Multifactorial evaluation of blood pressure fall upon hospitalization in essential hypertensive patients

Abstract

1. Studies were prospectively performed on 72 hospitalized patients with essential hypertension. Blood pressure was normalized within 1 week of admission in 33 patients (group I), but did not decrease in 39 patients (group II). To determine the factors that differentiate group I from group II, cardio-renal haemodynamic and endocrinological indices were evaluated using multivariate analysis. 2. Systolic, diastolic and mean blood pressures on admission were higher in group II (P less than 0.001), whose optic fundi showed more severe changes (P less than 0.001). Although group II had greater left ventricular posterior wall thickness (P less than 0.02), left ventricular mass index (P less than 0.05) and systemic vascular resistance (P less than 0.01) on echocardiography, their cardiac index and ejection fraction were comparable with those of group I. 3. Renal blood flow (P less than 0.05) and glomerular filtration rate (P less than 0.01) were lower in group II than in group I. Renal vascular resistance was more elevated (P less than 0.01) in group II than in group I. 4. After severe sodium depletion and ambulation, group I showed a greater increase in plasma noradrenaline and adrenaline (P less than 0.05). On multivariate analysis, those with lower systolic blood pressure, better renal function and more reactive sympathetic nervous system were discriminated as group I. 5. These data suggest that group I patients have lower systolic blood pressure on admission, greater sympathetic reactivity and better renal function, all of which contribute to their spontaneous blood pressure fall after admission.

Race Affects the Decline in Blood Pressure With Hospitalization

“…As previously shown, [13][14][15][16] the findings also indicated that the patient's preadmission BP was the single strongest determinant of hospital BP (ie, the greatest drop in BP following hospitalization occurred in those with the highest preadmission BP, those subjects with hypertension). Prior to the development of antihypertensive medications, hospitalization was one of the few treatments available for hypertension.…”

“…Prior to the development of antihypertensive medications, hospitalization was one of the few treatments available for hypertension. [13][14][15][16] The literature on white coat hypertension 28 suggests that a subset of approximately 20% of hypertensive individuals show a pronounced white coat effect, ie, may be more likely to show a reduction in BP outside the doctor's office. 28 In these two studies, the number of black and white hypertensive subjects was fairly balanced (29 and 32, respectively).…”

“…BP typically returned to prehospital admission levels within a few days following discharge. [13][14][15][16] This phenomenon appears to be related to diverse factors associated with hospitalization itself, including changes in sodium intake, habituation to the medical environment, and isolation from the stress and worries of the patient's regular environment. 13,14,16,17 Despite the literature on racial differences in BP, few if any studies have examined whether ethnicity influences this effect of hospitalization on BP.…”

Use of oral antihypertensive medication preceding blood pressure elevation in hospitalized patients

“…Individually, this blood pressure elevation is not a matter of using antihypertensive medication 1 . It is also important to observe that hypertensive patients experience a decrease in blood pressure after being admitted to the hospital regardless of the treatment [2][3][4][5] . In the last 2 decades, antihypertensive medications that act quickly after oral or sublingual administration [6][7][8][9][10][11][12] have been used.…”

Spontaneous fall in blood pressure and reactivity of sympathetic nervous system in hospitalized patients with essential hypertension.

“…Hypertensive patients often exhibit a spontaneous fall in blood pressure (BP) during hospitalization (1)(2)(3)(4). Although the mechanisms responsible for this spontaneous reduction should provide considerable insight into the pathophysiology of essential hypertension, only a few investigations have been carried out to elucidate this phenomenon.…”