Sleep actigraphy in hypertensive patients with the 'non-dipper' blood pressure profile

Several prospective studies have demonstrated a higher cardiovascular complication rate in patients with a non-dipping compared with a dipping blood pressure profile. However, the extent of blood pressure reduction during sleep can be highly variable in an individual patient, and a repeat ambulatory blood pressure study commonly shows a change in category. The reasons for this variability are not clear. In general, hypertensive patients with a non-dipper blood pressure profile have higher actigraphy-measured activity during time in bed than dipper hypertensive patients but no analysis of actigraphy-determined sleep parameters has been published. We therefore prospectively studied 52 hypertensive patients who were off antihypertensive drugs for at least 3 weeks and who underwent simultaneous ambulatory and wrist actigraphy monitoring. All patients were clinically free of any sleep-related disorder. The blood pressure profile was labelled dipper when the change in mean awake blood pressure to sleep blood pressure was 10% or higher and non-dipper if less than 10%. Overall activity levels were higher during the time in bed in the non-dipper group compared with the dipper group. An inverse relationship of daytime activity with age was seen in men (r = -0.54, P = 0.001) but not in women (r = -0.06, P = 0.79). Both groups of hypertensive patients had a similar total time in bed (458 +/- 92 min, in dippers and 433 +/- 106 min in non-dippers, P = 0.39). Sleep latency (time to onset of sleep after getting into bed) was a median of 7 min in dippers and 15 min in non-dippers (P = 0.10). In addition, dipper hypertensives spent more of the time in bed asleep than non-dippers (87% vs 76%, P = 0.004). Logistic regression analysis revealed that body mass index, kg/m(2) (OR, 1.3), and night-time activity (units/min) (OR, 1.1) were predictive of a non-dipping blood pressure profile. These data show a possible disturbance of sleep in non-dipper hypertensive patients.     

Long-term effect of biliopancreatic diversion on blood pressure in hypertensive obese patients

BACKGROUND: The weight loss surgically induced by gastroplasty or gastric banding has only a transitory effect on the arterial hypertension of the severely obese patients, and a prevalence of hypertension similar to that of controls has been reported 8 years after the operation. METHODS: We studied the effects of biliopancreatic diversion in a series of 73 severely obese patients with preoperative hypertension throughout a 10-year follow-up period. Body weight dropped from 135.5 kg to 84.8 kg and remained substantially unchanged during the entire 10-year period, hypertension resolved in 41 subjects within the first postoperative year and the resolution rate increased slightly and progressively with time: at 10 years only 15 subjects were still hypertensive. Mean systolic and diastolic blood pressure (BP) value decreased within the first postoperative year as well as the pulse pressure (mean +/- standard deviation from 168 +/- 25 to 143 +/- 22 mm Hg, from 105 +/- 18 to 88 +/- 13 mm Hg, and from 65 +/- 16 to 50 +/- 13 mm Hg, respectively) and remained essentially unchanged throughout all the follow-up; 10 years after surgery the systolic BP and pulse pressure values (127 +/- 14 mm Hg and 42 +/- 6 mm Hg, respectively) were significantly lower than those observed at shorter term. CONCLUSIONS: In severely obese patients with arterial hypertension, the weight loss determined by biliopancreatic diversion in most cases is accompanied by the normalization of BP, which remains into physiological range until very long term.     

