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Various aspects of blood pressure variability

  • D. P. Veerman

Zusammenfassung

Blood pressure is one of the most variable parameters in medicine; every clinician is familiar with the experience that routine office blood pressure readings obtained within a time span of several minutes can differ considerably (2,3,9,65). But also when studied in more detail, for instance by recording continuous beat-to-beat blood pressure, one is immediately struck by the fact that the systolic and diastolic values of every beat are different from their predecessors (34). This poses a problem for the clinician who attempts to extract a meaningful value of a series of readings of the blood pressure of a patient (9,25, 65). To evade this problem various tools have been developed, e.g. self- or home monitoring of blood pressure or ambulatory blood pressure monitoring.

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References

  1. 1.
    Appel ML, Berger RD, Saul JP, Smith JM, Cohen RJ (1989) Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol 14: 1139–1148PubMedCrossRefGoogle Scholar
  2. 2.
    Armitage D, Fox W, Rose GA, Tinker CM (1966) The variability of measurements of casual blood pressure II. Survey experience. Clin Sci 30: 337–344PubMedGoogle Scholar
  3. 3.
    Armitage P, Rose GA (1966) The variability of measurements of casual blood pressure I. A laboratory study. Clin Sci 30: 325–335PubMedGoogle Scholar
  4. 4.
    Athanassiadis D, Draper GJ, Honour AJ, Cranston WI (1969) Variability of automatic blood pressure measurements over 24-hour periods. Clin Sci 36: 147–156PubMedGoogle Scholar
  5. 5.
    de Boer RW, Karemaker JM, Strackee J (1987) Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model. Am J Physiol 253: H680–H689Google Scholar
  6. 6.
    Braunwald E, Ross Jr J (1979) Control of cardiac performance. In: Berne RM, Sperelakis N, Geiger SR, eds. Handbook of physiology vol I: the cardiovascular system. American Physiological Society, Bethesda 533–580Google Scholar
  7. 7.
    Brennan PJ, Greenberg G, Miall WE, Thompson SG (1982) Seasonal variations in arterial blood pressure. Br Med J 285: 919–923CrossRefGoogle Scholar
  8. 8.
    Bristow JD, Honour AJ, Pickering TG, Sleight P (1969) Cardiovascular and respiratory changes during sleep in normal and hypertensive subjects. Cardiovasc Res 3: 476–485PubMedCrossRefGoogle Scholar
  9. 9.
    Corcoran AC, Dustan HP, Page IH (1955) The evaluation of antihypertensive procedures, with particular reference to their effects on blood pressure. Ann Intern Med 43: 1161–1177PubMedGoogle Scholar
  10. 10.
    Degaute JP, van de Borne P, Linkowski P, van Cauter E (1991) Quantitative analysis of the 24-hour blood pressure and heart rate patterns in young men. Hypertension 18: 199–210PubMedGoogle Scholar
  11. 11.
    Dornhorst AC, Howard P, Leathart GL (1952) Respiratory variations in blood pressure. Circulation 6: 553–557PubMedGoogle Scholar
  12. 12.
    Eckberg DL, Kifle YT, Roberts VL (1980) Phase-relationship between normal human respiration and baroreflex responsiveness. J Physiol 304: 489–502PubMedGoogle Scholar
  13. 13.
    Floras JS, Hassan MO, Vann Jones J, Osikowska BA, Sever PS, Sleight P (1988) Factors influencing blood pressure and heart rate variability in hypertensive humans. Hypertension 11: 273–281PubMedGoogle Scholar
  14. 14.
    Freis ED (1990) Origins and development of antihypertensive treatment. In: Laragh JH, Brenner BM eds. Hypertension: pathophysiology, diagnosis and management. Raven Press Ltd, New York, pp 2093–2105Google Scholar
