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Left ventricular structural and functional relationships in untreated hypertension
AJH-APRIL 1995-VOL.8, NO.4, PART 2
94A ASH ABSTRACTS
G49
GSO
BLOOD PRESSURE LEVELS IN WHIlE WAT ~SIVE PATIENTS. THREE DIFFERENT METHODS AND THREE
EFFECI'S OF BLOOD PRESSURE MEASl1RE1tt&ll' ON BLCOD
DIFFERPM' READn~s. NR Musso, M Giacche. C Vergassola. Department of internal Medicine. University of Genoa. Genoa.
PffO'l'OPLE'rnYSMJMANOf.fBTRY BASIS.
Italy.
White coat hypertension (WeH) is usually defined by office readings above 140/90 mmHg and by normal values on ABPM. In 192 consecutive patients we recorded blood pressure levels by: mercury sphygmomanometer (MS). Finapres (FAP). and space labs 90207 (ABPM). On the basis of their values (ABPM and MS) patients were divided in: normotensive (N=27). WCH (N=151. treated hypertensive responders (N=41). treated hypertensive nonresponders (N=37), treated hypertensive false nonresponders (N:28. hypertensive patients with additional white coat effect), and untreated hy~rtensives (N=44), finapres readings after stabilization in supine position showed different blood pressure levels in the subgroups in the following order: untreated hyperiensive > treated nonresponders > treated responders> normotensive (P<.OS). WCH patient and false nonresponder values were between untreated and nonresponders IP ns vs both). In spite of normal ABPM (average 24 houri values these last subgroups had a high (>140/90 mmHg) MS reading and an elevated beat-to beat recording (i.e. in the untreated hypertensive range). This may be viewed as a part of the alarm reaction of WeH pat i ents (also with noninvasive continuous reading after stabilization), or as pathologic data following initial arterial wall damage in an early step of hypertension.
PRESSURE LEVELS IN 192 UNSELEC1'ED PATIENTS, ON A
NR Mussq. M Gi acche. Department of Internal Medicine. University of Genoa. Genoa, Italy. The diagnosis of Whi te Coat Hypertension (WeH) is usually defined by some degree of difference between office and average ambulatory blood pressure (ABPM) . We investigated in 192 consecutive outpatients an alternative method to ABPM for the d Iagnos is of WCH. Pat ients underwent a continuous noninvas ive monitoring of blood pressure by a Finnpres 2300 (FAP). After stabilization in supine position 10 min of recording was done: thereafter a mercury-sfigmomanometer (MS) measurement took place. After the procedure. the patients underwent an ABPM by a Spacelab 90207. On the basis of ABPM we selected 42 normotensive subjects, 106 treated hypertensive patients. and 44 untreated hypertensive patients: 15 out of 42 normotensive subjects had a WCH. The FAP revealed a significant increase of systolic blood pressure (11 mmHg. P<.0251 during MS in the whole group. NorlllOtensive and treated hypertensive subgroups had a significant systolic increase (pc.OS). too. The increase in diastolic values was inconsistent. The difference among FAP. MS and ABPM values was highly significant (P< .OOOl) and the difference between MS svstol ic value and the average FAP one was equal to the increase in FAP systolic value when MS measurement took place, FAP and ABPM systolic values were significantly different but the difference was only 2 mmHg. The maximal increase in systolic values (FAP) during MS was assessed in WCH patients (22 mmHg. pc.OS). t
Key Words:\'lhi te Coat Hypertension, Blood
Key Words: Ambulatory Blood Pressure Monito
Pressure Measurement.
ring, White Coat Hypertension.
G51
G52
AMBULATORY BLOOD PRESSURE NOOITORIMJ IN NORMAL
LEfT
AfID HYPERTENSIVE HUMANS. DETECTION OF 11iB WHITE COAT EFfECT IN 11fE DIFFEROO'IAL DIAGNOSIS. 1m M!J§_~. C vergassola. G ( ~ ) ba d gg i . Department of Internal Medicine. University of Genoa. Genoa, Italy. AmbUlatory blood pressure monitoring (ABPMI is usually accepted as a defining procedure for diagnOSIng white coat hypertension (WeH). We investigated in 192 consecutive patients the possible relationships between ABPM data and the dire.ct measurement of the blood pressure (BP) increase during office measurement by a photoplethysmomanometry (finapres-FAP) . Our outpatients were unselected and they were considered eligible when had at least 80 % of successful readings on ABPM and no artifacts on FAP. The incD3ase of BP on I~P during office measurement showed no significant relationships with the decrease of fiP during initial recordings of ABPM. nor with parameters of BP variability on ABPM. FAP systolic basal values were very similar to average 24h systolic ABPM (mean difference 1.8 mmHg P< .051. whereas diastolic values showed a marked d i ff'erence 117.8 mmHg P< .OOII . This was confirmed in each subgroup (27 normotensive. 15 Ylr.H. 106 treated hypertensive and 44 untreated hypertensive patients). The diagnosis of WCH was made in those patients with ABPM normal values and office BP > 140/90. In these patients no relationships were found between the FAP recorded increase in BP during office measurement and any parameter of ABPM recordings. ABPM alone is not able to different iate wcn from normotensive pat ients wi thout a parallel office BP measurement. KeyWo~s:White
Coat Hypertension, Blood Pressure Measurement, ABPM
VENTRICULAR STRUCTURAL
AND FUNCTIONAL
RELATIONSHIPS IN UNTREATED HYPERTENSION. J Mayet, M Sham, ADHughes, AVStanton. NR Poulter, P S Sever. RAFoalc. SAM Thom. The Peart-Rose Clinic andDepartment of Cardiology, SI. Mary's Hospital, ICSTM. London, UK. Left ventricular hypenrophy in panicular is a powerful predictor of subsequent cardiovascular morbidity and monality. Previous studies assessing haemodynamic factors which may be responsible forcardiac changes in these patients have been done on treated patients. In order to more fully investigate these haemodynamic relationships 98 never previously treated hypertensive subjects underwent electrocardiography, 2 dimensional and Doppler cchocardiography, 24 hour ambulatory blood pressure (BP) monitoring andexercise stress testing. Left ventricular mass index (LVMJ) \\'35 related more closely with mean 24 hour. than clinic BPs (24 hour systolic BP r-O.48, p
p
Of the indices of left ventricular diastolic function age (r=.().64, p
p=O.02) were imlependenlly related with FJA ratio. Age (r-O.40, p
Key Words:
hypcnension, ambulatory blood pressure, left ventricular diastolic function, left ventricrJlar hypertrophy
94A ASH ABSTRACTS
G49
GSO
BLOOD PRESSURE LEVELS IN WHIlE WAT ~SIVE PATIENTS. THREE DIFFERENT METHODS AND THREE
EFFECI'S OF BLOOD PRESSURE MEASl1RE1tt&ll' ON BLCOD
DIFFERPM' READn~s. NR Musso, M Giacche. C Vergassola. Department of internal Medicine. University of Genoa. Genoa.
PffO'l'OPLE'rnYSMJMANOf.fBTRY BASIS.
Italy.
White coat hypertension (WeH) is usually defined by office readings above 140/90 mmHg and by normal values on ABPM. In 192 consecutive patients we recorded blood pressure levels by: mercury sphygmomanometer (MS). Finapres (FAP). and space labs 90207 (ABPM). On the basis of their values (ABPM and MS) patients were divided in: normotensive (N=27). WCH (N=151. treated hypertensive responders (N=41). treated hypertensive nonresponders (N=37), treated hypertensive false nonresponders (N:28. hypertensive patients with additional white coat effect), and untreated hy~rtensives (N=44), finapres readings after stabilization in supine position showed different blood pressure levels in the subgroups in the following order: untreated hyperiensive > treated nonresponders > treated responders> normotensive (P<.OS). WCH patient and false nonresponder values were between untreated and nonresponders IP ns vs both). In spite of normal ABPM (average 24 houri values these last subgroups had a high (>140/90 mmHg) MS reading and an elevated beat-to beat recording (i.e. in the untreated hypertensive range). This may be viewed as a part of the alarm reaction of WeH pat i ents (also with noninvasive continuous reading after stabilization), or as pathologic data following initial arterial wall damage in an early step of hypertension.
