1
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Kario K, Hoshide S, Yamamoto K, Okura A, Rakugi H. Clinical studies on pharmacological treatment of hypertension in Japan. J Hum Hypertens 2024; 38:486-499. [PMID: 33963269 DOI: 10.1038/s41371-021-00533-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 12/16/2022]
Abstract
Differences in the epidemiology and phenotypes of hypertension in Japan compared with Western countries mean that optimal approaches to the pharmacological management of hypertension should be based on local data. Fortunately, there is a large body of evidence from studies conducted in Japanese populations to inform guidelines and treatment decisions. This article highlights treatment recommendations and BP targets for Japanese patients with hypertension, and summarizes key literature supporting these recommendations. The latest version of the Japanese Society of Hypertension (JSH) guidelines is consistent with US and European guidelines in recommending that the general BP target should be <130/80 mmHg for office blood pressure (BP) and <125/75 mmHg for home BP. There is good local evidence to support these targets. The JSH guidelines also strongly recommend that antihypertensive therapy is managed and monitored based on home BP, due to the closer association of this parameter with cardiovascular risk compared with office BP. Japan is a leader in out-of-office BP research, meaning that there is good evidence for the Japanese recommendations. Key features of antihypertensive agents for use in Japanese patients with hypertension include the ability to reduce stroke risk provide antihypertensive efficacy throughout the 24-h dosing period. Calcium channel blockers appear to be particularly effective in Asian populations, and are the most commonly prescribed agents in Japan. Again consistent with international recommendations, antihypertensive therapy should be started with a combination of agents to maximize the chances of achieving target BP.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayako Okura
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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2
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Nakagami H, Otsuka H, Akiyama H. Monitoring with wearable devices will clarify the association between indoor temperature and blood pressure. Hypertens Res 2023:10.1038/s41440-023-01261-7. [PMID: 36977899 DOI: 10.1038/s41440-023-01261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
The association of blood pressure and temperature is well known in seasonal observation, and low temperature in the winter season is often considered a cause of high blood pressure. The current evidence for short-term studies of temperature and blood pressure is based on the daily observation, however continuous monitoring with wearable devices will allow us to evaluate the rapid effect of cold temperature exposure on blood pressure. In a Japanese, prospective intervention study from 2014 to 2019 (the Smart Wellness Housing survey), approximately 90% of Japanese lived in cold houses (indoor temperature less than 18 °C). Importantly, the indoor temperature was associated with the increase of morning systolic blood pressure. We recently addressed the sympathetic nervous activation of individuals in both their houses and a highly insulated and airtight model house in the winter season using portable electrocardiography equipment. A few subjects showed a morning surge in sympathetic activity, which was more intense at their cold houses, which suggests the importance of the indoor environment in the management of early morning hypertension. In near future, real-time monitoring with wearable devices will provide important information for a better life-environment, leading to risk reduction of morning surge and cardiovascular events.
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Affiliation(s)
- Hironori Nakagami
- Department of Health Development and Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, Japan.
| | - Hiroki Otsuka
- Asahi Kasei Construction Materials Corporation, 1-105 Kanda Jimbocho, Chiyoda Ward, Tokyo, Japan
| | - Hitoshi Akiyama
- Asahi Kasei Construction Materials Corporation, 1-105 Kanda Jimbocho, Chiyoda Ward, Tokyo, Japan
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3
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Chu YH, Sun ZJ, Chang YF, Yang YC, Chang CJ, Chou YT, Wu JS. Different Factors Associated with Morning Blood Pressure Surge in Antihypertensive-Naïve Dipper and Non-Dipper Subjects. J Clin Med 2023; 12:jcm12072464. [PMID: 37048548 PMCID: PMC10095290 DOI: 10.3390/jcm12072464] [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: 01/18/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
The relationship between the morning blood pressure surge (MBPS) and cardiovascular risk is inconclusive. Previous studies have not taken into consideration dipping status in examining the MBPS and its associated factors. The aim was to examine factors associated with the MBPS in dippers and non-dippers. The MBPS was calculated by data obtained from ambulatory blood pressure monitoring, using the definition of sleep-trough morning surge. Dipping systolic blood pressure (DipSBP) was defined as [1 - (SBPsleeping/SBPawake)] × 100%. The value in milliseconds of standard deviation of normal-to-normal RR interval after waking up (SDNNaw) was calculated during the 2 h period after waking up. A total of 140 eligible subjects were divided into dippers (n = 62) and non-dippers (n = 78). Multiple regression analysis on data for all subjects revealed different correlations with the MBPS: positive in age, body mass index (BMI), and DipSBP, and inverse in cholesterol/high density lipoprotein-cholesterol (HDL-C) ratio, fasting blood glucose, and 2 h SDNNaw. When dippers were examined separately, age, female gender, and BMI correlated positively with MBPS, while cholesterol/HDL-C ratio and 2 h SDNNaw correlated negatively. For non-dippers, only age was associated with the MBPS. The factors associated with the MBPS were different for dippers and non-dippers. The MBPS seems to be a physiological response in this dipper group because age and BMI correlated positively with the MBPS, while parasympathetic neural activity after waking up and cholesterol/HDL-C ratio showed inverse correlations.
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Affiliation(s)
- Yi-Hsin Chu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin 64043, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
| | - Yu-Tsung Chou
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Health Management Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin 64043, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
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Roubsanthisuk W, Kunanon S, Chattranukulchai P, Panchavinnin P, Wongpraparut N, Chaipromprasit J, Pienvichitr P, Ayudhya RKN, Sukonthasarn A. 2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society. Hypertens Res 2023; 46:898-912. [PMID: 36759658 PMCID: PMC10073020 DOI: 10.1038/s41440-022-01133-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 02/11/2023]
Abstract
Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.
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Affiliation(s)
- Weranuj Roubsanthisuk
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirisawat Kunanon
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pairoj Chattranukulchai
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pariya Panchavinnin
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarkarpun Chaipromprasit
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pavit Pienvichitr
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Apichard Sukonthasarn
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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5
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Morning surge in sympathetic nervous activity in the indoor environment during the cold winter season. Hypertens Res 2023; 46:231-235. [PMID: 36224284 DOI: 10.1038/s41440-022-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 02/03/2023]
Abstract
We addressed to the sympathetic nervous activation of the same people in both their houses and a highly insulated and airtight model house (model house) during the cold winter season. Eight subjects (4 males and 4 females) stayed two nights at each house and were continuously monitored for sympathetic nerve system by calculating LF (low frequency)/HF (high frequency) in the analysis of heart rate variability using a wearable electrocardiography equipment. The room temperatures were kept constant at 20 °C or more in model house, but much lower in their houses. In all subjects, the sleeping duration is longer in model house compared with that in the participants' houses. Four subjects showed a morning surge in sympathetic activity that were more intense at their houses. This morning surge in sympathetic activity in a residential setting suggests the importance of the indoor environment in the management of early morning hypertension.
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Taş Ü, Taş S, Yavuz İ. The relationship between morning blood pressure surge and asymptomatic episodes of paroxysmal atrial fibrillation in patients with systemic arterial hypertension. Turk J Med Sci 2022; 52:1906-1916. [PMID: 36945988 PMCID: PMC10390146 DOI: 10.55730/1300-0144.5538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypertension is a known risk factor for developing atrial fibrillation. However, there is limited data to investigate the association between morning blood pressure surge (MBPS) and paroxysmal atrial fibrillation (PAF). We conducted the present study to determine whether there is a relationship between asymptomatic PAF and MBPS and whether MBPS may be a predictor of asymptomatic PAF episodes. METHODS This prospective study comprised 264 adult patients who were newly diagnosed with essential hypertension or were previously diagnosed but not receiving regular antihypertensive therapy. We evaluated the patients in 2 groups according to their 24-h electrocardiography monitoring results: group 1 included patients who exhibited PAF (n = 32, 23 females/9 males; mean age 60.2 ± 7.4 years) and group 2 included patients with no signs of PAF as a control group (n = 232, 134 females/98 males; mean age 56.9 ± 9.4 years). We calculated the MBPS as the difference between mean systolic blood pressure (SBP) in the 2 h after getting up and the minimum nocturnal SBP. RESULTS : MBPS values were significantly higher in group 1 than in group 2 (35.3 ± 7.0 vs. 22.0 ± 6.7, p < 0.001). MBPS was positively associated with left atrial diameter (LAD) (r = 0.441, p < 0.001), left ventricle mass index (LVMI) (r = 0.235, p < 0.001), the ratio of early (E) peak of mitral inflow velocity to early (Em) diastolic mitral annular velocity (E / Em) (r = 0.239, p < 0.001), 24-h mean (r = 0.270, p < 0.001) and daytime SBP (r = 0.291, p < 0.001). We determined a cut-off value for MBPS as 28.6 for predicting PAF episodes development and identified LAD and MBPS as independent risk factors for PAF. DISCUSSION Patients who had larger MBPS were observed to have higher PAF incidence. MBPS values may be sensitive in predicting asymptomatic episodes of paroxysmal atrial fibrillation.
