Fehlender nächtlicher Blutdruckabfall in der 24-Stunden Blutdruckmessung: Hinweis auf eine sekundäre Hypertonie

Schrader, J; Person, Christine; Pfertner, U.; Buhr-Schinner, Heike; Schoel, G.; Warneke, G.; Haupt, Axel; Scheler, F.

doi:10.1007/bf01718026

Cited by 22 publications

(5 citation statements)

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“…Patients who do not have a nocturnal BP drop are at greater risk for left ventricular hypertrophy [Verdecchia et al, 1990] and stroke [O'Brien et al, 1988]. Most patients with essential hypertension exhibit a nocturnal decrease in BP [Mallion et al, 1990] whereas this is lost in a number of disease states [Imai et al, 1988;Redman et al, 1976;Schrader et al, 1989].…”

Section: Discussionmentioning

confidence: 99%

Elevated ambulatory blood pressure in 20 subjects with Williams syndrome

et al. 1999

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Previous studies report conflicting frequencies of hypertension in cohorts of patients with Williams syndrome (WS). We studied blood pressure (BP) in WS using 24-hour ambulatory BP monitoring. This technique reliably measures day- and nighttime BP in a subject's natural environment and provides better prognostic information on long-term risks of hypertension than casual BP determinations. Twenty WS subjects evaluated through a multidisciplinary WS clinic and 35 age and gender-matched controls were studied. We found that WS subjects had significantly higher ambulatory BP than controls. After controlling for age, sex, and weight, the diagnosis of WS added approximately 10 mmHg to mean daytime and nighttime BPs. Hypertension, as defined by elevated mean daytime BP, was present in 40% of WS subjects versus 14% of controls (P < 0.05); among the children studied this difference was even more dramatic with 46% of WS children versus 6% of control children classified as hypertensive (P = 0.01). We also demonstrated normal diurnal BP variation but no evidence of a "white coat" effect or increased BP variability. Interestingly, parental reporting of a history of infantile hypercalcemia was strongly associated with the presence of hypertension (P = 0.008). Our data demonstrate that both children and adults with WS have higher mean BP and higher frequency of hypertension than healthy controls. Thus, elevated BP readings in the office setting should not be dismissed but require more thorough assessment.

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Section: Discussionmentioning

confidence: 99%

Elevated ambulatory blood pressure in 20 subjects with Williams syndrome

et al. 1999

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“…95% CL = Mean ± 95% CI [1] In addition, the spreadsheet was programmed to treat the rows in numerical order to compute in each individual BP series the following conventional estimates: daily mean (from 00.00 h to 24.00 h), diurnal mean (from 07.00 h to 23:00 h) and nocturnal mean (from 23.00 h to 07.00 h) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] 60+ ALL …”

Section: Discussionmentioning

confidence: 99%

“…50 It must be stressed that the identification of a patient affected by 'aperiodic hypertension' is of clinical relevance in that it has been demonstrated that hypertensives who lack a periodicity in their 24-h BP values more often than not are suffering from secondary forms of high BP. [51][52][53][54][55][56][57][58][59][60] Therefore, the identification of the aperiodic chronotype should alert clinicians to the necessity for clinical and laboratory tests in order to discover the etiology of the hypertension.…”

Section: Discussionmentioning

confidence: 99%

Rationale for Time-Qualified Reference Standards for 24-Hour Blood Pressure Values and Their Circadian Rhythms in Japanese Normotensive Adults

