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Paine NJ, Watkins LL, Blumenthal JA, Kuhn CM, Sherwood A. Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure. Psychosom Med 2015; 77:136-44. [PMID: 25647750 PMCID: PMC5119914 DOI: 10.1097/psy.0000000000000144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Depression and anxiety are considered risk factors for cardiovascular disease (CVD). The explanatory mechanisms, however, are still to be characterized. One proposed pathophysiological pathway is dysregulation of the autonomic nervous system, including heightened sympathetic nervous system activity. This study examined the relationship between symptoms of depression, anxiety, and sympathetic nervous system activity in individuals with untreated high blood pressure. METHODS A total of 140 participants with untreated high blood pressure (55% white, 38.5% female, mean [standard deviation] age = 45.5 [8.55] years) collected urine over a 24-hour period on 3 separate occasions. Urine samples were assayed for mean 24-hour epinephrine (EPI24) and norepinephrine excretion. Depressive symptoms were assessed using the Beck Depression Inventory, with anxiety symptoms assessed using the Spielberger State-Trait Anxiety Inventory. RESULTS Depression and anxiety scores were intercorrelated (r = 0.76, p < .001). EPI24 was positively correlated with anxiety (r = 0.20, p = .02) but not depression (r = 0.02, p = .77), whereas 24-hour urinary norepinephrine excretion was not correlated with anxiety (r = 0.10, p = .21) or with depression (r = 0.07, p = .39). Regression models, accounting for sex, age, body mass index, race, mean systolic ambulatory blood pressure, tobacco use, alcohol use, physical activity, and sleep efficiency confirmed that anxiety was associated with EPI24 excretion (p = .023) and that depressive symptoms were not (p = .54). CONCLUSIONS Anxiety was associated with heightened sympathoadrenal activity, suggesting a biological pathway through which anxiety could increase CVD risk. Anxiety and depression may confer increased CVD risk via different mechanisms.
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Affiliation(s)
- Nicola J. Paine
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Cynthia M. Kuhn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710 USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
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Fan LB, Blumenthal JA, Watkins LL, Sherwood A. Work and home stress: associations with anxiety and depression symptoms. Occup Med (Lond) 2015; 65:110-6. [PMID: 25589707 DOI: 10.1093/occmed/kqu181] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the evolving work environment of global competition, the associations between work and home stress and psychological well-being are not well understood. AIMS To examine the impact of psychosocial stress at work and at home on anxiety and depression. METHODS In medically healthy employed men and women (aged 30-60), serial regression analyses were used to determine the independent association of psychosocial stress at work and at home with depression symptoms, measured using the Beck Depression Inventory-II (BDI-II), and anxiety symptoms, measured using the Spielberger Trait Anxiety Inventory (STAI). Psychosocial stress at work was measured using the Job Content Questionnaire to assess job psychological demands, job control, job social support and job insecurity. Psychosocial stress at home was assessed by 12 questions including stress at home, personal problems, family demands and feelings about home life. RESULTS Serial regression analyses in 129 subjects revealed that job insecurity and home stress were most strongly associated with depression and anxiety symptoms. Job insecurity accounted for 9% of the variation both in BDI-II scores and in STAI scores. Home stress accounted for 13 and 17% of the variation in BDI-II scores and STAI scores, respectively. In addition, job social support was significantly and independently associated with STAI scores but not BDI-II scores. CONCLUSIONS Work and home stress were associated with anxiety and depression symptoms in both men and women. Both work and home stress should be considered in studies evaluating anxiety and depression in working populations.
