[The evaluation of a noninvasive monitor to record ambulatory arterial pressure: the DIASYS 200 Novacor]

BACKGROUND

The aim of this study was to validate the measurement precision of the portable automatic non invasive monitor of blood pressure-Novacor DIASYS 200.

METHODS

A mercury sphygmomanometer was used as the reference measurer. To validate the DIASYS 87 persons (45 males, 42 females--age range 17-76 years) with a systolic blood pressure between 90-225 mmHg and diastolic blood pressure of between 64-149 mmHg were selected.

RESULTS

The differences between the two apparatus were: systolic blood pressure 6.1 +/- 12.2 mmHg (r = 0.909); diastolic blood pressure -1.9 +/- 6.8 mmHg (r = 0.929) and cardiac frequency -2.0 +/- 6.3 ppm (r = 0.942). In healthy subjects of under 31 years of age (n = 20) the differences for systolic and diastolic blood pressure and cardiac frequency were 0.2 +/- 8.0 mmHg; -1.3 +/- 5.8 mmHg and -0.1 +/- 8.0 ppm, respectively. For subjects over the age of 59 years (n = 29) the measurements were 9.2 +/- 12.0 mmHg, 2.5 +/- 6.0 mmHg, -1.5 +/- 4.4 ppm, respectively. With the sample subdivided according to blood pressure the differences found in the normotensive subgroup (n = 23) were: -1.7 +/- 7.8 mmHg, -2. +/- 4.9 mmHg, and -2.4 +/- 7.9 ppm, respectively; in the subgroup with slightly high blood pressure (n = 40) 6.4 +/- 14.0 mmHg, -2.8 +/- 6.0 mmHg and -2.3 +/- 5.1 ppm, and in the subgroup with moderate-severe high blood pressure (n = 24) 10.4 +/- 10.9 mmHg, 0.2 +/- 9.1 mmHg and -0.9 +/- 6.5 ppm, respectively.

CONCLUSIONS

The DIASYS fulfills the criteria of validation and precision for the measurement of diastolic blood pressure and cardiac frequency in all the cases. However criteria for systolic blood pressure are only fulfilled in normotensive and young subjects (less than 31 years of age).

[A clinical study of the verapamil and captopril combination in hypertensive patients uncontrolled by monotherapy. An evaluation by recording the 24-hour ambulatory blood pressure]

BACKGROUND

By measuring ambulatory blood pressure monitoring (ABPM), the pharmacologic association of verapamil plus captopril in essential hypertensive patients not responding to isolated monotherapy of these drugs was studied since a synergism has been described between these two drugs.

METHODS

A lineal clinical trial with a previous period of selection (PeSe) in which verapamil and captopril were administered in two consecutive phases was carried out in 57 essential hypertensive patients of 52 +/- 19 years of age with those controlling their blood pressure (BP) being excluded. Following a lavage phase the remaining subjects were included in the experimental period (ExPe) in wash out the association of verapamil 120 mg+captopril 25 mg was administered and if the BP was not controlled this was increased to 240 mg + 50 mg, respectively. ABPM was performed prior to and at the end of the ExPe.

RESULTS

Of the 57 patients 21 were excluded in the SePe due to control or adverse effects. Of the 26 individuals who passed into the ExPe 20 presented mild-moderate HTA (M-HTA) and 6 severe HTA (S-HTA). In the M-HTA group, the reduction of BP (in mmHg) was 157 +/- 15/106 +/- 5 to 147 +/- 12/97 +/- 7 (p < 0.05/p < 0.001), five controlled BP, in the remaining subjects the reduction in the following phase was 150 +/- 11/100 +/- 6 at 136 +/- 11/93 +/- 6 (p < 0.01/p < 0.01). In the S-HTA group the BP descended in the ExPe from 184 +/- 15/121 +/- 6 to 167 +/- 24/107 +/- 10 (p < 0.05/p < 0.05). The 24 hour measurement of BP in the ExPe decreased from 140 +/- 13/96 +/- 8 to 124 +/- 10/86 +/- 7 (p < 0.001/p < 0.001). BP descended significantly in all the hours with the exception of the hours 24, 1, 6, 7, and 5.

