Ambulatory Blood Pressure Monitoring Measurements Research Articles

Abstract 459: Noninvasive Measures of Arterial Stiffness in a Young Normotensive/Prehypertensive Patient Population

Introduction Noninvasive measures of atherosclerosis have become established tools for cardiovascular risk prediction, largely studied in older individuals. Pulse pressure (PP) is a simple surrogate measure of arterial stiffness, while Ambulatory Arterial Stiffness Index (AASI) is a relatively new vascular compliance measure calculated as 1 minus the regression slope of DBP over SBP readings obtained from 24 hour ambulatory blood pressure monitoring (ABPM). We examined the hypothesis: PP and AASI correlate with blood pressure (BP), along with microvascular and endothelial function, in young adult normotensive and prehypertensive subjects. Methods 24 hour BP, PP, and AASI were calculated from ABPM, and clinic BP obtained in 140 subjects (87 female, 53 male; 117 non-black, 23 black) with mean +/- sd age 26 +/- 6 years. Strain gauge plethysmography was used to assess endothelial function. Microvascular function was measured with direct capillaroscopy visualization of capillaries. Pearson correlation coefficients and multiple linear regression were used to analyze BP, microvascular, and endothelial function as predictors of PP and AASI, controlling for BMI, gender, age and race. Results PP and AASI are correlated (r=0.59; p<0.001). Both PP and AASI were significantly associated with ABPM and clinic SBP measures (SBP24: p=0.001/p=0.002; SBP daytime: p=0.001/p=0.009; SBP clinic: p=0.001/p=0.047; p values =PP/AASI). No association was seen for any measures with DBP. Both PP (p=0.08) and AASI (p=0.056) were marginally associated with endothelial function, while only AASI was significantly associated with microvascular function (p=0.027) along with BP dipping (drop of 10% or more during sleep: SBP and DBP p<0.001), another known predictor of cardiovascular risk. Conclusions In conclusion, both PP and AASI are associated with SBP in young normotensive and prehypertensive patients, indicating potential usefulness of these measures for early identification of arterial stiffness and associated cardiovascular risk, prior to development of established hypertension. Microvascular and endothelial dysfunction may contribute to the pathophysiology underlying higher PP/AASI values, with AASI more closely correlated with these processes.

Ambulatory Blood Pressure in Chronic Kidney Disease

Chronic kidney disease (CKD) affects approximately 20 million adults in the United States. Patients with CKD have an increased risk of cardiovascular (CV) disease. Ambulatory blood pressure monitoring (ABPM) provides superior BP measurements when compared to office BP measurements in normotensive, hypertensive and CKD patients. ABPM measurements are often abnormal in CKD, with CKD patients frequently showing an altered circadian rhythm with an increased rate of non-dipping and reverse dipping. The prevalence of non-dippers and reverse-dippers increases progressively as stage of CKD progresses. ABPM has been shown to be a better tool for predicting CV risk, CKD progression, end stage renal disease (ESRD) or death than office-based pressures. ABPM is also additive and adds prognostic value for predicting CKD and CV outcomes when added to estimated glomerular filtration rate (eGFR). Although ABPM is time consuming, it is worth considering, as the data demonstrates that information from ABPM can potentially impact future CV and renal outcomes in patients with CKD.

How to use ambulatory blood pressure monitoring in resistant hypertension

Resistant hypertension is defined as an uncontrolled office blood pressure (BP) despite the use of at least three antihypertensive drugs, in adequate doses and combinations, preferentially including one diuretic. It is a clinical diagnosis based on office BP measurements. Ambulatory BP monitoring (ABPM) is the cornerstone in the management of patients with resistant hypertension, as it is mandatory for diagnosis, treatment, follow-up and prognosis. In relation to diagnosis, ABPM measurements have classified patients with resistant hypertension into four subgroups: true, white-coat, controlled and masked resistant hypertension. This classification largely defines the therapeutic approach and the follow-up for each group. In this way, the target of antihypertensive treatment is ambulatory BP control and not office BP control. Chronotherapy based on ABPM values might frequently lead to a more rational treatment regimen. In relation to prognosis, uncontrolled ambulatory BP levels at baseline identify a subgroup of patients with a very high cardiovascular risk profile and a significantly worse prognosis. ABPM parameters can provide a better cardiovascular risk stratification than other traditional risk factors and office BPs.

