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Rabizadeh S, Gholami B, Mahmoudzadeh Kani S, Rajab A, Farrokhpour H, Esteghamati A, Nakhjavani M. Uncontrolled hypertension in patients with type 2 diabetes: What are the correlates? J Clin Hypertens (Greenwich) 2021; 23:1776-1785. [PMID: 34418281 PMCID: PMC8678846 DOI: 10.1111/jch.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/20/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Suboptimal blood pressure (BP) control in patients with type 2 diabetes is associated with adverse micro‐ and macrovascular complications. This study aimed to investigate the predictors of uncontrolled hypertension in an Iranian population with type 2 diabetes. This is a cross‐sectional study of 2612 patients with type 2 diabetes, including 944 patients with hypertension. Controlled and uncontrolled hypertension were assessed. Multivariate logistic regression modeling was used to determined independent predictors of uncontrolled hypertension. Of 2612 patients with type 2 diabetes, 944 (36.1%) patients had hypertension. Of all patients with hypertension, 580 (61.4%) were still on monotherapy. Uncontrolled hypertension was detected in 536 participants (56.8%). Patients with uncontrolled hypertension had significantly higher body mass index (BMI) (29.8±4.8 vs. 28.6±4.6), waist circumference (99.11±10.95 vs. 96.68±10.92), pulse pressure (67.3±17.3 vs. 48.4±10.7), total cholesterol (177.1±45.5 vs. 164.3±40.5), non‐HDL cholesterol (133.0±43.5 vs. 120.1±38.7), triglycerides (175.7±80.3 vs. 157.4±76.7), and Atherogenic Index of Plasma (AIP) (0.57±0.23 vs. 0.52±0.24) (p < .05 for all of them) compared to patients with controlled hypertension. Multivariate logistic regression analysis revealed that uncontrolled hypertension was significantly associated with BMI (p = .001), pulse pressure (p = .001), total cholesterol (p = .006), and non‐HDL cholesterol (p = .009). In patients with triglycerides levels > 200 mg/dl non‐HDL cholesterol had a significant correlation with uncontrolled hypertension (OR = 4.635, CI95%:1.781–12.064, p = .002). In conclusion, BMI, pulse pressure, total cholesterol, and non‐HDL cholesterol are significant predictors of uncontrolled hypertension in patients with type 2 diabetes. Also, ineffective monotherapy, medical inertia and patients’ non‐compliance were other contributors to the uncontrolled hypertension.
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Affiliation(s)
- Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Gholami
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Mahmoudzadeh Kani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Rajab
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Farrokhpour
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kim HL, Chung J, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Association between household income and pulse pressure: data from the Korean National Health and Nutrition Examination Survey. Blood Press 2021; 30:258-264. [PMID: 34013800 DOI: 10.1080/08037051.2021.1928478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE There has been limited evidence for the association between socioeconomic status (SES) and arterial stiffness. This study was performed to investigate the association between household income and brachial pulse pressure (PP) in the general Korean population. MATERIALS AND METHODS This study was based on data acquired in the 2018 Korea National Health and Nutrition Examination Survey (2018 KNHANES). A total of 13004 subjects at the age of 20 years or older analysed. The information on monthly household income was obtained through the questionnaire, and was stratified into 5 groups for each quintile. Brachial blood pressure (BP) was measured 3 times, and the average of the second and third measured BPs were used. PP was calculated as the difference between systolic and diastolic BPs. RESULTS A lower household income was associated with a higher prevalence of cardiovascular risk factors. As household income increased, PP decreased proportionally (p < .001). In multiple linear regression analysis, household income (per quintile) was independently associated with PP even after controlling for potential confounders (β = -.125, p < .001). Multiple binary logistic regression analysis showed that the increased household income level was significantly associated lower probability having higher PP (≥ 43.5 mmHg) even after controlling for multiple covariates (the lowest vs. the highest household income; odds ratio, 0.48; 95% confidence interval, .41-.55; p < .001). CONCLUSION Low household income was associated with higher PP. This provides additional evidence for the association between low SES and high arterial stiffness.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jaehoon Chung
- Division of Cardiology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Das SK, McIntyre HD, Al Mamun A. Early life predictors of development of blood pressure from childhood to adulthood: Evidence from a 30-year longitudinal birth cohort study. Atherosclerosis 2020; 311:91-97. [PMID: 32949948 DOI: 10.1016/j.atherosclerosis.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The early life predictors of changes in the blood pressures of offspring between childhood and young adulthood have not been well defined. Thus, this study aimed to determine the life course association of offspring's blood pressure with prenatal and early infancy lifestyle, and other factors taking advantage of a large community-based, longitudinal study of a birth cohort in Australia - the MUSP study. METHODS The systolic and diastolic blood pressure (SBP, DBP) was measured for 3793, 3782, 2628 and 1780 offspring of the Australian longitudinal cohort study at 5, 14, 21 and 30 years of their age, respectively. Individual PP and mean arterial pressure (MAP) was equated, and Generalized Estimating Equations with time (age) and predictor interaction modelling were performed. RESULTS Blood pressures of the offspring increased significantly between 5 and 30 years. Early life factors such as pre-pregnancy overweight/obesity, and hypertensive disorder in pregnancy were significantly positively associated, and duration of gestation and pre-pregnancy thinness of the mothers negatively associated with this life course increase in the offspring's blood pressure. Rapid increase in body weight from birth to 5 years had a strong association with increasing blood pressures components throughout their life course. CONCLUSIONS Several maternal pre-pregnancy and pregnancy factors along with the early life growth characteristics of offspring are important predictors of increase in blood pressure of the offspring from their childhood to adulthood.
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Affiliation(s)
- Sumon Kumar Das
- Menzies School of Health Research, Charles Darwin University, NT 0810, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia.
| | - Harold David McIntyre
- Mater Clinical School, The University of Queensland, Brisbane, Australia; Mater Medical Research Institute, Raymond Tce, South Brisbane, Qld 4101, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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Characterization of resting and exercise inter-arm differences in SBP to isometric handgrip exercise in males and females. Blood Press Monit 2020; 25:252-258. [PMID: 32675474 DOI: 10.1097/mbp.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A large inter-arm difference (IAD; ≥10 mmHg) in SBP is linked to cardiovascular and peripheral vascular disease, hypertension, and premature mortality. Exercise-induced IAD (eIAD) is related to resting IAD, and acute aerobic activity alters eIAD and reduces IAD in recovery. Isometric handgrip exercise (IHE) affects blood pressure (BP), though the eIAD response to IHE is unknown. Further, the eIAD response may differ between males and females. OBJECTIVES To characterize the eIAD response to IHE in males and females. METHODS On visit 1, participants (16 females and 15 males, aged 18-35 years) completed three maximal voluntary isometric contractions (MVIC) per arm. On visit 2, before IHE, a series of three simultaneous, bilateral BP measures were averaged at rest. During IHE, participants maintained handgrip at 20% of MVIC for 2 minutes (arm randomly assigned), at which time bilateral BP was measured (IHE) during exercise and subsequent recovery (REC1 and REC2). Repeated-measures analysis of variance assessed eIAD and SBP (time × sex). RESULTS IHE increased absolute eIAD (4 mmHg). Differences in relative eIAD were observed at IHE and REC2 based on resting IAD status (P < 0.05). Females only had an exaggerated SBP and pulse pressure response in the working arm. CONCLUSION Acute IHE was shown to augment eIAD. Further eIAD and resting IAD were related. Acute IHE induced different bilateral responses between males and females, though the impact of sex on eIAD warrants further investigation. Future studies should address the effects of repeated bouts of IHE, which may benefit individuals with a large resting IAD.
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Akin S, Aydin Z, Cakir O, Kazan S. Correlation between pulse pressure and urinary albumin excretion in type 2 diabetic patients without microalbuminuria. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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LI J, Huang JY, Lo K, Zhang B, Huang YQ, Feng YQ. Association of pulse pressure with all-cause mortality in young adults. Postgrad Med J 2019; 96:461-466. [DOI: 10.1136/postgradmedj-2019-137070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023]
Abstract
BackgroundPulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.ObjectiveTo assess the association of pulse pressure (PP) with all-cause mortality in young adults.MethodsThis cohort from the 1999–2006 National Health and Nutrition Examination Survey included adults aged 18–40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50~60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality.ResultsAfter applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50~60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50–60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants.ConclusionAmong young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.
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Change in visceral adiposity is an independent predictor of future arterial pulse pressure. J Hypertens 2019; 36:299-305. [PMID: 28857792 DOI: 10.1097/hjh.0000000000001532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pulse pressure (PP), a marker of arterial stiffness, and body composition are both risk factors for cardiovascular disease. Little is known about whether changes in body composition may be linked to future PP. We sought to determine whether change in amount of abdominal and thigh fat over 5 years predicted PP at 10 years. METHODS Visceral fat as well as abdominal and thigh subcutaneous fat areas were measured by computed tomography at baseline and 5 years later in 284 Japanese Americans (mean age 49.3 years; 50.4% men) without hypertension, heart disease, and glucose-lowering medication use at baseline. PP at 10 years was calculated as the difference between SBP and DBP measured with a mercury sphygmomanometer. The association between change in fat at 5 years and arterial PP at 10 years, adjusted for baseline PP, was examined using linear regression analysis. MAIN RESULTS Change in abdominal visceral fat area at 5 years was positively associated with 10-year PP independent of sex, 5-year change in BMI, and baseline age, BMI, PP, abdominal visceral fat, smoking status, alcohol consumption, physical activity, homeostasis model assessment insulin resistance, and fasting plasma glucose. There were no significant associations between baseline amounts or change in abdominal or thigh subcutaneous fat areas and future PP. CONCLUSION The accumulation of abdominal visceral fat over time independently predicted future PP in Japanese Americans.
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Al‐Shafei AIM, El‐Gendy OAA. Regular consumption of green tea improves pulse pressure and induces regression of left ventricular hypertrophy in hypertensive patients. Physiol Rep 2019; 7:e14030. [PMID: 30912296 PMCID: PMC6434072 DOI: 10.14814/phy2.14030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022] Open
Abstract
This study characterized the effects of regular green tea (GT) and hot water (HW) ingestion on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and left ventricular hypertrophy (LVH) in two equal, sex- and age-matched groups; Grp1 and Grp2 (n = 100 each; age 53 ± 4 years) of hypertensive patients. Grp1 had regular GT treatment, followed by HW ingestion, whereas Grp2 had HW ingestion followed by GT treatment for periods of 4 months each. Electrocardiographic (ECG) and echocardiographic assessments of LVH were made before and at the end of both periods. SBP was lowered significantly by 6.6%; DBP by 5.1%, and PP by 9.1% by the end of month 4 of GT treatment in Grp1. Upon GT cessation and HW ingestion, SBP, DBP, and PP returned to pretreatment levels over 4 months. In Grp2, SBP, DBP, and PP were reduced insignificantly by 1.5%, 1.0%, and 2.3% by the end of the 4th month of HW ingestion. Conversely, over 4 months of GT treatment, SBP, DBP, and PP were significantly lowered by 5.4%, 4.1%, and 7.7% from the baseline values, respectively. ECG and echocardiographic evidence of LVH was shown in 20% of Grp1 and 24% of Grp2 patients before intervention. This was significantly lowered to 8% and 10% in Grp1 and Grp2 by GT treatment. However, this increased to 16% following HW ingestion in Grp1. HW ingestion did mot induce regression of LVH in Grp2. Thus, regular GT ingestion has cardiovascular protective effects.
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Affiliation(s)
- Ahmad I. M. Al‐Shafei
- Istanbul Medipol UniversityIstanbulTurkey
- Bahrain UniversitySouthern GovernorateBahrain
- Qassim UniversityQassimSaudi Arabia
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Association of Endothelial Function with Parental Hypertension in Normotensive-Obese African-American Women: A Pilot Study. Adv Prev Med 2019; 2019:5854219. [PMID: 30863643 PMCID: PMC6378072 DOI: 10.1155/2019/5854219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022] Open
Abstract
Obese African-American (AA) women are at high risk of hypertension (HT) and cardiovascular disease (CVD). Flow-mediated dilation (FMD) and arterial augmentation index (AI) are measures of endothelial function and arterial stiffness. Whether endothelial function and arterial stiffness predict risk of HT or CVD in obese African-American women with, versus without, parental histories of HT and whether aerobic exercise is an effective countermeasure remain unclear. The capacity for FMD is partly heritable. Therefore, we tested the hypotheses that less FMD and greater AI may be found in normotensive-obese, young-adult (18-26 year-old) AA women with hypertensive parents (n=10) than in a matched control group with normotensive parents (n=10) and that a single bout of aerobic exercise improves both endothelial function and arterial stiffness, with less improvement in the women with hypertensive parents. We studied each subject while at rest, 20 min before and 20 min after, 30 min of aerobic exercise. The exercise-induced changes and parental hypertension-related differences in AI were not significant. The exercise increased FMD in both of the groups with no significant difference in magnitude between the women with hypertensive and normotensive parents. FMD was significantly less in the women with hypertensive parents than in the women with normotensive parents after, but not before, the exercise (mean ±95% confidence interval of 11.3 ± 4.9% vs. 15.6 ± 4.9%, P=0.05). These findings suggest that a 30-min bout of aerobic exercise may improve FMD and unmask endothelial dysfunction in normotensive-obese, young-adult AA women with parental histories of HT. Future studies should determine whether regular aerobic exercise protects obese AA women from the endothelial dysfunction associated with diabetes and prevents CVD in this high-risk population.
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Sotiriou P, Kouidi E, Karagiannis A, Koutlianos N, Geleris P, Vassilikos V, Deligiannis A. Arterial adaptations in athletes of dynamic and static sports disciplines - a pilot study. Clin Physiol Funct Imaging 2018; 39:183-191. [PMID: 30417605 DOI: 10.1111/cpf.12554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Structural and functional arterial adaptations with regard to the type and level of training in young athletes are understudied. Our research aimed at evaluating them in two types of exercise (dynamic and static) and two levels of engagement (high and recreational). METHODS A total of 76 volunteers formed five groups. Group A included 17 high-level dynamic sports athletes 30·9 ± 6·4 years old, group B 14 recreational ones aged 28·7 ± 6·2 years, group C 15 high-level static sports athletes 26·4 ± 3·9 years old and group D 16 recreational ones, aged 25·8 ± 4·8 years. Fourteen sedentary men 30 ± 3·8 years old formed control group E. Structural indices of left cardiac chambers and thoracic aorta were echographically obtained, as well as common carotid intima-media thickness (cIMT). Furthermore, applanation tonometry was conducted, at rest and during a handgrip strength test, for the acquisition of central arterial pressure parameters, carotid-femoral pulse wave velocity (cfPWV) and total arterial compliance (Cτ ). RESULTS No significant differences in structural arterial markers were observed. However, group A obtained the highest handgrip central systolic pressure values (13·1% compared to group D, P<0·05). Resting cfPWV was lower in group B by 13·8% (P<0·05) than C and by 16·7% (P<0·01) than E, whereas Cτ was higher in group Β by 33·3% than C (P<0·05) and by 40·9% than E (P<0·01). CONCLUSION Functional arterial exercise-induced adaptations become apparent at an early age, without being in conjunction with structural ones. Recreational dynamic exercise results in the most favourable arterial characteristics.
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Affiliation(s)
- Panagiota Sotiriou
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Koutlianos
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Parashos Geleris
- 3rd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Vassilikos
- 3rd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Deligiannis
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Feaster M, Krause N. Job strain associated with increases in ambulatory blood and pulse pressure during and after work hours among female hotel room cleaners. Am J Ind Med 2018; 61:492-503. [PMID: 29569256 DOI: 10.1002/ajim.22837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previously documented elevated hypertension rates among Las Vegas hotel room cleaners are hypothesized to be associated with job strain. METHODS Job strain was assessed by questionnaire. Ambulatory blood pressure (ABP) was recorded among 419 female cleaners from five hotels during 18 waking hours. Multiple linear regression models assessed associations of job strain with ABP and pulse pressure for 18-h, work hours, and after work hours. RESULTS Higher job strain was associated with increased 18-h systolic ABP, after work hours systolic ABP, and ambulatory pulse pressure. Dependents at home but not social support at work attenuated effects. Among hypertensive workers, job strain effects were partially buffered by anti-hypertensive medication. CONCLUSIONS High job strain is positively associated with blood pressure among female hotel workers suggesting potential for primary prevention at work. Work organizational changes, stress management, and active ABP surveillance and hypertension management should be considered for integrated intervention programs.
