Assessment of Patients With Office Hypertension by 24-Hour Noninvasive Ambulatory Blood Pressure Monitoring

White, William Β.

doi:10.1001/archinte.1986.00360230126018

Cited by 72 publications

(24 citation statements)

References 16 publications

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“…1,21,25,26 Pavlov showed that sympathetic nervous system reactions were weakened by repeated exposure to stimulus, which may explain why there is a gradual fall of BP and HR in a patient who attends an outpatient clinic frequently. 25,45 This adaptation effect is consistent with our finding of minimum mean SBP at year 5 and minimum mean DBP at year 2 despite increasing age.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate and Subsequent Blood Pressure in Young Adults

et al. 1999

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Abstract-The objective of the present study was to examine the hypothesis that baseline heart rate (HR) predicts subsequent blood pressure (BP) independently of baseline BP. In the multicenter longitudinal Coronary Artery Risk Development in Young Adults study of black and white men and women initially aged 18 to 30 years, we studied 4762 participants who were not current users of antihypertensive drugs and had no history of heart problems at the baseline examination (1985)(1986). In each race-sex subgroup, we estimated the effect of baseline HR on BP 2, 5, 7, and 10 years later by use of repeated measures regression analysis, adjusting for baseline BP, age, education, body fatness, physical fitness, fasting insulin, parental hypertension, cigarette smoking, alcohol consumption, oral contraceptive use, and change of body mass index from baseline. The association between baseline HR and subsequent systolic BP (SBP) was explained by multivariable adjustment. However, HR was an independent predictor of subsequent diastolic BP (DBP) regardless of initial BP and other confounders in white men, white women, and black men (0.7 mm Hg increase per 10 bpm). We incorporated the part of the association that was already present at baseline by not adjusting for baseline DBP: the mean increase in subsequent DBP was 1.3 mm Hg per 10 bpm in white men, white women, and black men. A high HR may be considered a risk factor for subsequent high DBP in young persons. (Hypertension. 1999;33:640-646.)Key Words: heart rate Ⅲ blood pressure Ⅲ hypertension Ⅲ regression analysis Ⅲ race T hough evidence has been accumulating that heart rate (HR) is a correlate of blood pressure (BP), HR has not been the central focus of epidemiological investigations of BP. 1 Yet numerous cross-sectional or case-control studies show an independent relationship between HR and hypertension 14,[17][18][19] or with both systolic BP (SBP) and diastolic BP (DBP). 8,9,13,16,22,23 Prospective studies 2-7,10 -12,15,20,21,24,28 on the association between HR and subsequent BP are inconsistent. Many, but not all, lose statistical significance after adjustment for baseline BP, the most potent predictor of subsequent BP. Important confounders such as physical activity or fitness are not considered in these studies. Thus, whether HR affects BP level remains uncertain. Also, cross-sectional HR-BP associations have been found to be different in blacks compared with whites. 7,11,27 We tested the following hypotheses in young black and white participants in the Coronary Artery Risk Development In young Adults (CARDIA) study: 1. Baseline HR is an independent predictor of subsequent BP after adjustment for baseline BP and other confounders. 2. Race-sex is an effect modifier for the association between HR and subsequent BP. MethodsCARDIA is a multicenter longitudinal epidemiological study of the determinants of cardiovascular risk factors during young adulthood. Methods are described in detail elsewhere. 29,30 Briefly, 5115 black and white women and men aged 18 to 30 years at b...

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Section: Discussionmentioning

confidence: 99%

Heart Rate and Subsequent Blood Pressure in Young Adults

et al. 1999

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“…White-coat hypertension has been described in patients who have elevated blood pressure in the doctor's office but normal values during 24-hr ambulatory recordings [7,47]. Furthermore, restraint stress and swim stress enhance sympathetic activity, which causes an increase in plasma NA and AD [29].…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Modulation by Sympathetic Nerves in Dogs with Heart Failure.

