Identification of sleep disruption and sleep disordered breathing from the systolic blood pressure profile.

Arterial hypertension (AH) in patients with sleep-disordered breathing (SDB) is characterized by a higher level of blood pressure, increased variability and impaired circadian rhythm of blood pressure. The goal of the paper is to establish the changes in 24-hour blood pressure profile in patients with chronic cerebrovascular diseases and sleep-disordered breathing to optimize antihypertensive therapy. Materials and Methods. The trial enrolled 100 patients with chronic cerebrovascular diseases; the average age was 65 years (58.0; 74.5). Arterial hypertension was detected in 92 % of patients. All patients underwent 24-hour blood pressure monitoring. Cardiorespiratory monitoring was performed to verify sleep-disordered breathing. The authors also determined Apnea Hypopnea Index (AHI), saturation, and the duration of apnea episodes. Results. Patients with moderate and severe sleep-disordered breathing (AHI≥15) demonstrated an increased systolic blood pressure (SBP) within 24 hours, an increased diastolic blood pressure (DBP) at night (p<0.05), as well as increased SBP and DBP variability at night. A decrease in circadian rhythm of blood pressure was observed in 65–70 % of patients, including 16 % of patients with increased night-time blood pressure. These changes correlated with the severity of sleep-disordered breathing (AHI), total desaturation duration and depth (p<0.05). Conclusion. To increase the effectiveness of AH treatment and to control the target BP level in patients with chronic cerebrovascular diseases, it is necessary to find out whether patients suffer from sleep-disordered breathing, especially if night-time hypertension is detected. Keywords: cerebrovascular diseases, 24-hour blood pressure monitoring, sleep-disordered breathing. Артериальная гипертония (АГ) у больных с нарушением дыхания во сне (НДС) характеризуется более высоким уровнем АД, повышенной вариабельностью и нарушением циркадного индекса (ЦИ) АД. Цель – установить особенности изменений суточного профиля АД у больных хроническими цереброваскулярными заболеваниями (ЦВЗ) и НДС для оптимизации антигипертензивной терапии. Материалы и методы. В исследование включено 100 пациентов с ЦВЗ, средний возраст – 65 (58,0; 74,5) лет. АГ выявлена у 92 % больных. Всем пациентам выполнено суточное мониторирование АД. НДС верифицировали методом кардиореспираторного мониторирования. Определяли индекс апноэ/гипопноэ (ИАГ), сатурацию и длительность эпизодов апноэ. Результаты. При НДС умеренной и тяжелой степени (ИАГ≥15) выявлено повышение систолического АД (САД) в течение суток, диастолического АД (ДАД) ночью (p<0,05), а также повышенную вариабельность САД и ДАД в ночные часы, снижение ЦИ АД у 65–70 % больных, в т.ч. повышение АД ночью у 16 % больных. Эти изменения коррелировали с тяжестью НДС (ИАГ), суммарной длительностью и глубиной десатурации (р<0,05). Выводы. Для повышения эффективности лечения АГ и контроля целевого уровня АД больных с хроническими ЦВЗ необходимо обследовать на наличие НДС, особенно при выявлении ночной гипертонии. Ключевые слова: цереброваскулярные заболевания, суточное мониторирование артериального давления, нарушение дыхания во сне.

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Hol van a normális és a kóros vérnyomás közötti határ, és mi a terápiás cél a cardiovascularis és a renalis betegségekben?

Orvosi Hetilap ◽

10.1556/650.2021.32168 ◽

2021 ◽

Vol 162 (34) ◽

pp. 1351-1361

Author(s):

