Mean 24-h Diastolic Blood Pressure Research Articles

The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension

In this study, efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension. After a 2-week, single-blind, placebo run-in period, 60 patients were randomised to double-blind, once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks. Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases. Both telmisartan and perindopril significantly (p < 0.0001) reduced clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared with baseline values. Also, both drugs significantly (p < 0.0001) reduced 24-h mean ambulatory SBP and DBP compared with baseline. Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater (p < 0.05) in telmisartan-treated patients. A 24-h mean DBP of <85 mmHg was observed in 66.6% of the telmisartan-treated patients but in only 46.6% of the perindopril-treated patients (p < 0.05). It is concluded that telmisartan and perindopril both produce significant reductions in clinic SBP and DBP, but the mean reduction in ambulatory DBP during the last 8 h of the dosing interval is greater in patients treated with telmisartan.

Relationship between 24-H blood pressure and sleep disordered breathing in a normotensive community sample

Sleep disordered breathing (SDB) and hypertension are commonly associated. In this study, we assessed how longitudinal measures of SDB predict a 24-h ambulatory blood pressure monitoring (ABPM) profile. Participants ( n = 82) were recruited from a community-based urban (26% African American) sample and included family members of patients with laboratory diagnosed SDB (cases) and family members of neighborhood control subjects evaluated at baseline and at 5 years. Nearly all participants were normotensive and were not receiving therapy for SDB. During both examinations, the respiratory distress index (RDI) was assessed with overnight in-home polysomnography. Seated blood pressure (BP) was assessed at a baseline examination (t 1) and after a 5-year follow-up period (t 5), when 24-h ABPM also was performed. The change in RDI (t 5−t 1) over 5 years was significantly associated with 24-h mean systolic blood pressure (SBP) ( P = .04), 24-h maximum diastolic blood pressure (DBP) ( P = .03), sleep mean SBP ( P = .05), sleep mean DBP ( P < .05), and sleep maximum SBP ( P = .02). Regression analysis revealed that average 24-h mean arterial pressure (MAP) and mean 24-h DBP were each best predicted by change in RDI, explaining 5% of the variance in these 24-h BP readings, and by current smoking status. After accounting for these variables, BP was not predicted by any of the other potential confounders (all P > .10). Mean RDI (averaged between t 5 and t 1) was associated with mean MAP, mean SBP, and maximal SBP measured during sleep. This study documents for the first time the association between changes in sleep apnea activity and BP and in a community-based normotensive sample. Further long-term evaluation of the effects of these findings and the long-term consequences of hypertension are needed.

Effects of hormone replacement therapy on ambulatory blood pressure and vascular responses in normotensive women

The effects of chronic oestrogen replacement therapy (ERT) (conjugated equine oestrogen 0.625 mg/day) and combined oestrogen and progestogen replacement therapy (HRT) (ERT plus continuous medroxyprogesterone acetate 5 mg/day) on 24-h ambulatory blood pressure recordings, forearm vascular resistance (FVR) and FVR responses to noradrenaline, angiotensin II, acetylcholine and nitroprusside were studied in 17 normotensive postmenopausal women in a 3-month randomized, double-blind, placebo-controlled crossover trial with 1 month of therapy in each treatment arm. During the last few days of each 1-month treatment period, the subjects underwent 24-h ambulatory blood pressure recordings and measurements of FVR responses. ERT and HRT reduced mean 24-h diastolic blood pressure by 4 and 5 mmHg, systolic blood pressure by 6 and 9 mmHg and mean 24-h heart rate by 5 and 3 beats/min, respectively for ERT and HRT (p < 0.05). Basal FVR was reduced by approximately 18% by ERT and HRT, but FVR responses to noradrenaline, angiotensin II, acetylcholine and nitroprusside were unaffected. ERT and HRT therapy for 1 month lowers blood pressure and basal FVR, but does not appear to influence FVR responses to acetylcholine, nitroprusside, noradrenaline and angiotensin II.

Little Effect of Ordinary Antihypertensive Therapy on Nocturnal High Blood Pressure in Patients with Sleep Disordered Breathing

The antihypertensive effects of four different antihypertensive medications (β-blocking agent, atenolol 50 mg; calcium-antagonist, isradipine SRO [slow release] 2.5 mg; diuretic, hydrochlorothiazide [HCTZ] 25 mg; and angiotension converting enzyme-inhibitor, spirapril 6 mg) on obese patients with sleep disordered breathing and hypertension were compared by the ambulatory blood pressure measurement (ABPM). Eighteen patients were randomized in a double-blind, crossover fashion to receive each of the four different medications for 8 weeks. ABPM was performed at baseline and after an 8-week treatment with these medications. A 2- to 3-week washout period occurred both at baseline and between each of the four medications. Three patients were omitted from statistical analysis because of technical problems of ABPM. Atenolol, isradipine SRO, and spirapril decreased significantly ( P < .01) the mean 24-h systolic blood pressure, whereas HCTZ did not. The mean 24-h diastolic blood pressure decreased significantly after all four medications: 12 (SD ± 14) mm Hg with atenolol, 7 (SD ± 10) mm Hg with isradipine SRO, 3 mm Hg (SD ± 14) with HCTZ, and 6 (SD ± 15) mm Hg with spirapril ( P < .01). During nighttime none of the medications reduced the mean diastolic or systolic blood pressure significantly. According to the 24-h blood pressure curve the influence of these four medications during the whole measurement period was not similar. Atenolol and spirapril lost their antihypertensive effect during the early morning hours. The antihypertensive effect of HCTZ varied markedly from hour to hour. The trough-to-peak ratio of no medication was >0.50. Negative correlation was observed between the apnea time and the mean systolic 24-h (r = −0.604, P = NS) and the mean systolic nocturnal blood pressure change (r = −0.590, P = NS). Our study revealed that the daytime high blood pressure was quite easily controlled by the ordinary monotherapy in these patients with partial upper airway obstruction and hypertension. Instead none of the medications used decreased nocturnal high blood pressure markedly.

