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1.
J Clin Hypertens (Greenwich) ; 18(11): 1095-1102, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27480205

RESUMO

The clinical importance of white-coat hypertension (WCH) remains a controversial issue. The aim of this study was to evaluate the association of isolated systolic, isolated diastolic, and systolic/diastolic WCH with common carotid artery intima-media thickness (CCA-IMT) and to compare each subgroup of WCH against other blood pressure (BP) phenotypes in terms of CCA-IMT values. A total of 1382 consecutive patients underwent 24-hour ambulatory BP monitoring and carotid artery ultrasonographic measurements. According to the type of elevated office BP, WCH was divided into three groups: isolated systolic, isolated diastolic, and systolic/diastolic WCH. Patients with isolated systolic WCH (n=112) had significantly higher CCA-IMT values (0.737 mm) than those with isolated diastolic WCH (n=66) (0.685 mm) and nonsignificantly greater compared with those with systolic/diastolic WCH (n=228) (0.708 mm). Patients with isolated systolic WCH had CCA-IMT values similar to those with hypertension, patients with isolated diastolic WCH had similar values to those with normotension, and patients with systolic/diastolic WCH had an intermediate risk between normotension and hypertension.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Hipertensão do Jaleco Branco/classificação , Adulto , Idoso , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Espessura Intima-Media Carotídea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão do Jaleco Branco/complicações
2.
Int J Med Sci ; 11(8): 771-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24936139

RESUMO

BACKGROUND: High blood pressure (BP) poses a major risk for cognitive decline. Aim of the study was to highlight the relationship between cognitive assessment scores and an effective therapeutic BP control. METHODS: By medical visit and ambulatory BP monitoring (ABPM), we studied 302 treated hypertensives, subdivided according to office/daytime BP values into 120 with good (GC) and 98 poor (PC) BP control, 40 with "white coat hypertension" (WCH) and 44 a "masked-hypertension" phenomenon (MH). Patients underwent neuropsychological assessment to evaluate global cognitive scores at the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) and attention/executive functions (Delayed Recall, Digit Span Forwards, Digit Span Backwards, Selective Attention, Verbal Fluency, Stroop Test and Clock Drawing). Carotid intima-media thickness (IMT) served as the index of vascular damage. RESULTS: There were no differences among the groups in terms of gender, age, education, metabolic assessment, clinical history and hypertension treatment. GC presented lower office and ambulatory BP values and IMT. PC performed worse than GC on global executive and attention functions, especially executive functions. In PC, office systolic BP (SBP) was significantly associated to the MMSE and FAB scores and, in particular, to Verbal Fluency, Stroop Errors and Clock Drawing tests. Office diastolic BP (DBP) was associated to Selective attention, nocturnal SBP to Digit Span backwards and Verbal Fluency. Worse cognitive assessment scores were obtained in WCH than GC. CONCLUSIONS: The findings showed that in adult treated hypertensives, a poor BP control, as both doctor's office and daytime scores, is associated to impaired global cognitive and especially executive/attention functions.


Assuntos
Pressão Sanguínea , Transtornos Cognitivos/patologia , Hipertensão Mascarada/patologia , Hipertensão do Jaleco Branco/patologia , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Transtornos Cognitivos/etiologia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Hipertensão Mascarada/classificação , Hipertensão Mascarada/complicações , Pessoa de Meia-Idade , Fatores de Risco , Hipertensão do Jaleco Branco/classificação , Hipertensão do Jaleco Branco/complicações
3.
J Hum Hypertens ; 26(12): 696-700, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22071448

