Objectives: In hypertensive patients, the correlation between the blood pressure (BP) level and target organ damage, cardiovascular risk, and long-term prognosis is higher for ambulatory (ABPM) than for clinical measurements. We investigated the influence of ABPM on therapeutic decision-making in hypertensive subjects participating in the Hygia Project, designed to evaluate prospectively cardiovascular risk by ABPM in primary care centers of Northwest Spain. Methods: We evaluated 1671 hypertensive subjects (874 men), 61.8 ± 12.6 years of age. BP was measured every 20-min from 07:00 to 23:00 h and every 30-min at night for 48 h. The physicians registered via web the clinical information for each patient, including anthropometric variables; factors influencing prognosis (family history, diabetes, subclinical organ damage, established cardiovascular, cerebrovascular or renal disease); current treatment; analytical parameters; and clinic BP (three measurements). The physicians provided the therapeutic strategy for each patient based on all this clinical information but before having access to the data from ABPM, and once again after visualizing the ABPM report. Results: After using the ABPM report, the therapeutic scheme was changed in 1033 (62%) subjects. The most prevalent change was the timing of antihypertensive treatment (81% of the cases), giving priority to treatment at bedtime. Among those who changed their therapeutic scheme, 20% moved from no-treatment to treatment of some kind, and 10% from treatment to no-treatment. Among the 279 subjects with changed scheme where the number and class of medications was unchanged, 27% increased the dose, 24% decreased the dose, and 49% changed dosing-time, mainly increasing treatment at bedtime. Conclusions: This prospective blind study is the first to investigate the impact of ABPM on therapeutic decision-making. While discrepancies in diagnosis of hypertension between clinic and ambulatory BP measurements (isolated office and masked hypertension) account for just about 25% of the population, almost two-thirds of the patients in this study had their therapeutic scheme changed on the basis of ABPM. This study indicates that ABPM should be required for therapeutic decision-making in hypertension.
ABSTRACT BACKGROUND To evaluate the impact of daytime, nighttime, and nocturnal blood pressures (BPs) fall on heart failure (HF). METHODS We analyzed data from five cohorts including 15,526 treated hypertensive patients, experiencing 625 HF events, by study-level meta-analysis. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for 1SD increase in BP parameters or per group were calculated. RESULTS When individually analyzed after adjustment for covariates, clinic systolic BP (SBP) (HR 1.20, 95% CI 1.01–1.43), daytime SBP (HR 1.34, 95% CI 1.06–1.70), nighttime SBP (HR 1.43, 95% CI 1.20–1.71), nighttime diastolic BP (DBP) (HR 1.26, 95% CI 1.05–1.52), % of nocturnal SBP fall (HR 0.81, 95% CI 0.75–0.88), and nondipping (HR 1.64, 95% CI 1.54–1.98) were associated with HF. If daytime or nighttime BP was further adjusted for clinic BP results remained similar. When clinic, daytime, and nighttime BPs were mutually adjusted, nighttime SBP (HR 1.43, 95% CI 1.27–1.61) and nighttime DBP (HR 1.37, 95% CI 1.14–1.64) remained associated with the outcome. Heterogeneity across cohorts was explained by BP, sex, and follow-up duration. In sensitivity analyses, for daytime and nighttime BPs, no study had a relevant influential effect on overall estimates. Looking for publication bias and adjusting for missing studies by Duval and Tweedie’s method, clinic SBP lost significance but daytime SBP, and nighttime SBP and DBP remained significantly associated with HF. CONCLUSIONS Daytime and nighttime BPs are stronger than clinic BP in predicting HF, nighttime BP is stronger than daytime BP, and a reduced nocturnal BP fall is associated with outcome.
Abstract In this minireview, we summarize current research dealing with the combination of noble‐metal nanoparticles and different families of supramolecular macrocycles (cyclodextrins, cucurbit[ n ]urils, calixarenes, and pillar[ n ]arenes). We intended to select relevant publications on the synthesis of noble‐metal nanoparticles with macrocycles acting as capping agents or/and reducing agents, as well as on the post‐synthetic metal‐nanoparticle modification with macrocycles. We also discuss strategies in which supramolecular chemistry is applied to direct the self‐assembly of nanoparticles and formation of polymer composites. We finally describe the main applications of these materials in various fields.
Calvo, C; Hermida, R C; Ayala, D E; Dominguez, M J; Covelo, M; Mojon, A; Fernandez, J R; Lopez, J EAuthor Information
Hermida, R. C.1; Ayala, D. E.1; Calvo, C.2; Dominguez, M. J.2; Covelo, M.2; Mojon, A.1; Fernandez, J. R.1; Fontao, M. J.1; Soler, R.1; Lopez, J. E.2 Author Information