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Baross AW, Baxter BA, Wright BH, Kay AD. Effects of a maintenance period on ambulatory blood pressure and morning blood pressure surge in young normotensives post isometric training. Front Physiol 2024; 15:1405230. [PMID: 39210971 PMCID: PMC11358553 DOI: 10.3389/fphys.2024.1405230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/28/2024] [Indexed: 09/04/2024] Open
Abstract
Isometric resistance training (IRT) has emerged as an efficacious therapeutic intervention to reduce ambulatory blood pressure (BP), and BP diurnal variability. However, once the required decreases in BP have been achieved the efficacy of implementing a reduced maintenance dose is not understood. Therefore, the purpose of this study was to determine the effects of an 8-week maintenance period (8-week) following the cessation of the prescribed 8-week IRT in young normotensives. Twenty-two recreationally active, not resistance trained, normotensive (24-h ambulatory SBP, ≥130 mmHg) young adults were randomly assigned to a training-maintenance [TG-MT; n = 13 (female = 5); age 21 ± 2 years] or a non-training control [CON; n = 9 (female = 4); age 23 ± 3 years] group. Ambulatory BP, morning BP surge (MBPS) and average real variability (ARV) were measured prior to, after 8 weeks of bilateral leg IRT (4x2-minute contractions at 20% MVC with 2-min rest periods, 3 days/week) and following an 8-week (once per week) maintenance period. On completion of the maintenance period the significant reductions seen following the IRT were maintained within the TG-MT group in 24-h ambulatory SBP (6 ± 4 mmHg, p < 0.001), daytime (5 ± 5 mmHg, p = 0.002), MBPS (7 ± 10 mmHg, p = 0.019) and 24-h SBP ARV (2.03 ± 1.44 mmHg, p = 0.001), daytime SBP ARV (2.04 ± 1.78 mmHg, p = 0.003). These results show that reductions in ambulatory BP (24-h SBP and daytime SBP), in addition to BP diurnal variations (MBPS, 24-h SBP ARV and daytime SBP AVR) are maintained following an 8-week maintenance dose in young adults and add further weight to the growing body of evidence promoting IRT as an efficacious therapeutic exercise intervention to prevent or reduce BP.
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Affiliation(s)
- A. W. Baross
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - B. A. Baxter
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - B. H. Wright
- Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - A. D. Kay
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
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2
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Wu C, Zhao P, Xu P, Wan C, Singh S, Varthya SB, Luo SH. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev 2024; 2:CD004184. [PMID: 38353289 PMCID: PMC10865448 DOI: 10.1002/14651858.cd004184.pub3] [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] [Indexed: 02/16/2024]
Abstract
BACKGROUND Variation in blood pressure levels display circadian rhythms. Complete 24-hour blood pressure control is the primary goal of antihypertensive treatment and reducing adverse cardiovascular outcomes is the ultimate aim. This is an update of the review first published in 2011. OBJECTIVES To evaluate the effectiveness of administration-time-related effects of once-daily evening versus conventional morning dosing antihypertensive drug therapy regimens on all-cause mortality, cardiovascular mortality and morbidity, total adverse events, withdrawals from treatment due to adverse effects, and reduction of systolic and diastolic blood pressure in people with primary hypertension. SEARCH METHODS We searched the Cochrane Hypertension Specialised Register via Cochrane Register of Studies (17 June 2022), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2022); MEDLINE, MEDLINE In-Process and MEDLINE Epub Ahead of Print (1 June 2022); Embase (1 June 2022); ClinicalTrials.gov (2 June 2022); Chinese Biomedical Literature Database (CBLD) (1978 to 2009); Chinese VIP (2009 to 7 August 2022); Chinese WANFANG DATA (2009 to 4 August 2022); China Academic Journal Network Publishing Database (CAJD) (2009 to 6 August 2022); Epistemonikos (3 September 2022) and the reference lists of relevant articles. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the administration-time-related effects of evening with morning dosing monotherapy regimens in people with primary hypertension. We excluded people with known secondary hypertension, shift workers or people with white coat hypertension. DATA COLLECTION AND ANALYSIS Two to four review authors independently extracted data and assessed trial quality. We resolved disagreements by discussion or with another review author. We performed data synthesis and analyses using Review Manager Web for all-cause mortality, cardiovascular mortality and morbidity, serious adverse events, overall adverse events, withdrawals due to adverse events, change in 24-hour blood pressure and change in morning blood pressure. We assessed the certainty of the evidence using GRADE. We conducted random-effects meta-analysis, fixed-effect meta-analysis, subgroup analysis and sensitivity analysis. MAIN RESULTS We included 27 RCTs in this updated review, of which two RCTs were excluded from the meta-analyses for lack of data and number of groups not reported. The quantitative analysis included 25 RCTs with 3016 participants with primary hypertension. RCTs used angiotensin-converting enzyme inhibitors (six trials), calcium channel blockers (nine trials), angiotensin II receptor blockers (seven trials), diuretics (two trials), α-blockers (one trial), and β-blockers (one trial). Fifteen trials were parallel designed, and 10 trials were cross-over designed. Most participants were white, and only two RCTs were conducted in Asia (China) and one in Africa (South Africa). All trials excluded people with risk factors of myocardial infarction and strokes. Most trials had high risk or unclear risk of bias in at least two of several key criteria, which was most prominent in allocation concealment (selection bias) and selective reporting (reporting bias). Meta-analysis showed significant heterogeneity across trials. No RCTs reported on cardiovascular mortality and cardiovascular morbidity. There may be little to no differences in all-cause mortality (after 26 weeks of active treatment: RR 0.49, 95% CI 0.04 to 5.42; RD 0, 95% CI -0.01 to 0.01; very low-certainty evidence), serious adverse events (after 8 to 26 weeks of active treatment: RR 1.17, 95% CI 0.53 to 2.57; RD 0, 95% CI -0.02 to 0.03; very low-certainty evidence), overall adverse events (after 6 to 26 weeks of active treatment: RR 0.89, 95% CI 0.67 to 1.20; I² = 37%; RD -0.02, 95% CI -0.07 to 0.02; I² = 38%; very low-certainty evidence) and withdrawals due to adverse events (after 6 to 26 weeks active treatment: RR 0.76, 95% CI 0.47 to 1.23; I² = 0%; RD -0.01, 95% CI -0.03 to 0; I² = 0%; very low-certainty evidence), but the evidence was very uncertain. AUTHORS' CONCLUSIONS Due to the very limited data and the defects of the trials' designs, this systematic review did not find adequate evidence to determine which time dosing drug therapy regimen has more beneficial effects on cardiovascular outcomes or adverse events. We have very little confidence in the evidence showing that evening dosing of antihypertensive drugs is no more or less effective than morning administration to lower 24-hour blood pressure. The conclusions should not be assumed to apply to people receiving multiple antihypertensive drug regimens.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhao
- Medical Library, Sichuan University, Chengdu, China
| | - Ping Xu
- Medical Library, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Surjit Singh
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shuang-Hong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Baek MS, Song WK, Kim KE, Lee A, Lee JY, Shin JW, Kook MS. Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension. Am J Ophthalmol 2023; 254:161-176. [PMID: 37352910 DOI: 10.1016/j.ajo.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. DESIGN Retrospective cohort study. METHODS A total of 127 eyes from 127 newly diagnosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parameters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan-Meier survival analysis was used to compare VF survival estimates in patients with and without MBPS. RESULTS VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multivariate Cox regression model, a greater MBPS (hazard ratio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF progression was significantly greater in patients with higher MBPS (P = .021) at baseline according to Kaplan-Meier survival analysis. CONCLUSIONS An increased MBPS at baseline is a significant independent predictor of subsequent VF progression in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment.
