Monitoring Of Hypertensive Patients Research Articles

Assessing the relationship between lipoprotein(a) levels and blood pressure among hypertensive patients beyond conventional measures. An observational study

High lipoprotein(a) (Lp(a)) levels are associated with an increased risk of arterial hypertension (AHT) and atherosclerotic cardiovascular disease. However, little is known about the detailed profile of AHT based on Lp(a) levels. This observational study focused on elucidating the relationship between Lp(a) concentrations and specific indices obtained from 24-h ambulatory blood pressure (BP) monitoring in hypertensive patients over 18 years of age. We gathered and analyzed data on BP indices along with demographic, epidemiological, clinical, and laboratory variables from 227 hypertensive patients, median age 56 years, including 127 women (56%). After comparing hypertensive patients with Lp(a) levels above and below 125 nmol/L, we found that a 10 mmHg increase in nocturnal systolic BP and all pulse pressure indices (24-h, daytime, and night-time) was associated with an increased risk of high Lp(a) levels by more than 20% and 40%, respectively. Similarly, each 10% increase in the area under the function over time of nocturnal diastolic BP dipping was associated with more than a 30% decrease in the odds of belonging to the elevated Lp(a) levels category. Additionally, Lp(a) levels above 125 nmol/L were associated with higher 24-h, daytime, and night-time systolic BP and pulse pressure load. The relationship between Lp(a) and AHT appears to extend beyond conventional BP measurements, which may be relevant given the prognostic implications of nocturnal BP and pulse pressure indices.

CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements. Design and method: We collated clinic and 24 hour ambulatory BP data of 100 patients aged > 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021). Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical. We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods. Results: The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients. Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P <0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P <0.001; r = 0.566; Curve B). Conclusions: The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension

Target Blood Pressure Values in Ambulatory Blood Pressure Monitoring.

2018 ESC/ESH guidelines have recommended 24-h ambulatory blood pressure monitoring to assess hypotensive therapy in many circumstances. Recommended target blood pressure in office blood pressure measurements is between 120/70 and 130/80mmHg. Such targets for 24-h ambulatory blood pressure monitoring lacks. We aimed to define target values of blood pressure in 24-h ambulatory blood pressure monitoring in hypertensive patients. Office blood pressure measurements and 24-h ambulatory blood pressure monitoring data were collected from 1313 hypertensive patients and sorted following increasing systolic (SBP)/diastolic (DBP) blood pressure in office blood pressure measurements. The corresponding 24-h ambulatory blood pressure monitoring to office blood pressure measurements values were calculated. Values 130/80mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 113.74/66.95mmHg; daytime SBP/DBP mean: 135.02/81.78mmHg and 24-h SBP/DBP mean: 130.24/78.73mmHg. Values 120/70mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 109.50/63.43mmHg; daytime SBP/DBP mean: 131.01/78.47mmHg and 24-h SBP/DBP mean: 126.36/75.31mmHg. The proposed blood pressure target values in 24-h ambulatory blood pressure monitoring complement the therapeutic target indicated in the ESC/ESH recommendations and improves 24-h ambulatory blood pressure monitoring usefulness in clinical practice.

Abstract 12983: Diagnostic Performance of an Automated Blood Pressure Monitor With an Irregular Heartbeat Algorithm Designed to Detect Atrial Fibrillation

