Olmesartan with azelnidipine versus with trichlormethiazide on home blood pressure variability in patients with type II diabetes mellitus

Effects of dietary salt restriction on home blood pressure in diabetic patients with excessive salt intake: a pilot study

The aim of the present study was to examine whether dietary salt restriction guidance is beneficial for dietary salt restriction and lowering of home blood pressure in patients with diabetes with excessive salt intake. We performed an intervention trial of 37 people with type 2 diabetes and excessive salt intake. National registered dietitians provided dietary salt restriction guidance to each patient at the start of the study. All participants were instructed to perform triplicate morning and evening home blood pressure measurements using home blood pressure telemonitoring system. Daily salt intake at 2 months and 6 months was significantly lower than that at baseline; the difference was 0.8 [95% confidence interval (CI): 0.2–1.4, p = 0.009] g and 0.7 (95% CI: 0.1–1.3, p = 0.009) g, respectively. Morning systolic blood pressure at 2 months and 6 months was significantly lower than that at baseline; the difference was 2.7 (95% CI: 0.2–5.1, p = 0.034) mmHg and 5.8 (95% CI: 0.5–11.1, p = 0.034) mmHg, respectively. This intervention study revealed, for the first time, that dietary salt restriction guidance provided by a national registered dietitian is beneficial for reducing daily salt intake and home blood pressure in people with diabetes with excessive salt intake.

Severity of obstructive sleep apnea is associated with the nocturnal fluctuation of pulse rate, but not with that of blood pressure, in older hypertensive patients receiving calcium channel blockers

AIM

Obstructive sleep apnea (OSA) is associated with increased variability in nocturnal blood pressure (BP). Calcium channel blockers (CCB) are superior to other classes of antihypertensives in decreasing BP variability. We investigated whether OSA severity is associated with nocturnal BP variability in older hypertensive patients treated with CCB.

METHODS

We measured home systolic and diastolic BP and pulse rate (PR) automatically during sleep at an interval of an hour once a week using an electronic sphygmomanometer in 29 hypertensive patients (aged ≥65 years) receiving CCB. We calculated the coefficient of variation (CV) from four consecutive measurements. All patients underwent a home-based portable sleep study.

RESULTS

We found no difference in PR, BP or CV of BP between the patients with no-to-mild OSA and with moderate-to-severe OSA, categorized by the respiratory disturbance index (RDI) and 3% oxygen desaturation index (ODI). The CV of PR in patients with moderate-to-severe OSA was higher than the patients with no-to-mild OSA categorized by 3% ODI (P = 0.01). Body mass index was correlated with RDI and 3% ODI (r = 0.56 and 0.43, respectively). The CV of BP did not correlate to RDI or 3% ODI. The CV of PR was positively correlated both with RDI and with 3% ODI (r = 0.41 and 0.42, respectively).

CONCLUSIONS

The severity of OSA was associated with PR variability, but not with BP variability, in older patients receiving CCB. Our results suggest the need for future studies to determine whether CCB can suppress the influence of OSA on BP fluctuation during sleep. Geriatr Gerontol Int 2019; 19: 604-610.