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Home blood pressure measurements: relationship with clinic and blood pressure monitoring
AIR-APRIL 1996-VOL. 9, NO.4, PART 2
POSTERS: Blood Pressure Measurement
E45
E46
AMBULATORY BLOOD PRESSURE MONITORING: QUAlITY CONTROl AND IMPliCATIONS FOR CLINICAL TRIALS IN HYPERTENSION. ~ B Vaisse, 0 Herpin, S BouteIan'" VGressinI R A&mar, Saini MaloI Frence. " The quality conlrol 01 arrbulalofy blood preaIln I8CO!dnga (ASP) In clinlcallrials is rarely pertorrned. In a multicenter ltuetr In 407 h)ll8ltensive patients, 735 ASP were analyzed (Spacelaba 90207 : 624, 28 cantara ; Novacor : 111, 5 canters) : 375 after I 6-weeI\ treatment with Cdazapril and 360 after an addtional 6-week lJeetmenl with cilllZ2p1i1 alone or contined with either Isradipine, hyctochlorothi8Zlde or bisqxolol. ConlJuIarized dala were canlrany analyZed. An ABP was considered IS valid if the loIlowing C1iteria were 'ulfined : BP measurement every 15 minutes ckJring 24 houl1 ; ABP start between 7 and 11 AM, ~ 48 validated BP readngs, no more than 2 non consecutive hours Without validated SP measures. Readngl were automaticany edited il SBP ~ 50 and s 300 mmHg, OBP ~ 30 and s 200 mmHg, SSP· DSP ~ 20 mmHg if SSP ~ 140 mmHg and SBP • CSP ~ 10 mmHg if SBP < 140 mmHg, 40 :s HR s 200 ~. The mean nooiler of validated measurements was 85 :I: 13 (Spacelabl : 86 :I: 12 ; Novacor: 78 :I: 21). One or the 2 ABP were excluded In 17% of patients (651375) : 13% (47/3751 at dav 42 and 9% (341360) at day 84, lor the ronowing reasonl: Day 84 (n = 360) Day 42 In = 3751 ASP duration < 24 hI'S 81 84 validated SP readl1Qs < 48 11 7 1 hr with no readng 4 5 ~ 2 hrs with no readil1Q 43 38 ASP start <7 or) 11 AM 15 10 Tnal SIZEI may be reduced when ASP II used. OOI1ll8red to casual SP measurement because 01 the better reproducibility 01 thil technique (standard deviation 01 the differences 01 9.1 and 5.9 at day 42 and 84, Illspectively compared to 14.3 and 9.1 mmHg). However, quality conlrol 01 ABP should be pertormed, leadng to incrnase the stuetr population by 17%
ALBUMINURIA, LEFT VENTRICULAR MASS INDEX AND 24-H AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH ESSENTIAL AND SECONDARY HYPERTENSION. M LapiJlski,AJanusz.ewicz,E.D:tbro~AKuch-Woc18l,H.Berent, B. WOClal,W.JanUSleWicz Department of Hypertension and Angiology, Academy of Medicme, Banacha la, Warsaw, Poland The aim of the study was 10 determine albuminuna, left venlncular mass index (LVMI) and to perform 24-hour ambulatory blood PfCSSure monitoring in patients with essen\lal and secondary hypertension. The study was performed in 20 pts with essential hypertension (EH) (4F,16M;mean age: 42 ± 2 yrs), 12 patients (3M,9F;mean age 41±3 yrs) with pheochromocytoma (pHEO), II pts ( 3F,8 M;mean age 42 ± 4 yrs) with renovascular hypenension (RVH), 8 pts (5F,3M; mean age: 45 ± 3 yrs) with primary aldosteronism (PA) and I I healthy normotensive volunteers ( C ) ( 2F, 9M, mean age' 40 ± 2 yrs) During 24-hour ambulatory blood pressure monitoring (24-ABP) measurements were taken every 15 min in day-time (6 00-23 (0) and every 20 min in night-time (23.00-600) Wlth monitor 90201 by SpaceLabs. Simultaneously unne for albumin excretIon was collected. Albuminuria was measured with immunoturbidimelric method. Echocardlography was performed in all the patients Albuminuria was significantly higher in RVH than In EH. PA and PHEO (80±29 vs 21±3, 25±17, 26±1I mgl24h; respectively;p<0.05). In EH, RVH, PA and PHEO albuminuria "as significanlty higher as compared with C . SBP 24h and PBP 24h was significantly higher in RVH and PA as compared with EH , PHEO and C. No significant differences in LVMI were found belween EH , RVII , PHEO and PA , being higher than 10 C . No correlation was obsc:rved between albuminuria and SBP24 h, DBP24h and L VMJ in all groups. Our results indicale that patients with RVH are charactensed by more pronounced albuminuria than patients with EH, PHEO and PA , what may indicate the impauement of renal function in patients with lhis form of secondary hypertension
Key worda : ambulatory blood pressure monitoring, clinical trials, quality conlrol, sample size
Key Words: albuminuria, pnmary and secondary hypertenSion
£47
E48
HOME BLOOD PRESSURE MEASUREMENTS: RELATIONSHIP WITH CLINIC AND BLOOD PRESSURE MONITORING. ~ Cottone S., Piazza G., Volpe V., Lisi A., Galiano S. and
ACCURACY OF MICRO AM !600, A BLOOD PRESSURE AMBULATORY MONITORING DEVICE, VALUATED DURING EFFORT STRESS TEST
Ce~taG."
