By Stephen J. Mathes
Scientific Atlas of muscle flaps.
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Additional resources for Clinical Atlas of Muscle and Musculocutaneous Flaps
Environment There is a hierarchy of alerting: least at home, more in the clinic or office, and most in the hospital. , 2000). , 2009). , 1987). The data in Figure 2-3 were obtained from patients who had an intra-arterial recording. When the intra-arterial readings were stable, the BP was measured in the noncatheterized arm by both a male physician and a female nurse, half of the time by the physician first, the other half by the nurse first. The patients had not met the personnel but had been told that they would be coming.
Natural History Too few patients have been followed long enough to be sure of the natural history of WCH, but Pickering et al. (1999) found that only 10% to 30% become hypertensive over 3 to 5 years. More recently, Mancia et al. (2009) found that 43% of patients with WCH developed sustained hypertension after 10 years. , 2006b). 41 42 FIGURE 2-5 Event-free survival curve in patients with normotension, WCH, and sustained hypertension. (Reprinted from Pierdomenico SD, Lapenna D, Di Mascio R, et al.
2008). , 2008). , 1999). , 2008). , 2004). 25 Associations with Nondipping A number of associations have been noted with a lesser fall than usual in nocturnal BP. , 2004) • Mortality from cardiovascular disease (Redon & Lurbe, 2008) With concern over a greater risk in nondippers, Hermida et al. (2008) changed the prevalence of dipping from 16% to 57% by giving one of the three medications being taken by 250 resistant patients at bedtime. Associations with Excessive Dipping Just as a failure of the BP to fall during sleep may reflect or contribute to cardiovascular damage, there may 37 38 also be danger from too great a fall in nocturnal BP.