24-hour blood pressure profile in centenarians

OBJECTIVE: Ambulatory blood pressure in the elderly has been studied in the past, the age range most frequently examined being 65 to 80 years. The present study was aimed at determining 24-h blood pressure means and profile in centennial human beings. PATIENTS AND METHODS: Sphygmomanometric blood pressure (average of three values) and 24-h ambulatory blood pressure measurements were performed in 16 centennial subjects (age 101.7 0.4 years, mean SEM) and in 20 healthy normotensives aged 80.7 1.1 years. All subjects were in good clinical and mental conditions for their age. They had no history, signs or symptoms of cardiovascular or non-cardiovascular diseases and were under no drug treatment. RESULTS: In the centennial group sphygmomanometric blood pressure amounted to 131.2 3.0/70.7 2.2 mmHg (systolic/diastolic) and 24-h blood pressure and heart rate average values to 125.6 +/- 3.4/64.8 2.0 mmHg and 77.5 4.3 bpm, respectively. Blood pressure and heart rate showed no difference between daytime and night-time values, i.e. night-time was accompanied by no blood pressure and heart rate fall. In contrast, in all subjects, a significant reduction in blood pressure was observed during the post-prandial period, with no significant heart rate changes. In the octogenarian group, sphygmomanometric and 24-h blood pressure averages were 146.6 4.4/82.8 2.2 and 131.8 2.5/75.3 1.6 mmHg, respectively, with a clearcut reduction in night-time as well as in post-prandial values. CONCLUSIONS: In centenarians 24-h blood pressure values are: (1) lower than sphygmomanometric blood pressures and (2) slightly less than in subjects aged 80 years. At variance with these subjects, however, in centenarians nocturnal hypotension and bradycardia are abolished, presumably because of a derangement in the central sleep influences on the cardiovascular system.     

24-hour blood pressure in primary and secondary hypertension

The blood pressure is subject to physiological day-night fluctuations, which can be attenuated in secondary hypertension as well but not in essential hypertension. In this study, the blood pressure profile over 24 hours was determined in a large collective of patients with primary and secondary hypertension for comparison to assess the relevance of ambulatory blood pressure monitoring in secondary hypertension. There were 88 patients with essential hypertension (age 20 to 73 years) and 80 patients with secondary hypertension (age 19 to 70 years) with a mean blood pressure value from 8 a.m. to 8 p.m. greater than 135 mm Hg. Blood pressure and heart rate were monitored for 24 hours. In 58/80 patients with secondary hypertension renal parenchymal disease was present, 14 had renovascular disease, three had Cushing's syndrome, four had primary hyperaldosteronism and one had a pheochromocytoma. Of the 88 patients with essential hypertension 67, and of the 80 patients with secondary hypertension 69 were on antihypertensive treatment. The measurements were carried out with a portable automatic ambulatory monitor unit (SpaceLabs 90202) between 6 a.m. and midnight at intervals of 15 minutes and from midnight to 6 a.m. at intervals of 30 minutes. The duration of sleep was documented. In patients with secondary hypertension, as compared with patients with essential hypertension, there were higher blood pressure values during the night from 8 p.m. to 8 a.m., and during sleep (Table 1). The profile of the hourly mean values for systolic and diastolic blood pressure (Figure 1) shows that patients with secondary hypertension, as compared with patients with essential hypertension, have a clearly diminished blood pressure reduction during the night.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experience with 24-hour ambulatory blood pressure monitoring in hypertension

Traditional sphygmomanometric blood pressure measurements may lead to errors in the diagnosis of arterial hypertension due to a number of factors, among which are the alerting reaction and pressor response induced in patients by the doctor's visit. This phenomenon, as quantified in our laboratory by continuous intraarterial recordings, is responsible for an average rise in systolic and diastolic blood pressure of 27/15 mm Hg, a rise that does not seem to be reduced by simply desensitizing the patient by means of more frequent physician visits. Twenty-four hour ambulatory blood pressure monitoring may theoretically improve the diagnostic approach to hypertensive patients by overcoming some limitations of isolated cuff measurements. In recording intraarterial blood pressure in 108 ambulant hypertensive subjects, we have found that 24-hour blood pressure values are able to discriminate among patients with different degrees of target organ damage better than isolated sphygmomanometric readings. Moreover, these studies have indicated that 24-hour blood pressure variability may be as important as blood pressure mean values in the assessment of cardiovascular complications. In clinical practice, however, intraarterial blood pressure monitoring is not feasible, and only noninvasive recorders can be used. Use of these devices does not induce any alerting reaction in the patients and does not interfere with day-night blood pressure changes. Although it is characterized by intermittent readings, this approach is not incompatible with a precise estimate of 24-hour blood pressure mean values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Verapamil and 24-hour ambulatory blood pressure monitoring in essential hypertension

