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Chellappan A, Kansal K. Comparison of routine office blood pressure measurement versus standardized attended manually activated oscillometric office blood pressure measurement in patients with chronic kidney disease. J Family Med Prim Care 2024; 13:1894-1903. [PMID: 38948560 PMCID: PMC11213415 DOI: 10.4103/jfmpc.jfmpc_1619_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 07/02/2024] Open
Abstract
Context Erroneous blood pressure measurement could lead to improper treatment and hence progression of chronic kidney disease (CKD). In routine clinical practice, there is poor adherence to the various steps to be followed during blood pressure measurement. Automated oscillometric BP measurement is difficult to perform in routine clinical practice due to several practical limitations. Aims To evaluate the quality of blood pressure measurement and to compare routine office blood pressure measurement with standardized attended manually activated oscillometric blood pressure measurement in patients with CKD attending the nephrology outpatient department (OPD) of a tertiary care referral center. Settings and Design This cross-sectional study was conducted in patients aged more than 18 years with CKD stage 3-5ND, and previously diagnosed hypertension, in the nephrology OPD of a tertiary care referral center between July 2022 and September 2022. Methods and Material The quality of blood pressure measurement was evaluated using a questionnaire. The study participants had their blood pressure checked by both methods-routine office blood pressure and standardized attended manually activated oscillometric blood pressure. Results Standardized attended manually activated oscillometric blood pressure measurement yielded a significantly higher systolic blood pressure (SBP) compared to routine office blood pressure measurement (Mean SBP: 139.53 ± 29.1 vs 132.57 ± 23.59; P < 0.001). However, the diastolic blood pressure did not differ significantly between the two methods of measurement. Conclusions Standardized attended manually activated oscillometric BP measurement yields a higher systolic BP compared to routine office BP measurement. Further studies are required to compare the standardized attended oscillometric BP measurement used in this study with unattended automated oscillometric BP measurement and ambulatory BP measurement.
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Affiliation(s)
- Anand Chellappan
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India
| | - Keshiha Kansal
- Final Year Undergraduate Student, All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India
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2
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Desbiens LC, Nadeau-Fredette AC, Madore F, Agharazii M, Goupil R. Impact of Successive Office Blood Pressure Measurements During a Single Visit on Cardiovascular Risk Prediction: Analysis of CARTaGENE. Hypertension 2023; 80:2209-2217. [PMID: 37615094 DOI: 10.1161/hypertensionaha.123.21510] [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: 05/12/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Multiple office blood pressure (BP) readings correlate more closely with ambulatory BP than single readings. Whether they are associated with long-term outcomes and improve cardiovascular risk prediction is unknown. Our objective was to assess the long-term impact of multiple office BP readings. METHODS We used data from CARTaGENE, a population-based survey comprising individuals aged 40 to 70 years. Three BP readings (BP1, BP2, and BP3) at 2-minute intervals were obtained using a semiautomated device. They were averaged to generate BP1-2, BP2-3, and BP1-2-3 for systolic BP (SBP) and diastolic BP. Cardiovascular events (major adverse cardiovascular event [MACE]: cardiovascular death, stroke, and myocardial infarction) during a 10-year follow-up were recorded. Associations with MACE were obtained using adjusted Cox models. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores and their associated C statistics. RESULTS In the 17 966 eligible individuals, 2378 experienced a MACE during follow-up. Crude SBP values ranged from 122.5 to 126.5 mm Hg. SBP3 had the strongest association with MACE incidence (hazard ratio, 1.10 [1.05-1.15] per SD) and SBP1 the weakest (hazard ratio, 1.06 [1.01-1.10]). All models including SBP1 (SBP1, SBP1-2, and SBP1-2-3) were underperformed. At a given SBP value, the excess MACE risk conferred by SBP3 was 2× greater than SBP1. In atherosclerotic cardiovascular disease scores, SBP3 yielded the highest C statistic, significantly higher than most other SBP measures. In contrast to SBP, all diastolic BP readings yielded similar results. CONCLUSIONS Cardiovascular risk prediction is improved by successive office SBP values, especially when the first reading is discarded. These findings reinforce the necessity of using multiple office BP readings.
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Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital Maisonneuve-Rosemont, Montreal, Canada (L.-C.D., A.-C.N.-F.)
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital Maisonneuve-Rosemont, Montreal, Canada (L.-C.D., A.-C.N.-F.)
| | - François Madore
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital du Sacré-Coeur de Montréal Research Center, Canada (F.M., R.G.)
| | - Mohsen Agharazii
- Department of Medicine, Université Laval, Quebec City, Canada (M.A.)
- CHU de Quebec - Université Laval, Quebec City, Canada (M.A.)
| | - Rémi Goupil
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital du Sacré-Coeur de Montréal Research Center, Canada (F.M., R.G.)
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Alansare AB, Paley JL, Quinn TD, Gibbs BB. Paradoxical Associations of Occupational and Nonoccupational Sedentary Behavior With Cardiovascular Disease Risk Measures in Desk Workers. J Occup Environ Med 2023; 65:e506-e513. [PMID: 37130827 PMCID: PMC10330357 DOI: 10.1097/jom.0000000000002873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES We assessed sedentary behavior (SB) patterns and examined its associations, by domain, with cardiovascular disease (CVD) risk measures in desk workers ( N = 273). METHODS Sedentary behavior was measured by activPAL3 and partitioned into occupational and nonoccupational SB. Cardiovascular disease risk measures included blood pressure, pulse wave velocity, heart rate, and heart rate variability. Paired t tests evaluated patterns of SB across domains. Linear regressions estimated associations of occupational and nonoccupational SB with CVD risk measures. RESULTS Participants spent 69% of their time in SB; higher proportions were accumulated during occupational versus nonoccupational time. Higher all-domain SB was only associated with higher pulse wave velocity. Paradoxically, greater nonoccupational SB unfavorably associated with CVD risk measures, while higher occupational SB favorably correlated to CVD risk measures. CONCLUSIONS Observed paradoxical associations suggest that domain should be considered in efforts to improve cardiovascular health by reducing SB.
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Affiliation(s)
- Abdullah B Alansare
- From the Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia (A.B.A.); Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, Pennsylvania (J.L.P.); and Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia (T.D.Q., B.B.G.)
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Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial. Int J Dent 2023; 2023:5922663. [PMID: 36969376 PMCID: PMC10038732 DOI: 10.1155/2023/5922663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
Background. The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. Methods. In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20–60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov–Smirnov test, Mann–Whitney U test, independent T-test, and Fisher’s exact χ2 test were performed for statistical analysis (α = 0.05). Results. This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Conclusion. Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients’ vital signs significantly. This trial is registered with IRCT20220106053646N1.
