NOCTURNAL BLOOD-PRESSURE AND MYOCARDIAL-I SCHEMIA IN PATIENTS WITH CAD

The purpose of this study was to determine whether there is a correlat ion between nocturnal perfusion pressure (diastolic RR) and nocturnal ischemia (number and endurance of ischemic phases, intensity of ST-dep ression) in patients with coronary artery disease (CAD). Methods and P atients: During their clinical follow-up 103 patients with CAD (82 men , 21 women, age 60 +/- 8 years) underwent a 24-hour ECG Holter monitor ing (with ST-segment record) analysed by a pathfinder and a simultaneo us 24-hour blood pressure monitoring (ABPM) by SpaceLab. After analysi ng ABPM, 3 groups of patients were assigned according to severity of b lood pressure (BP). By definition of the groups, the differenes in noc turnal BP between these were significant. There were no significant di fferences between the groups concerning age and sex distribution, coro nary status and therapy. Results: In group 1 86.2% of the the patients had nocturnal episodes of ST-segment depression compared with 50% of group 2 and 33,3% of group 3. Group 1 patients revealed a significant higher incidence of episodes (2.8 +/- 2.4/night) compared with 1.2 +/- 1.8 (p < 0.01) and 0.6 +/- 1 (p < 0,001) of groups 2 and 3, respectiv ely, and a significant (p < 0,001) longer duration (1,602 s versus 304 s and 105 s, respectively). Group 1 patients had a significantly grea ter reduction in nocturnal diastolic BP with 14.3 +/- 6 mmHg compared with 11.5 +/- 6 mmHg (p < 0.05) and 6.6 +/- 5 mmHg Ip < 0.001), respec tively. Conclusion: The results of this study suggest that in patients with CAD a low nocturnal diastolic BP profile (< 70 mmHg) goes along with a higher incidence and longer duration of silent ischemic episode s. A drop in perfusion pressure seems to be responsible for that and s hould be taken into account when treating such patients with antihyper tensive or antiischemic drugs. ABPM and ECG Holter monitoring are indi cated in patients with CAD, but it is necessary to have a simultaneous 24-hour Holter monitoring with ST-segment analysis.