Ambulatory Conditions Research Articles

Advantages of Percutaneous Coronary Intervention in Relation to Medication Therapy in Patients with Stable Angina Pectoris (Three- Wessel Coronary Disease)

Patient, a man, age of 66 years, was admitted to the Internal Department,Interventional Cardiology Department for chest pains by type of stable anginapectoris. CCS II. In ambulatory conditions he was made non-invasive diagnostics,and after a positive ergometric test, a decision was made that the patient beadmitted to the catheterization hall for invasive diagnosis and possible percutaneouscoronary intervention.

Ambulatory pulse wave monitoring: current and future. Opinion paper of Russian Experts

The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. There are appropriate recommendations on their clinical use in clinical practice guidelines of various scientific societies. Operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions. The acceptable accuracy and reproducibility of ambulatory PWA makes it be a promising tool for evaluating vascular biomarkers in daily-life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, there is no sufficient evidence to support the routine clinical use of PWA in ambulatory conditions at the moment. In particular, long-term outcome studies are needed to show the predictive value of ambulatory PWV, CAP and AIx values.

National Survey of Indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey

BackgroundThere is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities.MethodsThe CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports.ResultsA total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes.ConclusionsThe CPS is the first community-based, national-level survey of its kind in Canada. Although the response rate was low, the CPS was distributed and successfully administered across a broad range of First Nations communities, and future considerations would benefit from a governance structure and leadership that strengthens community engagement, and a longitudinal research approach to increase the representativeness of the data. This type of information is important for communities and regions to inform decision making (maintain successes, and identify areas for improvement), strengthen health service delivery and infrastructure, increase accessibility to healthcare personnel, and allocate funding and/or resources to build capacity and foster a proactive chronic disease prevention and management approach for Indigenous communities across Canada.Trial registrationCurrent ClinicalTrial.gov protocol ID NCT02234973. Registered: September 9, 2014.

Завершающая склеротерапия рецидивных и резидуальных варикозно расширенных вен нижних конечностей после хирургического и эндовенозных методов лечения

Цель. Улучшение результатов лечения пациентов с рецидивными и резидуальными варикозно расширенными венами и варикозными узлами нижних конечностей (НК), развившимися после хирургического и эндовенозного лазерного методов лечения.
 Материалы и методы. У 32 больных (21 женщины и 11 мужчин) в возрасте от 28 до 71 года выполнили миниинвазивную завершающую склеротерапию рецидивных и резидуальных варикозно измененных вен и варикозных узлов, развившихся после хирургического и эндовенозного лазерного методов лечения в 45 НК.
 Результаты. По данным контрольной цветной ультразвуковой допплерографии установлена полная окклюзия подкожных вен и варикозных узлов во всех 45 НК без их реканализации. Транзиторный тромбофлебит развился у 3 пациентов. На чувство инородного тела в виде мелких хорд жаловались 3 пациента, парестезию и ощущение онемения - 2, экхимозы - 2. Эти осложнения не требовали специальных медикаментозных и физиотерапевтических методов лечения и спонтанно разрешились в течение 1 - 6 мес. Выраженных осложнений не наблюдали.
 Выводы. У пациентов с неудовлетворительными результатами хирургического лечения хронической венозной недостаточности и варикозных узлов (частота рецидива составляет 48,1%, резидуальной патологии подкожных вен - 25,0%) требуется применение альтернативных миниинвазивных методов лечения. Комплексный подход и правильный выбор эндовенозных лазерных методов лечения позволяют достичь полной окклюзии подкожных вен у 97,37% этих пациентов, сократить частоту возникновения рецидива заболевания и выраженных осложнений до минимума. Больным с реканализацией подкожных вен, а также развитием рецидива и резидуальных явлений в НК целесообразно выполнение завершающей склеротерапии под местной инфильтрационной анестезией в амбулаторных условиях или в стационаре.

Avoidable emergency admissions for ambulatory care sensitive conditions in the Republic of Ireland: analysis of regional determinants

Background : Over the past 10 years in Ireland, emergency admissions have increased by almost 1,000 per annum from 32,000 in 2005 to 41,500 in 2016. Emergency admissions among ambulatory care sensitive conditions ACSCs are deemed to be potentially avoidable in a well performing health system. Many of the underlying conditions that result in an emergency admission are treatable in a primary or urgent care setting. As a result, high emergency admissions among such conditions are seen as an indicator of an underperforming health system. Aim : To measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions among ACSCs over the period 2014 to 2016. Methods : Hospital In-Patient Enquiry admissions data was used to calculate age adjusted admission rates for ACSCs. These admission rates were constructed by county of residence for the period 2014-2016. A number of a priori factors were identified as potential drivers of these avoidable emergency admissions. Negative binomial regressions were used to identify which of these factors was significantly associated with admission rates. Population factors were first introduced into the model, including deprivation and rurality. The subsequent model included these population factors, together with health system factors such as primary care access, hospital policy and health care funding. We measured the reduction in variability in avoidable admissions at each stage. Results : Nationally, there were over 250,000 admissions for ACSCs for the period 2014-2016. The age-adjusted admission rates for the combined 14 conditions varied across counties. The national rate was 1,900 per 100,000 with a minimum of 1,462 per 100,000 in Kerry and a maximum of 2,959 per 100,000 in Carlow. Of the population factors, unemployment was associated with a 20% higher rate of avoidable admissions incidence rate ratio IRR: 1.22; 95% CI 1.05, 1.41. The system factors that influenced avoidable admissions included the conversion rate of emergency department presentations to admissions IRR: 0.96; 95% CI 0.92, 1; emergency admissions with length of stay equal to one IRR: 1.24; 95% CI 1.14, 1.34; and, the percentage of population with private health insurance IRR: 0.93; 95% CI 0.89, 0.97. The degree of unexplained variation in admissions in each county decreased as the model was expanded to include all factors. The degree of over-dispersion fell by 20% alpha = 0.05 to alpha =0.04 after adjusting for the population level factors of unemployment and rurality. This fell by a further 30%, to alpha =0.025 having allowed for system level factors. Therefore, the final full model was found to reduce the degree of unexplained variation in admissions in each county by 50%. Conclusions : Geographical variation in emergency admission for ACSCs is associated with unemployment, levels of short stay emergency admissions, conversion rates at emergency departments and levels of private insurance. These findings suggest that the management of ambulatory conditions is primarily driven by a combination of socioeconomic conditions and hospital admission policy.

The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics

Antibiotics are one of the most commonly prescribed classes of medication for children and adolescents. While they are arguably the most powerful tool we possess against bacterial infections, they are frequently given to children whose illnesses are due to viruses or other non-infectious etiologies. When antibiotics are not used judiciously, the consequences can be serious and accumulate over time. This review article quantifies the burden of antimicrobial use in the pediatric outpatient setting in the United States, reviews recommended first line antibiotic regimens for common outpatient pediatric and adolescent conditions, investigates the reasons for inappropriate prescribing of antibiotics in outpatient healthcare settings, and explores the range of consequences of overuse and inappropriate use of antibiotics, from adverse drug reactions to impact on the microbiome to rising rates of antimicrobial resistance in common ambulatory conditions.

Особенности лечения функциональных расстройств желудочно-кишечного тракта в амбулаторных условиях у пациентов, страдающих артериальной гипертонией 1 степени

Особенности лечения функциональных расстройств желудочно-кишечного тракта в амбулаторных условиях у пациентов, страдающих артериальной гипертонией 1 степени

Validation of the PHYSIO-PORT UP ambulatory blood pressure monitor in pregnant women according to the European Society of Hypertension International Protocol revision 2010.

The present study examines the performance of the ambulatory blood pressure monitor PHYSIO-PORT UP in pregnant and preeclamptic women. The systolic blood pressure (SBP) and the diastolic blood pressure (DBP) of 33 subjects (among them 13 with preeclampsia) were sequentially measured and compared to reference measurements. Those reference measurements were taken by two observers using a mercury sphygmomanometer. Subject recruitment and evaluation of the measurement results were performed according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP 2010). Three readings were recorded per subject under static conditions. The protocol did not include testing under ambulatory conditions. 87/90 (SBP/DBP) of the 99 readings had a difference ≤ 5 mmHg, 96/98 had a difference 98 ≤ 10 mmHg, and 98/99 had a difference ≤ 15 mmHg. 2 out of 3 readings ≤ 5 mmHg was achieved by 31/32 subjects. None of the subjects had less than 1 comparative reading ≤ 5 mmHg. In conclusion, the PHYSIO-PORT UP fulfilled all requirements of the ESH-IP 2010. According to these results, the PHYSIO-PORT UP can be recommended for blood pressure measurement in pregnant women.

Evaluation of activity of departments of a district hospital providing medical assistance to children in ambulatory conditions

Evaluation of activity of departments of a district hospital providing medical assistance to children in ambulatory conditions

Effects of Hypoxia and Bed Rest on Markers of Cardiometabolic Risk: Compensatory Changes in Circulating TRAIL and Glutathione Redox Capacity.

In chronic diseases, hypoxia and physical inactivity are associated with atherosclerosis progression. In contrast, a lower mortality from coronary artery disease and stroke is observed in healthy humans residing at high altitude in hypoxic environments. Eleven young, male volunteers completed the following 10-day campaigns in a randomized order: hypoxic ambulatory, hypoxic bed rest and normoxic bed rest. Before intervention, subjects were evaluated in normoxic ambulatory condition. Normobaric hypoxia was achieved in a hypoxic facility simulating 4000 m of altitude. Following hypoxia, either in bed rest or ambulatory condition, markers of cardiometabolic risk shifted toward a more atherogenic pattern consisting of: (a) lower levels of total HDL cholesterol and HDL2 sub-fraction and decreased hepatic lipase; (b) activation of systemic inflammation, as determined by C-reactive protein and serum amyloid A; (c) increased plasma homocysteine; (d) decreased delta-5 desaturase index in cell membrane fatty acids, a marker of insulin sensitivity. Bed rest and hypoxia additively decreased total HDL and delta-5 desaturase index. In parallel to the pro-atherogenic effects, hypoxia activated selected anti-atherogenic pathways, consisting of increased circulating TNF-related apoptosis-inducing ligand (TRAIL), a protective factor against atherosclerosis, membrane omega-3 index and erythrocyte glutathione availability. Hypoxia mediated changes in TRAIL concentrations and redox glutathione capacity (i.e., GSH/GSSG ratio) were greater in ambulatory conditions (+34 ± 6% and +87 ± 31%, respectively) than in bed rest (+17 ± 7% and +2 ± 27% respectively). Hypoxia-induced cardiometabolic risk is blunted by moderate level of physical activity as compared to bed rest. TRAIL and glutathione redox capacity may contribute to the positive interaction between physical activity and hypoxia.Highlights:– Hypoxia and bed rest activate metabolic and inflammatory markers of atherogenesis.– Hypoxia and physical activity activate selected anti-atherogenic pathways.– Hypoxia and physical activity positive interaction involves TRAIL and glutathione.

