The document was prepared by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (1). It presents practical and simple recommendations which are, however, important for accurate blood pressure measurement. Contrary to the majority of other guidelines, it does not assess level of evidence and classes of recommendations because many aspects of blood pressure measurement are based on usual clinical practice rather than on data from high-quality studies.

• Klíčová slova
• accuracy of blood pressure monitors, ambulatory blood pressure monitoring, home blood pressure, office blood pressure,
• MeSH
• ambulantní monitorování krevního tlaku * MeSH
• hypertenze * diagnóza   MeSH
• krevní tlak MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antihypertenziva * MeSH
• hypertenze * diagnóza   MeSH
• krevní tlak MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• komentáře MeSH
• úvodníky MeSH
• Názvy látek
• antihypertenziva * MeSH

Hypertension is one of the most common problems at higher age and belongs to the most important cardiovascular risk factors. Subjects aged 65 years and more have typically isolated systolic hypertension with increased pulse pressure as a consequence of decreased elasticity of central arteries. With increasing age, the prevalence of cardiovascular/ renal diseases and diabetes is higher. Therefore, we use drugs that have cardiprotective effect and do not affect negatively concomitant diseases. Diuretics have the largest data from prospective studies, calcium channels blockers are suitable especially in isolated systolic hypertension, and ACE inhibitors tested in high-risk hypertensive patients, especially after stroke. The HYVET study showed that the risk of cardiovascular events and of heart failure is decreased with antihypertensive troroeatment also in subjects aged 80 years and more. Key words: hypertension in the elderly - isolated systolic hypertension - pulse pressure - treatment of hypertension.

• Klíčová slova
• hypertension in the elderly - isolated systolic hypertension - pulse pressure - treatment of hypertension,
• MeSH
• antihypertenziva * terapeutické užití   MeSH
• blokátory kalciových kanálů MeSH
• hodnocení rizik MeSH
• hypertenze * komplikace   farmakoterapie   MeSH
• krevní tlak MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antihypertenziva * MeSH
• blokátory kalciových kanálů MeSH

White-coat hypertension (WCH) is very common: it is present in about one third of subjects with high office blood pressure (BP). A typical patient is a non-smoking female at higher age. Prognostic data are not very reliable because most patients are treated on the basis of elevated office BP; some long-term studies have shown that cardiovascular (CV) risk is increased compared to normotensives. The opposite disorder is masked hypertension (MH). Its prevalence in population-based studies is 13 %. MH is common in males, typically aged between 30 and 50 years, smokers with unfavorable risk profile, and it is also frequent in diabetics. The risk of future cardiovascular events is close to that of sustained hypertensives. It is important to search for MH actively, therefore, we should recommend home BP measurements also to those subjects whose office BP is normal. We do not have any prospective data about treatment of either WCH or MH. In subjects with low CV risk, only nonpharmacologic treatment may be initiated - in this case, however, the patient must be followed closely including out-of-office BP measurements; in those subjects where other CV risk factors and/or target organ damage are present, drug treatment should be considered, but as we have no evidence, only empirical approach is possible.Key words: ambulatory blood pressure monitoring - diagnosis - masked hypertension - prognosis - treatment - white-coat hypertension.

• MeSH
• celosvětové zdraví MeSH
• krevní tlak fyziologie   MeSH
• lidé MeSH
• maskovaná hypertenze diagnóza   epidemiologie   patofyziologie   MeSH
• měření krevního tlaku metody   MeSH
• prevalence MeSH
• prognóza MeSH
• rizikové faktory MeSH
• syndrom bílého pláště * diagnóza   epidemiologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

Liddle syndrome is an inherited form of arterial hypertension with autosomal dominant pattern of inheritance. It is caused by activating mutation of genes coding of the epithelial sodium channel in distal nephron. Mutation leads to excessive reabsorbtion of sodium ions and volume expansion resulting in arterial hypertension. Antoher typical laboratory findings are hypokalaemia, low levels of serum aldosteron and metabolic alkalosis. Phenotypic variability makes it difficult to identify patients with Liddle syndrome, often resulting in misdiagnosis and severe complications at early age. Genetic studies should be done to confirm the diagnosis. Therapy of Liddle syndrome is based on administration of epithelial sodium channel blocker amilorid.