Blood Pressure Treatment Adherence and Control Through 24-Hour Ambulatory Monitoring

Although systemic arterial hypertension (SAH) is an important cardiovascular risk factor, blood pressure level control often remains inadequate. Assessment of adherence to antihypertensive treatment through 24-hour ambulatory blood pressure monitoring (ABPM) may represent an important aid in the search for BP control targets. To assess adherence to antihypertensive treatment and its association with BP values at 24-hour ABPM in hypertensive patients treated in primary health care (PHC) centers. We carried out a cross-sectional study of 143 hypertensive patients, who constituted a representative sample of patients from PHC centers in the town of Antonio Prado, RS. The Morisky-Green test was used to evaluate adherence and verify the number of medications used by patients, followed by 24-hour ABPM. We observed that 65.7% of the sample was considered adherent to the proposed treatment, 20.3% were moderately adherent and only 14% were classified as non-adherent. Considering all the 143 patients evaluated, 79 (55.2%) were identified as having controlled hypertension (<130/80 mmHg) according to the 24-hour ABPM measurements, 64 (44.8%) were considered uncontrolled (>130/80 mmHg), 103 (72%) had absence of nocturnal BP dip and 60 (41.9%) were uncontrolled while awake. In this study, we observed a lack of adequate hypertension control with a consequent loss of opportunity for PHC professionals to adequately adjust the recommended BP control targets. This fact occurs in spite of proper adherence to antihypertensive treatment by patients in PHC centers.

Hypertension in Pediatric Patients With Renal Scarring in Association With Vesicoureteral Reflux

To examine the reflux nephropathy rate and severity as well as the hypertension rate in pediatric patients with vesicoureteral reflux (VUR). The study included 240 patients with VUR. Renal scarring (RS) was demonstrated by renal parenchymal examination using technetium-99m-labeled dimercaptosuccinic acid (99mTc-DMSA) scintigraphy. Office measurements of arterial blood pressure and ambulatory blood pressure monitoring (ABPM) of VUR patients were done during the follow-up period. Follow-up was a mean duration of 24 months. Rates of RS and hypertension increased parallel to increases in the degree of VUR. A gradual elevation in hypertension rates was evident during the follow-up period. All patients with hypertension had RS. Severe RS in 56 patients was associated with increasing blood pressure readings by 24-hour ABPM or office measurements in 19 patients (33.9%). ABPM measurements enabled us to detect additional patients compared with office measurements alone. Hypertension is a serious complication in children with reflux nephropathy and is associated with the severity of RS and VUR grade. ABPM seems to be superior over office measurements of blood pressure in identifying patients with hypertension.

Effect of placebo on ambulatory blood pressure monitoring in children

Ambulatory blood pressure monitoring (ABPM) has been proposed as a useful tool for more accurately diagnosing hypertension (HTN) and evaluating blood pressure (BP) response in pediatric anti-hypertensive trials. ABPM captures multiple BP measurements during routine daily activities and is thus an excellent method for identifying white-coat HTN. Additionally, ABPM measurements in adults do not demonstrate the placebo effect commonly seen with casual BP measurements, although this has yet to be evaluated in children. Therefore,, the aim of this study was to assess the effect of placebo on ABPM measurements in children. A total of 141 children aged 5-16 years with elevated BP were randomized into a multi-center, single-blind, cross-over trial. Subjects received a placebo pill prior to wearing a 24-h ABPM device at one of two visits separated by 1-2 weeks. Study procedures were otherwise identical at both visits. Mean systolic and diastolic BP for all measured time periods were similar between visits, as was the number of children diagnosed with HTN at each visit. Having confirmed HTN at baseline did not affect the impact of placebo on mean BP. If confirmed, this lack of placebo effect on ABPM measurements may allow for the design of direct comparison pediatric anti-hypertensive trials without a placebo arm.

