Which out-of-office measurement technique should be used for diagnosing hypertension in prehypertensives?

Hypertension (HT) is diagnosed with high office blood pressure (BP), although confirmation with the addition of out-of-office measurements is currently recommended. However, insufficient data are available concerning the use of out-of-office BP measurement techniques for the diagnosis of HT in the prehypertensive population. The aim of the present study was to determine which out-of-office measurements yielded earlier and more frequent detection of development of HT in prehypertensive patients. Two hundred seven prehypertensive patients under monitoring in the Cappadocia cohort were included in the study. Office BP was measured five times at 1-min intervals, followed by 24-h ambulatory BP monitoring (24-h ABPM). Home BP measurement (HBPM) was performed five times, at the same times in the morning and evening, at 1-min intervals for 1 week. The same procedure was carried out at 4-6-month intervals for ~2 years. HT was diagnosed in 25.6% of subjects, masked HT in 11.1%, and white coat HT in 2.9%, while 23.7% remained prehypertensive and 36.7% became normotensive. Briefly, 56.6% of the patients with HT were diagnosed with office plus 24-h ABPM, 13.2% with office plus HBPM, and 30.2% with office plus HBPM and 24-h ABPM. Office with 24-h ABPM yielded statistically significantly more diagnoses (p < 0.001). In conclusion, our prospective observational study evaluated the usefulness of out-of-office BP measurements in confirming diagnosis of HT in prehypertensive patients. The findings show that 24-h ABPM detected HT earlier and more frequently in this high-risk population

THE DETERMINATION OF DURATION OF SURVIVAL OF PERMANENT VASCULAR ACCESS ESTABLISHED FOR HEMODIALYSIS IN PATIENTS WITH CHRONIC KIDNEY FAILURE AND AN INVESTIGATION OF THE FACTORS AFFECTING THOSE DURATIONS

Amaç: Kronik böbrek yetersizliği tanısıyla hemodiyaliz planlanan ve kalıcı damar yolu oluşturulan hastalarda, bu kalıcı damar yollarının (arteriovenöz fistül (AVF), arteriovenöz greft (AVG) ve kalıcı kateter) patenslerinin belirlenmesi ve bu Patensi etki eden faktörlerin tespit edilip bu sayede bundan sonra oluşturulacak olan kalıcı damar yolu patenslerinin uzatılmasına katkı sağlamaktır. Materyal ve Metod: Çalışmamıza KTÜ Nefroloji kliniğinde Kronik Böbrek Yetmezliği tanısıyla takip edilen, KTÜ Tıp Fakültesi Göğüs Kalp Damar Cerrahisi kliniği cerrahları tarafından kalıcı hemodiyaliz girişi oluşturulması amacıyla AVF, AVG ve kalıcı kateter uygulanan ve arşivinden dosyalarına ulaşılabilen 18 yaş ve üzeri, 420 hasta alındı. Hastaların biyokimyasal, hematolojik ve demografik verileri kaydedildi. Bu parametrelerin vasküler erişim yolu patensi üzerine etkisi analiz edildi. Bulgular: Çalışmamızda kalıcı damar yolu oluşturulan 420 KBY hastasının % 86’sında AVF, % 10,5’unda AVG, % 9,8’inda ise kalıcı kateter uygulandığı belirlenmiştir. Çalışmaya alınan hastalarda ortalama AVF patensi 34.73 ay, ortalama AVG patensi 27.59 ay, ortalama kalıcı kateter patensi ise 8.53 ay olarak belirlendi. Vasküler erişim yolu patensini yaş, vasküler erişim yolu oluşturulmadan önceki santral venöz kataterizasyon öyküsü, vasküler erişim yolunun ilk kullanım zamanı ve operasyon öncesi üst ekstremite arteriyel ve venöz dopler USG incelemesinin etkilediği saptandı. Sonuç: Kalıcı damar yolunun ömrünün uzatılmasında hastanın yaşı, santral venöz kateter öyküsü ve fistül ve greftin olgunlaşma sürecinin beklenmesi önem arz etmektedir. Hemodiyaliz için kalıcı damar yolu planlanan hastada santral venöz kateter uygulamasından kaçınılmalı ve kanüle edilmeden önce AVFAVG’in olgunlaşma süreci beklenmelidir.Aim: To determine survival of permanent vascular access routes (arteriovenous fistula [AVF], arteriovenous graft [AVG] and permanent catheter) in patients scheduled for hemodialysis with a diagnosis of chronic kidney disease (CKD) and in whom permanent vascular access is established, and to identify factors affecting those survival rates, thus contributing to prolongation of survival of subsequent permanent vascular access routes pathways. Materials and Methods: 420 patients under monitoring with a diagnosis of CKD at the KTU Nephrology Clinic receiving AVF, AVG or permanent catheter for the purpose of establishing permanent hemodialysis access by surgeons from the KTU Medical Faculty Thoracic and Cardiovascular Surgery Department aged 18 or over and whose files were available from the archives were included in the study. Patients’ biochemical, hematological and demographic data were recorded. The effect of these parameters on vascular access survival was then analyzed. Results: AVF was applied in 86% of the 420 CKD cases in this study, AVG in 10.5% and permanent catheter in 9.8%. Mean AVF patensi was 34.73 months, mean AVG survival 27.59 months and mean permanent catheter survival 8.53 months. Vascular access survival was affected by age, a history of central venous catheterization before establishment of vascular access, time of first use of vascular access and upper extremity arterial and venous Doppler USG examination before surgery. Conclusion: The patient’s age, history of central venous catheter use and waiting time for fistula and graft maturation are important in terms of prolonging survival of permanent vascular access routes. Central venous catheterization should be avoided in patients scheduled for permanent vascular access for hemodialysis, and it is important to wait for AVF-AVG maturation before cannulation