The antihypertensive effects of oral regular and slow-release verapamil, a calcium-channel blocking agent, were evaluated in 22 patients with mild to moderate hypertension (sitting diastolic blood pressure [DBP] 95 to 112 mm Hg). The dose required to control blood pressure varied from 80 to 120 mg, 3 times a day. All patients received regular verapamil for a further 3 to 4 months, when systolic blood pressure (SBP) and DBP had risen from the end of the open-label phase. During a double-blind phase patients were randomly assigned to continue the same dose of regular verapamil, 3 times a day, or an equivalent daily dose of sustained-release verapamil (240 to 360 mg once a day). Seven of the 11 patients on regular and 3 of the 11 on sustained-release verapamil were also taking diuretics. This antihypertensive program was continued for at least 4 weeks. During the efficacy period, 24-hour ambulatory blood pressure monitoring was carried out. Mean 24-hour SBP and DBP were 133 +/- 20 and 89 +/- 13 mm Hg, respectively, on regular and 131 +/- 22 and 87 +/- 12 mm Hg, respectively, on sustained-release verapamil. There were no statistically significant differences noted between the 2 groups. Mean SBP and DBP varied similarly during awake and sleep hours with both formulations of verapamil. With regular verapamil, SBP was 139 +/- 18 and 124 +/- 20 mm Hg and DBP 92 +/- 11 and 84 +/- 13 mm Hg during awake and sleep hours, respectively; with sustained release, SBP was 138 +/- 21 and 122 +/- 22 mm Hg and DBP 92 +/- 10 and 80 +/- 10 mm Hg during awake and sleep hours, respectively. Heart rate fell during the entry period and continued during the entire study period. No other adverse effects were noted during the double-blind phase. In summary, verapamil is an effective antihypertensive medication and can be administered once a day as a sustained-release preparation; it is most useful in patients in whom adrenergic blocking drugs are indicated.     

Evaluation of the 24-hour blood pressure effects of eprosartan in patients with systemic hypertension

BACKGROUND: Eprosartan is a new nonphenyl angiotensin II receptor blocker, which has been approved for the treatment of hypertension. Although the drug has a relatively short plasma half-life of 5 to 9 h, clinical studies have suggested that its antihypertensive effect persists for 24 h. METHODS: We assessed both the changes in 24-h and trough blood pressure (BP) (last 4 h of the ambulatory BP while the patient was awake) of eprosartan at doses of 600 and 1,200 mg once daily in a randomized, double-blind, placebo-controlled trial. Ambulatory BP was monitored at placebo baseline and after 8 weeks of double-blind therapy. RESULTS: Two hundred patients randomized in the study with 177 patients completing the trial. The 24-h change in BP from baseline was 0.2/0.1 +/- 1.4/1.0 mm Hg, -7.9/ -5.4 +/- 1.0 mm Hg (P < .0001), and -7.4/-5.0 +/- 0.9 mm Hg (P < .0001) in the placebo, 600-mg eprosartan, and 1,200-mg eprosartan groups, respectively. Changes in trough ambulatory BP showed significant reductions of -6.3/-4.1 +/- 1.6/1.1 mm Hg and -7.7/-5.5 +/- 1.5/1.0 mm Hg for 600 mg of eprosartan and 1,200 mg of eprosartan, respectively. CONCLUSIONS: These data demonstrate that eprosartan at doses of 600 or 1200 mg significantly reduced BP throughout an entire 24-h dosing period. There were no differences between the 600- and 1,200-mg dose; thus, 600 mg once daily should be the only dose used in the treatment of hypertension with eprosartan.     

Impact of obesity on 24-hour ambulatory blood pressure and hypertension

The purpose of the present study was to determine the relationship between body mass index (BMI) and parameters derived from 24-hour ambulatory blood pressure monitoring including mean 24-hour daytime and nighttime systolic and diastolic blood pressures, 24-hour daytime and nighttime pulse pressure, mean 24-hour daytime and nighttime heart rate, dipping and nondipping status. 3216 outpatient subjects who visited our hypertension center and were never treated with antihypertensive medication underwent 24-hour blood pressure monitoring. BMI was significantly correlated with clinic systolic and diastolic blood pressures. Significant correlations were also found between BMI and mean 24-hour daytime and nighttime systolic blood pressure, 24-hour daytime and nighttime pulse pressure, and mean 24-hour daytime and nighttime heart rate. In multivariate regression analysis, clinic systolic, diastolic blood pressure, mean 24-hour systolic blood pressure, 24-hour pulse pressure, and high-density lipoprotein were independently correlated with BMI. The incidence of white coat hypertension was higher in overweight and obese patients than in normal weight subjects. Confirmed ambulatory blood pressure hypertension was also found to be higher in overweight and obese individuals compared with normal weight subjects. Our data also highlight the higher incidence of nondipping status in obesity. These findings suggest that obese patients had increased ambulatory blood pressure parameters and altered circadian blood pressure rhythm with increased prevalence of nondipping status.     

24-hour blood pressure differences in hypertension and normotension in bed-confined subjects

This study investigates whether the degree of hypertension may be evaluated by information derived from the 24-h blood pressure (BP) curve unrelated to the pressure height. We performed 24-h BP intra-arterial monitoring in 52 bed-confined subjects (10 normotensives, 10 borderlines, and 32 hypertensives on WHO criteria). Computer analysis of 1152 BP values per subject per 24-h revealed the following: During the night hours, the percentage of the 1152 systolic BP values greater than or equal to 160 (in mmHg) increased (or did not change if 100%) in all subjects with mean 24-h systolic BP (24-h BP) greater than 170 and it decreased (or did not change if 0%) in all subjects with 24-h BP less than 150. The change in the percentage of the 1152 diastolic BP values greater than or equal to 95 during the night hours did not correlate to either the mean 24-h diastolic or systolic BP. The higher the mean 24-h systolic BP, the lower the skewness of the distribution of the 1152 systolic BP values (p less than 0.01). No such correlation existed between the skewness of the distribution of the 1152 diastolic BP values and either the mean 24-h diastolic or systolic BP. It is concluded that both the change in systolic BP during the night hours and the skewness of its distribution during the 24-h monitoring period are correlated to the severity of hypertension.     

Structural changes of the myocardium and 24-hour blood pressure profile in subjects with hypertension studied during expedition work in the Far North

Echocardiography and 24-hour BP monitoring were carried out in 177 men with stage 1 and 2 essential hypertension aged 25-59 years when they worked the Far North shift (group l) and in 75 patients with essential hypertension living in moderate climatic zone (group 2). Normal left ventricular geometry was found in 10 and 39% of subjects in groups l and 2, respectively. Left ventricular hypertrophy (LVH) was 2 times more frequent in group 1 where it was predominantly concentric. Contrary to group 2 significant correlations between parameters of 24-hour BP monitoring and echocardiography were found in group 1. All variants of left ventricular geometry in group 1 were characterized by lower systolic BP, high variability of systolic and diastolic BP, impaired 24-hour BP rhythm because of decreased night-day difference. Group 1 subjects with concentric left ventricular hypertrophy had significantly increased left ventricular mass index. Diastolic nocturnal hypertension was the factor most closely related to the structural state of the myocardium in group 1.     

Hormone replacement therapy and 24-hour blood pressure profile of postmenopausal women

Menopause is associated with an increase in blood pressure (BP) and a decrease in physiologic nocturnal BP fall. These factors may play a role in the increased risk of cardiovascular events after menopause. Some studies indicate that transdermal estrogen replacement therapy may help restore the 24-h BP profile, but data on the effect of oral conjugated estrogens are lacking. We compared 24-h ambulatory BP profiles of 42 postmenopausal women not receiving hormone replacement therapy (HRT) and 20 women receiving HRT. HRT was associated with a significant increase in the proportion of dippers (50% in women not receiving HRT and 80% in women receiving HRT, P = .048). Increase in nocturnal dipping may account, in part, for the beneficial cardiovascular effects of HRT.     