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Affiliation(s)
- Matt Feaster
- Department of Epidemiology; University of California Los Angeles (UCLA); Los Angeles California
| | - Niklas Krause
- Department of Epidemiology; University of California Los Angeles (UCLA); Los Angeles California
- Department of Environmental Health Sciences; University of California Los Angeles (UCLA); Los Angeles California
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Noninvasive Measures of Pulsatility and Blood Pressure During Continuous-Flow Left Ventricular Assist Device Support. ASAIO J 2018; 65:241-246. [PMID: 29734257 DOI: 10.1097/mat.0000000000000805] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The reliability and validity of a palpable pulse and other noninvasive measures of pulsatility in patients on continuous-flow (CF) left ventricular assist device (LVAD) support have not been rigorously evaluated. We prospectively enrolled 23 patients who had CF-LVAD and an arterial catheter for blood pressure (BP) monitoring. Pulse pressure (PP) via the arterial line was compared with three noninvasive measures of pulsatility: presence of a palpable pulse, pulsatility index (PI), and aortic valve opening (AVO). In addition, the relationship between Doppler BP (DopBP) and arterial line pressures was evaluated. The study group comprised 30% females, 73% nonischemic cardiomyopathy, 87% axial flow device (HeartMate II [HMII]), and 13% centrifugal flow device (HeartWare ventricular assist device [HVAD]) support. Among four practitioners, the interobserver agreement for the presence of a palpable pulse was moderate (k = 0.41; 95% CI, 0.28-0.60). If the PP was ≥15 mm Hg, a radial pulse was palpated 82% of the time, whereas when the PP was <15 mm Hg, a radial pulse was palpated only 35% of the time. In subjects with a palpable pulse, there was a strong correlation between DopBP and systolic BP (SBP) (r = 0.94; 95% CI, 0.82-0.99), whereas the correlation between DopBP and mean arterial pressure (MAP) was much weaker (r = 0.42; 95% CI, 0.19-0.96). In subjects without a palpable pulse, there was a strong correlation between both the DopBP and SBP (r = 0.94; 95% CI, 0.80-1.0) and DopBP and MAP (r = 0.87; 95% CI, 0.77-1.00). Finally, PP was significantly associated with PI (odds ratio [OR], 0.3; 95% CI, 0.14-0.45; p = 0.0002) but not AVO (OR, 1.41: 95% CI, 0.70-2.83; p = 0.33). The presence of a palpable pulse has good interobserver agreement and allows for dichotomization of the DopBP to reflect the SBP in its presence and the MAP in its absence. This simple measure should be incorporated into BP management algorithms for CF-LVADs. The PI shows a modest correlation to PP.
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Lee IT, Sheu WHH, Lee WJ, Chen DY. Serum brain-derived neurotrophic factor predicting reduction in pulse pressure after a one-hour rest in nurses working night shifts. Sci Rep 2018; 8:5485. [PMID: 29615787 PMCID: PMC5882896 DOI: 10.1038/s41598-018-23791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/21/2018] [Indexed: 12/16/2022] Open
Abstract
Night shift work is associated with cardiovascular disease and central nervous system disorders in female nurses. Brain-derived neurotrophic factor (BDNF) exerts protective effects on neural and endothelial functions. This study examined the association between serum BDNF levels and pulse pressure after rest in female nurses working night shifts. In this study, blood samples were collected for BDNF measurement after a night shift when nurses had been working night shifts for three continuous weeks. Blood pressure was assessed before and after a one-hour morning rest within a week of resuming the night shift after one month without any night shift work. The pulse pressure of nurses (n = 48, age 29 ± 5 years) was significantly reduced (from 43 ± 7 to 41 ± 6 mmHg, P = 0.003) after rest, and serum BDNF were significantly and inversely correlated with pulse pressure changes (r = −0.435, P = 0.002). Higher serum BDNF was an independent factor for greater reduction in pulse pressure (95%CI = −0.609 ‒ −0.174, P = 0.001). Using a receiver operating characteristic curve analysis, serum BDNF >20.6 ng/mL predicted a pulse pressure reduction after a one-hour rest (sensitivity 66.7%, specificity 77.8%). In conclusion, higher serum BDNF predicted greater recovery of pulse pressure after a one-hour rest in female nurses after night shift work.
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Affiliation(s)
- I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Der-Yuan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,PhD Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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Olesen TB, Stidsen JV, Blicher MK, Pareek M, Rasmussen S, Vishram-Nielsen JK, Olsen MH. Impact of Age and Target-Organ Damage on Prognostic Value of 24-Hour Ambulatory Blood Pressure. Hypertension 2017; 70:1034-1041. [DOI: 10.1161/hypertensionaha.117.09173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/19/2017] [Accepted: 08/16/2017] [Indexed: 12/25/2022]
Abstract
Markers of target-organ damage and 24-hour ambulatory blood pressure (BP) measurement improve cardiovascular risk stratification. The prevalence of target-organ damage and raised BP increases with aging. The study aim was to evaluate the impact of age and target-organ damage on the prognostic value of ambulatory BP. Markers of target-organ damage and ambulatory BP were measured in 1408 healthy people aged 41 or 51 (middle-aged group), and 61 or 71 (older group) years. The primary outcome was cardiovascular events after 16 years of follow-up, with data obtained from national registries. The prognostic value of BP was evaluated with Cox regression models, adjusted for traditional risk factors and target-organ damage, including left ventricular mass, pulse wave velocity, carotid plaques, and urine albumin/creatinine ratio. A total of 323 events were observed. In comparison with traditional risk factors, adding systolic BP and presence of target-organ damage improved risk stratification by increasing concordance index from 0.711 to 0.728 (
P
=0.01). In middle-aged subjects with target-organ damage, increment in pulse pressure (hazard ratio, 1.70; 95% confidence interval, 1.31–2.21;
P
<0.01) and increment in average real variability (hazard ratio, 1.29; 95% confidence interval, 1.05–1.59;
P
=0.02) were associated with a greater risk of cardiovascular disease compared with subjects without target-organ damage: hazard ratio, 1.04 (95% confidence interval, 0.74–1.46;
P
=0.81);
P
for interaction, 0.02; and hazard ratio, 0.89 (95% confidence interval, 0.69–1.14;
P
=0.36);
P
for interaction, 0.01. Target-organ damage may be a marker of individual susceptibility to the harmful effects of pulse pressure and BP variability on the cardiovascular system in middle-aged individuals.
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Affiliation(s)
- Thomas B. Olesen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Jacob V. Stidsen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Marie K. Blicher
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Manan Pareek
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Susanne Rasmussen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Julie K.K. Vishram-Nielsen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Michael H. Olsen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
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15
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Kizilirmak Yilmaz F, Babur Guler G, Kaya O, Guler E, Gunhan Demir G, Gunes HM, Olgun FE, Barutcu İ, Boztosun B. Relationship between arterial stiffness parameters and the extent and severity of coronary artery disease. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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An early life course association of pulse pressure with adulthood estimated glomerular filtration rate. J Hypertens 2017; 35:392-400. [DOI: 10.1097/hjh.0000000000001172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Determinants of pulse pressure and annual rates of change in the Atherosclerosis Risk in Communities study. J Hypertens 2015; 33:2463-70. [DOI: 10.1097/hjh.0000000000000731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Alkerwi A, Sauvageot N, Crichton GE, Elias MF. Tea, but not coffee consumption, is associated with components of arterial pressure. The Observation of Cardiovascular Risk Factors study in Luxembourg. Nutr Res 2015; 35:557-65. [PMID: 26037903 DOI: 10.1016/j.nutres.2015.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 01/11/2023]
Abstract
There is uncertainty regarding the impact of tea and coffee consumption on arterial blood pressure. The present study aimed to examine the association between blood pressure (BP) components, namely, systolic BP (SBP), diastolic BP, mean arterial pressure, and pulse pressure (PP), and tea or coffee consumption, taking into account simultaneous consumption. The study population was derived from a national cross-sectional stratified sample of 1352 individuals aged 18 to 69 years, recruited between November 2007 and January 2009 to participate in the Observation of Cardiovascular Risk Factors in Luxembourg study. We hypothesized that greater tea consumption would be independently associated with lower BP. Tea and coffee consumptions in deciliters per day were obtained from a semiquantitative food frequency questionnaire. Participants were classified into 3 groups: nonconsumers, ≤3-dL/d consumers, and >3-dL/d consumers of each beverage separately. After exclusion of subjects taking antihypertensive medications, several general linear models were performed to investigate the independent relationship between tea/coffee consumption and BP components. Tea consumers (36.3%) were more likely to be younger women, nonsmokers, with better cardiometabolic profiles, and less frequent chronic pathologies, whereas the reverse was true for coffee consumers (88%). Greater tea consumption was associated with lower SBP and PP values, after adjustment for age, sex, education, lifestyle, and dietary confounding factors, including coffee drinking. No association between BP components and coffee consumption was observed. Daily consumption of 1 dL of tea was associated with a significant reduction of SBP by 0.6 mm Hg and PP by 0.5 mm Hg. Given the widespread consumption of tea and coffee throughout the world, together with the major cardiovascular disease risk, our findings have important implications for human health.
