- Email: [email protected]
G19 Blood pressure measurements in elderly patients
64A
ASH XII ABSTRACTS
AJH-APRfL 1997-VOL. 10, NO. 4, PART 2
G17
G18
LEFT VENTRICULAR MASS, RENAL FUNCTR)N, AND AMBULATORY BP IN 14 NEVER TREATED HYPERTENSIVE J.P. Fauvel, E. Chenemr,C. Barjhoux, P. Zech, N. Pozet, M Laville.Departrrsentofnephrology,Lyon, France.
WHEN SHOiJLDBLOOD PRESSURE BE MEASURED IN TREATEDHYPERTENSIVEPATIENTS? J. Sobtino”,M. Pladevall,L. Ribera,A. Minguez,J. M6dol,J. Plana,J. Soler,A. Cocab, l+ype~ension ResearchFoundation ofthe CatalanCommunity Hoapltala,Spain. Objactkve: Tocomparebloodpteeauremeasurements obtained inmediattybeforethe intakeof anti-hypertanaive medication rou h time)withmeasurements takenduringa doctorsviait. $as&sandMalhods:For &ninepatientsragulattyvis.ited in Cetaloniancountyhospitalhypetiension clinicswereincluded. Bloodpressurewas measuredbeforethe intakeoftheiruaual medication (be&en 7 and9 a.m.)Wtihtwodifferentmethoda: at home wtfha semi-automaticinetrumant(OMRON HEM705CP) and at the clinicusingthe traditionalmethod.Both methods werealsousedat thetimeofthe reoularvisitwiththe phyaician. Results: Both systolicand diastolicbloodpressuretaken before the intake of the medicationwere hiaher than the measurementstaken at the time of the doct&e visit, This findingwasconsistent wtihmethodsof measurement: wfihthe traditionalmethod(morningSBP 154.8 i 20.1 vs. clinicSBP 143.1i 16,5mmHg,IX0.00I; morning OBP93.1 * 8.9 vs. clinic DBP 64.9 * 9.3 mmHg, pc0,001 as well as with the semiautomatic method( morningSEL 149.6 i 16.8 vs. clinic SBP139.1~ 15.7mmHg, cO.tSJl;morningDBP 91.7 ~ 6.2 vs. clinicDBP63.5*9.8 mm~g,~0.001). Whenwecom#aredthe degree af optimalcantrol( BP <140 mmHgand BP c 90 mmHgachievedbeforetheIntakeofthe medicationandat the timeo) thedoctors visit,therewasan importantdifference:12% befaratheintakeofthe medication versus43% at the time the dactarswst, CI=O.0003). Conclusions{ Blood r+ssuremeasurements are hi~ her .5.before takingmedication intI e reaming(troughtime)than unn VISILS ta the doctorsofficeinthe aflemoonusually(peaktime This differencewaS St8tiStiC811Y Slonificantwith bothmethadsof measurement (the trsdfiiongl and the semiautomatic). Additionally, the degreeof controlwassmallerat troughtime than at visk time and this differencewas also statically significant.Giventhe increasedincidenceof early momin cwdovascularevents andthatnormalbloodpressureat trougR time mostlikelyimpliesgoodaverallcontrol,we suggestthat blaodpressurebe measuredinthe morningjustbeforetaking antihypertensive drugs. KeyWords: Bloodpressuremeasurement
I[t has been suggested that an increase in proximal sodium &abeorption may initiate essential hypertension. In 14 consecutive never treated hypertcneives (OMS criteria), ambulatoryblncd pressure, renal functionand left ventricular ‘mass index (LVMI, echocardiography, Penn) were indepcndenttydetermined. Studied parameters were: 24 h SBP mmHg 137*12 91*8 glomemlar filtration mtc 24 h DBPmmHg LVMI(glm2) (GFR, intdin clcarartce), 108+32 rend plasma flow (RPF, GFR mt/min/1,73 m’ 118*22 cc),filtration RPF mt/min/1,73 m’ 551+110 PAH ckatatt total I+ fraction 0.22+0.04 (tFRNa)
i~’
proximal
tFR Na %
98.6*0.6
73.9*6.5 fractional Na reabsorption pFR Na % (pFR Na, eveJuated by meanof Iithiumcleaance) (mmsd) The matrixof correlationcoefficientsbetweenparametersis: LVMf GFR RPF FF tFRNa pFRNa PAS 24H PAD 24H i3FR ~RPF FF ‘ma
0.63; NS NS NS 0.53* NS
@RNa
- 0.64:
