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Objectives: Standard operating procedures for office blood pressure measurement (OBPM) vary greatly between guidelines and studies. We aimed to compare the difference between a single OBPM and the mean of the three following measurements. Further, we studied how many patients with possible hypertension may be missed due to short-term masked hypertension (STMH) and how many might be overdiagnosed due to short-term white coat hypertension (STWCH).Design and Setting: In this cross-sectional, single-centre trial, 1000 adult subjects were enrolled. After 5 min of rest, four sequential standard OBPMs were performed at 2 min intervals in a quiet room in sitting position. We compared the first (fBPM) to the mean of the second to fourth measurement (mBPM). STMH was defined as fBPM <140 mm Hg systolic and <90 mm Hg diastolic and mBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg. STWCH was defined as fBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg and mBPM <140 mm Hg systolic and <90 mm Hg diastolic.Results: Complete measurements were available in 802 subjects. Between fBPM and mBPM, 662 (82.5%), 441 (55%) and 208 (25.9%) subjects showed a difference in systolic and 531 (66.2%), 247 (30.8%) and 51 (6.4%) in diastolic blood pressure (BP) values of >2 mm Hg, >5 mm Hg and >10 mm Hg, respectively. In 3.4% of initially normotensives STMH and in 34.3% of initially hypertensives, STWCH was apparent.Conclusions: There are significant differences between a single OBPM and the mean of consecutive BP measurements. Our study provides evidence that a single OBPM should not be the preferred method and should be discouraged in future guidelines.Trial Registration Number: NCT02552030;Results. [ABSTRACT FROM AUTHOR]

Objectives: Due to different release mechanisms, midregional pro-atrial natriuretic peptide (MR proANP) may be superior to N-terminal pro-B-type natriuretic peptide (NT proBNP) in the diagnosis of acute heart failure (AHF) in patients with atrial fibrillation (AF). We compared MR proANP and NT proBNP for their diagnostic value in patients with AF and sinus rhythm (SR). Design: Prospective cohort study. Setting: University hospital, emergency department. Patients: 632 consecutive patients presenting with acute dyspnoea. Main outcome measures: MR proANP and NT proBNP plasma levels were determined. The diagnosis of AHF was adjudicated by two independent cardiologists using all available data. Patients received long-term follow-up. Results: AF was present in 151 patients (24%). MR proANP and NT proBNP levels were significantly higher in the AF group compared with the SR group (385 (258e598) versus 201 (89e375) pmol/l for MR proANP, p<0.001 and 4916 (2169e10285) versus 1177 (258e5166) pg/ml, p<0.001 for NT proBNP). Diagnostic accuracy in AF patients was similar for MR proANP (0.90, 95% CI 0.84 to 0.95) and NT proBNP (0.89, 95% CI 0.81 to 0.96). Optimal cut-off levels in AF patients were significantly higher compared with the optimal cutoff levels for patients in SR (MR proANP 240 vs 200 pmol/l; NT proBNP 2670 vs 1500 pg/ml respectively). After adjustment in multivariable Cox proportional hazard analysis, MR proANP strongly predicted one-year all-cause mortality (HR¼1.13 (1.09e1.17), per 100 pmol/l increase, p<0.001). Conclusion: In AF patients, NT proBNP and MR proANP have similar diagnostic value for the diagnosis of AHF. The rhythm at presentation has to be taken into account because plasma levels of both peptides are significantly higher in patients with AF compared with SR. [ABSTRACT FROM AUTHOR]

We report a case of a 52-year-old woman, on immunosuppressive treatment with mycophenolate due to a history of giant cell myocarditis (GCM), who presented with new-onset severe blood-tinged diarrhoea after a cytomegalovirus (CMV) primoinfection. An extensively prolonged mycophenolate-related colitis was seen after withdrawal of mycophenolate due to an intestinal Epstein-Barr virus (EBV) infection--a rarely seen event itself. We postulate that colonic toxicity was triggered by CMV infection and perpetuated by intestinal EBV replication/infection. [ABSTRACT FROM AUTHOR]