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Mun J, Lee J, Park SM. Real-time closed-loop brainstem stimulation modality for enhancing temporal blood pressure reduction. Brain Stimul 2024; 17:826-835. [PMID: 38997106 DOI: 10.1016/j.brs.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Traditional pharmacological interventions are well tolerated in the management of elevated blood pressure (BP) for individuals with resistant hypertension. Although neuromodulation has been investigated as an alternative solution, its open-loop (OL) modality cannot follow the patient's physiological state. In fact, neuromodulation for controlling highly fluctuating BP necessitates a closed-loop (CL) stimulation modality based on biomarkers to monitor the patient's continuously varying physiological state. OBJECTIVE By leveraging its intuitive linkage with BP responses in ongoing efforts aimed at developing a CL system to enhance temporal BP reduction effect, this study proposes a CL neuromodulation modality that controls nucleus tractus solitarius (NTS) activity to effectively reduce BP, thus reflecting continuously varying physiological states. METHOD While performing neurostimulation targeting the NTS in the rat model, the arterial BP response and neural activity of the NTS were simultaneously measured. To evaluate the temporal BP response effect of CL neurostimulation, OL (constant parameter; 20 Hz, 200 μA) and CL (Initial parameter; 11 Hz, 112 μA) stimulation protocols were performed with stimulation 180 s and rest 600 s, respectively, and examined NTS activity and BP response to the protocols. RESULTS In-vivo experiments for OL versus CL protocol for direct NTS stimulation in rats demonstrated an enhancement in temporal BP reduction via the CL modulation of NTS activity. CONCLUSION This study proposes a CL stimulation modality that enhances the effectiveness of BP control using a feedback control algorithm based on neural signals, thereby suggesting a new approach to antihypertensive neuromodulation.
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Affiliation(s)
- Junseung Mun
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Jiho Lee
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea; Department of Electrical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea; Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea; Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea.
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2
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Mancia G, Schumacher H, Böhm M, Grassi G, Teo KK, Mahfoud F, Parati G, Redon J, Yusuf S. Impact of seasonal blood pressure changes on visit-to-visit blood pressure variability and related cardiovascular outcomes. J Hypertens 2024; 42:1269-1281. [PMID: 38690947 PMCID: PMC11198955 DOI: 10.1097/hjh.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Visit-to-visit blood pressure (BP) variability associates with an increased risk of cardiovascular events. We investigated the role of seasonal BP modifications on the magnitude of BP variability and its impact on cardiovascular risk. METHODS In 25 390 patients included in the ONTARGET and TRANSCEND trials, the on-treatment systolic (S) BP values obtained by five visits during the first two years of the trials were grouped according to the month in which they were obtained. SBP differences between winter and summer months were calculated for BP variability quintiles (Qs), as quantified by the coefficient of variation (CV) of on-treatment mean SBP from the five visits. The relationship of BP variability with the risk of cardiovascular events and mortality was assessed by the Cox regression model. RESULTS SBP was approximately 4 mmHg lower in summer than in winter regardless of confounders. Winter/summer SBP differences contributed significantly to each SBP-CV quintile. Increase of SBP-CV from Q1 to Q5 was associated with a progressive increase in the adjusted hazard ratio (HR) of the primary endpoint of the trials, i.e. morbid and fatal cardiovascular events. This association was even stronger after removal of the effect of seasonality from the calculation of SBP-CV. A similar trend was observed for secondary endpoints. CONCLUSIONS Winter/summer SBP differences significantly contribute to visit-to-visit BP variability. However, this contribution does not participate in the adverse prognostic significance of visit-to-visit BP variations, which seems to be more evident after removal of the BP effects of seasonality from visit-to-visit BP variations.
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Affiliation(s)
| | | | - Michael Böhm
- Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - Koon K. Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Felix Mahfoud
- Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - Josep Redon
- Department of Medicine, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Calderón-Pérez L, Escoté X, Companys J, Alcaide-Hidalgo JM, Bosch M, Rabassa M, Crescenti A, Valls RM, Pedret A, Solà R, Mariné R, Gil-Cardoso K, Rodríguez MA, Palacios H, Del Pino A, Guirro M, Canela N, Suñol D, Galofré M, Galmés S, Palou-March A, Serra F, Caimari A, Gutiérrez B, Del Bas JM. A single-blinded, randomized, parallel intervention to evaluate genetics and omics-based personalized nutrition in general population via an e-commerce tool: The PREVENTOMICS e-commerce study. Am J Clin Nutr 2024; 120:129-144. [PMID: 38960570 DOI: 10.1016/j.ajcnut.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Personalized nutrition (PN) has been proposed as a strategy to increase the effectiveness of dietary recommendations and ultimately improve health status. OBJECTIVES We aimed to assess whether including omics-based PN in an e-commerce tool improves dietary behavior and metabolic profile in general population. METHODS A 21-wk parallel, single-blinded, randomized intervention involved 193 adults assigned to a control group following Mediterranean diet recommendations (n = 57, completers = 36), PN (n = 70, completers = 45), or personalized plan (PP, n = 68, completers = 53) integrating a behavioral change program with PN recommendations. The intervention used metabolomics, proteomics, and genetic data to assist participants in creating personalized shopping lists in a simulated e-commerce retailer portal. The primary outcome was the Mediterranean diet adherence screener (MEDAS) score; secondary outcomes included biometric and metabolic markers and dietary habits. RESULTS Volunteers were categorized with a scoring system based on biomarkers of lipid, carbohydrate metabolism, inflammation, oxidative stress, and microbiota, and dietary recommendations delivered accordingly in the PN and PP groups. The intervention significantly increased MEDAS scores in all volunteers (control-3 points; 95% confidence interval [CI]: 2.2, 3.8; PN-2.7 points; 95% CI: 2.0, 3.3; and PP-2.8 points; 95% CI: 2.1, 3.4; q < 0.001). No significant differences were observed in dietary habits or health parameters between PN and control groups after adjustment for multiple comparisons. Nevertheless, personalized recommendations significantly (false discovery rate < 0.05) and selectively enhanced the scores calculated with biomarkers of carbohydrate metabolism (β: -0.37; 95% CI: -0.56, -0.18), oxidative stress (β: -0.37; 95% CI: -0.60, -0.15), microbiota (β: -0.38; 95% CI: -0.63, -0.15), and inflammation (β: -0.78; 95% CI: -1.24, -0.31) compared with control diet. CONCLUSIONS Integration of personalized strategies within an e-commerce-like tool did not enhance adherence to Mediterranean diet or improved health markers compared with general recommendations. The metabotyping approach showed promising results and more research is guaranteed to further promote its application in PN. This trial was registered at clinicaltrials.gov as NCT04641559 (https://clinicaltrials.gov/study/NCT04641559?cond=NCT04641559&rank=1).
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Affiliation(s)
| | - Xavier Escoté
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | - Judit Companys
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | | | - Mireia Bosch
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | - Montserrat Rabassa
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain; Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain
| | - Anna Crescenti
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | - Rosa M Valls
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
| | - Anna Pedret
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain; Internal Medicine Service, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Roger Mariné
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | | | - Miguel A Rodríguez
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - Héctor Palacios
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - Antoni Del Pino
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - María Guirro
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - Núria Canela
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - David Suñol
- Eurecat, Centre Tecnològic de Catalunya, Digital Health, Barcelona, Spain
| | - Mar Galofré
- Eurecat, Centre Tecnològic de Catalunya, Digital Health, Barcelona, Spain
| | - Sebastià Galmés
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Group of Nutrigenomics, Biomarkers and Risk Evaluation - NuBE), University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Centro de investigación Biomédica en red de Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain; Alimentómica S.L. Camí de na Pontons, Campanet, Spain
| | - Andreu Palou-March
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Group of Nutrigenomics, Biomarkers and Risk Evaluation - NuBE), University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Centro de investigación Biomédica en red de Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain; Alimentómica S.L. Camí de na Pontons, Campanet, Spain
| | - Francisca Serra
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Group of Nutrigenomics, Biomarkers and Risk Evaluation - NuBE), University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Centro de investigación Biomédica en red de Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain; Alimentómica S.L. Camí de na Pontons, Campanet, Spain
| | - Antoni Caimari
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Reus, Spain
| | - Biotza Gutiérrez
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Reus, Spain
| | - Josep M Del Bas
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Reus, Spain.
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Charbel T, El Koubayati G, Kharsa C, Aoun M. Acknowledging the impact of seasonal blood pressure variation in hypertensive CKD and non-CKD patients living in a Mediterranean climate. PLoS One 2023; 18:e0293403. [PMID: 38060575 PMCID: PMC10703340 DOI: 10.1371/journal.pone.0293403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND This study aims to assess seasonal blood pressure (BP) variation in chronic kidney disease (CKD) and non-CKD patients living in a Mediterranean climate, and to find out if this variation entails significant adjustment of treatment and if it impacts renal outcomes and mortality. METHODS This retrospective study included all hypertensive patients seen between February 2006 and April 2020 in two Lebanese clinics. Regression analyses were used to assess the association of seasonal BP variability and treatment adjustment with eGFR change from baseline, dialysis initiation and death. RESULTS A total of 398 patients of 64.2 ±13.9 years were followed for 51.1 ±44.3 months, 67% had eGFR< 60 mL/min. Mean systolic and diastolic BP was 137.7 ±14.7 and 76.5 ±9.5 mmHg respectively. Systolic and diastolic BP were significantly lower in the warm season in CKD and non-CKD patients (P<0.001). The majority (91.4%) needed seasonal treatment modifications. After adjustment to age, sex, baseline eGFR, BP and number of antihypertensive drugs, we found a significant loss of eGFR with treatment modifications in both seasons, double risk of dialysis with the increase of antihypertensive treatment in both seasons and a 2.5 more risk of death with reduced treatment in the warm season. CONCLUSION This study confirmed the seasonal BP variability in CKD and non-CKD patients from a Mediterranean climate. All types of treatment adjustment were associated with eGFR loss. Low BP in the warm season was highly associated with death.
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Affiliation(s)
- Tatiana Charbel
- Faculty of Medicine, Department of Internal Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georgio El Koubayati
- Faculty of Medicine, Department of Internal Medicine, Lebanese University, Beirut, Lebanon
| | - Chloe Kharsa
- Faculty of Medicine, Department of Internal Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Mabel Aoun
- Faculty of Medicine, Department of Nephrology, Saint-Joseph University, Beirut, Lebanon
- AUB Santé, Lorient, France
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5
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Takahashi R, Maruki T, Uchiyama K, Washida N, Shibagaki K, Yanai A, Nakayama T, Hayashi K, Kanda T, Itoh H. Seasonal variation in predialysis systolic blood pressure and cardiovascular events in patients on maintenance hemodialysis. Hypertens Res 2023; 46:2192-2202. [PMID: 37420091 DOI: 10.1038/s41440-023-01364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/22/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023]
Abstract
Predialysis systolic blood pressure (SBP) in patients on hemodialysis (HD) consistently followed a seasonal pattern, reaching a peak in winter and nadir in summer, similar to blood pressure in the general population. However, the relationship between seasonal variations in predialysis SBP and clinical outcomes is still under-investigated in Japanese patients on HD. This retrospective cohort study included 307 Japanese patients undergoing HD for >1 year in three dialysis clinics and evaluated the association between the standard deviation (SD) of predialysis SBP and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) with 2.5 years follow-up. The SD of predialysis SBP was 8.2 (6.4-10.9) mmHg. In the model fully adjusted for the SD of predialysis SBP, predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, renin-angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, C-reactive protein, albumin, hemoglobin, body mass index, normalized protein catabolism rate, and intradialytic SBP decline, Cox regression analyses showed that a higher SD of predialysis SBP (per 10 mmHg) was significantly associated with increased MACE risk (hazard ratio [HR], 1.89; 95% confidence interval [95% CI], 1.07-3.36) and all-cause hospitalization (HR, 1.57; 95% CI, 1.07-2.30). Therefore, greater seasonal variations in predialysis SBP were associated with worse clinical outcomes, including MACEs and all-cause hospitalization. Whether interventions to reduce seasonal variations in predialysis SBP will improve the prognosis of Japanese patients on HD must be investigated further.
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Affiliation(s)
- Rina Takahashi
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Tomomi Maruki
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan.
| | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | | | - Akane Yanai
- Department of Nephrology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Takashin Nakayama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Hayashi
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Kanda
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
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Nilles EK, Champon X, Mulder H, Shaw KM, Smith M, Lampron ZM, Wozniak G, Chamberlain AM, Carton T, Viera AJ, Ahmad FS, Steinberg BA, Chuang CH, Mctigue KM, McClay JC, Polonsky TS, Maeztu C, Sanders M, Warren N, Singh R, Liu M, VanWormer JJ, Park S, Modrow MF, Rakotz M, Cooper-Dehoff RM, Pletcher MJ, O'Brien EC. Seasonal variation in blood pressure control across US health systems. J Hypertens 2023; 41:751-758. [PMID: 36883471 PMCID: PMC10714346 DOI: 10.1097/hjh.0000000000003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation. METHODS We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures. RESULTS Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment. CONCLUSION In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.
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Affiliation(s)
- Ester Kim Nilles
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - XiaoXia Champon
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Hillary Mulder
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Kathryn M Shaw
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Myra Smith
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Zachary M Lampron
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | | | - Alanna M Chamberlain
- Department of Quantitative Health Sciences
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas Carton
- Louisiana Public Health Institute, Tulane University, New Orleans, Louisiana
| | - Anthony J Viera
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, North Carolina
| | - Faraz S Ahmad
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Kathleen M Mctigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Tamar S Polonsky
- Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Carlos Maeztu
- Department of Health Outcomes and Policy, Clinical and Translational Science Institute, University of Florida, Gainesville, Florida
| | - Margaret Sanders
- Louisiana Public Health Institute, Tulane University, New Orleans, Louisiana
| | | | | | - Mei Liu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, Wisconsin
| | - Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | | | | | - Rhonda M Cooper-Dehoff
- Department of Pharmacotherapy and Translational Research, Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Emily C O'Brien
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
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7
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Parati G, Bilo G, Kollias A, Pengo M, Ochoa JE, Castiglioni P, Stergiou GS, Mancia G, Asayama K, Asmar R, Avolio A, Caiani EG, De La Sierra A, Dolan E, Grillo A, Guzik P, Hoshide S, Head GA, Imai Y, Juhanoja E, Kahan T, Kario K, Kotsis V, Kreutz R, Kyriakoulis KG, Li Y, Manios E, Mihailidou AS, Modesti PA, Omboni S, Palatini P, Persu A, Protogerou AD, Saladini F, Salvi P, Sarafidis P, Torlasco C, Veglio F, Vlachopoulos C, Zhang Y. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗. J Hypertens 2023; 41:527-544. [PMID: 36723481 DOI: 10.1097/hjh.0000000000003363] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment. The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Paolo Castiglioni
- IRCCS Fondazione Don Carlo Gnocchi, Milan
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Sciences, University of Leuven, and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Enrico G Caiani
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Italy
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Przemysław Guzik
- Department of Cardiology -Intensive Therapy, University School of Medicine in Poznan, Poznan, Poland
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Geoffrey A Head
- Baker Heart and Diabetes Institute, Melbourne Victoria Australia
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Eeva Juhanoja
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Turku
- Department of Oncology; Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Thomas Kahan
- Karolinska Institute, Department of Clinical Sciences, Division of Cardiovascular Medicine, Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | | | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension and Medical Genomics, National Research Centre for Translational Medicine
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital Athens, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paolo Palatini
- Department of Medicine. University of Padova, Padua, Italy
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Athanasios D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesca Saladini
- Department of Medicine. University of Padova, Padua, Italy
- Cardiology Unit, Cittadella Town Hospital, Padova, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Franco Veglio
- Internal Medicine Division and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1 Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Han M, Lee YR, Park T, Ihm SH, Pyun WB, Burkard T, Cho MC, Camafort M, Yang E, Stergiou GS, Lee HY, Seo JM. Feasibility and measurement stability of smartwatch-based cuffless blood pressure monitoring: A real-world prospective observational study. Hypertens Res 2023; 46:922-931. [PMID: 36781979 DOI: 10.1038/s41440-023-01215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
Cuffless wearable devices are currently being developed for long-term monitoring of blood pressure (BP) in patients with hypertension and in apparently healthy people. This study evaluated the feasibility and measurement stability of smartwatch-based cuffless BP monitoring in real-world conditions. Users of the first smartwatch-based cuffless BP monitor approved in Korea (Samsung Galaxy Watch) were invited to upload their data from using the device for 4 weeks post calibration. A total of 760 participants (mean age 43.7 ± 11.9, 80.3% men) provided 35,797 BP readings (average monitoring 22 ± 4 days [SD]; average readings 47 ± 42 per participant [median 36]). Each participant obtained 1.5 ± 1.3 readings/day and 19.7% of the participants obtained measurements every day. BP showed considerable variability, mainly depending on the day and time of the measurement. There was a trend towards higher BP levels on Mondays than on other days of the week and on workdays than in weekends. BP readings taken between 00:00 and 04:00 tended to be the lowest, whereas those between 12:00 and 16:00 the highest. The average pre-post calibration error for systolic BP (difference in 7-day BP before and after calibration), was 6.8 ± 5.6 mmHg, and was increased with higher systolic BP levels before calibration. Smartwatch-based cuffless BP monitoring is feasible for out-of-office monitoring in the real-world setting. The stability of BP measurement post calibration and the standardization and optimal time interval for recalibration need further investigation.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young-Ro Lee
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Taeyoung Park
- Department of Applied Statistics and Department of Statistics and Data Science, Yonsei University, Seoul, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, South Korea
| | - Thilo Burkard
- Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eugene Yang
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Jong-Mo Seo
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
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9
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Kinuta M, Hisamatsu T, Fukuda M, Taniguchi K, Komukai S, Nakahata N, Kanda H. Associations of indoor and outdoor temperatures and their difference with home blood pressure: The Masuda Study. Hypertens Res 2023; 46:200-207. [PMID: 36229531 DOI: 10.1038/s41440-022-01059-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
Ambient temperature and blood pressure (BP) are closely related; however, few studies have examined the association of out-of-office BP with indoor or outdoor temperature. The effect of the difference between indoor and outdoor temperatures on BP also remains unknown. Therefore, this study aimed to investigate the association of indoor and outdoor temperatures and their difference with home BP. We studied healthy 352 participants (mean age, 49.8 years; 46.0% women) from a population-based cohort using 2-year data on temperature and self-measured home BP. We measured home BP and indoor temperature at the same time in the morning and evening every day. Outdoor temperature during the same period was based on national data. We observed 82,900 home BP measurements in the morning and 66,420 in the evening. In the mixed-effects model adjusted for age, sex, and possible confounders, indoor temperature was inversely associated with systolic and diastolic BP in the morning and evening. A 1 °C increase in indoor temperature reduced systolic and diastolic BP by 0.37 and 0.22 mmHg, respectively, in the morning and by 0.45 and 0.30 mmHg, respectively, in the evening (all P-values<0.001). The magnitude of associations was stronger for indoor than outdoor temperature. Similarly, a 1 °C increase in indoor temperature above outdoor temperature decreased systolic and diastolic BP by 0.33 and 0.12 mmHg, respectively, in the morning and by 0.45 and 0.26 mmHg, respectively, in the evening independent of outdoor temperature (all P-values <0.001). In conclusion, controlling indoor temperature is important to stabilize home BP levels.
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Affiliation(s)
- Minako Kinuta
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Mari Fukuda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kaori Taniguchi
- Department of Environmental Medicine and Public Health, Izumo, Shimane University Faculty of Medicine, Izumo, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Noriko Nakahata
- Department of Health and Nutrition, The University of Shimane Faculty of Nursing and Nutrition, Izumo, Japan
| | - Hideyuki Kanda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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10
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Temperature, cardiovascular mortality, and the role of hypertension and renin-angiotensin-aldosterone axis in seasonal adversity: a narrative review. J Hum Hypertens 2022; 36:1035-1047. [PMID: 35618875 DOI: 10.1038/s41371-022-00707-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
Environmental temperature is now well known to have a U-shaped relationship with cardiovascular (CV) and all-cause mortality. Both heat and cold above and below an optimum temperature, respectively, are associated with adverse outcomes. However, cold in general and moderate cold specifically is predominantly responsible for much of temperature-attributable adversity. Importantly, hypertension-the most important CV risk factor-has seasonal variation such that BP is significantly higher in winter. Besides worsening BP control in established hypertensives, cold-induced BP increase also contributes to long-term BP variability among normotensive and pre-hypertensive patients, also a known CV risk factor. Disappointingly, despite the now well-stablished impact of temperature on BP and on CV mortality separately, direct linkage between seasonal BP change and CV outcomes remains preliminary. Proving or disproving this link is of immense clinical and public health importance because if seasonal BP variation contributes to seasonal adversity, this should be a modifiable risk. Mechanistically, existing evidence strongly suggests a central role of the sympathetic nervous system (SNS), and secondarily, the renin-angiotensin-aldosterone axis (RAAS) in mediating cold-induced BP increase. Though numerous other inflammatory, metabolic, and vascular perturbations likely also contribute, these may also well be secondary to cold-induced SNS/RAAS activation. This review aims to summarize the current evidence linking temperature, BP and CV outcomes. We also examine underlying mechanisms especially in regard to the SNS/RAAS axis, and highlight possible mitigation measures for clinicians.
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11
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Rotbain Curovic V, Roy N, Hansen TW, Luiza Caramori M, Cherney DZ, De Boer IH, Emanuele MA, Hirsch IB, Lingvay I, Mcgill JB, Polsky S, Pop-Busui R, Sigal RJ, Tuttle KR, Umpierrez GE, Wallia A, Rosas SE, Rossing P. Baseline risk markers and visit-to-visit variability in relation to kidney outcomes - A post-hoc analysis of the PERL study. Diabetes Res Clin Pract 2022; 193:110119. [PMID: 36265753 DOI: 10.1016/j.diabres.2022.110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Baseline risk variables and visit-to-visit variability (VV) of systolic blood pressure (SBP), HbA1c, serum creatinine, and uric acid (UA) are potential risk markers of kidney function decline in type 1 diabetes. METHODS Post-hoc analysis of a double-blind randomized placebo-controlled clinical trial investigating allopurinol's effect on iohexol-derived glomerular filtration rate (iGFR) in type 1 diabetes with elevated UA. Primary outcome was iGFR change over three years. Linear regression with backwards selection of baseline clinical variables was performed to identify an optimized model forecasting iGFR change. Furthermore, VVs of SBP, HbA1c, serum creatinine, and UA were calculated using measurements from the run-in period; thereafter assessed by linear regression, with iGFR change as the dependent variable. RESULTS 404 participants were included in the primary analyses. In the optimized baseline variable model, higher HbA1c, SBP, iGFR, albuminuria, and heart rate, and mineralocorticoid receptor antagonist prescription were associated with greater iGFR decline. Higher VV of SBP was associated with greater iGFR decline (adjusted β (ml/min/1.73 m2/50 % increase): -0.79, p = 0.01). CONCLUSIONS We identified several risk markers for faster iGFR decline in a high-risk population with type 1 diabetes. While further research is needed, our results indicate possible new and clinically feasible measures to risk stratify for DKD in type 1 diabetes.
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Affiliation(s)
| | - Neil Roy
- Joslin Diabetes Center, Boston, MA, USA
| | | | | | - David Z Cherney
- University of Toronto, University Health Network, Toronto, ON, Canada
| | | | | | | | - Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Sarit Polsky
- Barbara Davis Center for Diabetes, Denver, CO, USA
| | | | | | - Katherine R Tuttle
- University of Washington, Seattle, WA, USA; Providence Health Care, Spokane, WA, USA
| | | | | | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark; University of Copenhagen, Copenhagen, Denmark
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12
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Gillis T, Garrison S. Confounding Effect of Undergraduate Semester-Driven "Academic" Internet Searches on the Ability to Detect True Disease Seasonality in Google Trends Data: Fourier Filter Method Development and Demonstration. JMIR INFODEMIOLOGY 2022; 2:e34464. [PMID: 37113451 PMCID: PMC9987186 DOI: 10.2196/34464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 04/29/2023]
Abstract
Background Internet search volume for medical information, as tracked by Google Trends, has been used to demonstrate unexpected seasonality in the symptom burden of a variety of medical conditions. However, when more technical medical language is used (eg, diagnoses), we believe that this technique is confounded by the cyclic, school year-driven internet search patterns of health care students. Objective This study aimed to (1) demonstrate that artificial "academic cycling" of Google Trends' search volume is present in many health care terms, (2) demonstrate how signal processing techniques can be used to filter academic cycling out of Google Trends data, and (3) apply this filtering technique to some clinically relevant examples. Methods We obtained the Google Trends search volume data for a variety of academic terms demonstrating strong academic cycling and used a Fourier analysis technique to (1) identify the frequency domain fingerprint of this modulating pattern in one particularly strong example, and (2) filter that pattern out of the original data. After this illustrative example, we then applied the same filtering technique to internet searches for information on 3 medical conditions believed to have true seasonal modulation (myocardial infarction, hypertension, and depression), and all bacterial genus terms within a common medical microbiology textbook. Results Academic cycling explains much of the seasonal variation in internet search volume for many technically oriented search terms, including the bacterial genus term ["Staphylococcus"], for which academic cycling explained 73.8% of the variability in search volume (using the squared Spearman rank correlation coefficient, P<.001). Of the 56 bacterial genus terms examined, 6 displayed sufficiently strong seasonality to warrant further examination post filtering. This included (1) ["Aeromonas" + "Plesiomonas"] (nosocomial infections that were searched for more frequently during the summer), (2) ["Ehrlichia"] (a tick-borne pathogen that was searched for more frequently during late spring), (3) ["Moraxella"] and ["Haemophilus"] (respiratory infections that were searched for more frequently during late winter), (4) ["Legionella"] (searched for more frequently during midsummer), and (5) ["Vibrio"] (which spiked for 2 months during midsummer). The terms ["myocardial infarction"] and ["hypertension"] lacked any obvious seasonal cycling after filtering, whereas ["depression"] maintained an annual cycling pattern. Conclusions Although it is reasonable to search for seasonal modulation of medical conditions using Google Trends' internet search volume and lay-appropriate search terms, the variation in more technical search terms may be driven by health care students whose search frequency varies with the academic school year. When this is the case, using Fourier analysis to filter out academic cycling is a potential means to establish whether additional seasonality is present.
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Affiliation(s)
- Timber Gillis
- Department of Family Medicine University of Alberta Edmonton, AB Canada
| | - Scott Garrison
- Department of Family Medicine University of Alberta Edmonton, AB Canada
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13
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Shah NP, Clare RM, Chiswell K, Navar AM, Shah BR, Peterson ED. Trends of blood pressure control in the U.S. during the COVID-19 pandemic. Am Heart J 2022; 247:15-23. [PMID: 34902314 PMCID: PMC8662834 DOI: 10.1016/j.ahj.2021.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
Importance COVID-19 altered lifestyles and disrupted routine health care. Whether blood pressure (BP) control worsened during COVID-19 is unknown. Objective To understand whether home BP control worsened during COVID-19 across the United States (US) . Design, Setting, and Participants A population-based analysis of home BP data from 72,706 participants enrolled in a digital health hypertension control program. Data was compared before (January 2019 to March 2020) and during (April 2020 to August 2020) COVID-19. Main Outcomes and Measures Monthly mean home BP readings, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were quantified before and during the pandemic. Multivariable adjustments were made for age, sex, race, region, and months enrolled. Home BP readings were also classified based on monthly averages and highest home BP readings into risk groups: Stage 2 HTN: BP> = 135 or DBP> = 85; Uncontrolled HTN: SBP> = 145 or DBP> = 95; or Severely uncontrolled HTN: SBP> = 160 or DBP> = 100). Results Overall, 72,706 participants were enrolled in a digital health hypertension program between 1/1/2019 and 8/31/2020. Compared with participants pre-COVID-19 (n = 33,440), those during COVID-19 (n = 39,266) were of similar age (mean 53.0 ± 10.7 years vs 53.3 ± 10.8 years); sex (46% vs 50.6% female) and race (29.1% vs 34.2% non-white). Relative to pre-Covid (Apr-Aug 2019) the mean monthly number of home BP readings rose during COVID-19 (Apr-Aug, 2020), from 7.3 to 9.3 per month (P < .001). During COVID-19, participants had higher monthly adjusted mean SBP (131.6 mmHg vs. 127.5 mmHg, P < .001); DBP (80.2 mmHg vs. 79.2 mmHg, P < .001); and MAP (97.4 mmHg vs. 95.3 mmHg; P < .001). Relative to the pre-pandemic period, during COVID-19 the proportion of participants with a mean monthly BP classified as uncontrolled or severely uncontrolled hypertension also rose, 15% vs 19% and 4% vs 5%, respectively Conclusions and Relevance Based on home BP readings, mean monthly BP rose modestly after COVID-19, despite increased utilization of home monitoring. Further studies are needed to examine the longitudinal effects of the pandemic on cardiovascular disease risk factors, the impact of these on long-term population health.
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14
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Bauer F, Lindtke J, Seibert F, Rohn B, Doevelaar A, Babel N, Schlattmann P, Bertram S, Zgoura P, Westhoff TH. Impact of weather changes on hospital admissions for hypertension. Sci Rep 2022; 12:5716. [PMID: 35383236 PMCID: PMC8983729 DOI: 10.1038/s41598-022-09644-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
Blood pressure (BP) shows a seasonal variation with higher levels at lower temperatures. Many hypertensives, however, report on BP disturbances rather in association with acutely changing weather conditions than with absolute temperatures. To date, the impact of changing meteorological parameters on hypertensive episodes remains elusive. We performed a retrospective time series regression analysis on 203,703 patients in three hospitals in Germany between 2010 and 2018, of whom 7362 patients were admitted for hypertensive disease. Numbers of daily admissions for hypertension were associated with metereological data obtained from three nearby weather stations. Data comprised temperature (mean, maximal, minimal and range within 24 h), athmospheric pressure, and precipitation. Changes of these parameters were calculated over a two and three day period. There was an inverse correlation between maximal daily temperature and the number of admissions for hypertensive disease, which remained significant both after adjustment for seasonality and week day in a spline model and in a constrained distributed lag model. A decrease of maximal temperature by 5 °C was associated with a 3% increase of risk for admission for hypertension and vice versa. There were no significant effects of precipitation and athmospheric pressure on the number of admissions. With regard to all observed metereological parameters, neither the change within two, nor within three days was consistently associated with the number of daily admissions. High temperatures are associated with lower numbers of hypertensive episodes requiring hospital admission. In contrast to the subjective perception of many hypertensive patients, however, acutely changing weather conditions are not associated with a higher risk of hypertensive emergency.
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Affiliation(s)
- Frederic Bauer
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Janine Lindtke
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Felix Seibert
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Benjamin Rohn
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Adrian Doevelaar
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Nina Babel
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Informatics and Data Science, Jena University Hospital, Jena, Germany
| | - Sebastian Bertram
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Panagiota Zgoura
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Timm H Westhoff
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
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15
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Xia HS, Liu Y, Li JX, Su H, Wu YQ. Long-term amlodipine-based combination therapy attenuates seasonal variation of blood pressure in hypertensive patients. Clin Exp Hypertens 2021; 43:742-749. [PMID: 34338579 DOI: 10.1080/10641963.2021.1960363] [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: 10/20/2022]
Abstract
Objectives: This study was to investigate whether long-term amlodipine-based combination therapy attenuates seasonal variation of office blood pressure (BP) in hypertensive patients. Methods: The data of 206 patients recruited in the Nanchang site of CHIEF trial were retrospectively analyzed. All patients received an amlodipine-based therapy for three years after reaching target BP with a 12-week titration treatment. Among them, 106 patients received amlodipine plus amiloride/hydrochlorothiazide (AA group) and 100 received amlodipine plus telmisartan (AT group) therapies. These patients were followed up every three months . The difference between the highest and lowest values of outdoor temperature in each three months was calculated as the seasonal temperature difference (T-d) and seasonal BP difference was calculated in the similar way. BP control rates in each season were calculated. Results: In the three years, the highest SBP and DBP values occurred in winter and the lowest values in summer. As a result, the BP control rate in summer was the highest and that in winter was the lowest, especially for SBP. Although T-d levels were similar during three following-up years, the seasonal SBP/DBP differences in 2011 were significantly lower than 2009 (10.03 ± 5.74/6.96 ± 3.72 vs 14.36 ± 8.19/9.78 ± 5.21 mmHg, P < .05), suggesting seasonal variation in BP was obviously reduced. Meanwhile, similar change was observed in AA and AT groups. Conclusions: Besides lower BP effectively, long-term amlodipine-based combination therapy could alleviate the seasonal BP variation in high-risk hypertensive patients.