Amniotic Fluid Index and Mean Diastolic Maternal Blood Pressure in Pregnancy-Induced Hypertensive Patients

Objective: To determine the correlation between maternal blood pressure value and the volume of amniotic fluid.Methods: Amniotic fluid index (AFI) and fetal and maternal Doppler, followed by 24-h ambulatory blood pressure were determined in patients with preeclampsia (n = 10), gestational hypertension patients (n = 28), fetal growth retardation (IUGR) (n = 23), and with a healthy normotensive pregnancy (n = 39). Mean 24-h diastolic blood pressure (M24h DBP) was used to describe the overall pressure regimen for each patient. Uteroplacental resistance and fetal peripheral resistance were investigated through color Doppler evaluation of the uterine, umbilical, and middle cerebral arteries.Results: A significant inverse linear correlation between AFI values and M24h DBP was found for the patients with gestational hypertension (r = −0.45, P <0.005). In the patients with normal uterine resistance (RI), normal fetal growth, and normal Doppler indexes there was a stronger negative correlation (r = -0.66, P < 0.00...

Screening Pregnant Women at 22-24 Weeks for Gestational Hypertension or Intrauterine Growth Retardation by Doppler Ultrasound Followed by 24-Hour Blood Pressure Recording

Objective: To improve the efficacy of screening patients at increased risk of hypertension or intrauterine growth retardation, we combined the assessment of increased uteroplacental resistance with a second-line screening using 24-h blood pressure monitoring.Methods: Doppler assessment of uterine artery flow (resistance index, diastolic notch) at 20 and at 24 weeks gestation and 24-h ambulatory blood pressure were determined in 48 consecutive patients. Mean 24-h diastolic blood pressure (M24-h DBP) was used as a measure to describe the overall pressure regimen for each patient. Based on a cutoff of 68 mm Hg, the series was divided into two groups: 18 high-risk patients with abnormal M24-h DBP (higher than 68 mm Hg). and 30 low-risk patients (equal to or lower than 68 mm Hg). The results were blinded to clinicians.Main Outcome Measures: The development of gestational hypertension, preeclampsia, and intrauterine growth retardation (IUGR).Results: None of the 18 pathological M24-h DBP as compared to 25/30 in the normal DBP group had a normal pregnancy outcome. The group with abnormal 24-h DBP monitoring delivered earlier and smaller infants than did the normal 24-h DBP group. Sensitivity of combining these two methods to detect gestational hypertension was 79% and positive predictive value was 83%, whereas the respective indices for IUGR were 90% and 50%.Conclusions: Screening patients with increased uteroplacental resistance with 24-h blood pressure recording improves the efficacy of the Doppler screening to identify patients at risk of an abnormal outcome of pregnancy.

Time course and effect of sodium intake on vascular and hormonal responses to enalapril (MK 421) in normal subjects.

Enalapril (MK 421) is a long-acting angiotensin converting-enzyme inhibitor which specifically lacks the sulfhydryl group of captopril. We measured arterial pressure and hormonal responses that occurred in 22 normotensive subjects treated with increasing doses of enalapril (2.5, 5, 10, and 20 mg) once daily, who were on either low (10 mEq) or high (200 mEq) sodium diets. In sodium-restricted subjects (n = 12), mean diastolic blood pressure declined from control levels in a dose-related fashion during the first 2 h. The mean 24-h diastolic blood pressure values were significantly lower than control (p less than 0.01) at all doses, with the greatest declines occurring with the 10 and 20 mg doses. Accompanying the decline in blood pressure was a significant increase in plasma renin activity (PRA) and reduction in plasma angiotensin II (AII) and aldosterone levels. As with blood pressure, the greatest changes were observed with the 5, 10, and 20 mg doses. However, only the 20 mg dose of enalapril produced prolonged and significant PRA increments (p less than 0.01) and AII decrements (p less than 0.05) of at least 24 h in duration. In sodium-replete subjects (n = 10), a similar pattern of diastolic blood pressure responses was observed; however, the effect of the drug was not so profound. No significant decrease in AII occurred at any dose of enalapril; however, PRA increased modestly but significantly (p less than 0.01) after administration of 5, 10, and 20 mg enalapril. Plasma aldosterone declined modestly but significantly, 2 (p less than 0.05) and 4 (p less than 0.01) h after the 10 mg dose.(ABSTRACT TRUNCATED AT 250 WORDS)