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Affiliation(s)
- Min Su Baek
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Keun Song
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ko Eun Kim
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anna Lee
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Yeong Lee
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joong Won Shin
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Michael S Kook
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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4
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Gmitrov J. Carotid Baroreceptor Magnetic Activation and Beat‐to‐Beat Blood Pressure Variability, Implications to Treat Abrupt Blood Pressure Elevation in Labile Hypertension. Bioelectromagnetics 2022; 43:413-425. [DOI: 10.1002/bem.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/20/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Juraj Gmitrov
- Diabetology Clinic Krompachy Hospital, Agel SK Inc. Krompachy Slovakia
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5
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Baross AW, Kay AD, Baxter BA, Wright BH, McGowan CL, Swaine IL. Effects of isometric resistance training and detraining on ambulatory blood pressure and morning blood pressure surge in young normotensives. Front Physiol 2022; 13:958135. [PMID: 36160861 PMCID: PMC9500147 DOI: 10.3389/fphys.2022.958135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Isometric resistance training (IRT) has been shown to reduce resting and ambulatory blood pressure (BP), as well as BP variability and morning BP surge (MBPS). However, there are no data available regarding how long after cessation of IRT these effects are maintained. Therefore, the purpose of this study was to determine the effects of 8 weeks of detraining on resting BP, ambulatory BP and MBPS following 8 weeks of IRT in a population of young normotensive individuals and to further substantiate previously reported reductions in MBPS following IRT. Twenty-five apparently healthy participants with resting BP within the normal range (16 men, age = 23 ± 6 years; 9 women, age = 22 ± 4 years, resting BP: 123 ± 5/69 ± 7 mmHg) were randomly assigned to a training-detraining (TRA-DT, n = 13) or control (CON, n = 12) group. Resting BP, ambulatory BP and MBPS were measured prior to, after 8 weeks of bilateral leg IRT using an isokinetic dynamometer (4 × 2-min contractions at 20% MVC with 2-min rest periods, 3 days/week) and following an 8-week detraining period. There were significant reductions in 24-h ambulatory systolic BP (SBP) and calculated SBP average real variability (ARV) following IRT that were maintained after detraining (pre-to-post detraining, −6 ± 4 mmHg, p = 0.008, −2 ± 1.5 mmHg, p = 0.001). Similarly, the training-induced decreases in daytime SBP and daytime SBP ARV (pre-to-post detraining, −5 ± 6 mmHg, p = 0.001; −2 ± 1.2 mmHg, p = 0.001, respectively), MBPS (pre-to-post detraining, −6 ± 9 mmHg, p = 0.046) and resting SBP (pre-to-post detraining, −4 ± 6 mmHg, p = 0.044) were preserved. There were no changes in night-time or night-time SBP ARV across all time points (pre-to-post detraining, −1 ± 8 mmHg, p = 1.00, −0.7 ± 2.9 mmHg, p = 1.00). These results confirm that IRT causes significant reductions in resting BP, ambulatory BP, ambulatory ARV and MBPS. Importantly, the changes remained significantly lower than baseline for 8 weeks after cessation of training, suggesting a sustained effect of IRT.
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Affiliation(s)
- A. W. Baross
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
- *Correspondence: A. W. Baross,
| | - A. D. Kay
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - B. A. Baxter
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - B. H. Wright
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - C. L. McGowan
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - I. L. Swaine
- Sport Science, University of Greenwich, London, United Kingdom
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Dinakis E, Nakai M, Gill P, Ribeiro R, Yiallourou S, Sata Y, Muir J, Carrington M, Head GA, Kaye DM, Marques FZ. Association Between the Gut Microbiome and Their Metabolites With Human Blood Pressure Variability. Hypertension 2022; 79:1690-1701. [PMID: 35674054 DOI: 10.1161/hypertensionaha.122.19350] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blood pressure (BP) variability is an independent risk factor for cardiovascular events. Recent evidence supports a role for the gut microbiota in BP regulation. However, whether the gut microbiome is associated with BP variability is yet to be determined. Here, we aimed to investigate the interplay between the gut microbiome and their metabolites in relation to BP variability. METHODS Ambulatory BP monitoring was performed in 69 participants from Australia (55.1% women; mean±SD, 59.8±7.26 years; body mass index, 25.2±2.83 kg/m2). These data were used to determine nighttime dipping, morning BP surge (MBPS) and BP variability as SD. The gut microbiome was determined by 16S ribosomal RNA (rRNA) sequencing and metabolite levels by gas chromatography. RESULTS We identified specific taxa associated with systolic BP variability, nighttime dipping, and MBPS. Notably, Alistipesfinegoldii and Lactobacillus spp. were only present in participants within the normal ranges of BP variability, MBPS and dipping, while Prevotella spp. and Clostridium spp., were found to be present in extreme dippers and the highest quartiles of BP SD and MBPS. There was a negative association between MBPS and microbial α-diversity (r=-0.244, P=0.046). MBPS was also negatively associated with plasma levels of microbial metabolites called short-chain fatty acids (r=-0.305, P=0.020), particularly acetate (r=-0.311, P=0.017). CONCLUSIONS Gut microbiome diversity, levels of microbial metabolites, and the bacteria Alistipesfinegoldii and Lactobacillus were associated with lower BP variability and Clostridium and Prevotella with higher BP variability. Thus, our findings suggest the gut microbiome and metabolites may be involved in the regulation of BP variability.
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Affiliation(s)
- Evany Dinakis
- Hypertension Research Laboratory, School of Biological Sciences (E.D., M.N., F.Z.M), Monash University, Melbourne, Australia
| | - Michael Nakai
- Hypertension Research Laboratory, School of Biological Sciences (E.D., M.N., F.Z.M), Monash University, Melbourne, Australia
| | - Paul Gill
- Department of Gastroenterology (P.G., J.M.), Monash University, Melbourne, Australia
| | - Rosilene Ribeiro
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Australia (R.R.)
| | - Stephanie Yiallourou
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences (Y.S., D.M.K.), Monash University, Melbourne, Australia.,Preclinical Disease and Prevention (S.Y., M.C.), Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Hospital, Melbourne, Australia (Y.S., D.M.K.)
| | - Yusuke Sata
- Neuropharmacology Laboratory (Y.S., G.A.H.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jane Muir
- Department of Gastroenterology (P.G., J.M.), Monash University, Melbourne, Australia
| | - Melinda Carrington
- Preclinical Disease and Prevention (S.Y., M.C.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Geoffrey A Head
- Department of Pharmacology, Faculty of Medicine Nursing and Health Sciences (G.A.H.), Monash University, Melbourne, Australia.,Neuropharmacology Laboratory (Y.S., G.A.H.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - David M Kaye
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences (Y.S., D.M.K.), Monash University, Melbourne, Australia.,Heart Failure Research Group (D.M.K., F.Z.M.), Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Hospital, Melbourne, Australia (Y.S., D.M.K.)
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences (E.D., M.N., F.Z.M), Monash University, Melbourne, Australia.,Heart Failure Research Group (D.M.K., F.Z.M.), Baker Heart and Diabetes Institute, Melbourne, Australia
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7
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Baross AW, Brook RD, Kay AD, Howden R, Gaillard EC, Gordon BDH, Milne KJ, McGowan CLM, Swaine IL. Effects of isometric leg training on ambulatory blood pressure and morning blood pressure surge in young normotensive men and women. Sci Rep 2022; 12:356. [PMID: 35013400 PMCID: PMC8748906 DOI: 10.1038/s41598-021-04092-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Despite the reported association between diurnal variations in ambulatory blood pressure (BP) and elevated cardiovascular disease risk, little is known regarding the effects of isometric resistance training (IRT), a practical BP-lowering intervention, on ambulatory BP and morning BP surge (MBPS). Thus, we investigated whether (i) IRT causes reductions in ambulatory BP and MBPS, in young normotensives, and (ii) if there are any sex differences in these changes. Twenty normotensive individuals (mean 24-h SBP = 121 ± 7, DBP = 67 ± 6 mmHg) undertook 10-weeks of bilateral-leg IRT (4 × 2-min/2-min rest, at 20% maximum voluntary contraction (MVC) 3 days/week). Ambulatory BP and MBPS (mean systolic BP (SBP) 2 h after waking minus the lowest sleeping 1 h mean SBP) was measures pre- and post-training. There were significant reductions in 24-h ambulatory SBP in men (− 4 ± 2 mmHg, P = 0.0001) and women (− 4 ± 2 mmHg, P = 0.0001) following IRT. Significant reductions were also observed in MBPS (− 6 ± 8 mmHg, p = 0.044; − 6 ± 7 mmHg, P = 0.019), yet there were no significant differences between men and women in these changes, and 24-h ambulatory diastolic BP remained unchanged. Furthermore, a significant correlation was identified between the magnitude of the change in MBPS and the magnitude of changes in the mean 2-h SBP after waking for both men and women (men, r = 0.89, P = 0.001; women, r = 0.74, P = 0.014). These findings add further support to the idea that IRT, as practical lifestyle intervention, is effective in significantly lowering ambulatory SBP and MBPS and might reduce the incidence of adverse cardiovascular events that often occur in the morning.
