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.
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Contribution of Neonatal Ultrasound Screening to Decrease Median Age at Diagnosis of Congenital Renal Anomalies
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