P275 Uncontrolled post-clinic blood pressure readings can identify nocturnal non-dipping blood pressure pattern

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
H Shahab ◽  
H Khan ◽  
M Tufail ◽  
A Artani ◽  
A Almas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pearson Correlation ◽  
P Value ◽  
Clinic Blood Pressure ◽  
Nocturnal Dipping ◽  
Cardiovascular Morbidity And Mortality ◽  
Minute Post ◽  
The Difference

Abstract Funding Acknowledgements Aga Khan University Faculty of Health Sciences Research Committee (#80096) On Behalf PC BP (Post Clinic Blood Pressure) Study Group Background Nocturnal non-dipping increases cardiovascular morbidity and mortality in both hypertensive and normotensive subjects. Ambulatory blood pressure monitoring(ABPM) can identify nocturnal blood pressure(BP) dipping patterns but clinic BP cannot. We previously showed that 15-minute post-clinic BP correlates well with 24- hour ABPM. Purpose We aimed to determine if 15-minute post-clinic BP reading helped to identify patients with nocturnal non-dipping pattern. Methods A cross-sectional study involving 150 participants, as part of the Post Clinic-Ambulatory Blood Pressure(PC-ABP) study, was conducted in cardiology clinics. Participants aged ≥18 years, with hypertension or those referred for its assessment, were included. Pregnant females were excluded. Post-clinic BP was taken 15 minutes after the patient-physician encounter in the clinic using an automated, validated BP device by a research assistant. All the participants were then referred for 24-hour ABPM. Patterns of nocturnal dipping were studied amongst groups of controlled(<140 mmHg) and uncontrolled(≥140mmHg) post-clinic systolic BP(SBP). Fischer exact test was used to determine the difference in dipping patterns amongst the two groups. Results The mean age of participants was 60.3 ± 11.9 years. Of 150 participants, 49% were male and of all, 76% were hypertensive. Mean nighttime SBP(±SD) was 121.9(±18) mmHg(p-value <0.001). Mean nighttime DBP(±SD) was 68.7(± 8.7) mmHg(p < 0.001). Patterns of nocturnal dipping amongst patients with mean post-clinic SBP <140mmHg versus ≥140mmHg has been shown in Table 1. The difference in nocturnal dipping patterns between the two groups was statistically insignificant(p-value 0.071). Pearson correlation coefficient between post-clinic SBP and nighttime SBP for patients with loss of dip was higher (0.64; p < 0.001) whereas it was 0.56(p-value <0.001) for those with preserved dip.  Conclusion Uncontrolled post-clinic BP can help in identifying patients with nocturnal non-dipping. Larger studies can help determine the prognostic value of post-clinic BP amongst patients with nocturnal non-dipping. Nocturnal Dipping Amongst The Two Groups Controlled PC SBP <140mmHg (n = 80) Uncontrolled PC SBP ≥140mmHg (n = 70) Preserved Nocturnal Dipping (10 to 20% nocturnal drop in SBP) 61.2% (n = 49) 47.1% (n = 33) Loss of Dip (>0% to <10% of nocturnal drop in SBP) 33.8% (n = 27) 48.6% (n = 34) Reversed Dip (≤0% drop in SBP) 5% (n = 4) 1.4%(n = 1) Excessive Dip (>20% drop in SBP) 0 2.9% (n = 2) Table 1 shows the patterns of nocturnal dipping amongst patients with controlled (<140mmHg) and uncontrolled (≥140mmHg) 15-minute post-clinic systolic blood pressure (PC SBP).

Clinic blood pressure shows low sensitivity to detect alterations in ambulatory blood pressure monitoring in patients with type 1 diabetes

2014 ◽  
Author(s):  
Francisco Javier Vilchez-Lopez ◽  
Isabel Mateo-Gavira ◽  
Florentino Carral-San Laureano ◽  
Maria Victoria Garcia-Palacios ◽  
Jose Ortego-Rojo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Low Sensitivity

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

2020 ◽  
Vol 59 (3) ◽  
pp. 228-235 ◽  
Author(s):  
Michelle Kaplinski ◽  
Heather Griffis ◽  
Fang Liu ◽  
Craig Tinker ◽  
Nina C. Laney ◽  
...  
Keyword(s):  
Blood Pressure ◽  
At Risk ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Medication ◽  
Blood Pressure Monitoring ◽  
Systemic Hypertension ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Multidisciplinary Program

Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.

