Efthimia Nasothimiou

Validation of the Microlife Watch BP Office professional device for office blood pressure measurement according to the International protocol.

ObjectiveTo assess the accuracy of oscillometric and auscultatory blood pressure (BP) measurement taken using the professional electronic device Microlife Watch BP Office according to the European Society of Hypertension International Protocol. MethodsThirty-three participants were included for the assessment of each measurement mode (oscillometric and auscultatory). Simultaneous BP measurements were taken by two observers (mercury sphygmomanometers) four times, sequentially with three measurements taken using the tested device. Absolute observer device BP differences were calculated. For each participant the number of measurements with a difference within 5 mmHg was calculated. ResultsIn phase 1 the device produced 32, 40 and 40 oscillometric systolic BP (SBP) measurements within 5, 10 and 15 mmHg, respectively and diastolic BP (DBP) 30, 40 and 43 (for auscultatory SBP 29, 42, 45 and DBP 33, 43, 45). In phase 2.1 the device produced 71, 90 and 96 SBP measurements within 5, 10 and 15 mmHg, respectively and DBP 71, 88 and 97 (for auscultatory SBP 72, 96, 99 and DBP 83, 96, 99). Twenty-four participants had at least two of their SBP differences within 5 mmHg and one participant had no difference within 5 mmHg, and DBP 23 and three participants, respectively (for auscultatory SBP 29 and 0 and DBP 29 and 1). Mean SBP difference was −1.4±6.3 mmHg and DBP −0.8±6.0 mmHg (auscultatory SBP −1.8±4.5 and DBP −0.4±4.0). ConclusionThe Microlife Watch BP Office device used in the oscillometric or the auscultatory mode fulfills the validation criteria of the International protocol and therefore can be recommended for clinical use.

Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring.

Objective To investigate the usefulness of home blood pressure measurements in comparison with ambulatory monitoring in the diagnosis of sustained, white-coat hypertension and masked hypertension in children and adolescents. Subjects and methods One hundred and two subjects, referred for elevated blood pressure, were assessed with clinic (two visits), home (6 days) and awake ambulatory blood pressure measurements [64 boys, mean age 12.8 ± 2.9 (SD) years, range 6–18 years]. Results Office hypertension was diagnosed in 38 subjects, ambulatory hypertension in 31 and home hypertension in 23 (P = 0.07). On the basis of clinic and ambulatory blood pressure, 52% of subjects were normotensive, 20% hypertensive, 18% had white-coat hypertension and 11% masked hypertension, whereas on the basis of clinic and home blood pressure, 55, 15, 23 and 8%, respectively. There was an agreement between ambulatory and home blood pressure in the diagnosis of hypertension in 82 cases (80%). When a 5-mmHg gray zone of diagnostic uncertainty was applied above and below the diagnostic thresholds, there were only eight cases with clinically important disagreement. By taking ambulatory blood pressure as the reference method for the diagnosis of hypertension, the sensitivity, specificity and positive and negative predictive values of home blood pressure were 55, 92, 74 and 82%, respectively, for the diagnosis of white-coat hypertension 89, 92, 70 and 98%, respectively, and for masked hypertension 36, 96, 50 and 93%, respectively. Conclusion In children and adolescents, there is a reasonable agreement between home and ambulatory blood pressure measurements as diagnostic methods in hypertension. Home blood pressure appears to be a useful diagnostic test in this population, particularly for the detection of white-coat hypertension.

Left-ventricular hypertrophy is associated better with 24-h aortic pressure than 24-h brachial pressure in hypertensive patients: the SAFAR study.

Objective: To test the hypothesis that left-ventricular hypertrophy (LVH) is better associated with aortic, than brachial, 24-h average blood pressure (BP) in individuals with hypertension. Background: The office aortic BP is associated better with organ damage, such as LVH, than the office brachial BP; whether the 24-h average aortic BP associates better with LVH, than the 24-h average brachial BP, has never been tested. Methods: Aortic ambulatory BP monitoring (ABPM) was performed with a novel validated oscillometric cuff-based BP recording device, also used for simultaneous brachial ABPM, and the application of pulse wave analysis method. Office brachial and aortic BP were assessed with validated oscillometric recording device and pulse wave analysis, respectively; left-ventricular mass was measured by ultrasound. Results: Regression analysis performed in 229 individuals (aged 54.3 ± 14.6 years; 56% men; 75% hypertensive patients) showed that the 24-h average aortic SBP was significantly better associated with left-ventricular mass index and LVH than the 24-h average brachial, as well as, office (brachial or aortic) SBP, independently of age, sex, obesity or treatment. Receiver operator characteristics curve analysis showed a higher discriminatory ability of 24-h average aortic than brachial SBP to detect the presence of LVH (area under the curve: 0.73 versus 0.69; P = 0.007). A high degree of interindividual overlap regarding aortic 24-h average SBP level was found in individuals in whom the corresponding brachial measurements denoted different hypertension levels. Conclusion: These data suggest that aortic ABPM, when compared to brachial ABPM, improves the individualized assessment of the BP-associated heart damage.

Diagnostic accuracy of home vs. ambulatory blood pressure monitoring in untreated and treated hypertension

Several studies with relatively small size and different design and end points have investigated the diagnostic ability of home blood pressure (HBP). This study investigated the usefulness of HBP compared with ambulatory monitoring (ABP) in diagnosing sustained hypertension, white coat phenomenon (WCP) and masked hypertension (MH) in a large sample of untreated and treated subjects using a blood pressure (BP) measurement protocol according to the current guidelines. A total of 613 subjects attending a hypertension clinic (mean age 53±12.4 (s.d.) years, men 57%, untreated 59%) had measurements of clinic BP (three visits, triplicate measurements per visit), HBP (6 days, duplicate morning and evening measurements) and awake ABP (20-min intervals) within 6 weeks. Sustained hypertension was diagnosed in 50% of the participants by ABP and HBP (agreement 89%, κ=0.79), WCP in 14 and 15%, respectively (agreement 89%, κ=0.56) and MH in 16% and 15% (agreement 88%, κ=0.52). Only 4% of the subjects (27/613) showed clinically significant diagnostic disagreement with BP deviation >5 mm Hg above the diagnostic threshold (for HBP or ABP). By taking ABP as reference, the sensitivity, specificity, positive and negative predictive value of HBP in detecting sustained hypertension were 90, 89, 89 and 90%, respectively, WCP 61, 94, 64 and 94% and MH 60, 93, 60 and 93%. Similar diagnostic agreement was found in untreated and treated subjects. HBP appears to be a reliable alternative to ABP in the diagnosis of hypertension and the detection of WCP and MH in both untreated and treated subjects.

Home Blood Pressure Monitoring Alone vs. Combined Clinic and Ambulatory Measurements in Following Treatment-Induced Changes in Blood Pressure and Organ Damage

BACKGROUND Out-of-office blood pressure (BP) measurement using home BP (HBP) or ambulatory BP (ABP) monitoring is often necessary for the accurate evaluation of hypertension. These methods have several similarities but also have major differences. Therefore, they are regarded as complementary, and there is uncertainty on how they should be applied in clinical practice. This study compared hypertension management based on clinic and ABP measurements or on HBP measurements alone. METHODS Untreated subjects with elevated BP were randomized to treatment initiation and titration based on clinic and ABP measurements or on HBP measurements alone. Target organ damage was assessed at baseline and after 1 year of treatment with echocardiographic left ventricular mass index (primary endpoint), pulse wave velocity, and urinary albumin excretion. RESULTS A total of 145 subjects were randomized, and 116 completed the study (mean age = 50.7±10.5 years; 69 men (59%); mean follow-up = 13.4±1.4 months). There was no difference between the 2 arms in treatment-induced change in left ventricular mass index (mean difference = 0.50±1.11 g/m2; 95% confidence interval (CI) = -1.70 to 2.70). Moreover, there was no difference between the 2 arms in treatment-induced changes in pulse wave velocity (mean difference = -0.16±0.42 m/s; 95% CI = -0.99 to 0.66), urinary albumin excretion (mean difference = -0.85±4.28 mg/dl; 95% CI = -9.37 to 7.66), HBP and ABP levels, and hypertension control rates. CONCLUSIONS These data suggest that HBP monitoring alone is as reliable as combined clinic and ABP measurements in monitoring the effects of antihypertensive drug treatment on BP and preclinical target organ damage.

Diagnostic value of rapid urease test and urea breath test for Helicobacter pylori detection in patients with Billroth II gastrectomy: A prospective controlled trial

AIM The aim of this work was to assess the reliability of rapid urease test (RUT) and urea breath test (UBT) for detecting Helicobacter pylori (H. pylori) in patients with Billroth II (BII) gastrectomy, using histology as reference. METHODS In this prospective controlled study, 31 consecutive patients with BII gastrectomy and 73 controls who had an indication for endoscopy were included. Their H. pylori status was assessed with biopsies for histology, RUT and UBT. Histology served as the gold standard. Only the biopsies from the gastric fundus were evaluated. Specificity, sensitivity, positive and negative predictive value, degree of agreement and k-statistics were used. RESULTS RUT and UBT for detecting H. pylori in the control group had excellent agreement [97%, kappa (k)=0.94 and 99%, k=0.97 respectively] with biopsies. In BII patients, RUT from fundic biopsies had very good agreement (87%, k=0.74) compared to histology from fundic biopsies, whereas the UBT was unreliable (agreement: 71%, k=0.41) compared to histology. CONCLUSION The RUT from fundic biopsies in BII patients is a reliable test for H. pylori detection, whereas the UBT is unreliable.

Home monitoring is the optimal method for assessing blood pressure variability

Blood pressure is a continuous variable with dynamic characteristics and considerable inherent fluctuation that is predominantly affected by physical and, to a lesser extent, mental activity. The assessment of the blood pressure abnormality and the classification of hypertension are traditionally made on the average of multiple measurements taken in the office or by 24-hour ambulatory or self-home monitoring, whereas the blood pressure fluctuations, which often rise well above the average blood pressure level, are usually regarded as ‘random’ and ‘noise,’ and are thus ignored.1

Prediction of treatment-induced changes in target-organ damage using changes in clinic, home and ambulatory blood pressure

Cross-sectional studies have shown that ambulatory and home blood pressure (ABP and HBP, respectively) measurements are more closely associated with preclinical organ damage than are office measurements. This study investigated the association between treatment-induced changes in BP assessed by the three methods and the corresponding changes in organ damage. Untreated hypertensives were evaluated with office, ABP and HBP measurements and indices of organ damage (echocardiographic left-ventricular mass index (LVMI), pulse wave velocity (PWV), albuminuria) before and after 12 months of treatment. A total of 116 subjects completed the study (mean age 50.7±10.5 years, 69 men (59%), mean follow-up 13.4±1.4 months). The treatment-induced change in the LVMI was correlated with changes in BP and pulse pressure (PP) assessed by all methods. The change in PWV was correlated with changes in home systolic and ABP and PP and with the change in home diastolic BP. Albuminuria showed no correlations. In linear regression models, changes in home BP and PP had the strongest predictive ability for the change in the LVMI, whereas the change in ABP was the strongest predictor of the change in PWV. The change in office BP had no predictive value. HBP and ABP measurements appear to be superior to office BP measurements and should be considered complementary rather than interchangeable methods for monitoring the effects of antihypertensive treatment on target-organ damage.

Long-term reproducibility of home vs. office blood pressure in children and adolescents : the Arsakeion school study

This study compared the long-term reproducibility of home blood pressure (BP) in comparison with office BP in children and adolescents. Forty-eight subjects (27 boys, mean age 11.3±3.1 (s.d.) years) recruited from the Arsakeion school study because of elevated office and/or home BP were assessed with office (1 visit, mercury sphygmomanometer) and home BP measurements (3 days, electronic devices) in two assessments 17±4.9 months apart (range 10–26 months). Home and office BP were compared on the basis of the following criteria: (a) s.d. of mean BP; (b) s.d. of differences; (c) variation coefficient (CV); (d) concordance correlation coefficient (CCC); (e) test-retest correlations; (f) correlation with ambulatory BP. (a) The s.d. of mean home BP was lower than that of office BP in both the initial (home BP 9.1/7.1 mm Hg, systolic/diastolic; office BP 13.1/8.0 mm Hg) and the second assessment (9.2/6.0 and 14.9/11.5 respectively). (b) The s.d. of differences was lower for home BP (8.3/6.5 mm Hg, systolic/diastolic) than for office BP (13.9/10.7 mm Hg). (c) The CV of home BP (5.3/6.6, systolic/diastolic) was lower than that of office BP (8.2/10.9). (d) The CCC of home BP (0.54/0.50, systolic/diastolic) was higher than that of office BP (0.51/0.41). (e) Test-retest correlations were closer for home BP (r=0.58/0.52, systolic/diastolic) than for office BP (0.51/0.44). (f) Awake ambulatory BP was more closely associated with home (r=0.77/0.40, systolic/diastolic) than with office BP (0.65/0.24). These data suggest that in children and adolescents the long-term reproducibility of home BP is superior to that of office measurements.

Ambulatory and home blood pressure monitoring in children and adolescents: diagnosis of hypertension and assessment of target-organ damage

The prevalence of elevated blood pressure in children and adolescents is more common than previously believed and often represents the early onset of essential hypertension, particularly in adolescents. The definition of hypertension in children is based on distribution criteria and normalcy tables that provide blood pressure percentiles for each measurement method (office, ambulatory and home) according to the individual’s age, gender and body size. Owing to the white coat and masked hypertension phenomena, ambulatory blood pressure monitoring is indispensable for the diagnosis of hypertension in children. Home blood pressure monitoring in children has been less well studied, and at present, treatment decisions should not be based solely on such measurements. Hypertension-induced preclinical target-organ damage (mainly echocardiographic left ventricular hypertrophy) is not uncommon in children and should be evaluated in all hypertensive children. Other indices of target-organ damage, such as carotid intima-media thickness, pulse wave velocity and microalbuminuria, remain under investigation in pediatric hypertension.