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Affiliation(s)
- Hua-Song Xia
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Yue Liu
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Ju-Xiang Li
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Hai Su
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Yan-Qing Wu
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
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16
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Narita K, Hoshide S, Kario K. Seasonal variation in blood pressure: current evidence and recommendations for hypertension management. Hypertens Res 2021; 44:1363-1372. [PMID: 34489592 DOI: 10.1038/s41440-021-00732-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/25/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Blood pressure (BP) exhibits seasonal variation, with an elevation of daytime BP in winter and an elevation of nighttime BP in summer. The wintertime elevation of daytime BP is largely attributable to cold temperatures. The summertime elevation of nighttime BP is not due mainly to temperature; rather, it is considered to be related to physical discomfort and poor sleep quality due to the summer weather. The winter elevation of daytime BP is likely to be associated with the increased incidence of cardiovascular disease (CVD) events in winter compared to other seasons. The suppression of excess seasonal BP changes, especially the wintertime elevation of daytime BP and the summertime elevation of nighttime BP, would contribute to the prevention of CVD events. Herein, we review the literature on seasonal variations in BP, and we recommend the following measures for suppressing excess seasonal BP changes as part of a regimen to manage hypertension: (1) out-of-office BP monitoring, especially home BP measurements, throughout the year to evaluate seasonal variations in BP; (2) the early titration and tapering of antihypertensive medications before winter and summer; (3) the optimization of environmental factors such as room temperature and housing conditions; and (4) the use of information and communication technology-based medicine to evaluate seasonal variations in BP and provide early therapeutic intervention. Seasonal BP variations are an important treatment target for the prevention of CVD through the management of hypertension, and further research is necessary to clarify these variations.
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Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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17
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Fujii T, Arima H, Takashima N, Kita Y, Miyamatsu N, Tanaka-Mizuno S, Shitara S, Urushitani M, Miura K, Nozaki K. Seasonal Variation in Incidence of Stroke in a General Population of 1.4 Million Japanese: The Shiga Stroke Registry. Cerebrovasc Dis 2021; 51:75-81. [PMID: 34515076 DOI: 10.1159/000518370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The purpose of this study was to investigate seasonal variation in stroke incidence using data from a large-scale stroke registry of general population in current Japan. METHODS Shiga Stroke Registry (SSR) is an ongoing population-based registry of stroke that occurred in the Shiga Prefecture in central Honshu, Japan. A total 6,688 cases of first-ever stroke, with onset dates ranging from 1 January 2011 to 31 December in 2013 were included in this study. Incidence rates of first-ever stroke in each season were estimated using the person-year approach and adjusted for age and sex using the Poisson regression models. RESULTS From 2011 to 2013, we identified a total of 6,688 stroke cases (3,570 men, 3,118 women), of which 4,480 cases had ischemic stroke (2,518 men, 1,962 women), 1,588 had intracerebral hemorrhage (857 men, 731 women) and 563 had subarachnoid hemorrhage (166 men, 397 women). Age- and sex-adjusted incidence rates of total stroke were 151 (95% confidence interval [CI] 144-160, p = <0.001 vs. summer) in spring, 130 (95% CI 122-137) in summer, 141 (95% CI 133-149, p = 0.020 vs. summer) in autumn and 170 (95% CI 161-179, p = <0.001 vs. summer) in winter. Seasonal variation was more pronounced in intracerebral hemorrhage than in ischemic stroke. CONCLUSION In the present large-scale stroke registry of general population, incidence rates of stroke were highest in winter and lowest in summer in current Japan.
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Affiliation(s)
- Takako Fujii
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshikuni Kita
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Tsuruga Nursing University, Fukui, Japan
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | | | - Satoshi Shitara
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Makoto Urushitani
- Department of Neurology, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
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18
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Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study. Hypertens Res 2021; 44:1417-1427. [PMID: 34331031 DOI: 10.1038/s41440-021-00714-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/09/2022]
Abstract
The risk factors for intradialytic systolic blood pressure decline remain poorly understood. We aimed to identify clinical and laboratory predictors of the intradialytic systolic blood pressure decline, considering its seasonal variation. In a retrospective cohort of 47,219 hemodialysis sessions of 307 patients undergoing hemodialysis over one year in three dialysis clinics, the seasonal variation and the predictors of intradialytic systolic blood pressure decline (predialysis systolic blood pressure--nadir intradialytic systolic blood pressure) were assessed using cosinor analysis and linear mixed models adjusted for baseline or monthly hemodialysis-related variables, respectively. The intradialytic systolic blood pressure decline was greatest and least in the winter and summer, respectively, showing a clear seasonal pattern. In both models adjusted for baseline and monthly hemodialysis-related parameters, calcium channel blocker use was associated with a smaller decline (-4.58 [95% confidence interval (CI), -5.84 to -3.33], P < 0.001; -3.66 [95% CI, -5.69 to -1.64], P < 0.001) and α blocker use, with a greater decline (3.25 [95% CI, 1.53-4.97], P < 0.001; 3.57 [95% CI, 1.08-6.06], P = 0.005). Baseline and monthly serum phosphorus levels were positively correlated with the decline (1.55 [95% CI, 0.30-2.80], P = 0.02; 0.59 [95% CI, 0.16-1.00], P = 0.007), and baseline and monthly normalized protein catabolic rates were inversely correlated (respectively, -22.41 [95% CI, -33.53 to -11.28], P < 0.001; 9.65 [95% CI, 4.60-14.70], P < 0.001). In conclusion, calcium channel blocker use, α blocker avoidance, and serum phosphorus-lowering therapy may attenuate the intradialytic systolic blood pressure decline and should be investigated in prospective trials.
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19
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Gorbunov VM, Smirnova MI, Koshelyaevskaya YN, Panueva NN, Furman NV, Dolotovskaya PV. The “Inverse” Seasonal Blood Pressure Variability Phenotype. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-06-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The seasonal blood pressure variability (BPV) is known to demonstrate a typical winter peak. Recently, more attention is paid to the opposite situation: the summer BP levels being higher than those in winter. This phenomenon is called inverse BPV. The present article summarizes recent data on this topic. The data of the HOMED-BP project, as well as the results of the original prospective study in 770 hypertensive patients from two Russian Federation regions (mean follow-up duration 6.4 years), were used. According to the preliminary knowledge, the prevalence of inverse BPV in hypertensive patients is relatively high (15-25%). This phenomenon is more typical for treated patients, particularly for those on combination therapy, and is associated with beta-blocker intake. Higher duration of hypertension and higher levels of some risk factors (smoking) characterize the patients with inverse BPV. According to the HOMED-BP data, patients with inverse BPV had the highest overall cardiovascular risk (hazard ratio in comparison with the reference group of “minimal” “normal” BPV was 3.07; p=0.004). In summary, inverse BPV is a potentially unfavorable BP phenotype. However, its reproducibility and prospective value deserve further investigation. The absolute magnitude of seasonal BPV in these patients, calculated using different BP measurement methods, warrants special attention.
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Affiliation(s)
- V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. I. Smirnova
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | - N. V. Furman
- Saratov State Medical University named after V.I. Razumovsky
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20
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Chen CW, Wu CH, Liou YS, Kuo KL, Chung CH, Lin YT, Kuo TBJ, Yang CCH. Roles of cardiovascular autonomic regulation and sleep patterns in high blood pressure induced by mild cold exposure in rats. Hypertens Res 2021; 44:662-673. [PMID: 33742169 DOI: 10.1038/s41440-021-00619-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 11/09/2022]
Abstract
Increased blood pressure (BP) caused by exposure to cold temperatures can partially explain the increased incidence of cardiovascular events in winter. However, the physiological mechanisms involved in cold-induced high BP are not well established. Many studies have focused on physiological responses to severe cold exposure. In this study, we aimed to perform a comprehensive analysis of cardiovascular autonomic function and sleep patterns in rats during exposure to mild cold, a condition relevant to humans in subtropical areas, to clarify the physiological mechanisms underlying mild cold-induced hypertension. BP, electroencephalography, electromyography, electrocardiography, and core body temperature were continuously recorded in normotensive Wistar-Kyoto rats over 24 h. All rats were housed in thermoregulated chambers at ambient temperatures of 23, 18, and 15 °C in a randomized crossover design. These 24-h physiological recordings either with or without sleep scoring showed that compared with the control temperature of 23 °C, the lower ambient temperatures of 18 and 15 °C not only increased BP, vascular sympathetic activity, and heart rate but also decreased overall autonomic activity, parasympathetic activity, and baroreflex sensitivity in rats. In addition, cold exposure reduced the delta power percentage and increased the incidence of interruptions during sleep. Moreover, a correlation analysis revealed that all of these cold-induced autonomic dysregulation and sleep problems were associated with elevation of BP. In conclusion, mild cold exposure elicits autonomic dysregulation and poor sleep quality, causing BP elevation, which may have critical implications for cold-related cardiovascular events.
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Affiliation(s)
- Chieh-Wen Chen
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Han Wu
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Syuan Liou
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Liang Kuo
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan
- Family Medicine Department, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Cheng-Hung Chung
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Lin
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Terry B J Kuo
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
| | - Cheryl C H Yang
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
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21
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Ciardullo S, Muraca E, Cannistraci R, Manzoni G, Perra S, Bianconi E, Oltolini A, Zerbini F, Grassi G, Mancia G, Lattuada G, Perseghin G. Seasonal variation in estimated cardiovascular risk in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2021; 31:1494-1500. [PMID: 33810954 DOI: 10.1016/j.numecd.2021.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Seasonal variations in several risk factors for cardiovascular events (CVD) were described. Here, we evaluate the impact of seasonal variations in blood pressure (BP), lipid profile and glycemic control on estimated CVD risk in patients with type 2 diabetes (T2D). METHODS AND RESULTS Retrospective monocentric study of patients with T2D who were visited at least once in the winter period and once in the summer period, less than 8 months apart, for which data related to systolic (S) BP, diastolic (D) BP, body mass index, glycosylated hemoglobin (HbA1c), total cholesterol, HDL cholesterol and smoking habit were available on both occasions. The 10-year CVD risk was calculated using the UKPDS risk engine and the ASCVD risk estimator. As many as 411 patients were included in the study. Significant within-patient differences between summer and winter were found for the absolute risk of events assessed with both calculators (Δs-w UKPDS-CHD: -1.33%, Δs-w UKPDS-Stroke: -0.84%, Δs-w ASCVD: -2.21%). The seasonal change in SBP was the main responsible for the change in risk estimated with both the UKPDS-Stroke (r2 = 0.43) and the ASCVD (r2 = 0.50) scores, while the change in total cholesterol was the main determinant of the change in risk for the UKPDS-CHD (r2 = 0.34). A significant correlation was identified between changes in temperature and changes in SBP (ρ = 0.130, p = 0.008), but not in other risk factors. CONCLUSIONS Seasonal variations in the classic CVD risk factors influence the risk estimated using validated calculators.
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Affiliation(s)
- Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
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22
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Blavier F, Barbe K, Faron G, Doutreloup S, Boukerrou M, Fuchs F, Gucciardo L. Effect of air temperature on human births, preterm births and births associated with maternal hypertension. J Matern Fetal Neonatal Med 2021; 35:6663-6669. [PMID: 33947297 DOI: 10.1080/14767058.2021.1919075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We studied potential effects of outdoor air temperatures or barometric pressure on births, preterm births and births associated with maternal hypertension. METHODS 12,269 births were retrospectively reviewed in Brussel and 25,880 in South Reunion Island. National Belgium and French weather reference centers provided outdoor air temperatures and barometric pressures from the nearest weather stations on the corresponding birthdays. Poisson regression models were used to assess if outdoor air temperatures or barometric pressure could be correlated, immediately and several days later, with the number of daily births, preterm births and births associated with hypertension. RESULTS Outdoor air temperature was significantly correlated to the number of daily births in Brussels. For each additional degree Celsius, overall births increased by 0.4% during the same day. Four days later, overall births increased by 1.8%, preterm births by 2.6% and births associated with hypertension by 5.7%. Similar observations on numbers of daily births were reported in South Reunion Island, without reaching statistical significance (p = .08). CONCLUSION As previously demonstrated in recent studies, increased air temperature leads progressively to higher rates of births and preterm births. An even stronger delayed effect of air temperature was observed on births associated with hypertension. This would be worth further investigating.
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Affiliation(s)
- Frédéric Blavier
- Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium.,Department of Obstetrics and Gynaecology, University Hospital of Montpellier, Montpellier, France
| | - Kurt Barbe
- Biostatistics and Medical Informatics, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gilles Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium
| | - Sébastien Doutreloup
- Laboratory of Climatology, Department of Geography, UR SPHERES, University of Liège, Liège, Belgium
| | - Malik Boukerrou
- Department of Gynaecology and Obstetrics, University Hospital of South Reunion Island, Saint Pierre, Reunion.,Faculty of Medicine, University of Reunion, St Denis, Reunion.,CEPOI, Perinatal Centre of Study of the Indian Ocean, St Denis, Reunion
| | - Florent Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium
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23
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Andreeva GF, Gorbunov VM. Basic Aspects of Seasonal Cardiovascular Mortality. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The review demonstrates the main aspects of seasonal cardiovascular mortality. Climatic factors, including seasonal weather changes, have a significant impact on the biosphere. People are also characterized by the seasonal dynamics of the activity of many organs and systems, biochemical parameters, and mortality. Cardiovascular mortality is also characterized by seasonal fluctuations: in winter it is maximum, in summer it is minimal. The same patterns are characteristic of mortality from cardiovascular diseases (myocardial infarction, stroke, cardiac arrhythmias, etc.). The article presents the basic patterns of seasonal cardiovascular mortality in various climatic zones, the cardiovascular mortality of countries located in the equatorial and subequatorial climatic region. In addition, the mortality displacement phenomenon, the paradox of winter mortality. The main trends in changes in cardiovascular mortality over a long period of time are demonstrated. The paper discusses some of the mechanisms that underlie the dynamics of cardiovascular mortality during the year: seasonal fluctuations in the level of vitamin D, lipids in the blood plasma, changes in hemodynamic parameters, the effects of microbial and viral infections in the cold season, etc. In addition, data on seasonal the dynamics of risk factors for cardiovascular diseases is considered: an increase in body weight, a physical activity decrease, a change in the nutrition structure in the winter, the seasonal dynamics of depression, anxiety, hostility, the relationship of seasonal cardiovascular mortality with socio-economic, demographic and other factors. In conclusion, the main ways of development and prevention of seasonal CV cardiovascular mortality M, taking into account modern technologies at the international level, for state health departments, for specific patients, are demonstrated.
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Affiliation(s)
- G. F. Andreeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
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24
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Gul M, Batur AF, Böcü K, Kaynar M, Kilic O, Göktaş S. Seasonal fluctuation of erectile dysfunction: A cross-sectional study from a tertiary university hospital across 10 years. Andrologia 2021; 53:e14019. [PMID: 33599339 DOI: 10.1111/and.14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022] Open
Abstract
Erectile dysfunction (ED) shares several risk factors with diabetes mellitus (DM), hypertension (HT) and coronary vascular disease (CVD), which were well-associated with seasonal fluctuation with the highest peak in winter. In this study, we aimed to determine whether ED demonstrates seasonal fluctuations with the above-mentioned systemic diseases. Database from a tertiary university hospital between 2010 and 2020 was deciphered to retrieve patients diagnosed with ED. Patients with primary bladder tumour and post-procedural ED constituted the negative control groups from the same study period. International index of erectile function questionnaire (IIEF-15) was used to segregate included patients into mild/moderate and severe ED groups. The probability of detecting DM, HT and CVD in patients with severe ED was significantly higher than that of with mild/moderate ED (p < 0.05). More ED symptoms emerged and were diagnosed in the winter seasons even though no statistical significance was observed between patients with mild/moderate and severe ED (p = 0.946, Cramer's V coefficient = 0.19). The seasonal variation of patients with bladder tumour and post-procedural ED groups showed no significant difference (p > 0.05, both). ED admissions are associated with higher peaks in the winter seasons. This may help in daily clinical practice to warrant better clinical and epidemiological interpretation of ED.
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Affiliation(s)
- Murat Gul
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Ali Furkan Batur
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Kadir Böcü
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Mehmet Kaynar
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Ozcan Kilic
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Serdar Göktaş
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
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25
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Five-year blood pressure trajectories of survivors of the tsunami following the Great East Japan Earthquake in Iwate. Hypertens Res 2021; 44:581-590. [PMID: 33473183 DOI: 10.1038/s41440-020-00607-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/04/2020] [Accepted: 11/15/2020] [Indexed: 11/08/2022]
Abstract
Whether tsunami survivors who suffered substantial damage experienced increases in blood pressure (BP) immediately after the disaster and in the medium to long term is unclear. We divided tsunami survivors into groups, those who relocated (substantial damage) and those who did not (little damage) and compared the BP trajectories between the groups over the first 5 years after the disaster. Of the 42,831 residents, 3914 were assessed from 2010 to 2015. Subgroup analysis was performed among the 2037 subjects with no information on antihypertensive medications between 2010 and 2015 (no antihypertensive medication group). The BP trajectories in the relocation and no relocation groups were compared using linear mixed models. The multivariate-adjusted mean systolic BP (SBP) values for all subjects significantly decreased after the disaster in both the group who relocated (2010: 130.6 mmHg, 2015: 124.8 mmHg) and the group who did not relocate (2010: 130.7 mmHg, 2015: 126.7 mmHg). The interaction between relocation and time points on SBP was significant (P = 0.017). In the no antihypertensive medication group, the SBP values in the subgroup who relocated were significantly lower in the second, third, and fifth years after the disaster than those in the subgroup who did not relocate. It was concluded that the SBP values of survivors of the tsunami caused by Great East Japan Earthquake decreased in the medium to long term after the disaster, and the group who relocated had a larger decrease in SBP than the group who did not relocate.
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26
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Mizoguchi T, Sugiura T, Dohi Y, Takase H, Yamashita S, Murai S, Seo Y, Ohte N. Home blood pressure on winter mornings could be exaggerated: A comparison with summer mornings. Clin Exp Hypertens 2020; 42:700-706. [PMID: 32522118 DOI: 10.1080/10641963.2020.1779283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Self-measured blood pressure at home (HBP) is quite important for the management of hypertension. We hypothesized that winter HBP measured according to the recommendation of the guidelines, but not HBP measured inside bed before getting up, is elevated in response to cold ambient temperatures in winter. This study aimed to investigate differences in HBP measured before and after getting up in winter and summer.Methods: Hypertensive subjects whose blood pressure was stably controlled were enrolled (n = 46, 73 years). They were instructed to measure HBP while in bed just after waking (HBP-bed), in addition to the ordinary HBP measurement in the morning (HBP-morning) according to the guidelines. The mean value of HBP for 7 consecutive days before the day of a regular hospital visit was considered as the HBP of each subject, and characteristics of the winter and summer BPs were investigated.Results: HBP-morning was significantly higher (P < .001) in winter than in summer, but HBP-bed was lower in winter than in summer (P < .05). HBP-morning was significantly higher than HBP-bed in winter, while HBP-morning was not different from HBP-bed in summer, resulting in greater changes in HBP after getting up in winter than in summer (P < .0001). Changes in HBP after getting up were significantly correlated with serum creatinine levels and the urinary albumin-to-creatinine ratio.Conclusions: These findings imply that elevated HBP-morning in winter reflects the response of BP to cold after getting up. Seasonal profiles of HBPs before and after getting up should be noted in the management of hypertension.
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Affiliation(s)
- Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University , Nagoya, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital , Hamamatsu, Japan
| | - Sumiyo Yamashita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shunsuke Murai
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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27
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Sailani MR, Metwally AA, Zhou W, Rose SMSF, Ahadi S, Contrepois K, Mishra T, Zhang MJ, Kidziński Ł, Chu TJ, Snyder MP. Deep longitudinal multiomics profiling reveals two biological seasonal patterns in California. Nat Commun 2020; 11:4933. [PMID: 33004787 PMCID: PMC7529769 DOI: 10.1038/s41467-020-18758-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The influence of seasons on biological processes is poorly understood. In order to identify biological seasonal patterns based on diverse molecular data, rather than calendar dates, we performed a deep longitudinal multiomics profiling of 105 individuals over 4 years. Here, we report more than 1000 seasonal variations in omics analytes and clinical measures. The different molecules group into two major seasonal patterns which correlate with peaks in late spring and late fall/early winter in California. The two patterns are enriched for molecules involved in human biological processes such as inflammation, immunity, cardiovascular health, as well as neurological and psychiatric conditions. Lastly, we identify molecules and microbes that demonstrate different seasonal patterns in insulin sensitive and insulin resistant individuals. The results of our study have important implications in healthcare and highlight the value of considering seasonality when assessing population wide health risk and management.
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Affiliation(s)
- M Reza Sailani
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Ahmed A Metwally
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Wenyu Zhou
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | | | - Sara Ahadi
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Kevin Contrepois
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Tejaswini Mishra
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Martin Jinye Zhang
- Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Łukasz Kidziński
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Theodore J Chu
- Department of Pediatrics, Division of Allergy and Immunology, Stanford University, Stanford, CA, 94305, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA.
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Nakanishi M, Mizuno T, Mizokami F, Koseki T, Takahashi K, Tsuboi N, Katz M, Lee JK, Yamada S. Impact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta-analysis of randomized clinical trials. J Clin Pharm Ther 2020; 46:114-120. [PMID: 32949161 DOI: 10.1111/jcpt.13262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hypertension (HTN) and chronic kidney disease (CKD) are recognized as silent killers because they are asymptomatic conditions that contribute to the burden of multiple comorbidities. The achievement of a blood pressure (BP) goal can dramatically reduce the risks of CKD. In this study, we aimed to assess the effectiveness of pharmacist intervention on BP control in patients with CKD and evaluate the usefulness of home-based BP telemonitoring. METHODS The terms "chronic kidney disease," "pharmacist," "BP" and "randomized controlled trial (RCT)" were used five databases to search for information regarding pharmacist intervention on BP control in patients with CKD. The inclusion criteria were as follows: (a) studies for adult patients with uncontrolled HTN and (b) studies with adequate data for meta-analysis. The primary outcome was an evaluation of achievement of BP goal in patients with CKD. The secondary outcome was usefulness of home-based BP telemonitoring by pharmacists in patients with CKD. RESULTS AND DISCUSSION Six RCTs were identified and included in the meta-analysis with a total of 2573 patients (mean age 66.0 years and 63.9% male). Pharmacist interventions resulted in significantly better BP control vs usual care (OR = 1.53, 95% CI = 1.15-2.04, P < .01). Pharmacist interventions using home-based BP telemonitoring were significantly superior to control/usual care (OR = 2.03, 95% CI = 1.49-2.77, P < .01), whereas pharmacist interventions without home-based BP telemonitoring did not significantly improve BP control compared to that with control/usual care (OR = 1.30, 95% CI = 0.97-1.75, P = .08). Home-based BP telemonitoring supported team-based care for HTN in these studies. In addition, patient self-monitoring with telemedicine devices might enhance patients' abilities to manage their condition by pharmacist instruction. WHAT IS NEW AND CONCLUSION The findings of this meta-analysis showed that pharmacist interventions with home-based BP telemonitoring improve BP control among adult patients with CKD.
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Affiliation(s)
- Masanori Nakanishi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.,Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomohiro Mizuno
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takenao Koseki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuo Takahashi
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Michael Katz
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Jeannie K Lee
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
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Chen H, Chen Y, Wu W, Huang J, Chen Z, Chen Z, Yan X, Wu S. Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study. BMJ Open 2020; 10:e035836. [PMID: 32948548 PMCID: PMC7511611 DOI: 10.1136/bmjopen-2019-035836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs). DESIGN Prospective cohort study. SETTING The average real variability of systolic blood pressure (ARVSBP) was the indicator for visit-to-visit BPV. The participants were divided into three groups: normal weight, overweight and obesity. We further divided these groups into four subgroups based on the ARVSBP. A Cox regression model was used to calculate the HRs of the ARVSBP on CVEs in the same and different BMI groups. Additionally, a competitive risk model was used to calculate the HRs of the ARVSBP on CVEs in the same BMI group. PARTICIPANTS In total, 41 043 individuals met the inclusion criteria (no historical CVEs or tumours, no incidence of CVEs or tumours and no death during the four examinations) and had complete systolic blood pressure and BMI data. RESULTS A total of 868 CVEs occurred. The cumulative incidence of CVEs increased as ARVSBP rose in both the normal weight and overweight groups. In same BMI groups, the risk of CVEs significantly increased as ARVSBP increased only in the normal weight group (highest quartiles of ARVSBP: HR (95% CI) 2.20 (1.46-3.31)). In the different BMI groups, the risk of CVEs in the ARVSBP subgroup in each BMI group was higher than that the least quintile of ARVSBP in the normal weight group (highest quartiles of ARVSBP in obesity: HR (95% CI) 2.28 (1.47-3.55)). The result of the competitive risk model did not change. CONCLUSIONS As BMI and ARVSBP increase, the risk of CVEs increases. However, the risk of visit-to-visit BPV on CVEs varies in different BMI groups, especially in people of normal weight. TRIAL REGISTRATION NUMBER CHiCTR-TNC1100 1489.
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Affiliation(s)
- Haojia Chen
- Cardiology, First Hospital of Medical College of Shantou University, Shantou, Guangdong, China
- Cardiology, Shantou University Medical College, Shantou, Guangdong, China
| | - Youren Chen
- Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Weiqiang Wu
- Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jianhuan Huang
- Cardiology, Shantou University Medical College, Shantou, Guangdong, China
- Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zekai Chen
- Cardiology, Shantou University Medical College, Shantou, Guangdong, China
- Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhichao Chen
- Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiuzhu Yan
- Foreign Language, Guangdong Polytechnic Normal University, Guangzhou, Guangdong, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1059] [Impact Index Per Article: 264.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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31
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Kario K. Management of Hypertension in the Digital Era: Small Wearable Monitoring Devices for Remote Blood Pressure Monitoring. Hypertension 2020; 76:640-650. [PMID: 32755418 PMCID: PMC7418935 DOI: 10.1161/hypertensionaha.120.14742] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Out-of-office blood pressure measurement is an essential part of diagnosing and managing hypertension. In the era of advanced digital health information technology, the approach to achieving this is shifting from traditional methods (ambulatory and home blood pressure monitoring) to wearable devices and technology. Wearable blood pressure monitors allow frequent blood pressure measurements (ideally continuous beat-by-beat monitoring of blood pressure) with minimal stress on the patient. It is expected that wearable devices will dramatically change the quality of detection and management of hypertension by increasing the number of measurements in different situations, allowing accurate detection of phenotypes that have a negative impact on cardiovascular prognosis, such as masked hypertension and abnormal blood pressure variability. Frequent blood pressure measurements and the addition of new features such as monitoring of environmental conditions allows interpretation of blood pressure data in the context of daily stressors and different situations. This new digital approach to hypertension contributes to anticipation medicine, which refers to strategies designed to identify increasing risk and predict the onset of cardiovascular events based on a series of data collected over time, allowing proactive interventions to reduce risk. To achieve this, further research and validation is required to develop wearable blood pressure monitoring devices that provide the same accuracy as current approaches and can effectively contribute to personalized medicine.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan; and the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
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32
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Seasonal blood pressure variation assessed by different measurement methods: systematic review and meta-analysis. J Hypertens 2020; 38:791-798. [DOI: 10.1097/hjh.0000000000002355] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trozic I, Platzer D, Fazekas F, Bondarenko AI, Brix B, Rössler A, Goswami N. Postural hemodynamic parameters in older persons have a seasonal dependency : A pilot study. Z Gerontol Geriatr 2020; 53:145-155. [PMID: 30868225 PMCID: PMC7066096 DOI: 10.1007/s00391-019-01525-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims It is known that blood pressure regulation differs seasonally. It is unknown, however, how the cardiovascular system in patients with a stroke reacts to postural changes in different seasons. The aim was therefore to investigate how different temperatures in cold and warm seasons influence the reactions of haemodynamic mechanisms as well as heart rate variability during a sit-to-stand test in patients with stroke and a control group. Methods Hemodynamic responses were assessed in both groups during a sit-to-stand test (5 min sitting followed by 5 min standing) beat to beat within two different seasons. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), stroke index (SI), cardiac index (CI) and heart rate variability (HRV) were continuously monitored. Results During the sitting baseline period delta values of DBP (+15.1 [Standard error (SE) 3.75] mmHg, p < 0.05) and MBP (+14.35 [SE 4.18] mmHg, p < 0.05) were significantly higher in colder months compared to warmer months whereas SI (−3.86 [SE 1.43] ml/beat/m2, p < 0.05) and CI (−0.4 [SE 0.11] l/min/m2, p < 0.05) were lower in colder months compared to warmer months in non-stroke participants. In patients with stroke during sitting, baseline period delta values of DBP (+19.92 [SE 8.03] mmHg, p < 0.05) and MBP (+19.29 [SE 8.6] mmHg, p < 0.05) were significantly higher in colder months compared to warmer months but SI (−5.43 [SE 1.96] ml/beat/m2, p < 0.05) was significantly lower in colder months compared to warmer months. After standing, there was a significant decrease in SBP in warmer months (−16.84 [SE 4.38] mmHg, p < 0.05) and a decrease in DBP in warmer months (−7.8 [SE 2.3] mmHg, p < 0.05) and colder months (−6.73 [SE 1.5] mmHg, p < 0.05) in non-stroke participants and a decrease in MBP in warmer months (−12.5 [SE 2.8] mmHg, p < 0.05) and colder months (−8.93 [SE 1.8] mmHg, p < 0.05) in non-stroke participants and in warmer months (−14.54 [SE 4.1] mmHg, p < 0.05) in patients with stroke. Conclusion Elderly with and
without stroke respond to orthostatic stress with a greater drop in blood pressure in the warmer seasons.
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Affiliation(s)
- Irhad Trozic
- Gravitational Physiology, Aging and Medicine Research Unit, Physiology Division, Otto Loewi Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, Graz, Austria
| | - Dieter Platzer
- Gottfried Schatz Forschungszentrum, Biophysik, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Bianca Brix
- Gravitational Physiology, Aging and Medicine Research Unit, Physiology Division, Otto Loewi Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, Graz, Austria
| | - Andreas Rössler
- Gravitational Physiology, Aging and Medicine Research Unit, Physiology Division, Otto Loewi Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, Graz, Austria
| | - Nandu Goswami
- Gravitational Physiology, Aging and Medicine Research Unit, Physiology Division, Otto Loewi Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, Graz, Austria. .,Medical University of Graz, Graz, Austria.
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Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens Res 2020; 43:609-620. [DOI: 10.1038/s41440-020-0421-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 01/21/2023]
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Affiliation(s)
- Vikas Kapil
- Barts Blood Pressure Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Cardiovascular Medicine and Device InnovationWilliam Harvey Research InstituteQueen Mary University LondonLondonUnited Kingdom
| | - Ajay K. Gupta
- Barts Blood Pressure Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Clinical PharmacologyWilliam Harvey Research InstituteQueen Mary University LondonLondonUnited Kingdom
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36
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Park S, Kario K, Chia Y, Turana Y, Chen C, Buranakitjaroen P, Nailes J, Hoshide S, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Teo BW, Zhang Y, Shin J, Van Minh H, Tomitani N, Kabutoya T, Sukonthasarn A, Verma N, Wang T, Wang J. The influence of the ambient temperature on blood pressure and how it will affect the epidemiology of hypertension in Asia. J Clin Hypertens (Greenwich) 2020; 22:438-444. [PMID: 31851429 PMCID: PMC8029770 DOI: 10.1111/jch.13762] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022]
Abstract
Epidemiologic studies have consistently demonstrated an increased risk of cardiovascular disease during colder temperatures. Hemodynamic changes associated with cold temperature and an increase in thrombogenicity may both account for the increase in cardiovascular risk and mortality. Studies using both in-office and out-of-office BP measurements have consistently shown an elevation in BP during the colder seasons. The large difference in BP between cold and warm months may increase the incidence of hypertension and reduce the hypertension control rate, potentially resulting in increased cardiovascular risk, especially among those at risk of cardiovascular disease. The current trends in global warming and climate change may have a profound impact on the epidemiology of hypertension and cardiovascular disease, as changes in the climate may significantly affect both BP variability and cardiovascular disease, especially in those with high cardiovascular risk and the elderly. Furthermore, climate change could have a significant influence on hypertension in Asia, considering the unique characteristics of hypertensive patients in Asia. As an increase in ambient temperature decreases the mean daytime average and morning surge in BP, but increases the nocturnal BP, it is difficult to predict how environmental changes will affect the epidemiology and prognosis of hypertension in the Asian-Pacific region. However, these seasonal variations in BP could be minimized by adjusting the housing conditions and using anticipation medicine. In this review, we discuss the impact of seasonal variation in the ambient temperature on hypertension and cardiovascular disease and discuss how this may impact the epidemiology of hypertension and cardiovascular disease.
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Affiliation(s)
- Sungha Park
- Division of CardiologyYonsei Cardiovascular HospitalYonsei University Health SystemSeoulKorea
- Integrative Research Center for Cerebrovascular and Cardiovascular DiseasesYonsei University College of MedicineSeoulKorea
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Yuda Turana
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Chen‐Huan Chen
- Department of MedicineSchool of Medicine National Yang‐Ming UniversityTaipeiTaiwan
| | - Peera Buranakitjaroen
- Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | - Jorge Sison
- Section of CardiologyDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversity of Indonesia‐National Cardiovascular CenterJakartaIndonesia
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Boon Wee Teo
- Division of Nephrology Department of MedicineYong Loo Lin School of MedicineSingapore CitySingapore
| | - Yu‐Qing Zhang
- Divisions of Hypertension and Heart FailureFu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | - Huynh Van Minh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHue CityVietnam
| | - Naoko Tomitani
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Narsingh Verma
- Department of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Tzung‐Dau Wang
- Department of Internal MedicineNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical TrialsShanghai Key Laboratory of HypertensionThe Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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37
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Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2020; 38:1235-1243. [DOI: 10.1097/hjh.0000000000002341] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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38
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Ushigome E, Kitagawa N, Kitae A, Kimura T, Iwai K, Oyabu C, Ushigome H, Yokota I, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Seasonal variation in home blood pressure and its relationship with room temperature in patients with type 2 diabetes. Diab Vasc Dis Res 2020; 17:1479164119883986. [PMID: 31726868 PMCID: PMC7510363 DOI: 10.1177/1479164119883986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Our aim was to examine the seasonal variations in home blood pressure measurements and the relationship of ambient temperature or room temperature with the seasonal variations in home blood pressure measurements using a home blood pressure telemonitoring system in patients with type 2 diabetes. The home blood pressure measurements of 41 patients with type 2 diabetes were self-measured. Patients performed triplicate morning and evening blood pressure measurements at least 5 days per month for 12 consecutive months. The lowest values of both systolic blood pressure and diastolic blood pressure were observed in August (126.3 and 70.4 mmHg, respectively), and the highest systolic and diastolic blood pressure values were observed in January (140.3 and 76.9 mmHg, respectively). The root mean squared error between the mean systolic blood pressure and room temperature was 6.50 mmHg and between mean systolic blood pressure and ambient temperature was 6.55 mmHg. Using a home blood pressure telemonitoring system, this study revealed for the first time that home blood pressure varied seasonally, with the highest values observed in January and the lowest values observed in August, and that the seasonal variations in home blood pressure were related to room temperature as well as ambient temperature.
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Affiliation(s)
- Emi Ushigome
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Nobuko Kitagawa
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Aya Kitae
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Tomonori Kimura
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Keiko Iwai
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Chikako Oyabu
- Department of Endocrinology and
Metabolism, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Hidetaka Ushigome
- Department of Organ Transplantation and
General Surgery, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate
School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Mai Asano
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and
Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of
Medicine, Kyoto, Japan
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Garnett C, Johannesen L, McDowell T. Redefining Blood Pressure Assessment — The Role of the Ambulatory Blood Pressure Monitoring Study for Drug Safety. Clin Pharmacol Ther 2019; 107:147-153. [DOI: 10.1002/cpt.1690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Christine Garnett
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
| | - Lars Johannesen
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
| | - Tzu‐Yun McDowell
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
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40
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Kang G. Discussion of "Blood pressure levels among Indigenous children living at different altitudes". Appl Physiol Nutr Metab 2019; 44:1121-1122. [PMID: 31561735 DOI: 10.1139/apnm-2019-0513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- GuanYang Kang
- Department of Cardiology, The Fifth People's Hospital of Dongguan (also called Taiping People's Hospital of Dongguan), The Dongguan Affiliated Hospital of Medical College of Jinan University, Dongguan, Guangdong, China.,Department of Cardiology, The Fifth People's Hospital of Dongguan (also called Taiping People's Hospital of Dongguan), The Dongguan Affiliated Hospital of Medical College of Jinan University, Dongguan, Guangdong, China
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41
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Weber MA. Blood pressure variability and cardiovascular prognosis: implications for clinical practice. Eur Heart J 2019; 38:2823-2826. [PMID: 28982228 DOI: 10.1093/eurheartj/ehx322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael A Weber
- State University of New York, Downstate College of Medicine, Brooklyn, NY, USA
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42
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Lee SW. A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration. Front Hum Neurosci 2019; 13:129. [PMID: 31105539 PMCID: PMC6499026 DOI: 10.3389/fnhum.2019.00129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/28/2019] [Indexed: 01/16/2023] Open
Abstract
There are two main paradigms for brain-related science, with different implications for brain-focused intervention or advancement. The paradigm of homeostasis (“stability through constancy,” Walter Cannon), originating from laboratory-based experimental physiology pioneered by Claude Bernard, shows that living systems tend to maintain system functionality in the direction of constancy (or similitude). The aim of physiology is to elucidate the factors that maintain homeostasis, and therapeutics aim to correct abnormal factor functions. The homeostasis paradigm does not formally recognize influences outside its controlled experimental frames and it is variable in its modeling of neural contributions. The paradigm of allostatic orchestration (PAO) extends the principle of allostasis (“stability through change”) as originally put forth by Peter Sterling. The PAO originates from an evolutionary perspective and recognizes that biological set points change in anticipation of changing environments. The brain is the organ of central command, orchestrating cross-system operations to support optimal behavior at the level of the whole organism. Alternative views of blood pressure regulation and posttraumatic stress disorder (PTSD) illustrate differences between the paradigms. For the PAO, complexities of top-down neural effects and environmental context are foundational (not to be “factored out”), and anticipatory regulation is the principle of their interface. The allostatic state represents the integrated totality of brain-body interactions. Health itself is an allostatic state of optimal anticipatory oscillation, hypothesized to relate to the state of criticality, a mathematical point of poise between phases, on the border between order and disorder (or the “edge of chaos”). Diseases are allostatic states of impaired anticipatory oscillations, demonstrated as rigidifications of set points across the brain and body (disease comorbidity). Conciliation of the paradigms is possible, with “reactive homeostasis” resolved as an illusion stemming from the anticipation of environmental monotony. Considerations are presented with respect to implications of the two paradigms for brain-focused intervention or advancement; the hypothesis that the state of criticality is a vehicle for evolutionary processes; concordance with a philosophy of freedom based on ethical individualism as well as self-creativity, non-obsolescence, empowerment, and citizenship; and concluding reflections on the science and ethics of the placebo, and the potential for virtuous cycles of brain-Anthropocene interactions.
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Affiliation(s)
- Sung W Lee
- Scholarly Projects Unit, Department of Academic Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
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Seasonal variation in 24 h blood pressure profile in healthy adults- A prospective observational study. J Hum Hypertens 2019; 33:626-633. [PMID: 30755660 DOI: 10.1038/s41371-019-0173-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/19/2018] [Accepted: 01/18/2019] [Indexed: 01/06/2023]
Abstract
The clinical and experimental data on seasonal variation in blood pressure is mainly from office and home blood pressure (BP) monitoring studies. There are few studies from temperate climates on seasonal changes with ambulatory blood pressure (ABP) monitoring and none from India. This is a prospective, observational study among healthy adults. ABP was measured in four different seasons in 28 subjects. Mean arterial pressure (MAP), ambulatory systolic blood pressure (SBP), and ambulatory diastolic blood pressure (DBP) were significantly higher in winter compared to summer season. 24-hour MAP was lowest in summer while highest MAP was recorded in winter (97.04 ± 8.30 and 103.89 ± 8.54, respectively). The mean difference was -6.86 mm Hg (95% CI: -10.74 to -2.97, p = 0.001). This difference was mainly due to increase in day time MAP. There was no difference in 24 h systolic and diastolic blood pressure between summer and winter. There was significant difference between summer and winter in the SBP (day time) [125.61 ± 11.44 and 131.93 ± 9.46, mean difference -6.32 (95% CI: -10.69 to -1.95, p = 0.005)] and DBP (day time) [79.57 ± 9.95 and 87.07 ± 9.9, mean difference -7.50 (95% CI: -12.49 to -2.51, p = 0.003)]. The night time systolic and diastolic BP was similar during winter and summer. Thus, BP increases significantly during winter compared to summer season. This change is primarily in the day time systolic, diastolic and mean blood pressures. Larger studies are required to further validate our findings.
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Angelini V, Daly M, Moro M, Navarro Paniagua M, Sidman E, Walker I, Weldon M. The effect of the Winter Fuel Payment on household temperature and health: a regression discontinuity design study. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe Winter Fuel Payment (WFP) is a non-NHS population-level policy intervention that aims to reduce cold exposure and enhance the health and well-being of older adults. Labelling this cash transfer as ‘winter fuel’ has been shown to lead to increased household energy expenditure, but it is not known if this expenditure produces warmer homes or health benefits.ObjectivesFirst, the association between indoor temperature and health was established to identify the outcome measures most likely to be affected by the WFP. Then, whether or not receiving the WFP is associated with raised household temperature levels and/or improved health was assessed.DesignRandom and fixed effects regression models were used to estimate the link between ambient indoor temperature and health. A regression discontinuity (RD) design analysis exploiting the sharp eligibility criteria for the WFP was employed to estimate the potential impact of the payment.SettingThe sample was drawn from the English Longitudinal Study of Ageing (ELSA), an observational study of community-dwelling individuals aged ≥ 50 years in England.ParticipantsAnalyses examining the association between household temperature and health had a maximum sample of 12,210 adults aged 50–90 years. The RD analyses drew on a maximum of 5902 observations.InterventionThe WFP provides households with a member who is aged > 60 years (up to 2010, from which point the minimum age increased) in the qualifying week with a lump sum annual payment, typically in November or December.Main outcome measuresDifferences in indoor temperature were examined, and, following an extensive literature review of relevant participant-reported health indicators and objectively recorded biomarkers likely to be affected by indoor temperature, a series of key measures were selected: blood pressure, inflammation, lung function, the presence of chest infections, subjective health and depressive symptom ratings.Data sourcesThe first six waves of the ELSA were drawn from, accessible through the UK Data Service (SN:5050 English Longitudinal Study of Ageing: Waves 0–7, 1998–2015).ResultsResults from both random and fixed-effects multilevel regression models showed that low levels of indoor temperature were associated with raised systolic and diastolic blood pressure levels and raised fibrinogen levels. However, across the RD models, no evidence was found that the WFP was consistently associated with differences in either household temperature or the health of qualifying (vs. non-qualifying) households.LimitationsThe presence of small effects cannot be ruled out, not detectable because of the sample size in the current study.ConclusionsThis study capitalised on the sharp assignment rules regarding WFP eligibility to estimate the potential effect of the WFP on household temperature and health in a national sample of English adults. The RD design employed did not identify evidence linking the WFP to warmer homes or potential health and well-being effects.Future workFurther research should utilise larger samples of participants close to the WFP eligibility cut-off point examined during particularly cold weather in order to identify whether or not the WFP is linked to health benefits not detected in the current study, which may have implications for population health and the evaluation of the effectiveness of the WFP.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Viola Angelini
- Faculty of Economics and Business Economics, University of Groningen, Groningen, the Netherlands
| | - Michael Daly
- Management Work and Organisation, Stirling Management School, University of Stirling, Stirling, UK
| | - Mirko Moro
- Economics Division, Stirling Management School, University of Stirling, Stirling, UK
| | - Maria Navarro Paniagua
- Department of Economics, Lancaster University Management School, Lancaster University, Lancaster, UK
| | - Elanor Sidman
- Management Work and Organisation, Stirling Management School, University of Stirling, Stirling, UK
| | - Ian Walker
- Department of Economics, Lancaster University Management School, Lancaster University, Lancaster, UK
| | - Matthew Weldon
- Department of Economics, Lancaster University Management School, Lancaster University, Lancaster, UK
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Nishizawa M, Fujiwara T, Hoshide S, Sato K, Okawara Y, Tomitani N, Matsuo T, Kario K. Winter morning surge in blood pressure after the Great East Japan Earthquake. J Clin Hypertens (Greenwich) 2018; 21:208-216. [DOI: 10.1111/jch.13463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Masafumi Nishizawa
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
- Minamisanriku Hospital; Miyagi Japan
| | - Takeshi Fujiwara
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
- Higashiagatsuma-machi National Health Insurance Clinic; Gunma Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Keiko Sato
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Takefumi Matsuo
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
- Hyogo Prefectural Awaji Medical Center; Hyogo Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Japan
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Kita T, Kitamura K. Seasonal variation of novel arterial stiffness indexes in Japanese hypertensive patients. Clin Exp Hypertens 2018; 41:670-674. [PMID: 30409046 DOI: 10.1080/10641963.2018.1539092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and Objective: Seasonal variation of blood pressure (BP) is well known, and a relationship between increases in BP and the incidence of cardiovascular accidents (CVAs) in the winter has been reported. Parameters of arterial stiffness may exhibit seasonal variation; however, available data are currently limited. Novel arterial stiffness indexes, namely the arterial velocity pulse index (AVI) and arterial pressure-volume index (API), can be determined through usual maneuver for BP measurement during the regular examination in the outpatient clinic.The present study assessed the seasonal variation of AVI and API in 59 hypertensive patients undergoing stable treatment and regularly visiting our outpatient clinic over a period of 30 months. Methods: BP, pulse rate (PR), AVI, and API were measured using the AVE-1500 (Pasesa) in the sitting position. Six time frames of assessment were established. All measurements (average: 17.9 measurements per person) were sorted using these six time frames, and their averages were used for analysis. Results: Significant seasonal variations in PR (P < 0.001) and AVI (P < 0.001), along with weak variation in systolic BP (SBP) (P = 0.047) and marginal variation in API (P = 0.055), were confirmed by repeated analysis of variance. SBP, API, and PR were decreased, whereas AVI was increased in the summer. Coefficient variations were SBP 5.1%, PR 4.9%, AVI 12.6%, and API 10.6%. Conclusion: AVI was associated with reflected wave like as augmentation index. Thus, a high AVI may suggest increased central wave reflection. Although the significance of seasonal variation of AVI remains unknown, AVI may influence seasonal variations in the incidence of CVA.
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Affiliation(s)
- Toshihiro Kita
- a Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki , Miyazaki , Japan
| | - Kazuo Kitamura
- a Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki , Miyazaki , Japan
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Chen H, Zhang R, Zheng Q, Yan X, Wu S, Chen Y. Impact of body mass index on long-term blood pressure variability: a cross-sectional study in a cohort of Chinese adults. BMC Public Health 2018; 18:1193. [PMID: 30348124 PMCID: PMC6196453 DOI: 10.1186/s12889-018-6083-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/01/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Obesity and overweight are related to changes in blood pressure, but existing research has mainly focused on the impact of body mass index (BMI) on short-term blood pressure variability (BPV). The study aimed to examine the impact of BMI on long-term BPV. METHODS Participants in the Kailuan study who attended all five annual physical examinations in 2006, 2008, 2010, 2012, and 2014 were selected as observation subjects. In total, 32,482 cases were included in the statistical analysis. According to the definition of obesity in China, BMI was divided into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24.0 ≤ BMI < 28.0 kg/m2), and obese (BMI ≥ 28.0 kg/m2). We used average real variability to evaluate long-term systolic BPV. The average real variability of systolic blood pressure (ARVSBP) was calculated as (|sbp2 - sbp1| + |sbp3 - sbp2 | + |sbp4 - sbp3| + |sbp5 - sbp4|)/4. Differences in ARVSBP by BMI group were analyzed using analysis of variance. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of BMI on ARVSBP. RESULTS Participants' average age was 46.6 ± 11.3 years, 24,502 were men, and 7980 were women. As BMI increases, the mean value of ARVSBP gradually increases. After adjusting for other confounding factors, stepwise multivariate linear regression analysis showed that ARVSBP increased by 0.077 for every one-unit increase in BMI. Multiple logistic regression analysis indicated that being obese or overweight, compared with being normal-weight, were risk factors for an increase in ARVSBP. The corresponding odds ratios of being obese or overweight were 1.23 (1.15-1.37) and 1.10 (1.04-1.15), respectively. CONCLUSIONS There was a positive correlation between BMI and ARVSBP, with ARVSBP increasing with a rise in BMI. BMI is a risk factor for an increase in ARVSBP. TRIAL REGISTRATION Registration No.: CHiCTR-TNC1100 1489 ; Registration Date: June 01, 2006.
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Affiliation(s)
- Haojia Chen
- Shantou University Medical College, Shantou, Guangdong China
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong China
| | - Ruiying Zhang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Qiongbing Zheng
- Shantou University Medical College, Shantou, Guangdong China
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong China
| | - Xiuzhu Yan
- School of Foreign Language, Guangdong Polytechnic Normal University, Guangzhou, Guangdong China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong China
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Arakawa K, Ibaraki A, Kawamoto Y, Tominaga M, Tsuchihashi T. Antihypertensive drug reduction for treated hypertensive patients during the summer. Clin Exp Hypertens 2018; 41:389-393. [DOI: 10.1080/10641963.2018.1489549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kimika Arakawa
- Department of Clinical Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ai Ibaraki
- Division of Hypertension, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yuki Kawamoto
- Graduate School of Medical Sciences, Department of Medicine and Clinical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuhiro Tominaga
- Division of Hypertension, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Vidal-Petiot E, Stebbins A, Chiswell K, Ardissino D, Aylward PE, Cannon CP, Ramos Corrales MA, Held C, López-Sendón JL, Stewart RAH, Wallentin L, White HD, Steg PG. Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial. Eur Heart J 2018; 38:2813-2822. [PMID: 28575274 DOI: 10.1093/eurheartj/ehx250] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/20/2017] [Indexed: 11/12/2022] Open
Abstract
Aims To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. Methods and results In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. Conclusion In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP.
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Affiliation(s)
- Emmanuelle Vidal-Petiot
- Cardiology and Physiology Departments, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Paris, France
| | - Amanda Stebbins
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| | - Diego Ardissino
- Azienda Ospedaliero, Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Philip E Aylward
- South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, 70 Francis street, Boston, MA 02115, USA and former employee at Harvard Clinical Research Institute, Boston, MA, USA
| | - Marco A Ramos Corrales
- San Jose Satelite Hospital, Naucalpan, Circunvalacion Poniente 53, 53100 Naucalpan de Juárez, Mexico
| | - Claes Held
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 14B, SE-752 37 Uppsala, Sweden
| | - José Luis López-Sendón
- Hospital Universitario La Paz, IdiPaz, Paseo de la Castellana 261, Planta 1, 28046 Madrid, Spain
| | - Ralph A H Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New Zealand
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 14B, SE-752 37 Uppsala, Sweden
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New Zealand
| | - Philippe Gabriel Steg
- Cardiology and Physiology Departments, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France.,NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK, FACT (French Alliance for Cardiovascular Trials), F-CRIN network, INSERM U1148, Paris, France
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50
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Modesti PA, Rapi S, Rogolino A, Tosi B, Galanti G. Seasonal blood pressure variation: implications for cardiovascular risk stratification. Hypertens Res 2018; 41:475-482. [DOI: 10.1038/s41440-018-0048-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
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