Day-night Blood Pressure Difference Research Articles

Cardiac organ damage in patients with Parkinson's disease and reverse dipping.

Patients with autonomic neuropathy associated with Parkinson's disease often show reverse dipping pattern/nocturnal hypertension at 24-h ambulatory blood pressure (BP) monitoring (24-h ABPM) and diurnal orthostatic hypotension. The aim of the study was to evaluate cardiac alterations in Parkinson's disease patients with reverse dipping, in comparison with non-reverse dippers Parkinson's disease and essential hypertensive patients. A total of 26 consecutive Parkinson's disease patients with reverse dipping at 24-h ABPM and no previous history of hypertension were compared with 26 non-reverse Parkinson's disease patients matched for age, sex and 24-h mean BP, and 26 essential hypertensive patients matched for nighttime mean BP. None of the Parkinson's disease patients suffered from cardiovascular diseases or were treated with antihypertensive or antihypotensive drugs. Reverse dipping was defined by a systolic day-night BP difference less than 0% at 24-h ABPM. Left ventricular (LV) hypertrophy was defined by a LV mass index at least 115 g/m in men and at least 95 g/m in women. LV mass, indexed for BSA, was significantly higher in reverse dipping than non-reverse Parkinson's disease patients (respectively 90.2 ± 25.3 vs. 77.4 ± 13.3 g/m, P = 0.04), and was similar to essential hypertensive patients (91.6 ± 24.8, P = 0.92). LV hypertrophy was detected in five reverse dipping Parkinson's disease patients and four hypertensive patients, but was not present in non-reverse Parkinson's disease patients (P = 0.046). Nocturnal BP values, nocturnal BP load, weighted BP variability and age were found to correlate with the increased LV mass index. Reverse dipping and nocturnal hypertension are related to higher LV mass and increased prevalence of LV hypertrophy in Parkinson's disease patients.

The Association between a 24-Hour Blood Pressure Pattern and Circadian Change in Plasma Aldosterone Concentration for Patients with Aldosterone-Producing Adenoma.

The absence of nocturnal blood pressure (BP) decline is associated with hypertensive complications. Data regarding circadian BP patterns in patients with aldosterone-producing adenoma (APA) are limited and equivocal. We evaluated the circadian BP profile in patients with APA and its relationship with the circadian aldosterone rhythm. BP in patients with APA and in those with essential hypertension (EH) were assessed through in-hospital 24-h ambulatory blood pressure monitoring. Over a 24-h in-hospital period, plasma aldosterone levels taken at midnight, 0400, 0800, 1200, 1600, and 2000 h were measured. To evaluate a correlation between BP and hormone rhythm, we included 27 patients with APA (APA group) and 27 patients with EH (EH group). Both groups had similar age, sex ratio, body mass index, duration of hypertension, family history of hypertension, and lipid profiles. The day-night BP differences in both patient groups were similar, whether expressed as absolute values or percentages. The proportions of patients with dipping BP profiles were also comparable (APA group, 5 of 27; EH group, 7 of 27; χ2 = 0.429; P = 0.513). At each time point, APA group plasma aldosterone concentrations (PACs) were higher than those of the EH group. A circadian change in relation to PAC was observed in both groups. A correlation between PAC and BP was statistically nonsignificant in most study patients in either group. Our data indicated that the circadian BP pattern was not associated with a change in PAC levels in patients with APA.

