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Repeated office blood pressure (ROBP) measurement for the diagnosis of white-coat or sustained hypertension
28A
POSTERS: Blood Pressure Measurement/Monitoring
AJH–May 2005–VOL. 18, NO. 5, PART 2
systolic BP. The 149 patients with WC hypertension were significantly older (60.2⫾13.3 vs. 54.8⫾14.9 years, mean⫾standard deviation; P ⬍ 0.0001) and more likely to be female (61.1 vs. 44.2%; P ⬍ 0.0001) compared to the 405 non-WC hypertension patients. The average office BPs were significantly higher in the WC hypertensive group (156.8⫾18.2/88.9⫾10.7 mm Hg vs. 137.2⫾17.2/83.6⫾11.7 mm Hg; P ⬍ 0.0001 for both systolic and diastolic). The average 24-hour BPs were 132.7⫾14.8/78.7⫾9.2 vs. 134.6⫾14.8/81.6⫾9.9 mmHg (P ⫽ 0.16/ 0.002) for the WC and non-WC patients respectively. During an average of 6.8⫾4.1 years of possible follow-up, 16 of the 149 (10.7%) patients with WC hypertension died compared to 22 of 405 (5.4%) non-WC hypertension patients (unadjusted risk ratio⫽2.0, P ⫽ 0.03 by log-rank test). In a Cox proportional hazards model using 2 or 3 covariates, age was the major predictor of mortality (adjusted relative risk 1.09 per year, 95% confidence interval 1.06-1.13, P ⬍ 0.0001) and neither gender nor WC hypertension was significant (adjusted relative risk 1.15, 95% CI: 0.60-2.21 for the latter when age was the only covariate). These data suggest that, in patients undergoing 24-hour ABPM at our hypertension center, WC hypertension was associated with older age and female gender, but was not an independent predictor of mortality (after adjustment for baseline differences between the WC and other hypertensive patients).
with elevated APP. 2-However, there are significant differences in other microvascular variables: RT, RFRVB, and RCVB, as well as a greater TVI, at the borderline of statistical significance.
Key Words: Ambulatory Blood Pressure Monitor, Mortality, White Coat Hypertension
P-55 FLOW-MEDIATED DILATATION AT THE FOREARM SKIN IN PATIENTS WITH ELEVATED AMBULATORY PULSE PRESSURE David Coca, Maria Calbacho, Arturo Ugalde, Enrique Bernal, Rosa Fabregate, Martin Fabregate, Olivia Sanchez, Jorge Haurie, Jose Saban-Ruiz. Endothelial Pathology Unit, Ramon y Cajal Hospital, Madrid, Spain. Introduction: Alterations in microvasculature might be an important factor in the pathogenesis of macrovascular damage due to the impairment of arterial nutrition. Aims: 1- To evaluate microvascular flow-mediated dilatation (FMD) in a population with elevated ambulatory PP versus a control group. 2To correlate FMD with small artery elasticity and ambulatory blood pressure monitoring (ABPM) variables. Methods: N⫽79, aged 31-81(60,16 ⫹-1,50), 51,9% M, 55 hypertensives. BMI (kg/m2), waist (cm). The following parameters were evaluated in 24h, during both activity (9:00 to 22:00) and rest (22:00 to 9:00) periods: average systolic BP (aSBP), average diastolic BP (aDBP), average Mean Arterial Pressure. Small artery elasticity index (C2), systemic vascular resistance, and total vascular impedance (TVI), assessed by the HDI/PulseWave CR-2000. Endothelium (ED) and non endothelium-dependent (NED) vasodilation: exploration of cutaneous microcirculatory responses at the forearm with laser Doppler (DRT4, MOOR Instruments). The skin blood flow response to transient occlusion of the circulation at the forearm (reactive hyperemia, RH) was measured using a laser Doppler imaging system. Peak-Flow associated to Reactive hyperemia (PFRH) respect to baseline was considered normal ⬎67% (group A), following our own criteria in control subjects, and abnormal ⬍67% (group B). Rising Time (RT)(msec). Recovering Flow Relative Variation respect to Baseline (RFRVB)(%). Recovering Concentration Variation respect to Baseline (RCVB). Statistical: t-Student, chi-square, Mann-Whitney U, McNemar,Fisher’s Exact Test. Results: 1-There was no correlation between APP and abnormal FMD explored with DRT4. 2-We found significant differences in RT (p⫽0,043), RFRVB (p⫽0,005) and RCVB (p⫽0,039). 3-No statistically significant differences were found with small artery elasticity index (C2) but TVI was greater in those who had an increased APP: p⫽0,05 (at the borderline of statistical significance). Conclusions: 1-Neither microcirculatory flow-mediated dilatation (FMD) nor alteration in small artery elasticity index was found in patients
Key Words: Ambulatory Pulse Pressure, Artery Elasticity, Flow Mediated Dilatation
P-56 MP-19 REPEATED OFFICE BLOOD PRESSURE (ROBP) MEASUREMENT FOR THE DIAGNOSIS OF WHITECOAT OR SUSTAINED HYPERTENSION Giuseppe Crippa, Giorgio Ragni, Claudio Venturi, Eugenio Arrigoni, Daniela Pancotti. Hypertension Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. Conventional sphygmomanometric blood pressure (BP) measurements performed in the medical environment by the physician are often inaccurate as a result of variable alert reactions of the subject (white-coat phenomenon) and systematic errors in the observer technique. These sources of bias may often lead to an overestimation of the real BP status and therefore, to incorrect diagnosis of hypertension in normotensive subjects. Aim of the present study was to investigate the influence of the way in which BP measurements were taken on the diagnosis of white-coat or sustained hypertension. We considered 122 subjects consecutively referred to our Hypertension Unit to confirm or deny the clinical diagnosis of hypertension through an ambulatory BP monitoring (ABPM). All subjects were untreated and had clinic BP constantly ⬎140/90 mmHg but home (selfmeasured) BP persistently ⬍ 140/90 mmHg. Before setting the device, BP was measured, in random order, by the physician, by the nurse and by using repeated office blood pressure (ROBP) measurement with automated device. After 20-minute resting , the doctor and the nurse each took 3 BP readings (phase V of the Korotkoff sounds). ROBP was performed by automated oscillometric device, set to obtain 10 valid readings at 2.5-minute intervals, with the patients sitting alone in the office. The average of the last 2 measurements obtained by the doctor and the nurse, the average of the last 5 measurements obtained with ROBP were compared with mean daytime ABP. Out of the 122 subjects, 41 presented with normal ABP values (daytime BP ⬍ 132/85 mmHg) suggesting white-coat hypertension. ROBP measurements correctly diagnosed white-coat hypertension in all but one the subjects. The average of the last 5 value (122.5/74.8 ⫾ 7.1/7.7 mmHg) practically overlapped with daytime ABP values (121.1/ 73.4 ⫾ 4.4/6.1 mmHg) in those patients and the correlation was high and significant (p⬍0.001; Pearson test). Conventional (office) BP measurement resulted on average 15/11 (doctor) and 11/9 mmHg (nurse) higher than daytime ABPM values. There was no significant correlation between physician or nurse BP and corresponding ROBP and daytime ABP values. In conclusion, our data indicate that ROBP measurements, performed under standardized conditions, in the medical environment, may be extremely helpful for the diagnosis of white coat hypertension. Key Words: Repeated Office Blood Pressure Measurement, Sustained Hypertension, White Coat Hypertension
P-57 REPEATED OFFICE BLOOD PRESSURE (ROBP) MEASUREMENT FOR THE EVALUATION OF ANTIHYPERTENSIVE TREATMENT EFFICACY Giuseppe Crippa, Giorgio Ragni, Claudio Venturi, Eugenio Arrigoni, Daniela Pancotti. Hypertension Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. It is increasingly being recognized that sphygmomanometric blood pressure (BP) measurement taken in the medical environment may overesti-
POSTERS: Blood Pressure Measurement/Monitoring
AJH–May 2005–VOL. 18, NO. 5, PART 2
systolic BP. The 149 patients with WC hypertension were significantly older (60.2⫾13.3 vs. 54.8⫾14.9 years, mean⫾standard deviation; P ⬍ 0.0001) and more likely to be female (61.1 vs. 44.2%; P ⬍ 0.0001) compared to the 405 non-WC hypertension patients. The average office BPs were significantly higher in the WC hypertensive group (156.8⫾18.2/88.9⫾10.7 mm Hg vs. 137.2⫾17.2/83.6⫾11.7 mm Hg; P ⬍ 0.0001 for both systolic and diastolic). The average 24-hour BPs were 132.7⫾14.8/78.7⫾9.2 vs. 134.6⫾14.8/81.6⫾9.9 mmHg (P ⫽ 0.16/ 0.002) for the WC and non-WC patients respectively. During an average of 6.8⫾4.1 years of possible follow-up, 16 of the 149 (10.7%) patients with WC hypertension died compared to 22 of 405 (5.4%) non-WC hypertension patients (unadjusted risk ratio⫽2.0, P ⫽ 0.03 by log-rank test). In a Cox proportional hazards model using 2 or 3 covariates, age was the major predictor of mortality (adjusted relative risk 1.09 per year, 95% confidence interval 1.06-1.13, P ⬍ 0.0001) and neither gender nor WC hypertension was significant (adjusted relative risk 1.15, 95% CI: 0.60-2.21 for the latter when age was the only covariate). These data suggest that, in patients undergoing 24-hour ABPM at our hypertension center, WC hypertension was associated with older age and female gender, but was not an independent predictor of mortality (after adjustment for baseline differences between the WC and other hypertensive patients).
with elevated APP. 2-However, there are significant differences in other microvascular variables: RT, RFRVB, and RCVB, as well as a greater TVI, at the borderline of statistical significance.
Key Words: Ambulatory Blood Pressure Monitor, Mortality, White Coat Hypertension
P-55 FLOW-MEDIATED DILATATION AT THE FOREARM SKIN IN PATIENTS WITH ELEVATED AMBULATORY PULSE PRESSURE David Coca, Maria Calbacho, Arturo Ugalde, Enrique Bernal, Rosa Fabregate, Martin Fabregate, Olivia Sanchez, Jorge Haurie, Jose Saban-Ruiz. Endothelial Pathology Unit, Ramon y Cajal Hospital, Madrid, Spain. Introduction: Alterations in microvasculature might be an important factor in the pathogenesis of macrovascular damage due to the impairment of arterial nutrition. Aims: 1- To evaluate microvascular flow-mediated dilatation (FMD) in a population with elevated ambulatory PP versus a control group. 2To correlate FMD with small artery elasticity and ambulatory blood pressure monitoring (ABPM) variables. Methods: N⫽79, aged 31-81(60,16 ⫹-1,50), 51,9% M, 55 hypertensives. BMI (kg/m2), waist (cm). The following parameters were evaluated in 24h, during both activity (9:00 to 22:00) and rest (22:00 to 9:00) periods: average systolic BP (aSBP), average diastolic BP (aDBP), average Mean Arterial Pressure. Small artery elasticity index (C2), systemic vascular resistance, and total vascular impedance (TVI), assessed by the HDI/PulseWave CR-2000. Endothelium (ED) and non endothelium-dependent (NED) vasodilation: exploration of cutaneous microcirculatory responses at the forearm with laser Doppler (DRT4, MOOR Instruments). The skin blood flow response to transient occlusion of the circulation at the forearm (reactive hyperemia, RH) was measured using a laser Doppler imaging system. Peak-Flow associated to Reactive hyperemia (PFRH) respect to baseline was considered normal ⬎67% (group A), following our own criteria in control subjects, and abnormal ⬍67% (group B). Rising Time (RT)(msec). Recovering Flow Relative Variation respect to Baseline (RFRVB)(%). Recovering Concentration Variation respect to Baseline (RCVB). Statistical: t-Student, chi-square, Mann-Whitney U, McNemar,Fisher’s Exact Test. Results: 1-There was no correlation between APP and abnormal FMD explored with DRT4. 2-We found significant differences in RT (p⫽0,043), RFRVB (p⫽0,005) and RCVB (p⫽0,039). 3-No statistically significant differences were found with small artery elasticity index (C2) but TVI was greater in those who had an increased APP: p⫽0,05 (at the borderline of statistical significance). Conclusions: 1-Neither microcirculatory flow-mediated dilatation (FMD) nor alteration in small artery elasticity index was found in patients
