Ambulatory blood pressure for special groups.
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Blood Pressure Monitoring, Ambulatory↗
Biomedical subjects
J Redon
Publications and source records attributed to J Redon.
Influence of the I/D polymorphism of the angiotensin-converting enzyme gene on the outcome of microalbuminuria in essential hypertension.
The objective of the present study was to analyze the influence of the I/D polymorphism of the ACE gene on the outcome of microalbuminuria in essential hypertensive patients who were receiving antihypertensive treatment. One hundred thirty-six essential hypertensive patients who were <50 years old and had never previously received treatment with antihypertensive drugs were included in the study. During a 3-year period, patients received nonpharmacological treatment consisting of moderate salt restriction and a low-calorie diet they were obese, with or without a regimen of antihypertensive drugs based on beta-blockers or ACE inhibitors. Hydrochlorothiazide was added when necessary to maintain the blood pressure goal of <135/85 mm Hg. At the beginning of the study and at yearly intervals, systolic and diastolic blood pressures (SBP and DBP, respectively), 24-hour urinary albumin excretion (UAE), renal function, and biochemical profile measurements were made. The insertion/deletion (I/D) polymorphism of the ACE gene was determined through the use of polymerase chain reaction. The variables used in the statistical analysis were the measurements at the start of the study and the increase or decrease detected during the follow-up, estimated as individual specific regression line slope values. At baseline, no differences in blood pressure or UAE values were observed among genotypes. Likewise, the genotype or allele frequency was not significantly different between normoalbuminurics and microalbuminurics. After the 3 treatment years, significant reductions in SBP, DBP, and UAE were found (SBP 151.6+/-17.3 reduced to 137.2+/-14.3 mm Hg, P<0.001; DBP 96.6+/-8.9 reduced to 84.5+/-9.8 mm Hg, P<0.001; UAE 36.7+/-71.5 reduced to 28.3+/-78.6 mg/24 h, P<0. 05). The slopes of these parameters over time did not differ significantly among genotypes. The slope of SBP was the main factor related to the slope of logUAE (P<0.003). A significant positive correlation coefficient between the SBP and logUAE slopes was observed for the DD patients (r=0.57, P<0.0001) but was absent in patients carrying the I allele (II r=-0.03, P=NS; I/D r=0.01, P=NS). Follow-up studies should be used to achieve a better understanding of the impact of candidate gene polymorphisms on the development of hypertension-induced organ damage. Assessment of the I/D polymorphism of the ACE gene may identify subjects who require a greatly lowered blood pressure to prevent organ damage and to reduce hypertension-associated complications and death.
Adult↗
[Clinical efficacy of losartan: are there any differences between angiotensin II type I receptor antagonists and other drugs?].
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Angiotensin I↗
[Remediable glucocorticoid hyperaldosteronism: molecular diagnosis].
BACKGROUND: The first family diagnosed in Spain of glucocorticoid remediable aldosteronism (GRA) is reported. SUBJECTS AND METHODS: We described the phenotype, biochemical values and genetic diagnosis of a GRA pedigree. DNA analysis was performed by using Southern-blot and polymerase chain reaction. RESULTS: We reported a 14-year-old boy who presented with severe hypertension, and strong family history of early-onset hypertension. His suppressed plasmatic renin activity, family history and failure to respond to conventional antihypertensive therapy raised GRA as a potential etiology. The diagnosis was confirmed by genetic testing, in the index case and in one of family members, which demonstrated the chimeric gene duplication, which was a resultant of a crossing-over between the proximal portion of 11 beta-hydroxylase gen, CYP11B1, and the distal portion of aldosterone synthetase gene CYP11B2. Two other family members, who died, suffered hyporeninemic severe hypertension. The cause of death in one of them was hemorrhagic stroke. Amiloride, which blocks sodium transport in the distal nephron, plus hydroclorothiazide was an effective treatment option. CONCLUSIONS: The role of molecular diagnosis techniques is essential for the rapid diagnosis of cases of arterial hypertension secondary to familial glucocorticoid remediable aldosteronism.
Adolescent↗
[Insertion/deletion polymorphism of the gene encoding for angiotensin-converting enzyme and microalbuminuria in essential arterial hypertension].
BACKGROUND: To assess the influence of insertion/deletion polymorphism in the ACE gene on the microalbuminuria in essential hypertension. PATIENTS AND METHODS: Seventy-nine patients with essential hypertension (37 males and 42 females) (mean age 39 [7] years, body mass index 28 [4] kg/m2), never treated with antihypertensive drugs were included in the study. Urinary albumin excretion (UAE) was assessed in two different days. Ambulatory blood pressure (BP) was assessed during 24 h period. Genotype ACE gene and gene frequencies were determined by an assay based on the polymerase chain reaction (PCR). RESULTS: The distribution of phenotypes was: II = 14 (17%), ID = 32 (40%) and DD = 33 (43%). The mean for UAE tended to be higher in the DD group (53.82 [88.4] mg/24 h) than ID (27.8 [39.6] mg/24 h) and II (23.8 [16.7] mg/24 h). Likewise, the average for UAE were higher in the DD group than in the II + ID group (26.6 [34.0] mg/24 h) (p = 0.06), although the differences did not achieved statistical significance. The relationship between log UAE and 24-hour mean BP was significantly higher in the DD group (r2 = 0.232; p = 0.005) than that observed in the other groups (r2 = 0.060; p = 0.101). CONCLUSIONS: In the present study with young patients with essential hypertension, in DD genotype, UAE seems to be higher and more dependent of BP levels than in the other hypertensives.
Adult↗
[Ambulatory arterial pressure and left ventricular hypertrophy in untreated hypertensive patients].
BACKGROUND: The study was designed to evaluate blood pressure (BP) values related to left ventricular hypertrophy (LVH) in a group of never treated middle-aged hypertensive subjects. PATIENTS AND METHOD: Non-invasive ambulatory blood pressure monitoring (ABPM) and echocardiography were performed in 149 hypertensive patients (25-50 years old) with diastolic blood pressure (DBP) 90-114 mmHg. LVH was considered when left ventricular mass (LVM) was > 134 g/m2 in males and > 110 g/m2 in females. RESULTS: 43% of patients had LVH. Patients with LVH had higher clinic and ambulatory BP values. The greatest differences were in mean 24-h SBP (p = 0.001) and in 24-h DBP (p = 0.006). With respect to LVH, there were no differences between dippers and non-dippers, males or females, and circadian or BP variability. LVM was positively correlated with clinical DBP (p = 0.24), 24 h SBP (p = 0.41), pulse pressure (PP) (p = 0.36) and absolute BP variability (p = 0.23). Multiple regression analysis confirmed that 24-h SBP and sex where positively associated with LVH independent of others factors. The existence of 24-h SBP > 150 mmHg dramatically increased the risk of LVH (odds ratio [OR] = 9.2; CI 95%: 2.8-29.3; p = 0.002). CONCLUSIONS: The present study indicates that in never treated middle-aged essential hypertensive patients the principal factor related to the presence of LVH is the value of systolic blood pressure throughout a 24-h period.
Adult↗
Factors related to quality of ambulatory blood pressure monitoring in a pediatric population.
To assess the factors related to the quality of ambulatory blood pressure monitoring in a pediatric population, we performed 24-h ambulatory blood pressure monitorings on 333 unselected children aged 3 to 18 years using a Spacelabs 90207 monitor. For each individual, the percentages of valid measurements (ratio between valid and total number of measurements, 76.4% +/-15.6%) and of successful measurements (percentage of valid preset measurements, 89.8% +/- 11.5%) were calculated. Two hundred eighty-one (84.1%) monitorings had a successful measurement rate of >80%. Two hundred thirteen (64%) were of excellent quality, as defined by the percentage of successful measurements being higher than or equal to 90%. Age (P < .0001) and 24-h systolic blood pressure (P < .04) were positively and independently associated (in multiple regression analysis) to the percentage of successful measurements, accounting for 8% of the variance. Furthermore, a significant negative correlation between causal pulse pressure and the number of erroneous measurements was observed (r = -0.18, P < .01). This study has shown that in a pediatric population, the quality of the monitoring depends only in part on age and ambulatory systolic blood pressure values when an oscillometric device is used. The results have demonstrated the important role pulse pressure amplitude plays when accounting for the number of erroneous measurements.
Adolescent↗
Assessing ambulatory blood pressure in renal diseases: facts and concerns.
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Ambulatory Care↗
Task force II: Ambulatory blood pressure monitoring in population studies.