Chair of Inlernal Medicine and Hypenension Center - University of Palermo - Italy The aim of this study was to compare home blood pressure (HOP) measurements recorded on both non- and workday, with clinic blood pressure (BPc), daytime and 24h- ambUlatory blood pressure monitoring (ADPM). Desi~n and Methpds: Nineteen essential hypertensiv,:" (10 M/9 F), with mean age 42.2 :I: 7 years, after a wash-out penpd of 15 days, underwent the evaluation of BPe, 24-h ABPM (Spacelabs 90207), and home blood pressure measurements (OMRON HEM-713 C) aI08:00 a.m.. 4:00 and 8:00 p.m.. on both non- and workday. Moreover, plasma adrenaline (A) and noradrenaline (NA), in both resting and slanding position, were obtained. ~: Systolic and Diastolic-HBP values showed no differences with both 24h·SBPIDBP and DAYTIME-SBPIDDP and were significantly lower than DPe (p < °2~~:ABPM DAY1TME- ABPM apc SBP PDP SBP PDP SBP PDP
~:
~
and G. FerJamo
Cardiology Sel'1llce and CorontJ1")l Care Unit, Ho:rpltal oILam.~la
Te"",. (Italy)
The most part of the protocols actually m use for the validation of Ambulatory Dlood Pressure MomlorUlg (ADPM) deVICeS, valuate their reliability at rest; bltle IS known on the contrary about the reliability and accuracy of these devices when valuated dwing dynanllc condiaons Aim ofow: study has been that to venf}r the accuracy, during effort stress test, of a Micro AM 5600 (Kontron Instruments), an Holter ECG and ABPM recorder, eompanng Systolic and Pyastobc Blood Pressure (SBP and OPB) values, obtamed With Micro AM to those
ohtained WIth "phygmomannmetnc melhod 15 patients (mean age 57 ± 54 ) have been selected and all of these W\lIe submitted to an ABPM by means of the MICRO AM and
contemporary 10 an effort stress test by means of a cyclo-eJllometnc system. BP values detecllon were earned out simultaneously in the same ann by collecting lb. two different BP detection system via a T tube We have obtUUtled the following results·
•
• Spby,..
MEAN
0.660§
0.611'
0.480·
NW: non- workday - W: workday • P< 0.05· 'p < 0.01 - § p < 0.005 - # P < 0.001
We found no correlation between basal plasma levels and percentage or A and NA with BPe, HBP and their differenres. Conclusions: Our results seem to demonSl1ate the usefulness of HOP recorded at 08:00 a.m. and of the average of home measurements in the follow-up of hypertensive patients. increa.
Key words: monitoring
Home blood pressure. Ambulatory blood pressure
Mi.... AM
... .WI ....
- ....
8DP DBP SDP DDP 8BP DDP wiu
"
1561 IH ±2U ±U.•
1S60 1S.2 t137 +117
210
110
110
60
001'-.978
~I
224
110
121
60
DBI'-.901
~1
Stabstical analysis: a linear conelation test was used Conclusion: the MICRO AM 5600 has &hown, dunng cffort S1=s test, a very good reproducibility in detection BP values, especially when these values are compared to those oblallled by means of
sphygmanometric method.
Key Words: [trolt stress test. nlood Pressure Ambulatory Monitoring Device.
113A
POSTERS: Blood Pressure Measurement
E45
E46
AMBULATORY BLOOD PRESSURE MONITORING: QUAlITY CONTROl AND IMPliCATIONS FOR CLINICAL TRIALS IN HYPERTENSION. ~ B Vaisse, 0 Herpin, S BouteIan'" VGressinI R A&mar, Saini MaloI Frence. " The quality conlrol 01 arrbulalofy blood preaIln I8CO!dnga (ASP) In clinlcallrials is rarely pertorrned. In a multicenter ltuetr In 407 h)ll8ltensive patients, 735 ASP were analyzed (Spacelaba 90207 : 624, 28 cantara ; Novacor : 111, 5 canters) : 375 after I 6-weeI\ treatment with Cdazapril and 360 after an addtional 6-week lJeetmenl with cilllZ2p1i1 alone or contined with either Isradipine, hyctochlorothi8Zlde or bisqxolol. ConlJuIarized dala were canlrany analyZed. An ABP was considered IS valid if the loIlowing C1iteria were 'ulfined : BP measurement every 15 minutes ckJring 24 houl1 ; ABP start between 7 and 11 AM, ~ 48 validated BP readngs, no more than 2 non consecutive hours Without validated SP measures. Readngl were automaticany edited il SBP ~ 50 and s 300 mmHg, OBP ~ 30 and s 200 mmHg, SSP· DSP ~ 20 mmHg if SSP ~ 140 mmHg and SBP • CSP ~ 10 mmHg if SBP < 140 mmHg, 40 :s HR s 200 ~. The mean nooiler of validated measurements was 85 :I: 13 (Spacelabl : 86 :I: 12 ; Novacor: 78 :I: 21). One or the 2 ABP were excluded In 17% of patients (651375) : 13% (47/3751 at dav 42 and 9% (341360) at day 84, lor the ronowing reasonl: Day 84 (n = 360) Day 42 In = 3751 ASP duration < 24 hI'S 81 84 validated SP readl1Qs < 48 11 7 1 hr with no readng 4 5 ~ 2 hrs with no readil1Q 43 38 ASP start <7 or) 11 AM 15 10 Tnal SIZEI may be reduced when ASP II used. OOI1ll8red to casual SP measurement because 01 the better reproducibility 01 thil technique (standard deviation 01 the differences 01 9.1 and 5.9 at day 42 and 84, Illspectively compared to 14.3 and 9.1 mmHg). However, quality conlrol 01 ABP should be pertormed, leadng to incrnase the stuetr population by 17%
ALBUMINURIA, LEFT VENTRICULAR MASS INDEX AND 24-H AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH ESSENTIAL AND SECONDARY HYPERTENSION. M LapiJlski,AJanusz.ewicz,E.D:tbro~AKuch-Woc18l,H.Berent, B. WOClal,W.JanUSleWicz Department of Hypertension and Angiology, Academy of Medicme, Banacha la, Warsaw, Poland The aim of the study was 10 determine albuminuna, left venlncular mass index (LVMI) and to perform 24-hour ambulatory blood PfCSSure monitoring in patients with essen\lal and secondary hypertension. The study was performed in 20 pts with essential hypertension (EH) (4F,16M;mean age: 42 ± 2 yrs), 12 patients (3M,9F;mean age 41±3 yrs) with pheochromocytoma (pHEO), II pts ( 3F,8 M;mean age 42 ± 4 yrs) with renovascular hypenension (RVH), 8 pts (5F,3M; mean age: 45 ± 3 yrs) with primary aldosteronism (PA) and I I healthy normotensive volunteers ( C ) ( 2F, 9M, mean age' 40 ± 2 yrs) During 24-hour ambulatory blood pressure monitoring (24-ABP) measurements were taken every 15 min in day-time (6 00-23 (0) and every 20 min in night-time (23.00-600) Wlth monitor 90201 by SpaceLabs. Simultaneously unne for albumin excretIon was collected. Albuminuria was measured with immunoturbidimelric method. Echocardlography was performed in all the patients Albuminuria was significantly higher in RVH than In EH. PA and PHEO (80±29 vs 21±3, 25±17, 26±1I mgl24h; respectively;p<0.05). In EH, RVH, PA and PHEO albuminuria "as significanlty higher as compared with C . SBP 24h and PBP 24h was significantly higher in RVH and PA as compared with EH , PHEO and C. No significant differences in LVMI were found belween EH , RVII , PHEO and PA , being higher than 10 C . No correlation was obsc:rved between albuminuria and SBP24 h, DBP24h and L VMJ in all groups. Our results indicale that patients with RVH are charactensed by more pronounced albuminuria than patients with EH, PHEO and PA , what may indicate the impauement of renal function in patients with lhis form of secondary hypertension
Key worda : ambulatory blood pressure monitoring, clinical trials, quality conlrol, sample size
Key Words: albuminuria, pnmary and secondary hypertenSion
£47
E48
HOME BLOOD PRESSURE MEASUREMENTS: RELATIONSHIP WITH CLINIC AND BLOOD PRESSURE MONITORING. ~ Cottone S., Piazza G., Volpe V., Lisi A., Galiano S. and
ACCURACY OF MICRO AM !600, A BLOOD PRESSURE AMBULATORY MONITORING DEVICE, VALUATED DURING EFFORT STRESS TEST
Ce~taG."