  15. 15.
    Giaconi S, Palombo C, Genovesi-Ebert A, Marabotti C, Voltervani D, Ghione S (1988) Long term reproducibility and evaluation of seasonal influences on blood pressure monitoring. J Hypertension 6 (Suppl 4): 64–66Google Scholar
  16. 16.
    Golehofen K, Hildebrandt G (1958) Die Beziehungen des Blutdruckrhytmus zu Atmung und peripherer Durchblutung. Pflüg Arch 267: 27–45CrossRefGoogle Scholar
  17. 17.
    Gropelli A, Giorgi DMA, Omboni S, Parati G, Mancia G (1992) Persistent blood pressure increase induced by heavy smoking. J Hypertension 10: 495–499CrossRefGoogle Scholar
  18. 18.
    Guyton CG (1986) Textbook of medical physiology. WB Sunders Company, Philadelphia, pp 149–346Google Scholar
  19. 19.
    Halberg F, Halberg J, Halberg F, Halberg E (1973) Reading,’Riting,’Rhitmatic, and’Rhythmics, a new relevant R in the educational process. Persp Biol Med 17: 128–141Google Scholar
  20. 20.
    Harlan WR, Harlan LC (1990) Blood pressure and calcium and magnesium intake. In: Laragh JH, Brenner BM eds. Hypertension: pathophysiology, diagnosis and management. Raven Press Ltd, New York, pp 229–240Google Scholar
  21. 21.
    Hayoz D, Tardy Y, Rutschmann B, Mignot JP, Achakri H, Feihl F, Meister JJ, Waeber B, Brunner HR (1993) Spontaneous diameter oscillations of the radial artery in humans. Am J Physiol 264: H2080–H2084PubMedGoogle Scholar
  22. 22.
    Huizinga J (1972) Casual blood pressure in populations. In: Vorester DJM (ed) Human biology of environmental change. International Biological Programme, London, pp 164–169Google Scholar
  23. 23.
    Imholz BPM, Wieling W, Langewouters GJ, van Montfrans GA (1991) Continuous finger arterial pressure; utility in the cardiovascular laboratory. Clin Auton Res 1: 43–53PubMedCrossRefGoogle Scholar
  24. 24.
    INTERSALT Research group (1988) INTERSALT: an international cooperative study on electrolytes and blood pressure. Br Med J 297: 319–328CrossRefGoogle Scholar
  25. 25.
    James PD, Pickering TG, Yee LS, Harshfield GA, Riva S, Laragh JH (1988) The reproducibility of average ambulatory, home and clinic pressures. Hypertension 11: 545–549PubMedGoogle Scholar
  26. 26.
    Kannel WB (1980) Host and environmental determinants of hypertension. Perspective from the Framingham study. In: Kesteloot H, Joossens JV (eds) Epidemiology of arterial blood pressure. Martinus Nijhof, The Hague, pp 265–296CrossRefGoogle Scholar
  27. 27.
    Kannel WB (1990) Hypertension and the risk of cardiovascular disease. In: Laragh JH, Brenner BM eds. Hypertension: pathophysiology, diagnosis and management. Raven Press Ltd, New York, pp 101–117Google Scholar
  28. 28.
    Karemaker JM (1993) Analysis of blood pressure and heart rate variability: theoretical considerations and clinical applicability. In Low PA, ed. Clinical autonomic disorders. Little, Brown and company, Boston, pp 315–329Google Scholar
  29. 29.
    Lind AR (1983) Cardiovascular adjustments to isometric contractions: static effort. In: Shepherd JT, Abboud FM, Geiger SR, eds. Handbook of physiology vol III: the cardiovascular system. American Physiological Society, Bethesda 947–966Google Scholar
  30. 30.
    Littler WA, Watson RDS (1978) Circadian variation in blood pressure. Lancet I: 995–996Google Scholar
  31. 31.
    Macmahon S (1987) Alcohol consumption and hypertension. Hypertension 9: 111–121PubMedGoogle Scholar
  32. 32.
    Mancia G (1993) Autonomic modulation of the cardiovascular system during sleep (Editorial). N Eng J Med 328: 347–349CrossRefGoogle Scholar
