Blood pressure
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The effectiveness of hypertension treatment remains low in many developed countries. The aim of our study was to evaluate the treatment effectiveness in hypertensives treated by general practitioners (GPs) in Poland. Twenty thousand three hundred and five hypertensive patients (mean age 60.1 +/- 12.0 years, 9918 women, 10 387 men), pharmacologically treated by 677 GPs in Poland, were investigated. ⋯ In this cohort, 26.7% of patients were treated with one, 37.6% with two, 26.7% with three, 8.2% with four and 0.8% with five antihypertensive drugs. Mean number of antihypertensive drugs prescribed for one hypertensive patient was 2.2 +/- 1.0. Effectiveness of hypertension treatment by GPs in Poland remained unsatisfactory despite frequent implementation of combined antihypertensive drug therapy.
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Five different semiautomatic manometers were tested, where oscillometry is the measuring principle. Three of the manometers (Omron R4, A&D UB 322 and Braun) were wrist manometers, where the occluding cuff is placed around the volar surface of the wrist. Two of the manometers (A&D UA 777 and Omron M4) measure on the upper arm. ⋯ The most important point is that the measuring accuracy in a single patient is unpredictable. If home readings are prepared, a test of the accuracy against auscultatory recordings should be done in every single patient. In the clinical wards, it is important to be aware of the measuring accuracy if oscillometric measurements are introduced replacing auscultatory measurements.
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Comparative Study
Nocturnal blood pressure and relation to vasoactive hormones and renal function in hypertension and chronic renal failure.
The purpose of this study was to assess the blood pressure profile and to measure vasoactive hormones in patients with essential hypertension (n=61), secondary hypertension (n=32) and chronic renal failure (n=32) matched with healthy control subjects (n=35), and to study the relationship between circadian changes in blood pressure and baseline levels of vasoactive hormones and renal function. Non-invasive, automatic blood pressure measurement was performed for 24 or 48 h. Venous plasma concentrations of renin, angiotensin II, aldosterone, arginine vasopressin, atrial natriuretic peptide and endothelin were measured. ⋯ In conclusion, patients with essential hypertension have elevated but normally configured 24-h blood pressure profiles, and patients with different kinds of secondary hypertension have elevated 24-h blood pressure profiles and attenuated nightly systolic and diastolic blood pressure falls. The more the renal function is reduced and the more the plasma levels of renin and aldosterone are increased, the more the nocturnal fall in blood pressure is reduced. It is suggested that the attenuated or absent decrease in nocturnal blood pressure in secondary renal hypertension is caused by an abnormally increased secretion of vasoactive hormones and/or by so far unknown factors released from the diseased kidney.
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Clinical Trial
Differences in orthostatic blood pressure changes measured with an oscillometric blood pressure monitor and a mercury sphygmomanometer.
To compare orthostatic blood pressure (BP) changes recorded with the SpaceLabs 90207 BP monitor (SL) and the standard mercury sphygmomanometer (HgS). ⋯ Orthostatic BP falls measured by an automatic oscillometric BP monitor may not be equivalent to those taken with a HgS and their use adds a further variable to the comparison of orthostatic BP changes between studies.