[Circadian blood pressure rhythm in preeclampsia as a predictor of maternal and obstetrical outcome]

[Article in German]

Munz W, Seufert R, Steiner E, Pollow K, Brockerhoff P.

Universitats-Frauenklinik der Johannes-Gutenberg-Universitat Mainz. wmunz uni-mainz.de

BACKGROUND: Preeclampsia is a pregnancy-induced multiorganic disease. The incidence is 5 - 7 % in all pregnant women. To assess the value of circadian blood pressure rhythm in preeclamptic women, 24-hour blood pressure monitoring might be useful. The purpose of this study was to determine the predictive value of circadian blood pressure rhythm for the maternal and obstetrical outcome in patients with mild preeclampsia. PATIENTS AND METHODS: Sixty-six patients with mild preeclampsia underwent 24-hour blood pressure monitoring between 29 and 39 weeks gestation. Twenty-eight patients with normal circadian blood pressure rhythm were compared with thirty-eight patients with suspended circadian blood rhythm. RESULTS: There was no difference in age, body mass index, gravidity, parity, miscarriage, or fetal outcome between the two groups. The rate of secondary caesarean section was 39.5 % in the suspended circadian blood pressure group and 21.4 % in the normal circadian blood pressure group, respectively (P = 0.03). CONCLUSIONS: In patients with mild preeclampsia, the circadian blood pressure rhythm appears to be unsuitable as a screening test. Further research is required for more etiological and pathophysiological insights into the development of clinically useful tools with predictive value.

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Blood pressure response to out-patient drug treatment of hypertension in 1973-1993 at Korle-Bu Teaching Hospital, Accra, Ghana.

Hesse IF.

Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box KB 4236, Accra, Ghana.

A retrospective audit of the first twelve months of out patient drug treatment of hypertension at the Korle-Bu Teaching Hospital during the period 1973-1993 is reported. A previous study had shown that at least 7 drug regimes were used to treat hypertension at Korle-Bu during the period. The aim of the present study was to compare the effect and efficacy of these antihypertensive drug treatment regimes on blood pressure during the first 12 months of treatment. Result of 155 (47%) case notes, which met the inclusion criteria, are presented. One month of drug treatment of hypertension significantly reduced systolic and diastolic blood pressure by 21.4 +/- 30.5 (p<0.001) and 13.8 +/- 16.5 (p<0.001) mmHg, respectively. This reduction in blood pressure was maintained to the 12th month. At 12 months, systolic and diastolic blood pressures were unchanged in 19% and 28% of patients, respectively, indicating no response to drug treatment. Recommended target blood pressure of < or = 140/90 mm Hg was achieved in only 25.6% of all patients. All drug treatment regimes significantly reduced blood pressure to a similar extent so that any differences were not statistically significant. However, the efficacy of the drug regimes differed significantly (p=0.02). It was greatest in patients treated with monotherapy with either diuretic or reserpine, intermediate with two drug combinations and least with 3 or 4 drugs. The data showed that diuretics were marginally better than reserpine as first line monotherapy. Furthermore, any diuretic based 2-drug regime was equally efficacious although a beta-blocker or methyldopa as second drug seemed favoured by the data. The addition of a third or fourth drug was counter productive as the increased number of drugs did not decrease blood pressure significantly.

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Blood pressure lowering and life expectancy based on a Markov model of cardiovascular events.

Sesso HD, Chen RS, L'Italien GJ, Lapuerta P, Lee WC, Glynn RJ.

Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave East, Boston, Mass 02215-1204, USA. hsesso hsph.harvard.edu

The life expectancy benefits of antihypertensive treatment, based on both systolic and diastolic blood pressure reduction, was estimated with a cardiovascular disease event Markov model with prospective data from 57 573 men and women. Seven patient states were defined, including (1) no cardiovascular disease, (2) stroke, (3) myocardial infarction, (4) revascularization, (5) history of cardiovascular disease, (6) noncardiovascular disease death, and (7) cardiovascular death. Risk functions were developed from gender-specific multivariate Cox proportional hazards models for primary events and age-, smoking-, and diabetes-adjusted models for secondary events. At baseline we assumed (1) hypothetical pretreatment blood pressures of 160/95 or 150/90 mm Hg; (2) strategies A and B lower blood pressure by 20/13 and 13/8 mm Hg, respectively; and (3) baseline age of 35 years. For subjects initially at 160/95 mm Hg, those with antihypertensive treatment, antihypertensive treatment and diabetes, or antihypertensive treatment, diabetes, and currently smoking had corresponding gains in life expectancy of 2.43, 2.80, and 2.43 years for Strategy A. An initial blood pressure of 150/90 mm Hg resulted in similar gains. Compared with Strategy B, with blood pressure reductions of 13/8 mm Hg, Strategy A provided additional gains in life expectancy of 0.84, 0.99, and 0.87 years for those with antihypertensive treatment, antihypertensive treatment and diabetes, or antihypertensive treatment, diabetes, and currently smoking. The initial blood pressure level did not affect the magnitude of life expectancy gains for equivalent blood pressure reductions. Greater gains in life expectancy among hypertensive and diabetic women suggest that blood pressure lowering may yield greater benefits in selected subgroups.

