Molecular adaptations to concurrent training.

This study investigated the chronic effects of concurrent training (CT) on morphological and molecular adaptations. 37 men (age=23.7±5.5 year) were divided into 4 groups: interval (IT), strength (ST) and concurrent (CT) training and a control group (C) and underwent 8 weeks of training. Maximum strength (1RM) and muscle cross-sectional area (CSA) were evaluated before and after training. Muscle samples were obtained before the training program and 48 h after the last training session. VO2max improved in 5±0.95% and 15±1.3% (pre- to post-test) in groups CT and IT, respectively, when compared to C. Time to exhaustion (TE) improved from pre- to post-test when compared to C (CT=6.1±0.58%; IT=8.3±0.88%; ST=3.2±0.66%). 1RM increased from pre-to post-test only in ST and CT groups (ST=18.5±3.16%; CT=17.6±3.01%). Similarly, ST and CT groups increased quadriceps CSA from pre-to post-test (6.2±1.4%; 7.8±1.66%). The p70S6K1 total protein content increased after CT. The ST group showed increased Akt phosphorylation at Ser473 (45.0±3.3%) whereas AMPK phosphorylation at Thr172 increased only in IT group, (100±17.6%). In summary, our data suggest that despite the differences in molecular adaptations between training regimens, CT did not blunt muscle strength and hypertrophy increments when compared with ST.

Multivariate analysis in the maximum strength performance.

This study performed an exploratory analysis of the anthropometrical and morphological muscle variables related to the one-repetition maximum (1RM) performance. In addition, the capacity of these variables to predict the force production was analyzed. 50 active males were submitted to the experimental procedures: vastus lateralis muscle biopsy, quadriceps magnetic resonance imaging, body mass assessment and 1RM test in the leg-press exercise. K-means cluster analysis was performed after obtaining the body mass, sum of the left and right quadriceps muscle cross-sectional area (∑CSA), percentage of the type II fibers and the 1RM performance. The number of clusters was defined a priori and then were labeled as high strength performance (HSP1RM) group and low strength performance (LSP1RM) group. Stepwise multiple regressions were performed by means of body mass, ∑CSA, percentage of the type II fibers and clusters as predictors' variables and 1RM performance as response variable. The clusters mean ± SD were: 292.8 ± 52.1 kg, 84.7 ± 17.9 kg, 19249.7 ± 1645.5 mm(2) and 50.8 ± 7.2% for the HSP1RM and 254.0 ± 51.1 kg, 69.2 ± 8.1 kg, 15483.1 ± 1104.8mm(2) and 51.7 ± 6.2%, for the LSP1RM in the 1RM, body mass, ∑CSA and muscle fiber type II percentage, respectively. The most important variable in the clusters division was the ∑CSA. In addition, the ∑CSA and muscle fiber type II percentage explained the variance in the 1RM performance (Adj R2=0.35, p=0.0001) for all participants and for the LSP1RM (Adj R2=0.25, p=0.002). For the HSP1RM, only the ∑CSA was entered in the model and showed the highest capacity to explain the variance in the 1RM performance (Adj R2=0.38, p=0.01). As a conclusion, the muscle CSA was the most relevant variable to predict force production in individuals with no strength training background.

Clinical presentation of obturator hernia and review of the literature.

PURPOSE: Obturator hernia (OH) is a rare type of pelvic hernia. As the symptoms are nonspecific and the physical findings are obscure, a correct diagnosis is often delayed until laparotomy for bowel obstruction, despite advances in diagnostic modalities. The high postoperative mortality rate is often attributed to the delay in diagnosis. This article aimed to review the diagnosis and management of OH patients at our hospital, by describing the clinical presentation, diagnostic modalities, and management. METHODS: We reviewed ten patients who underwent surgery for an OH within a 5-year period, all of whom were elderly, thin, and parous women. RESULTS: A correct preoperative diagnosis based on computed tomography (CT) findings was made in all ten patients. All of the patients survived, but three suffered postoperative complications. CONCLUSIONS: Based on our experience, when an elderly, thin, and parous woman presents with vomiting, abdominal or thigh pain, and intestinal obstruction, the differential diagnosis should include OH. Early diagnosis and prompt initiation of treatment reduces the risk of surgical complications and increases the chance of survival.

Effects of strength training and vascular occlusion.

The purpose of our study was to determine if vascular occlusion produced an additive effect on muscle hypertrophy and strength performance with high strength training loads. Sixteen physically active men were divided into two groups: high-intensity (HI = 6 RM) and moderate-intensity training (MI = 12 RM). An occlusion cuff was attached to the proximal end of the right thigh, so that blood flow was reduced during the exercise. The left leg served as a control, thus was trained without vascular occlusion. Knee extension 1 RM and quadriceps cross-sectional area (MRI) were evaluated pre- and post-8 weeks of training. We only found a main time effect for both strength gains and quadriceps hypertrophy (p < 0.001). Therefore, we conclude that vascular occlusion in combination with high-intensity strength training does not augment muscle strength or hypertrophy when compared to high-intensity strength training alone.

Reconstruction technique for umbilical endometriosis.

OBJECTIVE: To present a technique for immediate umbilical reconstruction in women undergoing resection of umbilical endometriosis. METHODS: Umbilical reconstruction using 2 semicircular defatted skin flaps was performed in 7 patients surgically treated for umbilical endometriosis from October 2000 to June 2004. The patients were followed up for at least 6 months. RESULTS: Anatomical aspect, depression, and abdominal wall scar were considered satisfactory, although hypertrophic umbilical scars developed in 2 patients. CONCLUSION: This technique using 2 semicircular defatted flaps is efficient in creating a new umbilicus with a natural appearance while leaving a minimal scar. Moreover, it allows for laparoscopic inspection of the abdominal cavity.

Malnutrition as an additional risk factor to gentamicin nephrotoxicity / Desnutrição como um fator de risco adicional na nefrotoxidade à gentamicina

A relação entre a desnutrição e as doenças infecciosas tem sido descrita há algum tempo. A gentamicina é um antibiótico aminoglicosídeo muito utilizado no tratamento de infecções graves por gram-negativos, apesar de sua nefrotoxidade. Estudos experimentais e clínicos também mostraram alterações importantes na função renal durante a desnutrição. Assim sendo, o objetivo do presente estudo foi verificar se o uso da gentamicina (G) em ratos submetidos à restrição alimentar (R) pode interferir no desenvolvimento da nefrotoxidade à gentamicina. Ratos Wistar machos com dois meses de idade foram submetidos à restrição alimentar (50 porcento) durante 30 dias. Nos 10 últimos dias, eles foram tratados com soro fisiológico ou gentamicina (40mg/kg/dia intraperitoneal). Os grupos estudados foram: C)- ratos com alimentação ad libitum + soro fisiológico, G)- alimentação ad libitum + gentamicina, R)- restrição alimentar + soro fisiológico, RG)- restrição alimentar + gentamicina. Uma queda significativa na taxa de filtração glomerular (TFG) foi observada nos grupos R (5,69 ± 0,22) e G (5,31 ± 0,27) se comparados ao grupo C (7,17 ± 0,42 ml.min kg). No grupo RG, a diminuição a TFG foi mais evidente do que nos grupos G ou R, (4,42 ± 0,24 ml.min-1.kg-1). Em todos os grupos experimentais, a diminuição da TFG ocorreu paralelamente à diminuição do fluxo plasmático renal (FPR), de modo que a fração de filtração (FF porcento) foi mantida. Um declínio na proporção inulina urina/plasma foi observado em ambos os grupos tratados com gentamicina e também no grupo com restrição alimentar. Apesar de G e R "per se" causarem um aumento na excreção de Na elevado a +, os valores mais altos foram obtidos no grupo RG. Apesar do nosso estudo ter sido realizado num modelo experimental, se extrapolado a protocolos humanos pode-se sugerir que o uso de antibióticos aminoglicosídeos nos pacientes desnutridos deve ser feito com cautela, especialmente devido a função renal e considerando o risco aumentado potencial exibido por estes pacientes.

Risk factors and predictors of coronary arterial lesions in Japanese hypertensive patients.

