Plasma Renin Activity and Its Association With Ischemic Heart Disease,Congestive Heart Failure,and Cerebrovascular Disease in a Large Hypertensive Cohort

Plasma renin activity (PRA) may be a surrogate for vascular damage. The authors hypothesize that PRA is associated with cardiovascular and cerebrovascular disease (CED). A cross‐sectional study (January 1, 1998, to December 31, 2009) was performed on hypertensive individuals 18 years and older using multivariable logistic regression models to estimate odds ratios (ORs) for ischemic heart disease (IHD), congestive heart failure (CHF), and CED based on PRA quartiles controlling for age, sex, race, diabetes mellitus (DM), and medication use. Among 7887 individuals (60% women; 34% whites, 23% blacks, and 19% Hispanics; and 29% with DM), the adjusted ORs (95% CI) for IHD were 0.94 (0.80–1.10), 1.09 (0.92–1.29), and 1.18 (1.00–1.39); for CHF were 1.23 (0.99–1.53), 1.27 (1.01–1.61), and 1.41 (1.13–1.77); and for CED were 0.95 (0.78–1.17), 0.77 (0.61–0.97), and 0.97 (0.78–1.20) for the second, third, and fourth quartiles compared with the first quartile. Higher PRA was associated with greater likelihood for prevalent IHD and CHF but not CED in this large ethnically diverse population of hypertensive individuals.     

Arm Position During Ambulatory Blood Pressure Monitoring: A Review of the Evidence and Clinical Guidelines

Ambulatory blood pressure monitoring (ABPM) offers advantages over clinic blood pressure measurement. Supporting the arm at the level of the right atrium has long been standard in clinic blood pressure measurement. In contrast, there is no consensus regarding arm position in the guidelines addressing ABPM. Research studies have used a variety of arm positions during ABPM. Discussed in this review are the merits of ABPM and a review of the several arm positions recommended in ABPM guidelines, suggested by cuff manufacturers, and used in research studies. To address this lack of standardization, a rationale for a clinically reasonable arm position during ABPM is offered. Specifically, the authors recommend advising the patient to keep the arm still and relaxed straight down at the side of the body when the cuff is going to inflate, when safe to do so.