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Shaw BS, Lloyd R, Da Silva M, Coetzee D, Moran J, Waterworth SPW, Mathunjwa ML, Shaw I. German volume training for health promotion: Acute vasopressor, pulmonary and metabolic responses. Front Physiol 2022; 13:1025017. [PMID: 36601344 PMCID: PMC9806216 DOI: 10.3389/fphys.2022.1025017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Resistance training (RT) is increasingly recommended for incorporation into comprehensive fitness or "exercise as medicine" programs. However, the acute effects of RT, and especially its different sub-types, and how they impact health outcomes are not fully investigated. This study evaluated German Volume Training (GVT) ("10 set × 10 rep scheme") for its efficacy for its use in health settings. This study utilized a randomized crossover design with subjects serving as their own controls to establish baseline values. Subjects were blinded to the study hypothesis. Subjects performed a single session of GVT or no exercise, in a randomised order separated by a 1-week washout period. Outcomes were assessed before and immediately post-exercise. GVT significantly (p < 0.05) decreased systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP), but increased heart rate (HR), rate pressure product (RPP) and rating of perceived exertion (RPE). No changes were found in the measured spirometry parameters. Increases were observed in carbon dioxide production (VCO2) and minute ventilation (VE), but not respiratory exchange ratio. Post hoc analysis demonstrated that post-GVT values were significantly lower for SBP (p = 0.017; d = 1.00), DBP (p = 0.013; d = 0.90), MAP (p = 0.024; d = 1.06), and VCO2 (p = 0.009; d = -1.32), and significantly higher for RPP (p = 0.001; d = -3.11), RPE (p = 0.001; d = -14.14), and HR (p = 0.001; d = -3.00). This study indicates that acute GVT promotes post-exercise hypotension and is of sufficient intensity to increase both objective HR and subjective RPE intensities appropriately for use in a variety of health promotion settings.
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Affiliation(s)
- Brandon S. Shaw
- Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Rohan Lloyd
- Department of Sport and Movement Studies, University of Johannesburg, Johannesburg, South Africa
| | - Monica Da Silva
- Department of Sport and Movement Studies, University of Johannesburg, Johannesburg, South Africa
| | - Donne Coetzee
- Department of Sport and Movement Studies, University of Johannesburg, Johannesburg, South Africa
| | - Jason Moran
- Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Sally P. W. Waterworth
- Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Musa L. Mathunjwa
- Department of Human Movement Science, University of Zululand, Kwadlangezwa, South Africa
| | - Ina Shaw
- Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom,*Correspondence: Ina Shaw,
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Alansare AB, Stoner L, Aljuhani OE, Gibbs BB. Utility of Estimated Pulse Wave Velocity for Tracking the Arterial Response to Prolonged Sitting. J Cardiovasc Dev Dis 2022; 9:411. [PMID: 36547408 PMCID: PMC9785284 DOI: 10.3390/jcdd9120411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Arterial stiffness, measured by pulse wave velocity (PWV), is a purported mechanism linking sedentary behavior to cardiovascular disease. This secondary analysis compared associations between measured carotid−femoral PWV (cfPWV) and carotid−radial (crPWV) responses to an acute bout of prolonged sitting with mathematically estimated cfPWV (ePWV). Methods: Overweight/obese adults with elevated blood pressure were enrolled (n = 25; 42 ± 12 yrs; 64% males). Participants performed an 8 h simulated workday of mostly sitting. cfPWV and crPWV were measured while supine in the morning, midday, and afternoon. ePWV was calculated at the same timepoints using age and seated mean arterial pressure (MAP). Pearson correlation coefficients associated ePWV with cfPWV and crPWV. Generalized linear models separately examined the effects of time on cfPWV, crPWV, and ePWV. Results: ePWV significantly associated with cfPWV and crPWV (r = 0.69 and 0.55, respectively; p < 0.05) in the morning (baseline). cfPWV significantly increased over time (β = 0.52 ± 0.20 and 0.48 ± 0.21 with and without MAP adjustment, respectively; p < 0.05). In contrast, ePWV and crPWV did not significantly increase overtime (β = 0.14 ± 0.09 and 0.25 ± 0.23, respectively; p > 0.05). Conclusions: Our results suggest that, although ePWV is associated with cfPWV and crPWV at a fixed timepoint, ePWV responds differently to prolonged sitting and likely does not capture the same acute vascular responses.
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Affiliation(s)
- Abdullah Bandar Alansare
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, King Khalid Rd, Riyadh 80200, Saudi Arabia
| | - Lee Stoner
- Department of Sport and Exercise, University of North Carolina, Chapel Hill, NC 27599, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Osama Eid Aljuhani
- Department of Physical Education, College of Sport Sciences and Physical Activity, King Saud University, King Khalid Rd, Riyadh 80200, Saudi Arabia
| | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
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Liu J, Li Y, Li J, Zheng D, Liu C. Sources of automatic office blood pressure measurement error: a systematic review. Physiol Meas 2022; 43. [PMID: 35952651 DOI: 10.1088/1361-6579/ac890e] [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: 01/21/2022] [Accepted: 08/11/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Accurate and reliable blood pressure (BP) measurement is important for the prevention and treatment of hypertension. The oscillometric-based automatic office blood pressure measurement (AOBPM) is widely used in hospitals and clinics, but measurement errors are common in BP measurements. There is a lack of systematic review of the sources of measurement errors. APPROACH A systematic review of all existing research on sources of AOBPM errors. A search strategy was designed in six online databases, and all the literature published before October 2021 was selected. Those studies that used the AOBPM device to measure BP from the upper arm of subjects were included. MAIN RESULTS A total of 1365 studies were screened, and 224 studies were included in this final review. They investigated 22 common error sources with clinical AOBPM. Regarding the causes of BP errors, this review divided them into the following categories: the activities before measurement, patient's factors, measurement environment, measurement procedure, and device settings. 13 sources caused increased systolic and diastolic BP (SBP and DBP), 2 sources caused the decrease in SBP and DBP, only 1 source had no significant effect on BPs, and the other errors had a non-uniform effect (either increase or decrease in BPs). The error ranges for SBP and DBP were -14 to 33 mmHg and -6 to 19 mmHg, respectively. SIGNIFICANCE The measurement accuracy of AOBPM is susceptible to the influence of measurement factors. Interpreting BP readings need to be treated with caution in clinical measurements. This review made comprehensive evidence for the need for standardized BP measurements and provided guidance for clinical practitioners when measuring BP with AOBPM devices.
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Affiliation(s)
- Jian Liu
- School of Instrument Science and Engineering, Southeast University, Sipailou 2, Nanjing, Jiangsu, 210096, CHINA
| | - Yumin Li
- School of Instrument Science and Engineering, Southeast University, Sipailou 2, Nanjing, Jiangsu, 210096, CHINA
| | - Jianqing Li
- School of Instrument Science and Engineering, Southeast University, Sipailou road2, Nanjing, Jiangsu, 210096, CHINA
| | - Dingchang Zheng
- Research Centre of Intelligent Healthcare, Coventry University, West Midlands, Coventry, CV1 5FB, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Sipailou 2, Nanjing, Jiangsu, 210096, CHINA
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Stanford DM, Chatlaong MA, Miller WM, Grant Mouser J, Dankel SJ, Jessee MB. A comparison of variability between absolute and relative blood flow restriction pressures. Clin Physiol Funct Imaging 2022; 42:278-285. [PMID: 35396926 DOI: 10.1111/cpf.12757] [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: 12/16/2021] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
Recommendations are that blood flow restriction (BFR) be applied relative to arterial occlusion pressure (AOP) to provide a similar stimulus. PURPOSE Compare variability of the change in blood flow, shear rate, and discomfort between recommended relative pressures and an absolute pressure. METHODS During one visit, brachial arterial blood flow was measured in 91 participants using pulse-wave Doppler ultrasonography. After 5-min seated rest, AOP was measured. Following another 5-min rest, blood flow and discomfort were assessed twice before cuff inflation as controls (C1 and C2), then again with a cuff inflated to each BFR pressure (all measures separated by 1-min). Change scores from C1 to all subsequent measures were calculated (i.e., C2-C1; 40%AOP-C1; 80%AOP-C1; 100mmHg-C1). Variability of the changes were compared via pairwise modified Pitman-Morgan tests (α=.008). RESULTS Variance (95%CI) of the change for blood flow (mL/min), shear rate (1/sec), and discomfort (AU) had similar trends. C2-C1 differed from all conditions (all p<.001), 40%AOP-C1 differed from 80%AOP-C1 and 100mmHg-C1 (all p<.001), which did not differ (both p≥.117). Blood flow: C2-C1=469.79 (357.90, 644.07), 40%AOP-C1=1263.18 (962.34, 1731.80), 80%AOP-C1=1752.90 (1335.42, 2403.18), 100mmHg-C1=1603.18 (1221.36, 2197.92); Shear rate: C2-C1=6248.24 (4760.10, 8566.15), 40%AOP-C1=14625.30 (11142.06, 20050.95), 80%AOP-C1=22064.02 (16809.13, 30249.27), 100mmHg-C1=20778.76 (15829.98, 28487.21); Discomfort: C2-C1=0.07 (0.05, 0.08), 40%AOP-C1=2.03 (1.55, 2.78), 80%AOP-C1=4.26 (3.25, 5.84), 100mmHg-C1=4.50 (3.43, 6.17). CONCLUSION Contrary to previous suggestions, applying relative pressures does not necessarily guarantee a similar stimulus. It seems that higher pressures produce more variable changes even if the external pressure applied is made relative to each individual. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daphney M Stanford
- Applied Human Health and Physical Function Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, Mississippi, USA
| | - Matthew A Chatlaong
- Applied Human Health and Physical Function Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, Mississippi, USA
| | - William M Miller
- Applied Human Health and Physical Function Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, Mississippi, USA
| | - J Grant Mouser
- Applied Physiology Laboratory, Department of Kinesiology and Health Promotion, Troy University, Troy, AL, USA
| | - Scott J Dankel
- Exercise Physiology Laboratory, Department of Health and Exercise Science, Rowan University, Glassboro, NJ, USA
| | - Matthew B Jessee
- Applied Human Health and Physical Function Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, Mississippi, USA
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Lin MS, Lin HS, Chang ML, Tsai MH, Hsieh YY, Lin YS, Tsai MS, Yang CL, Chen MY. Alanine aminotransferase to aspartate aminotransferase ratio and hepatitis B virus on metabolic syndrome: a community-based study. Front Endocrinol (Lausanne) 2022; 13:922312. [PMID: 35966065 PMCID: PMC9372398 DOI: 10.3389/fendo.2022.922312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The serum aminotransferase elevation in metabolic syndrome (MetS) reflected hepatosteatosis, but there is a conflict with the coexistence of viral hepatitis, especially for the hepatitis B virus (HBV). Thus, this study aimed to investigate the relationship between the alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio, MetS, and HBV infection in a rural Taiwanese population. METHODS We conducted a cross-sectional analysis in southern Taiwan between March and December 2019. Multivariable logistic regression analyses adjusted for demographics, education, dietary behaviors, irregular exercise, substance use, and viral markers were performed to investigate the association between the ALT/AST ratio and MetS. RESULTS Altogether, 2,416 participants (891 men and 1,525 women; mean age, 64.1 ± 14.9 years) were enrolled. Of the participants, 22.7% (n = 519) were seropositive for viral hepatitis. In the multivariable analysis, age [odds ratio (OR) 1.02, 95% CI 1.01-1.03, p < 0.001], ALT/AST ratio >1 (OR 2.63, 95% CI 2.15-3.21, p < 0.001), education (OR 0.96, 95% CI 0.94-0.98, p < 0.001), and HBV seropositivity (OR 0.70, 95% CI 0.52-0.95, p = 0.021) were associated with the risk of MetS. The area under the curve of the ALT/AST ratio was 0.62 (95% CI 0.60-0.64, p < 0.001), and the cutoff value was >0.852 for the Youden index. CONCLUSION An ALT/AST ratio >1 could be a simple index for MetS prediction during community checkups. In contrast to age and betel nut chewing, HBV seropositivity and higher education might be inversely associated with MetS. Aggressive health promotion for MetS prevention has emerged as essential in participants without HBV and with lower education levels. Further large-scale, longitudinal studies are needed to unlink these correlations.
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Affiliation(s)
- Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Huang-Shen Lin
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Ling Chang
- Department of Infection, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Horng Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Yung-Yu Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Shu Tsai
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Ling Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mei-Yen Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Mei-Yen Chen,
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Brady TM, Charleston J, Ishigami J, Miller ER, Matsushita K, Appel LJ. Effects of Different Rest Period Durations Prior to Blood Pressure Measurement: The Best Rest Trial. Hypertension 2021; 78:1511-1519. [PMID: 34601959 DOI: 10.1161/hypertensionaha.121.17496] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.)
| | - Jeanne Charleston
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Junichi Ishigami
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Edgar R Miller
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.).,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Kunihiro Matsushita
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.).,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
| | - Lawrence J Appel
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., E.R.M., K.M., L.J.A.).,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (J.C., J.I., E.R.M., K.M., L.J.A.)
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11
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Hiremath S, Ramsay T, Ruzicka M. Blood pressure measurement: Should technique define targets? J Clin Hypertens (Greenwich) 2021; 23:1538-1546. [PMID: 34268883 PMCID: PMC8678755 DOI: 10.1111/jch.14324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
Accurate assessment of blood pressure (BP) is the cornerstone of hypertension management. The objectives of this study were to quantify the effect of medical personnel presence during BP measurement by automated oscillometric BP (AOBP) and to compare resting office BP by AOBP to daytime average BP by 24‐h ambulatory BP monitoring (ABPM). This study is a prospective randomized cross‐over trial, conducted in a referral population. Patients underwent measurements of casual and resting office BP by AOBP. Resting BP was measured as either unattended (patient alone in the room during resting and measurements) or as partially attended (nurse present in the room during measurements) immediately prior to and after 24‐h ABPM. The primary outcome was the effect of unattended 5‐min rest preceding AOBP assessment as the difference between casual and resting BP measured by the Omron HEM 907XL. Ninety patients consented and 78 completed the study. The mean difference between the casual and Omron unattended systolic BP was 7.0 mm Hg (95% confidence interval [CI] 4.5, 9.5). There was no significant difference between partially attended and unattended resting office systolic BP. Resting office BP (attended and partially attended) underestimated daytime systolic BP load from 24‐h ABPM. The presence or absence of medical personnel does not impact casual office BP which is higher than resting office AOBP. The requirement for unattended rest may be dropped if logistically challenging. Casual and resting office BP readings by AOBP do not capture the complexity of information provided by the 24‐h ABPM.
