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Laboratory investigations (WP4): fasting plasma glucose, lipids, serum creatinine, serum

 

liver enzymes, biomarkers (for inflammation, copeptin, etc., see Table 1), urinary spot sample

 

for microalbuminuria and albumin/creatinine ratio. In addition, faeces samples will be

 

obtained for determination of secreted factors as well as a genetic screening for evaluation of

 

the gut bacterial content and composition (microbiota). A biobank will be established in

 

technical collaboration between Lund University and other partners (Region Skåne,

 

BBMRI.se). Assessment of leukocyte types and activation in whole blood will be performed

 

in representative subsets of subjects.

 

5. Metabolic investigation (WP5): including fasting blood sampling for plasma glucose and

 

serum lipids (total cholesterol: C, HDL-C, LDL-C and triglycerides, LpLA2, Lp(a), etc.), and

 

an oral glucose tolerance test (OGTT; 75 g glucose), with measurements at 0,30,(60) and 120

 

min of plasma glucose, incretins (GLP-1, GIP), insulin, C-peptide and glucagon.

 

6. Technical investigations (WP6): arterial stiffness (Sphygmocor ® assessment of pulse wave

 

velocity, augmentation index, central blood pressure), arteria carotis morphology and

 

function (Sekoya ® ultrasound device), 24-h ambulatory blood pressure recordings, and

 

central aortic pressure (24-h Arteriograph ® Central BP). We will perform screening

 

spirometry and evaluation of endothelial function (by EndoPat ®).Measurement of Advanced

 

Glycation End Products (AGE) will be conducted transdermally by use of an AGE-Reader®.

 

In addition, other investigations are optional and depending on funding, such as brain

 

magnetic resonance imaging (MRI) as well as echocardiography, and retinal artery imaging

 

 

The heart of the matter

 

Kathleen Armstrong

 

Tuesday, 11 October 2011

 

Kathleen Armstrong looks at developments

 

 in cardiac patient monitoring that are improving

 

both the diagnosis and treatment of cardiovascular disease (CVD).

 

The market for cardiac patient monitoring devices market is

 

 growing, driven by unhealthy lifestyles, an ageing population,

 

and the consequent increase in cardiovascular disease (CVD).

 

But the main reason is growth in the demand for easy-to-use,

 

patient-friendly devices that enable rapid and

 

robust diagnoses of CVD, according to a recent report

 

from Frost & Sullivan¹.

 

Robert Clark, general manager of Draeger UK,

 

says one of the major advances is the improvement in networking

 

 and the delivery of information.

 

All of its patient monitoring devices are WiFi-enabled

 

so patients can be monitored from wherever there is WiFi access in the trust. 

 

Draeger’s Infinity M300 is a telemetry device which is worn

 

by the patient and continues to communicate with a trust’s network

 

via the Infinity CentralStation wherever the patient is in the hospital.

 

It means the patient can continued to be monitored

 

when they go to the physiotherapist or for tests. 

 

“This gives the patient more flexibility and, because it continues

 

to monitor them, it can catch the episode that you want to capture,”

 

Clark says. At Derriford Hospital in Plymouth,

 

where the trust uses Draeger’s Infinity Omega solution, patients are

 

equipped with the telemetry device for a 24-hour assessment.

 

Because the information has been gathered without a break and

 

 is captured online, where it can be accessed by the cardiologist,

 

the patient no longer has to undergo a second session of monitoring

 

when they go to the cardiologist.

 

“Hospitals are now re-thinking their care processes,” Clark comments.  

 

Unimedic’s Arteriograph is a groundbreaking technology

 

that has advanced the way cardiac monitoring is undertaken.

 

Using a non-invasive catherisation method

 

with the help of a single arm cuff, the Arteriograph takes two minutes

 

 to measure individual cardiovascular risk and

 

evaluate the efficiency of applied therapy.

 

The device provides information on central and

 

peripheral blood pressure, endothelial function, arterial stiffness,

 

 arterial/heart age and cardiac fitness at the same time,

 

showing the effects of cardiovascular risk factors on the arteries.

 

Unimedic’s Arteriograph measures individual cardiovascular risk

 

 and evaluates the efficiency of applied therapy within two minutes

 

 

In mid-September the company also launched the Arteriograph 24,

 

an ambulatory device which will enable central blood pressure and

 

arterial stiffness to be monitored over a 24-hour period.

 

The device is the more-advanced version of

 

the most accurate (BHS AA validated) and best value

 

for money ambulatory blood pressure monitor on the market,

 

the TensioDay ABPM, which comes with a professional software package.

 

 It is an idea solution for practices wanting to comply

 

with the recommendations of the new NICE Hypertension Guideline

 

 for diagnosing high blood pressure.  

 

TensioDay ABPM helps practices to comply with new NICE guidelines

 

for diagnosing high blood pressure

 

  

 

13 July 2011 

 

Draeger UK
Unimedic
Welch Allyn
Deltex

 

 

 

 

Diurnal variation in blood pressure and arterial stiffness in CKD – the role of endothelin-1

 

Neeraj Dhaun,Rebecca Moorhouse, Iain M MacIntyre, Vanessa Melville,

 

Robert A Kimmitt, Kayleigh E Brown, Euan Kennedy, Jane Goddard, David J Webb

 

BHF Centre of Research Excellence, University of Edinburgh

 

 

 

Introduction

 

Hypertension and arterial stiffness are important independent cardiovascular risk factors in CKD to which endothelin-1 (ET-1) contributes. Whereas loss of nocturnal blood pressure (BP) dipping in CKD is associated with disease progression there are no data on diurnal variations in arterial stiffness. We examined the diurnal variation of BP, arterial stiffness and the ET system in CKD and the effects on these of ET_A receptor antagonism.

 

 

 

Methods

 

First, in a case-control study we compared 24h ambulatory BP and arterial stiffness using the TensioMed™ Arteriograph 24 ambulatory arterial stiffness monitor in 16 patients with CKD and 15 matched controls. Second, in an observational study we examined the diurnal variation in plasma and urinary ET-1 (midday and midnight) in 15 patients with CKD. Third, in a randomised double-blind, 3-way crossover study in 27 patients with CKD, we examined the effects of 6 weeks’ treatment with placebo, sitaxentan (an ET_A receptor antagonist), and nifedipine on the diurnal variation of BP assessed at baseline and week 6 of each study period. This was in addition to the primary endpoints of proteinuria, BP and arterial stiffness.

 

 

 

Results

 

There were nocturnal dips in systolic and diastolic BP (SBP, DBP) and pulse wave velocity (PWV), our measure of arterial stiffness, in 15 controls (SBP -3.2 ± 4.8%, p < 0.05; DBP -6.4 ± 6.2%, p = 0.001; PWV -5.8 ± 5.2%, p < 0.01), but not in 16 CKD patients. In 15 CKD patients, plasma ET-1 increased from 4.8 ± 1.5 at midday to 5.1 ± 1.5pg/ml at midnight (p < 0.01). Urinary ET-1 did not change. 6 weeks’ treatment with placebo and nifedipine did not affect nocturnal dips in SBP or DBP between baseline and week 6 whereas dipping was increased following 6 weeks’ sitaxentan treatment (baseline vs. week 6, SBP: -7.0 ± 6.2 vs. -11.0 ± 7.8mmHg, p < 0.05; DBP: -6.0 ± 3.6 vs. -8.3 ± 5.1mmHg, p < 0.05). There was no nocturnal dip in pulse pressure at baseline in the 3 phases of the study, whereas sitaxentan was linked to the development of a nocturnal dip in pulse pressure.

 

 

 

Conclusion

 

In CKD, activation of the ET system appears to contribute not only to raised BP, but also the loss of BP dipping. The clinical significance of these findings should be explored in future clinical trials.