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J M Mallion

Publications and source records attributed to J M Mallion.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Validation of electronic automatic-measurement arterial blood pressure devices].

Validation of automatic devices for self blood pressure measurement is a necessity, as the mercury columns are no longer available. The European consensus meeting organized by the Group for blood pressure measurement and evaluation (GEM), from French Society of Hypertension held last June 1999 has defined a new international protocol for clinical validation of these devices. The main parts of this protocol are the following: the blood pressure is measured at the same arm with two observers simultaneously and then with the automatic device sequentially seven times among 38 patients. The evaluation is interrupted after the 15th patient if the pre-analysis fails defined criteria. Technical supports are available: A CD-rom from French society of HTA for the training and certification of observers, a special kit for the evaluation (2 mercury column's and a double stethoscope) and a specific software for data analysis created by the GEM.

Automation↗
PubMed2000

[Measurement of carotid artery intima-media thickness. Analysis and reproducibility].

The intima-media thickness of the carotid artery is a cardiovascular risk factor, especially in hypertensive, diabetic or dyslipidemic patients. Very accurate tools of measurement are essential in order to optimise the analysis of the severity of the vascular lesions. Present methods use computer programmes for ultrasonic image enhancement and have already been shown to be very reproducible. However, there is still room for improvement in the detection of lesions at their initial stage of development and in the follow-up of their progression with or without antihypertensive or lipid lowering drugs.

Carotid Arteries↗
PubMed1999

[Current aspects of arterial hypertension. Prognostic value of self-monitoring blood pressure measurements in aged hypertensive patients: a SHEAF study protocol].

HOW TO MEASURE BLOOD PRESSURE: Studies conducted in large series have established the prognostic value of blood pressure measured by conventional methods. This measurement technique has however a certain number of limitations and alternative systems have been proposed, including self-monitoring methods. A preliminary study suggested that the prognostic value of self-monitoring blood pressure measurements would be superior to those obtained with conventional methods. These findings require confirmation. A LARGE SCALE STUDY: The primary objective of the SHEAF study is to determine the prognostic value of self-monitoring blood pressure measurements in terms of cardiovascular mortality in a population of hypertensive elderly subjects living in France. The study protocol projects to include 5,000 hypertensive patients, whether treated or not, aged 60 and over. Baseline pressures are to be measured by a physician using a mercury sphygmomanometer (3 successive measurements at 2 visits) and by the participants using a self-monitoring device in their home (3 measurements in the morning and evening for 4 consecutive days). The patients will be followed for 3 years and all cardiovascular events will be recorded, including: death, myocardial infarction, cerebral vascular events, transitory ischemic events, hospitalization for angina, episodes of angina, heart failure, angioplasy or coronary bypass. The results of this large-scale epidemiology study should be available in 2002. METHODOLOGICAL PRECAUTIONS: The SHEAF study will analyze the patient's usual blood pressures, whatever the treatment at study inclusion, rather than blood pressures observed after treatment withdrawal. Efforts will be made to limit the number of drop-outs.

Aged↗
PubMed1999

[The measurement of arterial pressure and the diagnosis of hypertension].

Blood pressure measurement remains the determining factor in defining hypertension. In daily practice, measurement in the practitioner's office is the reference used for diagnosis and follow-up. According to the classification established in the VIth Report of the NIH Joint National Committee in 1997, the upper normal value is below 139 mmHg for systolic and 89 mmHg for diastolic pressure. Hypertension cannot be confirmed by a single high measurement or at a single consultation. In addition, it should be remembered that: self-measurement should remain under medical control; its upper normal values (135/85) have the advantage of being obtained outside the medical setting; exercise tolerance tests, often using an ergometric bicycle, demonstrate the possibility of cardiovascular adaptation to physical exercise; ambulatory blood pressure measurement affords repeated measurements over 24 h, also with lower reference values (135/85 mmHg), and detects "white coat" hypertension and anomalies of the nycthemeral cycle.

Adaptation, Physiological↗
PubMed1999

Thrombolysis of mobile right atrial thrombi following severe pulmonary embolism.

Thrombolysis may favorably affect the clinical outcome of mobile right atrial thrombus following pulmonary embolism (PE). We report the case of three patients with mobile right atrial thrombus following PE, in whom fibrinolysis was performed. Atrial mass disappeared on the control echocardiogram, but control ventilation perfusion scan showed new perfusion defects in all patients. Thrombolysis seems successful for the treatment of patients with mobile right atrial thrombus following PE; however, recurrent PE may be induced by fibrinolysis. This may affect the benefit of such therapy and should be taken into account when using this therapeutic treatment.

