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Rodrigues GD, Nobrega ACLD, Soares PPDS. Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns. Exp Gerontol 2023; 172:112058. [PMID: 36529363 DOI: 10.1016/j.exger.2022.112058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
We hypothesized that inspiratory muscle training (IMT) increases the respiratory-induced low-frequency oscillations of mean blood pressure (MBP) and middle cerebral artery blood velocity (MCAv), upregulating cerebrovascular function in older women. Firstly, participants were recorded with free-breathing (FB) and then breathed at a slow-paced frequency (0.1 Hz; DB test) supported by sonorous metronome feedback. Blood pressure was recorded using finger photoplethysmography method, ECG, and respiration using a thoracic belt. To obtain the MCAv a transcranial ultrasound Doppler device was used. Spectral analysis of MBP, R-R intervals, and mean MCAv time series was obtained by an autoregressive model. The transfer function analysis (TFA) was employed to calculate the coherence, gain, and phase. After that, older women were enrolled in a randomized controlled protocol, the IMT-group (n = 8; 64 ± 3 years-old) performed IMT at 50 % of maximal inspiratory pressure (MIP), and Sham-group, a placebo training at 5 % MIP (Sham-group; n = 6; 66 ± 3 years-old). Participants breathed against an inspiratory resistance twice a day for 4-weeks. DB test is repeated post IMT and Sham interventions. IMT-group, compared to Sham-group, augmented tidal volume responses to DB (Sham-group 1.03 ± 0.41 vs. IMT-group 1.61 ± 0.56 L; p = 0.04), increased respiratory-induced MBP (Sham-group 26.37 ± 4.46 vs. IMT-group 48.21 ± 3.15 mmHg2; p = 0.04) and MCAv (Sham-group 14.16 ± 31.26 vs. IMT-group 79.90 ± 21.76 cm2s-2; p = 0.03) slow oscillations, and reduced TFA gain (Sham-group 2.46 ± 1.32 vs. IMT-group 1.78 ± 1.30 cm·s-1.mmHg-1; p = 0.01). Our findings suggest that IMT increases the respiratory-induced oscillations in MBP and MCAv signals and reduces TFA gain. It seems compatible with an improved dynamic cerebrovascular regulation following IMT in older women.
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Affiliation(s)
- Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Antonio Claudio Lucas da Nobrega
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil
| | - Pedro Paulo da Silva Soares
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil
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Ferreira FC, Padilha MCSV, Tobadini E, Bellocchi C, Carandina A, Montano N, Soares PPS, Rodrigues GD. Women have a greater cardiac vagal withdrawal to heat stress compared to men. Temperature (Austin) 2022; 10:444-453. [PMID: 38130655 PMCID: PMC10732604 DOI: 10.1080/23328940.2022.2135354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/07/2022] [Indexed: 10/31/2022] Open
Abstract
The heated environment shifts the sympatho-vagal balance toward sympathetic predominance and vagal withdrawal. Women's heart is more reliant on vagal autonomic control, while men's heart is more dependent on sympathetic control. However, sex differences in cardiovascular autonomic responses to heat stress remain unknown. We aimed to investigate the cardiovascular autonomic regulation under heat stress between sexes. Thirty-two young participants (27 ± 4 years old; 16 women) were enrolled in a single visit, resting for 30min at baseline (thermal reference condition TC; ∼24°C) and 30min under a heated environment (HOT; ∼38°C). Blood pressure (BP), skin temperature, electrocardiogram, and respiratory oscillations were continuously recorded. The heart rate variability (HRV) was assessed by spectral analysis (low-frequency [LFnu; sympathetic and vagal] and high-frequency [HFnu; vagal]), and symbolic analysis (0 V% [sympathetic] and 2UV%, and 2LV% [vagal]). The spontaneous baroreflex sensitivity (BRS) was calculated by the gain between BP and R-R within the LF band (αLF). The estimated maximal aerobic capacity and body surface area were employed as covariates in sex comparisons. The effects of HOT were the following: 1) Women have a greater cardiac vagal withdrawal to heat stress compared to men; 2) Sex differences on cardiac autonomic response to heat stress exist after controlling for the effect of estimated physical fitness and body surface area. Therefore, heat stress provokes a higher vagal withdrawal to the heart in women compared to men. It could be attributed to sex per se since significant differences between men and women were not modified after covariate analysis.
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Affiliation(s)
- Felipe C. Ferreira
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Michelle Cristina S. V. Padilha
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Eleonora Tobadini
- Department of Clinical Sciences and Community Health, University of Milan, 20122Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122Milan, Italy
| | - Chiara Bellocchi
- Department of Clinical Sciences and Community Health, University of Milan, 20122Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122Milan, Italy
| | - Angelica Carandina
- Department of Clinical Sciences and Community Health, University of Milan, 20122Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan, 20122Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122Milan, Italy
| | - Pedro Paulo S. Soares
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Gabriel D. Rodrigues
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
- Department of Clinical Sciences and Community Health, University of Milan, 20122Milan, Italy
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Crnošija L, Moštak I, Višnjić N, Junaković A, Karić A, Adamec I, Krbot Skorić M, Habek M. Blood pressure variability is altered in secondary progressive multiple sclerosis but not in patients with a clinically isolated syndrome. Neurophysiol Clin 2022; 52:290-298. [PMID: 35907760 DOI: 10.1016/j.neucli.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To investigate differences in beat-to-beat systolic blood pressure variability (SBPV) in people with secondary progressive MS (pwSPMS), clinically isolated syndrome (pwCIS) and healthy controls (HC). METHODS This retrospective case-control study included 46 pwSPMS, 46 pwCIS and 44 HC. A semi-automated software made with MATLAB R2019b (The MathWorks, Inc.) was used for the evaluation of SBPV. The frequency domain characteristics observed were the power spectrum in the LF and HF bands and the LF/HF ratio. Data is expressed in absolute power (mmHg2) of LF and HF and ratio (LF/HF) during both supine and tilt-up phases of testing. RESULTS There were no significant differences in mean systolic (sBP) or diastolic blood pressure (dBP) values during supine and tilt-up phases of testing between groups. During the supine phase of testing LF and LF/HF were significantly lower in the SPMS group (4.17±5.38 and 3.52±2.34, respectively) compared to the CIS (5.42±3.59, p = 0.015 and 5.92±4.63, p = 0.029, respectively) and HC group (6.03±4.55, p = 0.011 and 6.52 ± 5.09, p = 0.010, respectively), while during the tilt-up phase, LF was significantly lower compared to both the CIS and HC group, and HF was significantly lower only compared to the CIS group. CONCLUSION SBPV is altered in pwSPMS compared to pwCIS and normal controls. Further research in the field of MS related dysautonomia is warranted not only because of its relevance to comorbidities and MS symptoms, but also because of its likely involvement in the pathophysiology of MS.
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Affiliation(s)
- Luka Crnošija
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Ivan Moštak
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nika Višnjić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anamari Junaković
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Antea Karić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Mario Habek
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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Bartoloni E, Angeli F, Marcucci E, Perricone C, Cafaro G, Riccini C, Spighi L, Gildoni B, Cavallini C, Verdecchia P, Gerli R. Unattended compared to traditional blood pressure measurement in patients with rheumatoid arthritis: a randomised cross-over study. Ann Med 2021; 53:2050-2059. [PMID: 34751628 PMCID: PMC8583925 DOI: 10.1080/07853890.2021.1999493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The "unattended" BP measurement aims to reduce the "white-coat effect," a phenomenon associated with cardiovascular risk. Data on "unattended" BP measurement in RA and its impact on hypertensive organ damage are very limited. METHODS BP was measured in the same patient both traditionally ("attended" BP) and by the "unattended" protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage. RESULTS Sixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38-0.68) for systolic BP and 0.73 (95%, CI 0.60-0.82) for diastolic BP. "Unattended" (121.7/68.6 mmHg) was lower than "attended" BP (130.5/72.8 mmHg) for systolic and diastolic BP (both p < .0001). Among the two techniques, only "unattended" systolic BP showed a significant association with left ventricular mass (r = 0.11; p = .40 for "attended" BP; r = 0.27; p = .036 for unattended BP; difference between slopes: z = 3.92; p = .0001). CONCLUSIONS In RA patients, "unattended" BP is lower than traditional ("attended") BP and more closely associated with LV mass. In these patients, the "unattended" automated BP measurement is a promising tool which requires further evaluation.KEY MESSAGES"Unattended" automated blood pressure registration, aimed to reduce the "white-coat effect" is lower than "attended" value in rheumatoid arthritis patients."Unattended" blood pressure is more closely associated with left ventricular mass than "attende" registration.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Clara Riccini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Lorenzo Spighi
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Benedetta Gildoni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Claudio Cavallini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Paolo Verdecchia
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Inspiratory muscle training improves breathing pattern and sympatho-vagal balance but not spontaneous baroreflex sensitivity in older women. Respir Physiol Neurobiol 2021; 290:103672. [PMID: 33866039 DOI: 10.1016/j.resp.2021.103672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023]
Abstract
Even though recent studies reported a positive inspiratory muscle training (IMT) effect on cardiovascular autonomic modulation, its underlying mechanisms as the breathing pattern remain unclear. The study aimed to investigate the IMT effects on resting heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and spontaneous breathing pattern in older women. Fourteen healthy older women participated in this study, allocated in IMT (50 % MIP; n = 8) or Sham (5% MIP; n = 6) protocols for four weeks. Blood pressure, heart rate, and ventilatory data were continuously recorded before and after interventions. After four weeks, IMT-group increased maximal inspiratory pressure and vagal-mediated HRV, following by the reduction of sympatho-mediated HRV and the inspiratory time during the spontaneous breathing cycle compared to Sham-group, but did not change BRS. Therefore, the shorter inspiratory time suggests a putative mechanism behind improved vagal-mediated HRV post-IMT in older women.
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Huang JT, Cheng HM, Yu WC, Lin YP, Sung SH, Chen CH. Increased Nighttime Pulse Pressure Variability but Not Ambulatory Blood Pressure Levels Predicts 14-Year All-Cause Mortality in Patients on Hemodialysis. Hypertension 2019; 74:660-668. [PMID: 31352830 DOI: 10.1161/hypertensionaha.119.13204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased short-term blood pressure (BP) variability is associated with adverse cardiovascular outcomes in patients with hypertension. The present study investigated the long-term prognostic significance of the short-term blood pressure variability in patients on hemodialysis. A total of 149 patients (53.0% male; mean age: 54.5±15.1 years) receiving regular hemodialysis for >6 months were enrolled. They completed a 44-hour (excluding the hemodialysis session) ambulatory BP monitoring and comprehensive hemodynamic assessments, including carotid-femoral pulse wave velocity and pressure waveform decomposition (forward and backward wave amplitude). Blood pressure variability parameters, including average real variability (ARV) of systolic BP, diastolic BP, and pulse pressure (ARVp) during daytime, nighttime, and overall 44 hours were calculated. During a median follow-up of 14 years, 78 deaths (52.4%) were confirmed. In multivariable Cox regression analysis, none of the ambulatory BP parameters were predictive of mortality. In contrast, nighttime ARVp was consistently and significantly associated with all-cause mortality in multivariable Cox models adjusting for age, sex, albumin, hemodialysis treatment adequacy, and 44-hour systolic BP (continuous variable analysis, per 1-SD, hazard ratio=1.348; 95% CI, 1.029-1.767; categorical variable analysis, ≥8.5 versus <8.5 mm Hg; hazard ratio=1.825; 95% CI, 1.074-3.103). Forward wave amplitude and 44-hour systolic BP were identified as the 2 most important determinants of nighttime ARVp. Addition of nighttime ARVp to the base model significantly improved prediction of all-cause mortality (Net reclassification improvement =0.198; P=0.0012). In hemodialysis patients, increased short-term nighttime pulse pressure variability but not ambulatory BP levels were significantly predictive of long-term all-cause mortality.
