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3.
Adv Clin Exp Med ; 28(11): 1525-1530, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31693316

RESUMO

BACKGROUND: With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established. OBJECTIVES: This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment. MATERIAL AND METHODS: All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) >140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients' suitability for RDN. RESULTS: A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), ß-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), ß-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%). CONCLUSIONS: Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients.


Assuntos
Denervação , Hipertensão/cirurgia , Farmacovigilância , Artéria Renal/cirurgia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Hipertensão/tratamento farmacológico , Rim/inervação , Rim/cirurgia , Artéria Renal/inervação , Simpatectomia , Resultado do Tratamento
4.
Presse Med ; 48(11 Pt 1): 1319-1328, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31732365

RESUMO

Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.


Assuntos
Determinação da Pressão Arterial/normas , Consenso , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial , França , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Sociedades Médicas , Fatores de Tempo
5.
J Sports Med Phys Fitness ; 59(9): 1593-1598, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31610642

RESUMO

BACKGROUND: Central systolic blood pressure (cSBP), a measure of arterial stiffness, determines the afterload of the heart and provides greater prognostic significance regarding cardiovascular outcomes than peripheral systolic blood pressure (pSBP). Physical exercise is associated with an acute hypotensive effect on pSBP, but the significance of exercise on cSBP is missing. This study investigates the effect of a single exercise bout on pSBP and cSBP during a 24-hour ambulatory blood pressure monitoring (ABPM). METHODS: In 25 healthy male individuals (27.5±5.5 years) baseline pSBP and cSBP values were determined in a supine position using the oscillometric Mobil-O-Graph device. Afterward, they performed a maximum cardiopulmonary exercise test (CPET) on a bicycle ergometer. The 24-hour ABPM was launched 15 minutes after terminating CPET. RESULTS: Significant dipping of cSBP was found compared to baseline values in the first (-6.8 [-9.9 to -3.7] mmHg; P<0.001) second (-7.4 [-10.6 to -4.2] mmHg; P<0.001) and third hour (-6.4 [-11.5 to -1.3]; P=0.016) after exercise. Afterwards, cSBP continuously increases but remains significant reduced to baseline in the third (-6.4 [-11.5 to -1.3] mmHg; P=0.016), and fifth hour (-4.3 [-8.2 to -0.4] mmHg; P=0.033). There were only significant changes in pSBP compared to baseline values after 10 hours till the night period. The dipping pattern in the night period was similar in pSBP and cSBP. CONCLUSIONS: 24-h postexercise responses of pSBP and cSBP differs significantly. This suggests a different regulatory mechanism of exercise on the peripheral and central arteries that have further be elucidated.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Exercício/fisiologia , Adulto , Teste de Esforço/métodos , Humanos , Masculino , Adulto Jovem
6.
Kardiologiia ; 59(9): 64-70, 2019 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-31540577

RESUMO

In this review we present analysis the European recommendations on hypertension - what's new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.


Assuntos
Hipertensão , Anti-Hipertensivos , Pressão Sanguínea , Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Humanos
7.
Zhonghua Yi Xue Za Zhi ; 99(34): 2687-2690, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31505720

RESUMO

Objective: To explore the relationship between blood pressure load and sleep stability in hypertensive patients by cardiopulmonary coupling monitoring (CPC) and 24-hour ambulatory blood pressure monitoring. Methods: One hundred and fifty-five patients with essential hypertension were divided into high load group and low load group according to whether the blood pressure load was higher than 50%. The relationship between sleep stability and systolic blood pressure load was analyzed by logistic regression. Results: After adjusting for sex, age and body mass index (BMI), logistic regression analysis showed that stable sleep was the protective factor (OR=0.736,P=0.047) for the decrease of nocturnal blood pressure load, and unstable sleep was the risk factor for increasing day time blood pressure load (OR=1.336, P=0.037) in patients with hypertension. Conclusions: The effect of sleep stability on blood pressure load is different between day and night. Stable sleep is the protective factor of nocturnal systolic blood pressure load decrease, and unstable sleep is the harmful factor of daytime systolic blood pressure load increase. Increasing sleep stability helps to reduce systolic blood pressure load.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão Essencial , Pressão Sanguínea , Ritmo Circadiano , Humanos , Sono
9.
Hypertension ; 74(5): 1192-1199, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522619

RESUMO

Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00344903.


Assuntos
Afro-Americanos/estatística & dados numéricos , Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Imagem Cinética por Ressonância Magnética/métodos , Adulto , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Teorema de Bayes , Determinação da Pressão Arterial/métodos , Estudos Transversais , Eletrocardiografia/métodos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etnologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Texas
10.
Kardiologiia ; 59(8S): 63-72, 2019 Sep 16.
Artigo em Russo | MEDLINE | ID: mdl-31526363

RESUMO

AIM: To assess the incidence of blood pressure (BP) control and various phenotypes of BP by comparing the results of office and 44-hour ambulatory brachial and central BP measurement in patients with end-stage renal disease (ESRD) on program hemodialysis (HD). MATERIALS AND METHODS: In 68 patients ESRD receiving renal replacement therapy we evaluated office peridialysis BP and performed 44-hour ambu latory monitoring (ABPM) of brachial and central BP during peridialysis period using a validated oscillometric device BPLabVasotens (OOO "Petr Telegin"). Results were considered statistically significant with p<0.05. RESULTS: The frequency of control of peripheral office BP before the HD session was 25%, after - 23.5%; control of central BP - 48.6% and 49%, respectively. According to office measurement the frequency of systolic-diastolic hypertension was 44.1%, isolated systolic hypertension - 25%, isolated diastolic hypertension - 5.9%. The values of peripheral and central office systolic BP (SBP) before and after HD were not consistent with the corresponding mean and daily SBP levels for 44 hours and for the first and second days of the interdialysis period. The frequency of true uncontrolled arterial hypertension (AH) according to peripheral ABPM was 66.5%, masked uncontrolled AH - 9%. Circadian rhythm abnormalities for 44-h peripheral BP were detected in 77%, for central - in 76%. In 97% of patients agreement between phenotypes of the daily profile of peripheral and central BP was observed. 73% of patients had a significant increase in peripheral and central SBP and pulse pressure (PP) and an increase in the proportion of non-dippers from the 1st to the 2nd day. CONCLUSION: Patients with ESRD on HD were characterized by poor control of BP control and predominance of unfavourable peripheral and central ambulatory BP phenotypes. A single measurement of clinical peripheral and central BP in the peridialysis period was not sufficient to assess the control of hypertension in this population. The 24-h BP profiles in the 1st and 2nd days of interdialysis period had significant differences.


Assuntos
Hipertensão , Falência Renal Crônica , Pressão Sanguínea , Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Humanos , Falência Renal Crônica/terapia , Diálise Renal
11.
Clin Interv Aging ; 14: 1407-1418, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496668

RESUMO

Purpose: Acute reduction in blood pressure (BP) following an exercise session is evidenced in controlled settings with formal supervision in hypertensive older populations. This study investigated the effect of a self-selected exercise (SSE)-intensity session on ambulatory BP in hypertensive older women in a "real-world" setting. Methods: Twenty inactive older women with hypertension (64.9±4.5 years) were included in this randomized, controlled, crossover trial. After baseline assessments, participants performed 30 minutes of an SSE-intensity session on an outdoor track and a control session, separated by 7-10 days. Heart rate (HR), rating of perceived exertion (RPE), and affective response were assessed. Ambulatory BP was monitored for 20 hours following both sessions. Paired t-tests and generalized estimation were used for data analysis. Results: Participants exercised at 5.1±1.1 km/h, spent ~90% of the exercise time at moderate-vigorous intensity (≥40% of heart rate reserve). SSE-intensity session was reported as light (RPE 11.0±1.5) and pleasant (affect 3.4±1.2). SSE-intensity session elicited reductions in systolic BP in the first 6 hours postexercise (6.0 mmHg, CI 2.7-9.3 mmHg; P<0.001). Average systolic BP in the 20-hour (-3.4 mmHg, CI -5.9 to -0.9 mmHg; P=0.010) and awake (-4.0 mmHg, CI -6.4 to -1.6 mmHg; P=0.003) periods were lower following SSE-intensity session compared to control session. No differences were observed in average systolic BP during asleep period and diastolic BP during the 20-hour awake and asleep periods between the SSE-intensity session and control session (P>0.05). Conclusion: An SSE-intensity session elicited a reduction in ambulatory systolic BP in inactive older women with hypertension during awake and 20-hour periods. Also, the SSE-intensity session was reported as light and pleasant.


