Conventional 24-h SD of BP is markedly influenced by nocturnal BP fall. The weighted 24-h SD of BP removes the mathematical interference from night-time BP fall and correlates better with end-organ damage, therefore it may be considered as a simple index of 24-h BP variability superior to conventional 24-h SD.

Abstract-A downward titration of antihypertensive drug regimens in summertime is often performed on the basis of seasonal variations of clinic blood pressure (BP). However, little is known about the actual interaction between outdoor air temperature and the effects of antihypertensive treatment on ambulatory BP. Key Words: blood pressure monitoring, ambulatory Ⅲ hypertension Ⅲ aging S everal studies have reported that blood pressure (BP) values obtained both in the clinic and in ambulatory conditions are lower in hot than in cold months, which is also the case in a general population. 1 In summer, a reduction in cardiovascular mortality has also been observed, 2,3 with a reduction in the occurrence of stroke in hypertensive patients. 4,5 These findings might support the practice of downward titration of antihypertensive drug regimens, especially in the elderly. However, this clinical practice is not embodied in any of the guidelines. 6,7 Moreover, there is limited information regarding the effects of changes in daily mean outdoor air temperature (Ta) on ambulatory BP (ABP) in the elderly, in particular, in aged hypertensive subjects. Finally, no information is available on whether a clinic BP-guided reduction in the dosage of antihypertensive drug, in the case of hot weather, might be responsible for a reduced coverage of BP over 24 hours. The need to clarify these issues is underlined by the observation that older hypertensive patients do not show the same reduction in morbidity and mortality during hot months as younger subjects do. 3 The aim of the present study was, therefore, to more deeply investigate the climate-related changes in clinic and ABP and heart rate in subjects referred to our institutions for BP assessment during a 4-year period. This was done with special attention to the possible interaction between outdoor temperature-related BP changes, aging, and prescription of antihypertensive treatment. Methods

According to the results of the validation study based on the European Society of Hypertension International Protocol the Omron M5-I, R5-I, and HEM-907 may be recommended for clinical use in elderly individuals, without atrial fibrillation or frequent ectopic beats.

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Both carvedilol and nebivolol partly counteract the increase in BP at altitude in healthy normotensive individuals but are associated with a lower SpO2. Carvedilol seems more potent in this regard, whereas nebivolol more effectively prevents the shift to a nondipping BP profile and is better tolerated.

The treatment of depression in cardiovascular disease patients may therefore benefit from a psychological intervention focused on patients' illness representations, self-efficacy beliefs, and their perceived social support.

Slow deep breathing improves blood oxygenation (SpO2) and affects hemodynamics in hypoxic patients. We investigated the ventilatory and hemodynamic effects of slow deep breathing in normal subjects at high altitude. We collected data in healthy lowlanders staying either at 4559 m for 2–3 days (Study A; N = 39) or at 5400 m for 12–16 days (Study B; N = 28). Study variables, including SpO2 and systemic and pulmonary arterial pressure, were assessed before, during and after 15 minutes of breathing at 6 breaths/min. At the end of slow breathing, an increase in SpO2 (Study A: from 80.2±7.7% to 89.5±8.2%; Study B: from 81.0±4.2% to 88.6±4.5; both p<0.001) and significant reductions in systemic and pulmonary arterial pressure occurred. This was associated with increased tidal volume and no changes in minute ventilation or pulmonary CO diffusion. Slow deep breathing improves ventilation efficiency for oxygen as shown by blood oxygenation increase, and it reduces systemic and pulmonary blood pressure at high altitude but does not change pulmonary gas diffusion.

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