The Determinatıon of Duration of Survival of Permanent Vascular Access Established For Hemodialysis In Patients With Chronic Kidney Failure and An Investigation of The Factors Affecting Those Durations

Aim:To determine survival of permanent vascular access routes (arteriovenous fistula [AVF], arteriovenous graft [AVG] and permanent catheter) in patients scheduled for hemodialysis with a diagnosis of chronic kidney disease (CKD) and in whom permanent vascular access is established, and to identify factors affecting those survival rates, thus contributing to prolongation of survival of subsequent permanent vascular access routes pathways.Materials and Methods:420 patients under monitoring with a diagnosis of CKD at the KTU Nephrology Clinic receiving AVF, AVG or permanent catheter for the purpose of establishing permanent hemodialysis access by surgeons from the KTU Medical Faculty Thoracic and Cardiovascular Surgery Department aged 18 or over and whose files were available from the archives were included in the study. Patients’ biochemical, hematological and demographic data were recorded. The effect of these parameters on vascular access survival was then analyzed.Results:AVF was applied in 86% of the 420 CKD cases in this study, AVG in 10.5% and permanent catheter in 9.8%. Mean AVF patensi was 34.73 months, mean AVG survival 27.59 months and mean permanent catheter survival 8.53 months. Vascular access survival was affected by age, a history of central venous catheterization before establishment of vascular access, time of first use of vascular access and upper extremity arterial and venous Doppler USG examination before surgery.Conclusion:The patient’s age, history of central venous catheter use and waiting time for fistula and graft maturation are important in terms of prolonging survival of permanent vascular access routes. Central venous catheterization should be avoided in patients scheduled for permanent vascular access for hemodialysis, and it is important to wait for AVF-AVG maturation before cannulation

Down-regulation of miRNA 145 and up-regulation of miRNA 4516 may be associated with primary hypertension

