Diminished nocturnal decline in blood pressure in elderly hypertensive patients with left ventricular hypertrophy

Kuwajima, Iwao; Suzuki, Yasuko; Shimosawa, Tatsuo; Kanemaru, Akiko; Hoshino, Satoshi; Kuramoto, Kizuku

doi:10.1016/0002-8703(92)91038-3

Cited by 113 publications

(47 citation statements)

References 23 publications

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“…1,2 Using ABPM, the circadian variations in blood pressure have been defined, with a normal decline of more than 10% in average nighttime blood pressure as compared with daytime blood pressure ('dipping'). Absence of this nighttime decline ('non-dipping') has been shown to be correlated with target organ damage [3][4][5][6][7][8] and prognosis. 9,10 Non-dipping was also found to be more prevalent in certain clinical situations including renal hypertension and diabetes.…”

Section: Introductionmentioning

confidence: 99%

Non-dipping in diabetic patients: insights from the siesta

et al. 2002

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Non-dipping, ie failure to lower blood pressure during sleep, has been found to be more prevalent in diabetic than in non-diabetic subjects. However, the reasons remain to be clarified. Diabetic patients may wake up more frequently during the night (for instance, due to nocturia). This may result in inclusion of awake blood pressure measurements in the night-time average and thus erroneously raise this average, causing misclassification of patients as non-dippers. However, nondipping in diabetes may be due to blunted effect of sleep itself on blood pressure secondary to autonomic neuropathy. We undertook this study in order to further clarify this question. We studied 23 diabetic patients, and 23 matched controls who underwent 24-h ambulatory blood pressure monitoring, and reported taking an afternoon nap. Afternoon nap, by virtue of its short duration,

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Section: Introductionmentioning

confidence: 99%

Non-dipping in diabetic patients: insights from the siesta

et al. 2002

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“…This study also demonstrated significant improvement of left ventricular hypertrophy along with a decrease of BNP during NIF treatment compared with AML treatment. Cardiac hypertrophy has been reported to progress as a result of reduced nighttime parasympathetic activity, 34,35 so our finding that the nighttime HF component was larger during NIF treatment than during AML treatment may be associated with the inhibitory effect of NIF on ventricular hypertrophy.…”

Section: Discussionmentioning

confidence: 52%

Influence of nifedipine coat-core and amlodipine on systemic arterial stiffness modulated by sympathetic and parasympathetic activity in hypertensive patients

et al. 2009

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The aim of this study was to compare the effects of nifedipine coat-core (once daily formulation) and amlodipine on systemic arterial stiffness in patients with hypertension. Study drugs were assigned by the randomized open-label crossover method. After the blood pressure was maintained below 130/85 mm Hg for 8 months by treatment with either drug in 48 hypertensive patients (aged 63.2±6.9 years; 64.5% men), they were switched to the other drug for another 8 months. The blood pressure, heart rate, plasma catecholamine level and brachial-ankle pulse wave velocity were measured before and after a bicycle ergometer testing. Heart rate recovery was calculated from the change of the heart rate after treadmill exercise testing. The high-frequency and low-frequency components of the heart rate variability spectrum were analyzed from 24-h Holter electrocardiograms. The change of blood pressure after exercise testing showed no significant difference between the two medications. However, the increases of heart rate, noradrenalin and branchial-ankle pulse wave velocity after exercise were significantly smaller with nifedipine treatment than with amlodipine (P¼0.0472, P¼0.006 and P¼0.0472, respectively). Heart rate recovery was significantly faster with nifedipine treatment (P¼0.0280). The nighttime high-frequency component of heart rate variability was significantly larger after nifedipine treatment than after amlodipine (P¼0.0259), while the nighttime low/high-frequency ratio was significantly smaller with nifedipine (P¼0.0429). Nifedipine reduced functional arterial stiffness and improved heart rate recovery by altering the autonomic activity balance in hypertensive patients.

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“…26 It is unclear which aspect of the 24-h blood pressure profile is most critical in predicting cardiovascular complications. Attenuation of the normal nocturnal drop in blood pressure may be associated with greater risk of end organ disease 15,23,[27][28][29][30][31][32][33][34][35][36] although results are inconsistent. 37 There is little prospective data to demonstrate the prognostic significance of nocturnal blood pressure, 38 though it would appear that at least in the elderly night-time systolic blood pressure is a more accurate predictor of outcome.…”

Section: Discussionmentioning

confidence: 99%