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Cardiovascular effects of nicotine, chlorisondamine, and mecamylamine in the pigeon.

Chadman KK, Woods JH.

Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA.

Chlorisondamine and mecamylamine are nicotinic antagonists that produce both ganglionic and central blockade. Chlorisondamine, when administered as a large systemic dose, produces a persistent central block, despite being charged. The present study evaluated the cardiovascular effects of chlorisondamine. Shortly after administration, chlorisondamine (0.10, 1, and 10 mg/kg i.m.) lowered blood pressure significantly and decreased heart rate at the low dose (0.1 mg/kg i.m.) and increased heart rate at the high dose (10 mg/kg i.m.). Mecamylamine (1 and 10 mg/kg i.m.) also lowered blood pressure and heart rate. After both antagonists, heart rate returned to baseline values within 90 min and blood pressure within 24 h. Low doses of nicotine (0.01-0.03 mg/kg i.m.) lowered blood pressure but did not affect heart rate. Higher doses (0.10-3.2 mg/kg i.m.) transiently increased blood pressure and heart rate. Subsequent to antagonist administration, nicotine was administered to determine whether either drug blocked the cardiovascular effects of nicotine. Chlorisondamine (0.1, 1, and 10 mg/kg i.m.) administered 30 min before nicotine blocked the increases in blood pressure and heart rate. Only the high dose (10 mg/kg i.m.) of chlorisondamine administered 24 h before nicotine produced a blockade of nicotine's pressor effect. This block diminished within 3 days. Mecamylamine (1 mg/kg i.m.) antagonized only nicotine's tachycardic effect. Longer pretreatment with mecamylamine (10 mg/kg, 24 h before nicotine challenge) did not antagonize the cardiovascular effects of nicotine. Thus, chlorisondamine produces a longer lasting blockade of nicotine's cardiovascular effects than mecamylamine.

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Seasonal variations in blood pressure.

Rosenthal T.

Sackler School of Medicine, Tel Aviv University, Israel. rtalma post.tau.ac.il

The influence of temperature changes on risk factors like hypertension is often disregarded despite extensive literature on the phenomenon. Numerous surveys and studies have documented the correlation between temperature and blood pressure in various countries among adults, the elderly, and children. Twenty-four-hour blood pressure studies also generally show higher blood pressure in the winter. The suggested etiology is that cold increases sympathetic tone, evidenced by elevated blood pressure and plasma and urinary noradrenaline concentrations. The lower blood pressure in warm temperatures is attributed to cutaneous vasodilatation and loss of water and salt from sweating. Taking seasonal variations in blood pressure into account will increase the meaningful information collected in population surveys and mass screenings. It will also result in more personalized management of antihypertensive medications tailored to the individual. Copyright 2004 Le Jacq Communications, Inc.

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Clinical comparison of three methods to measure blood pressure in nonsedated dogs.

Stepien RL, Rapoport GS.

Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.

