Abstract P632: The Blood Pressure in Dialysis (BID) Pilot Study

Background: The optimal blood pressure (BP) target for hypertensive hemodialysis (HD) patients is unknown. Current KDOQI guidelines have been extrapolated from data in the general population. The BID pilot, funded by NIDDK and DCI, is the first trial to randomize hypertensive HD patients to intensive (110-140 mm Hg) vs. usual (155-165 mm Hg) control of systolic blood pressure (SBP). The study’s goal is to assess the feasibility of conducting a full-scale trial. Methods: BID consortium consists of 5 clinical centers, a cardiac MRI reading center and a data coordinating center. Standardized predialysis SBP, measured in the dialysis unit in accord with AHA recommendations (SDUSBP), guide therapy. To be eligible for randomization patients needed a 2-week running mean SDUSBP ≥ 155 mm Hg. Home BP measurements (HBPM) are obtained twice on the day after the midweek dialysis. Ambulatory Blood Pressure Monitoring (ABPM) during a 44h interdialytic period is obtained quarterly. We compared SDUSBP, HBPM and ABPM. Results: We enrolled 281 and randomized 126 participants. Major reasons for drop out during the baseline period were 2-week mean SDUSBP < 155 mm Hg (40.6%), no cardiac MRI (13.0%) and perception of protocol as burdensome (11.2%). Adherence with prescribed SDUSBP was satisfactory. The percent of patients with ≥ 4, ≥ 8 and ≥12 SBP per month were 96, 88 and 57% in month 1 and 78, 68 and 37% in month 12. In a constant cohort of participants followed ≥ 330 days 2-week mean SDUSBP were 144 ± 17.4 and 156 ± 15.2 mm Hg in the intensive and usual arms, respectively. Major reasons that participants in the intensive arm did not achieve target SBP included large interdialytic weight gain (27.2%), non-adherence with medications or dialysis prescription (40.9%), and intradialytic hypotension (31.9%). Differences between the SDUSBP and both HBPM and ABPM were often ≥ 10 mm Hg. Optimal control of BP requires measurements in and out of the dialysis unit. Rates of adverse events were similar to those in other NIDDK funded ESRD studies. Conclusion: The difference in BP between arms was achieved and maintained throughout the study. It is feasible to conduct a full-scale clinical trial of intensive vs. usual treatment of hypertension in HD patients.

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Perbedaan Derajat Ansietas antara Penyandang Hipertensi Belum Terkontrol dengan yang Terkontrol

e-CliniC ◽

10.35790/ecl.v7i2.26283 ◽

2019 ◽

Vol 7 (2) ◽

Author(s):

Cerelia E. C. Sugeng ◽

Emma Sy. Moeis ◽

Glady I. Rambert

Keyword(s):

Blood Pressure ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Blood Pressure Monitoring ◽

