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Renal Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Patients require 24-hour ambulatory blood pressure monitoring (unless present with severe or malignant hypertension when this is required to monitor response to therapy as opposed to confirming hypertension). The most useful diagnostic tests include blood and urine tests (to see if hypokalaemic metabolic alkalosis and evidence of hyperreninaemic hyperaldosteronism, renal dysfunction, haematuria and/or proteinuria), echocardiography (to exclude target organ damage with left ventricular hypertrophy but excluding coarctation of the aorta), Doppler renal ultrasound, DMSA scan prior to proceeding with renal vein renin and digital subtraction angiography. However, the vascular disease may involve intrarenal vessels and other organs (particularly the brain). Therefore, investigations should also be directed to identify these, especially if there are cerebral symptoms.
Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up
Published in Blood Pressure, 2019
Päivi A. Lempiäinen, Riitta-Liisa Vasunta, Risto Bloigu, Y. Antero Kesäniemi, Olavi H. Ukkola
Ambulatory blood pressure measurement (ABPM) is a method consisting of repeated blood pressure (BP) measurements during daytime and nighttime, providing an assessment of mean BP and diurnal pattern of BP variation over 24 h. Physiologically most individuals have a clear circadian BP rhythm characterized by a nighttime drop of 10–20% in both systolic and diastolic BP level. BP dropping by night is called dipping. Among some subjects the nocturnal decline is lacking. This phenomenon is called non-dipping [1]. Non-dipping pattern has been associated with several cardiovascular risk factors [2], metabolic syndrome [3], and other target organ damage such as chronic kidney disease [4]. Ambulatory mean systolic BP has been shown to predict cardiovascular events better than clinic BP in previous population studies [5], especially nighttime systolic BP [6]. In Dublin Outcome Study with a cohort of over 11,000 diabetic patients with a mean follow-up of 5.3 years, nighttime systolic BP was a significant predictor of cardiovascular (CV) mortality [7]. In another study with diabetic patients, non-dipping was recognized as an independent risk factor for cardiovascular events and mortality even in normotensive subjects [8]. In a recent large register-based study with a 5.7-year of follow-up, ambulatory systolic BP was a stronger predictor of all-cause and cardiovascular mortality than clinic systolic BP [9].
Telemonitoring for hypertensive disease in pregnancy
Published in Expert Review of Medical Devices, 2019
Asma Khalil, Helen Perry, Dorien Lanssens, Wilfried Gyselaers
Ambulatory blood pressure monitoring (ABPM) consists of wearing a BP monitor for a prolonged period (typically 24 h). The monitor is programmed to measure and record BP at selected intervals to provide a trend and average. ABPM is commonly used in the general population to diagnose hypertension and can be useful in distinguishing white coat hypertension. Higher ambulatory readings have been shown to correlate with subclinical echocardiographic changes and microalbuminuria in normotensive women with a previous history of preeclampsia [19] and are more closely associated with pregnancy outcomes including preterm birth and low birthweight (<10th centile) compared to clinic readings [20]. Rhodes et al. conducted a feasibility randomized controlled trial of ABPM in pregnancy and found it acceptable to patients and clinicians but that it did not reduce the amount of obstetric input; however, the study was underpowered for the main outcome measures [21].
Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus
Published in Clinical and Experimental Hypertension, 2018
Blood pressure is assessed using an automated, semi-automated, or manual device for office blood pressure measurement; or an automated device for home/self or ambulatory blood pressure monitoring.Office blood pressure: If blood pressure is assessed in a research/clinical office, multiple blood pressure readings must be taken and averaged at each assessment. Office blood pressure evaluation on repeated occasions (visits) is preferred to establish more accurately an individual’s blood pressure level both at baseline and during an intervention.Out-of-office blood pressure: It is further preferred that out-of-office (ambulatory or home/self) blood pressure be assessed rather than only assessments in research/clinical offices. For out-of-office assessments, it is preferred to use an ambulatory blood pressure over home/self-monitoring or to use both methods. For ambulatory blood pressure monitoring, there must be repeated blood pressure measurements over a minimum of 24 hours during a person’s routine day. The ambulatory monitoring must be performed at baseline and at least once during the intervention. For home/self-blood pressure monitoring, an average of two readings in the morning and two readings in the evening conducted on 5–7 serial days is recommended to establish a person’s blood pressure both at baseline and during the intervention (23–26). The validity (assessment) of home/self-blood pressure during an intervention must be assessed (conducted) at least once.