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Imenshahidi M, Roohbakhsh A, Hosseinzadeh H. Effects of telmisartan on metabolic syndrome components: a comprehensive review. Biomed Pharmacother 2024; 171:116169. [PMID: 38228033 DOI: 10.1016/j.biopha.2024.116169] [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: 11/19/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
Telmisartan is an antagonist of the angiotensin II receptor used in the management of hypertension (alone or in combination with other antihypertensive agents. It belongs to the drug class of angiotensin II receptor blockers (ARBs). Among drugs of this class, telmisartan shows particular pharmacologic properties, including a longer half-life than any other angiotensin II receptor blockers that bring higher and persistent antihypertensive activity. In hypertensive patients, telmisartan has superior efficacy than other antihypertensive drugs (losartan, valsartan, ramipril, atenolol, and perindopril) in controlling blood pressure, especially towards the end of the dosing interval. Telmisartan has a partial PPARγ-agonistic effect whilst does not have the safety concerns of full agonists of PPARγ receptors (thiazolidinediones). Moreover, telmisartan has an agonist activity on PPARα and PPARδ receptors and modulates the adipokine levels. Thus, telmisartan could be considered as a suitable alternative option, with multi-benefit for all components of metabolic syndrome including hypertension, diabetes mellitus, obesity, and hyperlipidemia. This review will highlight the role of telmisartan in metabolic syndrome and the main mechanisms of action of telmisartan are discussed and summarized. Many studies have demonstrated the useful properties of telmisartan in the prevention and improving of metabolic syndrome and this well-tolerated drug can be greatly proposed in the treatment of different components of metabolic syndrome. However, larger and long-duration studies are needed to confirm these findings in long-term observational studies and prospective trials and to determine the optimum dose of telmisartan in metabolic syndrome.
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Affiliation(s)
- Mohsen Imenshahidi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Thomas JJC, Daley AJ, Esliger DW, Kettle VE, Coombe A, Stamatakis E, Sanders JP. Accelerometer-Measured Physical Activity Data Sets (Global Physical Activity Data Set Catalogue) That Include Markers of Cardiometabolic Health: Systematic Scoping Review. J Med Internet Res 2023; 25:e45599. [PMID: 37467026 PMCID: PMC10398367 DOI: 10.2196/45599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Cardiovascular disease accounts for 17.9 million deaths globally each year. Many research study data sets have been collected to answer questions regarding the relationship between cardiometabolic health and accelerometer-measured physical activity. This scoping review aimed to map the available data sets that have collected accelerometer-measured physical activity and cardiometabolic health markers. These data were then used to inform the development of a publicly available resource, the Global Physical Activity Data set (GPAD) catalogue. OBJECTIVE This review aimed to systematically identify data sets that have measured physical activity using accelerometers and cardiometabolic health markers using either an observational or interventional study design. METHODS Databases, trial registries, and gray literature (inception until February 2021; updated search from February 2021 to September 2022) were systematically searched to identify studies that analyzed data sets of physical activity and cardiometabolic health outcomes. To be eligible for inclusion, data sets must have measured physical activity using an accelerometric device in adults aged ≥18 years; a sample size >400 participants (unless recruited participants in a low- and middle-income country where a sample size threshold was reduced to 100); used an observational, longitudinal, or trial-based study design; and collected at least 1 cardiometabolic health marker (unless only body mass was measured). Two reviewers screened the search results to identify eligible studies, and from these, the unique names of each data set were recorded, and characteristics about each data set were extracted from several sources. RESULTS A total of 17,391 study reports were identified, and after screening, 319 were eligible, with 122 unique data sets in these study reports meeting the review inclusion criteria. Data sets were found in 49 countries across 5 continents, with the most developed in Europe (n=53) and the least in Africa and Oceania (n=4 and n=3, respectively). The most common accelerometric brand and device wear location was Actigraph and the waist, respectively. Height and body mass were the most frequently measured cardiometabolic health markers in the data sets (119/122, 97.5% data sets), followed by blood pressure (82/122, 67.2% data sets). The number of participants in the included data sets ranged from 103,712 to 120. Once the review processes had been completed, the GPAD catalogue was developed to house all the identified data sets. CONCLUSIONS This review identified and mapped the contents of data sets from around the world that have collected potentially harmonizable accelerometer-measured physical activity and cardiometabolic health markers. The GPAD catalogue is a web-based open-source resource developed from the results of this review, which aims to facilitate the harmonization of data sets to produce evidence that will reduce the burden of disease from physical inactivity.
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Affiliation(s)
- Jonah J C Thomas
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, United Kingdom
| | - Amanda J Daley
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, United Kingdom
| | - Dale W Esliger
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, United Kingdom
- Lifestyle, National Institute of Health Research Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Victoria E Kettle
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, United Kingdom
| | - April Coombe
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Emmanuel Stamatakis
- Charles Perkin Centre, Faculty of Medicine and Health Science, University of Sydney, Sydney, Australia
| | - James P Sanders
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, United Kingdom
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3
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Chu YH, Sun ZJ, Chang YF, Yang YC, Chang CJ, Chou YT, Wu JS. Different Factors Associated with Morning Blood Pressure Surge in Antihypertensive-Naïve Dipper and Non-Dipper Subjects. J Clin Med 2023; 12:jcm12072464. [PMID: 37048548 PMCID: PMC10095290 DOI: 10.3390/jcm12072464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
The relationship between the morning blood pressure surge (MBPS) and cardiovascular risk is inconclusive. Previous studies have not taken into consideration dipping status in examining the MBPS and its associated factors. The aim was to examine factors associated with the MBPS in dippers and non-dippers. The MBPS was calculated by data obtained from ambulatory blood pressure monitoring, using the definition of sleep-trough morning surge. Dipping systolic blood pressure (DipSBP) was defined as [1 - (SBPsleeping/SBPawake)] × 100%. The value in milliseconds of standard deviation of normal-to-normal RR interval after waking up (SDNNaw) was calculated during the 2 h period after waking up. A total of 140 eligible subjects were divided into dippers (n = 62) and non-dippers (n = 78). Multiple regression analysis on data for all subjects revealed different correlations with the MBPS: positive in age, body mass index (BMI), and DipSBP, and inverse in cholesterol/high density lipoprotein-cholesterol (HDL-C) ratio, fasting blood glucose, and 2 h SDNNaw. When dippers were examined separately, age, female gender, and BMI correlated positively with MBPS, while cholesterol/HDL-C ratio and 2 h SDNNaw correlated negatively. For non-dippers, only age was associated with the MBPS. The factors associated with the MBPS were different for dippers and non-dippers. The MBPS seems to be a physiological response in this dipper group because age and BMI correlated positively with the MBPS, while parasympathetic neural activity after waking up and cholesterol/HDL-C ratio showed inverse correlations.
