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Usefulness of orthostatic blood pressure in the diagnosis of white coat hypertension in elderly patients
86A
POSTERS: Blood Pressure Measurement/Monitoring
P-155 PREDICTIVE VALUE OF AMBULATORY BLOOD PRESSURE IN DIABETIC PATIENTS Robert Zweiker, Andrea Siebenhofer, Johannes Plank, Peter Baeck, Thomas Pieber. Department of Medicine, Kar-Franzens University, Graz, Austria. Background: Arterial hypertension represents one of the most important risk factors in diabetes. It was the aim of this study evaluate the power of ambulatory blood pressure values in the prediction of cardio- and cerebrovascular events as well as end stage renal disease in type-I and type-II diabetic patients. Methods: We incuded 107 diabetic patients, in whom an ambulatory blood pressure monitoring (ABPM)(Takeda TM-2430) was obtained. ABPM was performed according to current guidelines using 15 minutes intervals during daytime and 30 minutes intervals during night-time. All patients gave informed consent and were followed for at least 12 months by means of a computer-supported standardized protocol developed for routine follow-up investigations of diabetics in Austria (Austrian Forum for Quality Control in Diabetic Medicine). Ambulatory blood pressure values of patients suffering from hard endpoints were compared to those without any events, who served as controls. A multivariant statistical analysis was performed. Results: Within the observation period 6 patients (4 type-1 diabetics, 4 males, mean age 55⫾16 years, HbA1c: 8,2⫾0,99%) had an event (4 myocardial infarctions, one stroke, one end-stage renal disease), this was an incidence of 5.2%. The control group consisted of 101 patients (74 type-1 diabetics, 60 males, mean age 48⫾14,3 years, HbA1c 8,6⫾1,22%). Ambulatory blood pressure (BP) data were as follows: 24-h-BP: 147⫾9/82⫾6 vs 135⫾13/80⫾7 mmHg (p⬍0.026/ns); daytime BP (8: 00-22:00) 147⫾8/81⫾6 vs 138⫾13/82⫾7 (ns/ns); night-time BP (0:006:00) 144⫾14/74⫾11 vs 125⫾18/70⫾10 mmHg (p⬍0.011/ns). Both groups were identical with respect to age, serum lipids and HbA1c levels, but urinary albumin excretion was significantly elevated in patients suffering from endpoints (p⬍0.01). Statistical analysis revealed that ambulatory systolic BP obtained for 24 hours as well as nighttime did have the highest predictive power for future cardio- and cerebrovascular events in diabetics. Diastolic as well as office BP did not show any relations to hard endpoints. It is speculated that nocturnal hypertension might serve as a hint to autonomic neuropathy in hypertensive diabetics. Conclusion: Our results underline the importance of ambulatory blood pressure readings covering a period of 24 hours in high-risk subgroups of hypertensive patients like diabetics. This findings support the recommendations of JNC VI for the use of additional blood pressure measuring procedures in patients with autonomic neuropathy. Key Words: Ambulatory Blood Pressure Monitoring, Diabetes, Nocturnal Blood Pressure
P-156 EFFECT OF HOME MONITORING ON HYPERTENSION CONTROL Cynthia Cheng, James S. Studdiford, Christopher V. Chambers, James J. Diamond. Family Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States. Self-monitoring of blood pressure provides physicians with multiple, supplementary readings which may aid in hypertension management, while actively involving patients in the disease control process. However, skeptics have questioned the usefulness, accuracy and prognostic value of self-performed blood pressure measurement, compared to readings performed in the usual office-based setting. The objective of this study was to assess the effect of six months of home monitor usage on blood pressure control. This was a prospective, single blind randomized controlled trial in an urban, university-based family practice.
