Circadian variation in blood pressure and heart rate in nonhypertensive congestive heart failure

被引:18
作者
Giles, TD [1 ]
Roffidal, L [1 ]
Quiroz, A [1 ]
Sander, G [1 ]
Tresznewsky, O [1 ]
机构
[1] ZENECA PHARMACEUT GRP INC,WILMINGTON,DE
关键词
ambulatory 24-h blood pressure; congestive heart failure; angiotensin-converting enzyme inhibitors; circadian variation;
D O I
10.1097/00005344-199612000-00001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This study was designed to determine whether decreases in the circadian variability of arterial blood pressure and heart rate measured in ambulatory patients would correlate with neurohumoral indices of the severity of congestive heart failure not the result of systemic arterial hypertension, and whether treatment with angiotensin-converting enzyme (ACE) inhibitors would restore a more normal pattern. The study also examined the ability of ambulatory blood pressure monitoring to discern pharmacodynamic patterns in patients with congestive heart failure, which is associated with decreased variability in circadian variations in blood pressure and heart rate among hospitalized patients. Increased plasma norepinephrine, renin activity, and atrial natriuretic peptide (ANP) have a positive correlation with worsening clinical status. ACE inhibitors have been found to be beneficial in the treatment of congestive heart failure. Ambulatory 24-h blood pressure and neurohumoral measurements were recorded in 30 patients with congestive heart failure (class II-IV, New York Heart Association) before treatment with lisinopril or captopril and repeated after 6 weeks of treatment. Fourier analysis was used as a curve-smoothing technique to compare the pharmacodynamics of the two ACE inhibitors. The absolute amplitude of systolic blood pressure correlated inversely with plasma norepinephrine and ANP (p = 0.004) but not with renin activity. Mean 24-h systemic arterial blood pressure did not decrease significantly after treatment with ACE inhibitors. An increase in absolute amplitude of systolic blood pressure correlated inversely with baseline amplitude (p < 0.00001). Inspection of the Fourier-smoothed curves demonstrated differences in the circadian effect of lisinopril and captopril on systolic blood pressure and rate-pressure product. Ambulatory 24-h blood pressure monitoring may prove useful in the assessment of the severity and treatment of congestive heart failure.
引用
收藏
页码:733 / 740
页数:8
相关论文
共 31 条
[1]   ATRIAL-NATRIURETIC-PEPTIDE ELEVATION IN CONGESTIVE-HEART-FAILURE IN THE HUMAN [J].
BURNETT, JC ;
KAO, PC ;
HU, DC ;
HESER, DW ;
HEUBLEIN, D ;
GRANGER, JP ;
OPGENORTH, TJ ;
REEDER, GS .
SCIENCE, 1986, 231 (4742) :1145-1147
[2]  
CANNON P J, 1983, Journal of the American College of Cardiology, V2, P755
[3]   EFFECTS OF CHRONIC CONGESTIVE HEART-FAILURE SECONDARY TO CORONARY-ARTERY DISEASE ON THE CIRCADIAN-RHYTHM OF BLOOD-PRESSURE AND HEART-RATE [J].
CARUANA, MP ;
LAHIRI, A ;
CASHMAN, PMM ;
ALTMAN, DG ;
RAFTERY, EB .
AMERICAN JOURNAL OF CARDIOLOGY, 1988, 62 (10) :755-759
[4]   ATRIAL-NATRIURETIC-FACTOR IN NORMAL SUBJECTS AND HEART-FAILURE PATIENTS - PLASMA-LEVELS AND RENAL, HORMONAL, AND HEMODYNAMIC-RESPONSES TO PEPTIDE INFUSION [J].
CODY, RJ ;
ATLAS, SA ;
LARAGH, JH ;
KUBO, SH ;
COVIT, AB ;
RYMAN, KS ;
SHAKNOVICH, A ;
PONDOLFINO, K ;
CLARK, M ;
CAMARGO, MJF ;
SCARBOROUGH, RM ;
LEWICKI, JA .
JOURNAL OF CLINICAL INVESTIGATION, 1986, 78 (05) :1362-1374
[5]   PROGNOSIS OF CONGESTIVE HEART-FAILURE AND PREDICTORS OF MORTALITY [J].
COHN, JN ;
RECTOR, TS .
AMERICAN JOURNAL OF CARDIOLOGY, 1988, 62 (02) :A25-A30
[6]   CONTRIBUTION OF VASOPRESSIN TO VASOCONSTRICTION IN PATIENTS WITH CONGESTIVE-HEART-FAILURE - COMPARISON WITH THE RENIN-ANGIOTENSIN SYSTEM AND THE SYMPATHETIC NERVOUS-SYSTEM [J].
CREAGER, MA ;
FAXON, DP ;
CUTLER, SS ;
KOHLMANN, O ;
RYAN, TJ ;
GAVRAS, H .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 7 (04) :758-765
[7]  
DZAU VJ, 1981, CIRCULATION, V63, P645, DOI 10.1161/01.CIR.63.3.645
[8]   ARTERIAL BAROREFLEX ABNORMALITIES IN HEART-FAILURE - REVERSAL AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION [J].
ELLENBOGEN, KA ;
MOHANTY, PK ;
SZENTPETERY, S ;
THAMES, MD .
CIRCULATION, 1989, 79 (01) :51-58
[9]   EFFECTS OF HEART-FAILURE ON BAROREFLEX CONTROL OF SYMPATHETIC NEURAL ACTIVITY [J].
FERGUSON, DW ;
BERG, WJ ;
ROACH, PJ ;
OREN, RM ;
MARK, AL ;
KEMPF, JS .
AMERICAN JOURNAL OF CARDIOLOGY, 1992, 69 (05) :523-531
[10]   SYMPATHOINHIBITORY RESPONSES TO DIGITALIS GLYCOSIDES IN HEART-FAILURE PATIENTS - DIRECT EVIDENCE FROM SYMPATHETIC NEURAL RECORDINGS [J].
FERGUSON, DW ;
BERG, WJ ;
SANDERS, JS ;
ROACH, PJ ;
KEMPF, JS ;
KIENZLE, MG .
CIRCULATION, 1989, 80 (01) :65-77