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Sherwood A, Ulmer C, Wu JQ, Blumenthal JA, Herold E, Smith PJ, Koch GG, Johnson K, Viera A, Edinger J, Hinderliter A. Cognitive behavior therapy for insomnia for untreated hypertension with comorbid insomnia disorder: The SLEEPRIGHT clinical trial. J Clin Hypertens (Greenwich) 2024; 26:441-447. [PMID: 38468418 PMCID: PMC11007791 DOI: 10.1111/jch.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 03/13/2024]
Abstract
Insomnia and poor sleep are associated with an increased risk of developing cardiovascular disease (CVD) and its precursors, including hypertension. In 2022, the American Heart Association (AHA) added inadequate sleep to its list of health behaviors that increase the risk for CVD. It remains unknown, however, whether the successful treatment of insomnia and inadequate sleep can reduce heightened CVD risk. SLEEPRIGHT is a single-site, prospective clinical trial designed to evaluate whether the successful treatment of insomnia results in improved markers of CVD risk in patients with untreated hypertension and comorbid insomnia disorder. Participants (N = 150) will undergo baseline assessments, followed by a 6-week run-in period after which they will receive cognitive behavior therapy for insomnia (CBT-I), comprised of 6 hourly sessions with an experienced CBT-I therapist over a 6-week period. In addition to measures of insomnia severity, as well as both subjective and objective measures of sleep, the primary outcome measures are nighttime blood pressure (BP) and BP dipping assessed by 24-h ambulatory BP monitoring (ABPM). Secondary outcomes include several CVD risk biomarkers, including clinic BP, lipid profile, vascular endothelial function, arterial stiffness, and sympathetic nervous system (SNS) activity. Data analysis will evaluate the association between improvements in insomnia and sleep with primary and secondary CVD risk biomarker outcomes. The SLEEPRIGHT trial (ClinicalTrials.Gov NCT04009447) will utilize CBT-I, the current gold standard treatment for insomnia disorder, to evaluate whether reducing insomnia severity and improving sleep are accompanied by improved biomarkers of CVD risk in patients with untreated hypertension.
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Affiliation(s)
| | - Christi Ulmer
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Jade Q. Wu
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Emma Herold
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Patrick J. Smith
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Gary G. Koch
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Anthony Viera
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Alan Hinderliter
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Blumenthal JA, Smith PJ, Mabe S, Hinderliter A, Craighead L, Watkins LL, Ingle K, Tyson CC, Lin PH, Kraus WE, Liao L, Sherwood A. Effects of Lifestyle Modification on Psychosocial Function in Patients With Resistant Hypertension: SECONDARY OUTCOMES FROM THE TRIUMPH RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2024; 44:64-70. [PMID: 37220236 PMCID: PMC10667561 DOI: 10.1097/hcr.0000000000000801] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE In a secondary analysis of the TRIUMPH clinical trial, psychological outcomes in patients with resistant hypertension (RH) receiving a diet and exercise intervention delivered in a cardiac rehabilitation setting were compared with those receiving a similar prescription of diet and exercise provided in a single counseling session by a health educator. METHODS One hundred forty patients with RH were randomly assigned to a 4-mo program of dietary counseling, behavioral weight management, and exercise (C-LIFE) or a single counseling session providing standardized education and physician advice (SEPA). Participants completed a battery of questionnaires to assess psychological functioning before and after the intervention. A global measure of psychological functioning was derived from the General Health Questionnaire (GHQ), Perceived Stress Scale (PSS), Medical Outcomes Study 36-item Short Form Health Survey, Spielberger State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory-II, and Patient-Reported Outcomes Measurement Information System (PROMIS) Anger scale. RESULTS Participants in the C-LIFE intervention achieved greater improvements in psychological functioning compared with SEPA (C-LIFE: 58.9 [56.1, 61.8] vs SEPA: 66.5 [62.1, 70.9]; P = .024). Greater improvements were especially evident for the GHQ, PSS, and HADS. Examination of mediation revealed that greater weight loss ( B =-0.17, P = .004) and improved oxygen uptake ( B =-0.12, P = .044) were associated with improved psychological functioning. CONCLUSION Compared with standard education and physician advice, a structured program of diet and exercise not only reduced blood pressure but also improved psychological functioning in patients with RH.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Alan Hinderliter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Linda Craighead
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Krista Ingle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Crystal C. Tyson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Pao-Hwa Lin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - William E. Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Lawrence Liao
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
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Viamonte SG, Joaquim AV, Alves AJ, Vilela E, Capela A, Ferreira C, Duarte BF, Rato ND, Teixeira MP, Tavares A, Santos M, Ribeiro F. Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk: A Randomized Clinical Trial. JAMA Cardiol 2023; 8:1119-1128. [PMID: 37819656 PMCID: PMC10568446 DOI: 10.1001/jamacardio.2023.3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023]
Abstract
Importance Cardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance. Objective To assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk. Design, Setting, and Participants This prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention. Interventions Participants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week. Main Outcomes and Measures The powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy. Results A total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (-12.3 [11.8] mm Hg vs -1.9 [12.9] mm Hg; P < .001), diastolic BP (-5.0 [5.7] mm Hg vs -0.5 [7.0] mm Hg; P = .003), and BMI (-1.2 [0.9] vs 0.2 [0.7]; P < .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P < .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P < .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P < .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P < .001). Conclusion and Relevance The CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy. Trial Registration ClinicalTrials.gov Identifier: NCT05132998.
