Ambulatory Blood Pressure Monitoring Results Research Articles

Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients.

Nocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated. In this cross-sectional study, a total of 524 hypertensive patients were recruited and evaluated with ambulatory BP monitoring between April 2012 and June 2013. Carotid plaque was classified into Grade 0 (normal or no observable plaque), Grade 1 (mild stenosis, 1%-24% narrowing), and Grade 2 (moderate stenosis, ≥25% narrowing). Multinomial logistic regression was applied to analyze the relationship between different degrees of carotid plaque and ambulatory BP monitoring results. Reverse-dipper pattern of BP was more common in older patients, smokers, and those with elevated fasting glucose. The incidences of coronary artery disease, lacunar infarction, and diabetes were also higher among hypertensive with reverse-dipper pattern. Multinomial logistic regression analysis showed that reverse dipper (odds ratio [OR] 2.500; 95% confidence interval [CI] 1.320-4.736; P = 0.005), age (OR 1.089; 95% CI 1.067-1.111; P < 0.001), smoke (OR 1.625; 95% CI 1.009-2.617; P = 0.046), and diabetes (OR 1.759; 95% CI 1.093-2.830; P = 0.020) were significantly different between mild carotid plaque and normal. Our results also suggested that mild carotid plaque was closely related to reverse-dipper pattern of BP (2.308; 95% CI 1.223-4.355; P = 0.010). Reverse-dipper pattern of BP may be a risk factor for carotid atherosclerosis and play a crucial role in the early formation of carotid plaque.

Left ventricular mass and diastolic function in obese children and adolescents

Our aims were to assess left ventricular structure and diastolic function in obese subjects stratified according to ambulatory blood pressure status, and to investigate independent predictors of the left ventricular mass (LVM) index. Obese subjects aged 9-19 years referred for ambulatory blood pressure monitoring (ABPM) were evaluated in the cross-sectional study. In addition to biochemical and anthropometric measurements, subjects underwent ABPM, Doppler echocardiography, and treadmill exercise test. According to ABPM results, 103 subjects with obesity (mean age 14.1 ± 2 years) were split in two groups: 49 hypertensive, and 54 without hypertension. Left ventricular hypertrophy was found in 16.3 % of hypertensive, and 5.6 % of normotensive. Variables included in stepwise regression analysis as potential determinants of LVM index were age, body mass index z score, waist circumference, peak systolic blood pressure on exercise test, 24-h heart rate, and night heart rate. Peak systolic blood pressure (adjusted R(2) = 0.051, β = 0.245, p = 0.013) remained as the independent predictor of LVM index. Diastolic function evaluated by mitral E/A ratio was decreased in both obese groups. Early markers of cardiac disease including hypertrophy and diastolic dysfunction of the left ventricle are present in youths with obesity prior to the development of sustained hypertension.

Analysis of 24-hour blood pressure profile, heart rate variability and carotid atherosclerosis in hypertensive patients among native and nonnative population living in Yamalo-Nenets autonomous district

To study special characteristics of the course of arterial hypertension (AH) among native and nonnative population of Yamalo-Nenets autonomous district. We examined 100 residents of Far North with AH (men and women aged 21-55, mean age 44.08 ± 1.15 years). All patients were divided into 2 equal groups by 50 subjects: group I consisted of representatives of native and group II--nonnative population. Examination was carried out in outpatient clinic in Salekhard and included 24-hour ambulatory blood pressure monitoring (ABPM), registration of heart rate variability, duplex scanning of brachiocephalic arteries, and assessment of blood lipid profile. The groups were matched by age, gender and disease duration. Analysis of heart rate variability detected significant degree of strain of regulatory systems in most patients of both groups. According to results of ABPM "non-dipper" patients prevailed in group I compared to group II (p = 0.01). Common carotid artery intima-media complex was significantly greater compared to normal value in all patients; it was thicker in group I (p < 0.03), but number of carotid artery stenoses was similar in both groups. No dyslipoproteinemia was detected. Compared with group of representatives of nonnative (adopted) population group of native subjects with AH was characterized by greater carotid intima media thickness and prevalence of "non-dipper" patients.

