Casual Blood Pressure Measurements Research Articles

Home and ambulatory blood pressure levels below target range and clinical effort to detect this condition: a population-based study in older treated hypertensives.

With implementation of stricter blood pressure (BP) treatment targets, potential for excessive BP lowering becomes an important issue, especially in older patients. Assess the magnitude, indicators and detection effort of BP levels below-target-range (BTR-BP) recommended by the European hypertension guidelines in older treated hypertensive patients (130-139/70-79mmHg). Cross-sectional, retrospective study (Seniors-ENRICA-2 cohort). General population. 1,329 treated hypertensive patients aged ≥65, assessed with three home casual BP measurements and 24-hour ambulatory BP monitoring (ABPM). Based on the European hypertension guidelines and the literature, BTR-BPs were defined as mean BP <130/70, <125/65, <130/70 and <110/55mmHg, for casual BP, 24-hour BP, daytime BP and nighttime BP, respectively, and hypotension as <110/70, <105/65, <110/70 and <90/55mmHg, respectively. Participants' mean age was 72 ± 4.4 (50.3%, women). Based on casual BP, 7.2% of patients were in target range (130-139/70-79mmHg), 44.3% in BTR-BP (<130/70) and 20.8% hypotensive (<110/70). Some 44.9, 54.9 and 22.0% of patients were in BTR-BP for 24-hour BP, daytime BP and nighttime BP, respectively, and 11.0, 21.1 and 5.6%, respectively, were hypotensive. The number of patients needed for ABPM to detect one case of 24-hour-, daytime-, and nighttime-BTR-BP was 3, 2 and 5, respectively, and 10, 5 and 18, respectively, for detecting one hypotensive case. Cardiovascular disease and female sex were associated with both BTR-BP and hypotension, and the number of antihypertensive drugs was only associated with hypotension. BTR-BP levels were common in older treated patients at home and in everyday life, more frequent than many trials report, and daytime ABPM is highly size-efficient for detecting the low ambulatory BP conditions.

Hipertensos Tratados e Avaliados por Telemonitoramento Residencial da Pressão Arterial. Estudo TeleMRPA

ResumoFundamento:Hipertensos tratados avaliados apenas com a medida casual da pressão arterial (PA) podem estar sujeitos a decisões equivocadas.Objetivos:Avaliar o comportamento da PA pela medida casual e residencial (MRPA), o comportamento das classes de anti-hipertensivos e as prevalências de hipertensão do avental branco (HABNC) e mascarada não-controladas (HMNC).Métodos:Estudo transversal que avaliou pacientes pela plataforma TeleMRPA entre 2017 e 2019. Foram excluídos aqueles sem medicamentos, com 3 ou mais, em uso de espironolactona e alfa-2 agonistas. As variáveis analisadas foram: idade, sexo, índice de massa corporal (IMC), número de medidas válidas da PA, médias da PA sistólica (PAS) e diastólica (PAD) pela medida casual e MRPA, e as classes de anti-hipertensivos. Utilizados os testes t pareado e não pareado e qui-quadrado. Adotado nível de significância de 5%.Resultados:Selecionados 22.446 pacientes, dos quais 6.731 preencheram os critérios, sendo 61,3% do sexo feminino, com idade média de 57,8 (±12,6) anos e IMC médio de 29,0 (±5,1) kg/m2. Os valores médios de PAS e PAD foram 6,6 mmHg (p<0,001) e 4,4 mmHg (p<0,001) maiores na medida casual que na MRPA. As taxas de controle da PA foram de 57,0% pela medida casual e 61,3% pela MRPA (p<0,001), com prevalência de HABNC e HMNC de 15,4% e 11,1%, respectivamente. O bloqueio do sistema renina-angiotensina-aldosterona ocorreu em 74,6% das vezes e 54,8% estavam em monoterapia.Conclusões:O uso da MRPA deve ser considerado no acompanhamento de hipertensos tratados em virtude das elevadas prevalências de HABNC e HMNC. Os anti-hipertensivos tiveram comportamentos distintos nas medidas domiciliares. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Shift work of nursing professionals and blood pressure, burnout and common mental disorders

To analyze the influence of shift work on blood pressure, the presence of burnout and common mental disorders in nursing professionals. A cross-sectional study. Burnout was assessed by the Maslach Burnout Inventory, and Common Mental Disorders by the Self-Reporting Questionnaire. Casual blood pressure measurement and Ambulatory Blood Pressure Monitoring (ABPM) were performed. 231 professionals participated. The majority (59.7%) worked in shifts, and this condition was associated (p≤0.05) with: higher weekly workload; doing the night shift; shorter training and work time at the institution; alcoholism; leisure activity; and alteration in ambulatory blood pressure monitoring of the sleep period. The professionals with common mental disorders and who worked in shifts had lower casual diastolic pressure levels (p = 0.039) and higher hypertension prevalence (p = 0.045). The presence of emotional exhaustion was associated with normal waking blood pressure and depersonalization with altered sleep blood pressure. Shift work was associated with a higher prevalence of work-related negative factors, inadequate habits and lifestyles, and change in sleep blood pressure.

Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Background: To assess hypertension related cardiovascular risk parameters in patients with rheumatoid arthritis. To determine the effect of long-term treatment with corticosteroids, non-steroid antiinflammatory drugs, and methotrexate on diurnal BP variability. Material and methods: 60 patients with clinically stable rheumatoid arthritis and treated hypertension. Casual blood pressure measurement and 24-hour ambulatory blood pressure monitoring. Results: Mean casual systolic blood pressure 139.0 ± 14.6 mmHg, diastolic blood pressure 85.7 ± 6.5 mmHg, and heart rate 74.9 ± 7.2 beats.min-1. Mean 24-hour systolic blood pressure 129.0 ± 12.7 mmHg, diastolic blood pressure 77.6 ± 7.4 mmHg, and heart rate 73.9 ± 8.7 beats.min-1. Mean casual pulse pressure 54.7 ± 15.6 mmHg, and the mean 24-hour ambulatory pulse pressure 50.1 ± 11.0 mmHg. The mean morning surge of systolic blood pressure 35.3 ± 11.00 mmHg. The number of patients with increased short-term variability of their systolic blood pressure using the coefficient of variation 30 (50%). A number of systolic nondippers in the group were treated with corticosteroids and non-steroidal anti-inflammatory drugs 34% and 35%, respectively, and a number of excessive diastolic dippers in the group were treated with methotrexate 49%. Conclusions: Certain hypertension characteristics in patients with rheumatoid arthritis can increase cardiovascular risk: Higher pulse pressure, elevated levels of morning surge of systolic blood pressure, increased short-term 24-hour blood pressure variability, higher number of systolic nondippers treated with corticosteroids and non-steroidal anti-inflammatory drugs, and excessive diastolic dippers treated with methotrexate. In addition increased heart rate may contribute to higher cardiovascular risk.

PP.01.13] MARKED BP DISTRIBUTION SHIFT FROM CASUAL TO AMBULATORY MEASUREMENT IN KENYA

Objective: Few studies have used ambulatory blood pressure monitoring (ABPM) to describe blood pressure (BP) patterns in sub-Saharan Africa (sSA). We conducted a population-based study in Kilifi, Kenya to determine the usefulness of ABPM in this setting. Methods Design and method: An age-stratified sample of 1248 individuals were randomly selected from our Demographic Surveillance Area. Of these, 986 underwent casual BP measurement at their homes using an automated Omron™ M10-IT monitor. All individuals with casual BP above 140/90mmHg (mean of 2 out of 3 readings) and a random subset with BP below 140/90mmHg were invited to undergo 24-hour ABPM within one week of screening. ESH defined cutoffs were used to define hypertensive status. Results: Of 415 individuals who underwent both casual and ABPM measurement, 162 (39%) had sustained hypertension, 161 (39%) were normotensive, 58 (14%) had whitecoat hypertension and 34 (8%) had masked hypertension. Population BP was markedly higher when using casual BP compared to ABPM (11mmHg 95% CI [9–13] systolic and 9mmHg [7–11] diastolic). If casual BP measurement only had been used, age standardized population prevalence of hypertension would have been 26.5% (19.3–35.6). ‘True’ prevalence by ABPM was 17.1% (11.0–24.4), masked hypertension 7.6 (2.8–13.7)% and white coat hypertension 3.8% (1.7–6.1) of the population. The sensitivity and specificity of casual BP measurement for ‘diagnosing’ hypertension were 80% (73–86) and 84% (79–88) respectively. The positive and negative predictive values were 80% (74–85) and 84% (79–89). BP indices and validity measures showed strong age related trends; for example sensitivity of casual BP was 9.7% (2.5–24.9) in 30–39 year olds but 91% (83–97) in 60–69 year olds. Non-dipping was present in 9% (3–15) of the population and was strongly associated with masked hypertension (OR 10, [4–27]). Conclusions: Casual BP measurement methods substantially overestimated hypertension prevalence, while failing to identify a significant proportion who were hypertensive on ABPM. Whether ABPM identifies those at risk of future vascular events better than casual methods and is justified on cost effectiveness in sSA are key research questions.

