Non-dipping morning blood pressure and isolated systolic hypertension in elderly.

OBJECTIVE: Morning hypertension is currently the blind spot in the clinical practice of hypertension, home 24-hour blood pressure measurement has been recommended in patients with a high clinic blood pressure and patients with target organ damage. AIM: To assess whether an increased early morning blood pressure surge, established via a single 24-hour blood pressure monitoring, in treated elderly hypertensive's is related to more prominent target organ damage. MATERIAL AND METHODS: 310 treated hypertensive patients randomly attended the out-patient clinic of our hypertension centre. The patients were divided in 2 groups: systolic/diastolic blood pressure hypertension (n = 266) and isolated systolic hypertension (n = 44 76 ± 10 yrs). RESULTS: Equivalent in both males and females, despite the rise in nondippers with an early morning surge (higher in females). Hyperlipidemia arises equally in dippers and nondippers, 45 % of nondippers had diabetes mellitus; 30 % suffered previous renal insufficiency and about 29 % of patients suffered from an endocrine disorder, mostly thyroid. Metabolic syndrome was only found to be associated with a nondipping pattern (3 %). Left ventricular hypertrophy was present in 100 % of patients, heart failure in 60 % nondippers and 56 % dippers, potential renal insufficiency in 34 % nondippers and 22 % dippers, retinopathy in 31 % non dippers and 11 % dippers, aortic aneurysm was only in nondippers. CONCLUSION: Early morning surge is a predictor of hypertensive target organ damage, being a dipper or nondipper patient with isolated systolic hypertension, might not make a difference depending on one's own degree of target organ damage and diurnal variation (Fig. 2, Ref. 30).

Periodicity of arrhythmias in healthy elderly men at the moderate altitude.

The 24-hour periodicity of supraventricular (SVPB) and ventricular (VEB) extrasystoles in healthy elderly men (age 49-69 years) was studied at two altitudes during 24 h Holter ECG monitoring. At the low altitude (200 m, n = 26), SVPB were more frequent than VEB. The highest occurrence of SVPB was at 17:00 h, the lowest at 01:00 and 02:00 h (P<0.001). The highest occurrence of VEB was at 09:00 h, the lowest one at 04:00 h (P<0.001). At 1350 m (n=9) the incidence of both SVPB and VEB was approximately twofold higher compared to that at the low altitude (P<0.001). The highest occurrence of SVPB was at 13:00 h, the lowest at 06:00 h (P<0.001). VEB were the most frequent at 10:00 h and 13:00 h, while the lowest frequency was observed at 06:00 h (P<0.001). Our results indicate that the incidence of SVPB and VEB in healthy persons at the moderate altitude is twofold and its periodicity is shifted compared to the low altitude. The cause of increased occurrence of extrasystoles is probably due to beta-adrenergic activation of the heart at the higher altitude.

Cardiovascular changes during sudden ascent in a cable cabin to the moderate altitude.

Our aim was to test the hypothesis that the occurrence of extrasystoles in higher decennia is proportional to the altitude. The occurrence of supraventricular (SVPB) and ventricular (VEB) extrasystoles, values of systolic and diastolic blood pressure and the heart rate were studied in 20 healthy elderly men (50-64 years) during cable cabin transportation to a moderate altitude. These values were measured in stations located at 898 m, 1764 m, and 2632 m above sea level during the transportation in both directions. Our records show that the values of blood pressure and heart rate were within normal limits during the whole period of transportation. Both SVPB and VEB were increasing during the ascent and decreasing to the initial values during the descent compared to the values at altitude of 898 m. The highest values (6 to 7-times exceeding the initial ones) were measured at the summit. The results have demonstrated that the occurrence of SVPB and VEB is proportional to the altitude. The increased incidence in the number of extrasystoles is suggested to be mediated by beta-adrenoceptors.

[The significance of spontaneous variability in ventricular extrasystole in the evaluation of the effectiveness of therapy of ventricular extrasystole]. / Význam spontánnej variability komorovej extrasystólie pri hodnotení úcinosti liecby komorových extrasystólií.

In a mixed population of 104 ambulatory patients the authors assessed, based on 24-hour Holter monitoring, the spontaneous variability of ventricular extrasystoles within one-, two-, three-, four-, six-, eight- and twelve-hour intervals. As significant they evaluated a decline of the frequency of ventricular extrasystoles by more than 90% during the subsequent period of time. The magnitude of variability is influenced substantially more by the frequency of extrasystoles than by the period of monitoring. This fact is not generally accepted so far, although it was already described in 1978. It is probable that this fact participates in a significant way in the difference of values of spontaneous variability reported by different departments.