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Affiliation(s)
- Ala'a Alkerwi
- Luxembourg Institute of Health (L.I.H.) (formerly CRP-Santé), Centre d'Etudes en Santé, Strassen, Grand Duchy of Luxembourg.
| | - Nicolas Sauvageot
- Luxembourg Institute of Health (L.I.H.) (formerly CRP-Santé), Centre d'Etudes en Santé, Strassen, Grand Duchy of Luxembourg
| | - Georgina E Crichton
- Luxembourg Institute of Health (L.I.H.) (formerly CRP-Santé), Centre d'Etudes en Santé, Strassen, Grand Duchy of Luxembourg; Nutritional Physiology Research Centre, University of South Australia, Adelaide, Australia
| | - Merrill F Elias
- Department of Psychology, University of Maine, Orono, ME, USA; Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA
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19
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Zhao L, Song Y, Dong P, Li Z, Yang X, Wang S. Brachial Pulse Pressure and Cardiovascular or All-Cause Mortality in the General Population: A Meta-Analysis of Prospective Observational Studies. J Clin Hypertens (Greenwich) 2014; 16:678-85. [PMID: 25052820 DOI: 10.1111/jch.12375] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Leilei Zhao
- Department of Cardiovascular-Internal Medicine; the First Affiliated Hospital of Henan University of Science and Technology; Luoyang China
| | - Yijuan Song
- Department of Cardiovascular-Internal Medicine; the First Affiliated Hospital of Henan University of Science and Technology; Luoyang China
| | - Pingshuan Dong
- Department of Cardiovascular-Internal Medicine; the First Affiliated Hospital of Henan University of Science and Technology; Luoyang China
| | - Zhijuan Li
- Department of Cardiovascular-Internal Medicine; the First Affiliated Hospital of Henan University of Science and Technology; Luoyang China
| | - Xuming Yang
- Department of Cardiovascular-Internal Medicine; the First Affiliated Hospital of Henan University of Science and Technology; Luoyang China
| | - Shaoxin Wang
- Department of Cardiovascular-Internal Medicine; the First Affiliated Hospital of Henan University of Science and Technology; Luoyang China
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20
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Zachariah JP, Graham DA, de Ferranti SD, Vasan RS, Newburger JW, Mitchell GF. Temporal trends in pulse pressure and mean arterial pressure during the rise of pediatric obesity in US children. J Am Heart Assoc 2014; 3:e000725. [PMID: 24811611 PMCID: PMC4309055 DOI: 10.1161/jaha.113.000725] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Somatic growth in childhood is accompanied by substantial remodeling of the aorta. Obesity is associated with increased aortic stiffness and flow and may interfere with aortic remodeling during growth. Wide pulse pressure (PP) indicates mismatch between aortic impedance and pulsatile flow and increases risk for future systolic hypertension and cardiovascular disease (CVD). We hypothesized that the rise of pediatric obesity would be associated with a temporal trend to higher PP. Methods and Results We analyzed demographic, anthropometric, and blood pressure (BP) data for 8‐ to 17‐year‐old children (N=16 457) from the cross‐sectional National Health and Nutrition Examination Surveys (NHANES) for 1976 through 2008. Multivariable adjusted survey regression was used to examine temporal trends in PP and mean arterial pressure (MAP) and the relation to obesity. Across this period, unadjusted PP was higher (0.29 mm Hg/y, 95% CI 0.26 to 0.33 mm Hg/y; P<0.0001), while MAP was lower (−0.24 mm Hg/y, 95% CI −0.27 to −0.20 mm Hg/y; P<0.0001) across examinations. Adjusting for body mass index partially attenuated the temporal trend for PP by 32% (P<0.0001). Obesity amplified the relation between taller height and higher PP (from 0.23 [95% CI 0.19 to 0.28] to 0.27 [95% CI 0.21 to 0.34] mm Hg/cm height in boys and from 0.08 [95% CI 0.04 to 0.13] to 0.22 [95% CI 0.13 to 0.31] mm Hg/cm height in girls; P<0.01 for both). Conclusions PP has increased during the rise of pediatric obesity. Higher PP may indicate mismatch between aortic diameter, wall stiffness, and flow in obese children during a period of rapid somatic growth when the aorta is already under considerable remodeling stress.
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Affiliation(s)
- Justin P Zachariah
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
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21
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Howe LD, Zimmermann E, Weiss R, Sørensen TIA. Do rapid BMI growth in childhood and early-onset obesity offer cardiometabolic protection to obese adults in mid-life? Analysis of a longitudinal cohort study of Danish men. BMJ Open 2014; 4:e004827. [PMID: 24736038 PMCID: PMC3996819 DOI: 10.1136/bmjopen-2014-004827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Some obese individuals have no cardiometabolic abnormalities; they are 'metabolically healthy, but obese' (MHO). Similarly, some non-obese individuals have cardiometabolic abnormalities, that is, 'metabolically at risk, normal weight' (MANW). Previous studies have suggested that early-onset obesity may be associated with MHO. We aimed to assess whether body mass index (BMI) in childhood and early-onset obesity are associated with MHO. SETTING General population longitudinal cohort study, Denmark. PARTICIPANTS From 362 200 young men (mean age 20) examined for Danish national service between 1943 and 1977, all obese men (BMI ≥31 kg/m(2), N=1930) were identified along with a random 1% sample of the others (N=3601). Our analysis includes 2392 of these men attending a research clinic in mid-life (mean age 42). For 613 of these men, data on childhood BMI are available. We summarised childhood BMI growth (7-13 years) using a multilevel model. Early-onset obesity was defined as obesity at examination for national service. OUTCOME MEASUREMENT We defined metabolic health at the mid-life clinic as non-fasting serum cholesterol <6.6 mmol/L, non-fasting glucose <8.39 mmol/L and pulse pressure <48 mm Hg. Participants were categorised into four groups according to their obesity (BMI ≥30 kg/m(2)) and metabolic health in mid-life. RESULTS 297 of 1097 (27.1%) of obese men were metabolically healthy; 826 of 1295 (63.8%) non-obese men had at least one metabolic abnormality. There was no evidence that rapid BMI growth in childhood or early-onset obesity was associated with either MHO or the MANW phenotype, for example, among obese men in mid-life, the OR for MHO comparing early-onset obesity with non-early-onset obesity was 0.97 (95% CI 0.85 to 1.10). CONCLUSIONS We found no robust evidence that early-onset obesity or rapid BMI growth in childhood is protective for cardiometabolic health.
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Affiliation(s)
- Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Esther Zimmermann
- Institute of Preventive Medicine, Frederiksberg and Bispebjerg Hospitals, The Capital Region, Copenhagen, Denmark
| | - Ram Weiss
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Thorkild I A Sørensen
- Institute of Preventive Medicine, Frederiksberg and Bispebjerg Hospitals, The Capital Region, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Novo Nordisk Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
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22
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Song Y, Shim JK, Song JW, Shim CY, Kim EK, Kwak YL. Association of Carotid Arterial Circumferential Strain With Left Ventricular Function and Hemodynamic Compromise During Off-Pump Coronary Artery Bypass Surgery. Circ J 2014; 78:2422-30. [DOI: 10.1253/circj.cj-14-0378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Young Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Chi-Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Eui-Kyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
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23
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Al-Shafei AIM. Ramadan fasting ameliorates arterial pulse pressure and lipid profile, and alleviates oxidative stress in hypertensive patients. Blood Press 2013; 23:160-7. [PMID: 24059637 DOI: 10.3109/08037051.2013.836808] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM Effects of Ramadan fasting on health are important. Its effects on arterial pulse pressure (PP), lipid profile and oxidative stress were characterized in hypertensives. METHODS PP, indices of lipid profile and oxidative stress were measured pre-, during and post-fasting in equal (40 each), sex- and age-matched groups (age 55 ± 5 years) of hypertensives (HT) and controls (C). RESULTS Fasting reduced PP significantly by 17.2% and insignificantly by 9.3% in the HT and C groups, respectively. Total cholesterol (TC) was lowered insignificantly by 11.7% and 4.7% in the HT and C patients, respectively. Triglycerides (TG) and malondialdehyde (MDA) were significantly lowered by: TG: 24.5% and 22.8%; MDA: 45.6% and 54.3%; while glutathione (GSH) elevated by 56.8% and 52.6% in the HT and C groups, respectively. High-density lipoproteins (HDL) were raised significantly by 33.3% and insignificantly by 6.7%, whereas low-density lipoproteins (LDL) decreased significantly by 17.7% and insignificantly by 4.0% in the HT and C groups, respectively. At 6 weeks post-fasting, MDA remained significantly lower than the pre-fasting level by 24.3% and 25.7%, and GSH higher by 30.2% and 26.3% in the HT and C groups, respectively, while PP and TC returned to pre-fasting values in both groups. The post-fasting, HDL was significantly higher by 20.3% and LDL lower by 12.0% than the fasting levels in the HT patients. CONCLUSION Fasting improves PP and lipids profile and ameliorates oxidative stress in hypertensives.
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Affiliation(s)
- Ahmad I M Al-Shafei
- Department of Physiology, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University (IMSIU) , Riyadh , Kingdom of Saudi Arabia
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24
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Daien V, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber is associated with renal function in apparently healthy subjects. Acta Ophthalmol 2013; 91:e283-8. [PMID: 23406335 DOI: 10.1111/aos.12094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the relation between retinal vascular caliber and renal function. PATIENTS AND METHODS Eighty apparently healthy subjects screened for cardiovascular risk factors (mean age 47 years, 51% female, 36% hypertensive, without diabetes or renal dysfunction) were recruited. Retinal vascular calibers were measured from fundus photographs and expressed as central retinal artery and venular equivalent. Renal function was assessed by measurement of glomerular filtration rate (urinary clearance of 99mTc-DTPA) and urinary albumin/creatinine ratio. RESULTS Mean glomerular filtration rate was 117 ml/min/1.73m(2). Overall, central retinal artery and venular equivalent were positively correlated with glomerular filtration rate (r = +0.31, p = 0.005 and r = +0.30, p = 0.006, respectively). In addition, central retinal artery equivalent was negatively correlated with urinary albumin/creatinine ratio (r = -0.34, p = 0.002). No significant relationship was found between central retinal venular equivalent and urinary albumin/creatinine ratio (r = +0.12, p = 0.32). The observed relations between retinal vascular calibers and renal function parameters remained significant after adjusting for potential confounding factors. CONCLUSION In apparently healthy subjects with normal renal function, retinal arteriolar and venular calibers were negatively correlated with kidney function, suggesting common determinants of these preclinical target organ damages.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.
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25
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Shatat IF, Flynn JT. Relationships between renin, aldosterone, and 24-hour ambulatory blood pressure in obese adolescents. Pediatr Res 2011; 69:336-40. [PMID: 21178817 DOI: 10.1203/pdr.0b013e31820bd148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Renin-angiotensin system (RAS) activation and abnormalities of ambulatory blood pressure (ABP) are present in obesity, but relationships between components of the RAS and ABP have not been defined in the young. Anthropometric measurements and 24-h ABP were obtained on 30 obese adolescents with and without type 2 diabetes mellitus. Plasma renin activity (PRA), aldosterone, and other cardiovascular risk factors were measured. Median PRA levels were 2.5 [interquartile range (IQR), 1.7-4.1] ng/mL/h and were higher in the diabetic subjects compared with the nondiabetics. Females had significantly higher PRA than males 3.2 (IQR, 2-4.8) versus 1.8 (IQR, 1.1-2.9) ng/mL/h (p = 0.04) and were more obese. BMI Z score and PRA were significantly correlated (rho = 0.46, p < 0.001). PRA inversely correlated with 24-h systolic ABP (rho = -0.46, p = 0.02) and strongly with 24-h pulse pressure (rho = -0.61, p = 0.001). Aldosterone levels were also correlated with 24-h pulse pressure (rho = -0.46, p = 0.02). In multivariate models, lower PRA was independently associated with 24-h systolic blood pressure. In this study, PRA was positively correlated with BMI, but the relationships between components of the RAS and ABP were inverse. Further studies are needed to define the pathophysiologic relationship between RAS components and blood pressure regulation in obese youth.
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Affiliation(s)
- Ibrahim F Shatat
- Division of Pediatric Nephrology, The Medical University of South Carolina Children's Hospital, Charleston, South Carolina 29425, USA.
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26
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Hallal PC, Menezes AMB, Bertoldi AD, Dumith SC, Araújo CL. Resting pulse rate among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. CAD SAUDE PUBLICA 2010; 26:1963-71. [DOI: 10.1590/s0102-311x2010001000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 09/14/2009] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe resting pulse rate and associated factors among adolescents. This was a cross-sectional analysis nested in a prospective cohort study, including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil in 1993, representing 87.5% of the original cohort. Pulse rate was measured with an electronic device at the beginning and end of the interview, and the mean value was used in the analyses. Mean pulse rate was 78.4bpm (SD = 11.0) in the total sample, 76.5bpm (SD = 10.7) in boys, and 80.2bpm (SD = 10.9; p < 0.001) in girls. Black adolescents showed lower mean pulse rates. There was a direct association between pulse rate and blood pressure. Physical activity was inversely associated with pulse rate in the crude analysis only. Elevated pulse rate is strongly associated with high blood pressure, and both variables are predictors of risk of chronic disease in adulthood.
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Affiliation(s)
- Pedro C. Hallal
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Brasil
| | | | | | | | - Cora Luiza Araújo
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Brasil
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27
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Baba Y, Ishikawa S, Kayaba K, Gotoh T, Kajii E. High pulse pressure is associated with increased risk of stroke in Japanese: the JMS Cohort Study. Blood Press 2010; 20:10-4. [PMID: 20831451 DOI: 10.3109/08037051.2010.516075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relationship between pulse pressure (PP) and stroke has been described in populations outside Japan. Here, we investigated the relationship between PP and stroke incidence in Japan. METHODS Study subjects were 11,097 people (4315 men and 6782 women) in 12 rural areas of Japan enrolled in the Jichi Medical School Cohort Study, a population-based prospective study. The subjects were divided into quintiles of PP. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995, and the incidence of all strokes and stroke subtypes was monitored. RESULTS A total of 412 strokes were observed during a mean follow-up period of 10.7 years. After adjusting for age, smoking status, drinking status, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, body mass index and diabetes mellitus, hazard ratios [HRs] in the second to fifth quintiles of PP for all strokes were 1.06 (95% confidence interval [CI] 0.69-1.64), 1.53 (CI 1.02-2.28), 2.02 (CI 1.38-2.96) and 2.22 (CI 1.53-3.20) compared with the first quintile using Cox's proportional hazard model, respectively. CONCLUSION Our findings suggest high PP is at an increased risk of stroke.
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Affiliation(s)
- Yosuke Baba
- Haga Red Cross Hospital, 2461 Dai-machi, Moka, Tochigi, Japan.
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28
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Solomon A, Christian BF, Norton GR, Woodiwiss AJ, Dessein PH. Risk factor profiles for atherosclerotic cardiovascular disease in black and other Africans with established rheumatoid arthritis. J Rheumatol 2010; 37:953-60. [PMID: 20231201 DOI: 10.3899/jrheum.091032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Black Africans reportedly experience a distinctly low risk for atherosclerotic cardiovascular disease (CVD). We investigated whether this protection was present among Africans with established rheumatoid arthritis (RA). METHODS We determined disparities in CVD risk factor profiles (major conventional: hypertension, dyslipidemia, smoking, and diabetes; other conventional: underweight, obesity, metabolic syndrome, chronic kidney disease, alcohol consumption, tension, depression, and body height; nonconventional: rheumatoid factor status and markers of inflammation) and arterial stiffness (brachial pulse pressure) between 291 black and 335 other (229 white, 64 Asian, and 42 mixed ancestry) consecutive Africans with RA in multivariable regression models. RESULTS After adjusting for demographic characteristics and healthcare sector attendance, black Africans had more prevalent hypertension (OR 1.76, p = 0.01) and diabetes (OR 1.90, p = 0.07), smoked less frequently (OR 0.12, p < 0.0001), and had concurrent lower total and high-density lipoprotein cholesterol concentrations that resulted in unaltered atherogenic indices (p = 0.2) than the other participants in the study. These findings translated into global scores for major conventional risk factor-mediated future CVD event rates that were not reduced in black patients. Proportions of individual metabolic syndrome components differed between black and other patients but their total numbers of metabolic risk factors (p = 0.4) and metabolic syndrome frequencies (OR 1.44, p = 0.1) were similar. Black ethnicity did not independently associate with rheumatoid factor status, markers of inflammation, and brachial pulse pressures. CONCLUSION The overall conventional and nonconventional atherosclerotic CVD risk burdens and arterial stiffness were not reduced in black patients with RA. CVD risk should be assessed and managed independent of ethnic origin and epidemiological transition stage in RA.
