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Fang Y, Zuo L, Duan H, Huang C, Wen J, Yang Q, Han C, Lv L, Zhou X. Hypertension phenotypes and adverse pregnancy outcome-related office and ambulatory blood pressure thresholds during pregnancy: a retrospective cohort study. Hypertens Res 2024:10.1038/s41440-024-01837-x. [PMID: 39152252 DOI: 10.1038/s41440-024-01837-x] [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: 11/29/2023] [Revised: 07/12/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
Blood pressure (BP) phenotypes, as determined by the consistency between office BP (OBP) and ambulatory BP (ABP) measurements, enhance risk assessment during pregnancy. However, diagnostic criteria for hypertension in pregnancy are based on data from non-pregnant populations regarding long-term cardiovascular risks. This study aimed to identify adverse pregnancy outcomes (APOs; including maternal/fetal outcomes)-related BP thresholds to refine risk assessment in pregnant women. We analyzed 967 high-risk pregnant women who underwent simultaneous OBP and ABP measurements at an average gestational age of 29.6 ± 8.0 weeks. All hypertension phenotypes were associated with an increased risk of maternal and fetal outcomes, except white coat hypertension, which showed no association with fetal outcomes. Using an XGBoost algorithm, the receiver operating characteristic (ROC) curve-derived daytime diastolic BP (DBP) thresholds of 81.5 mmHg for maternal and 82.5 mmHg for fetal outcomes were identified as the BP parameters most strongly linked to APOs. Incorporating these thresholds into the BP phenotype-based model improved the area under the curve for APOs and the net reclassification index for maternal and fetal outcomes. Decision curve analysis demonstrated a consistent positive net benefit after incorporating BP thresholds into the phenotype-based model for maternal and composite outcomes. In conclusion, in a Chinese pregnancy cohort, we identified daytime DBP as the most influential parameter for APOs, significantly enhancing the predictive performance of BP phenotype-based models. This study underscores the importance of ABP monitoring in high-risk pregnancies and the need for further research to establish optimal BP monitoring criteria for pregnancy.
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Affiliation(s)
- Yiwen Fang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lushu Zuo
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongli Duan
- Medical Genetic Center and Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chuanyi Huang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiying Wen
- Medical Genetic Center and Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Cha Han
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Lijuan Lv
- Medical Genetic Center and Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China.
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China.
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Ghazi L, Cohen JB, Townsend RR, Drawz PE, Rahman M, Pradhan N, Cohen DL, Weir MR, Rincon-Choles H, Juraschek SP. Orthostatic hypotension, orthostatic hypertension, and ambulatory blood pressure in patients with chronic kidney disease in CRIC. J Hypertens 2024; 42:329-336. [PMID: 37889527 PMCID: PMC10842034 DOI: 10.1097/hjh.0000000000003604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Orthostatic changes in blood pressure (BP), either orthostatic hypotension or orthostatic hypertension (OHTN), are common among patients with chronic kidney disease. Whether they are associated with unique out-of-office BP phenotypes is unknown. METHODS CRIC is a prospective, multicenter, observational cohort study of participants with CKD. BP measured at 2 min after standing and ambulatory BP monitoring (ABPM) were obtained on 1386 participants. Orthostatic hypotension was defined as a 20 mmHg drop in SBP or 10 mmHg drop in DBP when changing from seated to standing positions. Systolic and diastolic night-to-day ratio was also calculated. OHTN was defined as a 20 or 10 mmHg rise in SBP or DBP when changing from a seated to a standing position. White-coat effect (WCE) was defined as seated minus daytime ambulatory BP. RESULTS Of the 1386 participants (age: 58 ± 10 years, 44% female, 39% black), 68 had orthostatic hypotension and 153 had OHTN. Postural reduction in SBP or DBP was positively associated with greater systolic and diastolic WCE and systolic and diastolic night-to-day ratio. Orthostatic hypotension was positively associated with diastolic WCE (β = 3 [0.2, 5.9]). Diastolic OHTN was negatively associated with systolic WCE (β = -4 [-7.2, -0.5]) and diastolic WCE (β = -6 [-8.1, -4.2]). CONCLUSION Postural change in BP was associated with WCE and night-to-day-ratio. Orthostatic hypotension was positively associated with WCE and OHTN was negatively associated with WCE. These findings strengthen observations that postural changes in BP may associate with distinct BP patterns throughout the day. These observations are informative for subsequent research tailoring orthostatic hypotension and OHTN treatment to specific BP phenotypes.
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Affiliation(s)
- Lama Ghazi
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, PA
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Paul E Drawz
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Debbie L Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, PA
| | - Matthew R. Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | - Hernan Rincon-Choles
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Department of Nephrology, Cleveland, OH
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Collard D, Vriend EMC, Galenkamp H, Moll van Charante EP, Vogt L, Westerhof BE, van den Born BJH. Autonomic regulation in different hypertensive phenotypes - the HELIUS study. Blood Press 2023; 32:2270070. [PMID: 37861395 DOI: 10.1080/08037051.2023.2270070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
Background: Hypertension can be classified into different phenotypes based on systolic and diastolic blood pressure (BP) that carry a different prognosis and may therefore be differently associated with sympathetic activity. We assessed the association between cardiac autonomic function determined from continuous finger BP recordings and hypertensive phenotypes. Methods: We included 10,221 individuals aged between 18-70 years from the multi-ethnic HELIUS study. Finger BP was recorded continuously for 3-5 minutes from which cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) were determined. Hypertension was classified into isolated systolic (ISH; ≥140/<90), diastolic (IDH; <140/≥90) and combined systolic and diastolic hypertension (SDH; ≥140/≥90). Differences were assessed after stratification by age (younger: ≤40, older: >40 years) and sex, using regression with correction for relevant covariates. For xBRS, values were log-transformed. Results: In younger adults with ISH, xBRS was comparable to normotensive individuals in men (ratio 0.92; 95%CI 0.84-1.01) and women (1.00; 95%CI 0.84-1.20), while xBRS was significantly lower in IDH and SDH (ratios between 0.67 and 0.80). In older adults, all hypertensive phenotypes had significantly lower xBRS compared to normotensives. We found a similar pattern for HRV in men, while in women HRV did not differ between phenotypes. Conclusions: In younger men and women ISH is not associated with a shift towards increased sympathetic control, while IDH and SDH in younger and all hypertensive phenotypes in older participants were associated with increased sympathetic control. This suggests that alterations in autonomic regulation could be a contributing factor to known prognostic disparities between hypertensive phenotypes.
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Affiliation(s)
- D Collard
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E M C Vriend
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - H Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - E P Moll van Charante
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - L Vogt
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Nephrology, Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands
| | - B E Westerhof
- Amsterdam UMC, University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, The Netherlands
| | - B J H van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
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Fontes MAP, Marins FR, Patel TA, de Paula CA, Dos Santos Machado LR, de Sousa Lima ÉB, Ventris-Godoy AC, Viana ACR, Linhares ICS, Xavier CH, Filosa JA, Patel KP. Neurogenic Background for Emotional Stress-Associated Hypertension. Curr Hypertens Rep 2023; 25:107-116. [PMID: 37058193 PMCID: PMC10103037 DOI: 10.1007/s11906-023-01235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE OF REVIEW The response to natural stressors involves both cardiac stimulation and vascular changes, primarily triggered by increases in sympathetic activity. These effects lead to immediate flow redistribution that provides metabolic support to priority target organs combined with other key physiological responses and cognitive strategies, against stressor challenges. This extremely well-orchestrated response that was developed over millions of years of evolution is presently being challenged, over a short period of time. In this short review, we discuss the neurogenic background for the origin of emotional stress-induced hypertension, focusing on sympathetic pathways from related findings in humans and animals. RECENT FINDINGS The urban environment offers a variety of psychological stressors. Real or anticipatory, emotional stressors may increase baseline sympathetic activity. From routine day-to-day traffic stress to job-related anxiety, chronic or abnormal increases in sympathetic activity caused by emotional stressors can lead to cardiovascular events, including cardiac arrhythmias, increases in blood pressure and even sudden death. Among the various alterations proposed, chronic stress could modify neuroglial circuits or compromise antioxidant systems that may alter the responsiveness of neurons to stressful stimuli. These phenomena lead to increases in sympathetic activity, hypertension and consequent cardiovascular diseases. The link between anxiety, emotional stress, and hypertension may result from an altered neuronal firing rate in central pathways controlling sympathetic activity. The participation of neuroglial and oxidative mechanisms in altered neuronal function is primarily involved in enhanced sympathetic outflow. The significance of the insular cortex-dorsomedial hypothalamic pathway in the evolution of enhanced overall sympathetic outflow is discussed.
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Affiliation(s)
- Marco Antônio Peliky Fontes
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil.
| | - Fernanda Ribeiro Marins
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | - Tapan A Patel
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cristiane Amorim de Paula
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | - Liliane Ramos Dos Santos Machado
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | - Érick Bryan de Sousa Lima
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | - Ana Caroline Ventris-Godoy
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | - Ana Clara Rocha Viana
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | - Isadora Cristina Souza Linhares
- Department of Physiology & Biophysics, Federal University of Minas Gerais, Federal de Minas Gerais, Belo Horizonte, MG, 31270 901, Brazil
| | | | | | - Kaushik P Patel
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
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Abstract
White-coat hypertension (WCH) has been defined as an increased blood pressure (BP) in the doctor's office and a normal BP outside the office by 24 hr ambulatory BP monitoring (ABPM) or home BP measurement. It is generated by fear and anxiety of whether an abnormal value could be found and indicate the existence of hypertension. When first described, it was defined as a neuro-defense reaction related to the presence of the doctor in their office or clinic and associated with an increase in heart rate. Initially it was considered a benign condition, not associated with the hypertension mediated organ damage (HMOD) and not requiring treatment. However, recent studies have shown that WCH is not a benign condition and is associated with HMOD and cardiovascular (CV) events (CVE). According to recent ACC/AHA guidelines, the outside of office normal BP should be < 130/80 mmHg and according to the ESC/ESH guidelines, the outside of office normal BP should be < 135/85 mmHg. The prevalence of WCH varies by different studies from 15% to 40% and up to 50% in older subjects. Currently, the management of WCH if not associated with CV risk factors should be conservative with healthy lifestyle changes and exercise. Drug therapy should be considered if these measures do not work or in the presence of CV risk factors, HMOD, or preexisting cardiovascular disease.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Ma J, Li Y, Yang X, Liu K, Zhang X, Zuo X, Ye R, Wang Z, Shi R, Meng Q, Chen X. Signaling pathways in vascular function and hypertension: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther 2023; 8:168. [PMID: 37080965 PMCID: PMC10119183 DOI: 10.1038/s41392-023-01430-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/03/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
Hypertension is a global public health issue and the leading cause of premature death in humans. Despite more than a century of research, hypertension remains difficult to cure due to its complex mechanisms involving multiple interactive factors and our limited understanding of it. Hypertension is a condition that is named after its clinical features. Vascular function is a factor that affects blood pressure directly, and it is a main strategy for clinically controlling BP to regulate constriction/relaxation function of blood vessels. Vascular elasticity, caliber, and reactivity are all characteristic indicators reflecting vascular function. Blood vessels are composed of three distinct layers, out of which the endothelial cells in intima and the smooth muscle cells in media are the main performers of vascular function. The alterations in signaling pathways in these cells are the key molecular mechanisms underlying vascular dysfunction and hypertension development. In this manuscript, we will comprehensively review the signaling pathways involved in vascular function regulation and hypertension progression, including calcium pathway, NO-NOsGC-cGMP pathway, various vascular remodeling pathways and some important upstream pathways such as renin-angiotensin-aldosterone system, oxidative stress-related signaling pathway, immunity/inflammation pathway, etc. Meanwhile, we will also summarize the treatment methods of hypertension that targets vascular function regulation and discuss the possibility of these signaling pathways being applied to clinical work.
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Affiliation(s)
- Jun Ma
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yanan Li
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xiangyu Yang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xianghao Zuo
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Ziqiong Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qingtao Meng
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue District, Chengdu, Sichuan, 610041, People's Republic of China.
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Singh M, Singh N, Pahuja H, Arora R, Patel H. White Coat Effect: Is It Because of the Hospital Setting, or Is It Physician-Induced? Cureus 2023; 15:e38144. [PMID: 37257162 PMCID: PMC10214880 DOI: 10.7759/cureus.38144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION White coat hypertension (WCH) patients are those individuals who have high blood pressure (BP) in the medical environment but are normal during their daily activities. White coat hypertensive patients with normal daytime ambulatory blood pressure monitoring (ABPM) rapidly progress to sustained hypertension. WCH is mainly treated with non-pharmacological methods. Alpha-1 agonists and beta blockers are logical treatment choices for patients with fixed hypertension with the White Coat Effect (WCE). Masked hypertension patients are those individuals who have normal values at the doctor's office but elevated BP at home or during 24-hour ABPM (24-hour or daytime). ABPM is a more practical and reliable method for detecting patients with WCH. MATERIAL AND METHODS This observational study was conducted at Dayanand Medical College & Hospital, Ludhiana, over the course of one year (December 2015 to November 2016). The primary objective of the study was to determine whether there was a difference in blood pressure readings between the home setting and the hospital setting. The secondary objective was to determine whether the difference, if present, between the hospital and home readings was due to the hospital setting, physician presence, or a combination of both. Patients with stage 1 hypertension were included in the study, irrespective of antihypertensive treatment. Patients with ischemic heart disease, chronic liver failure, and chronic kidney disease who could not follow protocol instructions were excluded. RESULTS In our study, the mean age of patients was 53.91±12.86 years. The patient's mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings at the hospital were higher than their home readings (p-0.012; p-0.001, respectively). Mean hospital SBP and DBP readings recorded by the physician were higher than readings recorded by patients alone at home (p-0.002; p-0.014, respectively) and alone at the hospital (p-0.004; p-0.001, respectively). BP readings taken by the physician with a manual sphygmomanometer were significantly lower than those taken with a digital sphygmomanometer by patients and physicians in all settings (p<0.05). The mean rise in BP was significant in both the physician's presence and the hospital environment (p<0.05 for both), and this rise was more significantly associated with the hospital effect than the physician effect (p<0.05). CONCLUSION Misdiagnosis of hypertension results in inappropriate prescription and overuse of antihypertensive medications for individuals who are not persistently hypertensive. So it is very important to rule out WCH in both the hospital setting and the physician's presence, more precisely by ABPM. WCH can be diagnosed with regular BP monitoring by a digital sphygmomanometer at home.
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Affiliation(s)
- Manvir Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Navpreet Singh
- Internal Medicine, Gian Sagar Hospital & Medical College, Rajpura, IND
| | - Hardik Pahuja
- Psychiatry, Gian Sagar Hospital & Medical College, Rajpura, IND
| | - Rashmi Arora
- Anesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Zhao K, Zhu H, Ma J, Zhao Z, Zhang L, Zeng Z, Du P, Sun Y, Yang Q, Zhou J, Jing Z. Peripheral Eosinophil Count Is Associated With the Prognosis of Patients With Type B Aortic Dissection Undergoing Endovascular Aortic Repair: A Retrospective Cohort Study. J Am Heart Assoc 2022; 11:e027339. [PMID: 36416154 PMCID: PMC9851444 DOI: 10.1161/jaha.122.027339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Eosinophil count (EOS) has been proposed to provide prognostic information in multiple cardiovascular disorders. However, few researchers have investigated the predictive value of EOS for patients with type B aortic dissection who had thoracic endovascular repair. Methods and Results The authors reviewed the records of 912 patients with type B aortic dissection who were treated with thoracic endovascular repair in Changhai Hospital, Shanghai. By using receiver operating characteristic curve analysis, patients were divided into 2 groups based on the admission EOS cutoff value (<7.4×106/L [n=505] and ≥7.4×106/L [n=407]). To reduce selection bias, propensity score matching was applied. Multivariable regression analysis and Kaplan-Meier curves were performed to assess the association between EOS and long-term outcomes. Furthermore, we investigated nonlinear correlations between EOS and outcomes using general additive models with restricted cubic splines. In the matched population, lower EOS was associated with significantly higher 30-day mortality (4.1% vs 0%, P=0.007). There was no statistically difference in 30-day adverse events between the 2 groups (all P>0.05). Kaplan-Meier analysis revealed that patients with an EOS <7.4×106/L had a higher incidence of 1-year all-cause death (7.95% vs. 2.34%, P=0.008) and aortic-related death (5.98% vs 1.81%, P=0.023) than those with higher EOS. Multivariable Cox analysis showed that continuous EOS was independently associated with 1-year mortality (hazard ratio, 3.23 [95% CI, 1.20-8.33], P=0.019). In addition, we discovered a nonlinear association between EOS and 1-year outcomes. Conclusions Lower admission EOS values predict higher short- and long-term mortality after thoracic endovascular repair.
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Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Hongqiao Zhu
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Jiqing Ma
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Zhiqing Zhao
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Lei Zhang
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Zan Zeng
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Pengcheng Du
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Yudong Sun
- Depaertment of General surgery, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Qin Yang
- Department of CardiologyJinan Hospital of Integrated Traditional Chinese and Western MedicineJinanShandongChina
| | - Jian Zhou
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Zaiping Jing
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
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Shih LC, Wang YC, Hung MH, Cheng H, Shiao YC, Tseng YH, Huang CC, Lin SJ, Chen JW. Prediction of white-coat hypertension and white-coat uncontrolled hypertension using machine learning algorithm. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:559-569. [PMID: 36710891 PMCID: PMC9779877 DOI: 10.1093/ehjdh/ztac066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/11/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022]
Abstract
Aims The detection of white-coat hypertension/white-coat uncontrolled hypertension (WCH/WUCH) with out-of-office blood pressure (BP) monitoring is time- and resource-consuming. We aim to develop a machine learning (ML)-derived prediction model based on the characteristics of patients from a single outpatient visit. Methods and results Data from two cohorts in Taiwan were used. Cohort one (970 patients) was used for development and internal validation, and cohort two (464 patients) was used for external validation. WCH/WUCH was defined as an office BP of ≥140/90 mmHg and daytime ambulatory BP of <135/85 mmHg in treatment-naïve or treated individuals. Logistic regression, random forest (RF), eXtreme Gradient Boosting, and artificial neural network models were trained using 26 patient parameters. We used SHapley Additive exPlanations values to provide explanations for the risk factors. All models achieved great area under the receiver operating characteristic curve (AUROC), specificity, and negative predictive value in both validations (AUROC = 0.754-0.891; specificity = 0.682-0.910; negative predictive value = 0.831-0.968). The RF model was the best performing (AUROC = 0.884; sensitivity = 0.619; specificity = 0.887; negative predictive value = 0.872; accuracy = 0.819). The five most influential features of the RF model were office diastolic BP, office systolic BP, current smoker, estimated glomerular filtration rate, and fasting glucose level. Conclusion Our prediction models achieved good performance, underlining the feasibility of applying ML models to outpatient populations for the diagnosis of WCH and WUCH. Further validation with other prospective data sets should be considered in the future.
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Affiliation(s)
| | | | - Ming-Hui Hung
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han Cheng
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chieh Shiao
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hsuan Tseng
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, ROC Taipei, Taiwan,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, ROC Taipei, Taiwan,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
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10
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Elsaafien K, Harden SW, Johnson DN, Kimball AK, Sheng W, Smith JA, Scott KA, Frazier CJ, de Kloet AD, Krause EG. A Novel Organ-Specific Approach to Selectively Target Sensory Afferents Innervating the Aortic Arch. Front Physiol 2022; 13:841078. [PMID: 35399269 PMCID: PMC8987286 DOI: 10.3389/fphys.2022.841078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
The brain maintains cardiovascular homeostasis, in part, via the arterial baroreflex which senses changes in blood pressure (BP) at the level of the aortic arch. Sensory afferents innervating the aortic arch employ baroreceptors to convert stretch exerted on the arterial wall into action potentials carried by the vagus nerve to second order neurons residing within the nucleus of the solitary tract (NTS). Although the baroreflex was described more than 80 years ago, the specific molecular, structural, and functional phenotype of the baroreceptors remain uncharacterized. This is due to the lack of tools that provide the genetic and target organ specificity that is required to selectively characterize baroreceptor afferents. Here, we use a novel approach to selectively target baroreceptors. Male mice on a C57BL/6J background were anesthetized with isoflurane, intubated, and artificially ventilated. Following sternotomy, the aortic arch was exposed, and a retrograde adeno-associated virus was applied to the aortic arch to direct the expression of channelrhoropsin-2 (ChR2) and/or tdTomato (tdTom) to sensory afferents presumably functioning as baroreceptors. Consistent with the structural characteristics of arterial baroreceptors, robust tdTom expression was observed in nerve endings surrounding the aortic arch, within the fibers of the aortic depressor and vagus nerves, cell bodies of the nodose ganglia (NDG), and neural projections to the caudal NTS (cNTS). Additionally, the tdTom labeled cell bodies within the NDG also expressed mRNAs coding for the mechanically gated ion channels, PIEZO-1 and PIEZO-2. In vitro electrophysiology revealed that pulses of blue light evoked excitatory post-synaptic currents in a subset of neurons within the cNTS, suggesting a functional connection between the labeled aortic arch sensory afferents and second order neurons. Finally, the in vivo optogenetic stimulation of the cell bodies of the baroreceptor expressing afferents in the NDG produced robust depressor responses. Together, these results establish a novel approach for selectively targeting sensory neurons innervating the aortic arch. This approach may be used to investigate arterial baroreceptors structurally and functionally, and to assess their role in the etiology or reversal of cardiovascular disease.
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Affiliation(s)
- Khalid Elsaafien
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
| | - Scott W. Harden
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
| | - Dominique N. Johnson
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Aecha K. Kimball
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Wanhui Sheng
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
| | - Justin A. Smith
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Karen A. Scott
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
| | - Charles J. Frazier
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
| | - Annette D. de Kloet
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, United States
- Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, United States
- Annette D. de Kloet,
| | - Eric G. Krause
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, United States
- Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, United States
- *Correspondence: Eric G. Krause,
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11
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Gliemann L, Tamariz-Ellemann A, Collin Hansen C, Svarre Ehlers T, Møller S, Hellsten Y. Is the Pannexin-1 Channel a Mechanism Underlying Hypertension in Humans? a Translational Study of Human Hypertension. Hypertension 2022; 79:1132-1143. [PMID: 35291811 DOI: 10.1161/hypertensionaha.121.18549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In preclinical models, the pannexin-1 channel has been shown to be involved in blood pressure regulation through an effect on peripheral vascular resistance. Pannexin-1 releases ATP, which can activate constrictive purinergic receptors on the smooth muscle cells. Pannexin-1 opening is proposed to be mediated by α-adrenergic receptors to potentiate sympathetic constriction. This positions pannexin-1 as a putative pharmacological target in blood pressure regulation in humans. The aim was to provide the first translational evidence for a role of pannexin-1 in essential hypertension in humans by use of an advanced invasive mechanistic approach. METHODS Middle-aged stage-1 hypertensive (n=13; 135.7±6.4 over 83.7±3.7 mm Hg) and normotensive men (n=12; 117.3±5.7 over 72.2±3.5 mm Hg) were included. Blood pressure and leg vascular resistance were determined during femoral arterial infusion of tyramine (α-adrenergic receptor stimulation), sodium nitroprusside, and acetylcholine. Measurements were made during control conditions and with pannexin-1 blockade (3000 mg probenecid). Expression of purinergic- and α-adrenergic receptors in skeletal muscle biopsies was determined by Western blot. RESULTS The changes in leg vascular resistance in response to tyramine (+289% versus +222%), sodium nitroprusside (-82% versus -78%) and acetylcholine (-40% versus -44%) infusion were not different between the 2 groups (P>0.05) and pannexin-1 blockade did not alter these variables (P>0.05). Expression of pannexin-1 and of purinergic- and α-adrenergic receptors was not different between the 2 groups (P>0.05). CONCLUSIONS Contrary to our hypothesis, the data demonstrate that pannexin-1 does not contribute to the elevated blood pressure in essential hypertension, a finding, which also opposes that reported in preclinical models.
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Affiliation(s)
- Lasse Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | | | | | - Sophie Møller
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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12
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Kandzari DE, Mahfoud F, Weber MA, Townsend R, Parati G, Fisher NDL, Lobo MD, Bloch M, Böhm M, Sharp ASP, Schmieder RE, Azizi M, Schlaich MP, Papademetriou V, Kirtane AJ, Daemen J, Pathak A, Ukena C, Lurz P, Grassi G, Myers M, Finn AV, Morice MC, Mehran R, Jüni P, Stone GW, Krucoff MW, Whelton PK, Tsioufis K, Cutlip DE, Spitzer E. Clinical Trial Design Principles and Outcomes Definitions for Device-Based Therapies for Hypertension: A Consensus Document From the Hypertension Academic Research Consortium. Circulation 2022; 145:847-863. [PMID: 35286164 PMCID: PMC8912966 DOI: 10.1161/circulationaha.121.057687] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The clinical implications of hypertension in addition to a high prevalence of both uncontrolled blood pressure and medication nonadherence promote interest in developing device-based approaches to hypertension treatment. The expansion of device-based therapies and ongoing clinical trials underscores the need for consistency in trial design, conduct, and definitions of clinical study elements to permit trial comparability and data poolability. Standardizing methods of blood pressure assessment, effectiveness measures beyond blood pressure alone, and safety outcomes are paramount. The Hypertension Academic Research Consortium (HARC) document represents an integration of evolving evidence and consensus opinion among leading experts in cardiovascular medicine and hypertension research with regulatory perspectives on clinical trial design and methodology. The HARC document integrates the collective information among device-based therapies for hypertension to better address existing challenges and identify unmet needs for technologies proposed to treat the world’s leading cause of death and disability. Consistent with the Academic Research Consortium charter, this document proposes pragmatic consensus clinical design principles and outcomes definitions for studies aimed at evaluating device-based hypertension therapies.
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Affiliation(s)
| | - Felix Mahfoud
- Piedmont Heart Institute, Atlanta, GA (D.E.K.).,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Michael A Weber
- State University of New York, Downstate Medical College, New York (M.A.W.)
| | - Raymond Townsend
- University of Pennsylvania, Perelman School of Medicine, Philadelphia (R.T.)
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.).,Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Ospedale San Luca, Milan, Italy (G.P.)
| | | | - Melvin D Lobo
- Barts National Institute for Health Research Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L.)
| | - Michael Bloch
- University of Nevada/Reno School of Medicine (M. Bloch).,Renown Institute for Heart and Vascular Health, Reno, NV (M. Bloch)
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M., M. Böhm, C.U.)
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, United Kingdom (A.S.P.S.)
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany (R.E.S.)
| | - Michel Azizi
- University of Paris, Institut national de la santé et de la recherche médicale (INSERM), Centre d'investigation clinique 418, Assistance Publique-Hôpitaux de Paris Hypertension Department and Département médico-universitaire Cardiologie Rein Transplantation Neurovasculaire, Georges Pompidou European Hospital, France (M.A.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit and Research Foundation, University of Western Australia (M.P.S.)
| | - Vasilios Papademetriou
- Department of Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.)
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York' NY (A.J.K.).,Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.)
| | - Joost Daemen
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands (J.D., E.S.)
| | - Atul Pathak
- Department of Cardiovasculaire Medicine, European Society of Hypertension Excellence Center, Princess Grace Hospital, Monaco (A.P.).,Centre for Anthropobiology and Genomics of Toulouse, Toulouse, France (A.P.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M., M. Böhm, C.U.)
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Germany (P.L.)
| | - Guido Grassi
- Clinica Medica University Milano-Bicocca, Milan, Italy (G.G.)
| | - Martin Myers
- Division of Cardiology, Sunnybrook Health Sciences Centre (M.M.), University of Toronto, Canada
| | | | | | - Roxana Mehran
- Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.).,Mount Sinai Hospital, New York (R.M., G.W.S.)
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation (P.J.), University of Toronto, Canada
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.)
| | | | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University Health Sciences Center, New Orleans, LA (P.K.W.)
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Greece (K.T.)
| | - Donald E Cutlip
- Baim Institute for Clinical Research, Boston, MA (D.E.C.).,Beth Israel Deaconess Medical Center, Boston, MA (D.E.C.)
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13
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Dendritic cells as potential initiators of immune-mediated hypertensive disorders. Hypertens Res 2021; 45:527-529. [PMID: 34961789 DOI: 10.1038/s41440-021-00830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022]
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14
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Mancia G, Facchetti R, Bombelli M, Cuspidi C, Grassi G. White-Coat Hypertension: Pathophysiological and Clinical Aspects: Excellence Award for Hypertension Research 2020. Hypertension 2021; 78:1677-1688. [PMID: 34757765 DOI: 10.1161/hypertensionaha.121.16489] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few issues of modern cardiovascular medicine have been as controversial as the relationship between white-coat hypertension (WCH), that is, a common condition in which office blood pressure is elevated while out-of-office blood pressure (ambulatory blood pressure or home blood pressure) is normal. While earlier studies showed no increased risk of cardiovascular events in WCH compared with the normotensive state, more recent studies have changed this conclusion by showing that an increased cardiovascular risk represents a trait of this hypertensive phenotype. The present article will review a number of issues related to WCH, that is, its definition, pathophysiological background, clinical alterations, and prognostic significance. This will be done by considering the available evidence published during the last decades, with special focus on the data collected in PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni)-a research project performed with a cross-sectional and longitudinal design, which has provided a series of novel clinical information on WCH throughout the years. The final part of the article will discuss the therapeutic implications of the abovementioned evidence, as well as some controversial or still undefined issues related to WCH, whose investigation will be an important goal to pursue by future research.
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Affiliation(s)
- Giuseppe Mancia
- University of Milano-Bicocca (G.M.), University of Milano-Bicocca, Milan, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
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15
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Relationship between office isolated systolic or diastolic hypertension and white-coat hypertension across the age spectrum: a home blood pressure study. J Hypertens 2021; 38:663-670. [PMID: 31790056 DOI: 10.1097/hjh.0000000000002320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The current study investigated the prevalence of white-coat hypertension (WCH) and white-coat uncontrolled hypertension (WUCH) throughout the age spectrum among individuals with office isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systolic-diastolic hypertension (SDH) who were untreated or treated with antihypertensive medications, respectively. METHODS We cross-sectionally evaluated 8809 untreated (42% males, 52.1 ± 16.2 years) and 9136 treated (39% males, 59.7 ± 14.5 years) individuals from two independent Brazilian populations who underwent home blood pressure monitoring. Participants were also categorized as younger (<40 years), intermediate (≥40 and <60 years) and older (≥60 years) age. RESULTS Unadjusted and adjusted analyses showed that the frequency of WCH and WUCH was significantly greater (P < 0.05) in ISH and IDH than SDH at all age groups. Logistic regression analysis adjusted for sex, BMI and studied population showed that, compared with SDH, ISH had in average 4.1, 3.1 and 1.6-fold greater risk of WCH and 3.3, 3.6 and 2.0-fold greater risk of WUCH at younger, intermediate and older ages, whereas IDH had in average 2.3, 2.6 and 2.0-fold greater risk of WCH and 3.8, 3.2 and 3.8-fold greater risk of WUCH at younger, intermediate and older ages, respectively. CONCLUSION ISH and IDH were associated with higher prevalence of WCH and WUCH than SDH across all age spectrum. In addition, treated and untreated ISH individuals with age less than 60 years and treated IDH individuals of all ages had the highest risk of having WCH phenotypes.
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16
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Individual Differences in Cross-System Physiological Activity at Rest and in Response to Acute Social Stress. Psychosom Med 2021; 83:138-148. [PMID: 33395213 DOI: 10.1097/psy.0000000000000901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Individual differences in long-term cardiovascular disease risk are related to physiological responses to psychological stress. However, little is known about specific physiological response profiles in young adults that may set the stage for long-term increased cardiovascular disease risk. We investigated individual differences in profiles of resting cardiovascular physiology and stress reactivity, combining parasympathetic, sympathetic, and hemodynamic measures. METHODS Participants (n = 744, 71% women, mean [standard deviation] age = 20.1 [2.4] years) underwent the Trier Social Stress Test, while blood pressure (systolic blood pressure, diastolic blood pressure), electrocardiograms (interbeat interval), and impedance cardiograms (preejection period, left ventricular ejection time) were recorded. Respiratory sinus arrhythmia was derived from the combination of the electrocardiogram and the impedance cardiogram. A three-step latent profile analysis (LPA) was performed on resting and reactivity values to derive clusters of individual physiological profiles. We also explored demographic and health behavioral correlates of the observed latent clusters. RESULTS For resting physiology, LPA revealed five different resting physiology profiles, which were related to sex, usual physical activity levels, and body mass index. Five cardiovascular stress reactivity profiles were identified: a reciprocal/moderate stress response (Cr1; 29%), and clusters characterized by high blood pressure reactivity (Cr2: 22%), high vagal withdrawal (Cr3; 22%), autonomic coactivation (parasympathetic nervous system and sympathetic nervous system; Cr4; 13%), and overall high reactivity (Cr5; 12%). Men were more likely to belong to the high reactivity (Cr5) cluster, whereas women were more likely to have autonomic coactivation (Cr4). CONCLUSIONS We identified five cardiovascular physiological reactivity profiles, with individuals displaying generalized hyperreactivity, predominant vagal withdrawal, autonomic coactivation, or blood pressure-specific hyperreactivity. Longitudinal studies are needed to determine whether these profiles are useful in early detection of individuals at high risk for cardiovascular disease.
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17
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Xiang H, Xue Y, Wang J, Weng Y, Rong F, Peng Y, Ji K. Cardiovascular Alterations and Management of Patients With White Coat Hypertension: A Meta-Analysis. Front Pharmacol 2020; 11:570101. [PMID: 33041810 PMCID: PMC7527598 DOI: 10.3389/fphar.2020.570101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
A large and growing body of literature has focused on the association between "white coat hypertension" (WCH) and the underlying target organ damage. The evidence suggests that WCH is may not an entirely benign phenomenon. However, whether patients with WCH should receive antihypertensive drugs is unresolved. Therefore, we performed a meta-analysis to fully determine the ability of WCH to alter cardiovascular structure and to determine whether patients with WCH could benefit from drug intervention. Medline, EMBASE, and the Cochrane Library were searched from inception through 21 Oct 2019. A total of 25 studies (8,100 individuals) were included. In participants with WCH, values of aortic pulse wave velocity, augmentation index, intima-media thickness, interventricular septum thickness, left ventricular posterior wall thickness, and left ventricular mass index were lower than those with sustained hypertension, but greater than those in the normotensive group. Of note, antihypertensive drug therapy did not reduce the risk of cardiovascular events in patients with WCH. WCH is accompanied by alterations of cardiovascular structure; however, the benefits from antihypertensive therapy are limited.
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Affiliation(s)
- Huaqiang Xiang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yangjing Xue
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jinsheng Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yingbei Weng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fangning Rong
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yangpei Peng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Kangting Ji
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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18
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Ehlers TS, Sverrisdottir Y, Bangsbo J, Gunnarsson TP. High-Intensity Interval Training Decreases Muscle Sympathetic Nerve Activity in Men With Essential Hypertension and in Normotensive Controls. Front Neurosci 2020; 14:841. [PMID: 33013285 PMCID: PMC7461859 DOI: 10.3389/fnins.2020.00841] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
Exercise training is a cornerstone in reducing blood pressure (BP) and muscle sympathetic nerve activity (MSNA) in individuals with essential hypertension. High-intensity interval training (HIIT) has been shown to be a time efficient alternative to classical continuous training in lowering BP in essential hypertension, but the effect of HIIT on MSNA levels has never been investigated. Leg MSNA responsiveness to 6 weeks of HIIT was examined in 14 hypertensive men (HYP; age: 62 ± 7 years, night time BP: 136 ± 12/83 ± 8 mmHg, BMI: 28 ± 3 kg/m2), and 10 age-matched normotensive controls (NORM; age: 60 ± 8 years, night time BP: 116 ± 2/68 ± 4 mmHg and BMI: 27 ± 3 kg/m2). Before training, MSNA levels were not different between HYP and NORM (burst frequency (BF): 41.0 ± 10.3 vs. 33.6 ± 10.6 bursts/min and burst incidence (BI): 67.5 ± 19.7 vs. 64.2 ± 17.0 bursts/100 heart beats, respectively). BF decreased (P < 0.05) with training by 13 and 5% in HYP and NORM, respectively, whereas BI decreased by 7% in NORM only, with no difference between groups. Training lowered (P < 0.05) night-time mean arterial- and diastolic BP in HYP only (100 ± 8 vs. 97 ± 5, and 82 ± 6 vs. 79 ± 5 mmHg, respectively). The change in HYP was greater (P < 0.05) compared to NORM. Training reduced (P < 0.05) body mass, visceral fat mass, and fat percentage similarly within- and between groups, with no change in fat free mass. Training increased (P < 0.05) V̇O2-max in NORM only. Six weeks of HIIT lowered resting MSNA levels in age-matched hyper- and normotensive men, which was paralleled by a significant reduction in BP in the hypertensive men.
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Affiliation(s)
- Thomas Svare Ehlers
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Yrsa Sverrisdottir
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.,Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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19
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Climie RE, Lambert EA, Schlaich MP, Lambert GW. White Coat Hypertension-A Case for Assessing Vascular Age? Am J Hypertens 2020; 33:599-601. [PMID: 32347902 DOI: 10.1093/ajh/hpaa061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/09/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rachel E Climie
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Elisabeth A Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, University of Western Australia—Royal Perth Hospital, Perth, Australia
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia
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20
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Gunnarsson TP, Ehlers TS, Fiorenza M, Nyberg M, Bangsbo J. Essential hypertension is associated with blunted smooth muscle cell vasodilator responsiveness and is reversed by 10-20-30 training in men. Am J Physiol Cell Physiol 2020; 318:C1252-C1263. [DOI: 10.1152/ajpcell.00047.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Essential hypertension is associated with impairments in vascular function and sympathetic nerve hyperactivity; however, the extent to which the lower limbs are affected remains unclear. We examined the leg vascular responsiveness to infusion of acetylcholine (ACh), sodium nitroprusside (SNP), and phenylephrine (PEP) in 10 hypertensive men [HYP: age 59.5 ± 9.7 (means ± SD) yr; clinical and nighttime blood pressure: 142 ± 10/86 ± 10 and 141 ± 11/83 ± 6 mmHg, respectively; and body mass index (BMI): 29.2 ± 4.0 kg/m2] and 8 age-matched normotensive counterparts (NORM: age 57.9 ± 10.8 yr; clinical and nighttime blood pressure: 128 ± 9/78 ± 7 and 116 ± 3/69 ± 3 mmHg, respectively; and BMI: 26.3 ± 3.1 kg/m2). The vascular responsiveness was evaluated before and after 6 wk of 10-20-30 training, consisting of 3 × 5 × 10-s sprint followed by 30 and 20 s of low- to moderate-intensity cycling, respectively, interspersed by 3 min of rest. Before training, the vascular responsiveness to infusion of SNP was lower ( P < 0.05) in HYP compared with NORM, with no difference in the responsiveness to infusion of ACh and PEP. The vascular responsiveness to infusion of SNP and ACh improved ( P < 0.05) with training in HYP, with no change in NORM. With training, intra-arterial systolic blood pressure decreased ( P < 0.05) by 9 mmHg in both HYP and NORM whereas diastolic blood pressure decreased (5 mmHg; P < 0.05) in HYP only. We provide here the first line of evidence in humans that smooth muscle cell vasodilator responsiveness is blunted in the lower limbs of hypertensive men. This impairment can be reversed by 10-20-30 training, which is an effective intervention to improve the responsiveness of smooth muscle cells in men with essential hypertension.
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Affiliation(s)
- Thomas P. Gunnarsson
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Thomas S. Ehlers
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Matteo Fiorenza
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Michael Nyberg
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bangsbo
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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21
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Sheng CS, Li FK, Cheng YB, Wei FF, Huang JF, Guo QH, Zhang DY, Wang Y, An DW, Huang QF, Li Y, Wang JG. Blood pressure and heart rate variability and baroreflex sensitivity in white-coat, masked, and sustained hypertension. Hypertens Res 2020; 43:772-780. [PMID: 32051566 DOI: 10.1038/s41440-020-0413-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023]
Abstract
We investigated blood pressure (BP) and heart rate variability and baroreflex sensitivity (BRS) in white-coat, masked and sustained hypertension in untreated patients (n = 645). Normotension and white-coat, masked, and sustained hypertension were defined according to the clinic (cutoff 140/90 mmHg) and 24-h ambulatory (130/80 mmHg) BPs. The Finometer device recorded beat-to-beat finger BP and electrocardiograms in the supine and standing positions for the computation of frequency-domain power-spectral BP and heart rate variability indexes and BRS. In multivariate analysis, BP variability indexes in the supine position differed significantly (P < 0.0001) for both low-frequency (LF) and high-frequency (HF) components and the LF/HF ratio, with the lowest LF and HF power and highest LF/HF ratio in white-coat hypertension (n = 28), the highest LF and HF power and lowest LF/HF ratio in sustained hypertension (n = 198), and intermediate values in normotension (n = 189) and masked hypertension (n = 230). These differences diminished in the standing position, being significant (P < 0.0001) only for the LF component variability. The LF/HF ratio in BP in the supine position decreased with advancing age in normotension and sustained hypertension (P ≤ 0.03) but not white-coat or masked hypertension (P ≥ 0.12). For heart rate variability, a significant difference was observed only for the LF component in the supine position (P = 0.0005), which was lowest in white-coat hypertension. BRS in masked and sustained hypertension was significantly (P ≤ 0.0001) lower than that in normotension in both supine and standing positions and decreased with advancing age (P ≤ 0.0001). In conclusion, masked, but not white-coat, hypertension showed similar patterns of, but slightly less severe, changes in BP and heart rate variability and BRS to sustained hypertension.
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Affiliation(s)
- Chang-Sheng Sheng
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fei-Ka Li
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fang-Fei Wei
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Feng Huang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dong-Yan Zhang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Wang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De-Wei An
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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22
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Dell'Oro R, Quarti-Trevano F, Seravalle G, Zanchettin F, Bertoli S, Airoldi F, Mancia G, Grassi G. Sympathetic Nerve Traffic and Arterial Baroreflex Function in Apparent Drug-Resistant Hypertension. Hypertension 2019; 74:903-909. [PMID: 31378103 DOI: 10.1161/hypertensionaha.119.13009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
True drug-resistant hypertension (RHT) is characterized by a marked neuroadrenergic activation and reflex alterations compared with the nonresistant hypertensive state. It is unknown however, whether this behavior is specific for the RHT state or is also shared by apparent RHT (ARHT). In 38 middle-age patients with RHT, 44 treated essential controlled hypertensives (HT) and 32 ARHT; we evaluated sphygmomanometric, beat-to-beat (Finapres) and 24-hour (Spacelabs) blood pressure, heart rate and muscle sympathetic nerve traffic (microneurography). Measurements included plasma aldosterone, plasma norepinephrine, homeostasis model assessment index, and spontaneous baroreflex-muscle sympathetic nerve traffic sensitivity. All the various above-mentioned blood pressure values were significantly greater in both RHT and ARHT as compared with HT, while 24-hour blood pressure was significantly lower in ARHT as compared with RHT. In ARHT, muscle sympathetic nerve traffic was significantly lower than RHT (74.8±5.2 versus 89.2±4.8 bursts/100 hb, P<0.01) and similar to HT (69.7±4.8 bursts/100 hb, P=NS). RHT showed, at variance from the other 2 groups, greater plasma aldosterone and homeostasis model assessment index values and an impaired baroreflex function. In RHT, but not in ARHT and HT, muscle sympathetic nerve traffic was significantly and inversely related to baroreflex function (r=-0.40, P<0.02) and directly to plasma aldosterone and homeostasis model assessment index values (r=0.34-0.36, P<0.05). Plasma norepinephrine and heart rate values were not significantly different in the 3 groups. These data provide evidence that the marked sympathetic activation and baroreflex dysfunction detected in RHT is not present in ARHT, which displays a sympathetic and baroreflex profile superimposable to that seen in HT. These differences in the neurogenic function may have important clinical and therapeutic implications.
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Affiliation(s)
- Raffaella Dell'Oro
- From the Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca (R.D., F.Q.-T., G.S., F.Z., G.G.)
| | - Fosca Quarti-Trevano
- From the Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca (R.D., F.Q.-T., G.S., F.Z., G.G.)
| | - Gino Seravalle
- From the Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca (R.D., F.Q.-T., G.S., F.Z., G.G.)
| | - Francesca Zanchettin
- From the Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca (R.D., F.Q.-T., G.S., F.Z., G.G.)
| | - Silvio Bertoli
- Istituto di Ricerca a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan (S.B., F.A.)
| | - Flavio Airoldi
- Istituto di Ricerca a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan (S.B., F.A.)
| | | | - Guido Grassi
- From the Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca (R.D., F.Q.-T., G.S., F.Z., G.G.)
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Shirai K, Suzuki K, Tsuda S, Shimizu K, Takata M, Yamamoto T, Maruyama M, Takahashi K. Comparison of Cardio-Ankle Vascular Index (CAVI) and CAVI 0 in Large Healthy and Hypertensive Populations. J Atheroscler Thromb 2019; 26:603-615. [PMID: 31068504 PMCID: PMC6629744 DOI: 10.5551/jat.48314] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: The cardio-ankle vascular index (CAVI) represents the blood pressure-independent arterial stiffness from the origin of the aorta to the ankle. CAVI0 has been proposed as a variant index. We aimed to clarify the difference between CAVI and CAVI0 among large populations, and to explore reasons of the difference. Methods: The subjects were 5,293 Japanese healthy and 3,338 hypertensive people. Simple and multiple regression analyses were performed using age, sex, body mass index, systolic, and diastolic blood pressure (Pd) as variables. Sub-group analysis was performed by sex and age. The CAVI values with and without adjustment by reference pressure were also compared. Results: CAVI had a positive correlation with Pd, while CAVI0 had a negative correlation with Pd in the healthy population. The CAVI values of the hypertensive group were higher than those of healthy group in both men and women, but the CAVI0 values in women of the hypertensive group in the 30–39 age group was significantly lower than that of the corresponding healthy group. Differences of CAVI values with or without modification using the reference pressure were 1.09% ± 1.38% for the healthy group and 3.68% ± 1.66% for the hypertensive group. Conclusion: CAVI showed the expected values, but CAVI0 showed inexplicable results in the healthy and hypertensive populations. The differences were due to the strong dependency of CAVI0 on Pd. Differences of CAVI values with or without reference pressure were negligible. These results indicate that CAVI obtained by the VaSera system is appropriate, but CAVI0 is not.
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Affiliation(s)
| | | | | | - Kazuhiro Shimizu
- Department of Internal Medicine, Toho University Sakura Medical Center
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Cai P, Peng Y, Chen Y, Li L, Chu W, Wang Y, Wang X. Association of thyroid function with white coat hypertension and sustained hypertension. J Clin Hypertens (Greenwich) 2019; 21:674-683. [PMID: 30973206 DOI: 10.1111/jch.13536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital Army Military Medical University Chongqing China
| | - Yan Peng
- Department of Cardiology, Institute of Field Surgery, Daping Hospital Army Military Medical University Chongqing China
| | - YuXi Chen
- Department of Cardiology, Institute of Field Surgery, Daping Hospital Army Military Medical University Chongqing China
| | - Li Li
- Department of Cardiology, Institute of Field Surgery, Daping Hospital Army Military Medical University Chongqing China
| | - Wei Chu
- Department of Cardiology, Institute of Field Surgery, Daping Hospital Army Military Medical University Chongqing China
| | - Yan Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education Zunyi Medical University Zunyi China
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital Army Military Medical University Chongqing China
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Abstract
INTRODUCTION Hypertension is caused by increased cardiac output and/or increased peripheral resistance. Areas covered: The various mechanisms affecting cardiac output/peripheral resistance involved in the development of essential hypertension are covered. These include genetics; sympathetic nervous system overactivity; renal mechanisms: excess sodium intake and pressure natriuresis; vascular mechanisms: endothelial cell dysfunction and the nitric oxide pathway; hormonal mechanisms: the renin-angiotensin-aldosterone system (RAAS); obesity, obstructive sleep apnea (OSA); insulin resistance and metabolic syndrome; uric acid; vitamin D; gender differences; racial, ethnic, and environmental factors; increased left ventricular ejection force and hypertension and its association with increased basal sympathetic activity - cortical connections. Expert commentary: Maximum association of hypertension is found with sympathetic overactivity which is directly or indirectly involved in different mechanisms of hypertension including RAAS, OSA, obesity, etc.. It is not overt sympathetic activity but disturbed basal sympathetic tone. Basal sympathetic tone arises from hypothalamus; possibly affected by cortical influences. Therefore, hypertension is not merely a disease of circulatory system alone. Its pathogenesis involves alteration in ANS (autonomic nervous system) and likely in cortical-hypothalamic connections. Assessment of ANS and cortical-hypothalamic connections may be required for better understanding of hypertension.
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Affiliation(s)
- Tarun Saxena
- a Department of Internal Medicine , Mittal Hospital and Research Centre , Ajmer , India
| | - Azeema Ozefa Ali
- a Department of Internal Medicine , Mittal Hospital and Research Centre , Ajmer , India
| | - Manjari Saxena
- b Department Yoga and Physical education , Mittal Hospital and Research Centre , Ajmer , India
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Grassi G, Pisano A, Bolignano D, Seravalle G, D’Arrigo G, Quarti-Trevano F, Mallamaci F, Zoccali C, Mancia G. Sympathetic Nerve Traffic Activation in Essential Hypertension and Its Correlates. Hypertension 2018; 72:483-491. [DOI: 10.1161/hypertensionaha.118.11038] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/05/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Guido Grassi
- From the Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy (G.G., G.S., F.Q.-T.)
| | - Anna Pisano
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Davide Bolignano
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Gino Seravalle
- From the Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy (G.G., G.S., F.Q.-T.)
| | - Graziella D’Arrigo
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Fosca Quarti-Trevano
- From the Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy (G.G., G.S., F.Q.-T.)
| | - Francesca Mallamaci
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Carmine Zoccali
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.M.)
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27
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de Jong MR, Hoogerwaard AF, Adiyaman A, Smit JJJ, Ramdat Misier AR, Heeg JE, van Hasselt BAAM, Van Gelder IC, Crijns HJGM, Lozano IF, Toquero Ramos JE, Javier Alzueta F, Ibañez B, Rubio JM, Arribas F, Porres Aracama JM, Brugada J, Mont L, Elvan A. Treatment of atrial fibrillation in patients with enhanced sympathetic tone by pulmonary vein isolation or pulmonary vein isolation and renal artery denervation: clinical background and study design : The ASAF trial: ablation of sympathetic atrial fibrillation. Clin Res Cardiol 2018; 107:539-547. [PMID: 29487995 DOI: 10.1007/s00392-018-1214-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertension is an important, modifiable risk factor for the development of atrial fibrillation (AF). Even after pulmonary vein isolation (PVI), 20-40% experience recurrent AF. Animal studies have shown that renal denervation (RDN) reduces AF inducibility. One clinical study with important limitations suggested that RDN additional to PVI could reduce recurrent AF. OBJECTIVE The goal of this multicenter randomized controlled study is to investigate whether RDN added to PVI reduces AF recurrence. METHODS The main end point is the time until first AF recurrence according to EHRA guidelines after a blanking period of 3 months. Assuming a 12-month accrual period and 12 months of follow-up, a power of 0.80, a two-sided alpha of 0.05 and an expected drop-out of 10% per group, 69 patients per group are required. We plan to randomize a total of 138 hypertensive patients with AF and signs of sympathetic overdrive in a 1:1 fashion. Patients should use at least two antihypertensive drugs. Sympathetic overdrive includes obesity, exercise-induced excessive blood pressure (BP) increase, significant white coat hypertension, hospital admission or fever induced AF, tachycardia induced AF and diabetes mellitus. The interventional group will undergo PVI + RDN and the control group will undergo PVI. RESULTS Patients will have follow-up for 1 year, and continuous loop monitoring is advocated. CONCLUSION This randomized, controlled study will elucidate if RDN on top of PVI reduces AF recurrence.
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Affiliation(s)
- Mark R de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | | | - Harry J G M Crijns
- Department of Cardiology, Maastricht Universitair Medisch Centrum, Maastricht, The Netherlands
| | - Ignacio Fernández Lozano
- Department of Arrhythmia Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jorge E Toquero Ramos
- Department of Arrhythmia Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - F Javier Alzueta
- Department of Arrhythmia Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Borja Ibañez
- Department of Cardiology, Hospital Fundación Jimenez Díaz, Madrid, Spain
| | - José M Rubio
- Department of Cardiology, Hospital Fundación Jimenez Díaz, Madrid, Spain
| | - Fernando Arribas
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Josep Brugada
- Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lluís Mont
- Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
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Uyama H, Yamauchi M, Fujita Y, Yoshikawa M, Ohnishi Y, Kimura H. The effects of arousal accompanying an apneic event on blood pressure and sympathetic nerve activity in severe obstructive sleep apnea. Sleep Breath 2017; 22:149-155. [DOI: 10.1007/s11325-017-1548-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 11/27/2022]
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Warrit K, Boscan P, Ferguson LE, Bradley AM, Dowers KL, Twedt DC. Effect of hospitalization on gastrointestinal motility and pH in dogs. J Am Vet Med Assoc 2017. [DOI: 10.2460/javma.251.1.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Analysis of beat-to-beat blood pressure variability response to the cold pressor test in the offspring of hypertensive and normotensive parents. Hypertens Res 2017; 40:581-589. [DOI: 10.1038/hr.2017.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/05/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
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31
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Grassi G, Ram VS. Evidence for a critical role of the sympathetic nervous system in hypertension. ACTA ACUST UNITED AC 2016; 10:457-66. [DOI: 10.1016/j.jash.2016.02.015] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 02/07/2023]
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Oliveira-Sales EB, Colombari E, Abdala AP, Campos RR, Paton JFR. Sympathetic overactivity occurs before hypertension in the two-kidney, one-clip model. Exp Physiol 2015; 101:67-80. [PMID: 26537847 DOI: 10.1113/ep085390] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022]
Abstract
Our knowledge of mechanisms responsible for both the development and the maintenance of hypertension remains incomplete in the Goldblatt (two-kidney, one-clip; 2K1C) model. We tested the hypothesis that elevated sympathetic nerve activity (SNA) occurs before the onset of hypertension in 2K1C rats, considering the time course of the increase in SNA in relationship to the onset of the hypertension. We used a decorticated in situ working heart-brainstem preparation of three groups of male Wistar rats, namely sham-operated animals (SHAM, n = 7) and animals 3 weeks post-2K1C, of which some were hypertensive (2K1C-H, n = 6) and others normotensive (2K1C-N, n = 9), as determined in vivo a priori. Perfusion pressure was higher in both 2K1C groups (2K1C-H, 76 ± 1 mmHg; 2K1C-N, 74 ± 3 mmHg; versus SHAM, 60 ± 2 mmHg, P < 0.05). The SNA was significantly elevated in both 2K1C groups (2K1C-H, 47.7 ± 6.1 μV; 2K1C-N, 32.8 ± 2.8 μV; versus SHAM, 20.5 ± 2.5 μV, P < 0.05) owing to its increased respiratory modulation; the chemoreflex was augmented and baroreflex depressed. Precollicular transection reduced SNA in all groups (2K1C-H, -32.5 ± 7.5%; 2K1C-NH, -48 ± 6.9%; versus SHAM, -13.2 ± 1%, P < 0.05). Subsequent medullary spinal cord transection abolished SNA in both SHAM and 2K1C-N groups, but decreased it by only 57 ± 5.5% in 2K1C-H preparations. Thus, SNA is raised before the onset of hypertension, by the third week after renal artery clipping, and this originates, in part, from its enhanced respiratory modulation. Spinal circuits contribute to the elevation of SNA in the 2K1C model, but only after hypertension has developed.
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Affiliation(s)
- Elizabeth B Oliveira-Sales
- School of Physiology & Pharmacology, Bristol Heart Institute, University of Bristol, Bristol, UK.,Department of Physiology, Federal University of Sao Paulo, UNIFESP, SP, Brazil
| | - Eduardo Colombari
- School of Physiology & Pharmacology, Bristol Heart Institute, University of Bristol, Bristol, UK.,Department of Physiology & Pathology, School of Dentistry of Araraquara, São Paulo State University, UNESP, Araraquara, SP, Brazil
| | - Ana Paula Abdala
- School of Physiology & Pharmacology, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Ruy R Campos
- Department of Physiology, Federal University of Sao Paulo, UNIFESP, SP, Brazil
| | - Julian F R Paton
- School of Physiology & Pharmacology, Bristol Heart Institute, University of Bristol, Bristol, UK
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34
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Sympathetic nerve traffic and baroreflex function in optimal, normal, and high-normal blood pressure states. J Hypertens 2015; 33:1411-7. [DOI: 10.1097/hjh.0000000000000567] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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35
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Leong XF, Ng CY, Jaarin K. Animal Models in Cardiovascular Research: Hypertension and Atherosclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:528757. [PMID: 26064920 PMCID: PMC4433641 DOI: 10.1155/2015/528757] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/17/2014] [Accepted: 01/14/2015] [Indexed: 01/07/2023]
Abstract
Hypertension and atherosclerosis are among the most common causes of mortality in both developed and developing countries. Experimental animal models of hypertension and atherosclerosis have become a valuable tool for providing information on etiology, pathophysiology, and complications of the disease and on the efficacy and mechanism of action of various drugs and compounds used in treatment. An animal model has been developed to study hypertension and atherosclerosis for several reasons. Compared to human models, an animal model is easily manageable, as compounding effects of dietary and environmental factors can be controlled. Blood vessels and cardiac tissue samples can be taken for detailed experimental and biomolecular examination. Choice of animal model is often determined by the research aim, as well as financial and technical factors. A thorough understanding of the animal models used and complete analysis must be validated so that the data can be extrapolated to humans. In conclusion, animal models for hypertension and atherosclerosis are invaluable in improving our understanding of cardiovascular disease and developing new pharmacological therapies.
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Affiliation(s)
- Xin-Fang Leong
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
- Department of Clinical Oral Biology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Chun-Yi Ng
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Kamsiah Jaarin
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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Abstract
Several articles have dealt with the importance and mechanisms of the sympathetic nervous system alterations in experimental animal models of hypertension. This review addresses the role of the sympathetic nervous system in the pathophysiology and therapy of human hypertension. We first discuss the strengths and limitations of various techniques for assessing the sympathetic nervous system in humans, with a focus on heart rate, plasma norepinephrine, microneurographic recording of sympathetic nerve traffic, and measurements of radiolabeled norepinephrine spillover. We then examine the evidence supporting the importance of neuroadrenergic factors as promoters and amplifiers of human hypertension. We expand on the role of the sympathetic nervous system in 2 increasingly common forms of secondary hypertension, namely hypertension associated with obesity and with renal disease. With this background, we examine interventions of sympathetic deactivation as a mode of antihypertensive treatment. Particular emphasis is given to the background and results of recent therapeutic approaches based on carotid baroreceptor stimulation and radiofrequency ablation of the renal nerves.
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Affiliation(s)
- Guido Grassi
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Carver College of Medicine, University of Iowa, Iowa City (A.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Australia (M.E.).
| | - Allyn Mark
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Carver College of Medicine, University of Iowa, Iowa City (A.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Australia (M.E.)
| | - Murray Esler
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Carver College of Medicine, University of Iowa, Iowa City (A.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Australia (M.E.)
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Feber J, Ruzicka M, Geier P, Litwin M. Autonomic nervous system dysregulation in pediatric hypertension. Curr Hypertens Rep 2014; 16:426. [PMID: 24633841 DOI: 10.1007/s11906-014-0426-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Historically, primary hypertension (HTN) has been prevalent typically in adults. Recent data however, suggests an increasing number of children diagnosed with primary HTN, mainly in the setting of obesity. One of the factors considered in the etiology of HTN is the autonomous nervous system, namely its dysregulation. In the past, the sympathetic nervous system (SNS) was regarded as a system engaged mostly in buffering major acute changes in blood pressure (BP), in response to physical and emotional stressors. Recent evidence suggests that the SNS plays a much broader role in the regulation of BP, including the development and maintenance of sustained HTN by a chronically elevated central sympathetic tone in adults and children with central/visceral obesity. Consequently, attempts have been made to reduce the SNS hyperactivity, in order to intervene early in the course of the disease and prevent HTN-related complications later in life.
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Affiliation(s)
- Janusz Feber
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8 L1, Canada,
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Mancia G, Facchetti R, Parati G, Zanchetti A. Effect of long-term antihypertensive treatment on white-coat hypertension. Hypertension 2014; 64:1388-98. [PMID: 25245386 DOI: 10.1161/hypertensionaha.114.04278] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Limited evidence is available on the extent and frequency by which antihypertensive treatment lowers office blood pressure (BP) in white-coat hypertension (WCH). Data are even more scanty and discrepant on the corresponding effect on ambulatory BP (ABP). In the hypertensive patients of the European Lacidipine Study on Atherosclerosis (ELSA), office and ABP were measured before treatment and at 6-month (office BP) or 12-month (ABP) intervals during the 4-year administration of calcium channel blocker-based or β-blocker-based treatment. The two groups were pooled and data were analyzed separately in patients with both office and ABP elevation (n=1670; sustained hypertension) or WCH (n=251; office BP elevation only). In sustained hypertension, office and 24-hour mean systolic BP were both markedly reduced through the treatment period, the mean change being -20.0±12.5 and -10.1±11.0 mm Hg, respectively (P<0.0001 for both). In striking contrast, in WCH the office BP reduction was almost as marked as in sustained hypertension (-19.1±11.2 mm Hg; P<0.0001), whereas 24-hour systolic BP values showed no fall or a slight progressive significant increase, its mean change during treatment being 1.6±8.6 mm Hg (P=0.007). Lowering of office BP occurred at a lower treatment intensity in WCH than in sustained hypertension. Similar findings were obtained for diastolic BP. In WCH, antihypertensive treatment should not be expected to have a lowering effect on ABP, even when office BP undergoes a concomitant marked and persistent reduction. The consequence of this contrasting effect on the incidence of hypertension-related outcomes remains to be established.
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Affiliation(s)
- Giuseppe Mancia
- From the IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M., G.P., A.Z.); Department of Health Sciences, University of Milano-Bicocca, Milano, Italy (G.M., R.F., G.P.); and Università degli Studi di Milano, Milano, Italy (A.Z.).
| | - Rita Facchetti
- From the IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M., G.P., A.Z.); Department of Health Sciences, University of Milano-Bicocca, Milano, Italy (G.M., R.F., G.P.); and Università degli Studi di Milano, Milano, Italy (A.Z.)
| | - Gianfranco Parati
- From the IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M., G.P., A.Z.); Department of Health Sciences, University of Milano-Bicocca, Milano, Italy (G.M., R.F., G.P.); and Università degli Studi di Milano, Milano, Italy (A.Z.)
| | - Alberto Zanchetti
- From the IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M., G.P., A.Z.); Department of Health Sciences, University of Milano-Bicocca, Milano, Italy (G.M., R.F., G.P.); and Università degli Studi di Milano, Milano, Italy (A.Z.)
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Moraes DJA, Machado BH, Paton JFR. Specific Respiratory Neuron Types Have Increased Excitability That Drive Presympathetic Neurones in Neurogenic Hypertension. Hypertension 2014; 63:1309-18. [DOI: 10.1161/hypertensionaha.113.02283] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Davi J. A. Moraes
- From the School of Physiology and Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, BS8 1TD, England (D.J.A.M., J.F.R.P.); and Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049–900, SP, Brazil (D.J.A.M., B.H.M.)
| | - Benedito H. Machado
- From the School of Physiology and Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, BS8 1TD, England (D.J.A.M., J.F.R.P.); and Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049–900, SP, Brazil (D.J.A.M., B.H.M.)
| | - Julian F. R. Paton
- From the School of Physiology and Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, BS8 1TD, England (D.J.A.M., J.F.R.P.); and Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049–900, SP, Brazil (D.J.A.M., B.H.M.)
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Abstract
Physiological studies have long documented the key role played by the autonomic nervous system in modulating cardiovascular functions and in controlling blood pressure values, both at rest and in response to environmental stimuli. Experimental and clinical investigations have tested the hypothesis that the origin, progression, and outcome of human hypertension are related to dysfunctional autonomic cardiovascular control and especially to abnormal activation of the sympathetic division. Here, we review the recent literature on the adrenergic and vagal abnormalities that have been reported in essential hypertension, with emphasis on their role as promoters and as amplifiers of the high blood pressure state. We also discuss the possible mechanisms underlying these abnormalities and their importance in the development and progression of the structural and functional cardiovascular damage that characterizes hypertension. Finally, we examine the modifications of sympathetic and vagal cardiovascular influences induced by current nonpharmacological and pharmacological interventions aimed at correcting elevations in blood pressure and restoring the normotensive state.
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Affiliation(s)
- Giuseppe Mancia
- From the IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M.); Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza (Monza e Brianza), Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.)
| | - Guido Grassi
- From the IRCCS Istituto Auxologico Italiano, Milano, Italy (G.M.); Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza (Monza e Brianza), Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.)
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Jackson KL, Palma-Rigo K, Nguyen-Huu TP, Davern PJ, Head GA. Major Contribution of the Medial Amygdala to Hypertension in BPH/2J Genetically Hypertensive Mice. Hypertension 2014; 63:811-8. [DOI: 10.1161/hypertensionaha.113.02020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kristy L. Jackson
- From the Neuropharmacology Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia (K.L.J., K.P.-R., T.-P.N.-H., P.J.D., G.A.H.); and Department of Pharmacology, Monash University, Clayton, Victoria, Australia (K.L.J., G.A.H.)
| | - Kesia Palma-Rigo
- From the Neuropharmacology Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia (K.L.J., K.P.-R., T.-P.N.-H., P.J.D., G.A.H.); and Department of Pharmacology, Monash University, Clayton, Victoria, Australia (K.L.J., G.A.H.)
| | - Thu-Phuc Nguyen-Huu
- From the Neuropharmacology Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia (K.L.J., K.P.-R., T.-P.N.-H., P.J.D., G.A.H.); and Department of Pharmacology, Monash University, Clayton, Victoria, Australia (K.L.J., G.A.H.)
| | - Pamela J. Davern
- From the Neuropharmacology Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia (K.L.J., K.P.-R., T.-P.N.-H., P.J.D., G.A.H.); and Department of Pharmacology, Monash University, Clayton, Victoria, Australia (K.L.J., G.A.H.)
| | - Geoffrey A. Head
- From the Neuropharmacology Laboratory, Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia (K.L.J., K.P.-R., T.-P.N.-H., P.J.D., G.A.H.); and Department of Pharmacology, Monash University, Clayton, Victoria, Australia (K.L.J., G.A.H.)
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42
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Actions of rilmenidine on neurogenic hypertension in BPH/2J genetically hypertensive mice. J Hypertens 2014; 32:575-86. [DOI: 10.1097/hjh.0000000000000036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carthy ER. Autonomic dysfunction in essential hypertension: A systematic review. Ann Med Surg (Lond) 2013; 3:2-7. [PMID: 25568776 PMCID: PMC4268473 DOI: 10.1016/j.amsu.2013.11.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 11/18/2013] [Accepted: 11/21/2013] [Indexed: 11/24/2022] Open
Abstract
Introduction Greater sympathetic drive has been established in the early stages of essential hypertension, suggesting that neurohormonal dysregulation may be key to its aetiology and progression. The aims of this review are to discuss evidence of the role of autonomic dysfunction in essential hypertension and proposed mechanisms, and also some applications of this knowledge to current management strategies of essential hypertension. Methods A computer search was performed using the PUBMED database for peer reviewed original articles comparing autonomic function tested via heart rate variability (HRV), muscle sympathetic nerve activity (MSNA) or plasma noradrenaline levels in normotensive (mean blood pressure (BP) of ≤140/90 mmHg or ≤135/85 mmHg if measured via home BP measurements) and hypertensive groups (mean resting BP of ≥140/90 mmHg (or ≥135/85 mmHg if measured via home BP measurements). Subjects were excluded with secondary causes of hypertension or autonomic dysfunction. Results A total of 17 studies were included for discussion. The main findings of this study include that of reduced baroreflex sensitivity, believed to be secondary to increased arterial stiffness, is hypothesised to be implicated in the pathogenesis of essential hypertension. Also, angiotensin converting enzyme inhibitors were not as effective on markers of autonomic control of blood pressure when compared with alternative anti-hypertensive drugs. Conclusions Consistent research is needed to establish the effectiveness of pharmacotherapies at each of stage of hypertension, and on markers of autonomic dysfunction. Consistent study designs will enable more accurate accumulation of data across multiple studies, and appropriate application of such data into clinical practice.