Introduction: Patients with atrial fibrillation (AF) are constantly exposed to the risk of developing stroke, and early detection to initiate appropriate treatment for AF is important to prolong their healthy life. In previous reports, automated blood pressure (BP) monitors manufactured by A&D Co., Ltd. was equipped with an irregular heartbeat (IHB) algorithm specifically designed to detect AF, suggesting its usefulness for AF monitoring in hypertensive patients with a high prevalence of AF. Purpose: The aim of this study was to evaluate the diagnostic performance for AF of the A&D BP monitor UM-212 with an IHB algorithm in a clinical setting. Methods: A total of 242 consecutive patients was enrolled (mean age: 67.5 years, 62.3% male). BP measurements were performed three times per one patient using UM-212 and the presence or absence of IHB detection was recorded for each measurement. The definition of IHB algorithm designed to detect AF is as follows: the number of pulse waves varying more than 15% from the mean of the pulse peak interval is greater than 20% of the total pulse wave count. A 3ch real-time ECG was recorded during all BP measurements. The interpretation by automated ECG analysis software manufactured by Fukuda Denshi Co., Ltd. and the final ECG diagnosis by two cardiologists were performed separately. Results: Of the 242 patients, 31 had AF and 66 had non-AF arrhythmia. On a per-measurement basis (726 total), IHB detection had 98.9% of sensitivity and 90.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 90.3% of sensitivity and 96.5% of specificity for diagnosing AF. On a per-patient basis, IHB detection in all three BP measurements had 96.8% of sensitivity and 95.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 80.6% of sensitivity and 99.1% of specificity for diagnosing AF. Conclusions: The IHB algorithm designed to detect AF built into A&D BP monitors showed high sensitivity and high specificity for diagnosing AF in a clinical setting, especially its sensitivity tended to exceed that of automated ECG analysis software. Utilizing the IHB algorithm during routine BP measurements is expected to monitor AF in hypertensive patients and contribute to their health management.

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

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

Изменения артериального давления при суточном мониторировании у пациентов с артериальной гипертензией в исследовании Тримаран (преимущества тройной фиксированной комбинации над двойной)

Целью исследования было оценить терапевтическую эффективность генерического комбинированного препарата Комбисарт Н (фиксированная тройная комбинация валсартана/амлодипина/гидрохлортиазида производства АО «Киевский витаминный завод») по сравнению с препаратом Комбисарт (двойная фиксированная комбинация валсартана/амлодипина производства АО «Киевский витаминный завод») в лечении пациентов с артериальной гипертензией ІІ–ІІІ степени. Задачи исследования: изучить терапевтическую эффективность фиксированной тройной и двойной комбинации в лечении артериальной гипертензии; изучить переносимость и возможные побочные реакции препаратов, входящих в состав комбинаций, которые исследовались. Материалы и методы. В исследование были включены 50 пациентов с артериальной гипертензией ІІ–ІІІ степени. Проводили офисное измерение артериального давления (АД), суточное мониторирование АД, биохимическое исследование крови, оценивали качество жизни в динамике по показателям опросника качества жизни EQ-5D, влияние терапии на показатели эректильной функции у мужчин с помощью анкеты МИЭД (Международный индекс эректильной дисфункции), жесткость сосудистой стенки оценивали с помощью скорости распространения пульсовой волны в начале и через 3 месяца терапии. Результаты. Снижение среднесуточного АД в целом по группе составило 20,0/8,6 мм рт.ст. (Р < 0,05), на двойной (Комбисарт) комбинации — 18,0/16,1 мм рт.ст. (Р < 0,05), на тройной (Комбисарт Н) комбинации — 23,8/20,7 мм рт.ст. (Р < 0,05). Снижение среднедневного АД в целом по группе составило 24,8/21,0 мм рт.ст. (Р < 0,05), на двойной (Комбисарт) комбинации — 19,4/17,8 мм рт.ст. (Р < 0,05), на тройной (Комбисарт Н) комбинации — 17,8/22,6 мм рт.ст. (Р < 0,05). Снижение середненочного АД в целом по группе составило 18,4/17,7 мм рт.ст. (Р < 0,05), на двойной (Комбисарт) комбинации — 17,0/12,1 мм рт.ст. (Р < 0,05), на тройной (Комбисарт Н) комбинации — 20,5/18,2 мм рт.ст. (Р < 0,05). Достижение целевого АД при суточном мониторировании в целом по группе составило 86 %: у 77,3 % пациентов — на двойной комбинации, у 95,2 % — на тройной комбинации. Выводы. Тройная комбинация Комбисарт Н была более эффективной в снижении артериального давления при суточном мониторировании по сравнению с двойной комбинацией Комбисарт без увеличения побочных эффектов.