PRESSURE LEVELS IN 192 UNSELEC1'ED PATIENTS, ON A
NR Mussq. M Gi acche. Department of Internal Medicine. University of Genoa. Genoa, Italy. The diagnosis of Whi te Coat Hypertension (WeH) is usually defined by some degree of difference between office and average ambulatory blood pressure (ABPM) . We investigated in 192 consecutive outpatients an alternative method to ABPM for the d Iagnos is of WCH. Pat ients underwent a continuous noninvas ive monitoring of blood pressure by a Finnpres 2300 (FAP). After stabilization in supine position 10 min of recording was done: thereafter a mercury-sfigmomanometer (MS) measurement took place. After the procedure. the patients underwent an ABPM by a Spacelab 90207. On the basis of ABPM we selected 42 normotensive subjects, 106 treated hypertensive patients. and 44 untreated hypertensive patients: 15 out of 42 normotensive subjects had a WCH. The FAP revealed a significant increase of systolic blood pressure (11 mmHg. P<.0251 during MS in the whole group. NorlllOtensive and treated hypertensive subgroups had a significant systolic increase (pc.OS). too. The increase in diastolic values was inconsistent. The difference among FAP. MS and ABPM values was highly significant (P< .OOOl) and the difference between MS svstol ic value and the average FAP one was equal to the increase in FAP systolic value when MS measurement took place, FAP and ABPM systolic values were significantly different but the difference was only 2 mmHg. The maximal increase in systolic values (FAP) during MS was assessed in WCH patients (22 mmHg. pc.OS). t
Key Words:\'lhi te Coat Hypertension, Blood
Key Words: Ambulatory Blood Pressure Monito
Pressure Measurement.
ring, White Coat Hypertension.
G51
G52
AMBULATORY BLOOD PRESSURE NOOITORIMJ IN NORMAL
LEfT
AfID HYPERTENSIVE HUMANS. DETECTION OF 11iB WHITE COAT EFfECT IN 11fE DIFFEROO'IAL DIAGNOSIS. 1m M!J§_~. C vergassola. G ( ~ ) ba d gg i . Department of Internal Medicine. University of Genoa. Genoa, Italy. AmbUlatory blood pressure monitoring (ABPMI is usually accepted as a defining procedure for diagnOSIng white coat hypertension (WeH). We investigated in 192 consecutive patients the possible relationships between ABPM data and the dire.ct measurement of the blood pressure (BP) increase during office measurement by a photoplethysmomanometry (finapres-FAP) . Our outpatients were unselected and they were considered eligible when had at least 80 % of successful readings on ABPM and no artifacts on FAP. The incD3ase of BP on I~P during office measurement showed no significant relationships with the decrease of fiP during initial recordings of ABPM. nor with parameters of BP variability on ABPM. FAP systolic basal values were very similar to average 24h systolic ABPM (mean difference 1.8 mmHg P< .051. whereas diastolic values showed a marked d i ff'erence 117.8 mmHg P< .OOII . This was confirmed in each subgroup (27 normotensive. 15 Ylr.H. 106 treated hypertensive and 44 untreated hypertensive patients). The diagnosis of WCH was made in those patients with ABPM normal values and office BP > 140/90. In these patients no relationships were found between the FAP recorded increase in BP during office measurement and any parameter of ABPM recordings. ABPM alone is not able to different iate wcn from normotensive pat ients wi thout a parallel office BP measurement. KeyWo~s:White
Coat Hypertension, Blood Pressure Measurement, ABPM
VENTRICULAR STRUCTURAL
AND FUNCTIONAL
RELATIONSHIPS IN UNTREATED HYPERTENSION. J Mayet, M Sham, ADHughes, AVStanton. NR Poulter, P S Sever. RAFoalc. SAM Thom. The Peart-Rose Clinic andDepartment of Cardiology, SI. Mary's Hospital, ICSTM. London, UK. Left ventricular hypenrophy in panicular is a powerful predictor of subsequent cardiovascular morbidity and monality. Previous studies assessing haemodynamic factors which may be responsible forcardiac changes in these patients have been done on treated patients. In order to more fully investigate these haemodynamic relationships 98 never previously treated hypertensive subjects underwent electrocardiography, 2 dimensional and Doppler cchocardiography, 24 hour ambulatory blood pressure (BP) monitoring andexercise stress testing. Left ventricular mass index (LVMJ) \\'35 related more closely with mean 24 hour. than clinic BPs (24 hour systolic BP r-O.48, p
p
Of the indices of left ventricular diastolic function age (r=.().64, p
p=O.02) were imlependenlly related with FJA ratio. Age (r-O.40, p
Key Words:
hypcnension, ambulatory blood pressure, left ventricular diastolic function, left ventricrJlar hypertrophy