Complex mechanisms including genetic factors have been proposed in the pathogenesis of primary hypertension (HT). Micro RNAs (miRNAs) are single-stranded RNA molecules that are not converted into protein products. However, it has been established that genes regulate conversion into protein products. The primary aim of this study was to investigate the roles of miRNA 4516, miRNA 145, miRNA 24, and miRNA 181a in the pathogenesis of HT. The secondary aim was to investigate the relation between these miRNAs and renin, aldosterone, norepinephrine, renalase, and NOS. Fifty-two hypertensive and 51 control normotensive individuals under observation in the Cappadocia cohort were included in the study. miRNA 4516, miRNA 181a, miRNA 24, and miRNA 145 levels were measured using the ddPCR method. miRNA 4516 and norepinephrine levels were significantly higher in the HT group (P < .005 for both), while miRNA 145 levels were significantly lower (<.05). miRNA 4516 up-regulation (P < .05) and miRNA 145 down-regulation (P < .05) were identified as independent predictors of HT. Renalase exhibited negative correlation with miRNA 4516 and positive correlation with miRNA 145 in the patient and control group. In addition, negative correlation was present between miRNA 24 and NE and NOS and between miRNA 181a and NOS in the patient group. Our study identified, for the first time in the literature, miRNA 4516 up-regulation and miRNA 145 down-regulation as independent determinants of HT. Further studies performed in the light of our findings may lead to a better understanding of the pathogenesis and new therapeutic possibilities

Do Physicians Measure Patients' Blood Pressure, and Are Those Measurements Reliable?

To determine how and how often blood pressure (BP) measurement is performed in health institutions. The researchers observed whether or not 84 physicians performed BP measurement. Immediately after BP measurement by the physician, this was repeated by the researchers in a manner compatible with HT guidelines. The physicians' and researchers' BP measurement results were compared. Physicians measured BP in only 37% (427) of 1130 consecutive patient examinations. None of the physicians BP measurements were fully compatible with the guidelines BP measurement recommendations. Physicians who performed measurements determined the same SBP and DBP as the researchers in 34.3% of patients. Hypertension was determined in 18.9% of patients in clinics in which BP measurement was not performed by physicians. Not all physicians in our study measured BP, and the great majority of those who did failed to measure it reliably. We think that it is therefore vitally important for physicians across the world to receive regular, repeated, and effective training in the importance of BP measurement and how to perform it correctly

Do Physicians Measure Patients' Blood Pressure, and Are Those Measurements Reliable? (Meeting Abstract)

27th Scientific Meeting of the International-Society-of-Hypertension -- SEP 20-23, 2018 -- Beijing, PEOPLES R CHINA[No Abstract Available]Int Soc Hyperten

Soluble endothelial protein C is associated with blood pressure variability and salt consumption but not mean blood pressure in patients with newly diagnosed primary hypertension

Background: Hypertension is a widespread disease involving frequent thrombotic complications. Blood pressure variability (BPV) has recently been shown to be associated with end-organ damage and cardiovascular events. However, the pathogenesis of the relation between BPV and cardiovascular events has not yet been explained. Soluble endothelial protein C (sEPCR) exhibits a procoagulant effect by reducing the anticoagulant and anti-inflammatory effects of protein C and activated protein C. The purpose of this study was to evaluate sEPCR levels in hypertensive individuals and the parameters affecting that level, particularly BPV. Methods: Fifty-one newly diagnosed hypertensive subjects and 31 healthy individuals were included in the study. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed after office control, and simultaneous 24-h urine was collected. BPV was calculated with average real variability (ARV) from ABPM data. Blood specimens were collected under appropriate conditions for sEPCR levels and biochemical tests. sEPCR levels were compared between the patient and healthy groups, after which parameters affecting sEPCR elevation in the hypertensive group were evaluated. Results: sEPCR levels were significantly high in the hypertensive group (p < 0.05). At multivariate regression analysis in the hypertensive group, sEPCR was determined to be independently associated with 24-h systolic ARV (beta = 0.572, p < 0.05) and 24-h urine Na (beta = 0.428, p < 0.05). Conclusion: In our study, sEPCR was high in hypertensive individuals, and this elevation was related to ARV and urine Na excretion independently of mean blood pressure

Soluble endothelial protein C is associated with blood pressure variability and salt consumption but not mean blood pressure in patients with newly diagnosed primary hypertension

27th Scientific Meeting of the International-Society-of-Hypertension -- SEP 20-23, 2018 -- Beijing, PEOPLES R CHINA[No Abstract Available]Int Soc Hyperten