Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients.Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol.ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients.ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.     

动态血压监测的临床评定

无创性动态血压（ＡＢＰＭ）能较客观地反映血压水平及其昼夜变化规律，对高血压病的诊断、指导用药、药物疗效的评定以及预后评估等均有较大价值。本文对ＡＢＰＭ的发展及临床应用等问题进行综述。     

中老年人24小时动态血压变化的研究

目的探讨血压正常老年患者和老年高血压患者24h动态血压波动规律及与靶器官损害的关系.方法采用无创伤袖带式动态血压监测仪检测36例中年人(对照组),50例血压正常老年患者,60例老年高血压患者的动态血压.结果血压正常老年患者较中年血压正常者24h动态血压呈杓型曲线的比例明显下降.血压正常老年患者,血压昼夜波动曲线与心、脑、肾损害无相关性.老年高血压患者,血压曲线呈非杓型者比例增高,血压昼夜节律消失较节律正常的高血压患者有更显著的靶器官损害.结论对于非高血压患者,随年龄的增加,血压昼夜节律消失者增多,血压曲线变化与心、脑、肾损害无关,可能与原发病有关.对于高血压患者,血压昼夜节律紊乱可作为靶器官损害的预测因子.     

24h动态血压监测评价卡维地洛对原发性高血压患者的降压效应

目的 :评价卡维地洛对原发性高血压患者的降压效应。方法 :选择我科 2 0 0 3年 7月至 2 0 0 4年 1月住院的原发性高血压患者 4 2例 ,行首次 2 4 h动态血压监测后开始服用卡维地洛 ,初始剂量为 12 .5 mg,每日口服 1次。治疗开始后每日服药前测卧位血压 1次 ,若血压控制不满意 ,可根据病情增加剂量。 4周结束时重复行 2 4 h动态血压监测。治疗前和治疗 4周结束时行血、尿常规、肝肾功能、血脂、血电解质、空腹血糖等检查。结果 :经 4周卡维地洛治疗后 ,显效 37例 (88.10 % ) ,有效 4例 (9.5 2 % ) ,无效 1例 (2 .38% ) ,总有效率 (97.6 2 % )。治疗后患者平均收缩压(SBP)、平均舒张压 (DBP)谷峰比值分别为 6 3%和 6 5 %。结论 :本观察发现卡维地洛降压疗效确切 ,有效率为 97.6 2% ,有满意的谷 /峰比值 ,副作用少 ,是一种很有前途的新型抗高血压药物。     

氨氯地平与非洛地平缓释剂治疗原发性轻、中度高血压的随机、双盲平行对照研究

目的:对比氨氯地平与非洛地平缓释剂治疗轻中度原发性高血压的疗效和安全性;每日1次服药对24小时动态血压的影响;并对比药物漏服对血压控制的影响。方法:76例轻、中度高血压患者被随机、双盲分成两组,分别每日口服1次氨氯地平5～10mg(Ⅰ组)或非洛地平缓释剂5～10mg(Ⅱ组),治疗12周,并用24小时动态血压监测评价用药前后24小时血压变化情况及漏服48小时的血压变化。结果:氨氯地平治疗组舒张压降低15.1mmHg(治疗末为84.8mmHg),非洛地平缓释剂治疗组舒张压降低15.3mmHg(治疗末为85.0mmHg)。总有效率Ⅰ组病人为83.8％,Ⅱ组为87.9％(P=NS)。在药物的初始剂量下即能达到有效血压控制的病人数Ⅰ组为76％,Ⅱ组为52％(P<0.01)。药物漏服24和48h后,Ⅰ组临床血压仍低于140/90mmHg,24小时动态血压与漏服前相比无显著性差异,而Ⅱ组的临床血压高于140/90mmHg,临床血压和24小时动态血压与漏服前相比具有显著性差异。两治疗组的副作用发生率均较低。结论:氨氯地平与非洛地平缓释剂均能有效降低轻、中度高血压病人的血压,安全、疗效可靠,病人耐受性好,但漏服试验表明漏服24与48h氨氯地平仍能较好的控制血压。Ⅰ组的血压波动明显低于Ⅱ组。     

Circadian variability of blood pressure in obese children

Background and aimsThe aim of the present study was to evaluate the circadian rhythm of blood pressure pattern in obese children, and to investigate if the lack of normal diurnal rhythm of blood pressure is associated with cardiovascular risk factors.Methods and results73 obese children (body weight [mean ± SD]: 89.0 ± 17.8 kg; age [mean ± SD]: 14.2 ± 2.3 years), 42 dippers and 31 non-dippers were investigated. Following ambulatory blood pressure monitoring (ABPM), physical fitness testing was performed on a treadmill. Physical working capacity at 130, -150, -170 beat/min (PWC-130, -150, -170), resting and peak oxygen consumption (VO₂rest, VO₂peak) were determined.Forty-two percent of obese children were non-dipper. PWC-130 (74.8 ± 48.8 watts; 48.0 ± 38.5 watts), PWC-150 (132.9 ± 52.1 watts; 104.2 ± 49.3 watts), PWC-170 (185.9 ± 49.5 watts; 154.9 ± 53.4 watts) and VO₂rest, ([mean ± SD]: 0.29 ± 0.08 L/min; 0.26 ± 0.07 L/min), and VO₂ peak (2.77 ± 0.61 L/min; 2.44 ± 0.62 L/min) were significantly lower in the non-dipper group, as compared to dippers (p < 0.05). The prevalence of hypertension, on the basis of ABPM, was significantly higher in the non-dipper group (45.2% vs 83.9%, p < 0.001). This is due to increased prevalence of masked hypertension in the non-dipper group (19.0% vs 32.3%, p < 0.001).ConclusionThe normal circadian variation of the blood pressure is frequently absent in obese children. Most of the non-dipper obese children are hypertensive, and their physical fitness is decreased.     

Identifying patterns of diurnal blood pressure variation among ELSA‐Brasil participants

Ambulatory blood pressure monitoring (ABPM) is the gold standard method for the diagnosis of hypertension. ABPM provides a set of repeated measurements for blood pressure (BP), usually over 24 h. Traditional approaches characterize diurnal BP variation by single ABPM parameters such as average and standard deviation, regardless of the temporal nature of the data. In this way, information about the pattern of diurnal BP variation and relationship between parameters is lost. The objective of this study was to identify and characterize daily BP patterns considering the set of repeated measures from 24‐h ABPM. A total of 859 adult participants of the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil) performed a 24‐h ABPM record. Hypertension, sex, age, race/color, education, marital status, smoking, alcohol, physical activity, and BMI were the covariables analyzed. Techniques for longitudinal clustering, multinomial models, and models with mixed effects were used. Three daily BP patterns were identified. Daily BP patterns with high BP presented higher standard deviation and morning surge and lower nocturnal dipping. They showed greater systolic BP variability and faster rise than fall in diastolic BP during sleep. Hypertensive, “pardos,” and men had greater odds to present these patterns. Daily BP patterns with high BP presented the worst profile concerning ABPM parameters associated with cardiovascular risk. The daily BP patterns identified contribute to the characterization of diurnal BP variation.