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Affiliation(s)
- Anthony W Baross
- Sport and Exercise Science, University of Northampton, University Drive, NN1 5PH, Northampton, UK. .,Sport and Exercise Physiology, University of Northampton, University Drive, Northampton, NN1 5PH, UK.
| | - Robert D Brook
- Division of Cardiovascular Diseases, Wayne State University, Detroit, MI, USA
| | - Anthony D Kay
- Sport and Exercise Science, University of Northampton, University Drive, NN1 5PH, Northampton, UK
| | - Reuben Howden
- Laboratory of Systems Physiology: Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, USA
| | - Ebony C Gaillard
- Laboratory of Systems Physiology: Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, USA
| | - Ben D H Gordon
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA
| | - Kevin J Milne
- Department of Kinesiology, University of Windsor, Windsor, Canada
| | - Cheri L M McGowan
- Division of Cardiovascular Diseases, Wayne State University, Detroit, MI, USA.,Department of Kinesiology, University of Windsor, Windsor, Canada
| | - Ian L Swaine
- Department of Kinesiology, University of Windsor, Windsor, Canada.,Sport Science, University of Greenwich, London, UK
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Fukuda H, Ninomiya H, Ueba Y, Ohta T, Kaneko T, Kadota T, Hamada F, Fukui N, Nonaka M, Watari Y, Nishimoto S, Fukuda M, Hayashi S, Izumidani T, Nishimura H, Moriki A, Lo B, Ueba T. Impact of temperature decline from the previous day as a trigger of spontaneous subarachnoid hemorrhage: case-crossover study of prefectural stroke database. J Neurosurg 2020; 133:374-382. [PMID: 31277067 DOI: 10.3171/2019.4.jns19175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several environmental factors have been reported to correlate with incidence of spontaneous subarachnoid hemorrhage (SAH). However, because of different patient selection and study designs among these studies, meteorological factors that trigger the incidence of SAH in a short hazard period remain unknown. Among meteorological factors, daily temperature changes may disrupt and violate homeostasis and predispose to cerebrovascular circulatory disturbances and strokes. The authors aimed to investigate whether a decline in the temperature from the highest of the previous day to the lowest of the event day (temperature decline from the previous day [TDP]) triggers SAH in the prefecture-wide stroke database. METHODS All 28 participating institutions with primary or comprehensive stroke centers located throughout Kochi Prefecture, Japan, were included in the study. Data collected between January 2012 and December 2016 were analyzed, and 715 consecutive SAH patients with a defined date of onset were enrolled. Meteorological data in this period were obtained from the Kochi Local Meteorological Observatory. A case-crossover study was performed to investigate association of TDP and other environmental factors with onset of SAH. RESULTS The increasing TDP in 1°C on the day of the SAH event was associated with an increased incidence of SAH (OR 1.041, 95% CI 1.007-1.077) after adjustment for other environmental factors. According to the stratified analysis, a significant association between TDP and SAH was observed in women, patients < 65 years old, and patients with weekday onset. Among these factors, increasing TDP had a great impact on SAH onset in patients < 65 years old (p = 0.028, Mann-Whitney U-test). CONCLUSIONS TDP, temperature decline from the highest of the previous day to the lowest of the day, was correlated with the incidence of spontaneous SAH, particularly in younger patients < 65 years old.
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Affiliation(s)
| | - Hitoshi Ninomiya
- 1Department of Neurosurgery and
- 2Integrated Center for Advanced Medical Technologies, Kochi University Hospital
| | | | - Tsuyoshi Ohta
- 3Department of Neurosurgery, Kochi Health Sciences Center
| | | | | | | | | | | | - Yuya Watari
- 5Department of Neurosurgery, Kochi Red Cross Hospital
| | | | - Maki Fukuda
- 3Department of Neurosurgery, Kochi Health Sciences Center
| | | | | | | | - Akihito Moriki
- 7Department of Neurosurgery, Mominoki Hospital, Kochi, Japan; and
| | - Benjamin Lo
- 8Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Bagci S, Sabir H, Müller A, Reiter RJ. Effects of altered photoperiod due to COVID-19 lockdown on pregnant women and their fetuses. Chronobiol Int 2020; 37:961-973. [PMID: 32519912 DOI: 10.1080/07420528.2020.1772809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Maternal circadian rhythms provide highly important input into the entrainment and programming of fetal and newborn circadian rhythms. The light-dark cycle is an important regulator of the internal biological clock. Even though pregnant women spend a greater part of the day at home during the latter stages of pregnancy, natural light exposure is crucial for the fetus. The current recommended COVID-19 lockdown might dramatically alter normal environmental lighting conditions of pregnant women, resulting in exposure to extremely low levels of natural daylight and high-intensity artificial light sources during both day and night. This article summarizes the potential effects on pregnant woman and their fetuses due to prolonged exposure to altered photoperiod and as consequence altered circadian system, known as chronodisruption, that may result from the COVID-19 lockdown.
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Affiliation(s)
- S Bagci
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn , Bonn, Germany
| | - H Sabir
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn , Bonn, Germany
| | - A Müller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital-University of Bonn , Bonn, Germany
| | - R J Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio , San Antonio, Texas, USA
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10
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Kim HJ, Shin YU, Lee Y, Kang MH, Seong M, Cho H, Heo R, Park JK, Lim YH, Shin JH. Increasing incidence of macular edema in excessive morning blood pressure surge in patients with retinal vein occlusion. Sci Rep 2020; 10:4420. [PMID: 32157149 PMCID: PMC7064582 DOI: 10.1038/s41598-020-61386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/26/2020] [Indexed: 01/24/2023] Open
Abstract
Morning blood pressure surge (MBPS) had been known to be associated with hypertensive target organ injury and vascular events. Retinal vein occlusion (RVO) is also known to be related with underlying cardiovascular risk factors. This study investigated the effect of MBPS on patients with RVO. In total, 76 patients with RVO who had undergone systemic cardiovascular examination including a 24-hour ambulatory blood pressure monitoring, carotid artery intima media thickness, and pulse wave velocity were evaluated between January 2015 and February 2019. The MBPS was calculated as follows: mean systolic blood pressure measured over two hours after awakening minus mean systolic blood pressure measured during the one hour that included the lowest sleep blood pressure. Macular edema was significantly more prevalent in the MBPS group compared with the non-MBPS group. After adjusting for confounding factors, multivariate regression analyses revealed that MBPS independently predicted macular edema in patients with RVO [Odds ratio 4.75, 95% confidence interval 1.136–16.6, p = 0.015]. In conclusion, evaluating blood pressure patterns, especially MBPS, using 24-hour ambulatory blood pressure monitoring may be useful for assessing and predicting ophthalmologic outcome and may facilitate better blood pressure control in patients with RVO.
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Affiliation(s)
- Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Min Ho Kang
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Mincheol Seong
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea. .,Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
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11
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Ryu JW, Cha RH, Lee H, Kim YS, Lee JP, Song YR, Kim SG, Kim SJ. Association of Blood Pressure at Specific Time-Points with 1-Year Renal Outcomes in Patients with Diabetic Chronic Kidney Disease. Electrolyte Blood Press 2020; 17:36-44. [PMID: 31969922 PMCID: PMC6962443 DOI: 10.5049/ebp.2019.17.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/05/2022] Open
Abstract
Background The 24-hour mean blood pressure (mBP) is the best predictor of organ damage; however, it is not easily applicable in clinical practice. The APrODiTe study suggested that systolic blood pressure (SBP) values at 7:00 AM and 9:30 PM were associated with the 24-hour mSBP in patients with chronic kidney disease (CKD). We investigated the association of the SBP values at these time-points with the renal outcomes in patients with diabetic CKD during 1-year follow-up. Methods Ninety-six patients with diabetic CKD were included at 1-year follow-up. The renal outcomes were an increase in the random urine protein/creatinine ratio or estimated glomerular filtration rate (eGFR) deterioration, which means a decrease in eGFR ≥5 mL/min/1.73 m2 compared to the baseline values. Results The baseline SBP values at 7:00 AM, and 9:30 PM, and the 24-hour mSBP were 135.6±24.9 mmHg, 141.7±25.6 mmHg, and 136.4±20.7 mmHg, respectively. The SBP values measured at the same time-points after 1 year were similar to those at baseline. The SBP at 7:00 AM was significantly associated with eGFR deterioration in the univariate and multivariate analyses (odds ratio [OR]: 1.032; 95% confidence interval [CI]: 1.006-1.059; p=0.016). The SBP at 7:00AM and 24-hour mSBP did not show a concordant association with sustained proteinuria in the linear and logistic analyses. In the subgroup analysis, the association between the SBP at 7:00 AM and eGFR deterioration persisted in patients with CKD stage 3-5 (OR: 1.041; 95% CI: 1.010-1.073; p=0.010). Conclusion The SBP at 7:00 AM, in addition to the 24-hour mSBP, is also associated with eGFR deterioration in patients with diabetic CKD, particularly in those with CKD stage 3-5.
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Affiliation(s)
- Ji Won Ryu
- Department of Internal Medicine, Cheju Halla General Hospital, Cheju, Korea
| | - Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Se Joong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Kidney Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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12
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Oyama Y, Shuff S, Davizon-Castillo P, Clendenen N, Eckle T. Intense light as anticoagulant therapy in humans. PLoS One 2020; 15:e0244792. [PMID: 33382840 PMCID: PMC7775081 DOI: 10.1371/journal.pone.0244792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
Blood coagulation is central to myocardial ischemia and reperfusion (IR) injury. Studies on the light elicited circadian rhythm protein Period 2 (PER2) using whole body Per2-/- mice found deficient platelet function and reduced clotting which would be expected to protect from myocardial IR-injury. In contrast, intense light induction of PER2 protected from myocardial IR-injury while Per2 deficiency was detrimental. Based on these conflicting data, we sought to evaluate the role of platelet specific PER2 in coagulation and myocardial ischemia and reperfusion injury. We demonstrated that platelets from mice with tissue-specific deletion of Per2 in the megakaryocyte lineage (Per2loxP/loxP-PF4-CRE) significantly clot faster than platelets from control mice. We further found increases in infarct sizes or plasma troponin levels in Per2loxP/loxP-PF4-CRE mice when compared to controls. As intense light increases PER2 protein in human tissues, we also performed translational studies and tested the effects of intense light therapy on coagulation in healthy human subjects. Our human studies revealed that intense light therapy repressed procoagulant pathways in human plasma samples and significantly reduced the clot rate. Based on these results we conclude that intense light elicited PER2 has an inhibitory function on platelet aggregation in mice. Further, we suggest intense light as a novel therapy to prevent or treat clotting in a clinical setting.