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Affiliation(s)
- Ümmü Taş
- Department of Cardiology, Manisa Merkezefendi State Hospital, Manisa, Turkey
| | - Sedat Taş
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - İdil Yavuz
- Department of Statistics, Faculty of Science, Dokuz Eylül University, İzmir, Turkey
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7
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Gmitrov J. Carotid Baroreceptor Magnetic Activation and Beat‐to‐Beat Blood Pressure Variability, Implications to Treat Abrupt Blood Pressure Elevation in Labile Hypertension. Bioelectromagnetics 2022; 43:413-425. [DOI: 10.1002/bem.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/20/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Juraj Gmitrov
- Diabetology Clinic Krompachy Hospital, Agel SK Inc. Krompachy Slovakia
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8
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Kario K, Hoshide S, Nagai M, Okawara Y, Kanegae H. Sleep and cardiovascular outcomes in relation to nocturnal hypertension: the J-HOP Nocturnal Blood Pressure Study. Hypertens Res 2021; 44:1589-1596. [PMID: 34331030 DOI: 10.1038/s41440-021-00709-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
There is a lack of data on how nighttime blood pressure (BP) might modify the relationship between sleep duration and cardiovascular disease (CVD) risk. Self-reported sleep duration data were available for 2253/2562 patients from the J-HOP Nocturnal BP study; of these, 2236 had complete follow-up data (mean age 63.0 years, 83% using antihypertensive drugs). CVD outcomes included stroke, coronary artery disease (CAD), and atherosclerotic CVD (ASCVD [stroke + CAD]). Associations between sleep duration and nighttime home BP (measured using a validated, automatic, oscillometric device) were determined. During a mean follow-up of 7.1 ± 3.8 years, there were 133 ASCVD events (52 strokes and 81 CAD events). Short sleep duration (<6 versus ≥6 and <9 h/night) was significantly associated with the risk of ASCVD (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.07-3.22), especially stroke (HR 2.47, 95% CI 1.08-5.63). When nighttime systolic BP was <120 mmHg, those with a sleep duration <6 versus ≥6 and <9 h/night had a significantly higher risk of ASCVD and CAD events (HR [95% CI] 3.46 [1.52-7.92] and 3.24 [1.21-8.69], respectively). Even patients with "optimal" sleep duration (≥6 and <9 h/night) were at significantly higher risk of stroke when nighttime systolic BP was uncontrolled (HR [95% CI] 2.76 [1.26-6.04]). Adding sleep duration and nighttime BP to a base model with standard CVD risk factors significantly improved model performance for stroke (C-statistic 0.795, 95% CI 0.737-0.856; p = 0.038). These findings highlight the importance of both optimal sleep duration and control of nocturnal hypertension for reducing the risk of CVD, especially stroke. Clinical Trial registration: URL: http://www.umin.ac.jp/icdr/index.html . Unique identifier: UMIN000000894.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Genki Plaza Medical Center for Health Care, Tokyo, Japan
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9
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Narita K, Hoshide S, Kario K. Seasonal variation in blood pressure: current evidence and recommendations for hypertension management. Hypertens Res 2021; 44:1363-1372. [PMID: 34489592 DOI: 10.1038/s41440-021-00732-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/25/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Blood pressure (BP) exhibits seasonal variation, with an elevation of daytime BP in winter and an elevation of nighttime BP in summer. The wintertime elevation of daytime BP is largely attributable to cold temperatures. The summertime elevation of nighttime BP is not due mainly to temperature; rather, it is considered to be related to physical discomfort and poor sleep quality due to the summer weather. The winter elevation of daytime BP is likely to be associated with the increased incidence of cardiovascular disease (CVD) events in winter compared to other seasons. The suppression of excess seasonal BP changes, especially the wintertime elevation of daytime BP and the summertime elevation of nighttime BP, would contribute to the prevention of CVD events. Herein, we review the literature on seasonal variations in BP, and we recommend the following measures for suppressing excess seasonal BP changes as part of a regimen to manage hypertension: (1) out-of-office BP monitoring, especially home BP measurements, throughout the year to evaluate seasonal variations in BP; (2) the early titration and tapering of antihypertensive medications before winter and summer; (3) the optimization of environmental factors such as room temperature and housing conditions; and (4) the use of information and communication technology-based medicine to evaluate seasonal variations in BP and provide early therapeutic intervention. Seasonal BP variations are an important treatment target for the prevention of CVD through the management of hypertension, and further research is necessary to clarify these variations.
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Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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10
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Debnath S, Levy TJ, Bellehsen M, Schwartz RM, Barnaby DP, Zanos S, Volpe BT, Zanos TP. A method to quantify autonomic nervous system function in healthy, able-bodied individuals. Bioelectron Med 2021; 7:13. [PMID: 34446089 PMCID: PMC8394599 DOI: 10.1186/s42234-021-00075-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses. METHODS Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. RESULTS A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. CONCLUSIONS These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation. TRIAL REGISTRATION This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
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Affiliation(s)
- Shubham Debnath
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Todd J Levy
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Mayer Bellehsen
- Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, Bay Shore, NY, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Center for Disaster Health, Trauma, and Resilience, New York, NY, USA
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Douglas P Barnaby
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Bruce T Volpe
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
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11
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Efe SC, Cicek MB, Karagöz A, Doğan C, Bayram Z, Guvendi B, Akbal OY, Tokgoz HC, Uysal S, Karabağ T, Kaymaz C, Ozdemir N. Effect of non-dipper pattern on echocardiographic myocardial work parameters in normotensive individuals. Echocardiography 2021; 38:1586-1595. [PMID: 34435388 DOI: 10.1111/echo.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/02/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is known that non-dipper pattern (NDP) is associated with adverse outcomes in hypertensive patients. However, there is insufficient data on the outcome of NDP in normotensive individuals. Using myocardial work (MW) analysis, as a new echocardiographic examination method, this study aimed to determine the early myocardial effects of NDP in normotensive individuals. METHODS This study included 70 normotensive individuals who were followed by ambulatory blood pressure monitoring (ABPM). The subjects were divided into two groups according to dipper pattern (DP) and NDP. Conventional, strain, and MW findings were compared between the groups by making echocardiographic evaluations. RESULTS The demographic characteristics, laboratory parameters, and measurements of cardiac chambers, and left ventricular (LV) walls were similar between the groups. There was no statistical difference between the groups in terms of LV 3-2-4 chambers strains and global longitudinal strain (GLS) values. LVMW parameters, global work index (GWI), and global constrictive work (GCW) were not statistically different between groups (2012 ± 127, 2069 ± 137, p = 0.16; 2327 ± 173, 2418 ± 296, p = 0.18, respectively). However, global waste work (GWW) and global work efficiency (GWE) parameters were different between the groups (144 ± 63.9, 104 ± 24.8, p < 0.001; 93.2 ± 3.17, 95.4 ± 1.28, p < 0.001, respectively). In regression analysis, GWW was independently associated with NDP. GWW model showed better results with higher likelihood chi-square and R2 values than GLS model in discriminating the predictable capability for NDP status. CONCLUSION The results of MW analysis in this study showed that GWW values were higher and the GWE values were lower in normotensive individuals with NDP.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Buğrahan Cicek
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cem Doğan
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Zübeyde Bayram
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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12
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Saylik F, Sarıkaya R. Can Systemic Immune-Inflammation Index Detect the Presence of Exxaggerated Morning Blood Pressure Surge in Newly Diagnosed Treatment-Naive Hypertensive Patients? Clin Exp Hypertens 2021; 43:772-779. [PMID: 34338559 DOI: 10.1080/10641963.2021.1960366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The exaggerated morning blood pressure surge (MS) is associated with target organ damage and cardiovascular events. Systemic immune-inflammation index (SII) has been detected as a useful marker in tumors and cardiovascular diseases. The role of inflammation in the pathogenesis of hypertension is a well-known issue. We aimed to investigate whether there is an association between SII and exaggerated MS in newly diagnosed treatment-naive hypertensive patients.Material and Methods: In total, 343 newly diagnosed in clinical and 24-h ambulatory blood pressure (BP) monitoring treatment-naive hypertensive patients were included in this study. Morning surge was defined as the difference between morning BP, which was the mean of BP during 2 h after wake-up, and the lowest BP, which was the mean of three lowest BP during nighttime. A cutoff value of 52.1 mmHg was used to discriminate the high- and low value MS groups. SII was calculated based on neutrophil, platelet, and lymphocyte counts.Results: Neutrophil, platelet, SII, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) were higher, whereas lymphocyte counts were lower in the high-value MS than the low-value MS. These indices were all independently associated with exaggerated MS and SII was superior to all other indices for detecting the presence of exaggerated MS. SII was moderately correlated with morning BP surge (r: 0.489, p < 0.0001).Conclusion: SII was higher in patients with exaggerated MS and was independently associated with exaggerated MS. Furthermore, SII might be a better indicator than platelet, neutrophil, lymphocyte, NLR, and PLR for the presence of exaggerated MS.
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Affiliation(s)
- Faysal Saylik
- Department of Cardiology, Van Training and Research Hospital, Van, TURKEY
| | - Remzi Sarıkaya
- Department of Cardiology, Van Training and Research Hospital, Van, TURKEY
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Roy SK, Das P, Mondal A, Mandal A, Kuotsu K. Design, formulation and evaluation of multiparticulate time programmed system of ramipril for pulsed release: An approach in the management of early morning surge in blood pressure. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chen YK, Ni ZX, Li W, Xiao WM, Liu YL, Liang WC, Qu JF. Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study. J Stroke Cerebrovasc Dis 2021; 30:105673. [PMID: 33631472 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Whether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). METHODS This case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. RESULTS CSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1-3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r2 = 0.308-0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804-0.943; P = .001), with r2 = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489-47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709-196.660; P = .001) having the highest risks of CSVD (r2 = 0.413). CONCLUSIONS Lower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.
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Affiliation(s)
- Yang-Kun Chen
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China.
| | - Zhuo-Xin Ni
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Wei Li
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Wei-Min Xiao
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Wen-Cong Liang
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China; Department of Neurology, Graduate School of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
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de Queiroz NNM, de Melo FTC, de Souza Resende F, Janaú LC, de Souza Neto NJK, de Lemos MN, de Oliveira MCNI, de Alcântara AL, de Moraes LV, da Mota Queiroz A, de Souza ÍJA, Said NM, Dos Santos MC, de Souza D'Albuquerque Silva L, Motta ARB, de Sá Oliveira Dos Reis M, Lobato IJC, de Figueiredo PBB, de Souza ACCB, Freire Piani PP, Felício KM, Abrahão Neto JF, Felício JS. High-dose Cholecalciferol Supplementation Reducing Morning Blood Pressure in Normotensive DM1 Patients. Curr Diabetes Rev 2021; 17:378-386. [PMID: 32729423 DOI: 10.2174/1573399816999200729131508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitamin D (VD) deficiency has been related to several endocrine metabolic and cardiovascular diseases. The effect of VD supplementation on blood pressure (BP) in patients with diabetes is controversial. OBJECTIVE The aim of this study was to evaluate high-dose vitamin D supplementation effects on blood pressure of normotensive patients with diabetes mellitus 1 (DM1) patients by 24-hour ambulatory blood pressure monitoring (ABPM). METHODS We performed a clinical trial including 35 DM1 normotensive patients, who received doses of 4,000 or 10,000 IU/day of cholecalciferol for 12 weeks according to previous VD levels. They underwent 24-hour ABPM, along with glycated hemoglobin, creatine, lipids profile and PCRus dosage before and after VD supplementation. RESULTS We found an expressive reduction of systolic and diastolic morning blood pressures (117±14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in other pressoric markers. Besides, we noticed a relationship between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). CONCLUSION Our study suggests an association between supplementation of high doses of vitamin D and the reduction of morning blood pressure in normotensive DM1 patients.
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Affiliation(s)
- Natércia Neves Marques de Queiroz
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Franciane Trindade Cunha de Melo
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Fabrício de Souza Resende
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Luísa Corrêa Janaú
- State University of Para, Platter Perebebui, 2623, Marco, Belem 66087-662, Para, Brazil
| | - Norberto Jorge Kzan de Souza Neto
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Manuela Nascimento de Lemos
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Maria Clara Neres Iunes de Oliveira
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Angélica Leite de Alcântara
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Lorena Vilhena de Moraes
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Apolone da Mota Queiroz
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Ícaro José Araújo de Souza
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Nivin Mazen Said
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Márcia Costa Dos Santos
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Lilian de Souza D'Albuquerque Silva
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Ana Regina Bastos Motta
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Melissa de Sá Oliveira Dos Reis
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Isabel Jane Campos Lobato
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | | | - Ana Carolina Contente Braga de Souza
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Pedro Paulo Freire Piani
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - Karem Miléo Felício
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - João Felício Abrahão Neto
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
| | - João Soares Felício
- Endocrinology Division, University Hospital Joao de Barros Barreto, Federal University of Para, Mundurucus Street, 4487, Guama, Belem 66073-000, Para, Brazil
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Kubota K, Hoshide S, Kario K. Association of lower nighttime diastolic blood pressure and hypoxia with silent myocardial injury: The Japan Morning Surge-Home Blood Pressure study. J Clin Hypertens (Greenwich) 2020; 23:272-280. [PMID: 33314712 PMCID: PMC8029661 DOI: 10.1111/jch.14132] [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: 10/18/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Whether marked nocturnal blood pressure (BP) reduction is associated with cardiovascular disease (CVD) is still controversial. In addition, no report has yet discussed the relationship between lower nocturnal BP and CVD, involving modification by nighttime hypoxia. We evaluated 840 patients who had one or more cardiovascular risk factors by measuring their high‐sensitivity cardiac troponin T (Hs‐cTnT), N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP), and nighttime saturation levels and performing ambulatory BP monitoring. The lowest tertile in nighttime diastolic BP (DBP) (≤66 mmHg) had increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with the second tertile (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.01–3.63), and the lowest tertile of minimum blood oxygen saturation (≤81%) had increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with the third tertile (OR 2.15, 95% CI 1.13–4.10). Additionally, the patients with both lowest tertile of nighttime DBP and minimum SpO2 showed increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with those without this combination (OR 2.93, 95% CI 1.40–6.16). On the other hand, these associations were not found in the presence of ≥125 pg/ml of NT‐pro BNP. In the clinical population, each of lower nocturnal DBP and nighttime hypoxia was associated with asymptomatic myocardial injury, which was represented as higher Hs‐cTnT, and coexisting lower nocturnal DBP and nighttime hypoxia had an additive effect on the risk of myocardial injury.
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Affiliation(s)
- Kana Kubota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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Mizoguchi T, Sugiura T, Dohi Y, Takase H, Yamashita S, Murai S, Seo Y, Ohte N. Home blood pressure on winter mornings could be exaggerated: A comparison with summer mornings. Clin Exp Hypertens 2020; 42:700-706. [PMID: 32522118 DOI: 10.1080/10641963.2020.1779283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Self-measured blood pressure at home (HBP) is quite important for the management of hypertension. We hypothesized that winter HBP measured according to the recommendation of the guidelines, but not HBP measured inside bed before getting up, is elevated in response to cold ambient temperatures in winter. This study aimed to investigate differences in HBP measured before and after getting up in winter and summer.Methods: Hypertensive subjects whose blood pressure was stably controlled were enrolled (n = 46, 73 years). They were instructed to measure HBP while in bed just after waking (HBP-bed), in addition to the ordinary HBP measurement in the morning (HBP-morning) according to the guidelines. The mean value of HBP for 7 consecutive days before the day of a regular hospital visit was considered as the HBP of each subject, and characteristics of the winter and summer BPs were investigated.Results: HBP-morning was significantly higher (P < .001) in winter than in summer, but HBP-bed was lower in winter than in summer (P < .05). HBP-morning was significantly higher than HBP-bed in winter, while HBP-morning was not different from HBP-bed in summer, resulting in greater changes in HBP after getting up in winter than in summer (P < .0001). Changes in HBP after getting up were significantly correlated with serum creatinine levels and the urinary albumin-to-creatinine ratio.Conclusions: These findings imply that elevated HBP-morning in winter reflects the response of BP to cold after getting up. Seasonal profiles of HBPs before and after getting up should be noted in the management of hypertension.
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Affiliation(s)
- Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University , Nagoya, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital , Hamamatsu, Japan
| | - Sumiyo Yamashita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shunsuke Murai
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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Patterns of Circadian Variation in 24-Hour Ambulatory Blood Pressure, Heart Rate, and Sympathetic Tone Correlate with Cardiovascular Disease Risk: A Cluster Analysis. Cardiovasc Ther 2020; 2020:4354759. [PMID: 33042223 PMCID: PMC7528127 DOI: 10.1155/2020/4354759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
To investigate whether specific time series patterns for blood pressure (BP), heart rate (HR), and sympathetic tone are associated with metabolic factors and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). A total of 989 patients who underwent simultaneous 24-hour ambulatory BP and Holter electrocardiogram monitoring were enrolled. The patients were categorized into sixteen groups according to their circadian patterns using the consensus clustering analysis method. Metabolic factors, including cholesterol profiles and apolipoprotein, were compared. The 10-year ASCVD risk was estimated based on the Framingham risk model. Overall, 16 significant associations were found between the clinical variables and cluster groups. Age was commonly associated with all clusters in systolic BP (SBP), diastolic BP (DBP), HR, and sympathetic tone. Metabolic indicators, including diabetes, body mass index, total cholesterol, high-density lipoprotein, and apolipoprotein, were associated with the four sympathetic tone clusters. In the crude analysis, the ASCVD risk increased incrementally from clusters 1 to 4 across SBP, DBP, HR, and sympathetic tone. After adjustment for multiple variables, however, only sympathetic tone clusters 3 and 4 showed a significantly high proportion of patients at high risk (≥7.5%) of 10-year ASCVD (odds ratio (OR) = 5.90, 95% confidential interval (CI) = 1.27-27.46, and P value = 0.024 and OR = 15.28, 95% CI = 3.59-65.11, and P value < 0.001, respectively). Time series patterns of BP, HR, and sympathetic tone can serve as an indicator of aging. Circadian variations in sympathetic tone can provide prognostic information about patient metabolic profiles and indicate future ASCVD risk.
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Kario K, Weber MA, Böhm M, Townsend RR, Mahfoud F, Schmieder RE, Tsioufis K, Cohen SA, Fahy M, Kandzari DE. Effect of renal denervation in attenuating the stress of morning surge in blood pressure: post-hoc analysis from the SPYRAL HTN-ON MED trial. Clin Res Cardiol 2020; 110:725-731. [DOI: 10.1007/s00392-020-01718-6] [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] [Received: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
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Narita K, Hoshide S, Fujiwara T, Kanegae H, Kario K. Seasonal Variation of Home Blood Pressure and Its Association With Target Organ Damage: The J-HOP Study (Japan Morning Surge-Home Blood Pressure). Am J Hypertens 2020; 33:620-628. [PMID: 32202625 PMCID: PMC7368171 DOI: 10.1093/ajh/hpaa027] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/19/2019] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Although seasonal variation of home blood pressure (BP) has been reported to be higher in winter, seasonal difference in home BP (HBP) and its association with target organ damage (TOD) remains unclear. Methods This is a cross-sectional study using the dataset from the Japan Morning Surge-Home Blood Pressure (J-HOP) study to assess seasonal differences in HBP, prevalence of masked hypertension, and association of HBP with TOD. The J-HOP study is a nationwide, multicenter prospective study whose participants with cardiovascular risks underwent morning and evening HBP measurements for a 14-day period in 71 institutions throughout Japan. Urine albumin–creatinine ratio (UACR) and serum-B-type natriuretic peptide (BNP) were obtained at enrollment. Results Among 4,267 participants (mean age, 64.9 ± 10.9 years; 46.9% male; 91.4% hypertensives), 1,060, 979, 1,224, and 1,004 participants were enrolled in spring, summer, autumn, and winter, respectively. Morning and evening home systolic/diastolic BP levels, and prevalence of masked hypertension (office BP <140/90 mm Hg and HBP ≥135/85 mm Hg) were significantly lower in summer than other seasons after adjustment for covariates. When we assessed the interaction between BP parameters and each season for an association with TOD, we found the association between morning home diastolic BP and each of UACR and BNP was stronger in winter than other seasons (both P for interaction <0.05). Conclusions In this study, we revealed that the prevalence of masked hypertension was higher in other seasons than in summer and found a notable association between morning home diastolic BP and TOD in winter.
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Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Department of Cardiovascular Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Kario K, Kim BK, Aoki J, Wong AYT, Lee YH, Wongpraparut N, Nguyen QN, Ahmad WAW, Lim ST, Ong TK, Wang TD. Renal Denervation in Asia: Consensus Statement of the Asia Renal Denervation Consortium. Hypertension 2020; 75:590-602. [PMID: 32008432 PMCID: PMC8032219 DOI: 10.1161/hypertensionaha.119.13671] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Asia Renal Denervation Consortium consensus conference of Asian physicians actively performing renal denervation (RDN) was recently convened to share up-to-date information and regional perspectives, with the goal of consensus on RDN in Asia. First- and second-generation trials of RDN have demonstrated the efficacy and safety of this treatment modality for lowering blood pressure in patients with resistant hypertension. Considering the ethnic differences of the hypertension profile and demographics of cardiovascular disease demonstrated in the SYMPLICITY HTN (Renal Denervation in Patients With Uncontrolled Hypertension)-Japan study and Global SYMPLICITY registry data from Korea and Taiwan, RDN might be an effective hypertension management strategy in Asia. Patient preference for device-based therapy should be considered as part of a shared patient-physician decision process. A practical population for RDN treatment could consist of Asian patients with uncontrolled essential hypertension, including resistant hypertension. Opportunities to refine the procedure, expand the therapy to other sympathetically mediated diseases, and explore the specific effects on nocturnal and morning hypertension offer a promising future for RDN. Based on available evidence, RDN should not be considered a therapy of last resort but as an initial therapy option that may be applied alone or as a complementary therapy to antihypertensive medication.
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Affiliation(s)
- Kazuomi Kario
- From the Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tokyo, Japan (K.K.)
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (B.-K.K.)
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (J.A.)
| | - Anthony Yiu-tung Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, HKSAR (A.Y.-T.W.)
| | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan (Y.-H.L.)
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan (Y.-H.L.)
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (N.W.)
| | - Quang Ngoc Nguyen
- Department of Cardiology, Hanoi Medical University, Vietnam (Q.N.N.)
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia (W.A.W.A)
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center, Singapore (S.T.L.)
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Malaysia (T.K.O.)
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-D.W.)
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Ryu JW, Cha RH, Lee H, Kim YS, Lee JP, Song YR, Kim SG, Kim SJ. Association of Blood Pressure at Specific Time-Points with 1-Year Renal Outcomes in Patients with Diabetic Chronic Kidney Disease. Electrolyte Blood Press 2020; 17:36-44. [PMID: 31969922 PMCID: PMC6962443 DOI: 10.5049/ebp.2019.17.2.36] [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: 09/11/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/05/2022] Open
Abstract
Background The 24-hour mean blood pressure (mBP) is the best predictor of organ damage; however, it is not easily applicable in clinical practice. The APrODiTe study suggested that systolic blood pressure (SBP) values at 7:00 AM and 9:30 PM were associated with the 24-hour mSBP in patients with chronic kidney disease (CKD). We investigated the association of the SBP values at these time-points with the renal outcomes in patients with diabetic CKD during 1-year follow-up. Methods Ninety-six patients with diabetic CKD were included at 1-year follow-up. The renal outcomes were an increase in the random urine protein/creatinine ratio or estimated glomerular filtration rate (eGFR) deterioration, which means a decrease in eGFR ≥5 mL/min/1.73 m2 compared to the baseline values. Results The baseline SBP values at 7:00 AM, and 9:30 PM, and the 24-hour mSBP were 135.6±24.9 mmHg, 141.7±25.6 mmHg, and 136.4±20.7 mmHg, respectively. The SBP values measured at the same time-points after 1 year were similar to those at baseline. The SBP at 7:00 AM was significantly associated with eGFR deterioration in the univariate and multivariate analyses (odds ratio [OR]: 1.032; 95% confidence interval [CI]: 1.006-1.059; p=0.016). The SBP at 7:00AM and 24-hour mSBP did not show a concordant association with sustained proteinuria in the linear and logistic analyses. In the subgroup analysis, the association between the SBP at 7:00 AM and eGFR deterioration persisted in patients with CKD stage 3-5 (OR: 1.041; 95% CI: 1.010-1.073; p=0.010). Conclusion The SBP at 7:00 AM, in addition to the 24-hour mSBP, is also associated with eGFR deterioration in patients with diabetic CKD, particularly in those with CKD stage 3-5.
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Affiliation(s)
- Ji Won Ryu
- Department of Internal Medicine, Cheju Halla General Hospital, Cheju, Korea
| | - Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Se Joong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Kidney Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Kario K, Shin J, Chen C, Buranakitjaroen P, Chia Y, Divinagracia R, Nailes J, Hoshide S, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Teo BW, Turana Y, Zhang Y, Park S, Van Minh H, Wang J. Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network. J Clin Hypertens (Greenwich) 2019; 21:1250-1283. [PMID: 31532913 PMCID: PMC8030405 DOI: 10.1111/jch.13652] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 01/03/2023]
Abstract
Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | - Chen‐Huan Chen
- Department of MedicineSchool of Medicine National Yang‐Ming UniversityTaipeiTaiwan
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Yook‐Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | - Jorge Sison
- Section of Cardiology, Department of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversity of Indonesia‐National Cardiovascular Center, Harapan KitaJakartaIndonesia
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Boon Wee Teo
- Division of Nephrology, Department of MedicineYong Loo Lin School of MedicineSingaporeSingapore
| | - Yuda Turana
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sungha Park
- Division of Cardiology, Cardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Huynh Van Minh
- Department of Internal Medicine, University of Medicine and PharmacyHue UniversityHueVietnam
| | - Ji‐Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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24
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He Y, Yang M, Che S, Chen S, Jiang X, Guo Y. Effect of morning blood pressure peak on early progressive ischemic stroke: a prospective clinical study. Clin Neurol Neurosurg 2019; 184:105420. [PMID: 31310922 DOI: 10.1016/j.clineuro.2019.105420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/08/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To prospectively evaluate the effect of morning blood pressure peak (MBPP) on early progressive ischemic stroke (EPIS). PATIENTS AND METHODS A total of 135 patients with acute ischemic stroke were enrolled and completed all assessments. The patients were divided into EPIS group and non-EPIS group, with 22 and 113 cases in each group, respectively, according to the assessment of Scandinavian stroke scale within three days after onset. All cases received conventional treatment for stroke and its risk factors. 24 -h dynamic blood pressure monitoring was performed within 24 h after admission. Based on the 24 -h mean blood pressure, MBPP, morning blood pressure, and other risk factors for EPIS, we conducted a logistic regression analysis to evaluate whether MBPP was an independent risk factor for EPIS. RESULTS Mean systolic blood pressure, systolic and diastolic MBPP, morning systolic and diastolic blood pressure were all significantly higher in EPIS group than in non-EPIS group (p = 0.037, p = 0.001, p = 0.035, p = 0.003, p = 0.042, respectively). Logistic regression analysis showed that MBPP was an independent risk factor for EPIS (OR = 1.057, 95% CI 1.014-1.102, p = 0.009). Further stratified analysis showed that incidences of EPIS in patients with elevated MBPP combined with large artery atherosclerosis or small artery occlusion were comparable (41.2% vs. 25.0%, p = 0.367), and the systolic MBPP was significantly higher in morning EPIS group than in non-morning EPIS group (p = 0.041). CONCLUSION Elevated systolic MBPP might be an independent risk factor for EPIS, and play a more obvious effect on EPIS manifesting in the morning especially.
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Affiliation(s)
- Yitao He
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Miaojuan Yang
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Sixuan Che
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Siyan Chen
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Xin Jiang
- Department of Cardiology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China.
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Yoo JK, Sun DD, Parker RS, Urey MA, Romero SA, Lawley JS, Sarma S, Vongpatanasin W, Crandall CG, Fu Q. Augmented venoarteriolar response with ageing is associated with morning blood pressure surge. Exp Physiol 2018; 103:1448-1455. [DOI: 10.1113/ep087166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/09/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Dan-Dan Sun
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
| | - Rosemary S. Parker
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
| | - Marcus A. Urey
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Steven A. Romero
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Justin S. Lawley
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | | | - Craig G. Crandall
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
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26
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Yang S, Yuan J, Qin W, Yang L, Fan H, Li Y, Hu W. Twenty-four-hour ambulatory blood pressure variability is associated with total magnetic resonance imaging burden of cerebral small-vessel disease. Clin Interv Aging 2018; 13:1419-1427. [PMID: 30127599 PMCID: PMC6089119 DOI: 10.2147/cia.s171261] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Lacunae, brain atrophy, white matter hyperintensity, enlarged perivascular space and microbleed are magnetic resonance imaging (MRI) markers of cerebral small-vessel disease (cSVD). Studies have reported that higher blood pressure variability (BPV) predicted cardiovascular risk in hypertensive patients; however, the association between BPV and the total MRI burden of cSVD has not been investigated. In this study, we aimed to explore this relationship between BPV and cSVD MRI burden. Methods We prospectively recruited patients who attended our hospital for annual physical examination. Twenty-four-hour ambulatory BP monitoring was performed using an automated system. BPV was quantified by SD, weighted SD, and coefficient of variation. One point was awarded for the presence of each marker, producing a score between 0 and 5. Spearman correlation and ordinal logistic regression analyses were used to test the relationship between BPV and total cSVD MRI burden. Results A total of 251 subjects with an average age of 68 years were enrolled in this study, and 52.6% were male; 163 (64.94%) had one or more markers of cSVD. Correlation analysis indicated that higher systolic BP (SBP) levels and BPV metrics of SBP were positively related to higher cSVD burden. Ordinal logistic regression analyses demonstrated that higher SBP levels and SBP variability were independent risk factors for cSVD. There were no significant differences in 24-hour, day and night diastolic BP levels or BPV metrics of diastolic BP among the five subgroups. Conclusion Twenty-four-hour, day and night SBP levels and SBP variability were positively related to cSVD burden. Higher SBP levels and SBP variability were independent risk factors for cSVD.
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Affiliation(s)
- Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
| | - Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
| | - Huimin Fan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,
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27
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Kotruchin P, Hoshide S, Kario K. Carotid atherosclerosis and the association between nocturnal blood pressure dipping and cardiovascular events. J Clin Hypertens (Greenwich) 2018; 20:450-455. [PMID: 29450967 DOI: 10.1111/jch.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/28/2017] [Accepted: 12/08/2017] [Indexed: 12/20/2022]
Abstract
The impact of a nondipping blood pressure (BP) pattern, defined as (awake systolic BP - sleep systolic BP)/awake systolic BP < 0.1, on cardiovascular events in populations with different degrees of carotid atherosclerosis is uncertain. The authors hypothesized that a nondipping BP pattern would show differential predictive power for cardiovascular events, including total cardiovascular death, sudden death, nonfatal cardiovascular events, and nonfatal stroke, between populations with and without carotid atherosclerosis. To test this hypothesis, the authors analyzed 493 patients (mean age 67.9 years, 47.5% men) from the J-HOP (Japan Morning Surge-Home Blood Pressure) study for whom ambulatory BP monitoring and carotid intima-media thickness data were available. Twenty-nine cardiovascular events occurred during follow-up (1867 person-years). A nondipping BP pattern was independently associated with cardiovascular events in the population without carotid atherosclerosis, defined as carotid intima-media thickness < 1.1 mm after adjustment for other cardiovascular risk factors including age, sex, diabetes mellitus, chronic kidney disease, and 24-hour systolic BP (hazard ratio, 8.15; 95% confidence interval, 1.76-37.78 [P < .01]). This association was not found in the population with carotid intima-media thickness ≥ 1.1 mm. Therefore, in the hypertensive population without carotid atherosclerosis, physicians should consider ambulatory BP monitoring to determine the nocturnal BP pattern as an alternative approach to assessing cardiovascular events.
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Affiliation(s)
- Praew Kotruchin
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.,Division of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
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28
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Kitagawa N, Ushigome E, Matsumoto S, Oyabu C, Ushigome H, Yokota I, Asano M, Tanaka M, Yamazaki M, Fukui M. Threshold value of home pulse pressure predicting arterial stiffness in patients with type 2 diabetes: KAMOGAWA-HBP study. J Clin Hypertens (Greenwich) 2018; 20:472-477. [PMID: 29447439 DOI: 10.1111/jch.13209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 01/26/2023]
Abstract
This cross-sectional multicenter study was designed to evaluate the threshold value of home pulse pressure (PP) and home systolic blood pressure (SBP) predicting the arterial stiffness in 876 patients with type 2 diabetes. We measured the area under the receiver-operating characteristic curve (AUC) and estimated the ability of home PP to identify arterial stiffness using Youden-Index defined cut-off point. The arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). AUC for arterial stiffness in morning PP was significantly greater than that in morning SBP (P < .001). AUC for arterial stiffness in evening PP was also significantly greater than that in evening SBP (P < .001). The optimal cut-off points for morning PP and evening PP, which predicted arterial stiffness, were 54.6 and 56.9 mm Hg, respectively. Our findings indicate that we should pay more attention to increased home PP in patients with type 2 diabetes.
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Affiliation(s)
- Noriyuki Kitagawa
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinobu Matsumoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chikako Oyabu
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidetaka Ushigome
- Department of Organ Transplantation and General Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Muhei Tanaka
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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29
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Chi X, Li M, Zhan X, Man H, Xu S, Zheng D, Bi J, Wang Y, Liu C. Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients. Comput Biol Med 2018; 92:73-77. [DOI: 10.1016/j.compbiomed.2017.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 11/24/2022]
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30
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Huang G, Yang X, Huang J. Morning surge in blood pressure and sympathetic activity in Mongolians and Han Chinese: a multimodality investigation of hypertension and dyssomnia. PeerJ 2017; 5:e3758. [PMID: 28948098 PMCID: PMC5609520 DOI: 10.7717/peerj.3758] [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: 05/17/2017] [Accepted: 08/13/2017] [Indexed: 11/20/2022] Open
Abstract
Background Hypertension and dyssomnia are increasing significantly in Mongolians, and the related factors of ethnic differences in hypertension and dyssomnia between Mongolians and Han Chinese are unclear. This study examined the relationship of morning surge in blood pressure (MBP) with ethnicity, sleep situation, and sympathetic activity throughout the day. Methods Of 692 hypertensive patients screened, 202 subjects with dyssomnia were selected. They were then divided into Mongolian (n = 87) and Han (n = 115) groups. The differences in dyssomnia, 24-h blood pressure, and urinary catecholamine were analyzed in all subjects; they were then further divided according to the degree of dyssomnia (low, moderate, and severe) to determine the differences in blood pressure and catecholamine. Results Mongolians had a lower history of smoking, daytime dysfunction, nocturnal heart rates, and dopamine levels, but their body mass index, triglyceride, fasting glucose, morning surge in systolic blood pressure (MSBP), nocturnal systolic blood pressure (NSBP), nocturnal diastolic blood pressure, daytime systolic blood pressure, daytime heart rates, and dopamine level (D-DA) were higher than those of Han Chinese. With the aggravation of dyssomnia, MSBP, NSBP, D-NE, daytime epinephrine, and D-DA of Mongolians and Han Chinese increased gradually, but the rate of increase was faster in the latter (p < 0.05). D-DA was entered into the MSBP regression model of Mongolians (intercept, 157 mmHg), whereas D-DA and D-NE were entered into the MSBP regression model of Han Chinese (intercept, 142 mmHg). Conclusion Worsened dyssomnia induces higher MSBP and augments sympathetic excitability in Mongolians and Han Chinese. Mongolians with hypertension and dyssomnia had higher MSBP baseline and D-DA but lower N-DA. With an increase in D-DA, MSBP in Han and Mongolian patients increased gradually.
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Affiliation(s)
- Guanhua Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoming Yang
- Department of Cardiology, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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31
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Johnson AW, Hissen SL, Macefield VG, Brown R, Taylor CE. Magnitude of Morning Surge in Blood Pressure Is Associated with Sympathetic but Not Cardiac Baroreflex Sensitivity. Front Neurosci 2016; 10:412. [PMID: 27660603 PMCID: PMC5014858 DOI: 10.3389/fnins.2016.00412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/25/2016] [Indexed: 11/13/2022] Open
Abstract
The ability of the arterial baroreflex to regulate blood pressure may influence the magnitude of the morning surge in blood pressure (MSBP). The aim was to investigate the relationships between sympathetic and cardiac baroreflex sensitivity (BRS) and the morning surge. Twenty-four hour ambulatory blood pressure was recorded in 14 young individuals. The morning surge was defined via the pre-awakening method, which is calculated as the difference between mean blood pressure values 2 h before and 2 h after rising from sleep. The mean systolic morning surge, diastolic morning surge, and morning surge in mean arterial pressures were 15 ± 2, 13 ± 1, and 11 ± 1 mmHg, respectively. During the laboratory protocol, continuous measurements of blood pressure, heart rate, and muscle sympathetic nerve activity (MSNA) were made over a 10-min period of rest. Sympathetic BRS was quantified by plotting MSNA burst incidence against diastolic pressure (sympathetic BRSinc), and by plotting total MSNA against diastolic pressure (sympathetic BRStotal). Cardiac BRS was quantified using the sequence method. The mean values for sympathetic BRSinc, sympathetic BRStotal and cardiac BRS were −1.26 ± 0.26 bursts/100 hb/mmHg, −1.60 ± 0.37 AU/beat/mmHg, and 13.1 ± 1.5 ms/mmHg respectively. Significant relationships were identified between sympathetic BRSinc and the diastolic morning surge (r = 0.62, p = 0.02) and the morning surge in mean arterial pressure (r = 0.57, p = 0.03). Low sympathetic BRS was associated with a larger morning surge in mean arterial and diastolic blood pressure. Trends for relationships were identified between sympathetic BRStotal and the diastolic morning surge (r = 0.52, p = 0.066) and the morning surge in mean arterial pressure (r = 0.48, p = 0.095) but these did not reach significance. There were no significant relationships between cardiac BRS and the morning surge. These findings indicate that the ability of the baroreflex to buffer increases in blood pressure via reflexive changes in MSNA may play a role in determining the magnitude of the MSBP.
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Affiliation(s)
- Aaron W Johnson
- School of Medicine, Western Sydney University Sydney, NSW, Australia
| | - Sarah L Hissen
- School of Science and Health, Western Sydney University Sydney, NSW, Australia
| | - Vaughan G Macefield
- School of Medicine, Western Sydney UniversitySydney, NSW, Australia; Neuroscience Research AustraliaSydney, NSW, Australia
| | - Rachael Brown
- School of Medicine, Western Sydney University Sydney, NSW, Australia
| | - Chloe E Taylor
- School of Science and Health, Western Sydney University Sydney, NSW, Australia
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32
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Kario K. Systemic Hemodynamic Atherothrombotic Syndrome and Resonance Hypothesis of Blood Pressure Variability: Triggering Cardiovascular Events. Korean Circ J 2016; 46:456-67. [PMID: 27482253 PMCID: PMC4965423 DOI: 10.4070/kcj.2016.46.4.456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/28/2016] [Accepted: 05/27/2016] [Indexed: 12/02/2022] Open
Abstract
Blood pressure (BP) exhibits different variabilities and surges with different time phases, from the shortest beat-by-beat to longest yearly changes. We hypothesized that the synergistic resonance of these BP variabilites generates an extraordinarily large dynamic surge in BP and triggers cardiovascular events (the resonance hypothesis). The power of pulses is transmitted to the peripheral sites without attenuation by the large arteries, in individuals with stiffened arteries. Thus, the effect of a BP surge on cardiovascular risk would be especially exaggerated in high-risk patients with vascular disease. Based on this concept, our group recently proposed a new theory of systemic hemodynamic atherothromboltic syndrome (SHATS), a vicious cycle of hemodynamic stress and vascular disease that advances organ damage and triggers cardiovascular disease. Clinical phenotypes of SHATS are large-artery atherothombotic diseases such as stroke, coronary artery disease, and aortic and pheripheral artery disease; small-artery diseases, and microcirculation-related disease such as vascular cognitive dysfunction, heart failure, and chronic kidney disease. The careful consideration of BP variability and vascular diseases such as SHATS, and the early detection and management of SHATS, will achieve more effective individualized cardiovascular protection. In the near future, information and communication technology-based 'anticipation medicine' predicted by the changes of individual BP values could be a promising approach to achieving zero cardiovascular events.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.; Jichi Medical University Center of Excellence, Cardiovascular Research and Development (JCARD), Tochigi, Japan.; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
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Lai CT, Chen CY, Kuo TBJ, Chern CM, Yang CCH. Sympathetic Hyperactivity, Sleep Fragmentation, and Wake-Related Blood Pressure Surge During Late-Light Sleep in Spontaneously Hypertensive Rats. Am J Hypertens 2016; 29:590-7. [PMID: 26350298 DOI: 10.1093/ajh/hpv154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 08/13/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many cardiovascular disease events occur before morning awaking and are more severe in hypertensive patients. Sleep-related cardiovascular regulation has been suggested to play an important role in the pathogenesis. In this study, we explored whether such impairments are exaggerated during late sleep (before the active phase) in spontaneously hypertensive rats (SHRs). METHODS Polysomnographic recording was performed through wireless transmission in freely moving SHRs and Wistar-Kyoto rats (WKYs) over 24 hours. The SHRs were injected with saline and an α1-adrenergic antagonist (prazosin: 5 mg/kg) on 2 separate days. Cardiovascular and autonomic functions were assessed by cardiovascular variability and spontaneous baroreflex analysis. RESULTS Compared with the early-light period (Zeitgeber time (ZT) 0-6 hours), both the WKYs and SHRs during the late-light period (ZT 6-12 hours) showed sleep fragmentation, sympathovagal imbalance, and baroreflex impairment, which were exaggerated and more advanced in the SHRs. Like the morning blood pressure (BP) surge in humans, we found that there was a wake-related blood pressure surge (WBPS) during the late-light period in both groups of rats. The WBPS was also greater and occurred earlier in the SHRs, and was accompanied by a surge in vascular sympathetic index. Under α1-adrenergic antagonism, the late-light period-related sleep fragmentation and BP surge in the SHRs were partially reversed. CONCLUSIONS Our results reveal that sleep-related sympathetic overactivity, baroreflex sensitivity impairment, WBPS, and sleep fragmentation in SHRs deteriorates during the late-light period can be partially alleviated by treatment with an α1-adrenoceptor antagonist.
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Affiliation(s)
- Chun-Ting Lai
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Chen
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Terry B J Kuo
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Research Center for Adaptive Data Analysis, National Central University, Taoyuan, Taiwan; Chief of Division of Translational Medicine, Stroke & Neurovascular Center, Veterans General Hospital, Taipei, Taiwan
| | - Chang-Ming Chern
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Chief of Division of Translational Medicine, Stroke & Neurovascular Center, Veterans General Hospital, Taipei, Taiwan
| | - Cheryl C H Yang
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan;
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Ishikawa J, Watanabe S, Harada K. Awakening Blood Pressure Rise in a Patient with Spinal Cord Injury. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:177-81. [PMID: 26994759 PMCID: PMC4805135 DOI: 10.12659/ajcr.895825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 66 Final Diagnosis: Awakening blood pressure rise Symptoms: Syncope Medication: — Clinical Procedure: Ambulatory blood pressure monitoring Specialty: Cardiology
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Affiliation(s)
- Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Shintaro Watanabe
- Department of Cardiology, Sano Kosei General Hospital, Tochigi, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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Hong CH, Kuo TBJ, Huang BC, Lin YC, Kuo KL, Chern CM, Yang CCH. Cold Exposure Can Induce an Exaggerated Early-Morning Blood Pressure Surge in Young Prehypertensives. PLoS One 2016; 11:e0150136. [PMID: 26919177 PMCID: PMC4769082 DOI: 10.1371/journal.pone.0150136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/09/2016] [Indexed: 11/19/2022] Open
Abstract
Prehypertension is related to a higher risk of cardiovascular events than normotension. Our previous study reported that cold exposure elevates the amplitude of the morning blood pressure surge (MBPS) and is associated with a sympathetic increase during the final sleep transition, which might be critical for sleep-related cardiovascular events in normotensives. However, few studies have explored the effects of cold exposure on autonomic function during sleep transitions and changes of autonomic function among prehypertensives. Therefore, we conducted an experiment for testing the effects of cold exposure on changes of autonomic function during sleep and the MBPS among young prehypertensives are more exaggerate than among young normotensives. The study groups consisted of 12 normotensive and 12 prehypertensive male adults with mean ages of 23.67 ± 0.70 and 25.25 ± 0.76 years, respectively. The subjects underwent cold (16°C) and warm (23°C) conditions randomly. The room temperature was maintained at either 23°C or 16°C by central air conditioning and recorded by a heat-sensitive sensor placed on the forehead and extended into the air. BP was measured every 30 minutes by using an autonomic BP monitor. Electroencephalograms, electrooculograms, electromyograms, electrocardiograms, and near body temperature were recorded by miniature polysomnography. Under cold exposure, a significantly higher amplitude of MBPS than under the warm condition among normotensives; however, this change was more exaggerated in prehypertensives. Furthermore, there was a significant decrease in parasympathetic-related RR and HF during the final sleep transition and a higher early-morning surge in BP and in LF% among prehypertensives, but no such change was found in normotensives. Our study supports that cold exposure might increase the risk of sleep-related cardiovascular events in prehypertensives.
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Affiliation(s)
- Cian-Hui Hong
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Translational and Interdisciplinary Medicine, National Central University, Taoyuan, Taiwan
| | - Bo-Chi Huang
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Cheng Lin
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Liang Kuo
- Department of Family Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Chang-Ming Chern
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- * E-mail:
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Parati G, Ochoa JE, Lombardi C, Bilo G. Blood pressure variability: assessment, predictive value, and potential as a therapeutic target. Curr Hypertens Rep 2016; 17:537. [PMID: 25790801 DOI: 10.1007/s11906-015-0537-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A large body of evidence has consistently supported the relationship between blood pressure (BP) levels and the risk of cardiovascular complications. In recent years, several independent studies have also indicated that this risk may not only depend on the magnitude of the blood pressure elevation per se but also on the presence of other associated conditions such as increased blood pressure variability. This concept has been supported by a series of reports, most of which post hoc analyses of clinical trials in hypertension, showing that increasing values of BP variability (BPV) (either in the short term, in the midterm, or in the long term) may predict development, progression, and severity of cardiac, vascular, and renal organ damage, as well as cardiovascular events and mortality. Remarkably, studies conducted in populations at high cardiovascular risk have shown increasing values of BPV in the individual subjects (so-called intra- or within-individual BPV) to be strong predictors of cardiovascular morbidity and mortality, even to a larger extent than average BP values. However, in subjects at low to moderate cardiovascular risk, the contribution of BPV to cardiovascular risk prediction over and beyond average BP values has been shown to be only moderate. The aim of this paper is to critically review the evidence addressing the prognostic relevance of different components of BPV addressing a yet open question, i.e., whether routine assessment of BPV in clinical practice should be regarded as an additional target of antihypertensive treatment to improve cardiovascular protection.
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Affiliation(s)
- Gianfranco Parati
- Department of Health Sciences, University of Milan-Bicocca, Milan, Italy,
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Abstract
This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ damage as well as protection from major cardiovascular complications to a degree that justifies the complexity and cost of the procedure.
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Affiliation(s)
- Giuseppe Mancia
- From the University of Milano-Bicocca, IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M.); and Department of Medicine, Hospital of Assisi, Assisi, Italy (P.V.).
| | - Paolo Verdecchia
- From the University of Milano-Bicocca, IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M.); and Department of Medicine, Hospital of Assisi, Assisi, Italy (P.V.)