  33. 33.
    Mancia G, Bertinieri G, Grassi G et al. (1983) Effects of blood pressure measurement by the doctor on patient’s blood pressure and heart rate. Lancet II: 695–697Google Scholar
  34. 34.
    Mancia G, Ferrari A, Gregorini L et al. (1983) Blood pressure and heart rate variabilities in normotensive and hypertensive human beings. Circ Res 53: 96–104PubMedGoogle Scholar
  35. 35.
    Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A (1987) Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension 9: 209–215PubMedGoogle Scholar
  36. 36.
    Mann S, Millar-Craig MW, Melville DI, Balasubramanian V, Raftery EB (1979) Physical activity and the circadian rhythm of blood pressure. Clin Sci 57 (Suppl): 291S–294SGoogle Scholar
  37. 37.
    Manoach M, Gitter S (1971) On the origin of respiratory waves in circulation I: the role of the chest pump. Pflüg Arch 325: 40–49CrossRefGoogle Scholar
  38. 38.
    Marler JR, Price TR, Clark GL et al. (1989) Morning increase in onset of ischemic stroke. Stroke 20: 473–476PubMedCrossRefGoogle Scholar
  39. 39.
    Millar-Craig MW, Bishop CN, Raftery EB (1978) Circadian variation of blood pressure. Lancet 1: 795–797PubMedCrossRefGoogle Scholar
  40. 40.
    van Montfrans GA (1984) Continuous ambulatory blood pressure registration in uncomplicated hypertension. Cuff-responders and blood pressure variability. [Dissertation], University of Amsterdam, Amsterdam, 138 ppGoogle Scholar
  41. 41.
    Mulcahy D, Keegan J, Cunningham D et al. (1988) Circadian variation of total ischaemic burden and its alteration with anti-anginal agents. Lancet II: 755–759Google Scholar
  42. 42.
    Muller JE, Toiler GH, Stone PH (1989) Circadian variation and triggers of onset of acute cardiovascular events. Circulation 79: 733–743PubMedCrossRefGoogle Scholar
  43. 43.
    Muller JE, Stone PH, Turi ZG et al. (1985) Circadian variation in the onset of acute myocardial infarction. N Eng J Med 313: 1315–1322CrossRefGoogle Scholar
  44. 44.
    Orr WC, Hoffman HJ (1974) A 90 minute cardiac biorhytm: Methodology and data analysis using modified periodograms and complex demodulation. IEEE Trans Biomed Eng 21: 130–143PubMedCrossRefGoogle Scholar
  45. 45.
    Pagani M, Lombardi R, Guzetti S et al. (1986) Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 59: 178–193PubMedGoogle Scholar
  46. 46.
    Pagani M, Mazzuerro G, Ferrari A et al. (1991) Sympathovagal interaction during mental stress. A study using spectral analysis of heart rate variability in healthy control subjects and patients with a prior myocardial infarction. Circ 83 (Suppl II): II–43–II–51Google Scholar
  47. 47.
    Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G (1987) Relationship of 24–hour blood pressure mean and variability to severity of target–organ damage in hypertension. J Hypertension 5: 93–98CrossRefGoogle Scholar
  48. 48.
    Periti M, Salvaggio A, Quaglia G, di Marizio L (1987) Coffee consumption and blood pressure: an Italian study. Clin Sci 72: 443–447PubMedGoogle Scholar
  49. 49.
    Pickering TG (1990) Ambulatory monitoring and blood pressure variability. Science Press, London, pp 4. 1–4. 17Google Scholar
  50. 50.
    Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH (1982) Blood pressure during normal daily activities, sleep and exercise. Comparison of values in normal and hypertensive subjects. JAMA 247: 992–996PubMedCrossRefGoogle Scholar
  51. 51.
