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Takase H, Sugiura T, Yamashita S, Kawakatsu N, Hayashi K, Kin F, Isogaki T, Dohi Y. Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension. Blood Press 2024; 33:2323967. [PMID: 38465635 DOI: 10.1080/08037051.2024.2323967] [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: 12/21/2023] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population. MATERIALS AND METHODS This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of 'high blood pressure', an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint. RESULT During follow-up, 'high blood pressure' developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of 'high blood pressure'. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of 'high blood pressure'. CONCLUSION Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.
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Affiliation(s)
- Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | | | - Sumiyo Yamashita
- Department of Cardiology, Nagoya City University Mirai Kousei Hospital, Nagoya, Japan
| | - Naomi Kawakatsu
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Kazusa Hayashi
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Fumihiko Kin
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Takeru Isogaki
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
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Ahn S, Howie-Esquivel J, Davis EM, Chung ML, Lobo JM, Logan JG. Association of disrupted sleep with 24-hour blood pressure variability in caregivers. Heart Lung 2023; 60:45-51. [PMID: 36905754 DOI: 10.1016/j.hrtlng.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND A growing body of research highlights the negative impact of caregiving on cardiovascular disease (CVD) risk. OBJECTIVES This study aimed to examine associations of psychological symptoms and sleep quality with 24-hour blood pressure variability (BPV), which is an independent predictor of CVD, among family caregivers of community-dwelling individuals with chronic illness. METHODS For this cross-sectional study, we assessed caregiving burden and depressive symptoms using questionnaires and 7-day sleep quality (i.e., number of awakenings, wake after sleep onset, sleep efficiency) using an actigraph. The participants carried out a 24-hour ambulatory BP monitoring for systolic and diastolic BPV over 24 h and during awake/sleep times. We performed Pearson's correlations and multiple linear regression. RESULTS The analytic sample consisted of 30 caregivers (25 female; mean age 62 years). The number of awakenings during sleep was positively correlated with systolic BPV-awake (r = 0.426, p = 0.019) and diastolic BPV-awake (r = 0.422, p = 0.020). Sleep efficiency was negatively correlated with diastolic BPV-awake (r = -0.368, p = 0.045). Caregiving burden and depressive symptoms were not correlated with BPV. After controlling for age and mean arterial pressure, the number of awakenings was significantly associated with increased systolic BPV-24 h (β = 0.194, p = 0.018) and systolic BPV-awake (β = 0.280, p = 0.002), respectively. CONCLUSIONS Caregivers' disrupted sleep may play a role in increased CVD risk. While these findings should be confirmed in large clinical studies, improving sleep quality would need to be considered in CVD prevention for caregivers.
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Affiliation(s)
- Soojung Ahn
- School of Nursing, Vanderbilt University, Nashville, TN, USA.
| | | | - Eric M Davis
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jennifer M Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
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Soyaltin E, Demir BK, Erfidan G, Çamlar SA, Alaygut D, Mutlubaş F. Effects of ambulatory blood pressure monitoring parameters on left ventricular mass index in hypertensive children. Blood Press Monit 2022; 27:213-219. [PMID: 35258018 DOI: 10.1097/mbp.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to evaluate the effects of blood pressure (BP) values obtained by 24-h ambulatory BP monitoring (ABPM) of hypertensive children and adolescents on left ventricular mass index (LVMI). METHODS Patients diagnosed with HT with BP measurements confirmed with ABPM and evaluated with echocardiography for LVMI were included. The patients were divided into two groups according to their BMI as obese and nonobese. SDSs of ABPM parameters were compared between the groups. RESULTS A total of 158 children with HT were included in the study. Ninety of these patients were obese. In obese and nonobese cases, mean SDS levels were similar in ABPM parameters, whereas LVMI was significantly higher in obese patients ( P = 0.049). There was a significant correlation between LVMI and 24-h SBP SDS, daytime SBP SDS, 24-h SBP load and daytime BP load. In obese cases, there was a statistically significant correlation between LVMI and 24-h SBP SDS, daytime SBP SDS, 24-h SBP load, daytime SBP load as well as nighttime SBP SDS and nighttime SBP load. When the whole group was evaluated, 24-h SBP SDS was the most effective parameter influencing LVMI ( P = 0.001). Similarly, the most effective ABPM parameter on LVMI in obese patients was 24-h SBP SDS ( P = 0.001). CONCLUSION A significantly higher rate of LVMI in obese patients suggests that obesity itself is an effective factor on LVMI. In addition, systolic hypertension is more effective on cardiac functions compared with DBP measurements and systolic-DBP dipping ratios.
