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Blood pressure beat to beat monitoring during gastroscopy.
AJH-APRIL 1999-VOL. 12, NO. 4, PART 2
POSTERS: Blood Pressure Measurement (Including ABPM)
A057
A058
PRESSURE BEAT TO BEAT MONITORING DURING GASTROSCOPY. MR. Montebclli; F. Varone; ME. Riccioni*; R. Coppola*; L.Fazzari; F.Pichetti; M. Mettimano; A. Mign¢co; L. Savi. Dept. o f Internal Medicine, Hypertension Center, *Dept o f Surgery - Catholic University o f Rome.
AUGMENTATION OF CENTRAL BLOOD PRESSURE BY REFLECTION: EFFECT OF AGE K Kohara*, YN Jiang 1), M Igase, T Mild, K Hiwada ~)*. Dept of Geriatric Med, ~)2nd Dept of Intern Med, Ehime Univ, Ehime, Japan.
BLOOD
In order to investigate the pressure response to gastroscopy, a semi-invasive diagnostic procedure, we enrolled 50 patients which had to undergo this examination for several reasons; they were 30 normotensives (mean age 53,2 ± 17,53; 13 females and 17 males) and 20 hypertensives (mean age 65,85 :t= 11,78; 12 females and 8 males). We performed a beat-to-beat blood pressure analysis using a Finapres 2300 device throughout 10 consecutive phases: baseline, gastroscopy (introduction, esophageal transit, gastric antrum and body transit, pyloric transit, duodenum, gastric fundus, biopsies, extraction), recovery. Hypertensive patients were all on therapy, with a g o o d hasclinc control (SBP: 133,14; DBP: 81,8 mmHg); for normotensive patients baseline pressure levels were: SBP 113.83; DBP 70.67. We analyzed the variations o f blood pressure measurements throughout the consecutive phases o f gastroscopy; the percentage o f increase in the two groups was comparable with a peak at phase 5 (SBP increase: 25,6%, confidence limit 21,1%38,1%; DBP increase: 32,3%, confidence limit: 23,541%). At phase 5, 8 hypertensives showed SBP > 180 m m H g and 7 o f them had DBP > 110 m m H g . Gastroseopy constitutes a potent stress for blood pressure; therefore hypertensives m a y rcquire a careful monitoring during.this procedure and an appropriate prcmedication. Key words: Hypertension, Beat-to-beat Monitoring, Gastroscopy
contribute to the blood pressure in elderly hypertensive patients. The augmentation by the reflection of central blood pressure was estimated from the carotid augmentation index (CAI) on carotid pressure waveform in 143 essential hypertensive patients. Aortic augmentation index was calculated by the regression equation between CAI. Aortic pulse pressure was estimated by age-dependent peripheral amplification. Aortic pressure was divided into forward traveling and reflection backward traveling components and diastolic pressure. The reflection component of aortic pressure showed a significant positive correlation with age (r=0.57, p<0.0001). In the elderly patients with age~70, more than 20% of aortic SBP was due to the reflection wave. These findings indicate that reflection of the pressure wave significantly contributed to the augmentation of systolic hypertension in elderly hypertensive patients.
A059
A060
IS THERE ANY DIFFERENCE IN OFFICE BLOOD PRESSURE (BP) DEPENDING ON WHO MEASURES IT, THE DOCTOR OR THE PATIENT HIMSELF? Garcia-Polo I. ~ G a h i n C. Novella B. M6ndez J. ~%~.~..~.* Hospital de la Princesa, Madrid. Spain. The aim of the study is to det~mine whether there is any diffea~nce in office BP depending on who takes the mensmement: the patient himself or the doctor, and to analyze the correlation between ambulatozy blood pressure monitoring (ABPIv0 and office BP measured by the doctor or the patient himself. Seventy hypertensive outpafierds were enrolled. 58% men, mean age 58.3+11.3 years, time averagn since hypezton~on diagnosis 11.9 years. BP was mcamur~ with a validated scmiantomatic device Omrom HEM-711, after 5 mintges resting, 3 times at 2 minute intervals, by both the doctor and the patient, in a randomized way. Thereafter an ABPM (Spacelabs 90207) was performed. Daytime was defined with patient's activity dia~. T-test and Pearson correlation w~'e lied. Statistic si aificancewas considered ff ~<0.05. ABPM Doctor Patiemt Toteldif I)/P P/D n=70 n=30 N=40 SBP 129.4 140.2 138.8 1.4 3.34 0.07(-2.7±22.1 ±20 ~:19 (0.4-3.2) (1.06-5.6) 2.6)
24 HOURS AMBULATORY BLOOD PRESSURE MONITORING AND LEFT VENTR1CULAR HYPERTROPHY: WHICH IS THE BETTER PARAMETER OF CORRELATION?. C. Ascioti A. Butera, P. Pelaggi, G. Lupia Palmieri and G. Ferlaino.
p<0.0o5 DBP
79.38 ±12.7
85 ±9.3
89.8 *32
-4.8 (-12.5-
-9.1(-27.3 -1.63(2.94-9.1) -0.36)
2.8)
FIR
73.9 73.8 77.3 -3.57 0.3(-1.25- -5.9(-15.7±15 ±13 ±25 (-9.1-1.9) 0.4) 3.8) D/P.- differenceof meansif doet~ meamredfa~t. P/D.-differe~eesif patientmeasured first. TotaldiE-globaldifferencein means.SBP/DBPsystolicJdiastolicbloodpressure. HR.- heartrate.Dataare expressedas average± SD(mmHg)and 95 %IC. Significant conelation existed between doctor office DBP and daytime DBP average by ABPM (r = -0.3, p=0.01) and between patient office SBP and daytime SBP average by ABPM (r = -0.25, P--0.04). in conclusion: l.-Alert reaction associated to office measurement seems to be rather related to bealthcare environment than with the doctor's presence. 2.- Regardless of who takes the first BP ~ t , it is always significantly higher. 3.-Conelation between office BP and ABPM is poor, although the doctor's DBP and the patient's SBP are significance. Key Words: Self-monitoring, ABPM, alert reaction
The investigate
objective of how
much
the study the
was
reflection
to
wave
Key Words: isolated systolic hypertension, carotid arterial wave, hypertension in the elderly
Cardiology Service and Coronary Care Unit, Hospital of Lamezia Terme (Italy) Aim : to evaluate which parameter, among those detectable by means of a 24 Hours Ambulatory Blood Pressure Monitoring (ABPM), better correlates to Left Ventricular Hypertrophy (LVH).Materiuls and Methods: 42 hypertensive patiants, without any I~vious pharmacological antthypertensive therapy, were submitted to an ABPM (Micro AM 5600-Konlxon Instnunants) and to an mono-bi-dimensional echocardiogram. For each patient Left Vantricular Mass Index (LVMI-Devereux' formula) was calculated. The ABPM's parameters we considered were: Mean Value (MV), Blood Pressure Load (BPL) (both as percentage o f values and as Area Under Curve (AUC) of values over hypertensive threshold), Vmiabifity (V) (as Standard Deviation) and Coefficient o f Variation (VC), each one calculated for Systolic (S), Diastolic (D), Me~m (M) and Differantial (Diff) Blood Pressure (BP). These pm'ametors were calculated for each of the following monitoring periods: 24 hours, Day-Time, Night-Time, Working-Time and SlenpingTime.Stathticul ~ : each calculated value (100 values) was correlated to LVM1 by means of a linear correlation test. Results: a wide degree o f variability o f coefficient o f correlation was found. The more negative correlation value (r = - .02) was found for 24h S VC; the highest positive correlation (r = .91) was found for 24h S BPL. Conclmiom: Our results confiml pre~ous studies already reported in literature, affording to which SBP values better correlates to o r g m damage; in particular, our data demonstrate that, among the vmions parameters detectable by means of a 24 H ABPM, 24h SBPL is the parameter that better enrrelates to LVH. Key Words:
ABPM, Left Vemriculur Hypertrophy.
161A
POSTERS: Blood Pressure Measurement (Including ABPM)
A057
A058
PRESSURE BEAT TO BEAT MONITORING DURING GASTROSCOPY. MR. Montebclli; F. Varone; ME. Riccioni*; R. Coppola*; L.Fazzari; F.Pichetti; M. Mettimano; A. Mign¢co; L. Savi. Dept. o f Internal Medicine, Hypertension Center, *Dept o f Surgery - Catholic University o f Rome.
AUGMENTATION OF CENTRAL BLOOD PRESSURE BY REFLECTION: EFFECT OF AGE K Kohara*, YN Jiang 1), M Igase, T Mild, K Hiwada ~)*. Dept of Geriatric Med, ~)2nd Dept of Intern Med, Ehime Univ, Ehime, Japan.
BLOOD
In order to investigate the pressure response to gastroscopy, a semi-invasive diagnostic procedure, we enrolled 50 patients which had to undergo this examination for several reasons; they were 30 normotensives (mean age 53,2 ± 17,53; 13 females and 17 males) and 20 hypertensives (mean age 65,85 :t= 11,78; 12 females and 8 males). We performed a beat-to-beat blood pressure analysis using a Finapres 2300 device throughout 10 consecutive phases: baseline, gastroscopy (introduction, esophageal transit, gastric antrum and body transit, pyloric transit, duodenum, gastric fundus, biopsies, extraction), recovery. Hypertensive patients were all on therapy, with a g o o d hasclinc control (SBP: 133,14; DBP: 81,8 mmHg); for normotensive patients baseline pressure levels were: SBP 113.83; DBP 70.67. We analyzed the variations o f blood pressure measurements throughout the consecutive phases o f gastroscopy; the percentage o f increase in the two groups was comparable with a peak at phase 5 (SBP increase: 25,6%, confidence limit 21,1%38,1%; DBP increase: 32,3%, confidence limit: 23,541%). At phase 5, 8 hypertensives showed SBP > 180 m m H g and 7 o f them had DBP > 110 m m H g . Gastroseopy constitutes a potent stress for blood pressure; therefore hypertensives m a y rcquire a careful monitoring during.this procedure and an appropriate prcmedication. Key words: Hypertension, Beat-to-beat Monitoring, Gastroscopy
contribute to the blood pressure in elderly hypertensive patients. The augmentation by the reflection of central blood pressure was estimated from the carotid augmentation index (CAI) on carotid pressure waveform in 143 essential hypertensive patients. Aortic augmentation index was calculated by the regression equation between CAI. Aortic pulse pressure was estimated by age-dependent peripheral amplification. Aortic pressure was divided into forward traveling and reflection backward traveling components and diastolic pressure. The reflection component of aortic pressure showed a significant positive correlation with age (r=0.57, p<0.0001). In the elderly patients with age~70, more than 20% of aortic SBP was due to the reflection wave. These findings indicate that reflection of the pressure wave significantly contributed to the augmentation of systolic hypertension in elderly hypertensive patients.
A059
A060
IS THERE ANY DIFFERENCE IN OFFICE BLOOD PRESSURE (BP) DEPENDING ON WHO MEASURES IT, THE DOCTOR OR THE PATIENT HIMSELF? Garcia-Polo I. ~ G a h i n C. Novella B. M6ndez J. ~%~.~..~.* Hospital de la Princesa, Madrid. Spain. The aim of the study is to det~mine whether there is any diffea~nce in office BP depending on who takes the mensmement: the patient himself or the doctor, and to analyze the correlation between ambulatozy blood pressure monitoring (ABPIv0 and office BP measured by the doctor or the patient himself. Seventy hypertensive outpafierds were enrolled. 58% men, mean age 58.3+11.3 years, time averagn since hypezton~on diagnosis 11.9 years. BP was mcamur~ with a validated scmiantomatic device Omrom HEM-711, after 5 mintges resting, 3 times at 2 minute intervals, by both the doctor and the patient, in a randomized way. Thereafter an ABPM (Spacelabs 90207) was performed. Daytime was defined with patient's activity dia~. T-test and Pearson correlation w~'e lied. Statistic si aificancewas considered ff ~<0.05. ABPM Doctor Patiemt Toteldif I)/P P/D n=70 n=30 N=40 SBP 129.4 140.2 138.8 1.4 3.34 0.07(-2.7±22.1 ±20 ~:19 (0.4-3.2) (1.06-5.6) 2.6)
24 HOURS AMBULATORY BLOOD PRESSURE MONITORING AND LEFT VENTR1CULAR HYPERTROPHY: WHICH IS THE BETTER PARAMETER OF CORRELATION?. C. Ascioti A. Butera, P. Pelaggi, G. Lupia Palmieri and G. Ferlaino.
