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Molcan L. Short-term blood pressure variability and reduced cytosolic calcium levels. Hypertens Res 2024; 47:1425-1428. [PMID: 38467799 DOI: 10.1038/s41440-024-01640-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Lubos Molcan
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Ilkovicova 6, Bratislava, Slovakia.
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2
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Kim BS, Lee Y, Shin JH, Heo R, Kim HJ, Shin J. Blood pressure and variability responses to the down-titration of antihypertensive drugs. J Hypertens 2024; 42:809-815. [PMID: 38230618 DOI: 10.1097/hjh.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Several recent guidelines have proposed the gradual reduction of antihypertensive drugs for patients with well controlled blood pressure (BP). However, no studies have examined alterations in BP variability (BPV) during the down-titration of antihypertensives. This study aims to investigate changes in home BPV during the down-titration of antihypertensives. METHODS We analyzed 83 hypertensive patients who underwent down-titration of antihypertensives and had available home BP data during the down-titration. Down-titration was performed when home SBP was less than 120 mmHg, regardless of the clinic SBP. Primary exposure variable was the standard deviation (SD) of home BP. RESULTS Among 83 patients (mean age 66.3 ± 11.9 years; 45.8% men), down-titration led to increase home SBP (from 110.5 to 118.7 mmHg; P < 0.001), and home DBP (from 68.8 to 72.8 mmHg; P = 0.001) significantly. There were no significant differences in SDs of SBP [from 6.02 ± 3.79 to 5.76 ± 3.09 in morning, P = 0.570; from 6.13 ± 3.32 to 6.63 ± 3.70 in evening, P = 0.077; and from 6.54 (4.80, 8.31) to 6.37 (4.65, 8.76) in home SBP, P = 0.464] and SDs of DBP during the down-titration of antihypertensive drugs. CONCLUSION Down-titration of antihypertensive drugs did not have notable impact on clinic BP and home BPV, while significantly increasing home BP. These findings provide important insights indicating that the potential concern related to an increase in BPV in the planned strategy of reducing antihypertensive drugs is not substantial.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
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3
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Alshehri A, Ince J, Panerai RB, Divall P, Robinson TG, Minhas JS. Physiological Variability during Prehospital Stroke Care: Which Monitoring and Interventions Are Used? Healthcare (Basel) 2024; 12:835. [PMID: 38667597 PMCID: PMC11050416 DOI: 10.3390/healthcare12080835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Prehospital care is a fundamental component of stroke care that predominantly focuses on shortening the time between diagnosis and reaching definitive stroke management. With growing evidence of the physiological parameters affecting long-term patient outcomes, prehospital clinicians need to consider the balance between rapid transfer and increased physiological-parameter monitoring and intervention. This systematic review explores the existing literature on prehospital physiological monitoring and intervention to modify these parameters in stroke patients. The systematic review was registered on PROSPERO (CRD42022308991) and conducted across four databases with citation cascading. Based on the identified inclusion and exclusion criteria, 19 studies were retained for this review. The studies were classified into two themes: physiological-monitoring intervention and pharmacological-therapy intervention. A total of 14 included studies explored prehospital physiological monitoring. Elevated blood pressure was associated with increased hematoma volume in intracerebral hemorrhage and, in some reports, with increased rates of early neurological deterioration and prehospital neurological deterioration. A reduction in prehospital heart rate variability was associated with unfavorable clinical outcomes. Further, five of the included records investigated the delivery of pharmacological therapy in the prehospital environment for patients presenting with acute stroke. BP-lowering interventions were successfully demonstrated through three trials; however, evidence of their benefit to clinical outcomes is limited. Two studies investigating the use of oxygen and magnesium sulfate as neuroprotective agents did not demonstrate an improvement in patient's outcomes. This systematic review highlights the absence of continuous physiological parameter monitoring, investigates fundamental physiological parameters, and provides recommendations for future work, with the aim of improving stroke patient outcomes.
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Affiliation(s)
- Abdulaziz Alshehri
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- College of Applied Medical Sciences, University of Najran, Najran P.O. Box 1988, Saudi Arabia
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
| | - Ronney B. Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Pip Divall
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Thompson G. Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Jatinder S. Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
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4
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Dong L, Tian M, Li H, Dong J, Song X. Interdialytic home systolic blood pressure variability increases all-cause mortality in hemodialysis patients. Clin Cardiol 2024; 47:e24259. [PMID: 38549547 PMCID: PMC10979187 DOI: 10.1002/clc.24259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown. HYPOTHESIS We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD. METHODS A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan-Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis. RESULTS The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates. CONCLUSIONS The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.
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Affiliation(s)
- Liping Dong
- Department of NephrologyWuhan Fourth HospitalWuhanHubeiP.R. China
- Department of Clinical NutritionWuhan Fourth HospitalWuhanHubeiP.R. China
| | - Ming Tian
- Department of NephrologyWuhan Fourth HospitalWuhanHubeiP.R. China
| | - Hua Li
- Department of NephrologyWuhan Fourth HospitalWuhanHubeiP.R. China
| | - Junwu Dong
- Department of NephrologyWuhan Fourth HospitalWuhanHubeiP.R. China
| | - Xiaohong Song
- Department of NephrologyWuhan Fourth HospitalWuhanHubeiP.R. China
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Macdonald AS, McConnachie A, Dickie DA, Bath PM, Forbes K, Quinn T, Broomfield NM, Dani K, Doney A, Muir KW, Struthers A, Walters M, Barber M, Bhalla A, Cameron A, Guyler P, Hassan A, Kearney M, Keegan B, Lakshmanan S, Macleod MJ, Randall M, Shaw L, Subramanian G, Werring D, Dawson J. Allopurinol and blood pressure variability following ischemic stroke and transient ischemic attack: a secondary analysis of XILO-FIST. J Hum Hypertens 2024; 38:307-313. [PMID: 38438602 PMCID: PMC11001576 DOI: 10.1038/s41371-024-00906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18-2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31-2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.
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Affiliation(s)
- Alexander S Macdonald
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - David Alexander Dickie
- DD Analytics Cubed Ltd, 73 Union Street, Greenock, Scotland, PA16 8BG, UK
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kirsten Forbes
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Terence Quinn
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Krishna Dani
- Department of Neurology, Institute of Neurological Sciences Glasgow, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Alex Doney
- Medicine Monitoring Unit (MEMO), School of Medicine, University of Dundee. Ninewells Hospital, Dundee, DD1 9SY, UK
- Division of Imaging and Science Technology, School of Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Keith W Muir
- School of Psychology & Neuroscience, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Allan Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark Barber
- University Department of Stroke Care, University Hospital Monklands, Airdrie, ML6 OJS, UK
| | - Ajay Bhalla
- Department of Stroke, Ageing and Health, Guy's and St Thomas NHS Foundation Trust, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
| | - Alan Cameron
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Paul Guyler
- Department of Stroke Medicine, Mid and South Essex University Hospitals Group, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY, UK
| | - Ahamad Hassan
- Department of Neurology, Leeds General Infirmary, Leeds, UK
| | | | - Breffni Keegan
- Department of Medicine, Southwest Acute Hospital, Enniskillen, BT74 6DN, UK
| | - Sekaran Lakshmanan
- Department of Stroke Medicine, The Luton and Dunstable University Hospital, Bedfordshire, NHSFT, Lewsey Road, Luton, LU4 0DZ, UK
| | | | - Marc Randall
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Louise Shaw
- Department of Stroke Medicine, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Ganesh Subramanian
- Department of Stroke Medicine, Nottingham University Hospitals, Nottingham, NG5 1PB, UK
| | - David Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, University College Hospitals NHS Foundation Trust, London, UK
| | - Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.
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Bencivenga L, Strumia M, Rolland Y, Guyonnet S, Parini A, Cestac P, Andrieu S, Souto Barreto PD, Rouch L. Visit-to-visit blood pressure variability is associated with intrinsic capacity decline: Results from the MAPT Study. Eur J Intern Med 2024:S0953-6205(24)00097-9. [PMID: 38499456 DOI: 10.1016/j.ejim.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND The effectiveness of the body physiological regulatory mechanisms declines in late life, and increased Blood Pressure Variability (BPV) may represent an alteration in cardiovascular homeostatic patterns. Intrinsic Capacity (IC) has been proposed by the World Health Organization as a marker of healthy aging, based on individual's functional abilities and intended at preserving successful aging. We aimed to investigate the association of visit-to-visit BPV with IC decline in a population of community-dwelling older adults. METHODS The study population consisted of 1407 community-dwelling participants aged ≥70 years from the MAPT study evaluated during the 5-year follow-up. Systolic BPV (SBPV) and diastolic BPV (DBPV) were determined through six indicators. Cognition, psychology, locomotion and vitality constituted the four IC domains assessed. Total IC Z-score resulted from the sum of the four domains Z-scores divided by 4. The incidence of domain impairment over time was also assessed. RESULTS Higher SBPV was significantly associated with poorer IC Z-scores in all linear mixed models [1-SD increase of CV%: β(SE)=-0.010(0.001), p < 0.01]. Similar results were observed for DBPV [1-SD increase of CV%: β(SE)=-0.003(0.001), p = 0.02]. Incident IC impairment was significantly higher in participants with greater SBPV, [HR=1.16 (95 % CI, 1.01-1.33), p = 0.03], while greater DBPV did not show a higher risk of incident IC impairment. CONCLUSIONS Greater BPV is associated with IC decline over time. Our findings support BP instability as a presumable index of altered cardiovascular homeostatic mechanism, suggesting that BPV might be a clinical marker of aging and addressable risk factor for promoting healthy aging.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples Federico II, Napoli, Italy; Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.
