To assess the relationship of subclinical urinary albumin excretion with ambulatory and circadian variability of blood pressure.
Patients with essential hypertension (82 males and 59 females, mean ...+/- SD age 38.9 +/- 7.3 years) who had never been previously treated for hypertension were included in the study. Patients with nephropathy or diabetes mellitus, hyperglycemia > 120 mg/dl, glomerular filtration rate < 80 ml/min per 1.73 m2, urinary tract infection and positive dipstick for albumin or glucose were excluded. Twenty-four-hour ambulatory blood pressure monitoring on a regular working day using an oscillometric device was performed. Twenty-four-hour urinary albumin excretion was measured on two separate days using an immunonephelometric assay.
Microalbuminuric patients (urinary albumin excretion 30-300 mg/24 h, n = 31) had significantly higher mean ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) than those with normoalbuminuria (urinary albumin excretion < 30 mg/24 h, n = 96) during the 24-h, daytime (0800-2200 h) and night (2400-0600 h) periods, whereas for office blood pressure only DBP was significantly higher. Urinary albumin excretion was positively correlated with the means of SBP and DBP. Multiple regression analysis similarly confirmed that DBP during daytime was positively and day:night ratio of DBP inversely associated with urinary albumin excretion independent of age, sex and other parameters of ambulatory blood pressure.
In conclusion, the present study indicates that, in middle-aged essential hypertensive patients, the presence of microalbuminuria is a marker for the presence of higher values of blood pressure throughout a 24-h period.
VIVACE Context Based Search Platform Redon, Romaric; Larsson, Andreas; Leblond, Richard ...
Modeling and Using Context,
2007
Book Chapter, Conference Proceeding
Recenzirano
Odprti dostop
One of the key challenges of knowledge management is to provide the right knowledge to the right person at the right time. To face this challenge, a context based search platform was developed in the ...frame of the European Integrated Project VIVACE. This platform is based on the identification of a user context and the subsequent pushing of applicable knowledge to that particular user. We introduce a context model to represent the user’s context. This context model is used to describe the context of an engineer working in a specific company. Further, we developed means to index available knowledge based on company engineering context and means to search for knowledge applicable to the user’s context. Since it is not always possible to describe in which context the knowledge assets should be applied, we added learning capabilities which enable the system to learn the applicability of specific knowledge to a user’s context based on user feedback.
To assess the relationship between obesity, body fat distribution, and blood pressure in children and adolescents, various measures of obesity and the waist-to-hip circumference ratio were related to ...casual and ambulatory blood pressure as measured using a SpaceLabs 90207 monitor during a regular school day. Seventy obese and 70 nonobese children aged 6 to 16 years were included in the study. Regardless of the time period analyzed (24 h, daytime, or nighttime), ambulatory blood pressure and casual blood pressure were significantly higher among the obese children. The differences in systolic blood pressure observed between the groups were attributable to the presence of obesity as estimated by the ponderal index and by skinfold thickness. Similarly, systolic and diastolic loads, as an assessment of high blood pressure values over 24 h, were significantly higher in the obese children when compared to the loads for the nonobese children. Waist-to-hip circumference ratio was independently associated, (in multiple regression analysis) with systolic blood pressure, whether during 24 h, daytime, or nighttime periods, after controlling for age, sex, current height, ponderal index, and tricipital skinfold thickness. This study demonstrates that obesity is a determinant of ambulatory and casual blood pressure. Since obese children with a predominantly abdominal fat mass show higher blood pressure values, evaluation of body fat distribution in children may help to identify subjects more susceptible to developing hypertension later in life.
This study was designed to examine the relationship between birth weight (BW) and ambulatory blood pressure in children and adolescents, born at term in absence of intrauterine growth retardation.
...Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed on 332 children (150 boys), aged from 6 to 16 years. Subjects were stratified by BW textiles and age. ABPM was performed using SpaceLabs 90207 monitor during a regular school day. Blood pressure (BP) was measured every 20 min from 06:00 to 24:00, and thereafter every 30 min. Means of systolic BP (SBP) and diastolic BP (DBP) during 24 h, daytime (08:00 to 22:00), and nighttime (24:00 to 06:00) were calculated. Systolic and diastolic load was estimated as the percentage of measurements above the age- and sex-specific 95th percentile during the 24 h.
