Incomplete benefit of antihypertensive therapy on stroke reduction in older hypertensives with abnormal nocturnal blood pressure dipping (Extreme-Dippers and Reverse-Dippers)

被引:26
作者
Hoshide, Y
Kario, K
Schwartz, JE
Hoshide, S
Pickering, TG
Shimada, K
机构
[1] Jichi Med Sch, Dept Cardiol, Kawachi, Tochigi 3290498, Japan
[2] Mt Sinai Sch Med, Zena & Michael A Wiener Cardiovasc Ctr, Dept Internal Med, New York, NY USA
[3] SUNY Stony Brook, Dept Psychiat & Behav Sci, Stony Brook, NY 11794 USA
关键词
nocturnal blood pressure dipping; antihypertensive treatment; prognosis; stroke;
D O I
10.1016/S0895-7061(02)03020-0
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
To determine whether the benefits of antihypertensive treatment vary according to dipper status, 811 asymptomatic elderly Japanese hypertensives underwent 24-h ambulatory blood pressure monitoring. During a mean follow-up period of 41 months, 32 stroke events were observed in patients who remained nonmedicated (n = 385), and in 27 patients in the medicated group (n = 426), indicating a 24% lower rate of stroke as a result of antihypertensive therapy. Patients were divided into a white-coat hypertensive (WCHT) group (ambulatory blood pressure <130/80 mm Hg; n = 236) and a sustained hypertensive (SHT) group (n = 575). Sixty-one percent of SHT and 32% of WCHT patients were being medicated. In the SHT group, the stroke rates were 12.4% in nonmedicated and 7.4% in medicated group (P = .04), whereas in the WCHT group the stroke rates were 2.5% in nonmedicated and 1.3% in medicated group (P = not significant). The SHT were further classified according to their nocturnal systolic blood pressure (BP) decrease, as follows: 97 extreme-dippers with >20% nocturnal systolic BP decrease; 230 dippers with >10% but <20% decrease; 185 nondippers with >0% but <10% decrease; 63 reverse-dippers with <0% decrease. In the dipping groups of SHT, the stroke rates were similar according to medication versus no-medication in extreme-dippers (12% v 13%), and reverse-dippers (23% v 22%), but in nondippers there was a significantly lower rate (by 65%, P = .038) in the medicated (4.4%) than the nonmedicated (13%) groups. In dippers, the stroke rate was also lower in the medicated than the nonmedicated patients (4.7% v 8.8%), a decrease of 47% (P = .217), although the difference was not significant. In conclusion, in older SHT subjects, antihypertensive therapy using clinic BP may be less effective for the groups with extremely abnormal diurnal BP patterns (extreme-dippers and reverse-dippers) than those with relatively normal patterns (dippers and nondippers). Patients with WCHT also showed no benefit. (C) 2002 American Journal of Hypertension, Ltd.
引用
收藏
页码:844 / 850
页数:7
相关论文
共 30 条
[1]  
APPLEGATE WB, 1999, HYPERTENSION PRIMER, P236
[2]  
CRUICKSHANK JM, 1987, LANCET, V1, P581
[3]   Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension [J].
Fagard, RH ;
Staessen, JA ;
Thijs, L ;
Gasowski, J ;
Bulpitt, CJ ;
Clement, D ;
de Leeuw, PW ;
Dobovisek, J ;
Jääskivi, M ;
Leonetti, G ;
O'Brien, E ;
Palatini, P ;
Parati, G ;
Rodicio, JL ;
Vanhanen, H ;
Webster, J .
CIRCULATION, 2000, 102 (10) :1139-1144
[4]   THE J-CURVE PHENOMENON AND THE TREATMENT OF HYPERTENSION - IS THERE A POINT BEYOND WHICH PRESSURE REDUCTION IS DANGEROUS [J].
FARNETT, L ;
MULROW, CD ;
LINN, WD ;
LUCEY, CR ;
TULEY, MR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (04) :489-495
[5]   Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials [J].
Gueyffier, F ;
Bulpitt, C ;
Boissel, JP ;
Schron, E ;
Ekbom, T ;
Fagard, R ;
Casiglia, E ;
Kerlikowske, A ;
Coope, J .
LANCET, 1999, 353 (9155) :793-796
[6]   POSTPRANDIAL HYPOTENSION - EPIDEMIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT [J].
JANSEN, RWMM ;
LIPSITZ, LA .
ANNALS OF INTERNAL MEDICINE, 1995, 122 (04) :286-295
[8]   Blood pressure variability in elderly patients [J].
Kario, K ;
Pickering, TG .
LANCET, 2000, 355 (9215) :1645-1646
[9]   Relationship between extreme dippers and orthostatic hypertension in elderly hypertensive patients [J].
Kario, K ;
Eguchi, K ;
Nakagawa, Y ;
Motai, K ;
Shimada, K .
HYPERTENSION, 1998, 31 (01) :77-82
[10]   Autonomic nervous system dysfunction in elderly hypertensive patients with abnormal diurnal blood pressure variation - Relation to silent cerebrovascular disease [J].
Kario, K ;
Motai, K ;
Mitsuhashi, T ;
Suzuki, T ;
Nakagawa, Y ;
Ikeda, U ;
Matsuo, T ;
Nakayama, T ;
Shimada, K .
HYPERTENSION, 1997, 30 (06) :1504-1510