[Statement on "24-hour blood pressure monitoring" by the German League for the control of hypertension].
Explore the source record for details and available documents.
Blood Pressure Monitors↗
Biomedical subjects
P Baumgart
Publications and source records attributed to P Baumgart.
Reference data for ambulatory blood pressure monitoring: what results are equivalent to the established limits of office blood pressure?
In 1039 subjects ambulatory blood pressure monitoring was performed to define threshold values, which are equivalent to the established limits of the office blood pressure. Mean values and proportions of elevated single readings were correlated to office blood pressure by regression analyses. To avoid impact of varying sleeping periods on 24 h blood pressure, only daytime readings were considered. Correlations between average daytime blood pressure and office blood pressure were linear: Mean daytime values of 135 mmHg (systolic) and of 84 mmHg (diastolic) were equivalent to the casual blood pressure limits of 140 mmHg and 90 mmHg. Correlations between percentages of elevated single readings and office blood pressure were nonlinear: Proportions of 25% systolic readings greater than 140 mmHg and of 17% diastolic readings greater than 90 mmHg were equivalent to casual blood pressure limits of 140 mmHg and 90 mmHg. On the basis of the regression equations, any result of ambulatory blood pressure recording during daytime can now be evaluated in terms of the established standards of office blood pressure.
Blood Pressure Monitors↗
[Methadone substitution in HIV-infected drug addicts].
Explore the source record for details and available documents.
Adult↗
[Pneumocystis carinii pneumonia in HIV-positive and HIV-negative patients].
Bronchoalveolar lavage was used in 170 immunocompromised patients for detection of causative agents. Pneumocystis carinii was isolated 18 times from HIV-positive patients and 14 times from patients suffering from immunodeficiencies due to various other diseases. Patients with AIDS were in better clinical condition, had fewer infiltrates on chest x-ray, a higher oxygen partial pressure and lower LDH-plasma concentration than HIV-negative patients. In spite of the earlier stage of the disease patients with AIDS experience prodromal symptoms for a longer time and the number of isolated pneumocystis was larger. Mortality in AIDS patients was significantly lower than in patients with other causes of immunodeficiency.
Adult↗
[Doctor's-office blood pressure, home blood pressure, ergometry blood pressure and 24-hour blood pressure. The correlations with the echocardiographic parameters of heart muscle mass].
In 62 untreated hypertensives (31 men, 31 women; median age 40 [17-57] years) blood pressures (BP) were measured in the doctor's office, at home (self-measured) and every 15 min during 24-hour monitoring (by portable automated oscillometry), the results being compared with echocardiographic measurements of ventricular septal thickness (VST), left ventricular muscle mass (LVM) and left ventricular mass index (LVMI), in 41 of them also during and 5 min after 100 W bicycle ergometry. In the total cohort, 24-hour values correlated better with diastolic VST (systolic: r = 0.706, P less than 0.00001; diastolic: r = 0.507, P less than 0.0001) than office BP (systolic: r = 0.381, P less than 0.01; diastolic: r = 0.177, not significant) and home BP (systolic: r = 0.477, P less than 0.0001; diastolic: r = 0.371, P less than 0.05). In the 41 exercised hypertensives the correlation with echocardiographic values was less close than with their 24-hour BP, but slightly better than with office and home BP. Systolic BP correlated better than diastolic BP with echocardiographic values. VST generally correlated better with BP than LVM and LVMI. It is concluded that (1) 24-hour BP values correlate more closely with LVM than any other noninvasive BP measurement; (2) VST is affected more by systolic than diastolic BP; and (3) VST more specifically reflects the influence of BP on myocardial structure than does LVM and LVMI.
Adolescent↗
[Pneumonia in immunocompromised patients: the value of non-biopsy bronchoscopic examination procedures in the diagnosis of pathogens].
Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.
Aspergillosis↗
[Fever, dyspnea].
