Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
ABPM-AMBULATORY BP MONITORING
1. MONITORIZAREA AMBULATORIE
A TENSIUNII ARTERIALE
DE LA CERCETARE LA APLICABILITATEA CLINICA
Alexandru Andritoiu
Sp. Clinic de Urgenta Militar Craiova
Sectia Medicina Interna
2. 1961
Moto:
,, Blood pressure is a quantity with a
very large range…hypertension is
a quantitative disease,,
Sir George White Pickering
(1904-1980)
1968
3. Office BP vs. Out-of-Office BP
• Office BP
TA de cabinet
• Out-of-Office BP
ABPM
Auto-masurarea TA la domiciliu
ESH/ESC 2013
4. TEHNICI DE MONITORIZARE TA
Non-invazive
• ABPM ambulatory
blood pressure
monitoring
• HBPM home blood
pressure monitoring
Invazive
• Manometrie I.A.
5. Metode ABPM
• Metoda oscilometrica
• Metoda auscultatorie
• Metoda pletismografica
Protocoale de validare AAMI (1990) si BHS (1993)
12. Parametrii ABPM
TA -24 h (h 7.00-7.00)
TA diurna (h 7.00-22.00)
TA nocturna (h 22.00-7.00)
TA trezire (h 5.00-8.00)
TA max
TA min
TAM
PP
ID
FC
BP load
Index hiperbar
DS
25. Morning surge
Morning BP surge: TAS medie in timpul celor 2 ore dupa trezire-TAS medie din timpul de 1 ora
surge
ce include cea mai scazuta TAS din timpul somnului (Kario K 2003)
Cresterea TAS>50 mmHg si/sau TAD>20 mmHg in intervalul 6.00-10.00a.m. (Marfella R 2003)
29. Masket HT-subtipuri
• HTA matinala
• HTA diurna
• HTA nocturna
Kawano Y et al- Clin Exp Hypertens 2008;30(3):289-96
30. Caracteristicile pts cu Masket HT
•
•
•
•
•
•
•
•
•
•
Varsta tanara
Sex M,
Stress cotidian
Fumatori
Consumatori de alcool (seara)
Obezitate centrala
HTA ocazionala
Prehipertensivi
Pacienti cu scor mare de risc CV
Semne de afectare organe tinta cu TA normala la
cabinet
• Pacienti hipertensivi sub tratament
Poate precede HTA sustinuta
31. Lot - 46 adulti cu HTA la cabinet
40%
25%
20%
15%
WCH
episodica
diurna
sustinuta
Andritoiu A, 2000
32. HTA LA TINERI
Importanta metodei in expertiza medico-militara
Andritoiu A si colab. The significance of
high blood pressure in cardiovascular
pathology of young adults. The 4th Cong
BMMC 1999, Bucuresti
Andritoiu A. Monitorizarea ambulatorie a
A
tensiunii arteriale-aplicabilitate diagnostica si
prognostica. Rev Med Mil 1999;1107-126.
33. BP load
Definitie:
In 1988, the Mayo Clinic suggested the use of a BP load,
load
defined as the percentage of BP values exceeding a given
constant threshold,usually 140/90mm Hg for systolic/diastolic
BP during activity and 120/80mm Hg during resting hours.
The hyperbaric index (HBI), as a determinant of BP excess,
can be calculated as the total area of any given patient’s BP
above the threshold.
34. Stadializarea HTA dupa BP load
BP LOAD (%)
0- 5
5 - 15
15 - 25
25 - 75
75 -100
STADIU
%
normal
15
borderline
usoara
moderata
severa
35
20
25
5
Andritoiu A. Semnificatia parametrului BP load in evaluarea severitatii hipertensiunii.
