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Ding X, Zhou Y, Pan Y, Xu J, Yan H, Zhao X, Wang Y, Wang Y. Dipping Pattern and 1-year stroke functional outcome in ischemic stroke or transient ischemic attack. Clin Exp Hypertens 2023; 45:2139384. [DOI: 10.1080/10641963.2022.2139384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Xia Ding
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Gonzalez-Garcia J, Mayordomo-Colunga J, Gorostidi M, Gomez-Gonzalez B, Canteli E, Rey C. Non-dipping blood pressure pattern in pediatricians during on-duty. Nefrologia 2023; 43:616-621. [PMID: 36564227 DOI: 10.1016/j.nefroe.2022.05.013] [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: 03/08/2022] [Accepted: 05/30/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION People with a reduced nighttime dip in blood pressure have an increased cardiovascular risk. Our objective was to describe the different patterns in blood pressure (BP) among pediatricians who work in long on-duty shifts in relation with sex, medical rank and sleeping time. METHODS Descriptive, cross-sectional, two-center study. On duty pediatric Resident physicians and pediatric Consultants were recruited between January 2018 and December 2021. RESULTS Fifty-one physicians were included in the study (78.4% female, 66.7% Resident physicians). Resident physicians had a higher night/day ratio (0.91 vs 0.85; p<0.001) and a shorter nighttime period (3.87 vs 5.41, p<0.001) than Consultants. Physicians sleeping less than 5h had a higher night/day ratio (0.91 vs 0.87, p=0.014). Being a Resident showed a ∼4.5-fold increased risk of having a non-dipping BP pattern compared to Consultants. CONCLUSION We found a potential link between both being a Resident and, probably, having shorter sleeping time, and the non-dipping BP pattern in physicians during prolonged shifts.
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Affiliation(s)
| | - Juan Mayordomo-Colunga
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Network Biomedical Research Center, Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain; Health Research Institute of the Principado de Asturias, Oviedo, Spain
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain; Department of Nephrology, University of Oviedo, Oviedo, Spain
| | | | - Eva Canteli
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Corsino Rey
- Health Research Institute of the Principado de Asturias, Oviedo, Spain; Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain; Department of Pediatrics, University of Oviedo, Oviedo, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Institute of Health Carlos III, Madrid, Spain
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Non-dipping blood pressure pattern in pediatricians during on-duty. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dagher L, Shi H, Zhao Y, Marrouche NF. Wearables in cardiology: Here to stay. Heart Rhythm 2021; 17:889-895. [PMID: 32354455 DOI: 10.1016/j.hrthm.2020.02.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/15/2020] [Indexed: 01/05/2023]
Abstract
The adoption of wearables in medicine has rapidly expanded worldwide. New generations of wearables are emerging, driven by consumers' demand to monitor their own health. With the ongoing development of new features capable of assessing real-time biometric data, the impact of wearables on cardiovascular management has become inevitable. Smartwatches, among other wearable devices, offer a user-friendly noninvasive approach to continuously monitor for health parameters. With advancements in artificial intelligence, the photoplethysmography-generated pulse waveform has the potential to accurately detect episodes of atrial fibrillation and one day could replace conventional diagnostic and long-term monitoring methods. Clinical benefits that could arise from the use of such devices include refining stroke prevention strategies, personalizing AF management, and optimizing the patient-physician relationship. Wearables are changing not only the way clinicians conduct research but also the future of cardiovascular preventive and therapeutic care. As such, wearables are here to stay.
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Affiliation(s)
- Lilas Dagher
- Department of Cardiology, Tulane School of Medicine, New Orleans, Louisiana
| | - Hanyuan Shi
- Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana
| | - Yan Zhao
- Department of Cardiology, Tulane School of Medicine, New Orleans, Louisiana
| | - Nassir F Marrouche
- Department of Cardiology, Tulane School of Medicine, New Orleans, Louisiana.
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Chen YK, Ni ZX, Li W, Xiao WM, Liu YL, Liang WC, Qu JF. Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study. J Stroke Cerebrovasc Dis 2021; 30:105673. [PMID: 33631472 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Whether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). METHODS This case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. RESULTS CSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1-3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r2 = 0.308-0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804-0.943; P = .001), with r2 = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489-47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709-196.660; P = .001) having the highest risks of CSVD (r2 = 0.413). CONCLUSIONS Lower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.
