Prehypertension is real and can be associated with target organ damage

The relationship between QRS-T angle and left ventricular global longitudinal strain in prehypertensive patients

BACKGROUND AND AIM

This study aims to examine the relationship between the QRS-T angle (QRS-Ta) detected on electrocardiography and left ventricular global longitudinal strain (LV-GLS) calculated on echocardiography in prehypertensive patients.

MATERIALS AND METHODS

A total of 300 patients were included in our study, and the median value of QRS-Ta of the entire population was 27.The patients were divided into two groups (supramedian 148 patients, inframedian 152 patients) according to the median value. Statistical analysis was performed between the two groups.

RESULTS

LV-GLS was lower in the supramedian QRS-Ta group [20 (16-26) vs. 21 (16-27); p < 0.001]. A statistical difference was found between the two groups in age (p < 0.001), BMI (p < 0.001), Hs-troponin I (p < 0.001), aortic velocity (p = 0.023) and TAPSE (p = 0.005) parameters except for LV-GLS.The correlation between QRS-Ta and LV-GLS was determined by Spearman's correlation test (p < 0.001).In the multivariable logistic regression analysis model, LV-GLS (OR: 0.365, 95%CI 0.171-0.780, p = 0.009) was one of the independent predictors for increased QRS-Ta. Others were determined as age (p < 0.001) and TAPSE (p = 0.015).

CONCLUSIONS

In this study, a strong relationship was found between QRS-Ta, which is easily calculated by ECG, and LV-GLS, which is an advanced echocardiographic examination, in prehypertensive patients.

Cost-effectiveness and potential budget impact of non-pharmacological interventions for early management in prehypertensive people: an economic evaluation for China

BACKGROUND

Non-pharmacological interventions (NPIs) could be considered in the early management of prehypertensive population. This study aimed to evaluate the potential cost-effectiveness of NPIs and the budget impact of implementing NPIs on prehypertensive population in China and provide evidence of chronic disease management innovation for decision-makers.

METHODS

Five NPIs including usual care, lifestyle, strengthen exercise, relaxation, and diet therapy were selected based on the practice of hypertension management in China. A nine-state Markov model was constructed to evaluate the lifetime costs and health outcomes of five NPIs and a non-intervention group from the perspective of Chinese healthcare system. The effectiveness of NPIs was obtained from a published study. Parameters including transition probabilities, costs and utilities were extracted or calculated from published literature and open-access databases. Sensitivity analyses were conducted to test the uncertainty of all parameters. The impact of duration of intervention was considered in scenario analyses. A budget impact analysis (BIA) was conducted to evaluate the total cost and the medical cost saving of a hypothetical nationwide implementation of potential cost-effective NPI in prehypertensive people. Management strategies including focusing on patients with specific ages or different CVE risk levels, and different duration of implementation were taken into consideration.

RESULTS

Strengthen exercise was the most cost-effective intervention with a probability of 78.1% under the given WTP threshold. Our results were sensitive to the cost of interventions, and the utility of prehypertension and hypertension. The duration of implementation had limited impact on the results. BIA results showed that the program cost was hefty and far more than the medical cost saving with the course of simulation time. Applying management strategies which focused on individual characteristics could largely reduce the program cost despite it remained higher than medical cost saving.

CONCLUSIONS

Strengthen exercise was a potential NPI that can be considered in priority for early management in prehypertensive population. Although early management can acquire medical cost saving, the related program cost can be quite hefty. Precise strategies which may help reduce the cost of early management should be taken into consideration in program design.

Short-term efficacy of non-pharmacological interventions for global population with elevated blood pressure: A network meta-analysis

Background

This study aims to compare the potential short-term effects of non-pharmacological interventions (NPIs) on prehypertensive people, and provide evidence for intervention models with potential in future community-based management.

Methods

In this Bayesian network meta-analysis, Pubmed, Embase, and Web of science were screened up to 16 October 2021. Prehypertensive patients (systolic blood pressure, SBP 120-139 mmHg/diastolic blood pressure, DBP 80-89 mmHg) with a follow-up period longer than 4 weeks were targeted. Sixteen NPIs were identified during the scope review and categorized into five groups. Reduction in SBP and DBP was selected as outcome variables and the effect sizes were compared using consistency models among interventions and intervention groups. Grade approach was used to assess the certainty of evidence.

Results

Thirty-nine studies with 8,279 participants were included. For SBP, strengthen exercises were the most advantageous intervention group when compared with usual care (mean difference = -6.02 mmHg, 95% CI -8.16 to -3.87), and combination exercise, isometric exercise, and aerobic exercise were the three most effective specific interventions. For DBP, relaxation was the most advantageous intervention group when compared with usual care (mean difference = -4.99 mmHg, 95% CI -7.03 to -2.96), and acupuncture, meditation, and combination exercise were the three most effective specific interventions. No inconsistency was found between indirect and direct evidence. However, heterogeneity was detected in some studies.

Conclusion

NPIs can bring short-term BP reduction benefits for prehypertensive patients, especially exercise and relaxation. NPIs could potentially be included in community-based disease management for prehypertensive population once long-term real-world effectiveness and cost-effectiveness are proven.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518, identifier: CRD42020151518.

Supplementation of Water-Soluble Vitamins Reduces Hyperhomocysteinemia, Insulin Resistance, and High-Sensitivity C-reactive Protein in Prehypertension Subjects

BACKGROUND

Prehypertensives are at higher risk of developing cardiovascular diseases. Hyperhomocysteinemia, insulin resistance, and increased high-sensitivity C-reactive protein (hs-CRP) are independent risk factors for the development of cardiovascular complications. In prehypertensives, specific therapeutic approaches can be implemented at the earliest to prevent the onset of overt hypertension. So the present study was performed to study the effect of supplementation of water-soluble vitamins on cardiovascular risk factors like homocysteine, insulin resistance, and C-reactive protein in prehypertensive subjects.

METHODS

Sixty prehypertensive subjects were recruited into the study based on inclusion and exclusion criteria and randomized into two groups of 30 each. One group was given a placebo and the other was given water-soluble vitamins for four months. Serum homocysteine, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and hs-CRP were assayed.

RESULTS

After four months of treatment with water-soluble vitamins, there was a significant decrease in levels of serum homocysteine, hs-CRP, and HOMA-IR when compared to placebo treatment. After four months of treatment, there was a significant decrease in the levels of hs-CRP, homocysteine, and HOMA-IR in groups treated with water-soluble vitamins compared to the basal levels.

CONCLUSION

In subjects with prehypertension, supplementation of water-soluble vitamins decreases the level of homocysteine, insulin resistance, and hs-CRP.

High normal blood pressure and left ventricular structural and functional disorders in young adults

Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.

Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.

Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.

Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.

Prevalence of hypertension mediated organ damage in subjects with high-normal blood pressure without known hypertension as well as cardiovascular and kidney disease

Purpose of our study was to assess the prevalence of hypertension mediated organ damage (HMOD) in healthy subjects with high-normal Blood Pressure (BP) comparing them with subjects with BP values that are considered normal (<130/85 mmHg) or indicative of hypertension (≥140/90 mmHg). Seven hundred fifty-five otherwise healthy subjects were included. HMOD was evaluated as pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima-media thickness (IMT) and plaque. When subjects were classified according to BP levels we found that the high-normal BP group showed intermediate values of PWV and higher values of IMT. This corresponds to intermediate prevalence of arterial stiffness, while there were no differences for increased IMT or carotid plaque. No subjects showed left ventricular hypertrophy. At multivariable analysis, the odds of having arterial stiffness or carotid HMOD in the high-normal group resulted not different to the normal group. In conclusion, in our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac HMOD.

Hypertension Exercise Videos Reduce Blood Pressure of Hypertension Patients

BACKGROUND: Hypertension is a symptom of a cardiovascular degenerative disease that is mostly experienced by the elderly and cause is not certain. However, the reduction of blood pressure with drugs and non drugs can reduce damage to target organs and prevent cardiovascular diseases. AIM: Identified the effect of hypertension exercise videos of lowering blood pressure. METHODS:  The type of research that has been used is quasi experimental with Pretest and Posttest design with control group. The sampling technique used was random sampling, the number of samples was 30 samples which were the treatment group and 30 samples were control the control group. The data analysis used  was the T test and Wilcoxon and Mann Whitney test. RESULTS:  The mean reduction in systolic blood  pressure in respondents who did exercise  was 13.67 mm Hg with a standard deviation of 10.57, while the mean  in systolic  blood  pressure in respondents who did not exercise was 0.50 mmHg  a pressure were 40.95 in the group of respondents who did hypertension exercise with p value =0.000.This mean that there is significant difference, in the mean reduction in systolic and diastolic blood pressure between respondents those who do exercise. CONCLUSION. Hypertension exercise video reduce blood pressure of hypertension patients.

Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy

OBJECTIVES

Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal.

METHODS

In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg.

RESULTS

Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension.

CONCLUSIONS

HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.

Hypertension, Prehypertension, and Hypertension Control: Association With Decline in Cognitive Performance in the ELSA-Brasil Cohort

Hypertension, particularly in middle age, has been associated with worse cognitive function, but evidence is inconclusive. This study investigated whether hypertension, prehypertension, age, and duration of diagnosis, as well as blood pressure control, are associated with a decline in cognitive performance in ELSA-Brasil participants. This longitudinal study included 7063 participants, mean age 58.9 years at baseline (2008-2010), who attended visit 2 (2012-2014). Cognitive performance was measured in both visits and evaluated by the standardized scores of the memory, verbal fluency, trail B tests, and global cognitive score. The associations were investigated using linear mixed models. Hypertension and prehypertension at baseline were associated with decline in global cognitive score; being hypertension associated with reduction in memory test; and prehypertension with reduction in fluency test. Hypertension diagnose ≥55 years was associated with lower global cognitive and memory test scores, and hypertension diagnose <55 years with lower memory test scores. Duration of hypertension diagnoses was not associated with any marker of cognitive function decline. Among treated individuals, blood pressure control at baseline was inversely associated with the decline in both global cognitive and memory test scores. In this relatively young cohort, hypertension, prehypertension, and blood pressure control were independent predictors of cognitive decline in distinct abilities. Our findings suggest that both lower and older age of hypertension, but not duration of diagnosis, were associated with cognitive decline in different abilities. In addition to hypertension, prehypertension and pressure control might be critical for the preservation of cognitive function.

Associations between honey consumption and prehypertension in adults aged 40 years and older

Background: Honey has been shown to have multiple positive effects on human health. However, data on the associations of honey consumption with prehypertension are scarce. The aim of this study was to investigate whether honey consumption is associated with prehypertension in a Chinese population. Method: A cross-sectional study was conducted in 4,561 individuals aged ≥40 years. A validated 100-item semi-quantitative food frequency questionnaire was used to assess honey consumption. Blood pressure was measured at least twice by trained nurses. Multiple logistic regression models were used to explore the associations between honey consumption and prehypertension. Results: After adjustment for potential confounders, the odds ratios and 95% confidence intervals of prehypertension across increasing frequency of honey consumption were 1.00 (reference) for almost never, 1.17 (0.96, 1.41) for ≤6 times/week, and 1.25 (0.86, 1.84) for ≥7 times/week in men (P _{for trend} = 0.09); 1.00 (reference) for almost never, 0.76 (0.62, 0.92) for ≤6 times/week, and 0.84 (0.63, 1.12) for ≥7 times/week in women (P _{for trend} = 0.055), respectively. Conclusion: Our results showed that light-to-moderate intake of honey was associated with lower prevalence of prehypertension in women, but not men. Future studies are required to confirm these associations.

Antihypertensive, cardio- and neuro-protective effects of Tenebrio molitor (Coleoptera: Tenebrionidae) defatted larvae in spontaneously hypertensive rats

In pre-hypertension, moderate control of blood pressure (BP) can be obtained by a nutritional approach. The effects of a diet enriched with defatted larvae of the mealworm Tenebrio molitor (Coleoptera: Tenebrionidae) (TM) endowed with ACE inhibitory activity was studied in both spontaneously hypertensive rats (SHR) and in the age-matched normotensive Wistar Kyoto strain. These were fed for 4 weeks with standard laboratory rodent chow supplemented with or without TM or captopril. In SHR, the TM diet caused a significant reduction in BP, heart rate and coronary perfusion pressure, as well as an increase in red blood cell glutathione/glutathione disulphide ratio. Rat brain slices of SHR were more resistant to oxidative stress and contained lower levels of inflammatory cytokines, while vascular and liver enzyme-activities were not affected. These results suggest that TM can be considered a new functional food that can lower BP in vivo and thus control cardiovascular-associated risk factors such as hypertension.

Independent and combined effects of triglyceride-glucose index on prehypertension risk: a cross-sectional survey in China

Triglyceride-glucose (TyG) index is considered a simple and feasible indicator of insulin resistance (IR). This study aims to delve into the association and interaction of TyG index on the risk of prehypertension in Chinese adults. A community based cross-sectional survey conducted in Chinese population. Eligible participants were recruited, and questionnaire survey, anthropometric tests, and blood samples collection were performed. TyG index was obtained as ln [fasting TG(mg/dl) × FPG(mg/dl)/2]. Logistic regression model and the area under the receiver-operating characteristics (ROC) curves (AUC) were analyzed. Interaction analysis was conducted by calculating relative excess risk for interaction (RERI), attributable proportion for interaction (AP) as well as synergy index (SI). A total of 3115 recruited participants (1307 males and 1808 females) were aged 60.82 years on average. The prevalence of prehypertension reached 36.4% on the whole, 37.6% in male and 35.5% in female, respectively. The results of multivariable logistic regression model suggested that the adjusted OR for prehypertension was upregulated across TyG index quartiles, up to 2.06 (95% CI:1.53-2.77) for quartiles 4 versus quartiles 1. Furthermore, TyG index outperformed FPG (Z = 2.15, p = 0.032) and TG (Z = 6.10, p < 0.001) in discriminating prehypertension risk. Besides, TyG index with abdominal obesity (RERI:1.53, 95% CI:0.39-2.67; AP: 0.37, 95% CI: 0.16-0.59; SI:1.96, 95% CI:1.15-3.34) displayed a noticeable interaction on risk of prehypertension. Our study indicated that a higher TyG index rose the risk of prehypertension independently and synergistically with abdominal obesity in Chinese adults. Furthermore, it exhibited a higher predictability compared with conventional indices.

Prehypertension and risk for all-cause and cardiovascular mortality by diabetes status: results from the national health and nutrition examination surveys

Background

It is unclear whether prehypertension alone or combined with diabetes associate with a higher risk for cardiovascular or all-cause mortality. The purpose of this study was to explore the relationship between prehypertension and all-cause and cardiovascular mortality stratified by diabetes status.

Methods

All participants aged ≥18 years were enrolled from the 1999–2014 National Health and Nutrition Examination Surveys (NHANES). Prehypertension was defined as systolic/diastolic blood pressure (BP): 120–139/80–89 mmHg. The status of cardiovascular and all-cause mortality of participants were followed up through 31 December 2015. We performed Cox proportional hazards models and Kaplan-Meier survival curves to evaluate the relationships as mentioned above.

Results

In general, we enrolled 26,070 participants while 15,295 (58.67%) of them did not have diabetes nor prehypertension, 8,870 (34.02%) had prehypertension alone, 835 (3.20%) had diabetes alone, and 1,070 (4.11%) had both diabetes and prehypertension. Compared with participants without diabetes nor prehypertension, the multivariable adjusted hazard ratios and 95% confidence interval (CI) for all-cause mortality among participants with prehypertension alone, diabetes alone, and both diabetes and prehypertension were 1.08 (95% CI: 0.95, 1.23), 1.26 (0.98, 1.62), and 1.67 (1.38, 2.03) (P for trend <0.001), for cardiovascular mortality, the corresponding hazard ratios and 95% CI were 1.40 (95% CI: 0.92, 2.14), 2.21 (1.12, 4.38), and 2.87 (1.65, 4.99) (P for trend <0.001) respectively.

Conclusions

Our findings suggested that prehypertension associated with an increased risk for cardiovascular and all-cause mortality when compared with diabetes, but not for prehypertension alone. Early screening and intervention for BP among diabetic patients may be beneficial.

Antihypertensive phytocomplexes of proven efficacy and well-established use: Mode of action and individual characterization of the active constituents

Hypertension has become the leading risk factor for worldwide cardiovascular diseases. Conventional pharmacological treatment, after both dietary and lifestyle changes, is generally proposed. In this review, we present the antihypertensive properties of phytocomplexes from thirteen plants, long ago widely employed in ethnomedicines and, in recent years, increasingly evaluated for their activity in vitro and in vivo, also in humans, in comparison with synthetic drugs acting on the same systems. Here, we focus on the demonstrated or proposed mechanisms of action of such phytocomplexes and of their constituents proven to exert cardiovascular effects. Almost seventy phytochemicals are described and scientifically sound pertinent literature, published up to now, is summarized. The review emphasizes the therapeutic potential of these natural substances in the treatment of the 'high normal blood pressure' or 'stage 1 hypertension', so-named according to the most recent European and U.S. guidelines, and as a supplementation in more advanced stages of hypertension, however needing further validation by clinical trial intensification.

