SummaryBackground: It would be useful to have a clinical test that increases the suspicion of white coat hypertension (WCH) during the medical consultation.
BackgroundDuchenne muscular dystrophy is an X-chromosome-linked genetic disorder (locus
Xp21). Involvement of the cardiovascular system is characterized by fibrous
degeneration/replacement of myocytes with consequent ventricular hypertrophy
and arterial hypertension.ObjectiveTo assess, by using 24-hour ambulatory blood pressure monitoring, the
behavior of blood pressure variables in children and adolescents with a
confirmed diagnosis of Duchenne muscular dystrophy.MethodsProspective observational cohort study, which selected 46 patients followed
up on an outpatient basis, divided according to age groups. Blood pressure
was classified according to the age percentile. The monitoring
interpretation includes systolic and diastolic blood pressure means,
systolic and diastolic blood pressure loads, and nocturnal dipping. The
blood pressure means were calculated for the 24-hour, wakefulness and sleep
periods. Nocturnal dipping was defined as a drop in blood pressure means
during sleep greater than 10%. The significance level adopted was p <
0.05.ResultsNocturnal dipping for systolic blood pressure was present in 29.9% of the
participants. Approximately 53% of them had attenuated nocturnal dipping,
and 15%, reverse nocturnal dipping. The age groups of 9-11 years and 6-8
years had the greatest percentage of attenuation, 19.1% and 14.9%,
respectively. Regarding diastolic blood pressure, nocturnal dipping was
identified in 53.2% of the children, being extreme in 27.7% of those in the
age group of 6-11 years.ConclusionsThe early diagnosis of blood pressure changes can allow the appropriate and
specific therapy, aimed at increasing the life expectancy of patients with
Duchenne muscular dystrophy.
CONTEXT AND OBJECTIVE: Most hypertensive subjects undergoing treatment were diagnosed solely through measurements made in the consultation office. The objective of this study was to redo the diagnosis of treated patients after new clinical measurements and ambulatory blood pressure monitoring (ABPM). DESIGN AND SETTING: Cross-sectional study conducted in an outpatient specialty clinic. METHODS: Patients with mild-to-moderate hypertension or undergoing anti-hypertensive treatment, without target organ damage or diabetes, were included. After drug withdrawal lasting 2-3 weeks, new blood pressure (BP) measurements were made during two separate visits. ABPM was performed blindly, in relation to clinical measurements. The BP thresholds used for diagnosing hypertension, white-coat hypertension, normotension and masked hypertension were: 140 (systolic) and 90 (diastolic) mmHg for office measurements and 135 (systolic) and 85 (diastolic) mmHg for mean awake ABPM (MAA). RESULTS: Evaluations were done on 101 subjects (70% women); mean age 51 ± 10 years. The clinical BP was 155 ± 18/97 ± 10 mmHg (first visit) and 150 ± 16/94 ± 11 mmHg (second visit); MAA was 137 ± 13/ 86 ± 10 mmHg. Sixty-four patients (63%) were confirmed as hypertensive, 28 (28%) as white-coat hypertensive, nine (9%) as normotensive and none as masked hypertensive. After ABPM, 37% of the presumed hypertensive patients did not fit into this category. CONCLUSION: This study showed that hypertension was overdiagnosed among hypertensive subjects undergoing treatment. New diagnostic procedures should be performed after drug withdrawal, with the aid of BP monitoring.
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