Olmesartan medoxomil combined with hydrochlorothiazide improves 24-hour blood pressure control in moderate-to-severe hypertension

Background:Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has been shown to be more reliable than conventional measurements for hypertension assessment and the associated increased risk of cardiovascular events. Olmesartan/hydrochlorothiazide combination therapy has demonstrated increased blood pressure lowering over 24 hours compared with the component monotherapies. This prespecified pooled analysis of data from two trials investigated the effects of olmesartan/hydrochlorothiazide combination therapy and olmesartan monotherapy on 24-hour blood pressure control in patients with moderate-to-severe hypertension.Methods:After 8 weeks’ open-label olmesartan 40 mg monotherapy, uncontrolled patients (mean trough seated blood pressure 90–115/140–180 mmHg and 24-hour mean ambulatory diastolic blood pressure ≥80 mmHg with ≥30% of daytime ambulatory diastolic blood pressure readings >85 mmHg) were randomised to 8 weeks’ double-blind treatment with olmesartan 40 mg or olmesartan/hydrochlorothiazide 20/12.5, 40/12.5 or 40/25 mg (Study 1) or olmesartan/hydrochlorothiazide 20/25 or 40/25 mg (Study 2). This prespecified analysis of ambulatory blood pressure was performed on patients from the full analysis set of pooled studies 1 and 2, restricted to patients who provided at least one valid ABPM measurement at baseline.Results:After 8 weeks’ double-blind treatment, reductions in 24-hour, daytime and night-time blood pressure from baseline were observed for all treatment groups. These reductions were dose-dependent, with olmesartan/hydrochlorothiazide 40/25 mg demonstrating the greatest reductions in 24-hour blood pressure from baseline to Week 16 versus olmesartan monotherapy: −14.0/−8.8 vs −2.7/−2.0 mmHg, respectively; p < 0.0001.Conclusions:Adding hydrochlorothiazide to olmesartan provides more effective 24-hour blood pressure control versus olmesartan monotherapy in patients with moderate-to-severe hypertension.Clinical trial registration:Trial registration: ClinicalTrials.gov identifier: NCT00430508.Trial registration: ClinicalTrials.gov identifier: NCT00430950.

Ambulatory arterial stiffness indexes in acromegaly

Acromegaly is associated with increased cardiovascular morbidity and mortality and with specific heart and vascular abnormalities. The aim of our study was to investigate arterial stiffness using the ambulatory arterial stiffness index (AASI) and symmetric AASI (Sym-AASI), two indexes derived from 24-h ambulatory blood pressure monitoring (ABPM), in a group of normotensive and hypertensive patients with active acromegaly, compared with normotensive controls (NOR-CTR) or hypertensive controls (HYP-CTR). Ninety-six consecutive patients with active acromegaly (46 males, mean age 49±14 years) underwent 24-h ABPM and evaluation of cardiovascular risk factors. Based on ABPM measurement, acromegalic patients were divided into 64 normotensive (normotensive acromegalic patients (NOR-ACRO)) and 32 hypertensive (hypertensive acromegalic patients (HYP-ACRO)) patients, and were compared with 35 normotensive (NOR-CTR) and 34 hypertensive (HYP-CTR) age-, sex,- and ABPM-matched control subjects. The AASI and Sym-AASI indexes were significantly higher in acromegalic patients than in controls, either in the normotensive (NOR-ACRO vs NOR-CTR, P<0.0001 for AASI and P=0.005 for Sym-AASI) or in the hypertensive (HYP-ACRO vs HYP-CTR, P=0.01 for AASI and P=0.01 for Sym-AASI) group. Multiple logistic regression analysis showed a significant association of the highest AASI tertile with serum IGF1 (P=0.034) in the whole acromegalic group. AASIs are increased in acromegaly, independent of blood pressure (BP) elevation, and may have an important role in predicting cardiovascular risk in this disease.

