151
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Rodionov AV. High Blood Pressure Variability is an Additional Cardiovascular Risk Factor. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-02-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Blood pressure (BP) is a highly variable physiological indicator. Most people have BP changes within 40-50 mmHg during the day. Various external factors (from the patient’s position during BP measurement to poor adherence to therapy and abuse of short-acting antihypertensive drugs) affect the assessed indicators. Evaluation of the average daily, intra-visit, as well as long-term ("from visit to visit") BP variability is used in clinical practice. In the past twenty years a number of major studies demonstrated that increased BP variability is an independent prognostic factor that increases the risk of cardiovascular complications. The largest meta-analysis of 41 studies showed that an increase in long-term BP variability was associated with 15% and 18% increase in total and cardiovascular mortality, respectively. According to the IDHOCO project, the threshold coefficient of variation for day-today variability is >11.0/12.8. Different groups of antihypertensive drugs have an uneven effect on BP variability. Consistent data from ASCOT-BPLA, X-CELLENT and ACCOMPLISH studies indicate that among the main groups of antihypertensive drugs, calcium antagonists, mainly amlodipine, have the greatest potential for the variability reduction. A decrease in BP variability, as shown in a post-hoc analysis of CAMELOT and PREVENT studies, has a positive effect on the incidence of major adverse cardiac events (MACE). Thus, the BP variability is an important indicator that reflects the prognosis in hypertensive patients. BP variability reduction can be considered as one of the independent goals of therapy. Calcium antagonists can be considered as first-line drugs for patients with high BP variability.
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Affiliation(s)
- A. V. Rodionov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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152
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Stojan G, Magder LS, Petri M. Blood Pressure Variability and Age-related Blood Pressure Patterns in Systemic Lupus Erythematosus. J Rheumatol 2020; 47:387-393. [PMID: 31203220 PMCID: PMC6911645 DOI: 10.3899/jrheum.181131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite the high prevalence of cardiovascular (CV) disease among patients with systemic lupus erythematosus (SLE), the relationship between age, blood pressure (BP), and BP variability (BPV) is not well understood. We studied visit-to-visit BPV, its relationship to age, clinical, and demographic characteristics, and its potential role as a CV risk factor in patients with SLE. METHODS We analyzed systolic (SBP) and diastolic BP (DBP) measures in our cohort using mixed-effects regression models. From these models, we then obtained estimates of the mean BP, the visit-to-visit SD, and the between-person SD. The estimated means were compared to the general population using data from the National Health Statistics Reports from 2001 to 2008. In addition, we examined the relationship between BP (means, variances), patient demographic and clinical characteristics, and subsequent CV events. RESULTS The mean SBP in SLE increased with age and was significantly higher in younger patients compared to the general population. BPV in SLE was elevated across all ages. BPV was significantly higher in African Americans, in patients with traditional CV risk factors, those with high disease activity, and in patients taking prednisone. Hydroxychloroquine was associated with significantly lower BPV. Within-person variability in DBP of ≥ 9 mmHg was highly associated with CV events in a multivariate analysis. CONCLUSION Age-related BP patterns in SLE differ from the general population. Increased visit-to-visit BPV is affected by many disease-specific and traditional CV factors. Increased DBP variability is highly associated with CV events in SLE.
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Affiliation(s)
- George Stojan
- From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
- G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine.
| | - Laurence S Magder
- From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
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153
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Tohyama T, Hosokawa K, Saku K, Oga Y, Tsutsui H, Sunagawa K. Smart Baroreceptor Activation Therapy Strikingly Attenuates Blood Pressure Variability in Hypertensive Rats With Impaired Baroreceptor. Hypertension 2020; 75:885-892. [DOI: 10.1161/hypertensionaha.119.13673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased blood pressure (BP) variability (BPV) is an independent risk factor of cardiovascular events among hypertensive patients. The arterial baroreceptor reflex is a powerful regulator of BP and attenuates BPV via a sympathetic negative feedback control. Conventional baroreceptor activation therapy (cBAT) electrically stimulates the carotid baroreceptors with constant stimulation parameters. While cBAT lowers BP, it does not mount a pressure feedback mechanism. We hypothesized that baroreceptor activation therapy with a pressure feedback system (smart BAT [sBAT]) is able to reduce BPV as well as lower BP. We developed sBAT that electrically stimulated baroreceptors at a frequency proportional to the difference between instantaneous BP and a preset reference pressure, and compared its performance with cBAT. In 14-week-old spontaneously hypertensive rats (n=6), we implanted BP telemeter and created impaired arterial baroreceptors by modified sino-aortic denervation. One week after surgical preparation, we administered sBAT, cBAT or no stimulation (sham) for 15 minutes and compared BP and BPV under freely moving condition. Both cBAT and sBAT significantly lowered mean BP (sham, 141.3±12.8; cBAT, 114.3±11.4; and sBAT, 112.0±7.3 mm Hg). Conventional BAT did not affect BPV at all, while sBAT significantly reduced BPV (sham, 15.4±2.6; cBAT, 16.0±5.2; and sBAT, 9.7±3.3 mm Hg). sBAT also prevented transient excessive BP rise and fall. In conclusion, sBAT was capable of reducing BP and attenuating BPV in hypertensive rats with impaired baroreceptor. sBAT is a novel treatment option for hypertensive patients with increased BPV.
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Affiliation(s)
- Takeshi Tohyama
- From the Department of Cardiovascular Medicine, Graduate School of Medical Sciences (T.T., K. Saku, Y.O., H.T.), Kyushu University, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan (K.H., H.T.)
| | - Keita Saku
- From the Department of Cardiovascular Medicine, Graduate School of Medical Sciences (T.T., K. Saku, Y.O., H.T.), Kyushu University, Fukuoka, Japan
| | - Yasuhiro Oga
- From the Department of Cardiovascular Medicine, Graduate School of Medical Sciences (T.T., K. Saku, Y.O., H.T.), Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- From the Department of Cardiovascular Medicine, Graduate School of Medical Sciences (T.T., K. Saku, Y.O., H.T.), Kyushu University, Fukuoka, Japan
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan (K.H., H.T.)
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine (K. Sunagawa), Kyushu University, Fukuoka, Japan
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154
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Tully PJ, Tzourio C. Heterogeneity in the reporting of blood pressure variability: high time for methodological consensus. Age Ageing 2020; 49:168-170. [PMID: 32108871 DOI: 10.1093/ageing/afz155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
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155
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Miyauchi S, Nagai M, Dote K, Kato M, Oda N, Kunita E, Kagawa E, Yamane A, Higashihara T, Takeuchi A, Tsuchiya A, Takahari K. Visit-to-visit Blood Pressure Variability and Arterial Stiffness: Which Came First: The Chicken or the Egg? Curr Pharm Des 2020; 25:685-692. [PMID: 30931845 DOI: 10.2174/1381612825666190329122024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
Earlier studies have shown that visit-to-visit blood pressure (BP) variability (VVV) served as a significant independent risk factor of stroke, specifically, in the high-risk elderly of cardiovascular disease (CVD). Although the mechanism is not clearly understood, arterial remodeling such as carotid artery, coronary artery and large aortic artery would be a strong moderator in the relationship between VVV and CVD incidence. Recent studies have provided evidence that VVV predicted the progression of arterial stiffness. While the class of antihypertensive agents is suggested to be an important determinant of VVV, long-acting calcium channel blockers use (CCBs) is associated with the reduction of VVV, and thus, is suggested to decrease the arterial stiffness. Specifically, the relationship between VVV and coronary arterial remodeling has never been reviewed until now. This article summarizes the recent literature on these topics. In the elderly hypertensives, strict BP control using CCBs could play a pivotal role in suppressing arterial stiffening via VVV reduction.
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Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Noboru Oda
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Eiji Kunita
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Eisuke Kagawa
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Aya Yamane
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Arinori Takeuchi
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Akane Tsuchiya
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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156
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Lee SR, Choi YJ, Choi EK, Han KD, Lee E, Cha MJ, Oh S, Lip GY. Blood Pressure Variability and Incidence of New-Onset Atrial Fibrillation. Hypertension 2020; 75:309-315. [DOI: 10.1161/hypertensionaha.119.13708] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Blood pressure variability is a well-known risk factor for cardiovascular disease, but its association with atrial fibrillation (AF) is uncertain. We aimed to evaluate the association between visit-to-visit blood pressure variability and incident AF. This population-based cohort study used database from the Health Screening Cohort, which contained a complete set of medical claims and a biannual health checkup information of the Koran population. A total of 8 063 922 individuals who had at least 3 health checkups with blood pressure measurement between 2004 and 2010 were collected after excluding subjects with preexisting AF. Blood pressure variability was defined as variability independence of the mean and was divided into 4 quartiles. During a mean follow-up of 6.8 years, 140 086 subjects were newly diagnosed with AF. The highest blood pressure variability (fourth quartile) was associated with an increased risk of AF (hazard ratio, 95% CI; systolic blood pressure: 1.06, 1.05–1.08; diastolic blood pressure: 1.07, 1.05–1.08) compared with the lowest (first quartile). Among subjects in the fourth quartile in both systolic and diastolic blood pressure variability, the risk of AF was 7.6% higher than those in the first quartile. Moreover, this result was consistent in both patients with or without prevalent hypertension. In subgroup analysis, the impact of high blood pressure variability on AF development was stronger in high-risk subjects, who were older (≥65 years), with diabetes mellitus or chronic kidney disease. Our findings demonstrated that higher blood pressure variability was associated with a modestly increased risk of AF.
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Affiliation(s)
- So-Ryoung Lee
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
| | - You-Jung Choi
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
| | - Eue-Keun Choi
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (K.-D.H.)
| | - Euijae Lee
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
| | - Myung-Jin Cha
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
| | - Seil Oh
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
| | - Gregory Y.H. Lip
- From the Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., Y.-J.C., E.-K.C., E.L., M.-J.C., S.O., G.Y.H.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, United Kingdom (G.Y.H.L.)
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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157
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Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean: a systematic review of randomized trials. J Hypertens 2020; 37:16-23. [PMID: 30499920 DOI: 10.1097/hjh.0000000000001994] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the clinical relevance of regression to the mean for clinical trials and clinical practice. METHODS MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. RESULTS Eighty-six trials (349 488 participants), with mean follow-up of 3.7 years, were included. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14% (95% CI 11-17%) and stroke by 18% (15-22%), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the SBP 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP less than 140 mmHg. CONCLUSION Clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.