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Affiliation(s)
- L-B Fan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA, Department of Occupational and Environmental Health, School of Public Health, Kunming Medical University, Cheng Gong New City, Kunming, Yunnan 650500, P.R. China
| | - J A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - L L Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - A Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA,
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Ross AJ, Yang H, Larson RA, Carter JR. Sleep efficiency and nocturnal hemodynamic dipping in young, normotensive adults. Am J Physiol Regul Integr Comp Physiol 2014; 307:R888-92. [DOI: 10.1152/ajpregu.00211.2014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blunted dipping of nocturnal systolic arterial pressure (SAP) and heart rate (HR) are independent risk factors for hypertension and all-cause mortality. While several epidemiological studies report a significant association between short sleep duration and hypertension, associations between sleep efficiency and the nocturnal drop of SAP remain controversial. Moreover, relations between sleep efficiency and HR diurnal patterns have been overlooked. We hypothesized that low sleep efficiency (<85%) would be associated with blunted nocturnal SAP and HR dipping. Twenty-two normotensive subjects (13 men, 9 women; age: 18–28 yr) wore an actigraphy watch for 7 days and nights, and an ambulatory blood pressure monitor for 24 h on a nonactigraph night. There were no differences in age, sex, body mass index, mean sleep time, number of awakenings, or 24-h blood pressure between the low ( n = 12) and high ( n = 10) sleep efficiency groups. However, the low sleep efficiency subjects demonstrated a blunted dip of nocturnal SAP (10 ± 1% vs. 14 ± 1%, P = 0.04) and HR (12 ± 3% vs. 21 ± 3%, P = 0.03) compared with the high sleep efficiency group. The low sleep efficiency group also demonstrated a higher mean nocturnal HR (63 ± 2 vs. 55 ± 2 beats/min; P = 0.02). These findings support growing evidence that sleep efficiency, independent of total sleep time, may be an important cardiovascular risk factor.
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Affiliation(s)
- Amanda J. Ross
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
- Department of Neural and Behavioral Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and
| | - Huan Yang
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Robert A. Larson
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Jason R. Carter
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
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Kaya Z, Kayrak M, Demir K, Gündüz M, Alibasiç H, Karanfil M, Akıllı H, Arıbaş A, Tuncez A, İçli A. The relationship between white coat hypertension and sleep quality. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Mehmet Kayrak
- Department of Cardiology; Necmettin Erbakan University
| | | | - Mehmet Gündüz
- Department of Cardiology; Necmettin Erbakan University
| | | | | | - Hakan Akıllı
- Department of Cardiology; Necmettin Erbakan University
| | - Alpay Arıbaş
- Department of Cardiology; Necmettin Erbakan University
| | - Abdullah Tuncez
- Department of Cardiology; Konya Numune State Hospital; Konya Turkey
| | - Abdullah İçli
- Department of Cardiology; Necmettin Erbakan University
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Abstract
OBJECTIVE A nighttime dip in blood pressure is associated with decreased risk of cardiovascular morbidity and mortality. We examined whether personality traits predict nighttime dipping blood pressure. METHODS A community-based sample of 2848 adults from Sardinia (Italy) completed the Revised NEO Personality Inventory and 7 years later were examined with 24-hour ambulatory blood pressure monitoring. The primary analyses examined the associations of personality traits with continuous and categorical measures of mean arterial, systolic, and diastolic blood pressure nighttime dipping. RESULTS Agreeableness and conscientiousness were associated with more nocturnal blood pressure dipping (β = .05 [p = .025] and β = .07 [p < .001], respectively) and lower systolic blood pressure at night (β = -.05 [p = .018] and β = -.03 [p = .072], respectively). Nondippers were particularly more impulsive (p = .009), less trusting (p = .004), and less self-disciplined (p = .001), but there was no significant association between nocturnal dipping blood pressure and trait anxiety (p = .78) or depression (p = .59). The associations were stronger when comparing extreme dippers (nighttime drop ≥ 20%) to reverse dippers (nighttime increase in blood pressure). Indeed, scoring 1 standard deviation higher on conscientiousness was associated with approximately 40% reduced risk of reverse dipping (odds ratio = 1.43, confidence interval = 1.08-1.91). CONCLUSIONS We found evidence that reduced nighttime blood pressure dipping is associated with antagonism and impulsivity-related traits but not with measures of emotional vulnerability. The strongest associations were found with conscientiousness, a trait that may have a broad impact on cardiovascular health.