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Affiliation(s)
- Sofia Gonçalves Viamonte
- North Rehabilitation Center, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Ana Vieira Joaquim
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Jorge Alves
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Maia, Portugal
| | - Eduardo Vilela
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Andreia Capela
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Ferreira
- Hematology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Barbara Fresco Duarte
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Nuno Dias Rato
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Maia, Portugal
| | | | - Aida Tavares
- ISEG, Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
| | - Mário Santos
- Cardiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Investigation in Biomedicine, School of Medicine and Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- Institute of Biomedicine, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Ribeiro F, Teixeira M, Alves AJ, Sherwood A, Blumenthal JA. Lifestyle Medicine as a Treatment for Resistant Hypertension. Curr Hypertens Rep 2023; 25:313-328. [PMID: 37470944 DOI: 10.1007/s11906-023-01253-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Approximately 10% of the adults with hypertension fail to achieve the recommended blood pressure treatment targets on 3 antihypertensive medications or require ≥ 4 medications to achieve goal. These patients with 'resistant hypertension' have an increased risk of target organ damage, adverse clinical events, and all-cause mortality. Although lifestyle modification is widely recommended as a first-line approach for the management of high blood pressure, the effects of lifestyle modifications in patients with resistant hypertension has not been widely studied. This review aims to provide an overview of the emerging evidence on the benefits of lifestyle modifications in patients with resistant hypertension, reviews potential mechanisms by which lifestyles may reduce blood pressure, and discusses the clinical implications of the recent findings in this field. RECENT FINDINGS Evidence from single-component randomized clinical trials demonstrated that aerobic exercise, weight loss and dietary modification can reduce clinic and ambulatory blood pressure in patients with resistant hypertension. Moreover, evidence from multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce clinic and ambulatory blood pressure, and improve biomarkers of cardiovascular risk. This new evidence supports the efficacy of lifestyle modifications added to optimized medical therapy in reducing blood pressure and improving cardiovascular risk biomarkers in patients with resistant hypertension. These findings need to be confirmed in larger studies, and the persistence of benefit over extended follow-up needs further study.
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Affiliation(s)
- Fernando Ribeiro
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Manuel Teixeira
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Alberto J Alves
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Castêlo da Maia, Portugal
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
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Champaneria MK, Patel RS, Oroszi TL. When blood pressure refuses to budge: exploring the complexity of resistant hypertension. Front Cardiovasc Med 2023; 10:1211199. [PMID: 37416924 PMCID: PMC10322223 DOI: 10.3389/fcvm.2023.1211199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Resistant hypertension, defined as blood pressure that remains above goal despite using three or more antihypertensive medications, including a diuretic, affects a significant proportion of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Despite the availability of a wide range of pharmacological therapies, achieving optimal blood pressure control in patients with resistant hypertension remains a significant challenge. However, recent advances in the field have identified several promising treatment options, including spironolactone, mineralocorticoid receptor antagonists, and renal denervation. In addition, personalized management approaches based on genetic and other biomarkers may offer new opportunities to tailor therapy and improve outcomes. This review aims to provide an overview of the current state of knowledge regarding managing resistant hypertension, including the epidemiology, pathophysiology, and clinical implications of the condition, as well as the latest developments in therapeutic strategies and future prospects.
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Lifestyle modification and cognitive function among individuals with resistant hypertension: cognitive outcomes from the TRIUMPH trial. J Hypertens 2022; 40:1359-1368. [PMID: 35703293 PMCID: PMC9246836 DOI: 10.1097/hjh.0000000000003151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia. Lifestyle modification has been suggested to improve cognitive function through its salutary effects on vascular function. METHODS Participants included 140 patients with resistant hypertension participating in the TRIUMPH trial. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA). Participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. Biomarkers of vascular [flow mediated dilation of the brachial artery (FMD)], microvascular, and cerebrovascular function were also collected, in addition to weight, fitness, and ambulatory blood pressure. RESULTS Participants averaged 63 years of age, 48% women, 59% black, and obese [mean BMI = 36 kg/m 2 (SD = 4)]. Cognitive performance improved across the entire cohort during the 4-month trial [ t -scores pretreatment = 48.9 (48, 50) vs. posttreatment = 50.0 (49, 51), P < 0.001]. Postintervention Executive Function/Learning composite performance was higher for participants in C-LIFE compared to SEPA ( d = 0.37, P = 0.039). C-LIFE intervention effects on Memory and Processing Speed were moderated by sex and baseline stroke risk, respectively ( P = 0.026 and P = 0.043 for interactions), such that males and participants with greater stroke risk showed the greatest cognitive changes. FMD [C-LIFE: +0.3% (-0.3, 1.0) vs. SEPA: -1.4% (-2.5, -0.3), P = 0.022], and microvascular function [C-LIFE: 97 (65, 130) vs. SEPA: 025 (-75, 23), P < 0.001] were improved in C-LIFE compared with SEPA, whereas cerebrovascular reactivity was not [C-LIFE: -0.2 (-0.4, 0) vs. SEPA: 0.1 (-0.2, 0.4), P = 0.197). Mediation analyses suggested that increased executive function/learning was associated with reduced ambulatory SBP levels secondary to weight loss [indirect effect: B = 0.25 (0.03, 0.71)]. CONCLUSION Lifestyle modification individuals with resistant hypertension improves cognition, which appeared to be associated with reduced ambulatory SBP changes through weight loss. Cognitive improvements were accompanied by parallel improvements in endothelial and microvascular function.