    Di Rienzo M, Parati G, Castiglioni P, Omboni S, Ferrari AU, Ramirez AJ, Pdotti A, Mancia G (1991) Role of sinoaortic afferents in modulating BP and pulse-interval spectral characteristics in unanesthetized cats. Am J Physiol 261: H1911–H1818Google Scholar
  52. 52.
    Richardson DW, Honour AJ, Fenton GW, Stott FH, Pickering GW (1964) Variation of arterial pressure throughout the day and night. Clin Sci 26: 445–460PubMedGoogle Scholar
  53. 53.
    Rimoldi O, Pierini S, Ferrari A, Cerutti S, Paganni M, Malliani A (1990) Analysis of short-term oscillations of R-R and arterial pressure in conscious dogs. Am J Physiol 258: H967–H976PubMedGoogle Scholar
  54. 54.
    Shimada SG, Marsh DJ (1979) Oscillations in mean arterial pressure in conscious dogs. Circ Res 44: 692–700PubMedGoogle Scholar
  55. 55.
    Siegel G (1983) Principles of vascular rhytmogenesis. Prog Appi Microcirc 3: 40–62Google Scholar
  56. 56.
    Simpson FO (1985) Blood pressure and sodium intake. In: Bulpitt CJ (ed) Handbook of hypertension. Vol 6. Elsevier, Amsterdam; 175–190Google Scholar
  57. 57.
    Smits P, Thien Th, van’t Laar A (1985) Circulatory effects of coffee in relation to the pharmacokinetics of caffeine. Am J Cardiol 56: 958–963PubMedCrossRefGoogle Scholar
  58. 58.
    Struthers AD, Dollery CT (1988) Antihypertensive drugs: pharmakokinetics, pharmacodynamics, metabolism, side-effects, drug interactions. In: Doyle AE (ed) Handbook of hypertension. Vol. 11. Elsevier, Amsterdam: 1–40Google Scholar
  59. 59.
    Ten Harkel DJA (1992) Body fluid shifts and cardiovascular control. Studies in healthy humans and patients with autonomic failure. [Dissertation], University of Amsterdam, Amsterdam, 175 ppGoogle Scholar
  60. 60.
    Turjanmaa V, Kalli S, Sydänmaa, Uusitalo A (1990) Short-term variability of systolic blood pressure and heart rate in normotensive subjects. Clin Phys 10: 389–401CrossRefGoogle Scholar
  61. 61.
    Marler JR, Price TR, Clark GL et al. (1989) Morning increase in onset of ischemic stroke. Stroke 20: 473–476PubMedCrossRefGoogle Scholar
  62. 62.
    Veerman DP, van Montfrans GA (1993) Nurse measured or ambulatory blood pressure in routine hypertension care. J Hypertension 11: 287–292CrossRefGoogle Scholar
  63. 63.
    Veerman DP, van Montfrans GA, Wieling W (1990) Effects of cuff inflation on self recorded blood pressure. Lancet 335: 451–453PubMedCrossRefGoogle Scholar
  64. 64.
    Veerman DP, Imholz BPM, Wieling W, van Montfrans GA, Karemaker JM (1994) Effects of ageing on blood pressure variability in resting conditions. Hypertension, in pressGoogle Scholar
  65. 65.
    Watson RDS, Lumb R, Young MA, Stallard TJ, Davies P, Littler WA (1987) Variation in cuff blood pressure in outpatients with mild hypertension: implications for initiating antihypertensive treatment. J Hypertension 5: 207–211CrossRefGoogle Scholar
  66. 66.
    Wesseling KH, Settels JJ, Walstra HG, van Esch HJ, Donders JJH (1983) Baromodulation as the cause of short term blood pressure variability? In Alberi G, Bajzer Z, Baxa P (eds) Application of physics to medicine and biology. Singapore: World Scientific, pp 247–276Google Scholar
  67. 67.
    Wieling W (1988) Standing, orthostatic stress and autonomic failure. In: Bannister R (ed) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system. Oxford University Press, Oxford 308–328Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1994

Authors and Affiliations

  • D. P. Veerman
    • 1
  1. 1.Department of AnesthesiologyFree University HospitalAmsterdamThe Netherlands

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