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Ambulatory Monitoring Reveals Many Patients Have 'White Coat' Hypertension

DALLAS, March 28, 2011 /PRNewswire-USNewswire/ -- A third of patients thought to have resistant hypertension had "white coat" hypertension during 24-hour ambulatory monitoring, in a large study reported in Hypertension: Journal of the American Heart Association.

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In ambulatory blood pressure monitoring, the patient's blood pressure is checked at regular intervals under normal living and working conditions.

Resistant hypertension occurs when a patient's blood pressure remains above treatment goals, despite using three different types of drugs at the same time. In "white coat" hypertension, a patient's blood pressure is high at the doctor's office but normal in everyday life.

"Ambulatory monitoring showed that many of these patients' blood pressures were in the normal range when they were at home or participating in their usual activities," said Alejandro de la Sierra, M.D., lead author of the study and director of internal medicine at Hospital Mutua Terrassa, University of Barcelona in Spain. "While those who actually had 'white coat' hypertension are not risk free, their cardiovascular outcomes are much better."

The study included 69,045 patients with hypertension defined as systolic blood pressure of 140 millimeters of mercury (mm Hg) or above and diastolic blood pressure of 90 mm Hg or above in the Spanish Ambulatory Blood Pressure registry. Fifty-one percent were men and their average age was 64 years.

Thirty-seven percent of 8,295 patients determined to have resistant hypertension had "white coat" hypertension after being tested with ambulatory blood pressure monitoring for 24 hours. Close to 63 percent had true resistant hypertension.

Researchers based blood pressure estimates on two readings. They took ambulatory blood pressure every 20 minutes during the day and night and assessed age, gender, weight, height, body mass index, duration of hypertension and known cardiovascular risk factors such as smoking, diabetes, lipid profile, creatinine levels, electrocardiograms and clinical cardiovascular disease.

The researchers found:

More women (42 percent) had "white coat" hypertension with ambulatory blood pressure monitoring than men (34 percent). Those with true resistant hypertension appeared slightly younger, were more likely male, had a longer duration of hypertension and a worse cardiovascular risk profile.Those with true resistant hypertension included a higher number of smokers, diabetics, and patients with left ventricular hypertrophy and previous cardiovascular disease."Those with true resistant hypertension showed high blood pressure at work, during the day and at night," de la Sierra said. "The true resistant group also was more likely to have blood pressures that abnormally rose during the night when they were sleeping."

It made no difference in target blood pressure goals if antihypertensive medications were given either in the morning or at night, researchers said.

"Ambulatory blood pressure monitoring should be mandatory in resistant hypertension patients to define true and 'white coat' hypertension," de la Sierra said.

Limitations of the study included its cross-sectional nature and the lack of information to determine whether patients were taking medications correctly. However, the high number of patients more closely matched the usual clinical practice treated by primary care physicians and referral centers.

"Physicians should be encouraged to use ambulatory monitoring to confirm resistant hypertension in their patients as it would ensure the most effect treatment options are used," de la Sierra said. "Patients benefit by knowing whether their blood pressure is normal during daily activities or still needs the reinforcement of dietary and drug measures to achieve the goal."

Co-authors are Julian Segura, M.D.; Jose R. Banegas, M.D.; Manuel Gorostidi, M.D.; Juan J de la Cruz, Ph.D.; Pedro Armario, M.D.; Anna Oliveras, M.D.; Luis M. Ruilope, M.D. Author disclosures are on the abstract.

Lacer Laboratories in Spain funded the study.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at

NR11-1054 (Hypertension/de la Sierra)

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SOURCEAmerican Heart Association

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Western DIY outlets retreat in China

At a near-empty B&Q home improvement outlet in Beijing, much of the foot traffic is due to the location of a public toilet next to the entrance -- not the store's patio furniture or circular saws.

It's a sign of how foreign "do-it-yourself" big-box chains have struggled to attract customers in China, where homeowners have little experience in renovating apartments and prefer to pay low-wage decorators to do it for them.

"Do-it-yourself is not popular in China," Shaun Rein, managing director of China Market Research Group, told AFP.

"The feeling in China is that if you do it yourself that means you are a peasant -- not the sturdy, manly image DIY chains have crafted in the US."

Despite China's booming property sales and a home-improvement market growing 15 percent a year and worth $100 billion in 2009, such chains have been forced to pare back operations in China -- or leave the country altogether.

UK-based B&Q, whose website describes it as "the market leader in China," entered the Chinese market in 1999, but in 2009 abruptly closed 22 of its 63 stores.

Meanwhile US giant Home Depot, which entered China in 2006, has shuttered nearly half its outlets, leaving it with just seven.

The latest casualty of the tough Chinese home-decorating market is French construction group Saint-Gobain, which said this month it had closed all of its La Maison building material stores.

Analysts said overseas executives mistakenly assumed they could replicate the Western big-box model in China, where many people are renovating for the first time and have little experience using power tools.

"A lot of apartments in China are concrete boxes and have to be decorated from scratch -- very few homeowners know how to do that themselves," Zhou Wei, chief financial officer of advertising agency Charm Communications, told AFP.

These foreign retailers have also stocked products such as garden hoses, picnic tables and barbecues -- poor sellers in a country where people live largely in apartments with no balconies.

Rein said that on some of the few DIY items that do sell in China, both B&Q and Home Depot priced themselves out of the local market by charging much more than Chinese competitors.

In the Beijing B&Q store, bored sales assistants far outnumbered customers. An employee said this was normal for a weekday but it was busier at the weekends -- thanks to the smelly public toilet.

One of the shop's few customers, a man surnamed Ding, said he wanted to buy "important items" like pipe fittings for an apartment he was renovating, as he believed they would be better quality at a foreign outlet, albeit more expensive.

For everything else, he said he would get an interior designer to buy at Chinese stores where prices would be cheaper.

Home Depot spokesman Ron DeFeo admitted the company had made mistakes since entering the Chinese market more than four years ago and had since "learned a lot".

"Our stores were modelled after the US market and its DIY format, but China is more of a DIFM (do-it-for-me) market," DeFeo told AFP.

Another problem, according to Saint-Gobain spokesman Nicolas Nie, is that more and more homes sold in major cities such as Shanghai were already decorated, reducing the "prospect to serve individual customers".

B&Q did not respond to AFP requests for comment.

Foreign home-improvement stores are not alone in their struggle to find the right formula for consumers in the country of more than 1.3 billion people.

US toy maker Mattel this month shut the world's first and only Barbie concept store in Shanghai, while US consumer electronics giant Best Buy abruptly closed its self-branded stores last month.

Analysts said some overseas companies have been left in the dust by Chinese rivals who have opened more outlets across the country, secured better locations and enjoy stronger bargaining power with local manufacturers.

But some firms such as Swedish furniture giant Ikea appear to have found the right mix -- it plans to more than double its number of stores in China from the current eight by 2015.

Zhou said Ikea had adapted to the local market by giving novice home decorators examples in its stores of living room, bedroom and kitchen styles suited to Chinese apartments.

Leonardo backs under fire Eto'o

ROME (AFP) – Inter Milan coach Leonardo has leapt to the defence of striker Samuel Eto'o after the Cameroon captain was heavily criticised in some quarters for his performance against Juventus.

Eto'o missed a sitter from five yards, hitting the bar with an open goal to aim at while also completely missing an attempted volley as Inter rallied late on in Sunday's Serie A clash.

They lost the game 1-0, Eto'o's misses proving costly as they slipped to eight points behind leaders AC Milan.

Inter can close that gap to five if they win away to Fiorentina on Wednesday, in a match that was postponed in December due to the nerazzurri's participation at the Club World Cup.

"It takes a brave man to criticise Eto'o, he's scored 27 goals," said Leonardo.

"It can happen that in one second he doesn't find the right space or contact but talking about an Eto'o problem that doesn't exist, I can't believe someone can get knocked down for something like that.

"It seems to me as if it's an attack against Inter, as if they (the critics) were waiting for us to lose a game."

Leonardo also insisted that the title race was not over because of that defeat.

"Everything is still open, non-one can claim to have won," he added.

"We're playing well and we're the best team in the world. I can't get involved in these dramas, either accept me as I am or leave me alone."

And an angry Leonardo hit out at the brickbats.

"Often people exagerate, I'm asking for a bit of coherence. I defend the team, talking about me won't change much," he said.

"It makes me angry to hear people talk about this team as they have been, there's no (Diego) Milito issue or Eto'o issue or an issue with anyone, I can't accept this.

"I don't intend to hide a problem, we struggled also against Palermo but look at the numbers.

"I would sign on the dotted line for seven wins in our next nine matches, I'd like to see where we will be and where the others will be."

Leonardo has won seven league games and lost just two since taking over at Inter, while also winning a pair of cup matches.

But the defeat against an otherwise struggling Juventus has seen the critics emerged from the woodwork.

And the Brazilian has been criticised for his side's leaky defence, although they have also scored a lot of goals.

"My idea of football is to always try to win while playing good football," he said.

"At home and away it's always 11 against 11, always on the same pitch, there's no influence on a team this strong.

"We just need to play and try to hurt our opponents, we don't need to play less like we know how, all we need to do is play to hurt our opponents and we have the quality to do that."

Devils G Martin Brodeur has sprained right knee

NEWARK, N.J. – The New Jersey Devils are going to have to make do without goaltender Martin Brodeur for a little while.