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Affiliation(s)
- Jui-Tzu Huang
- From the Faculty of Medicine (J.-T.H., H.-M.C., W.-C.Y., Y.-P.L., S.-H.S., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hao-Min Cheng
- From the Faculty of Medicine (J.-T.H., H.-M.C., W.-C.Y., Y.-P.L., S.-H.S., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center (H.-M.C., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine (H.-M.C), Taipei Veterans General Hospital, Taiwan.,Department of Medical Education (H.-M.C., C.-H.C.), Taipei Veterans General Hospital, Taiwan
| | - Wen-Chung Yu
- From the Faculty of Medicine (J.-T.H., H.-M.C., W.-C.Y., Y.-P.L., S.-H.S., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Internal Medicine (W.-C.Y., Y.-P.L., S.-H.S.), Taipei Veterans General Hospital, Taiwan
| | - Yao-Ping Lin
- From the Faculty of Medicine (J.-T.H., H.-M.C., W.-C.Y., Y.-P.L., S.-H.S., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Internal Medicine (W.-C.Y., Y.-P.L., S.-H.S.), Taipei Veterans General Hospital, Taiwan
| | - Shih-Hsien Sung
- From the Faculty of Medicine (J.-T.H., H.-M.C., W.-C.Y., Y.-P.L., S.-H.S., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Internal Medicine (W.-C.Y., Y.-P.L., S.-H.S.), Taipei Veterans General Hospital, Taiwan
| | - Chen-Huan Chen
- From the Faculty of Medicine (J.-T.H., H.-M.C., W.-C.Y., Y.-P.L., S.-H.S., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center (H.-M.C., C.-H.C.), National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medical Education (H.-M.C., C.-H.C.), Taipei Veterans General Hospital, Taiwan
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Hsu PF, Cheng HM, Sung SH, Chuang SY, Lakatta EG, Yin FCP, Chou P, Chen CH. Hemodynamic Determinants of the Short-Term Blood Pressure Variability: Differential Roles of Arterial Stiffness and Wave Reflection. Am J Hypertens 2017; 30:256-263. [PMID: 28096150 DOI: 10.1093/ajh/hpw144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/23/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A high 24-hour ambulatory diastolic (DBP) but not systolic (SBP) blood pressure variability (BPV) is significantly predictive of long-term cardiovascular mortality in untreated hypertensive subjects, independent of office or 24-hour SBP. The present study was aimed to investigate hemodynamic factors that are independently associated with systolic and diastolic BPV from the 24-hour ambulatory blood pressure monitoring (ABPM). METHODS A cohort of 624 normotensive and 633 untreated hypertensive participants with baseline ABPM was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour SBP and DBP (ARVs and ARVd, respectively). Hemodynamic variables including total peripheral resistance (TPR), carotid-femoral pulse wave velocity (cf-PWV), and amplitudes of the decomposed forward (Pf) and backward (Pb) carotid pressure waves were analyzed. RESULTS In multivariable analyses, hemodynamic variables independently associated with 24-hour SBP were 24-hour heart rate (HR), TPR, cf-PWV, Pf, and Pb (model r2 = 0.535). Hemodynamic factors independently associated with ARV were 24-hour HR, Pf, and Pb for ARVs, and 24-hour HR, cf-PWV, Pf, and Pb for ARVd (model R2 = 0.345 and 0.220, respectively). Addition of 24-hour SBP to the ARV models only slightly improved variance explained by the models (R2 = 0.383 and 0.224, respectively). Pb accounted for >50% of total variance of ARVs and ARVd, whereas cf-PWV was a minor determinant of ARVd (<5% of total variance). CONCLUSIONS ARVd was associated with fewer hemodynamic variables than to 24-hour SBP. Among those hemodynamic variables wave reflection but not arterial stiffness had the dominant independent association with ARV.
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Affiliation(s)
- Pai-Feng Hsu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General, Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Edward G Lakatta
- The Laboratory of Cardiovascular Science, National Institute on Aging Intramural Research Program, Baltimore, Maryland, USA
| | - Frank C P Yin
- Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA
| | - Pesus Chou
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General, Hospital, Taipei, Taiwan
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Hsu PF, Cheng HM, Wu CH, Sung SH, Chuang SY, Lakatta EG, Yin FCP, Chou P, Chen CH. High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives. Am J Hypertens 2016; 29:806-13. [PMID: 26837643 DOI: 10.1093/ajh/hpw002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the long-term prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.
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Affiliation(s)
| | | | - Cheng-Hsueh Wu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Edward G Lakatta
- The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, Baltimore, Maryland, USA
| | - Frank C P Yin
- Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA
| | - Pesus Chou
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Pandey NR, Bian YY, Shou ST. Significance of blood pressure variability in patients with sepsis. World J Emerg Med 2014; 5:42-7. [PMID: 25215146 DOI: 10.5847/wjem.j.issn.1920-8642.2014.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis. METHODS Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis. RESULTS In patients with APACHE II score>19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (P<0.05), whereas the values of procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), PaO2, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR (P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT (P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively. CONCLUSIONS The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.
