Ambulatory Blood Pressure Values Research Articles

Out-of-office blood pressure measurement in children and adolescents

Out-of-office blood pressure measurement in children and adolescents

Office and out of office heart rate measurements: which clinical value?

Office and out of office heart rate measurements: which clinical value?

Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension

Resistant hypertension is defined as uncontrolled hypertension despite intensive treatment with at least three antihypertensive agents, one of which ideally should be a diuretic. To determine the efficacy and safety of the selective aldosterone antagonist eplerenone in this population, we studied patients with resistant hypertension (clinic blood pressure [BP] >140 mm Hg systolic or >90 mm Hg diastolic on maximal doses of more than three antihypertensive agents, including a loop or thiazide diuretic). At baseline and after 12 weeks of eplerenone therapy (50 to 100 mg daily titrated to effect), patients underwent clinic and 24-hour BP measurements, serum potassium, plasma renin activity, and serum aldosterone measurements. Patients (n = 52) completing the trial averaged 62 ± 10 years of age, were overweight (mean body mass index, 32.1 ± 5.5 kg/m 2), and had variable renal function (glomerular filtration rate, 106 ± 38 mL/minute); 70% were men and 74% were non-Black. The mean number of antihypertensive agents at baseline was 3.7 ± 0.8 (range, three to seven drugs) to achieve a clinic BP of 150.5/84.1 mm Hg. The mean serum aldosterone was 12.9 ± 7.6 ng/mL and plasma renin activity was 2.3 ± 2.7 ng/mL/hour. After eplerenone, the change from baseline in the clinic BP was −17.6/−7.9 mm Hg ( P < .0001 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and in 24-hour BP was −12.2/−6.0 mm Hg ( P < .0001 for both). The number of antihypertensive drugs decreased to 3.3 ± 0.9 (range, one to seven agents). Plasma potassium increased by 0.30 ± 0.45 mEq/L ( P < .001), but there were only three instances in two patients of mild hyperkalemia (potassium >5.5 mEq/L, but <6.0 mEq/L), despite all patients being on a background therapy that included an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Reductions in clinic and ambulatory BP were related to baseline clinic and ambulatory BP values ( r 2 > 0.3 for both SBP and DBP, P < .0001), weakly related to baseline serum aldosterone ( r = −0.30; P = .05), and unrelated to plasma renin activity, age, gender, or race. In conclusion, eplerenone demonstrated substantial efficacy in treatment-resistant hypertension and was well-tolerated with modest changes in plasma potassium. Serum aldosterone and plasma renin activity did not predict BP responses to eplerenone in this population.

Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients

Background Despite antihypertensive therapy, it is difficult to maintain optimal systemic blood pressure (BP) values in hypertensive patients (HPT). Exercise may reduce BP in untreated HPT. However, evidence regarding its effect in long-term antihypertensive therapy is lacking. Our purpose was to evaluate the acute effects of 40-minute continuous (CE) or interval exercise (IE) using cycle ergometers on BP in long-term treated HPT. Methods Fifty-two treated HPT were randomized to CE ( n = 26) or IE ( n = 26) protocols. CE was performed at 60% of reserve heart rate (HR). IE alternated consecutively 2 min at 50% reserve HR with 1 min at 80%. Two 24-h ambulatory BP monitoring were made after exercise (postexercise) or a nonexercise control period (control) in random order. Results CE reduced mean 24-h systolic (S) BP (2.6 ± 6.6 mm Hg, p = 0.05) and diastolic (D) BP (2.3 ± 4.6, p = 0.01), and nighttime SBP (4.8 ± 6.4, p < 0.001) and DBP (4.6 ± 5.2 mm Hg, p = 0.001). IE reduced 24-h SBP (2.8 ± 6.5, p = 0.03) and nighttime SBP (3.4 ± 7.2, p = 0.02), and tended to reduce nighttime DBP ( p = 0.06). Greater reductions occurred in higher BP levels. Percentage of normal ambulatory BP values increased after CE (24-h: 42% to 54%; daytime: 42% to 61%; nighttime: 61% to 69%) and IE (24-h: 31% to 46%; daytime: 54% to 61%; nighttime: 46% to 69%). Conclusion CE and IE reduced ambulatory BP in treated HPT, increasing the number of patients reaching normal ambulatory BP values. These effects suggest that continuous and interval aerobic exercise may have a role in BP management in treated HPT.

