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PubMedDate not supplied

Blood pressure by 24 h ambulatory recordings in type 2 (non-insulin dependent) diabetics. Relationship to urinary albumin excretion.

The relationship between blood pressure and microalbuminuria, both associated with cardiovascular disease and death, is sparsely studied in Type 2 (non-insulin-dependent) diabetes, and results may be interfered by the phenomenon of "white-coat-hypertension". We therefore investigated blood pressure by 24h ambulatory recordings (oscillometry) and examined whether blood pressure related to the level of urinary albumin excretion rate (UAER) by synchronous 24h collections. Seventeen diabetics (50-75 years of age) with microalbuminuria (15 less than UAER less than 200 micrograms/min) (DM), 15 with normal urinary albumin excretion (DN) and 10 healthy controls (C) participated. All groups were of comparable sex, age degree of obesity and had normal serum creatinine, and the groups of diabetics were of similar known duration, glycemic control and frequency of antihypertensive treatment. Blood pressures measured at the clinic were significantly higher (p less than 0.01) than 24h recordings. An average systolic pressure of 142 +/- 11 mmHg in DN was increased (p less than 0.01) as compared to C: 130 +/- 10 mmHg, but no further increase was seen in DM: 146 +/- 19 mmHg. Diastolic pressures were not different among the groups (C: 77 +/- 8 mmHg, DN: 80 +/- 11 mmHg, DM: 79 +/- 9 mmHg). Average 24h systolic pressure correlated to the UAER r = 0.61, p = 0.009 in DM, whereas not in DN. By the present method we found isolated systolic hypertension in Type 2 diabetes which may express "vascular stiffness". There was, however, no further rise in blood pressure in patients with microalbuminuria, but in these patients albuminuria may be pressure dependent and/or expressive of vascular pathology.

Aged↗
PubMed1991

[Value of ambulatory blood pressure monitoring in borderline hypertension in the child].

This study was undertaken to evaluate the reliability of ambulatory blood pressure monitoring (ABPM) in children and its diagnostic value in teenagers with borderline hypertension. The apparatus used was a Nippon Colin (NC) ABPM 630 which simultaneously obtains BP levels by the auscultatory and oscillometric methods. Among 61 children (mean age 12 +/- 3 years), proportion of measurement failures was 14% (470/3399) for oscillometry, 26.5% (893/3360) for auscultation, and 2.7% for both methods together. Comparison of conventional auscultatory blood pressure measurements (mercury manometer) and simultaneous NC-auscultatory BP values (50 pairs) showed slightly lower diastolic blood pressure values with the NC monitor (-3.8 +/- 4.9 mmHg, p less than 0.01). Comparison of blood pressure values provided by the two NC methods (1580 pairs) demonstrated slightly higher systolic blood pressure values (+2.5 +/- 4 mmHg; p less than 0.001) and slightly lower diastolic blood pressure values (-5 +/- 4 mmHg; p less than 0.001) with the oscillometric method. Thirty-four ambulatory blood pressure recordings were obtained in 28 children (mean age 13.3: range 8-17) with outpatient clinic blood pressure values suggestive of borderline hypertension. Numbers of ambulatory blood pressure readings were 44 +/- 5 during the day and 9 +/- 1 during the night. The mean of daytime blood pressure values was compared with reference blood pressure values obtained at rest in normal French children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Circadian blood pressure variations in young and in older patients].

Elevated blood pressure in the elderly is common despite they are normotensive. This "pseudo-hypertension" is probably a white-coat effect or depends on the increased arterial stiffness. Ambulant blood-pressure monitoring (by portable automated oscillometry) provides a reasonable accurate estimate of the blood pressure level throughout the day and better predicts cardiac end-organ damage. In normotensive elderly volunteers the systolic arterial pressure and the blood pressure amplitude was higher than in young normotensive subjects. The circadian profile of the two groups was comparable. Specific habits like an afternoon nap significantly influenced the blood pressure of the elderly. The blood pressure variability in geriatric hypertensives with antihypertensive therapy was smaller than in normotensive elderly controls. Any severe blood-pressure nadir at night was not registered in both groups. 24-hour ambulatory blood pressure monitoring is a careful method and should be used to determine the need and the effectiveness of antihypertensive treatment in the elderly.

Adult↗
PubMed1991

[Development of direct and indirect ambulatory 24-hour blood pressure monitoring].

The direct ambulatory 24-hour blood-pressure monitoring has been applied in two ways. With the so called "Oxford-system", blood pressure is recorded via a cannula in the brachial artery which is connected to a perfusion unit that is worn around the neck, on the front of the chest, with a tape recorder carried in a pouch on the patient's belt. Using the micro-catheter blood-pressure telemetry recording is done in the same way, but transmission of the data to a stationary-receiving unit is managed by telemetry. The usage of the latter method is limited by the weight and complexity of the patient-sited equipment. Compared to the Oxford-system there is the advantage of continuously observing the patients blood-pressure "on-line" during the recording. The invasive character of both methods limits the application to special, scientific investigations. In recent years the indirect recording machines for 24-hour blood-pressure monitoring has been developed further. They are now accurate, easy to apply and simple to work out. Beside the auscultatory way of recording, with or without ECG-gating, the oscillometry recording machines have been improved. There should be automatically-operated intervals with recordings in day-time every 15-20 minutes and during the night every 30 minutes. The recorded data should be analysed by computer, calculating mean values with standard deviations in day-time and night-time separately. Further more, there should be a listing of reading-errors and probably corrected measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1977

[Surgical treatment of primary hyperlipoproteinemia].

The authors report 4 cases of hyperlipemia and show the great benefit which results from ileal exclusion when there is an atherogenic risk. The considerable reduction in total lipid, cholesterol, triglycerides, and prebeta-lipoproteins is constant together with clarification of the serum. In one case, angina pectoris regressed considerably, as did arteritis of the lower limbs (unlimited walking became possible, oscillometry in the leg improved from 2 to 7). Surgery is indicated whenever by lack of will power, the diet and medical treatment cannot be followed, when social and economic conditions make proper medical treatment impossible, or when the latter has failed. The existence of arterial lesions, cardiac or cerebral complications makes surgery even more urgent. Gall-stones were observed in gall bladder. The authors raise the problem of oxalate stones. Only type II familial hyperlipemia in homozygotes should be excluded: and end-to-side portacaval anastomosis seems to be preferable.

Adult↗
PubMedDate not supplied

Ambulatory blood pressure monitor and 'analyzer'.

Earlier, we described the format provided by an ambulatory blood pressure monitor, the ABPM-630 with a data handler (AA-200), manufactured by Colin Medical Instruments. A detailed procedure for data transfer from the memory cassette into the analyzer and into an IBM PC in a format compatible with programs in the Chronobiology Laboratories is provided with a brief description of the hardware used. Among several instruments available for ambulatory blood pressure and heart rate monitoring, the ABPM-630 has several advantages: it does not require electrodes (a merit it shares with other instruments); it is portable, even if there are smaller ones; it functions silently, being activated by a CO2 cartridge; and it provides data obtained by two methods, by auscultation and by oscillometry, in part as a backup for one another, depending on whether auditory or movement noise are within limits acceptable to the instrumentation. This feature renders it more likely that some record will be obtained. In our earlier publication, we had referred to and then briefly described a special program which converts the format of the data handler into a format acceptable for analyses with programs from the University of Minnesota Chronobiology Laboratories. Herein, the operation of transferring data from the ABPM-630 memory cassette to an IBM-compatible personal computer (PC) is described, with an indication further of the programs used in the Chronobiology Laboratories.

Ambulatory Care↗
PubMed1990

[Arterial embolism of the limbs in infectious endocarditis of the heart valves].

Nine cases of infective endocarditis (IE) on native valves, complicated by arterial embolism of the limbs (AEL), were collected between June 1974 and October 1988 (prevalence 4.3 percent). Among the 11 AEL recorded, 9 involved the lower limbs and 2 the upper limbs. The diagnosis, suspected in patients with acute ischaemia (n = 6), transient (n = 1) or pseudophlebitic (n = 1) pain, or discovered by systematic pulse examination (n = 3), was confirmed by Doppler ultrasound (n = 3), angiography (n = 2) or oscillometry (n = 4). AEL occurred 2.8 weeks on average after the onset of treatment; it appeared 6 months after the end of treatment in 1 case and preceded the diagnosis of IE by 1 to 6 weeks in 3 cases. The causative organisms isolated in 7 cases were: non-haemolytic streptococci (n = 4), Staphylococcus aureus (n = 1), Haemophilus parainfluenzae (n = 1) and enterococcus (n = 1). Vegetations were found in 6 of the 7 patients explored by echocardiography. Two cases of embolism of the femoral artery required embolectomy. Effective heparin anticoagulation was obtained in only one patient. Six patients underwent valve replacement in the acute phase of endocarditis. After a mean follow-up period of 32 months (range 3 to 120 months), only one patient has symptoms (claudication of the left upper limb); 5 patients are asymptomatic with a reduced (n = 5) or abolished (n = 2) pulse. Three embolisms have left no sequelae. Altogether, AEL are not uncommon in infective endocarditis. They rarely influence the functional prognosis and are detected by systematic palpation of the pulses. Anticoagulation in effective doses is discussed. Attempts at removing the obstruction should be made only in cases with poorly tolerated proximal embolism. In patients with multiple or recurrent embolic accidents, valve replacement may be considered.

