140 research outputs found

    Predictive value of night-time heart rate for cardiovascular events in hypertension. The ABP-International study

    Get PDF
    Background - Data from prospective cohort studies regarding the association between ambulatory heart rate (HR) and cardiovascular events (CVE) are conflicting. Methods - To investigate whether ambulatory HR predicts CVE in hypertension, we performed 24-hour ambulatory blood pressure and HR monitoring in 7600 hypertensive patients aged 52 ± 16 years from Italy, U.S.A., Japan, and Australia, included in the ‘ABP-International’ registry. All were untreated at baseline examination. Standardized hazard ratios for ambulatory HRs were computed, stratifying for cohort, and adjusting for age, gender, blood pressure, smoking, diabetes, serum total cholesterol and serum creatinine. Results - During a median follow-up of 5.0 years there were 639 fatal and nonfatal CVE. In a multivariable Cox model, night-time HR predicted fatal combined with nonfatal CVE more closely than 24 h HR (p = 0.007 and = 0.03, respectively). Daytime HR and the night:day HR ratio were not associated with CVE (p = 0.07 and = 0.18, respectively). The hazard ratio of the fatal combined with nonfatal CVE for a 10-beats/min increment of the night-time HR was 1.13 (95% CI, 1.04–1.22). This relationship remained significant when subjects taking beta-blockers during the follow-up (hazard ratio, 1.15; 95% CI, 1.05–1.25) or subjects who had an event within 5 years after enrollment (hazard ratio, 1.23; 95% CI, 1.05–1.45) were excluded from analysis. Conclusions - At variance with previous data obtained from general populations, ambulatory HR added to the risk stratification for fatal combined with nonfatal CVE in the hypertensive patients from the ABP-International study. Night-time HR was a better predictor of CVE than daytime HR

    Lancet commission on hypertension group position statement on the global improvement of accuracy standards for devices that measure blood pressure

    Get PDF
    The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organisation for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP

    Syndrome dépressif et encéphalite limbique : à propos d’un cas

    Full text link
    International audienceLimbic encephalitis is frequently a paraneoplasic disorder. The symptoms are both neurologic and psychiatric such as loss of memory, seizure and depression. We present the case of a sixty years old man in which severe depression, personal and familial history of mood disorders coexists with limbic encephalitis without any neoplasic disorder. In this case, we discuss hypothesis of links between his depression and his limbic encephaliti

    RECTANGULAR CUFFS OVERESTIMATE BLOOD PRESSURE IN OBESE PEOPLE WITH VERY LARGE ARMS

    No full text
    Rectangular cuffs and bladders are currently used for blood pressure (BP) measurement at the upper arm. However, large arms always have a tronco-conical shape. Aim of this study was to ascertain whether rectangular and tronco-conical cuffs provide different readings in obese subjects with very large arms. In obese people, the upper arm has a pronounced tronco-conical shape and rectangular cuffs may overestimate BP. Tronco-conical cuffs should be used for BP measurement in subjects with very large arms

    Accuracy of the Microlife large-extra large-sized cuff (32-52 cm) coupled to an automatic oscillometric device.

    No full text
    To determine the accuracy of the large-extra large-sized (L-XL) cuff (32-52 cm) coupled to a Microlife WatchBP Office ABI blood pressure measuring device tested according to the requirements of the International Protocol of the European Society of Hypertension. The L-XL cuff tested in this study is designed to provide accurate blood pressure measurements in patients with large arms (arm circumference 6532 cm) over a wide range of arm circumferences using a single 145\ub11 7320\ub11 mm bladder. The evaluation was made in 33 patients with a mean\ub1standard deviation age of 53\ub117 years (range: 30-96 years). Their systolic blood pressure (SBP) was 142\ub121 mmHg (range: 110-180 mmHg), diastolic blood pressure (DBP) was 87\ub114 mmHg (range: 62-106 mmHg) and arm circumference was 36\ub15 cm (range: 32-50 cm). Blood pressure measurements were made in the sitting position. The L-XL cuff coupled to the WatchBP Office ABI passed all three phases of the European Society of Hypertension protocol for SBP and DBP. Mean blood pressure differences between device and observer were -1.3\ub15.1 mmHg for SBP and -1.8\ub15.8 mmHg for DBP. Similar device-observer differences were observed in patients divided into two subgroups according to whether their arm circumference was above or below the median in the group. These results indicate that the L-XL cuff coupled to the WatchBP Office ABI monitor provides accurate blood pressure readings in patients with large arms over a wide range of arm circumferences

    Operative risks and longterm stroke rates after carotid endarterectomy in symptomatic and asymptomatic patients.

    No full text

    Accuracy of Microlife WatchBP Office ABI monitor assessed according to the 2002 European Society of Hypertension protocol and the British Hypertension Society protocol.

    No full text
    OBJECTIVE: To determine the accuracy of the WatchBP Office ABI monitor for blood pressure measurement developed by the Microlife Company. METHODS: The device accuracy was tested in 85 subjects with a mean age of 54 \ub1 19 years. Their systolic and diastolic blood pressure (SBP/DBP) at entry was 141 \ub1 30/86 \ub1 19 mmHg, and upper arm circumference was 28 \ub1 5 cm. Initially, the data from 33 participants were examined according to the 2002 version of the European Society of Hypertension (ESH) protocol. An additional 52 subjects were then enrolled to fulfill the requirements of the British Hypertension Society (BHS) protocol. In all participants, sequential same arm measurements were performed by two trained observers. RESULTS: The device passed all three phases of the ESH protocol for SBP and DBP. For the BHS protocol the device was graded A for both SBP and DBP. The A/A grade was achieved in the low blood pressure category ( 160/100 mmHg). Mean blood pressure difference between device and observers in the first 33 subjects was -0.9 \ub1 5.5 mmHg for SBP and -2.2 \ub1 4.5 mmHg for DBP and in the 85 participants it was -1.2 \ub1 6.5 mmHg and -2.3 \ub1 5.1, respectively. CONCLUSION: These data show that the Microlife WatchBP Office ABI monitor satisfied the recommended ESH accuracy levels and achieved A/A grade of the BHS protocol across a wide range of BP

    Carotid endarterectomy in symptomatic and asymptomatic patients aged 75 years or more: Perioperative mortality and stroke risk rates.

    No full text
    The aim of this retrospective study was to determine whether age per se constitutes a contraindication to surgery in the elderly patient undergoing carotid endarterectomy (CEA) with regard to operative mortality and stroke risk morbidity. During an 8-year period, 96 patients aged 75 years or more underwent 103 CEAs. The age range was 75 to 89 years, with a median age of 79 and a mean age of 79.4 years. Fifty-nine CEAs with patch closure and 44 carotid eversion endarterectomies and reimplantation were performed for symptomatic (70.9%) and asymptomatic (29.1%) carotid lesions under general anesthesia and with continuous perioperative electroencephalographic (EEG) monitoring. In light of the efficacy and success achieved in this experience, advanced age does not seem in itself to contraindicate the performance of CEA; the surgical risk for elderly patients appears sufficiently low to justify the operation. A more aggressive approach may be warranted in elderly patients because of the morbidity and cost of the disease that it effectively prevents
    • …
    corecore