24-hour Pressure Research Articles

Relationship between Nocturnal Blood Pressure and Left Ventricular Hypertrophy in Hypertensive Patients

Objective: Left ventricular hypertrophy (LVH) is the most common target organ damage in hypertension. However, the association of LVH and circadian rhythm of blood pressure (BP) is unknown. The objective of the present study was to explore the relationship between circadian rhythm of BP and LVH using ambulatory blood pressure monitoring (ABPM). Study design: A total of 325 untreated hypertensive patients were recruited. The patients were divided into two groups: hypertensive patients with LVH (n=121) and without LVH (n=204). Twenty-four-hour ABPM was performed in all the patients to collect the following parameters: 24-hour average systolic and diastolic pressure, daytime average systolic and diastolic pressure, nocturnal average systolic and diastolic pressure, and night to day BP ratio. The relationship between LVH and the various ABPM parameters was analyzed. Results: We found that the average nocturnal systolic blood pressure (SBP) in hypertensive patients with LVH was higher than that in hypertensive patients without LVH (145 ± 16.1 mmHg versus 136 ± 12.7 mmHg, P<0.05). The average night to day SBP ratio in hypertensive patients with LVH was also higher than that in hypertensive patients without LVH (0.93 ± 0.04 versus 0.86 ± 0.04, P<0.05). Multiple regression analysis indicate that the average nocturnal SBP and the night to day SBP ratio were associated with LVH (Odds ratio (OR) 1.67, 95% CI: 1.31-3.21; OR: 1.88, 95% CI: 1.56-3.78) by adjustment for traditional covariates. Conclusion: The average nocturnal SBP and the average night-day SBP ratio are independent risk factors of LVH in patients with hypertension.

Twenty-four-Hour Profile of Central Blood Pressure and Central-to-Peripheral Systolic Pressure Amplification

The significant difference in central and peripheral blood pressure (BP) values has only recently been widely recognized. Ambulatory BP monitoring has been shown to have advantages over office BP measurements because ambulatory monitoring can provide important information not available when only office BP is measured. The aim of this study was to assess the 24-hour central systolic pressure (CSP) profile, CSP short-term variability, and 24-hour systolic pressure amplification profile. The study group comprised 50 hypertensive subjects and 50 normotensive subjects. All participants underwent 24-hour peripheral and central pressure monitoring. CSP was lower than peripheral pressure levels during the day (124.1 ± 15.7 mm Hg vs 133.9 ± 16.3 mm Hg; P < 0.001) and night hours (114.4 ± 14.5 mm Hg vs 121.5 ± 15.2 mm Hg; P < 0.001). The CSP nocturnal fall was lower than the peripheral pressure fall in normotensive subjects as well as in hypertensive subjects. Although 24-hour systolic pressure amplification was similar in subjects with and without hypertension (9.2 ± 3.1 mm Hg and 8.3 ± 2.4 mm Hg; P = NS), it was significantly lower during the night than during the day in both groups. The nocturnal fall in systolic pressure amplification was correlated with the day-night difference in heart rate (r = 0.70; P < 0.001). Central pressure differs significantly from peripheral pressure during regular daily activity as well as during night hours. Moreover, it appears that systolic pressure amplification varies throughout the 24-hour period and that the main factor determining nocturnal fall in systolic pressure amplification is nocturnal drop in the heart rate. More studies are required to demonstrate advantage of this novel technique over traditional pressure monitoring in clinical practice.

Nocturnal Ultrasound Measurements of Optic Nerve Sheath Diameter Correlate with Intracranial Pressure in Children with Craniosynostosis

Children with craniosynostosis are at risk for increased intracranial pressure, and additional possibilities to screen for increased intracranial pressure are required. The authors' aim was to use ultrasound measurements of the optic nerve sheath to understand and express the variability of intracranial pressure in syndromic craniosynostosis. Therefore, five pediatric patients with craniosynostosis underwent invasive 24-hour intracranial pressure monitoring and simultaneous optic nerve sheath measurements. In three patients, the intracranial pressure was abnormal, and during the second half of the night, the optic nerve sheath was increased in all three patients. The optic nerve sheath diameter changes during the night and is as dynamic as the intracranial pressure. To the best of their knowledge, the authors are the first to describe a real-time relationship of the optic nerve sheath with increased intracranial pressure in children.

Pivotal factors interfering in 24‐hour blood pressure fluctuation and arterial stiffness in a community of Chinese elderly hypertensive patients

To explore which sociodemographic and clinical factors could interfere in the parameters of ambulatory blood pressure monitoring and determine the affecting factors of Ambulatory Arterial Stiffness Index. Although the clinical relevance of ambulatory blood pressure monitoring and Ambulatory Arterial Stiffness Index have been studied, the explanation of their role and related interfering factors remains controversial in patients with different disease or age, etc. Cross-sectional study. The study was carried out between October 2008-October 2009. A convenience sample of hypertensive patients over 60 years old was recruited in China. Twenty-four hour ambulatory blood pressure monitoring was carried out on the non-dominant arm using an oscillometric device. (1) All 95 patients completed the study and their ages ranged from 60-76 years. (2) There were statistical differences for certain parameters of ambulatory blood pressure monitoring between different characteristics of patients. Financial status was an important factor interfering in patients' BP fluctuation, especially daytime and 24 hours systolic pressure. The higher body mass index the patients had, the higher the pressure was. (3) Multiple variants logistic analysis of Ambulatory Arterial Stiffness Index showed statistical differences only in coefficient variation of 24-hour diastolic pressure and daytime systolic blood pressure. There are more factors that interfered with systolic pressure and diastolic pressure during the day than night. Patients who have less nocturnal dipping may have a higher night time systolic pressure and diastolic pressure. The coefficient of variation of 24 hours diastolic pressure and daytime systolic pressure contribute more to Ambulatory Arterial Stiffness Index which should arouse practitioners' attention. Ambulatory blood pressure monitoring should be used as a routine procedure, as well as Ambulatory Arterial Stiffness Index calculated for older hypertensive patients. The findings may be used to guide community health providers to pay more attention to the factors that may influence BP fluctuation and Ambulatory Arterial Stiffness Index according to individual's characteristics.

A controlled clinical trial of the effect of gastric bypass surgery and intensive lifestyle intervention on nocturnal hypertension and the circadian blood pressure rhythm in patients with morbid obesity

Nocturnal hypertension, increased night-to-day systolic blood pressure (BP) ratio and nondipper status (night-to-day systolic BP ratio > 0.9) are associated with an increased risk of cardiovascular disease. Our aim was to compare the 1-year effect of Roux-en-Y gastric bypass (RYGB) versus a program of intensive lifestyle intervention (ILI) only on nocturnal hypertension and circadian BP rhythm. The study participants were part of a 1-year, controlled clinical trial comparing the effect of RYGB or ILI on obesity-related comorbidities. Ninety participants (49 in the RYGB group) successfully completed 24-hour ambulatory BP monitoring at baseline and follow-up and were eligible subsequently for analysis. A total of 71 subjects (79%) had nocturnal hypertension at baseline. The number of subjects with nocturnal hypertension decreased from 42 to 14 in the RYGB group (P ≤ .001) and from 29 to 27 (P = .791) in the ILI group. Subjects in the RYGB group had a lesser adjusted odds ratio (OR) of nocturnal hypertension at follow-up (OR 0.15; 95% confidence interval, 0.05-0.42; P ≤ .001); however, after further adjustment for weight loss, there was no additional beneficial effect of RYGB (P = .674). No differences between groups regarding improvement in the night-to-day systolic BP ratio were found after adjustment for 24-hour systolic pressure (P = .107). Both interventions showed a decrease in the proportion of subjects classified as nondippers, namely, 44% (P ≤ .001) and 28% (P = .002) in the RYGB and ILI groups, respectively. Only RYGB was associated with a decrease in the prevalence of nocturnal hypertension. Both interventions showed an improvement in dipper status, although RYGB was more effective.

Short-term blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO)

Ambulatory blood pressure monitoring not only provides information on the blood pressure level, but on the diurnal changes in blood pressure as well. The present review summarizes the main fi ndings of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) with regard to risk stratifi cation based on short-term blood pressure variability. An exaggerated morning surge, exceeding the 90th percentile of the population, is an independent risk factor for mortality and cardiovascular and cardiac events. Conversely, a sleep-through or pre-awakening morning surge less than 20 mm Hg in systolic blood pressure is probably not associated with an increased risk of death or cardiovascular events. Blood pressure variability represented by the average of the daytime and nighttime SD weighted for the duration of the daytime and nighttime interval (SDdn) and by average real variability (ARV24) predicted outcome, but only improved the prediction of the composite cardiovascular events by 0.1%. Overall, results of analyses using the IDACO support the concept that short-term blood pressure variability adds to risk stratifi cation, but 24-hour ambulatoryblood pressure level is the most valuable predictor for use in clinical practice.

