Previous results have indicated that valsartan administration at bed-time, as opposed to upon wakening, improves the diurnal/nocturnal ratio of blood pressure (BP) toward a normal dipping pattern, without loss of 24 h efficacy. This ratio is characterized by a progressive decrease with aging. Accordingly, we investigated the administration time-dependent antihypertensive efficacy of valsartan, an angiotensin blocking agent, in elderly hypertensive patients. We studied 100 elderly patients with grade 1-2 essential hypertension (34 men and 66 women), 68.2+/-4.9 years of age, randomly assigned to receive valsartan (160 mg/d) as a monotherapy either upon awakening or at bed-time. BP was measured for 48 h by ambulatory monitoring, at 20 min intervals between 07:00 to 23:00 h and at 30 min intervals at night, before and after 3 months of therapy. Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately determine the duration of sleep and wake spans to enable the accurate calculation of the diurnal and nocturnal means of BP for each subject. There was a highly significant BP reduction after 3 months of valsartan treatment (p < 0.001). The reduction was slightly larger with bed-time dosing (15.3 and 9.2 mm Hg reduction in the 24 h mean of systolic and diastolic BP, respectively) than with morning dosing (12.3 and 6.3 mm Hg reduction in the 24 h mean of systolic and diastolic BP, respectively). The diurnal/nocturnal ratio, measured as the nocturnal decline of BP relative to the diurnal mean, was unchanged in the group ingesting valsartan upon awakening (-1.0 and -0.3 for systolic and diastolic BP; p > 0.195). This ratio was significantly increased (6.6 and 5.4 for systolic and diastolic BP; p < 0.001) when valsartan was ingested at bed-time. The reduction of the nocturnal mean was doubled in the group ingesting valsartan at bed-time, as compared to the group ingesting it in the morning (p < 0.001). In elderly hypertensive patients, mainly characterized by a diminished nocturnal decline in BP, bed-time valsartan dosing is better than morning dosing since it improves efficacy during the nighttime sleep span, with the potential reduction in cardiovascular risk that has been associated with a normalized diurnal/nocturnal BP ratio.
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http://dx.doi.org/10.1080/07420520500180488 | DOI Listing |
J Perinat Neonatal Nurs
January 2025
Author Affiliations: School of Nursing, Center for Research Development and Scholarship, Vanderbilt University (Ms Sommer, Dr Muchira, Ms Chinni, and Dr Mogos); Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Dr Garrison); Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee (Ms Walden); and Medical College of Georgia, Augusta University, Augusta, Georgia (Mr van der Eerden).
Purpose: Early detection and management of hypertensive disorders during pregnancy and postpartum are essential. This systematic review and meta analysis aimed: (1) to examine the state of 24-hour ambulatory blood pressure (ABP) use, and (2) in a subset of studies, evaluate 24-hour ABP parameters in the prediction and identification of Hypertensive Disorders of Pregnancy (HDP).
Methods: A comprehensive literature search was conducted in March of 2022 for English language studies published after 2000.
Objective: Aim: To investigate the effects of exercise training on heart rate and blood pressure in soccer players of different skill levels.
Patients And Methods: Materials and Methods: 693 soccer players with different sports qualifications were studied. Heart rate (HR) and blood pressure (BP) were measured at rest at the beginning of the preparatory phase of the training cycle.
Eur Heart J Cardiovasc Imaging
January 2025
Heart Institute. Department of Cardiology. Cardiovascular Imaging Unit. Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
Aims: How the underlying etiology and pathophysiology of left ventricular (LV) hypertrophy affects LA remodeling and function remains unexplored. The present study aims to investigate the influence of various hypertrophic phenotypes on LA remodeling and function.
Methods And Results: Patients with LV hypertrophy who underwent cardiac magnetic resonance (CMR) were compared to a control group.
Pediatr Nephrol
January 2025
Cardiology Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt.
Background: Changes in cardiac function and structure as well as their association with the cardiac autonomic nervous system remain incompletely characterized in children with stage 5 chronic kidney disease (CKD) receiving hemodialysis (HD).
Methods: A prospective observational cohort study was conducted on 40 Egyptian children with CKD on regular HD compared to 40 age- and sex-matched healthy children. All participants underwent thorough clinical examination, laboratory investigations, 24-h Holter monitoring, and 2D/4D echocardiographic study (conventional and advanced modalities).
Am J Physiol Heart Circ Physiol
January 2025
Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Swine are increasingly utilized in cardiovascular research due to their anatomical and physiological similarities to humans, particularly for studying diastolic dysfunction. While MRI offers excellent structural imaging, echocardiography provides superior real-time assessment of diastolic parameters. To address the lack of standardized methods and reduce variability across studies, we present a comprehensive guide for performing echocardiography in Yorkshire pigs, detailing anatomical considerations, equipment requirements, and technical approaches.
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