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Affiliation(s)
- Nishant Raj Pandey
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yu-Yao Bian
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Song-Tao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
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Veerabhadrappa P. Blood pressure variability: does speed matter? Hypertens Res 2013; 36:1035-6. [DOI: 10.1038/hr.2013.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Nisbet LC, Yiallourou SR, Walter LM, Horne RSC. Blood pressure regulation, autonomic control and sleep disordered breathing in children. Sleep Med Rev 2013; 18:179-89. [PMID: 23850404 DOI: 10.1016/j.smrv.2013.04.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/10/2013] [Accepted: 04/29/2013] [Indexed: 02/07/2023]
Abstract
Sleep disordered breathing (SDB) ranges in severity from primary snoring (PS) to obstructive sleep apnoea (OSA). In adults, SDB is associated with adverse cardiovascular consequences which are mediated, in part, by autonomic dysfunction. Although SDB is common in children, fewer paediatric studies have investigated these cardiovascular effects. Initial research focused on those with OSA, indeed children with PS were occasionally utilised as the comparison control group. However, it is essential to understand the ramifications of this disorder in all its severities, as currently the milder forms of SDB are often untreated. Methodologies used to assess autonomic function in children with SDB include blood pressure (BP), BP variability, baroreflex sensitivity, heart rate variability, peripheral arterial tonometry and catecholamine assays. The aim of this review was to summarise the findings of paediatric studies to date and explore the relationship between autonomic dysfunction and SDB in children, paying particular attention to the roles of disease severity and/or age. This review found evidence of autonomic dysfunction in children with SDB during both wakefulness and sleep. BP dysregulation, elevated generalised sympathetic activity and impairment of autonomic reflexes occur in school-aged children and adolescents with SDB. The adverse effects of SDB seem somewhat less in young children, although more studies are needed. There is mounting evidence that the cardiovascular and autonomic consequences of SDB are not limited to those with OSA, but are also evident in children with PS. The severity of disease and age of onset of autonomic consequences may be important guides for the treatment of SDB.
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Affiliation(s)
- Lauren C Nisbet
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | - Lisa M Walter
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
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Thomopoulos C, Lombardi C, Parati G. Combined Exercise Training in Postmenopausal Women: Implications for Vascular Hemodynamics. J Clin Hypertens (Greenwich) 2013; 15:221-3. [DOI: 10.1111/jch.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 11/30/2012] [Accepted: 12/13/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Costas Thomopoulos
- Department of Cardiology; St Luca Hospital; IRCCS Istituto Auxologico Italiano; Milan Italy
| | - Carolina Lombardi
- Department of Cardiology; St Luca Hospital; IRCCS Istituto Auxologico Italiano; Milan Italy
| | - Gianfranco Parati
- Department of Cardiology; St Luca Hospital; IRCCS Istituto Auxologico Italiano; Milan Italy
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Pinter A, Horvath T, Sarkozi A, Kollai M. Relationship between heart rate variability and endothelial function in healthy subjects. Auton Neurosci 2012; 169:107-12. [PMID: 22749462 DOI: 10.1016/j.autneu.2012.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 05/24/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
Abstract
In various diseased states reduced cardiac vagal activity is accompanied by impaired endothelial function. Evidence from animal studies indicates interaction between the two systems, but such data from human studies is limited. The aim of this study was to test the hypothesis that cardiac vagal activity and endothelial function are related in healthy individuals. 46 young males were studied. From 10 minute long ECG recordings mean RR-interval and time and frequency domain vagal heart rate variability indices (RMSSD; pNN50 and HF, respectively) were determined. Heart rate variability indices were used to define cardiac vagal activity. Endothelial function was assessed by measuring brachial artery flow mediated dilation. Hyperemic, diastolic shear rate was used to normalize flow mediated dilation. All three vagal heart rate variability indices correlated significantly and positively with flow mediated dilation across subjects, with r values within the range of 0.43-0.52, p<0.01 for all relations. After adjusting for potential confounders, vagal heart rate variability indices remained significantly associated with normalized flow mediated dilation. RR-interval was related to most heart rate variability indices, but was not related to flow mediated dilation. Our data demonstrate that vagal heart rate variability indices are related to flow mediated dilation across healthy male subjects. The results cannot serve as evidence of a causal relationship, but are of interest and render for further investigation into underlying mechanisms.
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Affiliation(s)
- Alexandra Pinter
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University, Budapest, Hungary.
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14
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Age-related changes in phase-space distribution of ABPM data in normotensive and hypertensive patients. Auton Neurosci 2011; 161:103-9. [DOI: 10.1016/j.autneu.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 11/16/2010] [Accepted: 12/07/2010] [Indexed: 11/20/2022]
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15
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A longitudinal study of blood pressure variability in African-American and European American youth. J Hypertens 2010; 28:715-22. [PMID: 20075746 DOI: 10.1097/hjh.0b013e328336ed5b] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES High blood pressure variability is increasingly used as a predictor of target-organ damage and cardiovascular events. However, little is known about blood pressure variability changes with age and its possible sociodemographic, anthropometric, and genetic moderators. METHODS Twenty-four-hour ambulatory blood pressure was measured up to 12 times over a 15-year period in 344 European Americans and 297 African-Americans with an average age of 14 years at the initial visit. Blood pressure variability was indexed by the weighted 24-h standard deviation of ambulatory blood pressure recordings. RESULTS Both systolic and diastolic blood pressure variability increased with age and ambulatory blood pressure mean values. Men had higher levels of blood pressure variability (P < 0.001) and showed steeper linear increase rates with age than women. African-Americans showed higher values of blood pressure variability (P < 0.05) than European Americans. Body mass index and waist circumference were also associated with higher blood pressure variability levels (P < 0.001). Individuals with higher father's education level showed lower blood pressure variability. In the full model which included all the above factors, ethnic difference in systolic blood pressure variability was no longer significant. CONCLUSION The results of the present study suggest that men and African-Americans have higher blood pressure variability than women and European Americans. Apart from these ethnicity and sex effects, blood pressure variability increases with increases in age (especially in men), ambulatory blood pressure mean values and adiposity as well as decreased socioeconomic status.
