ACE-inhibitor therapy with spirapril increases nocturnal hypotensive episodes in elderly hypertensive patients.

The purpose of this double-blind, randomised trial with a 4-week placebo run-in period followed by an active treatment period using either spirapril 3 mg or 6 mg once a day was to clarify the existence of hypotensive episodes in elderly hypertensive patients treated by an ACE-inhibitor. Forty hypertensive patients aged 60-76 years underwent 24-h ABPM at the end of the run-in (week 4) and active treatment (week 9) periods. The mean 24-h systolic blood pressure (SBP) decreased from 161.9 (26.7) mm Hg to 150.6 (29.9) mm Hg (P < 0.001) and diastolic blood pressure (DBP) from 91.70 (14.7) mm Hg to 84.2 (17.3) mm Hg (P < 0.001). No episodes of mean arterial pressure (MAP) <50 mm Hg were seen during the placebo period. Instead 11 episodes were observed during the antihypertensive treatment (one in the 3 mg group and 10 in the 6 mg group, P < 0.01 between the two treatment groups). Fifty-four episodes of MAP <70 mm Hg were observed during the placebo period and 117 during the treatment period (P < 0.001). During the placebo period low MAPs were observed only during night time. During the treatment period they were seen also from 11 am to 4 pm. In conclusion, ACE-inhibitor therapy with spirapril significantly increased hypotensive episodes in elderly hypertensive patients which may worsen their cerebral and myocardial circulation.

Epidemiological perspective of body position and arm level in blood pressure measurement.

According to official recommendations, indirect blood pressure (BP) measurement should be performed in the brachial artery at heart level in the seated position. At lower levels the hydrostatic pressure of the column of blood in between the heart and the point of measurement is added. The clinical relevance of deviations from the recommendations was investigated in a population-based sample of 401 healthy men and women of ages 15-84 years. In the seated position, the systolic BP measured with the upper arm parallel to the sternum was higher than that with the forearm elevated at heart level. The difference was 9.4 (SD 6.6) mm in men and 8.2 (6.9) mm in women. The corresponding differences in diastolic BP were 13.6 (4.4) mm in men and 12.4 (4.5) mm in women. At heart level, the supine systolic BP was 7.9 (7.5) mm higher than the seated in men, and 8.2 (8.0) mm higher in women, while the diastolic BP was the same up to the age of 40. It is concluded that deviations from the recommended body position and arm level are clinically relevant. The pattern of discrepancy, falsely high BPs below the heart level and a higher pulse pressure in the supine position, is uniform in both sexes at all adult ages.