Prevalence of masked hypertension in patients with obstructive sleep apnea

Objective: Obstructive sleep apnea (OSA) is a common disorder with important clinical consequences. Many studies have proven that OSA is one of the most important causes of secondary hypertension. Masked hypertension is defined as a presence of normal office blood pressure together with abnormal results in 24hour ambulatory blood pressure monitoring (ABPM). The prevalence of this condition in patients with OSA is not well defined. The aim of this study was to evaluate the prevalence of masked hypertension using results of office blood pressure measurement compared with the results of ABPM.

Abstract 166: The Role of Ambulatory Blood Pressure Monitoring in Pediatric Hypertension Confirmation: A Cost and Efficacy analysis

Background: With the goal of averting future cardiovascular disease, the Affordable Care Act of 2010 mandates population-wide identification of children with high blood pressure (BP). Since children are prone to white coat (reactive) hypertension and masked hypertension, ambulatory blood pressure monitoring (ABPM) may be a cost-effective confirmatory test and therefore of high relevance to this mandate. Using actual patient data we evaluated the role of ABPM in patients referred to specialty clinic for evaluation of elevated blood pressure. Methods: From an unselected group of consecutive referral patients all receiving ABPM (n=58), we collected ABPM results, clinic auscultative BP and subsequent work-up patterns. Pre-elevated (90-95% referenced to age-sex-height) and elevated (&gt;95%) clinic BP (CBP) were defined per NHLBI 2011 integrated guidelines. ABPM stratified patients into a) normal (mean 24 systolic BP (SBP) &lt; 95%; SBP load &lt;25%);b) pre-elevated (mean 24 SBP 25%); and c)elevated (mean 24 hour SBP &gt;95%; SBP load &gt;25%). ABPM was treated as the gold standard. We then compared 3 high BP confirmation strategies: 1. Average CBP alone to stratify into normal, pre-elevated, or elevated BP; 2. CBP followed by ABPM for CBP &gt; 90%ile, using CBP and ABPM to stratify; 3. ABPM alone to stratify. The scenarios were compared by a) proportion elevated BP children appropriately identified; b) charges incurred. Charges included NHLBI 2011 recommended evaluation for elevated BP, extended secondary etiology work-up when indicated, target organ damage assessment in all pre-elevated, and screening for co-morbidities in obese pre-elevated patients. Rates of secondary etiology work-up and proportion obese were derived from the clinical cohort. We used an average cost approach with charges gleaned from our institution rate book. Results: CBP alone, CBP + ABPM, and ABPM alone identified 33.3% (3/9), 44.4% (4/9), and 100% (9/9) hypertensive cases respectively. Cost per hypertensive patient identified in each scenario was $28,994; $14,312; and $11,336 respectively. Conclusion: Given pediatric high BP is uncommon with many false positives and negatives, ABPM as a universal confirmatory test identifies more true hypertensives at a lower average cost.

L/N-Type Calcium Channel Blocker Cilnidipine Added to Renin-Angiotensin Inhibition Improves Ambulatory Blood Pressure Profile and Suppresses Cardiac Hypertrophy in Hypertension with Chronic Kidney Disease

Ambulatory blood pressure (BP) and heart rate (HR) profile are proposed to be related to renal deterioration and cardiovascular complication in hypertension and chronic kidney disease (CKD). In this study, we examined the beneficial effects cilnidipine, a unique L/N-type calcium channel blocker (CCB), in addition to renin-angiotensin system inhibitors, on ambulatory BP and HR profile, as well as cardiorenal function in hypertensive CKD patients. Forty-five patients were randomly assigned to the cilnidipine replacement group (n = 21) or the control CCBs group (n = 24) during a 24-week active treatment period. Although clinical BP values were similar in the cilnidipine and control CCBs groups after the treatment period, the results of ambulatory BP monitoring showed that the 24-h and daytime systolic BP levels in the cilnidipine group were significantly lower compared with the control group after the study. Furthermore, the left ventricular mass index (LVMI) was significantly decreased in the cilnidipine group compared to the control group after the study (LVMI, 135.3 ± 26.4 versus 181.2 ± 88.4, p = 0.031), with a significant difference in the changes in the LVMI between the cilnidipine and control groups (change in LVMI, −12.4 ± 23.7 versus 26.2 ± 64.4, p = 0.007). These results indicate that cilnidipine is beneficial for the suppression of pathological cardiac remodeling, at least partly, via a superior improving effect on ambulatory BP profile compared with control CCBs in hypertensive CKD patients.

Prevalence of white coat hypertension in children and adolescents

Objective: The aim of this study was to assess the prevalence of white coat hypertension in children and adolescents Design and methods: A cross sectional study was carried out in 142 patients 82 boys and 60 girls aged 12-19 years mean 16,27±2,8. To all patients were performed office blood pressure measurement (BP), Ambulatory Blood Pressure Monitoring (ABPM) and echocardiography. White Coat Hypertension (WCH) was diagnosed when office blood pressure measurement were 95 th percentile > for sex and age or >140/90 for those >18 years, and systolic and diastolic daytime values obtained by ABPM were <95 th percentile for sex and age or <135/85 mm Hg for those >18 years. All patients after follow up one year were undergoing second ABPM Results: At baseline we detected 15 patients with white coat hypertension. This condition represented 56% of the office hypertension. The prevalence of WHC hypertension was higher in the males than females (14,5% Vs 5,7% p=0,03) The mean age was not different to normotensive and hypertensive groups (16,17±2,1 vs 16,20±2,2 years and 16,19±2.09). During follow up 6 of 15 patients become normotensive 6 developed sustained hypertension and 3 had persistent White coat hypertension When compared patients that became normotensive than patients that developed sustained hypertension and had persistent WHC had higher baseline office systolic BP (142,03±7,3 vs 131,2±4,3 p<0,001) higher baseline daytime ambulatory systolic BP 127,53±5,73 vs 120,33±4.63 p<0,05. Conclusion: Children and adolescents with white coat hypertension should be followed closely due to its tendency to developed sustained hypertension. Higher values of systolic blood pressure associated with the development of hypertension

Interpreting treatment-induced blood pressure reductions measured by ambulatory blood pressure monitoring

It is well known that 24-h ambulatory blood pressure monitoring (ABPM) provides a more accurate picture of a patient's blood pressure (BP) compared with clinic BP measurement. Twenty-four-hour ABPM better predicts hypertension-related risks such as end-organ damage including left ventricular hypertrophy, cardiovascular (CV) events and mortality. Threshold BP values for hypertension based on 24-h ABPM results have been established, including daytime and night-time averages. Nevertheless, the relationship between 24-h ABPM and clinic BP measurement in patients on antihypertensive therapy, and in particular how each may change in response to antihypertensive therapy, is less clear. This review will provide an overview of current knowledge on the relation between clinic BP and ambulatory BP reductions in clinical trials on antihypertensive therapies. Reduction in CV risk and its correlation with the magnitude of reduction in both clinic and ambulatory BP are explored. The most striking result is that reduction in clinic BP and ambulatory BP do not correspond in a 1:1 fashion, that is, smaller changes in 24-h ABPM correspond to significantly larger changes in clinic BP.

Nurse-Driven Training Courses: Impact on Implementation of Ambulatory Blood Pressure Monitoring

Background:Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients.Objective:To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program.Materials and Methodology:Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhabitants. The ABPM implementation program was driven by two nurses that held four education sessions. After a 2-year follow-up period, we assessed the outcome of attendance at the educational sessions. First, we evaluated whether the program increased the number of orders of ABPM. Second, we used a survey to evaluate to what extent the input of our educational sessions was understood by attendants. Third, we analyzed the effect ABPM results had on the treatment of patients with a bad control of their hypertension.Results:After the training sessions we found a 6-fold increase in the number of patients undergoing ABPM. We analyzed 204 hypertensive individuals: 41% dippers, 34% were non-dippers, 20% were risers and 5% were extremely dippers. According to our survey, 100% of attendants had a good practice regarding ABPM management. However only 27% of riser patients were studied with a second ABPM.Conclusions:Specific training processes are needed for implementation of ABPM and an even more concentrated effort should be focused on training in the correct interpretation of ABPM results.

Reversed Dipper Blood-Pressure Pattern Is Closely Related to Severe Renal and Cardiovascular Damage in Patients with Chronic Kidney Disease

