Blood pressure during sleep: Antihypertensive medication

Abstract

To investigate whether excessive reduction of blood pressure (BP) by antihypertensive medications correlates with myocardial infarction, especially during steep in elderly patients, we used telemetry and cuvette dye-dilution methods to assess the direct BP and the hemodynamics of 68 inpatients with essential hypertension during wakefulness and steep. There were 25 patients ≥60 years old (OH-group) and 43 were ≤59 years old (YH-group). Of the OH-group, 36% showed high BP during the day, with marked decreases (minimum BP <110/70 mm Hg) during steep. Average cardiac index (CI) of the OH-group was low during wakefulness and extremely low during show-wave sleep. Changes of mean BP in the OH-group correlated with changes in total peripheral vascular resistance index (TPRI) during steep, but this correlation was not observed in the YH-group. The antihypertensive effects on nocturnal BP of the various medications was: central adrenergic inhibitors ≤ β blockers with intrinsic sympathomimetic activity ≤ α (αβ) blockers ≤ angiotensin-converting enzyme inhibitors ≤ calcium antagonists. Because BP and CI were found to be very low and TPRI seems to play an important role in BP regulation in sleeping elderly patients, excessive antihypertensive medication may be harmful to this subgroup. However, because the effects on nocturnal BP differ among various antihypertensive treatments, further research is required on the relation between antihypertensive medication and the hemodynamics of sleeping elderly hypertensive patients.