摘要:

Hypertensive disease in pregnancy represents a significant health problem in the world, and ranks second only to thromboembolism as a cause of maternal mortality in the USA. In addition, hypertension is associated with both perinatal morbidity and mortality secondary to direct effects on the fetus as well as the iatrogenic preterm deliveries performed for maternal indications. Conventional (office, mercury column or aneroid manometry) blood pressure measurement is the most common screening test performed during prenatal visits. During the past several years, investigators have focused on the use of 24‐h ambulatory and automated self (or home) blood pressure monitoring during pregnancy. This review article summarizes the current literature on both ambulatory and home blood pressure monitoring in pregnancy and how they relate to various clinical aspects of hypertension in pregnancy.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The primary goal of antihypertensive therapy is to restore blood pressure to normal levels and to prevent the complications associated with hypertension. In order to maximize these goals by improving patient compliance, clinical researchers have focused on developing antihypertensive agents that can be given once daily. These agents provide many advantages over multiple‐dose daily therapies, but it should not be assumed that they are all equivalent in providing adequate blood pressure control over the full 24‐h dosing interval. Ambulatory blood pressure monitoring has uncovered important differences in commonly used once‐daily therapies and has provided additional insights into the cardiovascular risks associated with high blood pressure loads and blood pressure variability. In addition to ambulatory blood pressure monitoring data, the calculated trough : peak ratio provides useful information on an agent's ability to provide smooth and consistent blood pressure control. Using such assessments, it has been found that agents with a trough : peak ratio ≥0.50 are better able to control blood pressure over the full 24 h while maintaining natural circadian patterns. Ambulatory blood pressure monitoring studies assessing a recently introduced class of antihypertensive drugs, the angiotensin receptor blockers, have demonstrated 24‐h efficacy with once‐daily dosing, particularly with the newer agents.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Accurate measurement of blood pressure is dependent on a number of factors including use of the appropriate sized cuff. Overestimation of blood pressure by using an inappropriately small cuff has been well documented. The prevalence of the use of the standard adult and large adult cuffs in hypertensive patients is less well defined in the literature. Worldwide, the increasing prevalence of obesity and its associated conditions such as hypertension accentuates the importance of the recognition of the relationship of appropriate sized cuff and accurate blood pressure measurement. This is the largest study to define the prevalence of blood pressure cuff sizes in a hypertensive population. Vendors of blood pressure measurement devices should be aware of the changing demographics and the need for the large adult arm cuff to be routinely available.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background>Assessment of 24‐h changes in blood pressure is one of the unique features that ambulatory blood pressure monitoring (ABPM) can provide. Most studies agree that sleep/wake periods should be based on patients’ actual sleep and wake times. Actual wake and sleep time determinations are often based on patients’ diary information. Several publications indicate that actigraphy is, at least, as accurate as activity diary in determining sleep/wake periods.ObjectivesTo compare subjects’ compliance with actigraphy and diary keeping and to compare actigraphy and diary data in determination of sleep and wake times, mean blood pressures, classification of hypertension, and assessment of nocturnal dipping status.MethodsWe evaluated ABPM studies of 62 subjects. Blood pressure data were obtained using Spacelabs monitors for 24 h. Sleep and wake times were determined by both the actigraph and patients’ activity diary.ResultsIn the 62 studies, 56 subjects had successful actigraphy (90%), 44 had activity diary completion (71%), and 38 subjects had both (61%). There was no statistically significant difference between the mean wake and sleep onset using the two methods, but up to 3 hours’ difference in wake or sleep onset was noted in some studies. Although the two methods did not significantly affect the calculated systolic blood pressure (SBP) or diastolic blood pressure (DBP) loads in either awake or sleep periods, approximately 55% of the subjects’ dipping status was changed when diary information on sleep time was used compared to actigraph.ConclusionsOur data indicate that in children and young adults, compliance with the actigraph was superior to diary completion and use of the actigraphy method rather than diary information changed the interpretation of some ABPM data. Our study suggested that actigraphy is superior to diary keeping in providing the information needed for appropriate interpretation of some ABPM data.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of the present study was to analyze the influence of the insertion/deletion (I/D) polymorphism of the angiotensin‐converting enzyme on ambulatory blood pressure values and circadian variability in untreated patients with hypertension.Material and methodsNinety‐nine essential hypertensive patients, less than 50 years old (mean age 39.5 ± 7.0 years), previously untreated with antihypertensive drugs were included. Twenty‐four hour ambulatory blood pressure monitoring (ABPM) was performed with a Spacelabs (90202 and 90207) monitor, during a regular working day in unrestricted ambulatory conditions. The I/D polymorphism of the ACE was determined by PCR.ResultsThe distributions of genotypes were in Hardy‐Weinberg equilibrium: I = 17 (17%), ID = 41 (41.5%), DD = 41 (41.5%). No significant differences were present among the groups in terms of age, sex, and biochemical and lipid profiles. The average of 24‐h ambulatory blood pressure was slightly higher in patients with the DD genotype as compared with patients with the II and ID genotypes. This was the result of higher nighttime blood pressure values, because no differences in blood pressure were observed during daytime. The systolic blood pressure (SBP) day : night ratio, as an estimate of circadian variability, was significantly lower in subjects homozygous for the D allele than it was in patients carrying the I allele (1.13 ± 0.09 vs. 1.17 ± 0.08,P = 0.014). The subjects in the lowest tertile of the SBP day : night ratio, exhibited a higher frequency of the D allele when compared with those in the middle tertile (0.74 vs. 0.59,P < 0.05) or with those in the highest tertile (0.74 vs. 0.54,P < 0.01). By using two‐way ANOVA with repeated measures, significant differences in SBP variation over time were observed when comparing homozygous for the D allele with subjects carrying the I allele (F = 2.11,P = 0.002).ConclusionsAmong the genotypes of the I/D polymorphism, subjects carrying DD genotype showed a blunted decline of the physiological nocturnal fall of blood pressure that was significant for SBP.