PULSE WAVE VELOCITY NON-DIPPING PATTERN IS ASSOCIATED WITH CARDIOVASCULAR MORTALITY IN HYPERTENSIVE PATIENTS UNDERGOING CHRONIC HEMODIALYISIS

Objective: Increased arterial stiffness is established as an independent cardiovascular (CV) risk factor. Although this association was found also in patients undergoing hemodialysis (HD), reports are frequently contradictory largely because measurements were obtained shortly before or after HD. The aim of our study was to analyze circadian variations of aortic stiffness using ABPM device which provides valid measures in ambulatory conditions and association with CV mortality. Design and method: A total of 31 hypertensive patients (19 M, 12 F; averaged age 59.4) who had been on intermittent HD treatment for more than 6 months were enrolled in this study (22.6% diabetic, 16.1% smokers) and followed up for average 18.6 months. Patients received HD treatment 4 hr/session three times a week during the study period. TensioMed Arteriograph which records oscillometric BP and pulse waveforms at the brachial artery and provides valid measures of aortic BP, AIx, and PWV in ambulatory conditions was applied on non-dialysis midweek day. Control group consist of 25 healthy subjects without prior diabetes, CKD, hypertension and hyperlipidemia. Results: Systolic BP, PWV and AIx non-dipping patterns were found in 74.2%, 64.5% and 61.3% of patients. We failed to find difference in AIx dipping pattern between patients and control subjects (38.7% vs. 28.0%; p = 0.4) while PWV non-dipping pattern was significantly more frequently found in HD patients (64.5% vs. 16.0%, p < 0.001). At the end of follow-up period 13 (41.9%) patient died from CV deaths. We have not found any differences in age, dialysis parameters, comorbidity, HD therapy and laboratory parameters between survived and deceased HD patients. Differences in basal systolic and diastolic BP, PWV, AIx between survived and deceased were not statistically significant. There were no differences in number of BP and AIx non-dippers between survived and deceased patients while significantly higher number of deceased patients had PWV nocturnal non-dipping pattern (84.5% vs.50.0%, p = 0.04). Conclusions: A newly introduced ABPM devices for ambulatory recordings provide new insights on importance of arterial stiffnes for CV moratlity in patients undergoing HD. Our results showed that PWV non-dipping pattern is independently associated with CV moratily.

Effect of omeprazole on antihypertensive efficacy of amlodipine in patients with comorbid pathology – arterial hypertension and acid-dependent disease

Objective:The problem of drug interactions is increasingly important today because they may induce serious adverse events as well as interfere with efficacy of pharmacotherapy. Combinations of drugs are most often prescribed to patients presenting with comorbid pathology. The incidence of a combination of arterial hypertension (AH) and acid-dependent diseases (ADDs) varies widely ranging from 11.6 to 50%. One of combinations of drugs prescribed to such patients is a combination of calcium channel blocker amlodipine and proton pump inhibitor omeprazole. The latter in the human body undergoes biotransformation mediated at the level of cytochrome P450 by isoenzymes CYP2C19 and CYP3A4. Amlodipine is a substrate of the isoenzyme CYP3A4, which increases the probability of the development of interaction between these drugs. The purpose of our study was to investigate antihypertensive efficacy of amlodipine in patients suffering from arterial hypertension combined with acid-dependent diseases and additionally taking omeprazole.Method:Study included a total of 150 patients with AH and ADD. Antihypertensive therapy was evaluated by means of office measuring of arterial pressure (AP) and circadian monitoring of AP (CMAP). The followed-up patients with AH and ADD were divided into 2 groups. Group One was composed of hypertensive patients undergoing pharmacotherapy with 10 mg amlodipine, whose condition required due to exacerbation of ADD administration of omeprazole at a dose of 20 mg for a period from 3 to 4 weeks. Group Two comprised hypertensive patients receiving antihypertensive therapy consisting of 10 mg amlodipine, who were found to have remission of acid-dependent diseases, with no additional medication taken.Results:The obtained findings demonstrated that one of the commonly used drug combinations in treatment of patients with AH and ADD in ambulatory conditions was a combination of omeprazole and amlodipine, accounting for 7.1%. The results of office measurement of arterial pressure (AP) 2 weeks after initiating pharmacotherapy with omeprazole in patients with AH and ADD demonstrated that the patients receiving omeprazole in addition to antihypertensive therapy were found to have a statistically significant decrease in systolic arterial pressure (SAP) and statistically significantly more pronounced dynamics of a decrease in diastolic arterial pressure (SAP) (p<0.05) compared with those not receiving therapy with omeprazole. Also, in the group of patients taking omeprazole, the findings of circadian monitoring of blood pressure (CMAP) showed a statistically significant decrease in average circadian SAP, average circadian DAP, mean value of daytime SAP and mean value of nighttime SAP (p<0.05).Conclusion:The obtained findings demonstrated that simultaneous prescription of amlodipine and omeprazole to patients with concomitant pathology, i.e., AH and ADD, turned out to enhance the antihypertensive affect of amlodipine, which probably resulted from substrate competition of amlodipine and omeprazole at the level isoenzyme CYP 3A4 of cytochrome P450.

Evaluation of a Novel Wireless Transmission System for Trauma Ultrasound Examinations From Moving Ambulances.

To determine if physicians trained in ultrasound interpretation perceive a difference in image quality and usefulness between Extended Focused Assessment with Sonography ultrasound examinations performed at bedside in a hospital vs. by emergency medical technicians minimally trained in medical ultrasound on a moving ambulance and transmitted to the hospital via a novel wireless system. In particular, we sought to demonstrate that useful images could be obtained from patients in less than optimal imaging conditions; that is, while they were in transport. Emergency medical technicians performed the examinations during transport of blunt trauma patients. Upon patient arrival at the hospital, a bedside Extended Focused Assessment with Sonography examination was performed by a physician. Both examinations were recorded and later reviewed by physicians trained in ultrasound interpretation. Data were collected on 20 blunt trauma patients over a period of 13 mo. Twenty ultrasound-trained physicians blindly compared transmitted vs. bedside images using 11 Questionnaire for User Interaction Satisfaction scales. Four paired samples t-tests were conducted to assess mean differences between ratings for ambulatory and base images. Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images.

Comparison of laboratory and ambulatory measures of central blood pressure and pulse wave reflection: hitting the target or missing the mark?

Prior studies demonstrating clinical significance of noninvasive estimates of central blood pressure (BP) and pulse wave reflection have relied primarily on discrete resting measures. The aim of this study was to compare central BP and pulse wave reflection measures sampled during a single resting laboratory visit against those obtained under ambulatory conditions. The secondary aim was to investigate the reproducibility of ambulatory central BP and pulse wave reflection measurements. Forty healthy participants (21 males; 24 ± 3 years) completed three measurements of brachial artery pulse wave analysis (Oscar 2 with SphygmoCor Inside) in the laboratory followed by 24 hours of ambulatory monitoring. Seventeen participants repeated the 24-hour ambulatory monitoring visit after at least 1 week. Ambulatory measures were divided into daytime (9 AM–9 PM), nighttime (1 AM–6 AM), and 24-hour periods. Compared with laboratory measurements, central systolic BP, augmentation pressure, and augmentation index (with and without heart rate normalization) were higher (all P < .01) during daytime and 24-hour periods but lower during the nighttime period (all P < .001). The drop in nighttime brachial systolic BP was larger than central systolic pressure (Δ −20 ± 6 vs. −15 ± 6 mm Hg; P < .0001). Repeat ambulatory measurements of central BP and pulse wave reflection displayed good-to-excellent intraclass correlation coefficients (r = 0.58–0.86; all P < .01), although measures of pulse wave reflection had higher coefficients of variation (14%–41%). The results highlight absolute differences in central BP and pulse wave reflection between discrete laboratory and ambulatory conditions. The use of ambulatory measures of central BP and pulse wave reflection warrant further investigation for clinical prognostic value.

Relationship between melatonin and bone resorption rhythms in premenopausal women.

Although evidence exists for a daily rhythm in bone metabolism, the contribution of factors such as melatonin levels, the light-dark cycle, and the sleep-wake cycle is difficult to differentiate given their highly correlated time courses. To examine these influences on bone resorption, we collected 48-h sequential urine samples under both ambulatory (8-h sleep:16-h wake) and constant routine (CR) (constant wake, posture, nutrition and dim light) conditions from 20 healthy premenopausal women. Urinary 6-sulphatoxymelatonin (aMT6s; ng/h) and the bone resorption marker amino-terminal cross-linked collagen I telopeptide (NTx; bone collagen equivalents nM/h) were assayed and fit by cosinor models to determine significant 24-h rhythms and acrophase. Most participants had significant 24-h aMT6s rhythms during both ambulatory and CR conditions (95 and 85%, respectively), but fewer had significant 24-h NTx rhythms (70 and 70%, respectively). Among individuals with significant rhythms, mean (±SD) aMT6s acrophase times were 3:57±1:50 and 3:43±1:25h under ambulatory and CR conditions, respectively, and 23:44±5:55 and 3:06±5:15h, respectively, for NTx. Mean 24-h levels of both aMT6s and NTx were significantly higher during CR compared with ambulatory conditions (p<0.0001 and p=0.03, respectively). Menstrual phase (follicular versus luteal) had no impact on aMT6s or NTx timing or 24-h levels. This study confirms an endogenous circadian rhythm in NTx with a night-time peak when measured under CR conditions, but also confirms that environmental factors such as the sleep-wake or light-dark cycles, posture or meal timing affects overall concentrations and peak timing under ambulatory conditions, the significance of which remains unclear.

An Efficient Kalman Noise Canceller for Cardiac Signal Analysis in Modern Telecardiology Systems

The monitoring of electrocardiography (ECG) in ambulatory conditions is an important task for achieving success in remote healthcare monitoring. In this paper, Kalman-based adaptive artifact cancellation structures, which are the hybrid versions of least-mean-square (LMS) algorithm variants, are proposed for the high-resolution enhancement of an ECG signal. The main advantage of the Kalman-based adaptive filter structure lies in the extraction of the ECG signal at a low signal-to-noise ratio (SNR). This property helps the Kalman noise canceller (KNC) to achieve greater monitoring accuracy. The hybrid version of this Kalman algorithm makes the noise canceller independent of the step-size parameter, whereas the performance of conventional adaptive filters depends on the step-size parameter. In the proposed KNCs, we use discrete wavelet transform to generate a reference component from the contaminated ECG signal itself. In addition to these constraints, in remote health care monitoring, it is necessary to lower the computational burden and increase the convergence rate of the noise canceller. In a practical remote health care monitoring system if the computational burden of the signal conditioning unit is more, then it takes a much greater amount of time to process samples in the filter. This leads to waiting of incoming samples at the input port of the filter. This causes overlapping of samples at the input port and causes ambiguity in the diagnosis process. To achieve the feature of low computational complexity, we combine Kalman-based LMS (KLMS) with sign algorithms. In addition, data normalization is introduced to improve convergence characteristics. Finally, to test the performance of the proposed implementations, real ECG signals from the MIT-BIH database is used. The measured parameters, namely, SNR, excess mean square error, and mis-adjustment are calculated in the enhancement process to judge the ability of various algorithms. Experimental results confirm that the proposed Kalman-based adaptive algorithms are better than the LMS-based algorithms. Among the implemented techniques sign regressor-based KNC performs better in terms of various considered measures.

The Medical Social Efficiency of Rehabilitation of Patients Having Cerebral Stroke in Ambulatory Conditions

The article substantiates efficiency of medical social rehabilitation activities in out-patient conditions on the basis of study of health conditions, life-style and medical care organization of patients with ischemic stroke. The obtained data demonstrated a higher efficiency of complex rehabilitation therapy. The efficient application of possibilities of out-patient polyclinic institution increases the level of physiological, psychological and social adaptation of patients.

