American journal of hypertension
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Clinical Trial
Loss of nocturnal blood pressure fall after liver transplantation during immunosuppressive therapy.
Hypertension, which develops after organ transplantation during immunosuppression with cyclosporine (CSA), is often associated with a loss of nocturnal decrease in blood pressure. Few data correlate circadian blood pressure patterns before transplant with those observed at fixed time points after transplant, or address the role of alternate immunosuppressive agents such as FK506. FK506 is unrelated structurally to CSA and less often leads to hypertension early after transplant. ⋯ Patients with ESLD were normotensive and maintained a normal nocturnal blood pressure fall (125 +/- 3/74 +/- 2 mm Hg awake; 109 +/- 3/60 +/- 2 mm Hg nocturnal). Awake ambulatory blood pressures were higher in CSA patients than in FK506 patients (148 +/- 3/95 +/- 2 v 128 +/- 3/78 +/- 2 mm Hg, respectively; P < .01), despite reduced glomerular filtration rates in both transplant groups. Both immunosuppressive regimens led to a loss of nocturnal blood pressure fall, as compared to ESLD patients or normotensive controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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A case is presented of a diabetic, hypertensive, female patient who suffers from a bleeding complication from application of an ambulatory blood pressure monitor. A recent literature search is referred to and practitioners are cautioned against this adverse reaction.
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Comparative Study
Noninvasive automatic blood pressure monitoring does not attenuate nighttime hypotension. Evidence from 24 h intraarterial blood pressure monitoring.
Automatic ambulatory blood pressure monitoring makes use of repeated cuff inflations throughout the day and night. This may interfere with the cardiovascular effects of sleep and thus alter the 24 h blood pressure profile. The possibility that intermittent automatic blood pressure measurements prevent nocturnal hypotension was examined in 17 mild or moderate essential hypertensive patients in whom blood pressure was recorded intraarterially for 48 h by the Oxford technique. ⋯ Separate computer analysis of 24 h intraarterial tracings obtained in absence and in concomitance of contralateral automatic blood pressure monitoring showed that the occurrence of automatic measurements had not interfered with the day-night intraarterial blood pressure and heart rate profiles. Thus the frequent cuff inflations that characterize automatic blood pressure monitoring do not attenuate nighttime hypotension and bradycardia. This finding supports use of the noninvasive approach in assessing blood pressure profiles.
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The effects of combined alpha/beta adrenoceptor blockade and of beta-receptor/slow channel calcium blockade on systemic and pulmonary hemodynamics and on adrenergic activity were compared in two matched groups of men suffering from ischemic heart disease and grade 1 to 2 hypertension. They were studied at rest supine and during ischemia-inducing exercise in the seated posture using invasive percutaneous techniques. Sixteen patients received 200 mg labetalol as a single oral doses, 15 received 100 mg metoprolol plus 10 mg nifedipine. ⋯ Plasma adrenaline increased after metoprolol/nifedipine only, noradrenaline with both regimens. Both combinations significantly lowered stroke work and the rate pressure product and had similar beneficial effects on the onset and the duration of angina. It is concluded that both combinations significantly reduce blood pressures and attenuate or offset the potential adverse hemodynamic effects of beta-receptor blockade alone without loss but rather enhancement of antianginal efficacy.