| | - Mathilde Strumia
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, Toulouse, France; Department of Pharmacy, Toulouse University, Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Sophie Guyonnet
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Angelo Parini
- Institut Des Maladies Métaboliques Et Cardiovasculaires (I2MC), Toulouse, France
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University, Toulouse, France
| | - Sandrine Andrieu
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, Toulouse, France
| | - Laure Rouch
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, Toulouse, France; Department of Pharmacy, Toulouse University, Toulouse, France
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7
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Annaloro A, Invernizzi C, Aguilar F, Alvarez J, Cuspidi C, Grassi G, Lurbe E. Association Between Elevated Body Mass Index and Cardiac Organ Damage in Children and Adolescents: Evidence and Mechanisms. High Blood Press Cardiovasc Prev 2024; 31:167-175. [PMID: 38530573 PMCID: PMC11043137 DOI: 10.1007/s40292-024-00633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/03/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Although a number of pathophysiological aspects of childhood obesity have been reported, few information are available on obesity-related cardiac organ damage. AIM The present study was aimed at assessing the impact of anthropometric, blood pressure (BP) and metabolic variable on cardiac structure and function in youth. METHODS In 78 subjects aged 5-16 years attending the outpatient clinic of cardiovascular risk (Valencia, Spain) anthropometric and metabolic variables, clinic and ambulatory BP and echocardiographic parameters were assessed. Subjects were also classified according to the presence of insulin resistance. RESULTS Subjects mean age (± SD) amounted to 12.03 ± 2.4 years and males to 53.8%. Ten subjects were normoweight, 11 overweight, 39 obese, and 18 severely obese. No significant difference in office and ambulatory BP was detected among different bodyweight groups. A significant direct correlation was observed between left ventricular mass index (LVMI) and obesity markers [body mass index (BMI): r = 0.38, waist circumference (WC): r = 0.46, P < 0.04 for both]. Left ventricular hypertrophy, relative wall thickness and left atrial diameter were significantly related to BMI and WC. In contrast, office and ambulatory BP were unrelated to other variables, and differences in LVMI among different BP phenotypes were not significant. When partitioning the population by insulin resistance, LVMI, adjusted for confounders, was significantly greater in the insulin-resistant group. CONCLUSIONS In children and adolescents characterized by different body weight patterns, weight factors "per se" and the related insulin resistance state appear to represent the main determinants of LVMI and left ventricular hypertrophy, independently on BP values and BP phenotypes.
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Affiliation(s)
- Alessandra Annaloro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Chiara Invernizzi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francisco Aguilar
- Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Julio Alvarez
- Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Empar Lurbe
- Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
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8
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Pichot V, Corbier C, Chouchou F, Barthélémy JC, Roche F. CVRanalysis: a free software for analyzing cardiac, vascular and respiratory interactions. Front Physiol 2024; 14:1224440. [PMID: 38250656 PMCID: PMC10797906 DOI: 10.3389/fphys.2023.1224440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: Simultaneous beat-to-beat R-R intervals, blood pressure and respiration signals are routinely analyzed for the evaluation of autonomic cardiovascular and cardiorespiratory regulations for research or clinical purposes. The more recognized analyses are i) heart rate variability and cardiac coherence, which provides an evaluation of autonomic nervous system activity and more particularly parasympathetic and sympathetic autonomic arms; ii) blood pressure variability which is mainly linked to sympathetic modulation and myogenic vascular function; iii) baroreflex sensitivity; iv) time-frequency analyses to identify fast modifications of autonomic activity; and more recently, v) time and frequency domain Granger causality analyses were introduced for assessing bidirectional causal links between each considered signal, thus allowing the scrutiny of many physiological regulatory mechanisms. Methods: These analyses are commonly applied in various populations and conditions, including mortality and morbidity predictions, cardiac and respiratory rehabilitation, training and overtraining, diabetes, autonomic status of newborns, anesthesia, or neurophysiological studies. Results: We developed CVRanalysis, a free software to analyze cardiac, vascular and respiratory interactions, with a friendly graphical interface designed to meet laboratory requirements. The main strength of CVRanalysis resides in its wide scope of applications: recordings can arise from beat-to-beat preprocessed data (R-R, systolic, diastolic and mean blood pressure, respiration) or raw data (ECG, continuous blood pressure and respiratory waveforms). It has several tools for beat detection and correction, as well as setting of specific areas or events. In addition to the wide possibility of analyses cited above, the interface is also designed for easy study of large cohorts, including batch mode signal processing to avoid running repetitive operations. Results are displayed as figures or saved in text files that are easily employable in statistical softwares. Conclusion: CVRanalysis is freely available at this website: anslabtools.univ-st-etienne.fr. It has been developed using MATLAB® and works on Windows 64-bit operating systems. The software is a standalone application avoiding to have programming skills and to install MATLAB. The aims of this paper area are to describe the physiological, research and clinical contexts of CVRanalysis, to introduce the methodological approach of the different techniques used, and to show an overview of the software with the aid of screenshots.
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Affiliation(s)
- Vincent Pichot
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
| | - Christophe Corbier
- LASPI EA3059, Saint-Etienne Jean-Monnet University, Roanne Technology University Institute, Roanne, France
| | - Florian Chouchou
- IRISSE EA4075, UFR SHE, University of La Réunion, Le Tampon, France
| | - Jean-Claude Barthélémy
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Roche
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
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Starmans NLP, Kappelle LJ, Muller M, Staals J, Teunissen CE, Biessels GJ, van der Flier WM, Wolters FJ. Blood Pressure Variability and Plasma Biomarkers of Neuronal Injury and Alzheimer's Disease: A Clinic-Based Study of Patients with Diseases Along the Heart-Brain Axis. J Alzheimers Dis 2024; 99:1207-1215. [PMID: 38788076 DOI: 10.3233/jad-240119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Higher blood pressure variability (BPV) predisposes to cognitive decline. To investigate underlying mechanisms, we measured 24-h ambulatory BPV, nocturnal dipping and orthostatic hypotension in 518 participants with vascular cognitive impairment, carotid occlusive disease, heart failure, or reference participants. We determined cross-sectional associations between BPV indices and plasma biomarkers of neuronal injury (neurofilament light chain) and Alzheimer's disease (phosphorylated-tau-181 and Aβ42/Aβ40). None of the BPV indices were significantly associated with any of the biomarkers. Hence, in patients with diseases along the heart-brain axis, we found no evidence for an association between BPV and selected markers of neuronal injury or Alzheimer's disease.
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Affiliation(s)
| | - Laurens Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Charlotte Elisabeth Teunissen
- Department of Clinical Chemistry, Neurochemistry Laboratory, Amsterdam Neuroscience, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wiesje Maria van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
- Department of Epidemiology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Johannes Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine and Alzheimer Center, Erasmus University Medical Center, Rotterdam, The Netherlands
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Mizrak I, Lund MAV, Landgrebe AV, Asserhøj LL, Holstein-Rathlou NH, Greisen G, Clausen TD, Main KM, Vejlstrup NG, Jensen RB, Pinborg A, Madsen PL. Cardiovascular autonomic nervous function in children conceived by assisted reproductive technology with frozen or fresh embryo transfer. Am J Physiol Heart Circ Physiol 2024; 326:H216-H222. [PMID: 37999646 DOI: 10.1152/ajpheart.00680.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
As a result of epigenetic changes, children conceived by assisted reproduction may be at risk of premature cardiovascular aging with notably increased blood pressures. Their cardiovascular autonomic nervous function is unknown. Therefore, this study investigated the cardiovascular autonomic nervous function in 8-12-yr-old children (51% girls) conceived naturally (n = 33) or by assisted reproduction with frozen (n = 34) or fresh (n = 38) embryo transfer by evaluating heart rate variability, during rest; from provocation maneuvers; and from baroreflex function. Heart rate and blood pressure response to provocation maneuvers and baroreflex function were comparable between children conceived naturally or by assisted reproduction. The mean RR-interval and high-frequency component of heart rate variability were lower in children conceived by assisted reproduction than in children conceived naturally. Children conceived by fresh embryo transfer had ∼17% lower heart rate-corrected standard deviation of normal-to-normal R-R intervals; ∼22% lower heart rate-corrected square root of the mean of the squared difference between successive R-R intervals; and ∼37% higher low-frequency/high-frequency ratio than naturally conceived children. Children conceived by assisted reproduction still had lower heart rate variability and vagal modulation than naturally conceived children after adjustment for confounders. Thus, these results raise the possibility of sympathetic predominance in children conceived by assisted reproduction. Therefore, it is important to reproduce these results in larger and older cohorts as sympathetic predominance relates with cardiovascular and metabolic diseases.NEW & NOTEWORTHY We observed that children conceived by assisted reproductive technology (both frozen and fresh embryo transfer) had lowered heart rate variability during rest as compared with children conceived naturally. During physiological stress maneuvers, however, the cardiovascular autonomic nervous regulation was comparable between children conceived by assisted reproductive technologies and naturally. Our findings highlight the potential that lowered heart rate variability during rest in children conceived by assisted reproductive technologies may precede premature hypertension.
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Affiliation(s)
- Ikram Mizrak
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten A V Lund
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann V Landgrebe
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louise L Asserhøj
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels-Henrik Holstein-Rathlou
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, North Zealand Hospital, Copenhagen University Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels G Vejlstrup
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke B Jensen
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per L Madsen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Lucca MB, Jorge JA, Cichelero FT, Martinez D, Borges RB, Hirakata VN, Fuchs FD, Fuchs SC. Effects of chlorthalidone plus amiloride compared with amlodipine on short-term blood pressure variability in individuals with hypertension and obstructive sleep apnea: a randomized controlled trial. Blood Press Monit 2023; 28:289-294. [PMID: 37466401 PMCID: PMC10621641 DOI: 10.1097/mbp.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare the effects of chlortalidone plus amiloride and amlodipine on blood pressure (BP) variability in patients with hypertension and obstructive sleep apnea syndrome (OSA). METHODS A randomized, controlled, double-blind trial enrolled men and women aged 40 years or older with a diagnosis of OSA (apnea-hypopnea index 10-40 apneas/h of sleep) confirmed by overnight laboratory polysomnography and systolic BP 140-159 mmHg or diastolic BP 90-99 mmHg. Participants were randomized to receive chlortalidone 25 mg plus amiloride 5 mg daily or amlodipine 10 mg daily for 8 weeks. BP variability was calculated from 24-hour ambulatory BP monitoring at baseline and follow-up using the following indices: SD, coefficient of variation, average real variability (ARV), time-rate index, and variability independent of the mean (VIM). RESULTS The study included 65 patients, with 33 assigned to the chlortalidone plus amiloride group and 32 to the amlodipine group. Participants in both groups had similar baseline characteristics. Short-term BP variability decreased within groups for SD and ARV indexes for 24-hour systolic BP and daytime systolic BP, but statistically significant time*group interactions were found for sleep systolic SD and VIM, with greater reduction in patients treated with amlodipine. CONCLUSION In brief, our study has shown that the use of chlorthalidone in combination with amiloride and amlodipine produces comparable effects on short-term BP variability in patients with hypertension and OSA. Therefore, our findings suggest that BP variability may not be a significant factor when choosing between these medications for the treatment of hypertension and OSA.
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Affiliation(s)
- Marcelo B. Lucca
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
| | - Juliano A. Jorge
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
| | - Fabio T. Cichelero
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
| | - Denis Martinez
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
| | - Rogério B. Borges
- Research Board, Diretoria de Pesquisa, Hospital de Clínicas de Porto Alegre
| | - Vania N. Hirakata
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- Research Board, Diretoria de Pesquisa, Hospital de Clínicas de Porto Alegre
| | - Flavio D. Fuchs
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- PREVER National Institute of Science and Technology, Hospital de Clínicas de Porto Alegre
| | - Sandra C. Fuchs
- Postgraduate Program of Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- PREVER National Institute of Science and Technology, Hospital de Clínicas de Porto Alegre
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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12
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Abiri A, Chou EF, Shen W, Fisher MJ, Khine M. Changes in beat-to-beat blood pressure and pulse rate variability following stroke. Sci Rep 2023; 13:19245. [PMID: 37935766 PMCID: PMC10630489 DOI: 10.1038/s41598-023-45479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Associations between cerebrovascular disease and impaired autonomic function and cerebrovascular reactivity have led to increased interest in variability of heart rate (HRV) and blood pressure (BPV) following stroke. In this study, beat-to-beat pulse rate variability (PRV) and BPV were measured in clinically stable stroke patients (6 ischemic, 2 hemorrhagic) at least one year after their last cerebrovascular event. Beat-to-beat blood pressure (BP) measurements were collected from subjects while resting in the sitting position for one hour. Compared with healthy controls, stroke patients exhibited significantly greater time-domain (standard deviation, coefficient of variation, average real variability) and normalized high-frequency BPV (all p < 0.05). Stroke patients also exhibited lower LF:HF ratios than control subjects (p = 0.003). No significant differences were observed in PRV between the two groups, suggesting that BPV may be a more sensitive biomarker of cerebrovascular function in long-term post-stroke patients. Given a paucity of existing literature investigating beat-to-beat BPV in clinically stable post-stroke patients long (> 1 year) after their cerebrovascular events, this pilot study can help inform future studies investigating the mechanisms and effects of BPV in stroke. Elucidating this physiology may facilitate long-term patient monitoring and pharmacological management to mitigate the risk for recurrent stroke.
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Affiliation(s)
- Arash Abiri
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - En-Fan Chou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Weining Shen
- Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Mark J Fisher
- Department of Neurology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Michelle Khine
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
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13
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Sheikh AB, Sobotka PA, Garg I, Dunn JP, Minhas AMK, Shandhi MMH, Molinger J, McDonnell BJ, Fudim M. Blood Pressure Variability in Clinical Practice: Past, Present and the Future. J Am Heart Assoc 2023; 12:e029297. [PMID: 37119077 PMCID: PMC10227216 DOI: 10.1161/jaha.122.029297] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Recent advances in wearable technology through convenient and cuffless systems will enable continuous, noninvasive monitoring of blood pressure (BP), heart rate, and heart rhythm on both longitudinal 24-hour measurement scales and high-frequency beat-to-beat BP variability and synchronous heart rate variability and changes in underlying heart rhythm. Clinically, BP variability is classified into 4 main types on the basis of the duration of monitoring time: very-short-term (beat to beat), short-term (within 24 hours), medium-term (within days), and long-term (over months and years). BP variability is a strong risk factor for cardiovascular diseases, chronic kidney disease, cognitive decline, and mental illness. The diagnostic and therapeutic value of measuring and controlling BP variability may offer critical targets in addition to lowering mean BP in hypertensive populations.
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Affiliation(s)
- Abu Baker Sheikh
- Department of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | - Paul A. Sobotka
- Division of CardiologyDuke University Medical CenterDurhamNCUSA
| | - Ishan Garg
- Department of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | - Jessilyn P. Dunn
- Department of Biomedical EngineeringDuke UniversityDurhamNCUSA
- Department of Biostatistics & BioinformaticsDuke UniversityDurhamNCUSA
| | | | | | | | - Barry J. McDonnell
- Department of Biomedical ResearchCardiff Metropolitan UniversitySchool of Sport and Health SciencesCardiffUnited Kingdom
| | - Marat Fudim
- Division of CardiologyDuke University Medical CenterDurhamNCUSA
- Duke Clinical Research InstituteDurhamNCUSA
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14
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Parati G, Bilo G, Kollias A, Pengo M, Ochoa JE, Castiglioni P, Stergiou GS, Mancia G, Asayama K, Asmar R, Avolio A, Caiani EG, De La Sierra A, Dolan E, Grillo A, Guzik P, Hoshide S, Head GA, Imai Y, Juhanoja E, Kahan T, Kario K, Kotsis V, Kreutz R, Kyriakoulis KG, Li Y, Manios E, Mihailidou AS, Modesti PA, Omboni S, Palatini P, Persu A, Protogerou AD, Saladini F, Salvi P, Sarafidis P, Torlasco C, Veglio F, Vlachopoulos C, Zhang Y. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗. J Hypertens 2023; 41:527-544. [PMID: 36723481 DOI: 10.1097/hjh.0000000000003363] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment. The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Paolo Castiglioni
- IRCCS Fondazione Don Carlo Gnocchi, Milan
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Sciences, University of Leuven, and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Enrico G Caiani
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Italy
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Przemysław Guzik
- Department of Cardiology -Intensive Therapy, University School of Medicine in Poznan, Poznan, Poland
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Geoffrey A Head
- Baker Heart and Diabetes Institute, Melbourne Victoria Australia
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Eeva Juhanoja
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Turku
- Department of Oncology; Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Thomas Kahan
- Karolinska Institute, Department of Clinical Sciences, Division of Cardiovascular Medicine, Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | | | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension and Medical Genomics, National Research Centre for Translational Medicine
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital Athens, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paolo Palatini
- Department of Medicine. University of Padova, Padua, Italy
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Athanasios D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesca Saladini
- Department of Medicine. University of Padova, Padua, Italy
- Cardiology Unit, Cittadella Town Hospital, Padova, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Franco Veglio
- Internal Medicine Division and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1 Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Ahn S, Howie-Esquivel J, Davis EM, Chung ML, Lobo JM, Logan JG. Association of disrupted sleep with 24-hour blood pressure variability in caregivers. Heart Lung 2023; 60:45-51. [PMID: 36905754 DOI: 10.1016/j.hrtlng.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND A growing body of research highlights the negative impact of caregiving on cardiovascular disease (CVD) risk. OBJECTIVES This study aimed to examine associations of psychological symptoms and sleep quality with 24-hour blood pressure variability (BPV), which is an independent predictor of CVD, among family caregivers of community-dwelling individuals with chronic illness. METHODS For this cross-sectional study, we assessed caregiving burden and depressive symptoms using questionnaires and 7-day sleep quality (i.e., number of awakenings, wake after sleep onset, sleep efficiency) using an actigraph. The participants carried out a 24-hour ambulatory BP monitoring for systolic and diastolic BPV over 24 h and during awake/sleep times. We performed Pearson's correlations and multiple linear regression. RESULTS The analytic sample consisted of 30 caregivers (25 female; mean age 62 years). The number of awakenings during sleep was positively correlated with systolic BPV-awake (r = 0.426, p = 0.019) and diastolic BPV-awake (r = 0.422, p = 0.020). Sleep efficiency was negatively correlated with diastolic BPV-awake (r = -0.368, p = 0.045). Caregiving burden and depressive symptoms were not correlated with BPV. After controlling for age and mean arterial pressure, the number of awakenings was significantly associated with increased systolic BPV-24 h (β = 0.194, p = 0.018) and systolic BPV-awake (β = 0.280, p = 0.002), respectively. CONCLUSIONS Caregivers' disrupted sleep may play a role in increased CVD risk. While these findings should be confirmed in large clinical studies, improving sleep quality would need to be considered in CVD prevention for caregivers.
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Affiliation(s)
- Soojung Ahn
- School of Nursing, Vanderbilt University, Nashville, TN, USA.
| | | | - Eric M Davis
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jennifer M Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
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16
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Kartaler F, Şahin M, Turan OE, Kutlu M. The Relationship Between the Dipping Pattern and Coronary Artery Disease Severity Assessed by the SYNTAX Score in Patients With Hypertension. Cureus 2023; 15:e36057. [PMID: 37065383 PMCID: PMC10096864 DOI: 10.7759/cureus.36057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background The morbidity and mortality rates related to hypertension (HT) are still high despite the developments in this area. Nondipper hypertension (NDHT) is related to worse clinical outcomes. But the dipping pattern of HT is not still used for treatment targets. In this study, we investigated the effect of dipping patterns on coronary artery disease (CAD) complexity evaluated by the SYNTAX score (SS). Methodology Patients with stable CAD and HT were included in the study. All patients were monitored with 24-hour ambulatory monitoring, and dipping patterns were evaluated. Coronary artery complexity was determined by SS for all patients and compared along with different dipping patterns. Results A total of 331 patients with HT and stable CAD were evaluated in the study. The mean age of the patients was 62.6 ± 9.9 years, and 172 (52%) were male. The number and percentage of patients with dipper HT (DHT), NDHT, over-dipper HT (ODHT), and reverse-dipper HT (RDHT) were 89 (26%), 143 (43%), 11 (3%), and 88 (26%), respectively. When the groups were compared according to SS, the SS of the patients with RDHT were significantly higher (the SS were 6.33, 4.99, 3.09, and 2.7 for RDHT, ODHT, NDHT, and DHT, respectively, P = 0.003). The mean SS between the DHT group and the NDHT group (P = 0.03) and between the DHT group and the RDHT group (P = 0.01) was significantly different. The less decrease or increase in mean blood pressure (MnBP) values was significantly correlated with high SS. Conclusions NDHT, especially the reverse dipping pattern, is closely related to complex CAD. Meticulous consideration of dipping patterns can identify high-risk patients and improve clinical outcomes.
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Affiliation(s)
| | - Mürsel Şahin
- Cardiology, Medical School, Karadeniz Technical University, Trabzon, TUR
| | - Oğuzhan E Turan
- Cardiology, Medical School, Dokuz Eylül University, İzmir, TUR
| | - Merih Kutlu
- Cardiology, Medical School, Karadeniz Technical University, Trabzon, TUR
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17
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Starmans NL, Wolters FJ, Leeuwis AE, Bron EE, Brunner La Rocca HP, Staals J, Biessels GJ, Kappelle LJ. Twenty-four hour blood pressure variability and the prevalence and the progression of cerebral white matter hyperintensities. J Cereb Blood Flow Metab 2023; 43:801-811. [PMID: 36597406 PMCID: PMC10108197 DOI: 10.1177/0271678x221149937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Blood pressure variability (BPV) is related to cerebral white matter hyperintensities (WMH), but longitudinal studies assessing WMH progression are scarce. Patients with cardiovascular disease and control participants of the Heart-Brain Connection Study underwent 24-hour ambulatory blood pressure monitoring and repeated brain MRI at baseline and after 2 years. Using linear regression, we determined whether different measures of BPV (standard deviation, coefficient of variation, average real variability (ARV), variability independent of the mean) and nocturnal dipping were associated with WMH and whether this association was mediated or moderated by baseline cerebral perfusion. Among 177 participants (mean age: 65.9 ± 8.1 years, 33.9% female), the absence of diastolic nocturnal dipping was associated with higher WMH volume at baseline (β = 0.208, 95%CI: 0.025-0.392), but not with WMH progression among 91 participants with follow-up imaging. None of the BPV measures were associated with baseline WMH. Only 24-hour diastolic ARV was significantly associated with WMH progression (β = 0.144, 95%CI: 0.030-0.258), most profound in participants with low cerebral perfusion at baseline (p-interaction = 0.042). In conclusion, absent diastolic nocturnal dipping and 24-hour diastolic ARV were associated with higher WMH volume. Whilst requiring replication, these findings suggest that blood pressure patterns and variability may be a target for prevention of small vessel disease.
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Affiliation(s)
- Naomi Lp Starmans
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Annebet E Leeuwis
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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18
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Dai J, Wu HY, Jiang XD, Tang YJ, Tang HK, Meng L, Huang N, Gao JY, Li J, Baker JS, Zheng CJ, Yang YD. Association between napping and 24-hour blood pressure variability among university students: A pilot study. Front Pediatr 2023; 11:1062300. [PMID: 36937964 PMCID: PMC10018217 DOI: 10.3389/fped.2023.1062300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Background Blood pressure variability (BPV) has been reported to be a predictor of cardiovascular and some cognitive diseases. However, the association between napping and BPV remains unknown. This study aimed to explore the association between napping and BPV. Materials and methods A cross-sectional study including 105 university students was conducted. Participants' 24 h ambulatory blood pressure monitoring (24 h ABPM) were measured, and napping behaviors were investigated. BPV were measured by the 24 h ABPM, included standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Results Among the participants, 61.9% reported daytime napping. We found that nap duration was significantly associated with daytime CV of diastolic blood pressure (DBP) (r = 0.250, P = 0.010), nighttime CV of systolic blood pressure (SBP) (r = 0.217, P = 0.026), 24 h WCV of DBP (r = 0.238, P = 0.014), 24 h ARV of SBP (r = 0.246, P = 0.011) and 24 h ARV of DBP (r = 0.291, P = 0.003). Compared with the no napping group, 24 h WCV of DBP, daytime CV of DBP, and daytime SD of DBP were significantly higher in participants with napping duration >60 min. With multiple regression analysis we found that nap duration was an independent predictor for 24 h ARV of SBP (β = 0.859, 95% CI, 0.101-1.616, P = 0.027) and 24 h ARV of DBP (β = 0.674, 95% CI, 0.173-1.175, P = 0.009). Conclusions Napping durations are associated with BPV among university students. Especially those with napping durations >60 min had a significantly higher BPV than those non-nappers.
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Affiliation(s)
- Jie Dai
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Hua-ying Wu
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Xiao-dong Jiang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Yong-jie Tang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Hao-Kai Tang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Li Meng
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Na Huang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jing-yu Gao
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jian Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Chan-Juan Zheng
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
- Correspondence: Yi-De Yang Chan-Juan Zheng
| | - Yi-De Yang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
- Correspondence: Yi-De Yang Chan-Juan Zheng
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19
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Therapeutic target and clinical impact of day-to-day blood pressure variability in hypertensive patients with covid-19. Hypertens Res 2023; 46:165-174. [PMID: 36280737 PMCID: PMC9589643 DOI: 10.1038/s41440-022-01077-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
Blood pressure variability (BPV) is essential in hypertensive patients and is frequently associated with organ damage. As of today, hypertension is still the most common comorbidity in COVID-19, but the impact of BPV and the therapeutic target of BPV on outcomes in COVID-19 patients with hypertension remain unclear. Therefore, this study investigated the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppressing hypertensive covid-19 patient BPV. This cohort retrospective study enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the severity of COVID-19, the presence of hypertension, and their BPV status. During hospitalization, mean arterial pressure (MAP) was measured at 6 a.m. and 6 p.m., and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. In addition, we compared the hypertensive status, COVID-19 severity, in-hospital mortality, and antihypertensive agents between the BPV groups. The mean age was 53.85 ± 18.84 years old. Hypertension was significantly associated with high BPV with prevalence ratio (PR) = 1.38 (95% CI = 1.13-1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95% CI = 1.09-1.76; p = 0.005). In laboratory findings, high BPV group had lower Albumin, higher WBC, serum Cr, CRP, and creatinine to albumin ratio. High BPV status also significantly increased risk of mortality (HR = 2.30; 95% CI = 1.73-3.86; p < 0.001). Patients with a combination of severe COVID-19 status, hypertension, and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95% CI = 2.32-4.97; p < 0.001) compared to other combination status groups. In COVID-19 patients with hypertension, combination therapy with calcium channel blockers (CCB) as well as CCB monotherapy significantly develop low BPV (PR = 2.002; 95 CI% = 1.33-3.07; p = 0.004) and low mortality (HR = 0.17; 95% CI = 0.05-0.56; p = 0.004). Hypertensive status and severe COVID-19 were significantly associated with high BPV, and these factors increased in-hospital mortality. CCBs might be antihypertensive agents that potentially effectively suppressing BPV and mortality in COVID-19 patients.
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20
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He GY, Li YH, Wei JJ, Xiao JD, Chen Y, Fan BL, Zhong WZ. Effect of perioperative blood pressure variability on cerebral hyperperfusion syndrome after carotid artery stenting: A retrospective study. Interv Neuroradiol 2022; 28:702-707. [PMID: 34967242 PMCID: PMC9706275 DOI: 10.1177/15910199211065198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effect of perioperative blood pressure variability on cerebral hyperperfusion syndrome after carotid artery stenting. METHODS A retrospective analysis was conducted of data collected from 418 patients who underwent carotid artery stenting in Guangxi Zhuang Autonomous Region People's Hospital in China. The blood pressure data were collected during operation (after balloon dilation, before stent release, after stent release) and within 3 days after the operation. The blood pressure variability was evaluated by measuring the mean, maximum, minimum, max-min, standard deviation (SD) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). The correlation between blood pressure variability and cerebral hyperperfusion syndrome was analysed. RESULTS Blood pressure data from 418 patients were analysed. Twenty patients (4.8%) developed cerebral hyperperfusion syndrome. The parameters of blood pressure variability were divided into four groups according to quartile. After adjusting for age, symptomatic carotid stenosis, unilateral carotid stenosis, bilateral carotid stenosis, collateral circulation, diabetes mellitus and chronic kidney disease, multivariate analysis showed that SBPMax, SBPMin, SBPMax-Min, SBPCV, DBPSD, DBPMax, DBPMin, DBPMax-Min and DBPCV were associated with the occurrence of cerebral hyperperfusion syndrome (P < 0.05), respectively. CONCLUSION This study suggests that blood pressure variability during the perioperative period may increase the risk of cerebral hyperperfusion syndrome.
