Assessment of mean platelet volume and soluble CD40 ligand levels in patients with non-dipper hypertension,dippers and normotensives

Abstract

Objective: Patients with a lack of nocturnal decline in blood pressure (BP) are at an increased risk for cardiovascular events. Mean platelet volume (MPV) and soluble CD40 ligand (sCD40L) are accepted biomarkers of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV and sCD40L levels are higher in non-dipper hypertensive (NDHT) patients than in dipper hypertensive (DHT) patients and healthy controls.

Methods: 124 consecutive patients were included to this study. Patients were divided into three groups: NDHT patient group [n?=?43; mean age 51.8?±?6.6; 31?males (72.1%)]; DHT patient group [n?=?41; mean age 50.2?±?7.3; 22?males (53.7%)]; and normotensive group [n?=?40; mean age 49.9?±?6.7; 22?males (55%)]. Physical examination, laboratory work-up and 24-h ABPM were performed for all participants.

Results: The sCD40L and MPV levels were significantly higher in the NDHT group than in the DHT and normotensive groups (p?<?0.05). In correlation analysis, MPV, 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), night-time SBP and night-time DBP were positively correlated with sCD40L.

Conclusion: Our study demonstrated that MPV and sCD40L levels were significantly higher in NDHT patients compared to DHT and normotensive patients. sCD40L levels were positively correlated with MPV, 24-h SBP, 24-h DBP, night-time SBP and night-time DBP.     

Red cell distribution width and hypertensive response to exercise in patients with type 2 diabetes mellitus

Objective: There is no study about hypertensive response to exercise (HRE), which is a marker of unborn hypertension (HT), and red cell distribution width (RDW) association, in diabetic normotensive patients. So, we aimed to investigate any correlation among RDW and HRE in normotensive type 2 diabetic patients. Methods: Consecutive type 2 diabetic patients without history of HT and with normal blood pressure (BP) on ambulatory BP monitoring were included to the study. We divided the patients into two groups depending on their peak systolic BP on exercise; HRE (Group 1) or normal response to exercise (Group 2). Results: Data of 75 diabetic patients (51.9?±?9.7) were analyzed (31 male (48%)). Their mean RDW was 13.11?±?0.46. Patients with HRE were significantly older than patients without HRE. Smoking was more frequent in Group 2. Gender distribution and body mass index were similar between the groups. Else hemoglobin, hematocrit, red blood cell count and RDW values were not significantly different. Office systolic BP and diastolic BP, daytime and 24-h systolic BP were significantly higher in Group 1 but heart rate was similar between the groups. Conclusions: This study revealed that RDW do not differ between diabetic normotensive patients with HRE or not.     

Evaluation of aortic elastic properties in patients with exaggerated systolic blood pressure response to exercise testing

Abstract

We aimed to evaluate the aortic elastic properties in subjects with hypertensive response to exercise stress test (HRE). Sixty-six patients were divided into two groups (33 patients in HRE group and 33 patients in normotensive group). Baseline demographic characteristics were similar. The mean aortic stiffness index (ASI) was significantly higher (p?=?0.001) whereas aortic distensibility (AD) was significantly lower (p?=?0.029) in patients suggesting HRE. The C-reactive protein levels of patients with HRE was higher in the HRE group (p?=?0.03). AD was significantly correlated with age (r?=??0.406, p?<?0.001), pre-test systolic blood presure (SBP) (r?=??0.427, p?<?0.001), peak exercise SBP (r?=??0.307, p?=?0.01), peak exercise diastolic blood presure (DBP) (r?=??0.315, p?=?0.008), and recovery time (3?min) SBP (r?=??0.497, p?=?0.004). Age (β?=??0.506, p?=?0.003) and peak DBP (β?=??0.322, p?=?0.049) were independent predictors of decreased AD. In conclusion, we found a deterioration in arterial elastic properties in patients with HRE.     

Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes

BACKGROUND: Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulatory blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means of ABPM in elderly patients experiencing falls or syncopes. METHODS: Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.4 +/- 8.1 years). Among them, 45 had been admitted for falls and 75 for syncope; 36 with no history of falls or syncope served as controls. Postprandial change in systolic blood pressure (deltaSBP) was calculated by subtracting the mean SBP within the 2 hours following the meal from the mean SBP within the 2 hours preceding the meal. PPH was defined by a deltaSBP > or = 20 mm Hg. RESULTS: For the entire group, mean SBP decreased after the three meals. On average, the decline in SBP was greater after breakfast than after lunch or dinner, and the number of patients experiencing PPH was greater after breakfast. Average maximal deltaSBP was significantly larger in the syncope group than in the other groups ( p < .05). Moreover, the number of patients experiencing PPH was significantly higher in the syncope/fall group than in the control group (23% vs 9%; p = .03). Compared with patients without PPH, patients with PPH were more likely to have a history of diabetes mellitus (p < .01) or to use more than three different drugs daily ( p = .04), and they showed greater daytime SBP variability (p < .0001). Furthermore, there was a strong positive correlation between preprandial SBP and deltaSBP after breakfast. CONCLUSIONS: About one out of four elderly patients with falls or syncope experiences PPH, usually after breakfast. Postprandial decline in BP contributes to BP variability. deltaSBP and preprandial SBP are positively correlated.     

Blood Pressure-Lowering Efficacy of Amiloride versus Enalapril as Add-On Drugs in Patients with Uncontrolled Blood Pressure Receiving Hydrochlorothiazide

A large proportion of patients with hypertension need a second drug to reach satisfactory control of blood pressure (BP), but there are few well-designed controlled trials comparing the efficacy of drugs added as a second option. In a double-blind randomized clinical trial, 82 patients with uncontrolled BP, receiving hydrochlorothiazide 25 mg daily, were selected to receive amiloride 2.5–5 mg/day (n?=?39) or enalapril 10–20 mg/day (n?=?43). Ambulatory blood pressure monitoring (ABPM) was done before and after 12-weeks of treatment. Office BP was measured in the 4^th, 8^th, and 12^th weeks. The doses of amiloride and enalapril were doubled in the fourth week, and propranolol was added in the 8th week if office BP was above 140/90 mm Hg. There was a greater BP reduction in patients treated with enalapril. The ABPM δ values between the groups were 3.6?±?2.2, 3.9?±?2.2, and 1.1?±?2.7 mmHg for 24-h, daily, and nightly systolic blood pressure, respectively, favoring enalapril. For diastolic blood pressure (DBP), the deltas were 1.7?±?2.0, 3.2?±?1.5, and 1.2?±?1.9 mmHg, respectively (p?=?0.039 for daily DBP). Office SBP decreased more and sooner in patients allocated to enalapril (p?=?0.003). More patients taking amiloride required propranolol to control BP (p?=?0.035). Potassium increased 0.3 mEq/L on the average in both groups. Cough, albeit predominantly mild, was reported more frequently by participants treated with enalapril. We conclude that enalapril is more effective than amiloride to lower BP of patients on hydrochlorothiazide with uncontrolled BP.

Trial registration: ClinicalTrials.gov identifier: NCT00394394.     

厄贝沙坦不同时间用药对血压昼夜节律的影响研究

目的按照时间药物学的原则,探讨不同用药时间服用厄贝沙坦对非杓型高血压患者血压昼夜节律的影响。方法采用动态血压检测的方法筛选出83例非杓型高血压患者,随机分为厄贝沙坦晨起服药组（41例）和晚上服药组（42例）,均给以厄贝沙坦150～300mg口服,1次/d,共治疗24周。药物治疗前后分别进行诊室血压和动态血压监测的检查。结果两组的诊室收缩压（SBP）在治疗后均明显降低,两组的诊室收缩压（SBP）在治疗前后差异无统计学意义（P〉0.05）。动态血压结果显示,两组均能降低夜间SBP（P〈0.05,P〈0.01）,夜间服药更能有效地降低夜间的SBP。晨起服药组的白天血压达标率（SBP〈135mmHg）为36.5%,晚上服药组的白天血压达标率为33.3%,差异无统计学意义（P〉0.05）。晨起服药组的夜间血压达标率（SBP〈125mmHg）为29.2%,晚上服药组的夜间血压达标率为61.9%,差异有显著意义（P〈0.01）。晨起服药组血压昼夜节律纠正率为19.5%,晚上服药组血压昼夜节律纠正率为52.4%,差异有显著意义（P〈0.01）。结论对于非杓型高血压患者,厄贝沙坦晚上服药可以有效地纠正夜间的高负荷血压,提高夜间血压达标率,改善血压昼夜节律。     

Does orthostatic hypotension predict the occurrence of nocturnal arterial hypertension in the elderly patient?