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Affiliation(s)
- Eren Soyaltin
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Belde Kasap Demir
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
- Division of Pediatric Nephrology and Rheumatology, Department of Pediatrics, Izmir Katip Çelebi University Medical Faculty, İzmir, Turkey
| | - Gökçen Erfidan
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Seçil Arslansoyu Çamlar
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Demet Alaygut
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Fatma Mutlubaş
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
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Hoshide S, Yoshihisa A, Tsuchida F, Mizuno H, Teragawa H, Kasai T, Koito H, Ando SI, Watanabe Y, Takeishi Y, Kario K. Pulse transit time-estimated blood pressure: a comparison of beat-to-beat and intermittent measurement. Hypertens Res 2022; 45:1001-1007. [PMID: 35388176 PMCID: PMC9106575 DOI: 10.1038/s41440-022-00899-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pulse transit time (PTT), which refers to the travel time between two arterial sites within the same cardiac cycle, has been developed as a novel cuffless form of continuous blood pressure (BP) monitoring. The aim of this study was to investigate differences in BP parameters, including BP variability, between those assessed by beat-to-beat PTT-estimated BP (eBPBTB) and those assessed by intermittent PTT-estimated BP at fixed time intervals (eBPINT) in patients suspected of having sleep disordered breathing (SDB). In 330 patients with SDB (average age, 66.8 ± 11.9 years; 3% oxygen desaturation index [ODI], 21.0 ± 15.0/h) from 8 institutes, PTT-estimated BP was continuously recorded during the nighttime. The average systolic eBPBTB, maximum systolic and diastolic eBPBTB, standard deviation (SD) of systolic and diastolic eBPBTB, and coefficient variation (CV) of systolic and diastolic eBPBTB were higher than the respective values of eBPINT (all P < 0.05). Bland-Altman analysis showed a close agreement between eBPBTB and eBPINT in average systolic BP and SD and CV of systolic BP, while there were disagreements in both minimum and maximum values of eBPBTB and eBPINT in patients with high systolic BP (P < 0.05). Although systolic BP variability incrementally increased according to the tertiles of 3%ODI in both eBPBTB and eBPINT (all P < 0.05), there was no difference in this tendency between eBPBTB and eBPINT. In patients with suspected SDB, the difference between eBPBTB and eBPINT was minimal, and there were disagreements regarding both the minimum and maximum BP. However, there were agreements in regard to the index of BP variability between eBPBTB and eBPINT.
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Affiliation(s)
- Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Sicence, Fukushima, Japan
| | | | - Hiroyuki Mizuno
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Koito
- Department of Internal Medicine, Misugikai Otokoyama Hospital, Kyoto, Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshihiko Watanabe
- Department of Internal Medicine, Nippon Dental University Hospital, Tokyo, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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Zhang X, Xu L, Zhou P, Song D, Wu J, Jia L. Intradialytic BP variability is associated with cardiovascular mortality and hospitalization in HD patients. Ther Apher Dial 2021; 26:624-631. [PMID: 34655281 DOI: 10.1111/1744-9987.13745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Studies showed that pre-dialysis BP variability (BPV) was an independent risk factor of cardiovascular disease (CVD) among HD patients, but which is limited on how intradialytic BPV affects prognosis. METHODS In this study, we designed a retrospective cohort study to examine the association between intradialytic BPV and CVD outcomes in HD patients. A total of 202 patients who underwent HD in our center were included, and all intradialytic BP measurements of November 2017 were obtained from the database. Patients were divided into four groups according to variability independent of the mean (VIM) interquartile. RESULTS The mean age was 62.1 ± 14.3 years, 60.9% were male, and median VIM was 14.75 (12.60-18.59). Multiple-regression analyses showed patients age, dialysis vintage, serum albumin, and the percentage of intradialytic weight gain as significant predictors of VIM (all p values were <0.05). Kaplan-Meier survival curves showed that CVD mortality was greater in patients with higher VIM (p = 0.05), whereas all-cause mortality had no significant difference between the four groups overall (p = 0.149). Furthermore, multivariate regression analyses demonstrated that VIM (HR = 1.091, p < 0.004) and age (HR = 1.059, p = 0.003) were significant independent predictors for CVD death. Logistic-regression models revealed that higher VIM groups were more likely to have CVD-related hospitalization (OR = 1.085, p = 0.030), whereas the association between VIM and all-cause hospitalization was not statistically significant (OR = 1.015, p = 0.669). CONCLUSIONS This retrospective study suggested that higher intradialytic BPV was associated with increasing age, longer dialysis vintage, lower albumin, and greater ultrafiltration; intradialytic BPV could be an effective predictor for CVD mortality and hospitalization in the HD population.
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Affiliation(s)
- Xuelei Zhang
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Ling Xu
- Department of Urology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Peiyi Zhou
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Dongqi Song
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Jian Wu
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lifang Jia
- Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China
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Ostroumova OD, Kochetkov AI, Arablincky NA, Shatalova NA, Romanovsky RR, Kirichenko AA. [What do we Mean by "Ideal" Blood Pressure Control?]. ACTA ACUST UNITED AC 2021; 61:68-78. [PMID: 34397344 DOI: 10.18087/cardio.2021.7.n1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022]
Abstract
Arterial hypertension (AH) is one of the most important risk factors for development of myocardial infarction, chronic heart failure, stroke, cognitive disorders and dementia, and chronic kidney disease. Currently, special attention is paid to increased blood pressure variability (BPV) as a new risk factor for development of cardiovascular and cerebrovascular complications. The available evidence-based body of clinical studies demonstrates the importance of reducing not only the blood pressure itself but also the increased BPV to provide significant improvement of the prognosis and limits the risk of complications. This notion has been validated in consensus documents on the management of patients with AH. Among antihypertensive drugs, the fixed-dose combination (FC) amlodipine/perindopril has demonstrated a unique capability for reducing all types of BPV (visit-to-visit, day-to-day, during 24 h). According to current clinical guidelines, this combination belongs to first-line FCs indicated for most patients with AH. A distinctive feature of the FC amlodipine/perindopril is numerous data from real-life clinical practice, which support both its high antihypertensive efficacy and the ability to decrease high BPV. Therefore, the FC amlodipine/perindopril can be recommended for a broad range of AH patients to achieve BP control and to improve the prognosis.
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Affiliation(s)
- O D Ostroumova
- Russian Medical Academy of Continuous Professional Education, Moscow; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - A I Kochetkov
- Russian Medical Academy of Continuous Professional Education, Moscow
| | - N A Arablincky
- Pirogov Russian National Research Medical University (Pirogov Medical University), Moscow
| | - N A Shatalova
- Clinical Center for Restorative Medicine and Rehabilitation, Moscow region, Zvenigorod
| | - R R Romanovsky
- Loginov Moscow Clinical Scientific Center of the Moscow Department of Healthcare, Moscow
| | - A A Kirichenko
- Russian Medical Academy of Continuous Professional Education, Moscow
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Ostroumova OD, Kochetkov AI, Butorov VN, Krotkova IF. How to Choose the Optimal Single-Pill Combination of the First-Line Antihypertensive Drugs? The Benefits of Amlodipine and Telmisartan Combination. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In patients with arterial hypertension (AH), an extremely important measure of the effectiveness of antihypertensive drugs (AHD) is not only a direct decrease in blood pressure (BP), but also its stable control throughout the 24 hours, preventing excessive morning surge and increased BP variability, which in turn are recognized cardiovascular risk factors. Currently, in the vast majority of hypertensive patients, the main antihypertensive therapy approach is using single-pill combinations (SPC) of AHD. Among the first-line combinations for a wide range of patients with AH and no special clinical conditions is amlodipine/telmisartan SPC. Distinctive features of these drugs, on the one hand, are unique pharmacological properties, consisting in an ultra-long antihypertensive effects, superior to other AHD in their classes; and on the other hand, there is an large body of evidence from numerous clinical trials confirming their high antihypertensive and target-organ protective potential as well as excellent capabilities in cardiovascular risk reduction. To assess the AHD effectiveness extent, several parameters have been proposed, of which the most rational and useful is the smoothness index, calculated using the ambulatory blood pressure monitoring data. Smoothness index describes both the degree of BP reduction and its distribution during the monitoring period. This index inversely associates with the changes in BP variability, and has predictive value in relation to the hypertension-mediated organ damage regression during different antihypertensive regimens. Amlodipine/telmisartan SPC has also been studied in many trials, including comparative ones with other AHD. In these works its direct powerful antihypertensive effect and a pronounced beneficial impact on the smoothness index have been proved, demonstrating stable BP control throughout the 24 hours (especially in the most dangerous morning hours), and also a decrease in BP variability. Therefore, amlodipine/telmisartan SPC can effectively reduce cardiovascular risk and improve prognosis in patients with AH.
