Ambulatory Blood Pressure In Hypertensive Patients Research Articles

Effects of daily walking on office, home and 24-h blood pressure in hypertensive patients

Aerobic exercise has been recommended in the management of hypertension. However, few studies have examined the effect of walking on ambulatory blood pressure (BP), and no studies have employed home BP monitoring. We investigated the effects of daily walking on office, home, and 24-h ambulatory BP in hypertensive patients. Sixty-five treated or untreated patients with essential hypertension (39 women and 26 men, 60 ± 9 years) were examined in a randomized cross-over design. The patients were asked to take a daily walk of 30–60 min to achieve 10 000 steps/d for 4 weeks, and to maintain usual activities for another 4 weeks. The number of steps taken and home BP were recorded everyday. Measurement of office and ambulatory BP, and sampling of blood and urine were performed at the end of each period. The average number of steps were 5349 ± 2267/d and 10 049 ± 3403/d in the control and walking period, respectively. Body weight and urinary sodium excretion did not change. Office, home, and 24-h BP in the walking period were lower compared to the control period by 2.6 ± 9.4/1.3 ± 4.9 mmHg (p < 0.05), 1.6 ± 6.8/1.5 ± 3.7 mmHg (p < 0.01), and 2.4 ± 7.6/1.8 ± 5.3 mmHg (p < 0.01), respectively. Average 24-h heart rate and serum triglyceride also decreased significantly. The changes in 24-h BP with walking significantly correlated with the average 24-h BP in the control period. In conclusion, daily walking lowered office, home, and 24-h BP, and improved 24-h heart rate and lipid metabolism in hypertensive patients. However, the small changes in BP may limit the value of walking as a non-pharmacologic therapy for hypertension.

Effect of bezafibrate on office, home and ambulatory blood pressure in hypertensive patients with dyslipidemia

It has been suggested that fibrates, lipid-lowering agents with a peroxisome proliferator-activated receptor-α agonistic property, lower blood pressure (BP) in some experimental models of hypertension. However, the effect of fibrates on BP in humans has been inconsistent, and there are few studies using home or ambulatory BP monitoring. We investigated the effects of bezafibrate on office, home and ambulatory BP in hypertensive patients with dyslipidemia. Thirty-two essential hypertensive patients with dyslipidemia (6 men and 26 women, mean age 65±8 years old) were assigned to a control period and a bezafibrate period (200 mg twice daily) for 8 weeks each in a randomized crossover manner. Bezafibrate significantly reduced serum triglyceride, total and low-density lipoprotein-cholesterol, blood glucose, plasma insulin, the homeostasis model assessment ratio and increased high-density lipoprotein-cholesterol. Compared with the control period, changes in office, home and 24-h BP with bezafibrate were -0.7±2.1/-1.6±1.2 mm Hg, +0.9±1.0/-0.5±0.6 and +0.8±1.4/-0.6±0.9 mm Hg, respectively. None of these differences in BP was significant. In conclusion, bezafibrate improved lipid metabolism and insulin sensitivity but did not affect office, home or ambulatory BP in hypertensive patients with dyslipidemia. Fibrates do not appear to lower BP in patients with essential hypertension.

Effects of isometric handgrip training on blood pressure (resting and 24 h ambulatory) and heart rate variability in medicated hypertensive patients

Isometric handgrip (IHG) training (four, 2-min sustained contractions at 30% of maximal voluntary contraction, three times per week for 8-10 weeks) lowers resting arterial blood pressure (BP) in hypertensive patients, including those receiving pharmacotherapy, although the mechanisms remain elusive. Ambulatory BP measurements are more efficacious in predicting cardiovascular disease-related events, yet the effects of IHG training on ambulatory BP are unknown. The objective of the current investigation was to test the hypotheses that 8 weeks of IHG training lowers resting and 24 h ambulatory BP concomitantly in medicated hypertensive patients, and may be the result of improved vagal modulation. BP was assessed using brachial artery oscillometry, and coarse-graining spectral analysis was used to determine spectral power. Resting and 24 h ambulatory BP and heart rate variability (HRV) were measured pretraining, midtraining, and post-training in 11 medicated hypertensive patients (mean ± SD, resting BP: 113.9 ± 12.7/60.7 ± 11.6 mmHg), and in nine medicated hypertensive controls (resting BP: 117.8 ± 14.3/67.5 ± 4.2 mmHg). Indices of BP and HRV were not significantly altered with IHG training (all P > 0.05). IHG training does not lower resting or ambulatory BP in hypertensive patients successfully treated with pharmacotherapy to within the normal range (≤ 120/80 mmHg), nor does it improve HRV. Future studies should examine alternative IHG training protocols in well-managed hypertensive patients and/or target poorly controlled medicated hypertensive patients.