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Affiliation(s)
- Yoshimasa Oyama
- Department of Anesthesiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Sydney Shuff
- Department of Anesthesiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Pavel Davizon-Castillo
- Department of Pediatrics, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Nathan Clendenen
- Department of Anesthesiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Tobias Eckle
- Department of Anesthesiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
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Murakami S, Otsuka K, Kono T. Repeated ambulatory monitoring reveals an evening rise in blood pressure in a Japanese population. J Clin Hypertens (Greenwich) 2019; 21:1675-1681. [PMID: 31566893 DOI: 10.1111/jch.13709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 01/18/2023]
Abstract
Recent studies have revealed 2 peaks in the onset of cardiovascular events, 1 in the morning and another in the evening. We evaluated whether blood pressure (BP) also rises in the morning/evening and identified the determinants of evening BP rise using 24-hour ambulatory BP monitoring for 7 consecutive days. We identified 2 BP peaks, 1 in the morning (0-3 hours after waking) and 1 in the evening (9-12 hours after waking). Subjects were subclassified according to the extent of evening BP rise: those in the top quartile (≥6.45 mm Hg, n = 34; ER group) vs all others. After adjustment for age, sex, and 24-hour systolic BP, evening BP rise was associated with the use of antihypertensive medications [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.46-8.74; P = .01] and estimated glomerular filtration rate (OR, 0.96; 95% CI, 0.93-0.99; P = .04), confirming its association with antihypertensive medication use and renal dysfunction.
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Affiliation(s)
- Shougo Murakami
- Department of Cardiovascular Medicine, Soseikai General Hospital, Kyoto, Japan
| | - Kuniaki Otsuka
- Executive Medical Center, Totsuka Royal Clinic, Tokyo Women Medical University, Tokyo, Japan
| | - Tatsuji Kono
- Department of Cardiovascular Medicine, Soseikai General Hospital, Kyoto, Japan
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14
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He Y, Yang M, Che S, Chen S, Jiang X, Guo Y. Effect of morning blood pressure peak on early progressive ischemic stroke: a prospective clinical study. Clin Neurol Neurosurg 2019; 184:105420. [PMID: 31310922 DOI: 10.1016/j.clineuro.2019.105420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/08/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To prospectively evaluate the effect of morning blood pressure peak (MBPP) on early progressive ischemic stroke (EPIS). PATIENTS AND METHODS A total of 135 patients with acute ischemic stroke were enrolled and completed all assessments. The patients were divided into EPIS group and non-EPIS group, with 22 and 113 cases in each group, respectively, according to the assessment of Scandinavian stroke scale within three days after onset. All cases received conventional treatment for stroke and its risk factors. 24 -h dynamic blood pressure monitoring was performed within 24 h after admission. Based on the 24 -h mean blood pressure, MBPP, morning blood pressure, and other risk factors for EPIS, we conducted a logistic regression analysis to evaluate whether MBPP was an independent risk factor for EPIS. RESULTS Mean systolic blood pressure, systolic and diastolic MBPP, morning systolic and diastolic blood pressure were all significantly higher in EPIS group than in non-EPIS group (p = 0.037, p = 0.001, p = 0.035, p = 0.003, p = 0.042, respectively). Logistic regression analysis showed that MBPP was an independent risk factor for EPIS (OR = 1.057, 95% CI 1.014-1.102, p = 0.009). Further stratified analysis showed that incidences of EPIS in patients with elevated MBPP combined with large artery atherosclerosis or small artery occlusion were comparable (41.2% vs. 25.0%, p = 0.367), and the systolic MBPP was significantly higher in morning EPIS group than in non-morning EPIS group (p = 0.041). CONCLUSION Elevated systolic MBPP might be an independent risk factor for EPIS, and play a more obvious effect on EPIS manifesting in the morning especially.
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Affiliation(s)
- Yitao He
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Miaojuan Yang
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Sixuan Che
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Siyan Chen
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Xin Jiang
- Department of Cardiology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China.
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Zeman M, Molcan L, Herichova I, Okuliarova M. Endocrine and cardiovascular rhythms differentially adapt to chronic phase-delay shifts in rats. Chronobiol Int 2016; 33:1148-1160. [PMID: 27459109 DOI: 10.1080/07420528.2016.1203332] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Disturbances in regular circadian oscillations can have negative effects on cardiovascular function, but epidemiological data are inconclusive and new data from animal experiments elucidating critical biological mechanisms are needed. To evaluate the consequences of chronic phase shifts of the light/dark (LD) cycle on hormonal and cardiovascular rhythms, two experiments were performed. In Experiment 1, male rats were exposed to either a regular 12:12 LD cycle (CONT) or rotating 8-h phase-delay shifts of LD every second day (SHIFT) for 10 weeks. During this period, blood pressure (BP) was monitored weekly, and daily rhythms of melatonin, corticosterone, leptin and testosterone were evaluated at the end of the experiment. In Experiment 2, female rats were exposed to the identical shifted LD schedule for 12 weeks, and daily rhythms of BP, heart rate (HR) and locomotor activity were recorded using telemetry. Preserved melatonin rhythms were found in the pineal gland, plasma, heart and kidney of SHIFT rats with damped amplitude in the plasma and heart, suggesting that the central oscillator can adapt to chronic phase-delay shifts. In contrast, daily rhythms of corticosterone, testosterone and leptin were eliminated in SHIFT rats. Exposure to phase shifts did not lead to increased body weight and elevated BP. However, a shifted LD schedule substantially decreased the amplitude and suppressed the circadian power of the daily rhythms of BP and HR, implying weakened circadian control of physiological and behavioural processes. The results demonstrate that endocrine and cardiovascular rhythms can differentially adapt to chronic phase-delay shifts, promoting internal desynchronization between central and peripheral oscillators, which in combination with other negative environmental stimuli may result in negative health effects.
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Affiliation(s)
- Michal Zeman
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University , Bratislava , Slovak Republic
| | - Lubos Molcan
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University , Bratislava , Slovak Republic
| | - Iveta Herichova
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University , Bratislava , Slovak Republic
| | - Monika Okuliarova
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University , Bratislava , Slovak Republic
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Drägert K, Bhattacharya I, Hall MN, Humar R, Battegay E, Haas E. Basal mTORC2 activity and expression of its components display diurnal variation in mouse perivascular adipose tissue. Biochem Biophys Res Commun 2016; 473:317-322. [PMID: 27016480 DOI: 10.1016/j.bbrc.2016.03.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
In adipose tissue mTOR complex 2 (mTORC2) contributes to the regulation of glucose/lipid metabolism and inflammatory molecule expression. Both processes display diurnal variations during the course of the day. RICTOR and mSIN1 are unique and essential components of mTORC2, which is activated by growth factors including insulin. To assess whether mTORC2 components display diurnal variations, we analyzed steady state mRNA expression levels of Rictor, mSin1, and mTor in various adipose tissues during a 24 h period. Diurnally regulated expression of Rictor was detected in brown adipose tissues displaying highest mRNA expression levels at the beginning of the 12 h light period (zeitgeber time 2, ZT2). Gene expression patterns of mSin1 and mTor displayed a similar diurnal regulation as Rictor in PVAT while smaller changes were detected for these genes in aorta during the course of the day. Basal mTORC2 activity was measured by phosphorylation of protein kinase C (PKC) α at serine 657 was higher at ZT14 as compared with ZT2 in PVAT. In line, gene expression of inflammatory molecules nitric oxide synthase 2 and tumor necrosis factor α was lower at ZT 14 compared to ZT2. Our findings provide evidence for a diurnal regulation of expression of mTORC2 components and activity. Hence, mTORC2 is possibly an integral part of diurnally regulated signaling pathways in PVAT and possibly in other adipose tissues.
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Affiliation(s)
- Katja Drägert
- Research Unit, Department of Internal Medicine, University Hospital Zurich, Switzerland; Center of Competence Multimorbidity and University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland
| | - Indranil Bhattacharya
- Research Unit, Department of Internal Medicine, University Hospital Zurich, Switzerland; Center of Competence Multimorbidity and University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland
| | | | - Rok Humar
- Research Unit, Department of Internal Medicine, University Hospital Zurich, Switzerland; Center of Competence Multimorbidity and University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland
| | - Edouard Battegay
- Research Unit, Department of Internal Medicine, University Hospital Zurich, Switzerland; Center of Competence Multimorbidity and University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Elvira Haas
- Research Unit, Department of Internal Medicine, University Hospital Zurich, Switzerland; Center of Competence Multimorbidity and University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Switzerland.