The morbidity rate of coronary artery disease has recently increased in Japan. This is attributable to changes from traditional to more westernized lifestyles. In this study, we therefore examined the risk factors and predictors of coronary arterial lesions in Japanese patients with essential hypertension. Coronary angiography was performed in 109 consecutive essential hypertension patients (57 men and 52 women; 66 +/- 8.0 years of age) with either angina pectoris or atypical chest pain, who were chosen from 485 consecutive hypertensive patients in a hypertension clinic in Sendai, Japan. Coronary arterial stenosis of greater than 50% was defined as significant and used as a dependent variable for the multiple regression analysis. Risk factors were defined as factors confirmed to have a causal relationship with coronary arterial lesions, whereas arteriosclerotic complications and hypertensive target organ damage were defined as predictors. Multiple logistic regression analysis was performed using these parameters as independent variables. Of 109 patients, 25 had a coronary arterial stenosis greater than 50%. A smoking habit (odds ratio (OR): 4.48; 95% confidence interval (CI): 1.13-17.82; p<0.05), hypercholesterolemia (OR: 5.34; 95% CI: 1.52-18.73; p<0.05), and 24-h diastolic blood pressure (OR: 2.33; 95% CI: 1.06-5.16; p<0.05) were significant risk factors, whereas carotid intima-media thickness (OR: 5.85; 95% CI: 1.48-23.2; p<0.05) was a significant predictor of coronary arterial lesion. When two of the major risk factors (a smoking habit, hypercholesterolemia, or impaired glucose tolerance including diabetes mellitus) were clustered in addition to the hypertension, the risk of coronary arterial lesions increased by 6.7 to 10.1 times. These findings indicate that the major risk factors established in Caucasians, i.e., a smoking habit, hypercholesterolemia and blood pressure level, are also risk factors for coronary arterial lesions in Japanese with essential hypertension. The presence of two or more risk factors increases the risk of coronary arterial lesions synergistically in the presence of hypertension.

Relationships among blood pressures obtained using different measurement methods in the general population of Ohasama, Japan.

To examine the relationships between casual, ambulatory and home blood pressure measurements in the general population, these measurements were obtained in 1,695 of 3,744 subjects aged 20 yr or older in Ohasama, Japan. Of these 1,695 subjects, 1,207 measured their home blood pressure more than 14 times in each of the morning and evening (881 untreated subjects including normotensives and untreated hypertensives, 56.4 +/- 11.5 yr of age; 326 treated subjects, 66.0 +/- 9.2 yr of age). We analyzed data in these 1,207 subjects, examining the distribution of each measurement, the relationships among measurements, and the factors affecting the blood pressure differences among the measurements. For systolic pressure, the casual measurement was the highest among the methods examined. The daytime ambulatory measurement was significantly higher than morning and evening home measurements. Morning home measurements were significantly higher than those in the evening. For diastolic pressure, however, the morning home measurement was the highest among the methods examined. Short-term pressure variability (standard deviation and variation coefficient of ambulatory measurements) was greater than long-term pressure variability (standard deviation and variation coefficient of home measurements). The pressure variability in treated subjects was greater than that in untreated subjects. The correlation between casual pressure and the other pressures was not as strong (r<0.567). Among the relationships between ambulatory and home measurements, the strongest correlation was observed between the 24-h ambulatory measurement and the morning home measurement (r=0.738) in untreated subjects. The morning home measurement was highly correlated with the evening home measurement (r>0.814). The differences among the methods examined were affected by blood pressure level and age. It should be noted that in elderly and treated subjects, blood pressure measurement using one method does not necessarily correlate with that obtained using the other methods. This information is useful for the estimation of the value of one type of blood pressure measurement from values obtained with other methods.

Characteristics of blood pressure measured at home in the morning and in the evening: the Ohasama study.

