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How reliable is isolated clinic hypertension defined by a single ambulatory blood pressure monitoring?
No full textPrevalence and correlates of multiple organ damage in a never-treated hypertensive population : role of ambulatory blood pressure
No full textAIM: Available evidence on multiple target organ damage (TOD) in the early phases of essential hypertension is scanty. We examined the prevalence and correlates of multiple TOD in never-treated patients with recently diagnosed hypertension. METHODS: A total of 602 consecutive outpatients with grades 1 and 2 hypertension underwent the following procedures: (i) routine examination, (ii) 24-h urine collection for microalbuminuria, (iii) ambulatory blood pressure monitoring over two 24-h periods within 4 weeks, (iv) echocardiography, (v) carotid ultrasonography. TOD at cardiac, vascular and renal levels was defined according to major international hypertension guidelines. RESULTS: Prevalence rates of patients negative for TOD (group I) or positive for one (group II), two (group III), or three (group IV) markers of TOD were as follows: 45, 33, 17 and 5%. In group II, alterations in left ventricular structure and geometry were more frequently present than carotid atherosclerosis and microalbuminuria; a similar trend was found in group III where a close association between cardiac and vascular, but not renal, signs of TOD was observed. In multiple regression analyses the risk of having three TOD was significantly related to age [odds ratio (OR): 2.11, 95% confidence interval (CI): 1.34-3.53], average 48-h systolic blood pressure (OR: 1.81, 95% CI: 1.22-2.95), smoking status (OR: 1.76, 95% CI: 1.22-2.86), male sex (OR: 1.36, 95% CI: 1.24-1.79), reproducible nondipping pattern (OR: 1.27, 95% CI: 1.12-1.61) and metabolic syndrome (OR: 1.16, 95% CI: 1.09-1.74). CONCLUSIONS: Our results show that: (i) a cluster of three TOD, namely at cardiac, carotid and renal levels, is not a common finding in a population of untreated essential hypertensive patients; a single TOD is present in about one-third of the patients and the parallel involvement of two organs in one-fifth of the cases; (ii) old age, ambulatory systolic blood pressure and smoking status are the most important predictors of multiple organ involvement
Reproducibility of dipping/nondipping pattern in untreated essential hypertensive patients : impact of sex and age
No full textOBJECTIVE: We aimed to evaluate the intrasubject short-term reproducibility of nocturnal blood pressure patterns (dipping/nondipping) in essential hypertensive patients in relation to age (<50 and ≥50 years) and sex. METHODS: A total of 619 never-treated essential grade 1 and 2 hypertensive patients (383 men, 236 women) underwent the following procedures: (1) repeated clinic blood pressure measurements, (2) routine examinations, (3) ambulatory blood pressure monitoring over two 24-h periods within 4 weeks. Dipping pattern was defined as a 10%, or more, reduction in average systolic blood pressure/ diastolic blood pressure at night compared to daytime values. RESULTS: Of the 407 patients showing a dipping pattern during the first ambulatory blood pressure monitoring period, 329 (80.1%) had the same pattern during the second ambulatory blood pressure monitoring recording. Of the 212 patients with a nondipping pattern during the first ambulatory blood pressure monitoring period, 140 (65.9%) confirmed the same pattern during the second ambulatory blood pressure monitoring period. Overall, 149 patients (24.1%) changed their initial nocturnal pattern at the second ambulatory blood pressure monitoring recording, without significant age and sex-related differences. Lower reproducibility rates of the nondipping as compared to the dipping pattern were found in the whole population as well as in men regardless of age and in younger but not in older women. CONCLUSIONS: These findings indicate that nocturnal blood pressure patterns have a limited short-term reproducibility in the whole study population as well as in different age and sex subgroups. As variability of nocturnal blood pressure patterns is not predicted by easy available clinical data, such as sex and age, a reliable classification of patients according to circadian blood pressure patterns should be obtained by repeating ambulatory blood pressure monitoring
Studies on left ventricular hypertrophy regression in arterial hypertension : a clear message for the clinician?
No full textBackground: Evidence-based medicine should provide clear and unbiased information to clinicians. We conducted an analysis on published randomized trials evaluating the effects of antihypertensive therapy on left ventricular (LV) morphology assessed by echocardiography to investigate (i) the consistency of criteria used for definition of LV hypertrophy (LVH) and (ii) the consistency of the way LVH regression and blood pressure (BP) control were reported. Methods: Studies identified by a PubMed search were eligible for inclusion in the analysis, if they fulfilled the following criteria: (i) publication in a peer-reviewed journal within the last 12 years; (ii) double blind, randomized, controlled, parallel-group design; (iii) numerosity of at least 50 adult hypertensive subjects; (iv) follow-up duration of at least 6 months; (v) comparison between single-drugs or association regimens; (vi) LV mass (LVM) or wall thickness measured by echocardiography. Results: Thirty-nine trials, including 9,162 hypertensive subjects of both genders in 78 active treatment arms or in 6 placebo arms were identified. Definition of LVH was provided by 34 studies (87.1%) according to 19 different criteria. All trials evaluated LVH regression as the absolute or relative changes of continuous variables such as LVM index (LVMI) or LV wall thickness. Data concerning prevalence rates of LVM normalization were reported in 12 studies (30.7%). The percentage of patients reaching BP target (<140/90 mm Hg) was reported in 11 studies (28.2%). Conclusions: Our findings indicate that (i) definition of hypertensive LVH phenotype is extremely variable, and (ii) no precise information on LVH regression rates or changes in LV geometrical patterns, as well as on target BP, is provided by the majority of papers
Left and right ventricular structural changes in obese hypertensives
No full textAim. Obesity is known to be independently related to left ventricular (LV) hypertrophy (LVH); however, in human hypertension the association of obesity with right ventricular hypertrophy (RVH) is still unsettled. We investigated the relationship of obesity with RVH and biventricular hypertrophy in essential hypertension. Methods. A cohort of untreated and treated uncomplicated essential hypertensives consecutively attending a hospital outpatient hypertension clinic, categorized in three groups according to body mass index (BMI) thresholds (51 and 47 g/m2.7 and RVWT>3.1 and 3.0 mm) in the three groups were 7.3%, 21.2% and 32.7%, respectively. In a multivariate analysis, BMI (OR = 3.58, 95% CI 1.82-7.03, p = 0.0002), was the most important correlate of biventricular hypertrophy. Conclusions. Our findings extend previous data on the impact of obesity on cardiac structure by showing that this phenotype is strongly associated with biventricular hypertrophy
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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