Ambulatory blood pressure (ABP) has only rarely been employed in population studies because of the difficulty posed by the greater complexity of this technique. The cross-sectional studies that have been published, however, have allowed a number of conclusions to be drawn. One, 24h average blood pressure of populations is significantly but not closely related to office blood pressure, which thus can not predict accurately daily-life values of blood pressure. Two, 24h average blood pressure is usually less than office blood pressure, the discrepancy increasing with the increase in office values and being of magnitude several mmHg at the office blood pressure of 140/90 mmHg (systolic/diastolic) Three, ABP in women is somewhat less than that in men and ABP for both sexes increases less with aging than does office blood pressure. Four, a circadian profile of blood pressure consisting in values that are much lower at night than are those during daytime characterizes both sexes and all ages with the possible exception of individuals aged 75 years and more, in whom the nocturnal hypotension appears to be attenuated. A similar attenuation has been found for blacks in comparison with whites. The upper limit of normality of ABP has not yet been defined conclusively, although 24h average values </=125/80 mmHg are almost invariably regarded as normal. Normality of ABP should be defined, however, by longitudinal population studies in which ambulatory values are related to prognosis. One of these studies has already been published and others will be completed in the near future.
Blood Pressure Monitoring, Ambulatory↗
Ambulatory blood pressure during diseases of the kidney.
During the last few years there has been a renewal of interest in blood-pressure-induced kidney damage due to a progressive increase in the incidence and prevalence of hypertension and vascular diseases as a cause of end-stage renal disease (ESRD). The need to prevent ESRD demands a continuation of effort to make the early identification of hypertensives who are at risk possible and to provide them with effective antihypertensive therapy. Since ambulatory blood pressure monitoring has been used successfully to assess blood pressure and identify risk markers for cardiovascular diseases, a logical approach would be to use it also to identify the risk markers for ESRD. Higher than normal percentages of non-dippers have been found among subjects with renal failure, during dialysis (haemofiltration, peritoneal dialysis and continuous ambulatory peritoneal dialysis), among cases of renovascular hypertension or cystic kidney disease and among cases of renal transplantation. Although this non-dipping pattern might be related to the presence of severe hypertension in some patients, such as those who have renovascular hypertension, in other cases the abnormal circadian variability is present with milder forms of hypertension or even in the absence of hypertension. Monitoring ambulatory blood pressure could offer advantages for protection of renal function during antihypertensive treatment of subjects with mild renal insufficiency. Furthermore, ambulatory blood pressure monitoring seems to have been prognostic for the development of proteinuria in a group of refractory hypertensives. Whether higher than normal nocturnal blood pressures and the non-dipping pattern are causes or consequences of renal disease should be addressed in prospective studies. The above notwithstanding, assessment of nocturnal blood pressure seems to be an important aid in the management of patients with hypertension-related renal disease and of patients who are susceptible to developing it.
Blood Pressure Monitoring, Ambulatory↗
Renal protection by antihypertensive drugs: insights from microalbuminuria studies.
During the last few years there has been a renewed interest in blood-pressure (BP)-induced kidney damage, owing to a progressive increase in the incidence and prevalence of hypertension and vascular diseases as a cause of end-stage renal disease (ESRD). The need to prevent ESRD demands continued efforts so as to identify early those people with hypertension who are at risk and to provide them with effective antihypertensive therapy. This review analyses what is needed in terms of surrogate endpoints for monitoring kidney damage and what is known about the impact of antihypertensive treatments in reducing the BP burden on the kidney in non-diabetic subjects. Although glomerular filtration rate (GFR) and proteinuria are useful surrogate endpoints for patients with nephropathy and GFR below or close to the threshold value for renal insufficiency, it is clear that monitoring changes in either GFR or proteinuria does not provide a sensitive endpoint for subjects with the mildest forms of renal disease, e.g. essential hypertensive patients who are at risk of developing kidney damage. In this case microalbuminuria may be useful, although unequivocal evidence demonstrating that microalbuminuria is a risk marker for developing renal insufficiency in non-diabetic renal diseases has not existed until now, and whether a decrease in microalbuminuria is of prognostic significance in patients with essential hypertension remains to be demonstrated. The beneficial effects of the antihypertensive agents on microalbuminuria are also proportional to BP reduction. If a large enough BP reduction is achieved there seem to be, at most, only minimal differences among the antihypertensive drug classes. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have additional beneficial effects on microalbuminuria independent of the BP reduction, owing to their direct role in glomerular haemodynamics. The heterogeneity in the changes in urinary albumin excretion during antihypertensive treatment may be related to the different factors involved in the presence of microalbuminuria or structural end-organ damage, or both.
Albuminuria↗
Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study.