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Affiliation(s)
- Guo-yong He
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
| | - Yan-hua Li
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
| | - Jun-jie Wei
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
| | - Ji-dong Xiao
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
| | - Yuan Chen
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
| | - Bing-lin Fan
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
| | - Wei-zhang Zhong
- Department of Neurology, the People’s Hospital of Guangxi Zhuang
Autonomous region, China
- Guangxi Academy of Medical Sciences, China
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21
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Gmitrov J. Carotid Baroreceptor Magnetic Activation and Beat‐to‐Beat Blood Pressure Variability, Implications to Treat Abrupt Blood Pressure Elevation in Labile Hypertension. Bioelectromagnetics 2022; 43:413-425. [DOI: 10.1002/bem.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/20/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Juraj Gmitrov
- Diabetology Clinic Krompachy Hospital, Agel SK Inc. Krompachy Slovakia
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22
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Long-term variability and change trend of systolic blood pressure and risk of type 2 diabetes mellitus in middle-aged Japanese individuals: findings of the Aichi Workers' Cohort Study. Hypertens Res 2022; 45:1772-1780. [PMID: 35982266 DOI: 10.1038/s41440-022-00993-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
Studies have reported that short-term blood pressure (BP) variability (BPV) is associated with type 2 diabetes mellitus (T2DM) incidence, but the association with long-term BPV remains unclear. The present study investigated the associations of long-term BPV as well as the time trend of BP changes over time with the incidence of T2DM. This study followed a cohort of 3017 Japanese individuals (2446 male, 571 female) aged 36-65 years from 2007 through March 31, 2019. The root-mean-square error (RMSE) and the slope of systolic BP (SBP) change regressed on year were calculated individually using SBP values obtained from 2003 to baseline (2007). A multivariable Cox proportional hazard model was applied to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for tertiles of SBP RMSE and continuous SBP slopes adjusted for age, sex, smoking status, regular exercise, sodium intake, family history of diabetes, sleep disorder, body mass index (BMI), SBP, and fasting blood glucose (FBG) at baseline, and BMI slope from 2003 to 2007. The highest RMSE tertile compared to the lowest was associated with a significantly higher incidence of T2DM after adjusting for covariates (HR: 1.79, 95% CI: 1.15, 2.78). The slope was also significantly associated with T2DM incidence until baseline SBP and FBG were adjusted (HR: 1.03, 95% CI: 0.99, 1.07). In conclusion, long-term SBP variability was significantly associated with an increased incidence of T2DM independent of baseline age, sex, BMI, SBP, FBG, lifestyle factors and BMI slope from 2003 until baseline.
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23
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Bencivenga L, De Souto Barreto P, Rolland Y, Hanon O, Vidal JS, Cestac P, Vellas B, Rouch L. Blood pressure variability: a potential marker of aging. Ageing Res Rev 2022; 80:101677. [PMID: 35738476 DOI: 10.1016/j.arr.2022.101677] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
Aging is characterized by alterations in neuro-cardiovascular regulatory mechanisms, leading to impaired physiological variability patterns. Repeated evidence has shown that increased Blood Pressure Variability (BPV) is associated with organ damage and exerts independent predictive value on several health outcomes: cardiovascular events, neurocognitive impairment, metabolic disorders and typical geriatric syndromes such as sarcopenia and frailty. Accordingly, it may constitute the epiphenomenon of the alterations in homeostatic mechanisms, typical of late life. Aging and altered BPV share the same molecular mechanisms, in particular the clinical state of subclinical inflammation has been widely ascertained in advanced age and it is also related to BP dysregulation through altered endothelial function and increased production of ROS. Arterial stiffness and autonomic dysfunction have been associated to impairment in BPV and also represent key features in elderly patients. Furthermore, accumulating evidence in the field of Geroscience has reported that several molecular changes described in cardiovascular aging and altered BPV also relate with the majority of the 9 identified hallmarks of aging. Indeed, BPV may be linked to genomic instability, epigenetic modification and mitochondrial oxidative damage, which represent milestones of aging process. The aim of the present paper is to analyse the interplay between BPV and the pathophysiology of the ageing process, in order to stimulate discussion about the potential role of BPV as a new marker of aging.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II"; Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, France
| | - Olivier Hanon
- EA4468 Université de Paris, France; Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France
| | - Jean-Sébastien Vidal
- EA4468 Université de Paris, France; Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France
| | - Philippe Cestac
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, France
| | - Laure Rouch
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; UMR INSERM 1295, Université Toulouse III, France
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24
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Domingues LB, Carpes LDO, Fuchs SC, Ferrari R. Effects of a single beach tennis session on short-term blood pressure variability in individuals with hypertension: a randomized crossover trial. Blood Press Monit 2022; 27:185-191. [PMID: 35258025 DOI: 10.1097/mbp.0000000000000586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the importance of blood pressure (BP) variability to estimate cardiovascular risk in patients with hypertension, not all exercise modalities can reduce short-term BP variability, and no studies have measured the acute effects of recreational sports on short-term BP variability. We investigated the acute effects of a single beach tennis (BT) session on short-term BP variability in individuals with hypertension. Twenty-two participants took part in this randomized clinical trial. They were randomly allocated to a BT session and a nonexercise control session (Con). BT and Con sessions lasted 45 min. Office BP and heart rate were measured throughout the experimental sessions to calculate rate-pressure products and estimate the cardiovascular demand of BT. To determine short-term BP variability after BT and Con sessions, average real variability (ARV) of systolic BP and diastolic BP was assessed over 24 h using ambulatory BP monitoring. Compared with Con, there were lower 24-h (Δ, -0.9 ± 0.4 mmHg; P = 0.049) and daytime (Δ, -1.4 ± 0.5 mmHg; P = 0.004) ARV of diastolic BP after BT. There were no significant differences in ARV of systolic BP between Con and BT. There was a higher rate-pressure product found during BT (P < 0.001). However, after the experimental sessions, there was no significant difference between BT and Con for the rate-pressure product under ambulatory conditions. In conclusion, a single BT session reduced daytime and 24-h diastolic BP variability in adults with hypertension. Trial registration: ClinicalTrials.gov, NCT03909308.
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Affiliation(s)
- Lucas Betti Domingues
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre
| | - Leandro de Oliveira Carpes
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre
| | - Sandra Costa Fuchs
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre
| | - Rodrigo Ferrari
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul
- Sports and Exercise Training Study Group, Clinical Research Center, Hospital de Clínicas de Porto Alegre
- Postgraduate Program in Human Movement Sciences, School of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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25
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Zhu W, Xu L, Chen X, Lee YJ, Zhang Z, Lou Q. Effects of different blood pressures and their long-term variability on the development of diabetic kidney disease in patients with type 2 diabetes mellitus. Clin Exp Hypertens 2022; 44:464-469. [PMID: 35531897 DOI: 10.1080/10641963.2022.2071917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Weiyan Zhu
- Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ZJ, China
| | - Lichen Xu
- Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ZJ, China
| | - Xue Chen
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, JS, China
| | - Yau-Jiunn Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Zongjun Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Department of Radiology, Nanjing, JS, China
| | - Qingqing Lou
- eDepartment of Endocrinology,The First Affiliated Hospital of Hainan Medical University, HI, China
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26
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Yoo JE, Yoon JW, Park HE, Han K, Shin DW. Blood Pressure Variability and the Risk of Fracture: A Nationwide Cohort Study. J Clin Endocrinol Metab 2022; 107:e1488-e1500. [PMID: 34850029 DOI: 10.1210/clinem/dgab856] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Although blood pressure variability (BPV) is associated with various health outcomes, only 1 study suggested that BPV is correlated with hip fractures. As cardiovascular disease and fractures share similar pathophysiology, there might be a link between BPV and fractures. OBJECTIVE To investigate the association between BPV and the incident fractures. DESIGN Retrospective cohort study. SETTING Population-based, using the Korean National Health Insurance System database. PATIENTS OR OTHER PARTICIPANTS A total of 3 256 070 participants aged ≥50 who participated in ≥3 health examinations within the previous 5 years, including the index year (2009-2010), were included. Outcome data were obtained through the end of 2016. EXPOSURE BPV was calculated using variability independent of the mean. High variability was defined as the highest quartile of variability. MAIN OUTCOME MEASURES Newly diagnosed fractures. RESULTS During the median follow-up of 7.0 years, there were 337 045 cases of any fracture (10.4%). After adjusting for age, sex, income, lifestyle factors, and comorbidities, a higher risk of fracture was observed with higher quartiles of BPV than the lowest quartile group: the adjusted hazard ratios (95% CIs) for incident any fracture were 1.07 (1.06-1.08) in the higher quartile of systolic BPV, 1.06 (1.05-1.07) in that of diastolic BPV, and 1.07 (1.06-1.08) in that of both systolic and diastolic BPV. Consistent results were noted for vertebral fractures and hip fractures, as well as in various subgroup analyses. CONCLUSIONS A positive association was noted between higher BPV and fracture incidence. BPV is an independent predictor for developing fracture.
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Affiliation(s)
- Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Won Yoon
- Division of Endocrinology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Wook Shin
- Supportive Care Center/ Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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27
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Xu F, Zhang L, Huang T, Yang R, Han D, Zheng S, Feng A, Huang L, Yin H, Lyu J. Influence of ambulatory blood pressure-related indicators within 24 h on in-hospital death in sepsis patients. Int J Med Sci 2022; 19:460-471. [PMID: 35370467 PMCID: PMC8964320 DOI: 10.7150/ijms.67967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/23/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Sepsis is a serious public health problem worldwide. Blood pressure is one of the indicators that is closely monitored in intensive-care units, and it reflects complex interactions between the internal cardiovascular control mechanism and the external environment. We aimed to determine the impact of indicators related to the ambulatory blood pressure on the prognosis of sepsis patients. Methods: This retrospective study was based on the Medical Information Mart for Intensive Care IV database. Relevant information about sepsis patients was extracted according to specific inclusion and exclusion criteria. Examined parameters included the average blood pressure, blood pressure variability (BPV), and circadian rhythm, and the study outcome was in-hospital death. We investigated the effects of these indicators on the risk of in-hospital death among sepsis patients using Cox proportional-hazards models, restricted cubic splines analysis, and subgroup analysis. Results: This study enrolled 10,316 sepsis patients, among whom 2,117 died during hospitalization. All parameters except the nighttime variation coefficient of the diastolic blood pressure (DBP) were associated with in-hospital death of sepsis patients. All parameters except for fluctuations in DBP exhibited nonlinear correlations with the outcome. The subgroup analysis revealed that some of the examined parameters were associated with in-hospital death only in certain subgroups. Conclusion: Indicators related to the ambulatory blood pressure within 24 h are related to the prognosis of sepsis patients. When treating sepsis, in addition to blood pressure, attention should also be paid to BPV and the circadian rhythm in order to improve the prognosis and the survival rate.
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Affiliation(s)
- Fengshuo Xu
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Luming Zhang
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Rui Yang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Didi Han
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Liying Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Haiyan Yin
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
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28
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Boubouchairopoulou N, Ntineri A, Kollias A, Destounis A, Stergiou GS. Blood pressure variability assessed by office, home, and ambulatory measurements: comparison, agreement, and determinants. Hypertens Res 2021; 44:1617-1624. [PMID: 34599293 DOI: 10.1038/s41440-021-00736-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/15/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
The present study compared the blood pressure variability (BPV) among office (OBP), home (HBP), and ambulatory blood pressure (ABP) measurements and assessed their determinants, as well as their agreement in identifying individuals with high BPV. Individuals attending a hypertension clinic had OBP measurements (2-3 visits) and underwent HBP monitoring (3-7 days, duplicate morning and evening measurements) and ABP monitoring (24 h, 20-min intervals). BPV was quantified using the standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM) using all BP readings obtained by each method. A total of 626 participants were analyzed (age 52.8 ± 12.0 years, 57.7% males, 33.1% treated). Systolic BPV was usually higher than diastolic BPV, and out-of-office BPV was higher than office BPV, with ambulatory BPV giving the highest values. BPV was higher in women than men, yet it was not different between untreated and treated individuals. Associations among BPV indices assessed using different measurement methods were weak (r 0.1-0.3) but were stronger between out-of-office BPV indices. The agreement between methods in detecting individuals with high BPV was low (30-40%) but was higher between out-of-office BPV indices. Older age was an independent determinant of increased OBP variability. Older age, female sex, smoking, and overweight/obesity were determinants of increased out-of-office BPV. These data suggest that BPV differs with different BP measurement methods, reflecting different pathophysiological phenomena, whereas the selection of the BPV index is less important. Office and out-of-office BP measurements appear to be complementary methods in assessing BPV.
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Affiliation(s)
- Nadia Boubouchairopoulou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Antonios Destounis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
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Tadic M, Cuspidi C, Suzic-Lazic J, Vukomanovic V, Mihajlovic S, Savic P, Blagojevic N, Grassi G, Celic V. Blood-pressure variability is associated with left-ventricular mechanics in patients with gestational hypertension and preeclampsia. Hypertens Res 2021; 44:1625-1632. [PMID: 34599294 DOI: 10.1038/s41440-021-00768-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/07/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
We aimed to investigate short- and long-term blood-pressure (BP) variability and left-ventricular (LV) structure, function, and mechanics in women with gestational hypertension and preeclampsia, as well as the relationship between BP variability and LV mechanics. This cross-sectional study included 140 pregnant women (45 normotensive controls, 50 patients with gestational hypertension and, 45 patients with preeclampsia) after 20 weeks of gestation. All participants underwent 24-h ambulatory BP monitoring and echocardiographic examination, as well as regular clinical BP measurements during each visit. Our results show that 24-h, daytime and nighttime systolic and diastolic BP, as well as visit-to-visit systolic and diastolic BPs, gradually increased from controls across patients with preeclampsia to those with gestational hypertension. Similar changes were observed for 24-h systolic BP-variability indices. LV longitudinal and circumferential strains gradually decreased from controls across women with gestational hypertension to patients with preeclampsia. Radial strain was significantly lower in women with preeclampsia than in controls. Indices of short- and long-term BP variability were independent of BP and demographic and echocardiographic parameters associated with LV longitudinal and circumferential strain. In conclusion, LV mechanics are impaired in women with gestational hypertension and preeclampsia compared with LV mechanics in normotensive controls. Short- and long-term BP variability was higher in patients with hypertensive disorders and was significantly associated with longitudinal and circumferential strains.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Internal Medicine, Cardiology Department, Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit Viale della Resistenza 23, 20036, Meda, Italy
| | - Jelena Suzic-Lazic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Internal Medicine, Cardiology Department, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vladan Vukomanovic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Internal Medicine, Cardiology Department, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Sladjana Mihajlovic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Gynecology, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Predrag Savic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Internal Medicine, Cardiology Department, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Nikola Blagojevic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Internal Medicine, Cardiology Department, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Vera Celic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Clinic for Internal Medicine, Cardiology Department, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
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de Oliveira Carpes L, Domingues LB, Schimitt R, Fuchs SC, Alhalimi T, Tanaka H, Ferrari R. Sex Differences in Post-exercise Hypotension, Ambulatory Blood Pressure Variability, and Endothelial Function After a Power Training Session in Older Adults. Front Physiol 2021; 12:657373. [PMID: 34335289 PMCID: PMC8322608 DOI: 10.3389/fphys.2021.657373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/11/2021] [Indexed: 01/04/2023] Open
Abstract
Background: The efficacy of power training (PT) to acutely reduce blood pressure (BP) in participants with hypertension is controversial, and no studies have assessed the influence of sex on post-exercise hypotension and its mechanisms in older adults. Purpose: The aims of this secondary, exploratory analysis were to compare the effects of a single bout of PT on post-exercise hypotension, BP variability, and endothelial function between older men and women with hypertension. Methods: Twenty-four participants with hypertension (12 men and 12 women aged to >60 years old) took part in this crossover study and randomly performed two experimental sessions: power exercise training (PT) and non-exercising control session (Con). The PT protocol was composed of 3 sets of 8–10 repetitions of five exercises performed in the following order: leg press, bench press, knee extension, upright row, and knee flexion, using an intensity corresponding to 50% of one repetition maximal test (1RM) and 2-min intervals between sets and exercises. The concentric phase of exercises during each repetition was performed “as fast as possible,” while the eccentric phase lasted 1 to 2 s. During Con, the participants remained at seated rest on the same exercise machines, but without any exercise. Each protocol lasted 40 min. Office BP, flow-mediated dilatation (FMD), 24-h ambulatory BP, and the average real variability (ARV) of systolic and diastolic BP were assessed before and after experimental sessions. Results: Comparing PT with Con, a reduced office BP after exercise was found in men (systolic BP—average post 1 h: −14 mmHg, p < 0.001; diastolic BP—average post 1 h: −8 mmHg, p < 0.001) and only a reduced systolic BP in women (average post 1 h: −7 mmHg, p = 0.04). Comparing men and women, a reduced systolic BP (post 60': −15 mmHg, p = 0.048; average post 1 h: −7 mmHg, p = 0.046) and diastolic BP (post 60': −9 mmHg, p = 0.049) after the first hour were found in men. In relation to 24-h ambulatory BP, ARV, and FMD, no statistically significant differences were found between men and women. Conclusion: In older adults with hypertension, the office BP response after the experimental sessions was different in men and women, showing that the PT protocol is more effective to acutely reduce BP in men. Additionally, the mechanisms behind this reduction remain unclear. This finding suggests that sex cannot be combined to analyze post-exercise hypotension. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03615625.
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Affiliation(s)
- Leandro de Oliveira Carpes
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas Betti Domingues
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Renato Schimitt
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra C Fuchs
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Taha Alhalimi
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Rodrigo Ferrari
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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The Association of Morning Surge and Night-Time Dipping Blood Pressure with Significant and Complex Coronary Artery Lesions. High Blood Press Cardiovasc Prev 2021; 28:467-474. [PMID: 34057691 DOI: 10.1007/s40292-021-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Hypertension responsible for more than 10 million deaths annually worldwide and abnormal diurnal blood pressure (BP) variation is associated with cardiovascular events. AIM This study aimed to investigate the association between the 24-h ambulatory night BP dipping and morning BP surge (MS) with characteristic of coronary artery lesions that may contribute cardiovascular events and mortality burden. METHODS A cross sectional study over 1-year, collected 263 cases of hypertensive (80%) and non-hypertensive patients, aged 61 ± 10 years, who undergoing invasive coronary angiography (CAG) and 24-h ambulatory BP monitoring admitted to cardiology department complain of chest pain. The night-time/day-time dip and sleep-trough MS were calculated. Non-dipper status was considered when night-time/day-time dip < 10%, and significant coronary lesion (SCL) when ≥ 50 % stenosis in 1.5 mm vessels. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score was used to quantify the complexity of SCL. RESULT The mean morning systolic BP (SBP) surge was higher in the high SYNTAX Score subgroup than low and intermediate subgroups (25 ± 11 vs 17 ± 13 and 10 ± 10 mmHg, p < 0.010). Non-dipper SBP status was more frequently in patients with SCL than non-SCL (p < 0.019). In ordinal regression, hypertension was independent predictor of SCL (odd ratio: 0.40, p < 0.003), the night-time/day-time BP dip was independent predictor of being in a higher SYNTAX score subgroup (systolic odd ratio: 0.88, diastolic odd ratio: 1.14 p < 0.05). CONCLUSION Hypertension is associated with SCL and the night-time/day-time BP dip as a continuous variable is associated with complex coronary lesion. Non-dipping as categorical variable and morning BP surge were not independent predictors of significant or complex coronary lesions.
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See CY, Tseng CT, Lin WR, Chao JY, Kuo TH, Wang MC. Seasonal Change in Home Blood Pressure Monitoring Is Associated With Renal Outcome and Mortality in Patients With Chronic Kidney Disease. Front Med (Lausanne) 2021; 8:672651. [PMID: 34124101 PMCID: PMC8192714 DOI: 10.3389/fmed.2021.672651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/20/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Blood pressure (BP) variation may result in poor cardiovascular and renal outcomes. We investigated the pattern of seasonal BP change and its association with outcomes in patients with chronic kidney disease (CKD) living in southern Taiwan. Methods: We conducted a retrospective analysis of a prospective observational cohort consisting of outpatients with CKD for the period between December 2014 and December 2019. These patients were grouped according to the pattern of seasonal BP variation, namely, consistently higher average systolic BP (≥8 mmHg) in wintertime than summertime (Group A), consistently lower average systolic BP (≥8 mmHg) in wintertime than summertime (Group B), large variation of average systolic BP (≥8 mmHg) without a specific pattern related to weather (Group C), and little fluctuation of average systolic BP (<8 mmHg) throughout the years (Group D). The study endpoints were ≥40% reduction in estimated glomerular filtration rate (eGFR), end stage renal disease (initiation of dialysis or transplantation), or death. Results: We analyzed 507 eligible patients, of whom 17.2% exhibited consistent BP elevation in the wintertime. There were 56.8% of patients conducting regular home BP monitoring. Cox regression analysis showed home BP monitoring was independently associated with better outcome in 507 CKD patients (HR 0.72, 95% CI 0.56–0.94, P = 0.0162). Compared with the other three groups, patients with BP elevation in the wintertime (Group A) were older, had a higher prevalence of diabetic nephropathy and nephrotoxic agent use, a lower prevalence of statin use, higher eGFR decline rate, and a worse outcome. Patients with BP reduction in the wintertime (Group B) were associated with the best outcome. Cox regression analysis indicated that consistent BP elevation in the wintertime in 288 CKD patients with home BP monitoring was significantly associated with a worse composite outcome (i.e., ≥40% reduction in eGFR, end stage renal disease, or death) after adjustment for various confounding factors. Conclusion: Home BP monitoring is crucial, and associated with better outcome in CKD patients. Consistent home BP elevation from summertime to wintertime in patients with CKD was associated with a poorer composite outcome.
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Affiliation(s)
- Chun Yin See
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Tzu Tseng
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Lin
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jo-Yen Chao
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Te-Hui Kuo
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Noriega de la Colina A, Badji A, Robitaille-Grou MC, Gagnon C, Boshkovski T, Lamarre-Cliche M, Joubert S, Gauthier CJ, Bherer L, Cohen-Adad J, Girouard H. Associations Between Relative Morning Blood Pressure, Cerebral Blood Flow, and Memory in Older Adults Treated and Controlled for Hypertension. Hypertension 2021; 77:1703-1713. [PMID: 33775122 DOI: 10.1161/hypertensionaha.120.16124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Adrián Noriega de la Colina
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.).,Department of Biomedical Sciences, Faculty of Medicine (A.N.C.), Université de Montreal, QC, Canada.,Montreal Heart Institute (MHI), Montreal, QC, Canada (A.N.C., C.G., C.J.G., L.B.).,Groupe de Recherche sur le Système Nerveux Central (GRSNC) (A.N.C., A.B., J.C.-A., H.G.).,Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA) (A.N.C., A.B., H.G.)
| | - Atef Badji
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.).,Department of Neurosciences, Faculty of Medicine (A.B.), Université de Montreal, QC, Canada.,NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montréal, QC, Canada (A.B., T.B., J.C.-A.).,Groupe de Recherche sur le Système Nerveux Central (GRSNC) (A.N.C., A.B., J.C.-A., H.G.).,Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA) (A.N.C., A.B., H.G.)
| | - Marie-Christine Robitaille-Grou
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.)
| | - Christine Gagnon
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.).,Montreal Heart Institute (MHI), Montreal, QC, Canada (A.N.C., C.G., C.J.G., L.B.)
| | - Tommy Boshkovski
- NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montréal, QC, Canada (A.B., T.B., J.C.-A.)
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montreal (IRCM) (M.L.-C.), Université de Montreal, QC, Canada
| | - Sven Joubert
- Department of Psychology, Faculty of Arts and Sciences (S.J.), Université de Montreal, QC, Canada
| | - Claudine J Gauthier
- Department of Physics (C.J.G.), Concordia University, Montreal, QC, Canada.,PERFORM Centre (C.J.G.), Concordia University, Montreal, QC, Canada
| | - Louis Bherer
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.).,Department of Medicine, Faculty of Medicine (L.B.), Université de Montreal, QC, Canada.,Montreal Heart Institute (MHI), Montreal, QC, Canada (A.N.C., C.G., C.J.G., L.B.)
| | - Julien Cohen-Adad
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.).,NeuroPoly Laboratory, Institute of Biomedical Engineering, Polytechnique Montréal, QC, Canada (A.B., T.B., J.C.-A.).,Groupe de Recherche sur le Système Nerveux Central (GRSNC) (A.N.C., A.B., J.C.-A., H.G.)
| | - Hélène Girouard
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada (A.N.C. A.B., M.-C.R.-G., C.G., L.B., J.C.-A., H.G.).,Department of Pharmacology and Physiology, Faculty of Medicine (H.G.), Université de Montreal, QC, Canada.,Groupe de Recherche sur le Système Nerveux Central (GRSNC) (A.N.C., A.B., J.C.-A., H.G.).,Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA) (A.N.C., A.B., H.G.)
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Caminiti G, Iellamo F, Mancuso A, Cerrito A, Montano M, Manzi V, Volterrani M. Effects of 12 weeks of aerobic versus combined aerobic plus resistance exercise training on short-term blood pressure variability in patients with hypertension. J Appl Physiol (1985) 2021; 130:1085-1092. [PMID: 33630677 DOI: 10.1152/japplphysiol.00910.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Short-term blood pressure (BP) variability (BPV), measured by 24-h ambulatory BP monitoring (ABPM), has been independently related to a higher risk of cardiovascular events and target organ in hypertensive patients. The aim of this study was to compare the effects of two different exercise modalities on BPV in hypertensive patients enrolled in a cardiac rehabilitation program. This study is a randomized trial, with two intervention arms: 1) aerobic training (AT) and 2) combined aerobic and resistance training (CT). We studied 55 male patients with hypertension. They were randomly assigned either to AT or CT group. The training program lasted 12 wk for each group. Short-term BP variability was evaluated by means of average real variability (ARV), at baseline and after 12 wk, by ABPM. Systolic and diastolic 24-h BP values decreased significantly (P < 0.01) in both groups, without between-groups differences (P = 0.11). The 24-h systolic BP variability decreased in both groups (AT: from 8.4 ± 1.2 to 7.6 ± 0.8; CT: from 8.8 ± 1.5 to 7.1 ± 1.1), with a greater decrease in CT (P = 0.02). Night-time systolic BPV decreased in CT (from 9.4 ± 1.3 to 8.3 ± 1.2, P = 0.03) and remained unchanged in AT (from 9.5 ± 1.2 to 9.4 ± 1.4). Day-time BPV decreased in both groups without between-groups differences (P = 0.07). CT was more effective than AT in reducing short-term BPV in hypertensive patients, and both exercise modalities reduced BP to a same extent. CT appears to be a more appropriate exercise modality if the objective is to reduce BPV in addition to BP levels.NEW & NOTEWORTHY Combined exercise training (CT) including aerobic plus resistance exercises could be more effective in comparison with aerobic exercise (AT) alone in reducing blood pressure variability (BPV) in hypertensive patients. We report that CT was indeed more effective than AT in reducing short-term BPV, and both exercise modalities reduced BP levels to the same extent. CT appears to be a more appropriate exercise modality if the objective is to reduce BPV in addition to BP levels.
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Affiliation(s)
| | - Ferdinando Iellamo
- Department of Cardiology, IRCCS San Raffaele, Rome, Italy.,Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università Tor Vergata, Rome, Italy
| | | | - Anna Cerrito
- Department of Cardiology, IRCCS San Raffaele, Rome, Italy
| | - Matteo Montano
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università Tor Vergata, Rome, Italy
| | - Vincenzo Manzi
- Department of Cardiology, IRCCS San Raffaele, Rome, Italy
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Cuspidi C, Carugo S, Tadic M. Blood pressure variability and target organ damage regression in hypertension. J Clin Hypertens (Greenwich) 2021; 23:1159-1161. [PMID: 33543570 PMCID: PMC8678798 DOI: 10.1111/jch.14208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/03/2022]
Abstract
The study by Triantafyllidi et al. supports the view that regression of subclinical cardiac damage requires an effective 24‐hour blood pressure (BP) control along with a reduction in BP variability and suggests that the assessment of BPV and its modifications during the course of therapy may be an useful approach in predicting the beneficial effects of treatment on cardiac structure. However, some aspects and limitations of this study require caution in drawing firm conclusions. So, further investigation is needed to determine if reduction of BPV is actually associated with a regression in cardiac and extracardiac organ damage to identify which which classes of antihypertensive drugs are most effective in reducing BPV, and to elucidate whether those treatments provide additional clinical benefit, independent of the conventional BP targets.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano, Milano, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione IRCCS Policlinico di Milano, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
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Liu X, Logan J, Kwon Y, Lobo JM, Kang H, Sohn M. Visit-to-visit blood pressure variability and sleep architecture. J Clin Hypertens (Greenwich) 2021; 23:323-330. [PMID: 33492762 PMCID: PMC8030048 DOI: 10.1111/jch.14162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 01/01/2023]
Abstract
Visit-to-visit blood pressure (BP) variability (BPV) is an independent risk factor of cardiovascular disease (CVD). Sleep architecture characterizes the distribution of different stages of sleep and may be important in CVD development. We examined the association between visit-to-visit BPV and sleep architecture using in-lab polysomnographic data from 3,565 patients referred to an academic sleep center. BPV was calculated using the intra-individual coefficient of variation of BP measures collected 12 months before the sleep study. We conducted multiple linear regression analyses to assess the association of systolic and diastolic BPV with sleep architecture-rapid eye movement (REM) and non-rapid eye movement (NREM) sleep duration. Our results show that systolic BPV was inversely associated with REM sleep duration (p = .058). When patients were divided into tertile groups based on their BPV, those in the third tertile (highest variability) spent 2.7 fewer minutes in REM sleep than those in the first tertile (lowest variability, p = .032), after adjusting for covariates. We did not find an association of systolic BPV with other measures of sleep architecture. Diastolic BPV was not associated with sleep architecture either. In summary, our study showed that greater systolic BPV was associated with lower REM sleep duration. Future investigation is warranted to clarify the directionality, mechanism, and therapeutic implications.