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Sincer I, Kurtoglu E, Calıskan M, Akkaya E, Vuruskan E, Küçükosmanoglu M, Çoşkun FY, Inci MF, Zorlu A. Significant correlation between uric acid levels and flow-mediated dilatation in patients with masked hypertension. Clin Exp Hypertens 2014; 36:315-20. [DOI: 10.3109/10641963.2013.827694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zheng H, Xie X, Xie N, Xu H, Huang J, Luo M. Sphingomyelin levels in nondipper and dipper hypertensive patients. Exp Ther Med 2014; 7:599-603. [PMID: 24520252 PMCID: PMC3919899 DOI: 10.3892/etm.2013.1455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 12/10/2013] [Indexed: 01/20/2023] Open
Abstract
A number of studies have focused on the association between sphingomyelin (SM) levels and atherosclerosis, however, there are few data concerning the correlation of SM with nondipper hypertension. The present study aimed to investigate the correlation between plasma SM levels and nondipper status in patients with hypertension. A total of 200 hypertensive patients were enrolled and divided into two groups according to their ambulatory blood pressure monitoring (AMBP) results: Dipper group (84 patients) and nondipper group (116 patients). All patients were subjected to transthoracic echocardiography examination and laboratory tests. No statistically significant difference was observed between the two groups in terms of basic clinical characteristics. However, the plasma SM levels in the dipper group were significantly lower than those of the nondipper group (41.9±17.5 vs. 96.4±14.3 mg/dl, P=0.003). The left ventricular mass index (LVMI) was higher in the nondipper patients than in the dipper patients and the diastolic function parameters in the nondipper patients were less favorable. Correlation analysis showed that the SM level was negatively correlated with the magnitude of systolic blood pressure (SBP) fall at night (r=−0.42, P<0.01) and diastolic blood pressure (DBP) fall at night (r=−0.31, P<0.01). The nondipper status had contributory effects on hypertensive concentric hypertrophy and diastolic function impairment. In addition, the plasma SM level was associated with a nondipper pattern of hypertension.
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Affiliation(s)
- Huan Zheng
- Geriatrics Department, Tongji Hospital Affiliated to Tongji University, Shanghai 20065, P.R. China ; School of Life Science, Center for Evolutionary Medicine and Informatics, Biodesign Institute, Arizona State University, Tempe, AZ 85281, USA
| | - Xiaoyun Xie
- Geriatrics Department, Tongji Hospital Affiliated to Tongji University, Shanghai 20065, P.R. China
| | - Nanzi Xie
- Geriatrics Department, Tongji Hospital Affiliated to Tongji University, Shanghai 20065, P.R. China
| | - Huifeng Xu
- Cardiology Department, Tongji Hospital Affiliated to Tongji University, Shanghai 20065, P.R. China
| | - Junling Huang
- Cardiology Department, Tongji Hospital Affiliated to Tongji University, Shanghai 20065, P.R. China
| | - Ming Luo
- Geriatrics Department, Tongji Hospital Affiliated to Tongji University, Shanghai 20065, P.R. China
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58
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Haney A, Buysse DJ, Okun M. Sleep and pregnancy-induced hypertension: a possible target for intervention? J Clin Sleep Med 2013; 9:1349-56. [PMID: 24340300 PMCID: PMC3836349 DOI: 10.5664/jcsm.3290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sleep disturbances in the general population are associated with elevated blood pressure. This may be due to several mechanisms, including sympathetic activation and hypothalamic-pituitary-adrenal (HPA) axis disturbance. Elevated blood pressure in pregnancy can have devastating effects on both maternal and fetal health and is associated with increased risk for preeclampsia and poor delivery outcomes. Preliminary evidence suggests that mechanisms linking sleep and blood pressure in the general population may also hold in the pregnant population. However, the effects of disturbed sleep on physiologic mechanisms that may directly influence blood pressure in pregnancy have not been well studied. The role that sleep disturbance plays in gestational blood pressure elevation and its subsequent consequences warrant further investigation. This review evaluates the current literature on sleep disturbance and elevated blood pressure in pregnancy and proposes possible treatment interventions.
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Zhang J, Yu B, Zhang XQ, Sheng ZF, Li SJ, Wang ZJ, Cui XY, Cui SY, Zhang YH. Tetrandrine, an antihypertensive alkaloid, improves the sleep state of spontaneously hypertensive rats (SHRs). JOURNAL OF ETHNOPHARMACOLOGY 2013; 151:729-732. [PMID: 24269338 DOI: 10.1016/j.jep.2013.09.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/23/2013] [Accepted: 09/28/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Radix of Stephania tetrandrae S. Moore has been used since antiquity in China as an antirheumatic, antihypertension, analgesic and antipyretic agent. Tetrandrine is the major component of Stephania tetrandrae. This study aims to evaluate the antihypertensive and hypnotic effect of tetrandrine on spontaneously hypertensive rats (SHR) and the possible mechanisms. MATERIALS AND METHODS Electroencephalography (EEG) and electromyography (EMG) were recorded in freely moving rats and the sleep parameters were analyzed with SleepSign software. The levels of serotonin (5-HT), norepinephrine (NE), dopamine (DA) and their metabolites were examined to investigate the underlying mechanisms by using HPLC-ECD. Blood pressure was measured by noninvasive blood pressure tail cuff test. RESULTS Tetrandrine (100mg/kg, i.g.) significantly suppressed blood pressure of SHR rats day by day during three days treatment. Meanwhile, tetrandrine remarkably improved the sleep efficiency by increasing total sleep time, rapid eye movement (REM) sleep and non-REM (NREM) sleep (including deep sleep and light sleep) time from the first day. Three days treatment of tetrandrine induced 5-HT concentration decrease in DRN, 5-HIAA concentration increase in LC and 5-HIAA/5-HT ratio increase in VTA and LC. In contrast, no changes in NE and DA concentrations in the DRN, VTA and LC occurred in SHR after tetrandrine treatment. These results indicate that modulation of 5-HT, its metabolite 5-HIAA and the 5-HIAA/5-HT ratio in DRN, VTA and LC are likely the mechanism of antihypertensive and hypnotic effects of tetrandrine at least in part. CONCLUSION This is the first observation that tetrandrine possesses both anti-hypertension and hypnotic effects in SHR and suggested that tetrandrine may be useful for the treatment of hypertension patients who accompanied with short sleep time and poor sleep efficiency.
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Affiliation(s)
- Juan Zhang
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Bin Yu
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Xue-Qiong Zhang
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Zhao-Fu Sheng
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Sheng-Jie Li
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Zi-Jun Wang
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Xiang-Yu Cui
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Su-Ying Cui
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China
| | - Yong-He Zhang
- Department Of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China.
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60
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Hinderliter AL, Routledge FS, Blumenthal JA, Koch G, Hussey MA, Wohlgemuth WK, Sherwood A. Reproducibility of blood pressure dipping: relation to day-to-day variability in sleep quality. ACTA ACUST UNITED AC 2013; 7:432-9. [PMID: 23850195 DOI: 10.1016/j.jash.2013.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/04/2013] [Accepted: 06/08/2013] [Indexed: 01/19/2023]
Abstract
Previous studies of the reproducibility of blood pressure (BP) dipping have yielded inconsistent results. Few have examined factors that may influence day-to-day differences in dipping. Ambulatory BP monitoring was performed on three occasions, approximately 1 week apart, in 115 untreated adult subjects with elevated clinic BPs. The mean ± standard deviation BP dip was 18 ± 7/15 ± 5 mm Hg (sleep/awake BP ratio = 0.87 ± 0.05/0.82 ± 0.06), with a median (interquartile range) day-to-day variation of 5.2 (3.1-8.1)/4.3 (2.8-5.6) mm Hg. There was no decrease in variability with successive measurements. The reproducibility coefficient (5.6 [95% confidence interval, 5.1-6.1] mm Hg) was greater and the intraclass correlation coefficient (0.53 [95% confidence interval, 0.42-0.63]) was smaller for the systolic dip than for 24-hour or awake systolic BPs, suggesting greater day-to-day variability in dipping. Variability in systolic dipping was greater in subjects with higher awake BP, but was not related to age, gender, race, or body mass index. Within individuals, day-to-day variations in dipping were related to variations in the fragmentation index (P < .001), a measure of sleep quality. Although mean 24-hour and awake BPs were relatively stable over repeated monitoring days, our study confirms substantial variability in BP dipping. Day-to-day differences in dipping are related to sleep quality.
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Affiliation(s)
| | - Faye S Routledge
- Duke University Medical Center, Durham, NC; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Gary Koch
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Rodriguez CJ, Jin Z, Schwartz JE, Turner-Lloveras D, Sacco RL, Di Tullio MR, Homma S. Socioeconomic status, psychosocial factors, race and nocturnal blood pressure dipping in a Hispanic cohort. Am J Hypertens 2013; 26:673-82. [PMID: 23547037 DOI: 10.1093/ajh/hpt009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Little information is available about the relationship of socioeconomic status (SES) to blunted nocturnal ambulatory blood pressure (ABP) dipping among Hispanics and whether this relationship differs by race. We sought to characterize ABP nondipping and its determinants in a sample of Hispanics. METHODS We enrolled 180 Hispanic participants not on antihypertensive medications. SES was defined by years of educational attainment. All participants underwent 24-hour ABP monitoring. A decrease of <10% in the ratio between average awake and average asleep systolic BP was considered nondipping. RESULTS The mean age of the cohort was 67.1 ± 8.7, mean educational level was 9.4 ± 4.4 years, and 58.9% of the cohort was female. The cohort was comprised of 78.3% Caribbean Hispanics with the rest from Mexico and Central/South America; 41.4% self-identified as white Hispanic, 34.4% self-identified as black Hispanic, and 24.4% did not racially self- identify. The percentage of nondippers was 57.8%. Educational attainment (10.5 years vs. 8.6 years; P <0.01) was significantly higher among dippers than nondippers. In multivariable analyses, each 1-year increase in education was associated with a 9% reduction in the likelihood of being a nondipper (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84-0.98; P = 0.01). There were significantly greater odds of being a nondipper for black Hispanics than for white Hispanics (OR, 2.83, 95% CI, 1.29-6.23; P = 0.005). Higher SES was significantly protective of nondipping in white Hispanics but not black Hispanics. CONCLUSIONS These results document a substantial prevalence of nondipping in a cohort of predominantly normotensive Hispanics. Dipping status varied significantly by race. Lower SES is significantly associated with nondipping status, and race potentially impacts on this relation.
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Affiliation(s)
- Carlos J Rodriguez
- Department of Medicine and Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA.
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Childhood Socioeconomic Position and Blood Pressure Dipping in Early Adulthood: a Longitudinal Study. Ann Behav Med 2013; 46:227-31. [DOI: 10.1007/s12160-013-9496-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Wuerzner G, Bochud M, Zweiacker C, Tremblay S, Pruijm M, Burnier M. Step count is associated with lower nighttime systolic blood pressure and increased dipping. Am J Hypertens 2013; 26:527-34. [PMID: 23467208 DOI: 10.1093/ajh/hps094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Higher nighttime blood pressure (BP) and the loss of nocturnal dipping of BP are associated with an increased risk for cardiovascular events. However, the determinants of the loss of nocturnal BP dipping are only beginning to be understood. We investigated whether different indicators of physical activity were associated with the loss of nocturnal dipping of BP. METHODS We conducted a cross-sectional study of 103 patients referred for 24-hour ambulatory monitoring of BP. We measured these patients' step count (SC), active energy expenditure (AEE), and total energy expenditure simultaneously, using actigraphs. RESULTS In our study population of 103 patients, most of whom were hypertensive, SC and AEE were associated with nighttime systolic BP in univariate (SC, r = -0.28, P < 0.01; AEE, r = -0.20, P = 0.046) and multivariate linear regression analyses (SC, coefficient beta = -5.37, P < 0.001; AEE, coefficient beta = -0.24, P < 0.01). Step count was associated with both systolic (r = 0.23, P = 0.018) and diastolic (r = 0.20, P = 0.045) BP dipping. Nighttime systolic BP decreased progressively across the categories of sedentary, moderately active, and active participants (125mm Hg, 116mm Hg, 112mm Hg, respectively; P = 0.002). The degree of BP dipping of BP increased progressively across the same three categories of activity (respectively 8.9%, 14.6%, and 18.6%, P = 0.002, for systolic BP and respectively 12.8%, 18.1%, and 22.2%, P = 0.006, for diastolic BP). CONCLUSIONS Step count is continuously associated with nighttime systolic BP and with the degree of BP dipping independently of 24-hour mean BP. The combined use of an actigraph for measuring indicators of physical activity and a device for 24-hour measurement of ambulatory BP may help identify patients at increased risk for cardiovascular events in whom increased physical activity toward higher target levels may be recommended.
