The variability of arterial pressure

Littler, W. A.; West, MJ; Honour, A. J.; Sleight, Peter

doi:10.1016/0002-8703(78)90461-1

Cited by 115 publications

(28 citation statements)

References 8 publications

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“…BP usually follows a circadian pattern with values peaking during the daytime hours falling to a nadir after midnight (27,28). From an operational standpoint, hypertensive subjects are divided, on the basis of their BP dip, or change, from day to night, into "dippers" and "nondippers" (reduction in BP Ͻ10%) (29).…”

Section: Day-night Bp Changesmentioning

confidence: 99%

Clinical Usefulness of Ambulatory Blood Pressure Monitoring

Verdecchia

Angeli

Gattobigio

2004

Journal of the American Society of Nephrology

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Abstract. During the past decade, several prospective studies showed that ambulatory BP (ABP) measurements provide a better prediction of major cardiovascular events when compared with clinic BP measurements. This review summarizes the available evidence supporting the use of ABP monitoring to refine prognostic stratification in hypertension. On the basis of available evidence, an operational flowchart is suggested to interpret results of ABP for better treatment of patients with elevated BP.The first device for noninvasive ambulatory BP (ABP) monitoring (ABPM) was developed in 1962 and subsequently modified by Sokolow et al. in 1966 (1). It used a microphone taped over the brachial artery, a cuff inflated by the patient, and a magnetic tape recorder for storing cuff pressure (1). During the past 20 yr, new devices have been were developed and ABPM is now widely used for research and clinical purposes. Evidence is accumulating that ABP measurements provide a better prediction of clinical outcome as compared with conventional clinic BP measurements (2-19). This review examines the evidence supporting the use of ABPM, discusses the advantages of ABPM over clinic BP to predict clinical outcome, and provides information on how to interpret ABPM profile and on when it should be used in clinical practice. Which Is the Rationale for Use of ABPM in Clinical Practice? Association between ABPM and Target Organ DamageMost studies have shown that end-organ damages associated with hypertension, including left ventricular (LV) hypertrophy, proteinuria, serum creatinine, atherosclerotic plaque, narrowing of the retinal arteries, and impaired arterial distensibility and compliance, are more strongly correlated with ABPM than with clinic BP measurements (2-16). The association between clinic BP and hypertension-related organ damage is relatively poor because the main limitations of clinic BP are those referred to the marked variability of BP measurements and the white-coat effect. ABPM and Prediction of Clinical OutcomeIn treated or untreated patients with hypertension, ABP is a significantly better predictor of cardiovascular (CV) and cerebrovascular events than clinic BP measurements (2-19). Table 1 provides an overview of event-based prognostic studies on ABP published in full-length papers by several independent groups. Each group is represented in Table 1 with its largest contribution (2-19). Even if most of the available evidence on the prognostic value of ambulatory BP relies on subjects who were untreated at the time of ABPM, a recent study from our group provided substantial evidence that achieved ambulatory BP during treatment is a potent determinant of the subsequent events and that its potency is superior to both pretreatment ABP and pretreatment and in-treatment clinic BP (17). How to Interpret ABP ProfileAn average daytime ABP Ͻ135 mmHg systolic and 85 mmHg diastolic is generally considered normal for adults; levels Ͻ130/80 mmHg may be considered optimal (20 -23). White-Coat HypertensionWhite-coat hypertension (W...

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Section: Day-night Bp Changesmentioning

confidence: 99%

Clinical Usefulness of Ambulatory Blood Pressure Monitoring

Verdecchia

Angeli

Gattobigio

2004

Journal of the American Society of Nephrology

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“…The mean and standard deviation of the histograms were then used to measure mean SBP and DBP and variability of BP respectively. 13 …”

Section: Ambulatory Intraarterial Blood Pressure Monitoringmentioning

confidence: 99%

Cardiovascular response in black and white hypertensives.

Rowlands¹,

Giovanni²,

McLeay³

et al. 1982

Hypertension

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SUMMARY Sixteen untreated black patients with mild-to-moderate hypertension and no evidence of target organ damage were matched for age, sex, casual blood pressure (BP), and socioeconomic status with 16 white hypertensives. All patients were studied under standardized conditions in the hospital where they underwent continuous intraarterial ambulatory monitoring of BP and assessment of BP control mechanisms. BP characteristics over prolonged periods of recording were similar for both groups, as were sinoaortic baroreflex activity and pressor response to isometric and dynamic exercise and to cold. Fasting cholesterol and triglyceride levels in both groups were similar. Resting plasma renin activity (PRA) was significantly lower in blacks, but no difference was observed in resting plasma norepinephrine levels. Urinary excretion of Na + and K + was also similar in both groups. Thus, results showed that casual BPs matched for black and whites, and recorded over a prolonged period, were similar in pattern, variability, and response to pressor stimuli. It appears that, if BP contributes to the different patterns of morbidity in blacks and whites, it is more likely to be the actual level of BP rather than differences in BP characteristics. (Hypertension 4: 817-820, 1982) KEY WORDS • ambulatory blood pressure • reflex cardiac control * atheroma T HE observation that the black population in North America has a higher blood pressure (BP) than the white population 1 2 has excited much interest. Associated with the higher BP is an increased incidence of target organ damage in blacks manifested as left ventricular hypertrophy (LVH), 3 cerebrovascular accidents/ and changes in optic fundi. 5The pathophysiological basis for raised BP in blacks and whites may differ, and reduced levels of plasma renin activity (PRA), 6 resting heart rate (HR), 7 and dopamine beta-hydroxylase (DBH) 8 could reflect differences in activity of the central nervous system. In addition, pathological studies have shown a different distribution of atheroma in the arteries of blacks and whites, 9 ' l0 the former having an increased deposition in the cerebral arteries, but conversely the coronary arteries are relatively spared, and this might be related to different BP characteristics and control between the groups.The purpose of this report is to compare the responses of matched black and white hypertensive pa-

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“…6 These methods have provided insight into the role of the sino-aortic baroreflexes in the moment-tomoment control of the cardiovascular system in the dog;" studies that clarify the factors determining variability of blood pressure in man are limited to those of BirkenhSger and co-workers, who observed that variability, measured with an automatic cuff method, correlated directly with resting cardiac output and plasma renin concentration. "•" We have measured direct arterial pressure and variability in hypertensive patients under standardized conditions and have examined the relationship of pressure and variability to age, time of day, sino-aortic baroreflex activity, biochemical indices of activity of the sympathetic nervous system and the renin-angiotensin system, and the responses to dynamic and isometric exercise and cold.…”

Section: ^"mentioning

confidence: 99%