Objective: The electronic cigarettes (EC) is a device that heats a liquid containing nicotine and flavors into an aerosol for inhalation. There is some evidence from controlled trials that electronic cigarette (EC) may help to stop smoking long-term. However, a large proportion of smokers who successfully quit cigarette smoking continue to use EC for unlimited time, switching from an addiction to another. There is a clear similarity between the detrimental vascular effects of EC and conventional cigarette. Little is known about the acute influence on blood pressure (BP) of nicotine inhalation by EC and it's duration of action in hypertensive subjects. Aim of this study was to evaluate the magnitude and time-course of BP changes during EC smoking. Design and method: This is a randomized, cross-over and placebo controlled study. We evaluated 30 mild-to-moderate hypertensive patients on pharmacological treatment and adequate BP control (< 140/90 mmHg). Patients (22 males, mean age 54 ± 21 years) were former smokers, who quitted tobacco cigarette in favor of EC at least 6 months before. BP and heart rate (HR) were measured by continuous non-invasive ambulatory BP and ECG monitoring (SOMNOtouch NIBP). BP and HR were monitored during a 30 minute rest in the sitting position; during other 30 minutes after smoking EC (inhalation equivalent to 0.8 mg of nicotine of a regular cigarette) or placebo EC (same device, same flavor but no nicotine in the solution). Results: EC vaping was accompanied by significant increase blood pressure, which lasted about 30 minutes (average 28 ± 11 minutes). Compared to placebo the EC smoking increased systolic BP by 9,6 ± 4,1 mmHg, diastolic BP by 7.1 ± 3.9 mmHg and heart rate by 16,4 ± 13 beat per minute. All the differences resulted statistically significant (Student's t test P < 0.05). Conclusions: Under these experimental conditions, EC smoking caused a statistically significant increase in BP and HR in hypertensive patients. This effect seems also clinically relevant since the duration of BP increase was relatively long (28 minutes) and the daily number of inhalations, in EC smokers, is usually high (> 20).

OBJECTIVE:Obstructive sleep apnoea (OSA) is considered a cause of secondary hypertension. About 50% of patients with OSA show elevated blood pressure levels. Non-dipper pattern (blunted or absent nocturnal decrease of blood pressure) is frequently observed in patients with OSA and is associated with increased cerebral, cardiovascular and renal events. The aim of this study was to observe the effect of barnidipine calcium channel blocker on these patients.PATIENTS AND METHODS:Forty-one patients (mean age 69 ± 17 years, 18 females) with previously diagnosed OSA (by reduced channel home-based polysomnography) who were not being treated with continuous positive airway pressure (CPAP) because of contraindications or because of patient intolerance or rejection were evaluated. Non-dipper status was defined as the presence of a nighttime fall in systolic blood pressure (BP) which was < 10% that of daytime systolic BP as observed in a previous ambulatory blood pressure (ABP) monitoring. OSA was defined according to the presence of 5 or more episodes per hour of apnoea, hypopnoea or arousal due to respiratory effort. The reproducibility of non-dipping status was confirmed through a second 24-h ABP monitoring performed at baseline. On top of the previous stable treatment regimen (which excluded calcium-channel blockers), a 10 mg dosing of barnidipine hydrochloride at bedtime was added to all subjects during a 12-week period.RESULTS:Among the 41 non-dipper patients, 32 (78%) showed complete normalization of circadian rhythm. Add-on treatment with barnidipine was generally well tolerated.CONCLUSIONS:Bedtime dosing of the calcium-channel blocker (CCB) barnidipine significantly reduced mean nighttime systolic and diastolic ABP in hypertensive patients presenting with non-dipper pattern and OSA--not on CPAP treatment. Moreover, it restored the previously altered circadian rhythm in the majority of them.

1Guglielmo DA Saliceto Hospital, AUSL Piacenza, Piacenza-Italy, 2Universita' Cattolica Del Sacro Cuore, Piacenza-Italy

1Guglielmo da Saliceto Hospital, Ausl Piacenza, Piacenza-Italy, 2Universita' Cattolica del Sacro Cuore, Piacenza-Italy

Nondipper pattern (blunted or absent nocturnal decrease of blood pressure) is associated with increased cerebral, cardiovascular and renal events. Therefore, the normalization of blood pressure (BP) circadian rhythm is an important goal of antihypertensive treatment. Aim of this study was the evaluation of the effect of a bedtime administration of the calcium channel blocker (CCB) barnidipine hydrochloride on blood pressure dipping status of treated hypertensive subjects. Patients were selected according to the presence of a nighttime fall in systolic BP < 10% of daytime systolic BP on a previous ambulatory BP monitoring (ABPM). The reproducibility of non-dipping status was confirmed through a second 24-h ABP monitoring in 48 patients (mean age 59 ± 16 years, 20 females), whose treatment did no include a CCB. On top of the previous stable treatment regimen, a bedtime (10.00–11.00 pm) 10 mg dosing of barnidipine was added to all subjects. At study entry, mean daytime ABP was 135/83 ± 7/8 mmHg, while mean nighttime was ABP 131/82 ± 7/7 mmHg. After 12 weeks of add-on treatment with barnidipine a 24-h ABPM was repeated. At study end, mean daytime ABP resulted slightly reduced (126/79 ± 7/6, −9/4 mmHg), while mean nighttime ABP decreased in overt fashion (115/74 ± 6/6, −16/8 mmHg). The decrease in systolic and diastolic mean ABP induced by barnidipine bedtime administration resulted statistically significant (daytime systolic p < 0.05, daytime diastolic p < 0.05; nigttime systolic p < 0.025, nighttime diastolic p < 0.025; Student's t test for paired data; two-sided p, α level p < 0.05). Among the 48 nondipper patients 27 (56%) of them showed complete normalization of circadian rhythm. Add-on treatment with barnidipine resulted generally well tolerated. Two patients developed mild symptomatic diurnal hypotension and 4 individuals presented mild leg oedema. In conclusion, in treated hypertensive patients presenting nondipper pattern, bedtime dosing of the CCB barnidipine (added to previous stable treatment regimen) significantly reduced nighttime systolic and diastolic mean ABP and, in 56% of the subjects restored the previously altered circadian rhythm.

It has been shown that home blood pressure (HBP) measurement is a reliable tool for the diagnosis of white coat (WCH) and masked (MH) hypertension. The ESH suggests duplicate morning and evening HBP measurement for 7 days per week. In the clinical practice, this schedule could raise problems due to patient's ability and adherence and possible misreporting. On the other hand, ABP monitoring, for reason of costs and availability, cannot be routinely performed in all subjects with suspected MH or WCH. Aim of this study was to compare a series of BP measurements, obtained by using an automated oscillometric device that provides multiple measurements. Repeated office blood pressure (ROBP) measurement consists of 10 consecutive BP readings, taken at 2.5 minute intervals, with the patient sitting alone in the doctor's office. The average of the last 6 measurements is considered as final value. The usefulness of ROBP for the diagnoses of WCH and MH has been tested in 48 individuals with normal office blood pressure (OBP) and elevated daytime ABP values (MH group) and in 41 subjects with high OBP and normal daytime ABP (WCH group). In patients with MH, systolic and diastolic ABP and ROBP values resulted in agreement: Also in the WCH group ABP and ROBP gave similar results (ABP versus ROBP not significantly different; Student's t test for paired data). The correlation between daytime ABP and ROBP values was highly significant (Pearson: p< 0.025) in both groups. In conclusion, this study confirms that ROBP, a series of standardized automated BP measurements performed in the medical environment, are useful for the diagnosis of masked and white coat hypertension. In the situation in which HBP measurement could be unreliable and ABPM not feasible, ROBP represents a valid alternative for the diagnosis of masked and white-coat hypertension.