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Veerabhadrappa P, Diaz KM, Feairheller DL, Sturgeon KM, Williamson S, Crabbe DL, Kashem A, Ahrensfield D, Brown MD. Enhanced blood pressure variability in a high cardiovascular risk group of African Americans: FIT4Life Study. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2010; 4:187-95. [PMID: 20885987 PMCID: PMC2945908 DOI: 10.1016/j.jash.2010.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High blood pressure (BP) levels in African Americans elicit vascular inflammation resulting in vascular remodeling. BP variability (BPV) correlates with target organ damage. We aimed to investigate the relationship between inflammatory markers and BPV in African Americans. Thirty-six African Americans underwent 24-hour ambulatory BP monitoring (ABPM). BPV was calculated using the average real variability index. Fasting blood samples were assayed for high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha), and white blood cell (WBC) count. Significant associations between hs-CRP and 24-hour systolic variability (r=0.50; P=.012) and awake systolic variability (r=0.45; P=.02) were identified after adjusting for age, body mass index, and 24-hour mean BP. ABPM variables were compared between the hs-CRP tertile groups. In post-hoc analysis, there was a significant difference in 24-hour and awake periods for both systolic and diastolic variability among the groups. TNF-alpha and WBC count showed no associations with ABPM variables. hs-CRP was associated with systolic variability, and higher levels of hs-CRP were related with greater BPV. Higher inflammatory status influences wider fluctuations in systolic BP, which in turn could facilitate early progression to target organ damage independent of absolute BP levels in African Americans.
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Affiliation(s)
- Praveen Veerabhadrappa
- Department of Kinesiology, College of Health Professions, Cardiovascular Research Center, School of Medicine, Temple University, Philadelphia, PA 19122, USA.
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Ozawa M, Tamura K, Okano Y, Matsushita K, Ikeya Y, Masuda S, Wakui H, Dejima T, Shigenaga AI, Azuma K, Ishigami T, Toya Y, Ishikawa T, Umemura S. Blood Pressure Variability As Well As Blood Pressure Level is Important for Left Ventricular Hypertrophy and Brachial-Ankle Pulse Wave Velocity in Hypertensives. Clin Exp Hypertens 2009; 31:669-79. [DOI: 10.3109/10641960903407033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Stenehjem AE, Os I. Reproducibility of blood pressure variability, white‐coat effect and dipping pattern in untreated, uncomplicated and newly diagnosed essential hypertension. Blood Press 2009; 13:214-24. [PMID: 15581335 DOI: 10.1080/08037050410021432] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the reproducibility of blood pressure (BP) variability, white-coat effect (WCE) and nocturnal dipping pattern in untreated patients with uncomplicated essential hypertension using 24-hour ambulatory BP monitoring (ABPM). METHODS Seventy-five newly diagnosed, untreated essential hypertensive subjects (54 men, 21 women 47.6 +/- 9.3 years) were recruited for the study based on conventional measured BP from a total of 180 patients referred for ABPM. Of these, 65 patients underwent repeated ABPM after 4 weeks observation without treatment. Reproducibility of BP, nocturnal dipping pattern, WCE and BP variability were assessed using different methods. RESULTS The average 24-hour BP (140.8 +/- 11.9/91.8 +/- 6.4 vs. 140.5 +/- 14.5/90.7 +/- 7.6 mmHg, ns) or PP (49.6 +/- 10.8 vs. 49.8 +/- 9.8 mmHg, ns) did not change, nor did daytime BP or PP. The WCE diminished significantly during the observation period (reduction in SBP WCE delta8.2 +/- 12.5 mmHg, p < 0.0001, in DBP WCE, delta3.3 +/- 9.2 mmHg, p = 0.008 and in PP WCE delta4.8 +/- 11.2 mmHg, p = 0.002). Variability in SBP, DBP and PP decreased consistently and significantly during the observation period. The nocturnal dipping pattern was unchanged in 82% of the patients. In 12% non-dipping pattern was converted to dipping pattern after repeated measurement. CONCLUSION Average ABPs are highly reproducible in patients with uncomplicated essential hypertension of limited duration. Similarly, nocturnal dipping pattern reproduced satisfactorily. These measures have important clinical applicability. The white-coat effect as well as variability are greatly attenuated during repeated measurements, and these measures may thus be of less utility in clinical practice.
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Affiliation(s)
- Aud E Stenehjem
- Department of Nephrology, Ullevål University Hospital, Oslo, Norway.
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Perez‐Lloret S, Risk M, Golombek DA, Cardinali DP, Sanchez R, Ramirez A. Blunting of Circadian Rhythms and Increased Acrophase Variability in Sleep‐Time Hypertensive Subjects. Chronobiol Int 2009; 25:99-113. [DOI: 10.1080/07420520801909403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Ozawa M, Tamura K, Okano Y, Matsushita K, Yanagi M, Tsurumi-Ikeya Y, Oshikawa J, Hashimoto T, Masuda S, Wakui H, Shigenaga AI, Azuma K, Ishigami T, Toya Y, Ishikawa T, Umemura S. Identification of an Increased Short-Term Blood Pressure Variability on Ambulatory Blood Pressure Monitoring as a Coronary Risk Factor in Diabetic Hypertensives. Clin Exp Hypertens 2009; 31:259-70. [DOI: 10.1080/10641960902822518] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kirkness CJ, Burr RL, Mitchell PH. Intracranial and blood pressure variability and long-term outcome after aneurysmal sub-arachnoid hemorrhage. Am J Crit Care 2009; 18:241-51. [PMID: 19411584 DOI: 10.4037/ajcc2009743] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Care of brain-injured patients in intensive care units has focused on maintaining arterial blood pressure and intracranial pressure within prescribed ranges. Research suggests, however, that the dynamic variability of these pressure signals provides additional information about physiological functioning and may reflect adaptive capacity. OBJECTIVES To see if long-term outcomes can be predicted from variability of arterial blood pressure and intracranial pressure in patients with aneurysmal subarachnoid hemorrhage. METHODS Arterial blood pressure and intracranial pressure were monitored continuously for 4 days in 90 patients (74% women; mean age, 53 years) in an intensive care unit after subarachnoid hemorrhage. Variability of arterial blood pressure and intracranial pressure signals was calculated on 4 timescales: 24 hours, 1 hour, 5 minutes, and the difference of sequential 5-second means. The Extended Glasgow Outcome Scale was used to assess functional outcome 6 months after subarachnoid hemorrhage. RESULTS Pressure variability was better than mean pressure levels for predicting 6-month functional outcome. When initial neurological condition was controlled for, greater faster variability (particularly 5-second) was associated with better outcomes (typical P<.001), whereas greater 24-hour variability was associated with poorer outcomes (typical P<.001). CONCLUSIONS The relationship between long-term functional outcome and variability of arterial blood pressure and intracranial pressure levels depends on the timescale at which the variability is measured. Because it is associated with better outcome, greater faster variability may reflect better physiological adaptive capacity.
