The Effects of Nocturnal Blood Pressure Paterns and Autonomic Alterations on Erectile Functions in Patients with Hypertension.
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Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction.This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring.In our study non-dipper hypertensives had statistically more erectile dysfunction (P=0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P= .003)(Daytime Systolic/Nighttime Diastolic Blood Pressure= 0.8 ± 0.07 / 3.90 ± 1.5, respectively). LF/HF daytime/ nighttime in holter reflecting sympathetic overactivity (P< .001).Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.Keywords:
Dipper
Autonomic function
Objective To investigate whether switching anti-hypertensive medication to bedtime could improve blood pressure control in non-dipper patients with refractory arterial hypertension.Methods 30 patients (as observation group) with refractory arterial hypertension and non-dipper pattern on ambulatory blood pressure monitoring were shifted all non-diuretic anti-hypertensive drugs from morning to evening.22 patients with similar characteristics and no changes in the therapeutic regimen formed the control group.Results After 12 weeks treatment,the changes of 24h average systolic/diastolic blood pressure,average diastolic blood pressure during the day and the average diastolic blood pressure at day/nigh were-(2.8 ± 4.2)/-(2.1 ± 3.4)mm Hg,(-1.1 ± 3.1)mm Hg and (-6.3 ±5.9)/(-4.3 ±5.7)mm Hg,respectively.The decrease of mean systolic blood pressure and mean diastolic blood pressure in the observation group were significantly larger than those in the control group(all P ＜0.05).The circadian blood pressure profile changed from non-dipper to dipper in 6 cases in the observation group and no changes were observed in the control group(x2 =4.974,P =0.0263).There was also no difference between two group in terms of untoward reaction.Conclusion In non-dipper patients with refractory arterial hypertension,changing the timing of anti-hypertensive medication to the evening could improve blood pressure control aud help the abnormal circadian blood pressure profile recover to the normal.
Key words:
Hypertension ; Chronotherapeutics ; Blood pressure monitoring, ambulatory
Dipper
Refractory (planetary science)
Bedtime
Chronotherapy (sleep phase)
Prehypertension
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To investigate the relationship among circadian blood pressure rhythm, autonomic nervous system and myocardial energy expenditure (MEE) level in patients with primary hypertension.A total of 102 hypertensive and 45 normotensive subjects were recruited. According to blood pressure reduction rate at night, the hypertensive patients were divided into non-dipper group (NDH group, n=54) with a reduction rate of <10% and dipper group (DH group, n=48) with a reduction rate of ≥10%. The circadian blood pressure rhythm and heart rate variability were measured with ambulatory blood pressure monitoring and 24-hour electrocardiograph monitoring, respectively, and MEE was measured by Doppler echocardiography to analyze their correlations.SDNN, SDANN, SDNNindex, RMSSD, PNN50, and HF were significantly lower in the hypertensive patients than in the control group (P<0.05); these parameters, except for PNN50, were all significantly lower in NDH group than in DH group (P<0.05). The hypertensive patients had significantly higher MEE than the control group (P<0.05), and MEE was significantly higher in NDH group than in DH group (P<0.05). Bivariate correlation analysis showed significant correlations of MEE with SDANN in the hypertensive patients (P<0.01).Patients with primary hypertension, especially those in NDH group, have impaired autonomic nervous system function. The hypertensive patients in NDH group show a more prominent increase in MEE in relation to sympathetic activation, suggesting the importance of restoring circadian blood pressure rhythm in the treatment of hypertension.
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Objective To investigate the influence of circadian rhythm disorders of blood pressure on heart rate in elderly hypertensive patients. Methods 200 elderly patients with isolated systolic hypertension were selected and divided into three groups [dipper type( n = 56),non-dipper type( n = 80) and reverse-dipper type( n = 64) ]according to the ambulatory blood pressure,32 healthy individuals were recruited as control group. All the patients and healthy subjects were submitted to 24-h ambulatory blood pressure monitoring. The 24 h daytime and nighttime heart rate and heart rate variability were recorded. Results The heart rate of hypertensive patients with non-dippers and reverse-dipper was significantly higher than that of patients with dipper and healthy subjects( P 0. 01,P 0. 05);The values of SDANN、SDNN、rMSSD、PNN50D were significantly lower in the reverse-dippers type group( P 0. 01,P 0. 05) compared with those of dippertype and non-dipper type group,the heart rate was positively correlated to the average systolic and diastolic blood pressure during the daytime and nighttime( P 0. 05). Conclusion The circadian rhythm disorders of blood pressure is associated with higher heart rate and lower heart rate variability.
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Heart Rhythm
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Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction.This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring.In our study non-dipper hypertensives had statistically more erectile dysfunction (P=0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P= .003)(Daytime Systolic/Nighttime Diastolic Blood Pressure= 0.8 ± 0.07 / 3.90 ± 1.5, respectively). LF/HF daytime/ nighttime in holter reflecting sympathetic overactivity (P< .001).Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.
Dipper
Autonomic function
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Background and Objectives:An increased pulse wave velocity (PWV) and a non-dipping pattern in hypertensive patients have been shown to be associated with an excess of target organ damage. The relationship between the PWV and circadian variation of blood pressure (BP) (dipper or nondipper) were sought, and also the LV diastolic function between dipper and nondipper patients compared. Subjects and Methods:44 hypertensive subjects, who had never been treated, were enrolled (mean age: 48±12 yrs, men: 29). The following procedures were undertaken. 1) 24 hour ambulatory BP monitoring; 2) echocardiography for LV geometry, LV mass index (LVMI), LV systolic and diastolic functions, including tissue Doppler and aortic PWV. The patients were divided into two groups with respect to their ambulatory BP profiles, i.e., dipper and nondipper. The PWV, LV geometry and diastolic functions were compared between dipper and nondipper patients, and the relationship between the PWV and diastolic function analyzed in all patients. Results:Twenty (45%) were nondipper patients. There were no significant differences in the LV geometry, LVMI and PWV between dipper and nondipper patients (PWV; 8.8±3.1 vs. 8.6±3.3 m/sec, p>0.05). In all patients, the PWV was related to the deceleration time (r=0.34, p=0.03) and the mitral E/A (r=-0.31, p=0.02) and mitral Em/Am ratios obtained by the tissue Doppler echocardiography (r=-0.31, p=0.03). The proportion with diastolic dysfunction was higher in the nondipper than the dipper patients (21 vs. 50%, p<0.01). There was a significant relation between the PWV and Em (r=-0.45, p=0.047) in the nondipper, but not in the dipper. Conclusion:Prolonged exposure to high BP (nondipper) was not related with increased aortic stiffness in never treated hypertensive patients. The PWV was closely related with LV diastolic dysfunction in nondipper patients. (Korean Circulation J 2004;34(11):1099-1106)
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Objective To analyze the relationship between the parameters of 24-hour ambulatory blood pressure monitoring(ABPM) and cardiac function in maintenance hemodialysis(MHD) patients.Methods Thirty-one MHD patients and 31 pre-ESRD patients were enrolled.24-hour average systolic(24h-SBP),24-hour average diastolic(24h-DBP),24-hour average mean arterial(24h-MAP),Daytime average systolic(D-SBP),Daytime average diastolic(D-DBP),Night-time average systolic(N-SBP),Nighttime average diastolic(N-DBP) blood pressure and circadian blood pressure rhythm were measured by ABPM.The left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),left atrial diameter(LAD),left ventricu-lar posterior wall thickness(LVPWT),interventricular septal thickness(IVST)were detected by ultrasonic cardiography.And other correlated parameters were also measured.Results The left ventricular hypertrophy(LVH),LVDd,LVDs and LVMI increased in MHD patients compared with pre-ESRD patients,while the fractional shortening decreased significantly.The levels of 24h-SBP,24h-DBP,24h-MAP,D-SBP,D-DBP,N-SBP and N-DBP increased significantly in MHD patients compared with the pre-ESRD patients,especially the non-dipper hypertension(90.3% vs 64.5%,P= 0.015).The percentage of hypertension at 24-hour average,Daytime average,Nighttime average blood pressure and N-SBP were higher in MHD patients compared with the control group.The non-dipper blood pressure in MHD patients whose 24-hour average blood pressure lower than 135/85mm Hg were 87.5%.The blood pressure was found positively correlated with cardiac function,especially the SBP and non-dipper blood pressure rhythm.On the other hand,Alb、 iPTH、duration of hemodialysis were also correlated with cardiac function.Conclusion The incidence of hypertension and non-dipper hypertension is very high in MHD patients.The cardiac function in maintenance hemodialysis is closely correlated with non-dipper blood pressure rhythm and high N-SBP.
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Aim. To study diurnal blood pressure profiles (DBPP) during work in different time of the day including nocturnal hours in persons with initial stages of blood pressure (BP) increase or decrease. Material and methods. The study cohort consisted of 995 locomotive drivers (46682 BP measurements) divided into groups with normal BP, higher normal BP, 1st stage arterial hypertension, and hypotension. DBPP was analyzed on the basis of the averaged curve for each group. Results. The averaged systolic DBPP in the normotonic group was of non-dipper type, while diastolic one was on the border between non-dipper and night-peaker. Patients with elevated BP and trend to BP elevation (beginning with higher normal BP) had reduced nocturnal BP lowering, particularly of diastolic BP. Its diurnal profile was clearly of night-peaker type. The main feature of DBPP in patients with hypotension was absence of evening BP rise characteristic for persons with normal BP and hypertension.
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Background: The association between nondipping profile and adverse cardiovascular outcome is still controversial. Tissue Doppler imaging (TDI), a new and useful addition to standard echocardiographic imaging techniques, permits a quantitative assessment of both global and regional function and timing of myocardial velocities. In this study, we aimed to assess whether a reduced nocturnal fall in blood pressure (BP) in orderly treated hypertensive patients with satisfactory BP control is related to more prominent structural and functional alterations of the ventricles. Method and Results: Sixty‐nine hypertensive patients with adequate BP control were divided into two groups with respect to ambulatory BP profiles as dippers and nondippers. In addition to conventional echocardiographic parameters, in septal and lateral segments of left ventricle and free wall of right ventricle, peak systolic velocity (Sm), early (Em), and late (Am) diastolic velocities, isovolumic contraction time (ICTm), isovolumic relaxation time (IRTm), and ejection times (ETm) were measured, and modified myocardial performance index (MPIm) was calculated. Left ventricular (LV) and atrial dimensions, ejection fraction, transmitral early to late diastolic flow ratio, LV mass index, and LV hypertrophy ratio did not differ between groups. Both regional and mean LV Sm, Em/Am, MPIm and right ventricular Sm and MPIm were similar in both groups. Conclusion: In treated hypertensive patients with satisfactory BP control, there was no significant difference in cardiac structural and functional abnormalities among dipper and nondipper subjects.
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Isovolumic relaxation time
Isovolumetric contraction
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Essential hypertension
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