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158
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Kim M, Han KD, Lee JH. Bodyweight variability and the risk of psoriasis: a nationwide population-based cohort study. J Eur Acad Dermatol Venereol 2020; 34:1019-1025. [PMID: 31747463 DOI: 10.1111/jdv.16099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bodyweight variability has been suggested to exacerbate chronic inflammation and increase the risk of adverse cardiovascular events. Little is known whether high variability in bodyweight affects the development of psoriasis. OBJECTIVE To investigate the association between weight variability and the risk of psoriasis. METHODS Using a representative cohort enrolled in the national health examination programme conducted by the Korean National Health Insurance Service, 8 016 907 people who were free of psoriasis and who underwent at least three health examinations between 2010 and 2015 were followed until the end of 2017. We classified participants numerically according to the variability indices and defined high variability (Q4) as the highest quartile of variability. Cox proportional hazard regression models were used to evaluate the risk of psoriasis according to the quartile groups of bodyweight variability. RESULTS In total, 187 128 (2.33%) participants developed psoriasis during a median follow-up of 3.4 years. There was an association between baseline body mass index and the risk of psoriasis. In the multivariable model adjusting for confounding variables, an incrementally increased risk of psoriasis was observed for higher quartiles compared with the lowest quartile group (Q1). The hazard ratio (HR) and 95% confidence intervals comparing the highest (Q4) and lowest quartiles (Q1) of bodyweight variability were 1.06 (1.05-1.07) for psoriasis. CONCLUSION High bodyweight variability was significantly associated with an increased risk of psoriasis. These findings imply that clinicians should encourage patients to maintain proper bodyweight to help prevent psoriasis.
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Affiliation(s)
- M Kim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K-D Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J H Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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159
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Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months. Sci Rep 2020; 10:811. [PMID: 31964961 PMCID: PMC6972830 DOI: 10.1038/s41598-020-57661-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 01/02/2020] [Indexed: 01/13/2023] Open
Abstract
Thus far, it is well known that increased blood pressure variability may exacerbate stroke outcomes. Blood pressure in the acute phase would be influenced by both reactive hypertension to stroke and intrinsic blood pressure reactivity. Thus, we aimed to evaluate the association between blood pressure variability and outcomes at 3 months using ambulatory blood pressure monitoring in ischemic stroke patients in the subacute phase after reactive hypertension subsided. We retrospectively examined 626 consecutive patients with acute ischemic stroke who underwent 24-hour ambulatory blood pressure monitoring during the subacute phase of stroke (median, 9 days from onset). The variability in blood pressure was evaluated by assessing the standard deviation and coefficient of variation of systolic and diastolic blood pressure. The primary outcome was functional status at 3 months. A poor outcome was defined as a modified Rankin scale score of 3 or more and a good outcome as 2 or less. We assessed the functional outcome at 3 months in 497 patients (79.4%). The mean systolic and diastolic blood pressure levels were not associated with functional outcome. The multivariable analysis revealed that increases in the standard deviations of systolic and diastolic blood pressure, coefficient of variation of diastolic blood pressure, and morning blood pressure surge were associated with poor outcome. Blood pressure variability during the subacute phase of ischemic stroke can be a useful prognostic indicator of poor functional outcome at 3 months in patients with acute ischemic stroke.
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160
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Sible IJ, Nation DA. Long-Term Blood Pressure Variability Across the Clinical and Biomarker Spectrum of Alzheimer's Disease. J Alzheimers Dis 2020; 77:1655-1669. [PMID: 32925032 PMCID: PMC8054661 DOI: 10.3233/jad-200221] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Elevated blood pressure is linked to cognitive impairment and Alzheimer's disease (AD) biomarker abnormality. However, blood pressure levels vary over time. Less is known about the role of long-term blood pressure variability in cognitive impairment and AD pathophysiology. OBJECTIVE Determine whether long-term blood pressure variability is elevated across the clinical and biomarker spectrum of AD. METHODS Alzheimer's Disease Neuroimaging Initiative participants (cognitively normal, mild cognitive impairment, AD [n = 1,421]) underwent baseline exam, including blood pressure measurement at 0, 6, and 12 months. A subset (n = 318) underwent baseline lumbar puncture to determine cerebrospinal fluid amyloid-β and phosphorylated tau levels. Clinical groups and biomarker-confirmed AD groups were compared on blood pressure variability over 12 months. RESULTS Systolic blood pressure variability was elevated in clinically diagnosed AD dementia (VIM: F2,1195 = 6.657, p = 0.001, η2 = 0.01) compared to cognitively normal participants (p = 0.001), and in mild cognitive impairment relative to cognitively normal participants (p = 0.01). Findings were maintained in biomarker-confirmed AD (VIM: F2,850 = 5.216, p = 0.006, η2 = 0.01), such that systolic blood pressure variability was elevated in biomarker-confirmed dementia due to AD relative to cognitively normal participants (p = 0.005) and in biomarker-confirmed mild cognitive impairment due to AD compared to cognitively normal participants (p = 0.04). CONCLUSION Long-term systolic blood pressure variability is elevated in cognitive impairment due to AD. Blood pressure variability may represent an understudied aspect of vascular dysfunction in AD with potential clinical implications.
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Affiliation(s)
- Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA 90007, USA
| | - Daniel A. Nation
- Department of Psychological Science, University of California, Irvine, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA
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161
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Cai Z, Chen Y. Efficacy of Tiaoqiheying decoction in the treatment of spasmodic pain and lipid metabolism after acute ischemic stroke. J Int Med Res 2020; 48:300060519894079. [PMID: 31948302 PMCID: PMC7114289 DOI: 10.1177/0300060519894079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the efficacy and safety of Tiaoqiheying decoction in treating acute ischemic stroke. Methods This prospective randomized study enrolled 102 patients with ischemic stroke who were randomly assigned to the control (placebo), external (external Tiaoqiheying decoction), and external/internal groups (oral and external Tiaoqiheying decoction) groups. Cholesterol (CHO), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels and the National Institute of Health Stroke Scale (NIHSS), modified Ashworth scale (AMS), visual analog scale (VAS), Barthel Index (BI), and Fugl–Meyer score (FMS) were determined before and after treatment. Results NIHSS scores were lower in the external/internal group than in the external and placebo groups. MAS and VAS scores for all patients were also lower after 4 weeks than before treatment, and they were significantly lower in the external/internal group versus the control group. CHO, TG, and LDL levels were significantly lower after 2 and 4 weeks, and their levels were lower in the external/internal group than in the other two groups. BI and FMS were higher in the external/internal group than in the other groups after 2 and 4 weeks of treatment. Conclusion Tiaoqiheying decoction may improve spasmodic pain and lipid metabolism after stroke.
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Affiliation(s)
- Zhixing Cai
- Department of Traditional Chinese Medicine, Tongren Hospital Affiliated with the Medical College of Shanghai Jiao Tong University, Shanghai, China
| | - Yue Chen
- Department of Traditional Chinese Medicine, Tongren Hospital Affiliated with the Medical College of Shanghai Jiao Tong University, Shanghai, China
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162
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Scutelnic A, Streit S, Sarikaya H, Jung S, Heldner MR. [Primary Prevention of Acute Stroke]. PRAXIS 2020; 109:277-289. [PMID: 32183656 DOI: 10.1024/1661-8157/a003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.
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Affiliation(s)
- Adrian Scutelnic
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Sven Streit
- Berner Institut für Hausarztmedizin (BIHAM), Inselspital, Universitätsspital und Universität Bern, Bern
| | - Hakan Sarikaya
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Simon Jung
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Mirjam R Heldner
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
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163
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Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, Hoshide S, Kabutoya T, Tomiyama H, Node K, Ohishi M, Ito S, Kishi T, Rakugi H, Li Y, Chen CH, Park JB, Wang JG. Systemic hemodynamic atherothrombotic syndrome (SHATS) – Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia. Prog Cardiovasc Dis 2020; 63:22-32. [DOI: 10.1016/j.pcad.2019.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
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164
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Tully PJ, Yano Y, Launer LJ, Kario K, Nagai M, Mooijaart SP, Claassen JAHR, Lattanzi S, Vincent AD, Tzourio C. Association Between Blood Pressure Variability and Cerebral Small-Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 9:e013841. [PMID: 31870233 PMCID: PMC6988154 DOI: 10.1161/jaha.119.013841] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Research links blood pressure variability (BPV) with stroke; however, the association with cerebral small‐vessel disease (CSVD) remains unclear. As BPV and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding cerebrovascular morphological characteristics. Methods and Results A systematic review was performed from inception until March 3, 2019. Eligibility criteria included population, adults without stroke (<4 weeks); exposure, BPV quantified by any metric over any duration; comparison, (1) low versus high or mean BPV and (2) people with versus without CSVD; and outcomes, (1) CSVD as subcortical infarct, lacunae, white matter hyperintensities, cerebral microbleeds, or enlarged perivascular spaces; and (2) standardized mean difference in BPV. A total of 27 articles were meta‐analyzed, comprising 12 309 unique brain scans. A total of 31 odds ratios (ORs) were pooled, indicating that higher systolic BPV was associated with higher odds for CSVD (OR, 1.27; 95% CI, 1.14–1.42; I2=85%) independent of mean systolic pressure. Likewise, higher diastolic BPV was associated with higher odds for CSVD (OR, 1.30; 95% CI, 1.14–1.48; I2=53%) independent of mean diastolic pressure. There was no evidence of a pairwise interaction between systolic/diastolic and BPV/mean ORs (P=0.47), nor a difference between BPV versus mean pressure ORs (P=0.58). Fifty‐four standardized mean differences were pooled and provided similar results for pairwise interaction (P=0.38) and difference between standardized mean differences (P=0.70). Conclusions On the basis of the available studies, BPV was associated with CSVD independent of mean blood pressure. However, more high‐quality longitudinal data are required to elucidate whether BPV contributes unique variance to CSVD morphological characteristics.
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Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health School of Medicine The University of Adelaide Australia
| | - Yuichiro Yano
- Community and Family Medicine Duke University Durham NC
| | - Lenore J Launer
- Intramural Research Program National Institute on Aging National Institutes of Health Bethesda MD
| | - Kazuomi Kario
- Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Michiaki Nagai
- Department of Cardiology Hiroshima City Asa Hospital Hiroshima Japan
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics Leiden University Medical Center Institute for Evidence-Based Medicine in Old AgeLeiden the Netherlands
| | - Jurgen A H R Claassen
- Radboud Alzheimer Center and Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen the Netherlands
| | - Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Andrew D Vincent
- Freemasons Foundation Centre for Men's Health School of Medicine The University of Adelaide Australia
| | - Christophe Tzourio
- Bordeaux Population Health University of Bordeaux Inserm Team HEALTHY UMR 1219 CHU Bordeaux Bordeaux France
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165
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Barrett R, Hodgkinson J. Quality evaluation of community pharmacy blood pressure (BP) screening services: an English cross-sectional survey with geospatial analysis. BMJ Open 2019; 9:e032342. [PMID: 31831543 PMCID: PMC6924779 DOI: 10.1136/bmjopen-2019-032342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The primary objective was to assess the accuracy (calibration and validation status) of digital blood pressure (BP) monitors used within community pharmacy in England and the secondary objectives were to assess the overall quality of the BP service by assessing service prevalence, service utilisation and other in-service considerations. DESIGN A cross-sectional survey. SETTING Primary-care retail-pharmacies. PARTICIPANTS 500 pharmacies that contribute to government dispensing-data were invited by post to complete the survey. Private contractors were excluded. INTERVENTIONS We conducted a questionnaire survey with a follow-up (September 2018 to December 2018). RESULTS 109 responses were received. 61% (n=66) of responding pharmacies provided a free BP check to their patients. 40 (61%) pharmacies used recommended validated clinical metres, 6 (9%) had failed validation and 20 (30%) provided too little information to enable us to determine their monitor's status. CONCLUSIONS Responding pharmacies were able to provide useful BP monitoring services to their patients, though quality enhancements need to be implemented. Majority of pharmacies use validated BP monitors, however, there was a lack of range of cuff sizes, variation in replacement and calibration of monitors and apparent absence of such practice in a minority of pharmacies alongside variation in training standards. We noted higher frequency of BP screening in the most deprived postcodes.We recommend in-service redesign and delivery improvements, and suggest professional bodies and researchers work together to create clearer frameworks for front-line practitioners, creating appropriate incentives to facilitate this service redesign.Funders and policy setters should consider the value added to the National Health Service and other healthcare agencies of such screening by pharmacy providers both nationally and internationally. It has the potential to reduce complications of undiagnosed hypertension and the medicines burden that it creates. Future work should examine the impact of pharmacist-led BP screening on patients.
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Affiliation(s)
- Ravina Barrett
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
- Pharmacy Practice, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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166
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Lattanzi S, Silvestrini M. Reader response: Neuroimaging findings in midlife and risk of late-life dementia over 20 years of follow-up. Neurology 2019; 93:1079-1080. [DOI: 10.1212/wnl.0000000000008629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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167
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Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka. Int J Hypertens 2019; 2019:6450281. [PMID: 31885898 PMCID: PMC6915156 DOI: 10.1155/2019/6450281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022] Open
Abstract
Visit-to-visit variability (VVV) is a relatively new concept in the hypertensive arena. Data regarding VVV are lacking in our region, and factors associated with VVV are rarely examined in previous studies. This study was conducted among 406 patients attended to the cardiology outpatient department of Teaching Hospital, Jaffna, Sri Lanka, in 2018 to assess the long-term variability of blood pressure (BP) by reviewing last six consecutive BP readings from the records retrospectively. Data regarding sociodemographic variables and behavioural factors such as medication adherence, physical activity, smoking, alcohol consumption, and relevant comorbidities were taken through an interviewer-administered questionnaire. Data were analysed by using SPSS version 25 and VVV of systolic blood pressure (SBP) matrix expressed as mean of SD and association were examined with various factors and VVV of SBP. SBP showed high VVV among the participants as expressed by mean of SD which was 13.06 ± 5.64. When comparing mean SD among the categories of different variables, female sex (P=0.023) and comorbidities such as diabetes mellitus (DM) (P=0.013), chronic kidney disease (CKD) (P=0.007), and risk of developing obstructive sleep apnoea (OSA) (P=0.04) showed significant variation. Medication adherence to prescribed hypertensive medication was a major issue even though significant association was not found with high VVV (P=0.536). The SD of SBP was then classified into high and low VVV groups by means of a cutoff point at the 50th percentile. Bivariate analysis by using Chi-squared test revealed comorbidities such as DM, CKD, and physical activity (P=0.044) were significantly associated with high VVV. Further multivariate regression analysis revealed that comorbidities such as DM and CKD have 1.561 times and 5.999 times more risk to show high variability, respectively. In conclusion, we recommend simple practical measures to achieve sustainable BP control among hypertensive patients with DM and CKD to minimize the VVV and improve their cardiovascular outcome.
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168
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Zhou TL, Kroon AA, van Sloten TT, van Boxtel MPJ, Verhey FRJ, Schram MT, Köhler S, Stehouwer CDA, Henry RMA. Greater Blood Pressure Variability Is Associated With Lower Cognitive Performance. Hypertension 2019; 73:803-811. [PMID: 30739535 DOI: 10.1161/hypertensionaha.118.12305] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An increasing number of individuals will face age-related cognitive difficulties because life expectancy has increased. It is, therefore, important to identify modifiable risk factors for cognitive impairment. Very short-term to mid-term blood pressure variability (BPV) may be such a factor because it may cause cerebral ischemia. To this end, we investigated whether greater systolic and diastolic BPV are cross-sectionally associated with memory function (n=1804), information processing speed (n=1793), and executive function (n=1780) in 40- to 75-year-old individuals from The Maastricht Study. A composite BPV-index was derived by standardizing within-visit, 24-hour, and 7-day BPV. We performed linear regression with adjustments for age, sex, educational level, 24-hour systolic or diastolic pressure, and cardiovascular risk factors. We found that a 1-SD greater systolic BPV was not associated with information processing speed (β [SD difference], -0.10; 95% CI, -0.14 to 0.06), or executive function (-0.09; 95% CI, -0.20 to 0.02) but was marginally associated with lower memory function (-0.11; 95% CI, -0.21 to 0.00). A 1-SD greater diastolic BPV was associated with lower information processing speed (-0.10; 95% CI, -0.20 to -0.00) and executive function (-0.12; 95% CI, -0.22 to -0.01) and marginally associated with lower memory function (-0.09; 95% CI, -0.20 to 0.01). These effects on cognitive performance are equivalent to ≈3 additional years of aging. In conclusion, greater very short-term to mid-term diastolic and, to a lesser extent, systolic BPV may be a modifiable risk factor for cognitive deterioration in 40- to 75-year-old, community-dwelling individuals.
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Affiliation(s)
- Tan Lai Zhou
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Abraham A Kroon
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S.).,Department of Epidemiology and Department of Arterial Mechanics, INSERM, UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S.)
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Miranda T Schram
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,Heart and Vascular Centre (M.T.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Coen D A Stehouwer
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Ronald M A Henry
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,Heart and Vascular Centre (M.T.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
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169
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Ma Y, Wolters FJ, Chibnik LB, Licher S, Ikram MA, Hofman A, Ikram MK. Variation in blood pressure and long-term risk of dementia: A population-based cohort study. PLoS Med 2019; 16:e1002933. [PMID: 31714941 PMCID: PMC6850672 DOI: 10.1371/journal.pmed.1002933] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/09/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Variation in blood pressure may relate to dementia risk via autonomic disturbance or hemodynamic mechanisms, but the long-term associations are unclear. We aimed to determine whether blood pressure variation over a period of years, considering both magnitude and direction, is associated with the risk of dementia. METHODS AND FINDINGS In a prospective cohort study ongoing since 1989 in the Netherlands, 5,273 dementia-free participants (58.1% women; mean [SD] age, 67.6 [8.0] years) were included. As of 2016, 1,059 dementia cases occurred during a median follow-up of 14.6 years. Absolute variation in systolic blood pressure (SBP) was assessed as the absolute difference in SBP divided by the mean over two sequential visits every 4.2 (median) years, with the first quantile set as the reference level. The direction was the rise or fall in SBP, with the third quantile set as the reference level. We estimated the risk of dementia in relation to SBP variation measured at different time windows (i.e., at least 0, 5, 10, and 15 years) prior to dementia diagnosis, with adjustments for age, sex, education, apolipoprotein E (APOE) genotype, vascular risk factors, and history of cardiovascular disease. We repeated the above analysis for variation in diastolic blood pressure (DBP). A large SBP variation was associated with an increased dementia risk, which became more pronounced with longer intervals between the assessment of SBP variation and the diagnosis of dementia. The hazard ratio (HR) associated with large variation (the highest quintile) increased from 1.08 (95% confidence interval [CI] 0.88-1.34, P = 0.337) for risk within 5 years of SBP variation measurement to 3.13 (95% CI 2.05-4.77; P < 0.001) for risk after at least 15 years since the measurement of SBP variation. The increased long-term risk was associated with both large rises (HR for the highest quintile, 3.31 [95% CI 2.11-5.18], P < 0.001) and large falls in SBP (HR for the lowest quintile, 2.20 [95% CI 1.33-3.63], P = 0.002), whereas the higher short-term risk was only associated with large falls in SBP (HR, 1.21 [95% CI 1.00-1.48], P = 0.017). Similar findings were observed for variation in DBP. Despite our assessment of major confounders, potential residual confounding is possible, and the findings on blood pressure variability over periods of years may not be generalizable to variability over periods of days and other shorter periods. CONCLUSIONS Results of this study showed that a large blood pressure variation over a period of years was associated with an increased long-term risk of dementia. The association between blood pressure variation and dementia appears most pronounced when this variation occurred long before the diagnosis. An elevated long-term risk of dementia was observed with both a large rise and fall in blood pressure.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Lori B. Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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170
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de Heus RA, Olde Rikkert MG, Tully PJ, Lawlor BA, Claassen JA. Blood Pressure Variability and Progression of Clinical Alzheimer Disease. Hypertension 2019; 74:1172-1180. [DOI: 10.1161/hypertensionaha.119.13664] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer’s Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer’s Disease Assessment Scale–cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer’s Disease Assessment Scale–cognitive subscale compared with patients in the lowest quartile (systolic: β, 2.24 [95% CI, 0.11–4.38],
P
=0.040; diastolic: β, 2.54 [95% CI, 0.33–4.75]
P
=0.024). This association was still present after 1.5 years (systolic: β, 2.86 [95% CI, 0.35–5.36],
P
=0.026; diastolic: β, 3.30 [95% CI, 0.67–5.93],
P
=0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer’s Disease Assessment Scale–cognitive subscale (systolic:
P
=0.036) and Disability Assessment for Dementia (systolic:
P
=0.020; diastolic:
P
=0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease.
Clinical Trial Registration
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A.A. de Heus
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Marcel G.M. Olde Rikkert
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Phillip J. Tully
- School of Medicine, The University of Adelaide, Australia (P.J.T.)
| | - Brian A. Lawlor
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland (B.A.L.)