24-hour blood pressure monitoring in hypertensive patients with abdominal obesity in the dynamics of antihypertensive treatment

Abstract Funding Acknowledgements Type of funding sources: None. Background 24-hour blood pressure monitoring (ABPM) is an additional method for examining patients with arterial hypertension (AH). The list of indications for its implementation is constantly expanding. One of the most important indications is the evaluation of the effectiveness of treatment against the background of physical and emotional stress. Aim study of the parameters of 24-hour blood pressure monitoring in patients with AH and AO in the dynamics of antihypertensive therapy. Methods 120 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: ACE inhibitors perindopril, thiazide diuretic indapamide and calcium antagonist amlodipine once in the morning at doses: 4 mg / 1.25 / 5 mg; 4 mg / 1.25 / 10 mg; 8 mg / 2.5 / 5 mg; 8 mg / 2.5 / 10 mg. ABPM was performed according to the standard method before and after 6 months of treatment. Results 24-hour systolic blood pressure (SBP) and 24-diastolic blood pressure (DBP) in patients were 148 (141-158) / 97 (81-101) mm Hg. 24-hour pulse blood pressure - 59 (51-63) mm Hg. The SBP time index was 86 (67-96)%, the DBP time index was 84%. Daytime SBP variability in patients was 17 (11-20) mm Hg, daytime DBP variability was 13 (8-14) mm Hg. SBP variability at night was 14 (9-13) mm Hg, DBP variability at night was 10 (8-12) mm Hg. As a result of treatment, the target blood pressure level was achieved in 69% of the examined according to the data of the office measurement of blood pressure and in 50% of the patients according to the results of ABPM. The number of patients with pathological variability of blood pressure decreased from 47% to 25% (p <0.05). An excessive morning rise in SBP at the beginning of the study was noted in 30% of patients, and at the end of the observation - in 15% (p <0.05). Morning BP dynamics was in 43%, and after therapy in 23% (p <0.01). The number of patients with nocturnal hypertension decreased from 75% to 35% after 6 months of treatment (p <0.0001). The distribution of patients by blood pressure profiles revealed that at the beginning of the study, the "diper" type was in 44% of the patients, the "over-diper" type in 22% of the patients, the "non-diper" type was in 28%, and the "night-picker" type was observed at 6%. After 6 months of treatment, the number of patients with the "diper" profile increased to 73%, and the number of patients with the "over-diper" profile decreased to 7%, the number of patients with unfavorable non-diper and night-picker profiles changed to 5% and 1% of patients, respectively. Conclusion The fixed combination of perindopril, indopamide and amlodipine led to the normalization of all parameters of the 24-hour BP profile in hypertensive patients with AO. Treatment was not accompanied by metabolic disturbances in these patients.

Ambulatory Central Aortic Blood Pressure Monitoring in Hypertensive Patients with Diabetes Mellitus Type 2

Ambulatory Central Aortic Blood Pressure Monitoring in Hypertensive Patients with Diabetes Mellitus Type 2

The effect of Ramadan fasting on ambulatory blood pressure in treated hypertensive patients using diuretics.