Acute Disease↗
PubMed1999

Study of arterial blood pressure by a Windkessel-type model: influence of arterial functional properties.

OBJECTIVE: To analyse the performance of a Windkessel blood pressure (BP) modeling of arterial compliance adjusted in a dynamic fashion according to a non-linear relationship between the arterial compliance (AC) and BP. Non invasive measurements of the radial BP waveform (MILLAR tonometry) were compared to those constructed by an electric simulator reproducing the model in a symmetrical network subdivided into 121 segments. We introduced at cardiac level the aortic stroke volume (Doppler echocardiography) and the dynamic values of compliance (relation of compliance-to pressure, constant or variable) whether the model was linear or non linear, measured by high resolution Doppler (NIUS 02) for each subject. RESULTS: At the radial artery segment the modelled BP obtained by the non linear model of AC was not significantly different from the measured BP wave, while in the linear model (AC constant at mean BP level) the systolic BP was significantly underestimated. (*P < 0.05). CONCLUSION: This work shows the limits inherent in simplification of arterial compliance in the Windkessel model using constant parameters. This demonstrates the influence of the dynamic properties of the arterial wall in a conduction artery on the level of systolic and diastolic BP.

Blood Pressure↗
PubMed1999

Toward a portable blood pressure recorder device equipped with an accelerometer.

The 24-h ambulatory systolic blood pressure (ASBP) recording has become a helpful tool in the diagnosis of hypertension and evaluation of the efficiency of anti-hypertensive drugs. Yet, the very high variability of ASBP makes the analysis of the recording rather difficult. A potential solution to reduce ASBP variability has been studied and is presented in this article. It consists of equipping the portable ASBP recorder device with other sensors, a three axes accelerometer and a heart rate recorder, so as to enable an analysis to be undertaken of the arterial pressure profile in the light of these concomitant data. A database has been collected, and a model linking ASBP variations with body acceleration and heart rate measurements is developed. Its performance is tested in prediction and the results compared with those obtained from one of the solutions currently used by physicians to deal with ASBP variability. The results obtained with 16 young subjects from the database, for whom two 24-h recordings are available, are significantly improved and very encouraging.

Adult↗
PubMed1999

Cardiac and vascular remodelling: effect of antihypertensive agents.

The 1996 World Health Organization (WHO) recommendations for mild hypertension stressed the need to evaluate target-organ lesions as treatment criteria. The effects of both vascular and heart remodelling on hypertension must to be taken into account, as they adversely influence the prognosis of patients with hypertension. It was previously demonstrated that at least three classes of antihypertensive agents were able to decrease morbidity and mortality in patients with hypertension. Meta-analyses have shown that angiotensin-converting enzyme inhibitors seem to have a marked effect on regression of left ventricular hypertrophy (LVH). However, the relationship between drug-induced LVH regression and reduced morbidity and mortality remains to be confirmed. The effect of antihypertensive agents on vascular hypertrophy, as assessed by intima-media thickness, and their involvement in reducing morbid events, also have to be determined at the vascular level. As experimental data have highlighted the involvement of angiotensin II in animal models of LVH and vascular hypertrophy development, the role of angiotensin II AT1 receptor blockers should also be assessed in this indication.

Angiotensin Receptor Antagonists↗
PubMed1999

High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months.

AIMS: Cardiac failure patients were studied systematically using polysomnography 1 month after recovering from acute pulmonary oedema, and again after 2 months of optimal medical treatment for cardiac failure. METHODS AND RESULTS: This prospective study of consecutive patients was conducted in a cardiac care unit of a university hospital. V o(2)measurements and left ventricular ejection fraction were recorded. Thirty-four patients, initially recruited with pulmonary oedema, improved after 1 month of medical treatment to NYHA II or III. They were aged less than 75 years and had a left ventricular ejection fraction less than 45% at the time of inclusion. Age was 62 (9) years, body mass index= 27 (5) kg x m(-2)and an ejection fraction= 30 (10)%. Eighteen of the 34 patients (53%) had coronary artery disease. Twenty-eight of the 34 had sleep apnoea syndrome with an apnoea+hypopnoea index >15 x h(-1)of sleep. Thus, the prevalence of sleep apnoea in this population was 82%. Twenty-one of 28 (75%) patients had central sleep apnoea and seven of 28 (25%) had obstructive sleep apnoea. Patients with central sleep apnoea had a lower Pa co(2)than those with obstructive sleep apnoea (33 (5) vs 37 (5) mmHg, P<0.005). Significant correlations were found between apnoea+hypopnoea index and peak exercise oxygen consumption (r= -0.73, P<0.01), and apnoea+hypopnoea index and Pa co(2)(r= -0.42, P = 0.03). When only central sleep apnoea patients were considered, a correlation between apnoea+hypopnoea index and left ventricular ejection fraction was also demonstrated (r= -0.46, P<0.04). After 2 months of optimal medical treatment only two patients (both with central sleep apnoea) showed improvement (apnoea+hypopnoea index <15 x h(-1)). CONCLUSIONS: We have demonstrated a high prevalence of sleep apnoea, which persisted after 2 months of medical treatment, in patients referred for acute left ventricular failure. Central sleep apnoea can be considered a marker of the severity of congestive heart failure.

Aged↗
PubMed1999

Clinical value of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring (ABPM) has now become an established clinical tool. It is appropriate to take stock and assess the situation of this technique. UPDATE ON EQUIPMENT: Important improvements in equipment have occurred, with reductions in weight, in awkwardness and in noisiness of the machines, better acceptability and tolerance by the patients, and better reliability. Validation programmes have been proposed and should be referred to. Limitations of the technique persist with intermittent recording in current practice. The reproducibility is limited in the short-term while recording over 24 h is acceptable. DIAGNOSIS AND PROGNOSIS: White-coat effect (WCE) is manifested as a transient elevation in blood pressure during the medical visit The frequency of this phenomenon, the size of the effect, age, sex and level of blood pressure (BP) or the situation of occurrence (general practitioner, specialist or nurse) have been interpreted differently. It does not seem that WCE predicts cardiovascular morbidity or mortality. White-coat hypertension (WCH) is diagnosed on the evidence of abnormal clinical measures of BP and normal ABPM. The latest upper limits of normality by ABPM recommended by the JNCVI are < 135/85 mmHg while patients are awake and < 120/75 mmHg while patients are asleep. If we accept these upper limits of normality in ABPM, WCH does not appear to be a real problem as regards risk factors or end-organ effects. In terms of prognosis, data are limited. Cardiovascular morbidity seems low in WCH but identical to that of hypertensive subjects in these studies. However, further studies are needed to confirm these results. WCH does not appear to benefit from anti-hypertensive treatment. It is obvious that the lower the BP regarded as the limit of normality, the less likely the occurrence of secondary effects of metabolism, or end-organ effects or complications in those classified as hypertensive. 24 HOUR CYCLE: One of the most specific characteristics of ABPM is the possibility of being able to discover modification or alteration of the 24 h cycle of BP. Non-dippers are classically defined as those who show a reduction in BP of less than 10/5 mmHg or 10% between the day (06.00-22.00 h) and the night, or an elevation in BP. In contrast, extreme dippers are those in whom the BP reduction is greater than 20%. CARDIOVASCULAR SYSTEM: The data remain inconclusive with regard to the existence of a consistent relationship between the lack of a nocturnal dip in blood pressure and target organ damage. As regards prognosis, it seems that an inversion of the day-night cycle is of pejorative significance. CEREBROVASCULAR SYSTEM: Almost all studies have shown that non-dippers had a significantly higher frequency of stroke than dippers. In contrast, too great a fall in nocturnal BP may be responsible for more marked cerebral ischaemia. RENAL SYSTEM: Non-dippers have a significantly elevated median urinary excretion of albumin. There is a significant correlation between the systolic BP and nocturnal diastolic BP, and urinary excretion of albumin. Various studies have confirmed the increased frequency of change in the 24 h cycle in hypertensive subjects at the stage of renal failure. DIABETES: BP abnormalities should be considered as markers of an elevated risk in diabetic subjects but cannot be considered at present as predictive of the appearance of micro-albuminuria or other abnormalities. ABPM is thus of interest in type I or type II diabetes both in the initial assessment and in the follow-up and adaptation of treatment. PHARMACO-THERAPEUTIC USES: The introduction of ABPM has truly changed the means and possibilities of approach to the study of the effects of anti-hypertensive medications, with new possibilities of analysis such as trough-peak ratio smoothness index, etc.

Blood Pressure Monitoring, Ambulatory↗
PubMed1999

Autonomic nervous system activity in dipper and non-dipper essential hypertensive patients. What about sex differences?

OBJECTIVES: To compare the autonomic nervous system activity indexes obtained from photoplethysmography in dipper and non-dipper hypertensive patients and to seek a potential influence of sex on the relation between autonomic nervous system and the nocturnal decrease in blood pressure. METHODS: We studied 245 hypertensive patients, who underwent 24 h ambulatory blood pressure monitoring (ABPM), photoplethysmographic blood pressure recording, and echocardiography. Non-dipping patients were defined as those whose nocturnal decrease in systolic blood pressure (SBP), diastolic blood pressure (DBP), or both was less than 10% of the daytime blood pressure. Spectral powers of SBP, DBP and heart rate were obtained from photoplethysmographic recordings over three main frequency bands: very low frequency (0.005-0.05 Hz), low frequency (0.05-0.14 Hz) and high frequency (0.14-0.40 Hz). RESULTS: Because their ABPM were normal (less than 135/85 mmHg; n = 33), of poor quality (n = 22) or performed at a period too far from the photoplethysmographic recording (n = 17), 66 patients were excluded from the analysis. The remaining 179 patients comprised 117 dippers and 62 non-dippers. The groups did not differ regarding clinical and echocardiographic characteristics, irrespective of sex. Low-frequency spectral powers were significantly lower in non-dippers than in dippers, whatever the signal, whereas high-frequency spectral powers did not differ significantly between the groups. The nocturnal decrease in blood pressure increased with increasing low-frequency spectral powers, but was negatively correlated with high-frequency spectral powers. Multivariate linear regression analysis identified low-frequency spectral power of SBP and clinic DBP as independent factors determining the decrease in blood pressure. After adjustment for all significant covariates, the odds of being a non-dipper did not differ between men and women. CONCLUSION: A non-dipper profile seemed to be associated, in both men and women, with lower low-frequency spectral powers compared with those in dippers, suggesting impaired sympathetic arterial modulation.

Adult↗
PubMed1999

Vasorelaxant actions of enoximone, dobutamine, and the combination on human arterial coronary bypass grafts.

Enoximone (a type III-selective phosphodiesterase inhibitor) and dobutamine (a beta-receptor agonist) are positive inotropic drugs frequently used in the postoperative management of coronary bypass surgery. The purpose of this study was to characterize their relaxant effects on the human internal mammary artery (IMA) and the gastroepiploic artery (GEA) and to test the hypothesis that their combination may have greater than additive relaxant effects. In organ baths, the relaxant effects of enoximone and dobutamine were tested on rings of IMA (n = 86) precontracted with U46619 (a thromboxane A2 mimetic), norepinephrine (NE), or KCl. The relaxant effects of dobutamine and enoximone also were tested on rings of GEA (n = 42) precontracted with U46619 and NE. The effect of the combination of enoximone and dobutamine were tested on rings of IMA (n = 24) precontracted with U46619 or NE. With respect to maximal relaxations induced by papaverine (10(-4) M), enoximone (< or =10(-3) M) caused full relaxations of IMA precontracted with NE, U46619, or KCI. Dobutamine (< or =10(-3) M) caused full relaxations of IMA precontracted with NE or KCI but only 46% (95% CI, 27-65) relaxation in the rings precontracted with U46619. Similar patterns of relaxation were observed in GEA rings, with dobutamine inducing partial relaxation in GEA precontracted with U46619. The pD2 values of enoximone and dobutamine were both significantly lower in segments precontracted with U46619. The in vitro threshold relaxant concentrations were in the upper limits or over the range of therapeutic plasma concentrations. The relaxant effect of the combination was significantly more important than the theoretic additive effect in IMA contracted with U46619 or NE. Enoximone and dobutamine are potent in vitro vasodilators but exert weak relaxant effects in IMA and GEA at concentrations in the therapeutic range. There is, however, a greater than additive vasorelaxant effect of the combination, suggesting that the vasorelaxant effect of the combination, in addition to the additive inotropic effect, may be beneficial to patients undergoing coronary bypass grafting.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1999

Blood Pressure Monitoring. Task force V: White-coat hypertension.

TERMINOLOGY: Two terms are in current use to describe patients whose blood pressures are high only in a medical setting (white-coat hypertension and isolated office or clinic hypertension). The term white-coat effect is also commonly used to describe the pressor response to the clinic setting. DEFINITIONS: White-coat hypertension is generally defined as a persistently elevated clinic blood pressure in combination with a normal ambulatory blood pressure (ABP). There is disagreement regarding the optimal cutoff point for ABP. The white-coat effect is operationally defined as the difference between the clinic blood pressure and daytime ABP. PREVALENCE OF WHITE-COAT HYPERTENSION: This varies according to the definition of white-coat hypertension and the population studied, but is approximately 20% among mild hypertensives, and increases with age. METABOLIC AND BIOCHEMICAL ASPECTS: Authors of some studies have suggested that white-coat hypertension is associated with metabolic abnormalities such as hyperlipidemia that lead to an increase in cardiovascular risk, but most have not found this. TARGET-ORGAN DAMAGE: Several measures of target-organ damage have been compared among normotensives, white-coat hypertensives, and sustained hypertensives; these include left ventricular mass, microalbuminuria, and carotid atherosclerosis. In general, target-organ damage in white-coat hypertension is less than that in sustained hypertension, but in some studies it has been found to be more prevalent than in normotensives. MORBIDITY AND MORTALITY: Authors of a relatively small number of prospective studies have concluded that white-coat hypertensives have a lower risk of morbidity than do sustained hypertensives, but a larger number have drawn the more general conclusion that, when there is a discrepancy between the clinic blood pressure and ABP, the prognosis is more closely related to the ABP. MANAGEMENT: When white-coat hypertensives are prescribed antihypertensive medication there is usually a decrease in clinic blood pressure, but little or no change in ABP. Thus drug treatment is not necessarily indicated. Another issue is the follow-up of white-coat hypertensives; there is general agreement that blood pressure outside the office should be monitored indefinitely. Some patient may have been wrongly classified as white-coat hypertensives, and others may progress to develop sustained hypertension.

Antihypertensive Agents↗
PubMed1999

[Effect of intensive antihypertensive treatment and of aspirin in a low dose in the hypertensive. The HOT (Hypertension Optimal Treatment) study].

The aim of the HOT Study (Hypertension Optimal Treatment) was to determine the optimal diastolic blood pressure decrease and to assess the effect of the acetyl salicylic acid as a primary prevention on the cardiovascular morbidity and mortality in hypertensive patients. The HOT Study is an open, prospective, randomised, international trial with blinded end points. This study included 18,790 patients, 50 to 80 years old (mean 61.5 years) in 26 countries (1,574 patients in France) with a primary hypertension (100 < or = PAD < or = 115 mmHg). The patients were randomised in 3 target diastolic blood pressure: < or = 80 mmHg (n = 6,262), < or = 85 mmHg (n = 6,264), < or = 90 mmHg (n = 6,264). The felodipine LP, a long acting dihydropyridine, was selected as a first line therapy, other hypertension drugs combined if necessary. The lowest incidence of cardiovascular events was observed at a diastolic blood pressure level of 82.6 mmHg. There was no increased risk below this level even in the hypertensive patients with medical history of coronary heart disease or stroke. In the diabetic population, the diastolic blood pressure decrease from 90 to 80 reduced the incidence of the major cardiovascular events by 51%. The acetyl salicylic acid reduced the myocardial infarction risk in the blood pressure well-controlled population.

Aged↗
PubMed1999

[Evaluation of the activity of the autonomic nervous system in "dipper" and "non dipper" essential hypertensives. Gender differences].

OBJECTIVES: 1) To compare the autonomic nervous system activity parameters obtained from a photoplethysmographic recording in dipper and non dipper hypertensive. 2) To look for an interaction between dipper/non dipper status and gender. METHODS: Prospective study involving 245 untreated hypertensives (51 +/- 13 years, 146 men, 99 women). All of the patients underwent a 24-hour ambulatory blood pressure measurement (ABPM) as well as an echocardiography for left ventricular mass index determination (LVMI) and a photoplethysmographic recording of blood pressure (BP). Nondippers were defined as those whose nocturnal decrease in systolic BP (SBP) and/or diastolic BP (DBP) was < 10% of daytime BP. Spectral powers were obtained from the photoplethysmographic recording using a fast Fourier transform over the low frequency band (LF) and the high frequency band (HF). Baroreflex sensitivity (BRS) was evaluated by the sequences method. RESULTS: Of the 245 patients, 159 were dippers (98 men, 61 women) and 86 were non dippers (48 men and 38 women). Clinic BP was significantly higher in non dippers than in dippers (168/101 vs 161/98 mmHg; p < 0.01 for SBP and p < 0.05 for DBP) whereas daytime ABPM and LVMI were not different, whatever the gender. LF spectral powers were significantly lower in non dippers than in dippers for SBP (respectively 25 +/- 11% vs 30 +/- 13%; p < 0.01) for DBP (respectively 35 +/- 14% vs 41 +/- 15%; p < 0.01) and for HR (respectively 34 +/- 15% vs 38 +/- 15%; p = 0.03). They showed a positive correlation with the nocturnal SBP fall (r = 0.21, p < 0.001 for SBP and DBP spectral powers, r = 0.19; p < 0.005 for HR spectral power) and with the nocturnal DBP fall, too (r = 0.19; p < 0.005 for SBP spectral power, r = 0.20; p < 0.002 for DBP spectral power, r = 0.19; p < 0.005 for HR spectral power). HF spectral powers tended to be higher in non dippers than in dippers but in a non significative way. BRS was roughly the same in dippers and non dippers (7.5 +/- 2.7 vs 7.0 +/- 3.1 ms/mmHg, NS). The interaction between non dipper/dipper status and sex was non significant whatever the LF spectral power. CONCLUSIONS: 1) The greater the nocturnal BP fall, the higher the sympathetic activity indexes. 2) This relationship was found both in males and females.