The objective of this study was to establish whether ambulatory blood pressure offers a better estimate of cardiovascular risk than does its clinical blood pressure counterpart in refractory hypertension. This prospective study assessed the incidence of cardiovascular events over time during an average follow-up of 49 months (range, 6 to 96). Patients were referred to specialized hypertension clinics (86 essential hypertension patients who had diastolic blood pressure > 100 mm Hg during antihypertensive treatment that included three or more antihypertensive drugs, one being a diuretic). Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed at the time of entrance. End-organ damage was monitored yearly, and the incidence of cardiovascular events was recorded. Patients were divided into tertiles of average diastolic blood pressure during activity according to the ABPM, with the lowest tertile <88 mm Hg (LT, n=29), the middle tertile 88 to 97 mm Hg (MT, n=29), and the highest tertile >97 mm Hg (HT, n=28). While significant differences in systolic and diastolic ambulatory blood pressures were observed among groups, no differences were observed at either the beginning or at the time of the last evaluation for office blood pressure. During the last evaluation, a progression in the end-organ damage score was observed for the HT group but not for the two other groups. Twenty-one of the patients had a new cardiovascular event; the incidence of events was significantly lower for the LT group (2.2 per 100 patient-years) than it was for the MT group (9.5 per 100 patient-years) or for the HT group (13.6 per 100 patient-years). The probability of event-free survival was also significantly different when comparing the LT group with the other two groups (LT versus MT log-rank, P<.04; LT versus HT log-rank, P<.006). The HT group was an independent risk factor for the incidence of cardiovascular events (relative risk, 6.20; 95% confidence interval, 1.38 to 28.1, P<.02). Higher values of ambulatory blood pressure result in a worse prognosis in patients with refractory hypertension, supporting the recommendation that ABPM is useful in stratifying the cardiovascular risk in patients with refractory hypertension.
Adult↗
Ambulatory blood pressure and the kidney.
During the last few years there has been a renewed interest in blood-pressure-induced kidney damage, due to a progressive increase in the incidence and prevalence of hyipertension and vascular diseases as a cause of end-stage renal disease (ESRD). The need to prevent ESRD demands continued efforts to achieve the early identification of persons with hypertension who are at risk and to provide them with effective antihypertensive therapy. Ambulatory blood pressure monitoring (ABPM) has been used successfully to assess blood pressure values and identify risk markers for cardiovascular diseases. A logical approach would be to use it also to identify those for ESRD. For hypertensive and type 1 diabetics ABPM data usually have a stronger correlation to the presence and magnitude of microalbuminuria than do routine office blood pressure measurements. The best Pearson correlation coefficients for relationship between ambulatory blood pressure values and urinary excretion of albumin were obtained with nocturnal blood pressure regardless of whether systolic, diastolic or mean blood pressure were considered. Moreover, high percentages of non-dippers have been found among subjects with renal failure, subjects undergoing dialysis (haemofiltration, peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD), subjects with renovascular hypertension and with cystic kidney disease, subjects who have had a kidney transplant and subjects with cyclosporine-induced hypertension. Finally, ABPM seems to be prognostic for development of proteinuria in some refractory hypertensives. Whether higher nocturnal blood pressure values and the non-dipping pattern constitute a cause or are consequences of renal disease should be addressed in prospective studies. Assessment of nocturnal blood pressure seems to be an important tool in the management of patients with hypertensive-related renal disease and of patients who are susceptible to developing it.
Journal Article↗
Hyperinsulinemia as a determinant of microalbuminuria in essential hypertension.