Chair of Inlernal Medicine and Hypenension Center - University of Palermo - Italy The aim of this study was to compare home blood pressure (HOP) measurements recorded on both non- and workday, with clinic blood pressure (BPc), daytime and 24h- ambUlatory blood pressure monitoring (ADPM). Desi~n and Methpds: Nineteen essential hypertensiv,:" (10 M/9 F), with mean age 42.2 :I: 7 years, after a wash-out penpd of 15 days, underwent the evaluation of BPe, 24-h ABPM (Spacelabs 90207), and home blood pressure measurements (OMRON HEM-713 C) aI08:00 a.m.. 4:00 and 8:00 p.m.. on both non- and workday. Moreover, plasma adrenaline (A) and noradrenaline (NA), in both resting and slanding position, were obtained. ~: Systolic and Diastolic-HBP values showed no differences with both 24h·SBPIDBP and DAYTIME-SBPIDDP and were significantly lower than DPe (p < °2~~:ABPM DAY1TME- ABPM apc SBP PDP SBP PDP SBP PDP
~:
~
and G. FerJamo
Cardiology Sel'1llce and CorontJ1")l Care Unit, Ho:rpltal oILam.~la
Te"",. (Italy)
The most part of the protocols actually m use for the validation of Ambulatory Dlood Pressure MomlorUlg (ADPM) deVICeS, valuate their reliability at rest; bltle IS known on the contrary about the reliability and accuracy of these devices when valuated dwing dynanllc condiaons Aim ofow: study has been that to venf}r the accuracy, during effort stress test, of a Micro AM 5600 (Kontron Instruments), an Holter ECG and ABPM recorder, eompanng Systolic and Pyastobc Blood Pressure (SBP and OPB) values, obtamed With Micro AM to those
ohtained WIth "phygmomannmetnc melhod 15 patients (mean age 57 ± 54 ) have been selected and all of these W\lIe submitted to an ABPM by means of the MICRO AM and
contemporary 10 an effort stress test by means of a cyclo-eJllometnc system. BP values detecllon were earned out simultaneously in the same ann by collecting lb. two different BP detection system via a T tube We have obtUUtled the following results·
•
• Spby,..
MEAN
0.660§
0.611'
0.480·
NW: non- workday - W: workday • P< 0.05· 'p < 0.01 - § p < 0.005 - # P < 0.001
We found no correlation between basal plasma levels and percentage or A and NA with BPe, HBP and their differenres. Conclusions: Our results seem to demonSl1ate the usefulness of HOP recorded at 08:00 a.m. and of the average of home measurements in the follow-up of hypertensive patients. increa.
Key words: monitoring
Home blood pressure. Ambulatory blood pressure
Mi.... AM
... .WI ....
- ....
8DP DBP SDP DDP 8BP DDP wiu
"
1561 IH ±2U ±U.•
1S60 1S.2 t137 +117
210
110
110
60
001'-.978
~I
224
110
121
60
DBI'-.901
~1
Stabstical analysis: a linear conelation test was used Conclusion: the MICRO AM 5600 has &hown, dunng cffort S1=s test, a very good reproducibility in detection BP values, especially when these values are compared to those oblallled by means of
sphygmanometric method.
Key Words: [trolt stress test. nlood Pressure Ambulatory Monitoring Device.
113A