scholarly journals The Impact of Obesity on Nighttime Blood Pressure Dipping

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 700
Author(s):  
Beata Moczulska ◽  
Maciej Zechowicz ◽  
Sylwia Leśniewska ◽  
Karolina Osowiecka ◽  
Leszek Gromadziński

Background and objectives: It is commonly known that obesity not only increases arterial hypertension (HT) risk but also impacts on the response to antihypertensives. This study aimed to assess blood pressure (BP) parameters based on Ambulatory Blood Pressure Measurement (ABPM) in obese patients. Materials and Methods: The study group consisted of 128 patients with obesity (BMI ≥ 30 kg/m2), with an average age of 43.25 years (±12.42), including 55 males and 73 females. They were divided into 2 groups: 1-with BMI ≥ 30 kg/m2 and <40 kg/m2, 2-with BMI ≥ 40 kg/m2. Each patient underwent 24-h blood pressure monitoring. The average 24-h, daytime and nighttime systolic and diastolic pressure, as well as 24-h mean heart rate and % of nocturnal dip, were assessed. Results: Mean BMI in group 1 was 34.73 kg/m2 (±2.96), and in group 2 it was 47.6 kg/m2 (±6.3). Group 1 was significantly older than group 2 (46.5 vs. 39 years old). The analysis of ABPM revealed significantly higher BP values in all measurements in group 2 (i.e., systolic blood pressure (SBP) 24 h median = 132 mmHg; diastolic blood pressure (DBP) 24 h median = 84 mmHg). The nocturnal dip was greater in group 1 (8.95%). Mean 24-h heart rate was also higher in group 2 (median = 76 beats/min) than group 1 (median = 67.5 beats/min). More than half of patients in group 2 had been previously treated for HT, and based on ABPM, new HT was diagnosed in 6 patients from group 1 and 14 patients from group 2. Three groups of patients were identified based on nighttime dip: dipper, non-dipper, and reverse-dipper. No patient of the extreme dipper type was found. Group 2 comprised of significantly more patients of the reverse-dipper type. Conclusions: Patients with extreme morbid obesity frequently exhibit HT of the reverse-dipping pattern. This type is often linked with a higher risk of more advanced cardiovascular illness.

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nabeel Aslam ◽  
Sobia Memon ◽  
Hani Wadei ◽  
Shehzad Niazi

Abstract Background and Aims Hypertension (HTN) and psychiatric disorders frequently co-exist in general population. Serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine re-uptake inhibitors (SNRIs) affect serotonin and norepinephrine and may lead to variation in blood pressure (BP). There is paucity of data on blood pressure variations using 24 hours ambulatory blood pressure monitoring (ABPM) with the use of SSRIs/NSRIs. Method Subjects who underwent psychiatric evaluation and ABPM within six month of each other between 1/1/2012 to 12/31/2016 at Mayo Clinic Florida were identified using billing data. Demographics, co-morbidities, medications, ABPM, and laboratory results were retrospectively collected from medical records. Subjects were divided into groups – subjects with no psychiatric diagnosis and no psychiatric medicine (Group 1) and subjects with psychiatric diagnosis and on SSRIs/NSRIs (Group 2). BP systolic and diastolic levels (day time, night time) were compared between groups controlling for age, sex, race, presence or absence of HTN, diabetes mellitus (DM) and smoking. Single and multivariable linear regression models were used to analyze group differences. Results Total of 367 subjects met inclusion criteria – Group 1=135; Group 2=232. The subjects in group 2 were older (median age 57 yrs vs 47 yrs p&lt;0.001), white (69.8 vs 60% p=0.002), smokers (15.9 vs 3.0% p&lt;0.001), history of HTN (62.5 vs 9.6%), and DM (21.1% vs 0%). ABPM showed that subjects in group 2 had higher median daytime systolic BP (131 vs 124), higher median night time systolic BP (120 vs 110), and higher median night time diastolic BP (68 vs 63). Multivariable linear regression controlling for age, sex, race, presence or absence of HTN, DM, and smoking showed that use of SSRIs/NSRIs (group 2) was significantly associated with higher night time systolic BP (8.36 mm; 95% CI 4.2, 12.5; p &lt;0.0001) and higher night time diastolic BP (4.6 mm, 95% CI 1.9, 7.29, p=0.001). On subgroup analysis comparing subjects with use of SSRIs vs NSRIs, there was no statistically significant difference in the daytime or night time systolic or diastolic BP. Conclusion Use of SSRIs and NSRIs are associated with higher nocturnal systolic and diastolic BP, which can potentially increase the risk of adverse cardiovascular outcome in this population. Higher nocturnal BP may be due to ongoing sympathetic activation during sleep with serotonin and norepinephrine with the use of SRRIs and NSRI. Further well designed prospective studies using ABPM are needed to determine the risk of nocturnal hypertension with the use of SSRIs/NSRIs that could have potential adverse cardiovascular outcome.


