Influence of the Echocardiogram on the Blood Pressure

Dr. Cristian Maximiliano Toldo^*, Dr. Sebastian Eugenio Puga & Dr. Pedro Vicente Kairuz

Medicina Ambulatoria Salta, Cardiologia, Salta, Argentina

*Correspondence to: Dr. Cristian Maximiliano Toldo, Medicina Ambulatoria Salta, Cardiologia, Salta, Argentina.

Copyright © 2018 Dr. Cristian Maximiliano Toldo, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abbreviations (if used)
PAS systolic blood pressure
PAD diastolic blood pressure

Introduction
It is known the effect of "white coat" on blood pressure in patients evaluated in the hospital setting, and the possible errors that can lead to the diagnosis and treatment [1]. We did not find data on the effects of complementary methods on blood pressure, so we decided to evaluate 100 consecutive patients in the echocardiography service of our center and record what effect it produced on blood pressure.

Materials and Methods
Observational, descriptive, cross-sectional and prospective study. A total of 100 patients were evaluated consecutively, recording systolic blood pressure (SBP) and diastolic blood pressure (DBP) in supine decubitus, in the left arm, before the echocardiographic study and after the end of it. We excluded patients under 16 years of age or frequent arrhythmia. The device used was an anaeroid tensiometer (Welch Allyn Ds 45, adult bracelet 11 and obese 12). Personal records were recorded and data was collected in Excel spreadsheet.

Results
The average age was 57 years, 54 were (54%) men and 46 (46%) women, 40 (40%) had arterial hypertension, 38 (38%) diabetes mellitus, 25 (25%) dyslipidemia, 43 (43 %) smoked, 38 (38%) were overweight and 24 (24%) had a body mass index greater than 31, 12 (12%) had hypothyroidism and 50 (50%) did not perform physical activity more than 3 times a week (Figure 1). The mean SBP recorded before the echocardiogram was 134.7mmHg and the mean DBP was 80.9mmHg. After the end of the echocardiogram, the average SBP was 125.4mmHg and DBP was 77.6mmHg (Figure 2). A difference of 9.3mmHg was registered for the TAS and 3.3mmHg for the TAD. The greatest difference in absolute values was 22mmHg for SBP and 10mmHg for DBP. There were 2 patients who had a post-procedural TA increase of 10mmHg for systolic and 4mmHg for diastolic. The SBP decreased 9.3mmHg (6.9%) and the DBP 3.3mmHg (4%) pre to post echocardiogram.

Discussions
How many times have we conducted studies with echocardiography, stratifying the severity of some valvulopathy without knowing the blood pressure? We believe that many, and the reasons are several, perhaps the most frequent and least substantiated is the "time factor". Since a couple of years ago our service began to register blood pressure at the end of the study in a systematic way, and in some cases we have found significant valvulopathies but in the context of arterial hypertension grade equal to or greater than 2, [2] and after treatment, the insufficiency reduced at least one degree.

When evaluating the severity of aortic stenosis with echocardiography, the guidelines recommend performing it in normotension and it is demonstrated that the increase in afterload increases the magnitude of mitral regurgitation [3].

Based on all this, we decided to investigate the repercussion of the anxiety linked to the echocardiographic study in a standard population of our daily practice as the "white coat" phenomenon does. After examining a population of 100 patients, we found a significant effect on blood pressure, but without this difference influencing the outcome of the study. We emphasize that this study was unicentric and with a small number of patients, so that a larger and more global population would be necessary to reinforce the final results.

Conclusion
After evaluating 100 patients, we found a decrease in SBP on average 9.3mmHg and DBP 3.3mmHg, demonstrating that in this particular complementary method, although there is a rise in blood pressure similar to that of "white coat" due to anxiety, its repercussion it does not influence the final result of the echocardiogram. In any case, when we evaluated the absolute values, the highest difference reached 20mmHg for the systolic pressure and 10mmHg for the diastolic. Reason for which we believe that the recording of blood pressure as the heart rate at the time of the examination should be part of the final report, especially in valvulopathies.

Bibliography

1. Gijón Conde, T. & Banegas, J. R. (2017). Ambulatory blood pressure monitoring for hypertension diagnosis? Hipertens Riesgo Vasc., 34(Suppl 1), 4-9.
2. Chobaniam, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., Roccella, E. J. & the National High Blood Pressure Education Program Coordinating Committee. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA., 289(19), 2560-2572.
3. Lax Jorge & Stutzbach Pablo. (2015). CONSENSO DE VALVULOPATÍA / Versión Resumida. Revista argentina de cardiología, 83(1), 68-80.