Office Blood Pressure ◽

Generalized Anxiety ◽

Pressure Monitoring ◽

Hypertensive Patients ◽

Significant Difference ◽

The Difference

Abstract: Hypertension and anxiety are among the group of the most common chronic disease worldwide, and according to numerous studies they are oftentimes associated each other. Patients suffered from chronic illnesses, such as hypertension, may have negative emotion that increases the risk of mental disorders, most commonly anxiety disorder. This study was aimed to assess the difference of anxiety degree between uncontrolled and controlled hypertensive patients. This was an observational analytical study with a cross-sectional design. Subjects were divided into two groups: controlled and uncontrolled hypertensive patients. Measurement of blood pressure parameter was performed by using office blood pressure monitoring. Anxiety parameter was classified based on the scoring of the Generalized Anxiety Disorder Scale (GAD-7). Data were analyzed by using the Mann-Whitney test. Subjects consisted of 60 hypertensive patients (35 males and 25 females), aged 30-70 years (mean 56.48 years). There were 35 controlled hypertension patients and 22 uncontrolled hypertensive patients. The results showed that the difference in anxiety degree based on GAD-7 between controlled hypertensive and uncontrolled hypertensive groups obtained a p-value of 0.000. In conclusion, there was a significant difference in anxiety degree between uncontrolled and controlled hypertensive patients. Screening for anxiety among hypertensive patients is a simple and cost-effective tool that may improve outcomes.Keywords: anxiety, uncontrolled hypertension, controlled hypertension Abstrak: Hipertensi dan ansietas merupakan kelompok penyakit kronik yang paling umum di seluruh dunia. Berdasarkan banyak penelitian kedua penyakit ini saling berhubungan satu sama lain. Penyandang hipertensi mungkin memiliki emosi negatif yang meningkatkan risiko terjadinya gangguan mental berupa ansietas. Ansietas dan dukungan sosial rendah akan menghambat proses penyembuhan terutama dalam mengontrol tekanan darah. Penelitian ini bertujuan untuk menge-tahui apakah terdapat perbedaan derajat ansietas antara penyandang hipertensi belum terkontrol dengan hipertensi terkontrol. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Subyek penelitian dibagi menjadi dua kelompok, yaitu kelompok penyandang hipertensi belum terkontrol dan hipertensi terkontrol. Pengukuran parameter tekanan darah dilakukan dengan menggunakan alat Oscillometric digital dengan cara Office Blood Pressure Monitoring (OBPM). Parameter ansietas diklasifikasikan berdasarkan skala Generalized Anxiety Disorder Scale (GAD-7). Adanya perbedaan derajat ansietas antara kedua kelompok dinilai dengan uji Mann-Whitney. Subyek penelitian terdiri dari 60 penyandang hipertensi (35 laki-laki dan 25 perempuan) berusia 30-70 tahun (rerata 56,48 tahun). Terdapat 25 penyandang hipertensi yang belum terkontrol dan 35 penyandang hipertensi terkontrol. Hasil penelitian menunjukkan bahwa terdapat perbedaan derajat ansietas berdasarkan GAD-7 antara kedua kelompok (p=0,000). Simpulan penelitian ini ialah terdapat perbedaan bermakna dalam derajat ansietas antara penyandang hipertensi yang belum terkontrol dengan yang terkontrol. Skrining ansietas pada penyandang hipertensi merupakan modalitas penting dalam penatalaksanaan penyandang hipertensi.Kata kunci: ansietas, hipertensi belum terkontrol, hipertensi terkontrol

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1052 Continuous Blood Pressure Monitoring In Sleep

SLEEP ◽

10.1093/sleep/zsaa056.1048 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A399-A400

Author(s):

R H Roth ◽

H Bonner ◽

J Logan ◽

M Baruch ◽

D Calhoun ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Monitoring ◽

Decomposition Analysis ◽

Limited Data ◽

Cardiovascular Risks ◽

Nocturnal Hypertension ◽

Spot Check ◽

Lack Of Sleep ◽

Data Points ◽

The Difference

Abstract Introduction Abnormal nocturnal blood pressure(BP) such as non-dipping or nocturnal hypertension(reverse-dipping) represents a potent marker for cardiovascular risks. Standard cuff-based ambulatory nocturnal BP measurement yields limited data points potentially resulting in imprecise results, especially compared to continuously recorded BP. We hypothesized nocturnal BP based on periodic measurement would be different from true average beat-to-beat based BP. Methods We prospectively enrolled patients undergoing clinically indicated in-lab polysomnography, both CPAP and non-CPAP studies, for sleep apnea evaluation. Nocturnal BP was continuously monitored beat-to-beat by a noninvasive Caretaker™ device, which uses the Pulse Decomposition Analysis(PDA) algorithm. We compared BP recorded at 30-minute intervals with average BP continuously recorded over 30 minutes, both recorded by Caretaker™. We also looked at the differences between recording spot and continuous BP from an awake or sleeping state and BP variability(SD) based on continuously recorded BP. Using first 30 min as a reference, we determined dipping status (dipping: 10-20% reduction, level: 0-10% reduction, riser: any increase) by the two methods. Results A total of 18 patients were recruited(male:11, mean age:52.2). Among a total of 261 periodic BP measurements, 60 (30.0%) were obtained while awake. Mean nocturnal SBP by periodic BP measurement was higher compared with beat-to-beat-derived average BP(135.6mmHg[24.2] vs. 131.5[20.3], p<0.0001). The difference between the two methods remained similar when continuous BP was derived from sleep vs. awake period(4.5mmHg[3.1] vs. 7.7[9.9], p=0.202). BP variability was more pronounced during awake compared with sleep period(6.7mmHg[8.1] versus 3.95[7.5], p=0.047). 8 patients were dippers by spot check measurement, but 11 were dippers by continuous BP. Conclusion Standard ambulatory periodic nocturnal BP recording may not yield true sleep BP patterns due to its spot-check nature and lack of sleep-awake information, which leads to inaccurate dipping measurements. Incorporation of beat-to-beat continuous BP measurement can provide more accurate and meaningful nocturnal BP information. Support N/A

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Twenty-four-hour Blood Pressure Monitoring in Central Serous Chorioretinopathy – A Case-control Study

European Ophthalmic Review ◽

10.17925/eor.2013.07.01.42 ◽

2013 ◽

Vol 07 (01) ◽

pp. 42

Author(s):

Pradeep Venkatesh ◽

Vikas Jain ◽

Satpal Garg ◽

◽

...