Objective: to specify the frequency and pattern of mental disorders in patients with rheumatoid arthritis (RA) and their association with a number of demographic parameters, stressors, inflammatory activity, duration of RA and its therapy, pain, and concomitant cardiovascular diseases (CVD).Subject and methods. One hundred and sixteen patients with verified RA were examined; 86% were women with a median age of

Objective: to specify the frequency and pattern of mental disorders in patients with rheumatoid arthritis (RA) and their association with a number of demographic parameters, stressors, inflammatory activity, duration of RA and its therapy, pain, and concomitant cardiovascular diseases (CVD).Subject and methods. One hundred and sixteen patients with verified RA were examined; 86% were women with a median age of

The comparative effects of azilsartan medoxomil and olmesartan on ambulatory and clinic blood pressure.

The current study assesses the antihypertensive efficacy and safety of the investigational angiotensin receptor blocker (ARB), azilsartan medoxomil (AZL-M), compared with placebo and the ARB olmesartan medoxomil (OLM-M). This randomized, double-blind, placebo-controlled, multicenter study assessed change from baseline in mean 24-hour ambulatory systolic blood pressure (SBP) following 6 weeks of treatment. Patients with primary hypertension (n=1275) and baseline 24-hour mean ambulatory systolic pressure ≥ 130 mm Hg and ≤ 170 mm Hg were studied; 142 received placebo and the remainder received 20 mg, 40 mg, or 80 mg AZL-M or 40 mg OLM-M. Mean age of participants was 58 ± 11 years, baseline mean 24-hour SBP was 146 mm Hg. Dose-dependent reductions in 24-hour mean SBP at study end occurred in all AZL-M groups. Reduction in 24-hour mean SBP was greater with AZL-M 80 mg than OLM-M 40 mg by 2.1 mm Hg (95% confidence interval, -4.0 to -0.1; P=.038), while AZL-M 40 mg was noninferior to OLM-M 40 mg. The side effect profiles of both ARBs were similar to placebo. AZL-M is well tolerated and more efficacious at its maximal dose than the highest dose of OLM-M.

Central Pressure and Biomarker Responses to Renin Inhibition with Hydrochlorothiazide and Ramipril in Obese Hypertensives: The ATTAIN Study

Background/Aims: In obese, hypertensive subjects, the renin-angiotensin system (RAS) is enhanced and natriuresis impaired, suggesting a role for combination RAS blockade with diuretics. Data suggest that renin inhibition may attenuate diuretic-induced RAS activation and oxidative stress. Methods: In this 8-week, double-blind study of 386 obese individuals (mean body mass index: 35.3) with stage 2 hypertension (mean age: 54.9 years; mean sitting systolic blood pressure, SBP: ≧160 but <200 mm Hg), we compared the efficacy of aliskiren + hydrochlorothiazide (HCTZ) in reducing blood pressure (BP), plasma renin activity (PRA), and a urinary marker of oxidative stress to ramipril. Subjects were randomized to aliskiren/HCTZ 150/12.5 mg or ramipril 5 mg for 1 week, and after the 1st week force titrated to aliskiren/HCTZ 300/25 mg or ramipril 10 mg for 7 weeks. Results: After 8 weeks, aliskiren/HCTZ provided greater reductions in office BP than ramipril (–28.1/–10.1 vs. –16.6/–3.6 mm Hg, p < 0.0001) as well as 24-hour ambulatory and central pressure measures. Aliskiren/HCTZ also lowered PRA (–45 vs. +83%) and the urinary F2-isoprostane/creatinine ratio (–18 vs. +7%) to a greater extent than ramipril. Adverse events (AEs) were similar in the two groups (35.8% with aliskiren/HCTZ vs. 37.3% on ramipril reporting at least one AE). Conclusions: Our findings suggest that the aliskiren/HCTZ combination reduced BP, PRA, and isoprostanes to a greater extent than did ramipril in obese patients with stage 2 hypertension.

Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Intracardiac pressures in heart failure (HF) have been measured in patients while supine in the hospital but change at home with posture and activity. The optimal level of chronic ambulatory pressure is unknown. This analysis compared chronic intracardiac pressures to later HF events and sought a threshold above which higher pressures conferred worse outcomes. Median pressures were measured every 24 hours from continuous 8-minute segments for 6 months after implantation of hemodynamic monitors in 261 patients with New York Heart Association class III-IV HF in the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure Study. Baseline and chronic daily medians of estimated pulmonary artery diastolic, right ventricular systolic, and right ventricular end-diastolic pressures were compared with HF event rate. The group median for chronic 24-hour estimated pulmonary artery diastolic pressure was 28 mm Hg (excluding 7 days before and after events). Despite weight-guided management, events occurred in 100 of 261 (38%) patients. Event risk increased progressively with higher chronic 24-hour estimated pulmonary artery diastolic pressure, from 20% at 18 mm Hg to 34% at 25 mm Hg and 56% at 30 mm Hg, with similar relations for right ventricular pressures. Among patients with baseline day median estimated pulmonary artery diastolic pressures of ≥25 mm Hg, event risk was 1.10/6 mo when they remained chronically ≥25 mm Hg, but risk fell to 0.47 when 24-hour pressures declined to <25 mm Hg for more than half of the days. Despite current management, many patients with advanced HF live on a plateau of high filling pressures from which later events occur. This risk is progressively higher with higher chronic ambulatory pressures. It is not known whether more targeted intervention could maintain lower chronic ambulatory pressures and better outcomes.

Comparison of Scanning Laser Polarimetry and Optical Coherence Tomography in Quantitative Retinal Nerve Fiber Assessment

To investigate the relationship between retinal nerve fiber layer (RNFL) measurements in corresponding areas obtained with scanning laser polarimetry and optical coherence tomography and to compare their discriminating ability in the diagnosis of preperimetric and perimetric glaucoma. Three hundred eighty-six subjects-57 healthy controls, 145 ocular hypertensive patients, 89 with preperimetric glaucoma, and 95 with perimetric glaucoma-were recruited from the Erlangen Glaucoma Registry. Perimetry, 24-hours intraocular pressure profile, stereographic optic disc slides, optical coherence tomography StratusOCT, and scanning laser polarimetry GDx VCC (Carl Zeiss Meditec, Inc, Dublin, CA) were performed in all patients. Receiver operating characteristic (ROC) curves were constructed for mean RNFL values, sector data, and indices. Sensitivity was estimated at >or=90% and >or=80% of specificity to compare the discriminating ability of each imaging modality. For discrimination between glaucomatous and healthy eyes in GDx VCC the nerve fiber index demonstrated the largest area under the ROC curve (AUROC) (0.962+/-0.013), whereas in StratusOCT the largest AUROC (0.986+/-0.006) was found in the inferior quadrant. For preperimetric glaucoma detection the nerve fiber index achieved the largest AUROC (0.783+/-0.037). In contrast, the total RNFL average obtained using StratusOCT showed the largest AUROC (0.904+/-0.025). Bland-Altman plots showed good agreement between both instruments. Both the GDx VCC and StratusOCT demonstrate increasing RNFL loss with advanced glaucomatous damage and were comparable in the diagnosis of perimetric glaucoma. Preperimetric glaucomatous damage may be better assessed by StratusOCT.

Ambulatory Blood Pressure in Young Adults with Very Low Birth Weight

We hypothesized that, as compared with a matched control group born at term, young adults with very low birth weight (VLBW <1.5 kg) would have higher 24-hour ambulatory blood pressure. We studied 118 18- to 27-year-old subjects born with VLBW within the greater Helsinki area and 120 term-born control subjects with similar age, sex, and birth hospital. The mean birth weight for VLBW subjects was 1.1 kg (standard deviation [SD], 0.2) and for controls, 3.6 kg (SD, 0.5). Gestational ages were 29.2 (SD, 2.3) and 40.1 (SD, 1.0) weeks. Current education of higher-educated parents served as an indicator of childhood socioeconomic status. Ambulatory blood pressure was measured during a 24-hour period with an oscillometric device (Spacelabs 90207). VLBW subjects had, with sex, age, and body mass index adjustment, a 2.4 mm Hg (95% confidence interval, 0.2 to 4.6) higher 24-hour systolic pressure. We found hypertension in 11 VLBW subjects and in 3 term-born subjects, giving an adjusted odds ratio of 4.0 (1.1 to 14.8). When socioeconomic status was taken into account, results remained unchanged. Higher rates of hypertension and higher 24-hour blood pressure among young adults with VLBW may indicate higher risk for adverse cardiovascular outcomes.