RESUMO

Ambulatory blood pressure (ABP) monitoring is recommended as a standard method for the evaluation of resistant hypertension (RH). This study assessed the diagnostic value of home blood pressure (HBP) monitoring in RH. Subjects on stable treatment with ≥3 antihypertensive drugs were included. Clinic RH (CRH) was defined as elevated clinic blood pressure and true RH (TRH) as elevated ABP. The diagnosis of CRH was verified by ABP and HBP monitoring. The diagnostic value of HBP was assessed by taking ABP as reference method. Threshold for hypertension diagnosis was ≥135/85 mm Hg (systolic and/or diastolic) for HBP and awake ABP and ≥140/90 mm Hg for clinic blood pressure. Among 73 subjects on ≥3 antihypertensive drugs, 44 (60%) had CRH and 40 (55%) TRH. There was agreement between ABP and HBP in diagnosing CRH in 82% of the cases (26 subjects (59%) with CRH and 10 (23%) without CRH; kappa 0.59). Regarding the diagnosis of TRH, there was agreement between ABP and HBP in 74% of the cases (36 subjects (49%) with TRH and 18 (25%) without TRH; kappa 0.46). The sensitivity, specificity, and positive and negative predictive values of HBP in detecting CRH were 93%, 63%, and 81% and 83%, respectively, and TRH were 90%, 55%, and 71%, and 82%, respectively (ABP taken as reference method). These data suggest that HBP is a reliable alternative to ABP in the evaluation of RH. These methods are necessary in both uncontrolled and controlled subjects on triple therapy to detect the white coat phenomenon and also masked RH.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Vasoespasmo Coronário/classificação , Vasoespasmo Coronário/diagnóstico , Hipertensão/classificação , Hipertensão/diagnóstico , Idoso , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Vasoespasmo Coronário/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Hipertensão Mascarada/classificação , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Hipertensão do Jaleco Branco/classificação , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/tratamento farmacológico
4.
Clin J Am Soc Nephrol ; 6(8): 2003-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21737856

RESUMO

BACKGROUND AND OBJECTIVES: Among people with essential hypertension, ambulatory BP measurement is superior to BP obtained in the clinic in predicting cardiovascular outcomes. In part, this is because it can detect white-coat hypertension and masked hypertension. Whether the same is true for hemodialysis patients is not known. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using a threshold of 140/80 mmHg for median midweek dialysis-unit BP and 135/85 mmHg for 44-hour ambulatory BP, we defined four categories of BP: sustained normotension (SN), white-coat hypertension (WCH), masked hypertension (MHTN), and sustained hypertension (SHTN). RESULTS: Among 355 long-term hemodialysis patients, the prevalence of SN was 35%, WCH 15%, MHTN 15%, and SHTN 35%. Over a mean follow-up of 29.6 (SD 21.7) months, 102 patients died (29%), yielding a crude mortality rate of 121/1000 patient-years. Unadjusted and multivariate-adjusted analyses showed increasing all-cause mortality with increasing severity of hypertension (unadjusted hazard ratios from SN, WCH, MHTN, SHTN: 1, 1.12, 1.70, 1.80, respectively [P for trend < 0.01]; adjusted hazard ratios: 1, 1.30, 1.36, 1.87, respectively [P for trend 0.02]). When a predialysis BP threshold of 140/90 mmHg was used to classify patients into BP categories, the prevalence of SN was 24%, WCH 26%, MHTN 4%, and SHTN 47%. Hazard ratios for mortality were similar when compared with median midweek dialysis-unit BP. CONCLUSIONS: As in the essential hypertension population, MHTN and WCH have prognostic significance. The prognostic value of BP obtained in the dialysis unit can be refined with ambulatory BP monitoring.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea , Falência Renal Crônica/terapia , Hipertensão Mascarada/diagnóstico , Visita a Consultório Médico , Diálise Renal , Hipertensão do Jaleco Branco/diagnóstico , Adulto , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Indiana , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Masculino , Hipertensão Mascarada/classificação , Hipertensão Mascarada/mortalidade , Hipertensão Mascarada/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Modelos de Riscos Proporcionais , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Terminologia como Assunto , Fatores de Tempo , Hipertensão do Jaleco Branco/classificação , Hipertensão do Jaleco Branco/mortalidade , Hipertensão do Jaleco Branco/fisiopatologia
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