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Affiliation(s)
- Xiaoyue Liu
- School of NursingUniversity of VirginiaCharlottesvilleVAUSA
| | - Jeongok Logan
- School of NursingUniversity of VirginiaCharlottesvilleVAUSA
| | | | | | - Hyojung Kang
- College of Applied Health SciencesUniversity of Illinois at Urbana‐ChampaignUrbanaILUSA
| | - Min‐Woong Sohn
- College of Public HealthUniversity of KentuckyLexingtonKYUSA
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Zevallos CB, Dai B, Dandapat S, Quispe-Orozco D, Holcombe A, Ansari S, Farooqui M, Derdeyn CP, Samaniego EA, Ortega-Gutierrez S. Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures. J Neurol Sci 2020; 420:117209. [PMID: 33187680 DOI: 10.1016/j.jns.2020.117209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contrast-induced neurotoxicity (CIN) is a rare complication of neurointerventional procedures and its understanding remains limited. We evaluated the association of CIN with systemic hemodynamics in patients undergoing neuroendovascular interventions. METHODS We conducted a 1:2 matched case-control study from a prospectively collected database of 2510 neurointerventional patients. We defined CIN as new neurological deficits presented ≤24 h post-operation after excluding other possible etiologies. We obtained demographic, clinical and imaging data, and baseline and intraprocedural blood pressures (BP) from medical records. The area between baseline and intraprocedural BP was used to measure sustained variability of BP over time. A generalized linear mixed model and generalized estimating equation were used to analyze the BP difference between groups over time. RESULTS We evaluated 11 CIN cases and 22 controls. 2746 and 5837 min of continued BP data were analyzed for cases and controls, respectively. CIN cases had higher measurements and greater variability for: Systolic BP (SBP) [median 125 (IQR:121-147) vs. 114 (IQR:107-124) mmHg], median area above baseline [median 350 (IQR:25-1328) vs. 52 (IQR:0-293) mmHg*minutes] and mean arterial pressure (MAP) [median 85 (IQR:79-98) vs. 80 (IQR:74-89) mmHg]. CIN cases demonstrated a significant mean increase in SBP and MAP of 23.41 mmHg (p < 0.01) and 13.79 mmHg (p < 0.01) when compared to controls, respectively, over the perioperative time. CONCLUSION Sustained hypertension and high BP variability may contribute to the pathophysiology of CIN. Acute hypertension can increase blood-brain barrier permeability and potentially allow contrast to leak into the brain parenchyma causing direct toxicity and CIN symptoms.
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Affiliation(s)
- Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Biyue Dai
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrea Holcombe
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sameer Ansari
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Abderhalden LA, Meyer S, Dawson-Hughes B, Orav EJ, Meyer U, de Godoi Rezende Costa Molino C, Theiler R, Stähelin HB, Ruschitzka F, Egli A, Forman JP, Willett WC, Bischoff-Ferrari HA. Effect of daily 2000 IU versus 800 IU vitamin D on blood pressure among adults age 60 years and older: a randomized clinical trial. Am J Clin Nutr 2020; 112:527-537. [PMID: 32542307 DOI: 10.1093/ajcn/nqaa145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Observational studies report higher blood pressure (BP) among individuals with lower 25-hydroxyvitamin D concentration. Whether dosage of vitamin D supplementation has a differential effect on BP control remains unclear. OBJECTIVE The study aimed to determine if daily vitamin D supplementation with 2000 IU is more effective than 800 IU for BP control among older adults. METHODS This randomized, double-blind, ancillary trial of the Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis enrolled adults aged ≥60 y who underwent elective surgery due to severe knee osteoarthritis. Participants were randomly assigned to receive high dose (2000 IU) or standard dose (800 IU) daily vitamin D3 for 24 mo. Outcomes included daytime and 24-h mean systolic BP. BP variability and serum 25-hydroxyvitamin D concentration were examined in a post hoc and observational analysis. RESULTS Of the 273 participants randomly assigned, 250 participants completed a follow-up 24-h ambulatory BP monitoring (mean age: 70.4 ± 6.4 y; 47.2% men). The difference in daytime mean systolic BP reduction between the 2000 IU (n = 123) and 800 IU (n = 127) groups was not statistically significant (-2.75 mm Hg vs. -3.94 mm Hg; difference: 1.18 mm Hg; 95% CI: -0.68, 3.05; P = 0.21), consistent with 24-h mean systolic BP. However, systolic BP variability was significantly reduced with 2000 IU (average real variability: -0.37 mm Hg) compared to 800 IU vitamin D3 (0.11 mm Hg; difference: -0.48 mm Hg; 95% CI: -0.94, -0.01; P = 0.045). Independent of group allocation, maximal reductions in mean BP were observed at 28.7 ng/mL of achieved serum 25-hydroxyvitamin D concentrations. CONCLUSIONS While daily 2000 IU and 800 IU vitamin D3 reduced mean systolic BP over 2 y to a small and similar extent, 2000 IU reduced mean systolic BP variability significantly more compared with 800 IU. However, without a placebo control group we cannot ascertain whether vitamin D supplementation effectively reduces BP.This trial was registered at www.clinicaltrials.gov as NCT00599807.
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Affiliation(s)
- Lauren A Abderhalden
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | - Sandra Meyer
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - E John Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Ursina Meyer
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | - Caroline de Godoi Rezende Costa Molino
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | - Robert Theiler
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | | | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Egli
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | - John P Forman
- Department of Nephrology, Brigham and Women's Hospital, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
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Kubota K, Yamaga E, Ueda K, Inokoshi M, Minakuchi S. Comparison of cardiovascular response between patients on warfarin and hypertensive patients not on warfarin during dental extraction. Clin Oral Investig 2020; 25:2141-2150. [PMID: 32808177 DOI: 10.1007/s00784-020-03526-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate cardiovascular response in patients on warfarin and hypertensive patients not on warfarin during dental extraction. MATERIALS AND METHODS This retrospective study included 53 patients who had undergone dental extraction while on warfarin (mean age 78.8 ± 6.3 years, 26 men) and 66 with hypertension who had undergone dental extraction but were not on warfarin (mean age 77.4 ± 6.8 years, 22 men). Vital signs were monitored in both groups during extraction. RESULTS The highest systolic blood pressure (SBP) values (mean 150.1 ± 21.1 mmHg) were observed in patients on warfarin before (9.0%) and after (10.3%) administration of local anesthesia (LA), during extraction (39.7%), and during (33.3%) and after (7.7%) suturing (n = 78; p < 0.01), and in hypertensive patients not receiving warfarin (160.6 ± 24.8 mmHg) before (19.2%) and after (27.3%) administration of LA, during extraction (29.3%), and during (18.2%) and after (6.1%) suturing (n = 99; p < 0.01). The highest SBP was linearly correlated with SBP before administration of LA in patients on warfarin (highest SBP = 0.9415 × SBP before LA + 23.243, R2 = 0.75481) and in hypertensive patients not on warfarin (highest SBP = 1.0027 × SBP before LA + 15.789, R2 = 0.60341). CONCLUSIONS The highest SBP was not distributed evenly between patients on warfarin and hypertensive patients not on warfarin during dental extraction and was strongly associated with SBP before LA regardless of anticoagulant status. CLINICAL RELEVANCE Thorough management of SBP is required in patients on warfarin to avoid thromboembolism and major hemorrhagic complications. Knowing the SBP value before dental treatment would help predict the risk of cardiovascular complications.
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Affiliation(s)
- Kazumasa Kubota
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Eijiro Yamaga
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Kaori Ueda
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Masanao Inokoshi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Chong RS, Chee ML, Tham YC, Majithia S, Thakur S, Teo ZL, Da Soh Z, Chua J, Tan B, Wong DWK, Schmetterer L, Sabanayagam C, Cheng CY. Association of Antihypertensive Medication with Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness. Ophthalmology 2020; 128:393-400. [PMID: 32739337 DOI: 10.1016/j.ophtha.2020.07.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To evaluate the association between different classes of antihypertensive medication with retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness in a nonglaucomatous multiethnic Asian population. DESIGN Population-based, cross-sectional study. PARTICIPANTS A total of 9144 eyes for RNFL analysis (2668 Malays, 3554 Indians, and 2922 Chinese) and 8549 eyes for GC-IPL analysis (2460 Malays, 3230 Indians, and 2859 Chinese) aged 44 to 86 years. METHODS Participants underwent standardized systemic and ocular examinations and interviewer-administered questionnaires for collection of data on medication and other variables. Intraocular pressure (IOP) readings were obtained by Goldmann applanation tonometry before pupil dilation for fundoscopy and OCT imaging. Blood pressure (BP) was measured with an automatic BP monitor. Mean arterial pressure (MAP) was defined as diastolic BP plus 1/3 (systolic BP - diastolic BP). Regression models were used to investigate the association of antihypertensive medication with OCT measurements of RNFL and GC-IPL. MAIN OUTCOME MEASURES Average and sectoral RNFL and GC-IPL thickness. RESULTS After adjusting for age, gender, ethnicity, MAP, IOP, body mass index (BMI), and presence of diabetes, we found that participants taking any type of antihypertensive medication (β = -0.83; 95% confidence interval [CI], -1.46 to -0.02; P = 0.01), specifically angiotensin-converting enzyme inhibitors (ACEIs) (β = -1.66; 95% CI, -2.57 to -0.75; P < 0.001) or diuretics (β = -1.38; 95% CI, -2.59 to -0.17; P < 0.05), had thinner average RNFL in comparison with participants who were not receiving antihypertensive treatment. Use of a greater number of antihypertensive medications was significantly associated with thinner average RNFL (P for trend = 0.001). This association was most evident in the inferior RNFL quadrant in participants using ACEIs (β = -2.44; 95% CI, -3.99 to -0.89; P = 0.002) or diuretics (β = -2.76; 95% CI, -4.76 to -0.76; P = 0.007). A similar trend was noted in our analysis of macular GC-IPL thickness. CONCLUSIONS Use of 2 or more antihypertensive medications, ACEI, and diuretics were associated with a loss of structural markers of retinal ganglion cell health in a multiethnic Asian population.
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Affiliation(s)
- Rachel S Chong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Miao-Li Chee
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Yih-Chung Tham
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Shivani Majithia
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Sahil Thakur
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Zhen Ling Teo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Zhi Da Soh
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Jacqueline Chua
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; NTU Institute of Health Technologies, Singapore
| | - Damon W K Wong
- Singapore Eye Research Institute, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; NTU Institute of Health Technologies, Singapore
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; NTU Institute of Health Technologies, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Charumathi Sabanayagam
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore.
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