Al 38-lea Cong Nat Cardiol 1999, Sinaia
35. Stadializarea HTA dupa BP load
BP load(%)
Grad
N=45
%
0-5
normal
10
22
6-15
borderline
12
27
16-25
usoara
5
11
26-75
moderata
10
22
76-100
severa
8
18
Andritoiu A, 2000
36. Valorile BP load fct tipul HTA (ABPM)
WC-HT
6.42+/-6.43
HTA episodica
10.76+/-9.85
HTA diurna
43.67+/-20.46
HTA sustinuta
77.64+/-22.79
N = 45 pacienti
Andritoiu A, 2000
40. Presiunea Pulsului (PP)
Definitie:
diferenta dintre presiunea sistolica si
presiunea diastolica: forta generata de
cord la fiecare contractie
PP: predictor de evenimente CV
mai bun decat TAS si/sau TAD izolate
TAS = 120 mmHg; TAD=80 mmHg; PP=40 mmHG
41. Componenta fazica - pulsatila (PP)
LOT I
LOT II
(hipertensivi)
(normali)
PP - 24 h 50,7 +/- 6,3
PP - day 51,5 +/- 6,4
PP - night 45,1 +/- 9,6
p<
50,8 +/- 4,7
NS
51,1 +/- 5,3
NS
48,9 +/- 4,0
NS
Creste semnificativ in HTA sistolica (ateromatoza Ao)
Andritoiu A, 2000
42. Variabilitatea TA in 24 h
• variabilitatea beat-to-beat
• variabilitatea measure-to-measure
Parametrul:
SD (TAS, TAD, TAM, PP)
51. Non-Dipping
•
•
•
•
•
•
•
•
•
•
•
•
•
Salt sensitive hypertension
HTA secundara
Disfunctie autonoma
Diabet zaharat
Sdr. de apnee in som
Sdr. Cushing
Feocromocitom
Hiperaldosteronismul primar
Virsta avansata (HT sistolica severa)
Etnicitate (rasa Afro-Americana)
Medicamente (ciclosporina, corticosteroizi)
Insuf. renala (dializati)
Insuf. cardiaca congestiva
52.
53. VARIABILITATEA CIRCADIANA
LOT I
LOT II
(hipertensivi)
p<
(normali)
ID - TAM
15,5 +/- 8,5
13,8 +/- 6,4
ns
DS .TAS-24h
15,4 +/- 3,8
11,3 +/- 2,8
0,05
Andritoiu A, 2000
55. VALOAREA PROGNOSTICA
Cresterea TAS-24h cu 1 mmHg este asociata unei cresteri
a riscului de mortalitate cardiovasculara de 4.7% !
Studii:
•
•
•
•
Perloff et al.- JAMA 1983:249:2792-2798.
Perloff D, Sokolow M, Cowan R, Juster RP – J Hypertens 1989;7(suppl):S3-S10.
Perloff D Sokolow M – J Hypertens 1990 (suppl):S105-S111.
Perloff D, Sokolow M, Cowan R – J Hypertens 1991 ;9 (suppl):S33-S39.
,, Average ambulatory BP was better correlated than office BP with the degree of
target-organ damage and the presence of cardiovascular complications”.
,,The patients with a low ambulatory BP, in relation to the level to the level
predicted from the office blood pressure, had a better prognostic, and were less
likely to develop clinical events over a 10-year period, than patients with higher
BP levels”
56. VALOAREA PROGNOSTICA A DATELOR ABPM
Studiu pe 3 ani
899 pts cu HTA esentiala vs 176 normotensivi
WCH ……………0,45 evenimente / 100pts / an
HTA ……………2,59 evenimente / 100 pts / an
Normo-TA………0,56 evenimente / 100 pts / an
•
Un traseu anormal de monitorizare TA ambulatorie a identificat 95%
dintre subiectii care aveau sa sufere un eveniment cardiovascular in
urmatorii 3,3 ani!
• Valoarea predictiva negativa a ABPM = 98% !
Verdecchia P. Al XII-lea Cong Cardiol;10-14 sept 1994, Berlin
59. Presiunile monitorizate pe 24h se coreleaza
cu o varietate de leziuni de organ
• scorul global al afectarii organelor tinta
•
•
•
•
•
•
•
masa VS (gradul HVS)
afectarea functiei VS
nivelul microalbuminuriei
hipertrofia peretelui arterial
distensibilitatea arterelor elastice
deteriorarea creierului (dementa vasculara)
retinopatie
60. Evaluarea afectarii unor tinte in HTA
(lot 800 pts)
78%
43%
22%
14%
FO I / I I
Placa ASC
HVS
Mi Alb
Cuspidi C, 2001
61. AF. ORG. TINTA (TOD)
(ABPM - 45 hipertensivi)
14
12
10
8
6
4
2
0
FO
HVS
E/A<1
CAR
AB
ALB
Andritoiu A, 2000
63. Relatia ABPM – FO la un lot de 45 pacienti cu HTA
Hipertensiune
BP load
Grad 0/I
Grad II/III
WC-HT
6.42+/-6.43
12
0
Episodica
10.76+/-9.85
12
0
Diurna
43.67+/-20.46
2
4
Sustinuta
77.64+/-22.79
3
11
Andritoiu A, 2000
64. Relatia cu HVS (Eco)
TAS-24h si TAD 24h se coreleaza cu:
•
•
•
•
•
•
SIV+PPVS
PPVS
SIV+PPVS/DTDVS
h/r (HVS concentrica)
Masa VS
AS – cu TAD-24h
Prisant LM, Carr AA. 1990
65. Corelatia dintre masa VS (Eco) si TAS-24h
vs TAS determinata ocazional (cabinet)
Studiu
Rowlands
Devereux
Drayer
Kleinert
Prisant
Verdecchia
n
50
100
12
93
55
253
TAS -24h
0,60
0,50
0,81
0,26
0,50
0,48
TAS-cab
0,51
0,24
0,55
0,22
0,33
0,38
66. Principalii determinanti directi ai HVS
•
•
•
•
•
TA medie -24 h
TAS diurna
TAS la trezire
BP load
Var. presionala
•
•
•
•
•
•
•
•
•
•
•
Stresul de forfecare
Stresul parietal
IMC
Virsta
Sexul
Aportul de sodiu in dieta
Factori genetici
Viscozitatea singelui
Rezistenta la insulina
Ingestia cronica de alcool
Factori neuro-hormonali (catecolamine, angiotensina, renina)
70. 100 pts hipertensivi
•
GROUP I
GROUP II
GROUP III
R-CCA
Dd
L-CCA
R-CCA
L-CCA
R-CCA
L-CCA
5,8+/-0.8
5,6+/-0.7
6,5+/-0.7
6.7+/-0,9
8,3+/-0.3
7.7+/-0,2
0,45+/-0,2
0,44+/-0,2
0,67+/-0,2
0,65+/-0,3
0,89+/-0,3
0,93+/-0.2
(mm)
IMTh
(mm)
% Plaques
28,5%
80%
% Segnif.stenosis
22 %
14%
Mean stenosis(%)
45+/-10,7 %
38+/-9,7%
Andritoiu Al. Modificari morfologice si functionale ale arterelor carotide comune in hipertensiune
comparativ cu imbatrinirea-studiu Eco-Doppler. A II-a Conf Nat Ultrasonografie , Craiova, 1999.
71. Distributia topografia a placilor ATS-CAR
GROUP II
CCA-middle
CCA-bulb
ICA
ECA
TOTAL
3
4
5
2
12
GROUP III
5
10
11
6
32
Andritoiu Al. Modificari morfologice si functionale ale arterelor carotide comune in hipertensiune
comparativ cu imbatrinirea-studiu Eco-Doppler. A II-a Conf Nat Ultrasonografie , Craiova, 1999.
72. Modificarile a. brahiale in HTA
Se coreleaza cu parametrii ABPM-24h si la trezire !
•
•
•
Cresterea in diametru/arie
Modificarea profilului spectral
Alterarea vasodilatatiei
- dependenta de endoteliu (Ach)
- independenta de endoteliu (NTG)
Andritoiu A, 2000
79. Relatia scor-TOD si parametrii ABPM la trezire
(lot 45 pacienti HT)
TAS
R= 0.87
TAD
R= 0.72
TAM
R= 0.80
SBP load
R= 0.74
DBP load
R= 0.61
FC
R= 0.23
Andritoiu A, 2002
82. Hypertension in pregnancy, as diagnosed by ABPM, is
superior to the office measurement of BP in predicting
outcomes
83. ABPM in sarcina
Recomandata de:
de
Soc. Elvetiana de Hipertensiune
Soc. Franceza de Hipertensiune
Nerecomandata de:
de
Marea Britanie, SUA, Germania, Brazilia
84. Valorile normale (ABPM) in sarcina
Sapt.
TA diurna
9-17
18-22
26-30
>30
130/77
132/79
133/81
135/86
(Brown MA et colab. 1998)
Trim I
Trim II
Trim III
TA-24h
110/70
116/74
125/80
TA diurna
113/69
119/78
126/83
TA nocturna
100/71
113/73
111/78
(Gheorman V, Andritoiu A, Raca N 2002)
85. Profilul circadian al TAS, TAD, TAM, FC
in sarcina
Hermida RC, Hypertension 2001;38:746
86. Valorile medii
pe fiecare trimestru de sarcina
Parametru
ABPM
TRIM I
TRIM II
TRIM III
99.5+/-5.5
104.1+/-6
108.7+/-8.2
TAD 24 h
66.3+/-2.2
67.8+/-3
70.3+/-5.3
TAM 24 ore
77.8+/-9.7
79.6+/-10.2
86.8+/-12.4
TAS diurna
101.3+/-5.8
106.3+/-6
111.7+/-7.2
TAD diurna
66.8+/-1.2
69.3+/-4
72+/-5.6
TAM diurna
79.6+/-5.6
82.6+/-6.6
88.4+/-6.7
TAS nocturna
95.3+/-2.3
99+/-6.8
100.5+/-5.5
TAD nocturna
62.8+/-3.9
65.3+/-4
66.7+/-5.4
TAM nocturna
76.8+/-5.2
77.3+/-4.5
79.2+/-5.6
TAS 24 h
Andritoiu A, Raca N, Gheorman V.- Metode noi in predictia preeclampsiei. Ed. Info, Craiova, 2007.
87. Limita cut-off
Parametru
ABPM
TRIM I
TRIM II
TRIM III
TA – 24 h
110.5/70
116/74
125/80
TA diurna
113/69
119/78
126/83
TA nocturna
100/71
113/73
111/78
140
120
125
116
110.5
100
80
74
70
80
60
40
20
0
TRIM I
TRIM II
TAS
TRIM III
TAD
Andritoiu A, 2006
88. PP – presiunea pulsului
(TAS-TAD)
Parametru
42
ABPM
TRIM I
TRIM II
33.5+/-5.5
36.1+/-6
33.3+/-5.8
36.1 36.3+/-6
40.2+/-7.2
PP nocturn 33.5 33.3+/-2.3
34
34.2+/-6
33.5+/-5.5
40
PP 24 ore
PP-24 ore
38
PP diurn
36
TRIM III
38.5
38.5+/-8.2
32
30
TRIM. I
TRIM. II
TRIM. III
virsta sarcinii
Andritoiu A, 2006
89. Sarcina de presiune
(BP load)
Parametrul
ABPM
TRIM I
TRIM II
TRIM III
SBP load
3.2+/-0.05
6.2+/-0.05
7.5+/-0.02
DBP load
3.3+/-0.08
4.6.+/-0.06
5.5+/-0.03
Andritoiu A, 2006
90. Frequency distribution of maximum BP load from normotensive pregnant women (top)
and women with a final diagnosis of gestational hypertension or preeclampsia (bottom)
sampled in different trimesters of pregnancy.
Hermida R C - Hypertension 2001;38:723-729
91. Parametrii ABPM
intervalul de trezire (h 5.00-8.00 am)
Parametru
ABPM
TRIM I
TRIM II
TRIM III
TAS
103.5 +/-12.2
106.6+/-11.3
114.5+/-10.9
TAD
69+/- 11.3
72+/- 13.6
76+/-13.2
TAM
78.6 +/-3.2
83 +/-3.3
88 +/-3.6
FC
72.6+/-8.9
86.6+/-11.2
86.7+/-10.2
Andritoiu A, 2006
92. Relatia TA clinica -TA ambulatorie
Normal Probability Plot
Normal Probability Plot
196
Variables
TAS CAB
TAS DIURNA
176
124
Variables
TAD DIURNA
TAD CAB
114
104
156
94
136
84
116
74
96
64
0.1
1
5
20
50
percentage
TAS
80
95
99
99.9
0.1
1
5
20
50
80
95
99
99.9
percentage
TAD
Andritoiu A, 2006
94. Parametrii presionali
TA cabinet @ cele 4 subgrupe
n
TA - 24 ore @ cele 4 subgrupuri
n
180
160
160
140
140
120
mmHg
mmHg
120
100
80
60
100
80
60
40
40
20
20
0
0
NORM
WCH
HTG
subgrup
PE
TAS cab
TAD cab
NORM
WCH
HTG
PE
TAS 24 ore
TAD 24 ore
subgrup
Diferente semnificative statistic s-au observat intre subgrupul PE si
subgrupurile NORM si WCH (p <0.001), cit si intre subgrupul PE si
subgrupul HTG (p=0.01).
Andritoiu A, 2006
95. TAM-24 ore
TAM - 24 ore @ cele 4 subgrupuri
n
120
100
mmHg
80
60
40
20
0
NORM
WCH
HTG
subgrup
PE
TAM -24 ore
Diferente s-au inregistrat intre subgrupul PE si subgrupurile NORM si
WCH (p<0.001), inclusiv intre PE si HTG (p = 0.004).
Andritoiu A, 2006
96. TA diurna si TA nocturna in cele 4 subgrupuri
TA diurn[ @ cele 4 subgrupuri
n
TA nocturn[ @ cele 4 subgrupuri
n
140
140
120
120
100
100
mmHg
mmHg
160
80
60
80
60
40
40
20
20
0
0
NORM
WCH
subgrup
HTG
PE
TAS diurna
TAD diurna
Diferente statistice s-au remarcat
intre subgrupul PE si NORM, WCH
(p<0.001), inclusiv intre PE si HTG
(p=0.01).
NORM
WCH
subgrup
HTG
PE
TAS nocturna
TAD nocturna
Diferente statistice s-au remarcat intre
subgrupurile PE si NORM si WCH (p<0.001)
cit si intre PE si HTG (p =0.01).
Andritoiu A, 2006
97. WC-HT
hipertensiunea de halat alb
AU
ACM
A OFT
WCH
NORM
WCH
NORM
WCH
NORM
IP
0.78
0.76
0.88
0.87
1.15
1.18
IR
0.55
0.53
0.58
0.57
0.67
0.66
S/D
2.3
2.2
2.2
2.2
2.8
2.7
Parametrii ABPM
FC - 24 ore
WCH vs NORM
bpm
88
86
mmHg
WCH vs NORM
180
160
140
120
100
80
60
40
20
0
TAS
CAB
84
82
80
TAD
CAB
TAS 24 TAD 24 TAM 24 TAS
TAD
TAS
H
H
H
DIURN DIURN NOCT
WCH
78
TAD
NOCT
NORM
76
WCH
NORM
Andritoiu A, 2006
99. PE - preeclampsie
Distribuia valorilor TA @ subgrupul PE
n
AU
ACM
180
A OFT
160
140
NORM
PE
NORM
PE
NORM
mmHg
120
PE
100
80
60
IP
1.74
0.76
0.83
0.87
1.01
IR
0.75
0.53
0.58
0.67
0.61
0.66
S/D
3.75
2.2
2.2
2.2
2.5
40
1.18
2.7
20
0
1
NORM
4
5
6
7
8
9
TAS 24 H
TAD 24 H
Parametrii ABPM
PE vs NORM
mmHg
HTG
3
nr. paciente
FC - 24 ore
PE vs NORM
bpm 100
90
80
70
60
50
40
30
20
10
0
2
180
160
140
120
100
80
60
40
20
0
TAS
CAB
TAD
CAB
TAS 24 TAD 24 TAM 24 TAS
TAD
TAS
H
H
H
DIURN DIURN NOCT
PE
TAD
NOCT
NORM
Andritoiu A, 2006
102. Corelatiile stabilite intre parametrii determinati prin
ABPM si PE
in grupul cu risc crescut
Parametru ABPM
r=
p<
TAS-24 ore
0.68
0.001
TAD-24 ore
0.72
0.001
TAM -24 ore
0.71
0.001
TAS diurna
0.69
0.001
TAD diurna
0.72
0.001
TAS nocturna
0.63
0.001
TAD nocturna
0.70
0.001
FC-24 ore
-0.24
NS
Andritoiu A, 2006
104. PROFILUL CIRCADIAN AL HTA
Sb%
Sp%
55.55
96.42
VP(+) %
71.42
VP(-) %
AC %
RR
93.1
90.77
10.44
Corelatia dintre profilul non-dipper si rata aparitiei PE
r = 0.71; p<0.001
Andritoiu A, 2006
105. Scorul de risc preeclamptic
Variabila
Punctaj
Clinic
Cel puin un factor derisc (diabet, primiparitate,
varsta =>35 ani, antec. PE sau fat mort)
1 p.
TAD cabinet =>100 mmHg
1p
Doppler
IR-a uterina >0.6
1p.
S/D a. uterina >2.4
1p.
Notch grad 1, 2, 3,
1p, 2p, 3p.
Notch bilateral
x 2 p.
Notch absent
0p.
IR <0.5 aa. cerebrale materne
1 p.
ABPM
TAM-24 ore >100 mmHg
1
TAD nocturna > 75 mmHg
1
Profil non-dipper
1
Scor maxim de risc
14
Andritoiu A, 2006
106. SCOR DE RISC PREECLAMPTIC
puncte
11.55
12
10
8
4.87
6
4
1.61
1.17
NORM
WCH
2
0
HTG
PE
Plot of Fitted Model
PE = -0.0938699 + 0.0736661*SCOR
1
0.8
PE
0.6
0.4
0.2
0
0
3
6
9
12
15
SCOR
Andritoiu A, 2006
108. Ceasul biologic - master clock
• Complex de gene
• Arie speciala in
cortex
• Nc. suprachiasmatic
• Locus ceruleus
Rolul SN autonom - baroreflexe
Melatonina-mesager endogen
109. The cardiovascular system is highly organised in time
Lemmer B. - Pharmacol Ther 2006
•
•
•
•
•
TA
FC
RVP
DC
Hh vasoactivi
CA, SRAA, Et-1, AMPc
110. Definitii
• Chronobiologia –stiinta preocupata de mecanismele
biologice ale bolilor in relatie cu o structura temporala;
• Chronoterapia (cronofarmacologia): disciplina ce
studiaza efectul farmacologic al medicamentelor in relatie
cu comportamnetul bolii pe o anume perioada de timp.
• Cronofarmacokinetica
• Cronofarmacodinamia
111. Cronofarmacokinetica
• Absorbtia
• Distributia
• Secretiile gastro-dd
• Golirea gastrica
• Metabolizarea
• Eliminarea renala
Cronofarmacodinamie
• Efecte diferite pe
intervalul 24 ore
• Momentul
administrarii poate
modifica rap.
doza/concentratie
Cronotoxicitate
114. Obiectivele cronoterapiei in HTA
concentratii mai mari atunci cind este mai multa
nevoie (e.x: perioada post-trezire) si mai mici cind
nevoile sunt mai reduse (e.g., in intervalul de
somn nocturn)
•
•
•
Normalizarea valorilor TA pe intreg intervalul circadian
Reducerea riscului cardio-vascular
Imbunatatirea/normalizarea profilului circadian al TA (dipper)
Morning versus evening dosing of a once-daily agent !
115. Studii
Morning vs evening dosing
ACE inhibitors
• quinapril, enalapril, benazepril, perindopril
BRA
• valsartan
Beta-blockers
• Atenolol, propranolol MR
Calcium channel blockers
• nifedipine-GITS
Depinde de formularea farmaceutica
Instant vs ER
• amlodipine
• isradipine
• nitrendipine
• ditizem
• verapamil COER
116. The impact of dosing time on the response to
antihypertensive therapy
• circadian patterns were generally unchanged
when comparing morning vs evening
administration of a variety of
antihypertensive agents
• nocturnal medication dosing generally
reduced asleep BP more than morning
dosing
Lemmer B. Blood Press Monit 1999;1:161-169.
120. Ce ne rezerva viitorul ....
trialuri clinice comparative ptr. a evalua
efectele antihipertensivelor
homeostatice vs cronoterapeutice pe
end-pointurile clinice ( imbunatatirea
controlului TA, QOL, ischemiei
miocardice si performantelor
miocardice)
124. Studii personale
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Andritoiu A si colab. Monitorizarea automata pe 24 h a tensiunii arteriale. Studiu pe 20
pacienti tineri hipertensivi comparativ cu normalul. Al 37 Cong Nat Cardiol, 1998, Sinaia
Andritoiu A si colab. Parametrii de presiune arteriala evaluati prin computerizare automata
24h la un grup de pacienti cu hipertensiune arteriala. Al 37-lea Cong Nat Cardiol 1998, Sinaia
Andritoiu A si colab. Monitorizarea automata 24h a tensiunii arteriale (ABPM). A 3-a Conf Nat
Semiol Med 1998, Craiova
Andritoiu A. Semnificatia diagnostica si prognostica a monitorizarii ambulatorii a tensiunii
arteriale. Infomedica 1999;8:2-9.
Andritoiu A. Semnificatia parametrului BP load in evaluarea severitatii hipertensiunii. Al 38-lea
Cong Nat Cardiol 1999, Sinaia
Andritoiu A si colab. The significance of high blood pressure in cardiovascular pathology of
young adults. The 4th Cong BMMC 1999, Bucuresti
Andritoiu A. Monitorizarea ambulatorie a tensiunii arteriale-aplicabilitate diagnostica si
prognostica. Rev Med Mil 1999;1107-126.
Andritoiu A. Hipertensiunea de halat alb - intre normal si patologic. Infomedica 2001;10:12-16.
Andritoiu A. Complianta terapeutica in managementul hipertensiunii arteriale. Rev Med Mil
2001;2:195-206.
Andritoiu A. Parametrii monitorizarii tensionale la trezire si afectarea organelor tinta in HTA. Al
41-lea Cong Nat Cardiol 2002, Sinaia
Andritoiu A. Monitorizarea ambulatorie a TA – relatia cu afectarea organelor tinta in HTA. Al
41-lea Cong Nat Cardiol 2002, Sinaia
Raca N, Gheorman V, Andritoiu A. Parametrii ABPM in sarcina normala. Al 2-lea Cong Nat
Obst-Ginecologie, 2002, Bucuresti
Forest plot shows the prevalence of white-coat hypertension. When studies were divided on the basis of the criteria used for diagnosis of white-coat hypertension, it was found that studies that used a more strict criterion (clinic systolic BP ≥130 mmHg, ambulatory BP <130 mmHg) were more likely to find white-coat hypertension, compared with studies that used a more liberal criterion (clinic systolic BP ≥140 mmHg, home BP ≥130 to 135 mmHg).
Forest plot shows the prevalence of masked hypertension among patients with normal BP in the clinic. When studies were divided on the basis of the criteria used for diagnosis of masked hypertension, it was found that studies that used a more strict criterion (clinic systolic BP <130 mmHg, ambulatory BP ≥130 mmHg) were less likely to find masked hypertension, compared with studies that used a more liberal criterion (clinic systolic BP <140 mmHg, home BP ≥130 to 135 mmHg).
Figure 1. Frequency distribution of maximum BP load from normotensive pregnant women (top) and women with a final diagnosis of gestational hypertension or preeclampsia (bottom) sampled in different trimesters of pregnancy. The BP load was obtained for each BP profile as the percentage of all individual BP readings >125/95/75 mm Hg during activity and 105/80/65 mm Hg during resting hours for SBP, MAP, DBP, respectively. Maximum load indicates the maximum of the values obtained for each of the 3 cardiovascular variables.
