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

BACKGROUND AND OBJECTIVES: Ambulatory 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 PATIENTS: Prospective 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. RESULTS: From 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. CONCLUSION: Ambulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.

Correlation of cardiac troponin I levels with infective endocarditis & its adverse clinical outcomes.

BACKGROUND: To study the association of increased cardiac troponin I levels in infective endocarditis (IE) with its adverse clinical outcomes including in-hospital mortality, perivalvular invasive infection and central nervous system events. METHODS: A prospective cohort study of 26 patients comprising of 19 males and 7 females with an average age of 28years diagnosed with IE using Modified Duke Criteria were taken. A blood sample was drawn from each patient and all samples were analyzed for quantitative estimation of troponin I using ELISA technique. A cardiac troponin I level >1.0ng/ml was considered increased. All data was analyzed by independent- samples t test using SPSS Version 16.0. RESULTS: All 26 patients had vegetations diagnosed on echocardiography. Of the 26 patients, 9 (35%) had elevated cardiac troponin I levels and 17 patients (65%) had normal cardiac troponin I levels. Of the 9 patients who had elevated cardiac troponin I levels, 7 (77.78%) had adverse clinical outcomes, the level of statistical significance being p value<0.0002. Of the 17 patients with normal cardiac troponin I levels, only 1 (5.88%) had adverse clinical outcome, the level of statistical significance being p value<0.0001. CONCLUSION: Patients with IE and increased cardiac troponin I levels have worse prognosis with increased incidence of adverse clinical outcomes than those with IE and normal cardiac troponin I levels reflecting potential of cardiac troponin I as a prognostic marker in IE.