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Abstract
There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06032-3940, USA,
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18
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Lee HT, Park JK, Choi SY, Choi BY, Kim MK, Mori M, Yamori Y, Lim YH, Shin J. Mediating effects of nocturnal blood pressure and morning surge on the contributions of arterial stiffness and sodium intake to morning blood pressure: A path analysis. Blood Press 2015; 25:28-35. [PMID: 26415624 DOI: 10.3109/08037051.2016.1091157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the mediating effects of nocturnal blood pressure (BP) and morning surge on the contribution of arterial stiffness and sodium intake to morning BP in a middle-aged general population. METHODS The study included 124 subjects aged 30-59 years, from rural Yeoju County, Gyeonggi Province, South Korea. Ambulatory BP monitoring, 24 h urinary sodium excretion (24 h UNa) and brachial-ankle pulse wave velocity (baPWV) measurements were performed in all subjects. RESULTS The mean ± SD age was 48.1 ± 8.2 years and the proportion of male subjects was 41.1%. After adjusting for covariates, morning systolic blood pressure (SBP) was significantly correlated with morning surge [coefficient = 0.761, 95% confidence interval (CI) 0.651-0.872, p < 0.001], nocturnal SBP (coefficient = 0.576, 95% CI 0.454-0.698, p < 0.001) and baPWV (coefficient = 3.550, 95% CI 1.447-5.653, p = 0.001). Path analysis modeling revealed that baPWV had significant direct (0.035, p = 0.013) and indirect effects (0.042, p = 0.012) on morning SBP. The indirect effect mediated by nocturnal SBP was statistically significant (0.054, p = 0.005), but the indirect effect mediated by the morning surge was not significant. The 24 h UNa had no significant direct or indirect effects on morning SBP. CONCLUSION baPWV had significant direct and indirect effects on morning SBP. The indirect effect was mediated by nocturnal SBP, but not by morning surge. The 24 h UNa had neither significant direct nor indirect effects on morning SBP.
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Affiliation(s)
- Hyung Tak Lee
- a Departments of Internal Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
| | - Jin-Kyu Park
- a Departments of Internal Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
| | - Sung Yong Choi
- b Departments of Preventive Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
| | - Bo Youl Choi
- b Departments of Preventive Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
| | - Mi Kyung Kim
- b Departments of Preventive Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
| | - Mari Mori
- c Institute for World Health Development, Mukogawa Women's University , Hyogo , Japan
| | - Yukio Yamori
- c Institute for World Health Development, Mukogawa Women's University , Hyogo , Japan
| | - Young Hyo Lim
- a Departments of Internal Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
| | - Jinho Shin
- a Departments of Internal Medicine , Hanyang University, College of Medicine , Seoul , Republic of Korea
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Pre-awakening diastolic hypotension in treated hypertensive patients: prevalence and predictors. J Hum Hypertens 2015. [DOI: 10.1038/jhh.2015.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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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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Weir MR, Punzi HA, Flack JM, Stoakes KA, Chavanu KJ, Li W, Dubiel R. A Randomized, Double-Blind, Forced-Titration Study to Compare Olmesartan Medoxomil versus Losartan Potassium in Patients with Stage 1 and 2 Hypertension. Postgrad Med 2015; 123:80-7. [DOI: 10.3810/pgm.2011.01.2248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gosse P, Schumacher H. Effect of telmisartan vs. ramipril on ‘dipping’ status and blood pressure variability: pooled analysis of the PRISMA studies. Hypertens Res 2013; 37:151-7. [DOI: 10.1038/hr.2013.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/11/2013] [Accepted: 08/02/2013] [Indexed: 11/09/2022]
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Ushigome E, Fukui M, Hamaguchi M, Matsumoto S, Mineoka Y, Nakanishi N, Senmaru T, Yamazaki M, Hasegawa G, Nakamura N. Morning pulse pressure is associated more strongly with elevated albuminuria than systolic blood pressure in patients with type 2 diabetes mellitus: post hoc analysis of a cross-sectional multicenter study. Diabetes Res Clin Pract 2013; 101:270-7. [PMID: 23871575 DOI: 10.1016/j.diabres.2013.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 11/16/2022]
Abstract
AIMS Recently, focus has been directed toward pulse pressure as a potentially independent risk factor for micro- and macrovascular disease. This study was designed to examine the relationship between pulse pressure taken at home and elevated albuminuria in patients with type 2 diabetes. METHODS This study is a post hoc analysis of a cross-sectional multicenter study. Home blood pressure measurements were performed for 14 consecutive days in 858 patients with type 2 diabetes. We investigated the relationship between systolic blood pressure or pulse pressure in the morning or in the evening and urinary albumin excretion using univariate and multivariate analyses. Furthermore, we measured area under the receiver-operating characteristic curve (AUC) to compare the ability to identify elevated albuminuria, defined as urinary albumin excretion equal to or more than 30 mg/g creatinine, of systolic blood pressure or pulse pressure. RESULTS Morning systolic blood pressure (β=0.339, P<0.001) and morning pulse pressure (β=0.378, P<0.001) were significantly associated with logarithm of urinary albumin excretion independent of other potential co-factors. AUC for elevated albuminuria in morning systolic blood pressure and morning pulse pressure were 0.668 (0.632-0.705; P<0.001) and 0.694 (0.659-0.730; P<0.001), respectively. AUC of morning pulse pressure was significantly greater than that of morning systolic blood pressure (P=0.040). CONCLUSIONS Our findings implicate that morning pulse pressure is associated with elevated albuminuria in patients with type 2 diabetes, which suggests that lowering morning pulse pressure could prevent the development and progression of diabetic nephropathy.
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Affiliation(s)
- Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Lado MJ, Méndez AJ, Rodríguez-Liñares L, Otero A, Vila XA. Nocturnal evolution of heart rate variability indices in sleep apnea. Comput Biol Med 2012; 42:1179-85. [DOI: 10.1016/j.compbiomed.2012.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 09/06/2012] [Accepted: 09/23/2012] [Indexed: 10/27/2022]
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Chrysant SG, Germino FW, Neutel JM. Olmesartan medoxomil-based antihypertensive therapy evaluated by ambulatory blood pressure monitoring: efficacy in high-risk patient subgroups. Am J Cardiovasc Drugs 2012; 12:375-89. [PMID: 23116225 DOI: 10.1007/bf03262472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension affects approximately 26% of the world's adult population and is a recognized major risk factor for morbidity and mortality associated with cardiovascular, cerebrovascular, and renal diseases. However, despite the availability of a range of effective antihypertensive agents and a growing awareness of the consequences of high blood pressure (BP), the treatment and control of hypertension remains suboptimal. A number of patient subgroups are categorized as 'high risk' and may have hypertension that is more difficult to treat, including obese individuals, patients with stage 2 hypertension, those with type 2 diabetes mellitus (T2DM), patients with coronary artery disease or a history of stroke, and Black patients. As the benefits of lowering BP in patients with hypertension are unequivocal, particularly in high-risk patients, treating high-risk patients with hypertension to BP goals and maintaining 24-hour BP control is important to help reduce cardiovascular risk and improve outcomes. Although the BP goals recommended in current consensus guidelines for the management of patients with hypertension are based on cuff BP measurements, ambulatory BP monitoring (ABPM) provides a valuable diagnostic tool and allows a more accurate assessment of BP levels throughout the 24-hour dosing period. ABPM is a better predictor of prognosis than office BP measurement and is also useful for assessing whether antihypertensive therapy remains effective in the critical last few hours of the dosing period, which usually coincides with the morning BP surge associated with arousal and arising. ABPM has been adopted by new evidence-based guidelines in the United Kingdom to confirm a suspected diagnosis of hypertension, which is an indication of the growing importance of ABPM in the management of hypertension. This review provides an overview of the efficacy and safety of antihypertensive therapy based on olmesartan medoxomil ± hydrochlorothiazide and amlodipine/olmesartan medoxomil in high-risk patient populations enrolled in studies that reported ambulatory BP endpoints. The studies identified in this review showed that a titrate-to-BP goal strategy using olmesartan medoxomil- or amlodipine/olmesartan medoxomil-based antihypertensive therapy was an effective and well-tolerated approach for maintaining BP control throughout the full 24-hour dosing period in high-risk patients with difficult-to-treat hypertension.
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Affiliation(s)
- Steven G Chrysant
- Oklahoma Cardiovascular and Hypertension Center and the University of Oklahoma School of Medicine, Oklahoma City, OK 73132, USA.
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White WB, Maraka S. Is it possible to manage hypertension and evaluate therapy without ambulatory blood pressure monitoring? Curr Hypertens Rep 2012; 14:366-73. [PMID: 22639014 DOI: 10.1007/s11906-012-0277-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the management of patients with hypertension, blood pressure (BP) has been traditionally measured in the physician's office. The contribution of ambulatory BP monitoring (ABPM) to the management of hypertensive patients has been increasingly recognized through clinical and epidemiological research. Ambulatory BP monitoring can enhance the ability to detect white-coat or masked hypertension, determine the absence of nocturnal dipping status, and evaluate BP control in patients on antihypertensive therapy. Recently, the United Kingdom National Clinical Guideline Centre published guidelines for the clinical management of primary hypertension in adults, recommending the routine use of ABPM to make the initial diagnosis of hypertension. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to the cost of the equipment, data evaluation, and staff training as well as the possible inconvenience to the patient. In this review, we summarize the clinical importance of ABPM and discuss the current guidelines for establishing the diagnosis of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06032-3940, USA.
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Cohn JN. Is it the blood pressure or the blood vessel? ACTA ACUST UNITED AC 2012; 1:5-16. [PMID: 20409829 DOI: 10.1016/j.jash.2006.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 11/10/2006] [Indexed: 11/28/2022]
Abstract
The physiologic link between vascular health and arterial pressure makes it difficult to separate the adverse effects of pressure and vascular functional and structural alterations in determining the adverse complications of hypertension. Since endothelial dysfunction and nitric oxide deficiency are characteristic features of hypertension and of other risk factors for morbid events, it is proposed that blood pressure elevation may be viewed in part as a complication of functional and structural changes in the microcirculation, and that structural changes in the conduit arteries leading to morbid events may be viewed as a complication of both pressure elevation and endothelial dysfunction. Improvement in endothelial dysfunction will relax the microcirculation and lower blood pressure. Thus pressure elevation and its lowering in resposne to treatment serves as a useful guide to the vascular abnormality and its amelioration, but vascular structural abnormalities are the proximate cause of vascular events and therapy aimed at the vasculature rather than the pressure may serve as a more sensitive and specific guide to treatment.
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Affiliation(s)
- Jay N Cohn
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Impact of the combination of an angiotensin II receptor blocker and low-dose hydrochlorothiazide on patients with morning hypertension. Hypertens Res 2012; 35:702-3. [DOI: 10.1038/hr.2012.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Twenty-four hour and early morning blood pressure control of olmesartan vs. ramipril in elderly hypertensive patients. J Hypertens 2012; 30:1468-77. [DOI: 10.1097/hjh.0b013e32835466ac] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Efficacy/safety of olmesartan medoxomil versus losartan potassium in naïve versus previously treated subjects with hypertension. Adv Ther 2012; 29:524-37. [PMID: 22763801 DOI: 10.1007/s12325-012-0029-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Indexed: 01/13/2023]
Abstract
INTRODUCTION A predefined exploratory analysis of a prospective, randomized, double-blind, forced-titration study of olmesartan medoxomil (OM) versus losartan potassium (LOS) in subjects with hypertension not previously or previously treated with antihypertensive medication is reported. METHODS The study included a 3-4-week placebo run-in and an 8-week active treatment period: OM (weeks 1-4, OM 20 mg; weeks 5-8, OM 40 mg); placebo + OM (weeks 1-2, placebo; weeks 3-4, OM 20 mg; weeks 5-8, OM 40 mg); and LOS (weeks 1-4, LOS 50 mg; weeks 5-8, LOS 100 mg). Analyses focused on comparison of OM and placebo + OM combined versus LOS. Efficacy endpoints were mean change from baseline in seated cuff diastolic blood pressure (SeDBP) at week 8 (primary); seated cuff systolic blood pressure (SeSBP) at weeks 4 and 8, and SeDBP at week 4 (secondary), and BP target achievement (tertiary). RESULTS The randomized population (n = 941) had a mean ± SD age of 51.9 ± 9.7 years, 54.5% were male, and 20.1% were naïve to antihypertensive medication. For treatmentnaïve subjects, baseline seated BP (SeBP) (±SD) was 157.4 (±10.9)/101.8 (±4.3) mmHg with OM and 156.3 (±10.8)/101.1 (±3.9) mmHg with LOS, while non-naïve subjects had 158.4 (±10.2)/100.9 (±4.0) mmHg with OM and 158.8 (±10.1)/101.3 (±4.2) mmHg with LOS. OM monotherapy produced significantly greater changes in least-squares mean (±SE) SeDBP compared with LOS in both treatment-naïve (-9.7 [1.0] vs. -6.6 [1.0] mmHg; P = 0.0232 vs. LOS) and non-naïve subjects (-9.6 [0.5] vs. -7.3 [0.5] mmHg; P = 0.0013 vs. LOS). A significantly greater proportion of patients achieved the SeBP goal of <140/90 mmHg with OM compared with LOS in treatment-naïve (34.1% vs. 19.0%, respectively; P = 0.0109) and non-naïve subjects (31.0% vs. 19.6%; P = 0.0008). CONCLUSION Overall, OM monotherapy resulted in significantly greater SeBP reductions and greater SeBP goal achievement than LOS, irrespective of previous medication use. Both OM and LOS therapy were well tolerated.
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Yano Y, Kario K. Nocturnal Blood Pressure, Morning Blood Pressure Surge, and Cerebrovascular Events. Curr Hypertens Rep 2012; 14:219-27. [DOI: 10.1007/s11906-012-0261-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Resting sympathetic outflow does not predict the morning blood pressure surge in hypertension. J Hypertens 2012; 29:2381-6. [PMID: 21986622 DOI: 10.1097/hjh.0b013e32834c1ecd] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The blood pressure (BP) rise on awakening (morning surge) might be a predictor of hypertension-related cardiovascular complications. Previous studies suggest that the autonomic nervous system may contribute to the early morning BP increase. We tested the hypothesis that resting sympathetic outflow [assessed by direct measures of intraneural sympathetic nerve activity (SNA)] may help predict the morning BP surge in hypertension. METHODS We measured muscle SNA (MSNA), heart rate (HR) and BP during undisturbed supine rest in 68 newly diagnosed untreated hypertensive patients (53 men and 15 women, age 40 ± 3 years, BMI 27 ± 1 kg/m(2), mean ± SEM). The morning BP surge was defined as the difference between the morning BP and the pre-awake BP. RESULTS SBP averaged 143 ± 3 mmHg for daytime and 126 ± 2 mmHg for night-time. Mean HR was 81 ± 2 beats/min for daytime and 69 ± 2 beats/min for night-time. Average MSNA was 32 ± 2 bursts/min., SBP morning surge 19 ± 2 mmHg and HR morning surge 14 ± 2 beats/min. In univariate analysis, MSNA correlated with daytime SBP (r = 0.28, P = 0.02); night-time SBP (r = 0.26, P = 0.03); daytime HR (r = 0.28, P = 0.02); and night-time HR (r = 0.26, P = 0.03). Multivariate analysis, taking into consideration age, BMI and sex, revealed that MSNA was independently related to both daytime (P = 0.006) and night-time HR (P = 0.02), but not to ambulatory SBP. The morning surge of SBP and HR was not related to MSNA (r = 0.01 and r = 0.07, respectively, P = NS). CONCLUSION In patients with essential hypertension, MSNA is related to both daytime and night-time HR, but not to the morning BP surge.
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Hasegawa H, Takano H, Kameda Y, Kubota A, Kobayashi Y, Komuro I. Effect of switching from telmisartan, valsartan, olmesartan, or losartan to candesartan on morning hypertension. Clin Exp Hypertens 2012; 34:86-91. [PMID: 22251314 DOI: 10.3109/10641963.2011.628729] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Candesartan Cooperative Research of Therapy Design for Early Morning Hypertension in CHIBA was designed to investigate whether switching from angiotensin II receptor blockers (ARBs) except candesartan to candesartan might be effective in Japanese patients with morning hypertension. Seventy-eight mild to moderate hypertensive patients, who were treated with the standard doses of ARBs except candesartan (losartan, 50 mg; valsartan, 80 mg; telmisartan, 40 mg; or olmesartan, 20 mg), were entered into 12-week treatment period with candesartan 8 mg according to a multicenter, open-label design. Morning and office blood pressures (BPs) were significantly reduced (morning, -10.1 ± 10.5/-4.5 ± 8.4 mm Hg; office, -13.1 ± 17.3/-6.2 ± 11.3 mm Hg) after medication change. Target BPs (morning BPs ≤ 135/85 mm Hg and office BPs ≤ 140/90 mm Hg) achievement rates were 42.9% in the morning and 64.3% at office. No adverse events were recognized in all patients. Candesartan treatment significantly reduced the morning and office BPs compared with other ARBs in Japanese patients with morning hypertension.
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Affiliation(s)
- Hiroshi Hasegawa
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
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Nonlinear heart rate dynamics: Circadian profile and influence of age and gender. Med Eng Phys 2012; 34:108-17. [DOI: 10.1016/j.medengphy.2011.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 07/04/2011] [Accepted: 07/11/2011] [Indexed: 11/22/2022]
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Morning blood pressure surge, morning platelet aggregation, and silent cerebral infarction in older Japanese hypertensive patients. J Hypertens 2011; 29:2433-9. [DOI: 10.1097/hjh.0b013e32834cf1c0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shimizu M, Ishikawa J, Yano Y, Hoshide S, Shimada K, Kario K. The relationship between the morning blood pressure surge and low-grade inflammation on silent cerebral infarct and clinical stroke events. Atherosclerosis 2011; 219:316-21. [DOI: 10.1016/j.atherosclerosis.2011.06.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Variation in blood pressure levels display circadian rhythms. The morning surge in blood pressure is known to increase the risk of myocardial events in the first several hours post awakening. A systematic review of the administration-time-related-effects of evening versus morning dosing regimen of antihypertensive drugs in the management of patients with primary hypertension has not been conducted. OBJECTIVES To evaluate the administration-time-related-effects of antihypertensive drugs administered as once daily monotherapy in the evening versus morning administration regimen on all cause mortality, cardiovascular morbidity and reduction of blood pressure in patients with primary hypertension. SEARCH STRATEGY We searched Cochrane CENTRAL on Ovid (4th Quarter 2009), Ovid MEDLINE (1950 to October 2009), EMBASE (1974 to October 2009), the Chinese Biomedical literature database (1978 to 2009) and the reference lists of relevant articles. No language restrictions were applied. SELECTION CRITERIA Randomized controlled trials comparing the administration-time-related effects of evening with morning dosing monotherapy regimens in patients with primary hypertension were included. Patients with known secondary hypertension, shift workers or white coat hypertension were excluded. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Data synthesis and analysis were done using RevMan 5.1. Random effects meta-analysis and sensitivity analysis were conducted. MAIN RESULTS 21 randomized controlled trials (RCTs) in 1,993 patients with primary hypertension met the inclusion criteria for this review - ACEIs (5 trials), CCBs (7 trials), ARBs (6 trials), diuretics (2 trials), alpha-blockers (1 trial), and beta-blockers (1 trial). Meta-analysis showed significant heterogeneity across trials.No RCT reported on all cause mortality, cardiovascular mortality, cardiovascular morbidity and serious adverse events.There was no statistically significant difference for overall adverse events (RR=0.78, 95%CI: 0.37 to 1.65) and withdrawals due to adverse events (RR=0.53, 95%CI: 0.26 to 1.07).No significant differences were noted for morning SBP (-1.62 mm Hg, 95% CI: -4.19 to 0.95) and morning DBP (-1.21 mm Hg, 95% CI: -3.28 to 0.86); but 24-hour BP (SBP: -1.71 mm Hg, 95% CI: -2.78 to -0.65; DBP: -1.38 mm Hg, 95% CI: -2.13 to -0.62) showed a statistically significant difference. AUTHORS' CONCLUSIONS No RCT reported on clinically relevant outcome measures - all cause mortality, cardiovascular morbidity and morbidity. There were no significant differences in overall adverse events and withdrawals due to adverse events among the evening versus morning dosing regimens. In terms of BP lowering efficacy, for 24-hour SBP and DBP, the data suggests that better blood pressure control was achieved with bedtime dosing than morning administration of antihypertensive medication, the clinical significance of which is not known.
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Affiliation(s)
- Ping Zhao
- Sichuan UniversityLibraryNo. 17, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Ping Xu
- Sichuan UniversityLibraryNo. 17, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Chaomin Wan
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of PediatricsNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Zhengrong Wang
- Sichuan UniversityWest China School of Preclinical Medicine and Forensic MedicineSection 3, No.17, South Renmin RoadChengduSichuanChina
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Brunner HR, Arakawa K. Antihypertensive efficacy of olmesartan medoxomil and candesartan cilexetil in achieving 24-hour blood pressure reductions and ambulatory blood pressure goals. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-3-22-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background. For patients with hypertension, effective 24-hour blood pressure (BP) control is vital to ensure protection against the early morning surge in BP and the associated increased risk of cardiovascular events. The aim of this analysis was to assess the 24-hour antihypertensive efficacy of olmesartan medoxomil (20 mg once daily) compared with candesartan cilexetil (8 mg once daily), with particular emphasis on BP control during the early morning period.Methods. This is an additional analysis of a previously reported randomised, double-blind study in which 635 patients with mainly mild to moderate hypertension were randomised to 8 weeks of treatment with either olmesartan medoxomil 20 mg/day or candesartan cilexetil 8 mg/day. Changes from baseline during the last 4 and 2 hours of ambulatory BP measurement (ABPM) after 1, 2 and 8 weeks of treatment were compared between the two groups. In addition, the proportions of patients who achieved various ABPM goals, including those suggested by the European Society of Hypertension/European Society of Cardiology (ESH/ESC) [<125/80 mm Hg] and the Japanese Society of Hypertension (JSH) [<135/80 mm Hg], over 24 hours, during the daytime and at the last 4 and 2 hours of ABPM measurement were also compared.Results.After 8 weeks, significantly greater proportions of patients treated with olmesartan medoxomil 20 mg achieved 24-hour and daytime ABPM goals recommended by the guidelines of the ESH/ESC (25,6 % and 18,3 %, respectively) and JSH (37,5 % and 26,6 %, respectively) compared with candesartan cilexetil 8 mg (24-hour ESH/ESC goal 14,9 %,p<0,001; 24-hour JSH goal 26,6 %,p=0,003; daytime ESH/ESC goal 9,6 %,p=0,002; daytime JSH goal 16,4 %,p=0,002). During the last 4 hours of 24-hour ABPM, the proportions of patients who achieved the ESH/ESC and JSH ABPM goals were significantly greater with olmesartan medoxomil (33,3 % and 39,1 %, respectively) than with candesartan cilexetil (22,9 %,p<0,001 and 31,6 %,p=0,047, respectively). Similarly, during the last 2 hours of 24-hour ABPM, the proportions of patients who achieved these BP goals were either significantly greater (JSH) or approached statistical significance (ESH/ESC) with olmesartan medoxomil (26,9 % and 19,9 %, respectively), compared with candesartan cilexetil (19,6 %,p=0,028 and 14,3 %,p=0,061, respectively).Conclusion. Compared with candesartan cilexetil 8 mg, greater proportions of olmesartan medoxomil-treated patients (20 mg) achieved ESH/ESC and JSH ABPM goals over 24 hours. The superior BP control of olmesartan medoxomil was also reflected in the larger proportions of olmesartan medoxomil-treated patients who achieved the ESH/ESC and JSH ABPM goals during the early morning surge period. This not only demonstrates that olmesartan medoxomil 20 mg provides superior 24-hour BP reduction, but also suggests that olmesartan medoxomil may provide greater protection against the increased risk of cardiovascular events associated with the early morning BP surge period.
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Affiliation(s)
- Hans R. Brunner
- Lausanne University, Medizinische Poliklinik, Universitaetsspital
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SASAI T, INOUE Y, MATSUO A, MATSUURA M, MATSUSHIMA E. Changes in respiratory disorder parameters during the night in patients with obstructive sleep apnoea. Respirology 2010; 16:116-23. [DOI: 10.1111/j.1440-1843.2010.01873.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kario K, Yano Y, Matsuo T, Hoshide S, Eguchi K, Shimada K. Additional impact of morning haemostatic risk factors and morning blood pressure surge on stroke risk in older Japanese hypertensive patients. Eur Heart J 2010; 32:574-80. [PMID: 21169614 DOI: 10.1093/eurheartj/ehq444] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Stroke events occur most frequently in the morning hours. Impaired haemostatic activity and morning blood pressure (BP) surge, defined as the morning BP increase from sleep, have individually been associated with stroke risk in general or hypertensive populations. However, their combined impact on the risk of a stroke remains unknown. METHODS AND RESULTS A total of 514 hypertensive patients aged > 50 years (mean 72.3 years; 37% men) underwent 24 h BP monitoring, measurement of haemostatic risk factors [plasma fibrinogen, plasminogen activator inhibitor-1 (PAI-1), and prothrombin fragment 1+2(F1+2)], and brain MRI at baseline. The incidence of stroke was prospectively ascertained. During an average of 41 months (1751 person-years), there were 43 stroke events (ischaemic, 30; haemorrhagic, 5; undefined, 8). On multivariable analysis adjusted for confounding factors, the hazard ratio [HR (95% confidence interval (CI)] for stroke in the highest vs. lower quartiles of PAI-1 was 2.5 (1.3-4.6), that for F1+2 was 2.6 (1.4-5.0), and that for the morning BP surge was 1.2 (1.1-1.4; all P< 0.01). In particular, the ratio was substantially higher in cases with the highest quartile of both PAI-1 and F1+2 levels compared with those with the lower quartiles of both parameters (HR: 8.2; 95% CI: 3.7-18.2; P< 0.001). Among the patients with the highest quartile of the morning BP surge (n= 128), the multivariable HR (95% CI) for the highest vs. lower quartiles of PAI-1 was 3.4 (1.3-9.1) and that for F1+2 was 3.3 (1.3-8.7) (both P< 0.05). CONCLUSION High levels of plasma PAI-1 and F1+2, as well as an excessive morning BP surge, are independently and additively associated with an increased risk of stroke in older hypertensive patients.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi 329-0498, Japan.
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Gonokami K, Obara T, Kobayashi M, Katada S, Hara A, Metoki H, Asayama K, Kikuya M, Ohkubo T, Imai Y. Blood pressure-lowering effect and duration of action of bedtime administration of doxazosin determined by home blood pressure measurement. Clin Exp Hypertens 2010; 32:311-7. [PMID: 20662733 DOI: 10.3109/10641960903443541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The effects and duration of action of bedtime administration of doxazosin 2 mg for 4 weeks on uncontrolled morning home hypertension were investigated. Morning home blood pressure (HBP) was significantly lowered by bedtime administration of doxazosin. Doxazosin significantly lowered evening HBP only in the subgroup of patients with an uncontrolled evening HBP. The evening (E)/morning (M) ratio was greater in patients with an uncontrolled evening HBP than in those with a controlled evening HBP. The results suggest that bedtime administration of doxazosin effectively suppresses morning HBP in uncontrolled morning hypertensives and lowers evening HBP in uncontrolled evening hypertensives.
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Affiliation(s)
- Kenta Gonokami
- Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan
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Matsumoto S, Shimodozono M, Miyata R, Kawahira K. The angiotensin II type 1 receptor antagonist olmesartan preserves cerebral blood flow and cerebrovascular reserve capacity, and accelerates rehabilitative outcomes in hypertensive patients with a history of stroke. Int J Neurosci 2010; 120:372-80. [PMID: 20402577 DOI: 10.3109/00207450903389362] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We aimed to determine the effects of angiotensin II receptor blocker on cerebral hemodynamics and rehabilitative outcome. Sixteen hypertensive patients with a history of stroke received 10-20 mg olmesartan daily for eight weeks. Blood pressure decreased after treatment compared with the baseline, whereas cerebral blood flow (CBF) values of the affected and nonaffected sides increased. The results of the cerebrovascular reserve capacity were also statistically increased in the affected side. Improvements were observed in three rehabilitative outcome parameters. These findings suggest that olmesartan has beneficial effects in hypertensive patients with stroke and impaired CBF autoregulation, and might improve cerebral circulation and rehabilitative outcome.
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Affiliation(s)
- Shuji Matsumoto
- Department of Rehabilitation and Physical Medicine, Graduate school of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Sabater-Hernández D, Fikri-Benbrahim O, Faus MJ. Utilidad de la monitorización ambulatoria de la presión arterial en la toma de decisiones clínicas. Med Clin (Barc) 2010; 135:23-9. [DOI: 10.1016/j.medcli.2009.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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Derosa G, Salvadeo SAT. Endothelial function, blood pressure control, and risk modification: impact of irbesartan alone or in combination. Integr Blood Press Control 2010; 3:21-30. [PMID: 21949618 PMCID: PMC3172058 DOI: 10.2147/ibpc.s6081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 01/13/2023] Open
Abstract
Irbesartan, an angiotensin II type 1 receptor antagonist, is approved as monotherapy, or in combination with other drugs, for the treatment of hypertension in many countries worldwide. Data in the literature suggest that irbesartan is effective for reducing blood pressure over a 24-hour period with once-daily administration, and slows the progression of renal disease in patients with hypertension and type 2 diabetes. Furthermore, irbesartan shows a good safety and tolerability profile, compared with angiotensin II inhibitors and other angiotensin II type 1 receptor antagonists. Thus, irbesartan appears to be a useful treatment option for patients with hypertension, including those with type 2 diabetes and nephropathy. Irbesartan has an inhibitory effect on the pressor response to angiotensin II and improves arterial stiffness, vascular endothelial dysfunction, and inflammation in hypertensive patients. There has been considerable interest recently in the renoprotective effect of irbesartan, which appears to be independent of reductions in blood pressure. In particular, mounting data suggests that irbesartan improves endothelial function, oxidative stress, and inflammation in the kidneys. Recent studies have highlighted a possible role for irbesartan in improving coronary artery inflammation and vascular dysfunction. In this review we summarize and comment on the most important data available with regard to antihypertensive effect, endothelial function improvement, and cardiovascular risk reduction with irbesartan.
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Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Sibilla AT Salvadeo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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Feng XM, Ren Q, Zhang WZ, Shen HF, Rong ZX, Fang C, Chen HZ. Preparation and evaluation of a novel delayed-onset sustained-release system of propranolol hydrochloride. J Pharm Pharmacol 2010; 60:817-22. [DOI: 10.1211/jpp.60.7.0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
The objective of this work was to prepare and evaluate a new delayed-onset sustained-release system, comprising a sustained-release core tablet with hydroxypropyl methylcellulose as polymer matrix and an ethylcellulose/Eudragit L coating capable of delaying the drug release. The sustained core containing propranolol hydrochloride as the model drug was prepared by granulate tableting and the polymer coating was applied in a computer-controlled coating pan. The dissolution tests demonstrated that the in-vitro drug release was pH-dependent with sufficient gastric resistance, and the lag time (t10%) could be controlled by adjusting the coating level. Three dosage forms including commercial tablet, sustained-release tablet and the delayed-onset sustained-release tablet were administrated to six beagle dogs and the plasma levels of propranolol hydrochloride were measured with high-performance liquid chromatography. The delayed-onset sustained-release tablet had a lag time of 3.0 h in-vitro and 3.5 h in-vivo, and a tmax of 7.0 h. The relative bioavailability for delayed-onset sustained-release tablet was 96.98% compared with commercial tablets. The results indicate that the new propranolol delayed-onset sustained-release system could achieve a relatively constant drug release followed by a programmed lag time, and this may provide a promising drug delivery form for chronopharmacotherapy of certain cardiovascular diseases.
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Affiliation(s)
- Xue-mei Feng
- Department of Pharmacology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pharmaceutics and Industry, Polymer Pharmaceutical and Excipient Tech. Co., Ltd, Shanghai, China
| | - Qi Ren
- Shanghai Institute of Pharmaceutics and Industry, Polymer Pharmaceutical and Excipient Tech. Co., Ltd, Shanghai, China
| | - Wen-zhi Zhang
- Shengyang Pharmaceutical University, Shenyang, China
| | - Hui-feng Shen
- Shanghai Institute of Pharmaceutics and Industry, Polymer Pharmaceutical and Excipient Tech. Co., Ltd, Shanghai, China
| | - Zheng-xing Rong
- Department of Pharmacology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Fang
- Department of Pharmacology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-zhuan Chen
- Department of Pharmacology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gmitrov J. Static magnetic field blood pressure buffering, baroreflex vs. vascular blood pressure control mechanism. Int J Radiat Biol 2010; 86:89-101. [DOI: 10.3109/09553000903419973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Diurnal rhythms influence cardiovascular physiology such as heart rate and blood pressure and the incidence of adverse cardiac events such as heart attack and stroke. For example, shift workers and patients with sleep disturbances, such as obstructive sleep apnea, have an increased risk of heart attack, stroke, and sudden death. Diurnal variation is also evident at the molecular level, as gene expression in the heart and blood vessels is remarkably different in the day as compared to the night. Much of the evidence presented here indicates that growth and renewal (structural remodeling) are highly dependent on processes that occur during the subjective night. Myocardial metabolism is also dynamic with substrate preference also differing day from night. The risk/benefit ratio of some therapeutic strategies and the appearance of biomarkers also vary across the 24-hour diurnal cycle. Synchrony between external and internal diurnal rhythms and harmony among the molecular rhythms within the cell is essential for normal organ biology. Cell physiology is 4 dimensional; the substrate and enzymatic components of a given metabolic pathway must be present not only in the right compartmental space within the cell but also at the right time. As a corollary, we show disrupting this integral relationship has devastating effects on cardiovascular, renal and possibly other organ systems. Harmony between our biology and our environment is vital to good health.
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Affiliation(s)
- Tami A Martino
- Department of Biomedical Sciences, OVC, University of Guelph, Guelph, ON, Canada, N1G2W1.
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Matsumoto S, Shimodozono M, Miyata R, Kawahira K. Effect of the angiotensin II type 1 receptor antagonist olmesartan on cerebral hemodynamics and rehabilitation outcomes in hypertensive post-stroke patients. Brain Inj 2009; 23:1065-72. [DOI: 10.3109/02699050903379404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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White WB. Matching the circadian rhythms of hypertension with pharmacotherapy. Clin Cardiol 2009. [DOI: 10.1002/clc.4960261604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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