NS NS
(*
NS 0.69** NS 0.57* 0.63; NS
0.82** NS
~0.05.**psO.Ol; negative retadonstrip)
~Conclusions:1) In these newly diagnosed and never treated ‘hypertensives,24 h BP is inversely related to PFR Na. A-riafysingthis correlationone can sup&se that an increasein pFR Na is presentat aprchypertensivestate (low 24 h BP) and Mat the pressure - proximal nafriurcsis increases as BP increases. 2) LVMI is closely related to FF but not tu either ~FR nor RPF as previouslyreported. KeyWords: Tubular Fractional sodium reabsorption - Renal hemodynamice Left ventricular mass
G19 BLOODPRESSURE MEASUREMENTSfN ELDERLY PATIENTS. ~. GeriatricDepartment,BispebjergHospitsf,Copenhagen,Denmark, In this studywe wantedto fmdthe frequencyof thin armsamonggeriatricpatientsin order to measurethe blood pressure(BP) with the right size of the cum We wantedto demonstratethe differencesin BP measurementswhen using correct cuffor not.The mid arm circumferenceon both armswere measured.The BP was measuredwith a semiautomaticapparatusUA 753 using three differentcuffs:9 x 25, 12 x 35, end 15 x 43 cm. We studied 140consecutivegeriatricpatients,92 women, 48 men,with the averageage of 82,3 year ( 61- 96). The studywas completedby 136patients,90 women and 48 men.Thinarms(< 25 cm) were found in 60 (44,1%), thick arms(> 35 cm) in 4 (2,9%) Md no~~ arms in 72 ( 52,9%), On thinarmsthe BP in averagewas 121,7/71,1 mm Hg when measuredwith a standardcuff (12x35 cm)versus 130,9/76,1mm Hgwiththestnall cuff(9 x 25 cm) (p<0,001),On 4 thick armsthe BP was in average 134,2/71,2mm Hg with the standardcuffversus 129,3/65,2mm Hg with a large cuff(15 x 43 cm). We concludethat 44,1 Y. of the geriatricpatientshad thin arms,and 2,9 ‘??o had thick arms.Usinga standardcuffthe BP willbe strongfyunderestimatedin thin arms and overestimatedin thick arms. It is importantto use the right cuffwhenmeasuring the BP, otherwisethe result willbe wrong diagnosisend inexpedienttreatmentor lack of treatment.
G20 sEm~ImTvmmKmARrrlNssE Nsas4mlNmEDAlLYPRAcncE? (lEEEnK18mDY:mmmmKNLYmNnu3um ~CESltVAIKSNI E@#atd,3LVdiir=dE1, Fkkm3kRS2 smnew@JIEhus+s’, tJmmyHx@srArswp’,Bsgmn Inulcm.6scdsMHo@43r~prsrstid~k
~Rmairplsxta241ru
~m@-*g~d
arb4alvtkrd-(mwakommkrt
Srddmdbgqk P--rnb-w.
TwmmdrddrdrI “’ . .“ Emamhaeatkwdtytkqsmd:ar aximnbtkAEEam@rqtkUsrbtkFINNcrmeSimLdwrSdmms Wwaiakduirlgcrmasidcxrmrkadk&rmdar@tl@rywFr)&irsd &.Bkmilkz mmir&x(LVM@Idng131@n %urrnarxtl133@?inwartn XO@kwcinirkdrntkst@. h59%dtkqtkASE m!irdwwd
hmkrb-ti
““‘ ~ ‘ax&s.maaqkxflrhmhntydrmr ‘ M-nr&tinaeaillxkd b-aqxzkir~
r33rpimdnsamnsmmTkty FENNvaaaAsEdmei~d frlS3Skti*&by amr&ksylrd@ttAsEnEamnm5wecorawlag3 RNN. -rtElmnklKedLwtwwavMrtm@ilkmivdi&Ts&Lmiivzalumrdrrt
rhE&rdw4htJEAsr&bi
.
:o.7)ttEwiaiiiydE DqieagrxtdsMily @raiandFii2tdoxrrMm qxs&LV?vt~ wmiqKstst(lE?9glTkld@rwwrwe61r frunpid_k&r&@ydmlioW-n& ‘tkEGrD9uL$’tHwskd@ni6 asumapIEdl+ &v+szluMsEani urcFBwmrmdLlawhmtlqamEdinlfwMypx6.zdGud&@cs@wly WhmrhlE wrrehmdb?IwealAfrFaddmmt@@kw&ksfvhro.Olk? inWdWki@’inttEI@I@Yb=@SeXdqXSd&UraESrntMVt a~~ d-LvHaKtrk waMim&ha&lkndtlELVMbjmam -~~
da&edmmk@y
Keywords: BloodPressuremeasurements,cuffs,elderly
intldityjswizd
EanmrnMirrkbiiypxlimd ndl!gdmlkiritb
KeyWords:Mmmi@@y,kRwlrkmbr --~w
ASH XII ABSTRACTS
AJH-APRfL 1997-VOL. 10, NO. 4, PART 2
G17
G18
LEFT VENTRICULAR MASS, RENAL FUNCTR)N, AND AMBULATORY BP IN 14 NEVER TREATED HYPERTENSIVE J.P. Fauvel, E. Chenemr,C. Barjhoux, P. Zech, N. Pozet, M Laville.Departrrsentofnephrology,Lyon, France.
