Objective: Our objective was to test the agreement between nighttime home and nighttime ambulatory blood pressure (BP) and to compare their associations with left ventricular hypertrophy, arterial stiffness and carotid atherosclerosis. Design and method: A population sample of 248 participants underwent measurements for 24-hour ambulatory BP and nighttime home BP (3 measurements at 2, 3 and 4 hours during 2 nights). We measured ambulatory BP with a Microlife WatchBP O3 device and home BP with a timer-equipped Microlife WatchBP Home N device. In addition, the participants underwent measurement of pulse wave velocity (PWV) and ultrasonographic examinations for left ventricular mass index (LVMI) and carotid intima-media thickness (IMT). The agreement between nighttime BPs were assessed with paired t-test, intra-class correlation and Bland-Altman plots. In addition, Pearson's correlation coefficients were calculated to assess the associations between nighttime BPs and end-organ damage, and the coefficients were compared with method described by Dunn and Clark. Results: The mean number of ambulatory and home nighttime BP measurements was 16.6 ± 3.5 and 5.6 ± 1.3, respectively. No significant differences were found between mean ambulatory and home nighttime BPs (systolic/diastolic difference: 0.7 ± 7.6/0.2 ± 6.0 mmHg, p = 0.16/0.64). Furthermore, no systematic differences in systolic or diastolic nighttime BPs were identified between the two methods in Bland-Altman plots. Intra-class correlation coefficients for the relationships between systolic/diastolic nighttime BPs were high (0.81/0.71, p < 0.0001 for both). Correlation coefficients for BP indices and end-organ damage and their comparisons are shown in the Table. All home and ambulatory nighttime BP indices were positively correlated with PWV, LVMI, and IMT. The only significant difference in the correlations between end-organ damage and nighttime ambulatory or nighttime home BP, was a slightly stronger correlation between PWV and ambulatory systolic BP than for home systolic BP (p = 0.03, Table). Conclusions: We conclude that home and ambulatory monitors produce similar nighttime BP values that had comparable associations with end-organ damage. Therefore, nighttime home BP measurement can be promoted as an alternative to ambulatory monitoring for measuring nighttime BP.
Background: New strategies are needed to prevent the global epidemic of diabetes and subsequent rise in cardiovascular diseases. We describe a community-based, two-stage screening strategy using home waist circumference measurement and a risk factor questionnaire as a primary screening tool. Methods: We mailed a tape for measurement of waist and a risk factor questionnaire to every inhabitant aged 45–70 years living in the rural town of Harjavalta in Finland. Thereafter we performed an oral glucose tolerance test, anthropometric variables and blood pressure of subjects having at least one risk factor for type 2 diabetes or cardiovascular disease. People with previously known diabetes or vascular disease were excluded. Results: Seventy-three percent (2085/2856) of the invited inhabitants participated, and 84% of the respondents had at least one pre-specified risk factor. Waist circumference ≥80 cm in women and ≥94 cm in men (n = 1168), positive metabolic syndrome criteria of the International Diabetes Federation (n = 681) or the Finnish Diabetes Risk Score questionnaire ≥12 points (n = 697) identified 95, 92 and 63% of the new cases of type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively. Conclusion: The International Diabetes Federation criteria for elevated waist circumference are very sensitive but lack specificity in diagnosing glucose disorders. The criteria for metabolic syndrome and the Finnish Diabetes Risk Score questionnaire are more efficient tools for the selection of patients for further risk stratification in general practise.
Objective: To clarify if a difference is noticed in quality of life between Finnish drug-treated hypertensive patients who reached target daytime systolic and diastolic blood pressure (below 140/90 mmHg) compared to those who did not. Design and method: SF-36 quality of life questionnaire was filled out by 106 hypertensive patients (47 females, 59 males, aged 66.2 (7.5) years). All used at least one antihypertensive agent. 24 hour ambulatory blood pressure (ABPM) and pulse wave- velocity (PWV) were performed and laboratory tests taken. Sixty-four of the patients reached ABPM daytime systolic and diastolic blood pressure (<140/90 mmHg) and 42 did not. Results: No significant difference was seen between the groups in any SF-36 quality of life parameters (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health or the mean of them). The mean 24-hour ambulatory systolic blood pressure (SBP) was 142.9 (10.3) mmHg and diastolic blood pressure (DBP) 79.9 (7.1) mmHg in the patients who did not reach the target and 129.1 (7.7) mmHg and 77.4 (6.1) mmHg in the patients who reached (p = 0.0001). No significant difference was seen in age, weight, waist-hip ratio, carotid-femoral PWV, lipid values, GHbA1c or serum creatinine. Carotid-femoral PWV was 11.8 (3.8) and 11.5 (2.9) m/s. The mean (SD) of the eight SF-36 questionnaire scores was 71.8 (19.1) and 73.3 (19.8) (maximum 100). All SF-36 parameters correlated significantly (p < 0.001) to each other. The high mean of the quality of life parameters correlated in the patients who did not reach the target to male gender, low 24-hour ABPM SBP standard deviation (SD), mean arterial BP SD, low daytime SBP SD and diastolic BP SD and mean BP SD. The high mean of the quality of life parameters correlated in the patients who reached the target to waist-hip ratio, type 1 diabetes mellitus, no change in carotid artery, low carotid-radial PWV and high 24-hour heart rate. Conclusions: The SF-36 scores of the Finnish drug-treated hypertensive patients did not differ markedly between those who reached blood pressure target and those who did not reach.
Objective: To assess the risk of progression from white-coat hypertension (WCHT) and masked (MHT) to sustained hypertension (SHT) in a nationwide unselected population sample. Design and method: Both office and home blood pressure (BP) were measured in all participants in the years 2000 and 2011. We compared the risk of progression to SHT (office BP >=140/90 mmHg and home BP >=135/85 mmHg or start of treatment with antihypertensive medication) between 528 participants with normotension (NT, office BP <140/90 mmHg and home BP <135/85 mmHg), 142 participants with WCHT (office BP >=140/90 mmHg and home BP <135/85 mmHg), and 63 participants with MHT (office BP <140/90 mmHg and home BP >=135/85 mmHg) with no antihypertensive drug treatment at baseline. Office BP was measured twice by a nurse on a single occasion and home BP was measured twice every morning and evening for one week with a validated, oscillometric device. We used the chi-square and Mantel-Haenszel tests to compare differences and trends in categorical variables. A multivariable-adjusted logistic regression model (adjusted for age, gender, body mass index, diabetes, hypercholesterolemia and smoking) was used to evaluate the association between baseline BP categories and incident SHT.Results: Over an 11-year follow-up, the rate of progression to SHT increased from NT (18%) to WCHT (52%) and MHT (73%), P < 0.0001. Progression to SHT became more likely with an increasing baseline home BP (P for trend <0.0001). During follow-up, 2.4%, 10.4% and 16.4% of participants with NT, WCHT and MHT (P < 0.0001), respectively, suffered a major adverse cardiovascular event (a composite of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure and coronary intervention). The multivariable-adjusted odds ratios (95% confidence interval) for developing SHT, as compared with NT, were 4.6 (3.1–7.0, P < 0.0001) for WCHT and 10.7 (5.7–20.1, P < 0.0001) for MHT (Figure). The other covariates did not reach statistical significance. Conclusions: Neither WCHT, nor MHT can be considered a harmless benign phenomenon. Persons in these categories have a several-fold risk of developing SHT than those with NT and could benefit from active follow-up and lifestyle counselling.
Risk of cardiovascular events within the diabetic population has decreased and survival increased with patients living longer and thus facing the development of end-stage renal disease (ESRD). This calls for good care of patient with diabetes with a focus on hypertension. Patient data were collected from 42 Finnish primary care centres. Each was asked to enrol 10–12 consecutive patients with type-2 diabetes between March 2011 and August 2012. Along with the office blood pressure measurements and laboratory tests, the presence of albuminuria was measured and glomerular filtration rate estimated (eGFR). The 2013 ESH criteria for diabetic hypertensive patients (<140/85 mmHg) was reached by 39% of all 625 study patients and 38% of the pharmacologically treated 520 patients. The absence of detectable albumin in urine was significantly associated with the control of systolic blood pressure and achievement of treatment goals. Beta blockers were the most common antihypertensive agents and patients treated with them had lower eGFR compared to those not treated with these agents. The blood pressure of patients was not in full concordance with the present guideline recommendations. However, satisfactory improvement in blood pressure control, reduction of albuminuria and hence ESRD prevention was achieved.
Abstract Fabry disease (FD) is an X chromosome‐linked, life‐threatening lysosomal disease caused by one of more than 1000 currently known variants in the α‐galactosidase A (GLA) gene. The follow‐up part of the Fabry Disease in Ostrobothnia (FAST) study reports the long‐term effect of enzyme replacement therapy (ERT) on a prospectively collected cohort of 12 patients, 4 males and 8 females, mean age 46 years (SD 16), with the classical variant c.679C > T p.Arg227Ter, which is one of the most common FD variants worldwide. In the natural history period of the FAST study, half of the patients in both sexes had at least one major event, of which 80% were of cardiac origin. During 5 years of ERT, four patients had a total of six major clinical events consisting of one silent ischemic stroke, three ventricular tachycardias and two increased left ventricular mass indexes. In addition, four patients developed minor cardiac events, four patients minor renal events, and one patient a minor neurological event. ERTs may delay but not prevent the progression of the disease in most patients with the variant Arg227Ter. This variant might be suitable for investigating the efficacy of second‐generation ERTs compared to the currently used ERTs regardless of sex.
Objective: To clarify the change in quality of life during six months after starting the antihypertensive treatment in hypertensive patients. Design and method: The patients were non-treated and participated during the years 1999–2002 in a six-month study where their antihypertensive treatment was titrated during six months according to a predetermined schedule to reach the target pressure. SF-36 questionnaire was filled out every six weeks by 88 patients (49 females and 39 males, aged 55.4 (7.8), 36–71 years). After six months they used at least one antihypertensive agent. Blood pressure was measured every six weeks by using 24 hour ambulatory measurement. Results: Daytime systolic blood pressure (SBP) decreased from 144.8 (11.6) to 129.8 (10.1) mmHg (p = 0.001) and diastolic blood pressure (DBP) from 94.1 (7.0) to 82.2 (6.4) mmHg (p = 0.001). Nocturnal SBP decreased from 128.5 (12.8) to 113.2 (10.3) mmHg (p = 0.001) and DBP from 77.9 (7.8) to 67.4 (6.9) mmHg (p = 0.001). Daytime heart rate (HR) changed from 72.7 (9.5) to 72.0 (8.3) beats/min (p = 0.09) and nocturnal HR decreased from 62.0 (7.8) to 60.5 (6.7) beats /min (p = 0.001). None of the eight SF-36 parameters nor their mean value changed significantly during the six months of the study. The change in physical functioning and role physical were negatively explained by daytime SBP in the beginning, in bodily pain negatively by daytime SBP and nocturnal HR at the end, in general health negatively by 24 hour SBP in the beginning, in role emotional negatively by daytime SBP at the end. Vitality, social functioning and mental health were explained by none of the parameters. The mean of the parameters of SF-36 questionnaire was explained negatively by daytime SBP in the beginning. Conclusions: According to our results quality of life did not change significantly during the six months after starting antihypertensive medication although blood pressure decreased significantly. Low change in the SF-36 physical parameters was mostly explained by high systolic blood pressure in the beginning of the study. Mental SF-36 parameters were not explained by any of the measured parameters.
Fabry Registry data were analyzed among 83 agalsidase beta-treated patients with Fabry disease who switched to migalastat. Outcomes (estimated glomerular filtration rate [eGFR], urine protein-creatinine ratio [UPCR], plasma globotriaosylceramide [GL-3], plasma globotriaosylsphingosine [lyso-GL-3], interventricular septal wall thickness [IVST], left posterior wall thickness [LPWT], left ventricular mass index [LVMI]) were assessed using linear mixed models to estimate annual change over time in the pre- and postswitch periods. eGFR decreased throughout both periods (preswitch: -0.85 mL/min/1.73 m
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