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So the position sensor gives
automatically results very similar to the definition from day and night
assessment from voluntarily triggered measurements by the pt. The actual
vs arbitrary definition of day and night influence significantly the results
of day-night differences and thus the definition of Dippers/non-Dippers.
Key Words
Ambulatory Blood Pressure Monitoring, Dippers, Position sensor.
AJH - April 1999
- Vol. 12, No 4, Part 2
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The determination of ambulatory blood pressure in very elderly hypertensives: effect of lying or sleeping in the day
E. Pinto, C.J.Bulpitt, N.Beckett, R.Peters, W.Banya, c.Nachev, V.Gergova, S.Nedogoda, L.Thijs, J.A.Staessen, C.Rajkumar. On behalf of the HYVET Investigators. Imperial College London, UK, Hospital St Anna, Sophia, Bulgaria, Hospital Alexandrovska, Sophia, Bulgaria, Volgograd Medical, Academy, Volgograd, Russia, University of Leuven, Belgium.
Background
This is the fist study in very elderly hypertensives to report ambulatory blood pressure measurements in relation to the patient's position during day time.
Objective
To determine ambulatory blood pressure in very elderly hypertensives (aged 80 years or more) and to report results according to body position, lying or sitting/standing.
Design and methods
This study is a side-project of the Hypertension in the Very Elderly Trial (HYVET). HYVET aims to investigate the effect of active treatment on outcom in hypertensive patients aged 80 years or more. ABPM (ambulatory blood pressure monitoring) is carried out annually using the Diasys Integra II monitor (Novacor, France). Daytime measurements were taken every half-hour from 10 am to 8 pm. This monitor also records the patient's position (lying or sitting/standing) simultaneously with each BP measurement.
Results
Results of 50 patients with 3 or more readings in both the lying and sitting/standing position (mean age 84 +/- 3.7 yeards s.d.) who were in the placebo phase or already randomised to either active or placebo treatment in eight participating centres. Daytime SBP was 128.1 +/- 15 mmHg. When values for only sitting/standing patients were used SBP was133.6 +/- 17 mmHg. For measurements during the day when the patients were lying down SBP decreased to 118.7 +/- 17 mmHg (p<0.001). Daytime DBP was 76.6 +/- 10 mmHg, sitting/standing-day time 81.1 +/- 12 mmHg and lying down 69.0 +/- 9 mmHg (p<0.001). The HR values were 75.6 +/- 9 beats/min, 79 +/- 10 beats/min sitting/standing and 70.2 +/- 9 beats/min lying down (p<0.0001).
Conclusion
The lower pressures when lying are thouyght to be due to sleeping or resting. In very elderly patients, it is important to account for body position in the interpretation of the day time ambulatory blood pressure recordings.
J. Hypertens., 2004, 22:S22, P1.7
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Effect of position on the ambulatory measurement of QKd interval in very elderly hypertensives
E. Pinto, C.J.Bulpitt, N.Beckett, R.Peters, W.Banya, C.Nachev, D.L.Dumitrascu, R.Antikainen, V.Stoyanovsky, M.Comsa, F.Dockery, J.A.Staessen, C.Rajkumar. On behalf of the HYVET Investigators. Imperial College London, UK, Hospital St Anna, Sophia, Bulgaria, UMF Cluj Napoca, Cluj Romania, Oulu City Hospital, oulu, Finland, National Multiprofile Transport Hospital, Sophia Bulgaria, Cabinet Medical Comsa Marius, Fagaras, Romania, University of Leuven, Belgium.
Background
Arterial compliance is know to decrease with age and conditions such as hypertension. No studies, however, have reported the effect of position on the ambulatory measurement of arterial compliance.
Objective
To determine the effetc of the body position on arterial compliance in very elderly hypertensives by measuring ambulatory QKD intervals during daytime.
Design and Methods
This study is a side-project of the Hypertension in the Very Elderly Trial (Hyvet). HYVET aims to investigate the effect of active treatment on outcome in hypertensive patients aged 80 years or more. The measurement of the QKD interval (Q wave (ECG) to Korotkoff Diastole sound) interval over a 24hr period is carried out annually using the Diasys Integra II monitor (Novacor, France). Daytime measurements were taken every half-hour from 10am to 8 pm. This monitor also records the patient's position (lying or sitting/standing) simultaneously with each BP measurement.
Results
Results of 37 patients (age 84 +/- 4 years, mean +/- s.d.) with 3 or more readings in both the lying and sitting/standing position who were in the placebo run-in phase or already randomised to either active or placebo treatment in eight participating centres were analysed in this study. The daytime QKD interval (10 am to 8 pm) was 180.7 +/- 19 ms (178.7 +/- 20 ms sitting/standing versus 182.6 +/- 21 ms lying, NS). SBP was 133 +/- 13 mmHg and HR 78 +/- 11 beats/min sitting/standing and 117 +/- 15 mmHg and 70 +/- 10beat/min lying. Adjusted for systolic blood pressure (100 mmHg) and heart rate (60 beats/min), the QKD100-60 for daytime was 200 +/- 9 ms. The QKD100-60 for lying position was 196 +/- 10 ms and for standing was 205 +/- 8 ms (p=0.0001).
Conclusions
We conclude that QKD interval is not affected by position unless corrected for systolic blood pressure and heart rate.
J.Hypertens., 2004, 22:S115, P1.340
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Blood pressure surge on rising
P. Gosse, R. Lasserre, C. Minifié, P. Lemetayer, J. Clementy
Hôpital Saint-André, Bordeaux, France
Objective
Since cardiovascular complications tend to occur more often in the morning, it is tempting to link to the surge in BP on rising. This was verified in a cohort of hypertensive patients (HT).
Design and Methods
We performed 24h ABPM along with a measurement of BP on rising (either manually or automatically from the device coupled with a position sensor) in 507 untreated HT. Left ventricular mass (LVM) was measured with echo at baseline. HT were the treated and followed by their GP and news were obtained at regular intervals (mean follow-up = 92 +/- 36 months). Surge in BP was the difference between measurement triggered in the minute following rising and the last measurement within the 30' before.
Results
Rising led to a mean increase of 14 mmHg in SBP and a 13 bpm increase in HR without significant correlation between the two. The increase in SBP on rising was linked with the overall variability in SBP (standard deviation, p<0.001), but independent of the mean 24h SBP. It was associated with LVM at baseline (linear regression, p<0.05) and an increased risk of future cardiovascular complications (Cox model, p<0.01) independently of age and average 24h SBP.
Conclusions
SBP surge on rising was associated with LVH and an increased risk of cardiovascular complications independently of age and average 24h SBP.
J.Hypertens., 2004, 22:1113-1118
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