Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population. Follow-up Results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study

Background: Recurrent stroke has higher morbidity and mortality than incident stroke. We evaluated hemodynamic risk factors for multiple recurrent strokes. Methods: We included patients in the SPS3 trial. The primary predictor was the top tertile, compared to the bottom tertile, of the mean systolic blood pressure (mSBP) and blood pressure variability represented as standard deviation (sdSBP) using blood pressures from day 30 of the trial to the end of follow-up. We excluded blood pressures from the first 30 days to reduce confounding from the trial’s intervention. We fit a logistic regression model to ≥2 recurrent strokes from day 30 to the end of follow-up and, to accurately analyze the multiple failure-time data, we ordered the multiple failure events to the Prentice, Williams and Peterson extension of the Cox proportional-hazards model. Results: We included 2,882 patients, of which 223 had a recurrent stroke and 41/223 had ≥2 recurrent strokes for a total of 272 strokes. The mean (SD) number of blood pressure readings was 78.0 (37.4). The etiology of the 272 strokes was 161 (59.2%) lacunar, 22 (8.1%) intracranial atherosclerosis, 10 (3.7%) extracranial atherosclerosis, 24 (8.8%) cardioembolic, and 55 (20.2%) cryptogenic or other. In both unadjusted and adjusted logistic regression models and PWP Cox models, the top tertile of sdSBP was consistently predictive of multiple recurrent strokes, while mSBP was not (Tables 1/2). Conclusions: We found that in patients with an index lacunar stroke, higher SBP variability, but not mean SBP, was predictive of multiple recurrent strokes of varying mechanisms.

Download Full-text

Abstract P263: Symptomatic Post-Acute SARS-CoV-2-Infection Hypertension Syndrome

Hypertension ◽

10.1161/hyp.78.suppl_1.p263 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Lauren East ◽

Zainab Mahmoud ◽

Amanda Verma

Keyword(s):

Blood Pressure ◽

Chest Pain ◽

Vital Signs ◽

Wilcoxon Test ◽

Initial Visit ◽

Office Visits ◽

Paired Data ◽

Cardiology Clinic ◽

Blood Pressures

Introduction: The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular symptoms following acute COVID-19 infection. One clinical manifestation seen in the clinic is an increase in blood pressure, with associated symptoms like chest pain. Our investigation aims to describe the increase in blood pressure seen in symptomatic patients presenting to the Post-COVID Cardiology Clinic. Methods: The study employed a retrospective cohort design of consecutive adult patients who presented between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection. Demographic information, symptoms, vital signs, and follow-up visit data were collected for the patients. To determine a baseline blood pressure, two blood pressure readings from office visits prior to COVID-19 infection were averaged. The blood pressure values were compared between baseline and cardiology office visits using a non-parametric Wilcoxon test for paired data. Results: One-hundred patients were included in the cohort (mean age 46.4 years (SD 46.4); 81% (81) female). At the initial visit, there was a significant increase in systolic (median 128 mmHg) and diastolic (median 83.5 mmHg) blood pressure from baseline (systolic median 121.5, p=0.029; diastolic median 76, p<0.001). All patients with an increase in blood pressure reported symptoms like chest pain. In the subset of 36 (36%) patients that have followed up, 35 (97%) patients were prescribed a new anti-hypertensive or required an increased dose of a prior anti-hypertensive at their initial visit. Blood pressures at follow-up were not significantly different from baseline (median systolic delta= 1.0mmHg, diastolic delta= -1.0mmHg; p>0.05), and 83% (30) reported improvement in symptoms. Conclusions: Patients presenting with cardiovascular symptoms post-acute COVID-19 show increased blood pressure when compared to blood pressure prior to infection. During subsequent follow-up appointments, patients showed improvement in their blood pressure and symptoms. While the pathophysiology has yet to be determined, it is likely related to the effects of a proinflammatory state, endothelial dysfunction, dysautonomia, or altered effects of the RAAS.

Download Full-text

Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends

PEDIATRICS ◽

10.1542/peds.75.6.1071 ◽

1985 ◽

Vol 75 (6) ◽

pp. 1071-1075

Author(s):

David E. Fixler ◽

W. Pennock Laird ◽

Kent Dana

Keyword(s):

Blood Pressure ◽

Stress Testing ◽

Isometric Exercise ◽

Systolic Pressure ◽

Exercise Stress ◽

Female Adolescents ◽

Exercise Stress Testing ◽

Stress Tests ◽

Blood Pressures

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.

Download Full-text

Clinical Comparison of Automatic, Noninvasive Measurements of Blood Pressure in the Forearm and Upper Arm With the Patient Supine or With the Head of the Bed Raised 45°: A Follow-Up Study

American Journal of Critical Care ◽

10.4037/ajcc2006.15.2.196 ◽

2006 ◽

Vol 15 (2) ◽

pp. 196-205 ◽

Cited By ~ 12

Author(s):

Kathleen Schell ◽

Denise Lyons ◽

Elisabeth Bradley ◽

Linda Bucher ◽

Maureen Seckel ◽

...

Keyword(s):

Blood Pressure ◽

Vital Signs ◽

Upper Arm ◽

Mean Values ◽

Noninvasive Measurements ◽

Starting Position ◽

Arm Circumference ◽

Blood Pressures ◽

Cuff Size

• Background Noninvasive measurement of blood pressure in the forearm is used when the upper arm is inaccessible and/or when available blood pressure cuffs do not fit a patient’s arm. Evidence supporting this practice is limited. • Objective To compare noninvasive measurements of blood pressure in the forearm and upper arm of medical-surgical inpatients positioned supine and with the head of the bed raised 45°. • Methods Cuff size was selected on the basis of forearm and upper arm circumference and manufacturers’ recommendations. With a Welch Allyn Vital Signs 420 Series monitor, blood pressures were measured in the forearm and then in the upper arm of 221 supine patients with their arms resting at their sides. Patients were repositioned with the head of the bed elevated 45° and after 2 minutes, blood pressures were measured in the upper arm and then the forearm. Starting position was alternated on subsequent subjects. • ResultsPaired t tests revealed significant differences between systolic and diastolic blood pressures measured in the upper arm and forearm with patients supine and with the head of the bed elevated 45°. The Bland-Altman procedure revealed that the distances between the mean values and the limits of agreement were from 15 to 33 mm Hg for individual subjects. • Conclusions Noninvasive measurements of blood pressure in the forearm and upper arm cannot be interchanged in medical-surgical patients who are supine or in patients with the head of the bed elevated 45°.

Download Full-text

PROGNOSTIC VALUE OF OFFICE BLOOD PRESSURE MEASUREMENT AND HYPERTENSION DIAGNOSIS IN ATRIAL FIBRILLATION

Journal of Hypertension ◽

10.1097/01.hjh.0000539119.05690.0f ◽

2018 ◽

Vol 36 (Supplement 1) ◽

pp. e57 ◽

Cited By ~ 2

Author(s):

A. Kollias ◽

K. Kyriakoulis ◽

E. Stambolliu ◽

G.S. Stergiou

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Pressure Measurement ◽

Prognostic Value ◽

Blood Pressure Measurement ◽

Office Blood Pressure ◽

Hypertension Diagnosis

Download Full-text

Validation of the Omron HBP-9031C professional office blood pressure monitor in the general population according to the ANSI/AAMI/ISO 81060-2:2013 protocol

Journal of Human Hypertension ◽

10.1038/s41371-020-0301-0 ◽

2020 ◽

Vol 34 (10) ◽

pp. 735-738 ◽

Cited By ~ 1

Author(s):

Kanako Saito ◽

Yukiko Hishiki ◽

Hakuo Takahashi

Keyword(s):

Blood Pressure ◽

General Population ◽

Office Blood Pressure ◽

Blood Pressure Monitor ◽

Pressure Monitor

Download Full-text

Evaluating the Situational Specificity of Relaxation in Mild Essential Hypertension

Perceptual and Motor Skills ◽

10.2466/pms.1980.51.2.667 ◽

1980 ◽

Vol 51 (2) ◽

pp. 667-674

Author(s):

John E. Martin ◽

Leonard H. Epstein

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Diastolic Blood Pressure ◽

Systolic Pressure ◽

Progressive Relaxation ◽

Multiple Baseline ◽

Self Monitoring ◽

Situational Specificity ◽

Blood Pressures

A multiple baseline across subject/settings design was employed to assess the specificity of the effects of progressive relaxation in two recently diagnosed, mild hypertensives. Relaxation was implemented successively across laboratory and home settings. In Subject 1, laboratory relaxation was associated with control over diastolic blood pressure, while in Subject 2, control over systolic pressure was observed. Improvements to normotensive levels were observed for both subjects, and the changes were maintained in both settings for Subject 2 at 6- and 12-mo. follow-up. Subject 1 discontinued her medications, relaxation, and self-monitoring of blood pressure, which was associated with an increase in blood pressure during treatment maintenance; however, at 6- and 12-mo. follow-up, both home and laboratory blood pressures were within normotensive range.

Download Full-text

Urinary albumin excretion and blood pressure in the general population

Clinical Science ◽

10.1042/cs0760039 ◽

1989 ◽

Vol 76 (1) ◽

pp. 39-42 ◽

Cited By ~ 56

Author(s):

Peter Gosling ◽

D. G. Beevers

Keyword(s):

Blood Pressure ◽

General Population ◽

Urinary Albumin Excretion ◽

Excretion Rate ◽

Albumin Excretion Rate ◽

Urinary Albumin ◽

Albumin Excretion ◽

Arterial Blood ◽

Blood Pressures ◽

Excretion Rates

1. Twenty-four hour urinary albumin excretion rate was measured by a sensitive radioimmunoassay in 99 male and 100 female randomly selected factory workers, aged between 20 and 60 years. 2 The median (range) albumin excretion rates for men and women of 4.67 (1.0–25.8) and 5.25 (0.2–33.0) mg/24 h, respectively, were not significantly different. 3. No correlation was established between diastolic, systolic or mean arterial blood pressure and albumin excretion rate for the whole group. 4. Twenty-eight subjects with systolic and/or diastolic blood pressures ≥ 140/90 mmHg (18.7/12.0 kPa) showed a positive correlation between mean arterial blood pressure and albumin excretion rate (r = 0.412,P < 0.01). 5. There was no significant relationship between number of cigarettes smoked, age or alcohol intake and albumin excretion rate. 6. The data suggest that in the general population albumin excretion rate is variable and not dependent on blood pressure, but at blood pressures > 140/90 mmHg (18.7/12.0 kPa) albumin excretion rate may become pressure dependent, although high albumin excretion rates were sometimes found in subjects with blood pressures < 140/90 mmHg (18.7/12.0 kPa).

Download Full-text