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Affiliation(s)
- Catherine J. Kirkness
- Catherine J. Kirkness and Robert L. Burr are research associate professors and Pamela H. Mitchell is a professor and associate dean for research in Biobehavioral Nursing and Health Systems at University of Washington, Seattle
| | - Robert L. Burr
- Catherine J. Kirkness and Robert L. Burr are research associate professors and Pamela H. Mitchell is a professor and associate dean for research in Biobehavioral Nursing and Health Systems at University of Washington, Seattle
| | - Pamela H. Mitchell
- Catherine J. Kirkness and Robert L. Burr are research associate professors and Pamela H. Mitchell is a professor and associate dean for research in Biobehavioral Nursing and Health Systems at University of Washington, Seattle
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A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood. Hypertens Res 2009; 32:404-10. [PMID: 19325561 DOI: 10.1038/hr.2009.32] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluates the tracking stability of office blood pressure (BP), ambulatory BP (ABP), BP variability (BPV) and nocturnal BP drops (dipping) from childhood to early adulthood, and their dependence on ethnicity, gender and family history (FH) of essential hypertension (EH). Generalized estimating equations (GEEs) were used to estimate tracking coefficients for 295 European Americans and 252 African Americans, with a maximum of 12 measurements over a 15-year period. Office BP and ABP had moderate-to-relatively high tracking coefficients (r= 0.30-0.59; P<or=0.001). Twenty-four hour readings tracked better than office readings for diastolic BP (DBP; 0.57 vs. 0.46, P=1.72 x 10(-6)) and pulse pressure (PP) (0.59 vs. 0.51, P=2.70 x 10(-4)), and equally well for systolic BP (SBP; 0.55 vs. 0.54, P=0.805). Daytime readings tracked better than their night-time counterparts for SBP (0.50 vs. 0.37, P=7.62 x 10(-13)), DBP (0.49 vs. 0.30, P=7.98 x 10(-32)) and PP (0.55 vs. 0.50, P=0.0061). All BPV (r=0.08-0.28; P<or=0.001) and dipping measures (r=0.07-0.12; odds ratio, 1.60-1.73; P<or=0.001) had low tracking coefficients. Males had significantly higher tracking stability for office SBP, DBP and ambulatory PP than females (P<0.01). Subjects with a positive FH of EH had significantly higher tracking stability for daytime and night-time DBP and dipping indexed by continuous variables than those with a negative FH (P<0.001). No significant ethnic differences were observed. The high tracking stability of 24-h ABP highlights the importance of using ambulatory BP monitoring in both research and clinical settings.
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Mancia G, Parati G, Bilo G, Maronati A, Omboni S, Baurecht H, Hennig M, Zanchetti A. Assessment of long-term antihypertensive treatment by clinic and ambulatory blood pressure: data from the European Lacidipine Study on Atherosclerosis. J Hypertens 2007; 25:1087-94. [PMID: 17414674 DOI: 10.1097/hjh.0b013e32805bf8ce] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Information on the features of long-term modifications of clinic and 24-h ambulatory blood pressure (ABP) by treatment is limited. The present study aimed to address this issue. METHODS Ambulatory BP monitoring and clinic BP (CBP) measurements were performed at baseline and at yearly intervals over a 4-year follow-up period in 1523 hypertensives (56.1 +/- 7.6 years) randomized to treatment with lacidipine or atenolol in the European Lacidipine Study on Atherosclerosis (ELSA). RESULTS CBP was always greater than ABP, while reductions in all BP values (greater for CBP than for ABP) were on average maintained throughout 4 years, CBP changes showing limited relationship with ABP changes (r = 0.14-0.27). BP reductions by treatment during daytime and night-time were correlated (r = 0.63-0.73). BP normalization was achieved in a greater percentage of patients for CBP (41.7%) than for ABP (25.3%), with systolic BP control being always less common than diastolic BP control. BP normalization was more frequent at single yearly visits than throughout the 4 years. Twenty-four-hour BP variability was reduced by treatment over 4 years in absolute but not in normalized units. CONCLUSIONS The present study provides the best evidence available on long-term effect of antihypertensive treatment on both ABP and CBP. On average, ABP was sustainedly reduced by treatment throughout the follow-up period, but 24-h BP was more difficult to control than CBP. In several patients, ABP control was unstable between visits, the percentage of patients under control over 4 years being much less than that of those controlled at each year. Treatment induced a reduction in absolute but not in normalized BP variability estimates. This has clinical implications because of the prognostic importance of ABP mean values and variability.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica and Department of Clinical Medicine and Prevention, University of Milano-Bicocca and Ospedale S. Gerardo, Monza, Milan, Italy.