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Affiliation(s)
- Yi-Hsin Chu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin 64043, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan
| | - Yu-Tsung Chou
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Health Management Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin 64043, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
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Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1847-1858. [PMID: 35983870 DOI: 10.1097/hjh.0000000000003240] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
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Thosar SS, Rueda JF, Berman AM, Lasarev MR, Herzig MX, Clemons NA, Roberts SA, Bowles NP, Emens JS, Ellison DH, Shea SA. Separate and interacting effects of the endogenous circadian system and behaviors on plasma aldosterone in humans. Am J Physiol Regul Integr Comp Physiol 2018; 316:R157-R164. [PMID: 30521366 DOI: 10.1152/ajpregu.00314.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Measurements of aldosterone for diagnosis of primary aldosteronism are usually made from blood sampled in the morning when aldosterone typically peaks. We tested the relative contributions and interacting influences of the circadian system, ongoing behaviors, and prior sleep to this morning peak in aldosterone. To determine circadian rhythmicity and separate effects of behaviors on aldosterone, 16 healthy participants completed a 5-day protocol in dim light while all behaviors ranging from sleep to exercise were standardized and scheduled evenly across the 24-h circadian period. In another experiment, to test the separate effects of prior nocturnal sleep or the inactivity that accompanies sleep on aldosterone, 10 healthy participants were studied across 2 nights: 1 with sleep and 1 with maintained wakefulness (randomized order). Plasma aldosterone was measured repeatedly in each experiment. Aldosterone had a significant endogenous rhythm ( P < 0.001), rising across the circadian night and peaking in the morning (~8 AM). Activity, including exercise, increased aldosterone, and different behaviors modulated aldosterone differently across the circadian cycle (circadian phase × behavior interaction; P < 0.001). In the second experiment, prior nocturnal sleep and prior rested wakefulness both increased plasma aldosterone ( P < 0.001) in the morning, to the same extent as the change in circadian phases between evening and morning. The morning increase in aldosterone is due to effects of the circadian system plus increased morning activities and not prior sleep or the inactivity accompanying sleep. These findings have implications for the time of and behaviors preceding measurement of aldosterone, especially under conditions of shift work and jet lag.
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Affiliation(s)
- Saurabh S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | - Jose F Rueda
- Division of Nephrology and Hypertension, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | - Alec M Berman
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | - Michael R Lasarev
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | - Maya X Herzig
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | - Noal A Clemons
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | - Sally A Roberts
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | - Nicole P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
| | | | - David H Ellison
- Division of Nephrology and Hypertension, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon
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Kaplan KA, Talavera DC, Harvey AG. Rise and shine: A treatment experiment testing a morning routine to decrease subjective sleep inertia in insomnia and bipolar disorder. Behav Res Ther 2018; 111:106-112. [PMID: 30399503 DOI: 10.1016/j.brat.2018.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 09/28/2018] [Accepted: 10/26/2018] [Indexed: 12/29/2022]
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Morning blood pressure surge in young black and white adults: The African-PREDICT Study. J Hum Hypertens 2018; 33:22-33. [DOI: 10.1038/s41371-018-0089-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
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Bilo G, Grillo A, Guida V, Parati G. Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects. Integr Blood Press Control 2018; 11:47-56. [PMID: 29872338 PMCID: PMC5973439 DOI: 10.2147/ibpc.s130277] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Morning hours are the period of the day characterized by the highest incidence of major cardiovascular events including myocardial infarction, sudden death or stroke. They are also characterized by important neurohormonal changes, in particular, the activation of sympathetic nervous system which usually leads to a rapid increase in blood pressure (BP), known as morning blood pressure surge (MBPS). It was hypothesized that excessive MBPS may be causally involved in the pathogenesis of cardiovascular events occurring in the morning by inducing hemodynamic stress. A number of studies support an independent relationship of MBPS with organ damage, cerebrovascular complications and mortality, although some heterogeneity exists in the available evidence. This may be due to ethnic differences, methodological issues and the confounding relationship of MBPS with other features of 24-hour BP profile, such as nocturnal dipping or BP variability. Several studies are also available dealing with treatment effects on MBPS and indicating the importance of long-acting antihypertensive drugs in this regard. This paper provides an overview of pathophysiologic, methodological, prognostic and therapeutic aspects related to MBPS.
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Affiliation(s)
- Grzegorz Bilo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Grillo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Valentina Guida
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Zhan Y, Kang T, Wei Y. Target organ damage in primary hypertensive patients: role of the morning heart rate surge. Clin Exp Hypertens 2016; 38:631-638. [PMID: 27653768 DOI: 10.1080/10641963.2016.1182180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The morning heart rate surge (MHRS) and morning blood pressure surge (MBPS) may be responsible for the high prevalence of cardiovascular events during the morning period. The clinical significance of the MBPS has been well established, but that of the MHRS remains unclear. Thus, we evaluated the association between the MHRS and target organ damage (TOD). METHODS A cross-sectional study of 580 hypertensive patients was performed. MHRS and heart rate variability (HRV) were analyzed by 24 h electrocardiogram. TOD was assessed by estimated glomerular filtration rate, carotid intima-media thickness (IMT), and left ventricular mass index. RESULTS The prevalence of TOD tended to decrease with sleep-trough MHRS (first to fourth quartiles: 71%, 70.3%, 58.6%, and 52.7%, respectively) or prewaking MHRS quartiles (first to fourth quartiles: 65.3%, 73.6%, 61.4%, and 54.2%, respectively), whereas the opposite trend was observed for standard deviation of all normal NN intervals (SDNN). Moreover, sleep-trough MHRS, prewaking MHRS, SDNN, and SDNN index were significantly lower in patients with TOD than in those without TOD. According to four logistic regression models, the associations of prewaking MHRS, SDNN, and SDNN index with TOD were lost after adjustment for age and BP. Patients in the first (≤11.125 bpm) and second sleep-trough MHRS quartiles (11.125-15.75 bpm) had a 1.95-2.06-fold increased risk of TOD compared with those in the fourth quartile (p < 0.05). CONCLUSION A blunted sleep-trough MHRS, which may serve as a surrogate marker for autonomic imbalance, was independently associated with TOD in primary hypertensive patients.