• Klíčová slova
• Aldosterone, Liddle syndrome, NEDD4, amilorid, arterial hypertension, epithelial sodium channel, hypokalaemia,
• MeSH
• epiteliální sodíkový kanál genetika   metabolismus   MeSH
• hypertenze * MeSH
• hypokalemie * diagnóza   etiologie   terapie   MeSH
• Liddleův syndrom * diagnóza   genetika   terapie   MeSH
• lidé MeSH
• mutace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• epiteliální sodíkový kanál MeSH

OBJECTIVE: To investigate determinants of increase in aortic pulse wave velocity (PWV) in elderly subjects free from overt cardiovascular disease and not treated for arterial hypertension at baseline. METHODS: The present study included 90 lecture attendees ("Continuing Adult Education") who were examined at baseline and after a median follow-up of 9.5 years, including the PWV measurement using SphygmoCor. We used multiple linear regression analyses to assess predictors of PWV change. As independent covariates, we considered parameters with known effect on arterial stiffness and use of antihypertensive and lipid lowering medication. RESULTS: At baseline, mean age was 66.9 ± 5.1 years, and 37.8% of subjects had arterial hypertension, respectively. The PWV increased from 9.4 to 10.2 m/s; p = 0.035. While accounting for covariates, PWV was significantly and independently associated with four factors: baseline heart rate (β = 0.074, χ(2) = 7.40; p = 0.0079), mean arterial pressure (β = 0.070, χ(2) = 11.39; p = 0.0011), fasting glucose (β = 0.790, χ(2) = 11.30; p = 0.0012), and use of antihypertensive medication (β = - 1.416, χ(2) = 7.95; p = 0.0060). We did not observe correlation between PWV increase and lipid or renal parameters and lipid lowering medication. CONCLUSIONS: In elderly subjects without manifest cardiovascular disease, mechanical load and glucose concentration play a major role in the aortic stiffening. Use of antihypertensive treatment was associated with smaller PWV increase.

• MeSH
• antihypertenziva terapeutické užití   MeSH
• aorta patofyziologie   MeSH
• hypertenze patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• rychlost toku krve fyziologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stárnutí patologie   MeSH
• tuhost cévní stěny fyziologie   MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antihypertenziva MeSH

• Publikační typ
• časopisecké články MeSH

Aortic stiffness is strongly related to age and mean arterial pressure (MAP). In the present analysis, we investigated whether antihypertensive treatment modulates the association of the aortic pulse wave velocity (PWV) with age and with MAP in the general population. In the Czech post-MONICA cross-sectional study, we measured the PWV in 735 subjects (mean age 61.2±7.8 years, 54.1% women, 44.3% on antihypertensive medication). We used a linear regression model to assess the effect of treatment on the PWV. The independent covariates in our analysis included sex, age, MAP, heart rate, body mass index, plasma glucose, low-density lipoprotein cholesterol, smoking and observer. The patients receiving treatment were older (64.1±6.7 vs. 58.9±7.8 years), had higher systolic blood pressure (135.9±16.2 vs. 130.1±16.5 mm Hg) and had higher pulse wave velocity (9.1±2.2 vs. 8.2±2.1 m s(-1); P for all <0.0001) than untreated subjects. After adjustment for MAP, the use of treatment modified the association between age and the PWV (regression equations, treated patients 9.68-0.009 × age vs. untreated subjects 6.98+0.020 × age, difference of regression slopes, F=11.2; P=0.0009). In analyses adjusted for age, treatment was associated with a smaller increase of the PWV with MAP (treated patients 9.63-0.006 × MAP vs. untreated subjects 7.18+0.010 × MAP, F=10.70; P=0.0001). These results were driven primarily by subjects whose blood pressure was below 140/90 mm Hg. In the cross-sectional analysis from a random sample of the general population, antihypertensive treatment was associated with a less steep increase in the PWV with age and the mean arterial pressure. Further longitudinal studies are needed to confirm this finding.