Optimal control of blood pressure can reverse left ventricular hypertrophy in uremic hypertensive hemodialysis patients

We investigated the effects of antihypertensive treatment on left ventricular hypertrophy (LVH) of long-term hemodialysis patients. In uremic patients, it is still controversial in antihypertensive effect to the regression of LVH. The left ventricular size and function of 39 uremic hypertensive long-term hemodialysis patients (27 men, 12 women, mean age 58.3) was evaluated with M-mode, 2-dimensional and Doppler echocardiography before, and 12 months after, the start of combined antihypertensive therapy. This therapy included angiotensin II converting enzyme inhibitors, beta-blockers and calcium antagonists. Patients were classified as responders or nonresponders, depending upon whether their systolic blood pressure (SBP) decreased by more than 10 mmHg after antihypertensive treatment for 12 months. Before treatment, 36 (92%) patients had LVH and diastolic dysfunction and three (8%) had systolic dysfunction. At the end of 12 months, only 25 (64%) patients had LVH, 30 (77%) had diastolic dysfunction and 2 (5%) had systolic dysfunction. Left ventricular mass index (LVMI) also decreased from 203.63 +/- 70.47 g/m2 to 178.57 +/- 67.31 g/m2. LVMI correlated with systolic blood pressure (SBP) but did not correlate with diastolic blood pressure (DBP). There were 26 responders and 13 non-responders. Among responders, both the SBP (153.91 +/- 13.24 mmHg vs 134.43 +/- 14.21 mmHg, p < 0.01) and DBP (90.39 +/- 7.89 mmHg vs 79.98 +/- 7.35 mmHg, p < 0.01) decreased significantly after antihypertensive therapy. Responders also exhibited progressive regression of LVH (LVMI decreased significantly from 208.52 +/- 72.03 g/m2 to 168.52 +/- 55.53 g/m2, p < 0.05). However, LVH regression was not found in nonresponders (LVMI showed 194.84 +/- 64.36 g/m2 vs 193.66 +/- 77.67 g/m2). We conclude that good control of blood pressure can reverse LVH in hypertensive hemodialysis patients.     

Cardiovascular risk profile and blood pressure control in Italian hypertensive patients under specialist care

BACKGROUND: Information on the association between high hypertension and metabolic risk factors in Italy is limited. Furthermore, data on the rate of blood pressure control in the Italian hypertensive population are restricted to some Italian regions only, and refer usually to surveys performed, in most instances, several years ago. METHODS: In the present study, a total of 4059 essential hypertensive patients were examined consecutively from March to June 2000 by 450 cardiovascular specialists (cardiologists, internists and diabetologists) operating throughout the Italian territory. Analysable data were obtained in 3812 patients. RESULTS: Blood pressure control by treatment (< 140/90 mmHg) was infrequent (11.9%), this being particularly the case for systolic as compared to diastolic blood pressure (15.1 versus 33.7%). Hypertension was the only risk factor in only 13.7% of the patients, the association with diabetes, hypercholesterolaemia or obesity characterizing the remaining cases. About 60% of the patients fell into the high or very high cardiovascular risk category of the World Health Organization/International Society of Hypertension (WHO/ISH) Guidelines. Compared to low or moderate cardiovascular risk, multiple antihypertensive drug treatment was more frequently used in individuals at high or very high risk. These conditions were frequently underdiagnosed by physicians. CONCLUSIONS: Thus, in Italy, hypertension continues to be a poorly controlled condition. Despite being a Mediterranean country, the occurrence of hypertension is commonly associated with metabolic risk factors and often with a high or very high cardiovascular risk profile. This is not properly identified by specialist physicians.     

Alcohol raises blood pressure in hypertensive patients

The acute effect of drinking beer on blood pressure was studied in 18 hypertensive patients who were either regular, moderate (MI) or low intake (LI) drinkers. Patients in the MI group showed a significant rise in systolic blood pressure (SBP; average 12 mmHg) and pulse rate with alcohol, but no change after alcohol-free drink. No such changes with alcohol were seen in LI patients. There was a small transient rise in diastolic pressure (DBP) in response to alcohol in both the MI and LI patients. Resting plasma catecholamine levels were similar in both groups but only the MI group showed a significant rise in plasma noradrenaline (P less than 0.05) with alcohol, paralleling the rise in SBP and pulse rate. Plasma renin activity (PRA) and cortisol were unaffected by alcohol. In both groups significant falls in plasma calcium levels occurred with alcohol. The greater haemodynamic changes with alcohol in the MI group were associated with increased sympathetic activity. Chronic moderate alcohol intake, however, does not alter resting plasma catecholamine levels, at least, after hypertension is established.     