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Affiliation(s)
- Ahmed Solomon
- Department of Rheumatology, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Relation of blood pressure components and categories and all-cause, stroke and coronary heart disease mortality in urban Chinese women: a population-based prospective study. J Hypertens 2009; 27:468-75. [PMID: 19262225 DOI: 10.1097/hjh.0b013e3283220eb9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine whether various levels of blood pressure (BP), particularly normal and high normal BP or prehypertension, predict cardiovascular mortality among urban Chinese women. METHODS We evaluated the impact of all measures of BP on total mortality and stroke and coronary heart disease (CHD)-specific mortality in a population-based cohort study, the Shanghai Women's Health Study. Included in this analysis were 68 438 women aged 40-70 years at baseline for whom BP was assessed. RESULTS During an average of 5 years of follow-up, we identified 1574 deaths from all causes, 247 from stroke and 91 from CHD. Hypertension and higher levels of individual BP parameters including systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were positively associated with all-cause, stroke, and CHD mortality (Ptrend < 0.05 for all except for DBP and CHD mortality). Prehypertension [adjusted hazard ratio (HRadj) = 1.65; 95% confidence interval, 0.98-2.78], particularly high normal BP (HRadj = 2.34; 95% confidence interval, 1.32-4.12), was associated with an increased risk of mortality from stroke. Hypertension accounted for 9.3% of mortality from all causes, 25.5% of mortality from stroke, and 21.7% mortality from CHD. High normal BP accounted for 10.8% of mortality from stroke. Isolated systolic BP also predicted stroke and mortality from CHD. CONCLUSION Hypertension is a significant contributor to mortality, particularly stroke and CHD mortality, among women in Shanghai. High normal BP is associated with high stroke mortality.
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Alici G, Aliyev F, Bellur G, Okcun B, Türkoğlu C, Karpuz H. Effect of Seven Different Modalities of Antihypertensive Therapy on Pulse Pressure in Patients with Newly Diagnosed Stage I Hypertension. Cardiovasc Ther 2009; 27:4-9. [DOI: 10.1111/j.1755-5922.2008.00066.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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31
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Anan F, Masaki T, Eto T, Fukunaga N, Iwao T, Kaneda K, Eshima N, Saikawa T, Yoshimatsu H. Postchallenge plasma glucose and glycemic spikes are associated with pulse pressure in patients with impaired glucose tolerance and essential hypertension. Hypertens Res 2008; 31:1565-71. [PMID: 18971531 DOI: 10.1291/hypres.31.1565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated pulse pressure (PP) is associated with an increased risk of cardiovascular events. We examined whether PP is associated with post-challenge hyperglycemia in Japanese patients with essential hypertension and impaired glucose tolerance (IGT). In a total of 70 untreated essential hypertensive patients (age: 57+/-4 years, mean+/-SD; males=35, females=35), 24-h ambulatory blood pressure (ABP) monitoring, 75 g oral glucose tolerance testing (OGTT), metabolic analysis and echocardiography were performed. Patients were categorized into a high PP group (PP>or=60 mmHg, n=33) or a normal PP group (PP<60 mmHg, n=37). In all patients, 24-h systolic ABP, daytime systolic ABP, nighttime systolic ABP, and nighttime heart rate were significantly higher in the high PP group. Additionally, fasting immunoreactive insulin (F-IRI), homeostasis model assessment (HOMA) index, left ventricular mass index (LVMI) were also elevated in the high PP group. Finally, the high PP group exhibited impaired insulin secretion, increased post-challenge glucose concentrations and greater glucose spikes (PGS) during 75 g OGTT. Of the parameters measured, 24-h PP correlated positively with age, triglyceride, uric acid, F-IRI, HOMA index, 1-h postload glucose and insulin, 2-h postload glucose and insulin, PGS60, PGS120, PGSmax, LVMI, and deceleration time but correlated negatively with HDL-cholesterol and E/A ratio. Multiple regression analysis revealed that PP level was independently predicted by age, LVMI, and PGS120. Our results show that age, LVMI, and PGS120 are significantly associated with high PP in Japanese patients with IGT and essential hypertension.
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Affiliation(s)
- Futoshi Anan
- First Department of Internal Medicine, Faculty of Medicine, Oita University, and Department of Cardiology, Oita Red Cross Hospital, Oita, Japan.
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32
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Jörneskog G, Kahan T, Ekholm M, Bröijersén A, Wallén NH. Altered vascular responses to circulating angiotensin II in familial combined hyperlipidemia. J Cardiovasc Med (Hagerstown) 2008; 9:1037-44. [DOI: 10.2459/jcm.0b013e32830a48bd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wakabayashi I, Masuda H. Relationships Between Vascular Indexes and Atherosclerotic Risk Factors in Patients With Type 2 Diabetes Mellitus. Angiology 2008; 59:567-73. [DOI: 10.1177/0003319707312517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The relationships of cardio-ankle vascular index, (a new indicator of arterial stiffness), common carotid artery intima-media thickness, and ankle-brachial pressure index with atherosclerotic risk factors were compared in patients with type 2 diabetes. There were significant correlations between each pair of the above vascular indexes. Both cardio-ankle vascular index and intima-media thickness showed significant correlations with age, systolic blood pressure, pulse pressure, and serum total cholesterol. Ankle-brachial pressure index showed a significant negative correlation with pulse pressure but not with systolic blood pressure and total cholesterol. Logistic regression analysis showed that cardio-ankle vascular index and intima-media thickness were associated with systolic blood pressure and pulse pressure independently of age. These results suggest that there are significant associations among the 3 vascular indexes and that systolic blood pressure and pulse pressure are major, age-independent determinants of cardio-ankle vascular index and common carotid artery intima-media thickness in patients with diabetes.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine,
| | - Hiroshi Masuda
- Department of Internal Medicine, Nishinomiya Kaisei Hospital Hyogo, Japan
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Wakabayashi I, Masuda H. Association of pulse pressure with carotid atherosclerosis in patients with type 2 diabetes mellitus. Blood Press 2007; 16:56-62. [PMID: 17453753 DOI: 10.1080/08037050701248051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pulse pressure is known to be a potent risk factor for cardiovascular disease. However, it has not been determined whether pulse pressure is associated with cerebrovascular disease in patients with diabetes mellitus. The purpose of the present study was to investigate association of pulse pressure with carotid atherosclerosis in patients with diabetes and to determine whether age and gender affect the association. A cross-sectional study was performed using outpatients with type 2 diabetes. Carotid atherosclerosis and arterial stiffness were evaluated by intima-media thickness of common carotid arteries (IMT) and aortic pulse wave velocity (a-PWV), respectively. The relationship of brachial pulse pressure with IMT was analyzed. Pulse pressure was significantly correlated with age, duration of diabetes, systolic blood pressure, serum sialic acid, a-PWV and IMT. The mean IMT in the highest tertile group of pulse pressure after adjustment for gender was significantly higher than the mean IMT in the lowest tertile group. In analysis using subgroups of gender, a significant correlation between pulse pressure and IMT was shown in women but not in men. In multiple regression analysis, there was a significant correlation between pulse pressure and IMT in women independently of age, body mass index, systolic blood pressure, hemoglobin A1c, atherogenic index, a-PWV, history of therapy for hypertension and history of nephropathy. The results of this study suggest that pulse pressure is a major age-independent predictor of carotid atherosclerosis in female patients with diabetes.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
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Cardús A, Panizo S, Parisi E, Fernandez E, Valdivielso JM. Differential effects of vitamin D analogs on vascular calcification. J Bone Miner Res 2007; 22:860-6. [PMID: 17352647 DOI: 10.1359/jbmr.070305] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED We tested the effects of calcitriol and its analog paricalcitol on VSMC calcification in vitro and in vivo. For that reason, cells and animals with five-sixths nephrectomy were treated with both compounds. Calcitriol, but not paricalcitol, increased VSMC calcification in vitro and in vivo independently of calcium and phosphate levels. This increase in calcification was parallel to an increase in the RANKL/OPG ratio. INTRODUCTION Vascular calcification is a common finding in patients with endstage renal disease. Furthermore, those patients often present secondary hyperparathyroidism, partly because of a decrease of calcitriol synthesis on the kidney. Thus, one of the main therapeutic options is to treat those patients with calcitriol or analogs. However, this treatment presents unwanted side effects, such as increases in vascular calcification. MATERIALS AND METHODS We tested the effect on vascular smooth muscle cell (VSMC) calcification of calcitriol and one of its analogs, paricalcitol, in vitro and in vivo in animals with endstage renal disease. RESULTS Calcitriol increased calcification of VSMCs cultured in calcification media. This effect was not present when cells were incubated with paricalcitol. Furthermore, only cells incubated with calcitriol showed an increased RANKL/osteoprotegerin (OPG) expression. Animals with renal failure treated with hypercalcemic doses of calcitriol and paricalcitol showed an increase in systolic blood pressure. However, diastolic blood pressure only raised significantly in those animals treated with paricalcitol. This effect led to a significant increase in pulse pressure in animals treated with calcitriol. The increase in pulse pressure was likely caused by the extensive calcification observed in arteries of animals treated with calcitriol. This increase in calcification was not seen in arteries of animals treated with paricalcitol, despite having similar levels of serum calcium and phosphorus as animals treated with calcitriol. Furthermore, the decreases in serum PTH levels were similar in both treatments. CONCLUSIONS We conclude that paricalcitol has a different effect than calcitriol in VSMC calcification and that this could explain part of the differences observed in the clinical settings.