Analysis of white coat hypertension in type 2 diabetic patients: 24-hours versus 48-hours monitoring

ABPM is the best method of detecting WCH in diabetic patients. We report ABPM findings in 100 diabetic individuals with WCH during 2 years. All of the referred subjects underwent casual and ambulatory blood pressure measurements. The mean age of participants was 41.43 year (±13.3 SD) and the age range from 19–74 years; majority were male (80%). The proportion of ambulatory-confirmed average 24-hours true hypertension was significantly reduced when the duration of the study was increased to 48 hours (P&lt;0.001). Day-time systole (P=0.036) as well as night-time systole (P=0.001) and diastole (P&lt;0.001) were statistically different during the two period of monitoring. Dipping pattern had increased from 53% to 60% (P=0.02) but non-dipper pattern was a common finding. Blood pressure load had been normalized in 19% of patients when the duration of study increases to 48 hours (P&lt;0.001). WCH was common in T2DM and the best diagnostic tool was 48-hours ABPM. The dominant rhythm was dipper and absence of nocturnal drop was also common. Blood pressure load might be accurately determined with 48-hours ABPM.

Association between waist circumference and childhood-masked hypertension: A community-based study.

The aim of this study is to determine the association between waist circumference (WC) and childhood-masked hypertension. A territory-wide, school-based cohort of 1385 Hong Kong students (672 boys and 713 girls) aged 8-17 years was analysed. The ambulatory blood pressure-monitoring assessment was performed using validated oscillometric recorders (A&D TM-2430 (A&D Inc., Tokyo, Japan)) following American Heart Association's recommendations. Subjects were considered normotensive if their casual blood pressure, 24-h daytime and night-time average systolic blood pressure and diastolic blood pressure (DBP) were <95th percentile. If one or more of the ambulatory blood pressure parameters was ≥95th percentile, subjects would be considered suffering from masked hypertension (MH). Subjects who had three successive casual blood pressure measurements above the 95th percentile were excluded. By body mass index, 148 (10.7%) subjects were obese, 182 (13.1%) overweight and 359 (25.9%) having larger WC (≥85th percentiles). MH was diagnosed in 217 subjects (15.7%). Subjects with larger WC or obesity were significantly associated with higher 24-h daytime and night-time systolic blood pressure (≥95th percentile) (odds ratios from 1.84 to 2.09 and from 2.07 to 3.54 for larger WC and obese respectively, all P < 0.05) as well as 24-h DBP for larger WC (odds ratio = 2, P = 0.015) than normal subjects adjusted by sex, age and height. Waist circumference and body mass index are independent risk factors of childhood and adolescent MH. WC appears a significant associated factor of elevated 24-h DBP in children aged 8-17 years.

动态血压监测在老年高血压诊治中的临床意义

目的：研究24 h动态血压监测在老年高血压诊治中的临床意义。方法：对871例高血压患者和380例正常血压者进行偶测血压、24 h动态血压监测和心脏超声检查，分析偶测血压与24 h动态血压在两组病人中的区别，超声左室指数与血压的关系。结果：①偶测收缩压显著高于24 h平均收缩压；②高血压组血压及血压负荷均明显大于对照组；③随着血压的升高左室肥厚的检出率显著增加；④动态血压监测结果和左室质量指数显著相关。结论：动态血压监测较偶测血压更能反映血压对心脏靶器官的影响，有助于判断高血压程度、指导高血压的治疗。 Objective: The objective is to evaluate clinical importance of 24 hours ambulatory blood pressure monitoring in the treatment of elderly hypertension. Methods: Casual blood pressure measurement, 24 hours ambulatory blood pressure monitoring and echocardiography were performed in 871 older patients with hypertension and 380 the elderly with normotension. The differences of casual blood pressure measurement and 24 hours ambulatory blood pressure monitoring between the two groups and the correlation between blood pressure and LVMI (left ventricle mass index) were tested. Results: Casual systolic blood pressure was significantly higher than 24 h systolic blood pressure in all groups. The blood pressure and blood pressure load in the patients with hypertension was significantly higher than the patients with mormotension. Left ventricular hypertrophy detected increased with the increase of hypertension stage. 24 hours ambulatory blood pressure significantly correlated with LVMI. Conclusion: Ambulatory blood pressure moni-toring provided more information about the damage of the target organ and the diagnosis and treatment, compared with casual blood pressure measurement.

Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows.

Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review.

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort (n=10), 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.

Hypertension in children after renal transplantation.

Hypertension (HT) is a common and serious complication following renal transplantation in children, and an important risk factor for cardiovascular morbidity and mortality. This study evaluated the clinical characteristics of HT in children after renal transplantation. Twenty-four children who were followed up at least 6 months after renal transplantation were enrolled in the study. From the clinical records, demographic and laboratory data, casual blood pressure (BP) measurement, ambulatory BP monitoring (ABPM), medication, and left ventricular mass index (LVMI) at echocardiogram were documented. Mean age at time of transplantation was 12.6 ± 3.0 years and mean follow-up period was 19.6 ± 15.8 months. HT was detected in 21 children (87.5%) after renal transplantation. Twelve patients (50%) had HT both before and after transplantation and nine (38%) had HT only after transplantation. HT developed in 67% within the first week and in 95% within the first month. All hypertensive children had night-time HT and no child had isolated daytime HT. The efficacy of HT control was 42%. Median LVMI in patients with HT after renal transplantation was 42.3 g/m(2.7). Severe HT, an important complication, was frequently seen in the early period after renal transplantation. Predominance of nocturnal HT and the lack of isolated daytime HT after transplantation underline the importance of ABPM. ABPM should be performed regularly in the first year after transplantation, not only for diagnosis but also for evaluation of HT control.

Prognostic value of 24-h ABPM in acute ischemic stroke for short-, medium-, and long-term outcome: a systematic review and meta-analysis.

The association of blood pressure levels during the acute phase of ischemic stroke with outcome remains controversial. The objective of this systematic review is to assess the predictive value for stroke outcome assessed by the modified Rankin scale score of systolic and diastolic blood pressure, measured by ambulatory blood pressure monitoring methods during the acute phase of ischemic stroke, compared with the values of casually derived blood pressure measurement on admission. We searched for studies with patients admitted within 24 h of stroke onset, and who had ambulatory blood pressure monitoring during the first 24 h of admission. We identified studies that reported blood pressure in those with good outcome and in those with poor outcome at end of follow-up, and performed a meta-analysis of the effect of mean blood pressure on outcome. High systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor short-, medium-, and long-term outcome, but the same was not found for casual blood pressure measurements. An increase in systolic blood pressure of 9·1 mmHg (95% confidence interval: 6·6-11·6, P < 0·001; I(2) = 9%) and an increase in diastolic blood pressure of 2·3 mmHg (95% confidence interval: 0·8-3·7, P = 0·002; I(2) = 0%) were associated with poor outcome. Higher systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor outcome. The same was not found for higher casual blood pressure measurements on admission, and it is possible that ambulatory blood pressure monitoring conveys better prognostic information.

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort (n=10), 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort, 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus (p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus (p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.

Impact of Ambulatory Blood Pressure Monitoring on Reclassification of Hypertension Prevalence and Control in Older People in Spain.

Ambulatory blood pressure monitoring (ABPM) accurately classifies blood pressure (BP) status but its impact on the prevalence and control of hypertension is little known. The authors conducted a cross-sectional study in 2012 among 1047 individuals 60 years and older from the follow-up of a population cohort in Spain. Three casual BP measurements and 24-hour ABPM were performed under standardized conditions. Approximately 68.8% patients were hypertensive based on casual BP (≥140/90 mm Hg or current BP medication use) and 62.1% based on 24-hour ABPM (≥130/80 mm Hg or current BP medication use) (P=.009). The proportion of patients with treatment-eligible hypertension who met BP goals increased from 37.4% based on the casual BP target to 54.1% based on the 24-hour BP target (absolute difference, 16.7%; P<.01). These results were consistent across alternative BP thresholds. Therefore, compared with casual BP, 24-hour ABPM led to a reduction in the proportion of older patients recommended for hypertension treatment and a substantial increase in the proportion of those with hypertension control.

Evaluation of hypertension by ambulatory blood pressure monitoring in children with solitary kidney

In this study, we aimed to investigate the blood pressure (BP) profile in children with a unilateral functioning solitary kidney (UFSK). A group of 49 patients between the ages of 5 and 18 years, and 30 healthy controls between the ages of 6 and 16 years were investigated. Gender, weight, height and body mass index (BMI) of patients and controls were recorded. BP profile was determined by ambulatory BP monitoring (ABPM). We have observed a higher risk of hypertension compared with healthy children. Also, masked hypertension is more frequently in the patients group and white-coat hypertension was observed in the control group. The mean night-time systolic BP (SBP) load (p = 0.01) and 24-h diastolic BP (DBP) load (p = 0.008) of children with multicystic dysplastic kidney (MCDK) was significantly higher than the healthy group. The mean night-time SBP load (p = 0.001) of children with unilateral renal agenesis (URA) and 24-h DBP load (p = 0.003) of children with unilateral atrophic or hypoplastic kidney were significantly higher than healthy group. We showed that the children with a solitary kidney had increased risk of hypertension. ABPM reflects the BP profile more precisely than casual BP measurement and it can be used to evaluate white-coat and masked hypertension in children with a solitary kidney.