A 52-year-old female complained about non-distinct symptoms such as fatigue, night sweats and bone pain. Because of a febrile bronchitis, chest X-ray was performed, which disclosed enlarged hilar nodes and intestinal and acinar pulmonary infiltrates. Endobronchial biopsy and cultures from bronchial aspirate permitted to diagnose infection by legionella concomitant with sarcoidosis. After antibiotic treatment for legionellosis over four weeks, immunosuppressive therapy for sarcoidosis was initiated with glucocorticoids.
Diagnosis, Differential↗
[Morning rise in blood pressure: before or following awakening?].
The coincidence of the circadian peak of cardiovascular events with the morning blood pressure rise suggests causal connections. Rapidly acting antihypertensives taken before getting up may attenuate the increase early enough, if the onset does not occur before awakening. In 111 normotensives and in 109 subjects with untreated essential hypertension ambulatory blood pressure monitoring was performed to study whether the onset of the blood pressure rise occurs before or after waking up. The individual 24 h blood pressure profiles obtained by intermittent readings at intervals of 15 minutes were synchronized by the time of waking up. The resulting blood pressure curves showed no substantial blood pressure rise during sleep, but steep increases after awakening: Within the first hour after waking up blood pressure increased from 107.3 + 11.4/62.3 +/- 9.6 mm Hg (mean + sd) to 121.4 +/- 16.0/75.3 + 12.6 mm Hg in normotension and from 124.7 + 16.0/72.7 + 12.2 mm Hg to 140.3 + 17.2/84.5 + 13.3 mm Hg in hypertension. The velocity of this increase was dependent on the lag between waking up and getting up. There was no phase difference between early morning blood pressure and heart rate rises. Thus to attenuate the morning blood pressure increase, rapidly acting drugs after awakening may be considered instead of long acting antihypertensives administered prior to sleep.
Adult↗
[Bronchoscopic diagnosis of therapy refractory pneumonia].
In 73 patients with pneumonia treated empirically with antibiotics or antimycotics, a bronchoscopy with bronchoalveolar lavage was performed in an attempt to identify the pathogens involved. Patients in whom it proved possible to detect a specific pathogen showed a lower mortality rate than did those in whom it was not possible to clarify the aetiology of the pneumonia (24 per cent and 34 per cent, respectively). In patients receiving empirical treatment over a long term, pneumonia persisted longer, and the mortality rate was higher, than in patients who were submitted to invasive examination early on.
Adolescent↗
Diurnal variations of blood pressure in shift workers during day and night shifts.
The dependence of blood pressure upon internal rhythms and the short-term effects of shift rota on the blood pressure were investigated in shift workers. Blood pressure was measured every 30 min using automatic records for 24h in 17 physically working men in a chemical factory during their morning and night shifts. There were no differences of the mean blood pressure between the respective sleeping phases or between the working periods. The amplitudes of circadian blood pressure variations were equal. There was a phase difference of 8h corresponding to the lag between the working periods. At this 8-h lag the hourly means of the 24-h blood pressure were closely correlated (r=0.69). Comparisons of 24-h blood pressure profiles during the first and last days of night shift week showed that the effects of night work on the blood pressure were already fully developed within the first 24h (r=0.86). Thus the diurnal variations of the blood pressure are determined by the working and sleeping periods and largely independent of endogenous rhythm. There is no short-term alteration of the mean 24-h blood pressure after shift rota.
Adult↗
Primary angiosarcoma of the heart.
A case report on a 27 year old woman with an inoperable angiosarcoma of the right atrium is presented. The tumor localization was established by echocardiography, computed tomography and cinecardiography. There was no evidence of distant metastases at diagnosis. After exploratory thoracotomy with surgical biopsy a radiotherapy was started covering the whole heart and the mediastinum. Superior Vena Cava Syndrome was improved quickly and reducing the target volume to the right atrium after 40 Gy radiotherapy was continued up to a total dose of 60 Gy. A complete remission was documented by echocardiography and computed tomography. Chemotherapy ("VAPAC") for distant metastases led to partial remission. The patient died 15 months after diagnosis from brain metastases. Autopsy revealed no macroscopic evidence of tumor in the right atrium. A combined modality approach with surgical tumor mass reduction followed by high dose locoregional radiotherapy (60 Gy) and combination chemotherapy (e.g. "VAPAC") is suggested.
Adult↗
Nocturnal hypertension in renal failure, haemodialysis and after renal transplantation.
Diurnal blood pressure variations in 20 patients with advanced renal failure, 20 patients on chronic haemodialysis, and 21 renal transplant recipients were compared with those of matched control groups without renal disease, using 24-h ambulatory blood pressure monitoring. Whereas the blood pressure during the day (from 8 a.m. to 8 p.m.) was roughly the same in the patients compared with their respective control groups, during the night (from 8 p.m. to 8 a.m.) it was substantially higher in all patient groups. The differences between the mean daytime and night-time values were significantly lower in the patients (P less than 0.05 to P less than 0.001). The nocturnal blood pressure decrease may be attenuated or even reversed in renal failure, in haemodialysis and after renal transplantation. In a proportion of these patients, 24-h ambulatory blood pressure monitoring showed an elevated nocturnal blood pressure, which may require some modification of treatment.
Blood Pressure↗
Histones bind to contractile proteins and inhibit actomyosin ATPase.
Nuclear histones bind to and precipitate the major contractile proteins, actin and myosin. The binding of histone to actin seems to reach saturation at 2:1 ratio, the interaction may serve some regulatory function(s) in intranuclear events. The binding of histone to myosin is not saturable, and, although it inhibits the actin-activated Mg2+-dependent myosin ATPase activity, does therefore not seem of physiological importance.
Actins↗
[Medical and psychosocial effects of methadone substitution in HIV infected substance-dependent patients].
After an average observation time of 12 months we can confirm that methadone substitution on an outpatient basis has proved significantly useful for a majority of chronically intravenously opiate-dependent HIV-infected patients of the stages CDC IV or WR 3-6 if methadone is given under controlled conditions, the improvement consisting in an amelioration of certain medical and psychosocial parameters. In 25 out of 30 patients methadone substitution resulted in termination of the previously existing intravenous heroin addiction. In the further course of treatment one of these 25 patients could then be induced to undergo a methadone withdrawal course followed by long-term withdrawal therapy. Since the patients were no longer dependent on heroin, they were no longer compelled to procure it under all circumstances, so that crime and prostitution connected with the pressure to obtain heroin by all means were now superfluous. This provided the most important prerequisites for medical and social care for the patients. The decisive factors determining the effectivity of substitution and hence a successful stabilisation are the integration of the patient in a network of care including the family doctor, outpatient HIV care by a relevant clinic, drug advice centre of AIDS help, and a Public Health Office. This also guarantees that the patients act responsibly in respect of their AIDS infection. In very few patients the permanent success of the treatment was at high risk due to unsatisfactory social care, lack of social security measures, progression of the underlying disease, a too low methadone dosage level, and partnership conflicts.
Adult↗
Statistical analysis of circadian blood pressure recordings in controlled clinical trials.
This paper proposes a coherent strategy for the statistical evaluation of 24-h ambulatory blood pressure recordings in controlled clinical trials. Because the usual cosinor method for the smoothing of individual profiles leads to unrealistic consequences, an alternative flexible approach has been developed. The new approach is based on a periodic spline model which is fitted by robust multivariate regression techniques. The model is used mainly to extract those circadian parameters that cannot be obtained from the original profiles due to artefacts or irregular sample points. In the comparison of groups of patients, the individually obtained parameters are then tested with exact non-parametric methods. For the prior selection of highly discriminating parameters, the method of classification trees is recommended.
Antihypertensive Agents↗
Twenty-four-hour blood pressure is not dependent on endogenous circadian rhythm.
The effects of shifted working and sleeping phases on the diurnal blood pressure rhythm were investigated in 15 physically working industrial shift workers at a slowly rotated three-shift system. Ambulatory 24-h blood pressure monitoring was performed during the morning and night shifts. In the two shifts the mean 24-h blood pressure was identical. There were no differences in the blood pressure levels in the sleeping phases or in the working periods between the two 24-h cycles. Diurnal blood pressure fluctuations had equal amplitudes. Corresponding to the lag between the working period there was a phase difference of 8 h between the 24-h blood pressure curves. At this lag, there was a high correlation between the mean hourly blood pressure values (r = 0.683). Twenty-four-hour blood pressure curves during the first and last day of a night shift were nearly equal. Thus the effects of shift rotation on the 24-h blood pressure profile were fully expressed within the first 24 hours. The immediate and complete adaptation of the 24-h blood pressure curve to shifted activity and sleeping phases indicates that activity determines the diurnal blood pressure profile. The blood pressure is largely independent of internal circadian rhythm.
Adaptation, Physiological↗
Can secondary hypertension be identified by twenty-four-hour ambulatory pressure monitoring?
Circadian blood pressure rhythms were examined in subjects exhibiting various forms of secondary and essential hypertension and in normotensive subjects with and without renal disease. Indirect ambulatory blood pressure recordings were performed in 284 subjects for 24 h. In contrast to patients with essential hypertension and to normotensive healthy subjects, the circadian fluctuations of blood pressure were reduced in secondary hypertensives and in normotensive renal patients. In renal hypertensives, these alterations in the diurnal blood pressure variations were dependent on the degree of renal failure. Calculations based on comparisons of the mean sleeping and mean daytime blood pressures identified 89.8% of the essential hypertensives and 72.5% of the patients with secondary hypertension. A large proportion of the patients with secondary hypertension had very high blood pressure levels during sleep, in many cases even exceeding the daytime levels. Thus, 24-h ambulatory blood pressure curves from patients with secondary and essential hypertension can be distinguished from each other. In secondary hypertension, blood pressure monitoring during both day and night is particularly useful for evaluating frequently severe nocturnal hypertension, which may require particular treatment.
Blood Pressure Determination↗
[24-hour blood pressure in primary and secondary hypertension].
The blood pressure is subject to physiological day-night fluctuations, which can be attenuated in secondary hypertension as well but not in essential hypertension. In this study, the blood pressure profile over 24 hours was determined in a large collective of patients with primary and secondary hypertension for comparison to assess the relevance of ambulatory blood pressure monitoring in secondary hypertension. There were 88 patients with essential hypertension (age 20 to 73 years) and 80 patients with secondary hypertension (age 19 to 70 years) with a mean blood pressure value from 8 a.m. to 8 p.m. greater than 135 mm Hg. Blood pressure and heart rate were monitored for 24 hours. In 58/80 patients with secondary hypertension renal parenchymal disease was present, 14 had renovascular disease, three had Cushing's syndrome, four had primary hyperaldosteronism and one had a pheochromocytoma. Of the 88 patients with essential hypertension 67, and of the 80 patients with secondary hypertension 69 were on antihypertensive treatment. The measurements were carried out with a portable automatic ambulatory monitor unit (SpaceLabs 90202) between 6 a.m. and midnight at intervals of 15 minutes and from midnight to 6 a.m. at intervals of 30 minutes. The duration of sleep was documented. In patients with secondary hypertension, as compared with patients with essential hypertension, there were higher blood pressure values during the night from 8 p.m. to 8 a.m., and during sleep (Table 1). The profile of the hourly mean values for systolic and diastolic blood pressure (Figure 1) shows that patients with secondary hypertension, as compared with patients with essential hypertension, have a clearly diminished blood pressure reduction during the night.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenal Gland Neoplasms↗