 h and 22 to 7 h. Echography of left ventricular mass index (LVMI)/Penn convention, formula of Devereux, and carotido-femoral distensibility by pulse wave velocity (PWV, Complior Colson France). RESULTS: Ambulatory measures of BP and HR and of cardiovascular parameters were as follows. [table: see text] The slope of nocturnal fall (NDS) and morning rise in SBP (MRS) is significantly correlated with LVMI (NDP r = -0.02, p = 0.049, MPP r = 0.21, p = 0.029) and with PWV (MPP: r = 0.32, p = 0.005). No relationship was found with the DBP values. By multivariate analysis taking into account age, sex, 24 h SBP, MPP slope velocity was the only variable which was significantly related with the model of PWV and LVMI (p < 0.001). CONCLUSION: Dipper and non-dipper studies have been performed to examine the consequences of day night variations in BP. The evolution of diurnal changes in BP seems to have an effect on the vessels and heart and may be a simple analysis tool for assessing prognosis and therapeutic effects.     

Correlation of repeated measurements of home blood pressure on one occasion and diagnosis of hypertension: study by measurement over seven consecutive days

In spite of the recent recognition of the usefulness of home blood pressure (BP) measurement, there are no clear guidelines for which measurements should be used for clinical evaluation. Therefore, the present study examined the correlation of repeated measurements of home BP on one occasion and the diagnosis of hypertension (HT) or normotension (NT). Home BP was measured with 700 volunteers aged 20 years or older (468 male and 232 female, mean age 40.6 years) in a sitting position three times each in the morning and evening for seven consecutive days. Excluding the measurements on the first day, the mean values were calculated for the first measurement (group A), second measurement (group B), the mean of the first and second measurements (group C), and the mean of the second and third measurements (group D). The correlation with the frequency of diagnosis of HT (>/=135/85 mmHg) and NT (<125/80 mmHg) was studied. Home BP in the morning and evening were both highest in group A (morning: 122.1 +/-0.6 (SEM)/75.9 +/-0.4 mmHg, evening: 120.4 +/-0.6/71.8 +/-0.4 mmHg) and lowest in group D (morning: 119.5 +/-0.6 / 75.2 +/-0.4 mmHg, evening: 117.5 +/-0.6/70.6 +/-0.4 mmHg). Using morning home BP, HT was diagnosed more often in group A (27.4%) than in group D (24.7%), with a lower frequency of NT diagnosis (55.7% vs. 61.7%; p = 0.06). With regard to the diagnosis made from evening home BP, HT was diagnosed more often and NT was diagnosed less often in group A (HT/NT: 18.4%/61.4%) than in group D (13.7%/68.0%), with statistical significance (p = 0.02). In conclusion, when the clinical diagnosis was made from seven-day home BP, the diagnosis of HT was made more frequently and NT diagnosis was made less frequently using the first measurement than the mean of the second and third measurements. This trend was more pronounced when diagnosis was made from evening home BP.     

Is the white coat effect an alert reaction?

Is the white coat effect an alert reaction? In this cross-sectional study we compared the white coat effect on systolic blood pressure with the systolic blood pressure reactivity obtained during a stress test. The influence of the sympathetic system (LF band of systolic BP) and the parasympathetic system (HF band of pulse rate) on white coat systolic blood pressure and stress test systolic blood pressure were analysed. We stratified 174 subjects into two groups, according to their blood pressure: hypertensives (HT, n=44, BP>140/90 mmHg) and normotensives (NT, n=130). The BP was recorded during an occupational health consultation, over 24 hours, and beat to beat during a stress test (Finapress). White coat systolic BP was calculated as the difference between the consultation BP and the average systolic BP over 24 hours. The white coat systolic BP was not related with an increase in pulse rate. In contrast, during the stress test the increases in systolic BP and pulse rate were correlated (r=0.44; p<0.001). The white coat systolic BP was lower than the stress test systolic BP in the NT (6.6 +/- 7.2 vs 23 +/- 12 mmHg; p<0.001) and in the HT (16 +/- 11 vs 29 +/- 17 mmHg; p<0.001). The HT had a lower parasympathetic index than the NT (0.45 +/- 0.43 vs 0.92 +/- 0.83 bpm2; p<0.001). In the HT the white coat systolic BP was positively correlated with the stress test systolic BP (r=0.47: p<0.01) and negatively with the parasympathetic activity index. In conclusion, for recently diagnosed and untreated HT an early alteration of the parasympathetic system reveals that the white coat effect is a low amplitude alert reaction.     

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

Objective

To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients.

Out-of-office blood pressure in children and adolescents: disparate findings by using home or ambulatory monitoring

BACKGROUND: The validity of home blood pressure (HBP) measurements in children has not been evaluated, although in clinical practice such measurements are being used. This study compares HBP, with clinic (CBP) and daytime ambulatory blood pressure (ABP) in children and adolescents. METHODS: Fifty-five children and adolescents aged 6 to 18 years were evaluated with CBP (three visits), HBP (6 days), and daytime ABP. Mean age was 12.3 +/- 2.9 (SD) years, 33 boys. According to the Task Force CBP criteria, 26 were hypertensives, 6 had high-normal BP (hypertensive group), and 23 were normotensives (normotensive group). RESULTS: In the hypertensive group, CBP was 130.8 +/- 7.6/72.5 +/- 8.1 mm Hg (systolic/diastolic), HBP 118.9 +/- 6.3/73.7 +/- 6.7, and ABP 130.8 +/- 8.1/75.5 +/- 8.3. In the normotensive group, CBP was 112.8 +/- 8/63.1 +/- 6.3, HBP 106.7 +/- 8.4/67.2 +/- 5.2, and ABP 123.9 +/- 7.2/72 +/- 4.3. Strong correlations (P < .001) were observed between CBP-HBP (r = 0.73/0.57, systolic/diastolic), CBP-ABP (r = 0.59/0.49), and HBP-ABP (r = 0.72/0.66). In normotensive subjects, ABP was higher than both CBP and HBP for systolic and diastolic BP (P < .001). Furthermore, systolic HBP was lower than CBP (P < .01), whereas the opposite was true for diastolic BP (P < .05). In hypertensive subjects systolic HBP was lower than both CBP and ABP (P < .001), whereas CBP did not differ from ABP. For diastolic BP no differences were found among measurement methods. CONCLUSIONS: These data suggest that, in contrast to adults in whom HBP is close to the levels of daytime ABP, in children and adolescents HBP appears to be significantly lower than daytime ABP. Until more data become available, caution is needed in the interpretation of HBP in children and adolescents.     

Sodium-potassium cotransport in hypertension and hypotension

Furosemide-sensitive Na-K cotransport was measured as zero-trans efflux of each ion from fresh or Na loaded erythrocytes in normotensives (n = 34), essential (n = 41) or secondary (n = 12) hypertensives and essential (n = 17) or secondary (n = 5) hypotensives. The stoichiometry of Na and K efflux was 0.9:1 in fresh cells and 1:1 in cells loaded with sufficient Na to give near the maximum velocity (Vmax) in a combined analysis. There was a tendency toward a negative correlation between the Vmax of Na efflux and serum total cholesterol (p = 0.09) in the whole and it was significant in normotensives (r = -0.60). Vmax of Na efflux also negatively correlated to age (p less than 0.01). After adjustment for age and total cholesterol level, essential hypertensives had a significantly (p less than 0.01) higher mean Vmax of Na efflux (0.657 +/- 0.029 mM/l cells/hr) than normotensives (0.388 +/- 0.045), while essential hypotensives had a lower value (0.212 +/- 0.047) (p less than 0.01). Na efflux from fresh cells adjusted for internal Na content was higher in essential hypertensives (0.173 +/- 0.018) than in normotensives (0.107 +/- 0.026) (p less than 0.05). Thus, elevated cotransport was linked to essential hypertension and reduced cotransport to hypotension. Whether it is a cause or a result remains to be further investigated.