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Lurbe E, Invitti C, Torro I, Maronati A, Aguilar F, Sartorio A, Sartorio G, Redon J, Parati G. The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth. J Hypertens 2007; 24:1557-64. [PMID: 16877958 DOI: 10.1097/01.hjh.0000239291.32883.e3] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Obesity is an increasingly frequent problem among children and adolescents, and may lead to blood pressure (BP) increase. The aim of the present study was to assess the prevalence of hypertension, white-coat and masked hypertension in obese adolescents making systematic use of both office BP and 24-h ambulatory BP measurement. The impact of different degrees of obesity on BP and heart rate variability was also investigated. METHODS Office and ambulatory BP were obtained in 285 overweight and obese Caucasian adolescents (11-18 years old) and in 180 age- and sex-matched controls. The extent of obesity was quantified using body mass index z score. RESULTS A significant positive relationship between body mass index z score and both office and ambulatory systolic BP was found after adjusting for age and height in both boys and girls. Obese youths had not only higher BP levels, but also higher BP variability compared with controls. Among obese youths, 20.8% had abnormal BP conditions, 6.6% were white-coat hypertensives, 9.2% were masked hypertensives and 5% were sustained hypertensives. CONCLUSIONS The prevalence of these abnormal BP conditions, which can be identified thanks to ambulatory BP monitoring, further emphasizes the usefulness of this diagnostic tool in obese youths.
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Affiliation(s)
- Empar Lurbe
- Pediatric Nephrology and Cardiovascular Risk Unit, Consorcio Hospital General, University of Valencia, Recava, Spain.
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Parati G, Ibsen H. Twenty-four-hour ambulatory blood pressure profiles of high-risk patients in general practice: data from an ambulatory blood pressure monitoring registry. J Hypertens 2007; 25:929-33. [PMID: 17414652 DOI: 10.1097/hjh.0b013e32813a32b1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bilo G, Parati G. Temporal blood pressure patterns and cardiovascular events: 'good night' or 'good morning'? J Hypertens 2007; 24:1703-5. [PMID: 16915016 DOI: 10.1097/01.hjh.0000242391.84601.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parati G, Faini A, Castiglioni P. Accuracy of blood pressure measurement: sphygmomanometer calibration and beyond. J Hypertens 2006; 24:1915-8. [PMID: 16957546 DOI: 10.1097/01.hjh.0000244935.19299.f5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guzman JC, Garcia RG, Dillenburg R, Sieger FS, Lopez-Jaramillo P, Morillo CA. Central serotoninergic response to orthostatic challenge in patients with neurocardiogenic syncope. ACTA ACUST UNITED AC 2006; 8:306-11. [PMID: 16627460 DOI: 10.1093/europace/euj053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To determine whether central serotoninergic system activity is impaired by orthostatic challenge in patients with neurocardiogenic syncope (NCS). METHODS AND RESULTS Thirty-five [mean age: 24 (SD): 6 years] patients with a clinical history of NCS and positive head-up tilt test and 35 age-matched healthy volunteers (CON = 25+/-5 years) with negative response were studied. Overnight dexamethasone suppression test (DST) (1.5 mg given at 11 p.m.) was performed to assess the sensitivity of the hypothalamic-pituitary-adrenal axis by measuring next day cortisol (microg/dL) at 8 a.m. and 4 p.m. Cardiac autonomic function, cortisol, and prolactin (ng/dL) were also determined at baseline supine (BAS) and after 5, 10, and 15 min of orthostatic stress (OS) at 60 degrees . No significant differences were observed in cortisol plasma levels after the DST: CON = 0.6+/-0.6 microg/dL vs. NCS = 0.6+/-0.5; P = 0.7. Cardiac autonomic function, cortisol, and prolactin responses were similar in both study groups (CON vs. NCS; P > 0.05) during BAS: cortisol = 8.6+/-4 vs.8.7+/-4 microg/dL and prolactin = 16.8+/-9 vs. 16.8+/-9 ng/dL; OS-5: cortisol = 8.7+/-5 vs. 8.5+/-4 microg/dL and prolactin = 16.9+/-9 vs. 15.8+/-9 ng/dL; OS-10: cortisol = 8.5+/-5 vs. 8.1+/-3 microg/dL; prolactin = 16.2+/-9 vs. 15.8+/-9 ng/dL, and OS-15: cortisol = 9.0+/-5 vs. 8.4+/-4 microg/dL; prolactin = 17.1+/-9 vs. 15.5+/-9 ng/dL. CONCLUSION Central serotoninergic response during orthostatic challenge was not impaired in patients with recurrent NCS. These findings suggest that the activation of the hypothalamic-pituitary-adrenal axis is not altered in patients with recurrent NCS.
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Affiliation(s)
- Juan Camilo Guzman
- Autonomic Physiology Laboratory, Research Institute, Fundacion Cardiovascular de Colombia, Bucaramanga, Santander, Colombia, Ontario, Canada
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From measurement to profiles, phenomena and indices: a workshop of the European Society of Hypertension. Blood Press Monit 2005. [DOI: 10.1097/00126097-200512000-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Exposure to particulate matter (PM) air pollution increases the risk for myocardial infarctions, strokes, and cardiovascular mortality. A variety of responsible mechanisms have been described, including PM-induced elevations in blood pressure. Observational studies and controlled experiments have provided evidence that PM is capable of acutely increasing blood pressure in certain scenarios. Enhanced sympathetic tone and vascular dysfunction due to PM-induced systemic oxidative stress/inflammation are leading explanations. The hemodynamic responses to air pollution may be altered by underlying cardiovascular risk factors and the chemical composition of the PM. However, even the small elevations in blood pressure observed following certain exposures to PM have tremendous public health implications, due to the ubiquitous nature of air pollution.
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Affiliation(s)
- Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 322, Ann Arbor, MI 48106-0739, USA.