CONCLUSIONS

The association of verapamil-captopril demonstrates efficacy and synergism in hypertensive patients previously uncontrolled by monotherapy of these drugs.

[Day-night differences of arterial pressure in "white coat" arterial hypertension]

Prevalence and day-night differences of blood pressure (BP) are studied in "White Coat" Hypertension (AHT). An outpatient register of BP was performed during 24 hours in 95 patients with mild AHT. "White Coat" Hypertension was defined when diastolic BP during the day was below 90 mmHg (WCH group) and with no "White Coat" Hypertension (non-WCH) when it was over said figure. BP values for WCH group (n = 36) in comparison with non-WCH (n = 59) were: Day period 130 +/- 13/85 +/- 4 versus 143 +/- 14/99 +/- 7 mmHg (p < 0.001; p < 0.001). Night period 119 +/- 18/74 +/- 8 versus 127 +/- 15/84 +/- 8 mmHg (p < 0.05/p < 0.001). Day-night differences in BP were lower in WCH in comparison with non-WCH group: 11 +/- 9/11 +/- 8 versus 17 +/- 10/15 +/- 7 mmHg (p < 0.01; p < 0.01). A positive correlation was observed between BP variability in 24 hours and day-night difference in non-WCH group (Systolic BP: r = 0.512, p < 0.001; Diastolic BP: r = 0.676, p < 0.001). This correlation was not found in the WCH group. "White Coat" Hypertension is present in 38% of the subjects with mild AHT and could constitute an independent aspect of the alert reaction.

[The role of E. coli adhesins in the pathogenesis of urinary infection]

One thousand five hundred strains obtained from patients suffering from different clinical forms of urinary infections (UI) and dependent glands have been studied with the aim of establishing the pathogenic responsibility of E. coli adhesion protein (ADH) in urinary infections (UI). ADH were determined using agglutination techniques with guinea pig and human red cells, C. albicans and S. cerevisiae spores and GAL-GAL sensitized latex. In non complicated UI, the presence of ADH is the main invasion mechanism for E. coli. The frequency of adherent strains is very high (569/648) in acute cases (207/247 cystitis + 69/98 recurrent cystitis + 108/114 pyelonephritis + 140/154 prostatitis + 28/35 orchyepidimitis and scarce (14/184) in asymptomatic or chronic cases (6/107 bacteriurias + 7/67 prostatitis + 1/10 orchyepidimitis). A close relationship is established between the presence of ADH and clinical symptoms. The acute cases with general symptoms are caused in 85% of cases (188/216) by strains with ADH type MR specially subtype P. The acute cases with local symptoms (only urinary syndrome) are caused in 77% of cases (297/387) by strains with ADH type Ms. In complicated UI the expression of adhesion proteins does not constitute and essential requisite in order to invade the urinary tract. It is suggested that males are significantly more resistant the females to UI both parenchymal and urinary tract. It is deduced that underlying factors are more predisposing to UI the smaller the adherence rate of isolated strains is. Thus, reflux and neurogenic bladder probes are by far more aggressive alterations than prostatic adenoma, bladder tumor and lithiasis.

[The continuous recording of ambulatory arterial pressure. The value of monitoring 4-hour subperiods]

The ambulatory continuous arterial pressure monitoring permits a more exact definition of the degree of arterial hypertension. A ACMPA was performed in 86 subjects, 64 hypertensive and 22 normotensive controls during a daytime period of 16 hour with a noninvasive device. The results were compared to those obtained in the four four-hour subperiods. The correlation of each subperiod with the global studied period was: r = 0.915; subperiod 16-19 hours, r = 0.933; subperiod 20-23 hours, r = 0.924. It was observed that in any four-hour subperiod was quite similar to the mean value of the whole period. We conclude that in those cases in which it is not possible to perform a 24 hour ACMAP or during the whole daytime, a short four-hour monitoring is valid.