摘要:

The number of studies of the efficacy of drugs in hypertension and of their effects on morbidity and mortality continues to be large. Traditionally such studies were carried out by measuring the blood pressure (BP) in the office. Recently, there has been an increasing use of other approaches, such as self-measurement. The advantages of this technique may be the achievement of greater precision of measurement, explained by elimination of the white-coat effect, reduction in placebo effect and reduction in variability of BP. Some have even noted a greater reproducibility than using ambulatory BP monitoring. We now have available reference values and normal ranges for self-BP monitoring. The feasibility and the limitations of self-BP measurement are also known. Self-measurement allows multiple recordings of BP over the short term as well as over the long term. Moreover, the compliance of this technique is satisfying. The analysis of the data requires precise recommendations. One cannot refer to trough : peak ratio, which is used in ambulatory recordings. However, other methods of analysis such as evening BP : morning BP ratio or measures taken after taking treatment are useful. The number of subjects needed for a study is much smaller than in a study performed using office measurements for a similar or better statistical power. Such a method has a higher predictive value than clinic measurement both for study of end organ damage and for morbidity and mortality. Finally home measurement is much less costly. In conclusion, provided one uses validated equipment and if one follows recommendations for each measurement and for the succession of measurements, then self-measurement of BP at home seems a useful and practical tool for therapeutic trials.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The effect of the long acting calcium channel blocker, barnidipine hydrochloride (barnidipine) on 24-h ambulatory blood pressure (ABP) was evaluated in J-MUBA (Japanese Multicentre Study on Barnidipine with Ambulatory Blood Pressure Monitoring). Following an observation period of two weeks, antihypertensive treatment with barnidipine was continued for at least six months. At the end of each period, ABP were measured. The patients were divided into high- and low-range groups based on ABP measurement. Throughout the 24 h, barnidipine exerted an excellent antihypertensive effect in the high-range group, but not in the low-range group. Barnidipine had comparable effects in the daytime and nighttime in inverted dippers and non-dippers, but it was more effective on daytime ABP than on nighttime ABP in dippers and in extreme dippers. Morning blood pressure before and after waking was evaluated before and after barnidipine administration in 233 patients. Barnidipine inhibited increases in blood pressure before and after waking, especially in surge-type patients whose blood pressure increased rapidly after waking. A positive correlation among 24-h ABP, daytime and night time ABP, morning blood pressure, and clinic blood pressure during the observation period and the antihypertensive effect of barnidipine was observed, with barnidipine exhibiting stronger antihypertensive effects in patients with persistently high blood pressure. It was concluded that the antihypertensive effects of barnidipine are maintained for 24 h but it has no excessive hypotensive effects on lower blood pressure and is thus a safe antihypertensive agent.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Despite increasing financial and human resources invested, the disappointing rate of hypertension (HT) control continues to pose a challenge to health care providers in the civilized world. Low HT control is associated with the poor patient compliance. Nowadays, SBPM is an accepted method to improve the patient compliance as well as HT control. However SBPM has several limitations such as:- only few devices are validated according to BHS/AAMI- unreliable data recorded by the patient (under/over reporting)- extra work load to the physician in the assessment of the log-book entries of the patient.By using telemedicine in the SBPM, a virtual HT clinic can be built up. In our developed system (TensioPhone/TensionCare) we remind the patient the BP measurement and pill intake, and SBP data are automatically transferred to the center for analysis. The analysed and structured data are then sent to the physician and the patient as a printed report. Regular communication between the health care team and the patient can contribute to make the virtual hypertension clinic become a reality and to substantiallly improve HT control rates.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveEffects of environmental conditions on blood pressure (BP) and heart rate (HR) variations as putative factors underlying the onset of vascular events.MethodsBP and HR were monitored around the clock for 7 days on 54 residents from Urausu, Hokkaido, Japan. Daytime, night-time, and 24-h means served to identify dippers and non-dippers. Questionnaire-assessed depression and subjective quality of life were related to BP and HR by analyses of variance and linear regression. Statistical significance was at 5%.ResultsA circaseptan (about 7-day) component characterizes the 24-h mean and standard deviation (SD) of HR, and the daytime and day–night ratio of systolic BP. The SD of HR is higher on weekends and lower on Mondays and Thursdays. When awake, systolic BP is lowest on Sundays and the day–night ratio is optimal on weekends (Saturdays: 15.7 ± 9.4%; Sundays: 14.0 ± 13.2%). Depression was detected in 15 subjects, who had higher mean systolic and diastolic BP values (systolic BP:P = 0.028 Fridays,P = 0.021 Tuesdays; diastolic BP:P = 0.022 Mondays,P = 0.006 daytime Mondays) and a lower day–night ratio of diastolic BP (P = 0.012 Tuesdays,P = 0.005 Wednesdays, andP = 0.038 Thursdays). A depressive mood correlated positively with 24-h averages of systolic (P = 0.037) and diastolic (P = 0.030) BP.ConclusionsDepression (and subjective quality of life) can affect BP and HR variability. The results indicate the role that psychological factors may play in the pathogenesis of cardiovascular disease. Therapeutic implications are suggested for primary and secondary prevention.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundHow far should blood pressure (BP) be lowered to achieve the greatest reduction in the risk of cardiovascular disease? Although a few trials have tried to answer this question, they failed to convincingly establish an optimal target BP level, in part because of poor reproducibility and the wide variability of conventional casual BP measurement they used. At the same time, in Japan, calcium antagonist (Ca-A) and angiotensin-converting enzyme inhibitor (ACE-I) have been two major medications in initial therapy for hypertension, while angiotensin II receptor antagonist (ARB), which has recently been introduced, is also now used widely as an initial therapy. However, no large-scale interventional trial has been conducted to show which of these three initial medications can give the greatest benefit in reducing the risk of cardiovascular disease in the Japanese hypertensive patient.ObjectiveThe objectives of the study are, first, to determine an optimal target BP level, based on BP values self-measured at home (home BP). This way of measurement provides more reproducible and less variable BP values than conventional casual measurements. Secondly, we seek to determine the optimal initial antihypertensive medication for the Japanese hypertensive population.MethodThe study is a 2×3 factorial randomized controlled trial conducted with a prospective randomized open-blinded endpoint design. The study will include a total of 9000 untreated essential hypertensive patients aged 40 to 78 years with home BP values ≥135/85 mmHg. Eligible patients are randomized to one of the two home BP target groups (systolic/diastolic home BP within the range of 134–125/84–80 mmHg, or ≥125/80 mmHg), and to regimens based on one of three initial antihypertensive drugs (Ca-A or ACE-I or ARB). These randomizations, performed by our host computer, are transmitted to terminals at the outpatient clinic through the Internet. The patient measures BP at home with newly developed equipment (HEM-7471C-N; Omron, Japan) that records BP values, the date, and the time of each measurement. The data are downloaded to the outpatient terminal at every clinic visit then transmitted to the host computer via the Internet. Based on these home BP values, the host computer determines the necessity of additional therapy or dose increments in four further steps to reach the randomized target BP, and then transmits the information to the terminal at the outpatient clinic. The primary study outcome is a composite of non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death. The scheduled average post-randomization duration of follow-up is 7 years.ConclusionThis is the first large-scale home BP-based and Internet-connected intervention trial on antihypertensive treatment. The HOMED-BP study (Hypertension Objective treatment based on Measurement by Electrical Devices of BP) will improve the recruitment of general practitioners and participants and will supply unbiased BP data, providing reliable information on optimal target BP levels and the optimal initial antihypertensive medication.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe aim of this paper is to summarize the issues raised during a consensus conference on the role of different blood pressure (BP) monitoring techniques in research, including pathophysiological studies, clinical outcome trials and clinical pharmacology trials.MethodsThis review includes the contribution of the participants in a task force at the Eighth Consensus Conference on Ambulatory BP Monitoring (October 28–31, 2001, Sendai, Japan) and the results of a discussion open to all conference participants. Individual contributions have been summarized together with the points raised during the subsequent discussion, and the main statements are also presented in a table format.Points of consensus(1)BP monitoring in pathophysio-logical studies. The essential role played by continuous BP monitoring in this field had been acknowledged, and further development of non-invasive beat-by-beat monitoring techniques has been advocated.(2)BP monitoring in clinical trials. In clinical trials automated ambulatory BP monitoring (ABPM) and self BP measurements (SBPM) at home share similar advantages, with specific features that make these approaches not alternative solutions but rather approaches able to complement each other. A few examples of application of ABPM and SBPM in clinical trials include the Treatment of Hypertension according to Home or Office Blood Pressure (THOP) trial and the Trial of Preventing Hypertension (TROPHY).(3)Use of ABPM in clinical pharmacology studies. Use of ABPM is now an established routine, aimed at describing the 24-h effect of new antihypertensive drugs. An example of these applications that was discussed in the conference is the use of ABPM in the evaluation of a new long-acting calcium channel blocker (Barnidipine) (J-MUBA study).(4)Specific models for the analysis of BP fluctuations. The features characterizing the chronobiological approach to description of 24-h BP profiles and its limitations (mainly consisting of the high risk of data over-modelling) are discussed. Also the possible occurrence of a circaseptan (approximately with a 7-day period) rhythm in BP has been addressed, although repeated performance of 24-h ABPM over a week obviously faces a number of practical problems.(5)Progress in technology:BP monitoring and telemedicine. The possibility to implement an interactive telemonitoring system of home SBPM values and the perspectives for a clinical application of this technology in the Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) trial is discussed.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID