Ambulatory blood pressure monitoring in pregnancy: what is normal?

This paper aims to explore the meaning of spirituality in relation to nursing care using concept synthesis. Walker and Avant give three ways in which concept synthesis can occur: discovering new dimensions to old concepts, searching for similarities and discrepancies among sets of related concepts, and observing previously undescribed phenomena. It is the first two of these methods which have been used here. The phenomena that emerged from a reading of the literature around spirituality were meaning, presencing, empathy/compassion, giving hope, love, religion/transcendence, touch and healing. These phenomena were studied in order to sort them into fewer categories. They all appeared to be products of a relationship, some physical (presencing, touch and healing), and others emotional (meaning, empathy/compassion, hope, love, and religion/transcendence). Some of the phenomena appeared to fit in both categories, especially healing, which could be of a physical or emotional/spiritual nature. Once the two main categories had been arranged, it was obvious that a split between psyche and soma was not appropriate for labelling the spiritual dimensions of nursing care, as the original definition of spirit was something which motivated the body. Spiritual care is inseparable from physical, social and psychological care because together they form the whole (Bradshaw 1994 p. 282). The two categories were then collapsed into one and given the label 'connection'.     

Blood glucose monitoring by diabetic adolescents: Compliance and metabolic control.

Evaluated a behavioral contract for self-monitoring of blood glucose (SMBG) compliance among diabetic adolescents, using reflectance meters with memory to assess the target behavior. 30 patients were randomized to either meter-alone or meter?+?contract (MPC) conditions; an additional 12 patients served in a conventional-therapy control group. Compliance for the meter-alone group declined sharply during the 16-wk intervention, but remained at or above baseline levels for the MPC group. Despite the large between-group differences in SMBG frequency, both groups showed moderate improvement in measures of diabetic control, suggesting that SMBG frequency had little impact on health status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory blood pressure monitoring during pregnancy. Comparison with mercury sphygmomanometry

There is little information concerning the relationship between blood pressures obtained by standard mercury sphygmomanometry and ambulatory blood pressure monitoring (ABPM) in pregnancy. We compared readings obtained with these two methods using an Hawksley random zero mercury sphygmomanometer and an Accutracker II ABPM device. Blood pressures were compared over 90 min with the pregnant woman seated and, in a separate study, over 30 min during standing and ambulation. When pregnant women were seated, the ABPM overestimated the systolic blood pressure (BP) by 5 (3,6) mm Hg (mean, 95% confidence limits) (P < .001) and underestimated diastolic phase IV readings by 7 (-9, -6) mm Hg (P < .001) and phase V readings by 3 (-5, -1) mm Hg (P < .01). Eighty-three percent of systolic readings agreed within 10 mm Hg. Seventy-six percent of diastolic phase V (but only 45% of phase IV) readings agreed within 6 mm Hg. When pregnant women were ambulatory, the ABPM overestimated systolic BP by 7 (4,10) mm Hg (P < .001) and underestimated diastolic phase IV readings by 6 (-8, -4) mm Hg (P < .001) and phase V readings by 4 (-6, -2) mm Hg (P < .01). Eighty percent of systolic readings agreed within 10 mm Hg. Fifty-five percent of diastolic phase V and 50% of diastolic phase IV readings agreed within 6 mm Hg. The Accutracker II blood pressure readings are reasonably comparable to those of mercury sphygmomanometry in pregnant women, particularly when assessing group data.(ABSTRACT TRUNCATED AT 250 WORDS)     

Contrast sensitivity in diabetic pregnancy

BACKGROUND: Adenosine is a potent mediator of arteriolar tone in particular during ischemia, hypoxia, and exercise. Functional disturbance of this dilatory pathway may be highly significant for the pathophysiology and pathogenesis of arterial hypertension. PATIENTS AND METHODS: Forearm blood flow (FBF) was quantified by venous occlusion plethysmography following intra-arterial infusion of adenosine at increasing doses in 13 patients with arterial hypertension (HT) and 12 age-matched normotensive controls (NT). Hyperemic peak flow was measured following 3 minutes of non-flow ischemia. RESULTS: FBF at rest was comparable in both groups and was dose-dependently increased by adenosine in both groups. In patients with HT adenosine-induced vasodilation was significantly impaired over the entire dose-response curve compared with NT (6.0 mumol/min: 14.5 +/- 1.0 versus 8.6 +/- 0.9 ml.min-1.100 ml-1 of tissue, p < 0.01). Maximum forearm blood flow during reactive hyperemia was also profoundly impaired in the hypertensive patients (-38%, p < 0.01). In the overall group of normotensive and hypertensive subjects, flow responses to adenosine were i) significantly correlated with peak flow (adenosine 2.0 mumol/min: r = 0.79, p < 0.001), and total flow during reactive hyperemia and ii) inversely related to the magnitude of arterial blood pressure. CONCLUSIONS: The study reported presents first evidence that adenosine-dependent dilation of forearm resistance arteries is impaired in patients with arterial hypertension. This vascular dysfunction is associated with the impairment of ischemia-induced reactive hyperemia which in turn may contribute to progressive end-organ damage in arterial hypertension.     