OBJECTIVE: To determine whether the presence of orthostatic hypotension--which, in this age-group, could be due to varying degrees of autonomic dysfunction--is an indicator of nocturnal arterial hypertension. PATIENTS: Between 1999 and 2001 we prospectively and consecutively studied 93 elderly patients with untreated (office) arterial hypertension, 65 (70%) of whom were true hypertensives according to 24 h ambulatory blood pressure monitoring (ABPM). INTERVENTIONS: The patients were studied by clinical examination including blood pressure (BP) measurement in dorsal decubitus and orthostatic position, 24 h ABPM, evaluation of vascular distensibility by carotid-femoral pulse wave velocity (PWV) and Doppler echocardiography. For this study we analyzed especially the ambulatory behavior of BP, so we could relate the variation of systolic blood pressure (SBP) during orthostatism with non-dipper status for SBP and absolute nocturnal values of SBP. MEASUREMENTS AND RESULTS: The results indicated that a greater decrease of blood pressure with orthostatism corresponded to a greater probability of nocturnal hypertension (p = 0.005) and of non-dipper status (p = 0.02). These results are in agreement with those subsequently found by other authors (Kario et al., 2002). CONCLUSIONS: In this way, by means of a simple clinical maneuver that should always be performed in an elderly hypertensive patient, we can suspect the presence of nocturnal hypertension--which is a high-risk cardiovascular situation--and use this information to help select patients to undergo 24 hour-ABPM.     

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension.

Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1?±?10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3?±?12.7 years) had non-dipper hypertension.

Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3?±?0.9 versus 1.8?±?0.5, p?p?=?0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22–7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13–6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%.

Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.     

The relationship of age-adjusted Charlson comorbidity ındex and diurnal variation of blood pressure

Backgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients.

Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed.

Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = ?0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012–1.165)

Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality.     

Differences in exercise blood pressure response between dipper and non-dipper elderly patients with essential hypertension

We evaluated the circadian variation and exercise stress response patterns of blood pressure (BP) in elderly patients with essential hypertension. Ambulatory BP monitoring for 48 hours every 30 minutes, and treadmill exercise test using a Bruce protocol at PM 3 to 5 were performed in 49 untreated patients with hypertension. Mean daytime (awake), and night-time (sleeping) systolic BP (SBP) and diastolic BP (DBP) values were analyzed by reviewing the patients' diaries, and the nocturnal reduction rate (NRR) of SBP and DBP were calculated according to the following formula. NRR (%) = [(daytime mean-nighttime mean)/daytime mean] x 100. The patients were divided into two groups according to the presence (dipper, n = 25) or absence (non-dipper, n = 24) of a reduction in both SBP and DBP during the night by an average of more than 10% of the daytime BP. Mean values of SBP and DBP measured over 48 hours in the dipper and non-dipper groups were similar. Responses of SBP to dynamic exercise at 2 to 5 minutes in the non-dipper group were significantly smaller than those in the dipper group (p < 0.05). Non-dipper patients with hypertension responded to dynamic exercise stress with smaller increases in SBP than did those in the dipper group. The differences in BP responses to exercise may affect the circadian blood pressure profile in dipper and non-dipper elderly patients with essential hypertension.     

Influence of blood pressure level on urinary albumin excretion rate and erythropoietin production in diabetic patients

The purpose of this study was to investigate blood pressure variations during diabetic incipient nephropathy and to evaluate theirs consequences for erythropoietin (EPO) production. PATIENTS AND METHODS: This study included 94 diabetic patients (mean age: 59.9 +/- 15.3 years, diabetes duration: 13.8 +/- 15.3 years). Patients were divided in two groups according to urinary albumin excretion rate (UAE): group 1: UAE <30 mg/24 hrs, N=64 and group 2: 30相似文献   

Diurnal variation of blood pressure; reproducibility and association with left ventricular hypertrophy in hemodialysis patients

OBJECTIVE: The objective of this paper is to describe the pattern of diurnal blood pressure (BP) change in hemodialysis patients, determine the association of the non-dipping pattern of diurnal BP with left ventricular mass index (LVMI), and to determine if the nocturnal profile of BP is reproducible when repeated over time. METHODS: In a cross-sectional study, ambulatory blood pressure monitoring (ABPM) was performed over a midweek 44-h period and echocardiography was performed on the interdialytic day. Patients with a night/day systolic and diastolic BP ratio on both days >0.9 were defined as non-dippers. Ambulatory blood pressure monitoring was repeated at 6 and 12 months follow-up. RESULTS: Of the 59 patients, 88% were African-American, and 48% were non-dippers. Mean LVMI was significantly higher in the non-dipper (68.3+/-25 g/height) compared to the dipper patients (55.6+/-16, P<0.05). Mean nocturnal systolic BP (r=0.35) and the night/day systolic BP ratio (r=0.39) had a higher correlation with M-mode LVMI than pre-dialysis (r=0.32). After adjustment for 44-h mean SBP, night/day systolic BP ratio remained independently associated with LVMI (beta coefficient 147.62, P=0.004). Of 12 patients who had a non-dipper profile at baseline, 11 (92%) demonstrated the same profile after 6 months and 1 year of follow-up. CONCLUSION: Many hemodialysis patients demonstrate a non-dipper profile; the degree of decline in nocturnal BP is independently associated with LVMI even after adjustment for mean BP. Patients who are identified as non-dippers consistently reproduce the same profile over time.     

Clinical trial of arotinolol in the treatment of hypertension: dippers vs. non-dippers.

To compare the effects of an alpha, beta blocker, arotinolol, in the treatment of essential hypertension between patients with a dipper and those with a non-dipper profile by means of 24-h ambulatory blood pressure monitoring (ABPM), a multicenter single blind parallel trial was carried out in five clinical centers. After a one-week single blind placebo run-in period, the patients underwent ABPM if their clinic diastolic blood pressure (DBP) ranged from 90-109 mmHg and their clinic systolic blood pressure (SBP) was <180 mmHg. They were divided into two groups according to the absence (non-dipper group, 24 cases) or presence (dipper group, 23 cases) of nocturnal BP reduction > or =10% of daytime BP. ABPM was measured again at the end of the active treatment phase. All patients were given Arotinolol 10-20 mg twice daily for 4 weeks. Twenty four-hour systolic and diastolic average BPs (MSBP, MDBP), 24-h systolic and diastolic blood pressure load (LS BP, LDBP), daytime systolic and diastolic average BPs (dMSBP, dMDBP), daytime systolic and diastolic blood pressure load (dLSBP, dLDBP), nighttime systolic and diastolic average BPs (nMSBP, nMDBP) and nighttime systolic and diastolic blood pressure load (nLSBP, nLDBP) were calculated. Arotinolol was effective in 78.2% of dippers and 54.2% of non-dippers, but the difference in effectiveness between these groups was not statistically significant. After treatment, SBP and DBP-including 24-h, daytime and nighttime systolic and diastolic BPs- were significantly reduced in both groups. During the daytime period, the systolic and diastolic blood pressures were significantly reduced in both dippers and non-dippers, while nighttime systolic and diastolic blood pressures were significantly reduced only in the non-dipper group. No significant changes were found in the dipper group over this period. In conclusion, Arotinolol, which can be dosed twice daily, is an effective antihypertensive agent which effectively lowers blood pressure during the day while reducing nighttime blood pressure more in non-dippers than in dippers, without excessive lowering blood pressure in the latter.     

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension

Aims: Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension.

Materials and method: This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5?±?8 years) and 30 non-dipper patients (17 male, mean age 50.6?±?5.4 years). Tp-e interval and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups.

Results: No statistically significant difference was found between two groups in terms of basic characteristics. In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in non-dipper patients compared to the dippers (39.4?±?11.5 versus 27.3?±?7.5?ms and 37.5?±?9.5 versus 29.2?±?6.5?ms, p?=?0.001 and p?=?0.01, respectively). Tp-e interval and Tp-e/QT ratio were also significantly higher in non-dipper patients (97.5?±?11.2 versus 84.2?±?8.3?ms and 0.23?±?0.02 versus 0.17?±?0.02, all p value <0.001).

Conclusion: Our study revealed that QTd, Tp-e interval and Tp-e/QT ratio are prolonged in patients with non-dipper hypertension.     

Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients

This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period. ABPM was performed once for 24 h in the absence of dialysis during the final 2 weeks of the study period and was compared to the 2-week dialysis unit BP and home BP. There was a significant difference between dialysis unit systolic blood pressure (SBP) and home SBP over the 9-month period. No significant difference was observed between the 2hr-HD SBP and home SBP. When analyzing 2 weeks of dialysis unit BP and home BP, including ABPM, SBPs were significantly different (dialysis unit BP > home BP > ABPM; P = 0.009). Consistent with the 9-month study period, no significant difference was observed between 2hr-HD SBP and home SBP (P = 0.809). The difference between 2hr-HD SBP and ambulatory SBP was not significant (P = 0.113). In conclusion, the 2hr-HD SBP might be useful for predicting home BP and ABPM in HD patients.     

Limited reproducibility of 24-h ambulatory blood pressure monitoring

Abstract

Results of 24-h ambulatory blood pressure monitoring (ABPM) including average blood pressure, variability, and nocturnal dipping are considered the gold standard for diagnosis and the best predictor of the future end organ damage in chronic hypertension. Here we report on the reproducibility of ABPM results for these three measures over a period of months. A total of 35 hypertensive patients (43% female, mean age 64 years), underwent two separate ABPM recordings within 14 weeks, with unchanged medical treatment and lifestyle in the interim. The day and night average blood pressure, dipping status of systolic pressure, and the standard deviation of systolic and diastolic blood pressure as a measure of variability were compared between the two recordings. Individual values for average systolic and diastolic pressures showed only a modest correlation between the two measurements (r?=?0.56, r?=?0.81, p?<?0.01). Standard deviations of 24-h pressure were also positively but weakly correlated (r?=?0.4, p?<?0.001). The occurrence of dipping was reproducible in 71% of the patients. Average blood pressure, pressure variability, and dipping as assessed by ABPM are only moderately reproducible. Clinical decision-making based on single ABPM datasets should be made with caution, and repetition of ABPM seems justified in some cases.     

Effect of Low-Dose Manidipine on Ambulatory Blood Pressure in Very Elderly Hypertensives

Summary. To evaluate the effect of manidipine 10 mg on 24-hour ambulatory blood pressure (BP) and heart rate (HR) in very elderly hypertensive patients, 54 patients aged 76–89 years (mean age 81.8 years) with systolic blood pressure (SBP) >160 mmHg and diastolic blood pressure (DBP) >90 mmHg were studied. After a 4-week placebo washout period, patients were randomized to receive manidipine 10 mg or placebo, both administered once daily for 8 weeks. Patients were checked after the initial run-in placebo phase and every 4 weeks thereafter. At each visit casual BP and HR were measured. At the end of the placebo period and after 8 weeks of active treatment, noninvasive 24-hour ambulate blood pressure measurement ABPM was performed. Manidipine significantly lowered casual sitting and standing SBP (P <0.001) and DBP (P <0.001) at the trough level. ABPM showed a significant decrease in 24-hour SBP and DBP values (P < 0,001), daytime SBP and DBP (P <0.001), and night-time SBP (P <0.001) and DBP (P <0.005). In addition, ABPM confirmed a consistent antihypertensive activity throughout the 24-hour dosing interval, without effect on the circadian BP profile. The trough/peak ratio was 0.67 for SBP and 0.59 DBP. No statistically significant change in HR was observed. The treatment was well tolerated, and there were no serious side effects. In conclusion, in very elderly hypertensive patients, once-daily administration of manidipine 10 mg was well tolerated and effective in reducing casual as well ambulatory BP.     

Associations between blood pressure responses to acute stress and impaired renal function and serum uric acid level

Abstract

The study aimed to examine correlations between blood pressure (BP) responses to direct laryngoscopy and tracheal intubation and parameters of renal function, serum uric acid (SUA) level, and mean preoperative BP. Fifty-four patients (≥40 years) who were scheduled for oral surgery were analyzed. General anesthesia was induced by the rapid sequence method without opioid analgesics. Systolic and diastolic BP (SBP, DBP) in the operation room were measured when an electrocardiogram, a BP cuff, and a pulse oximetry probe were attached to the patients (T1) and immediately after the trachea was intubated (T2). The ΔSBP was defined as the difference between SBP at T2 and T1. The increasing rate of SBP (ΔSBP_r) was defined as ΔSBP/SBP at T1. SBP at T2 was associated with increasing age (R?=?0.44), serum creatinine (R?=?0.32), SUA (R?=?0.30), mean preoperative SBP and DBP (R?=?0.54 and 0.37, respectively), and reduced estimated glomerular filtration rate (eGFR) (R?=??0.44). Serum creatinine and SUA were positively associated, and eGFR was negatively associated with ΔSBP (R?=?0.36, 0.34, and ?0.29) and ΔSBP_r (R?=?0.39, 0.37, and ?0.29). Multivariate regression analysis revealed that age and mean preoperative SBP was independently associated with SBP at T2, and serum creatinine was independently associated with ΔSBP and ΔSBP_r. These findings suggested that elevated serum creatinine level, as well as elevated preoperative BP level, was associated with enhanced BP responses to acute stress in middle-aged to elderly patients.     

Negative association between plasma aldosterone concentration/plasma renin activity and morning blood pressure surge in never-treated hypertensive patients

Morning blood pressure (BP) surge (MS) has been known to be a predictor of cardiovascular events. Currently, few studies have evaluated the underlying mechanism underlying MS, which may include neurohormonal factors and the renin–angiotensin–aldosterone system (RAAS). This study aimed to examine plasma aldosterone concentration (PAC) and plasma renin activity (PRA) and BP parameters with or without MS in never-treated subjects with essential hypertension. This cross-sectional study included a total of 261 patients (mean age: 48.8 years; 60.5% male) with never-treated essential hypertension who were registered in a working group at The Catholic University of Korea. The patients were divided into the MS group, which was defined as having the highest quartile of morning BP increase from sleep (>31?mmHg; n?=?66) and the non-MS group (≤31?mmHg; n?=?195). We collected 24-h ambulatory BP, pulse wave velocity, ankle brachial index, PAC and PRA from all patients. The measured PAC and PRA were lower in the MS group than in the non-MS group (PAC: 9.0?±?5.4?ng/dl versus 12.2?±?8.7?ng/dl, p?p?=?0.002). The MS group had greater variations in daytime, nighttime and 24-h systolic blood pressure (SBPs) than the non-MS group (24-h SBP: 15.6?±?4.4?mm Hg for the non-MS group and 18.9?±?4.9?mmHg for the MS group; p?相似文献   

Effect of the type of diabetes on the prognosis over 4 years of arterial blood pressure

The aim of this study was to analyse over a four years period the blood pressure rise according to the type of diabetes. The study population was composed of 79 diabetic patients (type 1: 36; type 2: 43). An evaluation of diabetes mellitus is undertaken at a four years interval (A0, A4). In the same time, blood pressure level is assessed using clinic BP and 24 h-ambulatory blood pressure monitoring (ABPM). Type 2 diabetic patients were older than type 1 (60.9 +/- 9.5 vs 43.5 +/- 12.5 years, p < 0.001). The two groups did not differ in body mass index, tobacco consumption, diabetes duration, glycemic control and serum creatinine. Hypertension was more frequent in type 2 diabetes (46.5 vs 11.1%, p < 0.01) and baseline systolic but not diastolic casual BP was significantly higher in type 2 diabetes compared with type 1 (142 +/- 14 vs 132 +/- 15 mmHg, p < 0.01). Between A0 and A4 the increase in type 1 and type 2 diabetics casual BP was not significant. Type 1 diabetic patients 24 h-ABPM did not differ from significant manner at A0 and at A4. Type 2 diabetic subjects had an increase in 24 h and night time SBP (24 h: 123 +/- 14 at A0 vs 130 +/- 16 mmHg at A4, p < 0.05; night time: 116 +/- 15 at A0 vs 125 +/- 17 mmHg at A4, p < 0.02). This reduction in nocturnal BP fall was not associated with an increase in diabetes complications frequency. BP evolution seems to be closely linked to the type of diabetes and to patients age. In this study, frequency of diabetes complications does not increase when BP level is lower than references values for ABPM.