Regression to the mean of repeated ambulatory blood pressure monitoring in five studies

Abstract BACKGROUND: Corticosteroids are still a cornerstone in multiple myeloma (MM) therapy, both as a single agent and as a part of many protocols, including VAD regimen (vincristine, adriblastine, dexamethasone). Corticosteroids are known to be involved in blood pressure (BP) regulation and to affect this parameter. The impact of dexamethasone (Dex) administration on BP in MM patients during VAD protocol treatment is poorly documented. AIM: The purpose of the study was to evaluate the blood pressure changes during Dex administration in patients treated with VAD protocol due to MM. METHODS: Thirteen patients with MM (7 men and 6 women; mean age 62,45 ± 8,14) were assessed. Primary hypertensive patients (7 persons) were not excluded. They were administered Dex in standard dose of 40 mg (day 1–4, 9–12, 17–21) according to VAD protocol. Blood pressure was assessed by the use of commercially available instruments of Ambulatory Blood Pressure Monitoring (ABPM). The BP recordings lasted 48 hours, were started on the day before the first day of VAD and were obtained every 10 minutes during mornings, every 15 minutes during the rest of days and every 20 minutes during nights. Average of systolic and diastolic blood pressure (SBP/DBP) were estimated for the 2-hour time before Dex and for the 14-hour time in the 2-hour periods after Dex. Minimal and maximal range of SBP/DBP increase and the mean amount of SBP/DBP increase were also determined. RESULTS: 48-hour BP recordings revealed a significant increase in systolic and diastolic blood pressure after Dex administration in all patients. SBP and DBP began to increase after 3 hours after Dex, then rose continually and reached the peak in the period from 6 to 10 hour after Dex. In comparison to 2-hour period before Dex, in which SBP/DBP amounted 139,63/82,92 ± 23,47/9,38 mmHg, the mean SBP/DBP increase rate was: in the 2–4 hour period after Dex - 146,68/88,15 ± 24,38/10,51 mmHg (p<0,05), in the 6–8 – 148,07/92,66 ± 14,07/9,04 mmHg (ns), in the 8–10 – 147,8/87,99 ± 14,07/9,04 mmHg (p<0,01), in the 10–12 – 143,44/86,12 ± 17,22/9,77 mmHg (p<0,05) and in the 12–14 – 144,47/88,59 ± 17,04/12,54 mmHg (p<0,01). The minimal range of SBP/DBP increase was 10,50/−2,00 mmHg, maximal range of SBP/DBP increase was 35,43/40,00 mmHg and the mean amount of SBP/DBP increase was 20,06/11,6 ± 8,36/14,23 mmHg. CONCLUSION: Our preliminary study revealed that Dex administration causes an increase in BP in all patients. The mean increase in BP amounted 20,06/11,6 ± 8,36/14,23 mmHg and was similar in all patients, regardless their initial value of BP. So our study demonstrates the need of individualized hypertension treatment with strict control of BP in hypertensive patients when corticosteroid therapy is indicated.

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Ambulatory blood pressure monitoring in patients with ST- elevation myocardial infarction: one year follow-up study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194591 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4054

Author(s):

Srikanth Nathani

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

St Elevation ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The aim of this study was evaluation of nocturnal dipping of blood pressure in ST-elevation myocardial infarction (STEMI) patients and determining the effect of dipping on outcomes at 12 months follow-up.Methods: This was an observational, single-centre, retrospective study that included STEMI patients, performed in a tertiary care hospital in India from November 2016 to October 2017. The primary endpoint of the study was the assessment of outcomes at 12 months. The patients were divided into two groups on the basis of blood pressure dipping, i.e., patients with positive dipping were considered in group 1 and patients with negative dipping were considered in group 2.Results: Total 43 patients were included in the study. Group 1 consisted of 27 patients and Group 2 consisted of 16 patients. Mean 24 hr systolic blood pressure (SBP) and asleep SBP in Group 1 patients was 128.15±18.05 mmHg and 122.67±18.94 mmHg, respectively. Mean 24 hr diastolic (DBP) and asleep DBP in Group 1 patients was 78.07±10.73 mmHg and 73.41±12.35 mmHg, respectively. In the patients with non-dipping, mean 24 hr SBP and asleep SBP was 130.56±27.32 mmHg and 135.13±29.58 mmHg, respectively. Mean 24 hr DBP and asleep DBP was 76.00±15.40 mmHg and 79.69±17.05 mmHg, respectively. The mean percentage of asleep dipping of SBP was 5.7±6.7% in Group 1 and -4.6±6.82% in Group 2. Similarly, the mean percentage of asleep dipping of DBP was 7.6±9.0% in Group 1 and -6.3±9.1% in Group 2.Conclusions: In view of the results, it can be concluded that ambulatory blood pressure monitoring in patients with STEMI can provide a significant prognostication of the future events.

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Does the mean 24-h pulse rate from ambulatory blood pressure monitoring reflect the mean 24-h ventricular rate from Holter electrocardiogram in atrial fibrillation patients?