Blood pressure tracking

Interactions between nitric oxide (NO) and angiotensin (ANG) II in renal vascular beds were examined in anesthetized dogs. The renal blood flow (RBF) response to an intrarenal arterial injection of ANG II was significantly augmented by intrarenal infusion of the NO synthase inhibitor N(G)-nitro-L-arginine (LNA, 50 microg/kg/min). The simultaneous intrarenal infusion of L-arginine (1 mg/kg/min) prevented the potentiating action of LNA. Similar potentiation was also seen in phenylephrine-induced renal vasoconstriction. Moreover, during simultaneous intrarenal infusion of sodium nitroprusside (SNP), an NO donor, the potentiating action of LNA on the renal vasoconstrictor action of ANG II disappeared. Under these conditions, the released NO stimulated by ANG II was still inhibited by LNA, if present, but basally released NO was resupplied by SNP, as indicated by the return of the RBF. During an infusion of phenylephrine, which produced an increase in renal vascular tone similar to that observed during the infusion of LNA, the renal vasoconstrictor action of ANG II was not augmented. These data suggest that basally released NO plays an important role in the regulation of renal hemodynamics by modulating the renal vasoconstrictor actions of ANG II and phenylephrine.     

Intra-abdominal pressure monitoring

MOTIVATION: The CloneIt program searches for sub-cloning strategies, in-frame deletions and frameshifts within a plasmid sequence. AVAILABILITY: The program, written in ANSI-C language, is available at http://locus.jouy.inra.fr/soft/cloneit/clonei t.html CONTACT: lindenb@biotec.jouy.inra.fr     

Blood pressure levels in diabetes mellitus

Levels of fasting plasma glucose, body mass index, serum total lipids, serum total cholesterol, serum triglycerides and blood pressure of 177 Libyan diabetic patients were determined. The respective mean values were 212.4 +/- 5.6 mg/dl, 26.6 +/- 0.45 kg/m2, 825.7 +/- 20.5 mg/dl, 176.4 mg/dl, 144 +/- 5.8 mg/dl and 135.3 +/- 1.7/83 +/- 0.89 mm Hg. The mean levels of all variables except plasma glucose are significantly higher in the female patients than their male counterparts. Correlations were present between blood pressure levels and age/body mass index/serum total lipids. There was a significant correlation between systolic pressure levels and the duration of diabetes. Serum cholesterol and serum triglyceride levels correlated with diastolic blood pressure levels only.     

Serum proinsulin in normal and gestational diabetic pregnancy

The tubular transport of urate and sodium was examined by clearance, free-flow micropuncture, intratubular microinjection and precession techniques in control rats and in rats receiving a new uricosuric diuretic, indanyloxyacetic acid (MK-196). The i.v. infusion of MK-196 (50 mg/kg of body wt/hr) resulted in significant increases in the fractional excretion of sodium (FENa) from 0.98 +/- 0.01 to 11.86 +/- 2.88% (P less than 0.001) and in FEurate from 14.1 +/- 1.03 to 56.0 +/- 2.86% (P less than 0.001). End-proximal tubular fluid to plasma inulin (TF/Pinulin) ratios were 2.43 +/- 0.15 and 2.51 +/- 0.10 in control and drug-treated animals, respectively (P = NS). Total urinary urate recovery after MK-196 administration was higher following microinjections of [2-14C] urate into early proximal tubule sites: 70.5 +/- 2.7% in controls vs. 84.9 +/- 0.9 (P less than 0.001), and after microinjections into late proximal tubule sites: 82.8 +/- 2.9% vs. 91.3 +/- 1.9 (P less than 0.05). Urinary precession of urate from inulin was demonstrable following placement of isotopes of these compounds on the surface of the kidney in controls, but was abolished by MK-196. This agent, therefore, inhibits the reabsorption and secretion of urate in the proximal convoluted tubule, the net effect being a marked increase in urinary urate excretion. By contrast, its inhibitory effect on sodium reabsorption is exerted at a site or sites distal to the accessible portion of the proximal tubule. The demonstration of reduced urate reabsorption and normal sodium reabsorption in the proximal tubule suggests that the reabsorption of these constituents of the glomerular filtrate is not intimately linked at this nephron site.     

