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Nikos Zakopoulos - One of the best experts on this subject based on the ideXlab platform.

  • adolescent obesity is associated with high Ambulatory Blood Pressure and increased carotid intimal medial thickness
    The Journal of Pediatrics, 2005
    Co-Authors: Stella Stabouli, Vasilios Kotsis, Christos Papamichael, Andreas Constantopoulos, Nikos Zakopoulos
    Abstract:

    OBJECTIVES: To investigate 24-hour Ambulatory Blood Pressure, lipid profiles, and carotid artery intimal-medial thickness (IMT) in adolescents with and without obesity. STUDY DESIGN: Ambulatory Blood Pressure data from 93 consecutive adolescents referred to our hypertension center for possible hypertension were analyzed. Fasting serum glucose and lipid concentrations were measured in all subjects. Carotid artery IMT was also measured by B-mode ultrasound imaging in all patients. Obesity was defined as body mass index > or =95(th) percentile for age and sex. Twenty-two of the subjects were obese and 71 nonobese. RESULTS: Mean 24-hour, daytime, and nighttime systolic Blood Pressures were significantly higher in obese subjects compared with nonobese subjects (P < .002). Twenty-four-hour, daytime, and nighttime pulse Pressures were also significantly higher in obese subjects (P < .001). The magnitude of systolic white coat effect was significantly higher in obese subjects (P < .006) and white coat hypertension was significantly more frequent in obese subjects (P < .0001). Obese subjects had higher triglycerides (P < .001) and lower HDL cholesterol (P < .01) than nonobese subjects. Finally, obese adolescents had thicker mean IMT of internal carotid arteries than nonobese adolescents (P < .005). CONCLUSIONS: Obese adolescents have higher Ambulatory Blood Pressure and higher carotid artery IMT, possibly indicating an early course of obesity-related hypertension and carotid artery structural alterations.

  • adolescent obesity is associated with high Ambulatory Blood Pressure and increased carotid intimal medial thickness
    The Journal of Pediatrics, 2005
    Co-Authors: Stella Stabouli, Vasilios Kotsis, Christos Papamichael, Andreas Constantopoulos, Nikos Zakopoulos
    Abstract:

    Objectives To investigate 24-hour Ambulatory Blood Pressure, lipid profiles, and carotid artery intimal-medial thickness (IMT) in adolescents with and without obesity. Study design Ambulatory Blood Pressure data from 93 consecutive adolescents referred to our hypertension center for possible hypertension were analyzed. Fasting serum glucose and lipid concentrations were measured in all subjects. Carotid artery IMT was also measured by B-mode ultrasound imaging in all patients. Obesity was defined as body mass index ≥95 th percentile for age and sex. Twenty-two of the subjects were obese and 71 nonobese. Results Mean 24-hour, daytime, and nighttime systolic Blood Pressures were significantly higher in obese subjects compared with nonobese subjects ( P P P P P P P Conclusions Obese adolescents have higher Ambulatory Blood Pressure and higher carotid artery IMT, possibly indicating an early course of obesity-related hypertension and carotid artery structural alterations.

  • impact of obesity on 24 hour Ambulatory Blood Pressure and hypertension
    Hypertension, 2005
    Co-Authors: Vasilios Kotsis, Stella Stabouli, Marshall J Bouldin, Annette K Low, Savvas Toumanidis, Nikos Zakopoulos
    Abstract:

    The purpose of the present study was to determine the relationship between body mass index (BMI) and parameters derived from 24-hour Ambulatory Blood Pressure monitoring including mean 24-hour daytime and nighttime systolic and diastolic Blood Pressures, 24-hour daytime and nighttime pulse Pressure, mean 24-hour daytime and nighttime heart rate, dipping and nondipping status. 3216 outpatient subjects who visited our hypertension center and were never treated with antihypertensive medication underwent 24-hour Blood Pressure monitoring. BMI was significantly correlated with clinic systolic and diastolic Blood Pressures. Significant correlations were also found between BMI and mean 24-hour daytime and nighttime systolic Blood Pressure, 24-hour daytime and nighttime pulse Pressure, and mean 24-hour daytime and nighttime heart rate. In multivariate regression analysis, clinic systolic, diastolic Blood Pressure, mean 24-hour systolic Blood Pressure, 24-hour pulse Pressure, and high-density lipoprotein were independently correlated with BMI. The incidence of white coat hypertension was higher in overweight and obese patients than in normal weight subjects. Confirmed Ambulatory Blood Pressure hypertension was also found to be higher in overweight and obese individuals compared with normal weight subjects. Our data also highlight the higher incidence of nondipping status in obesity. These findings suggest that obese patients had increased Ambulatory Blood Pressure parameters and altered circadian Blood Pressure rhythm with increased prevalence of nondipping status.

Eoin Obrien - One of the best experts on this subject based on the ideXlab platform.

  • european society of hypertension practice guidelines for Ambulatory Blood Pressure monitoring
    Journal of Hypertension, 2014
    Co-Authors: Gianfranco Parati, George S. Stergiou, Eoin Obrien, Roland Asmar, Grzegorz Bilo, Peter W. De Leeuw, Alejandro De La Sierra, Lawrence J Beilin, Denis Clement, Eamon Dolan
    Abstract:

    Given the increasing use of Ambulatory Blood Pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on Blood Pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of Blood Pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

  • Ambulatory Blood Pressure measurement is indispensable to good clinical practice
    Hipertensión y Riesgo Vascular, 2009
    Co-Authors: Eoin Obrien
    Abstract:

    Summary Traditional clinic or office Blood Pressure measurement (OBPM) is limited in the amount of information it can provide for the adequate management of hypertension; Ambulatory Blood Pressure measurement (ABPM), which can diagnose white coat hypertension in as many as 20% of people who appear to have hypertension with OBPM, and masked hypertension which may affect 10 and 20% of the population, is a vastly superior technique. Furthermore, nighttime BP measured by ABPM is superior to OBPM in predicting cardiovascular events. Perhaps the greatest value for ABPM will be to enable Blood Pressure control in the aging community, thereby leading to prevention of stroke. There should be an imperative to change contemporary clinical practice if we are to avert the burden of stroke and heart failure in an aged population. We have adequate drugs to achieve effective BP lowering in the vast majority of patients; what we lack is the determination to achieve effective BP control as early as possible.

  • Ambulatory Blood Pressure measurement a trove of hidden gems
    Hypertension, 2006
    Co-Authors: Eoin Obrien
    Abstract:

    One of the consequences of hypertension is increasing stiffness of the arteries, which leads to cardiovascular events and increased mortality.1 Clearly this process is a continuous one and, contrary to acceptance that such change is inevitable, it is not now unreasonable to assume that if stiffening in the arterial system could be detected at an early rather than at a late stage, therapeutic interventions might be initiated to delay or even prevent its occurrence. However, measuring arterial stiffness requires special equipment and trained staff, facilities that are not generally available and that are, moreover, costly. It has been proposed recently that a measure of arterial stiffness could be obtained from the routine use of Ambulatory Blood Pressure measurement (ABPM) by using the dynamic relationship between diastolic and systolic Blood Pressure over 24 hours, calculated as 1 minus the regression slope of diastolic on systolic Blood Pressure. The rationale underlying the Ambulatory arterial stiffness index (AASI) is that average distending Pressure varies during the day and that the relation between diastolic and systolic Blood Pressure, with this changing distending Pressure, depends largely on the structural and functional characteristics of the large arteries. In the Dublin Outcome Study, AASI predicted cardiovascular mortality in a large cohort of hypertensive individuals. Moreover, this prediction withstood additional adjustment for other risk factors, including pulse Pressure. Interestingly, AASI was a stronger predictor of fatal …

  • Ambulatory Blood Pressure measurement is indispensable to good clinical practice
    Journal of Hypertension, 2003
    Co-Authors: Eoin Obrien
    Abstract:

    Summary Traditional clinic or office Blood Pressure measurement (OBPM) is limited in the amount of information it can provide for the adequate management of hypertension; Ambulatory Blood Pressure measurement (ABPM), which can diagnose white coat hypertension in as many as 20% of people who appear to have hypertension with OBPM, and masked hypertension which may affect 10 and 20% of the population, is a vastly superior technique. Furthermore, nighttime BP measured by ABPM is superior to OBPM in predicting cardiovascular events. Perhaps the greatest value for ABPM will be to enable Blood Pressure control in the aging community, thereby leading to prevention of stroke. There should be an imperative to change contemporary clinical practice if we are to avert the burden of stroke and heart failure in an aged population. We have adequate drugs to achieve effective BP lowering in the vast majority of patients; what we lack is the

  • use and interpretation of Ambulatory Blood Pressure monitoring recommendations of the british hypertension society
    BMJ, 2000
    Co-Authors: Eoin Obrien, Andrew J S Coats, Patrick Owens, J C Petrie, Paul L Padfield, W Littler, Michael De Swiet, F Mee
    Abstract:

    Over the past 20 years or so, the accuracy of using the conventional Riva-Rocci sphygmomanometer and Korotkoff's sounds to measure Blood Pressure has been questioned, and efforts have been made to improve measurements with automated devices.1 2 In the same period, the phenomenon of white coat hypertension has been recognised—whereby some patients who apparently have raised Blood Pressure actually have normal Blood Pressure when the measurement is repeated away from the medical environment; this has focused attention on methods of measurement that provide profiles of Blood Pressure rather than rely on isolated measurements made under circumstances that may influence Blood Pressure.3 These methods have included repeated measurements of Blood Pressure using the traditional technique, self measurement of Blood Pressure in the home or workplace, and Ambulatory Blood Pressure measurement using automated devices.2 Ambulatory monitoring is advantageous because it gives multiple measurements throughout the day and night This paper considers only the Ambulatory measurement of Blood Pressure in adults. Its purpose is not to make a case for or against Ambulatory measurement; others have already done so.4 5 Although the results of a number of ongoing, longitudinal studies are forthcoming, there is now firm evidence that Ambulatory Blood Pressure measurement is a more sensitive predictor of cardiovascular outcome than conventional measurement.6 We have not considered the complex issues of health economics that the increasing use of Ambulatory measurement raises.7 We realise that this technique is being used more often and that doctors who find Ambulatory measurement useful in the day to day management of patients with high Blood Pressure need recommendations from those who have experience. However, regardless of the technique used to diagnose hypertension it is only one factor in determining a patient's risk profile and must be assessed in relation to concomitant disease, …

Takayoshi Ohkubo - One of the best experts on this subject based on the ideXlab platform.

  • diagnostic thresholds for Ambulatory Blood Pressure monitoring based on 10 year cardiovascular risk
    Circulation, 2007
    Co-Authors: Masahiro Kikuya, Takayoshi Ohkubo, Lutgarde Thijs, Tine W Hansen, Tatiana Kuznetsova, Christian Torppedersen, Kristina Bjorklundbodegard, Tom Richart, Lars Lind, Hans Ibsen
    Abstract:

    Background— Current diagnostic thresholds for Ambulatory Blood Pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement. Methods and Results— We performed 24-hour ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) Blood Pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 1...

  • prediction of stroke by Ambulatory Blood Pressure monitoring versus screening Blood Pressure measurements in a general population the ohasama study
    Journal of Hypertension, 2000
    Co-Authors: Takayoshi Ohkubo, Ichiro Tsuji, Kenichi Nagai, Masahiro Kikuya, Atsushi Hozawa, Sadayoshi Ito, H Satoh, Shigeru Hisamichi, Yutaka Imai
    Abstract:

    Objective To investigate the association between 24 h, daytime and night-time Ambulatory Blood Pressures and first symptomatic stroke, to compare their predictive powers for stroke with that of casual (screening) Blood Pressure, and to compare the predictive power for stroke between daytime and night-time Blood Pressures, in a general population in Ohasama, Japan. Design A prospective cohort study. Subjects and methods We obtained Ambulatory Blood Pressure on 1464 subjects aged ≥ 40 years without history of symptomatic stroke, then followed-up their stroke-free survival. There were 74 first symptomatic stroke during the follow-up period (mean = 6.4 years). The prognostic significance of Blood Pressure for stroke risk was examined by a Cox proportional hazards regression model adjusted for possible confounding factors. Results The non-parametric and parametric analysis indicated that 24-h, daytime and night-time Ambulatory Blood Pressures were linearly related with stroke risk. The likelihood ratio analysis demonstrated that these Ambulatory Blood Pressures were significantly better related to stroke risk than did screening Blood Pressure, and that daytime Blood Pressure better predicted stroke risk than did night-time Blood Pressure. Conclusions The present study which prospectively investigated the relation between Ambulatory Blood Pressure and first symptomatic stroke risk in a general population demonstrated that (i) Ambulatory Blood Pressure values were linearly related to stroke risk; (ii) Ambulatory Blood Pressures had the stronger predictive power for stroke risk than did screening Blood Pressure; and (iii) daytime Blood Pressure better related to stroke risk than did night-time Blood Pressure.

  • prediction of mortality by Ambulatory Blood Pressure monitoring versus screening Blood Pressure measurements a pilot study in ohasama
    Journal of Hypertension, 1997
    Co-Authors: Takayoshi Ohkubo, Yutaka Imai, Ichiro Tsuji, Kenichi Nagai, Noriko Watanabe, Naoyoshi Minami, Osamu Itoh, Takehiko Bando, Mariko Sakuma, Akira Fukao
    Abstract:

    Objective To compare the prediction of mortality by Ambulatory Blood Pressure monitoring and screening Blood Pressure measurements in a general population. Design A prospective cohort study. Patients and methods We obtained Blood Pressure data for 1542 subjects (565 men and 977 women) aged ≥ 40 years who were followed up for up to 8.1 years (mean 5.1 years). Subjects were subdivided into five groups according to their Ambulatory and screening Blood Pressure levels. The prognostic significance of Blood Pressure for mortality was examined by the Cox proportional hazards regression model. Results The association between Blood Pressure level and mortality was more distinctive for the Ambulatory Blood Pressure than it was for the screening Blood Pressure. The risk of cardiovascular mortality increased significantly for the highest quintiles of 24 h Ambulatory Blood Pressure, whereas there was no significant association between the screening Blood Pressure and the cardiovascular mortality. When both 24 h and screening Blood Pressure values were included in the Cox model, only the systolic Ambulatory Blood Pressure was related significantly to the increased risk of cardiovascular mortality. Conclusions The Ambulatory Blood Pressure had a stronger predictive power for mortality than did the screening Blood Pressure. This appears to have been the first study of the prognostic significance of Ambulatory Blood Pressure monitoring versus screening Blood Pressure measurements in a general population.

Marie Krouselwood - One of the best experts on this subject based on the ideXlab platform.

Sofia Shames - One of the best experts on this subject based on the ideXlab platform.