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Cho JS, Ihm SH, Kim CJ, Park MW, Her SH, Park GM, Kim TS. Obstructive Sleep Apnea Using Watch-PAT 200 Is Independently Associated With an Increase in Morning Blood Pressure Surge in Never-Treated Hypertensive Patients. J Clin Hypertens (Greenwich) 2015; 17:675-81. [PMID: 26033308 DOI: 10.1111/jch.12581] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/11/2015] [Accepted: 02/19/2015] [Indexed: 12/22/2022]
Abstract
This study aimed to examine the association between obstructive sleep apnea (OSA) and morning blood pressure surge in never-treated patients with essential hypertension. This prospective study included a total of 58 patients (mean age, 51.7 years; 55.2% men) with never-treated essential hypertension. The patients were divided into non-OSA (n=23, 49.3±12.7 years) and OSA (n=35, 53.2±9.8 years) groups. The OSA group was defined as having an apnea-hypopnea index level >5 as measured by the Watch-PAT 200. The authors collected 24-hour ambulatory BP, plasma aldosterone concentration, and plasma renin activity data from all of the patients. The measured sleep-trough morning systolic blood pressure (SBP) increases were higher in the OSA group than in the non-OSA group (28.7±11.8 mm Hg vs 19.6±12.8 mm Hg, P=.008). The sleep-trough morning SBP increase was inversely correlated with the lowest oxygen saturation (r=-0.272, P=.039). OSA known to be associated with increased daytime and nocturnal sympathetic activity was associated with significantly higher sleep-trough morning SBP levels in this study.
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Affiliation(s)
- Jung Sun Cho
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gyung-Min Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Seok Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi, Japan
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Nishimura M, Yoshida SI, Haramoto M, Mizuno H, Fukuda T, Kagami-Katsuyama H, Tanaka A, Ohkawara T, Sato Y, Nishihira J. Effects of white rice containing enriched gamma-aminobutyric acid on blood pressure. J Tradit Complement Med 2015; 6:66-71. [PMID: 26870683 PMCID: PMC4738072 DOI: 10.1016/j.jtcme.2014.11.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/03/2014] [Accepted: 09/28/2014] [Indexed: 11/25/2022] Open
Abstract
Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter with beneficial effects including antihypertension and antistress properties. In this study, we examined the effects of GABA-enriched white rice (GABA rice) on blood pressure (BP) in 39 mildly hypertensive adults in a randomized, double-blind, placebo-controlled study. The participants were divided into a test group (n = 22) who consumed rice with 11.2 mg GABA/100 g of rice and a placebo group (n = 17) who consumed rice with 2.7 mg GABA/100 g of rice. For 8 weeks, the participants took 150 g of either the GABA rice or the placebo rice. Hematological examinations were performed on both groups at 0, 4, and 8 weeks after the start of rice consumption. Home BP was self-measured two times daily, morning and evening, from 1 weeks before to 2 weeks after the intervention. Although the hospital BP and evening BP measurements of the participants showed no significant change, consumption of the GABA rice improved the morning BP compared with the placebo rice after the 1st week and during the 6th and 8th weeks. These results showed the possibility that the GABA rice improves morning hypertension.
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Affiliation(s)
- Mie Nishimura
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | | | | | | | - Tomohiko Fukuda
- Hokuren Agricultural Research Institute, Higashi-ku, Sapporo, Japan
| | - Hiroyo Kagami-Katsuyama
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | - Aiko Tanaka
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | - Tatsuya Ohkawara
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | - Yuji Sato
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | - Jun Nishihira
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
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Effect of azilsartan versus candesartan on morning blood pressure surges in Japanese patients with essential hypertension. Blood Press Monit 2014; 19:164-9. [PMID: 24710336 PMCID: PMC4011626 DOI: 10.1097/mbp.0000000000000042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Morning blood pressure (BP) surge is reported as a risk factor for cardiovascular events and end-organ damage independent of the 24-h BP level. Controlling morning BP surge is therefore important to help prevent onset of cardiovascular disease. We compared the efficacy of azilsartan and candesartan in controlling morning systolic BP (SBP) surges by analyzing relevant ambulatory BP monitoring data in patients with/without baseline BP surges. As part of a 16-week randomized, double-blind study of azilsartan (20-40 mg once daily) and candesartan (8-12 mg once daily) in Japanese patients with essential hypertension, an exploratory analysis was carried out using ambulatory BP monitoring at baseline and week 14. The effects of study drugs on morning BP surges, including sleep trough surge (early morning SBP minus the lowest night-time SBP) and prewaking surge (early morning SBP minus SBP before awakening), were evaluated. Patients with sleep trough surge of at least 35 mmHg were defined by the presence of a morning BP surge (the 'surge group'). Sleep trough surge and prewaking surge data were available at both baseline and week 14 in 548 patients, 147 of whom (azilsartan 76; candesartan 71) had a baseline morning BP surge. In surge group patients, azilsartan significantly reduced both the sleep trough surge and the prewaking surge at week 14 compared with candesartan (least squares means of the between-group differences -5.8 mmHg, P=0.0395; and -5.7 mmHg, P=0.0228, respectively). Once-daily azilsartan improved sleep trough surge and prewaking surge to a greater extent than candesartan in Japanese patients with grade I-II essential hypertension.
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Bombelli M, Fodri D, Toso E, Macchiarulo M, Cairo M, Facchetti R, Dell’Oro R, Grassi G, Mancia G. Relationship Among Morning Blood Pressure Surge, 24-Hour Blood Pressure Variability, and Cardiovascular Outcomes in a White Population. Hypertension 2014; 64:943-50. [DOI: 10.1161/hypertensionaha.114.03675] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular events have their greatest prevalence in the early morning period. Whether this is attributable to an arousal-dependent blood pressure (BP) increase is far from being clear. It is also not clear to what extent this phenomenon reflects overall 24-hour BP variability. In 2051 subjects (aged 25–74 years) representative of the population of Monza (Italy), we measured 24-hour ambulatory systolic BP (SBP) and calculated the difference between the 2-hour average values after morning arousal and the lowest 3 or average 2-hour values before arousal (morning BP surge 1 and 2, respectively). For either measure, we sought the relationship with a variety of indices of 24-hour SBP variability and collected information on (1) the occurrence of cardiovascular and all cause deaths during a follow-up of ≈16 years and (2) the appearance of echocardiographic left ventricular hypertrophy after 10 years from the baseline visit. Morning SBP surge 1 was directly related to indices of 24-hour SBP variability, including those made independent on the magnitude of the day–night SBP difference. There was a weak positive relationship between morning SBP surge 1 and the risk of cardiovascular and all-cause death, which disappeared after adjustment for confounders. This was the case also for development of left ventricular hypertrophy. Morning SBP surge 2 was smaller, inconsistently related to 24-hour SBP variability and not at all related to fatal events or new-onset left ventricular hypertrophy. In a white population, morning BP surge was not found to be an independent predictor of cardiovascular death, all-cause death, or development of high cardiovascular risk (as documented by new-onset cardiac damage) even when appropriately assessed by measures that reflect its association with 24-hour BP variability.
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Affiliation(s)
- Michele Bombelli
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Danilo Fodri
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Elena Toso
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Mario Macchiarulo
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Matteo Cairo
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Rita Facchetti
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Raffaella Dell’Oro
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Guido Grassi
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Giuseppe Mancia
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
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Delgado P, Riba-Llena I, Tovar JL, Jarca CI, Mundet X, López-Rueda A, Orfila F, Llussà J, Manresa JM, Alvarez-Sabín J, Nafría C, Fernández JL, Maisterra O, Montaner J. Prevalence and associated factors of silent brain infarcts in a Mediterranean cohort of hypertensives. Hypertension 2014; 64:658-63. [PMID: 24958500 DOI: 10.1161/hypertensionaha.114.03563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean population. This is a cohort study in randomly selected hypertensives, aged 50 to 70 years old, and free of clinical stroke and dementia. On baseline, all participants underwent a brain magnetic resonance imaging to assess prevalence and location of silent infarcts, and data on vascular risk factors, comorbidities, and the presence of subclinical cardiorenal damage (left ventricular hypertrophy and microalbuminuria) were collected. Multivariate analyses were performed to determine SBIs associated factors. A total of 976 patients (49.4% men, mean age 64 years) were enrolled, and 163 SBIs were detected in 99 participants (prevalence 10.1%; 95% CI, 8.4%-12.2%), most of them (64.4%) located in the basal ganglia and subcortical white matter. After adjustment, besides age and sex, microalbuminuria and increasing total cardiovascular risk (assessed by the Framingham-calibrated for Spanish population risk function) were independently associated with SBIs. Male sex increased the odds of having SBIs in 2.5 as compared with females. Our results highlight the importance of considering both global risk assessment and sex differences in hypertension and may be useful to design future preventive interventions of stroke and dementia.
