Physical activity as a determinant of diurnal blood pressure variation.

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ORALS: Theme II: Debate: Ambulatory Blood Pressure Monitoring Should Be Routine in Clinical Management

1999;12:314

CONVENTIONAL AND AMBULATORY BLOOD PRESSURE AS PREDICTORS OF CARDIOVASCULAR RISK IN OLDER PATIENTS WITH SYSTOLIC HYPERTENSION. JA Staessen, L Thijs, R Fqlard. for ihe Systolic Hypertension in Europe (Sysi-Eur) Tnal Investigators University of Leaven, Belgium. Coniext Ambulaicq bleed pressure (BP) moniioring requires fuOher dinical valid% lion in pmsp%ciive outcome studies. Objective: To compare the prognostic significance of conventional and ambulaiwy BP measurement in older padents with isdaied sysidic hypertension. Design: Suteiudy io the dwbl&!ind place~nlmlled Systolic Hypertension in Europe trial. Setting: Family practices and out-patient clinics at pimary and semndary referral centers. Patidpanis: Older (260 years) patients whose unlreaiao BP MI cOnventional measurement was 160.219 mm Hg systolic and <95 mm Hg diastolic. Interventions: The patients were randomiwl 10nitrendipine (1040 mglday) with the possiMe ad&on of enalapdl(5.20 mglday)&/or hydrxkloroihiazide(12.525 ml/day)or to matchingplacebos. Main outcome measures: Total and cardiovascular morialii, all cardiovascular end pdnis. fatal and nonfatal simke, and faith and nonfaid wdiac end points. Results: With cumulative adjustments applied for sex. age, pceviws cardkxasurlar mmplicaiions, smoking and residence in western Europe, systolic BP ai randomize lion predicted a wore8 prognosis, whereas the asscciaiioasbetweendiasidicBP and ouicome were not significant. In the placebo grwp (n-393), iha 24.hour, daytime (10 AM to 8 PM) and nighttime (06 AM) systolic BP pcedicied the incidence of all cardiovascular comdicadans even afier further adiusiment for ihe mnveniional BP. The nighttime s+ic BP behaved as a mixe &rate PrediCtOrof end pOinis than the datiime level. A hioher niahi-iodav ratio of svsiolic BP increased the risk of cardiovascular mmplic&ns ov& and at&e ihe 2i-hour level. The riskof cardiovascular complications was similarfor sysidic BP levelsai randomization of 166 mmHg on conventional measurement or 142 mmHg (Cl, 126.156mmHg). 145 mmHg (Cl, 126164 m Hg) or 132 mmHg (Cl. 120.145mm Hg) on 24hw daytimeor nighikmemonitoringIn the activeireaimenigroup(n=415)systolicambulatoryBP lostits prognostic srgnitrcaece etheradjusbnenifor the mnveniinalBP. Conclusions: In older patients with isolated systolic hypertension, the systolicambulaiorvBP. esoeciallvwhen measuredai niahi,or whenexceedioa142 mm Ha. 145 mm Hg. or’132rn’Hg M) 24haur, day& or nighiiimemeasu&ent was a sionificani oredictor of cardiovascular complications, over and above the cnnvenii&al BP

PHYSICAL ACTlVITY AS A DETERMINANT OF DIURNAL BLOOD PRESSURE VARIATION. KJ&~Q*, TG Pickering*, JE Schwartz. WeiII Medical College of Cornell University and SUNYStony Brook, New York Them are reports indteating that diurnal blood pressme (BP) variation, in addition to high BP per se, is related to target organ damage and the mcidence of cardiovascular events However, the determinants of diurnal BP variation are not adequately understood. We used actigraphy and ambulatory BP (ABP) monitoring to study the diurnal variation of BP and physical activity in 161 adults. The within-person correlation between BP and activity was stronger during sleep than when awake. However. the correlation between activity and pulse rate (PR) was consistently higher during the awake period than during sleep, and activity was more strongly related to PR than to BP. The sleep/awake ratio of systolic BP (SBP) was positively correlated with wean sleep activity (r=.27, p
(with a sleep systolic BP decrease of ~20% ofawake systolic BP), 102 dippers (with decreases of z 10% to <20%), and 40 nondippers (with decreases of
average SBP response to activity (the within-person

of awake SBP regressed an activity) did not differ significantly dipping subgroup. detemnnants

slope by

In conclusion, physical activrty is one ofihe

ofABP and iis drumal

variation. Non-dipping

siatns is

more closely related to activity during sleep than to awake activity, suggesting impaired

sleep quality. WhiIe the number ofextreme-

dippers is small, their activity does not differ significantly Key Words:

ambulatoryblcodpressure,cardiovascular risk. elderly,iSolaiecsystolichypelteesion

Key Words:

diurnal blood pressure variation, physical activity, sleep quality. position, extreme-dippers,

DO WE UNDERTREAT HYPERTENSIVE SMOKERS. A COMPARISON OF 24HAMBlJLATORY BLOOD PRESSURE TL Bnttenschan, LE Bang, KS Krlstensen and TL Svendsen. The Hypertension Clinic, Department of CardioIoa~~ City Hospital of Holbzk, Denmark. The acute effect of smoking is a rise in blood pressure and heart rate. Nevertheless, in several epidemlological studies, smokers tend to have slightly lower blood pressure than non-smokers. We studied the ambulatory blood pressure consecutively in 26 treated hypertensive smokers @IO cigarettes per day) and 26 tmated hypertensive non-smokers to test the hypothesis that smoking is associated with a rise in ambulatory blood pressure. There was no difference between smokers and non-smokers in office blood pressure (153,8f22,2/98,5fl0,6 vs. 149,MI6,1/96,9il I,6 mmHg). We found statistically significant higher daytime systolic and diastolic blood pressure in smokers (153,7*16,2/96,1i9,5 vs. 145,0f12,1/90,lf10,0 mmHg) than in non-smokers. Them WBSno difference in nighttime blood pressure behveen smokers and nonsmokers. Daytime heart rate was also significantly higher in smokers (86,6+9,4 vs. 76,Ml0,9). We conclude that smokers tend to have MONITORING.

higher daytime blood pressnre than do non-smokers despite similar office blood pressure. This difference may not be recogalised by measnrlng office blood pressure alone. The consequence of this might be that smoking hypertensiven tend to be undertreated which might be a contibntery factor for the lncreesed morbidity and

from the

(normal) dippers. non-dippers

MARITAL FACTORS OVER 3 YEARS INFLUENCE BLOOD PRESSURE AND LEFT VENTRICULAR MASS IN MILDLY HYPERTENSIVE PATIENTS B. Baker, K. Helmets, M. Paquette, B. O’Kelly and S. Tobe’ University of Toronto, Toronto, Canada To assess the predictive value of marital strain on 3 year ambulatory blood pressure (ABP) and let? ventricular mass (LVM), 74 subjects completed self-report measures and underwent 24hr ABP monitoring and M mode echocardiography at baseline and 3 year follow-up. Participants at baseline were employed, living with a significant other, with repeated diastolic BP measures of !%105mmHg and no antihypertensive medication for 6 months. ABP parameters of systolic [SBP], and DBP were summarized into daytime [7am -1 Ipm], nighttime and 24 hr means. At entry, the mean age of the group was 48yrs; 57% were male, and 28% were regular drinkem. Baseline marital satisfaction from the Dyadic Adjustment Scale [DAS] was inversely related to 24 hr DBP [p=O.O7] and daytime DBP [p=O.O5] at 3 year follow-up, after controlling for other significant predictors. Total baseline DAS score had a significant inverse relationship with 3 year LVM (p=O.O3) after controIlina for other factors (male gender. 0=0.07. bodv mass . i .

observed in smokers. To optimize blood pressure treatment, we recommend regularly ambulatory blood pressure monitoring in smokers (;r 10 cigarettes/d). This study also emphasises the need for tittnm investigations of the effect of antihypertensive treatment ln smokers. mortality

In mild hypertensives, baseline dyadic adjustment measures are 3 year DBP, and IelI ventricnl& mass. Depending on marital satisfaction, spottsal contact may aggmvate or ameliorate ABP. Marital factors can affect the cmtme of early hypertension. related to

Ke

Words:

2x-h ABPM, smoking, hypertension Key

Words:

Hypertension, matit.al factors, blood pressure, let? ventricular mass