Adolescent↗
PubMed1989

[Blood pressure variations from clinostatism to orthostatism].

The reactivity of blood pressure (BP) and heart rate (HR) to change from supine to standing position was examined in 257 healthy adults, adolescents and children divided into equivalent group of both sexes. BP and HR were measured every minute during 14 minutes in a supine position then during 5 minutes in a standing position with an automatic device using the oscillometry method. A second measurement session was repeated two weeks later. On most patients an increase of diastolic BP (7.73 +/- 4.34 mmHg) and HR (16.40 +/- 7.47/mn) was observed after standing whereas systolic BP modifications were inconstant (2.19 +/- 5.55 mmHg). A comparison of variability indices according to postural state showed a significant higher variability index in a standing position only in female subjects. There was no difference according to age groups. Reproducibility of diastolic BP and HR increase is good two weeks later in respectively 65 p. 100 and 80 p. 100 subjects but it appears very poor for systolic BP. The results in healthy subjects would be compared to those observed in hypertensives to determinate if a postural change test may provide a clinical simple way to discriminate abnormalities in blood pressure regulation.

Adolescent↗
PubMed1989

[False and true hypertension in the aged subject. Diagnostic errors and potential solutions].

Arterial hypertension has the same definition in elderly people as in young adults. Epidemiologically, it has clearly been demonstrated that in the elderly it is a risk factor of morbidity and cardiovascular mortality. The international reference method for measuring blood pressure is by auscultation and mercury manometer. However, this indirect measurement is the source of many errors due to the material or the observer, or inherent in the method. A typical example of this is pseudohypertension in the elderly. Several solution are offered to improve the reliability of indirect blood pressure measurement, the most convincing one being the use of scientifically validated autonomous instruments relying on the oscillometry system. Ambulatory blood pressure measurement is interesting, being of diagnostic, therapeutic and probably prognostic value, but all this has to be confirmed in elderly subjects.

Aged↗
PubMed1989

Objective assessment of nasal obstruction.

Attempts to find objective tests to assess nasal obstruction have a long history. The physiologic and pathologic fluctuations that occur within the nose over short periods of time have hampered these efforts, and all presently available techniques have significant drawbacks. The most commonly used is active rhinomanometry, and relatively recent standardization has led to the popularization of the anterior method. Posterior active and passive rhinomanometry are also available; other methods include plethysmography, peak expiratory flow rate, rhinohygrometry, thermography, oscillometry, echorhinometry, audiometric rhinomanometry, and rhinostereometry. A reliable technique would have many applications, particularly in pre- and post-therapeutic evaluation. At present, however, no method enjoys routine clinical usage, although there is considerable interest in future development.

Airway Obstruction↗
PubMed1989

[Usefulness of thermographic examination in the diagnosis of early peripheral ischemia of the extremities in patients with diabetes mellitus].

Vascular damage is the main complication of diabetes. An early sign of this complication is damage to the arterial and capillary vessels in the lower extremities with later impairment of peripheral blood flow. The aim of the present study was evaluation of the usefulness of thermography in the detection of early circulatory disturbances in the lower extremities during diabetes, and comparison of its results with those obtained in oscillometry. The study comprised 28 patients with type I diabetes aged from 16 to 57 years and 27 patients with type II diabetes aged from 35 to 65 years. The control group included 10 clinically health subjects in similar age group. It was found that thermographic changes were much more frequent than pains in the extremities and abnormal values of oscillometric++ index in diabetes type I and II. Nearly half the patients with evident thermographic disturbances had no oscillometric changes, and 2/3 of the patients felt no pains in the extremities.

Adolescent↗
PubMed1987

[Variability of arterial pressure and heart rate measured at two periods of 15 minutes to 15 days intervals].

Intra individual blood pressure (BP) and heart rate (HR) variations and their possible correlation with sex and age were evaluated in 271 healthy adults, adolescents and children divided into equivalent groups of both sexes. BP and HR were measured every minute during 14 minutes with an automatic device using the oscillometry method. A second measurement session was repeated two weeks later. On most patients, a decrease of BP was observed during the first minutes towards a point of relative stability, which is reached after the eighth measurement. Mean differences between the first and the fourteenth minutes is about 12 mmHg for systolic BP and 18 mmHg for diastolic BP. The mean values of the 14 determinations on day 1 and day 15 showed a significant correlation from 65 to 75 according to different groups. The variability index within one subject was almost similar in all groups. A comparison of the variability indices observed on day 1 and day 15 showed a significant correlation only for systolic BP in male and for HR in female subjects. Reproducibility of variability appears very inconstant. The results suggest that this procedure cannot characterize subjects with a high BP variability. This study suggests that fourteen repeated measurements of BP values over a fortnight period allows a better estimation of BP level at rest. It cannot be equivalent to 24 hour BP record to estimate variability.

Adolescent↗
PubMed1987

[A new instrument for blood pressure determination in neonatal care].

A new instrument for measuring blood pressure by oscillometry conceived for neonates was tested in 30 children between 32.6 kg and 1200 g body weight (the emphasis being on infants) using sphygmanometric and invasive arterial measurements for comparison. High accuracy and good reproducibility of the individual measurements were found, the time required for measurement being short. The authors discuss the problems governing the sphygmanometric and oscillometric method.

Adolescent↗
PubMed1987

[Effectiveness of sympathetic block using various technics].

Blocking of sympathetic conduction aims at permanent or temporary elimination of those pain pathways conducted by the sympathetic nervous system. In order to provide an objective evaluation of sufficient blocking effect, earlier inquiries referred to parameters such as: (1) observation of clinical signs such as Horner's syndrome, Guttman's sign, anhidrosis, extended venous filling; (2) difference in skin temperature of at least 1.5 degrees C between blocked and unblocked side; (3) increase in amplitude of the pulse wave; and (4) depression of the psychogalvanic reflex (PGR) on the blocked side (Fig. 1). In clinical practice, these control parameters are effective because they are time-saving, technically simple, and highly evidential. Further parameters for evaluating sympathetic blockade are examination of hydrosis by means of color indicators such as bromocresol and ninhydrin, oscillometry, and plethysmography. The effectiveness of sympathetic blockade after stellate ganglion and sympathetic trunk blocks has been verified by various authors. In a clinical study, 16 patients were divided into four groups in order to test the effectiveness of sympathetic blockade after spinal anesthesia with 3 ml 0.75% bupivacaine (group I) and 4 ml 0.75% bupivacaine (group II) and after peridural anesthesia with 15 ml 0.75% bupivacaine (group III) and 20 ml 0.75% bupivacaine (group IV) by means of temperature difference, response of pulse wave amplitude and PGR between blocked lower and unblocked upper extremity, and sensory levels of block. The patients were classified as ASA I and II; their ages varied from 20 to 63 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Behavior of adrenaline, noradrenaline, blood pressure and heart rate in intubation in relation to different doses of fentanyl].

In 24 patients undergoing ENT surgery the reactions of blood pressure, heart rate and plasma catecholamines were studied during standardized induction of anaesthesia as well as after additional fentanyl administration of 0.1 or 0.2 mg before intubation. In the control group (n = 8) six measurements were performed, i.e. one minute before and after the administration of the drugs for induction, as well as immediately after the insertion of the laryngoscope and one minute after intubation. In the reference groups two measurements were performed: before induction of anaesthesia and one minute after intubation, in the period of maximal circulatory reaction. 0.1 or 0.2 mg were administered in the fentanyl groups (n = 8 in each) after precurarization before injecting thiopentone. The blood pressure was measured by oscillometry, the heart rate was recorded by an ECG monitor, and the plasma catecholamines were determined by a radio-enzymatic method. In the control group without fentanyl only a rise in heart rate was observed in the induction period until laryngoscopy. After the insertion of the laryngoscope the increase in systolic and diastolic blood pressures, heart rate and plasma noradrenaline levels were marked. One minute after intubation these parameters rose again. The adrenaline concentration hardly changed during the entire period of induction. The administration of 0.1 mg fentanyl proved to be insufficient to depress the sympathoadrenergic reaction during intubation. Although plasma catecholamines did not rise, a marked increase in blood pressure and heart rate could not be avoided. The difference compared to 0.2 mg fentanyl was significant in the parameters blood pressure and heart rate (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Endotracheal↗
PubMed1979

[The clofibrate-dipyridamole combination in the treatment of athero-arteriosclerotic vasculopathy].