- Department of Medical Gerontology, Trinity College Institute of Neuroscience, Dublin, Ireland (B.A.L.)
| | - Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
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Mazza A, Townsend DM, Schiavon L, Torin G, Lenti S, Rossetti C, Rigatelli G, Rubello D. Long-term effect of the perindopril/indapamide/amlodipine single-pill combination on left ventricular hypertrophy in outpatient hypertensive subjects. Biomed Pharmacother 2019; 120:109539. [PMID: 31627089 PMCID: PMC7104809 DOI: 10.1016/j.biopha.2019.109539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/25/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most antihypertensive drugs used in monotherapy or in combination therapy reduce the left ventricular mass index (LVMI). However, little is known about the effects on LVMI of a triple fixed-dose combination (TFC) therapy, containing in a single pill an angiotensin-converting enzyme inhibitor (ACEI), a diuretic and a calcium channel blocker (CCB). METHODS In this prospective open-label study, 92 patients with essential hypertension were randomized to treatment with a TFC of perindopril/indapamide/amlodipine at different doses or a triple free combination therapy (FCT) including ACEI/diuretic/CCB. Office blood pressure (BP) measurement, 24 h-ambulatory BP monitoring and echocardiography were performed at baseline and during a 14-month follow-up. The BP variability (BPV) over 24 h was calculated as ± standard deviation of the daytime systolic BP. Differences between office and monitored BP and LVMI were evaluated by ANOVA for repeated measures. RESULTS A significant BP-lowering effect was observed for both treatments. At follow-up, BPV was reduced in both the treatment groups vs. the baseline (14.0±1.5 vs. 17.0±1.8 and 16.2±2.1 vs. 17.6±2.3, respectively), but it was lower in the TFC vs. the FCT group (14.0±1.5 vs. 16.1±2.2, P < 0.05). LVMI was lower in both the treatment groups, but the change was greater for TFC vs. FCT (-8.3±4.9% vs. -2.0 ±2.1%, P < 0.0001). Left ventricular hypertrophy (LVH) regression was greater in the TFC vs. the FCT group (43.5% vs. 30.4%, P < 0.05). CONCLUSIONS Independently of BP values achieved, the antihypertensive TFC therapy was more effective than FCT in LVMI reduction and LVH regression, possibly related to drugs' intrinsic properties and to BPV modulation.
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Affiliation(s)
- Alberto Mazza
- ESH Excellence Hypertension Centre, Internal Medicine Unit, S. Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy.
| | - Danyelle M Townsend
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, USA
| | - Laura Schiavon
- Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Gioia Torin
- ESH Excellence Hypertension Centre, Internal Medicine Unit, S. Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy; Unit of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Lenti
- Internal Medicine Unit, S. Donato General Hospital, Arezzo, Italy
| | - Ciro Rossetti
- Unit of Internal Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Trasfusional Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
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172
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Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases. High Blood Press Cardiovasc Prev 2019; 26:353-359. [PMID: 31559570 PMCID: PMC6825020 DOI: 10.1007/s40292-019-00339-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/31/2019] [Indexed: 12/18/2022] Open
Abstract
Blood pressure (BP) is characterized by continuous dynamic and spontaneous oscillations occurring over lifetime and defining the so-called blood pressure variability (BPV). BPV has been associated with target organ damage, cardiovascular (CV) risk and death, suggesting the use of BPV as a new target in hypertension management in addition to mean BP values lowering. The purpose of the review is to focus on the therapeutic implications of BPV and summarize the effects of different drug classes on various types of BPV. Despite most first-line antihypertensive medications contribute to reduce both short and long term BPV, calcium channel blockers (CCBs) as monotherapy or fixed-combination therapy appear to be the most effective on BPV control. Further randomized interventional trials are needed to investigate which drug combinations are most appropriate according to patient CV risk stratification, in order to improve their CV outcomes.
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173
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Chen AX, Moran JL, Libianto R, Baqar S, O'Callaghan C, MacIsaac RJ, Jerums G, Ekinci EI. Effect of angiotensin II receptor blocker and salt supplementation on short-term blood pressure variability in type 2 diabetes. J Hum Hypertens 2019; 34:143-150. [PMID: 31501493 DOI: 10.1038/s41371-019-0238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/21/2019] [Accepted: 08/01/2019] [Indexed: 11/09/2022]
Abstract
High blood pressure variability (BPV) has been associated with increased cardiovascular (CV) risk. The effect of dietary salt and renin-angiotensin-aldosterone system (RAAS) activity on short-term BPV in type 2 diabetes mellitus (T2DM) is not well characterised. We aimed to determine the effect of dietary salt (sodium chloride, NaCl) supplementation on 24-h mean arterial BPV (24hBPV) during angiotensin II receptor blocker (telmisartan) use and to evaluate the effects of age, sex, plasma renin activity (PRA) and serum aldosterone on 24hBPV. In a randomised, double-blind, crossover study, patients with T2DM (n = 28), treated with telmisartan received NaCl (100 mmol/24 h) or placebo capsules during 2 weeks of telmisartan. Following a 6-week washout, the protocol was repeated in reverse. 24hBPV was evaluated as a co-efficient of variation [CV (%) = mean/standard deviation] × 100). Twenty-four hour urinary sodium excretion, ambulatory BP and biochemical tests were performed at each phase. Results were analysed using a linear mixed model to generate predicted values for 24hBPV. Predicted 24hBPV was higher with telmisartan vs baseline (p = 0.01), with a trend towards reduced 24hBPV with salt (p = 0.052). Predicted 24hBPV was lower in females (p = 0.017), increasing age (p = 0.001) and increasing PRA (p = 0.011). In patients with T2DM, predicted 24hBPV increased from baseline with telmisartan, but there was no additional increase in predicted 24hBPV with salt supplementation. This suggests that in the short-term, salt supplementation has no apparent deleterious effects on 24hBPV. Long-term studies are required to evaluate the effect of 24hBPV on CV outcomes in patients with T2DM.
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Affiliation(s)
- Angela X Chen
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - John L Moran
- Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Renata Libianto
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Sara Baqar
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher O'Callaghan
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Pharmacology, Austin Health, Melbourne, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - George Jerums
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia. .,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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174
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Lattanzi S, Brigo F, Silvestrini M. Hypertension and arterial stiffness. J Clin Hypertens (Greenwich) 2019; 21:1481-1483. [PMID: 31498537 DOI: 10.1111/jch.13690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/15/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.,Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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175
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Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers. J Hypertens 2019; 36:2177-2184. [PMID: 29794815 DOI: 10.1097/hjh.0000000000001783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE SBP variability may be a target for mitigating end-organ damage associated with vascular disease. We evaluated the relationship between increased SBP variability and risk of incident diabetic foot ulceration. METHODS Using a nested case-control design, we followed patients diagnosed with diabetes and treated within the US Department of Veterans Affairs Healthcare system for development of a diabetic foot ulcer (event) between 2006 and 2010. Each case was randomly matched to up to five controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using at least three blood pressure measurements from the year preceding the event. The association between SBP variability and foot ulceration was examined using conditional logistic regression. Potential protective effects of calcium channel blockers, which blunt SBP variability, were also explored. RESULTS The study sample included 51 111 cases and 129 247 controls. Compared with those in quartile 1 (lowest variability), patients in quartiles 2-4 had higher adjusted odds ratios for diabetic foot ulcer development: 1.11 (95% CI 1.07-1.16), 1.20 (95% CI 1.15-1.25), 1.29 (95% CI 1.24-1.34) (P for trend <0.001). Calcium channel blockers were associated with reduced risks of ulceration for those without peripheral vascular disease (OR = 0.87, 95% CI 0.84-0.90, P < 0.001) or neuropathy (OR = 0.85, 95% CI 0.82-0.89, P < 0.001) in adjusted subgroup analyses. CONCLUSION This study describes a graded relationship between SBP variability and risk of diabetic foot ulceration, providing a potential new and modifiable target to reduce this common complication.
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176
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Guo R, Xie Y, Zheng J, Wang Y, Dai Y, Sun Z, Xing L, Zhang X, Sun Y, Zheng L. Short-term blood pressure changes have a more strong impact on stroke and its subtypes than long-term blood pressure changes. Clin Cardiol 2019; 42:925-933. [PMID: 31361034 PMCID: PMC6788570 DOI: 10.1002/clc.23242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background Elevated blood pressure (BP) is closely related to stroke and its subtypes. However, different time periods changes in BP may result in differential risk of stroke. Hypothesis Short‐term blood pressure changes have a more strong impact on stroke and its subtypes than long‐term blood pressure changes. Methods We designed the study on the effects of short‐ (2008‐2010) and long‐term (2004‐2010) BP changes on stroke events (2011‐2017), including 22 842 and 28 456 subjects, respectively. The difference in β coefficients between short‐ and long‐term BP changes on the effects of stroke were examined using the Fisher Z test. Results During a median 12.5‐year follow‐up period, 1014 and 1505 strokes occurred in short‐ and long‐term groups. In short‐term group, going from prehypertension to hypertension, the risk of stroke events increased (stroke: hazard ratio [HR] = 1.537 [1.248‐1.894], ischemic stroke: 1.456 [1.134‐1.870] and hemorrhagic stroke: 1.630 [1.099‐2.415]); going from hypertension to prehypertension, the risk of stroke events decreased (stroke:0.757 [0.619‐0.927] and hemorrhagic stroke:0.569 [0.388‐0.835]). Similarly, in long‐term group, going from prehypertension to hypertension, individuals had an increased risk of stroke (1.291, 1.062‐1.569) and hemorrhagic stroke (1.818, 1.261‐2.623); going from hypertension to prehypertension, participants had a decreased risk of stroke (0.825, 0.707‐0.963) and hemorrhagic stroke (0.777, 0.575‐0.949). Furthermore, the effects of BP changes during short‐term period on stroke events were greater than that in long‐term period. Conclusions Short‐ and long‐terms BP changes were both associated with the risk of stroke events. Furthermore, short‐term BP changes had a stronger impact than did long‐term changes on risk of stroke events.
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Affiliation(s)
- Rongrong Guo
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Yanxia Xie
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Jia Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Yali Wang
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Yue Dai
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Liying Xing
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, P. R. China
| | - Xingang Zhang
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, P. R. China
| | - Yingxian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
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177
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Loutradis C, Sarafidis PA, Theodorakopoulou M, Ekart R, Alexandrou ME, Pyrgidis N, Angeloudi E, Tzanis G, Toumpourleka M, Papadopoulou D, Mallamaci F, Zoccali C, Papagianni A. Lung Ultrasound-Guided Dry-Weight Reduction in Hemodialysis Patients Does Not Affect Short-Term Blood Pressure Variability. Am J Hypertens 2019; 32:786-795. [PMID: 31162530 DOI: 10.1093/ajh/hpz064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Increased short-term blood pressure (BP) variability (BPV) in hemodialysis is associated with increased cardiovascular and all-cause mortality. Studies on the impact of BP-lowering interventions on BPV are scarce. This study examined the effect of dry-weight reduction with a lung ultrasound-guided strategy on short-term BPV in hemodialysis patients with hypertension. METHODS This is a prespecified analysis of a randomized clinical trial in 71 hemodialysis patients with hypertension, assigned in a 1:1 ratio in the active group, following a strategy for dry-weight reduction guided by pre-hemodialysis lung ultrasound and the control group following standard-of-care treatment. All patients underwent 48-hour ambulatory BP monitoring at baseline and after 8 weeks. BPV was calculated with validated formulas for the 48-hour interval and the 2 daytime and nighttime periods. RESULTS Dry-weight changes were -0.71 ± 1.39 in active vs. +0.51 ± 0.98 kg in the control group (P < 0.001), generating a between-group difference of 5.9/3.5 mm Hg (P < 0.05) in 48-hour BP at study end. All brachial BPV indices [SD, weighted SD, coefficient of variation, and average real variability (ARV)] did not change significantly from baseline to study end in the active [systolic blood pressure (SBP)-ARV: 12.58 ± 3.37 vs. 11.91 ± 3.13, P = 0.117; diastolic blood pressure (DBP)-ARV: 9.14 ± 1.47 vs. 8.80 ± 1.96, P = 0.190] or control (SBP-ARV: 11.33 ± 2.76 vs. 11.07 ± 2.51, P = 0.544; DBP-ARV: 8.38 ± 1.50 vs. 8.15 ± 1.49, P = 0.295) group (between-group comparison P = 0.211/0.117). Aortic BPV indices followed a similar pattern. Likewise, no significant changes in BPV indices for the daytime and nighttime periods were noted in both groups during follow-up. CONCLUSIONS This study is the first to evaluate the effects of a nonpharmacological intervention on short-term BPV in hemodialysis, showing no effect of dry-weight reduction on BPV, despite BP decrease.
