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The aim of the present study was to evaluate the effects of 12 weeks of muscle power training (MPT) on casual blood pressure (BP) (before and after each training session) and resting BP (pre- and post-training program) in type 2 diabetes mellitus (T2DM) elderly. Methods: Twelve T2DM elderly individuals (68.75 ± 7.83 years), non-insulin-dependents participated in the present study and performed the MPT program twice a week. Casual BP was measured before and after training sessions, and resting BP was measured 48 h before the first and 48 h after the last training session. Results: Significant decrease in casual systolic (SBP) (−7.08 ± 4.12 mm Hg [effect size [ES]: −1.42 to −0.11]; p < 0.01) and diastolic (DBP) BP (−3.14 ± 1.24 mm Hg [ES: −1.24 to −0.18]; p > 0.01) was found after training sessions, without significant effect (p > 0.05) of the week along time or casual BP × week interaction. No significant change in resting SBP (−5.08 ± 8.93 mm Hg [ES: −0.41]; p = 0.07) and DBP (0.47 ± 6.06 mm Hg [ES: +0.11]; p = 0.79) was found. Conclusion: MPT was able to reduce casual BP after training sessions. However, there was no significant reduction in resting BP after MPT. Nevertheless, although not statistically significant, there were important clinical reductions in resting SBP in T2DM elderly patients.

Oh dear. Another article from academic medicine[1][1] telling us how badly we are doing. Are the authors really telling us that an asymptomatic woman in her late 80s with a casual blood pressure of 160/60 mm Hg has to reduce her systolic blood pressure to 140 mm Hg? Why is there no mention of

Background Hypertension (HT) is a common and serious complication following renal transplantation in children, and an important risk factor for cardiovascular morbidity and mortality. This study evaluated the clinical characteristics of HT in children after renal transplantation. Methods Twenty-four children who were followed up at least 6 months after renal transplantation were enrolled in the study. From the clinical records, demographic and laboratory data, casual blood pressure (BP) measurement, ambulatory BP monitoring (ABPM), medication, and left ventricular mass index (LVMI) at echocardiogram were documented. Results Mean age at time of transplantation was 12.6 ± 3.0 years and mean follow-up period was 19.6 ± 15.8 months. HT was detected in 21 children (87.5%) after renal transplantation. Twelve patients (50%) had HT both before and after transplantation and nine (38%) had HT only after transplantation. HT developed in 67% within the first week and in 95% within the first month. All hypertensive children had night-time HT and no child had isolated daytime HT. The efficacy of HT control was 42%. Median LVMI in patients with HT after renal transplantation was 42.3 g/m(2.7). Conclusions Severe HT, an important complication, was frequently seen in the early period after renal transplantation. Predominance of nocturnal HT and the lack of isolated daytime HT after transplantation underline the importance of ABPM. ABPM should be performed regularly in the first year after transplantation, not only for diagnosis but also for evaluation of HT control.

Ambulatory blood pressure measurement (ABPM) gives better prediction of cardiovascular morbidity and mortality, and endorgan damage associated with hypertension (HTN) than clinic or casual blood pressure measurements, since the diurnal blood pressure profile and nocturnal blood pressure levels are not ascertained by the later. 1 Although the technology has been available for more than three decades, its role in the evaluation and management of hypertension has been well established only in the past decade. Ambulatory blood pressure measurement is indicated to identify ‘white coat’ effect/hypertension, masked hypertension, to evaluate drug-resistant hypertension, and to assess adequacy of control in patients at high-risk of cardiovascular disease. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure and prevention of cardiovascular events. This review summarizes the utility of ambulatory blood pressure monitoring in the manage ment of hypertension and its practical importance.

Methodological issues are pointed to as the main sources of inconsistencies in studies about the association between job strain and blood pressure (BP)/hypertension. Our aim was to analyze the relationship between job strain and the whole BP distribution, as well as potential differences by gender, age, and use of antihypertensives. Additionally, we addressed issues relating to the operationalization of the exposure and outcome variables that influence the study of their inter-relations. We evaluated the baseline date of 12,038 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008-2010), a multicenter cohort study of 35-74-year-old civil servants. Job strain was assessed by the Demand-Control-Support Questionnaire. The distribution of casual BP by categories of job strain was compared by a combination of exploratory techniques. Participants were classified into three subgroups (normotensives, medicated hypertensives, and unmedicated hypertensives), and analyses were stratified by gender and age. The relationship between job strain and casual BP varied along the whole outcome distribution. Hypertensive participants had greater differences in casual BP by job strain category, especially medicated hypertensives. Differences in casual BP were also greater for systolic than for diastolic BP and for older participants. No differences were encountered by gender. The exclusion of participants susceptible to misclassification for the exposure and outcome variables increased the differences observed between the categories of low and high job strain. In conclusion, the relationship between job strain and casual BP varied along the whole outcome distribution and by use of antihypertensive drugs, age, and BP parameter evaluated. Misclassification for exposure and outcome variables should be considered in analyses of this topic.

Background: In practice there is no definite clinical value of grading by casual blood pressure(CBP) and it is need to put forward new Suggestions. Methods: According to the method of three grades by CBP, blood pressure of 270 hypertensives without treatment were graded by three patterns: 4 times of CBP per day(pattern A), 2 times of CBP that not on the same day(pattern B) and 4 times from randomized daily ambulatory blood pressure(pattern C), and then repeatability were compared. Results: (1), In pattern A: BP gradings on the same level in total of 4 times of CBP were 18.50% (50/270 cases), BP gradings between two levels were 38.20% (103/270 cases), BP gradings between three levels were 43.30% (117/270 cases), total of BP gradings between two to three levels were 81.50% (220/270 cases); (2), In pattern B: BP gradings were respectively 25.19% (68/270 cases), 41.48% (112/270 cases), 33.33% (90/270 cases), 74.81% (202/270 cases); (3), In pattern C: BP gradings were respectively 23.70% (64/270 cases), 38.89% (105/270 cases), 37.41% (101/270 cases), 76.30% (206/270 cases). Conclusion: The repeatability of blood pressure gradings judgment are very poor all of above three patterns, and were no clinical value. New recommendations are: (1) It is necessary to classified into stages by target organ damage in hypertensives without ABPM, and not necessary to do grading of CBP; The stages include the phase of pure high blood pressure, the phase of high blood pressure with compensatory target organ damage, the phase of high blood pressure with decompensated target-organ damage; (2) It is necessary not only to classified into stages by target organ damage in hypertensives with ABPM but also necessary to do grading by average ambulatory blood pressure in daytime and nighttime respectively. Key words: hypertension; casual blood pressure; Ambulatory blood pressure; grading; Stage; proposals.

Background: Despite of the recommendations to use population specific blood pressure (BP) references which consider time, ethnicity and environmental factors, there is limited information regarding BP profile among Tanzanians. This cross sectional study was done to determine casual BP profile among healthy volunteer students of the Catholic University of Health and Allied Sciences in Mwanza, Tanzania. Methods: Socio-demographic and lifestyle data were collected using questionnaires. Systolic BP (SBP) and diastolic BP (DBP) were measured using aneroid sphygmomanometer. Results: A total of 299 students (males=204; females=95) were involved in the study. Their mean age was 23.4 ± 0.2 years. SBP ranged from 82-150mmHg (mean= 115.7 ± 0.7mmHg) and DBP ranged from 44–100mmHg (mean= 71.9±0.6mmHg). Mean arterial pressure (MAP) was 86.5±0.5mmHg. Males had significantly higher BP than females; and BP was noticed to increase with increased age and body weight. Upper limits of the normal SBP and DBP calculated as mean + 2SDs and 95 th percentiles were 140.5mmHg and 138mmHg, respectively and for DBP were 91.8 mmHg and 90 mmHg, respectively. Conclusion : The observed upper limits of the distribution of normal BP for the age of the participants are higher than the World Health Organization recommended values. We recommend a larger study to determine BP among healthy Tanzanians to establish the normal values.

