Physical activity, dipping and haernodynamics

Objective To determine the effect of physical activity on diurnal blood pressure (BP) and haemodynamic variation. Methods Ambulatory measurements were performed during 24 h in 36 subjects (18 hypertensive, 13 male), aged 49.7 +/- 13.5 years. BP was recorded in the brachial artery. Physical activity and posture were measured with five acceleration sensors. Results Of the subjects 50% were dippers (nocturnal decrease in systolic or diastolic BP greater than or equal to 10%). Dippers and non-dippers had similar daytime BP, daytime, night-time, and day-night difference in physical activity, subjective sleep quality, and nocturnal cardiac output decrease (14.9 +/- 9.6 and 16.0 +/- 5.9%). In non-dippers vascular resistance increased from day to night by 9.7 +/- 8.3%, while it remained unchanged (-1.0 +/- 13.9%) in dippers. Day-night changes in heart rate and cardiac output were correlated with day-night changes in physical activity (r = 0.39 and 0.43), whereas day-night changes in systolic BP were correlated with night-time activity (r = -0.34). By selection of the active (i.e. walking) and inactive (i.e. not walking) periods during the day; we showed that physical activity has a large potential effect on dipping status and diurnal haemodynamic variation underlying BP variation. Depending on the BP taken (systolic or diastolic, respectively) the proportion of dippers increased to 81% or decreased to 25% if only the walking period was considered, whereas it decreased to 36% or increased to 53% if only the non-walking period was considered. Conclusions Non-dippers differ from dippers by an increase of vascular resistance during the night. The degree of physical activity normally encountered during ambulatory monitoring has little influence on the diurnal BP profile or dipping status, but significantly influences underlying haemodynamics. Related to the different effects of posture and activity on systolic and diastolic BP, dipping classification may vary with the BP index taken. (C) 2004 Lippincott Williams Wilkins.