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Leosco D, Parisi V, Femminella GD, Formisano R, Petraglia L, Allocca E, Bonaduce D. Effects of exercise training on cardiovascular adrenergic system. Front Physiol 2013; 4:348. [PMID: 24348425 PMCID: PMC3842896 DOI: 10.3389/fphys.2013.00348] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/12/2013] [Indexed: 12/20/2022] Open
Abstract
In heart failure (HF), exercise has been shown to modulate cardiac sympathetic hyperactivation which is one of the earliest features of neurohormonal derangement in this syndrome and correlates with adverse outcome. An important molecular alteration related to chronic sympathetic overstimulation in HF is represented by cardiac β-adrenergic receptor (β-AR) dysfunction. It has been demonstrated that exercise reverses β-AR dysfunction by restoring cardiac receptor membrane density and G-protein-dependent adenylyl cyclase activation. In particular, several evidence indicate that exercise reduces levels of cardiac G-protein coupled receptor kinase-2 (GRK2) which is known to be involved in both β1-AR and β2-AR dysregulation in HF. Similar alterations of β-AR system have been described also in the senescent heart. It has also been demonstrated that exercise training restores adrenal GRK2/α-2AR/catecholamine (CA) production axis. At vascular level, exercise shows a therapeutic effect on age-related impairment of vascular reactivity to adrenergic stimulation and restores β-AR-dependent vasodilatation by increasing vascular β-AR responsiveness and reducing endothelial GRK2 activity. Sympathetic nervous system overdrive is thought to account for >50% of all cases of hypertension and a lack of balance between parasympathetic and sympathetic modulation has been observed in hypertensive subjects. Non-pharmacological, lifestyle interventions have been associated with reductions in SNS overactivity and blood pressure in hypertension. Several evidence have highlighted the blood pressure lowering effects of aerobic endurance exercise in patients with hypertension and the significant reduction in sympathetic neural activity has been reported as one of the main mechanisms explaining the favorable effects of exercise on blood pressure control.
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Affiliation(s)
- Dario Leosco
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Grazia D Femminella
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Roberto Formisano
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Elena Allocca
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
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Maseko MJ, Woodiwiss AJ, Libhaber CD, Brooksbank R, Majane OHI, Norton GR. Relations between white coat effects and left ventricular mass index or arterial stiffness: role of nocturnal blood pressure dipping. Am J Hypertens 2013; 26:1287-94. [PMID: 23926123 DOI: 10.1093/ajh/hpt108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Whether independent relationships between white coat effects (office minus day (office-day blood pressure (BP))) and organ damage or arterial stiffness may be explained by associations with an attenuated nocturnal BP dipping, has not been determined. METHODS In 750 participants from a sample of African ancestry, office and 24-hour BP, carotid-femoral pulse wave velocity (PWV) (applanation tonometry and SphygmoCor software) (n = 662), and left ventricular mass indexed to height(2.7) (LVMI) (echocardiography) (n = 463) were determined. RESULTS Office-day systolic BP (SBP) was correlated with day minus night (day-night) SBP, percentage night divided by day (night/day) SBP, and night SBP (P < 0.0005), and these relationships persisted with adjustments for confounders, including day SBP (P < 0.005). With adjustments for 24-hour SBP and additional confounders, office-day SBP was associated with LVMI (P < 0.01) and PWV (P < 0.0001). With adjustments for day SBP and additional confounders, day-night SBP, percentage night/day SBP, and night SBP were related to PWV (P < 0.05) but not to LVMI (P > 0.44). The relationships between office-day SBP and LVMI or PWV persisted with adjustments for either day-night or percentage night/day SBP (LVMI: P = 0.01; PWV: P < 0.0001) or night SBP (LVMI: P < 0.01; PWV: P = 0.0001), and in product of coefficient mediation analysis with appropriate adjustments, neither indexes of nocturnal BP dipping nor nocturnal BP per se contributed toward the impact of office-day BP on LVMI or PWV (P > 0.09). CONCLUSIONS In a group of African ancestry, although white coat effects are independently associated with an attenuated nocturnal decrease in SBP, neither decreased BP dipping nor nocturnal BP contribute toward the independent relationships between white coat effects and LVMI or arterial stiffness.
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Affiliation(s)
- Muzi J Maseko
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Scienes, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Scienes, University of the Witwatersrand, Johannesburg, South Africa;
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Scienes, University of the Witwatersrand, Johannesburg, South Africa; School of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Brooksbank
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Scienes, University of the Witwatersrand, Johannesburg, South Africa
| | - Olebogeng H I Majane
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Scienes, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Scienes, University of the Witwatersrand, Johannesburg, South Africa;
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Zhou J, Liu C, Shan P, Zhou Y, Xu E, Ji Y. Characteristics of white coat hypertension in Chinese Han patients with type 2 diabetes mellitus. Clin Exp Hypertens 2013; 36:321-5. [PMID: 24047449 DOI: 10.3109/10641963.2013.827696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study documented the prevalence and clinical features of white coat hypertension (WCH) among Chinese Han patients with type 2 diabetes mellitus (T2DM). METHODS Clinic and ambulatory blood pressure (BP) measurements were compared in 856 patients with T2DM to determine the frequency of WCH (WCH was defined as clinical blood pressure ≥140/90 mmHg and daytime blood pressure <135/85 mmHg and/or 24-h ambulatory BP (ABP) mean value of <130/80 mmHg on ambulatory BP monitoring (ABPM). Weight, waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), fasting blood glucose, glycosylated hemoglobin level and circadian BP patterns were also measured to find clinical features predictive of WCH in T2DM. RESULTS The prevalence of WCH was 7.36% (63/856) in the overall population, 6.13% (29/473) in male and 8.88% (34/383) in female (p < 0.05). WCH accounted for 14.03% (63/449) of diagnosed hypertension. Age, course of T2DM, male WC were independent protective factors, whereas female sex, smoking and alcohol consumption were independent risk factors for WCH in T2DM. Non-dippers and reverse dippers made up larger proportion of the WCH group (p < 0.01). CONCLUSION WCH is relatively common among T2DM patients, it is a unique condition distinct from essential hypertension (EH), and WCH patients also exhibit significant differences in clinical parameters.
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Wehrwein EA, Novotny M, Swain GM, Parker LM, Esfahanian M, Spitsbergen JM, Habecker BA, Kreulen DL. Regional changes in cardiac and stellate ganglion norepinephrine transporter in DOCA-salt hypertension. Auton Neurosci 2013; 179:99-107. [PMID: 24075956 DOI: 10.1016/j.autneu.2013.08.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022]
Abstract
Uptake of norepinephrine via the neuronal norepinephrine transporter is reduced in the heart during deoxycorticosterone (DOCA)-salt hypertension. We hypothesized that this was due to reduced norepinephrine transporter mRNA and/or protein expression in the stellate ganglia and heart. After 4 weeks of DOCA-salt treatment there was no change in norepinephrine transporter mRNA in either the right or the left stellate ganglia from hypertensive rats (n=5-7, p>0.05). Norepinephrine transporter immunoreactivity in the left stellate ganglion was significantly increased (n=4, p<0.05) while the right stellate ganglion was unchanged (n=4, p>0.05). Whole heart norepinephrine content was significantly reduced in DOCA rats consistent with reduced uptake function; however, when norepinephrine was assessed by chamber, a significant decrease was noted only in the right atrium and right ventricle (n=6, p<0.05). Cardiac norepinephrine transport binding by chamber revealed that it was only reduced in the left atrium (n=5-7, p>0.05). Therefore, 1) contrary to our hypothesis reduced reuptake in the hypertensive heart is not exclusively due to an overall reduction in norepinephrine transporter mRNA or protein in the stellate ganglion or heart, and 2) norepinephrine transporter regulation occurs regionally in the heart and stellate ganglion in the hypertensive rat heart.
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Affiliation(s)
- Erica A Wehrwein
- Department of Physiology, Michigan State University, East Lansing, MI, United States.
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Prochnau D, Figulla HR, Surber R. Renal denervation in the treatment of drug-resistant hypertension: current knowledge and future perspectives. Expert Rev Med Devices 2013; 10:247-56. [PMID: 23480093 DOI: 10.1586/erd.13.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Resistant hypertension remains a challenging issue even for modern medicine. Therefore, research is focusing on the development of new technologies to optimize the treatment of this condition. It has been demonstrated that the dysfunction of the sympathetic nervous system is crucial in the development and maintenance of advanced stages of hypertension. Based on these findings, clinical trials have recently shown that catheter-based percutaneous renal denervation therapy is safe and effective in the treatment of resistant hypertension. This review discusses the current scientific knowledge of renal denervation therapy in resistant hypertension, including the different methods that have been described in the literature so far, as well as limitations of the available data. Furthermore, new potential targets for this fascinating therapy will be addressed.
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Affiliation(s)
- Dirk Prochnau
- Department of Internal Medicine I, Friedrich Schiller University, Jena, Germany.
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Paton JFR, Ratcliffe L, Hering D, Wolf J, Sobotka PA, Narkiewicz K. Revelations about carotid body function through its pathological role in resistant hypertension. Curr Hypertens Rep 2013; 15:273-80. [PMID: 23828147 PMCID: PMC3712134 DOI: 10.1007/s11906-013-0366-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Much recent attention has been given to the carotid body because of its potential role in cardiovascular disease states. One disease, neurogenic hypertension, characterised by excessive sympathetic activity, appears dependent on carotid body activity that may or may not be accompanied by sleep-disordered breathing. Herein, we review recent literature suggesting that the carotid body acquires tonicity in hypertension. We predict that carotid glomectomy will be a powerful way to temper excessive sympathetic discharge in diseases such as hypertension. We propose a model to explain that signalling from the 'hypertensive' carotid body is tonic, and hypothesise that there will be a sub-population of glomus cells that channel separately into reflex pathways controlling sympathetic motor outflows.
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Affiliation(s)
- Julian F R Paton
- School of Physiology & Pharmacology, Bristol Heart Institute, University of Bristol, Medical Sciences Building, Bristol, England, UK.
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50
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Interpreting treatment-induced blood pressure reductions measured by ambulatory blood pressure monitoring. J Hum Hypertens 2013; 27:715-20. [DOI: 10.1038/jhh.2013.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/19/2013] [Accepted: 03/26/2013] [Indexed: 11/08/2022]
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