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Affiliation(s)
- Yuliang Zhan
- a Department of Cardiology , The First Affiliated Hospital of Nanchang University , Nanchang , People's Republic of China
| | - Ting Kang
- a Department of Cardiology , The First Affiliated Hospital of Nanchang University , Nanchang , People's Republic of China
| | - Yunfeng Wei
- a Department of Cardiology , The First Affiliated Hospital of Nanchang University , Nanchang , People's Republic of China
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Turak O, Afsar B, Siriopol D, Ozcan F, Cagli K, Yayla C, Oksuz F, Mendi MA, Kario K, Covic A, Kanbay M. Morning Blood Pressure Surge as a Predictor of Development of Chronic Kidney Disease. J Clin Hypertens (Greenwich) 2016; 18:444-8. [PMID: 26530334 PMCID: PMC8031569 DOI: 10.1111/jch.12707] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 08/16/2023]
Abstract
Blood pressure (BP) usually increases upon awakening--a physiological mechanism called morning BP surge (MBPS). BP values above the MBPS threshold are associated with target organ damage, including left ventricular hypertrophy and proteinuria. Despite these data, there have been no studies that have investigated the association between elevated MBPS and the development of incident chronic kidney disease (CKD). In this study, patients with essential hypertension were included and underwent ambulatory BP measurements and MBPS. Patients were followed for a median of 3.33 years. In total, 622 patients were enrolled. The mean age of patients was 57.6±12.4 years, 54.0% were men, 16.7% had diabetes, and 10.6% had prevalent cardiovascular disease. During follow-up, 32 patients developed CKD. Higher MBPS, analyzed both as continuous and categorical variables, was associated with incident CKD in all models. Elevated MBPS is associated with kidney function deterioration and the development of CKD. Studies are needed to further examine underlying mechanisms regarding MBPS and these renal outcomes.
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Affiliation(s)
- Osman Turak
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Baris Afsar
- Department of NephrologyNumune State HospitalKonyaTurkey
| | - Dimitrie Siriopol
- Nephrology ClinicDialysis and Renal Transplant Center“C.I. PARHON” University Hospital, and “Grigore T. Popa” University of MedicineIasiRomania
| | - Firat Ozcan
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Kumral Cagli
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Cagri Yayla
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Fatih Oksuz
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Mehmet Ali Mendi
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Kazuomi Kario
- Department of Sleep and Circadian CardiologyJichi Medical University School of MedicineTochigiJapan
| | - Adrian Covic
- Nephrology ClinicDialysis and Renal Transplant Center“C.I. PARHON” University Hospital, and “Grigore T. Popa” University of MedicineIasiRomania
| | - Mehmet Kanbay
- Division of NephrologyDepartment of MedicineKoc University School of MedicineIstanbulTurkey
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Asher A, Shabtay A, Brosh A, Eitam H, Agmon R, Cohen-Zinder M, Zubidat AE, Haim A. "Chrono-functional milk": The difference between melatonin concentrations in night-milk versus day-milk under different night illumination conditions. Chronobiol Int 2015; 32:1409-16. [PMID: 26588495 DOI: 10.3109/07420528.2015.1102149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pineal melatonin (MLT) is produced at highest levels during the night, under dark conditions. We evaluated differences in MLT-concentration by comparing daytime versus night time milk samples, from two dairy farms with different night illumination conditions: (1) natural dark (Dark-Night); (2) short wavelength Artificial Light at Night (ALAN, Night-Illuminated). Samples were collected from 14 Israeli Holstein cows from each commercial dairy farm at 04:30 h ("Night-milk") 12:30 h ("Day-milk") and analyzed for MLT-concentration. In order to study the effects of night illumination conditions on cows circadian rhythms, Heart Rate (HR) daily rhythms were recorded. MLT-concentrations of Night-milk samples from the dark-night group were significantly (p < 0.001) higher than those of Night-illuminated conditions (30.70 ± 1.79 and 17.81 ± 0.33 pg/ml, respectively). Interestingly, night illumination conditions also affected melatonin concentrations at daytime where under Dark-Night conditions values are significantly (p < 0.001) higher than Night-Illuminated conditions, (5.36 ± 0.33 and 3.30 ± 0.18 pg/ml, respectively). There were no significant differences between the two treatments in the milk yield and milk composition except somatic cell count (SCC), which was significantly lower (p = 0.02) in the Dark-Night group compared with the Night-Illuminated group. Cows in both groups presented a significant (p < 0.01) HR daily rhythm, therefore we assume that in the night illuminated cows feeding and milking time are the "time keeper", while in the Dark-night cows, HR rhythms were entrained by the light/dark cycle. The higher MLT-concentration in Dark-night cows with the lower SCC values calls upon farmers to avoid exposure of cows to ALAN. Therefore, under Dark-night conditions milk quality will improve by lowering SCC values where separation between night and day of such milk can produce chrono-functional milk, naturally rich with MLT.
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Affiliation(s)
- A Asher
- a Agricultural Research Organization , Newe Ya'ar, Ramat Yishay , Israel and.,b Department of Evolutionary and Environmental Biology , Faculty of Natural Sciences, The Israeli Center for Interdisciplinary Research in Chronobiology, University of Haifa , Mount Carmel , Haifa , Israel
| | - A Shabtay
- a Agricultural Research Organization , Newe Ya'ar, Ramat Yishay , Israel and
| | - A Brosh
- a Agricultural Research Organization , Newe Ya'ar, Ramat Yishay , Israel and
| | - H Eitam
- a Agricultural Research Organization , Newe Ya'ar, Ramat Yishay , Israel and
| | - R Agmon
- a Agricultural Research Organization , Newe Ya'ar, Ramat Yishay , Israel and
| | - M Cohen-Zinder
- a Agricultural Research Organization , Newe Ya'ar, Ramat Yishay , Israel and
| | - A E Zubidat
- b Department of Evolutionary and Environmental Biology , Faculty of Natural Sciences, The Israeli Center for Interdisciplinary Research in Chronobiology, University of Haifa , Mount Carmel , Haifa , Israel
| | - A Haim
- b Department of Evolutionary and Environmental Biology , Faculty of Natural Sciences, The Israeli Center for Interdisciplinary Research in Chronobiology, University of Haifa , Mount Carmel , Haifa , Israel
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Denardo SJ, Gong Y, Cooper-DeHoff RM, Farsang C, Keltai M, Szirmai L, Messerli FH, Bavry AA, Handberg EM, Mancia G, Pepine CJ. Effects of verapamil SR and atenolol on 24-hour blood pressure and heart rate in hypertension patients with coronary artery disease: an international verapamil SR-trandolapril ambulatory monitoring substudy. PLoS One 2015; 10:e0122726. [PMID: 25835002 PMCID: PMC4383326 DOI: 10.1371/journal.pone.0122726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/05/2015] [Indexed: 11/23/2022] Open
Abstract
Elevated nighttime blood pressure (BP) and heart rate (HR), increased BP and HR variability, and altered diurnal variations of BP and HR (nighttime dipping and morning surge) in patients with systemic hypertension are each associated with increased adverse cardiovascular events. However, there are no reports on the effect of hypertension treatment on these important hemodynamic parameters in the growing population of hypertensive patients with atherosclerotic coronary artery disease (CAD). This was a pre-specified subgroup analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable patients aged ≥50 years with hypertension and CAD randomized to either verapamil SR- or atenolol-based hypertension treatment strategies. The subgroup consisted of 117 patients undergoing 24-hour ambulatory monitoring at baseline and after 1 year of treatment. Hourly systolic and diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR- and atenolol-based treatment strategies compared with baseline (P<0.0001). Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies decreased SBP variability (weighted standard deviation: P = 0.012 and 0.021, respectively). Compared with verapamil SR, atenolol also increased the prevalence of BP and HR nighttime dipping among prior non-dippers (BP: OR = 3.37; 95% CI: 1.26 – 8.97; P = 0.015; HR: OR = 4.06; 95% CI: 1.35-12.17; P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5 beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based strategies resulted in favorable changes in ambulatory monitoring parameters that have been previously associated with increased adverse cardiovascular events.
