Bulas J

24-h ambulatory blood pressure, daytime and nighttime urinary albumin and retinol-binding protein excretion in type I diabetic patients

We studied 24-h ambulatory blood pressure (SBP, DBP), actual glycemic control assessed from seven blood glucose measurements, 16-h daytime and 8-h nighttime urinary excretion of albumin (UAE) and retinol-binding protein (URBP) in 20 normoalbuminuric (group A, nighttime UAE < 20 micrograms/min) and 20 microalbuminuric and low-proteinuric type I diabetic patients (group B, nighttime UAE 20-500 micrograms/min) matched for age and diabetes duration. Glycemic control was similar in the two groups. Daytime and nighttime SBP and DBP were higher in group B compared to group A (p < 0.01). Nighttime decrease in SBP and DBP correlated with nighttime decrease in UAE in group B (p < 0.05, p < 0.001), but not in group A. There was no correlation between BP and actual glycemic control in either group. We found higher daytime and nighttime URBP in group B compared to group A (p < 0.05). We conclude that, in microalbuminuric and low-proteinuric patients, daytime and nighttime BP was elevated but still in the normal or borderline range, and nighttime decrease in BP correlated with nighttime decrease in UAE but not with actual glycemic control. Increased URBP in these patients suggests slightly impaired proximal tubular function in early stages of diabetic nephropathy.

Remodeling in myocardial infarction and body surface potential maps

This study deals with the capabilities of body surface integral and departure maps to evaluate the chronic stage of myocardial infarction based on dividing the left ventricle into 12 segments. The effects of ventricular remodeling on electrocardiographic potential distributions are considered. A 61-year-old male patient was examined five times by body surface potential mapping during a period of 9 months after acute myocardial infarction. Integral maps were calculated for 60 ms after QRS onset and compared with mean data from a control group using departure maps. Integral maps showed a continual reduction of negative potentials in the lower half of the torso with time. The negative area covered the lower torso in the departure maps during the whole study, but its form and value changed. According to the location of the departure area, the surface projection of the scar moved from a position corresponding to inferior segments to a position corresponding to posterior segments. Its size also decreased. Echocardiographic examinations showed progressive enlargement of both ventricles with time. Therefore, the authors postulate that the changing pattern of body surface potential maps was mainly influenced by ventricular remodeling after myocardial infarction.

Central Systolic Hypertension in Patients with Well-Controlled Hypertension

Background. Central systolic blood pressure (CSBP) has prognostic significance and simplified devices for its estimation have been introduced recently. The aim of this study was to assess the achievement of the target CSBP in treated hypertensive patients. Subjects and Methods. One hundred patients with well-controlled hypertension were analysed. For CSBP estimation, we used the Arteriograph (TensioMed Ltd.), which uses one cuff for all measurements, the “single-point measurement” approach. Results. We found that 62% of patients had CSBP ≥ 130 mmHg, the suggested cut-off value for hypertension. When sex-specific classification was employed (CSBP ≥ 137 mmHg for female and CSBP ≥ 133 mmHg for male), only 13% of patients (mainly women) remained in the hypertensive range. We also found that 55% of patients had a CSBP higher than brachial pressure. Multiple analyses showed that CSBP was significantly associated with sex, height, and return time. Conclusions. A high proportion of treated hypertensive patients had CSBP levels that exceeded their brachial BP. CSBP positively correlated with lower height and shorter return time of the reflected pressure wave and was significantly higher in females compared to males. These findings suggest that, for CSBP classification, it is important to take height and sex-specific differences into account.