Blood Pressure Decline In Patients Research Articles

Association of Metabolic Syndrome and Blood Pressure Nondipping Profile in Untreated Hypertension

There is a marked association between metabolic syndrome (MS) and increased cardiovascular risk. Moreover, nondipping (patients with <10% decline in the asleep relative to the awake blood pressure (BP) mean) has also been associated with increased cardiovascular morbidity and mortality. We investigated the association between MS and impaired nocturnal BP decline in 1,770 nondiabetic, untreated hypertensive patients (824 men and 946 women), 48.7 +/- 13.2 years of age. BP was measured by ambulatory monitoring for 48 h to increase reproducibility of the dipping pattern. Physical activity was simultaneously monitored every minute by wrist actigraphy. MS was present in 42.4% of the patients. The prevalence of a nondipper BP profile was significantly higher in patients with MS (46.1% vs. 37.5% in patients without MS, P < 0.001). Patients with MS were characterized by significant elevations in uric acid (5.9 mg/dl vs. 5.2 mg/dl, P < 0.001), fibrinogen (314 mg/dl vs. 304 mg/dl, P = 0.021), and globular sedimentation rate (13.8 mm vs. 11.6 mm, P < 0.001). Nondipping was significantly associated to the presence of MS in a multiple logistic regression model adjusted by other significant confounding factors, including age, serum creatinine, and cigarette smoking. The single most relevant factor in the definition of MS associated to nondipping was elevated waist perimeter. This study documents a significant increase of a blunted nocturnal BP decline in patients with MS. Patients with MS were also characterized by elevated values of relevant markers of cardiovascular risk, including fibrinogen and globular sedimentation rate.

Diurnal blood pressure pattern in patients with primary aldosteronism

The aim of the study was to evaluate diurnal blood pressure (BP) profiles in patients with primary aldosteronism and to compare them to those in subjects with essential hypertension. The effects of specific therapy on the circadian BP profiles have been studied. Sixty-four patients with primary aldosteronism were included in the study. Thirty of them revealed an aldosterone-producing adenoma (APA) and 34 had idiopathic hyperaldosteronism (IHA) due to bilateral adrenal hyperplasia. We did not find any significant differences in ambulatory BP monitoring (ABPM) between patients with APA and IHA. However, the circadian BP variation in the patients with primary hyperaldosteronism due to APA was preserved, while the patients with IHA showed lower nocturnal decline in comparison with patients with essential hypertension. There was a significant decline in office and ambulatory BP levels after treatment in the patients with both APA and IHA. The awake-sleep BP difference in patients with APA remained unchanged after surgical treatment, while in patients with IHA the night-time systolic and diastolic BP decline was significantly higher after spironolactone treatment. Primary hyperaldosteronism due to APA was associated with normal circadian BP variability and the surgical treatment led to highly significant decline in all BP parameters but had no influence on the extent of nocturnal BP variation. Spironolactone therapy restored normal nocturnal BP decline in patients with IHA. Reduction of night-time BP decline in patients with IHA is more likely to be related to the duration of the disease rather than to the aldosterone levels.

Increased prevalence of blunted nocturnal ambulatory blood pressure decline in patients with metabolic syndrome

Increased prevalence of blunted nocturnal ambulatory blood pressure decline in patients with metabolic syndrome