Does Placebo Lower Blood-Pressure?

Gould, Brian A.; Davies, Anthony B.; Mann, Stewart; Altman, D G; Raftery, E. B.

doi:10.1016/s0140-6736(81)92799-9

Cited by 149 publications

(39 citation statements)

References 32 publications

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“…We also now know that administration of a placebo in a double-blind fashion over 6 weeks has no significant influence on blood pressure using intra-arterial techniques (Gould et al, 1981b) and the same methods of analysis as used in this study, hence also confirming the longer term reproducibility of this technique.…”

Section: Clinic Blood Pressures (N = 16)supporting

confidence: 77%

A study of nadolol to determine its effect on ambulatory blood pressure over 24 hours, and during exercise testing.

Hornung¹,

Gould²,

Kieso³

et al. 1982

Brit J Clinical Pharma

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1 The effect of once daily nadolol therapy in sixteen ambulant patients with essential hypertension has been closely assessed during exercise and over 24 h by continuous intra‐arterial recording. 2 The drug was well tolerated and showed similar efficacy to other beta‐adrenoceptor blocking agents. Whilst blood pressure reduction was observed throughout the whole day, it was not uniform and lost significance during the morning period when blood pressure levels were highest. 3 This provides further evidence that the antihypertensive action of a beta‐adrenoceptor drug over 24 h cannot be predicted from its plasma half‐life which, with regard to nadolol, is up to 24 h. 4 An explanation for the loss of blood pressure control during the morning may be that the rapid rise in blood pressure leading to the peak levels at this time may be mediated through alpha‐ rather than beta‐adrenergic receptors at the periphery.

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Section: Clinic Blood Pressures (N = 16)supporting

confidence: 77%

A study of nadolol to determine its effect on ambulatory blood pressure over 24 hours, and during exercise testing.

Hornung¹,

Gould²,

Kieso³

et al. 1982

Brit J Clinical Pharma

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“…Although some controversy exists over the physiologic mechanisms producing this pattern,'7-20 the basic day-night change is undisputed. We have demonstrated its reproducibility2l' 22 and independence of physical activity23 but, despite a large number of studies, we have not identified any group of patients with a qualitatively different pattern.…”

mentioning

confidence: 78%

Circadian variation of blood pressure in autonomic failure.

Mann¹,

Altman²,

Raftery³

et al. 1983

Circulation

246

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We have monitored ambulant intra-arterial blood pressure with the Oxford system in six subjects with autonomic failure who exhibited postural hypotension. Plotting pooled hourly mean values we have demonstrated a consistent circadian trend in blood pressure that was the inverse of the normal pattern, with the highest pressures at night and the lowest in the morning. In four subjects, confinement to bed did not substantially alter this pattern. Heart rate variability was much reduced in four of the subjects, but relatively normal in two in whom blood pressure variation was also less abnorrnal. There was a correlation of the nadir of the blood pressure measurements with the reported time of peak incidence of orthostatic symptoms. These findings are of importance in both the management and physiologic testing of patients with this condition. Circulation 68, No. 3, 477-483, 1983. THE PRINCIPAL cardiovascular abnormalities found in subjects with autonomic failure are an unvarying heart rate and orthostatic hypotension, 1-1 the latter producing the disabling postural dizziness associated with the condition. Such large swings of blood pressure might be expected to obscure trends due to factors other than posture, although supine blood pressure measurements in such patients are also known to be highly variable,6 7 often showing hypertensive levels8'9 that may be exacerbated by treatment. 101 I Several of the many case reports of this condition" 7 8. [12][13][14] comment on the greater severity of postural symptoms in the morning, with improvement during the afternoon and evening. This observation has suggested the presence of important circadian periodicity.We have previously reported circadian trends in blood pressure in normal and hypertensive subjects,'5' 16 the highest levels occurring in the morning and the lowest during sleep at night. Although some controversy exists over the physiologic mechanisms producing this pattern,'7-20 the basic day-night change is undisputed. We have demonstrated its reproducibility2l' 22 and independence of physical activity23 but,

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“…Thus, the greater fall in office BP in patients with severely elevated pretreatment BP is caused to a large extent by the reduction of the white coat effect. Because 24-hour ABP is void of white coat and placebo effect, the changes in ABP are smaller and the pretreatment BP level lower, [13][14][15] thereby explaining at least in part why changes in office BP and ABP are not related to each other in a 1:1 fashion. The statistical phenomenon of regression to mean might be also one contributing factor, but it is impossible to quantify the effect size from our data set.…”

Section: Discussionmentioning

confidence: 99%

Disproportional Decrease in Office Blood Pressure Compared With 24-Hour Ambulatory Blood Pressure With Antihypertensive Treatment

et al. 2014

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The present analysis is based on the data of 3A Registry. 6 The 3A Registry is a prospective, observational, noninterventional, multicenter registry listed under clinicaltrials.gov (NCT01454583) and the Abstract-The long-term relationship between 24-hour ambulatory blood pressure (ABP) and office BP in patients on therapy is not well documented. From a registry we included all patients in whom antihypertensive therapy needed to be uptitrated. Drug treatment included the direct renin inhibitor aliskiren or an angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker or drugs not blocking the renin-angiotensin system, alone or on top of an existing drug regimen. In all patients, office BP and 24-hour ABP were obtained at baseline and after 1 year with validated devices. In the study population of 2722 patients, there was a good correlation between the change in office BP and 24-hour ABP (systolic: r=0.39; P<0.001; diastolic: r=0.34; P<0.001). However, the numeric decrease in office BP did not correspond to the decrease in ABP in a 1:1 fashion, for example, a decrease of 10, 20, and 30 mm Hg corresponded to a decrease of ≈7.2, 10.5, and 13.9 mm Hg in systolic ABP, respectively. The disproportionally greater decrease in systolic office BP compared with ABP was dependent on the level of the pretreatment BP, which was consistently higher for office BP than ABP. The white coat effect (difference between office BP and ABP) was on average 10/5 mm Hg lower 1 year after intensifying treatment and the magnitude of that was also dependent on pretreatment BP. There was a disproportionally greater decrease in systolic office BP than in ABP, which for both office BP and ABP seemed to depend on the pretreatment

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Does Placebo Lower Blood-Pressure?

Cited by 149 publications

References 32 publications

A study of nadolol to determine its effect on ambulatory blood pressure over 24 hours, and during exercise testing.

A study of nadolol to determine its effect on ambulatory blood pressure over 24 hours, and during exercise testing.

Circadian variation of blood pressure in autonomic failure.

Disproportional Decrease in Office Blood Pressure Compared With 24-Hour Ambulatory Blood Pressure With Antihypertensive Treatment

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