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Wang TD, Chiang CE, Chao TH, Cheng HM, Wu YW, Wu YJ, Lin YH, Chen MYC, Ueng KC, Chang WT, Lee YH, Wang YC, Chu PH, Chao TF, Kao HL, Hou CJY, Lin TH. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension. ACTA CARDIOLOGICA SINICA 2022; 38:225-325. [PMID: 35673334 PMCID: PMC9121756 DOI: 10.6515/acs.202205_38(3).20220321a] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Abstract
Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.
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Affiliation(s)
- Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Hao-Min Cheng
- School of Medicine, Institute of Public Health and Community Medicine Research Center, and Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital
| | - Yih-Jer Wu
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Yen-Hung Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Michael Yu-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
| | - Kwo-Chang Ueng
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Yu-Chen Wang
- Division of Cardiology, Department of Medicine, Asia University Hospital
- Department of Medical Laboratory Science and Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Tzu-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Hsien-Li Kao
- Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine Kaohsiung Medical University Hospital
- Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Smith PJ, Sherwood A, Hinderliter AL, Mabe S, Tyson C, Avorgbedor F, Watkins LL, Lin PH, Kraus WE, Blumenthal JA. Cerebrovascular Function, Vascular Risk, and Lifestyle Patterns in Resistant Hypertension. J Alzheimers Dis 2022; 87:345-357. [PMID: 35275539 DOI: 10.3233/jad-215522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) and blunted cerebral hemodynamic recruitment are thought to be important mechanisms linking hypertension to cerebrovascular and cognitive outcomes. Few studies have examined cardiovascular or dietary correlates of CVR among hypertensives. OBJECTIVE To delineate associations between cardiometabolic risk, diet, and cerebrovascular functioning among individuals with resistant hypertension from the TRIUMPH trial (n = 140). METHODS CVR was assessed by examining changes in tissue oxygenation (tissue oxygenation index [TOI] and oxygenated hemoglobin [HBO2]) using functional near-infrared spectroscopy (fNIRS) during a breath holding test, a standardized CVR assessment to elicit a hypercapnic response. Participants also underwent fNIRS during three cognitive challenge tasks. Vascular function was assessed by measurement of brachial artery flow mediated dilation and hyperemic flow response. Cardiometabolic fitness was assessed from peak VO2 on an exercise treadmill test and body mass index. Dietary patterns were quantified using the DASH eating score. Cognitive function was assessed using a 45-minute test battery assessing Executive Function, Processing Speed, and Memory. RESULTS Greater levels fitness (B = 0.30, p = 0.011), DASH compliance (B = 0.19, p = 0.045), and lower obesity (B = -0.30, p = 0.004), associated with greater changes in TOI, whereas greater flow-mediated dilation (B = 0.19, p = 0.031) and lower stroke risk (B = -0.19, p = 0.049) associated with greater HBO2. Similar associations were found for cerebral hemodynamic recruitment, and associations between CVR and cognition were moderated by duration of hypertension. CONCLUSION Impaired CVR elevated cardiometabolic risk, obesity, vascular function, and fitness among hypertensives.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Crystal Tyson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Forgive Avorgbedor
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lana L Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Pao-Hwa Lin
- Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Wake AD, Tuji TS, Sime AT, Mekonnin MT, Taji TM, Hussein AA. Nonadherence to Self-Care Practices, Antihypertensive Medications, and Associated Factors among Hypertensive Patients in a Follow-up Clinic at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional Study. Int J Hypertens 2021; 2021:7359318. [PMID: 34754517 PMCID: PMC8572638 DOI: 10.1155/2021/7359318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension is one of the most common noncommunicable diseases affecting several individuals globally. However, the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital is unknown. OBJECTIVE To assess the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital, Arsi Zone, Oromia Regional State, Ethiopia, in 2020. METHODS An institution-based cross-sectional survey was conducted on 115 hypertensive patients who visited the follow-up clinic at Asella Referral and Teaching Hospital from December 24, 2020, to January 15, 2021. Data were entered into EpiData version 4.2.0.0 and exported to SPSS version 21.0 for statistical analysis. Binary and multivariable logistic regression analysis was used to assess the presence of statistical association between dependent and independent variables. RESULTS A total of 115 hypertensive patients were enrolled into the study, giving a response rate of 98.29%. The mean age of the study participants was 55.17 years (SD = 17.986). More than half of them (59 (51.3%)) were females. More than half of them (58 (50.4%)) were married. Nearly two-thirds of them (79 (68.7%)) had formal education. The level of nonadherence to self-care practices was 67.0% (n = 77, 95% CI: 60.0, 75.7). Meanwhile, the patient's level of nonadherence to antihypertensive medications was 16.5% (n = 19, 95% CI: 10.4, 24.3). The multivariable logistic regression analysis showed that age >45 years (AOR = 2.89, 95% CI: 1.16, 7.18), having no formal education (AOR = 1.67, 95% CI: 1.32, 3.74), and having ≤5 years' duration since diagnoses of hypertension (AOR = 1.56, 95% CI: 1.07, 3.25) were factors significantly associated with nonadherence to self-care practices. Being male (AOR = 2.09, 95% CI: 1.93, 9.59), being married (AOR = 4.22, 95% CI: 1.29, 13.76), and having an average monthly income of ≤2500 ETB (AOR = 1.58, 95% CI: 1.09, 7.08) were factors significantly associated with nonadherence to medications. CONCLUSION In the present study, the level of both nonadherence to self-care practices and antihypertensive medications was relatively high. There is a need to initiate programs that could create awareness about adherence to self-care practices and antihypertensive medications among hypertensive patients to improve their level of adherence.
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Techane Sisay Tuji
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
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Blumenthal JA, Hinderliter AL, Smith PJ, Mabe S, Watkins LL, Craighead L, Ingle K, Tyson C, Lin PH, Kraus WE, Liao L, Sherwood A. Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial. Circulation 2021; 144:1212-1226. [PMID: 34565172 DOI: 10.1161/circulationaha.121.055329] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although lifestyle modifications generally are effective in lowering blood pressure (BP) among patients with unmedicated hypertension and in those treated with 1 or 2 antihypertensive agents, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown. METHODS One hundred forty patients with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease) were randomly assigned to a 4-month program of lifestyle modification (C-LIFE [Center-Based Lifestyle Intervention]) including dietary counseling, behavioral weight management, and exercise, or a single counseling session providing SEPA (Standardized Education and Physician Advice). The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of the baroreflex on heart rate, high-frequency heart rate variability to assess vagally mediated modulation of heart rate, flow-mediated dilation to evaluate endothelial function, pulse wave velocity to assess arterial stiffness, and left ventricular mass to characterize left ventricular structure. RESULTS Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (-12.5 [95% CI, -14.9 to -10.2] mm Hg) compared with SEPA(-7.1 [-95% CI, 10.4 to -3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (-7.0 [95% CI, -8.5 to -4.0] mm Hg), with no change in SEPA (-0.3 [95% CI, -4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus -1.1 ms/mm Hg [95% CI, -2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms2 [95% CI, 0.2 to 0.6] versus -0.2 ln ms2 [95% CI, -0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, -0.3 to 1.0] versus -1.4% [95% CI, -2.5 to -0.3]; P=0.022). There were no between-group differences in pulse wave velocity (P=0.958) or left ventricular mass (P=0.596). CONCLUSIONS Diet and exercise can lower BP in patients with resistant hypertension. A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02342808.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill (A.L.H.)
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Lana L Watkins
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Linda Craighead
- Department of Psychology, Emory University, Atlanta, GA (L.C.)
| | - Krista Ingle
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Crystal Tyson
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - Pao-Hwa Lin
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - William E Kraus
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - Lawrence Liao
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
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Abstract
PURPOSE OF REVIEW In the United States (US), 46% of adults have hypertension (systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 80 mmHg). Approximately, 16% of patients with hypertension have apparent treatment-resistant hypertension (aTRH) and the incidence of true resistant hypertension (RHT) is thought to be much lower (~ 2%). These patients with RHT are at a higher risk for adverse events and worse clinical outcomes. RECENT FINDINGS Although lifestyle interventions have proven to be effective as the first line of defense in treating hypertension, their role in the management of patients with RHT is not well established. Despite fewer in number, available studies examining lifestyle interventions in patients with RHT do indeed show promising results. In this review, we aim to discuss the role of common lifestyle interventions such as physical activity, exercise, weight loss, and dietary modifications on blood pressure control in patients with RHT.
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12
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Sadeghi R, Masoudi MR, Patelarou A, Khanjani N. Predictive Factors for the Care and Control of Hypertension based on the Health Belief Model among hypertensive patients during the COVID-19 epidemic in Sirjan, Iran. Curr Hypertens Rev 2021; 18:78-84. [PMID: 34082684 DOI: 10.2174/1573402117666210603115309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypertension is a leading risk factor for morbidity and mortality around the world. Preventing this health problem is considered an important priority. The aim of this study was to investigate the predictive factors for care and control of hypertension (CCH) according to the health belief model (HBM) in patients with hypertension during the COVID-19 epidemic in Sirjan, Iran. METHODS In this cross-sectional study, participants were chosen by simple random sampling. Data were collected by a valid and reliable researcher-made questionnaire from 200 patients with high blood pressure aged 30-60 years. Data were analyzed by SPSS21 and analysis based on descriptive statistics, Pearson correlation coefficients and linear regression were conducted. RESULTS The results of Pearson correlation coefficients showed that there was a significant correlation between almost all constructs of Health Belief Model (HBM), but the strongest correlations were between self-efficacy and perceived susceptibility (r = 0.940, P ≤ 0.001), and between perceived barriers with perceived benefits (r = -0.615, P ≤ 0.001). According to linear regression, perceived barriers (β = -0.291), cues to action (β = -0.590), and knowledge (β = 0.973) predicted more than 26% of CCH variability. Knowledge had a stronger role than other variables. CONCLUSIONS The results of this study show that the constructs of the Health Belief Model can predict CCH in hypertensive patients. This model can be used as a tool for designing and implementing educational interventions to increase CCH among hypertensive patients.
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Affiliation(s)
- Reza Sadeghi
- Department of Public Health, Sirjan School of Medical Sciences, Sirjan. Iran
| | | | - Athina Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Heraklion. Greece
| | - Narges Khanjani
- Neurology Research Center, Kerman University of Medical Sciences, Kerman. Iran
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13
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A Systematic Review of the Efficacy of DASH Diet in Lowering Blood Pressure Among Hypertensive Adults. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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14
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Special Article - The management of resistant hypertension: A 2020 update. Prog Cardiovasc Dis 2020; 63:662-670. [PMID: 32795462 DOI: 10.1016/j.pcad.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 11/21/2022]
Abstract
Resistant hypertension (RH) induces higher morbidity and mortality due to cardiovascular disease and stroke than hypertension without treatment resistance. New guidelines define RH as blood pressure (BP) ≥130/80 mmHg in a patient taking ≥3 antihypertensive agents of different classes or BP <130/80 mmHg in a patient taking ≥4 antihypertensive drugs. According to the new definition, pseudo-resistance due to error in BP measurement, white coat effect and medication nonadherence must be excluded to make the diagnosis of RH. This 2020 update focuses on the lifestyle and antihypertensive drug management of RH and includes recent proof-of-principle trials of renal nerve ablation in hypertension. Stepwise evidence-based pharmacologic treatment of RH includes optimization of the 3-drug regimen, substitution of a thiazide-like for a thiazide diuretic and addition of a mineralocorticoid receptor antagonist as the fourth drug. Non-evidence-based recommendations include addition of a β-blocker as the fifth drug and switching to a minoxidil-based regimen as the final step in achieving BP control.
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15
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Pathan MK, Cohen DL. Resistant Hypertension: Where are We Now and Where Do We Go from Here? Integr Blood Press Control 2020; 13:83-93. [PMID: 32801854 PMCID: PMC7415451 DOI: 10.2147/ibpc.s223334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022] Open
Abstract
Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and American Heart Association now define resistant hypertension as blood pressure that remains above goal despite use of three maximally titrated anti-hypertensive medications including a diuretic or as a hypertensive patient who requires 4 or more agents for adequate BP control. These agents typically include a calcium-channel blocker, a renin-angiotensin system inhibitor, and a diuretic at maximal or maximally tolerated doses. As recognition of resistant hypertension increases, it is important to distinguish pseudo-resistant or apparent hypertension from true resistant hypertension. Etiologies of apparent resistant hypertension include measurement error and medication non-adherence. The prevalence of true resistant hypertension is likely much lower than reported in the literature when accounting for patients with apparent resistant hypertension. Evaluation of patients with true resistant hypertension includes screening for causes of secondary hypertension and interfering medications. Successful management of resistant hypertension includes lifestyle modification and optimization of medical therapy, often including the use of mineralocorticoid receptor antagonists. Looking ahead at developments in hypertension management, a slew of new device-based therapies are under active development. Of these, renal denervation is the closest to routine clinical application. Further study is needed before these devices can be recommended in the routine treatment of resistant hypertension.
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Affiliation(s)
- Mansur K Pathan
- Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, Philadelphia, PA19104, USA
| | - Debbie L Cohen
- Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, Philadelphia, PA19104, USA
- Correspondence: Debbie L Cohen; Mansur K Pathan Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA19104, USATel + 1 215-615-0794 Email ;
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Yuenyongchaiwat K, Thanawattano C, Buranapuntalug S, Pongpanit K, Saengkrut P. Development and application of a respiratory device on blood pressure in adults with high blood pressure. Interv Med Appl Sci 2020; 11:21-26. [PMID: 32148900 PMCID: PMC7044573 DOI: 10.1556/1646.10.2018.34] [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] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this study is to develop a prototype of a novel respiratory device that we validated and assessed clinically and examined the effect of prototype of respiratory device on blood pressure (BP). Methods Prototype of respiratory device (TU-Breath Training) was designed with pressure cuff and application software was created. The immediate effect of resisted breathing was determined in 20 adults with high BP (systolic BP ≥ 130 mmHg and diastolic BP ≥ 90 mmHg). A crossover study was designed. A total of 20 eligible participants were asked to sit quietly for 10 min. Heart rate (HR), BP, and oxygen saturation (SpO2) were measured and recorded. After the resting period, all participants were randomized and counterbalanced for undergoing the set of inspiratory muscle training by TU-Breath Training and control group. A set of respiratory training were composed of 10 times per set for three sets, while the control group was asked to sit for 10 min. Results After inspiratory training, both the systolic and diastolic BP decreased significantly. Compared with control group, using TU-Breath Training decreased systolic BP (−7.00 ± 5.93 mmHg) and diastolic BP (−5.95 ± 8.88 mmHg), but did not show differences in HR and SpO2. Conclusion The study indicated that in high-BP participants, the prototype of respiratory device (TU-Breath Training) elicits decreased BP.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
| | - Chusak Thanawattano
- Department of Biomedical Signal Processing Lab, National Electronics and Computer Technology Center (NECTEC), Pathum Thani, Thailand
| | - Sasipa Buranapuntalug
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
| | - Khajonsak Pongpanit
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
| | - Patcharin Saengkrut
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
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Dassanayake S, Sole G, Wilkins G, Skinner M. Exercise: a therapeutic modality to treat blood pressure in resistant hypertension. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1733781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Suranga Dassanayake
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gerard Wilkins
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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18
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Impact of therapeutic lifestyle changes in resistant hypertension. Prog Cardiovasc Dis 2019; 63:4-9. [PMID: 31756356 DOI: 10.1016/j.pcad.2019.11.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/17/2019] [Indexed: 12/25/2022]
Abstract
Hypertensive individuals are at an increased risk of developing heart disease and stroke. Adopting healthy lifestyles, such as being active on ≥4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN). Among the 1 in 3 Americans who have HTN (systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg), 16% are diagnosed with resistant HTN (RHT). Although there are comparatively fewer studies examining the blood pressure lowering effects of therapeutic lifestyle interventions in patients with resistant HTN, the available literature appears promising. This paper reviews key studies that quantify the blood pressure lowering effects of certain therapeutic lifestyles in patients with RHT and highlights areas needing more attention.
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 572] [Impact Index Per Article: 114.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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Smith PJ, Blumenthal JA, Hinderliter AL, Mabe SM, Schwartz JE, Avorgbedor F, Sherwood A. Neurocognition in treatment-resistant hypertension: profile and associations with cardiovascular biomarkers. J Hypertens 2019; 37:1040-1047. [PMID: 30921110 PMCID: PMC7279118 DOI: 10.1097/hjh.0000000000002002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertension in midlife has been associated with increased risk of stroke and neurocognitive decline. Few studies, however, have examined neurocognition among individuals with treatment-resistant hypertension or potential mechanisms by which treatment-resistant hypertension may impair neurocognition. METHODS We examined the pattern of neurocognitive impairment and potential mechanisms in a sample of 96 overweight adults with treatment-resistant hypertension, aged 41-81 years. Neurocognitive function was assessed using a 45-min test battery consisting of executive function and memory. Vascular and metabolic mechanisms examined included cerebrovascular risk factors (CVRFs: Framingham Stroke Risk Profile), insulin sensitivity (homeostatic model assessment of insulin resistance), waist-to-hip ratio, microvascular function (hyperemic response), and peak oxygen consumption from an exercise treadmill test. Simple path analyses were used to assess the association between potential vascular and metabolic mechanisms and neurocognition. RESULTS Neurocognitive impairments were common, with 70% of the sample exhibiting impaired performance on at least one executive function subtest and 38% on at least one measure of memory. Higher levels of aerobic fitness, greater insulin sensitivity, and better microvascular function, as well as lower CVRFs and waist-to-hip ratio were associated with better neurocognition. In path analyses, aerobic fitness, microvascular function, and CVRFs all were independently associated with neurocognitive performance. Insulin resistance associated with worse executive function but better memory performance among older participants. CONCLUSION Neurocognitive impairments are common in adults with treatment-resistant hypertension, particularly on tests of executive function. Better neurocognition is independently associated with aerobic fitness, microvascular function, and CVRFs.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham
| | - Alan L. Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie M. Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham
| | - Jeanne E. Schwartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham
| | - Forgive Avorgbedor
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham
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Kaczmarski KR, Sozio SM, Chen J, Sang Y, Shafi T. Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES). BMC Nephrol 2019; 20:138. [PMID: 31023262 PMCID: PMC6485047 DOI: 10.1186/s12882-019-1315-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Apparent treatment-resistant hypertension (aTRH) is a common condition associated with risk of cardiovascular events. However, the risk of cardiovascular mortality associated with aTRH in the US population is unknown. We aimed to assess the risk of cardiovascular disease (CVD) mortality associated with aTRH in the US population. Methods We analyzed data from 6357 adult hypertensive participants of the National Health and Nutrition Examination Survey (1988–1994 and 1999–2010) linked to the National Death Index. Based on presence of uncontrolled hypertension [blood pressure (BP) ≥140/90 mmHg] and the number of antihypertensives prescribed, we classified participants into the following groups: non-aTRH (BP < 140/90 mmHg and ≤ 3 antihypertensives); controlled aTRH (BP < 140/90 mmHg and ≥ 4 antihypertensives); and uncontrolled aTRH (BP ≥140/90 mmHg and ≥ 3 antihypertensives). Results Of the 6357 participants, 1522 had aTRH, representing a US prevalence of 7.6 million. Of the participants with aTRH, 432 had controlled aTRH and 1090 had uncontrolled aTRH. During follow-up (median 6 years), there were 550 CVD deaths. The cumulative incidence of CVD mortality was significantly higher in the aTRH group compared with non-aTRH group (log-rank p < 0.001). In fully adjusted models, aTRH was associated with a 47% higher risk of CVD mortality compared with the non-aTRH group [1.47 (1.1–1.96)]. Similar increase in risk of CVD mortality was noted across aTRH subgroups compared with the non-aTRH group: controlled aTRH [1.66 (1.03–2.68)] and uncontrolled aTRH [1.43 (1.05–1.94)]. Among non-aTRH subgroups, those on 3 antihypertensive medications had a 35% increased risk of CVD mortality than those on < 3 medications [1.35 (0.98–1.86)]. Conclusions aTRH is a common condition, affecting approximately 7.6 million Americans. Regardless of BP control, people with aTRH remain at a higher risk of cardiovascular outcomes. The risk of cardiovascular disease mortality remains high among those with controlled BP on 3 medications (non-aTRH) or ≥ 4 medications (controlled aTRH), groups not generally considered at high risk. Future risk reduction interventions should consider focusing on these high-risk groups. Electronic supplementary material The online version of this article (10.1186/s12882-019-1315-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katerina R Kaczmarski
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jingsha Chen
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tariq Shafi
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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22
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Sharman JE, Boutouyrie P, Laurent S. Arterial (Aortic) Stiffness in Patients with Resistant Hypertension: from Assessment to Treatment. Curr Hypertens Rep 2018; 19:2. [PMID: 28091867 DOI: 10.1007/s11906-017-0704-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of the review is to examine whether measurement of aortic stiffness could be especially value-adding for risk stratification and treatment among patients with resistant hypertension (RH). RECENT FINDINGS Adverse arterial remodeling and increased aortic stiffness is associated with RH, and it may be of additional clinical benefit to measure aortic stiffness in these patients. However, there is insufficient evidence to determine whether aortic stiffness is excessively high relative to the level of blood pressure (BP) among people with RH. This issue needs resolution as it could help refine management decisions guided by aortic stiffness. If conventional antihypertensive therapy fails to lower BP in patients with RH, there is good rationale for effectiveness of spironolactone as add on therapy, and this should also improve aortic stiffness. Lifestyle intervention with exercise and diet should be additionally efficacious towards improving BP and aortic stiffness in patients with RH, but there is limited data in this patient population. For better characterization on the effects of BP treatment on aortic stiffness, measures of central aortic BP may help refine management decisions above and beyond conventional arm cuff BP. There is strong evidence to support the use of aortic stiffness as a tool to aid risk stratification in hypertension management. Although there is a theoretical basis for special additional benefit of measuring aortic stiffness in patients with RH (as distinct from uncomplicated hypertension), at this time, there is inadequate data available to make definitive conclusions and is an area for future investigation.
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Affiliation(s)
- James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, Australia.
| | - Pierre Boutouyrie
- Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
| | - Stéphane Laurent
- Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
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23
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Blumenthal JA, Sherwood A. Missing ingredients for a lifestyle recipe to treat hypertension. J Thorac Dis 2018; 10:653-656. [PMID: 29608194 PMCID: PMC5864654 DOI: 10.21037/jtd.2018.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 03/22/2024]
Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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24
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Michishita R, Ohta M, Ikeda M, Jiang Y, Yamato H. Effects of Lifestyle Modification on an Exaggerated Blood Pressure Response to Exercise in Normotensive Females. Am J Hypertens 2017; 30:999-1007. [PMID: 28911021 DOI: 10.1093/ajh/hpx081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/01/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study was designed to examine the effects of a lifestyle modification on the improvement in an exaggerated systolic blood pressure (SBP) response to exercise in normotensive females. METHODS The subjects were 78 normotensive females with (n = 25) and without (n = 53) an exaggerated SBP response to exercise who were not taking any medications. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP: ≥190 mm Hg). A lifestyle modification program consisting of aerobic exercise and diet counseling was conducted for 12 weeks. The brachial-ankle pulse wave velocity (baPWV), plasma nitrate/nitrite (NOx), plasma thiobarbituric acid-reactive substances (TBARS), high-sensitivity C-reactive protein, fibrinogen levels, and the white blood cell (WBC) counts were measured before and after 12-week intervention. RESULTS After 12-week intervention, the exercise-induced SBP elevation decreased in an exaggerated SBP response group (P < 0.05). In addition, the plasma NOx significantly increased, and the WBC counts and plasma TBARS decreased in an exaggerated SBP response group (P < 0.05). In an exaggerated SBP response group, a stepwise multiple regression analysis showed that the percent change in exercise-induced SBP elevation was independently associated with the percent changes in the plasma NOx level and baPWV (r2 = 0.647, P < 0.0001). CONCLUSIONS These results suggest that a lifestyle modification is considered to be important for reducing an exaggerated SBP response to exercise by improving the arterial stiffness and nitric oxide bioavailability.