Dizzy Spells Complicating Hypertension Management

Dizzy Spells Complicating Hypertension Management

Intraocular pressure control over 24 hours using travoprost and timolol fixed combination administered in the morning or evening in primary open‐angle and exfoliative glaucoma

To evaluate intraocular pressure (IOP) control over 24 hours using travoprost and timolol fixed combination (TTFC) administered in the morning or evening in primary open-angle and exfoliative glaucoma. Patients were randomized to TTFC administered in either the morning or evening for 8 weeks. Previously treated patients underwent an untreated washout period of 4-6 weeks, after which baseline IOP was required to be > 25 mm Hg and < 38 mmHg (in two readings taken at 10.00 +/- 1 hours). During the treatment period, IOP was measured at 10.00, 14.00, 18.00, 22.00, 02.00 and 06.00 hours. Patients were then treated with the opposite dosing regimen for 8 weeks and IOP measurements were repeated. In 32 subjects who completed the study, the untreated baseline IOP following washout was 27.7 +/- 3.5 mmHg. Both dosing regimens reduced IOP from baseline at each time-point and throughout the 24-hour diurnal curve (p < 0.0001). When treatments were compared directly, evening dosing (18.4 +/- 3.3 mmHg) provided a statistically significant lower 24-hour curve than morning dosing (19.2 +/- 3.5 mmHg; p = 0.001). Evening dosing also resulted in a lower 24-hour IOP fluctuation (3.8 +/- 1.6 mmHg) than morning dosing (5.1 +/- 1.6 mmHg; p = 0.0002) and lower peak IOP (p = 0.0003). Both morning and evening administration of TTFC provide effective 24-hour IOP reduction, but evening dosing demonstrates better 24-hour pressure control.

Determinants of the Ambulatory Arterial Stiffness Index in 7604 Subjects From 6 Populations

The ambulatory arterial stiffness index (AASI) is derived from 24-hour ambulatory blood pressure recordings. We investigated whether the goodness-of-fit of the AASI regression line in individual subjects (r(2)) impacts on the association of AASI with established determinants of the relation between diastolic and systolic blood pressures. We constructed the International Database on the Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (7604 participants from 6 countries). AASI was unity minus the regression slope of diastolic on systolic blood pressure in individual 24-hour ambulatory recordings. AASI correlated positively with age and 24-hour mean arterial pressure and negatively with body height and 24-hour heart rate. The single correlation coefficients and the mutually adjusted partial regression coefficients of AASI with age, height, 24-hour mean pressure, and 24-hour heart rate increased from the lowest to the highest quartile of r(2). These findings were consistent in dippers and nondippers (night:day ratio of systolic pressure >or=0.90), women and men, and in Europeans, Asians, and South Americans. The cumulative z score for the association of AASI with these determinants of the relation between diastolic and systolic blood pressures increased curvilinearly with r(2), with most of the improvement in the association occurring above the 20th percentile of r(2) (0.36). In conclusion, a better fit of the AASI regression line enhances the statistical power of analyses involving AASI as marker of arterial stiffness. An r(2) value of 0.36 might be a threshold in sensitivity analyses to improve the stratification of cardiovascular risk.

Rapid and severe rise in static and pulsatile intracranial pressures during a generalized epileptic seizure

In a patient with no prior history of seizures we were able to record static (mean) intracranial pressure (ICP) and pulsatile ICP (mean ICP wave amplitude) continuously during a first-time generalized epileptic seizure. The patient experienced episodic headache five months after a subarachnoid haemorrhage. In order to rule out low-pressure hydrocephalus she was admitted for a 24-hour intracranial pressure registration. ICP parameters were normal prior to the seizure. We observed an immediate and enormous rise in both static (mean) ICP and pulsatile ICP (mean ICP wave amplitude). Mean ICP and ICP wave amplitude peaked at 93 mmHg and 22 mmHg, respectively. Pulsatile ICP remained elevated after normalization of static ICP and may indicate impairment of intracranial compliance even after the static ICP was normalized.