OBJECTIVE: To analyze the relationship between insulinemia and urinary albumin excretion in a group of nonobese, young adult hypertensive patients, who had never been treated with antihypertensive drugs. PATIENTS AND METHODS: Forty-nine patients who fulfilled the inclusion criteria were included. Twenty-four-hour ambulatory blood pressure monitorings, urinary albumin excretion (UAE) measurements, and an oral glucose-tolerance test measuring glucose and insulin, were performed, and left ventricular mass was measured by echocardiography. Hypertensive patients were classified as normoalbuminuric when their UAE was < 30 mg/24 h (40 patients; mean UAE 13.4 +/- 7.0 mg/24 h), and as microalbuminuric when their UAE was 30-300 mg/24 h (nine patients; mean UAE 90.5 +/- 86.6 mg/24 h). RESULTS: In comparison with that of the normoalbuminuric group, the fasting plasma glucose concentration for the microalbuminuric group was only slightly higher (100 +/- 9 versus 95 +/- 8 mg/dl, NS). In contrast, the fasting insulin concentration in the microalbuminuric group was significantly higher than that observed in the normoalbuminuric group (25.2 +/- 6.7 versus 16.6 +/- 5.2 microU/ml, P<0.0001). During the oral glucose-tolerance test, the area under the curve (AUC) for glucose (317 +/- 41 versus 253 +/- 53 mg/dl x 2/h, P<0.001) and the AUC for insulin (253 +/- 171 versus 124 +/- 43 microU/ml x 2/h, P<0.001) were significantly higher in the microalbuminuric group than were those AUC observed in the normoalbuminuric group. After adjustments for age, sex, body mass index and average 24 h ambulatory mean blood pressure were made, the fasting insulin level was associated independently with an increase in UAE in a multiple regression model with base 10 logarithm of the UAE as the dependent variable. Variations in fasting insulin level alone accounted for 33% of the UAE variance. In contrast, the 24 h ambulatory mean blood pressure, rather than the insulin level, was the strongest predictor of the left ventricular mass index. CONCLUSIONS: Mild hypertensive patients with microalbuminuria were hyperinsulinemic in the absence of obesity, and their insulin level was the main determinant of microalbuminuria in these patients. Microalbuminuria in essential hypertension seems to identify patients with a cluster of cardiovascular risk factors and a bad risk profile. Thus, assessment of microalbuminuria may be useful in the stratification of risk in essential hypertension.
Adult↗
Treatment of patients with essential hypertension and microalbuminuria.
There has been increasing interest in the question of whether microalbuminuria can be used in the risk stratification of patients with essential hypertension. A cluster of cardiovascular and/or renal risk factors may be associated with microalbuminuria in hypertension. Despite this, prospective data about the potential role of microalbuminuria as a prognostic marker of cardiovascular and/or renal risk have been sparse and inconclusive until now. Blood pressure values have been considered the most important determinant of microalbuminuria in essential hypertension; however, hyperinsulinaemia--a metabolic component-was noted to be present in conjunction with high blood pressure. Furthermore, 2 other factors may be also related to microalbuminuria: salt sensitivity and renal structural changes (nephrosclerosis). We are now aware that the clinical and physiological implications of abnormal urinary albumin excretion (UAE) are much broader than anticipated, possibly involving haemodynamic, metabolic and vascular components overlapping several clinical syndromes. Achievement of short term UAE reduction with antihypertensive treatment depends on structural abnormalities established in the glomerulus, the extent of blood pressure reduction and the antihypertensive drug class used. In terms of UAE reduction, better results are obtained with ACE inhibitors or angiotensin II antagonists such as losartan and valsartan, than with other antihypertensive classes, although their true impact in preserving renal function needs to be assessed. The capacity of new calcium antagonists, such as amlodipine, lacidipine or mibefradil, to reduce UAE also needs to be assessed further. Thus, microalbuminuria may be seen as an integrated marker of risk and should be assessed in recently diagnosed patients with essential hypertension. In microalbuminuric patients, the target should be to decrease blood pressure < 135/85 mm Hg, reduce salt intake to around 100 mmol/day and prescribe a low-calorie diet if obesity is present. ACE inhibitors or angiotensin II antagonists have more potential benefits than the other classes of antihypertensive drugs in reducing UAE. Finally, a yearly assessment of microalbuminuria is recommended during treatment, to monitor the impact of therapy.
Albuminuria↗
Relationship between birth weight and awake blood pressure in children and adolescents in absence of intrauterine growth retardation.
This study was designed to examine the relationship between birth weight (BW) and ambulatory blood pressure in children and adolescents, born at term in absence of intrauterine growth retardation. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed on 332 children (150 boys), aged from 6 to 16 years. Subjects were stratified by BW tertiles and age. ABPM was performed using SpaceLabs 90207 monitor during a regular school day. Blood pressure (BP) was measured every 20 min from 06:00 to 24:00, and thereafter every 30 min. Means of systolic BP (SBP) and diastolic BP (DBP) during 24 h, daytime (08:00 to 22:00), and nighttime (24:00 to 06:00) were calculated. Systolic and diastolic load was estimated as the percentage of measurements above the age- and sex-specific 95th percentile during the 24 h. BW was inversely related to daytime (SBP (P = .04) and SBP load (P = .04) when controlled for sex, current height, ponderal index (weight/height3), and age. The predictive values of daytime SBP throughout the pediatric age group in the two extreme tertiles of BW (lowest, 2.500 to 3.200 kg; and highest, 3.501 to 4.820 kg) were obtained from regression equations including SBP during activity period or SBP load and age. Children who had lower BW tended to have higher daytime SBP or SBP load at any age although this difference was not statistically significant. These differences became more evident as the subjects got older. BW is a determinant of daytime SBP even in the absence of intrauterine growth retardation. The influence of BW seems to increase with age.