• MeSH
• analýza pulzové vlny MeSH
• antihypertenziva terapeutické užití   MeSH
• aorta účinky léků   fyziologie   MeSH
• dospělí MeSH
• hypertenze farmakoterapie   patologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• stárnutí fyziologie   MeSH
• statistické modely MeSH
• tuhost cévní stěny účinky léků   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antihypertenziva MeSH

PURPOSE: We studied the performance of unattended automated office blood pressure (uAOBP) measurement in children, in relation to oscillometric office BP (OBP) and ambulatory blood pressure monitoring (ABPM). MATERIALS AND METHODS: One hundred and eleven stable treated and untreated outpatients investigated for hypertension underwent uAOBP measurements (seated unattended in a quiet room separate from the renal clinic room, six times after a 5 min rest with the BpTRU device), and immediately before using the oscillometric device. Ambulatory 24 h blood pressure monitoring (ABPM) was performed on the same day in a subgroup of 42 children. RESULTS: UAOBP measurements were successful in 106 children (95%), 5 pre-school children did not tolerate to be alone in the room. The mean ± SD systolic/diastolic uAOBP, OBP and daytime ABP were 109.1 ± 14.0/70.8 ± 10.7 mmHg, 121.6 ± 16.5/77.6 ± 10.5 mmHg and 123.5 ± 11.3/73.7 ± 6.8 mmHg, respectively. Systolic/diastolic uAOBP was significantly lower than OBP by 13.6/7.6 mmHg (p < 0.0001) and lower than daytime ABP by 14.4 ± 0.5/2.9 ± 0.3 mmHg (p < 0.0001). The heart rate was not significantly different during uAOBP than during OBP measurements. On Bland Altman analysis the uAOBP underestimated OBP by a mean of 15.6 mmHg for systolic BP and by 8.6 mmHg for diastolic BP. In all 9 children with white-coat systolic hypertension uAOBP was within the normal range (<95th pc for OBP), in six of nine children with white-coat diastolic hypertension uAOBP was within the normal range however, in three of them it was elevated despite normal ABP. CONCLUSION: uAOBP measurement is feasible in school-aged children, its values are considerably lower than OBP as well as daytime ABP and it could help with detection of white-coat systolic hypertension. The clinical applicability of uAOBP in children should be confirmed in further studies.

• Klíčová slova
• Unattended automated office blood pressure, children, masked hypertension, white-coat hypertension,
• MeSH
• ambulantní monitorování krevního tlaku MeSH
• dítě MeSH
• hypertenze * diagnóza   MeSH
• krevní tlak MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• předškolní dítě MeSH
• syndrom bílého pláště * diagnóza   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: We aimed to evaluate the prognostic impact of renal insufficiency and fluctuation of glomerular filtration observed during hospitalization for heart failure (HF). METHODS: We followed 3,639 patients hospitalized for acute HF and assessed the mortality risk associated with moderate or severe renal insufficiency, either permanent or transient. RESULTS: After adjustment, severe renal failure defined as estimated glomerular filtration (eGFR) <30 mL/min indicates ≈60% increase in 5-year mortality risk. Similar risk also had patients with only transient decline of eGFR to this range. In contrast, we did not observe any apparent mortality risk attributable to mild/moderate renal insufficiency (eGFR 30-59.9 mL/min), regardless of whether it was transient or permanent. CONCLUSION: Even transient severe renal failure during hospitalization indicates poor long-term prognosis of patients with manifested HF. In contrast, only moderate renal insufficiency observed during hospitalization has no additive long-term mortality impact.

• Klíčová slova
• Acute decompensated heart failure, Glomerular filtration, Mortality risk, Worsening of renal function,
• MeSH
• hodnoty glomerulární filtrace MeSH
• hospitalizace MeSH
• ledviny MeSH
• lidé MeSH
• prognóza MeSH
• renální insuficience * komplikace   MeSH
• srdeční selhání * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH