- Email: [email protected]
G29 White-coat effect and blood pressure variability
POSTERS: Blood Pressure Measurement 67A
AJH-APRIL 1997-VOL. 10, NO. 4, PART 2
G29
G30
WHITE-COAT EFFECT AND BLOOD PRESSURE VAfUABILITV C. Bellido”,D. Pilfsiro*,O. Iavlodi”, H. Bersrdoneand J. Lerman, Hospksl de Clinicas “Jos6 de Bsn Martin”, Univwsidsd de Busnos Aires ARGENTINA.
AGE AND BLOOD PRESSURE VALUES AS A DJ?ISRMINANTS OF AMBULATORY BLOOD PRESSURE MONITORING QUALITY IN PSDJATB1CRPLIL4TION ~*, Jose Tacons, Fr.wwiscoAguifar, Josep Redon*, Vic.mteAfvarez, Pediatric Nephmlogy, Hospital General and Hypertension Cli”ic, Hospital Chico. University of Valencia, Spain ‘fle &@iys of the present study was to assess ASPM quafity and the factom affecting this in pediatric populations. andmetb@s: threehundredand forty-ninesubjects(175 boys),ased3 to 18 yr (meanage 11.5i3,6 yT) were included.Accordingto theiroffice BP, 34 (9.4%) were hypertemives. In aft subjects,24 hourAMBP using an oscillomeuic device (Spacelabs 90207) was performed during a regtim school day. Readings were programmed at 20 min inte.rvafsfrom 6 am to midnight and thereafter every 30 min. The folfowing were calculated for each monitoring: a) “umber of total reedings (TR), perccmage of vafid readings (vR), and pcrcenrage of successful readings tetwccn the prese% (SPR); and b) average of 24 hours for systotic and diastolic BP, The q.afity M monitoringwas&tired awording the SPR, lower valws ¬c Iowexquafity.Tbe impact of the diffcrmt variabk in the quatily of the monitoringwas so”ght by multipleregressionamtysis, -: The nuder of ‘JR, and the percentageof VR md SPR were 79ill, 77+16%, and$xltll%, res~ctively. It cmbe obsemed in the figure that the cumulative percentage of VR diffem fmm that of the SPR. The sbiftto the right observed in tbe cumulative percmtage of SPR indicare rhat despite a relatively low VR there is a high SPR. Age (pcO.001) and 24hourSBP (wO.01) were indefxndentfy related to SPR, Lmver terdles of either, age or 24hourSBP, hadloweraveragesof SPR and awi&distibution ofvdws.
Aim of the study: Compsriszmof the blood pressure variability in hypertensivepstients(HT) without(WC -) and with wfrfiecmt etfest
(Wc+), Methods: We studied 13S stsge 1-II (.JNC-V) HT, 68 men and 70 women, aged 21-73 (mean + SD = 51 i 12) years, 67 wW’!Out and 71 with trestment. All pstients undwwsnt to 24-h ambutekxy blood pressure monitoring.White-mat effect was defMted S3 a dMference betweenofficeand mean a.vske ambulatorybleed prsssurecfat Ikast 20 mm Hg systolicand 10 mm Hg disstolic.Btoodpressurevmfsbility (var) was assessedas SD/mean x 1000. Statisticswere trerformedbv t .studefrttestand X2. fJciharad@sIltesTreatad~ Remdts: wc Wc+ wc 4s(72) 19(2s) n (%) 51 (72) 23(4s) Menn (%) 5(m =(~ 4S* 12 48* 12 53*1 I Ne (v=~) 14* 16 le2*17 CPS(mmHg) 14*1S 92*9 c9*a’ CPd(mtntig) GS*9 KS* Is 123+ lr 24h SBP(mmHg) 141* 17 132*47 1?3*42 1E8*72 24h SBP%ar 24.hDSP(mmHg) ee*7 62*9 7s*s6KS*37 K6*4S 194* 7724h DBPvar 16*ZO 12S* 19. 7:m-23:mssP (Innl Hg) 136*37 122*41 152* 7313*47 7:CW3:02SSPmr ea*12 i3*15 70XZ3:C0DBP(mmHg) 34* 12 f4S** IS??*3W 13S*SS 7C@23:C0 DSPmr 12S* t6 23:01-S:SSSP (mmHg) 122* 13 113* IT 12S+51 lm*42 104*33 23fllS:=SSPvar S3* 10 34*9” Z37YI.6:=DSP(mmHg) SO*9 117*43 123*47 23:01 -6:EerJsPw 1S2*53
W+ ZO(26) 5(=)” 56*I2 4a3* le
Iwis 122*14 m2*23 73*9 187*’O 124* W KO*3J 83* ?3’ 166*44” 117* 12” 1D3*28
ES*W 134*42
Vakesare sqmsed an meal * so. CPS, Caewa Syatdict4a0dpreswle; Cw, -ldia6taSc W prsswre;55P, systolkkbad~re; DSP,@astoSc blood p#3.sure.. p <0.01V9wc-,““p