Arterial Hemodynamics in Prehypertensives

Compared to age-matched normotensive adults, those with essential hypertension have been shown to have distinct arterial hemodynamic abnormalities consisting of increased peripheral resistance, pulse wave velocity, and wave reflection magnitude as well as decreased wave reflection time and aortic compliance. These abnormalities are further exacerbated by beta-adrenergic blockade. To see if there are similar hemodynamic abnormalities that antedate the onset of fixed hypertension, we compared age-matched normotensives with prehypertensives selected from patients undergoing diagnostic cardiac catheterization. Ascending aortic pressure and flow were measured with a micromanometer and flow velocity sensor in the baseline state and after beta-adrenergic blockade. In the baseline state the prehypertensive compared to the normotensive group had elevated blood pressure, resistance, left ventricular end-diastolic pressure (LVEDP), and wave reflections. Beta-adrenergic blockade increased resistance, LVEDP, and wave reflections in both groups. Some of these findings are the same as those we previously reported in young persons with established, essential hypertension. The differences in LVEDP and wave reflections, both in the baseline state and after beta-blockade, were still present in subgroups with no differences in blood pressure. Hence, the elevated wave reflections in prehypertensives do not appear to be directly related to the level of blood pressure. These results support the notion that the elevated blood pressure in hypertension may represent a later manifestation of an already abnormal vascular system rather than the vascular abnormalities resulting from hypertension. Consequently, even before blood pressure becomes elevated, early diagnosis and treatment of the vascular abnormalities in prehypertensives may be warranted.

Short-Term Consumption of Cuban Policosanol Lowers Aortic and Peripheral Blood Pressure and Ameliorates Serum Lipid Parameters in Healthy Korean Participants: Randomized, Double-Blinded, and Placebo-Controlled Study

The current study was designed to investigate the short-term effects of policosanol consumption on blood pressure (BP) and the lipid parameters in healthy Korean participants with prehypertension. A total of 84 healthy participants were randomly allocated to three groups receiving placebo, 10 mg of policosanol, or 20 mg of policosanol for 12 weeks. Based on an average of three measurements of peripheral BP, the policosanol 20 mg group exhibited the most significant reduction, that is, up to 7.7% reduction of average systolic BP (SBP) from 136.3 ± 6.1 mmHg (week 0) to 125.9 ± 8.6 mmHg (week 12, p < 0.001). Between group comparisons using repeated measures ANOVA showed that the policosanol 20 mg group had a significant reduction of SBP at 12 weeks (p = 0.020) and a reduction of diastolic BP (DBP) at 8 weeks (p = 0.041) and 12 weeks (p = 0.035). The policosanol 10 mg and 20 mg groups showed significant reductions in aortic SBP of 7.4% and 8.3%, respectively. The policosanol groups showed significant reductions of total cholesterol (TC) of 9.6% and 8.6% and low-density lipoproteins (LDL-C) of 21% and 18% for 10 mg and 20 mg of policosanol, respectively. Between group comparisons using repeated measures ANOVA showed that the policosanol (10 mg and 20 mg) groups at 12 weeks had a significant reduction of TC (p = 0.0004 and p = 0.001) and LDL-C (p = 0.00005 and p = 0.0001) and elevation of %HDL-C (p = 0.048 and p = 0.014). In conclusion, 12-week consumption of policosanol resulted in significant reductions of peripheral SBP and DBP, aortic SBP and DBP, mean arterial pressure (MAP), and serum TC and LDL-C with elevation of % HDL-C.

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients

Background

Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients.

Objectives

The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients.

Methods

Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients.

Results

According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936).

Conclusions

We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.

Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults

Nicotinamide adenine dinucleotide (NAD+) has emerged as a critical co-substrate for enzymes involved in the beneficial effects of regular calorie restriction on healthspan. As such, the use of NAD+ precursors to augment NAD+ bioavailability has been proposed as a strategy for improving cardiovascular and other physiological functions with aging in humans. Here we provide the evidence in a 2 × 6-week randomized, double-blind, placebo-controlled, crossover clinical trial that chronic supplementation with the NAD+ precursor vitamin, nicotinamide riboside (NR), is well tolerated and effectively stimulates NAD+ metabolism in healthy middle-aged and older adults. Our results also provide initial insight into the effects of chronic NR supplementation on physiological function in humans, and suggest that, in particular, future clinical trials should further assess the potential benefits of NR for reducing blood pressure and arterial stiffness in this group.