AJH–April 2002–VOL. 15, NO. 4, PART 2
We enrolled 98 subjects with JNC VI Stage 1 or 2 hypertension. Half of the subjects were randomized to continue usual care for their hypertension (Control), and half to receive an automated home monitor (Intervention). After receiving instructions for automated home blood pressure monitor use from a trained nurse, intervention group subjects were asked to check and record outpatient blood pressures twice weekly for six months. We measured blood pressure readings using a standard mercury sphygmomanometer in the office at baseline and upon study completion for all subjects. Baseline blood pressures were 134.19⫾12.5/80.1⫾12.4 and 134.0⫾15.5/77⫾9.5 in intervention and control subjects respectively (mean⫾SD). Diastolic blood pressure (DBP) and mean arterial pressure (MAP) dropped 3.8⫾10.3 mm and 3.5⫾9.8 mm Hg respectively in the home monitoring group (p⬍0.05). No corresponding change in systolic blood pressure (SBP) was observed. Control subjects did not demonstrate a significant change in SBP, DBP, or MAP. Results obtained in this study of mildly hypertensive patients suggest that use of home-blood pressure monitoring may have a modest potential blood-pressure lowering effect. Further study of home monitor use in patients with more uncontrolled hypertension may reveal a greater degree of blood pressure lowering. Key Words: Blood Pressure Measurement/Monitoring, Non-Pharmacologic Therapy, Clinical Trials
P-157 USEFULNESS OF ORTHOSTATIC BLOOD PRESSURE IN THE DIAGNOSIS OF WHITE COAT HYPERTENSION IN ELDERLY PATIENTS Paula Amado, Jose´ Carmona, Nuno Vasconcelos, Lurdes Almeida, Isabel Santos, Conceic¸ a˜ o Silveira, Jose´ Nazare´ . Cardiology, Egas Moniz Hospital, Lisbon, Lisbon, Portugal. White coat hypertension (WCH) is associated to a small cardiovascular risk. It’s very frequent among older people and do not need pharmacological treatment. Until now only Ambulatory Blood Pressure Monitoring (ABPM) can diagnose it. We wanted to know if there were clinical parameters that could differentiate WCH from sustained hypertensive (HT) patients in an older population. Design and Methods: Between 1999-2001 we propectively studied, 93 untreated elderly hypertensives (71⫾8, 53% males), in the office, by clinical examination and by ECG, ABPM (Spacelabs 90207), Vascular Distensibility (Complior-Colson), EcoDoppler (Esaote AV3 Partner) studies. We analysed supine BP (SBP), orthostatic BP (OBP) one minute after, and the difference between supine and orthostatic BP (DBP), Ambulatory BP (ABP), pulse wave velocity (PWV) and EcoDoppler parameters. The results were compared with a control group of 20 normotensive (NT) individuals (67⫾ years old, 55% males). Results: we found by ABPM that 28 (30%) pts were whitecoat hypertensives (WCH), 71⫾8 years old, 53% males, SBP:169⫾16/ 86⫾mmHg and 24 h ABP 128 ⫾/72⫾mmHg. Conclusions: It can be concluded that in the absence of a significant fall in orthostatic blood pressure in an older patient with office hypertension we should suspect of white coat hypertension. This simple measurement can avoid the pharmacological treatment initiation in a low risk population.
SBP OBP ABP 24h sys ABP
NT (N ⴝ 20)
WCH (28)
HT (65)
p
143 ⫾ 12 141 ⫾ 11 0,7 ⫾ 11* 122 ⫾ 8
169 ⫾ 16 169 ⫾ 17 0 ⫾ 11 128 ⫾ 5
176 ⫾ 22 169 ⫾ 22 ⫺7 ⫾ 15 149 ⫾ 19
0,000 0,000 0,03 0,000
*NS
Key Words: Orthostatic Blood Pressure, White Coat Hypertension, Erderly Patients
POSTERS: Blood Pressure Measurement/Monitoring
P-155 PREDICTIVE VALUE OF AMBULATORY BLOOD PRESSURE IN DIABETIC PATIENTS Robert Zweiker, Andrea Siebenhofer, Johannes Plank, Peter Baeck, Thomas Pieber. Department of Medicine, Kar-Franzens University, Graz, Austria. Background: Arterial hypertension represents one of the most important risk factors in diabetes. It was the aim of this study evaluate the power of ambulatory blood pressure values in the prediction of cardio- and cerebrovascular events as well as end stage renal disease in type-I and type-II diabetic patients. Methods: We incuded 107 diabetic patients, in whom an ambulatory blood pressure monitoring (ABPM)(Takeda TM-2430) was obtained. ABPM was performed according to current guidelines using 15 minutes intervals during daytime and 30 minutes intervals during night-time. All patients gave informed consent and were followed for at least 12 months by means of a computer-supported standardized protocol developed for routine follow-up investigations of diabetics in Austria (Austrian Forum for Quality Control in Diabetic Medicine). Ambulatory blood pressure values of patients suffering from hard endpoints were compared to those without any events, who served as controls. A multivariant statistical analysis was performed. Results: Within the observation period 6 patients (4 type-1 diabetics, 4 males, mean age 55⫾16 years, HbA1c: 8,2⫾0,99%) had an event (4 myocardial infarctions, one stroke, one end-stage renal disease), this was an incidence of 5.2%. The control group consisted of 101 patients (74 type-1 diabetics, 60 males, mean age 48⫾14,3 years, HbA1c 8,6⫾1,22%). Ambulatory blood pressure (BP) data were as follows: 24-h-BP: 147⫾9/82⫾6 vs 135⫾13/80⫾7 mmHg (p⬍0.026/ns); daytime BP (8: 00-22:00) 147⫾8/81⫾6 vs 138⫾13/82⫾7 (ns/ns); night-time BP (0:006:00) 144⫾14/74⫾11 vs 125⫾18/70⫾10 mmHg (p⬍0.011/ns). Both groups were identical with respect to age, serum lipids and HbA1c levels, but urinary albumin excretion was significantly elevated in patients suffering from endpoints (p⬍0.01). Statistical analysis revealed that ambulatory systolic BP obtained for 24 hours as well as nighttime did have the highest predictive power for future cardio- and cerebrovascular events in diabetics. Diastolic as well as office BP did not show any relations to hard endpoints. It is speculated that nocturnal hypertension might serve as a hint to autonomic neuropathy in hypertensive diabetics. Conclusion: Our results underline the importance of ambulatory blood pressure readings covering a period of 24 hours in high-risk subgroups of hypertensive patients like diabetics. This findings support the recommendations of JNC VI for the use of additional blood pressure measuring procedures in patients with autonomic neuropathy. Key Words: Ambulatory Blood Pressure Monitoring, Diabetes, Nocturnal Blood Pressure
P-156 EFFECT OF HOME MONITORING ON HYPERTENSION CONTROL Cynthia Cheng, James S. Studdiford, Christopher V. Chambers, James J. Diamond. Family Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States. Self-monitoring of blood pressure provides physicians with multiple, supplementary readings which may aid in hypertension management, while actively involving patients in the disease control process. However, skeptics have questioned the usefulness, accuracy and prognostic value of self-performed blood pressure measurement, compared to readings performed in the usual office-based setting. The objective of this study was to assess the effect of six months of home monitor usage on blood pressure control. This was a prospective, single blind randomized controlled trial in an urban, university-based family practice.