WHEN SHOiJLDBLOOD PRESSURE BE MEASURED IN TREATEDHYPERTENSIVEPATIENTS? J. Sobtino”,M. Pladevall,L. Ribera,A. Minguez,J. M6dol,J. Plana,J. Soler,A. Cocab, l+ype~ension ResearchFoundation ofthe CatalanCommunity Hoapltala,Spain. Objactkve: Tocomparebloodpteeauremeasurements obtained inmediattybeforethe intakeof anti-hypertanaive medication rou h time)withmeasurements takenduringa doctorsviait. $as&sandMalhods:For &ninepatientsragulattyvis.ited in Cetaloniancountyhospitalhypetiension clinicswereincluded. Bloodpressurewas measuredbeforethe intakeoftheiruaual medication (be&en 7 and9 a.m.)Wtihtwodifferentmethoda: at home wtfha semi-automaticinetrumant(OMRON HEM705CP) and at the clinicusingthe traditionalmethod.Both methods werealsousedat thetimeofthe reoularvisitwiththe phyaician. Results: Both systolicand diastolicbloodpressuretaken before the intake of the medicationwere hiaher than the measurementstaken at the time of the doct&e visit, This findingwasconsistent wtihmethodsof measurement: wfihthe traditionalmethod(morningSBP 154.8 i 20.1 vs. clinicSBP 143.1i 16,5mmHg,IX0.00I; morning OBP93.1 * 8.9 vs. clinic DBP 64.9 * 9.3 mmHg, pc0,001 as well as with the semiautomatic method( morningSEL 149.6 i 16.8 vs. clinic SBP139.1~ 15.7mmHg, cO.tSJl;morningDBP 91.7 ~ 6.2 vs. clinicDBP63.5*9.8 mm~g,~0.001). Whenwecom#aredthe degree af optimalcantrol( BP <140 mmHgand BP c 90 mmHgachievedbeforetheIntakeofthe medicationandat the timeo) thedoctors visit,therewasan importantdifference:12% befaratheintakeofthe medication versus43% at the time the dactarswst, CI=O.0003). Conclusions{ Blood r+ssuremeasurements are hi~ her .5.before takingmedication intI e reaming(troughtime)than unn VISILS ta the doctorsofficeinthe aflemoonusually(peaktime This differencewaS St8tiStiC811Y Slonificantwith bothmethadsof measurement (the trsdfiiongl and the semiautomatic). Additionally, the degreeof controlwassmallerat troughtime than at visk time and this differencewas also statically significant.Giventhe increasedincidenceof early momin cwdovascularevents andthatnormalbloodpressureat trougR time mostlikelyimpliesgoodaverallcontrol,we suggestthat blaodpressurebe measuredinthe morningjustbeforetaking antihypertensive drugs. KeyWords: Bloodpressuremeasurement
I[t has been suggested that an increase in proximal sodium &abeorption may initiate essential hypertension. In 14 consecutive never treated hypertcneives (OMS criteria), ambulatoryblncd pressure, renal functionand left ventricular ‘mass index (LVMI, echocardiography, Penn) were indepcndenttydetermined. Studied parameters were: 24 h SBP mmHg 137*12 91*8 glomemlar filtration mtc 24 h DBPmmHg LVMI(glm2) (GFR, intdin clcarartce), 108+32 rend plasma flow (RPF, GFR mt/min/1,73 m’ 118*22 cc),filtration RPF mt/min/1,73 m’ 551+110 PAH ckatatt total I+ fraction 0.22+0.04 (tFRNa)
i~’
proximal
tFR Na %
98.6*0.6
73.9*6.5 fractional Na reabsorption pFR Na % (pFR Na, eveJuated by meanof Iithiumcleaance) (mmsd) The matrixof correlationcoefficientsbetweenparametersis: LVMf GFR RPF FF tFRNa pFRNa PAS 24H PAD 24H i3FR ~RPF FF ‘ma
0.63; NS NS NS 0.53* NS
@RNa
- 0.64:
NS NS
(*
NS 0.69** NS 0.57* 0.63; NS
0.82** NS
~0.05.**psO.Ol; negative retadonstrip)
~Conclusions:1) In these newly diagnosed and never treated ‘hypertensives,24 h BP is inversely related to PFR Na. A-riafysingthis correlationone can sup&se that an increasein pFR Na is presentat aprchypertensivestate (low 24 h BP) and Mat the pressure - proximal nafriurcsis increases as BP increases. 2) LVMI is closely related to FF but not tu either ~FR nor RPF as previouslyreported. KeyWords: Tubular Fractional sodium reabsorption - Renal hemodynamice Left ventricular mass
G19 BLOODPRESSURE MEASUREMENTSfN ELDERLY PATIENTS. ~. GeriatricDepartment,BispebjergHospitsf,Copenhagen,Denmark, In this studywe wantedto fmdthe frequencyof thin armsamonggeriatricpatientsin order to measurethe blood pressure(BP) with the right size of the cum We wantedto demonstratethe differencesin BP measurementswhen using correct cuffor not.The mid arm circumferenceon both armswere measured.The BP was measuredwith a semiautomaticapparatusUA 753 using three differentcuffs:9 x 25, 12 x 35, end 15 x 43 cm. We studied 140consecutivegeriatricpatients,92 women, 48 men,with the averageage of 82,3 year ( 61- 96). The studywas completedby 136patients,90 women and 48 men.Thinarms(< 25 cm) were found in 60 (44,1%), thick arms(> 35 cm) in 4 (2,9%) Md no~~ arms in 72 ( 52,9%), On thinarmsthe BP in averagewas 121,7/71,1 mm Hg when measuredwith a standardcuff (12x35 cm)versus 130,9/76,1mm Hgwiththestnall cuff(9 x 25 cm) (p<0,001),On 4 thick armsthe BP was in average 134,2/71,2mm Hg with the standardcuffversus 129,3/65,2mm Hg with a large cuff(15 x 43 cm). We concludethat 44,1 Y. of the geriatricpatientshad thin arms,and 2,9 ‘??o had thick arms.Usinga standardcuffthe BP willbe strongfyunderestimatedin thin arms and overestimatedin thick arms. It is importantto use the right cuffwhenmeasuring the BP, otherwisethe result willbe wrong diagnosisend inexpedienttreatmentor lack of treatment.
G20 sEm~ImTvmmKmARrrlNssE Nsas4mlNmEDAlLYPRAcncE? (lEEEnK18mDY:mmmmKNLYmNnu3um ~CESltVAIKSNI E@#atd,3LVdiir=dE1, Fkkm3kRS2 smnew@JIEhus+s’, tJmmyHx@srArswp’,Bsgmn Inulcm.6scdsMHo@43r~prsrstid~k
~Rmairplsxta241ru
~m@-*g~d
arb4alvtkrd-(mwakommkrt
Srddmdbgqk P--rnb-w.
TwmmdrddrdrI “’ . .“ Emamhaeatkwdtytkqsmd:ar aximnbtkAEEam@rqtkUsrbtkFINNcrmeSimLdwrSdmms Wwaiakduirlgcrmasidcxrmrkadk&rmdar@tl@rywFr)&irsd &.Bkmilkz mmir&x(LVM@Idng131@n %urrnarxtl133@?inwartn XO@kwcinirkdrntkst@. h59%dtkqtkASE m!irdwwd
hmkrb-ti
““‘ ~ ‘ax&s.maaqkxflrhmhntydrmr ‘ M-nr&tinaeaillxkd b-aqxzkir~
r33rpimdnsamnsmmTkty FENNvaaaAsEdmei~d frlS3Skti*&by amr&ksylrd@ttAsEnEamnm5wecorawlag3 RNN. -rtElmnklKedLwtwwavMrtm@ilkmivdi&Ts&Lmiivzalumrdrrt
rhE&rdw4htJEAsr&bi
.
:o.7)ttEwiaiiiydE DqieagrxtdsMily @raiandFii2tdoxrrMm qxs&LV?vt~ wmiqKstst(lE?9glTkld@rwwrwe61r frunpid_k&r&@ydmlioW-n& ‘tkEGrD9uL$’tHwskd@ni6 asumapIEdl+ &v+szluMsEani urcFBwmrmdLlawhmtlqamEdinlfwMypx6.zdGud&@cs@wly WhmrhlE wrrehmdb?IwealAfrFaddmmt@@kw&ksfvhro.Olk? inWdWki@’inttEI@I@Yb=@SeXdqXSd&UraESrntMVt a~~ d-LvHaKtrk waMim&ha&lkndtlELVMbjmam -~~
da&edmmk@y
Keywords: BloodPressuremeasurements,cuffs,elderly
intldityjswizd
EanmrnMirrkbiiypxlimd ndl!gdmlkiritb
KeyWords:Mmmi@@y,kRwlrkmbr --~w