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.