Adolescent↗
Ambulatory blood pressure monitoring during antihypertensive treatment: the case of non-responder patients.
OBJECTIVE: To analyse the discrepancies between casual and ambulatory blood pressure in hypertensive patients during treatment. PATIENTS AND METHODS: Patients were gathered intio two groups according to casual diastolic blood pressure (DBP) and antihypertensive treatment: group A (responders) with casual DBP < 90 mmHg administered one or more antihypertensive drugs and group B (non-responders) with DBP >/= 95 mmHg taking two or more antihypertensive drugs, maintained during three consecutive visits at 2-week intervals. For all of them casual blood pressure measurements, 24 h ambulatory blood pressure monitoring and assessment of end-organ damage were performed. RESULTS: The difference between casual blood pressure and average 24 h ambulatory blood pressure were significantly higher for group B than those observed for group A (26 versus 7 mmHg systolic, 16 versus 5 mmHg diastolic). Thirty per cent of the patients in group B and 16% in group A had casual blood pressure more than 20 mmHg higher than awake ambulatory blood pressure, whereas 8% in group B and 20% in group A had higher values for ambulatory than for casual blood pressure. In group A 8% of patients had awake DBP higher than 95 mmHg and 8% had awake DBP 85-95 mmHg. Patients of group A with awake DBP >/= 85 mmHg were younger than those with awake DBP < 85 mmHg (41.4+/-8.8 and 52.1+/-13.4 years, respectively). In patients of group B, there was less end-organ damage in the patients with awake DBP < 85 mmHg than there was in patients with awake DBP >/= 95 mmHg (World Health Organization grade I/II-III, 6/10 and 3/20, respectively). CONCLUSION: The differences between casual and ambulatory blood pressures were higher in the 'non-responder' patients. In group A the small percentage of patients who had persistently higher ambulatory blood pressure were younger. In group B one-quarter of the patients had 'normal' ambulatory blood pressure and less end-organ damage. Ambulatory blood pressure monitoring will be useful for better assessment of hypertension control in a subset of hypertensive patients.
Journal Article↗
Microalbuminuria, left ventricular mass and ambulatory blood pressure in essential hypertension.
The objective of the present study was to assess the relationship between microalbuminuria (Malb) and left ventricular hypertrophy (LVH), when levels of ambulatory BP was token in to account as a confounder factor. Patients with essential hypertension, aged 25 to 50 years old, never treated with antihypertensive drugs, were included in the study. The inclusion criteria were: (a) absence of diabetes, renal disease or urinary tract infection; (b) urinary albumin excretion (UAE) estimated in urine of 24 hours in two separate days; (c) echocardiography suitable for measurement of left ventricular mass (LVM); and (d) good quality ambulatory blood pressure monitoring during 24 hours. UAE was measured using a immunonephelometric assay (Behring Institute) and Malb was considered when UAE 30 to 300 mg/24 hours during the two days. LVM was calculated by the Devereaux formula and referred to height (LVMI g/m). AMBP was performed using an oscilometric device (Spacelabs 90202 or 90207) during a regular working day. Readings were programmed every 20 minutes between 6 a.m. to midnight and thereafter every 30 minutes. The average BP during a 24 hour period was calculated. One hundred and fifty one patients (96 male, mean age 37 +/- 8 years, body mass index 27.7 +/- 3.7 g/m2) were included. The average values of office BP was 148 +/- 15/96 +/- 8 mm Hg, and the average BP during 24 hours was 137 +/- 13/88 +/- 12 mm Hg. UAE was 30.1 +/- 52.3 mg/24 hr and the LVMI 140.6 +/- 44.1 g/m. The percentage of Malb patients was 28% and those with LVH 34%. A significant relationship between UAE and office and ambulatory SBP and DBP was observed. LVMI was also significantly related to ambulatory SBP and DBP, a relationship that was not found for office BP. In a multiple regression model, significant relationship between UAE and LVMI emerged, independent of diastolic ambulatory BP, age and sex (P < 0.04). In conclusion; we observed a significant relationship between UAE and LVMI, in part, independent of blood pressure. The fact that Malb is associated with the presence of LVH, supports the idea that Malb is a risk marker in essential hypertensive patients.
Adult↗