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Diazepam as an oral hypnotic increases nocturnal blood pressure in the elderly

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Abstract

Background

No study has evaluated the cardiovascular effects of diazepam in elderly subjects that assume diazepam to induce sleep.

Purpose

The present study was carried out in order to evaluate the effects of chronic administration of diazepam as hypnotic drug on blood pressure (BP) and heart rate (HR) in healthy elderly subjects.

Patients and methods

Healthy, elderly subjects, aged 65–74 years, were treated with diazepam 5 mg or placebo—both administered once a day in the evening—for 4 weeks in two cross-over periods, each separated by a 2-week placebo period, according to a randomized, double-blind, cross-over design. At the end of each study period, clinical as well as 24-h ambulatory BP and HR were evaluated.

Results

A total of 25 subjects were included in the analysis. At the end of a 4-week diazepam treatment, clinical as well 24-h BP and HR mean values were not significantly affected. Analysis of sub-periods showed that during night-time, systolic BP (SBP) values under diazepam were 7.6% higher than under placebo, with a mean difference of 7.9 mmHg (p < 0.01), diastolic BP (DBP) values were 5.8% higher, with a mean difference of 3.7 mmHg (p < 0.05 vs placebo) and HR values were 6.6% higher with a mean difference of 4.2 b/min (p < 0.05). The HR increase observed with diazepam persisted during the morning hours, whereas during the afternoon and evening hours SBP, DBP and HR values were similar in the two treatment groups.

Conclusions

In elderly subjects chronic assumption of diazepam as hypnotic agent produced an increase in BP, in particular SBP, during night-time and of HR during night-time and morning hours. These effects, which probably depend on a diazepam-mediated increase in sympathetic drive and decrease in vagal tone, might be of clinical relevance due to the role of increased BP and HR as independent predictors of cardiovascular morbidity and mortality.

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Authors and Affiliations

  1. Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy

    Roberto Fogari, Alfredo Costa, Natascia Ghiotto, Matteo Cotta Ramusino, Giulia Perini & Daniele Bosone

  2. Department of Brain and Behaviour, University of Pavia, Pavia, Italy

    Alfredo Costa, Matteo Cotta Ramusino & Giulia Perini

  3. Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy

    Annalisa Zoppi, Angela D’Angelo & Domenico Battaglia

  4. CIRNA-Onlus Foundation, Pavia, Italy

    Roberto Fogari

Authors
  1. Roberto Fogari
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  2. Alfredo Costa
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  3. Annalisa Zoppi
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  4. Angela D’Angelo
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  7. Matteo Cotta Ramusino
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  8. Giulia Perini
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  9. Daniele Bosone
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Correspondence to Roberto Fogari.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

A written informed consent for the research protocol was obtained from all individual participants included in the study population.

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Fogari, R., Costa, A., Zoppi, A. et al. Diazepam as an oral hypnotic increases nocturnal blood pressure in the elderly. Aging Clin Exp Res 31, 463–468 (2019). https://doi.org/10.1007/s40520-018-0991-0

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  • DOI: https://doi.org/10.1007/s40520-018-0991-0

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