Kawasaki¹,

Uezono

Cugini

et al. 1999

Jpn Circ J

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t is well known that blood pressure (BP) is a variable that changes physiologically during the day because of a nyctohemeral (day-night) variability. [1][2][3][4][5] Nevertheless, clinicians still continue to compare its values to the fixed standards given by JNC-VI 6 and by WHO/ISH Guidelines 7 in their 'ad hoc' reports. Methodologically, this is an error. Endocrinologists would make the same error if they returned to comparing the morning or evening cortisol values to fixed limits of reference.It is also well known that the BP within-day variability physiologically represents a biological rhythm within an oscillatory period of about 24 h. [8][9][10][11] Nevertheless, clinicians still continue to ignore this phenomenon in approaching the 24-h BP pattern in practice. Methodologically, this is another error. Endocrinologists would make the same error if they did not exploit cortisol circadian variability for clinical purposes.These 2 errors arise from the fundamental problem of how to standardize 24-h BP values, especially now that technically-validated automated devices are available for its noninvasive ambulatory monitoring. [12][13][14][15][16][17][18][19][20][21][22] These recorders are officially accepted [23][24][25][26][27] and recognized clinically in their supremacy to casual sphygmomanometry. [28][29][30][31] Obviously, in order to eliminate the first error, clinicians need reference standards in which the circadian limits of BP are qualified. Additionally, in order to eliminate the second error, clinicians need reference standards for the parameters of the BP circadian rhythm. The present study attempts to overcome both errors by presenting the procedure that was followed in order to obtain the reference standards in normal Japanese subjects for BP within-day and the circadian rhythmicity.Jpn Circ J 1999; 63: 744 -751 (Received February 10, 1999; revised manuscript received June 9, 1999; accepted June 29, 1999) ¶ Principal Investigator of ABPM Research Group (MHW-63C-6). The aim of this study was to demonstrate that blood pressure (BP) has to be standardized according to its circadian variability, including the properties shown in its circadian rhythm. The BP time-qualified standards were derived from a sample of 644 clinically healthy normotensive Japanese subjects (320 males, 324 females; age range, 18-93 years), stratified by age-group and gender, who underwent noninvasive ambulatory monitoring according to a fixed protocol. The monitored data series shows that BP exhibits a within-day variability at any age of life in both males and females. Additionally, the monitored data series shows that BP exhibits a significant circadian rhythm at any age of life in both males and females. The age-and sex-related reference limits for the BP within-day variability constitute the time-qualified standards against which both the casual and monitored BP measurements can be compared in order to detect whether or not they are compatible with normotension. The reference limits for the BP circadian rhythm repre...

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“…Dies sind vor allem Patienten mit sekund/iren Hypertonieformen, mit Schwangerschaftshypertonie oder mit kardialen oder renalen Hochdruckfolgesch/iden [2,8,27,44,50,51]. Dies sind vor allem Patienten mit sekund/iren Hypertonieformen, mit Schwangerschaftshypertonie oder mit kardialen oder renalen Hochdruckfolgesch/iden [2,8,27,44,50,51].…”

Section: Fehlender N~ichtlicher Blutdruckabfallunclassified

Bedeutung der 24-Stunden-Blutdruckmessung in der Diagnostik und Therapie der arteriellen Hypertonie

1990

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The use of ABPM allows an improved assessment of blood pressure (BP) and therefore of the individual cardiovascular risk. It is able to identify patients who truly need therapy more exactly. Mostly patients with white coat hypertension who don't need therapy are identified. Furthermore, ABPM correlates more closely to target organ damage and to cardiovascular morbidity and mortality. This may be helpful to treat especially those patients who truly need therapy. BP exhibits a typical circadian rhythm with the highest values during the early morning hours and a decline during the night. A change of the day/night rhythm during shift work leads to an adaptation of BP rhythm. The early morning rise of BP and heart rate is accompanied by hemodynamic, rheological and biochemical alterations, which together may contribute to the increased frequency of vascular complications during the morning hours. The nightly decline of BP is often absent in patients with secondary hypertension and cardiac or renal organ damage. A lack of the nocturnal BP decline should therefore lead to further patients' evaluation. Elevated nocturnal BP seems to worsen the prognosis. ABPM offers better individual control of BP in patients on treatment and therefore is helpful to optimize the treatment. A more exact individual BP control during the awakening and sleeping period is possible as well as an avoidance of overtreatment. Patients could be protected both from prescription of too many drugs and from lowering BP too much. A further advantage lies in an improved control of patients with nocturnal hypertension.

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Fehlender nächtlicher Blutdruckabfall in der 24-Stunden Blutdruckmessung: Hinweis auf eine sekundäre Hypertonie

Cited by 22 publications

References 10 publications

Elevated ambulatory blood pressure in 20 subjects with Williams syndrome

Elevated ambulatory blood pressure in 20 subjects with Williams syndrome

Rationale for Time-Qualified Reference Standards for 24-Hour Blood Pressure Values and Their Circadian Rhythms in Japanese Normotensive Adults

Bedeutung der 24-Stunden-Blutdruckmessung in der Diagnostik und Therapie der arteriellen Hypertonie

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