Abstract 129: In Defense of Clinic Blood Pressure

For genetic studies of hypertension, between 1994 and 2006, we established a cohort of 2,639 African Americans (53% female), 51% of whom were hypertensive (H). The purpose of this report is twofold: a) to evaluate the relationship of baseline hypertension status and blood pressure (BP) level with subsequent mortality in this cohort; and b) to compare the relationship of clinic and 24-hour BPs with the subsequent incidence of fatal and non-fatal cardiovascular (CV) events in a subset of the original cohort. Clinic BP was obtained in triplicate in all 2,369 subjects as part of screening procedures for a 3-day inpatient clinical study of a sub-sample (n=266). BP medications were discontinued for 1-week after the screening visit and prior to inpatient study. Detailed phenotyping along with 24-hour BPs were obtained during the 3-day study. Compared to normotensives (N) at baseline, H had higher standardized clinic BP (145 ± 20 [SD] / 94 ± 13 vs 118 ± 10/ 76 ± 8 mm Hg), were slightly older (45 ± 7 vs 42 ± 7 years; p<0.0001), and had higher BMI (29 ± 6 vs 27 ± 5 kg/m 2 ; p<0.0001) in the overall cohort. Mortality data were obtained from the National Death Index. Average time from baseline to mortality was 12 ± 3 years. All-cause mortality was related to clinic systolic BP (p<0.03) and was greater in H than N (176 vs 70 deaths; p< 0.0002) after adjustment for age, sex, BMI, and duration of follow-up. CV mortality was also greater in H than N (52 vs 19 deaths; p<0.01). During a follow-up of 14 ± 4 years of the in-patient cohort, 49 subjects had a fatal (n=11) or non-fatal (n=38) CV event. After adjustment for covariates, clinic systolic and diastolic BPs were strongly associated with CV events (p<0.0001). The association of clinic BPs with CV events was as robust as the associations with overall 24-hour BP, day BP, and night BP. Average difference between day and night BP was 7 ± 8/5 ± 6 mm Hg (p< 0.0001), but day-night BP difference was not associated with CV events (p=0.45). In conclusion, in middle-aged African Americans, 24-hour BPs were no more predictive of CV events than BPs measured during a single outpatient visit. In addition, both all-cause mortality and CV mortality were related to the clinic BP. These results will require confirmation with larger sample sizes.

OP.1A.04] 24H AMBULATORY BLOOD PRESSURE MONITORING PROFILE IN PARKINSON'S DISEASE WITH AUTONOMIC NEUROPATHY

Objective: Patients with Autonomic Neuropathy (AN) are characterized by orthostatic hypotension (OH), supine hypertension, high blood pressure (BP) variability and reverse dipping pattern on 24 h Ambulatory Blood Pressure Monitoring (24 h ABPM). AN is a common finding in Parkinson's disease (PD), and it is related to a higher motor impairment due to neurogenic OH. Aim of the study was the evaluation of the prevalence of AN and the assessment of the related 24 h ABPM profile in PD patients without known cardiovascular comorbidities. Design and method: 79 patients with PD and without known cardiovascular diseases were studied (mean age 63.2 ± 10.3 years; 67% males). None of the patients suffered from hypertension, diabetes, dyslipidemia, chronic kidney disease, and sleep apnea, and they were not treated with antihypertensive or antihypotensive drugs. Patients underwent cardiovascular autonomic reflex tests (deep breathing, lying to standing, Valsalva maneuver, and postural BP), and AN was defined by the presence of at least two pathological tests. On the same day, they underwent 24 h ABPM. 24 h ABPM dipping patterns were defined according to day-night BP difference (<0%: reverse dipping; 0–10%: non dipping; >10%: dipping). Nocturnal hypertension was defined as night-time systolic and diastolic BP > = 120/70 mmHg. Results: Results. Prevalence of AN was 29%. PD patients with AN were older (68.8 ± 10.1 vs 63.2 ± 10.3 years, p = 0.003) and had a higher prevalence of OH (78% vs 25%, p < 0.001). 24-h mean BP values were similar in patients with and without AN, while night-time BP values were higher (125 ± 17/73 ± 13 vs 111 ± 13/64 ± 11 mmHg, p < 0.05) and prevalence of nocturnal hypertension was higher (65% vs 36%, p = 0.016) in AN. Prevalence of reverse dipping pattern was much higher in patients with AN (74% vs 13%, p < 0.001) and they were characterized by a higher BP variability (SD of night-time SBP: 11.0 ± 4.1 vs 9.0 ± 2.9 mmHg, p = 0.048). Conclusions: PD patients with AN and without known cardiovascular diseases have a high prevalence of reverse dipping pattern and nocturnal hypertension. 24 h ABPM may represent a useful diagnostic tool in the diagnostic management of AN in PD patients.

The effect of fixed-dose combination of valsartan and amlodipine on nighttime blood pressure in patients with non-dipper hypertension.

