Sleep quality and continuous, non-invasive beat-to-beat blood pressure recording.

OBJECTIVE: To investigate the effects of continuous, non-invasive, beat-to-beat finger blood pressure monitoring on sleep in healthy men. DESIGN: After 1 night of habituation to the laboratory environment, which consisted of the placement of electroencephalographic equipment without recording, polygraphic sleep recordings were performed during two consecutive nights (nights 1 and 2) in 15 healthy men (mean +/- SD age 25 +/- 6 years). Blood pressure was recorded continuously for 24 h from the end of night 1 to the end of night 2. RESULTS: The blood pressure recording procedure caused a decrease in the amount of rapid eye movement (REM) sleep and increased the duration of nocturnal awakenings. Consequently, sleep efficiency was decreased by approximately 5%. The blood pressure measurements did not affect the duration of light and of deep sleep. Although the respective predominance of deep sleep and of REM sleep at the beginning and at the end of the sleep period were preserved during the night of blood pressure recording, the blood pressure recording procedure hampered the rise in REM sleep during the final two thirds of the sleep period. CONCLUSION: In healthy young men continuous, non-invasive, beat-to-beat finger blood pressure monitoring induced modest reductions in sleep efficiency of similar magnitude to those observed previously with non-invasive ambulatory blood pressure monitoring.Journal Articleinfo:eu-repo/semantics/publishe

Effects of chronic congestive heart failure on 24-hour blood pressure and heart rate patterns: a hemodynamic approach.

For 29 patients with congestive heart failure (CHF), 24-hour noninvasive ambulatory blood pressure (ABP) and heart rate (HR) measurement profiles were described, using the periodogram method, and were compared with the same findings in 22 matched controls. Right-sided heart catheterization was performed in all patients. The mean cardiac index was 2.2 L/min/m2 (range 1.3 to 2.9 L/min/m2). More severe CHF, as assessed by cardiac index, pulmonary artery wedge pressure, and right atrial pressure, correlated significantly with a reduction in the amplitude of the circadian ABP and HR rhythms (0.38 less than r less than 0.63; p less than 0.05). Moreover, a reduced increase in cardiac index during cycloergometric exercise in 11 CHF patients correlated with a blunting of the circadian systolic ABP and HR profiles (0.57 less than r less than 0.90; p less than 0.05). Our results indicate that there is a reduction in the amplitude of the circadian BP and HR rhythms related to the severity of CHF.Comparative StudyJournal Articleinfo:eu-repo/semantics/publishe

Quantitative analysis of the 24-hour blood pressure and heart rate patterns in young men.

To characterize the normal nycterohemeral blood pressure and heart rate profiles and to delineate the relative roles of sleep and circadian rhythmicity, we performed 24-hour ambulatory blood pressure monitoring with simultaneous polygraphic sleep recording in 31 healthy young men investigated in a standardized physical and social environment. Electroencephalographic sleep recordings were performed during 4 consecutive nights. Blood pressure and heart rate were measured every 10 minutes for 24 hours starting in the morning preceding the fourth night of recording. Sleep quality was not significantly altered by ambulatory blood pressure monitoring. A best-fit curve based on the periodogram method was used to quantify changes in blood pressure and heart rate over the 24-hour cycle. The typical blood pressure and heart rate patterns were bimodal with a morning acrophase (around 10:00 AM), a small afternoon nadir (around 3:00 PM), an evening acrophase (around 8:00 PM), and a profound nocturnal nadir (around 3:00 AM). The amplitude of the nycterohemeral variations was largest for heart rate, intermediate for diastolic blood pressure, and smallest for systolic blood pressure (respectively, 19.9%, 14.1%, and 10.9% of the 24-hour mean). Before awakening, a significant increase in blood pressure and heart rate was already present. Recumbency and sleep accounted for 65-75% of the nocturnal decline in blood pressure, but it explained only 50% of the nocturnal decline in heart rate. Thus, the combined effects of postural changes and the wake-sleep transition are the major factors responsible for the 24-hour rhythm in blood pressure. In contrast, the 24-hour rhythm of heart rate may reflect an endogenous circadian rhythm, amplified by the effect of sleep. We conclude that modulatory factors different from those controlling nycterohemeral changes in blood pressure influence the 24-hour variation in heart rate.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Circadian rhythms of blood pressure after liver transplantation.

Twenty-four-hour systolic blood pressure, diastolic blood pressure, and heart rate profiles were recorded in 17 liver-transplanted patients by noninvasive ambulatory monitoring and were analyzed with the periodogram method. These recordings were compared with those of control subjects matched for age, sex, and daytime ambulatory blood pressure. Abnormal blood pressure patterns were found in seven of the 17 patients, whereas the other 10 patients had circadian blood pressure profiles that were not different from those of control subjects. These two groups of liver-transplanted patients did not differ in age, sex, oral dose of cyclosporine, specific serum cyclosporine level, and proportion of patients receiving azathioprine and antihypertensive medications. In contrast, the daily oral dose of prednisolone was significantly higher (p < 0.001) in the seven patients with abnormal circadian blood pressure patterns. Moreover, only the daily oral dose of prednisolone was inversely correlated with the magnitude of the nighttime systolic and diastolic blood pressure decrease (r = -0.64 and r = -0.66, p < 0.01). In contrast to blood pressure, patients and control subjects had similar circadian heart rate variations. We conclude that exogenous glucocorticoid administration may have a dose-dependent effect on the nighttime blood pressure fall and may play an important role in the pathogenesis of the abnormal circadian blood pressure profiles observed in liver-transplanted patients.Journal Articleinfo:eu-repo/semantics/publishe

Patient compliance and therapeutic coverage: amlodipine versus nifedipine (slow-release) in the treatment of angina pectoris

Patient compliance with therapy is often poor and overestimated by the treating physician; it is particularly important in cardiovascular diseases such as hypertension and angina pectoris. Compliance was studied in an open parallel study in out-patients with stable angina pectoris, given either amlodipine (5 mg, once daily) or slow-release nifedipine (20 mg, twice daily) for 12 weeks. Compliance was assessed using pill counting and using an electronic device, the medication event monitoring system, to record the time and date of each opening and closure of the pill container. There was no difference between the two groups in pill count or in 'taking compliance' (the percentage of prescribed doses taken as indicated by the monitoring system). Compliance was significantly better (P < 0.001) with amlodipine, however, for 'correct dosing' (the percentage of days on which the correct dose was taken) and for 'timing compliance' (the percentage of doses taken at the prescribed time interval after the last dose). 'Therapeutic coverage' (the estimated proportion of treatment time for which the drug was active) was also significantly better for amlodipine (P < 0.001). There was no difference in reported side-effects between the two therapies

Effects of wake and sleep stages on the 24-h autonomic control of blood pressure and heart rate in recumbent men.

Fifteen recumbent young health volunteers underwent 24-h beat-to-beat blood pressure (BP) and interbeat interval (IBI) recordings to explore the effects of wake and polygraphically recorded sleep on the nyctohemeral variations in the spectral frequency components of BP and IBI and in the arterial baroreflex sensitivity (BRS), independent of the confounding effects of changes in posture and physical activity. Spectral analysis of BP and IBI provided markers of sympathetic and vagal controls and of arterial BRS. When falling asleep, the low-frequency (LF) BP and IBI components showed a marked decrease while there was a clear-cut increase in the high-frequency (HF) IBI component. In contrast, only a slight nighttime rapid eye movement-related arterial BRS increase was observed. The final morning awakening induced a pronounced decrease in arterial BRS and the HF IBI component while there was a marked rise in the LF BP component. Hence, a clear 24-h variation in sympathetic and vagal tone but not in arterial BRS persists, independent of changes in activity and position.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe