Key result
Circadian-tailored treatment linked to ~42 mm Hg lower morning systolic BP in CVI.
Why the study?
The venous system and delivered circulatory volume contribute to arterial BP, motivating evaluation of how chronic venous insufficiency influences the BP pattern in essential arterial hypertension and development of a tailored treatment plan.
Does a tailored circadian non-pharmacological and pharmacological treatment algorithm improve diurnal blood pressure control in older patients with co-existing essential hypertension and chronic venous insufficiency?
Cohort (n=22)
Open-label
No
Does a tailored circadian non-pharmacological and pharmacological treatment algorithm improve diurnal blood pressure control in older patients with co-existing essential hypertension and chronic venous insufficiency?
Answers are grounded in this paper and cite their sources.
Co-existing chronic venous insufficiency in elderly hypertensive patients can cause an inverse-dipping "Circadian Roller Coaster" blood pressure pattern (morning peak, early daytime drop, evening/nocturnal rise) that responds to timed positional and short-acting pharmacological therapy.
Background: The clinical scenario of essential arterial Hypertension (HTN) is heterogenous and influenced by co morbid conditions. The venous system and the delivered cir culatory volume are determinants of the preload and con tributors to the arterial blood pressure. Hypothesis. Chronic venous insufficiency (CVI) affects the clinical scenario of HTN. Aims of the study:| 1. To evaluate the influence of CVI on the BP pattern in patients with HTN. 2. To develop a treat ment plan for patients with co-existing HTN and CVI. Methods: 1. Analysis of the diurnal BP pattern in twenty two patients (7 males, 81.4 years, SD 4.9) with HTN and co morbid CVI. 2. Evaluation of a treatment algorithm in this cohort of patients. Results: The BP pattern observed in this cohort of pa tients entailed a morning BP peak (SBP 177.6, DBP 100.5), early daytime BP decrease (SBP 134.8, DBP 78.1), BP rise in the late afternoon/evening (SBP 146.7, DBP 85.2) and then through the night towards the morning peak. The pattern, named by the authors the Circadian Roller Coaster (CRC), is explained by the positional fluid shifts, augmented by CVI, superimposed on the pathophysiology of HTN. The current guidelines were adapted to the CRC pathophysiology to de velop a treatment algorithm which led to a change in the circadian BP curve with a reasonable control of BP in the morning, (SBP 135.9, DBP 99.6), early daytime (SBP 125.5, DBP 68.1) and evening (SBP 135.3, DBP 71.2). Conclusion: Patients with co-existing HTN and CVI can present with a certain diurnal BP pattern, CRC. As inverse dippers, these patients are at elevated risk for target organ damage. The authors recommend screening for CRC in pa tients with co-existing HTN and CVI and a treatment algo rithm tailored to the complex pathophysiology present in these patients.
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Grigoriy Goldenberg (2026) conducted a cohort in Essential arterial hypertension with co-existing chronic venous insufficiency (Circadian Roller Coaster syndrome) (n=22). Circadian-tailored antihypertensive and venous decompression algorithm (compression therapy, afternoon leg elevation, evening short-acting vasodilators, and late-afternoon loop diuretics) vs. Baseline pre-treatment blood pressure was evaluated on Morning (7:00 AM) systolic blood pressure (mm Hg). A circadian-tailored treatment algorithm reduced mean morning systolic BP from 177.6 to 135.9 mm Hg and evening systolic BP from 146.7 to 135.3 mm Hg in patients with hypertension and CVI.
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