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Urch B, Silverman F, Corey P, Brook JR, Lukic KZ, Rajagopalan S, Brook RD. Acute blood pressure responses in healthy adults during controlled air pollution exposures. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:1052-5. [PMID: 16079078 PMCID: PMC1280348 DOI: 10.1289/ehp.7785] [Citation(s) in RCA: 230] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Exposure to air pollution has been shown to cause arterial vasoconstriction and alter autonomic balance. Because these biologic responses may influence systemic hemodynamics, we investigated the effect of air pollution on blood pressure (BP). Responses during 2-hr exposures to concentrated ambient fine particles (particulate matter < 2.5 microm in aerodynamic diameter; PM2.5) plus ozone (CAP+O3) were compared with those of particle-free air (PFA) in 23 normotensive, nonsmoking healthy adults. Mean concentrations of PM2.5 were 147 +/- 27 versus 2 +/- 2 microg/m3, respectively, and those of O3 were 121 +/- 3 versus 8 +/- 5 ppb, respectively (p < 0.0001 for both). A significant increase in diastolic BP (DBP) was observed at 2 hr of CAP+O3 [median change, 6 mm Hg (9.3%); binomial 95% confidence interval (CI), 0 to 11; p = 0.013, Wilcoxon signed rank test] above the 0-hr value. This increase was significantly different (p = 0.017, unadjusted for basal BP) from the small 2-hr change during PFA (median change, 1 mm Hg; 95% CI, -2 to 4; p = 0.24). This prompted further investigation of the CAP+O3 response, which showed a strong association between the 2-hr change in DBP (and mean arterial pressure) and the concentration of the organic carbon fraction of PM2.5 (r = 0.53, p < 0.01; r = 0.56, p < 0.01, respectively) but not with total PM2.5 mass (r < or = 0.25, p > or = 0.27). These findings suggest that exposure to environmentally relevant concentrations of PM2.5 and O3 rapidly increases DBP. The magnitude of BP change is associated with the PM2.5 carbon content. Exposure to vehicular traffic may provide a common link between our observations and previous studies in which traffic exposure was identified as a potential risk factor for cardiovascular disease.
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Affiliation(s)
- Bruce Urch
- Gage Occupational and Environmental Health Unit, St. Michael's Hospital, Toronto, Ontario, Canada.
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Leon H, Guzman JC, Kuusela T, Dillenburg R, Kamath M, Morillo CA. Impaired Baroreflex Gain in Patients with Inappropriate Sinus Tachycardia. J Cardiovasc Electrophysiol 2005; 16:64-8. [PMID: 15673390 DOI: 10.1046/j.1540-8167.2005.04441.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to determine the characteristics of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex gain (BRG) at rest and during orthostatic stress in patients with clinical criteria of inappropriate sinus tachycardia (IST). METHODS AND RESULTS Beat-to-beat HRV and BPV, measured by time- and frequency-domain methods, and noninvasive BRG, calculated by cross-spectral analysis, were obtained during 10 minutes both at rest and during the stabilization phase (5-15 min) of orthostatic stress at 60 degrees in 8 patients with clinical criteria of IST and 9 healthy volunteers (CON). IST patients had a higher resting mean heart rate (78.8 +/- 5.3 vs 58.5 +/- 4.2 beats/min, P=0.01) and mean blood pressure (90.4 +/- 2.4 vs 72.0 +/- 4.2 mmHg; P=0.002). RMSSD, pNN50m, and BRG were significantly reduced in IST patients at rest. BRG during orthostatic stress (7.2 +/- 0.8 vs 20.3 (2.4 ms/mmHg, P <0.01) was significantly reduced in IST patients. Delta BRG (-16.9%+/- 11 vs -50.1%+/- 5, P=0.02) was markedly blunted during orthostatic stress in IST patients. CONCLUSION BRG was markedly impaired both at rest and during orthostatic stress in IST patients. This alteration may be responsible for the higher resting heart rate and mean blood pressures seen at rest and may facilitate tachycardia during orthostatic stress. A primary alteration in sinus node automaticity coupled with impaired BRG determines heart rate response to orthostatic stress in patients with IST.
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Affiliation(s)
- Hernando Leon
- Autonomic Physiology Laboratory, Research Institute, Fundacion Cardiovascular de Colombia, Bucaramanga, Santander, Colombia
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Parati G, Bilo G, Mancia G. Prognostic and Diagnostic Value of Ambulatory Blood Pressure Monitoring. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50117-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parati G, Bilo G, Mancia G. Blood pressure measurement in research and in clinical practice: recent evidence. Curr Opin Nephrol Hypertens 2004; 13:343-57. [PMID: 15073495 DOI: 10.1097/00041552-200405000-00013] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW For over a century the technique of blood pressure measurement developed by Riva-Rocci and Korotkoff has provided most of the data on hypertension diagnosis and treatment. Its limitations, however, are becoming increasingly evident and therefore alternative solutions are under investigation. This paper is intended to provide an overview of important recent progress in this field, and to highlight future perspectives. RECENT FINDINGS A major development in blood pressure measurement is the technical improvement of electronic manometers for use either in the clinic (with the auscultatory approach, as an alternative to use of mercury columns), or in automated oscillometric devices yielding blood pressure measurements devoid of observer-dependency, and allowing long-term blood pressure monitoring. In the latter case, blood pressure measurement is made possible in settings other than the physician's office, either through ambulatory blood pressure monitoring or through self blood pressure measurement at home. These methods are growing in clinical importance, but further studies are needed to define their indications more precisely in the clinical evaluation of hypertensive patients. Recently, important steps towards better standards of blood pressure measurement have been taken, as summarized in the guidelines jointly issued by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC), in the 7th Joint National Committee Report and (in even more detail) in the Blood Pressure Measurement Guidelines published by the ESH Working Group on Blood Pressure Monitoring. SUMMARY Blood pressure measurement is a rapidly developing field, the importance of which is increasingly acknowledged in the light of the growing awareness of the impact of hypertension on public health. Despite remarkable progress, many methodological issues still remain to be properly addressed.
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Affiliation(s)
- Gianfranco Parati
- Department of Clinical Medicine, Prevention and Applied Biotechnologies, University of Milano-Bicocca, and Cardiology II, San Luca Hospital, Italian Auxological Institute, Milan, Italy.
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