Blood pressure variability (BPV) refers to the fluctuations of blood pressure in a certain period of time. In recent years, BPV is becoming a predictive marker for cardiovascular events. Given the hemodynamic and internal environmental change brought by hemodialysis as well as the complex complications, hemodialysis patients always have complex BPV. Nowadays there is no consensus on an optimal standard to evaluate BPV in hemodialysis population. Metrics usually used are as follows: blood pressure change during a certain period of time, standard deviation, coefficient of variation, variation independent of mean, average real variability, weighted mean of daytime and night-time standard deviation, residual derived from generalized linear models, and residual standard deviation. Impact factors of BPV in hemodialysis patients include age, ultrafitration volume, hemodialysis frequency and time length, peripheral vascular disease, serum calcium, antihypertensive drugs and so on. Recent studies showed significant associations between both long-term and short-term BPV with prognosis of hemodialysis patients. This review focuses on the evaluation methods, the influencing factors and the impact on prognosis of BPV.
Objective To explore the best mode of blood pressure monitoring by comparing the correlation of deferent kinds of blood pressure variability with arterial stiffness. Methods This study was conducted among 140 hypertensive patients in Wuhou Strict, Chengdu. Baseline data was collected including demographic data, biochemical examination and brachial-ankle pulse wave velocity (baPWV) measurement and so on. A consecutive home blood pressure was also gained by the individuals themselves and the clinical blood pressure was also recorded during the visit. The correlation between baPWV and the blood pressure variability were tested. Results The blood pressure variability measured at home in the morning was independently correlated with baPWV (r=0.313, P=0.011), the blood pressure variability measured at home in the evening was also independently correlated with baPWV (r=0.241, P=0.042), and day-to-day morning blood pressure variability measured at home was correlated with baPWV (r= 0.269, P=0.030). The correlation of month-to-month blood pressure variability and blood pressure variability gained at clinic room with baPWV was not significant (P>0.05). Conclusion In the monitoring of blood pressure variability in hypertensive patients, the blood pressure variability monitoring at home is better than that at the clinic room; and monitoring in the morning is better than that in the evening.
ObjectiveTo explore the characteristics of blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients with and without diabetes mellitus and the effects of BPV on cardiac function based on the research of clinical data. MethodsOne hundred MHD patients treated in the Hemodialysis Center of the People’s Hospital of Taixing City between January 2013 and January 2015 were recruited and divided into diabetes group (n=46) and non-diabetes group (n=54). Interdialytic and intradialytic BPV and cardiac function were monitored and compared between the two groups. Standard deviation (SD) and coefficient of variation (CV) were used for the evaluation of BPV. ResultsTriacylglycerol, cholesterol and plasma albumin were significantly different between the diabetes group and non-diabetes group (P<0.05), while hemoglobin, serum calcium, phosphorus and parathyroid hormone were not significantly different between the two groups (P>0.05). Forty-two patients in the diabetes group and 53 in the non-diabetes group took antihypertensive drugs. The varieties of antihypertensive drugs and the proportion of patients who used antihypertensive drugs were not significantly different between the two groups. The ambulatory blood pressure monitoring displayed 40 patients (86.9%) with reverse dipper or non-dipper blood pressure in the diabetes group and 35 (64.8%) in the non-diabetes group, and the difference was significant (P<0.05). The interdialytic mean systolic blood pressure (SBP), SBP-SD and SBP-CV in the diabetes group were all significantly higher than those in the non-diabetes group (P<0.05), and the mean diastolic blood pressure (DBP), DBP-SD and DBP-CV were also significantly different between the two groups (P<0.05). The intradialytic mean SBP, SBP-SD and SBP-CV in the diabetes group were significantly higher than those in the non-diabetes group (P<0.05), but there were no significant differences in intradialytic mean DBP, DBP-SD and DBP-CV between the two groups. In patients with reverse dipper or non-dipper blood pressure, the interventricular septal thickness, left ventricular end-diastolic diameter and ejection fraction were significantly different between the diabetes group and the non-diabetes group. However, in patients with dipper blood pressure, the cardiac function parameters were not significantly different between the two groups. Conclusion MHD patients with diabetes have higher ratio of reverse dipper or non-dipper blood pressure, more significant blood pressure variability and more severe cardiac function damage.
ObjectiveTo investigate the influence and management of blood pressure on intraoperative cortex somatosensory evoked potential (CSEP) in the surgery of severe scoliosis. MethodsFrom June 2009 to March 2012, CSEP monitoring during surgery of severe scoliosis were performed on 43 patients, in whom 4 had abnormal CSEP while blood pressure decline. There were 2 males and 21 females. The average age was 16.1 years. The average preoperative Cobb angle was 96.1° (88.7-107.5°). Latency and amplitude of cortical potentials were observed with the value of the latency extension more than 10% and peak amplitude reduction more than 50% defined as abnormality. The arterial blood pressure (ABP) was used to evaluate the intraoperative blood pressure. ResultThe incidence rate of bilateral CSEP wave abnormalities after blood pressure decline was 9.3% in the surgery of severe scoliosis. One case of CSEP abnormality occurred during the installing of pedicle screws; two cases during the Smith-Petersen osteotomy, and one case during the bone graft after correction. With the ABP dropping to about 92/57 mm Hg (1 mm Hg=0.133 kPa), the amplitude decreased 80% in 24-33 minutes. After the ABP increased to 113/75 mm Hg by treatment, the index was backed up normally in 5-10 minutes. There was no neurological complication after surgery. ConclusionA high incidence rate and significantly decreased amplitude of CSEP abnormality after blood pressure decline in the surgery of severe scoliosis are found. Intraoperative stable blood pressure should be maintained for patients with severe scoliosis. When the amplitude of CSEP decreases followed with blood pressure decline, blood pressure should be actively corrected by treatment, so that the CSEP may get back to normal as soon as possible.
ObjectiveTo investigate the impact of disposable tissue on blood pressure measurement, in order to prevent the sphygmomanometer cuff to be polluted. MethodsA total of 120 subjects including 60 patients with hypertension and 60 normal blood pressure subjects, treated between July 1 and July 31, 2012, were divided equally into two groups. Each group had 30 normal pressure and 30 high pressure subjects. Subjects in group A took blood pressure measurement without disposable tissue first, 1 to 2 minutes before another measurement with disposable tissue. Group B subjects took the measurement with disposable tissue at first, and then without it. We analyzed the influence of the use of disposable tissue and the sequence of tissue usage on the measurement result. ResultsNo significant difference was found in the systolic and diastolic blood pressure between measuring with and without tissue (P> 0.05). Diastolic blood pressure was not significantly influenced by the order of tissue usage (P>0.05), while systolic pressure was significantly influenced (P<0.05). Between the subjects with and without hypertension, the differences of systolic blood pressure and diastolic blood pressure measured with bare arms and disposable tissues were not statistically significant (P>0.05). ConclusionUsing disposable tissue or not does not affect blood pressure measurements whether the patient suffers from hypertension, but the order of disposable tissue usage may affect systolic blood pressure in non-hypertensive patients.
Blood pressure variability (BPV) is a novel predictor related to blood pressure level, and a large number of studies based on the hypertension cohort have shown that BPV is an independent predictor of target organ damages and cardiovascular adverse outcomes. Due to the significant hemodynamic changes, BPV in patients with chronic kidney disease (CKD) and hemodialysis is higher than the simple hypertension cohort, suggesting that BPV may be of great significance to patients with chronic kidney disease and hemodialysis. In recent years, studies based on CKD and hemodialysis cohort have published in succession whose results revealed that BPV of this cohort is of great prognostic significance for predicting target organ damages and cardiovascular disease risks. This article aims to provide an overview on these research, so as to survey and predict the clinical significance of BPV in CKD and hemodialytic patients.
In recent years, the prevalence of hypertension in China has gradually increased. Although the awareness rate, treatment rate and control rate of hypertensive patients in China have been significantly raised, the overall level is still lower than that of western developed countries. In order to improve the rate of family blood pressure control, real-time warning of patients’ overall blood pressure level to doctors and the implementation of doctor-side medical intervention to patients are becoming a necessary condition. At present, the maturing home blood pressure tele-monitoring (HBPT) enhances the feasibility of increasing the interaction between doctors and patients. Randomized controlled trial evidence proves that remote monitoring can improve patient compliance and improve target blood pressure control rate. This paper introduces the relevant research results of HBPT in recent years, aiming to explore the advantages of HBPT for hypertension management and the prospect of further promotion and application.
ObjectiveTo explore the nursing intervention effect on pre-hypertension. MethodsA total of 240 prehypertension patients in our community from July 2012 to January 2013 were randomly divided into observation group and control group with 120 patients in each group. No intervention was carried out for the control group. Blood pressure profile was established for the observation group and health education, exercise intervention, diet and body weight intervention measures were also given to the patients in this group. The improvement of life behavior and blood pressure control, and the awareness of hypertension health knowledge were compared between the two groups. ResultsAwareness of the disease knowledge, risk factors, complications, prevention and treatment in the observation group was significantly better than those in the control group (P<0.05). After intervention, the improvement scores of diet control, exercise increase, smoking quitting and alcohol drinking control in the observation group were significantly higher than those in the control group (P<0.05). The systolic blood pressure, diastolic blood pressure and body mass index after intervention in the observation group were significantly lower than those in the control group (P<0.05). ConclusionCommunity nursing intervention can increase the health knowledge in pre-hypertensive patients, help patients establish a good way of life and control blood pressure effectively, and reduce the incidence of hypertension.
Objective To review randomized controlled trials of blood pressure (BP) lowering therapy on stroke prevention to provide evidence for clinical practice. Methods We searched Medline (1966-2003.6) and the large-sample randomized controlled trials on BP lowering regimen in patients with stroke history were reviewed. Endpoints included the ocurrance of stroke, coronary heart disease and mortality. Results Three trials of PATS, PROGRESS and HOPE were analysed. The review showed that stroke recurrent risk was reduced by 28%, CHD risk decreased by 15% and total mortality risk reduced by 11% in BP lowering treatment group compared with placebo control group. Stroke risk was reduced not only in hypertensive patients with previous cerebrovascular diseases but also in non-hypertensive patients. Conclusions BP lowering therapy is beneficial for the secondary prevention of stroke.
Objective To systematically review the impact of vitamin D supplement on blood pressure, so as to provide a basis for clinical treatment. Methods Such databases as The Cochrane Library (Issue 8, 2011), MEDLINE (1996 to August 2011), EMbase (1974 to August 2011), CBM (1989 to 2011), CNKI (1997 to August 2011) and VIP (1989 to 2011) were searched to collect the randomized controlled trials (RCTs) about the impact of vitamin D supplement on blood pressure. Two reviewers independently screened the literature according to the inclusion criteria, extracted the data and assessed the quality. Then the meta-analysis was performed using RevMan 5.0 software. Results A total of 8 studies involving 907 participants were included. The methodological quality based on the improved Jadad scales displayed that, 7 studies scored 4 to 7 and only 1 study scored less than 4. The results of meta-analysis showed that compared with the placebo groups, vitamin D supplement had no significant difference in both systolic and diastolic blood pressure. Conclusion Based on current research evidences, compared with placebo, vitamin D supplement has no marked impact on either systolic or diastolic blood pressure. Due to the lack of studies, this conclusion still needs to be proved by conducting more well designed, large sample, and multicenter RCTs.