1
|
Xiao Y, Yang T, Zhang L, Wei Q, Ou R, Hou Y, Liu K, Lin J, Jiang Q, Shang H. Association between the blood pressure variability and cognitive decline in Parkinson's disease. Brain Behav 2023; 13:e3319. [PMID: 37969048 PMCID: PMC10726805 DOI: 10.1002/brb3.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES High visit-to-visit blood pressure variability (BPV) was found to be associated with cognitive decline in the elderly. This study aimed to investigate the impact of visit-to-visit BPV on cognition in patients with early-stage Parkinson's disease (PD). DESIGN This is a retrospective analysis of a prospective cohort. SETTING AND PARTICIPANTS A total of 297 patients with early-stage PD (103 mild cognitive impairments [PD-MCI] and 194 normal cognitions [PD-NC] at baseline) were included from the Parkinson's Progression Markers Initiative study. METHODS Variation independent of mean (VIM) of the first year was used as the indicator of BPV. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition. Patients were divided into PD-MCI and PD-NC according to the MoCA score at baseline. Longitudinal cerebrospinal fluid (Aβ-42, Aβ, α-synuclein, neurofilament light protein, tau phosphorylated at the threonine 181 position, total tau, glial fibrillary acidic protein) and serum (neurofilament light protein) biomarkers were assessed. The Bayesian linear growth model was used to evaluate the relationship between baseline BPV and the rate of change in cognition and biomarkers. RESULTS Higher systolic VIM of the first year was related to a greater rate of decline in MoCA score in the following years in PD-MCI (β = -.15 [95% CI -.29, -.01]). No association was found between BPV and biomarkers. CONCLUSION AND IMPLICATIONS Higher systolic VIM predicted a steeper decline in cognitive tests in PD-MCI independently from the mean value of blood pressure, orthostatic hypotension, and supine hypertension.
Collapse
Affiliation(s)
- Yi Xiao
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Tianmi Yang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lingyu Zhang
- Health Management CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Qianqian Wei
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Ruwei Ou
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yanbing Hou
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Kuncheng Liu
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Junyu Lin
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Qirui Jiang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Huifang Shang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| |
Collapse
|
2
|
Kim H, Alvin Ang TF, Thomas RJ, Lyons MJ, Au R. Long-term blood pressure patterns in midlife and dementia in later life: Findings from the Framingham Heart Study. Alzheimers Dement 2023; 19:4357-4366. [PMID: 37394941 PMCID: PMC10597747 DOI: 10.1002/alz.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Long-term blood pressure (BP) measures, such as visit-to-visit BP variability (BPV) and cumulative BP, are strong indicators of cardiovascular risks. This study modeled up to 20 years of BP patterns representative of midlife by using BPV and cumulative BP, then examined their associations with development of dementia in later life. METHODS For 3201 individuals from the Framingham Heart Study, multivariate logistic regression analyses were performed to examine the association between long-term BP patterns during midlife and the development of dementia (ages ≥ 65). RESULTS After adjusting for covariates, every quartile increase in midlife cumulative BP was associated with a sequential increase in the risk of developing dementia (e.g., highest quartile of cumulative systolic blood pressure had approximately 2.5-fold increased risk of all-cause dementia). BPV was not significantly associated with dementia. DISCUSSION Findings suggest that cumulative BP over the course of midlife predicts risk of dementia in later life. HIGHLIGHTS Long-term blood pressure (BP) patterns are strong indicators of vascular risks. Cumulative BP and BP variability (BPV) were used to reflect BP patterns across midlife. High cumulative BP in midlife is associated with increased dementia risk. Visit-to-visit BPV was not associated with the onset of dementia.
