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
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
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
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 ETA receptor antagonism.
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 ETA 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.
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.
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.