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Affiliation(s)
- Yang-Kun Chen
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China.
| | - Zhuo-Xin Ni
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Wei Li
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Wei-Min Xiao
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
| | - Wen-Cong Liang
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China; Department of Neurology, Graduate School of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China
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Night-time ambulatory blood pressure is the best pretreatment blood pressure predictor of 11-year mortality in treated older hypertensives. Blood Press Monit 2018; 23:237-243. [DOI: 10.1097/mbp.0000000000000331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Eguchi K, Ohmaru T, Ohkuchi A, Hirashima C, Takahashi K, Suzuki H, Kario K, Matsubara S, Suzuki M. Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy. J Hum Hypertens 2015; 30:62-7. [DOI: 10.1038/jhh.2015.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/07/2014] [Accepted: 01/08/2015] [Indexed: 11/09/2022]
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Abstract
BACKGROUND AND OBJECTIVES Aberrant circadian rhythm with persistent nocturnal sympathetic hyperactivity has pointed out malfunctioning autonomic nervous system in fibromyalgia (FM) patients. This is a common pathogenesis shared also by patients with nondipping blood pressure (BP) pattern. Therefore, we aimed to investigate the frequency of nondipping BP pattern in normotensive women with newly diagnosed FM compared with healthy women. METHODS Sixty-seven normotensive women with new diagnosis of FM and 38 age-matched healthy volunteer women were recruited into the study. All subjects underwent 24-hour ambulatory BP monitoring on a usual working day. Individuals were defined as "dippers" if their nocturnal BP values decreased by more than 10% compared with daytime values; defined as "nondippers" in case of a decline less than 10%. Serum creatinine, fasting blood glucose, cholesterol levels, albumin, and thyroid-stimulating hormone levels were assessed. RESULTS Ambulatory measurements showed significantly higher diastolic BP values in patients with FM for both average of 24-hour recordings. Patients with FM had significantly lower systolic (9.1 ± 3.9 vs 11.5 ± 4.9, P = 0.010) and diastolic dipping ratios (12.3 ± 6.1 vs 16.1 ± 6.4, P = 0.004). The number of nondippers in the FM group was significantly higher than that of controls for both systolic (66% vs 34%, P = 0.002) and diastolic BP measurements (42% vs 21%, P=0.031). Patients with FM were 3.68 times more likely to be systolic nondipper and 2.69 times more likely to be diastolic nondipper. CONCLUSIONS We have demonstrated a significant relationship between FM and nondipping BP pattern, and we suggest that nondipping profile, which has been closely associated with cardiovascular morbidity, may appear as an additional risk factor in patients with FM.
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Figueroa JJ, Bott-Kitslaar DM, Mercado JA, Basford JR, Sandroni P, Shen WK, Sletten DM, Gehrking TL, Gehrking JA, Low PA, Singer W. Decreased orthostatic adrenergic reactivity in non-dipping postural tachycardia syndrome. Auton Neurosci 2014; 185:107-11. [PMID: 25033770 DOI: 10.1016/j.autneu.2014.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/19/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
Whether non-dipping - the loss of the physiologic nocturnal drop in blood pressure - among patients with postural tachycardia syndrome (POTS) is secondary to autonomic neuropathy, a hyperadrenergic state, or other factors remains to be determined. In 51 patients with POTS (44 females), we retrospectively analyzed 24-hour ambulatory blood pressure recordings, laboratory indices of autonomic function, orthostatic norepinephrine response, 24-hour natriuresis and peak exercise oxygen consumption. Non-dipping (<10% day-night drop in systolic blood pressure) was found in 55% (n=28). Dippers and non-dippers did not differ in: 1) baseline characteristics including demographic and clinical profile, sleep duration, daytime blood pressure, 24-hour natriuresis, and peak exercise oxygen consumption; 2) severity of laboratory autonomic deficits (sudomotor, cardiovagal and adrenergic); 3) frequency of autonomic neuropathy (7/23 vs. 8/28, P=0.885); 4) supine resting heart rate (75.3±14.0bpm vs. 74.0±13.8bpm, P=0.532); or 5) supine plasma norepinephrine level (250.0±94.9pg/ml vs. 207.0±86.8pg/ml, P=0.08). However, dippers differed significantly from non-dippers in that they had significantly greater orthostatic heart rate increment (43±16bpm vs. 35±10bpm, P=0.007) and significantly greater orthostatic plasma norepinephrine increase (293±136.6pg/ml vs. 209±91.1pg/ml, P=0.028). Our data indicate that in patients with POTS, a non-dipping blood pressure profile is associated with a reduced orthostatic sympathetic reactivity not accounted for by autonomic neuropathy.