OBJECTIVE: To determine the qualitative and quantitative differences of blood pressure measured at home (home measurement) in the morning versus the evening. METHODS: Of 3744 participants, aged 20 years or older in the Ohasama population, more than 14 home measurements in the morning and in the evening, respectively, were obtained in each of 1207 individuals (881 untreated, 56.1 +/- 11.4 years and 326 treated, 66.0 +/- 9.2 years). A casual/screening measurement was also obtained in these individuals. RESULTS: The home measurements in the morning were significantly higher than those in the evening. The bivariate linear regression analysis demonstrated that the difference between diastolic home measurement in the morning and that in the evening increased with an increase in diastolic home measurements. The multiple step-wise linear regression analysis, however, demonstrated that male sex, the use of antihypertensive medication, and SD of home measurements in individuals (blood pressure variability), but not level of home measurements, were positively associated with the difference between home measurement in the morning and that in the evening. The SD of home measurement in the evening in individuals was significantly larger than that in the morning, and the SD in treated individuals was significantly larger than that in untreated individuals. The correlations between casual and home measurements were moderate in untreated individuals (r = 0.509-0.567) but poor in treated subjects (r= 0.223-0.384). The correlations between home systolic measurements in the morning and in the evening were very close in both treated and untreated subjects (r = 0.814-0.902). The correlations between the SD of home measurements in the morning and in the evening were moderate in both treated and untreated individuals (r = 0.585-0.657). CONCLUSIONS: Qualitative and quantitative differences in home blood pressure measurement, due to the differential time of measurement, should be taken into consideration in clinical use of home blood pressure measurements.

Altered sympathetic and vagal modulations of the cardiovascular system in patients with pheochromocytoma: their relations to orthostatic hypotension.

To examine sympathetic and vagal cardiovascular regulatory mechanisms in the pathogenesis of orthostatic hypotension in pheochromocytoma, we continuously monitored blood pressure (Finapres) and RR interval (electrocardiogram) in supine and standing positions in 12 patients with pheochromocytoma, 43 patients with essential hypertension, and 30 normotensive subjects. Mayer wave power spectrum of systolic blood pressure variability (approximately 0.1 Hz) and respiratory power spectrum of the RR interval variability (approximately 0.25 Hz) were taken as measures of sympathetic vascular and cardiac vagal modulations, respectively. Systolic blood pressure decreased more upon standing in pheochromocytoma patients (-21 +/- 7 mm Hg) than in normotensive subjects (-5 +/- 2 mm Hg) or essential hypertensive patients (-3 +/- 2 mm Hg) (P < .005 for both), whereas heart rate tended to increase most in the pheochromocytoma group. Postural reduction in systolic blood pressure was highly correlated with postural increase in heart rate (reciprocal change in RR interval) in the pheochromocytoma group (r = 0.716, P < .01) suggesting that baroreflex is well functioning in those patients. The Mayer wave power spectrum in recumbency was extremely depressed in pheochromocytoma patients (1.1 +/- 0.2 mm Hg2) compared with normotensives (4.5 +/- 0.8 mm Hg2) or essential hypertensives (5.6 +/- 0.6 mm Hg2) (P < .001 for both). This parameter increased significantly with standing in all groups but remained lower in patients with pheochromocytoma (5.1 +/- 1.0 mm Hg2) than in normotensives (7.1 +/- 0.9 mm Hg2, P = NS), whereas essential hypertensive patients demonstrated far greater value (19.2 +/- 3.8, P < .01 for both). The respiratory power spectrum of the RR interval in recumbency of pheochromocytoma patients (189 +/- 54 msec2) was less than in normotensive subjects (714 +/- 100 msec2, P < .001) but did not differ from that in patients with essential hypertension (214 +/- 41 msec2). The respiratory power spectrum of the RR interval upon standing was markedly suppressed in pheochromocytoma patients (36.9 +/- 16.7 msec2) compared with normotensive subjects (129.5 +/- 23.6 msec2) or essential hypertensive patients (126.6 +/- 28.6 msec2) (P < .001 for both). Postural decrement in the respiratory power spectrum of the RR interval correlated positively with postural increase in heart rate (r = 0.577, P < .05) in patients with pheochromocytoma. After successful surgery (n = 9), the Mayer wave power spectrum of the systolic blood pressure and the blood pressure response to orthostasis were normalized. These data suggest that altered sympathetic vascular regulation is central to the pathogenesis of orthostatic hypotension in pheochromocytoma, whereas cardiac vagal regulation acts to compensate.

Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan.

OBJECTIVE: To compare the predictive powers of self-measurement of blood pressure at home (home blood pressure measurement) and casual (screening) blood pressure measurement for mortality. DESIGN: A prospective cohort study. SUBJECTS AND METHODS: We obtained home and screening blood pressure measurements for 1789 subjects aged > or = 40 years who were followed up for a mean of 6.6 years. The prognostic significance of blood pressure for mortality was determined by the Cox proportional hazards regression model adjusted for age, sex, smoking status, past history of cardiovascular disease, and the use of antihypertensive medication. RESULTS: When the home blood pressure values and the screening blood pressure values were simultaneously incorporated into the Cox model as continuous variables, only the average of multiple (taken more than three times) home systolic blood pressure values was significantly and strongly related to the cardiovascular mortality risk. The average of the two initial home blood pressure values was also better related to the mortality risk than were the screening blood pressure values. CONCLUSIONS: Home blood pressure measurement had a stronger predictive power for mortality than did screening blood pressure measurement for a general population. This appears to be the first study in which the prognostic significances of home and screening blood pressure measurements have been compared.

Discrepancy between screening blood pressure and ambulatory blood pressure: a community-based study in Ohasama.

We investigated factors underlying discrepancy between screening blood pressure and daytime ambulatory blood pressure (the difference) in a community-based population in northeastern Japan. Screening and ambulatory pressures were measured in 706 untreated subjects aged 20 yr or older. We analyzed the effects of age and blood pressure on the difference and then performed multivariate stepwise linear regression analysis using the difference as the dependent variable. The systolic difference positively correlated with age in men. Women in their 40s exhibited a large difference, disturbing the linear relationship between the difference and age. The difference positively correlated with the screening pressure in men and women. A positive difference (screening pressure > ambulatory pressure) was observed at screening pressures above 130/75 mmHg. The difference inversely correlated with the ambulatory pressure. Multivariate analysis demonstrated that body mass index and male sex were positively associated with the systolic and diastolic blood pressure differences. The daytime pulse rate was negatively associated with the systolic difference, and the standard deviation of daytime diastolic ambulatory blood pressure was positively associated with the diastolic difference. The diastolic difference in subjects with isolated systolic hypertension based on the screening pressure was significantly smaller than that in subjects with systolic/diastolic hypertension. The difference in subjects with isolated systolic hypertension based on ambulatory pressure was significantly higher than that in systolic/diastolic hypertension. When white-coal (isolated screening) hypertension was defined as a screening systolic pressure > or = 140 mmHg, a diastolic pressure > or = 90 mmHg, or both, and a 24-h ambulatory pressure < 136/87 mmHg in men and < 131/86 mmHg in women, white-coat (isolated screening) hypertension was present in 79 (56.8%) of 139 subjects with screening hypertension. The results confirm that the discrepancy between screening and ambulatory blood pressure is due to a variety of factors, including age, sex, blood pressure levels, and baroreflex function. Our results indicate that screening blood pressure in elderly hypertensive patients should be evaluated carefully.

Decreased blood pressure variability at rest in patients with primary aldosteronism.

Increased blood pressure (BP) variability in essential hypertension (EH) is attributed in part to a reduction in baroreflex sensitivity. We previously showed that baroreflex sensitivity is not reduced in hypertension associated with primary aldosteronism (PA) compared with normotensive (NT) subjects. This study examined whether the preservation of baroreflex function in patients with PA would prevent an increase in BP variability. The beat-to-beat BP (measured with Finapres) and RR interval (from electrocardiograms) were monitored for 10 min in the supine and standing positions in 34 patients with PA, 60 patients with EH, and 45 NT subjects. Recordings were also performed during mild ergometer exercise in 7 PA patients, 8 EH patients, and 9 NT subjects. Blood pressure variability was assessed by both standard deviation (SD) and coefficient of variation (CV). Baroreflex sensitivity (BRS) was assessed by the closed-loop gain between systolic BP and RR interval variability. The SD and the CV of systolic BP (SBP) and the CV of diastolic (DBP) BP were significantly smaller in patients with PA than in patients with EH in both supine and standing positions. The SD of SBP and DBP were similar in patients with PA and NT subjects, although the CV were significantly smaller in patients with PA. The BRS was inversely correlated with both the SD and CV for SBP in the supine (r = -0.397 and -0.440, P < .05, respectively) and standing (r = -0.457 and -0.412, P < .05, respectively) positions in patients with PA. Exercise reduced the BRS in all groups (70%, 26%, and 64% for PA, EH, and NT, respectively, P < .01). Blood pressure variability did not change significantly during exercise, compared with rest, in the PA and NT groups but was decreased (P < .05) in the patients with EH. In conclusion, primary aldosteronism is characterized by decreased supine and standing BP variability, which is due in part to the preservation of baroreflex function. Our data further showed that BP variability is minimized by nonbaroreflex mechanisms during mild exercise.

Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study.

To investigate the relation between nocturnal decline in blood pressure and mortality, we obtained ambulatory blood pressures in 1542 residents aged 40 years or over of a rural Japanese community. Subjects were followed-up for a mean of 5.1 years and were then subdivided into four groups according to the percent decline in nocturnal blood pressure: 1) extreme dippers: percent decline in nocturnal blood pressure > or = 20% of the daytime blood pressure; 2) dippers: decline of > or = 10% but < 20%; 3) nondippers: decline of > or = 0% but < 10%; and 4) inverted dippers: no decline. The relationship between the decline in nocturnal blood pressure and mortality was examined by the Cox proportional hazards regression model adjusted for age, sex, smoking status, previous history of cardiovascular disease, and the use of antihypertensive medication. The mortality risk was highest in inverted dippers, followed by nondippers. There was no difference in mortality between extreme dippers and dippers. This relationship was observed for both treated and untreated subjects, was more pronounced for cardiovascular than for noncardiovascular mortality, and did not change after the data were adjusted for 24-h, daytime, and nighttime blood pressure levels.

Factors that affect blood pressure variability. A community-based study in Ohasama, Japan.

Factors that affect blood pressure (BP) variability, ie, standard deviation (SD) and variation coefficient (VC: SD/average ambulatory BP) of ambulatory BP, were examined in a community-based sample in northeastern Japan. Screening and ambulatory BPs were measured in 823 subjects > or = 20 years of age, and the effects of age and BP on the SD and the VC were examined. In bivariate regression analysis, the SD of ambulatory BP was positively correlated with age and the ambulatory BP. The VC was also correlated with age. Both the SD and the VC were strongly correlated with the magnitude of the nocturnal decline in BP. Ambulatory BP was positively correlated with age and negatively correlated with heart rate and the SD of heart rate. Multivariate analysis demonstrated that the nocturnal decline in BP showed the strongest association with the SD and the VC of 24-h BP. However, age and BP were still independently and positively associated with the SD and the VC of ambulatory BP. Furthermore, pulse pressure and BMI were independently and positively associated with the SD and the VC of ambulatory BP. Since the SD and the VC of 24-h ambulatory BP were determined mainly by the nocturnal decline in BP, this variable appears to be an index of the circadian variation in BP and not an index of short-term BP variability. Pulse pressure, an index of arterial stiffness, was a relatively strong predictor of the SD and the VC of BP. In addition, the SD of heart rate, an index of baroreflex function, decreased with increasing age. Findings suggest that the increase in BP variability in hypertensive and elderly subjects may be explained, in part, by a disturbance of baroreflex function associated with an increase in arterial stiffness due to aging and hypertension.

Determinants of circadian blood pressure variation: a community-based study in Ohasama.