The influence of the Ramadan fasting on blood pressure (BP) in patients taking diuretics therapy has not been addressed specifically yet. The aim of this study was to examine the effect of long Ramadan fasting on BP with ambulatory BP monitoring in hypertensive patients using diuretics. This prospective, observational study was done on 129 hypertensive patients and was carried out in two groups: 73 treated hypertensive patients were assigned to the diuretic group and 56 treated hypertensive patients were allocated to the non-diuretic group. Twenty-four-hour ambulatory BP monitoring was performed during and after Ramadan. Mean overall, daytime and nighttime BP were measured and compared in both groups. The differences in mean SBP and DBP were recorded between the two monitoring periods. In diuretic group, 24-h SBP decreased from 128.2 ± 17.9 to 119.3 ± 9.5 mmHg during Ramadan (8.9 units; P < 0.001). DBP decreased from 79.4 ± 10.9 to 75.3 ± 7.6 mmHg (4.1 units; P < 0.001). On the other hand, SBP and DBP were lower insignificantly in the non-diuretic group. The reduction in SBP was significantly higher in the diuretic group (overall: P = 0.005, daytime: P = 0.011, nighttime: P = 0.022). Thiazide-like diuretics lowered BP more than thiazide-type diuretic despite an insignificant difference. This study suggested that Ramadan fasting might cause significant reductions in mean SBP and DBP measurements in patients using diuretics. Despite decreasing in BP, diuretics generally well tolerated and can be safe in well-controlled hypertensive patients during Ramadan fasting.

The Current State of Home Blood Pressure Monitoring in Hypertensive Patients

The Current State of Home Blood Pressure Monitoring in Hypertensive Patients

Comparison of Ambulatory Tonometric and Oscillometric Blood Pressure Monitoring in Hypertensive Patients.

AimCorrect measurement of blood pressure (BP) is important for optimal diagnosis and treatment of patients with hypertension. The aim of this study was to compare a wrist-worn device using tonometric measurements of BP to a conventional device using oscillometric measurements of 24 h BP, diagnosing of hypertension, and non-dipping.MethodsOne-hundred patients in the Renal Outpatient Clinic had 24 h ambulatory BP monitoring performed with a tonometric device, BPro, and an oscillometric device, A&D, simultaneously.ResultsTwenty-four-hour and daytime systolic BP was significantly lower using tonometric monitoring compared to oscillometric (7 and 6 mmHg, respectively, p< 0.001). In the population of patients diagnosed with hypertension, the tonometric device diagnosed 90% of patients with uncontrolled hypertension correctly (positive predictive value), whereas 49% of patients classified as normotensive were uncontrolled hypertensive (negative predictive value). The mean difference between relative nocturnal BP decrease between tonometric and oscillometric was 2±8% (p< 0.01), and 33% of patients classified as dippers were non-dippers (negative predictive value).ConclusionUsing the BPro device for tonometric monitoring of BP and classification of hypertension and non-dipping in patients diagnosed with hypertension leads to misclassification of patients. Therefore, the BPro device is not suitable for clinical practice in hypertensive patients from a Renal Outpatient Clinic.

Prospects for Blood Pressure Remote Monitoring in Hypertensive Patients in the Ryazan Region

Aim. To study the effectiveness and benefits of blood pressure (BP) remote monitoring in outpatients with hypertension.Material and methods. The study included 100 patients with a verified diagnosis of hypertension, who didn’t achieve target BP pressure levels. The patients measured their BP twice a day over 6 months with facilities with automatic data transmission over GSM-channel to a remote monitoring center. BP parameters were being transmitted online to the remote monitoring center, where they were being processed and transferred to the personal account planner (created by the Web interface based on the software and hardware complex) of the attending physician and operator of the remote monitoring center. It is important that doctor received information only on clinically significant measurement results, based on which he determined the urgency of contact with the patient and the further tactics of his management.Results. No malfunctions in the work of communication facilities, technical failures in the software and hardware complex were registered over the entire period of the study. After 6 months of the monitoring it was possible to achieve target BP levels less than 135/85 mm Hg in 70% of patients. The proportion of patients with a high level of normal BP increased from 10% to 19%, while the proportion of patients with grade 1 and 2 of hypertension decreased significantly (from 33% to 7% and from 54% to 3%, respectively). At the beginning of telemedicine monitoring 3% of patients had stage 3 of hypertension, at the end of the study – 1%.Conclusion. The technology of telemedicine monitoring has shown itself as a simple, affordable and reliable way of management of outpatients with hypertension in conditions of real clinical practice. It was possible to achieve BP levels less than 135/85 mm Hg in 70% of patients by the method of remote outpatient monitoring. BP remote monitoring changed fundamentally the decision-making strategy of the patients management: it was not the patient who independently determined the need for consultation with a medical professional, but the attending physician made a decision on the method and urgency of contact with the patient on the basis of the data of objective monitoring indicators.

Influence of subclinical hypothyroidism on indicators of 24-hour arterial blood pressure monitoring in hypertensive patients with high additional risk

Significant prevalence of arterial hypertension (40 % of the adult population) and unsatisfactory level of high blood pressure adequate control (only 14 % of the urban and 8 % of the rural population in Ukraine) underlines the need to study the factors influencing AH course and contributing to a lack of antihypertensive therapy efficacy. One of such factors is subclinical hypothyroidism (SH). Aim. To study Influence of subclinical hypothyroidism on indicators of 24-hour arterial blood pressure monitoring in hypertensive patients with high additional risk. Materials and methods. After signing of written informed consent for the study, 124 patients with arterial hypertension (AH) and 16 practically healthy people (control group) were involved. The main group included 32 AH patients (women 87.5 % (n = 28), men 12.5 % (n = 4)) with moderately elevated thyroid stimulating hormone level (TSH) (4.0–15.6 μD/ml) and normal levels of thyroid hormones. The comparison group consisted of 92 AH patients (women 81.52 % (n = 75), men 18.48 % (n = 17)) with normal levels of TSH (0.4–4.0 μD/ml). The groups of patients were matched for age (54.16 ± 10.16) years versus (57.69 ± 9.76) years, (P = 0.093), sex (P = 0.4319), height (P = 0.993), weight (P = 0.719), body surface area (P = 0.901), body mass index (P = 0.669). All patients underwent a combined 24-hour blood pressure monitoring and ECG using a “Cardiology-04-AD-3” device (St. Petersburg, RF). Results. AH patients with or without concomitant SH were of comparable mean daytime and nighttime indices of SBP and DPB, indicators of SBP and DBP variability, PBP, indices for hypertension and hypotension, circadian indices, indices of percentage SBP and DBP increases, SBP and DBP load (with the exception of daytime SBP load). Patients with AH and SH, in contrast to AH patients without SH, tended to have 8.5 % (P < 0.05) higher indices of daytime SBP load, and 19.3 % (P < 0.05) lower daytime DBP hypotension index. Conclusions . AH patients with or without concomitant SH are comparable by the vast majority of ABPM indicators. However, in AH patients with concomitant SH, unlike those without SH, a larger daytime SBP load and a lower daytime DBP hypotension index were detected.

Protocol for hypertensive individuals assisted in Basic Health Care.

Hypertension has low control rate in Brazil and around the World, resulting in social and medical costs; thus there is the need to apply control strategies. This study aimed to create and validate a protocol for consultation and monitoring of hypertensive patients attended in primary health care. It is constituted a methodological research which uses the Delphi method for content validation. The analysis of the protocol by experts was performed in three cycles, using a scale that was not important to extremely important, with a graduation from 1 to 5. The analysis was performed by the Likert scale, percentage of agreement, content validation index, Pearson correlation. The percentage of agreement was 96%. The CVI of 0.98. The Likert scale scored items, at least, as very important. The Pearson correlation was positive for all items ranging from moderate to strong. The protocol is composed of 53 items, divided into seven dimensions. It was concluded that the protocol enables more expressive and systematics monitoring of hypertensive patients and it identifies social and individual conditions that contribute to high blood pressure, so it may be used to guide the consultation, encouraging dialogue between the professional and patient and effective recording of care.