Falsch-Non-Response bei Hypertonie-Behandlung in der Hausarztpraxis

Many hypertensive patients still have elevated blood pressure values despite antihypertensive treatment. However, which patients really do not respond to antihypertensive treatment? 41 primary care patients with treated essential arterial hypertension with office blood pressure > 140/90 mmHg received 24-hour ambulatory blood pressure measurement. The patients were categorized into a group with elevated blood pressure both in office (> or = 140/90 mmHg) and daytime ambulatory blood pressure measurement (> 135/85 mmHg) and into a group with False Non-Response to treatment (office blood pressure > or = 140/90 mmHg but normal daytime mean ambulatory blood pressure < 135/85 mmHg). Patients in the group with False NonResponse were significantly more likely to be female compared to patients with both office and ambulatory hypertension (67% vs. 23%, p = 0.009), whereas diabetes mellitus was a significant predictor of elevated blood pressure both in office and ambulatory measurement (7% vs. 39%, p = 0.033). False-Non-Response is common in primary care patients treated for hypertension. These patients have normal ambulatory BP values despite elevated office BP values. Female gender and absence of diabetes mellitus are significant predictors of False Non-response to antihypertensive treatment.

Do Dispositional Pessimism and Optimism Predict Ambulatory Blood Pressure During Schooldays and Nights in Adolescents?

We tested the hypotheses that (1) high pessimism and low optimism (LOT-R overall and subscale scores) would predict high ambulatory blood pressure (ABP) level and 24-hour load (percentage of ABP values exceeding the pediatric 95th percentile) among healthy Black and White adolescents (n=201; 14-16 yrs) across 2 consecutive school days and (2) that the relationships for the pessimism and optimism subscales would show nonlinear effects. The hypotheses were confirmed for pessimism but not for optimism. The results suggest that high pessimism may have different effects than low optimism on ABP and that even moderate levels of pessimism may effect blood pressure regulation. These results suggest that optimism and pessimism are not the opposite poles on a single continuum but ought to be treated as separate constructs.

Kidney and Circadian Blood Pressure Rhythm

Association between nondipper pattern of circadian rhythm of blood pressure (BP) and impaired renal capacity to excrete sodium into urine was confirmed by Bankir et al1 in this issue of Hypertension based on a large number of subjects. Although this association has been observed in small studies,2,3 their study1 is the first to show it in a large-scale setting, and, therefore, is highly welcomed. Because there is a tight link between kidney and hypertension, renal dysfunction causes hypertension, whereas hypertension accelerates renal damage. It is well appreciated that the kidneys play an important role in the long-term regulation of BP. Usually it takes almost 1 week for kidneys to achieve a new steady-state balance of sodium, when sodium intake is altered. Therefore, renal participation in the short-term BP regulation, such as circadian rhythm, has been overlooked. However, the findings of Bankir et al1 strongly suggest that nocturnal hypertension and nondipper pattern of circadian BP rhythm are because of impaired renal capacity to excrete sodium, and circadian BP rhythm is at least in part regulated by kidneys. Sodium sensitivity of BP is also determined by renal capacity to excrete sodium and is regulated by glomerulotubular balance between glomerular ultrafiltration capability and rate of tubular sodium reabsorption.4 Thus, sodium sensitivity is increased in chronic kidney disease (CKD) where glomerular filtration rate (GFR) is reduced and also in disorders with enhanced tubular sodium reabsorption, including primary aldosteronism, diabetes mellitus, and metabolic syndrome, where GFR is augmented. When sodium sensitivity is increased, glomerular capillary pressure is usually elevated, resulting in albuminuria and renal damage. It becomes evident that, in patients with high-sodium sensitivity, the nocturnal dip in …

The value of ambulatory blood pressure in older adults: the Dublin outcome study

ambulatory blood pressure (ABPM) appears to be a more accurate predictor of cardiovascular outcome than blood pressure (BP) measured in the clinic setting in younger adults. the purpose of this study was to determine if ABPM predicted total and cardiovascular mortality independently of clinic BP and other cardiovascular risk factors in those aged 65 years and over. one thousand one hundred and forty-four individuals aged 65 and over referred to a single BP clinic had 24-h ABP measurement and clinic measurement at baseline off treatment. There were 385 deaths (of which 246 were cardiovascular) during a mean follow-up period of 6.7 years. with adjustment for gender, age, risk indices and also for clinic BP, a higher mean value of ABPM was an independent predictor of cardiovascular mortality. The relative hazard ratio for each 10-mmHg rise in systolic blood pressure (SBP) was 1.10 (1.06-1.18, P < 0.001) for daytime and 1.18 (1.11-1.25, P < 0.001) for night-time SBP. The hazard ratios for each 5-mmHg rise in diastolic blood pressure (DBP) were 1.05 (1.00-1.10, P = NS) for daytime and 1.09 (1.04-1.14, P < 0.001) for night-time diastolic pressure. The hazard ratios for night-time ABPM remained significant after adjustment for daytime ABPM. ambulatory measurement of BP is superior to clinic measurement in predicting cardiovascular mortality in elderly subjects. Night-time BP is the strongest predictor of outcome in this age group.