Ambulatory 24-hour blood pressure monitoring in patients with resistant hypertension

The aim of the study was to assess the usefulness of 24-hour blood pressure (BP) and heart rate (HR) monitoring in patients with "resistant" hypertension. 30 patients (44.1 +/- 9.9 years) with diastolic BP 100 mm Hg or more in spite of treatment with three or more antihypertensive drugs were studied. Ambulatory recording of BP and HR was performed by means of Del Mar Avionics monitoring system 9000. Mean recording time was 21.5 hours and mean number of measurements during one recording--56.7. Mean ambulatory systolic and diastolic BP values were significantly lower than mean value of three casual measurements (146.0 +/- 24.6 vs 171.5 +/- 21.2 mm Hg for systolic and 97.2 +/- 11.3 vs 110.4 +/- 7.5 mm Hg for diastolic BP p less than 0.01) In 14 (46.6%) systolic BP and in 10 patients (33.3%) diastolic BP were normal. The patients with normal and abnormal ambulatory BP recordings did not differ in regard to age and mean clinic BP levels. However, patients with abnormal ambulatory BP recordings were more often overweight and showed a greater frequency of left ventricular hypertrophy and family history of hypertension and its complications. The results of the study show that ambulatory BP monitoring may be of value in assessing the response to antihypertensive treatment in patients with so called resistant hypertension as judged on the basis of clinic pressure.     

Early 24-hour blood pressure elevation in normotensive subjects with parental hypertension

Subjects with a family history of parental hypertension are reported to have a slightly higher office blood pressure in the prehypertensive stage. Whether this reflects a hyperreactivity to blood pressure measurement or a more permanent blood pressure elevation, however, is not known. In the present study, blood pressure was measured in 15 normotensive subjects whose parents are both hypertensive (FH++), 15 normotensive subjects with one hypertensive parent (FH(+)-), and 15 normotensive subjects whose parents are not hypertensive (FH--); among the three groups, subjects were matched for age, sex, and body mass index. The measurements were made in the office during a variety of laboratory stressors and during a prolonged resting period, and for a 24-hour period (ambulatory blood pressure monitoring). Office blood pressure was higher in the FH++ group than in the FH-- group (p less than 0.05). The pressor responses to laboratory stressors were similar in the two groups, but the FH++ group had higher prolonged resting and 24-hour blood pressure than the FH-- group; the difference was always significant (p less than 0.05) for systolic blood pressure. The FH++ group also had a greater left ventricular mass index (on echocardiographic examination) than the FH-- group (p less than 0.01). The blood pressure values and echocardiographic values of the FH(+)- group tended to be between those of the other two groups. Thus, the higher blood pressure shown by individuals in the prehypertensive stage with a family history of parental hypertension does not reflect a hyperreactivity to stress but an early permanent blood pressure elevation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angiotensin II receptor blocker telmisartan: effect on 24-hour blood pressure profile and left ventricular hypertrophy in patients with hypertension

AIM: To study antihypertensive efficacy of monotherapy with telmisartan and its action on left ventricular myocardium remodeling in patients with hypertension. MATERIAL AND METHODS: Telmisartan (40-80 mg/day) was given for 24 weeks to 24 patients aged 37-69 years with I-II degree of blood pressure (BP) elevation and hypertrophy of left ventricular myocardium. Antihypertensive action of telmisartan was assessed by 24-hour BP monitoring. Left ventricular myocardial mass was estimated by echocardiography before and after 24 weeks of therapy. RESULTS: Telmisartan equally decreased both diurnal and nocturnal systolic and diastolic BP (by10.4-11.7%), lowered maximal BP during morning hours, and restored initially disturbed 24-hour BP rhythm. Target BP levels were achieved in 16 patients (70%). Therapy with telmisartan was associated with significant 10.9% reduction of left ventricular myocardial mass index (from 151.6-/+5.4 to 135.1-/+5.9 g/m2, p=0,02) at the account of decreased thickness of left ventricular wall. CONCLUSION: These results give reason for the use of telmisartan for the treatment of patients with hypertensive disease and left ventricular hypertrophy.     

