scholarly journals The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oleg V. Mamontov ◽  
Andrey V. Kozlenok ◽  
Alexei A. Kamshilin ◽  
Evgeny V. Shlyakhto
Keyword(s):  
Blood Pressure ◽  
Cold Stress ◽  
Valsalva Maneuver ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Peripheral Resistance ◽  
Autonomic Regulation ◽  
Tilt Test ◽  
Hypertensive Patients

Purpose. Comprehensive study of autonomic regulation assessed during follow-up could provide new detailed information about the risks stratification for hypertensive patients. Therefore, we investigated the associations of these indices with death, stroke, and revascularization during the follow-up observation of 55 patients. Methods. All patients were with target organ damage, and 27 of them had associated clinical conditions (ACC). Mean age of patients with and without ACC was 62.6 ± 4.2 and 51.9 ± 9.9 (mean ± SD) years, respectively. Follow-up was from 66 to 95 months. At entry, autonomic regulation was assessed by the tilt test, Valsalva maneuver, hand-grip test, and cold-stress vasoconstriction. Hemodynamic parameters were measured by continuous blood pressure monitoring, occlusion plethysmography, and electrocardiography. Re-examination of patients was carried out by questioning and physical and laboratory examination. Results. We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs. 1.69 ± 0.37, P<0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P<0.05) but with higher peripheral resistance (1.36 ± 0.19 vs. 0.89 ± 0.25, P<0.001) and respiratory-range blood pressure variability (BPV) (18.2 ± 14.2 vs. 6.2 ± 4.2 mmHg, P<0.001). Higher total-range BPV (103 ± 51 vs. 65 ± 45 mmHg, P<0.05) in patients who had a stroke was observed. Initial diastolic orthostatic hypertension (6.6 ± 10.8 vs. 0.4 ± 6.3 mmHg, P<0.05) and lower Valsalva index (1.36 ± 0.11 vs. 1.82 ± 0.37, P<0.05) in patients who suffered a new ACC were important findings as well. Conclusions. This study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course.

scholarly journals THE PARTICULARITIES OF ABPM PARAMETERS IN HYPERTENSIVE PATIENTS WITH NON-DIALYSIS CKD

2017 ◽  
Vol 64 (4) ◽  
pp. 279-283
Author(s):  
Alexandru Minca ◽  
◽  
Mihai Comsa ◽  
Maria Mirabela Manea ◽  
Maria Daniela Tanasescu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Stiffness Index ◽  
Area Index ◽  
Hypertensive Patients ◽  
Arterial Stiffness Index

Chronic kidney disease (CKD) affects approximately two million people (in a population of 20 million) in Romania. Hypertension is often associated with CKD and both (hypertension and CKD) are risk factors for cardiovascular (CV) events. Ambulatory blood pressure monitoring (ABPM) is increasingly used all around the world for the diagnosis and monitoring of BP (blood pressure) because it is proven that the ABPM is superior to office BP measurements in evaluating patients with hypertension, with or without CKD. Reduced nocturnal BP fall (non-dipping or reverse-dipping patterns) is associated with target organ damage, especially kidney disease and the proportion of non-dippers and reverse-dippers patients increases progressively with the reduction of glomerular filtration rate (GFR). Another ABPM parameter, ambulatory arterial stiffness index (AASI), is an index which was recently proposed for the evaluation of arterial stiffness (a better tool than PP). It has prognostic value for cardiac death and stroke and several studies have showed that is negatively related to eGFR and is positively related to albuminuria. Hyperbaric area index (HBI) might be considered a novel sensitive marker [independent of patterns of NBPC (nocturnal BP change)] for the reduction of kidney function. These facts suggest that ABPM offers multiple useful data with impact, not only in future CV and renal outcomes assessment, but also in the treatment and management of hypertensive patients with CKD.

The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Yusuf Selcoki ◽  
Burak Uz ◽  
Nuket Baybek ◽  
Ali Akcay ◽  
Beyhan Eryonucu
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Pressure Monitoring ◽  
Hypertensive Patients ◽  
Spot Urine

AbstractIndividuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as ‘nondippers’. Non-dipping patterns in hypertensive patients have been shown to be associated with an excess of target organ damage and other adverse outcomes. The present study was designed to investigate the relationship between nocturnal BP pattern, defined on the basis of the ambulatory blood pressure monitoring (ABPM) recording, and cardiac and renal target organ damage in a population of at least one year treated essential hypertensive subjects. The present analysis involved 123 patients with treated essential hypertension attending the outpatient clinic of our centre. Each patient was subjected to the following procedures: blood sampling for routine blood chemistry, spot urine for proteinuria, 24-hour periods of ABPM, and echocardiography. In the ABPM period, a dipping pattern was observed in 65 of the 123 patients, and a non-dipping pattern in 58 patients. Body mass index was higher in the non-dippers (26 ± 4 versus 28 ± 4, p<0.05). The proteinuria in spot urine was significantly higher in the non-dippers (10 ± 6 versus 24 ± 48, p<0.03). Left ventricular mass, interventricular septum thickness, posterior wall thickness and left ventricular systolic diameter were significantly higher in the non-dippers compared to the dippers. Left ventricular diastolic function was similar in non-dipper cases, except E-wave deceleration time. In treated essential hypertensives the blunted or absent nocturnal fall in blood pressure can be a strong predictor of cardiac and renal events. Hypertensive patients should be evaluated by ambulatory blood pressure monitoring. To prevent patients at risk for morbidity and mortality casualities as a result of hypertension, patients should be evaluated by ambulatory blood pressure monitoring. This method can be utilized for exacting future follow-ups with the patient.

