Personality characteristics influencing determinacy of day and night blood pressure and heart rate.

The evidence of emotional impacts on day and night blood pressure (BP), heart rate (HR) and non-dipping of BP remains fragmentary. Personality traits previously tested by self-reports as determinants of office, screening or mean daytime BP produced mixed results. Therefore, we hypothesized that some traits are acting together as modifiers of 24-h and day/night ambulatory BP and HR. A population sample of healthy 47-54 year-old men, n = 85, unaware of their BP status, was evaluated. In multiple regression, 25% of the 24-h systolic BP (SBP) variation was explained by independent augmenting predictors Trait Anger-Anger Expression Styles, Large and Lasting Emotions, and by an attenuating predictor Anxiety. Only Verbal Aggression increased night-time SBP much more than daytime SBP and diminished day-night dipping of SBP. Strong Large/Lasting Emotions and Indirect Aggression increased daytime SBP only. Day and night HR increased with a high Suspicious Hostility (7.4% of variation), in particular with items Distrust/Vulnerability (11.5% of variation). In conclusion, mean levels of HR and BP during a 24-h period are slightly modified by particular personality traits. Some traits appear to affect either daytime or night-time periods more. Day to night carry-over effects on SBP may occur.

Master blood pressure variation in office, by self, and in sleep recordings.

Variation inherent to each session in any recording situation has to be mastered to obtain informative mean values and differences. Variation due to time trend and unsteady consecutive readings versus inter-arm variations in blood pressure (BP) in the operator-initiated, self-initiated, and sleep recordings were studied by oscillometry. They were small in operator-initiated recordings, increased in self-recordings, and were paramount in sleep. A passive supine patient and simultaneous recordings with cuffs placed in equal horizontal positions are essential conditions for the estimation of a real mean inter-arm difference. The relative variation of pulse pressure (PP), compared with other components, was largest within each situation. Most of the systolic BP (SBP)/diastolic BP (DBP) variation in sleep was due to unequal vertical cuff distances to the heart level. Only sleep PP was independent of the vertical position of cuffs. A plot of inter-arm differences can visualize systematic errors in sequences of sleep SBP/DBP. As is well known, every doubling of variation (SD) requires quadrupling the number of independent recordings in order to retain the same size of confidence interval (CI) for a mean value.

Patient-specific differences between blood pressure estimated from 24 h ambulatory measurements and serial office self-recordings.

The long-term true blood pressure, estimated in terms of the repeatable 24 h ambulatory mean (24 hAmb) pressure, is probably best related to progressive cardiovascular deterioration and is vital for clinical decision-making. Serial self-measurements (SELF) under quiet conditions may reflect this level, but with an annoying uncertainty in individual patients. This uncertainty is characterized by analyzing differences between the SELF readings of seated/supine patients on their own and the reference 24 hAmb values based on 72 recordings. From at-random replicated sessions of 59 subjects, the sources of uncertainty can be separated into three components: a systematic (non-random) variable difference in level from person to person, a mean systematic difference in level between methods, and random variability determining repeatability between sessions. An unstable alerting reaction distorts about six initial self-recordings and increases the random variability. The following 7-12 or 13-24 'steady-state' values show a comparable random variability but reflect the 24 hAmb level only when compared as the average of all patients. The standard deviation for repeatability is about 50-100% higher for SELF than for 24 hAmb. The patient-specific difference between methods contributes more than +/-10 mmHg to the uncertainty interval of the SELF results. These patient-specific differences recur at repeat sessions and thus cannot be reduced by averaging the results of sequential SELF sessions. In contrast, two 24 hAmb results provide a 95% uncertainty interval of +/-5 mm Hg. Thus, the averaged results of multiple SELF sessions can be used to detect major changes in blood pressure but are, as a result of patient-specific differences, too unreliable when the value to be estimated (the true value) is the expected long-term value of 24 hAmb results.