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Relation of ambulatory pulse pressure with hypertensive left ventricular hypertrophy
93A
AJH–April 2002–VOL. 15, NO. 4, PART 2
POSTERS: Blood Pressure Measurement/Monitoring
P-176 IMPACT OF DIURNAL PATTERNS OF VASCULAR RESISTANCE AND COMPLIANCE ON BLOOD PRESSURE NIGHT FALL
Strong negative relationship between ambulatory PP is recorded with heart rate variability parameters (standard deviation NN intervals SDNN, R⫽-0.24, p⬍0.05; SDNN per day, R⫽-0.28, p⬍0.03; RMSD, R⫽-0.38, p⬍0.02; RMSD day, R⫽-0.34, p⬍0.005; RMSD night: R⫽0.38, p⬍0.002). Patients from the first group had significantly higher functional capacity at the exercise test (METTs 7,47 vs 5,85, p⬍0.05) and significantly higher value of the SDNN (131.4 vs 108.5, p⬍0.02) than patients from group IV. No significant correlation of the ambulatory PP with other clinical parameters was found. Our results showed significant relationship of the ambulatory PP with the heart rate variability and functional capacity at hypertensive patients with LVH.
Sergey A. Golubev, Jeffrey J. Tsai, Maxim N. Mily. Clinical Pharmacology, Vitebsk State Medical University, Vitebsk, Belarus; Pulse Metric, Inc., San Diego, CA, United States. Underlying mechanisms of non-dipping fenomenon are under discussions in aspects of demographic and metabolic factors, daily activities, autonomic cardiovascular regulation. We aimed to investigate by means of 24-hour noninvasive pulse wave analyses possible differences in daytime and nighttime vascular hemodynamics between essential hypertensives (EH) with and without sufficient nighttime BP fall. Ninenteen randomly selected untreated verified EH (11 males; aged (mean⫾SD) 37.9⫾ 9.4 years; daytime SBP 156.1⫾15.3, daytime DBP 90.3⫾9.9 mmHg) underwent 24 hour ambulatory oscillometric BP and HR measurements (DynaPulse 5000A; Pulse Metric, Inc., USA) with systemic vascular (SV) and brachial artery compliance and resistance evaluation at each measurement by the previously validated pulse dynamics analysis technology. The vascular hemodynamics variables were compared between dippers (10 subjects) and non-dippers (9 subjects).In the sample investigated non-dippers were significantly older then dippers (44.4⫾5.8 vs. 32.0⫾8.2 years; p⬍0.01), but didn’t differ in hypertension duration, BMI, 24-hour and daytime SBP and DBP. Non-dippers had significantly higher nighttime SV resistance (22.3⫾2.9 vs. 19.0⫾1.9 mmHg/L/min; p⬍0.01) but not systemic compliance or brachial artery parameters compared with dippers. After adjustment for age the difference in nighttime SV resistance disappeared. Thus, in the studied EH non-dippers differ from dippers by nighttime but not by daytime vascular hemodynamics with higher SV resistance during sleep, and were older. Relationships between aging and non-dipping status, reported also by others, seems to be associated with enhanced resistive vessels remodeling rather then with less daytime activity. Key Words: Blood Pressure Monitoring, Arterial Compliance, Non-Dipping Phenomenon
P-177 RELATION OF AMBULATORY PULSE PRESSURE WITH HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY Branko K. Lovic, Ivan S. Tasic, Dragan B. Lovic, Stevan Ilic, Dragan B. Djordjevic, Natasa L. Miladinovic Tasic. Cardiology, Institute for Cardiology Niska Banja, Niska Banja, Serbia, Yugoslavia. Pulse pressure (PP) and left ventricular hypertrophy (LVH) are an independent predictor of cardiac risk in patients with essential hypertension. However, their interconnection is not examined enough. Aim of the study is assessment of relationships between ambulatory pulse pressure with clinical parameters at hypertensive patients with LVH. 73 hypertensive patients were analysed (43 male), average age 56.3 ⫾ 8.5 with echocardiographic LVH (left ventricular mass index: 163.5 ⫾ 31,8 g/m2). Each subject underwent two-dimensional and Doppler echocardiography, 12-lead electrocardiogram examination, exercise stress testing (Bruce - protocol), 24-hour ambulatory blood pressure monitoring, and 24-hour Holter monitoring (analysis of ventricular arrhythmias and heart rate variability). Patients were grouped as follows: PP ⬍47 (Gr. 1,n⫽16), 47-52 (Gr. 2, n⫽17), 53-59 (Gr. 3, n⫽17) and ⬎59 mm Hg (Gr. 4, n⫽23).