We investigated factors affecting the nocturnal decline in blood pressure (BP). A cross sectional study was done in 706 community-based untreated subjects > or = 20 years of age. Screening and ambulatory BPs were measured and the effects of age and the ambulatory BP on the nocturnal decline were examined. Bivariate analysis demonstrated that the magnitude of the decline and the percent decline in the nocturnal BP increased with increase in daytime ambulatory BP and decreased with increase in nighttime ambulatory BP. Although the magnitude of the nocturnal decline in BP increased with increasing daytime BP, the nocturnal BP in hypertensives was still higher than those in normotensives. The magnitude decreased with increasing age in men but not in women, while the percent decline decreased with increasing age in both men and women. Since bivariate analysis demonstrated that the daytime BP, nighttime BP, and standard deviation of the 24-hour BP strongly correlated with the magnitude of the nocturnal decline, these parameters were excluded as independent variables from the multivariate analysis. In the multivariate analysis the nighttime pulse pressure was negatively and daytime pulse pressure was positively associated with the magnitude of the decline and the percent decline in the nocturnal BP. A non-dipping circadian variation was frequently observed in elderly normotensive men but the rate of nondipper was rather low in hypertensive individuals in the general population. A marked dipping pattern was frequently observed in hypertensive women > or = 70 years of age. The nocturnal BP levels in subjects with daytime hypertension are higher than those in subjects with daytime normotension. Therefore, BP must ideally be lowered over 24-hour period in hypertensive subjects. The diminished magnitude of the decline and the decrease in the percent decline in the nocturnal BP in the elderly may be mediated by the disturbed baroreflex function due to the decrease in compliance of large elastic artery. However, in some elderly hypertensive women, excess nocturnal decline in BP is observed. In such subjects, we should take care of the nocturnal BP levels during treatment.

Seasonal variation in blood pressure in normotensive women studied by home measurements.

1. The factors influencing the seasonal variation in blood pressure measured at home in normotensive women were examined. 2. Sixteen female subjects (56.3 +/- 7.9 years old, mean +/- SD) measured their blood pressure and pulse rate at home each morning for more than 20 times per month for at least 1.5 years. Blood pressure and body weight were also determined in the office once or twice a month in that period. Monthly means of outdoor and indoor temperatures and daytime length were obtained from the Meteorological Observatory. The single cosinor method was used to evaluate circannual rhythm. 3. We observed a biphasic seasonal variation in self-recorded blood pressure measured at home, environmental temperature and daytime length but found no apparent seasonal variation in body weight and blood pressure measured in the office. The lowest levels of systolic and diastolic blood pressure measured at home were observed in July. The longest daytime length was recorded in June, while the highest outdoor temperature and indoor temperature were recorded in August, indicating that the longest daytime length preceded and the highest environmental temperature lagged behind the lowest level of blood pressure. The shortest daytime length is in December. The lowest outdoor and indoor temperature were observed in January, while the highest levels of self-recorded systolic blood pressure and diastolic blood pressure were in January and December, respectively. Half-amplitudes of self-recorded systolic and diastolic blood pressure were 2.6 +/- 1.0 mmHg and 2.0 +/- 0.8 mmHg, respectively. 4. These findings indicate the importance of a seasonal effect, i.e. daytime length and the environmental temperature, on the blood pressure of individuals.

Increased gain in baroreceptor-heart rate reflex in patients with primary aldosteronism.

OBJECTIVE: Reduced baroreflex sensitivity has been reported in several kinds of human hypertension. However, the nature of the baroreceptor-heart rate reflex in hypertension due to excess mineralocorticoid has never been fully explored. PATIENTS AND METHODS: Thirty patients with primary aldosteronism, 60 patients with essential hypertension (World Health organization stages I or II) and 45 normotensive subjects were enrolled. The groups did not differ in mean age. Blood pressure was similar between patients with primary aldosteronism and those with essential hypertension. Blood pressure (Finapres) and the RR interval (ECG) were monitored continuously at rest. The closed loop gain between systolic blood pressure and RR interval variabilities was used to measure the sensitivity of the baroreceptor-heart rate reflex. RESULTS: Baroreflex sensitivity in the group with primary aldosteronism was significantly greater than in the essential hypertensive group, but did not differ significantly between the group with aldosteronism and the normotensive group. Three to four weeks after removal of an adrenal adenoma (n = 25), both systolic and diastolic blood pressure were decreased significantly in the aldosteronism group but were still higher than in the normotensive group. The baroreflex sensitivity was reduced by about 40% after adrenalectomy compared to pre-operative values. The decrease in the baroreflex gain following adrenalectomy was correlated negatively with the decrease in systolic blood pressure (r = -4.00, P=0.05). CONCLUSION: These results demonstrate that hypertension due to excess mineralocorticoids is characterized by an increase in the gain of the baroreceptor-heart rate reflex. The reduction in baroreflex gain following adrenalectomy may delay the normalization of blood pressure.