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Blood pressure during sleep: antihypertensive medication
O Tochikubo1, K Minamisawa, T Miyakawa
1Internal Medicine II, Yokohama City University, Japan.
The American Journal of Cardiology
|April 22, 1991
Summary
Excessive reduction of blood pressure in elderly patients during sleep may be harmful. Different antihypertensive medications impact nocturnal blood pressure differently, requiring further study in older hypertensive individuals.
Area of Science:
- Cardiology
- Gerontology
- Pharmacology
Background:
- Essential hypertension is common in elderly patients.
- Nocturnal blood pressure changes and their correlation with hemodynamics are not fully understood.
- The impact of antihypertensive medications on nocturnal hemodynamics in the elderly requires investigation.
Purpose of the Study:
- To investigate the correlation between excessive blood pressure reduction by antihypertensive medications and myocardial infarction during sleep in elderly patients.
- To assess blood pressure and hemodynamics during wakefulness and sleep in elderly and younger hypertensive patients.
- To compare the effects of different antihypertensive medications on nocturnal blood pressure.
Main Methods:
- Telemetry and cuvette dye-dilution methods were used to measure blood pressure and hemodynamics.
- 68 inpatients with essential hypertension were studied, divided into an older (>=60 years) and younger (<59 years) group.
- Hemodynamic parameters including cardiac index and total peripheral vascular resistance index were assessed during wakefulness and sleep.
Main Results:
- Elderly patients (OH-group) exhibited marked decreases in blood pressure during sleep, with low cardiac index during wakefulness and slow-wave sleep.
- Changes in mean blood pressure in the OH-group correlated with total peripheral vascular resistance index during sleep, unlike the younger group.
- Antihypertensive medication effects on nocturnal blood pressure varied, with central adrenergic inhibitors and beta blockers showing less effect than ACE inhibitors and calcium antagonists.
Conclusions:
- Excessive reduction of blood pressure and cardiac index in sleeping elderly hypertensive patients suggests potential harm from aggressive antihypertensive medication.
- Total peripheral vascular resistance index appears crucial for blood pressure regulation in sleeping elderly patients.
- Further research is needed to understand the relationship between specific antihypertensive treatments and the hemodynamics of elderly hypertensive patients during sleep.