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PubMed1993

Short-term effects of blood transfusion on blood volume and resting peripheral blood flow in preterm infants.

The effects of blood transfusion on cardiac output and blood pressure are variable, but resting peripheral blood flow (RPBF) may be a sensitive indicator of changes in blood volume. The purpose of this investigation was to study the effects of red cell transfusion on blood volume (Evans blue), blood pressure, RPBF in the leg (strain-gauge plethysmography) and blood viscosity (cone-plate viscometer) in preterm infants during the first week after birth. Fourteen infants with mean +/- SD birth weight of 1658 +/- 429 g, gestational age 33 +/- 3 weeks and postnatal age 64 +/- 40 h received 18 +/- 4 ml/kg of packed red cells (red cells 11 +/- 2 ml/kg, plasma 7 +/- 1 ml/kg) because their hematocrit was less than 0.45 l/1. Mean blood volume before transfusion was 88 +/- 15 ml/kg. The increase in blood volume (9 +/- 4 ml/kg) measured 4 to 6 h after transfusion was smaller than the transfused volume (18 +/- 4 ml/kg), due to a shift of plasma to the extravascular space. The plasma shift increased with increasing pretransfusion blood volume (r = 0.70; p = 0.007). Red cell transfusion caused an increase in RPBF by 25% (p < 0.01), whereas systolic blood pressure (BP) increased by only 12%. Peripheral resistance (R = BP/RPBF) decreased by 9% (p < 0.01). Blood viscosity (eta) increased by 21% (p < 0.001) and vascular hindrance (R/eta) decreased by 24% (p < 0.001), indicating vasodilatation of limb arteries. The increase in RPBF and the decrease in hindrance were particularly pronounced in infants with high pretransfusion blood volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed2002

Uncontrolled early morning blood pressure in medicated patients: the ACAMPA study. Analysis of the Control of Blood Pressure using Abulatory Blood Pressure Monitoring.

BACKGROUND: A blood pressure surge during the early morning may help to precipitate cardiovascular events. The objective of this study was thus to assess the blood pressure behaviour profile of early morning blood pressure in patients receiving antihypertensive treatment. DESIGN: The ACAMPA study is a multi-center, open, prospective, observational study that was carried out by 24 investigators in Spain. METHODS: Two hundred and ninety patients with essential hypertension who had been receiving the same antihypertensive treatment for at least 2 months were included in the study. Office blood pressure was measured before taking medication in the morning, and 24-h ambulatory blood pressure monitoring was performed. In addition to the automatic measurements, patients were instructed to take a blood pressure measurement after waking. RESULTS: The group analysis used 240 patients (mean age 54 years, including 101 males). Good clinical control (a blood pressure of less than 140/90 mmHg) was found in 53 cases (22%). The differences between the clinical and ambulatory readings during the period of activity were minimal in the group with good control (127 +/- 9/81 +/- 7 versus 127 +/- 10/81 +/- 7 mmHg; non-significant) but were significant in the group with poor control (155 +/- 16/93 +/- 10 versus 138 +/- 14/86 +/- 11 mmHg; P < 0.001). The blood pressure values were synchronized according to the moment of awakening. In almost half of the patients with good control, systolic and diastolic blood pressure values were higher than normal (135/85 mmHg); in those patients with poor control, this fraction rose to over 70%. The proportion of patients presenting high blood pressure values became even greater during the second hour after waking (62% in patients with good blood pressure control and 82% in those with poor control). CONCLUSIONS: In a large number of antihypertensive patients receiving treatment, blood pressure values remain high during the early-morning hours. At least half of those patients with an apparently well-controlled office blood pressure do not have their blood pressure under control for the period shortly after waking.

Adolescent↗
PubMed2000

Pig and goat blood as substitutes for sheep blood in blood-supplemented agar media.

In many developing countries sheep and horse blood, the recommended blood supplements in bacteriological media, are not readily available, whereas pig and goat blood are. Therefore, this study examined the use of pig and goat blood as potential substitutes for sheep blood in blood-supplemented bacteriologic media commonly used in clinical microbiology laboratories. In general, the growth characteristics and colony morphologies of a wide range of aerobic and anaerobic bacteria and Candida albicans were similar on media containing pig, goat, and sheep blood, although differences were found. Enterococcus sp. uniformly produced alpha-hemolysis when incubated in CO(2), but in anaerobic conditions the hemolysis varied. In contrast, beta-hemolytic streptococci produced identical hemolytic reactions on all three media. Synergistic hemolysis was not observed on pig blood agar in the CAMP test nor on goat blood agar in the reverse CAMP test. The preparation of chocolate agar (heated) with pig blood required heating to a higher temperature than with sheep or goat blood to yield suitable growth of Haemophilus species. In general, we conclude that pig and goat blood are suitable alternatives to sheep blood for use in bacteriological media in settings where sheep and horse blood are not readily available.

