Blood Pressure Measurements Taken by Patients are Similar to Home and Ambulatory Blood Pressure Measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements"

Early detection of global and regional left ventricular diastolic dysfunction in systemic lupus erythematosus: the role of the echocardiography

INTRODUÇÃO: A ecocardiografia bidimensional é um método de diagnóstico por imagem não invasivo que avalia, de modo eficaz, a função diastólica global e regional do ventrículo esquerdo. O comprometimento da função diastólica ventricular esquerda no lúpus eritematoso sistêmico (LES) é quase sempre silencioso, sugerindo um estado subclínico de disfunção diastólica. OBJETIVO: Este estudo tem por finalidade demonstrar as diversas técnicas ecocardiográficas para a aferição da função diastólica no LES. PACIENTES E MÉTODOS: Foram avaliadas consecutivamente 50 pacientes com LES e 50 controles do sexo feminino, pareadas por sexo e idade. Os exames foram realizados por dois observadores independentes cujos resultados tiveram concordância. RESULTADOS: Não houve diferença significativa da função diastólica global do ventrículo esquerdo entre os grupos, exceto pelo método da velocidade de propagação do fluxo mitral (Vp), que evidenciou diminuição da velocidade de enchimento rápido nas pacientes com LES. Foi detectado maior comprometimento da função diastólica regional nas pacientes com LES, na protodiástole, à altura do anel mitral, mais evidente na porção basal do septo interventricular. CONCLUSÃO: No LES, a disfunção diastólica do ventrículo esquerdo pode ser constatada através da avaliação do Doppler tissular na região do anel mitral e pela velocidade de propagação do fluxo mitral.INTRODUCTION: Bidimensional echocardiography is a non-invasive imaging diagnostic method that effectively assesses global and regional left ventricular diastolic function. Disruption of left ventricular diastolic function in systemic lupus erythematosus (SLE) is almost always clinically silent, suggesting a subclinical diastolic dysfunction. OBJECTIVE: We evaluate in the the present study the different echocardiographic techniques available to assess the diastolic dysfunction in SLE. PATIENTS AND METHODS: Fifty consecutive SLE patients and 50 healthy females, matched by gender and age, were evaluated. Exams were conducted by two independent observers whose results showed concordance. RESULTS: Significant differences in global left ventricular diastolic function between both groups, except for mitral flow propagation velocity (Vp), which showed a reduction in rapid filling in SLE patients, were not observed. Greater involvement of regional diastolic function, in protodiastole, at the level of the mitral ring, especially in the basal area of the interventricular septum, was observed. CONCLUSION: Left ventricular diastolic dysfunction in SLE patients can be identified by tissue Doppler of the mitral ring and by mitral flow propagation velocity.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Federico Foundatio