Impact of thyroid function screening in a large cohort of patients admitted to an emergency department.

Background: Thyroid dysfunctions are highly prevalent and can worsen underlying cardiopathies, but despite that the routine screening of thyroid function in the Emergency Department (ED) setting is not generally recommended.

Objective: To understand if staff training and implementation of rapid TSH screening (rTSH) could improve the management of patients arrived in the ED. Specifically, we aimed at evaluating the prevalence of undiagnosed thyroid diseases among ED patients; the effects of educational meetings in the clinical decision-making process; the usefulness of rTSH, in terms of variation of either the clinical work out or the existing treatment.

Pulsed intravenous methylprednisolone combined with oral steroids as a treatment for poorly responsive type 2 amiodarone-induced thyrotoxicosis.

Objectives: Amiodarone-induced thyrotoxicosis (AIT) affects up to 3% of treated patients. Type 2 AIT (AIT2) is a destructive thyroiditis and is usually treated with medium-high oral doses of prednisone. As AIT may worsen the underlying heart disease, a rapid control of thyroid function is desirable.

Lack of effect of percutaneous transluminal renal angioplasty on nocturnal hypotension in renovascular hypertensive patients.

Objective: To investigate whether nocturnal blood pressure fall is blunted in renovascular hypertension and can therefore be used as a diagnostic criterion for this condition.

Methods: In 14 renovascular hypertensive patients (age 43.8+/-2.

Permanent blood pressure control over the 24 h by trandolapril.

Noninvasive ambulatory blood pressure monitoring (ABPM) has proved to be an innovative tool for the assessment of the efficacy of antihypertensive drugs. It enables evaluation of the magnitude of the drug-related blood pressure fall and also of the duration of this effect throughout 24 h. Moreover, ambulatory blood pressures have advantages compared to office blood pressure: they are not affected by the white coat effect occurring at the time of the doctor's visit, are devoid of a placebo effect, are more reproducible than occasional clinic measurements, and may yield important information on the prognosis of hypertensive patients.

Ambulatory blood pressure monitoring in the evaluation of antihypertensive treatment: additional information from a large data base.

Aims of our study were i) to compare in a large number of hypertensive subjects the relative effect of antihypertensive treatment on clinic (C) blood pressure (BP) and various ambulatory (A) BP components, and ii) to determine whether antihypertensive treatment affects BP variability. In 266 mild essential hypertensive outpatients (age: 18-78 years) CBP (trough measurements) and ABP (Spacelabs 90202 or 90207) were measured after 3 to 4 weeks of wash-out and after 4 to 8 weeks of treatment with an ACE-inhibitor (n = 135) or a calcium-antagonist (n = 131). ABP recordings were analyzed to obtain average 24 h, day-time (6 a.

Lack of placebo effect on ambulatory blood pressure.

Several studies have reported that, at variance with clinic blood pressure, ambulatory blood pressure is not reduced by treatment with placebo. However, this evidence has usually been obtained in small groups of subjects and no data are available from a larger sample of patients. To address this issue we have analyzed data from 116 outpatients involved in placebo-controlled studies on antihypertensive treatment.

Ambulatory blood pressure monitoring in the evaluation of antihypertensive drugs.

Unlabelled: CLINIC VERSUS AMBULATORY BLOOD PRESSURE MEASUREMENT: Clinic blood pressure measurements do not give the best estimate of the efficacy of antihypertensive drugs because (1) they provide readings for one time-point only, (2) they are subject to a 'white-coat' effect and also show a significant placebo effect and (3) they are poorly reproducible. Ambulatory blood pressure monitoring overcomes these problems and offers the possibility of obtaining reliable, reproducible and detailed information on the time-course and magnitude of the effect of antihypertensive treatment on blood pressure over 24 h. MEAN 24-H VERSUS MEAN HOURLY AMBULATORY BLOOD PRESSURE VALUES: Compared with mean 24-h values, reproducibility is poorer for mean hourly ambulatory values, which show greater variability when tested under different conditions.

Clinical use of ambulatory blood pressure monitoring: a critical appraisal.