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Affiliation(s)
- O. D. Ostroumova
- Medical Academy of Continuous Professional Education;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - V. N. Butorov
- Medical Academy of Continuous Professional Education
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8
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1028] [Impact Index Per Article: 257.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Radchenko GD, Mushtenko LO, Sirenko YM. Influence of fixed-dose combination perindopril/amlodipine on target organ damage in patients with arterial hypertension with and without ischemic heart disease (results of EPHES trial). Vasc Health Risk Manag 2018; 14:265-278. [PMID: 30349279 PMCID: PMC6188174 DOI: 10.2147/vhrm.s163608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background The EPHES trial (Evaluation of influence of fixed dose combination Perindo-pril/amlodipine on target organ damage in patients with arterial HypErtension with or without iSchemic heart disease) compared the dynamics of target organ damage (TOD) in hypertensive patients with and without ischemic heart disease (IHD) treated with the fixed-dose combination (FDC) perindopril + amlodipine. Methods The analysis included 60 hypertensive patients (aged >30 years): 30 without IHD and 30 with IHD. At randomization, FDC was administered at a daily baseline dose of 5/5 mg with uptitration to 10/10 mg every two weeks. If target blood pressure (BP<140/90 mmHg) was not achieved after six weeks, indapamide 1.5 mg was added to the regimen. All patients underwent body mass index measurements, office and ambulatory BP measurements, pulse wave velocity (PWVe) and central systolic BP evaluation, augmentation index adjusted to heart rate 75 (Aix@75) evaluation, biochemical analysis, ECG, echocardiography with Doppler, ankle-brachial index measurement, and intima-media thickness measurement. The follow-up period was 12 months. Results Therapy based on FDC perindopril/amlodipine was effective in lowering BP (office, ambulatory, central) in both groups. We noted significant decrease in Aix@75 with the therapy in both groups, but ΔAix@75 was lesser in the group with IHD than the group without IHD. FDC provided significant improvement in PWVe and left ventricular diastolic function, and decrease in albuminuria, left ventricular hypertrophy (LVH), and left atrium size. ΔPWVe was significantly (P<0.005) less in patients without IHD than those with IHD (2.5±0.2 vs 4.4±0.5 m/s, respectively). In spite of almost equal LVH regression, the positive dynamics of ΔE/A and ΔE/E´ were more in patients with IHD than those without IHD (64.4% and 54.1% vs 39.8 and 23.2%, respectively; P<0.05 for both comparisons). Adverse reactions were in 2 (6.5%) patients without IHD and 3 (10%) with IHD (P=NS). In the group with IHD, we noted significant decrease in angina episode rate – from 2.5±0.4 to 1.2±0.2 (P<0.01) per week. Conclusion Thus, treatment based on FDC was effective in decreasing BP and TOD regression in both patients with and without IHD. However, the dynamics of changes in TOD were different between the two groups, which should be taken into consideration during management of patients with and without IHD.
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Affiliation(s)
- Ganna D Radchenko
- State Institute "National Scientific Center "Institute of Cardiology named after acad.M.Strazhesko" of Ukrainian National Academy of Medical Science, Kyiv, Ukraine,
| | - Liliya O Mushtenko
- State Institute "National Scientific Center "Institute of Cardiology named after acad.M.Strazhesko" of Ukrainian National Academy of Medical Science, Kyiv, Ukraine,
| | - Yuriy M Sirenko
- State Institute "National Scientific Center "Institute of Cardiology named after acad.M.Strazhesko" of Ukrainian National Academy of Medical Science, Kyiv, Ukraine,
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Three-year change in endothelin-1 and markers of vascular remodelling in a bi-ethnic South African cohort: the SABPA study. J Hum Hypertens 2017; 31:708-714. [PMID: 28726796 DOI: 10.1038/jhh.2017.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 11/08/2022]
Abstract
South Africans are at high risk for developing cardiovascular disease. Endothelin-1 is known for its vasoconstrictive properties and its ability to contribute to vascular structural changes. In this study we investigated the association of change in endothelin-1 levels and change in markers implicated in vascular remodelling after 3 years. Serum endothelin-1 levels and markers of vascular remodelling such as carotid intima-media thickness, carotid cross-sectional wall area (CSWA) and arterial compliance were measured. Participants were divided into two groups according to an increase (n=185) and a decrease (n=152) in plasma endothelin-1 levels after 3 years. In partial regression analysis, the extent of endothelin-1 increase correlated positively with a change in pulse pressure and inversely with the change in arterial compliance in the group with increased endothelin-1 levels after 3 years. In the group with decreased endothelin-1 levels, the extent of decreased endothelin-1 correlated inversely with a change in CSWA. In multiple regression analysis, after splitting for race, the increase in endothelin-1 levels associated positively with the change in pulse pressure (Adj. R2=0.092; β=0.278; P=0.036) in the black participants only. In conclusion, with increased endothelin-1 levels after 3 years, the positive association between endothelin-1 and pulse pressure suggest subclinical haemodynamic changes with potential premature onset of cardiovascular disease in the black participants.
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11
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Swart R, Schutte AE, van Rooyen JM, Mels CMC. Serum selenium levels, the selenoprotein glutathione peroxidase and vascular protection: The SABPA study. Food Res Int 2017; 104:69-76. [PMID: 29433785 DOI: 10.1016/j.foodres.2017.06.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023]
Abstract
Selenium is an important co-factor for the optimal functioning of the antioxidant enzyme, glutathione peroxidase (GPx). Studies investigating the associations of selenium with blood pressure (BP) and hemodynamic measures are sparse. This study investigated whether 24h blood pressure, vascular resistance, arterial compliance and arterial stiffness relate to both serum selenium and GPx activity. In this cross-sectional study selenium levels, GPx activity, ambulatory blood pressure and arterial stiffness of 200 black and 209 white school teachers from South Africa were measured. Serum selenium levels were significantly lower in black compared to white teachers (p<0.001), independent of sex. One in 10 black men and one in five black women were selenium deficient (<8μg/100ml). Only in white men inverse independent associations of 24h systolic BP (β=-0.19; p=0.039) and 24h diastolic BP (β=-0.21; p=0.029) with selenium were found. In the same group, an inverse association between carotid-dorsalis pedis pulse wave velocity (cd-PWV) and GPx activity (β=-0.23; p=0.017) were also found. To conclude, lower serum selenium levels in black populations from the same geographical region as their white counterparts may impact on the loss of the vasculoprotective effects of selenium and selenoproteins such as GPx.
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Affiliation(s)
- R Swart
- Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.
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12
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Visit-to-visit SBP variability and cardiovascular disease in a multiethnic primary care setting. J Hypertens 2017; 35 Suppl 1:S50-S56. [DOI: 10.1097/hjh.0000000000001333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Schutte AE, Botha S, Fourie CMT, Gafane-Matemane LF, Kruger R, Lammertyn L, Malan L, Mels CMC, Schutte R, Smith W, van Rooyen JM, Ware LJ, Huisman HW. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 2017; 31:491-500. [PMID: 28332510 DOI: 10.1038/jhh.2017.18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
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Affiliation(s)
- A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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14
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Interpretation of ambulatory blood pressure profile: a prognostic approach for clinical practice. J Hypertens 2016; 33:454-7. [PMID: 25629359 DOI: 10.1097/hjh.0000000000000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Abdel-Rheim AEDR, Amin AS, Ali HM, Hassan HM. Left ventricular hypertrophy in controlled hypertension: Is blood pressure variability blamed? Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Salman IM. Current Approaches to Quantifying Tonic and Reflex Autonomic Outflows Controlling Cardiovascular Function in Humans and Experimental Animals. Curr Hypertens Rep 2016; 17:84. [PMID: 26363932 DOI: 10.1007/s11906-015-0597-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of the autonomic nervous system in the pathophysiology of human and experimental models of cardiovascular disease is well established. In the recent years, there have been some rapid developments in the diagnostic approaches used to assess and monitor autonomic functions. Although most of these methods are devoted for research purposes in laboratory animals, many have still found their way to routine clinical practice. To name a few, direct long-term telemetry recording of sympathetic nerve activity (SNA) in rodents, single-unit SNA recording using microneurography in human subjects and spectral analysis of blood pressure and heart rate in both humans and animals have recently received an overwhelming attention. In this article, we therefore provide an overview of the methods and techniques used to assess tonic and reflex autonomic functions in humans and experimental animals, highlighting current advances available and procedure description, limitations and usefulness for diagnostic purposes.