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Affiliation(s)
- Gregoire Wuerzner
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.
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Fortmann AL, Gallo LC. Social support and nocturnal blood pressure dipping: a systematic review. Am J Hypertens 2013; 26:302-10. [PMID: 23382479 PMCID: PMC3888008 DOI: 10.1093/ajh/hps041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 09/22/2012] [Accepted: 10/06/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Attenuated nocturnal blood pressure (BP) dipping is a better predictor of cardiovascular disease (CVD) morbidity and mortality than resting BP measurements. Studies have reported associations between social support, variously defined, and BP dipping. METHODS A systematic review of the literature was conducted to investigate associations of functional and structural social support with nocturnal BP dipping assessed over a minimum of 24 hours. RESULTS A total of 297 articles were identified. Of these, 11 met criteria for inclusion; all studies were cross-sectional in design and included adult participants only (mean age = 19 to 72 years). Evidence was most consistent for an association between functional support and BP dipping, such that 5 of 7 studies reported statistically (or marginally) significant positive associations with BP dipping. Statistically significant functional support-BP dipping associations were moderate (standardized effect size (d) = 0.41) to large (d = 2.01) in magnitude. Studies examining structural support were fewer and relatively less consistent; however, preliminary evidence was observed for associations of marital status and social contact frequency with BP dipping. Statistically significant structural support findings were medium (d = 0.53) to large (d = 1.13) in magnitude. CONCLUSIONS Overall, findings suggest a link between higher levels of functional support and greater nocturnal BP dipping; preliminary evidence was also observed for the protective effects of marriage and social contact frequency. Nonetheless, the relatively small number of studies conducted to date and the heterogeneity of findings across meaningful subgroups suggest that additional research is needed to substantiate these conclusions.
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Affiliation(s)
- Addie L Fortmann
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.
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Sato M, Yasuhara Y, Tanioka T, Iwasa Y, Yasui T, Miyake M, Kobayashi H, Kongsuwan W, C. Locsin R. Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder. Health (London) 2013. [DOI: 10.4236/health.2013.53a069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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66
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Ulmer CS, Calhoun PS, Bosworth HB, Dennis MF, Beckham JC. Nocturnal blood pressure non-dipping, posttraumatic stress disorder, and sleep quality in women. Behav Med 2013; 39:111-21. [PMID: 24236808 PMCID: PMC3964784 DOI: 10.1080/08964289.2013.813434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. The frequency of non-dippers did not differ by diagnostic status (d = .15). However, non-dippers endorsed more traumatic event categories (d = .53), more PTSD hyperarousal symptoms (d = .53), poorer overall sleep quality (d = .59), more frequent use of sleep medication (d = .62), greater sleep-related daytime dysfunction (d = .58), and longer sleep onset latencies (d = .55) than dippers. Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.
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Affiliation(s)
- Christi S Ulmer
- a Durham Veterans Affairs Medical Center and Duke University Medical Center
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Turak O, Ozcan F, Tok D, Işleyen A, Sökmen E, Taşoğlu I, Aydoğdu S, Sen N, McFann K, Johnson RJ, Kanbay M. Serum uric acid, inflammation, and nondipping circadian pattern in essential hypertension. J Clin Hypertens (Greenwich) 2012; 15:7-13. [PMID: 23282120 DOI: 10.1111/jch.12026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Uric acid (UA) is independently associated with the emergence of hypertension. Nocturnal nondipping pattern of hypertension is associated with a greater risk of cardiovascular, renal, and cerebrovascular complications than dippers. The aim of the present study was to evaluate the relationship between the circadian blood pressure rhythm and UA level in patients with newly diagnosed essential hypertension. The study included 112 essential hypertensive patients and 50 healthy controls. The hypertensive patients were divided into two groups according to the results of 24-hour ambulatory blood pressure monitoring, including 60 dippers (35 men, 25 women; mean age, 52.6±15.8 years) and 52 nondippers (29 men, 23 women; mean age, 55.9±13.2 years). Nondippers had significantly higher serum UA levels than the dippers and controls (5.8±0.8, 5.1±0.9 and 4.2±0.9 mg/dL, respectively; P<.001). Serum high-sensitivity C-reactive protein levels were also significantly higher in the nondipper group than the other groups (P<.001) and significantly correlated with serum UA (r=0.358, P<.001). Multivariate logistic regression analysis revealed an independent positive association between serum UA levels and nondipper pattern (odds ratio, 2.28; 95% confidence interval, 1.33-3.94; P=.003). Serum UA is strongly and independently associated with the nondipper circadian pattern in essential hypertension.
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Affiliation(s)
- Osman Turak
- Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Association of insomnia and short sleep duration with atherosclerosis risk in the elderly. Am J Hypertens 2012; 25:1149-55. [PMID: 22854638 DOI: 10.1038/ajh.2012.107] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Short sleep duration is associated with an increased risk of cardiovascular disease and all-cause mortality, although a relationship with atherosclerosis in the elderly remains unclear. METHODS Eighty-six volunteers aged ≥65 years (mean, 73.6 ± 4.9 years) were evaluated for insomnia. Total sleep time (TST) and sleep efficiency were measured by actigraphy. Subjective symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI). Atherosclerosis was evaluated using ultrasonographic measurements of carotid intima-media thickness (IMT). RESULTS IMT was significantly greater and sleep efficiency was significantly lower in subjects with TST ≤5 h than those with TST >7 h (1.3 ± 0.5 vs. 0.9 ± 0.3 mm; P = 0.009; 91.0 ± 6.0 vs. 81.6 ± 11.3%, P = 0.03, respectively). IMT was also significantly greater in the insomnia group than the noninsomnia group (1.3 ± 0.5 vs. 1.1 ± 0.4 mm; P = 0.03). IMT was significantly correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and TST (SBP: r = 0.49, P < 0.0001; DBP: r = 0.33, P = 0.0021; TST: r = -0.28, P = 0.010). Multiple regression analysis revealed that SBP, TST, and the PSQI were significant contributing factors for increased IMT (SBP: coefficient β = 0.56, P = 0.0001; TST: coefficient β = -0.32, P = 0.005; PSQI: coefficient β = 0.22, P = 0.05). CONCLUSIONS High blood pressure, short sleep duration (≤5 h), poor sleep, and insomnia were associated with atherosclerosis risk leading to cardiovascular disease in the elderly.
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Sleep disturbance among spontaneously hypertensive rats is mediated by an α1-adrenergic mechanism. Am J Hypertens 2012; 25:1110-7. [PMID: 22764061 DOI: 10.1038/ajh.2012.93] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Inadequate sleep may aggravate hypertension, but the pathophysiology of sleep disturbance in hypertension remains unknown. Among spontaneously hypertensive rats (SHR), sleep disturbance co-occurred with sympathetic hyperactivity; therefore, we hypothesized that the sleep disturbance can be alleviated by antagonizing the adrenergic overdrive. METHODS Polysomnographic recording was performed in SHR by telemetry. The animals were first injected with saline, and 2 days later with a hypotensive agent. Cardiac and vascular sympathetic activity were assessed using the normalized low-frequency power (LF%) of heart rate variability and the low-frequency power of arterial pressure variability (BLF), respectively. RESULTS A comparison was made between the saline and hypotensive drug treatments. During quiet sleep (QS), the α1-blocker prazosin induced a significant decrease in BLF, but had no effect on LF%. The total time and bout duration of QS were lengthened and QS interruption was reduced (P < 0.05 for all). When both α1- and α2-adrenoceptors were blocked by phentolamine, both BLF and LF% were lower (P < 0.05 for both), but no modification to sleep structure could be observed. To antagonize β-adrenergic activity, atenolol and propranolol were injected. The LF% after either antagonist treatment was significantly decreased; however, sleep structure was not significantly changed. The QS-promoting effect of prazosin is specific to SHR, because prazosin is ineffective when administered to Wistar-Kyoto rats. CONCLUSIONS α1-adrenergic antagonism may reverse, at least partially, the poor sleep quality of SHR, suggesting a vicious cycle can be established between adrenergic overdrive and sleep disturbance.
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Özcan F, Turak O, Durak A, İşleyen A, Uçar F, Giniş Z, Uçar F, Başar FN, Aydoğdu S. Red cell distribution width and inflammation in patients with non-dipper hypertension. Blood Press 2012; 22:80-5. [DOI: 10.3109/08037051.2012.707336] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Routledge FS, Hinderliter AL, Blumenthal JA, Sherwood A. Sex differences in the endothelial function of untreated hypertension. J Clin Hypertens (Greenwich) 2012; 14:228-35. [PMID: 22458744 DOI: 10.1111/j.1751-7176.2012.00593.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Vascular endothelial dysfunction is associated with increased risk for adverse cardiovascular (CV) events. However, less is known about sex differences in the endothelial function of untreated hypertensive individuals. The purpose of this study was to assess endothelial function in women and men with untreated hypertension. Ninety participants (35 women, 55 men), aged 40 to 60 years (mean age, 46.1±8.2 years), with untreated stage 1 hypertension (systolic blood pressure 140-159 mm Hg and/or diastolic blood pressure 90-99 mm Hg) underwent brachial artery endothelial-dependent flow-mediated dilation and endothelial-independent glyceryl trinitrate dilation. Women had a smaller flow-mediated dilation response than men (adjusted mean±standard error of the mean [SEM]; 1.8±0.6% vs 3.9±0.4%, P=.036), adjusting for baseline arterial diameter (P=.004), age (P=.596), ethnicity (P=.496), log shear stress ratio (P<.001), body mass index (P=.009), 24-hour diastolic blood pressure (P=.169), high-density lipoprotein (P=.225), log creatinine (P=.927), and log physical activity (P=.682). Glyceryl trinitrate dilation did not differ by sex in adjusted models. Women between the ages of 40 and 60 years with untreated stage 1 hypertension exhibited a greater impairment of endothelial function compared with their male counterparts. These findings raise the possibility that female sex may impart a greater risk of CV events in patients with untreated stage 1 hypertension potentially due to poorer endothelial function.
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Affiliation(s)
- Faye S Routledge
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Abstract
Self-reported short sleep duration is linked to higher blood pressure and incident hypertension in adults. Few studies have examined sleep and blood pressure in younger samples. We evaluated the associations between actigraphy-assessed time spent asleep and ambulatory blood pressure in adolescents. Participants were 246 black and white adolescents (mean age: 15.7 years) who were free from cardiovascular or kidney disease and were not taking sleep, cardiovascular, or psychiatric medications. Sleep duration and efficiency were assessed with in-home wrist actigraphy and sleep diaries across 1 week; ambulatory blood pressure monitoring was used to obtain 24-hour, sleep, and wake blood pressure, as well as sleep:wake blood pressure ratios across 2 full days and nights. Results showed that shorter actigraphy-assessed sleep across 1 week was related to higher 48-hour blood pressure and higher nighttime blood pressure. Shorter sleep was also related to a higher systolic blood pressure sleep:wake ratio. These results were independent of age, race, sex, and body mass index. Follow-up analyses by race revealed that associations between sleep duration and blood pressure were largely present in white, but not black, adolescents. These data are consistent with the hypothesis that the cardiovascular consequences of short sleep may begin as early as adolescence.
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Affiliation(s)
- Elizabeth J Mezick
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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