P274 Three-hour ambulatory blood pressure monitoring: a new surrogate for ambulatory blood pressure assessment in the pakistani population

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
H Shahab ◽  
H Khan ◽  
M Tufail ◽  
A Almas ◽  
A H Khan
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Gold Standard ◽  
Blood Pressure Monitoring ◽  
Pearson Correlation ◽  
Pressure Monitoring ◽  
Limits Of Agreement ◽  
Pakistani Population ◽  
Blood Pressure Study

Abstract Funding Acknowledgements Aga Khan University Faculty of Health Sciences Research Committee (#80096) On Behalf PC BP (Post Clinic Blood Pressure) Study Group Background The gold standard Ambulatory Blood Pressure Monitoring (ABPM) eliminates white coat effect. However, it is expensive and 24 hours long, making it cumbersome. Prior studies in other populations have investigated the utility of shorter intervals in which ABPM can be used to get the same results as 24-hour ABPM. Purpose Our objective was to determine if 3-hour ABPM correlates with 24-hour ABPM in the Pakistani population. Methods A cross-sectional study, involving 150 participants as part of the PC ABP (post clinic ambulatory blood pressure) study, was conducted in the cardiology clinics, starting 2015. Participants ≥18years of age and were either hypertensive or referred for assessment of hypertension were included. Pregnant females were excluded. Blood pressure (BP) readings were taken with an ambulatory BP monitor over a 24 hour period, every half hour during daytime and every hour during nighttime. After excluding the first hour called the white-coat window, the mean of the first 6 systolic readings taken every half hour during the daytime was calculated and was called systolic 3-hour ABPM. Pearson correlation coefficients were calculated and Bland Altman plots were constructed to determine the correlation and limits of agreement between mean systolic 3-hour ABPM and mean daytime ABPM. Results Of 150 participants, 49% were male.  Of all participants, 76% were hypertensive. Mean age of the participants was 60.3 ± 11.9 years. Mean systolic 3-hour ABPM was 135.0 ± 16mmHg. Mean systolic daytime ABPM was 134.7 ± 15mmHg respectively. Pearson correlation coefficient between mean systolic 3-hour ABPM and mean systolic daytime ABPM was 0.85 (p-value of <0.001). The difference between systolic 3-hour ABPM and systolic daytime ABPM was 0.3mmHg (95% Confidence Interval -1.1 to 1.7mmHg). The limits of agreement were 18mmHg to -17mmHg for systolic 3-hour ABPM and systolic daytime ABPM. Conclusion Three-hour ABPM correlates well with 24-hour gold standard ABPM in the Pakistani population. We suggest using this shortened study for the assessment of hypertension where a full ABPM cannot be conducted due to expense or logistic reasons, thus saving time and upfront cost.

Secondary Hypertension in Children and Adolescents: Novel Insights

2020 ◽  
Vol 16 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Katerina Chrysaidou ◽  
Athanasia Chainoglou ◽  
Vasiliki Karava ◽  
John Dotis ◽  
Nikoleta Printza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Children And Adolescents ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Pressure Monitoring ◽  
Cardiovascular Morbidity And Mortality ◽  
Rising Incidence ◽  
Hypertension In Children

Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.

scholarly journals An Observational Study: Ambulatory Blood Pressure Monitoring after Percutaneous Transluminal Coronary Angioplasty

2018 ◽  
Vol 03 (01) ◽  
pp. 017-022
Author(s):  
Gopi Kenchi ◽  
Sunisha Gajula ◽  
Malleshwar Dangati
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Pulse Pressure ◽  
Coronary Angioplasty ◽  
Blood Pressure Monitoring ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Laboratory Parameters ◽  
Nocturnal Dipping ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

Abstract Aim In recent studies, lack of fall in nocturnal blood pressure (BP) has been presented as an independent predictor of poor prognosis. The aim of this study is to investigate the prognostic value of various variables of BP by 24-hour ambulatory blood pressure (ABP) measurement and sex-related differences after percutaneous transluminal coronary angioplasty (PTCA). Methods This study included 100 patients who underwent PTCA in the authors’ institute from June 2017 to January 2018. They were monitored by 24-hour ABP for 1 day in the hospital. Results One hundred patients were recruited in this study with mean age of 61.64 years, with female-to-male ratio of 0.27:1. All demographic, clinical, and laboratory parameters including the ABP parameters were comparable between females and males, except smoking and alcoholism that were more frequent in males.Out of 100 patients, 41 had nocturnal dipping in BP and 59 did not have nocturnal dipping. In this study, the variables among nondippers, 16 (27.1%) were females, 43 (72.8%) were males, 45 (63.3%) had diabetes mellitus (DM), 46 (75.4%) had hypertension (HTN), mean systolic blood pressure (SBP) was 141.7 ± 13.9 mm Hg, mean diastolic blood pressure (DBP) was 86.34 ± 5.64 mm Hg, mean pulse pressure (PP) was 55.39 ± 9.25 mm Hg, and pulse-wave velocity (PWV) was 6.69 ± 2.22 m/s.In females were more nondippers (27.1%) than dippers (12.1%), which was statistically significant (p = 0.05). Nondippers were more among hypertensive patients (77.9% vs. 36.5%; p = 0.00). Higher mean SBP (p = 0.001), higher mean BP (p = 0.032), and higher mean pulse pressure (p = 0.00) were observed in nondippers.However, age, ejection fraction (EF), presence of DM, coronary artery disease (CAD) severity, type of presentation, and PWV were not different in dipper versus nondippers. Conclusion With comparable clinical, laboratory parameters along with BP parameters between females and males, immediate post-percutaneous coronary intervention (PCI) patients, female PCI patients had more nondippers (p = 0.05). Overall nondippers had higher SBP, mean BP, and PP than dippers. Diabetes, severity of CAD, and type of presentation of CAD (as ACS or CSA) did not influence the nocturnal dipping quality of the BP.

scholarly journals Patient preferences for ambulatory blood pressure monitoring devices: Wrist-type or arm-type?

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255871
Author(s):  
Wei-wei Zeng ◽  
Sze Wa Chan ◽  
Brian Tomlinson
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Patient Acceptability ◽  
Additional Information ◽  
Type Device ◽  
Significant Difference ◽  
The Difference

Background Ambulatory blood pressure monitoring (ABPM) is important in evaluating average 24-hour blood pressure (BP) levels, circadian rhythm, sleeping BP and BP variability but many patients are reluctant to use standard ABPM devices. Methods We compared two validated ABPM devices, the BPro tonometric wrist monitor and the A&D TM-2430 oscillometric upper arm monitor, for agreement of recordings and acceptability in 37 hypertensive patients (aged 55±9 years). Results Successful BP measurements were less frequent with the wrist-type than the arm-type device during the sleeping (66.3% vs. 92.9%, P <0.01) and awake periods (56.2% vs. 86.5%, P <0.01). Comparable paired readings showed no significant difference in systolic BP but diastolic BP (DBP) values were higher with the wrist compared to the arm monitor (24-hour 89±13 vs. 85±14 mmHg, P <0.01) with similar differences awake and sleeping. Bland-Altman analysis showed some large discrepancies between individual arm and wrist monitor measurements. More patients found the wrist monitor more comfortable to use than the arm monitor. Conclusions Despite the difference in individual BP measurements and the systematic overestimation of DBP values with the BPro device, wrist monitors with good patient acceptability may be useful to facilitate ABPM in some patients to provide additional information about cardiovascular risk and response to antihypertensive therapies.

Abstract 14769: The Relationship Between Regular Physical Exercise and Nocturnal Blood Pressure in Korean Ambulatory Blood Pressure Monitoring Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bae Keun Kim ◽  
Lee Yonggu ◽  
Lim Young-Hyo ◽  
Jinho Shin
Keyword(s):  
Blood Pressure ◽  
Physical Exercise ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Independent Factor ◽  
Pressure Monitoring ◽  
Exercise Frequency ◽  
Nocturnal Dipping ◽  
The Relationship ◽  
Regular Physical Exercise

Introduction: There have been many reports showing that regular physical exercise can reduce the blood pressure (BP). Thus physical exercise is one of the important components of lifestyle modification of hypertension. It is known that nocturnal BP is an independent factor for the cardiovascular event but there are few studies for the relationship between physical exercise and nocturnal BP. Hypothesis: Hypothesized regular physical exercise reduced nocturnal BP, therefore, we aimed to analyze the relationship between regular physical exercise assessed by a questionnaire (7-day physical activity recall) and nocturnal BP in the general population. Methods: Among 4145 subjects whose data for both clinical data and ambulatory blood pressure monitoring (ABPM) data file from the 5308 Korean ABPM (KorABP) study subjects, 3689 subjects were analyzed. The exclusion criteria was age less than 20 years (n=84), missing data for the questionnaire for physical exercise (n=372). Physical exercise was defined as regular structured exercise which intensity was heavier than the fast walking for 30 minutes. The count was recorded as the number per week. Results: Age was 55.5 ± 14.1 years and female was 45.9 %. Prevalence of hypertension, antihypertensive medication (AHM), diabetes and cardiovascular diseases were 58.9%, 32.5%, 13.0%, and 21.1%, respectively. Daytime and nighttime systolic BP was 138.5 ± 17.2 mmHg and 126.3 ± 18.8 mmHg. When adjusted for age, sex, BMI, and AHM, exercise frequency was independently decreased daytime systolic BP (β = -0.52 mmHg per ex-ercise, p = 0.02). For the nighttime systolic BP further adjusted by daytime systolic BP and sleep quality, ex-ercise frequency was an independent factor (β = -0.26 mmHg per exercise, p = 0.002). The statistical significances were observed even for only for 1 times per week. When further adjusted by smoking, exercise frequency was in-dependent for nocturnal dipping (β = 0.18% per exercise, p = 0.015). Conclusions: Regular physical exercise is independently associated with lower nocturnal BP also lower daytime BP and with increased nocturnal dipping, which was independent of AHM status.

Abstract P172: Orthostatic Hypotension And 24-hr Ambulatory Blood Pressure Monitoring In The Sprint Trial

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Paul Drawz ◽  
Nicholas Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Blood Pressure Monitoring ◽  
Treatment Strategies ◽  
White Coat ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Ambulatory Bp Monitoring ◽  
Trial Testing ◽  
The Difference

Background: Clinic blood pressure (BP) is measured in the seated position, which can miss important home BP phenotypes such as low ambulatory BP (white coat effects) or high supine BP (nocturnal non-dippers). Orthostatic hypotension (OH) is determined based on BP measurements in both seated (or supine) and standing positions, and thus could theoretically identify these important phenotypes in clinic. Objective: To determine the association of OH with white coat effects or night-to-daytime systolic BP (SBP) Methods: SPRINT was a randomized trial testing the effects of intensive (<120 mmHg) or standard (<140 mmHg) SBP treatment strategies in adults at higher risk of cardiovascular disease. OH was assessed at 6, 12, or 24-mths and defined as a decrease in standing and mean seated SBP ≥20 or DBP ≥10 mmHg after 1 min of standing. White coat effects, based on 24-hr ambulatory BP monitoring performed at the 27-mth visit (every 30-minutes), were defined as the difference between 27-mth seated clinic and ambulatory BP ≥ 20/≥10 mmHg. SBP dipping ratio was defined as the ratio of night-to-daytime SBP >0.9. Results: Of 897 adults (mean age 71.5 [SD, 9.5] yrs, 28.7% female, 28.0% black), 128 had OH at least once. Among those with OH, 14.8% had white coat effects versus 7.2% among those without OH. Moreover, 68.8% of those with OH demonstrated non-dipping patterns versus only 52.0% of those without OH. OH was positively associated with both white coat effects (OR=2.24; 95% CI: 1.28, 4.27) and higher night-to-daytime SBP (β=0.04; 95% CI: 0.02, 0.06) ( Table ). Conclusions: Clinic-based assessments of OH may be a useful tool for identifying BP phenotypes often missed with traditional seated BP assessments.

Sign in / Sign up

Export Citation Format

Share Document