Generally, the evaluation of the blood pressure response to resistance exercise has been limited to the evaluation of discontinuous casual blood pressure monitoring, often measured at the end of the exercise.To continuously evaluate the blood pressure response at different intensities of leg press exercise with the same duration and number of repetitions.Seven normotensive healthy men performed an incremental test on the leg press machine at relative intensities of one repetition maximum (1RM). The blood pressure and heart rate were measured simultaneously to the incremental exercise by a photoplethysmographic method.The mean ± SD peak values of the heart rate, diastolic blood pressure (DBP) and systolic blood pressure (SBP) were obtained on 70% of 1RM and were 145 ± 20 bpm, 113.1 ± 15.4 mmHg, and 192.4 ± 20.0 mmHg, respectively. The SBP was characterized by a decrease followed by an increase during the sets of exercise. The decrease in the SBP was 12-22 mmHg and took approximately 25 seconds to reach the minimum value before the increase. It was observed for all participants in most of the intensities. The rate of increase in the SBP was not statistically different between the intensities.Both duration and intensity of exercise have an impact on the blood pressure response. Above 30% of 1RM, the SBP decreases in approximately 20 seconds and starts to increase until the end of the set of leg press exercise.

OBJETIVO: Determinar a reprodutibilidade da pressão arterial casual de participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) e confirmar o diagnóstico pressórico pela monitorização.MÉTODOS: A pressão arterial casual foi medida em aparelho oscilométrico. Uma subamostra dos participantes do estado do Espírito Santo (N = 255) foi reavaliada com igual metodologia de uma a dez semanas após; além disso, foi realizada monitorização. O diagnóstico de hipertensão seguiu os pontos de corte de 140/90 mmHg ou 130/80 mmHg para a pressão casual e na monitorização, respectivamente. A hipertensão do jaleco branco foi definida pela presença hipertensão na medida casual e normotensão na monitorização e o inverso para a hipertensão mascarada.RESULTADOS: Os dados referem-se a 230 participantes que nas duas ocasiões estavam sem medicação (N1 = 153) ou sob a mesma medicação anti-hipertensiva (N2 = 77). No N1, a normotensão casual foi confirmada em 120 dos 134 pela monitorização. No N2, a monitorização confirmou o controle pressórico em 43 dos 54 participantes com pressão controlada pela medida casual. A concordância geral de diagnósticos entre a pressão casual e monitorada foi de 78% (kappa = 0,44). No grupo N1, seis indivíduos (4%) apresentaram hipertensão do jaleco branco e 23 (25%), mascarada.CONCLUSÕES: A concordância de diagnósticos entre a pressão arterial casual e a monitorada foi moderada. A padronização rigorosa da medida casual adotada no ELSA-Brasil foi capaz de reduzir a hipertensão do jaleco branco. A alta frequência de hipertensão mascarada sugere que a medida pressórica da monitorização indique grau elevado de estresse no trabalho. OBJECTIVE: To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health).METHODS: Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension.RESULTS: Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension.CONCLUSIONS: Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.

The GDR-MONICA project comprises 25 administratively defined areas with a population of nearly two million people aged 25–64. Data from the first random sample survey are reported here. The survey gathered information regarding risk factors, dietary behaviour, physical activity and psychosocial factors from 11,281 persons aged 25–64. The average risk factor levels were high in the population: The mean casual blood pressure was 140/88 mmHg and 138/86 mmHg for men and women respectively. In both sexes the mean total cholesterol level exceeded 6.1 mmol/L, and the mean body mass index (BMI) was just over 26.0. The study population consumed, on average, excessive amounts of energy, fat, alcohol, and sodium, and too few carbohydrates. Preliminary conclusions regarding unfavourable trends in risk factor levels have been drawn by comparing the present data with other recent reliable epidemiological studies.

Malignant hypertension seems to be the consequence of very high blood pressure. Furthermore, an increase in sympathetic andrenin-angiotensin system activity is considered to be the main mechanisms producing malignant hypertension. In the presentstudy, 10 offspring of malignant hypertensive (OMH) parents (age 28 ± 5 years, 7 males, 3 females, 2 white and 8 non-white) and10 offspring of normotensive (ONT) parents (age 28 ± 6 years, 2 males, 8 females, 3 white and 7 non-white) were evaluated. TheOMH group had significantly higher (P < 0.05) casual blood pressure (125 ± 10/81 ± 5 mmHg) compared with ONT (99 ± 13/67± 5 mmHg). The increase in blood pressure was greater in OMH (∆ SBP = 17 ± 2 vs ∆ SBP = 9 ± 1 mmHg in ONT) during coldpressor testing, but they had a lower increase in heart rate ( ∆ HR = 13 ± 2 vs ∆ HR = 20 ± 3 bpm in ONT) during isometric exercise(handgrip test). Sympathetic activity, measured by microneurography, was significantly higher (P < 0.05) before exercise inOMH (17 ± 6 vs 11 ± 4 burst/min in ONT) and exhibited a greater increase (∆ = 18 ± 10 vs ∆ = 8 ± 3 burst/min in ONT) duringisometric exercise. This study showed increased sympathetic activity in OMH before exercise and a greater response duringisometric exercise, suggesting an autonomic abnormality before exercise and a greater sympathetic response to physical stressin OMH compared to ONT.Key words: Malignant hypertension; Offspring of malignant hypertensive parents; Sympathetic activity; MicroneurographyPublication supported by FAPESP.Received September 17, 2007. Accepted August 19, 2008

BACKGROUND The objective of the Snapshot Hypertension Registry (SHR) was to assess the quality of antihypertensive drug treatment in hypertensive patients seen by cardiologists on three consecutive days in December 2005. METHODS Full data sets were obtained for 7302 patients (89.9% of total returned) seen by 268 cardiologists. Mean age of hypertensive patients was 65.4 +/- 11.2 years, 62 % were male, and 93 % were referred to the cardiologist by a general practitioner. RESULTS Judging from their casual ("snapshot") blood pressure, 35.3 % were well treated (< 140/90 mm Hg). According to the 24-hour ambulatory blood pressure even a lower rate of hypertensive patients, namely 27.6 %, had their blood pressure well controlled (< 130/80 mm Hg). Of all patients, 24 % were on monotherapy. Only 33.7 % of the patients on monotherapy were normotensive. Of all patients on a combination of drugs 36.9 % were normotensive according to the casual blood pressure measurements. Private patients were prescribed angiotensin receptor blockers more frequently than patients who only had statutory health insurance. CONCLUSIONS The Snapshot Registry analysis revealed that the casual blood pressure in the majority of hypertensive patients who were reviewing antihypertensive medication was not in the normotensive range. In addition, our data demonstrate that evidence-based antihypertensive medication was often not adequately used in Germany.

The influence of age and sex on blood pressure levels was studied in Jatapu population of Srikakulam district, Andhra Pradesh. The occupational mobility and the acculturation in this community might have brought some changes in their blood pressure. The present Jatapu population shows a positive relationship between age, sex and blood pressure, like some of the neighboring tribal populations of Eastern Ghats region of Andhra Pradesh.

Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review. Resumo Nas últimas cinco décadas muito têm sido questionadas as medidas casuais da pressão arterial (PA). Significativa porcentagem de pacientes apresenta PA muito diversa quando examinados na clínica ou fora dela. Por isso, é hoje observada uma mudança de paradigma com relação ao melhor modo de se avaliar a PA. O método que mais se consolidou é a Monitorização Ambulatorial da Pressão Arterial - MAPA. É possível obter-se o registro de medidas de PA durante 24 horas avaliando-se vários parâmetros como: médias de PA, cargas de pressão, áreas sob as curvas, variações entre vigília e sono, variabilidade de pressão de pulso etc. As medidas de PA obtidas pela MAPA são mais bem correlacionadas, por exemplo, com os riscos da hipertensão arterial. As principais indicações para a MAPA são: suspeita de hipertensão do avental branco e da hipertensão mascarada, avaliação da eficácia terapêutica nas 24 horas e avaliação de sintomas. Crescem as evidências de que o emprego da MAPA contribui para avaliar os comportamentos da PA, estabelecer diagnósticos, prognóstico e avaliar a eficácia terapêutica anti-hipertensiva. Sem dúvidas, o estudo do comportamento da PA e suas variações durante as 24 horas pela MAPA nos deixaram com menos sombras e mais luzes, e justifica o título desta revisão.

Introduction Although evidence exists that adolescents’ hypertension could lead to adults’ hypertension, it is a general belief that measures for early detection and treatment of this condition is seldom undertaken especially in medically underserved communities such as Maiduguri, Northeastern Nigeria. This study investigated the prevalence of undiagnosed hypertension among adolescents in Maiduguri, Nigeria, and explored the association between undiagnosed hypertension and adolescents’ physical characteristics and parental socio-demographic factors. Methods Participants’ physical characteristics were assessed, and information on their socio-demographics including parental socioeconomic status were obtained. Blood pressures and heart rates of the participants were also measured three times at 5–10-min period. Results The prevalence of undiagnosed hypertension among the students was 13.2 %, and overwhelming majority (82.4 %) of the hypertensive students were in the prehypertensive stage, while 17.6 % were in the stage 1 classification of hypertension. Higher prevalence of undiagnosed hypertension was observed for the females compared to the male adolescents (X2 = 15.49, p = 0.001), and presence of undiagnosed hypertension is positively but tenuously linked to age (r = 0.11, p = 0.01), body mass index (r = 0.10, p = 0.01), and parental income (r = 0.26, p = 0.02) of the students. Discussion This study suggests that any effective programs designed to mitigate undiagnosed hypertension among adolescents in this city should include strategies that address possible barriers to physical activity and exercise among female adolescents in the society.

To assess home blood pressure status in a Japanese urban population, we analyzed home blood pressure values in normotensive subjects determined by casual blood pressure (140/90 mmHg), hypertensive subjects without medication (or = 140/90 mmHg) and treated hypertensive patients. The subjects (468 male, 232 female; mean age 41 years old) were recruited from a company located in Tokyo. Home blood pressure was measured with a semi-automatic device (Omron HEM-759P). Subjects were instructed to perform triplicate morning and evening measurements on 7 consecutive days. In the treated hypertensive group (n = 70), there was a significant difference between morning (139 +/- 12/88 +/- 9 mmHg) and evening (130 +/- 12/79 +/- 8 mmHg) home blood pressure. In the normotensive group (n = 558), however, only the diastolic blood pressure (DBP) component of the home blood pressure was significantly different between morning (115 +/- 13/72 +/- 9 mmHg) and evening (114 +/- 12/68 +/- 8 mmHg). In the nontreated hypertensive group (n = 72), casual blood pressure (145 +/- 14/92 +/- 9 mmHg) was higher than morning (138 +/- 16/89 +/- 11 mmHg) and evening (134 +/- 16/83 +/- 11 mmHg) home blood pressure, but no difference was seen between morning and evening systolic blood pressure (SBP). According to the reference value of the Japanese Society of Hypertension 2004 (SBPor = 135 mmHg and/or DBPor = 85 mmHg), 7.2% (systolic) and 8.7% (diastolic) of subjects in the normotensive group were classified as hypertensive by home blood pressure. Casual blood pressure in the treated hypertensive group was normal in 64.3% for SBP and 70.0% for DBP. However, their morning SBP (32.9%), morning DBP (40.0%), evening SBP (10.0%), and evening DBP (17.1%) were classified as hypertensive by home blood pressure. Furthermore, patients who were taking antihypertensive drug(s) only in the morning (n = 52) showed higher morning SBP (6 mmHg, p = 0.086) and morning DBP (6 mmHg, p = 0.005) than patients taking drug(s) by other administration schedules (n = 18), but no difference in evening home blood pressure was observed. In conclusion, a proportion of the subjects defined as normotensive by casual blood pressure were classified as hypertensive by home blood pressure in the present urban population. Furthermore, morning home blood pressure control in the treated hypertensive group classified as under control by casual blood pressure was insufficient, especially in patients who were taking medication only in the morning.

