Med Biol Eng Comput - Cardiac oxygen supply is compromised during the night in hypertensive patients.

Tópicos

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Resumo

The enhanced heart rate and blood pressure soon after awaking increases cardiac oxygen demand, and has been associated with the high incidence of acute myocardial infarction in the morning. The behavior of cardiac oxygen supply is unknown. We hypothesized that oxygen supply decreases in the morning and to that purpose investigated cardiac oxygen demand and oxygen supply at night and after awaking. We compared hypertensive to normotensive subjects and furthermore assessed whether pressures measured non-invasively and intra-arterially give similar results. Aortic pressure was reconstructed from 24-h intra-brachial and simultaneously obtained non-invasive finger pressure in 14 hypertensives and 8 normotensives. Supply was assessed by Diastolic Time Fraction (DTF, ratio of diastolic and heart period), demand by Rate-Pressure Product (RPP, systolic pressure times heart rate, HR) and supply/demand ratio by A(dia)/A(sys), with A(dia) and A(sys) diastolic and systolic areas under the aortic pressure curve. Hypertensives had lower supply by DTF and higher demand by RPP than normotensives during the night. DTF decreased and RPP increased in both groups after awaking. The DTF of hypertensives decreased less becoming similar to the DTF of normotensives in the morning; the RPP remained higher. A(dia)/A(sys) followed the pattern of DTF. Findings from invasively and non-invasively determined pressure were similar. The cardiac oxygen supply/demand ratio in hypertensive patients is lower than in normotensives at night. With a smaller night-day differences, the hypertensives' risk for cardiovascular events may be more evenly spread over the 24 h. This information can be obtained noninvasively.

Resumo Limpo

enhanc heart rate blood pressur soon awak increas cardiac oxygen demand associ high incid acut myocardi infarct morn behavior cardiac oxygen suppli unknown hypothes oxygen suppli decreas morn purpos investig cardiac oxygen demand oxygen suppli night awak compar hypertens normotens subject furthermor assess whether pressur measur noninvas intraarteri give similar result aortic pressur reconstruct h intrabrachi simultan obtain noninvas finger pressur hypertens normotens suppli assess diastol time fraction dtf ratio diastol heart period demand ratepressur product rpp systol pressur time heart rate hr supplydemand ratio adiaasi adia asi diastol systol area aortic pressur curv hypertens lower suppli dtf higher demand rpp normotens night dtf decreas rpp increas group awak dtf hypertens decreas less becom similar dtf normotens morn rpp remain higher adiaasi follow pattern dtf find invas noninvas determin pressur similar cardiac oxygen supplydemand ratio hypertens patient lower normotens night smaller nightday differ hypertens risk cardiovascular event may even spread h inform can obtain noninvas

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