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Affiliation(s)
- Scott J. Denardo
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Yan Gong
- Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Rhonda M. Cooper-DeHoff
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Csaba Farsang
- St Imre Teaching Hospital Cardiometabolic Centre, Budapest, Hungary
| | - Matyas Keltai
- Semmelweis University, Hungarian Institute of Cardiology, Budapest, Hungary
| | - László Szirmai
- N&Sz StudyMaster Medical Research Center Ltd., Szentendre, Hungary
| | - Franz H. Messerli
- Division of Cardiology, St Luke’s-Roosevelt Hospital Center and Columbia University, College of Medicine and Physicians, New York, New York, United States of America
| | - Anthony A. Bavry
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- North Florida/South Georgia Veterans Affairs Health System, Gainesville, Florida, United States of America
| | - Eileen M. Handberg
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Giuseppe Mancia
- Clinica Medica, Ospedale San Gerardo dei Tintori Monza, University of Milano-Bicocca, Milan, Italy
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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Kario K. Morning surge in blood pressure: a phenotype of systemic hemodynamic atherothrombotic syndrome. Am J Hypertens 2015; 28:7-9. [PMID: 25315475 DOI: 10.1093/ajh/hpu179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Department of Sleep and Circadian Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan.
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Kurtz TW, Lujan HL, DiCarlo SE. The 24 h pattern of arterial pressure in mice is determined mainly by heart rate-driven variation in cardiac output. Physiol Rep 2014; 2:2/11/e12223. [PMID: 25428952 PMCID: PMC4255824 DOI: 10.14814/phy2.12223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Few studies have systematically investigated whether daily patterns of arterial blood pressure over 24 h are mediated by changes in cardiac output, peripheral resistance, or both. Understanding the hemodynamic mechanisms that determine the 24 h patterns of blood pressure may lead to a better understanding of how such patterns become disturbed in hypertension and influence risk for cardiovascular events. In conscious, unrestrained C57BL/6J mice, we investigated whether the 24 h pattern of arterial blood pressure is determined by variation in cardiac output, systemic vascular resistance, or both and also whether variations in cardiac output are mediated by variations in heart rate and or stroke volume. As expected, arterial pressure and locomotor activity were significantly (P < 0.05) higher during the nighttime period compared with the daytime period when mice are typically sleeping (+12.5 ± 1.0 mmHg, [13%] and +7.7 ± 1.3 activity counts, [254%], respectively). The higher arterial pressure during the nighttime period was mediated by higher cardiac output (+2.6 ± 0.3 mL/min, [26%], P < 0.05) in association with lower peripheral resistance (-1.5 ± 0.3 mmHg/mL/min, [-13%] P < 0.05). The increased cardiac output during the nighttime was mainly mediated by increased heart rate (+80.0 ± 16.5 beats/min, [18%] P < 0.05), as stroke volume increased minimally at night (+1.6 ± 0.5 μL per beat, [6%] P < 0.05). These results indicate that in C57BL/6J mice, the 24 h pattern of blood pressure is hemodynamically mediated primarily by the 24 h pattern of cardiac output which is almost entirely determined by the 24 h pattern of heart rate. These findings suggest that the differences in blood pressure between nighttime and daytime are mainly driven by differences in heart rate which are strongly correlated with differences in locomotor activity.
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Affiliation(s)
- Theodore W Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - Heidi L Lujan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Stephen E DiCarlo
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
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Turak O, Afsar B, Ozcan F, Canpolat U, Grbovic E, Mendi MA, Oksuz F, Siriopol D, Covic A, Caliskan M, McFann K, Johnson RJ, Kanbay M. Relationship between elevated morning blood pressure surge, uric acid, and cardiovascular outcomes in hypertensive patients. J Clin Hypertens (Greenwich) 2014; 16:530-5. [PMID: 24919769 DOI: 10.1111/jch.12359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/01/2014] [Accepted: 05/08/2014] [Indexed: 01/19/2023]
Abstract
Early morning blood pressure surge (MBPS) is a risk factor for cardiovascular events (CVEs), but the relationship with uric acid is not well understood. The authors aimed to determine the association between MBPS and increased uric acid and the effect of elevated MBPS and uric acid combination on CVEs. A total of 921 patients underwent 24-hour ambulatory blood pressure monitoring and were followed for a median of 40 months. During this period, 103 (11.2%) CVEs occurred. There was a significant relationship between increasing quartiles of serum uric acid level and increasing values of MBPS (P<.0001). Patients in the highest quartile stratified by elevated MBPS and serum uric acid level had a 3.55 odds of major CVE compared with patients in the lowest quartile. Serum uric acid is associated with MBPS and development of new CVEs.
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Affiliation(s)
- Osman Turak
- Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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16
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The relationship between indoor, outdoor and ambient temperatures and morning BP surges from inter-seasonally repeated measurements. J Hum Hypertens 2014; 28:482-8. [DOI: 10.1038/jhh.2014.4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 11/09/2022]
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Alessi A, Brandão AA, de Paiva AMG, Nogueira ADR, Feitosa A, Gonzaga CDC, Amodeo C, Mion D, de Souza DDSM, Barbosa E, Lima Junior E, Nobre F, Fuchs FD, Chaves Junior H, Schneider JC, Gemelli J, Villela-Martin JF, Scala LCN, Gomes MAM, Malachias MVB, de Morais NS, Moreira Filho O, Passarelli Junior O, Jardim PCBV, Miranda RD, Póvoa R, Fuchs SC, Baiocchi S, Jardim TV, Barroso WKS. I Brazilian position paper on prehypertension, white coat hypertension and masked hypertension: diagnosis and management. Arq Bras Cardiol 2014; 102:110-8. [PMID: 24676366 PMCID: PMC3987343 DOI: 10.5935/abc.20140011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 01/22/2023] Open
Affiliation(s)
- Alexandre Alessi
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - Audes Feitosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Celso Amodeo
- Brazilian Society of Cardiology Arterial Hypertension Department
| | - Decio Mion
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Eduardo Barbosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Fernando Nobre
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - João Gemelli
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | | | | | | | | | | | | | - Rui Póvoa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Sergio Baiocchi
- Brazilian Society of Cardiology Arterial Hypertension Department
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Mizuno K. Human circadian rhythms and exercise: Significance and application in real-life situations. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2014. [DOI: 10.7600/jpfsm.3.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Blood pressure regulation VII. The “morning surge” in blood pressure: measurement issues and clinical significance. Eur J Appl Physiol 2013; 114:521-9. [DOI: 10.1007/s00421-013-2692-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/02/2013] [Indexed: 12/21/2022]
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Oudegeest-Sander MH, Eijsvogels TH, Verheggen RJ, Poelkens F, Hopman MT, Jones H, Thijssen DH. Impact of Physical Fitness and Daily Energy Expenditure on Sleep Efficiency in Young and Older Humans. Gerontology 2013; 59:8-16. [DOI: 10.1159/000342213] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022] Open
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Abstract
Blood pressure (BP) varies according to many internal and external factors, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies throughout the day and night. These changes in BP are closely related to mental and physical activities, and the sympathetic nervous system mainly contributes to the diurnal variation in BP. Other behavioral factors, such as food consumption and obesity, dietary intake of sodium, drinking and smoking habits, consumption of coffee and tea, and bathing, also affect the diurnal variation in BP. Alterations in diurnal BP variation due to behavioral factors are frequently seen in patients with hypertension and can be classified as morning hypertension, daytime hypertension and nighttime hypertension. Appropriate lifestyle modifications may normalize or improve both the level and rhythm of BP in these patients.
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Galzerano D, Capogrosso C, Di Michele S, Galzerano A, Paparello P, Lama D, Gaudio C. New standards in hypertension and cardiovascular risk management: focus on telmisartan. Vasc Health Risk Manag 2010; 6:113-33. [PMID: 20448797 PMCID: PMC2860444 DOI: 10.2147/vhrm.s7857] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Indexed: 12/21/2022] Open
Abstract
Blockade of the renin–angiotensin system is an important approach in managing high blood pressure, and has increasingly been shown to affect cardiovascular disease processes mediated by angiotensin II throughout the cardiovascular and renal continua. Telmisartan is an angiotensin II receptor blocker (ARB) displaying unique pharmacologic properties, including a longer half life than any other ARB, that result in large and sustained reductions of blood pressure. In patients with mild-to-moderate hypertension, telmisartan has proved superior to other antihypertensive agents (valsartan, losartan, ramipril, perindopril, and atenolol) in controlling blood pressure particularly towards the end of the dosing interval. There is also clinical evidence that telmisartan reduces left ventricular hypertrophy, reduces arterial stiffness and the recurrence of atrial fibrillation, and confers renoprotection. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET®) study has demonstrated that telmisartan has similar cardiovascular protective effects to ramipril in a large, high-risk patient population but was better tolerated. The powerful and sustained blood pressure control apparent in clinical trials, together with cardiovascular protection and tolerability demonstrated in ONTARGET® means that telmisartan may be a preferred option for patients with hypertension.
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Atkinson G, Jones H, Ainslie PN. Circadian variation in the circulatory responses to exercise: relevance to the morning peaks in strokes and cardiac events. Eur J Appl Physiol 2009; 108:15-29. [PMID: 19826832 DOI: 10.1007/s00421-009-1243-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
Abstract
Sudden cardiac and cerebral events are most common in the morning. A fundamental question is whether these events are triggered by the increase in physical activity after waking, and/or a result of circadian variation in the responses of circulatory function to exercise. Although signaling pathways from the master circadian clock in the suprachiasmatic nuclei to sites of circulatory control are not yet understood, it is known that cerebral blood flow, autoregulation and cerebrovascular reactivity to changes in CO(2) are impaired in the morning and, therefore, could explain the increased risk of cerebrovascular events. Blood pressure (BP) and the rate pressure product (RPP) show marked 'morning surges' when people are studied in free-living conditions, making the rupture of a fragile atherosclerotic plaque and sudden cardiac event more likely. Since cerebral autoregulation is reduced in the morning, this surge in BP may also exacerbate the risk of hemorrhagic and ischemic strokes in the presence of other acute and chronic risk factors. Increased sympathetic activity, decreased endothelial function, and increased platelet aggregability could also be important in explaining the morning peak in cardiac and cerebral events but how these factors respond to exercise at different times of day is unclear. Evidence is emerging that the exercise-related responses of BP and RPP are increased in the morning when prior sleep is controlled. We recommend that such 'semi-constant routine' protocols are employed to examine the relative influence of the body clock and exogenous factors on the 24-h variation in other circulatory factors.
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Affiliation(s)
- Greg Atkinson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
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Abstract
Hypertension is a major risk factor for cardiovascular disease and death. The "silent" rise of blood pressure that occurs over time is largely asymptomatic. However, its impact is deafening-causing and exacerbating cardiovascular disease, end-organ damage, and death. The present article addresses recent observations from human and animal studies that provide new insights into how the circadian clock regulates blood pressure, contributes to hypertension, and ultimately evolves vascular disease. Further, the molecular components of the circadian clock and their relationship with locomotor activity, metabolic control, fluid balance, and vascular resistance are discussed with an emphasis on how these novel, circadian clock-controlled mechanisms contribute to hypertension.
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Affiliation(s)
- R Daniel Rudic
- Department of Pharmacology and Toxicology, 1120 15th St., Medical College of Georgia, Augusta, GA 30912, USA.
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Jones H, George K, Edwards B, Atkinson G. Effects of Time of Day on Post‐Exercise Blood Pressure: Circadian or Sleep‐Related Influences? Chronobiol Int 2009; 25:987-98. [DOI: 10.1080/07420520802548044] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Wang MY, Huang CJ, Chang NC, Tsai PS. Reproducibility of Morning Blood Pressure Surge and Its Relation to Blood Pressure Reactivity. Clin Exp Hypertens 2009; 29:357-68. [PMID: 17729053 DOI: 10.1080/10641960701578345] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the stability of the morning blood pressure surge (MBPS) and its relation to blood pressure (BP) reactivity in untreated hypertensives. Thirty-six participants completed a stress task at baseline. Ambulatory BP monitoring was carried out three times on a weekday. The MBPS demonstrated small reproducibility and large coefficient of variation. The MBPS correlated with nighttime BP (p = 0.001) but not morning BP or BP reactivity. Dippers had greater MBPS than did nondippers (p < 0.05). The MBPS provides distinct information that is different from the BP response to mental stress.
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Affiliation(s)
- Mei-Yeh Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University [corrected] Cardinal Tien College of Healthcare & Management, HsinTien, Taipei, Taiwan
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Yamazaki T, Asanoi H, Ueno H, Yamada K, Takagawa J, Kameyama T, Hirai T, Nozawa T, Inoue H. Circadian Dynamics of Heart Rate and Physical Activity in Patients with Heart Failure. Clin Exp Hypertens 2009. [DOI: 10.1081/ceh-48870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Uen S, Asghari S, Nickenig G, Mengden T. Early Morning Surge and Dipping Status of Blood Pressure: Are These of Predictive Value for Silent Myocardial Ischemia? J Clin Hypertens (Greenwich) 2009; 11:351-7. [DOI: 10.1111/j.1751-7176.2009.00139.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Association of an abnormal blood glucose level and morning blood pressure surge in elderly subjects with hypertension. Am J Hypertens 2009; 22:611-6. [PMID: 19325533 DOI: 10.1038/ajh.2009.61] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We previously reported that morning blood pressure (BP) surge (MBPS) was an independent risk factor for stroke. We evaluated the determinants of MBPS in hypertensive patients. METHODS We analyzed 24-h ambulatory BP monitoring (ABPM) records in 458 hypertensive patients (mean: 72.2 +/- 8.5 years). The MBPS was calculated as the mean systolic BP (SBP) over 2 h after waking minus mean SBP during the hour of sleep that included the lowest nighttime BP. The cutoff value for identifying the top decile (the MBPS group) was defined as > or =55 mm Hg. RESULTS The MBPS was associated with age, fasting plasma glucose, and 24-h SBP, and they were independent and significant determinants of MBPS in multivariate analysis (age, P = 0.01; fasting plasma glucose, P < 0.01; 24-h SBP, P = 0.04) after adjustment for confounding factors of gender, body mass index (BMI), and smoking status. The subjects in the MBPS group (n = 45) were older in age (76.4 years vs. 71.8 years, P < 0.01) and had higher fasting plasma glucose (97.6 mg/dl vs. 91.4 mg/dl, P = 0.04) than those in the non-MBPS group. In logistic regression analysis, the MBPS group was associated with older age (10 years older: odds ratio (OR) 1.85, 95% confidence interval (CI) 1.26-2.72, P < 0.01) and higher fasting plasma glucose (10-mg/dl increase: OR 1.16, 95% CI 1.01-1.33, P = 0.03). CONCLUSION In addition to older age and higher mean 24-h SBP, higher fasting plasma glucose was associated with MBPS.
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Jones H, George K, Atkinson G. Timing of Exercise Within the Waking Period Does Not Alter Blood Pressure During Subsequent Nocturnal Sleep in Normotensive Individuals. J Exerc Sci Fit 2009. [DOI: 10.1016/s1728-869x(09)60022-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stergiou GS, Mastorantonakis SE, Roussias LG. Morning blood pressure surge: the reliability of different definitions. Hypertens Res 2008; 31:1589-94. [PMID: 18971534 DOI: 10.1291/hypres.31.1589] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preliminary evidence suggests that the morning surge (MS) in blood pressure (BP) is an independent predictor of cerebrovascular disease. However, the optimal definition of MS is uncertain. To compare the reproducibility of several MS definitions used in the literature, 132 untreated hypertensives were assessed with ambulatory BP monitoring twice, 2 weeks apart. Five MS definitions were compared. MS-1: the average BP of the first hour after rising minus the average BP of the first hour before rising; MS-2: BP 2 h after rising minus that of 2 h before rising; MS-3: BP 3 h after rising minus that of 3 h before rising; MS-4: BP 2 h after rising minus the average BP during sleep; MS-5: BP 2 h after rising minus the average BP of 3 consecutive readings, centered on the lowest reading during sleep. The reproducibility of each MS definition was assessed using the concordance correlation coefficient (CCC), the standard deviation of differences (SDD) and the coefficient of variation (CV) between repeated MS assessments, and the agreement in detecting "surgers," defined as subjects at the top quartile (Q4) of the MS distribution. CCCs were 0.20/0.30, 0.43/0.45, 0.53/0.51, 0.51/0.47, and 0.46/0.48 (systolic/diastolic) for MS-1 to MS-5 respectively; SDDs were 14.3/11.4, 12.1/9.9, 11.2/9.5, 10.3/8.2, and 11.9/9.8, respectively; CVs were 0.49/0.57, 0.44/0.39, 0.37/0.35, 0.36/0.31, and 0.27/0.24, respectively; and the agreement in detecting "surgers" was 69%/70%, 71%/76%, 75%/75%, 81%/83%, and 74%/75%, with kappa of 0.18/0.20, 0.23/0.36, 0.33/0.33, 0.49/0.53 and 0.29/0.31, respectively. There are important differences in the reproducibility of MS calculated by different methods. MS4 appears to provide the most reproducible definition of MS.
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Affiliation(s)
- George S Stergiou
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
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Battaglia C, Mancini F, Cianciosi A, Busacchi P, Persico N, Paradisi R, Facchinetti F, de Aloysio D. Cardiovascular risk in normal weight, eumenorrheic, nonhirsute daughters of patients with polycystic ovary syndrome: a pilot study. Fertil Steril 2008; 92:240-9. [PMID: 18692809 DOI: 10.1016/j.fertnstert.2008.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 05/02/2008] [Accepted: 05/03/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To verify whether healthy daughters with polycystic ovaries (PCO) of patients with polycystic ovary syndrome (PCOS) have an increased risk of cardiovascular disease in comparison with healthy controls. DESIGN Prospective observational study. SETTING University hospital. PATIENT(S) Seventeen eumenorrheic daughters with PCO of patients with PCOS (group 1) and 20 healthy volunteers (group 2) with regular ovulatory cycles. INTERVENTION(S) Fasting blood sampling, ultrasonographic and Doppler analyses, 24-hour ambulatory blood pressure monitoring. MAIN OUTCOME MEASURE(S) Medical examination; blood measurement of nitrites and nitrates, biochemical and hormonal parameters; utero-ovarian ultrasonographic analysis and color Doppler evaluation of uterine and stromal ovarian arteries; brachial artery flow-mediated vasodilatation; 24-hour ambulatory blood pressure monitoring. An oral glucose tolerance test was performed to analyze glucose, insulin, and C-peptide levels. RESULT(S) At Doppler analysis a significantly higher uterine and a lower ovarian artery pulsatility index was found in group 1 compared with group 2. The brachial artery diameter, after the reactive hyperemia, showed a greater vasodilatation in controls in comparison with women with PCO. The 24-hour blood pressure monitoring demonstrated that patients with PCO have significant higher 24-hour, daytime, and nighttime diastolic and mean arterial pressure values than controls. The nitrites and nitrates plasma levels were lower in group 1 compared with group 2. The glucose and insulin plasma values were higher in patients with PCO than in controls. CONCLUSION(S) Eumenorrheic nonhirsute daughters of patients with PCOS who have PCO appearance on ultrasound have an increased cardiovascular risk.
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Affiliation(s)
- Cesare Battaglia
- Department of Obstetrics and Gynecology, Alma Mater Studiorum-University of Bologna, Via Massarenti 13, Bologna, Italy.
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Jones H, Pritchard C, George K, Edwards B, Atkinson G. The acute post-exercise response of blood pressure varies with time of day. Eur J Appl Physiol 2008; 104:481-9. [DOI: 10.1007/s00421-008-0797-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
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YANO Y, KARIO K. Unresolved Issues of the Morning Blood Pressure Surge: The Next Stage of Clinical Applicability for the Morning Surge. Hypertens Res 2008; 31:1491-4. [DOI: 10.1291/hypres.31.1491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Waterhouse J, Atkinson G, Reilly T, Jones H, Edwards B. Chronophysiology of the cardiovascular system. BIOL RHYTHM RES 2007. [DOI: 10.1080/09291010600906109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Atkinson G, Davenne D. Relationships between sleep, physical activity and human health. Physiol Behav 2007; 90:229-35. [PMID: 17067643 PMCID: PMC2782301 DOI: 10.1016/j.physbeh.2006.09.015] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 09/04/2006] [Indexed: 01/04/2023]
Abstract
Although sleep and exercise may seem to be mediated by completely different physiological mechanisms, there is growing evidence for clinically important relationships between these two behaviors. It is known that passive body heating facilitates the nocturnal sleep of healthy elderly people with insomnia. This finding supports the hypothesis that changes in body temperature trigger somnogenic brain areas to initiate sleep. Nevertheless, little is known about how the core and distal thermoregulatory responses to exercise fit into this hypothesis. Such knowledge could also help in reducing sleep problems associated with nocturnal shiftwork. It is difficult to incorporate physical activity into a shiftworker's lifestyle, since it is already disrupted in terms of family commitments and eating habits. A multi-research strategy is needed to identify what the optimal amounts and timing of physical activity are for reducing shiftwork-related sleep problems. The relationships between sleep, exercise and diet are also important, given the recently reported associations between short sleep length and obesity. The cardiovascular safety of exercise timing should also be considered, since recent data suggest that the reactivity of blood pressure to a change in general physical activity is highest during the morning. This time is associated with an increased risk in general of a sudden cardiac event, but more research work is needed to separate the influences of light, posture and exercise per se on the haemodynamic responses to sleep and physical activity following sleep taken at night and during the day as a nap.
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Affiliation(s)
- Greg Atkinson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, Webster Street, Liverpool L3 2ET, UK.
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IKEDA T, GOMI T, SHIBUYA Y, SHINOZAKI S, SUZUKI Y, MATSUDA N. Add-On Effect of Bedtime Dosing of the .ALPHA.1-Adrenergic Receptor Antagonist Doxazosin on Morning Hypertension and Left Ventricular Hypertrophy in Patients Undergoing Long-Term Amlodipine Monotherapy. Hypertens Res 2007; 30:1097-105. [DOI: 10.1291/hypres.30.1097] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Atkinson G, Drust B, George K, Reilly T, Waterhouse J. Chronobiological considerations for exercise and heart disease. Sports Med 2006; 36:487-500. [PMID: 16737342 DOI: 10.2165/00007256-200636060-00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although regular physical activity is beneficial for many clinical conditions, an acute bout of exercise might increase the risk of an adverse clinical event, such as sudden cardiac death or myocardial infarction, particularly in vulnerable individuals. Since it is also known that the incidence of these events peaks in the morning and that some cardiac patients prefer to schedule leisure-time physical activity before lunch, the question arises as to whether morning exercise is 'inherently' more risky than physical activity performed at other times of day. We attempt to answer this question by reviewing the relevant epidemiological data as well as the results of chronobiological and exercise-related studies that have concentrated on the pathophysiological mechanisms for sudden cardiac events. We also consider generally how chronobiology might impact on exercise prescription in heart disease. We performed a structured literature search in the PubMed and WEBofSCIENCE databases for relevant studies published between 1981 and 2004. The limited amount of published epidemiological data did not allow us to conclude that a bout of vigorous exercise in the morning increases the relative risk of either primary cardiac events in apparently healthy individuals, or secondary events in cardiac patients enrolled in supervised exercise programmes. Nevertheless, these data are not directly relevant to individuals who have a history of heart disease and perform uncontrolled habitual activities. It appears as though the influence of time of day on the cardiovascular safety of this type of exercise has not been examined in this population. There is evidence that several pathophysiological variables (e.g. blood pressure, endothelial function, fibrinolysis) vary in parallel with typical diurnal changes in freely chosen activity. Nevertheless, few studies have been designed to examine specifically whether such variables respond differently to a 'set' level of exercise in the morning compared with the afternoon or evening. Even fewer researchers have adequately separated the influences of waking from sleep, adopting an upright posture and physical exertion per se on these pathophysiological responses at different times of day. In healthy individuals, exercise is generally perceived as more difficult and functional performance is decreased in the morning hours. These observations have been confirmed for patients with heart disease in only one small study. It has also not been confirmed, using an adequately powered study involving cardiac patients, that the responses of heart rate and oxygen consumption (VO(2)) to a set bout of exercise show the highest reactivity in the afternoon and evening, which is the case with healthy individuals. Confirmation of this circadian variation would be important, since it would mean that exercise might be prescribed at too high an intensity in the morning if heart rate or VO(2) responses are employed as markers of exercise load. We conclude that there is some parallelism between the diurnal changes in physical activity and those in the pathophysiological mechanisms associated with acute cardiac events. Nevertheless, more studies are needed to ascertain whether the responses of endothelial function, fibrinolysis and blood pressure to a set exercise regimen differ according to time of day. The results of epidemiological studies suggest that morning exercise is just as safe as afternoon exercise for cardiac patients enrolled in a supervised rehabilitation programme. Nevertheless, it is unclear whether time of day alters the risk of a cardiac event occurring during spontaneous physical activity performed by individuals with established risk factors for heart disease.
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Affiliation(s)
- Greg Atkinson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, UK.
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Abstract
Alterations in the circadian rhythm of blood pressure, whether a loss of the nighttime dip or an exaggeration of the early morning increase that occurs upon rising, indicate increased cardiovascular risk. Estimates of the magnitude of the blood pressure surge on rising vary depending on technique and population, but it is usually around 10-30 mm Hg systolic and 7-23 mm Hg diastolic. The magnitude of the surge increases with age, alcohol consumption, and smoking and is greater in whites. Blood pressure variations and morning plasma aldosterone are closely correlated. A high morning surge is linked to increased target organ damage as well as strokes and other cardiovascular complications. Therapeutic options exist to reduce the magnitude of the morning blood pressure surge-notably, the use of drugs with a long duration of action, the use of medications that specifically antagonize the morning surge (such as alpha blockers), and the administration of drugs upon awakening but before rising.
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Affiliation(s)
- Philippe Gosse
- Service De Cardiologie, Hypertension Arterielle, Hôpital Saint-André, Bordeaux, France.
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Jones H, Atkinson G, Leary A, George K, Murphy M, Waterhouse J. Reactivity of Ambulatory Blood Pressure to Physical Activity Varies With Time of Day. Hypertension 2006; 47:778-84. [PMID: 16505205 DOI: 10.1161/01.hyp.0000206421.09642.b5] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) fluctuates over a 24-hour period, but it is unclear to what extent this variation is governed completely by changes in physical activity. Our aim was to use a BP “reactivity index” to investigate whether the BP response to a given level of physical activity changes during a normal sleep-wake cycle. Hypertensive patients (n=440) underwent simultaneous 24-hour ambulatory BP, heart rate (HR), and activity monitoring. BP and HR were measured every 20 minutes. Actigraphy data were averaged over the 15 minutes that preceded a BP measurement. Individual BP and HR reactivity indices were calculated using least-squares regression for twelve 2-hour periods. These indices were then analyzed for time-of-day differences using a general linear model. Systolic BP and HR were generally more reactive to physical activity than diastolic BP. The highest reactivity of systolic BP (mean±SE=4±1 mm Hg per logged unit change in activity) was observed between 8:00
am
and 10:00
am
(
P
=0.014). Between 10:00
am
and 12:00
pm
, BP reactivity then decreased (
P
=0.048) and showed a secondary rise in the early afternoon. These 24-hour changes in BP reactivity did not differ significantly between groups formed on the basis of early and late wake times (
P
=0.485), medication use, age, and sex (
P
>0.350). In conclusion, under conditions of normal living, the reactivity of BP and HR to a given unit change in activity is highest in the morning and shows a secondary rise in the afternoon.
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Affiliation(s)
- Helen Jones
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 2ET, United Kingdom.
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Haas DC, Gerber LM, Shimbo D, Warren K, Pickering TG, Schwartz JE. A comparison of morning blood pressure surge in African Americans and whites. J Clin Hypertens (Greenwich) 2005; 7:205-9; quiz 210-1. [PMID: 15860959 PMCID: PMC8109463 DOI: 10.1111/j.1524-6175.2005.03503.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
African Americans have twice the risk of suffering a stroke compared to whites, but the reasons for this disparity have yet to be elucidated. Recent data suggest that the morning blood pressure (BP) surge is an independent predictor of strokes. Whether African Americans and whites differ with respect to morning BP surge is unknown. African-American (n=183) and white (n=139) participants, age 18-65, were studied with 24-hour ambulatory BP monitoring. Morning surge was defined as morning BP minus the trough BP during sleep. The morning surge was significantly lower in African Americans than in whites (23 mm Hg vs. 27 mm Hg; both SEM=1.0; p=0.009). This relationship was no longer evident after adjusting for gender, age, and body mass index (23 mm Hg vs. 26 mm Hg; SE=1.0 and 1.1; p=nonsignificant). Morning BP surge is unlikely to account for differences in stroke incidence between African Americans and whites.
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Affiliation(s)
- Donald C Haas
- Cardiovascular Institute, Mount Sinai School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA.
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Abstract
OBJECTIVES Since cardiovascular complications tend to occur more often in the morning, it is tempting to link this to the surge in blood pressure (BP) on rising. Our objective was to measure BP and heart rate (HR) on rising and compare values with those recorded immediately beforehand and seek variables related to marked changes in the two parameters in a cohort of initially untreated hypertensives. METHODS The 24-h ambulatory BP measurement along with an accurate measurement of the BP on rising (either manually or automatically from the device coupled with a position sensor) was obtained in untreated hypertensives. Left ventricular mass was measured with echocardiography at baseline. Patients were then treated and followed by their general physician and news was obtained at regular intervals. RESULTS A total of 507 patients with adequate recordings were included. Rising led to a mean increase of 14 mmHg in systolic blood pressure (SBP) and a 13 beats per minute (bpm) increase in HR. This elevation in BP on rising in the morning differed from the alteration in BP on normal changes in position. It was associated with left ventricular hypertrophy at baseline and an increased risk of future cardiovascular complications. CONCLUSIONS Our study confirms the surge in BP on rising in the morning. This elevation in BP is accompanied by an acceleration in cardiac rhythm with no significant correlation between the two parameters. The increase in BP on rising was linked with the overall variability in BP, but was independent of the mean BP over 24 h. It was associated with an increased risk of cardiovascular complications independently of age and average 24-h SBP.
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Affiliation(s)
- Philippe Gosse
- Service de Cardiologie/Hypertension Artérielle, Hopital Saint André, 1 rue Jean Burguet, 33075 Bordeaux, France.
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Marfella R, Gualdiero P, Siniscalchi M, Carusone C, Verza M, Marzano S, Esposito K, Giugliano D. Morning blood pressure peak, QT intervals, and sympathetic activity in hypertensive patients. Hypertension 2003; 41:237-43. [PMID: 12574088 DOI: 10.1161/01.hyp.0000050651.96345.0e] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the relation between morning blood pressure (BP) variations, sympathetic activity, and QT intervals in 156 never-treated subjects with essential hypertension and different patterns of morning BP increase. The morning BP peak (MP) was defined as a rise in systolic BP >or=50 mm Hg and/or diastolic BP >or=22 mm Hg during early morning (6:00 to 10:00 AM) compared with mean BP during the night. Clinical characteristics of patients with morning BP peak (MP+, n= 69, morning systolic BP=+54+/-4, diastolic BP=+32+/-5 mm Hg) did not differ from patients without BP peak (MP-, n= 87, morning systolic BP=+24+/-5, diastolic BP=+19+/-3 mm Hg). The daytime (10:00 AM to 10:00 PM) and the nighttime (10:00 PM to 6:00 AM) BP profile did not differ between the two groups. During daytime and nighttime ECG monitoring, the corrected QT (QTc) interval, and QTc dispersion did not differ significantly between the two groups, whereas during the morning period the QT values were significantly broader in the MP+ group compared with the MP- group (P<or=0.001). Morning LF/HF ratio was significantly higher in MP+ patients than in MP- patients (P<or=0.02). Both systolic and diastolic morning BP, in combination with ratio LF/HF power, were significant predictors of QTc dispersion (adjusted R(2)=0.59, P<or=0.01) and QTc interval (adjusted R(2)=0.41, P<or=0.01), whereas inclusion of physical activity and echocardiographic parameters did not add explanatory information. The prolongation of cardiac repolarization times and morning sympathetic overactivity coexist in hypertensive patients with morning BP peaks, and they might contribute to raised cardiovascular risk in these patients.
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Affiliation(s)
- Raffaele Marfella
- Department of Geriatric and Metabolic Diseases, Second University of Naples, Naples Italy.
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