BW was inversely related to daytime SBP (
P = .04) and SBP load (
P = .04) when controlled for sex, current height, ponderal index (weight/height
3). and age. The predictive values of daytime SBP throughout the pediatric age group in the two extreme tertiles of BW (lowest, 2.500 to 3.200 kg and highest, 3.501 to 4.820 kg) were obtained from regression equations including SBP during activity period or SBP load and age. Children who had lower BW tended to have higher daytime SBP or SBP load at any age although this difference was not statistically significant. These differences became more evident as the subjects got older. BW is a determinant of daytime SBP even in the absence of intrauterine growth retardation. The influence of BW seems to increase with age.
The objective was to investigate the association between BMI and single nucleotide polymorphisms previously identified of obesity-related genes in two Spanish populations. Forty SNPs in 23 ...obesity-related genes were evaluated in a rural population characterized by a high prevalence of obesity (869 subjects, mean age 46 yr, 62% women, 36% obese) and in an urban population (1425 subjects, mean age 54 yr, 50% women, 19% obese). Genotyping was assessed by using SNPlex and PLINK for the association analysis.
Polymorphisms of the FTO were significantly associated with BMI, in the rural population (beta 0.87, p-value <0.001). None of the other SNPs showed significant association after Bonferroni correction in the two populations or in the pooled analysis. A weighted genetic risk score (wGRS) was constructed using the risk alleles of the Tag-SNPs with a positive Beta parameter in both populations. From the first to the fifth quintile of the score, the BMI increased 0.45 kg/m2 in Hortega and 2.0 kg/m2 in Pizarra. Overall, the obesity predictive value was low (less than 1%).
The risk associated with polymorphisms is low and the overall effect on BMI or obesity prediction is minimal. A weighted genetic risk score based on genes mainly acting through central nervous system mechanisms was associated with BMI but it yields minimal clinical prediction for the obesity risk in the general population.
Background: Some studies have described a large number of hypertensive patients who are followed by a primary care physician without achieving adequate blood pressure (BP) control but whose treatment ...nevertheless is not intensified. It is not known whether physicians are aware of this clinical inertia and what factors are associated with this problem. Objective: The aim of this study was to describe the factors associated with clinical inertia in hypertensive patients. Methods: This was an observational, cross-sectional, multicentre study conducted in a network of primary care centres and hospital hypertension units in Spain. Using a consecutive sampling approach, 512 physicians selected 5077 hypertensive patients in whom they suspected poor BP control after chart review. The main variables documented were BP control and cardiovascular risk according to European Society of Hypertension guidelines, changes in treatment after visit, type of treatment, and healthcare setting. A binomial logistic regression multivariate analysis, adjusted for physician, was performed. Results: Of the selected patients, 70.9% had poor BP control according to measurements taken in the physician's office, and in 1499 (42.1%) of those poorly controlled patients, treatment was not intensified (clinical inertia). Factors associated with clinical inertia were as follows: being seen at a primary care centre (p < 0.001), not having left ventricular hypertrophy (p < 0.001) or microalbuminuria (p < 0.001), taking fixed-dose (p = 0.049) or free-dose (p = 0.001) combination therapy, BP measured in other settings (nurse's office, patient's home) than the physician's office (p = 0.034) or the pharmacy (p = 0.019), older age (p = 0.032), and lower systolic (p < 0.001) and diastolic (p < 0.001) BP. Of the hypertensive patients with clinical inertia, 90.2% (95% CI 88.7, 91.7) had high cardiovascular risk. Conclusions: Clinical inertia was associated with a profile that included older age, lack of co-morbid conditions and being seen at a primary care centre. PUBLICATION ABSTRACT
The objective in the present study was to evaluate if obesity beginning in the first two decades of life influences the relationship between ambulatory blood pressure and urinary sodium excretion.
...Eighty-five obese and 88 non-obese children aged 3-19 years were included in the study. For each subject, a 24h ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. The averages of ambulatory blood pressure and of the urinary excretion rates for sodium, potassium and creatinine were calculated separately for 24-h, awake and sleep periods as defined by a mini-diary.
Weight and sodium excretion are directly associated with systolic blood pressure; however, the relationship between blood pressure and sodium excretion seems to be modified in obese children as compared to controls. The interaction between sodium excretion and weight was negative indicating that the rate of change of systolic blood pressure by sodium unit is smaller for the obese than for the non-obese, even though at the same urinary sodium excretion level the obese children had higher ambulatory systolic blood pressure.
Obesity during the first two decades of life seems to restrict sodium excretion, leading to higher blood pressure values. The capacity to excrete sodium seems to be heterogeneous, the lowest capacity being at the highest blood pressure values. Subsets of the obese, those with the lowest ability to excrete sodium, may be further protected by low sodium intake in order to prevent a rise in blood pressure.
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