Ambulatory Care↗
PubMed1999

[Evaluation of the ambulatory blood pressure monitor SAVE 33 model 2].

UNLABELLED: This work tests a new ambulatory blood pressure device: Save 33 II. The evaluation is conducted according to the phases II and IV of the British Hypertension Society (BHS) protocol: the phases I and III (before and after use) are not performed as this device has received the European quality label 'CE' that guarantees a +/- 3 mmHg accuracy before and after 10,000 simulated cycles. Two trained observers (hearing test and certification done according to the BHS recommendations) have performed 7 sequential BP measurements with conventional and automatic method, at the same arm, among 85 patients. The ranges of mean blood pressure are 78-203 mmHg, for SBP and 53-130 mmHg for DBP. RESULTS: The Save 33 II monitor satisfies the grade B of BHS evaluation for both systolic and diastolic pressures. This device also satisfies the Association for the Advancement of Medical Instrumentation (AAMI) protocol: mean difference between methods and standard deviation less than 5 +/- 8 mmHg: -2.7 +/- 6.8 mmHg for SBP and -0.86 +/- 6.6 mmHg for DBP. The in-use assessment is conform to BHS criteria for 20 recordings (less than 20% invalid values during day and night); the 5 other recordings have not enough night values, due to batteries failure (2 cases), sleeping discomfort (2 cases) and a cuff withdraw. CONCLUSION: This device, in the tested configuration, agrees the B grade of BHS and can be recommended for ambulatory blood pressure measurement.

Adolescent↗
PubMed1999

[Kinetics of circadian variations in ambulatory arterial blood pressure and cardiovascular sequelae].

OBJECTIVE: To study the relationships between evolution of changes in blood pressure (BP) over the 24 hour cycle and their cardiac and vascular consequences in mild to moderate hypertensive (HT) subjects (WHO criteria). MATERIAL AND METHODS: 151 patients presenting with mild to moderate essential HT (Age 49 +/- 12 yrs, 63 M 44W)--ambulatory measurement of BP over 24 hours (Spacelabs 90207) automatic determination of the diurnal cycle by Fourier analysis (5 harmonics) and calculation of the slope of BP variation (mmHg/hr) at the point of transition from day to night (nocturnal dip slope (NDS)), and at the change from night to day (morning rise slope (MRS). Patients with inversion of the day-night cycle were excluded, day-night being arbitrarily defined as 7 to 22 h and 22 to 7 h. Echography of left ventricular mass index (LVMI)/Penn convention, formula of Devereux, and carotido-femoral distensibility by pulse wave velocity (PWV, Complior Colson France). RESULTS: Ambulatory measures of BP and HR and of cardiovascular parameters were as follows. [table: see text] The slope of nocturnal fall (NDS) and morning rise in SBP (MRS) is significantly correlated with LVMI (NDP r = -0.02, p = 0.049, MPP r = 0.21, p = 0.029) and with PWV (MPP: r = 0.32, p = 0.005). No relationship was found with the DBP values. By multivariate analysis taking into account age, sex, 24 h SBP, MPP slope velocity was the only variable which was significantly related with the model of PWV and LVMI (p < 0.001). CONCLUSION: Dipper and non-dipper studies have been performed to examine the consequences of day night variations in BP. The evolution of diurnal changes in BP seems to have an effect on the vessels and heart and may be a simple analysis tool for assessing prognosis and therapeutic effects.

Adult↗