Stroke and blood pressure variability

2004 ◽  
Vol 107 (1) ◽  
pp. 27-28 ◽  
Author(s):  
Justin C. T. PEPPERELL
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Pressure Variability ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Risk Markers ◽  
Medium Term ◽  
Short Term ◽  
Potential Benefits ◽  
Patient Groups

Sleep apnoea is associated with increased cardiovascular risk. Sleep apnoea is common after stroke and associated with increased blood pressure variability as described by Turkington and co-workers in this issue of Clinical Science. Both sleep apnoea and blood pressure variability confer a poor prognosis after stroke and are potentially treatable. Many studies of CPAP (continuous positive airway pressure) demonstrate decreases in cardiovascular risk markers in other patient groups. Although difficult to apply in these patients in the short term, CPAP has some potential benefits in medium-term rehabilitation and secondary prevention following stroke, which warrants further study.

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

2018 ◽  
Vol 48 (4) ◽  
pp. 295-305 ◽  
Author(s):  
Athanasios Bikos ◽  
Elena Angeloudi ◽  
Evangelos Memmos ◽  
Charalampos Loutradis ◽  
Antonios Karpetas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Pressure Variability ◽  
Hemodialysis Patients ◽  
Adverse Outcomes ◽  
Short Term ◽  
Ambulatory Bp Monitoring ◽  
Average Real Variability ◽  
Regular Hemodialysis ◽  
Sustained Increase

Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

scholarly journals How important is blood pressure variability?

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E1-E6 ◽  
Author(s):  
Enrico Agabiti Rosei ◽  
Giulia Chiarini ◽  
Damiano Rizzoni
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Pressure Variability ◽  
Prognostic Significance ◽  
Early Morning ◽  
Continuous Variable ◽  
Short Term ◽  
Arterial Blood ◽  
Relevant Risk Factor

Abstract Arterial blood pressure (BP) is a continuous variable, with a physiology characterized by significant variability stemming from the complex interaction among haemodynamic factors, neuronal reflexes, as well as hormonal, behavioural, and environmental stimuli. The homoeostatic response accounts for the physiologic variability in BP in normotensive individuals, which is more evident in hypertensive patients. Blood pressure variability is a complex phenomenon, which could be classified in various types: very short term (beat to beat), short term (during 24 h), mid-term (day by day), long term (<5 years), and very long term (>5 years). Accurate measurement of BP variability represents a complex and often controversial endeavour, despite several methodological approaches are available. Albeit a prognostic significance has been demonstrated for some indicators of BP variability, the clinical significance of this measurement is still uncertain. In fact, none of the indicators presently available for BP variability, including early morning BP rise, substantially affects, and redefines, the cardiovascular risk of the hypertensive patient, over and beyond the mere BP values. Accordingly, in defining the cardiovascular risk, the focus should be on the absolute BP values, which remain the most relevant risk factor, and the one more susceptible to modification with both non-pharmacologic and pharmacologic treatment.

Effect of short-term positive airway pressure on blood pressure in controlled hypertensive patients with obstructive sleep apnoea syndrome: a prospective cohort study

2015 ◽  
Vol 92 (1085) ◽  
pp. 134-136
Author(s):  
José Heriston de Morais Lima ◽  
Amilton da Cruz Santos ◽  
Sandra Emília Benício Barros ◽  
Pollyana Soares de Abreu Morais ◽  
José Natal Figueiroa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Prospective Cohort ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Short Term ◽  
Hypertensive Patients ◽  
Obstructive Sleep

Continuous positive airway pressure improves blood pressure and serum cardiovascular biomarkers in obstructive sleep apnoea and hypertension

2021 ◽  
pp. 2003687
Author(s):  
Macy Mei-Sze Lui ◽  
Hung-Fat Tse ◽  
David Chi-Leung Lam ◽  
Kui-Kai Lau ◽  
Carmen Wing-Sze Chan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Myocardial Injury ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Control Group ◽  
Cpap Treatment ◽  
Obstructive Sleep

RationaleThe impact of treatment for obstructive sleep apnoea (OSA) on reduction of cardiovascular risk is unclear. This study aimed to examine the effect of continuous positive airway pressure (CPAP) on ambulatory blood pressure (BP) and subclinical myocardial injury in subjects with OSA and hypertension.MethodsSubjects with hypertension requiring at least three anti-hypertensive medications and moderate-severe OSA were enrolled. Eligible subjects were randomized (1:1) to receive either CPAP treatment or control (no CPAP) for eight weeks. Changes in ambulatory BP and serum biomarkers were compared. Stratified analysis according to circadian BP pattern was performed.Main resultsNinety two subjects (75% men; age, 51±8 years; apnoea-hypopnoea index 40±8 events·h−1, taking average of 3.4 anti-hypertensive drugs [range 3–6]) were randomised. The group on CPAP treatment, compared to the control group, demonstrated significant reduction in 24-h systolic BP (−4.4 mmHg, 95% CI −8.7 to −0.1, p=0.046), 24-h diastolic BP (−2.9 mmHg, 95% CI −5.5 to −0.2, p=0.032), daytime systolic BP (−5.4 mmHg, −9.7 to −1.0, p=0.016) and daytime diastolic BP (−3.4 mmHg, 95% CI −6.1 to −0.8, p=0.012). CPAP treatment was associated with significant BP lowering only in non-dippers, but not in dippers. Serum troponin I (mean difference −1.74 pg·mL−1, 95% CI −2.97 to −0.5, p=0.006) and brain natriuretic peptide (−9.1 pg·mL−1, 95% CI −17.6 to −0.6, p=0.036) were significantly reduced in CPAP compared to control group.ConclusionIn a cohort with OSA and multiple cardiovascular risk factors including difficult-to-control hypertension, short-term CPAP treatment improved ambulatory BP and alleviated subclinical myocardial injury and strain.

Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome

2004 ◽  
Vol 107 (3) ◽  
pp. 317-322 ◽  
Author(s):  
Shin-ichi KINEBUCHI ◽  
Junichiro J. KAZAMA ◽  
Makoto SATOH ◽  
Kunihiko SAKAI ◽  
Hideaki NAKAYAMA ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Sodium Thiosulphate ◽  
Short Term ◽  
Obstructive Sleep ◽  
Clearance Test

Patients with OSAS (obstructive sleep apnoea syndrome) demonstrate renal signs such as proteinuria, glomerular hypertrophy and focal glomerular sclerosis. We performed a clinical study to investigate the glomerular function in OSAS patients and the short-term effect of CPAP (continuous positive airway pressure) on it. OSAS patients underwent a sodium thiosulphate and p-aminohippurate double clearance test, polysomnography and ambulatory blood pressure monitoring before and a week after the induction of CPAP. Twenty-seven consecutive patients (24 males) with moderate-to-severe OSAS admitted to our hospital for the induction of CPAP, and 32 healthy donors for renal transplantation as controls participated in the study. Before treatment, the glomerular filtration rate, estimated by the sodium thiosulphate clearance test, was within normal range, and the renal plasma flow was significantly lower than normal in the OSAS patients, thus the FF (filtration fraction) value was much higher than normal. FF before CPAP was not significantly correlated with age, body mass index or blood pressure; however, indices of increased hypoxaemia correlated with increased FF values. Polysomnographic variables after CPAP showed significant improvements in all patients, and only the nocturnal blood pressures were slightly lower than before CPAP. In 21 patients who underwent the clearance test after CPAP, FF significantly decreased from 0.26±0.04 to 0.23±0.03 (P<0.001). OSAS patients were generally in a glomerular-hyperfiltrating condition that appeared to cause the renal findings associated with OSAS. CPAP might prevent nephropathy by ameliorating the glomerular hyperfiltration in OSAS patients.

Comparative effects of CPAP and mandibular advancement splint therapy on blood pressure variability in moderate to severe obstructive sleep apnoea

2021 ◽  
Vol 80 ◽  
pp. 294-300
Author(s):  
Hasthi U. Dissanayake ◽  
Kate Sutherland ◽  
Craig L. Phillips ◽  
Ronald R. Grunstein ◽  
Anastasia S. Mihailidou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Blood Pressure Variability ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Splint Therapy ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep
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