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Faraci FM, Scheer FA. Hypertension: Causes and Consequences of Circadian Rhythms in Blood Pressure. Circ Res 2024; 134:810-832. [PMID: 38484034 PMCID: PMC10947115 DOI: 10.1161/circresaha.124.323515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Hypertension is extremely common, affecting approximately 1 in every 2 adults globally. Chronic hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. Despite considerable efforts to define mechanisms that underlie hypertension, a potentially major component of the disease, the role of circadian biology has been relatively overlooked in both preclinical models and humans. Although the presence of daily and circadian patterns has been observed from the level of the genome to the whole organism, the functional and structural impact of biological rhythms, including mechanisms such as circadian misalignment, remains relatively poorly defined. Here, we review the impact of daily rhythms and circadian systems in regulating blood pressure and the onset, progression, and consequences of hypertension. There is an emphasis on the impact of circadian biology in relation to vascular disease and end-organ effects that, individually or in combination, contribute to complex phenotypes such as cognitive decline and the loss of cardiac and brain health. Despite effective treatment options for some individuals, control of blood pressure remains inadequate in a substantial portion of the hypertensive population. Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.
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Affiliation(s)
- Frank M. Faraci
- Department of Internal Medicine, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
- Department of Neuroscience and Pharmacology, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
| | - Frank A.J.L. Scheer
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, 02115
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, 02115
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2
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Kim HJ, Jo SH. Nighttime administration of antihypertensive medication: a review of chronotherapy in hypertension. Korean J Intern Med 2024; 39:205-214. [PMID: 37967524 PMCID: PMC10918378 DOI: 10.3904/kjim.2023.304] [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: 07/19/2023] [Revised: 08/14/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023] Open
Abstract
Hypertension remains a global health concern because of suboptimal blood pressure control despite advancements in antihypertensive treatments. Chronotherapy, defined as evening or bedtime administration of medication based on biological rhythms, is emerging as a potential strategy to improve blood pressure control and treatment outcomes. Clinical trials have investigated the potential effects of nighttime administration of antihypertensive medication in the improvement of 24 hours blood pressure control and reduction of cardiovascular risk. Implementing chronotherapy in clinical practice could have significant implications in enhancing blood pressure control and improving clinical outcomes in patients with hypertension, particularly those with resistant hypertension. However, recent trials have reported contradictory results, causing confusion in real-world practice. Herein we review, analyze, and critique the current evidence and propose suggestions regarding the clinical application and future directions of chronotherapy.
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Affiliation(s)
- Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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3
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Wu C, Zhao P, Xu P, Wan C, Singh S, Varthya SB, Luo SH. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev 2024; 2:CD004184. [PMID: 38353289 PMCID: PMC10865448 DOI: 10.1002/14651858.cd004184.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Variation in blood pressure levels display circadian rhythms. Complete 24-hour blood pressure control is the primary goal of antihypertensive treatment and reducing adverse cardiovascular outcomes is the ultimate aim. This is an update of the review first published in 2011. OBJECTIVES To evaluate the effectiveness of administration-time-related effects of once-daily evening versus conventional morning dosing antihypertensive drug therapy regimens on all-cause mortality, cardiovascular mortality and morbidity, total adverse events, withdrawals from treatment due to adverse effects, and reduction of systolic and diastolic blood pressure in people with primary hypertension. SEARCH METHODS We searched the Cochrane Hypertension Specialised Register via Cochrane Register of Studies (17 June 2022), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2022); MEDLINE, MEDLINE In-Process and MEDLINE Epub Ahead of Print (1 June 2022); Embase (1 June 2022); ClinicalTrials.gov (2 June 2022); Chinese Biomedical Literature Database (CBLD) (1978 to 2009); Chinese VIP (2009 to 7 August 2022); Chinese WANFANG DATA (2009 to 4 August 2022); China Academic Journal Network Publishing Database (CAJD) (2009 to 6 August 2022); Epistemonikos (3 September 2022) and the reference lists of relevant articles. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the administration-time-related effects of evening with morning dosing monotherapy regimens in people with primary hypertension. We excluded people with known secondary hypertension, shift workers or people with white coat hypertension. DATA COLLECTION AND ANALYSIS Two to four review authors independently extracted data and assessed trial quality. We resolved disagreements by discussion or with another review author. We performed data synthesis and analyses using Review Manager Web for all-cause mortality, cardiovascular mortality and morbidity, serious adverse events, overall adverse events, withdrawals due to adverse events, change in 24-hour blood pressure and change in morning blood pressure. We assessed the certainty of the evidence using GRADE. We conducted random-effects meta-analysis, fixed-effect meta-analysis, subgroup analysis and sensitivity analysis. MAIN RESULTS We included 27 RCTs in this updated review, of which two RCTs were excluded from the meta-analyses for lack of data and number of groups not reported. The quantitative analysis included 25 RCTs with 3016 participants with primary hypertension. RCTs used angiotensin-converting enzyme inhibitors (six trials), calcium channel blockers (nine trials), angiotensin II receptor blockers (seven trials), diuretics (two trials), α-blockers (one trial), and β-blockers (one trial). Fifteen trials were parallel designed, and 10 trials were cross-over designed. Most participants were white, and only two RCTs were conducted in Asia (China) and one in Africa (South Africa). All trials excluded people with risk factors of myocardial infarction and strokes. Most trials had high risk or unclear risk of bias in at least two of several key criteria, which was most prominent in allocation concealment (selection bias) and selective reporting (reporting bias). Meta-analysis showed significant heterogeneity across trials. No RCTs reported on cardiovascular mortality and cardiovascular morbidity. There may be little to no differences in all-cause mortality (after 26 weeks of active treatment: RR 0.49, 95% CI 0.04 to 5.42; RD 0, 95% CI -0.01 to 0.01; very low-certainty evidence), serious adverse events (after 8 to 26 weeks of active treatment: RR 1.17, 95% CI 0.53 to 2.57; RD 0, 95% CI -0.02 to 0.03; very low-certainty evidence), overall adverse events (after 6 to 26 weeks of active treatment: RR 0.89, 95% CI 0.67 to 1.20; I² = 37%; RD -0.02, 95% CI -0.07 to 0.02; I² = 38%; very low-certainty evidence) and withdrawals due to adverse events (after 6 to 26 weeks active treatment: RR 0.76, 95% CI 0.47 to 1.23; I² = 0%; RD -0.01, 95% CI -0.03 to 0; I² = 0%; very low-certainty evidence), but the evidence was very uncertain. AUTHORS' CONCLUSIONS Due to the very limited data and the defects of the trials' designs, this systematic review did not find adequate evidence to determine which time dosing drug therapy regimen has more beneficial effects on cardiovascular outcomes or adverse events. We have very little confidence in the evidence showing that evening dosing of antihypertensive drugs is no more or less effective than morning administration to lower 24-hour blood pressure. The conclusions should not be assumed to apply to people receiving multiple antihypertensive drug regimens.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhao
- Medical Library, Sichuan University, Chengdu, China
| | - Ping Xu
- Medical Library, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Surjit Singh
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shuang-Hong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Garcia-Molina G. Feasibility of Unobtrusively Estimating Blood Pressure Using Load Cells under the Legs of a Bed. SENSORS (BASEL, SWITZERLAND) 2023; 24:96. [PMID: 38202958 PMCID: PMC10780971 DOI: 10.3390/s24010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
The ability to monitor blood pressure unobtrusively and continuously, even during sleep, may promote the prevention of cardiovascular diseases, enable the early detection of cardiovascular risk, and facilitate the timely administration of treatment. Publicly available data from forty participants containing synchronously recorded signals from four force sensors (load cells located under each leg of a bed) and continuous blood pressure waveforms were leveraged in this research. The focus of this study was on using a deep neural network with load-cell data as input composed of three recurrent layers to reconstruct blood pressure (BP) waveforms. Systolic (SBP) and diastolic (DBP) blood pressure values were estimated from the reconstructed BP waveform. The dataset was partitioned into training, validation, and testing sets, such that the data from a given participant were only used in a single set. The BP waveform reconstruction performance resulted in an R2 of 0.61 and a mean absolute error < 0.1 mmHg. The estimation of the mean SBP and DBP values was characterized by Bland-Altman-derived limits of agreement in intervals of [-11.99 to 15.52 mmHg] and [-7.95 to +3.46 mmHg], respectively. These results may enable the detection of abnormally large or small variations in blood pressure, which indicate cardiovascular health degradation. The apparent contrast between the small reconstruction error and the limit-of-agreement width owes to the fact that reconstruction errors manifest more prominently at the maxima and minima, which are relevant for SBP and DBP estimation. While the focus here was on SBD and DBP estimation, reconstructing the entire BP waveform enables the calculation of additional hemodynamic parameters.
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Affiliation(s)
- Gary Garcia-Molina
- Sleep Number Labs, San Jose, CA 95113, USA; or
- Center for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
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Chen Y, Liu N, Guo Y, Zheng C, Fu D, Cai Y, Nie K, Xia L. Effect of Liuzijue exercise in different periods on circadian rhythm of blood pressure in patients with essential hypertension: A randomized trial. Medicine (Baltimore) 2023; 102:e36481. [PMID: 38050268 PMCID: PMC10695507 DOI: 10.1097/md.0000000000036481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Exercising at different times of the day is a widely employed strategy for treating essential hypertension, aimed at enhancing the circadian rhythm of blood pressure. This study aimed to investigate the effects of Liuzijue exercise in the morning and afternoon on the circadian rhythm of blood pressure in patients with essential hypertension. METHODS This clinical randomized trial recruited 36 patients. They were randomly divided into 3 groups: morning exercise, afternoon exercise, and waiting treatment group. Randomization was performed at a ratio of 1:1:1, ensuring an equal distribution of participants among the 3 groups. Based on maintaining routine work and rest and continuing the original drug treatment, the exercise performed Liuzijue exercise for 12 weeks. The exercise time was 9:00 to 10:00 in the morning exercise group and 14:00 to 15:00 in the afternoon exercise group. The waiting treatment group did not perform any form of fitness exercise. The subjects in the 3 groups were monitored by 24-hour ambulatory blood pressure on the day before and after the first day. RESULTS After the 12-week Liuzijue exercise intervention, mean systolic blood pressure during the night significantly decreased in the morning exercise group (P < .01). In contrast, the waiting group experienced substantial increases in 24-hour mean systolic blood pressure (24hSBP), 24-hour mean diastolic blood pressure (24hDBP), mean systolic blood pressure during the daytime (dSBP), and mean diastolic blood pressure during the daytime (dDBP) (P < .01). Further analysis showed that the morning exercise group had significantly lower 24hSBP, 24hDBP, dSBP, dDBP, and mean systolic blood pressure during the night than the waiting group (P < .05). Additionally, the morning exercise group had lower 24hSBP and dSBP levels than the afternoon exercise group (P < .05). In contrast, the afternoon exercise group had lower 24hDBP and dDBP than the waiting treatment group (P < .05). CONCLUSIONS The 12-week Liuzijue exercise in the morning regimen demonstrated superior efficacy in reducing 24-hour ambulatory blood pressure levels among patients with essential hypertension. Moreover, it facilitates the transition of non-dipper blood pressure patterns to dippers, thereby rectifying aberrant circadian rhythms.