Blood Pressure Monitoring ◽

10.1097/mbp.0000000000000481 ◽

2020 ◽

Vol 25 (6) ◽

pp. 332-337

Author(s):

Hui-yu Tong ◽

Jian-hua Yu ◽

Kui Hong ◽

Jing Chen ◽

Hong-yu Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Pulse Rate ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Ventricular Rate ◽

Pressure Monitoring ◽

The Mean

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Efficacy of chlorthalidone and hydrochlorothiazide in combination with amiloride in multiple doses on blood pressure in patients with primary hypertension: a protocol for a factorial randomized controlled trial

Trials ◽

10.1186/s13063-019-3909-z ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Vítor Magnus Martins ◽

Lucas Helal ◽

Filipe Ferrari ◽

Leonardo Grabinski Bottino ◽

Sandra Costa Fuchs ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Primary Hypertension ◽

Blood Pressure Lowering ◽

Pressure Monitoring ◽

Pressure Lowering ◽

The Mean

Abstract Background Thiazide diuretics have demonstrated favorable blood pressure lowering efficacy, but the equivalent doses of their more common agents, chlorthalidone and hydrochlorothiazide, are still unclear. Further, concerns exist regarding adverse metabolic effects, which may be attenuated with the concomitant administration of a potassium-sparing diuretic, such as amiloride. This trial aims to investigate the efficacy of chlorthalidone and hydrochlorothiazide, in combination with amiloride at different doses, for initial management of patients with primary hypertension. Methods/design This is a factorial (2 × 2) randomized double-blinded clinical trial comparing the association of a thiazide diuretic (chlorthalidone 25 mg/day or hydrochlorothiazide 50 mg/day) with a potassium-sparing diuretic (amiloride 10 mg/day or amiloride 20 mg/day) in patients with primary hypertension. The primary outcome will be the mean change from baseline in 24-h systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes will be the mean change from baseline in daytime and nighttime systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring, mean change from baseline in systolic and diastolic blood pressure measured by office blood pressure, incidence of adverse events, variation of laboratory parameters, and proportion of patients who achieved blood pressure control. The follow-up will last 12 weeks. For a P alpha of 0.05, power of 80%, standard deviation of 9 mmHg, and absolute difference of 6 mmHg on systolic blood pressure on 24-h ambulatory blood pressure monitoring, it will be necessary to study a total of 76 patients. The sample size will be increased by 10% to compensate for losses, resulting in 84 patients being randomized. Discussion Diuretics are pivotal drugs for the treatment of hypertension. Chlorthalidone and hydrochlorothiazide, in combination with amiloride in multiple doses, will be tested in terms of blood pressure lowering efficacy and safety. Since the intensity of blood pressure reduction is the major determinant of reduction in cardiovascular risk in hypertensive patients, this study will help to determine which combination of diuretics represents the most appropriate treatment for this population. Trial registration ClinicalTrials.gov, NCT03928145. Registered on 25 April 2019. Last update on 29 April 2019.

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Efficacy of chlorthalidone and hydrochlorothiazide in combination with amiloride in multiple doses on blood pressure in patients with primary hypertension: a protocol for a factorial randomized controlled trial.

10.21203/rs.2.12261/v2 ◽

2019 ◽

Author(s):

Vitor Magnus Martins ◽

Lucas Helal ◽

Filipe Ferrari ◽

Leonardo Grabinski Bottino ◽

Sandra Costa Fuchs ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Primary Hypertension ◽

Blood Pressure Lowering ◽

Pressure Monitoring ◽

Pressure Lowering ◽

The Mean

Abstract Background Thiazide diuretics have demonstrated favorable blood pressure lowering efficacy, but it is still unclear what are the equivalence of doses of their more common agents, chlorthalidone and hydrochlorothiazide. Further, there exist concerns regarding adverse metabolic effects which may be attenuated with the concomitant administration of a potassium-sparing diuretic, such as amiloride. This trial aims to investigate the efficacy of chlorthalidone and hydrochlorothiazide, in combination with amiloride in different doses, for the initial management in patients with primary hypertension. Methods This is a factorial (2x2) randomized double-blinded clinical trial comparing the association of a thiazide diuretic (chlorthalidone 25 mg/day or hydrochlorothiazide 50 mg/day) with a potassium-sparing diuretic (amiloride 10 mg/day or amiloride 20 mg/day) in patients with primary hypertension. The primary outcome will be the mean change from baseline in 24-h systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes will be the mean change from baseline in daytime and nighttime systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring, mean change from baseline in systolic and diastolic blood pressure measured by office blood pressure, incidence of adverse events, variation of laboratory parameters and proportion of patients who achieved blood pressure control. The follow-up will last 12 weeks. For a P alpha of 0.05, power of 80%, and standard deviation of 9 mmHg, and absolute difference of 6 mmHg on systolic blood pressure on 24-h ambulatory blood pressure monitoring, it will be necessary to study a total of 76 patients. The sample size will be increased by 10% to compensate losses, resulting in 84 patients being randomized. Discussion Diuretics are pivotal drugs for the treatment of hypertension. Chlorthalidone and hydrochlorothiazide, in combination with amiloride in multiple doses, will be tested in terms of blood pressure lowering efficacy and safety. Since the intensity of blood pressure reduction is the major determinant of reduction in cardiovascular risk in hypertensive patients, this study will help to determine which combination of diuretics represents the most appropriate treatment for this population.

