Introduction: BP assessed by ABPM is better related to TOD than office measurement. Evaluate TOD patients presented at a Hypertension Lab for first screening. Methods: 353 hypertensive (188 Female, aged 19-89) by 24h-ABPM (SpaceLabs 90307), lab. tests, LVMIU by Echo (Terason, M3000), Divided in two groups: Controlled [C] by 24h-BP (<130x80 mmHg) and Not controlled [NC] (>130/80 mmHg), albuminuria (ALB). Results: Table shows no difference detected in lab panel, except Glu, Trygl, ALB and LVMI. Discussion: Expected Higher, Glu, trygl, ALB levels and LVMI, in NC group, with significant statistical differences comparing C group. Expected because the high blood pressure are the trigger to TOD. Conclusion: Screening with 24-h ABPM is a valuable tool to hypertensives patients and should be used more frequently to prevent TOD progression.
BP assessed by ABPM is better related to TOD than office measurement. Evaluate TOD patients presented at a Hypertension Lab for first screening. Methods: 278 hypertensive (147 Female, aged 19-89) by 24h-ABPM (SpaceLabs 90307), lab. tests, LVMI by Echo (Terason M3000); Divided in two groups: Controlled [C] by 24h-BP (<130x80 mmHg) and Not controlled [NC] (>130/80 mmHg), albuminuria (ALB) was log transformed in order to allow proper analysis. Dipping pattern 24h-ABPM: dipper (DP) (>10- 20%), nondipper-absente (NDP) (<10%), reverse dipper (RDP)(> 20%). Results: Table 1 and 2 : Demography and ALB,LVMI. No differences detected in lab panel, except Glu, Trygl, ALB and LVMI. Discussion: Expected Higher LVMI, Glu, trygl, ALB levels, in NC group, with significant statistical differences comparing C group. Expected reverse dipping pattern would show differences when compared with dipper pattern but probably the small number of subjects didn’t allow detect such differences. Conclusion: Screening with 24-h ABPM is a valuable tool to hypertensives and dipper pattern should be achived to prevent TOD progression.
Introduction: Resistant hypertension (RHTN) defined as the failure to reach goal BP, with at least 3 drugs including a diuretic (JNC-VII). Affects 5-30% HTN, become high risk of developing target organ damage, like LVH rasing morbi-mortality (Framingham Study). Then is necessary a better treatment plan the early diagnosis. The electrocardiogram (ECG) and the vectorcardiogram (VCG), graphic methods (GM), alone, present, in spite of high specificity, have low sensitivity compared with echocardiography (ECHO). Objective: Analyze ECG/VCG for LVH diagnosed by ECHO in RHTN. Methods: Population: 120 RHTN. Excluded diabetic, valve heart, coronary, renal diseases and obese. Study Protocol: After 06 months, between 2008 and 2011, measures BP monthly (JNC-VII) receiving directions, as well as pill counts (Taylor Method) to assess compliance. Underwent ECHO (ASE) then GM. ECG&VCG methods: ECG Criterion: Sokolow-Lyon I(SL-I):SV1+RV5(6)≥3.5mV & II(SL-II):RavL≥1.1mV; Gübner(G):SDI+RDIII≥2.5mV;Cornell(C):RavL+SV3≥2/2.8mV(woman/man);Romhilt-Estes(RE):Point Score≥5points; Perugia(P): RE or C(modify) or Strain. VCG Criterion: Mag Max QRS on Planes horizontal(HP) & frontal(FP): vector≥2mV and right saggital(rSP): vector≥1.6 mV; Defl QRS HP & rSP: angle≥ 330° & ≥150°. Statistical Analysis: Sensibility(SENS), accuracy(ACCU) and specificity(SPEC) to analyse GM. Results: Criterion Sens (%) Accu (%) Spec (%) SL-I 27 (16/60) 61 (73/120) 93 (56/60) G 18 (11/60) 58 (69/120) 97 (58/60) SL-II 18 (11/60) 58 (69/120) 97 (58/60) C 25 (15/60) 59 (71/120) 93 (56/60) RE 32 (19/60) 58 (77/120) 95 (58/60) P 50 (30/60) 68 (81/120) 85 (51/60) Mag Max QRS PH 28 (17/60) 61 (73/120) 93 (56/60) Mag Max QRS PSr 12 (07/60) 52 (62/120) 92 (55/60) Mag Max QRS PF 25 (15/60) 57 (68/120) 88 (53/60) Defl QRS PH 12 (07/60) 52 (62/120) 92 (55/60) Defl QRS PSr 13 (08/60) 50 (60/120) 87 (52/60) COMBINED* 70 (42/60) 76 (91/120) 82 (49/60) Conclusion: ECG: P had the best SENS & ACCU, SL-II and G both showed the best SPEC. VCG: best criteria Mag Max QRS PH. Combined criteria* using best SENS and ACCU of each GM improved SENS & ACCU demonstrated SPEC without injury to LVH in RHTN detection. Can be worn with method in a cost effectiveness ratio and in places where access is difficult to ECHO to be performed.
Introduction: Left ventricular hypertrophy (LVH) is an important cardiocerebrovascular risk factor and due to this fact, when present , in hypertensive patients should plan a more elaborate therapeutic treatment. The hsCRP is systemic inflammatory marker associated with increased risk of myocardial infarction and vascular diseases. Objective: Identify hsCRP as a strong biomarker with correlation with LVH in resistant hypertensive patients (RHTN). Methodology: A total of 180 patients: 60 RHTN and 60 RHTN with LVH with echocardiographic diagnosis (LVH-RHTN), compared to 60 normal subjects (control), with equal distribution of gender and age. The hs-CPR was measured using nephelometry method. Results: In LVH-RHTN hsCRP was 3.96 ± 1.11 mg/L and was significantly higher when compared with RHTN, which was 2.20 ± 0.53 mg/L, and with hsCRP 0.56 ± 0.23 in CON (p <0.001). There is a strong correlation between elevated hsCRP and LVH in patients with resistant hypertension, as shown by the Pearson coefficient (r = 0.74). Conclusion: hsCRP can be considered a strong predictor biomarker in presence of LVH in RHTN.
The difficult of most of patients in access the echocardiogram (ECHO) diagnosis services are common in small cities located far away from reference towns centers. Graphics methods (GM) , like electrocardiogram (ECG) and vectorcardiogram (VCG), have high sensibility but low specificity in detect LVH. The ECHO diagnosis criterion of LVH based on indexed left ventricular mass (LVMI), is usual and used now a days beside other methods like Nuclear Magnetic Ressonance. Objectives: Evaluate LVMI correlation with ECG and VCG criteria in patients with RHTN. Population: 120 RHTN patients were evaluated. Excluded patients with diseases: diabetes, valve heart, coronary, Chagas, renal, obese and excentric LVH. Study Protocol: After 06 months, between 2008& 2011, measures BP monthly following the technique (JNC-VII) and receive directions, as well as pill counts (the method of Taylor) to assess compliance. Underwent echocardiography, following the recommendations of the ASE, then ECG and VCG. Formula to calculate LVMI : LVMI = 0,8 x{1.04x [(SIVD + DDVE + PPVED)3 - (DDVE)3]} + 0,6 g/(M-60) x 0,01 + H) ECG and VCG criteria to detect LVH: ECG Criterion: Sokolow-Lyon I(SL-I):SV1+RV5(6)≥3.5mV & II(SL-II):RavL≥1.1mV; Gübner(G):SDI+RDIII≥2.5mV; Cornell(C):RavL+SV3≥2/2.8mV(woman/man); Romhilt-Estes(RE):Point Score≥5points; Perugia(P): RE or C(modify) or Strain. VCG Criterion: Mag Max QRS on Planes horizontal(HP) & frontal(FP): vector≥2mV and right saggital(rSP): vector≥1.6 mV; Defl QRS HP & rSP: angle≥ 330° & ≥150°. Statistical Analysis: The correlations were obtained using the Pearson’s correlation formula and the is considered a good correlation values above 50%, and excellent correlation values above 70%. Values less than 50% are considered weak correlation. Results are expressed as mean and standard deviation, and relative values in percentage. Results: Criterion Correlation R SL- I 0.49 G 0.42 SL-II 0.50 C 0.49 RE 0.51 Mag Max QRS HP 0,59 Mag Max QRS rSP 0.60 Mag Max QRS FP 0.51 Defl QRS PH 0.33 Defl QRS rSP 0.56 Conclusion: The better correlation between LVMI and ECG criterion was Romhilt-Estes and the better for the VCG was Mag Max QRS HP. The VCG had the best correlation. Considered a good alternative to estimate the LVMI.
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