1,721,042 research outputs found
Ambulatory blood pressure monitoring in type 2 diabetes and metabolic syndrome: a review.
No full textMasked hypertension in treated hypertensive patients.
No full textWe read with interest the Critique article by Clement regarding our article and we are grateful for his comments. However, some aspects need to be clarified to avoid confusion. Clement states that the population we studied may be different from that seen in regular hypertension clinics, and that we come up with a very high prevalence of masked hypertension (340 of 742 patients). For reference, Clement reports the prevalence of masked hypertension in the office versus ambulatory study, that is, 143 of 1963 patients..
Risk of atrial fibrillation in dipper and nondipper sustained hypertensive patients.
No full textObjective The risk of atrial fibrillation (AF) in sustained hypertensive patients with different circadian blood pressure (BP) patterns is unknown. We investigated the risk of new onset AF in dipper and nondipper sustained hypertensive patients.Methods The occurrence of AF was evaluated in 1141 patients aged >= 40 years with sustained hypertension (clinic BP >= 140 and/or 90 mmHg and daytime BP >= 135 and/or 85 mmHg). Among these patients, 783 had night-time systolic BP fall >= 10% (dippers) and 358 had night-time BP decline <10% (nondippers).Results During the follow-up (6.1 +/- 3.2, range 0.5-12.9 years), AF occurred in 43 patients. The AF rate per 100 patient-years in dippers and nondippers was 0.38 and 1.13, respectively. AF free survival was significantly different between the groups (P=0.0002). After adjustment for other covariates, including left atrial enlargement or left ventricular hypertrophy (these variables were analyzed in separate models because of a strong association between them) and 24-h Bp, Cox regression analysis showed that the risk of AF was significantly higher in nondippers than in dippers [nondippers vs. dippers, relative risk (RR) 2.02, 95% confidence interval (CO 1.08-3.79, P=0.028 in the model including left atrial enlargement, and RR 1.97, 95% Cl: 1.05-3.69, P=0.035 in the model including left ventricular hypertrophy].Conclusion This study shows that nondipper sustained hypertensive patients have a two-fold greater risk of developing AF than dipper ones. This aspect could partly contribute to explain the higher cardiovascular risk previously observed in nondipper hypertensive patients
Regression of echocardiographic left ventricular hypertrophy after 2 years of therapy reduces cardiovascular risk in patients with essential hypertension.
No full textBackground
There is still ambiguity about the prognostic relevance of
regression of left ventricular hypertrophy (LVH) (as revealed
by echocardiography) in a large population of subjects with
hypertension, with and without evidence of LVH in their
electrocardiograms (ECGs). This holds true even after
adjusting for various confounders including in treatment
ambulatory blood pressure (BP). The most suitable time point
for a follow-up echocardiography also remains a matter for
debate. In this study, we investigated the prognostic relevance
of regression of LVH after 2 years of therapy, in a large population
of subjects with hypertension, and possessing the aforesaid
characteristics.
Methods
The occurrence of adverse cardiovascular events was evaluated
in 387 patients with LVH shown by echocardiography at baseline,
and these patients were studied again after 2 years of therapy.
At the second examination, 245 subjects showed regression of LVH,
whereas 142 did not.
Results
During the time period before the subsequent follow up
(6.2 ± 3 years, range 1.9–12.9 years), 59 first adverse events
(26 cardiac and 33 cerebrovascular) had occurred among these
subjects. The event rates per 100 patient-years in patients with
and without LVH regression were 1.06 and 4.4, respectively.
After adjusting for several covariates at the 2-year visit, including
in treatment ambulatory BP, Cox regression analysis showed
that cardiovascular risk was significantly lower in patients with
LVH regression than in those without (RR 0.36, 95% CI 0.19–0.68,
P = 0.002). When left ventricular (LV) mass index reduction was
analyzed instead of LVH status, it was found to be significantly
associated with reduced risk (RR 0.62 per 1-s.d. decrease,
95% CI 0.44–0.88, P = 0.01).
Conclusions
Regression of LVH, as revealed by echocardiography after 2 years
of therapy, is associated with reduced cardiovascular risk in patients
with hypertension, whether or not LVH was revealed in their ECGs.
This holds true even after adjusting for various confounders
including in treatment ambulatory BP.
Am J Hypertens 2008; 21:464-47
Hypertension and coronary artery disease: importance of circadian blood pressure rhythm for treatment strategy
No full textCircadian blood pressure rhythm in essential hypertension: night-pealers, non-dippers, dippers and over-dippers
No full textIpertensione cardiopatica ischemica: può il profilo pressorio delle 24 H influenzare il trattamento?
No full textMorning blood pressure surge, dipping, and risk of ischemic stroke in elderly patients treated for hypertension
No full textBACKGROUND:
The independent prognostic significance of morning surge (MS) in blood pressure (BP) is not yet clear. We investigated the association between MS in systolic BP (SBP) and risk of ischemic stroke in elderly patients treated for hypertension.
METHODS:
Occurrence of ischemic stroke was evaluated in 1,191 elderly patients treated for hypertension (aged 60-90 years). Patients were divided according to tertiles of MS in SBP in the population as a whole, dipping status, and group-specific tertiles of MS in SBP in dippers and nondippers.
RESULTS:
During follow-up (9.1±4.9 years, range 0.4-20 years), 139 ischemic strokes occurred. The event rate per 100 patient-years was 1.28. After adjustment for various covariates, Cox regression analysis showed that stroke risk was not significantly associated with tertiles of MS in SBP in the population as a whole. When nondippers and dippers were analyzed separately by group-specific tertiles of MS in SBP, stroke risk was not associated with MS in nondippers. Conversely, in dippers, stroke risk was significantly higher in the third tertile (>23mm Hg) of MS in SBP (hazard ratio, 2.08; 95% confidence interval, 1.03-4.23; P = 0.04). Additional analysis showed that stroke risk was significantly and similarly higher in dippers with MS >23mm Hg and in nondippers than in dippers with MS <23mm Hg.
CONCLUSIONS:
In elderly patients treated for hypertension, high MS in SBP predicts stroke in dippers but not in nondippers. Nondippers are at high stroke risk with or without MS >23mm Hg
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