Email this article Methodological approaches to estimation of a morning urge of arterial pressure in essential hypertensives
- Authors: Lazareva NV1, Oschepkova EV1, Zelveyan PA1, Buniatyan MS1, Rogoza AN1
-
Affiliations:
- Issue: Vol 79, No 4 (2004)
- Pages: 65-69
- Section: Editorial
- URL: https://ter-arkhiv.ru/0040-3660/article/view/29839
- ID: 29839
Cite item
Full Text
Abstract
Aim. To estimate the time intervals of a morning arterial pressure urge (MAPU) and MAPU characteristics in patients with essential hypertension (EH).
Material and methods. The study enrolled 70 patients (50 male and 20 female) with EH of the first (n = 41) and second (n = 20) degrees aged 34-65 years (mean age 50.4 ±0.9 years). The control group consisted of 9 healthy men. Morning dynamics of arterial pressure (AP) and heart rate (HR) was studied basing on the data of 24-h AP monitoring (Spacelabs-90207, USA). Results. Dynamics of AP from nocturnal to diurnal patterns in both hypertensive and normotensive subjects falls into 3 phases: a premorning urge (from 4-5 a.m. to waking up) with a characteristic slow rise in AP and HR; a morning urge (from waking up for 4-5 hours) with a characteristic forced AP and HR rise); a diurnal urge (from 11 a.m. to 13-14 p.m.) with characteristic slowing down of AP and HR rise. Patients with EH of the first and second degree vs normotensive subjects had unfavourable changes in morning dynamics of AP and HR: a significant progressive growth of maximal systolic and diastolic pressure proportional to mean circadian AP levels; a rise of morning hours index of AP which characterizes amplitude-speed features of AP and HR.
Conclusion. To characterize MAPU most completely it is recommended to estimate the following parameters: wave index (to assess AP conversion from one level to another), mean rate of AP change per hour (to prevent influence of random factors on the rate of MAPU); relative maximal values of AP (to estimate maximal AP values in morning hours and nocturnal mean AP).
Material and methods. The study enrolled 70 patients (50 male and 20 female) with EH of the first (n = 41) and second (n = 20) degrees aged 34-65 years (mean age 50.4 ±0.9 years). The control group consisted of 9 healthy men. Morning dynamics of arterial pressure (AP) and heart rate (HR) was studied basing on the data of 24-h AP monitoring (Spacelabs-90207, USA). Results. Dynamics of AP from nocturnal to diurnal patterns in both hypertensive and normotensive subjects falls into 3 phases: a premorning urge (from 4-5 a.m. to waking up) with a characteristic slow rise in AP and HR; a morning urge (from waking up for 4-5 hours) with a characteristic forced AP and HR rise); a diurnal urge (from 11 a.m. to 13-14 p.m.) with characteristic slowing down of AP and HR rise. Patients with EH of the first and second degree vs normotensive subjects had unfavourable changes in morning dynamics of AP and HR: a significant progressive growth of maximal systolic and diastolic pressure proportional to mean circadian AP levels; a rise of morning hours index of AP which characterizes amplitude-speed features of AP and HR.
Conclusion. To characterize MAPU most completely it is recommended to estimate the following parameters: wave index (to assess AP conversion from one level to another), mean rate of AP change per hour (to prevent influence of random factors on the rate of MAPU); relative maximal values of AP (to estimate maximal AP values in morning hours and nocturnal mean AP).
References
- Kannel W. Implications of Framingham study: data for treatment impact of other risk factors. In: Laragh J. et al., eds. Frontiers in hypertension research. New York: Springer-Verlag; 1981. 17-21.
- Muller J., Tofler G., Stone P. Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 1989; 79 (4): 733-743.
- Middlekauff H., Sontz E. Morning sympathetic nerve activity is not increased in humans. Circulation 1995; 91: 2549-2555.
- Неберидзе Д. Мягкая артериальная гипертония: Гетерогенность и риск сердечно-сосудистых осложнений: Автореф. дис. ... д-ра мед. наук. М.; 1994.
- Brezinski D., Tofler G., Muller J. et al. Morning increase in platelet aggregability. Circulation 1988; 78 (1): 35-40.
- Gabbasov Z., Parfyonova Ye., Popov E. et al. Association of platelet function in hypertensive patients left ventricular hypertrophy, transient myocardial ischemia, and coronary artery disease. Platelets 1998; 9: 191 - 195.
- Tofter G., Brezinski D., Schafer A. et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N. Engl. J. Med. 1987; 316 (24): 1514-1518.
- Кобаяава Ж., Котовская Ю., Моисеев В. Особенности утреннего подъема артериального давления у больных ГБ с различными вариантами суточного ритма. Кардиология 1999; 39 (6): 23-26.
- Ольбинская Л., Мартынов А., Хапаев Б. Мониторироаание артериального давления в кардиологии. М.; 1998.
- Chalmers J. et al. WHO - 1SH Hypertension Guidelines Committee. 1999. World Health Organization - International Society of Hypertension Guidelines for the Management of Hypertension. J. Hypertens. 1999; 17: 151 - 185.
- Арабидзе Г. Симптоматические артериальные гипертонии. В кн.: Чазов Е. И. (ред.) Руководство по кардиологии. М.: Медицина; 1982; т. 4: 65-101.
- Суточное мониторирование АД (методические вопросы) / Рогоза А., Никольский В., Ощепкова Е. и др.; Под ред. Г. Г. Арабидзе, О. Ю. Атькова. М.: "Эй энд Ди"; 1996.
- Millar-Craig M., Mann S., Balasubramanian V. Orcadian rhythms in hypertension. Scott. Med. J. 1981; 26 (4): 309-314.
- Khoury A., Sunderajan P., Kaplan N. The early morning rise in blood pressure is related mainly to ambulation. Am. J. Hypertens. 1992; 5 (6): 339-344.
- Suzuki V., Kuwajima I., Mitani K. et al. The relation between blood pressure variation and daily physical activity in early morning surge in blood pressure. Nippon Ronen Idakkai Zasshi 1993; 30 (10): 841-848.
- Halberg F., Halberg E., Halberg J. et al. Chronobiological assessment of human blood pressure variation in health and disease. Chronobiologia 1985; 10: 137-155.
- Wiltich S., Goldberg R., Maclure M. et al. Increased onset of sudden cardiac dath in the first three hours after awakening. Am. J. Cardiol. 1992; 70: 65-68.
Supplementary files
