Diferencia de presión arterial entre brazos: concordancia entre 2 métodos automáticos de medición simultánea y reproducibilidad entre visitas / Interarm blood pressure difference: Concordance between two methods of automatic simultaneous measurement and between visits reproducibility

Objetivo: La diferencia de presión arterial sistólica entre brazos (dPEB) aumentada (≥10mmHg) se ha relacionado con mayor morbimortalidad cardiovascular. Hay poca evidencia sobre cómo determinar la dPEB y su fiabilidad ha sido poco estudiada. Nuestros objetivos fueron evaluar la concordancia entre 2 oscilómetros automáticos de medición simultánea de la dPEB (2 aparatos OMRON y un aparato Microlife WatchBP® [WBP]) y analizar la reproducibilidad de la dPEB entre visitas en población general atendida en un centro de atención primaria. Diseño: Estudio descriptivo transversal de concordancia entre los 2 métodos y de fiabilidad de la dPEB entre 2 visitas separadas una semana. Emplazamiento: Centro de Atención Primaria de Parets del Vallès, Barcelona. Participantes: Población general de 35-74 años. Intervenciones y mediciones principales: Ciento cuarenta y nueve pacientes completaron las 2 visitas. En cada visita se midió la dPEB 3 veces con ambos métodos, y se consideró la media de las 3 determinaciones. Mediante revisión de la historia y entrevista con el paciente se recogieron otras variables como sociodemográficas y antropométricas, antecedentes patológicos y tratamiento farmacológico. Se calculó la concordancia entre los dispositivos y la reproducibilidad entre visitas mediante el coeficiente de concordancia de Lin (CCL) para la dPEB expresada de manera continua y los índices kappa (k) para la dPEB categorizada en normal o patológica. Resultados: La concordancia entre métodos para la dPEB expresada de forma continua fue baja: CCL: 0,13 (0,02-0,24). La concordancia fue también baja para la dPEB categorizada en normal o patológica (k=−0,03 [−0,05-0,00]). La reproducibilidad entre visitas fue baja para ambos métodos, y tanto para la dPEB continua como categorizada: con OMRON® CCL: 0,19 (0,03-0,34) y k=−0,02 (−0,16-0,12) y para WBP® CCL: 0,14 (−0,01-0,29) y k=0,49 (0,33-0,64).(AU)

Objective: An increased interarm blood pressure difference (IAD) (≥10mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre. Design: Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. Site: Parets del Vallès primary care centre (Barcelona). Participants: General population aged 35-74 years. Interventions and main measurements: One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological. Results: Concordance for IAD expressed continuously was low: CCL=0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k=−0.03 (−0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL=0.19 (0.03-0.34) and k=−0.02 (−0.16-0.12) and for WBP™ CCL=0.14 (−0.01-0.29) and k=0.49 (0.33-0.64).(AU)

[Interarm blood pressure difference: Concordance between two methods of automatic simultaneous measurement and between visits reproducibility]. / Diferencia de presión arterial entre brazos: concordancia entre 2 métodos automáticos de medición simultánea y reproducibilidad entre visitas.

OBJECTIVE: An increased interarm blood pressure difference (IAD) (≥10mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre. DESIGN: Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. SITE: Parets del Vallès primary care centre (Barcelona). PARTICIPANTS: General population aged 35-74 years. INTERVENTIONS AND MAIN MEASUREMENTS: One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological. RESULTS: Concordance for IAD expressed continuously was low: CCL=0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k=-0.03 (-0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL=0.19 (0.03-0.34) and k=-0.02 (-0.16-0.12) and for WBP™ CCL=0.14 (-0.01-0.29) and k=0.49 (0.33-0.64). CONCLUSIONS: Concordance between two automatic oscillometers in the simultaneous IAD measurement was low. Reproducibility between visits was also low for both methods.

Differentiated clinical presentation of early and late-onset Alzheimer's disease: is 65 years of age providing a reliable threshold?

Early-onset and late-onset Alzheimer's disease (EOAD and LOAD) are two forms of the disease with the same characteristic neuropathological hallmarks. However, higher burdens of neuritic plaques and neurofibrillary tangles in frontal and parietal lobes have been found in EOAD than in LOAD patients. Thus, the EOAD subjects may have a differentiated clinical presentation compared to the LOAD ones. Some authors have found less hippocampal memory presentations and more focal cortical abnormalities (such as visuoconstructive or executive dysfunction) in EOAD than LOAD patients. The aim of the present study was to determine which initial clinical profiles differ between EOAD and LOAD; and to analyze whether another age cut-off could discriminate better between EOAD and LOAD clinical presentations than the conventional limit of 65. All patients fulfilling NINCDS-ADRDA criteria for probable Alzheimer's disease who referred to our Hospital between October 2007 and December 2012 were included in the study. The conventional age limit of 65 was established to distinguish between EOAD and LOAD. Baseline neuropsychological scores, adjusted for age and education, were compared between both groups. A total of 181 patients (38 EOAD, 143 LOAD) entered in the analysis. Sex distribution and time of evolution of symptoms did not differ between groups. The EOAD patients performed worse than LOAD in attentional, imitation praxis and verbal learning tests. In addition, the age cut-off of 70 was found to differentiate between early- and late-onset groups better than the standard cut-off of 65 years old. Our results support a differentiated neuropsychological impairment pattern in EOAD compared to LOAD.

Polyneuropathy while on duodenal levodopa infusion in Parkinson's disease patients: we must be alert.

Some reports have emerged describing the occurrence of Guillain-Barré syndrome and polyneuropathy related to vitamin B(12) deficiency in some patients with Parkinson's disease (PD) treated with continuous duodenal levodopa infusion. We describe five PD patients who developed axonal polyneuropathy and vitamin B(12) deficiency while on treatment with duodenal levodopa infusion, review other cases reported in the literature, discuss potential etiologic factors, and suggest a possible algorithm for the management and prevention of this complication. One case of Guillain-Barré syndrome and at least 12 cases of polyneuropathy related to vitamin B(12) deficiency have been reported in PD patients treated with duodenal levodopa infusion. Levodopa gel infusion may induce a decrease in vitamin B(12) levels, leading to peripheral neuropathy. Additional pathogenetic mechanisms include alterations related to the metabolism of L: -dopa, abnormal L: -dopa absorption, and direct neurotoxicity of L: -dopa at high doses. Vitamin B(12) supplementation may need to be considered in PD patients on duodenal levodopa infusion therapy. Vitamin B(12) deficiency in patients on duodenal levodopa infusion therapy may be more frequent than the published data suggest. We must be alert.