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Affiliation(s)
- Pilar Delgado
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
| | - Iolanda Riba-Llena
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José L Tovar
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Carmen I Jarca
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Xavier Mundet
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Antonio López-Rueda
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Francesc Orfila
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Judit Llussà
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Josep M Manresa
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José Alvarez-Sabín
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Cristina Nafría
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José L Fernández
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Olga Maisterra
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Joan Montaner
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
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Kuo TBJ, Hong CH, Hsieh IT, Lee GS, Yang CCH. Effects of cold exposure on autonomic changes during the last rapid eye movement sleep transition and morning blood pressure surge in humans. Sleep Med 2014; 15:986-97. [PMID: 25011661 DOI: 10.1016/j.sleep.2014.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/24/2014] [Accepted: 03/19/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Various studies have linked the occurrence of cardiovascular events and low ambient temperatures as well as the morning blood pressure surge (MBPS). We hypothesized that low ambient temperatures produce a higher sympathetic change during the last rapid eye movement (REM) sleep transition and that this may play an important role in cold-related cardiovascular events. METHODS All experiments were carried out on 12 healthy male adults, aged 24.00±0.74 years, who participated in two experimental conditions randomly (>1 day apart): warm (23 °C) and cold (16°C). Blood pressure (BP) was measured every 30 min for 24 h by autonomic ambulatory BP monitoring. The electroencephalograms, electrocardiograms, ambient temperature, near-body temperature, and physical activity were recorded by miniature polysomnography for 24 h. RESULTS The cold conditions resulted in: (i) higher MBPS than under warm conditions; (ii) significant and greater sympathetic index changes during the sleep-wake transition than during cover-to-uncover and supine-to-sit position tests; (iii) the non-REM-REM transition-related sympathetic elevation during the cold conditions being significantly higher in late sleep period than in early sleep period; (iv) at 1h prior to morning awakening, the value of total power of heart rate variability changes being significantly negatively correlated with the changes of near-body temperature; and (v) significantly higher arousal index and shorter average interval of REM periods than in warm conditions. CONCLUSION Cold exposure elevates the amplitude of MBPS and is associated with late sleep stage transition sympathetic activation, which might have important implications for cold-related cardiovascular events.
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Affiliation(s)
- Terry B J Kuo
- Sleep Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biophotonics, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Cian-Hui Hong
- Sleep Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Te Hsieh
- Sleep Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biophotonics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Guo-She Lee
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Cheryl C H Yang
- Sleep Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
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Pierdomenico SD, Pierdomenico AM, Cuccurullo F. Morning blood pressure surge, dipping, and risk of ischemic stroke in elderly patients treated for hypertension. Am J Hypertens 2014; 27:564-70. [PMID: 24048146 DOI: 10.1093/ajh/hpt170] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The independent prognostic significance of morning surge (MS) in blood pressure (BP) is not yet clear. We investigated the association between MS in systolic BP (SBP) and risk of ischemic stroke in elderly patients treated for hypertension. METHODS Occurrence of ischemic stroke was evaluated in 1,191 elderly patients treated for hypertension (aged 60-90 years). Patients were divided according to tertiles of MS in SBP in the population as a whole, dipping status, and group-specific tertiles of MS in SBP in dippers and nondippers. RESULTS During follow-up (9.1±4.9 years, range 0.4-20 years), 139 ischemic strokes occurred. The event rate per 100 patient-years was 1.28. After adjustment for various covariates, Cox regression analysis showed that stroke risk was not significantly associated with tertiles of MS in SBP in the population as a whole. When nondippers and dippers were analyzed separately by group-specific tertiles of MS in SBP, stroke risk was not associated with MS in nondippers. Conversely, in dippers, stroke risk was significantly higher in the third tertile (>23mm Hg) of MS in SBP (hazard ratio, 2.08; 95% confidence interval, 1.03-4.23; P = 0.04). Additional analysis showed that stroke risk was significantly and similarly higher in dippers with MS >23mm Hg and in nondippers than in dippers with MS <23mm Hg. CONCLUSIONS In elderly patients treated for hypertension, high MS in SBP predicts stroke in dippers but not in nondippers. Nondippers are at high stroke risk with or without MS >23mm Hg.
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Affiliation(s)
- Sante D Pierdomenico
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università Gabriele d'Annunzio, Chieti, Italy
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Cho JS, Ihm SH, Jang SW, Chung WB, Choi YS, Shin DI, Seo SM, Park MW, Kim GH, Her SH, Kim CJ, Kim TH, Kang MK, Chang K, Park CS. Negative association between plasma aldosterone concentration/plasma renin activity and morning blood pressure surge in never-treated hypertensive patients. Clin Exp Hypertens 2014; 36:195-9. [DOI: 10.3109/10641963.2014.897717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Head GA, Andrianopoulos N, McGrath BP, Martin CA, Carrington MJ, Lukoshkova EV, Davern PJ, Jennings GL, Reid CM. Predictors of mean arterial pressure morning rate of rise and power function in subjects undergoing ambulatory blood pressure recording. PLoS One 2014; 9:e93186. [PMID: 24667944 PMCID: PMC3965554 DOI: 10.1371/journal.pone.0093186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/03/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BP(power)) derived from ambulatory blood pressure recordings. METHODS BP(power) and RoR were calculated from 409 ambulatory blood pressure (ABP) recordings from subjects attending a cardiovascular risk clinic. Anthropometric data, blood biochemistry, and history were recorded. The 409 subjects were 20-82 years old (average 57, SD = 13), 46% male, 9% with hypertension but not on medication and 34% on antihypertensive medication. RESULTS Average RoR was 11.1 mmHg/hour (SD = 8) and BP(power) was 273 mmHg(2)/hour (SD = 235). Only cholesterol, low density lipoprotein and body mass index (BMI) were associated with higher BP(power) and RoR (P<0.05) from 25 variables assessed. BP(power) was lower in those taking beta-blockers or diuretics. Multivariate analysis identified that only BMI was associated with RoR (4.2% increase/unit BMI, P = 0.020) while cholesterol was the only remaining associated variable with BP(power) (17.5% increase/mmol/L cholesterol, P = 0.047). A follow up of 213 subjects with repeated ABP after an average 1.8 years identified that baseline cholesterol was the only predictor for an increasing RoR and BP(power) (P<0.05). 37 patients who commenced statin subsequently had lower BP(power) whereas 90 age and weight matched controls had similar BP(power) on follow-up. CONCLUSIONS Cholesterol is an independent predictor of a greater and more rapid rise in morning BP as well as of further increases over several years. Reduction of cholesterol with statin therapy is very effective in reducing the morning blood pressure surge.
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Affiliation(s)
- Geoffrey A. Head
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
- * E-mail:
| | - Nick Andrianopoulos
- NHMRC Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne, Australia
| | - Barry P. McGrath
- Monash Health Dandenong Australia and Monash University, Melbourne, Australia
| | - Catherine A. Martin
- Monash Health Dandenong Australia and Monash University, Melbourne, Australia
- Australian Catholic University, Fitzroy, Australia
| | - Melinda J. Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | | | - Pamela J. Davern
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Garry L. Jennings
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Christopher M. Reid
- NHMRC Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne, Australia
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Morning Blood Pressure Surge and Nighttime Blood Pressure in Relation to Nocturnal Sleep Pattern and Arterial Stiffness. J Cardiovasc Nurs 2014; 29:E10-7. [DOI: 10.1097/jcn.0b013e318291ee43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Orthostatic hypertension-a condition characterized by a hyperactive pressor response to orthostatic stress-is an emerging risk factor for cardiovascular disease and is associated with hypertensive target-organ damage (resulting in silent cerebrovascular disease, left ventricular hypertrophy, carotid atherosclerosis and/or chronic kidney disease) and cardiovascular events (such as coronary artery disease and lacunar stroke). The condition is also considered to be a form of prehypertension as it precedes hypertension in young, normotensive adults. Orthostatic blood pressure changes can be assessed using orthostatic stress tests, including clinic active standing tests, home blood pressure monitoring and the head-up tilting test. Devices for home and for ambulatory blood pressure monitoring that are equipped with position sensors and do not induce a white-coat effect have increased the sensitivity and specificity of diagnosis of out-of-clinic orthostatic hypertension. Potential major mechanisms of orthostatic hypertension are sympathetic hyperactivity (as a result of hypersensitivity of the cardiopulmonary and arterial baroreceptor reflex) and α-adrenergic hyperactivation. Orthostatic hypertension is also associated with morning blood pressure surge and extreme nocturnal blood pressure dipping, both of which increase the pulsatile haemodynamic stress of central arterial pressure and blood flow in patients with systemic haemodynamic atherothrombotic syndrome.
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Ushigome E, Fukui M, Hamaguchi M, Matsumoto S, Mineoka Y, Nakanishi N, Senmaru T, Yamazaki M, Hasegawa G, Nakamura N. Morning pulse pressure is associated more strongly with elevated albuminuria than systolic blood pressure in patients with type 2 diabetes mellitus: post hoc analysis of a cross-sectional multicenter study. Diabetes Res Clin Pract 2013; 101:270-7. [PMID: 23871575 DOI: 10.1016/j.diabres.2013.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 11/16/2022]
Abstract
AIMS Recently, focus has been directed toward pulse pressure as a potentially independent risk factor for micro- and macrovascular disease. This study was designed to examine the relationship between pulse pressure taken at home and elevated albuminuria in patients with type 2 diabetes. METHODS This study is a post hoc analysis of a cross-sectional multicenter study. Home blood pressure measurements were performed for 14 consecutive days in 858 patients with type 2 diabetes. We investigated the relationship between systolic blood pressure or pulse pressure in the morning or in the evening and urinary albumin excretion using univariate and multivariate analyses. Furthermore, we measured area under the receiver-operating characteristic curve (AUC) to compare the ability to identify elevated albuminuria, defined as urinary albumin excretion equal to or more than 30 mg/g creatinine, of systolic blood pressure or pulse pressure. RESULTS Morning systolic blood pressure (β=0.339, P<0.001) and morning pulse pressure (β=0.378, P<0.001) were significantly associated with logarithm of urinary albumin excretion independent of other potential co-factors. AUC for elevated albuminuria in morning systolic blood pressure and morning pulse pressure were 0.668 (0.632-0.705; P<0.001) and 0.694 (0.659-0.730; P<0.001), respectively. AUC of morning pulse pressure was significantly greater than that of morning systolic blood pressure (P=0.040). CONCLUSIONS Our findings implicate that morning pulse pressure is associated with elevated albuminuria in patients with type 2 diabetes, which suggests that lowering morning pulse pressure could prevent the development and progression of diabetic nephropathy.
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Affiliation(s)
- Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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