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MESH Headings
- Animals
- Aorta/chemistry
- Aorta/drug effects
- Aorta/pathology
- Blood Pressure/drug effects
- Bone Density Conservation Agents/pharmacology
- Calcinosis/blood
- Calcinosis/chemically induced
- Calcinosis/genetics
- Calcitriol/pharmacology
- Calcium/analysis
- Calcium/blood
- Calcium/metabolism
- Cells, Cultured
- Ergocalciferols/pharmacology
- Gene Expression/drug effects
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Nephrectomy
- Osteoprotegerin/genetics
- Parathyroid Hormone/blood
- Phosphorus/blood
- RANK Ligand/genetics
- Rats
- Rats, Sprague-Dawley
- Vascular Diseases/blood
- Vascular Diseases/chemically induced
- Vascular Diseases/genetics
- Vitamin D/analogs & derivatives
- Vitamin D/pharmacology
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Affiliation(s)
- Anna Cardús
- Department of Medicine, University of Lleida, Lleida, Spain
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Abstract
BACKGROUND Wide pulse pressure is a potent risk factor for atherosclerotic disease, and hypertension is induced by habitual alcohol drinking. This concise study investigated whether age affects the relationship between alcohol drinking and pulse pressure. METHODS The participants were 99 661 male workers (20-69 years old) who had received periodic health check-ups. The mean levels of pulse pressure and blood pressure were compared among three different groups divided by the average amount of daily alcohol intake (nondrinkers; light drinkers, < 30 g ethanol/day; heavy drinkers, >or= 30 g ethanol/day) in each age group. RESULTS The mean pulse pressure was decreased in the thirties and forties age groups compared with that in the twenties age group, and then was increased with advance of age in the fifties and sixties age groups. Pulse pressure was significantly wider in heavy drinkers than in nondrinkers and light drinkers in all age groups, and the difference between pulse pressure of nondrinkers and that of heavy drinkers was greater in the fifties and sixties age groups than in the younger groups. Pulse pressure in light drinkers was significantly wider than that in nondrinkers in the fifties and sixties age groups but was not different from that in nondrinkers in the twenties to forties age groups. CONCLUSIONS Association of alcohol intake with pulse pressure is dependent on the amount of alcohol and is stronger in the elderly. Age as well as amount of alcohol intake should therefore be taken into account when the influence of alcohol drinking on pulse pressure is considered.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
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Karpanou EA, Vyssoulis GP, Stefanadis CI, Cokkinos DV. Differential pulse pressure response to various antihypertensive drug families. J Hum Hypertens 2006; 20:765-71. [PMID: 16855624 DOI: 10.1038/sj.jhh.1002069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pulse pressure (PP) is emerging as a major pressure predictor of cardiac disease. The study comprised 10 185 untreated patients with essential hypertension. A total of 5395 men and 4790 women 56+/-13 years old, with uncomplicated essential hypertension, after a 15-day washout period and after 6 months of antihypertensive monotherapy were included. All patients included in the final cohort were responders and had normalized their blood pressure. PP was decreased least with diuretics (-5 mm Hg) and most with angiotensin II receptor blockers (ARBs) and calcium antagonists (-15 mm Hg), followed by angiotensin-converting enzyme inhibitors (ACEI) (-12 mm Hg) alpha- and beta-blockers (-10 and -9 mm Hg), differentiating among antihypertensive classes (P<0.001). The magnitude of PP fall was related to the degree of left ventricular (LV) mass reduction (P<0.001), seen best with ARBs (r=0.42) and least with ACEIs (r=0.18). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists, whereas diuretics confer poor response. PP was decreased least with diuretics (-5 mm Hg) and most with ARBs and calcium channel blockers (-15 mm Hg), followed by ACEI (-12 mm Hg) alpha- and beta-blockers (-10 and -9 mm Hg), differentiating among antihypertensive classes (P<0.001). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists.
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Affiliation(s)
- E A Karpanou
- 1st Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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Aboyans V, Criqui MH. Can we improve cardiovascular risk prediction beyond risk equations in the physician's office? J Clin Epidemiol 2006; 59:547-58. [PMID: 16713516 DOI: 10.1016/j.jclinepi.2005.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 10/09/2005] [Accepted: 11/07/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Beyond a global estimation of the cardiovascular risk through the assessment of major risk factors and their integration in dedicated risk scales or equations, the use of specific markers provides additive prognostic information at an individual level, including predisposing factors, which are not included in the risk equations as well as the individual susceptibility to their long-term exposure. However, the majority of these markers require specific devices and skills, which are not widely available in primary care. METHODS Some clinical and/or "low-cost" parameters are shown to be valuable risk markers, and their use could refine the risk estimation in a physician's office. Several epidemiologic studies suggest the heart rate, the pulse pressure and the ankle-brachial index are effective cardiovascular risk markers. The arms systolic pressure asymmetry could also be a useful marker of risk. RESULTS AND CONCLUSIONS Through a general review, the authors evaluate the potential of these clinical markers, including their use in combination for more accurate risk determination.
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Affiliation(s)
- Victor Aboyans
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France.
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Alli C, Mariotti G, Avanzini F, Colombo F, Barlera S, Tognoni G. Long-term prognostic impact of repeated measurements over 1 year of pulse pressure and systolic blood pressure in the elderly. J Hum Hypertens 2005; 19:355-63. [PMID: 15772693 DOI: 10.1038/sj.jhh.1001827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Systolic blood pressure (SBP) and pulse pressure (PP) have been identified in western industrialized countries as major predictors of cardiovascular events in the elderly on the basis of measurements taken at a single visit. Considering the wide variability of blood pressure (BP) in older people, this study set out to assess the prognostic significance of measurements of SBP and PP taken over several months according to a monitoring scheme mimicking routine care. A total of 444 Italian general practitioners enrolled a cohort of 3858 unselected elderly outpatients and followed them up for 10 years. BP was recorded at recruitment, 1 week later and at quarterly visits during the first year. The average BP of these six visits was used to define the patient's BP status. During the 10-year follow-up, 1561 participants died, 709 from cardiovascular diseases. Proportional hazard regression analysis, adjusted for all main prognostic factors including antihypertensive treatment, showed that for each 10-mmHg increment in SBP and PP there were, respectively, 5 and 9% increases in risk for total mortality (TM) and 9 and 13% increases in risk for cardiovascular mortality (CVM) (all P < 0.01). However, including both SBP and PP in the model, only PP showed an independent, significant relationship with TM and CVM. In conclusion, prognostic information based on repeated measurements of PP is stronger than that given by SBP and consequently should be recommended in the definition of cardiovascular risk in the elderly.