Traditional sphygmomanometric techniques are heavily affected by the 'white-coat' effect and cannot be used to assess blood pressure variability over the 24h period. These limitations can be overcome in part using ambulatory monitoring, which (1) quantifies both the mean and the variability of blood pressure over 24h, including blood pressure fluctuations between day and night, (2) does not trigger any alerting reaction in the patient, (3) provides reproducible 24h blood pressure means and (4) allows the action of antihypertensive drugs to be assessed over 24h without interference from a placebo effect. Moreover, ambulatory blood pressure values are more closely related to the end-organ damage associated with hypertension than are isolated clinic readings.

Blood pressure variability: clinical implications and effects of antihypertensive treatment.

HYPOTHESIS ON RELATIONSHIP BETWEEN BLOOD PRESSURE VARIABILITY AND END-ORGAN DAMAGE: Several studies have shown that the cardiovascular complications of hypertension are more closely related to ambulatory 24-h or daytime average blood pressure than to office readings. A few studies have also provided evidence that in hypertensive patients, not only average ambulatory blood pressure but also the degree of blood pressure variability is significantly and independently related to the end-organ damage associated with hypertension. LIMITATIONS OF PREVIOUS STUDIES: A common limitation of previous studies is that they were based on cross-sectional or retrospective observations, so that the correlative evidence they provide does not allow the relationship between blood pressure variability and end-organ damage to be interpreted causally.

Ambulatory blood pressure monitoring in the diagnosis of hypertension and evaluation of antihypertensive drug efficacy.

Ambulatory blood pressure monitoring is invaluable in the assessment of the efficacy of antihypertensive drug treatment because it allows the reduction of blood pressure to be confirmed within the context of daily life. It also allows the determination of whether treatment produces an even blood pressure reduction over the 24-hour period or whether it is characterized by an uneven profile, for example, a precipitous fall early after administration of the drug and a later return towards elevated blood pressure values. A lack of information on prognostic and normal values does not permit quantification of the optimal blood pressure reduction to be achieved throughout the monitoring period.

Twenty-four-hour ambulatory blood pressure monitoring and antihypertensive treatment: focus on ACE inhibitors.

The use of ambulatory blood pressure monitoring in clinical studies offers some advantages in comparison to the clinic blood pressure measurement. In fact, this approach does not induce any alerting reaction and provides 24-h blood pressure values that are more reproducible and not affected by the placebo effect. This allows a better evaluation of blood pressure under antihypertensive treatment and an optimization of the number of patients to be studied in pharmacologic trials.

Ambulatory blood pressure monitoring in elderly hypertensive patients.

Ambulatory blood pressure monitoring (ABPM) has been shown to provide a reliable estimation of hourly blood pressure values over the 24 hours. Favourable features of this technique are the lack of alerting reaction to automatic blood pressure readings, at variance from what usually occurs when blood pressure is measured in the doctor's office, and the ability of ABPM to provide information on the 24 hour blood pressure profile without interfering with the physiological nocturnal hypotension. Although automatic blood pressure readings obtained in free-moving subjects are not always accurate, ABPM has been shown to represent a useful approach to evaluate the efficacy of antihypertensive drugs, as it allows to compare the 24 hour blood pressure profile obtained before and during treatment.

Ambulatory blood pressure monitoring and antihypertensive treatment.

Ambulatory blood pressure monitoring is becoming increasingly popular among clinicians and investigators because of its potential to overcome the well-known limitations inherent to conventional blood pressure measurement. This paper will focus on the use of this approach in the evaluation of antihypertensive treatment. It will be argued that due to lack of prognostic validity and high cost, ABPM should not be employed routinely in treating hypertensives.

Clinical value of blood pressure measurements: focus on ambulatory blood pressures.

Because clinic blood pressure values are compromised by 2 major limitations--the alerting reaction to clinic measurements and the spontaneous blood pressure variability--they have only a limited correlation with average 24-hour blood pressure values. Whether the latter should be employed routinely in substitution for, or in addition to, traditional blood pressure measurements has not yet been determined, however. To date, average 24-hour blood pressure values have been shown to correlate more closely than clinic blood pressure values with the organ damage of hypertension.