2020 ◽  
Vol 48 ◽  
Author(s):  
Bárbara Silva Correia ◽  
Eduardo Raposo Monteiro ◽  
João Victor Barbieri Ferronatto ◽  
Luciana Branquinho Queiroga ◽  
José Ricardo Herrera Becerra

Background: Arterial blood pressure is one of the most commonly variables monitored during anesthetic procedures in veterinary patients. The most reliable method for measuring arterial blood pressure in dogs and cats is the direct (invasive) method. However, the oscillometric method is less complex and more practical for clinical routine in small animals. Nevertheless, oscillometric monitors present great variability in accuracy. The present study aimed to determine the accuracy of the Delta Life DL 1000 oscillometric monitor for measurement of systolic, mean and diastolic blood pressures (SAP, MAP and DAP, respectively) in anesthetized dogs of different weight ranges.Materials, Methods & Results: This study was approved by the Institutional Ethics Committee of Animal Use. Fifteen female dogs of different breeds, weighing 11.6 ± 10.0 kg and with a mean age of 48 ± 51 months were used. All animals were scheduled for elective surgery under general anesthesia in the Institution Veterinary Hospital. Dogs were anesthetized with morphine, propofol and isoflurane and had one 20 or 22 gauge catheter introduced into the dorsal pedal artery for continuous, invasive monitoring of SAP, MAP and DAP. A blood pressure cuff was positioned over the middle third of the radius and connected to Delta Life DL 1000 monitor. Oscillometric readings of SAP, MAP and DAP were registered every 5 minutes, and invasive values were simultaneously recorded. Values obtained with both methods were compared (invasive versus oscillometric) by use of the Bland Altman method to determine the bias, standard deviation of bias and 95% limits of agreement. The percentages of errors between the methods within 10 mmHg and within 20 mmHg were calculated. The results obtained were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of indirect methods of arterial blood pressure measurement. Data were stratified into two groups according to the weight: < 10 kg (Group 1; n = 9); and ≥ 10 kg (Group 2; n = 6). In Group 1, 119 paired measurements were obtained, four of which classified as hypotension (SAP < 90 mmHg), 98 as normotension (SAP from 90 to 140mmHg) and 17 as hypertension (SAP > 140 mmHg). Bias (± SD) values in Group 1 were as follows: SAP, 5.2 ± 18.1 mmHg; MAP, -3.4 ± 17.2 mmHg; and DAP, 12.0 ± 17.5 mmHg. The percentages of errors within 10 mmHg were 40.3% for SAP; 45.4% for MAP and 28.6% for DAP. The percentages of errors within 20 mmHg were 72.3% for SAP, 84.0% for MAP and 68.1% for DAP. In Group 2, 66 paired measurements were obtained, nine of which classified as hypotension, 56 as normotension and one as hypertension. Bias (± SD) in Group 2 were as follows: SAP, 13.6 ± 14.3 mmHg; MAP, -1.1 ± 13.5 mmHg; and DAP, 8.2 ± 16.0 mmHg. The percentages of errors within 10 mmHg were 33.3% for SAP, 77.3% for MAP and 33.3% for DAP. The percentages of errors within 20 mmHg were 65.1% for SAP, 92.4% for MAP and 83.4% for DAP.Discussion: Based on the results of this study and reference criteria from the ACVIM, the Delta Life DL 1000 monitor had a poor accuracy for SAP, MAP and DAP and did not meet the criteria from the ACVIM in anesthetized dogs under 10 kg. Measurements of MAP in dogs ≥ 10 kg met the ACVIM criteria, but measurements of SAP and DAP did not. Based on the findings in this study, the DL 1000 oscillometric monitor is not recommended for blood pressure measurement in anesthetized dogs < 10 kg. In dogs ≥ 10 kg, measurements of MAP yielded acceptable values, but SAP and DAP measurements did not.


2019 ◽  
Vol 72 (5) ◽  
pp. 1007-1011
Author(s):  
Igor I. Kobza ◽  
Oksana Z. Didenko ◽  
Ostap G. Yavorskyi ◽  
Тaras I. Kobza

Introduction: hypertension and diabetes remain the main risk factors for stroke, which leads to premature disability and mortality. The aim: To study the dynamics of blood pressure (BP) in patients of different age groups with hypertension and diabetes type II before and after carotid endarterectomy. Materials and methods: 90 patients with hypertension and diabetes type II were selected for CE. Patients are divided into two age groups: up to 65 years (group 1) and after 65 years (group 2). We assessed the dynamics of ambulatory blood pressure monitoring (ABPM). The examination was carried out 2 days before and 6 months after surgery. CE was conducted under local anaesthesia. Results: Before operation in patients in group 2, there was a significantly higher level of average systolic BP per 24 hours (p <0.02), per day (p <0.01), per night (p <0.01) and diastolic BP per night (p <0,01). At the preoperative stage, there was a significant increase in the parameters of the variability of BP, but the increase in the variability of BP with age was not fixed. After surgery, patients with Group 1 observed a more significant positive dynamics of ABPM indices than patients in Group 2. In two age groups, the percentage of patients with an insufficient reduction of BP at night was prevalent. Conclusions: Surgical treatment of carotid stenosis is associated with a steady decrease in BP in the distant period after CE. Significant regression of BP is characteristic for patients of the younger age group.


BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021038 ◽  
Author(s):  
Gianfranco Parati ◽  
Enrico Agabiti-Rosei ◽  
George L Bakris ◽  
Grzegorz Bilo ◽  
Giovanna Branzi ◽  
...  

IntroductionMasked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM.Methods and analysisMASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed.Ethics and disseminationMASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal.Trial registration numberNCT02804074; Pre-results.


2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Attila Frigy ◽  
Annamária Magdás ◽  
Victor-Dan Moga ◽  
Ioana Georgiana Coteț ◽  
Miklós Kozlovszky ◽  
...  

Objective.The possible effect of blood pressure measurements per se on heart rate variability (HRV) was studied in the setting of concomitant ambulatory blood pressure monitoring (ABPM) and Holter ECG monitoring (HM).Methods.In 25 hypertensive patients (14 women and 11 men, mean age: 58.1 years), 24-hour combined ABPM and HM were performed. For every blood pressure measurement, 2-minute ECG segments (before, during, and after measurement) were analyzed to obtain time domain parameters of HRV: SDNN and rMSSD. Mean of normal RR intervals (MNN), SDNN/MNN, and rMSSD/MNN were calculated, too. Parameter variations related to blood pressure measurements were analyzed using one-way ANOVA with multiple comparisons.Results.2281 measurements (1518 during the day and 763 during the night) were included in the analysis. Both SDNN and SDNN/MNN had a constant (the same for 24-hour, daytime, and nighttime values) and significant change related to blood pressure measurements: an increase during measurements and a decrease after them (p<0.01for any variation).Conclusion.In the setting of combined ABPM and HM, the blood pressure measurement itself produces an increase in short-term heart rate variability. Clarifying the physiological basis and the possible clinical value of this phenomenon needs further studies.


2014 ◽  
Vol 5 (1) ◽  
pp. 5-9
Author(s):  
V. A Aydarova ◽  
Z. T Astahova ◽  
F. U Kanukova ◽  
M. M Besaeva

The study examined the effectiveness of drug correction of high numbers of blood pressure (BP) by means of modern groups of antihypertensive drugs, the effect of a fixed combination of perindopril and indapamide on circadian blood pressure monitoring, and a commitment to patients of antihypertensive therapy, based on the opened simple randomization three groupswere formed: 1st comprised of 21 patients with isolated systolic hypertension (ISAH) and 22 patients with systolic-diastolic hypertension (SDAH) - they all received monotherapy with calcium antagonists (amlodipine 10 mg/day); Group 2 - of 16 ISAH patients and 24 SDAH patients - who received monotherapy with perindopril (2 mg/day) and the third group - of 17 patients with ISAH and 14 patients with SDAH - who received combination therapy with the drug noliprel (Servier) with a fixed combination of perindopril (2 mg) and indapamide of 0,625 mg. Treatment efficacy was assessed primarily to reduce the absolute numbers of blood pressure, and taken into account as a reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP), uncontrolled drop of which, according to the literature, in elderly patients can have fatal consequences


Author(s):  
Srikanth Nathani

Background: The aim of this study was evaluation of nocturnal dipping of blood pressure in ST-elevation myocardial infarction (STEMI) patients and determining the effect of dipping on outcomes at 12 months follow-up.Methods: This was an observational, single-centre, retrospective study that included STEMI patients, performed in a tertiary care hospital in India from November 2016 to October 2017. The primary endpoint of the study was the assessment of outcomes at 12 months.  The patients were divided into two groups on the basis of blood pressure dipping, i.e., patients with positive dipping were considered in group 1 and patients with negative dipping were considered in group 2.Results: Total 43 patients were included in the study. Group 1 consisted of 27 patients and Group 2 consisted of 16 patients. Mean 24 hr systolic blood pressure (SBP) and asleep SBP in Group 1 patients was 128.15±18.05 mmHg and 122.67±18.94 mmHg, respectively. Mean 24 hr diastolic (DBP) and asleep DBP in Group 1 patients was 78.07±10.73 mmHg and 73.41±12.35 mmHg, respectively. In the patients with non-dipping, mean 24 hr SBP and asleep SBP was 130.56±27.32 mmHg and 135.13±29.58 mmHg, respectively. Mean 24 hr DBP and asleep DBP was 76.00±15.40 mmHg and 79.69±17.05 mmHg, respectively. The mean percentage of asleep dipping of SBP was 5.7±6.7% in Group 1 and -4.6±6.82% in Group 2. Similarly, the mean percentage of asleep dipping of DBP was 7.6±9.0% in Group 1 and -6.3±9.1% in Group 2.Conclusions: In view of the results, it can be concluded that ambulatory blood pressure monitoring in patients with STEMI can provide a significant prognostication of the future events.