Nocturnal Blood Pressure Versus Nondipping Pattern

Thirty years ago methods to assess blood pressure (BP) automatically during regular living conditions represented a new dawn in the field of hypertension. Today ambulatory blood pressure monitoring (ABPM) is a tool available not only in specialized clinics but also in many segments of primary care. A large number of studies have demonstrated the better reproducibility and the prognostic superiority of BP values obtained by using ABPM as compared with the BP obtained from standard clinical measurements. The prognostic value of ambulatory BP was established for the general population as well as for hypertension in general or under specific conditions such as refractory hypertension, diabetes, chronic renal insufficiency, or pregnancy.1 Based on outcome and on epidemiological studies, reference values for ambulatory BP have been recommended even though limitations about their precision still exist today.2 Because ABPM provides large numbers of measurements, researchers have been tempted to look for more information than just the average of BP values during 24 hours or over more restricted periods such as the day, night, or morning. Therefore, assessment of other BP parameters has been considered. Blood pressure changes during the 24-hour period, the so-called circadian variability,3 and BP variation among measurements, intrinsic variability,4 have received increasing attention. Although the significance of intrinsic variability has been challenged when BP is measured intermittently every 15 or 20 minutes, circadian variability has become an increasingly used parameter even though reproducibility has introduced some limitations. Clinical observations have identified subjects with a blunted decline in the physiological BP nocturnal fall, the nondipper pattern.5 …

Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients

Data relating dipping status to metabolic syndrome (MS) scores are not available. The purpose of this study is to investigate any possible association of different dipping patterns to MS scores in untreated patients with essential hypertension. The study included 6256 consecutive, treatment-naive patients with essential hypertension who attended our outpatient clinics. All underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring, and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria and patients were classified into five groups: group I (hypertension), group II (hypertension+any one component), group III (hypertension+any two components), group IV (hypertension+any three components), and group V (all five components). Dipping pattern was defined as 'dippers' with nocturnal systolic blood pressure (NSBP) falling >or=10 but <20%, 'nondippers' with NSBP falling >or=0% but <10%, 'extreme dippers' with NSBP falling >or=20%, and 'reverse dippers' with NSBP increasing. Hypertensive patients with MS (n=2573) had higher clinical and ambulatory blood pressure values (P<0.001), whereas the dominant dipping pattern in the non-MS group was nondippers (47.6%), and in the MS group, extreme dippers (37.8%). Furthermore, a considerable decrease in the prevalence of dippers was noticed with the increasing number of MS components (21.1 vs. 19.2 vs. 14.5 vs. 8.4 vs. 7.2%, P<0.001). In contrast, a significant rise in the prevalence of reverse dippers was observed with the increasing number of MS components (7.4 vs. 10.1 vs. 14.9 vs. 20.4 vs. 31.2%, P<0.001). It seems that hypertensive patients have an increased prevalence of abnormal dipping patterns as the number of MS components rises.

Self-Measurement of Blood Pressure at Home Reduces the Need for Antihypertensive Drugs

It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (n=216) or office pressures (OPs; n=214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (-6.5 g/m(2) versus -5.6 g/m(2); P=0.72), or in median urinary microalbumin concentration (-1.7 versus -1.5 mg per 24 hours; P=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.