Changes in 24 hour blood pressure and in cardiac and vascular structure in normotensive subjects with parental hypertension.

Subjects with family history of hypertension represent a suitable model to investigate the mechanisms responsible for early cardiovascular structural and functional changes occurring in essential hypertension. In our study we have addressed the factors involved in determining the mild elevation in office blood pressure frequently observed in normotensive subjects with hypertensive parents. In 15 normotensive subjects with both parents hypertensive (FH++) and in 15 normotensive subjects with one parent hypertensive (FH(+)-) we found no evidence of a hyperreactivity to stress as compared to the responses of 15 normotensive subjects with no parental hypertension (FH--).

Ambulatory blood pressure monitoring.

This paper reviews the evidence that, in patients with hypertension, end-organ damage correlates more closely with blood pressure values obtained by ambulatory blood pressure monitoring than with those obtained by conventional sphygmomanometry. However, ambulatory blood pressure monitoring is not suitable for routine use in the clinical setting because of a lack of standard reference values and data regarding the prognostic significance of this method. Ambulatory blood pressure values are reproducible and this method avoids the so-called placebo effect; thus, this method is useful in clinical studies investigating the efficacy and duration of action of antihypertensive drugs.

Prognostic value of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring has both advantages and disadvantages in clinical practice. The structural and functional organ abnormalities associated with hypertension are more closely correlated to 24-h blood pressure mean values than to clinic or other conventional sphygmomanometric blood pressures. Furthermore, an additional relationship can be seen between the incidence and severity of these abnormalities and the magnitude of day and night blood pressure changes or 24-h blood pressure variability.

Methodological problems in evaluation of cardiovascular effects of stress in humans.

Cardiovascular effects of stress in humans are often assessed by application of physical or emotional stimuli in a laboratory environment. Although this method provides important information, these procedures have several limitations. First, blood pressure and heart rate responses to laboratory stressors are characterized by a limited within-subject reproducibility.

Advantages and disadvantages of non-invasive ambulatory blood pressure monitoring.

Our studies have shown that (1) automatic blood pressure readings obtained from portable monitors do not induce any alerting reaction or pressor response in the patient; (2) although the measurements are intermittent, non-invasive ambulatory blood pressure monitoring is able to provide a true estimate of 24-h blood pressure and heart rate mean values (the assessment of 24-h blood pressure and heart rate variabilities is less accurate); (3) the nocturnal fall in blood pressure is not altered by the possible disturbance to the patient's sleep induced by repeated cuff inflations; and (4) even when the automatic blood pressure readings obtained are similar to simultaneous readings obtained by a sphygmomanometer, the accuracy of the values provided by portable monitors used in truly ambulatory conditions cannot be taken for granted. These findings have particular implications for the cost: benefit ratio if ambulatory blood pressure monitoring is to be used in the routine evaluation of hypertensive patients.

Early 24-hour blood pressure elevation in normotensive subjects with parental hypertension.

Subjects with a family history of parental hypertension are reported to have a slightly higher office blood pressure in the prehypertensive stage. Whether this reflects a hyperreactivity to blood pressure measurement or a more permanent blood pressure elevation, however, is not known. In the present study, blood pressure was measured in 15 normotensive subjects whose parents are both hypertensive (FH++), 15 normotensive subjects with one hypertensive parent (FH(+)-), and 15 normotensive subjects whose parents are not hypertensive (FH--); among the three groups, subjects were matched for age, sex, and body mass index.

Early twenty-four-hour blood pressure elevation in subjects with parental hypertension.

We studied 15 normotensive offspring of hypertensive parents, comparing them with 15 normotensive controls matched for sex, body mass index and age. In the offspring, both parents were hypertensive, while in the controls, neither parent was hypertensive. Blood pressure was measured at rest, during a variety of laboratory stressors (mental arithmetic, mirror drawing test, hand grip and cold pressor test), and was also monitored for 24 h in ambulatory conditions (Spacelabs 5300 M, Richmond, Washington, USA).