2017 ◽  
Vol 4 (1) ◽  
pp. 49
Author(s):  
Rahul Bhalke ◽  
Maroti S. Karale ◽  
Umesh Deshmukh

<p><strong> </strong></p><p class="abstract"><strong>Background:</strong> A number of cardiovascular responses occur during laryngoscopy and intubation which can have serious consequences during anaesthesia.We planned to conduct a study to evaluate effectiveness of intravenous Esmolol and intravenous Fentanyl in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation.</p><p class="abstract"><strong>Methods:</strong> A prospective, observational, randomized, double blind comparative clinical study, conducted on 60 cases of ASA grade I/II patients undergoing elective abdominal surgery under general anesthesia. The data obtained was divided in the two groups based on drug used 5 min prior to induction, Group 1 (I.V. Esmolol 2 mg/kg) and Group 2 (I.V. Esmolol 2 mg/kg &amp; I.V. Fentanyl 2 µg/kg). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at various time intervals.</p><p class="abstract"><strong>Results:</strong> There was no significant difference in HR, SBP, DBP, MAP after premedication and induction in both the groups. However at intubation, both groups showed an increase in HR, SBP, DBP and MAP but the rise was attenuated in both groups. Increase in HR was more in group 1 as compared to group 2 and it was statistically significant at 01 and 02 minutes post intubation. The increase in SBP was statistically significant at 00, 01 and 02 minutes post intubation. The increase in MAP was statistically significant immediately after induction, at 00, 01, 02, 05 and 10 minutes post intubation.  </p><p class="abstract"><strong>Conclusions:</strong> Combination of intravenous Esmolol and intravenous Fentanyl is more effective in attenuating heart rate, systolic, diastolic and mean arterial pressure response to intubation than intravenous Esmolol alone.</p>


2015 ◽  
Vol 23 (3) ◽  
pp. 113-127
Author(s):  
Alexandru M. Morega ◽  
Cristina Săvăstru ◽  
Mihaela Morega

Abstract Cardiovascular investigations start with the arterial blood pressure measurement and the easiest and accessible approach takes the recording of the systolic and diastolic pressure levels by a sphygmomanometer, usually during compression of the upper arm, or the wrist (same level as the heart), on the path of the brachial artery. More information on arterial hemodynamic, beyond blood pressure monitoring, could result from investigations based on the pulse wave analysis, like applanation tonometry, which is based on pressure sensed on the arm’s surface, at several observation points along the brachial tree. The reactivity and the accuracy of the sensors depend on their design; capacitive and piezoelectric sensors are good candidates for this task. Based on numerical analysis, the work presented here evaluates the usage of applanation tonometry data for the investigation of hemodynamic parameters and examines some technical and medical aspects of the method. The multiphysics numerical model assembles three different problems: hemodynamic flow, structural deformation of the arm and generation of electricity through deformable sensors.


2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Reingard Seibt ◽  
Bettina Hunger ◽  
Lisa Stieler ◽  
Regina Stoll ◽  
Steffi Kreuzfeld

Blood pressure is the most important, modifiable risk factor for cardiovascular diseases. Lifestyle factors and also workload are the main, potential risk factors for the development of hypertension. This study focused on the early detection of unknown hypertension by screening employees in the hotel and restaurant industry (HRI). 148 HRI employees without hypertension (mean age: 34 years, men: 45%) self-measured their blood pressure during rest and for 24 hours of a normal workday. Individuals with a resting blood pressure ≥ 135/85 mmHg were classified as hypertensive. A further analysis investigated whether the currently applicable thresholds for hypertension during work, leisure, and sleep were exceeded on a working day. At rest, 36% of the study participants suffered from hypertension, which increased to 70% under workload and 46% during leisure time and dropped to 8% during sleep. Normal nocturnal dipping (10–20%) occurred only in 18% of cases; 78% were extreme dippers (>20%). Occupational hypertension screening is a suitable component of preventive healthcare. Resting blood pressure measurement alone is insufficient for the early detection of risk individuals and should be supplemented by 24-hour ambulatory blood pressure monitoring under working conditions. The impact of workload on blood pressure needs to be given more attention in the guidelines.


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