BackgroundA non-dipper blood pressure (BP) pattern is very common in chronic kidney disease (CKD) patients and affects the progression and development of cardiovascular disease. However, data on the reversed dipper BP pattern on target-organ damage in Chinese CKD patients are lacking.MethodsA total of 540 CKD patients were enrolled. Ambulatory blood pressure monitoring (ABPM), clinical BP, ultrasonographic assessment and other clinical data were collected. Univariate and multivariate analyses were used to ascertain the relationship between ABPM results and clinical parameters.ResultsA total of 21.9% CKD patients had a reversed dipper BP pattern, 42% of patients had a non-dipper BP pattern and 36.1% of patients had a dipper BP pattern. Patients with reversed dipper BP pattern had the worst renal function and most severe cardiovascular damages among these CKD patients (p<0.05). The estimated glomerular filtration rate (eGFR) and left ventricular mass index (LVMI) correlated significantly with the rate of decline of nocturnal BP. A reversed dipper BP pattern was an independent factor affecting kidney damage and left ventricular hypertrophy. Age, lower hemoglobin level, higher 24-h systolic BP from ABPM, and higher serum phosphate levels were independent associated with a reversed dipper BP pattern after multivariate logistic regression analyses.ConclusionThe reversed dipper BP pattern is closely related to severe renal damage and cardiovascular injuries in CKD patients, and special attention should be given to these CKD patients.

Impact on hypertension reclassification by Ambulatory Blood Pressure Monitoring (ABPM) according to the V Brazilian Guidelines on ABPM

New recommendations on reference values for normal test results in ambulatory blood pressure monitoring (ABPM) were proposed by the V Brazilian Guidelines on Ambulatory Blood Pressure Monitoring, based mainly on the IDACO study. This epidemiological study is aimed at evaluating the impact of adopting these new standards in an arterial hypertension referral center. The results of 1,567 ABPM tests carried out between 2005 and 2010 were analyzed; 481 patients were excluded from the sample for not meeting minimum quality criteria of the test. Reference values from the IV Brazilian Guidelines on ABPM (2005) were used for the classification of these tests regarding the abnormality and compared with the changes proposed by the V Brazilian Guidelines on ABPM (2011). Statistical analysis was performed by Pearson's chi-square method and p values < 0.05 were considered statistically significant. For the 1,086 tests evaluated, there was a significant difference in the proportion of patients with altered ABPM results, especially for the variable systolic pressure in the sleeping period: 49% when adopting the cutoff values of 2005 and 71% when adopting the values of 2011, with statistical significance, p < 0.0001. The recommendations of the new guidelines had a great impact on the hypertension classification by ABPM test results in the study population. The question of thresholds of these tests for therapeutic targets of patients known to be hypertensive is still open and requires further studies, preferably national ones, for better definition of the subject.

475 A RETROSPECTIVE REVIEW OF THE AMBULATORY BLOOD PRESSURE PATTERNS IN SUBGROUPS OF SPINAL CORD INJURED PATIENTS

Background: Ambulatory blood pressure monitoring (ABPM) is advantageous over conventional BP measurement as it is able to evaluate diurnal BP patterns in the setting of variable BP seen in spinal cord injury (SCI). Patients with high SCI have been noted to lose the nocturnal dip in BP and to have nocturnal polyuria. Methods: A retrospective study was conducted on medical records of patients with traumatic SCI who were referred for ABPM. Results of ABPM and nocturnal urine production were compared between groups of patients classified according to level, completeness and chronicity of SCI. Patients with night:day systolic BP < 90% were classified as dippers, 90-100% as non-dippers and >100% as reversed-dippers. Results: Patients (45 quadriplegic, 9 paraplegic) were predominantly males (92.6%) of average age 40.8 ± 2.5 years (mean ± SEM). Mean 24-hour BP was 111.1 ± 1.4/65.0 ± 1.2 mmHg, with a mean night:day systolic BP of 101.7 ± 1.3%, and 56% were reversed dippers. There was a greater proportion of reversed dippers in quadriplegics than paraplegics (62% vs 22%, p = 0.027), complete than incomplete (73.9% vs 38.9%, p = 0.02), and acute than chronic (73% vs 40%, p = 0.03) SCI. Quadriplegic patients with higher nocturnal urine production also tended to be reversed dippers (80% vs 30%, p = 0.034) and have acute SCI (90% vs 43%, p = 0.036). Conclusions: In our referred population, patients with acute, complete and quadriplegic injuries tended to have the greatest reversal of diurnal BP variation and nocturnal urine production. Further study of ambulatory BP patterns and urine production in SCI may be useful in characterising the course of BP patterns after SCI, and its effects on patients.

Red cell distribution width and inflammation in patients with non-dipper hypertension

Red cell distribution width (RDW) is independently associated with morbidity and mortality in cardiovascular diseases. RDW is elevated in hypertensive patients compared with normotensives. Based on the nocturnal course, hypertension classified as dipper and non-dipper. Non-dipper hypertension is associated with higher inflammation and worse prognosis. We aimed to investigate whether RDW and high-sensitive C-reactive protein (hsCRP) are elevated in non-dipper hypertensive patients compared with dippers. The study included total 247 essential hypertensive patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed for each patient. Thereafter patients were divided into the two groups on the basis of the results of 24-h ABPM: 127 dipper hypertensives and 120 non-dipper hypertensives. Complete blood count and biochemistry were measured by standard methods and hsCRP was assessed by using BN2 model nephelometer. Non-dippers had significantly higher RDW levels than dippers [14.6 (13.8–17.0) vs 13.0 (12.5–13.4), p < 0.001, respectively]. After adjustment for hemoglobin, low-density lipoprotein-cholesterol, sex, age and hs-CRP, mean RDW values were for dipper and non-dippers 13.4 (12.4–13.2) and 14.5 (13.7–16.8), respectively (p < 0.001). RDW was negatively correlated with the percentage decline of systolic and diastolic BP from day to night (r = − 0.392, p < 0.001 and r = − 0.294, p < 0.001, respectively). Serum hsCRP levels were also significantly higher in the non-dippers (p < 0.001) and it was significantly positively correlated with RDW (r = 0.403, p < 0.001). In receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict non-dipping pattern was > 13.8%, with 80% sensitivity and 75% specificity. RDW is significantly increased in patients with non-dipper hypertension compared with the dipper hypertension. Inflammatory activity was closely related to RDW in non-dipper hypertensives. RDW, as easy and quick measurable tool, can predict non-dipping pattern in essential hypertension.

Hypertensive disorders during pregnancy

Hypertensive disorders during pregnancy

Masked Hypertension, Endothelial Dysfunction, and Arterial Stiffness in Type 2 Diabetes Mellitus: A Pilot Study

The aim of this study was to assess the relationship between masked hypertension (MHT) and vascular damage in patients with type 2 diabetes. The study subjects were patients with type 2 diabetes who were normotensive based on blood pressure (BP) measurement in the clinic (n = 80) without antihypertensive drugs and free of retinopathy, macroalbuminuria, overt cardiovascular disease. Subjects underwent 24-h ambulatory blood pressure monitoring (ABPM), measurement of flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV). Based on the results of ABPM, subjects with mean daytime systolic BP ≥135 and/or 85 mm Hg were defined as MHT and their clinical data were compared with those of normotensive patients (NT). The data were also compared with those of type 2 diabetic patients with hypertension (HT) as measured in the clinic (n = 32). MHT was detected in 47.5% of the study subjects with normotension at clinic (n = 38). Impaired FMD (5.65 ± 2.00% for NT, 4.26 ± 1.88% for MHT, 3.90 ± 1.71% for HT, P < 0.001) and higher baPWV (1,514.2 ± 212.7 cm/s for NT, 1,749.9 ± 339.7 cm/s for MHT, and 1,768.6 ± 302.8 cm/s for HT, P < 0.001) were similarly noted in patients with MHT and HT compared with NT. Multivariate regression analysis indicated that daytime systolic BP measured by ABPM, the estimated duration of diabetes and serum triglycerides were significantly associated with FMD and daytime systolic BP measured by ABPM, not systolic BP at clinic, age, and HbA(1c) were significantly associated with baPWV. Given that patients with impaired FMD and higher baPWV are known to be at higher risk of cardiovascular disease, our data suggest that type 2 diabetic patients with MHT could be also at increased risk of cardiovascular disease.

UK Guidelines Call for Routine 24-Hour Ambulatory Blood Pressure Monitoring in All Patients to Make the Diagnosis of Hypertension-Not Ready for Prime Time in the United States

UK Guidelines Call for Routine 24-Hour Ambulatory Blood Pressure Monitoring in All Patients to Make the Diagnosis of Hypertension-Not Ready for Prime Time in the United States

