Resistant hypertension or white-coat effect?

AJH-APRIL 1995-VOL.8, NO.4,PART 2

84A ASHABSTRACTS

GIO

G9 RESISTANT EFFEC1'?

HYPERTENSION

OR

WHITE·COAT

S,D.PjerdQmenjcQ, T.Antidormi, D.Lapenna, M.Neei, F.Cuccurullo, A.Mezzetti. Hypertension Unit, Chair of Internal Medicine, University of Chietl, Italy Sometruehypertensives present high casual BP values despite being prescribed multiple medications. Aimof the studywasto evaluate whether these pts showa resistant hypertension (RH) or a white-coat effect (WCE).We selected 27 subjects (14 M and 13 F, age 56±I1 yrs) with a previous diagnosis of true hypertension, confirmed by ambulatory BP monitoring (ABPM), who had persistently elevated casual "J'l)tolic and diastolic BP(cSBP/cDBP > 140/90 mmHg) despite multiple treatment. Thesepts underwent further ABPM (Spacelabs) to evaluate 24-hour systolic and diastolic BP (24hSBP and 24hDBP), awake systolic and diastolicBP (aSBP and aDBP) and sleep systolic and diastolic BP (sSBP and sDBP). Seven pts(4 M and 3 F, age 49±12 yrs) showed RH, whereas 20pts (lO Mand 10F,age 59±9) presented WCE, that is high casual BPand "normal" ambulatory BP,

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difference between cSBP/cDBP and aSBP/aDBP before treatment (20±l/18±1), was higher than in the other true hypertensives lind it persisted aftertreatment. We conclude that many hypertensives whohave high casual BP despite multiple treatment, reallyshow a WeE. ABPM identifies these subset ofpts andavoids unnecessary overtreatment. Key Words: ambulatory BP monitoring, whhe-coat effect, resistant hypertension

CAIDJOIAnlAR mcrIVllY 10 m-JI'AL SIRE5S TAS\ IWJ ~LIPID LEVF1.5 IN ro.N3 Mn.LLY H'I'PFlmN5lVE alBjB:rS.

P.Arrmrlo, R.Hem3rrlez del Ret, P~&inchez, j .julia, G.Torrcs, l.A.Navarro, J.Castellsague & H,Pameil. Roo Cross Ho!:pital. Ho!pitalet de Ll, (Barcelcra).

EPAIN.

In this sttrly \\e exanUnErl the relati01!hip bet\l.OOl senm lipids levels arrl cardiMSOJlar reactivity in 40 abjects Bg(d 1~ (nl"ill'l1S):31±7>. 6SY. rmles, with mId hypertErlsi01: SF bet\l.EE!1 UP-Ioo ~ an:! or DIP ~1C5 nJTlt (1l".WI'liS):1471'B/94!:6 mnt'.

M?thcds: hl ergamtry am a nmtal arithretic stress talk (M\T> \\ere perfcnred in tt;,\) different d3ys. J-Ypemncti ve SJl:>jects ~re definm as an abolute value of bleed pressure (IF) cilrl~ ergamtry U:O/l00 rmIt or a IF ch:lnge (rmxil1ll.l-blseline) cilrl~ M\T l25 ~ for systolic IF am/or ~ 15~ for diastolic fP. RC9.ll tsr No significant differences \\ere diserved in the nmn of lipici values between the hyperreactive am nonroreactive aibjects to ergoretry or to M\T. Ergamtty: total cholesterol (5.3, 5.8 mroll1), Hl.. cholesterol 0.3, 1.2 mrollU. triglycerides 0.2, 0.9 mrcl/I), respectively. M\T: total cholesterol (5.6. 5.5 mrollD; IlL cholesterol 0.3. 1.3 mrolll) am triglycerides Cl.l, 1.0) in hyperrmctive am nomorooctive 9Jbjects, ~tivE:ly. No sl£1lific.ant riiffermce WiS cbservm in the percentage of hyperreactive 9Jbjects accotdi~ to the total cholesterol level (~r <6,2 mroIIl). Co1clusi01s: No siglificant effect of carrliCMiscular rmctivy in lipid profile WiS coserved. No si£1lificant difference \'8.S coserved betwem the percentege of hyperreactive to a mntsl or a jilysical stress tas< -in the !'wertEn1ive 9Jbjects with hypercholesterolmia in ccrparisci with those with la,.,er cholesterol levels, Key Words: CamiCMi5CJ.llar reactivity, hypeltholesterolmia, Mild lftpertEnsim, Mntal stress test, Ergaretty.

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G12

THE CIRCADIAN BLOOD PRESSURE RHYTHM IN SECONDARY

REPImJ:1Bll.IlY CF 00 MNI'AL srnESS TAS
HYPERTENSION L Rosentbal, G. Shliamser, J. Carroll, A. Shamiss, N, Nussinovilch, E. Grossman Chorley Hypertension Instrtute, Chaim ShebaMedical Center, Tel Hashomer, Saclder Faculty ofMedicine, Tel Aviv UniVersity, Israel The absence 01 reduced nocturnal blood pressure has diagnosl/c importance In view oftheconstant exposure of these individuals tohIgh blood pressure leading tocardiovascular complications, The conflicting findings in the literature onthe circadian rhythm 01 blood pressure inpatients wnh secondary hypertension led us toexamine this phenomenon using ambulatory blood pressure monitoring. The study was conducted on 34 secondary hypertensive patients: 19with renal artery stenosis (AAS) , 13With primary hyperaldosteronism (ALD), and2with pheochromocytoma (PHR). Another 22SUbjects with essential hypertension served as control.

Ambulatory blood pressure wasmeasured over a 24 hour period using a Medilog Ambulatory Blood Pressure monitor. Readings were obtained every 15minutes during thedayand every 30 minutes at night. Data were evaluated by Cosinor statistical analysis which determines cyclical variations, range of blood pressure (ampl~ude X2), acrophase which is a measure to the lima ofpeak blood pressure. andMesor which isa measure of mean blood pressure, Anocturnal fall in blood pressure wasseen inpatients w~h RAS and ALD. but not in thetwo patients with PHEO. Surgery parformed in only one 01 thesePHEO patients resulted in a change in thecircadian blood pressure curve anda nocturnal fall wasobserved. These findings demonstrate that 24h blood pressure monitoring cannot serve as a diagnostic tool for the detection 01 secondary hypertension. Nevertheless, in patients In whom theie Is no noclumal decrease of blood pressure, it is advisable tolook for secondary hypertension.

KeyWords:

Circadian rhythm, 24hour blood pressure monitoring, secondary hypertension

P.Amnrio, R.Hernmnez del Ret, J.Castellsag..xe, G.Torres. U.Navarro & H.p:udell. Roo Cross Ho!:pital. Hospitalet de LId>. (Bsrcelera), 9'AlN. (lJr gro.JP his previeusly 91c:wl a lo,o,o-inteD11rliate correlaticn betltoe61 blo:rl pressire (IF) re~ses to t\\O different mntal stress tasks arrl the 24-ha.r Pitb..llatoty Bloo:! Pressrre Mnitoring profile. The cbjetive of thi 5 stt.r:o/ is to assess the terporal stability of IF am heart rate QR) re~ses to a rrmtal arithretic ta!k (M\T) arrl to a stressful interview (51). Both ta9. For both ta!ks, \\e calmlatei the correlatici coefficiEnts bet~ffi the fi rst arrl ll1'6lterl test for