Background This study assessed 5-year changes in ambulatory blood pressure (ABP) in healthy, older individuals and determined the extent to which it could be predicted from earlier BP measures and other cardiovascular risk factors. Methods A total of 162 men and women, aged 55 to 79 years, with no prior medical disorders, completed a medical examination and two 24-h ABP sessions. The procedures were repeated 5 years later in 80% (130) of these subjects. A modified hierarchical regression analysis was used to determine whether initial ABP and casual blood pressure (CBP) measures and demographic and physical examination data could predict ABP in 5 years. Results The CBP and most ABP levels during waking and sleep increased after 5 years. However, CBP remained in the normotensive range for 73% of the subjects. The ABP variability tended to decrease over time. The ABP and CBP measures accounted for at least 50% of the variance in the prediction of ABP level after 5 years. In comparison, the predictability of ABP variability was quite low, particularly during sleep ( Conclusions The ABP and CBP were good predictors of future ABP level in healthy older subjects, but ABP variability was more difficult to predict. Except for age, none of the standard cardiovascular risk factors contributed significantly to the prediction of ABP level or variability.

INTRODUCTION The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. PATIENTS AND METHODS ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. RESULTS Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (P

From casual blood pressure measurement to long-term blood pressure burden: better elucidation of the association between versatile blood pressures and cardiovascular events

OBJECTIVE Tracking of blood pressure begins in childhood but the relationship between casual blood pressure in childhood and adult levels is not strong enough to predict adult hypertension. The variability of blood pressure in children might suggest that 24 recordings would have less consistency than casual readings when repeated even a relatively short time later. This study compares the short-term tracking ability of casual versus 24-h blood pressure. DESIGN An ambulatory blood pressure device was placed on 50 teenagers. Readings were taken at rest and the device was then worn for approximately 24 h, which included the schoolday. The protocol was repeated 1 year later. RESULTS The correlation coefficient for systolic readings taken 1 year later were: 0.4 for casual, 0.6 for school, 0.6 for home, 0.5 for night-time and 0.8 for 24-h mean systolic blood pressures. When divided into upper and lower tertiles of systolic blood pressure the relationship between tertile ranking 1 year later was stronger for 24-h blood pressure than the casual readings. Casual diastolic pressure was more consistent than the 24-h mean diastolic measurement. CONCLUSIONS In adolescents, in whom tracking of casual blood pressure has been shown to be poor, 24-h mean systolic blood pressure tracks better than any other time period and significantly better than the casual systolic readings. This study needs to be extended and the ability of 24-h blood pressure to track from childhood to adult life investigated.

Background: White-coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee-VI (JNC-VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time. Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC-VI classification, and the prevalence of white-coat hypertension diagnosed by using JNC-VI normal ABP criteria. Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC-VI classification, and their casual BP was compared with ABP. The criterion of white-coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC-VI criteria (< 135/85 during daytime and < 120/75 during nighttime). Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased. There were considerable overlaps in the distribution of ABP among stages. The prevalence of white-coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3. Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC-VI is very useful for the evaluation of hypertension to differentiate white-coat hypertension from true hypertension.

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Causal BPs were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHG and/or diastolic blood pressure (DBP) fell in the range 85-100 mmHg; BPs below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring. Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life.

Ambulatory blood pressure monitoring (ABPM) is an important tool in the diagnosis and management of childhood hypertension. Normal ambulatory blood pressure (ABP) values in children with body heights between 100 and 120 cm have not been reported. The aim of the study was to establish the normal range of values for ABPM in these children. 24-hour ABPM was performed in 40 normotensive (auscultatory casual blood pressure was obtained before ABPM) subjects, aged from 4 to 6 years (26 males, 14 females) with body heights between 95 and 125 cm. ABPM was carried out on non-dominant arm using the oscillometric device (SpaceLab 90207) with appropriate cuff size. The monitor was programmed to measure BP every 15 min. during the day (6 a.m. to 10 p.m.) and every 30 min. during the night (10 p.m. to 6 a.m.). The mean daytime SBP/DBP in boys and girls was 108+/-6/67+/-5 and 105+/-5/66+/-1, respectively. The mean nighttime SBP/DBP in boys and girls was 98+/-6/56+/-5 and 97+/-7/56+/-4, respectively. There was a significant difference between day and night readings of SBP, DBP and heart rate (nocturnal fall was observed). The distribution of ABP noted in this study could serve as preliminary reference. A multicenter study should be performed to provide normal ranges of ABP.

The diagnosis of hypertension in children or adults is predicated on the accurate measurement of the blood pressure and the proper interpretation of that measurement. Outside of the hospital setting, blood pressure is measured noninvasively, that is, not using indwelling arterial lines. The generally agreed-upon term for noninvasive BP measurement outside of a strict study setting and while the patient is at rest is the “casual blood pressure.” This chapter will review currently available methods of casual BP measurement and identify the advantages, disadvantages, and pitfalls of these methods.

Casual blood pressure measurement has provided the basis for the present knowledge of the potential risk associated with hypertension and has guided patient management for many years. The possibility of carrying out repeated ambulatory blood pressure measurements using automatic or semiautomatic devices allows for the gathering of more representative values of blood pressure and for observing the behavior of blood pressure during both moments of activity as well as rest. Ambulatory blood pressure measurement is now increasingly recognized as being indispensable to the diagnosis and management of hypertension, and it has contributed significantly to our understanding of hypertension. Likewise, the better relationship of ambulatory blood pressure measurements with the presence of organ damage and the prognosis to develop it have provided additional support to ambulatory blood pressure as a clinical valuable tool in the research, evaluation, and management of high blood pressure in children and adolescents.

Abstract Apparently healthy men (n=1999, 40 to 59 years old) were investigated from 1972 through 1975 to determine whether systolic blood pressure during bicycle ergometer exercise predicts morbidity and mortality from myocardial infarction beyond that of casual blood pressure taken after 5 minutes of supine rest. During a follow-up of 31 984 patient-years (average, 16 years), 235 subjects had myocardial infarctions, of which 143 were nonfatal and 92 were fatal. Exercise blood pressure was more strongly related than casual blood pressure to both morbidity and mortality from myocardial infarction. Among 520 men with casual systolic blood pressure ≥140 mm Hg, 304 increased their systolic blood pressure to ≥200 mm Hg during 6 minutes of exercise at an initial workload of 600 kpm/min. These 304 men had an excessive risk of myocardial infarction (18.8% versus 9.5% among the 1294 men with casual blood pressure P P =.0011), including those with casual blood pressure ≥140 mm Hg and exercise blood pressure

We investigated the long-term reproducibility of noninvasive 24-hour ambulatory blood pressure monitoring (ABPM) compared with casual blood pressure measurements in 54 individuals (47 +/- 11 years) with borderline hypertension. ABPM and casual blood pressure measurements were obtained 3 times over 2 year period. ABPM data were analyzed to determine the average 24-hour blood pressure (24-BP), the average blood pressure during the waking hours (Day-BP), and the average blood pressure from the time the subject went to bed until he awoke (Night-BP). ABPM measurements were similar for Year 1, 2, and 3 (24-BP: Year 1; 130 +/- 10/79 +/- 6 mmHg; Year 2; 130 +/- 10/79 +/- 7 mmHg; and Year 3; 130 +/- 10/78 +/- 7 mmHg). Bland-Altman analysis and standard deviation of the difference also indicated the reproducibility of 24-BP was better than casual pressure. The 24-BP was significantly correlated with both Day-BP and Night-BP for each year. Day-BP showed the stronger correlation. Our results suggest that Day-BP provides reproducible estimation in subjects with borderline hypertension.