M. Winnicki

Ambulatory Blood Pressure Monitoring Editing Criteria* Is Standardization Needed?

The effect of different editing methods on the reproducibility of ambulatory blood pressure and on its correlation with microalbuminuria was studied in a population of 584 stage I hypertensives participating in the Hypertension and Ambulatory Recording Venetia Study (HARVEST) Group. For systolic blood pressure (SBP), a modified version of the Casadei method showed the best reproducibility indices, followed by the original Casadei and the Kennedy methods. The Staessen, SpaceLabs, and A&D methods showed poorer indices, irrespective of whether calculations were made in recordings with more or less than 10% artifactual readings. For diastolic blood pressure (DBP), reproducibility indices did not substantially vary with the various editing procedures except for the Kennedy method, which showed a slightly better performance. Blood pressure variability (standard deviation) showed a better reproducibility with the original and modified versions of the Casadei and the Kennedy procedures than with the other methods, especially in the subjects with percentage of measurement errors greater than 10%. The correlation coefficients between 24-h SBP and albumin excretion rate ranged from 0.128 for the raw data to 0.154 for the data edited according to the Casadei procedures. For DBP, the correlation coefficients were similar except for DBP edited with the Kennedy method, which did not correlate with albumin excretion rate to a statistically significant level. These data suggest that, to make the results of different laboratories comparable, common ambulatory blood pressure editing criteria should be used. The modified version of the Casadei procedure, which is automatic and can be applied to recordings obtained from any device, should be regarded as the method of choice.

Alpha-adducin Gly460Trp polymorphism, left ventricular mass and plasma renin activity

Objective Left ventricular hypertrophy (LVH) is associated with an increased risk for cardiovascular morbidity and mortality. Epidemiological studies suggest that LVH may be influenced by genetic factors. However, the evidence associating individual genes with left ventricular (LV) mass is inconsistent and contradictory. Methods We investigated the association between angiotensin-converting enzyme insertion/deletion, angiotensinogen M235T and α-adducin Gly460Trp polymorphisms with LV mass and plasma renin activity (PRA) in 162 men with mild, never-treated hypertension who were recruited for the Hypertension and Ambulatory Recording Venetia Study. The effect of each polymorphism on LV mass and PRA was tested in one-way analysis of covariance using LV mass index or PRA as the dependent variable after adjusting for covariates. Results The α-adducin polymorphism was the only individual polymorphism independently associated with LV mass index (F = 7.78, P = 0.006). Patients homozygous for the Trp allele of that polymorphism had a LV mass index (123.4 ± 10.5 g/m2) significantly higher compared with heterozygotes (90.8 ± 2.5 g/m2, P < 0.01) or Gly homozygotes (94.7 ± 1.7 g/m2, P < 0.05). These subjects also have significantly lower PRA (F = 4.2, P = 0.017). Albeit uncommon, 40% of Trp homozygotes of the α-adducin polymorphism had LVH (odds ratio, 15.1; 95% confidence interval, 3.0–82.1). Conclusions The homozygotic state of the Trp allele of α-adducin Gly460Trp polymorphism is independently associated with increased LV mass and low PRA. These data suggest that genetic considerations may contribute importantly to risk stratification, and perhaps therapeutic interventions targeted at LVH and the renin–angiotensin system in hypertensive patients.