Ambulatory Blood Pressure Measurements in the Management of Hypertension: Practical Importance

Ambulatory blood pressure measurement (ABPM) gives better prediction of cardiovascular morbidity and mortality, and endorgan damage associated with hypertension (HTN) than clinic or casual blood pressure measurements, since the diurnal blood pressure profile and nocturnal blood pressure levels are not ascertained by the later. 1 Although the technology has been available for more than three decades, its role in the evaluation and management of hypertension has been well established only in the past decade. Ambulatory blood pressure measurement is indicated to identify ‘white coat’ effect/hypertension, masked hypertension, to evaluate drug-resistant hypertension, and to assess adequacy of control in patients at high-risk of cardiovascular disease. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure and prevention of cardiovascular events. This review summarizes the utility of ambulatory blood pressure monitoring in the manage ment of hypertension and its practical importance.

A Comparison of Casual In-Clinic Blood Pressure Measurements to Standardized Guideline-Concordant Measurements in Severely Obese Individuals.

Background/Objectives. The objective of this study was to compare casual BP taken in a bariatric clinic to standardized guideline-concordant BP. Subjects/Methods. A cross sectional analysis was performed using baseline data from a weight management trial. Patients were recruited from a Canadian bariatric care program. Standardized BP was performed using a Watch BP oscillometric device. Casual in-clinic BP single readings, taken using a Welch Allyn oscillometric device, were chart-abstracted. Paired t-tests, Bland-Altman plots, and Pearson's correlations were used for analysis. Results. Data from 134 patients were analyzed. Mean age was 41.5 ± 8.9 y, mean BMI was 46.8 ± 6.5 kg/m2, and 40 (30%) had prior hypertension. Mean casual in-clinic BP was 128.8 ± 14.1/81.6 ± 9.9 mmHg and mean standardized BP was 133.2 ± 15.0/82.0 ± 10.3 mmHg (difference of −4.3 ± 12.0 for systolic (p < 0.0001) and −0.4 ± 10.0 mmHg for diastolic BP (p = 0.6)). Pearson's coefficients were 0.66 (p < 0.0001) for SBP and 0.50 (p < 0.0001) for DBP. 28.4% of casual versus 26.9% of standardized measurements were ≥140/90 mmHg (p < 0.0001). Conclusion. In this bariatric clinic, casual BP was unexpectedly lower than standardized BP. This could potentially lead to the underdiagnosis of hypertension.

Impact of light salt substitution for regular salt on blood pressure of hypertensive patients.

BackgroundStudies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients.ObjectiveTo evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients.MethodsUncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks.ResultsThe study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032).ConclusionsThe light salt substitution for regular salt significantly reduced BP of hypertensive patients.

Renal hypertension and cardiovascular disorder in children with chronic kidney disease

Renal hypertension is one of the earliest and the most prevalent complications of pediatric chronic kidney disease (CKD). Among renal patients, hypertension is frequently underdiagnosed and undertreated. For casual blood pressure measurement, the best method is auscultatory, while for ambulatory blood pressure measurement, oscillometric method is the most commonly used. Both casual and ambulatory blood pressure measurement provide more powerful means of diagnosing hypertension. Masked hypertension is a condition in which casual blood pressure is normal but ambulatory blood pressure is elevated. The risk of cardiovascular morbidity and mortality is higher with masked hypertension as compared to the controls. Children and adolescents with CKD are at high risk of cardiovascular disease that has been established as the leading cause of death in patients with end stage renal disease. Left ventricular hypertrophy remains the most thoroughly documented form of end-organ damage caused by hypertension in children and adolescents with CKD. Based on clear evidence on the correlation between blood pressure and cardiovascular morbidity, mortality, and renal function, renal hypertension must be aggressively treated. Target blood pressure for patients with renal hypertension should be at low normal values: < 75 percentile for patients without proteinuria and <50 percentile for patients with proteinuria. Renin-angiotensin system antagonists are considered the first choice pharmacological option in hypertensive CKD 2-4 patients while the management of volume overload is the most important in dialysis patients. Successful transplantation can eliminate or significantly improve uremia-related cardiovascular risk factors and increase predicted life expectancy.