Circadian blood pressure patterns in ambulatory hypertensive patients

Drayer, Jan I.M.; Weber, Michael A.; Deyoung, J. L.; Wyle, Frederic A.

doi:10.1016/0002-9343(82)90327-8

Cited by 133 publications

(31 citation statements)

References 9 publications

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“…This cannot be explained solely by the elevated blood pressure seen in these subjects because no significant correlation has been found between blood pressure and its variability. 34 We therefore could not find distinct differences in the blood pressure parameters between antihypertensive-treated patients with Binswanger-type dementia and those with lacunar-type dementia.…”

Section: Discussionmentioning

confidence: 62%

Twenty-four-hour variation of blood pressure in vascular dementia of the Binswanger type.

Tohgi

Chiba

Kimura

1991

Stroke

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Using a noninvasive portable blood pressure recorder, we compared 24-hour variations of blood pressure among 1) 35 patients with Binswanger-type dementia, 2) 43 with lacunar-type dementia, 3) 26 with a single lacunar stroke, and 4) 30 controls. Each group was divided into antihypertensive-treated and -untreated subgroups. Among the untreated subgroups, patients with Binswanger-type dementia had significantly greater 24-hour mean systolic blood pressures, 24-hour systolic blood pressure standard deviations, and maximal systolic blood pressure variations than the controls (p<0.05). Among the treated patients, blood pressure variability increased similarly in all subgroups with cerebrovascular lesions compared with the controls (p<0.05). The nocturnal blood pressure decreases seen in the controls were absent among both untreated and treated patients with Binswanger-or lacunar-type dementia (/7<0.05). Our results suggest the importance of hypertension, short-term variations in blood pressure, and a sustained nighttime elevation of blood pressure for the pathogenesis of both Binswanger-type and lacunar-type dementia in patients receiving antihypertensive medication. (Stroke 1991^22:603-608) V ascular dementia of the Binswanger type, also termed subcortical arteriosclerotic encephalopathy, is characterized pathologically by diffuse white matter changes and multiple small infarcts in the cerebral white matter.1 -9 Although there has been some debate concerning this disease entity, it is now generally accepted that vascular dementia of the Binswanger type is part of the spectrum of cerebrovascular disease that occurs largely as a result of hypertensive changes in the walls of small penetrating arteries. 10Because the cerebral white matter is located in the end-fields of penetrating arteries, its metabolism may be impaired by wide fluctuations in blood pressure, particularly if cerebrovascular autoregulation is impaired. Previous reports have indicated that patients with impaired blood pressure regulation such as hypertension, labile systolic pressure, and orthostatic hypotension are at high risk for developing Binswanger-type dementia. Received November 7, 1990; accepted February 5, 1991. pressure changes and how low it may fall during the day. Moreover, it remains to be determined whether the significance of such blood pressure abnormalities is the same in the pathogenesis of single lacunar stroke or lacunar states not associated with diffuse white matter changes such as in Binswanger-type dementia.However, it has been demonstrated that ambulatory blood pressure readings correlate more closely with target-organ damage than casual blood pressure readings. 11 -14 Therefore, using a noninvasive portable blood pressure recorder, we compared 24-hour variations in the blood pressure of patients with lacunartype dementia, Binswanger-type dementia, a single lacunar stroke, and controls. Subjects and MethodsThe 134 subjects comprised four groups: 1) 30 controls (mean±SD age 69 ±10 years) with minor neurological or nonneurolo...

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Section: Discussionmentioning

confidence: 62%

Twenty-four-hour variation of blood pressure in vascular dementia of the Binswanger type.

Tohgi

Chiba

Kimura

1991

Stroke

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“…The arterial baroreflex plays a pivotal role in the neural regulation of blood pressure, and blood pressure variability is regulated by this compensatory reflex mechanism. Arterial baroreflex function is decreased in elderly individuals (9,10), and as a result, their blood pressure fluctuates (11). Although the mechanism of blood pressure variability in the elderly has been well elucidated, its clinical significance remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

Impact of Blood Pressure Variability on Cardiovascular Events in Elderly Patients with Hypertension

et al. 2005

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Blood pressure variability is one of the characteristic features of hypertension in the elderly. However, its clinical significance remains to be determined. We therefore examined the impact of blood pressure variability on the development of cardiovascular events in elderly hypertensive patients. A total of 106 consecutive hypertensive patients aged more than 60 years old (mean age, 73.9 ±8.1 years old; male, 54%), all of whom underwent 24-h ambulatory blood pressure monitoring, were followed up (median, 34 months; range, 3-60 months

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“…After prolonged tiapamil treatment (recording on the seventh day of treatment) mean daytime BP was also significantly lower than under placebo; it was 155 13/86 + 14 mm Hg Time (h) Figure 3 Comparison of the hourly profile of BP and HR after tiapamil 450 mg single oral dose (-) and after placebo (0) *P < 0.05, **P < 0.01, ***P < (Drayer et al, 1982) that was observed in most of these old patients, at this time of the day.…”

Section: Resultsmentioning

confidence: 98%

“…The variability of the blood pressure in elderly subjects is well known, and the standard deviation from the mean of the blood pressure values can be used to express it (Drayer et al, 1982). In a group of hypertensive patients aged from 60 to 64 years, observed in an outpatient clinic, the Framingham study reports a standard deviation of 16 mm Hg for the SBP (Kannel et al, 1980b).…”

Section: Resultsmentioning

confidence: 99%