Effects of age on hypertensive status in patients with chronic kidney disease

To evaluate effect of age on hypertensive status in chronic kidney disease (CKD). We studied 459 prevalent CKD patients (stages 2-5, no dialysis), grouped by age (< 55, 55-64, 65-74, >or= 75 years), undergoing clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement. Prevalence of diabetes, left ventricular hypertrophy and previous cardiovascular disease progressively increased with aging; glomerular filtration rate (GFR) and hemoglobin decreased. Achievement of CBP target decreased from 16% in patients < 55 years to 6% in those >or= 75 years (P = 0.023). ABP 24-h systolic rose while diastolic decreased, with a consequent pulse pressure increase from 45 +/- 8 to 65 +/- 14 mmHg (P < 0.0001). Age, proteinuria, diabetes, cardiovascular disease and anemia but not GFR predicted higher 24-h pulse pressure. CBP overestimated systolic/diastolic daytime ABP by 14 +/- 18/7 +/- 11 mmHg on average, a greater difference in older than younger groups (P < 0.005). Conversely, CBP night-time ABP difference did not vary among groups (24 +/- 20/16 +/- 11 mmHg). These age-dependent differences determined a rising prevalence of white-coat hypertension (from 19 to 40%, P = 0.001) and night/day ratio of at least 0.9 (from 43 to 66%, P = 0.0004). Age, diabetes, left ventricular hypertrophy and anemia but not GFR predicted nondipping status. Among the oldest patients, 13% had diastolic CBP below 70 mmHg, with 48% below the corresponding values of daytime (< 69 mmHg) or night-time ABP (< 60 mmHg). In CKD, prevalence of white-coat hypertension, nondipping status and potentially dangerous low diastolic ABP increases with aging. This suggests wider use of ABP monitoring in older patients and need for trials addressing identification of an age-specific blood pressure target.

N-terminal probrain natriuretic peptide predicts altered circadian variation in essential hypertension

Diminished nocturnal blood pressure fall in nondipper hypertensive patients are closely associated with poor prognosis. N-terminal probrain natriuretic peptide can also identify poor prognosis in miscellaneous heart diseases. In this study, we aimed to clarify the association between probrain natriuretic peptide levels and diminished nocturnal blood pressure fall in patients with essential hypertension. Twenty-six consecutive nondipper (age: 53+/-8 years, 14 men) (group 1), and 26 dipper hypertensive patients (age: 52+/-9 years, 16 men) (group 2), based on ambulatory blood pressure monitoring, and age and sex-matched 28 normotensive participants (age: 50+/-11 years, 16 men) (group 3) were compared with each other. Although systolic and diastolic ambulatory blood pressure values were similar in hypertensives during the day, those at night were higher in group 1 (P<0.0001). Echocardiographic findings revealed that the left ventricular mass index was higher in both group 1 (184+/-47) and group 2 (142+/-39) compared with control participants (102+/-19) (P<0.0001), but ejection fraction and relative wall thickness were similar in all groups. The transmitral E-wave velocity decreased in group 1 (0.62+/-0.15 m/s) and group 2 (0.7+/-0.14 m/sec) compared with group 3 (0.95+/-0.22 m/s) (P<0.01). The transmitral E/A ratio decreased (0.71+/-0.12, 0.81+/-0.2 and 0.79+/-0.57, respectively P<0.05), and the transmitral E-wave deceleration time increased in group 1 (208+/-46, 203+/-38 and 169+/-42 ms, respectively, P<0.05). The isovolumic relaxation time increased (112+/-23, 110+/-18 and 86+/-11 m/s, respectively, P<0.01). Although group 1 and 2 have a similar number of patients with diastolic dysfunction (23/26 and 22/26, respectively, P>0.05), there were great differences between plasma probrain natriuretic peptide levels (88+/-20, 58+/-22 and 47+/-20 pg/ml, respectively, P<0.0001). In addition, serum uric acid (6.5+/-1.4, 5.3+/-1.5 and 5.0+/-1.9, respectively P<0.001), and creatinine levels (0.88+/-0.2 and 0.78+/-0.2 vs. 0.72+/-0.3, respectively P<0.05) were higher in group 1. These observations suggest that nondipper state may be related to the increase in left ventricular mass index and probrain natriuretic peptide levels and elevation in both plasma uric acid and creatinine levels. Serum probrain natriuretic peptide levels are found to be correlated with left ventricular mass index (Pearson's correlation 469 P<0.0001); but not creatinine (Pearson's correlation 188 P>0.05).