OP.7D.07] 24-HOUR CENTRAL BLOOD PRESSURE IS BETTER ASSOCIATED WITH TARGET ORGAN DAMAGE OF HYPERTENSION THAN BRACHIAL BLOOD PRESSURE

Objective: The VASOTENS international, multicenter, observational, non-randomized, prospective study aims at evaluating the impact of 24-hour pulse wave analysis of ambulatory blood pressure (BP) recordings on target organ damage and cardiovascular prognosis of hypertensive patients. In the present analysis of study baseline data we checked whether organ damage of hypertension i) is better associated with 24-hour central than peripheral BP and ii) is related to ambulatory arterial stiffness, estimated by pulse wave velocity (PWV) and augmentation index (AIx). Design and method: In 334 hypertensive patients (mean age 53+/−15, 52% males, 45% treated) we obtained 24-hour ABPMs, echocardiograms, carotid ultrasonograms and serum creatinine. Hypertensive organ damage was estimated by calculation of left ventricular mass index (LVMI, cardiac damage), intima-media thickness (IMT, vascular damage) and creatinine clearance (CC, renal damage). 24-hour hemodynamics and stiffness were estimated through the validated VASOTENS technology, based on transfer function analysis of brachial oscillograms. 24-hour brachial (bSBP) and aortic systolic BP (aSBP), standard deviation of bSBP, PWV and AIx were obtained. Relation of vascular indices with LVMI, IMT and CC was evaluated by bivariate and multivariate analysis (stepwise linear regression analysis). Results: In the bivariate analysis a statistically significant relation was found for age, bSBP and aSBP vs. LVMI and IMT (see table, correlation coefficients or r). IMT was also significantly related to SBP variability and arterial stiffness, whereas increasing age, SBP variability and AIx were significantly associated with a decline of renal function.In the multivariate analysis, including all variables entered in the bivariate model, adjusted by sex, statistically significant (p < 0.001) association was observed for aSBP and age with LVMI (standardized regression coefficient 0.25 and 0.18, respectively), and for age with IMT (0.56) and CC (−0.53). Conclusions: In hypertensive patients age appears to be the major determinant of organ damage, with central SBP, and marginally peripheral SBP, PWV and AIx, also playing a significant role. Our results suggest that estimation of 24-hour central hemodynamics and arterial stiffness in ambulatory conditions may help improve the individualized assessment of the BP-associated organ damage of hypertension

Effects of concurrent and aerobic exercises on postexercise hypotension in elderly hypertensive men

Despite the fact that simultaneous performance of resistance and aerobic exercises (i.e., concurrent exercise) has become a standard exercise prescription for the elderly, no information is available on its effects on post-exercise hypotension (PEH) in elderly men with hypertension. PurposeTo compare the effects of different types of exercise on PEH in elderly men with hypertension. MethodsTwenty elderly men with essential hypertension participated in three crossover interventions, in random order, and on separate days: a non-exercise control session at seated rest, aerobic exercise performed for 45min, and 45min of concurrent resistance and aerobic exercise consisted of 4 sets of 8 repetitions at 70% 1RM of resistance exercise followed by aerobic exercise on treadmill. After each session, blood pressure (BP) was measured continuously for 1h in the laboratory and for 24h under ambulatory conditions. ResultsDuring the first hour in laboratory, diastolic BP was lower after aerobic (−5mmHg) and concurrent exercise (−6mmHg) in comparison with Control. Day-time diastolic BP was significantly lower after aerobic exercise (−7mmHg) when compared to the control. No significant differences were found among the three experimental sessions for night-time and 24-hour diastolic BP, as well as day-time, night-time and 24-hour systolic BP. ConclusionConcurrent exercise produced acute PEH similar to aerobic exercise but such effect did not last as long as aerobic exercise in elderly patients with essential hypertension.

Commentaries on health services research

Commentaries on health services research