Percentage of readings Qnduaim.TheABPM in m un.selectedpediaki. populationprovidevafuable infonnadon about amhulatmy BPparmneters. Awm-se ABPM quafity is expected in younger subjects mdin Omwwitb lower ambulatory BP. Kay Wortfa: Ambulatorybtoodpmue,
G32
G31 DIFFERENT EFFECTOF AGE ONDAYTIMEAND NIGHT3TMESYSTOLICBLOODPRESSURE
JAifie, G. Waiswn*, C.R.GaIana*,M Magi,kfl Cdmera*. Hypertension Unit. Hospital ltaliano. BuenosAires. Argentina &IL to compare.the age-relatedchangein clinic,daytimeand
nighttimebloodpressure. Methcds We included142 consecutiveunmedicatedsubjects refktredfor ABPMbecauseof hi@ O&S bbmdpressure.Clinic BPwasmeasursdby a doctor(meanof4 valuaa,2 in supineand 2 in uprightpositicxr)usinga mercuryaphygmottrattometer. We i3SWSMd ABPMusing a Spacelabs90207 (readin&!s every 10 tllitlltteS from 07.00to 23.00andevery20 lllill@S from 23.00to 07.00).Nighttimeperiodwas based ut patientreportedsleep time.Difl%reoces weretestedby ANOVA. Ni_sDavtime Clinic B2sJ& DBP DBP SBP DBP SB? Age (y) SBP 15-29 136i13 8&t10 136+10 83*9 llti14 65+12 30-44 134+17 89=t13 134+12 9fJi10 114+=1171+9 45-59 142+18 91+11 138+13 88+10 12&t13 74*1O 60-75 153+19788*1O 143+12$91+11 130+16t73*10 There was no sigttifkatnt@eel of age cm DBP. Clinicand nighttimeSBPiocreaaed in a parsllelotsnner(t p
Cmclusiotts:ABPMduringdaytime,btrtnti duringoishtdnta, attmustedthe age-relatsd increasein SBP. Daytime SBP c.cidd un&4m#ethedegrea ofhypertsmaim in olderpatieota.
Kay
WOdS:&s,
cbihkm, adolescents, monitoring quafity
ABPfu, circadiandtythm, dtitematet%k
DETERMINANTS OF DIFFERENCES WITHIN TIME-FJXED AND DIARY-GUIDED METHODS lNTHE ASSESSMENT OF BLOOD PRESSURE CIRCADIAN VARIBILJTY Antonio Vicentc*, Enrosr Lurke*, Jose Tacons, Vicente Alvarez, Josep Redon*. Hypertension Clinic, Hospital Clinico ard Pediatric Nephrology, Hospital General. University of Valencia, Spain The *of the present study was to aosfyzc factors related to thediscrcpurcies fxtween time-fixed anddimy-guided metbcds uwf to assess the BP circadian variability. ~: four hundred and two subjects (201 males, age range 3-84 yr) were included. According to office BP, 1S6(40%) were hypertensive. In all subjects, ’24 hours AMBP using an oscilometric device (Spacelabs W?OWW207) was performed duringa regular =hcol or workingday. Readings were programmed every 20 min between 6 am to midnight and thereafter every 30 min (man readings 61+7). Average for ’24hours (afl readings), awake (from 8sm to 10pm) and sleep psriods (see below) for systolic and diastolic Mccd pressure were calculated. Three different approaches to estimate nighttime were used: a) long period (LP), from llpm-7am; b) sftortperiod(SP), from midnight to 6anr; aod c) true deepperiod (TP), defined following a diary. The differences between the averages of night BPs within methods were sought using ANOVA, and the impact of clinical characteristics in the differen@sobeerved within methfs wem anafyzedusingmultiple regressionanalysis. &W!JS: LP overestimates the average of nighttime SBP and DBP in comparison to TP (SBP 2.2%5.33; DBP 1.17S.39), while no differences were ohmvcd frctwcen SP and TP (SBPO.06&5.24; DBP 0.53s3 .43). The pwccntcgeof nondippers(definedby a reduction>1O% for SBP and DBP) were 26%, 1S% and 17% for LP, SP and TP, respectively (FO.05). The differerw for both, SBP and DBP, between LP and TP was independently related only to the numhcr of sleep hours (wO.OCO1). No relationship was ohserved for age, sex, and ion: the long pcrimfapproach snrbulatory BP values. C~
overstimatcsnighttimeBP in Mb nornr- and hyptcnsives, and wastheresinfactoreffectingthis.The the numfxrofsfeephoutx usc of shod psriodstomfctdatcnighttimeBP is a god sftcmadve todiary-guidcd intbe asws.smentofcircsdicn
variability.