Failure to decrease blood pressure (BP) during the night is associated with higher cardiovascular (CV) morbidity and mortality. There is strong evidence that fixed-dose combinations (FDCs) of antihypertensive agents are associated with significant improvement and non-significant adverse effects. The aim of the present study was to evaluate whether FDC affected nocturnal BP favorably in patients with uncontrolled, non-dipper hypertension (HT). All non-dipper hypertensives were either newly diagnosed with stage 2-3 HT or had HT uncontrolled with monotherapy. Patients (n=195) were consecutively assigned to 4 treatment groups: FDC of valsartan/amlodipine (160/5 mg), free-drug combination of valsartan 160 mg and amlodipine 5 mg, amlodipine 10 mg, and valsartan 320 mg. Ambulatory blood pressure monitoring (ABPM) was repeated at 4th and 8th week. Average 24-h (24-hour) and nocturnal BP were similar among the groups at baseline evaluation, and had significantly decreased by the fourth week of treatment. However, BP continued to decrease only slightly between the 4th and 8th weeks in the valsartan and amlodipine monotherapy groups, but continued to decrease significantly in both combination groups. After 4 weeks, day-night BP difference and day-night BP % change were significantly elevated in the combination and valsartan groups. Between the 4th and 8th weeks, however, day-night BP difference and day-night BP % change continued to rise only in the FDC group, nearly reducing to baseline levels in the free-drug combination and valsartan groups. An additional 2.2 mmHg decrease was observed in the FDC group, compared to the free-drug combination group. In non-dipper HT, FDC of valsartan and amlodipine improved diurnal-nocturnal ratio of BP and provided 24-h coverage.

Clinical Significance of the Blood Pressure Changes from Day to Night

Blood pressure (BP) decreases by 10% to 20% from day to night. However, in 25% to 35% of hypertensive subjects there is some reduction in the day-night BP decline. In 3% to 5% of uncomplicated hypertensive subjects there is actually an increase, not a decrease, in BP from day to night. Many studies from independent centers showed that not only left ventricular hypertrophy, but also ventricular arrhythmias, silent cerebrovascular disease, microalbuminuria and progression of renal damage are more advanced in subjects with blunted or abolished fall in BP from day to night than in those with normal day-night BP difference. There is also evidence from longitudinal studies that a blunted, abolished or even reversed BP drop from day to night is associated with an increase in the risk of serious cardiovascular complications. However, if the quantity or quality of sleep is poor during overnight BP monitoring, night-time BP rises and its prognostic significance is no longer reliable. Studies which compared the prognostic value of daytime BP with that of night-time BP inevitably found the superiority of the latter for predicting prognosis. The exciting potential therapeutic implication that the control of night-time BP could be more rewarding, in terms of prevention of cardiovascular disease, than that of daytime BP has yet to be addressed in appropriately designed intervention trials. Of note, 24-hour ABP monitoring is the only practical way to assess the day-night rhythm of BP. Keywords: Hypertension, ambulatory blood pressure, circadian blood pressure rhythm, myocardial infarction, stroke, epidemiology, PIUMA, nondippers, brain arteriosclerosis

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

Limited information is available on whether and to what extent the different patterns of the nocturnal blood pressure profile reported in hypertension are characterized by differences in sympathetic drive that may relate to, and account for, the different day-night blood pressure changes. In 34 untreated middle-aged essential hypertensive dippers, 17 extreme dippers, 18 nondippers, and 10 reverse dippers, we assessed muscle sympathetic nerve traffic, heart rate, and beat-to-beat arterial blood pressure at rest and during baroreceptor deactivation and stimulation. Measurements were also performed in 17 age-matched dipper normotensives. All patients displayed reproducible blood pressure patterns at 2 different monitoring sessions. The 4 hypertensive groups did not differ by gender or 24-hour or daytime blood pressure. Muscle sympathetic nerve traffic was significantly higher in nondipper, dipper, and extreme dipper hypertensives than in normotensive controls (58.6+/-1.8, 55.6+/-0.9, and 53.3+/-0.8 versus 43.5+/-1.4 bursts/100 heartbeats, respectively; P<0.01 for all), a further significant increase being detected in reverse dippers (76.8+/-3.1 bursts/100 heartbeats; P<0.05). Compared with normotensives, baroreflex-heart rate control was similarly impaired in all the 4 hypertensive states, whereas baroreflex-sympathetic control was preserved. The day-night blood pressure difference correlated inversely with sympathetic nerve traffic (r=-0.76; P<0.0001) and homeostasis model assessment index (r=-0.32; P<0.005). Thus, the reverse dipping state is characterized by a sympathetic activation greater for magnitude than that seen in the other conditions displaying abnormalities in nighttime blood pressure pattern. The present data suggest that in hypertension, sympathetic activation represents a mechanism potentially responsible for the day-night blood pressure difference.