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Affiliation(s)
- Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Kidney Research Center, University of Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcel Ruzicka
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Kidney Research Center, University of Ottawa, Ontario, Canada
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12
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Barone Gibbs B, Conroy MB, Huber K, Muldoon MF, Perera S, Jakicic JM. Effect of Reducing Sedentary Behavior on Blood Pressure (RESET BP): Rationale, design, and methods. Contemp Clin Trials 2021; 106:106428. [PMID: 33971295 PMCID: PMC8222181 DOI: 10.1016/j.cct.2021.106428] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
Sedentary behavior (SB) has recently been recognized as a strong risk factor for cardiovascular disease, with new guidelines encouraging adults to 'sit less, move more.' Yet, there are few randomized trials demonstrating that reducing SB improves cardiovascular health. The Effect of Reducing Sedentary Behavior on Blood Pressure (RESET BP) randomized clinical trial addresses this gap by testing the effect of a 3-month SB reduction intervention on resting systolic BP. Secondary outcomes include other BP measures, pulse wave velocity, plasma renin activity and aldosterone, and objectively-measured SB (via thigh-mounted activPAL) and physical activity (via waist-worn GT3X accelerometer). RESET BP has a targeted recruitment of 300 adults with desk jobs, along with elevated, non-medicated BP (systolic BP 120-159 mmHg or diastolic BP 80-99 mmHg) and physical inactivity (self-reported aerobic physical activity below recommended levels). The multi-component intervention promotes 2-4 fewer hours of SB per day by replacing sitting with standing and light-intensity movement breaks. Participants assigned to the intervention condition receive a sit-stand desk attachment, a wrist-worn activity prompter, behavioral counseling every two weeks (alternating in-person and phone), and twice-weekly automated text messages. Herein, we review the study rationale, describe and evaluate recruitment strategies based on enrollment to date, and detail the intervention and assessment protocols. We also document our mid-trial adaptations to participant recruitment, intervention deployment, and outcome assessments due to the intervening COVID-19 pandemic. Our research methods, experiences to date, and COVID-specific accommodations could inform other research studying BP and hypertension or targeting working populations, including those seeking remote methods.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Molly B Conroy
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Kimberly Huber
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Matthew F Muldoon
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Subashan Perera
- Departments of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - John M Jakicic
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States of America
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Silveira-Rodrigues JG, Pires W, Gomes PF, Ogando PHM, Melo BP, Aleixo IMS, Soares DD. Combined exercise training improves specific domains of cognitive functions and metabolic markers in middle-aged and older adults with type 2 diabetes mellitus. Diabetes Res Clin Pract 2021; 173:108700. [PMID: 33600868 DOI: 10.1016/j.diabres.2021.108700] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
AIM To investigate the effects of 8-weeks of CT on specific domains of cognitive function, metabolic and cardiovascular parameters of subjects with Type 2 Diabetes Mellitus (T2DM). METHODS 31 sedentary T2DM adults and older divided into CT (3x/week, during 8-week, n = 16) or Control group (CONT, n = 15). Before and after the intervention, a cognitive task battery, blood samples, and functional tests were assessed. RESULTS CT improved inhibitory control (d = 0.89), working memory (d = 0.88), cognitive flexibility (d = 0.67) and attention/concentration (d = 0.64) in T2DM subjects. However, memory, verbal fluency, and processing speed (d < 0.1, p > 0.05 for all) were not changed. The CT-induced improvements on global cognitive z-score (r = -0.51; p < 0.001) were inversely correlated to cognitive screening scores. Moreover, CT improved functional performance (p < 0.05) and reduced insulin levels (p = 0.04). Although there was no statistical significance, there were a clinically relevant reduction of peripheral insulin sensitivity (d = 0.51, p = 0.09), resistin levels (d = 0.53, p = 0.08), diastolic (d = 0.63, p = 0.09) and mean blood pressure (d = 0.50, p = 0.09). Conversely, no changes were observed for glucose, fructosamine and blood lipids (d < 0.2 for all). CONCLUSION CT partially reversed the negative effects of T2DM on specific cognitive domains possibly by amelioration of metabolic regulation. Moreover, lower cognitive scores may modulate the responsivity of cognitive function to CT.
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Affiliation(s)
- João Gabriel Silveira-Rodrigues
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 Belo Horizonte, MG 31270-901, Brazil.
| | - Washington Pires
- Sports Center of Federal University of Ouro Preto, St. Two, MG 35400-000, Brazil
| | - Patrícia Ferreira Gomes
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 Belo Horizonte, MG 31270-901, Brazil
| | - Pedro Henrique Madureira Ogando
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 Belo Horizonte, MG 31270-901, Brazil
| | - Bruno Pereira Melo
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 Belo Horizonte, MG 31270-901, Brazil
| | - Ivana Montandon Soares Aleixo
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 Belo Horizonte, MG 31270-901, Brazil
| | - Danusa Dias Soares
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 Belo Horizonte, MG 31270-901, Brazil
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Associations between various attended automated office blood pressure estimations and all-cause and cardiovascular mortality: Minhang study. J Hypertens 2020; 38:1072-1079. [DOI: 10.1097/hjh.0000000000002384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Diederichs C, Neuhauser H. The frequency and determinants of blood pressure measurement by a health professional in Germany: A cross-sectional study. Medicine (Baltimore) 2019; 98:e15093. [PMID: 31008932 PMCID: PMC6494385 DOI: 10.1097/md.0000000000015093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022] Open
Abstract
Strong evidence exists for the benefits of screening for hypertension to reduce the risk of cardiovascular disease and death. The aim of this study was to analyze the frequency and determinants of blood pressure (BP) measurement by a health professional in the general population and in individuals without hypertension in Germany.Data from 17,431 participants 15+ years from the cross-sectional GEDA2014/2015-EHIS survey were used to calculate the percentage of the population who had no BP measurement within the last year and the last 3 years. In multivariate models, the determinants of no BP measurement were analyzed. The frequency of BP measurement was compared between 30 European countries.In Germany, 27.5% of men and 16.6% of women had no BP measurement by a health professional within the last year and 10.9%, respectively 5.4% not within the last 3 years. In individuals without known hypertension, 34.1% of men and 23.6% of women aged 15 to 19 years had no BP measurement in the last 3 years compared to 5.2% of men and 4.8% of women 70+ years. Independent predictors of not receiving a BP measurement in the last 3 years besides age were male sex, good self-rated health, low health awareness, and no medical consultations but not educational level. Germany has low proportions of no BP measurement compared to other European countries.Hypertension screening needs improvement in all age groups, especially in the young who have the lowest screening proportions but also in the elderly who have the highest hypertension risk.
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Affiliation(s)
- Claudia Diederichs
- Robert Koch Institute, Department of Epidemiology and Health Monitoring
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Hannelore Neuhauser
- Robert Koch Institute, Department of Epidemiology and Health Monitoring
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
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Sharma VK, Savitha S, Vinod KV, Rajappa M, Subramanian SK, Rajendran R. Assessment of autonomic functions and its association with telomerase level, oxidative stress and inflammation in complete glycemic spectrum- an exploratory study. Diabetes Metab Syndr 2019; 13:1193-1199. [PMID: 31336464 DOI: 10.1016/j.dsx.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS In the present study we intended to study autonomic functions and its association with telomerase level, oxidative stress and inflammation in complete glycemic spectrum. MATERIALS AND METHODS Age, gender and BMI matched 28 subjects in the age group of 25-50 years were recruited across complete glycemic spectrum as follows: 1) Normoglycemics (controls) 2) Prediabetics and 3) Frank diabetics. We assessed heart rate variability, cardiac autonomic function, lipid profile, adiponectin, malondialdehyde and telomerase level. RESULTS Time domain parameters and frequency domain parameters were significantly lower, and LFnu and LF/HF ratio were significantly higher in prediabetes and diabetes than control. Serum Adiponectin and HDL levels were significantly lower in diabetes than prediabetes and control, and prediabetes had significantly lower HDL than controls. Other lipid profile parameters (TC, TG, VLDL, LDL, non-HDL & derived lipid parameters were significantly higher in diabetes than prediabetes and control and prediabetes had significantly higher values than controls. MDA levels were significantly higher and TAS was significantly lower in diabetics than prediabetics and control group. Telomerase level was significantly higher in diabetes as compared to prediabetes and control. Telomerase had significantly negative correlation with SDNN, HF, TP, HDL and adiponectin, and significant positive correlation with MDA, fasting insulin, HOMA IR, TC, and AIP. CONCLUSION Oxidative damage, inflammation and autonomic dysregulation may be involved in Telomere/Telomerase dysregulation in diabetes and telomerase levels can be used as a cardio-metabolic marker of diabetes.
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Affiliation(s)
- Vivek Kumar Sharma
- Department of physiology, Government Institute of Medical Sciences, Greater Noida, Gautam Buddha University, U.P, 201310, India.
| | - S Savitha
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Kolar Viswanath Vinod
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | | | - Rajathi Rajendran
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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17
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Restorative effects of urban green environments and the role of urban-nature orientedness and noise sensitivity: A field experiment. Health Place 2019; 55:59-70. [DOI: 10.1016/j.healthplace.2018.11.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 11/17/2022]
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18
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Sharma VK, Nandeesha H, Vinod KV, Subramanian SK, Sankar DS, Rajendran R. Comparison of anthropometric, cardiovascular, autonomic, baroreflex sensitivity, aerobic fitness, inflammatory markers and oxidative stress parameters between first degree relatives of diabetes and controls. Diabetes Metab Syndr 2019; 13:652-658. [PMID: 30641784 DOI: 10.1016/j.dsx.2018.11.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 01/22/2023]
Abstract
AIM We aimed at assessing cardiovascular risk of first degree relatives of diabetes (FDRD). METHODS A cross sectional study involving 90 apparently healthy normoglycemic volunteers aged between 15 and 50 years (45 FDRD and 45 FDRs of non-diabetics). We measured anthropometric parameters, baroreflex sensitivity, heart rate variability, cardiac autonomic function tests, and aerobic capacity, fasting blood glucose and insulin, lipid profile, inflammatory markers, nitric oxide and oxidative stress markers. RESULTS FDRD had significantly higher hip circumference and BF%. Blood pressure, total peripheral resistance and cardiac output were comparable. FDRD had higher HR and rate pressure product. There were no significant differences in cardio-respiratory fitness (VO2max) and physical activity level. Time and Frequency domain parameters were comparable except for reduced NN50 and total power. Baroreflex sensitivity, 30:15 ratio and E: I ratio were significantly less in FDRD. Fasting glucose was comparable. Fasting Insulin, HOMA IR, HOMA %B and HOMA AD were higher while HOMA %S and QUICKI index were lower in FDRD. Lipid profile or lipid derived parameters were comparable except for higher non-HDLc in FDRD. Adiponectin was lower while Leptin and Leptin/apidonectin ratio was higher in FDRD. IL-6, hsCRP, TNF- alpha and MDA were significantly higher in FDRD, while TAS and nitric oxide were significantly lower in FDRD. CONCLUSION Higher body fat percentage, with insulin resistance, deranged cardiac autonomic function, higher oxidative stress and inflammation, lower adiponectin and nitric oxide levels places FDRD at higher cardiovascular risk and necessitates early lifestyle modification/intervention.
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Affiliation(s)
- Vivek Kumar Sharma
- Department of Physiology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India.
| | - Hanumanthappa Nandeesha
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Kolar Vishwanath Vinod
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Senthil Kumar Subramanian
- Department of Physiology, All India Institute of Medical Sciences, Mangalagiri, Andhara Pradesh, India.
| | | | - Rajathi Rajendran
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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Impact of variations in blood pressure with orthostatism on mortality: the HOMO study. Blood Press Monit 2018; 22:184-190. [PMID: 28263203 DOI: 10.1097/mbp.0000000000000251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the impact of orthostatic hypotension (OH) and orthostatic hypertension (OHT) on all-cause mortality. PATIENTS AND METHODS A total of, 1176 adults from the community over 18 years of age were included in this ambispective study. The mean follow-up was 9.4 years. OH and OHT were defined as a decrease or an increase, respectively, in systolic blood pressure (BP) of at least 20 mmHg and/or diastolic BP of at least 10 mmHg from sitting to standing position at 1 and/or 3 min after standing. The impact of systolic or diastolic OH and systolic or diastolic OHT at 1 and 3 min after standing was also analyzed separately. RESULTS In total, 135 individuals died during the follow-up. Neither OH [hazard ratio (HR) 1.23; 95% confidence interval (CI): 0.72-2.10] nor OHT (HR 0.90; 95% CI: 0.59-1.38) was associated with all-cause mortality in the adjusted models. In contrast, systolic OHT at 3 min (HR 2.31; 95% CI: 1.14-4.68) was independently associated with global mortality. CONCLUSION Systolic OHT at 3 min is associated with all-cause mortality. The determination of this parameter could add valuable prognostic information during the routine examination of patients.
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20
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Moore MN, Schultz MG, Nelson MR, Black JA, Dwyer NB, Hoban E, Jose MD, Kosmala W, Przewlocka-Kosmala M, Zachwyc J, Otahal P, Picone DS, Roberts-Thomson P, Veloudi P, Sharman JE. Identification of the Optimal Protocol for Automated Office Blood Pressure Measurement Among Patients With Treated Hypertension. Am J Hypertens 2018; 31:299-304. [PMID: 29126128 DOI: 10.1093/ajh/hpx180] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/15/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Automated office blood pressure (AOBP) involving repeated, unobserved blood pressure (BP) readings during one clinic visit is recommended for in-office diagnosis and assessment of hypertension. However, the optimal AOBP protocol to determine BP control in the least amount of time with the fewest BP readings is yet to be determined and was the aim of this study. METHODS One hundred and eighty-nine patients (mean age 62.8 ± 12.1 years; 50.3% female) with treated hypertension referred to specialist clinics at 2 sites underwent AOBP in a quiet room alone. Eight BP measurements were taken starting immediately after sitting and then at 2-minute intervals (15 minutes total). The optimal AOBP protocol was defined by the smallest mean difference and highest intraclass correlation coefficient (ICC) compared with daytime ambulatory BP (ABP). The same BP device (Mobil-o-graph, IEM) was used for both AOBP and daytime ABP. RESULTS Average 15-minute AOBP and daytime ABP were 134 ± 22/82 ± 13 and 137 ± 17/83 ± 11 mm Hg, respectively. The optimal AOBP protocol was derived within a total duration of 6 minutes from the average of 2 measures started after 2 and 4 minutes of seated rest (systolic BP: mean difference (95% confidence interval) 0.004(-2.21, 2.21) mm Hg, P = 1.0; ICC = 0.81; diastolic BP: mean difference 0.37(-0.90, 1.63) mm Hg, P = 0.57; ICC = 0.86). AOBP measures taken after 8 minutes tended to underestimate daytime ABP (whether as a single BP or the average of more than 1 BP reading). CONCLUSIONS Only 2 AOBP readings taken over 6 minutes (excluding an initial reading immediately after sitting) may be needed to be comparable with daytime ABP.
