[Blood pressure monitors in primary healthcare centres]. / Blodtrykksapparater på legekontorer.

BACKGROUND: Blood pressure monitoring is one of the most common procedures in clinical medicine. Evaluation and treatment of hypertension are costly and have considerable implications for the individuals involved. Mercury manometers have been dominant for a century, but are currently being replaced by other types of equipment. No national guidelines/recommendations exist on types of blood pressure monitors to be used. The aim of this study was to assess the types of blood pressure monitors used in Norwegian general practice, and to what extent routines have been established for control and calibration of the equipment. MATERIAL AND METHODS: In 2007, a questionnaire was distributed to 65 university-affiliated primary healthcare centres in Mid-Norway. The questions included what type of blood pressure monitors are in use and whether routines exist for calibration of them. RESULTS: 45 healthcare centres with a total of 173 general practitioners (corresponding to 74 % of the doctors) responded. 18 (6 %) of the 320 monitors identified were of the mercury type, the rest were aneroid or oscillometric. Many centres had 24-hour monitors. Two healthcare centres (4 % of the doctors) had established routines for calibration of their blood pressure monitors. INTERPRETATION: Routines should be established for quality assurance of blood pressure monitors in Norwegian primary healthcare services.

Left ventricular apical rotation is related to ambulatory blood pressure and body mass in healthy elderly females.

OBJECTIVE: The interaction between left ventricular (LV) apical rotation, blood pressure (BP) and body mass in elderly females may reveal mechanisms involved in the syndrome of diastolic heart failure. METHODS: Thirty-one healthy females, age 69-84 years, were studied with echocardiography, ambulatory BP and an exercise capacity (VO2peak) test. RESULTS: LV apical short-axis loops were eligible for speckle tracking analysis in 27 subjects. Peak apical rotation (PAR) correlated inversely with diastolic BP (r = -0.47, p = 0.01). PAR correlated positively with stroke volume and body weight (p<0.05), but not with VO2peak (n = 19, p = ns). PAR also correlated with peak rotation velocity in systole (r = 0.76, p<0.0001) and in diastole (r = 0.58, p = 0.001). Diastolic peak rotation velocity correlated with mitral E wave peak velocity (r = 0.48, p = 0.01). There was a significant reduction in LV volumes during the 4 years of follow-up. CONCLUSIONS: In healthy elderly females, there seems to be an interaction between LV apical rotation, BP and body mass. Peak apical rotation and peak diastolic rotation velocity correlate with indices of LV filling and ejection, indicating that suction, a crucial element for effective early LV filling, may be preserved in healthy elderly subjects. Suction deteriorates with elevations of the arterial BP. An age- and BP-related reduction in LV end-diastolic volume may represent an additional impediment to LV filling. Both features may contribute to the development of LV diastolic dysfunction and to episodes of diastolic heart failure.

Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey.

OBJECTIVE: To find an effective screening strategy for detecting patients with chronic kidney disease and to describe the natural course of the disease. DESIGN: Eight year follow-up of a cross sectional health survey (the HUNT II study). SETTING: Nord-Trøndelag County, Norway PARTICIPANTS: 65,604 people (70.6 % of all adults aged >or=20 in the county). MAIN OUTCOME MEASURES: Incident end stage renal disease (ESRD) and cardiovascular mortality monitored by individual linkage to central registries. RESULTS: 3069/65,604 (4.7%) people had chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2)), so we would need to screen 20.6 people (95% confidence interval 20.0 to 21.2) to identify one case. Restriction of screening to those with hypertension, diabetes, or age >55 would identify 93.2% (92.4% to 94.0%) of patients with chronic kidney disease, with a number needed to screen of 8.7 (8.5 to 9.0). Restriction of screening according to guidelines of the United States kidney disease outcomes quality initiative (US KDOQI) gave similar results, but restriction according to the United Kingdom's chronic kidney disease guidelines detected only 60.9% (59.1% to 62.8%) of cases. Screening only people with previously known diabetes or hypertension detected 44.2% (42.7% to 45.7%) of all cases, with a number needed to screen of six. During the eight year follow-up only 38 of the 3069 people with chronic kidney disease progressed to end stage renal disease, and the risk was especially low in people without diabetes or hypertension, women, and those aged >or=70 or with a glomerular filtration rate 45-59 ml/min/1.73 m(2) at screening. In contrast, there was a high cardiovascular mortality: 3.5, 7.4, and 10.1 deaths per 100 person years among people with a glomerular filtration rate 45-59, 30-44, and <30 ml/min/1.73 m(2), respectively. CONCLUSION: Screening people with hypertension, diabetes mellitus, or age >55 was the most effective strategy to detect patients with chronic kidney disease, but the risk of end stage renal disease among those detected was low.

Tissue Doppler imaging of the left ventricle in healthy elderly females does not support the concept of "isolated" diastolic dysfunction.

The concept of "isolated" left ventricular diastolic dysfunction has recently been challenged, since left ventricular contraction abnormalities can be demonstrated in subjects with normal left ventricular ejection fraction (EF). In this study of 35 healthy females (aged 65--80 years) with EF>50%, the ratio of peak early transmitral flow velocity to peak early diastolic myocardial velocity (E/Em) correlated significantly with peak systolic myocardial longitudinal velocity (Sm) (r=-0.57, p<0.0001), assessed as an average in six basal left ventricular segments. E/Em correlated also with age (r=0.51, p<0.002), but not significantly with ambulatory daytime systolic blood pressure (r=0.32, p=0.06), nor with left ventricular mass. In conclusion, there is a significant correlation between left ventricular diastolic and systolic function also in an apparently healthy population when adequately sensitive methods are used, in terms of tissue Doppler assessment of the left ventricular longitudinal motion. Although age may influence left ventricular longitudinal motion, an influence of arterial blood pressures is unclear.

Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5-yr follow-up.

BACKGROUND: Although cardiovascular disease is a major cause of death after renal transplantation (Tx), predictors for cardiovascular events have not been well defined. Aims of this cross-sectional study were first to assess cardiovascular morbidity and mortality in stable renal Tx patients, and to identify predictors for cardiovascular events during long-term follow-up. METHODS: In all, 406 renal Tx patients (mean age: 47 yr, 60.1% males, 70.9% using cyclosporine A) commenced a baseline registration (median) 48 months after Tx, and 405 was thereafter followed in 5 yr. Kaplan-Meier plots and multivariate regression analysis (Cox proportional hazards model) were used to identify and characterize predictors for cardiovascular events. RESULTS: There were 88 deaths (average annual mortality: 4.4%), and 74% of these were cardiovascular. In age groups 40-49, 50-59, and 60-69 yr, odds ratio for cardiovascular mortality in patients vs. general population was 46.2, 20.1, and 8.0, respectively. Death from ischemic heart disease (IHD) was independently predicted by baseline congestive heart failure (relative risk: RR 5.33), diabetes (RR 2.28), systolic blood pressure (mmHg, RR 1.02), age (yr, RR 1.06), and high-density lipoprotein cholesterol (mmol/L, RR 0.36). Predictors for a major ischemic heart event (death from or onset of IHD) were in addition baseline total cholesterol (mmol/L, RR 1.18) and cerebrovascular disease (RR 2.98). CONCLUSIONS: Thus, IHD was the major cause of death late after renal Tx, and a major ischemic heart event was predicted by baseline congestive heart failure, diabetes, age, hypertension, and hypercholesterolemia.