Association of clinic and ambulatory blood pressure with vascular damage in the elderly: the EPICARDIAN study

In middle-aged adults, vascular damage correlates better with ambulatory than with clinic blood pressure. This study aimed to determine whether vascular damage evaluated by carotid ultrasonography in the elderly is also more closely related to ambulatory than to clinic blood pressure, and which blood pressure variables are better associated with vascular damage. Cross-sectional study of 292 randomly selected >65 years old participants who underwent 24-h noninvasive ambulatory blood pressure monitoring. Blood pressure variables analyzed were (a) clinic blood pressure: systolic and diastolic blood pressure, pulse pressure; (b) ambulatory blood pressure monitoring: mean values of systolic and diastolic blood pressure, systolic and diastolic blood pressure load, pulse pressure, as well as variability, evaluated within 24 h, diurnal and nocturnal periods; and day-night blood pressure difference. A clinical history, physical examination, carotid ultrasonography and laboratory tests were performed. To estimate the relationship between blood pressure and vascular damage, univariate and multivariate analyses were performed. Mean age: 73+/-6 years, 45% men, 76.7% hypertensive patients. In the simple regression analysis, the best significant correlations (P<0.05) were common carotid intima-media thickness with 24-h and nocturnal pulse pressure (r=0.32), and common carotid diameter with 24-h systolic blood pressure load (r=0.47). In the multivariate analysis, the significant associations (P<0.05) were (a) linear regression: nocturnal pulse pressure with common carotid intima-media thickness, and diurnal pulse pressure as well as 24-h systolic blood pressure load with common carotid diameter; (b) logistic regression, adjusted odds ratio: nocturnal pulse pressure and nocturnal diastolic blood pressure load with the presence of carotid atherosclerotic plaques 1.03 and 0.98, respectively. In the elderly, ambulatory blood pressure monitoring is better associated with carotid damage than clinic blood pressure. Systolic blood pressure variables are the best associated, blood pressure load and pulse pressure being better associated with carotid damage than the mean levels of ambulatory blood pressure.

Circadian Blood Pressure and Heart Rate Changes in Patients in a Persistent Vegetative State After Traumatic Brain Injury

Alteration of autonomic nervous system regulation is known to be present in the persistent vegetative state after traumatic brain injury, termed the dysautonomic syndrome. This study assessed the circadian blood pressure and heart rate pattern and variability in the persistent vegetative state through noninvasive 24-hour ambulatory blood pressure monitoring. The study was performed in 20 subjects: 10 patients (six men and four women; mean age, 29.5+/-9.9 years; range, 19-39 years) in a vegetative state (mean, 27.3+/-5.6 days after trauma) and 10 healthy subjects as controls (six men and four women; mean age, 28+/-5.7 years; range, 29-37 years). The patients showed a blood pressure nondipper pattern; 24-hour, daytime, and nighttime values of blood pressure and heart rate were significantly higher in patients than in controls. The day-night difference in heart rate and blood pressure was also significantly lower in patients. Finally, SD and variation coefficients were significantly lower in patients. The results show changes in the variability and circadian blood pressure and heart rate patterns in persistent vegetative state patients with dysautonomic syndrome, as an expression of the sympathetic-parasympathetic activity imbalance in the control of vasomotor tone.

Twenty-four-hour non-invasive monitoring of systemic haemodynamics and cerebral blood flow velocity in healthy humans.

Acute short-term changes in blood pressure (BP) and cardiac output (CO) affect cerebral blood flow (CBF) in healthy subjects. As yet, however, we do not know how spontaneous fluctuations in BP and CO influence cerebral circulation throughout 24 h. We performed simultaneous monitoring of BP, systemic haemodynamic parameters and blood flow velocity in the middle cerebral artery (MCAV) in seven healthy subjects during a 24-h period. Finger BP was recorded continuously during 24 h by Portapres and bilateral MCAV was measured by transcranial Doppler (TCD) during the first 15 min of every hour. The subjects remained supine during TCD recordings and during the night, otherwise they were seated upright in bed. Stroke volume (SV), CO and total peripheral resistance (TPR) were determined by Modelflow analysis. The 15 min mean value of each parameter was assumed to represent the mean of the corresponding hour. There were no significant differences between right vs. left, nor between mean daytime vs. night time MCAV. Intrasubject comparison of the twenty-four 15-min MCAV recordings showed marked variations (P < 0.001). Within each single 15-min recording period, however, MCAV was stable whereas BP showed significant short-term variations (P < 0.01). A day-night difference in BP was only observed when daytime BP was evaluated from recordings in the seated position (P < 0.02), not in supine recordings. Throughout 24 h, MCAV was associated with SV and CO (P < 0.001), to a lesser extent with mean arterial pressure (MAP; P < 0.005), not with heart rate (HR) or TPR. These results indicate that in healthy subjects MCAV remains stable when measured under constant supine conditions but shows significant variations throughout 24 h because of activity. Moreover, changes in SV and CO, and to a lesser extent BP variations, affect MCAV throughout 24 h.