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Affiliation(s)
- Ibrahim M Salman
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
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17
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Blood Pressure Variability and Left Ventricular Mass in Hypertensive Patients. CURRENT HEALTH SCIENCES JOURNAL 2016; 42:47-50. [PMID: 30568812 PMCID: PMC6256143 DOI: 10.12865/chsj.42.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/27/2016] [Indexed: 11/25/2022]
Abstract
Objectives The purpose of the study is to evaluate 24h blood pressure values by automatic ambulatory monitoring (ABPM) in a group of hypertensive patients already on therapy and to find correlations between different blood pressure parameters and the presence of left ventricular hypertrophy (LVH). Design and method: 39 patients diagnosed with essential hypertension grades 1-3 were enrolled in the study; echocardiography was done and left ventricular mass and mass index were calculated. Based on 24 h ABPM we calculated BP variability estimated as standard deviation (SD) and average real variability (ARV), pulse pressure, dipper profile and morning BP surge. We compared these parameters in pts with and without LVH and calculated correlations with LV mass. Results: Nocturnal diastolic BP variability estimated as SD had significantly higher values in pts with LVH (13,2 vs 9,9 mmHg, p=0,015), ARV/24 hour and ARV during nighttime had higher values in pts with LVH vs those with normal LV mass (12,25 vs 9,7 mmHg and 12,35 vs 9,36 mmHg, p=0,03). Nocturnal diastolic BP variability correlated with LV mass index (r=0,325 for ARV and r =0,327 for SD). Other variables did not correlate with LV mass. Conclusions Nocturnal diastolic BP variability correlates with LVH independently of mean BP value. ABPM offers a valueable analysis of BP and enables the calculation of different parameters- as variability- which predict target organ damage.
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Milazzo V, Maule S, Di Stefano C, Tosello F, Totaro S, Veglio F, Milan A. Cardiac Organ Damage and Arterial Stiffness in Autonomic Failure: Comparison With Essential Hypertension. Hypertension 2015; 66:1168-75. [PMID: 26459422 DOI: 10.1161/hypertensionaha.115.05913] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/12/2015] [Indexed: 11/16/2022]
Abstract
Autonomic failure (AF) is characterized by orthostatic hypotension, supine hypertension, and increased blood pressure (BP) variability. AF patients develop cardiac organ damage, similarly to essential hypertension (EH), and have higher arterial stiffness than healthy controls. Determinants of cardiovascular organ damage in AF are not well known: both BP variability and mean BP values may be involved. The aim of the study was to evaluate cardiac organ damage, arterial stiffness, and central hemodynamics in AF, compared with EH subjects with similar 24-hour BP and a group of healthy controls, and to evaluate determinants of target organ damage in patients with AF. Twenty-seven patients with primary AF were studied (mean age, 65.7±11.2 years) using transthoracic echocardiography, carotid-femoral pulse wave velocity, central hemodynamics, and 24-hour ambulatory BP monitoring. They were compared with 27 EH subjects matched for age, sex, and 24-hour mean BP and with 27 healthy controls. AF and EH had similar left ventricular mass (101.6±33.3 versus 97.7±28.1 g/m(2), P=0.59) and carotid-femoral pulse wave velocity (9.3±1.8 versus 9.2±3.0 m/s, P=0.93); both parameters were significantly lower in healthy controls (P<0.01). Compared with EH, AF patients had higher augmentation index (31.0±7.6% versus 26.1±9.2%, P=0.04) and central BP values. Nighttime systolic BP and 24-hour systolic BP predicted organ damage, independent of BP variability. AF patients develop hypertensive heart disease and increased arterial stiffness, similar to EH with comparable mean BP values. Twenty-four-hour and nighttime systolic BP were determinants of cardiovascular damage, independent of BP variability.
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Affiliation(s)
- Valeria Milazzo
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy.
| | - Simona Maule
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Cristina Di Stefano
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Francesco Tosello
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Totaro
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Veglio
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alberto Milan
- From the Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
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Asayama K, Schutte R, Li Y, Hansen TW, Staessen JA. Blood pressure variability in risk stratification: What does it add? Clin Exp Pharmacol Physiol 2014; 41:1-8. [PMID: 23573998 DOI: 10.1111/1440-1681.12091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/29/2013] [Accepted: 04/04/2013] [Indexed: 11/28/2022]
Abstract
1. In this minireview we address the predictive value of blood pressure variability, over and beyond level of pressure, in randomly selected population samples. All reviewed studies had sufficient power, long follow-up duration and a wide age range. 2. We assessed blood pressure variability derived from home visit, self-measured home pressure and 24 h ambulatory monitoring. The conclusions are based mainly on novel indices of blood pressure variability: variability independent of the mean, difference between maximum and minimum blood pressure and average real variability. 3. None of these variability indices or morning surge in blood pressure substantially refined risk profiling over and beyond the blood pressure level. 4. In risk stratification, clinicians should concentrate on blood pressure level, the predominant risk factor modifiable by lifestyle measures and antihypertensive drug treatment.