Brodeur has a sprained right knee and the team said Tuesday that his status is going to be listed as day to day. The injury will not require surgery, but general manager Lou Lamoriello refused to say much more than that.

Lamoriello said Brodeur will need to rehabilitate the knee. But there is no timetable for his return. The Devils play at Toronto on Thursday and return home for a game on Friday against San Jose.

Brodeur, 38, was hurt on Sunday when something "popped" in his knee in the first period of a 4-1 win over the Canadiens in Montreal. An MRI on Monday disclosed the sprain.

Johan Hedberg will start for the Devils against the Carolina Hurricanes on Tuesday at the Prudential Center. Mike McKenna was called up from Albany of the AHL to back up Hedberg.

Brodeur, who has a 13-19-2 mark with a 2.74 goals against average, was not immediately available for comment.

"I am just going to try to play it game by game," said Hedberg, who played the final two periods in the Devils' 4-1 win in Montreal. He has posted a 6-10-2 record this season.

The Devils, who have had the worst record in the NHL most of the season, have posted a 9-1-2 mark since Jan. 9. Brodeur has gone 8-1-1 in that span.

"It's tough with Marty, but Moose (Hedberg) has been playing pretty good for us," center Travis Zajac said, "so we are going to have to lean on him while Marty is hurt."

U.S. cities, counties gird for community grant fight

WASHINGTON (Reuters) – U.S. cities and counties are getting ready to fight for federal grants they say keep local economies strong and residents employed, after President Barack Obama signaled he is open to cutting them.

In Sunday's edition of The New York Times, Jacob Lew, director of the White House Office of Management and Budget, wrote that Obama will seek to pare 7.5 percent, or $300 million, from Community Development Block Grants in the budget he proposes next week.

Obama has said he is committed to reducing the country's projected $1.5 trillion deficit by cutting spending in many areas.

But city and county officials, still smarting from the 2007-09 economic recession that devastated municipal budgets, say lower grant amounts from the federal government will hurt their poorest citizens and they fear Obama will suggest deeper cuts.

"It is literally the lifeblood for creating affordable housing in Philadelphia," Michael Nutter, the city's mayor told Reuters, saying the program commonly called "CDBG" has helped get homeless people off the street and built up neighborhoods in the City of Brotherly Love.

"Everyone knows that it works. You will hear as much about it from Republican mayors as from Democrat mayors," he said.

The grants help finance housing, sewer, streets and economic development in low- and moderate-income neighborhoods, Lew wrote. He added the Obama administration is "very aware of the financial difficulties" cities and counties face.

"CDBG funds provide immediate, direct, and tangible benefits to millions of Americans right where they live," said National Association of Counties Executive Director Larry Naake in a statement, calling Lew's proposal "alarming."

For Donald Plusquellic, mayor of Akron, Ohio, Lew's suggestion comes after years of slashing CDBG and other federal aid. His city uses CDBG, which started in 1974, to keep people in their homes and help small business stay afloat, he said.

"I know that everybody's expected to sacrifice. But the cities have been cut over the last 30 years in so many ways," he said, adding he was "very disappointed."

"President Obama worked on the local neighborhood level and he knows how valuable these funds are to address neighborhood problems that city budgets just can't afford right now," he said.

Local governments have been hit hard by rising unemployment rates and the end of the housing boom, both of which drove down tax revenues. The drop in income has forced them to cut spending on health and assistance programs as well as education and emergency response.

Former U.S. President George W. Bush tried to wipe out CDBG. Reversing that course, Obama put aside $4.4 billion for CDBG in the budget he proposed last year.

Saying that reducing the federal deficit "is imperative to the country's and our communities' fiscal well-being," National League of Cities Spokesman Greg Minchak questioned whether CDBG cuts would have any "real impact on that goal."

"Unfortunately, the converse is true for the local economies of cities and towns. The impact of this cut on thousands of projects and programs at the neighborhood level, and the jobs supported by those projects, will be very real," said Minchak, whose group represents city officials.

Since Republicans took control of the House of Representatives in last November's elections promising to cut spending, states and local governments have worried about slashed federal assistance.

The Republican Study Group, a caucus of more than 170 conservative House members, has suggested eliminating CDBG and some Republicans are putting forward $32 billion in cuts to domestic programs.

"If the president is going to cut it 7.5 percent what is the new Republican House going to do?" said Tom Cochran, executive director of the U.S. Conference of Mayors, casting Lew's editorial as the opening salvo in negotiations on CDBG.

"We will be examining the budget on February 14. We are concerned about other cuts," he added.

Akron's Plusquellic said cutting aid to cities "seems un-American to me."

"At some point, if some of the congressional leaders are successful in cutting this program ... we will be spending more money fixing up cities in Iraq than in America," he added.