The Influence of Increasing Dialysis Treatment Time and Reducing Dry Weight on Blood Pressure Control in Hemodialysis Patients: A Prospective Study

A good blood pressure control can be achieved with long hemodialysis sessions (dialysis center of Tassin, France). However, it is not well known whether a higher dialysis dose or a lower dry weight is responsible for this phenomenon. In a preliminary study, 21 hypertensive dialysis patients, dialyzed three times a week for 3–5 h, were randomized into three groups during a 3-month study period. In 6 patients, the dialysis treatment time was increased by 2 h, and the dry weight was gradually decreased (group 1). In 7 patients the dialysis treatment time was increased by 2 h without a change in dry weight (group 2). In 8 patients the dry weight was gradually lowered without changing the dialysis treatment time (group 3). Before and after the study, cardiac index and left ventricular mass index (echocardiography) and forearm vascular resistance (strain gauge plethysmography) were determined on a middialytic day. The blood pressure was assessed by 48-hour ambulatory monitoring. The antihypertensive medication was reduced when the postdialytic blood pressure became <130/80 mm Hg. The dry weight was reduced by 2.6 ± 1.4 kg in group 1 and by 2.3 ± 0.8 kg in group 3 (p < 0.05). The number of classes of antihypertensive medication was reduced from 3.3 to 1.8 in group 1 (NS), from 2.4 to 1.7 in group 2 (NS), and from 3.1 to 1.3 in group 3 (p < 0.05). The dose of the remaining antihypertensive drugs was reduced by 50% in group 1 (p < 0.05), by 32% in group 2 (NS), and by 72.2% in group 3 (p < 0.05). The interdialytic systolic blood pressure decreased significantly after increasing the dialysis time without changing the dry weight (group 2: 7 ± 5 mm Hg; p < 0.05). The systolic blood pressure was also lower in the other patients groups: group 1: 13 ± 26 mm Hg, group 3 : 7 ± 16 mm Hg (NS). The pulse pressure decreased significantly in group 2 (7 ± 5 mm Hg; p < 0.05) and in group 3 (6 ± 7 mm Hg; p < 0.05) and tended to decrease in group 1 (11 ± 12 mm Hg; p = 0.08). The diastolic blood pressure and the day-night blood pressure difference did not change significantly, nor did cardiac index and left ventricular mass index. The forearm vascular resistance tended to decrease in the patients on long dialysis sessions. This preliminary study suggests that the dialysis treatment time might have an independent beneficial effect on blood pressure control.

Effects of stress and behavioral interventions in hypertension--the effects of smoking and nicotine replacement therapy on blood pressure.

Effects of stress and behavioral interventions in hypertension--the effects of smoking and nicotine replacement therapy on blood pressure.

Dipping is superior to cusums analysis in assessment of the risk of stroke in a case-control study

Background: Blunted nocturnal decline in blood pressure (BP) is associated with increased risk of stroke. Mean day-night BP difference (dipping) and cusums-derived circadian alteration magnitude (CDCAM) of BP are the common measures of diurnal BP variation. Although a significant number of clinical trials have demonstrated that dipping is associated with a lower risk of cardiovascular events, the clinical value of CDCAM of BP is unknown. We evaluated the association between dipping and CDCAM of BP and the risk of stroke. Methods: We analyzed 24-h ambulatory BP recordings of 110 control subjects and 91 stroke survivors enrolled in a case-control stroke study. Nondipping was defined as nocturnal drop of < 10 mm Hg in systolic BP. The associations between nondipping, CDCAM of BP, and risk of stroke were calculated in the same sample. Results: There were significantly fewer nondippers in the control group as compared with those among the stroke survivors. The odds ratio for stroke of nondippers was 2.3. By contrast, there was no significant difference in CDCAM of systolic BP between the control and stroke survivor groups. This finding could not be explained by the presence of reverse dippers in both groups. Conclusions: In this case-control study, classification of subjects into dippers and nondippers was found to be more clinically useful than cusums analysis of BP profile. Analysis of prospective data is needed to determine the clinical value of the cusums analysis of BP profile.

Reproducibility of heart rate measured in the clinic and with 24-hour intermittent recorders

This study was undertaken to assess the reproducibility of office versus ambulatory heart rates in 839 hypertensive subjects participating in the Hypertension and Ambulatory Recording Venetia Study (HARVEST). A 24-hour heart rate was recorded twice; this procedure was repeated three months later. Reproducibility was better for ambulatory than for office measurement, and was greater for 24-hour than for daytime heart rate, and lowest for night-time heart rate. Reproducibility of office heart rate was impaired above 85 bpm, and was poorer in subjects with more severe office hypertension. A small but significant decrease in average daytime (−1 bpm, P < 0.0001) and virtually no change in night-time heart rate (−0.3 bpm, NS) were observed at repeat recording. Heart rate reproducibility indices were related to the extent of the heart rate and blood pressure white-coat effect, but did not vary according to age, gender, body mass index, day-night blood pressure difference, or alcohol or tobacco use. Results indicate that heart rate recorded over the 24 hours has a better reproducibility than office heart rate, and could thus be a better prognostic indicator than traditional measurement of resting heart rate in the hospital setting.

Blood pressure rhythm and prevalence of vascular events in hypertensive subjects.

To evaluate the influence of age on the day-night blood pressure rhythm and on the prevalence of vascular events in those whose systolic blood pressure (SBP) fell by <10% overnight (non-dippers). Cross-sectional observational cohort study. Outpatient hypertension clinic. 419 Hypertensive patients (214 male, 205 female). All subjects were submitted to ambulatory blood pressure monitoring (Spacelabs 90207). The nocturnal fall of SBP was calculated from (day SBP--night SBP)/day SBP, where 'day' values were recorded between 0600 h and 2200 h and 'night' values between 2200 h and 0600 h. Dippers and non-dippers were divided in two subgroups according to age (under or over 65 years). Information on gender, smoking, diabetes mellitus and body mass index was collected and cerebrovascular and cardiovascular events, evaluated by history and medical records, were registered. The day-night difference in blood pressure significantly decreased with age and the prevalence of non-dippers was greater in elderly than in younger subjects (65.1% vs. 29.8%). No difference was found between groups for cerebrovascular events, irrespective of age. A relationship between non-dipping pattern and cardiovascular events was found only in younger hypertensive non-dippers (odds ratio, 2.0; 95% confidence interval, 1.20-3.21); in elderly people the prevalence of cardiovascular events was similar in dippers and non-dippers. Cardiovascular risk is not increased in elderly non-dipper hypertensive subjects. This contrasts with results in younger populations.

Effects of alcohol restriction on 24-hour ambulatory blood pressure in japanese men with hypertension

Purpose: Restriction of alcohol intake is widely recommended in the treatment of hypertension. However, we have observed that alcohol may have biphasic effects on blood pressure in Japanese men with hypertension. Methods: Hypertensive men (n = 34) who habitually drank alcohol were randomly assigned to keep their drinking habits constant for 4 weeks, or to abstain (or reduce alcohol intake to a maximum of 15 mL/day) for 4 weeks in a crossover design. Amount of alcohol intake was recorded by each patient throughout the study. Office and 24-hour ambulatory blood pressure were measured at the end of both periods. Results: After alcohol restriction, mean (± SD) ethanol intake decreased from 66 ± 26 mL/day to 11 ± 10 mL/day. Office systolic blood pressure decreased slightly from 142 ± 12 mm Hg to 139 ± 11 mm Hg, and diastolic blood pressure decreased significantly from 95 ± 7 mm Hg to 93 ± 7 mm Hg in the low-alcohol period. Daytime systolic blood pressure fell by 3 ± 9 mm Hg ( P <0.05), but nighttime systolic blood pressure rose by 4 ± 9 mm Hg ( P <0.05) with restriction of alcohol intake. Thus, average 24-hour blood pressure did not change, although 24-hour heart rate and day-night difference in blood pressure decreased significantly in the low-alcohol period. Conclusion: In Asian men with hypertension, restriction of alcohol intake reduces daytime blood pressure but not nighttime or 24-hour blood pressure.

Sympathetic Activity and Blood Pressure Pattern in Autosomal Dominant Polycystic Kidney Disease Hypertensives

To study the potential role of sympathetic activity in the pathogenesis of arterial hypertension associated with autosomal dominant polycystic kidney disease (ADPKD) and to analyze its relationship with 24-hour blood pressure pattern, plasma catecholamines and 24-hour ambulatory blood pressure monitoring were evaluated in 30 ADPKD hypertensive patients (of which 17 without and 13 with renal failure) and in 50 essential hypertensives. The groups were matched for sex, body mass index, known duration of hypertension, and clinic blood pressure. Plasma catecholamines, determined in resting position, were higher in ADPKD patients without renal failure than in essential hypertensives. Nighttime diastolic blood pressure was higher and the percentage day-night difference in mean blood pressure was lower in hypertensives with ADPKD compared to patients with essential hypertension. Blood pressure was significantly correlated with plasma noradrenaline in ADPKD patients, independently of renal function. No significant differences were observed between ADPKD patients with and without renal failure, with respect to plasma catecholamines, 24-hour daytime and nighttime ambulatory blood pressures and the percentage day-night difference in mean blood pressure.

Nocturnal Fall in Blood Pressure in the Elderly is Related to Presence of Hypertension and not Age

Morfis L, Howes LG. Nocturnal fall in blood pressure in the elderly is related to presence of hypertension and nor age.Aims: To determine whether the reduced nocturnal fall in blood pressure (BP) reported in elderly hypertensives is due to ageing or to the presence of hypertension. Methods: Twenty-four hour ambulatory BP recordings of 68 normotensive elderly were compared with those of 55 elderly treated hypertensives, aged 63–88 years. Mean night-time BPs were calculated from the average of readings during sleep and mean daytime BPs from the remaining recordings. The maximum day-night BP differences were calculated. Plasma renin, aldosterone and noradrenaline were measured. Results: Normotensive subjects were aged 72.0 ± 4.7 years and treated hypertensives 73.7 ± 4.9 years (p = 0.049). Normotensives had lower systolic BP (SBP) than hypertensives (125 ± 12mmHg versus 135 t 14 mmHg, p < 0.01). The fall in SBP at night was greater in normotensives than in hypertensives (18 ± 9 versus 14 ± 9 mmHg, p < 0.02). Non-dipping occurred in 24% of all subjects, with 59% of these being hypertensives. The nocturnal fall in SBP was not related to age (β = -0.04, p < 0.62) but was inversely related to a history of hypertension (X2 = 5.82, p = 0.02). Serum noradrenaline was significantly related to nocturnal SBP fall (0 = 0.28, p = 0.01). Conclusions: Elderly normotensives have a greater decline in nocturnal SBP than treated elderly hypertensives. The failure of SBP to fall at night appears to be more a feature of hypertension than of ageing. Early morning noradrenaline estimations are higher in patients with a greater nocturnal blood pressure fall.

Predictors of diurnal blood pressure changes in 2042 subjects with essential hypertension

To determine the independent predictors of day-night blood pressure changes in a large population of subjects with essential hypertension. We studied 2042 white untreated subjects with essential hypertension (mean age 52 years, range 17-93, 1052 men) who underwent 24 h ambulatory blood pressure monitoring on an outpatient basis. Night-time workers were excluded from analysis. For both sexes, the changes in systolic and diastolic blood pressures from day to night decreased progressively with age and increased with the reported duration of sleep. The 1207 employed subjects who underwent ambulatory blood pressure monitoring during a usual working day had greater day-night blood pressure differences than did those who did not work (16.2 versus 14.0%). By using multiple regression analysis we assessed the independent association of several variables with the diurnal blood pressure changes. Age and diabetes for both sexes, and clinic blood pressure in men, were inversely associated with the nocturnal fall in blood pressure. The duration of sleep and the occurrence of blood pressure monitoring during a normal work day predicted a greater day-night blood pressure difference for both sexes; smoking predicted a greater nocturnal fall in blood pressure for women. Age is associated with an important and progressive attenuation of the day-night blood pressure difference in untreated and unrestricted subjects with essential hypertension. Other factors influencing diurnal blood pressure variations include clinic blood pressure, diabetes, the reported duration of sleep, smoking habits and working activity during blood pressure monitoring. These factors should be treated as potential confounders in the analysis of the relationship between diurnal blood pressure changes and target organ damage or prognosis.

Day-night difference in blood pressure is augmented in renovascular hypertension

Day-night difference in blood pressure is augmented in renovascular hypertension