Collapse
Affiliation(s)
- Hyun Kim
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Robert J. Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue Shapiro 7 Boston, MA 02215
| | - Michael J. Lyons
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Dept. of Neurology, Medicine and Alzheimer’s Disease Research Center, Boston University School of Medicine, 72 E. Concord St, Boston MA 02118
- Dept. of Epidemiology, Boston University School of Public Health, 715 Albany St.Boston, MA 02118
| |
Collapse
|
3
|
Olié V, Chatignoux E, Bonaldi C, Grave C, Gabet A, Blacher J. How to avoid overestimating the burden of hypertension in epidemiological studies? A new methodology to account for within-person variability of blood pressure. Int J Epidemiol 2022; 51:1824-1834. [PMID: 35904461 DOI: 10.1093/ije/dyac152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hypertension (HT) is a major modifiable risk factor for cardiovascular and renal diseases. HT is diagnosed as blood pressure (BP) exceeding a certain threshold. Because of the high within-person variability of BP, the estimation of HT in epidemiological studies based on single visit measurements tends to overestimate HT prevalence. Our study aimed to determine the correction factors to correct the bias in the estimation of HT prevalence in epidemiological studies. METHODS We used data from the National Health and Nutrition Examination Survey study in which BP was measured at three visits. A Bayesian hierarchical model was used to estimate the different components of BP variability (between individuals, between visits or between measures) by age and sex. These components allowed us to calculate the correction factors necessary to correct HT prevalence in epidemiological studies with single BP measurement. The method was then applied to data from the French Esteban study in which three standardized BP measurements were performed at a single clinical examination. RESULTS The components of BP variability varied with age and sex, with different patterns observed for systolic and diastolic BP. Between-visit and between-individual variations drove BP variability, with between-measure variability being much lower. The uncorrected prevalence of HT in the Esteban study overestimated the burden of HT by 12.6% in the French population, with more than one in five untreated individuals being misclassified. The overestimation was higher in younger adults and women. CONCLUSION Taking into account within-person BP variability in epidemiological studies could avoid a substantial overestimation of the burden of HT.
Collapse
Affiliation(s)
| | | | | | | | | | - Jacques Blacher
- Université Paris Cité; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu University Hospital, AP-HP, Paris, France
| |
Collapse
|
4
|
Li A, Zhou Q, Mei Y, Zhao J, Zhao M, Xu J, Ge X, Xu Q. Novel Strategies for Assessing Associations Between Selenium Biomarkers and Cardiometabolic Risk Factors: Concentration, Visit-to-Visit Variability, or Individual Mean? Evidence From a Repeated-Measures Study of Older Adults With High Selenium. Front Nutr 2022; 9:838613. [PMID: 35711534 PMCID: PMC9196882 DOI: 10.3389/fnut.2022.838613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Aims Previous studies have focused only on the cardiometabolic effects of selenium concentrations. We explored whether selenium levels and their visit-to-visit variability (VVV) and individual mean (IM) are independently associated with cardiometabolic risk factors. Methods A three-wave repeated-measures study of older adults with high selenium (n = 201) was conducted in Beijing from 2016 to 2018. Whole blood selenium and urinary selenium concentrations were measured. VVV and IM were used to profile the homeostasis of the selenium biomarkers. Four indicators, namely standard deviation, coefficient of variation, average real variability, and variability independent of the mean, were employed to characterize VVV. We considered 13 cardiometabolic factors: four lipid profile indicators, three blood pressure indices, glucose, uric acid, waistline, hipline, waist-hip ratio, and sex-specific metabolic syndrome score. Linear mixed-effects regression models with random intercepts for the participants were employed to explore the associations of the selenium concentrations, VVV, and IM with the cardiometabolic factors. Results The geometric mean whole blood and urinary selenium levels were 134.30 and 18.00 μg/L, respectively. Selenium concentrations were significantly associated with numerous cardiometabolic factors. Specifically, whole blood selenium was positively associated with total cholesterol [0.22, 95% confidence interval (CI): 0.12, 0.33], low-density lipoprotein cholesterol (LDL-C; 0.28, 95% CI: 0.13, 0.42), glucose (0.22, 95% CI: 0.10, 0.34), and uric acid (0.16, 95% CI: 0.04, 0.28). After adjustment for VVV, the IM of whole blood selenium was positively correlated with total cholesterol (0.002, 95% CI: 0.001, 0.004), triglycerides (0.007, 95% CI: 0.004, 0.011), and LDL-C (0.002, 95% CI: 0.000, 0.004). However, we did not observe any robust associations between the VVV of the selenium biomarkers and cardiometabolic risk factors after adjustment for IM. Conclusion Our findings suggest that selenium concentrations and their IMs are significantly associated with cardiometabolic risk factors among older adults with high selenium. Longer repeated-measures studies among the general population are required to validate our findings and elucidate the relevant underlying mechanisms.
Collapse
Affiliation(s)
- Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Cheng Y, Li J, Ren X, Wang D, Yang Y, Miao Y, Sheng CS, Tian J. Visit-to-visit office blood pressure variability combined with Framingham risk score to predict all-cause mortality: A post hoc analysis of the systolic blood pressure intervention trial. J Clin Hypertens (Greenwich) 2021; 23:1516-1525. [PMID: 34216524 PMCID: PMC8678842 DOI: 10.1111/jch.14314] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022]
Abstract
We aim to determine if visit‐to‐visit blood pressure variability (BPV) adds prognostic value for all‐cause mortality independently of the Framingham risk score (FRS) in the systolic blood pressure intervention trial (SPRINT). We defined BPV as variability independent of the mean (VIM) and the difference of maximum minus minimum (MMD) of the systolic blood pressure (SBP). Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Based on FRS stratification, there were 1035, 2911, and 4050 participants in the low‐, intermediate‐, and high‐risk groups, respectively. During the trial, 230 deaths occurred since the 12th month with an average follow‐up of 2.5 years. In continuous analysis, 1‐SD increase of SBP VIM and MMD were significantly associated with all‐cause mortality (HR 1.18, 95% CI 1.05–1.32, p = .005; and HR 1.21, 95% CI 1.09–1.35, p < .001, respectively). In category analysis, the highest quintile of BPV compared with the lowest quintile had significantly higher risk of all‐cause mortality. Cross‐tabulation analysis showed that the 3rd tertile of SBP VIM in the high‐risk group had the highest HR of all‐cause mortality in total population (HR 4.99; 95% CI 1.57–15.90; p = .007), as well as in intensive‐therapy group (HR 7.48; 95% CI 1.01–55.45; p = .05) analyzed separately. Cross‐tabulation analysis of SBP MMD had the same pattern as VIM showed above. In conclusion, visit‐to‐visit BPV was an independent predictor of all‐cause mortality, when accounting for conventional risk factors or FRS. BPV combined with FRS conferred an increased risk for all‐cause mortality in the SPRINT trial.
Collapse
Affiliation(s)
- Yi Cheng
- Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Li
- Clinical Research Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinping Ren
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Wang
- Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yulin Yang
- State Key Laboratory of Medical Genomics, Clinical Trial Center, Department of Endocrinology and Metabolism, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ya Miao
- State Key Laboratory of Medical Genomics, Clinical Trial Center, Department of Endocrinology and Metabolism, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingyan Tian
- State Key Laboratory of Medical Genomics, Clinical Trial Center, Department of Endocrinology and Metabolism, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
6
|
Kim Y, Lim JS, Oh MS, Yu KH, Lee JS, Park JH, Kim YJ, Rha JH, Hwang YH, Heo SH, Ahn SH, Lee JH, Kwon SU. Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis. Sci Rep 2021; 11:5049. [PMID: 33658545 PMCID: PMC7930263 DOI: 10.1038/s41598-021-83945-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/18/2021] [Indexed: 12/27/2022] Open
Abstract
Blood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.
Collapse
Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Republic of Korea
| | - Ju-Hun Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Sun U Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
7
|
The dawning of the digital era in the management of hypertension. Hypertens Res 2020; 43:1135-1140. [PMID: 32655134 DOI: 10.1038/s41440-020-0506-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Awareness, treatment, and control of hypertension are of the utmost importance in conquering stroke and cardiovascular disease. To reduce the global burden of hypertension, the Japanese Society of Hypertension (JSH) established the "JSH Future Plan" based on an increasing need to transform the strategy for combating hypertension. In addition to energizing conventional approaches in basic, translational, and clinical research, the application of rapidly evolving digital health technologies and artificial intelligence to hypertension healthcare and research (digital hypertension) holds promise for providing further insights into the pathophysiology and therapeutic targets and implementing predictive, personalized, and preemptive approaches in clinical practice. With great potential to revolutionize the landscape of hypertension, digital hypertension has some technical, legal, ethical, social, and financial issues to overcome. Given the multidisciplinary framework, digital hypertension requires comprehensive and strategic collaboration among industry, academia, and government to move forward toward the goal of "Future Medicine".
Collapse
|
8
|
Tully PJ, Tzourio C. Heterogeneity in the reporting of blood pressure variability: high time for methodological consensus. Age Ageing 2020; 49:168-170. [PMID: 32108871 DOI: 10.1093/ageing/afz155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| |
Collapse
|
9
|
Baroreflex failure and beat-to-beat blood pressure variation. Hypertens Res 2018; 41:547-552. [DOI: 10.1038/s41440-018-0056-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 02/07/2023]
|
10
|
Tani S, Asayama K, Oiwa K, Harasawa S, Okubo K, Takahashi A, Tanabe A, Ohkubo T, Hirayama A, Kushiro T. The effects of increasing calcium channel blocker dose vs. adding a diuretic to treatment regimens for patients with uncontrolled hypertension. Hypertens Res 2017; 40:892-898. [PMID: 28446804 DOI: 10.1038/hr.2017.56] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 12/15/2022]
Abstract
In patients with insufficient blood pressure (BP) control, despite using a combination regimen containing an angiotensin receptor blocker and a calcium channel blocker (CCB), whether a greater dose of CCB or adding a diuretic is more effective at lowering BP remains unclear. We conducted a multicenter randomized clinical trial to compare the efficacy of switching from the daily administration of a single-pill fixed-dose combination of irbesartan (100 mg) and amlodipine (5 mg) to irbesartan (100 mg) with an increased dose of amlodipine (10 mg) (HD group, n=62) or irbesartan (100 mg) and amlodipine (5 mg) with 1 mg of indapamide (D group, n=63) in patients with poorly controlled hypertension. BP measured at home was monitored by a physician using a telemonitoring system. Between the HD and D groups, no significant differences were observed in morning home BP changes (mean reduction of systolic/diastolic BP, 1.7/0.9 mmHg; 95% confidence intervals, -2.4 to 5.7/-1.4 to 3.2; P=0.19/0.37), achievement rate of target BP (45.2% vs. 42.9%, P=0.80), BP variability independent of the mean (P⩾0.74), other variability indices (P⩾0.55) and time to stabilization, which was calculated using a fitted analysis (13.1 days vs. 11.4 days, P=0.99). Although a significant increase in serum uric acid was observed in the D group (P<0.0001), neither clinically relevant abnormal laboratory test results nor critical BP changes were observed throughout the trial period. Both antihypertensive drug combination strategies were effective treatment options. Further investigation is required to determine the appropriate use of both therapies based on the various pathologies associated with hypertension.
Collapse
Affiliation(s)
- Shigemasa Tani
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Koji Oiwa
- Japan Community Health Care Organization, Yokohama Chuo Hospital, Yokohama, Japan
| | - Shinsuke Harasawa
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuaki Okubo
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuhiko Takahashi
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ayumi Tanabe
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
11
|
Analysis of beat-to-beat blood pressure variability response to the cold pressor test in the offspring of hypertensive and normotensive parents. Hypertens Res 2017; 40:581-589. [DOI: 10.1038/hr.2017.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/05/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
|
12
|
Saito I, Kario K, Kushiro T, Teramukai S, Yaginuma M, Mori Y, Okuda Y, Shimada K. Home blood pressure and cardiovascular risk in treated hypertensive patients: the prognostic value of the first and second measurements and the difference between them in the HONEST study. Hypertens Res 2016; 39:857-862. [PMID: 27488173 PMCID: PMC5506240 DOI: 10.1038/hr.2016.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 12/12/2022]
Abstract
Hypertension guidelines recommend using the average of two home blood pressure (HBP) measurements obtained on one occasion to monitor blood pressure. We studied the prognostic value of the first and second measurements or their average value during the follow-up period, as well as the relationships among the difference between the first and second HBP measurements and the prognosis using data from the HONEST (HBP measurement with Olmesartan-Naive patients to Establish Standard Target blood pressure) study. During the mean 2.02 years follow-up, 280 patients had cardiovascular events. Hazard ratios (HRs) for cardiovascular events for each 1 mm Hg increase in the first, second and averaged morning home systolic blood pressure (MHSBP) were similar. Hazards were significantly higher in patients with a large difference between the first and second MHSBP (ΔMHSBP) of <-5 mm Hg (HR: 2.12) or ⩾5 mm Hg (HR: 1.44) compared with those with a small ΔMHSBP of ⩾-5 to <5 mm Hg using the Cox proportional hazards model adjusted for the averaged MHSBP during the follow-up and other risk factors. Hazards in patients with an averaged MHSBP ⩾145 mmHg and a small ΔMHSBP (HR: 3.11), those with an averaged MHSBP ⩾125 to <145 mm Hg and a large ΔMHSBP (HR: 1.91) and those with an averaged MHSBP ⩾145 mm Hg and a large ΔMHSBP (HR: 4.63) were higher compared with those with an averaged MHSBP <125 mm Hg and a small ΔMHSBP. In conclusion, the first, second and averaged MHSBP measurements have similar prognostic values. Prognosis is worse for patients with a large ΔMHSBP. In clinical practice, it would be prudent to measure the HBP two times and use the average HBP of two measurements obtained on one occasion with particular attention to patients with a large ΔMHSBP.
Collapse
Affiliation(s)
- Ikuo Saito
- Keio University Health Center, Yokohama, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | |
Collapse
|
13
|
Tully PJ, Tzourio C. Psychiatric correlates of blood pressure variability in the elderly: The Three City cohort study. Physiol Behav 2016; 168:91-97. [PMID: 27818215 DOI: 10.1016/j.physbeh.2016.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The modifiable factors associated with blood pressure variability (BPV) are still being established and their clinical relevance is poorly understood. Generalized anxiety disorder (GAD) and depression have been implicated with higher BPV in the short term (e.g. hours, days) however their effects on BPV over longer periods are unknown. METHODS In a prospective cohort study, 1454 elderly participants (age 78.5±3.78years, 59% women) underwent structured interview for GAD and major depression. Participants performed home blood pressure monitoring (HBPM) over 3 consecutive days and underwent serial clinic BP measures on 4 separate follow-ups over an 8year period. Systolic and diastolic BPV was calculated using the coefficient of variation (CV) and standard deviation method. Generalized linear models assessed the association between GAD and depression with BPV over an 8year period. RESULTS GAD was associated with significantly increased systolic BPV over 8years in age, sex and mean systolic BP (β=0.25, SE=0.09; p=0.007) and fully adjusted models (β=0.23, SE=0.10; p=0.017). BPV from HBPM was strongly associated with 8year systolic BPV in age-sex (β=3.10, SE=0.82; p<0.001) and fully adjusted models (β=3.09, SE=0.84; p<0.001). The association between GAD and longer term BPV was consistent when analyzing morning and evening HBPM measures of BPV. There was no association between diastolic BPV over 8years with GAD or depression. CONCLUSIONS GAD but not depression was associated with increased systolic BPV over an 8year period controlling for HBPM. GAD has clinical relevance for control of systolic BPV in elderly participants.
Collapse
Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia.
| | - Christophe Tzourio
- Bordeaux Population Health, University of Bordeaux, France; INSERM, Neuroepidemiology, UMR897, F-33000 Bordeaux, France
| |
Collapse
|
14
|
Irigoyen MC, De Angelis K, Dos Santos F, Dartora DR, Rodrigues B, Consolim-Colombo FM. Hypertension, Blood Pressure Variability, and Target Organ Lesion. Curr Hypertens Rep 2016; 18:31. [PMID: 27002717 DOI: 10.1007/s11906-016-0642-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertensive patients have a higher risk of developing health complications, particularly cardiovascular (CV) events, than individuals with normal blood pressure (BP). Severity of complications depends on the magnitude of BP elevation and other CV risk factors associated with the target organ damage. Therefore, BP control and management of organ damage may contribute to reduce this risk. BP variability (BPV) has been considered a physiological marker of autonomic nervous system control and may be implicated in increased CV risk in hypertension. This review will present some evidence relating BPV and target organ damage in hypertension in clinical and experimental settings.
Collapse
Affiliation(s)
- Maria-Cláudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil.
| | - Kátia De Angelis
- Laboratory of Translational Physiology, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Fernando Dos Santos
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil
| | - Daniela R Dartora
- Instituto de Cardiologia do Rio Grande do Sul/ Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
| | - Bruno Rodrigues
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fernanda Marciano Consolim-Colombo
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil.,Laboratory of Translational Physiology, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| |
Collapse
|
15
|
Hsu PF, Cheng HM, Wu CH, Sung SH, Chuang SY, Lakatta EG, Yin FCP, Chou P, Chen CH. High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives. Am J Hypertens 2016; 29:806-13. [PMID: 26837643 DOI: 10.1093/ajh/hpw002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the long-term prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.
Collapse
Affiliation(s)
| | | | - Cheng-Hsueh Wu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Edward G Lakatta
- The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, Baltimore, Maryland, USA
| | - Frank C P Yin
- Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA
| | - Pesus Chou
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | | |
Collapse
|
16
|
Excessive variability in systolic blood pressure that is self-measured at home exacerbates the progression of brain white matter lesions and cognitive impairment in the oldest old. Hypertens Res 2015; 39:245-53. [PMID: 26631851 DOI: 10.1038/hr.2015.135] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/30/2015] [Accepted: 09/08/2015] [Indexed: 01/20/2023]
Abstract
To investigate the effects of variability in self-measured systolic blood pressure at home on the progression of cognitive impairment and white matter lesions in the oldest old. Between April 2009 and October 2009, 248 oldest old aged 80 years or older were eligibly enrolled from geriatric practices and community-dwelling areas of Shandong, China. Self-measured blood pressure at home (HBP) was measured for 7 consecutive days at the baseline, and the Mini-Mental State Examination (MMSE) score and brain white matter hyperintensities (WMH) were assessed at the baseline and during the final follow-up visit. Variability in systolic HBP was evaluated using coefficient of variation (CV) in serial daily systolic HBP measurements of the last 6 consecutive days. After an average of 2.3 years of follow-up visits, 232 oldest old were included in and 16 were excluded from the analysis. The MMSE score declined -4.76 (interquartile ranges: -10.71, -0.83) %, the periventricular WMH, deep WMH, total WMH and WMH fraction increased 16.46 (s.d.: 6.72)%, 10.05 (s.d.: 6.40)%, 14.69 (s.d.: 6.07)% and 15.95 (s.d.: 6.32)%, respectively, in the total oldest old. A declined percentage of the MMSE score and increased percentages of the periventricular WMH, deep WMH, total WMH and WMH fraction in the high group divided by tertile of the CV of the systolic HBP at baseline were greater than those in the low group (P<0.05). The significant differences were retained after adjusting for covariates, including the MMSE score, periventricular WMH, deep WMH and WMH fraction at the baseline (P<0.05). Excessive variability in self-measured systolic HBP exacerbates the progression of cognitive impairment and brain white matter lesions in the oldest old.
Collapse
|