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Affiliation(s)
- C Alli
- Dipartimento di Ricerche Cardiovascolari, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Verhave JC, Fesler P, du Cailar G, Ribstein J, Safar ME, Mimran A. Elevated Pulse Pressure Is Associated With Low Renal Function in Elderly Patients With Isolated Systolic Hypertension. Hypertension 2005; 45:586-91. [PMID: 15738348 DOI: 10.1161/01.hyp.0000158843.60830.cf] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past decade, pulse pressure has emerged as a strong predictor of cardiovascular morbidity and mortality. During aging, elevation of pulse pressure is a consequence of stiffening of the arterial wall. The relationship between pulse pressure and the renal aging process was studied in a cohort of 212 patients with never-treated isolated systolic hypertension. Glomerular filtration rate and effective renal plasma flow were measured using constant infusion of technetium 99m (
99m
Tc)-DTPA and
131
I-ortho-iodohippurate, respectively, and timed urine collections. The relationship between pulse pressure and renal function was studied using a linear regression model in the total population and in 40 to 49, 50 to 59, and 60 years and older age categories. In the whole population, there was an inverse relationship between pulse pressure and glomerular filtration rate; however, this relation did not persist after adjustment for age. In fact, the inverse relationship between pulse pressure and glomerular filtration rate was only present in patients 60 years of age or older. This relationship in elderly patients remained after adjustment for age, gender, MAP, and cardiovascular risk factors (
P
=0.006). It is suggested that pulse pressure, a marker of arterial stiffening, may have a detrimental influence on the age-related decline in glomerular filtration rate, after 60 years of age in patients with never-treated isolated systolic hypertension.
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Nakano S, Konishi K, Furuya K, Uehara K, Nishizawa M, Nakagawa A, Kigoshi T, Uchida K. A prognostic role of mean 24-h pulse pressure level for cardiovascular events in type 2 diabetic subjects under 60 years of age. Diabetes Care 2005; 28:95-100. [PMID: 15616240 DOI: 10.2337/diacare.28.1.95] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prognostic role of ambulatory 24-h pulse pressure (PP) on various vascular events in relatively young type 2 diabetic subjects under 60 years of age. RESEARCH DESIGN AND METHODS In this prospective study, 237 type 2 diabetic subjects without any history of vascular complications were analyzed. After excluding 9 dropout subjects, 228 subjects (mean age, 46 years; 69% men; mean follow-up period, 100 months) entered the study. RESULTS Distribution of 24-h PP for all subjects showed left skewed data, indicating that there may be a diabetic subgroup that had a wide PP. Therefore, further analysis was performed by stratifying the diabetic subjects by quartile of 24-h PP. Outcomes for the widest quartile (n = 58; cut point = 53.3 mmHg) was then compared with those from the other narrower quartiles (n = 170). In the diabetic subjects with a wide PP, cardiovascular events occurred more frequently than those in the diabetic subjects with a narrow one (20.7 vs. 4.1%; P < 0.001), resulting in the significant difference in the cumulative incidence of cardiovascular events (P < 0.001, log-rank test), but not cerebrovascular events, between the two subgroups. The Cox model revealed that a wide 24-h PP at baseline independently predicted subsequent cardiovascular events but not cerebrovascular events. By contrast, only duration of diabetes was the risk factor for cerebrovascular events. CONCLUSIONS This study showed that a wide 24-h PP is predictive for cardiovascular events in relatively young diabetic subjects.
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Affiliation(s)
- Shigeru Nakano
- Department of Internal Medicine, Division of Endocrinology, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
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Kristjansson K, Sigurdsson JA, Lissner L, Sundh V, Bengtsson C. Blood pressure and pulse pressure development in a population sample of women with special reference to basal body mass and distribution of body fat and their changes during 24 years. Int J Obes (Lond) 2003; 27:128-33. [PMID: 12532164 DOI: 10.1038/sj.ijo.0802190] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2001] [Revised: 06/20/2002] [Accepted: 08/02/2002] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To study blood pressure and pulse pressure longitudinally and their association with basal and change of body mass index (BMI) and waist to hip ratio (WHR). DESIGN A prospective population study of 1462 women in Gothenburg, Sweden, aged 38-60 y at baseline, with a longitudinal follow-up of 24 y. OUTCOME MEASURES Incidence of hypertension, systolic and diastolic blood pressure, and pulse pressure at baseline and after 12 and 24 y of follow-up. RESULTS Systolic and diastolic blood pressure as well as pulse pressure increased with age and turned down again at high age. BMI and WHR at baseline were each independently associated with baseline systolic and diastolic blood pressure, but only BMI with pulse pressure. However, baseline BMI and WHR were not associated with change of systolic, diastolic or pulse pressure during 12 or 24 y of follow-up. Increase in BMI during the follow-up period was associated with increase in systolic and diastolic blood pressure but not with increase in pulse pressure. There were no such associations with WHR changes which, were either unrelated or in one analysis inversely related with blood pressure changes. When considering incidence of hypertension during the first 12 y of follow-up, BMI and change in BMI were significant predictors, independent of WHR. CONCLUSION Age, BMI and increments in BMI seem to be strong predictors for hypertension and increased systolic and diastolic blood pressure in women. In contrast, WHR plays a lesser and uncertain role in the development of hypertension in middle-aged women. Changes in BMI seem not to be accompanied by changes in pulse pressure during a long time follow-up.
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Affiliation(s)
- K Kristjansson
- Department of Family Medicine, Solvangur Health Centre, University of Iceland, Hafnarfjördur, Iceland.
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Stress M. Blood pressure regulation, cognition, and depression in response to orthostatic challenge in African American children: an initial investigation. Behav Med 2003; 29:27-32. [PMID: 14977245 DOI: 10.1080/08964280309596172] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Poor blood pressure regulation (BPR) in response to orthostasis could contribute to cerebral hypoperfusion and cell damage. The authors of this study examined neuropsychological function and mood in relation to BPR following orthostatic challenge in African American children, aged 6 to 9 years. Participants (N = 33) laid supine for 5 minutes, before having their BP taken. Participants then stood and had BP measured again at 1, 3, and 5 minutes. After a rest, the authors administrated neuropsychological and depression tests while the participants were seated. The authors calculated the difference between supine and 1-minute standing systolic blood pressure (SBP) and pulse pressure (PP) scores. In response to orthostatic challenge, smaller increases in SBP were predictive of decreased verbal memory whereas smaller increases in PP were associated with increased depressive symptomatology and poor prospective memory. In conclusion, less effective BPR was associated with increased depression and poor performance on some neuropsychological tests.
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Affiliation(s)
- Maureen Stress
- Finch University of Health Sciences, Chicago Medical School, Department of Clinical Psychology, USA
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Cushman WC, Materson BJ, Williams DW, Reda DJ. Pulse pressure changes with six classes of antihypertensive agents in a randomized, controlled trial. Hypertension 2001; 38:953-7. [PMID: 11641316 DOI: 10.1161/hy1001.096212] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulse pressure has been more strongly associated with cardiovascular outcomes, especially myocardial infarction and heart failure, than has systolic, diastolic, or mean arterial pressure in a variety of populations. Little is known, however, of the comparative effects of various classes of antihypertensive agents on pulse pressure. In retrospective analyses of the Veterans Affairs Single-Drug Therapy for Hypertension Study, we compared changes in pulse pressure with 6 classes of antihypertensive agents: 1292 men with diastolic blood pressure of 95 to 109 mm Hg on placebo were randomized to receive hydrochlorothiazide, atenolol, captopril, clonidine, diltiazem, prazosin, or placebo. Drug doses were titrated to achieve a goal diastolic blood pressure of <90 mm Hg during a 4- to 8-week medication titration phase. Pulse pressure change (placebo subtracted) was assessed from baseline to the end of the 3-month titration and 1-year maintenance. Mean baseline systolic, diastolic, and pulse pressures were 152, 99, and 53 mm Hg, respectively. Reductions in pulse pressure during titration were greater (P<0.001) with clonidine (6.7 mm Hg) and hydrochlorothiazide (6.2 mm Hg) than with captopril (2.5 mm Hg), diltiazem (1.6 mm Hg), and atenolol (1.4 mm Hg); reduction with prazosin (3.9 mm Hg) was similar to all but clonidine. After 1 year, pulse pressure was reduced significantly more (P<0.001) with hydrochlorothiazide (8.6 mm Hg) than with captopril and atenolol (4.1 mm Hg with both); clonidine (6.3 mm Hg), diltiazem (5.5 mm Hg), and prazosin (5.0 mm Hg) were intermediate. These data show that classes of antihypertensive agents differ in their ability to reduce pulse pressure. Whether these differences affect rates of cardiovascular events remains to be determined.
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Affiliation(s)
- W C Cushman
- Veterans Affairs Medical Center, Memphis, Tennessee, USA.
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