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Affiliation(s)
- Juan J Figueroa
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Win-Kuang Shen
- Department of Cardiology, Mayo Clinic, Scottsdale, AZ, United States
| | - David M Sletten
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Jade A Gehrking
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
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Jaubert MP, Jin Z, Russo C, Schwartz JE, Homma S, Elkind MSV, Rundek T, Sacco RL, Di Tullio MR. Alcohol consumption and ambulatory blood pressure: a community-based study in an elderly cohort. Am J Hypertens 2014; 27:688-94. [PMID: 24363276 DOI: 10.1093/ajh/hpt235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although heavy alcohol consumption is associated with hypertension, the impact of lighter consumption on blood pressure (BP) is controversial. The protective effect of light alcohol consumption on cardiovascular disease described in previous studies could be, in part, mediated by effects of alcohol on BP. However, only a few studies investigating the association between alcohol and BP included elderly subjects, despite their higher risk of hypertension sequelae. Accordingly, we evaluated the relationship between alcohol consumption and 24-hour ambulatory BP in a community-based elderly cohort. METHODS Among the participants in the Cardiac Abnormalities and Brain Lesion study, 553 subjects (mean age = 70.6 ± 9.6 years) who underwent 24-hour ambulatory BP monitoring were examined. Alcohol consumption was categorized as (i) none (reference; <1 drink/month); (ii) very light consumption (1 drink/month to 1 drink/week); (iii) light consumption (2 drinks/week to 1 drink/day); (iv) moderate-to-heavy consumption (>1 drink/day). Former drinkers were excluded. RESULTS After adjustment for relevant covariables, mean values of daytime diastolic BP (DBP), nighttime DBP, and 24-hour DBP were significantly higher in moderate-to-heavy drinkers than in the reference group, whereas systolic BP parameters were not significantly different across consumption groups. Daytime systolic BP and DBP variability (SD of the measurements) were significantly lower in very light drinkers than in the reference group, independent of potential confounders. CONCLUSIONS Moderate-to-heavy alcohol consumption was associated with higher DBP values. Very light alcohol consumption was associated with reduced daytime BP variability. The latter association may contribute to the known beneficial cardiovascular effects of light alcohol consumption.
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Abstract
We have reviewed the most relevant data regarding ABPM and brain damage, with specific reference to first and recurrent stroke, silent structural brain lesions such as lacunar infarcts and white matter lesions, and cognitive impairment. Only two large studies have evaluated the usefulness of ABPM in relation to antihypertensive treatment in primary stroke prevention. In the Syst-Eur trial, drug treatment reduced ABPM and office BP more than placebo in patients with sustained isolated systolic hypertension (ISH). In contrast, in those patients with white-coat hypertension (WCH) changes in ABPM between the treatment groups were not significantly different. Patients with WCH had a lower incidence of stroke (p < 0.05) during follow-up than patients with sustained ISH, suggesting that WCH is a benign condition. In the HYVET trial 50 % of the very elderly patients included with office systolic BP > 160 mmHg had WCH. However, a significant 30 % stroke reduction was observed in treated patients including those with WCH, indicating that WCH may not be a benign condition in the elderly. In the acute stroke setting, where treatment of hypertension is not routinely recommended due to the lack of evidence and the differing results of the very few available trials, ABPM data shows that sustained high BP during the first 24 h after acute stroke is related to the formation of cerebral edema and a poorer functional status. On the other hand, even when nondipping status was initially related to a poorer prognosis, data indicate that patients with very-large nocturnal dipping, the so-called "extreme dippers", are those with the worse outcomes after stroke. The association between different ABPM parameters (circadian pattern, short-term variability) and poorer performance scores in cognitive function tests have been reported, especially in elderly hypertensives. Unfortunately most of these studies were cross-sectional and the associations do not establish causality.
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Kim HM, Cho SY, Park SU, Sohn IS, Jung WS, Moon SK, Park JM, Ko CN, Cho KH. Can acupuncture affect the circadian rhythm of blood pressure? A randomized, double-blind, controlled trial. J Altern Complement Med 2012; 18:918-23. [PMID: 22906144 DOI: 10.1089/acm.2011.0508] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of the study was to investigate the effect of acupuncture on the circadian rhythm of blood pressure (BP) in patients with hypertension. DESIGN The study was designed as a randomized, double-blind, controlled trial. Subjects were randomly divided into an active acupuncture group and a sham acupuncture group. Each patient received real or sham acupuncture treatment twice a week for 8 weeks. Acupuncture needles were inserted at bilateral ST 36 plus PC 6; placebo points. SUBJECTS Thirty-three (33) patients with essential hypertension were the subjects. OUTCOME MEASURES Twenty-four (24)-hour ambulatory BP was assessed before and after treatment. RESULTS After the treatment period, there was a significant increase in nocturnal diastolic BP dipping compared to that at baseline (10.20±7.56 mm Hg versus 5.21±10.19 mm Hg, p=0.038) in the active acupuncture group but not in the sham acupuncture group. The nocturnal diastolic BP dipping response to active acupuncture treatment was significantly different from the response seen with the sham acupuncture treatment (p=0.041). The number of dippers also increased from 4 to 8 in the active acupuncture group. Average systolic and diastolic BP was not changed significantly except for nighttime diastolic BP (90.32±11.47 mm Hg to 87.83±9.16 mm Hg, p=0.041). CONCLUSIONS It is suggested that acupuncture treatment could be useful for improving the circadian rhythm of BP in patients with hypertension.