Agar↗
PubMed1994

Lack of dependence of cerebral blood flow on blood viscosity after blood exchange with a Newtonian O2 carrier.

Whether the increase in cerebral blood flow measured after hemodilution is mediated by a decrease in blood viscosity or in oxygen delivery to the brain is debated. In the present study, blood was replaced by an oxygen-carrying blood substitute, ultrapurified, polymerized, bovine hemoglobin (UPBHB). In contrast to normal blood, UPBHB yields a constant and defined viscosity in the brain circulation, since its viscosity is not dependent on the shear rate. CBF was determined after blood exchange with UPBHB in one group of conscious rats (UPBHB group) and in another group of blood-exchanged conscious rats in which viscosity was increased fourfold by the addition of 2% polyvinylpyrrolidone (PVP), mw 750,000 (UPBHB-PVP group). Local CBF (LCBF) was measured in 34 brain structures by means of the quantitative iodo(14C)antipyrine method. After blood replacement, systemic parameters such as cardiac index, arterial blood pressure, blood gases, and acid-base status were not different between the UPBHB and the UPBHB-PVP groups. In particular, arterial oxygen content was similar in both groups. Compared with a control group without blood exchange, LCBF was increased after blood exchange in the different brain structures by 60-102% (UPBHB group) and by 33-101% (UPBHB-PVP group). Mean CBF was increased by 77% in the UPBHB group and by 69% in the UPBHB-PVP group. No significant differences were observed in the values of LCBF or mean CBF between the UPBHB group and the UPBHB-PVP group. The results show that a fourfold variation in the viscosity of a Newtonian blood substitute does not result in differences in CBF values.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Percutaneous umbilical blood sampling and umbilical vein transfusions. Rapid serologic differentiation of fetal blood from maternal blood.

Percutaneous umbilical blood samples (PUBS), obtained under ultrasound guidance, are used for prenatal diagnosis and management of hemolytic disease of the newborn (HDN) and other fetal disorders. Rapid testing at the time of sampling is vital to distinguish fetal from maternal blood. Blood typing was performed by slide technique in the treatment room during 38 procedures on 25 patients. Anti-I was used to test 50 presumed PUBS; venous I-positive maternal blood was tested in parallel. Because anti-I cannot detect fetal blood after umbilical vein transfusion (UVT) of I-positive donor blood, ABO and Rh blood typing reagents were used to test 29 samples when maternal and fetal or donor blood groups differed. Monoclonal reagents were used for optimal detection of weak AB antigens in fetal blood. Avid, chemically modified anti-D was used for Rh typing. Blood typing showed 27 (34%) of 79 samples to be maternal blood. Fetal blood was obtained in 8 of 10 cases investigated for fetal disorder and in 16 cases of potential HDN (anti-D, 5; -CD, 5; -cE, 2; -K, 2; -c; -E). The absence of HDN (antigen-negative fetus) was determined in 4 cases. UVT afforded live birth of 9 of 10 infants with HDN and was not indicated in two cases.

Blood Grouping and Crossmatching↗
PubMed2003

Significance of blood pressure self-measurement as compared with office blood pressure measurement and ambulatory 24-hour blood pressure measurement in pharmacological studies.