Keyword(s):

Blood Pressure ◽

Central Serous Chorioretinopathy ◽

Case Control Study ◽

Blood Pressure Monitoring ◽

Case Control ◽

Mean Difference ◽

National Committee ◽

The Mean ◽

The Difference ◽

Control Study

Purpose:A case-control study to explore the diurnal variation of blood pressure (BP) in patients with central serous chorioretinopathy (CSCR).Methods:One-hundred patients (50 cases with central serous chorioretinopathy and 50 age- and sex-matched controls) participated in this study. Twenty-four-hour BP was recorded by auscultatory method using manual standard mercury sphygmomanometer by a single, trained observer. Hypertension was categorised according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII) classification.Results:Mean systolic BP (SBP) and diastolic BP (DBP) in cases and controls were 123.4 mmHg (range 112.3134.6), 81.72 mmHg (range 73.090.5); 118.33 mmHg (range 108.4128.2); and 77.50 mmHg (range 71.483.6), respectively. The difference in SBP and DBP was statistically significant at p=0.02 for the former and p=0.006 for the latter. The mean difference in maximum and minimum SBP in cases was 18 (±15.81) mmHg versus 9.04 (±3.08) mmHg in controls (p=0.001). Mean difference for DBP in cases was 15.16 (±7.86) mmHg versus 9.16 (±3.68) mmHg in controls (0.001). On the JNC-VII classification scale for hypertension, 66 % of cases were found to be pre-hypertensive (60 %) or hypertensive (6 %). Comparative figures for controls were pre-hypertension (30 %) and hypertension (2 %). The mean SBP and DBP was consistently higher in patients with CSCR compared with controls over the entire 24-hour period. The difference in variation between maximum and minimum SBP and DBP was also found to be statistically significant between the groups.Conclusion:A significant correlation exists between higher values BP and central serous chorioretinopathy. Screening of CSCR patients for pre-hypertension may be useful in decreasing the risk of progression to established hypertension, with its associated risks.

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

PLoS ONE ◽

10.1371/journal.pone.0255871 ◽

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.

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

European Heart Journal ◽

10.1093/ehjci/ehz872.096 ◽

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).

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Continuous systolic blood pressure monitoring by the difference in electrocardiogram and pulse oximetry in near-term, exteriorized goat fetuses

Journal of the Society for Gynecologic Investigation ◽

10.1016/s1071-5576(03)00041-8 ◽

2003 ◽

Vol 10 (4) ◽

pp. 200-204 ◽

Cited By ~ 10

Author(s):

H Sameshima

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Pulse Oximetry ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

The Difference ◽

Near Term

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Comparative analysis of daily blood pressure profile in patients with recurrent and primary ischemic stroke

East European Journal of Neurology ◽

10.33444/2411-5797.2017.2(14).18-27 ◽

2017 ◽

pp. 18-27

Author(s):

N. Svyrydova ◽

O. Mykytei

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Comparative Analysis ◽

Blood Pressure Monitoring ◽

Pressure Profile ◽

Hypertensive Encephalopathy ◽

Control Group ◽

Blood Pressure Profile ◽

Significant Difference ◽

The Difference

To conduct a comparative analysis of daily blood pressure profile in patients with recurrent and primary ischemic stroke. We were examined 124 patients, of which 94 patients with ischemic stroke in acute period, which came to the hospital in up to 2 days after the onset of the disease and were observed in the neurological department. The control group consisted of 30 patients with hypertensive encephalopathy. The conducted analysis of daily blood pressure monitoring in patients with recurrent and primary ischemic stroke indicates the importance of using this diagnostic method as a reliable difference in many indicators of arterial pressure is obtained. The difference averages of daily monitoring of blood pressure for all periods day informative confirms the difference in blood pressure in patients with primary and repeated ischemic stroke, as observed significant difference of values: the day indices of systolic, diastolic, blood pressure pulse heart rate parameters. The study allowed to increase the effectiveness of the diagnosis of recurrent ischemic stroke by studying the characteristics of central hemodynamics.

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

Hypertension ◽

10.1161/hyp.76.suppl_1.p172 ◽

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.

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