237 Assessment of blood pressure control after surgical treatment of acute thoracic aortic disease

Hypertension is an important predisposing factor for the occurrence of acute type A aortic dissection (AD) or intramural hematoma (AH), both conditions requiring urgent surgical treatment. It is also a recognized pejorative factor for morbidity and mortality after aortic surgery. Despite of this, the assessment of blood pressure (BP) control after surgical treatment of AD or AH is little studied. We performed a pilot study among patients treated by surgery for AD or AH between 1990 and 2005 in our institution. Clinical BP measurement and 24 hours ambulatory BP monitoring (ABPM) were performed especially for the study. Among the 217 patients of the cohort, 81 were died. We analyzed the results of the first 43 surviving patients (34 men, mean age = 66 + 10 years). Clinical BP parameters were: systolic BP = 148 + 24 mmHg and diastolic BP = 81 + 11mmHg. ABPM results were: 24-hours systolic BP = 127 + 15 mmHg and 24-hour diastolic BP = 70 + 9 mmHg). The mean number of drugs for hypertension was 2.6 + 1.2. Thirty two patients (72%) received a beta-blocker and 20 patients (46%) an angiotensin-converting enzyme inhibition. At mean follow-up of 14 years, Hypertension was diagnosed in 34 (79%), 26 (60%) of the patients using respectively clinic and ABPM. In this very high cardiovascular risk population, only 21% and 40% patients were normotensives in clinic and in ABPM respectively. This result must be improved using a more systematic BP follow-up by cardiologists, particularly by using systematically ABPM. Moreover, the number of antihypertensive drugs must be increased to improve the BP control.

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.

Blood Pressure Control in Hypertensive Pediatric Renal Transplants: Role of Repeated ABPM Following Transplantation

Hypertension in pediatric renal transplants is a widespread condition associated with high mortality risk in early adult life. Ambulatory blood pressure monitoring (ABPM) was found to be superior to office blood pressure (BP) in identifying true hypertensive and responders to treatment. The aim of this study was to investigate the role of repeated ABPM, performed at yearly intervals following transplantation, in the assessment and decision-making processes of post-transplant hypertension. Thirty-seven recipients (23 males; aged 10.5 +/- 4.3 years) who were followed for 4.3 +/- 2.2 years (range 2-9) after transplantation were eligible for analysis. The mean follow-up time between the baseline (1 year post-transplantation) and the most recent ABPM examination was 3.3 +/- 2.2 years (range 1-8). Throughout the follow-up period, antihypertensive therapy was either started or intensified in 27 recipients. These interventions were decided based on ABPM results obtained on 40 of 44 occasions. At last follow-up, 24 of 29 treated hypertensive recipients displayed controlled BP. This figure was significantly higher compared to our historical hypertensive control recipients in whom ABPM was applied for the first time in treatment at 6 +/- 3.3 years (range 2-15) after transplantation, while therapeutic decisions were driven by office BP measurements (95 % confidence interval (95% CI) for the difference between proportions (80.6-32 %) 36-60 %, P = 0.001). Our study shows that, in a population with high risk for hypertension, repeated ABPM may significantly help to improve BP control.

Comparative study on auscultatory and oscillometric methods of ambulatory blood pressure measurements in adult patients

Ambulatory blood pressure (BP) monitors measure BP by oscillometric (Osc) or auscultatory (Aus) methods. In this study, we aimed to compare the values obtained by BP measurement methods in the ambulatory blood pressure monitoring (ABPM) device that can take measurements using both the methods, factors influencing these values, and their relevancy in obtaining valid measurement percentages. The study was conducted on 212 patients. BP values of these patients were measured with the Nissei DS-250 (Nihon Seimitsu Sokki Co. Ltd, Gunma, Japan) monitor capable of recording BP simultaneously by the Aus and the Osc methods. The cases, for which no records were obtained by any one of the two methods, were considered to have missing records. The impacts of age, sex, body mass index, and arm circumference on the valid BP measurement values were examined. The valid measurement percentage without any missing records obtained by the Osc method was 87.3 and 16% by the Aus method. The body mass index, age, and arm circumference did not affect this percentage. The 24-h BP measurement values were higher by the Osc method. The differences between both methods in systolic blood pressure and diastolic blood pressure were 3.8+/-4.6 and 2.3+/-2.7 mmHg, respectively. Although the Aus method yielded higher standard deviation values than the Osc method for systolic blood pressure, standard deviation values obtained by the Osc method were higher than those obtained by the Aus method for diastolic blood pressure. The percentage of obtaining valid measurements by the Osc method used in the Nissei DS-250 model ABPM device examined in this study is higher when compared with the Aus method. Therefore, while examining ABPM results, the Osc method may be preferable over the Aus method.