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The clinical implications of diminished circadian blood pressure variations during hypertensive pregnancies are not fully understood. We used the COS-INOR-method to quantify circadian blood pressure amplitudes of 32 patients with preeclampsia (GG) and 21 patients with superimposed pre-eclampsia (PG). The two groups did not significantly differ in body weight, age, and gestational date at admission. No differences could be detected in 24-h blood pressure values between the two groups (GG: 127 +/- 14/82 +/- 12 mmHg, PG: 128 +/- 16/86 +/- 9 mmHg). Circadian amplitudes of systolic blood pressure variations (GG: 5.9 +/- 5.5 mmHg, PG: 4.5 +/- 6.9 mmHg) and diastolic blood pressure variations (GG: 3.8 +/- 3.0 mmHg, PG: 5.3 +/- 4.1 mmHg) did not differ significantly. The slope between successive changes of mean arterial blood pressure and successive changes in heart rate was significantly higher in patients with superimposed pre-eclampsia (GG: 0.16 +/- 0.27 mmHg/bpm, PG: 0.36 +/- 0.24 mmHg/bpm, p less than 0.005). We conclude that patients with pre-eclampsia and superimposed pre-eclampsia do not differ in 24-h blood pressure and circadian blood pressure variability, however, if blood-pressure variability is related to heart-rate variability differences become apparent that might be due to altered blood-pressure regulation.

The impact of clinical parameters on the pathogenesis of myocardial hypertrophy was examined in 75 male patients with mild essential hypertension. Clinical parameters were age, body weight, sodium excretion (as an estimate for dietary salt intake), systolic and diastolic blood pressure at work, casual blood pressure, resting and stress blood pressure during mental stress test and physical exercise. Left ventricular mass as a parameter for the degree of left ventricular hypertrophy was assessed by 2-D guided M-mode echocardiography. Left ventricular mass correlated with body weight (r = 0.47, p less than 0.002), with body mass index (r = 0.48, p less than 0.001), with systolic blood pressure at the worksite (r = 0.28, p less than or equal to 0.05), and systolic blood pressure at rest (r = 0.35, p less than or equal to 0.01), whereas no correlation was found between casual or stress blood pressure readings during physical exercise and mental stress with the degree of left ventricular hypertrophy. Sodium excretion was related to the end-diastolic diameter of the left ventricle (r = 0.33, p less than or equal to 0.01) and to left ventricular mass (r = 0.35, p less than or equal to 0.01). Multiple regression analysis revealed that sodium excretion over 24 hours, systolic blood pressure at the worksite and body mass index were independent determinants of left ventricular mass. Thus, dietary salt intake was found to modulate the degree of left ventricular hypertrophy independently of the pressure load imposed on the myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Previous studies showed the importance of the response of blood pressure to emotional stress in essential hypertension. However, it is unclear to what extent the response of blood pressure to emotional stress is influenced by antihypertensive treatment, and especially by beta-blockers. In the present study the influence of antihypertensive treatment with either beta-blockers (beta) or diuretics (D) was compared in two series of experiments on male hypertensives, carried out after 2 weeks (beta, n = 11; D, n = 11) and 1 year of treatment (beta, n = 11; D, n = 9). One of the two drugs was randomly allocated to each patient. In the first series of experiments an ergometric exercise test was also performed (workload depending on age and body surface area, 60-100 W). The two medications caused a similar decrease in basal blood pressure. The response of blood pressure to emotional stress was also the same in both groups, and equal to that in untreated hypertensives. However, the reaction of systolic blood pressure to dynamic exercise was lower in the patients treated with beta-blockers (30.2 +/- 9.5 mm Hg) than in those treated with diuretics (42.9 +/- 12.1 mm Hg; p = 0.013). The effect of antihypertensive treatment on the reactivity of blood pressure therefore cannot comprehensively be tested by means of a single stress test. In terms of controlling the response of blood pressure to stress, beta-blockers are not generally more effective than diuretics, but only in certain situations.