AJH–April 2002–VOL. 15, NO. 4, PART 2
We enrolled 98 subjects with JNC VI Stage 1 or 2 hypertension. Half of the subjects were randomized to continue usual care for their hypertension (Control), and half to receive an automated home monitor (Intervention). After receiving instructions for automated home blood pressure monitor use from a trained nurse, intervention group subjects were asked to check and record outpatient blood pressures twice weekly for six months. We measured blood pressure readings using a standard mercury sphygmomanometer in the office at baseline and upon study completion for all subjects. Baseline blood pressures were 134.19⫾12.5/80.1⫾12.4 and 134.0⫾15.5/77⫾9.5 in intervention and control subjects respectively (mean⫾SD). Diastolic blood pressure (DBP) and mean arterial pressure (MAP) dropped 3.8⫾10.3 mm and 3.5⫾9.8 mm Hg respectively in the home monitoring group (p⬍0.05). No corresponding change in systolic blood pressure (SBP) was observed. Control subjects did not demonstrate a significant change in SBP, DBP, or MAP. Results obtained in this study of mildly hypertensive patients suggest that use of home-blood pressure monitoring may have a modest potential blood-pressure lowering effect. Further study of home monitor use in patients with more uncontrolled hypertension may reveal a greater degree of blood pressure lowering. Key Words: Blood Pressure Measurement/Monitoring, Non-Pharmacologic Therapy, Clinical Trials
P-157 USEFULNESS OF ORTHOSTATIC BLOOD PRESSURE IN THE DIAGNOSIS OF WHITE COAT HYPERTENSION IN ELDERLY PATIENTS Paula Amado, Jose´ Carmona, Nuno Vasconcelos, Lurdes Almeida, Isabel Santos, Conceic¸ a˜ o Silveira, Jose´ Nazare´ . Cardiology, Egas Moniz Hospital, Lisbon, Lisbon, Portugal. White coat hypertension (WCH) is associated to a small cardiovascular risk. It’s very frequent among older people and do not need pharmacological treatment. Until now only Ambulatory Blood Pressure Monitoring (ABPM) can diagnose it. We wanted to know if there were clinical parameters that could differentiate WCH from sustained hypertensive (HT) patients in an older population. Design and Methods: Between 1999-2001 we propectively studied, 93 untreated elderly hypertensives (71⫾8, 53% males), in the office, by clinical examination and by ECG, ABPM (Spacelabs 90207), Vascular Distensibility (Complior-Colson), EcoDoppler (Esaote AV3 Partner) studies. We analysed supine BP (SBP), orthostatic BP (OBP) one minute after, and the difference between supine and orthostatic BP (DBP), Ambulatory BP (ABP), pulse wave velocity (PWV) and EcoDoppler parameters. The results were compared with a control group of 20 normotensive (NT) individuals (67⫾ years old, 55% males). Results: we found by ABPM that 28 (30%) pts were whitecoat hypertensives (WCH), 71⫾8 years old, 53% males, SBP:169⫾16/ 86⫾mmHg and 24 h ABP 128 ⫾/72⫾mmHg. Conclusions: It can be concluded that in the absence of a significant fall in orthostatic blood pressure in an older patient with office hypertension we should suspect of white coat hypertension. This simple measurement can avoid the pharmacological treatment initiation in a low risk population.
SBP OBP ABP 24h sys ABP
NT (N ⴝ 20)
WCH (28)
HT (65)
p
143 ⫾ 12 141 ⫾ 11 0,7 ⫾ 11* 122 ⫾ 8
169 ⫾ 16 169 ⫾ 17 0 ⫾ 11 128 ⫾ 5
176 ⫾ 22 169 ⫾ 22 ⫺7 ⫾ 15 149 ⫾ 19
0,000 0,000 0,03 0,000
*NS
Key Words: Orthostatic Blood Pressure, White Coat Hypertension, Erderly Patients