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Affiliation(s)
- Myles N Moore
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Nathan B Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Ella Hoban
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Matthew D Jose
- Menzies Institute for Medical Research, University of Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Wojciech Kosmala
- Menzies Institute for Medical Research, University of Tasmania, Australia
- Wroclaw Medical University, Wrocław, Poland
| | - Monika Przewlocka-Kosmala
- Menzies Institute for Medical Research, University of Tasmania, Australia
- Wroclaw Medical University, Wrocław, Poland
| | | | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Philip Roberts-Thomson
- Menzies Institute for Medical Research, University of Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Panagiota Veloudi
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Australia
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Abstract
PURPOSE OF REVIEW The appropriate treatment targets for individuals with elevated blood pressure (BP) have received increased attention in light of recent clinical trial results. However, it is well known that the method used to measure BP can have a significant impact on the observed BP. In this review, we summarize the existing literature on the impact of BP measurement technique on observed BP readings. RECENT FINDINGS Manual BPs obtained in-clinic routinely differ from those obtained using automated devices. Further, clinic-based readings (either manual or automated) typically correlate poorly with readings from ambulatory BP monitoring or home-based devices. However, few studies utilize randomization or sound experimental design to explore differences in BP readings by method or technique. While numerous studies report differences in BP by method, most lack statistical rigor and therefore provide limited insight into the true effect of technique on BP measurements.
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Quer G, Nikzad N, Chieh A, Normand A, Vegreville M, Topol EJ, Steinhubl SR. Home Monitoring of Blood Pressure: Short-Term Changes During Serial Measurements for 56398 Subjects. IEEE J Biomed Health Inform 2017; 22:1691-1698. [PMID: 29989995 DOI: 10.1109/jbhi.2017.2776946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hypertension is one of the greatest contributors to premature morbidity and mortality worldwide. It has been demonstrated that lowering blood pressure (BP) by just a few mmHg can bring substantial clinical benefits, reducing the risk of stroke and ischemic heart disease. Properly managing high BP is one of the most pressing global health issues, but accurate methods to continuously monitoring BP at home are still under discussion. Indeed, the BP for any given individual can fluctuate significantly during intervals as short as a few minutes. In clinical settings, the guidelines suggest to wait for 5 or 10 minutes in seated rest before taking the measure, in order to alleviate the effect of the stress induced by the clinical environment. Alternatively, BP measured in the home environment is thought to provide a more accurate measure free of the stress of a clinical environment, but there is currently a lack of extensive studies on the trajectory of serial BP measurements over minutes in the home setting. In this paper, we aim at filling this gap by analyzing a large dataset of more than 16 million BP measurements taken at home with commercial BP monitoring devices. In particular, we propose new techniques to analyze this dataset, taking into account the limitations due to the uncontrolled data collection, and we study the characteristics of the BP trajectory for consecutive measures over several minutes. We show that the BP values significantly decrease after 10 minutes minutes from the initial measurement (4.1 and 6.6 mmHg for the diastolic and systolic BP, respectively), and continue to decrease for about 25 minutes. We also describe statistically the clinical relevance of this change, observing more than 50% misclassifications for measurements in the hypertension region. We then propose a model to study the inter-subject variability, showing significant variations in the expected decrease in systolic BP. These results may provide the initial evidence for future large clinical studies using participant-monitored BP.
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Targeted LOWering of Central Blood Pressure in patients with hypertension: Baseline recruitment, rationale and design of a randomized controlled trial (The LOW CBP study). Contemp Clin Trials 2017; 62:37-42. [DOI: 10.1016/j.cct.2017.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022]
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A minimal resting time of 25 min is needed before measuring stabilized blood pressure in subjects addressed for vascular investigations. Sci Rep 2017; 7:12893. [PMID: 29018246 PMCID: PMC5635024 DOI: 10.1038/s41598-017-12775-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/15/2017] [Indexed: 02/07/2023] Open
Abstract
Blood pressure (BP) measurement is a central element in clinical practice. According to international recommendations 3 to 5 minutes of resting is needed before blood pressure measurement. Surprisingly, no study has modelled the time course of BP decrease and the minimum resting-time before BP measurement. A cross-sectional bicentric observational study was performed including outpatients addressed for vascular examination. Using two automatic BP monitors we recorded the blood pressure every minute during 11 consecutive minutes. The data was analyzed by non-linear mixed effect regression. Systolic (SBP) and diastolic BPs were studied and we tested the effect of covariates on its evolution through log-likelihood ratio tests. We included 199 patients (66+/−13years old). SBP was found to decrease exponentially. Simulations based on the final model show that only half the population reaches a stabilized SBP (defined as SBP + 5 mmHg) after 5 min of resting-time while it takes 25 min to ensure 90% of the population has a stabilized SBP. In conclusion, our results and simulations suggest that 5 minutes are not enough to achieve a stabilized SBP in most patients and at least 25 minutes are required. This questions whether the diagnosis of hypertension can be reliably made during routine visits in general practitioners’ offices.
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Ahlawat R, Tiwari P, D'Cruz S. Direct Cost for Treating Chronic Kidney Disease at an Outpatient Setting of a Tertiary Hospital: Evidence from a Cross-Sectional Study. Value Health Reg Issues 2017. [PMID: 28648314 DOI: 10.1016/j.vhri.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) has a high morbidity and mortality in developing countries. And this burden is also increasing rapidly in India. Unaffordability due to high cost of medication and hemodialysis remains one of the major barriers in the successful treatment of CKD. OBJECTIVES To determine the direct cost involved in treating CKD at an outpatient department of a public tertiary care hospital. METHODS This cross-sectional study was carried out at a public tertiary care hospital. Patients diagnosed with CKD by a physician were included in the study after obtaining a written informed consent. All the relevant data were collected on a predesigned case record form. RESULTS The results are based on data obtained from 150 patients. The average age of the patients was 55.7 ± 10.1 years. The average number of drugs per prescription was found to be 6.5 ± 1.7. The annual average costs of treatment for patients on medication only and for patients on hemodialysis plus medication were Rs 25,836 (US $386) and Rs 2,13,144 (US $3181), respectively (Rs = Indian rupee). Treatment cost was found to be statistically significantly higher in patients on hemodialysis, treatment support by employer, patients with a smoking habit, patients with comorbidities, and patients with end-stage renal disease. Calcium tablets, vitamin D sachets, iron supplements, torsemide, and amlodipine were the top five medications prescribed. CONCLUSIONS Reimbursement, patient's dialysis status, habits, and comorbidities were found to have a significant effect on the direct cost of treatment.
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Affiliation(s)
- Rajiv Ahlawat
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India.
| | - Sanjay D'Cruz
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Efecto del ejercicio aeróbico en la rigidez vascular en una población sana. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review. J Hypertens 2017; 35:421-441. [PMID: 27977471 PMCID: PMC5278896 DOI: 10.1097/hjh.0000000000001197] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/13/2016] [Accepted: 11/05/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND To interpret blood pressure (BP) data appropriately, healthcare providers need to be knowledgeable of the factors that can potentially impact the accuracy of BP measurement and contribute to variability between measurements. METHODS A systematic review of studies quantifying BP measurement inaccuracy. Medline and CINAHL databases were searched for empirical articles and systematic reviews published up to June 2015. Empirical articles were included if they reported a study that was relevant to the measurement of adult patients' resting BP at the upper arm in a clinical setting (e.g. ward or office); identified a specific source of inaccuracy; and quantified its effect. Reference lists and reviews were searched for additional articles. RESULTS A total of 328 empirical studies were included. They investigated 29 potential sources of inaccuracy, categorized as relating to the patient, device, procedure or observer. Significant directional effects were found for 27; however, for some, the effects were inconsistent in direction. Compared with true resting BP, significant effects of individual sources ranged from -23.6 to +33 mmHg SBP and -14 to +23 mmHg DBP. CONCLUSION A single BP value outside the expected range should be interpreted with caution and not taken as a definitive indicator of clinical deterioration. Where a measurement is abnormally high or low, further measurements should be taken and averaged. Wherever possible, BP values should be recorded graphically within ranges. This may reduce the impact of sources of inaccuracy and reduce the scope for misinterpretations based on small, likely erroneous or misleading, changes.
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Affiliation(s)
- Noa Kallioinen
- School of Psychology, The University of Queensland, St. Lucia
| | - Andrew Hill
- School of Psychology, The University of Queensland, St. Lucia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Herston
| | | | - Helen E. Ward
- The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside
| | - Marcus O. Watson
- School of Psychology, The University of Queensland, St. Lucia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Herston
- School of Medicine, The University of Queensland Mayne Medical School, Herston, Queensland, Australia
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28
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Intensive blood pressure lowering in chronic kidney disease: the time has come. Curr Opin Nephrol Hypertens 2017; 26:197-204. [PMID: 28198732 DOI: 10.1097/mnh.0000000000000316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Release of the findings from the Systolic Blood Pressure Intervention Trial has resulted in a renewed examination of intensive blood pressure (BP) lowering. Only a few national hypertension guidelines (Canada and Australia) have changed recommendations, but considerable heterogeneity still exists with respect to the patient population to whom intensive BP lowering may apply. RECENT FINDINGS There is fairly robust evidence that lower BP targets in nondiabetic chronic kidney disease (CKD) results in a decrease in heart failure and mortality. Similar data exist in patients with diabetes and CKD for reduction in stroke. Consideration of the differences in BP measurement methods in newer trials helps us understand and interpret the findings. SUMMARY Though often times less is more with respect to therapeutic measures, in patients with CKD, more BP lowering will result in more cardiovascular benefit. Use of newer oscillometric BP devices with adequate resting prior and judicious patient selection are the key aspects to be considered when applying intensive BP lowering.
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Ruzicka M, Burns KD, Hiremath S. Precision Medicine for Hypertension Management in Chronic Kidney Disease: Relevance of SPRINT for Therapeutic Targets in Nondiabetic Renal Disease. Can J Cardiol 2017; 33:611-618. [PMID: 28365055 DOI: 10.1016/j.cjca.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/22/2016] [Accepted: 01/01/2017] [Indexed: 01/13/2023] Open
Abstract
In this review we evaluate the literature to determine if lower blood pressure (BP) targets are beneficial for patients with nondiabetic chronic kidney disease (CKD). Modification of Diet in Renal Disease (MDRD), African American Study of Kidney Disease and Hypertension (AASK), and Ramipril Efficacy in Nephropathy-2 (REIN-2), designed to assess the benefit of lower BP on progression of nondiabetic CKD, generally came to the same negative conclusion. They were not designed and powered to assess an effect of lower BP on cardiovascular outcomes. The Systolic Blood Pressure Intervention Trial (SPRINT) was the first trial designed and powered to address this issue, and showed a clear benefit of a lower targeted and achieved BP. SPRINT did not show any renal benefits from lower BP, and it was not designed to assess this outcome, and it enrolled patients with less "renal risk" per se. A distinguishing feature of SPRINT compared with other large trials is that it highlighted the importance of precise BP measurement methods in defining targets in hypertension treatment. Accordingly, we propose that SPRINT is truly a "game-changing" clinical trial that sets the bar for management of hypertension in select patients with nondiabetic CKD. In these patients, systolic BP target depends critically on the BP measurement method: < 140 mm Hg when derived from 3 readings using a mercury sphygmomanometer after 5 minutes of rest, < 130 mm Hg when calculated from at a minimum of 3 readings using an automated oscillometric device, and < 120 mm Hg when taken using an automated oscillometric device after 5 minutes of unattended rest.
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Affiliation(s)
- Marcel Ruzicka
- Renal Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Kidney Research Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Kevin D Burns
- Renal Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Renal Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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30
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Velilla-Zancada SM, Prieto-Díaz MA, Escobar-Cervantes C, Manzano-Espinosa L. [Orthostatic hypotension; that great unknown]. Semergen 2016; 43:501-510. [PMID: 27865581 DOI: 10.1016/j.semerg.2016.09.006] [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: 08/06/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 12/01/2022]
Abstract
Orthostatic hypotension is an anomaly of growing interest in scientific research. Although certain neurogenic diseases are associated with this phenomenon, it can also be associated with non-neurological causes. Although orthostatic hypotension is defined by consensus as a decrease in the systolic blood pressure of at least 20mmHg, or a decrease in diastolic blood pressure of at least 10mmHg, within 3min of standing, the studies differ on how to diagnose it. Orthostatic hypotension is associated with certain cardiovascular risk factors and with drug treatment, but the results are contradictory. The purpose of this review is to update the knowledge about orthostatic hypotension and its treatment, as well as to propose a method to standardise its diagnosis.
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Affiliation(s)
- S M Velilla-Zancada
- Centro de Salud Espartero, Logroño, La Rioja, España; Grupo de trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, España.
| | - M A Prieto-Díaz
- Grupo de trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, España; Centro de Salud Vallobín-La Florida, Oviedo, Asturias, España
| | - C Escobar-Cervantes
- Grupo de trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, España; Departamento de Cardiología, Hospital La Paz, Madrid, España
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Veloudi P, Blizzard CL, Head GA, Abhayaratna WP, Stowasser M, Sharman JE. Blood Pressure Variability and Prediction of Target Organ Damage in Patients With Uncomplicated Hypertension. Am J Hypertens 2016; 29:1046-54. [PMID: 27076601 DOI: 10.1093/ajh/hpw037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/23/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The average of multiple blood pressure (BP) readings (mean BP) independently predicts target organ damage (TOD). Observational studies have also shown an independent relationship between BP variability (BPV) and TOD, but there is limited longitudinal data. This study aimed to determine the effects of changes in mean BP levels compared with BPV on left ventricular mass index (LVMI) and aortic pulse wave velocity (aPWV). METHODS Mean BP levels (research-protocol clinic BP (clinic BP), 24-hour ambulatory BP, and 7-day home BP) and BPV were assessed in 286 patients with uncomplicated hypertension (mean age 64±8 SD years, 53% women) over 12 months. Reading-to-reading BPV (from 24-hour ambulatory BP) and day-to-day BPV (from 7-day home BP) were assessed at baseline and 12 months, and visit-to-visit BPV (clinic BP) was assessed from 5 visits over 12 months. LVMI was measured by 3D echocardiography and aPWV with applanation tonometry. RESULTS The strongest predictors of the changes in LVMI (ΔLVMI) were the changes in mean 24-hour systolic BPs (SBPs) (P < 0.02). Similarly, the strongest predictors of the changes in aPWV (ΔaPWV) were the changes in mean 24-hour ambulatory SBPs (P < 0.01) and the changes in mean clinic SBP (P < 0.001). However, none of the changes in BPV were independently associated with ΔLVMI or ΔaPWV (P > 0.05 for all). CONCLUSIONS Changes in mean BP levels, but not BPV, were most relevant to changes in TOD in patients with uncomplicated hypertension. Thus, from this point of view, BPV appears to have limited clinical utility in this patient population.
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Affiliation(s)
- Panagiota Veloudi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Geoffrey A Head
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Walter P Abhayaratna
- Canberra Hospital, College of Medicine, Biology and Environment, Australian National University, Garran, Canberra, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia;
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Wright JT, Whelton PK, Reboussin DM. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2016; 374:2295. [PMID: 27276569 DOI: 10.1056/nejmc1602668] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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33
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Kosmala W, Marwick TH, Stanton T, Abhayaratna WP, Stowasser M, Sharman JE. Guiding Hypertension Management Using Central Blood Pressure: Effect of Medication Withdrawal on Left Ventricular Function. Am J Hypertens 2016; 29:319-25. [PMID: 26152757 DOI: 10.1093/ajh/hpv108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/16/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance. METHODS A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation. RESULTS Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (∆UC vs. ∆CBP; P = 0.27) and E/e' ratio (∆UC vs. ∆CBP; P = 0.60), and systolic parameters: LV longitudinal strain (∆UC vs. ∆CBP; P = 0.55), circumferential strain (∆UC vs. ∆CBP; P = 0.79), and ejection fraction (∆UC vs. ∆CBP; P = 0.15). CONCLUSIONS Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function. Clinical trials registration: Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358.
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Affiliation(s)
- Wojciech Kosmala
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Wroclaw Medical University, Wroclaw, Poland
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tony Stanton
- School of Medicine, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Walter P Abhayaratna
- Australia National University, Canberra, Australian Capital Territory, Australia
| | - Michael Stowasser
- School of Medicine, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia;
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Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis. Hypertension 2015; 67:183-90. [PMID: 26597821 DOI: 10.1161/hypertensionaha.115.06066] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/28/2015] [Indexed: 12/27/2022]
Abstract
Accumulating evidence suggests that central blood pressure (BP) may reflect the hemodynamic stress on target organs more accurately than brachial BP. A systematic review assessing the relationship of central versus brachial BP with preclinical target-organ damage was performed. Meta-analysis of cross-sectional data showed that central compared with brachial systolic BP was more closely associated with (1) left ventricular mass index (12 studies, n=6431; weighted age [SD], 49.9 [13.1] years; 51% hypertensives): pooled correlation coefficients r=0.30; 95% confidence interval (CI), 0.23-0.37 versus r=0.26; 95% CI, 0.19-0.33, respectively; P<0.01 for difference; (2) carotid intima-media thickness (7 studies, n=6136; weighted age, 55.6 [13.2] years; 48% hypertensives): r=0.27; 95% CI, 0.19-0.34 versus r=0.23; 95% CI, 0.16-0.30, respectively; P<0.01 for difference; (3) pulse-wave velocity (14 studies, n=3699; weighted age, 53.9 [13.3] years; 53% hypertensives): r=0.42; 95% CI, 0.37-0.47 versus r=0.39; 95% CI, 0.33-0.45, respectively; P<0.01 for difference. Four studies assessing urine albumin excretion (n=3718; weighted age, 56.4 [5] years; 69% hypertensives) reported similar correlations (P=not significant) with central (r=0.22; 95% CI, 0.14-0.29) and brachial systolic BP (r=0.22; 95% CI, 0.12-0.32). Similar findings were observed for central compared with brachial pulse pressure in terms of relationship with target-organ damage. Metaregression analyses did not reveal any significant effect of age. In conclusion, central compared with brachial BP seems to be more strongly associated with most of the investigated indices of preclinical organ damage.
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Affiliation(s)
- Anastasios Kollias
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - Styliani Lagou
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - Maria Elena Zeniodi
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - Nadia Boubouchairopoulou
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - George S Stergiou
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece.
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Babcock MC, Lefferts WK, Heffernan KS. Relation between exercise central haemodynamic response and resting cardiac structure and function in young healthy men. Clin Physiol Funct Imaging 2015; 37:372-378. [PMID: 26519349 DOI: 10.1111/cpf.12310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/11/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular (LV) structure and function are predictors of cardiovascular (CV) morbidity and mortality and are related to resting peripheral haemodynamic load in older adults. The central haemodynamic response to exercise may reveal associations with LV structure and function not detected by traditional peripheral (brachial) measures in a younger population. PURPOSE To examine correlations between acute exercise-induced changes in central artery stiffness and wave reflections and measures of resting LV structure and function. METHODS Sixteen healthy men (age 26 ± 6 year; BMI 25·3 ± 2·7 kg m-2 ) had measures of central haemodynamic load measured before/after a 30-s Wingate anaerobic test (WAT). Common carotid artery stiffness and reflected wave intensity were assessed via wave intensity analysis as a regional pulse wave velocity (PWV) and negative area (NA), respectively. Resting LV structure (LV mass) and function [midwall fractional shortening (mFS)] were assessed using M-mode echocardiography in the parasternal short-axis view. RESULTS There was a significant association between mFS and WAT-mediated change in carotid systolic BP (r = -0·57, P = 0·011), logNA (r = -0·58, P = 0·009) and PWV (r = -0·44, P = 0·045). There were no significant associations between resting mFS and changes in brachial systolic BP (r = -0·26, P>0·05). There were no associations between resting LV mass and changes in any haemodynamic variable (P>0·05). CONCLUSION Exercise-induced increases in central haemodynamic load reveal associations with lower resting LV function in young healthy men undetected by traditional peripheral haemodynamics.
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Affiliation(s)
- Matthew C Babcock
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Wesley K Lefferts
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
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Hiremath S, Edwards C, McCormick BB, Ruzicka M. Reply to Dr Myers' commentary on the use of automated blood pressure machines in office blood pressure measurements. J Clin Hypertens (Greenwich) 2014; 16:540. [PMID: 24803307 DOI: 10.1111/jch.12332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Swapnil Hiremath
- Renal Hypertension Unit, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Wassertheurer S, Hametner B. What time is the right time, and how to measure? J Hum Hypertens 2013; 28:73. [PMID: 23842083 DOI: 10.1038/jhh.2013.65] [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]
Affiliation(s)
- S Wassertheurer
- Health and Environment Department, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - B Hametner
- Health and Environment Department, AIT Austrian Institute of Technology GmbH, Vienna, Austria
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