Summary. Serial haemodynamic investigations were performed in 15 women at 38 weeks gestation and then 2, 6, 12 and 24 weeks after delivery. Cardiac output was measured by Doppler and cross‐sectional echocardiography at the aortic, pulmonary and mitral valves. Cardiac chamber size and ventricular function were investigated by M‐mode echocardiography. Flow measurements at the three intracardiac sites correlated closely. Cardiac output fell from a mean of 7.421/min at 38 weeks to 4.961/min at 24 weeks after delivery, a fall of 33%. Most of this decrease (28%) had occurred by 2 weeks. This was associated with a 20% reduction in heart rate and an 18% reduction in stroke volume. By 2 weeks after delivery there was a significant decrease in left atrial dimension and left ventricular end‐diastolic dimension. Left ventricular wall thickness and mass declined throughout the period of study as did aortic, pulmonary and mitral valve areas. M‐mode derived indices of myocardial contractility were all significantly reduced by 2 weeks and thereafter showed no further change. No haemodynamic differences were found between lactating and non‐lactating mothers.

Summary. A non‐invasive technique for the measurement of cardiac output in pregnancy by combined cross‐sectional and Doppler echocardiography at three intracardiac sites is described. The validity of the technique for use during pregnancy is reviewed. Comparison with cardiac output determined simultaneously by the direct Pick technique in 15 non‐pregnant subjects showed close agreement for all three measurement sites. Acceptable measurements were obtained from the aortic and pulmonary valves in all pregnant subjects and from the mitral valve in 84% of pregnant subjects. The within‐patient intra‐observer and hour‐to‐hour variabilities of cardiac output in pregnant and non‐pregnant subjects were <5% of the mean for all three valves studied. Flow measurements at each of the three intracardiac sites correlated closely. The advantages and limitations of the technique for use during pregnancy are discussed.

No abstract

Only 2 AOBP readings taken over 6 minutes (excluding an initial reading immediately after sitting) may be needed to be comparable with daytime ABP.

The aim of our study was to estimate the size of regression to the mean with home blood pressure (BP) monitoring and compare with that for office BP. Office and home BP measures were obtained from the BP GUIDE (value of central Blood Pressure for GUIDing managEment for hypertension) study, in which 286 patients had BP measured every 3 months for 12 months. Patients were categorized by 10 mm Hg strata of baseline BP, and regression to the mean measures was calculated for home and office BP. High baseline home BP readings tended to be lower on long‐term follow‐up, and low baseline readings tended to be higher. For example, patients in the group with mean baseline home systolic BP ≥ 150 mm Hg had a mean baseline systolic BP of 156 mm Hg, which fell to 143 mm Hg at 12 months; and patients in the group with mean baseline home systolic BP < 120 mm Hg had a mean baseline systolic BP of 113 mm Hg which rose to 120 mm Hg at 12 months. Similar patterns were seen in intervention and control groups, and for diastolic BP. The regression dilution ratio for home systolic BP and diastolic BP was 0.52 and 0.64, respectively, compared to 0.40 and 0.55 for office systolic BP and diastolic BP, respectively. Home BP is subject to regression to the mean to a similar degree as office BP. These findings have implications for the diagnosis and management of hypertension using home BP.

No abstract

Background: A hypertensive response to exercise (HRE) is associated with cardiovascular disease and high blood pressure (BP). A poor cardiovascular risk factor profile may underlie these associations, although this has not been systematically elucidated. Via systematic review and metaanalysis, we aimed to assess the relationship between exercise BP and cardiovascular risk factors, and determine if cardiovascular risk is higher in those with an HRE vs. no-HRE across different study populations (including those with/without high BP at rest).Methods: Three online databases were searched for crosssectional studies reporting data on exercise BP, an HRE and cardiovascular risk factors (including arterial structure, lipid, metabolic, inflammatory and kidney function markers). Random-effects meta-analyses and meta-regression were used to calculate pooled correlations between exercise BP and each risk factor and pooled mean differences between those with/without an HRE.Results: Thirty-eight studies (38 295 participants, aged 50 AE 3years; 78% male) were included. Exercise SBP was associated with arterial, lipid and kidney function risk markers (P < 0.05). Those with an HRE had greater aortic stiffness (R0.80 AE 0.35 m/s), total (R0.14 AE 0.03 mmol/l) and low-density lipoprotein (R0.12 AE 0.03 mmol/l) cholesterol, triglycerides (R0.24 AE 0.04 mmol/l), glucose (R0.15 AE 0.05 mmol/l), white blood cell count (R0.49 AE 0.16 mmol/l) and albumin-to-creatinine ratio (standardized mean difference: R0.97 AE 0.34), and lower flow-mediated dilation (À4.13 AE 1.02%) and high-density lipoprotein cholesterol (À0.04 AE 0.01 mmol/l) vs. those with no-HRE (P < 0.05 all). Results were broadly similar across study populations. Conclusion:Exercise SBP is associated with multiple cardiovascular risk factors, which appear worse in those with an HRE vs. no-HRE. As results were similar across population groups, an HRE should be considered an important indicator of cardiovascular risk.

Manual measurement of blood pressure (BP) during exercise testing is the recommended standard. Automated measurement of BP is an alternative method used during clinical exercise testing, but there is little data comparing manual and automated BP in this setting. The aim of this study was to determine the concordance between manual and automated BP during a standard clinical treadmill exercise test. 416 participants (66 ± 5 years; 54% male) completed a Bruce treadmill exercise test at baseline or follow‐up within a clinical trial of participants with type 2 diabetes mellitus. Manual and automated BP were measured simultaneously at each exercise test stage. Manual BP was measured by a technician blinded to automated BP values (Tango+, Suntech). Concordance between manual and automated BP was assessed using mean differences and intraclass correlations (ICC). Concordance between manual and automated BP across all exercise stages was excellent for systolic BP (overall mean difference: 3 ± 11 mm Hg, P = .598; ICC = 0.964 [95% CI 0.942‐0.977] and pulse pressure (overall mean difference: 2 ± 14 mm Hg, P = .595; ICC = 0.934 [95% CI 0.899‐0.956]). Concordance between manual and automated diastolic BP across all exercise stages was moderate‐to‐good (overall mean difference: 1 ± 9 mm Hg, P = .905; ICC = 0.784 [95% CI 0.672‐0.858]). Automated BP using the Tango + device is concordant with manual BP during early stages of a standard clinical exercise test. Thus, this automated method may be a suitable alternative to manual measurement of BP during clinical exercise testing.