Effects of the Timolol-Dorzolamide Fixed Combination and Latanoprost on Circadian Diastolic Ocular Perfusion Pressure in Glaucoma

To evaluate the effect of the timolol-dorzolamide fixed combination (TDFC) and latanoprost 0.005% on 24-hour intraocular pressure (IOP), systolic (SBP) and diastolic (DBP) blood pressure, and diastolic ocular perfusion pressure (DOPP) in patients with primary open-angle glaucoma (POAG). This was an institutional, randomized clinical trial. After a 24-hour assessment without treatment, 27 previously untreated patients with POAG were randomized to 6 weeks' treatment with twice-daily TDFC (8 AM and 8 PM) followed by once-daily latanoprost 0.005% (8 PM), or vice versa. One eye was analyzed per patient. The mean values of IOP, DBP, SBP, and DOPP (difference between DBP and IOP) were recorded at each time point, and the 24-hour data are the mean values of each patient's measurements over the 24-hour period. The differences between the values of the first treatment period and the baseline and the second treatment period and washout were calculated and analyzed by means of an analysis of variance model that tested the effects of sequence and treatment. Both treatments significantly reduced 24-hour IOP (P < 0.0001), but TDFC led to lower 24-hour pressure (mean +/- SD: 15.4 +/- 1.9 vs. 16.7 +/- 1.7 mm Hg; P = 0.004). Latanoprost did not lead to any significant reduction in mean 24-hour SBP and DBP (SBP: P = 0.952; DBP: P = 0.831), but TDFC did (SBP and DBP: P < 0.0001). Both treatments significantly increased 24-hour DOPP (P < 0.0001), with no difference between the two medications (P = 0.09). In previously untreated patients with POAG, TDFC, and latanoprost equally enhanced 24-hour DOPP: the former by counteracting the decrease in DBP with a substantial reduction in IOP and the latter by not affecting DBP and significantly reducing IOP. (isrctn.org number, ISRCTN67123277.).

Meta-analysis of 24-Hour Intraocular Pressure Studies Evaluating the Efficacy of Glaucoma Medicines

To evaluate efficacy and safety data of currently available ocular hypotensive medicines derived from 24-hour studies, of similar design, in patients with primary open-angle glaucoma (POAG), exfoliative glaucoma, or ocular hypertension (OH). Meta-analysis of published articles evaluating patients with POAG, exfoliative glaucoma, or OH. We included articles that were randomized, prospective, single- or double-masked, comparative studies of ocular hypotensive therapies over 24 hours. Each article selected contained an untreated baseline, >or=4-week treatment period, >/=20 patients per treatment arm, and >or=6 time points not spaced >5 hours apart and used Goldmann applanation or Tonopen tonometry (supine measurements) to measure intraocular pressure (IOP). Twenty-four-hour IOP efficacy. This analysis included 864 separate 24-hour treatment curves from 386 patients in 28 treatment arms from 11 studies. A statistical difference in the mean diurnal pressure decrease existed between monotherapy treatments for POAG/OH patients, with bimatoprost (29%) and travoprost (27%) showing the greatest 24-hour reduction (P = 0.026). Timolol 0.5% was less effective than latanoprost (24% vs. 19% reduction) but decreased the pressure at each night time point (P = 0.0003). Dorzolamide showed a 19% 24-hour pressure reduction and brimonidine 0.2% a 14% one. In exfoliative glaucoma patients, latanoprost and travoprost showed higher baseline and treatment pressures, although the pressure reductions (29% and 31%, respectively) were greater generally than observed with POAG/OH. An evening-dosed latanoprost/timolol fixed combination reduced the pressure 33%, and the dorzolamide/timolol fixed combination (DTFC), 26%. However, the power to detect a difference for this specific comparison was probably low, due to the limited number of patients (n = 20) in the DTFC group. A statistical difference between evening-dosed (24%) and morning-dosed (18%) latanoprost (P<0.0001) was noted, but not between evening (27%) and morning (26%) travoprost (P = 0.074). The mean reduction of night time points was statistically lower than day time points for latanoprost (P = 0.031), timolol (P = 0.032), and brimonidine (P = 0.050), but not for dorzolamide. Dorzolamide (P = 0.60), travoprost (P = 0.064), and bimatoprost (P = 0.057) did not demonstrate nighttime pressures lower than daytime ones. The mean reduction of night time points was statistically lower than that of day time points for latanoprost (P = 0.031), timolol (P = 0.032), and brimonidine (P = 0.050), but not for dorzolamide (P = 0.60), bimatoprost (P = 0.057), travoprost (P = 0.064). Similar relative efficacies generally exist in various classes of ocular hypotensive agents during night and day hours.