Key Words: Pulse Pressure, Left Ventricular Hypertrophy, Heart Rate Variability
P-178 MEDICAL OPINION CONCERNING HOME BLOOD PRESSURE MEASUREMENT IN URUGUAY Margarita E. Dı´az, Margarita Dighiero. Latir Study, Hospital Pasteur, Montevideo, Uruguay. The objective of the study was to determine whether practitioners in Uruguay consider that home blood pressure measurements (HBPM) are helpful in the management of hypertension. Physicians practising in Uruguay were surveyed. The sample, which was geographically stratified, comprised 442 practitioners out of the 11050 physicians in the country who were likely to attend patients with hypertension. Each physician answered in writing a self-administered questionnaire on hypertension management in the course of a scheduled interview. The results were seventy-four percent (95% CI: 67-80), 13% (9-19) and 12% (8-18) of 201 physicians who responded to a question on whether they find HBPM useful answered that these evaluations are helpful, neither helpful nor unhelpful, and inconvenient for the management of patients with hypertension, respectively. Corresponding percentages of answers from the older-than-50 subset of physicians (n⫽51) were 59 (44-72), 23 (13-38) and 18 (8-31); percentages derived from the answers from younger-than-50 colleagues (n⫽146) were 79 (72-86), 10 (6-16) and 10 (6-16). Opinion and age bore a significant association (2 test, P⬍0.05). Fifteen percent (10-21), 50% (43-57) and 35% (28-42) of 205 physicians who answered a question on whether they adjust their patients’ antihypertensive medication on the basis of HBPM responded that they do, that they do it in selected instances and that they do it very infrequently or never, respectively. Corresponding percentages of the answers from the older-than-50 subset (n⫽54) were 17 (8-29), 48 (34-62) and 35 (23-49); and percentages derived from the answers from youngerthan-50 colleagues (n⫽148) were 15 (10-22), 51 (42-59) and 34 (27-43) respectively. There was no association between the answers to this question and age. In Uruguay, about three quarters of physicians regard HBPM as useful for the management of hypertension. This proportion is slightly lower when practitioners aged above 50 are considered and slightly higher in the lower age group. However, only 15% of all physicians use HBPM to adjust antihypertensive medication routinely (no difference between the age groups). This could reflect that physicians do not trust the accuracy of the HBPM measurements that are brought to them in some instances, because they are suspicious about the quality of the instrument used, and/or of the proficiency with which assessments are being carried out by persons who have not been properly trained. Key Words: Home BP Measurement, Physician Believes, Physician Behaviours
AJH–April 2002–VOL. 15, NO. 4, PART 2
POSTERS: Blood Pressure Measurement/Monitoring
P-176 IMPACT OF DIURNAL PATTERNS OF VASCULAR RESISTANCE AND COMPLIANCE ON BLOOD PRESSURE NIGHT FALL
Strong negative relationship between ambulatory PP is recorded with heart rate variability parameters (standard deviation NN intervals SDNN, R⫽-0.24, p⬍0.05; SDNN per day, R⫽-0.28, p⬍0.03; RMSD, R⫽-0.38, p⬍0.02; RMSD day, R⫽-0.34, p⬍0.005; RMSD night: R⫽0.38, p⬍0.002). Patients from the first group had significantly higher functional capacity at the exercise test (METTs 7,47 vs 5,85, p⬍0.05) and significantly higher value of the SDNN (131.4 vs 108.5, p⬍0.02) than patients from group IV. No significant correlation of the ambulatory PP with other clinical parameters was found. Our results showed significant relationship of the ambulatory PP with the heart rate variability and functional capacity at hypertensive patients with LVH.