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Affiliation(s)
- Yixiao Chen
- School of Health Preservation and Rehabilitation, Chengdu University of TCM, Chengdu, China
- People’s Republic of China – Key Laboratory of Traditional Chinese Medicine Regimen and Health Industry Development, State Administration of TCM, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Health Preservation and Wellness in Sichuan Province, Sichuan, China
| | - Nannan Liu
- School of Health Preservation and Rehabilitation, Chengdu University of TCM, Chengdu, China
- People’s Republic of China – Key Laboratory of Traditional Chinese Medicine Regimen and Health Industry Development, State Administration of TCM, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Health Preservation and Wellness in Sichuan Province, Sichuan, China
| | - Yuyan Guo
- Chongqing Bishan District Medical and Health Affairs Center, Chongqin, China
| | | | - Dijun Fu
- The Southwest Hospital of AMU, Chongqin, China
| | - Yugang Cai
- The Daying Hospital of Traditional Chinese Medicine in Suining City, Suning, China
| | - Kaidi Nie
- School of Health Preservation and Rehabilitation, Chengdu University of TCM, Chengdu, China
- People’s Republic of China – Key Laboratory of Traditional Chinese Medicine Regimen and Health Industry Development, State Administration of TCM, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Health Preservation and Wellness in Sichuan Province, Sichuan, China
| | - Lina Xia
- School of Health Preservation and Rehabilitation, Chengdu University of TCM, Chengdu, China
- People’s Republic of China – Key Laboratory of Traditional Chinese Medicine Regimen and Health Industry Development, State Administration of TCM, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Health Preservation and Wellness in Sichuan Province, Sichuan, China
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6
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Toprak K, Yıldız Z, Akdemir S, Esen K, Kada R, Can Güleç N, Omar B, Biçer A, Demirbağ R. Low pregnancy-specific beta-1-glycoprotein is associated with nondipper hypertension and increased risk of preeclampsia in pregnant women with newly diagnosed chronic hypertension. Scand J Clin Lab Invest 2023; 83:479-488. [PMID: 37887078 DOI: 10.1080/00365513.2023.2275083] [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: 04/21/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
Chronic hypertension is one of the major risk factors for preeclampsia. Pregnancy-specific beta-1-glycoprotein (PSG-1) is a protein that plays a critical role in fetomaternal immune modulation and has been shown to be closely associated with pregnancy adverse events such as preeclampsia. It is also known that PSG-1 and its source placenta are associated with many molecular pathways associated with blood pressure regulation. In addition, the nondipping pattern (NDP) of chronic hypertension has been shown to be an independent risk factor for preeclampsia. Dipper individuals experience a notable nighttime drop in blood pressure, typically around 10% or more compared to daytime levels, while nondipper individuals show a smaller nighttime blood pressure decrease, indicating potential circadian blood pressure regulation disruption. In this context, we aimed to reveal the relationship between PSG-1, NDP and preeclampsia in this study. A total of 304 pregnant women who were newly diagnosed in the first trimester and started on antihypertensive medication were included in this study. All subjects performed 24-h ambulatory blood pressure monitoring twice throughout pregnancy, the first in the 1. trimester to confirm the diagnosis of hypertension and the second between 20+0 and 21+1 gestational weeks to determine the dipper-nondipper status of hypertension. Subjects were grouped as dipper and nondipper according to blood pressure, and groups were compared in terms of PSG-1 levels. In this study, low PSG-1 levels and NDP were independently associated with preeclampsia. Findings from this study suggest that PSG-1 may play an important role in the causal relationship between NDP and preeclampsia.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Zafer Yıldız
- Department of Obstetrics and Gynecology, Siverek State Hospital, Sanliurfa, Turkey
| | - Selim Akdemir
- Department of Obstetrics and Gynecology, Siverek State Hospital, Sanliurfa, Turkey
| | - Kamil Esen
- Department of Obstetrics and Gynecology, Siverek State Hospital, Sanliurfa, Turkey
| | - Rahime Kada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Nuran Can Güleç
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Bahadır Omar
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Asuman Biçer
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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7
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Mitchell JW, Gillette MU. Development of circadian neurovascular function and its implications. Front Neurosci 2023; 17:1196606. [PMID: 37732312 PMCID: PMC10507717 DOI: 10.3389/fnins.2023.1196606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
The neurovascular system forms the interface between the tissue of the central nervous system (CNS) and circulating blood. It plays a critical role in regulating movement of ions, small molecules, and cellular regulators into and out of brain tissue and in sustaining brain health. The neurovascular unit (NVU), the cells that form the structural and functional link between cells of the brain and the vasculature, maintains the blood-brain interface (BBI), controls cerebral blood flow, and surveils for injury. The neurovascular system is dynamic; it undergoes tight regulation of biochemical and cellular interactions to balance and support brain function. Development of an intrinsic circadian clock enables the NVU to anticipate rhythmic changes in brain activity and body physiology that occur over the day-night cycle. The development of circadian neurovascular function involves multiple cell types. We address the functional aspects of the circadian clock in the components of the NVU and their effects in regulating neurovascular physiology, including BBI permeability, cerebral blood flow, and inflammation. Disrupting the circadian clock impairs a number of physiological processes associated with the NVU, many of which are correlated with an increased risk of dysfunction and disease. Consequently, understanding the cell biology and physiology of the NVU is critical to diminishing consequences of impaired neurovascular function, including cerebral bleeding and neurodegeneration.
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Affiliation(s)
- Jennifer W. Mitchell
- Department of Cell and Developmental Biology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Martha U. Gillette
- Department of Cell and Developmental Biology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Carle-Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States
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8
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Bumgarner JR, Walker WH, Quintana DD, White RC, Richmond AA, Meléndez-Fernández OH, Liu JA, Becker-Krail DD, Walton JC, Simpkins JW, DeVries AC, Nelson RJ. Acute exposure to artificial light at night alters hippocampal vascular structure in mice. iScience 2023; 26:106996. [PMID: 37534143 PMCID: PMC10391664 DOI: 10.1016/j.isci.2023.106996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/15/2023] [Accepted: 05/25/2023] [Indexed: 08/04/2023] Open
Abstract
The structure and function of the cardiovascular system are modulated across the day by circadian rhythms, making this system susceptible to circadian rhythm disruption. Recent evidence demonstrated that short-term exposure to a pervasive circadian rhythm disruptor, artificial light at night (ALAN), increased inflammation and altered angiogenic transcripts in the hippocampi of mice. Here, we examined the effects of four nights of ALAN exposure on mouse hippocampal vascular networks. To do this, we analyzed 2D and 3D images of hippocampal vasculature and hippocampal transcriptomic profiles of mice exposed to ALAN. ALAN reduced vascular density in the CA1 and CA2/3 of female mice and the dentate gyrus of male mice. Network structure and connectivity were also impaired in the CA2/3 of female mice. These results demonstrate the rapid and potent effects of ALAN on cerebrovascular networks, highlighting the importance of ALAN mitigation in the context of health and cerebrovascular disease.
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Affiliation(s)
- Jacob R Bumgarner
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - William H Walker
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - Dominic D Quintana
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - Rhett C White
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - Alexandra A Richmond
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | | | - Jennifer A Liu
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - Darius D Becker-Krail
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - James W Simpkins
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
| | - A Courtney DeVries
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
- Department of Medicine, Division of Oncology/Hematology West Virginia University Morgantown, WV 26505, USA
- WVU Cancer Institute West Virginia University Morgantown, WV 26505 USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University Morgantown, WV 26505, USA
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9
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Chai R, Ye Z, Wu Q, Xue W, Shi S, Du Y, Wu H, Wei Y, Hu Y. Circadian rhythm in cardiovascular diseases: a bibliometric analysis of the past, present, and future. Eur J Med Res 2023; 28:194. [PMID: 37355671 DOI: 10.1186/s40001-023-01158-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND One of the most prominent features of living organisms is their circadian rhythm, which governs a wide range of physiological processes and plays a critical role in maintaining optimal health and function in response to daily environmental changes. This work applied bibliometric analysis to explore quantitative and qualitative trends in circadian rhythm in cardiovascular diseases (CVD). It also aims to identify research hotspots and provide fresh suggestions for future research. METHODS The Web of Science Core Collection was used to search the data on circadian rhythm in CVD. HistCite, CiteSpace, and VOSviewer were used for bibliometric analysis and visualization. The analysis included the overall distribution of yearly outputs, top nations, active institutions and authors, core journals, co-cited references, and keywords. To assess the quality and efficacy of publications, the total global citation score (TGCS) and total local citation score (TLCS) were calculated. RESULTS There were 2102 papers found to be associated with the circadian rhythm in CVD, with the overall number of publications increasing year after year. The United States had the most research citations and was the most prolific country. Hermida RC, Young ME, and Ayala DE were the top three writers. The three most notable journals on the subject were Chronobiology International, Hypertension Research, and Hypertension. In the early years, the major emphasis of circadian rhythm in CVD was hormones. Inflammation, atherosclerosis, and myocardial infarction were the top developing research hotspots. CONCLUSION Circadian rhythm in CVD has recently received a lot of interest from the medical field. These topics, namely inflammation, atherosclerosis, and myocardial infarction, are critical areas of investigation for understanding the role of circadian rhythm in CVD. Although they may not be future research priorities, they remain of significant importance. In addition, how to implement these chronotherapy theories in clinical practice will depend on additional clinical trials to get sufficient trustworthy clinical evidence.
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Affiliation(s)
- Ruoning Chai
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zelin Ye
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qian Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenjing Xue
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuqing Shi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yihang Du
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huaqin Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Wei
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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10
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Sayed M, Rashed M, Abbas AM, Youssef A, Abdel Ghany M. Postpartum Detection of Diastolic Dysfunction and Nondipping Blood Pressure Profile in Women With Preeclampsia. Tex Heart Inst J 2023; 50:493184. [PMID: 37209088 DOI: 10.14503/thij-20-7459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Left ventricular diastolic dysfunction and nocturnal "nondipping" of blood pressure detected via ambulatory blood pressure monitoring are predictors of increased cardiovascular morbidity. METHODS A prospective cohort study including normotensive women with a history of preeclampsia in their current pregnancy was conducted. All cases were subjected to 24-hour ambulatory blood pressure monitoring and 2-dimensional transthoracic echocardiography 3 months after delivery. RESULTS This study included 128 women with a mean (SD) age of 28.6 (5.1) years and a mean (SD) basal blood pressure of 123.1 (6.4)/74.6 (5.9) mm Hg. Among the participants, 90 (70.3%) exhibited an ambulatory blood pressure monitoring profile illustrating nocturnal blood pressure "dipping" (the mean night to day time blood pressure ratio ≤ 0.9), whereas 38 (29.7%) were nondippers. Diastolic dysfunction (impaired left ventricular relaxation) was present in 28 nondippers (73.7%), whereas none of the dippers exhibited diastolic dysfunction. Women with severe preeclampsia were more frequently nondippers (35.5% vs 24.2%; P = .02) and experienced diastolic dysfunction (29% vs 15%; P = .01) than were those with mild preeclampsia. Severe preeclampsia (odds ratio [OR], 1.08; 95% CI, 1.05-10.56; P < .001) and history of recurrent preeclampsia (OR, 1.36; 95% CI, 1.3-4.26; P ≤ .001) were significant predictors for nondipping status and diastolic dysfunction (OR, 1.55; 95% CI, 1.1-2.2; and OR, 1.23; 95% CI, 1.2-2.2, respectively; P < .05). CONCLUSION Women with a history of preeclampsia were at higher risk for developing late cardiovascular events. The severity and recurrence of preeclampsia were significant predictors of both nondipping profile and diastolic dysfunction.