A7180 Detecting sodium-sensitivity from information of 24-hour ambulatory blood pressure monitoring in hypertensive patients in northeast China

Objectives: Salt sensitivity is important cardiovascular risk factor. Commonly salt sensitivity detection methods include acute saline load test and chronic saline load test. Paolo Castiglioni assess the reliability of an easier approach based on data from 24-hour ambulatory blood pressure monitoring performed in hypertensive subjects during daily-life conditions and habitual diet. Our aim was to verify whether it is equally applicable to assess salt sensitivity in patients with hypertension in northeast China. Methods: We enrolled 17 mild to moderate hypertensive subjects in northeast China who underwent 24-hour ambulatory blood pressure monitoring during usual sodium intake. Patients were divided into 3 classes of sodium sensitivity risk on the basis of ambulatory blood pressure monitoring data: low risk if dippers and a 24-hour heart rate 70 bpm; high risk if nondippers and a 24-hour heart rate of 70 bpm; intermediate risk with the remaining combinations (dippers with heart rate 70 bpm or nondippers with heart rate 70 bpm). Then patients underwent a salt sensitivity test with rapid extracellular volume expansion with intravenous fluids and volume and sodium depletion induced by diuretic administration. Results: 9 sodium-sensitive patients were founded. The prevalence of sodium-sensitive patients increased significantly from the low-risk class (33%) to the intermediate-risk (50%) and high-risk (75%) classes. Conclusion: This easier protocol for assessing salt sensitivity is likely to be applicable to hypertensive patients in northeast China, if there is more data.

Combination approach with ambulatory Blood Pressure and Electrocardiography Monitoring in Patients with Hypertension and Myocardial Infarction – A Prospective Study.

Introduction: With the increasing number of deaths due to cardiovascular events, there is an urgent need for optimising the risk factors associated with it. The safety and cost effective non-invasive method to assess the blood pressure and modulate the treatment plan accordingly is to utilise the ambulatory blood pressure monitoring and Holter Electrocardiography in daily use in patients with hypertension. Aim: To examine the functional state of cardiovascular system and possible predictive value of the daily application of the combined method of arterial blood pressure monitoring and ECG monitoring in hypertensive patients at different levels of the disease progression. Methods and materials: We examined 37 patients with AH without any clinical significant pathology were included in the first group and 32 hypertensive patients with a history of myocardial infarction (MI) in the second group. The average age of participants in this study was 59,02±2,18 years. All patients underwent a comprehensive examination of the functional state of the cardiovascular system using the combined ECG and arterial BP monitoring validated device «CardiosensBP» XAI-MEDICA (Ukraine). The statistical data was processed using «STATISTICA® for Windows 6.0» (StatSoft Inc., #AXXR712D833214FAN5). Results: The hypertensive state is characterized by an excess of the target values ??of systemic blood pressure: the daily mean values ??of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher at 6,93% (P<0,05) and 5,68% (P<0,01) respectively in both groups. Indicators of pressure increase and morning surge(MS) are significant in patients of the second clinical group exclusively SBP, namely: the index of time (IT) - by 24,68% (P<0,01), the index of measurements (IM) - by 16,84% (P<0,05), MS - by 31,98% (P<0,01). Conclusions: The practice of application of daily arterial blood pressure and ECG monitoring has an important prognostic value in cardiovascular system functional status estimation and also enables the physician in optimising the treatment plan accordingly.

Realities and prospects of remote blood pressure monitoring in hypertensive patients.

Despite the success in increasing the effectiveness of treatment of arterial hypertension (AH), frequency of achieving target levels of blood pressure (BP) in hypertensive patients and the scope of their regular supervision in most countries of the world, including in the Russian Federation are insufficient. Modern telemedicine technology, involving remote monitoring of blood pressure, have the potential to significantly improve the situation. The analysis in the world of research on this subject showed the presence of benefits and advantages as well as the barriers and disadvantages in comparison with the common practice of monitoring of patients AG. But the overall balance is in favor of this technology. In the Russian Federation in the presence of a single domestic randomized studies of remote monitoring of blood pressure in hypertensive patients currently undergoing a pilot project in seven regions of the country. Practice shows that with proper organization of the work achieved good results in the achievement of target BP levels. To date, in our country, taking into account the accumulated international and domestic experience, the full normative and methodical base, and the availability of affordable hardware, and proven organizational technologies can and should expand the practice of remote blood pressure monitoring in hypertensive patients. This will significantly increase the proportion of hypertensive patients that are under medical supervision, and significantly improve the effectiveness of antihypertensive therapy. Immediate consequence of such practices will reduce the number of calls to urgent and emergency care reduction in the number of trumpeter, and further reducing the number of strokes and myocardial infarctions, and ultimately reducing cardiovascular mortality.

A Prospective Study on Combinational Drug Efficacy in Hypertensive Patients

AIM AND OBJECTIVES : The main of aim of this study is to evaluate the combination drug efficacy in hypertensive patients and also reduction of blood pressure by using combination drugs. METHODS AND MATERIALS: This study which includes prospective monitoring of hypertensive patients who are taking different type of combination durgs to reduce blood pressure. This is prospective study done in hypertensive patients. The statistical method used in the study is student t test. RESULTS : Totally 100 patients were included in the study. Three month was readings were taken. 1st month reading is taken as initial value and 3rd month reading is taken as final value. The baseline blood pressure was reduced from 171.2±3.2 to 137.1±2.6 in systolic blood pressure where as diastolic blood is reduced from 101.20±3.2 to 87.10±2.6 of patients using group D. The other group combinations also have slight changes in the reduction of blood pressure. The combination therapy shows greater efficacy in hypertensive patients. CONCLUSION: The percentage reduction of blood pressure after using group D was more than compared with other combinations. This study concludes that combination drugs shows efficacy in hypertensive patients.

Utilización de medidas domiciliarias de la presión arterial en el diagnóstico y seguimiento del paciente hipertenso

Clinical measures of blood pressure can lead to errors in the process of diagnosis and monitoring of hypertensive patients, therefore, the scientific societies recommend the use of other measurement methods such as home or ambulatory monitoring measures.With household measures, most of the doubts in the process of diagnosis and monitoring of hypertensive patients are resolved.The home measures should be used in the diagnostic process of hypertension, such as screening test white coat hypertension and masked hypertension and monitoring of hypertensive patients as a screening test for treatment-resistant hypertension. In addition, monitoring of hypertensive patients domiciliary measures have been shown to improve patient compliance, reduce clinical inertia and it is possible teletransmission data, aspects that have been shown to help improve the control. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients.

This study aimed to analyze whether blood pressure (BP) measurement is concordant between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and determine whether the decision on treatment changes is similar on the basis of information provided by both methods. Treated hypertensive patients were studied with ABPM and HBPM to evaluate therapeutic efficacy and/or diagnose resistant hypertension (HTN). Modification of pharmacological treatment was decided on the basis of pre-established criteria; therefore, the number of therapeutic changes between both techniques was compared. A total of 200 patients were included. The average daytime ABPM systolic blood pressure (SBP) was 136±16 compared with 136±15 (P=1) with HBPM; the average diurnal diastolic blood pressure (DBP) was 83±12 and 81±9, respectively (P=0.06). The concordance between both methods was very good for SBP [r=0.85; Bland-Altman 0.2 (95% confidence interval 0.9-1.4 mmHg)], and good for the DBP [r=0.77; Bland-Altman 1.8 (95% confidence interval 0.8-2.8 mmHg)]. Both methods were in agreement that HTN was controlled in 68 patients and that it was not controlled in 90 patients, that is, they were concordant in 158 patients (79%, κ=0.6). More patients required changes with ABPM than HBPM (149 vs. 99 patients, P<0.0001) CONCLUSION: There were no significant differences in the measurement of diurnal SBP and DBP between both methods. The concordance to determine proper control of HTN was 79%. There was a significant difference in the decision to modify the treatment in favor of the ABPM.