24 h rhythm of blood pressure and forearm peripheral resistance in normotensive and hypertensive subjects confined to bed

Casíglia, Edoardo; Palatini, Paolo; Colangeli, Giovanna; Ginocchio, Giuliana; Menza, Giuseppe di; Onesto, Caterina; Pegoraro, Luiz Fernando; Biasin, Renata; Canali, Cristina; Pessina, Achille C.

doi:10.1097/00004872-199601000-00006

Cited by 28 publications

(21 citation statements)

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“…This method has been widely validated and used by us in several clinical studies. 22 Patients laid in a supine position for at least 30 minutes before ultrasonographic and plethysmographic measurements were performed.…”

Section: Patientsmentioning

confidence: 99%

Acute effects of the oral administration of midodrine, an α-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites

et al. 1998

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The effects of the acute administration of arterial vasoconstrictors on renal plasma flow (RPF) and urinary sodium excretion (UNaV) in cirrhotic patients with ascites with or without hepatorenal syndrome (HRS) are still controversial. As a consequence, vasoconstrictors are not actually used in the treatment of renal sodium retention or HRS in these patients, regardless of the several lines of evidence suggesting that these renal functional abnormalities are related to a marked arterial vasodilation. The lack of an orally available effective arterial vasoconstrictor probably represents a further reason for this omission. Consequently, the present study was made to evaluate the acute effects of the oral administration of midodrine, an orally available ␣-mimetic drug, on systemic and renal hemodynamics and on UNaV in cirrhotic patients with ascites. Mean arterial pressure (MAP), heart rate (HR), cardiac index ( The improvement in systemic hemodynamics, which was also maintained during the the 3-to 6-hour period after midodrine administration, was accompanied by a significant increase in RPF (541.5 ؎ 43.1 vs. 385.7 ؎ 39.9 mL · min ؊1 ; P F .005), GFR (93.1 ؎ 6.5 vs. 77.0 ؎ 6.7 mL · min ؊1 ; P F .025), and UNaV (92.7 ؎ 16.4 vs. 72.2 ؎ 10.7 Eq · min ؊1 ; P F .025). In addition, a decrease in PRA (5.33 ؎ 1.47 vs. 7.74 ؎ 2.17 ng · mL ؊1 · h; P F .05), ADH (1.4 ؎ 0.2 vs. 1.7 ؎ 0.2 pg · mL ؊1 ; P F .05), and NOx (33.4 ؎ 5.0 vs. 49.3 ؎ 7.3 mol ؊1 ; P F .05) was found. In patients with HRS, the effects of the drug on the systemic hemodynamics was smaller and shorter. Accordingly, regardless of a significant decrease in PRA (15.87 ؎ 3.70 vs. 20.70 ؎ 4.82 ng · mL ؊1 · h; P F .0025) in patients with HRS, no significant improvement was observed in RPF, GFR, or UNaV. In conclusion, the acute oral administration of midodrine is associated with a significant improvement in systemic hemodynamics in nonazotemic cirrhotic patients with ascites. As a result, renal perfusion and UNaV also improve in these patients. By contrast, midodrine only slightly improves systemic hemodynamics in patients with type 2 HRS, with no effect on renal hemodynamics and renal function. (HEPATOLOGY 1998;28:937-943.)It has been hypothesized that a peripheral arterial vasodilation is the main factor in the pathogenesis of the functional renal abnormalities in patients with cirrhosis. 1-3 Arterial vasodilation is thought to be related to an excess of local or systemic vasodilators such as glucagon, prostacyclin, substance P, vasoactive intestinal peptide, bile acids, and nitric oxide. [3][4][5][6][7] The localization of arterial vasodilation as well as its link with renal sodium retention are also debated. Clinical and experimental studies suggest that the reduction of arterial vascular resistance occurs mainly in the splanchnic area, whereas in many other vascular beds, i.e., in the renal vascular bed, arterial resistance is normal or even increased in cirrhosis with ascites. 8,9 The reflex activation of the neurohumoral pressor systems, sympathetic nervous ...

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Section: Patientsmentioning

confidence: 99%

Acute effects of the oral administration of midodrine, an α-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites

et al. 1998

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“…25,27,28 The changes in BP probably reflect corresponding changes in peripheral resistance. 29 These data suggest that a hypertensive drug which produces a fall in BP during sleep is likely to confer a treatment benefit, at least in 'non-dippers', but the hypothesis is not strictly logical. As clinical trials of antihypertensive drug treatment have shown, reversal of a risk factor does not necessarily reverse the associated risk.…”

Section: Excessive Effect On Bpmentioning

confidence: 99%

Shortcomings in the trough to peak ratio as a guide to the dose interval for antihypertensive drugs

1998

J Hum Hypertens

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“…Reference standards used to diagnose MESORhypertension, CHAT or ecphasia (odd timing of circadian acrophase) were derived from data obtained on clinically healthy Caucasian controls of corresponding gender and age. In view of racial/ethnic differences in 24-h BP profiles noted in an international ABPM database, 22,32,33 further work is needed to obtain gender-and age-qualified Figure 5 As compared with patients with cerebral infarct, patients with intra-cerebral haemorrhage tend to be 'reverse dippers', with a negative day-night ratio of diastolic blood pressure. Noteworthy is the observation that o20% of patients in either group are 'dippers' with an anticipated day-night ratio between 10 and 20%.…”

Section: Circadian Bp and Hr Characteristics In Chinese Peoplementioning

confidence: 99%

Circadian blood pressure and heart rate characteristics in haemorrhagic vs ischaemic stroke in Chinese people

Jiang

Liu

et al. 2009

J Hum Hypertens

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To compare the circadian variation of blood pressure (BP) between patients with intra-cerebral haemorrhage (ICH) and with cerebral infarction (CI), around-the-clock BP measurements were obtained from 89 hypertensive patients with ICH, from 63 patients with CI and from 16 normotensive volunteers. The single and populationmean cosinor yielded individual and group estimates of the MESOR (Midline Estimating Statistic Of Rhythm, a rhythm-adjusted mean value), circadian double amplitude and acrophase (measures of extent and timing of predictable daily change). Comparison shows that without any difference in BP MESOR, the circadian amplitude of systolic (S) BP was larger in ICH than CI patients (Po0.001), and both groups differed from the healthy volunteers in BP MESOR and pulse pressure (Po0.001) and in the circadian amplitude of SBP (Po0.005). The smaller population circadian amplitude of diastolic (D) BP of the ICH group (P ¼ 0.042) is likely related to a larger scatter of individual circadian acrophases in this group as compared with that in the other two groups, an inference supported by a smaller day-night ratio of DBP for ICH vs CI patients (P ¼ 0.007). Heart rate (HR) variability, gauged by the standard deviation (SD), was decreased in both patient groups as compared with that in healthy controls, more so among ICH than CI patients (P ¼ 0.025). Thus, patients with ICH had a higher incidence of abnormal circadian characteristics of BP than patients with CI, the major differences relating to a larger circadian amplitude of SBP, a smaller HR-SD, and a larger incidence of odd circadian acrophases of DBP.

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24 h rhythm of blood pressure and forearm peripheral resistance in normotensive and hypertensive subjects confined to bed

Cited by 28 publications

References 0 publications

Acute effects of the oral administration of midodrine, an α-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites

Acute effects of the oral administration of midodrine, an α-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites

Shortcomings in the trough to peak ratio as a guide to the dose interval for antihypertensive drugs

Circadian blood pressure and heart rate characteristics in haemorrhagic vs ischaemic stroke in Chinese people

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