Document Detail

The clinical significance of abnormal diurnal blood pressure variation in healthy late middle-aged and older adults.
MedLine Citation:
PMID:  18608199     Owner:  NLM     Status:  MEDLINE    
Objective. A fall in nocturnal blood pressure (BP) is generally observed in normotensive subjects as well as in those with mild to moderate essential hypertension, regardless of the level of daytime BP. Among elderly hypertensive subjects, extreme-dippers with a marked nocturnal fall in BP as well as non-dippers with nocturnal fall absence are at increased risk for cardiovascular and cerebrovascular complications. However, the relationship between these abnormal diurnal BP variation patterns in normotensive elderly subjects has not been investigated. Methods. We classified 45 healthy late middle-aged and older adults into three groups according to the nocturnal systolic BP fall pattern examined by 24-h ambulatory BP monitoring (dipper, non-dipper and extreme-dipper), and compared the parameters of initial atherosclerosis, endothelial function and autonomic function. As a parameter of atherosclerotic factors, the intima-media thickness (IMT) of the carotid artery was examined, and as a parameter of endothelial function, brachial artery endothelium-dependent flow-mediated dilation (FMD) was ultrasonographyically measured. Autonomic function was assessed by power spectral analysis of heart rate variability (HRV). Results. No difference was observed in the severity of IMT between the three groups. The percent change of FMD in subjects in the extreme-dipper group was significantly lower than that of subjects in the dipper group, indicating that extreme-dippers in healthy elderly subjects may be associated with endothelial dysfunction. Also, HRV due to sympathetic modulation of subjects in the extreme-dipper group was significantly higher than that of subjects in the dipper and non-dipper groups, suggesting the activation of sympathetic tone. Conclusion. In healthy elderly subjects, the extreme-dipper type may reflect a decrease in endothelial function, i.e. initial stage atherosclerosis, rather than the dipper type.
Toshihiko Hamada; Tetsuhito Murata; Kosuke Narita; Tetsuya Takahashi; Yuji Wada; Hideki Kimura; Haruyoshi Yoshida
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Blood pressure     Volume:  17     ISSN:  0803-7051     ISO Abbreviation:  Blood Press.     Publication Date:  2008  
Date Detail:
Created Date:  2008-07-30     Completed Date:  2008-10-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9301454     Medline TA:  Blood Press     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  134-40     Citation Subset:  IM    
Department of Clinical and Laboratory Science, University of Fukui, Fukui, Japan.
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MeSH Terms
Atherosclerosis / physiopathology*,  ultrasonography
Blood Pressure* / physiology
Blood Pressure Monitoring, Ambulatory
Carotid Arteries / pathology,  ultrasonography
Cerebral Infarction / diagnosis
Circadian Rhythm* / physiology
Endothelium, Vascular / physiopathology*,  ultrasonography
Heart Rate
Hypertension / physiopathology*
Magnetic Resonance Imaging
Middle Aged
Reference Values
Tunica Intima / pathology,  ultrasonography
Vasodilation* / physiology

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