Office blood pressure variability in non-hypertensive patients during a preventive examination

Background. Despite advantages of ambulatory and home blood pressure monitoring, office blood pressure measurement remains the principal method for the diagnosis and management of hypertension. There still seems to be too little evidence to date showing variation in blood pressure during a medical visit and the current recommendations are mainly based on expert’s opinions. The aim of this study was to evaluate the difference between the first two blood pressure measurements performed during a preventive examination and to verify whether the second measurement could influence clinical decisions in non-hypertensive patients. Material and methods. The study involved 52 consecutive patients without history of hypertension or other cardiovascular diseases. Blood pressure and heart rate (HR) were measured twice, the first reading after 5 minutes rest and the second 1 minute later. Results. Significant differences were found between the first (fBPM) and second (sBPM) blood pressure measurements, both systolic blood pressure (SBP) 142.4 mmHg (IQR, 130.8-152.0) vs. 138.1 mmHg (IQR, 125.8-149.5), p<0.001 and diastolic blood pressure (DBP) 85.8 mmHg (IQR, 80.0-91.5) vs. 83.9 mmHg (IQR, 77.0-90.3), p<0.001, and heart rate (HR) 73.1/min (IQR, 64.8-80.0) vs. 71.8/min (IQR, 64.8-77.3), p<0.001. For 63.5% of the participants, the difference between the measurements was over 5 mmHg of SBP and for 23.1% of DBP. According to fBPM, 53.8% of the patients met the criteria for the diagnosis of hypertension and according to sBPM 48.1% (NS). Conclusion. A single blood pressure measurement may result in incorrect diagnosis of hypertension and unnecessary initiation of treatment

Abdominal aortic aneurysm influences the indices of arterial stiffness recorded by pulse wave analysis

Background: Abdominal aortic aneurysm (AAA), forming a blood reservoir alters the geometry of the aorta, which along with increased stiffness of the aortic wall modifies central blood pressure wave, especially the reflected wave. The aim of the study was to compare indices of arterial stiffness recorded by pulse wave analysis (PWA) between patients with AAA and controls. Material and methods: Sixty-nine patients (from 75 originally included) with asymptomatic AAA and 69 (from 74) age-, sex- and body mass index (BMI)-matching patients as a control group were analysed. The following variables of PWA recorded by applanation tonometry were evaluated: central pulse pressure (CPP), central systolic (CSBP) and diastolic (CDBP) blood pressure, central augmentation index (CAIx), the time from the beginning of a pulse wave to: the first systolic peak (CT1), to the beginning of the reflected wave (CT1R) and to the second systolic peak pressure (CT2). Results: Patients with AAA had higher CAIx [33% (12) vs. 28% (20); p < 0.001] than in the control group, lower CPP [36 mm Hg (10) vs. 45 mm Hg (24); p < 0.001), higher CDBP [79 mm Hg (14) vs. 73 mm Hg (13); p = 0.017) and no significant difference in CSBP [115 mm Hg (15) vs. 119 mm Hg (23); NS). Shorter CT1 [102 ms (9) vs. 106 ms (12); p = 0.004) and CT1R [133 ms (11) vs. 138 ms (13.5); p = 0.04) and longer CT2 (232 ms (36) vs. 217 ms (35); p = 0.007) were observed in patients with AAA. Data are presented as median with interquartile range. Conclusion: Differences of central blood pressure variables suggest increased arterial stiffness in patients with AAA. Despite lower values of pulse pressure, overall pressure load of the returning wave is higher, which affect the afterload of the heart