OBJECTIVE: To determine arterial blood pressure in client-owned dogs, using direct arterial puncture, oscillometry, and Doppler ultrasonography in a clinical setting. DESIGN: Prospective study. ANIMALS: 8 clinically normal client-owned dogs. PROCEDURE: Blood pressures of nonsedated dogs were measured simultaneously, using each of the 3 methods. Mean values obtained were compared with published mean values. Ability of noninvasive methods (Doppler ultrasonography and oscillometry) to accurately predict results of the invasive method, and relationships between blood pressure and age, body weight, and degree of patient anxiety were determined. RESULTS: Calculated ranges of values (mean +/- 2 SD) determined by direct arterial puncture were: systolic pressure, 114 to 194 mm Hg; diastolic pressure, 66 to 102 mm Hg; and mean pressure, 85 to 129 mm Hg. Ranges determined by use of oscillometry were: systolic, 110 to 190 mm Hg; diastolic, 35 to 107 mm Hg; and mean, 78 to 138 mm Hg. Ultrasonographic and oscillometric values did not accurately predict direct values, but mean values of systolic and mean pressures were similar among methods. Relationships were not detected between age or body weight and blood pressure. Significant differences in blood pressure were not detected between anxious and nonanxious dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Mean values of systolic, diastolic, and mean arterial blood pressure measured in nonsedated client-owned dogs, using invasive and noninvasive methods in a clinical setting, are comparable with those determined for acclimatized, trained, or sedated dogs. However, results of noninvasive methods may not accurately reflect direct values.

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Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort.

Hardy R, Kuh D, Langenberg C, Wadsworth ME.

Medical Research Council National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free and University College Medical School, WC1E 6BT, London, UK. rebecca.hardy ucl.ac.uk

BACKGROUND: The negative effect of birthweight on systolic blood pressure has been suggested to be initiated in utero and amplified with age. We aimed to investigate this hypothesis. METHODS: A sample of 3634 people from a birth cohort study of men and women born in Britain in 1946 were included in analyses. Cohort members have been contacted regularly since birth, and systolic and diastolic blood pressures were measured at ages 36, 43, and 53 years. Multilevel models, with blood pressure as a repeated outcome, were used to test the amplification hypothesis and to compare results for birthweight with those for childhood social class. FINDINGS: Considering both men and women together, a consistent negative association between birthweight and systolic blood pressure was noted from age 36 to 53 years, but no evidence was recorded of substantial amplification with age. A 1 kg higher birthweight was associated with a slower mean increase in systolic blood pressure by -0.4 mm Hg (95% CI -1.3 to 0.4; p=0.3) per 10-year increase in age. Birthweight was not associated with diastolic blood pressure at any age. People from a manual social class in childhood had higher systolic and diastolic blood pressure than did those from a non-manual class. The effect on systolic blood pressure rose with age, by 1.0 mm Hg (95% CI 0.1 to 2.0; p=0.03) per 10 years, but was largely accounted for by current body-mass index, which was an increasingly strong determinant of blood pressure. INTERPRETATION: These findings suggest that weight control throughout life is key to prevention of raised blood pressure during middle age. Understanding the link between the early childhood socioeconomic environment and adult obesity could make this strategy more effective.

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Role of 24-hour monitoring in assessing blood pressure changes in polycystic ovary syndrome.

Orbetzova MM, Shigarminova RG, Genchev GG, Milcheva BA, Lozanov LB, Genov NS, Zacharieva SZ.

Clinical Centre of Endocrinology and Gerontology, SHATENG, Medical University--Sofia, Bulgaria. morbetzova hotmail.com

INTRODUCTION: Polycystic ovary syndrome (PCOS) is associated with higher risk of developing cardiovascular diseases including higher incidence of hypertension later in life. Absence of circadian blood pressure fluctuations is considered as a marker of pre-hypertensive state and correlates highly with target organ damage in hypertension. AIM: Characterization of the circadian blood pressure rhythms as well as comparison of the results from the clinical measurements and Holter-monitored blood pressure data in women with PCOS. MATERIALS AND METHODS: The study comprised 35 women (mean age 22.6 +/- 5.9 years, mean BMI 31.4 +/- 7.1 kg/m2) with proven diagnosis. 24-hour ambulatory Holter-monitoring using Oscar device (Sun Tech Medical Instruments, USA) was performed in parallel with clinical measurements of blood pressure. RESULTS: There were 25.7% of the subjects diagnosed with hypertension according to the criteria of ambulatory monitoring observing discrepancy with the criteria for normal clinically measured blood pressure in 7 cases (20%). The "white coat" effect was observed in 11.4%. Physiological nocturnal drop in the systolic pressure was not observed in 51.4% of the patients and in the diastolic pressure - in 22.9% of the cases. CONCLUSIONS: The results confirm the advantages and the importance of the 24-hour monitoring as a diagnostic and predictive method for assessment of blood pressure alterations even in the absence of overt hypertension. PCOS is characterized by higher incidence of unstable blood pressure that is an additional risk factor for further development of cardiovascular diseases in this relatively young age group.

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