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Efficacy of chlorthalidone and hydrochlorothiazide in combination with amiloride in multiple doses on blood pressure in patients with primary hypertension: a protocol for a factorial randomized controlled trial.

10.21203/rs.2.12261/v1 ◽

2019 ◽

Author(s):

Vitor Magnus Martins ◽

Lucas Helal ◽

Filipe Ferrari ◽

Leonardo Grabinski Bottino ◽

Sandra Costa Fuchs ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Primary Hypertension ◽

Blood Pressure Lowering ◽

Pressure Monitoring ◽

Pressure Lowering ◽

The Mean

Abstract Background Thiazide diuretics have demonstrated favorable blood pressure lowering efficacy, but it is still unclear what are the equivalence of doses of their more common agents, chlorthalidone and hydrochlorothiazide. Besides, concernments about adverse metabolic effects do exist, which may be attenuated with the concomitant administration of a potassium-sparing diuretic, such as amiloride. This trial aims to investigate the efficacy of chlorthalidone and hydrochlorothiazide, in combination with amiloride in different doses, for the initial management in patients with primary hypertension. Methods This is a factorial (2x2) randomized double-blinded clinical trial comparing the association of a thiazide diuretic (chlorthalidone 25 mg/day or hydrochlorothiazide 50 mg/day) with a potassium-sparing diuretic (amiloride 10 mg/day or amiloride 20 mg/day) in patients with primary hypertension. The primary outcome will be the mean change from baseline in 24-h systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes will be the mean change from baseline in daytime and nighttime systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring, mean change from baseline in systolic and diastolic blood pressure measured by office blood pressure, incidence of adverse events, variation of laboratory parameters and proportion of patients who achieved blood pressure control. The follow-up will last 12 weeks. For a P alpha of 0.05, power of 80%, and standard deviation of 9 mmHg, and absolute difference of 6 mmHg on systolic blood pressure on 24-h ambulatory blood pressure monitoring, it will be necessary to study a total of 76 patients. The sample size will be increased by 10% to compensate losses, resulting in 84 patients being randomized. Discussion Diuretics are pivotal drugs for the treatment of hypertension. Chlorthalidone and hydrochlorothiazide, in combination with amiloride in multiple doses, will be tested in terms of blood pressure lowering efficacy and safety. Since the intensity of blood pressure reduction is the major determinant of reduction in cardiovascular risk in hypertensive patients, this study will help to determine which combination of diuretics represents the most appropriate treatment for this population.

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Comparison of the manual blood pressure record with ambulatory blood pressure monitoring in young patients found to be hypertensive during routine medical examination before induction to high altitude areas

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20204072 ◽

2020 ◽

Vol 7 (10) ◽

pp. 1563

Author(s):

Munish Sharma ◽

Anupam Pandit

Keyword(s):

Blood Pressure ◽

High Altitude ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Young Patients ◽

White Coat Hypertension ◽

Pressure Monitoring ◽

The Mean ◽

Manual Blood Pressure

Background: Ambulatory blood pressure monitoring (ABPM) measurements has been found to be superior to Outpatient Department (OPD) blood pressure measurements (OBPM) for predicting clinical outcomes. There have been various indications of ABPM like to exclude white coat hypertension, evaluation of symptomatic hypotension and hypertension, pregnancy induced hypertension etc. We studied use of ABPM in evaluation of young subjects who were found to be hypertensive in OBPM.Methods: This prospective study was performed at Command Hospital, Kolkata, India from December 2017 to November 2019.This study had a total of 100 subjects. All patients were young healthy individuals and found to have high blood pressure (BP) readings during routine examination done before induction to high altitude areas (>9000 feet). All subjects who were found to be hypertensive in OBPM were evaluated with 24 hours ABPM at least one week after cessation of all medications. Data expressed as the mean±SD. Comparisons of (a) the peripheral hospital mean systolic and diastolic BP over 01 week and (b) 24 hours mean ABPM. Results: In the study, the Mean Systolic BP was 143.33±11.82 with corresponding ABPM 123.92±13.17 which is statistically significant. The mean diastolic BP was 87.30±7.20 mm with corresponding ABPM as 71.55±4.11 MAP in manual blood pressure is 125.55 mm and 103.6 mm in ABPM. The results are highly significant.Conclusions: The study concludes that automated BP recordings may provide a more accurate estimate of a patient's BP status and may prevent unnecessary labelling of young patients as hypertensive.

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