With the increasing use of blood pressure self-measurement in pharmacological studies, the question arises as to whether this method can replace office blood pressure measurement or ambulatory 24-h blood pressure measurement for testing and comparing the efficacy of antihypertensives. Ambulatory 24-h blood pressure measurement or self-measurement available for analysis can be obtained in 70 to 90% of patients. Self-measurement shows a better correlation with the prognostically relevant ambulatory 24-h blood pressure measurement than office blood pressure measurement for appraising the antihypertensive effect. Although similar antihypertensive effects were found for ambulatory 24-h blood pressure measurement and self-measurement in the group comparison, substantial discrepancies can be observed in the individual patient owing to the different nature of these two methods of measurement. Both ambulatory 24-h blood pressure measurement and self-measurement are superior to office blood pressure measurement in terms of their reproducibility. This increases the sensitivity of clinical studies and reduces the number of cases required. Owing to the white-coat effect, variable compliance and drug holidays and their effects on the efficacy of antihypertensive medication are not detected by office blood pressure measurement and ambulatory 24-h blood pressure measurement. Self-measurement detects drug holidays, which are reflected in an increase of the blood pressure measurement values, and per se promotes compliance. Self-measurements and ambulatory 24-h measurements in pharmacological studies must be regarded as complementary, so that it is appropriate to use both methods whenever possible. Data management, data analysis and monitoring in pharmacological studies are facilitated by instruments with automatic data storage which allows telemonitoring.

Amlodipine↗
PubMed2005

Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy.

AIM: Autologous blood donation (ABD) is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be determined. METHODS: Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group I (GI) and group II (GII) according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss, blood products used and the changes of perioperative hemoglobin (Hb) between groups were analyzed and compared by using Mann-Whitney U test. RESULTS: The results show that the intraoperative CVP changes between GI (n = 35) and GII (n = 49) up to graft procurement were the same, subsequently the blood loss, but ABD resulted in significantly lower perioperative Hb levels in GI. CONCLUSION: Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital. It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.

Adult↗
PubMed1996

[The quantitative regional cerebral blood flow measurement with autoradiography method using 123I-IMP SPECT: evaluation of arterialized venous blood sampling as a substitute for arterial blood sampling].

The purpose of this study is validation of calibrating a standard input function in autoradiography (ARG) method by one point venous blood sampling as a substitute for that by one point arterial blood sampling. Ten and 20 minutes after intravenous constant infusion of 123I-IMP, arterialized venous blood sampling from a dorsal vein were performed on 15 patients having ischemic cerebrovascular disease. And arterial blood sampling from radial artery was performed 10 min after 123I-IMP infusion. The mean difference rates of integrated input function between calibrated standard input function by arterial blood sampling at 10 min and that by venous blood sampling were 4.1 +/- 3% and 9.3 +/- 5.4% at 10 and 20 min after 123I-IMP infusion, respectively. The ratio of venous blood radioactivity to arterial blood radioactivity at 10 min after 123I-IMP infusion was 0.96 +/- 0.02. There was an excellent correlation between ARG method CBF values obtained by arterial blood sampling at 10 min and those obtained by arterialized venous blood sampling at 10 min. In conclusion, a substitution by arterialized venous blood sampling from dorsal hand vein for artery can be possible. The optimized time for arterialized venous blood sampling was 10 min after 123I-IMP infusion.

Aged↗
PubMed1996

[Autologous blood transfusion: results with routine use of autologous blood transfusion, normovolemic hemodilution and postoperative retransfusion of drainage blood salvaged with the Solcotrans system].

BACKGROUND: Although the medical advantages of autologous blood transfusion are undisputed today, it has been established only in a few hospitals. At our hospital we have employed infusion of previously stored autologous blood and normovolemic hemodilution routinely in all patients undergoing major orthopedic surgery since June 1, 1986. QUESTION: In this study the efficacy of additionally infusing salvaged drainage blood postoperatively in reducing the need for homologous blood transfusion was examined. METHOD: From June 1, 1990 through December 30, 1993 the effectiveness of autotransfusion techniques with the additional use of postoperative infusion of salvaged blood was studied in 318 patients. RESULTS: Preexisting anemia with hemoglobin value of less than 11 g/dl proved to be the only contra-indication for autologous blood transfusions and was found in 8 (2.5%) of our patients. These patients were not eligible for the autologous blood program. The 310 remaining patients were all given their previously stored autologous blood with hemodilution. In addition, 261 of these patients (84%) were also given salvaged drainage blood postoperatively using the solcotrans system or solcotrans-plus-orthopedic system. Of the total 310 patients, 218 (70.3%) did well without homologous blood. This was also true for 206 (78.9%) of the patients treated with all 3 autotransfusion procedures. No complications implicating the autotransfusion techniques were encountered. In addition, the method described and as employed in our hospital led to a cost reduction of about 40% compared to homologous transfusions. DISCUSSION AND CONCLUSION: The efficiency of autologous blood transfusions and hemodilution in reducing the need for homologous blood at our hospital, as previously described, could be increased by 22% using the solcotrans system. The advanced age of our patients (average 73 years) and the number of preexisting, in part considerable, medical problems permit the conclusion that these autotransfusion techniques are quite well tolerated. The contraindications could be reduced to a few exceptions. The logistics necessary to carry out these procedures are simple and can be achieved with a bit of will and effort in all hospitals including those of middle and small size.