Betaxolol in obese hypertensive patients. Long-term effects on blood pressure and serum lipids.

The antihypertensive and metabolic effects of betaxolol (20 mg/day) were monitored in 40 patients (17 male), aged 54 +/- 2 yr (mean +/- SEM), with moderate essential hypertension. In a subgroup, consisting of 35 obese patients with a Quetelet index greater than 25.0, blood pressure, heart rate, side effects and biochemical variables were registered bi-monthly for a period of 6 months and after a placebo run-in and run-out period of 2 weeks. Betaxolol decreased blood pressure from 165 +/- 3/107 +/- 1 to 151 +/- 3/95 +/- 2 mmHg after 2 weeks and further to 151 +/- 3/93 +/- 2 mmHg after 6 months (p less than 0.001). Ninety percent of the patients responded to therapy with betaxolol. Heart rate fell from 77 +/- 2 to 64 +/- 1 bpm (p less than 0.001). No significant changes were observed in levels of total cholesterol, LDL-cholesterol or HDL-cholesterol. Triglycerides tended to increase from 2.2 +/- 0.3 to 2.8 +/- 0.4 mmol/l after 4 months of treatment (NS). Renal function was not influenced by betaxolol. Side effects, recorded on a standard questionnaire, did not differ between betaxolol and placebo. In conclusion, betaxolol in a fixed dose of 20 mg/day is an effective antihypertensive drug in the long-term treatment of obese, hypertensive patients, without adverse effects on lipoproteins.     

Postexercise blood pressure reduction in elderly hypertensive patients

OBJECTIVES: We sought to study: 1) the impact of hemodynamic and left ventricular function on short-term postexercise blood pressure reduction in elderly hypertensive patients; and 2) the 22-h postexercise effects on ambulatory blood pressure in elderly hypertensive patients. BACKGROUND: Although early exercise provokes postexercise blood pressure reduction, the mechanisms underlying this response are not completely understood. Besides, it is unclear whether the reduction in blood pressure after exercise lasts long enough to have clinical relevance in elderly hypertensive patients. METHODS: We studied 24 elderly hypertensive patients (age 68.9 +/- 1.5 years) and 18 age-matched normotensive control subjects (age 68.1 +/- 1.2 years). Cardiac output (carbon dioxide rebreathing) and blood pressure (auscultatory) were measured at rest and after a 45-min period of low-intensity bicycle exercise (50% maximal oxygen uptake) and at 15, 30, 60 and 90 min after exercise. Left ventricular function (by Doppler echocardiography) was also evaluated. Ambulatory blood pressure monitoring was evaluated after 45 min of exercise or 45 min of rest, in a randomized order. RESULTS: In the hypertensive patients, exercise provoked a significant reduction in blood pressure, cardiac output, stroke volume and left ventricular end-diastolic volume. It also provoked a significant reduction in systolic, mean and diastolic blood pressure during a 22-h period, at daytime and nighttime. CONCLUSIONS: The short-term reduction in blood pressure after exercise in elderly hypertensive patients is associated with a decrease in stroke volume and left ventricular end-diastolic volume. The 22-h postexercise reduction in blood pressure demonstrates the clinical relevance of low-intensity exercise in elderly hypertensive patients.     