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Affiliation(s)
- Marwa Sayed
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mariam Rashed
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr Youssef
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abdel Ghany
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
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11
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Gibson M, Yiallourou S, Pase MP. The Association Between 24-Hour Blood Pressure Profiles and Dementia. J Alzheimers Dis 2023; 94:1303-1322. [PMID: 37458039 DOI: 10.3233/jad-230400] [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: 07/18/2023]
Abstract
Midlife hypertension increases risk for dementia. Around one third of adults have diagnosed hypertension; however, many adults are undiagnosed, or remain hypertensive despite diagnosis or treatment. Since blood pressure (BP) follows a circadian rhythm, ambulatory BP monitoring allows for the assessment of BP over a 24-hour period and provides an important tool for improving the diagnosis and management of hypertension. The measurement of 24-hour BP profiles, especially nocturnal BP, demonstrate better predictive ability for cardiovascular disease and mortality than office measurement. However, few studies have examined 24-hour BP profiles with respect to dementia risk. This is an important topic since improvements in BP management could facilitate the primary prevention of vascular cognitive impairment and dementia. Therefore, this review discusses the evidence linking BP to dementia, with a focus on whether the implementation of 24-hour BP measurements can improve risk prediction and prevention strategies. Pathways linking nocturnal BP to dementia are also discussed as are risk reduction strategies. Overall, limited research suggests an association between 24-hour BP elevation and poorer cognition, cerebral small vessel disease, and dementia. However, most studies were cross-sectional. Further evidence is needed to substantiate 24-hour BP profiles, over and above office BP, as predictors of vascular cognitive impairment and incident dementia.
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Affiliation(s)
- Madeline Gibson
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Stephanie Yiallourou
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Matthew P Pase
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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12
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Changes in Circadian Variations in Blood Pressure, Pain Pressure Threshold and the Elasticity of Tissue after a Whole-Body Photobiomodulation Treatment in Patients with Fibromyalgia: A Tripled-Blinded Randomized Clinical Trial. Biomedicines 2022; 10:biomedicines10112678. [PMID: 36359198 PMCID: PMC9687325 DOI: 10.3390/biomedicines10112678] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
This study analysed circadian variation changes in blood pressure (BP), the pain pressure threshold (PPT) and the elasticity of tissue in patients with fibromyalgia (FM) after a whole-body photobiomodulation (PBM) treatment. This was a tripled-blinded randomized clinical trial including forty participants with FM. Participants using validated self-measurement BP devices attained readings that were used to calculate the circadian variation. Additionally, a standard pressure algometer of 1cm2 was used to assess 13 tender points by exerting a pressure of up to 4 kg, and strain elastography assessed the elasticity of tissue. Circadian variations in BP showed significant differences after the PBM intervention (p = 0.036). When comparing PPT between groups, statistically significant differences were found in the occiput (p = 0.039), low cervical (p = 0.035), trapezius (p = 0.037), second rib (p < 0.001) and medial epicondyle points (p = 0.006). Furthermore, there were statistically significant differences in both the trapezius and the forearm at the distal dorsal third SEL values (p ≤ 0.001) when comparing groups. Whole-body PBM produces changes in circadian blood pressure, the pain pressure threshold and the elasticity of tissue after a treatment program was carried out. However, more studies are needed to corroborate our findings as well as to better understand the underlying mechanisms.
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13
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Guzman-Limon ML, Jiang S, Ng D, Flynn JT, Warady B, Furth SL, Samuels JA. Nocturnal Hypertension in Children With Chronic Kidney Disease Is Common and Associated With Progression to Kidney Replacement Therapy. Hypertension 2022; 79:2288-2297. [PMID: 35979846 PMCID: PMC9458620 DOI: 10.1161/hypertensionaha.121.18101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 06/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nocturnal hypertension is a risk factor for chronic kidney disease (CKD) progression among adults. In children, effects of nocturnal hypertension on CKD progression is less studied. METHODS We investigated the relationships between nocturnal, daytime, or sustained hypertension and progression to kidney replacement therapy in children using Cox proportional hazards models. Nocturnal and diurnal hypertension respectively defined as: mean blood pressure >95th percentile and/or load >25% for either systolic or diastolic blood pressure within sleep or wake periods. RESULTS One thousand five hundred seventy-seven ambulatory blood pressure monitoring studies from 701 CKiD participants were reviewed. Nighttime, daytime, and both types of hypertension were 19%, 7%, and 33%, respectively. Participants with both daytime and nocturnal hypertension had the highest risk of kidney replacement therapy. Among children with CKD, compared with those who were normotensive, those with isolated nocturnal hypertension had a hazard ratio of 1.49 ([CI, 0.97-2.28]; P=0.068) while those with both daytime and nocturnal hypertension had a HR of 2.23 ([CI, 1.60-3.11]; P<0.001) when adjusted for age, race, sex, and baseline proteinuria and glomerular filtration. Estimates for risk were similar among glomerular and nonglomerular participants but not significant in glomerular due to smaller sample size. CONCLUSIONS The presence of both daytime and nocturnal hypertension is significantly associated with risk of kidney replacement therapy. Our study confirms the utility of ambulatory blood pressure monitoring in children with CKD. Identifying and controlling both daytime and nocturnal hypertension using ambulatory blood pressure monitoring may improve outcomes and delay CKD progression in this population.
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Affiliation(s)
- Monica L Guzman-Limon
- McGovern Medical School at UTHealth, Pediatric Nephrology & Hypertension, Houston, TX (M.L.G.-L., J.A.S.)
| | - Shuai Jiang
- Johns Hopkins University, Baltimore, MD (S.J., D.N.)
| | - Derek Ng
- Johns Hopkins University, Baltimore, MD (S.J., D.N.)
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington, and Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.)
| | | | - Susan L Furth
- The Children's Hospital of Philadelphia, PA (S.L.F.)
| | - Joshua A Samuels
- McGovern Medical School at UTHealth, Pediatric Nephrology & Hypertension, Houston, TX (M.L.G.-L., J.A.S.)
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14
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Poza JJ, Pujol M, Ortega-Albás JJ, Romero O. Melatonin in sleep disorders. Neurologia 2022; 37:575-585. [PMID: 30466801 DOI: 10.1016/j.nrl.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/06/2018] [Accepted: 08/18/2018] [Indexed: 12/19/2022] Open
Abstract
Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age, in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefore appear to be a natural way of restoring sleep quality, which is lost as patients age. However, despite the undeniable theoretical appeal of this approach to insomnia, little scientific evidence is available that supports any benefit of this substitutive therapy. Furthermore, the most suitable dose ranges and pharmaceutical preparations for melatonin administration are yet to be clearly defined. This review addresses the physiology of melatonin, the different pharmaceutical preparations, and data on its clinical usefulness.
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Affiliation(s)
- J J Poza
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España.
| | - M Pujol
- Unidad Multidisciplinar de Sueño, Hospital Universitario de Santa María, Lleida, España
| | - J J Ortega-Albás
- Unidad de Sueño, Hospital General Universitario de Castellón, Castellón, España
| | - O Romero
- Unidad Multidisciplinar de Sueño, Hospital Universitario Vall d́Hebron, Barcelona, España
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15
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Acute Effects of Inorganic Nitrate Intake on Brachial and Femoral Flow-Mediated Vasodilation, and on Carotid Artery Reactivity Responses: Results of a Randomized, Double-Blinded, Placebo-Controlled Cross-Over Study in Abdominally Obese Men. Nutrients 2022; 14:nu14173560. [PMID: 36079817 PMCID: PMC9460748 DOI: 10.3390/nu14173560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 12/26/2022] Open
Abstract
Most trials on the effects of inorganic nitrate intake have focused on only one specific aspect of the endothelial cell response to a stimulus, thereby possibly missing other important effects. The aim of the present randomized, double-blinded, placebo-controlled cross-over study was therefore to investigate in eighteen healthy abdominally obese men (18–60 years, waist circumference ≥ 102 cm) acute effects of potassium nitrate on brachial and femoral flow-mediated vasodilation (FMD), and on carotid artery reactivity (CAR) to a cold pressure test. Participants received in random order a drink providing 10 mmol potassium nitrate (i.e., 625 mg of nitrate) or an iso-molar placebo drink with potassium chloride. Fasted and 4 h post-drink FMD and blood pressure measurements were performed. CAR responses were assessed at 4 h. Circulating nitrate plus nitrite concentration increased following nitrate intake (p = 0.003). Compared with placebo, potassium nitrate did not affect brachial (mean [95% confidence interval]: −0.2% [−2.5, 2.1], p = 0.86) and femoral FMD responses (−0.6% [−3.0; 1.7], p = 0.54). CAR responses were also not different (−0.8% [−2.5, 0.9], p = 0.32). Finally, changes in blood pressure and heart rate did not differ. No adverse events were observed. In conclusion, this trial did not provide evidence for effects of a single dose of inorganic nitrate on 4 h vascular endothelial function in abdominally obese men.
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16
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Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1847-1858. [PMID: 35983870 DOI: 10.1097/hjh.0000000000003240] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
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17
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Abstract
Sex as a biological variable is the focus of much literature and has been emphasized by the National Institutes of Health, in part, to remedy a long history of male-dominated studies in preclinical and clinical research. We propose that time-of-day is also a crucial biological variable in biomedical research. In common with sex differences, time-of-day should be considered in analyses and reported to improve reproducibility of studies and to provide the appropriate context to the conclusions. Endogenous circadian rhythms are present in virtually all living organisms, including bacteria, plants, invertebrates, and vertebrates. Virtually all physiological and behavioral processes display daily fluctuations in optimal performance that are driven by these endogenous circadian clocks; importantly, many of those circadian rhythms also show sex differences. In this review, we describe some of the documented sex differences in circadian rhythms.
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Affiliation(s)
- James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia 26506, USA
| | - Jacob R Bumgarner
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia 26506, USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia 26506, USA
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18
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Circadian Variation of Blood Pressure in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116481. [PMID: 35682067 PMCID: PMC9180615 DOI: 10.3390/ijerph19116481] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023]
Abstract
The aim of this study was to analyze the impact of circadian variation of blood pressure (BP) in patients with chronic musculoskeletal pain (CPM). A further purpose was to study differences in circadian variation of BP between genders and the correlation between BP circadian variation and pain. We performed a cross-sectional, observational study in which seventy-five participants with CMP participated. Circadian variation in BP was calculated using the diurnal/nocturnal BP ratio, and all participants used validated self-measurement BP devices. The Numeric Pain Rating Scale was used to assess pain perception. All circadian BP values from participants who suffered from CPM followed pathologic cardiovascular parameters (BP ratio < 10%). When comparing BP ratios between genders, statistically significant differences were found (p = 0.011). BP itself did not correlate with pain in any subgroup. Circadian variations of BP in those suffering from CMP are shown and new possibilities of research and treatment are proposed.
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19
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Ibarz-Blanch N, Morales D, Calvo E, Ros-Medina L, Muguerza B, Bravo FI, Suárez M. Role of Chrononutrition in the Antihypertensive Effects of Natural Bioactive Compounds. Nutrients 2022; 14:nu14091920. [PMID: 35565887 PMCID: PMC9103085 DOI: 10.3390/nu14091920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 12/13/2022] Open
Abstract
Hypertension (HTN) is one of the main cardiovascular risk factors and is considered a major public health problem. Numerous approaches have been developed to lower blood pressure (BP) in hypertensive patients, most of them involving pharmacological treatments. Within this context, natural bioactive compounds have emerged as a promising alternative to drugs in HTN prevention. This work reviews not only the mechanisms of BP regulation by these antihypertensive compounds, but also their efficacy depending on consumption time. Although a plethora of studies has investigated food-derived compounds, such as phenolic compounds or peptides and their impact on BP, only a few addressed the relevance of time consumption. However, it is known that BP and its main regulatory mechanisms show a 24-h oscillation. Moreover, evidence shows that phenolic compounds can interact with clock genes, which regulate the biological rhythm followed by many physiological processes. Therefore, further research might be carried out to completely elucidate the interactions along the time–nutrition–hypertension axis within the framework of chrononutrition.
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Affiliation(s)
| | | | - Enrique Calvo
- Correspondence: (E.C.); (F.I.B.); Tel.: +34-977558837 (E.C.)
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20
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Miao H, Yang S, Zhang Y. Differences of blood pressure measured at clinic versus at home in the morning and in the evening in Europe and Asia: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2022; 24:677-688. [PMID: 35488438 PMCID: PMC9180344 DOI: 10.1111/jch.14487] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/01/2022]
Abstract
Numerous studies have indicated that there might be great differences among different populations in Europe and Asia in terms of home morning and evening blood pressure (BP). Thus, the authors performed a systematic review to determine the quantitative differences of BP measured at clinic versus at home in the morning and in the evening in Europe and Asia. PubMed, Embase, and Scopus databases were searched up to October 2021. Studies that compared clinic BP with home morning and (or) home evening BP in European and Asian populations were included. A random effect model was applied to pool the differences between clinic BP and home morning/evening BP. Thirty‐five studies, for a total of 49 432 patients, were included in this meta‐analysis. Mean clinic systolic blood pressure (SBP) values were significantly higher than home morning SBP values by 3.79 mmHg (95% CI, 2.77–4.80). The differences were much larger in Europe [(6.53 mmHg (95% CI, 4.10–8.97)] than in Asia [(2.70 mmHg (95% CI, 1.74–3.66)], and the region was a significant predictor for the differences. Mean clinic SBP values were also significantly higher than home evening SBP values by 6.59 mmHg (95% CI, 4.98–8.21). The differences were much smaller in Europe [5.85 mmHg (95% CI, 3.24–8.45)] than in Asia [7.13 mmHg (95% CI, 4.92–9.35)], while age and clinic SBP might contribute to it. Our findings showed that the difference between clinic and home morning SBP was much larger in European than Asian populations, whereas the difference between clinic and home evening SBP was the opposite. The differing characteristics of the region, ethnic, age, and clinic BP might explain the diversities.
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Affiliation(s)
- Huanhuan Miao
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shijie Yang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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The impact of measurement timepoint on autonomic function testing in male and female individuals. Proc Nutr Soc 2022. [DOI: 10.1017/s0029665122001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Hermida-Ayala RG, Mojón A, Fernández JR, Smolensky MH, Hermida RC. Ingestion-time differences in the pharmacodynamics of dual-combination hypertension therapies: Systematic review and meta-analysis of published human trials. Chronobiol Int 2021; 39:493-512. [PMID: 34906002 DOI: 10.1080/07420528.2021.2005084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The pharmacodynamics of hypertension medications can be significantly affected by circadian rhythms in the biological mechanisms of the 24 h blood pressure (BP) pattern. Hypertension guidelines fail to recommend the time of day when patients, including those who require treatment with multiple medications, are to ingest BP-lowering therapy. We conducted a systematic review of published prospective trials that investigated hypertension medications for ingestion-time differences in BP-lowering, safety, patient adherence, and markers of target organ pathology. Among the search-retried 155 trials, 17 published between 1991 and 2020 totaling 1,508 hypertensive participants concerned the differential ingestion-time dependent effects of 14 unique dual-combination therapies. All but one (94.1%) of the trials, involving 98.5% of the total number of investigated individuals, reported clinically and statistically significant benefits - including enhanced reduction of asleep BP without induction of sleep-time hypotension, reduced prevalence of BP non-dipping, decreased adverse effects, improved kidney function, and reduced cardiac pathology - when dual-combination hypertension medications were ingested at-bedtime/evening rather than upon-waking/morning. A systematic and comprehensive review of the literature published in the past three decades reveals no single dual-combination hypertension trial reported significantly better benefit of the still conventional, yet unjustified by medical evidence, upon-waking/morning hypertension treatment scheme.
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Affiliation(s)
- Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, McGovern School of Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ramón C Hermida
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
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23
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Haghayegh S, Smolensky MH, Khoshnevis S, Hermida RC, Castriotta RJ, Diller KR. The Circadian Rhythm of Thermoregulation Modulates both the Sleep/Wake Cycle and 24 h Pattern of Arterial Blood Pressure. Compr Physiol 2021; 11:2645-2658. [PMID: 34636410 DOI: 10.1002/cphy.c210008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borbély proposed an interacting two-component model of sleep regulation comprising a homeostatic Process S and a circadian Process C. The model has provided understanding of the association between core body temperature (CBT) as a key element of Process C that is deterministic of sleep onset and offset. However, it additionally provides a new perspective of the importance of the thermoregulatory mechanisms of Process C in modulating the circadian rhythm of arterial blood pressure (ABP). Herein, we examine the circadian physiology of thermoregulation, including at the end of the activity span the profound redistribution of cardiac output from the systemic circulation to the arteriovenous anastomoses of the glabrous skin that markedly enhances convective transfer of heat from the body to the environment to cause (i) decrease of the CBT as a pathway to sleep onset and (ii) attenuation of the asleep ABP mean and augmentation of the ABP decline (dipping) from the wake-time mean, in combination the strongest predictors of the risk for blood vessel and organ pathology and morbid and mortal cardiovascular disease events. We additionally review the means by which blood perfusion to the glabrous skin can be manipulated on demand by selective thermal stimulation, that is, mild warming, on the skin of the cervical spinal cord to intensify Process C as a way to facilitate sleep induction and promote healthy asleep ABP. © 2021 American Physiological Society. Compr Physiol 11:1-14, 2021.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biostatics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
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24
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Barros JP, de Paula T, Mediano MFF, Rangel MVDS, Monteiro W, da Cunha FA, Farinatti P, Borges JP. The Effects of Acute Aerobic Exercise on Blood Pressure, Arterial Function, and Heart Rate Variability in Men Living With HIV. Front Physiol 2021; 12:685306. [PMID: 34335295 PMCID: PMC8320391 DOI: 10.3389/fphys.2021.685306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aims to investigate the effects of acute cycling on blood pressure (BP), arterial function, and heart rate variability (HRV) in men living with HIV (MLHIV) using combined antiretroviral therapy (cART). METHODS Twelve MLHIV (48.7 ± 9.2 years; 25.2 ± 2.8 kg m-2) and 13 healthy controls (41.2 ± 9.9 years; 26.3 ± 2.9 kg m-2) performed a cycling bout (ES) (intensity: 50% oxygen uptake reserve; duration: time to achieve 150 kcal-MLHIV: 24.1 ± 5.5 vs. controls: 23.1 ± 3.0 min; p = 0.45), and a 20-min non-exercise session (NES). RESULTS At rest (p < 0.05), MLHIV presented higher brachial systolic/diastolic BP (SBP/DBP: 123.2 ± 14.2/76.8 ± 6.3 vs. 114.3 ± 5.1/71.6 ± 2.6 mmHg) and central BP (cSBP/cDBP: 108.3 ± 9.3/76.5 ± 6.5 vs. 101.6 ± 4.9/71.3 ± 4.4 mmHg) vs. controls but lower absolute maximal oxygen uptake (2.1 ± 0.5 vs. 2.5 ± 0.3 L min-1) and HRV indices reflecting overall/vagal modulation (SDNN: 24.8 ± 7.1 vs. 42.9 ± 21.3 ms; rMSSD: 20.5 ± 8.5 vs. 38.1 ± 22.8 ms; pNN50: 3.6 ± 4.2 vs. 13.6 ± 11.3%). DBP postexercise lowered in controls vs. MLHIV (∼4 mmHg, p < 0.001; ES: 0.6). Moreover, controls vs. MLHIV had greater reductions (p < 0.05) in augmentation index (-13.6 ± 13.7 vs. -3.1 ± 7.2% min-1; ES: 2.4), and HRV indices up to 5 min (rMSSD: -111.8 ± 32.1 vs. -75.9 ± 22.2 ms min-1; ES: 3.8; pNN50: -76.3 ± 28.3 vs. -19.0 ± 13.7% min-1; ES: 4.4). Within-group (ES vs. NES; p < 0.05) reductions occurred in controls for SBP (∼10 mmHg, 2 h), DBP (∼6 mmHg, 20, 30, and 70 min), cSBP (∼9 mmHg, 30 min), cDBP (∼7 mmHg, 30 and 70 min), augmentation index (∼10%, 30 min), and pNN50 (∼20%; up to 2 h), while in MLHIV only cSBP (∼6 mmHg, 70 min) and cDBP (∼4 mmHg, 30 min) decreased. Similar increases (up to 5 min) in heart rate (∼22 bpm) and decreases in SDNN (∼18 ms) and rMSSD (∼20 ms) occurred in both groups. CONCLUSION MLHIV under cART exhibited attenuated postexercise hypotension vs. healthy controls, which seemed to relate with impairments in vascular function.
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Affiliation(s)
- Juliana Pereira Barros
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Tainah de Paula
- Department of Clinical Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Research and Education, National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Walace Monteiro
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, Brazil
| | - Felipe Amorim da Cunha
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, Brazil
| | - Juliana Pereira Borges
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
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25
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Meléndez-Fernández OH, Walton JC, DeVries AC, Nelson RJ. Clocks, Rhythms, Sex, and Hearts: How Disrupted Circadian Rhythms, Time-of-Day, and Sex Influence Cardiovascular Health. Biomolecules 2021; 11:883. [PMID: 34198706 PMCID: PMC8232105 DOI: 10.3390/biom11060883] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases are the top cause of mortality in the United States, and ischemic heart disease accounts for 16% of all deaths around the world. Modifiable risk factors such as diet and exercise have often been primary targets in addressing these conditions. However, mounting evidence suggests that environmental factors that disrupt physiological rhythms might contribute to the development of these diseases, as well as contribute to increasing other risk factors that are typically associated with cardiovascular disease. Exposure to light at night, transmeridian travel, and social jetlag disrupt endogenous circadian rhythms, which, in turn, alter carefully orchestrated bodily functioning, and elevate the risk of disease and injury. Research into how disrupted circadian rhythms affect physiology and behavior has begun to reveal the intricacies of how seemingly innocuous environmental and social factors have dramatic consequences on mammalian physiology and behavior. Despite the new focus on the importance of circadian rhythms, and how disrupted circadian rhythms contribute to cardiovascular diseases, many questions in this field remain unanswered. Further, neither time-of-day nor sex as a biological variable have been consistently and thoroughly taken into account in previous studies of circadian rhythm disruption and cardiovascular disease. In this review, we will first discuss biological rhythms and the master temporal regulator that controls these rhythms, focusing on the cardiovascular system, its rhythms, and the pathology associated with its disruption, while emphasizing the importance of the time-of-day as a variable that directly affects outcomes in controlled studies, and how temporal data will inform clinical practice and influence personalized medicine. Finally, we will discuss evidence supporting the existence of sex differences in cardiovascular function and outcomes following an injury, and highlight the need for consistent inclusion of both sexes in studies that aim to understand cardiovascular function and improve cardiovascular health.
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Affiliation(s)
- O. Hecmarie Meléndez-Fernández
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA; (J.C.W.); (R.J.N.)
| | - James C. Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA; (J.C.W.); (R.J.N.)
| | - A. Courtney DeVries
- Department of Medicine, Division of Oncology/Hematology, West Virginia University, Morgantown, WV 26505, USA;
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26505, USA
| | - Randy J. Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA; (J.C.W.); (R.J.N.)
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26
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Hermida RC, Hermida-Ayala RG, Mojón A, Smolensky MH, Fernández JR. Systematic review and quality evaluation of published human ingestion-time trials of blood pressure-lowering medications and their combinations. Chronobiol Int 2021; 38:1460-1476. [PMID: 34107831 DOI: 10.1080/07420528.2021.1931280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The pharmacokinetics (PK) - absorption, distribution, metabolism, and elimination - and pharmacodynamics (PD) of hypertension medications can be significantly affected by circadian rhythms. As a consequence, the time when blood pressure (BP) lowering medications are ingested, with reference to the staging of all involved circadian rhythms modulating PK and PD, can affect their duration of action, magnitude of effect on features of the 24 h BP profile, and safety. We conducted a systematic and comprehensive review of published prospective human trials that investigated individual hypertension medications of all classes and their combinations for ingestion-time differences in BP-lowering, safety, patient adherence, and markers of hypertension-associated target organ pathology of the kidney and heart. The systematic review yielded 155 trials published between 1976 and 2020 - totaling 23,972 hypertensive individuals - that evaluated 37 different single and 14 dual-combination therapies. The vast (83.9%) majority of them reported clinically and statistically significant benefits - including enhanced reduction of asleep BP mean without induced sleep-time hypotension, reduced prevalence of the higher cardiovascular risk non-dipper 24 h BP profile, decreased incidence of adverse effects, improved kidney function, and reduced cardiac pathology - when hypertension medications are ingested at-bedtime/evening rather than upon-waking/morning. Nonetheless, the findings and conclusions of some past conducted trials are inconsistent, often due to disparities and deficiencies of the investigative protocols. Accordingly, we developed a quality assessment method based upon the eight items identified as crucial according to the recently published guidelines of the International Society for Chronobiology and the American Association for Medical Chronobiology and Chronotherapeutics for the design and conduct of human clinical trials on ingestion-time differences of hypertension medications. Among the most frequent deficiencies are: absence or miscalculation of minimum required sample size (83.2%), incorrect choice of primary BP endpoint (53.6%), and inappropriate arbitrary and unrepresentative clock hours chosen for tested treatment times (53.6%). The inability of the very small proportion (16.1%) of trials to verify the advantages of the at-bedtime/evening treatment strategy is likely explained by deficiencies of their study design and conduct. Nonetheless, regardless of the quality score of the 155 trials retrieved by our systematic review, it is most noteworthy that no single published prospective randomized trial reported significantly enhanced BP-lowering, safety, compliance, or other benefits of the unjustified by medical evidence, yet still most recommended, upon-waking/morning hypertension treatment-time scheme.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, McGovern School of Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
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27
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Davidson S, Villarroel M, Harford M, Finnegan E, Jorge J, Young D, Watkinson P, Tarassenko L. Day-to-day progression of vital-sign circadian rhythms in the intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:156. [PMID: 33888129 PMCID: PMC8063456 DOI: 10.1186/s13054-021-03574-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/11/2021] [Indexed: 01/15/2023]
Abstract
Background Disrupted vital-sign circadian rhythms in the intensive care unit (ICU) are associated with complications such as immune system disruption, delirium and increased patient mortality. However, the prevalence and extent of this disruption is not well understood. Tools for its detection are currently limited. Methods This paper evaluated and compared vital-sign circadian rhythms in systolic blood pressure, heart rate, respiratory rate and temperature. Comparisons were made between the cohort of patients who recovered from the ICU and those who did not, across three large, publicly available clinical databases. This comparison included a qualitative assessment of rhythm profiles, as well as quantitative metrics such as peak–nadir excursions and correlation to a demographically matched ‘recovered’ profile. Results Circadian rhythms were present at the cohort level in all vital signs throughout an ICU stay. Peak–nadir excursions and correlation to a ‘recovered’ profile were typically greater throughout an ICU stay in the cohort of patients who recovered, compared to the cohort of patients who did not. Conclusions These results suggest that vital-sign circadian rhythms are typically present at the cohort level throughout an ICU stay and that quantitative assessment of these rhythms may provide information of prognostic use in the ICU. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03574-w.
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Affiliation(s)
- Shaun Davidson
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Mauricio Villarroel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Mirae Harford
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford University Hospitals NHS Trust, NIHR Biomedical Research Centre, Oxford, UK
| | - Eoin Finnegan
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - João Jorge
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford University Hospitals NHS Trust, NIHR Biomedical Research Centre, Oxford, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford University Hospitals NHS Trust, NIHR Biomedical Research Centre, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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28
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Abstract
Circadian rhythms describe physiological systems that repeat themselves with a cycle of approximately 24 h. Our understanding of the cellular and molecular origins of these oscillations has improved dramatically, allowing us to appreciate the significant role these oscillations play in maintaining physiological homeostasis. Circadian rhythms allow living organisms to predict and efficiently respond to a dynamically changing environment, set by repetitive day/night cycles. Since circadian rhythms underlie almost every aspect of human physiology, it is unsurprising that they also influence the response of a living organism to disease, stress, and therapeutics. Therefore, not only do the mechanisms that maintain health and disrupt homeostasis depend on our internal circadian clock, but also the way drugs are perceived and function depends on these physiological rhythms. We present a holistic view of the therapeutic process, discussing components such as disease state, pharmacokinetics, and pharmacodynamics, as well as adverse reactions that are critically affected by circadian rhythms. We outline challenges and opportunities in moving toward personalized medicine approaches that explore and capitalize on circadian rhythms for the benefit of the patient.
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Affiliation(s)
- Yaakov Nahmias
- Center for Bioengineering, School of Computer Science and Engineering, Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Ioannis P Androulakis
- Department of Biomedical Engineering and Department of Chemical & Biochemical Engineering, Rutgers University, Piscataway, New Jersey 08854, USA; .,Department of Surgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey 08854, USA
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29
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Hermida RC, Hermida-Ayala RG, Smolensky MH, Mojón A, Fernández JR. Ingestion-time differences in the pharmacodynamics of hypertension medications: Systematic review of human chronopharmacology trials. Adv Drug Deliv Rev 2021; 170:200-213. [PMID: 33486007 DOI: 10.1016/j.addr.2021.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Pharmacokinetics of hypertension medications is significantly affected by circadian rhythms that influence absorption, distribution, metabolism and elimination. Furthermore, their pharmacodynamics is affected by ingestion-time differences in kinetics and circadian rhythms comprising the biological mechanism of the 24 h blood pressure (BP) pattern. However, hypertension guidelines do not recommend the time to treat patients with medications. We conducted a systematic review of published evidence regarding ingestion-time differences of hypertension medications and their combinations on ambulatory BP-lowering, safety, and markers of target organ pathology. Some 153 trials published between 1976 and 2020, totaling 23,869 hypertensive individuals, evaluated 37 different single and 14 dual-fixed combination therapies. The vast (83.7%) majority of the trials report clinically and statistically significant benefits - including enhanced reduction of asleep BP without inducing sleep-time hypotension, reduced prevalence of the higher cardiovascular disease risk BP non-dipping 24 h profile, decreased incidence of adverse effects, improved renal function, and reduced cardiac pathology - when hypertension medications are ingested at-bedtime/evening rather than upon-waking/morning. Non-substantiated treatment-time difference in effects by the small proportion (16.3%) of published trials is likely explained by deficiencies of study design and conduct. Systematic and comprehensive review of the literature published the past 45 years reveals no single study reported significantly better benefit of the still conventional, yet unjustified by medical evidence, upon-waking/morning hypertension treatment schedule.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo 36310, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX 78712-0238, USA.
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, 15703, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX 78712-0238, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo 36310, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo 36310, Spain
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30
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Hermida RC, Mojón A, Hermida-Ayala RG, Smolensky MH, Fernández JR. Extent of asleep blood pressure reduction by hypertension medications is ingestion-time dependent: Systematic review and meta-analysis of published human trials. Sleep Med Rev 2021; 59:101454. [PMID: 33571840 DOI: 10.1016/j.smrv.2021.101454] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
Combined evidence of published prospective outcome trials and meta-analyses substantiate elevated asleep blood pressure (BP) and blunted sleep-time relative BP decline (non-dipping), regardless of wake-time office BP and awake or 24 h BP means, are jointly the most highly significant independent prognostic markers of cardiovascular disease (CVD) risk and worthy therapeutic targets for prevention. Nonetheless, current guidelines continue to recommend the diagnosis of hypertension, when based on ambulatory BP monitoring (ABPM), rely, solely, on either the 24 h or "daytime" BP means. They also fail to recommend the time to treat patients. We conducted a systematic review of published human trials regarding ingestion-time differences in the effects of hypertension medications on asleep BP and sleep-time relative BP decline. Some 62 such trials published between 1992 and 2020, totaling 6120 hypertensive persons, evaluated 21 different single and 8 dual-fixed combination therapies. The vast (82.3%) majority of the trials substantiate the bedtime/evening vs. upon-waking/morning treatment schedule produces statistically significant better clinical benefits, including enhanced reduction of asleep systolic BP by an average 5.17 mmHg (95%CI [4.04, 6.31], P < 0.001 between treatment-time groups) without inducing sleep-time hypotension, reduced prevalence of the high CVD risk non-dipper 24 h BP pattern, improved kidney function, and reduced cardiac pathology. Furthermore, systematic and comprehensive review of the ABPM-based literature published the past 29 years reveals no single study that reported significantly better benefits of the most recommended, yet unjustified by medical evidence, morning hypertension treatment-time scheme.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA.
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain
| | - Ramón G Hermida-Ayala
- Chief Pharmacology Officer, Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, 15703, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain
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31
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Hermida RC, Smolensky MH, Balan H, Castriotta RJ, Crespo JJ, Dagan Y, El-Toukhy S, Fernández JR, FitzGerald GA, Fujimura A, Geng YJ, Hermida-Ayala RG, Machado AP, Menna-Barreto L, Mojón A, Otero A, Rudic RD, Schernhammer E, Skarke C, Steen TY, Young ME, Zhao X. Guidelines for the design and conduct of human clinical trials on ingestion-time differences - chronopharmacology and chronotherapy - of hypertension medications. Chronobiol Int 2021; 38:1-26. [PMID: 33342316 PMCID: PMC8112296 DOI: 10.1080/07420528.2020.1850468] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/28/2022]
Abstract
Current hypertension guidelines fail to provide a recommendation on when-to-treat, thus disregarding relevant circadian rhythms that regulate blood pressure (BP) level and 24 h patterning and medication pharmacokinetics and pharmacodynamics. The ideal purpose of ingestion-time (chronopharmacology, i.e. biological rhythm-dependent effects on the kinetics and dynamics of medications, and chronotherapy, i.e. the timing of pharmaceutical and other treatments to optimize efficacy and safety) trials should be to explore the potential impact of endogenous circadian rhythms on the effects of medications. Such investigations and outcome trials mandate adherence to the basic standards of human chronobiology research. In-depth review of the more than 150 human hypertension pharmacology and therapeutic trials published since 1974 that address the differential impact of upon-waking/morning versus at-bedtime/evening schedule of treatment reveals diverse protocols of sometimes suboptimal or defective design and conduct. Many have been "time-of-day," i.e. morning versus evening, rather than circadian-time-based, and some relied on wake-time office BP rather than around-the-clock ambulatory BP measurements (ABPM). Additionally, most past studies have been of too small sample size and thus statistically underpowered. As of yet, there has been no consensual agreement on the proper design, methods and conduct of such trials. This Position Statement recommends ingestion-time hypertension trials to follow minimum guidelines: (i) Recruitment of participants should be restricted to hypertensive individuals diagnosed according to ABPM diagnostic thresholds and of a comparable activity/sleep routine. (ii) Tested treatment-times should be selected according to internal biological time, expressed by the awakening and bed times of the sleep/wake cycle. (iii) ABPM should be the primary or sole method of BP assessment. (iv) The minimum-required features for analysis of the ABPM-determined 24 h BP pattern ought to be the asleep (not "nighttime") BP mean and sleep-time relative BP decline, calculated in reference to the activity/rest cycle per individual. (v) ABPM-obtained BP means should be derived by the so-called adjusted calculation procedure, not by inaccurate arithmetic averages. (vi) ABPM should be performed with validated and calibrated devices at least hourly throughout two or more consecutive 24 h periods (48 h in total) to achieve the highest reproducibility of mean wake-time, sleep-time and 48 h BP values plus the reliable classification of dipping status. (vii) Calculation of minimum required sample size in adherence with proper statistical methods must be provided. (viii) Hypertension chronopharmacology and chronotherapy trials should preferably be randomized double-blind, randomized open-label with blinded-endpoint, or crossover in design, the latter with sufficient washout period between tested treatment-time regimens.
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Affiliation(s)
- Ramón C. Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
| | - Michael H. Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
- Division of Cardiology, McGovern School of Medicine, the University of Texas at Houston, Houston, Texas, USA
| | - Horia Balan
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Richard J. Castriotta
- Department of Medicine; Division of Pulmonary, Critical Care and Sleep Medicine; Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Juan J. Crespo
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain
- Centro de Salud de Bembrive, Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | - Yaron Dagan
- Applied Chronobiology Research Center, Tel-Hai Academic College, Israel; Human Biology Department, Haifa University, Israel
- Sleep and Fatigue Institute, Assuta Medical Center, Israel
| | - Sherine El-Toukhy
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - José R. Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Garret A. FitzGerald
- Institute for Translational Medicine and Therapeutics, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akio Fujimura
- Department of Clinical Pharmacology, Jichi Medical University, Tochigi, Japan
- Department of Internal Medicine, Shin-Kaminokawa Hospital, Tochigi, Japan
| | - Yong-Jian Geng
- Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ramón G. Hermida-Ayala
- Chief Pharmacology Officer, Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | | | - Luiz Menna-Barreto
- Escola de Artes, Ciências e Humanidades, Grupo Multidisciplinar de Desenvolvimento e Ritmos Biológicos (GMDRB), Universidade de São Paulo, São Paulo, Brazil
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), Ourense, Spain
| | - R. Daniel Rudic
- Department of Pharmacology & Toxicology, Augusta University, Augusta, Georgia, USA
| | - Eva Schernhammer
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Channing Division of Network Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tomoko Y. Steen
- Department of Microbiology and Immunology, School of Medicine, Georgetown University, Washington, DC, USA
| | - Martin E. Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Xiaoyun Zhao
- Respiratory and Critical Care Medicine Department, Sleep Medicine Center, Tianjin Chest Hospital, Tianjin, China
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32
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Hermida RC, Mojón A, Fernández JR, Otero A, Crespo JJ, Domínguez-Sardiña M, Ríos MT, Smolensky MH. Ambulatory blood pressure monitoring-based definition of true arterial hypertension. Minerva Med 2020; 111:573-588. [DOI: 10.23736/s0026-4806.20.06834-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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33
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Hermida RC, Hermida-Ayala RG, Smolensky MH, Mojón A, Fernández JR. Ingestion-time – relative to circadian rhythms – differences in the pharmacokinetics and pharmacodynamics of hypertension medications. Expert Opin Drug Metab Toxicol 2020; 16:1159-1173. [DOI: 10.1080/17425255.2020.1825681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ramón C. Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, TX, USA
| | | | - Michael H. Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, TX, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
| | - José R. Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
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Rotenberg L, Silva-Costa A, Griep RH. On-shift naps are associated with systolic and diastolic blood pressure level among night working nursing professionals. Chronobiol Int 2020; 37:1365-1372. [DOI: 10.1080/07420528.2020.1819114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lucia Rotenberg
- Laboratory of Health and Environmental Education, Oswaldo Cruz Institute - Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Aline Silva-Costa
- Department of Collective Health, Federal University of Triangulo Mineiro - Uberaba, MG, Brazil
| | - Rosane Härter Griep
- Laboratory of Health and Environmental Education, Oswaldo Cruz Institute - Fiocruz, Rio de Janeiro, RJ, Brazil
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Poza J, Pujol M, Ortega-Albás J, Romero O. Melatonin in sleep disorders. NEUROLOGÍA (ENGLISH EDITION) 2020; 37:575-585. [DOI: 10.1016/j.nrleng.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/18/2018] [Indexed: 12/18/2022] Open
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Role of the Immune System and the Circadian Rhythm in the Pathogenesis of Chronic Pancreatitis: Establishing a Personalized Signature for Improving the Effect of Immunotherapies for Chronic Pancreatitis. Pancreas 2020; 49:1024-1032. [PMID: 32833942 DOI: 10.1097/mpa.0000000000001626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pancreatitis, in both acute and chronic forms, poses a major therapeutic challenge and is associated with great morbidity and several complications. The nature of pancreatic injury in chronic pancreatitis (CP) and the wide range of causative processes that lead to CP have made effective therapy a true unmet need. Multiple physiological, genetic, environmental, and behavioral factors contribute to the development of CP. As a result, several fields of research are aimed at identifying and addressing the factors that contribute to pancreatic injury. In this article, we review the current understanding of the pathogenesis and natural history of CP. We focus on the autonomous nervous system, immune system, and role of a chronobiological therapeutic approach to alleviate symptoms and prevent or reverse pancreatic injury associated with CP. We aim to demonstrate that individualizing chronopharmacological treatments for CP is a promising direction for future treatment using immune, nervous, and circadian systems.
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Hermida RC, Hermida-Ayala RG, Smolensky MH, Mojón A, Crespo JJ, Otero A, Ríos MT, Domínguez-Sardiña M, Fernández JR. Does Timing of Antihypertensive Medication Dosing Matter? Curr Cardiol Rep 2020; 22:118. [DOI: 10.1007/s11886-020-01353-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lin HZ, Hsieh TC, Wu JL, He MS, Lee YC. Systemic Alpha1-Adrenoceptor Antagonists and Increased Risk of Open-Angle Glaucoma: A Nationwide Population-Based Cohort Study. Invest Ophthalmol Vis Sci 2020; 61:15. [PMID: 32766746 PMCID: PMC7441300 DOI: 10.1167/iovs.61.10.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the risk of open-angle glaucoma (OAG) among patients receiving alpha1-adrenoceptor (α1-AR) antagonists for lower urinary tract symptoms (LUTS). Methods This was a nationwide, population-based, retrospective cohort study from Asia/Taiwan. One million beneficiaries were randomly sampled from among 27.38 million individuals enrolled in the National Health Insurance program, and subjects with a diagnosis of LUTS from 2001 to 2012 were identified (N = 105,341). After 1:1 propensity score matching by gender, age, comorbid medical diseases, number of all medical visits during the observational period, and index date, 4081 patients were enrolled in the study group, comprised of patients who had taken α1-AR antagonists, and 4081 patients were enrolled in the control group, comprised of patients who had never taken α1-AR antagonists. The incidence and risk of OAG (defined as two ambulatory visits with a ICD-9 diagnosis code 365, excluding ICD-9 diagnosis codes 365.2–365.6, 365.02, 365.03, 365.13, 365.14, and 365.8) were calculated. Results Patients taking α1-AR antagonists had a higher incidence ratio of 1.86 (95% confidence interval [CI], 1.30–2.65) for developing OAG. After adjusting for age, gender, and comorbidities, the hazard ratio (HR) for OAG for patients taking α1-AR antagonists was 1.66 (95% CI, 1.16–2.39; P = 0.006). Among patients with hypertension, the hazard ratio for OAG associated with taking α1-AR antagonists increased to 1.79 (95% CI, 1.07–2.99; P = 0.003). On the other hand, the association of α1-AR antagonists with OAG was not significant among patients with diabetes mellitus, hyperlipidemia, or older age. Conclusions The findings of our study suggest an increased risk for OAG among patients taking α1-AR antagonists for LUTS, especially in patients with hypertension.
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Affiliation(s)
- Hong-Zin Lin
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | | | - Jung-Lun Wu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Ming-Shan He
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
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Yap T, Affandi JS, Reid CM, Xu D. Translating research evidence into clinical practice: a reminder of important clinical lessons in management of resistant hypertension through a case study in general practice. BMJ Case Rep 2020; 13:e235007. [PMID: 32606122 PMCID: PMC7328755 DOI: 10.1136/bcr-2020-235007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 11/04/2022] Open
Abstract
A case of a 59-year-old man with resistant hypertension, despite 8 months of non-pharmacological and pharmacological management up to maximal doses of triple antihypertensive therapy. Review of the literature found a study that reported improved blood pressure control with bedtime dosing of antihypertensive treatment. Changing to bedtime dosage of antihypertensives resulted in significant improvement in blood pressure control to below target levels. This highlights the importance of the clinicians' awareness and implementation of research findings and hence delivery of best evidence-based care.
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Affiliation(s)
- Timothy Yap
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Jacquita S Affandi
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Dan Xu
- Department of General Practice, Curtin University Bentley Campus, Perth, Western Australia, Australia
- Department of Medical Education, Sun Yan-sen University of Medical Sciences, Guangzhou, China
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40
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Hermida RC, Smolensky MH, Mojón A, Crespo JJ, Ríos MT, Domínguez-Sardiña M, Otero A, Fernández JR. New perspectives on the definition, diagnosis, and treatment of true arterial hypertension. Expert Opin Pharmacother 2020; 21:1167-1178. [PMID: 32543325 DOI: 10.1080/14656566.2020.1746274] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Office blood pressure measurements (OBPM), still used today for diagnosis and management of hypertension, fail to reveal clinically important features of the mostly predictable blood pressure (BP) 24 h pattern, and lead to >45% of individuals being misclassified. Current hypertension guidelines do not provide recommendation on when-to-treat, despite multiple prospective clinical trials documenting improved normalization of 24 h BP pattern and significant reduction in cardiovascular disease (CVD) events when hypertension medications are ingested at bedtime rather than upon waking. AREAS COVERED In this review, the authors discuss current evidence on the: (i) most relevant attributes of the 24 h BP pattern deterministic of CVD risk; (ii) asleep systolic BP (SBP) mean as the most significant therapeutic target for CVD risk reduction; (iii) ingestion-time differences in pharmacodynamics of BP-lowering medications as reported with high consistency in multiple clinical trials; and (iv) enhanced prevention of CVD events achieved by bedtime hypertension chronotherapy. EXPERT OPINION Several prospective trials consistently document asleep SBP mean and sleep-time relative SBP decline (dipping) constitute highly significant CVD risk factors, independent of OBPM. Bedtime, compared to customary upon-waking, hypertension chronotherapy reduces risk of major CVD events. Collectively, these findings call for new definition of true hypertension and, accordingly, its proper diagnosis and management.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin , Austin, TX, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS) , Vigo, Spain
| | - María T Ríos
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS) , Vigo, Spain
| | | | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS) , Ourense, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain
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Silva FRD, Guerreiro RDC, Andrade HDA, Stieler E, Silva A, de Mello MT. Does the compromised sleep and circadian disruption of night and shiftworkers make them highly vulnerable to 2019 coronavirus disease (COVID-19)? Chronobiol Int 2020; 37:607-617. [PMID: 32432519 DOI: 10.1080/07420528.2020.1756841] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Rotating and permanent night shiftwork schedules typically result in acute and sometimes chronic sleep deprivation plus acute and sometimes chronic disruption of the circadian time structure. Immune system processes and functionalities are organized as circadian rhythms, and they are also strongly influenced by sleep status. Sleep is a vital behavioral state of living beings and a modulator of immune function and responsiveness. Shiftworkers show increased risk for developing viral infections due to possible compromise of both innate and acquired immunity responses. Short sleep and sleep loss, common consequences of shiftwork, are associated with altered integrity of the immune system. We discuss the possible excess risk for COVID-19 infection in the context of the common conditions among shiftworkers, including nurses, doctors, and first responders, among others of high exposure to the contagion, of sleep imbalance and circadian disruption. ABBREVIATIONS ACE2: Angiotensin-converting enzyme 2; APC: Antigen.-presenting .cells; CCL: Chemokine (C-C motif) ligand; CD+: .Adhesion molecule expression; COVID-19: 2019 coronavirus disease; DCs: Dendritic cells; GH: Growth hormone; HPA: Hypothalamic-pituitary-adrenal; HSF: Heat shock factor; HSP70: Heat shock protein 70; HSP90: Heat shock protein 90; IL: Interleukin; INFγ: Interferon-gamma; LT/LB: T/B lymphocytes; MHC: Major histocompatibility complex; NK: Natural .killer; RAAS: renin-angiotensin-aldosterone system; SARS: .Severe acute respiratory syndrome; SCN: Suprachiasmatic nucleus;SD: Sleep deprivation; SNS: Sympathetic nervous system; Th1/Th2: T helper lymphocytes 1/2; TLR2/TLR4: Toll-like receptor 2/4; TNF-α: Tumor .necrosis .factor alpha; VEGF: Vascular endothelial growth factor.
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Affiliation(s)
| | | | | | - Eduardo Stieler
- Department of Sports, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Andressa Silva
- Department of Sports, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Marco Túlio de Mello
- Department of Sports, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
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Yan L, Jin J, Jiang S, Zhu W, Gao M, Zhao X, Yuan J. QTc Interval Predicts Disturbed Circadian Blood Pressure Variation. Open Med (Wars) 2020; 15:139-146. [PMID: 32190737 PMCID: PMC7065424 DOI: 10.1515/med-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/07/2020] [Indexed: 11/15/2022] Open
Abstract
Background The relationship between electrocardiographic evaluation and circadian blood pressure (BP) variation in young and middle-aged hypertensive patients remains unknown. Methods A total of 171 hypertensive patients were included in the study. First, patients were divided into a young and middle-aged group and an elderly group. The two groups were then separately classified into three subgroups on the basis of circadian variation of BP as dippers, non-dippers and reverse-dippers. The electrocardiographic evaluation was calculated from 12-lead electrocardiography (ECG). Results QTc intervals were shortest in the dippers and longest in the reverse-dippers in the young and middle-aged group (QTc dipper: 416.53±18.37ms; non-dipper: 438.30±29.71ms; reverse-dipper: 444.93±25.47ms; for dipper vs non-dipper, and dipper vs reverse-dipper P<0.05). QTc interval was found to be an independent risk factor for the non-dipper BP pattern (Odds ratio 1.049; 95% CI 1.01-1.089; P=0.012) and reverse-dipper BP pattern (Odds ratio 1.051; 95% CI 1.007-1.098; P=0.023) in young and middle-aged hypertensive patients. No significant differences in other ECG parameters were found among the three subgroups in the young and middle-aged group. Conclusion Our study suggested that QTc interval might serve as a risk factor for non-dipper BP pattern and reverse-dipper BP pattern in young and middle-aged hypertensive patients.
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Affiliation(s)
- Liyuan Yan
- Department of Cardiology, the First Affiliated Hospital of Soochow University, No.188, Shizi Road, Suzhou, 215006, Jiangsu, China
| | - Jianling Jin
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Shili Jiang
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Wei Zhu
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Meiwen Gao
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xin Zhao
- Department of Cardiology, the First Affiliated Hospital of Soochow University, No.188, Shizi Road, Suzhou, 215006, Jiangsu, China
| | - Jiamin Yuan
- Department of Cardiology, the First Affiliated Hospital of Soochow University, No.188, Shizi Road, Suzhou, 215006, Jiangsu, China
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Yan L, Jin J, Zhao X, Huang X, Zhu W, Jiang S, Gao M, Yuan J. Heart rate acceleration and deceleration capacities associated with circadian blood pressure variation. Ann Noninvasive Electrocardiol 2020; 25:e12748. [PMID: 32103582 PMCID: PMC7358884 DOI: 10.1111/anec.12748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background Heart rate acceleration and deceleration capacities are novel parameters that can quantify sympathetic and vagal modulation. However, how acceleration and deceleration capacities associated with circadian blood pressure (BP) variation remains unknown. Methods A total of 141 patients with essential hypertension were included in our study. Based on the nocturnal decline rate of systolic BP (SBP), patients were divided into two groups, as dippers and nondippers. Baseline demographic characteristics, ambulatory blood pressure monitoring (ABPM) parameters, Holter recordings, and echocardiographic parameters were collected. Results The absolute values of acceleration capacity (AC) (−7.75 [−8.45 ~ −6.3] ms vs. −6.6 [−8.25 ~ −5.2] ms, p = .047) and deceleration capacity (DC) (7.35 [6.1 ~ 8.1] ms vs. 6.3 [5.1 ~ 7.6] ms, p = .042) were significantly higher in dippers than in nondippers. By multivariate logistic regression analysis, left atrial diameter (LAd) was found to be an independent risk factor for nondipper status in acceleration capacity model (odds ratio 1.174, 95% confidence interval 1.019–1.354, p = .027) and deceleration model (odds ratio 1.146, 95% confidence interval 1.003–1.309, p = .045). Sleep SBP was positively correlated to acceleration capacity (r = .256, p = .002) and negatively correlated to deceleration capacity (r = −.194, p = .021). Conclusions The absolute values of acceleration capacity and deceleration capacity were higher in patients with dipper hypertension than in patients with nondipper hypertension. However, acceleration and deceleration capacities were not independent risk factors for blunted BP variation. Sleep SBP seemed to be better correlated to the impairment of autonomic nervous system (ANS) function than other ABPM parameters.
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Affiliation(s)
- Liyuan Yan
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianling Jin
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Zhao
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingmei Huang
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Zhu
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shili Jiang
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meiwen Gao
- Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiamin Yuan
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Xu Y, Zhou X, Zheng Y, Guan H, Fu C, Xiao J, Ye Z. The association of urinary uric acid excretion with ambulatory blood pressure values in patients with chronic kidney disease. Clin Hypertens 2020; 26:4. [PMID: 32082613 PMCID: PMC7023683 DOI: 10.1186/s40885-020-0136-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To analyze the association between hypertension and urinary uric acid excretion in patients with chronic kidney disease (CKD). METHODS We screened 87 patients who had been admitted at the Dept of Nephrology, Huadong hospital between April 2017 to April 2019 who had completed 24-h ambulatory blood pressure monitoring and retained 24-h urine biochemical test specimens, thirty adult patients (age ≤ 65 years) with CKD 1-2 stages were recruited in the study. Pearson's correlation analysis and multiple linear regression analysis were used to study the correlation of urinary uric acid excretion with ambulatory blood pressure values and the association of morning mean diastolic pressure (mMDP), night mean diastolic pressure (nMDP) and CV of dMSP (coefficient of variation of day mean systolic pressure) with fractional excretion of uric acid (FEua) and uric acid clearance rate (Cur). Independent T test was used to compare the differences of blood pressure values in FEua1 (FEua< 6.0%) and FEua2 (FEua≥6.0%) or Cur1 (Cur < 6.2 ml/min/1.73 m2) and Cur2 (Cur ≥ 6.2 ml/min/1.73m2) groups according to the median of FEua or Cur, respectively. RESULTS After adjusting for confounding factors, multiple linear regression analysis showed that FEua was positively associated with the mMDP and nMDP, Cur was positively associated with CV of dMSP. Levels of mMDP and nMDP in FEua1 group was lower than that in FEua2 group (both P < 0.05), level of CV of dMSP in Cur2 group were higher than that in Cur1 group (P < 0.01). CONCLUSIONS We demonstrated that there is a positive correlation of FEua with morning and night mean diastolic pressure separately and Cur is positively related to CV of dMSP in CKD population. Monitoring the trend of urinary uric acid, may have a role in the early detection for hypertension or relative risks in the population of CKD.
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Affiliation(s)
- Ying Xu
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
| | - Xun Zhou
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
| | - Yuqi Zheng
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
| | - Haochen Guan
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
| | - Chensheng Fu
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
| | - Jing Xiao
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
| | - Zhibin Ye
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan’an Road, Shanghai, 200040 People’s Republic of China
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Gupta R, Malik AH, Popli T, Ranchal P, Yandrapalli S, Aronow WS. Impact of bedtime dosing of antihypertensives compared to morning therapy: A meta-analysis of randomised controlled trials. Eur J Prev Cardiol 2020; 28:e5-e8. [PMID: 34551083 DOI: 10.1177/2047487320903611] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rahul Gupta
- Department of Internal Medicine, Westchester Medical Center, USA
| | - Aaqib H Malik
- Department of Internal Medicine, Westchester Medical Center, USA
| | - Tarun Popli
- Department of Infectious Diseases, Westchester Medical Center, USA
| | - Purva Ranchal
- Department of Internal Medicine, Westchester Medical Center, USA
| | | | - Wilbert S Aronow
- Department of Internal Medicine, Westchester Medical Center, USA.,Department of Cardiology, Westchester Medical Center, USA
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Soliman RH, Johnston JG, Gohar EY, Taylor CM, Pollock DM. Greater natriuretic response to ENaC inhibition in male versus female Sprague-Dawley rats. Am J Physiol Regul Integr Comp Physiol 2020; 318:R418-R427. [PMID: 31913682 DOI: 10.1152/ajpregu.00060.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Genes for the epithelial sodium channel (ENaC) subunits are expressed in a circadian manner, but whether this results in time-of-day differences in activity is not known. Recent data show that protein expression of ENaC subunits is higher in kidneys from female rats, yet females are more efficient in excreting an acute salt load. Thus, our in vivo study determined whether there is a time-of-day difference as well as a sex difference in the response to ENaC inhibition by benzamil. Our results showed that the natriuretic and diuretic responses to a single dose of benzamil were significantly greater in male compared with female rats whether given at the beginning of the inactive period [Zeitgeber time 0 (ZT0), 7 AM] or active period (ZT12, 7 PM). However, the response to benzamil was not significantly different between ZT0 and ZT12 dosing in either male or female rats. There was no difference in renal cortical α-ENaC protein abundance between ZT0 and ZT12 or males and females. Given previous reports of flow-induced stimulation of endothelin-1 (ET-1) production and sex differences in the renal endothelin system, we measured urinary ET-1 excretion to assess the effects of increased urine flow on intrarenal ET-1. ET-1 excretion was significantly increased following benzamil administration in both sexes, but this increase was significantly greater in females. These results support the hypothesis that ENaC activity is less prominent in maintaining Na+ balance in females independent of renal ET-1. Because ENaC subunit genes and protein expression vary by time of day and are greater in female rat kidneys, this suggests a clear disconnect between ENaC expression and channel activity.
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Affiliation(s)
- Reham H Soliman
- Section of Cardio-renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jermaine G Johnston
- Section of Cardio-renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eman Y Gohar
- Section of Cardio-renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Crystal M Taylor
- Section of Cardio-renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David M Pollock
- Section of Cardio-renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Haikerwal A, Doyle LW, Cheung MM, Wark JD, Opie G, Roberts G, Patton G, Cheong JL. High Blood Pressure in Young Adult Survivors Born Extremely Preterm or Extremely Low Birthweight in the Post Surfactant Era. Hypertension 2020; 75:211-217. [DOI: 10.1161/hypertensionaha.119.13780] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More infants born extremely preterm (<28 weeks’ gestation) or extremely low birthweight (<1000 g) are surviving into adulthood in recent years. Preterm adolescents have higher blood pressure (BP) than normal birthweight controls, but how their BP changes with increasing age is not known. We compared BP at 25 years and trajectories of BP (change per year) from 18 to 25 years between survivors born <28 weeks/<1000 g and normal birthweight (>2499 g) controls born in the early 1990s, when survival rates began to rise. Participants were derived from 297 consecutive survivors born <28 weeks/<1000 g in 1991 to 1992 in Victoria, Australia, and 260 contemporaneous controls. At age 25 years, ambulatory BP was measured in 151 and 119 participants, respectively. Participants born <28 weeks/<1000 g had higher 24-hour systolic (mean difference 4.5 [95% CI, 1.2–7.7 mm Hg]), diastolic (3.4 [1.5–5.2 mm Hg]), and mean BPs (3.6 [1.4–5.8 mm Hg]) compared with the controls. Similar patterns were observed for both awake and asleep periods. Asleep ambulatory BP between 18 and 25 years increased more in participants born <28 weeks/<1000 g than in controls (systolic 0.56, diastolic 0.41, and mean 0.41 mm Hg increase per year; all
P
<0.05). Young adults born <28 weeks/<1000 g in the post surfactant era have higher BP and an increased trajectory of ambulatory BP compared with controls. With more survivors born <28 weeks/<1000 g now reaching adulthood, these findings are important for early detection and timely management of hypertension in this high-risk population.
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Affiliation(s)
- Anjali Haikerwal
- From the Newborn Services, The Royal Women’s Hospital, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
| | - Lex W. Doyle
- From the Newborn Services, The Royal Women’s Hospital, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Department of Obstetrics and Gynecology, The Royal Women’s Hospital (L.W.D., G.O., J.L.Y.C.), The University of Melbourne, Australia
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
| | - Michael M. Cheung
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
- Heart Research, Murdoch Children’s Research Institute, Melbourne, Australia (M.M.C.)
- Department of Cardiology, Royal Children’s Hospital, Melbourne, Australia (M.M.C.)
| | - John D. Wark
- Department of Medicine, The Royal Melbourne Hospital (J.D.W.), The University of Melbourne, Australia
- Bone and Mineral Medicine, The Royal Melbourne Hospital, Australia (J.D.W.)
| | - Gillian Opie
- Department of Obstetrics and Gynecology, The Royal Women’s Hospital (L.W.D., G.O., J.L.Y.C.), The University of Melbourne, Australia
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia (G.O.)
| | - Gehan Roberts
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
- Centre for Community Child Health (G.R.), Royal Children’s Hospital, Melbourne, Australia
| | - George Patton
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
- Centre for Adolescent Health (G.P.), Royal Children’s Hospital, Melbourne, Australia
| | - Jeanie L.Y. Cheong
- From the Newborn Services, The Royal Women’s Hospital, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Department of Obstetrics and Gynecology, The Royal Women’s Hospital (L.W.D., G.O., J.L.Y.C.), The University of Melbourne, Australia
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48
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Ren M, Zhang H, Benmarhnia T, Jalaludin B, Dong H, Wu K, Wang Q, Huang C. Short-term effects of real-time personal PM2.5 exposure on ambulatory blood pressure: A panel study in young adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 697:134079. [PMID: 31484088 DOI: 10.1016/j.scitotenv.2019.134079] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/03/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Short-term exposure to PM2.5 has been shown to be associated with changes in blood pressure. However, most of the evidence is based on PM2.5 measurements from fixed stations and resting blood pressure measured at a regular time. OBJECTIVES To evaluate the short-term daily and hourly effects of real-time personal PM2.5 exposure on ambulatory blood pressure, and to compare the effects with those of PM2.5 exposure from fixed stations. METHODS Between April 2017 and December 2017, 37 young adults were recruited in a panel study from a central urban area and a suburban area, to measure personal hourly PM2.5 and ambulatory systolic blood pressure (SBP) as well as diastolic blood pressure (DBP) for three consecutive days. Hourly PM2.5 concentrations were also obtained from the nearest monitoring station operated by Guangdong Environmental Monitoring Center. Generalized additive mixed model was employed to evaluate the effects of PM2.5 on ambulatory blood pressure. RESULTS During the study period, the mean concentration of personal PM2.5 exposure was 60.30 ± 52.14 μg/m3, while the value of PM2.5 from fixed stations was 36.77 ± 21.52 μg/m3. Both personal PM2.5 exposure and exposure from fixed stations averaged over the previous 1 to 3 days decreased blood pressure. During daytime, a 10 μg/m3 increase in 1-day moving average of personal PM2.5 was associated with a 0.54 mmHg (95% CI: -1.03, -0.05) and 0.22 mmHg (95% CI: -0.59, 0.15) decrease in SBP and DBP, respectively. When using PM2.5 exposures from fixed stations, the decrease in SBP and DBP were 0.95 mmHg (95% CI: -1.82, -0.07) and 0.74 mmHg (95% CI: -1.46, -0.03). Stratified analysis showed stronger effects in the central urban area and among males. CONCLUSIONS Both personal PM2.5 exposure and exposure from fixed stations averaged over the previous 1 to 3 days decreased blood pressure. Stronger effects were found in a central urban area and among males.
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Affiliation(s)
- Meng Ren
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Huanhuan Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California San Diego, USA.
| | - Bin Jalaludin
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Australia.
| | - Haotian Dong
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Kaipu Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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49
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Gottlieb JF, Benedetti F, Geoffroy PA, Henriksen TEG, Lam RW, Murray G, Phelps J, Sit D, Swartz HA, Crowe M, Etain B, Frank E, Goel N, Haarman BCM, Inder M, Kallestad H, Jae Kim S, Martiny K, Meesters Y, Porter R, Riemersma-van der Lek RF, Ritter PS, Schulte PFJ, Scott J, Wu JC, Yu X, Chen S. The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology. Bipolar Disord 2019; 21:741-773. [PMID: 31609530 DOI: 10.1111/bdi.12847] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence. METHODS PRISMA-based systematic review of the literature. RESULTS The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated. CONCLUSIONS The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.
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Affiliation(s)
- John F Gottlieb
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Chicago Psychiatry Associates, Chicago, IL, USA
| | | | - Pierre A Geoffroy
- Department of Psychiatry and Addictive Medicine, University Hospital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris Diderot University - Paris VII, Paris, France
| | - Tone E G Henriksen
- Faculty of Medicine, Section for Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Faculty of Psychology, Bergen Stress and Sleep Group, University of Bergen, Bergen, Norway.,Valen Hospital, Fonna Health Authority, Division of Mental Health Care, Valen, Norway
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Greg Murray
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Dorothy Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Holly A Swartz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Bruno Etain
- Department of Psychological Medicine, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Namni Goel
- Department of Psychiatry Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bartholomeus C M Haarman
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maree Inder
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Håvard Kallestad
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Psychiatry, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Seong Jae Kim
- Department of Psychiatry, Doeun Hospital, Jincheon, Korea
| | - Klaus Martiny
- Department of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
| | - Ybe Meesters
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Rixt F Riemersma-van der Lek
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Philipp S Ritter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Joseph C Wu
- Department of Psychiatry & Human Behavior, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Xin Yu
- Department of Public Mental Health, Peking University Institute of Mental Health, Beijing, China
| | - Shenghao Chen
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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50
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Mahdi A, Watkinson P, McManus RJ, Tarassenko L. Circadian Blood Pressure Variations Computed From 1.7 Million Measurements in an Acute Hospital Setting. Am J Hypertens 2019; 32:1154-1161. [PMID: 31418774 PMCID: PMC7427624 DOI: 10.1093/ajh/hpz130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/14/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knowledge of the circadian blood pressure (BP) variations in the acute hospital setting is very limited. METHODS This is a retrospective analysis of BP data for in-hospital patients stratified by age and sex. We used data collected with the help of a standardized electronic health record system between March 2014 and April 2018 on the adult general wards in 4 acute hospitals in Oxford, UK. RESULTS A total of 41,455 unique patient admissions with 1.7 million sets of vital-sign measurements have been included in the study. The typical 24-hour systolic BP profile (dipping pattern during sleep followed by a gradual increase during the day) was only seen in the younger age groups (up to 40–49 for men and 30–39 for women). For older age groups, there was a late nocturnal rise in systolic BP, the amplitude of which increased with age. The late nocturnal BP rise above the age of 50 was seen whether or not the patient was treated for or previously identified with hypertension. CONCLUSION Hospitalized patients’ circadian patterns of BP largely mirror those found in the community. High-quality hospital data may allow for the identification of patients at significant cardiovascular risk through either opportunistic screening or systematic screening.
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Affiliation(s)
- Adam Mahdi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, Oxford, UK
- Sensyne Health, Schrödinger Building, Heatley Road, Oxford Science Park, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Sensyne Health, Schrödinger Building, Heatley Road, Oxford Science Park, Oxford, UK
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