Proposal of RAS-diuretic vs. RAS-calcium antagonist strategies in high-risk hypertension: insight from the 24-hour ambulatory blood pressure profile and central pressure

I here propose an individualized renin angiotensin system (RAS) inhibitor-based combination therapy with calcium-channel blockers (CCBs) or with diuretics, based on the 24-hr ambulatory blood pressure (BP) profiles and central pressure in relation to the target organ damage in high-risk hypertensive patients. For high-risk patients with increased circulating volume, such as that caused by chronic kidney disease (CKD) or congestive heart failure (CHF), who are likely to exhibit a non-dipper/riser pattern of nocturnal BP fall, diuretics are recommended in combination with a RAS inhibitor to reduce nocturnal BP preferentially. For high-risk patients with arterial diseases such as cardiovascular disease and increased arterial stiffness, who are likely to exhibit exaggerated BP variability, such as morning BP surge and day-to-day BP variability, a CCB is recommended for use in combination with a RAS inhibitor to reduce BP variability and central BP. In particular, bedtime dosing of a RAS inhibitor targeting sleep-early morning activation of RAS may be particularly effective for cardiorenal protection.     

Peculiarities of regulatory mechanisms of autonomic nervous system in patients with arterial hypertension and disturbed 24-hour blood pressure profile

BACKGROUND: Insufficient nocturnal blood pressure (BP) decline is associated with elevated risk of complications of hypertensive disease. Heart rate variability (HRV) reflects activity of sympathetic and parasympathetic parts of autonomic nervous system. AIM: To elucidate special characteristics of HRV in patients with various types of 24-hour BP rhythm. Material and methods. Bifunctional 24-hour monitoring and echocardiography were carried out in 42 men with stage I-II hypertensive disease and I-II degree of arterial hypertension (mean age 21.7+/-4.5 years) and 16 practically healthy young people (mean age 24.6+/-5.2 years). RESULTS: Subjects with insufficient (<10%) and adequate nocturnal BP decline (non-dippers and dippers) were distinguished (groups ND and D, respectively). Patients with hypertension in group ND had elevation of systolic BP variability during night and day time, augmentation of nocturnal and diurnal HRV low frequency power, lowering of nocturnal high frequency power, lowering of pNN50 and rMSSD values at night. HRV parameters of control subjects in this group did not differ from those of healthy people. All HRV parameters in group D were characterized by significant 24-hour rhythmicity. This rhythmicity was substantially disturbed in patients of group ND. Parameters of central hemodynamics were similar in groups D and ND. CONCLUSION: These results evidence for the presence of enhanced activity of sympathetic part of autonomic nervous system in non-dipper patients with hypertensive disease throughout 24 hours and during night time and for disturbed circadian rhythm of autonomic nervous system activity. This can serve as a basis for increased rate of cardiovascular complications in this category of patients.     

24-hour blood pressure monitoring in the evaluation of supine hypertension and orthostatic hypotension

The presence of orthostatic hypotension has been shown to be a significant, independent predictor of all-cause mortality. Systolic and diastolic orthostatic hypotension, reversal of the circadian pattern, and postprandial hypotension are some of the hemodynamic factors that may contribute to the increased mortality seen in patients with orthostatic hypotension. The high variability of blood pressure in orthostatic hypotension cannot usually be adequately assessed by a one-time measurement. In this group of patients, 24-hour ambulatory.     

