[Comparison of conventional versus 24-hour blood pressure measurement. How often do variations in diagnostic/therapeutic evaluation occur?]. / Vergleich konventionelle versus 24-Stunden-Blutdruckmessung. Wie oft Abweichung in der diagnostischen/therapeutischen Beurteilung?

QUESTION: The question as to whether and to what extent 24-hour blood pressure measurement (Holter monitoring) is capable of improving the diagnosis and treatment of arterial hypertension was investigated. METHODS: For this purpose, 50 patients with the diagnosis--based on random blood pressure measurement--of, or receiving treatment for, hypertension were referred to our hospital by general practitioners. In 26 patients, the diagnosis hypertension, and in 24 patients the "well-controlled hypertension" were checked with the aid of 24-hour ambulatory monitoring. RESULTS: Of the patients referred with the diagnosis hypertension, 27% were shown by 24-hour blood pressure measurement not to be suffering from hypertension. The treatment of the 24 patients considered to be "well-controlled hypertensives" was validated by 24-hour blood pressure measurement in only 13 cases.

[The day-night rhythm in the 24-hour blood pressure profile. A possibility of distinguishing between primary and secondary hypertension?]. / Tag-Nacht-Rhythmus im 24-Stunden-Blutdruckprofil. Möglichkeit zur Unterscheidung zwischen primärer und sekundärer Hypertonie?

Automatic 24-hour blood pressure measurements were undertaken in 60 patients with primary systemic hypertension (24 women, 36 men; mean age 51 +/- 23 years) and 105 with secondary hypertension (36 women, 69 men; mean age 51 +/- 24 years). The aim of the study was to ascertain whether the absence of a day-night blood pressure rhythm is a reliable sign that the hypertension is secondary or whether it can also occur in primary hypertension. None of the patients was receiving any treatment. Day-night rhythm was abolished in 10 patients with primary hypertension (16%) and in 65 of those with secondary hypertension (62%). But an analysis of 11 case reports indicated that in an individual case there is no absolute rule. While absence of the day-night rhythm points to secondary hypertension, there are numerous exceptions.

[Return of circadian blood pressure and heart rate changes in patients with heart transplants]. / Rückkehr des zirkadianen Blutdruck- und Herzfrequenzverhaltens bei Herztransplantierten.

A loss of the circadian rhythm pattern of blood pressure (BP) and heart rate, as well as the development of hypertension have been found after heart transplantation (Htx). To study whether a return of this rhythm occurs in the long-term after Htx, we used 24-h ambulatory monitoring to study 62 patients 5 days to 6.5 years after Htx. Patients were divided into two groups (Group 1: less than 6 months after Htx (n = 30), Group 2: 6 months or more after Htx (n = 32)). Group 2 had a higher BP and heart rate, as well as a significantly higher difference between systolic day and systolic night BP than group 1. There was also a significantly higher difference in heart rate between day and night values in group 2. The return of the circadian rhythm pattern in the longer term after heart transplantation may result from partial reinnervation of the heart, although other neurohumoral factors or concomitant medication may play a role.

[24-hour blood pressure profile: reproducibility of automatic ambulatory measurement]. / 24-Stunden-Blutdruckprofil: Reproduzierbarkeit bei ambulanter automatischer Messung.

Twelve patients (8 males, 4 females; mean age 53 [43-60] years) who were undergoing rehabilitation treatment after myocardial infarction were studied to ascertain the reproducibility of ambulatory automatic blood pressure measurements. All were in the last stage of a rehabilitation programme (tolerance to ordinary activity; symptom-free exercise at 75 W). Within two weeks 2, 3 or 4 blood-pressure profiles over 24 hours (total of 32 readings) were obtained by automatic measurement and the records and mean values were compared. Single mild stresses, such as gymnastic exercise or visit to the doctor, were identifiable on the records, but did not alter the overall profile or mean values. Normotensives, hypertensives and borderline hypertensives had 24-hour profiles which were nearly identical with regard to the curve "envelope", day-night profile and mean values in the individual patients. Mean values of diastolic and systolic pressures day by day in each patient showed no deviations greater than 5 mm Hg. Therapeutic measures were recognizable by parallel fall of the curve "envelope", as well as by a reduction in mean value.--At least in these selected patients a single 24-hour profile would in principle have sufficed to describe blood pressure behaviour.

Effects of different once-a-day medications on 24-hour blood pressure recordings in hypertensives.

Compliance with antihypertensive treatment can be increased by using medications that are taken only once daily. There is, however, concern as to whether the efficacy of such drugs is sufficient to cover 24 h. Ambulatory blood pressure monitoring (ABPM) is an ideal technique to assess the effect of this kind of drug and to determine over- or undertreatment. In this study three drugs were examined as once-a-day preparations. Thirty-six patients were treated with three different doses of bisoprolol, as an example of the beta 1-selective beta-blockers; 12 patients were treated with a combination of the AChE-inhibitor enalapril and hydrochlorothiazide; eight patients were treated with nifedipine once per day, a new galenic form of nifedipine, as an example of the calcium-channel blockers. In each group we saw a significant downward shift over the entire 24-h curve. Our results also show that using 24-h blood pressure monitoring devices can help establish an appropriate dose, avoid over- and undertreatment, and control the total burden of the patient.