p<0.0o5 DBP
79.38 ±12.7
85 ±9.3
89.8 *32
-4.8 (-12.5-
-9.1(-27.3 -1.63(2.94-9.1) -0.36)
2.8)
FIR
73.9 73.8 77.3 -3.57 0.3(-1.25- -5.9(-15.7±15 ±13 ±25 (-9.1-1.9) 0.4) 3.8) D/P.- differenceof meansif doet~ meamredfa~t. P/D.-differe~eesif patientmeasured first. TotaldiE-globaldifferencein means.SBP/DBPsystolicJdiastolicbloodpressure. HR.- heartrate.Dataare expressedas average± SD(mmHg)and 95 %IC. Significant conelation existed between doctor office DBP and daytime DBP average by ABPM (r = -0.3, p=0.01) and between patient office SBP and daytime SBP average by ABPM (r = -0.25, P--0.04). in conclusion: l.-Alert reaction associated to office measurement seems to be rather related to bealthcare environment than with the doctor's presence. 2.- Regardless of who takes the first BP ~ t , it is always significantly higher. 3.-Conelation between office BP and ABPM is poor, although the doctor's DBP and the patient's SBP are significance. Key Words: Self-monitoring, ABPM, alert reaction
The investigate
objective of how
much
the study the
was
reflection
to
wave
Key Words: isolated systolic hypertension, carotid arterial wave, hypertension in the elderly
Cardiology Service and Coronary Care Unit, Hospital of Lamezia Terme (Italy) Aim : to evaluate which parameter, among those detectable by means of a 24 Hours Ambulatory Blood Pressure Monitoring (ABPM), better correlates to Left Ventricular Hypertrophy (LVH).Materiuls and Methods: 42 hypertensive patiants, without any I~vious pharmacological antthypertensive therapy, were submitted to an ABPM (Micro AM 5600-Konlxon Instnunants) and to an mono-bi-dimensional echocardiogram. For each patient Left Vantricular Mass Index (LVMI-Devereux' formula) was calculated. The ABPM's parameters we considered were: Mean Value (MV), Blood Pressure Load (BPL) (both as percentage o f values and as Area Under Curve (AUC) of values over hypertensive threshold), Vmiabifity (V) (as Standard Deviation) and Coefficient o f Variation (VC), each one calculated for Systolic (S), Diastolic (D), Me~m (M) and Differantial (Diff) Blood Pressure (BP). These pm'ametors were calculated for each of the following monitoring periods: 24 hours, Day-Time, Night-Time, Working-Time and SlenpingTime.Stathticul ~ : each calculated value (100 values) was correlated to LVM1 by means of a linear correlation test. Results: a wide degree o f variability o f coefficient o f correlation was found. The more negative correlation value (r = - .02) was found for 24h S VC; the highest positive correlation (r = .91) was found for 24h S BPL. Conclmiom: Our results confiml pre~ous studies already reported in literature, affording to which SBP values better correlates to o r g m damage; in particular, our data demonstrate that, among the vmions parameters detectable by means of a 24 H ABPM, 24h SBPL is the parameter that better enrrelates to LVH. Key Words:
ABPM, Left Vemriculur Hypertrophy.
161A