scholarly journals Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

2018 ◽  
Vol 64 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Ioan Tilea ◽  
Dorina Petra ◽  
Elena Ardeleanu ◽  
Adina Hutanu ◽  
Andreea Varga
Keyword(s):  
Blood Pressure ◽  
Current Knowledge ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Sleep Apnea Syndrome ◽  
Predictive Markers ◽  
Distribution Width ◽  
Hypertensive Patients ◽  
Obstructive Sleep ◽  
Clinical Conditions

AbstractHypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor.The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

scholarly journals Uric Acid Is Not Associated With Blood Pressure Phenotypes and Target Organ Damage According to Blood Pressure Phenotypes

2020 ◽  
Author(s):  
Anping Cai ◽  
Lin Liu ◽  
Mohammed Siddiqui ◽  
Dan Zhou ◽  
Jiyan Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Uric Acid ◽  
Arterial Stiffness ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Uncontrolled Hypertension ◽  
Hypertensive Patients

Abstract BACKGROUND Hypertensive patients with increased serum uric acid (SUA) are at increased cardiovascular (CV) risks. Both the European and American hypertension guidelines endorse the utilization of 24 h-ambulatory blood pressure monitoring (24 h-ABPM) for hypertensive patients with increased CV risk. While there is difference in identifying uric acid as a CV risk factor between the European and American guidelines. Therefore, it is unknown whether 24 h-ABPM should be used routinely in hypertensive patients with increased SUA. METHODS To address this knowledge gap, we investigated (i) the correlation between SUA and 24 h-ABP; (ii) the association between SUA and blood pressure (BP) phenotypes (controlled hypertension [CH], white-coat uncontrolled hypertension [WCUH], masked uncontrolled hypertension [MUCH], and sustained uncontrolled hypertension [SUCH]); (iii) the association between SUA and target organ damage (TOD: microalbuminuria, left ventricular hypertrophy [LVH], and arterial stiffness) according to BP phenotypes. RESULTS In 1,336 treated hypertensive patients (mean age 61.2 and female 55.4%), we found (i) there was no correlation between SUA and 24 h, daytime, and nighttime systolic blood pressure/diastolic blood pressure, respectively; (ii) in reference to CH, SUA increase was not associated WCUH (odds ratio [OR] 0.968, P = 0.609), MUCH (OR 1.026, P = 0.545), and SUCH (OR 1.003, P = 0.943); (iii) the overall prevalence of microalbuminuria, LVH, and arterial stiffness was 2.3%, 16.7%, and 23.2%, respectively. After adjustment for covariates, including age, sex, smoking, body mass index, diabetes mellitus, and estimated glomerular filtration rate, there was no association between SUA and TOD in all BP phenotypes. CONCLUSIONS These preliminary findings did not support routine use of 24 h-ABPM in treated hypertensive patients with increased SUA.

Reasons for not achieving control: therapeutic inertia in monitoring hypertension in primary care.

2020 ◽  
Author(s):  
Arleen De León Robert ◽  
Carmen López-Alegría ◽  
Isabel María Hidalgo-García ◽  
María Concepción Escribano-Sabater ◽  
José Joaquin Antón-Botella ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Monitoring ◽  
Total Sample ◽  
University Hospital ◽  
Clinical Inertia ◽  
Hypertensive Patients ◽  
Therapeutic Inertia ◽  
Clinical Ethics Committee

Abstract Background: Physicians’ failure to change/adjust treatments after learning of poor follow-up control in hypertensive patients can be defined as clinical inertia, a frequent and serious problem that affects health care activity at the international level. Method: A total of 153 hypertensive patients under 80 years of age who met the inclusion and exclusion criteria and had received ambulatory blood pressure monitoring (ABPM) for 24 hours as the follow-up method to evaluate their level of blood pressure (BP) control. One year after data collection, the included patients were studied retrospectively, and the changes introduced by their physicians were checked based on their results. Results: Sixty-five hypertensive patients (42.5%) out of the total sample (153) were classified as poorly controlled; of these, 36 were subject to therapeutic inertia (55%). Of the 29 hypertensive patients who did undergo treatment adjustment (45%), 15 (52%) underwent adjustment before the month of notification. Conclusion: Therapeutic inertia in the care of hypertensive patients continues to be a common problem in primary care. Young hypertensive patients of male sex, smokers and nondiabetic patients were the most affected groups. Test record: Registered retrospectively by the Clinical Ethics Committee of the José María Morales Meseguer University Hospital with the code EST: 62/17

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