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.

The Association of Orthostatic Hypotension with Ambulatory Blood Pressure Phenotypes in SPRINT

2020 ◽  
Author(s):  
Lama Ghazi ◽  
Paul E Drawz ◽  
Nicholas M Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Treatment Strategies ◽  
Ambulatory Bp Monitoring ◽  
Increased Risk ◽  
Trial Testing ◽  
The Difference ◽  
Pattern Versus ◽  
Reverse Dipping

Abstract Background Clinic blood pressure (BP) when measured in the seated position, can miss meaningful BP phenotypes, including low ambulatory BP (white coat effects [WCE]) or high supine BP (nocturnal non-dipping). Orthostatic hypotension (OH) measured via both seated (or supine) and standing BP, could identify phenotypes poorly captured by seated clinic BP alone. Methods We examined the association of OH with WCE and night-to-daytime systolic BP (SBP) in a subpopulation of SPRINT, a randomized trial testing the effects of intensive or standard (&lt;120 versus &lt;140mmHg) SBP treatment strategies in adults at increased risk of cardiovascular disease. OH was assessed during follow-up (6, 12, 24 months) and defined as a decrease in mean seated SBP ≥20 or diastolic BP ≥10 mmHg after 1 min of standing. WCE, based on 24-hour ambulatory BP monitoring performed at 27 months, was defined as the difference between 27-month seated clinic and daytime ambulatory BP ≥20/≥10 mmHg. Reverse dipping was defined as a ratio of night-to-daytime SBP &gt;1. Results Of 897 adults (mean age 71.5±9.5 years, 29% female, 28% black), 128 had OH at least once. Among those with OH, 15% had WCE (versus 7% without OH). Moreover, 25% of those with OH demonstrated a non-dipping pattern (versus 14% without OH). OH was positively associated with both WCE (OR=2.24; 95% CI: 1.28,4.27) and reverse dipping (OR=2.29; 95% CI: 1.31, 3.99). Conclusions The identification of OH in clinic was associated with two BP phenotypes often missed with traditional seated BP assessments. Further studies on mechanisms of these relationships are needed.

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

The ???white coat??? response on ambulatory blood pressure monitoring

1995 ◽  
Vol 13 (12) ◽  
pp. 1493
Author(s):  
N. Prasad ◽  
Robert J. MacFayden ◽  
L. Peebles ◽  
J. Anderson ◽  
Thomas M. MacDonld
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
White Coat ◽  
Pressure Monitoring

scholarly journals Perbedaan Derajat Ansietas antara Penyandang Hipertensi Belum Terkontrol dengan yang Terkontrol

e-CliniC ◽  
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

White-coat, masked and sustained hypertension detected by home blood pressure monitoring in adolescents: prevalence and associated factors

2018 ◽  
Vol 27 (3) ◽  
pp. 151-157 ◽  
Author(s):  
Thiago Veiga Jardim ◽  
Carolina de Souza Carneiro ◽  
Polyana Morais ◽  
Vanessa Roriz ◽  
Karla Lorena Mendonça ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Associated Factors ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
White Coat ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Sustained Hypertension

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.

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