Sergey A. Golubev, Jeffrey J. Tsai, Maxim N. Mily. Clinical Pharmacology, Vitebsk State Medical University, Vitebsk, Belarus; Pulse Metric, Inc., San Diego, CA, United States. Underlying mechanisms of non-dipping fenomenon are under discussions in aspects of demographic and metabolic factors, daily activities, autonomic cardiovascular regulation. We aimed to investigate by means of 24-hour noninvasive pulse wave analyses possible differences in daytime and nighttime vascular hemodynamics between essential hypertensives (EH) with and without sufficient nighttime BP fall. Ninenteen randomly selected untreated verified EH (11 males; aged (mean⫾SD) 37.9⫾ 9.4 years; daytime SBP 156.1⫾15.3, daytime DBP 90.3⫾9.9 mmHg) underwent 24 hour ambulatory oscillometric BP and HR measurements (DynaPulse 5000A; Pulse Metric, Inc., USA) with systemic vascular (SV) and brachial artery compliance and resistance evaluation at each measurement by the previously validated pulse dynamics analysis technology. The vascular hemodynamics variables were compared between dippers (10 subjects) and non-dippers (9 subjects).In the sample investigated non-dippers were significantly older then dippers (44.4⫾5.8 vs. 32.0⫾8.2 years; p⬍0.01), but didn’t differ in hypertension duration, BMI, 24-hour and daytime SBP and DBP. Non-dippers had significantly higher nighttime SV resistance (22.3⫾2.9 vs. 19.0⫾1.9 mmHg/L/min; p⬍0.01) but not systemic compliance or brachial artery parameters compared with dippers. After adjustment for age the difference in nighttime SV resistance disappeared. Thus, in the studied EH non-dippers differ from dippers by nighttime but not by daytime vascular hemodynamics with higher SV resistance during sleep, and were older. Relationships between aging and non-dipping status, reported also by others, seems to be associated with enhanced resistive vessels remodeling rather then with less daytime activity. Key Words: Blood Pressure Monitoring, Arterial Compliance, Non-Dipping Phenomenon
P-177 RELATION OF AMBULATORY PULSE PRESSURE WITH HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY Branko K. Lovic, Ivan S. Tasic, Dragan B. Lovic, Stevan Ilic, Dragan B. Djordjevic, Natasa L. Miladinovic Tasic. Cardiology, Institute for Cardiology Niska Banja, Niska Banja, Serbia, Yugoslavia. Pulse pressure (PP) and left ventricular hypertrophy (LVH) are an independent predictor of cardiac risk in patients with essential hypertension. However, their interconnection is not examined enough. Aim of the study is assessment of relationships between ambulatory pulse pressure with clinical parameters at hypertensive patients with LVH. 73 hypertensive patients were analysed (43 male), average age 56.3 ⫾ 8.5 with echocardiographic LVH (left ventricular mass index: 163.5 ⫾ 31,8 g/m2). Each subject underwent two-dimensional and Doppler echocardiography, 12-lead electrocardiogram examination, exercise stress testing (Bruce - protocol), 24-hour ambulatory blood pressure monitoring, and 24-hour Holter monitoring (analysis of ventricular arrhythmias and heart rate variability). Patients were grouped as follows: PP ⬍47 (Gr. 1,n⫽16), 47-52 (Gr. 2, n⫽17), 53-59 (Gr. 3, n⫽17) and ⬎59 mm Hg (Gr. 4, n⫽23).
Key Words: Pulse Pressure, Left Ventricular Hypertrophy, Heart Rate Variability
P-178 MEDICAL OPINION CONCERNING HOME BLOOD PRESSURE MEASUREMENT IN URUGUAY Margarita E. Dı´az, Margarita Dighiero. Latir Study, Hospital Pasteur, Montevideo, Uruguay. The objective of the study was to determine whether practitioners in Uruguay consider that home blood pressure measurements (HBPM) are helpful in the management of hypertension. Physicians practising in Uruguay were surveyed. The sample, which was geographically stratified, comprised 442 practitioners out of the 11050 physicians in the country who were likely to attend patients with hypertension. Each physician answered in writing a self-administered questionnaire on hypertension management in the course of a scheduled interview. The results were seventy-four percent (95% CI: 67-80), 13% (9-19) and 12% (8-18) of 201 physicians who responded to a question on whether they find HBPM useful answered that these evaluations are helpful, neither helpful nor unhelpful, and inconvenient for the management of patients with hypertension, respectively. Corresponding percentages of answers from the older-than-50 subset of physicians (n⫽51) were 59 (44-72), 23 (13-38) and 18 (8-31); percentages derived from the answers from younger-than-50 colleagues (n⫽146) were 79 (72-86), 10 (6-16) and 10 (6-16). Opinion and age bore a significant association (2 test, P⬍0.05). Fifteen percent (10-21), 50% (43-57) and 35% (28-42) of 205 physicians who answered a question on whether they adjust their patients’ antihypertensive medication on the basis of HBPM responded that they do, that they do it in selected instances and that they do it very infrequently or never, respectively. Corresponding percentages of the answers from the older-than-50 subset (n⫽54) were 17 (8-29), 48 (34-62) and 35 (23-49); and percentages derived from the answers from youngerthan-50 colleagues (n⫽148) were 15 (10-22), 51 (42-59) and 34 (27-43) respectively. There was no association between the answers to this question and age. In Uruguay, about three quarters of physicians regard HBPM as useful for the management of hypertension. This proportion is slightly lower when practitioners aged above 50 are considered and slightly higher in the lower age group. However, only 15% of all physicians use HBPM to adjust antihypertensive medication routinely (no difference between the age groups). This could reflect that physicians do not trust the accuracy of the HBPM measurements that are brought to them in some instances, because they are suspicious about the quality of the instrument used, and/or of the proficiency with which assessments are being carried out by persons who have not been properly trained. Key Words: Home BP Measurement, Physician Believes, Physician Behaviours