Ocena częstości występowania nadciśnienia tętniczego mierzonego z zastosowaniem całodobowego ambulatoryjnego monitorowania ciśnienia tętniczego (ABPM) u czternastolatków i piętnastolatków – obserwacje wstępne

IntroductionHypertension is one of the main factors resulting in the disease of cardiovascular system. Its incidence rises along with age and its significant increase of suffering from hypertension is observed in groups of adolescents. AimThe aim of this study was to present the evaluation of hypertension incidence in groups of adolescents at the age of fourteen and fifteen and defining the incidence of co-occurrence of emotional disorders, obesity and other diseases in children with hypertension. Material and methodsTo date, 959 students at the age of fourteen and fifteen were tested. The ambulatory blood pressure monitoring measurement was obtained with an Oscar 2 oscillometric device. Parents were asked to complete a survey on child and family health. The average value of systolic blood pressure (SBP), diastolic blood pressure (DBP) for the daytime and nighttime, blood pressure load and nocturnal dipping were assessed in this trial. In selected patients underwent psychological testing. In all the rated weight, height and BMI percentile using body mass index charts. Results.BP load in excess of 25% was found in 341 students which is the subject 35.55% of the studied group. Mean value of daytime SBP and DBP higher than 95 percentiles for the gender, height and age was obtained in 142 students which is 14,80% of the studied population, mean value of nighttime SBP and DBP respectively in 168 students which is 17.52% of the studied population. Both BP load in excess of 25% and the mean SBP exceeding 95 percentiles in 199 students (20.75%) was detected. In total, the abnormal result of ABPM was gained in 361 of studied population which constitutes 37.64%. A higher proportion of elevated BP and increased mean daytime and nighttime BP were observed for SBP than for DBP. In all children with ambulatory blood pressure abnormality, further trials have been. 209 patients were scheduled to be measured. In the above group the hypertension was established in 85 of studied population. In this group 30.50% of ill patient suffered from emotional disorders; the obesity was detected in 32.94% of patients; in 9.40% of patients both the obesity and emotional disorders co-occurred; in 9.40% of studied patients suffered from the disorder of thyroid gland; in 1.12% of patients the disorder of kidneys was detected. Conclusions1. Increased a frequency of prevalence of elevated blood pressure among young people in the adolescence. 2. The dominant form of hypertension in adolescents was the isolated systolic hypertension. 3. Emotional disorders and obesity often co-occured with the hypertension. 4. Patients with ambulatory blood pressure monitoring abnormal results need the confirmation of diagnosis in the further clinical trials.

Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function

Life expectancy is still reduced in aortic coarctation (AoC) patients despite a successful repair because of late arterial hypertension and atherosclerosis. Masked hypertension (MH) consists of an elevated daytime or awake ambulatory blood pressure (BP) in the presence of a normal BP on conventional measurement at the office. To assess the prevalence of MH among AoC normotensive young patients successfully treated and to evaluate the impact of MH on left ventricular (LV) geometry and function.We studied 76 AoC patients (mean age 14.5±5.7 years, male 64%). According to 24 h ambulatory BP monitoring (ABPM) our sample was divided in real normotensive patients (Group RN, n=40) and MH patients (Group MH, n=36). There was an increased pressure gradient in the aortic arch (15 mm Hg±4 vs 13 mm Hg±4.7, P<0.05), increased LV mass (51 g m(-2.7)±13 vs 46 g m(-2.7)±12, P<0.05), in MH AoC patients. Regional longitudinal deformation properties of the basal septal segment (-15%±2.4 vs -20%±5, P<0.01) and LV twist values (14°±1.6 vs 12°±1.9, P<0.0001) were reduced in the MH group. There is a high prevalence of MH in young patients with repaired AoC, which is associated with abnormal LV structure and function. Clinicians should consider 24 h ABPM measurements in apparently normotensive patients followed up for AoC repair.

