The Influence of Antihypertensive Agents on Circadian Rhythms of Blood Pressure and Heart Rate in Patients with Essential Hypertension.

Abstract

The effects of once-daily administration of calcium (Ca) channel blockers, R-blockers and angiotensinconverting enzyme (ACE) inhibitors on circadian rhythms of blood pressure (BP) and heart rate (HR) were studied using the cosinor method. Sixty-two recruited patients with essential hypertension (WHO stage I or II) were divided into three groups based on the class of administered drugs. In the Ca channel blocker group (n=37, age 54± 9.0 years), 18 patients were given YM 730 at a mean dose of 11± 4.0 mg/day (mean ± s.n. ), 8 were given nitrendipine (11 ± 6.7 mg/day), and 11 were given nisoldipine (8±6.4 mg/day). In the f3-blocker group (n=15, age 42+13.5 years), 13 patients were given atenolol (44+11.0 mg/day), 1 was given nadolol (30 mg/day), and 1 was given sustained-release propranolol (60 mg/day). In the ACE inhibitor group (n =10, age 56± 8.7 years), 7 patients were given enalapril (6± 2.8 mg/day), and 3 were given lisinopril (20 mg/day). Ambulatory BP monitoring (ABPM) was performed before and during treatment. Mean arterial pressure (MAP) and HR were monitored under ambulatory conditions every five minutes for 24 hr with a finger volume oscillometric device. In all three groups, the mesor of MAP decreased significantly, while the amplitude and acrophase did not change during treatment. /l-Blockers reduced the amplitude as well as the mesor of HR. Ca channel blockers increased the amplitude of HR without influencing the mesor. ACE inhibitors had no effect on the circadian rhythm parameters of HR. These results suggest that Ca channel blockers, /l-blockers and ACE inhibitors lowered BP throughout the day without changing the circadian BP rhythm. However, the three drug classes may have different influences on the autonomic nervous system that regulates circadian cardiac rhythm. circadian rhythm ; blood pressure ; heart rate ; antihypertensive agents ; essential hypertension

Blood Pressure Rhythmicity and Visceral Fat in Children With Hypertension

“…26 It seems that different drug classes exert different effects on the autonomic nervous system and the neurogenic and humoral factors affecting circadian rhythmicity. 27 The clinical characteristics including intermediary phenotype, severity of hypertension, prevalence of TOD and MS were typical for adolescents with PH.…”

Differences in circadian time structure of diastolic blood pressure between diabetes mellitus and essential hypertension

“…Thus, this multi-group comparison study, despite the limitation of small sample size, suggests for the first time that people with diabetes mellitus, both type 1 and type 2, are more likely to have their circadian acrophase of DBP occurring 2–4 hours earlier than normotensive and hypertensive subjects. Current drug therapy can unlikely explain this phase shift since 1) the percentage of T2D patients (90%) receiving antihypertensive therapy was similar to that of HT patients (100%), and 2) cosinor analysis has generally demonstrated the preservation of circadian rhythms in patients receiving antihypertensive drugs [12-15]. In the whole study sample, the magnitude and direction of DBP phase shift depended on HbA1c levels (advance) and/or SBP acrophase (delay).…”

Morning surge in blood pressure using a random‐effects multiple‐component cosinor model

“…Although not as common as the single‐component cosinor model, attempts to extend the model by including multiple cosine terms (Fourier analysis) allow more flexible curves to be obtained while remaining periodic . Most studies to date exploring the use of sinusoidal functions for ABPM have focused on fixed‐effects where the inference is on population effects . A key feature of ABPM analysis however is the exploration of subject‐specific effects (random‐effects) where its use in cosinor models has been limited .…”

“…To date, the main approaches proposed to model 24-hour BP that incorporate all the data and fully use the benefits of the longitudinal nature of ABPM include the cosinor method, [9][10][11][12][13] cubic splines, 14 polynomials, 15 and recently a double logistic model. 16,17 Moreover, there is no accepted "standard" method for analysing ABPM, 15 and research on the longitudinal analysis of 24-hour ABPM is lacking.…”

“…[18][19][20] Most studies to date exploring the use of sinusoidal functions for ABPM have focused on fixed-effects where the inference is on population effects. [9][10][11][12][13] A key feature of ABPM analysis however is the exploration of subject-specific effects (randomeffects) where its use in cosinor models has been limited. 21 Although mixed model approaches to cosinor analysis have previously been explored in different applications, [22][23][24] this work is considered an extension of these in relation to ABPM.…”