Acute Effects of a Single Dose of Phosphodiesterase Type 5 Inhibitor (Sildenafil) on Systemic Arterial Blood Pressure During Exercise and 24-Hour Ambulatory Blood Pressure Monitoring in Heart Transplant Recipients

Background Arterial systemic hypertension (SH) can be associated with a decrease in endothelium-dependent nitric oxide (NO). Sildenafil increases cyclic guanosine monophosphate (cGMP), a mediator of NO. However, little is known about the effects of PDE5 inhibition on 24-hour ambulatory pressure (ABP) and exercise blood pressure, noreprinephrine (Nor), and exercise capacity, especially after orthotopic heart transplantation (OHT). Methods We studied 22 OHT patients who on the 1st day underwent a cardiopulmonary (CP) self-controlled treadmill 6′ walk test (6′) and, then, an ECG monitored CP treadmill maximal exercise test (Ex) within 60 and 90 minutes after oral Sildenafil (Sil; 50 mg) or placebo (Pl) given at random, and ABP. We determined at basal position (b), in the last minute of the 6′ and at the peak Ex, the HR (bpm), Systolic blood pressure (SBP), and diastolic blood pressure (DBP), (mm Hg), VO2 (mL/kg/min), Slope VE/VCO2, exercise time (ET, min), distance (D; miles), and Nor (pg/mL). Also, after CP tests, 24-h SBP and DBP, the measurements were repeated on the 2 nd day when the cross-over was done. Results Sil significantly reduced blood pressure in the basal position and during exercise. It also promoted a significant reduction in SBP and DBP during 24 hours, daytime and nighttime. Sil did not change exercise capacity. Conclusion The NO-cGMP pathway seems to play a role in blood pressure control in OHT. In addition to antihypertensive therapy, PDE5 inhibition may have potential beneficial effects on hypertensive OHT.

Endogenous subclinical hyperthyroidism: Metabolic and cardiac parameters

Background Subclinical hyperthyroidism (SH) is defined by suppressed TSH and normal levels of thyroid hormones. Endogenous subclinical hyperthyroidism (ESH) is probably less common than exogenous SH. Adverse effects of SH due to exogenous administration of thyroxine have been well studied, while the impact of ESH on the cardiovascular system and metabolic parameters remains controversial. Methods In a cross-sectional study, we examined patients with endogenous clinical hyperthyroidism (ECH; n = 20), ESH (TSH < 0.1 μU/mL, n = 25), and mild ESH (TSH = 0.1–0.3 μU/mL, n = 32), as well as healthy controls ( n = 50). Biochemical and metabolic parameters influenced by thyroid hormones were assessed and cardiac parameters were studied using echocardiography and 24-hour ECG-blood pressure monitoring. Results Biochemical and metabolic parameters did not differ significantly between ESH and healthy subjects. The ECH group had significantly higher sex hormone-binding globulin, osteocalcin, and carboxy-terminal telopeptide levels than healthy subjects. No significant differences were noted in echocardiographic parameters between ESH patients and healthy subjects. The ECH group had a significantly higher heart rate, cardiac output, and cardiac index than the control group, as well as end-diastolic and end-systolic diameters of the left ventricle, and end-diastolic and end-systolic volumes of the left ventricle. The 24-hour ECG-blood pressure monitoring parameters did not differ significantly either between SH and healthy subjects while, in the ECH group, mean heart rate, maximum heart rate, and mean tachycardia episodes were significantly increased. Conclusion Only subjects with ECH showed differences in metabolic and cardiac parameters from controls, while no significant effects were noted in the endogenous subclinical forms.