Nocturnal Blood Pressure Dipping is Abolished in Old-Elderly Hospitalized Patients.

INTRODUCTION: During sleep there is reduction of blood pressure (BP) caused by a decrease of the sympathetic nervous tone. This nocturnal "dipping" phenomenon, assessable with ambulatory blood pressure monitoring (ABPM), is blunted with increasing age. AIM: To assess the effect of hospitalization on night-time BP fall in old-elderly patients. METHODS: We analysed 78 ABPM of old-elderly hospitalized patients (mean age 91 ± 0.5 years) and those of 18 outpatients as control group. The nocturnal BP fall was assessed calculating: the dipping value (DV) i.e. the difference between mean diurnal systolic BP (mDSBP) and mean nocturnal systolic BP (mNSBP) and the "dipping pattern" i.e. mNSBP/mDSBPx100. RESULTS: Hospitalized patients showed a lower rate of normal dipping patterns (9 vs. 39%), an higher rate of reverse dippers (59 vs. 28%; p < 0.05) and a lower DV (-0.9 ± 1 vs. 9 ± 4 mmHg; p < 0.05) than patients of control group. At multivariate regression analysis including age, gender and hospitalization, DV was significantly correlated only with the hospitalization (ß -0.3, t -2.9; p < 0.05). CONCLUSIONS: In old-elderly hospitalized patients nocturnal BP fall is abolished. This enhancement of the age related reduction of nocturnal BP dipping may be due to the stress associated with hospital environment.

ABPM Induced Alarm Reaction: A Possible Cause of Overestimation of Daytime Blood Pressure Values Reduced By Treatment with Beta-Blockers.

INTRODUCTION: Alarm reaction to clinical blood pressure (BP) measurement, defined white-coat effect (WCE), can cause overestimation of true BP values. AIM: To assess whether ambulatory blood pressure monitoring (ABPM) can similarly affect BP values during the initial hours of recording. METHODS: In 420 ABPMs selected for a first systolic BP (SBP) reading at least 10 mmHg higher than the mean daytime SBP, we calculated mean diurnal and 24 h SBP with and without the exclusion of the two first hours of recording defined as the WCE window (WCEw). We also calculated the magnitude and duration of WCE. These analyses were also performed separately in patients off anti-hypertensive treatment (n = 156), and on treatment with and without the inclusion of beta-blockers (respectively n = 113 and 151). RESULTS: Exclusion of WCEw period reduced mean diurnal and 24 h SBP respectively from 135 ± 0.5 to 133 ± 0.5 (p < 0.01) and from 131 ± 0.5 to 130 ± 0.5 (p < 0.02). As a result the percentage of patients diagnosed as having diurnal or 24 h hypertension was reduced respectively from 48 to 40 % and from 52 to 47 %. The magnitude of WCEw was similar in both genders but the duration was longer in females (66 ± 2 vs. 56 ± 2 min, p < 0.01). Treatment with beta-blockers was associated with a shorter duration of WCE in both genders but this effect was statistically significant only in males. CONCLUSIONS: In some patients ABPM is not free from WCE. WCE may affect the overall estimation of BP profile and is longer but less blunted by beta-blockers in females than in males.

Endogenous time-varying risk aversion and asset returns.

Stylized facts about statistical properties for short horizon returns in financial markets have been identified in the literature, but a satisfactory understanding for their manifestation is yet to be achieved. In this work, we show that a simple asset pricing model with representative agent is able to generate time series of returns that replicate such stylized facts if the risk aversion coefficient is allowed to change endogenously over time in response to unexpected excess returns under evolutionary forces. The same model, under constant risk aversion, would instead generate returns that are essentially Gaussian. We conclude that an endogenous time-varying risk aversion represents a very parsimonious way to make the model match real data on key statistical properties, and therefore deserves careful consideration from economists and practitioners alike.

Oral and sublingual immunotherapy in paediatric patients.

PURPOSE OF REVIEW: Sublingual immunotherapy is becoming a routine treatment for respiratory allergy in several countries and it has been validated in international documents. This article will review the available literature on oral and sublingual immunotherapy, discussing the possible use of sublingual immunotherapy in paediatric patients. RECENT FINDINGS: As oral immunotherapy was found to be poorly effective in clinical trials, its use has been discontinued. In contrast, several controlled studies have shown the efficacy of sublingual immunotherapy in children with allergic asthma and rhinitis, and a postmarketing survey has confirmed its safety. Moreover, new data on the long-lasting efficacy of this treatment and on the absence of local immunological effects have recently been published. SUMMARY: The clinical efficacy and the optimal safety profile of sublingual immunotherapy make it a good candidate for treating respiratory allergy in children. Some aspects, such as the dose-response relationship and preventive effect, will be a research challenge for future developments and better definition of indications in children.