Assuntos
Terapia por Exercício/métodos , Exercício/fisiologia , Frequência Cardíaca , Hipertensão/terapia , Idoso , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Estudos Cross-Over , Feminino , Humanos , Hipertensão/fisiopatologia , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional
12.
Sci Total Environ ; 697: 134079, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31484088

RESUMO

BACKGROUND: Short-term exposure to PM2.5 has been shown to be associated with changes in blood pressure. However, most of the evidence is based on PM2.5 measurements from fixed stations and resting blood pressure measured at a regular time. OBJECTIVES: To evaluate the short-term daily and hourly effects of real-time personal PM2.5 exposure on ambulatory blood pressure, and to compare the effects with those of PM2.5 exposure from fixed stations. METHODS: Between April 2017 and December 2017, 37 young adults were recruited in a panel study from a central urban area and a suburban area, to measure personal hourly PM2.5 and ambulatory systolic blood pressure (SBP) as well as diastolic blood pressure (DBP) for three consecutive days. Hourly PM2.5 concentrations were also obtained from the nearest monitoring station operated by Guangdong Environmental Monitoring Center. Generalized additive mixed model was employed to evaluate the effects of PM2.5 on ambulatory blood pressure. RESULTS: During the study period, the mean concentration of personal PM2.5 exposure was 60.30 ±â€¯52.14 µg/m3, while the value of PM2.5 from fixed stations was 36.77 ±â€¯21.52 µg/m3. Both personal PM2.5 exposure and exposure from fixed stations averaged over the previous 1 to 3 days decreased blood pressure. During daytime, a 10 µg/m3 increase in 1-day moving average of personal PM2.5 was associated with a 0.54 mmHg (95% CI: -1.03, -0.05) and 0.22 mmHg (95% CI: -0.59, 0.15) decrease in SBP and DBP, respectively. When using PM2.5 exposures from fixed stations, the decrease in SBP and DBP were 0.95 mmHg (95% CI: -1.82, -0.07) and 0.74 mmHg (95% CI: -1.46, -0.03). Stratified analysis showed stronger effects in the central urban area and among males. CONCLUSIONS: Both personal PM2.5 exposure and exposure from fixed stations averaged over the previous 1 to 3 days decreased blood pressure. Stronger effects were found in a central urban area and among males.


Assuntos
Poluição do Ar/estatística & dados numéricos , Pressão Sanguínea , Exposição Ambiental/estatística & dados numéricos , Material Particulado/análise , Poluentes Atmosféricos , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Modelos Lineares , Masculino , Adulto Jovem
13.
Pol Merkur Lekarski ; 47(278): 52-59, 2019 Aug 30.
Artigo em Polonês | MEDLINE | ID: mdl-31473752

RESUMO

Tuberous sclerosis complex (TSC) is a genetic disease that leads to formation of tumors i.e. in brain kidneys, heart, lungs, and skin. AIM: The aim of the study was to summarize center's experience in the first year of program of nephrologic follow-up in patients with TSC. MATERIALS AND METHODS: During 12 months 30 children with TSC (14 boys and 16 girls aged from 3 months to 17 years 11 months, mean 7.57±5.02 years) were hospitalized. Following parameters were evaluated: genetic and biochemical tests, blood pressure in ambulatory blood pressure monitoring (ABPM), kidney lesions in ultrasonography (30 patients) and in magnetic resonance (14 patients). RESULTS: Genetic tests were performed in 6 children - in 5 TSC2 mutation was found, in one boy with TSC and numerous renal cysts only PKD1 mutation was revealed. Mean GFR was 130.81±23.23 mL/ min/1.73 m2. Four children (13.3%) had arterial hypertension. Renal lesions were found in 28 (93.3%) children: 18 patients had angiomyolipomas (AML) (mean diameter 15.4±12.5, max 38 mm), 23 patients had renal cysts (mean diameter 7.6±7.0, max 30 mm); 13 patients had AMLs and cysts. A dysplastic lesion (39x26x15 mm) in right kidney was found in one girl. Children with AML were older than remaining patients (10.08±4.55 vs. 4.25±3.50 [years], p<0.001). Children with cysts were characterized by higher systolic (p=0.017), diastolic (p=0.027) and mean (p=0.014) arterial pressure, and mean arterial pressure Z-score (p=0.025) in ABPM. Maximal kidney cyst diameter correlated positively with systolic, diastolic, mean arterial pressure, mean arterial pressure Z-score, and diastolic blood pressure load in ABPM (r = 0.61-0.75, p = 0.033-0.005). Two children with numerous AML with diameter >30 mm were treated with sirolimus. CONCLUSIONS: Because of common focal lesions in kidneys children with TSC should be kept under regular nephrologic follow-up. Presence of large renal cysts may predispose children with TSC to arterial hypertension.


Assuntos
Angiomiolipoma , Nefropatias , Esclerose Tuberosa , Adolescente , Angiomiolipoma/etiologia , Monitorização Ambulatorial da Pressão Arterial , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Nefropatias/etiologia , Masculino , Esclerose Tuberosa/complicações
15.
Hypertension ; 74(4): 998-1004, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401878

RESUMO

The International Society of Peritoneal Dialysis recommends that adequate blood pressure (BP) assessment among patients on peritoneal dialysis should at least include measurements performed once-weekly at home and at each visit at clinic. However, the quality of evidence to support this guidance is suboptimal. Using ambulatory daytime BP as reference standard, we explored the diagnostic performance of clinic and home BP recordings in a cohort of 81 stable patients receiving peritoneal dialysis. BP was recorded using 3 different methodologies: (1) triplicate automated clinic BP recordings after a 5-minute seated rest with the validated monitor HEM 705 CP (Omron Healthcare); (2) 1-week averaged home BP recorded with a validated automated monitor on awaking and at bedtime; and (3) ambulatory BP monitoring with the Mobil-O-Graph device (IEM, Germany). The area under the curve of receiver operating characteristic curves in detection of ambulatory daytime systolic BP (SBP) ≥135 mm Hg was similar for clinic [area under the curve, 0.859; 95% CI, 0.776-0.941] and home SBP (area under the curve, 0.895; 95% CI, 0.815-0.976). In Bland-Altman analysis, clinic SBP overestimated daytime ambulatory SBP by 5.02 mm Hg with 95% limits of agreement ranging from -17.92 to 27.96 mm Hg. Similarly, home SBP overestimated daytime ambulatory SBP by 4.23 mm Hg, again with wide 95% limits of agreement (-16.05 to 24.51 mm Hg). These results show that 1-week averaged home SBP is of at least similar accuracy with standardized clinic SBP in diagnosing hypertension confirmed by ambulatory BP monitoring among patients on peritoneal dialysis.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Hipertensão/diagnóstico , Falência Renal Crônica/fisiopatologia , Diálise Peritoneal , Adulto , Idoso , Feminino , Humanos , Hipertensão/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade
16.
Transplant Proc ; 51(7): 2355-2357, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31402245

RESUMO

The diagnosis of arterial hypertension has traditionally been based on measurements of blood pressure (BP) in the clinic. However, home or ambulatory BP monitoring (ABPM) is reported to correlate better with target organ damage than clinic BP readings. The other potential advantage of out-of-clinic BP measurement is the detection of both white-coat hypertension (WCHT) and masked hypertension (MHT). Studies have suggested that MHT have an increased risk of cardiovascular disease (CVD). We aimed to investigate the prevalence of MHT and to evaluate risk factors by ABPM in our renal transplant recipients. One hundred twenty-ninety patients who were followed up in our nephrology clinic were included in the study. The prevalence of MHT was 17%. In logistic regression analysis, we investigated factors associated with MHT. In a model with age, sex, smoking, presence of Diabetes mellitus (DM) and blood glucose, estimated glomerular filtration rate (eGFR), donor type, body mass index, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), we found that WHR (r: 18.61, P: .007) and smoking (r: 2.79, P: .011) were related with MHT. MHT was related to target organ damage and cardiovascular disease. The diagnosis and treatment of MHT are important. These findings suggesting that patients with high WC and smokers should be investigated with ABPM to diagnose masked hypertension. This approach may reduce adverse cardiovascular outcomes after transplantation.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Transplante de Rim/efeitos adversos , Hipertensão Mascarada/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Fatores de Risco , Transplantados , Circunferência da Cintura
18.
JAMA ; 322(5): 409-420, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386134

RESUMO

Importance: Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes. Objective: To evaluate the association of BP indexes with death and a composite CV event. Design, Setting, and Participants: Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016). Exposures: Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings). Main Outcomes and Measures: Multivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC). Results: Among 11 135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP. Conclusions and Relevance: In this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Ritmo Circadiano , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
19.
Hypertension ; 74(4): 756-766, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446802

RESUMO

Mortality due to cardiovascular disease rises sharply in winter. Known as excess winter mortality, this phenomenon is partially explained by cold exposure-induced high blood pressure. Home blood pressure, especially in the morning, is closely associated with cardiovascular disease risk. We conducted the first large nationwide survey on home blood pressure and indoor temperature in 3775 participants (2095 households) who intended to conduct insulation retrofitting and were recruited by construction companies. Home blood pressure was measured twice in the morning and evening for 2 weeks. The relationship between home blood pressure and indoor temperature in winter was analyzed using a multilevel model with 3 levels: repeatedly measured day-level variables (eg, indoor ambient temperature and quality of sleep), nested within individual-level (eg, age and sex), and nested within household level. Cross-sectional analyses involving about 2900 participants (1840 households) showed that systolic blood pressure in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mm Hg increase/10°C decrease) than that in the evening (6.5 mm Hg increase/10°C decrease) in participants aged 57 years (mean age in this survey). We also found a nonlinear relationship between morning systolic blood pressure and indoor temperature, suggesting that the effect of indoor temperature on blood pressure varied depending on room temperature range. Interaction terms between age/women and indoor temperature were significant, indicating that systolic blood pressure in older residents and women was vulnerable to indoor temperature change. We expect that these results will be useful in determining optimum home temperature recommendations for men and women of each age group. Clinical Trial Registration- URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000030601.


Assuntos
Pressão Sanguínea/fisiologia , Habitação , Temperatura Ambiente , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano/fisiologia , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estações do Ano
20.
Ethiop J Health Sci ; 29(4): 431-438, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31447515

RESUMO

Background: Failure to diagnose and adequately classify newly-diagnosed hypertensive patients may lead to non-recognition of White Coat Hypertension (WCH) and inappropriate use of antihypertensive medications. This study determined the prevalence and predictors of white coat hypertension among newly-diagnosed hypertensive patients in a tertiary health centre in Nigeria. Methods: One hundred and twenty newly-diagnosed hypertensive patients and 120 controls were recruited for the study. All the participants had 24-hour Ambulatory Blood Pressure Monitoring (ABPM) using an oscillometric device (CONTEC®). Data were analyzed using SPSS version 20.0. Results: Out of 120 patients, 52 were males and the mean age was 44.2 ± 9.7 years whereas of the 120 controls, 53 were males and the mean age was 44.0 ± 7.5 years. The mean body mass index of the patients, BMI (27.0 ± 4.5kg/m2) was higher than control (24.1 ± 4.5kg/m2), p-value <0.001. The prevalence of WCH was 36.7%. The mean age and BMI of those with WCH were 43.3 ± 11.4 years and 26.4 ± 4.5kg/m2 respectively. Females constituted a greater proportion (70.5%). In multivariate analysis, high level of education and being overweight or obese were significant determinants of WCH. Conclusion: High prevalence of WCH existed among participants studied. High level of education and being obese were predictors of white coat hypertension. Hence, ambulatory blood pressure monitoring should be included as part of routine work-up for newly-diagnosed hypertensive patients in order to limit the number of those who may be committed to lifelong antihypertensive medications with its unwanted side effects.


Assuntos
Centros de Atenção Terciária/estatística & dados numéricos , Hipertensão do Jaleco Branco/epidemiologia , Adulto , Monitorização Ambulatorial da Pressão Arterial , Índice de Massa Corporal , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Prevalência , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/etiologia
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