Effect of body weight changes on 24-hour blood pressure and left ventricular mass in hypertension: a 4-year follow-up

BACKGROUND: Few data are available on the long-term effects of weight loss on 24-h blood pressure (BP) and left ventricular mass in overweight hypertensive patients. METHODS: A total of 181 never-treated overweight hypertensive subjects (body mass index, 25 to 39 kg/m(2), office BP 145/94 +/- 12/7 mm Hg) had 24-h BP monitoring and echocardiography twice, at baseline and after 3.8 +/- 2 years (minimum 1 year). None of the subjects received antihypertensive drugs during the follow-up. Main outcome measures were changes in 24-h BP and in left ventricular mass. RESULTS: Percent change in body weight had a direct relationship with 24-h BP changes (r = 0.35 and 0.31 for systolic and diastolic BP, respectively; both P <.001). The associations with office BP changes (r = 0.13, P =.10 for systolic BP; r = 0.15, P =.06 for diastolic BP) were significantly weaker (both P <.01, z test). The patients who lost weight during follow-up (n = 106) had a significantly lower increase in 24-h BP (+0.6 +/- 9/ +0.2 +/- 6 v +4.9 +/- 9/ +2.7 +/- 7 mm Hg for systolic/diastolic BP, both P <.01) and in left ventricular mass (-3 +/- 30 g v +9 +/- 32 g, P <.02) than the remaining subjects. In a multiple linear regression, a 10% weight loss independently predicted a 4.3/3.8 mm Hg decrease in 24-h systolic/diastolic BP. CONCLUSIONS: Long-term weight loss determines a sustained BP reduction during the 24 h and a decrease in left ventricular mass in overweight hypertensive subjects. The relation of weight loss with ambulatory BP changes is closer than that with office BP.     

Once- and twice-daily bevantolol for systemic hypertension using 24-hour ambulatory intraarterial blood pressure recording

The antihypertensive efficacy of bevantolol, a selective beta 1-adrenoreceptor antagonist, was evaluated in 17 patients with essential hypertension, using continuous ambulatory intraarterial blood pressure (BP) monitoring. The study compared a twice-daily regimen (titrated dose of 200 to 600 mg/day) with the same amount given in a single daily dose. Within-patient comparisons of mean hourly systolic and diastolic BPs and heart rate showed a highly significant effect with twice-daily therapy (p less than 0.001) for all of the 24 hours. Similar significant results were obtained with a single morning dose. There was no difference between the pattern or extent of BP reduction with the 2 regimens. The decrease in BP after bevantolol persisted during the physiologic tests (rest, tilt, isometric and dynamic exercise). Four patients developed minor side effects with the single morning dose, and only 1 patient with the twice-daily regimen. These effects included tiredness, fatigue and dizziness. Unlike pure beta-blocking agents, bevantolol controlled the early morning increase in BP, lending support to the belief that it possesses vasodilatory properties in addition to beta blockade. These results suggest that bevantolol may be useful as first-line therapy in a once-daily dosage for the treatment of essential hypertension.     

Effect of doxazosin GITS on 24-hour blood pressure profile in patients with stage 1 to stage 2 primary hypertension

OBJECTIVE: To investigate the effect of the doxazosin gastrointestinal therapeutic system (GITS) on the 24 h blood pressure (BP) profile by ambulatory blood pressure measurements (ABPM) in patients with stage 1 to stage 2 primary hypertension. METHODS AND RESULTS: Seventeen hypertensive patients-either untreated or after a two-week run-in/washout period-underwent office and ABPM monitoring before and six weeks after an open-label once-daily morning dose of 4 mg of doxazosin GITS, an alpha(1)-adrenoceptor antagonist. Fourteen patients responded; three did not. Data analyses refers to the responders: linear analysis demonstrated statistically significant reductions from baseline in daytime, night-time, and total 24 h means for systolic BP (SBP) (7-10 mmHg) and diastolic BP (DBP) (5-10 mmHg) after treatment, with no statistically significant change in heart rate (HR). Rhythm analysis demonstrated statistically significant reductions from baseline in mean mesor (8 mmHg), maximum (6 mmHg) and minimum (10 mmHg) values in SBP, and in mean mesor (5 mmHg), maximum (7 mmHg) and minimum (5 mmHg) values in DBP. Circadian rhythm parameters in BP and HR were not significantly altered by treatment. Treatment with doxazosin GITS was well tolerated. CONCLUSIONS: A single morning dose of doxazosin GITS at 4 mg significantly reduced ambulatory SBP and DBP throughout a 24 h period while preserving a normal 24 h BP and HR rhythm profile in stage 1 to stage 2 hypertensives.