AJH-APRIL 1997-VOL. 10, NO. 4, PART 2
G29
G30
WHITE-COAT EFFECT AND BLOOD PRESSURE VAfUABILITV C. Bellido”,D. Pilfsiro*,O. Iavlodi”, H. Bersrdoneand J. Lerman, Hospksl de Clinicas “Jos6 de Bsn Martin”, Univwsidsd de Busnos Aires ARGENTINA.
AGE AND BLOOD PRESSURE VALUES AS A DJ?ISRMINANTS OF AMBULATORY BLOOD PRESSURE MONITORING QUALITY IN PSDJATB1CRPLIL4TION ~*, Jose Tacons, Fr.wwiscoAguifar, Josep Redon*, Vic.mteAfvarez, Pediatric Nephmlogy, Hospital General and Hypertension Cli”ic, Hospital Chico. University of Valencia, Spain ‘fle &@iys of the present study was to assess ASPM quafity and the factom affecting this in pediatric populations. andmetb@s: threehundredand forty-ninesubjects(175 boys),ased3 to 18 yr (meanage 11.5i3,6 yT) were included.Accordingto theiroffice BP, 34 (9.4%) were hypertemives. In aft subjects,24 hourAMBP using an oscillomeuic device (Spacelabs 90207) was performed during a regtim school day. Readings were programmed at 20 min inte.rvafsfrom 6 am to midnight and thereafter every 30 min. The folfowing were calculated for each monitoring: a) “umber of total reedings (TR), perccmage of vafid readings (vR), and pcrcenrage of successful readings tetwccn the prese% (SPR); and b) average of 24 hours for systotic and diastolic BP, The q.afity M monitoringwas&tired awording the SPR, lower valws ¬c Iowexquafity.Tbe impact of the diffcrmt variabk in the quatily of the monitoringwas so”ght by multipleregressionamtysis, -: The nuder of ‘JR, and the percentageof VR md SPR were 79ill, 77+16%, and$xltll%, res~ctively. It cmbe obsemed in the figure that the cumulative percentage of VR diffem fmm that of the SPR. The sbiftto the right observed in tbe cumulative percmtage of SPR indicare rhat despite a relatively low VR there is a high SPR. Age (pcO.001) and 24hourSBP (wO.01) were indefxndentfy related to SPR, Lmver terdles of either, age or 24hourSBP, hadloweraveragesof SPR and awi&distibution ofvdws.
Aim of the study: Compsriszmof the blood pressure variability in hypertensivepstients(HT) without(WC -) and with wfrfiecmt etfest
(Wc+), Methods: We studied 13S stsge 1-II (.JNC-V) HT, 68 men and 70 women, aged 21-73 (mean + SD = 51 i 12) years, 67 wW’!Out and 71 with trestment. All pstients undwwsnt to 24-h ambutekxy blood pressure monitoring.White-mat effect was defMted S3 a dMference betweenofficeand mean a.vske ambulatorybleed prsssurecfat Ikast 20 mm Hg systolicand 10 mm Hg disstolic.Btoodpressurevmfsbility (var) was assessedas SD/mean x 1000. Statisticswere trerformedbv t .studefrttestand X2. fJciharad@sIltesTreatad~ Remdts: wc Wc+ wc 4s(72) 19(2s) n (%) 51 (72) 23(4s) Menn (%) 5(m =(~ 4S* 12 48* 12 53*1 I Ne (v=~) 14* 16 le2*17 CPS(mmHg) 14*1S 92*9 c9*a’ CPd(mtntig) GS*9 KS* Is 123+ lr 24h SBP(mmHg) 141* 17 132*47 1?3*42 1E8*72 24h SBP%ar 24.hDSP(mmHg) ee*7 62*9 7s*s6KS*37 K6*4S 194* 7724h DBPvar 16*ZO 12S* 19. 7:m-23:mssP (Innl Hg) 136*37 122*41 152* 7313*47 7:CW3:02SSPmr ea*12 i3*15 70XZ3:C0DBP(mmHg) 34* 12 f4S** IS??*3W 13S*SS 7C@23:C0 DSPmr 12S* t6 23:01-S:SSSP (mmHg) 122* 13 113* IT 12S+51 lm*42 104*33 23fllS:=SSPvar S3* 10 34*9” Z37YI.6:=DSP(mmHg) SO*9 117*43 123*47 23:01 -6:EerJsPw 1S2*53
W+ ZO(26) 5(=)” 56*I2 4a3* le
Iwis 122*14 m2*23 73*9 187*’O 124* W KO*3J 83* ?3’ 166*44” 117* 12” 1D3*28
ES*W 134*42
Vakesare sqmsed an meal * so. CPS, Caewa Syatdict4a0dpreswle; Cw, -ldia6taSc W prsswre;55P, systolkkbad~re; DSP,@astoSc blood p#3.sure.. p <0.01V9wc-,““p
Percentage of readings Qnduaim.TheABPM in m un.selectedpediaki. populationprovidevafuable infonnadon about amhulatmy BPparmneters. Awm-se ABPM quafity is expected in younger subjects mdin Omwwitb lower ambulatory BP. Kay Wortfa: Ambulatorybtoodpmue,
G32
G31 DIFFERENT EFFECTOF AGE ONDAYTIMEAND NIGHT3TMESYSTOLICBLOODPRESSURE
JAifie, G. Waiswn*, C.R.GaIana*,M Magi,kfl Cdmera*. Hypertension Unit. Hospital ltaliano. BuenosAires. Argentina &IL to compare.the age-relatedchangein clinic,daytimeand
nighttimebloodpressure. Methcds We included142 consecutiveunmedicatedsubjects refktredfor ABPMbecauseof hi@ O&S bbmdpressure.Clinic BPwasmeasursdby a doctor(meanof4 valuaa,2 in supineand 2 in uprightpositicxr)usinga mercuryaphygmottrattometer. We i3SWSMd ABPMusing a Spacelabs90207 (readin&!s every 10 tllitlltteS from 07.00to 23.00andevery20 lllill@S from 23.00to 07.00).Nighttimeperiodwas based ut patientreportedsleep time.Difl%reoces weretestedby ANOVA. Ni_sDavtime Clinic B2sJ& DBP DBP SBP DBP SB? Age (y) SBP 15-29 136i13 8&t10 136+10 83*9 llti14 65+12 30-44 134+17 89=t13 134+12 9fJi10 114+=1171+9 45-59 142+18 91+11 138+13 88+10 12&t13 74*1O 60-75 153+19788*1O 143+12$91+11 130+16t73*10 There was no sigttifkatnt@eel of age cm DBP. Clinicand nighttimeSBPiocreaaed in a parsllelotsnner(t p
Cmclusiotts:ABPMduringdaytime,btrtnti duringoishtdnta, attmustedthe age-relatsd increasein SBP. Daytime SBP c.cidd un&4m#ethedegrea ofhypertsmaim in olderpatieota.
Kay
WOdS:&s,
cbihkm, adolescents, monitoring quafity
ABPfu, circadiandtythm, dtitematet%k
DETERMINANTS OF DIFFERENCES WITHIN TIME-FJXED AND DIARY-GUIDED METHODS lNTHE ASSESSMENT OF BLOOD PRESSURE CIRCADIAN VARIBILJTY Antonio Vicentc*, Enrosr Lurke*, Jose Tacons, Vicente Alvarez, Josep Redon*. Hypertension Clinic, Hospital Clinico ard Pediatric Nephrology, Hospital General. University of Valencia, Spain The *of the present study was to aosfyzc factors related to thediscrcpurcies fxtween time-fixed anddimy-guided metbcds uwf to assess the BP circadian variability. ~: four hundred and two subjects (201 males, age range 3-84 yr) were included. According to office BP, 1S6(40%) were hypertensive. In all subjects, ’24 hours AMBP using an oscilometric device (Spacelabs W?OWW207) was performed duringa regular =hcol or workingday. Readings were programmed every 20 min between 6 am to midnight and thereafter every 30 min (man readings 61+7). Average for ’24hours (afl readings), awake (from 8sm to 10pm) and sleep psriods (see below) for systolic and diastolic Mccd pressure were calculated. Three different approaches to estimate nighttime were used: a) long period (LP), from llpm-7am; b) sftortperiod(SP), from midnight to 6anr; aod c) true deepperiod (TP), defined following a diary. The differences between the averages of night BPs within methods were sought using ANOVA, and the impact of clinical characteristics in the differen@sobeerved within methfs wem anafyzedusingmultiple regressionanalysis. &W!JS: LP overestimates the average of nighttime SBP and DBP in comparison to TP (SBP 2.2%5.33; DBP 1.17S.39), while no differences were ohmvcd frctwcen SP and TP (SBPO.06&5.24; DBP 0.53s3 .43). The pwccntcgeof nondippers(definedby a reduction>1O% for SBP and DBP) were 26%, 1S% and 17% for LP, SP and TP, respectively (FO.05). The differerw for both, SBP and DBP, between LP and TP was independently related only to the numhcr of sleep hours (wO.OCO1). No relationship was ohserved for age, sex, and ion: the long pcrimfapproach snrbulatory BP values. C~
overstimatcsnighttimeBP in Mb nornr- and hyptcnsives, and wastheresinfactoreffectingthis.The the numfxrofsfeephoutx usc of shod psriodstomfctdatcnighttimeBP is a god sftcmadve todiary-guidcd intbe asws.smentofcircsdicn
variability.