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Affiliation(s)
- Kei Asayama
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
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20
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Gao S, Hendrie HC, Wang C, Stump TE, Stewart JC, Kesterson J, Clark DO, Callahan CM. Redefined blood pressure variability measure and its association with mortality in elderly primary care patients. Hypertension 2014; 64:45-52. [PMID: 24799611 DOI: 10.1161/hypertensionaha.114.03576] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Visit-to-visit blood pressure (BP) variability has received considerable attention recently. The objective of our study is to define a variability measure that is independent of change over time and determine the association between longitudinal summary measures of BP measurements and mortality risk. Data for the study came from a prospective cohort of 2906 adults, aged ≥60 years, in an urban primary care system with ≤15 years of follow-up. Dates of death for deceased participants were retrieved from the National Death Index. Systolic and diastolic BP measurements from outpatient clinic visits were extracted from the Regenstrief Medical Record System. For each patient, the intercept, regression slope, and root mean square error for visit-to-visit variability were derived using linear regression models and used as independent variables in Cox proportional hazards models for both all-cause mortality and mortality attributable to coronary heart disease or stroke. Rate of change was associated with mortality risk in a U-shaped relationship and that participants with little or no change in BP had the lowest mortality risk. BP variability was not an independent predictor of mortality risk. By separating change over time from visit-to-visit variability in studies with relatively long follow-up, we demonstrated in this elderly primary care patient population that BP changes over time, not variability, were associated with greater mortality risk. Future research is needed to confirm our findings in other populations.
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Affiliation(s)
- Sujuan Gao
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
| | - Hugh C Hendrie
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
| | - Chenkun Wang
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
| | - Timothy E Stump
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
| | - Jesse C Stewart
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
| | - Joe Kesterson
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
| | - Daniel O Clark
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
| | - Christopher M Callahan
- From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.)
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Leisman D, Meyers M, Schnall J, Chorny N, Frank R, Infante L, Sethna CB. Blood Pressure Variability in Children With Primary vs Secondary Hypertension. J Clin Hypertens (Greenwich) 2014; 16:437-41. [DOI: 10.1111/jch.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Leisman
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Melissa Meyers
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Jeremy Schnall
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Nataliya Chorny
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Rachel Frank
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Lulette Infante
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Christine B. Sethna
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
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Rickards CA, Tzeng YC. Arterial pressure and cerebral blood flow variability: friend or foe? A review. Front Physiol 2014; 5:120. [PMID: 24778619 PMCID: PMC3985018 DOI: 10.3389/fphys.2014.00120] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/13/2014] [Indexed: 01/09/2023] Open
Abstract
Variability in arterial pressure and cerebral blood flow has traditionally been interpreted as a marker of cardiovascular decompensation, and has been associated with negative clinical outcomes across varying time scales, from impending orthostatic syncope to an increased risk of stroke. Emerging evidence, however, suggests that increased hemodynamic variability may, in fact, be protective in the face of acute challenges to perfusion, including significant central hypovolemia and hypotension (including hemorrhage), and during cardiac bypass surgery. This review presents the dichotomous views on the role of hemodynamic variability on clinical outcome, including the physiological mechanisms underlying these patterns, and the potential impact of increased and decreased variability on cerebral perfusion and oxygenation. We suggest that reconciliation of these two apparently discrepant views may lie in the time scale of hemodynamic variability; short time scale variability appears to be cerebroprotective, while mid to longer term fluctuations are associated with primary and secondary end-organ dysfunction.
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Affiliation(s)
- Caroline A Rickards
- Department of Integrative Physiology, Cardiovascular Research Institute, University of North Texas Health Science Center Fort Worth, TX, USA
| | - Yu-Chieh Tzeng
- Cardiovascular Systems Laboratory, Centre for Translational Physiology, University of Otago Wellington, New Zealand
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Compromised bioavailable IGF-1 of black men relates favourably to ambulatory blood pressure: The SABPA study. Atherosclerosis 2014; 233:139-44. [DOI: 10.1016/j.atherosclerosis.2013.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/26/2013] [Accepted: 12/09/2013] [Indexed: 02/01/2023]
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van der Walt C, Malan L, Uys AS, Malan NT. Low Grade Inflammation and ECG Left Ventricular Hypertrophy in Urban African Males: The SABPA Study. Heart Lung Circ 2013; 22:924-9. [DOI: 10.1016/j.hlc.2013.03.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 01/25/2013] [Accepted: 03/19/2013] [Indexed: 12/16/2022]
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25
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Bertera FM, Del Mauro JS, Lovera V, Chiappetta D, Polizio AH, Taira CA, Höcht C. Enantioselective pharmacokinetics and cardiovascular effects of nebivolol in L-NAME hypertensive rats. Hypertens Res 2013; 37:194-201. [DOI: 10.1038/hr.2013.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 12/22/2022]
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Höcht C. Blood Pressure Variability: Prognostic Value and Therapeutic Implications. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/398485] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs.
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Affiliation(s)
- Christian Höcht
- Cátedra de Farmacología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113 Buenos Aires, Argentina
- Instituto de Fisiopatología y Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113 Buenos Aires, Argentina
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Bertera FM, Del Mauro JS, Lovera V, Chiappetta D, Héctor Polizio A, Alberto Taira C, Höcht C. Acute effects of third generation β-blockers on short-term and beat-to-beat blood pressure variability in sinoaortic-denervated rats. Hypertens Res 2013; 36:349-55. [DOI: 10.1038/hr.2012.209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Does age elevate blood pressure in obstructive sleep apnea? Eur Arch Otorhinolaryngol 2013; 270:383. [DOI: 10.1007/s00405-012-2089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
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Schutte R, Thijs L, Liu YP, Asayama K, Jin Y, Odili A, Gu YM, Kuznetsova T, Jacobs L, Staessen JA. Within-subject blood pressure level--not variability--predicts fatal and nonfatal outcomes in a general population. Hypertension 2012; 60:1138-47. [PMID: 23071126 DOI: 10.1161/hypertensionaha.112.202143] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To assess the prognostic significance of blood pressure (BP) variability, we followed health outcomes in a family-based random population sample representative of the general population (n=2944; mean age: 44.9 years; 50.7% women). At baseline, BP was measured 5 times consecutively at each of 2 home visits 2 to 4 weeks apart. We assessed within-subject overall (10 readings), within- and between-visit systolic BP variability from variability independent of the mean, the difference between maximum and minimum BP, and average real variability. Over a median follow-up of 12 years, 401 deaths occurred and 311 participants experienced a fatal or nonfatal cardiovascular event. Overall systolic BP variability averaged (SD) 5.45 (2.82) units, 15.87 (8.36) mmHg, and 4.08 (2.05) mmHg for variability independent of the mean, difference between maximum and minimum BP, and average real variability, respectively. Female sex, older age, higher-mean systolic BP, lower body mass index, a history of peripheral arterial disease, and use of β-blockers were the main correlates of systolic BP variability. In multivariable-adjusted analyses, overall and within- and between-visit BP variability did not predict total or cardiovascular mortality or the composite of any fatal plus nonfatal cardiovascular end point. For instance, the hazard ratios for all cardiovascular events combined in relation to overall variability independent of the mean, difference between maximum and minimum BP, and average real variability were 1.05 (0.96-1.15), 1.06 (0.96-1.16), and 1.08 (0.98-1.19), respectively. By contrast, mean systolic BP was a significant predictor of all end points under study, independent of BP variability. In conclusion, in an unbiased population sample, BP variability did not contribute to risk stratification over and beyond mean systolic BP.
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Affiliation(s)
- Rudolph Schutte
- Department of Cardiovascular Sciences, Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, BE-3000 Leuven, Belgium
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Effect of nebivolol on beat-to-beat and short-term blood pressure variability in spontaneously hypertensive rats. Naunyn Schmiedebergs Arch Pharmacol 2012; 385:833-43. [DOI: 10.1007/s00210-012-0756-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/13/2012] [Indexed: 01/06/2023]
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Ruilope LM. Normotension, blood pressure variability and early target organ damage. Hypertens Res 2011; 34:1075. [DOI: 10.1038/hr.2011.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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32
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Blood pressure variability and its implications in people of African descent. Hypertens Res 2011; 34:1076-7. [DOI: 10.1038/hr.2011.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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