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundFinapres monitors and oscillometric sphygmomanometers are widely used in blood pressure measurements on the fingers. However, the reliability of finger blood pressure measurement devices still remains a matter of debate.DesignThe volume clamp and modified oscillometric methods for non‐invasive beat‐to‐beat finger mean arterial pressure monitoring are compared during intensive spontaneous changes in vascular tone. The degree of vasoconstriction is established by recording the thumb pulp skin blood flow with a laser Doppler instrument. The oscillometric mean arterial pressure (MAPo) and the Finapres mean arterial pressure (MAPf) are simultaneously recorded from adjacent fingers in eight healthy volunteers in a sitting position at room temperature 22–23°C.ResultsThe changes in blood pressure were similarly tracked by the two blood pressure monitors, except the episodes with peripheral vasoconstriction. The difference (MAPo – MAPf) for all simultaneously recorded mean blood pressure values in episodes without vasoconstriction was (mean ± SD) 0.7 ± 1.8 mmHg (P = 0.33) and in episodes with vasoconstriction 10.6 ± 5.6 mmHg (P < 0.01). A disagreement between the devices during vasoconstriction is assumed to be caused mainly by the tendency of the oscillometric method to overestimate the finger mean blood pressure, and by the tendency of the volume clamp method (Finapres) to underestimate the finger mean blood pressure in condition of peripheral vasoconstriction.ConclusionFor both types of finger monitors (oscillometric blood pressure devices as well as Finapres or Portapres) it is recommended that intensive vasoconstriction in the subject be avoided during measurements. The presence of acute vasoconstrictions can be determined by simultaneous recording of finger skin blood flow.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundData on the reproducibility of serial measurements of ambulatory blood pressure in hypertensive patients are lacking. The purpose of this study was to examine (1) the reproducibility of four consecutive ambulatory blood pressure measurements, and (2) the reproducibility of nocturnal falls in blood pressure in hypertensive patients.MethodsTwenty patients with mild to moderate essential hypertension underwent four separate ambulatory blood pressure monitorings, on the same day of the week, at 30‐day intervals. Antihypertensive therapy was discontinued for 2 weeks before each recording. Comparing the mean values of blood pressure over 24 h, as well as diurnal, nocturnal and hourly periods, among the four recordings determined the reproducibility of blood pressure measurements. A day/night difference in mean systolic and in mean diastolic blood pressure defined the nocturnal fall in blood pressure.ResultsNo significant differences were observed in either hourly, 24‐h, diurnal or nocturnal systolic blood pressure, diastolic blood pressure and heart rate, or in the nocturnal fall in systolic and diastolic blood pressure among the four recordings.ConclusionsHourly systolic blood pressure, diastolic blood pressure, heart rate, and nocturnal fall in blood pressure were reproducible in four ambulatory blood pressure monitorings recorded over 4 months. These findings suggest that ambulatory blood pressure monitoring is a reliable tool to monitor blood pressure changes.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare the antihypertensive efficacy of amlodipine and nifedipine gastrointestinal therapeutic system (GITS) measured by office and ambulatory blood pressure monitoring (ABPM) during treatment and, after patients have missed two doses.MethodAfter a single blind run‐in 4‐week placebo period, 58 patients were randomly allocated to amlodipine (5 mg/daily,n = 30) or nifedipine GITS (30 mg/daily;n = 28) in a double‐blind, double dummy fashion. Patients received active medication for 4 weeks. Then, to simulate failure of compliance, patients received two single blinded doses of placebo. Ambulatory blood pressure monitoring was carried out at the end of run‐in placebo phase, the first day, the last day of active treatment and up to 72 h after the last active dose.ResultsDiastolic blood pressure was controlled in 61.9% patients on amlodipine and 52.9% on nifedipine GITS. Reductions in blood pressure were similar in both groups. ABPM showed significant reduction in blood pressure from the first day in the nifedipine GITS group, while amlodipine group had marginal effect. Peak reduction in systolic/diastolic blood pressure was 26/15 mmHg at 5–6 h after ingestion of amlodipine tablets. The trough reduction was 22/13 mmHg; with a trough‐to‐peak ratio of 84.61% for systolic and 86.67% for diastolic blood pressure. Peak reduction in systolic/diastolic blood pressure with nifedipine GITS was 19/15 mmHg and the trough reduction was 21/17 mmHg, giving a trough‐to‐peak ratio of 100% for both systolic and diastolic blood pressure.When patients received placebo after 4 weeks of active treatment, simulating a compliance failure, amlodipine maintained reduction in systolic and diastolic blood pressure for at least up to 72 h after the last active dose, maintaining 57.71% of the effect for systolic blood pressure and 60.00% for diastolic blood pressure. In contrast, nifedipine GITS effect was rapidly lost during this study phase, with a reduction in systolic and diastolic blood pressure of only 14–16%, 72 h after the last active dose.ConclusionThis study showed that amlodipine and nifedipine GITS reduce blood pressure to about the same extent during chronic treatment. In the case of compliance failure, such as missing one or two doses, amlodipine maintained significant and important antihypertensive effect with the trough‐to‐peak ratio still over 50% 72 h after the last active dose. On the other hand, the coverage of nifedipine GITS was limited to about 36 h after the last active dose.

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1359-5237    

出版商:OVID    

年代:2001

数据来源: OVID