老年高血压患者家庭血压监测情况调查研究

目的调查广州市65岁以上离退休老年高血压患者家庭血压监测的相关知识及行为情况。方法选取2016年3~5月在我院参加离退休干部体检和社区健康体检的高血压患者765例,其中家庭测血压354例(测量组),家庭未测血压411例(未测组)。进行横断面调查,包括基线资料(性别、年龄、生命体征、既往疾病史、检验结果等)和家庭血压测量频率、测量时间、血压达标情况等。结果765例高血压患者中,每天测血压224例(29.3%),每天多次测血压32例(4.2%),无固定时间测血压98例(12.8%)。晨起测血压205例(26.8%),睡前测血压12例(1.6%),晨起+睡前测血压17例(2.2%),有症状时测血压120例(15.7%)。测量组降压目标知晓率和达标率明显高于未测组(33.9%vs 22.4%,P=0.000;53.7%vs 44.0%,P=0.008),收缩压明显低于未测组[(137.46±18.23)mm Hg vs(140.78±18.36)mm Hg,P=0.008]。结论调查人群中家庭血压监测率不高,且家庭血压相关知识认知不足,医护人员在健康教育中应着重加强家庭血压相关知识指导及培训,以提高血压达标率。     

Ambulatory blood pressure monitoring in elderly hypertensive patients

Ambulatory blood pressure monitoring in elderly persons provides the clinician with the opportunity to determine blood pressure outside the office more accurately. Recent technologic developments in the recorders have greatly improved the feasibility of their use and the accuracy of their recordings. Correlations of the blood pressures obtained by ambulatory blood pressure recorders with standard mercury sphygmomanometers indicate that the measurements are accurate and may improve the assessment of risks related to hypertensive cardiovascular diseases. Clinicians should be aware of the applications of ambulatory blood pressure monitoring and alert to situations in which it can be useful in clinical decision making.     

Morning versus evening amlodipine treatment: effect on circadian blood pressure profile in essential hypertensive patients

OBJECTIVE: To determine the antihypertensive efficacy and the potential impact on circadian blood pressure pattern of morning versus evening administration of amlodipine to essential hypertensive patients. METHODS: Twelve mild-to-moderate essential hypertensives were investigated in this open, randomized cross-over study. Blood pressure and heart rate were measured by use of ambulatory blood pressure monitoring after a wash-out period of 1 week and after treatment schedules with 5 mg amlodipine once a day either at 0800 h or at 2000 h for 3 weeks. Effects were evaluated by linear and rhythm analysis using the ABPM-FIT program. RESULTS: Both morning and evening administrations of amlodipine significantly (P < 0.01) reduced the elevated systolic and diastolic blood pressures during daytime. However, due to baseline values being lower during night-time, a significant (P < 0.05) reduction was observed only in systolic, not in diastolic, blood pressure. Maximal blood pressure values were significantly (P 相似文献   

Accuracy of oscillometric blood pressure monitoring with concurrent auscultatory blood pressure in hemodialysis patients

BACKGROUND: Oscillometric devices are commonly used to measure blood pressure and their validation entails sequential measurements of auscultated and oscillometric blood pressures. It is unknown whether simultaneous measurement of auscultated blood pressure and concurrent digitization and recording of the sounds can improve assessment of such devices. The aim of this study was to develop a technique of simultaneous measurement of blood pressure using oscillometric and auscultated measurements in the same deflation. Using such a device, we validated the Omron HEM-907 blood pressure measuring device in hemodialysis patients. METHODS: Twenty non-hypertensive subjects and 20 hemodialysis patients were studied. Six blood pressure readings were obtained in each participant; three readings were obtained using the automatic, oscillometric mode of Omron HEM-907 and three readings were obtained using the manual mode of the Omron HEM-907. In each situation, simultaneous digitized Korotkoff sounds and manometric pressures were recorded. The grading scale indicated by the British Hypertension Society protocol was used to assess the device. RESULTS: Systolic blood pressure measured simultaneously by digitized sound and pressures agreed closely for systolic pressure (Grade A for both hemodialysis and normal controls) but not for diastolic pressure (Grade C for both hemodialysis and controls). Sequential comparison of oscillometric readings with auscultated systolic and diastolic pressure yielded a Grade B for both hemodialysis patients and controls. When concurrent digitized systolic readings were used, however, Grade A was achieved for both populations for systolic readings, but Grade C for diastolic readings. The mean differences (SD) between the oscillometric and auscultatory blood pressure reading in normal controls were 4.3 (8.9) and 0.6 (8.7) for systolic and diastolic blood pressures, respectively. In hemodialysis patients, the mean differences (SD) were 2.7 (9.3) and 0.4 (7.0) for systolic and diastolic blood pressures, respectively. CONCLUSION: Simultaneous measurement of digitized Korotkoff sounds and pressure can improve the assessment of devices for systolic but not diastolic blood pressure. The Omron HEM-907 device can be recommended for use in hemodialysis patients.     