Effect on blood pressure of a continued nursing intervention using chronotherapeutics for adult Chinese hypertensive patients

(1) To explore the effect of continued nursing intervention on hypertensive patients based on chronotherapeutics. (2) To identify the factors affecting hypertensive patients' compliance to the chronotherapeutics-oriented nursing interventions. Chronotherapy provides a means of individual treatment for hypertension according to the circadian blood-pressure profile of each patient and constitutes a new option in optimising blood-pressure control and reducing risk from hypertension. Experimental study. All participants enrolled were randomly divided into the intervention group and the control group and they all took antihypertensive medicine prescribed by their doctors under ambulatory blood pressure monitoring. According to individual ambulatory blood pressure monitoring measures, interventions were implemented. (1) There were significant differences in blood pressure and compliance to chronotherapeutics between the two groups before and after the intervention. (2) Single variant and multiple factors analysis revealed different characteristics influencing chronotherapeutic compliance of hypertensive patients. Under ambulatory blood pressure monitoring, continued nursing intervention for hypertensive patients guided by chronotherapeutics could effectively improve blood-pressure control and chronotherapeutic compliance. Health care providers who deal with Chinese hypertensive patients can improve patients' therapeutic compliance and blood pressure control guided by chronotherapeutics. According to different influencing factors on patients' chronotherapeutic compliance nurses should pay more attention to those whose compliance might be worse.

Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial

Objective To assess the effect of continuous positive airway pressure (CPAP) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of...

Abstract 5149: Ambulatory Blood Pressure in a Large Cohort of Treated Hypertensive Subjects

Aim: To examine the concordance of blood pressure control by means of both clinic (office) measurements and ambulatory blood pressure monitoring (ABPM), in a large cohort of treated hypertensive subjects from the Spanish Ambulatory Blood Pressure Monitoring registry Methods: A total number of 43 499 hypertensives under antihypertensive treatment were analyzed. Office BP control was defined if the patient had BP below 140/90 mmHg. Ambulatory BP control was considered by means of 3 different criteria: if daytime BP (based on patient’s reported activity) was below 135/85 mmHg. if 24-hour BP was below 130/80 mmHg, and if nighttime BP was below 120/70 mmHg. Clinical characteristics were compared between patients with daytime BP below or above 135/85 mmHg Results: Table 1 shows numbers and proportions of patient having control or lack of control by means of office and ABPM (the 3 criteria used). Concordant control of BP was present in 17.4%, 15.7%, and 12.9%, by the 3 different criteria. The main source of difference between office and ABPM was the proportion of patients with isolated office resistance, the proportion of which, using the 3 aforementioned criteria was 34.5%, 29.1%, and 26.8%, respectively. When compared to patients with normal ABPM values, the presence of elevated daytime BP (higher than 135/85 mmHg) was associated (p&lt;0.001 for all comparisons) with male gender (57.5% vs 47.7%), diabetes (25.1% vs 20.9%), smoking (17.5% vs 12.5%), left ventricular hypertrophy on EKG (11.1 vs 9.1), and chronic kidney disease (3.0% vs 2.0%). Conclusion: Blood pressure control in the treated hypertensive population by using ABPM is twice as observed by office measurements. The proportion of patients with isolated office resistance (white coat) is relatively large. Normal values of ABPM in treated patients are more frequent in women, nondiabetic, and nonsmokers subjects, as well as in those without organ damage. Blood Pressure Control by means of Office and ABPM measurements

Serum Adiponectin Levels and Ambulatory Blood Pressure Monitoring in Pediatric Renal Transplant Recipients

BACKGROUND.: Reduced levels of serum adiponectin, an adipokine, are associated with cardiovascular and obesity-related diseases; however, relations between adiponectin and hypertension are unclear. METHODS.: This cross-sectional study examined adiponectin and ambulatory blood pressure monitoring (ABPM) in 33 pediatric renal transplant recipients (TXP), aged 8 to 19 years, median of 1.9 years after transplant. Serum total adiponectin (microg/mL) and high molecular weight-to-total adiponectin ratio (HMWr), 24-hr ABPM, and dual x-ray absorptiometry measures of fat mass were obtained. RESULTS.: The 12 TXP with hypertension (defined as BP index >1.0 and BP load >25%) had lower total adiponectin levels (7.4+/-3.2 vs. 10.9+/-5.2 microg/mL, P=0.045) compared with nonhypertensive TXP. Hypertensive TXP trended toward lower HMWr compared with nonhypertensive TXP (0.40+/-0.09 vs. 0.47+/-0.11, P=0.064). Levels did not differ according to sex, obesity or dipper status. In univariate analyses, total adiponectin and HMWr were negatively and significantly correlated with indexed BP in the daytime, nighttime, and 24-hr periods (R=-0.35 to -0.57). After adjustment for estimated glomerular filtration rate, fat mass, anti-hypertensive medication and fasting glucose, (1) lower total adiponectin was significantly and independently associated with greater elevations in all ABPM indexes except for nighttime systolic indexed BP, and (2) HMWr was inversely associated with all ABPM indexes. Lower adiponectin levels (P=0.049) and HMWr (P=0.042) were associated with greater odds of hypertension. CONCLUSION.: These data indicate that lower total adiponectin and HMWr were significantly and independently associated with greater ambulatory blood pressure.

Arterial HTN in children with T1DM-frequent and not easy to diagnose

To evaluate the diagnostic efficacy of the office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension (HTN) in children with diabetes mellitus type 1 (T1DM). We analyzed OBP and ABPM measurements in 84 diabetic children (43 boys) obtained at a median age of 14.9 yr and 6.3 +/- 3.5 yr after diagnosis of T1DM. OBP and ABPM results were converted into standard deviation scores (SDS). In addition, we analyzed blood pressure loads and nighttime dipping. The comparison between OBP and ABPM was performed using kappa coefficient and receiver operator curve (ROC). HTN was diagnosed in 43/84 (51%) patients using OBP (>95th percentile), and in 24/84 (29%) patients using ABPM ( > or = 95th percentile during 24 h, day or night). Both methods were in agreement in 33 ABPM normotensive and 16 ABPM hypertensive patients (most had nighttime HTN); 32% patients had white-coat HTN and 9.5% patients had masked HTN. The kappa coefficient was 0.175 (95% CI from -0.034 to 0.384) suggesting poor agreement between OBP and ABPM. Diastolic OBP was a better predictor of ABPM HTN (ROC area under the curve (AUC) = 0.71 +/- 0.06) than systolic OBP (AUC = 0.58 +/- 0.07). The percentage of non-dippers ranged from 7 to 23% in ABPM normotensive patients, and 21-42% in ABPM hypertensive patients who also had significantly higher BP loads (p < 0.0001). Children with T1DM often suffer from nocturnal, white coat- and masked HTN, which can not be assessed and predicted by the OBP.

Candesartan Cilexetil Effectively Reduces Blood Pressure in Hypertensive Children

The angiotensin-receptor blocker candesartan cilexetil is a well-tolerated antihypertensive agent with demonstrated benefits in adults with hypertension. However, there are few data supporting its use in children with hypertension. To determine the efficacy and tolerability of candesartan cilexetil in the treatment of pediatric hypertension. In an open-label, uncontrolled pilot study, hypertensive pediatric patients were eligible for participation if untreated systolic and/or diastolic blood pressure (BP) exceeded the 95th percentile for sex, age, and height. Patients underwent a 7-day washout period prior to initiation of weight-based dosing of candesartan cilexetil (2-8 mg daily). The dose was doubled after 7 days of therapy if inadequate antihypertensive response was determined by clinic-measured casual BP monitoring (CBPM) and home BP monitoring (HBPM). Three methods of BP measurement were compared before and after 2 weeks of treatment with the final dose of candesartan cilexetil: CBPM, HBPM, and 24-hour continuous ambulatory BP monitoring (ABPM). Self-reported adverse effects and clinical laboratory analyses were used to determine tolerability. Eleven patients (mean age 14.2 y) received a final candesartan cilexetil median daily dose of 8 mg (0.13 mg/kg, range 2-16 mg). Study treatment resulted in significant reductions in systolic and diastolic BP as measured by CBPM (-7.4%, p = 0.03 and -5.9%, p = 0.01, respectively) and by ABPM (-6.0%, p = 0.03 and -10.8%, p = 0.006, respectively), but no significant reductions as measured by HBPM. No clinically significant changes in laboratory measures were observed, and patients reported nonspecific mild adverse effects. Candesartan cilexetil effectively reduced BP as demonstrated by CBPM and ABPM measurements and was well tolerated in this group of hypertensive children.

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

Ambulatory blood pressure and cardiac abnormalities

It is well-known that children with established hypertension are at increased risk to develop left ventricular hypertrophy. It is less clear whether children who are at risk of developing hypertension, or who have pre-hypertension, are also at risk of cardiac abnormalities. In this issue of The Journal, Richey et al evaluated young patients with blood pressure greater than the 90th percentile, or with a first degree relative with hypertension. They used 24-Hour Ambulatory Blood Pressure Monitoring (ABPM) to better characterize the level of blood pressure. They found a positive correlation between left ventricular mass index and ABPM measures. These results suggest that ABPM may be a useful method to evaluate blood pressure in young patients who have hypertension or are at risk of hypertension.

COMPARATIVE STUDY OF EFFICIENCY AND SAFETY OF THE NEW DRUG OF AMLODOPINE – S-AMLODOPINE IN PATIENTS WITH ARTERIAL HYPERTENSION OF I-II DEGREE

Aim. To evaluate efficacy and safety of a new drug of amlodipine – S-amlodipine (Azomex, Emcur, India) compared to original drug of racemic amlodipine (Norvasc, Pfizer, USA) in patients with arterial hypertension (HT) of I-II grade. Material and methods . 39 patients with HT of I-II grade were randomized into two groups and took drugs of amlodipine during 8 weeks. Ambulatory blood pressure monitoring (ABPM) was undertaken before treatment and at the end of treatment. Results. 34 patients completed 8-week therapy. Both drugs showed antihypertensive effect: significant decrease in average levels of systolic and diastolic blood pressure (BP) recorded by office and ABPM measurements. Compared to racemic amlodipine S-amlodipine caused bigger decrease in systolic and diastolic BP and bigger decrease in daily and 24-hour average diastolic BP after 4 week of therapy. Conclusion. S-amlodipine is effective antihypertensive drug, showing more significant BP decrease in comparison with this of racemic amlodipine after 4 weeks of treatment.

Comparison of ambulatory blood pressure and Task Force criteria to identify pediatric hypertension

The aim of this study was to assess the level of agreement between central European ambulatory blood pressure monitoring (ABPM) and American Task Force (TF) criteria when applied to blood pressure (BP) measurements collected by ABPM to evaluate patients with hypertension. In 169 patients, we applied both sets of criteria and calculated mean daytime and nighttime BP and daytime BP loads. The frequency of hypertension for daytime systolic BP was significantly higher when TF criteria were used (p <or= 0.001). However, the frequency of hypertension for nighttime systolic BP was significantly increased when ABPM criteria were applied (p <or= 0.01). Therefore, with daytime ABPM measurements, hypertension was overdiagnosed with TF criteria, while nighttime hypertension was underdiagnosed using TF criteria. In contrast with previous reports, 40% of our patients with essential hypertension showed absence of nighttime dipping, regardless of the criteria used. The number of hypertensive patients was significantly higher using ABPM compared to TF criteria when patients with BP load >or=50% were evaluated (p <or= 0.01). Therefore, current recommendations for ABPM use in children such as to define white coat hypertension or as a screening tool to differentiate between primary and secondary hypertension need to be validated using yet to be produced normative ABPM criteria in American children.