A group of patients with athero-arteriosclerotic vascular disease (coronary heart disease and atherosclerosis of the extremities) have been subjected to platelet antiaggregating-antidyslipidaemic treatment with a chlofibrate-dipyridamol association; a control series was treated with chlofibrate alone. Frequency of angina pectoris, pain intensity and trinitrine consumption ware evaluated in patients with coronary heart disease, claudicometry, oscillometry and thermometry in patients with atherosclerosis of the extremities. The following laboratory parameters were also analysed: cholesterolaemia, triglyceridaemia, prothrombin activity, fibrinogenaemia, uricaemia and tolerance of oral glucose loading. Analysis of the results has shown that the association improved the parameters considered in statistically significant fashion; chlofibrate alone led to significant modifications of coronaropathic group parameters (with the exception of pain intensity) whereas it did not lead to significant changes in parameters evaluated for atherosclerosis of the extremities. All laboratory parameters were modified favourably by the association to a statistically greater extent than by chlofibrate alone. Both the association and chlofibrate were well tolerated.

Adult↗
PubMed1981

[An automatic non-invasive method for the measurement of systolic, diastolic and mean blood pressure].

A new automatic apparatus for the measurement of arterial pressure by a non-invasive technique was compared with direct intra-arterial measurement in 20 adult patients in a surgical intensive care unit. The apparatus works on the basis of the principle of oscillometry. Blood pressure is determined with a microprocessor by analysis of the amplitude of the oscillations produced by a cuff which is inflated then deflated automatically. Thus mean arterial pressure corresponds to the maximum amplitude. Systolic and diastolic pressures are deduced by extrapolation to zero of the amplitudes on either side of the maximum reading. Mean arterial pressure (AP) proved to be very reliable within the limits studied: 8.0 - 14.7 kPa (60 - 110 mmHg) with a difference in mean direct AP and indirect AP of 0,09 +/- 0.9 kPa SD (0.71 +/- 7 mmHg) and a coefficient of linear correlation between the two methods of r = 0.82. This non-invasive technique determined systolic arterial pressure (sAP) in a less reliable fashion than AP when compared with the invasive technique, with a tendency to flatten the extreme values. The correlation coefficient here was 0.68. Finally, diastolic arterial pressure (dAP) showed a better degree of agreement through with a difference in mean indirect AP and mean direct AP of 1.0 +/- 0.8 kPa (7.6 +/- 6.0 mmHg). These results indicate a good degree of agreement for measurements of mean arterial pressure, clinically the most important, between the two methods used. Measurements of diastolic pressure and above all of diastolic pressure seemed to be less in agreement. This difference could be due to an error in determination of the automatic apparatus tested or to the peripheral site (radial artery) of the intra-arterial catheter used, itself falsifying the humeral arterial pressure.

Blood Pressure Determination↗
PubMed1983

Microhaemorheological properties of binifibrate. Part II: Preliminary open studies in patients with peripheral arteriopathies.

3-Pyridinecarboxylic acid 2-[2-(4-chlorophenoxy)-2-methyl-1-oxo-propoxy]-1,3-propanediyl ester (binifibrate, Biniwas) an anti-arteriosclerotic and hypolipidaemic agent which showed an effect on microhaemorheological properties during studies in experimental animals (rat and rabbit), was administered to six hyperlipidaemic patients who suffered from circulatory disturbances in the lower limbs. The treatment with binifibrate was applied at a dosage of 3 X 600 mg/day during one month. Both subjective symptoms such as paraesthesia, dysthaesia, coldness at rest and functional weakness of movements were improved, as well as objective symptoms measured by oscillometry. The microhaemorheological analyses demonstrated a positive variation in relative parameters. The correlation between microhaemorheological parameters and clinical symptoms is discussed.

Adult↗