Blood pressure measurement by pharmacists

The feasibility of blood pressure measurement by general practice pharmacists was examined in nine pharmacies. Two hundred and fifteen subjects were screened and 13 were referred to their general practitioners. Ten subjects (five per cent of the initial sample) were confirmed to be hypertensive by their doctors. The upper limits of normotension were 160/100 mmHg aged up to 50 years, 160/105 mmHg aged 51-60 years and a diastolic pressure of 110 mmHg over 60 years. Ninety-eight per cent of a sample of the lay public who completed a written questionnaire were in favour of blood pressure measurement by pharmacists. The study showed that general practice pharmacists were able to measure blood pressure within acceptable limits of accuracy and that, with the collaboration of general practitioners, the pharmacies were suitable agencies for screening for hypertension.     

Blood pressure and Alzheimer's disease

To fulfill criteria for probable Alzheimer's disease (AD), patients must be free of cerebrovascular lesions that may explain the cognitive decline. These criteria probably lead to an underestimation of the links between risk factors for stroke and AD. However, the association between stroke and AD is probably more frequent than expected. Arterial hypertension is the most important risk factor for stroke. The aim of this study is to evaluate, from the literature, the possible relationship between blood pressure and AD. Cognitive performances are usually lower in patients with arterial hypertension. A longitudinal study revealed that patients with AD aged 79-85 are more likely to have had higher values of blood pressure 10 to 15 years earlier, and they usually have a spontaneous decline of blood pressure beginning 1 or 2 years before the onset of AD. The relationship between arterial hypertension and AD is probably due to the summation of Alzheimer pathology, white matter changes and cerebrovascular lesions. A possible consequence of these findings would be to prevent, or to postpone, AD by an early treatment of arterial hypertension. This is currently evaluated in drug trials.     

Fetal heart rate monitoring casebook. Fetal heart rate monitoring in diabetic ketoacidosis

The production of interleukin-3 by peripheral blood mononuclear cells (MNC) was assessed in patients with relapsing multiple sclerosis (MS) in both the active and the stable state, and in healthy controls. IL-3 levels were compared to levels of production of interleukin-2 (IL-2), tumor necrosis factor (TNF) and gamma-interferon (gamma-IFN). No significant differences in IL-3 levels were observed between stable-state patients and controls. When levels of cytokine production of patients in the inactive phase were compared to those of the same patients during relapse a significant decrease in IL-3 levels was observed, as opposed to significant increases in gamma-IFN and TNF levels, and an increase, though a non-significant, in IL-2 levels. The functional significance of lowered IL-3 production is unknown. However, the findings support the hypothesis of a highly complex interaction of overlapping regulatory influences within the cytokine network which parallels MS disease activity.     

Self monitoring of blood glucose in blind diabetic patients

Blind diabetic patients face particular difficulties in blood glucose self monitoring (BGSM). We investigated the quality of BGSM in blind and severely visually impaired diabetic patients and assessed the effects of training in BGSM using a blood glucose meter with voice edition of values and a modified test strip holder for easier placement of blood samples on the strip (One Touch II talk (OT II)). Twenty-six insulin-treated diabetic patients (23 IDDM and 3 NIDDM) participated. At baseline the quality of BGSM was checked in 14 patients who already regularly performed BGSM without external help. Thereafter all 26 patients received an extensive instruction in BGSM for blind patients. At re-examination, after a mean period of 41 days, the quality of BGSM performed by the patients without assistance was checked in three different blood samples. Blood glucose was measured in the same sample by a routine laboratory method. At baseline the mean absolute difference between BGSM and the reference method was -0.3 mmol l(-1) (range; +/- SD) (-7.7-4.8; +/- 2.6 mmol l(-1)); 74% of BGSM measurements deviated by more than 10% from the reference values and 43% by more than 20%. At follow-up all 26 patients reported daily BGSM without external help. The mean absolute difference between BGSM and the reference method was -0.1 (-2.7-2.8; +/- 0.9 mmol l(-1)); 25% of BGSM measurements deviated by more than 10 % from the laboratory reference values and 5% by more than 20%. The results of this study suggest that a substantial number of blind diabetic patients do not perform BGSM on their own at all and in those who do the reliability of the results is poor. However, after extensive instruction, the majority of blind diabetic patients should be able to perform BGSM and to obtain reliable results.     

Blood pressure reactivity in adult male twins.

Examined possible genetic contributions to cardiovascular reactivity by contrasting patterns of association in 82 monozygotic (MZ) and 88 dizygotic adult male twin pairs (aged 21–61 yrs). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded during baseline and during a mental arithmetic task. The task produced significant elevations in all 3 cardiovascular measures. Levels of SBP and DBP reactivity were significantly correlated in MZ pairs only. Statistical tests suggest a heritability estimate of about 50% that was marginally significant for SBP and DBP changes during the task. There was no indication of a genetic influence on HR reactivity. Resting level and static task period measures of SBP, DBP, and HR demonstrated statistically significant heritability estimates of 60–80%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)