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Affiliation(s)
- Hye-Mi Kim
- Department of Cardiovascular & Neurologic Diseases, College of Oriental Medicine, Kyung Hee University, Seoul, Korea
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Losartan/hydrochlorothiazide combination vs. high-dose losartan in patients with morning hypertension--a prospective, randomized, open-labeled, parallel-group, multicenter trial. Hypertens Res 2012; 35:708-14. [PMID: 22399096 DOI: 10.1038/hr.2012.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The treatment of morning hypertension has not been established. We compared the efficacy and safety of a losartan/hydrochlorothiazide (HCTZ) combination and high-dose losartan in patients with morning hypertension. A prospective, randomized, open-labeled, parallel-group, multicenter trial enrolled 216 treated outpatients with morning hypertension evaluated by home blood pressure (BP) self-measurement. Patients were randomly assigned to receive a combination therapy of 50 mg losartan and 12.5 mg HCTZ (n=109) or a high-dose therapy with 100 mg losartan (n=107), each of which were administered once every morning. Primary efficacy end points were morning systolic BP (SBP) level and target BP achievement rate after 3 months of treatment. At baseline, BP levels were similar between the two therapy groups. Morning SBP was reduced from 150.3±10.1 to 131.5±11.5 mm Hg by combination therapy (P<0.001) and from 151.0±9.3 to 142.5±13.6 mm Hg by high-dose therapy (P<0.001). The morning SBP reduction was greater in the combination therapy group than in the high-dose therapy group (P<0.001). Combination therapy decreased evening SBP from 141.6±13.3 to 125.3±13.1 mm Hg (P<0.001), and high-dose therapy decreased evening SBP from 138.9±9.9 to 131.4±13.2 mm Hg (P<0.01). Although both therapies improved target BP achievement rates in the morning and evening (P<0.001 for both), combination therapy increased the achievement rates more than high-dose therapy (P<0.001 and P<0.05, respectively). In clinic measurements, combination therapy was superior to high-dose therapy in reducing SBP and improving the achievement rate (P<0.001 and P<0.01, respectively). Combination therapy decreased urine albumin excretion (P<0.05) whereas high-dose therapy reduced serum uric acid. Both therapies indicated strong adherence and few adverse effects (P<0.001). In conclusion, losartan/HCTZ combination therapy was more effective for controlling morning hypertension and reducing urine albumin than high-dose losartan.
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Ogura M, Yamada Y, Terawaki H, Hamaguchi A, Kimura Y, Hosoya T. Home systolic blood pressure on the morning of dialysis days has prognostic impact for hypertensive hemodialysis patients. Clin Exp Nephrol 2011; 16:427-32. [PMID: 22183563 PMCID: PMC3376255 DOI: 10.1007/s10157-011-0575-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/27/2011] [Indexed: 01/20/2023]
Abstract
Background Hypertension is a leading cause of cardiovascular (CV) disease in the general population. Although hypertension is very common in maintenance hemodialysis (HD) patients, adequate blood pressure (BP) values and measurement timing have not been defined. Methods A total of 49 hypertensive HD patients were recruited. Average age was 63 ± 11 years, and duration of dialysis therapy was 6.2 ± 4.2 years. Dialysis unit BPs and various types of home BPs were separately measured, and which BPs were the most critical markers in evaluating the effect of hypertension on left ventricular hypertrophy and CV events was investigated. Results Predialysis systolic BPs were not correlated with any home BPs. Left ventricular mass index (LVMI) had a significant positive correlation with home BPs, especially morning systolic BPs on HD days (P < 0.01) and non-HD days (P < 0.05), on univariate and multivariate analysis. In contrast, predialysis BPs did not correlate with LVMI. During the follow-up period (47 ± 18 months), it was demonstrated that diabetes and home BPs, especially systolic BPs on the morning of HD days, were significant predictors of CV events on multivariate Cox regression analysis. A 10 mmHg increase in BP had a significantly elevated relative risk for CV events. Conclusions Home BP, especially systolic BPs in the morning on HD days, can provide pivotal information for management of HD patients.
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Affiliation(s)
- Makoto Ogura
- Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
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Simvastatin prevents large blood pressure variability induced aggravation of cardiac hypertrophy in hypertensive rats by inhibiting RhoA/Ras–ERK pathways. Hypertens Res 2010; 34:341-7. [DOI: 10.1038/hr.2010.229] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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