[Determination of diurnal blood pressure variations in cirrhosis]

Cirrhotic patients have disturbed systemic haemodynamics with reduced arterial blood pressure, but this has not been investigated during daily activity and sleep. Systolic (SBP), diastolic (DBP), and man arterial blood pressure (MAP), and heart rate (HR) were measured by an automatic ambulatory device for monitoring blood pressure in 35 patients with cirrhosis and 35 healthy matched controls. During the day-time, SBP, DBP and MAP were significantly lower in the patients than in the controls (median 118 vs 127; 70 vs 78; 86 vs 94 mmHg, p < 0.0001 to p < 0.05). The night-time blood pressures were almost similar in the two groups (108 vs 110; 65 vs 67; 78 vs 82 mmHg, NS). Conversely, HR was significantly higher in the patients both in the day-time (86 vs 72 min-1, p < 0.0001) and night (80 vs 64 min-1, p < 0.0001). Consequently, the reduction in blood pressure and HR from day-time to night-time was significantly lower in the patients than in the controls (p < 0.0001 to p < 0.01). Multiple regression analysis revealed HR, serum albumin, serum sodium, and clotting factors 2, 7 and 10 as significant independent predictors of SBP in cirrhosis. In conclusion, cirrhotic patients have elevated HR, but surprisingly normal arterial blood pressure during the night-time, and the circadian variation in blood pressure and HR is diminished probably due to an almost unaltered cardiac output during the 24 hours. These results may reflect a major defect in the ability of optimal regulation of blood pressure in cirrhotic patients.