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Affiliation(s)
- Ryoma Michishita
- Department of Health Development, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanori Ohta
- Department of Health Development, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
- International College of Arts and Sciences, Department of Food and Health Science, Fukuoka Women's University, Fukuoka, Japan
| | | | - Ying Jiang
- Department of Health Development, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroshi Yamato
- Department of Health Development, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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25
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Braam B, Taler SJ, Rahman M, Fillaus JA, Greco BA, Forman JP, Reisin E, Cohen DL, Saklayen MG, Hedayati SS. Recognition and Management of Resistant Hypertension. Clin J Am Soc Nephrol 2017; 12:524-535. [PMID: 27895136 PMCID: PMC5338706 DOI: 10.2215/cjn.06180616] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events.
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Affiliation(s)
- Branko Braam
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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26
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27
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Affiliation(s)
- Raymond R. Townsend
- From the Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, FL
| | - Murray Epstein
- From the Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, FL
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28
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Azzarito T, Lugini L, Spugnini EP, Canese R, Gugliotta A, Fidanza S, Fais S. Effect of Modified Alkaline Supplementation on Syngenic Melanoma Growth in CB57/BL Mice. PLoS One 2016; 11:e0159763. [PMID: 27447181 PMCID: PMC4957829 DOI: 10.1371/journal.pone.0159763] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023] Open
Abstract
Tumor extracellular acidity is a hallmark of malignant cancers. Thus, in this study we evaluated the effects of the oral administration of a commercially available water alkalizer (Basenpulver®) (BP) on tumor growth in a syngenic melanoma mouse model. The alkalizer was administered daily by oral gavage starting one week after tumor implantation in CB57/BL mice. Tumors were calipered and their acidity measured by in vivo MRI guided 31P MRS. Furthermore, urine pH was monitored for potential metabolic alkalosis. BP administration significantly reduced melanoma growth in mice; the optimal dose in terms of tolerability and efficacy was 8 g/l (p< 0.05). The in vivo results were supported by in vitro experiments, wherein BP-treated human and murine melanoma cell cultures exhibited a dose-dependent inhibition of tumor cell growth. This investigation provides the first proof of concept that systemic buffering can improve tumor control by itself and that this approach may represent a new strategy in prevention and/or treatment of cancers.
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Affiliation(s)
- Tommaso Azzarito
- Department of Drug Research and Medicine Evaluation, National Institute of Health, Rome, Italy
| | - Luana Lugini
- Department of Drug Research and Medicine Evaluation, National Institute of Health, Rome, Italy
| | | | - Rossella Canese
- Department of Cell Biology and Neurosciences, National Institute of Health, Rome, Italy
| | - Alessio Gugliotta
- Department of Drug Research and Medicine Evaluation, National Institute of Health, Rome, Italy
| | - Stefano Fidanza
- Department of Drug Research and Medicine Evaluation, National Institute of Health, Rome, Italy
| | - Stefano Fais
- Department of Drug Research and Medicine Evaluation, National Institute of Health, Rome, Italy
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29
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Atherosclerotic Renal Artery Stenosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:209-213. [DOI: 10.1007/5584_2016_89] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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Valsan D, Burhan U, Teehan G. Resistant Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:181-189. [PMID: 27864800 DOI: 10.1007/5584_2016_38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Conservatively, ten million people in the USA alone may suffer from RH and may be similarly prevalent elsewhere. Given the strong linear correlation between hypertension and cardiovascular outcomes, better control is paramount. We favor a multi-pronged approach. It may not suffice to address this by pharmacologic means only. Careful attention to modifiable risk factors, particularly sodium intake, adhering to a proper diet (i.e. DASH), and avoiding agents, i.e. non-steroidals, that can elevate the blood pressure, is key. Frequent follow up to establish the right treatment regimen and home blood pressuring monitoring can have a strong impact on control. Finally, consideration of device therapy may be a more viable option in the future.
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Affiliation(s)
- Debbie Valsan
- Lankenau Medical Center, Lancaster Avenue, Suite 130, Wynnewood, PA, USA, 19096
| | - Umber Burhan
- Lankenau Medical Center, Lancaster Avenue, Suite 130, Wynnewood, PA, USA, 19096
| | - Geoffrey Teehan
- Lankenau Medical Center, Lancaster Avenue, Suite 130, Wynnewood, PA, USA, 19096
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