http://www.stockton-press.co.uk/jhh. Twenty-four hour ambulatory blood pressure monitoring in young and elderly hypertensive subjects. D Musialik, T Kosicka, ...
Journal of Human Hypertension (1998) 12, 641–642 1998 Stockton Press. All rights reserved 0950-9240/98 $12.00 http://www.stockton-press.co.uk/jhh
Twenty-four hour ambulatory blood pressure monitoring in young and elderly hypertensive subjects D Musialik, T Kosicka, A Skołuda, A Boruczkowska, O Trojnarska and A Tykarski Department of Internal Medicine, Department of Hypertension, Medical Academy Poznan´, 61–848 Poznan´, ul.Dluga 1/2, Poland
The aim of our study was to compare blood pressure (BP) measured by 24-h ambulatory monitoring in young and elderly hypertensives and to find a dependency between left ventricular mass (LVM) and different pressure ratios. We also estimated the calcium ionized concentration and serum lipids in all subjects. Two hypertensive groups divided accordingly by age were studied. The duration of hypertension was similar in both groups. The Oxford Medilog ABP was used for the arterial BP recordings. Mean arterial BP, BP loads and night/day mean arterial pressure ratio were evaluated. In both groups left ventricular mass index (LVMI) were calculated. The serum calcium ionized concentration (Ca++) was estimated and serum lipids were determined. We found 10 non-dippers in the young group and seven non-dippers in the elderly hypertensives. LVM and LVMI
were comparable in both groups. We showed the correlation of the nocturnal mean arterial pressure with LVM in elderly hypertensives and the dependency of nocturnal BP load with LVM in this group. Serum calcium ionized concentration was significantly decreased in the elderly patients, and LDL-cholesterol was significantly higher in this group. We found a negative correlation between serum calcium and triglycerides in young and elderly hypertensives. We found more non-dippers in the young hypertensives and a positive correlation between LVM and nocturnal mean arterial pressure and nocturnal BP load in elderly subjects. These results suggest the cardiovascular prognosis is not good in both groups. The prognosis in elderly hypertensives was also worsened by the low serum calcium ionized and high LDL-cholesterol concentrations.
Keywords: hypertension; 24-hour monitoring; left ventricular mass; ionized calcium; serum lipids
Introduction The diurnal pattern of blood pressure (BP) variation detected by non-invasive ambulatory BP monitoring has been associated with target organ damage. The present study points to the importance of elevated sleeping BP as a factor contributing to the increase of left ventricular mass (LVM) in hypertensive patients. Lipid and mineral disturbances are observed in many hypertensive subjects. The high BP level, as well as LV hypertrophy and abnormalities in lipid metabolism are important risk factors for cardiovascular events in essential hypertension (EH). The aim of our study was to compare BP measured by 24-h ambulatory monitoring in young and elderly hypertensives and to find the dependency between LVM and different BP ratios. We also estimated the calcium ionized concentration and serum lipids in all subjects.
Materials and methods We studied two hypertensive groups: group I consisted of 15 persons aged 22 to 45 years (35 ± 8), group II had 15 persons aged 65 to 79 years (70 ± 4). The duration of hypertension were equal, 6.3 ± 2.7 Correspondence: D Musialik
and 9.3 ± 5 years, respectively. In both groups body mass index was similar and was as follows: group I 26.7 kg/m2, group II 27.6 kg/m2(NS). The Oxford Medilog ABP recorder was used for the arterial BP recordings. The following parameters were estimated in all cases: (1) average daytime and night-time BP; (2) mean arterial pressure daytime (MAPd) and mean arterial pressure night-time (MAPn); (3) the night/day mean arterial pressure ratio which distinguished dippers from non-dippers (ratio ⬎0.9 is regarded as disadvantageous); (4) BP load, ie, percentage of abnormal measuring during the day, night and 24-h. All measurements were made by Hewlett Packard (USA) Sonos 1000 with electronic transducer 3.5 Mhz. In both groups LVM and LVM index (LVMI) were calculated based on echocardiography Penn’s method. The serum calcium ionized concentration (Ca++) in both groups was estimated by 634 Ca++/pH Analyser (Ciba-Corning, USA). Serum lipids, ie, total cholesterol (TCH), high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol, and triglyceride (TG) were determined using enzymatic methods with Ciba-Corning’s Express Plus Analyser.
24-h ambulatory BP monitoring in young and elderly hypertensives D Musialik et al
642
Results
Conclusions
We found 10 non-dippers in group I and seven nondippers in group II. LVM and LVMI were comparable in both groups. We showed the correlation of the nocturnal mean arterial pressure with LVM in elderly hypertensives and the dependency of nocturnal BP load with LVM in this group. Serum calcium ionized concentration was decreasing significantly in the elderly patients and LDL-cholesterol was significantly higher in this group. We found a negative correlation between serum calcium and triglyceride in young and elderly hypertensives.
The following conclusions were reached:
Discussion Some authors point out that BP variation detected by the non-invasive 24-h ambulatory BP monitoring may contribute to LV hypertrophy.1,2 Hypertensive patients with nocturnal BP fall (dippers) as opposed to those who do not (non-dippers) have less extensive LV hypertrophy.3 In our study more non-dippers are in the young hypertensives group and it worsened their prognosis. We confirmed, as with other authors, the dependence between mean BP at night and LVM, also the dependence between nocturnal BP load and LVM.1,2 Some studies have shown that the hypertensive state is associated with a negative calcium balance.4–6 Data from epidemiologic, clinical and basic research suggested that abnormal calcium metabolism is a factor in the pathogenesis of increased BP in humans. The result is that many studies have confirmed that the intake of calcium significantly lowered BP in hypertensive patients.6,7 In our study a lower level of serum ionized calcium was observed in elderly hypertensives and it suggests the usefulness of calcium supplementation in these patients. Recent studies have described a negative correlation between ionized magnesium level and triglycerides in hypertension.8 In our study we confirm the existence of a negative correlation between serum ionized calcium and triglycerides in young and elderly hypertensives. The relationship between divalent cations and plasma lipid, although not fully understood, have been known for some time.
(1) There were more non-dippers in group I and this suggests a poor cardiovascular prognosis for these patients. (2) In our study we found correlations of LVM with night-time mean arterial pressure and with nocturnal BP load in elderly hypertensives. Hypertrophy of LVM can be induced by increasing the estimated parameters measured by 24-h BP monitoring. (3) Serum calcium ionized concentration was decreasing significantly in elderly subjects and it worsened their prognosis. (4) We estimated significantly higher LDL-cholesterol concentration in elderly hypertensives. (5) Negative correlations between calcium ionized concentration and triglycerides were found in both groups.
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