Uechi

Shimizu

Mizuno

2002

The Journal of Veterinary Medical Science

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ABSTRACT. To clarify heart rate modulation by the sympathetic nervous system, dogs with naturally acquired and experimentally induced heart failure were examined. Heart rate and plasma catecholamine concentrations were measured in clinically healthy dogs (contr ol dogs) and dogs with mitral regurgitation (MR) during a resting period, a standing period, a period of standing in a medical examination room (to which the dogs were unaccustomed), a running period, and a period of recovery after running. The heart rate and plasma cate cholamine concentration increased in control dogs during the standing period and the medical examination room period, relative to the resting period. However, dogs with MR did not exhibit any clear increase in heart rate or catecholamine concentration under these light stress conditions. Running stress increased plasma catecholamine levels in control dogs; however, dogs with MR did not exhibit any significant changes. Thirty-two dogs with naturally acquired heart disease were classified as grades I to III on the ISACHC scale. The degree of increase in heart rate and plasma catecholamine levels in dogs with naturally acquired heart failure depended on their degree of heart failure. In conclusion, an increased heart rate and an activated sympathetic nervous system were observed, even in mild heart failure. This chronically activated sympathetic activity is expected to increase myocardial oxygen consumption, myocardial hypertrophy, and fibrosis, and to portend a poorer prognosis in heart failure. KEY WORDS: catecholamine, exercise, mitral regurgitation, stress.J. Vet. Med. Sci. 64(11): 1023-1029, 2002 Congestive heart failure (CHF) is characterized by increased peripheral vascular resistance and tachycardia. The reduced cardiac output in cardiac disease leads to failure of the peripheral blood circulation because of decreased parasympathetic tone and increased sympathetic tone [1,9,32,36,38,39]. Neurohumoral activation of the sympathetic nervous system and the renin-angiotensin-aldosterone axis, etc. increases circulating blood volume and arterial pressure by causing vasoconstriction and sodium and fluid retention [16]. Elevated plasma noradrenaline (NA) has been shown to contribute to the pathological chronotropic response, which leads to progression of CHF [9,32,36,38,39,44]. Chronic adrenergic stimulation has been shown to have a direct cardiotoxic effect [22,26], and elevated NA levels are associated with a poorer prognosis and increased mortality [9,11,31].The purpose of this study was to measure the plasma concentrations of the catecholamines NA and adrenaline (AD) in dogs with naturally acquired heart disease, mitral regurgitation (MR), tricuspid regurgitation (TR), and dilated cardiomyopathy and right ventricle heart failure due to Dirofilalia imitis infection. We also evaluated in changes in the plasma concentrations of NA and AD during rest, light stress, running, and recovery from running in iatrogenic mitral regurgitation dogs. MATERIALS AND METHODSThe methods used in this study ...

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“…Therefore, readings obtained while the patients were in the clinic are included in these components. The mean number of total CLIN readings in the 100 procedures ±SEM (range), was 4.9±0.1 (2)(3)(4)(5)(6)(7)(8). Clinicunrelated readings were defined as those occurring during routine daily activities (ACT), did not include those while bedbound or asleep, and their mean number was 17.4±0.5 (4-30) in the 100 procedures.…”

Section: Discussionmentioning

confidence: 99%

“…2 Knowledge of the magnitude of this response can have implications for patient management and for assessment of cardiovascular risk. The magnitude of the white coat phenomenon has been estimated in outpatients by comparison of intra-arterial 3 or noninvasive 4 ambulatory BPs to sphygmomanometric readings in the clinic. These approaches did not take into consideration possible differences attributable to the use of two methods of measurement.…”

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confidence: 99%

Magnitude, reproducibility, and components of the pressor response to the clinic.

Elijovich

Laffer²

1990

Hypertension

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We investigated the magnitude of the pressor response to the clinic with ambulatory monitors by comparing blood pressure readings related to the medical visit with all clinic-unrelated readings during the day. One hundred studies were conducted on 51 hypertensive patients who were placed either on placebo (67) or on monotherapy with hydrochlorothiazide, atenolol, or the converting enzyme inhibitors captopril or zofenopril. On placebo, clinic-related systolic (162±2), diastolic (101±l), and pulse (61 ±2) pressures (mm Hg) were significantly higher than the respective clinic-unrelated values (149±2, 93±1, and 56±1 mm Hg). Heart rates were not different. Despite significant reductions of blood pressure, the same pattern was found during treatment. After initiating the monitoring and while in transit to job or home (initial component of the clinic-related readings), systolic (166±2 mm Hg) and pulse (64±2 mm Hg) pressures were higher than those during return to the office the next day (final component, 158±3 and 58±2 mm Hg). Blood pressures of both components, however, were significantly higher than the clinic-unrelated ones. In 19 repeat studies carried out 2-24 months apart on placebo, the average pressor response did not change from the first (13±3/11±2) to the second (13±4/11±2 mm Hg) procedure. No correlation, however, was found between the first and second study responses of individual patients. We conclude that the pressor response to the clinic 1) has a magnitude of 13±2/9±1 mm Hg (p<0.001), 2) is not altered by antihypertensive therapies with different mechanisms of action, 3) is not reproducible, 4) is associated with increased pulse pressure, and 5) has a hitherto undescribed component that differs from the "white coat phenomenon" in that it precedes the encounter with the physician. (Hypertension 1990;15(suppl I):I-161-I-165)

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Assessment of Patients With Office Hypertension by 24-Hour Noninvasive Ambulatory Blood Pressure Monitoring

Cited by 72 publications

References 16 publications

Heart Rate and Subsequent Blood Pressure in Young Adults

Heart Rate and Subsequent Blood Pressure in Young Adults

Heart Rate Modulation by Sympathetic Nerves in Dogs with Heart Failure.

Magnitude, reproducibility, and components of the pressor response to the clinic.

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