Ambulatory blood pressure monitoring (ABPM) became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.
Objectives: The objective of this study is to analyse the blood pressure behaviour, before and after compensation by medical treatment of decompensated chronic congestive heart failure, in normotensive and in sinus rhythm patients with ischemic heart disease. Its main purpose is to find out whether heart failure compensation is associated with still normal blood pressures or, on the contrary, with the risk of an arterial hypotension.
Methods: Data recorded by 24 hours ambulatory blood pressure monitoring, before and after an efficient compensation of heart failure in 16 patients (13 males and 3 females) with decompensated chronic congestive heart disease secondary to ischemic heart disease in functional NYHA classes III (5 patients) or IV (11 patients) were analysed and compared.
Results: In the decompensated state, mean systolic blood pressure per 24 h was normal, but well below the superior limit accepted as normal. Significant decreases of all systolic and diastolic blood pressures, per 24 h, diurnal and nocturnal, close to or even in the domain of arterial hypotension, were recorded after the efficient compensatory treatment. None of the patients had clinical symptoms of arterial hypotension. Significant prevalence of the non-dipper state, high in the decompensated state and still present after the efficient heart failure compensation, was found. A significant decrease of the heart rate after heart failure compensation was observed. Decompensated state was associated mainly with heart rates above 70/min, while the compensated state was associated mainly with heart rates below 70/min.
Conclusions: Significant asymptomatic decrease of the blood pressure, with a tendency towards arterial hypotension, is revealed by ambulatory blood pressure monitoring, after the efficient treatment of the decompensated chronic congestive heart failure, in normotensive and in sinus rhythm patients with ischemic heart disease. This blood pressure decrease could add a supplementary cardiovascular risk. A high prevalence of the non-dipper state, with its negative significance, was found especially in the decompensated, but also in the compensated state of the chronic congestive heart failure.
Background: Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important role in the management of hypertensive patients. The aim of our study was to determine the frequency of seven known adverse prognostic features in an ambulatory assisted hypertensive patient population.
Methods: The study included all the 957 hypertensive patients with a performed 24-H ABPM, examined in the 2008–2011 period in a preventive ambulatory cardiology system. The studied adverse prognostic features were: daytime systolic blood pressure (BP) >140 mmHg, daytime diastolic BP >90 mmHg, nighttime systolic BP >125 mmHg, nighttime diastolic BP >75 mmHg, nocturnal dipping <10%, early morning hypertension >140/90 mm Hg, pulse pressure >53 mm Hg. Patient data were introduced in an integrated patient data management system as an electronic health record. The frequency of adverse prognostic features was compared in type 2 diabetic versus non-diabetic patients, and in patients with or without manifest cardiovascular complications (ischemic heart disease, stroke, lower extremity arterial disease).
Results: The frequency of the studied adverse prognostic features was as follows: high daytime systolic BP 38.1%, high daytime diastolic BP 21.4%, high nighttime systolic BP 45.5%, high nighttime diastolic BP 31.3%, absent nocturnal dipping 59.9%, morning hypertension 33.6%, high pulse pressure 51.5%, morning surge 5.1%. A large proportion of subjects (86.2%) had one or more adverse features reported on the 24-H ABPM.
Conclusions: In clinical practice there is a frequent association of multiple adverse prognostic features of ambulatory blood pressure monitoring. The presence of some prognostic features is associated with the presence of diabetes, stroke history, ischemic heart disease or lower extremity arterial disease.
Introduction: Considering the fact that approximately 10% of children are born with various, mild or severe anomalies of the urinary system, and most of them remain asymptomatic until the development of complications, early diagnosis plays a crucial role in the prognosis of these patients. In the era of ultrasonography, an early diagnosis means a diagnosis established during intrauterine life, but considering the multiple traps of prenatal diagnosis, neonatal screening of these malformations has a major importance.
Material and methods: We have performed a retrospective study of the cases with congenital malformations of the urinary system, admitted to the 2nd Pediatric Clinic of Tîrgu Mureș, between January 2003 and December 2008. Concidering that between 2006 and 2008 neonatal ultrasound screening has been performed for these malformations, the patients were divided into two groups based on the year of admission. Establishment of the median age of patients with renourinary malformations was considered an important factor as it was aimed at emphasizing the role of neonatal screening in the early diagnosis of these anomalies.
Results: The mean age of the patients at the time of diagnosis of congenital malformation of the urinary system in case of the 2003–2005 study group was 4.82 years. Using an ultrasound screening in the neonatal period, the mean age at the time of diagnosis of congenital malformations of the urinary system dropped to 50.9 months compared to 57.9 months calculated for the three years when this screening has not been performed.
Conclusion: In the absence of a neonatal ultrasound screening of congenital malformations of the urinary system, the diagnosis of these anomalies is established late, in most cases only at the time of occurrence of complications
How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients.
We conducted a prospective study which enrolled 45 patients. Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits. A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. Office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups.