Circadian variation in blood pressureImplications for the elderly patient

Abstract

In most people, blood pressure (BP) displays a characteristic diurnal pattern, with a decline during sleep and a sharp increase around the time of awakening. The early morning surge in BP is synchronous with an increase in the risk of catastrophic cardiovascular events, including acute myocardial infarction, sudden cardiac death, and stroke. Although most clinical investigations have centered on modulating or even preventing the morning surge, emerging data suggest that it may be important to avoid nocturnal hypotension, especially in elderly patients and in those with established atherosclerotic disease. Considerable evidence has been accumulated to suggest that excessive lowering of BP at night (whether naturally or through the use of antihypertensive medications) can result in untoward ischemic phenomena, including silent cerebral damage (Binswanger's disease) or ophthalmologic symptoms (eg, anterior ischemic optic neuropathy). Controlled-onset extended-release verapamil, through its unique delivery system, tends to diminish the morning BP surge, whereas it preserves a normal nocturnal BP decline; its effect on preventing early morning cardiovascular catastrophes (while preserving relatively normal nocturnal BP) is currently being tested in a large, international clinical trial. Am J Hypertens 1999; 12:43S-49S

Prognostic value of blood pressure in acute stroke

“…[13][14][15][16][17][18]27,28 A differential effect might also exist in relation to stroke outcome. Moreover, instead of analysing a single measurement such as the first one post-stroke, using several BP measurements may more reliably reflect any impact of BP level on brain tissue damage or salvage.…”

“…BP values registered between 06.00 and 09.00 and between 18.00 and 24.00 were not included in the analyses, because in these periods it is assumed that the BPswitch between the night-time and daytime period occurs. 18 We also analysed the first blood pressure taken after admission to the stroke unit.…”

Pressão arterial de 24 horas em mulheres idosas normotensas e com hipertensão do avental branco

“…The explanations proposed for these observations include the fact that the elderly spends more time in bed than younger people, experiences less deep sleep wakes up more often at night and has a more fragmented sleep 33 . The elderly also present a higher morning surge of BP than younger individuals, and throughout time, particularly when they present sustained arterial hypertension, they will tend to develop more areas of potential ischemia in the brain (shadow areas), in the heart, kidneys and peripheral vessels.…”

“…The elderly also present a higher morning surge of BP than younger individuals, and throughout time, particularly when they present sustained arterial hypertension, they will tend to develop more areas of potential ischemia in the brain (shadow areas), in the heart, kidneys and peripheral vessels. Finally, elderly individuals present a higher absolute risk of cardiovascular events than younger individuals, not only due to the age, but attributable in part, to sleep apnea, with consequent cardiac arrhythmias, which are more common among individuals older than 65 years 33 .…”

Best reproducibility of the ankle–arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure

“…Systematic error may be caused by (i) observer bias, (ii) last digit preference, (iii) problems with equipment, or (iv) variation in used technique [12,13]. Random variation reflects fluctuations in biological, mechanical and environmental circumstances, such as seasonal variation, body mass index, use of antihypertensive drug therapy, plasma cholesterol, smoking status, and diabetes [14][15][16]. In our study, AAI measurements were performed by a well-trained and experienced observer.…”