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Affiliation(s)
- Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Robert Ekart
- Department of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia
| | | | - Nikolaos Pyrgidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Elena Angeloudi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Georgios Tzanis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Maria Toumpourleka
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Francesca Mallamaci
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
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178
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Xu L, Huang J, Zhang Z, Qiu J, Guo Y, Zhao H, Cai Z, Huang X, Fan Y, Xu Y, Ma J, Wu W. Bioinformatics Study on Serum Triglyceride Levels for Analysis of a Potential Risk Factor Affecting Blood Pressure Variability. Curr Bioinform 2019. [DOI: 10.2174/1574893614666190109152809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:
The purpose of this study was to establish whether Triglycerides (TGs) are
related to Blood Pressure (BP) variability and whether controlling TG levels leads to better BP
variability management and prevents Cardiovascular Disease (CVD).
Methods:
In this study, we enrolled 106 hypertensive patients and 80 non-hypertensive patients.
Pearson correlation and partial correlation analyses were used to define the relationships between
TG levels and BP variability in all subjects. Patients with hypertension were divided into two subgroups
according to TG level: Group A (TG<1.7 mmol/L) and Group B (TG>=1.7 mmol/L). The
heterogeneity between the two subgroups was compared using t tests and covariance analysis.
Results:
TG levels and BP variability were significantly different between the hypertensive and
non-hypertensive patients. Two-tailed Pearson correlation tests showed that TG levels are positively
associated with many BP variability measures in all subjects. After reducing other confounding
factors, the partial correlation analysis revealed that TG levels are still related to the Standard Deviation
(SD), Coefficient of Variation (CV) of nighttime systolic blood pressure and CV of
nighttime diastolic blood pressure, respectively (each p<0.05). In the subgroups, group A had a
lower SD of nighttime Systolic Blood Pressure (SBP_night_SD; 11.39±3.80 and 13.39±4.16,
p=0.011), CV of nighttime systolic blood pressure (SBP_night_CV; 0.09±0.03 and 0.11±0.03,
p=0.014) and average real variability of nighttime systolic blood pressure (SBP_night_ARV;
10.99±3.98 and 12.6±3.95, p=0.024) compared with group B, even after adjusting for age and other
lipid indicators.
Conclusion:
TG levels are significantly associated with BP variability and hypertriglyceridemia,
which affects blood pressure variability before causing target organ damage.
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Affiliation(s)
- Lin Xu
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Jiangming Huang
- Guangdong Provincial Armed Police Corps Hospital Guangzhou 510010, China
| | - Zhe Zhang
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Jian Qiu
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Yan Guo
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Hui Zhao
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Zekun Cai
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Xiaomin Huang
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Yongwang Fan
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Yehao Xu
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Jun Ma
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou 510010, China
| | - Wanqing Wu
- The School of Biomedical Engineering, Sun Yat-Sen University, Guanzhou 510275, China
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179
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Béjot Y. Targeting blood pressure for stroke prevention: current evidence and unanswered questions. J Neurol 2019; 268:785-795. [PMID: 31243539 DOI: 10.1007/s00415-019-09443-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 12/22/2022]
Abstract
High blood pressure (BP) is the leading modifiable risk factor of stroke worldwide. Although randomized clinical trials have demonstrated the beneficial effect of BP reduction on stroke risk, there are still insufficiently explored issues concerning the optimal personalized management of BP in stroke patients in terms of thresholds to be achieved and drug classes to be prescribed. Few data are available about BP control in specific clinical contexts such as in older patients, in various stroke subtypes, or in association with co-morbidities such as diabetes. In addition, although drug trials based their conclusions on achieved mean BP values, recent findings indicate that aspects such as circadian variations of BP and BP variability should be taken into account as well. This article aims to highlight current knowledge about BP control in stroke prevention and to provide new perspectives to be addressed in future studies so as to guide clinicians in their day-to-day practice.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, E7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France.
- Department of Neurology, University Hospital of Dijon, Hôpital François Mitterrand, 14 rue Paul Gaffarel, BP 77908, 21079, Dijon cedex, France.
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180
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Reese T, Dickson AL, Shuey MM, Gandelman JS, Barnado A, Barker KA, Neal JE, Khan OA, Dupont WD, Stein CM, Chung CP. Increased blood pressure visit-to-visit variability in patients with systemic lupus erythematosus: association with inflammation and comorbidity burden. Lupus 2019; 28:954-960. [PMID: 31221051 DOI: 10.1177/0961203319856988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Blood pressure visit-to-visit variability is a novel risk factor for deleterious long-term cardiac and renal outcomes in the general population. We hypothesized that patients with systemic lupus erythematosus (SLE) have greater blood pressure visit-to-visit variability than control subjects and that blood pressure visit-to-visit variability is associated with a higher comorbidity burden. METHODS We studied 899 patients with SLE and 4172 matched controls using de-identified electronic health records from an academic medical center. We compared blood pressure visit-to-visit variability measures in patients with SLE and control subjects and examined the association between blood pressure visit-to-visit variability and patients' characteristics. RESULTS Patients with SLE had higher systolic blood pressure visit-to-visit variability 9.7% (7.8-11.8%) than the control group 9.2% (7.4-11.2%), P < 0.001 by coefficient of variation. Additional measures of systolic blood pressure visit-to-visit variability (i.e. standard deviation, average real variation, successive variation and maximum measure-to-measure change) were also significantly higher in patients with SLE than in control subjects. In patients with SLE, blood pressure visit-to-visit variability correlated significantly with age, creatinine, CRP, triglyceride concentrations and the Charlson comorbidity score (all P < 0.05). Hydroxychloroquine use was associated with reduced blood pressure visit-to-visit variability (P < 0.001), whereas the use of antihypertensives, cyclophosphamide, mycophenolate mofetil and corticosteroids was associated with increased blood pressure visit-to-visit variability (P < 0.05). CONCLUSION Patients with SLE had higher blood pressure visit-to-visit variability than controls, and this increased blood pressure visit-to-visit variability was associated with greater Charlson comorbidity scores, several clinical characteristics and immunosuppressant medications. In particular, hydroxychloroquine prescription was associated with lower blood pressure visit-to-visit variability.
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Affiliation(s)
- T Reese
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A L Dickson
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M M Shuey
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J S Gandelman
- 2 Vanderbilt University School of Medicine, Nashville, TN, USA
| | - A Barnado
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - K A Barker
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J E Neal
- 3 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - O A Khan
- 3 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W D Dupont
- 3 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C M Stein
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,4 Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - C P Chung
- 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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181
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Ayala Solares JR, Canoy D, Raimondi FED, Zhu Y, Hassaine A, Salimi‐Khorshidi G, Tran J, Copland E, Zottoli M, Pinho‐Gomes A, Nazarzadeh M, Rahimi K. Long-Term Exposure to Elevated Systolic Blood Pressure in Predicting Incident Cardiovascular Disease: Evidence From Large-Scale Routine Electronic Health Records. J Am Heart Assoc 2019; 8:e012129. [PMID: 31164039 PMCID: PMC6645648 DOI: 10.1161/jaha.119.012129] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023]
Abstract
Background How measures of long-term exposure to elevated blood pressure might add to the performance of "current" blood pressure in predicting future cardiovascular disease is unclear. We compared incident cardiovascular disease risk prediction using past, current, and usual systolic blood pressure alone or in combination. Methods and Results Using data from UK primary care linked electronic health records, we applied a landmark cohort study design and identified 80 964 people, aged 50 years (derivation cohort=64 772; validation cohort=16 192), who, at study entry, had recorded blood pressure, no prior cardiovascular disease, and no previous antihypertensive or lipid-lowering prescriptions. We used systolic blood pressure recorded up to 10 years before baseline to estimate past systolic blood pressure (mean, time-weighted mean, and variability) and usual systolic blood pressure (correcting current values for past time-dependent blood pressure fluctuations) and examined their prospective relation with incident cardiovascular disease (first hospitalization for or death from coronary heart disease or stroke/transient ischemic attack). We used Cox regression to estimate hazard ratios and applied Bayesian analysis within a machine learning framework in model development and validation. Predictive performance of models was assessed using discrimination (area under the receiver operating characteristic curve) and calibration metrics. We found that elevated past, current, and usual systolic blood pressure values were separately and independently associated with increased incident cardiovascular disease risk. When used alone, the hazard ratio (95% credible interval) per 20-mm Hg increase in current systolic blood pressure was 1.22 (1.18-1.30), but associations were stronger for past systolic blood pressure (mean and time-weighted mean) and usual systolic blood pressure (hazard ratio ranging from 1.39-1.45). The area under the receiver operating characteristic curve for a model that included current systolic blood pressure, sex, smoking, deprivation, diabetes mellitus, and lipid profile was 0.747 (95% credible interval, 0.722-0.811). The addition of past systolic blood pressure mean, time-weighted mean, or variability to this model increased the area under the receiver operating characteristic curve (95% credible interval) to 0.750 (0.727-0.811), 0.750 (0.726-0.811), and 0.748 (0.723-0.811), respectively, with all models showing good calibration. Similar small improvements in area under the receiver operating characteristic curve were observed when testing models on the validation cohort, in sex-stratified analyses, or by using different landmark ages (40 or 60 years). Conclusions Using multiple blood pressure recordings from patients' electronic health records showed stronger associations with incident cardiovascular disease than a single blood pressure measurement, but their addition to multivariate risk prediction models had negligible effects on model performance.
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Affiliation(s)
- Jose Roberto Ayala Solares
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- National Institute for Health
Research Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Dexter Canoy
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- National Institute for Health
Research Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
| | - Francesca Elisa Diletta Raimondi
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
| | - Yajie Zhu
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
| | - Abdelaali Hassaine
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- National Institute for Health
Research Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Gholamreza Salimi‐Khorshidi
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
| | - Jenny Tran
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
| | - Emma Copland
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- National Institute for Health
Research Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Mariagrazia Zottoli
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- National Institute for Health
Research Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Ana‐Catarina Pinho‐Gomes
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
| | - Milad Nazarzadeh
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- Collaboration Center of Meta‐Analysis ResearchTorbat Heydariyeh University of Medical SciencesTorbat HeydariyehIran
| | - Kazem Rahimi
- Deep MedicineOxford Martin SchoolOxfordUnited Kingdom
- The George Institute for Global Health (UK)University of OxfordUnited Kingdom
- National Institute for Health
Research Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
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182
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Shin DH, Song S, Lee YB. Comparison of the Effect of Fimasartan versus Valsartan on Blood Pressure Variability in Acute Ischemic Stroke: A Double-Blind Randomized Trial. Cardiovasc Ther 2019; 2019:7836527. [PMID: 31772615 PMCID: PMC6739756 DOI: 10.1155/2019/7836527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/04/2022] Open
Abstract
Higher blood pressure variability (BPV) is associated with poor functional outcome and mortality in acute stroke. This randomized controlled trial was conducted to compare the effect on BPV between fimasartan and valsartan (Boryung Pharmaceutical Co., Ltd., Seoul, Republic of Korea) in patients with acute ischemic stroke. Eighty patients were randomly assigned to receive either valsartan or fimasartan after 7 days of acute ischemic stroke onset, for duration of 8 weeks. Of them, 62 patients completed the study [valsartan (n=31), fimasartan (n=31)]. We measured BP for 24 hours using ambulatory BP monitoring device before and after 8 weeks of starting BP medication. We calculated several indexes such as standard deviation (SD), weighted 24-hour BP with SD (wSD), coefficient of variation (CV), and average real variability (ARV) to assess BPV and to compare indexes of BPV between 2 drugs. SD values of systolic BP in daytime, nighttime, and 24 h period (15.55±4.02 versus 20.55±8.77, P=0.006; 11.98±5.52 versus 16.47±6.94, P=0.007; 17.22±5.30 versus 21.45±8.51, P=0.024), wSD of systolic BP (8.27±3.01 versus 10.77±4.18, P=0.010), and ARV of systolic BP (15.85±6.17 versus 19.68±7.83, P=0.040) of patients receiving fimasartan after 8 weeks were significantly lower than patients receiving valsartan. In paired t-test, SD values of daytime, nighttime, and 24 h period of systolic BP of patients receiving fimasartan were significantly decreased after 8 weeks (15.55±4.02 versus 18.70±7.04, P=0.038; 11.98±5.52 versus 17.19±7.35, P=0.006; 17.22±5.30 versus 20.59±5.91, P=0.015). Our study showed that fimasartan had greater effect on reducing BPV after acute ischemic stroke than valsartan. Trials registry number is KCT0003254.
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Affiliation(s)
- Dong Hoon Shin
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Soohwa Song
- Department of Biomedical Engineering, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Yeong Bae Lee
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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183
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Beat-to-beat blood pressure variability and heart rate variability in relation to autonomic dysregulation in patients with acute mild-moderate ischemic stroke. J Clin Neurosci 2019; 64:187-193. [DOI: 10.1016/j.jocn.2019.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/22/2018] [Accepted: 03/04/2019] [Indexed: 11/23/2022]
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184
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Lee HT, Namgung J, Lim YH, Park HC, Park JK, Shin J. The relationship between visit-to-visit variability in blood pressure and incidence of metabolic syndrome: a general population-based cohort study in Korea. Clin Hypertens 2019; 25:11. [PMID: 31123598 PMCID: PMC6518773 DOI: 10.1186/s40885-019-0117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/18/2019] [Indexed: 01/13/2023] Open
Abstract
Background Previous studies demonstrated that visit-to-visit variability of blood pressure (BP) has significant relationship with cardiovascular disease. Visit-to-visit variability in BP might have prognostic value for cardiovascular disease. The aim of this study is to evaluate the effect of visit-to-visit variability in BP on development of metabolic syndrome in general population without cardiovascular disease, diabetes mellitus, metabolic syndrome, and BP medication. Method We used data from the Korean Genome Epidemiology Study conducted by the Korean Centers for Disease Control and Prevention. All cohorts who were followed first 3 periods formed the basis of the study sample, which consisted of 7195 people. Of these samples, 3431 subjects who had cardiovascular disease, diabetes mellitus, or metabolic syndrome were excluded, and 312 subjects who were using antihypertensive medication in first 3 periods were excluded. Our final study sample consisted of 3452 cohorts. Results The mean age was 53.5 (8.25) years. The proportion of male was 50.2%. Average follow-up duration was 5.91 (0.17) years. In generalized estimating equation, the development of metabolic syndrome was associated with mean systolic BP (SBP) (Odd ratio (OR) 1.042, 95% confidence interval (CI) 1.035–1.048, p < 0.001), mean diastolic BP (DBP) (OR 1.058, 95% CI 1.049–1.069, p < 0.001), standard deviation (SD) of SBP (OR 1.036, 95% CI 1.017–1.055, p < 0.001), SD of DBP (OR 1.053, 95% CI 1.027–1.080, p < 0.001), and coefficient of variation (CV) of DBP (OR 1.025, 95% CI 1.005–1.046, p = 0.016) after adjusted for age, sex, and metabolic syndrome component. When mean SBP, mean DBP, SBP variability, and DBP variability were entered all together in the analysis model, SD of DBP (OR 1.033, 95% CI 1.003–1.063, p = 0.030) and CV of DBP (OR 1.027, 95% CI 1.004–1.051, p = 0.020) were significantly associated with the development of metabolic syndrome. Conclusion In general population without cardiovascular disease, diabetes mellitus, metabolic syndrome, and BP medication, SD of DBP and CV of DBP was associated with the development of metabolic syndrome. Visit-to-visit variability in DBP might be helpful for the prediction of future metabolic syndrome development.
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Affiliation(s)
- Hyung Tak Lee
- Departments of Internal Medicine, Gumdan Top General Hospital, Incheon, Republic of Korea
| | - June Namgung
- 2Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Young-Hyo Lim
- 3Division of Cardiology, Departments of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-gu, 133-792 Seoul, Republic of Korea
| | - Hwan-Cheol Park
- 3Division of Cardiology, Departments of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-gu, 133-792 Seoul, Republic of Korea
| | - Jin-Kyu Park
- 3Division of Cardiology, Departments of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-gu, 133-792 Seoul, Republic of Korea
| | - Jinho Shin
- 3Division of Cardiology, Departments of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-gu, 133-792 Seoul, Republic of Korea
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Effects of doxazosin mesylate versus nifedipine on blood pressure variability in hypertensive patients: a randomized crossover study (SIMILAR). Blood Press Monit 2019; 24:252-258. [PMID: 31116151 DOI: 10.1097/mbp.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Blood pressure variability (BPV) is a powerful predictor of end-organ damage, cardiovascular events and mortality independently of the BP level. Calcium channel blockers may offer an advantage over other first-line antihypertensive drugs by preventing increased BPV. But the effect of alpha-receptor blockers on BPV in hypertensive patients is still unclear. METHODS In this crossover trial, 36 hypertensive patients were randomly assigned to two groups, receiving doxazosin mesylate gastrointestinal therapeutic system (GITS) (4 mg/day) or nifedipine GITS (30 mg/day) for 12 weeks, followed by a 2-week washout period then a 12-week crossover phase. At baseline and after 12-week treatment, 24-hour ambulatory BP monitoring was performed. BPV was evaluated through standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic BP (SBP) and diastolic BP (DBP) during daytime, nighttime and over 24 hours. RESULTS After 12-week treatment, both doxazosin and nifedipine significantly decreased SBP and DBP (P < 0.05), whereas no between-group differences were shown (P>0.05). Systolic BPV (24-hour SD, CV, and ARV; daytime SD; nighttime SD and CV) and diastolic BPV (24-hour SD and ARV) were significantly lowered by nifedipine (P < 0.05); doxazosin resulted in significant reductions of systolic BPV (24-hour SD, CV and ARV; daytime SD; nighttime SD) and diastolic BPV (nighttime SD and CV) (P < 0.05). Doxazosin was revealed to be as effective as nifedipine for reducing BPV (P > 0.05) except for 24-hour SBP ARV. CONCLUSIONS Doxazosin mesylate GITS had similar therapeutic effects on BP, BP SD, and BP CV lowering as nifedipine GITS in patients with mild-to-moderate essential hypertension.
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Nozato S, Yamamoto K, Nozato Y, Akasaka H, Hongyo K, Takeda M, Takami Y, Takeya Y, Sugimoto K, Ito N, Rakugi H. Severity of obstructive sleep apnea is associated with the nocturnal fluctuation of pulse rate, but not with that of blood pressure, in older hypertensive patients receiving calcium channel blockers. Geriatr Gerontol Int 2019; 19:604-610. [PMID: 31044515 DOI: 10.1111/ggi.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/19/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Abstract
AIM Obstructive sleep apnea (OSA) is associated with increased variability in nocturnal blood pressure (BP). Calcium channel blockers (CCB) are superior to other classes of antihypertensives in decreasing BP variability. We investigated whether OSA severity is associated with nocturnal BP variability in older hypertensive patients treated with CCB. METHODS We measured home systolic and diastolic BP and pulse rate (PR) automatically during sleep at an interval of an hour once a week using an electronic sphygmomanometer in 29 hypertensive patients (aged ≥65 years) receiving CCB. We calculated the coefficient of variation (CV) from four consecutive measurements. All patients underwent a home-based portable sleep study. RESULTS We found no difference in PR, BP or CV of BP between the patients with no-to-mild OSA and with moderate-to-severe OSA, categorized by the respiratory disturbance index (RDI) and 3% oxygen desaturation index (ODI). The CV of PR in patients with moderate-to-severe OSA was higher than the patients with no-to-mild OSA categorized by 3% ODI (P = 0.01). Body mass index was correlated with RDI and 3% ODI (r = 0.56 and 0.43, respectively). The CV of BP did not correlate to RDI or 3% ODI. The CV of PR was positively correlated both with RDI and with 3% ODI (r = 0.41 and 0.42, respectively). CONCLUSIONS The severity of OSA was associated with PR variability, but not with BP variability, in older patients receiving CCB. Our results suggest the need for future studies to determine whether CCB can suppress the influence of OSA on BP fluctuation during sleep. Geriatr Gerontol Int 2019; 19: 604-610.
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Affiliation(s)
- Satoko Nozato
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoichi Nozato
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Hongyo
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masao Takeda
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Takeya
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norihisa Ito
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35-e66. [PMID: 30827125 PMCID: PMC11409525 DOI: 10.1161/hyp.0000000000000087] [Citation(s) in RCA: 671] [Impact Index Per Article: 134.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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188
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Blood pressure variability in individuals with and without (pre)diabetes: The Maastricht Study. J Hypertens 2019; 36:259-267. [PMID: 28885385 DOI: 10.1097/hjh.0000000000001543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The mechanisms associating (pre)diabetes and cardiovascular disease (CVD) are incompletely understood. We hypothesize that greater blood pressure variability (BPV) may underlie this association, due to its association with (incident) CVD. Therefore, we investigated the association between (pre)diabetes and very short-term to mid-term BPV, that is within-visit, 24-h and 7-day BPV. METHODS Cross-sectional data from The Maastricht Study [normal glucose metabolism (NGM), n = 1924; prediabetes, n = 511; type 2 diabetes mellitus (T2DM), n = 975; 51% men, aged 60 ± 8 years]. We determined SD for within-visit BPV (n = 3244), average real variability for 24-h BPV (n = 2699) day (0900-2100 h) and night (0100-0600 h) separately, and SD for 7-day BPV (n = 2259). Differences in BPV as compared with NGM were assessed by multiple linear regressions with adjustment for potential confounders. RESULTS In T2DM, the average systolic/diastolic values of within-visit, 24-h and 7-day BPV were 4.8/2.6, 10.5/7.3 and 10.4/6.5 mmHg, respectively, and in prediabetes 4.9/2.6, 10.3/7.0 and 9.4/5.9 mmHg, respectively. T2DM was associated with greater nocturnal systolic BPV [0.42 mmHg (95% confidence interval: 0.05-0.80)], and greater 7-day systolic [0.76 mmHg (0.32-1.19)] and diastolic BPV [0.65 mmHg (0.29-1.01)], whereas prediabetes was associated with greater within-visit systolic BPV only [0.35 mmHg (0.06-0.65)], as compared with NGM. CONCLUSION Both T2DM and prediabetes are associated with slightly greater very short-term to mid-term BPV, which may, according to previous literature, explain a small part of the increased CVD risk seen in (pre)diabetes. Nevertheless, these findings do not detract from the fact that very short-term to mid-term BPV is substantial and important in individuals with and without (pre)diabetes.
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189
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Ye K, Fonkoue IT, Li Y, DaCosta DR, Shah A, Park J. Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease. Am J Med Sci 2019; 358:11-18. [PMID: 31084910 DOI: 10.1016/j.amjms.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/21/2019] [Accepted: 04/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND End stage renal disease (ESRD) is characterized by autonomic dysfunction. During orthostatic stress, sympathetic (SNS) activity increases and parasympathetic (PNS) activity decreases to maintain arterial blood pressure (BP). We hypothesized that ESRD patients have impaired ability to adjust cardiac SNS and PNS activity during orthostasis, which could contribute to increased blood pressure variability, orthostatic intolerance and falls. METHODS We measured beat-to-beat BP and Electrocardiography at baseline and during increasing lower body negative pressure (LBNP) in 20 ESRD patients and 18 matched controls (CON). Heart rate variability was quantified as total power (TP) and standard deviation of the N-N interval, reflecting both SNS and PNS; high frequency (HF), root mean square of successive differences of neighboring N-N intervals (RMSSD), and percent of consecutive N-N intervals differing >50 milliseconds (pNN50), reflecting cardiac PNS activity; and low frequency (LF) and LF/HF, reflecting sympoathovagal balance. BP variability was quantified as the standard deviation in systolic (SDSAP) and diastolic (SDDAP) BP. RESULTS Baseline HF, RMSSD, and pNN50 were significantly lower in ESRD (P < 0.05). While CON had a significant decrease in HF (P = 0.015), RMSSD (P = 0.003), and pNN50 (P = 0.005) during LBNP, there was no change in heart rate variability in ESRD. There was no significant difference in BP response, but ESRD had a significantly blunted heart rate response during graded LBNP compared to controls (P < 0.001). There was no significant difference in SDSAP or SDDAP during LBNP between groups (P > 0.05). CONCLUSIONS These data suggest that ESRD patients have impaired autonomic adjustments to orthostatic stress.
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Affiliation(s)
- Kara Ye
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia
| | - Ida T Fonkoue
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dana R DaCosta
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia
| | - Amit Shah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia.
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190
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Lattanzi S, Brigo F, Silvestrini M. Blood pressure and stroke: From incidence to outcome. J Clin Hypertens (Greenwich) 2019; 21:605-607. [PMID: 30957397 DOI: 10.1111/jch.13525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.,Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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191
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Viazzi F, Bonino B, Mirijello A, Fioretto P, Giorda C, Ceriello A, Guida P, Russo GT, De Cosmo S, Pontremoli R. Long-term blood pressure variability and development of chronic kidney disease in type 2 diabetes. J Hypertens 2019; 37:805-813. [PMID: 30817462 DOI: 10.1097/hjh.0000000000001950] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Long-term visit-to-visit SBP variability (VVV) has been shown to predict cerebro-cardiovascular events and end-stage renal disease in chronic kidney disease (CKD) patients. Whether SBP VVV is also a predictor of CKD development in diabetes is currently uncertain. We assessed the role of SBP VVV on the development of CKD in patients with type 2 diabetes (T2D) and hypertension in real life. METHODS Clinical records from 30 851 patients with T2D and hypertension, with normal estimated glomerular filtration rate (eGFR) and regular visits during a 4-year follow-up were analyzed. SBP variability was measured by three metrics: coefficient of variation; SD of the mean SBP and average absolute difference of successive values in each individual. CKD was defined as eGFR less than 60 and/or a reduction in eGFR at least 30% from baseline. RESULTS Over the 4-year follow-up, 9.7% developed eGFR less than 60 and 4.5% an eGFR reduction at least 30% from baseline. Several clinical characteristics (older age, male sex, SBP, DBP, albuminuria, glycated hemoglobin, insulin treatment) were related to intraindividual SBP variability. Patients with VVV in the upper quintile showed an increased risk of developing both components of CKD [adjusted odds ratio (OR) 1.21, P < 0.001 and 1.32, P < 0.001, respectively]. The multivariable adjusted ORs of SBP coefficient of variation quintiles 2-5 for the incidence of CKD were incrementally higher (OR 1.04, P = 0.601, OR 1.05, P = 0.520, OR 1.21, P < 0.017 and OR 1.42, P < 0.001 as compared with the first quintile). CONCLUSION Increased long-term BP variability predicts CKD in patients with T2D and hypertension.
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Affiliation(s)
| | - Barbara Bonino
- Università degli Studi and Policlinico San Martino-IST, Genova
| | - Antonio Mirijello
- Department of Medical Sciences, Scientific Institute 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia
| | | | - Carlo Giorda
- Diabetes and Metabolism Unit, ASL Turin 5, Chieri, Turin, Italy
| | - Antonio Ceriello
- Institud d'Investigations Biomediques August Pii Sunyer (IDIBAPS) and Cerntro de Incestigation Biomedicaen Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
- U.O. Diabetologia e Malattie Metaboliche, Multimedica IRCCS, Milano
| | - Pietro Guida
- Associazione Medici Diabetologi, Rome
- Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, Bari
| | - Giuseppina T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Salvatore De Cosmo
- Department of Medical Sciences, Scientific Institute 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia
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Reply. J Hypertens 2019; 37:861-862. [PMID: 30817470 DOI: 10.1097/hjh.0000000000002044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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193
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Robinson TG, Davison WJ, Rothwell PM, Potter JF. Randomised controlled trial of a Calcium Channel or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Regime to Reduce Blood Pressure Variability following Ischaemic Stroke (CAARBS): a protocol for a feasibility study. BMJ Open 2019; 9:e025301. [PMID: 30782930 PMCID: PMC6398677 DOI: 10.1136/bmjopen-2018-025301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Raised blood pressure (BP) is common after stroke and is associated with a poor prognosis, yet trials of BP lowering in the immediate poststroke period have not demonstrated a benefit. One possible explanation for this may be that BP variability (BPV) rather than absolute levels predicts outcome, as BPV is increased after stroke and is associated with poor outcomes. Furthermore, there is evidence of distinct antihypertensive class effects on BPV despite similar BP-lowering effects. However, whether BPV in the immediate poststroke period is a therapeutic target has not been prospectively investigated.The objectives of this trial are to assess the feasibility and safety of recruiting patients following an acute ischaemic stroke or transient ischaemic attack (TIA) to an interventional randomised controlled trial comparing the effects of two different antihypertensive drug classes on BPV. Secondary exploratory objectives are to assess if different therapeutic strategies have diverse effects on levels of BPV and if this has an impact on outcomes. METHODS 150 adult patients with first-ever ischaemic stroke or TIA who require antihypertensive therapy for secondary prevention will be recruited within 7 days of the event from stroke services across three sites. After baseline assessments they will be randomly assigned to treatment with a calcium channel blocker or ACE inhibitor/angiotensin receptor blocker-based regimen and followed up for a period of three months. ETHICS AND DISSEMINATION Ethical and regulatory approvals have been granted. Dissemination is planned via publication in peer-reviewed medical journals and presentation at relevant conferences. TRIAL REGISTRATION NUMBER ISRCTN10853487.
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Affiliation(s)
- Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - William J Davison
- Department of Ageing and Stroke Medicine, University of East Anglia, Norwich, UK
| | - Peter M Rothwell
- Nuffield Department of Neurosciences, University of Oxford, Oxford, UK
| | - John F Potter
- Department of Ageing and Stroke Medicine, University of East Anglia, Norwich, UK
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194
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Amari Y, Morimoto S, Iida T, Yurugi T, Oyama Y, Aoyama N, Nakajima F, Shimizu S, Ichihara A. Characteristics of visit-to-visit blood pressure variability in hemodialysis patients. Hypertens Res 2019; 42:1036-1048. [PMID: 30770904 DOI: 10.1038/s41440-019-0231-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/19/2019] [Accepted: 01/26/2019] [Indexed: 11/10/2022]
Abstract
Visit-to-visit blood pressure variability (VVBPV) is an independent risk factor for cardiovascular morbidity and mortality in the general population. Hemodialysis (HD) patients have a poor prognosis due to an increased prevalence of cardiovascular disease. Intradialytic hypotension is associated with excess mortality, but whether VVBPV influences mortality is still unclear in HD patients. The present study aimed to investigate the characteristics of VVBPV in these patients. A total of 324 maintenance HD patients, who could be followed for 60 months, were recruited. We used variation independent of the mean (VIM) in pre-dialysis systolic blood pressure (pre-VIM-SBP) as an index of VVBPV. We investigated (1) the reproducibility of pre-VIM-SBP, (2) the relationship between pre-VIM-SBP and background factors, and (3) the association between pre-VIM-SBP and mortality. Pre-VIM-SBP showed significant reproducibility [intraclass correlation, 0.45 (P < 0.001)]. Higher pre-VIM-SBP was associated with less physical activity and worse left ventricular diastolic function. Higher pre-VIM-SBP was associated with a higher rate of cardiovascular deaths independent of other factors. These data suggest that VVBPV in HD patients is reproducible and associated with various background factors. VVBPV is independently correlated with cardiovascular mortality (hazard ratio: 1.166, 95% confidence interval: 1.030-1.320, P = 0.015). Further studies are necessary to confirm the mechanism of increased VVBPV and to clarify whether reducing VVBPV will improve the prognosis for HD patients.
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Affiliation(s)
- Yoshifumi Amari
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Moriguchi Keijinkai Hospital, Osaka, Japan
| | - Satoshi Morimoto
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takeshi Iida
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Moriguchi Keijinkai Hospital, Osaka, Japan
| | - Takatomi Yurugi
- Department of Nephrology, Moriguchi Keijinkai Hospital, Osaka, Japan
| | - Yasuo Oyama
- Department of Nephrology and Dialysis, Neyagawa Keijinkai Clinic, Osaka, Japan
| | - Naoki Aoyama
- Department of Nephrology and Dialysis, Moriguchi Keijinkai Clinic, Osaka, Japan
| | - Fumitaka Nakajima
- Department of Nephrology and Dialysis, Kadoma Keijinkai Clinic, Osaka, Japan
| | - Satoru Shimizu
- Department of Medical Education, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
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195
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Joly JM, Pamboukian SV. Blood pressure in a mechanically assisted circulation: "Heat, spirit, perfection". J Heart Lung Transplant 2019; 38:406-407. [PMID: 30737006 DOI: 10.1016/j.healun.2019.01.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Joanna M Joly
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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196
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van Middelaar T, van Dalen JW, van Gool WA, van den Born BJH, van Vught LA, Moll van Charante EP, Richard E. Visit-To-Visit Blood Pressure Variability and the Risk of Dementia in Older People. J Alzheimers Dis 2019; 62:727-735. [PMID: 29480175 DOI: 10.3233/jad-170757] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND High visit-to-visit variability (VVV) in blood pressure (BP) is associated with cerebrovascular lesions on neuroimaging. OBJECTIVE Our primary objective was to investigate whether VVV is associated with incident all-cause dementia. As a secondary objective, we studied the association of VVV with cognitive decline and cardiovascular disease (CVD). METHODS We included community-dwelling people (age 70-78 year) from the 'Prevention of Dementia by Intensive Vascular Care' (preDIVA) trial with three to five 2-yearly BP measurements during 6-8 years follow-up. VVV was defined using coefficient of variation (CV; SD/mean×100). Cognitive decline was assessed using the Mini-Mental State Examination (MMSE). Incident CVD was defined as myocardial infarction or stroke. We used a Cox proportional hazard regression and mixed-effects model adjusted for sociodemographic factors and cardiovascular risk factors. RESULTS In 2,305 participants (aged 74.2±2.5), mean systolic BP over all available visits was 150.1 mmHg (SD 13.6), yielding a CV of 9.0. After 6.4 years (SD 0.8) follow-up, 110 (4.8%) participants developed dementia and 140 (6.1%) CVD. Higher VVV was not associated with increased risk of dementia (hazard ratio [HR] 1.00 per point CV increase; 95% confidence interval [CI] 0.96-1.05), although the highest quartile of VVV was associated with stronger decline in MMSE (β -0.09, 95% CI -0.17 to -0.01). Higher VVV was associated with incident CVD (HR 1.07; 95% CI 1.04-1.11). CONCLUSION In our study among older people, high VVV is not associated with incident all-cause dementia. It is associated with decline in MMSE and incident CVD.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Jan W van Dalen
- Department of Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | | | - Lonneke A van Vught
- Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
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197
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van Eeden WA, van Hemert AM, Carlier IVE, Penninx BW, Giltay EJ. Severity, course trajectory, and within-person variability of individual symptoms in patients with major depressive disorder. Acta Psychiatr Scand 2019; 139:194-205. [PMID: 30447008 PMCID: PMC6587785 DOI: 10.1111/acps.12987] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression shows a large heterogeneity of symptoms between and within persons over time. However, most outcome studies have assessed depression as a single underlying latent construct, using the sum score on psychometric scales as an indicator for severity. This study assesses longitudinal symptom-specific trajectories and within-person variability of major depressive disorder over a 9-year period. METHODS Data were derived from the Netherlands Study of Depression and Anxiety (NESDA). This study included 783 participants with a current major depressive disorder at baseline. The Inventory Depressive Symptomatology-Self-Report (IDS-SR) was used to analyze 28 depressive symptoms at up to six time points during the 9-year follow-up. RESULTS The highest baseline severity scores were found for the items regarding energy and mood states. The core symptoms depressed mood and anhedonia had the most favorable course, whereas sleeping problems and (psycho-)somatic symptoms were more persistent over 9-year follow-up. Within-person variability was highest for symptoms related to energy and lowest for suicidal ideation. CONCLUSIONS The severity, course, and within-person variability differed markedly between depressive symptoms. Our findings strengthen the idea that employing a symptom-focused approach in both clinical care and research is of value.
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Affiliation(s)
- W. A. van Eeden
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - A. M. van Hemert
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - I. V. E. Carlier
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - B. W. Penninx
- Department of PsychiatryAmsterdam Public Health Research Institute and Amsterdam NeuroscienceVU University Medical CenterGGZ inGeestAmsterdamThe Netherlands
| | - E. J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
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198
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Appleton JP, Woodhouse LJ, Bereczki D, Berge E, Christensen HK, Collins R, Gommans J, Ntaios G, Ozturk S, Szatmari S, Wardlaw JM, Sprigg N, Rothwell PM, Bath PM. Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke. Stroke 2019; 50:405-412. [PMID: 30626285 PMCID: PMC6358219 DOI: 10.1161/strokeaha.118.023190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/25/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Abstract
Background and Purpose- Increased blood pressure (BP), heart rate, and their derivatives (variability, pulse pressure, rate-pressure product) are associated with poor clinical outcome in acute stroke. We assessed the effects of glyceryl trinitrate (GTN) on hemodynamic parameters and these on outcome in participants in the ENOS trial (Efficacy of Nitric Oxide in Stroke). Methods- Four thousand and eleven patients with acute stroke and raised BP were randomized within 48 hours of onset to transdermal GTN or no GTN for 7 days. Peripheral hemodynamics were measured at baseline (3 measures) and daily (2 measures) during treatment. Between-visit BP variability over days 1 to 7 (as SD) was assessed in quintiles. Functional outcome was assessed as modified Rankin Scale and cognition as telephone mini-mental state examination at day 90. Analyses were adjusted for baseline prognostic variables. Data are mean difference or odds ratios with 95% CI. Results- Increased baseline BP (diastolic, variability), heart rate, and rate-pressure product were each associated with unfavorable functional outcome at day 90. Increased between-visit systolic BP variability was associated with an unfavourable shift in modified Rankin Scale (highest quintile adjusted odds ratio, 1.65; 95% CI, 1.37-1.99), worse cognitive scores (telephone mini-mental state examination: highest quintile adjusted mean difference, -2.03; 95% CI, -2.84 to -1.22), and increased odds of death at day 90 (highest quintile adjusted odds ratio, 1.57; 95% CI, 1.12-2.19). GTN lowered BP and rate-pressure product and increased heart rate at day 1 and reduced between-visit systolic BP variability. Conclusions- Increased between-visit BP variability was associated with poor functional and cognitive outcomes and increased death 90 days after acute stroke. In addition to lowering BP and rate-pressure product, GTN reduced between-visit systolic BP variability. Agents that lower BP variability in acute stroke require further study.
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Affiliation(s)
- Jason P Appleton
- From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.)
- Department of Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (J.P.A., N.S., P.M.B.)
| | - Lisa J Woodhouse
- From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.)
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary (D.B.)
| | - Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Norway (E.B.)
| | - Hanne K Christensen
- Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark (H.K.C.)
| | - Rónán Collins
- Stroke Services, Trinity College Dublin, Tallaght Hospital, Ireland (R.C.)
| | - John Gommans
- Department of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand (J.G.)
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece (G.N.)
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey (S.O.)
| | - Szabolcs Szatmari
- Department of Neurology, Clinical County Emergency Hospital, Targu Mures, Romania (S.S.)
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, (J.M.W.)
| | - Nikola Sprigg
- From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.)
- Department of Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (J.P.A., N.S., P.M.B.)
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (P.M.R.)
| | - Philip M Bath
- From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.)
- Department of Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (J.P.A., N.S., P.M.B.)
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199
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Loutradis C, Bikos A, Raptis V, Afkou Z, Tzanis G, Pyrgidis N, Panagoutsos S, Pasadakis P, Balaskas E, Zebekakis P, Liakopoulos V, Papagianni A, Parati G, Sarafidis P. Nebivolol reduces short-term blood pressure variability more potently than irbesartan in patients with intradialytic hypertension. Hypertens Res 2019; 42:1001-1010. [DOI: 10.1038/s41440-018-0194-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022]
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200
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Wang X, Shi N, Shi H, Ye H, Li N, Sun P, Bai D, Yuan H. Correlations of Acute Cerebral Hemorrhage Complicated with Stress Ulcer Bleeding with Acute Physiology and Chronic Health Evaluation (APACHE) II Score, Endothelin (ET), Tumor Necrosis Factor-alpha (TNF-α), and Blood Lipids. Med Sci Monit 2018; 24:9120-9126. [PMID: 30554231 PMCID: PMC6319162 DOI: 10.12659/msm.911915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study investigated the correlations between acute cerebral hemorrhage complicated with stress ulcer bleeding and corresponding indexes, including the Acute Physiology and Chronic Health Evaluation (APACHE) II score, vascular endothelin-1 (ET-1), tumor necrosis factor-alpha (TNF-α), and blood lipid factors. Material/Methods A total of 53 patients with acute cerebral hemorrhage complicated with stress ulcer bleeding were selected as the observation group and 50 patients with simple acute cerebral hemorrhage were selected as the control group. The APACHE II score and the levels of ET-1, TNF-α, and blood lipid factors, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and malondialdehyde (MDA), were detected and the correlations of were analyzed between the 2 groups of patients. Results The blood lipid index TG, APACHE II score, ET-1, TNF-α, renal function indexes [blood urea nitrogen (BUN) and creatinine (Cr)], mortality rate, hemoglobin, and MDA in the observation group were significantly higher than those in the control group, while HDL-C in the observation group was obviously lower than in the control group (p<0.05). The APACHEII score had positive correlations with TG and TNF-α (r=0.8960, r=0.8563, respectively), while it was negatively correlated with TC, HDL-C, LDL-C, and ET-1 (r=−0.909, r=−0.9292, r=−0.8543, and r=−0.8899, respectively) (p<0.001 in all comparisons). APACHEII score, BUN, and Cr were all risk factors. Conclusions Stress ulcer in patients with acute cerebral hemorrhage is associated with blood lipid changes and inflammation, which provides clues for the diagnosis and treatment of acute cerebral hemorrhage.
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Affiliation(s)
- Xiaohong Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Department of Gastroenterology, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Na Shi
- Department of Central Laboratory, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Huanling Shi
- Department of Endoscopy Center, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Hong Ye
- Department of Pathology, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Ning Li
- Department of Pathology, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Peng Sun
- Department of Pathology, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Dongfang Bai
- Department of Endocrinology, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
| | - Haipeng Yuan
- Department of Gastroenterology, Tai'an Central Hospital, Tai'an, Shandong, China (mainland)
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