Adolescent↗
PubMed1998

Blood transfusion strategies for total knee arthroplasty: minimizing autologous blood wastage, risk of homologous blood transfusion, and transfusion cost.

In this nonrandomized study, alternative strategies were suggested to 10 orthopaedic surgeons to minimize autologous blood wastage, the risk of homologous blood transfusion, and cost associated with blood product usage after total knee arthroplasty (TKA). One hundred fifty-five patients with 177 consecutive TKAs over a 2-year period were studied. Group 1 patients had undergone unilateral TKA and did not predonate; 1A patients (n = 19) were drained with a Hemovac, and 1B patients (n = 28) with a postoperative blood recovery system. Group 2 patients (n = 47) predonated one packed red blood cell (pRBC) unit. Group 3 patients (n = 20) predonated 2 pRBC units. Group 4 patients had undergone bilateral sequential TKAs (n = 21) and had predonated 2 pRBC units. Group 5 patients (n = 14) had undergone revision TKA procedures and their blood requirements were individualized. Group 6 patients (n = 6) had preexisting anemia and were excluded from the study. There was no significant difference in total blood loss (909 mL) between groups. Female sex was associated with significantly lower admission hematocrit. Homologous blood was required for 4% of patients in the entire study and the percentage was not statistically different between groups. Twenty-five percent of patients who predonated autologous pRBCs did not use all or some of it. In group 1, the postoperative blood recovery system had a significant effect on reducing postoperative hematocrit drop (P = .0001), but it was not a significant factor if autologous pRBCs were available. The costs associated with group 1A were significantly less (P = .0001) compared with the other groups; group 1A had the highest admission hematocrit (43.2). Transfusion with autologous pRBCs was related to lower admission hematocrit rather than to increased postoperative blood loss. An algorithm is presented to provide cost-effective management of blood products after TKA.

Aged↗
PubMed1994

Phenotypic analysis and characterization of CD34+ cells from normal human bone marrow, cord blood, peripheral blood, and mobilized peripheral blood from patients undergoing autologous stem cell transplantation.

Single- and multicolor flow cytometry were used to define progenitor subsets in normal human bone marrow and peripheral blood, cord blood, and blood following mobilization of CD34+ progenitor cells by cyclophosphamide or cyclophosphamide/etoposide/G-CSF treatment. CD34 cells were quantitated and subsets of CD34+ cells were defined by coexpression of CD33, CD13, CD10, CD19, CD45RA, and CD71. Myeloid and erythroid progenitors were quantitated by sorting single CD34+ cells into individual wells of 96-well plates containing methylcellulose, IL-3, GM-CSF, G-CSF, IL-6, and erythropoietin. Comparative studies of CD34 cells showed that the percentage of CD34+ mononuclear cells was greatest in blood samples from patients following mobilization treatment with cyclophosphamide/etoposide/G-CSF averaging 2%. By comparison, the remaining sample groups ranged from 1.68 to 0.15% CD34 cells in this order, bone marrow > cord blood > cyclophosphamide mobilized blood > peripheral blood. Comparison of CD34 cells per milliliter of bone marrow or blood showed a range of 22.4 x 10(4) to 0.65 x 10(4)/ml in the following order, bone marrow > chemotherapy/etoposide/G-CSF > cord blood > cyclophosphamide-mobilized blood. Comparative analysis of CD34 subsets from different sources showed significant differences, particularly bone marrow and blood samples. A distinct population of CD34+ CD19+ (Leu 12) CD10+ (CALLA) pre-B lymphocyte cells was defined in bone marrow with lower side and forward light scatter characteristics and was variable between donors (29.8 +/- 16.9%, mean +/- 1 SD; range, 3-54%; n = 8). This population was not found to a significant degree in blood and also expressed CD45RA (Leu 18). Coexpression studies of CD45RA and CD71 (transferrin receptor) expression on CD34+ cells defined a CD45RA- CD71+ population containing 89 +/- 6.3% (n = 4) BFU-E and a CD45RA+ CD71+ population that contained all CFU-GM (n = 4). LeuM7 (CD13) stained a larger percentage to a greater intensity than MY7 (CD13). Coexpression of CD45RA (Leu 18) and CD13 (LeuM7) defined a subset of CD13+ CD45RA+ cells enriched for CFU-GM and CFU-M with a cloning efficiency of 31%. Coexpression of CD33 (MY9) and CD13 (MY7) defined a population that was predominantly CFU-GM with a cloning efficiency of 38%. These studies define CD34+ phenotypes containing pure populations of B lymphocyte, granulocyte-macrophage, or erythroid progenitors and demonstrate the utility of multiparameter flow cytometry to define lineage-committed CD34+ cells.

Adult↗
PubMed2006

Structural characterization of blood group A glycolipids in blood group A liver tissue in situ perfused with O blood: the dominating presence of type 1 core chain A antigens.

BACKGROUND: Biochemical studies of organ blood group antigen expression show a mixed pattern originating from both the organ tissue and remaining blood cells trapped in the organ despite in vitro perfusion of the vascular tree. The blood group A glycolipid expression was studied in a unique case in which a human liver had been in situ perfused by recipient blood. CASE HISTORY: A blood group O recipient was re-transplanted with an ABO incompatible A1Le (a - b +) liver. Because of discrepancy in size, liver segments II and III were removed 2 h after re-vascularization. Thereafter, the removed A1 liver segment was physiologically in situ perfused with O blood, eliminating a major part of the donor blood cells/plasma. EXPERIMENTAL: Total neutral glycolipids were isolated from the liver tissue and separated by high-performance liquid chromatography. Purified glycolipid fractions were stained with anti-A monoclonal antibodies (mAbs) and structurally characterized by mass spectrometry and proton nuclear magnetic resonance (NMR) spectroscopy. RESULTS: Two blood group A reactive glycolipid compounds were isolated. One component had a thin-layer chromatography (TLC) mobility as a six-sugar glycolipid and reacted with mAbs specific for A type 1 mono-fucosyl structures. The second glycolipid fraction migrated as seven-sugar components and reacted with mAbs specific for type 1 difucosyl (ALeb) as well as Leb determinants. Mass spectrometry of the six-sugar component showed a structure similar to a blood group A hexaglycosylceramide with one fucose. Mass spectrometry and proton NMR spectroscopy of the seven-sugar fraction revealed a mixture of blood group Leb hexa- and ALeb hepta-glycosylceramides, respectively. All fractions were non-reactive with antibodies specific for A antigens based on types 3 and 4 core chain structures. In addition, TLC immunostaining of glycolipids isolated from blood group A livers, harvested for organ transplantation but discarded for various reasons, revealed trace amounts of several A glycolipids with a complex pattern. CONCLUSION: The in situ perfused liver tissue contains blood group A glycolipids based exclusively on type 1 core chains. The secretor gene (Se) codes for a fucosyltransferase acting on all core chain precursors while the H-gene fucosyltransferase only utilizes the type 2 chain precursor. Whether this explains that only A type 1 chain compounds were found has to be established.

ABO Blood-Group System↗
PubMed2005

Genetic variance of SGK-1 is associated with blood pressure, blood pressure change over time and strength of the insulin-diastolic blood pressure relationship.

BACKGROUND: Insulin stimulation of the serum- and glucocorticoid-regulated kinase 1 (SGK-1) prolongs the half-life of the epithelial sodium channel, a protein which is essential for blood pressure regulation. The aim of this study was to investigate if variation in the SGK-1 gene is associated with increased blood pressure and strength of the insulin-blood pressure relationship. METHODS: A promoter C/T, an intron 6 C/T and an exon 8 C/T polymorphism in the SGK-1 gene were genotyped in 4830 subjects from the Malmö Diet and Cancer (MDC) material of whom 4001 were free from antihypertensive medication. Of these, 2171 subjects had also been investigated 11.2 +/- 4.4 years earlier in the Malmö Preventive Project (MPP). RESULTS: In untreated MDC subjects, intron 6 CC genotype carriers had higher diastolic blood pressure than carriers of the T allele (P = 0.02) and exon 8 C allele carriers had higher systolic blood pressure than TT genotype carriers (P = 0.05). Subjects simultaneously carrying the intron 6 CC genotype and the exon 8 CC or CT genotype (SGK-1 risk) had higher systolic blood pressure (P = 0.03) and higher diastolic blood pressure (P = 0.009) than noncarriers. From MPP to MDC, the percent change in blood pressure per year was higher for systolic blood pressure (P = 0.002) and diastolic blood pressure (P = 0.001) in SGK-1 risk carriers than noncarriers. The correlation between fasting plasma insulin concentration and diastolic blood pressure was stronger in SGK-1 risk carriers than in non-carriers (P = 0.04). CONCLUSION: Our data suggest that SGK-1 risk carriers are at increased risk of hypertension and are more sensitive to the blood pressure elevating effects associated with hyperinsulinemia.