Ede Kékes ◽

Judit Nagy ◽

Péter Vályi

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Systolic Blood Pressure ◽

Pressure Profile ◽

Individual Treatment ◽

Factors Influencing ◽

Blood Pressure Profile ◽

Atherosclerotic Process ◽

The Individual ◽

Preventive Methods

Összefoglaló. Az irodalmi adatok arra utalnak, hogy a systolés vérnyomás értékének emelkedése már 110–115 Hgmm-től együtt jár az atherosclerosissal összefüggő elváltozások kialakulásával is és ezzel együtt a cardiovascularis és a renalis funkció romlásával. Az összefüggés exponenciális, de mértékét az életkor jelentősen befolyásolja. A kezelés során az elérendő vérnyomás célértéke a jelenlegi adatok alapján 120–130 Hgmm között helyezkedik el a 18–65 év közötti populációban; idősebb korban – különösen 80 év felett – ennél magasabb, a 130 Hgmm alatti érték elérése nem reális, de talán nem is szükséges. A leghelyesebb az egyéni vérnyomásprofil meghatározása, és számos befolyásoló tényezőt is figyelembe kell venni a páciens legmegfelelőbb kezeléséhez. A populáció egészségének javításához és megőrzéséhez az egyik legfontosabb és leggyakoribb cardiovascularis kockázati tényezőt, a magas vérnyomást időben fel kell fedezni, amihez a vérnyomást rendszeresen szükséges ellenőrizni, és ezzel párhuzamosan kell végezni a prevenciót célzó tevékenységeket (nevelés, oktatás, szűrés, egészségtudatos életmód) is. Orv Hetil. 2021; 162(34): 1351–1361. Summary. The data in the literature suggest that the increase in the value of systolic blood pressure from 110–115 mmHg leads to the development of atherosclerotic process and to the deterioration of cardiovascular and renal function. The correlation is initially linear, then above 140–150 mmHg it is already exponential, but it is also related to the progression of the age. The systolic target for therapy is between 120–130 mmHg in the population aged 18–65; in older ages – especially over 80 years – it is higher and reaching the value below 130 mmHg is unrealistic, and may even be not necessary. It is the best to determine the individual treatment, taking into account the individual blood pressure profile and the factors influencing the patient. In order to improve and maintain the health of the population – in addition to unknown hypertension – it is necessary to regularly monitor blood pressure and apply the known preventive methods (education, training, screening, etc). Orv Hetil. 2021; 162(34): 1351–1361.

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Ambulatory Monitoring of Blood Pressure Disturbs Sleep and Raises Systolic Pressure at Night in Patients Suspected of Suffering from Sleep-Disordered Breathing

Clinical Science ◽

10.1042/cs0910045 ◽

1996 ◽

Vol 91 (1) ◽

pp. 45-50 ◽

Cited By ~ 17

Author(s):

E. Heude ◽

P. Bourgin ◽

P. Feigel ◽

P. Escourrou

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Ambulatory Blood Pressure ◽

Sleep Disordered Breathing ◽

Diastolic Pressure ◽

Ambulatory Monitoring ◽

Systolic Pressure ◽

Aged Patients ◽

Ambulatory Monitor ◽

Disordered Breathing

1. The aim of the study was to assess the effect of ambulatory monitoring of blood pressure on sleep and on blood pressure in middle-aged patients. 2. Nine consecutive patients (seven men, two women; mean age 57 years) complaining of snoring and various degrees of excessive daytime somnolence were studied. Five patients were normotensive and four were being treated for hypertension. During one night standard laboratory polysomnography was performed with monitoring of blood pressure by a silent ambulatory monitor and continuous infrared blood pressure by photoplethysmography. 3. Ambulatory blood pressure significantly disturbs sleep architecture, causing EEG arousals in 64% of measurements, and induces a significant rise in blood pressure during systolic pressure measurement by the ambulatory monitor (rise in systolic pressure, 13.7 ± 15.9 mmHg, P > 0.001; rise in diastolic pressure, 3.7 ± 8.2 mmHg, P > 0.01). At the time of diastolic measurement, blood pressure had returned to the preinflation value. The rise in systolic blood pressure was higher when an arousal was associated with cuff inflation (P > 0.001). This rise in blood pressure is probably the consequence of sympathetic nervous system activation. 4. We conclude that ambulatory blood pressure recordings of systolic blood pressure during sleep should be interpreted with caution as systolic blood pressure may be significantly increased in patients suspected of suffering from sleep-disordered breathing.

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CARDIOVASCULAR REMODELING IN PATIENTS WITH HYPERTENSION WITH DIFFERENT DEGREES OF COGNITIVE IMPAIRMENT

Wiadomości Lekarskie ◽

10.36740/wlek201904132 ◽

2019 ◽

Vol 72 (4) ◽

pp. 670-676

Author(s):

Natalia Y. Osovska ◽

Yulia V. Mazur ◽

Olga M. Bereziuk ◽

Serhii P. Dmytryshyn ◽

Maryna M. Velychkovych ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Systolic Blood Pressure ◽

Cognitive Activity ◽

Pressure Profile ◽

Left Ventricular ◽

The State ◽

Cardiovascular Remodeling ◽

Blood Pressure Profile ◽

Moderate Cognitive Impairment

Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

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