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R N Idema

Publications and source records attributed to R N Idema.

10 recordsLinked to original sources
PubMed1998

The use of Fourier analysis in the calculation of trough to peak ratio from ambulatory blood pressure measurements.

The trough:peak (T:P) ratio serves as an index of efficacy of antihypertensive drugs with respect to their dose and dose interval. There is no consensus regarding the method for the calculation of the T:P ratio. We assessed the influences of curve smoothing, the average fall in 24-h mean arterial pressure (MAP) and the length of the peak effect period on the result of T:P ratio calculation. Forty-two patients with essential hypertension (aged 27-81 years; 20 males) had a 24-h ambulatory blood pressure (BP) measurement on two occasions. The first was performed at baseline, the second after 12 weeks of treatment with a beta-blocker, angiotensin-converting enzyme inhibitor, calcium slow-channel blocker, diuretic or a centrally acting drug, all taken once daily. BP data were analysed both by Fourier analysis (FA) with four harmonics and by time block analysis (TBA). The peak effect was defined as the maximum drop in MAP over a period of 0 to 3 h following drug intake at any time in the 24 h, and the trough effect as the fall in MAP over the last 2 h of the dose interval. FA gave higher T:P ratio values than TBA (0.51 vs 0.43; P < 0.05) and the variability of the results was reduced by FA (FA: 0.49-0.52; TBA: 0.35-0.46). A greater fall in 24-h MAP was associated with a higher T:P ratio (r = 0.42, P < 0.02; TBA: r = 0.31, P = 0.09). Half of the patients whose fall in 24-h MAP after treatment was <10 mm Hg, had higher trough BP values, resulting in negative T:P ratios. With increasing length of the peak period, the calculated peak effect was reduced and the T:P ratio increased (both FA and TBA: P < 0.001). The mean trough responses during the last 2 h of the dose interval were similar after TBA and FA. Based on these data, we recommend the use of FA for calculation of T:P ratios, especially when the magnitude of the antihypertensive effect is small. We also suggest using peak- and trough-effect periods of 2 h each. Whenever T:P ratios are calculated, the method used for curve smoothing and the length of peak- and trough-effect periods should be specified in order to obtain meaningful results. T:P ratios need to be interpreted individually together with the magnitude of the antihypertensive drug effect and the circadian BP profile.

Adult↗
PubMed1996

Multicentre evaluation of the EBIO plus glucose analyser.

The EBIO plus, a newly developed dedicated glucose analyser, was tested at three different sites for its analytical characteristics and practicability. Results were linear over a range of 2-50 mmol/l, precision was satisfactory (overall CV < 5.3% at a concentration level of 1.8 mmol/l and < 3.7% at a concentration level of 4.5-21 mmol/l). Calibration was stable up to 90 minutes. No significant influences were observed for several potential interfering substances at physiological or therapeutical levels. Practicability was found to be good. Sample through-put depends on calibration frequency and is maximally 166 per hour. Some problems with outliers had to be overcome in the beginning of the evaluation period, but in the end all evaluators concluded that the EBIO plus is user friendly with good analytical characteristics.

Blood Glucose↗
PubMed1994

Abnormal diurnal variation of blood pressure, cardiac output, and vascular resistance in cardiac transplant recipients.

BACKGROUND: An attenuated or absent nocturnal decline in blood pressure has repeatedly been documented in cardiac transplant recipients. The present study was aimed at investigating the hemodynamic mechanism underlying this abnormality. METHODS AND RESULTS: In 23 cardiac transplant recipients (11 to 36 months after transplantation) and in 23 control subjects matched for age and 24-hour mean arterial pressure, invasive 24-hour ambulatory blood pressure was measured by means of the Oxford technique. Beat-to-beat relative values of stroke volume were determined by means of a pulse-contour method, and relative changes of cardiac output (stroke volume x heart rate) and total peripheral vascular resistance (blood pressure/cardiac output) over the 24-hour period were calculated. The nocturnal decline in blood pressure was 20 +/- 8% (mean +/- SD) in control subjects but only 5 +/- 9% (P < .001) in cardiac transplant recipients. In control subjects, the nocturnal decline in blood pressure was associated with a nocturnal fall in cardiac output of 24 +/- 13%, whereas vascular resistance compared with daytime value did not change. The small nocturnal decline in blood pressure in cardiac transplant recipients was associated with an attenuated nocturnal fall in cardiac output of 14 +/- 12% (P < .05 versus control subjects). In addition, vascular resistance compared with daytime value was increased by 9 +/- 9% (P < .05) during the night. Both in cardiac transplant recipients and in control subjects, the nocturnal changes in blood pressure were correlated with the nocturnal changes in cardiac output but not with the nocturnal changes in total peripheral vascular resistance. CONCLUSIONS: This study confirms the attenuated nocturnal fall in blood pressure in cardiac transplant recipients. Hemodynamically, this attenuated blood pressure decline is characterized by a reduced nocturnal fall in cardiac output, and it is associated with a nocturnal increase in vascular resistance.

Adolescent↗
PubMed1992

A new model for diurnal blood pressure profiling. Square wave fit compared with conventional methods.

For the characterization of diurnal blood pressure variation, we developed a simple mathematical model that nevertheless does justice to the specific form characteristics of individual blood pressure registrations. Analysis was based on 24-hour continuous intra-arterial measurement of blood pressure obtained in 23 hospitalized patients with mild-to-moderate untreated essential hypertension (mean +/- SD, 112 +/- 13 mm Hg). The day-night difference for mean arterial pressure varied markedly (mean, 18.6 mm Hg; range, 6.8-36.0). Inspection of profiles suggested a model of blood pressure as two contiguous, complementary periods of constant pressure, a so-called square wave. Determination of the times of transience between both periods (segmentation) was performed individually using a least-square error criterion. Results were compared with those obtained by conventional methods, including analysis by Fourier modeling. The square wave fit accounted for a larger fraction (66%) of circadian variance of mean arterial pressure than modeling based on segmentation by visual inspection (59%, considerable observer bias) or by clock time (50%). Application of the Minnesota Cosinor Method resulted in the poorest description (47%). Segmentation based on harmonic modeling (61%) appeared to be cumbersome (10 harmonics needed), and the significance of additional information offered over the square wave fit is dubious. Observer bias makes segmentation by visual inspection unsuitable for assessment of the circadian variance of blood pressure. Even when daily activities are strictly regulated (hospital environment), circadian variance is not well modeled by clock time. As compared with harmonic analysis, square wave fitting is simple, and it appears to best model the circadian variance. The method can also be applied to data obtained from noninvasive ambulatory blood pressure monitoring.

Blood Pressure Determination↗
PubMed1989

Comparison of Finapres non-invasive beat-to-beat finger blood pressure with intrabrachial artery pressure during and after bicycle ergometry.

To evaluate the accuracy of continuous non-invasive blood pressure measurements in the finger during exercise, Finapres blood pressures of six normotensive healthy males were measured during increasing levels of bicycle exercise, using simultaneously registered ipsilateral intrabrachial artery pressures as a reference. At rest, finger systolic blood pressure was higher and finger diastolic and mean arterial pressures were lower than the corresponding intrabrachial pressures in five of the six subjects. During exercise, average finger diastolic and mean arterial pressures did not differ further from these intrabrachial pressures, but finger systolic pressure increased considerably more than the direct systolic pressure, exceeding it by 26 +/- 20 mmHg (mean +/- s.d.) at maximal exercise. This latter finding potentially limits the use of finger blood pressure measurements during exercise.

Adult↗