Ambulatory blood pressure monitoring in hypertensive patients with high cardiovascular risk: a cross-sectional analysis of a 20 000-patient database in Spain

To evaluate ambulatory blood pressure monitoring (ABPM) parameters in a broad sample of high-risk hypertensive patients. The Spanish Society of Hypertension is developing a nationwide project in which more than 900 physicians send ABPM registries and corresponding clinical records to a central database via www.cardiorisc.com. Between June 2004 and July 2005 a 20 000-patient database was obtained; 17 219 were valid for analysis. We identified 6534 patients with high cardiovascular risk according to the 2003 European Society of Hypertension/European Society of Cardiology guidelines stratification score. Office blood pressure (BP) was 158.8/89.9 mmHg and 24-h BP was 135.8/77.0 mmHg. Patients with grade 3 BP in the office showed ambulatory systolic BP values less than 160 mmHg in more than 80%. A non-dipping pattern was observed in 3836 cases (58.7%), whereas this abnormality was present in 47.9% of patients with low-to-moderate risk [odds ratio (OR) 1.54; 95% confidence interval (CI) 1.45-1.64]. The prevalence of non-dippers was higher as ambulatory BP increased ( approximately 70% when 24-h systolic BP > 155 mmHg) and was similar in both groups. At the lowest levels of BP (24-h systolic BP < 135 mmHg) a non-dipping pattern was more prevalent in high-risk cases (56.6 versus 45.7%; OR 1.51; 95% CI 1.40-1.64). There was a remarkable discrepancy between office and ambulatory BP in high-risk hypertensive patients. The prevalence of a non-dipper BP pattern was almost 60%. In the lowest levels of ambulatory BP, high-risk patients showed a higher prevalence of non-dipping BP than lower-risk cases. These observations support the recommendation of a wider use of ABPM in high-risk hypertensive patients.

Ambulatory Blood Pressure for Cardiovascular Risk Stratification

Ambulatory blood pressure (ABP) monitoring is increasingly recognized as a valuable tool to refine prediction of cardiovascular risk related to blood pressure (BP).1 After the first landmark study published by Perloff and colleagues 24 years ago,2 several longitudinal event-based studies provided unequivocal evidence of an independent association between ABP and risk of cardiovascular disease. Although experimental procedures and statistical analyses varied from study to study, ABP generally improved cardiovascular risk stratification over and beyond traditional risk factors, including clinic BP.3 The Table, obtained through an electronic search of literature using the terms “ambulatory blood pressure” and “prognosis,” shows a list of longitudinal event-based studies performed by independent groups. It is worth noting that the list of available studies is longer because each group generally published other analyses of their database. Only the first-appearing or main contribution from each group has been included in the Table. View this table: Longitudinal Event-Based Studies From Independent Groups That Addressed the Prognostic Value of ABP Article p 2145 Three aspects of available investigations deserve special mention. First, the prognostic value of ABP has been examined not only in subjects with clinical diagnosis of hypertension but also in the general population and in a variety of settings, including diabetes mellitus, renal failure, and cerebrovascular disease. Second, subjects could be untreated or treated at the time of ABP monitoring. This point may raise concerns, because drug treatment could exert unpredictable effects on 24-hour ABP profile and, consequently, interpretation and applicability of results. Third, although a continuous relation emerged in most studies between ABP and cardiovascular risk, several investigators tried to define clinical categories based on arbitrary thresholds of ABP. Although such categories are potentially useful to make diagnostic and therapeutic decisions in clinical practice, their prognostic role requires confirmation from large and independent cohort …

Add-on Amlodipine Improves Arterial Function and Structure in Hypertensive Patients Treated With an Angiotensin Receptor Blocker

The present study was designed to determine whether adding amlodipine further improved functional and structural cardiovascular damage in hypertensive patients whose blood pressure was already well controlled with an angiotensin II type 1 receptor blocker (ARB). The cardiothoracic ratio on chest radiographs, level of urinary albumin excretion, pulse wave velocity (PWV), intima-media thickness (IMT) of the carotid arteries, and 24 hour ambulatory blood pressure (BP) were evaluated before and 12 months after the start of add-on of amlodipine or placebo in 50 hypertensive patients being treated with an ARB. The add-on amlodipine therapy significantly improved the PWV from 1689 +/- 61 to 1447 +/- 47 cm/s and the IMT from 0.88 +/- 0.08 to 0.75 +/- 0.06 mm in the hypertensive patients treated with an ARB without altering their mean 24 hour ambulatory BP values, but did not alter the cardiothoracic ratio or urinary albumin excretion. Amlodipine also significantly decreased the variability of ambulatory BP, but the decrease did not significantly contribute to the changes in PWV or IMT. Thus, the add-on low-dose amlodipine therapy had benefits in terms of the vascular function and vascular structure of hypertensive patients treated with an ARB that were independent of its depressor effects. The antiatherogenic pleiotropic properties of amlodipine have a preventive effect on the progression of arterial stiffness in hypertensive patients treated with an ARB.

Plasma Fibrinogen, Ambulatory Blood Pressure, and Silent Cerebrovascular Lesions

Twenty-four-hour ambulatory blood pressure (24-hour ABP) values are considered a powerful predictor of stroke. Silent cerebrovascular lesions are associated with an increased risk of stroke. Because fibrinogen is a major determinant of plasma viscosity, an elevated fibrinogen level might also be associated with stroke risk. We evaluated the association of 24-hour ABP and plasma fibrinogen levels with the risk of silent cerebrovascular lesions (white matter hyperintensity and lacunar infarct) detected by MRI. The study cohort comprised 958 individuals from the general population of Ohasama, a rural Japanese community. Multiple logistic regression analysis adjusted for age, sex, smoking and drinking status, use of antihypertensive medication, body mass index, 24-hour ABP, and a history of hypercholesterolemia, diabetes mellitus, and atrial fibrillation demonstrated that each 1-SD increase in fibrinogen level was associated with a significantly increased risk of silent cerebrovascular lesions (odds ratio, 1.26; P=0.001). The 24-hour ABP was also significantly and independently associated with the risk of silent cerebrovascular lesions. Even when 24-hour ABP values were within normal range (<135/80 mm Hg), elevated fibrinogen levels were associated with an increased risk of silent cerebrovascular lesions. Fibrinogen and 24-hour BP had additive effects on silent cerebrovascular lesions. The 24-hour ABP and plasma fibrinogen levels were closely and independently associated with the risk of silent cerebrovascular lesions including white matter hyperintensity and lacunar infarct.

Event related brain potentials in elderly patients with recently diagnosed isolated systolic hypertension

Objective Isolated Systolic Hypertension (ISH) is a known risk factor for cognitive impairment, but the time of onset of neurocognitive changes relative to the onset of ISH has yet to be established. The purpose of this study was to investigate the relationship between systolic BP values and neurocognitive function in the early stages of ISH. Methods Twenty elderly patients with recently (<2 years) diagnosed ISH and 10 elderly normotensive controls underwent Ambulatory Blood Pressure Monitoring (ABPM) and neurocognitive assessment, performed using the Mini Mental State Examination (MMSE), and the recording of ERPs with an odd ball acoustic paradigm. Results There were no significant differences in MMSE scores or in the P300 latency between ISH patients and controls. The N2 latency was significantly higher in ISH patients vs. controls ( p < 0.0001), and showed a significant association with both clinical and ambulatory systolic BP and pulse pressure values in the overall study population. Conclusions These findings suggest the existence of early subclinical alterations in neurocognitive function in early ISH, detectable through ERPs. Significance Our findings underscore the ISH may constitute a threat to neurocognitive health in the elderly.

The PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) Study

The PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study represents a major research project aimed at investigating the normality values, prognostic significance and relationships of ambulatory and home blood pressure with end-organ damage and metabolic alterations. This article reviews the background, rationale and main results of the various PAMELA studies published to date. These include studies focused on (i) the normal values of ambulatory and home blood pressure in different age decades; (ii) the relevance of the different blood pressures in predicting the occurrence of end-organ damage; (iii) the prognostic significance of ‘white-coat’ and ‘masked’ hypertension; (iv) the ‘power’ of different blood pressures in predicting cardiovascular and all-cause death; and (v) the main features of the blood pressure control in the population. Altogether, the findings reported in this review emphasise the clinical relevance of ambulatory and home blood pressure and the importance of obtaining information on different blood pressures both in treated and untreated hypertensive patients.

The research about ambulatory blood pressure monitoring during the course of nurisng patients with primary hypertension

目的 探讨原发性高血压患者24 h血压的变化规律,比较动态血压和偶测血压的应用价值,为临床合理选择用药及护理提供依据.方法 对60例原发性高血压患者和34例健康人进行24 h动态血压监测,并与偶测血压比较.结果 高血压病患者的偶测血压值均高于动态血压均值(P＜0.01),而健康人动态与偶测血压比较无显著差异(P＞0.05).高血压病患者与健康人24 h血压节律均显示出两峰一谷及昼高夜低的特点,但高血压病患者第1峰更为突出.结论 动态血压较偶测血压监测对原发性高血压病的诊断更为准确,对临床合理用药及护理指导价值更大。