Tele-monitoring of home blood pressure in treated hypertensive patients

AIM: To compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the assessment of antihypertensive effect. METHODS: 362 patients on antihypertensive medication performed HBP measurement (5 days, duplicate measurements, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. RESULTS: CBP was much higher than ABP and average HBP (p < 0.001). There was a progressive decline in HBP over the course of the study, achieving the level of daytime ABP on the last 2 monitoring days. The correlation between CBP and ABP was weak (systolic: r = 0.343, diastolic r = 0.430), whereas strong correlations existed between HBP and ABP (systolic r = 0.804, diastolic r = 0.776). A progressive improvement in the strength of the correlation between average HBP of single days and ABP was obtained over the 5 monitoring days. The HBP readings taken in the afternoon showed a stronger correlation with ABP than the values measured in the morning, at noon and in the evening. Averaging more HBP readings taken on succeeding days resulted in a progressive improvement in the agreement with ABP with a further benefit when readings of day 1 were included. CONCLUSIONS: The accuracy of telemedical HBP measurement is substantially better than that of CBP. The results suggest, that HBP should be measured for 5 days, and afternoon measurements should be preferred in assessing control of hypertension.     

老年高血压病人血压变异性分析

目的：探讨老年高血压病患血压变异性与靶器官损害及年龄的关系。方法：对478例老年高血压病人及229例非高血压进行了24小时动态血压监测，以测得的血压标准差作为血压变异性指标。结果：高血压病患的24小时血压变异性大于非高血压（P＜0．05），高血压病人中靶器官损害的24小时血压变异性大于无损害的（P＜0．05）；各年龄组间的血压变异性无明显差别。结论：老年高血压病人24小时血压变异性增加，靶器官损害的24小时变异性更高。     

Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients.Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol.ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients.ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.     

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.     

排便对高血压患者血压的影响

目的:探讨高血压患者排便时血压的变化。方法:测定126例高血压患者排便前、排便中及排便后的血压并进行统计分析,比较三者的差别,评估排便对血压的影响。结果:血压在排便时明显升高,其收缩压与舒张压分别为(151.13±24.21)mmHg、(92.10±19.69)mmHg,明显高于排便前(135.08±20.28)mmHg、(85.05±15.48)mmHg,排便后(133.39±19.13 mmHg)、(83.42±15.37)mmHg(P0.05)。排便前、后血压无显著差别(P0.05)。结论:高血压患者排便时血压明显升高。     

Usefulness of ambulatory blood pressure monitoring in hypertensive patients

Treated or untreated hypertensive patients may have very different blood pressure levels when measured by the doctor in his surgery and when measured by ambulatory monitoring during their usual everyday activities. It is now possible to record blood pressure non-invasively with a portable blood pressure measuring device, the Remler M2000. Using this device, we observed that less than half of the patients referred by their medical practitioner for hypertension had abnormally high blood pressures during their everyday activities. We also noted that the ambulatory blood pressure profile of a given hypertensive patient cannot be predicted from the blood pressure recorded by his or her doctor. Consequently, we concluded that ambulatory blood pressure recordings would appear to be essential for the detection of patients with high blood pressure readings at the doctor's surgery and during everyday activities. These patients probably include the only group which really needs appropriate antihypertensive therapy.