Adult↗
PubMed1995

Blood flow rate and total blood flow related to length density and total length of blood vessels in mini-pig urinary bladder after chronic outflow obstruction and after recovery from obstruction.

Chronic partial bladder outlet obstruction was created in mini-pigs by implanting a 6-7 mm ring around the proximal urethra. After a median obstruction period of 63 days the ring was removed, and after a median recovery period of 60 days the animals were sacrificed. At each study occasion the blood flow rate (ml per 100 g per min) was measured by washout of locally injected 133Xe in the bladder wall and the washout curves analyzed by the corrected initial slope method. Stereological estimation of length density and total length of blood vessels in the bladder were performed. The results can be summarized as follows: (1) no differences in the blood flow rate at the time of ring implantation, obstruction, or recovery, (2) no decrease in the blood flow rate in normal bladders after bladder distension, (3) a significant decrease in blood flow rate in obstructed bladders after distension, (4) a 6-fold increase in total bladder blood flow after obstruction, (5) an unchanged blood flow per length of blood vessels per min during the study, (6) no changes in length densities of blood vessels during the study, and (7) a 7-fold increase in total length of blood vessels after obstruction and reversion to control level after recovery. The unchanged blood flow per length of vessels implies that capillary proliferation matched the increased bladder mass during the study.

Animals↗
PubMed1984

Serial blood water estimations and in-line blood viscometry: the continuous measurement of blood volume during dialysis procedures.

It has been shown in vitro that serial measurements of blood water during ultrafiltration accurately reflect changing blood volume. It has been shown that minute changes in blood hydration produce detectable changes in blood viscosity. An 'in-line' capillary viscometer has been constructed which can be placed in parallel with an extracorporeal circuit to give a continuous semi-quantitative measure of blood viscosity during ultrafiltration or haemodialysis. By making serial measurements of blood water each 'viscometer curve' can be corrected to permit calculation of blood volume provided that the starting blood volume is known. Blood volume changes of less than 1% can be detected in vitro and provided that blood volume changes solely as a result of the removal or influx of water it can be measured continuously to within an accuracy of 4% for volume changes up to 30% irrespective of starting packed cell volume or blood water.

Blood↗
PubMed1995

[New aspects in evaluating the hypertensive patient: measuring blood pressure in the physician's office--ambulatory blood pressure monitoring--blood pressure self-measurement].

The "average" blood pressure of hypertensives, which is held responsible for the adverse effects of hypertension is poorly reflected by causal readings (CR), which are taken as a surrogate. CR do not only differ from average blood pressures, but also fail to give information on blood pressure variability. According to white coat effect and blood pressure variability a satisfying classification of severity and consecutively of prognosis cannot be done in an individual. Furthermore CR fail to inform us sufficiently about therapeutic effects in single patients. To improve we have to change to blood pressure judgements which are based on many instead of occasional readings. Ambulatory blood pressure monitoring (ABM) is a possibility to overcome this weakness. Compared to casual readings the average of the ambulatory readings is higher reproducible and does not depend on placebo treatment. In spite of this advantage a general substitution of CR by ABM is impossible because the number of equipment available is too small, nobody wants to cover the costs, the procedure is inconvenient, and up till now we miss guidelines how to proceed in the daily routine. Blood pressure self-monitoring is an additional way to improve the weakness of CR. The amount of blood pressure readings needed for a satisfying judgement of blood pressure are taken and registered by the patients. The self recorded data can be used as a valuable data base to calculate average blood pressure and blood pressure variability and drug effects. Mean values of twice daily recordings of a month are highly reproducible and do highly correlate to average ABM recordings of the day.

Antihypertensive Agents↗
PubMed1990

[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↗