Key Words: Ambulatory Pulse Pressure, Artery Elasticity, Flow Mediated Dilatation
P-56 MP-19 REPEATED OFFICE BLOOD PRESSURE (ROBP) MEASUREMENT FOR THE DIAGNOSIS OF WHITECOAT OR SUSTAINED HYPERTENSION Giuseppe Crippa, Giorgio Ragni, Claudio Venturi, Eugenio Arrigoni, Daniela Pancotti. Hypertension Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. Conventional sphygmomanometric blood pressure (BP) measurements performed in the medical environment by the physician are often inaccurate as a result of variable alert reactions of the subject (white-coat phenomenon) and systematic errors in the observer technique. These sources of bias may often lead to an overestimation of the real BP status and therefore, to incorrect diagnosis of hypertension in normotensive subjects. Aim of the present study was to investigate the influence of the way in which BP measurements were taken on the diagnosis of white-coat or sustained hypertension. We considered 122 subjects consecutively referred to our Hypertension Unit to confirm or deny the clinical diagnosis of hypertension through an ambulatory BP monitoring (ABPM). All subjects were untreated and had clinic BP constantly ⬎140/90 mmHg but home (selfmeasured) BP persistently ⬍ 140/90 mmHg. Before setting the device, BP was measured, in random order, by the physician, by the nurse and by using repeated office blood pressure (ROBP) measurement with automated device. After 20-minute resting , the doctor and the nurse each took 3 BP readings (phase V of the Korotkoff sounds). ROBP was performed by automated oscillometric device, set to obtain 10 valid readings at 2.5-minute intervals, with the patients sitting alone in the office. The average of the last 2 measurements obtained by the doctor and the nurse, the average of the last 5 measurements obtained with ROBP were compared with mean daytime ABP. Out of the 122 subjects, 41 presented with normal ABP values (daytime BP ⬍ 132/85 mmHg) suggesting white-coat hypertension. ROBP measurements correctly diagnosed white-coat hypertension in all but one the subjects. The average of the last 5 value (122.5/74.8 ⫾ 7.1/7.7 mmHg) practically overlapped with daytime ABP values (121.1/ 73.4 ⫾ 4.4/6.1 mmHg) in those patients and the correlation was high and significant (p⬍0.001; Pearson test). Conventional (office) BP measurement resulted on average 15/11 (doctor) and 11/9 mmHg (nurse) higher than daytime ABPM values. There was no significant correlation between physician or nurse BP and corresponding ROBP and daytime ABP values. In conclusion, our data indicate that ROBP measurements, performed under standardized conditions, in the medical environment, may be extremely helpful for the diagnosis of white coat hypertension. Key Words: Repeated Office Blood Pressure Measurement, Sustained Hypertension, White Coat Hypertension
P-57 REPEATED OFFICE BLOOD PRESSURE (ROBP) MEASUREMENT FOR THE EVALUATION OF ANTIHYPERTENSIVE TREATMENT EFFICACY Giuseppe Crippa, Giorgio Ragni, Claudio Venturi, Eugenio Arrigoni, Daniela Pancotti. Hypertension Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. It is increasingly being recognized that sphygmomanometric blood pressure (BP) measurement taken in the medical environment may overesti-