scholarly journals Twenty-Four–Hour Ambulatory Blood Pressure versus Clinic Blood Pressure Measurements and Risk of Adverse Outcomes in Children with CKD

2018 ◽  
Vol 13 (3) ◽  
pp. 422-428 ◽  
Author(s):  
Elaine Ku ◽  
Charles E. McCulloch ◽  
Bradley A. Warady ◽  
Susan L. Furth ◽  
Barbara A. Grimes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Confidence Interval ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Single Visit ◽  
Unadjusted Analysis

Backgroundand objectives Our objective was to determine whether clinic BPs (taken at either a single visit or two sequential visits) are inferior to ambulatory BPs in their ability to discriminate risk of adverse outcomes in children with CKD.Design, setting, participants, & measurementsWe included 513 participants of the CKD in Children Study who had clinic BPs and 24-hour ambulatory BP monitoring performed during similar timeframes. Predictors of interest were systolic BPs taken at a single visit or two repeated visits within a 1-year period compared with mean wake and sleep systolic ambulatory BPs. Outcomes were left ventricular hypertrophy and ESKD. We determined the ability for each BP parameter to provide risk discrimination using c statistics.ResultsDuring mean follow-up of 3.5 years, 123 participants developed ESKD. In cross-sectional unadjusted analysis, every 0.1 increase in systolic BP index was associated with a 2.0 times higher odds of left ventricular hypertrophy (95% confidence interval, 1.5 to 2.8) by clinic BPs versus 1.8 times higher odds (95% confidence interval, 1.3 to 2.4) by ambulatory wake BP. The c statistic was highest for clinic BP (c=0.65; 95% confidence interval, 0.58 to 0.73) but similar to ambulatory wake BP (c=0.64; 95% confidence interval, 0.57 to 0.71) for the discrimination of left ventricular hypertrophy. In longitudinal unadjusted analysis, every 0.1 increase in systolic BP index was associated with a higher risk of ESKD using repeated clinic (hazard ratio, 1.5; 95% confidence interval, 1.3 to 1.8) versus ambulatory wake BP (hazard ratio, 1.6; 95% confidence interval, 1.3 to 2.0). Unadjusted c statistics were the same for wake (c=0.61; 95% confidence interval, 0.56 to 0.67) and clinic systolic BPs (c=0.61; 95% confidence interval, 0.55 to 0.66) for discriminating risk of ESKD.ConclusionsClinic BPs taken in a protocol-driven setting are not consistently inferior to ambulatory BP in the discrimination of BP-related adverse outcomes in children with CKD.

scholarly journals Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD

2020 ◽  
Vol 15 (4) ◽  
pp. 493-500
Author(s):  
Jason Lee ◽  
Charles E. McCulloch ◽  
Joseph T. Flynn ◽  
Joshua Samuels ◽  
Bradley A. Warady ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cross Section ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Pediatric Ckd ◽  
Sectional Analysis

Background and objectivesElevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs.Design, setting, participants, & measurementsWe studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters.ResultsOverall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load.ConclusionsBP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3

Effects of Antihypertensive Therapy on Blood Pressure and Left Ventricular Hypertrophy in Patients with Severe Hypertension.

2000 ◽  
Vol 41 (3) ◽  
pp. 339-348
Author(s):  
Sumino Hiroyuki ◽  
Nakamura Tetsuya ◽  
Kanda Tsugiyasu ◽  
Sakamaki Tetsuo ◽  
Sato Kunio ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Antihypertensive Therapy ◽  
Ventricular Hypertrophy ◽  
Severe Hypertension ◽  
Left Ventricular

Intraventricular pressure gradients change during the development of left ventricular hypertrophy: Effect of salvianolic acid B and beta-blocker

Ultrasound ◽  
2021 ◽  
pp. 1742271X2098758
Author(s):  
Danfu Ma ◽  
Ahmed S Mandour ◽  
Tomohiko Yoshida ◽  
Katsuhiro Matsuura ◽  
Kazumi Shimada ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Treatment Group ◽  
Left Ventricular Hypertrophy ◽  
Pressure Gradient ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Salvianolic Acid B ◽  
Intraventricular Pressure ◽  
Salvianolic Acid ◽  
Intraventricular Pressure Gradient

Introduction Intraventricular pressure gradient is regarded as a non-invasive indicator of diastolic function. Salvianolic acid B (Sal-B), a traditional Asian medicine, revealed its usefulness in myocardial infarction models; however, the hemodynamic effect of salvianolic acid B is still unknown. The present study aimed to investigate the intraventricular pressure gradient changes during the development of left ventricular hypertrophy with or without salvianolic acid B and a beta-blocker. Methods In total, 48 rats were divided into four groups; Sham, Non-treatment, salvianolic acid B, and Carvedilol. Aortic coarctation-induced left ventricular hypertrophy was done in three groups and the treatment was started from the third to the sixth week. Blood pressure, conventional echocardiography, and color M-mode echocardiography for measurement of intraventricular pressure gradient were carried out for six consecutive weeks. Results At 4.5 weeks, the LV mass was elevated in the coarctation groups but the blood pressure was significantly lower in salvianolic acid B and Carvedilol groups ( P < 0.05). In the Non-treatment group, the total intraventricular pressure gradient was increased at 4.5 and 6 weeks (2.60 and 2.65, respectively). Meanwhile, the basal intraventricular pressure gradient was elevated at 3 and 6 weeks (1.67 and 1.75) compared with the Sham group. Salvianolic acid B and Carvedilol significantly reduced the basal intraventricular pressure gradient at six weeks compared with the Non-treatment group (1.52 and 1.51 vs 1.75, respectively). Conclusions Salvianolic acid B and Carvedilol promote cardiac function by decreasing the elevated basal intraventricular pressure gradient. The current preclinical results revealed the efficacy of salvianolic acid B as a potential therapy for left ventricular hypertrophy because of the non-blood pressure lowering effect.

scholarly journals Prevalence and associated factors of electrocardiographic left ventricular hypertrophy in a rural community, central Thailand

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Patipan Viwatrangkul ◽  
Sakda Lawanwisut ◽  
Pondfah Leekhaphan ◽  
Tatchamon Prasart-intara ◽  
Pathomphon Phiensuparp ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Rural Community ◽  
Associated Factors ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Hypertensive Crisis ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Cardiac Condition

AbstractLeft ventricular hypertrophy (LVH) is considered a cardiac condition with life-threatening complications. Detected LVH is a strong predictor of cardiovascular diseases and death. This condition is normally diagnosed at offices. We aimed to determine the prevalence and associated factors of electrocardiographic-LVH (ECG-LVH) among adults in a Thai rural community. A cross-sectional study was conducted in Na-Yao rural community of Thailand in 2020. A total of 638 individuals aged ≥ 20 years were interviewed using standardized structured questionnaires related to demographic information, risk behaviors, comorbidities and anthropometric measurements. LVH was determined by Sokolov-Lyon and Cornell criteria based on the collected electrocardiograms. The prevalence of ECG-LVH among adults was 6.6%. The factors independently associated with ECG-LVH were being male (AORs 2.04, 95% CI 1.05–3.98), history of diabetes mellitus (AORs 1.01, 95% CI 1.01–1.02), and hypertensive crisis ≥ 180/110 mmHg (AORs 7.24, 95% CI 1.31–39.92). However, resting heart rate was negatively associated with ECG-LVH (p < 0.05). Our data emphasized that LVH was one of the significant health problems among adults in a rural community. This condition could lead to severe complications. Thus, effective detection and public health interventions should be provided at the community level.

scholarly journals Doctors’ Knowledge of Hypertension Guidelines Recommendations Reflected in Their Practice

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Nafees Ahmad ◽  
Amer Hayat Khan ◽  
Irfanullah Khan ◽  
Amjad Khan ◽  
Muhammad Atif
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Median Number ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Attitude Score ◽  
Cross Sectional ◽  
Uncomplicated Hypertension ◽  
Adequate Knowledge ◽  
Hypertension Guidelines

Aim. To evaluate doctors’ knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008). Methods. Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors’ knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor). SPSS 17 was used for data analysis. Results. Nineteen doctors (73.07%) had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines’ recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15±1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5–20). Statistically significant correlation (rs = 0.635, P<0.001) was observed between doctors’ knowledge and practice scores. A total of 349 (67.1%) prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P=0.008), left ventricular hypertrophy (OR = 0.091, P=0.001) and heart failure (OR = 1.923, P=0.039) were significantly associated with guidelines adherence. Conclusion. Doctors’ knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus.

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