Vers un Holter tensionnel de demi-journée? Représentation du niveau tensionnel moyen diurne pour des périodes de 4 heures
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2018 ESC/ESH guidelines have recommended 24-h ambulatory blood pressure monitoring to assess hypotensive therapy in many circumstances. Recommended target blood pressure in office blood pressure measurements is between 120/70 and 130/80 mmHg. Such targets for 24-h ambulatory blood pressure monitoring lacks. We aimed to define target values of blood pressure in 24-h ambulatory blood pressure monitoring in hypertensive patients. Office blood pressure measurements and 24-h ambulatory blood pressure monitoring data were collected from 1313 hypertensive patients and sorted following increasing systolic (SBP)/diastolic (DBP) blood pressure in office blood pressure measurements. The corresponding 24-h ambulatory blood pressure monitoring to office blood pressure measurements values were calculated. Values 130/80 mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 113.74/66.95 mmHg; daytime SBP/DBP mean: 135.02/81.78 mmHg and 24-h SBP/DBP mean: 130.24/78.73 mmHg. Values 120/70 mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 109.50/63.43 mmHg; daytime SBP/DBP mean: 131.01/78.47 mmHg and 24-h SBP/DBP mean: 126.36/75.31 mmHg. The proposed blood pressure target values in 24-h ambulatory blood pressure monitoring complement the therapeutic target indicated in the ESC/ESH recommendations and improves 24-h ambulatory blood pressure monitoring usefulness in clinical practice.
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BACKGROUND: High blood pressure in the young has been related to the development of hypertension in adults; hence the importance of identifying adolescents with the risk of developing it.OBJECTIVE: To investigate the relationship between 24 h ambulatory blood pressure monitoring and the response of blood pressure in adolescents to exercise. DESIGN: A prospective and cross-sectional study. METHODS: We classified 101 men aged 13-18 years as obese hypertensive, lean hypertensive, obese normotensive, and lean normotensive. Mean blood pressure and variability were measured with ambulatory blood pressure monitoring, and expressed as 24 h, awake, and sleeping periods. Treadmill tests were also performed. RESULTS: Hypertensives and obese normotensives had higher ambulatory blood pressure monitoring values (P< 0.0001). Systolic blood pressure during sleep in obese subjects was significantly higher than that in lean usbjects (119.9 +/- 9 versus 113.6 +/- 8 mmHg, P < 0.001, obese hypertensives versus lean hypertensives; and 113.6 +/- 2 versus 103.0 +/- 2 mmHg, P < 0.002, obese normotensives versus lean normotensives) and nocturnal drop of systolic blood pressure was lower in obese subjects. We found a significant correlation between systolic blood pressure during ambulatory blood pressure monitoring and systolic blood pressure during moderate and maximal exercise for all periods (P < 0.0001). Blood pressure variability during awake period was higher in subjects with maximum exercise systolic blood pressure >/= 200 mmHg (7.4 +/- 2 versus 6.4 +/- 2%, P < 0.01).CONCLUSION: Systolic blood pressure measured by ambulatory blood pressure monitoring is related to response of systolic blood pressure to exercise and ambulatory blood pressure monitoring can identify groups of subjects at greater than normal risk through their higher blood pressure during sleep. Greater than normal blood pressure variability in adolescents is an indicator of the risk of reaching abnormal exercise values of systolic blood pressure. Higher casual blood pressure than ambulatory blood pressure monitoring values for adolescents should be considered abnormal.
Prehypertension
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Home measurement and ambulatory 24-hour monitoring of blood pressure (BP) have many advantages over conventional office BP measurement and are increasingly used in clinical practice. However, their effect on the treatment of hypertension requires additional study. We assessed the hypothesis that the adjustment of antihypertensive treatment based on home BP instead of ambulatory BP would lead to equivalent BP control. After a 4-week wash-out period with placebo, a total of 110 patients whose daytime diastolic ambulatory BP averaged 85 mmHg or higher were randomized to either ambulatory BP or home BP groups. Antihypertensive treatment was then adjusted in a stepwise fashion at 6-week intervals according to the mean daytime ambulatory diastolic BP or the mean home diastolic BP during the preceding week, depending on the patient's randomization group. Both ambulatory BP monitoring and home BP measurement were performed on all patients during the study. If the diastolic BP guiding treatment was above 80 mmHg, a physician blinded to the randomization intensified hypertensive treatment; if equal to or below 80 mmHg the treatment was left unchanged. A total of 98 patients completed the study; 52 in the home BP group (age 54±1.4 y, 37% men) and 46 in the ambulatory BP group (age 54±1.0 y, 50% men). After a 24-week follow-up period BP was significantly reduced within both groups (p<0.01). The between-group differences in systolic and diastolic BP changes were statistically nonsignificant (p>0.05). An equal share of patients had progressed to multiple-drug treatment in the home and ambulatory BP groups (65.4% vs. 67.4%, p=0.83). We conclude that the adjustment of antihypertensive treatment based on home BP measurement instead of 24-hour ambulatory BP monitoring led to equally intensive drug treatment with preservation of BP control. (See Table) Changes in BPs After a 24-week Follow-up Values expressed as mean ± SEM. SBP, systolic blood pressure; DBP, diastolic blood pressure. Changes in BPs After a 24-week Follow-up Values expressed as mean ± SEM. SBP, systolic blood pressure; DBP, diastolic blood pressure.
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SUMMARY 1. The diagnosis of isolated systolic hypertension, diastolic hypertension and normotension in elderly subjects, as defined by casual office blood pressure measurement, was compared with 24 h ambulatory blood pressure monitoring using an Accutracker II. 2. Mean day‐time ambulatory blood pressure monitoring underestimated the casual systolic blood pressure in all three clinical groups. Diastolic pressure was not underestimated to the same extent. 3. Ambulatory blood pressure monitoring best reflected casual blood pressure determination for normotensive subjects. In subjects with isolated systolic hypertension ambulatory blood pressures were only consistent with that diagnosis for 8% of the day time period. For 34% of the day time, their ambulatory blood pressures were consistent with diastolic/ mixed hypertension. 4. It is concluded that isolated systolic hypertension may not be a sustained condition, but rather an isolated response to office measurement of blood pressure.
Prehypertension
Isolated systolic hypertension
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Objective To study blood pressure compliance status of patients with resistant hypertension to guide medication time adjustment by ambulatory blood pressure.Methods All 116patients were randomly divided into ambulatory blood pressure group(group A),bedtime medicine group(group B)and morning medicine group(group C).Ambulatory blood pressure parameters were observed with ambulatory blood pressure monitoring(ABPM)before medication adjustment and four weeks after treatment.Results In group A,24hmean systolic blood pressure(24h-MSBP),24hmean diastolic blood pressure(24h-MDBP),24hmean arterial pressure(24hMAP),daytime average systolic blood pressure(d-SBP),night mean diastolic blood pressure(n-SBP),night average diastolic blood pressure(n-DBP),night mean arterial pressure(n-MAP)and blood pressure load of patients were significantly improved and blood pressure load of patients using antihypertensive drugs with the onset time less than4hours were significantly improved(P0.01).Patients using antihypertensive drugs(the onset time4hours)or long-acting antihypertensive drugs(Half-life24hours)in group A and group B are better than group C.Conclusion Medication time adjustment guided by ambulatory blood pressure can significantly improve blood pressure compliance status for patients with resistant hypertension.
Bedtime
Prehypertension
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Masked Hypertension
White coat hypertension
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Background Ambulatory blood pressure monitoring allows characterization of the patient's average blood pressure load as well as various profiles of blood pressure. Results from clinical studies suggest that dippers (patients whose blood pressures decrease during night-time) have a lower risk of cardiovascular events than do nondippers with similar daytime blood pressures. However, the definitions of dipping as well as of daytime and night-time vary among clinical studies. Objective To determine whether various definitions lead to markedly different classifications of dipper status. Design and methods We analyzed 894 24 h ambulatory blood pressure recordings that had been performed at our institution according to three previously published definitions of daytime and night-time and five definitions of dipping. Results There were small but statistically significant differences among the mean daytime and night-time blood pressures determined using the various definitions. Likewise, the proportions of dippers varied significantly with definitions of dipping and of daytime and night-time. Conclusions Differences among definitions of dipping as well as of daytime and night-time lead to significant variations in the characterization of patients' 24 h blood blood pressure profiles. The results of this analysis can be used when comparing the results of clinical studies as well as in their design.
Dipper
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Objective To analyze the differences between the offspring of patients with essential hypertension and those of non-hypertensive patients by ambulatory blood pressure monitoring results, and to assess blood pressure control results in offspring of patients with essential hypertension after taking medication. Methods(1) Ambulatory blood pressure monitoring was performed in 72 offspring of patients with essential hypertension(the study group) and 61 offspring of non-hypertensive patients(the control group). Comparison was made between the two groups in 24-hour average blood pressure, blood pressure load, blood pressure variability(BPV).(2) For offspring diagnosed with essential hypertension, the efficacy was evaluated by ambulatory blood pressure monitoring after eight weeks of drug treatment. Results(1) In the study group, blood pressure load values were significantly higher than those in the control group(P0.05). No significant difference was found in 24-hour average blood pressure between the two groups.(2) After drug treatment, the patients with essential hypertension and 24-hour average blood pressure in the study group showed statistically significant difference with those before treatment(P0 05). The systolic blood pressure T/P was larger than 50% in 7 cases, and diastolic blood pressure T/P was greater than 50% in 6 cases. The systolic and diastolic blood pressure SI was larger than 1 in 6 cases, and lower than 1 in 3 cases. Conclusion(1) Ambulatory blood pressure monitoring would make an early assessment of offspring with essential hypertension by blood pressure status. There are great significances for early prevention or blood pressure control to the hypertensive group of normal patients and patients with hypertension.(2) Ambulatory blood pressure monitoring is a good evaluation for the results of blood pressure control in offspring of patients with hypertension, which helps patients choose the best drugs and the best medication.
Essential hypertension
Prehypertension
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Masked Hypertension
White coat hypertension
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Objective To investigate the characteristics of ambulatory blood pressure levels and circadian rhythm in the youth with essential hypertension(EH) before and after treatment.Methods 95 young patients with EH were treated with antihypertensive drugs.Four indexes of 24-hour ambulatory blood pressure monitor were measured and compared before and after treatment,including mean blood pressure,mean pulse pressure,blood pressure load and blood pressure circadian rhythm.Results Systolic pressure and diastolic pressure in EH patients were all higher than the normal value in the whole day but decreased obviously(P 0.05) after the treatment.Before the treatment,the systolic pressure load was 30%and the diastolic pressure load was 36%in daytime;which was 28%and 32%at night.After the treatment,the systolic pressure load decreased to 4%in daytime and 3%at night;the diastolic pressure load decreased to 3%in daytime and 4%at night.The differences were statistically significant(P 0.01).The patients with abnormity in circadian rhythm of blood pressure(nondipper) account for 81.1%(77/95 ) before the treatment.The decrease rates of systolic pressure and diastolic pressure during the night were all increased obviously(P 0.05) after the treatment.However,there was only 19.5%(15/77) nondipper blood pressure circadian rhythms changing into dippers.Conclusion After treatments young EH patients had much lower mean blood pressure and blood pressure load in the whole day.Decrease rate of blood pressure during the night increased obviously,whereas only a part of patients recovered to normal blood pressure circadian rhythms.
Essential hypertension
Pulse pressure
Dipper
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